Wilson disease (WD) is a genetic disorder with copper metabolism disturbances leading to copper accumulation in many organs with their secondary damage. It is caused by mutation in the ATP7B gene on chromosome 13, which encodes ATP-ase 7B involved in copper transport. The age of neurologic symptom onset in WD is 20-30 years, but there is a wide spectrum of disease including: age at onset, clinical signs and treatment efficacy. More than 500 mutations of ATP7B have been described so far, but the WD genotype does not explain the disease variability. Several other factors are suspected to influence WD presentation, including polymorphisms in the genes encoding: apolipoprotein E, prion-related protein, methyltenetetrahydrofolate reductase, Murr1, antioxidant-1, X-linked inhibitor of apoptosis as well as iron metabolism disturbances, gender impact, inflammatory reactions and oxidative stress. The explanation of their significance can change the therapy of WD. The aim of our study was to review and assess the clinical significance of the factors affecting WD presentation. PMID:23650006
Litwin, Tomasz; Cz?onkowska, Anna
Osteomyelitis frequently complicates infections in the feet of patients with diabetes. Gram-positive cocci, especially Staphylococcus aureus, are the most commonly isolated pathogens, but gram-negative bacteria also cause some cases of diabetic foot osteomyelitis (DFO). These gram-negatives require different antibiotic regimens than those commonly directed at gram-positives. There are, however, few data on factors related to their presence and how they influence the clinical picture. We conducted a retrospective study to determine the variables associated with the isolation of gram-negative bacteria from bone samples in cases of DFO and the clinical presentation of these infections. Among 341 cases of DFO, 150 had a gram-negative isolate (alone or combined with a gram-positive isolate) comprising 44.0% of all patients and 50.8% of those with a positive bone culture. Compared with gram-positive infections, wounds with gram-negative organisms more often had a fetid odor, necrotic tissue, signs of soft tissue infection accompanying osteomyelitis, and clinically severe infection. By multivariate analysis, the predictive variables related to an increased likelihood of isolating gram-negatives from bone samples were glycated hemoglobin <7% (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.1-3.5) and a wound caused by traumatic injury (OR = 2.0, 95% CI = 1.0-3.9). Overall, patients whose bone samples contained gram-negatives had a statistically significantly higher prevalence of leukocytosis and higher white blood cell counts than those without gram-negatives. In conclusion, gram-negative organisms were isolated in nearly half of our cases of DFO and were associated with more severe infections, higher white blood cell counts, lower glycated hemoglobin levels, and wounds of traumatic etiology. PMID:23446368
Aragón-Sánchez, Javier; Lipsky, Benjamin A; Lázaro-Martínez, Jose L
Leprosy is a chronic infectious peripheral neuropathy caused by Mycobacterium leprae. The different clinical presentations of the disease are determined by the quality of the host immune response. Early detection of leprosy and treatment by multidrug therapy are the most important steps in preventing deformity and disability. Thus the early recognition of the clinical leprosy presentation is essential. Mononeuritis, mononeuritis multiplex (MM), polyneuritis (MM summation) are the most frequent. The frequent anesthetic skin lesions are absent in the pure neuritic leprosy presentation form. Isolated peripheral nerve involvement is common, including the cranial ones. Arthritic presentation is occasionally seen, usually misdiagnosed as rheumatoid arthritis. Attention should be given to autonomic dysfunctions in leprosy. There are clinical presentations with severe neuropathic pain - painful small-fiber neuropathy. Leprous late-onset neuropathy (LLON) clinical presentation should be considered facing a patient who develop an inflammatory neuropathy many years after a previous skin leprosy treatment. PMID:24141500
Nascimento, Osvaldo J M
Data on presentation, aetiology, and prognostic indicators of childhood pneumonia, which can help design strategies for controlling the disease, are generally scarce in developing countries. In this paper, the distribution of aetiologic agents, clinical presentation, and evolution of pneumonia cases are des- cribed, and the factors associated with duration of pneumonia episode and of hospital admission exam- ined. During June
Luis C. Nacul; Betty R. Kirkwood; Araci C. Carneiro; Claudio S. Pannuti; Marcelo Magalhaes; Paul Arthur
Background: A recurrent episode of diverticulitis is a new distinct episode of acute inflammation after a period of complete remission of symptoms. Outdated literature suggested a high recurrence rate (>40%) and a worse clinical presentation with less chance of conservative treatment. More recent studies showed a more benign course with no need toward an aggressive policy of treatment. Methods: We
Gian Andrea Binda; Antonio Amato; Alberto Serventi; Alberto Arezzo
One hundred and sixteen patients with proven bronchiectasis diagnosed at least five years previously were studied to determine the clinical outcome, change in pulmonary function, and degree of social disability. Twenty-two patients had died and the mean duration of follow-up in the survivors was 14 years. The patients who died were characterised by a poorer initial ventilatory capacity than the
D A Ellis; P E Thornley; A J Wightman; M Walker; J Chalmers; J W Crofton
Listeria monocytogenes is an uncommon cause of illness in the general population. However, this bacterium is an important cause of severe infections in neonates, pregnant women, the elderly, transplant recipients and other patients with impaired cell-mediated immunity. Various clinical syndromes due to L. monocytogenes have been described such as sepsis, central nervous system infections, endocarditis, gastroenteritis and localized infections. A
Introduction Our aims were to assess risk factors, clinical features, management and outcomes in critically ill patients in whom Aspergillus spp. were isolated from respiratory secretions, using a database from a study designed to assess fungal infections. Methods A multicentre prospective study was conducted over a 9-month period in 73 intensive care units (ICUs) and included patients with an ICU stay longer than 7 days. Tracheal aspirate and urine samples, and oropharyngeal and gastric swabs were collected and cultured each week. On admission to the ICU and at the initiation of antifungal therapy, the severity of illness was evaluated using the Acute Physiology and Chronic Health Evaluation II score. Retrospectively, isolation of Aspergillus spp. was considered to reflect colonization if the patient did not fulfil criteria for pneumonia, and infection if the patient met criteria for pulmonary infection and if the clinician in charge considered the isolation to be clinically valuable. Risk factors, antifungal use and duration of therapy were noted. Results Out of a total of 1756 patients, Aspergillus spp. were recovered in 36. Treatment with steroids (odds ratio = 4.5) and chronic obstructive pulmonary disease (odds ratio = 2.9) were significantly associated with Aspergillus spp. isolation in multivariate analysis. In 14 patients isolation of Aspergillus spp. was interpreted as colonization, in 20 it was interpreted as invasive aspergillosis, and two cases were not classified. The mortality rates were 50% in the colonization group and 80% in the invasive infection group. Autopsy was performed in five patients with clinically suspected infection and confirmed the diagnosis in all of these cases. Conclusion In critically ill patients, treatment should be considered if features of pulmonary infection are present and Aspergillus spp. are isolated from respiratory secretions.
Garnacho-Montero, Jose; Amaya-Villar, Rosario; Ortiz-Leyba, Carlos; Leon, Cristobal; Alvarez-Lerma, Francisco; Nolla-Salas, Juan; Iruretagoyena, Jose R; Barcenilla, Fernando
Purpose Corneal graft rejection is the most common reason for the failure of an allograft corneal transplant. We undertook this study to identify and compare risk factors and treatment outcomes for early and late corneal graft rejections after optical penetrating keratoplasty. Methods A retrospective case file analysis of 880 primary penetrating keratoplasties was performed at a tertiary ophthalmic care centre. Patients were divided into early rejectors (rejection episode within 6 months postoperatively) and late rejectors (rejection episode after 6 months postoperatively). Main parameters evaluated were demographics, preoperative diagnosis and clinical signs, donor tissue details, surgical technique, details of rejection episode, treatment, and outcome information. Results A total of 156 patients with rejection episodes were identified. Of these, 42 (26.9%) patients experienced early rejection episodes and 114 (73.1%) patients experienced late rejection episodes. Preoperative donor and recipient characteristics, surgical technique, and clinical presentation of graft rejection were found to be similar between both groups after a Bonferroni correction was applied (P>0.005). Treatment outcomes of graft rejections were not significantly different (P=0.46) between early and late rejectors, with 83% of patients responding to rejection treatment (80% early rejectors; 85% late rejectors). Conclusion Patients with early and late graft rejection have similar characteristics and both groups respond to treatment equally.
Perera, C; Jhanji, V; Lamoureux, E; Pollock, G; Favilla, I; Vajpayee, R B
The term late-onset non-infectious pulmonary complications (LONIPCs) has been used to refer to events occurring later than 3 months after allogeneic hematopoietic stem transplant (HSCT), such as bronchiolitis obliterans, bronchiolitis obliterans with organizing pneumonia, and lymphocytic or idiopathic interstitial pneumonia. The incidence of LONIPCs varies widely, ranging between 10% and 26%. Median time for LONIPC development is about 8-12 months after HSCT. Clinical symptoms may be insidious and non specific at the beginning and can be present in different types of infections. The diagnosis is made on the basis of thoracic high-resolution computed tomography and pulmonary function tests (PFT). It usually requires that standard cultures for infective agents on bronchoalveolar lavage are negative and is confirmed by transbronchial or lung biopsy, whenever possible. Total body irradiation and high doses of drugs used in the conditioning regimens, HLA disparity between donor and recipient, and chronic graft-versus-host disease (GVHD) are the main risk factors for LONIPCs. Since patients with LONIPCs have an increased risk of mortality because of infections or respiratory failure, pre- and post-transplant PFTs are strongly recommended in order to timely identify affected patients. The administration of antithymocyte globulin before unrelated donor transplants and slow taper of cyclosporine after transplant have been shown to prevent chronic GVHD and, therefore, the occurrence of LONIPCs. PMID:19442201
Patriarca, Francesca; Poletti, Venerino; Costabel, Ulrich; Battista, Marta Lisa; Sperotto, Alessandra; Medeot, Marta; Toffoletti, Eleonora; Fanin, Renato
Three unusual clinical forms of sporotrichosis described in this paper will be a primer for the clinicians for an early diagnosis and treatment, especially in its unusual presentations. Case 1, a 52-year-old man, developed sporotrichosis over pre-existing facial nodulo-ulcerative basal cell carcinoma of seven-year duration, due to its contamination perhaps from topical herbal pastes and lymphocutaneous sporotrichosis over right hand/forearm from facial lesion/herbal paste. Case 2, a 25-year-old woman, presented with disseminated systemic-cutaneous, osteoarticular and possibly pleural (effusion) sporotrichosis. There was no laboratory evidence of tuberculosis and treatment with anti-tuberculosis drugs (ATT) did not benefit. Both these cases were diagnosed by histopathology/culture of S. schenckii from tissue specimens. Case 3, a 20-year-old girl, had multiple intensely pruritic, nodular lesions over/around left knee of two-year duration. She was diagnosed clinically as a case of prurigo nodularis and histologically as cutaneous tuberculosis, albeit, other laboratory investigations and treatment with ATT did not support the diagnosis. All the three patients responded well to saturated solution of potassium iodide (SSKI) therapy. A high clinical suspicion is important in early diagnosis and treatment to prevent chronicity and morbidity in these patients. SSKI is fairly safe and effective when itraconazole is not affordable/available. PMID:20445301
Mahajan, Vikram K; Sharma, Nand Lal; Shanker, Vinay; Gupta, Poonam; Mardi, Kavita
We hypothesised that the relative importance of physical and psychological risk factors for mechanical low back pain (LBP) might differ importantly according to whether there is underlying spinal pathology, psychological risk factors being more common in patients without demonstrable pathology. If so, epidemiological studies of LBP could benefit from tighter case definitions. To test the hypothesis, we used data from an earlier case-control study on patients with mechanical LBP who had undergone magnetic resonance imaging (MRI) of the lumbosacral spine. MRI scans were classified for the presence of high-intensity zone (HIZ), disc degeneration, disc herniation, and nerve root displacement/compression. Information about symptoms and risk factors was elicited by postal questionnaire. Logistic regression was used to assess associations of MRI abnormalities with symptoms and risk factors, which were characterised by odds ratios (ORs) and 95% confidence intervals (CIs). Among 354 patients (52% response), 306 (86.4%) had at least 1, and 63 (17.8%) had all 4 of all MRI abnormalities. Radiation of pain below the knee (280 patients) and weakness or numbness below the knee (257 patients) were both associated with nerve root deviation/compression (OR 2.5, 95% CI 1.4 to 4.5; and OR 1.8, 95% CI 1.1 to 3.1, respectively). However, we found no evidence for the hypothesised differences in risk factors between patients with and without demonstrable spinal pathology. This suggests that when researching the causes and primary prevention of mechanical LBP, there may be little value in distinguishing between cases according to the presence or absence of the more common forms of potentially underlying spinal pathology.
Shambrook, James; McNee, Philip; Harris, E Clare; Kim, Miranda; Sampson, Madeleine; Palmer, Keith T; Coggon, David
The purpose of this study was to identify subjective complaints and objective findings in patients treated for femoroacetabular\\u000a impingement (FAI). Three hundred and one arthroscopic hip surgeries were performed to treat FAI. The most frequent presenting\\u000a complaint was pain, with 85% of patients reporting moderate or marked pain. The most common location of pain was the groin\\u000a (81%). The average
Marc J. Philippon; R. Brian Maxwell; Todd L. Johnston; Mara Schenker; Karen K. Briggs
The immune response in the skin of dogs infected with Leishmania chagasi and its association with distinct levels of tissue parasitism and clinical progression of canine visceral leishmaniasis (CVL) are poorly understood and limited studies are available. A detailed analysis of the profiles of cytokines (IFN-?, IL-4, IL-5, IL-10, IL-12, IL-13, TGF-?1 and TNF-?) and transcription factors (T-bet, GATA-3 and
Daniel Menezes-Souza; Rodrigo Corrêa-Oliveira; Renata Guerra-Sá; Rodolfo Cordeiro Giunchetti; Andréa Teixeira-Carvalho; Olindo Assis Martins-Filho; Guilherme Corrêa Oliveira; Alexandre Barbosa Reis
Acute cholecystitis is the most common complication of cholecystolithiasis. With some 64,000 patients per year requiring surgical inpatient treatment it remains a prevalent surgical disease. The presentation varies between mild, severe and life-threatening forms and predominantly in old and morbid patients. Gallbladder perforation is a possible complication which is often only diagnosed during surgery. Typical clinical symptoms are pain in the upper abdomen, fever and leucocytosis. Ultrasonography may often be used to confirm the clinical diagnosis. PMID:23404248
Götzky, K; Landwehr, P; Jähne, J
Background: The term juvenile idiopathic arthritis (JIA) describes a clinically heterogeneous group of arthritides. The onset in all subgroups is before 16 years of age, but each group presents with different clinical signs and symptoms. The cause of the disease is unknown, but both genetic and environmental factors are believed to be involved. Management of the disease has greatly improved
Günther E. Dannecker; Pierre Quartier
Darier's disease, also known as keratosis follicularis or dyskeratosis follicularis, is a rare disorder of keratinization. It is an autosomal dominant genodermatosis with high penetrance and variable expressivity. Its manifestation appears as hyperkeratotic papules, primarily affecting seborrheic areas on the head, neck, and thorax and less frequently on the oral mucosa. When oral manifestations are present, the palatal and alveolar mucosae are primarily affected. They are usually asymptomatic and are discovered in routine dental examination. Histologically, the lesions are presented as suprabasal clefts in the epithelium with acantholytic and dyskeratotic cells represented by "corps ronds and grains". This paper reports a case of a 53-year-old woman that was admitted to our clinic with more than 10-year history of keratotic papules, presented on the hands and feet, nose, ears, genitalia, and whitish lesions on palatal mucosae. PMID:23573430
Ferizi, Mybera; Begolli-Gerqari, Antigona; Luzar, Bostjan; Kurshumliu, Fisnik; Ferizi, Mergita
Orofacial granulomatosis is a granulomatous disease of orofacial region, which can occur for a variety of reasons. The clinical features are highly variable and sometimes so insidious that signs and symptoms are not frequently severe to cause alarm. The lips are most commonly involved with persistent/recurrent swelling. The medical history is very important as Crohn's disease and sarcoidosis can present oral manifestation. Other causes like mycobacterial infection, foreign body reaction, fungal infection, and allergy were excluded with further investigation to establish diagnosis. Here and we report a case of orofacial granulomatosis with a review of the literature. PMID:24151561
Ravindran, Rathy; Karunakaran, Anila
Orofacial granulomatosis is a granulomatous disease of orofacial region, which can occur for a variety of reasons. The clinical features are highly variable and sometimes so insidious that signs and symptoms are not frequently severe to cause alarm. The lips are most commonly involved with persistent/recurrent swelling. The medical history is very important as Crohn's disease and sarcoidosis can present oral manifestation. Other causes like mycobacterial infection, foreign body reaction, fungal infection, and allergy were excluded with further investigation to establish diagnosis. Here and we report a case of orofacial granulomatosis with a review of the literature.
The term mastocytosis is referred to as an array of uncommon, usually sporadic, heterogeneous clinical illnesses that result from the hyperplasia of tissue mast cells. It comprises many different clinical manifestations varying from indolent cutaneous forms to systemic and malignant conditions. The characteristic presentation of mastocytosis consists of cutaneous manifestations: either a solitary mastocytoma, urticaria pigmentosa, or less commonly, diffuse cutaneous mastocytosis. Urticaria pigmentosa is the most common manifestation of cutaneous mastocytosis that manifests as a generalized eruption of round or oval erythematous macules, papules and plaques with variable amounts of brown pigment, usually on the trunk, but may also occur in all regions of the body including face and mucous membranes. Pruritus, dermographism and Darier's sign are additional features of these eruptions. Mastocytosis may also be manifested as mastocytoma, a rare, benign, pediatric tumor that results from hyperplasia of mast cells in papillary dermis in the first few weeks of life. The clinical course of mastocytosis is variable. The prognosis for the majority of pediatric patients with urticaria pigmentosa is extremely good, and over half of cases clear completely by adolescence, while those with aggressive systemic mastocytosis or mast cell leukemia show a progressive course, usually with a fatal outcome. PMID:19623875
Bulat, Vedrana; Mihi?, Liborija Lugovi?; Situm, Mirna; Buljan, Marija; Blaji?, Iva; Pusi?, Jana
Advances in proteomics technology offer great promise in the understanding and treatment of the molecular basis of disease. The past decade of proteomics research, the study of dynamic protein expression, post-translational modifications, cellular and sub-cellular protein distribution, and protein-protein interactions, has culminated in the identification of many disease-related biomarkers and potential new drug targets. While proteomics remains the tool of choice for discovery research, new innovations in proteomic technology now offer the potential for proteomic profiling to become standard practice in the clinical laboratory. Indeed, protein profiles can serve as powerful diagnostic markers, and can predict treatment outcome in many diseases, in particular cancer. A number of technical obstacles remain before routine proteomic analysis can be achieved in the clinic; however the standardisation of methodologies and dissemination of proteomic data into publicly available databases is starting to overcome these hurdles. At present the most promising application for proteomics is in the screening of specific subsets of protein biomarkers for certain diseases, rather than large scale full protein profiling. Armed with these technologies the impending era of individualised patient-tailored therapy is imminent. This review summarises the advances in proteomics that has propelled us to this exciting age of clinical proteomics, and highlights the future work that is required for this to become a reality.
Verrills, Nicole M
Dermatomyositis (DM) is a chronic inflammatory disorder of the skin and muscles. Evidence supports that DM is an immune-mediated disease and 50–70% of patients have circulating myositis-specific auto-antibodies. Gene expression microarrays have demonstrated upregulation of interferon signaling in the muscle, blood, and skin of DM patients. Patients with classic DM typically present with symmetric, proximal muscle weakness, and skin lesions that demonstrate interface dermatitis on histopathology. Evaluation for muscle inflammation can include muscle enzymes, electromyogram, magnetic resonance imaging, and/or muscle biopsy. Classic skin manifestations of DM include the heliotrope rash, Gottron's papules, Gottron's sign, the V-sign, and shawl sign. Additional cutaneous lesions frequently observed in DM patients include periungual telangiectasias, cuticular overgrowth, “mechanic's hands”, palmar papules overlying joint creases, poikiloderma, and calcinosis. Clinically amyopathic DM is a term used to describe patients who have classic cutaneous manifestations for more than 6 months, but no muscle weakness or elevation in muscle enzymes. Interstitial lung disease can affect 35–40% of patients with inflammatory myopathies and is often associated with the presence of an antisynthetase antibody. Other clinical manifestations that can occur in patients with DM include dysphagia, dysphonia, myalgias, Raynaud phenomenon, fevers, weight loss, fatigue, and a nonerosive inflammatory polyarthritis. Patients with DM have a three to eight times increased risk for developing an associated malignancy compared with the general population, and therefore all patients with DM should be evaluated at the time of diagnosis for the presence of an associated malignancy. This review summarizes the immunopathogenesis, clinical manifestations, and evaluation of patients with DM.
Marvi, Umaima; Chung, Lorinda; Fiorentino, David F
Background: Matrix metalloproteinases (MMPs) and Tissue Inhibitor of Matrix Metalloproteinases (TIMPs) may be associated with atherogenesis and plaque rupture. We evaluated the relationship between MMP-1, MMP-9, TIMP-1 and IL-6 levels and risk factors, presentation, extent and severity of atherosclerotic coronary artery disease (CAD). Methods: Consecutive patients who underwent coronary angiography were randomly included. The serum concentrations of MMP-1, MMP-9, TIMP-1 and IL-6 were analyzed with ELISA method in 134 patients. Participants were divided into 5 groups; stable angina pectoris (SAP; n= 34), unstable angina pectoris (USAP; n=29), non-ST elevation myocardial infarction (NSTEMI; n=16), acute ST elevation myocardial infarction (STEMI; n=25) and controls (n=30). Coronary angiographic Gensini score was calculated. Results: MMP-1 levels were higher in STEMI and NSTEMI groups compared with USAP, SAP and control groups (STEMI vs USAP p=0.005; STEMI vs SAP p=0.001; STEMI vs control p<0.001; NSTEMI vs USAP p=0.02; NSTEMI vs SAP p=0.027; NSTEMI vs control p<0.001). In STEMI group, MMP-9 levels were higher than USAP and control groups (p=0.002; p<0,001). TIMP-1 levels were not significantly different within all 5 groups. MMP-1 levels were found to be elevated in diabetic patients (p=0.020); whereas MMP-9 levels were higher in smokers (p=0.043). Higher MMP-1, MMP-9 and IL-6 levels were correlated with severe Left Anterior Descending artery (LAD) stenosis and higher angiographic Gensini Score (for severe LAD stenosis; r = 0.671, 0.363, 0.509 p<0.001; for Gensini score; r = 0.717, 0.371, 0.578 p<0.001). Conclusions: Serum levels of MMP-1, MMP-9, and IL-6 are elevated in patients with CAD; more so in acute coronary syndromes. MMP-1, MMP-9 and IL-6 are associated with more extensive and severe CAD (as represented by Gensini score).
Tanindi, Asli; Sahinarslan, Asife; Elbeg, Sehri; Cemri, Mustafa
Pituitary autoimmune disease is considered an autoimmune organ-specific disorder, characterized by a pituitary infiltration of lymphocytes, macrophages, and plasma cells that could lead to loss of pituitary function. Hypophysitis may be secondary to systemic diseases or infections. Primary pituitary hypophysitis is classified into lymphocytic, granulomatous, xanthomatous, mixed forms (lymphogranulomatous, xanthogranulomatous), necrotizing and IgG4 plasmacytic, according to the histological findings. Concerning lymphocytic hypophysitis (LH), it is characterized by lymphocytic infiltration and can be subclassified according to the affected area on: lymphocytic adenohypophysitis, lymphocytic infundibulo-neurohypophysitis and lymphocytic panhypophysitis. LH had always been considered a rare disease. Nevertheless, with improved imaging techniques, especially magnetic resonance imaging (MRI), LH diagnosis has been increased. This disease usually affects young women during pregnancy or postpartum period with headache, visual impairment, ACTH deficiency and a homogenous sellar mass with thickening of pituitary stalk in MRI. Definitive diagnosis depends on histopathological evaluation; nevertheless, a presumptive diagnosis could be done in a typical case. As no specific autoantigen was identified in LH, there is no antipituitary antibody (APA) method available for helping diagnosis. However, APA used in some centers for research could support an autoimmune origin for some hypopituitarism previously named as idiopathic, confirming nuances in clinical presentation of pituitary autoimmune disease. Therapeutic approach should be based on the grade of suspicious and clinical manifestations of LH. PMID:22426958
Glezer, A; Bronstein, M D
In the 47 months from September, 1981, 1531 new cases of amblyopia were identified in the ophthalmic clinics of Leicestershire. Amblyopia was due to strabismus in 689 (45%), combined strabismus and anisometropia in 540 (35%), anisometropia alone in 252 (17%), and form deprivation in 50 (3%). The median age at presentation for strabismic amblyopia (3.64 years) was significantly lower than for combined strabismus and anisometropia (4.68 years) and anisometropia (6.27 years). Boys presented later than girls, as did Asians compared with Caucasians. Only 38 (15%) of children with a visual defect without strabismus (anisometropia) were identified before the age of 5 years. The major reason for this late identification is the lack of a reliable single test for preschool vision assessment. PMID:2899674
Shaw, D E; Fielder, A R; Minshull, C; Rosenthal, A R
Endophthalmitis is a rare but sight-threatening complication that can occur after ocular surgery or trauma or as a consequence of systemic infection. To optimize visual outcome, early diagnosis and treatment are essential. Over recent decades, advances in hygienic standards, improved microbiologic and surgical techniques, development of powerful antimicrobial drugs, and the introduction of intravitreal antibiotic therapy have led to a decreased incidence and improved management of endophthalmitis. However, endophthalmitis still represents a serious clinical problem. This review focuses on current principles and techniques for evaluation and treatment of endophthalmitis. In addition, it addresses recent developments regarding antimicrobial treatment and prophylaxis of infectious endophthalmitis.
Kernt, M; Kampik, A
Objective To explore associated clinical factors in children with pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS). Study design Children with tics and/or OCD (n = 109) were examined by personal and family history, diagnostic interview, physical examination, medical record review, and measurement of baseline levels of streptococcal antibodies. Results Significant group differences were found on several variables, such that those diagnosed with PANDAS (versus without PANDAS) were more likely to have had dramatic onset; definite remissions; remission of neuropsychiatric symptoms during antibiotic therapy; a history of tonsillectomies/adenoidectomies; evidence of GAS infection, and clumsiness. Conclusion The identification of clinical features associated with PANDAS should assist in delineating risks for this subtype of OCD/tics.
Murphy, Tanya K.; Storch, Eric A.; Lewin, Adam B.; Edge, Paula J.; Goodman, Wayne K.
Management of retinoblastoma (Rb), the most common intraocular malignant tumor in childhood, is tailored to each individual case and based on the overall situation. We present a case of bilateral Rbs in a 4-month-old girl, referred to our center for bilateral leukocoria. In the right eye, the optic disc was partially visible, and three large foci of retinoblastoma were noted adjective in the vitreous cavity with satellite retinal detachment. The macula was obscured by the tumors. The tumor was therefore classified as group D (International classification of retinoblastoma), and thus underwent intravenous chemotherapy with the standard three-agent protocol of ifosfamide, carboplatin and etoposide (ICE protocol) delivered monthly for six cycles, regressing with a type I calcified pattern. The left eye presented three multifocal yellow-white retinal masses, with a total retinal detachment, and secondary glaucoma. The lesions were classified as group E and, therefore, taking the results obtained by Shields et al. in group E tumors into consideration, underwent enucleation. This case clearly shows that this cancer is curable if detected at a stage in which it is still contained within the retina, subretinal space or vitreous, and that the management of Rb relies on an experienced team of ocular oncologists, pediatricians and pediatric ophthalmologists working together for the single goal of saving the child's life. PMID:23277210
Pichi, Francesco; Lembo, Andrea; De Luca, Mariacarla; Hadjistilianou, Theodora; Nucci, Paolo
The histiocytoses, whether reactive or neoplastic, can be related histologically and immunophenotypically to their normal counterparts within the histiocytic system. This system has two subsets: The dendritic (antigen-presenting) cells and the phagocytic histiocytic (antigen-processing) cells. Dermatopathic lymphadenitis and Langerhans cell histiocytosis (histiocytosis X) are reactive proliferative disorders of dendritic cells. Malignancies of dendritic cells exist, but they are very rare. Benign proliferations of phagocytic histiocytes include the hemophagocytic syndromes, both familial and reactive, as well as sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) and histiocytic necrotizing lymphadenitis (Kikuchi's disease). Neoplasms of phagocytic histiocytes include acute monocytic leukemia and the very rare entities, malignant histiocytosis and true histiocytic lymphoma. The latter must be distinguished from sinusoidal, large cell anaplastic lymphomas. PMID:2150325
Gonzalez, C L; Jaffe, E S
Endometriosis is found predominantly in women of childbearing age. The prevalence of endometriosis is difficult to determine accurately. Laparoscopy or surgery is required for the definitive diagnosis. The most common symptoms are dysmenorrhea, dyspareunia, and low back pain that worsen during menses. Endometriosis occurring shortly after menarche has been frequently reported. Endometriosis has been described in a few cases at the umbilicus, even without prior history of abdominal surgery. It has been described in various atypical sites such as the fallopian tubes, bowel, liver, thorax, and even in the extremities. The most commonly affected areas in decreasing order of frequency in the gastrointestinal tract are the recto-sigmoid colon, appendix, cecum, and distal ileum. The prevalence of appendiceal endometriosis is 2.8%. Malignant transformation is a well-described, although rare (<1% of cases), complication of endometriosis. Approximately 75% of these tumors arise from endometriosis of the ovary. Other less common sites include the rectovaginal septum, rectum, and sigmoid colon. Unopposed estrogens therapy may play a role in the development of such tumors. A more recent survey of 27 malignancies associated with endometriosis found that 17 (62%) were in the ovary, 3 (11%) in the vagina, 2 (7%) each in the fallopian tube or mesosalpinx, pelvic sidewall, and colon, and 1 (4%) in the parametrium. Two cases of cerebral endometriosis and a case of endometriosis presenting as a cystic mass in the cerebellar vermis has been described. Treatment for endometriosis can be expectant, medical, or surgical depending on the severity of symptoms and the patient's desire to maintain or restore fertility.
Agarwal, Neha; Subramanian, Arulselvi
BACKGROUND: The accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis. METHODS: Based upon the clinical presentation, the patients
Cengiz Bolukbas; Fusun F Bolukbas; Tulin Kendir; Remzi A Dalay; Nihat Akbayir; Mehmet H Sokmen; Ali T Ince; Mithat Guran; Erkan Ceylan; Guray Kilic; Oya Ovunc
Oral candidiasis is a clinical fungal infection that is the most common opportunistic infection affecting the human oral cavity. This article reviews the pathogenesis, clinical presentations, diagnosis and treatmentstrategies for oral candidiasis. PMID:23705242
Lalla, Rajesh V; Patton, Lauren L; Dongari-Bagtzoglou, Anna
Background: We describe a retrospective analysis of the clinical presentation and imaging features in nine patients with adrenal histoplasmosis in nonimmunocompromised patients from a nonendemic region. Methods: Clinically, a tuberculosis-like presentation in four patients and a tumor-like presentation in five patients were seen. All patients were seronegative for the human immunodeficiency virus. Ultrasound (US) in all patients, computed tomography (CT)
N. Kumar; S. Singh; S. Govil
This paper discusses sexual fetishism as a factor contributing to sexual dysfunction. Help-seeking is triggered by the effects of the fetishistic desires and related behaviours on normal sexual functioning. The paper discusses the nature and management of these problems. Clinical case material is provided to illustrate some of the ways in which fetishism manifests as a clinical problem in this
P. DE Silva
Background: The presence and degree of neuronal degeneration already existing in patients at their initial presentation with a clinically isolated syndrome sugges- tive of multiple sclerosis (CIS) is unclear, and whole brain or whole normalised grey matter analyses have not demonstrated significant atrophy in CIS cohorts at clinical presentation. Voxel-based analyses allow detection of regional atrophy throughout the brain and,
R G Henry; M Shieh; D T Okuda; A Evangelista; M L Gorno-Tempini; D Pelletier
The vein of Galen aneurysmal malformation is a congenital vascular malformation that comprises 30% of the pediatric vascular and 1% of all pediatric congenital anomalies. Treatment is dependent on the timing of presentation and clinical manifestations. With the development of endovascular techniques, treatment paradigms have changed and clinical outcomes have significantly improved. In this article, the developmental embryology, clinical features and pathophysiology, diagnostic workup, and management strategies are reviewed. PMID:22107867
Recinos, Pablo F; Rahmathulla, Gazanfar; Pearl, Monica; Recinos, Violette Renard; Jallo, George I; Gailloud, Philippe; Ahn, Edward S
Study objective: To examine the clinical presentation and outcome of patients treated in the ED or toxicology clinic for suspected brown recluse spider bites. Methods: We assembled a retrospective case series of patients at a southeastern US university hospital. Our study group comprised 111 patients with suspected brown recluse spider bites treated during a 30-month period. Our main outcome measures
Seth W Wright; Keith D Wrenn; Lindsay Murray; Donna Seger
Polycythemias or erythrocytoses in childhood and adolescence are very rare. Systematic data on the clinical presentation and laboratory evaluations as well as on treatment regimens are sparse. The diagnostic program in absolute erythrocytosis includes extensive clinical, hematological, biochemical, and molecular biological examinations which should be applied following a stepwise algorithm. Absolute erythrocytoses are usually subdivided into primary and secondary forms.
Objective: To determine the prevalence and associated clinical symptoms of pes anserine bursitis in symptomatic adult knees. Materials and methods: A retrospective review was performed of the reports of 509 knee MRI studies obtained from July 1998 to June 2004 on 488 patients presenting to an orthopaedic clinic with knee pain suspected to be due to internal derangement. The MRI
W. J. Rennie; A. Saifuddin
...computing the present value are those used by the Board of Actuaries of the Civil Service Retirement System for valuation of CSRS and FERS, based on dynamic assumptions. (3) The present value factors are unisex factors obtained by averaging...
Background Results from clinical trials are typically disseminated first by presentation at scientific meetings. An important question has to do with the role of presentation in improving the quality of manuscripts submitted to the journals as well as the effect of presentation in speeding, or delaying subsequent publication. The aim of this research is focused on presentation practices of trialists to examine their effect on the timing of publications of clinical trial results. Methods Six hundred and one (601) trials published in 1996 and 1997 were identified via MEDLINE using medical subject heading “clinical trials” or the occurrence of the term in the text and by limiting to publication type “clinical trial”. Authors of those trials were surveyed to determine prior presentation history for the identified trials. Results Among the 601 trials identified, complete responses to questionnaires were obtained for 379 (63 percent) trials. The median time from completion to first submission of the primary results manuscript was 11 months and the median time from completion to publication was 25 months for the 220 trials involving presentation prior to submission for publication. The corresponding median times from completion to first submission and publication for the subset of trials not involving presentation prior to the submission were 8 and 19 months (159 trials), respectively. The adjusted relative hazard for publication for trials involving presentation prior to first submission was 0.55 versus trials not involving presentation prior to first submission (95% confidence interval, 0.44 to 0.69). Conclusion Despite the importance of dissemination of results prior to publication, investigators should carefully weigh a potential gain in quality against a potential for delay in submission of the primary results manuscript by presentation at scientific meetings. The findings of our study suggest that presentation prior to submission may increase time to publication. Inclusion of presentation dates in clinical trial registers should be considered to allow future studies investigating presentation and publication practices.
Unalp, Aynur; Tonascia, Susan; Meinert, Curtis L
In this study the records of 45 patients with sickle cell disease involved in 63 presentations of acute chest syndrome at the Princess Margaret Hospital in Nassau, the Bahamas, between 1997 and 2001 were examined. Patients were divided into three groups on the basis of age (<13 years, 13–18 years, ?19 years) with a view to assessing clinical presentation. The
C Taylor; F Carter; J Poulose; S Rolle; S Babu; S Crichlow
Merkel cell carcinoma (MCC) is an uncommon aggressive neuroendocrine tumor of the skin that classically presents on chronic sun-damaged skin as a skin-colored, red or violaceous, firm and nontender papule or nodule with a smooth and shiny surface. Ulcerations can be observed very seldom and only in very advanced lesions. We present a unique case of a MCC presenting with two unusual clinical features: The Telangiectatic surface and the pedunculated aspect.
Errichetti, Enzo; Piccirillo, Angelo; Ricciuti, Federico; Ricciuti, Francesco
Despite the clinical importance of race effects on comorbidity and symptom patterns in recent community studies, little is known about such effects in various treatment facilities. This study evaluated the effect of race on the clinical profile of 604 alcoholics who presented for initial evaluation and treatment at a psychiatric hospital. The factor that most strongly distinguished the racial groups
Jack R Cornelius; Horacio Fabrega; Marie D Cornelius; Juan Mezzich; Patrick J Maher; Ihsan M Salloum; Michael E Thase; Richard F Ulrich
Leukemia cutis is an extramedullary manifestation of leukemia. The frequency and age distribution depend on the leukemia subtype. The clinical and morphological findings have a wide range of cutaneous manifestations and may present with nodular lesions and plaques. Rare manifestations include erythematous macules, blisters and ulcers which can each occur alone or in combination. Apart from solitary or grouped lesions, leukemia cutis may also present with an erythematous rash in a polymorphic clinical pattern. Consequently, leukemia cutis has to be distinguished from numerous differential diagnoses, i. e. cutaneous metastases of visceral malignancies, lymphoma, drug eruptions, viral infections, syphilis, ulcers of various origins, and blistering diseases. In the oral mucosa, gingival hyperplasia is the main differential diagnosis. The knowledge of the clinical morphology is of tremendously importance in cases in which leukemia was not yet known. PMID:22115500
Wagner, Gunnar; Fenchel, Klaus; Back, Walter; Schulz, Alina; Sachse, Michael Max
Acetaminophen or paracetamol, a commonly used over-the-counter analgesic, is known to elicit severe adverse reactions when taken in overdose, chronically at therapeutic dosage or, sporadically, following single assumptions of a therapeutic dose. Damage patterns including liver damage and, rarely, acute tubular necrosis or a fixed drug exanthema. We present a case of fatal acetaminophen toxicity with postmortem blood concentration 78 ?g/mL and unusual clinical features, including a visually striking and massive epidermolysis and rhabdomyolysis, disseminated intravascular coagulation and myocardial ischemia. This case is compared with the most similar previous reports in terms of organ damage, clinical presentation, and cause of death. We conclude that a number of severe patterns of adverse effects to acetaminophen are emerging that were previously greatly underestimated, thus questioning the adequacy of the clinical spectrum traditionally associated with acetaminophen intoxication and leading to the need to review this spectrum and the associated diagnostic criteria. PMID:23822653
De-Giorgio, Fabio; Lodise, Maria; Chiarotti, Marcello; d'Aloja, Ernesto; Carbone, Arnaldo; Valerio, Luca
The clinical presentation and long term outcome (mean follow up eight years, range 0.25 to 21) of 15 patients with autosomal recessive primary familial hypomagnesaemia is described. The most common (67%) presenting events were generalised hypocalcaemic-hypomagnesaemic seizures at a mean (SD) age of 4.9 (2.5) weeks. Thirteen infants, treated soon after diagnosis with high dose enteral magnesium developed normally. Their
Hanna Shalev; Moshe Phillip; Aharon Galil; Rivka Carmi; Daniel Landau
We report a case of laboratory-acquired meningococcal disease in a 31-y-old female research assistant. The clinical presentation of the case was atypical with polyserositis affecting knees, pleura and pericardium, without septicaemia or meningitis. The diagnosis was made by positive PCR for Neisseria meningitidis (genogroup C, genosubtype P1.7, 16, 35 and without mutations of the penA gene) in the patient's right knee. Serology confirmed the diagnosis after recovery. This case had an atypical clinical picture, exemplifies the use of non-culture methods for diagnosis and characterization, and reminds us about the importance of safe routines for the laboratory work. PMID:17852886
Athlin, Simon; Vikerfors, Tomas; Fredlund, Hans; Olcén, Per
Introduction. Pleural mesothelioma with metastasis to the subcutaneous tissue of the abdominal wall at first diagnosis and without penetration into the peritoneum is an extremely rare clinical presentation. Methods. Patients with pleural mesothelioma have low survival rate. Usually, the disease at presentation is confined to its site of origin (most often the pleural cavity). A 55-year-old man was referred to our center due to increasing dyspnea and a painful periumbilical mass in the anterior abdominal wall. CT scan revealed both advanced mesothelioma of the pleura and a tumor mass confined to the subcutaneous fatty tissue without penetration through the peritoneum. Results. Video-assisted thoracoscopy confirmed the diagnosis of epithelioid pleural mesothelioma, which was also confirmed by a biopsy of the periumbilical mass. Systemic chemotherapy with cisplatin and pemetrexed was initiated. Under the ongoing systemic chemotherapy, the evaluation revealed partial remission of pleura mesothelioma and its subcutaneous manifestation of the abdominal wall. Conclusion. Mesothelioma of the pleura with a simultaneous metastasis to the subcutaneous fatty tissue of the abdominal wall at presentation without penetration of peritoneum is a rare clinical presentation of mesothelioma disease. The knowledge of its natural history is very limited. This is the first ever clinical documentation of a patient with pleura mesothelioma and simultaneous subcutaneous manifestation of abdominal wall.
Falkenstern-Ge, R. F.; Kimmich, M.; Bode-Erdmann, S.; Friedel, G.; Ott, G.; Kohlhaufl, M.
Paracoccidioidomycosis (PCM) is a systemic fungal disease endemic to Latin America and characterized by two clinical presentations, i.e., patients develop either acute/subacute or chronic clinical manifestations. The differences in clinical presentations are mainly dependent on the host immune response, but may also be related to demographic characteristics of some patients. In this retrospective study, 1,219 PCM cases treated between 1970 and 2009 in a university medical center, located in southeastern Brazil, were analyzed according to their clinical and demographic features. The most affected anatomical sites were lungs (63.8%) and oral mucosa (50.0%), with increasing involvement of these sites in accord with the age of the patients. Generalized lymphadenopathy (28.1%) and skin lesions (29.6%) were more frequent on the first decades of life. Involvement of the larynx (16.1%), gut (7.5%), spleen (4.7%), central nervous system (3.4%), bones and joints (2.2%), and adrenal (2.1%) were also variable according to the age of the host. The acute/subacute form of the disease accounted for 26.4% of PCM cases and, on a multivariate analysis, was inversely associated with aging (OR = 0.8 per year, P < 0.001), and directly associated with female sex (OR = 7.2, P < 0.001), mixed black and white racial background (OR = 2.3, P < 0.001) or black skin color (OR = 4.6, P < 0.001). Based on these findings, we have shown that host immune response, as well as age, gender and ethnicity may influence the clinical presentation of PCM. PMID:22928923
Bellissimo-Rodrigues, Fernando; Bollela, Valdes Roberto; Da Fonseca, Benedito Antônio Lopes; Martinez, Roberto
Two patients with primary actinomycotic brain infection are presented here. The first case had 2 predisposing factors, cardiac septal defect and chronic mastoiditis, whereas the second patient was a chronic smoker, belonging to a desert region. Both the patients were successfully managed with surgical debridement and prolonged administration of antibiotics. PMID:22824696
Mohindra, Sandeep; Savardekar, Amey; Rane, Swapnil
Primary aortoenteric fistula is a rare but potentially fatal cause of gastrointestinal bleeding. The diagnosis of primary aortoeteric fistula is difficult to make and is usually accompanied by a very high level of clinical suspicion. In the context of a known abdominal aortic aneurysm it is reasonable to have a high index of clinical suspicion ofaortoenteric fistula. It should be included in the differential diagnosis with low back pain and a palpable midline abdominal mass in a haemodynamically stable patient. We present a case of a 59 year old man with no past history of abdominal aortic aneurysm presented with lower back and periumblical pain. Initial misdiagnosis led to a delay in treatment and the patient succumbed to the illness. PMID:18173048
Mehmood, Rao Khalid; Mushtaq, Abid; Andrew, David R; Miller, George Allan
Fascioliasis, which is a zoonotic infestation caused by the trematode Fasciola hepatica (liver fluke), is primarily a disease of herbivorous animals such as sheep and cattle. Humans become accidental hosts through ingesting uncooked aquatic plants such as watercress. It presents a wide spectrum of clinical pictures ranging from fever, eosinophilia and vague gastrointestinal symptoms in the acute phase to cholangitis, cholecystitis, biliary obstruction, extrahepatic infestation, or asymptomatic eosinophilia in the chronic phase. However, it may often be overlooked, especially in the acute phase, because of vague symptoms. As a result of newly introduced serological assays facilitating the diagnosis, there has been an increase in the number of reported cases. Here, we report the clinical and laboratory assessment and therapeutic approach of a series of three cases diagnosed (in order of) one week, three months and one and a half years after presentation of the first symptoms of the disease. PMID:22798118
Arslan, Ferhat; Batirel, Ay?e; Samasti, Mustafa; Tabak, Fehmi; Mert, Ali; Özer, Serdar
The authors report a case of a 64-year-old male with Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) pathology at autopsy who did not manifest the core symptoms of DLB until very late in his clinical course. His initial presentation of early executive and language dysfunction suggested a cortical dementia similar to frontotemporal lobar degeneration (FTLD). Core symptoms of
Lauren T. Bonner; Debby W. Tsuang; Monique M. Cherrier; Charisma J. Eugenio; Jennifer Q. Du; Ellen J. Steinbart; Pornprot Limprasert; Albert R. La Spada; Benjamin Seltzer; Thomas D. Bird; James B. Leverenz
Urticaria pigmentosa (UP) is the most frequent clinical feature of cutaneous mastocytosis. It usually begins in a bimodal way: a peak of incidence from birth to the age of 3 and the other one between 2(nd) and 6(th) decades of life. Darier's sign is constant over the affected skin without affecting the surrounding skin. When UP starts early, it has a good prognosis disappearing into adolescence, while late onset is often associated with persistent or systemic involvement. This article reports two cases of UP, one with the classic description of the disease and the other with an unusual clinical presentation, prompting the pediatrician to incorporate both forms as different manifestations of the same entity. PMID:21829861
Spada, Julieta; Lequio, Mariana; Pyke, María de los Ángeles; Hernández, Marisa; Chouela, Edgardo
Age-related changes in the spinal column result in a degenerative cascade known as spondylosis. Genetic, environmental, and\\u000a occupational influences may play a role. These spondylotic changes may result in direct compressive and ischemic dysfunction\\u000a of the spinal cord known as cervical spondylotic myelopathy (CSM). Both static and dynamic factors contribute to the pathogenesis.\\u000a CSM may present as subclinical stenosis or
Darren R. Lebl; Alex Hughes; Frank P. Cammisa; Patrick F. O’Leary
Darier's disease, also known as keratosis follicularis or dyskeratosis follicularis, is a rare disorder of keratinization. It is an autosomal dominant genodermatosis with high penetrance and variable expressivity. Its manifestation appears as hyperkeratotic papules primarily affecting seborrheic areas on the head, neck, thorax, and less frequently the oral mucosa. When oral manifestations are present, the palatal and alveolar mucosae are primarily affected. They usually asymptomatic and are discovered in routine dental examination. Histologically, the lesions present as suprabasal clefts in the epithelium with acantholytic and dyskeratotic cells represented by "corps ronds and grains." This paper reports a case of an adult male patient who presented with painful whitish lesions on buccal mucosa with crusty lips as the only clinical sign of Darier's disease. As this patient did not have skin lesions or family history, an intraoral biopsy confirmed the diagnosis of Darier's disease by a multidisciplinary team. PMID:22937379
Manoja, K G D; Siriwardena, B S M S; Jayasooriya, P R; Siriwardane, D J L; Tilakaratne, W M
Darier's disease, also known as keratosis follicularis or dyskeratosis follicularis, is a rare disorder of keratinization. It is an autosomal dominant genodermatosis with high penetrance and variable expressivity. Its manifestation appears as hyperkeratotic papules primarily affecting seborrheic areas on the head, neck, thorax, and less frequently the oral mucosa. When oral manifestations are present, the palatal and alveolar mucosae are primarily affected. They usually asymptomatic and are discovered in routine dental examination. Histologically, the lesions present as suprabasal clefts in the epithelium with acantholytic and dyskeratotic cells represented by “corps ronds and grains.” This paper reports a case of an adult male patient who presented with painful whitish lesions on buccal mucosa with crusty lips as the only clinical sign of Darier's disease. As this patient did not have skin lesions or family history, an intraoral biopsy confirmed the diagnosis of Darier's disease by a multidisciplinary team.
