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Das Stevens-Johnson-Syndrom  

Microsoft Academic Search

Nach einleitender Erörterung der Terminologie des Erythema exsudativum multiforme Hebra (E.e.m.H.) und des E.e.m.-Syndroms (Stevens-Johnson-Syndrom und mit diesem eng verwandte Krankheitsbilder) wird ein eigener Fall des letzteren mit schwerem Verlauf dargestellt. Versuche, einen Erreger zu isolieren, schlugen fehl, berechtigen aber nicht dazu, eine Virusätiologie grundsätzlich auszuschließen. Die Beziehungen des E.e.m.-Syndroms zur Primär-atypischen Pneumonie und zum Herpes simplex werden ausführlich diskutiert.

P. Jordan; R. Burkhardt; Th. Nasemann



Stevens-Johnson syndrome after radiotherapy  

Microsoft Academic Search

We have reported a case of classic Stevens-Johnson syndrome in association with treatment using a cobalt radiation therapy unit. Previous reports of such an association have been extremely rare. At the time of the reaction, the patient's only medications were methyldopa and trichlormethiazide. Other drugs in the thiazide class have been associated with such a reaction. We feel this is




Intravenous immunoglobulin prophylaxis for recurrent Stevens-Johnson syndrome  

Microsoft Academic Search

Human intravenous immunoglobulin has been described as a treatment for patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. We describe the prophylactic use of intravenous immunoglobulin to prevent Stevens-Johnson syndrome in a woman undergoing cardiac catheterization with a previous history of four episodes of Stevens-Johnson after receiving intravenous contrast dye.

Adelaide A Hebert; Melissa A Bogle



Efavirenz-Associated Stevens-Johnson Syndrome  

Microsoft Academic Search

Persons with human immunodeficiency virus (HIV) infection are highly susceptible to adverse dermatological reactions to specific medications [1, 2]. Stevens-Johnson syndrome has been observed in HIV-infected individuals treated with sulfonamides [3], sulfones [4], thiacetazone [5], and antiretrovirals [6, 7]. Among the antiretrovirals, it is particularly nevirapine that has been associated with this syndrome [6, 7]. Nevirapine-induced rash has been reported

R. Colebunders; T. Vanwolleghem; P. Meurrens; F. Moerman



Conjunctival Pigmentation in Stevens–Johnson Syndrome  

Microsoft Academic Search

We report a 29-year-old white female with conjunctival pigmentation after a Stevens–Johnson syndrome (SJS) episode triggered\\u000a by sulfasalazine. The patient developed bilateral tarsal and forniceal conjunctiva and black pigmentation. Diagnostic biopsy\\u000a showed stromal monocyte infiltration consistent with chronic phase SJS and conjunctival pigment of melanic origin and not\\u000a due to drug deposition. Treatment with topical steroids and unpreserved artificial tears

Graciana Fuentes-Páez; Maria C. Mendez; Javier Montañez; Jose M. Herreras; Maria A. Saornil; Margarita Calonge



Cocaine-Related Stevens-Johnson Syndrome  

Microsoft Academic Search

We report the case of a 26-year-old student with erosive skin changes on his oral and genital mucosa and skin as well as on his thighs twice after cocaine snorting. The second of these two episodes was documented histologically, and other underlying causes of disease were excluded. A diagnosis of recurring Stevens-Johnson syndrome was made. Treatment was initiated with bed

G. F. L. Hofbauer; G. Burg; F. O. Nestle



HLA class I and II gene polymorphisms in Stevens-Johnson syndrome with ocular complications in Japanese  

Microsoft Academic Search

Purpose: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute-onset mucocutaneous diseases induced by infectious agents and\\/or inciting drugs. Although the pathobiological mechanisms underlying the onset of SJS\\/ TEN have not been fully established, the extreme rarity of cutaneous and ocular surface reactions to drug therapies led us to suspect individual susceptibility. Our previous study of polymorphisms in the

Mayumi Ueta; Katsushi Tokunaga; Chie Sotozono; Tsutomu Inatomi; Toshio Yabe; Masaki Matsushita; Yoko Mitsuishi; Shigeru Kinoshita


Stevens-Johnson-Syndrom — eine interdisziplinäre Herausforderung  

Microsoft Academic Search

\\u000a Zusammenfassung  Wegen einer vermuteten Begleitkonjunktivitis beidseits wurde uns ein 9-jähriges Mädchen mit Herpes-simplex-ähnlichen, mukokutanen\\u000a Veränderungen im Gesichtsbereich konsiliarisch vorgestellt.\\u000a \\u000a Nach Ausschluss eines Herpes corneae und ausführlicher Exploration ergab sich für uns bereits der Verdacht auf ein mögliches\\u000a Stevens-Johnson-Syndrom. Zusätzliche Beiträge der Dermatologie und Pädiatrie halfen, die Diagnose abzusichern.\\u000a \\u000a \\u000a \\u000a In diesem Fall hatte die interdisziplinäre Zusammenarbeit zur rechtzeitigen Diagnosekorrektur und Therapieanpassung geführt.

U. Oser; O. Pinter; N. Hausmann



Imatinib-induced Stevens-Johnsons syndrome.  


Imatinib mesylate is a tyrosine kinase inhibitor used widely as the first-line treatment for chronic myeloid leukaemia (CML). The side-effect profile of this drug includes fluid retention, muscle cramps, diarrhoea, myelosuppression and skin rashes. Of these, rashes of the type maculo-papular eruptions and oedema developed most commonly. The cutaneous adverse reactions other than maculo-papular eruptions are rare with imatinib. Severe and life-threatening cutaneous reactions can occur in 5% cases. Here, the author reports a case of newly diagnosed CML that developed Steven-Johnsons syndrome due to imatinib therapy. Patient responded and discharged successfully on withdrawal of the culminating drug. PMID:23349042

Jha, Praveen; Himanshu, D; Jain, Nirdesh; Singh, Ajay Kumar



Stevens-Johnson syndrome from tetrazepam.  


We present a case of a patient showing a cutaneous and systemic affectation compatible with the Stevens-Johnson syndrome due to the intake of tetrazepam as a muscular relaxant. The symptoms remitted after the suspension of the involved medicines and after treatment with systemic corticoids. Months later, a study with patch tests, with the standard battery and the medicines that she took (indapamide, tetrazepam, acetyl salicylic acid, botriozolam and levomepromazine) was carried out. She presented positivity to tetrazepam at 48 and 96 hours. The oral provocations with the other medicines, which she consumed, were negative. The study of cross reactivity with other benzodiazepines was negative. In the medical literature, different cutaneous affectations regarding benzodiazepine use (generalised drug eruptions, contact dermatitis, erythema multiforme, ...) have been described byt non Stevens-Johnson syndrome. The patch tests are useful in the diagnosis of this type of cutaneous reactions, avoiding in this way the achievement of oral provocations, with the potential risk for the patient that they imply. The absence of cross-reactions with other substances of the same group has to be pointed out, even with those with which keeps great structural similarity as the diazepam. In spite of the absence of cross reactions with the rest of benzodiazepines, faced with the seriousness of the case presented, it is advised to the patient to avoid this type of medicines. PMID:9645262

Sánchez, I; García-Abujeta, J L; Fernández, L; Rodríguez, F; Quiñones, D; Duque, S; López, R; Jerez, J


Acetaminophen induced Steven Johnson syndrome-toxic epidermal necrolysis overlap  

Microsoft Academic Search

Steven Johnson Syndrome and Toxic Epidermal Necrolysis are rare but severe form of hypersensitivity inflammatory reactions to multiple offending agents including drugs. Acetaminophen is extensively used due to its analgesic and anti-pyretic properties. It is rendered to be relatively safe, with hepatotoxicity considered to be the major adverse effect. However, very few cases of Steven Johnson Syndrome and Toxic Epidermal

Ali Khawaja; Ahmed Shahab; Syed Ather Hussain



Stevens-Johnson syndrome secondary to ingestion of salmon berries.  


Stevens-Johnson syndrome is an immune mucocutaneous disorder which can follow viral infections, mycoplasma infections and the ingestion of some drugs. There is also evidence supporting this disease as a hypersensitivity disorder. We observed a four-year-old girl with Stevens-Johnson syndrome attributed to ingestion of salmon berries (Rubus spectabilis). PMID:1892228

Steiner, G C; Arnold, R W; Roth, R R; Ice, J S



Microsoft Academic Search

SUMMARY Most of the medical practitioner's are under the impression that Stevens Johnson Syndrome (SJS) is an uncommon life threatening drug reaction. In fact it is not as rare a disorder as we are led to believe. Stevens Johnson Foundation claims that they come to know of 15 new cases a week and that is only people with internet access.

Jannatun Nur; Fazle Rabbi Chowdhury; Nazmul Ahasan HAM


Surgical treatment of children blinded by Stevens-Johnson syndrome  

Microsoft Academic Search

PURPOSE:The surgical treatment of severe Stevens-Johnson syndrome is considered to be very difficult, especially in children. However, ocular surface reconstruction is possible in certain cases.METHODS:We have performed ocular surface reconstruction by allogeneic corneal epithelial stem cell transplantation in four children blinded by Stevens-Johnson syndrome.RESULTS:Two cases failed, and the other two had excellent results. The successful cases had good lacrimal function

Kazuo Tsubota; Jun Shimazaki



Vaginal Adhesions Caused by Stevens-Johnson Syndrome  

Microsoft Academic Search

Stevens-Johnson syndrome is a rare, life-threatening condition characterized by epidermal necrosis and involvement of the mucosal surfaces. We report a case of Stevens-Johnson syndrome with vaginal involvement in an 11-yr-old girl who was treated conservatively in the acute stage of the disease. After recovery from the profound systemic upset, she underwent vaginoscopy, which demonstrated some adhesions, which were divided. We

Roger Hart; Catherine Minto; Sarah Creighton



Stevens-Johnson syndrome induced by sodium valproate monotherapy  

PubMed Central

A case of Stevens-Johnson syndrome following treatment with sodium valproate is presented here. A 20-year-old male was put on sodium valproate monotherapy for the migraine, with generalized epilepsy. He developed vesicles and bullae in the oral and nasal mucosa with conjunctivitis, after 10 days of treatment. The lesions resolved after treating with systemic steroids. This case has been presented because Stevens-Johnson syndrome with sodium valproate monotherapy has been very rarely reported.

Naveen, KN; Arunkumar, JS; Hanumanthayya, K; Pai, VV



Stevens-Johnson syndrome induced by sodium valproate monotherapy.  


A case of Stevens-Johnson syndrome following treatment with sodium valproate is presented here. A 20-year-old male was put on sodium valproate monotherapy for the migraine, with generalized epilepsy. He developed vesicles and bullae in the oral and nasal mucosa with conjunctivitis, after 10 days of treatment. The lesions resolved after treating with systemic steroids. This case has been presented because Stevens-Johnson syndrome with sodium valproate monotherapy has been very rarely reported. PMID:22624102

Naveen, Kn; Arunkumar, Js; Hanumanthayya, K; Pai, Vv



Mucositis, conjunctivitis but no rash - the "Atypical Stevens - Johnson syndrome".  


The Stevens-Johnson syndrome (SJS) classically involves a rash, conjunctivitis and mucositis. We describe the case of a young adult male with isolated mucositis and conjunctivitis . Previous rare reports of severe SJS like syndromes without a rash are confined to children, usually with mycoplasma pnemoniae infection.(1) Terminology for this syndrome includes - "Stevens-Johnson Syndrome without skin lesions", or "Atypical Stevens - Johnson Syndrome".(2) This case highlights the importance of maintaining an open mind when a "full house" of clinical features is absent. It also illustrates the use of a rapid electronic literature review as a clinical tool. The importance of updating records when a drug has been cleared of causing harm is highlighted. PMID:22041607

McGouran, D C R; Petterson, T; McLaren, J M; Wolbinski, M P



Intravenous Immunoglobulin Therapy for Stevens-Johnson Syndrome  

Microsoft Academic Search

Stevens-Johnson syndrome (SJS) is an acute mucocutaneous disorder that can be associated with considerable morbidity. Several previous reports, all involving either adults with acquired immunodeficiency syndrome or children , suggest that intravenous immunoglobulin may be an effective treatment for SJS. We report a case of SJS in an immunocompetent adult whose condition improved dramatically after therapy with intravenous immunoglobulin.




CASE REPORT: Stevens-Johnson Syndrome and Cholestatic Hepatitis  

Microsoft Academic Search

Stevens-Johnson Syndrome (SJS) is a rare but severe dermatological condition that typically occurs after the ingestion of medications such as nonsteroidal drugs, antibiotics, and anticonvulsants. Extracutaneous manifestations of the syndrome can occur and may involve the conjunctiva, trachea, buccal mucosa, gastrointestinal tract, and genitourinary tract. Cholestatic liver disease, which may precede the skin manifestations of SJS, has been reported to

Michael S. Morelli; Francis X. O'Brien



Toxic Epidermal Necrolysis and Stevens Johnson Syndrome: Our Current Understanding  

Microsoft Academic Search

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN, Lyell's syndrome) are now considered to be distinct clinical entities within a spectrum of adverse cutaneous drug reactions of increasing severity based on their surface of skin detachment. Within this spectrum, SJS which can be considered as a minor form of TEN is characterized by less than 10% body surface area of

Lars E French



Phenobarbital induced Stevens-Johnson syndrome in a child  

PubMed Central

Phenobarbital, an antiepileptic agent has numerous adverse reactions including StevensJohnson syndrome (SJS), a rare medical emergency. A 12-year-old male epileptic child with phenobarbital-induced SJS was referred for the management of severe pain in relation to extensively decayed molar tooth and oral mucosal ulcerations. The patient was managed by withdrawal of phenobarbital and palliative treatment of the lesions.

Gaur, Sumit; Agnihotri, Rupali



Eruptive melanocytic nevi after Stevens-Johnson syndrome  

Microsoft Academic Search

Widespread melanocytic nevi may rarely appear suddenly after a severe bullous disease. We describe two patients in whom eruptive melanocytic nevi developed 3 weeks after a severe episode of Stevens-Johnson syndrome. Benign melanocytic proliferation may develop after a bullous dermatosis and should not be confused with malignant or metastatic melanoma. (J Am Acad Dermatol 1997;37:337-9.)

Toru Shoji; Clay J. Cockerell; Amy Beth Koff; Jag Bhawan



Stevens-Johnson syndrome caused by the antiretroviral drug nevirapine  

Microsoft Academic Search

Nevirapine is a non-nucleoside reverse transcriptase inhibitor widely used in combination with other antiretroviral agents for the treatment of HIV infection. Severe rash, including the Stevens-Johnson syndrome (SJS), is the major toxicity of nevirapine and is described in the package labeling with a prominent, boxed warning. Though physicians treating large populations of patients with HIV are well aware of this

Denise W. Metry; Christopher J. Lahart; Kathryn L. Farmer; Adelaide A. Hebert



Stevens-Johnson Syndrome: A Clinical and Histological Study  

Microsoft Academic Search

A description is given of a case of Stevens-Johnson syndrome clinically and histologically ascertained in a middle-aged male with typical localization and later chronicity of the ocular involvement. Besides, an outline is drawn of its clinical picture and of the etiopathogenetical hypothesis, dwelling upon the allergic hypothesis though not excluding the iatrogenic one.

A. Magli; A. Sammartino; A. Loffredo; A. Cecio; A. Sorrentino



Stevens-Johnson syndrome managed in the clinitron bed  

Microsoft Academic Search

The problems presented by the Stevens-Johnson syndrome are in many ways analogous to a major burn with an attendant high mortality. A case study is presented in which many of the problems of nursing this condition were overcome using the fluidised bead-bed, and the impact of a warm environmental temperature and nutrition were studied.

Patricia Davies; D. W. Ryan



Erythema multiforme and Stevens-Johnson syndrome following radiotherapy  

Microsoft Academic Search

Erythema multiforme (EM) and Stevens-Johnson syndrome (SJS) are thought to be hypersensitivity syndromes with various causes,\\u000a and radiotherapy might be one of the causes of these syndromes. We herein report two cases of EM\\/SJS following radiotherapy.\\u000a The first case was a 63-year-old woman with breast cancer. At the end of postoperative radiotherapy with 60?Gy, severe pruritic\\u000a erythema appeared in the

Tadamasa Yoshitake; Katsumasa Nakamura; Yoshiyuki Shioyama; Tomonari Sasaki; Saiji Ooga; Madoka Abe; Yusuke Urashima; Kazunori Urabe; Hiromi Terashima; Hiroshi Honda



Stevens-Johnson syndrome after treatment with rituximab  

Microsoft Academic Search

Rituximab is a chimeric mouse\\/human anti-CD20 antibody licensed for the treatment of low-grade non- Hodgkin's lymphoma and has recently also been shown to have a role in the treatment of diffuse large B-cell lymphoma. We report a case of Stevens-Johnson syndrome after treatment with rituximab, which occurred in a 36-year-old man with relapsed follicular lymphoma. The patient developed mucositis and

S. Lowndes; A. Darby; G. Mead; A. Lister



A marker for Stevens-Johnson syndrome …: ethnicity matters  

Microsoft Academic Search

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe cutaneous adverse drug reactions, which can be caused by a certain number of specific drugs among which is carbamazepine, an antiepileptic agent. A very strong association of carbamazepine-induced SJS with HLA-B*1502 has recently been described in the Han Chinese population. Here in, we report preliminary results from a

C Lonjou; L Thomas; N Borot; N Ledger; C de Toma; H LeLouet; E Graf; M Schumacher; A Hovnanian; M Mockenhaupt; J-C Roujeau



Stevens-Johnson syndrome and toxic epidermal necrolysis  

Microsoft Academic Search

Since their first descriptions in 1922 and 1948, respectively, Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS\\/TEN)\\u000a have become recognized as manifestations—with different severity—of the same disease process along a spectrum of illness.\\u000a Even today, decades after their description, there is still disagreement about when a particular bullous disease evolves from\\u000a erythema multiforme to SJS\\/TEN. There is no disagreement, however, about

Steven J. Parrillo



Stevens–Johnson syndrome and toxic epidermal necrolysis  

Microsoft Academic Search

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, but potentially life threatening, diseases characterized by widespread epidermal necrosis, and are predominantly medication-induced. Unfortunately, though they are often associated with long-term debilitating sequelae, there are currently no efficacious pharmaceutical interventions proven through large clinical trials. It has been well established that the epidermal damage in these diseases is due

Andrea T. Borchers; Jennifer L. Lee; Gurtej S. Cheema; M. Eric Gershwin



Acquired labial sinechiae and hydrocolpos secondary to Stevens-Johnson syndrome.  


Stevens-Johnson syndrome frequently affects the genitalia. Vaginal problems have been recognized in female patients; however, reports about the problem and its treatment are rare. Labial sinechiae have not yet been reported as sequelae of Stevens-Johnson syndrome. Amenorrhea, cyclical abdominal pain, and a hypogastric mass in girls affected by Stevens-Johnson syndrome could indicate acquired vaginal obstruction. Extensive labial sinechiae in such patients can cause dysuria, urinary tract infection, and sexual dysfunction. After a diagnosis of Stevens-Johnson syndrome in girls, it is prudent to schedule a prepubertal genital examination to diagnose genital disease preemptively and avoid obstructed menstruation and future sexual problems. PMID:22921694

de Jesus, Lisieux Eyer; Dekermacher, Samuel; Manhães, Carolina R; Faria, Luciana M; Barros, Malena L



Intravenous immunoglobulins for the management of Stevens-Johnson syndrome with minimal skin manifestations  

Microsoft Academic Search

Here we describe the successful use of intravenous immunoglobulin (IVIG) in the management of mycoplasma-induced, atypical\\u000a Stevens-Johnson syndrome (SJS) with minimal skin manifestations. The patient was successfully managed with high-dose IVIG\\u000a 0.5 g\\/kg for 4 consecutive days. No complications were noted. IVIG may be useful in the management of mycoplasma-induced SJS.

Christos S. Zipitis; Nandu Thalange



Severe airflow obstruction and eosinophilic lung disease after Stevens-Johnson syndrome  

Microsoft Academic Search

Respiratory involvement is a frequent complication of Stevens-Johnson syndrome (SJS). However, there are very few convincing reports of persistent pulmonary sequelae, as demonstrated by spirometry, radiology and pathology. The current study presents a case of a 13-yr-old female with T-cell acute lymphocytic leukaemia who developed persistent, severe, obstructive lung disease following an episode of SJS. A lung biopsy demonstrated bronchiolar

A. P. Shah; H. Xu; P. J. Sime; D. R. Trawick



Nitric Oxide Synthase in Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome  

Microsoft Academic Search

Toxic epidermal necrolysis and Stevens–Johnson syndrome are severe cutaneous drug reactions of unknown mechanism. Nitric oxide can cause apoptosis and necrosis. The inducible form of nitric oxide synthase generates large amounts of nitric oxide and has been described in human skin. We propose that a large burst of nitric oxide in toxic epidermal necrolysis and Stevens–Johnson syndrome may cause the

Lisa H. Lerner; Abrar A. Qureshi; Bhaskar V. Reddy; Ethan A. Lerner



Stevens-Johnson syndrome after erythromycin therapy while deployed at sea.  


Stevens-Johnson syndrome is a cutaneous reaction pattern that represents the progression of symptoms of erythema multiforme. These reactions can range from mild (EM minor) to severe (EM major) and even life-threatening (Stevens-Johnson syndrome or toxic epidermal necrolysis). The difference between Stevens-Johnson syndrome and toxic epidermal necrolysis is the percentage of body surface area involved; toxic epidermal necrolysis involves widespread skin necrosis and bullous formation with epidermal detachment resembling scalded skin. The three most common triggers for Stevens-Johnson syndrome are herpes simplex infection, Mycoplasma infection, and drug reactions. This is a case of Stevens-Johnson syndrome occurring after erythromycin treatment aboard an aircraft carrier while deployed at sea in the Persian Gulf. PMID:10957862

Williams, D A



Stevens-Johnson syndrome developing in a girl with minimal change nephrotic syndrome on deflazacort therapy  

Microsoft Academic Search

RationaleStevens-Johnson syndrome is a vesiculobullous disease of skin and mucosa. This generalized hypersensitivity reaction is well known to occur in association with certain drugs or viral infections. The disease is often treated with corticosteroids. However, corticosteroids induced Stevens-Johnson syndrome have been described. We present a case with nephrotic syndrome who developed cutaneous bullae and mucositis while being treated with oral

W. Kim; E. Kim; H. Lee; J. Jeong; S. Nahm



Genetic predisposition to oxcarbazepine induced Stevens-Johnson syndrome.  


Stevens-Johnson syndrome (SJS) is a rare immunologic reaction that may involve skin or various mucosal surfaces. The etiology may range from multiple pharmacologic agents to viral infections. Associated findings can range from minimal skin and mucosal involvement to extensive dermal exfoliation, nephritis, lymphadenopathy, hepatitis, and multiple serologic abnormalities. We report a female patient of 38 years with a history of drug allergy who was administered oxcarbazepine for the management of right partial bronchial seizure due to left parasagittal mass lesion following which she developed papular rashes all over the body and diagnosed as SJS. Although carbamazepine (CBZ) is the most common cause of SJS, a new anticonvulsant, oxcarbazepine, which is structurally related to CBZ, has been shown to induce SJS. PMID:22013310

Wal, Pranay; Wal, Ankita; Pandey, Umeshwar; Rai, Awani K; Bhandari, Anil



HLA-A*0206 with TLR3 Polymorphisms Exerts More than Additive Effects in Stevens-Johnson Syndrome with Severe Ocular Surface Complications  

PubMed Central

Background Stevens-Johnson syndrome (SJS) is an acute inflammatory vesiculobullous reaction of the skin and mucosa, often including the ocular surface, and toxic epidermal necrolysis (TEN) occurs with its progression. Although SJS/TEN is thought to be initiated by certain types of medication coupled with possible infection. In the present study we examined the multiplicative interaction(s) between HLA-A*0206 and 7 Toll-like receptor 3 (TLR3) Single-nucleotide polymorphisms (SNPs) in patients with SJS/TEN. Principal Findings We analyzed the genotypes for HLA-A and 7 TLR3 SNPs in 110 Japanese SJS/TEN patients with severe ocular complications and 206 healthy volunteers to examine the interactions between the two loci. We found that HLA-A*0206 exhibited a high odds ratio for SJS/TEN (carrier frequency: OR?=?5.1; gene frequency: OR?=?4.0) and that there was a strong association with TLR3 rs.5743312T/T SNP (OR?=?7.4), TLR3 rs.3775296T/T SNP (OR?=?5.8), TLR3 rs.6822014G/G SNP (OR?=?4.8), TLR3 rs.3775290A/A SNP (OR?=?2.9), TLR3 rs.7668666A/A SNP (OR?=?2.7), TLR3 rs.4861699G/G SNP (OR?=?2.3), and TLR3 rs.11732384G/G SNP (OR?=?1.9). There was strong linkage disequilibrium (LD) between rs.3775296 and rs.5743312 and between rs.7668666 and rs.3775290. The results of interaction analysis showed that the pair, HLA-A*0206 and TLR3 SNP rs3775296T/T, which exhibited strong LD with TLR3 rs.5743312, exerted more than additive effects (OR?=?47.7). The other pairs, HLA-A*0206 and TLR3 rs.3775290A/A SNP (OR?=?11.4) which was in strong LD with TLR3 rs7668666A/A SNP, and TLR3 rs4861699G/G SNP (OR?=?7.6) revealed additive effects. Moreover, the combination HLA-A*0206 and TLR3 rs3775296T/T was stronger than the TLR3 rs6822014G/G and TLR3 rs3775290A/A pair, which reflected the interactions within the TLR3 gene alone. Significance By interaction analysis, HLA-A*0206 and TLR3 SNP rs3775296T/T, which were in strong LD with TLR3 SNP rs5743312T/T, manifested more than additive effects that were stronger than the interactions within the TLR3 gene alone. Therefore, multiplicative interactions of HLA-A and TLR3 gene might be required for the onset of SJS/TEN with ocular complications.

Ueta, Mayumi; Tokunaga, Katsushi; Sotozono, Chie; Sawai, Hiromi; Tamiya, Gen; Inatomi, Tsutomu; Kinoshita, Shigeru



Bronchiolitis obliterans in children with Stevens-Johnson syndrome: follow-up with high resolution CT  

Microsoft Academic Search

About one third of children with Stevens-Johnson syndrome have pulmonary involvement. As a consequence of airway epithelial injury, bronchiolitis obliterans can occur in these patients. Two cases of Stevens-Johnson syndrome-associated bronchiolitis obliterans in children were diagnosed and followed by high resolution CT without open lung biopsy. Serial changes of high resolution CT features of bronchiolitis obliterans are discussed and the

M. J. Kim; K. Y. Lee



Conjunctival inflammation in the chronic phase of Stevens–Johnson syndrome  

Microsoft Academic Search

AIMSTo understand the immunopathogenesis of the corneal conjunctivalisation in Stevens–Johnson syndrome.METHODSConjunctivalised corneas from five patients with Stevens–Johnson syndrome were studied immunohistochemically for several cell surface antigens and two cytokines. Chemical injury specimens were also studied.RESULTSIn all cases, immunohistochemistry revealed LFA-1, CD4, CD8, and CD68 on subepithelial infiltrating cells. Also, HLA-DR and ICAM-1 were found on the surfaces of epithelial cells,

Satoshi Kawasaki; Kohji Nishida; Chie Sotozono; Andrew J Quantock; Shigeru Kinoshita



Protein-Losing Cytomegalovirus Gastritis in a Patient with Stevens-Johnson Syndrome  

Microsoft Academic Search

We present a case of protein-losing cytomegalovirus gastritis in a previously immunocompetent 14-year-old Japanese girl that occurred during treatment of drug (zonisamide)-induced Stevens-Johnson syndrome with hepatic failure. Her hepatic failure and symptoms of Stevens-Johnson syndrome were successfully treated with intravenous prednisolone and infusion of fresh-frozen plasma or albumin, as the occasion demanded. However, during the course of treatment, she complained

Mikio Yoshioka; Nobuhisa Ishiguro; Xiaoming Ma; Hideaki Kikuta; Junichi Kodaira; Tomoo Itoh; Kunihiko Kobayashi



Technique of amniotic membrane transplant dressing in the management of acute Stevens-Johnson syndrome  

Microsoft Academic Search

Purpose: To report the technique of amniotic membrane transplantation dressing during the acute phase of Stevens-Johnson syndrome.Methods: Interventional case report. We report the clinical presentation, surgical technique and clinical outcome of a patient with acute Stevens-Johnson syndrome and progressive tarsal conjunctival epithelial loss.Results: A 10-year-old girl presented with extensive corneal, bulbar and tarsal conjunctival epithelial loss and severe ocular pain

Mahiul M K Muqit; Roger B Ellingham; Claire Daniel



Stevens-Johnson Syndrome triggered by chemical hair relaxer: a case report  

Microsoft Academic Search

This case report describes a 41-year-old Afro-Caribbean lady presenting with a constellation of pyrexia, conjunctivitis, arthralgia, sterile dysuria, apthous ulceration, labial crusting and widespread erythema multiforme. A diagnosis of Stevens-Johnson Syndrome was made. She had taken no medications recently (the most common precipitant of Stevens-Johnson Syndrome) and a full screen for the common and atypical bacterial and viral triggers was

Matthew J Booker



Oral Acetazolamide after Boston Keratoprosthesis in Stevens Johnson Syndrome  

PubMed Central

Background Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare but severe and sometimes fatal condition associated with exposure to medications; sulfamethoxazole is among the most common causes. We sought to address the safety of acetazolamide, a chemically related compound, in patients with prior SJS/TEN and glaucoma. A retrospective case series is described of patients at the Massachusetts Eye and Ear Infirmary who underwent keratoprosthesis surgery for corneal blindness from SJS/TEN, and later required oral acetazolamide for elevated intraocular pressure. Findings Over the last 10?years, 17 patients with SJS/TEN received a Boston keratoprosthesis. Of these, 11 developed elevated intraocular pressure that required administration of oral acetazolamide. One of 11 developed a mild allergic reaction, but no patient experienced a recurrence of SJS/TEN or any severe adverse reaction. Conclusion Although an increase in the rate of recurrent SJS/TEN due to oral acetazolamide would not necessarily be apparent after treating only 11 patients, in our series, acetazolamide administration was well tolerated without serious sequela.



