Note: This page contains sample records for the topic hypotension clinical presentation from
While these samples are representative of the content of,
they are not comprehensive nor are they the most current set.
We encourage you to perform a real-time search of
to obtain the most current and comprehensive results.
Last update: November 12, 2013.

Spontaneous intracranial hypotension presenting as a reversible dorsal midbrain syndrome.  


A 47-year-old woman with postural headache, episodic stupor, and vertical gaze palsy had brain imaging findings consistent with spontaneous intracranial hypotension (SIH), including severe descent of the mesodiencephalic structures and diffuse pachymeningeal enhancement. The source of the cerebrospinal fluid leakage was a ruptured dorsal perineural cyst. Clinical symptoms improved after a targeted epidural blood patch was performed. Dorsal midbrain syndrome has not been reported previously as a manifestation of SIH. Perhaps distortion of structures in this brain region can occur in SIH as it does in obstructive hydrocephalus. PMID:19145127

Fedi, Marco; Cantello, Roberto; Shuey, Neil H; Mitchell, L Anne; Comi, Cristoforo; Monaco, Francesco; Versino, Maurizio



Clinical effects of elastic bandage on neurogenic orthostatic hypotension.  


Neurogenic orthostatic hypotension (OH) often causes troublesome symptoms such as dizziness, syncope and falling, interfering active daily life or various therapies in rehabilitation. Nonpharmacologic measures for treating patients with OH include wearing elastic leotard, head-up tilting at night, etc. Elastic garment or antigravity suits is certainly effective, but it may be uncomfortable and not practical. Although elastic bandage (EB) bound on the lower limbs has been thought to be useful, there is few clinical report about its beneficial evidence. We investigated short-term clinical effects of commercially available EB on OH, and estimated the mechanism of its effectiveness by measuring some blood pressure-related humoral variables in neurodegenerative patients with OH. PMID:12697524

Hasegawa, Y; Hakusui, S; Hirayama, M; Ieda, T; Koike, Y; Matsuoka, Y; Takahashi, A



Prevalence of orthostatic hypotension among patients presenting with syncope in the ED  

Microsoft Academic Search

We sought to determine the prevalence of orthostatic hypotension as a cause of syncope in the emergency setting, and describe the characteristics of patients diagnosed with this condition. Blood pressure orthostatic changes were measured prospectively in a standardized fashion up to 10 minutes, or until symptoms occurred, in all consecutive patients with syncope as a chief complaint presenting in the

Francois P. Sarasin; Martine Louis-Simonet; David Carballo; Slim Slama; Alain-François Junod; P-F Unger



Comparison of Dialysis and Clinical Characteristics of Patients with Frequent and Occasional Hemodialysis-Associated Hypotension  

Microsoft Academic Search

Background: Symptomatic dialysis hypotension (DH) continues to be a common problem. By comparing patients prone and resistant to DH, several dialysis session and patient related characteristics have been identified that confer susceptibility to DH. Less is known, however, about the comparison of patients with frequent and only occasional DH. The aim of the study was to compare clinical and dialysis-session-

András Tislér; Katalin Akócsi; Ibolya Hárshegyi; Gábor Varga; Sándor Ferenczi; Mária Grosz; Imre Kulcsár; Lajos Löcsey; József Sámik; István Solt; János Szegedi; Eszter Tóth; Gyula Wágner; István Kiss



Interrogating a clinical database to study treatment of hypotension in the critically ill  

PubMed Central

Objective In intensive care, it is imperative to resolve hypotensive episodes (HEs) in a timely manner to minimise end-organ damage. Clinical practice guidelines generally recommend initial treatment with fluid resuscitation followed by vasoactive agent administration if patients remain hypotensive. However, the impact of such interventions on patient outcomes has not been clearly established. Hence, the objective of this study was to investigate the relationship between fluid and vasoactive agent interventions and patient outcomes, while highlighting the utility of electronic medical records in clinical research. Design Retrospective cohort study. Setting Intensive care units (ICUs) at a large, academic, tertiary medical center. Participants Patients in Multi-parameter Intelligent Monitoring in Intensive Care II (a large electronic ICU database) who experienced a single HE during their ICU stay. 2332 patients had complete data. Primary and secondary outcome measures The primary outcome of interest was inhospital mortality. Secondary outcomes were ICU length of stay (LOS), HE duration, Hypotension Severity Index (defined as the mean arterial pressure curve area below 60?mm?Hg during the HE) and rise in serum creatinine. Results Fluid resuscitation was associated with significantly shorter ICU LOS among ICU survivors (p=0.007). Vasoactive agent administration significantly decreased HE duration (p<0.001) and Hypotension Severity Index (p=0.002) but was associated with increased inhospital mortality risk (p<0.001), prolonged ICU LOS among ICU survivors (p=0.04) and rise in serum creatinine (p=0.002) after adjustment for confounders. Propensity score analyses as well as sensitivity analyses in treatment-, diagnosis- and ICU service-specific subpopulations corroborated the relationship between vasoactive agents and increased inhospital mortality. Conclusions An adverse relationship between vasoactive agents and inhospital mortality was found in patients with hypotension. This study has implications for the care of critically ill patients with hypotension and illustrates the utility of electronic medical records in research when randomised controlled trials are difficult to conduct.

Kothari, Rishi; Ladapo, Joseph A; Scott, Daniel J; Celi, Leo A



Leprosy neuropathy: clinical presentations.  


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



Persistent Sepsis-Induced Hypotension without Hyperlactatemia: A Distinct Clinical and Physiological Profile within the Spectrum of Septic Shock  

PubMed Central

Introduction. A subgroup of septic shock patients will never develop hyperlactatemia despite being subjected to a massive circulatory stress. Maintenance of normal lactate levels during septic shock is of great clinical and physiological interest. Our aim was to describe the clinical, hemodynamic, perfusion, and microcirculatory profiles associated to the absence of hyperlactatemia during septic shock resuscitation. Methods. We conducted an observational study in septic shock patients undergoing resuscitation. Serial clinical, hemodynamic, and perfusion parameters were registered. A single sublingual microcirculatory assessment was performed in a subgroup. Patients evolving with versus without hyperlactatemia were compared. Results. 124 septic shock patients were included. Patients without hyperlactatemia exhibited lower severity scores and mortality. They also presented higher platelet counts and required less intensive treatment. Microcirculation was assessed in 45 patients. Patients without hyperlactatemia presented higher PPV and MFI values. Lactate was correlated to several microcirculatory parameters. No difference in systemic flow parameters was observed. Conclusion. Persistent sepsis-induced hypotension without hyperlactatemia is associated with less organ dysfunctions and a very low mortality risk. Patients without hyperlactatemia exhibit less coagulation and microcirculatory derangements despite comparable macrohemodynamics. Our study supports the notion that persistent sepsis-induced hypotension without hyperlactatemia exhibits a distinctive clinical and physiological profile.

Hernandez, Glenn; Bruhn, Alejandro; Castro, Ricardo; Pedreros, Cesar; Rovegno, Maximiliano; Kattan, Eduardo; Veas, Enrique; Fuentealba, Andrea; Regueira, Tomas; Ruiz, Carolina; Ince, Can



A transient third cranial nerve palsy as presenting sign of spontaneous intracranial hypotension  

Microsoft Academic Search

Spontaneous intracranial hypotension is an uncommon cause of sudden and persistent headache: associated symptoms are common,\\u000a among which there are cranial nerve palsies, especially of the abducens nerve. We report a case of a 21-year-old man with\\u000a a transient and isolated third nerve palsy due to spontaneous intracranial hypotension. To our knowledge, there are only few\\u000a reports in the literature

Antonio Russo; Alessandro Tessitore; Mario Cirillo; Alfonso Giordano; Rosa De Micco; Gennaro Bussone; Gioacchino Tedeschi


Clinical Presentation and Risks  

Microsoft Academic Search

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



[New directions in the hypotensive therapy of open-angle glaucoma (experimental and clinical research)].  


Clinical use of eye drops of a hybrid beta-alpha-adrenoblocker OF-4680 to reduce intraocular pressure has shown a high efficacy of the drug, not inferior to thymolol, for local hypotensive therapy of open-angle glaucoma. A combination of thymolol with taurin helped reduce the inhibiting effect of the beta-blocker on chamber humor secretion and simultaneously enhanced its discharge. The results evidence the desirability of correcting glutathion deficiency, detected in the patients with narrow-angle glaucoma, by lipoic acid. PMID:8100372

Bunin, A Ia; Ermakov, V N; Filina, A A


Spontaneous intracranial hypotension presenting as pseudo-subarachnoid hemorrhage on CT scan.  


We report a 20-year-old man who suffered from severe headache. A brain CT scan revealed that he had diffuse brain swelling and increased attenuation of the basal cisterns and Sylvian fissure. Subarachnoid hemorrhage (SAH) was diagnosed but the results of CT angiography and conventional arterioangiography were negative. His headache relapsed and remitted several times during the following months. Brain MRI demonstrated brain sagging with a crowded foramen magnum. Spontaneous intracranial hypotension (SIH) was finally diagnosed and his headache subsided after application of an epidural blood patch. Pseudo-SAH on CT scan is an unusual manifestation of SIH that often results in delay of diagnosis and adequate treatment. PMID:21745742

Koh, Elly; Huang, Shih-Hao; Lai, Yen-Jun; Hong, Chien-Tai



Listeriosis: clinical presentation  

Microsoft Academic Search

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

Mehmet Doganay



[Spontaneous intracranial hypotension syndrome].  


Spontaneous intracranial hypotension is a rare but well known entity first described by the German neurosurgeon Schaltenbrand. We report the clinical and radiological findings of four patients (2 males, 2 females, mean age 55 years) presenting with this clinical entity and peculiar constant MRI findings. Intense postural headache was present in all patients together with a very low CSF pressure at lumbar tap although none of the patients had any history of recent lumbar puncture, spinal or cerebral surgery or cranio-cervical trauma. MRI revealed in all patients an intense meningeal enhancement and thickening which was most prominent on the dural side of the subdural space. The ventricular system was thin, presenting almost like slit ventricules. A downward shift of the cerebellar tonsils and hemorrhagic subdural collections were also observed in two patients. Biopsy of meninges performed in two patients showed fibrosis of the leptomeninges together with signs of old hemorrhage in one case. We postulate that histologic and radiologic changes are due to chronic subdural bleeding in relation with abnormal displacement of the nervous structures due to intracranial hypotension. The underlying cause of spontaneous intracranial hypotension is rarely established and the course of the disease is benign. Some authors have advocated to perform isotopic cysternography in search for a CSF leak, particularly in the spine, that could be surgically corrected. No such investigation has been conducted yet in our patients because the spontaneous evolution has been mostly favorable. PMID:9033953

Ben Amor, S; Maeder, P; Gudinchet, F; Duc, C; Ingvar-Maeder, M



Neurogenic orthostatic hypotension: pathophysiology, evaluation, and management.  


Neurogenic orthostatic hypotension is a distinctive and treatable sign of cardiovascular autonomic dysfunction. It is caused by failure of noradrenergic neurotransmission that is associated with a range of primary or secondary autonomic disorders, including pure autonomic failure, Parkinson's disease with autonomic failure, multiple system atrophy as well as diabetic and nondiabetic autonomic neuropathies. Neurogenic orthostatic hypotension is commonly accompanied by autonomic dysregulation involving other organ systems such as the bowel and the bladder. In the present review, we provide an overview of the clinical presentation, pathophysiology, epidemiology, evaluation and management of neurogenic orthostatic hypotension focusing on neurodegenerative disorders. PMID:23180176

Metzler, Manuela; Duerr, Susanne; Granata, Roberta; Krismer, Florian; Robertson, David; Wenning, Gregor K



Spontaneous intracranial hypotension  

Microsoft Academic Search

Spontaneous intracranial hypotension (SIH) is caused by leakage of cerebrospinal fluid (CSF), with resultant CSF hypovolemia\\u000a and intracranial hypotension. Although in some patients SIH may be preceded by minor trauma, it often occurs in the absence\\u000a of any identifiable initiating event. Orthostatic headache is the primary clinical manifestation, usually accompanied by one\\u000a or more other symptoms of SIH. Diagnosis can

Todd J. Schwedt; David W. Dodick



[Controlled hypotension].  


Induced hypotension is defined as a reduction in mean arterial blood pressure to 50-60 mm Hg in normotensive subjects. The aim of induced hypotension is to decrease intraoperative blood loss, decrease the need for blood transfusions and improve operating conditions. Most studies indicate that induced hypotension can decrease intraoperative blood loss by 50% in many surgical procedures; however, some studies report that blood loss is not significantly reduced. Current methods of induced hypotension are based on the use of rapid and short-acting vasodilators as primary agents (nitroprusside, nitroglycerine, urapidil), supplemented by volatile anesthetics (isoflurane) and/or beta-blockers (esmolol) to improve effect, reduce dosage and prevent side effects (reflex tachycardia, tachyphylaxis, rebound hypertension). Proper positioning of the patient and controlled ventilation aid in reducing blood loss. Major risks of induced hypotension are a reduction in blood flow (i.e. ischaemia) of vital organs (brain, myocardium) and elevation of intracranial pressure in neurosurgical patients. Thus, major contraindications of induced hypotension are severe coronary artery disease, hypertension combined with arteriosclerosis of cerebral vessels and increased intracranial pressure in patients with cerebral disease. Complications are rare in otherwise healthy patients, but may be higher in elderly patients and those with underlying organ dysfunction. Therefore, careful assessment and selection of patients, together with consideration of the potential complications, appropriate choice of drugs and invasive beat-by-beat monitoring, are essential for the safe practice of induced hypotension. PMID:7785759

Larsen, R; Kleinschmidt, S



A Clinical, Physiology and Pharmacology Evaluation of Orthostatic Hypotension in the Elderly  

Microsoft Academic Search

Orthostatic hypotension is very common in the elderly. It increases morbidity and is an independant predictor of all cause\\u000a mortality. It is defined as a fall in systolic blood pressure greater than 20 mm Hg or a fall in diastolic blood pressure\\u000a greater than 10 mm Hg within 3 minutes of standing. Symptoms include light headedness, weakness, blurred vision, fatigue

Manish Sahni; David T Lowenthal; John Meuleman



[Postprandial hypotension].  


Postprandial hypotension is the independent risk factor of general mortality, coronary disorders and stroke. It is reviewed risk factors, pathogenesis, symptoms, treatment and prognosis of this disease. PMID:23951909


[Arterial hypertension with orthostatic hypotension].  


Arterial hypertension (AH) with orthostatic hypotension (OH) is quite important clinical problem, present especially in older age and in various forms of autonomic nervous system (ANS) failure. ANS damage may be primary, or secondary, most offen in diabetes mellitus. In older age OH occurrence is about 30% and postprandial hypotension is also possible. Various antihypertensive drugs, also tricyclic antidepressants, alpha1-adrenergic receptors antagonists and diuretics may provoke OH. Diagnostic value has simple screening bedside orthostatic test, respectively head up tilt table test and cardiovascular reflex tests. Therapy is non-medicamentous with enough fluids, compression of legs and higher head and neck position in the night. AH with OH can be treated with short-acting antihypertensive drugs, eventually with transdermal nitroglycerin. OH can be treated with clonidine, midodrine, fludrocortisone or beta1-blocker. PMID:21137166

Krahulec, B; Bartosová, Z



Cutaneous sporotrichosis: unusual clinical presentations.  


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


Orthostatic Hypotension  

Microsoft Academic Search

Orthostatic hypotension is a physical finding defined by the American Autonomic Society and the American Academy of Neurology as a systolic blood pressure decrease of at least 20 mm Hg or a diastolic blood pressure decrease of at least 10 mm Hg within three minutes of stand- ing. The condition, which may be symptomatic or asymptomatic, is encountered commonly in



Intradialytic hypotension  

Microsoft Academic Search

Intradialytic hypotension (IDH) is common in children during conventional, 4 hour haemodialysis (HD) sessions. The declining\\u000a blood pressure (BP) was originally believed to be caused by ultrafiltration (UF) and priming of the HD circuit, however emerging\\u000a data now supports a multifactorial aetiology. Therefore strategies to improve haemodynamic stability need to be diverse and\\u000a address specific patient requirements or risks. In

Wesley Hayes; Daljit K. Hothi



Clinical presentation of femoroacetabular impingement  

Microsoft Academic Search

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



Primary neurogenic orthostatic hypotension  

PubMed Central

Eight further cases of neurogenic orthostatic hypotension are described together with a necropsy study on one case. Three cases showed evidence of autonomic dysfunction in isolation, while in five cases this was accompanied by evidence of more diffuse central nervous system degeneration. (Parkinsonism, cerebellar ataxia, dementia, pyramidal signs, bulbar weakness, and muscular wasting were all seen in varying proportions.) The various clinical presentations, investigations, pathology, treatment, and prognosis are discussed. In the experience of the authors, when assessed, an abnormal Valsalva response is invariable, confirming the breakdown of the circulatory reflex. A normal vasopressor response is likewise invariable, eliminating an abnormality of blood vessels themselves, and confirming the lesion as neurogenic. The demonstration of loss of sweating to indirect body heating, which also is usual suggests that the defect is central or on the efferent side of the reflex and a normal pilo-erector response to acetylcholine confirms this as preganglionic. Emphasis is laid on the non-specificity of many accepted physiological tests in this disorder and on the delay in diagnosis consequent upon the variable presentation.

Hughes, R. C.; Cartlidge, N. E. F.; Millac, P.



Spontaneous intracranial hypotension with pituitary adenoma  

Microsoft Academic Search

Spontaneous intracranial hypotension (SIH) is an unusual syndrome that is characterised by positional headache, neck rigidity,\\u000a nausea and vomiting. The characteristic magnetic resonance imaging (MRI) findings are diffuse smooth pachymeningeal thickening\\u000a and enhancement, downward displacement of posterior fossa structures and pituitary gland enlargement. An unusual case of SIH\\u000a with pituitary macro–adenoma and subsequent subdural haemorrhage is presented, and its clinical

A. K. Firat; H. M. Karakas; Z. Y. Firat; B. Kahraman; G. Erdem



N^G-Methyl-L-Arginine Inhibits Tumor Necrosis Factor-Induced Hypotension: Implications for the Involvement of Nitric Oxide  

Microsoft Academic Search

Clinical assessment of the activity of tumor necrosis factor (TNF) against human cancer has been limited by a dose-dependent cardiovascular toxicity, most frequently hypotension. TNF is also thought to mediate the vascular collapse resulting from bacterial endotoxin. The present studies address the mechanism by which TNF causes hypotension and provide evidence for elevated production of nitric oxide, a potent vasodilator

Robert G. Kilbourn; Steven S. Gross; Amal Jubran; James Adams; Owen W. Griffith; Roberto Levi; Robert F. Lodato



Pulmonary Embolism as a Cause of Systemic Hypotension and Shock.  

National Technical Information Service (NTIS)

Experimental pulmonary thromboembolism in dogs supports the clinical observation that severe systemic arterial hypotension and death may result from a relatively small embolus. Severe systemic arterial hypotension, in contrast to pulmonary hypertension, i...

L. F. Parmley R. L. North G. E. Pickens



[Abducens nerve palsy in spontaneous intracranial hypotension].  


Described by Schaltenbrand (1940), spontaneous intracranial hypotension is an unusual syndrome, sometimes revealed by an abducens nerve palsy motivating the patient to consult emergency ophthalmology services. The Authors report the case of a 50-Year-old Turkish woman who presented with diplopia due to a left abducens nerve palsy. These symptoms were associated with headache and nausea. Brain magnetic resonance imaging demonstrated diffuse pachymeningeal enhancement with gadolinium. A lumbar puncture showed low spinal fluid pressure (6 cm H2O), leading to the diagnosis of palsy by spontaneous intracranial hypotension. First, a classic treatment was prescribed with no result: increased water intake, corticoid therapy, and rest. Then a blood patch consisting of an injection of autologous blood by lumbar puncture between the third and fourth lumbar vertebrae to plug the spontaneous leak of spinal fluid, with success. A review of the literature provides information on the physiopathological mechanism, the clinical and imaging symptoms, and the treatment. PMID:15173648

Guigon, B; Tailla, H; de la Marnière, E; Macarez, R; Bazin, S; Madzou, M



Severe bradycardia and prolonged hypotension in ciguatera.  


Ciguatera results when ciguatoxin-contaminated coral reef fish from tropical or subtropical waters are consumed. The clinical features that present in affected persons are mainly gastrointestinal, neurological, general, and much less commonly, cardiovascular. We report the case of a 50-year-old man who developed the characteristic combination of acute gastrointestinal and neurological symptoms after the consumption of an unidentified coral reef fish head. In addition to those symptoms, he developed dizziness, severe bradycardia (46 bpm) and prolonged hypotension, which required the administration of intravenous atropine and over three days of intravenous fluid replacement with dopamine infusion. Patients with ciguatera can develop severe bradycardia and prolonged hypotension. Physicians should recognise the possible cardiovascular complications of ciguatera and promptly initiate treatment with intravenous atropine, intravenous fluid replacement and inotropic therapy if such complications are observed. PMID:23665698

Chan, Thomas Yan Keung



Spontaneous intracranial hypotension without intracranial hypotension.  


A 52-year-old man with a family history of multiple aneurysms presented with the gradual onset of generalized headaches and bilateral sixth nerve palsies. Following intravenous contrast, MRI revealed diffuse pachymeningeal enhancement consistent with spontaneous intracranial hypotension (SIH). Lack of any postural component to the headaches and repeatedly normal opening pressures on lumbar puncture delayed the diagnosis. A cerebrospinal fluid (CSF) leak was not found, but an epidural blood patch led to resolution of symptoms. Although the atypical features of nonorthostatic headache and normal CSF opening pressure have been documented in SIH, and failure to find the site of the leak is not unusual, this case illustrates a confluence of all these findings. An underlying disorder of connective tissue has been linked to SIH, and we propose that decreased meningeal compliance could account for a symptomatic low-volume state of CSF without a low opening pressure. PMID:21119535

Peeraully, Tasneem; Rosenberg, Michael L



[Spontaneous intracranial hypotension: case report].  


Intracranial hypotension (IH) is a rare cause of acute headache. There are secondary IH (more frequently, after lumbar puncture, head and back trauma, brain and spine surgery) and essential (spontaneous intracranial hypotension SIH). SIH was first described by Schaltenbrand in 1938. This syndrome is characterized mainly by acute postural headache. The authors report a case of 45-year-old women with SIH. Clinical diagnosis was confirmed by lumbar puncture and characteristic MR. The symptoms completely regressed within 2 weeks. The treatment was based on bed rest, hypotonic solutions, steroids, caffeine. Pathophysiology, diagnosis and treatment of SIH are discussed. PMID:11732271

Weglewski, A; Jury?czyk, J


Atrial myxoma presenting with orthostatic hypotension in an 84-year-old Hispanic man: a case report  

Microsoft Academic Search

INTRODUCTION: Left atrial myxomas remain the most common benign primary cardiac tumors, and these cardiac growths can masquerade as mitral stenosis, infective endocarditis and collagen vascular disease. Atrial myxomas are found in approximately 14-20% of the population and can lead to embolization, intercardiac obstructions, conduction disturbances and lethal valve obstructions. CASE PRESENTATION: An 84-year-old Hispanic man presented with complaints of

Ralph M Vicari; Enrique Polanco; Norberto Schechtmann; José O Santiago; Kautilya Shaurya; Michael Halstead; Danielle Marszal; Tamsin Grosskreutz; Shalini Thareja



[Epidemiology and clinical presentation of acute cholecystitis].  


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



N sup G -methyl-L-arginine inhibits tumor necrosis factor-induced hypotension: Implications for the involvement of nitric oxide  

Microsoft Academic Search

Clinical assessment of the activity of tumor necrosis factor (TNF) against human cancer has been limited by a dose-dependent cardiovascular toxicity, most frequently hypotension. TNF is also thought to mediate the vascular collapse resulting from bacterial endotoxin. The present studies address the mechanism by which TNF causes hypotension and provide evidence for elevated production of nitric oxide, a potent vasodilator

R. G. Kilbourn; J. Adams; S. S. Gross; O. W. Griffith; R. Levi; A. Jubran; R. F. Lodato



Pathological contrast enhancement of the oculomotor and trigeminal nerves caused by intracranial hypotension syndrome.  