Manoja, K. G. D.; Siriwardena, B. S. M. S.; Jayasooriya, P. R.; Siriwardane, D. J. L.; Tilakaratne, W. M.
Background andPurpose: Patients withstroke symptomscommonlydelay many hoursbefore seeking medical attention. We sought toexplore thefactors associated withearly presentation ofstroke patients tophysicians. Methods: Weprospectively studied 100consecutive acutestroke patients presenting tothree large, urban medical centers. Usinga standardized, structured interview andchartreview, we assessed patient education aboutstroke, riskfactors, clinical features ofthestroke, source ofstroke recognition, and timing ofpresentation. We didnotstudy thedistance fromthesite ofstroke onsettothesite ofphysician contact.
Jamie M. Brooks; Lawrence M. Brass; Pierre B. Fayad; Kara L. Sawaya; Francis Nazareno; Steven R. Levine
Although pediatricians are frequently confronted with patients presenting urolithiasis symptoms without obvious stones, the syndrome of occult urolithiasis may be still viewed with some skepticism. We have compared the clinical and metabolic features of 197 children with obvious calculi, 189 with microcalculi (diameter ? 3 mm based on renal sonography), and 114 with symptoms of urolithiasis and normal renal sonography findings. Only microcalculi and normal sonography subjects with a urinary abnormality potentially leading to urolithiasis were included in the study. Age at presentation increased significantly (p?=?0.0001) in the groups in the order normal sonography to microcalculi to calculi groups. There was no significant difference among the three groups in terms of family history of urolithiasis, gender distribution, and degree of hypercalciuria, hyperuricosuria, hyperoxaluria, or hypocitraturia. The average frequency of pain attacks of patients with recurrent abdominal pain (RAP) ranged from 3.6 to 4.6 days of pain per month among the three groups, which is four to ninefold lower than that reported for children with functional or organic gastrointestinal RAP. The consistency of many clinical and urinary metabolic characteristics indicates a common underlying disorder in overt and occult urolithiasis. The increase of age at presentation from the normal sonography to microcalculi and calculi groups may reflect progressive crystal accretion leading ultimately to overt stone formation. PMID:21688190
Polito, Cesare; Apicella, Andrea; Marte, Antonio; Signoriello, Giuseppe; La Manna, Angela
Research shows that a large number of medical presentations do not result in a medical diagnosis but rather are related to behavioral health problems. Factors such as age, lower education and economic status, health beliefs, and medical and psychological factors are linked to high medical service utilization. Research consistently shows that patients with psychological problems use more services than those
William O’Donohue; Michael A. Cucciare
Mucopolysaccharidosis type IVA (MPS IVA) was described in 1929 by Luis Morquio from Uruguay and James Brailsford from England, and was later found as an autosomal recessive lysosomal storage disease. MPS IVA is caused by mutations in the gene encoding the enzyme, N-acetylgalactosamine-6-sulfate sulfatase (GALNS). Reduced GALNS activity results in impaired catabolism of two glycosaminoglycans (GAGs), chondroitin-6-sulfate (C6S) and keratan sulfate (KS). Clinical presentations of MPS IVA reflect a spectrum of progression from a severe "classical" phenotype to a mild "attenuated" phenotype. More than 180 different mutations have been identified in the GALNS gene, which likely explains the phenotypic heterogeneity of the disorder. Accumulation of C6S and KS manifests predominantly as short stature and skeletal dysplasia (dysostosis multiplex), including atlantoaxial instability and cervical cord compression. However, abnormalities in the visual, auditory, cardiovascular, and respiratory systems can also affect individuals with MPS IVA. Diagnosis is typically based on clinical examination, skeletal radiographs, urinary GAG, and enzymatic activity of GALNS in blood cells or fibroblasts. Deficiency of GALNS activity is a common assessment for the laboratory diagnosis of MPS IVA; however, with recently increased availability, gene sequencing for MPS IVA is often used to confirm enzyme results. As multiple clinical presentations are observed, diagnosis of MPS IVA may require multi-system considerations. This review provides a history of defining MPS IVA and how the understanding of the disease manifestations has changed over time. A summary of the accumulated knowledge is presented, including information from the International Morquio Registry. The classical phenotype is contrasted with attenuated cases, which are now being recognized and diagnosed more frequently. Laboratory based diagnoses of MPS IVA are also discussed. PMID:23665161
Hendriksz, C J; Harmatz, P; Beck, M; Jones, S; Wood, T; Lachman, R; Gravance, C G; Orii, T; Tomatsu, S
Granular cell tumors are relatively uncommon benign lesions occurring in almost any part of the body. We report the cytological diagnosis of granular cell tumor in 25-year-old male patient who presented with an inguinal mass clinically suspected to be a lymphadenopathy. Fine needle aspiration revealed polygonal cells with abundant, granular cytoplasm and eccentrically located vesicular nuclei and inconspicuous nucleoli. The histopathological examination of the surgical excision confirmed the diagnosis. If resection is complete, local surgical excision is curative for benign granular cell tumors. Granular cell tumor has a characteristic cytological appearance, and fine-needle aspiration cytology has been suggested to be diagnostic modality of choice. PMID:20432759
Loncar, Branka; Marjanovi?, Ksenija; Pauzar, Biljana; Staklenac, Blazenka
To define the risk factors and clinical presentation of patients under age 40 who present to the emergency department (ED) of a community hospital with an acute myocardial infarction (MI), a retrospective cross-sectional study was conducted over a 7-year period. Two hundred and nine consecutive cases of initial MI who met World Health Organization criteria (chest pain, ECG changes, and
Mark G. Kanitz; Sam J. Giovannucci; Jeffrey S. Jones; Michael Mott
The authors report a case of a 64-year-old male with Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) pathology at autopsy who did not manifest the core symptoms of DLB until very late in his clinical course. His initial presentation of early executive and language dysfunction suggested a cortical dementia similar to frontotemporal lobar degeneration (FTLD). Core symptoms of DLB including dementia, hallucination, and parkinsonian symptoms were not apparent until late in the course of his illness. Autopsy revealed both brainstem and cortical Lewy bodies and AD pathology. Family history revealed 7 relatives with a history of dementia including 4 with possible or probable DLB. This case is unique because of the FTLD-like presentation, positive family history of dementia, and autopsy confirmation of DLB.
Bonner, Lauren T.; Tsuang, Debby W.; Cherrier, Monique M.; Eugenio, Charisma J.; Du, Jennifer Q.; Steinbart, Ellen J.; Limprasert, Pornprot; La Spada, Albert R.; Seltzer, Benjamin; Bird, Thomas D.; Leverenz, James B.
Scrotal calcinosis (SC) is a rare benign disease that affects patients in childhood or early adulthood. It is characterized by slow-growing yellowish-white nodules consisting of deposits of calcium and phosphates, within the scrotal skin. The nodules vary in number, and can be solitary or grouped. Owing to the age of onset and anatomical location, SC may be a source of embarrassment and lead to social isolation. Because of its rarity, the aetiology of SC is still controversial. We report a very rare case of an SC in a 59-year-old white man who presented with multiple nodules with different clinical patterns in the scrotum, which had been present for > 42 years. Despite the rarity and the multiple long-lasting lesions, surgical excision of the scrotal nodules can offer a very good aesthetic outcome in a single procedure even under local anaesthesia. PMID:19817761
Chiummariello, S; Figus, A; Menichini, G; Bellezza, G; Alfano, C
To report an unusual clinical presentation of ocular trauma in a child. Observational case report used in this study. A 12 year-old previously healthy boy presented with decreased vision and corneal opacity in the right eye following a punch in the face three years earlier. At presentation, his vision in the right eye was counting fingers. Ophthalmologic examination of the right eye revealed paracentral Descemet's membrane detachment and slit-lamp examination showed corneal opacity occupying almost 80 % of the corneal surface. In addition, there was a corneal white liquid collection communicating with the anterior chamber. The contralateral eye was within normal limits. The patient underwent penetrating keratoplasty. Bacteriological cultures of the corneal liquid did not reveal the presence of germs. The post-operative course was uneventful, the graft was clear and there was no evidence of graft rejection or failure. Visual acuity in the operated eye was 5/10. At present, the patient is still being followed up. The authors believe that this case is unique since Descemet's membrane detachment with liquid collection and corneal opacification has never been reported in literature to date. PMID:23007966
Limaïem, Rim; Limaïem, Faten; Bouraoui, Rim; Abbès, Imen; El Matri, Leila
We present a rare case of mucopolysaccharidosis (MPS) with a typical presentation of mental retardation and absence of corneal clouding. The purpose of presenting this case report is to highlight the distinctive manifestation of MPS (Hunter's disease) and to provide a concise report of Hunter's disease for medical practitioners with the hope that such information will help identify boys earlier in the course of their disease. This report is of a 7-year-old boy who presented to the children outpatient through a referral with a history of inability to grasp objects, inability to express self, and coarse skin, which started 5 years ago. On examination, he was short statured, with a big head, protruding abdomen, coarse skin, swollen wrist joints, and clubbed fingers. There was mild mental retardation. Investigations revealed mucopolysaccharides in urine ad radiographic findings were in keeping with diagnosis. Based on the clinical features and radiological findings, one can diagnose a case of MPS. However, careful and critical approach is necessary to exactly diagnose the type of MPS as enzymatic studies are not available in most centers.
Chinawa, JM; Adimora, GN; Obu, HA; Tagbo, B; Ujunwa, F; Onubogu, I
Traditional Chinese medicine clinical pharmacy is the contact theory of traditional Chinese medicine and herbal application on the bridge, this paper systematically reviews the clinical pharmacy of traditional Chinese medicine the history, current situation of clinical pharmacy to conduct a comprehensive review, put forward the development of Chinese clinical pharmacy path, in order to strengthen the traditional Chinese medicine clinical pharmacy discipline construction and research. PMID:23668029
Zhai, Hua-Qiang; Wang, Yan-Ping; Wang, Yong-Yan
In vivo antimicrobial resistance has yet to be documented in Chlamydia trachomatis; however, there have been anecdotal reports of persistent infection. The purpose of this case series was to describe a group of patients who have persistent chlamydia infection despite adequate treatment and where re-infection was considered unlikely. Patients were selected using a clinical questionnaire. For inclusion patients had to have tested positive for C. trachomatis, at least twice, using a nucleic acid amplification test despite having been fully compliant with at least two rounds of recommended therapy and be deemed to be at low risk of re-infection. Patients were grouped into categories based on sexual behaviour. Twenty-eight patients are included in this case series; 46% declared no sexual contact since initial diagnosis (category 1), a further 36% declaring contact that was considered low risk of re-infection (categories 2-4); 61% showed signs and symptoms at initial presentation increasing to 75% at re-attendance. Thirty-nine percent of patients received azithromycin only while 48% received doxycycline also. This case series identifies patients with persistent chlamydia despite receiving treatment. There is a need for a case definition of clinical treatment failure, development of susceptibility testing methods and guidance on appropriate treatment for patients with persistent infection. PMID:23970750
Pitt, R A; Alexander, S; Horner, P J; Ison, C A
Dual-energy X-ray absorptiometry (DXA) measurement of bone mineral density (BMD) is the reference standard for diagnosing osteoporosis but does not directly reflect deterioration in bone microarchitecture. The trabecular bone score (TBS), a novel grey-level texture measurement that can be extracted from DXA images, predicts osteoporotic fractures independent of BMD. Our aim was to identify clinical factors that are associated with baseline lumbar spine TBS. In total, 29,407 women ?50 yr at the time of baseline hip and spine DXA were identified from a database containing all clinical results for the Province of Manitoba, Canada. Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Multiple linear regression and logistic regression (lowest vs highest tertile) was used to define the sensitivity of TBS to other risk factors associated with osteoporosis. Only a small component of the TBS measurement (7-11%) could be explained from BMD measurements. In multiple linear regression and logistic regression models, reduced lumbar spine TBS was associated with recent glucocorticoid use, prior major fracture, rheumatoid arthritis, chronic obstructive pulmonary disease, high alcohol intake, and higher body mass index. In contrast, recent osteoporosis therapy was associated with a significantly lower likelihood for reduced TBS. Similar findings were seen after adjustment for lumbar spine or femoral neck BMD. In conclusion, lumbar spine TBS is strongly associated with many of the risk factors that are predictive of osteoporotic fractures. Further work is needed to determine whether lumbar spine TBS can replace some of the clinical risk factors currently used in fracture risk assessment. PMID:23452869
Leslie, William D; Krieg, Marc-Antoine; Hans, Didier
Thymic neoplasms constitute a broad category of rare lesions with a wide spectrum of pathologic characteristics and clinical presentations which therefore require a high index of suspicion to diagnose. The natural history of the disease is seldom predictable, anywhere from an indolent to an aggressively malignant course. Although the classification and staging of these lesions are complex and controversial, complete radical surgical resection remains the gold standard of therapy. Radiation and chemotherapy are important elements of the multimodality approach to treating these patients and it is important for thoracic surgeons to work closely with their colleagues in other disciplines in the management of and future research endeavors in thymic neoplasm. In this review, we discuss the evaluation of the patient with an anterior mediastinal mass, the classification and staging of thymic neoplasms, the role of surgery, radiation and chemotherapy in treating this disease, as well as future directions in research for novel targeted therapies. PMID:23585946
Rashid, Omar M; Cassano, Anthony D; Takabe, Kazuaki
Cytotoxic lymphomas comprise a spectrum of peripheral T-cell lymphomas that can have a initial or late cutaneous presentation. We describe a 46-year-old man from Cape Verde, with a dermatosis involving his face and trunk, consisting of monomorphic papules with a smooth surface and both motor and sensory polyneuropathy.The hypothesis of leprosy was supported by the clinical and initial hystopathological findings and the patient was referred to our hospital with suspected Hansen's disease. In the new skin and lymph node biopsies a lymphocyte population was identified whose immunohystochemistry study allowed the diagnosis of T-cell lymphoma with expression of cytotoxic markers. The patient was started on chemotherapy with initial remission of the skin lesions but, subsequently, progression of systemic disease.
Maio, Paula; Bento, Diogo; Vieira, Raquel; Afonso, Ana; Sachse, Fernanda; Kutzner, Heinz
Cytotoxic lymphomas comprise a spectrum of peripheral T-cell lymphomas that can have a initial or late cutaneous presentation. We describe a 46-year-old man from Cape Verde, with a dermatosis involving his face and trunk, consisting of monomorphic papules with a smooth surface and both motor and sensory polyneuropathy.The hypothesis of leprosy was supported by the clinical and initial hystopathological findings and the patient was referred to our hospital with suspected Hansen's disease. In the new skin and lymph node biopsies a lymphocyte population was identified whose immunohystochemistry study allowed the diagnosis of T-cell lymphoma with expression of cytotoxic markers. The patient was started on chemotherapy with initial remission of the skin lesions but, subsequently, progression of systemic disease. PMID:23739711
Maio, Paula; Bento, Diogo; Vieira, Raquel; Afonso, Ana; Sachse, Fernanda; Kutzner, Heinz
Twelve patients with cor triatriatum have been seen at our institution since 1979. The clinical presentation, diagnostic evaluation, and surgical results are outlined in this retrospective review. Operation is the treatment of choice for this rare congenital cardiac defect. One patient died 1 day before scheduled operation, and 2 patients died postoperatively, yielding a surgical mortality rate of 17% and an overall mortality rate of 25%. Resection of the obstructing atrial membrane was performed using hypothermic cardiopulmonary bypass in all cases. Left atriotomy was performed in 6 patients, and right atriotomy was performed in 7. The two postoperative deaths occurred in patients who had serious associated cardiac defects. Associated anomalies include atrial septal defect, persistent left superior vena cava, and partial anomalous pulmonary venous return. The postoperative course has been excellent in all 9 surviving patients; all remain asymptomatic. Cor triatriatum is amenable to surgical repair with excellent results when diagnosed early and when not complicated by other severe cardiac anomalies. PMID:2222044
Rodefeld, M D; Brown, J W; Heimansohn, D A; King, H; Girod, D A; Hurwitz, R A; Caldwell, R L
Trichotillomania (TTM), or compulsive hair pulling, is a disorder that typically onsets in childhood. It is mistaken to believe that children will "age out" of this behavior, as pediatric TTM often has a chronic, debilitating course that does not remit without treatment, resulting in considerable psychological and physical impairment. Because most children with TTM will be seen initially by nursing professionals in the practices of dermatologists, pediatricians, gastroenterologists, and other disciplines, raising nurses' awareness of this disorder is of the utmost importance for accurate nursing diagnosis and assessment. As the health care providers who spend the greatest amount of time with patients, nurses' detection and diagnosis of TTM can make a critical difference in the initiation of early intervention. Therefore, the purpose of this article is to provide an overview of pediatric TTM, including its epidemiology, clinical presentation, and treatment options, from the perspective of nurses who may interact with such patients in their workplace. PMID:22525810
Labouliere, Christa D; Storch, Eric A
We show that in a locally lambda-presentable category, every lambda(m)-injectivity class (i.e., the class of all the objects injective with respect to some class of lambda-presentable morphisms) is a weakly reflective subcategory determined by a functorial weak factorization system cofibrantly generated by a class of lambda-presentable morphisms. This was known for small-injectivity classes, and referred to as the \\
Intraorbital foreign bodies usually occur after a high velocity injury such as gunshot or industrial accidents; more rarely they occur following trivial trauma. A retained foreign body can give rise to serious complications, the most devastating of which is loss of the eye. This retrospective, interventional case report reviews the clinical features, radiological appearance and surgical management of two patients who presented at Sultan Qaboos University Hospital, Oman with intraorbital foreign bodies. Details of ocular history, preoperative ocular examination findings including visual acuity, surgical procedure and subsequent management were noted. The two patients, aged 10 years and 9 years old respectively, sustained orbital trauma with sharp objects. Both patients were found to have intraorbital foreign bodies that were documented clearly by computed tomography (CT) scans of the orbit. The first patient presented straight after injury, had no ocular involvement, underwent immediate surgical exploration and ended up with full recovery. The second patient presented to us after a delay of 4 days, and was found to have endophthalmitis. This patient ultimately lost all visual function in the affected eye. A CT scan is the modality of choice for orbital foreign body detection and localization. Early surgical exploration and foreign body extraction greatly influence the visual prognosis and final outcome. PMID:21654960
Al-Mujaini, Abdullah; Al-Senawi, Rana; Ganesh, Anuradha; Al-Zuhaibi, Sana; Al-Dhuhli, Humoud
This study was conducted to determine the causes and clinical presentations of osteomalacia/rickets in adolescents seen at the King Abdulaziz Medical City (KAMC), Riyadh. Because osteomalacia and rickets constitute the same entity, the term osteomalacia will be used for future discussion. A retrospective file review was performed on all adolescents (10-16 years) with osteomalacia, defined as alkaline phosphatase levels ?500 IU/L, seen at the KAMC, Riyadh, from 2000 to 2006. We recorded the signs and symptoms, dietary history and amount of sun exposure at presentation. A total of 135 patients were found to fit the inclusion criteria for the study. Of them, 57 had nutritional causes, with a mean age of 13.2 years, and included 32 females. At diagnosis, 22 patients were found to have bone pain, 10 had bone deformities, eight had pathological fractures and 17 were asymptomatic. Secondary causes for osteomalacia were found in 59 cases who had liver and renal disease and in 19 other patients who were on medications such as anticonvulsants and steroids, which are known to cause osteomalacia. Our study indicates that osteomalacia is a significant health burden that deserves special attention. Bone pain is the most common presenting symptom at diagnosis. Because of the high risk of osteomalacia associated with the use of anticonvulsants and steroids, it is advised that all patients on these drugs should be routinely screened for secondary osteomalacia. PMID:24029258
Hazzazi, Mohammad A; Alzeer, Ibrahim; Tamimi, Waleed; Al Atawi, Mohsen; Al Alwan, Ibrahim
This is an interesting case series on a very common genetic condition which are often diagnosed late as clinical signs are inconspicuous. We would like to highlight the principal clinical examination finding which led to diagnosis.
Sukumaran, Anju; Buchlis, John
Femoroacetabular impingement (FAI) is considered a cause of labrochondral disease and secondary osteoarthritis. Nevertheless,\\u000a the clinical syndrome associated with FAI is not fully characterized. We determined the clinical history, functional status,\\u000a activity status, and physical examination findings that characterize FAI. We prospectively evaluated 51 patients (52 hips)\\u000a with symptomatic FAI. Evaluation of the clinical history, physical exam, and previous treatments
John C. Clohisy; Evan R. Knaus; Devyani M. Hunt; John M. Lesher; Marcie Harris-Hayes; Heidi Prather
Introduction The purpose of this case report is to describe the clinical presentation, examination findings, and management decisions of a patient with thoracic myelopathy who presented to a chiropractic clinic. Case Report/Methods After receiving a diagnosis of a diffuse arthritic condition and kidney stones based on lumbar radiograph interpretation at a local urgent care facility, a 45-year-old woman presented to an outpatient chiropractic clinic with primary complaints of generalized low back pain, bilateral lower extremity paresthesias, and difficulty walking. An abnormal neurological examination result led to an initial working diagnosis of myelopathy of unknown cause. The patient was referred for a neurological consult. Results Computed tomography revealed severe multilevel degenerative spondylosis with diffuse ligamentous calcification, facet joint hypertrophy, and disk protrusion at T9-10 resulting in midthoracic cord compression. The patient underwent multilevel spinal decompressive surgery. Following surgical intervention, the patient reported symptom improvement. Conclusion It is important to include a neurologic examination on all patients presenting with musculoskeletal complaints, regardless of prior medical attention. The ability to recognize myelopathy and localize the lesion to a specific spinal region by clinical examination may help prioritize diagnostic imaging decisions as well as facilitate diagnosis and treatment.
Gay, Charles W.; Bishop, Mark D.; Beres, Jacqueline L.
PurposeThe oral case presentation is an essential part of clinical medicine, but teaching medical students to present clinical data remains difficult. Presentation skills depend on the ability to obtain, process, and organize patient data. Clinical reasoning is fundamental to the development of these skills. We compared a clinical reasoning curriculum with standard ward instruction for improving presentation skills and clinical
Jeff Wiese; Paul Varosy; Lawrence Tierney
Osteosarcoma (OS) is a malignant mesenchymal tumor, which rarely occurs in the maxilla. Although variable histologic and radiographic features of OS have been reported previously, in the majority of the cases painful swelling of the jaw is mentioned as the first clinical presentation. Furthermore, early diagnosis and wide surgical resection of the tumor are the most important determinant factors of prognosis. Therefore, the unusual clinical presentations of OS should be considered meticulously to expedite the diagnosis process. We describe a case of OS of the maxilla with extremely unusual presenta-tion in a 42-year-old female, that was initially designated as “epulis fissuratum”. Here, we highlight the importance of com-bining the clinical, radiographic and histopathologic examination to obtain a definitive diagnosis and also the significance ofearly effective surgical intervention in evaluation of pathologic lesions.
Amini Shakib, Pouyan; Foroughi, Ramin; Seyedmajidi, Maryam
(Full text is available at http://www.manu.edu.mk/prilozi). The University Clinic of Toxicology (UCT) in Skopje was founded as the Clinic for Toxicology and Emergency Internal Medicine on January 15th 1976. Today UCT has a modern building with office space of 1,300 m(2) on 4 floors, 40 hospital beds and 72 employees including 18 doctors. UCT works in accordance with the public healthcare services in the Republic of Macedonia through the use of specialist / consultative and hospital healthcare for people over the age of 14 years. The Clinic also provides services in the field of emergency internal medicine, acute poisoning with medications, pesticides, corrosives, poisonous gases and mus-hrooms, heavy metals and other chemicals. The Clinic takes an active part in the detoxification programme for users of opiates and psychotropic substances, protocols for enteral and parenteral nutrition and guides for home treatment. Yearly there are more than 14,000 ambulance admissions, over 1,400 hospitalized patients, over 4,000 urgent EHO checks, more than 1,000 urgent upper endoscopies and over 700 other toxicological analyses and other interventions. The educational services and activities are realized through the chair for internal medicine. The Clinic offers undergraduate and graduate level education for medical students and dentists, for medical nurses, radiology technicians, speech therapists and physiotherapists. Over 300 papers and reports have been published to date by the medical staff at the UCT in the form of abstracts and integrated projects in the Republic of Macedonia and aboard. 8 doctorates have been successfully completed by employees from the Clinic as well as 4 master's theses and 1 in-depth project. UCT employees are the authors of some textbooks and monographs. UCT have undertaken some scientific projects. Employees from the Clinic of Toxicology are members taking an active part in many domestic and international associations. Key words: Toxicology Clinic, historical note, healthcare, education, research. PMID:23928801
Purpose: We compare patient populations attending chiropractors in the field to those in teaching clinics to allow educational institutions to determine if students are exposed to a similar case mix. The purpose of our study was to describe and compare descriptively the clinical case mix of a recently opened community-based teaching clinic to previously published practice data. Methods: A retrospective descriptive cross-sectional study was conducted using new patient records completed at a clinic. Data were extracted using a specifically designed abstraction form. Results: We manually abstracted 649 files. A total of 580 new patient files was included in the analysis, among which 57.7% included female patients with a mean age of 43 years (SD 18), and 42.1% presented with a chief complaint of more than one year in duration. The vast majority of patients complained of spinal pain (81.4%), most commonly low back pain. Almost 92% of the diagnoses were classified as simple (sprain/strain). The average number of visits per patient was 7.4 (SD 11.3); 54.7% received spinal manipulation on their first visit. The majority of patients were referred by the treating intern (64.8%) and about 24% of patients were local residents. Conclusions: Our study contributed to the few studies detailing patients attending chiropractic academic teaching clinics. It provided benchmark demographic and clinical data that may be used for operational planning. Our study suggested that the case mix of this teaching clinic provides interns with appropriate learning opportunities to achieve entry to practice competencies.
Lishchyna, Natalia; Mior, Silvano
The clinical characteristics of nail changes in seven patients receiving taxane-containing chemotherapy are described. They include nail pigmentation, subungual hematoma, Beau's lines and onycholysis and subungual suppuration. The incidence of such changes (ranging from 0% to 44%) is reviewed from a Medline search of the literature. PMID:12562663
Minisini, A M; Tosti, A; Sobrero, A F; Mansutti, M; Piraccini, B M; Sacco, C; Puglisi, F
The author, a co-founder and the Director of the Gender & Sexuality Psychosocial Program at Children's National Medical Center in Washington, D.C., discusses clinical issues and interventions for prepubertal children with atypical gender development. He describes developmental issues related to concepts of gender for preadolescent children. The importance of working within the family system and helping the family to accept
To ascertain the factors linked to invasive pneumococcal disease (IPD) caused by the different serotypes in the period 2007-2009, following the conjugate vaccine's inclusion in the childhood vaccination schedule, a total of 2013 IPD cases were reviewed. The mean annual incidence in this period was 10.74 cases per 100,000 inhabitans and the lethality was 8.8%. Overall serotype distribution displayed certain peculiarities, such as the high frequency of serotype 5. Serotype 3, male gender, sepsis and presence of risk factors were significantly associated with lethality. Vaccinated children under 5 years of age had a higher risk of disease due to serotype 19A. Serotype 8 was associated with the presence of underlying risk factors. PMID:21683112
Rodríguez, M Angeles Gutiérrez; González, Amai Varela; Gavín, María Ascensión Ordobás; Martínez, Fernando Martín; Marín, Natividad García; Blázquez, Belén Ramos; Moreno, Juan Carlos Sanz
Glioblastoma is found preferentially in men (1.5/1), nearing age 60, but all ages can be concerned. Clinical symptoms are intracranial mass without specificity, intracranial hypertension and localization signs. From the clinical history, the essential prognosis factors are: age, Karnofsky score and cognitive dysfunction. Conventional MRI sequences, including T1-FSE with and without contrast injection and T2-FSE or Flair-weighted sequences, provide the diagnosis in most cases, showing an intraparenchymal mass with a heterogeneous, irregularly enhanced signal. Other sequences define the tumor more precisely. Diffusion sequences provide the differential diagnosis with an abscess or a highly cellular tumor such as lymphoma. Perfusion sequences allow appreciation of tumor microvascularization outlining the tumor's most active areas. Magnetic resonance spectroscopy (SRM) sequences allow noninvasive exploration of tumor metabolism. Beyond its diagnostic role, imagery assists the surgical procedure itself, particularly with functional MRI, allowing a precise preoperative mapping of functional cortical areas. Biopsy can also be guided toward the most active areas of the tumor. In the postoperative period, MRI completes the surgeon's impression on whether or not there is residual tumor. Finally, this exam has become essential in follow-up to diagnose recurrence, radionecrosis, or pseudoprogression. PMID:20870253
Lonjon, M; Mondot, L; Lonjon, N; Chanalet, S
AIMTo estimate the accurate incidence and prevalence of permanent neonatal diabetes mellitus, and to determine the clinical profile of this condition in the Sultanate of Oman.METHODSAll children diagnosed as having permanent neonatal diabetes mellitus between 1991 and 1995 in Oman were included in the study.RESULTSThe mean incidence was 2.2 per 100 000 live births\\/year and the prevalence among under 5s
Bhasker Bappal; Palany Raghupathy; Vasantha de Silva; Saleh Mohamed Al Khusaiby
Mindfulness-based psychotherapies are increasingly found in the evidence-based practice realm of clinical social work. This\\u000a paper provides an understanding of the concept of mindfulness as well as the research into the neurological and behavioral\\u000a benefits of mindfulness skills training. Mindfulness skills training is explored as both the foundation of specific therapy\\u000a protocols and as a method to foster clinician attention,
Alzheimer’s disease (AD) is an incurable neurodegenerative disorder that produces cognitive impairments that increase in severity as the disease progresses. The clinical symptoms are related to the presence of neuritic plaques and neurofibrillary tangles in the cerebral cortex which represent the pathophysiological hallmarks of AD. The debilitating nature of the disease can result in clinical burden for the patient, emotional strain for those that care for patients with Alzheimer’s, and significant financial burden to society. The goals of current treatments, such as cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonist, are to reduce the severity or slow the progression of cognitive symptoms. Although these treatments have demonstrated modest clinical benefit, they are unable to prevent, prohibit, or reverse the underlying pathophysiology of AD. Considerable progress has been made toward the development of disease-modifying treatments. Treatments currently under development mainly target the production, aggregation, and removal of existing amyloid ?-peptide aggregates which are believed to instigate the overall development of the neuropathology. Additional strategies that target tau pathology are being studied to promote neural protection against AD pathology. The current research has continued to expand our knowledge toward the development of disease modifying Alzheimer’s therapies; however, no specific treatment strategy capable of demonstrating empirical efficacy and safety has yet to emerge.
Husain, Mustafa M; Trevino, Kenneth; Siddique, Haroon; McClintock, Shawn M
Ear and nose foreign bodies are common problems affecting the children but adults are not an exception. A prospective study\\u000a involving 87 patients is undertaken concentrating on presentation of patients with various types of ear or nasal foreign bodies.\\u000a In the present study common presenting complaints and uncommon presentation scenarios encountered by us like a nasal foreign\\u000a body with intra
Prayaga N. Srinivas Moorthy; Madhira Srivalli; Goli V. S. Rau; Codadu Prasanth
Brucellosis is a zoonotic infection and has endemic characteristics. Neurobrucellosis is an uncommon complication of this infection. The aim of this study was to present unusual clinical manifestations and to discuss the management and outcome of a series of 18 neurobrucellosis cases. Initial clinical manifestations consist of pseudotumor cerebri in one case, white matter lesions and demyelinating syndrome in three cases, intracranial granuloma in one case, transverse myelitis in two cases, sagittal sinus thrombosis in one case, spinal arachnoiditis in one case, intracranial vasculitis in one case, in addition to meningitis in all cases. Eleven patients were male and seven were female. The most prevalent symptoms were headache (83%) and fever (44%). All patients were treated with rifampicin, doxycycline plus trimethoprim-sulfamethoxazole or ceftriaxone. Duration of treatment (varied 3-12 months) was determined on basis of the CSF response. In four patients presented with left mild sequelae including aphasia, hearing loss, hemiparesis. In conclusion, although mortality is rare in neurobrucellosis, its sequelae are significant. In neurobrucellosis various clinical and neuroradiologic signs and symptoms can be confused with other neurologic diseases. In inhabitants or visitors of endemic areas, neurobrucellosis should be kept in mind in cases that have unusual neurological manifestations. PMID:21412590
Ceran, Nurgul; Turkoglu, Recai; Erdem, Ilknur; Inan, Asuman; Engin, Derya; Tireli, Hulya; Goktas, Pasa
Objectives Jugular foramen paraganglioma is a locally invasive, benign tumor, which grow slowly and causes various symptoms such as pulsatile tinnitus and low cranial nerve palsy. Complete surgical resection is regarded as the ideal management of these tumors. The goal of this study is to identify the clinical characteristics and most effective surgical approach for jugular foramen paraganglioma. Methods Retrospective analysis of 9 jugular foramen paraganglioma patients who underwent surgical resection between 1986 and 2005 was performed. Clinical records were reviewed for analysis of initial clinical symptoms and signs, audiological examinations, neurological deficits, radiological features, surgical approaches, extent of resection, treatment outcomes and complications. Results Most common initial symptom was hoarseness, followed by pulsatile tinnitus. Seven out of 9 patients had at least one low cranial nerve palsy. Seven patients were classified as Fisch Type C tumor and remaining 2 as Fisch Type D tumor on radiologic examination. Total of 11 operations took place in 9 patients. Total resection was achieved in 6 cases, when partial resection was done in 3 cases. Two patients with partial resection received gamma knife radiosurgery (GKS), when remaining 1 case received both GKS and two times of revision operation. No mortality was encountered and there were few postoperative complications. Conclusion Neurologic examination of low cranial nerve palsy is crucial since most patients had at least one low cranial nerve palsy. All tumors were detected in advanced stage due to slow growing nature and lack of symptom. Angiography with embolization is crucial for successful tumor removal without massive bleeding. Infratemporal fossa approach can be considered as a safe, satisfactory approach for removal of jugular foramen paragangliomas. In tumors with intracranial extension, combined approach is recommended in that it provides better surgical view and can maintain the compliance of the patients.
Chung, Sa Myung; Kim, Hyun Su; Jung, Jinsei; Lee, Ho-Ki
Synthetic cannabinoids are relatively novel substances of abuse. The use of these compounds among adolescents and young adults has been increasing, making it important for pediatric providers to be familiar with the presenting signs and symptoms of intoxication. We describe three case presentations of reported synthetic cannabinoid intoxication and provide a brief discussion of these compounds. PMID:22430444
Cohen, Joanna; Morrison, Sephora; Greenberg, Jeffrey; Saidinejad, Mohsen
Although tetanus is a well-recognised, well-described, preventable and eradicable infection, it continues to ravage the lives of children in developing countries, especially among neonates. A cross-sectional review of cases of neonatal tetanus seen in LUTH was carried out retrospectively. Thirty-nine (39) cases were studied, comprising 26 (63.4%) males and 15 (36.6%) females, giving a male: female ratio of 1.6:1. Case fatality rate was 10.3%, thirty-five (89.7%) cases survived, of which nine (23.8%) survived with complications. Clinical factors that influence outcome were: a short interval between onset and presentation (p = 0.03), low tetanus score below 6.0 (p = 0.002), hyperpyrexia (p = 0.0001), heart failure (p = 0.035), cyanosis (p = 0.008) and crepitations (p = 0.003). Although several management factors were associated with mortality, these failed to meet statistical significance (p > 0.05). In this study, clinical factors, including presentation interval, were the principal determinants of outcome. The need for intensification and sustenance of preventive measures, early recognition and presentation, prompt treatment as well as improved care are emphasised. We recommend periodic audit of patient clinical data towards improving quality of care. PMID:14567043
Okoromah, C N; Lesi, F E; Egri-Okwaji, M T; Iroha, E
A case of painless isolated extraocular muscle sarcoid and a literature review are presented. The atypical features in our case include a lack of overt inflammatory symptoms and signs, such as pain, ptosis, and diplopia. The presentation of minimal symptoms without improvement warrant a biopsy to establish the diagnosis and to administer appropriate treatment in order to prevent potential long-term complications from sarcoidosis.
So, Wing Lung Alvin; Hardy, Thomas G.; McKelvie, Penelope
A boy with agminated spindle cell nevi is described. Present within the area of involvement were congenital nevocellular and composite spindle/nevocellular nevi. Other unusual features included a dynamic pattern of growth and regression of the lesions, with the presence of halo nevi and background café au lait pigmentation. This unique presentation of multiple nevi is discussed in the context of previous reports of agminated spindle cell nevi. PMID:6863631
Lancer, H A; Muhlbauer, J E; Sober, A J
This review describes the symptomatic presentation of schizophrenia with onset in childhood. Phenomenologic data from an original sample of 35 children with onset before the age of 12, from the University of California, Los Angeles (UCLA) Childhood-Onset Schizophrenia Research Program, are presented and compared with similar data from two other major studies. Similarities and differences between childhood-onset and adult-onset forms
Andrew T. Russell
Portopulmonary hypertension affects up to 6% of patients with advanced liver disease, but the predictors and biologic mechanism for the development of this complication are unknown. We sought to determine the clinical risk factors for portopulmonary hypertension in patients with advanced liver disease. We performed a multicenter case-control study nested within a prospective cohort of patients with portal hypertension recruited from tertiary care centers. Cases had a mean pulmonary artery pressure >25 mm Hg, pulmonary vascular resistance >240 dynes · second · cm?5, and pulmonary capillary wedge pressure ? 15 mm Hg. Controls had a right ventricular systolic pressure < 40 mm Hg (if estimable) and normal right-sided cardiac morphology by transthoracic echocardiography. The study sample included 34 cases and 141 controls. Female sex was associated with a higher risk of portopulmonary hypertension than male sex (adjusted odds ratio =2.90, 95% confidence interval 1.20-7.01, P = 0.018). Autoimmune hepatitis was associated with an increased risk (adjusted odds ratio = 4.02, 95% confidence interval 1.14-14.23, P = 0.031), and hepatitis C infection was associated with a decreased risk (adjusted odds ratio =0.24, 95% confidence interval 0.09-0.65, P =0.005) of portopulmonary hypertension. The severity of liver disease was not related to the risk of portopulmonary hypertension. Conclusion Female sex and autoimmune hepatitis were associated with an increased risk of portopulmonary hypertension, whereas hepatitis C infection was associated with a decreased risk in patients with advanced liver disease. Hormonal and immunologic factors may therefore be integral to the development of portopulmonary hypertension.
Kawut, Steven M.; Krowka, Michael J.; Trotter, James F.; Roberts, Kari E.; Benza, Raymond L.; Badesch, David B.; Taichman, Darren B.; Horn, Evelyn M.; Zacks, Steven; Kaplowitz, Neil; Brown, Robert S.; Fallon, Michael B.
The scleroderma (literally, hard skin), or progressive systemic sclerosis (PSS), is a multisystem disease and can present various anaesthetic problems. The anaesthesist should be aware of the difficulty in opening mouth wide enough for laryngoscopy and intubation, the possibility that cardiopulmonary changes may be present and the probability of lesions in oesophagus, bowel, kidneys, skin and joints. In this article the authors describe the anesthetic management of a patient with Thibierge-Weissenbach syndrome (scleroderma with calcinosis cutis) and explore potential problems that should be anticipated by the anesthesiologist. PMID:2943098
D'Eramo, C; Zuccoli, P; Monica, M; Stocchetti, N; Volta, F; Scandellari, R
Amphetamine was discovered over 100 years ago. Since then, it has transformed from a drug that was freely available without prescription as a panacea for a broad range of disorders into a highly restricted Controlled Drug with therapeutic applications restricted to attention deficit hyperactivity disorder (ADHD) and narcolepsy. This review describes the relationship between chemical structure and pharmacology of amphetamine and its congeners. Amphetamine's diverse pharmacological actions translate not only into therapeutic efficacy, but also into the production of adverse events and liability for recreational abuse. Accordingly, the balance of benefit/risk is the key challenge for its clinical use. The review charts advances in pharmaceutical development from the introduction of once-daily formulations of amphetamine through to lisdexamfetamine, which is the first d-amphetamine prodrug approved for the management of ADHD in children, adolescents and adults. The unusual metabolic route for lisdexamfetamine to deliver d-amphetamine makes an important contribution to its pharmacology. How lisdexamfetamine's distinctive pharmacokinetic/pharmacodynamic profile translates into sustained efficacy as a treatment for ADHD and its reduced potential for recreational abuse is also discussed. PMID:23539642
Heal, David J; Smith, Sharon L; Gosden, Jane; Nutt, David J
Leishmaniasis is a disease with worldwide increasing incidence, which in Germany is almost exclusively observed in patients who have travelled to classical endemic regions such as the Mediterranean basin. Cause of the disease is an infection with protozoan parasites of the genus Leishmania, which are transmitted by sand flies and replicate intracellularly within mammalian hosts. Depending on the inoculated parasite (sub-) species and the immune status of the host, a local cutaneous, diffuse cutaneous, mucocutaneous or visceral form of leishmaniasis will develop. Cutaneous leishmaniasis, which frequently appears only weeks after the bite of a sand fly, starts with the formation of a papule, which subsequently can turn into a skin ulcer. The latter may heal spontaneously after months leaving behind a scar or persist as chronic, non-healing cutaneous leishmaniasis. If cutaneous leishmaniasis is suspected, a sterile skin biopsy followed by appropriate diagnostic measures in a specialized laboratory to identify the pathogen should be performed. For the decision on the type of therapy, several clinical parameters (e.g. number and localization of lesions, immune status) and, most importantly, the underlying parasite (sub-) species need to be considered. Therapy can consist of a variety of topical measures or systemic drug treatment. A modern and safe vaccine does not yet exist. PMID:22422121
von Stebut, E; Schleicher, U; Bogdan, C
Ehlers Danlos syndrome type IV is an often lethal disease caused by various mutations of type III collagen genes. It presents in infancy and childhood in several ways, and the symptoms and signs include low birth weight, prematurity, congenital dislocation of the hips, easy inappropriate bruising (sometimes suspected as child battering), and a diagnostic facial phenotype. These features predict a
F M Pope; P Narcisi; A C Nicholls; M Liberman; J W Oorthuys
The diagnosis of cystic fibrosis (CF) is based on the occurrence of two mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene and on assays that measure the basic defect of abnormal chloride transport in the affected organs. However, in cases of atypical CF not all diagnostic tests may be positive. We present a patient with an atypical CF
Inez Bronsveld; Jan Bijman; Frauke Mekus; Manfred Ballmann; Henk J Veeze; Burkhard Tümmler
The watermelon stomach syndrome is an increasingly recognized cause of persistent acute or occult gastrointestinal bleeding, typically in elderly women. This disorder often presents with severe iron deficiency anemia, and a variety of associated conditions including autoimmune disease, cirrhosis, achlorhydria, and hypochlorhydria. Diagnosis is made by the characteristic endoscopic appearance of visible linear watermelon-like vascular stripes in the antrum. Histology
Jeffrey E. Gretz; Sami R. Achem
We present a retrospective review of Hantavirus infection in the emergency department. Thirteen cases of Hantavirus infections with renal syndrome from July 1989 to August 1999 were analysed. The diagnosis was confirmed by detection of Hantavirus antibodies in all cases. Fever, chills and headaches were universally present. Intense back pain was associated in 77% of the patients. Thrombocytopenia, abnormal urinalysis, hypertransaminasaemia, increased lactate dehydrogenase were the principal biological patterns. All these parameters returned to their normal level, and all the patients recovered a normal renal function without sequels. The management is supportive. Only one patient in our series had to be dialysed. Hantavirus disease should be included in the differential diagnosis of acute renal failure with thrombocytopenia, particularly in patients with suspected exposure in known endemic areas. The differential diagnosis of any perplexing case of undifferentiated febrile illness with acute renal failure and thrombocytopenia should include Hantavirus infection. PMID:11314815
Courouble, P; Vanpee, D; Delgrange, E; Donckier, J; Pochet, J M; Gillet, J B
A retrospective case note study was done of children below the age of 14 years who attended Dhoolpet Leprosy Research Centre (DLRC) over the decade 1990-1999. The aim of the study was to describe the pattern of clinical presentation, the role of household or near neighbour contacts and the incidence of neuritis and reactions. In all, 3118 leprosy patients were registered during this period, of whom 306 were children [182 (60%) male]; 95 children had a single patch, 159 had five or fewer than five patches and 37 had multiple patches. The youngest case detected was 9 months old. The spectrum of leprosy in these children was: TT 62 (20.3%); BT 203 (66.3%); BB 3 (1%); BL 23 (7.5%); LL 5 (1.6%) and PNL 10 (3.3%). Twenty-nine cases (9.4%) were smear positive. Ninety-one children (29.7%) developed a reaction, 86 type I and five type II. A history of contact was present in 119 (38.8%) cases, family contact in 113 (95%) and other than family in six (5%). Classification of the contact was available in only 60 patients. Among the contacts of the index case, 21 (35%) suffered from PB leprosy and 39 (65%) from MB leprosy. All contacts were from the immediate family. This study shows that childhood leprosy cases continue to present in significant numbers to this outpatient clinic. There is a high level of family contact with leprosy in these cases, strengthening the strategy of screening children in leprosy-affected households. The high incidence of reactions and nerve damage in children emphasizes the importance of early detection and treatment. PMID:12449890
Jain, S; Reddy, R G; Osmani, S N; Lockwood, D N J; Suneetha, S
We report a 14-year-old boy who presented with loss of consciousness and gait instability. The electroencephalogram (EEG) showed generalized slowing with irregular activity and cerebral magnetic imaging revealed asymmetrical nonspecific signals on basal ganglia. His second electroencephalogram revealed periodical generalized high-voltage slow wave complexes which did not disappear with diazepam induction. Subacute sclerosing panencephalitis (SSPE) was considered and the diagnosis was confirmed with the identification of measles antibodies in cerebrospinal fluid. Our findings show that SSPE should be in mind in the differential diagnosis of meningoencephalitis and acute disseminated encephalomyelitis and highlight the significance of EEG in the diagnosis of unidentified cases. PMID:23248691
Komur, Mustafa; Arslankoylu, Ali E; Okuyaz, Cetin; Kuyucu, Necdet
Plasmablastic lymphoma is a high-grade B-cell lymphoma that poses major diagnostic problems and carries an extremely poor prognosis. This tumor was first described in the oral cavity of HIV+ patients but has since been identified in other sites and in seronegative patients. We describe 2 cases of plasmablastic lymphoma of the urinary tract that both presented with hydronephrosis. One occurred in an HIV+ patient and harbored a MYC translocation; the other, in an HIV- patient with no translocation detected. PMID:21531157
Tille, Jean-Christophe; Pelte, Marie-Françoise; Schwartz, Julien; Dietrich, Pierre-Yves; McKee, Thomas A
Eosinophilic esophagitis (EE) is a relatively new, chronic, TH 2-type allergic inflammation of the esophagus. EE occurs more frequently in men. Allergic diseases such as asthma or atopic dermatitis are present in 50-70 % of patients or their relatives. In adults, the most common presenting symptom of EE is dysphagia, with or without food bolus impaction. Endoscopic findings of EE include mucosal furrows, corrugated or concentric rings or ridges in the esophagus ("feline esophagus"), with or without tiny whitish exudates. The diagnosis is confirmed by the observation of high counts of eosinophils in the esophageal epithelium (at least 24 /HPF). The cornerstones of medical therapy are either topical or systemic corticosteroids. Additional therapies included leukotriene receptor antagonists (montelukast) and IL-5 blockers (Mepolizumab). Complications of EE such as esophageal strictures should be carefully dilated using either bougies or a balloon. Currently it is still not known whether the late complications of EE can be prevented by the use of anti-inflammatory agents and this can only be demonstrated through further long-term follow-up studies. PMID:18080228
von Arnim, U; Mönkemüller, K; Malfertheiner, P; Straumann, A
Objective Although the clinical manifestation and risk factors of cerebral microangiopathy (CM) remain unclear, the number of diagnoses is increasing. Hence, patterns of association among lesion topography and severity, clinical symptoms and demographic and disease risk factors were investigated retrospectively in a cohort of CM patients. Methods Patients treated at the Department of Neurology, University of Bonn for CM (n?=?223; 98m, 125f; aged 77.32±9.09) from 2005 to 2010 were retrospectively enrolled. Clinical symptoms, blood chemistry, potential risk factors, demographic data and ratings of vascular pathology in the brain based on the Wahlund scale were analyzed using Pearson's chi square test and one-way ANOVA. Results Progressive cognitive decline (38.1%), gait apraxia (27.8%), stroke-related symptoms and seizures (24.2%), TIA-symptoms (22%) and vertigo (17%) were frequent symptoms within the study population. Frontal lobe WMLs/lacunar infarcts led to more frequent presentation of progressive cognitive decline, seizures, gait apraxia, stroke-related symptoms, TIA, vertigo and incontinence. Parietooccipital WMLs/lacunar infarcts were related to higher frequencies of TIA, seizures and incontinence. Basal ganglia WMLs/lacunar infarcts were seen in patients with more complaints of gait apraxia, vertigo and incontinence. Age (p?=?.012), arterial hypertension (p<.000), obesity (p<.000) and cerebral macroangiopathy (p?=?.018) were positively related to cerebral lesion load. For increased glucose level, homocysteine, CRP and D-Dimers there was no association. Conclusion This underlines the association of CM with neurological symptoms upon admission in a topographical manner. Seizures and vertigo are symptoms of CM which may have been missed in previous studies. In addition to confirming known risk factors such as aging and arterial hypertension, obesity appears to increase the risk as well. Since the incidence of CM is increasing, future studies should focus on the importance of prevention of vascular risk factors on its pathogenesis.