Mycoplasma pneumoniae and Atypical Stevens-Johnson Syndrome: A Case Series  

Microsoft Academic Search

Mycoplasma pneumoniae is a common cause of community-acquired respiratory illness in the adolescent population. Stevens-Johnson syndrome is an extrapulmonary manifestation that has been associated with M pneumoniae infections. Three adolescent males presented within a 1-month period with M pneumoniae respiratory illnesses and severe mucositis but without the classic rash typical of Stevens-Johnson. Diagnosis was facilitated by the use of a

Karen A. Ravin; Lara D. Rappaport; Noel S. Zuckerbraun; Robert M. Wadowsky; Ellen R. Wald; Marian M. Michaels


Toxic epidermal necrolysis and Stevens-Johnson syndrome  

PubMed Central

Toxic epidermal necrolysis (TEN) and Stevens Johnson Syndrome (SJS) are severe adverse cutaneous drug reactions that predominantly involve the skin and mucous membranes. Both are rare, with TEN and SJS affecting approximately 1or 2/1,000,000 annually, and are considered medical emergencies as they are potentially fatal. They are characterized by mucocutaneous tenderness and typically hemorrhagic erosions, erythema and more or less severe epidermal detachment presenting as blisters and areas of denuded skin. Currently, TEN and SJS are considered to be two ends of a spectrum of severe epidermolytic adverse cutaneous drug reactions, differing only by their extent of skin detachment. Drugs are assumed or identified as the main cause of SJS/TEN in most cases, but Mycoplasma pneumoniae and Herpes simplex virus infections are well documented causes alongside rare cases in which the aetiology remains unknown. Several drugs are at "high" risk of inducing TEN/SJS including: Allopurinol, Trimethoprim-sulfamethoxazole and other sulfonamide-antibiotics, aminopenicillins, cephalosporins, quinolones, carbamazepine, phenytoin, phenobarbital and NSAID's of the oxicam-type. Genetic susceptibility to SJS and TEN is likely as exemplified by the strong association observed in Han Chinese between a genetic marker, the human leukocyte antigen HLA-B*1502, and SJS induced by carbamazepine. Diagnosis relies mainly on clinical signs together with the histological analysis of a skin biopsy showing typical full-thickness epidermal necrolysis due to extensive keratinocyte apoptosis. Differential diagnosis includes linear IgA dermatosis and paraneoplastic pemphigus, pemphigus vulgaris and bullous pemphigoid, acute generalized exanthematous pustulosis (AGEP), disseminated fixed bullous drug eruption and staphyloccocal scalded skin syndrome (SSSS). Due to the high risk of mortality, management of patients with SJS/TEN requires rapid diagnosis, evaluation of the prognosis using SCORTEN, identification and interruption of the culprit drug, specialized supportive care ideally in an intensive care unit, and consideration of immunomodulating agents such as high-dose intravenous immunoglobulin therapy. SJS and TEN are severe and life-threatening. The average reported mortality rate of SJS is 1-5%, and of TEN is 25-35%; it can be even higher in elderly patients and those with a large surface area of epidermal detachment. More than 50% of patients surviving TEN suffer from long-term sequelae of the disease.



Stevens-Johnson Syndrome triggered by chemical hair relaxer: a case report  

PubMed Central

This case report describes a 41-year-old Afro-Caribbean lady presenting with a constellation of pyrexia, conjunctivitis, arthralgia, sterile dysuria, apthous ulceration, labial crusting and widespread erythema multiforme. A diagnosis of Stevens-Johnson Syndrome was made. She had taken no medications recently (the most common precipitant of Stevens-Johnson Syndrome) and a full screen for the common and atypical bacterial and viral triggers was negative. The identified trigger was the use of a chemical hair relaxant treatment a few days previously. With supportive measures and a course of oral prednisolone, the patient quickly improved and made a full recovery. This case highlights the importance of considering occupational and recreational precipitants of Stevens-Johnson Syndrome.

Booker, Matthew J



Erythema multiforme and Stevens-Johnson syndrome\\/toxic epidermal necrolysis associated with lupus erythematosus  

Microsoft Academic Search

BackgroundThe occurrence of erythema multiforme (EM)-like lesions in association with lupus erythematosus (LE) is often referred to as “Rowell syndrome”. However, the existence of Rowell's syndrome, or at least its nosographic independence from LE, is questioned. The association of Stevens-Johnson syndrome (SJS)\\/toxic epidermal necrolysis (TEN) with LE is also controversial.

Daniele Torchia; Paolo Romanelli; Francisco A. Kerdel


Stevens-Johnson syndrome in a boy with nephrotic syndrome during prednisolone therapy  

Microsoft Academic Search

Stevens-Johnson syndrome (SJS) is a mucocutaneous disease that can be lethal. It can occur in association with altered immunological conditions and the administration of various drugs, including corticosteroids. We report a case of SJS in a 14-year-old male with nephrotic syndrome, who was treated with oral prednisolone for 6 weeks. He presented symptoms of fever, skin lesions consisting of multiple vesiculopapular

Dae Sun Jo; Jun-Won Yang; Pyoung Han Hwang; Dae-Yeol Lee



Intravenous Ulinastatin Therapy for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Pediatric Patients  

Microsoft Academic Search

Background: More effective therapy is needed for the treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The clinical efficacy of intravenous ulinastatin therapy was investigated in 3 Japanese pediatric patients with SJS or TEN. Methods: Ulinastatin was given to 1 pediatric SJS patient and 2 pediatric TEN patients within 7 days (patient 1; SJS), 6 days (patient 2;

Yasuji Inamo; Takahiro Okubo; Mika Wada; Sachiko Fuchigami; Kouji Hashimoto; Tatsuo Fuchigami; Shigeru Takahashi; Shigemasa Sawada; Kensuke Harada



Immune Complexes in Erythema Multiforme and the Stevens-Johnson Syndrome  

Microsoft Academic Search

Early cutaneous lesions of erythema multiforme or mucosal lesions of the Stevens-Johnson syndrome contain delicate granular deposits of immune reactants and\\/or complement components lodged in the walls of vessels of the papillary dermis. Such deposits are not present in normal, unaffected skin although they can be caused to occur there by injection of substances which increase vascular permeability. Factors which

Kirk D. Wuepper; Patricia A. Watson; John A. Kazmierowski



Stevens-Johnson syndrome limited to multiple sites of radiation therapy in a patient receiving phenobarbital  

Microsoft Academic Search

Stevens-Johnson syndrome (SJS) is a severe cutaneous eruption that most often appears as an adverse reaction to a medication. There have been 21 reported cases of atypical erythema multiforme, toxic epidermal necrolysis, and SJS arising in patients receiving radiation therapy in addition to phenytoin, phenobarbital, or carbamazepine. We report the second case of SJS resulting from concomitant phenobarbital and radiation

Karynne O. Duncan; Robert E. Tigelaar; Jean L. Bolognia



Analysis of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Japan from 2000 to 2006  

Microsoft Academic Search

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse drug reactions with high mortality. Methods: To present the current clinical characteristics and treatment of SJS and TEN in Japan, we retro- spectively analyzed reports of SJS and TEN published in medical journals from 2000 to 2006. Results: Fifty-two cases of SJS (19 males and 33 females; mean

Yumiko Yamane; Michiko Aihara; Zenro Ikezawa



Stevens–Johnson syndrome with sulfasalazine treatment: Report of two cases  

Microsoft Academic Search

We report two cases of Stevens–Johnson syndrome (SJS) associated with the use of sulfasalazine in two ulcerative colitis patients previously tolerant to mesalamine. SJS and toxic epidermal necrolysis (TEN) are very rare adverse cutaneous reactions that can be associated with the use of sulfasalazine. The most severe cases can result in death, and for the others, permanent skin, mucosal or

Lydjie Tremblay; Guillaume Pineton de Chambrun; Bénédicte De Vroey; Céline Lavogiez; Emmanuel Delaporte; Jean-Frédéric Colombel; Antoine Cortot



Concomitant use of lamotrigine and aripiprazole increases risk of Stevens-Johnson syndrome?  


Stevens-Johnson syndrome is a severe and potentially life-threatening cutaneous reaction associated with lamotrigine. The incidence of developing Stevens-Johnson syndrome during lamotrigine therapy is low. On the basis of the glutamate and dopamine neuron dysregulation hypothesis in schizophrenia, we propose new strategies for the treatment of schizophrenic patients using a glutamate system stabilizer lamotrigine as an adjunctive treatment for the poor responders of a dopamine system stabilizer, aripiprazole. The finding of Stevens-Johnson syndrome in two cases out of three treated with lamotrigine plus aripiprazole, however, has a much higher index of suspicion and it is correct to warn of its possible raised risk. As lamotrigine is currently licensed for the prophylactic treatment of bipolar depression, many of these patients have psychotic features where it would be considered reasonable to add an antimanic atypical antipsychotic such as aripriprazole. The two case reports raised the question about the possible increased risk of Stevens-Johnson syndrome with the combination therapy. PMID:17519650

Shen, Yu-Chih; Chen, Shaw-Ji; Lin, Chaucer C H; Chen, Chia-Hsiang



Two cases of Stevens–Johnson syndrome following intake of klavox with review of literature  

Microsoft Academic Search

We present two case reports of Stevens-Johnson syndrome (triad of fever, stomatitis and conjunctivitis) due to klavox (amoxicillin\\u000a + clavulanic acid) which has been reported in few publications as etiology but it is not commonly seen. We conclude that klavox\\u000a can precipitate development of SJS.

Kamal-Eldin Ahmed Abou-Elhamd



Vanishing bile duct and Stevens-Johnson syndrome associated with ciprofloxacin treated with tacrolimus  

Microsoft Academic Search

Stevens-Johnson syndrome (SJS) is a serious and potentially life-threatening disease. Vanishing bile duct syndrome (VBDS) is a rare cause of progressive cholestasis. Both syndromes are mostly related with drugs. We report a case of a patient with ciprofloxacin-induced SJS and acute onset of VBDS, and reviewed the related literature. It is the first case of ciprofloxacin-induced VBDS successfully treated with

Gokhan Okan; Serpil Yaylaci; Onder Peker; Sabahattin Kaymakoglu; Murat Saruc



Use of intravenous immunoglobulin in toxic epidermal necrolysis and Stevens–Johnson syndrome: Our current understanding  

Microsoft Academic Search

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN, Lyell's disease, syndrome) are considered to be part of a spectrum of adverse cutaneous drug reactions with increasing severity and extent of skin detachment, ranging from SJS (less than 10% body surface area skin detachment, 1–5% mortality) to TEN (greater than 30% skin detachment, 25–35% mortality).Both SJS and TEN are characterized morphologically

Lars E. French; Jennifer T. Trent; Francisco A. Kerdel



An Unusual Combination of Phototoxicity and Stevens-Johnson Syndrome due to Antimalarial Therapy  

Microsoft Academic Search

A 12-year-old boy developed a phototoxic rash with subsequent progression to Stevens-Johnson syndrome due to prophylactic ingestion of antimalarials (chloroquine and sulfadoxine-pyrimethamine; Fansidar®). The patient recovered from his skin symptoms after 4 weeks during which he received systemic corticosteroids and antibiotics. This unusual combination of two different patterns of adverse cutaneous drug reactions was most probably caused by the sulfonamide

B. Ordel; A. Sivayathorn; H. Hönigsmann



Positive patch test with phenytoin in a case of Stevens-Johnson syndrome  

Microsoft Academic Search

Background: The Stevens-Johnson syndrome (SJS) or erythema multiformis ma- jor a rather infrequent reaction with a possible immunologic mechanism, with a mean yearly incidence estimated at 1-2 cases per million population. Phenytoin and other anticonvulsivants, such as phenobarbital and carbamazepine, have be- en associated to SJS cases. We report the case of a 40-year-old female who had been diagnosed of

J. Martínez Escribano; J. D. López Sánchez


Stevens-Johnson syndrome in children receiving phenobarbital therapy and cranial radiotherapy  

Microsoft Academic Search

Stevens-Johnson syndrome (SJS) is a severe cutaneous eruption that most often appears as an adverse reaction to medication.\\u000a In this report, we present two children with brain tumour who developed SJS while receiving cranial irradiation and anticonvulsant\\u000a therapy with phenobarbital. Concomitant application of these two therapies may play an important role in the occurrence of\\u000a the disease.

Antonio Ruggiero; Paola Sabrina Buonuomo; Palma Maurizi; Maria Pia Cefalo; Mirta Corsello; Riccardo Riccardi



Erythema exsudativum multiforme majus (Stevens-Johnson-Syndrom) infolge Suxinutin-Überempfindlichkeit  

Microsoft Academic Search

Bei einem 13jährigen Mädchen mit Retropulsiv-Petit mal-Epilepsie tritt unter Suxinutin am 8. Tage ein masernähnlicher rash und 9 Monate nach Absetzen des Medikamentes bei einem zweiten Behandlungsversuch am 7. Tage ein sogenanntes Stevens-Johnson-Syndrom auf. Das schwere Krankheitsbild klingt mit intensiver Behandlung einschließlich hoher Cortisongaben innerhalb weniger Tage komplikationslos ab. Es wird als symptomatisches Erythema exsudativum multiforme majus infolge Sensibilisierung durch

Klaus Müller



Diagnosis, classification, and management of erythema multiforme and Stevens–Johnson syndrome  

Microsoft Academic Search

BACKGROUNDIn adults, erythema multiforme (EM) is thought to be mainly related to herpes infection and Stevens–Johnson syndrome (SJS) to drug reactions.AIMSTo investigate this hypothesis in children, and to review our experience in the management of these patients.METHODSA retrospective analysis of 77 paediatric cases of EM or SJS admitted to the Children's Hospital in Bordeaux between 1974 and 1998.RESULTSThirty five cases,

C Léauté-Labrèze; T Lamireau; D Chawki; J Maleville; A Taïeb



Sight and comfort: complex procedures in end-stage Stevens–Johnson syndrome  

Microsoft Academic Search

Background: We describe our complex surgical techniques in the management of a patient with end-stage ocular surface disease from Stevens–Johnson syndrome.Methods and results: Her severe discomfort due to absolute ocular dryness in the right eye was successfully treated with submandibular gland autotransplantation. Impending loss of the left eye due to repeated perforation and infection was prevented with a penetrating corneal

G Geerling; C S C Liu; J K G Dart; P Sieg; J Herold; J R O Collin



Stevens-Johnson syndrome associated with concomitant use of lamotrigine and valproic acid  

Microsoft Academic Search

Lamotrigine (LTG) is a novel antiepileptic drug effective in partial and generalized seizures. Recently, this drug has started being used for mood stabilization in psychiatric patients. Cutaneous side effects of this drug are mostly maculopapular eruptions that have been seen in 3% to 10% of patients. We describe a 33-year-old female patient in whom Stevens-Johnson syndrome (SJS) developed because of

Ba?ak Yalçin; Ay?en Karaduman



Stevens-Johnson Syndrome Induced by Combination of Imatinib and Allopurinol  

Microsoft Academic Search

We report a case of Stevens-Johnson syndrome (SJS) caused by imatinib combined with allopurinol. An 82-year-old female patient who had a diagnosis of chronic myeloid leukemia was initially treated with imatinib 200 mg\\/day and allopurinol 100 mg for 42 days, and had a satisfactory hematological response. The dose of imatinib was adjusted to 400 mg\\/day for 14 days. After two

Huei-Jen Hsieh; Agnes L. F. Chan; Shun-Jen Lin



Fatal Stevens-Johnson syndrome following urography with iopamidol in systemic lupus erythematosus  

Microsoft Academic Search

A 46 year old white woman with active systemic lupus erythematosus developed a skin rash 8 hours after intravenous urography with the non-ionic contrast medium iopamidol. Severe Stevens-Johnson syndrome with erythema multiforme, intrahepatic cholestasis, pulmonary infiltrates and acute renal failure ensued, leading to her death. Although non-ionic contrast media are generally less toxic than traditional ionic agents, their use in

J. S. Savill; R. Barrie; S. Ghosh; M. Muhlemann; P. Dawson; C. D. Pusey



Irradiated fields spared Stevens-Johnson syndrome in a patient undergoing radiotherapy for bone metastases  

Microsoft Academic Search

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are two of the most severe, rare, and life-threatening\\u000a adverse reactions to medications. Their incidence is approximately two patients per million population per year. Several cases\\u000a have been reported in the literature in which SJS and TEN have occurred in patients with a neoplasm undergoing radiation therapy\\u000a and who are taking an

Daniela Musio; Elisabetta Parisi; Francesco Dionisi; Giuseppe Parisi; Rossella Caiazzo; Nadia Bulzonetti; Miriam Lichtner; Nicola Raffetto; Vincenzo Vullo; Enzo Banelli



Relevance and consequences of erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis in gynecology  

Microsoft Academic Search

Background  Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) can be distinguished by location,\\u000a morphology and extent of cutaneous and mucosal lesions. EM has minimal effects on pregnancy and the genital tract. SJS and\\u000a TEN on the other hand are related with premature labor and vaginal scarring that can lead to long-term painful lesions, stenosis,\\u000a vaginal adenosis and

Ilse C. Niemeijer; Marinus C. G. van Praag; Nicolette van Gemund



Management of Dysphagia in Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson Syndrome (SJS)  

Microsoft Academic Search

Toxic epidermal necrolysis (TEN) is a rare and potentially fatal skin disorder, precipitated by severe allergic drug reaction,\\u000a and is one of a spectrum of conditions, which includes Stevens-Johnson syndrome (SJS). Mucosal involvement is common, resulting\\u000a in extreme pain on swallowing and poor oral intake. The aim of this study was to describe swallow function in TEN and SJS\\u000a and

Nicola A. Clayton; Peter J. Kennedy



A Case of Severe Stevens-Johnson Syndrome Successfully Treated by Osteo-odonto-keratoprosthesis Surgery  

Microsoft Academic Search

It is difficult to treat severe Stevens-Johnson syndrome (SJS) patients with completely dry ocular surfaces, even using corneal transplantation with amniotic membrane and limbal grafts. 1 For such cases, osteo-odontokeratoprosthesis (OOKP), 2?5 which was first described by Strampelli, 2 and Falcinelli et al., 3 is a useful method for visual rehabilitation. We believe OOKP can be performed without prior surgery.

Masahiko Fukuda; Akira Nakao; Suguru Hamada; Christopher Liu; Yoshikazu Shimomura



Stevens–Johnson syndrome induced by mizoribine in a patient with systemic lupus erythematosus  

Microsoft Academic Search

A 32-year-old Japanese woman, who had a treatment history of systemic lupus erythematosus (SLE) with lupus nephritis World\\u000a Health Organization class IV for 11 months, visited our hospital due to fever, facial erythema, and erosion of the oral cavity\\u000a on November 10, 2003. Her mucosal erosion and facial skin erythema progressed over the following week, and Stevens–Johnson\\u000a syndrome was diagnosed

Kakushi Matsushita; Atsuo Ozaki; Hirosaka Inoue; Tomoe Kaieda; Masaki Akimoto; Atsushi Satomura; Naomichi Arima; Heiichiro Hamada; Yukio Suruga; Noriko Aoki; Hiroshi Fujiwara; Chuwa Tei



Stevens-Johnson Syndrome in India – Risk Factors, Ocular Manifestations and Management  

Microsoft Academic Search

We conducted a study to analyse the presentation, risk factors, ocular manifestations and ophthalmic management results of Stevens-Johnson syndrome (SJS) in Indian patients. A total of 20 patients with SJS with ocular involvement were studied. Female predominance (70%) was observed. The age ranged from 10 to 30 years (mean ± SD: 16.85 ± 5.96). The commonest precipitating risk factor was

Neelam Pushker; Radhika Tandon; Rasik B. Vajpayee



Mycoplasma pneumoniae infection is associated with Stevens-Johnson syndrome, not erythema multiforme (von Hebra)  

Microsoft Academic Search

A review of the English-language medical literature revealed at least 70 cases of well-documented Mycoplasma pneumoniae infections associated with the Stevens-Johnson syndrome. There were no cases associated with erythema multiforme (von Hebra). Most of the patients were children and young adults, and male patients were more commonly affected. Most patients had prodromal symptoms of an upper respiratory tract infection before

Yong-Kwang Tay; J. Clark Huff; William L Weston



Acute Renal Failure and Its Risk Factors in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis  

Microsoft Academic Search

Background: Skin lesion is the most frequent manifestation of adverse drug reactions. Drug-induced cutaneous hypersensitivity and drug-induced acute interstitial nephritis might share a similar mechanism involving drug-specific T cells. We thus investigated the renal outcome of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), the most severe drug-induced cutaneous hypersensitivity, and hypothesize that skin detachment in SJS\\/TEN might be associated

Chi-Chih Hung; Wan-Chun Liu; Mei-Chuan Kuo; Chih-Hung Lee; Shang-Jyh Hwang; Hung-Chun Chen



Fatal Stevens-Johnson syndrome following urography with iopamidol in systemic lupus erythematosus.  

PubMed Central

A 46 year old white woman with active systemic lupus erythematosus developed a skin rash 8 hours after intravenous urography with the non-ionic contrast medium iopamidol. Severe Stevens-Johnson syndrome with erythema multiforme, intrahepatic cholestasis, pulmonary infiltrates and acute renal failure ensued, leading to her death. Although non-ionic contrast media are generally less toxic than traditional ionic agents, their use in patients with immunological disease may be hazardous. Images Figure 1

Savill, J. S.; Barrie, R.; Ghosh, S.; Muhlemann, M.; Dawson, P.; Pusey, C. D.



Infectious crystalline keratopathy and endophthalmitis secondary to mycobacterium abscessus in a monocular patient with Stevens-Johnson syndrome  

Microsoft Academic Search

PURPOSE: To describe the clinical and laboratory features of infectious crystalline keratopathy and endophthalmitis secondary to Mycobacterium abscessus in a patient with Stevens-Johnson syndrome.METHOD: Case report. A 19-year-old man with a history of Stevens-Johnson syndrome and multiple corneal transplants developed white crystalline corneal infiltrates.RESULTS: Anterior chamber aspirate disclosed acid-fast bacilli. A repeat corneal transplant was performed and antibiotic therapy begun.

Harvey S Uy; Quan D Nguyen; Marlene L Durand; Barbara Paton; C. Stephen Foster



Stevens-Johnson syndrome associated with ciprofloxacin: A review of adverse cutaneous events reported in Sweden as associated with this drug  

Microsoft Academic Search

Stevens-Johnson syndrome is a severe mucocutaneous reaction, which can be elicited by various drugs. We present 2 cases with this syndrome associated with ciprofloxacin treatment and review the adverse cutaneous events reported as possibly related to ciprofloxacin treatment in Sweden between 1988 and 2000. Eight cases, excluding ours, of Stevens-Johnson syndrome, toxic epidermal necrolysis, and erythema multiforme were reported. This

Jenny Hällgren; Maria Tengvall-Linder; Matty Persson; Carl-Fredrik Wahlgren



Reactivation of Cytomegalovirus in a Patient with Stevens-Johnson Syndrome-Toxic Epidermal Necrolysis  

PubMed Central

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse cutaneous reactions to drugs. We describe the case of a 19 year old patient with SJS/TEN overlap syndrome, who developed severe interstitial pneumonia after she had received antiepileptic drugs. A cytomegalovirus infection was diagnosed by Real Time Polymerase Chain Reaction (RT-PCR) detection on Bronchoalveolar lavage. Based on observations on biological data, temporal relationship, and clinical features, it could be inferred that the reactivation of cytomegalovirus with viral replication can predispose a person to TEN-SJS. We discuss here, in the light of the current literature, the probable association between drug-induced SJS-TEN and fulminant reactivation of cytomegalovirus.

Tagajdid, Mohamed Rida; Doblali, Taoufik; Elannaz, Hicham; Hammi, Salaheddine; Belfequih, Bouchra; Mrani, Saad



Aetiology in Sixteen Cases of Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome Admitted within Eight Months in a Teaching Hospital  

Microsoft Academic Search

Toxic epidermal necrolysis and Stevens-Johnson syn- drome are serious cutaneous reactions associated with significant mortality and morbidity. Eight patients with toxic epidermal necrolysis and eight patients with Stevens-Johnson syndrome were admitted consecutively to a single centre between August 2001 and March 2002. An aetiological study including viral serology and PCR was performed in view of the clustering of admissions related

Chi Keung Yeung; Malik Peiris; Shing Yan Ma; Henry Hin Lee Chan; Charmine Hon



Clinical characteristics of childhood erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis in Taiwanese children  

Microsoft Academic Search

Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are mucocutaneous diseases associated with significant morbidity and mortality. This study compared childhood EM, SJS and TEN in terms of clinical courses, laboratory data, etiologies and outcomes in Taiwan. The initial laboratory findings, clinical presentations, etiologies and subsequent clinical courses of 30 patients with a diagnosis of EM, SJS

Nga-Shuen Lam; Yao-Hsu Yang; Li-Chieh Wang; Yu-Tsan Lin; Bor-Luen Chiang


Multifocal Stevens-Johnson syndrome after concurrent phenytoin and cranial and thoracic radiation treatment, a case report  

Microsoft Academic Search

A 46 year old male patient with metastatic prostate cancer developed Stevens-Johnson syndrome (SJS), initially in three well-demarcated areas on his scalp, chest and back, corresponding to ports of radiation therapy while on phenytoin. The rash spread from these locations and became more generalized and associated with pain and sloughing in the mucous lining of the mouth. There is a

Abdullah O Kandil; Tomas Dvorak; John Mignano; Julian K Wu; Jay-Jiguang Zhu



Are Multimorbidities Underestimated in Scoring Systems of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Like in SCORTEN?  

PubMed Central

Objective: Toxic epidermal necrolysis and Stevens-Johnson syndrome have related high morbidity and mortality. We predict that preexisting multimorbidity is a major prognostic factor of both these diseases. Methods: A retrospective analysis in toxic epidermal necrolysis and Stevens-Johnson syndrome patients over the past 10 years. Three severity categories (minor, moderate, and severe multimorbidity) were defined according to a point-rating system. Results: Twenty-seven inpatients, with a median age of 63 years, diagnosed with toxic epidermal necrolysis (n = 13) or Stevens-Johnson syndrome/toxic epidermal necrolysis (n = 14) were assessed in this study. Of these, 14 patients died during the course of the study. Nonsurvivors showed significantly higher multimorbidity (P = .038), with higher scoring on the points system for disease severity (P = .003), than survivors and CART (Classification and Regression Trees) cross-validation (P < .05). Limitations: Restricted number of patients due to low prevalence rate. Conclusion: The complexity of associated multimorbidity appears to have a large influence on toxic epidermal necrolysis and Stevens-Johnson syndrome prognosis, which has not been considered in any of the established scoring systems.

von Wild, Tobias; Stollwerck, Peter L.; Namdar, Thomas; Stang, Felix H.; Mailander, Peter; Siemers, Frank



Erythema multiforme and Stevens-Johnson syndrome in patients receiving cranial irradiation and phenytoin  

SciTech Connect

In 15 months we encountered eight patients with intracranial tumors who developed erythema multiforme (EM) or erythema multiforme bullosa (Stevens-Johnson syndrome). All occurred shortly after use of phenytoin (DPH) and brain radiation therapy (WBRT). The clinical picture differed from the classic form of EM in that the erythema began on the scalp and spread to the extremities, progressing in three cases to extensive bullous formation. There were no cases of EM among patients who received either DPH or radiotherapy alone. The combination of DPH, WBRT, and tapering of steroids seems to predispose to EM. The pathogenesis of the disorder is probably immunologic. In the absence of seizures, anticonvulsants should not be given routinely to patients with brain tumors. When anticonvulsants are necessary in patients scheduled for WBRT, DPH may not be the drug of choice.

Delattre, J.Y.; Safai, B.; Posner, J.B.



Drug-associated acute-onset vanishing bile duct and Stevens–Johnson syndromes in a child  

Microsoft Academic Search

Acute vanishing bile duct syndrome is a rare but established cause of progressive cholestasis in adults, is most often drug or toxin related, and is of unknown pathogenesis. It has not been reported previously in children. Stevens–Johnson syndrome is a well-recognized immune complex–mediated hypersensitivity reaction that affects all age groups, is drug or infection induced, and has classic systemic, mucosal,

Maya Srivastava; Maureen M. Jonas



Effect of High-Dose Intravenous Immunoglobulin Therapy in Stevens-Johnson Syndrome: A Retrospective, Multicenter Study  

Microsoft Academic Search

Background:Stevens-Johnson syndrome (SJS) is a severe cutaneous drug reaction associated with considerable morbidity, possible transition to toxic epidermal necrolysis (TEN) and death in certain cases. Objective: To determine whether treatment with high-dose IVIG in SJS patients may improve outcome. Methods: Data from 12 patients (collected between January 1997 and November 2000 from7 university dermatology centers in Europe and North America)

Christa Prins; Carmela Vittorio; R. Steven Padilla; Thomas Hunziker; Peter Itin; John Förster; Eva-B. Bröcker; Jean-Hilaire Saurat; Lars E. French



The Risk of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Associated with Nonsteroidal Antiinflammatory Drugs: A Multinational Perspective  

Microsoft Academic Search

Objective. To quantify the risk ofthe severe cutaneous adverse reactions Stevens-Johnson syndrome (SJS) and toxic epidennal necrolysis (TEN) associated with use of nonsteroidal antiinflammatory drugs (NSAID). Methods. ThreeJarge data sources were analyzed: an international case-control study on severe cuta­ neous reactions (SCAR Study), a population based registry in Gennany, and the US Food and Drug Administration (FDA) spontaneous reporting system.



Hydrogen-Cyanamide-Related Severe Cutaneous Reactions Simulating Erythema multiforme and Stevens-Johnson Syndrome\\/Toxic Epidermal Necrolysis  

Microsoft Academic Search

Fifteen grapevine workers developed skin reactions resembling erythema multiforme (EM) and Stevens-Johnson syndrome\\/toxic epidermal necrolysis (SJS\\/TEN) following exposure to Dormex, a plant growth regulator, the active ingredient of which is hydrogen cyanamide. Five patients needed hospitalization, and all recovered following treatment. Whether these were contact EM-like reactions due to hydrogen cyanamide or classical EM, SJS-TEN induced by this chemical remains

Arun C. Inamadar; Aparna Palit



Soluble Fas Ligand: Is It a Critical Mediator of Toxic Epidermal Necrolysis and Stevens–Johnson Syndrome?  

Microsoft Academic Search

Although soluble Fas ligand (sFasL) is an important candidate in toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS), Stur and colleagues report that elevated sFasL has been detected in maculopapular rashes. In addition to sFasL, other factors, including predisposing genetic factors, should also be investigated to determine their precise pathogenesis in TEN and SJS.

Junko Murata; Riichiro Abe



Phenytoin-induced Stevens–Johnson syndrome with negative HLA-B*1502 allele in mainland China: Two cases  

Microsoft Academic Search

Antiepileptic drugs-induced Stevens–Johnson syndrome (SJS) is a life-threatening severe cutaneous adverse reaction. Recent studies in Thailand and Taiwan showed a significant association between phenytoin (PHT)-induced SJS and human leucocyte antigen HLA-B*1502 allele. Although the US FDA had issued an alert to clinicians, insufficient information is available to recommend testing for HLA-B*1502 in Asian patients in line for PHT treatment. Therefore,

Fa-Yun Hu; Xin-Tong Wu; Dong-Mei An; Bo Yan; Hermann Stefan; Dong Zhou



Stevens-Johnson syndrome caused by combined use of lamotrigine and fluoxetine and review of the literature  

Microsoft Academic Search

Stevens-Johnson syndrome (SJS) is a rare, life-threatening acute allergic drug reaction presenting with target lesions and\\u000a blebs of epidermis. Although a variety of etiologies such as infections and underlying malignancies have been implicated as\\u000a potential causes of SJS, drugs remain the predominant inciting agent. This report presents a SJS case due to combined use\\u000a of lamotrigine and fluoxetine. A 41-year-old

Mehmet Ulu?; Nuray Can Ulu?; Mustafa Kemal Celen; Mehmet Faruk Geyik; Celal Ayaz



Drug Rash with Eosinophilia and Systemic Symptoms versus Stevens-Johnson Syndrome – a Case that Indicates a Stumbling Block in the Current Classification  

Microsoft Academic Search

A 43-year-old man developed a skin eruption characterized by ‘macules with blisters’ typical to Stevens-Johnson syndrome, as well as erosions of the lips and buccal mucosa, 2 weeks after he had started treatment with lamotrigine. He had a fever (39.6°C), elevated liver enzymes and atypical lymphocytes in the peripheral blood. This undoubtedly reflects a case of Stevens-Johnson syndrome induced by

Ronni Wolf; Batya Davidovici; Hagit Matz; Keren Mahlab; Edith Orion; Zev M. Sthoeger



Stevens-Johnson syndrome and toxic epidermal necrolysis: consequence of treatment of an emerging pathogen.  