The typical symptom of intracranial hypotension syndrome is orthostatic headache. The headache may also be accompanied by neck pain and stiffness, low backache, radicular symptoms, quadriplegia, interscapular pain, nausea/vomiting, and cranial nerve involvement symptoms (hearing and visual problems, face pain and numbness, hypogeusia). Radiologically, on cranial magnetic resonance imaging, intracranial hypotension syndrome is characterized by dural thickening and contrast enhancement, subdural effusion, engorgement of the venous structures, sagging or downward displacement of the brain, and pituitary hyperemia. Although clinical findings related to cranial nerves 3 and 5 have been described in intracranial hypotension, pathological contrast enhancement of these nerves has not. We present a 32-year-old patient whose cranial magnetic resonance imaging shows bilateral pathological contrast enhancement of cranial nerves 3 and 5 and describe a new imaging finding in intracranial hypotension syndrome. PMID:21521210

Albayram, Sait; Asik, Murat; Hasiloglu, Zehra Isik; Dikici, Atilla Suleyman; Erdemli, Halil Eren; Altintas, Ayse



A Rare Clinical Presentation of Darier's Disease.  


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



Idiopathic orofacial granulomatosis with varied clinical presentation.  


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



Idiopathic Orofacial Granulomatosis with Varied Clinical Presentation  

PubMed Central

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.

Ravindran, Rathy



Most common clinical presentations of cutaneous mastocytosis.  


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



Clinical Proteomics: Present and Future Prospects  

PubMed Central

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



[Wilson disease - factors affecting clinical presentation].  


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


Clinical Presentation and Evaluation of Dermatomyositis  

PubMed Central

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



Pituitary autoimmune disease: nuances in clinical presentation.  


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



Controlled hypotension: a guide to drug choice.  


For half a century, controlled hypotension has been used to reduce bleeding and the need for blood transfusions, and provide a satisfactory bloodless surgical field. It has been indicated in oromaxillofacial surgery (mandibular osteotomy, facial repair), endoscopic sinus or middle ear microsurgery, spinal surgery and other neurosurgery (aneurysm), major orthopaedic surgery (hip or knee replacement, spinal), prostatectomy, cardiovascular surgery and liver transplant surgery. Controlled hypotension is defined as a reduction of the systolic blood pressure to 80-90 mm Hg, a reduction of mean arterial pressure (MAP) to 50-65 mm Hg or a 30% reduction of baseline MAP. Pharmacological agents used for controlled hypotension include those agents that can be used successfully alone and those that are used adjunctively to limit dosage requirements and, therefore, the adverse effects of the other agents. Agents used successfully alone include inhalation anaesthetics, sodium nitroprusside, nitroglycerin, trimethaphan camsilate, alprostadil (prostaglandin E1), adenosine, remifentanil, and agents used in spinal anaesthesia. Agents that can be used alone or in combination include calcium channel antagonists (e.g. nicardipine), beta-adrenoceptor antagonists (beta-blockers) [e.g. propranolol, esmolol] and fenoldopam. Agents that are mainly used adjunctively include ACE inhibitors and clonidine. New agents and techniques have been recently evaluated for their ability to induce effective hypotension without impairing the perfusion of vital organs. This development has been aided by new knowledge on the physiology of peripheral microcirculatory regulation. Apart from the adverse effects of major hypotension on the perfusion of vital organs, potent hypotensive agents have their own adverse effects depending on their concentration, which can be reduced by adjuvant treatment. Care with use limits the major risks of these agents in controlled hypotension; risks that are generally less important than those of transfusion or alternatives to transfusion. New hypotensive drugs, such as fenoldopam, adenosine and alprostadil, are currently being evaluated; however, they have disadvantages and a high treatment cost that limits their development in this indication. New techniques of controlled hypotension subscribe to the use of the natural hypotensive effect of the anaesthetic drug with regard to the definition of the ideal hypotensive agent. It must be easy to administer, have a short onset time, an effect that disappears quickly when administration is discontinued, a rapid elimination without toxic metabolites, negligible effects on vital organs, and a predictable and dose-dependent effect. Inhalation agents (isoflurane, sevoflurane) provide the benefit of being hypnotic and hypotensive agents at clinical concentrations, and are used alone or in combination with adjuvant agents to limit tachycardia and rebound hypertension, for example, inhibitors of the autonomic nervous system (clonidine, beta-blockers) or ACE inhibitors. When they are used alone, inhalation anaesthetics require high concentrations for a significant reduction in bleeding that can lead to hepatic or renal injury. The greatest efficacy and ease-of-use to toxicity ratio is for techniques of anaesthesia that associate analgesia and hypotension at clinical concentrations without the need for potent hypotensive agents. The first and oldest technique is epidural anaesthesia, but depending on the surgery, it is not always appropriate. The most recent satisfactory technique is a combination treatment of remifentanil with either propofol or an inhalation agent (isoflurane, desflurane or sevoflurane) at clinical concentrations. In light of the current literature, and because of their safety and ease of use, these two techniques are preferred. PMID:17488147

Degoute, Christian-Serge



Acarbose, an Glucosidase Inhibitor, Attenuates Postprandial Hypotension in Autonomic Failure  

Microsoft Academic Search

Postprandial hypotension is an important clinical condition that predisposes to syncope, falls, angina, and cerebrovascular events. The magnitude of the fall in blood pressure after meals depends on enteric glucose availability. We hypothesized that acarbose, an -glucosidase inhibitor that decreases glucose absorption in the small intestine, would attenuate postprandial hypotension. Acarbose or placebo was given 20 minutes before a standardized

Cyndya Shibao; Alfredo Gamboa; Andre Diedrich; Cynthia Dossett; Leena Choi; Ginnie Farley; Italo Biaggioni


Mortality and prognosis in patients with neurogenic orthostatic hypotension.  


The prognosis of neurogenic orthostatic hypotension (NOH) has been poorly studied. The aim of this study was to evaluate retrospectively comorbidities and causes of death in patients with NOH. Clinical information and causes of death were obtained for 104 patients (45 with multiple system atrophy, 9 with pure autonomic failure, 43 with Parkinson's disease, and 7 with other types of autonomic neuropathy) referred to the Autonomic Unit from 1996 to 2009. Cardiovascular diseases (hypertension, cardiac comorbidities, atrial fibrillation and heart failure) were present in 53 (51%) NOH patients. At the end of follow-up, 44 patients were deceased. Type of NOH was the main factor associated with mortality. The main causes of death were infectious/respiratory (54%) and cardiac (16%). In NOH patients, cardiovascular diseases are frequent, although mortality is mainly due to infectious and respiratory causes. Detection of cardiovascular diseases may be useful in the choice of anti-hypotensive treatments. PMID:23158582

Maule, Simona; Milazzo, Valeria; Maule, Milena Maria; Di Stefano, Cristina; Milan, Alberto; Veglio, Franco


Spontaneous intracranial hypotension: report of four cases and review of the literature  

Microsoft Academic Search

Spontaneous intracranial hypotension is an unusual syndrome of postural headache and low cerebrospinal fluid pressure without\\u000a an established cause. We present four cases, analyze those previously reported in the literature, examine the MRI, CT, angiographic\\u000a and cisternographic finding and discuss the clinical picture, proposed pathophysiologic mechanisms and potential treatment.

G. A. Christoforidis; B. A. Mehta; J. L. Landi; E. J. Czarnecki; R. A. Piaskowski



Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives  

PubMed Central

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



Enflurane for controlled hypotension.  

PubMed Central

Enflurane was substituted for halothane in an established technique of controlled hypotension, involving beta-blockade and sympathetic ganglion blockade, for 2 groups of patients. One group was undergoing major plastic surgery and/or major maxillo-facial surgery and these patients breathed spontaneously. The other group was undergoing major neurosurgery and received intermittent positive pressure ventilation (IPPV). All patients were carefully monitored during anaesthesia and for 24 hours postoperatively. Good operation conditions were produced and no ill effects of controlled hypotension were detected in any of the patients.

Firn, S.



Spontaneous intracranial hypotension: a cause of severe acute headache  

PubMed Central

Severe acute headache is a common presenting symptom to an accident and emergency department. Spontaneous intracranial hypotension (SIH) is an increasingly recognised cause of these symptoms and has characteristic clinical and imaging findings. SIH is characterised by headache worse on standing, low opening cerebrospinal fluid pressures at lumbar puncture and uniform pachymeningeal enhancement with gadolinium enhanced magnetic resonance imaging of the brain, all in the absence of dural trauma. Atypical presentations occur and severe neurological decline can rarely be associated with this condition. A review of five patients presenting recently to our institution with classical imaging findings together with a review of the literature is presented.

Vaidhyanath, Ram; Kenningham, Richard; Khan, Arshad; Messios, Nicholas



Spontaneous intracranial hypotension: a cause of severe acute headache  

PubMed Central

Severe acute headache is a common presenting symptom to an accident and emergency department. Spontaneous intracranial hypotension (SIH) is an increasingly recognised cause of these symptoms and has characteristic clinical and imaging findings. SIH is characterised by headache worse on standing, low opening cerebrospinal fluid pressures at lumbar puncture and uniform pachymeningeal enhancement with gadolinium enhanced magnetic resonance imaging of the brain, all in the absence of dural trauma. Atypical presentations occur and severe neurological decline can rarely be associated with this condition. A review of five patients presenting recently to our institution with classical imaging findings together with a review of the literature is presented.

Vaidhyanath, Ram; Kenningham, Richard; Khan, Arshad; Messios, Nicholas



Idiopathic orthostatic hypotension treated with levodopa and MAO inhibitor: a preliminary report  

PubMed Central

The clinical and pathophysiological features of a case of idiopathic orthostatic hypotension (Shy-Drager syndrome) are presented. Recent reports on the pathological findings in this condition indicate that there may be a defect in catecholamine synthesis in the pigmented brain stem nuclei and sympathetic ganglia similar to that in idiopathic parkinsonism. On this basis a new form of therapy using levodopa combined with MAO inhibition is derived. The results of a trial of this therapy, which produced improvements in both the hypotension and in the extrapyramidal features of the disease, are reported.

Sharpe, J.; Marquez-Julio, A.; Ashby, P.



Primary neurogenic orthostatic hypotension  

Microsoft Academic Search

Eight further cases of neurogenic orthostatic hypotension are described together with a necropsy study on one case. Three cases showed evidence of autonomic dysfunction in isolation, while in five cases this was accompanied by evidence of more diffuse central nervous system degeneration. (Parkinsonism, cerebellar ataxia, dementia, pyramidal signs, bulbar weakness, and muscular wasting were all seen in varying proportions.)The various

R. C. Hughes; N. E. F. Cartlidge; P. Millac



Confounders of vasovagal syncope: orthostatic hypotension.  


A syncope evaluation should start by identifying potentially life-threatening causes, including valvular heart disease, cardiomyopathies, and arrhythmias. Most patients who present with syncope, however, have the more benign vasovagal (reflex) syncope. A busy syncope practice often also sees patients with neurogenic orthostatic hypotension presenting with syncope or severe recurrent presyncope. Recognition of these potential confounders of syncope might be difficult without adequate knowledge of their presentation, and this can adversely affect optimal management. This article reviews the presentation of the vasovagal syncope confounder and the putative pathophysiology of orthostatic hypotension, and suggests options for nonpharmacologic and pharmacologic management. PMID:23217690

Nwazue, Victor C; Raj, Satish R



The importance of accurately assessing orthostatic hypotension  

Microsoft Academic Search

Potential adverse outcomes of orthostatic hypotension (OH) range from mild symptoms of dizziness to more severe consequences of falls, fractures, and immobility. OH can be a significant problem among patients who use psychotropic medications. Clinical practitioners have observed that OH assessment among patients receiving psychotropic medications is often overlooked or inaccurate. This article addresses two areas critical to the development

Dorothy J Irvin; Marilyn White



Bilateral retinoblastoma: clinical presentation, management and treatment.  


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: clinical presentation and differential diagnosis.  


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



Medical therapy and physical maneuvers in the treatment of the vasovagal syncope and orthostatic hypotension.  


Patients with vasovagal syncope and neurogenic orthostatic hypotension can both present with pre-syncope and syncope resulting from systemic hypotension. While not directly responsible for increased mortality, both of these conditions can have a tremendous deleterious impact on the daily lives of patients. This negative impact can take the form of both physical symptoms and injury, but also a psychological impact from living in fear of the next syncopal episode. Despite these similarities, these are different disorders with fixed damage to the autonomic nerves in neurogenic orthostatic hypotension, as opposed to a transient reflex hypotension in "neurally mediated" vasovagal syncope. The treatment approaches for both disorders are parallel. The first step is to educate the patient about the pathophysiology and prognosis of their disorder. Next, offending medications should be withdrawn when possible. Non-pharmacological therapies and maneuvers can be used, both in an effort to prevent the symptoms and to prevent syncope at the onset of presyncope. This is all that is required in many patients with vasovagal syncope. If needed, pharmacological options are also available for both vasovagal syncope and neurogenic orthostatic hypotension, many of which are focused on blood volume expansion, increasing cardiac venous return, or pressor agents to increase vascular tone. There is a paucity of high-quality clinical trial data to support the use of these pharmacological agents. We aim to review the literature on these different therapy choices and to give recommendations on tailored approaches to the treatment of these conditions. PMID:23472781

Raj, Satish R; Coffin, Samuel T


Endometriosis - Morphology, Clinical Presentations and Molecular Pathology  

PubMed Central

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



A reversible cause of skin hyperpigmentation and postural hypotension.  


Vitamin B12 deficiency results in neuropsychiatric, hematologic, gynecologic, cardiovascular, and cutaneous manifestations. It is seen most commonly in the elderly, malabsorption diseases??(>60% of all cases), vegans, and vegetarians. Manifestations of pernicious anemia may be similar to Addison disease and may lead to a misdiagnosis. Herein, we report two cases of vitamin B12 deficiency in which clinical features shared many similarities with Addison disease. Both patients presented with progressive darkening of hands and postural hypotension that reversed with replenishment of vitamin B12. Vitamin B12 deficiency should be considered in patients presenting with skin lesions especially with other coexisting autoimmune diseases. PMID:23840983

Cherqaoui, Rabia; Husain, Mehreen; Madduri, Sujay; Okolie, Pamela; Nunlee-Bland, Gail; Williams, James



Clinical presentation of abdominal tuberculosis in HIV seronegative adults  

Microsoft Academic Search

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



Management of postural hypotension  

Microsoft Academic Search

Several mechanisms counteract the gravitational forces on blood and maintain systemic arterial pressure and cerebral perfusion\\u000a upon assumption of the upright posture. Failure of these mechanisms can lead to a postural decrease in blood pressure. Postural\\u000a hypotension is defined as a reduction of at least 20 mm Hg in systolic blood pressure or at least a 10 mm Hg decrease

Mahendr S. Kochar



Spontaneous intracranial hypotension  

Microsoft Academic Search

Spontaneous intracranial hypotension (SIH) is typically manifested by orthostatic headaches that may be associated with one\\u000a or more of several other symptoms, including pain or stiffness of the neck, nausea, emesis, horizontal diplopia, dizziness,\\u000a change in hearing, visual blurring or visual field cuts, photophobia, interscapular pain, and occasionally face numbness or\\u000a weakness or radicular upper-limb symptoms. Cerebrospinal fluid (CSF) pressures,

Bahram Mokri



N sup G -methyl-L-arginine inhibits tumor necrosis factor-induced hypotension: Implications for the involvement of nitric oxide  

SciTech Connect

Clinical assessment of the activity of tumor necrosis factor (TNF) against human cancer has been limited by a dose-dependent cardiovascular toxicity, most frequently hypotension. TNF is also thought to mediate the vascular collapse resulting from bacterial endotoxin. The present studies address the mechanism by which TNF causes hypotension and provide evidence for elevated production of nitric oxide, a potent vasodilator initially characterized as endothelium-derived relaxing factor. Nitric oxide is synthesized by several cell types, including endothelial cells and macrophages, from the guanidino nitrogen of L-arginine; the enzymatic pathway is competitively inhibited by N{sup G}-methyl-L-arginine. The authors found that hypotension induced in pentobarbital-anesthetized dogs by TNF was completely reversed within 2 min following administration of N{sup G}-methyl-L-arginine. In contrast, N{sup G}-methyl-L-arginine failed to reverse the hypotensive response to an equivalent depressor dose of nitroglycerin, a compound that acts by forming nitric oxide by a monenzymatic, arginine-independent mechanism. The effect of N{sup G}-methyl-L-arginine on TNF-induced hypotension was antagonized, and the hypotension restored, by administration of excess L-arginine findings suggest that excessive nitric oxide production mediates the hypotensive effect of TNF.

Kilbourn, R.G.; Adams, J. (Univ. of Texas M. D. Anderson Cancer Center, Houston (USA)); Gross, S.S.; Griffith, O.W.; Levi, R. (Cornell Univ. Medical College, New York, NY (USA)); Jubran, A.; Lodato, R.F. (Univ. of Texas Health Science Center, Houston (USA))



Oral candidiasis: pathogenesis, clinical presentation, diagnosis and treatment strategies.  


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



The Management of Orthostatic Hypotension in Parkinson's Disease  

PubMed Central

Orthostatic hypotension (OH) is a common and disabling symptom affecting Parkinson’s disease (PD) patients. We present the effect of the different therapies commonly used to manage PD on this clinical manifestation. For this purpose, we describe the relationship between OH and the current treatments employed in PD, such as L-DOPA, dopaminergic agonists, and continuous dopaminergic stimulation therapies. Additionally, we review the therapeutic measures that could be used to ameliorate OH. There are different approaches to deal with this manifestation, including pharmacological and non-pharmacological treatments, although none of them is specifically aimed for treating OH in PD.

Sanchez-Ferro, Alvaro; Benito-Leon, Julian; Gomez-Esteban, Juan Carlos



Intracranial Hypotension as a Cause of Radiculopathy from Cervical Epidural Venous Engorgement: Case Report  

Microsoft Academic Search

Summary: We describe the case of a 40-year-old man with spontaneous intracranial hypotension who presented with cervical radiculopathy associated with epidural venous en- gorgement. Epidural venous engorgement can occur sec- ondary to intracranial hypotension and manifests intracra- nially as pachymeningeal venous engorgement. In the cervical spine, two cases of epidural venous engorgement due to intracranial hypotension have been reported in

Sait Albayram; Bruce A. Wasserman; David M. Yousem; Robert Wityk


Radionuclide Cisternography in Diagnosing Spontaneous Intracranial Hypotension  

Microsoft Academic Search

It has been postulated that spontaneous intracranial hypotension is caused by the rupture of spinal meningeal diverticuli or cysts that resulting in cere- brospinal spinal fluid leakage. We present a case of 31- year-old man who suffered a 2-month history of wors- ening headache in the upright posture, which was ame- liorated completely when recumbent. No clear precipi- tant could

Mei-Fang Cheng; Mei-Hsiu Pan; Yen-Wen Wu; Yai-Chin Tsai; Ruoh-Fang Yen; Kai-Yuan Tzen


Hypotension in the PACU: An algorithmic approach  

Microsoft Academic Search

Hypotension is a common postoperative complication in the perianesthesia setting and contributes to increased patient morbidity and mortality rates. An understanding of the etiologies, diagnosis, and treatment of this complication is critical to successful treatment of the patient. This article presents an algorithm designed to provide the perianesthesia nurse with a step-by-step guide to the assessment and management of the

Gregory E. Cowling; Richard E. Haas



Adrenal histoplasmosis: clinical presentation and imaging features in nine cases  

Microsoft Academic Search

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



Acute Bilateral Visual Loss Related to Orthostatic Hypotension  

PubMed Central

A 50-year-old man had undergone lumbar vertebral surgery and was confined to bed in the supine position for three months. When he sat up from the prolonged supine position, he showed clinical signs of orthostatic hypotension and reported decreased vision in both eyes. He also had underlying anemia. Ophthalmologic findings suggested bilateral anterior ischemic optic neuropathy (ION) as the cause of the visual loss. Although there are numerous reports of ION in the setting of hemodynamic compromise, such as systemic hypotension, cases of ION-associated orthostatic hypotension are very rare.

Kim, Jung-Yeul; Kim, Kyoung-Nam; Kim, Woo-Jin



Regional grey matter atrophy in clinically isolated syndromes at presentation  

Microsoft Academic Search

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



Controlled hypotension for spinal surgery.  


Controlled, deliberate hypotension during anesthesia for major spinal surgery reduces intraoperative blood loss and transfusion requirement. Hypotension may be achieved with increased doses of volatile anesthetic agents or by continuous infusion of vasodilating drugs. Safe application of this technique requires knowledge of the physiology of hemorrhagic shock and close intraoperative monitoring to avoid vasoconstriction and end-organ ischemia. PMID:15197633

Dutton, Richard P



Nicardipine for controlled hypotension during orthognathic surgery.  


Nicardipine is the first intravenously administered dihydropyridine calcium channel blocker. Its primary physiologic actions include vasodilatation with limited effects on the inotropic and dromotropic function of the myocardium. Although it was used in the past as an agent for controlled hypotension during orthopedic surgery in adults and children, we are unaware of reports concerning its use for controlled hypotension during maxillofacial surgery. We present our experience with nicardipine as an agent for controlled hypotension during orthognathic surgery in nine adolescents ranging in age from 11 to 16 years and in weight from 39 to 61 kg. Following induction of general anesthesia, nicardipine was started at 5 micrograms/kg per minute. The target mean arterial pressure of 50 to 65 mmHg was reached in 2 to 12 minutes (mean 5.5 minutes). Intraoperative infusion requirements to maintain the target mean arterial pressure varied from 1 to 7 micrograms/kg per minute (mean 3.6 micrograms/kg per minute). No adverse effects related to nicardipine were noted. Our preliminary experience suggests the efficacy of nicardipine for controlled hypotension in adolescents during orthognathic surgery. Future studies are required to determine its advantages and disadvantages over more commonly used agents such as sodium nitroprusside or adrenergic antagonists. PMID:9145121

Tobias, J D



An Observational Study of the Etiology, clinical presentation and outcomes associated with peritonitis in Lilongwe, Malawi  

PubMed Central

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.



Vein of Galen malformations: epidemiology, clinical presentations, management.  


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



Clinical Presentation and Outcome of Brown Recluse Spider Bite  

Microsoft Academic Search

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



Childhood polycythemias\\/erythrocytoses: classification, diagnosis, clinical presentation, and treatment  

Microsoft Academic Search

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.

H. Cario



Juvenile Idiopathic Arthritis: Classification, Clinical Presentation and Current Treatments  

Microsoft Academic Search

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



Pes anserine bursitis: incidence in symptomatic knees and clinical presentation  

Microsoft Academic Search

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



Pharmacologic drugs for controlled hypotension.  