Okroglic, Sandra; Widmann, Catherine N.; Urbach, Horst; Scheltens, Philip; Heneka, Michael T.
This paper is focused on the factors causing long patient waiting time/clinic overtime in outpatient clinics and how to mitigate them using discrete event simulation. A two-week period of data collection is conducted in an outpatient clinic of a Singapore government hospital. Detailed time study from patient arrival to patient departure is conducted, and the possible factors causing long patient waiting time/clinic overtime are discussed. A discrete simulation model is constructed to illustrate how to improve the clinic performance by mitigating the detected factors. Simulation and implementation results show that significant improvement is achieved if the factors are well addressed. PMID:20703659
Zhu, Zhecheng; Heng, Bee Hoon; Teow, Kiok Liang
Objective Diagnosis of pulmonary embolism (PE) remains difficult and is often missed in the elderly due to nonspecific and atypical presentation. Diagnostic algorithms able to rule out PE and validated in young adult patients may have reduced applicability in elderly patients, which increases the number of diagnostic tools use and costs. The aim of the present study was to analyze the reported clinical presentation of PE in patients aged 65 and more. Materials and Methods Prospective and retrospective English language studies dealing with the clinical, instrumental and laboratory aspects of PE in patients more than 65 and published after January 1987 and indexed in MEDLINE using keywords as pulmonary embolism, elderly, old, venous thromboembolism (VTE) in the title, abstract or text, were reviewed. Results Dyspnea (range 59%–91.5%), tachypnea (46%–74%), tachycardia (29%–76%), and chest pain (26%–57%) represented the most common clinical symptoms and signs. Bed rest was the most frequent risk factor for VTE (15%–67%); deep vein thrombosis was detected in 15%–50% of cases. Sinus tachycardia, right bundle branch block, and ST-T abnormalities were the most frequent ECG findings. Abnormalities of chest X-ray varied (less than 50% in one-half of the studies and more than 70% in the other one-half). Arterial blood gas analysis revealed severe hypoxemia and mild hypocapnia as the main findings. D-Dimer was higher than cut-off in 100% of patients in 75% of studies. Clinical usefulness of D-Dimer measurement decreases with age, although the strategies based on D-Dimer seem to be cost-effective at least until 80 years. Conclusion Despite limitations due to pooling data of heterogeneous studies, our review could contribute to the knowledge of the presentation of PE in the elderly with its diagnostic difficulties. A diagnostic strategy based on reviewed data is proposed.
Masotti, Luca; Ray, Patrick; Righini, Marc; Le Gal, Gregoire; Antonelli, Fabio; Landini, Giancarlo; Cappelli, Roberto; Prisco, Domenico; Rottoli, Paola
Four factors of clinical decision making identified by medical students include quality of care, cost, ethics, and legal concerns. This paper argues that physicians have two responsibilities in the clinical decision-making model: to be the primary advocate for quality health care and to ensure balance among the four factors, working in partnership…
Leist, James C.; Konen, Joseph C.
Acquired hemophilia is a rare disorder that has potentially disastrous consequences if not recognized and treated in the setting of acute hemorrhage. We report a case of undiagnosed acquired hemophilia due to factor VIII inhibitor in which a tongue hematoma was the chief manifestation. Diagnosis, acute management, and long-term therapeutic options are reviewed. PMID:15093846
Wendell, Catherine M; Bellazzini, Marc A; Howes, David S
Wind loads on structures under the buffeting action of wind gusts have traditionally been treated by the “gust loading factor” (GLF) method in most major codes and standards around the world. In this scheme, the equivalent-static wind loading used for design is equal to the mean wind force multiplied by the GLF. Although the traditional GLF method ensures an accurate
Ahsan Kareem; Yin Zhou
Recurrent meningitis secondary to a congenital labyrinthine anomaly is a rare clinical entity, diagnosis of which is dependent upon certain clinical, radiological and intraoperative features. In the following report we describe two children with congenital labyrinthine fistula and recurrent meningitis whose clinical presentation, radiological features and intraoperative findings were dissimilar and thus, illustrative of two different ways of presentation of
V Rupa; V Rajshekhar; Dudley J Weider
The authors present data and information about appoint- ment, tenure, and compensation policies to describe how medical schools are redefining the terms under which they relate to their full-time clinical faculties. First, the authors note the increasing differentiation of clinical fac- ulty members into two groups, researchers and clinicians. The present-day competitive realities of both research and clinical enterprises have
Robert F. Jones; Jennifer S. Gold
Epidemiological studies suggest unique occurrence patterns of Hodgkin lymphoma (HL) worldwide. In most Western countries there is a clear bimodal age distribution with an early peak in young adults followed by a second peak in older adults, particularly among males. In the Middle East and Asia, HL is more common in early childhood. There also are marked racial differences in the presentations of HL and HL subtypes, and particular single nucleotide polymorphisms (SNPs) have been identified as etiological factors suggesting that gene-gene and gene-environment interactions are involved. Personal health choices such as exercise and smoking may modify an individual's chances of developing HL. Numerous studies highlight the impact that exposure to Epstein-Barr virus and other environmental factors have on HL risk. Understanding the relative importance of each of these findings and their links to HL development and survival will help clinical researchers expand curative therapies and create preventative strategies for HL.
Maggioncalda, Alison; Malik, Neha; Shenoy, Pareen; Smith, Melody; Sinha, Rajni; Flowers, Christopher R.
Obsessionality and obsessive-compulsive symptoms have been regarded as important characteristics in the clinical presentation of the eating disorders. In this report, we examined the relation between obsessionality and the clinical presentation and outcome of a sample of eating-disordered patients. Self-rated obsessional symptoms, defined by the obsessive-compulsive subscale of the Symptom Checklist 90 (revised version), were compared with presenting clinical symptomatology,
Jon K. Zubieta; Mark A. Demitrack; Ada Fenick; Dean D. Krahn
OBJECTIVETo evaluate recent changes in the spectrum and clinical presentation of infective endocarditis and to determine predictors of outcome.DESIGNA retrospective case study.METHODSDemographic, clinical, and echocardiographic characteristics were examined in 212 patients who fulfilled the Duke criteria for infective endocarditis between January 1980 and December 1995 to assess changes in clinical presentation and survival.RESULTSClinical presentation and course did not change significantly
R O-M Netzer; E Zollinger; C Seiler; A Cerny
Insight has emerged as a significant treatment outcome predictor in adult obsessive-compulsive disorder (OCD), with some suggesting that OCD with poor insight represents a distinct clinical subtype. Despite its clinical relevance, limited data exist on insight in pediatric OCD patients. The present study investigated the relation between poor insight and clinical characteristics among children and adolescents with OCD (N=78, ages
Vanessa A. Milsom; Lisa J. Merlo; Michael Larson; Gary R. Geffken; Marni L. Jacob; Tanya K. Murphy; Wayne K. Goodman
Introduction. The small renal masses (SRMs) have increased over the past two decades due to more liberal use of imaging techniques. SRMs have allowed discussions regarding their prognostic, diagnosis, and therapeutic approach. Materials and methods. Clinical presentation, incidental diagnosis, and prognosis factors of SRMs are discussed in this review. Results. SRMs are defined as lesions less than 4 cm in diameter. SRM could be benign, and most malignant SMRs are low stage and low grade. Clinical symptoms like hematuria are very rare, being diagnosed by chance (incidental) in most cases. Size, stage, and grade are still the most consistent prognosis factors in (RCC). An enhanced contrast SRM that grows during active surveillance is clearly malignant, and its aggressive potential increases in those greater than 3 cm. Clear cell carcinoma is the most frequent cellular type of malign SRM. Conclusions. Only some SRMs are benign. The great majority of malign SRMs have good prognosis (low stage and grade, no metastasis) with open or laparoscopic surgical treatment (nephron sparing techniques). Active surveillance is an accepted attitude in selected cases.
Sanchez-Martin, F. M.; Millan-Rodriguez, F.; Urdaneta-Pignalosa, G.; Rubio-Briones, J.; Villavicencio-Mavrich, H.
OBJECTIVESWe examined the association between the features of the culprit lesion in coronary artery disease (CAD) and clinical presentation as shown by intravascular ultrasound (IVUS).BACKGROUNDThe association between coronary remodeling pattern and clinical presentation of CAD is unclear.METHODSWe analyzed 125 selected patients who underwent preintervention IVUS. Acute myocardial infarction (AMI) and unstable angina pectoris (UAP) were categorized as an acute coronary
Mamoo Nakamura; Hideo Nishikawa; Sei Mukai; Morimichi Setsuda; Kazuki Nakajima; Hiroya Tamada; Hiroyuki Suzuki; Takahiro Ohnishi; Yutaka Kakuta; Takeshi Nakano; Alan C Yeung
Veterinarians working in several Virginia, USA counties noticed an increase in clinical salmonellosis in cattle herds during 1994. We conducted a case–control study to identify potential risk factors for salmonellosis in cattle herds in this region. The potential impact of exposure to poultry-related factors was of particular interest because of the close proximity of poultry and cattle operations in this
Lorin D Warnick; Lisa M Crofton; Kevin D Pelzer; M. J Hawkins
In view of the growing interest in the influence of cultural factors in psychological assessment, this article critically evaluates assessment issues with Asian American populations. Examined are issues in (a) the extent and symptoms of psychopathology, (b) personality assessment, and (c) face-to-face clinical assessment. It is argued that, without understanding cultural factors, researchers and practi- tioners may draw inappropriate and
David Sue; Stanley Sue
Turcot syndrome (TS) is a rare hereditary disorder clinically characterized by the occurrence of primary tumors of the colon and the central nervous system (CNS). Here we present the case of an 11-year-old boy with a synchronous clinical presentation of both glioblastoma multiforme (GBM) and colonic adenocarcinoma. A molecular genetic study revealed microsatellite instability in the DNA mismatch repair (MMR) gene. This patient ultimately survived for 13 months after clinical presentation. Based on this case study, the synchronous presentation of glioblastoma multiforme and adenocarcinoma of the colon might suggest a shorter survival rate for patients with Turcot syndrome. A literature review complements this paper.
Dipro, Sabiq; Al-Otaibi, Faisal; Alzahrani, Adel; Ulhaq, Anwar; Al Shail, Essam
Most people in the United States who are infected with sexually transmitted diseases (STDs) do not attend STD clinics for treatment in spite of the low-cost efficacious treatment. We asked a clinic and a community sample about perceived benefits and problems of attending an STD clinic. Analyses yielded two treatment-oriented and two socially oriented, factors, which were also expressed in qualitative interviews. Further analyses suggested that treatment-oriented factors were more strongly associated with clinic attendance than were social factors, although respondents were more positive about expected quality of treatment than they were about retaining confidentiality. We suggest that implications of the results favor integrating STD care with other health care. PMID:15476764
Hogben, Matthew; Bloom, Fred; McFarlane, Mary; St Lawrence, Janet S; Malotte, C Kevin
Streptococcus pneumoniae can asymptomatically colonize the nasopharynx and cause a diverse range of illnesses. This clinical spectrum from colonization to invasive pneumococcal disease (IPD) appears to depend on the pneumococcal capsular serotype rather than the genetic background. According to a literature review, serotypes 1, 4, 5, 7F, 8, 12F, 14, 18C, and 19A are more likely to cause IPD. Although serotypes 1 and 19A are the predominant causes of invasive pneumococcal pneumonia, serotype 14 remains one of the most common etiologic agents of non-bacteremic pneumonia in adults, even after 7-valent pneumococcal conjugate vaccine (PCV7) introduction. Serotypes 1, 3, and 19A pneumococci are likely to cause empyema and hemolytic uremic syndrome. Serotype 1 pneumococcal meningitis is prevalent in the African meningitis belt, with a high fatality rate. In contrast to the capsule type, genotype is more closely associated with antibiotic resistance. CC320/271 strains expressing serotype 19A are multidrug-resistant (MDR) and prevalent worldwide in the era of PCV7. Several clones of MDR serotype 6C pneumococci emerged, and a MDR 6D clone (ST282) has been identified in Korea. Since the pneumococcal epidemiology of capsule types varies geographically and temporally, a nationwide serosurveillance system is vital to establishing appropriate vaccination strategies for each country. PMID:23341706
Song, Joon Young; Nahm, Moon H; Moseley, M Allen
The age of new dialysis patients is rapidly increasing. In the present study, we examined clinical presentation in new peritoneal dialysis (PD) patients 80 years of age or older at our hospital. Data were collected from the records of patients newly starting continuous ambulatory PD (CAPD) therapy between January 2005 and July 2010. During that period, 11 patients 80 years of age or older (average age: 83.1 +/- 3.8 years) were introduced to PD therapy. The reason for dialysis was hypertensive nephrosclerosis in 8 patients, and chronic glomerulonephritis, chronic tubulointerstitial nephritis, and an unknown primary disease in 1 patient each; there were no cases of diabetic nephropathy. At dialysis start, average serum creatinine was 6.1 +/- 1.4 mg/dL, arterial wall calcification was found by computed tomography or chest radiography in 10 of 11 patients (90.9%), and aortic or mitral valve calcification, or both, was found by echocardiography in 3 patients (27.3%). By the end of January 2011, 8 patients had died. Average survival after the start of PD was 31.9 +/- 22.3 months. Hypertensive nephrosclerosis, a cause less often seen in younger patients, was the most common primary disease among our elderly dialysis patients. As we previously reported, vascular and valvular calcification are important factors for determining prognosis; however, no significant relationships were observed in the present study, probably because almost all the patients had such calcifications. PMID:22073833
Sueyoshi, Keita; Inoue, Tsutomu; Kojima, Eriko; Sato, Takahiko; Tsuda, Masahiro; Kikuta, Tomohiro; Watanabe, Yusuke; Takane, Hiroshi; Takenaka, Tsuneo; Suzuki, Hiromichi
Computed tomography (CT) is an established technique for detecting shoulder lesions in dogs, however the clinical significance of shoulder CT lesions often remains uncertain. The purposes of this retrospective study were to describe the prevalence of CT lesions in both shoulder joints for 89 dogs presenting with thoracic limb lameness and to compare CT lesions with clinical characteristics. For all included dogs, results of a full orthopedic examination, other diagnostic tests, and signalment data were available in medical records. Multilevel, multivariable logistic regression was used to test clinical significance of the most prevalent CT lesions and determine factors associated with their presence. Computed tomographic lesions were detected in one or both shoulder joints for 51/89 dogs (57.3%). Mineralization of one or more surrounding peri-articular soft-tissue structures was identified in 31.5% of dogs, with supraspinatus muscle/tendon mineralization being the most frequently identified (24.7%). The prevalence of humeral head osteochondrosis was 9 and 21.3% of dogs had shoulder osteoarthritis. Border collies (odds ratio [OR] 9.3; 95% CI 1.39-62.1, P = 0.02) and dogs with shoulder pain (OR 4.3; 95% CI 1.08-17.1, P = 0.04) had increased risk of osteochondrosis lesions. Border collies (OR 8.4; 95% CI 1.27-55.6; P = 0.03) and older animals (OR 1.04; 95% CI 1.02-1.1, P < 0.001) had increased risk of osteoarthritis lesions. Female entire dogs had an increased risk of supraspinatus mineralization lesions (OR 6.8; 95% CI 1.55-29.5, P = 0.01). Findings indicated that shoulder CT lesions are common in dogs with thoracic limb lameness, and that some CT lesions are not associated with shoulder pain. PMID:23594097
Maddox, Thomas W; May, Chris; Keeley, Benjamin J; McConnell, J Fraser
Nuclear factor-kappa B (NF-kappaB)/Rel transcription factors play an important role in the inducible regulation of a variety of genes involved in the inflammatory and proliferative responses of cells. The present study was designed to elucidate the implication of NF-kappaB/Rel in the pathogenesis of atherosclerosis. Activation of the dimeric NF-kappaB complex is regulated at a posttranslational level and requires the release of the inhibitor protein IkappaB. The newly developed mAb alpha-p65mAb recognizes the IkappaB binding region on the p65 (RelA) DNA binding subunit and therefore selectively reacts with p65 in activated NF-kappaB. Using immunofluorescence and immunohistochemical techniques, activated NF-kappaB was detected in the fibrotic-thickened intima/media and atheromatous areas of the atherosclerotic lesion. Activation of NF-kappaB was identified in smooth muscle cells, macrophages, and endothelial cells. Little or no activated NF-kappaB was detected in vessels lacking atherosclerosis. Electrophoretic mobility shift assays and colocalization of activated NF-kappaB with NF-kappaB target gene expression suggest functional implications for this transcription factor in the atherosclerotic lesion. This study demonstrates the presence of activated NF-kappaB in human atherosclerotic tissue for the first time. Atherosclerosis, characterized by features of chronic inflammation and proliferative processes, may be a paradigm for the involvement of NF-kappaB/Rel in chronic inflammatory disease.
Brand, K; Page, S; Rogler, G; Bartsch, A; Brandl, R; Knuechel, R; Page, M; Kaltschmidt, C; Baeuerle, P A; Neumeier, D
Previous exploratory factor analyses (EFA) of the Wechsler Memory Scale-Revised (WMS-R) have yielded highly disparate factor structures, while the few reported confirmatory factor analyses (CFA) of this instrument have been more consistent. The present study employed a CFA approach to identify the factor structure of the WMS-R in a mixed clinical sample of 306 patients, the majority of whom had
John L. Woodard
This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update\\u000a Sessions during the Late Breaking Clinical Trial Sessions at the 60th annual meeting of the American College of Cardiology\\u000a in New Orleans, USA, from 2nd April to 5th April 2011. This article gives an overview on a number of novel clinical trials
K. Walenta; J. M. Sinning; N. Werner; M. Böhm
Although, in the course of the last 50 years, the achievements in the medical field have been aston- ishing, at the beginning of the third millennium a number of clinical pictures are still left with- out a precise nosographic origin. In the past, the delay in scientific communication was the main explanation presented for the lack of understanding of clinical
Andrea A. Conti; Antonio Conti; Marco Masoni; Gian Franco Gensini
A retropharyngeal internal carotid artery is considered a rare anatomic variant with clinical implications. We present a 73-year-old woman with asymptomatic left carotid stenosis, in whom we elected to proceed with medical treatment. An evaluation of her computed tomography angiography scan revealed a retropharyngeal internal carotid artery. This case report outlines this rare entity and highlights its clinical significance. PMID:23988542
Mousa, Albeir Y; Aburahma, Ali F
BACKGROUND: Legionella species cause severe forms of pneumonia with high mortality and complication rates. Accurate clinical predictors to assess the likelihood of Legionella community-acquired pneumonia (CAP) in patients presenting to the emergency department are lacking. METHODS: We retrospectively compared clinical and laboratory data of 82 consecutive patients with Legionella CAP with 368 consecutive patients with non-Legionella CAP included in two
Rico Fiumefreddo; Roya Zaborsky; Jeannine Haeuptle; Mirjam Christ-Crain; Andrej Trampuz; Ingrid Steffen; Reno Frei; Beat Müller; Philipp Schuetz
Despite the clinical importance of gender effects on symptom patterns and comorbidity patterns in alcoholics, little is known about such effects in treatment facilities other than alcoholism treatment centers. This study evaluated the effect of gender on the clinical profile of 604 alcoholics who presented for initial evaluation and treatment at a psychiatric hospital. It demonstrated that major depression and
Jack R Cornelius; Patricia J Jarrett; Michael E Thase; Horacio Fabrega; Gretchen L Haas; Amy Jones-Barlock; Juan E Mezzich; Richard F Ulrich
Since the mid-1990s, the focus of studies on tooth wear has steadily shifted from the general condition towards the more specific area of dental erosion; equally, a shift has occurred from studies in adults to those in children and adolescents. During this time, understanding of the condition has increased greatly. This paper attempts to provide a critical overview of the development of this body of knowledge, from earlier perceptions to the present. It is accepted that dental erosion has a multifactorial background, in which individual and lifestyle factors have great significance. Notwithstanding methodological differences across studies, data from many countries confirm that dental erosion is common in children and young people, and that, when present, it progresses rapidly. That the condition, and its ramifications, warrants serious consideration in clinical dentistry, is clear. It is important for the oral healthcare team to be able to recognize its early signs and symptoms and to understand its pathogenesis. Preventive strategies are essential ingredients in the management of patients with dental erosion. When necessary, treatment aimed at correcting or improving its effects might best be of a minimally invasive nature. Still, there remains a need for further research to forge better understanding of the subject.
Johansson, Ann-Katrin; Omar, Ridwaan; Carlsson, Gunnar E.; Johansson, Anders
Background Temporomandibular disorder (TMD) patients might present a number of concurrent clinical diagnoses that may be clustered according to their similarity. Profiling patients’ clinical presentations can be useful for better understanding the behavior of TMD and for providing appropriate treatment planning. The aim of this study was to simultaneously classify symptomatic patients diagnosed with a variety of subtypes of TMD into homogenous groups based on their clinical presentation and occurrence of comorbidities. Methods Clinical records of 357 consecutive TMD patients seeking treatment in a private specialized clinic were included in the study sample. Patients presenting multiple subtypes of TMD diagnosed simultaneously were categorized according to the AAOP criteria. Descriptive statistics and two-step cluster analysis were used to characterize the clinical presentation of these patients based on the primary and secondary clinical diagnoses. Results The most common diagnoses were localized masticatory muscle pain (n?=?125) and disc displacement without reduction (n?=?104). Comorbidity was identified in 288 patients. The automatic selection of an optimal number of clusters included 100% of cases, generating an initial 6-cluster solution and a final 4-cluster solution. The interpretation of within-group ranking of the importance of variables in the clustering solutions resulted in the following characterization of clusters: chronic facial pain (n?=?36), acute muscle pain (n?=?125), acute articular pain (n?=?75) and chronic articular impairment (n?=?121). Conclusion Subgroups of acute and chronic TMD patients seeking treatment can be identified using clustering methods to provide a better understanding of the clinical presentation of TMD when multiple diagnosis are present. Classifying patients into identifiable symptomatic profiles would help clinicians to estimate how common a disorder is within a population of TMD patients and understand the probability of certain pattern of clinical complaints.
There has been growing recognition of a changing clinical presentation of celiac disease (CD), with the manifestation of milder\\u000a symptoms. Serologic testing is widely used to screen patients with suspected CD and populations at risk. The aim of this retrospective\\u000a analysis was to evaluate the clinical presentation of CD in childhood, assess the diagnostic value of serologic tests, and\\u000a investigate
Eberhard Lurz; Ursina Scheidegger; Johannes Spalinger; Martin Schöni; Susanne Schibli
The disturbance of vitamin D metabolism plays an important role in determining the clinical presentation of hyperthyroidism. We studied 72 patients (65 women, 7 men) with primary hyperparathyroidism (pHPT). Clinical presentation, biochemical indices, and bone mineral density (BMD) were compared in three patient groups classified according to their serum 25-hydroxyvitamin D (25OHD) levels: 23 patients whose 25OHD level was 40
Hiroyuki Yamashita; Shiro Noguchi; Shinya Uchino; Shin Watanabe; Eisuke Koike; Tsukasa Murakami; Takashi Fujihira; Yutaka Koga; Toshihiro Masatsugu; Hiroto Yamashita
Articles dealing with late-presenting congenital diaphragmatic hernia (CDH) in children published until 2003 were collectively reviewed. The main purpose of the presented study was to gain insight into the clinical spectrum of this variant of CDH and to discuss its clinical and surgical aspects. In 125 articles, 362 patients were reported. Left posterolateral hernia was the dominant anatomical type, found in 79.4% of
The aim of the study was to compare demographic characteristics, anamnestic findings, cerebrovascular risk factors, and clinical and neuroimaging data of cardioembolic stroke patients with and without atrial fibrillation and of atherothrombotic stroke patients with and without atrial fibrillation. Predictors of early diagnosis of cardioembolic vs. atherothrombotic stroke infarction in atrial fibrillation patients were also determined. Data of cardioembolic stroke
Adrià Arboix; Lluis Garc??a-Eroles; Juan B Massons; Montserrat Oliveres; Ramón Pujades; Cecilia Targa
For survival, embryonic motoneurons in vertebrates depend on as yet undefined neurotrophic factors present in the limb bud. Members of the neurotrophin family are currently the best candidates for such neurotrophic factors, but inactivation of their receptor genes leads to only partial loss of motoneurons, which suggests that other factors are involved. Glial cell line-derived neurotrophic factor (GDNF), originally identified
Christopher E. Henderson; Heidi S. Phillips; Richard A. Pollock; Alun M. Davies; Corinne Lemeulle; Mark Armanini; Barbara Moffet; Richard A. Vandlen; Vassilis E. Koliatsos; Arnon Rosenthal; Ve Koliatsor
This article discusses the affective factors from the point of view of clinical psychology. Our scheme of personality description places sense feelings and instinct feelings at the first level of complexity. An attempt should be made, in regard to sense feelings, to show what the person does because his feeling of pleasure or displeasure is unusually strong in connection with
Edward M. Westburgh
background We conducted a nationwide study in the Netherlands to determine clinical features and prognostic factors in adults with community-acquired acute bacterial meningitis. methods From October 1998 to April 2002, all Dutch patients with community-acquired acute bacterial meningitis, confirmed by cerebrospinal fluid cultures, were prospectively eval- uated. All patients underwent a neurologic examination on admission and at discharge, and outcomes
Diederik van de Beek; Jan de Gans; Lodewijk Spanjaard; Martijn Weisfelt; Johannes B. Reitsma; Marinus Vermeulen
Depression in elderlies is not known quite well and thus cannot be treated adequately. The fact that elderliness is accepted as a property of depressive symptoms both by the relatives of the patients and doctors is one of the factors which make it difficult to recognize depression. Existence of multiple physical diseases in elderlies, use of multiple medicines, occurrence of pharmacokinetic and pharmacodynamics changes depending on the age necessitate to take several factors into account while diagnosing and using medicines. In this study, clinical properties and risk factors of depression in old age period was reviewed and the properties of such depressions were summarized.
Background RBFOX1 is an important splicing factor regulating developmental and tissue-specific alternative splicing in heart, muscle, and neuronal tissues. Constitutional genetic defects in RBFOX1 are implicated in multiple medical conditions. Results We identified 14 copy number variants (CNV) involving RBFOX1 from 2,124 consecutive pediatric patients referred for chromosomal microarray analysis (CMA), including 13 intragenic deletions and a single intragenic duplication. The clinical significances of the intragenic deletions of RBFOX1 were evaluated. Conclusions Our data strongly supports the associations of intragenic deletions of RBFOX1 with a diversity of neurodevelopmental and neuropsychiatric disorders, and possibly other clinical features.
The study objective was to determine the nutritional status and its association with sociodemographic characteristics and health complaints of older persons presenting at the General Outpatients Department (GOPD) Clinic of University College Hospital (UCH), Ibadan, Nigeria. A cross-sectional descriptive design was used to select 500 consecutively presenting participants aged 60 years and older between September and December, 2009. The Mini-Nutritional
L. A. Adebusoye; I. O. Ajayi; M. D. Dairo; A. O. Ogunniyi
Since antibiotics have been widely used in the treatment of bacterial endocarditis, mycotic aneurysms caused by septic emboli have become ex- tremely rare. We report the case of a 66-year-old male patient who presented mycotic aneurysm of the right tibio- peroneal trunk two weeks after aortic and mitral valve replacement due to Enterococcus fecalis endo- carditis. The clinical presentation simulated
Raghid KREIDY; Joe HATEM
|Objective: To present data from a general infant psychiatry clinic, including range and frequency of presenting symptoms, relationship between symptoms and diagnoses, and comparison of two diagnostic systems, DSM-IV and Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-3). Method: A…
Frankel, Karen A.; Boyum, Lisa A.; Harmon, Robert J.
Although gastric lipomas, an extremely rare tumor, were once found mostly during autopsy studies and laparotomy for upper intestinal hemorrhages and obstruction, we are now able to diagnose these masses with CT scanners and gastrointestinal endoscopy. Surgery is now necessary only under certain circumstances. We present two cases of gastric lipomas with different clinical presentations, both diagnosed preoperatively. PMID:6507422
Maderal, F; Hunter, F; Fuselier, G; Gonzales-Rogue, P; Torres, O
Rift Valley fever (RVF) virus is an emerging pathogen that is transmitted in many regions of sub-Saharan Africa, parts of Egypt, and the Arabian peninsula. Outbreaks of RVF, like other diseases caused by hemorrhagic fever viruses, typically present in locations with very limited health resources, where initial diagnosis must be based only on history and physical examination. Although general signs and symptoms of human RVF have been documented, a specific clinical syndrome has not been described. In 2007, a Kenyan outbreak of RVF provided opportunity to assess acutely ill RVF patients and better delineate its presentation and clinical course. Our data reveal an identifiable clinical syndrome suggestive of severe RVF, characterized by fever, large-joint arthralgia, and gastrointestinal complaints and later followed by jaundice, right upper-quadrant pain, and delirium, often coinciding with hemorrhagic manifestations. Further characterization of a distinct RVF clinical syndrome will aid earlier detection of RVF outbreaks and should allow more rapid implementation of control.
Kahlon, Summerpal S.; Peters, Clarence J.; LeDuc, James; Muchiri, Eric M.; Muiruri, Samuel; Njenga, M. Kariuki; Breiman, Robert F.; Clinton White, A.; King, Charles H.
Methamphetamine is not a new drug. It has a long and storied history of legitimate clinical use and recreational abuse. Unfortunately, abuse of methamphetamine is increasing with alarming frequency in the United States and leads to appalling destruction of dentition. The pathognomonic effects of methamphetamine abuse on teeth have led to the term "meth mouth." This term, while descriptive of the clinical appearance of patients, is a misnomer. A review of available information on methamphetamine abuse is presented and discussed. A clinical case is documented to help clinicians recognize and manage patients who may be abusing methamphetamines. PMID:17694215
Goodchild, Jason H; Donaldson, Mark
Hepatic tuberculosis is an exceptional form of presentation of extrapulmonary tuberculosis, but in the last years a greater incidence has been found in patients with HIV infection and/or consumptive diseases or immunosuppressive treatment. For this condition, the diagnosis of hepatic tuberculosis in other population groups represents a true clinical challenge because of the scarce specificity of both the clinical and biological manifestations. Despite deferral of the diagnosis, fast improvement is observed in the clinical symptomatology in most cases following initiation of tuberculostatic treatment. PMID:15002791
Fontseré, N; Bonet, J; Bonal, J; Romero, R
Identifying healthcare providers' perceptions of clinical documentation methods can inform the design of computer-based documentation tools. The authors investigated the cognitive factors underlying such perceptions by performing a qualitative analysis that included open-ended in-depth interviews of a convenience sample of healthcare providers who use a variety of documentation methods. A total of 16 providers participated in the study; subjects included physicians and nurse practitioners from medical and surgical specialties who used paper- and computer-based documentation tools. Based on interview data, authors identified five factors that influenced satisfaction with clinical documentation tools: document system time efficiency, availability, expressivity, structure, and quality. These factors, if validated by subsequent investigations, can be used to develop a formal conceptual model of providers' perceptions of their satisfaction with various documentation systems. PMID:16904384
Rosenbloom, S Trent; Crow, Adrienne N; Blackford, Jennifer Urbano; Johnson, Kevin B
Pregnancy-related lumbopelvic pain has puzzled medicine for a long time. The present systematic review focuses on terminology, clinical presentation, and prevalence. Numerous terms are used, as if they indicated one and the same entity. We propose “pregnancy-related pelvic girdle pain (PPP)”, and “pregnancy-related low back pain (PLBP)”, present evidence that the two add up to “lumbopelvic pain”, and show that
W. H. Wu; O. G. Meijer; K. Uegaki; J. M. A. Mens; J. H. van Dieën; P. I. J. M. Wuisman; H. C. Östgaard
An appendicolith is composed of firm feces and some mineral deposits. After increased use of abdominal computed tomography, appendicoliths are more frequently detected. Most of the patients with appendicolith are asymptomatic. However, an appendicolith may be associated with complicated appendicitis with serious outcomes. We reported three patients who exhibited different clinical symptoms due to appendicolithiasis. While one of the patients was confused with urolithiasis, the other two patients presented with phlegmenous and perforated appendicitis. We submit that appendicoliths may present different clinical findings and can mimic several pathologies including urinary disorders.
Kaya, Bulent; Eris, Cengiz
The paper deals with the peculiarities of formation, clinical presentations and therapy of diffuse nontoxic goiter of children. The paper highlights the connection of the disease with the genetic predisposition, the impact of natural and anthropogenic strumagenes, immune processes. The clinical presentations of the diffuse nontoxic goiter are diffuse enlargement of thyroid gland, normal or high level of thyrotropichypophysis hormone when the content of thyroxin and triiodothyronine is normal, which is treated as the subclinic hypothyroidism syndrome. The variety of the disease pathogenesis theories leads to testing of different therapeutic methods, the principal ones among them are the use of iodine preparation and replacement therapy. PMID:23356134
Byriak, V N; Murashko, E S
OBJECTIVE Invasive candidiasis is a leading cause of infection-related morbidity and mortality in extremely low-birth-weight (<1000 g) infants. We quantify risk factors predicting infection in high-risk premature infants and compare clinical judgment with a prediction model of invasive candidiasis. METHODS The study involved a prospective observational cohort of infants <1000 g birth weight at 19 centers of the NICHD Neonatal Research Network. At each sepsis evaluation, clinical information was recorded, cultures obtained, and clinicians prospectively recorded their estimate of the probability of invasive candidiasis. Two models were generated with invasive candidiasis as their outcome: 1) potentially modifiable risk factors and 2) a clinical model at time of blood culture to predict candidiasis. RESULTS Invasive candidiasis occurred in 137/1515 (9.0%) infants and was documented by positive culture from ? 1 of these sources: blood (n=96), cerebrospinal fluid (n=9), urine obtained by catheterization (n=52), or other sterile body fluid (n=10). Mortality was not different from infants who had positive blood culture compared to those with isolated positive urine culture. Incidence varied from 2–28% at the 13 centers enrolling ? 50 infants. Potentially modifiable risk factors (model 1) included central catheter, broad-spectrum antibiotics (e.g., third-generation cephalosporins), intravenous lipid emulsion, endotracheal tube, and antenatal antibiotics. The clinical prediction model (model 2) had an area under the receiver operating characteristic curve of 0.79, and was superior to clinician judgment (0.70) in predicting subsequent invasive candidiasis. Performance of clinical judgment did not vary significantly with level of training. CONCLUSION Prior antibiotics, presence of a central catheter, endotracheal tube, and center were strongly associated with invasive candidiasis. Modeling was more accurate in predicting invasive candidiasis than clinical judgment.
Benjamin, Daniel K.; Stoll, Barbara J.; Gantz, Marie G.; Walsh, Michele C.; Sanchez, Pablo J.; Das, Abhik; Shankaran, Seetha; Higgins, Rosemary D.; Auten, Kathy J.; Miller, Nancy A.; Walsh, Thomas J.; Laptook, Abbot R.; Carlo, Waldemar A.; Kennedy, Kathleen A.; Finer, Neil N.; Duara, Shahnaz; Schibler, Kurt; Chapman, Rachel L.; Van Meurs, Krisa P.; Frantz, Ivan D.; Phelps, Dale L.; Poindexter, Brenda B.; Bell, Edward F.; O'Shea, T. Michael; Watterberg, Kristi L.; Goldberg, Ronald N.
Factor IX concentrate was obtained using DEAE-Sephadex A-50 as an adsorbent. The yield of factor IX in vitro averaged 81%. Each bottle of the concentrate contained 288-512 u. of factor II, 96--360 u. of factor VII, 440--660 u. of factor IX and 256--680 u. of factor X. The results of studies showed trace amounts of factor Xa in the final product, in the range of 0.01--0.04 u/ml. The concentrate was found to be free of thrombin. In the years 1976--1977 the new concentrate was administered 48 times to 10 patients with severe haemophilia B. The in vivo recovery of factor IX was 27--65%. Clinical results of treatment were satisfactory in all patients. No significant changes were observed in platelet count, fibrinogen level and the concentration of fibrinogen degradation products after infusion of the concentrate. The ethanol gelation test was negative in all cases. PMID:665130
Lopaciuk, S; Poszwi?ski, P
Thyroid stimulating hormone (TSH) secreting adenomas are the rarest type of pituitary adenomas (1:1000000 in the population; 0.2- 2.8% of adenomas). Plurihormonal thyrotropic adenomas are even rarer usually having cosecretion of growth hormone (GH) and prolactin. We report perhaps for the first time, TSH, GH, adrenocorticotrophic hormone (ACTH) and gonadotropins secreting pituitary macroadenoma diagnosed in a 40 year lady presenting with features of thyrotoxicosis for 5 months, amenorrhea for 3 months and newly diagnosed diabetes and hypertension for 2 months along with headache, nausea, and vomiting, who had acromegaloid habitus, grade-II goitre, increased uptake on Technitium-99 pertechnate thyroid scan (4.1%; normal: 0.24-3.34%), with increased T3 (5.98 pg/ ml; 1.5-4.1), increased T4 (2.34 ng/dl; 0.9-1.8), inappropriately high TSH (2.32 ?IU/ml; 0.4-4.2), insulin like growth factor-1 (711 ng/ ml; 109-264), non-suppressed post-glucose GH (15.9 ng/ml; <1 ng/ml), normal estradiol (52 pg/ml; 21-251), inappropriately high luteinizing hormone (53.5 mIU/ml; 1.1-11.6), inappropriately high follicle stimulating hormone (59 mIU/ml; 3-14.4), non-suppressed overnight dexamethasone cortisol (5.8 mcg/dl; <2), elevated ACTH (58 pg/ml 5-15), withdrawal bleed on progestrogen challenge, bitemporal hemianopia on automated perimetry and pituitary macroadenoma on MRI imaging of sella. Thyroid hormone resistance was ruled out by documenting normal sex hormone binding globulin and ferritin levels. Her clinical and biochemical phenotype was not suggestive of multiple hormone resistance seen in pseudohypoparathyroidism. This report intends to highlight the challenges in the diagnosis of plurihormonal thyrotropic adenoma.
Maisnam, Indira; Dutta, Deep; Jain, Rajesh; Ghosh, Sujoy; Mukhopadhyay, Satinath; Chowdhury, Subhankar
Thyroid stimulating hormone (TSH) secreting adenomas are the rarest type of pituitary adenomas (1:1000000 in the population; 0.2- 2.8% of adenomas). Plurihormonal thyrotropic adenomas are even rarer usually having cosecretion of growth hormone (GH) and prolactin. We report perhaps for the first time, TSH, GH, adrenocorticotrophic hormone (ACTH) and gonadotropins secreting pituitary macroadenoma diagnosed in a 40 year lady presenting with features of thyrotoxicosis for 5 months, amenorrhea for 3 months and newly diagnosed diabetes and hypertension for 2 months along with headache, nausea, and vomiting, who had acromegaloid habitus, grade-II goitre, increased uptake on Technitium-99 pertechnate thyroid scan (4.1%; normal: 0.24-3.34%), with increased T3 (5.98 pg/ ml; 1.5-4.1), increased T4 (2.34 ng/dl; 0.9-1.8), inappropriately high TSH (2.32 ?IU/ml; 0.4-4.2), insulin like growth factor-1 (711 ng/ ml; 109-264), non-suppressed post-glucose GH (15.9 ng/ml; <1 ng/ml), normal estradiol (52 pg/ml; 21-251), inappropriately high luteinizing hormone (53.5 mIU/ml; 1.1-11.6), inappropriately high follicle stimulating hormone (59 mIU/ml; 3-14.4), non-suppressed overnight dexamethasone cortisol (5.8 mcg/dl; <2), elevated ACTH (58 pg/ml 5-15), withdrawal bleed on progestrogen challenge, bitemporal hemianopia on automated perimetry and pituitary macroadenoma on MRI imaging of sella. Thyroid hormone resistance was ruled out by documenting normal sex hormone binding globulin and ferritin levels. Her clinical and biochemical phenotype was not suggestive of multiple hormone resistance seen in pseudohypoparathyroidism. This report intends to highlight the challenges in the diagnosis of plurihormonal thyrotropic adenoma. PMID:23565411
Maisnam, Indira; Dutta, Deep; Jain, Rajesh; Ghosh, Sujoy; Mukhopadhyay, Satinath; Chowdhury, Subhankar
Introduction Peritonitis is a life-threatening condition with a multitude of etiologies that can vary with geographic location. The aims of this study were to elucidate the etiology, clinical presentation and outcomes associated with peritonitis in Lilongwe, Malawi. Methods All patients admitted to Kamuzu Central Hospital (KCH) who underwent an operation for treatment of peritonitis during the calendar year 2008 were eligible. Peritonitis was defined as abdominal rigidity, rebound tenderness, and/or guarding in one or more abdominal quadrants. Subjects were identified from a review of the medical records for all patients admitted to the adult general surgical ward and the operative log book. Those who met the definition of peritonitis and underwent celiotomy were included. Results 190 subjects were identified. The most common etiologies were appendicitis (22%), intestinal volvulus (17%), perforated peptic ulcer (11%) and small bowel perforation (11%). The overall mortality rate associated with peritonitis was 15%, with the highest mortality rates observed in solid organ rupture (35%), perforated peptic ulcer (33%), primary/idiopathic peritonitis (27%), tubo-ovarian abscess (20%) and small bowel perforation (15%). Factors associated with death included abdominal rigidity, generalized (versus localized) peritonitis, hypotension, tachycardia and anemia (p < 0.05). Age, gender, symptoms (obstipation, vomiting) and symptom duration, tachypnea, abnormal temperature, leukocytosis, hemoconcentration, thrombocytopenia and thrombocytosis were not associated with mortality (p = NS). Conclusions There are several signs and laboratory findings predictive of poor outcome in Malawian patients with peritonitis. Tachycardia, hypotension, anemia, abdominal rigidity and generalized peritonitis are the most predictive of death (P < 0.05 for each). Similar to studies from other African countries, in our population the most common cause of peritonitis was appendicitis, and the overall mortality rate among all patients with peritonitis was 15%. Identified geographical differences included intestinal volvulus, rare in the US but the 2nd most common cause of peritonitis in Malawi and gallbladder disease, common in Ethiopia but not observed in Malawi. Future research should investigate whether correction of factors associated with mortality might improve outcomes.
Clinical investigations not otherwise approvable that present an opportunity to understand, prevent, or alleviate a serious problem affecting the health or welfare of children. 50.54 Section 50.54 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN...
Clinical, radiological and biochemical findings of two new cases of Sanfilippo disease, type D are reported. A high percentage of heparan sulfate was found in the urinary glycosaminoglycan pattern and a severe deficiency of N-acetylglucosamine-6-sulfate sulfatase was demonstrated in skin cultured fibroblasts from the patients. One of the patients presented mild intellectual impairment which differentiates him from the other cases
G. V. Coppa; P. L. Giorgi; L. Felici; O. Gabrielli; E. Donti; S. Bernasconi; H. Kresse; E. Paschke; C. Mastropaolo
Auditory processing disorders may have detrimental consequences on a child's life, if undiagnosed and untreated. We review causes of auditory processing disorders in order to raise clinical awareness. Auditory processing disorders may present against a background of neurological disease or developmental disorders, as well as in isolation. Clinicians need to be aware of potential causes and implications of auditory processing
D-E Bamiou; F E Musiek; L M Luxon
Primary central nervous system lymphoma (PCNSL) usually presents with clinical and neuroimaging findings consistent with single or multiple intracranial mass lesions. On cranial magnetic resonance imaging (MRI), such lesions are nearly always contrast enhancing, reflecting disruption of the blood-brain barrier at the site of tumor nodules. We describe 2 cases from the UCLA Medical Center who developed a rapidly progressive
Rohit Bakshi; John C. Mazziotta; Paul S. Mischel; Reza Jahan; David B. Seligson; Harry V. Vinters
This review article gives an overview on a number of novel clinical trials and registries in the field of cardiovascular medicine.\\u000a Key presentations made at the 75th annual meeting of the German Cardiac Society, held in Mannheim, Germany, in April 2009\\u000a are reported. The data were presented by leading experts in the field with relevant positions in the trials and
L. S. Maier; S. H. Schirmer; K. Walenta; C. Jacobshagen; M. Böhm
Chronic Helicobacter pylori infection is associated with mucosal inflammation. The aim of the present study was to assess human neutrophil and monocyte activation by H. pylori strains obtained from patients with different clinical presentations. Bacterial sonicates from 12 strains were used to stimulate phagocyte upregu- lation of CD11b\\/CD18 adherence molecules assessed by fluorescence flow cytometry and oxidative burst responses assessed
PER SYRAK HANSEN; MAE F. GO; KIM VARMING; LEIF P. ANDERSEN; ROBERT M. GENTA; DAVID Y. GRAHAM; HENRIK NIELSEN
Small cell lung cancer (SCLC) is one of many types rapidly growing malignant diseases, such as Burkitt's lymphoma and testicular germ cell cancers. At present, there is no reliable way to screen for SCLC, and imaging modalities tend to be delayed in detecting this type of cancer. The clinical presentation of acutely and rapidly growing SCLC can mimic those of pulmonary inflammatory or infectious disorders, and in some instances, this delays appropriate management and negatively affects patient outcome. PMID:22619563
Harris, Kassem; Khachaturova, Inga; Azab, Basem; Maniatis, Theodore; Murukutla, Srujitha; Chalhoub, Michel; Hatoum, Hassan; Kilkenny, Thomas; Elsayegh, Dany; Maroun, Rabih; Alkaied, Homam
Small cell lung cancer (SCLC) is one of many types rapidly growing malignant diseases, such as Burkitt’s lymphoma and testicular germ cell cancers. At present, there is no reliable way to screen for SCLC, and imaging modalities tend to be delayed in detecting this type of cancer. The clinical presentation of acutely and rapidly growing SCLC can mimic those of pulmonary inflammatory or infectious disorders, and in some instances, this delays appropriate management and negatively affects patient outcome.