We report a case of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) secondary to trimethoprim-sulfamethoxazole (TMP-Sx) therapy for presumed community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. Although the association between SJS/TEN and the sulfonamide class of antibiotics is well established, the increasing prevalence of CA-MRSA has left practitioners with limited regimens to effectively treat skin and soft tissue infections (SSTIs) in the outpatient setting. In the case of SSTIs, alternative treatment of these infections should be considered, especially when the bacterial pathogen is unknown. Future investigations evaluating the efficacy of adjunctive antibiotics for purulent SSTIs and monitoring the incidence of SJS/TEN in the era of CA-MRSA are necessary to reduce unnecessary use of sulfonamide drugs. The potential development of SJS/TEN, a severe life-threatening illness, emphasizes the need for judicious use of TMP-Sx and close monitoring and follow-up for patients who were given TMP-Sx for SSTIs. PMID:19687711

Mistry, Rakesh D; Schwab, Sandra H; Treat, James R



Genome-wide association study of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Europe  

PubMed Central

Background Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but extremely severe cutaneous adverse drug reactions in which drug-specific associations with HLA-B alleles were described. Objectives To investigate genetic association at a genome-wide level on a large sample of SJS/TEN patients. Methods We performed a genome wide association study on a sample of 424 European cases and 1,881 controls selected from a Reference Control Panel. Results Six SNPs located in the HLA region showed significant evidence for association (OR range: 1.53-1.74). The haplotype formed by their risk allele was more associated with the disease than any of the single SNPs and was even much stronger in patients exposed to allopurinol (ORallopurinol = 7.77, 95%CI = [4.66; 12.98]). The associated haplotype is in linkage disequilibrium with the HLA-B*5801 allele known to be associated with allopurinol induced SJS/TEN in Asian populations. Conclusion The involvement of genetic variants located in the HLA region in SJS/TEN is confirmed in European samples, but no other locus reaches genome-wide statistical significance in this sample that is also the largest one collected so far. If some loci outside HLA play a role in SJS/TEN, their effect is thus likely to be very small.



HLA-B*1502 genotyping in two Chinese patients with phenytoin-induced Stevens–Johnson syndrome  

Microsoft Academic Search

Previous studies have reported that patients with phenytoin-induced Stevens–Johnson syndrome and toxic epidermal necrolysis (PHT-induced SJS\\/TEN) were positive for HLA-B*1502. We genotyped two patients with PHT-induced SJS using both polymerase chain reaction with sequence-specific primers and sequencing. The results revealed that one patient from Henan Province had HLA-B*1501\\/B*5401, and the other patient from Guangdong Province had HLA-B*1502\\/B*4601. When this information

Fu-Li Min; Yi-Wu Shi; Xiao-Rong Liu; Wei-Ping Liao




PubMed Central

Background: Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), are the acute emergencies in dermatology practice. Prompt diagnosis and management may reduce the morbidity and mortality in SJS/TEN patients. Early identification of the offending drug is necessary for early withdrawal and to prevent the recurrences of such a devastating illness. Aims To study the demography, offending agents, clinical and laboratory features, treatment, complications, morbidity and mortality of SJS/TEN in our hospital. Materials and Methods: In this retrospective study, we reviewed the medical records of SJS, TEN, SJS/TEN overlap of inpatients over a period of 10 years Results: Maximum number of SJS/TEN cases were in the age group of 11-30 years. Males predominated in the SJS group with a ratio of 1.63:1, whereas females predominated the TEN group with a ratio of 1:2.57.Nonsteroidal anti-inflammatory drugs (NSAIDs) were the commonest group of drugs among the SJS group in 5/21 patients (23.8%). Antimicrobials were the commonest group of drugs causing TEN in 11/25 patients (44%). Mucosal lesions preceded the onset of skin lesions in nearly 50%. Our study had one patient each of SJS/TEN due to amlodipine and Phyllanthus amarus, an Indian herb. The most common morbidity noted in our study was due to ocular sequelae and sepsis leading to acute renal failure respectively. Kaposi's varicelliform eruption was found in three of our patients. Conclusion: Antimicrobials and NSAIDS are the common offending agents of SJS/TEN in our study.

Sanmarkan, Abarna Devi; Sori, Tukaram; Thappa, Devinder Mohan; Jaisankar, T J



The Use of Autologous Serum in the Development of Corneal and Oral Epithelial Equivalents in Patients with Stevens-Johnson Syndrome  

Microsoft Academic Search

PURPOSE. To evaluate the use of autologous serum (AS) from patients with severe ocular surface disease (OSD) in the devel- opment of transplantable corneal and oral epithelial tissue equivalents and to compare it with the use of conventional culture methods by using fetal bovine serum (FBS). METHODS. AS was obtained from patients with severe OSD secondary to Stevens-Johnson syndrome. Corneal

Takahiro Nakamura; Leonard P. K. Ang; Helen Rigby; Eiichi Sekiyama; Tsutomu Inatomi; Chie Sotozono; Nigel J. Fullwood; Shigeru Kinoshita



Amniotic Membrane Transplantation as a New Therapy for the Acute Ocular Manifestations of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis  

Microsoft Academic Search

Stevens-Johnson syndrome and its more severe variant, toxic epidermal necrolysis, have relatively low overall incidence; however, this disease presents with high morbidity and mortality. The majority of patients develop ocular inflammation and ulceration at the acute stage. Due to the hidden nature of these ocular lesions and the concentration of effort toward life-threatening issues, current acute management has not devised

Elizabeth Shay; Ahmad Kheirkhah; Lingyi Liang; Hossam Sheha; Darren G. Gregory; Scheffer C. G. Tseng



Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Assessment of Medication Risks with Emphasis on Recently Marketed Drugs. The EuroSCAR-Study  

Microsoft Academic Search

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe cutaneous adverse reactions (SCAR) related to a variety of medications. They have a significant public health impact because of high mortality and morbidity. A multinational case–control study conducted in Europe between 1997 and 2001 evaluated the risk of medications to induce SCAR. Cases were actively detected through a

Maja Mockenhaupt; Cecile Viboud; Ariane Dunant; Luigi Naldi; Sima Halevy; Jan Nico Bouwes Bavinck; Alexis Sidoroff; Jürgen Schneck; Jean-Claude Roujeau; Antoine Flahault



Stevens-Johnson syndrome after lenalidomide therapy for multiple myeloma: a case report and a review of treatment options.  


Stevens- Johnson syndrome (SJS) is a severe and life-threatening condition. Although allopurinol, an antihyperuricemia drug, is the drug most commonly associated with SJS, more than 100 different causative drugs have been reported. Among hematologic drugs recently introduced into the market, drugs such as rituximab, imatinib, and bortezomib are reported. Here, we describe a patient with SJS while receiving lenalidomide in combination with prednisolone for treatment-naïve multiple myeloma. Although SJS has been reported rarely as an adverse reaction to Lenalidomide, this drug should be considered in the etiology of SJS, and the increased number of prescriptions of Lenalidomide for the therapy of multiple myeloma has to stress the awareness of its potentially serious side-effects. PMID:21702057

Allegra, Alessandro; Alonci, Andrea; Penna, Giuseppa; Russo, Sabina; Gerace, Demetrio; Greve, Bruna; D'Angelo, Arianna; Catena, Sara; Musolino, Caterina



Comparison of the Causes and Clinical Features of Drug Rash With Eosinophilia and Systemic Symptoms and Stevens-Johnson Syndrome  

PubMed Central

Purpose Drug rash with eosinophilia and systemic symptoms (DRESS) and the Stevens-Johnson syndrome (SJS) are both severe drug reactions. Their pathogenesis and clinical features differ. This study compared the causes and clinical features of SJS and DRESS. Methods We enrolled 31 patients who were diagnosed with DRESS (number=11) and SJS (number=20). We retrospectively compared the clinical and laboratory data of patients with the two disorders. Results In both syndromes, the most common prodromal symptoms were itching, fever, and malaise. The liver was commonly involved in DRESS. The mucosal membrane of the oral cavity and eyes was often affected in SJS. The most common causative agents in both diseases were antibiotics (DRESS 4/11 (37%), SJS 8/20 (40%)), followed by anticonvulsants (DRESS 3/11 (27%), SJS 7/20 (35%)). In addition, dapsone, allopurinol, clopidogrel, sulfasalazine and non-steroidal anti-inflammatory drugs (NSAIDs) were sporadic causes. Conclusions The most common causes of DRESS and SJS were antibiotics, followed by anticonvulsants, NSAIDs and sulfonamides. The increase in the use of antibiotics in Korea might explain this finding.

Jeung, Yun-Jin; Lee, Jin-Young; Oh, Mi-Jung; Choi, Dong-Chull



Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS): Experience with high-dose intravenous immunoglobulins and topical conservative approach  

Microsoft Academic Search

Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS) are rare, drug-induced, severe acute exfoliative skin and mucosal disorders.Several treatments previously proposed have produced contradictory results in small series; in 1998 the use of intravenous immunoglobulins (IVIG) was introduced with excellent clinical findings.Our experience (1999–2005) using IVIG in the therapy of TEN\\/SJS, together with a local conservative approach, is reported and

Maurizio Stella; Alessandra Clemente; Daniele Bollero; Daniela Risso; Paola Dalmasso



ALDEN, an Algorithm for Assessment of Drug Causality in Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Comparison With Case–Control Analysis  

Microsoft Academic Search

Epidermal necrolysis (EN)—either Stevens–Johnson syndrome (SJS) or toxic EN (TEN)—is a severe drug reaction. We constructed and evaluated a specific algorithm, algorithm of drug causality for EN (ALDEN), in order to improve the individual assessment of drug causality in EN. ALDEN causality scores were compared with those from the French pharmacovigilance method in 100 cases and the case–control results of

B Sassolas; C Haddad; M Mockenhaupt; A Dunant; Y Liss; K Bork; U F Haustein; D Vieluf; J C Roujeau; H Le Louet



Carbamazepine-Induced Stevens-Johnson Syndrome Sparing the Skin Previously Affected by Herpes Zoster Infection in a Patient with Systemic Lupus Erythematosus: A Reverse Isotopic Phenomenon  

Microsoft Academic Search

The reverse isotopic response is a rarely encountered phenomenon. The spared lesions are various and mainly inflammatory in nature, with herpes zoster infection being the most common. A novel case of Stevens-Johnson syndrome triggered by carbamazepine sparing the skin area previously affected by herpes zoster infection in a 39-year-old Indian female with systemic lupus erythematosus is documented. Several features as

Daniela Tenea



Possible involvement of gelatinase A (MMP2) and gelatinase B (MMP9) in toxic epidermal necrolysis or Stevens-Johnson syndrome  

Microsoft Academic Search

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are considered to be drug-induced diseases, and are characterized by extensive mucocutaneous disorder and epidermal necrosis which result in the detachment of the epidermis. Inactive and active forms of metalloproteinases (MMP2 and MMP9) secreted by skin explants maintained in organ culture for 72 h and in blister fluid from two TEN and three

F. Gaultier; A.-L. Ejeil; S. Igondjo-Tchen; D. Dohan; S. M. Dridi; L. Maman; C. B. Wierzba; D. Stania; B. Pellat; A. Lafont; G. Godeau; B. Gogly



Comprehensive survival analysis of a cohort of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis.  


Stevens-Johnson syndrome and toxic epidermal necrolysis are severe cutaneous adverse reactions that are of major concern because of high mortality rates. On the basis of data collected in the RegiSCAR study, the aim was to assess risk factors (including modalities of patient management) for mortality, regardless of the cause, up to 1 year after the reaction. Within this cohort, the mortality rate was 23% (95% confidence interval (CI) 19-27%) at 6 weeks and 34% (95% CI 30-39%) at 1 year. Severity of reaction was a risk factor for mortality only in the first 90 days after onset, whereas serious comorbidities and age influenced mortality beyond 90 days and up to 1 year after onset of reaction. The risk of death for patients with identified drug cause was borderline lower than for patients with a reaction of unknown cause (hazard ratio 0.66, 95% CI 0.45-0.96). The study could not provide conclusive evidence regarding patient management. This large-scale population-based follow-up study of such patients confirmed high in-hospital mortality and revealed a remarkable number of deaths after discharge, which could mainly be attributed to severe comorbidities and older age, whereas the impact of severity of reaction on the risk of death was limited to the first few weeks. PMID:23389396

Sekula, Peggy; Dunant, Ariane; Mockenhaupt, Maja; Naldi, Luigi; Bouwes Bavinck, Jan Nico; Halevy, Sima; Kardaun, Sylvia; Sidoroff, Alexis; Liss, Yvonne; Schumacher, Martin; Roujeau, Jean-Claude



Bronchiolitis obliterans associated with Stevens-Johnson Syndrome: histopathological bronchial reconstruction of the whole lung and immunohistochemical study  

PubMed Central

This study presents an extremely rare case of constrictive bronchiolitis obliterans (BO) associated with Stevens-Johnson Syndrome (SJS) provides the morphological and immunohistochemical features using histopathological bronchial reconstruction technique. A 27-year-old female developed progressive dyspnea after SJS induced by taking amoxicillin at the age of 10. Finally, she died of exacerbation of type II respiratory failure after 17 years from clinically diagnosed as having BO. Macroscopic bronchial reconstruction of the whole lungs at autopsy showed the beginning of bronchial obliterations was in the 4th to 5th branches, numbering from each segmental bronchus. Once they were obliterated, the distal and proximal bronchi were dilated. Microscopic bronchial reconstruction demonstrated the localization of obliteration was mainly from small bronchi to membranous bronchioli with intermittent airway luminal narrowing or obliteration. Moreover, CD3-, CD20-, and CD68-positive cells were found in the BO lesions. CD34- and D2-40-positive cells were mainly distributed in the peribronchiolar lesions and bronchiolar lumens, respectively. SMA- and TGF-?-positive cells were seen in the fibrous tissue of BO lesions. The virtual slides The virtual slide(s) for this article can be found here:



Validation of a claims-based diagnostic code for Stevens-Johnson syndrome in a commercially insured population.  


PURPOSE: To validate the administrative claims identification of a diagnosis of Stevens-Johnson syndrome (SJS) using medical records as the "gold standard" in a large, commercially insured US population. METHODS: Patients with >1 medical claim with the International Classification of Diseases, Ninth Revision, Clinical Modification code 695.1x between 1 July 2000 and 31 May 2007 were queried in the HealthCore Integrated Research Database(SM) , which contains administrative claims data for 14 commercial health insurance plans. Trained nurses and pharmacists abstracted pertinent information from the identified patients' medical records, which were then reviewed by two independent dermatologists to identify criteria to determine SJS diagnosis. Positive predictive values (PPVs) based on the claims and chart data were computed for all the cases. RESULTS: Medical charts for 200 claims-identified cases, with the International Classification of Diseases, Ninth Revision, Clinical Modification code 695.1x, were abstracted and reviewed by the dermatologists. A total of five cases (PPV?=?2.50%, 95%CI = 0.8%-5.7%) were determined to be SJS with clinical certainty. PPVs varied with data stratification: PPV for inpatient claims only (PPV?=?2.00%, 95%CI = 0.24%-7.04%), inpatient claims with 695.1x in first diagnosis field (PPV?=?4.11%, 95%CI?=?0.86%-11.54%), and final decisions of either clinical certainty or probable cases of SJS (PPV?=?6.00%, 95%CI?=?3.14%-10.25%). CONCLUSION: These findings demonstrate the difficulties associated with identifying rare disorders, which lack specific diagnostic criteria, within administrative claims databases. They underscore the challenges of using claims data to monitor ill-defined clinical conditions as well as the need to validate claims-identified cases with information from other sources, such as medical charts. Copyright © 2012 John Wiley & Sons, Ltd. PMID:22539145

Eisenberg, Debra F; Daniel, Gregory W; Jones, Judith K; Goehring, Earl L; Wahl, Peter M; Winters, Peter; Levin, Jay; Bohn, Rhonda L



A systematic review of treatment of drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in children.  


Stevens-Johnson (SJS) and Toxic Epidermal Necrolysis (TEN) are two uncommon mucocutaneous diseases usually considered as severe drug reactions and are characterized by different grades of epidermal necrosis. Several treatment modalities have been proposed with variable results but the lack of controlled studies makes difficult to analyze them objectively especially in children. All publications describing management for SJS and TEN in children were searched in MEDLINE, EMBASE, and the Cochrane Library. Reports included were divided in two categories: A, studies with 5 or more patients and observational studies; and B, reports with less than 5 patients. A formal meta-analysis was not feasible. Description was made using central tendency measures. From 1389 references only 31 references with a total of 128 cases were included, 88 category A and 40 category B. The 4 main treatment modalities were: intravenous immunoglobulin (IVIG), steroids (prednisolone, methylprednisolone, dexamethasone), dressings with or without surgical debridement, and support treatment alone. Miscellaneous treatments: Of 12 patients, 3 received ulinastatin, 4 patients plasmapheresis, 2 patients IV pentoxifylline and the last three patients received different treatment each (cyclosporine, methylprednisone/G-CSF and methylprednisolone/IVIG). Patients receiving IVIG and steroids showed similar findings while patients treated with dressing and support treatment alone, reported both longer time to achieve remission and hospitalization stays and appear to be associated with more complications and deaths. There is scant quality literature about management of SJS and TEN in children. Steroids and IVIG seem to improve the outcome of SJS and TEN patients but results from different reports are variable. Patients treated only with care support seem to have higher morbidity and mortality. Further studies are necessary to define optimal management. PMID:21467603

Del Pozzo-Magana, Blanca R; Lazo-Langner, Alejandro; Carleton, Bruce; Castro-Pastrana, Lucila I; Rieder, Michael J



Causative Drugs and Clinical Outcome in Stevens Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and SJS-TEN Overlap in Children  

PubMed Central

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the most severe adverse drug reactions in children. Objectives: The objective was to study the causative drugs and outcome in children with SJS, SJS-TEN overlap, and TEN. Materials and Methods: Retrospective analysis of all the in-patient records of children below 18 years of age with the diagnosis of SJS, SJS-TEN overlap, and TEN was carried out. Results and Conclusions: Twenty children were identified, eight patients each were diagnosed as SJS and TEN and four as SJS-TEN overlap. Multiple drugs were implicated in 15 cases while single drug was responsible in 5 cases. Antibiotics (40.7%) were implicated as the commonest cause followed by NSAIDS (25.9%) and anticonvulsants (7.4%). Seventeen patients recovered completely and three patients died.

Sethuraman, Gomathy; Sharma, Vinod K; Pahwa, Pooja; Khetan, Pooja



Serum Levels of the Th1 Promoter IL12 and the Th2 Chemokine TARC Are Elevated in Erythema Multiforme and Stevens-Johnson Syndrome\\/Toxic Epidermal Necrolysis and Correlate with Soluble Fas Ligand Expression  

Microsoft Academic Search

Background: No data exist as to Th2 chemokines in erythema multiforme (EM) and Stevens-Johnson syndrome (SJS)\\/toxic epidermal necrolysis (TEN). Objective: To evaluate thymus- and activation-regulated chemokine (TARC), macrophage-derived chemokine (MDC) and regulated upon activation, normal T-lymphocyte-expressed and secreted chemokine (RANTES) expression in EM and SJS\\/TEN and to correlate with the serum levels of the Th1 promoter interleukin (IL)-12 and soluble

Pietro Quaglino; Marzia Caproni; Emiliano Antiga; Elena Del Bianco; Simona Osella-Abate; Paola Savoia; Alessandra Frezzolini; Donatella Schena; Angelo Marzano; Walter Volpi; Clara De Simone; Aurora Parodi; Paolo Fabbri; Maria Grazia Bernengo



Stevens-Johnson syndrome and toxic epidermal necrolysis: assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study.  


Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe cutaneous adverse reactions (SCAR) related to a variety of medications. They have a significant public health impact because of high mortality and morbidity. A multinational case-control study conducted in Europe between 1997 and 2001 evaluated the risk of medications to induce SCAR. Cases were actively detected through a hospital network covering more than 100 million inhabitants. Three hospitalized patients per case matched on age, gender, and date of interview were enrolled as controls. After validation by an expert committee blinded to exposures, 379 SCAR cases and 1,505 controls were included. Among drugs recently introduced into the market, strong associations were documented for nevirapine (relative risk (RR)>22) and lamotrigine (RR>14), and weaker associations for sertraline (RR=11 [2.7-46]), pantoprazole (RR=18 [3.9-85]), and tramadol (RR=20 [4.4-93]). Strong associations were confirmed for anti-infective sulfonamides, allopurinol, carbamazapine, phenobarbital, phenytoin, and oxicam-NSAIDs , with some changes in relative numbers of exposed cases. Thus, many cases were still related to a few "old" drugs with a known high risk. Risk was restricted to the first few weeks of drug intake. The use of such drugs as first-line therapies should be considered carefully, especially when safer alternative treatments exist. A number of widely used drugs did not show any risk for SJS and TEN. PMID:17805350

Mockenhaupt, Maja; Viboud, Cecile; Dunant, Ariane; Naldi, Luigi; Halevy, Sima; Bouwes Bavinck, Jan Nico; Sidoroff, Alexis; Schneck, Jürgen; Roujeau, Jean-Claude; Flahault, Antoine



Developing a data mining approach to investigate association between physician prescription and patient outcome - A study on re-hospitalization in Stevens-Johnson Syndrome.  


Stevens-Johnson syndrome (SJS) is a potentially life-threatening skin reaction. Drugs are the major causes for cases of SJS. While treating patients with SJS, the first and most important step is to identify and discontinue any possible responsible drugs. However, potential drugs that may lead to SJS are many and encompass various therapeutic areas. Very few physicians are familiar with the potential risk of all these drugs. If properly treated, most SJS cases are expected to recover without much sequelae. All drugs that have been associated with SJS should be avoided in these patients to prevent recurrence. If the physicians fail to identify and discontinue the drugs causing SJS, or even adding new drugs related to SJS, the patient may get worse or SJS may recur. These conditions can cause SJS patients to be re-hospitalized. Currently the reasons for re-hospitalization of SJS patients in Taiwan are not known. This study uses Taiwan National Health Insurance Research Database to analyze the causes of re-hospitalization for cases of SJS. First, we classified prescription history of re-hospitalized patients through the rule-based classification method. Secondly, by using the basic prescription actions, we identified drug association patterns. Then, by employing A-priori algorithm, pairs of drugs with relatively higher frequency of appearance were identified and their degrees of association were measured by using selected symmetric and asymmetric association mining methods. Finally, by listing and ranking up these pairs of drugs according to the value of support based on their degrees of association, we provide prescribing physicians with possible means of increasing the awareness and reducing re-hospitalization of SJS patients. PMID:23910224

Ou-Yang, Chao; Agustianty, Sheila; Wang, Han-Cheng



Association of HLA-B*5801 allele and allopurinol-induced stevens johnson syndrome and toxic epidermal necrolysis: a systematic review and meta-analysis  

PubMed Central

Background Despite some studies suggesting a possible association between human leukocyte antigen, HLA-B*5801 and allopurinol induced Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), the evidence of association and its magnitude remain inconclusive. This study aims to systematically review and meta-analyze the association between HLA-B*5801 allele and allopurinol-induced SJS/TEN. Methods A comprehensive search was performed in databases including MEDLINE, Pre-MEDLINE, Cochrane Library, EMBASE, International Pharmaceutical Abstracts (IPA), CINAHL, PsychInfo, the WHO International, Clinical Trial Registry, and from their inceptions to June 2011. Only studies investigating association between HLA-B*5801 with allopurinol-induced SJS/TEN were included. All studies were extracted by two independent authors. The primary analysis was the carrier frequency of HLA-B*5801 comparison between allopurinol-induced SJS/TEN cases and each comparative group. The pooled odds ratios were calculated using a random effect model. Results A total of 4 studies with 55 SJS/TEN cases and 678 matched-controls (allopurinol-tolerant control) was identified, while 5 studies with 69 SJS/TEN cases and 3378 population-controls (general population) were found. SJS/TEN cases were found to be significantly associated with HLA-B*5801 allele in both groups of studies with matched-control (OR 96.60, 95%CI 24.49-381.00, p < 0.001) and population-control (OR 79.28, 95%CI 41.51-151.35, p < 0.001). Subgroup analysis for Asian and Non-Asian population yielded similar findings. Conclusion We found a strong and significant association between HLA-B*5801 and allopurinol-induced SJS/TEN. Therefore, HLA-B*5801 allele screening may be considered in patients who will be treated with allopurinol.



Effect of Age and Early Intervention with a Systemic Steroid, Intravenous Immunoglobulin or Amniotic Membrane Transplantation on the Ocular Outcomes of Patients with Stevens-Johnson Syndrome  

PubMed Central

Purpose This retrospective observational case series of fifty-one consecutive patients referred to the eye clinic with acute-stage Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) from 1995 to 2011 examines the effect of early treatment with a systemic corticosteroid or intravenous immunoglobulin (IVIG) on the ocular outcomes in patients with SJS or TEN. Methods All patients were classified by age (?18 years vs. >18 years) and analyzed by treatment modality and early intervention with systemic corticosteroids (?5 days), IVIG (?6 days), or amniotic membrane graft transplantation (AMT) (?15 days). The main outcomes were best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) and ocular involvement scores (OIS, 0-12), which were calculated based on the presence of superficial punctate keratitis, epithelial defect, conjunctivalization, neovascularization, corneal opacity, keratinization, hyperemia, symblepharon, trichiasis, mucocutaneous junction involvement, meibomian gland involvement, and punctal damage. Results The mean logMAR and OIS scores at the initial visit were not significantly different in the pediatric group (logMAR = 0.44, OIS = 2.76, n = 17) or the adult group (logMAR = 0.60, OIS = 2.21, n = 34). At the final follow-up, the logMAR and OIS had improved significantly in the adult group (p = 0.0002, p = 0.023, respectively), but not in the pediatric group. Early intervention with IVIG or corticosteroids significantly improved the mean BCVA and OIS in the adult group (p = 0.043 and p = 0.024, respectively for IVIG; p = 0.002 and p = 0.034, respectively for corticosteroid). AMT was found to be associated with a significantly improved BCVA or OIS in the late treatment group or the group with a better initial OIS (p = 0.043 and p = 0.043, respectively for BCVA; p = 0.042 and p = 0.041, respectively for OIS). Conclusions Our findings suggest that patients with SJS or TEN who are aged 18 years or less have poorer ocular outcomes than older patients and that early treatment with steroid or immunoglobulin therapy improves ocular outcomes.

Kim, Kyeong Hwan; Park, Sung Wook; Wee, Won Ryang



Relationship Between the HLA-B*1502 Allele and Carbamazepine-Induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Meta-analysis.  


IMPORTANCE The US Food and Drug Administration recommends screening for the HLA-B*1502 allele before initiation of carbamazepine therapy in patients of Asian ancestry, but there remains unclear evidence of a relationship between HLA-B*1502 and Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) among carbamazepine users, especially in some racial/ethnic populations. OBJECTIVE To determine the relationship between the HLA-B*1502 allele and carbamazepine-induced SJS and TEN. DATA SOURCES A comprehensive search of the following data sources was performed without language restriction from the inception of the database until January 8, 2013: EMBASE, PubMed,, Cochrane Library, IPA (International Pharmaceutical Abstracts), HuGENet (Human Genome Epidemiology Network), and CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the reference lists of identified studies. STUDY SELECTION Inclusion criteria were studies that investigated the relationship between HLA-B*1502 and carbamazepine-induced SJS and TEN and that reported sufficient data for calculating the frequency of HLA-B*1502 carriers among cases and controls. The search yielded 525 articles, of which 16 met the inclusion criteria. The studies included 227 SJS or TEN cases, 602 matched control subjects, and 2949 population control subjects. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted the following data: study design, eligibility criteria, diagnostic criteria, patient demographics, genotype distribution, HLA-B genotyping technique, selection of cases and controls, dosage of carbamazepine and duration of use, and results of Hardy-Weinberg equilibrium in the control group. The Newcastle-Ottawa Scale was used to assess the quality of studies. The overall odds ratios (ORs) with corresponding 95% CIs were calculated using a random-effects model. The primary analysis was based on matched control studies. Subgroup analyses by race/ethnicity were also performed. MAIN OUTCOME AND MEASURE The primary outcome was carbamazepine-induced SJS and TEN. The outcome measure is given as an overall OR. RESULTS The summary OR for the relationship between HLA-B*1502 and carbamazepine-induced SJS and TEN was 79.84 (95% CI, 28.45-224.06). Racial/ethnic subgroup analyses yielded similar findings for Han-Chinese (115.32; 18.17-732.13), Thais (54.43; 16.28-181.96), and Malaysians (221.00; 3.85-12?694.65). Among individuals of white or Japanese race/ethnicity, no patients with SJS or TEN were carriers of the HLA-B*1502 allele. CONCLUSIONS AND RELEVANCE We found a strong relationship between the HLA-B*1502 allele and carbamazepine-induced SJS and TEN in Han-Chinese, Thai, and Malaysian populations. HLA-B*1502 screening in patients requiring carbamazepine therapy is warranted. PMID:23884208

Tangamornsuksan, Wimonchat; Chaiyakunapruk, Nathorn; Somkrua, Ratchadaporn; Lohitnavy, Manupat; Tassaneeyakul, Wichittra



Síndrome de Stevens-Johnson y necrólisis epidérmica tóxica por profilaxis con TARGA en el Hospital Nacional Almanzor Aguinaga Asenjo, Lambayeque,Perú Stevens Johnson syndrome and toxic epidermal necrolysis induced by HAART prophylaxis in the National Hospital Almanzor Aguinaga Asenjo, Lambayeque, Perú  

Microsoft Academic Search

RESUMEN Síndrome de Stevens-Johnson (SSJ) y necrólisis epidérmica tóxica (NET) son reacciones inflamatorias agudas originadas por hipersensibilidad (reacción inmunológica), que incluye piel y membranas mucosas. Se presenta un caso de reacción adversa medicamentosa en un paciente varón de 25 años, que recibió profilaxis con Terapia Antiretroviral de Gran Actividad. Presentó exantema, que progresa a SSJ y evoluciona a NET. Permaneció

Victor A. Soto Cáceres; Rosa E. Rodríguez Barboza



Conjunctival Pigmentation in Stevens-Johnson Syndrome  

Microsoft Academic Search

\\u000a Editor’s Preface  Examination of the conjunctiva\\/sclera and surrounding structures is an important component of any physical exam. The articles\\u000a by Dr. Fuentes-Paez et al. and by Dr. Sharma et al. provide critical information for a good exam of the eye and surrounding\\u000a structures. Reading these two articles in conjunction with a basic text of ocular microanatomy will provide a great refresher

Graciana Fuentes-Páez; Maria C. Mendez; Javier Montañez; Jose M. Herreras; Maria A. Saornil; Margarita Calonge



Ocular Cicatricial Pemphigoid Occurring as a Sequela of Stevens-Johnson Syndrome  

Microsoft Academic Search

Ocular cicatricial pemphigoid is a chronic scarring inflammation of the ocular mucosae that can lead to blindness. Although cicatricial pemphigoid has been classified clinically, histopathologically, and immunopathologically, no definite initiating factor or precipitating factor has been identified. In this report, we describe five cases of ocular cicatricial pemphigoid that developed following an acute episode of severe ocular inflammatory injury secondary

Lawrence S. Chan; H. Kaz Soong; C. Stephen Foster; Craig Hammerberg; Kevin D. Cooper



Concurrence of Stevens-Johnson Syndrome and Bilateral Parotitis after Minocycline Therapy  

Microsoft Academic Search

Minocycline is an antibiotic of tetracycline derivatives that is commonly used in the treatment of moderate to severe acne vulgaris. It has been reported to cause rare adverse events from mild cutaneous eruption to severe forms including drug-induced lupus, serum sickness-like reaction, and hypersensitivity reactions, etc. The risks of adverse events attributed to minocycline have not been ascertained reliably and

Jimi Yoon; Seung Hun Lee; Tae-Heung Kim; Deok-Jin Choi; Jin-Pyeong Kim; Tae-Jin Yoon



IgA-lineare Dermatose im Erwachsenenalter mit klinischen Zeichen eines Stevens-Johnson-Syndroms  

Microsoft Academic Search

Zusammenfassung  \\u000a Die IgA-lineare Dermatose ist mittels direkter Immunfluoreszenz leicht zu diagnostizieren. Klinisch ist die Differentialdiagnostik\\u000a nicht unproblematisch, da diese Erkrankung einer Reihe von anderen blasenbildenden Dermatosen, z.B. bullösem Pemphigoid und\\u000a Dermatitis herpetiformis Duhring, ähnelt. Wir berichten über eine 73jährige Patientin, die mit dem Verdacht auf ein bullöses\\u000a Pemphigoid in die Hautklinik eingewiesen wurde. Einen Tag nach stationärer Aufnahme zeigten sich

Birgit Schneck; Christian Termeer; Maja Mockenhaupt; Matthias Augustin; Erwin Schöpf



Lamotrigine-lnduced Stevens-Johnson Syndrome: Demonstration of Specific Lymphocyte Reactivity in vitro  

Microsoft Academic Search

The novel antiepileptic drug lamotrigine (LTG) is effective as an adjunctive medication in partial seizures. The main adverse effects of LTG are skin eruptions, occurring in 3–10% of the treated patients, but these are rarely severe. The risk of cutaneous side effects is increased in patients receiving sodium valproate comedication, probably by doubling the plasma half-life of LTG due to

B. Sachs; A. C. Rönnau; S. von Schmiedeberg; Th. Ruzicka; E. Gleichmann; H.-C. Schuppe



Complications of nephrotic syndrome.  


Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS. PMID:22087198

Park, Se Jin; Shin, Jae Il



Complications of nephrotic syndrome  

PubMed Central

Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS.

Park, Se Jin



Lemierre's Syndrome Complicating Pregnancy  

PubMed Central

Lemierre's syndrome is an anaerobic suppurative thrombophlebitis involving the internal jugular vein secondary to oropharyngeal infection. There is only one previous case report in pregnancy which was complicated by premature delivery of an infant that suffered significant neurological damage. We present an atypical case diagnosed in the second trimester with a live birth at term. By reporting this case, we hope to increase the awareness of obstetricians to the possibility of Lemierre's syndrome when patients present with signs of unabating oropharyngeal infection and pulmonary symptoms.

Thompson, M.; Awonuga, A. O.; Bell, J.; Ray, C.; Awonuga, M. T.; Helfgott, A.



Stevens-Johnson-Syndrom mit Übergang in eine toxisch epidermale Nekrolyse nach Carbamazepin-Einnahme, Heroin und Alkoholabusus  

Microsoft Academic Search

Zusammenfassung  \\u000a Wir berichten über einen 28jährigen Patienten, bei dem es nach Alkohol- und Heroinkonsum unter gleichzeitiger Carbamazepin-Medikation\\u000a zu einem schweren bullösen Exanthem und Schleimhautenanthem verbunden mit Hepatitis, Fieber und Blutbildveränderungen kam.\\u000a Nach Carbamazepin-Karenz erfolgten eine 5tägige systemische Prednisolon-Therapie unter Flüssigkeits- und Elektrolytsubstitution\\u000a sowie lokale Behandlungsmaßnahmen, was zur Besserung führte. Schwere bullöse Hautreaktionen werden heute in Erythema exsudativum\\u000a multiforme majus (EEMM),

G. Petter; U.-F. Haustein



Use of Cross-linked Donor Corneas as Carriers for the Boston Keratoprosthesis

Chemical Injuries; Unspecified Complication of Corneal Transplant; Autoimmune Diseases; Ocular Cicatricial Pemphigoid; Stevens Johnson Syndrome; Lupus Erythematosus, Systemic; Rheumatoid Arthritis; Other Autoimmune Diseases



Acute vanishing bile duct syndrome after ibuprofen therapy in a child  

Microsoft Academic Search

We report the case of a 10 year-old girl who had Stevens-Johnson syndrome and cholestasis after ibuprofen therapy. Liver histology was compatible with vanishing bile duct syndrome. She received ursodeoxycholic acid, and liver tests normalized within 7 months. This report confirms that ibuprofen may induce acute vanishing bile duct syndrome.

M. Taghian; T. A. Tran; S. Bresson-Hadni; A. Menget; S. Felix; E. Jacquemin



[Thromboembolic complications in nephrotic syndrome].  


Thromboembolic complications are among the most important extrarenal consequences of nephrotic syndrome (NS). In addition to deep vein thrombosis in the legs and pulmonary embolism, NS is very frequently accompanied by renal vein thrombosis. Due to enhanced procoagulatory and antifibrinolytic potential and reduced anticoagulatory potential, multifactor disruption of hemostatic equilibrium leads to hypercoagulability in NS patients, which is aggravated by an increase in blood viscosity and endothelial dysfunction. Circulating antibodies against ?-enolase, a plasmin(ogen)-binding protein, and the possibility of certain molecules being renally eliminated in specific manner are discussed as reasons for the particular frequency of thromboembolic complications in patients with idiopathic membranous nephropathy. Serum albumin concentration is an indicator for the risk of thrombosis in NS patients. When applying the current KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guideline for glomerulonephritis to NS patients with a serum albumin concentration of less than 25 g/l and at least one additional thrombogenic risk factor, primary prophylactic anticoagulation ("conditioned prophylaxis") with an orally administered vitamin K antagonist (target INR 2-3) is recommended as long as the serum albumin concentration is less than 30 g/l. PMID:23677507

Maurin, N



Lemierre's syndrome complicated by carotid thrombosis  

Microsoft Academic Search

.   Lemierre's syndrome, also known as postanginal sepsis, is a rare condition that presents as an increasing sore throat due\\u000a to acute pharyngitis or tonsillitis and progresses to sepsis, due to suppurative thrombophlebitis of the internal jugular\\u000a vein. We present an atypical case of Lemierre's syndrome complicated by carotid thrombosis. The etiological factors and the\\u000a diagnostic and therapeutic measures are

N. Maalikjy Akkawi; B. Borroni; M. Magoni; L. A. Vignolo; A. Padovani



Lutembacher's syndrome complicated by jaundice.  


We encountered a 78-year-old female with jaundice induced by Lutembacher's syndrome, which, to our knowledge, is the first such case to be reported. Laboratory data and ultrasonographic examination revealed liver congestion with dilatation of the inferior vena cava and hepatic veins. A large atrial septal defect was found using two-dimensional echocardiography; the mitral valve area measured 1.6 cm2 by planimeter. Clinicians should be aware of congenital heart disease as an underlying cause of jaundice. PMID:8982972

Saito, Y; Kanda, T; Sakahira, K; Suda, T; Kobayashi, I



Gastrointestinal complications of the haemolytic uraemic syndrome.  

PubMed Central

The haemolytic uraemic syndrome (HUS) is a well recognized cause of acute renal failure in children. Gastrointestinal involvement is common, and may result in rectal bleeding which can be an important presenting symptom. Previous publications have stressed the importance of correct diagnosis to avoid unnecessary surgery. Occasionally serious gastrointestinal complications do occur. We present five children with life-threatening gastrointestinal complications of the HUS and discuss the indications for laparotomy. Images Figure 1. Figure 2. Figure 3.

Crabbe, D C; Broklebank, J T; Spicer, R D



Neurological complications of primary Sjögren's syndrome  

Microsoft Academic Search

Objective: To better delineate the spectrum of neurological complications of primary Sj?gren's syndrome (PSS). Methods: A detailed neurological investigation was prospectively performed in a group of 25 consecutive patients with PSS followed\\u000a in an internal medicine department between June 1996 and December 1997 (Internal Medicine group). In addition, eleven patients\\u000a with neurological complications of PSS were identified in the Neurological

C. Lafitte; Z. Amoura; P. Cacoub; P. Pradat-Diehl; C. Picq; F. Salachas; J. M. Léger; J. C. Piette; J. Y. Delattre



Klippel-Trenaunay syndrome complicating pregnancy.  


The Klippel-Trenaunay syndrome is a rare congenital disorder that affects one or more limbs. It is characterised by cutaneous vascular nevi, venous malformations and hypertrophy of soft tissues and bone. There are very few cases reported in pregnant women, so the level of uncertainty is high when it appears during gestation. It is a disease that increases obstetric risk and can exacerbate complications, mainly thromboembolic and haemorrhagic. We report below the case of a pregnant woman diagnosed with this syndrome and the multidisciplinary management held in our centre. PMID:22854239

González-Mesa, Ernesto; Blasco, Marta; Andérica, José; Herrera, José



[Managing complications in intraoperative floppy iris syndrome].  


The intraoperative floppy iris syndrome (IFIS) describes an ophthalmologically relevant phenomenon which is observed after systemic intake of alpha blockers for treatment of benign prostate hyperplasia. This leads to an increase in intraoperative complications in cataract surgery characterized by a flaccid iris which billows in response to currents with a tendency to prolapse towards the area of surgery. This results in damage to the iris by the instruments used or posterior capsule rupture with loss of lens material. We describe the preoperative and intraoperative measures and techniques to deal with this challenging situation in order to minimize development of IFIS and reduce the complication rate. PMID:23338529

Handzel, D M; Rausch, S; Kälble, T; Briesen, S



Neurological complications of Grönblad-Strandberg syndrome  

Microsoft Academic Search

Neurological complications resulting from pronounced cerebrovascular changes were observed in a 59-year-old female suffering from Grönblad-Strandberg syndrome. In addition to typical skin changes of the pseudoxanthoma elasticum and ocular alterations (exudative macular degeneration and angioid streaks) there were an unusual number of disturbed endocrinological functions. The ophthalmological findings revealed characteristic breaks in Bruch's membrane, proliferation of chorioidal vessels into the

K. Fasshauer; C. D. Reimers; H.-J. Gnau; I. Strempel; C. Rossberg



Rapid improvement of human orf (ecthyma contagiosum) with topical imiquimod cream: report of four complicated cases.  


Orf is a zoonosis caused by an epitheliotropic DNA parapox virus. Human orf is a generally benign, self-limiting condition that usually regresses in 6-8 weeks without specific treatment. However, it may be accompanied by local symptoms including pain, pruritus, lymphangitis and axillary adenitis, or less frequently by systemic symptoms such as fever or malaise. Furthermore, it may be complicated by erythema multiforme, Stevens-Johnson syndrome, erysipelas, generalized mucocutaneous eruption, toxic erythema, eyelid oedema and giant, persistent or recurrent lesions in immunocompromised patients. Imiquimod, a potent topical immune response modifier, enhances both the innate and acquired immunity by stimulation of immune system cells resulting in local antiviral, antitumour and immunoregulatory activity. We present, for the first time, four complicated cases of orf successfully treated by topical imiquimod resulting in rapid regression of both orf and associated lesions. Two of the cases were complicated with erythema multiforme, one with recurrent eyelid oedema, and another had giant orf associated with axillary lymphadenitis. We suggest that topical imiquimod may be an effective and safe therapy for complicated orf cases. PMID:16428161

Erba?ci, Zülal; Erba?ci, Ibrahim; Almila Tuncel, A



Grisel's syndrome: a rare complication following adenoidectomy  

PubMed Central

Summary Grisel’s syndrome, defined as subluxation of the atlanto-axial joint, not associated with trauma or bone disease, is found primarily in children. There are few references to this syndrome in the ENT literature but it may occur in association with any condition that results in hyperaemia and pathological relaxation of the transverse ligament of the atlanto-axial joint. Several common otolaryngeal conditions have been associated with the syndrome: pharyngitis, adenotonsillitis, tonsillar abscess, cervical abscess, and otitis media. Moreover, the syndrome has been observed after numerous otolaryngologic procedures such as tonsillectomy, adenoidectomy and mastoidectomy. Non-traumatic subluxation of the atlanto-axial joint should be suspected in cases of persistent neck pain and stiffness. X-rays and computed tomography scans of the cervical spine can confirm the diagnosis. Early management, consisting of cervical immobilization and medical treatment, is considered the key factor for a satisfactory outcome. Inappropriate treatment may result in a permanent and painful neck deformity that may even require surgical fusion. Neurological complications have been reported in the literature, with outcome ranging from mild paresthesia, clonus, to quadriplegia or acute respiratory failure and death. The case is described of an 8-year-old boy who developed Grisel’s syndrome following adenoidectomy. The pathogenesis, classification, diagnosis, and treatment of this condition are discussed.

Bocciolini, C; Dall'Olio, D; Cunsolo, E; Cavazzuti, PP; Laudadio, P



Grisel's syndrome: a rare complication following adenoidectomy.  


Grisel's syndrome, defined as subluxation of the atlanto-axial joint, not associated with trauma or bone disease, is found primarily in children. There are few references to this syndrome in the ENT literature but it may occur in association with any condition that results in hyperaemia and pathological relaxation of the transverse ligament of the atlanto-axial joint. Several common otolaryngeal conditions have been associated with the syndrome: pharyngitis, adenotonsillitis, tonsillar abscess, cervical abscess, and otitis media. Moreover, the syndrome has been observed after numerous otolaryngologic procedures such as tonsillectomy, adenoidectomy and mastoidectomy. Non-traumatic subluxation of the atlanto-axial joint should be suspected in cases of persistent neck pain and stiffness. X-rays and computed tomography scans of the cervical spine can confirm the diagnosis. Early management, consisting of cervical immobilization and medical treatment, is considered the key factor for a satisfactory outcome. Inappropriate treatment may result in a permanent and painful neck deformity that may even require surgical fusion. Neurological complications have been reported in the literature, with outcome ranging from mild paresthesia, clonus, to quadriplegia or acute respiratory failure and death. The case is described of an 8-year-old boy who developed Grisel's syndrome following adenoidectomy. The pathogenesis, classification, diagnosis, and treatment of this condition are discussed. PMID:16482983

Bocciolini, C; Dall'Olio, D; Cunsolo, E; Cavazzuti, P P; Laudadio, P



Adrenal insufficiency complicated with antiphospholipid syndrome (APS).  


We describe a 69-year-old woman with bilateral adrenal hemorrhage complicated with antiphospholipid syndrome (APS). She was hospitalized with nausea and vomiting in September 2003. Laboratory data demonstrated hyponatremia, hypoglycemia and prolongation of activated partial thromboplastin time (aPTT). Abdominal computed tomography showed bilateral adrenal enlargement. In October 2003, she demonstrated altered mental status with progressive hyponatremia, a high level of ACTH, and a low level of serum cortisol. She also showed thrombocytopenia, anti-cardiolipin IgG antibody, anti-beta2GPI antibody, and lupus anticoagulants. After four months, anti-cardiolipin IgG antibody was still positive. Based on these findings, she was diagnosed as having APS complicated with adrenal insufficiency due to hemorrhagic infarction. After treatment with corticosteroid, a low dose of aspirin and normal saline infusion, her condition quickly improved. Platelet counts and aPTT were also normalized. To our knowledge, this is the second Japanese case of APS complicated with bilateral adrenal hemorrhage. APS should be considered an important underlying cause of adrenal insufficiency. PMID:16974059

Fujishima, Naohito; Komatsuda, Atsushi; Ohyagi, Hideaki; Fujishima, Masumi; Tada, Mitsunori; Ohtani, Hiroshi; Wakui, Hideki; Hirokawa, Makoto; Sawada, Ken-ichi



Jugular thrombophlebitis complicating bacterial pharyngitis (Lemierre's syndrome)  

Microsoft Academic Search

Lemierre's syndrome is a rare syndrome caused byFusobacterium necrophorum, a gram-negative anaerobic organism that normally inhabits the oropharynx. The syndrome follows primary oropharyngeal infection and affects previously healthy adolescents in a characteristic manner with fatal results if left untreated. The authors present two cases seen at their institution and discuss the clinical and radiologic features of the syndrome, along with

S. De Sena; D. L. Rosenfeld; S. Santos; I. Keller



Musculoskeletal complications of severe acute respiratory syndrome.  


The severe acute respiratory syndrome (SARS) was a highly infectious pneumonia that emerged in southern China early in 2003. A large number of SARS patients experienced large joint arthralgia, although this was, for the most part, not associated with any abnormality on magnetic resonance imaging. The main musculoskeletal complications of SARS were osteonecrosis and reduced bone mass, and these arose not from the disease per se but as a sequel to treatment of SARS with high-dose steroids. SARS patients were almost universally steroid naive with no other known predisposition to osteonecrosis. Prevalence of osteonecrosis in SARS patients treated with steroids ranged from 5% to 58%. Osteonecrosis most commonly affected the proximal femur and femoral condyles and was most strongly related to cumulative steroid dose and duration of steroid therapy. Osteonecrosis risk was <1% in patients receiving <3 g and 13% in patients receiving >3 g cumulative prednisolone-equivalent dose. Most osteonecrotic lesions tended to improve with a reduction in lesion volume over a follow-up period of 5 years. The relative reduction in osteonecrotic lesion volume was greatest for smaller lesions. PMID:22081289

Griffith, James F



Tapia's syndrome -- a rare complication following cardiac surgery  

PubMed Central

Tapia's syndrome is a rare complication following cardiac surgery. It includes the extracranial involvement of the recurrent laryngeal nerve and the hypoglossal nerve and results in ipsilateral paralysis of the vocal cord and the tongue. It is usually a complication related to anaesthesia and positioning of the head of the patient during surgery. We describe this rare complication which occurred at our institute. A 49-year old man developed Tapia's syndrome after an uneventful coronary artery bypass surgery. He complained of dysphonia, hoarseness of voice and an inability to swallow soon after extubation. The syndrome resolved completely over the following weeks with no neurological deficit.

Nalladaru, Zubin; Wessels, Andre; DuPreez, Leon



Grisel's syndrome as a sequela of a complicated acute mastoiditis.  


Grisel's syndrome is a rare complication of ENT area infections. It consists of a non-traumatic atlantoaxial subluxation after an infectious process. Its characteristic symptom is persistent torticollis despite a resolved infection. The knowledge of this condition helps early diagnosis and treatment. We therefore present the case of a patient with Grisel's syndrome as a sequela of an acute mastoiditis complicated by a Bezold's abscess. PMID:22264911

Coca-Pelaz, Andrés; Vivanco-Allende, Ana; Meilán-Martínez, Ángela; Gómez-Martínez, Justo R



Major vascular complications in Behçet's syndrome  

Microsoft Academic Search

Two patients with Behçet's syndrome are described. One patient developed spontaneous bilateral popliteal artery aneurysms and the other spontaneous thrombosis of the superior vena cava. These cases emphasize that primary inflammatory lesions of large vessels, with arterial aneurysm formation and thrombosis may be a feature of the syndrome.

B. Anthony Enoch; T. C. L. Khoo; J. L. Castillo-Olivares; R. G. Grainger; L. Henry



Gastrointestinal complications of the Ehlers-Danlos syndrome  

Microsoft Academic Search

The gastrointestinal abnormalities encountered in 125 patients with the Ehlers-Danlos syndrome have been described. Spontaneous perforation of the intestine and massive gastrointestinal haemorrhage are uncommon but potentially lethal complications of the Ehlers-Danlos syndrome. Less dangerous abnormalities, such `as external hernia, hiatus hernia, eventration of the diaphragm, intestinal diverticula, and rectal prolapse were all encountered in patients in the series. Abdominal

Peter H. Beighton; J. Lamont Murdoch; Theodore Votteler



Two Cases of Walker-Warburg Syndrome Complicated by Hydrocephalus  

Microsoft Academic Search

Walker-Warburg syndrome is a very rare autosomal recessive disorder with congenital muscular dystrophy, brain malformations on the basis of a neuronal migration defect and ocular abnormalities. We report our experience in treating two cases of Walker-Warburg syndrome complicated by hydrocephalus with shunting and endoscopic techniques.

M. Preuss; M. Heckmann; M. Stein; U. Nestler



Complication After Breast Implantation in Poland Syndrome  

Microsoft Academic Search

Congenital or developmental deformities of the chest rarely cause severe functional problems in the manner of larger anomalies of the limbs. Poland syndrome is known as a variety of associated anomalies centered on the trunk and upper limbs. The authors report the case of a 28-year-old female with absence of the pectoralis major muscle and depression of the left anterior

Rogerio P. Rocha; Presper Feres Daher; Ewaldo B. de Souza Pinto; Oswaldo R. Saldaña; Jose E. de Sousa; Raphael B. Pacheco; Fabiano B. Martins



Lemierre syndrome: a complication of acute pharyngitis  

Microsoft Academic Search

Lemierre syndrome, otherwise known as postanginal sepsis or necrobacillosis, is an illness that originates as an acute pharyngitis or tonsillitis which progresses to sepsis, usually fusobacterial, due to suppurative thrombophlebitis of the internal jugular vein. Septic thromboemboli then seed various organs, resulting in multiple organ system pathology, most commonly affecting pulmonary and hepatic systems and joints. Although rare in the

Andrea Williams; Mark Nagy; Jennifer Wingate; Luna Bailey; Mark Wax



[Original clinical classification of a complicated diabetic foot syndrome].  


Original clinical classification of a complicated diabetic foot syndrome (DFS), based on summarizing of experience, concerning surgical treatment of 1532 patients, suffering complicated DFS, was proposed, necessitating determination of clinical form (symbol C), anatomic localization (symbol Z) and etiological factor (symbol E) of the lower extremity tissues affection. The classification applied permits to choose a surgical tactics depending on presence of specific complication of DFS, and this creates conditions for unification and universal registration of form and severity of a complicated DFS, as well as the volume of a surgical aid PMID:21510361

Shapoval, S D; Riazanov, D Iu; Savon, I L; Bereznitski?, Ia S



Pulmonary Hemorrhage Complicating a Typical Hemolytic-Uremic Syndrome  

Microsoft Academic Search

We describe a case of pulmonary bleeding and subsequent acute respiratory distress syndrome (ARDS) in a 20-month-old female suffering from a typical postdiarrheal hemolytic-uremic syndrome (HUS). Acute renal failure was treated early by peritoneal dialysis. It is of interest to underline that thrombocytopenia or any coagulative impairment was absent when this complication occurred, and spontaneous diuresis recovery was ongoing. All

M. Piastra; A. Ruggiero; A. Langer; E. Caresta; A. Chiaretti; S. Pulitanò; G. Polidori; R. Riccardi



Common variable immunodeficiency complicated with hemolytic uremic syndrome  

PubMed Central

Common variable immunodeficiency is a primary immunodeficiency disease characterized by reduced serum immunoglobulins and heterogeneous clinical features. Recurrent pyogenic infections of upper and lower respiratory tracts are the main clinical manifestations of common variable immunodeficiency. Hemolytic uremic syndrome is a multisystemic disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia, and organ ischemia due to platelet aggregation in the arterial microvasculature. This is one of the rare cases of patients diagnosed with common variable immunodeficiency, which was complicated by hemolytic uremic syndrome.



Respiratory complications of Ehlers-Danlos syndrome type IV.  


Pulmonary complications are described in a case of Ehlers-Danlos syndrome type IV, established by studies of collagen biosynthesis. At age 20.5 years the patient, who had previously suffered a spontaneous colonic perforation, developed intermittent recurrent hemoptysis and had a spontaneous hemopneumothorax. At presentation, imaging studies revealed multiple scattered cavitary lesions in both lungs. On separate occasions large parenchymal cysts ensued and subsequently regressed. Reviews of other reported patients indicate that pulmonary complications do occur in patients with Ehlers-Danlos syndrome type IV but have not resulted directly in patient mortality. PMID:9147885

Dowton, S B; Pincott, S; Demmer, L



Toxic shock syndrome: A rare complication to enhanced external counterpulsation  

PubMed Central

Enhanced external counterpulsation (EECP) is known to reduce angina pectoris in patients in whom revascularization is not possible. The therapy is associated with few adverse effects. A case with a previously unknown complication – toxic shock syndrome – that occurred twice in an EECP-treated patient is described. Toxic shock syndrome initially resembles the state of septic shock. Early recognition of the syndrome and initiation of therapy is of vital importance to prevent rapid progression and a possibly fatal outcome. Awareness of this condition among cardiologists offering EECP is essential.

J?rgensen, Peter Godsk; Lindberg, Jens; May, Ole



Toxic shock syndrome: A rare complication to enhanced external counterpulsation.  


Enhanced external counterpulsation (EECP) is known to reduce angina pectoris in patients in whom revascularization is not possible. The therapy is associated with few adverse effects. A case with a previously unknown complication - toxic shock syndrome - that occurred twice in an EECP-treated patient is described. Toxic shock syndrome initially resembles the state of septic shock. Early recognition of the syndrome and initiation of therapy is of vital importance to prevent rapid progression and a possibly fatal outcome. Awareness of this condition among cardiologists offering EECP is essential. PMID:21165367

Jørgensen, Peter Godsk; Lindberg, Jens Aage; May, Ole



Arterial complications of Ehlers-Danlos syndrome.  


Two patients considered to be examples of the Type IV or "arterial" variety of the Ehlers-Danlos Syndrome (EDS) are presented. In case 1 there seems to be little doubt about the diagnosis. Case 2, which is currently under treatment also appears to be an example of EDS, Type IV. The multiple arterial aneurysms and the findings on the skin biopsy appear to substantiate the diagnosis. These two cases demonstrate some of the features of the Type IV variety of EDS. In the first case visceral artery aneurysms dominated the clinical picture and in the second case peripheral arterial aneurysms were dominant. In neither case were the classical manifestations of the disorder, skin hyperelasticity and joint hypermobility, prominent. PMID:3997972

Sheiner, N M; Miller, N; Lachance, C


TRALI Syndrome Complicated by Retroperitoneal Bleeding.  


Transfusion-related acute lung injury (TRALI) is an underdiagnosed and underreported syndrome which by itself is the third leading cause of transfusion-related mortality. The incidence of TRALI is reported to be 1 in 2000 to 5000 transfusions. When combined with uncontrollable bleeding, survival is unachievable. We report the case of a 25-year-old man, who underwent open heart surgery as an infant to correct his congenital heart disease in association with right pulmonary artery atresia. He presented with hemoptysis secondary to aspergilloma and required a pneumonectomy of the nonfunctional right lung. During pneumolysis, significant bleeding occurred from the superior vena cava. The patient required a blood transfusion and was placed on cardiopulmonary bypass to control the bleeding. Simultaneous occurrence of severe pulmonary edema and retroperitoneal bleeding were noted. Approximately 8 L of frothy edema fluid were drained from the only functional left lung starting ~15 minutes after the transfusion and lasting for several hours until the end of the case. It most likely represented TRALI syndrome. Increasing abdominal girth and poor volume return to the pump were consistent with and pathognomonic for retroperitoneal bleeding. Though primary surgical bleeding in the chest was controlled successfully and a pneumonectomy performed without further difficulty, we were unable to separate the patient from cardiopulmonary bypass due to the inability to oxygenate. As a result, we could not reverse the anti-coagulation which potentially exacerbated the retroperitoneal bleeding. After multiple unsuccessful attempts the patient succumbed. This ill-fated case demonstrates the quandary of obtaining vascular access for emergency cardiopulmonary bypass while in the right thoracotomy position. It may be beneficial to have both the femoral artery and vein cannulated before positioning a patient in a lateral decubitus position. In addition, early direct access to the right atrium may obviate a need for femoral venous cannulation. Also, adult extracorporeal membrane oxygenation may be indicated if faced with such a severe pulmonary edema without ongoing hemorrhage. PMID:22942633

Singh, Vijay A; Zeltsman, David



Gastrointestinal complications of the Ehlers-Danlos syndrome  

PubMed Central

The gastrointestinal abnormalities encountered in 125 patients with the Ehlers-Danlos syndrome have been described. Spontaneous perforation of the intestine and massive gastrointestinal haemorrhage are uncommon but potentially lethal complications of the Ehlers-Danlos syndrome. Less dangerous abnormalities, such `as external hernia, hiatus hernia, eventration of the diaphragm, intestinal diverticula, and rectal prolapse were all encountered in patients in the series. Abdominal surgery in affected patients may be made difficult by fragility of tissues and a bleeding tendency. In the postoperative period, tearing out of sutures and wound dehiscence may occur.

Beighton, Peter H.; Murdoch, J. Lamont; Votteler, Theodore



Klippel-Trénaunay Syndrome: Clinical features, complications, and management  

Microsoft Academic Search

Klippel-Trnaunay Syndrome (KTS) is rare and not well recognized among most physicians, which has lead to inappropriate management\\u000a and delayed referral in many cases. Presented herein is the largest series ever reported from a single center in Saudi Arabia,\\u000a comprised of 18 patients seen between 1990 and 1996, whose clinical features, complications, and management are discussed.\\u000a All 18 patients had

Mussaad M. S. Al-Salman



Down syndrome: perinatal complications and counseling experiences in 216 patients.  


Two hundred and sixteen infant evaluations were selected for analysis from those of 669 outpatients (930 total visits) at a weekly Down syndrome clinic. Each record contained perinatal history and physical examination results, and 191 of the 216 included a systematic interview regarding parental experiences with diagnosis and counseling. Gastrointestinal problems (77% of neonates), cardiac anomalies (38%), and hematologic problems (11%) were the most common complications; cited problems included anal stenosis (11%), which is described as a newly recognized cause of constipation in early infancy. Counseling experiences were positive in 66 (34%) of the 191 parent interviews, with counselor knowledge, timing, setting, and attitudes being cited as key factors. Appropriate counseling and surveillance for gastrointestinal problems can greatly facilitate parental adjustment to the neonate with Down syndrome. PMID:10559764

Spahis, J K; Wilson, G N



Treatment of GERD Complications (Barrett's, Peptic Stricture) and Extraesophageal Syndromes  

PubMed Central

Apart from typical reflux symptoms and esophagitis, the clinical presentation of GERD can be dominated by mucosal complications of reflux (Barrett’s esophagus, esophageal adenocarcinoma, Peptic structure) or by extra-esophageal syndromes, most notably asthma, laryngitis, or chronic cough. Managing these entities is much less straightforward than with esophagitis. With respect to adenocarcinoma, metaplasia and dysplasia are recognized precursors, but the potential of these lesions to evolve to cancer has not been shown to lessen as a result of treatment, medical or surgical. Consequently, management focuses on strategies to identify and eliminate high grade dysplasia and intramucosal cancer, lesions that are potentially curable by endoscopic ablation or surgical resection. With respect to the extra-esophageal GERD syndromes, these are increasingly recognized as multifactorial conditions with reflux as an exacerbating factor. Treatment trials have been generally disappointing and the clinical challenge remains in accurately identifying afflicted patients who might benefit from more intensive medical or surgical reflux treatment.

Bansal, Ajay; Kahrilas, Peter J.



Complicated osteoporosis in progeroid syndrome: treatment with teriparatide.  


Human progeroid syndromes (PSs) include a group of genetic "premature aging" diseases that affect a variety of organ systems. Bone diseases are common sequelae of patients diagnosed with PSs. Teriparatide therapy is recommended for elderly men with low bone mineral density (BMD; T-score <-2.5) and at least 1 fragility fracture who are unable to tolerate bisphosphonates. We describe a 20-yr-old patient affected by PS and severe osteoporosis complicated with femoral fracture. The patient experienced a significant improvement in lumbar spine BMD after treatment with teriparatide. PMID:22154431

Iglesias Bolaños, Paloma; Guijarro de Armas, Guadalupe; Civantos Modino, Soraya; Vega Piñero, Belen; Pavón de Paz, Isabel; Monereo Megías, Susana



Portal venous gas and thrombosis complicating superior mesenteric artery syndrome (Wilkie's syndrome) in a child.  