Due to the risks of transfusion reactions and the transmission of infectious diseases, there has been increased interest in measures to limit intraoperative blood loss and avoid the need for homologous transfusion. Controlled hypotension is one technique that has been used to limit intraoperative blood loss. Several drugs have been used alone or in combination for controlled hypotension, including the inhalational anesthetics, direct acting vasodilators such as nitroglycerin and nitroprusside, beta adrenergic antagonists, and calcium channel blockers. Various drugs available to the clinician for controlled hypotension are reviewed. PMID:7546762

Testa, L D; Tobias, J D



Reduced cognitive performance and prolonged reaction time accompany moderate hypotension  

Microsoft Academic Search

The aim of the present study was to investigate the impact of hypotension on attentional and motor performance. Twenty-six moderately hypotensive subjects (mean systolic blood pressure = 108.8 mmHg) were compared to 29 normotensive controls (mean systolic blood pressure = 123.5 mmHg). The participants were presented with two standard German tests of attention (“Aufmerksamkeits-Belastungs-Test”, Test d2; ”Zahlen-Verbindungs-Test”, ZVT). Additionally, reaction

Stefan Duschek; Nathan Weisz; Rainer Schandry



Presentation in relation to publication of results from clinical trials  

PubMed Central

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



Clinical presentation of acute chest syndrome in sickle cell disease  

Microsoft Academic Search

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



L-dihydroxyphenylserine (Droxidopa) in the treatment of orthostatic hypotension  

Microsoft Academic Search

Neurogenic orthostatic hypotension is a cardinal feature of generalised autonomic failure and commonly is the presenting sign\\u000a in patients with primary autonomic failure. Orthostatic hypotension can result in considerable morbidity and even mortality\\u000a and is a major management problem in disorders such as pure autonomic failure, multiple system atrophy and also in Parkinson’s\\u000a disease. Treatment is ideally two pronged, using

Christopher J. Mathias



Pedunculated and Telangiectatic Merkel Cell Carcinoma: An Unusual Clinical Presentation  

PubMed Central

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



Subdural haematoma: a potentially serious consequence of spontaneous intracranial hypotension  

PubMed Central

Background: Spontaneous intracranial hypotension (SIH) is characterised by postural headache and low opening pressure at lumbar puncture without obvious cause. Cranial magnetic resonance imaging often shows small subdural collections without mass effect, dural enhancement, venous sinus dilatation, or downward displacement of the brain. The condition is thought to be benign. Objectives: To evaluate the incidence of subdural haematoma as a serious complication of SIH. Methods: A prospective survey of all cases of SIH presenting to a large neuroscience unit over a two year period. Results: Nine cases of SIH were seen. Four of these were complicated by acute clinical deterioration with reduced conscious level because of large subdural haematomas requiring urgent neurosurgical drainage. Conclusions: SIH should not be considered a benign condition. Acute deterioration of patients' clinical status may occur secondary to large subdural haematomas, requiring urgent neurosurgical intervention.

de Noronha, R J; Sharrack, B; Hadjivassiliou, M; Romanowski, C



Spontaneous Intracranial Hypotension Secondary to Lumbar Disc Herniation  

PubMed Central

Spontaneous intracranial hypotension is often idiopathic. We report on a patient presenting with symptomatic intracranial hypotension and pain radiating to the right leg caused by a transdural lumbar disc herniation. Magnetic resonance (MR) imaging of the brain revealed classic signs of intracranial hypotension, and an additional spinal MR confirmed a lumbar transdural herniated disc as the cause. The patient was treated with a partial hemilaminectomy and discectomy. We were able to find the source of cerebrospinal fluid leak, and packed it with epidural glue and gelfoam. Postoperatively, the patient's headache and log radiating pain resolved and there was no neurological deficit. Thus, in this case, lumbar disc herniation may have been a cause of spontaneous intracranial hypotension.

Kim, Kyoung-Tae



Leukemia cutis - epidemiology, clinical presentation, and differential diagnoses.  


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



Possible fatal acetaminophen intoxication with atypical clinical presentation.  


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



Clinical presentation and outcome in primary familial hypomagnesaemia  

Microsoft Academic Search

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



Atypical clinical presentation of laboratory-acquired meningococcal disease.  


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



Standing worsens cognitive functions in patients with neurogenic orthostatic hypotension.  


In previous studies, addressing the association between orthostatic hypotension and cognitive decline, patients underwent neuropsychological evaluation in sitting position, and blood pressure values and cognition were not measured concurrently. Furthermore, no studies assessed the acute effects of orthostatic hypotension on cognitive performances. The aim of our study was to evaluate the effect of a documented fall in systolic blood pressure (SBP) of at least 20 mmHg on a battery of cognitive tests in patients with neurogenic orthostatic hypotension. Ten consecutive patients with neurogenic orthostatic hypotension, normal brain imaging, and a normal Mini Mental State Examination in supine position were enrolled in the study. Patients underwent a detailed neuropsychological assessment (Brief Mental Deterioration battery and computerized tests) over two test sessions: the first while tilted to an angle able to cause a fall of at least 20 mmHg in SBP; the second while supine, after 30 min of rest. Parallel forms of the tests were presented on each testing session. Patients scored significantly worse in the visual search test, analogies test, immediate visual memory, and the measure of global cognitive functioning of Brief Mental Deterioration battery during the orthostatic challenge compared to the supine position. Orthostatic hypotension was associated with a significant worsening of cognitive performances, affecting both global cognitive functioning and specific tasks, mainly exploring executive functions. The assessment of cognitive function in patients with neurogenic orthostatic hypotension should be performed considering the body's position of the subject. PMID:21894556

Poda, R; Guaraldi, P; Solieri, L; Calandra-Buonaura, G; Marano, G; Gallassi, R; Cortelli, P



[Orthostatic hypotension and supine hypertension in pure autonomic failure].  


Orthostatic hypotension is associated with significant morbidity and mortality in elderly patients. In orthostatic hypotension caused by central and peripheral nervous system disorders (neurogenic orthostatic hypotension), the release of catecholamine in the standing posture is insufficient to compensate adequately for decreased venous return to the heart. Primary autonomic failure exhibits, often, supine hypertension, that can be worsened by pressor agents, such as midodrine, used to prevent syncope episodes. Salt-retaining steroid fludrocortisone, also, used to treat orthostatic hypotension, increases blood pressure both in supine and in standing position. We describe 3 patients with neurogenic orthostatic hypotension caused by pure autonomic failure. They complained of several syncope episodes. On examination, orthostatic hypotension and supine hypertension were detected in the absence of pharmacological therapy. All the patients presented hypertensive organ disease. Fludrocortisone acetate was started in one patient, and short-acting vasopressor agents during the day and dihydropyridine-calcium antagonist during the night in the other two. During the follow-up a transient ischemic attack occurred in the patient treated with fludrocortisone. When fludrocortisone was titrated down and short-acting antihypertensive drugs were started, the patient did not complain of any symptoms. Supine hypertension is part of pure autonomic failure, and short-acting antihypertensive agents should be associated with vasopressor agents to prevent hypertensive target organ disease. PMID:15633433

Sartori, Michelangelo; Pessina, Achille C



Cerebral Sinus Venous Thrombosis in Two Patients with Spontaneous Intracranial Hypotension  

Microsoft Academic Search

We report 2 patients who had clinical and neuroimaging signs of spontaneous intracranial hypotension and who developed cerebral sinus venous thrombosis. This sequence of events – known after dural puncture but not in spontaneous intracranial hypotension – was suggested by the change in the pattern of headache, from a postural to a permanent and increasing one. The diagnostic and therapeutic

Stéphane Berroir; David Grabli; Françoise Héran; Pierre Bakouche; Marie-Germaine Bousser



Maternal hypotension during spinal anesthesia for caesarean delivery.  


The aim of the study was to review maternal hypotension during caesarean delivery with spinal anesthesia. Obstetric complications, such as obstetric hemorrhage and problems related to concomitant maternal diseases are not considered. Reports of hypotension during spinal anesthesia for elective caesarean delivery are frequent (70-80%) when pharmacological prophylaxis is not used. Although some physical methods (leg wrapping, thromboembolic stockings) and the prevention of aorto-caval compression (left lateral tilt of the uterus) are useful, main prevention relies on two pharmacological methods, vasopressor therapy and intravascular fluid loading generally in combination. Ephedrine has been the vasopressor of choice in obstetrics for decades but phenylephrine is now the preferred first line approach during elective procedures at least. Crystalloid preloading is clinically ineffective and should be abandoned. Crystalloid coloading at the onset of sympathetic blockade is better but its efficacy may depend on the volume infused and the speed of administration. Preloading with hydroxyethylstarch is more consistently effective in reducing the incidence and severity of hypotension and hydroxyethylstarch coloading appears equally effective. Preoperative tests and new monitoring devices are available to predict or permit early detection of hypotension, but their feasibility and reliability in routine clinical practice is not yet established. With these tools, it may become possible to tailor prophylaxis to the assessed risk of the individual. Combining a prophylactic vasopressor regimen with hydroxyethylstarch preloading, hydroxyethylstarch coloading or crystalloid coloading is the best method to decrease the incidence and severity of hypotension during spinal anesthesia for caesarean delivery. PMID:23135692

Mercier, F J; Augè, M; Hoffmann, C; Fischer, C; Le Gouez, A



Pleural Mesothelioma Presenting as Periumbilical Metastasis: The First Clinical Documentation  

PubMed Central

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.



Endemic paracoccidioidomycosis: relationship between clinical presentation and patients' demographic features.  


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



Clinical presentation of a missed primary aorto-enteric fistula.  


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: 3 cases with three different clinical presentations.  


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



Familial Dementia with Lewy Bodies with an Atypical Clinical Presentation  

Microsoft Academic Search

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



Induced hypotension during anesthesia with special reference to orthognathic surgery.  

PubMed Central

Since Gardner first used arteriotomy during anesthesia to improve visibility in the surgical field, various techniques and pharmacological agents have been tried for the same purpose. With reports documenting the spread of acquired immune deficiency syndrome through blood transfusions, prevention of homologous blood transfusions during surgery has also become a major concern. Induced hypotension has been used to reduce blood loss and thereby address both issues. In orthognathic surgery, induced hypotension during anesthesia has been used for similar reasons. It is recommended that hypotensive anesthesia be adjusted in relation to the patient's preoperative blood pressure rather than to a specific target pressure and be limited to that level necessary to reduce bleeding in the surgical field and in duration to that part of the surgical procedure deemed to benefit by it. A mean arterial blood pressure (MAP) 30% below a patient's usual MAP, with a minimum MAP of 50 mm Hg in ASA Class I patients and a MAP not less than 80 mm Hg in the elderly, is suggested to be clinically acceptable. Various pharmacological agents have been used for induced hypotension during orthognathic surgery. In addition, there are many drugs that have been used in other types of surgery that could be used in orthognathic surgery to induce hypotension. Recent reports using control groups do not show significant differences in morbidity and mortality attributable to induced hypotension during anesthesia. Appropriate patient evaluation and selection, proper positioning and monitoring, and adequate fluid therapy are stressed as important considerations in patients undergoing induced hypotension during orthognathic surgery.

Rodrigo, C.



Head turning-induced hypotension in elderly people.  


Carotid sinus hypersensitivity has a high prevalence in the elderly and is a possible cause of falls. In carotid sinus hypersensitivity, external triggers cause sudden reductions in blood pressure, leading to dizziness or syncope, resulting in falls. Turning of the head is considered an important example of such an external trigger in everyday life, wherein rotation of the neck is thought to manipulate the hypersensitive carotid sinus. However, direct evidence for this is lacking. The aim of this study was to investigate the effects of head turning in elderly with carotid sinus hypersensitivity. We performed a prospective, observational study in 105 elderly patients who visited a geriatric falls clinic in a university teaching hospital and in 25 community dwelling healthy elderly subjects. Continuous measurements of blood pressure and heart rate (Finapres) were performed before, during, and after head turning. Head turning-induced hypotension was defined as a drop in systolic blood pressure of at least 20 mmHg during head turning. Carotid sinus hypersensitivity was examined with carotid sinus massage. We also tested for two other common geriatric hypotensive syndromes, orthostatic hypotension and post prandial hypotension, using active standing and a meal test. All three hypotensive syndromes were defined using consensus definitions. Head turning resulted in hypotension in 39% of patients (mean systolic blood pressure drop 36 mm Hg) and in 44% of the healthy elderly, irrespective of the direction of the head movement. Carotid sinus hypersensitivity was associated with head-turning induced hypotension (OR= 3.5, 95% CI= 1.48 to 8.35). We conclude that head turning is indeed an important cause of sudden drops in blood pressure in elderly with carotid sinus hypersensitivity. PMID:23977361

Schoon, Yvonne; Olde Rikkert, Marcel G M; Rongen, Sara; Lagro, Joep; Schalk, Bianca; Claassen, Jurgen A H R



Controlled hypotension in children: a critical review of available agents.  


Due to the potential for the transmission of infectious diseases with the homologous transfusion of blood products, there has been an increased interest in measures to limit intraoperative blood loss and avoid the need for homologous transfusion during high-risk surgical procedures including spinal surgery. Controlled hypotension (also referred to as deliberate or induced hypotension), defined as a reduction of systolic blood pressure to 80 to 90 mm Hg, a reduction of mean arterial pressure (MAP) to 50 to 65 mm Hg or a 30% reduction of baseline MAP, is one technique that has been used to limit intraoperative blood loss. In the adult population, several agents have been used alone or in combination for controlled hypotension including the inhalational anesthetic agents, direct-acting vasodilators such as nitroglycerin (glyceryl trinitrate) and nitroprusside, beta-adrenoceptor antagonists, and calcium channel antagonists. Despite clinical studies that have clearly demonstrated a reduction in blood loss with controlled hypotension when compared with the normotensive state and despite potential theoretical issues with each agent, there are no definitive studies demonstrating the preferred pharmacologic agent. When considering the pediatric-aged patient, studies have reported the use of the inhalational agent sevoflurane, the alpha(2)-adrenoceptor agonist dexmedetomidine as well as various vasodilators including sodium nitroprusside, nitroglycerin, fenoldopam, and alprostadil for controlled hypotension. Sevoflurane offers the advantages of easy dosage titration, no need for an additional intravenous infusion as well as providing anesthesia in addition to controlled hypotension. Disadvantages include a slightly higher cost than some of the intravenous agents and the inability to monitor evoked potentials with high sevoflurane concentrations. Whereas sodium nitroprusside, nicardipine and fenoldopam all provide the desired level of hypotension in pediatric-aged patients, nitroglycerin was not effective in this age group of patients in one study. When comparing nicardipine and sodium nitroprusside, nicardipine offers the potential advantages of fewer episodes of excessive hypotension, less rebound tachycardia and, in one study, less blood loss. Although fenoldopam has been shown to be effective, cost issues may limit is widespread application for this technique. The pharmacologic profile of dexmedetomidine indicates that this drug has potential in controlled hypotension and clinical data are needed to define its role. PMID:12083972

Tobias, Joseph D



[Urticaria pigmentosa: two different clinical presentations in pediatric patients].  


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



Seating-Induced Postural Hypotension Is Common in Older Patients with Decompensated Heart Failure and May Be Prevented by Lower Limb Compression Bandaging  

Microsoft Academic Search

Background: Postural hypotension induced by transition from supine to sitting position and measures for its prevention in heart failure has not been investigated. Objective: Our purpose was to evaluate the prevalence of postural hypotension and associated clinical manifestations as well as the contribution of various risk factors for postural hypotension on transition from lying to sitting in older patients with

Oleg Gorelik; Dorit Almoznino-Sarafian; Vita Litvinov; Irena Alon; Miriam Shteinshnaider; Eynat Dotan; David Modai; Natan Cohen



Spontaneous intracranial hypotension: a study of six cases with MR findings and literature review.  


Spontaneous intracranial hypotension is clinically characterized by orthostatic headache and other symptoms caused by low cerebrospinal fluid pressure due to leakage of cerebrospinal fluid from dural punctures or other medical causes. The other symptoms are mainly due to traction of the cranial and spinal nerves owing to descent of the brain caused by low cerebrospinal fluid pressure. Magnetic resonance imaging is very useful in the diagnosis because of its characteristic findings. We describe the MRI findings in six cases that had variable clinical presentation. PMID:16981936

Sainani, N I; Lawande, M A; Pungavkar, S A; Desai, M; Patkar, D P; Mohanty, P H



A Rare Clinical Presentation of Intraoral Darier's Disease.  


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



A Rare Clinical Presentation of Intraoral Darier's Disease  

PubMed Central

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.



Clinical presentation and metabolic features of overt and occult urolithiasis.  


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



Review of clinical presentation and diagnosis of mucopolysaccharidosis IVA.  


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



Orthostatic Hypotension: Evaluation and Treatment  

Microsoft Academic Search

Orthostatic hypotension (OH) may be dependent upon various neurogenic and non-neurogenic disorders and conditions. Neurogenic causes include the main autonomic failure syndromes, primary (multiple system atrophy, pure autonomic failure, and autonomic failure associated with Parkinson's disease) and secondary (central nervous system diseases, peripheral neuropathies and systemic diseases). Non-neurogenic causes of OH include cardiac impairment, fluid and electrolyte loss, vasodilatation, and

Simona Maule; Grazia Papotti; Diego Naso; Corrado Magnino; Elisa Testa; Franco Veglio


Orthostatic hypotension in older persons: A diagnostic algorithm  

Microsoft Academic Search

Orthostatic hypotension (OH) is a frequent phenomenon in older persons and usually has a multifactorial origin. When the diagnosis\\u000a is suspected, the work-up should initially be directed at the most prevalent causes. This clinical algorithm may be a useful\\u000a tool in the diagnostic process.

T. Krecinic; F. Mattace-Raso; N. Van Der Velde; G. Pereira; T. Van Der Cammen



Bradycardia and hypotension during spinal anesthesia: early observations  

Microsoft Academic Search

Soon after spinal anesthesia was introduced, surgeons became aware of the eventual occurrence of bradycardia and hypotension. However, the measurement of blood pressure was not a routine practice. The usual clinical observation consisted of palpation of the pulse for estimation of its fullness and for counting its rate. Therefore, it took a few years for the complete description of the

Carlos Parsloe



Granular cell tumor--clinically presented as lymphadenopathy.  


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



Cardiac evaluation in hypotension-prone and hypotension-resistant hemodialysis patients  

Microsoft Academic Search

Cardiac evaluation in hypotension-prone and hypotension-resistant hemodialysis patients.BackgroundHypotension during hemodialysis occurs frequently, but the precise mechanism remains unclear. In this study, the presence of myocardial ischemia and myocardial contractile reserve during infusions of the ?-adrenergic receptor agonist dobutamine was assessed by means of dobutamine-atropine stress echocardiography (DSE) in hypotension-prone (HP) and hypotension-resistant (HR) hemodialysis patients.MethodsEighteen HP patients (age 53 ±

Don Poldermans; Riccardo Rambaldi; Anton H. Van Den Meiracker; Marinus A. Van Den Dorpel; Guido Rocchi; Eric Boersma; Jeroen J. Bax; Willem Weimar; Jos R. T. C. Roelandt; Robert Zietse; Don Poldermans



Familial Dementia With Lewy Bodies With an Atypical Clinical Presentation  

PubMed Central

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: a very rare multiple clinical presentation.  


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



An unusual clinical presentation of ocular trauma in a child.  


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



Clinical Presentation of Mucopolysaccharidosis Type II (Hunter's Syndrome)  

PubMed Central

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



[Present and future of traditional Chinese medicine clinical pharmacy].  


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



Presentation of clinically suspected persistent chlamydial infection: a case series.  


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



Thymic neoplasm: a rare disease with a complex clinical presentation.  


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



Non Hodgkin T cell lymphoma: an atypical clinical presentation*  

PubMed Central

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



Non Hodgkin T cell lymphoma: an atypical clinical presentation.  


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


Cor triatriatum: clinical presentation and surgical results in 12 patients.  


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



Pediatric trichotillomania: clinical presentation, treatment, and implications for nursing professionals.  


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



Intraorbital foreign body: clinical presentation, radiological appearance and management.  


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



Clinical presentation and etiology of osteomalacia/rickets in adolescents.  


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



Key Diagnostic Finding in a Condition with Variable Clinical Presentations  

PubMed Central

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



Short term variability of oxygen saturation during hemodialysis is a warning parameter for hypotension appearance  

Microsoft Academic Search

Acute hypotension is a frequent complication of hemodialysis. Blood oxygenation may play a role in hypotension and hypoxemia may be considered as a surrogate marker of hemodynamic instability. Continuous, non-invasive monitoring of oxygen saturation (SO2) during hemodialysis is now possible, by means of sensors measuring SO2 in blood entering the dialyzer. The aim of the present work was to analyze

E. Mancini; L. Corazza; D. C. Cannarile; M. L. Soverini; S. Cavalcanti; S. Cavani; A. Fiorenzi; A. Santoro



Use of Computed Tomography of the Head in the Hypotensive Blunt-Trauma Patient  

Microsoft Academic Search

Study objective: To identify patients presenting with hypotension due to blunt trauma who should undergo computed tomography (CT) of the head before urgent chest or abdominal operation.Design: Retrospective registry-based record review. Setting: Urban Level I trauma center. Participants: Consecutive trauma patients with suspected head injury, blunt mechanism of injury, and hypotension who were discharged between January 1, 1989, and December

Robert J Winchell; David B Hoyt; Richard K Simons



Ischemic hepatitis secondary to hepatic artery steal in a patient with celiac artery stenosis and severe postural hypotension.  


Ischemic hepatitis, also known as hypoxic hepatitis or shock liver is defined as an acute, transient elevation of aminotransferase levels in the absence of any known causes. The pathogenesis is multifactorial. Many studies have suggested systemic hypotension as a major contributor to the pathogenesis of ischemic hepatitis but that alone is not enough to cause it. Celiac artery stenosis does not commonly cause clinically significant hepatic ischemia because of its rich collaterals. We present a case of a 78-year-old male with a background of severe orthostatic hypotension, who presented with elevation of liver enzymes due to hepatic artery steal precipitated by celiac artery stenosis. Clinical investigations showed elevated transaminases and unremarkable CT scan. Invasive celiac artery angiography showed a critical ostial lesion and it was stented. The liver enzymes peaked the day following stenting and normalized over the next 9 days. This confirmed clinically significant hepatic artery steal due to an ostial celiac artery stenosis. Relieving the celiac artery stenosis normalized the liver enzymes confirming the interdependence of the two components of this rare syndrome. Our report is the only report to our knowledge where classic hepatic artery steal and shock liver was demonstrated due to the rare combination of severe orthostatic hypotension and celiac artery ostial stenosis. PMID:21538779

Panwar, Vikram; Ranaweera, Priyantha



Clinical Presentation of Patients with Symptomatic Anterior Hip Impingement  

Microsoft Academic Search

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



Fetishism and sexual dysfunction: Clinical presentation and management  

Microsoft Academic Search

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



Clinical presentation of a patient with thoracic myelopathy at a chiropractic clinic  

PubMed Central

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.



Neurogenic orthostatic hypotension: chasing "the fall".  


Orthostatic hypotension (OH) is a frequently encountered problem affecting nearly 30% of the population aged more than 60 years. It can result from neurological and non-neurological derangements which compromise the perfusion of the brain in an erect posture. Neurogenic OH is a manifestation of autonomic failure. It is an important cause of recurrent falls in the elderly, syncopal events and also has been shown to be associated with increased long term mortality from vascular and non-vascular causes. This review will discuss the pathophysiology, aetiology, clinical features and management of neurogenic OH and its differentiation from OH caused by non-neurological causes at each step. A clinician should primarily look for any reversible causes in a patient with neurogenic OH and should not forget that treatment is aimed at restoring the functioning capability of the patient rather than normotension. Co-existent supine hypertension in some patients should be taken into account while treating them. PMID:18230746

Gupta, D; Nair, M D



Predicting Acute Hypotensive Episode by Bhattacharyya Distance  

NASA Astrophysics Data System (ADS)

Acute hypotensive episode (AHE) is a serious clinical event, which can lead to irreversible organ damage and sometimes death. When detected in time, an appropriate intervention can significantly lower the risks for the patient. An algorithm is developed for automated statistical prediction of AHE in patients, using mean arterial pressure (MAP). The dataset used for this work is from MIMIC II of PhysioNet/Computers in Cardiology. The algorithm consists of probability distributions of MAP and information divergence methods for calculating the statistical distance between two probability distributions. The Bhattacharyya Distance is found out to be most accurate method for calculating such statistical distance. Beat classification of AHE patients with respect to Non-AHE patient is carried out by using training set of MIMIC II database. The comparison is also carried out for feasibility of Bhattacharyya distance with another divergence method like KL ivergence

Awandekar, Vaibhav; Cheeran, A. N.



Nicardipine for controlled hypotension during spinal surgery.  