Harris, Kassem; Khachaturova, Inga; Azab, Basem; Maniatis, Theodore; Murukutla, Srujitha; Chalhoub, Michel; Hatoum, Hassan; Kilkenny, Thomas; Elsayegh, Dany; Maroun, Rabih; Alkaied, Homam
There is ample information on the clinical role of biologic factors in female breast cancer: urokinase-type plasminogen activator (uPA), its receptor uPAR, its inhibitors PAI-1 and PAI-2, cathepsin D and pS2-protein. However such reports are missing or very rare for male breast cancer. We determined the cytosolic levels of oestrogen receptor (ER), progesterone receptor (PgR), cathepsin D, pS2-protein, uPA, uPAR,
Marion E. Meijer-van Gelder; Maxime P. Look; Joan Bolt-de Vries; Harry A. Peters; Jan G. M. Klijn; John A. Foekens
Clinical geneticists have contributed to the creation and operation of birth defects surveillance systems and epidemiology research programs. Over the years, many continue to assist the multidisciplinary staff at state-based and regional programs, national networks, and international databases. Currently, all centers participating in the National Birth Defects Prevention Study include a clinical geneticist, which has increased awareness of this role. It is generally assumed that the medical skills and expertise acquired from clinical practice of a clinical geneticist can assist in the tasks of record review, case classification, coding, staff education, peer networking, and research, but these activities have not been formally reviewed. To increase the general knowledge base, this article used the framework of an historical descriptive review focusing on a sample of birth defects surveillance systems presented as illustrative case studies. We examined the contribution of clinical geneticists to a sample of epidemiologic research studies from each program. Looking to the future, we discuss the education of other clinical geneticists, the need to evaluate performance, and the geneticist's participation with other public health colleagues in the shared goal of birth defects prevention. PMID:19107957
Lin, Angela E; Rasmussen, Sonja A; Scheuerle, Angela; Stevenson, Roger E
Introduction. Cancer diagnosis and treatment are often associated with physical and psychosocial impairments. Many cancer patients request complementary and alternative therapies such as mind-body medicine. Concept. The department of internal and integrative medicine at the Essen-Mitte Clinics offer a mind-body medicine day care clinic for cancer patients that is based on the Mindfulness-Based Stress Reduction Program and the mind-body medicine cancer program of the Harvard Mind/Body Medical Institute. The program encompasses mindfulness training, yoga, mindful exercise, nutrition, naturopathic self-help strategies, and cognitive restructuring. Cases. Two patients who had participated in the day care clinic program are presented here. One patient presented with anxiety and depression after recently diagnosed breast cancer and the other with psychological impairments as a result of multiple nevi excision after malignant melanoma surgery. Both patients improved in terms of anxiety and further psychological symptoms. CONCLUSIONS: The Essen-Mitte Clinics mind-body medicine day care clinic appears to alleviate psychological consequences of cancer and its treatment. Further studies and randomized controlled trials are necessary to confirm these results. PMID:23329568
Paul, Anna; Cramer, Holger; Lauche, Romy; Altner, Nils; Langhorst, Jost; Dobos, Gustav J
Background Human parainfluenza viruses (HPIVs) are important causes of upper respiratory tract illness (URTI) and lower respiratory tract illness (LRTI). To analyse epidemiologic and clinical characteristics of the four types of human parainfluenza viruses (HPIVs), patients with acute respiratory tract illness (ARTI) were studied in Guangzhou, southern China. Methods Throat swabs (n=4755) were collected and tested from children and adults with ARTI over a 26-month period, and 4447 of 4755 (93.5%) patients’ clinical presentations were recorded for further analysis. Results Of 4755 patients tested, 178 (3.7%) were positive for HPIV. Ninety-nine (2.1%) samples were positive for HPIV-3, 58 (1.2%) for HPIV-1, 19 (0.4%) for HPIV-2 and 8 (0.2%) for HPIV-4. 160/178 (88.9%) HPIV-positive samples were from paediatric patients younger than 5?years old, but no infant under one month of age was HPIV positive. Seasonal peaks of HPIV-3 and HPIV-1 occurred as autumn turned to winter and summer turned to autumn. HPIV-2 and HPIV-4 were detected less frequently, and their frequency of isolation increased when the frequency of HPIV-3 and HPIV-1 declined. HPIV infection led to a wide spectrum of symptoms, and more “hoarseness” (p=0.015), “abnormal pulmonary breathing sound” (p<0.001), “dyspnoea” (p<0.001), “pneumonia” (p=0.01), and “diarrhoea” (p<0.001) presented in HPIV-positive patients than HPIV-negative patients. 10/10 (100%) HPIV-positive adult patients (?14?years old) presented with systemic influenza-like symptoms, while 90/164 (54.9%) HPIV-positive paediatric patients (<14?years old) presented with these symptoms (p=0.005). The only significant difference in clinical presentation between HPIV types was “Expectoration” (p<0.001). Co-infections were common, with 33.3%–63.2% of samples positive for the four HPIV types also testing positive for other respiratory pathogens. However, no significant differences were seen in clinical presentation between patients solely infected with HPIV and patients co-infected with HPIV and other respiratory pathogens. Conclusions HPIV infection led to a wide spectrum of symptoms, and similar clinical manifestations were found in the patients with four different types of HPIVs. The study suggested pathogenic activity of HPIV in gastrointestinal illness. The clinical presentation of HPIV infection may differ by patient age.
Outlined in the paper are the basic trends and tasks of clinical-and-social ophthalmology--research and practice related with the medical-and-social consequences of disabling visual impairments as well as of blindness and disability due to vision. They comprise: 1) A study of the epidemiological, social-and-hygienic and clinical-and-ophthalmologic aspects of blindness and disability; 2) Scientific elaboration of methodological, clinical, social and managerial positions and criteria of ophthalmologic and of medical-and-social expertise; 3) A theoretical definition of the methodological principles for medical-and-social rehabilitation of the disabled due to vision. Data are presented of the rate of blindness and disability due to ophthalmic pathologies in the Russian Federation. The modern standpoints of ophthalmologic medical-and-social expertise and rehabilitation of persons with visual lesions are elucidated. PMID:15017769
Libman, E S
The clinical manifestations of contact allergic dermatitis to dental materials are not uniform. This study was performed to detect the frequent allergens in the dental series associated with contact dermatitis and to define the causal relationship between the different allergens and the relevant clinical presentations. Between the years 2000 and 2004, 134 patients, aged 20-80 years, were patch tested. 121 patients were included in the study. The most frequent oral manifestations were cheilitis and perioral dermatitis (25.6%), burning mouth (15.7%), lichenoid reaction (14.0%), and orofacial granulomatosis (10.7%). 18 (14.9%) patients were dental personnel, all of whom suffered from hand dermatitis. The common allergens detected included goldsodiumthiosulphate (14.0%), nickel sulfate (13.2%), mercury (9.9%), palladium chloride (7.4%), cobalt chloride (5.0%), and 2-hydroxyethyl methacrylate (5.8%). Positive reactions to metals were frequent in all the different clinical variants, and no specific association between a specific clinical presentation and a particular allergen was found. Allergy to mercury was not a significant factor contributing to the pathogenesis of oral lichenoid reactions. However, a strong association with contact allergy to mercury in dental fillings was found in 2 patients with orofacial granulomatosis. PMID:16958919
Khamaysi, Ziad; Bergman, Reuven; Weltfriend, Sara
Clinical heterogeneity is the prominent feature of spinocerebellar ataxia type 3 (SCA3) which is sometimes neglected and often impedes the timely diagnosis of patients. In this study, the clinical data of 201 unrelated Chinese SCA3 patients were retrospectively studied. The rare clinical features were summarized and the underlying genetic mutations were screened by direct DNA sequencing. Three patients were found primarily presenting with the rare clinical features, including dystonic phenotype without response to levodopa, chorea and memory decline, and hearing impairment, respectively. We firstly reported three diverse heterogeneities of SCA3 patients, which are quite uncommon in the Chinese SCA3 patients. Our results expanded the variable phenotypes of SCA3 and provided the explicit information for the rare and special SCA3 manifestations. Based on this new knowledge, we suggested that when the presentation was consistent with HD or DRD while negative in the corresponding genetic testing, SCA3 should be considered, and clinicians should divert partial attention to the examinations on the auditory system of SCA3 patients. PMID:23174085
Dong, Yi; Sun, Yi-Min; Ni, Wang; Gan, Shi-Rui; Wu, Zhi-Ying
Hypertrophic cardiomyopathy is an inherited disease in some feline breeds including the Maine Coon and Ragdoll. In these breeds, distinct causative genetic mutations have been identified. The two breeds appear to have slightly different clinical presentations, including age of diagnosis. The observation that these two breeds may have different clinical presentations, as well as different genetic mutations, suggests that hypertrophic cardiomyopathy is a diverse disease in the cat. Hypertrophic cardiomyopathy is poorly described in the Sphynx. The objective of this study was to phenotypically characterize Sphynx hypertrophic cardiomyopathy and to evaluate for a familial etiology. Records of 18 affected cats (11 female, seven male) were evaluated. Age of affected cats ranged from 0.5 to 7 years (median, 2 years). Four affected cats were from a single family and included an affected cat in each of four generations (three females, one male). Further studies are warranted to evaluate for a causative mutation and better classify the phenotypic expression. PMID:22412161
Silverman, Sarah J; Stern, Joshua A; Meurs, Kathryn M
Research linking psychopathic tendencies to childhood behavior problems is predicated on the assumption that the findings are based on using psychometrically sound measures of psychopathic tendencies. Although evaluated with community samples, the psychometric properties of such measures have not been evaluated with inpatient clinical populations thereby limiting conclusions. Hence, the goal of the present study was to evaluate the factor structure of a widely used measure-the Antisocial Process Screening Device (APSD)-with an inpatient population. Parents of 328 children (M age = 8.90 years) completed the APSD at the time of their child's admission for treatment. Although confirmatory factor analyses supported the three- and two-factor solutions proposed by the authors of the measure, the two-factor structure was more parsimonious. Factors of the two-factor model were also related to symptoms of childhood behavior disorders. The findings extend current research on the APSD's factor structure to an inpatient population. PMID:18577599
Fite, Paul J; Greening, Leilani; Stoppelbein, Laura; Fabiano, Gregory A
Ureteral seminal vesicle anomaly associated with ipsilateral renal agenesis is a rare occurrence. Cystic anomaly of the seminal\\u000a vesicle may be asymptomatic or discovered by rectal examination and cystoscopy for evaluation of bladder irritative symptoms,\\u000a perineal and testicular pain, ejaculatory disturbances and rarely infertility. The condition was diagnosed in three patients\\u000a with various clinical presentations.
J. Kaneti; L. Lissmer; Z. Smailowitz; I. Sober
This study aimed to identify the incidence and clinical correlates of aggression and violence in first episode psychosis. We prospectively recruited subjects with a first episode of DSM-psychosis presenting from a geographically defined catchment area to a secondary referral psychiatric service over a four-year period (n=157). We used the Modified Overt Aggression Scale to retrospectively assess aggression (a hostile or
Sharon R. Foley; Brendan D. Kelly; Mary Clarke; Orfhlaith McTigue; Maurice Gervin; Moyyad Kamali; Conall Larkin; Eadbhard O'Callaghan; Stephen Browne
Professional encounters in Bedouin society between male therapists and their female clients are discussed in terms of the conflict between clinical precepts and Bedouin codes of social conduct. The effects of the conflict on the transference relationship are examined by means of case presentations, and rules of conduct acceptable in both the professional realm and Bedouin society are proposed as an avenue toward resolution. PMID:7977659
Mass, M; al-Krenawi, A
Sinus histiocytosis is a rare inflammatory disease mainly affecting the cervical lymph nodes, presenting with skin lesions in 10% of cases. Our patient had a solitary nodule on the trunk without any other clinical signs. The histology reported a dermal neoplasm composed mainly of macrophages and lymphocytes. Macrophages were aggregated in clusters resembling lymph node sinuses. Lymphophagocytosis or emperipolesis (the presence of an intact cell within the cytoplasm of another cell) was noted and the diagnosis of sinus histiocytosis established.
Duarte-Williamson, Emilia; Antony, Fiona; Rotarescu, Radu
Gastric antral vascular ectasia (GAVE), though a rare disorder, causes up to 4% of non-variceal upper GI bleeding. This paper gives an overview of studies examining clinical presentation and pathophysiology, and reviews the current evidence for invasive and non-invasive treatments. GAVE is often associated with systemic illnesses, such as cirrhosis of the liver, autoimmune connective tissue disorders, bone marrow transplantation
Christian P. Selinger; Yeng S. Ang
AIM: To investigate the association between serum antibody levels and a subsequent celiac disease diagnosis in a large series of children and adults. METHODS: Besides subjects with classical gastrointestinal presentation of celiac disease, the study cohort included a substantial number of individuals with extraintestinal symptoms and those found by screening in at-risk groups. Altogether 405 patients underwent clinical, serological and histological evaluations. After collection of data, the antibody values were further graded as low [endomysial (EmA) 1:5-200, transglutaminase 2 antibodies (TG2-ab) 5.0-30.0 U/L] and high (EmA 1: ? 500, TG2-ab ? 30.0 U/L), and the serological results were compared with the small intestinal mucosal histology and clinical presentation. RESULTS: In total, 79% of the subjects with low and 94% of those with high serum EmA titers showed small-bowel mucosal villous atrophy. Furthermore, 96% of the 47 EmA positive subjects who had normal mucosal villi and remained on follow-up either subsequently developed mucosal atrophy while on a gluten-containing diet, or responded positively to a gluten-free diet. CONCLUSION: Irrespective of the initial serum titers or clinical presentation, EmA positivity as such is a very strong predictor of a subsequent celiac disease diagnosis.
Kurppa, Kalle; Rasanen, Tiia; Collin, Pekka; Iltanen, Sari; Huhtala, Heini; Ashorn, Merja; Saavalainen, Paivi; Haimila, Katri; Partanen, Jukka; Maki, Markku; Kaukinen, Katri
Lymphoedema is a clinical condition caused by impairment of the lymphatic system, leading to swelling of subcutaneous soft tissues. As a result, accumulation of protein-rich interstitial fluid and lymphostasis often causes additional swelling, fibrosis and adipose tissue hypertrophy leading to progressive morbidity and loss of quality of life for the patient. Lymphoedema can be distinguished as primary or secondary. Lymphoedema is a complication frequently encountered in patients treated for cancer, especially after lymphadenoectomy and/or radiotherapy based on destruction of lymphatics. However, although lymphatic impairment is sometimes caused by obstructive solid metastasis, we present three cases of secondary lymphoedema with minor dermatological features without detectable solid metastasis. Sometimes this type of lymphoedema is mistakenly called malignant lymphoedema. All patients were previously treated for cancer without clinical signs of recurrence, presented with progressive lymphoedema and minor dermatological features of unknown origin. Clinical and histopathological examination of the skin revealed diffuse lymphangitis carcinomatosa, leading to secondary lymphoedema and adjustment of the therapeutic approach and prognosis. We reviewed literature on these rare presentations of cancer recurrence and recommend, where appropriate, consulting a dermatologist when discrete skin abnormalities are seen in patients with a history of cancer and developing lymphoedema. PMID:20030691
Damstra, R J; Jagtman, E A; Steijlen, P M
Objective The purpose of this case series is to describe the presentation of 2 patients who presented to a chiropractic teaching clinic with Paget-Schroetter syndrome (PSS) and to discuss the potential role for conservative therapy in the management of symptoms. Clinical Features Two patients presented with a vascular and muscular findings suggesting activity-related upper extremity deep vein thrombosis. One patient presented with recent onset of symptoms (pain in the neck with a “pinched nerve sensation” in the left upper trapezius); and the other presented with chronic, low-grade neck pain of 1 year's duration. Intervention and Outcome The initial treatment approach for the patient with acute symptoms included soft tissue therapy. During the second appointment, he was immediately referred for medical evaluation and management because of worsening symptoms. He was diagnosed with thrombus in the left brachial vein, started immediately on a thrombolytic agent, and referred to a thrombosis clinic. Treatment for the second patient with chronic symptoms included soft tissue therapy, spinal manipulative therapy, and active care. Two months after 3 treatments, she reported improved symptoms. She remains under supportive care and has reported continued relief of her symptoms. Conclusion Although a rare condition, PSS has the potential to result in significant morbidity and potentially fatal complications; thus, it is critical that practitioners recognize the signs and symptoms to facilitate appropriate and timely referrals. Clinicians should be aware of the presentation and proposed pathogenesis of PSS, and consider this diagnosis in patients with unilateral upper limb and/or neck pain.
Stainsby, Brynne E.; Muir, Bradley J.; Miners, Andrew L.
Background: Sjögren's syndrome is an autoimmune syndrome involving the exocrine glands specially the salivary and lacrimal glands leading to xerostomia and xerophtalmia. This paper presents a case with primary Sjögren's syndrome that severe dental caries were the first clinical manifestation. Case Presentation: A 42-year-old man was referred to the School of Dentistry, Tehran University of Medical Sciences due to unexplained severe dental decays. After systematic evaluation and consultation with the rheumatologist and the ophthalmologist, the diagnosis of primary Sjögren's syndrome was suggested and confirmed by serologic and histopathologic study. Conclusion: Primary Sjögren's syndrome should be considered in the differential diagnosis of patients with early severe dental caries. PMID:24009970
Ahmadi, Elham; Fallahi, Sasan; Alaeddini, Mojgan; Hasani Tabatabaei, Masoomeh
Background Cornelia de Lange syndrome (CdLS) is a rare autosomal-dominant disorder characterised by facial dysmorphism, growth and psychomotor developmental delay and skeletal defects. To date, causative mutations in the NIPBL (cohesin regulator) and SMC1A (cohesin structural subunit) genes account for > 50% and 6% of cases, respectively. Methods We recruited 50 patients with a CdLS clinical diagnosis or with features that overlap with CdLS, who were negative for mutations at NIPBL and SMC1A at molecular screening. Chromosomal rearrangements accounting for the clinical diagnosis were screened for using array Comparative Genomic Hybridisation (aCGH). Results Four patients were shown to carry imbalances considered to be candidates for having pathogenic roles in their clinical phenotypes: patient 1 had a 4.2 Mb de novo deletion at chromosome 20q11.2-q12; patient 2 had a 4.8 Mb deletion at chromosome 1p36.23-36.22; patient 3 carried an unbalanced translocation, t(7;17), with a 14 Mb duplication of chromosome 17q24.2-25.3 and a 769 Kb deletion at chromosome 7p22.3; patient 4 had an 880 Kb duplication of chromosome 19p13.3, for which his mother, who had a mild phenotype, was also shown to be a mosaic. Conclusions Notwithstanding the variability in size and gene content of the rearrangements comprising the four different imbalances, they all map to regions containing genes encoding factors involved in cell cycle progression or genome stability. These functional similarities, also exhibited by the known CdLS genes, may explain the phenotypic overlap between the patients included in this study and CdLS. Our findings point to the complexity of the clinical diagnosis of CdLS and confirm the existence of phenocopies, caused by imbalances affecting multiple genomic regions, comprising 8% of patients included in this study, who did not have mutations at NIPBL and SMC1A. Our results suggests that analysis by aCGH should be recommended for CdLS spectrum cases with an unexplained clinical phenotype and included in the flow chart for diagnosis of cases with a clinical evaluation in the CdLS spectrum.
During the last three years the School of Nursing and Midwifery at the University of Tasmania has used a needs assessment survey to explore the needs of organizations and nursing professionals that facilitate and clinically supervise Bachelor of Nursing students in the workplace. Findings from the survey indicated that staff at healthcare organizations wanted a communication strategy that was easily accessible by clinicians who supervised students during work integrated learning placements. In particular they wanted to receive timely information related to the role and function of supervisors in practice. The development of the digital strategy to strengthen the development of a community of practice between the University, organizations, facilities and clinical supervisors was identified as the key method of improving communication. Blogging and micro blogging were selected as methods of choice for the implementation of the digital strategy because they were easy to set up, use and enable equity of access to geographically dispersed practitioners in urban and rural areas. Change champions were identified to disseminate information about the strategy within their workplaces. Although clinicians indicated electronic communication as their preferred method, there were a number of human factors at a systems and individual level identified to be challenges when communicating with clinical supervisors who were based off-campus. Information communication technology policies and embedded culture towards social presence were impediments to using this approach in some organizations. Additionally, it was found that it is necessary for this group of clinicians to be educated about using digital methods to undertake their role as clinical supervisors in their varied clinical practice environments. PMID:23941949
Mather, Carey; Marlow, Annette; Cummings, Elizabeth
The aim of this study was to correlate clinical and computerized tomography (CT) features of bisphosphonate-related osteonecrosis of the jaws (BRONJ). All ONJ patients for whom there was complete CT scan imaging were eligible. Selected clinical parameters retrieved from their medical records were analyzed for correlation with CT parameters. The clinical presentation of BRONJ was supported by findings in CT imaging in 78.3%. The lesion's size on CT correlated with the presence of purulent secretion (p = 0.03). When sequestrum was present, the median lesion's size on CT was relatively big (28 mm, range 21-43 mm). The mandibular canal cortex was never breached. CT has reasonable detection competence for diagnosing BRONJ. Purulent secretion indicates the likelihood that a more extensive involvement will be displayed on CT. A large lesion on CT should raise the index of suspicion for sequestrum. The CT appearance of a continuous cortex of the mandibular canal may serve as a differential parameter between BRONJ and metastasis to the jaw. PMID:19603201
Elad, Sharon; Gomori, Moshe J; Ben-Ami, Noa; Friedlander-Barenboim, Silvina; Regev, Eran; Lazarovici, Towy S; Yarom, Noam
Polycythemia vera (PV) in children and adolescents is very rare. Data on clinical and laboratory evaluations as well as on treatment modalities are sparse. Here, we report the long-term clinical course of a PV patient first diagnosed more than 40 years ago at age 12. In addition, after a systematic review of the scientific medical literature, clinical and hematological data of 35 patients (19 female and 17 male) from 25 previous reports are summarized. Three patients developed PV following antecedent hematological malignancies. Budd-Chiari syndrome was diagnosed in seven patients indicating a particular risk of young patients of developing this disorder. One patient presented with ischemic stroke, one patient with gangrene, and three patients with severe hemorrhage. Three patients died from disease-related complications. Hematocrit levels and platelet counts were not correlated with disease severity. Leukocytosis >15 x 10(9)/L was present in 9/35 patients and associated with a thromboembolic or hemorrhagic complication in seven patients. The few available data on molecular genetics and endogenous erythroid colony growth indicate changes comparable to those detectable in adult patients. Treatment varied enormously. It included aspirin, phlebotomy, hydroxycarbamide, busulfan, melphalan, pyrimethamine, and interferon-alpha. Two patients successfully underwent stem cell transplantation. Currently, it is impossible to treat an individual pediatric PV patient with an evidence-based regimen. PMID:19468728
Cario, Holger; McMullin, Mary Frances; Pahl, Heike L
Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, inflammatory neurodegenerative disease. This study investigated the relationships of clinical stage with epidemiological and magnetic resonance imaging (MRI) findings in SSPE by retrospective review of 76 cases (57 male) diagnosed by typical periodic electroencephalographic features, clinical symptoms and elevated measles antibody titre in cerebrospinal fluid. Clinical stage at diagnosis was I or II in 48 patients, III in 25 and IV in three. Prominent findings at presentation were atonic/myoclonic seizures (57.9%) and mental deterioration with behaviour alteration (30.3%). Frequent MRI findings (13 - 32 patients) were subcortical, periventricular and cortical involvement and brain atrophy; the corpus callosum, basal ganglia, cerebellum and brainstem were less frequently involved. Five patients had pseudotumour cerebri. Cranial MRI at initial diagnosis was normal in 21 patients (19 stage I/II, two stage III/IV). Abnormal MRI findings were significantly more frequent in the later stages, thus a normal initial cranial MRI does not exclude SSPE, which should, therefore, be kept in mind in childhood demyelinating diseases even when the presentation is unusual. PMID:21672364
Cece, H; Tokay, L; Yildiz, S; Karakas, O; Karakas, E; Iscan, A
This study carried out from January to June 2007, was undertaken to describe the clinical presentation of childhood malaria in Douala, a meso-endemic area as far as malaria transmission is concerned. One hundred and seventy eight children were enrolled after informed consent of their parents. The sample characteristics were recorded and clinical as well as preliminary laboratory investigations were performed. Thirty eight children coming for vaccination and counselling was targeted to serve as control. According to the results obtained, cerebral malaria (CM) seems to be associated with young age, whilst Malaria anaemia (MA) was predominant among older children. Hyperpyrexia and hyperparasitaemia were high among CM patients and 11.1% of them died, however, no neurological squeal was noticed immediately after discharge on those who survived. Haemoglobin and glycaemia were low on MA and CM patients; these groups had low percentage in bed nets utilization as well. These results suggest that the clinical presentation of the disease differ with the geographic location and malaria disease features varies according to the severity. Such studies could contribute to the management of the disease. PMID:19137849
Mfonkeu, J B Pankoui; Gouado, I; Kuate, H Fotso; Zambou, O; Grau, G; Combes, V; Zollo, P H Amvam
OBJECTIVE: To describe the clinical manifestations, laboratory results, imaging findings, and treatments in patients with idiopathic retroperitoneal fibrosis (IRF) seen at Mayo Clinic in Rochester, MN. PATIENTS AND METHODS: In this retrospective study, we used International Classification of Diseases, Ninth Revision codes to identify all patients evaluated for IRF between January 1, 1996, and December 31, 2006, at Mayo Clinic in Rochester, MN. Medical records were reviewed, and clinical information was abstracted. Idiopathic retroperitoneal fibrosis was diagnosed on the basis of compatible imaging findings. Patients were followed up until their last visit at Mayo Clinic, death, or December 31, 2008, whichever came first. RESULTS: Of the 185 patients identified as having IRF, 113 (61%) were men and 72 (39%) were women. Mean ± SD age at diagnosis was 57.6±11.8 years. Biopsy specimens were obtained in 142 cases (77%). The most common presenting symptoms were back pain (38%) and abdominal pain (40%). Baseline erythrocyte sedimentation rate and/or C-reactive protein levels were elevated in 88 (58%) of the 151 patients tested. The median creatinine level at diagnosis was 1.3 mg/dL (interquartile range, 1.1-2.1 mg/dL). Fifteen patients (8%) were treated with ureteral procedures only, 58 patients (31%) with medications only, and 105 patients (57%) with a combination of medical and surgical therapies. Seven patients (4%) were not treated. Corticosteroids were initiated in 116 patients (63%), and tamoxifen was used in 120 patients (65%). Follow-up was available for 151 patients (82%). Creatinine levels were normal at last visit in 102 (68%) of the 151 patients with follow-up. No patient developed end-stage renal disease. Relapses occurred in 18 (12%) of the 151 patients. Eleven patients died. CONCLUSION: In this cohort, outcomes such as end-stage renal disease or death from renal failure were not observed. Relapses may occur, and patients with IRF warrant long-term follow-up.
Kermani, Tanaz A.; Crowson, Cynthia S.; Achenbach, Sara J.; Luthra, Harvinder S.
Introduction The incidence of Kaposi sarcoma (KS) has increased dramatically among women in sub-Saharan Africa since the onset of the HIV pandemic, but data on KS disease in women are limited. To identify gender-related differences in KS presentation and outcomes, we evaluated the clinical manifestations and response in men and women with AIDS-associated KS in Uganda. Methods and Findings HIV-infected adults with KS attending the Infectious Diseases Institute (IDI) and Uganda Cancer Institute (UCI) in Kampala, Uganda between 2004 and 2006 were included in a retrospective cohort. Evaluation of KS presentation was based on the clinical features described at the initial KS visit. Response was evaluated as the time to “improvement”, as defined by any decrease in lesion size, lesion number, or edema. The cohort consisted of 197 adults with HIV and KS: 55% (108/197) were women. At presentation, the median CD4 T-cell count was significantly lower in women (58 cells/mm3; IQR 11–156 cells/mm3) than men (124 cells/mm3; IQR 22–254 cells/mm3) (p?=?0.02). Women were more likely than men to present with lesions of the face (OR 2.8, 95% CI, 1.4, 5.7; p?=?0.005) and hard palate (OR 2.0, 95% CI, 1.1, 3.7; p?=?0.02), and were less likely than men to have lower extremity lesions (OR 0.54, 95% CI, 0.3, 0.99; p?=?0.05). Women were less likely than men to demonstrate clinical improvement (HR?=?0.52, CI 0.31, 0.88; p?=?0.01) in multivariate analysis. Conclusions The clinical presentation and response of KS differs between men and women in Uganda. These data suggest that gender affects the pathophysiology of KS, which may have implications for the prevention, diagnosis, and treatment of KS in both men and women. Prospective studies are needed to identify predictors of response and evaluate efficacy of treatment in women with KS, particularly in Africa where the disease burden is greatest.
Phipps, Warren; Ssewankambo, Fred; Nguyen, Huong; Saracino, Misty; Wald, Anna; Corey, Lawrence; Orem, Jackson; Kambugu, Andrew; Casper, Corey
THIS ARTICLE PRESENTS THE RESULTS OF A REVIEW of studies of psychology that describe how ordinary human reasoning may lead patients to provide an unreliable history of present illness. Patients make errors because of mistakes in comprehension, recall, evaluation and expression. Comprehension of a question changes depending on ambiguities in the language used and conversational norms. Recall fails through the forgetting of relevant information and through automatic shortcuts to memory. Evaluation can be mistaken because of shifting social comparisons and faulty personal beliefs. Expression is influenced by moods and ignoble failures. We suggest that an awareness of how people report current symptoms and events is an important clinical skill that can be enhanced by knowledge of selected studies in psychology. These insights might help clinicians avoid mistakes when eliciting a patient's history of present illness.
Redelmeier, Donald A.; Schull, Michael J.; Hux, Janet E.; Tu, Jack V.; Ferris, Lorraine E.
BACKGROUND Identification of von Willebrand factor (vWF) abnormalities in a variety of conditions is hampered by the limitations of currently available diagnostic tests. Although direct multimer visualization by immunoelectrophoresis is a commonly used method, it is impractical as a routine clinical test. In this study, we used a biophysical analysis tool, fluorescence correlation spectroscopy (FCS), to measure vWF distributions. The goals were to develop a method that is quicker and simpler than vWF gel electrophoresis and to evaluate the potential of FCS as a clinical diagnostic technique. METHODS We analyzed plasma from 12 patients with type 1 von Willebrand disease (vWD), 14 patients with type 2 vWD, and 10 healthy controls using a fluctuation-based immunoassay approach. RESULTS FCS enabled identification and proper classification of type 1 and type 2 vWD, producing quantitative results that correspond to qualitative gel multimer patterns. FCS required minimal sample preparation and only a 5-min analysis time. CONCLUSIONS This study represents the first implementation of FCS for clinical diagnostics directly on human plasma. The technique shows potential for further vWF studies and as a generally applicable laboratory test method.
Torres, Richard; Genzen, Jonathan R.; Levene, Michael J.
Introduction The most frequent urine metabolic risk factor in adults is idiopathic hypercalciuria while in children is hypocitraturia.\\u000a If there is really a change of metabolic abnormalities with age it would be interesting to study risk factors in the intermediate population: young adults.\\u000a \\u000a \\u000a \\u000a \\u000a Objective We evaluated metabolic risk factors, clinical presentation and family history of stone formers between 17 and 27 years old.
Francisco R. Spivacow; Armando L. Negri; Elisa E. del Valle; Irene Calviño; José R. Zanchetta
Non-attendance for scheduled appointments is common in many medical specialties. However, there are no published reports on non-attendance in pediatric allergy clinics. We investigated the factors for non-attendance in pediatric allergy patients. We assessed the effects of age, gender, ethnic origin, waiting time for an appointment and the timing of the appointment on non-attendance proportions. Chi-square tests were used to analyze statistically significant differences of categorical variables. Logistic regression models were used for multivariate analyses. A total of 442 visits in a 21-month period were included in the study. The overall proportion of non-attendance at the pediatric allergy clinic was 33.0%. Jewish rural patients had 19.4% non-attendance; Jewish urban patients had 35.6% non-attendance; and Bedouin patients had 57.1% non-attendance (p < 0.001). Non-attendance was higher in spring and winter (43.5% and 36.7%, respectively) than in summer and autumn (26.9% and 26.5%, respectively) (p = 0.016). Non-attendance was not significantly influenced by gender, age, hour of the appointment or waiting time for the appointment. A multivariate logistic regression model demonstrated that the ethnic origin of the patients and the season of the year were significantly associated with non-attendance. We conclude that in children attending allergy clinics, factors that determine non-attendance include the ethnic origin of the patients and the season of the year. PMID:18208462
Dreiher, Jacob; Goldbart, Aviv; Hershkovich, Jacob; Vardy, Daniel A; Cohen, Arnon D
Rhabdomyoma is the most common pediatric heart tumor. Cardiac rhabdomyomas (CRs) have a natural history of spontaneous regression and are closely associated with tuberous sclerosis complex (TSC). We aimed to evaluate the clinical presentation and outcome of CRs and their association with TSC. Patients with CRs diagnosed in last six years were retrospectively analyzed. A total of 25 tumors were identified in seven patients by echocardiography. Three patients were diagnosed prenatally by fetal echocardiography, three patients in the neonatal period and one patient in early infancy. The median followup period was two years (range: 5 months-6 years). Five patients (71%) had multiple tumors. Three patients had arrhythmias and two patients required surgery. Only 36% (9/25) of the tumors regressed. TSC was diagnosed in four patients during the follow-up. CRs may have different presentations and clinical course. Surgery is only necessary when hemodynamically significant obstruction is present. As CRs are associated with long-term development of TSC and other diagnostic features are not yet typically apparent in the prenatal and neonatal periods, careful evaluation and follow-up are essential to exclude TSC. PMID:21434532
Atalay, Semra; Aypar, Ebru; Uçar, Tayfun; Altu?, Nahide; Deda, Gülhis; Teber, Serap; Tutar, Ercan
Background Henoch Schonlein purpura (HSP) is a common vasculitis of small vessels whereas endothelin-1 (ET-1) is usually reported elevated in vasculities and systematic inflammation. The aim of the present study was to investigate whether ET-1 levels are correlated with the clinical presentation and the outcome of HSP. Methods The study sample consisted of thirty consecutive patients with HSP. An equal number of healthy patients of similar age and the same gender were served as controls. The patients' age range was 2–12.6 years with a mean ± SD = 6.3 ± 3 years. All patients had a physical examination with a renal, and an overall clinical score. Blood and urinary biochemistry, immunology investigation, a skin biopsy and ET-1 measurements in blood and urine samples were made at presentation, 1 month later and 1 year after the appearance of HSP. The controls underwent the same investigation with the exception of skin biopsy. Results ET-1 levels in plasma and urine did not differ between patients and controls at three distinct time points. Furthermore the ET-1 were not correlated with the clinical score and renal involvement was independent from the ET-1 measurements. However, the urinary ET-1 levels were a significant predictor of the duration of the acute phase of HSP (HR = 0.98, p = 0.032, CI0.96–0.99). The ET-1 levels did not correlate with the duration of renal involvement. Conclusion Urinary ET-1 levels are a useful marker for the duration of the acute phase of HSP but not for the length of renal involvement.
Fessatou, S; Nicolaidou, P; Gourgiotis, D; Georgouli, H; Douros, K; Moustaki, M; Fretzayas, A
Background The literature reports many variations of Poland’s syndrome. This article describes 18 cases of Poland’s syndrome in different\\u000a stages of treatment, with variable clinical presentations and reconstructive techniques.\\u000a \\u000a \\u000a \\u000a Methods This study evaluated 15 females and 3 males, ages 2 to 43 years, for breast deformity, nipple–areolar complex position, pectoralis\\u000a muscle malformation, thoracic deformities, and the presence of brachysyndactyly. Surgical treatment was
Renato da Silva Freitas; André Ricardo Dall’Oglio Tolazzi; Vanessa Dello Mônaco Martins; Breno Albuquerque Knop; Ruth Maria Graf; Gilvani Azor de Oliveira e Cruz
Background Shigellosis remains considerable public health problem in some developing countries. The nature of Shigellae suggests that they are highly adaptable when placed under selective pressure in a human population. This is demonstrated by variation and fluctuations in serotypes and antimicrobial resistance profile of organisms circulating in differing setting in endemic locations. Antimicrobial resistance in the genus Shigella is a constant threat, with reports of organisms in Asia being resistant to multiple antimicrobials and new generation therapies. Methods Here we compare microbiological, clinical and epidemiological data from patients with shigellosis over three different periods in southern Vietnam spanning14 years. Results Our data demonstrates a shift in dominant infecting species (S. flexneri to S. sonnei) and resistance profile of the organisms circulating in southern Vietnam. We find that there was no significant variation in the syndromes associated with either S. sonnei or S. flexneri, yet the clinical features of the disease are more severe in later observations. Conclusions Our findings show a change in clinical presentation of shigellosis in this setting, as the disease may be now more pronounced, this is concurrent with a change in antimicrobial resistance profile. These data highlight the socio-economic development of southern Vietnam and should guide future vaccine development and deployment strategies. Trial Registration Current Controlled Trials ISRCTN55945881
Background Kaposi sarcoma (KS) is one of the most common pediatric cancers in sub-Saharan Africa. Few data are available about the clinical presentation or response to treatment of children with epidemic (HIV-associated) KS. Methods Medical records of all children with KS and HIV infection referred to the Uganda Cancer Institute in Kampala, Uganda from October 2004 to June 2007 were reviewed. Charts were abstracted for age, sex, location of KS lesions at presentation, biopsy results, CD4 T-cell count and percentage, and KS treatment and outcome. Results Seventy-three children with epidemic KS were identified, 37 males and 36 females. The median age was 10.1 years (range 2 - 18). KS presented with lymph node involvement in 60% of cases. The median absolute and percentage CD4 T-cells at presentation were 210 cells/uL and 7.4%, respectively. Those children with lymphadenopathic KS were younger (mean difference 3.7 years; p = 0.01) and had higher CD4 T-cell counts (mean difference 242 cells/uL; p = 0.03) than those without lymph node involvement. Of 32 patients for whom outcome data were available, a complete response to chemotherapy and/or antiretroviral therapy was documented in 20 (62.5%) patients. Conclusions In comparison to cutaneous involvement, lymph node involvement of epidemic KS occurs at younger ages and at higher CD4 levels. This clinical presentation may reflect recent infection with human herpesvirus 8 followed by a rapid progression to malignancy. Favorable response to treatment was observed in the majority of cases, but prospective studies are needed to determine optimal management.
Gantt, Soren; Kakuru, Abel; Wald, Anna; Walusansa, Victoria; Corey, Lawrence; Casper, Corey; Orem, Jackson
The aim of the study was to compare demographic characteristics, anamnestic findings, cerebrovascular risk factors, and clinical and neuroimaging data of cardioembolic stroke patients with and without atrial fibrillation and of atherothrombotic stroke patients with and without atrial fibrillation. Predictors of early diagnosis of cardioembolic vs. atherothrombotic stroke infarction in atrial fibrillation patients were also determined. Data of cardioembolic stroke patients with (n=266) and without (n=81) atrial fibrillation and of atherothrombotic stroke patients with (n=75) and without (n=377) were obtained from 2000 consecutive patients included in the prospective Sagrat Cor-Alianza Hospital of Barcelona Stroke Registry. Risk factors, clinical characteristics and neuroimaging features in these subgroups were compared. The independent predictive value of each variable on early diagnosis of stroke subtype was assessed with a logistic regression analysis. In-hospital mortality in patients with atrial fibrillation was significantly higher than in non-atrial fibrillation patients both in cardioembolic (32.6% vs. 14.8%, P<0. 005) and atherothrombotic stroke (29.3% vs. 18.8%, P<0.04). Valvular heart disease (odds ratio (OR) 4.6; 95% confidence interval (95% CI) 1.19-17.68) and sudden onset (OR 1.8; 95% CI 0.97-3.63) were predictors of cardioembolic stroke, and subacute onset (OR 8; 95% CI 1.29-49.42), COPD (OR 5.2; 95% CI 1.91-14.21), hypertension (OR 3. 63; 95% CI 1.92-6.85), hypercholesterolemia (OR 2.67; 95% CI 1.13-6. 28), transient ischaemic attack (OR 2.49; 95% CI 1.05-5.90), ischaemic heart disease (OR 2.30; 95% CI 1.15-4.60) and diabetes (OR 2.26; 95% CI 1.14-4.47) of atherothrombotic stroke. In conclusion, some clinical features at stroke onset may help clinicians to differentiate cerebral infarction subtypes in patients with atrial fibrillation. Atrial fibrillation is associated with a higher in-hospital mortality both in cardioembolic and atherothrombotic stroke patients. PMID:10748308
Arboix, A; García-Eroles, L; Massons, J B; Oliveres, M; Pujades, R; Targa, C
Background Drug-induced liver injury (DILI) is increasingly recognized as a common cause of acute hepatitis. The clinical impact of DILI following liver transplantation (LT) is not known. Aims To describe the frequency, clinical presentation, and outcomes of DILI among LT recipients. Methods LT recipients with possible DILI were identified using electronic pathology and clinical note database retrieval tools. Diagnostic criteria were applied to identify cases of DILI. Results Among 1689 LT recipients, 29 individuals with DILI (1.7%) were identified. Mean age was 52 years with 52 % women. Major indications for LT were primary sclerosing cholangitis (28%), cholangiocarcinoma (14%), and hepatocellular carcinoma (14%). Severity of DILI was mild or moderate in 92% of cases. Nausea or diarrhea (31%), jaundice (24%), and pruritus (10%) were the most common symptoms at diagnosis. Mean ALT was 204±263 U/L, AST 108 ± 237 U/L, ALP 469 ± 689 U/L, and TB 1.9±10.3 mg/dL. Median duration of medication use until DILI diagnosis was 57 days, and major classes of agents were antibiotics (48%), immunosuppressive agents (14%), and antihyperlipidemic drugs (7%), Trimethoprim-sulfamethoxazole was the most common single implicated agent (n=11). Serum liver enzymes improved within a median time of 34 days (range, 5-246 days) after drug withdrawal. Hepatic re-transplantation or death did not occur. Among 50 cases with possible DILI explained by other causes, 13 (26%) individuals had no alternate diagnosis despite histology compatible with DILI. Conclusions DILI is a rare yet under-recognized event among LT recipients. The majority of cases are not clinically severe, and resolve following drug cessation without hepatic retransplantation or death.
Sembera, Stepan; Lammert, Craig; Talwalkar, Jayant A.; Sanderson, Schuyler O.; Poterucha, John J.; Hay, J. Eileen; Wiesner, Russell H.; Gores, Gregory J.; Rosen, Charles B.; Heimbach, Julie K.; Charlton, Michael R.
Background Angina without significant stenosis, or nonobstructive coronary artery disease, attracts clinical attention. Microvascular coronary artery spasm (microvascular CAS) can cause nonobstructive coronary artery disease. We investigated the clinical features of microvascular CAS and the therapeutic efficacy of calcium channel blockers. Methods and Results Three hundred seventy consecutive, stable patients with suspected angina presenting nonobstructive coronary arteries (<50% diameter) in coronary angiography were investigated with the intracoronary acetylcholine provocation test, with simultaneous measurements of transcardiac lactate production and of changes in the quantitative coronary blood flow. We diagnosed microvascular CAS according to lactate production and a decrease in coronary blood flow without epicardial vasospasm during the acetylcholine provocation test. We prospectively followed up the patients with calcium channel blockers for microvascular coronary artery disease. We identified 50 patients with microvascular CAS who demonstrated significant impairment of the endothelium-dependent vascular response, which was assessed by coronary blood flow during the acetylcholine provocation test. Administration of isosorbide dinitrate normalized the abnormal coronary flow pattern in the patients with microvascular CAS. Multivariate logistic regression analysis indicated that female sex, a lower body mass index, minor–borderline ischemic electrocardiogram findings at rest, limited–baseline diastolic-to-systolic velocity ratio, and attenuated adenosine triphosphate–induced coronary flow reserve were independently correlated with the presence of microvascular CAS. Receiver-operating characteristics curve analysis revealed that the aforementioned 5-variable model showed good correlation with the presence of microvascular CAS (area under the curve: 0.820). No patients with microvascular CAS treated with calcium channel blockers developed cardiovascular events over 47.8±27.5 months. Conclusions Microvascular CAS causes distinctive clinical features and endothelial dysfunction that are important to recognize as nonobstructive coronary artery disease so that optimal care with calcium channel blockers can be provided. Clinical Trial Registration URL: www.umin.ac.jp/ctr. Unique identifier: UMIN000003839.