We report a case of a 10-year-old girl presenting with portal venous gas and thrombosis associated with superior mesenteric artery syndrome. To our knowledge, this is the first reported case of superior mesenteric artery syndrome complicated by gastric wall pneumatosis, portal venous gas, and thrombosis in childhood. Although these complications usually lead to bowel resection in adults and result in a high mortality rate, our pediatric patient was successfully treated nonoperatively with intensive care management and jejunal tube feedings. Presence of portal venous gas may occur in superior mesenteric artery syndrome in children and does not necessarily lead to bowel injury, allowing conservative medical management as a first-line treatment. PMID:20385295

Rod, Julien; Sarnacki, Sabine; Petit, Thierry; Ravasse, Philippe



Neuromyelitis optica--complication or comorbidity in primary Sjögren's syndrome?  


We report two cases of neuromyelitis optica (NMO) associated with primary Sjögren's syndrome (pSS), comparing the clinical and laboratory features of these predominant neurological patients and reporting their different outcome. NMO - a severe demyelinating disorder of the central nervous system - primarily affects the spinal cord and optic nerves, resulting in longitudinally extensive transverse myelitis and/or optic neuritis. Our patients had a late pSS diagnosis, due to the absence of sicca syndrome and specific Sjögren serology in the early stages of their diseases, when the neurological symptoms prevailed. Many NMO patients have an accompanying autoimmune disease, most commonly Sjögren syndrome and systemic lupus erythematosus or a related profile of non-organ-specific autoantibodies. Neurologic involvement occurs in approximately 20% of patients with pSS, usually preceding the diagnosis (in 75-80% of the cases) [1,2]. The frequency of both neurologic manifestations (revealing pSS) and negative autoimmune serology, especially in the event of CNS involvement, could explain why underlying pSS is misdiagnosed [3,4]. Screening for pSS should be systematically performed in cases of acute or chronic myelopathy and/or cranial nerve involvement, mainly because these patients have a severe outcome. The presence of the anti-aquaporin4 antibodies, besides anti-Ro and anti-La, in both reported cases, is intriguing and raises the question of whether we are facing two distinct diseases or the NMO is just complicating an unusually less expressive Sjögren's syndrome subtype. PMID:22568275

Ni?escu, Doina; Nicolau, Adriana; Caraiola, Simona; Prede?eanu, Denisa; Ionescu, R; T?n?sescu, C



Severe cutaneous adverse reactions: emergency approach to non-burn epidermolytic syndromes  

Microsoft Academic Search

Introduction  Although severe cutaneous adverse reactions (SCARs), such as Stevens–Johnson syndrome and toxic epidermal necrolysis, are\\u000a rare, they are associated with considerable morbidity and mortality.\\u000a \\u000a \\u000a \\u000a Methods  The current knowledge regarding background, differential diagnoses, critical care and implications for inter-hospital emergency\\u000a medical service (EMS) transport of these patients is discussed.\\u000a \\u000a \\u000a \\u000a Conclusion  SCAR patients will substantially benefit from early interdisciplinary care and thorough consideration of

Manuel Florian Struck; Peter Hilbert; Maja Mockenhaupt; Beate Reichelt; Michael Steen



[Pseudoexfoliation syndrome and cataract surgery. Avoidance and treatment of complications].  


Eyes with pseudoexfoliation syndrome often exhibit insufficient mydriasis, zonular weakness and pronounced fibrotic capsular shrinkage. This may make cataract surgery as such difficult but also leads to postoperative complications, such as rhexis ovalization or phimosis (capsule contraction syndrome) or progressive zonular weakening with final spontaneous dislocation of the capsule-implant complex (CIC). To avoid or correct for this special techniques and implants may be used: as prophylaxis, intracameral adrenalin and retroiridal capsulorhexis, iris retractors or dilators, various models of capsular tension and bending rings, bimanual capsule ring implantation, capsular bag stabilization with iris retractors or segments and secondary capsulorhexis may be used. Rhexis phimosis may be excised by a special diathermic probe, a subluxated CIC may be sutured to the sclera either in toto or the lens only after removal from the capsule bag, the latter also to the posterior iris surface. When luxated into the vitreous cavity, the CIC may be lifted to the iris plane and refixed as described or exchanged for a new lens sutured into the sulcus or an angle or iris-supported anterior chamber lens. PMID:23053332

Menapace, R



Posterior fossa syndrome: identifiable risk factors and irreversible complications.  


Cerebellar mutism was first described by Rekate et al. in 1985 as a transient condition which occurs after posterior fossa operations in children. Posterior fossa syndrome (PFS) and cerebellar mutism are often used interchangeably in the literature. In our experience, we found cerebellar mutism to be a reversible component of a persistent neurologic syndrome. The cause and identifiable risk factors have not been clearly elucidated in the literature. To further characterize PFS, we reviewed 253 children with posterior fossa tumors who underwent surgical resection. We documented 20 cases of PFS (8%), 12 males and 8 females. Age ranged from 1.5 to 13 years (mean = 6.5). Of the 20, 16 were medulloblastoma, 3 ependymoma and 1 astrocytoma. There was a 21 % incidence (16/76) of PFS in medulloblastoma of the posterior fossa. The incidence for ependymoma was 13% (3/24) and 1% (1/102) for astrocytoma. All 20 cases (100%) had brainstem involvement by the tumor. The most frequent postoperative findings included mutism, ataxia, 6th and 7th nerve palsies and hemiparesis. Mutism had a latency range of 1-7 days (mean = 1.7) and a duration of 6-365 days (mean = 69.2, median = 35). Although mutism resolved in all cases, the remaining neurologic complications which characterized our findings of PFS were rarely reversible. We describe potential risk factors for developing PFS after surgery with hopes of making neurosurgeons more aware of potential problems following the removal of lesions in this area. Early recognition of PFS would further promote patient and family understanding and coping with this syndrome. PMID:10708354

Doxey, D; Bruce, D; Sklar, F; Swift, D; Shapiro, K



Ophthalmic complications including retinal detachment in hyperimmunoglobulinemia E (Job's) syndrome: Case report and review of literature  

PubMed Central

Hyperimmunoglobulinemia E (Job's) syndrome is characterized by markedly increased levels of immunoglobulin E, recurrent cutaneous and systemic pyogenic infections, atopic dermatitis, and peripheral eosinophilia. Although ocular involvement in Job's syndrome is rare, there are reports of keratoconus, staphylococcal chalazia with blepharitis, and Candida endophthalmitis by various authors. We present the first case report of retinal detachment with complicated cataract in Job's syndrome.

Arora, Vipul; Kim, Usha R; Khazei, Hadi M; Kusagur, Shivayogi



Lemierre syndrome caused by acute isolated sphenoid sinusitis and its intracranial complications  

Microsoft Academic Search

Classically, Lemierre syndrome is a rare clinical entity in which acute oropharyngeal infection causes septic internal jugular vein thrombosis and leads to septic lesions to distant organs, such as the lung. Lemierre syndrome also presents with odontogenic infections, mastoiditis, parotitis, and sinusitis. We report the first case of Lemierre syndrome following acute isolated sphenoid sinusitis that was complicated with cavernous

Sang-Chul Lim; Sung-Su Lee; Tae-Mi Yoon; Joon-Kyoo Lee



Sufficient Weight Reduction Decreases Cardiovascular Complications in Diabetic Patients with the Metabolic Syndrome  

Microsoft Academic Search

Background: The metabolic syndrome is associated with an increased risk of cardiovascular complications. Especially patients with evident cardiac pathology are at high risk for further complications. A sufficient weight reduction would improve the metabolic pathology and reduce the cardiovascular risk. Unfortunately, overweight and obese patients, even with complicated coronary heart disease, do not alter lifestyles regarding fat intake and physical

Giuseppe Cocco; Stefano Pandolfi; Valentin Rousson



Intraabdominal Compartment Syndrome Complicating Transurethral Resection of Bladder Tumor  

PubMed Central

Abdominal compartment syndrome can result from many different causes. We present a case where this dangerous syndrome occurred in the operating room during a transurethral resection of a bladder tumor. It was initially recognized by an elevation in the peak inspiratory pressure. We report the typical physiologic changes that occur with this syndrome and its treatment options.

Narain, Sachin; Giquel, Jadelis; Ariza, Armando; Martinez-Ruiz, Ricardo; Kava, Bruce R.; Matadial, Christina



Intraabdominal compartment syndrome complicating transurethral resection of bladder tumor.  


Abdominal compartment syndrome can result from many different causes. We present a case where this dangerous syndrome occurred in the operating room during a transurethral resection of a bladder tumor. It was initially recognized by an elevation in the peak inspiratory pressure. We report the typical physiologic changes that occur with this syndrome and its treatment options. PMID:22957294

Narain, Sachin; Giquel, Jadelis; Ariza, Armando; Martinez-Ruiz, Ricardo; Kava, Bruce R; Matadial, Christina



Serious aortic complications in a patient with Turner syndrome.  


An asymptomatic young woman was discovered to have life-threatening aneurysms and dissection of the thoracic aorta during routine evaluation in a Turner syndrome (TS) study. The presence of a heart murmur and hypertension had led to diagnosis and surgical repair of an atrial septal defect at age 5 and of aortic coarctation at age 12. The diagnosis of TS was made at 16 years of age due to short stature and delayed pubertal development. She was treated with growth hormone from age 16 to 18 and with atenolol, thyroid hormone, and estrogen. She discontinued her medications and was lost to medical follow-up at age 20. Upon presenting here at age 26, she reported a very active lifestyle, including vigorous exercise and an acting career, with no symptoms of chest or back pain or shortness of breath. Cardiovascular imaging revealed aortic regurgitation, an unsuspected dissection of a severely dilated ascending aorta, and a large descending aortic aneurysm. She required surgical replacement of her aortic valve and ascending aorta, followed by endovascular repair of the descending aortic aneurysm. This patient illustrates the importance of considering the diagnosis of TS in girls with congenital aortic defects and the absolute necessity for close, expert follow-up of these patients who are at high risk for complications after surgical repair due to an underlying aortopathy, hypertension, and metabolic disorders. This patient also emphasizes the need to publicize and follow screening guidelines as there is an increasing number of patients with congenital defects who need transition to adult care. PMID:22923005

Oza, Nishaki Mehta; Siegenthaler, Michael; Horvath, Keith; Rosing, Douglas R; Chen, Marcus Y; Arai, Andrew E; Gould, Harley N; Bakalov, Vladimir; Bondy, Carolyn A



Adults with Down's syndrome: the prevalence of complications and health care in the community  

PubMed Central

Background Individuals with Down's syndrome are predisposed to a variety of medical conditions which can impose an additional, but preventable, burden of secondary disability. Although there are guidelines for health checks and medical management of children with Down's syndrome, the needs of adults are relatively neglected. Aim To determine the prevalence of common medical problems in adults with Down's syndrome, and to assess current practice regarding medical surveillance of these patients. Design of study Detailed notes analysis. Setting Data were obtained from the primary care records of adults with Down's syndrome living in the Newcastle upon Tyne and Gateshead areas. Method Case notes were reviewed to obtain details regarding complications and to determine the frequency of medical surveillance of individuals with Down's syndrome. Results Complications such as hypothyroidism, coeliac disease, and obesity occur more frequently in adults with Down's syndrome than previous paediatric prevalence studies suggest. Surveillance of common complications that occur in individuals with Down's syndrome is infrequent. In this study, 48% of adults with Down's syndrome had not seen a doctor in the previous 12 months and 33% had not had a medical assessment in the previous 3 years. Conclusion Many individuals with Down's syndrome do not have access to regular healthcare checks, despite the high frequency of common medical complications in adult life. Debate regarding the practicality and relevance of introducing regular health checks is warranted.

Henderson, Alex; Lynch, Sally A; Wilkinson, Steve; Hunter, Morag



[SMART syndrome: case report of a rare complication after cerebral radiation therapy].  


The authors report a 71-year-old woman case who developed, 7 years after a cerebral radiation therapy for a parietooccipital glioblastoma, a stroke-like migraine attacks after radiotherapy syndrome (SMART syndrome), a rare complication characterized by reversible neurologic deficits with migraine described after cerebral irradiation. Transient gyriform reversible enhancement is found on MRI during crises. This case report allows discussing the clinical, iconographic presentation and the clinical outcome of this syndrome at the light of the literature publication. PMID:22819470

Truntzer, P; Monjour, A; Gaultier, C; Ahle, G; Guillerme, F; Boutenbat, G; Stilhart, B; Salze, P; Atlani, D



[The attempt of clinical classification of the complicated diabetic foot syndrome].  


The experience of surgical treatment of 1532 patients with the complicated forms of diabetic foot syndrome (DFS) was analyzed. The original clinical classification of the complicated DFS was suggested. The classification considered the clinical form (symbol "C"), anatomic localization (symbol "Z") and etiology (symbol "E"). The classification allows to define surgical tactics depending on concrete complications of the DFS, frames conditions for the unification and uniform registration of the form and severity of the disease and volume of the surgical treatment. PMID:21716224

Shapoval, S D; Riazanov, D Iu; Savon, I L; Zinich, E L; Smirnova, D A



Sick sinus syndrome as a complication of mediastinal radiation therapy  

SciTech Connect

A 33-year-old man who had received mediastinal radiation therapy for Hodgkin's disease 12 years earlier developed a symptomatic sick sinus syndrome requiring the implantation of a permanent pacemaker. The sick sinus syndrome and a finding of an occult constrictive pericarditis were considered to be due to the previous mediastinal irradiation. A ventricular pacemaker was chosen because mediastinal radiotherapy also increases the risk of developing atrioventricular conduction defects.

Pohjola-Sintonen, S.; Toetterman, K.J.K.; Kupari, M. (Helsinki Univ. Central Hospital (Finland))



Hemoptysis Complicating Scimitar Syndrome: From Diagnosis to Treatment  

SciTech Connect

We report the case of a 24-year-old patient with known scimitar syndrome presenting with hemoptysis. Multidetector CT angiography showed the scimitar vein draining the right lung to the inferior vena cava associated with right lower lobe bronchopulmonary sequestration. The presence of hemoptysis associated with scimitar syndrome is likely secondary to an anomalous systemic arterial blood supply. We treated this patient successfully with transcatheter occlusion of the anomalous feeding arterial vessels.

Nedelcu, Cosmina; Carette, Marie-France [AP-HP, Tenon Hospital, Radiology Department (France); Parrot, Antoine [Respiratory Intensive Care Unit, AP-HP, Tenon Hospital (France); Hammoudi, Nadjib [AP-HP, Tenon Hospital, Cardiology Department (France); Marsault, Claude; Khalil, Antoine, E-mail: antoine_khalil@yahoo.f [AP-HP, Tenon Hospital, Radiology Department (France)



Degos' syndrome complicated by bowel perforation: focus on radiological findings.  


We describe a 50-year-old man who first presented with multiple skin lesions which were characteristic of Degos' syndrome. The patient developed multiple episodes of abdominal pain. Some episodes resolved with conservative management, for others he underwent urgent operations for bowel perforations. The patient subsequently underwent extensive small bowel resection, but further systemic deterioration ensued and he died. The imaging findings of Degos' syndrome and the implications of pneumatosis intestinalis and pneumoperitoneum are discussed. PMID:23535679

Yeung, Jessie T H; Ma, Johnny K F; Yung, Alfred W T



Sjögren's syndrome: diagnosis and management of oral complications.  


Sjogren's syndrome, a common autoimmune disease process, is characterized by destruction of exocrine (including the lacrimal and salivary) glands. Patients with this disorder may initially complain of a dry mouth or have rapid onset of new carious lesions. Here, a case of Sjogren's syndrome is presented that was initially diagnosed because of dental complaints, and long-term treatment of Sjogren's patients is discussed. PMID:9171038

Lilly, J P; Fotos, P G


Clinical features and respiratory complications in Myhre syndrome  

Microsoft Academic Search

We describe the clinical characteristics of 4 singleton cases, 3 males and 1 female, with Myhre Syndrome (OMIM 139210), who were born to non-consanguineous parents. Three cases had no family history of similarly affected individuals but 1 male’s mother had short stature, some facial features suggestive of Myhre syndrome and evidence of skewed X-chromosome inactivation in her blood DNA. Short

Ruth McGowan; Ramkumar Gulati; Pamela McHenry; Alexander Cooke; Sandra Butler; Wee Teik Keng; Victoria Murday; Margo Whiteford; Frederik G. Dikkers; Brigit Sikkema-Raddatz; Ton van Essen; John Tolmie



[Complicated course of diabetic foot syndrome. An attempt to create the new classification concerning necrotic-purulent complications severity].  


There was analyzed in detail a current state of diabetic foot syndrome (DFS) problem. In spite of that DFS constitutes the discrete nosological entity, it is not included into International Classification of the Diseases (ICD-10). The absence of classification of complicated DFS does not permit to elaborate protocols of the patients treatment standards and to determine real terms of their stationary treatment. Basing on analysis of the work experience of Purulent-septic center, owing hospital beds for the treatment of patients, suffering DFS, concerning diagnosis and treatment of more than 1500 patients with the DFS complications, the original classification of complicated DFS was presented by the authors, which is proposed for discussion in a wide round of specialists. PMID:20568505

Shapoval, S D; Savon, I L; Zinich, O L



Clinical features and respiratory complications in Myhre syndrome.  


We describe the clinical characteristics of 4 singleton cases, 3 males and 1 female, with Myhre Syndrome (OMIM 139210), who were born to non-consanguineous parents. Three cases had no family history of similarly affected individuals but 1 male's mother had short stature, some facial features suggestive of Myhre syndrome and evidence of skewed X-chromosome inactivation in her blood DNA. Short stature, deafness, learning difficulties, skeletal anomalies and facial dysmorphisms were evident in all cases. Arthralgia and stiff joints with limited movement were also present. The facial appearance, thickened skin, a 'muscular' habitus are memorable features. The female patient was least affected: this patient and one affected male displayed streaky skin with areas of patchy thickening, suggestive of genetic mosaicism. One patient developed sleep apnoea, a restrictive ventilatory defect and died following a choking episode. Another affected male developed recurrent, progressive, proximal, tracheal stenosis requiring partial tracheal resection, laser treatment and eventually tracheotomy. Review of Myhre syndrome patients in the literature and syndromes in the differential diagnosis, suggests heterogeneity in Myhre syndrome and clinical overlap with Laryngotracheal stenosis, Arthropathy, Prognathism and Short stature syndrome. PMID:21816239

McGowan, Ruth; Gulati, Ramkumar; McHenry, Pamela; Cooke, Alexander; Butler, Sandra; Keng, Wee Teik; Murday, Victoria; Whiteford, Margo; Dikkers, Frederik G; Sikkema-Raddatz, Brigit; van Essen, Ton; Tolmie, John



Corneal Stromal Calcification After Topical Steroid-Phosphate Therapy  

Microsoft Academic Search

econdary corneal calcification involving the full thickness of the stroma is a rare poten- tial complication of severe dry eye conditions, recurrent corneal ulcerations, chronic ocular inflammation, or multiple surgical procedures. We describe on a patient with un- usual, hitherto unreported calcareous degeneration of the corneal stroma after topical steroid-phosphate therapy for chronic keratoconjunctivitis after Stevens-Johnson syndrome. The patient's serum

Ursula Schlotzer-Schrehardt; Zbigniew Zagorski; Leonard M. Holbach; Carmen Hofmann-Rummelt; Gottfried O. H. Naumann



Lemierre's syndrome: a serious complication of a routine dental procedure.  


Lemierre's syndrome is the clinical presentation characterized by oropharyngeal or tonsillar infection, anaerobic septicaemia often with distant septic emboli, and clinical or radiological evidence of thrombosis of the internal jugular vein. We report a case of Lemierre's syndrome in a 44-year-old type II diabetic male. This case is unique for two reasons. Firstly, we believe it is the first reported iatrogenic case following a routine dental procedure. Secondly, the internal jugular vein thrombosis was found to occur on the contralateral side to the primary infection. PMID:23713647

Ghaly, B; Bertram, A; Naim, A



Intracranial complications of acute otitis media and Gradenigo's syndrome.  


We describe the case of a 12-year-old girl with acute otitis media complicated by acute mastoiditis, epidural empyema, thrombosis of the sigmoid sinus and paralysis of the abducens nerve. The patient underwent a mastoidectomy on the left side combined with drainage of the epidural empyema through an extended burr holl and received intravenous antibiotics for 6 weeks and anticoagulation for 12 weeks. This report discusses the intracranial complications of acute otitis media, which were a common problem before the advent of adequate antibiotic drugs but have become rare since their introduction. PMID:23909122

Colpaert, C; Van Rompaey, V; Vanderveken, O; Venstermans, C; Boudewyns, A; Menovsky, T; de Veuster, I; Van de Heyning, P; Hamans, E



Bilateral opercular syndrome: an unusual complication of perinatal difficulties  

Microsoft Academic Search

We describe an 8-year-old boy with pseudobulbar palsy and speech disturbance associated with fetal distress, mild birth asphyxia and probably intracranial hemorrhage. There is a remarkable dissociation between orofacial voluntary movements and emotional expression. MRI revealed cortical atrophy and subcortical gliosis of both opercula. The clinical and neuroradiological features correspond to bilateral opercular syndrome. We assume that a reduction of

Tatsuya Koeda; Kenzo Takeshita; Toshiro Kisa



Impact of the Antiphospholipid Syndrome on Complications during Pregnancy  

Microsoft Academic Search

The antiphospholipid syndrome (APS) is an autoimmune disease characterized by the appearance of antiphospholipid antibodies (APA) and at least one clinical manifestation like venous and arterial thrombosis or recurrent miscarriages and fetal loss in the second and third trimester. This most common acquired thrombophilia can also cause placental insufficiency, preeclampsia, intrauterine growth retardation, and placental abruption. Several potential pathogenic pathways

Ekkehard Schleussner



Trigeminal trophic syndrome complicating a case of borderline tuberculoid leprosy.  


An example of trigeminal trophic syndrome presenting as ulceration of ala nasi in a case of borderline tuberculoid leprosy is reported. To the best of our knowledge, this is only the second case report of this manifestation in leprosy to be documented. PMID:22655477

Verma, Prashant; Pandhi, Deepika; Singal, Archana



Lemierre's Syndrome: A serious complication of an odontogenic infection  

Microsoft Academic Search

Necrobacillosis, postanginal septicaemia or Lemierre's Syndrome is characterised by suppurative thrombophle- bitis of the internal jugular vein with embolization to several sites, including the lungs. We report the case of a 38-year-old man who was initially hospitalized because of odontogenic cellulitis. Given the deterioration of his clinical state (septic shock and multiple organ failure), neck computed tomography was performed, revealing

Pablo Rosado; Lorena Gallego; Luis Junquera; Juan C. de Vicente


Macrophage activation syndrome: a potentially fatal complication of rheumatic disorders  

Microsoft Academic Search

AIMSTo review the precipitating events, clinical features, treatment, and outcome of macrophage activation syndrome (MAS).METHODSRetrospective review of cases of MAS from a prospectively collected database of children with rheumatic diseases from 1980 to 2000.RESULTSNine patients (eight girls) were considered to have evidence of MAS. The primary diagnosis was systemic onset juvenile idiopathic arthritis in seven, enthesitis related arthritis in one,

S Sawhney; P Woo; K J Murray



Radiation fibrosis syndrome: neuromuscular and musculoskeletal complications in cancer survivors.  


Radiation-induced toxicity is a major cause of long-term disability after cancer treatment. Radiation fibrosis describes the insidious pathologic fibrotic tissue sclerosis that can occur in response to radiation exposure. Radiation fibrosis syndrome describes the myriad clinical manifestations of progressive fibrotic tissue sclerosis resulting from radiation treatment. Radiation-induced damage can include "myelo-radiculo-plexo-neuro-myopathy," causing muscle weakness and dysfunction and contributing to neuromuscular injury. Similarly, radiation damage to neuromuscular structures contributes to radiation-induced trismus and cervical dystonia in head and neck cancer survivors. This narrative review discusses the pathophysiology, anatomy, evaluation, and treatment of neuromuscular, musculoskeletal, and functional disorders that can result as late effects of radiation treatment. Rehabilitation medicine physicians with extensive training in neuromuscular and musculoskeletal medicine as well as in the principles of functional restoration are uniquely positioned to help lead efforts to improve the quality of life for cancer survivors with radiation fibrosis syndrome. PMID:22108231

Stubblefield, Michael D



Spontaneous intracranial hypotension: The syndrome and its complications  

Microsoft Academic Search

Opinion statement  Spontaneous intracranial hypotension (SIH) is a syndrome that was largely unknown until the advent of MRI. The incidence of\\u000a SIH is estimated at 5 per 100,000, which is half the incidence of subarachnoid hemorrhage. The major feature is a postural\\u000a headache of acute or subacute onset. This headache is absent or minimal when the patient is lying down and

James R. Couch



Postural orthostatic tachycardia syndrome: a rare complication following electrical injury.  


We report on two previously healthy patients who developed severe form of postural orthostatic tachycardia syndrome (POTS) following an electric injury. Both the patients developed symptoms of orthostatic intolerance in the form of dizziness, fatigue, lightheadedness, and palpitations, weeks to months after electrical injury. Orthostatic intolerance produced considerable functional impairment in these patients. Early recognition of POTS when it occurs after an electrical injury allows for prompt evaluation and management to occur. PMID:20015131

Kanjwal, Khalil; Karabin, Beverly; Kanjwal, Yousuf; Grubb, Blair P



Peripheral gangrene complicating idiopathic and recessive hemolytic uremic syndromes  

Microsoft Academic Search

Three patients with hemolytic uremic syndrome (HUS) developed peripheral gangrene. Bilateral carotid artery thromboses occurred\\u000a in one of these patients after recovery from HUS. One patient had a long history of juvenile rheumatoid arthritis. In the\\u000a second patient, a flu-like illness preceded the onset of HUS. The third was one of two sisters, with the HUS appearing more\\u000a than 1

Bernard S. Kaplan; Clotilde D. Garcia; Russell W. Chesney; William E. Segar; Katia Giugno; Roberto Chem





... problems. Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) Blood sugar levels rise dangerously high in HHNS, a rare and serious condition. Kidney Disease (Nephropathy) Keep your diabetes and blood pressure under ... target levels for blood glucose, blood pressure, and cholesterol to ...


Pregnancy outcomes in women complicated by thalassemia syndrome at Maharaj Nakorn Chiang Mai Hospital  

Microsoft Academic Search

Objective  To determine the maternal and fetal outcomes of women complicated with thalassemia syndrome.\\u000a \\u000a \\u000a \\u000a Study design  Retrospective descriptive study.\\u000a \\u000a \\u000a \\u000a Materials and methods  The database of Maternal-Fetal Medicine unit and medical records, between January 2001 and April 2008, were reviewed to search\\u000a for pregnant women complicated with thalassemia syndrome and medical records were reviewed for patient’s baseline characteristics\\u000a and pregnancy outcomes. The inclusion criteria

Kuntharee Traisrisilp; Suchaya Luewan; Theera Tongsong



[Dystonia as a complication of gastroesophageal reflux: Sandifer syndrome].  


A girl aged 4 years and 5 months was admitted because of vomiting, poor appetite, epigastrial pain, weight loss and an abnormal posturing of the head and neck since the age of 3 1/2 years. This abnormal posturing consisted of maximal lateral flexion of the head and neck to the left. A number of investigations including EEG and CT-Scan of the head, had been performed repeatedly, and despite normal results various neuropsychiatric diagnoses were made. In our hospital massive gastrooesophageal reflux and oesophagitis were demonstrated and the diagnosis of Sandifer's syndrome was established. A fundoplication was performed and the child is free of symptoms since. PMID:3437909

Sacher, M; Novak, W



Premature Birth with Complicated Perinatal Course Delaying Diagnosis of Prader-Willi Syndrome  

PubMed Central

Prader-Willi syndrome in the newborn is essentially characterized by marked hypotonia, feeding difficulties, hypogonadism, and possible characteristic facial features. However, diagnosis at this age may be particularly difficult, and dysmorphic features may be subtle or absent. Prematurity can furthermore delay clinical features recognition and typical complications due to preterm birth may contribute to divert the diagnosis. We describe a preterm baby with a complicated perinatal course later diagnosed as PWS.

Ciana, G.; Fertz, M. C.; Pecile, V.; Demarini, S.



Acute hepatitis E complicated by Guillain-Barre syndrome in Portugal, December 2012--a case report.  


Autochthonous hepatitis E virus (HEV) infection has been increasingly reported in Europe and the United States, mostly arising from genotype 3 and less frequently genotype 4. We report here on a patient with HEV genotype 3a infection complicated by Guillain-Barré syndrome in Portugal in December 2012. We draw attention to the diagnosis of autochthonous HEV infection and to its rare, but important, neurological complications. PMID:23987830

Santos, L; Mesquita, J R; Rocha Pereira, N; Lima-Alves, C; Serrão, R; Figueiredo, P; Reis, J; Simões, J; Nascimento, Ms; Sarmento, A



Late Intrahepatic Hematoma Complicating Transjugular Intrahepatic Portosystemic Shunt for Budd-Chiari Syndrome  

SciTech Connect

Late intrahepatic hematoma is a rare complication of the transjugular intrahepatic portosystemic shunt (TIPS) procedure. We describe a patient with Budd-Chiari syndrome (BCS), who presented with a large inrahepatic hematoma 13 days after TIPS. Review of the literature reveals only two previous cases, both occurring in patients with BCS and presenting after a similar time interval. This potentially serious complication appears to be specific for TIPS in BCS.

Terreni, Natalia; Vangeli, Marcello; Raimondo, Maria Luisa [Royal Free Hospital, Sheila Sherlock Hepatobiliary Pancreatic and Liver Transplantation Unit (United Kingdom); Tibballs, Jonathan M. [Royal Free Hospital, Department of Radiology (United Kingdom); Patch, David; Burroughs, Andrew K. [Royal Free Hospital, Sheila Sherlock Hepatobiliary Pancreatic and Liver Transplantation Unit (United Kingdom)], E-mail:



Thrombotic microangiopathic syndrome: a novel complication of diabetic ketoacidosis.  


Thrombotic microangiopathic syndrome secondary to diabetic ketoacidosis is an under reported entity in children. We describe 2 girls who developed thrombotic thrombocytopenic purpura (TTP) and thrombocytopenia associated multi organ failure (TAMOF) in new onset diabetes. Both patients presented with classical findings of DKA and were intubated due to low GCS, admitted in PICU and managed according to DKA guidelines. Later on, both patients developed thrombocytopenia, acute kidney injury, and low hemoglobin along with evidence of microangiopathy on peripheral smear. One patient developed paraparesis while other patient had high LDH levels. The clinical diagnosis of TTP and TAMOF was made respectively. Both patients were treated with plasmapharesis and renal replacement therapy. Both gradually improved and were discharged. PMID:23942435

Khan, Muhammad Rehan; Maheshwari, Prem Kumar; Haque, Anwarul



["Spontaneous" rupture of the left iliac vein complicating Cockett's syndrome].  