Nicardipine is the first intravenously administered dihydropyridine calcium channel blocker. Its primary physiologic actions include vasodilatation with limited effects on the inotropic and dromotropic function of the myocardium. Several reports have documented its use in adult patients for pharmacologic control of blood pressure. We present our experience with nicardipine as an agent for controlled hypotension during spinal surgery in 24 children. After the induction of general anesthesia, nicardipine was started at 5 (22 patients) or 10 micrograms/kg/min (two patients). The target mean arterial pressure (MAP) of 55-65 mm Hg was reached in 5.1 +/- 2.1 min (range, 2-10). Intraoperative infusion requirements to maintain the target MAP varied from 0.5 to 7 micrograms/kg/min (mean, 2.5 +/- 1.1). No adverse effects related to nicardipine were noted. Nicardipine appears to be an effective agent for controlled hypotension in children. Future studies are required to determine its advantages/disadvantages compared with more commonly used agents such as sodium nitroprusside or adrenergic antagonists. PMID:8728640

Tobias, J D; Hersey, S; Mencio, G A; Green, N E


Improving oral presentation skills with a clinical reasoning curriculum: a prospective controlled study  

Microsoft Academic Search

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



University Clinic of Toxicology - historical note and present work.  


(Full text is available at 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

Bozinovska, C



Multifactorial Model and Treatment Approaches of Refractory Hypotension in a Patient Who Took an ACE Inhibitor the Day of Surgery  

PubMed Central

In the field of anesthesiology, there is wide debate on discontinuing angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) therapy the day of noncardiac surgery. Although there have been many studies attributing perioperative hypotension to same-day ACEI and ARB use, there are many additional variables that play a role in perioperative hypotension. Additionally, restoring blood pressure in these patients presents a unique challenge to anesthesiologists. A case report is presented in which a patient took her ACEI the day of surgery and developed refractory hypotension during surgery. The evidence of ACEI use on the day of surgery and development of hypotension is reviewed, and additional variables that contributed to this hypotensive episode are discussed. Lastly, current challenges in restoring blood pressure are presented, and a basic model on treatment approaches for refractory hypotension in the setting of perioperative ACEI use is proposed.

Srivastava, Karan; Sacher, Vikas Y.; Nelson, Craig T.; Lew, John I.



Hypotensive Reactions Associated with Platelet Transfusion Through Leukocyte Reduction Filters  

Microsoft Academic Search

This article reports a case of hypotensive reaction following platelet transfusion (PT) and presents a possible etiologic mechanism implicating negatively charged leukocyte reduction filters (LRFs) and angiotensin converting enzyme (ACE) inhibitors. A 14-year-old boy with acute lymphoblastic leukemia was admitted to the pediatric intensive care unit (PICU) for respiratory failure following bone marrow transplantation. He was being treated with ACE

France Gauvin; Baruch Toledano; Heather A. Hume; Jacques Lacroix



Pathophysiology and management of spontaneous intracranial hypotension--a review  

Microsoft Academic Search

Spontaneous Intracranial Hypotension is a syndrome involving reduced intracranial pressure secondary to a dural tear which occurs mostly due to connective tissue disorders such as Marfans Syndrome, and Ehler Danlos Syndrome. Patients with dural ectasias leading to CSF leakage into the subdural or epidural space classically present with orthostatic headaches and cranial nerve deficits mostly seen in cranial nerves V-VIII.

Nadir Ali Syed; Farhan Arshad Mirza; Aqueel Hussain Pabaney; Rameez-ul-Hassan



Demographic and Clinical Characteristics of New Patients Presenting to a Community Teaching Clinic  

PubMed Central

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



Recurrent spontaneous intracranial hypotension in early pregnancy  

PubMed Central

Spontaneous intracranial hypotension (SIH) is an uncommon condition characterised by postural headache secondary to low cerebrospinal fluid pressure. Here we present a case of recurrence of SIH in early pregnancy in a 26-year-old woman. She first presented at the age of 21 years at 15 weeks’ gestation with a history of headache, nausea, vomiting, neck stiffness and photophobia. Findings from a MRI brain scan led to a diagnosis of SIH. She was treated with autologous epidural blood patching and remained asymptomatic until her second pregnancy 5 years later, when she re-presented at 16 weeks’ gestation with similar symptoms. She was again diagnosed with SIH and required a repeat treatment of autologous epidural blood patching. She subsequently remained symptom free and delivered a healthy boy at term.

McGrath, Emer; Monaghan, Thomas S; Alexander, Michael; Hennessy, Michal J



Taxane-induced nail changes: incidence, clinical presentation and outcome.  


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



Transgender Children: Clinical and Ethical Issues in Prepubertal Presentations  

Microsoft Academic Search

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

Edgardo Menvielle



Diacetyl nadolol: 3-month ocular hypotensive effect in glaucomatous eyes.  

PubMed Central

In a double-masked, 3-month clinical study the ocular hypotensive effects of diacetyl nadolol (DAN), timolol, and nadolol were compared. When applied topically to the eyes of glaucomatous patients timolol 0.5% was found to be significantly more effective than DAN 2% in controlling IOP at 3 of 10 evaluation periods. Fewer patients, however, developed tolerance to DAN 2% than to timolol 0.5%. DAN 0.5% was also effective in lowering intraocular pressure in 3 of 8 patients tested. Nadolol 2% had no long-term ocular hypotensive effect. Two of 8 patients treated with DAN 2% developed a bilateral periorbital dermatitis and were removed from the study even though their intraocular pressures were well controlled. No other clinically significant local or systemic side effects were observed during the course of the study.

Duzman, E; Rosen, N; Lazar, M



Hypotensive peptides from milk proteins.  


Hypertension is the major controllable risk factor associated with cardiovascular disease (CVD) events such as myocardial infarction, stroke, heart failure, and end-stage diabetes. A 5 mm Hg decrease in blood pressure has been equated with approximately 16% decrease in CVD. In the U.S. alone current annual antihypertensive drug costs are approximately dollars 15 billion. The renin-angiotensin-aldosterone system is a target for blood pressure control. Cleavage of angiotensinogen by renin produces angiotensin I which is subsequently hydrolyzed by angiotensin-I-converting enzyme (ACE) to angiotensin II (a potent vasoconstrictor). Various side effects are associated with the use of ACE inhibitory drugs in the control of blood pressure including hypotension, increased potassium levels, reduced renal function, cough, angioedema, skin rashes, and fetal abnormalities. Milk proteins, both caseins and whey proteins, are a rich source of ACE inhibitory peptides. Several studies in spontaneously hypertensive rats show that these casokinins and lactokinins can significantly reduce blood pressure. Furthermore, a limited number of human studies have associated milk protein-derived peptides with statistically significant hypotensive effects (i.e., lower systolic and diastolic pressures). The advent of effective milk protein based functional food ingredients/nutraceuticals for the prevention/control of blood pressure therefore has the potential to significantly reduce global healthcare cost. PMID:15051858

FitzGerald, Richard J; Murray, Brian A; Walsh, Daniel J



Permanent neonatal diabetes mellitus: clinical presentation and epidemiology in Oman  

Microsoft Academic Search

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: The Present Moment in Clinical Social Work  

Microsoft Academic Search

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,

Kielty Turner



Present and prospective clinical therapeutic regimens for Alzheimer's disease  

PubMed Central

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



Nonspecific dizziness: frequency of supine hypertension associated with hypotensive reactions on head-up tilt  

Microsoft Academic Search

The clinical syndrome of supine hypertension associated with orthostatic hypotension (OH) in given individuals is recognized by specialists, but is underdiagnosed in the community. The objective of this study was to assess supine hypertension associated with hypotensive reactions on head-up tilt (SH-HRT) among patients evaluated for nonspecific dizziness. Consecutive patients with nonspecific dizziness were studied with a 10-min supine 30-min

J E Naschitz; R Mussafia-Priselac; Y Kovalev; N Zaigraykina; G Slobodin; N Elias; S Storch; I Rosner



Neurogenic orthostatic hypotension of Parkinson's disease: What exploration for what treatment?  

Microsoft Academic Search

The aim of this short review is to illustrate, using orthostatic hypotension as an example, the clinical problems related to autonomic features in Parkinson's disease. Orthostatic hypotension is frequently encountered in Parkinson's disease and its diagnosis remains manometric (a fall of at least 20 and\\/or 10mmHg in standing blood pressure). It is often associated with supine hypertension to be taken

J.-M. Senard; A. Pathak



Cortical blood flow during head-up postural change in subjects with orthostatic hypotension  

Microsoft Academic Search

Regional cerebral blood flow was measured with the 133-Xenon inhalation method in seven healthy subjects with orthostatic hypotension not due to autonomic failure (i.e. non-neurogenic clinical disorder). Measurements were performed during supine rest and during head-up tilt (70°). All subjects had a consistent drop in systolic blood pressure and the typical symptomatology of orthostatic hypotension. The results showed lower mean

Ulla Passant; Siegbert Warkentin; Lennart Minthon; Roger Fäldt; Lars Edvinsson



An early approach to controlled hypotension: Felice Visalli and the "pneumoanemizator.".  


In this historical vignette, the authors describe the conception and realization of the "pneumoanemizator," an ingenious pneumatic apparatus originally designed in the 1940s for the purpose of controlled hypotension. The authors also give a biographical sketch of its inventor, the pioneering Italian neurosurgeon Felice Visalli. The general working features of this nearly forgotten device and its performance in experimental and clinical trials are evoked in the light of a brief history of controlled hypotension. PMID:9890388

De Caro, G M; Brunori, A



Study on Clinical Presentation of Ear and Nose Foreign Bodies  

Microsoft Academic Search

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


Hemodynamic study of hypotension during hemodialysis  

Microsoft Academic Search

Hemodynamic study of hypotension during hemodialysis. Hemodynamic parameters were investigated continuously during hemodialysis by catheterization in 14 patients. Eight patients (group 1) exhibited a sudden fall (?30 mm Hg) in mean arterial pressure (MAP) while six others (group 2) did not. In group 1, the following sequence of events induced the hypotension: (1) hypovolemia caused by ultrafiltration; (2) decrease in

Jean-Pierre Kinet; Daniel Soyeur; Noëlle Balland; Michel Saint-Remy; Pierre Collignon; Jean-Pierre Godon; J P Kinet



Managing hypotension during anaesthesia for caesarean section  

Microsoft Academic Search

Hypotension is the most important common complication of regional anaesthesia for caesarean section. Methods of managing hypotension include lateral uterine displacement, mechanical leg compression, intravenous prehydration, and use of vasopressors. Uterine displacement is accepted as standard, although the optimal degree of tilt is unknown, and most anaesthetists overestimate the amount of tilt they believe they are applying. Leg compression is

Warwick D. Ngan Kee



Neurobrucellosis: clinical, diagnostic, therapeutic features and outcome. Unusual clinical presentations in an endemic region.  


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


Clinical Presentation and Management of Jugular Foramen Paraganglioma  

PubMed Central

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



Acute, transient hemorrhagic hypotension does not aggravate structural damage or neurologic motor deficits but delays the long-term cognitive recovery following mild to moderate traumatic brain injury  

PubMed Central

Objectives Posttraumatic hypotension is believed to increase morbidity and mortality in traumatically brain-injured patients. Using a clinically relevant model of combined traumatic brain injury with superimposed hemorrhagic hypotension in rats, the present study evaluated whether a reduction in mean arterial blood pressure aggravates regional brain edema formation, regional cell death, and neurologic motor/cognitive deficits associated with traumatic brain injury. Design Experimental prospective, randomized study in rodents. Setting Experimental laboratory at a university hospital. Subjects One hundred nineteen male Sprague-Dawley rats weighing 350-385 g. Interventions Experimental traumatic brain injury of mild to moderate severity was induced using the lateral fluid percussion brain injury model in anesthetized rats (n = 89). Following traumatic brain injury, in surviving animals one group of animals was subjected to pressure-controlled hemorrhagic hypotension, maintaining the mean arterial blood pressure at 50-60 mm Hg for 30 mins (n = 47). The animals were subsequently either resuscitated with lactated Ringer’s solution (three times shed blood volume, n = 18) or left uncompensated (n = 29). Other groups of animals included those with isolated traumatic brain injury (n = 34), those with isolated hemorrhagic hypotension (n = 8), and sham-injured control animals receiving anesthesia and surgery alone (n = 22). Measurements and Main Results The withdrawal of 6-7 mL of arterial blood significantly reduced mean arterial blood pressure by 50% without decreasing arterial oxygen saturation or Pao2. Brain injury induced significant cerebral edema (p < .001) in vulnerable brain regions and cortical tissue loss (p < .01) compared with sham-injured animals. Neither regional brain edema formation at 24 hrs postinjury nor the extent of cortical tissue loss assessed at 7 days postinjury was significantly aggravated by superimposed hemorrhagic hypotension. Brain injury-induced neurologic deficits persisted up to 20 wks after injury and were also not aggravated by the hemorrhagic hypotension. Cognitive dysfunction persisted for up to 16 wks postinjury. The superimposition of hemorrhagic hypotension significantly delayed the time course of cognitive recovery. Conclusions A single, acute hypotensive event lasting 30 mins did not aggravate the short- and long-term structural and motor deficits but delayed the speed of recovery of cognitive function associated with experimental traumatic brain injury.

Schutz, Christian; Stover, John F.; Thompson, Hilaire J.; Hoover, Rachel C.; Morales, Diego M.; Schouten, Joost W.; McMillan, Asenia; Soltesz, Kristie; Motta, Melissa; Spangler, Zachery; Neugebauer, Edmund; McIntosh, Tracy K.



Clinical presentation of intoxication due to synthetic cannabinoids.  


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



Atypical Clinical Presentation of Isolated Extraocular Muscle Sarcoid  

PubMed Central

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



Multiple agminated spindle cell nevi: unique clinical presentation and review.  


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



The Clinical Presentation of Childhood-Onset Schizophrenia  

Microsoft Academic Search

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



[Anesthesiologic management in scleroderma patients. Presentation of a clinical case].  


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, past and present--a pharmacological and clinical perspective.  


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



[Cutaneous leishmaniasis as travelers' disease. Clinical presentation, diagnostics and therapy].  


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



Intracranial actinomycosis: varied clinical and radiologic presentations in two cases.  


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


Clinical presentations of Ehlers Danlos syndrome type IV  

Microsoft Academic Search

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



Clinical presentation of exclusive cystic fibrosis lung disease  

Microsoft Academic Search

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: clinical presentation, diagnosis, and treatment  

Microsoft Academic Search

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



The response to methylene blue in patients with severe hypotension during liver transplantation.  


Methylene blue is a useful therapy for catecholamine-resistant vasoplegic shock. Three cases of methylene blue administration for the treatment of catecholamine-resistant hypotension during orthotopic liver transplantation are presented. PMID:22608589

Cheng, Sara S; Berman, Gregory W; Merritt, Glenn R; Hendrickse, Adrian; Fiegel, Matthew J; Teitelbaum, Isaac; Campsen, Jeffrey; Wachs, Michael; Zimmerman, Michael; Mandell, M Susan



Hantavirus infections: clinical presentation in the emergency room.  


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



Cervical Spondylotic Myelopathy: Pathophysiology, Clinical Presentation, and Treatment  

Microsoft Academic Search

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



Childhood leprosy in an urban clinic, Hyderabad, India: clinical presentation and the role of household contacts.  


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



Atypical clinical course subacute sclerosing panencephalitis presenting as acute Encephalitis.  


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 clinically presenting in the urinary tract.  


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--pathogenesis, clinical presentation and therapeutic management].  


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



Resuscitation of Hypothermic-Hypovolemic-Hypotensive Baboons.  

National Technical Information Service (NTIS)

Because baboon hemodynamics, lung function, oxygen transport function, clotting proteins, and platelet function are similar to those of man, we made a study of hypothermic, hypovolemic, hypotensive baboons to evaluate treatment programs. When the temperat...

C. R. Valeri R. C. Dennis A. J. Melaragno M. D. Altschule



Sympathoinhibition and hypotension in carotid sinus hypersensitivity.  


Carotid sinus reflex hypersensitivity is a known cause of syncope in humans. The condition is characterized by cardioinhibition and vasodepression, each to varying degrees. The extent and importance of sympathoinhibition has not been determined in patients with carotid sinus hypersensitivity. This study reports on the extent of sympathoinhibition measured directly directly during carotid massage with and without atrioventricular sequential pacing, in a patient with symptomatic carotid sinus reflex hypersensitivity. Carotid massage elicited asystole, hypotension and complete inhibition of muscle sympathetic nerve activity. Carotid massage during atrioventricular pacing produced similar sympathoinhibition, but with minimal hypotension. Therefore, sympathoinhibition did not contribute importantly to the hypotension during carotid massage in the supine position in this patient. Further investigations are required to elucidate the relation of sympathoinhibition to hypotension in patients with carotid sinus hypersensitivity in the upright position. PMID:1290922

Smith, M L; Ellenbogen, K A; Eckberg, D L



Current pharmacologic treatment for orthostatic hypotension  

Microsoft Academic Search

Orthostatic hypotension is treated effectively with the combined use of non-pharmacological and pharmacological interventions.\\u000a Patients should be counseled as to the nature of the underlying disorder and reversible causes of orthostatic hypotension\\u000a should be removed. Should symptoms persist, pharmacological treatment is implemented. First line pharmacotherapeutic interventions\\u000a include volume repletion in combination with alpha-adrenoreceptor agonists. If unsuccessful there are several supplementary

Roy Freeman



On the mechanism of L-DOPA-induced postural hypotension in the cat  

PubMed Central

1. The effects of L-DOPA on postural hypotension and carotid occlusion pressor effect were studied, mainly in cats; the recovery of the blood pressure upon tilting was used as a measure of postural hypotension. 2. L-DOPA (30 mg/kg) partially depressed the carotid occlusion pressor effect and caused some degree of postural hypotension, L-DOPA (100 mg/kg) had more marked effects; the responses returned to control after 90 to 150 minutes. L-DOPA itself caused a pressor response in all cats. 3. The dopa decarboxylase inhibitor N1-(DL-seryl)-N2-(2,3,4-trihydroxybenzyl) hydrazine (RO4-4602, 50 and 10 mg/kg) had no effect itself on the tilt response but completely prevented the effects of L-DOPA on the carotid occlusion pressor effect and postural hypotension. 4. After RO4-4602 (3 and 1 mg/kg), L-DOPA (100 mg/kg) caused a brief rise of blood pressure followed by a longer lasting fall in horizontally-orientated cats (i.e. `supine' hypotension). No postural hypotension was observed after L-DOPA under these conditions. 5. Noradrenaline elicited only small and transient effects on postural hypotension, but dopamine's effects were more marked and longer lasting. Pressor dose-response relationships for noradrenaline were the same before and after L-DOPA, as well as in cats pretreated with L-DOPA for 4 days. 6. In cats with kidneys and intestines removed, the tilt reflex was still present. Dose-response curves to L-DOPA were the same as in normal animals. RO4-4602 (3 mg/kg) prevented postural hypotension and block of the carotid occlusion pressor effect; supine hypotension was also observed after L-DOPA. 7. The recovery response to tilting in spinal cats was markedly depressed or absent unless the blood pressure was elevated by angiotensin, in which experiments L-DOPA depressed the recovery upon tilting (i.e. induced postural hypotension). 8. Blood pressure responses to tyramine were increased after 10 mg/kg of L-DOPA, but depressed after 100 mg/kg. The response to tyramine was not depressed, however, when RO4-4602 was given to block the dopa-dopamine conversion. 9. The response to sympathetic stimulation in pithed rats was depressed after L-DOPA and dopamine, but not after ?-methyldopa. 10. ?-Methyldopa (300 mg/kg) given acutely caused a moderate degree of postural hypotension and a more marked postural hypotension if given for two days. 11. It is concluded that it is possible to differentiate between the supine and postural hypotension caused by L-DOPA and that supine hypotension is due to a central effect and postural hypotension to an extracerebral effect. Postural hypotension is discussed in relation to six hypotheses presented to explain its effect. Postural hypotension after L-DOPA is probably not due to a-adrenoceptor blockade, a central effect or any effect on the kidney. The most likely hypothesis is that L-DOPA forms dopamine which acts as a false transmitter in the peripheral sympathetic nervous system.

Dhasmana, K. M.; Spilker, B. A.



Cerebral and systemic effects of hypotension induced by adenosine or ATP in dogs.  


The authors evaluated the systemic and cerebral hemodynamic and metabolic effects of 1 h of hypotension to a mean arterial pressure of either 50 mmHg or 40 mmHg induced by intravenous adenosine or ATP in dogs maintained on 70% nitrous oxide and 0.1% halothane. Following the hypotensive period, brain biopsy specimens were taken for the determination of cerebral metabolites and calculation of the energy charge. Hypotension induced by either adenosine or ATP produced a marked 40-62% decrease in systemic vascular resistance with little change in cardiac index or oxygen consumption but resulted in a mild metabolic acidosis. Because of a profound decrease in cerebral perfusion pressure with hypotension (to 31-33 mmHg at an MAP of 50 mmHg and 22-24 mmHg at an MAP of 40 mmHg) CBF decreased 54-65% and was inadequate to meet the unchanged cerebral oxygen demands, resulting in some anaerobic metabolism with an accumulation of lactate. While the ease with which one can induce and maintain hypotension with these agents may be advantageous in clinical practice, the effects of adenosine and ATP on cerebral hemodynamics and metabolism may offer no advantage over other hypotensive agents. PMID:3985400

Newberg, L A; Milde, J H; Michenfelder, J D



Case report: quetiapine and refractory hypotension during general anesthesia in the operating room.  


Quetiapine is an atypical antipsychotic with known ?-adrenergic antagonism. We present a case of refractory hypotension that occurred after induction of general anesthesia in a patient being treated with quetiapine. This patient was not currently taking antihypertensives and had no known cardiovascular abnormalities. We observed that the hypotension was most responsive to vasopressin. We recommend further investigation regarding the interaction of quetiapine and general anesthesia. PMID:23868884

Poole, Katherine A; Weber, Nina; Aziz, Michael



Syndrome of recurrent meninigitis due to congenital perilymph fistula with two different clinical presentations  

Microsoft Academic Search

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 Present and Future of Appointment, Tenure, and Compensation Policies for Medical School Clinical Faculty  

Microsoft Academic Search

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



Cardiovascular autonomic functions & cerebral autoregulation in patients with orthostatic hypotension  

PubMed Central

Background & objectives: Patients of orthostatic hypotension may or may not have symptoms of the cerebral hypoperfusion despite fall in the blood pressure. The present study was done to quantify autonomic functions and cerebral autoregulation in patients of orthostatic hypotension with or without symptoms. Methods: The study was conducted in 15 patients of orthostatic hypotension and 15 age, sex matched control subjects. The sympathetic reactivity was measured by diastolic blood pressure response to handgrip test (?DBP in HGT) and cold pressor test (?DBP in CPT). The parasympathetic reactivity was measured by E:I ratio during deep breathing test (DBT) and Valsalva ratio (VR) during Valsalva maneuver. The cerebral autoregulation was computed from the changes in the cerebral blood flow, cerebrovascular conductance and blood pressure measured during different time points during head-up tilt (HUT). Results: The sympathetic reactivity was lower in patients as compared to controls [?DBP in HGT: 10 (4 - 16) vs 18 (12 - 22) mmHg, P<0.01; ?DBP in CPT : 10 (4-12) vs 16 (10-20) mmHg, P<0.01]. The parasympathetic reactivity was also lower in patients as compared to controls. The sympathetic and parasympathetic reactivity was comparable in the symptomatic and asymptomatic patients. The maximum fall in blood pressure during HUT was comparable between symptomatic and asymptomatic patients (29.14 ± 10.94 vs 29.50 ± 6.39 mmHg), however, the percentage fall in the cerebral blood flow was significantly higher in the symptomatic (P<0.05) compared to asymptomatics. Interpretation & conclusions: Patients with orthostatic hypotension had deficits in sympathetic and parasympathetic control of cardiovascular system. Cerebral autoregulation was present in asymptomatic patients (increase in cerebrovascular conductance) during HUT while it was lost in symptomatic patients.

Khandelwal, Ekta; Jaryal, Ashok Kumar; Deepak, K.K.



Orthostatic hypotension: evaluation and treatment.  