Ohba, Keisuke; Sugiyama, Seigo; Sumida, Hitoshi; Nozaki, Toshimitsu; Matsubara, Junichi; Matsuzawa, Yasushi; Konishi, Masaaki; Akiyama, Eiichi; Kurokawa, Hirofumi; Maeda, Hirofumi; Sugamura, Koichi; Nagayoshi, Yasuhiro; Morihisa, Kenji; Sakamoto, Kenji; Tsujita, Kenichi; Yamamoto, Eiichiro; Yamamuro, Megumi; Kojima, Sunao; Kaikita, Koichi; Tayama, Shinji; Hokimoto, Seiji; Matsui, Kunihiko; Sakamoto, Tomohiro; Ogawa, Hisao
Splanchnic vein thrombosis (SVT) is an unusual manifestation of venous thromboembolism which involves one or more abdominal veins (portal, splenic, mesenteric and supra-hepatic veins). SVT may be associated with different underlying disorders, either local (abdominal cancer, liver cirrhosis, intra-abdominal inflammation or surgery) or systemic (hormonal treatment, thrombophilic conditions). In the last decades, myeloproliferative neoplasm (MPN) emerged as the leading systemic cause of SVT. JAK2 mutation, even in the absence of known MPN, showed a strong association with the development of SVT, and SVT was suggested to be the first clinical manifestation of MPN. Recently, an association between SVT, in particular supra-hepatic vein thrombosis, and paroxysmal nocturnal hemoglobinuria has also been reported. SVT occurs with heterogeneous clinical presentations, ranging from incidentally detected events to extensive thrombosis associated with overt gastrointestinal bleeding, thus representing a clinical challenge for treatment decisions. In the absence of major contraindications, anticoagulant therapy is generally recommended for all patients presenting with acute symptomatic SVT, but there is no consensus about the use of anticoagulant drugs in chronic or incidentally detected SVT. High quality evidence on the acute and long-term management is substantially lacking and the risk to benefit-ratio of anticoagulant therapy in SVT still needs to be better assessed. PMID:23026649
Riva, Nicoletta; Donadini, Marco P; Dentali, Francesco; Squizzato, Alessandro; Ageno, Walter
The incidence of and mortality from squamous cell carcinoma (SCC) of the tongue have increased during the recent decades in the Western world. Much effort has been made to predict tumour behaviour, but we still lack specific prognostic indicators. The aim of our study was to evaluate the relative importance of the known demographic, clinical and histological factors in a homogeneous population-based group of patients with SCC of the mobile tongue. The demographic and clinical factors were reviewed retrospectively from primary and tertiary care patient files. Histological prognostic factors were determined from pre-treatment biopsies. The TNM stage was found to be the most important prognostic factor. In particular, local spread outside the tongue rather than spread to regional lymph nodes was related to poor prognosis. Several demographic and histopathological factors were closely related to TNM stage. When the cases were divided into stage I–II carcinomas and stage III–IV carcinomas, it appeared that the patient’s older age (> 65 years), a high malignancy score and an absence of overexpressed p53 protein were associated with a poorer prognosis in stage I–II carcinomas. Such cases may require more aggressive treatment. Among patients with stage III–IV carcinomas, heavy use of alcohol was significantly associated with a poor disease-specific survival time. © 2000 Cancer Research Campaign
Kantola, S; Parikka, M; Jokinen, K; Hyrynkangs, K; Soini, Y; Alho, O-P; Salo, T
We analyzed the clinical presentation of 800 severe malaria cases six months to 15 years of age (mean +/- SD = 4.3 +/- 3.0) recruited at the pediatric ward of the Ouagadougou University Hospital, and at the Sourou and Nayala District Hospitals in Burkina Faso. Inclusion criteria followed the World Health Organization (WHO) definition of severe and complicated malaria. The children were treated according to WHO guidelines with a complete regimen of drugs that were provided free of charge as part of the study. The case fatality rate of each sign and symptom of severe malaria was calculated on the 686 children whose outcomes were known. A total of 95 patients (13.8%) died while in the hospital; the mean +/- SD age of these children was 3.2 +/- 2.1 years. The age distribution and the clinical patterns of severe malaria was compared in patients from the urban areas of Ouagadougou characterized by relatively low transmission, and from rural areas where the mean inoculation rates are at least 20-fold higher. The mean +/- SD age of the urban and rural patients was 4.8 +/- 3.0 and 2.2 +/- 1.9 years, respectively (P < 0.001). The prevalence of coma was higher in the urban subsample (53.6% versus 28.9%; P < 0.001) while that of severe anemia (hemoglobin < 5 g/dL) was higher in rural patients (47.4% versus 14.8%; P < 0.001). Our data, in line with previous results obtained comparing rural areas characterized by different inoculation rates, show that the epidemiologic context influences the clinical presentation of severe malaria. PMID:9790426
Modiano, D; Sirima, B S; Sawadogo, A; Sanou, I; Paré, J; Konaté, A; Pagnoni, F
Old world cutaneous leishmaniasis (OWCL) usually causes a single, self-healing and uncomplicated lesion mainly on the exposed area of body. This report presents four cases of OWCL from Iran that misdiagnosed with sarcoidosis, lymphoma, and acne agminata. Two out of four patients showed a history of purplish red plaques for at least 5 years who misdiagnosed as sarcoidosis because of histological and clinical characteristics. The other one presented with flesh-colored nodules disseminated all over his skin that was misdiagnosed as lymphoma for ten years. The last patient was misdiagnosed as acne agminata due to tuberculoid reactions in examination of the lesion biopsy. All the patients responded to the treatment with meglumine antimonate. PMID:23690110
Moravvej, Hamideh; Barzegar, Mohammadreza; Nasiri, Soheila; Abolhasani, Ehsan; Mohebali, Mehdi
Cutaneous sarcomatoid carcinoma is a high-grade malignancy. We describe a clinical case of an aggressive sarcomatoid carcinoma in an 87-year-old woman, who presented to the outpatients department with a haemorrhagic nodule on the dorsum of her right hand. By the time of excision 3 weeks later, the nodule had enlarged to 100 × 90 × 65 mm in size. On histological examination, a poorly differentiated carcinoma was seen, with both carcinomatous and sarcomatous elements, in keeping with a sarcomatoid carcinoma. The tumour was positive for cytokeratin, epithelial, smooth-muscle actin, and vimentin stains. Two months later, the patient presented with a recurrent growth on the excised scar along with numerous large right axillary lymph nodes. A right axillary dissection along with excision of the growth confirmed tumour recurrence with metastasis to lymph nodes. Soon after, the patient developed cerebral metastasis, which proved fatal. This case thus highlights the aggressive potential of sarcomatoid carcinoma. PMID:22439885
Chittari, K; Birnie, A J; Kulkarni, K R; Perks, A G B; Varma, S
Objective To aid in the timely diagnosis of patients who present with clinically isolated syndrome (CIS). Patients and methods We studied 25 patients (18 women, 7 men), originally presented in our clinic with a CIS suggestive of multiple sclerosis (MS). All patients underwent the full investigation procedure including routine tests, serology, cerebrospinal fluid (CSF) examinations, evoked potentials (EPs), and magnetic resonance imaging (MRI) of brain and cervical spinal cord. Patients were imaged at baseline, and every three months thereafter up to a year. Results The CIS was consisted of optic neuritis in 12 cases, incomplete transverse myelitis (ITM) in 7 cases, Lhermitte sign in 2 cases, internuclear ophthalmoplegia (INO) in 2 cases, mild brainstem syndrome in 1 case, and tonic-clonic seizures in 1 case. Using the baseline and three-month scans 18/25 (72%) patients developed definite MS in one year of follow up while 7 (28%) had no further findings during this observation period. Immunomodulatory treatments were applied to all definite MS patients. Conclusion In light of new treatments available, MRIs at 3 month intervals are helpful to obtain the definite diagnosis of MS as early as possible.
Pelidou, Sigliti-Henrietta; Giannopoulos, Sotirios; Tzavidi, Sotiria; Lagos, Georgios; Kyritsis, Athanassios P
Muscle-eye-brain disease (MEB) is an autosomal recessive congenital muscular dystrophy with ocular abnormalities and type II lissencephaly. MEB is caused by mutations in the protein O-linked mannose beta1,2-N-acetylglucosaminyltransferase (POMGnT1) gene on chromosome 1q33. POMGnT1 is a glycosylation enzyme that participates in the synthesis of O-mannosyl glycan. The disease is characterized by altered glycosylation of alpha-dystroglycan. The clinical spectrum of MEB phenotype and POMGnT1 mutations are significantly expanded. We would like to present two cases with MEB disease with POMGnT1 mutations, whose clinical picture shows heterogeneity. The patient with R442H mutation had the classical form of the disease although the one with IVS17-2A-->G homozygous mutation had severe autistic features as the dominating presenting sign. These two cases represent different spectrums of one disorder. To the best of our knowledge, autistic features and stereotypical movements have not been included thus far as a part of broad and heterogeneous MEB spectrum. PMID:15938569
Haliloglu, G; Gross, C; Senbil, N; Talim, B; Hehr, U; Uyanik, G; Winkler, J; Topaloglu, H
AIM To report the characteristics and clinical presentations of retinoblastoma in a series of pediatric patients from Iran. METHODS In this retrospective study, profiles of pediatric patients with retinoblastoma archived in a referral eye hospital in north-west of Iran during 7 years (n=40 patients with 57 eyes) were reviewed. Demographics, as well as the laterality, clinical manifestations and the types of treatment were the major endpoints. The Student's t test, Mann-Whitney U-test, Chi-square or Fishers' Exact test was used for analysis where appropriate. RESULTS There were 23 cases (57.7%) with unilateral and 17 cases (42.5%) with bilateral involvement. The male to female ratio was 1 to 1.4 with a mean admitting age of 24.0±11.3 (range: 5-62) months. The mean diagnosis delay was 7.4±9.6 months (range: 10 days to 13 months). The most common presenting sign was leukocoria (97.5%) followed by proptosis (7.5%), strabismus (7.5%), hyphema (5%), orbital cellulitis (5%) and glaucoma (2.5%). Enucleation was performed in 95.7% of the cases with unilateral involvement and at least one eye of the patients with bilateral disease. A second enucleation was performed in other 3 patients (17.6%) of the latter group. CONCLUSION This is the first study evaluating a series of Iranian children with retinoblastoma.
Nabie, Reza; Taheri, Nazli; Fard, Ali Mahdavi; Fouladi, Rohollah Fadaei
Interstitial lung disease (ILD) is defined as a rare, heterogeneous group of parenchymal lung conditions that develop primarily because of underlying developmental or genetic disorders. Affected infants typically present with clinical syndromes characterized by dyspnea, tachypnea, crackles and hypoxemia. Until recently, the understanding of ILD in infants has been limited largely owing to a lack of evidence-based information of underlying pathogenesis, natural history, imaging findings and histopathological features. However, ILD in infants is now better understood and managed because of (1) advances in imaging methods that result in rapid and accurate detection, (2) improved thoracoscopic techniques for lung biopsy, (3) a consensus regarding the pathological criteria for these particular lung conditions and (4) a new classification system based on the underlying etiology of ILD. This article reviews the new classification system, imaging technique, clinical presentation and imaging findings of ILD in infants. Specialized knowledge of this new classification system in conjunction with recognition of characteristic imaging findings of ILD in infants has great potential for early and accurate diagnosis, which in turn can lead to optimal patient management. PMID:23229343
Lee, Edward Y
Quality of life (QOL) data is complex since it is both multidimensional and longitudinal. This complexity is compounded with its unbalanced nature through missing observations as a consequence of patient non-compliance with assessment schedules, and, for example, in cancer clinical trials data absence due to patient attrition often through death. QOL data poses difficulties for presentation and analysis and hence interpretation. This paper illustrates, using data from a randomized trial of the United Kingdom Medical Research Council Lung Cancer Working Party, a step-by-step approach to presentation of QOL data. This begins with a description of compliance and its relationship with patient attrition caused by death, to a final summary profile to indicate change over time. We recognize that no single summary statistic is likely to be able to encapsulate all the subtleties of QOL data. We stress the importance of examining data graphically before performing detailed analysis and also to facilitate interpretation in the final clinical report. Although a description of analytical methods is not the purpose of this paper, we draw attention to the need for imputing missing values and to the (multi-level) modelling approach to summarizing the data, both essential adjuncts to the less formal methods described here. PMID:9549818
Machin, D; Weeden, S
We describe a family with a rapidly progressive neurodegenerative disorder characterized by amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) but with unusual neuropathologic features that include pallidoluysionigral degeneration. The proband presented with primary progressive aphasia that evolved into mutism. He subsequently developed dementia with mild disinhibition and parkinsonism and late in the disease showed evidence of motor neuron disease. Two other cases (the proband's mother and maternal uncle) had features of ALS exclusively. All 3 had a young onset (fourth decade) and rapid clinical course, with average time from onset of symptoms to death of 4 years. Postmortem neuropathologic examination of the proband and his uncle showed ALS changes and extensive pallidoluysionigral degeneration without neurofibrillary tangles, ubiquitin inclusions, or detectable abnormalities in the dentate nucleus of the cerebellum. Although this exceptional combination of neuropathologic features has been described in rare cases of sporadic ALS-FTD, no pedigrees have ever been reported. In 2 affected members of this family, we failed to identify mutations in genes associated with weakness, movement disorders, or dementia, including ALS, FTD, selected spinocerebellar ataxias, and Huntington disease. Thus, this disorder may represent a novel autosomal dominantly inherited and rapidly progressive neurodegenerative disorder with a spectrum of clinical presentations but common neuropathologic features. PMID:17620990
Portera-Cailliau, Carlos; Russ, Carsten; Brown, Robert H; Budson, Andrew E; Vonsattel, Jean-Paul; Folkerth, Rebecca D; Corbo, Joseph C
ABSTRACT. Objective. Human milk provides neo- nates with a meaningful degree of protection from infec- tion, but the responsible mechanisms are not well under- stood. Discovering these mechanisms is important, because of the possibility of supplementing infant for- mulas with factors that simulate human milk’s protective capacity. We postulated that granulocyte colony-stimu- lating factor (G-CSF), a cytokine known to augment
Darlene A. Calhoun; DO Mathilde Lunøe Yan Du; Robert D. Christensen
A considerable percentage of patients exhibit anemia post kidney transplant. Its origin is multifactorial and the main causes involved depend on the post transplant period considered. We studied in a group of 134 consecutive patients the associated factors and the clinical implications of "late anemia" (6 months post transplant). Multiple regression analysis showed that post transplant oliguria and acute rejection episodes were significantly associated with anemia. Graft survival at 36 months was significantly reduced in the anemic group (83 % versus 96%, p < 0.01). No differences in patients survival or rate of cardiovascular events were observed. We concluded that anemia at 6 months post transplant is independently and significantly associated with events that reduced functioning renal mass and kidney survival. PMID:23570761
Freiberg, Mónica; Chiurchiu, Carlos; Capra, Raúl; Eckhardt, Andrea; De La Fuente, Jorge; Douthat, Walter; De Arteaga, Javier; Massari, Pablo U
Brown tumor or osteoclastoma is a lytic bone tumor, which is common in secondary hyperparathyroidism (1.5-13%) in chronic dialysis patients, mainly in those with untreated renal osteodystrophy. Brown tumor appears as a result from excess osteoclast activity and consists of collections of osteoclasts intermixed with fibrous tissue and poorly mineralized woven bone. It can be manifested as a single or multiple bone lesions. Although invasive, it has no malignant potential and should be distinguished from giant cell tumors of the bone. Two unusual cases of brown tumor in dialysis patients are reported. We present a first patient with five subtotal parathyroidectomies between 2002 and 2009 and a tendency toward recurrence of secondary hyperparathyroidism (sHPTH). The double MRI check up could not reveal any ectopic parathyroid gland. Although the patient had permanently high PTH values, serum calcium level was never above the normal range. However, the brown tumor in the cervical spine was destructing the cervical vertebrae and required surgical intervention. Despite the conservative treatment with calcium and non-calcium-based binders and various forms of vitamin D, the patient's clinical and biochemical condition improved only after the use of cinacalcet. The second patient, a 58-years-old female on chronic hemodialysis since 1998, was found with high PTH serum levels in 2009. The development of sHPTH was scintigraphically confirmed and surgically treated. During the late 2008, she started feeling pain, numbness and swelling of the 3rd right hand finger, prior to the full clinical manifestation of the tumor. The CT scan of the right hand showed osteolytic changes and soft tissue destruction of the middle phalanx of the 3rd right hand finger. This formation corresponded to an unusual presentation of brown tumor associated with sHPTH. As expected, after the parathyroidectomy, there was no marked change in the destructed bone of the 3rd right hand finger middle phalanx, but only a gradual improvement in the subjective clinical condition of the patient. Based on these two reports, we would recommend that in cases of severe or recurrent sHPTH either total parathyroidectomy or early administration of calcimimetics should be considered. Furthermore, the implementation of regular checkup and treatment according to the KDIGO guidelines should be advised and clinical appearance of any bone tumor immediately checked for an association with sHPTH, which is a rather common entity in dialysis patients. PMID:20424916
Resic, H; Masnic, F; Kukavica, N; Spasovski, G
Introduction: Iliopsoas abscess (IPA) is a collection of pus in the iliopsoas compartment, which is considered rare in Japan. However, the number of patients with IPA has recently increased among the elderly or compromised hosts. Subjects and Methods: This retrospective study aims to examine the clinical pictures, pathological findings, and the prognostic factor of IPA. We analyzed all patients with IPA who were admitted to our hospital from April 2006 to July 2011. Patients’ characteristics, treatment, clinical outcome, radiological findings, bacteria isolated, and comorbidities were evaluated. The comorbidities were evaluated by the Charlson comorbidity index (CCI). We compared the survival and non-survival groups to assess the prognostic factors of IPA. Results: A total of 33 patients were enrolled in this study, which included 14 males and 19 females. The mean age of the patients was 71.5 years (range 32-92 years). The most common underlying disease was spinal disease (16 of 33, 48.5%). Twenty-nine patients (87.9%) were cured and four patients (12.1%) died. While 12 patients (36.4%) were initially treated conservatively with antibiotics alone, percutaneous drainage was performed initially in 19 patients (57.6%). Two patients (6%) directly underwent exploratory surgery and open drainage. In terms of patients’ characteristics, there were no significant differences in either group. The score of CCI in non-survivors was higher than that in survivors (1.38 vs. 5.5, P < 0.001). Conclusions: The epidemiology of IPA is quite different from what it used to be. CCI appears to be useful in evaluating the patients’ prognosis with IPA.
Asai, Nobuhiro; Ohkuni, Yoshihiro; Yamazaki, Ikuo; Kawamura, Yasutaka; Kaneko, Norihiro; Aoshima, Masahiro
Central acetabular fracture dislocation is usually caused by high-energy external trauma. However, 26 cases that occurred as a result of a seizure attack appeared in the literature from 1970 to 2007, with the seizure attacks themselves caused by many different factors. In this setting, the central acetabular fracture not caused by direct trauma might initially remain unnoticed leading to a delayed diagnosis. In some cases, this may lead to death as a result of massive blood loss. We here present a case of bilateral central acetabular fracture dislocation as a result of a seizure attack. PMID:23259117
Nehme, Alexandre H; Matta, Jihad F; Boughannam, Alaa G; Jabbour, Fouad C; Imad, Joseph; Moucharafieh, Ramzi
Central acetabular fracture dislocation is usually caused by high-energy external trauma. However, 26 cases that occurred as a result of a seizure attack appeared in the literature from 1970 to 2007, with the seizure attacks themselves caused by many different factors. In this setting, the central acetabular fracture not caused by direct trauma might initially remain unnoticed leading to a delayed diagnosis. In some cases, this may lead to death as a result of massive blood loss. We here present a case of bilateral central acetabular fracture dislocation as a result of a seizure attack.
Nehme, Alexandre H.; Matta, Jihad F.; Boughannam, Alaa G.; Jabbour, Fouad C.; Imad, Joseph; Moucharafieh, Ramzi
Children with intellectual and developmental disabilities are at heightened risk for mental disorders. Using current diagnostic criteria, disruptive behavior disorders, specifically Attention-Deficit/Hyperactivity Disorder (ADHD), appear to be the most prevalent co-occurring disorders. However, the validity of ADHD as a diagnosis for children and adolescents with intellectual disabilities remains unclear. The present study examined the clinical presentation of ADHD (prevalence, sex differences, and comorbidity) among adolescents with and without intellectual disability (ID) as well as investigated the validity of ADHD for adolescents with ID by examining similarities in terms of symptom presentation, developmental course, and associated functional impairment. The sample included 142 adolescents and their families, about a third of whom were classified in the ID group and the remaining were in the typically developing (TD) group. Findings indicated that adolescents with ID continue to be at elevated risk for ADHD (risk ratio: 3.38:1) compared to their typically developing peers. Additionally, the presentation of ADHD appeared similar among adolescents with and without ID, supporting the validity of an ADHD diagnosis for this population of adolescents. Implications for public policy and intervention are discussed. PMID:23224424
Neece, Cameron L; Baker, Bruce L; Crnic, Keith; Blacher, Jan
BACKGROUND: Spondyloepiphyseal dysplasia (SED) is a rare disease that causes vertebral abnormalities and short-trunk dwarfism. The two forms of SED are congenita and tarda. Each form arises in a genetically distinct fashion and manifests with a different set of complications. SED congenita is more severe, and patients usually display atlantoaxial instability and odontoid hypoplasia. Patients often have various neurologic deficits caused by compression of the spinal cord. The region most affected is the craniovertebral junction (CVJ). METHODS: A review of the PubMed Database, 1970 to the present, was performed using the search term "spondyloepiphyseal dysplasia" and limited to English-language articles. The search identified 22 articles discussing COL2A1 gene mutations and 10 clinical articles describing patients with SED and associated spinal abnormalities. RESULTS: Findings from the literature concerning diagnosis, presenting symptoms, and intervention taken are discussed. Additionally, a patient with a diagnosis of SED congenita who presented with bilateral hand numbness is described. The patient underwent a suboccipital craniotomy; posterior decompression of the foramen magnum, the arch of C1, and the lamina of C2; and instrumented fusion of C1-3 to relieve his symptoms. CONCLUSIONS: In this article, the authors survey the current literature surrounding neurosurgical interventions and present an algorithm for treatment. PMID:22381876
Veeravagu, Anand; Lad, Shivanand P; Camara-Quintana, Joaquin Q; Jiang, Bowen; Shuer, Lawrence
This study draws on theory by Solomon Asch (1946, 1952) to examine how presenting with intimate partner violence versus methamphetamine use shapes characteristics of substance abuse assessment interviews. When responding to an initial open-ended question from a substance abuse counselor, the methamphetamine user and intimate partner violence survivor may elicit very different reactions from the counselor. We predicted that these differing presenting problems would initiate different trajectories for overall impression formation. To test this hypothesis, 18 substance abuse practitioners interviewed one standardized patient (an actor portraying a substance abuse client) who alternated her presenting problem between a) violence in a domestic setting and b) methamphetamine use. The remainder of her story was identical for counselors in either presenting problem group. Results included differences between the two groups in median length of the interviews and failure of both groups to explore domestic violence as a cooccurring problem. Clinical practices related to substance abuse counseling and intimate partner violence are discussed in light of these findings. PMID:20070136
Fussell, Holly; Haaken, Janice; Lewy, Colleen S; McFarland, Bentson H
Background: The aim was to determine the clinical characteristics of patients with seasonal rhinitis (SR) and to disclose differences in the treatment of SR between an adult allergy clinic and other clinics over time. Methods: A retrospective study was conducted based on clinical records of 774 out of 955 patients diagnosed with SR in an adult allergy clinic between 1
B. Bozkurt; G. Karakaya; A. F. Kalyoncu
Brain metastases (BM) are the most frequent intracranial SOL and extremely heterogeneous group of tumours from morphological point of view. Nevertheless, studies devoted to BM up to now paid little attention to the histogenesis of the primary tumour. Lung carcinoma is the most common source of BM; morpologically this is a very heterogeneous group of tumors, and they demostrate different clinical pathway and outcome. The aim of present study was to evaluate clinical and morphological prognostic factors in 126 patients with lung carcinoma metastases to the brain, operated in 2004-2010 at Burdenko Neurosurgical Institute. Statistical analysis demonstrated that age, gender, amount and location of BM, primary operation and even histological tumour type were not significant prognostic factors, meanwhile absence of extracranial metastases and Karnofsky index above 70 were significant factors of the favorable prognosis. PMID:23659117
Rotin, D L; Paklina, O V; Kobiakov, G L; Shishkina, L V; Kravchenko, É V; Stepanian, M A
The session was aimed at physicians and physicists with an interest in the use of PET CT and other imaging modalities in clinical trials and clinical medicine. A basic understanding of PET imaging principles is useful as a background for viewing this material.
Differential diagnosis of neck tumours puts precedence on diagnosing neoplastic lesions. In the case of neck tumours, these are unfortunately late signs, but in patients with a primary neoplastic focus within the head and neck, neck tumour is often the first sign of the disease. The authors describe a clinical case of neck tumour with initially unclear etiology. The preoperative diagnostics including ultrasonography, thin-needle puncture, MRI, carotid angiography and videostroboscopy was significant for surgical treatment planning; yet it was the intraoperative clinical picture which indicated that the tumour derived from the inferior parotid pole. The preoperative histopathological diagnosis using thin-needle biopsy: cellulae carcinomatosae and the clinical picture resulted in block operation with neck lymphatic system removal and tissue defect reconstruction by means of a pectoral flap. The histopathological examination confirmed non-cornifying basal cell epithelioma only in the essential lesion with no metastases to lymph nodes and surrounding tissue margins free of infiltrates. Two and a half years after the procedure, the patient presented with a tumour localized on the front thoracic wall and two rapidly enlarging tumours in the nape of the neck. In the collected specimen of the tumour on the front thoracic wall, a diagnosis of acinic cell carcinoma was made. The deteriorating general condition of the patient, his cancer emaciation, problems with movement and suspected liver metastases confirmed by abdominal USG as well as radiological bone lesions resulted in the abandonment of surgical treatment due to disseminated neoplastic process and the patient was referred for palliative care. PMID:20169911
Komorski, Józef Andrzej; Nienartowicz, Jan Marian
Congenital vertebral malformations (CVM) pose a significant health problem because they can be associated with spinal deformities, such as congenital scoliosis and kyphosis, in addition to various syndromes and other congenital malformations. Additional information remains to be learned regarding the natural history of congenital scoliosis and related health problems. Although significant progress has been made in understanding the process of somite formation, which gives rise to vertebral bodies, there is a wide gap in our understanding of how genetic factors contribute to CVM development. Maternal diabetes during pregnancy most commonly contributes to the occurrence of CVM, followed by other factors such as hypoxia and anticonvulsant medications. This review highlights several emerging clinical issues related to CVM, including pulmonary and orthopedic outcome in congenital scoliosis. Recent breakthroughs in genetics related to gene and environment interactions associated with CVM development are discussed. The Klippel-Feil syndrome which is associated with cervical segmentation abnormalities is illustrated as an example in which animal models, such as the zebrafish, can be utilized to provide functional evidence of pathogenicity of identified mutations. PMID:23653580
Giampietro, P F; Raggio, C L; Blank, R D; McCarty, C; Broeckel, U; Pickart, M A
Previous research has examined the relationship between social anxiety disorder (SAD) and substance use disorders. Cannabis use disorders (CUDs) are becoming increasingly problematic within the population of individuals with SAD, yet the nature of this comorbidity remains largely unexamined. The aim of the current study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to examine differences between outpatients with SAD with versus without comorbid CUDs. The current study included 873 outpatients with a current diagnosis of SAD. Patients with SAD and comorbid CUDs (n = 173) were then compared to those with SAD without CUDs (n = 700) on demographic and clinical characteristics. Compared to patients without the comorbidity, patients with comorbid SAD and CUDs were more likely to have a lifetime diagnosis of PTSD and specific phobia and lifetime substance use disorders (including alcohol). SAD patients with comorbid CUDs were also more likely to report better physical health, and fewer limitations related to their physical health. These analyses remained significant after controlling for gender, the presence of other substance use disorders, mood disorders, and other anxiety disorders. Findings of this study suggest that there may be a unique relationship between SAD and CUDs that can potentially impact the clinical presentation of individuals with SAD. Future research is needed to examine the impact of this comorbidity in other patient populations. PMID:22047609
Tepe, Elizabeth; Dalrymple, Kristy; Zimmerman, Mark
The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non-contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival. PMID:11722268
Mayer, T A; Bersoff-Matcha, S; Murphy, C; Earls, J; Harper, S; Pauze, D; Nguyen, M; Rosenthal, J; Cerva, D; Druckenbrod, G; Hanfling, D; Fatteh, N; Napoli, A; Nayyar, A; Berman, E L
Rationale: Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors. Objectives: We sought to identify donor, recipient, and perioperative risk factors for PGD. Methods: We performed a 10-center prospective cohort study enrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was International Society for Heart and Lung Transplantation grade 3 PGD at 48 or 72 hours post-transplant. The association of potential risk factors with PGD was analyzed using multivariable conditional logistic regression. Measurements and Main Results: A total of 1,255 patients from 10 centers were enrolled; 211 subjects (16.8%) developed grade 3 PGD. In multivariable models, independent risk factors for PGD were any history of donor smoking (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2-2.6; P = 0.002); FiO2 during allograft reperfusion (OR, 1.1 per 10% increase in FiO2; 95% CI, 1.0-1.2; P = 0.01); single lung transplant (OR, 2; 95% CI, 1.2-3.3; P = 0.008); use of cardiopulmonary bypass (OR, 3.4; 95% CI, 2.2-5.3; P < 0.001); overweight (OR, 1.8; 95% CI, 1.2-2.7; P = 0.01) and obese (OR, 2.3; 95% CI, 1.3-3.9; P = 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1-5.6; P = 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6-7.7; P = 0.002); and mean pulmonary artery pressure (OR, 1.3 per 10 mm Hg increase; 95% CI, 1.1-1.5; P < 0.001). PGD was significantly associated with 90-day (relative risk, 4.8; absolute risk increase, 18%; P < 0.001) and 1-year (relative risk, 3; absolute risk increase, 23%; P < 0.001) mortality. Conclusions: We identified grade 3 PGD risk factors, several of which are potentially modifiable and should be prioritized for future research aimed at preventative strategies. Clinical trial registered with www.clinicaltrials.gov (NCT 00552357). PMID:23306540
Diamond, Joshua M; Lee, James C; Kawut, Steven M; Shah, Rupal J; Localio, A Russell; Bellamy, Scarlett L; Lederer, David J; Cantu, Edward; Kohl, Benjamin A; Lama, Vibha N; Bhorade, Sangeeta M; Crespo, Maria; Demissie, Ejigayehu; Sonett, Joshua; Wille, Keith; Orens, Jonathan; Shah, Ashish S; Weinacker, Ann; Arcasoy, Selim; Shah, Pali D; Wilkes, David S; Ware, Lorraine B; Palmer, Scott M; Christie, Jason D
In two patients eclampsia started 9 days postpartum. Headache and visual disturbances preceded seizures but none of the classic pre-eclamptic signs oedema, proteinuria, and hypertension were present until shortly before seizure onset. Brain herniation (patient 1) and status epilepticus (patient 2) necessitated neurointensive care management. Brain MRI initially showed only frontal sulcal effacement in one patient but later showed white matter hyperintensities on T2 weighted images and a previously undescribed pattern of cortical-subcortical postgadolinium enhancement on T1 weighted images in both. Neurological deficits and MRI findings were reversed with therapy in both patients. It is concluded that late postpartum eclampsia can manifest without classic prodromi and that characteristic MRI findings may lag behind clinical manifestation.??
Veltkamp, R; Kupsch, A; Polasek, J; Yousry, T; Pfister, H
Many new interventions are being created to address health problems of the developing world. However, many developing countries have fragile health systems and find it difficult to accommodate change. Consequently, it is essential that new interventions are well aligned with health systems and their users. Establishing target product profiles (TPPs) is a critical, early step towards tailoring interventions to suit both of these constituencies. Specific analyses can help identify and establish relevant TPP criteria such as optimal formulation, presentation and packaging. Clinical trials for a new intervention should be designed to address both TPP-specific questions and anticipated use of the intervention in target countries. Examples are provided from research on malaria vaccines that are also applicable to other new public health interventions.
Brooks, Alan; Nunes, Julia K.; Garnett, Andrew; Biellik, Robin; Leboulleux, Didier; Birkett, Ashley J.; Loucq, Christian
We review here 7 cases of neonatal transfusion-associated babesiosis at a NICU in the northeast United States. Transfusion from 2 infected units of blood resulted in the 7 cases described. The clinical presentation was highly variable in this cohort; the extremely low birth weight neonates were the most severely affected. Antibiotic therapy was effective in neonates with mild and asymptomatic infection; however, double-volume exchange blood transfusion with prolonged multidrug treatment was required for the 2 most severe cases. The risk of Babesia microti infection is not eliminated through current blood-bank practices. Neonatologists in endemic areas should have a high index of suspicion for babesiosis in premature infants exposed to blood transfusions. PMID:21890833
Simonsen, Kari A; Harwell, Joseph I; Lainwala, Shabnam
In the past decade, the frequency of diagnosed fungal infections has risen sharply due to several factors, including the increase in the number of immunosuppressed patients resulting from the AIDS epidemic and treatments during and after organ and bone marrow transplants. Linked with the increase in fungal infections is a recent increase in the frequency with which these infections are recalcitrant to standard antifungal therapy. This review summarizes the factors that contribute to antifungal drug resistance on three levels: (i) clinical factors that result in the inability to successfully treat refractory disease; (ii) cellular factors associated with a resistant fungal strain; and (iii) molecular factors that are ultimately responsible for the resistance phenotype in the cell. Many of the clinical factors that contribute to resistance are associated with the immune status of the patient, with the pharmacology of the drugs, or with the degree or type of fungal infection present. At a cellular level, antifungal drug resistance can be the result of replacement of a susceptible strain with a more resistant strain or species or the alteration of an endogenous strain (by mutation or gene expression) to a resistant phenotype. The molecular mechanisms of resistance that have been identified to date in Candida albicans include overexpression of two types of efflux pumps, overexpression or mutation of the target enzyme, and alteration of other enzymes in the same biosynthetic pathway as the target enzyme. Since the study of antifungal drug resistance is relatively new, other factors that may also contribute to resistance are discussed.
White, Theodore C.; Marr, Kieren A.; Bowden, Raleigh A.
Epidermodysplasia verruciformis (EV) is a rare autosomal-recessive condition associated with a predisposition to infection with specific types of human papillomaviruses. A spectrum of wart-like lesions on the face, dorsa of the hands, and legs are characteristic clinical findings. Lesions usually develop in early childhood, persist, and may eventuate in cutaneous squamous cell carcinoma, usually in sun-exposed areas. These lesions are locally destructive and sometimes metastasize. We present a case of a 34-year-old African American woman with EV with a 9-month history of a right index finger ungual longitudinal pigmented band and nail splitting. Biopsy showed hyperkeratotic and parakeratotic subungual epithelium with verrucous hyperplasia. The superficial keratinocytes showed koilocytic changes. In addition, there was extensive, focally full-thickness keratinocyte dysmaturation with variable nuclear atypia and numerous mitotic figures, without apparent invasion. An associated melanocytic hyperplasia (confirmed by Melan-A stain), composed of large, pigment-laden dendritic melanocytes, was present without appreciable atypia or pagetoid spread. The findings are of a squamous cell carcinoma in situ arising in association with EV with incidental melanocytic hyperplasia. To the best of our knowledge, this is first report of a subungual presentation of this condition with associated melanonychia. PMID:19033934
Stetsenko, Galina Y; McFarlane, Rob J; Chien, Andy J; Fleckman, Philip; Swanson, Paul; George, Evan; Argenyi, Zsolt B
Helicobacter pylori infection, peptic ulcer and gastric cancer are common problems in Egypt. We investigated the prevalence of cagA-positive Helicobacter pylori infections among Egyptian adults in relation to presentation (e.g. dyspepsia vs asymptomatic controls) in Minofyia, Egypt. Patients included men or women seeking care for at least 3 months of upper gastrointestinal symptoms. Helicobacter pylori status was determined by rapid urease test and gastric histopathology in patients and by anti-Helicobacter pylori IgG antibodies in controls. CagA status was determined using an anti-cag A ELISA. 99 Helicobacter pylori infected patients were entered including 90 dyspeptic patients (30 each with gastric cancer, peptic ulcer, and non-ulcer dyspepsia) and 9 non-dyspeptic healthy controls. Age ranged from 27 to 78 y (mean 49.5 y); 50% were men. Anti-cagA antibodies were present in 62.2% of dyspeptic patients compared with 11% of asymptomatic controls (p = 0.004). Anti-cagA antibodies were more prevalent among dyspeptic patients with gastric cancer or peptic ulcer (73.3%) compared to those with non-ulcer dyspepsia (40%) (p = 0.004). The prevalence of cagA in Egypt was related to the clinical presentation of Helicobacter pylori infection being lowest in asymptomatic controls (11.1%) and increasingly prevalent in non-ulcer dyspepsia (40%), peptic ulcer (66.7%), and gastric cancer (89%). PMID:19086246
Said Essa, Abdallah; Alaa Eldeen Nouh, Mohammed; Mohammed Ghaniam, Naglaa; Graham, David Y; Said Sabry, Hany
Aims The characteristic histological feature of autoimmune hepatitis (AIH) is interface hepatitis with predominant portal lymphoplasmacytic necroinflammatory infiltration. Centrilobular necrosis (CN), reminiscent of toxic or circulatory liver injury, has been reported in AIH. The aim of this study was to assess the frequency of CN in patients with AIH and its correlation with laboratory and clinical data. Methods Liver biopsies were obtained from 114 patients (90 women, 24 men, mean (SD) age 45.4 (19.4)?years) with AIH and were evaluated under code by a single pathologist according to the modified Knodell score. Results CN was found in 20 (17.5%) patients with virtually unaffected portal areas in four cases. Patients with AIH with CN had a higher total hepatic activity index (median (range) 11 (6 to 15) v 5 (2 to 10)) and presented less frequently with cirrhosis (10% v 38%). Patients with CN had a higher frequency of acute onset (87% v 32%), higher bilirubin (median (range) 12.0 (0.43 to 40.0) v 1.9 (0.36 to 46)) and higher ALT levels (median (range) 25.6 (2.7 to 63.9) v 7.2 (0.7 to 62.6)), than did patients with AIH without centrizonal injury. Conclusion CN with sparing of the portal areas represents a rare histological pattern in AIH. CN is associated with an acute clinical presentation and might reflect an early lesion preceding portal involvement. Recognition of this particular histological appearance enables early diagnosis of AIH and a timely initiation of immunosuppressive therapy.
Hofer, H; Oesterreicher, C; Wrba, F; Ferenci, P; Penner, E
So-called 'absent pulmonary valve syndrome' is a rare cardiac malformation, usually associated with tetralogy of Fallot. Congenital absence of the leaflets of the pulmonary valve is less common when the ventricular septum is intact. Characteristic features of the syndrome include dysplasia or absence of the pulmonary valvar leaflets, permitting severe pulmonary regurgitation, and aneurysmal dilation of the pulmonary arteries. The purpose of our study was to review our experience with patients diagnosed as having the absent pulmonary valve syndrome, and to describe their clinical presentation, natural history, and outcome. We reviewed retrospectively data from 18 patients with absent pulmonary valve syndrome, 10 boys and eight girls, treated between March 1983 and May 2003. We identified two groups of patients, one made up of 11 patients with a ventricular septal defect, in whom the morphology of the subpulmonary outflow tract was phenotypic for tetralogy of Fallot, and another group, with seven patients, having an intact ventricular septum. Family history of congenital heart disease was common only in patients with ventricular septal defect, being found in 73%, all of whom were diagnosed during infancy with variable respiratory distress. Diagnosis was delayed in 43% of the patients with an intact ventricular septum. Cardiac surgery was performed in eight patients with ventricular septal defect (73%), compared to only two patients (28%) with an intact ventricular septum. Overall mortality was 28%, with five patients dying. Although our sample was small, two clinical patterns emerged depending on the presence or absence of a ventricular septal defect. Patients with a ventricular septal defect and phenotypic features of tetralogy of Fallot have a strong family history of congenital cardiac disease, develop respiratory symptoms during infancy and exhibit a variable prognosis, despite cardiac surgery. Patients with an intact ventricular septum are usually asymptomatic, present later in life, and show a relatively benign prognosis. PMID:15680047
Zucker, Nili; Rozin, Ilya; Levitas, Aviva; Zalzstein, Eli
ObjectivesTo describe patterns of service use and to predict risk factors for re-presentation to a metropolitan emergency department (ED) among people who are homeless.MethodsA retrospective cohort analysis was undertaken over a 24-month period from a principal referral hospital in Melbourne, Australia. All ED visits relating to people classified as homeless were included. A predictive model for risk of re-presentation was
G. Moore; M. F. Gerdtz; G. Hepworth; E. Manias
Minority melanoma patients have worse survival. In this study, we evaluated the impact of socioeconomic and demographic factors\\u000a on minority melanoma patients presenting to two different New York City hospitals (one public and one private) managed by\\u000a the same multidisciplinary team. Sociodemographic and clinicopathologic characteristics were retrieved for melanoma patients\\u000a presenting to Bellevue Hospital Center (BHC), a public hospital, and
Lindsay G. WichMichelle; Michelle W. Ma; Leah S. Price; Stanislav Sidash; Russell S. Berman; Anna C. Pavlick; George Miller; Umut Sarpel; Judith D. Goldberg; Iman Osman
Lay Abstract Gastrointestinal dysfunction (GID) in children with autism spectrum disorder (ASD) is not well understood. Differences in factors associated with GID, such as eating habits, have been reported between ASD and non-ASD populations, but relationships between these factors and GID have not been examined. There is also the possibility that what we do know about GID in ASD is influenced by parents’ perceptions of GID in their children. Although parents know their children best, they are not necessarily experts in determining GID. This study examined how well parents and pediatric gastrointestinal clinicians agree on GID in children, and how factors thought to relate to GID in ASD, actually do relate to GID. 121 children were studied, in three groups: co-occurring ASD and GID, ASD without GID, and GID without ASD. Clinical evaluations by pediatric gastroenterologists validated parental reports of GID in ASD, with constipation the leading type of GID in ASD. Presence of GID in ASD was not associated with differences in diet or medications, but was associated with language and social impairments. These findings suggest that healthcare providers of children with ASD should be vigilant for GID, particularly in children who lack the ability to communicate verbally. Scientific Abstract The objectives of this study were to characterize gastrointestinal dysfunction (GID) in autism spectrum disorder (ASD), to examine parental reports of GID relative to evaluations by pediatric gastroenterologists, and to explore factors associated with GID in ASD. 121 children were recruited into three groups: co-occurring ASD and GID, ASD without GID, and GID without ASD. A pediatric gastroenterologist evaluated both GID groups. Parents in all three groups completed questionnaires about their child’s behavior and GI symptoms, and a dietary journal. Functional constipation was the most common type of GID in children with ASD (85.0%). Parental report of any GID was highly concordant with a clinical diagnosis of any GID (92.1%). Presence of GID in children with ASD was not associated with distinct dietary habits or medication status. Odds of constipation were associated with younger age, increased social impairment, and lack of expressive language (adjusted odds ratio in nonverbal children: 11.98, 95% CI 2.54 – 56.57). This study validates parental concerns for GID in children with ASD, as parents were sensitive to the existence, although not necessarily the nature, of GID. The strong association between constipation and language impairment highlights the need for vigilance by healthcare providers to detect and treat GID in children with ASD. Medications and diet, commonly thought to contribute to GID in ASD, were not associated with GID status. These findings are consistent with a hypothesis that GID in ASD represents pleiotropic expression of genetic risk factors.
Gorrindo, Phillip; Williams, Kent C.; Lee, Evon B.; Walker, Lynn S.; McGrew, Susan G.; Levitt, Pat
Primary mediastinal large B-cell lymphoma (PMLBCL) is a unique clinico-pathological subtype, for which there is no optimal\\u000a therapy yet. We evaluated clinical characteristics and prognostic factors in 39 consecutive, previously untreated Chinese\\u000a patients with PMLBCL. The median age was 28 years (range 16–72 years). The majority of patients were stage I\\/II (23 cases,\\u000a 59%). Bulky mediastinal mass was present in 18 cases
Ying-Jie ZhuJia-Jia; Jia-Jia Huang; Yi Xia; Wei Zhao; Wen-Qi Jiang; Tong-Yu Lin; Hui-Qiang Huang; Zhi-Ming Li
Thalidomide is an effective treatment for several inflammatory and autoimmune disorders including erythema nodosum leprosum, Behcet's syndrome, discoid lupus erythematosus, and Crohn's disease. Thalidomide is believed to exert its anti-inflammatory effects, at least in part, by inhibiting tumor necrosis factor-? (TNF-?) production by monocytes. We studied the effects of thalidomide on epidermal Langerhans cells (LC). LCs are epidermal antigen-presenting dendritic
Liang Deng; Wanhong Ding; Richard D. Granstein
|Two Clinical Pharmacokinetics Laboratories at Buffalo are described: one at the Millard Fillmore Hospital and the other at the Buffalo Children's Hospital. Their research efforts are reviewed and their scientific contributions to clinical therapeutics and pharmaceutical research are noted. (LBH)|
Koup, Jeffrey R.
During a triinstitutional study to test whether individually ventilated caging systems impaired welfare and reproduction relative to static housing systems, varying numbers (2 to 7) of discoid-shaped, fleshy structures were found in utero of 17 postpartum female mice on study. Further investigation revealed these structures to be retained fetal membranes (RFM). A point prevalence of 24.3% was calculated based on a total population of 70 postpartum female mice on study. This finding was preceded by 3 typical clinical presentations, which are described here. We designed a case-control matched cross-sectional epidemiologic study to identify associated risk factors and antemortem indicators of RFM. Housing on the bottom shelves and attachment to the rack systems were factors associated with a diagnosis of the condition. In addition, neutrophilia, monocytosis, lymphopenia, and decreasing hematocrit values were associated with the diagnosis of RFM. These results confirmed that a CBC can be a useful antemortem screening test for the identification of affected mice. We conclude that RFM are likely an incidental finding although they may present concurrent with other pregnancy complications.
Johnson, Jenelle K; Vemulapalli, Tracy H; Van Alstine, William G; Roberts, Christopher S; Garner, Joseph P; Hickman, Debra L
Background Approximately 2/3 of Veterans admitting to Veterans Health Administration (VHA) facilities present >12?hours after symptom onset of acute myocardial infarction (AMI) (“late presenters”). Veterans admitted to VHA facilities with AMI may delay hospital presentation for different reasons compared to their general population counter parts. Despite the large descriptive literature on factors associated with delayed presentation in the general population, the literature describing these factors among the Veteran AMI population is limited. The purpose of this analysis is to identify predictors of late presentation in the Veteran population presenting with AMI to VHA facilities. Identifying predictors will help inform and target interventions for Veterans at a high risk of late presentation. Methods In our cross-sectional study, we analyzed a cohort of 335 male Veterans from nine VHA facilities with physician diagnosed AMI between April 2005 and December 2006. We compared demographics, presentation characteristics, medical history, perceptions of health, and access to health care between early and late presenting Veterans. We used standard descriptive statistics for bivariate comparisons and multivariate logistic regression to identify independent predictors of late presentation. Results Our cohort was an average of 64?±?10?years old and was 88% white. Sixty-eight percent of our cohort were late presenters. Bivariate comparisons found that fewer late presenters had attended at least some college or vocational school (late 53% vs. early 66%, p?=?0.02). Multivariate analysis showed that presentation with ST-elevation myocardial infarction (STEMI) was associated with early presentation (OR?=?0.4 95%CI [0.2, 0.9]) and ?2 angina episodes in the prior 24?hours (versus 0-1 episode) was associated with late presentation (OR?=?7.5 95%CI [3.6,15.6]). Conclusions A significant majority of Veterans presenting to VHA facilities with AMI were late presenters. We found few differences between early and late presenters. Having a STEMI was independently associated with early presentation and reporting ?2 angina episodes in the 24?hours prior to hospital admission was independently associated with late presentation. These independent predictors of early and late presentation are similar to what has been reported for the general population. Despite these similarities to the general population, there may be untapped opportunities for patient education within the VHA to decrease late presentation.
This paper concerns factors relating to the clinic and the way in which the insertion of IUDs is managed from a psychological and technical standpoint. 3 aspects of clinical service are examined: 1) the influence of the psychological state at time of insertion, 2) individual differences in relation to side effects amongst users and the way in which those are influenced by managment techniques, and 3) technical aspects of the insertion of the device. Insertion pain and discomfort may influence subsequent tolerance of the IUD in 3 ways: 1) patient compliance may be enhanced by trouble-free insertion, 2) an unpleasant experience may influence attitudes towards the IUD, and 3) the experience of pain at insertion may reduce subsequent tolerance of discomfort. IUDs increase the amount of menstrual flow which, along with pain, constitute frequent requests for removal. Removal rates for pain and bleeding vary from 0-16.8/100 users. Removal rates for bleeding are also influenced by cultural attitudes. Insertion techniques influence acceptability of IUDs. Also, the incidence of expulsion, pregnancy, and removal declines with increasing age and parity. Discontinuation rates after 24 months were 91% for women below 2nd parity and only 37% for women of 6 or more parity. In the youngest age group the discontinuation rate was 76% compared with 35% in the oldest age group. The timing of IUD insertion and positioning of the IUD influence continuation rates. An implication of these concerns is that IUD insertion procedures may have to become more complex to achieve compatibility between IUD-uterine configurations. PMID:12264121
Reading, A E; Goldstuck, N D
Background Brain metastases (BM) from hepatocellular carcinoma (HCC) are extremely rare and are associated with a poor prognosis. The aim of this study was to define clinical outcome and prognostic determinants in patients with BM from HCC. Methods Between January 1994 and December 2009, all patients with HCC and BM treated in Sun Yat-sen University Cancer Center were retrospectively reviewed. Univariate and multivariate survival analyses were performed to identify possible prognostic factors. Results Forty-one patients were diagnosed with BM from HCC, an incidence of 0.47%. The median age at diagnosis of BM was 48.5 years. Thirty-three patients (80.5%) developed extracranial metastases at diagnosis of BM, and 30 patients (73.2%) had hepatitis B. Intracranial hemorrhage occurred in 19 patients (46.3%). BM were treated primarily either with whole brain radiation therapy (WBRT; 5 patients), stereotactic radiosurgery (SRS; 7 patients), or surgical resection (6 patients). The cause of death was systemic disease in 17 patients and neurological disease in 23. Patients in a high RPA (recursive partitioning analysis) class, treated with conservatively and without lung metastases, tended to die from neurological disease. Median survival after the diagnosis of BM was 3 months (95% confidence interval: 2.2-3.8 months). In multivariate analysis, the presence of extracranial metastases, a low RPA class and aggressive treatment, were positively associated with improved survival. Conclusions BM from HCC is rare and associated with an extremely poor prognosis. However, patients with a low RPA class may benefit from aggressive treatment. The clinical implication of extracranial metastases in HCC patients with BM needs further assessment.