The case history reported concerns a female patient aged 42 years for whom the clinical picture was that of a blue phlebitis (phlegmatia caerulea dolens), associated with a state of shock evoking a severe pulmonary embolus. The absence of echocardiographic dilatation of the right cavities, and the appearance of a left iliac fossa mass, steered the diagnosis towards internal haemorrhage. Emergency laparotomy allowed diagnosis and treatment of a so-called spontaneous rupture of the left iliac vein, a rare condition for which 20 cases have been reported in the literature. Re-operation performed 24 hours afterwards for the absence of venous return allowed the discovery of Cockett's syndrome with ascending thrombosis, requiring cross-venous bypass associated with the creation of an arterio-venous fistula in order to maintain permeability. One year afterwards the appearance of signs of cardiac insufficiency led to the closure of this fistula. PMID:12741313

Kismoune, N; Eicher, J C; Jazayeri, S; André, F; Terriat, B; David, M; Wolf, J E



The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery  

Microsoft Academic Search

Background: The abdominal compartment syndrome (ACS) is a recognized complication of damage control surgery (DCS). The purposes of this study were to (1) determine the effect of ACS on outcome after DCS, (2) identify patients at high risk for the development of ACS, and (3) determine whether ACS can be prevented by preemptive intravenous bag closure during DCS.Methods: Patients requiring

Christopher D Raeburn; Ernest E Moore; Walter L Biffl; Jeffrey L Johnson; Daniel R Meldrum; Patrick J Offner; Reginald J Franciose; Jon M Burch



Budd-Chiari Syndrome Complicating Hydatid Cyst of the Liver Managed by Venoplasty and Stenting  

SciTech Connect

Budd-Chiari syndrome (BCS) and portal hypertension is an uncommon complication of hydatid cyst of the liver. Previous reports describe cyst excision or portosystemic shunt surgery for such patients. Here we present a case of hydatid cyst of the liver with BCS that was treated successfully with hepatic venoplasty and transjugular stent placement.

Sarawagi, Radha, E-mail:; Keshava, Shyamkumar N., E-mail:; Surendrababu, Narayanam R. S., E-mail: [Christian Medical College, Department of Radiology (India); Zachariah, Uday G., E-mail:; Eapen, Eapen C., E-mail: [Christian Medical College, Department of Gastroenterology (India)



Frey’s Syndrome following Submandibular Gland Excision: An Unusual Postoperative Complication  

Microsoft Academic Search

Gustatory sweating and flushing, or Frey’s syndrome, is a fairly common complication following surgery or injury to the parotid gland and is thought to be caused by aberrant nerve regeneration. A similar condition has been reported in the literature following surgery to the submandibular region. Since this was first described in 1934, only 7 subsequent cases of submandibular sweating and

A. Teague; S. Akhtar; J. Phillips



Targeting Oxidant Stress as a Strategy for Preventing Vascular Complications of Diabetes and Metabolic Syndrome  

Microsoft Academic Search

Oxidant stress plays a central role in mediating the macro- and microvascular complications of diabetes and metabolic syndrome. Radicals antagonize protective nitric oxide (NO) bioactivity, through direct quenching of NO and uncoupling of NO synthase, while promoting inflammation and fibrosis via activation of NF-kappaB and TGF-beta, respectively. Oxidants are key mediators of insulin resistance in hypertrophied adipocytes - which gives

Mark F. McCarty; Toyoshi Inoguchi


[Acute coronary syndrome during dissection of left main as a complication of radiofrequency ablation].  


We present a case of 44 year-old female who was admitted to the hospital due to performed radio frequency ablation because of VF during WPW syndrome, which was complicated by dissection of left main. The dissection was treated with success by primary percutaneous coronary intervention with two metal stents. PMID:22427091

Kulawik, Tomasz; Ka?u?a, Bernadetta; Ku?nierz, Jacek



Fatal Complications After Self-Expandable Metallic Stent Placement for Inferior Vena Cava Syndrome  

SciTech Connect

We present the case of a 71-year-old man with inferior vena cava syndrome due to metastatic lymph nodes from hepatocellular carcinoma with serious complications that were strongly suspected to result from rapid changes in hemodynamics after self-expandable metallic stent placement.

Yamagami, Takuji, E-mail:; Nakamura, Toshiyuki; Kin, Yoko; Takimoto, Yukiko; Nishimura, Tsunehiko [Kyoto PrefecturalUniversity of Medicine, Kyoto, Department of Radiology (Japan)



Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome?  

Microsoft Academic Search

Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disease and is recognised as a major public health burden. Large-scale epidemiological studies have demonstrated an independent relationship between OSAS and various cardiovascular disorders. The pathogenesis of cardiovascular complications in OSAS is not completely understood but a multifactorial aetiology is likely. Inflammatory processes have emerged as critical in the pathogenesis of

S Ryan; C T Taylor; W T McNicholas



Life-threatening complications of transient abnormal myelopoiesis in neonates with Down syndrome  

Microsoft Academic Search

Neonates with Down syndrome can present with a haematological disorder called transient abnormal myelopoiesis (TAM). While TAM is usually a self-limiting disease, patients with severe complications such as hydrops fetalis, cardiorespiratory failure and liver fibrosis have been described. Here, we present five consecutive neonates with trisomy 21 and TAM, four of whom were critically ill and were therefore treated with

Sabine Dormann; Marcus Krüger; Roland Hentschel; Regina Rasenack; Brigitte Strahm; Udo Kontny; Charlotte Niemeyer



Mucosal lesions may be a minor complication of SAPHO syndrome: a study of 11 Japanese patients with SAPHO syndrome.  


Since the term synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome was proposed by Chamot et al. (Rev Rhum Mal Osteoartic 54:187-196, 1987), clinical reviews concerning this syndrome have been mainly reported from Europe. We carried out a retrospective analysis of 11 Japanese patients with SAPHO syndrome, and reviewed the clinical features of our series in comparison with those in a European large case study. In this study the major features of SAPHO syndrome were chronic osteitis of the anterior chest wall and pustulotic arthro-ostitis with middle age onset, and mucosal lesions seemed to be a minor complication of SAPHO syndrome. The non-erosive peripheral large joints arthritis and the particular HLA types (HLA-B51, B52, or A26), which had been reported to be increased in Behcet's disease, were frequently seen in SAPHO syndrome with mucosal lesions. This study also suggests that SAPHO syndrome with mucosal lesions may be part of a broader disease spectrum including Behcet's disease. PMID:19774382

Yabe, Hiroki; Ohshima, Hisaji; Takano, Yoji; Koyanagi, Takahiro; Usui, Hiroshi; Nojiri, Kenya; Ochi, Kensuke; Kihara, Michiya; Horiuchi, Yukio



Lower extremity anterior compartment syndrome complicating bilateral mastectomy and immediate breast reconstruction: A case report and literature review  

PubMed Central

‘Well leg compartment syndrome’ refers to compartment syndrome occurring in a nontraumatic setting. This occurs most commonly in the lower limb during surgery performed with the patient in an anatomically vulnerable position. While this complication is well documented in the setting of orthopedic, urological and gynecological surgeries, it is an exceptionally rare complication in plastic surgery; only seven cases have been published on compartment syndrome complicating an operation performed on a supine patient. A case involving a 56-year-old woman who developed an anterior compartment syndrome of her right lower leg following a bilateral mastectomy with immediate breast reconstruction is presented. A detailed literature review is also included.

Tashakkor, A Yashar; Macadam, Sheina A



Infectious endocarditis complicated by an ischemic stroke and revealing Marfan syndrome.  


Marfan syndrome is a systematic genetic disease of the connective tissue. The cardiac affection would predict the prognosis and ischemic stroke might complicate it. The purpose of this work is to discuss the mechanisms of the ischemic stroke in Marfan syndrome which have to be considered in all young patients of ischemic strokes. We report the case of a 17-year-old male patient who presented with right hemiparesis with brachio-facial dominance, hemihypoesthesia and Broca's aphasia; these symptoms were followed by partial right somato-motor epileptic seizure. The cerebral computed tomographic (CT) scan demonstrated early signs of ischemic stroke in the left Sylvian artery. Cardiovascular examination revealed a systolic murmur in the mitral site. Marfan syndrome with infectious endocarditis complicated by ischemic stroke was diagnosed. However, the family pathological history was negative. The Marfan syndrome diagnosis was approved considering the following criteria: Ligamentous hyperlaxity, crystalline ectopia and mitral valve prolapsus with mitral insufficiency. The patient benefited of antibiotherapy for 4 weeks. The patient underwent sessions of motor physical therapy and orthophonic rehabilitation. Then, cardiac surgery was carried out and valvuloplasty was performed. The surgical treatment confirmed the presence of mitral insufficiency and prolapsus of the big mitral valve and multiple friable anterior-posterior vegetations with broken cordage of the small mitral valve. Replacement of the mitral valve was achieved, and the post-surgery follow-ups were simple. The diagnosis of Marfan syndrome was based on well-defined criteria. The evolution of the patient was marked by a complete improvement of the cardiac and motor deficits, and disappearance of the Broca's aphasia. A fibroelastic disease such Marfan syndrome has to be considered in unexplained ischemic stroke in all young patients. Hence, the diagnosis of Marfan syndrome involves an anticipation of the neurovascular complications by early cardiovascular care. PMID:21814418

Souirti, Zouhayr; Boujraf, Saïd; Charai, Nadia; Chtaou, Naïma; Belahsen, Faouzi; Messouak, Ouafae; Messouak, Mohammed



Dapsone hypersensitivity syndrome: A rare life threatening complication of dapsone therapy  

PubMed Central

Dapsone can cause several adverse effects, the most serious being dapsone hypersensitivity syndrome (DHS), which is potentially fatal. Here we report a case of severe, life threatening dapsone systemic hypersensitivity syndrome in a 17-year-old male who presented with high grade fever, eosinophilia, lymphadenopathy, skin rash, hepatitis and encephalopathy, which was managed successfully with oral steroids. The case is being reported to emphasize the need for timely diagnosis and prompt treatment of this rare complication for successful outcomes. DHS is also reviewed in brief.

Vinod, Kolar Vishwanath; Arun, Karyampudi; Dutta, Tarun Kumar



Myelodysplastic syndrome complicated with inflammatory intestinal ulcers: significance of trisomy 8.  


Three cases of myelodysplastic syndrome (MDS) complicated with inflammatory intestinal ulcers all had cytogenetic abnormalities with trisomy 8. The first two patients were diagnosed with intestinal Behçets disease and were successfully treated with salazosulphapiridine, and the third patient died after leukemic transformation. We review the reported cases of MDS complicated with Behçets disease. Most of these cases are Japanese, having intestinal involvement as well as cytogenetic abnormalities with trisomy 8. We discuss the significance of trisomy 8 in intestinal involvement in MDS. PMID:17170506

Kawabata, Hiroshi; Sawaki, Toshioki; Kawanami, Takafumi; Shimoyama, Kumiko; Karasawa, Hiromi; Fukushima, Toshihiro; Masaki, Yasufumi; Ogawa, Noriyoshi; Hirose, Yuko; Ozaki, Kazuaki; Shimanaka, Koshi; Takase, Shujiro; Ueno, Hiroshi; Umehara, Hisanori



Preventing the aortic complications of Marfan syndrome: a case-example of translational genomic medicine  

PubMed Central

The translational path from pharmacological insight to effective therapy can be a long one. We aim to describe the management of Marfan syndrome as a case-example of how pharmacological and genomic insights can contribute to improved therapy. We undertook a literature search for studies of Marfan syndrome, to identify milestones in description, understanding and therapy of the syndrome. From the studies retrieved we then weaved an evidence-based description of progress. Marfan syndrome shows considerable heterogeneity in clinical presentation. It relies on defined clinical criteria with confirmation based on FBN1 mutation testing. Surgical advances have prolonged life in Marfan syndrome. First-line prophylaxis of complications with ?-adrenoceptor blockers became established on the basis that reduction of aortic pressure and heart rate would help. Over-activity of proteinases, first suggested in 1980, has since been confirmed by evidence of over-expression of matrix metalloproteinases (MMP), notably MMP-2 and MMP-9. The search for MMP inhibitors led to the evaluation of doxycycline, and both animal studies and small trials, provided early evidence that this widely used antimicrobial agent was useful. Identification of the importance of TGF-? led to evaluation of angiotensin II type I receptor (AT1R) blockers with highly promising results. Combination prophylactic therapy would appear rational. Pharmacological and genomic research has provided good evidence that therapy with losartan and doxycycline would prevent the aortic complications of Marfan syndrome. If on-going well designed trials confirm their efficacy, the outlook for Marfan syndrome patients would be improved considerably.

Li-Wan-Po, Alain; Loeys, Bart; Farndon, Peter; Latham, David; Bradley, Caroline



Bilateral Ocular Ischaemic Syndrome--Rare Complication of Rhinocerebral Mucormycosis in an Omani Patient  

PubMed Central

Ocular ischaemic syndrome (OIS) is a relatively uncommon condition. Simultaneous bilateral involvement is even less common and has been reported in only 22% of all cases of OIS. It has variable clinical presentations, of which visual loss and ocular pain are the most common. It is believed to occur when there is a 90% or greater carotid artery obstruction. This syndrome is often associated with a number of systemic diseases including diabetes mellitus, hypertension, coronary artery disease, and cerebrovascular disease. Only occasionally has it been described as a complication of rhinocerebral mucormycosis. We report an unusual case of bilateral OIS secondary to bilateral internal carotid artery thrombosis as a complication of invasive rhinocerebral mucormycosis. In addition, a review of clinical presentation, diagnostic work-up and treatment options for OIS is provided.

Al-Jabri, Samiya; Al-Abri, Mohamed; Al-Hinai, Ahmed; Al-Azri, Faisal



Survival and complication free survival in Marfan’s syndrome: implications of current guidelines  

Microsoft Academic Search

OBJECTIVETo evaluate survival and complication free survival in patients with Marfan’s syndrome and to assess the possible influence of recently revised guidelines for prophylactic aortic root replacement in these patients.METHODS130 patients who had been attending one institution over 14 years were evaluated. Kaplan–Meier analysis was performed in 125 patients who did not present with aortic root dissection as the first

M. Groenink; T. A. J. Lohuis; J. G. P. Tijssen; M. S. J. Naeff; R. C. M. Hennekam; Wall van der E. E; B. J. M. Mulder



Thromboembolic complications in children with nephrotic syndrome in Bulgaria (1974–1996)  

Microsoft Academic Search

Over a period of 22 years, 447 children with nephrotic syndrome (NS) have been retrospectively studied for clinically apparent\\u000a thromboembolic complications (TEC). The incidence of TEC is 2% (9\\/447); 16 clinically apparent TEC were registered in 9 children.\\u000a The incidence of TEC was 1.5% among patients with steroid-sensitive NS and 3.8% among those with steroid-resistant NS. TEC\\u000a were predominantly venous

M. I. Lilova; I. G. Velkovski; I. B. Topalov



SMART syndrome: a late reversible complication after radiation therapy for brain tumours  

Microsoft Academic Search

With intensified treatment leading to longer survival, complications of therapy for brain tumours are more frequently observed.\\u000a Regarding radiation therapy, progressive and irreversible white matter disease with cognitive decline is most feared. We report\\u000a on four patients with reversible clinical and radiological features occurring years after radiation for brain tumours, suggestive\\u000a for the so called SMART syndrome (stroke-like migraine attacks

Joost P. KerklaanGeert; Geert J. Lycklama á Nijeholt; Ruud G. J. Wiggenraad; Bianca Berghuis; Tjeerd J. Postma; Martin J. B. Taphoorn



Macular hole formation in a patient with Irvine-Gass syndrome: coincidence or rare complication?  

PubMed Central

Background Macular edema (ME) is caused by abnormal retinal capillary permeability and has also been described as a postoperative complication of cataract surgery (Irvine-Gass syndrome). Objective To present a patient with Irvine-Gass syndrome in the right eye complicated with a macular hole (MH) in the same eye and possible associations between these two entities. Case report A 72-year-old male with a history of uneventful bilateral cataract surgery was followed-up with biomicroscopy and optical coherence tomography (OCT). Four weeks after cataract surgery oculus dexter (OD), there was progressive visual deterioration (best corrected visual acuity [BCVA]: 0.5). OCT disclosed cystoid ME. A parabulbar triamcinolone injection, dexamethasone 0.1% and ketorolac 0.4% eye drops, both 4 times per day OD were administered. Six weeks later (BCVA OD: 0.2), OCT revealed cystoid ME and full-thickness MH. Conclusion ME secondary to diabetes or central retinal vein occlusion may lead to MH by inducing focal vitreomacular traction and by triggering inflammatory mechanisms which facilitate a marked thinning of the fovea. MH may occur even in cases of pseudophakic ME, representing a rare complication of Irvine-Gass syndrome.

Moschos, Marilita M; Gatzioufas, Zisis; Rotsos, Tryfon; Symeonidis, Chrysanthos; Song, Xuefei; Seitz, Berthold



Acute abdominal compartment syndrome complicating a colonoscopic perforation: a case report  

PubMed Central

Introduction A perforation occurring during colonoscopy is an extremely rare complication that may be difficult to diagnose. It can be responsible for acute abdominal compartment syndrome, a potentially lethal complex pathological state in which an acute increase in intra-abdominal pressure may provoke the failure of several organ systems. Case presentation We report a case of acute abdominal compartment syndrome after perforation of the bowel during a colonoscopy in a 60-year-old North African man with rectal cancer, resulting in respiratory distress, cyanosis and cardiac arrest. Our patient was treated by needle decompression after the failure of cardiopulmonary resuscitation. An emergency laparotomy with anterior resection, including the perforated sigmoid colon, was then performed followed by immediate anastomosis. Our patient remains alive and free of disease three years later. Conclusion Acute abdominal compartment syndrome is a rare disease that may occasionally occur after a colonoscopic perforation. It should be kept in mind during colonoscopy, especially considering its simple salvage treatment.



SMART syndrome: a late reversible complication after radiation therapy for brain tumours.  


With intensified treatment leading to longer survival, complications of therapy for brain tumours are more frequently observed. Regarding radiation therapy, progressive and irreversible white matter disease with cognitive decline is most feared. We report on four patients with reversible clinical and radiological features occurring years after radiation for brain tumours, suggestive for the so called SMART syndrome (stroke-like migraine attacks after radiation therapy). All four patients (males, age 36-60 years) had been treated with focal brain radiation for a primary brain tumour or with whole-brain radiation therapy for brain metastases. Ranging from 2 to 10 years following radiation therapy patients presented with headache and focal neurological deficits, suggestive for tumour recurrence. Two patients also presented with focal seizures. MRI demonstrated typical cortical swelling and contrast enhancement, primarily in the parieto-occipital region. On follow-up both clinical and MRI features improved spontaneously. Three patients eventually proved to have tumour recurrence. The clinical and radiological picture of these patients is compatible with the SMART syndrome, a rare complication of radiation therapy which is probably under recognized in brain tumour patients. The pathophysiology of the SMART syndrome is poorly understood but bears similarities with the posterior reversible encephalopathy syndrome (PRES). These four cases underline that the SMART syndrome should be considered in patients formerly treated with radiation therapy for brain tumours, who present with new neurologic deficits. Before the diagnosis of SMART syndrome can be established other causes, such as local tumour recurrence, leptomeningeal disease or ischemic disease should be ruled out. PMID:21373901

Kerklaan, Joost P; Lycklama á Nijeholt, Geert J; Wiggenraad, Ruud G J; Berghuis, Bianca; Postma, Tjeerd J; Taphoorn, Martin J B



[Septic shock Fusobacterium necrophorum from origin gynecological at complicated an acute respiratory distress syndrome: a variant of Lemierre's syndrome].  


We report a case of a female patient of 47 years old who presents in a state of septic shock with acute insufficient respiratory complicated with syndrome of acute respiratory distress, together with a list of abdominal pain and polyarthralgia too. In her case of medical history, it is retained that she has had a intra-uterine device since 6 years without medical follow up. The initial thoraco-abdomino-pelvic scan shows a left ovarian vein thrombosis, as well as the opaqueness alveolus diffused interstitiel bilaterally and an aspect of ileitis. The IUD is taken off because of sudden occuring of purulent leucorrhoea. This results in a clinical and paraclinical improvement, whereas aminopenicillin was administered to the patient since 1 week. The microbiological blood test allows to put in evidence Fusobacterium necrophorum found in a blood culture and is sensitive to the amoxicilline-acide clavulanique and metronidazole. Isolation of this bacteria, classically found in Lemierre's syndrome, allowed to explain the multilfocalization of the symtoms and the list of pain. The whole concerns about a variant of Lemierre's syndrom: a state of septic shock secondary then caused by the anaerobic Gram negative bacilli, which is a commensal bacteria of the female genital tractus, complicated of septic emboli typical. PMID:21464014

Huynh-Moynot, Sophie; Commandeur, Diane; Deserts, Marc Danguy Des; Drouillard, Isabelle; Leguen, Patrick; Ould-Ahmed, Mehdi


A 10-month-old with Lemierre syndrome complicated by purulent pericarditis.  


Lemierre syndrome is a potentially life-threatening septic thrombophlebitis associated with a neck infection. We present a case of a 10-month-old female infant with Lemierre syndrome complicated by thrombotic strokes and purulent pericarditis. A healthy 10-month-old female infant presented to the pediatric emergency department of our tertiary care center complaining of 5 days of fever to 105°F and 1 day of neck stiffness and decreased oral intake. In the pediatric emergency department, she developed septic shock, requiring vasopressor support, endotracheal intubation, and broad-spectrum antibiotics. A computed tomographic scan demonstrated a neck abscess associated with a right internal jugular thrombus and septic emboli to her lungs and brain. This constellation was consistent with Lemierre syndrome. Further studies demonstrated the thrombus extended into her left ventricular outflow tract. She was emergently taken to the operating room for incision and drainage of her neck abscess, started on anticoagulation with heparin, and eventually transitioned to enoxaparin. Her hospital course was complicated by a middle cerebral artery distribution infarction and subsequent hemorrhagic conversion with generalized tonic clonic seizures managed by levetiracetam. Ten days into her hospital stay, she developed pericardial tamponade, and cardiac surgery performed a pericardial window for loculated, purulent pericardial effusion. Initial blood cultures were positive for methicillin-sensitive Staphylococcus aureus, and the patient was treated with 6 weeks of nafcillin. She has recovered with minimal permanent sequelae. This is one of the youngest cases of Lemierre syndrome documented. To our knowledge, it is also the first case complicated by purulent pericarditis reported in the literature. PMID:22809766

Root, Rachel W; Barrett, Tyler W; Abramo, Thomas J



Abdominal compartment syndrome is an early, lethal complication of acute pancreatitis.  


Data defining the optimal management of abdominal compartment syndrome resulting from acute pancreatitis are lacking. We investigated the outcomes of patients with acute pancreatitis who underwent surgery for treatment of abdominal compartment syndrome at a tertiary referral center. An electronic database was searched to identify patients with acute pancreatitis who underwent laparotomy between January 1, 2000, and December 31, 2009, for treatment of abdominal compartment syndrome. Twelve patients underwent decompressive laparotomy for abdominal compartment syndrome. The median interval between onset of pancreatitis and laparotomy was 4.5 days. Nine patients underwent a laparotomy within seven days of onset of pancreatitis. As a result of cardiopulmonary instability, four decompressive laparotomies were performed in the intensive care unit. In 11 patients, cardiopulmonary improvement was observed. Statistically significant improvements were seen across multiple physiologic parameters. Despite this initial improvement, six patients (50%) died from multisystem organ failure. Two patients survived without need for pancreatic débridement. Abdominal compartment syndrome is an uncommon but likely underrecognized and highly lethal complication of acute pancreatitis that should be considered in patients who become critically ill early in the course of their pancreatitis. Prompt recognition and decompressive laparotomy may rescue some of these patients and does not mandate future débridement. PMID:23711270

Boone, Brian; Zureikat, Amer; Hughes, Steven J; Moser, A James; Yadav, Dhiraj; Zeh, Herbert J; Lee, Kenneth K W



Complications of Carotid Blowout Syndrome in Patients with Head and Neck Cancers Treated by Covered Stents  

PubMed Central

Summary The purpose of this study was to improve clinical assessment of carotid-blowout syndrome (CBS) in patients with head-and-neck cancers and with covered stents by evaluating immediate and delayed complications of reconstructive management. Eleven such patients were treated with self-expandable covered stents. We evaluated immediate and delayed complications by assessing clinical and imaging findings. Technical success and immediate hemostasis were achieved in all patients. Immediate complications were noted in four patients (36.4%), including thromboembolism in three patients and, in one patient, dissection of the carotid artery and type III endoleak by the overlapped self-expandable stent causing rebleeding. Delayed complications were noted in eight patients (72.7%), including six episodes of rebleeding in five patients, distal marginal stenosis in five patients, and delayed carotid thrombosis in three patients (one with brain abscess formation). We suggest close follow-up of the patients and aggressive re-intervention of their complications to improve outcomes.

Chang, Feng-Chi; Luo, Chao-Bao; Lirng, Jiing-Feng; Guo, Wan-Yuo; Wu, Hsiu-Mei; Teng, Michael Mu Huo; Chang, Cheng-Yen



Abdominal compartment syndrome -- a major complication of large incisional hernia surgery.  


The incidence of Intraabdominal Hypertension (IAH) and Abdominal Compartment Syndrome (ACS) is underestimated within the surgery of large size parietal-abdominal defects, with the maximum transverse diameter above 10 cm, being considered the main risk factor for the development of intra abdominal hypertension, together with ventilatory restraint under 60% and obesity. Intraabdominal hypertension has a prevalence of at least 50% among critical patients and was identified as an independent life-threatening risk factor.However, doctors do not evaluate it properly and do not realize the potential lethal consequences of untreated intraabdominal hypertension. These consequences may be abdominal compartment syndrome, followed by multiple organ dysfunction and even patient death. The paper intends to highlight the importance of the early recognition of this pathology, as a key factor in the correct management of these complications. PMID:23790795

Mavrodin, C I; Pariza, G; Ion, D; Antoniac, V I


Propofol-Related Infusion Syndrome: Role of Propofol in Medical Complications of Sedated Critical Care Patients  

PubMed Central

Background: Propofol is a popular anesthetic and sedative. Use of propofol has increased manifold in this country over the last decade, and it is most commonly used in intensive care settings. Its rapid action with short half-life, decreased cerebral oxygen consumption, and reduction of intracranial pressure are properties that have made it a favorite in the intensive care unit. Many of these patients are critically ill or injured and require prolonged sedation. Propofol has been associated with morbidity and mortality, and in such cases the question often arises regarding the role propofol plays in these complications. Objective: To address the issue of propofol-related infusion syndrome and its management. Method: A hypothetical clinical vignette was created to give a classic presentation of propofol-related infusion syndrome. Conclusion: It is hoped that this short report will bring more awareness of this entity so that it will be considered in the differential diagnosis in sedated critical care patients.

Imam, Talha H



Pregnancy complicated by the Klippel-Trenaunay syndrome. A case report.  


A primigravida with the Klippel-Trenaunay syndrome was admitted to the hospital at 34 weeks' gestation with a complaint of right calf pain. Superficial thrombophlebitis was diagnosed, and she was treated with compresses and analgesia. Speculum examination failed to reveal the presence of lower genitourinary tract arteriovenous malformations. Color flow mapping of the uterus did not identify any arteriovenous malformations. The patient delivered vaginally at term, and the postpartum course was unremarkable. Pregnancies complicated by the Klippel-Trenaunay syndrome are at increased risk of adverse perinatal outcomes, related primarily to the increased risk of hemorrhagic diathesis. The mode of delivery should be considered carefully in an attempt to minimize the risk to both mother and fetus. PMID:7776315

Pollack, R N; Quance, D R; Shatz, R M



Cowden syndrome complicated with hepatocellular carcinoma possibly originating from non-alcoholic steatohepatitis (NASH).  


There is currently no report that has documented hepatocellular carcinoma (HCC) in a case of Cowden syndrome. Here, we present the first reported case of HCC in a 60-year-old female patient with Cowden syndrome. We diagnosed the patient using a pathognomonic criterion of the International Cowden Consortium Operational Diagnostic Criteria and performed genetic analysis. Enhanced computed tomography demonstrated a hypervascular tumor in segment VII of the liver. The patient was diagnosed with Cowden syndrome because her mucocutaneous lesions met the pathognomonic criterion. Mutational analysis confirmed a heterozygous germ line TGT?TAT transition at nucleotide 407 in exon 5 of the phosphatase and tensin homolog detected on the chromosome 10 (PTEN) gene. Needle biopsy showed a poorly differentiated HCC. We also diagnosed non-alcoholic steatohepatitis (NASH) from hepatic histological findings of Mallory's bodies and ballooning cells. PTEN-deficient mice reportedly develop HCC through NASH. This is the first reported case of Cowden syndrome complicated with HCC possibly originating from NASH. PMID:21269388

Sugihara, Takaaki; Mandai, Mari; Koda, Masahiko; Matono, Tomomitsu; Nagahara, Takakazu; Ueki, Masaru; Murawaki, Yoshikazu



Blood Rheology and Platelet Function in Untreated Early-Stage Essential Hypertensives Complicated with Metabolic Syndrome  

PubMed Central

We examined whether hemorheology and platelet function are affected in essential hypertensives (EHTs) of the World Health Organization stage I when complicated with metabolic syndrome (Mets). In 156 untreated EHTs, blood viscosity and platelet surface markers were determined. Blood viscosity was significantly elevated in 54 subjects with Mets compared with 102 subjects without Mets. Hematocrit and plasma viscosity increased in the group with Mets, although red blood cell rigidity index “k” did not differ between groups. As a whole group, blood viscosity correlated positively with hematocrit and plasma viscosity. Additionally, plasma viscosity correlated positively with plasma leptin, triglyceride, homeostasis model assessment index, C-reactive protein, and plasma fibrinogen, but negatively with high-density lipoprotein cholesterol. In contrast, no differences were seen in platelet surface markers between groups. In conclusion, EHTs of the early stage complicated with Mets are characterized by increased blood viscosity due to hemoconcentration and increased plasma viscosity.

Sugimori, Hiroko; Tomoda, Fumihiro; Koike, Tsutomu; Kinuno, Hiroyuki; Kurosaki, Hiroko; Masutani, Toshitaka; Inoue, Hiroshi



Life-Threatening Complication During Percutaneous Ablation of Adrenal Gland Metastasis: Takotsubo Syndrome  

SciTech Connect

A rare life-threatening complication during percutaneous cryoablation of an adrenal gland metastasis from a lung carcinoma is reported. The patient presented hypertensive crisis at the beginning of the thawing cycle, followed by electrocardiographic change which necessitated interruption of the procedure and his transfer to the intensive care unit with suspicion of heart infarct. There was a slight increase in cardiac enzyme levels, and ventricular angiography demonstrated transient hypokinesis-dyskinesis of the mid left ventricular segments without apical involvement, while the coronary arteries showed no significant stenosis on coronarography. These findings led to the diagnosis of Takotsubo cardiomyopathy left ventricular dysfunction syndrome. This is the first case of Takotsubo cardiomyopathy occurring as a complication during percutaneous ablation of an adrenal gland tumor.

Tsoumakidou, Georgia, E-mail:; Buy, Xavier, E-mail: [University Hospital of Strasbourg, Department of Non Vascular Interventional Radiology (France); Zickler, Pierre, E-mail: pierre.zickler@chru-strasbourg.f [University Hospital of Strasbourg, Department of Anaesthesiology (France); Zupan, Michel, E-mail:; Douchet, Marie-Pierre, E-mail: Marie.pierre-douchet@chru-strasbourg.f [University Hospital of Strasbourg, Department of Cardiology (France); Gangi, Afshin, E-mail: gangi@rad6.u-strasbg.f [University Hospital of Strasbourg, Department of Non Vascular Interventional Radiology (France)



A case of neutrophilic dermatosis (ND) complicated by cryofibrinogenemia (CFGN) and myelodysplastic syndrome (MDS).  