Orthostatic hypotension (OH) may be dependent upon various neurogenic and non-neurogenic disorders and conditions. Neurogenic causes include the main autonomic failure syndromes, primary (multiple system atrophy, pure autonomic failure, and autonomic failure associated with Parkinson's disease) and secondary (central nervous system diseases, peripheral neuropathies and systemic diseases). Non-neurogenic causes of OH include cardiac impairment, fluid and electrolyte loss, vasodilatation, and old age. A number of drugs may also cause OH, through their vasoactive action or by interfering with the autonomic nervous system. Symptoms of OH are debilitating, often confining patients to bed, and longitudinal studies have shown that OH increases the risk of stroke, myocardial ischemia and mortality. The therapeutic goal is to decrease the incidence and severity of postural symptoms, rather than restore normotension. In non-neurogenic OH, treatment of the underlying cause may be curative. In neurogenic OH a combination of non-pharmacological and pharmacological measures is often needed. Patient education and non-pharmacological measures represent the first step; among these interventions, fluid repletion and physical countermanoeuvres have been proven very effective. Pharmacological treatment comprises a number of agents acting on blood vessels, on blood volume or with other pressor mechanisms. The drugs most currently used are fludrocortisone and midodrine. Fludrocortisone expands the extravascular body fluid volume and improves alpha-adrenergic sensitivity. Midodrine is a peripheral, selective alpha1-adrenergic agonist that causes arterial and venous vasoconstriction. Despite the wide use of these drugs, multicentre, randomised and controlled studies for the treatment of OH are still scarce and limited to few agents and groups of patients. Pharmacological management of OH substantially improves the quality of life of patients, although it may be problematic. The development of supine hypertension and subsequent congestive heart failure should be avoided, especially in those patients with a pre-existing cardiovascular risk, such as in diabetes or ischemic heart disease. PMID:17346129

Maule, Simona; Papotti, Grazia; Naso, Diego; Magnino, Corrado; Testa, Elisa; Veglio, Franco



Evaluation and management of orthostatic hypotension.  


Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or a decrease in diastolic blood pressure of 10 mm Hg within three minutes of standing when compared with blood pressure from the sitting or supine position. It results from an inadequate physiologic response to postural changes in blood pressure. Orthostatic hypotension may be acute or chronic, as well as symptomatic or asymptomatic. Common symptoms include dizziness, lightheadedness, blurred vision, weakness, fatigue, nausea, palpitations, and headache. Less common symptoms include syncope, dyspnea, chest pain, and neck and shoulder pain. Causes include dehydration or blood loss; disorders of the neurologic, cardiovascular, or endocrine systems; and several classes of medications. Evaluation of suspected orthostatic hypotension begins by identifying reversible causes and underlying associated medical conditions. Head-up tilt-table testing can aid in confirming a diagnosis of suspected orthostatic hypotension when standard orthostatic vital signs are nondiagnostic; it also can aid in assessing treatment response in patients with an autonomic disorder. Goals of treatment involve improving hypotension without excessive supine hypertension, relieving orthostatic symptoms, and improving standing time. Treatment includes correcting reversible causes and discontinuing responsible medications, when possible. Nonpharmacologic treatment should be offered to all patients. For patients who do not respond adequately to nonpharmacologic treatment, fludrocortisone, midodrine, and pyridostigmine are pharmacologic therapies proven to be beneficial. PMID:21888303

Lanier, Jeffrey B; Mote, Matthew B; Clay, Emily C



Obsessionality in eating-disorder patients: Relationship to clinical presentation and two-year outcome  

Microsoft Academic Search

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



Infective endocarditis: clinical spectrum, presentation and outcome. An analysis of 212 cases 1980–1995  

Microsoft Academic Search

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 in pediatric obsessive-compulsive disorder: Associations with clinical presentation  

Microsoft Academic Search

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




Presentations Name Position Presentation (ppt) Sudhir Srivastava, PhD, MPH Chief, Cancer Biomarkers Research Group Metabolomics: An Untapped Frontier (ppt, 161kb) John Milner, PhD Chief, Nutritional Sciences research Group Can Metabolomics


Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study  

Microsoft Academic Search

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



[The epidural blood patch technique for the management of headache due to spontaneous intracranial hypotension].  


Spontaneous intracranial hypotension is a clinical entity characterized by orthostatic headache, low CSF pressure and specific cranial imaging techniques. Headache can be accompanied by the symptoms such as tinnitus, vertigo, diplopia, nausea and vomiting. It is important for the diagnosis to show the level of CSF leakage. Epidural blood patch should be planned for the treatment of patients with no reduction of the complaints following conservative treatment. In this case report, we have discussed the diagnostic methods of spontaneous intracranial hypotension and the importance of an epidural blood patch for its treatment in the light of the literature. PMID:24104537

Güldo?u?, Fuat; Kelsaka, Ebru



Turcot Syndrome: A Synchronous Clinical Presentation of Glioblastoma Multiforme and Adenocarcinoma of the Colon  

PubMed Central

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



Spontaneous Intracranial Hypotension: Spinal MR Findings  

Microsoft Academic Search

Summary: We report three patients with spontaneous in- tracranial hypotension in whom spinal MR imaging re- vealed ventral extradural fluid collections that were cen- tered at the cervicothoracic junction in two patients and extended throughout the entire spine in the third patient. These spinal fluid collections most likely resulted from the accumulation of CSF at the site of dural leakage.

Barry M. Rabin; Sudipta Roychowdhury; Joel R. Meyer; Bruce A. Cohen; Kenneth D. LaPat; Eric J. Russell


Diagnostic criteria for headache due to spontaneous intracranial hypotension: a perspective.  


The clinical and radiographic manifestations of spontaneous intracranial hypotension are highly variable and many patients do not satisfy the 2004 International Classification of Headache Disorders criteria. We developed new diagnostic criteria for spontaneous intracranial hypotension based on cases we have seen reflecting the variable manifestations of the disorder. These criteria provide a basis for change when the classification criteria are next revised. The diagnostic criteria consist of A, orthostatic headache; B, the presence of at least one of the following: low opening pressure (? 60 mm H(2) O), sustained improvement of symptoms after epidural blood patching, demonstration of an active spinal cerebrospinal fluid leak, cranial magnetic resonance imaging changes of intracranial hypotension (eg, brain sagging or pachymeningeal enhancement); C, no recent history of dural puncture; and D, not attributable to another disorder. PMID:21658029

Schievink, Wouter I; Dodick, David W; Mokri, Bahram; Silberstein, Stephen; Bousser, Marie-Germaine; Goadsby, Peter J



Orthostatic Hypotension in Older Nursing Home Residents Who Fall: Are They Dizzy?  

Microsoft Academic Search

Orthostatic hypotension (OH) and dizziness have been linked to older adult falls. As a treatable condition, the detection of OH is of clinical importance to falls prevention. Gaps in the literature about symptoms associated with OH among older adult fallers, such as dizziness led to this secondary analysis of blood pressure data and reported symptoms. Of the 194 Registered Nurse

Deanna Gray-Miceli; Sarah J. Ratcliffe; Sizhu Liu; Dean Wantland; Jerry Johnson



Clinical implications of pneumococcal serotypes: invasive disease potential, clinical presentations, and antibiotic resistance.  


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



Early Physiological Responses to Hemorrhagic Hypotension  

PubMed Central

The identification of early indicators of hemorrhagic hypotension (HH) severity may support early therapeutic approaches and bring insights into possible mechanistic implications. However, there are few systematic investigations of physiological variables during early stages of hemorrhage. We hypothesized that, in certain subjects, early physiological responses to blood loss are associated with the ability to survive hemorrhage levels that are lethal to subjects that do not present the same responses. Therefore, we examine the relevance of specific systemic changes during and after the bleeding phase of HH. Stepwise hemorrhage, representing pre-hospital situations, was performed in 44 rats and measurements were made after each step. Heart and respiratory rates, arterial and venous blood pressures, gases, acid-base status, glucose, lactate, electrolytes, hemoglobin, O2 saturation, tidal volume and minute volume were measured before, during and after bleeding 40% of the total blood volume. Fifty percent of rats survived ? 100 min (survivors, S); others were considered nonsurvivors (NS). Our findings were: 1) S and NS subjected to a similar hemorrhage challenge showed significantly different responses during non-lethal levels of bleeding; 2) survivors showed higher blood pressure and ventilation than NS; 3) while pH was lower in NS at later stages, changes in bicarbonate and base excess occurred already during the hemorrhage phase and were higher in NS; 4) plasma K+ levels and glucose extraction were higher in NS. We conclude that cardio-respiratory and metabolic responses, essential for the survival at HH, can differentiate between S and NS even before a lethal bleeding was reached.

Torres Filho, Ivo P.; Torres, Luciana N.; Pittman, Roland N.



Hotline update of clinical trials and registries presented at the American College of Cardiology Congress 2011  

Microsoft Academic Search

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



Racial effects on the clinical presentation of alcoholics at a psychiatric hospital  

Microsoft Academic Search

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



Clinical pictures of unknown origin in neurology: past, present and future usefulness of artificial intelligence  

Microsoft Academic Search

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



Retropharyngeal internal carotid artery: a rare presentation with significant clinical implications.  


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



Clinical predictors for Legionella in patients presenting with community-acquired pneumonia to the emergency department  

Microsoft Academic Search

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



Gender effects on the clinical presentation of alcoholics at a psychiatric hospital  

Microsoft Academic Search

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



Profiling the clinical presentation of diagnostic characteristics of a sample of symptomatic TMD patients  

PubMed Central

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.



Clinical presentation of celiac disease and the diagnostic accuracy of serologic markers in children  

Microsoft Academic Search

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



Vitamin D Status in Japanese Patients with Hyperparathyroidism: Seasonal Changes and Effect on Clinical Presentation  

Microsoft Academic Search

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



Late-presenting congenital diaphragmatic hernia in children: a clinical spectrum  

Microsoft Academic Search

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

Maciej Bag?aj



2-vessel occlusion/hypotension: a rat model of global brain ischemia.  


Cardiac arrest followed by resuscitation often results in dramatic brain damage caused by ischemia and subsequent reperfusion of the brain. Global brain ischemia produces damage to specific brain regions shown to be highly sensitive to ischemia (1). Hippocampal neurons have higher sensitivity to ischemic insults compared to other cell populations, and specifically, the CA1 region of the hippocampus is particularly vulnerable to ischemia/reperfusion (2). The design of therapeutic interventions, or study of mechanisms involved in cerebral damage, requires a model that produces damage similar to the clinical condition and in a reproducible manner. Bilateral carotid vessel occlusion with hypotension (2VOH) is a model that produces reversible forebrain ischemia, emulating the cerebral events that can occur during cardiac arrest and resuscitation. We describe a model modified from Smith et al. (1984) (2), as first presented in its current form in Sanderson, et al. (2008) (3), which produces reproducible injury to selectively vulnerable brain regions (3-6). The reliability of this model is dictated by precise control of systemic blood pressure during applied hypotension, the duration of ischemia, close temperature control, a specific anesthesia regimen, and diligent post-operative care. An 8-minute ischemic insult produces cell death of CA1 hippocampal neurons that progresses over the course of 6 to 24 hr of reperfusion, while less vulnerable brain regions are spared. This progressive cell death is easily quantified after 7-14 days of reperfusion, as a near complete loss of CA1 neurons is evident at this time. In addition to this brain injury model, we present a method for CA1 damage quantification using a simple, yet thorough, methodology. Importantly, quantification can be accomplished using a simple camera-mounted microscope, and a free ImageJ (NIH) software plugin, obviating the need for cost-prohibitive stereology software programs and a motorized microscopic stage for damage assessment. PMID:23851591

Sanderson, Thomas H; Wider, Joseph M



Predicting hypotensive episodes during spinal anesthesia with the application of artificial neural networks.  


Hypotension is one of the most frequent adverse effects of spinal anesthesia. Several factors might be related to the occurrence of hypotension. Predictions of the hypotensive event, however, had been addressed by only a few authors using logistic regression (LR) models. Artificial neural networks (ANN) are pattern-recognition tools that can be used to detect complex patterns within data sets. The purpose of this study was to develop the ANN-based predictive model to identify patients with high risk of hypotension during spinal anesthesia. From September 2004 to December 2006, the anesthesia records of 1501 patients receiving surgery under spinal anesthesia were used to develop the ANN and LR models. By random selection 75% of data were used for training and the remaining 25% of data were used as test set for validating the predictive performance. Five senior anesthesiologists were asked to review the data of test set and to make predictions of hypotensive event during spinal anesthesia by clinical experience. The ANN model had a sensitivity of 75.9% and specificity of 76.0%. The LR model had a sensitivity of 68.1% and specificity of 73.5%. The area under receiver operating characteristic curves were 0.796 and 0.748. The ANN model performed significantly better than the LR model. The prediction of clinicians had the lowest sensitivity of 28.7%, 22.2%, 21.3%, 16.1%, and 36.1%, and specificity of 76.8%, 84.3%, 83.1%, 87.0%, and 64.0%. The computer-based predictive model should be useful in increasing vigilance in those patients most at risk for hypotension during spinal anesthesia, in allowing for patient-specific therapeutic intervention, or even in suggesting the use of alternative methods of anesthesia. PMID:18760495

Lin, Chao-Shun; Chiu, Jainn-Shiun; Hsieh, Ming-Hui; Mok, Martin S; Li, Yu-Chuan; Chiu, Hung-Wen



Norepinephrine Precursor Therapy in Neurogenic Orthostatic Hypotension  

Microsoft Academic Search

Background—In patients with neurogenic orthostatic hypotension (NOH), the availability of the sympathetic neurotransmitter norepinephrine (NE) in the synaptic cleft is insufficient to maintain blood pressure while in the standing posture. Methods and Results—We determined the effect of oral administration of the synthetic amino acid L-threo-3,4- dihydroxyphenylserine (L-DOPS), which is decarboxylated to NE by the enzyme L-aromatic amino acid decarboxylase (L-AADC)

Horacio Kaufmann; Daniela Saadia; Andrei Voustianiouk; David S. Goldstein; Courtney Holmes; Melvin D. Yahr; Rachel Nardin; Roy Freeman



Spontaneous intracranial hypotension causing reversible frontotemporal dementia.  


Spontaneous intracranial hypotension (SIH) causes postural headache and neurologic symptoms owing to traction and brain compression. A 66-year-old man with chronic headache and progressive personality and behavioral changes typical of frontotemporal dementia was examined. He had MRI findings of SIH with low CSF pressure. His headache, dementia, and imaging abnormalities abated after treatment with prednisone. SIH can cause reversible frontotemporal dementia, and should be considered when dementia and behavioral changes are accompanied by headache. PMID:11971102

Hong, M; Shah, G V; Adams, K M; Turner, R S; Foster, N L



Headache attributed to spontaneous intracranial hypotension  

Microsoft Academic Search

Recent evidence suggests that spontaneous intracranial hypotension (SIH) is not as rare as previously thought. Orthostatic\\u000a headache is the prototypical manifestation of SIH, but various headache syndromes have also been reported such as migraine-like\\u000a headache, tension-type headache and non-specific headaches among the others. The International Headache Society (IHS) has\\u000a recently proposed diagnostic criteria for headache attributed to SIH. Seventy patients

Eliana Mea; Luisa Chiapparini; Mario Savoiardo; Angelo Franzini; Gennaro Bussone; Massimo Leone



[Hypotension after turning to the prone position].  


Hypotension after positioning is sometimes seen especially in patients with cervical spinal lesion operated on under prone position. Patients with spinal lesion and those with brain lesion are compared in the frequency of hypotension after positioning to prone. Sixty-one cases operated on with prone position were studied. Ages ranged from 40 to 82 (mean 61) years and ASA grade was 1 or 2 in each case. Cervical laminoplasty (group C) or craniotomy (group B) are performed in 40 and 21 patients, respectively. Ephedrine was administrated when the systolic blood pressure decreased under 80 mmHg and the frequency of ephedrine use was compared. There were no differences in age and sex distribution between group C and B. The induction doses of propofol and fentanyl in group B were larger than those of group C, but ephedrine use in group C was more frequent than in group B. In T2-weighted image of the cervical cord, high signal intensity areas were depicted in cases with hypotension. The sympathetic flow descends in the medial part in the lateral funiculus. Damage of this pathway would cause autonomic dysfunction in patients with cervical spinal lesion and strict monitoring is necessary during positioning to prone. PMID:12632620

Sato, Kiyotaka; Kato, Masato



Hypotensive effects of the Crotalus durissus cascavella venom: involvement of NO.  


Crotalus durissus cascavella is a snake native of northeastern Brazil. The aim of the study was to investigate the effects of C. d. cascavella venom on rat mean arterial pressure and vascular reactivity in the mesenteric vascular bed. The venom evoked a dose-dependent decrease in mean arterial pressure, cardiac and respiratory frequency with increased plasma nitrite levels. L-NAME (10 mg/kg) blunted both the hypotension and increased nitrite production observed after the venom administration. To investigate the effects of C. d. cascavella in resistance vessels, the vascular mesenteric bed was studied, and the results suggested that the hypotensive effect of the venom is not dependent on a direct vasodilatory activity. In conclusion, C. d. cascavella venom presented indirect hypotensive effects with the involvement of nitric oxide. PMID:21815429

Evangelista, Janaina S A M; Evangelista, João J F; Evangelista, Inez L; Nojosa, Diva M B; Nascimento, Nilberto R F; Souza, Marcellus H L P; Alves, Renata S; Martins, Alice M C; Moraes, Maria Elisabete A; Monteiro, Helena S A



Nutritional Status of Older Persons Presenting in a Primary Care Clinic in Nigeria  

Microsoft Academic Search

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



MYCOTIC ANEURYSM OF THE TIBIOPERONEAL TRUNK An extremely rare localization with pseudophlebitis clinical presentation  

Microsoft Academic Search

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



Diagnoses and Presenting Symptoms in an Infant Psychiatry Clinic: Comparison of Two Diagnostic Systems.  

ERIC Educational Resources Information Center

|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.



Gastric lipomas--an update of clinical presentation, diagnosis, and treatment.  


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



Severe Rift Valley Fever May Present with a Characteristic Clinical Syndrome  

PubMed Central

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 abuse and dentistry: a review of the literature and presentation of a clinical case.  


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 in a patient with diabetic nephropathy. An unusual clinical presentation].  


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


Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence  

Microsoft Academic Search

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



Osteosarcoma of the Maxilla: A Rare Case with Unusual Clinical Presentation  

PubMed Central

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



Different Clinical Presentation of Appendicolithiasis. The Report of Three Cases and Review of the Literature  

PubMed Central

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



[Peculiarities of formation, clinical presentations and therapy of diffuse nontoxic goiter of children].  


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


[Orthostatic hypotension: 2nd part. Epidemiology, complications and treatments].  


Orthostatic hypotension (OH) is a rather common phenomenon in clinical practice. It may occur in 5-10 % of normal individuals, but its prevalence increases with age and various pathologies, so that it may rise above 35 % in certain subgroups of patients. OH is associated with various comorbidities, in particular cardio-cerebro-vascular accidents and falls (especially in the elderly), and may even increase mortality. It is, however, difficult to determine whether OH is simply a marker of frailty or whether it is really a risk factor. OH treatment involves physical manoeuvres or medications, which aim at inducing a peripheral vasoconstriction (midodrine, etilefrine) or an increase of circulating blood volume (9-alpha-fluohydrocortisone). However, their use should be cautious, because of a risk of arterial hypertension in supine position. PMID:23755705

Tyberghein, M; Philips, J-C; Krzesinski, J-M; Scheen, A J



Prevalence and Risk Factors for Intraoperative Hypotension during Craniotomy for Traumatic Brain Injury  

PubMed Central

Background Hypotension after traumatic brain injury (TBI) is associated with poor outcomes. However, data on intraoperative hypotension (IH) are scarce and the effect of anesthetic agents on IH is unknown. We examined the prevalence and risk factors for IH, including the effect of anesthetic agents during emergent craniotomy for isolated TBI. Methods A retrospective cohort study of patients ? 18 years who underwent emergent craniotomy for TBI at Harborview Medical Center (level-1 trauma center) between October 2007 and January 2010. Demographic, clinical and radiographic characteristics, hemodynamic and anesthetic data were abstracted from medical and electronic anesthesia records. Hypotension was defined as systolic blood pressure (SBP) < 90 mmHg. Univariate analyses were performed to compare the clinical characteristics of patients with and without IH and multiple logistic regression analysis was used to determine independent risk factors for IH. Results Data abstracted from 113 eligible patients aged 48±19 years was analyzed. Intraoperative hypotension was common (n=73, 65%) but not affected by the choice of anesthetic agent. Independent risk factors for IH were multiple Computed Tomographic (CT) lesions (AOR 19.1 [95% CI: 2.08–175.99]; p=0.009), SDH (AOR 17.9 [95% CI: 2.97–108.10]; p=0.002), maximum CT lesion thickness (AOR 1.1 [95% CI: 1.01–1.13]; p=0.016), and anesthesia duration (AOR 1.1 [95% CI: 1.01–1.30]; p=0.009). Conclusion Intraoperative hypotension was common in adult patients with isolated TBI undergoing emergent craniotomy. The presence of multiple CT lesions, subdural hematoma, maximum thickness of CT lesion and longer duration of anesthesia increase the risk for IH.

Sharma, Deepak; Brown, Michelle J; Curry, Parichat; Noda, Sakura; Chesnut, Randall M.; Vavilala, Monica S.



Diagnosis and treatment of supine hypertension in autonomic failure patients with orthostatic hypotension.  


Orthostatic hypotension is seen in various medical conditions. It can be secondary to medications or volume depletion. It can also be due to autonomic neuropathy secondary to other diseases, such as diabetes mellitus, or to primary degenerative processes of the autonomic nervous system. Orthostatic hypotension dominates the clinical picture of patients suffering from autonomic failure. Paradoxically, about one half of these patients also suffer from supine hypertension, which induces pressure natriuresis, worsening orthostatic hypotension. It also complicates the treatment of orthostatic hypotension. Supine hypertension is mediated by an increase in peripheral vascular resistance. This is due to residual sympathetic tone in patients with multiple system atrophy (Shy-Drager syndrome), but the cause is not known in patients with pure autonomic failure, who have increased vascular resistance despite very low levels or plasma norepinephrine and renin activity. The recent observation that patients with supine hypertension develop left ventricular hypertrophy suggests they should be treated. During the day, avoiding the supine position is often all that is required. Short-acting vasodilators (e.g., transdermal nitroglycerin) can be used during the night. PMID:11927799

Jordan, Jens; Biaggioni, Italo


Early predictors of the need for emergent surgery to control hemorrhage in hypotensive trauma patients.  