A prospective study was performed to evaluate the presentation, therapeutic management, and clinical outcome of nonfunctioning pituitary adenomas (NFPAs). In most of 385 consecutive patients, NFPAs were macroadenomas. The mean follow-up duration was 5.5 ± 1.4 years. Presentation was dominated by headache, visual disturbance, and hypopituitarism. Pituitary apoplexy (clinical and subclinical) was observed in 88 patients. Appropriate steroids replacement was given before surgery. Endoscope-assisted transsphenoidal surgery (TSS) was performed, and was well tolerated by all patients. At discharge, visual disturbances were improved in 215 (87.6%) patients who had complained of visual impairment preoperatively. The shorter the time from presentation of pituitary apoplexy to surgery, the better the outcome in visual function. Seventy-two (18.7%) patients developed transient diabetes insipidus (DI) and 85 (22.1%) patients developed hyponatremia, but all these improved within six weeks. Hypocortisolism was confirmed in 84 (21.8%) patients with an abnormal postoperative day 2 (POD2) 0800 serum cortisol level and in 122 (31.7%) patients with an abnormal POD6 0800 serum cortisol level. Hypothyroidism occurred in 135 (35.1%) patients. Steroids replacement was thus given immediately. Eight (2.1%) patients needed lifetime hormone substitution. No adrenal crisis occurred. Five (1.3%) patients died within six weeks. Residual tumors were confirmed in 79 patients (20.8%) by postoperative four-month enhanced MR imaging. Tumor recurrence or regrowth occurred in 56 patients (14.7%) during the follow-up period. These patients required repeat TSS or radiosurgery. The findings of this study support the use of TSS as a feasible initial treatment for NFPAs. With appropriate perioperative management of abnormal fluid, electrolyte, and endocrinological function, TSS was associated with minimum morbidity and was well tolerated by patients regardless of age. However, close screening of pituitary function and adequate neuroradiological follow-up should be performed after surgery for detection of tumor recurrence or regrowth. The indications for repeat TSS and postoperative radiosurgery in residual or recurrent NFPAs should be better defined. PMID:20730474
Chen, Lukui; White, William L; Spetzler, Robert F; Xu, Bainan
We prospectively studied 110 adult patients coming to Black Lion Hospital between August 1987 and July 1989 with community acquired pneumonia (CAP) for various etiologic agents and clinical and radiographic presentation. Streptococcus pneumoniae was the most common offending pathogen in 72% and 67.5% from sputum and lung aspirate (LA) Gram stain respectively, and in 41% by pneumococcal serotyping of sputum. Blood and LA culture grew Streptococcus pneumoniae in 4 (6%), Staphylococcus aureus in 4 (6%), Enterobacteriaceae in (3%), Pseudomonas, Klebsiella and Streptococcus viridans in one case each. Non-bacterial pathogens included Mycoplasma pneumoniae in 3 (3%), Influenza A in 4 (4%), Influenza B in 3 (3%) and psittacosis/LGV in 4 (4%). Fever, cough, chest pain, tachypnea and coarse crepitations/bronchial breathing were the most common presenting signs and symptoms. Thirty per cent had associated diarrhoea and vomiting initially and 9% had altered state of consciousness at admission. Six patients came in a state of shock. Thirty-nine per cent had underlying illnesses. Ninety-three per cent had either segmental or lobar consolidation. Parapneumonic effusion occurred in 14%. The mortality was 11%. Tachypnea, the presence of underlying illness, altered state of consciousness, extreme leucocytosis and the presence of bilateral and multilobar lung involvement were found to be signs of poor prognosis. Our finding is similar to those from other African countries, except that we are reporting psittacosis/LGV for the first time in Africa. PMID:8033877
We describe seven Turkish children with DOCK8 deficiency who have not been previously reported. Three patients presented with typical features of recurrent or severe cutaneous viral infections, atopic dermatitis, and recurrent respiratory or gastrointestinal tract infections. However, four patients presented with other features. Patient 1-1 featured sclerosing cholangitis and colitis; patient 2-1, granulomatous soft tissue lesion and central nervous system involvement, with primary central nervous system lymphoma found on follow-up; patient 3-1, a fatal metastatic leiomyosarcoma; and patient 4-2 showed no other symptoms initially besides atopic dermatitis. Similar to other previously reported Turkish patients, but in contrast to patients of non-Turkish ethnicity, the patients’ lymphopenia was primarily restricted to CD4+ T cells. Patients had homozygous mutations in DOCK8 that altered splicing, introduced premature terminations, destabilized protein, or involved large deletions within the gene. Genotyping of remaining family members showed that DOCK8 deficiency is a fully penetrant, autosomal recessive disease. In our patients, bone marrow transplantation resulted in rapid improvement followed by disappearance of viral skin lesions, including lesions resembling epidermodysplasia verruciformis, atopic dermatitis, and recurrent infections. Particularly for patients who feature unusual clinical manifestations, immunological testing, in conjunction with genetic testing, can prove invaluable in diagnosing DOCK8 deficiency and providing potentially curative treatment.
Sanal, Ozden; Jing, Huie; Ozgur, Tuba; Ayvaz, Deniz; Strauss-Albee, Dara M.; Ersoy-Evans, Sibel; Tezcan, Ilhan; Turkkani, Gulten; Matthews, Helen F.; Haliloglu, Goknur; Yuce, Aysel; Yalcin, Bilgehan; Gokoz, Ozay; Oguz, Kader K.; Su, Helen C.
Purpose Early intervention for prostate cancer is associated with excellent long-term survival, but many affected men, especially those with low-risk disease characteristics, might not suffer adverse impact to quantity or quality of life were treatment deferred. We sought to characterize temporal trends in clinical presentation and primary disease management among patients with low-risk prostate cancer. Methods Data were abstracted from CaPSURE, a disease registry of 8685 men with various stages of prostate cancer. 2078 men were included who were diagnosed between 1989 and 2001 and had a serum prostate specific antigen (PSA) ? 10 ng/ml, Gleason sum ? 6, and clinical T-stage ? 2a. Trends in risk distribution, tumor characteristics, and primary treatment were evaluated. Results The proportion of patients with low-risk tumor characteristics rose from 29.8% in 1989–1992 to 45.3% in 1999–2001 (p<.0001). There have been sharp increases in the use of brachytherapy and androgen deprivation monotherapy, from 3.1 and 3.1%, to 12.0 and 21.7%, respectively. Utilization rates for prostatectomy, external-beam EBRT, and observation have fallen accordingly, from 63.8, 16.1, and 13.8% to 51.6, 6.8, and 7.9% (p<.0001 for all except prostatectomy, p=.0019). Age and socioeconomic status were significantly associated with treatment selection, but overall the treatment trends were echoed on subgroup analysis of patients 75 years old or greater. Conclusions Low-risk features characterize a growing proportion of prostate cancer patients, and there have been significant shifts in the management of low-risk disease. Over-treatment may be a growing problem, especially among older patients.
Cooperberg, Matthew R.; Lubeck, Deborah P.; Meng, Maxwell V.; Mehta, Shilpa S.; Carroll, Peter R.
Beta-mannosidosis is an autosomal recessive lysosomal storage disease resulting from a deficiency of the lysosomal enzyme beta-mannosidase. The clinical manifestations of this disease in reported human cases are very heterogeneous ranging from relatively mild to moderately severe. This is in contrast with the severe prenatal onset seen in ruminant beta-mannosidosis. In humans, mental retardation, hearing loss, frequent infections, and behavioral problems are relatively common. Dysmorphology and skeletal involvement such as those seen in ruminants are unusual. The purpose of this study is to determine the range of clinical expression in human beta-mannosidosis resulting from null mutations. We determined that the beta-mannosidase gene consists of 17 exons. Intron-based PCR primers were designed and used to amplify each of the exons in genomic DNA isolated from patient fibroblasts. We identified two patients with null mutations. Results of the analysis showed that one patient was heterozygous for nonsense mutations G334T (E83X) in exon 2 and C1363T (Q426X) in exon 10, resulting in truncation of the deduced peptide sequence from 879 to 82 and 425 amino acids, respectively. The second patient was homozygous for a deletion mutation in exon 11 (1541delAT). This deletion causes a reading frame shift and 26 out of frame amino acids before a stop codon occurs in exon 12, resulting in truncation of the deduced peptide sequence from 879 to 510 amino acids. Because disease presentation in these patients with null mutations is very variable, ranging from mild to severe, we conclude that beta-mannosidosis in humans may indeed be milder than typical of other lysosomal storage disorders. PMID:12468273
Bedilu, Rebecca; Nummy, Katherine A; Cooper, Alan; Wevers, Ron; Smeitink, Jan; Kleijer, Wim J; Friderici, Karen H
Goiter is common among growing children and adolescents but thyrotoxicosis is a rare thyroid disorder in this age group. This study was undertaken to determine the prevalence of thyrotoxicosis and clinical presentation of the disease among children and adolescents presenting for goiter at the clinics of Pediatric Endocrinology of Tehran and Iran University of Medical Sciences and private offices. In
H. Moayeri; Z. Haghshenas
To define the clinical and anatomical factors associated with dyskinesias following thalamic infarction, we performed neurological examination and three-dimensional brain magnetic resonance imaging for 23 patients with thalamic infarction. We measured the total volumes and the largest diameters of the lesions on axial and coronal images. Using the atlas of human thalamus, we investigated the damaged thalamic nuclei. We compared the means of the volumes and the largest diameters of the lesions, and the frequencies of damaged thalamic nuclei between patients with and without thalamic dyskinesias. Seven (two pseudochoreoathetosis and five dystonia) of the 23 patients with thalamic infarction developed dyskinesias. No specific neurological deficits at the onset of stroke predicted the development of dyskinesias. The mean volume of the lesions of patients with dyskinesias (739 mm(3)) was significantly larger than that of those without dyskiensias (92.9 mm(3)). The means of the largest axial (11.6 mm) and coronal (10.8 mm) diameters were significantly larger in patients with dyskinesias, compared to those (axial, 7.1 mm; coronal, 6.4 mm) of patients without dyskinesias. Patients with dyskinesias had damage in the centromedian (CM) thalamic nucleus more frequently compared to those without dyskinesias. Patients with a large thalamic infarction involving the CM nucleus are more likely to develop dyskinesias. PMID:11137519
Lee, M S; Kim, Y D; Yang, J W; Lyoo, C H; Oh, S H; Kim, H S
Use of mobile phone and sending text message is a very common in today's life. While sending a text message the users need to use their thumb and other palm muscles extensively. The thumb most of the time adducted on the key pad of the mobile and use high force to type the letters. Studies in literature showed that text messaging has an adverse effect on musculoskeletal system of hand. But the extensive study on the type of disorders set in among the users who extensively use mobile phone for texting. This study aims at to evaluate risk factor and clinical feature of the MSD due to hand held devices. Twenty seven subjects participated in this study. Predefined protocols were used to evaluate type of MSD occurred among the subjects. The study revealed that development of tendinitis in extensor pollicis longus, myofascial pain syndrome (70.37%) of adductor pollicis, 1st interossei and extensor digitorum communis . Other associated problems diagnosed were thoracic outlet syndrome (51.85%), fibromyalgia syndrome (25.93%), hypothyroidism (7.41%), wrist tendinitis (14.81%) and De Quervain's syndrome (7.41%). It has been observed that the pathology were tendinitis of extensor pollicis longus, myofascial pain syndrome of thenar muscles and 1st interossei, extensor digitorum communis. PMID:22316873
Sharan, Deepak; Ajeesh, P S
The decision making process is central to the practice of a clinician and has traditionally been described in terms of the hypothetico-deductive model. More recently, models adapted from cognitive psychology, such as the dual process and script theories have proved useful in explaining patterns of practice not consistent with purely cognitive based practice. The purpose of this paper is to introduce the concept of mental workload as a key determinant of the type of cognitive processing used by clinicians. Published research appears to be consistent with 'schemata' based cognition as the principle mode of working for those engaged in complex tasks under time pressure. Although conscious processing of factual data is also used, it may be the primary mode of cognition only in situations where time pressure is not a factor. Further research on the decision making process should be based on outcomes which are not dependant on conscious recall of past actions or events and include a measure of mental workload. This further appears to support the concept of the patient, within the clinical environment, as the most effective learning resource. PMID:22411354
Gelastic seizures are epileptic events characterized by bouts of laughter. Laughter-like vocalization is usually combined with facial contraction in the form of a smile. Autonomic features such as flushing, tachycardia, and altered respiration are widely recognized. Conscious state may not be impaired, although this is often difficult to asses particularly in young children. Gelastic seizures have been associated classically to hypothalamic hamartomas, although different extrahypothalamic localizations have been described. Hypothalamic hamartomas are rare congenital lesions presenting with the classic triad of gelastic epilepsy, precocious puberty and developmental delay. The clinical course of patients with gelastic seizures associated with hypothalamic hamartomas is progressive, commencing with gelastic seizures in infancy, deteriorating into more complex seizure disorder resulting in intractable epilepsy. Electrophysiological, radiological, and pathophysiological studies have confirmed the intrinsic epileptogenicity of the hypothalamic hamartoma. Currently the most effective surgical approach is the trancallosal anterior interforniceal approach, however newer approaches including the endoscopic and other treatment such as radiosurgery and gamma knife have been used with success. This review focuses on the syndrome of gelastic seizures associated with hypothalamic hamartomas, but it also reviews other concepts such as status gelasticus and some aspects of gelastic seizures in other locations.
Tellez-Zenteno, Jose F; Serrano-Almeida, Cesar; Moien-Afshari, Farzad
Medical records and liver histology of 68 English springer spaniels (ESS) with a histological diagnosis of CH were reviewed retrospectively. PCR was performed on liver tissue for canine adenovirus-1 (CAV-1), canine parvovirus, canine herpesvirus and pathogenic Leptospira species. Follow-up information was obtained to calculate survival times. Median age at presentation was three years seven months (range, seven months to eight years five months) and there were 48 female and 20 male dogs. Clinical signs were non-specific and five dogs were asymptomatic. All dogs had an increase in serum activity of one or more hepatobiliary enzymes. Histopathology demonstrated hepatocyte necrosis and apoptosis with varying amounts of fibrosis. A predominantly lymphoplasmacytic infiltrate throughout the hepatic parenchyma was found in all 68 dogs, but 45 of these dogs also had a neutrophilic component to the inflammatory infiltrate. There was no significant copper accumulation and no aetiological agent was identified by PCR. The median survival time was 189 days (range, 1 to 1211 days), 38 dogs died within three months and 12 dogs survived more than a year following diagnosis.
Bexfield, N. H.; Andres-Abdo, C.; Scase, T. J.; Constantino-Casas, F.; Watson, P. J.
Pharyngeal trauma in cattle can occur during the administration of oral medication using a balling gun. The number of cases of severe complications due to bolus application that have been referred to our hospital has increased from nil between 1996 and 2008 to three or four per year. In our experience, reports by bovine veterinarians of patients with severe and often fatal pharyngeal trauma, which were not referred to the clinic, have become more common in recent years as well. The incidence of this complication is likely to be higher than this number of referrals suggests. Diagnosis without the help of imaging techniques, such as radiography and endoscopy, may be difficult, especially in cases where exploration of the pharynx cannot be carried out, or is unable to confirm the absence or presence of a lesion. Prognosis is often poor in cases where perforation has been confirmed. Boluses are increasingly administered by the owners or farm personnel without the supervision of a veterinarian. In order to prevent losses due to balling gun-induced injuries, the veterinarian plays a crucial role in giving advice to his clients. Five cases of cattle suffering from varying degrees of balling gun-induced trauma are presented, and consideration is given to incorrect application techniques. PMID:23677645
Mann, S; Nuss, K A; Feist, M; Weber, B K; Zoller, D K; Metzner, M
Background Late complications of allogeneic hematopoietic stem cell transplantation (HSCT) include a risk of secondary malignancies, including oral cancers. Optimization of best clinical practices for early diagnosis and treatment of oral premalignant or malignant lesions requires an assessment of potential predisposing risk factors as well as treatment outcomes. Methods The medical records of patients who developed oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC) following allogeneic HSCT were reviewed. Data on demographics, HSCT course, chronic graft-versus-host disease (cGVHD), smoking and alcohol consumption, oral lesion characteristics, mode of therapy and clinical outcome were recorded; landmark survival was calculated. Results Twenty-six patients with OED (n = 8) and OSCC (n = 18) were identified with a median follow-up of 26.5 and 21.5 months, respectively. Premalignant and malignant oral lesions were diagnosed at a median time of 2.5 and 8 years after HSCT, respectively. Chronic GVHD was present in 96% of patients and of these, 96% had oral involvement. Multifocal oral cancer was found in 28% of cases, and localized recurrence was observed in 44% of cases. Five-year overall survival was 75% and 70% for OED and OSCC, respectively. Conclusions These results suggest that oral cGVHD may be considered a potential risk factor for the development of OSCC following allogeneic HSCT. The observation that oral cancers were frequently multifocal and recurred locally supports the concept of field cancerization and suggests that these cancers may be more aggressive compared with the non-HSCT population. Vigilant follow-up and coordination of care between hematologists and oral health specialists are critical to minimize morbidity and mortality.
Mawardi, Hani; Elad, Sharon; Correa, M. Elvira; Stevenson, Kristen; Woo, Sook-Bin; Almazrooa, Soulafa; Haddad, Robert; Antin, Joseph H.; Soiffer, Robert; Treister, Nathaniel
Chronic wounds, especially in diabetics, represent a serious threat to human health.Correcting a compromised state of tissue oxygenation by the administration of supplemental O2 is known to benefit wound healing. Beyond its role as a nutrient and antibiotic, O2 supports wound healing by driving redox-signaling.HBO (hyperbaric oxygen) therapy is widely used and approved by CMS to treat specific ulcerations. The current literature supports that approaches to topically oxygenate wounds may be productive.Here, we present the results of two simultaneous studies testing the effects of HBO and portable topical oxygen (TO) therapies. These two therapeutic approaches have several contrasting features.A total of 1854 patients were screened in outpatient wound clinics for non-randomized enrollments into the HBO (n=32, 31% diabetic) and TO (n=25, 52% diabetic) studies.Under the conditions of the current study, HBO treatment seemed to benefit some wounds while not benefiting the others. Overall, HBO did not result in statistically significant improvements in wound size in the given population over the time monitored in this study.TO significantly improved wound size. Among the three (VEGF, TGF?1 and COL1A1) O2-sensitive genes studied in wound-edge tissue biopsies, TO treatment was associated with higher VEGF165 expression in healing wounds. Expression of the other genes mentioned was not affected by TO. All of the genes studied did not significantly change in expression in patients of the HBO study. This work establishes a link between VEGF gene expression and healing outcome for TO therapy.Taken together, this report presents evidence demonstrating that TO treatment benefits wound healing in patients suffering from chronic wounds. TO treatment is associated with induction in VEGF expression in the wound edge tissue and improvement in wound size.
Gordillo, Gayle M; Roy, Sashwati; Khanna, Savita; Schlanger, Richard; Khandelwal, Sorabh; Phillips, Gary; Sen, Chandan K.
Critical limb ischemia (CLI) is a major cause of limb loss and mortality among patients with advanced peripheral artery disease. Our objective was to evaluate the gender-specific differences in patient characteristics and clinical outcomes among patients with CLI. We performed a retrospective analysis of 97 women and 122 men presenting with CLI who underwent angiography from 2006 to 2010. Baseline demographics, procedural details, and lesion characteristics were assessed for each patient. Kaplan–Meier analysis was used to assess long-term patient and lesion-level outcomes. Cox proportional hazard modeling was used to evaluate the relationship between gender and major adverse cardiovascular events (MACE). Compared to men, women were less likely to have a history of coronary artery disease (39% vs 54%, p = 0.02) or diabetes (57% vs 70%, p = 0.05) but had similar baseline medical therapy. At angiography, women were more likely to have significant femoropopliteal (77% vs 67%, p = 0.02) and multi-level infrainguinal disease (63% vs 51%, p = 0.02). Women were also more likely to undergo multi-vessel percutaneous intervention (69% vs 55%, p = 0.05), but had similar rates of limb salvage after percutaneous intervention or surgical bypass (HR 0.94 [95% CI 0.45–1.94], p = 0.9). During follow-up, women had higher rates of subsequent major adverse cardiovascular events (HR 1.63 [95% CI 1.01–2.63], p = 0.04). In conclusion, women with CLI are more likely to present with femoropopliteal and multi-level infrainguinal disease. Despite similar rates of limb salvage, women with CLI have an increased rate of subsequent major adverse cardiovascular events.
McCoach, Caroline E; Armstrong, Ehrin J; Singh, Satinder; Javed, Usman; Anderson, David; Yeo, Khung Keong; Westin, Gregory G; Hedayati, Nasim; Amsterdam, Ezra A; Laird, John R
As the number of therapists in mental health settings continues to decline, research is needed to explore the scope, satisfaction, and efficacy of services. In this study, we used Patton's (1997) Utilization-Focused Program Evaluation to explore scope of services, therapist and client satisfaction, and perceived efficacy of services in a free-standing community-based mental health occupational therapy clinic. Surveys were administered to 36 clients and 9 therapists and followed up by qualitative interviews with 6 therapists. We identified characteristics unique to a free-standing psychiatric occupational therapy clinic, along with factors contributing to satisfaction and perceived efficacy of services. The importance of a supportive therapeutic environment and emphasis on the therapist-client relationship were cited as key factors influencing both satisfaction and effectiveness of service. Results are presented and compared with the existing literature. PMID:20092105
Haertl, Kristine; Behrens, Kari; Houtujec, Jill; Rue, Ashley; Ten Haken, Rachel
BackgroundPhysical violence frequently brings victims to seek care in emergency departments, providing opportunity for prevention.ObjectiveTo describe physical aggression-related injuries in youth 5–19 years presenting to an urban emergency department and identify risk factors.MethodsWe used retrospective data from one paediatric tertiary centre affiliated with the Canadian Hospitals Injury Reporting and Prevention Program. Intentional injuries inflicted by other youth were examined from
A Gorgos; C Hervouet-Zeiber; L Dunand; E Rousseau
Objective.To assess weight stigma, self-perception of weight status, and factors contributing to accurate self-perception of weight status in obese youth presenting for treatment at a hospital-based multidisciplinary weight management program. Methods. Participants (N = 97; mean age = 8.56 ± 1.66 years) used a figural rating scale to assess weight stigma and their current and ideal body type, and Sizing
Meg H. Zeller; Lisa M. Ingerski; Lindsay Wilson; Avani C. Modi
OBJECTIVES: To assess the level of awareness with regards to risk factors, presenting features and complications of hypertension. Moreover, to Compare the level of awareness amongst patients (hypertensives) and nonpatients (normotensives) in Karachi, Pakistan.METHODS: This cross-sectional study was carried out on a random sample of 440 people (220-normotensives\\/220-hypertensives) using an interview based questionnaire. Data entry was performed on Epi-info v
Syed Nabeel Zafar; Saqib Ali Gowani; Faria Amber Irani; Mohammad Ishaq
Late complications of allogeneic hematopoietic stem cell transplantation (HSCT) include a risk of secondary malignancies. Optimization for early diagnosis and treatment of oral premalignant or malignant lesions requires an assessment of potential predisposing risk factors. The medical records of patients who developed oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC) following allogeneic-HSCT were reviewed. Data on HSCT course, chronic graft-versus-host disease (cGVHD), and clinical outcome were recorded; landmark survival was calculated. Twenty-six patients with OED (n=8) and OSCC (n=18) were identified with a median follow-up of 26.5 and 21.5 months, respectively. Premalignant and malignant oral lesions were diagnosed at a median time of 2.5 and 8 years after HSCT, respectively. Chronic GVHD was present in 96% of patients and of these, 96% had oral involvement. Multifocal oral cancer was found in 28% of cases, and localized recurrence was observed in 44% of cases. These results suggest that oral cGVHD may be considered a potential risk factor for the development of OSCC following allogeneic-HSCT. The observation that oral cancers were frequently multifocal and recurred locally suggests that these cancers may be more aggressive. Vigilant follow-up and coordination of care are critical. PMID:21460866
Mawardi, H; Elad, S; Correa, M E; Stevenson, K; Woo, S-B; Almazrooa, S; Haddad, R; Antin, J H; Soiffer, R; Treister, N
Summary We compared MRI criteria used to predict conversion of suspected multiple sclerosis to clinically definte multiple sclerosis. Seventy-four patients with clinically isolated neurological symptoms suggestive of multiple sclerosis were studied with MRI. Logistic regression analysis was used to remove redundant information, and a diagnostic model was built after each MRI parameter was dichotomized according to maximum accuracy using receiver
Frederik Barkhof; Massimo Filippi; L. H. Miller; Philip Scheltens; Adriana Campi; Chris H. Polman; Giancarlo Comi; H. J. Adhr; Nick Losseff; Jacob Valk
Graft versus host disease (GVHD) is an alloimmune inflammatory process, which results from a donor-origin cellular response against host tissues. The chronic syndrome of GVHD (cGVHD) occurs in approximately 50% of patients post hematopoietic stem cell transplantation (HSCT) and remains the leading cause of non-malignant mortality. Oral cavity is one of the most frequent sites involved in cGVHD, possibly only second to skin. The oral tissues targeted by cGVHD are the mucosae, the salivary glands, the musculoskeletal apparatus and the periodontal structures. The mucosal cGVHD is accompanied by pain and mucosal irritation. Patients with cGVHD present with mucosal erosion and atrophy, lichenoid-hyperkeratotic changes, pseudomembranous ulcerations and mucoceles. Dry mouth may exacerbate mucosal irritation and erosion. In addition to impaired oral functions, cGVHD may lead to secondary malignancies in the form of solid cancers, particularly squamous cell carcinomas of the oral cavity. Moreover, administration of systemic azathioprine, a commonly used immunosuppressive drug in cGVHD patients, may significantly increase the incidence of tumors of oral cavity. The increased risk of secondary malignancies indicates the need for lifelong surveillance, particularly in younger patients. Scoring of oral GVHD was first addressed by NIH only in 2005. The NIH consensus paper referred to standard criteria for diagnosis, classification, and response to treatment. These scales were introduced for clinical use, although they require prospective validation studies. In the past, other scales were suggested and may still be used for research purposes. Management of oral cGVHD is compromised of preventive protocols and when cGVHD is developed, systemic and topical treatment. Because the majority of patients with oral cGVHD will develop the extensive form of the disease, they will be treated systemically. Systemic treatment is based on steroids and immunosuppressants, and, thus, increases the frequency of opportunistic infections. Only a few well-designed controlled trials using systemic treatments for cGVHD assessed oral outcomes. When the oral mucosa is the only site resistant to high doses of systemic corticosteroids or when GVHD is manifested only in the oral mucosa, the treatment approach should be topical therapy. Topical steroid preparations are the mainstay of local treatment. Budesonide is a novel steroid preparation that is being developed in the recent years for cGVHD. Its high topical anti-inflammatory activity together with low systemic bioavailability may provide enhanced treatment effects for local oral disease while sparing the host immunity. Second line of topical therapy includes pharmacologic immunosuppressants and phototherapy, combined with palliative treatment. This article aims at presenting the novel information about the clinical presentation, scoring scales, long term complications and treatment for mucosal cGVHD. PMID:19263864
Elad, S; Levitt, M; M Y, Shapira
Background & Aims Aim of this study was to evaluate whether the PNPLA3 I148M polymorphism, previously associated with hepatocellular carcinoma (HCC) risk, influences the clinical presentation of HCC and survival. Methods we considered 460 consecutive HCC patients referred to tertiary care centers in Northern Italy, 353 with follow-up data. Results Homozygosity for PNPLA3 148M at risk allele was enriched in HCC patients with alcoholic liver disease or nonalcoholic fatty liver disease (ALD&NAFLD: relative risk 5.9, 95% c.i. 3.5–9.9; other liver diseases: relative risk 1.9, 95% c.i. 1.1–3.4). In ALD&NAFLD patients, the PNPLA3 148M allele was associated with younger age, shorter history of cirrhosis, less advanced (Child A) cirrhosis at HCC diagnosis, and lower HCC differentiation grade (p<0.05). Homozygosity for PNPLA3 148M was associated with reduced survival in the overall series (p?=?0.009), and with a higher number of HCC lesions at presentation (p?=?0.007) and reduced survival in ALD&NAFLD patients (p?=?0.003; median survival 30, 95% c.i. 20–39 vs. 45, 95% c.i. 38–52 months), but not in those with HCC related to other etiologies (p?=?0.86; 48, 95% c.i. 32–64 vs. 55, 95% c.i. 43–67 months). At multivariate Cox regression analysis, homozygosity for PNPLA3 148M was the only negative predictor of survival in ALD&NAFLD patients (HR of death 1.57, 95% c.i. 1.12–2.78). Conclusions PNPLA3 148M is over-represented in ALD&NAFLD HCC patients, and is associated with occurrence at a less advanced stage of liver disease in ALD&NAFLD. In ALD&NAFLD, PNPLA3 148M is associated with more diffuse HCC at presentation, and with reduced survival.
Valenti, Luca; Motta, Benedetta Maria; Soardo, Giorgio; Iavarone, Massimo; Donati, Benedetta; Sangiovanni, Angelo; Carnelutti, Alessia; Dongiovanni, Paola; Rametta, Raffaela; Bertelli, Cristina; Facchetti, Floriana; Colombo, Massimo; Fargion, Silvia; Fracanzani, Anna Ludovica
Available data correlating symptoms of colon cancer patients with the severity of the disease are very limited. In a population-based setting, we correlated information on symptoms of colon cancer patients with several pathological tumor parameters and survival. Information on all patients diagnosed with colon cancer in Iceland in 1995-2004 for this retrospective, population-based study was obtained from the Icelandic Cancer Registry. Information on symptoms of patients and blood hemoglobin was collected from patients' files. Pathological parameters were obtained from a previously performed standardized tumor review. A total of 768 patients entered this study; the median age was 73 years. Tumors in patients presenting at diagnosis with visible blood in stools were significantly more likely to be of lower grade, having pushing border, conspicuous peritumoral lymphocytic infiltration, and lower frequency of vessel invasion. Patients with abdominal pain and anemia were significantly more likely to have vessel invasion. Logistic regression showed that visible blood in stools was significantly associated with protecting pathological factors (OR range 0.38-0.83, p < 0.05). Tumors in patients presenting with abdominal pain were strongly associated with infiltrative margin and scarce peritumoral lymphocytic infiltration (OR = 1.95; 2.18 respectively, p < 0.05). Changes in bowel habits were strongly associated with vessel invasion (OR = 2.03, p < 0.05). Cox regression showed that blood in stools predicted survival (HR = 0.54). In conclusion, visible blood in stools correlates significantly with all the beneficial pathological parameters analyzed and with better survival of patients. Anemia, general symptoms, changes in bowel habits, acute symptoms, and abdominal pain correlate with more aggressive tumor characteristics and adverse outcome for patients. PMID:23654359
Alexiusdottir, Kristin K; Snaebjornsson, Petur; Tryggvadottir, Laufey; Jonasson, Larus; Olafsdottir, Elinborg J; Björnsson, Einar Stefan; Möller, Pall Helgi; Jonasson, Jon G
Spinocerebellar ataxia type 2 (SCA2) is an autosomal dominant genetic disease characterized by cerebellar dysfunction associated with slow saccades, early hyporeflexia, severe tremor of postural or action type, peripheral neuropathy, cognitive disorders, and other multisystemic features. SCA2, one of the most common ataxias worldwide, is caused by the expansion of a CAG triplet repeat located in the N-terminal coding region of the ATXN2 gene, which results in the incorporation of a segment of polyglutamines in the mutant protein, being longer expansions associated with earlier onset and more sever disease in subsequent generations. In this review, we offer a detailed description of the clinical manifestations of SCA2 and compile the experimental evidence showing the participation of ataxin-2 in crucial cellular processes, including messenger RNA maturation and translation, and endocytosis. In addition, we discuss in the light of present data the potential molecular mechanisms underlying SCA2 pathogenesis. The mutant protein exhibits a toxic gain of function that is mainly attributed to the generation of neuronal inclusions of phosphorylated and/or proteolytic cleaved mutant ataxin-2, which might alter normal ataxin-2 function, leading to cell dysfunction and death of target cells. In the final part of this review, we discuss the perspectives of development of therapeutic strategies for SCA2. Based on previous experience with other polyglutamine disorders and considering the molecular basis of SCA2 pathogenesis, a nuclei-acid-based strategy focused on the specific silencing of the dominant disease allele that preserves the expression of the wild-type allele is highly desirable and might prevent toxic neurodegenerative sequelae. PMID:22996397
Magaña, J J; Velázquez-Pérez, L; Cisneros, B
Mucopolysaccharidosis type IIIB (MPS IIIB, Sanfilippo syndrome type B) is a lysosomal storage disorder caused by deficiency of the enzyme N-acetyl-?-D-glucosaminidase (NAGLU). Information on the natural course of MPS IIIB is scarce but much needed in view of emerging therapies. To improve knowledge on the natural course, data on all 52 MPS IIIB patients ever identified by enzymatic studies in the Netherlands were gathered. Clinical data on 44 patients could be retrieved. Only a small number (n = 9; 21%) presented with a classical MPS III phenotype; all other patients showed a much more attenuated course of the disease characterized by a significantly slower regression of intellectual and motor abilities. The majority of patients lived well into adulthood. First signs of the disease, usually mild developmental delay, were observed at a median age of 4 years. Subsequently, patients showed a slowing and eventually a stagnation of development. Patients with the attenuated phenotype had a stable intellectual disability for many years. Molecular analysis was performed in 24 index patients. The missense changes p.R643C, p.S612G, p.E634K, and p.L497V were exclusively found in patients with the attenuated phenotype. MPS IIIB comprises a remarkably wide spectrum of disease severity, and an unselected cohort including all Dutch patients showed a large proportion (79%) with an attenuated phenotype. MPS IIIB must be considered in patients with a developmental delay, even in the absence of a progressive decline in intellectual abilities. A key feature, necessitating metabolic studies, is the coexistence of behavioral problems. PMID:20852935
Valstar, Marlies J; Bruggenwirth, Hennie T; Olmer, Renske; Wevers, Ron A; Verheijen, Frans W; Poorthuis, Ben J; Halley, Dicky J; Wijburg, Frits A
Mucopolysaccharidosis type IIIB (MPS IIIB, Sanfilippo syndrome type B) is a lysosomal storage disorder caused by deficiency of the enzyme N-acetyl-?-D-glucosaminidase (NAGLU). Information on the natural course of MPS IIIB is scarce but much needed in view of emerging therapies. To improve knowledge on the natural course, data on all 52 MPS IIIB patients ever identified by enzymatic studies in the Netherlands were gathered. Clinical data on 44 patients could be retrieved. Only a small number (n?=?9; 21%) presented with a classical MPS III phenotype; all other patients showed a much more attenuated course of the disease characterized by a significantly slower regression of intellectual and motor abilities. The majority of patients lived well into adulthood. First signs of the disease, usually mild developmental delay, were observed at a median age of 4 years. Subsequently, patients showed a slowing and eventually a stagnation of development. Patients with the attenuated phenotype had a stable intellectual disability for many years. Molecular analysis was performed in 24 index patients. The missense changes p.R643C, p.S612G, p.E634K, and p.L497V were exclusively found in patients with the attenuated phenotype. MPS IIIB comprises a remarkably wide spectrum of disease severity, and an unselected cohort including all Dutch patients showed a large proportion (79%) with an attenuated phenotype. MPS IIIB must be considered in patients with a developmental delay, even in the absence of a progressive decline in intellectual abilities. A key feature, necessitating metabolic studies, is the coexistence of behavioral problems.
Valstar, Marlies J.; Bruggenwirth, Hennie T.; Olmer, Renske; Wevers, Ron A.; Verheijen, Frans W.; Poorthuis, Ben J.; Halley, Dicky J.
Background:? Although a diagnosis of autism spectrum disorder (ASD) appears to be stable in children as young as age three, few studies have explored stability of a diagnosis in younger children. Predictive value of diagnostic tools for toddlers and patterns of symptom change are important considerations for clinicians making early diagnoses. Most findings come from high-risk samples, but reports on children screened in community settings are also needed. Methods:? Stability of diagnosis and Autism Diagnostic Observation Schedule - Toddler Module (ADOS-T) classifications and scores was examined across two time points in a sample of 82 children identified through the FIRST WORDS(®) Project. Children received two comprehensive diagnostic evaluations at average ages of 19.39 (SD?=?2.12) and 36.89 (SD?=?3.85)?months. Results:? Stability was 100% when confirming and ruling out a diagnosis of ASD based on a comprehensive diagnostic evaluation that included clinic and home observations, although diagnosis was initially deferred for 17% of the sample. Receiver Operating Characteristic curves revealed excellent sensitivity and acceptable specificity for the ADOS-T compared to concurrent diagnosis. Logistic regressions indicated good predictive value of initial ADOS-T scores for follow-up diagnosis. Finally, both ASD and Non-ASD children demonstrated a decrease in Social Affect scores (i.e., improvement), whereas children with ASD demonstrated an increase in Restricted and Repetitive Behavior scores (i.e., worsening), changes that were accounted for by nonverbal developmental level in mixed model analyses. Conclusions:? Short-term stability was documented for children diagnosed at 19?months on average, although a minority of children initially showed unclear diagnostic presentations. Findings highlight utility of the ADOS-T in making early diagnoses and predicting follow-up diagnoses. Children with ASD demonstrated improvement in social communication behaviors and unfolding of repetitive behaviors, suggesting that certain early patterns of change in symptoms may be characteristic of ASD. PMID:23078094
Guthrie, Whitney; Swineford, Lauren B; Nottke, Charly; Wetherby, Amy M
Non-uniform, unclear, or incomplete presentation of food intake data limits interpretation, usefulness, and comparisons across studies. In this contribution, we discuss factors affecting uniform reporting of food intake across studies. The amount of food eaten can be reported as mean portion size, number of servings or total amount of food consumed per day; the absolute intake value for the specific study depends on the denominator used because food intake data can be presented as per capita intake or for consumers only. To identify the foods mostly consumed, foods are reported and ranked according to total number of times consumed, number of consumers, total intake, or nutrient contribution by individual foods or food groups. Presentation of food intake data primarily depends on a study's aim; reported data thus often are not comparable across studies. Food intake data further depend on the dietary assessment methodology used and foods in the database consulted; and are influenced by the inherent limitations of all dietary assessments. Intake data can be presented as either single foods or as clearly defined food groups. Mixed dishes, reported as such or in terms of ingredients and items added during food preparation remain challenging. Comparable presentation of food consumption data is not always possible; presenting sufficient information will assist valid interpretation and optimal use of the presented data. A checklist was developed to strengthen the reporting of food intake data in science communication. PMID:23800564
Faber, Mieke; Wenhold, Friede A M; Macintyre, Una E; Wentzel-Viljoen, Edelweiss; Steyn, Nelia P; Oldewage-Theron, Wilna H
Significant advances in three-dimensional echocardiography have made this modality a powerful diagnostic tool in the cardiology clinic. It can provide accurate and reliable measurements of chamber size and function, including the quantification of left ventricular mechanical dyssynchrony to guide patient selection for cardiac resynchron-isation therapy. Furthermore, three-dimensional echocardiography offers novel views and comprehensive anatomic definition of valvular and congenital abnormalities, improving diagnosis and preoperative planning. In addition, it is extremely useful in monitoring the effectiveness of surgical or percutaneous transcatheter interventions. As its efficacy for more and more clinical applications is demonstrated, it is clear that three-dimensional echocardiography has become part of the routine clinical diagnostic armamentarium. In this article, we describe the development of three-dimensional echocardiography over the last decades, review the scientific evidence for its current clinical use and discuss potential future applications. (Neth Heart J 2009;17:18-24.)
Kleijn, S.A.; Kamp, O.
...with a panel of experts in pertinent disciplines (for example: science, medicine, education, ethics, law) and following opportunity...The clinical investigation will be conducted in accordance with sound ethical principles; and (iii) Adequate provisions are...
The highly variable clinical course of cervical artery dissections still poses a major challenge to the treating physician. This study was conducted (1) to describe the differences in clinical and angiographic presentation of patients with carotid and vertebral artery dissections (CAD, VAD), (2) to define the circumstances that are related to bilateral arterial dissections, and (3) to determine factors that predict a poor outcome. Retrospectively and by standardised interview, we studied 126 patients with cervical artery dissections. Preceding traumata, vascular risk factors, presenting local and ischemic symptoms, and patient-outcome were evaluated. Patients with CAD presented more often with a partial Horner's syndrome and had a higher prevalence of fibromuscular dysplasia than patients with VAD. Patients with VAD complained more often of neck pain, more frequently reported a preceding chiropractic manipulation and had a higher incidence of bilateral dissections than patients with CAD. Bilateral VAD was significantly related to a preceding chiropractic manipulation. Multivariate analysis showed that the variables stroke and arterial occlusion were the only independent factors associated with a poor outcome. This study emphasises the potential dangers of chiropractic manipulation of the cervical spine. Probably owing to the systematic use of forceful neck-rotation to both sides, this treatment was significantly associated with bilateral VAD. Patients with dissection-related cervical artery occlusion had a significantly increased risk of suffering a disabling stroke. PMID:14586598
Dziewas, Rainer; Konrad, Carsten; Dräger, Bianca; Evers, Stefan; Besselmann, Michael; Lüdemann, Peter; Kuhlenbäumer, Gregor; Stögbauer, Florian; Ringelstein, E Bernd
OBJECTIVES--To determine the symptomatic and functional status during follow up of patients referred to hospital with unexplained fatigue and to identify patient variables associated with persistent functional impairment. DESIGN--Follow up by postal questionnaire six weeks to four years (median 1 year) after initial clinical assessment of patients referred to hospital during 1984-8. SETTING--Infectious diseases outpatient clinic in a teaching hospital.
M. Sharpe; K. Hawton; V. Seagroatt; G. Pasvol
HIV/AIDS has significantly affected health care practices. The need for high adherence and regular clinic visits places pressure on health care providers and patients. Poor quality of care has been described in many contexts, but some clinics have achieved excellent treatment results. Using a success case approach, this study aimed to understand factors which contribute to successful care at a South African pediatric HIV/AIDS clinic with documented high patient adherence and follow-up rates. Data included over 50 hours of ethnographic observations and interviews with a total of 35 clinic staff and caregivers. Thematic analysis highlighted strong congruence between caregiver and staff perceptions. Factors which seemed to contribute to successful care included organizational routines, staff-patient relationships, communication, teamwork, leadership, job commitment, caregivers' negative experiences at other clinics, and faith in the "life-saving" care at this clinic. Results suggest the need for all factors to be present in order to promote quality of care. Recommendations for other clinic settings are discussed. PMID:22615495
The report includes surveys of more than 1,000 respondents from three groups (present Clinical Experience Abstract (CEA) recipients, members of the American Society of Hospital Pharmacists, and physicians who were specialists in either internal medicine o...
R. F. Clarke H. Shosteck
Objective: To study the clinical presentation of lung cancer patients at our palliative care unit(PCU). Design: We examined the clinical presentation of lung cancer patients at our PCU and compared it with the clinical presentation of patients with malignant tumors besides those indicative of lung cancer. Results: The PCU occupancy ratio of lung cancer patients to inpatients was 24%, which was dependent on the type of carcinoma. Lung cancer patients in need of oxygen inhalation and/or terminal sedation were more in number than those with other types of malignant tumors. On the other hand, few patients needed treatment. Dyspnea is the major reason for the terminal sedation of lung cancer patients. Conclusion: Severe dyspnea appeared to be the typical clinical presentation of terminal-phase lung cancer patients. PMID:24105054
Kambayashi, Takatoyo; Nakatsukasa, Hironobu; Kawashima, Ichiro
PurposeInfected aortic aneurysms are difficult to treat, and are associated with significant mortality. Hospital survival is poor in patients with severe aortic infection, Salmonella species infection, Staphylococcus aureus infection, aneurysm rupture, and suprarenal aneurysm location. We reviewed the clinical outcome in 46 patients with primary infected aortic aneurysms and identified clinical variables associated with prognosis.