A case of neutrophilic dermatosis (ND) complicated by cryofibrinogenemia (CFGN) and myelodysplastic syndrome (MDS) is reported. Although the patient presented pancytopenia, the skin lesions were compatible with those of ND from the clinical and histopathological findings. Further, immunofluorescence technique revealed cryofibrinogen (CFG) deposits on the walls of the blood vessels in the skin lesion, and a high titer of CFG components was disclosed in the patient's peripheral blood. In this case, CFGN may have been associated with MDS; hence CFG deposits probably played a role, at least in part, in the skin lesion formation. This is probably the first case of ND complicated by CFGN. And careful examination of an underlying disease is recommended in association with ND and/or CFGN. PMID:1640024

Watanabe, R; Iijima, M; Otsuka, F



Leptin and bone turnover in monochorionic twins complicated by twin–twin transfusion syndrome  

Microsoft Academic Search

Introduction  To test the hypothesis that the bone metabolism of a growth-restricted foetus is regulated by genetic, placental and\\/or foetal\\u000a factors through leptin, we investigated the foetal bone turnover in monochorionic pregnancies complicated with or without\\u000a twin–twin transfusion syndrome (TTTS).\\u000a \\u000a \\u000a \\u000a Methods  Maternal and cord bloods were collected from gestational-age-matched monochorionic twins with (n?=?15) and without (n?=?15) TTTS. The samples were assayed for

R. Bajoria; S. R. Sooranna; R. Chatterjee



Combined primary aldosteronism and Cushing's syndrome due to a single adrenocortical adenoma complicated by Hashimoto's thyroiditis.  


A 43-year-old Japanese woman presented hypertension, hypokalemia and typical Cushingoid signs. Autonomous secretion of both aldosterone and cortisol was shown. Abdominal computed tomography demonstrated a single tumor in the right adrenal gland, which established the diagnosis of combined primary aldosteronism and Cushing's syndrome. The resected tumor was a golden yellow-colored adenoma (diameter 4.3 cm) which expressed P450(aldo) and P450(11beta), causing oversecretion of both hormones from this adenoma. After tumor resection, overproduction of both hormones disappeared and she developed adrenal insufficiency, suggesting the strong suppression of normal adrenal function. This case was complicated by Hashimoto's thyroiditis. PMID:12487169

Tanaka, Masami; Izeki, Masakazu; Miyazaki, Yasushi; Horigome, Masayuki; Yoneda, Takashi; Tsuyuki, Shizuo; Takami, Shigeto; Aiba, Motohiko



Lung ultrasonography of pulmonary complications in preterm infants with respiratory distress syndrome  

PubMed Central

Aim. To evaluate the diagnostic possibilities of lung ultrasonography (LUS) in detecting pulmonary complications in preterm infants with respiratory distress syndrome (RDS). Material and methods. A prospective study included 120 preterm infants with clinical and radiographic signs of RDS. LUS was performed using both a transthoracic and a transabdominal approach within the first 24 h of life, and, after that, follow-up LUS examinations were performed. In 47 detected pulmonary complications of RDS (hemorrhage, pneumothorax, pneumonia, atelectasis, bronchopulmonary dysplasia), comparisons between LUS and chest X-ray (CXR) were made. Also, 90 subpleural consolidations registered during LUS examinations were analysed. Statistical analysis included MANOVA and discriminant analysis, t-test, confidence interval, and positive predictive value. Results. In 45 of 47 instances the same diagnosis of complication was detected with LUS as with CXR, indicating a high reliability of the method in premature infants with RDS. The only two false negative findings concerned partial pneumothorax. The positive predictive value of LUS was 100%. A statistically significant difference of LUS findings between the anterior and posterior lung areas was observed in both right and left hemithoraces. Conclusions. LUS enables the detection of pulmonary complications in preterm infants with RDS and has the potential to reduce the number of CXRs. The specific guidelines for its use should be provided in a more extensive study.



Drug Hypersensitivity: Pharmacogenetics and Clinical Syndromes  

PubMed Central

Severe cutaneous adverse reactions (SCARs) include syndromes such as drug reaction, eosinophilia and systemic symptoms (DRESS) or drug-induced hypersensitivity syndrome (DIHS) and Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN). An important advance has been the discovery of associations between HLA alleles and many of these syndromes including abacavir hypersensitivity reaction, allopurinol DRESS/DIHS and SJS/TEN and SJS/TEN associated with aromatic amine anticonvulsants. These HLA associations have created the promise for prevention through screening and have additionally shed further light on the immunopathogenesis of SCARs. The roll-out of HLA-B*5701 into routine clinical practice as a genetic screening test to prevent abacavir hypersensitivity provides a translational roadmap for other drugs. Numerous hurdles exist in the widespread translation of several other drugs such as carbamazepine where the positive predictive value of HLA-B*1502 is low and the negative predictive value of HLA-B*1502 for SJS/TEN may not be 100% in all ethnic groups. International collaborative consortia have been formed with the goal of developing phenotype standardization and undertaking HLA and genome-wide analyses in diverse populations with these syndromes.

Phillips, Elizabeth J.; Chung, Wen-Hung; Mockenhaupt, Maja; Roujeau, Jean-Claude; Mallal, Simon A.



Effect of bromocriptine on cardiovascular complications associated with metabolic syndrome in fructose fed rats  

PubMed Central

Objective: The objective of the present study was to evaluate the effect of bromocriptine on cardiovascular complications associated with type-2 diabetes mellitus (DM). Materials and Methods: Metabolic syndrome or type 2 DM was induced by administration of fructose (66% solution, p.o.) in rats. Bromocriptine mesylate (10 mg/kg, i.p.) was given in fructose-treated rats for a period of 6 weeks after induction of diabetes. After drug treatment, the parameters such as body weight, food and water intake, serum glucose, triglycerides, cholesterol, insulin, and blood pressure (BP) were measured weekly and at the end of study. At the end of treatment, BP was determined by invasive method and vascular reactivity was tested with adrenaline (Adr), noradrenaline (NA), and phenylephrine (PE). Acetylcholine-induced vasorelaxation was tested on isolated rat aorta and histopathology of hearts was also done. Results: Fructose-fed rats showed significant weight gain, hyperglycemia, hyperlipidemia, hyperinsulinemia, and rise of BP. Administration of bromocriptine at a dose 10 mg/kg, i.p. significantly decreased weight gain, serum glucose, triglyceride, cholesterol and insulin levels in rats fed on fructose. Bromocriptine also significantly reduced elevated BP in fructose-fed hypertensive rats. Chronic treatment with bromocriptine significantly improved the relaxant response to acetylcholine on fructose-fed hyperinsulinemic rat aorta and also reduced the pressor response to Adr, NA, and PE. Bromocriptine also showed a protection from hypertrophy and degenerative changes in myocardium. Conclusion: Bromocriptine has beneficial effect in reduction of cardiovascular complications associated with metabolic syndrome.

Nade, Vandana S.; Kawale, Laxman A.; Todmal, Umesh B.; Tajanpure, Anjali B.



Severe Asherman's syndrome complicated with placenta increta conceived by intracytoplasmic sperm injection following hysteroscopic surgery.  


Although severe Asherman's syndrome is a disease that may cause infertility, pregnancy and childbirth are possible by performing hysteroscopic surgery. However, the obstetrical outcome is not always satisfactory. We report a case where severe Asherman's syndrome occurred following a cesarean section. Hysteroscopic surgery was performed due to secondary infertility, and pregnancy was achieved through a subsequent intracytoplasmic sperm injection. At 23 weeks of gestation, the patient was hospitalized due to the threat of premature labor, and a cesarean section was performed at 29 weeks of gestation after pregnancy-induced hypertension occurred. It was determined to be abnormal adherent placentation such as placenta increta through intraoperative findings, and a cesarean hysterectomy was performed. The pathological diagnosis of the uterus was placenta increta. Due to the risk of complications from placenta increta in pregnancies following hysteroscopic surgery in patients with severe Asherman's syndrome, it is important to realize the high risk involved in such cases during the pregnancy course, and careful perinatal management should be required. PMID:23444767

Sugaya, S; Yahata, T; Nishikawa, N; Arinami, Y; Maruhashi, T; Takakuwa, K; Tanaka, K



Four cases of atopic dermatitis complicated by Sjögren's syndrome: link between dry skin and autoimmune anhidrosis.  


We report four adult cases of atopic dermatitis (AD) complicated by Sjögren's syndrome (SS). The patients fulfilled diagnostic criteria for AD and SS. All cases showed persistent itchy dry skin and eczematous lesions complicated by sicca symptoms including dry eyes and dry mouth with moderate joint pain. One case manifested annular erythema and another manifested widespread discoid erythema. To investigate the underlying cause of dry skin in these cases, sweating function was evaluated using a quantitative sudomotor axon reflex test (QSART) in which the axon reflex is stimulated by acetylcholine iontophoresis. The sweating latency time was significantly prolonged in eczematous skin of AD and AD/SS compared to normal controls. Axon reflex (AXR) sweat volume was also significantly reduced in AD (normal and eczematous skin) and AD/SS (normal and eczema) compared to normal control. In contrast, the direct sweat volume of lesional or non-lesional AD skin induced by direct stimulation with acetylcholine was only slightly reduced compared to that in normal controls, but not in SS and lesional skin of AD/SS patients. These results suggest that the impaired sweat response in AD is attributable to an abnormal sudomotor axon reflex, which is accelerated and modulated when complicated by SS resulting in dry skin in the present cases. PMID:21364310

Kitaba, Shun; Matsui, Saki; Iimuro, Eriko; Nishioka, Megumi; Kijima, Akiko; Umegaki, Noriko; Murota, Hiroyuki; Katayama, Ichiro



Obstetric complications in women with polycystic ovary syndrome: a systematic review and meta-analysis  

PubMed Central

Background Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of childbearing age. The risk of pregnancy and neonatal complications in women with PCOS is debatable. In order to determine the risk of pregnancy and neonatal complications, evidence regarding these risks was examined. Methods Literature searches were performed in the electronic databases MEDLINE, EMBASE, and CENTRAL based on the established strategy and eligible tries were included according to inclusion and exclusion criteria. A systematic literature review looking at rates of gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preeclampsia, premature delivery, neonatal birth weight, caesarean section and admission to a neonatal intensive care unit (NICU) was conducted in women with PCOS. Pregnancy outcomes between women with PCOS versus controls were included. Sensitivity analyses were performed to determine the reliability of the available evidence and to validate the results. The study was performed with the approval of the ethics committee of the First Affiliated Hospital of Guangxi Medical University. Results A total of 27studies, involving 4982 women with PCOS and 119692 controls were eligible for the meta-analysis. Women with PCOS demonstrated a significantly higher risk of developing GDM (OR3.43; 95% CI: 2.49–4.74), PIH (OR3.43; 95% CI: 2.49–4.74), preeclampsia (OR2.17; 95% CI: 1.91–2.46), preterm birth (OR1.93; 95%CI: 1.45–2.57), caesarean section (OR 1.74; 95% CI: 1.38–2.11) compared to controls. Their babies had a marginally significant lower birth weight (WMD ?0.11g; 95%CI: -0.19 – -0.03), and higher risk of admission to NICU (OR 2.32; 95% CI: 1.40–3.85) compared to controls. Conclusions Women with PCOS have increased risk of adverse pregnancy and neonatal complications. It is necessary to establish guidelines for supervision during pregnancy and parturition to prevent these complications.



Influence of metabolic syndrome superposition on familial combined hyperlipoproteinemia cardiovascular complication rate  

PubMed Central

Introduction Familial combined hyperlipoproteinemia (FCHL) is a very common and aggressive genetic mixed hyperlipoproteinemia, with many features similar to that of the metabolic syndrome (MS). We aimed to evaluate whether the presence of the MS per se could account for a significant part of the elevated cardiovascular disease (CVD) risk associated with FCHL. Material and methods A retrospective cross-sectional evaluation of MS features’ influence on CVD prevalence in a large sample of adult Italian FCHL affected patients (64 familial clusters; 867 subjects) was carried out. Results Age is associated with early cardiovascular complications, both in men (OR 1.08, 95% CI: 1.05-1.11, p < 0.0001) and in women (OR 1.09, 95% CI: 1.04-1.13, p = 0.0001). No MS component appears to be related to cardiovascular complications in men, whilst only low plasma high-density lipoprotein cholesterol (HDL-C) shows such a relation in women. Among non-MS parameters, only low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) (Lp(a)) plasma levels are significantly associated with early cardiovascular complications in male FCHL patients (LDL-C: OR 2.24, 95% CI: 1.02-4.91, p = 0.04; Lp(a): OR 4.64, 95% CI: 1.85-11.62, p = 0.001), but not in women (LDL-C: OR 1.83, 95% CI 0.53-6.34, p = 0.34; Lp(a): OR 3.65, 95% CI: 0.89-14.97, p = 0.07). Conclusions Our data support the hypothesis that MS is not associated with a higher prevalence of cardiovascular complications in FCHL affected subjects, probably because of the strongest risk increase associated with the FCHL itself.

Derosa, Giuseppe; Maffioli, Pamela; Reggi, Alessandra; Grandi, Elisa; Borghi, Claudio



Successful management of a patient with Marfan syndrome complicated with acute aortic dissection using landiolol during Cesarean section  

Microsoft Academic Search

Aortic dissection is a lethal complication in pregnant women with Marfan syndrome. To decrease arterial wall stress, beta-blockers\\u000a have been used as standard treatment, although uterine contractions caused by beta-2-adrenergic receptor antagonism may result.\\u000a Herein, we report a patient with Marfan syndrome who was given landiolol, a selective beta-1-adrenergic receptor antagonist\\u000a with a short half-life, for management during a Cesarean

Noboru Saeki; Shima Taguchi; Masashi Kawamoto



Posterior reversible encephalopathy syndrome in a renal allograft recipient: A complication of immunosuppression?  

PubMed Central

Posterior reversible encephalopathy syndrome (PRES) is an uncommon post-renal transplant complication. We report a 16-year-old boy who had an acute cellular rejection immediate post-transplant and was given intravenous methylprednisolone along with an increase in tacrolimus dose. He was diagnosed to have PRES based on clinical and radiological features within 6 h of intensified immunosuppression. This is an unusual case report of successfully managing PRES with continuation of the intensified immunosuppression as warranted by the clinical situation, along with aggressive blood pressure control. After 6 weeks, magnetic resonance imaging showed complete resolution of lesions. He has good graft function and no residual neurological deficits while on small doses of three antihypertensives, 12 months after transplantation.

Alexander, S.; David, V. G.; Varughese, S.; Tamilarasi, V.; Jacob, C. K.



[Pulmonary contusion and acute respiratory distress syndrome (ARDS) as complications of blunt chest trauma].  


Blunt chest traumas are common nowadays due to development of motor transport. They are associated with high mortality rates because of serious injuries of internal organs. The mechanisms of injuries are complex and may cause damages ranging from small ones, such as bruises or abrasions, to life-threatening trauma. Among typical injuries there are rib fractures, sternal fractures, pneumothorax, hemothorax, diaphragm lacerations, pulmonary contusions, cardiac tamponade, cardiac rupture and many others. The authors of the article would like to emphasize the pathophysiology and diagnostic difficulties in such blunt chest trauma complications as pulmonary contusions and acute respiratory distress syndrome, for which no causal treatment is available and only early diagnosis and administration of symptomatic treatment may increase the patients' chances to survive. In Forensic Medicine Department, Medical University of ?ód?, an opinion was issued on a case which illustrates the clinical problem. PMID:20073267

Michalska, Agata; Jurczyk, Agnieszka P; Macha?a, Waldemar; Szram, Stefan; Berent, Jaros?aw


Postoperative Complications in Patients With Obstructive Sleep Apnea Syndrome Undergoing Hip or Knee Replacement: A Case-Control Study  

Microsoft Academic Search

• Objective: To identify and assess the impact of postop- erative complications in patients with unrecognized or known obstructive sleep apnea syndrome (OSAS) under- going hip replacement or knee replacement compared with control patients undergoing similar operations. Al- though OSAS is a risk factor for perioperative morbidity, data quantifying the magnitude of the problem in patients undergoing non-upper airway operations



Granulomatous skin lesions complicating Varicella infection in a patient with Rothmund-Thomson syndrome and immune deficiency: case report  

PubMed Central

Rothmund-Thomson syndrome (RTS)(OMIM 268400) is a rare autosomal recessive genodermatosis characterized by poikiloderma, small stature, skeletal and dental abnormalities, cataract and an increased risk of cancer. It is caused by mutations in RECQL4 at 8q24. Immune deficiency is not described as a classical feature of the disease. Here we report the appearance of granulomatous skin lesions complicating primary Varicella Zoster Virus infection in a toddler with Rothmund Thomson syndrome and immune deficiency. Although granulomatous disorders are sometimes seen after Herpes zoster, they are even more rare after Varicella primary infection. Granulomas have hitherto not been described in Rothmund-Thomson syndrome. With this report we aim to stress the importance of screening for immune deficiency in patients with Rothmund-Thomson syndrome.



Toxic shock syndrome complicating influenza A in a child: case report and review.  


Despite extensive literature on toxic shock syndrome, reports of its manifestations in children remain relatively uncommon. Similarly, toxic shock syndrome in association with influenza B or influenza-like illness has been reported in 12 patients, but it has been reported to occur following influenza A in only two patients to date. We report a third case of toxic shock syndrome in a child with influenza A and review the association between epidemic influenza and toxic shock syndrome ("the Thucydides syndrome"). PMID:8353244

Tolan, R W



The sympathetic skin response in the shoulder-hand syndrome complicating tetraplegia.  


To determine the utility of the sympathetic skin response (SSR) in studying sympathetic outflow in cervical spinal cord injury (CSCI) patients who develop features of reflex sympathetic dystrophy, we studied seven consecutive CSCI patients with the shoulder-hand syndrome (SHS), and seven patients with similar injuries but without the manifestations of the SHS. The mean SSR amplitude was more than three times greater in patients with the SHS, a statistically significant difference. We restudied six patients with a SHS after symptoms had improved following steroid treatment: the mean amplitude fell significantly, approaching the mean for the control group. When pain was asymmetric, the SSR amplitude was higher in the arm with greater pain. Four of the seven SHS patients demonstrated an unusual pattern of spontaneous cyclical electrical activity during a period of severe pain. We conclude that a SHS complicating CSCI is associated with increased amplitude of the SSR, supporting the theory that sympathetic hyperactivity is important in the pathophysiology of reflex sympathetic dystrophy in this setting. PMID:8848315

Aisen, M L; Stallman, J; Aisen, P S



Male Child with Van Wyk-Grumbach's Syndrome and Other Complications of Long-Standing Primary Hypothyroidism: A Case Report  

PubMed Central

Primary hypothyroidism in the juvenile population generally leads to retardation of linear growth and delay or even arrest of puberty. However, in rare conditions, children with long-standing hypothyroidism present with signs of Van Wyk-Grumbach's syndrome (VWGS) which include juvenile hypothyroidism, delayed bone age, and pseudoprecocious puberty. We report a rare case of prepubertal male child from Asian origin, presented with long-standing untreated hypothyroidism complicated with VWGS and other complications including obesity, short stature, hepatomegaly, asymptomatic mild pericardial effusion, and pituitary hyperplasia.

Omran, Ahmed; Peng, Jing; Shrestha, Biswas; Ashhab, Muhammad Usman; Yin, Fei



Pregnancies complicated by Twin–Twin transfusion syndrome: outcome and long-term neurological follow-up  

Microsoft Academic Search

Objective: To relate prenatal data of monochorionic pregnancies complicated by Twin–Twin transfusion syndrome (TTTS) with survival rates and neurological morbidity. Study design: Thirty-two cases of TTTS underwent biweekly ultrasound examinations. Amnioreduction was the standard of care. Mortality and neurological morbidity were evaluated; the children had neurodevelopmental follow-up with a mean follow-up time of 24 months. Results: Ten out of 32

Tiziana Frusca; Mirella Soregaroli; Anna Fichera; Fabrizio Taddei; Paolo Villani; Patrizia Accorsi; Paola Martelli



Dialysis disequilibrium syndrome and other treatment complications of extreme uremia: a rare occurrence yet not vanished.  


Severe uremia is now a rare occurrence in most developed nations, and yet is still present in many countries of the world. It includes clinical manifestations such as calciphylaxis and uremic frost, which are now rarely seen. Patients with extremely high levels of blood urea nitrogen (above 175 mg/dL) are at a higher risk of experiencing first-time hemodialysis-related complications, in particular dialysis disequilibrium syndrome (DDS). DDS is a central nervous disorder characterized by a wide variety of neurological symptoms that range from nausea and vomiting to even death due to cerebral edema. There are 2 main theories to explain its pathophysiology: the reverse urea effect, which considers that the shift of urea between brain intracellular space and plasma is not immediate, causing a higher concentration of urea within the brain and leading to cerebral edema. The second theory considers that after hemodialysis, patients have transient paradoxical metabolic acidosis within the central nervous system, displacing Na(+) and K(+) from organic anions, making them osmotically active and again leading to cerebral edema. The main goal is to prevent the occurrence of DDS, for which there are several proposed measures including continuous renal replacement therapies. Once established, treatment should be focused on supportive therapy. Another uncommon phenomenon described in patients who initiate hemodialysis is transient pulmonary leukocyte margination, which in conjunction with an inflammatory milieu, may lead to non-cardiogenic pulmonary edema. We present the case of a young adult with severe uremia who, despite application of recommended measures, developed DDS and non-cardiogenic pulmonary edema. PMID:18638082

Lopez-Almaraz, Ernesto; Correa-Rotter, Ricardo



Medical complications, clinical findings, and educational outcomes in adults with Noonan syndrome.  


Noonan syndrome (NS) is a heterogeneous developmental disorder caused by missense mutations in genes involved in the Ras/MAPK signaling pathway, a major mediator of early and late developmental processes. The diagnosis of NS is made on clinical grounds with molecular confirmation of a mutation found in 63% of cases. Key clinical features include short stature, cardiac defects, developmental delay, lymphatic dysplasias, bleeding tendency, and a constellation of distinctive facial features and physical exam findings. The prevalence of medical issues or the development of new ones in adults with NS is not well-studied. This cross-sectional study reports on the prevalence of clinical conditions and their ages of onset in a cohort of 35 adolescents and adults with NS aged 16-68 years old (mean age 28 years). In this cohort, 34 of 35 subjects (97%) had had full PTPN11 sequencing; 37% were PTPN11 positive, 23% were SOS1 positive, and 3% were BRAF positive. Mean adult height in both men and women was at the 3rd-10th centile. The most prevalent clinical findings in this cohort included pulmonary valve stenosis (71%), easy bruising (63%), GERD (60%), constipation (51%), scoliosis (54%), chronic joint pain (54%), lymphedema (49%), depression (49%), anxiety (49%), Chiari malformation (20%), and osteopenia/osteoporosis (14%). In summary, adults with NS are affected by multi-organ morbidity and require special medical management aimed towards the most prevalent and serious known medical complications. Larger studies characterizing the clinical conditions found in NS adults are needed to provide potential genotype-phenotype correlations that may aid in clinical management. PMID:23165751

Smpokou, Patroula; Tworog-Dube, Erica; Kucherlapati, Raju S; Roberts, Amy E



Surviving a delayed trans-diaphragmatic hepatic rupture complicated by an acute superior vena cava and thoracic compartment syndromes.  


We describe the first reported survivor of a delayed trans-diaphragmatic hepatic rupture complicated by acute superior vena cava (SVCS) and thoracic compartment syndromes (TCS). A thirty one year old male was involved in a boating accident. The patient was diagnosed with a grade IV liver laceration, which was initially managed with both angio-embolization and open surgical repair. Exactly one month from admission, the patient presented with an abrupt cardiac arrest, which was further complicated by a SVCS and TCS. The SVCS was managed with bilateral thoracostomies which revealed a delayed trans-diaphragmatic hepatic rupture into the right chest cavity. The TCS was managed with a decompressive thoraco-abdominal incision. The patient survived and is now leading a normal life. Our success was largely due to an integrated trauma system of physicians, nurses and technicians that prompted the early recognition of two potentially life threatening complications of a delayed trans-diaphragmatic hepatic rupture. PMID:21887041

Parra, Michael W; Rodas, Edgar B; Bartnik, Jakub P; Puente, Ivan



Poland's syndrome complicated with breast cancer: mammographic, ultrasonographic, and computed tomographic findings.  


Poland's syndrome is a rare congenital anomaly characterized by unilateral chest wall hypoplasia and ipsilateral hand abnormalities. It has been reported in association with various malignancies and other developmental defects. We report here the case of a 58-year-old woman with Poland's syndrome who developed breast cancer in the ipsilateral normal breast. A review of the literature reveals that two studies of breast carcinoma associated with Poland's syndrome have been reported, but this paper is the first example of a carcinoma occurring in an otherwise normal breast associated with Poland's syndrome. PMID:18415780

Ji, J; Zhang, S; Shao, C; Xu, M; Chen, S; Lu, C; Wang, Z; Zhao, Z; Fan, X; Tu, J



[Peripubertal ovarian cyst torsion as an early complication of undiagnosed polycystic ovarian syndrome].  


The aim of the authors is to present two cases which raise the possibility of an association between polycystic ovarian syndrome/hyperandrogenism and ovarian cyst torsion in peripubertal girls. Androgen excess may cause more frequently ovarian cyst formation in premenarcheal or young adolescents with undiagnosed polycystic ovarian syndrome than in adults. The authors recommend that polycystic ovarian syndrome as well as late onset congenital adrenal hyperplasia should be considered in peripubertal adolescents with ovarian cyst torsion. In case polycystic ovarian syndrome is confirmed, adequate management according to age and pubertal development of the patients should be commenced. PMID:23315226

Ságodi, László; Schmidt, Ildikó; Vámosi, Ildikó; Barkai, László



Complications of Evans' syndrome in an infant with hereditary spherocytosis: a case report  

Microsoft Academic Search

Hereditary spherocytosis (HS) is a genetic disorder of the red blood cell membrane clinically characterized by anemia, jaundice and splenomegaly. Evans' syndrome is a clinical syndrome characterized by autoimmune hemolytic anemia (AIHA) accompanied by immune thrombocytopenic purpura (ITP). It results from a malfunction of the immune system that produces multiple autoantibodies targeting at least red blood cells and platelets. HS

Hideki Yoshida; Hiroyuki Ishida; Takao Yoshihara; Takashi Oyamada; Masataka Kuwana; Toshihiko Imamura; Akira Morimoto



CASE REPORT: Ovarian Hyperstimulation Syndrome Complicating a Spontaneous Singleton Pregnancy: A Case Report  

Microsoft Academic Search

It has been known that most cases of ovarian hyperstimulation syndrome (OHSS) are associated with the use of exogenous gonadotropins to induce multiple ovulation. However, OHSS is infrequently associated with a spontaneous ovulatory cycle, usually in the case of multiple gestations, hypothyroidism, or polycystic ovarian syndrome. We report a case of severe OHSS in a spontaneously pregnant woman with no

Hee-Dong Chae; Eun-Joo Park; Sung-Hoon Kim; Chung-Hoon Kim; Byung-Moon Kang; Yoon Seok Chang



Abdominal Compartment Syndrome Secondary to Retroperitoneal Hematoma as a Complication of ERCP After Liver Transplantation  

Microsoft Academic Search

Endoscopic retrograde cholangiopancreatography (ERCP) is frequently employed in the management of postoperative biliary complications in the liver transplant patient. Bleeding after ERCP most commonly presents as gastrointestinal bleeding and often can be managed with repeat endoscopy. ERCP can also be complicated by retroperitoneal hematoma, which in rare cases can lead to hemodynamic compromise due to relentless hemorrhage or from secondary

S. Milanchi; D. Magner; S. K. Lo; A. S. Klein; S. D. Colquhoun; N. N. Nissen



Bloom syndrome complicated by colonic cancer in a young Tunisian woman.  


Bloom syndrome (BS) is an autosomal recessive inherited disorder characterized by chromosomal instability leading to a high risk of cancer at an early age. The diagnosis should be considered in patients with short stature, photosensitivity, variable degrees of immunodeficiency, and hypogonadism. We report a 19-year-old woman, with history of dysmorphic features and recurrent infections. The diagnosis of bloom syndrome was made and confirmed cytogenetically at the age of 14 years. She developed a colon cancer revealed by venous thrombosis and anemia. She died after 15 days of the cancer diagnosis. This is the first registrated case of confirmed Bloom syndrome in Tunisian population. PMID:21778134

Benjazia, Elhem; Turki, Hajer; Atig, Amira; Khalifa, Mabrouk; Letaief, Amel; Bahri, Fethi; Braham, Ahlem



[Correction of the immune disorders in patients with diabetes mellitus type II with complicated diabetic foot syndrome].  


There were examined 86 patients, suffering mixed form of diabetic foot syndrome. In all the patients diabetes mellitus type II was diagnosed, the disease duration have constituted (12.3 +/- 2.5) yrs at average. The immune status was estimated, using determination of the lymphocytes subpopulations with the help of the monoclonal antibodies towards antigens reaction by the flowcytometry method, as well as concentration of the main classes of immunoglobulins IgA, IgM, IgG. The investigation was performed in dynamics: immediately after a patient admittance to hospital, on the 7 - 8th, 12 - 16th and 25 - 30th day. Basing on the analysis of the data obtained, there was conclusion made, that immediately after admittance to the hospital in the patients, suffering complicated diabetic foot syndrome, the disorders of cellular immunity of degree II and of humoral immunity of I degree were revealed. The indices improvement were noted while application of certain immunocorrecting therapy. PMID:22013692

Savon, I L



Analysis of Families with Lynch Syndrome Complicated by Advanced Serrated Neoplasia: The Importance of Pathology Review and Pedigree Analysis  

PubMed Central

The identification of Lynch syndrome has been greatly assisted by the advent of tumour immunohistochemistry (IHC) for mismatch repair (MMR) proteins, and by the recognition of the role of acquired somatic BRAF mutation in sporadic MMR-deficient colorectal cancer (CRC). However, somatic BRAF mutation may also be present in the tumours in families with a predisposition to develop serrated polyps in the colorectum. In a subgroup of affected members in these families, CRCs emerge which demonstrate clear evidence of MMR deficiency with absent MLH1 staining and high-level microsatellite instability (MSI). This may result in these families being erroneously classified as Lynch syndrome or, conversely, an individual is considered “sporadic” due to the presence of a somatic BRAF mutation in a tumour. In this report, we describe two Lynch syndrome families who demonstrated several such inconsistencies. In one family, IHC deficiency of both MSH2 and MLH1 was demonstrated in tumours from different affected family members, presenting a confusing diagnostic picture. In the second family, MLH1 loss was observed in the lesions of both MLH1 mutation carriers and those who showed normal MLH1 germline sequence. Both families had Lynch syndrome complicated by an independently segregating serrated neoplasia phenotype, suggesting that in families such as these, tumour and germline studies of several key members, rather than of a single proband, are indicated to clarify the spectrum of risk.

Walsh, Michael D; Buchanan, Daniel D; Walters, Rhiannon; Roberts, Aedan; Arnold, Sven; McKeone, Diane; Clendenning, Mark; Ruszkiewicz, Andrew R; Jenkins, Mark A; Hopper, John L; Goldblatt, Jack; George, Jillian; Suthers, Graeme K; Phillips, Kerry; Young, Graeme P; Macrae, Finlay; Drini, Musa; Woods, Michael O; Parry, Susan; Jass, Jeremy R; Young, Joanne P



[The post-poliomyelitis syndrome--a real complication. A poliomyelitis material from the Haukeland hospital].  