Twenty-five to 30 per cent of hypotensive trauma patients require an emergent surgery, however, we have no reliable means to quickly determine that need. Our goal was to determine, via retrospective review, parameters available within minutes of arrival that predict the need for emergent surgery to control hemorrhage in hypotensive trauma patients. Inclusion criterion was initial systolic blood pressure (SBP) < 90 mm Hg in the emergency department (ED). Patients who were dead on arrival or underwent ED thoracotomy were excluded. Emergent surgery was defined as sternotomy, thoracotomy, laparotomy, or major neck vascular repair on day of admission. Potential clinical predictors were analyzed in a binary logistic regression model. Six hundred and thirty-nine hypotensive patients were identified and 193 excluded, leaving 446 with a mean age of 33 +/- 19 years and Injury Severity Score of 22 +/- 17. Thirty-two per cent suffered penetrating trauma, 30 per cent needed emergent surgery, and 19 per cent died. Independent predictors were: prolonged extrication (odds ratio (OR) 2.3), no loss of consciousness (OR 2.8), intubation (OR 1.7), central line placement (OR 1.7), and blood transfusion (OR 2.1, all P < 0.05). We concluded that hypotensive trauma patients without head injuries who require prolonged extrication, intubation, central venous access, and blood transfusion in the ED are more likely to need emergent surgery. PMID:19886150

Kaiser, Meghann; Ahearn, Patrick; Nguyen, Xuan-Mai; Barleben, Andrew; Cinat, Marianne; Barrios, Cristobal; Hoyt, David; Malinoski, Darren



The venous system is the main determinant of hypotension in patients with vasovagal syncope  

Microsoft Academic Search

Aims In patients with vasovagal syncope (VVS), a neural reflex appears the main determinant of hypo- tension leading to loss of consciousness; whether hypotension is mainly due to involvement of the arter- ial system or the venous system remains a debated issue. The aim of the present study was to assess which of these two systems is responsible for the

Maurizio Dinelli; Paolo Suzzani; Salvatore Scarfo; Fabio Tassinari; Paolo Alboni


Spontaneous intracranial hypotension: morphological findings and CSF flow dynamics studied by MRI  

Microsoft Academic Search

We report on a case of spontaneous intracranial hypotension (SIH) presenting with classic MR findings, such as diffuse smooth thickening and intense contrast enhancement of the dura matter, increased size of the pituitary gland and downward displacement of the brain. In this case an engorgement of the cavernous sinuses is reported as an additional imaging finding of SIH. Moreover, phase-contrast

Zafiria Metafratzi; Maria I. Argyropoulou; Christina Mokou-Kanta; Spiros Konitsiotis; Anastasia Zikou; Stavros C. Efremidis



Role of Thromboxane A2 in the Hypotensive Effect of Captopril in Essential Hypertension  

Microsoft Academic Search

SUMMARY We have previously reported that captopril stimulates thromboxane A2 synthesis in patients with essential hypertension. In the present study, the hypotensive effects of captopril and OKY-046, a selective inhibitor of thromboxane A2 synthetase, were studied in nine patients with essential hypertension to determine whether thromboxane A3 is involved in the regulation of blood pressure. A single oral dose of



Prophylactic ephedrine and hypotension associated with spinal anesthesia for cesarean delivery  

Microsoft Academic Search

Hypotension commonly accompanies induction of spinal anesthesia for cesarean section. To determine whether intravenous ephedrine prophylaxis would benefit prehydrated obstetrical patients presenting for elective cesarean section, we studied 30 patients randomly assigned to one of three experimental groups. All patients were preloaded with crystalloid (15 ml\\/kg), given spinal anesthesia and positioned with left uterine displacement (LUD). During induction, all patients

S. W. King; M. A. Rosen



21 CFR 50.54 - Clinical investigations not otherwise approvable that present an opportunity to understand...  

Code of Federal Regulations, 2010 CFR

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 heterogeneity in Sanfilippo disease (mucopolysaccharidosis III) type D: presentation of two new cases  

Microsoft Academic Search

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



Aetiology and clinical presentations of auditory processing disorders—a review  

Microsoft Academic Search

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



Lymphomatosis cerebri Presenting as a Rapidly Progressive Dementia: Clinical, Neuroimaging and Pathologic Findings  

Microsoft Academic Search

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



Hotline update of clinical trials and registries presented at the German Cardiac Society Meeting 2009  

Microsoft Academic Search

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



Proinflammatory Activation of Neutrophils and Monocytes by Helicobacter pylori in Patients with Different Clinical Presentations  

Microsoft Academic Search

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




Small cell lung cancer doubling time and its effect on clinical presentation: a concise review.  


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 Doubling Time and its Effect on Clinical Presentation: A Concise Review  

PubMed Central

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



Clinical geneticists in birth defects surveillance and epidemiology research programs: past, present and future roles.  


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



An Oncology Mind-Body Medicine Day Care Clinic: Concept and Case Presentation.  


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



Orthostatic Hypotension, Hypotension and Cognitive Status: Early Comorbid Markers of Primary Dementia?  

Microsoft Academic Search

Objective: Few studies have explored the relationship between orthostatic hypotension (OH) and cognition. The aim of this study was to examine the association of OH with cognitive impairment and decline in a cohort of Chinese elderly, and its effect modification by blood pressure (BP) status at baseline. Method: Among 2,321 community-living older adults, free of cardiovascular disease and stroke, baseline

Philip Lin Kiat Yap; Mathew Niti; Keng Bee Yap; Tze Pin Ng



Diagnosis and management of hypotension in neonates.  


The diagnosis and management of hypotension in neonates is a frequently encountered issue in the intensive care setting. There is an ongoing debate as to the appropriateness of blood pressure monitoring as an indicator of organ perfusion and tissue hypoxia. These ultimately determine morbidity and mortality in the sick newborn. This article explores the methods available for the assessment of organ perfusion and speculates on other means that may become available in the future. Different modalities of treatment currently in use are discussed, with the aim of using information gained from perfusion monitoring techniques to determine the optimal choice of therapy. PMID:24020669

Farrugia, Ryan; Rojas, Hector; Rabe, Heike



Epidemiology and clinical presentation of the four human parainfluenza virus types  

PubMed Central

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.



[Present-day positions of the clinical-and-social ophthalmology].  


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


Arginine vasopressin as a rescue vasopressor to treat epidural anaesthesia-induced arterial hypotension.  


Epidural anaesthesia is a well-established and recognized technique in anaesthetic practice. Its benefits are multiple and range from positive effects on the respiratory and cardiocirculatory system, a reduced need for analgesics and decreased costs to earlier hospital discharge. Disadvantages like sympathetic blockade followed by hypotension, bradycardia, and cardiac arrest, however, must be taken into consideration. Treatment of these side effects consists of fluid infusion and vasopressor drugs. During epidural anaesthesia, plasma arginine vasopressin (AVP) concentrations are increased. In case reports and a small clinical study, administration of AVP or one of its analogues could rapidly reverse hypotension and restore cardiovascular stability. Because no major controlled clinical trial has yet evaluated the effects of AVP on morbidity, AVP can so far not be recommended as a first-line drug to treat cardiovascular instability during epidural anaesthesia. In refractory cases, however, the use of AVP as a rescue vasopressor may be beneficial. PMID:18683483

Jochberger, Stefan; Dünser, Martin W



The risk of hypotension following co-prescription of macrolide antibiotics and calcium-channel blockers  

PubMed Central

Background The macrolide antibiotics clarithromycin and erythromycin may potentiate calcium-channel blockers by inhibiting cytochrome P450 isoenzyme 3A4. However, this potential drug interaction is widely underappreciated and its clinical consequences have not been well characterized. We explored the risk of hypotension or shock requiring hospital admission following the simultaneous use of calcium-channel blockers and macrolide antibiotics. Methods We conducted a population-based, nested, case-crossover study involving people aged 66 years and older who had been prescribed a calcium-channel blocker between Apr. 1, 1994, and Mar. 31, 2009. Of these patients, we included those who had been admitted to hospital for the treatment of hypotension or shock. For each antibiotic, we estimated the risk of hypotension or shock associated with the use of a calcium blocker using a pair-matched analytic approach to contrast each patient’s exposure to each macrolide antibiotic (erythromycin, clarithromycin or azithromycin) in a seven-day risk interval immediately before admission to hospital and in a seven-day control interval one month earlier. Results Of the 7100 patients admitted to hospital because of hypotension while receiving a calcium-channel blocker, 176 had been prescribed a macrolide antibiotic during either the risk or control intervals. Erythromycin (the strongest inhibitor of cytochrome P450 3A4) was most strongly associated with hypotension (odds ratio [OR] 5.8, 95% confidence interval [CI] 2.3–15.0), followed by clarithromycin (OR 3.7, 95% CI 2.3–6.1). Azithromycin, which does not inhibit cytochrome P450 3A4, was not associated with an increased risk of hypotension (OR 1.5, 95% CI 0.8–2.8). We found similar results in a stratified analysis of patients who received only dihydropyridine calcium-channel blockers. Interpretation In older patients receiving a calcium-channel blocker, use of erythromycin or clarithromycin was associated with an increased risk of hypotension or shock requiring admission to hospital. Preferential use of azithromycin should be considered when a macrolide antibiotic is required for patients already receiving a calcium-channel blocker.

Wright, Alissa J.; Gomes, Tara; Mamdani, Muhammad M.; Horn, John R.; Juurlink, David N.



Risk factors for vascular dementia: Hypotension as a key point  

PubMed Central

Physiologically, the cerebral autoregulation system allows maintenance of constant cerebral blood flow over a wide range of blood pressure. In old people, there is a progressive reshape of cerebral autoregulation from a sigmoid curve to a straight line. This implies that any abrupt change in blood pressure will result in a rapid and significant change in cerebral blood flow. Hypertension has often been observed to be a risk factor for vascular dementia (VaD) and sometimes for Alzheimer disease although not always. Indeed, high blood pressure may accelerate cerebral white matter lesions, but white matter lesions have been found to be facilitated by excessive fall in blood pressure, including orthostatic dysregulation and postprandial hypotension. Many recent studies observed among other data, that there was a correlation between systolic pressure reduction and cognitive decline in women, which was not accounted for by other factors. Baseline blood pressure level was not significantly related to cognitive decline with initial good cognition. Some researchers speculate that blood pressure reduction might be an early change of the dementing process. The most confounding factor is that low pressure by itself might be a predictor of death; nevertheless, the effect of low blood pressure on cognition is underestimated because of a survival bias. Another explanation is that clinically unrecognized vascular lesions in the brain or atherosclerosis are responsible for both cognitive decline and blood pressure reduction. We discuss the entire process, and try to define a possible mechanism that is able to explain the dynamic by which hypotension might be related to dementia.

Moretti, Rita; Torre, Paola; Antonello, Rodolfo M; Manganaro, Davide; Vilotti, Cristina; Pizzolato, Gilberto



Chinese patients with spinocerebellar ataxia type 3 presenting with rare clinical symptoms.  


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



Intradialytic hypotension: Is midodrine beneficial in symptomatic hemodialysis patients?  

Microsoft Academic Search

Symptomatic hypotension during hemodialysis is a disabling complication in end-stage renal disease (ESRD) patients, especially in certain groups of patients who are at higher risk for this problem. Autonomic dysfunction is thought to play a significant role. We evaluated the efficacy of midodrine, an oral agent with selective ?-adrenergic agonist activity used in the treatment of neurogenic orthostatic hypotension, or

Dinna N. Cruz; Rex L. Mahnensmith; Mark A. Perazella



Epidemic hypotension in a dialysis center caused by sodium azide  

Microsoft Academic Search

Epidemic hypotension in a dialysis center caused by sodium azide. The water used for dialysate (dialysis fluid) in hemodialysis centers is produced by water treatment systems (WTS), which require careful and frequent monitoring. On November 3, 1988, nine patients receiving hemodialysis treatments at a single dialysis center suddenly developed hypotension within 30 minutes of onset of dialysis. Eight patients exhibited

Steven M Gordon; Jonathan Drachman; Lee A Bland; Marie H Reid; Martin Favero; William R Jarvis



Hypertrophic cardiomyopathy in the Sphynx cat: a retrospective evaluation of clinical presentation and heritable etiology.  


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



Spontaneous intracranial hypotension due to intradural thoracic osteophyte with superimposed disc herniation: report of two cases  

Microsoft Academic Search

Spontaneous intracranial hypotension (SIH) is a clinical syndrome in which absolute or relative hypovolemia of the cerebrospinal\\u000a fluid (CSF) results in various neurological symptoms. The etiology of spontaneous CSF leaks often remains unknown. However,\\u000a it is believed that the most common cause is the fragility of spinal meninges at the level of radicular nerve root sleeve.\\u000a These tears can be

Zehra Isik Hasiloglu; Bashar Abuzayed; Ahmet Esat Imal; Emin Cagil; Sait Albayram


Agenesis of kidney associated with malformations of the seminal vesicle. Various clinical presentations  

Microsoft Academic Search

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



Incidence and clinical correlates of aggression and violence at presentation in patients with first episode psychosis  

Microsoft Academic Search

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



When a man encounters a woman, Satan is also present: clinical relationships in Bedouin society.  


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 (Rosai-Dorfman disease) presenting with solitary cutaneous nodule: a very rare clinical entity  

PubMed Central

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



Pulmonary embolism in the elderly: a review on clinical, instrumental and laboratory presentation  

PubMed Central

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



Gastric Antral Vascular Ectasia (GAVE): An Update on Clinical Presentation, Pathophysiology and Treatment  

Microsoft Academic Search

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



Endomysial antibodies predict celiac disease irrespective of the titers or clinical presentation  

PubMed Central

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



Cancer-related secondary lymphoedema due to cutaneous lymphangitis carcinomatosa: clinical presentations and review of literature.  


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



Upper extremity deep vein thrombosis presenting to a chiropractic clinic: a description of 2 cases  

PubMed Central

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.



Severe dental caries as the first presenting clinical feature in primary Sjögren's syndrome.  


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



Spontaneous CSF Collection in the Cervical Spine may Cause Neurological Deficit and Intra-cranial Hypotension  

PubMed Central

Objective: a case is described of a spontaneously occurring cerebrospinal fluid collection in the ventral cervical spine which caused radiculopathy and spontaneous intracranial hypotension. Case: a sixty eight year old Caucasian man presented with a 2 year history of proximal upper limb weakness with a his-tory of trivial cervical trauma many years previously. Methods: the patient was investigated with blood tests for causes of peripheral neuropathy, nerve conduction and electro-myography studies, lumbar puncture and MRI of the brain and spine with contrast. Results: a cerebrospinal fluid collection was identified in the ventral cervical spinal cord causing mass effect associated with cord atrophy and there were signs of spontaneous intracranial hypotension on the MRI brain including subdural cere-brospinal fluid collections, meningeal enhancement and slumped posterior fossa. Conclusions: this is the first description of a spontaneous spinal fluid collection causing direct compression and cord sig-nal change, manifest as a motor deficit, with intracranial signs of spontaneous hypotension. Spinal imaging is recom-mended in cases of spontaneous intracranial hypotension and cerebrospinal fluid collections in the spine may rarely be a cause of radiculopathy in such cases.

Zakaria, Rasheed; Wilby, Martin; Fletcher, Nicholas A



Effects of propranolol in a case of orthostatic hypotension.  

PubMed Central

In a hypertensive patient with orthostatic hypotension, the changes in several haemodynamic indices with respect to posture were evaluated. In the upright position, systemic blood pressure was reduced as compared with the supine position, and peripheral vasodilation was present, as shown by an increase in Jantsch's index of the impedance plethysmographic tracings. Systolic time intervals remained unchanged with changes in posture. Propranolol 10 mg intravenously brought the response to normal. In fact, after beta-blockade in the standing position the blood pressure remained unchanged and normal peripheral vasoconstriction was observed. Similar results were seen during atrial pacing at a constant heart rate of 130 beats/minute. In this patient, propranolol appears to normalise the response to the posture change, by restoring normal vasoconstriction in the upright position.

Brevetti, G; Chiariello, M; Lavecchia, G; Rengo, F



Long-lasting hypotensive effect in renal hypertensive rats induced by nitric oxide released from a ruthenium complex.  


In this study, we investigated the effect of the ruthenium complex [Ru(terpy)(bdq)NO] (TERPY) on the arterial pressure from renal hypertensive 2 kidney-1 clip (2K-1C) rats, which was compared with sodium nitroprusside (SNP). The most interesting finding was that the intravenous bolus injection of TERPY (2.5, 5.0, 7 mg/kg) had a dose-dependent hypotensive effect only in 2K-1C rats. On the other hand, SNP (35 and 70 ?g/kg) presented a similar hypotensive effect in both normotensive (2K) and 2K-1C although the effect of 70 ?g/kg was >35 ?g/kg. The injection of the nonselective NO-synthase inhibitor N-nitro-L-arginine methyl ester (L-NAME) increased the arterial pressure in 2K and 2K-1C rats with a similar magnitude. After infusion of L-NAME, the hypotensive effect induced by TERPY and SNP was potentiated in both 2K and in 2K-1C rats. The administration of the superoxide scavenger 4-hydroxy-2,2,6,6-tetramethylpiperidine-N-oxyl increased the hypotensive effect induced by TERPY or SNP in both 2K and 2K-1C rats. The hypotensive effect induced by TERPY was longer than that produced by SNP. Taken together, our results show that the TERPY has a long-lasting hypotensive effect, which has a dose dependence and higher magnitude in 2K-1C compared with in 2K rats. In comparison with SNP, TERPY is less potent in inducing arterial pressure fall, but it presents a much longer hypotensive effect. PMID:22635073

Rodrigues, Gerson J; Pereira, Amanda C; Vercesi, Juliana A; Lima, Renata G; Silva, Roberto S; Bendhack, Lusiane M



Bisphosphonate-related osteonecrosis of the jaw: clinical correlations with computerized tomography presentation.  


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



Clinical and hematological presentation of children and adolescents with polycythemia vera.  


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



Epidemiological findings and clinical and magnetic resonance presentations in subacute sclerosing panencephalitis.  


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



Clinical presentation, haematological indices and management of children with severe and uncomplicated malaria in Douala, Cameroon.  


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



Idiopathic Retroperitoneal Fibrosis: A Retrospective Review of Clinical Presentation, Treatment, and Outcomes  

PubMed Central

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.



Urinary dysfunction and orthostatic hypotension in multiple system atrophy: which is the more common and earlier manifestation?  

Microsoft Academic Search

OBJECTIVESUrinary dysfunction and orthostatic hypotension are the prominent autonomic features in multiple system atrophy (MSA). A detailed questionnaire was given and autonomic function tests were performed in 121 patients with MSA concerning both urinary and cardiovascular systems.METHODSReplies to the questionnaire on autonomic symptoms were obtained from 121 patients including three clinical variants; olivopontocerebellar atrophy (OPCA) type in 48, striatonigral degeneration

Ryuji Sakakibara; Takamichi Hattori; Tomoyuki Uchiyama; Kohei Kita; Masato Asahina; Atsuya Suzuki; Tomonori Yamanishi



Spontaneous dural tear leading to intracranial hypotension and tonsillar herniation in Marfan syndrome: a case report  

PubMed Central

Background We describe the case of a 38 year old male with Marfan syndrome who presented with orthostatic headaches and seizures. Case Presentation The patient was diagnosed with Spontaneous Intracranial Hypotension secondary to CSF leaks, objectively demonstrated by MR Myelogram with intrathecal contrast. Epidural autologus blood patch was administered at the leakage site leading to significant improvement. Conclusion Our literature search shows that this is the second reported case of a Marfan patient presenting with symptomatic spontaneous CSF leaks along with tonsillar herniation.



Management of neurogenic orthostatic hypotension: an update.  


Orthostatic hypotension (OH) is common in elderly people and in patients with disorders such as diabetes and Parkinson's disease. Grading of the severity of OH and its effect on the patient's quality of life are important. The symptoms vary with orthostatic stress, and subtle symptoms such as tiredness and cognitive impairment should be recognised. Standard drug treatment for OH is effective but worsens supine hypertension, whereas pyridostigmine can improve OH slightly but significantly without worsening of supine hypertension. Because orthostatic stress varies from moment to moment and drug treatment is suboptimal, drug treatment of OH needs to be combined with non-pharmacological approaches, such as compression of venous capacitance beds, use of physical counter-manoeuvres, and intermittent water-bolus treatment. PMID:18420158

Low, Phillip A; Singer, Wolfgang



Evaluation and treatment of orthostatic hypotension.  


This paper provides recommendations on the treatment of orthostatic hypotension (OH) as reviewed by the American Society of Hypertension. It focuses on recent reports on the evaluation and management of OH and provides practical advice for clinicians on how to screen, diagnose, and treat patients using behavioral, nonpharmacologic, and pharmacologic strategies. The authors also provide a stepwise approach on how to apply new findings to successfully control OH and reduce the risk of syncope and falls in these patients. Treatment of OH is also discussed in special situations such as in hypertensive and hospitalized patients. It should be noted, however, that research in this area is mostly limited to studies in small numbers of patients. Unfortunately, the trials of the type needed to develop evidence-based guidelines are not available for this condition. PMID:23721882

Shibao, Cyndya; Lipsitz, Lewis A; Biaggioni, Italo



Gender Differences in Clinical Presentation and Outcomes of Epidemic Kaposi Sarcoma in Uganda  

PubMed Central

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



Problems for clinical judgement: 1. Eliciting an insightful history of present illness  

PubMed Central

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.



Fetal and neonatal cardiac rhabdomyomas: clinical presentation, outcome and association with tuberous sclerosis complex.  


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


Hypoglycaemic and hypotensive effects of Globimetula cupulata (DC) Van Tieghem (Loranthaceae) aqueous leaf extract in rats.  


The leaves of some mistletoes, specifically Loranthus micranthus Linn, Tapinanthus dodoneifolius (DC) Danser and Globimetula cupulata (DC) Van Tieghem (family: Loranthaceae), are used traditionally in Nigerian folk medicine to manage, control and/or treat a plethora of human ailments, including diabetes mellitus and hypertension. In order to scientifically appraise some of the folkloric, ethnomedical uses of Globimetula species, the present study was undertaken to investigate the hypoglycaemic and hypotensive effects of Globimetula cupulata aqueous leaf extract (GCE, 50-800 mg/kg po) in rat experimental paradigms. The hypoglycaemic effect of the plant extract was examined in normal (normoglycaemic) and diabetic (hyperglycaemic) rats using a streptozotocin (STZ)-induced diabetes model. Normotensive Wistar and hypertensive Dahl salt-sensitive rats were used to investigate the hypotensive (antihypertensive) effect of the plant extract. Metformin (MFM, 500 mg/kg po) was used as the reference hypoglycaemic agent for comparison. Acute oral administrations of G cupulata aqueous leaf extract (GCE, 50-800 mg/kg po) caused dose-related, significant (p < 0.05-0.001) hypoglycaemia in normal and STZ-treated diabetic rats. Furthermore, acute intravenous administrations of GCE (50-800 mg/kg iv) produced dose-dependent, significant reductions (p < 0.05-0.001) in systemic arterial blood pressure and heart rates of the normotensive and hypertensive rats used. Although the exact hypoglycaemic and hypotensive mechanisms of action of the plant extract still remain speculative, it is unlikely that the extract induced hypotension in the mammalian experimental animal model via cholinergic mechanisms, since its cardiovascular effects were resistant to atropine pretreatment. However, the findings of this experimental study indicated that Globimetula cupulata aqueous leaf extract possesses hypoglycaemic and hypotensive properties. This therefore lends pharmacological support to the folkloric, ethnomedical uses of the plant in the management and/ or control of diabetes mellitus and hypertension among the Yoruba-speaking people of western Nigeria. PMID:17392989

Ojewole, J A O; Adewole, S O


Endothelin 1 levels in relation to clinical presentation and outcome of Henoch Schonlein purpura  

PubMed Central

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



Poland’s Syndrome: Different Clinical Presentations and Surgical Reconstructions in 18 Cases  

Microsoft Academic Search

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



A changing picture of shigellosis in southern Vietnam: shifting species dominance, antimicrobial susceptibility and clinical presentation  

PubMed Central

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



Acute controlled hypotension and EEG in patients with hypertension and cerebrovascular disease  

PubMed Central

Forty-seven patients with hypertension and/or cerebrovascular disease were examined by an acute controlled hypotension test. This was performed by intravenous administration of the ganglionic blocking agent pentholonium and head-up tilting on a pivoted table with observation of the clinical neurological state and simultaneous EEG recording. Blood pressure was reduced by approximately 55% and brought to the point where signs of general cerebral ischaemia developed. By tilting back to horizontal the blood pressure returned to near the normal level. No change in focal neurological symptoms or changes in the EEG were observed, and it is concluded that the majority of hypertensive patients with or without previous stroke do tolerate normalization of their blood pressure. Controlled hypotension with tilting seems a simple and valuable test for excluding those few subjects who might not tolerate a blood pressure reduction. Whether EEG monitoring during the test increases the value of the test has not been answered.

Harmsen, P.; Kjaerulff, J.; Skinh?j, E.



Neurogenic orthostatic hypotension of Parkinson's disease: what exploration for what treatment?  


The aim of this short review is to illustrate, using orthostatic hypotension as an example, the clinical problems related to autonomic features in Parkinson's disease. Orthostatic hypotension is frequently encountered in Parkinson's disease and its diagnosis remains manometric (a fall of at least 20 and/or 10 mmHg in standing blood pressure). It is often associated with supine hypertension to be taken into account before prescribing. To distinguish between the role of disease and of drugs (not only antiparkinsonian drugs), a simple clinical test of autonomic nervous system activity (deep breathing test and standing test with measurement of 30/15 ratio) can be used. When diagnosis with multisystem atrophy is discussed, cardiac [¹²³I]-metaiodobenzylguanidine (MIBG) scintigraphy is of value showing in Parkinson's disease a decreased uptake of the radiopharmaceutical indicating postganglionic sympathetic denervation. Concerning treatment, nonpharmacological methods have to be systematically used since no drug has been specifically evaluated for the treatment of orthostatic hypotension of Parkinson's disease. PMID:20817229

Senard, J-M; Pathak, A



[Magnetic resonance in dural post-puncture headache in patient with cerebrospinal fluid hypotension].  