Ron-Bin Hsu; Robert J Chen; Shoei-Shen Wang; Shu-Hsun Chu
We review here those malformations of the cerebral cortex which are most often observed in epilepsy patients, for which a genetic basis has been elucidated or is suspected and give indications for genetic testing. There are three forms of lissencephaly (agyria-pachygyria) resulting from mutations of known genes, which can be distinguished because of their distinctive imaging features. They account for about 85% of all licence-phalies. Lissencephaly with posteriorly predominant gyral abnormality is caused by mutations of the LIS1 gene on chromosome 17. Anteriorly predominant lissencephaly in hemizygous males and subcortical band heterotopia (SBH) in heterozygous females are caused by mutations of the XLIS (or DCX) gene. Mutations of the coding region of XLIS were found in all reported pedigrees, and in most sporadic female patients with SBH. Missense mutations of both LIS1 and XLIS genes have been observed in some of the rare male patients with SBH. Autosomal recessive lissencephaly with cerebellar hypoplasia has been associated with mutations of the reelin gene. With few exceptions, children with lissencephaly have severe developmental delay and infantile spasms early in life. Patients with SBH have a mild to severe mental retardation with epilepsy of variable severity and type. X-linked bilateral periventricular nodular heterotopia (BPNH) consists of typical BPNH with focal epilepsy in females and prenatal lethality in males. About 88% of patients have focal epilepsy. Filamin A (FLNA) mutations have been reported in some families and in sporadic patients. Additional, possibly autosomal recessive gene(s) are likely to be involved in causing BPNH non-linked to FLN1. Tuberous sclerosis (TS) is a dominant disorder caused by mutations in at lest two genes, TSC1 and TSC2. 75% of cases are sporadic. Most patients with TS have epilepsy. Infantile spasms are a frequent early manifestation of TS. Schizencephaly (cleft brain) has a wide anatomo-clinical spectrum, including focal epilepsy in most patients. Familial occurrence is rare. Heterozygous mutations in the EMX2 gene have been reported in some patients. However, at present, there is no clear indication on the possible pattern of inheritance and on the practical usefulness that mutation detection in an individual with schizencephaly would carry in terms of genetic counselling. Amongst several syndromes featuring polymicrogyria, bilateral perisylvian polymicrogyria had familial occurrence on several occasions. Genetic heterogeneity is likely, including autosomal recessive, X-linked dominant, X-linked recessive inheritance and association to 22q11.2 deletions. FISH analysis for 22q11.2 is advisable in all patients with perisylvian polymicrogyria. Parents of an affected child with normal karyotype should be given up to a 25% recurrence risk. PMID:12185771
Guerrini, Renzo; Carrozzo, Romeo
We review here those malformations of the cerebral cortex which are most often observed in epilepsy patients, for which a genetic basis has been elucidated or is suspected and give indications for genetic testing. There are three forms of lissencephaly (agyria-pachygyria) resulting from mutations of known genes, which can be distinguished because of their distinctive imaging features. They account for about 85% of all lissencephalies. Lissencephaly with posteriorly predominant gyral abnormality is caused by mutations of the LIS1 gene on chromosome 17. Anteriorly predominant lissencephaly in hemizygous males and subcortical band heterotopia (SBH) in heterozygous females are caused by mutations of the XLIS(or DCX) gene. Mutations of the coding region of XLIS were found in all reported pedigrees, and in most sporadic female patients with SBH. Missense mutations of both LIS1 and XLIS genes have been observed in some of the rare male patients with SBH. Autosomal recessive lissencephaly with cerebellar hypoplasia has been associated with mutations of the reelin gene. With few exceptions, children with lissencephaly have severe developmental delay and infantile spasms early in life. Patients with SBH have a mild to severe mental retardation with epilepsy of variable severity and type. X-linked bilateral periventricular nodular heterotopia (BPNH) consists of typical BPNH with focal epilepsy in females and prenatal lethality in males. About 88% of patients have focal epilepsy. Filamin A (FLNA) mutations have been reported in some families and in sporadic patients. Additional, possibly autosomal recessive gene(s) are likely to be involved in causing BPNH non-linked to FLN1. Tuberous sclerosis (TS) is a dominant disorder caused by mutations in at lest two genes, TSC1 and TSC2. 75% of cases are sporadic. Most patients with TS have epilepsy. Infantile spasms are a frequent early manifestation of TS. Schizencephaly (cleft brain) has a wide anatomo-clinical spectrum, including focal epilepsy in most patients. Familial occurrence is rare. Heterozygous mutations in the EMX2 gene have been reported in some patients. However, at present, there is no clear indication on the possible pattern of inheritance and on the practical usefulness that mutation detection in an individual with schizencephaly would carry in terms of genetic counselling. Amongst several syndromes featuring polymicrogyria, bilateral perisylvian polymicrogyria had familial occurrence on several occasions. Genetic heterogeneity is likely, including autosomal recessive, X-linked dominant, X-linked recessive inheritance and association to 22q11.2 deletions. FISH analysis for 22q11.2 is advisable in all patients with perisylvian polymicrogyria. Parents of an affected child with normal karyotype should be given up to a 25% recurrence risk. PMID:11749114
Guerrini, R; Carrozzo, R
Objectives Sleep and sleep disorders are different in several important ways between men and women. We aimed to investigate gender differences\\u000a in initial symptoms and associating medical diseases of patients admitting to our sleep clinic.\\u000a \\u000a \\u000a \\u000a Methods Ninety-one patients, 20 women (22%) and 71 men (78%), admitting consecutively to the sleep clinic were studied. A detailed\\u000a sleep and medical history of the patients
Nese Dursunoglu; Sibel Ozkurt; Serdar Sar?kaya
The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Wash- ington, DC. This report details the clinical
Thom A. Mayer; Susan Bersoff-Matcha; Cecele Murphy; James Earls; Scott Harper; Denis Pauze; Michael Nguyen; Jonathan Rosenthal; Donald Cerva; Glenn Druckenbrod; Dan Hanfling; Naaz Fatteh; Anthony Napoli; Ashna Nayyar; Elise L. Berman
A prospective study was initiated to analyse the bacterial aetiology and clinical picture of mild community-acquired pneumonia in Slovenia using the previously described Pneumonia Severity Index. Radiographically confirmed cases of pneumonia in patients treated with oral antibiotics in seven study centres were included. An aetiological diagnosis was attempted using culture of blood and sputum, urinary antigen testing for Streptococcus pneumoniae
B. Bona?; D. Keše; T. Avši?-Županc; S. Kreft; G. Lesni?ar; J. Gorišek-Reberšek; L. Rezar; S. Letonja
This article reviews current knowledge of the etiology of diabetic neuropathy and the outcomes and limitations of previous trials and discusses future directions for the investigation of its prevention and treatment. Proposed mechanisms for the development of diabetic neuropathy have been widely studied. It has been shown that there is improvement of nerve function associated with some short-term clinical trials
Michael A. Pfeifer; Mary P. Schumer
summary The ESPEN Guidelines on Parenteral Nutrition (PN) reflect current scientific knowledge in the field of clinical nutrition in adults. They summarize the indications for PN and its anticipated outcomes in respect of the underlying disease, nutritional status and quality of life. They are companion documents to the ESPEN Guidelines on Enteral Nutrition and follow the same general format. They
Federico Bozzetti; Alastair Forbes
PURPOSE: To investigate why some patients with an intracranial dural arteriovenous fistula (DAVF) with spinal venous drainage have myelopathy and others do not.METHODS:We reviewed the clinical and radiologic data for 12 patients who had a DAVF with spinal venous drainage diagnosed at our institutions from 1982 to 1995. RESULTS: Six patients had progressive spinal cord indications of disease (patients with
Laurent Brunereau; Y. Pierre Gobin; Jean-Francois Meder; Christophe Cognard; Jean-Michel Tubiana; Jean-Jacques Merland
|Illinois State University's teacher education program's professional sequence is organized around separate teaching skills, each of which relates to student outcomes in classrooms. Initially, a group of University High (U-High) Laboratory School supervisors was formed to develop clinical experiences which would enable prospective teachers to…
Waimon, Morton D.; And Others
The purpose of this article is to describe the role and foci of care of the geropsychiatric clinical nurse specialist (GCNS) through a case example representative of the aged mentally ill who receive care at home. A historical look at the evolution of home health care of mentally ill elderly reveals the recognition of need in these persons as early
Donna Felber; Elizabeth Stacy Kinion
In an 8-year retrospective study, 631 injuries due to the racquet sports of squash (59%), tennis (21%) and badminton (20%) were seen in a sports injury clinic, males predominating (58 to 66%). The proportion of squash injuries was higher than expected and probably relates to higher physical stress and risk of contact in this sport. Also they occurred mainly in
M D Chard; S M Lachmann
BACKGROUND: Data on collagenous colitis have been based on a limited number of patients. AIMS: To obtain more information on this disease from a register set up at Orebro Medical Center Hospital. PATIENTS AND METHODS: Twenty five Swedish hospitals have contributed to this patient register, which comprises 163 histopathologically verified cases. Clinical data were retrospectively analysed. RESULTS: Collagenous colitis followed
J Bohr; C Tysk; S Eriksson; H Abrahamsson; G Järnerot
Our objective was to determine the brain magnetic resonance imaging (MRI) abnormalities in a selected group of patients with mucopolysaccharidosis (MPS) types I and II who had only mild clinical manifestations. We retrospectively assessed MRI brain studies in 18 patients with MPS (type I: 6 and type II: 12). We evaluated abnormal signal intensity in the white matter, widening of
M. Gisele Matheus; Mauricio Castillo; J. Keith Smith; Diane Armao; Diane Towle; Joseph Muenzer
Background Because of the high global prevalence of latent TB infection (LTBI), a key challenge in endemic settings is distinguishing patients with active TB from patients with overlapping clinical symptoms without active TB but with co-existing LTBI. Current methods are insufficiently accurate. Plasma proteomic fingerprinting can resolve this difficulty by providing a molecular snapshot defining disease state that can be used to develop point-of-care diagnostics. Methods Plasma and clinical data were obtained prospectively from patients attending community TB clinics in Peru and from household contacts. Plasma was subjected to high-throughput proteomic profiling by mass spectrometry. Statistical pattern recognition methods were used to define mass spectral patterns that distinguished patients with active TB from symptomatic controls with or without LTBI. Results 156 patients with active TB and 110 symptomatic controls (patients with respiratory symptoms without active TB) were investigated. Active TB patients were distinguishable from undifferentiated symptomatic controls with accuracy of 87% (sensitivity 84%, specificity 90%), from symptomatic controls with LTBI (accuracy of 87%, sensitivity 89%, specificity 82%) and from symptomatic controls without LTBI (accuracy 90%, sensitivity 90%, specificity 92%). Conclusions We show that active TB can be distinguished accurately from LTBI in symptomatic clinic attenders using a plasma proteomic fingerprint. Translation of biomarkers derived from this study into a robust and affordable point-of-care format will have significant implications for recognition and control of active TB in high prevalence settings.
Sandhu, Gurjinder; Battaglia, Francesca; Ely, Barry K.; Athanasakis, Dimitrios; Montoya, Rosario; Valencia, Teresa; Gilman, Robert H.; Evans, Carlton A.; Friedland, Jon S.
|Background: The clinical profile of depressive disorder in children and young people in Child Adolescent and Family Services (CAFS), Northampton was studied. Methods: Twenty-five patients who had attended the CAFS over a period of 2 years were analysed retrospectively. Results: The age range of subjects was 8 to 19 years. Majority of patients…
Majumder, Pallab; Hammad, Hala
We prospectively compared the clinical course of 119 patients treated for status epilepticus (SE) in private practice community hospitals and 344 SE patients treated in the VCU university hospitals in Richmond, Virginia USA over a 2-year period to test the hypothesis that SE presents with the same mortality and clinical patterns in both clinical settings. Of the patients reviewed, the major etiologies for SE were cerebrovascular disease, decreased anti-epileptic drug levels in epileptic patients, anoxia-hypoxia, and remote symptomatic. The other etiologies included were alcohol related, trauma, central nervous system infections, tumors, systemic infection, metabolic disorders, idiopathic, and hemorrhage. These observations provide the first direct prospective comparison of SE present in university and private practice community hospital settings in the same geographic area. Mortality was the highest in the elderly population while the pediatric population had low mortality in both clinical settings. Etiology risk factors for outcome were similar for both the populations. The data also suggest that the higher degree of illness severity in university hospitals may be associated with a higher incidence of SE, but not with mortality or a different clinical presentation of the condition. The results of this study demonstrate that SE has the same mortality and is present in an essentially identical manner in university and private practice community hospitals and underscores the fact that mortality in SE is not just associated with tertiary care hospitals and the importance of recognizing the severity of SE in the private practice setting. PMID:19324574
DeLorenzo, Robert J; Kirmani, Batool; Deshpande, Laxmikant S; Jakkampudi, Vamsy; Towne, Alan R; Waterhouse, Elizabeth; Garnett, Linda; Ramakrishnan, Viswanathan
This study examined the relation between the five factor model of personality and dissociative tendencies using a heterogeneous clinical population. Thus, 86 psychiatric patients (33 male, 53 female) from a variety of adult psychiatric clinics completed the Dissociative Experiences Scale [Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and
Gary Groth-Marnat; Melinda Jeffs
Nurses regularly encounter patients bringing with them medical data from the Internet. The purpose of the present study was to examine the prevalence of these encounters, nurses' attitudes to these patients, and the factors that might influence their attitudes. A cross-sectional study of a convenience sample of 110 nurses (32 practical nurses, 35 registered nurses and 43 academically trained nurses). The main variables measured were: attitudes toward patients presenting Internet information, professional self-esteem, and three indices of Internet use. The results show that most nurses had encountered patients presenting Internet medical information and held positive attitudes to them. Nurses with such experience had more positive attitudes than nurses with no such experience. Professional self-esteem and indices of Internet use were also positively correlated to favorable attitudes to these patients. Regression analysis showed that professional self-esteem and Internet self-efficacy predicted attitudes to these patients. Since the number of patients presenting Internet information can only multiply, there is a need to prepare and train nurses for encounters with such patients. PMID:19041453
Barnoy, Sivia; Volfin-Pruss, Diana; Ehrenfeld, Malka; Kushnir, Talma
The prevalence of psychiatric disorders among children with unexplained chronic pain (UCP) is high in unselected populations and pain clinics, yet the clinical relevance of these disorders in children referred for unexplained pain is not known. This study assessed the prevalence of clinically relevant psychiatric disorders and their predictors in children referred to a children’s hospital for UCP. Psychiatry morbidity was assessed in 134 children, aged 8–17 years, using the Diagnostic Interview Schedule for Children–parent version (DISC-P) and the Semi-structured Clinical Interview for Children and Adolescents (SCICA). Clinical relevance was determined using a maladjustment criterion of 61 or lower on the Children’s Global Assessment Scale (CGAS). Pain parameters were measured with standardized questionnaires. Results were analysed by logistic regression. According to the DISC-P, 21% of the children had clinically relevant psychiatric disorders, predominantly anxiety disorders (18%). According to the SCICA, 28% of the children had clinically relevant psychiatric disorders, consisting of anxiety, affective, and disruptive disorders (12, 19, and 9%, respectively). Headache (compared to musculoskeletal pain) was an independent clinical predictor of psychiatric morbidity (OR = 3.10; 95% CI 1.07–8.92, p = 0.04/adjusted OR 2.99; 95% CI 1.02–8.74, p = 0.04). In conclusion, clinically relevant psychiatric disorders are common among children and adolescents referred for UCP. Adding a child psychiatrist assessment, treatable affective and disruptive disorders become identifiable. Children with an additional risk are those presenting with headache.
Konijnenberg, Antoinette Y.; van der Hoeven, Joost; Kimpen, Jan L. L.; Buitelaar, Jan K.; van Engeland, Herman; de Graeff-Meeder, Elisabeth R.
Recently we showed an integral epidermal growth factor receptor (EGFR)–E2F3a signaling path, in which E2F3a was found to be essential in EGFR-mediated proliferation in ovarian cancer cells. The present work evaluates the clinical relevance of this novel axis and of E2F3a itself in a large set of 130 ovarian cancer specimens. For this purpose E2F3a and its counterpart, E2F3b, were
D Reimer; M Hubalek; H Kiefel; S Riedle; S Skvortsov; M Erdel; G Hofstetter; N Concin; H Fiegl; E Müller-Holzner; C Marth; P Altevogt; A G Zeimet
Objective: To better define the effect of individual risk factors and combinations thereof on the growth of small choroidal melanocytic tumors. Design: Retrospective analysis. Setting: Clinical practice of ocular oncology. Patients: The study included 1287 patients with small suspicious choroidal melanocytic tumors, measuring 3 mm or less in thickness, managed with observation. Results: On multivariate analysis, the clinical risk factors
Carol L. Shields; Jacqueline Cater; Jerry A. Shields; Arun D. Singh; Maria Carmen; M. Santos; Cynthia Carvalho
OBJECTIVE:Recent reports indicate an increasing prevalence of type 2 diabetes mellitus (TD2M) in children and adolescents around the world in all ethnicities, possibly due to increasing prevalence of obesity. Therefore, it is essential that clinicians are aware of the clinical features of T2DM in these age groups.METHODS:All published cases of T2DM in children and adolescents were evaluated and the different
Summary In Jakarta, Indonesia, over 80% of patients with typhoid fever or paraty- phoid fever are treated in outpatient settings. In a community-based prospec- tive passive surveillance study, we identified 59 typhoid, 23 paratyphoid fever and 259 non-enteric fever outpatients, all blood culture-confirmed. We compared their symptoms with the aim of developing a clinical prediction rule that may help direct
Albert M. Vollaard; Soegianto Ali; Suwandhi Widjaja; Henri A. G. H. van Asten; Leo G. Visser; Charles Surjadi; Jaap T. van Dissel
Purpose To assess how completely trials published in conference proceedings are reported and whether this has changed over time.Methods Conference abstracts published at the American Society of Clinical Oncology (ASCO) conference (1992 and 2002) were read to identify reports of randomized trials. A checklist was devised (based on CONSORT) to assess the completeness of reporting.Results Four-hundred and ninety-four abstracts reporting
Sally Hopewell; Mike Clarke
Combined methylmalonic acidemia and homocystinuria, cblC type, is an inborn error of intracellular cobalamin metabolism with\\u000a a wide spectrum of clinical manifestations that is stated to be the most common inherited disorder of cobalamin metabolism.\\u000a This metabolic disease is caused by mutations in the MMACHC gene and results in impaired intracellular synthesis of adenosylcobalamin and methylcobalamin, cofactors for the methylmalonyl-CoA
Nuria Carrillo-Carrasco; Randy J. Chandler; Charles P. Venditti
This article reviews severe disorders of the mother-infant relationship involving emotional rejection of the infant in the first year of its life. Infants exposed to their mother’s hatred and rage may suffer far-ranging and long-term disadvantages, and are at risk of maltreatment. Diagnosis, therapy and research have been hampered by the lack of recognition of this clinical syndrome in the
Over an 18 month period Streptococcus suis type 2 was isolated in pure or mixed culture in 19 disease outbreaks in pigs. Morbidity and case fatality were variable. Clinical signs were of a nervous or respiratory disease or of death with no premonitory signs. Gross and microscopic findings included one or more of fibrinous polyserositis, fibrinous or hemmorhagic bronchopneumonia, purulent meningitis, myocardial necrosis, focal myocarditis and valvular endocarditis. Brain, cerebrospinal fluid and lung were most reliable sites for isolation of the organism.
John, V.S. St.; Wilcock, B.; Kierstead, M.
Based on our previous qualitative exploration, this research presents the second phase in our study of factors associated\\u000a with utilization of a free HIV VCT clinic in Jinan City, Northern China, by female sex workers (FSWs). A total of 970 FSWs\\u000a from entertainment venues were interviewed and prospectively followed to determine who ultimately sought and received VCT\\u000a at the clinic,
Ying Wang; Bing Li; Jingbin Pan; Sohini Sengupta; Catherine Boland Emrick; Myron S. Cohen; Gail E. Henderson
AIM: To determine the factors associated with clinical outcomes and complications of Histoacryl® glue injection for acute gastric variceal hemorrhage. METHODS: Patients who presented to the Siriraj Gastrointestinal Endoscopy Center with active gastric variceal bleeding and were admitted for treatment between April 2008 and October 2011 were selected retrospectively for study inclusion. All bleeding varices were treated by injection of Histoacryl® tissue glue (B. Braun Melsungen AG, Germany) through a 21G or 23G catheter primed with lipiodol to prevent premature glue solidification. Data recorded for each patient included demographic and clinical characteristics, endoscopic findings, clinical outcomes in terms of early and late re-bleeding, mortality, and procedure-related complications. Data from admission (baseline) and post-treatment were comparatively analyzed using stepwise logistic regression analysis to determine the correlation between factors and clinical outcomes. RESULTS: A total of 90 patients underwent Histoacryl® injection to treat bleeding gastric varices. The mean age was 55.9 ± 13.9 (range: 15-88) years old, and 74.4% of the patients were male. The most common presentations were hematemesis (71.1%), melena (12.2%), and coffee ground emesis (8.9%). Initial hemostasis was experienced in 97.8% of patients, while re-bleeding within 120 h occurred in 10.0%. The presence of ascites was the only factor associated with early and late re-bleeding [odds ratio (OR) = 10.67, 95%CI: 1.27-89.52, P = 0.03 and OR = 4.15, 95%CI: 1.34-12.86, P = 0.01, respectively]. Early procedure-related complications developed in 14.4% of patients, and were primarily infections and non-fatal systemic embolization. Late re-bleeding was significantly correlated with early procedure-related complications by univariate analysis (OR = 4.01, 95%CI: 1.25-12.87, P = 0.04), but no factors were significantly correlated by multivariate analysis. The overall mortality rate was 21.1%, the majority of which were related to infections. The factors showing strong association with higher mortality risk were elevated total bilirubin (OR = 16.71, 95%CI: 3.28-85.09, P < 0.01), a large amount of transfused fresh frozen plasma (OR = 1.001, 95%CI: 1.000-1.002, P = 0.03), and late re-bleeding (OR = 10.99, 95%CI: 2.15-56.35, P = 0.02). CONCLUSION: Histoacryl® injection is a safe and effective hemostatic method for treating gastric variceal hemorrhage. Patients with compromised liver, including ascites, have a higher risk of re-bleeding.
Prachayakul, Varayu; Aswakul, Pitulak; Chantarojanasiri, Tanyaporn; Leelakusolvong, Somchai
|Few studies examine the effectiveness of panic control treatment across diverse ethnic groups. In this paper we present data on 40 patients (African American, n = 24; Caucasian, n = 16) with panic disorder and comorbid agoraphobia who presented at an anxiety disorder clinic in an inner-city area. On initial assessment both groups were similar on…
Friedman, Steven; Braunstein, Jeffrey W.; Halpern, Beth
Aims. We analyzed the prevalence of nephropathy according to past body weight status in Japanese subjects with type 2 diabetes because the influence of past obesity on diabetic complications is not certain. Methods. We examined the prevalence of nephropathy in 2927 subjects with type 2 diabetes mellitus according to current BMI and maximum BMI in the past. We defined “current obesity” as BMI on hospitalization of 25 or more, “previous obesity” as BMI on hospitalization of less than 25 and self-reported maximum BMI in the past of 25 or more, and “continuously lean” as maximum BMI of less than 25. Results. The prevalence of nephropathy was significantly higher in subjects with current obesity (40.6%) or previous obesity (35.6%) than in those who were continuously lean (24.3%) (P < 0.017). In logistic regression analysis, previous obesity, as well as current obesity, was a significant risk factor for nephropathy, independent of sex, age, disease duration, hypertension, dyslipidemia, HbA1c, and diabetic retinopathy. Conclusions. Obesity in the past, as well as the present body weight status, was a risk factor for diabetic nephropathy.
Meguro, Shu; Kabeya, Yusuke; Tanaka, Karin; Kawai, Toshihide; Tomita, Masuomi; Katsuki, Takeshi; Oikawa, Yoichi; Atsumi, Yoshihito; Shimada, Akira; Tanaka, Masami; Irie, Junichiro; Saisho, Yoshifumi; Itoh, Hiroshi
AimThere is uncertainty about how to assess unselected acutely ill medical patients at the time of their admission to hospital. This study examined the use of the Simple Clinical Score (SCS) and the medically relevant Cape Triage discriminator clinical presentations to determine the need for admission to an acute medical unit.MethodA prospective study of 270 unselected consecutive acute medical admissions.
Andrew Emmanuel; Asyik Ismail; John Kellett
Aim To determine regional differences in the incidence, incidence trends, and clinical presentation of type 1 diabetes in children under the age of 15 years in Croatia in a 9-year period (1995-2003). Methods We included the patients who had been diagnosed with the disease and had started the insulin treatment before they were 15 years old. Regional differences between eastern, central, and southern Croatia were observed. The gross incidence was expressed by the number of newly diagnosed type 1 diabetes patients in 100?000 children of the same age and sex per year, ie, for the 0-14 age group, and for the 0-4, 5-9, and 10-14 subgroups. Results The highest incidence was observed in southern Croatia (10.91 per 100?000/y) and the lowest in central Croatia (8.64 per 100?000/y), and in eastern Croatia the incidence was 8.93 per 100?000/y. All three regions showed a growing incidence trend, which was significant only in eastern and southern Croatia. There was 35.9% of patients with diabetic ketoacidosis in eastern Croatia, 41.7% in central Croatia, and 31.3% in southern Croatia. Conclusion Croatian regions show differences in the incidence, incidence trends, and disease presentation of type 1 diabetes. A further follow-up is needed to establish whether the regional differences are a consequence of the population dynamics in the observed period or they will continue to exist, pointing to differences in environmental risk factors.
Stipancic, Gordana; La Grasta Sabolic, Lavinia; Pozgaj Sepec, Marija; Radica, Ana; Skrabic, Veselin; Severinski, Srecko; Kujundzic Tiljak, Mirjana
Paralleling the growing popularity of organized sports among pediatric athletes, the stress and intensity of training regimens has escalated the frequency and severity of pediatric overuse injuries. It is essential that radiologists have a thorough knowledge of the pathogenesis of these injuries and of their characteristic patterns with different imaging techniques in order to appropriately diagnose overuse injuries in the pediatric skeleton. Knowledge of the classification, mechanism, clinical and imaging manifestations of acute and chronic overuse injuries of the lower extremities common among pediatric athletes can assist in imaging-based diagnosis and characterization of injury. PMID:23759208
Chang, Geraldine H; Paz, David A; Dwek, Jerry R; Chung, Christine B
Summary High-frequency stimulation of the subthalamic nucleus (STN) constitutes one of the most effective treatments for advanced forms of Parkinson's disease. The cost and potential risks of this procedure encourage the determination of clinical characteristics of patients that will have the best postoperative outcome. Forty-one Parkinson's disease patients underwent surgery for bilateral STN stimulation. The selection criteria were severe parkinsonian
M. L. Welter; J. L. Houeto; S. Tezenas; V. Mesnage; A. M. Bonnet; B. Pillon; I. Arnulf; B. Pidoux; D. Dormont; P. Cornu; Y. Agid
Virtual reality environments have many potential applications in medicine, including surgical training, tele-operated robotic surgery, assessment and rehabilitation of behavioural and neurological disorders and diagnosis, therapy and rehabilitation of physical disabilities. Although there is much potential for the use of immersive virtual reality environments in clinical applications, there are problems which could limit their ultimate usability. Some users have experienced
Christopher H. Lewis; Michael J. Griffin
This study was a retrospective analysis of patients with CLI who underwent infrapopliteal percutaneous transluminal angioplasty\\u000a (PTA). The main goal was to evaluate clinical and morphological factors that influence the clinical outcome of PTA in long-term\\u000a follow-up. A total of 1,445 PTA procedures were performed in 1,268 patients. Main indications for PTA included gangrene, nonhealing\\u000a ulcers, or rest pain. The
Jan H. PeregrinBoris; Boris Kožnar; Josef Ková?; Jarmila Laštovi?ková; Ji?í Novotný; Daniel Vedlich; Jelena Skibová
The major modes of presentation of patients with celiac disease are the classic diarrhea-predominant form and silent celiac disease. Those with silent celiac disease lack diarrhea, although they may present with manifestations of celiac disease that include an irritable bowel syndrome, anemia, osteoporosis, neurologic diseases, or malignancy. A significant proportion of patients are diagnosed through screening at-risk groups including relatives
PETER H. R. GREEN
Background The Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) is a 34-item instrument developed to monitor clinically significant change in out-patients. The CORE-OM covers four domains: well-being, problems/symptoms, functioning and risk, and sums up in two total scores: the mean of All items, and the mean of All non-risk items. The aim of this study was to examine the psychometric properties of the Norwegian translation of the CORE-OM. Methods A clinical sample of 527 out-patients from North Norwegian specialist psychiatric services, and a non-clinical sample of 464 persons were obtained. The non-clinical sample was a convenience sample consisting of friends and family of health personnel, and of students of medicine and clinical psychology. Students also reported psychological stress. Exploratory factor analysis (EFA) was employed in half the clinical sample. Confirmatory (CFA) factor analyses modelling the theoretical sub-domains were performed in the remaining half of the clinical sample. Internal consistency, means, and gender and age differences were studied by comparing the clinical and non-clinical samples. Stability, effect of language (Norwegian versus English), and of psychological stress was studied in the sub-sample of students. Finally, cut-off scores were calculated, and distributions of scores were compared between clinical and non-clinical samples, and between students reporting stress or no stress. Results The results indicate that the CORE-OM both measures general (g) psychological distress and sub-domains, of which risk of harm separates most clearly from the g factor. Internal consistency, stability and cut-off scores compared well with the original English version. No, or only negligible, language effects were found. Gender differences were only found for the well-being domain in the non-clinical sample and for the risk domain in the clinical sample. Current patient status explained differences between clinical and non-clinical samples, also when gender and age were controlled for. Students reporting psychological distress during last week scored significantly higher than students reporting no stress. These results further validate the recommended cut-off point of 1 between clinical and non-clinical populations. Conclusions The CORE-OM in Norwegian has psychometric properties at the same level as the English original, and could be recommended for general clinical use. A cut-off point of 1 is recommended for both genders.
Acute lymphoblastic leukemia has a wide variety of presentations. There is paucity of any data addressing pancytopenia at presentation in acute lymphoblastic leukemia. In this study we assessed 84 patients with pancytopenia at presentation. They had a significantly lower incidence of bulky disease at presentation. A significantly higher fraction of these patients (n=66, 78.57%) opted for therapy (P=0.005) as compared with the rest. The estimated mean survival in patients presenting with pancytopenia (67.2±17.2 mo) was significantly higher (P=0.031, log-rank test) as compared with that of other patients (47.2±7.4 mo). Pancytopenia was an independent predictor of better survival (P=0.043) in multivariate analysis. PMID:23929316
Kulkarni, Ketan P; Marwaha, Ram K
The purpose of this study was to describe epidemiological, clinical and microbiological characteristics of confirmed novel\\u000a influenza A (H1N1) infection, investigating factors associated with disease severity. We retrospectively selected patients\\u000a seeking care for respiratory symptoms in two periods (May–August and September–November 2009) with different epidemiological\\u000a characteristics. Only patients with confirmed pandemic influenza A (H1N1) were enrolled in this study. A
S. Di Giambenedetto; L. Zileri Dal Verme; M. Sali; S. Farina; V. Di Cristo; S. Manzara; A. De Luca; G. Pignataro; M. Prosperi; A. Di Franco; N. Gentiloni Silveri; G. Delogu; R. Cauda; M. Fabbiani; G. Fadda
Inclusion body myopathy (IBM) associated with paget's disease of the bone (PDB) and fronto-temporal dementia (FTD) or IBMPFD, is a rare multisystem degenerative disorder due to mutations in valosin containing protein (VCP). VCP is a ubiquitously expressed protein that facilitates the degradation of proteins via the ubiquitin proteasome and autophagy pathways. Affected brain and muscle tissue in IBMPFD have ubiquitinated and TAR DNA binding protein-43 (TDP-43) inclusions. In skeletal muscle, this pathology is consistent with IBM. While in the CNS, IBMPFD is a frontotemporal lobar degeneration with ubiquitinated inclusions (FTLD-U) subtype. Recent studies suggest that IBMPFD mutations in VCP disrupt its function in protein degradation. This review will explore the clinical phenotype and pathology of IBMPFD with an emphasis on central nervous system degeneration. In addition, we will discuss the current understanding regarding VCP's function in terminally differentiated tissue and how disease associated mutations result in both myo- and neurodegeneration. PMID:21222596
Weihl, C C
Inclusion body myopathy (IBM) associated with paget’s disease of the bone (PDB) and fronto-temporal dementia (FTD) or IBMPFD, is a rare multisystem degenerative disorder due to mutations in valosin containing protein (VCP). VCP is a ubiquitously expressed protein that facilitates the degradation of proteins via the ubiquitin proteasome and autophagy pathways. Affected brain and muscle tissue in IBMPFD have ubiquitinated and TAR DNA binding protein-43 (TDP-43) inclusions. In skeletal muscle, this pathology is consistent with IBM. While in the CNS, IBMPFD is a frontotemporal lobar degeneration with ubiquitinated inclusions (FTLD-U) subtype. Recent studies suggest that IBMPFD mutations in VCP disrupt its function in protein degradation. This review will explore the clinical phenotype and pathology of IBMPFD with an emphasis on central nervous system degeneration. In addition, we will discuss the current understanding regarding VCP’s function in terminally differentiated tissue and how disease associated mutations result in both myo- and neurodegeneration.
Weihl, Conrad C.
It has been well known for decades that high intensity focused ultrasound (HIFU) generates heat in tissues resulting in coagulative necrosis. Implementation, however, has been slow, due to difficulties with finding an appropriate imaging modality that could not only guide treatment, but also provide real-time thermal feedback. These problems have been overcome with the newest magnetic resonance-guided high intensity focused ultrasound systems (MRgHIFU). With its superior spatial resolution enabling accurate image guidance coupled with its ability to provide real-time thermography during treatments, MRI is moving further into the realm of therapeutics for oncologic patient care. This article will discuss the implementation of an MR-guided HIFU system, current clinical indications and touch on future directions. PMID:23870333
Ellis, Samantha; Rieke, Viola; Kohi, Maureen; Westphalen, Antonio C
Gastrointestinal anisakiasis is a parasitic infection occurring in people that consume raw or inadequately cooked fish or squid. It is frequently characterized by severe epigastric pain, nausea and vomiting caused by the penetration of the larvae into the gastric wall. Acute gastric anisakiasis with severe chest discomfort is rarely reported in Italy. On the other hand, gastro-allergic anisakiasis with rash, urticaria and isolated angioedema or anaphylaxis is a clinical entity that has been described only recently. Also, if patients usually develop symptoms within 12 hours after raw seafood ingestion, not always endoscopic exploration can promptly identify the Anisakis larvae. Moreover, some authors consider the prevailing allergic reaction as a natural and effective defense against the parasitic attack. We report two cases of peculiar manifestations of anisakiasis in both acute and chronic forms (severe chest discomfort and anaphylactoid reaction). PMID:23368654
Pontone, Stefano; Leonetti, Giovanni; Guaitoli, Eleonora; Mocini, Renzo; Manfredelli, Simone; Catania, Antonio; Pontone, Paolo; Sorrenti, Salvatore
The classic kidney disease of Human Immunodeficiency Virus (HIV) infection, HIV-associated nephropathy, is characterized by progressive acute renal failure, often accompanied by proteinuria and ultrasound findings of enlarged, echogenic kidneys. Definitive diagnosis requires kidney biopsy, which demonstrates collapsing focal segmental glomerulosclerosis with associated microcystic tubular dilatation and interstitial inflammation. Podocyte proliferation is a hallmark of HIV-associated nephropathy, although this classic pathology is observed less frequently in antiretroviral-treated patients. The pathogenesis of HIV-associated nephropathy involves direct HIV infection of renal epithelial cells, and the widespread introduction of combination antiretroviral therapy has had a significant impact on the natural history and epidemiology of this unique disease. These observations have established antiretroviral therapy as the cornerstone of treatment for HIV-associated nephropathy, in the absence of prospective clinical trials. Adjunctive therapy for HIV-associated nephropathy includes ACE inhibitors or angiotensin receptor blockers, as well as corticosteroids in selected patients with significant interstitial inflammation or rapid progression.
Wyatt, Christina M.; Klotman, Paul E.; D'Agati, Vivette D.
AIM: To identify the characteristic clinical, laboratory and radiological findings and response to treatment in patients with fascioliasis. METHODS: Patients who were diagnosed with Fasciola hepatica infection were included in this prospective study. Initial clinical, laboratory and radiological findings were recorded. All patients were followed until a complete response was achieved or for 6 mo after treatment discontinuation. RESULTS: Fasciola hepatica infection was diagnosed in 30 patients (24 females; mean age: 42.6 years) between January 2008 and February 2011. Twenty-two (73%) patients had hepatic phase fascioliasis, 5 patients had biliary phase, and 3 patients had biliary phase associated with acute pancreatitis. Of the 8 patients with biliary phase fascioliasis, 2 patients displayed features that overlapped with both hepatic and biliary phase. Abdominal pain and right upper abdominal tenderness were the most prominent signs and symptoms in all patients. Eosinophilia was the most prominent laboratory abnormality in both patients with hepatic and biliary phase (100% and 50%, respectively). Multiple nodular lesions like micro-abscesses on abdominal computerized tomography were the main radiological findings in patients with hepatic phase. Small linear filling defects in the distal choledochus were the main endoscopic retrograde cholangiopancreatography (ERCP) findings in patients with biliary phase. Patients with hepatic phase were treated with triclabendazole alone, and patients with biliary phase were treated with triclabendazole and had live Fasciola hepatica extracted from the bile ducts during ERCP. CONCLUSION: Fasciola hepatica infection should be considered in the differential diagnosis of patients with hepatic or biliary disease and/or acute pancreatitis associated with eosinophilia.
Kaya, Muhsin; Bestas, Remzi; Cetin, Sedat
CONTEXT: Although chest pain is widely considered a key symptom in the diagnosis of myocardial infarction (MI), not all patients with MI present with chest pain. The extent to which this phenomenon occurs is largely unknown.\\u000aOBJECTIVES: To determine the frequency with which patients with MI present without chest pain and to examine their subsequent management and outcome.\\u000aDESIGN: Prospective
John G. Canto; Michael G. Shlipak; William J. Rogers; Judith A. Malmgren; Paul D. Frederick; Costas T. Lambrew; Joseph P. Ornato; Hal V. Barron; Catarina I. Kiefe
A 35-year-old patient with hemophilia A presented with rapidly progressive polyarteritis nodosa (PAN). He had been infected\\u000a with hepatitis B virus (HBV) by repeated transfusion and was positive for hepatitis B surface antigen but negative for hepatitis\\u000a B surface antibody.The patient presented symptoms of acute epididymitis followed by emergency admission because of acute appendicitis.\\u000a On day 7 of admission, he
Tadashi Matsushita; Hiroaki Adachi; Hidetaka Watanabe; Yoshie Shimoyama; Tatsuya Adachi; Gen Sobue; Masafumi Ito; Tetsuhito Kojima; Hidehiko Saito; Tomoki Naoe
A myogenic growth factor has been purified from a skeletal muscle, the anterior latissimus dorsi, of adult chickens. In the range of 1-10 ng, this factor stimulates DNA synthesis as well as protein and muscle-specific myosin accumulation in myogenic cell cultures. Purification is achieved through binding of the factor to heparin. The factor is distinct from transferrin and works synergistically with transferrin in stimulating myogenesis in vitro.
Kardami, Elissavet; Spector, Dennis; Strohman, Richard C.
Hemophilia B is caused by decreased factor IX procoagulant activity. An HhaI restriction site polymorphism near the factor IX gene has been detected by the polymerase chain reaction. Frequency and linkage data already observed in Caucasians are confirmed and the polymorphism is also prevalent in the factor IX genes of Black and Asian populations.
Alexander P. Reiner; Arthur R. Thompson
Living donor surgery has come to the forefront of public attention because increasing numbers of potential donors respond to the organ shortage. Because of several factors including decreased morbidity from donor surgery, online resources appealing for organs, and increased publicity about donation, new populations of unrelated donors are seeking evaluation for donor surgery. However, concern about potential coercion of vulnerable
Sheila G. Jowsey; Terry D. Schneekloth
Research from psychological, biochemical, and epidemiological methods reveals a growing body of evidence for the intergenerational transmission of suicide. In particular, family history of suicidal behavior and mental disorders appear to play significant roles in later suicide ideation and attempts. Family disruption associated with parental mental disorder and suicide attempts may be a primary contributory factor in suicide attempts. In
Gregory L. Wilson
This review summarizes data demonstrating the role of TF in tumor development, metastasis and angiogenesis. TF is a transmembrane protein that is expressed constitutively in some kinds of extravascular cells and transiently in intravascular cells after stimulation with cytokines and growth factors. Originally TF was considered to have a function in the initiation of coagulation. In the last years it
Yvonne Förster; Axel Meye; Sybille Albrecht; Bernd Schwenzer
Background Pituitary stalk interruption syndrome (PSIS) may induce an isolated growth hormone (GH) deficiency or multiple hypothalamic-pituitary (HP) deficiencies. Patients with multiple HP deficiencies, primarily those with adrenocorticotropin (ACTH) deficiency, are at increased risk of morbidity and mortality. Our objective was to identify the factors influencing each symptom and the MRI features of the syndrome to enhance its diagnosis and genetic analysis. Methods This study was a retrospective, single-center, case-cohort study of 53 patients with PSIS who had reached pubertal age. Results Patients were classified as having an isolated GH deficiency (n?=?24, Group 1) or HP deficiencies (n?=?29, Group 2); of these, 19 had complete HP deficiency, and 10 had GH deficiency associated with TSH (n?=?4), TSH and ACTH (n?=?3), TSH and gonadotropin (n?=?1) deficiencies or amenorrhea (n?=?2). The following features were less frequent in Group 1 than in Group 2: breech presentation (4% vs 35%, P?=?0.008), hypoglycemia (0% vs 59%, P<0.00001), micropenis (13% vs 69%, P<0.003), hypothalamic origin (0% vs 52%, P<0.000001), ophthalmic malformation (8% vs 38%, P<0.02) and psychomotor delay (0% vs 31%, P<0.004). The frequencies of all other malformations were similar in both groups (37% vs 59%). A visible pituitary stalk was characteristic of patients belonging to Group 1 (P<0.0002). The GH peak was greater in Group 1 than in Group 2 (P<0.0003), as was the anterior pituitary height (P?=?0.01). Conclusion The factors that best discriminate patients with multiple HP deficiencies from those with an isolated GH deficiency are breech presentation, hypoglycemia, and micropenis. No patient with an isolated GH deficiency had psychomotor delay, but associated malformations and/or syndromes, with the exception of ophthalmic disorders, occurred with similar frequencies in both groups. We have also shown that each of the above characteristics is associated with a given HP deficiency and/or malformation/syndrome in the majority of cases.
Pham, Luu-Ly; Lemaire, Pierre; Harroche, Annie; Souberbielle, Jean-Claude; Brauner, Raja
The classical presentation of sporadic Creutzfeldt-Jakob disease (sCJD) is rapid progressive dementia often associated with myoclonus and ataxia followed by death in less than a year from diagnosis. The few patients in the literature who presented with parkinsonism and who were suspected to have progressive supranuclear palsy (PSP) all ran a malignant course and most of them died within 3 years of diagnosis. We screened the Queen Square Brain Bank database and, among 213 patients with a clinical diagnosis of PSP, we found ten patients with 3 years or less disease duration, including one patient with CJD pathology. We report this patient and review other similar cases from the literature. Ten additional cases with similar presentation were identified in the literature. The mean disease duration was 24.2 months. The classical clinical, radiological and laboratory findings for sCJD were absent in the majority of these cases. Clinical presentation of these patients consists of: early falls, prominent dementia, early vertical supranuclear gaze palsy and symmetric akinetic syndrome. In the patients who were subtyped at post-mortem, all four represented the MM2 subtype of sCJD. A rapidly progressive course of PSP with early falls, cognitive impairments and vertical supranuclear gaze palsy should raise suspicion of underlying sCJD pathology regardless of absence of supportive findings on ancillary tests. This case and the literature support the notion that biochemical properties of the prion protein can influence the clinical presentation of sCJD. PMID:23180183
Petrovic, Igor N; Martin-Bastida, Antonio; Massey, Luke; Ling, Helen; O'Sullivan, Sean S; Williams, David R; Holton, Janice L; Revesz, Tamas; Ironside, James W; Lees, Andrew J; Silveira-Moriyama, Laura
Osteomalacia is uncommon in an affluent subtropical city like Hong Kong, where sunlight exposure is adequate and nutritional support is good. We present three patients who had osteomalacia with different presentations. A 74-year-old male with oncogenic osteomalacia presented with multiple bone pain. His biochemical markers returned to normal 4 days postoperatively after resection of a second toe giant cell tumour of tendon sheath. A 62-year-old woman with a history of liver problem and proximal muscle weakness was admitted with atraumatic fracture of the left distal humerus due to osteomalacia. An 81-year-old vegetarian woman with inadequate sun exposure complained of multiple bone pains. Subsequent investigation revealed dietary- and sunlight-deficient osteomalacia with multiple bony abnormalities including marked femur bowing. PMID:21135425
Fok, A W M; Ng, T P
Use of chemotherapy for patients with estrogen receptor (ER)-positive breast cancer has been a conflicting issue. Recent studies have identified predictive markers allowing identification of poor-prognosis ER-positive breast cancers in need of more aggressive therapy. In general, tumours belonging to the so-called luminal B class, tumours expressing a high Ki67, human epidermal growth factor receptor 2 (HER-2) overexpression or a high score on the Oncotype DX gene expression profile reveal a poor prognosis compared with ER-rich tumours of the luminal A class. In contrast, recent studies have shown these tumours, contrasting tumours of the luminal A class, to benefit from more aggressive anthracycline-containing chemotherapy including a taxane. In the case of metastatic disease, patients with HER-2-positive, ER-positive tumours may benefit from having endocrine therapy and an anti-HER-2 agent administered in combination.
Background Acute pyelonephritis (APN) is differently defined according to imaging or clinical criteria. In adults information on the relationship between imaging and clinical data is lacking. Our study was aimed at analysing the relationship between the clinical and imaging presentation of APN, defined according to imaging criteria (parenchymal involvement at MR or CT scan). Methods All consecutive patients hospitalized for "non-complicated" APN were considered (June 2005-December 2009). Clinical, biochemical and imaging data at hospitalization were analyzed by univariate and logistic regression analysis. Results There were 119 patients, all females, median age 32 years (15-72). At hospitalization, inflammatory markers were elevated (CRP median: 12.1 mg/dL, normal < 0.8). Incomplete presentations were frequent: fever was absent in 6.7%, pain in 17.8%, lower urinary tract symptoms in 52.9%. At CT or MR scan the lesions were bilateral in 12.6%, multiple in 79.8%; abscesses were present in 39.5%. Renal scars were found in 15.1%. Positive cultures were correlated with multiple foci (multivariate OR 4.2; CI 1.139-15.515). No other sign/symptom discriminated between small lesions, abscesses or multifocal involvement. Conclusions APN is a protean disease. In the absence of strict correlation with clinical or biochemical markers, imaging studies are required to assess the severity of kidney involvement.
Background and Purpose: Posterior circulation stroke accounts for approximately 20% of all strokes with varied clinical presentation, which differ from strokes in anterior circulation, with reference to etiology, clinical features, and prognosis. Short penetrating and circumferential branches in the posterior circulation supply the brain stem, thalamus, cerebellum, occipital, and medial temporal lobes. Materials and Methods: We prospectively analyzed 80 participants of posterior circulation ischemic stroke from a registry of 944 participants attending a tertiary care referral university hospital. Patients were analyzed for demographics, stroke risk factors, clinical characteristics, neuroimaging, and stroke subtypes. Results: Posterior circulation ischemic stroke accounted for 80 (8.5%) of 944 of all strokes and 80 (10.45%) of 765 of ischemic stroke. Sixty-three were males with mean age 51.7 ± 14.4 years. Twenty-one participants were young (defined as age less than 45 years). Hypertension was found to be the most common risk factor (63.75%). Vertigo was the most common clinical symptom reported in 45 (56.25%) cases. Sixty-eight (85%) patients had large artery disease, 8 (10%) had documented cardioembolic source, 3 (3.75%) small artery disease, and 2 (2.5%) vasculitis. Posterior cerebral artery was most commonly involved. Topographically distal intracranial involvement was most frequent (66.25%) followed by proximal (30%) and middle intracranial territory (3.75%). Conclusions: Our study demonatrated the occurrence of posterior circulation stroke in relatively younger age group compared to the Western world. We also found higher percentage of large artery disease, while cardioembolism as a less frequent cause of posterior circulation ischemic stroke in North Indian population. Distal territory involvement was most common in our study.
Mehndiratta, Manmohan; Pandey, Sanjay; Nayak, Rajeev; Alam, Anwar
OBJECTIVE: To determine awareness of cancer risk factors in the patients and attendants of Out-patient Clinics at a University Hospital in Karachi, Pakistan.METHODS: A cross-sectional survey was conducted on 315 respondents reporting to a tertiary care hospital in Karachi, Pakistan, to assess their level of awareness regarding risk factors of cancer.RESULTS: The respondents belonged to an urban population with the
Hadi Bhurgri; Saqib Ali Gowani; Ahmed Itrat; Saira Samani; Akbar Zuberi; Momin Saulat Siddique; Waris Qidwai; Yasmin Bhurgri
A high standard of radiotherapeutic practice must be sought in all phases of management of a patient with malignant disease. Radiation therapy must be appropriately chosen and integrated with surgery, cytotoxic chemotherapy and all other modes of treatment. The most suitable technique with a dose, fractionation and time regime must devised and executed with technical and personal care. Follow-up to truly assess tumor control and morbidity is essential so as to guide the management of future patients. To achieve this in Europe great reliance is placed upon the training and qualification of the therapist and staff. High standards are applied to the professional qualifications for radiation physicists, nurses and technical staff. In the countries belonging to the European economic union, a new Diploma in Radiation Therapy has been established to be a standard for consultant practice through all the countries included. The European Organization for Research and Treatment of Cancer has recently initiated a quality control study in some of the centers included in the Radiotherapy Group. A preliminary report has just appeared on the results of the clinical and dosimetric studies in 8 centers placed in 5 European countries.
The clinical diagnosis of fibroid uterus is based on physical examination findings and/or ultrasound. However, it is not uncommon for routine pathology examination to report no significant fibroids in such cases. Myometrial hyperplasia (MMH) is a structural variation with irregular zones of hypercellularity and increased nucleus/cell ratio that appears in adolescence, can progress during the childbearing years, and can sometimes cause grossly detectable bulges on pathologic examination. MMH can be inframucosal, intramural (microscopic), or subserosal. Three premenopausal women with a preoperative diagnosis of fibroids on pelvic examination, and/or sonograms, underwent hysterectomies. In all the 3 cases, the Myoma Index (number of fibroids×size of largest fibroid) indicated insignificant fibroids. The pathology simulating fibroids was firm, bulging inframucosal MMH. Firm, bulging MMH can mimic uterine fibroids on ultrasound and physical examination. In hysterectomies for fibroid uterus with a Myoma Index <3.7, it is recommended that pathologists evaluate for MMH as the possible explanation for the findings on physical examination and/or ultrasound. PMID:24071875
Newcomb, Patricia M; Cramer, Stewart F; Leppert, Phyllis C
Early detection of Breast Cancer is currently emerging as a big clinical entity requiring a non invasive, radiation less, harmless, cost effective diagnostic technique. Survival is improved if detected early. Breast Cancer is the second most common cancer in India. Health corporate system of India is urgently requiring a cost effective, noninvasive novel technique like "Electrical Impedance Tomography (EIT)" for screening large poor rural population of India for early diagnosis of Breast Cancer. EIT is the technique to visualize spatial distribution of Electro-impedance (or conductivity) inside the object, such as human body. A medical device which allows imaging of the distribution of conductivity in 3D in regions below the skin surface has been developed and tested. Its purpose is to enable early detection and preliminary diagnosis of breast tumors. The system uses a planar array consisting of 256 electrodes and enables obtaining images of the three-dimensional conductivity distribution in regions below the skin's surface up to several centimeters deep. The developed measuring system and image reconstruction algorithm can be used for breast tissue imaging and diagnostic, in particular for malignant tumor detection. Initially ten patients as control and ten patients with breast lesions have been studied with this new technique. It was found that electrical impedance mammograms from different groups has clear visual distinctions and statistically significant difference in breast glands conductivity. The results are quiet encouraging. EIT may emerge as the first line noninvasive imaging method of choice for screening large population for early detection of breast cancer.