Magnetic resonance imaging (MRI) has allowed us to establish a set of radiologic signs associated with intracranial hypotension syndrome. Findings are partly influenced by cerebral displacement. Intracranial hypotension syndrome is characterized by a decrease in cerebrospinal fluid (CSF) pressure to less than 60 mm H2O associated with occipital headache radiating to the frontal and temporal zones. For diagnostic purposes, the most common cause is anesthetic or therapeutic dural puncture, although spontaneous CSF leakage can occur. CSF protein and lymphocyte counts may be high, while the cranial meninges biopsy is normal. MRI images may show a descended brain, taking the start of the sylvian aqueduct and the location of the cerebellar amygdalae as points of reference; diminished size of the subarachnoidal cisterns and occasionally of the cerebral ventricles; meningeal enhancement from increased uptake of the contrast solution; subdural hygromas and hematomas; and pituitary enlargement. Paraspinal fluid and dilated epidural veins may be observed. Radiologic images and clinical signs are related. When CSF pressure is very low, there is greater meningeal enhancement, subdural collection and cerebral displacement. Findings gradually disappear as symptoms diminish. The signs and symptoms that might develop during intracranial hypotension syndrome vary according to the brain structure that might be affected during descent, repositioning and the traction of anchoring structures. MRI allows the degree of cerebral and spinal involvement to be ascertained, to predict whether resolution of the clinical picture will be early or late and to visualize the effect of approaches to reducing CSF leakage. PMID:12025253

Reina, M A; Alvarez-Linera, J; López, A; Benito-León, J; De Andrés, J A; Sola, R G



Clinical Presentation and Outcome of Epidemic Kaposi Sarcoma in Ugandan Children  

PubMed Central

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



Frequency, Clinical Presentation, and Outcomes of Drug-Induced Liver Injury after Liver Transplantation  

PubMed Central

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.



Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease  

PubMed Central

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: 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



Severe malaria in Burkina Faso: influence of age and transmission level on clinical presentation.  


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



Recurrent serous macular detachment after topical ocular hypotensive medication.  


We document the recurrence of a CSMD in a patient subsequent to the instillation of topical ocular hypotensive medications and its resolution on discontinuation of therapy. An independent cause or causes contributing to the development of CSMD other than the use of topical ocular hypotensive medications cannot be ruled out in this case, neither can it be considered dissociated from the use of these drugs. We recommend that patients with VTS, those with a history of CSMD or having developed recurrent episodes of CSMD requiring management with topical ocular hypotensive medications, be cautiously monitored for the possible occurrence or exacerbation of CSMD. PMID:18537988

Besada, Eulogio; Shechtman, Diana; Frauens, Barry J



Cutaneous leishmaniasis with unusual clinical and histological presentation: report of four cases.  


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



Sarcomatoid carcinoma of the hand: a clinical case with an aggressive and uncommon presentation.  


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



Multiple sclerosis presented as clinically isolated syndrome: the need for early diagnosis and treatment  

PubMed Central

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



Clinical spectrum of muscle-eye-brain disease: from the typical presentation to severe autistic features.  


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



Characteristics and clinical presentations of pediatric retinoblastoma in North-western Iran  

PubMed Central

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 in infants: new classification system, imaging technique, clinical presentation and imaging findings.  


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



Suggestions for the presentation of quality of life data from clinical trials.  


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


A familial form of pallidoluysionigral degeneration and amyotrophic lateral sclerosis with divergent clinical presentations.  


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



Unusual clinical presentation of brown tumor in hemodialysis patients: two case reports.  


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



Examining the validity of ADHD as a diagnosis for adolescents with intellectual disabilities: clinical presentation.  


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



Neurosurgical Interventions for Spondyloepiphyseal Dysplasia Congenita: Clinical Presentation and Assessment of the Literature.  


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



Clinical perception: a study of intimate partner violence versus methamphetamine use as presenting problems.  


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



Presentations from the SNM NCI Workshop: Use of PET CT in the Clinic and Clinical Trials: Quantitation for Change Analysis

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.


[Acinic cell carcinoma of glandule parotidea presenting untypical clinical symptoms and their bad prognosis].  


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


Gram-negative diabetic foot osteomyelitis: risk factors and clinical presentation.  


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



Comparison between shoulder computed tomography and clinical findings in 89 dogs presented for thoracic limb lameness.  


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



The impact of comorbid cannabis use disorders on the clinical presentation of social anxiety disorder.  


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



Clinical presentation of inhalational anthrax following bioterrorism exposure: report of 2 surviving patients.  


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



[Orthostatic hypotension: implications for the treatment of cardiovascular diseases].  


Several cardiovascular drugs may induce or worsen orthostatic hypotension especially in patients treated for hypertension, coronary artery disease and heart failure. Orthostatic hypotension is more frequent in polymedicated elderly patients with co-morbidities (prevalence 23%). In hypertensive elderly patients, the combination of three antihypertensive agents including a beta-blocker induces more frequently orthostatic hypotension. Supplementation in water and especially salt is generally not recommended in case of hypertension and heart failure. Education of patient to preventive counter-pressure maneuvers and muscle training of the lower limbs must be part of treatment. Midodrine causes supine hypertension in almost 25% of patients precluding to take this medication at the end of the afternoon. In severe heart failure, midodrine seems to be helpful to optimize drug treatment in patients suffering from hypotension. PMID:22819184

Mansourati, Jacques



Late onset postpartum eclampsia without pre-eclamptic prodromi: clinical and neuroradiological presentation in two patients  

PubMed Central

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



Aligning new interventions with developing country health systems: Target product profiles, presentation, and clinical trial design  

PubMed Central

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



Clinical presentation and treatment of transfusion-associated babesiosis in premature infants.  


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



Clinical presentation in patients more than 80 years of age at the start of peritoneal dialysis.  


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



Subungual Bowen disease in a patient with epidermodysplasia verruciformis presenting clinically as longitudinal melanonychia.  


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



Prevalence of cagA in relation to clinical presentation of Helicobacter pylori infection in Egypt.  


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



Centrilobular necrosis in autoimmune hepatitis: a histological feature associated with acute clinical presentation  

PubMed Central

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



Clinical presentation, natural history, and outcome of patients with the absent pulmonary valve syndrome.  


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



Hypotensive effect of chemical constituents from Aloe barbadensis.  


Hypotensive effects of aloeemodin, aloin A, elgonica dimer A and bisbenzopyran from Aloe barbadensis have been studied. Aloeemodin has emerged as a potent hypotensive agent in current pharmacological investigations and caused 26 %, 52 %, and 79 % falls in mean arterial blood pressure at the corresponding doses of 0.5, 1, and 3 mg/kg in rats. The paper also describes the absolute configuration of elgonica dimer A (1). PMID:11731923

Saleem, R; Faizi, S; Siddiqui, B S; Ahmed, M; Hussain, S A; Qazi, A; Dar, A; Ahmad, S I; Qazi, M H; Akhtar, S; Hasnain, S N



Randomised trial of dopamine compared with hydrocortisone for the treatment of hypotensive very low birthweight infants  

PubMed Central

AIM—To compare the efficacy of hydrocortisone with dopamine for the treatment of hypotensive, very low birthweight (VLBW) infants.?METHODS—Forty infants were randomly allocated to receive either hydrocortisone (n=21) or dopamine (n=19).?RESULTS—All 19 infants randomised to dopamine responded; 17 of 21 (81%) did so in the hydrocortisone group. Three of the four non-responders in the hydrocortisone group had clinically significant left to right ductal shunting. The incidence of bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular haemorrhage, necrotising enterocolitis, symptomatic patent ductus arteriosus, hyperglycaemia, sepsis (bacterial or fungal) or survival did not differ between groups. The adrenocorticotrophic hormone (ACTH) stimulated plasma cortisol activity, either before or after treatment, did not differ between the two groups of infants. Although a significant difference in efficacy between dopamine and hydrocortisone was not noted (P = 0.108), there were four treatment failures in the hydrocortisone group, compared with none in the dopamine group.?CONCLUSION—Both hydrocortisone and dopamine are effective treatments for hypotension in very low birthweight infants.?? Keywords: hydrocortisone; dopamine; hypotension; very low birthweight; plasma cortisol

Bourchier, D.; Weston, P.



Antipsychotic pharmacotherapy and orthostatic hypotension: identification and management.  


Orthostatic hypotension is a common adverse effect of antipsychotics that may delay or prevent titration to a dose necessary to control psychotic symptoms. Complications of orthostatic hypotension include syncope, transient ischaemic attack, stroke, myocardial infarction and death. The risk of orthostatic hypotension associated with antipsychotic therapy is increased in patients with disorders of the autonomic nervous system, fluid imbalance and those taking concomitant drug therapy that affects haemodynamic tone. Prospective monitoring for changes in postural blood pressure is important because patients with psychotic disorders often do not articulate symptoms of orthostasis and the subjective report of dizziness does not correlate well with orthostatic blood pressure changes. Nonpharmacological strategies and patient education, most notably, slowly rising from the supine position, are crucial first steps in the prevention and treatment of both symptomatic and asymptomatic orthostatic hypotension. Pharmacological treatment is only recommended when symptomatic orthostatic hypotension persists despite proper nonpharmacological therapy and there is a compelling indication for antipsychotic treatment. Fludrocortisone is a reasonable first choice for symptomatic orthostatic hypotension. Other agents including desmopressin and midodrine may be considered in patients who do not respond favourably to a trial of fludrocortisone, but safety concerns and lack of evidence limit the utility of these agents. PMID:21790209

Gugger, James J



Clinical Pharmacokinetic Service and Research--Present Status and Future Goals at SUNY-Buffalo  

ERIC Educational Resources Information Center

|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.



Neural mechanism of electroacupuncture's hypotensive effects  

PubMed Central

EA at P 5–6 and S 36–37 using low current and low frequency may be able to reduce elevated blood pressure in a subset of patients (~70%) with mild to moderate hypertension. The effect is slow in onset but is long-lasting. Experimental studies have shown that EA inhibition of cardiovascular sympathetic neurons that have been activated through visceral reflex stimulation is through activation of neurons in the arcuate nucleus of the hypothalamus, vlPAG in the midbrain and NRP in the medulla, which, in turn, inhibit the activity of premotor sympathetic neurons in the rVLM. The arcuate also provides direct projections to the rVLM that contain endorphins. Glutamate, acetylcholine, opioids, GABA, nociceptin, serotonin and endocannabinoids all appear to participate in the EA hypotensive response although their importance varies between nuclei. Thus, a number of mechanisms underlying the long-lasting effect of EA on cardiovascular function have been identified but clearly further investigation is warranted.

Li, Peng; Longhurst, John C.



Neural mechanism of electroacupuncture's hypotensive effects.  


EA at P 5-6 and S 36-37 using low current and low frequency may be able to reduce elevated blood pressure in a subset of patients (?70%) with mild to moderate hypertension. The effect is slow in onset but is long-lasting. Experimental studies have shown that EA inhibition of cardiovascular sympathetic neurons that have been activated through visceral reflex stimulation is through activation of neurons in the arcuate nucleus of the hypothalamus, vlPAG in the midbrain and NRP in the medulla, which, in turn, inhibit the activity of premotor sympathetic neurons in the rVLM. The arcuate also provides direct projections to the rVLM that contain endorphins. Glutamate, acetylcholine, opioids, GABA, nociceptin, serotonin and endocannabinoids all appear to participate in the EA hypotensive response although their importance varies between nuclei. Thus, a number of mechanisms underlying the long-lasting effect of EA on cardiovascular function have been identified but clearly further investigation is warranted. PMID:20444652

Li, Peng; Longhurst, John C



Hemodynamic determinants of chronic hypotension and their modification through vasopressor application  

Microsoft Academic Search

Chronic low blood pressure is typically accompanied by symptoms such as fatigue, reduced drive, dizziness, headaches and cold\\u000a limbs. Reduced cognitive performance, diminished cerebral blood flow and autonomic dysregulation have been furthermore documented\\u000a in this condition. The present contribution reports two studies exploring systemic hemodynamics in chronic hypotension and\\u000a their modification through vasopressor application. In study I, effects of the

Stefan Duschek; Heike Heiss; Boriana Buechner; Natalie Werner; Rainer Schandry; Gustavo A. Reyes del Paso



Orthostatic headache and bilateral abducens palsy secondary to spontaneous intracranial hypotension  

Microsoft Academic Search

Spontaneous intracranial hypotension (SIH) is a well-documented syndrome characterized typically by a benign, self-limited\\u000a course. Patients typically present with postural or exertional headaches that can be temporarily relieved by lying in a supine\\u000a or recumbent position. A 35-year-old Caucasian male suffered orthostatic headache that developed to a bilateral abducens palsy.\\u000a We ordered relative rest and the patient improved and completely

Jesús Porta-Etessam; Daniela Di Capua; Manuela Jorquera; Maria-L. Cuadrado; Azahara Marcos



Refractory hypotension and edema caused by right atrial compression in a woman with polycystic kidney disease  

Microsoft Academic Search

We present the case of a 60-year-old woman with a history of autosomal dominant polycystic kidney disease and long-standing hypertension who developed persistent hypotension. While in the hospital for the treatment of bacteriemia, the patient had low systolic blood pressures (90 to 100 mm Hg), which was thought to be the consequence of infection. After the infection was adequately controlled

Lada Beara Lasic; Maria V. DeVita; Paul J. Spiegel; Nino D. Marino; Ellen Mellow; Michael F. Michelis



Hypotensive effects of intravenously administered uridine and cytidine in conscious rats: Involvement of adenosine receptors  

Microsoft Academic Search

In the present study, we investigated the cardiovascular effects of intravenously injected uridine or cytidine, and the role of adenosine receptors in mediating these effects, in conscious normotensive rats. Intravenous (i.v.) administration of uridine (124, 250, 500 mg\\/kg) dose-dependently decreased arterial pressure and heart rate. Cytidine (124, 250, 500 mg\\/kg; i.v.) produced slight dose-related hypotension without changing heart rate. Plasma uridine and

M. Sertac Yilmaz; Cenk Coskun; Oner Suzer; Murat Yalcin; Duygu Mutlu; Vahide Savci



A prospective study of nonfunctioning pituitary adenomas: presentation, management, and clinical outcome.  


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



Dental Erosion and Its Growing Importance in Clinical Practice: From Past to Present  

PubMed Central

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



Community acquired pneumonia in adults in Addis Abeba: etiologic agents, clinical and radiographic presentation.  


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

Aderaye, G



Additional diverse findings expand the clinical presentation of DOCK8 deficiency  

PubMed Central

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.



The Changing Face of Low-risk Prostate Cancer: Trends in Clinical Presentation and Primary Management  

PubMed Central

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.



Variable clinical presentation of lysosomal beta-mannosidosis in patients with null mutations.  


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




Microsoft Academic Search

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


Initial Systolic Time Interval (ISTI) as a Predictor of Intradialytic Hypotension (IDH)  

NASA Astrophysics Data System (ADS)

In haemodialysis treatment the clearance and volume control by the kidneys of a patient are partially replaced by intermittent haemodialysis. Because this artificial process is performed on a limited time scale, unphysiological imbalances in the fluid compartments of the body occur, that can lead to intradialytic hypotensions (IDH). An IDH endangers the efficacy of the haemodialysis session and is associated with dismal clinical endpoints, including mortality. A diagnostic method that predicts the occurrence of these drops in blood pressure could facilitate timely measures for the prevention of IDH. The present study investigates whether the Initial Systolic Time Interval (ISTI) can provide such a diagnostic method. The ISTI is defined as the time difference between the R-peak in the electrocardiogram (ECG) and the C-wave in the impedance cardiogram (ICG) and is considered to be a non-invasive assessment of the time delay between the electrical and mechanical activity of the heart. This time delay has previously been found to depend on autonomic nervous function as well as preload of the heart. Therefore, it can be expected that ISTI may predict an imminent IDH caused by a low circulating blood volume. This ongoing observational clinical study investigates the relationship between changes in ISTI and subsequent drops in blood pressure during haemodialysis. A registration of a complicated dialysis showed a significant correlation between a drop in blood pressure, a decrease in relative blood volume and a substantial increase in ISTI. An uncomplicated dialysis, in which also a considerable amount of fluid was removed, showed no correlations. Both, blood pressure and ISTI remained stable. In conclusion, the preliminary results of the present study show a substantial response of ISTI to haemodynamic instability, indicating an application in optimization and individualisation of the dialysis process.

Biesheuvel, J. D.; Vervloet, M. G.; Verdaasdonk, R. M.; Meijer, J. H.



Gelastic seizures associated with hypothalamic hamartomas. An update in the clinical presentation, diagnosis and treatment  

PubMed Central

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



Chronic hepatitis in the English springer spaniel: clinical presentation, histological description and outcome  

PubMed Central

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.



Balling gun-induced trauma in cattle: clinical presentation, diagnosis and prevention.  


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



Topical Oxygen Therapy Induces VEGF Expression and Improves Closure of Clinically Presented Chronic Wounds  

PubMed Central

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.



Gender-related variation in the clinical presentation and outcomes of critical limb ischemia  

PubMed Central

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



Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis  

Microsoft Academic Search

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



[Chronic graft-versus-host-disease involving the oral mucosa: clinical presentation and treatment].  


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



[A man in his fifties with syncope and hypotension].  


A man in his fifties was admitted to our hospital because of syncope and hypotension. In the emergency room he reported abdominal pain, but focused assessment with sonography for trauma (FAST) was negative. His systolic blood pressure varied between 60 and 90 mmHg and an arterial blood gas revealed lactic acidosis with normal haemoglobin, which still might indicate acute bleeding. An ECG did not indicate myocardial infarction. In the absence of an obvious bleeding focus, the patient was urgently transported to a CT lab nearby, to identify possible bleeding and rule out other causes of circulatory shock, such as cardiac tamponade. Before radiologic scanning was initiated, the patient lost consciousness and displayed pulseless electrical activity. Resuscitation was initiated and pericardiocentesis was resultless. On vital indication and clinical suspicion of cardiac tamponade, an emergency median sternotomy was performed and a haematoma was evacuated from the pericardial space. The patient was stabilised and immediately taken to the operation theatre where a ruptured ascending aortic aneurysm was identified. The operation was successful, but following serious hypoperfusion, the patient suffered acute kidney failure requiring dialysis for several months, gram-negative septicaemia caused by a central venous catheter, cerebral infarction leading to hemiparesis and impaired vision, ventilator-associated pneumonia/acute lung injury and acalculous cholecystitis. This case report describes the findings on admission, the diagnostic process including surgical resuscitation and a complicated course of multi-organ failure. After almost 5 months, the patient was discharged from our hospital to another institution for further rehabilitation. He now has minimal sequelae and lives at home. Our take-home message is that seriously ill patients require fast, resolute and broad examination; they may need immediate surgical treatment including emergency intervention; and a good clinical outcome may be achieved in spite of serious complications. PMID:22511095

Mordal, Geir Christian Enli; Hov, Karen Roksund; Bjørnstad, Johannes Lagethon; Meidell, Nina Knutrud



PNPLA3 I148M Polymorphism, Clinical Presentation, and Survival in Patients with Hepatocellular Carcinoma  

PubMed Central

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



Spinocerebellar ataxia type 2: clinical presentation, molecular mechanisms, and therapeutic perspectives.  


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



Plurihormone secreting pituitary macroadenoma masquerading as thyrotoxicosis: Clinical presentation and diagnostic challenges  

PubMed Central

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



Plurihormone secreting pituitary macroadenoma masquerading as thyrotoxicosis: Clinical presentation and diagnostic challenges.  


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



Mucopolysaccharidosis type IIIB may predominantly present with an attenuated clinical phenotype.  


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 may predominantly present with an attenuated clinical phenotype  

PubMed Central

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.



Early diagnosis of autism spectrum disorder: stability and change in clinical diagnosis and symptom presentation.  


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



The prevalence and significance of post-exercise (postural) hypotension in ultramarathon runners.  


A consistent finding in exercise-associated collapse is a marked postural fall in the systolic blood pressure associated with a tachycardia. The prevalence and significance of these post-exercise (postural) changes in blood pressure among noncollapsed ultradistance athletes has not been well documented. The aim of this study was to compare pre- and post-race changes in systolic and diastolic blood pressures with changes in body weight and plasma volume and with symptoms of post-exercise hypotension, including the effects of posture, among a group of 31 runners competing in an 80-km footrace. During the race, runners developed a mean (+/- SD) weight loss of 3.5 (+/- 1.2) kg and plasma volume change of 12.8% (+/- 9.1). Asymptomatic postural hypotension defined as a fall in systolic blood pressure of greater than 20 mm Hg from the supine to the erect position without syncopal symptoms was present in two runners (7%) before the race and in 21 runners (68%) afterward. The degree of postural variation in systolic blood pressure was unrelated to changes in body weight or a fall in plasma volume. We conclude that (i) all runners were dehydrated by the race activity with a range of 1% to 7% and an average of 4.6%; (ii) asymptomatic post-exercise (postural) hypotension developed in the majority (68%) of ultramarathon runners in this study; (iii) the post-exercise hypotension is likely of multifactorial origin and is not entirely related to whole body dehydration or a reduction in plasma volume; and (iv) despite marked levels of dehydration among our sample of runners, their cardiovascular status in the supine position was not greatly compromised. PMID:8614313

Holtzhausen, L M; Noakes, T D




PubMed Central

The gaseous compound carbon monoxide (CO) has been identified as an important endogenous biological messenger in the brain and is a major component in regulation of cerebrovascular circulation in newborns. CO is produced endogenously by catabolism of heme to CO, free iron, and biliverdin during enzymatic degradation of heme by heme oxygenase (HO). The present study was designed to test the hypothesis that endogenously produced CO contributes to hypotension-induced vasodilation of cerebral arterioles. Experiments used anesthetized piglets with implanted, closed cranial windows. Topical application of the HO substrate, heme-L-lysinate (HLL), caused dilation of pial arterioles that was blocked by a metal porphyrin inhibitor of HO, chromium mesoporphyrin (CrMP). In normotensive piglets (arterial pressure 64±4 mm Hg), CrMP did not cause vasoconstriction of pial arterioles but rather a transient dilation. Hypotension (50% of basal blood pressure) increased cerebral CO production and dilated pial arterioles from 66±2?m to 92±7?m. In hypotensive piglets, topical CrMP or i.v. SnPP decreased cerebral CO production and produced pial arteriolar constriction to normotensive diameters. In additional experiments, since prostacyclin and nitric oxide (NO) are also key dilators that can contribute to cerebrovascular dilation, we held their levels constant. NO/prostacyclin clamp was accomplished with continuous, simultaneous application of indomethacin, N?-nitro-L-arginine (L-NNA), and minimal dilatory concentrations of iloprost and sodium nitroprusside (SNP). With constant NO and prostacyclin, the transient dilator and prolonged constrictor responses to CrMP of normotensive and hypotensive piglets, respectively, were the same as when NO and prostaglandins were not held constant. These data suggest that endogenously produced CO contributes to cerebrovascular dilation in response to reduced perfusion pressure.

Kanu, Alie; Whitfield, John; Leffler, Charles W.



Study of factors related to hypotension in hemodialysis patients.  