Chakraborti, K. L., Dr; Selvamurthy, W., Dr
Syringocystadenoma papilliferum is a rare adnexal tumor that often occurs as a solitary tumor in the head and neck region, although occurrences on other anatomical locations have been described. Linear configurations have been described, but an agminated form is a more rare and underreported variant of this tumor. We describe a case of a healthy 10-year old female with agminated syringocystadenoma papilliferum occurring on her left supraclavicular region, with the clinical appearance of grouped molluscum contagiosum papules.Case synopsis A healthy 10-year-old girl was referred for the treatment of a "collection of molluscum contagiosum" of the left supra clavicular region of several years duration. The lesions were asymptomatic and refractory to cryotherapy. The patient was a healthy girl with no significant systemic findings. Cutaneous exam revealed a clustered group of pink, dome shaped, umbilicated papules over a 1.5 x 1 cm area within the left supraclavicular fossa (Figure 1a). An excisional biopsy was performed. Routine H&E stained sections revealed cystic epidermal invaginations with papillary projections. The superficial portions of the cyst were lined by stratified keratinizing epithelium, whereas the deeper papillated portion exhibited a double layer of basal-like cells and luminal eosinophilic columnar cells with focal decapitation secretion. The papillary structures contained fibrovascular cores and lymphoplasmacytic infiltrates. A component of hamartomatous follicular growth was not identified (Figure 1b-d.). A diagnosis was made of agminated syringocystadenoma papilliferum. PMID:24021448
Ogunrinade, Kunle; Blobstein, Steven H; Desman, Garrett T
Forkhead Transcription Factors: Vital Elements in Biology and Medicine provides a unique platform for the presentation of novel work and new insights into the vital role that forkhead transcription factors play in both cellular physiology as well as clinical medicine. Internationally recognized investigators provide their insights and perspectives for a number of forkhead genes and proteins that may have the greatest impact for the development of new strategies for a broad array of disorders that can involve aging, cancer, cardiac function, neurovascular integrity, fertility, stem cell differentiation, cellular metabolism, and immune system regulation. Yet, the work clearly sets a precedent for the necessity to understand the cellular and molecular function of forkhead proteins since this family of transcription factors can limit as well as foster disease progression depending upon the cellular environment. With this in mind, our concluding chapter for Forkhead Transcription Factors: Vital Elements in Biology and Medicine offers to highlight both the diversity and complexity of the forkhead transcription family by focusing upon the mammalian forkhead transcription factors of the O class (FoxOs) that include FoxO1, FoxO3, FoxO4, and FoxO6. FoxO proteins are increasingly considered to represent unique cellular targets that can control numerous processes such as angiogenesis, cardiovascular development, vascular tone, oxidative stress, stem cell proliferation, fertility, and immune surveillance. Furthermore, FoxO transcription factors are exciting considerations for disorders such as cancer in light of their pro-apoptotic and inhibitory cell cycle effects as well as diabetes mellitus given the close association FoxOs hold with cellular metabolism. In addition, these transcription factors are closely integrated with several novel signal transduction pathways, such as erythropoietin and Wnt proteins, that may influence the ability of FoxOs to lead to cell survival or cell injury. Further understanding of both the function and intricate nature of the forkhead transcription factor family, and in particular the FoxO proteins, should allow selective regulation of cellular development or cellular demise for the generation of successful future clinical strategies and patient well-being.
Maiese, Kenneth; Chong, Zhao Zhong; Hou, Jinling; Shang, Yan Chen
Presented is a study of a 20-year-old girl with mild, breathy dysphonia, previously diagnosed as psychogenic. In actuality, her voice change was a sign of early myasthenia gravis. It is pointed out that voice changes can be a first and only sign of early neurologic disease. (Author/KW)
Aronson, Arnold E.
|Distance education in social work has grown significantly due to the use of interactive television and computer networks. Given the recent developments in delivering distance education utilizing Web-based technology, this article presents a literature review focused on identifying generational trends in the development of Web-based learning…
Coe Regan, Jo Ann R.; Youn, Eric J.
BACKGROUND: Splenic artery aneurysms (SAA) are uncommon but the most common visceral artery aneurysm. Splenic artery aneurysms are important to recognize because up to 25% may be complicated by rupture and the mortality rate after rupture is between 25% and 70%. CASE REPORT: We present a patient who have abdominal pain. Previously healthy 22-year-old female admitted to emergency department with
Sezgin Sarikaya; Baki Ekci; Can Aktas; Asli Cetin; Didem Ay; Alp Demirag
This study examined the effects of comorbid separation anxiety disorder (SAD) on the expression of externalizing symptoms in children presenting with oppositional defiant disorder (ODD) as well as the treatment effects on anxiety and internalizing symptoms. Participants were 64 children with ODD seen in parent–child interaction therapy (PCIT), including 15 children with comorbid SAD. Children with ODD+SAD did not differ
Rhea M. Chase; Sheila M. Eyberg
Non Hodgkin lymphoma (NHL) constitutes 5% of all head & neck cancer. The incidence of it has been increased over the last four decades. One of main characteristic of NHL is extranodal presentation that has different pattern in various part of world. A retrospective was designed in a tertiary referral center. It has been done between January 1996 and March
Ebrahim Razmpa; Babak Saedi
BACKGROUND: Hepatic artery thrombosis is a devastating complication after orthotopic liver transplantation often requiring revascularization or re-transplantation. It is associated with considerably increased morbidity and mortality. Acute cognitive dysfunction such as delirium or acute psychosis may occur after major surgery and may be associated with the advent of surgical complications. CASE PRESENTATION: Here we describe a case of hepatic artery
Armin D Goralczyk; Volker Meier; Giuliano Ramadori; Aiman Obed; Thomas Lorf
Striking variability has been observed in the presenting features in infancy of patients subsequently shown to have tetralogy of Fallot. Some patients presented with severe cyanosis in the neonatal period while others had a systolic murmur and cyanosis only on crying. In these latter patients cyanosis became present at rest over the subsequent months. Yet others presented with episodic attacks of unconsciousness, and a final group presented with dyspnoea and heart failure, accompanying a left-to-right shunt. Angiography demonstrates corresponding variations in the anatomy of the ventricular outflow tracts. In the severely cyanosed patients, the conus septum was deviated so as to obstruct the pulmonary outflow tract, and was best visualized in the lateral projection. In the patients with increasing cyanosis or episodic attacks of unconsciousness, the conus septum again obstructed the pulmonary infundibulum, but was obliquely orientated, not being seen clearly on either lateral or frontal projections. The episodic attacks were considered to be related to infundibular spasm, as previously shown to occur in Fallot's tetralogy. In contrast, increasing cyanosis was believed to be related to hypertrophy of infundibular musculature. In the patients with an initial left-to-right shunt, the arteries were orientated side-by-side so that the conus septum was observed in the frontal projection. Again, subsequent cyanosis was related to ventricular hypertrophy producing outflow tract obstruction. These findings are interpreted in the setting of a recent study, indicating that Fallot's tetralogy is produced by rotation of the embryonic conus together with sinistro-anterior deviation of the conus septum. Images
Shinebourne, E A; Anderson, R H; Bowyer, J J
Insulin resistance is thought to be involved in the pathogenesis of many equine conditions such as pars intermedia dysfunction, equine metabolic syndrome, diabetes mellitus, hyperlipaemia, laminitis, endotoxaemia and osteochondrosis dissecans (OCD); whereas polysaccharide storage myopathy in Quarter Horses and equine motor neuron disease (EMD) have been associated with increased insulin sensitivity. However, it is clear that there is not one ideal test, in terms of both practicality and accuracy, for evaluating insulin sensitivity in horses and improved diagnostic techniques are required. This review sets out the background to the subject and identifies current knowledge regarding the measurement of insulin sensitivity by tolerance testing and clamping techniques. Factors affecting insulin sensitivity, such as breed, pregnancy, lactation, obesity and nutritional factors are discussed. In addition, the relationship with training, nutritional supplementation and drug administration are considered. PMID:18065318
Firshman, A M; Valberg, S J
Purpose: To examine the effect of clinical presentation and interval to breast surgery on local recurrence and survival in early-stage breast cancer. Methods and Materials: The data from 397 patients with Stage T1-T2N0 breast carcinoma treated with conservative surgery and breast radiotherapy between 1985 and 1992 were reviewed at the London Regional Cancer Program. The clinical presentation consisted of a mammogram finding or a palpable lump. The intervals from clinical presentation to definitive breast surgery used for analysis were 0-4, >4-12, and >12 weeks. The Kaplan-Meier estimates of the time to local recurrence, disease-free survival, and cause-specific survival were determined for the three groups. Cox regression analysis was used to evaluate the effect of clinical presentation and interval to definitive surgery on survival. Results: The median follow-up was 11.2 years. No statistically significant difference was found in local recurrence as a function of the interval to definitive surgery (p = .424). A significant difference was noted in disease-free survival (p = .040) and cause-specific survival (p = .006) with an interval of >12 weeks to definitive breast surgery. However, the interval to definitive surgery was dependent on the presentation for cause-specific survival, with a substantial effect for patients with a mammographic presentation and a negligible effect for patients with a lump presentation (interaction p = .041). Conclusion: The results of this study suggest that an interval of >12 weeks to breast surgery might be associated with decreased survival for patients with a mammographic presentation, but it appeared to have no effect on survival for patients presenting with a palpable breast lump.
Vujovic, Olga, E-mail: firstname.lastname@example.org [Department of Radiation Oncology, London Regional Cancer Program, London, ON (Canada); Yu, Edward [Department of Radiation Oncology, London Regional Cancer Program, London, ON (Canada); Cherian, Anil [Department of Medical Oncology, London Regional Cancer Program, London, ON (Canada); Perera, Francisco; Dar, A. Rashid [Department of Radiation Oncology, London Regional Cancer Program, London, ON (Canada); Stitt, Larry [Department of Biometry, London Regional Cancer Program, London, ON (Canada); Hammond, A. [Department of Radiation Oncology, London Regional Cancer Program, London, ON (Canada)
Taken in conjunction with a history and clinical examination, the plain X-ray film may provide invaluable help in reaching or confirming a diagnosis in the patient with an acute abdomen. Designed for the casualty officer or trainee surgeon, this clinical handbook is a practical guide to the interpretation of the plain abdominal X-ray. The format of the first edition has been retained, providing typical examples of X-rays of the conditions which present as abdominal emergencies. Each X-ray is accompanied by a legend in four sections: the characteristic radiological signs demonstrated in the film; the differential diagnosis suggested by the X-ray; the presenting signs and symptoms of the condition under discussion; and a list of possible clinical differential diagnoses.
Gough, M.H.; Gear, M.W.; Daar, A.S.
Hepatocyte growth factor (HGF), originally identified as the most potent mitogen for hepatocytes, is now known to be a cytokine\\u000a with numerous functions in a wide variety of cells. HGF transduces its various activities via a receptor encoded by the c-met proto-oncogene and coupled to a number of transducers integrating the HGF signal inside the target cells. Extensive investigation\\u000a has
Toshimi Kaido; Masayuki Imamura
A phase I and pharmacokinetic study of recombinant tumor necrosis factor (rH-TNF Asahi) was carried out in 29 patients, who received a total of 72 courses with doses ranging from 1 to 48x104 units\\/m2. Drug was given as 1-h i. v. infusions. Acute toxicities, taking the form of fever, chills, tachycardia, hypertension, peripheral cyanosis, nausea and vomiting, headache, chest tightness,
Patrick J. Creaven; John E. Plager; Sherry Dupere; Robert P. Huben; Hiroshi Takita; Arnold Mittelman; April Proefrock I
Subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm is a devastating subset of stroke, occurring in relatively\\u000a young people (mean age around 50 years) of whom around a third die within the initial weeks after the bleed. Environmental\\u000a and genetic risk factors both have a role in SAH. A recent genome-wide association study of intracranial aneurysms in Finnish,\\u000a Dutch and
Ynte M Ruigrok; Gabriel JE Rinkel
The incidence of fungal infections has increased over the past decade. In addition to classical pathogens, such as Aspergillus spp, new fungal species are increasingly reported. Despite the availability of new antifungals, mortality of invasive fungal\\u000a infections remains very high. The host immune status is the main factor for survival. However, most of these pathogens have\\u000a high minimum inhibitory concentrations
Laura Alcazar-Fuoli; Juan L. Rodríguez-Tudela; Emilia Mellado
Background Abnormal posture (AP) is often seen in Parkinson's disease (PD), and marked forms known as dropped head syndrome and camptocormia encumber daily living activities. Unlike other motor disabilities such as bradykinesia or muscular rigidity, AP is not always improved but rather deteriorated by PD medication. Purpose To clarify factors associated with neck and thoracolumbar AP. Methods Neck flexion (NF) and thoracolumbar (TL) angles were measured in 216 consecutive PD patients and 175 elderly healthy controls. The differences in NF and TL angles between PD patients and controls were designated as ?NFA and ?TLA, respectively. The association of ?NFA or ?TLA and predictable factors such as age, sex, duration of PD, Hoehn Yahr (H–Y) stage, Unified Parkinson's Disease Rating Scale Part 3 (UPDRS-3), daily dose of dopamine agonists, and comorbid orthopedic spinal lesions was investigated in PD patients. Patients were divided into quartiles according to ?NFA or ?TLA. The association between predictable factors and ?NFA or ?TLA was estimated as odds ratio (OR), comparing with the lowest quartile as the reference by multivariate regression analysis. Results Compared with controls, distributions of all three posture angles were significantly shifted rightward in PD patients. Although there were no difference in UPDRS-3 scores in the quartiles of ?NFA, the highest quartile was associated with H–Y stage ?3 [OR 2.99, 95% confidence interval (CI) 1.33–6.70, p?=?0.008] after adjustment for age, sex and comorbid orthopedic spinal lesions. The highest quartile of ?TLA was associated with comorbid orthopedic spinal lesions [OR 5.83 (1.42–23.8), p?=?0.014], and UPDRS-3 score [OR 3.04 (1.80–5.15)/10 points, p<0.0001]. Conclusion Thoraco-lumbar AP was associated with UPDRS-3 scores and orthopedic spinal lesions, and in contrast, neck AP was not associated with these factors, suggesting that they had different pathomechanisms.
Oeda, Tomoko; Umemura, Atsushi; Tomita, Satoshi; Hayashi, Ryutaro; Kohsaka, Masayuki; Sawada, Hideyuki
Fibroblast growth factor 21 (FGF21) has been proposed as a novel putative therapeutic agent in type 2 diabetes. A large amount\\u000a of data, predominantly obtained from murine models but also from non-human primates, suggest that FGF21 ameliorates obesity-associated\\u000a hyperglycemia and hyperlipidemia primarily via effects on adipose tissue and the pancreas. In addition, FGF21 has been reported\\u000a to play a pivotal
We examined if croup presentations to the emergency department (ED) were associated with weather changes in a warm temperate climate. We collected data on all 729 cases with an ED discharge or admission diagnosis of croup over a 798 day time period. We obtained detailed climatic records from the New South Wales Meteorological Office for the same time period. Only one daily variable, ground temperature at 9:00, was significantly associated with the number of croup attendances (linear regression -0.2062; 95% CI -0.272 to -0.138). There was a stronger correlation (-0.426; 95% CI -0.684 to -0.072) between the calculated mean monthly temperature and the monthly number of croup admissions. Even in this milder climate, croup is associated with cooler weather. We are unable to conclude that hospital attendances for croup are caused by changes in temperature alone, as other factors such as the prevalence of viral illness also follow a seasonal, and therefore, temperature-related pattern. PMID:23558151
Atkinson, Paul R T; Boyle, Adrian A; Lennon, Richard S P
Recent in vivo and in vitro experimental evidence indicates that transforming growth factor-alpha (TGF-alpha) is an important growth factor in the process of recovery and remodeling that occurs after acute lung injury. However, there are very little clinical data on TGF-alpha in patients with acute lung injury. Therefore, the purpose of this study was to determine if TGF-alpha is present in biologically significant concentrations in the pulmonary edema fluid from patients with acute lung injury, and to determine if the presence of TGF-alpha is specific for acute lung injury by including control patients with hydrostatic edema. Using an enzyme-linked immunosorbent assay, plasma and pulmonary edema fluid TGF-alpha levels were measured in 43 patients (34 with increased permeability edema, nine with hydrostatic edema). TGF-alpha was detected in 24 of 34 patients (71%) with increased permeability pulmonary edema (range, 0.035 to 2.57 ng/mL) compared with only two of nine patients with hydrostatic edema (p < 0.05). TGF-alpha was not detected in any plasma samples. These concentrations of TGF-alpha in pulmonary edema fluid have potent in vivo and in vitro effects on alveolar epithelial sodium transport and alveolar epithelial cell motility. In conclusion, biologically relevant concentrations of soluble TGF-alpha are present in the pulmonary edema fluid on day 1 of patients with acute lung injury, a remarkable finding with important implications for the repair and resolution of acute lung injury, particularly since TGF-alpha was detected so early in the course of acute lung injury. PMID:9118703
Chesnutt, A N; Kheradmand, F; Folkesson, H G; Alberts, M; Matthay, M A
Glanders or farcy, caused by Burkholderia mallei, is an infectious and zoonotic disease of solipeds. Horses, donkeys and mules are the only known natural reservoir of B. mallei. Although glanders has been eradicated from most countries, it has regained the status of a re-emerging disease because of the numerous recent outbreaks. Pre-symptomatic or carrier animals are the potential source of infection for the healthy equine population and play a crucial role in the spreading of the infectious agent. Glanders is characterized by ulcerating nodular lesions of the skin and mucous membrane. Generalized symptoms include fever, malaise, depression, cough, anorexia and weight loss. Burkholderia mallei can invade its host through mucous membranes, gastrointestinal tract and the integument. Its virulence mechanisms and pathogenesis are not yet completely understood. A major problem when using serological tests for diagnosing glanders is the occurrence of false-positive and false-negative results leading to difficulties in international trade with equids and to the spread of glanders to disease-free regions. Moreover, poor tests critically result in poor control of disease. These tests are not only incapable of discriminating between B. mallei and B. pseudomallei antibodies, they are also unable to differentiate between malleinized and naturally infected animals. Combined use of both serological and molecular detection methods increases the detection rate of glanders. Countermeasures against glanders include early detection of disease in susceptible animals, stringent quarantine measures, testing and safe destruction of infected carcasses, adequate compensation to the animal owners, disinfection of infected premises and awareness about glanders and the zoonotic implications through veterinary extension services. An account of the clinical picture and successful experimental therapy of spontaneous equine glanders is also given. PMID:22630609
Khan, I; Wieler, L H; Melzer, F; Elschner, M C; Muhammad, G; Ali, S; Sprague, L D; Neubauer, H; Saqib, M
Respiratory failure is rarely a presenting symptom of motor neuron disease. Seven patients with motor neuron disease who presented with acute respiratory failure of unknown cause and required mechanical ventilation were studied. They all had symptoms and signs suggestive of diaphragmatic weakness. Respiratory involvement seemed disproportionately severe, as six were ambulatory and only three noted limb weakness. Only one had tongue weakness and none had swallowing difficulty. Electrophysiological studies showed widespread denervation and, in particular, diaphragmatic involvement to explain the severe respiratory failure. Weaning from the ventilator was unsuccessful in all cases. The four patients examined at necropsy showed severe loss of anterior horns cells in the cervical cord, with only minimal upper motor neuron involvement. Motor neuron disease should be recognised as a cause of acute respiratory failure, secondary to diaphragmatic paralysis from involvement of phrenic motor neurons. Images
Chen, R; Grand'Maison, F; Strong, M J; Ramsay, D A; Bolton, C F
A 65-year-old man presented to our Emergency Unit with a history of chest pain of 12 h duration. The pain was dull, non-exertional, and also involved the epigastric and umbilical regions. Other review of systems was unremarkable. He reported similar episodes of chest discomfort lasting a few minutes, and associated with weakness in the prior few days. The prompt resolution
Davide Ermacora; Beatrice Segafredo; Gentian Denas; Seena Padayattil Jose; Vittorio Pengo
Summary A patient is described with a testicular Non-Hodgkin's Lymphoma (NHL) presenting with panhypopituitarism caused by a hypophyseal localization. A67Gallium scintigraphy showed avid uptake in the hypophyseal region. Obviously67Gallium could reach the tumor, by the intravenous route, which was the reason to treat the patient with intravenous chemotherapy. A complete remission was induced, which seems to be lasting (+ 25
Andries R. Jonkhoff; Peter C. Huijgens; Willem O. Schreuder; Gerrit J. J. Teule; Jan J. Heimans
The case of a 29-year-old HIV positive male patient suffering from a Kaposi's sarcoma exclusively located in the proximal third of the trachea and subglottic region is presented. The patient was found to have included an obstruction of the upper airway. A characteristic endoscopic appearance led to the final diagnosis. A combined treatment with Nd-YAG laser endoscopic resection and laringotracheal
J. Belda; E. Canal??s; J. M. Gimferrer; A. Xaubet; X. Baldó; A. Guelar
A man aged 55 with negative family history presented with progressive decline in spatial orientation and visual functions\\u000a for 2 years. He showed impaired optic fixation, optic ataxia, agraphia, acalculia, ideomotor apraxia, disturbed right–left\\u000a differentiation but preserved color matching, memory and motor perception, gradually progressing to dementia, without extrapyramidal\\u000a signs. Brain MRI and PET showed severe bilateral atrophy and hypometabolism in
Kurt A. JellingerAnja; Anja Grazer; Katja Petrovic; Stefan Ropele; Günter Alpi; Peter Kapeller; Thomas Ströbel; Reinhold Schmidt
Schizophrenia and intellectual disability (ID) co-occur three times more than would be expected by chance. This has led to\\u000a speculation that a particular form of schizophrenia may give rise to both the symptoms of schizophrenia and the intellectual\\u000a impairment. If this was the case, one may expect the presentation of schizophrenia in an ID population to differ from that\\u000a in
Killian A. Welch; Stephen M. Lawrie; Walter Muir; Eve C. Johnstone
In this paper we describe a case of a 71-year-old man affected by left hemidiaphragm agenesis who presented an extensive enterothorax\\u000a after an asymptomatic history for many years. The patient had late development of severe constipation and occasional episodes\\u000a of bowel obstruction and vomiting. The surgical correction of this congenital anomaly consisted of restoring the continuity\\u000a of the diaphragmatic barrier
L. Fei; C. Saviano; F. Moccia; G. del Genio; V. Trapani; A. Nunziale; G. Lombardi; M. Cecchi
Congenital Morgagni hernia is a rare entity, accounting for less than 1,5% of all types of congenital diaphragmatic hernias.\\u000a The majority of Morgagni hernias are diagnosed late because patients can be asymptomatic or present with non-specific respiratory\\u000a and gastrointestinal symptoms and signs. The medical records of all patients diagnosed with CMH and treated in our hospital\\u000a were retrospectively reviewed for
Slavkovi? An?elka; Marjanovi? Zoran; ?or?evi? Ivona; Jovanovi? Zorica; Budi? Ivana
A patient presenting with bilateral enlargement of parotid and lacrimal glands, xerostomia, and keratoconjunctiva sicca, whose labial biopsy specimen showed changes consistent with Sjögren's syndrome, is described. The patient was initially misdiagnosed as having primary Sjögren's syndrome (SS). Subsequent investigations, however, performed to exclude an associated lymphoma or sarcoidosis, showed histological changes of the latter. The possibility that early infiltrates of the salivary glands in sarcoid may mimic those of SS is discussed. Images
Melsom, R D; Speight, P M; Ryan, J; Perry, J D
Hydralazine is a commonly used drug for treatment of hypertension and is known to cause drug-induced lupus erythematosus. It has rarely been reported to cause anti neutrophil cytoplasmic antibody positive vasculitis, a life-threatening complication. Presentation could be extremely variable delaying diagnosis. Although drug-induced vasculitis has been infrequently associated with rapidly progressing glomerulonephritis, pulmonary involvement presenting as pulmonary renal syndrome is extremely rare. We report a case of hydralazine-induced vasculitis presenting as pulmonary renal syndrome with fatal outcome even after aggressive treatment. Numerous antibodies are associated with hydralazine including anti myeloperoxidase antibody, anti-nuclear antibody, anti-histone antibody, and anti-elastase antibody. Additionally, we also report the presence of anti-phospholipid antibodies specific to anti-cardiolipin, anti-beta2 glycoprotein, and anti-phosphatid that have not been previously reported. We conclude that early diagnosis and prompt discontinuation of the drug is necessary for the treatment of hydralazine-induced anti neutrophil cytoplasmic antibody vasculitis. PMID:21590349
Marina, Vamsee Priya; Malhotra, Deepak; Kaw, Dinkar
To be able to live a good, independent life cognitive functions need to be intact. Dementia, stroke and neuropsychiatric disorders are the major disorders underlying disability. Stroke is usually a consequence of an underlying vessel wall disease that has lasted for a longer period. This vessel wall disease is commonly silent or without prominent symptoms. Damage to the small penetrating arterioles of the brain, arteriolosclerosis, induced by aging and hypertension, as well as other factors such as diabetes and genetic vulnerability, plays an important role in the origin of white matter changes. The pathological vascular wall process leads to lumen constriction, impaired ability to change lumen diameter according to metabolic needs and possible ischemic-hypoxic tissue damage in the vulnerable vascular architectural terminal areas of the long penetrating arteries. The arteriolosclerotic blood vessels are associated with inflammation and remodelling of the extracellular matrix. Enzymes connected to this process have also been found to be involved in demyelination and blood brain barrier opening but also in the repair process of angiogenesis and neurogenesis. Biochemical changes reflecting these processes might be early indicators of small vessel disease and hence increase the knowledge about the disease characteristic mechanisms. Moreover, monitoring disease modifying treatment effects can be an important application for small vessel disease specific biochemical markers. PMID:22920584
Wallin, Anders; Ohrfelt, Annika; Bjerke, Maria
There is increased interest in the role that ethnicity, sociocultural factors, and gender play in research, health care delivery, and response to intervention. The impact of these factors on AIDS awareness programs, on the phenomenology of suicide and anorexia nervosa, and on clinical psychopharmacology in a homogeneous population is discussed. Risky sex practices can be related to cultural norms that stigmatize condom use and sex education; economic deprivation; and male dominance. Gender, cultural, and ethnic demographics can identify high-risk groups as well as influence effective interventions. Suicide rates and risk factors are compared in African-American, Canadian Native, and South Korean adolescents. Academic stress was a differential risk factor for the Koreans. Anorexia nervosa predominantly affects women and has cultural differences in prevalence. The homogeneous population in Hong Kong illustrates the impact of ethnicity, sociocultural factors, and gender on clinical psychopharmacology. Attention to ethnicity, sociocultural factors, and gender can individualize and improve the effectiveness of clinical psychopharmacology. PMID:8783899
Objective: To simultaneously and prospectively compare the clinical presentation, course, and parental psychiatric history between children and adolescents with major depressive disorder. Method: A group of prepubertal children (n = 46) and postpubertal adolescents (n = 22) were assessed with structured interviews for psychopathology and parental…
Birmaher, Boris; Williamson, Douglas E.; Dahl, Ronald E.; Axelson, David A.; Kaufman, Joan; Dorn, Lorah D.; Ryan, Neal D.
Complex regional pain syndrome (CRPS), a fairly common problem in rheumatological and orthopaedic practice, is an allodynic pain state of uncertain pathology often variably and unpredictably responsive to treatments. Although published diagnostic criteria are available, in the reality of clinical practice these do not appear to encompass the wide variety of symptoms that a patient may present with. This leads
C. S. McCabe; D. R. Blake
BACKGROUND: Although La Crosse virus (LACV) is one of the most common causes of pediatric arboviral infections in the United States, little has been done to assess its geographic distribution, identify areas of higher risk of disease, and to provide a national picture of its clinical presentation. Therefore, the objective of this study was to investigate the geographic distribution of
Andrew D. Haddow; Agricola Odoi
BackgroundAlthough La Crosse virus (LACV) is one of the most common causes of pediatric arboviral infections in the United States, little has been done to assess its geographic distribution, identify areas of higher risk of disease, and to provide a national picture of its clinical presentation. Therefore, the objective of this study was to investigate the geographic distribution of LACV
Andrew D. Haddow; Agricola Odoi; Laurent Rénia
We report the use of paper-based microfluidic devices fabricated from a novel polymer blend for the monitoring of urinary ketones, glucose, and salivary nitrite. Paper-based devices were fabricated via photolithography in less than 3 min and were immediately ready for use for these diagnostically relevant assays. Patterned channels on filter paper as small as 90 microm wide with barriers as narrow as 250 microm could be reliably patterned to permit and block fluid wicking, respectively. Colorimetric assays for ketones and nitrite were adapted from the dipstick format to this paper microfluidic chip for the quantification of acetoacetate in artificial urine, as well as nitrite in artificial saliva. Glucose assays were based on those previously demonstrated (Martinez et al., Angew Chem Int Ed 8:1318-1320, 1; Martinez et al., Anal Chem 10:3699-3707, 2; Martinez et al., Proc Nat Acad Sci USA 50:19606-19611, 3; Lu et al., Electrophoresis 9:1497-1500, 4; Abe et al., Anal Chem 18:6928-6934, 5). Reagents were spotted on the detection pad of the paper device and allowed to dry prior to spotting of samples. The ketone test was a two-step reaction requiring a derivitization step between the sample spotting pad and the detection pad, thus for the first time, confirming the ability of these paper devices to perform online multi-step chemical reactions. Following the spotting of the reagents and sample solution onto the paper device and subsequent drying, color images of the paper chips were recorded using a flatbed scanner, and images were converted to CMYK format in Adobe Photoshop CS4 where the intensity of the color change was quantified using the same software. The limit of detection (LOD) for acetoacetate in artificial urine was 0.5 mM, while the LOD for salivary nitrite was 5 microM, placing both of these analytes within the clinically relevant range for these assays. Calibration curves for urinary ketone (5 to 16 mM) and salivary nitrite (5 to 2,000 microM) were generated. The time of device fabrication to the time of test results was about 25 min. PMID:20425107
Klasner, Scott A; Price, Alexander K; Hoeman, Kurt W; Wilson, Rashaun S; Bell, Kayla J; Culbertson, Christopher T
Pigmented lesions are commonly found in the oral cavity. Oral pigmentations may be physiological or pathological in nature. It may represent as a localized anomaly of limited significance or the presentation of potentially life threatening multisystem disease. Oral pigmentation has a multifactorial etiology. Most of the oral pigmentations are physiologic. Evaluation of a patient with pigmented lesions should include a full medical and dental history, extraoral and intraoral examinations. In this article, we report a case of extensive physiologic pigmentation of the oral cavity in a 12 year old female patient, posing a diagnostic challenge. PMID:23886725
Mallikarjuna, K; Gupta, S; Shukla, S; Chaurasia, S
Acute respiratory distress syndrome (ARDS) poses a major challenge in intensive care settings. The main underlying causes of ARDS are trauma, pancreatitis, and pulmonary manifestation of systemic inflammatory response syndrome/sepsis.Lemierre syndrome represents a nearly forgotten entity arising from oropharyngeal infections with Fusobacterial species, and it is of renewed and increasing interest because of evolving antibiotic resistances.We report two cases of young female patients afflicted by Lemierre syndrome with additional severe ARDS and present an overview of the current literature. PMID:23564539
Litmathe, J; Zardo, P; Dickgreber, N; May, G; Sucker, C; Fischer, S
Spindle cell lipoma of the hypopharynx is an extremely rare entity. Here, we present the first case of this lesion originated in the cricopharyngeal region, with symptoms of chronic progressive dysphagia, which can be confused with other pathologies; endoscopic and magnetic resonance imaging (MRI) evaluation are the methods of choice for its diagnostic approach. The best therapeutic approach is endoscopic resection with rapid recovery and few complications. Long-term followup is recommended, either endoscopic or imaging, given that it can be confused with an undiagnosed liposarcoma; additionally, its long-term behavior is unknown.
Pena-Valenzuela, Alberto; Garcia Leon, Nathalia
This essay provides an explanation and interpretation of the undertreatment of pain by discussing some of the scientific, clinical, cultural, and philosophical aspects of this problem. One reason why pain continues to be a problem for medicine is that pain does not conform to the scientific approach to health and disease, a philosophy adopted by most health care professionals. Pain does not fit this philosophical perspective because (1) pain is subjective, not objective; (2) the causal basis of pain is often poorly understood; (3) pain is often regarded as a "mere" symptom, not as a disease; (4) there often are no "magic bullets" for pain; (5) pain does not fit the expert knowledge model. In order for health care professionals to do a better job of treating pain, some changes need to occur in medical philosophy, education, and practice. PMID:11760227
Resnik, D B; Rehm, M; Minard, R B
Academic achievement indices including GPAs and MCAT scores are used to predict the spectrum of medical student academic performance types. However, use of these measures ignores two changes influencing medical school admissions: student diversity and affirmative action, and an increased focus on communication skills. To determine if GPA and MCAT predict performance in medical school consistently across students, and whether either predicts clinical performance in clerkships. A path model was developed to examine relationships among indices of medical student performance during the first three years of medical school for five cohorts of medical students. A structural equation approach was used to calculate the coefficients hypothesized in the model for majority and minority students. Significant differences between majority and minority students were observed. MCAT scores, for example, did not predict performance of minority students in the first year of medical school but did predict performance of majority students. This information may be of use to medical school admissions and resident selection committees. PMID:18030590
White, Casey B; Dey, Eric L; Fantone, Joseph C
Purpose To use the clinical and radiological data to differentiate non-cholesterol versus cholesterol gall bladder (GB) polyps, which can be useful in deciding the treatment of the patient. Methods One hundred and eighty-seven patients underwent cholecystectomy for GB polyps of around 10 mm for 10 years, and were divided into two groups, cholesterol polyps (146 patients) and non-cholesterol polyps (41 patients) based on the postoperative pathological findings. Gender, age, body weight, height, body mass index (BMI), symptoms, laboratory findings, size, number of polyps, presence of GB stone and maximum diameter measured by preoperative ultrasonography (USG), computed tomography (CT), and pathological diameter were subjected to comparative analysis. Results Patients diagnosed with cholesterol polyps were younger in age and had higher BMI, and the total cholesterol levels and white blood cell levels were higher, but were not statistically significant. It was notable to see that 28.6% of the cholesterol polyps were not found in the preoperative CT yet the percentage of the undetectable rate was significantly lower (8%) in the non-cholesterol polyp group. There was a discrepancy in maximum diameters between the two radiological methods in both groups but the discrepancy was significantly larger in the cholesterol polyp group. Conclusion The clinical signs that can be helpful to diagnose whether it is a cholesterol polyp or not are younger patients who have high BMI, polyps which are detectable only on the USG and large maximum diameters between the USG and CT. And if the discrepancy of the maximum diameter is lesser than 1mm the polyp may be considered as a non-cholesterol polyp.
Song, Hye-Lin; Kim, Hungdai; Park, Yong-Lai; Yoo, Chang-Hak; Son, Byung-Ho; Yoon, Ji-Sup; Kim, Hyung-Ok
...used to convert a lump sum basic employee death benefit under 5 U.S.C. 8442(b...that the revised factor would apply to deaths occurring on or after October 1, 2004. The revised factor, however, applies to deaths occurring on or after October 1,...
This prospective study was undertaken in Dhaka Shishu hospital, Bangladesh from 15th Oct. 2005 to 15th October 2006 to determine the Risk factors, Clinical manifestation and bacteriological profile of neonatal sepsis. Eighty suspected cases of septicaemia admitted in neonatal ward of Dhaka Shishu Hospital were included in this study. Patients, who had history of perinatal asphyxia, congenital cyanotic heart disease etc. were excluded from the study. Thirty neonates without signs & symptoms of septicaemia admitted for other causes like jaundice, feeding problems etc. were taken as a control group. After taking informed consent, detailed history was obtained from mother or relatives accompanying the baby. Hematological investigations like total WBC count, differential count, absolute neutrophil count, band cell count, platelet count, CRP, blood culture were done. Low socioeconomic conditions, place of delivery, low birth weight, prolong rupture of membrane appears to be the principal predisposing factors for neonatal sepsis. Clinical presentation includes reluctant to feed (96.7%), lethargy (73.4%), abdominal distention (70%), Hypothermia (40%), Jaundice (50%) are more common. Predominant organism was gram negative. Among them: Klebsiella (60%), Serratia (20%), Acenetobactor (13.3%). This isolates were most often sensitive to third generation cephalosporin. Imipenam is highly sensitive and is recommended when other therapy fails. Periodic surveillance for agent of infection & their antimicrobial sensitivity profile is recommended. PMID:19377435
Waliullah, M S; Islam, M Nazrul; Siddika, Mohosina; Hossain, M Khalid; Hossain, M Anwar
Background Splenic artery aneurysms (SAA) are uncommon but the most common visceral artery aneurysm. Splenic artery aneurysms are important to recognize because up to 25% may be complicated by rupture and the mortality rate after rupture is between 25% and 70%. Case report We present a patient who have abdominal pain. Previously healthy 22-year-old female admitted to emergency department with abdominal pain. Her physical examination reveals only left upper quadrant tenderness. Suddenly she developed hypovolemic shock. On emergent laparotomy massive blood collection within peritoneal cavity and retroperitoneal space at the left upper quadrant was detected. The source of bleeding was evident as rupture of splenic artery aneurysm. Splenectomy was performed following the ligation of splenic artery proximal to lesion. On the tenth day she was discharged from the hospital with complete recovery. Conclusion It is important to remember rupture of splenic artery aneurysm in patients with abdominal pain and hypovolemic shock status.
BackgroundIn co-cultures of pachytene spermatocytes with Sertoli cells, ?-NGF regulates the second meiotic division by blocking secondary spermatocytes in metaphase (metaphase II), and thereby lowers round spermatid formation. In vertebrates, mature oocytes are arrested at metaphase II until fertilization, because of the presence of cytostatic factor (CSF) in their cytoplasm. By analogy, we hypothesized the presence of CSF in male
Marie-Hélène Perrard; Emeric Chassaing; Guillaume Montillet; Odile Sabido; Philippe Durand
Metastatic renal cell cancer (mRCC) accounts for 25–30% of patients with renal cell cancer at presentation. In addition to this, a significant proportion of patients with localized disease at presentation will develop metastatic disease. With the introduction of tyrosine kinase inhibitors (TKIs), the treatment of mRCC has been radically altered. Several newer generation vascular endothelial growth factor receptor TKIs have been tested in the clinical setting over recent years, resulting in the availability of more drugs. We review the latest results from clinical trials and the implications these have on the management of patients with mRCC.
OBJECTIVE To describe the presentation, resolution of symptoms, processes of care, and outcomes of pneumococcal pneumonia, and to compare features of the bacteremic and nonbacteremic forms of this illness. DESIGN A prospective cohort study. SETTING Five medical institutions in 3 geographic locations. PARTICIPANTS Inpatients and outpatients with community-acquired pneumonia (CAP). MEASUREMENTS Sociodemographic characteristics, respiratory and nonrespiratory symptoms, and physical examination findings were obtained from interviews or chart review. Severity of illness was assessed using a validated prediction rule for short-term mortality in CAP. Pneumococcal pneumonia was categorized as bacteremic; nonbacteremic, pure etiology; or nonbacteremic, mixed etiology. MAIN RESULTS One hundred fifty-eight (6.9%) of 2,287 patients (944 outpatients, 1,343 inpatients) with CAP had pneumococcal pneumonia. Sixty-five (41%) of the 158 with pneumococcal pneumonia were bacteremic; 74 (47%) were nonbacteremic with S. pneumoniae as sole pathogen; and 19 (12%) were nonbacteremic with S. pneumoniae as one of multiple pathogens. The pneumococcal bacteremia rate for outpatients was 2.6% and for inpatients it was 6.6%. Cough, dyspnea, and pleuritic pain were common respiratory symptoms. Hemopytsis occurred in 16% to 22% of the patients. A large number of nonrespiratory symptoms were noted. Bacteremic patients were less likely than nonbacteremic patients to have sputum production and myalgias (60% vs 82% and 33% vs 57%, respectively; P <.01 for both), more likely to have elevated blood urea nitrogen and serum creatinine levels, and more likely to receive pencillin therapy. Half of bacteremic patients were in the low risk category for short-term mortality (groups I to III), similar to the nonbacteremic patients. None of the 32 bacteremic patients in risk groups I to III died, while 7 of 23 (30%) in risk group V died. Intensive care unit admissions and pneumonia-related mortality were similar between bacteremic and nonbacteremic groups, although 46% of the bacteremic group had respiratory failure compared with 32% and 37% for the other groups. The nonbacteremic pure etiology patients returned to household activities faster than bacteremic patients. Symptoms frequently persisted at 30 days: cough (50%); dyspnea (53%); sputum production (48%); pleuritic pain (13%); and fatigue (63%). CONCLUSIONS There were few differences in the presentation of bacteremic and nonbacteremic pneumococcal pneumonia. About half of bacteremic pneumococcal pneumonia patients were at low risk for mortality. Symptom resolution frequently was slow.
Brandenburg, Jennifer A; Marrie, Thomas J; Coley, Christopher M; Singer, Daniel E; Obrosky, D Scott; Kapoor, Wishwa N; Fine, Michael J
Hirsuitism though not uncommon (24%), is not considered to be a prominent feature of acromegaly because of its lack of specificity and occurrence. Hirsuitism is very common in women of reproductive age (5-7%) and has been classically associated with polycystic ovarian syndrome (PCOS). Twenty-eight year lady with 3 year duration of hirsuitism (Modified Ferriman Gallwey score-24/36), features of insulin resistance (acanthosis), subtle features of acromegaloidism (woody nose and bulbous lips) was diagnosed to have acromegaly in view of elevated IGF-1 (1344 ng/ml; normal: 116-358 ng/ml), basal (45.1 ng/ml) and post glucose growth hormone (39.94 ng/ml) and MRI brain showing pituitary macroadenoma. Very high serum androstenedione (>10 ng/ml; normal 0.5-3.5 ng/ml), elevated testosterone (0.91 ng/ml, normal <0.8) and normal dehydroepiandrosterone sulphate (DHEAS) (284 mcg/dl, normal 35-430 mcg/dl) along with polycystic ovaries on ultrasonography lead to diagnosis of associated PCOS. She was also diagnosed to have diabetes. This case presentation intends to highlight that hirsuitism may rarely be the only prominent feature of acromegaly. A lookout for subtle features of acromegaly in all patients with hirsuitism and going for biochemical evaluation (even at the risk of investigating many patients of insulin resistance and acromegloidism) may help us pick up more patients of acromegaly at an earlier stage thus help in reducing disease morbidity.
Jain, Rajesh; Dutta, Deep; Shivaprasad, KS; Maisnam, Indira; Ghosh, Sujoy; Mukhopadhyay, Satinath; Chowdhury, Subhankar
Hirsuitism though not uncommon (24%), is not considered to be a prominent feature of acromegaly because of its lack of specificity and occurrence. Hirsuitism is very common in women of reproductive age (5-7%) and has been classically associated with polycystic ovarian syndrome (PCOS). Twenty-eight year lady with 3 year duration of hirsuitism (Modified Ferriman Gallwey score-24/36), features of insulin resistance (acanthosis), subtle features of acromegaloidism (woody nose and bulbous lips) was diagnosed to have acromegaly in view of elevated IGF-1 (1344 ng/ml; normal: 116-358 ng/ml), basal (45.1 ng/ml) and post glucose growth hormone (39.94 ng/ml) and MRI brain showing pituitary macroadenoma. Very high serum androstenedione (>10 ng/ml; normal 0.5-3.5 ng/ml), elevated testosterone (0.91 ng/ml, normal <0.8) and normal dehydroepiandrosterone sulphate (DHEAS) (284 mcg/dl, normal 35-430 mcg/dl) along with polycystic ovaries on ultrasonography lead to diagnosis of associated PCOS. She was also diagnosed to have diabetes. This case presentation intends to highlight that hirsuitism may rarely be the only prominent feature of acromegaly. A lookout for subtle features of acromegaly in all patients with hirsuitism and going for biochemical evaluation (even at the risk of investigating many patients of insulin resistance and acromegloidism) may help us pick up more patients of acromegaly at an earlier stage thus help in reducing disease morbidity. PMID:23565405
Jain, Rajesh; Dutta, Deep; Shivaprasad, Ks; Maisnam, Indira; Ghosh, Sujoy; Mukhopadhyay, Satinath; Chowdhury, Subhankar
Distant metastasis from colorectal carcinoma most often occurs in the liver and lungs. Metastasis to bones, adrenals, lymph nodes, brain, and skin has also been reported. Metastatic colorectal carcinoma to the testes is very uncommon. Even more uncommon is testicular metastasis from rectal carcinoma. Researchers throughout the last few decades have not acquired a clear understanding of the lymphatic pathways involved in reported cases of testicular metastasis from primary colorectal carcinoma. These cases may present with testicular complaints after or even before the diagnosis of colorectal cancer; this is why it is crucial to differentiate between primary testicular tumor and a secondary one from a colorectal primary. We searched the English medical literature using the MEDLINE/PUBMED database from 1950 through January 2010. Our search yielded 33 cases of testicular metastasis from rectal or colonic carcinoma. These cases are reviewed and summarized. This paper reviews the literature for all cases of testicular metastasis from colonic and rectal adenocarcinomas shedding light on the possible pathways of metastasis. We recommend that physicians be aware of the risk of metastasis from the colorectal region to the testis in their evaluation of patients with testicular symptoms in the setting of colorectal carcinoma. PMID:21069550
Hatoum, Hassan A; Abi Saad, George S; Otrock, Zaher K; Barada, Kassem A; Shamseddine, Ali I
Clinical data from 624 asbestos exposed workers were analysed by factor analysis. Fifteen clinical variables were found to reflect several underlying factors: "obstruction," "interstitial disorder," "x ray change," "air tapping," and "age/exposure." Scoring individual subjects along these axes can facilitate identifying early cases and avoiding false diagnosis. The analysis suggests that screening should be multimodal and that radiographic abnormality need not imply physiological impairment.
Harber, P; Lew, M; Tashkin, D P; Simmons, M
Burst abdomen, incisional herniation, sinus formation and post-operative wound infection continue to bedevil the surgeon. A prospective study of 1129 laparotomy wounds defined the extent of the problem; 1.7% incidence of dehiscence, 7.4% herniation and 6.7% sinus formation, all significantly associated with wound infection. Mass closure reduced the dehiscence rate from 3.8% to 0.76%. Infection reduced wound strength in a rat laparotomy model due to a decrease in fibroblast concentration and activity. A monofilament non-absorbable suture was shown experimentally to be the most suitable suture for closing infected abdominal wounds. Electron microscopy demonstrated bacteria in the interstices of infected multifilament sutures. A randomised clinical trial comparing polyglycolic acid and monofilament nylon in the closure of abdominal wounds confirmed the experimental findings; polyglycolic acid resulted in a significantly higher wound failure rate with no decrease in sinus formation. A mass closure technique using monofilament nylon is recommended for laparatomy closure and efforts should continue to reduce wound sepsis. Images Fig. 1 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 9 Fig. 10 Fig. 11 Fig. 12
Bucknall, T. E.