The factors related to hypotension in hemodialysis patients were evaluated. The subjects consisted of 120 hemodialysis patients (61 males and 59 females), whose ages ranged between 28 and 82 years, and who had undergone hemodialysis treatment for a period ranging between 3 and 201 months. They were divided into three groups: Group A, 53 normotensive patients; Group B, 52 patients with hypotension during hemodialysis; and Group C, 15 patients with constant hypotension. The evaluated factors were age, sex, etiology of renal failure, hemodialysis term, ultrafiltered volume, responsiveness to vasopressor drugs, Cr, Na, Ht, TP, cardiothoracic ratio, presence or absence of heart disease, and microvibration pattern. Statistical analysis was performed using multivariate analysis (Quantification II and IV methods). The results of the Quantification IV method indicated that Groups A and B were similar but Group C was quite different from the other two groups. The results of the Quantification II method indicated that the most important factor which characterized the difference between Group A and Group C was the responsiveness to vasopressor drugs, and the most important factor in the difference between Group B and Group C was the microvibration pattern. Group B was characterized by abnormal microvibration patterns and Group C was characterized by a low responsiveness of the peripheral vessels to vasopressor drugs. We conclude that the hypotension during hemodialysis was caused predominantly by dysfunction of the autonomic nervous system, while the constant hypotension was caused predominantly by a deterioration of constriction of the peripheral vessels. PMID:1635287

Furukawa, A; Miyamoto, T; Tamura, M; Kawanishi, Y; Numata, A; Yuasa, M; Imagawa, A; Kagawa, S



Clinical application of three-dimensional echocardiography: past, present and future  

PubMed Central

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.



21 CFR 50.54 - Clinical investigations not otherwise approvable that present an opportunity to understand...  

Code of Federal Regulations, 2013 CFR

...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...



Follow up of patients presenting with fatigue to an infectious diseases clinic  

Microsoft Academic Search

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



Concentric visual field defect related to spontaneous intracranial hypotension.  


Spontaneous intracranial hypotension (SIH) is a rare syndrome characterized by postural headache associated with a low cerebrospinal fluid pressure in the absence of dural puncture or penetrating trauma. Cranial magnetic resonance imaging (MRI) typically shows diffuse pachymeningeal gadolinium enhancement, subdural fluid collections, prominence of cerebral venous sinuses and brain descent. Visual signs and symptoms have been described infrequently in patients with SIH. These include third or sixth nerve palsy, superior nasal quadrantanopia and temporal hemianopia. We report a 34 year-old woman who presented with a two-year history of orthostatic headache, dizziness and transient visual obscurations. Campimetry showed a bilateral concentric visual field defect. She also described that intermittently a transparent fluid leaked out of her nose. She had no past history of trauma, sinus surgery or intracranial surgery. Cranial MRI was normal. Neuro-ophthalmological examination ruled out any other causes of concentric visual field defects. Lumbar puncture showed a cerebrospinal fluid (CSF) opening pressure of 9 cm H2O. Radioisotope cisternography suggested a dural leak at cribiform plate. The cribiform plate region was repaired endoscopically with improvement of all symptoms. One year later she remains asymptomatic and the visual field defects have improved. PMID:23277208

Pilo-de-la-Fuente, Belen; Gonzalez Martin-Moro, Julio; Navacerrada, Francisco; Plaza-Nieto, Francisco Jose; Jimenez-Jimenez, Felix Javier



The Need for Information on Adverse Drug Reactions Including the Reactions of Present and Potential Readers to Clinical Experience Abstracts.  

National Technical Information Service (NTIS)

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



[Examination of clinical presentation in terminal-phase lung cancer patients at a single palliative care unit].  


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



Epileptogenic brain malformations: clinical presentation, malformative patterns and indications for genetic testing.  


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



Epileptogenic brain malformations: clinical presentation, malformative patterns and indications for genetic testing.  


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



Severe hypotension after first dose of enalapril in heart failure.  

PubMed Central

The new, long acting converting enzyme inhibitor enalapril was given to 26 patients with moderate to severe heart failure. In 23 cases the mean systolic blood pressure fell from 120 (SD 22) to 108 (25) mm Hg without adverse effects. Profound hypotension with severe bradycardia and sweating, however, occurred in three patients, most pronounced two to four hours after the first dose. The haemodynamic and biochemical changes in these patients were similar to those seen in patients with severe symptomatic hypotension after the first dose of the converting enzyme inhibitor captopril, except that with enalapril the changes occurred later and were longer lasting. Evidence of myocardial damage and reversible renal failure was seen in one patient, and acute reversible deterioration in renal function occurred in one other. In patients with heart failure converting enzyme inhibitors should be administered initially under strict medical supervision with appropriate facilities available for dealing with occasional profound hypotension.

Cleland, J G; Dargie, H J; McAlpine, H; Ball, S G; Morton, J J; Robertson, J I; Ford, I



Is the clinical presentation different between men and women admitting to the sleep laboratory?  

Microsoft Academic Search

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



Intragenic deletion of RBFOX1 associated with neurodevelopmental/neuropsychiatric disorders and possibly other clinical presentations  

PubMed Central

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.



Management of neurogenic orthostatic hypotension in patients with autonomic failure.  


The maintenance of blood pressure in the upright position requires intact autonomic cardiovascular reflexes. Diseases that affect the sympathetic innervation of the cardiovascular system result in a sustained fall in blood pressure upon standing (i.e., neurogenic orthostatic hypotension) that can impair the blood supply to the brain and other organs and cause considerable morbidity and mortality. Here we review treatment options for neurogenic orthostatic hypotension and include an algorithm for its management that emphasizes the importance of non-pharmacologic measures and provides guidance on pharmacologic treatment options. PMID:23857549

Schroeder, Christoph; Jordan, Jens; Kaufmann, Horacio



Hemodynamic mechanisms underlying prolonged post-faint hypotension  

Microsoft Academic Search

Objective  During hypotension induced by tilt-table testing, low presyncopal blood pressure (BP) usually recovers within 1 min after\\u000a tilt back. However, in some patients prolonged post faint hypotension (PPFH) is observed. We assessed the hemodynamics underlying\\u000a PPFH in a retrospective study.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Seven patients (2 females, aged 31–72 years) experiencing PPFH were studied. PPFH was defined as a systolic BP below 85 mmHg\\u000a for at

Wouter Wieling; Josien Rozenberg; Ingeborg K. Go-Schön; John M. Karemaker; Berend E. Westerhof; David L. Jardine


Clinical Presentation of Inhalational Anthrax Following Bioterrorism Exposure Report of 2 Surviving Patients  

Microsoft Academic Search

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


Aetiology and Clinical Presentation of Mild Community-Acquired Bacterial Pneumonia  

Microsoft Academic Search

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



Perspectives in Diabetes Clinical Trials of Diabetic Neuropathy: Past, Present, and Future  

Microsoft Academic Search

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


The ESPEN clinical practice guidelines on Parenteral Nutrition: Present status and perspectives for future research  

Microsoft Academic Search

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



Intracranial Dural Arteriovenous Fistulas with Spinal Venous Drainage: Relation between Clinical Presentation and Angiographic Findings  

Microsoft Academic Search

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


The Use of Student Time Task Measures in Pre Student Teaching Clinical Experiences: A Panel Presentation.  

ERIC Educational Resources Information Center

|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 geropsychiatric clinical nurse specialist in home health care: A case presentation  

Microsoft Academic Search

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



Racquet sports--patterns of injury presenting to a sports injury clinic  

Microsoft Academic Search

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



Collagenous colitis: a retrospective study of clinical presentation and treatment in 163 patients  

Microsoft Academic Search

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



Brain MRI findings in patients with mucopolysaccharidosis types I and II and mild clinical presentation  

Microsoft Academic Search

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



Atrial fibrillation and stroke: clinical presentation of cardioembolic versus atherothrombotic infarction  

Microsoft Academic Search

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



Discriminating Active from Latent Tuberculosis in Patients Presenting to Community Clinics  

PubMed Central

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.



Clinical Profile of Childhood Onset Depression Presenting to Child Adolescent and Family Services in Northampton  

ERIC Educational Resources Information Center

|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



Present outlook in bronchiectasis: clinical and social study and review of factors influencing prognosis  

Microsoft Academic Search

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



When the Heart is Stopped for Good: Hypotension-Bradycardia Paradox Revisited  

NSDL National Science Digital Library

Critical examination of the pathophysiological mechanism and significance of the hypotension-bradycardia paradox unique to the occurrence of bradycardia/asystole in the wake of hypotension in vasovagal syncope

Dr. E. Sankaranarayanan Prakash (Asian Institute of Medicine, Science, and Technology School of Medicine Faculty of Medical and Health Sciences); Dr. Madanmohan (Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER))



Psychiatric disorders in children and adolescents presenting with unexplained chronic pain: what is the prevalence and clinical relevancy?  

PubMed Central

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.



Genomic imbalances in patients with a clinical presentation in the spectrum of Cornelia de Lange syndrome  

PubMed Central

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.



Shengmai Injection, a Traditional Chinese Patent Medicine, for Intradialytic Hypotension: A Systematic Review and Meta-Analysis  

PubMed Central

Intradialytic hypotension (IDH) is a global public health problem. A rising number of IDH sufferers resort to Chinese patent medicine, Shengmai Injection (SMI) in China. The objectives of present study are to assess the effectiveness and safety of SMI as an adjunct therapy for IDH. A systematic search of 6 medical databases was performed up to December 2011. Randomized trials involving SMI adjuvant therapy versus conventional therapy were identified. RevMan 5.0 was used for data analysis. Ten randomized clinical trials with 437 participants were identified. Methodological quality was considered inadequate in all trials. Compared with conventional therapy, SMI adjunct therapy showed significant effects in improving the clinic effective rate (P < 0.01), decreasing the incidence of IDH episode (P < 0.01), decreasing the frequency of nursing interventions (P < 0.01), and increasing diastolic blood pressure (P < 0.01). There was no statistical significance in the improvement of mean arterial pressure (P = 0.22) and systolic blood pressure (P = 0.08) between two groups. Four studies had mentioned adverse events, but no serious adverse effects were reported in any of the included trials. In conclusion, SMI adjunct therapy appears to be potentially effective in treatment of IDH and is generally safe. However, further rigorous designed trials are needed.

Chen, Chao-yang; Lu, Ling-yan; Chen, Peng; Ji, Kang-ting; Lin, Jia-feng; Yang, Peng-lin; Tang, Ji-fei; Wang, Yan



Clinical presentation of type 2 diabetes mellitus in children and adolescents  

Microsoft Academic Search

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

T Reinehr



Identification of typhoid fever and paratyphoid fever cases at presentation in outpatient clinics in Jakarta, Indonesia  

Microsoft Academic Search

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



Abstracts presented at the American Society of Clinical Oncology conference: how completely are trials reported?  

Microsoft Academic Search

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. I. Clinical presentations, diagnosis and management  

Microsoft Academic Search

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


Maternal Rejection of the Young Child: Present Status of the Clinical Syndrome  

Microsoft Academic Search

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

Ian Brockington



Streptococcus suis Type 2 Infection in Swine in Ontario: A Review of Clinical and Pathological Presentations  

PubMed Central

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.



Are elderly haemodialysis patients at risk of falls and postural hypotension?  

Microsoft Academic Search

Background:The numbers of older people on haemodialysis isrising. As aging and renal failure are riskfactors for autonomic failure and haemodialysisinvolves significant fluid shifts wehypothesized that older patients would besusceptible to hypotensive events betweendialysis sessions. Postural hypotension is arisk factor for falls. Falls are debilitatingand a leading cause of morbidity and mortalityin the elderly.Aim:To investigate whether postural hypotension andsymptoms of hypotension

Russell G. Roberts; Rose Anne Kenny; Elizabeth J. Brierley



Glycopyrronium and hypotension following combined spinal-epidural anaesthesia for elective Caesarean section in women with relative bradycardia.  


The ability of glycopyrronium to reduce the severity of hypotension following subarachnoid block in parturients with a relative bradycardia was evaluated in a double-blind randomised controlled study. Women with a resting heart rate of < or = 80 beat x min(-1) presenting for elective Caesarean section were randomly allocated to receive either glycopyrronium 2 microg x kg(-1) or normal saline intravenously once positioned for combined spinal-epidural anaesthesia. Following spinal injection of 2.6 ml hyperbaric bupivacaine 0.5% and fentanyl 15 microg, women randomly allocated to the saline group were given 6 mg ephedrine so that all parturients received some prophylaxis against hypotension other than the fluid preload. Further ephedrine and fluid boluses were administered if mean arterial pressure fell 20% or more from resting values. Using a sequential analysis technique, analysis after the first 20 subjects indicated the study should be stopped, with no difference in ephedrine requirements or hypotension between the groups. We conclude that pretreatment with glycopyrronium 2 microg x kg(-1) is no more effective than 6 mg ephedrine in preventing hypotension following subarachnoid block in parturients with relatively low resting heart rates. PMID:11843734

Rucklidge, M W M; Durbridge, J; Barnes, P K; Yentis, S M



Effects of infusion of different fluids during controlled hypotension on gastric intramucosal pH and postoperative gastroenterological function.  


The present study was aimed to investigate the effects of infusion of different fluids combined with controlled hypotension on gastric intramucosal pH (pHi) and postoperative gastrointestinal function in patients undergoing hepatocarcinoma surgery. Forty-five patients (ASA II) scheduled for surgical resection of hepatocarcinoma undergoing controlled hypotension were randomly assigned to three groups and received infusion of 20 mL/kg Ringer's solution (R group), 6% HAES(H group) or 6% Voluven group (W group). Intragastric PgCO2, pHi, hematocrit and hemoglobin were measured. The significant decrease of pHi and increase of PgCO2 were produced at 1 and 2 h after controlled hypotension in the R group (P < 0.05 or P < 0.01). The time of bowel movement after operation was shorter in the W group than the R group. Meanwhile, we also did not find obvious difference in blood gas indexes among the three groups. The infusion of HAES and Voluven during controlled hypotension could improve gastrointestinal perfusion and accelerate the recovery of postoperative gastrointestinal function. PMID:23554689

Wang, Guanglei; Liu, Su; Liu, Gongjian



Cognitive Behavioral Treatment of Panic Disorder and Agoraphobia in a Multiethnic Urban Outpatient Clinic: Initial Presentation and Treatment Outcome  

ERIC Educational Resources Information Center

|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



Aetiology and Clinical Presentation of Pneumonia in Hospitalized and Outpatient Children in Northeast Brazil and Risk Factors for Severity  

Microsoft Academic Search

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



Predicting hypotensive episodes during spinal anesthesia with the application of artificial neural networks  

Microsoft Academic Search

Hypotension is one of the most frequent adverse effects of spinal anesthesia. Several factors might be related to the occurrence of hypotension. Predictions of the hypotensive event, however, had been addressed by only a few authors using logistic regression (LR) models. Artificial neural networks (ANN) are pattern-recognition tools that can be used to detect complex patterns within data sets. The

Chao-shun Lin; Jainn-shiun Chiu; Ming-hui Hsieh; Martin S. Mok; Yu-chuan Li; Hung-wen Chiu



Left-Ventricular Diastolic Dysfunction as a Risk Factor for Dialytic Hypotension  

Microsoft Academic Search

Objectives: Intradialytic hypotension may adversely affect the outcome of chronic hemodialysis and thus reduce the patients’ life expectancy. The aim of this study was to assess the link between left-ventricular diastolic dysfunction and dialytic hypotension. Methods: We performed a prospective cross-sectional study of 72 hemodialysis patients with a low dialysis vintage, 36 of whom had dialysis hypotension, based on echocardiography

Guy Rostoker; Mireille Griuncelli; Christelle Loridon; Abbès Benmaadi; Eric Illouz



Assessing the need for hospital admission by the cape triage discriminator presentations and the simple clinical score  

Microsoft Academic Search

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



Lower extremity overuse injuries in pediatric athletes: clinical presentation, imaging findings, and treatment.  


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



Pharmacological options in the management of orthostatic hypotension in older adults.  


Orthostatic hypotension (OH) is a common disorder in older adults with potentially serious clinical consequences. Understanding the key underlying pathophysiological processes that predispose individuals to OH is essential when making treatment decisions for this group of patients. In this article, we discuss the key antihypotensive agents used in the management of OH in older adults. Commonly, midodrine is used as a first-line agent, given its supportive data in randomized, controlled trials. Fludrocortisone has been evaluated in open-label trials and has long-established usage in clinical practice. Other agents are available and in clinical use, either alone or in combination, but larger randomized trial evaluations are yet to be published. It is important to bear in mind that a patient may be taking medications that predispose to or exacerbate the symptoms of OH. Withdrawal of such medications, where possible, should be considered before commencing other pharmacological agents that attenuate the symptoms of OH. PMID:19900022

Kearney, Fiona; Moore, Alan



Functional effects of cardiac sympathetic denervation in neurogenic orthostatic hypotension  

Microsoft Academic Search

BackgroundDiseases characterized by neurogenic orthostatic hypotension (NOH), such as Parkinson disease (PD) and pure autonomic failure (PAF), are associated with cardiac sympathetic denervation, as reflected by low myocardial concentrations of 6-[18F]fluorodopamine-derived radioactivity. We studied the impact of such denervation on cardiac chronotropic and inotropic function.

Richard Imrich; Basil A. Eldadah; Oladi Bentho; Sandra Pechnik; Yehonatan Sharabi; Courtney Holmes; Ehud Grossman; David S. Goldstein



Organic bipolar disorder occurring together with spontaneous intracranial hypotension.  


Spontaneous intracranial hypotension (SIH) is known to cause postural headache, often combined with auditory, and vestibular symptoms, nausea, vomiting, and diplopia. We report a 63-year-old male patient who for the first time developed a depressive episode followed by acute manic symptoms during the course of SIH, both relieved after treatment of the underlying organic disturbance. PMID:15313524

Fitzek, Sabine; Smesny, Stefan; Fitzek, Clemens; Axer, Hubertus; Wohlfarth, Mathias; Vieweg, Uwe; Witte, Otto W



Atrial natriuretic peptide blocks renin response to renal hypotension  

SciTech Connect

The authors have reported that the renin response to systemic hypotension is inhibited in the presence of elevated atrial pressure and that elevations in atrial pressure of similar or larger magnitude cause graded increases in plasma atrial natriuretic peptide (ANP). Therefore they tested the hypothesis that comparable increments in plasma ANP can inhibit renal hypotension-induced increases in plasma renin activity (PRA) in conscious dogs. Renal perfusion pressure was controlled using cuffs implanted around the abdominal aorta just above the renal arteries. Reducing renal perfusion pressure by 10 or 30% of control caused graded increases in PRA. Infusion of 1-28 rat ANP, which increased plasma ANP by 34.8 +/- 7.5 (SE) pg/ml, eliminated increases in PRA in response to a 10% reduction in renal perfusion pressure and markedly inhibited the response to a 30% pressure reduction. ANP and PRA were measured by radioimmunoassay. These results indicate that increments in plasma ANP which reproduce endogenous release inhibit renal hypotension-induced stimulation of PRA. Furthermore, the results provide an explanation for the inhibition of the renin response to renal hypotension during elevate atrial pressure.

Scheuer, D.A.; Thrasher, T.N.; Quillen, E.W. Jr.; Metzler, C.H.; Ramsay, D.J.



Orthostatic hypotension and subjective sleep quality in older people  

Microsoft Academic Search

Poor sleep quality and orthostatic hypotension are common complaints in an older population, and both are related to factors such as polypharmacy and depression. However, it is not known whether there is a direct association between the two. Our objective is to investigate a potential association between orthostatic blood pressure response and subjective sleep quality in older people. A within-subjects,

Joanna E. McHugh; Chie W. Fan; Rose A. Kenny; Brian A. Lawlor



Frequency of hypotension during conventional or asymmetric hyperbaric spinal block  

Microsoft Academic Search

Background and Objectives. The purpose of this randomized, double-blind study was to evaluate if use of an asymmetric spinal block affects the incidence of hypotension during spinal anesthesia. Methods. With Ethical Committee approval and patient consent, 120 patients undergoing lower limb surgery were placed in the lateral position with the side to be operated on dependent, and received 8 mg

Andrea Casati; Guido Fanelli; Giorgio Aldegheri; Eleonora Colnaghi; Elisabetta Casaletti; Valeria Cedrati; Giorgio Torri



The Many Faces of Celiac Disease: Clinical Presentation of Celiac Disease in the Adult Population  

Microsoft Academic Search

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




Acute lymphoblastic leukemia with pancytopenia at presentation: clinical correlates, prognostic impact, and association with survival.  


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



Splanchnic perfusion during delayed, hypotensive, or aggressive fluid resuscitation from uncontrolled hemorrhage.  


The purpose of this study was to determine the effect of three different fluid resuscitation strategies on splanchnic perfusion in a clinically relevant model of uncontrolled hemorrhage after liver trauma. Anesthetized swine were instrumented with a gastric near-infrared spectroscopy probe (GStO2), a jejunal tonometer (PrCO2), a portal vein catheter (SpvO2, lactate), and an ultrasonic blood flow probe on the superior mesenteric artery. The liver was lacerated to produce uncontrolled hemorrhage and a shock state characterized by a 40-60% decrease in cardiac output and a decrease in mean arterial pressure (MAP) to 42 +/- 1 mmHg. Animals were randomly assigned to either delayed resuscitation (n = 6); hypotensive resuscitation with lactated Ringer's infusion to MAP = 60 mmHg (n = 6); or aggressive resuscitation with LR to MAP >/= 75 mmHg (n = 6). For the remainder of the protocol, the treatment was identical. The data showed that blood loss (47 +/- 7 and 45 +/- 10 mL/kg) and total fluid requirements (118 +/- 73 and 171 +/- 85 mL/kg) were similar with either hypotensive or aggressive resuscitation. In contrast, with delayed resuscitation, both values were lower (27 +/- 2 mL/kg and 87 +/- 33 mL/kg, both P < 0.05). Despite aggressive resuscitation, SpvO2 and GstO2 were about 10% lower (both P < 0.05 within group) and PrCO2 was about 20 mmHg higher (P < 0.05 within group) than the corresponding values in the other two groups. Thus, delayed resuscitation minimized the blood loss but did not restore tissue oxygenation, whereas aggressive resuscitation was associated with maximal blood loss and splanchnic hypoperfusion. For this reason, it is reasonable to conclude that hypotensive resuscitation might be an effective strategy to maintain splanchnic perfusion after blunt abdominal trauma and uncontrolled hemorrhage. PMID:14560114

Varela, J Esteban; Cohn, Stephen M; Diaz, I; Giannotti, Giovanni D; Proctor, Kenneth G



Atrial fibrillation and stroke: clinical presentation of cardioembolic versus atherothrombotic infarction.  


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



[Effect of controlled hypotension on cerebral oxygen delivery].  


The margin of safety for controlled hypotension is still unclear especially in the central nervous system (CNS) which is one of the most sensitive organs to hypoxia and ischemia. Recently, cerebral optical spectroscopy in the infrared light range was developed as a useful tool which makes it possible to monitor cerebral oxygenation (rSO2) non-invasively and continuously during anesthesia. Resulting rSO2 mainly reflects oxygen extracts by cerebral tissue and then indicates cerebral oxygen delivery. We examined the limitation of controlled hypotension in the brain in 12 patients by monitoring rSO2 during anesthesia. rSO2 under room air breathing (control value as normal physiological condition) was 67 +/- 3% (mean +/- SEM). It significantly increased by 5.6 +/- 0.8% under 100% oxygen breathing, but decreased near to the control value under sevoflurane anesthesia (FIO2 1.0). During moderate controlled hypotension (70% of normal blood pressure) by prostaglandin E1 under sevoflurane anesthesia (FIO2 1.0). rSO2 remained at control value, indicating that cerebral oxygen delivery was still sufficiently maintained. However rSO2 decreased significantly by 9.0 +/- 1.1% in same controlled hypotension condition under FIO2 0.4. This decrease in rSO2 could be potentially harmful for CNS although any post-operative neurological disorder was not observed in our cases. We conclude that cerebral oxygen delivery may be insufficient even in the moderate controlled hypotension, and thus higher FIO2 is recommended in such procedures. PMID:9251505

Tsuchiya, M; Tokai, H; Imazu, Y; Arai, K; Manabe, M



Valosin containing protein associated fronto-temporal lobar degeneration: clinical presentation, pathologic features and pathogenesis.  


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



Valosin containing protein mutations in fronto-temporal lobar degeneration: Clinical presentation, pathology and pathogenesis  

PubMed Central

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.



Clinical applications for magnetic resonance guided high intensity focused ultrasound (MRgHIFU): present and future.  


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



Should the host reaction to anisakiasis influence the treatment? Different clinical presentations in two cases.  


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



HIV-Associated Nephropathy: Clinical Presentation, Pathology, and Epidemiology in the Era of Antiretroviral Therapy  

PubMed Central

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 enlar