Over a four-year period, all in-patients at our department with the diagnosis of polio-sequelae were clinically examined for development of new neuromuscular deficit. 19 out of 125 patients (15%) had developed a postpolio syndrome. All 19 had acquired additional functional deficit and 17 new, localized pareses. Five patients had developed polio-related hypoventilation. The mean time from acute poliomyelitis to debut of the post-polio syndrome was 39 years. The post-polio syndrome occurred in patients with severe pareses in the acute stage, but was not related to age, sex or specific epidemic. Most of the 106 other patients had similar subjective complaints but did not have any clinical signs indicating new neuromuscular deficit. 67 of these patients had tendinitis and/or myalgia and 83 had chronic pain. Whereas many patients have progressive symptoms many years after poliomyelitis, only a minority develop the post-polio syndrome. PMID:9148448

Tjensvoll, A B; Gilhus, N E



Thrombotic thrombocytopenic purpura with an autoantibody to ADAMTS13 complicating Sjögren's syndrome: two cases and a literature review.  


An association between thrombotic thrombocytopenic purpura (TTP) and Sjögren's syndrome (SS) is rare. This is the first report of two patients with TTP who had inhibitory autoantibodies to ADAMTS13 (a disintegrin-like and metalloprotease with thrombospondin type 1 repeats) complicating primary SS. A rapid diagnosis of TTP, which is a potentially lethal condition, made it possible to treat the two cases successfully. Only eight similar cases with TTP complicating SS have been reported in the literature. The possible presentation of primary SS without classic sicca symptoms, but with haematological abnormalities including TTP, should be recognised. Furthermore, it is important to measure ADAMTS13 activity and anti-ADAMTS13 antibodies, because TTP with SS seems to be a concurrent overlapping autoimmune disorder. We suggest that plasma exchanges in combination with corticosteroids should be administered as early as possible, since they appeared to be effective in treating TTP with SS, including in our cases. PMID:22526830

Yamashita, Hiroyuki; Takahashi, Yuko; Kaneko, Hiroshi; Kano, Toshikazu; Mimori, Akio



Controversial treatment of a victim of severe head injury complicated by septic shock and acute respiratory distress syndrome  

PubMed Central

Pneumonia, severe sepsis, and acute respiratory distress syndrome (ARDS) are frequent complications after head trauma. Recombinant human activated protein C (APC) reportedly improves circulation and respiration in severe sepsis, but is contraindicated after head injury because of increased risk of intracranial bleeding. A 21-year-old man with severe head injury after a car accident was endotracheally intubated, mechanically ventilated, and hemodynamically stabilized before transfer to our university hospital. His condition became complicated with pneumonia, septic shock, ARDS, coagulation dysfunction, and renal failure. In spite of intensive therapy, oxygenation and arterial blood pressure fell to critically low values. Simultaneously, his intracranial pressure peaked and his pupils dilated, displaying no reflexes to light. His antibiotic regimen was changed and ventilation was altered to high frequency oscillations, and despite being ethically problematic, we added APC to his treatment. The patient recovered with modest neurological sequelae.

Haavind, Anniken; Hevr?y, Olav; Hennig, Rune; Bjertnaes, Lars



HELLP Syndrome Complicated Bile Duct Injury and Subsequent Left Hepatic Lobe Atrophy  

Microsoft Academic Search

The combination of hemolysis, elevated liver enzymes, and low platelet count occurring during an immediately after pregnancy constitutes HELLP syndrome. The peripheral smear in HELLP syndrome is consistent with microangiopathic anemia. Liver enzymes, particularly aspartate aminotransferase (AST), are usually elevated to >70 IU\\/L, or two times the upper limit of normal. The platelet count typically is <100,000\\/ml) (1, 3). HELLP

Ayse L. Mindikoglu; Shilun D. Li; Sherri L. Yong; Marc A. Borge; John Brems; David H. Van Thiel



Catheter-directed thrombolytic therapy combined with angioplasty for hepatic vein obstruction in Budd-Chiari syndrome complicated by thrombosis  

PubMed Central

The aim of this study was to assess the efficacy and safety of catheter-directed thrombolysis combined with angioplasty in the treatment of hepatic vein obstruction in Budd-Chiari syndrome (BCS) complicated by thrombosis. In 14 cases of BCS, the patients with hepatic vein obstruction complicated by thrombosis who underwent catheter-directed urokinase thrombolysis, balloon dilatation and/or stent placement were followed up with an ultrasound examination of the liver. Among the 13 cases of successful treatment, one hepatic vein was recanalized in 12 patients (right hepatic vein, seven cases; left hepatic vein, three cases; middle hepatic vein, one case and accessory hepatic vein, one case) and two hepatic veins (right and left) were recanalized in one patient without serious complications, such as bleeding and pulmonary embolism. There was one patient in whom the treatment was unsuccessful. During an average follow-up period of 24.8±19.6 months, hepatic vein restenosis was observed in one patient in the sixth month after opperation; however, a successful result was obtained following a second balloon dilatation. The remaining 12 patients did not demonstrate any recurrence of restenosis or thrombosis. Catheter-directed thrombolysis combined with angioplasty was observed to be an effective and safe method for the treatment of hepatic vein obstruction in BCS complicated by thrombosis.




Carcinoid tumor of the common bile duct: a rare complication of von Hippel-Lindau syndrome.  


Von Hippel-Lindau syndrome (VHL) is a rare autosomal-dominant, inherited familial cancer syndrome. Hemangioblastomas, pheochromocytomas and renal carcinoma are the frequent reported VHL tumors. Neuroendocrine tumors have also been described, mostly in the pancreas and rarely in the biliary trees. We report the second case of bile duct carcinoid in a 31-year-old VHL woman. She underwent right adrenalectomy for a pheochromocytoma in the past. She also had a positive family history of phenotypic expression of VHL syndrome. The patient presented with biliary colic. Endoscopic retrograde cholangio-pancreatography showed intra-luminal bile duct mass. Surgical exploration identified a beige nodular lesion that was a carcinoid tumor on histology. This new association should be clarified by further genetic investigations. PMID:18300362

Nafidi, Otmane; Nguyen, Bich-N; Roy, André



Carcinoid tumor of the common bile duct: A rare complication of von Hippel-Lindau syndrome  

PubMed Central

Von Hippel-Lindau syndrome (VHL) is a rare autosomal-dominant, inherited familial cancer syndrome. Hemangioblastomas, pheochromocytomas and renal carcinoma are the frequent reported VHL tumors. Neuroendocrine tumors have also been described, mostly in the pancreas and rarely in the biliary trees. We report the second case of bile duct carcinoid in a 31-year-old VHL woman. She underwent right adrenalectomy for a pheochromocytoma in the past. She also had a positive family history of phenotypic expression of VHL syndrome. The patient presented with biliary colic. Endoscopic retrograde cholangio-pancreatography showed intra-luminal bile duct mass. Surgical exploration identified a beige nodular lesion that was a carcinoid tumor on histology. This new association should be clarified by further genetic investigations.

Nafidi, Otmane; Nguyen, Bich N; Roy, Andre



Management of Reproductive Health in Cowden Syndrome Complicated by Endometrial Polyps and Breast Cancer  

PubMed Central

BACKGROUND Cowden syndrome is an autosomal-dominant condition associated with mutations in the tumor suppressor gene PTEN. Gynecologic malignancies are common with a 5–10% risk of endometrial cancer and 25–50% risk of breast cancer. CASE A 37-year-old woman with a history of breast cancer, other neoplasms, and multiple skin lesions was diagnosed with Cowden syndrome after a germline PTEN mutation was identified. The endometrium had high glucose uptake on positron emission tomography scan and was irregularly thickened on ultrasonography; biopsy revealed endometrial polyps and simple hyperplasia. Fifteen months later, hysteroscopy again confirmed numerous benign endometrial polyps. CONCLUSION Recurrent, multiple endometrial polyps portend a high risk of endometrial cancer in women with Cowden syndrome. Monitoring for malignancy and consideration of hysterectomy after childbearing is completed is warranted.

Kalin, Asli; Merideth, Melissa A.; Regier, Debra S.; Blumenthal, Gideon M.; Dennis, Phillip A.; Stratton, Pamela



Systemic Lupus Erythematosus and Antiphospholipid Syndrome during Pregnancy: Maternal and Fetal Complications and their Management  

Microsoft Academic Search

Systemic lupus erythematosus affects mostly young women. Despite this, the interrelationship between SLE and pregnancy has remained poorly understood for years. Fear of maternal or fetal complications has often resulted in advice against pregnancy. Since the mid-seventies, an increasing number of authors are providing specific care for pregnant women with SLE. Their experience over the years has demonstrated that pregnancy

Guillermo Ruiz-Irastorza; Munther A. Khamashta; Graham R. V. Hughes


Malignancy as a possible complication of complex regional pain syndrome: a case report.  


A synovial sarcoma presented in the knee of a young woman 20 years after the onset of pain which was attributed to complex regional pain syndrome (CRPS). Was this a chance occurrence, or could there be any link between the two conditions? Did the pain itself and the persistent inflammatory and immunological response to pain contribute to the development of malignancy, or could the malignancy have been present subclinically for many years and have contributed to the ongoing pain syndrome? This case report looks into the diagnosis of synovial sarcoma and CRPS and the relationship between the neurogenic inflammation seen in CRPS and that seen in malignancies. The diagnosis of CRPS is a diagnosis of exclusion. Constant vigilance of patients with this unpleasant condition is necessary. PMID:20002598

Kennedy, Rick; Hester, Joan; Simon, Dominic W N



A Case Study of Recipient Twin Surviving Complications of Twin-to-Twin Transfusion Syndrome.  


Twin-to-twin transfusion syndrome (TTTS) has a high rate of mortality and morbidity. This article describes the clinical course of a recipient twin in a case of TTTS. The twin was on long-term respiration support and survived two resuscitations, pneumothorax, chest tube placement, blood exchange, necrotizing enterocolitis and corrective surgery. This case demonstrates that the effective use of a collaborative, multidisciplinary care approach between two hospitals can result in a newborn surviving a severe case of TTTS. PMID:24138658

Squires, Linda Sharee



Massive intravenous immunoglobulin treatment in pregnancy complicated by Guillain–Barré Syndrome  

Microsoft Academic Search

A pregnant woman developed acute demyelinating poly-neuropathy (Guillain–Barré syndrome (GBS)) in the 28th week of gestation (GW) after flu-like infection. Hypertension, liver dysfunction, and a decrease in consciousness level developed at 29GW. Blood chemical analysis revealed increased levels of liver enzymes GOT 247 IU\\/l and GPT 624 IU\\/l. Viral serological study showed a positive test for Epstein–Barr virus IgM. Weakness

Hideto Yamada; Noriko Noro; Emi H Kato; Yasuhiko Ebina; Kazutoshi Cho; Seiichiro Fujimoto



Recent advances in the management of ocular complications of sjögren’s syndrome  

Microsoft Academic Search

Sjögren’s syndrome (SS) is an autoimmune disorder, the principal ocular manifestation of which is decreased tear production\\u000a leading to chronic irritation and damage to the corneal and conjunctival epithelium. The most important advance in the treatment\\u000a of ocular manifestations of SS is the introduction of topical anti-inflammatory agents such as cyclosporine A, which increases\\u000a tear production and decreases symptoms without

Michael Samarkos; Haralampos M. Moutsopoulos



[Serious bleeding in systemic lupus erythematosus complicated by lupus anticoagulant-hypoprothrombinaemia syndrome].  


Severe hemorrhagic diathesis due to lupus anticoagulant complicated by hypoprothrombinaemia resulting from prothrombin autoantibodies is a rare disorder and is often associated with systemic lupus erythematosus (SLE). We report a case in which a 15-year-old girl with SLE developed marked haemorrhagic manifestations due to menorrhagia and nosebleeds. The acute bleeding episode was treated with SAGM, tranexamic acid and recombinant factor VIIa. Lupus anticoagulant, cardiolipin antibodies and antiprothrombin antibodies were successfully depressed within weeks after corticosteroid therapy was begun. PMID:16472441

Engelsen, Jytte; Nielsen, Susan M; Thorsen, Sixtus



Excessive naked megakaryocyte nuclei in myelodysplastic syndrome mimicking idiopathic thrombocytopenic purpura: a complicated pre- and post-transplantation course.  


A boy 3 years 7 months old with thrombocytopenia and history of intracranial hemorrhage who underwent bone marrow transplantation is presented. He was refractory to steroids, immunoglobulin G, vincristine, azathioprine, cyclosporine A, interleukin-11, chemotherapy, and splenectomy. Idiopathic thrombocytopenic purpura was excluded by light /electron microscopic and flow cytometric findings; the diagnosis of refractory cytopenia, a subgroup of pediatric myelodysplastic syndrome, was made. Naked megakaryocyte nuclei were 55.38 +/- 28.2% vs. 31.67 +/- 23.22% of all megakaryocytes in the patient and the control group of 9 patients with idiopathic thrombocytopenic purpura, respectively (p = .016). The posttransplatation course was complicated by delayed platelet engraftment, bronchiolitis obliterans associated with pneumocystis carinii pneumonia, which resolved completely. PMID:19657988

Olcay, Lale; Tuncer, A Murat; Okur, Hamza; Erdemli, Esra; Uysal, Zumrut; Cetin, Mualla; Duru, Feride; Cetinkaya, Duygu Uckan



[Coronary-subclavian steal syndrome, a complication following surgical revascularization of myocardium].  


Coronary-subclavian steal syndrome (CSS) is defined as a reversal of flow in a previously constructed internal mammary artery coronary conduit, producing myocardial ischemia. The most often cause is a proximal subclavian artery stenosis or closure. For the first time was CSS described in 1974 and initially was believed to be rare. However, today is the internal mammary artery to the left anterior descending coronary artery used in cardiosurgery as a standard and we can see increasing documentation of this phenomenon. A case report is presented and possibilities of management are discussed in the article. PMID:23256834

Gloger, V



Fetal and Maternal Complications after Selective Fetoscopic Laser Surgery for Twin-to-Twin Transfusion Syndrome: A Single-Center Experience  

Microsoft Academic Search

Objective: To report the incidence of fetal and maternal complications after selective fetoscopic laser surgery for twin-to-twin transfusion syndrome (TTTS). Methods: A total of 150 cases of TTTS were treated from January 2004 to June 2009 (period 1, 2004–2006, 62 cases; period 2, 2007 to June 2009, 88 cases). Fetal complications (double and single intrauterine fetal death, recurrence of TTTS,

M. A. Rustico; M. M. Lanna; S. Faiola; V. Schena; M. Dell’Avanzo; V. Mantegazza; C. Parazzini; G. Lista; B. Scelsa; D. Consonni; E. Ferrazzi



Compartment syndrome of the thigh after blunt trauma: a complication not to be ignored.  


We report a case of anterior thigh compartment syndrome, which occurred after man's thigh was bruised after flipping repeatedly over his bike and being hit by the frame of the bike nearly at around 6 pm. The next day at 1:30 am, he was admitted to the hospital. The initial presentation was a hematoma, and the patient was kept in bed with local cooling. The compartment syndrome of the thigh (CST) diagnosis was made around 6:00 pm when the level of pain was interpreted as disproportionate to the treated lesion; anterior compartment pressure measure was 84 mmHg. A compartment fasciotomy was performed. It is difficult to diagnose a CST in case of muscular contusion as the latter causes symptoms that are similar to CST. A conservative treatment without fasciotomy was carried out by several authors, especially in sportsmen showing a CST following contusion. This conservative treatment implies close monitoring of intramuscular pressures and adjuvant measures (bed rest, holding the thigh at the heart level and oxygenotherapy). PMID:22218939

Uzel, André-Pierre; Bulla, Antonio; Henri, Stéphane



Conservative management of ulnar tunnel syndrome: secondary to excessive healing tissue; a rare complication after flexor tendon injury--a case report.  


The ulnar tunnel syndrome occurs usually from ganglions, lipoma, cysts, chronic repetitive trauma, bicycling, and the activities that require either prolonged wrist hyper extension or continued pressure on the hypothenar eminence. The ulnar tunnel syndrome after flexor tendon repair is a rare complication. We report on a 24-year-old man with ulnar tunnel syndrome after a flexor tendon repair secondary to girder cut injury. The patient was managed conservatively for his hypertrophic scar for 9 weeks. After 9 weeks, the patient presented with no clawing and complete closure of the hand. PMID:22627928

Sudhagar, G; Le blanc, Monique



Spectrum of X-linked hydrocephalus (HSAS), MASA syndrome, and complicated spastic paraplegia (SPG1): Clincal review with six additional families  

SciTech Connect

X-linked hydrocephalus (HSAS) (MIM{sup *}307000), MASA syndrome (MIM {sup *}303350), and complicated spastic paraplegia (SPG1) (MIM {sup *}3129000) are closely related. Soon after delineation, SPG1 was incorporated into the spectrum of MASA syndrome. HSAS and MASA syndrome show great clinical overlap; DNA linkage analysis places the loci at Xq28. In an increasing number of families with MASA syndrome or HSAS, mutations in L1CAM, a gene located at Xq28, have been reported. In order to further delineate the clinical spectrum, we studied 6 families with male patients presenting with MASA syndrome, HSAS, or a mixed phenotype. We summarized data from previous reports and compared them with our data. Clinical variability appears to be great, even within families. Problems in genetic counseling and prenatal diagnosis, the possible overlap with X-linked corpus callosum agenesis and FG syndrome, and the different forms of X-linked complicated spastic paraplegia are discussed. Since adducted thumbs and spastic paraplegia are found in 90% of the patients, the condition may be present in males with nonspecific mental retardation. We propose to abandon the designation MASA syndrome and use the term HSAS/MASA spectrum, incorporating SPG1. 79 refs., 6 figs., 2 tabs.

Schrander-Stumpel, C.; Hoeweler, C. [Univ. of Limburg (Netherlands); Jones, M. [Children`s Hospital, Sandiego, CA (United States)] [and others



Successful Management of Pregnancy Complicated by Klippel-Trenaunay Syndrome Using MR Angiography-Based Evaluation  

PubMed Central

Klippel-Trenaunay syndrome (KTS) is a rare congenital disease, and extensive cutaneous hemangiomas and abnormal venous vessels are characteristic. In our case, to manage her pregnancy with KTS, whole-body MRA was performed before delivery. A 29-year-old woman was referred at 28 weeks because of prominent vulvovaginal varicosities due to KTS. At 35 weeks, hypertrophy and multiple venous varicosities of her leg as well as massive vulvovaginal varicosities became prominent with a normal coagulation profile. Systematic MRAs revealed hemangiomas and varicosities in the right leg, the lower abdomen, and the pubic region, while no obvious AVM was detected around the bronchial tube and spine. We decided to deliver her baby by cesarean section at 37 weeks under general anesthesia, and a healthy baby was delivered. No blood transfusion was required. Prophylaxis against thrombosis was performed after the operation. She was discharged with her baby. Her vulvovaginal varicosities shrunk considerably one month later.

Tanaka, Reiko; Fujita, Yasuyuki; Ishibashi Hiasa, Kana; Yumoto, Yasuo; Hidaka, Nobuhiro; Fukushima, Kotaro; Wake, Norio



Recent advances in the management of ocular complications of Sjögren's syndrome.  


Sjögren's syndrome (SS) is an autoimmune disorder, the principal ocular manifestation of which is decreased tear production leading to chronic irritation and damage to the corneal and conjunctival epithelium. The most important advance in the treatment of ocular manifestations of SS is the introduction of topical anti-inflammatory agents such as cyclosporine A, which increases tear production and decreases symptoms without any significant side effect. Stimulators of tear secretion, both topical, such as diquafosol, and systemic, such as pilocarpine and cevimeline, are also effective, although they have been associated with frequent side effects. Topical use of autologous serum is another new and effective form of treatment, but problems in the preparations prevent their widespread use. Additionally, nonpharmacologic treatments, such as insertion of punctal plugs, are beneficial in the dry eye of SS, whereas several other modalities, such as anti-CD4 monoclonal antibody eye drops and gene transfer, are still in experimental phases. PMID:15967078

Samarkos, Michael; Moutsopoulos, Haralampos M



Variable expressivity and clinical heterogeneity can complicate the diagnosis and management of pfeiffer syndrome.  


We report here a newborn female infant with striking features consistent with severe Pfeiffer syndrome (PS). Pfeiffer syndrome is a rare craniofacial disorder that has an autosomal dominant mode of inheritance (OMIM 101600). Our patient had unexpected differences between her clinical features and those predicted from her genetic tests. The following clinical features were noted: severe exophthalmos, syndactyly, upper extremity contractures, and relative macroglossia. A head computed tomography with three-dimensional reconstruction showed that she did not have craniosynostosis. Genetic tests included a normal 46,XX karyotype and a chromosomal microarray that revealed a copy number gain at 14q23.1 as well as a copy number loss at 16p13.2. FGFR2 sequencing revealed a c.870G>T transversion in exon 8, which is predicted to encode a Trp290Cys substitution.The clinical features of severe exophthalmos and other features typical of PS without craniosynostosis were most consistent with a diagnosis of PS type III. However, her Trp290Cys FGFR2 mutation is reported to be associated with PS type II that includes kleeblatschädel (or "cloverleaf") skull anomalies as a cardinal feature. Our patient's lack of craniosynostosis predicted from this mutation is a striking example of variable expressivity. Such discrepancies between the physical findings (phenotype) and the mutation identified (genotype) and the association of different findings with different mutations in the same gene (clinical heterogeneity) can present difficulties in case management. Clinicians should be guided by careful phenotyping rather than by genotypic predictions alone. PMID:24036790

Ettinger, Nicholas; Williams, Misti; Phillips, John A



A case of chronic hepatitis C developing insulin-dependent diabetes, thyroid autoimmunity and stiff-person syndrome as complications of interferon therapy  

Microsoft Academic Search

We describe the case of a 66-year-old man with chronic hepatitis C who developed type 1 diabetes mellitus (T1DM) and thyroid autoimmunity during Interferon ? (INF?) therapy and then stiff-person syndrome (SPS). This is the first reported case in which SPS has appeared as complication of IFN? therapy.

G. Scavone; F. Zaccardi; A. Manto; S. Caputo; D. Pitocco; G. Ghirlanda



[Peculiarities of the lower extremities perfusion in patients with complicated diabetic foot syndrome].  


Analysis of the microcirculation indices in 246 patients, suffering diabetic foot syndrome (DFS), was presented. For a neuropathic form of DFS characteristic is lowering of the arterioles tone and enhancement of the blood volume in them, witnessed by raising of constant component of the blood flow. General worsening of perfusion is caused by lowering of endothelial secretion activation, and as well as neurogenic and myogenic control mechanisms. Occurrence of neurogenic regulation disorder is witnessed by the neurogenic oscillations lowering, the neurogenic and myogenic tone raising. In ischemic form of DFS there was noted the perfusion disorder, connected with reduction of the arterial inflow volume. The indices changes witness the disorder of sympathetic regulation of microcirculation and arteriole-venular reactions. The change of the perfusion indices, caused by a congestion processes in arterioles and venules, is characteristic for the mixed form of DFS. The perfusion control mechanisms was noted, as a consequence of the endothelial secretion lowering and the neurogenic and myogenic mechanisms activation of a control. The neurogenic and myogenic tone raising occurs depending on the sympathetic component activity, causing the arterioles diameter reduction. PMID:23888810

Shapoval, S D; Savon, I L; Smirnova, D A; Martyniuk, V B; Vasilevskaia, L A; Iakunich, A N; Sofilkanych, M M



The secondary abdominal compartment syndrome: not just another post-traumatic complication  

PubMed Central

The secondary abdominal compartment syndrome (ACS) is defined as the presence of organ dysfunction with concurrent intra-abdominal hypertension (IAH) in a scenario lacking primary intraperitoneal injury or intervention. This state appears to be related to visceral, abdominal wall and retroperitoneal edema and ascites induced by resuscitation. Despite a diverse range of associated causes such as pancreatitis, intra-abdominal sepsis, cardiac arrest, thermal injury and extraperitoneal trauma, this class of ACS is characterized by the presence of shock requiring aggressive fluid resuscitation. Secondary ACS is an extreme condition along a continuum of raised intra-abdominal pressure (IAP) that is pathoneumonic when associated with new overt organ failure. When IAP is above normal but is not associated with organ failure, IAH is diagnosed. Because these conditions are common among critically ill patients, the measurement of IAP is crucial. It is unclear whether preventing IAH reduces progression to ACS or influences outcomes. When overt ACS is confirmed, immediate surgical decompression of the patient's abdomen via a standard laparotomy is usually required. Because many disease processes resulting in critical illness require aggressive fluid resuscitation as a primary therapy, it is likely that secondary ACS is much more common than previously believed. Further study is needed.

Ball, Chad G.; Kirkpatrick, Andrew W.; McBeth, Paul



Serious air leak syndrome complicating high-flow nasal cannula therapy: a report of 3 cases.  


Despite the absence of clinical safety data, heated, humidified high-flow nasal cannula (HHFNC) therapy is increasingly being used as an alternative to positive-pressure ventilation in pediatrics. This use of HHFNC is "off label" because the US Food and Drug Administration's approval for these devices was only for air humidification and not as a modality to provide positive distending pressure. For the first time we describe 3 cases who developed serious air leaks related to HHFNC therapy. The first child was a previously healthy 2-month-old male infant with respiratory syncytial virus bronchiolitis who developed a right pneumothorax on day 5 of his illness at 8 liters per minute (lpm). He subsequently required intubation and ventilation for 14 days. The second case involved an otherwise healthy 16-year-old boy with cerebral palsy who developed pneumomediastinum and died of its complications. He was receiving 20 lpm HHFNC therapy when he developed pneumomediastinum. The third case involved a 22-month-old, previously healthy boy who developed subdural hematoma secondary to abuse. He developed a right pneumothorax while receiving HHFNC at a flow of 6 lpm, requiring chest tube placement. These cases emphasize the need for extreme caution while using HHFNC for the off-label indication of providing positive distending pressure in children, especially at flows higher than the patient's minute ventilation. A more detailed study to specifically look at the serious adverse events related to HHFNC is urgently needed. PMID:23382446

Hegde, Satyanarayan; Prodhan, Parthak



Caprelsa (vandetanib) REMS  

Center for Drug Evaluation (CDER)

Text Version... including Stevens-Johnson syndrome), some leading to death, have been ... ILD) has been observed with CAPRELSA and deaths have been ... More results from


Department of Health and Human Services Public Health ...  

Center for Biologics Evaluation and Research (CBER)

Text Version... of Stevens-Johnson syndrome, hypersensitivity reaction and toxic ... o The most common adverse reactions of moderate ... 06-May-2013 Time period of ... More results from



Center for Drug Evaluation (CDER)

Text Version... Texas, MD Anderson Cancer Center. DR. ... one and two, exclude versus approve. It looks like those ... associated with Stevens-Johnson syndrome. ... More results from


Proposed Prescribing Information PAS November 2010 Latex  

Center for Biologics Evaluation and Research (CBER)

Text Version... somnolence; irritability Skin Stevens-Johnson Syndrome; alopecia ... 2, New York, John Wiley & Sons ... Medicine,” GW Thorn, RD Adams, E. Braunwald ... More results from


Drug Safety Newsletter  

Center for Drug Evaluation (CDER)

Text Version... Finally, we describe serious skin reactions, Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), following the use of ... More results from


Poison ivy: an underreported cause of erythema multiforme.  


The relationship between herpes simplex virus (HSV) and erythema multiforme (EM) has been well described. Many authors contend that EM (excluding Stevens-Johnson syndrome and toxic epidermal necrolysis) occurs almost exclusively as a response to HSV infection. During the past year, however, we have observed several cases of EM complicating severe Rhus allergic contact dermatitis. Although this association has been previously documented, the paucity of cases in the literature, along with our experience, suggests that this is an underreported phenomenon. We describe 4 of our cases. PMID:15577759

Werchniak, Andrew E; Schwarzenberger, Kathryn



Marfan Syndrome  


... can cause many complications. Sometimes the complications are life threatening. Overview Marfan syndrome is a genetic disorder. ... live longer and enjoy a good quality of life. Many people who have Marfan syndrome and are ...


Multiple Ligament Knee Injury: Complications  

PubMed Central

Non-operative and operative complications are common following multiple ligament knee injuries. This article will describe common complications seen by the surgeon and physical therapist following this complex injury. Complications include fractures, infections, vascular and neurologic complications following injury and surgery, compartment syndrome, complex regional pain syndrome, deep venous thrombosis, loss of motion and persistent laxity issues. A brief description of these complications and methods for evaluation and treatment will be described.

Hosseinzadeh, Pooya; Giangarra, Charles E.



Effective intravenous immunoglobulin therapy for Churg-Strauss syndrome (allergic granulomatous angiitis) complicated by neuropathy of the eighth cranial nerve: a case report  

PubMed Central

Introduction We report the case of a patient with Churg-Strauss syndrome with eighth cranial nerve palsy. Vestibulocochlear nerve palsy is extremely rare in Churg-Strauss syndrome. To the best of our knowledge, only one case of complicated neuropathy of the eighth cranial nerve has been described in a previous report presenting an aggregate calculation, but no differentiation between polyarteritis nodosa and Churg-Strauss syndrome was made. High-dose immunoglobulin was administered to our patient, and her neuropathy of the eighth cranial nerve showed improvement. Case presentation At the age of 46, a Japanese woman developed Churg-Strauss syndrome that later became stable with low-dose prednisolone treatment. At the age of 52, she developed sudden difficulty of hearing in her left ear, persistent severe rotary vertigo, and mononeuritis multiplex. At admission, bilateral perceptive deafness of about 80dB and eosinophilia of 4123/?L in peripheral blood were found. A diagnosis of cranial neuropathy of the eighth cranial nerve associated with exacerbated Churg-Strauss syndrome was made. Although high doses of steroid therapy alleviated the inflammatory symptoms and markers, the vertigo and bilateral hearing loss remained. Addition of a high-dose immunoglobulin finally resulted in marked alleviation of the symptoms associated with neuropathy of the eighth cranial nerve. Conclusions A high dose of immunoglobulin therapy shows favorable effects in neuropathy of the eighth cranial nerve, but no reports regarding its efficacy in cranial neuropathy have been published.



Compartment Syndrome of the Arm: A Complication of Noninvasive Blood Pressure Monitoring during Thrombolytic Therapy for Myocardial Infarction  

Microsoft Academic Search

We report a rare case of tricep compartment syndrome caused by a hematoma which resulted from noninvasive blood pressure monitoring (NIBPM) during thrombolytic therapy. Clinicians administering thrombolytic agents should be aware of the risk of bleeding and compartment syndrome at the site of NIBPM. Appropriate preventative measures should be instituted when using automated pneumatic cuffs. An understanding of the pathophysiology

J. Winslow Alford; Mark A. Palumbo; Michael J. Barnum



Successful treatment of advanced peripheral T-cell lymphoma with an angiocentric growth pattern complicated with hemophagocytic syndrome by high-dose chemotherapy and autologous peripheral blood stem cell transplantation  

Microsoft Academic Search

Peripheral T-cell lymphomas (PTCL) account for about 10% of all lymphomas in Western countries, respond poorly to therapy, and have short survival with no sustained remission. Furthermore, the complication of hemophagocytic syndrome (HPS) sometimes makes the prognosis of this disease extremely worse. We report here a case of PTCL with an angiocentric growth pattern complicated with HPS successfully treated by

T. Sato; K. Kogawa; S. Iyama; D. Kobayashi; Y. Sato; K. Kuribayashi; K. Takada; S. Hagiwara; T. Oku; S. Takahashi; T. Matsunaga; M. Takahashi; T. Terui; J. Kato; Y. Niitsu



[Structure of psychological needs of patients over 60 years of age, hospitalized for ischemic heart disease complicated by asthenic- depressive syndrome, and in healthy persons].  


Using psychotherapy methods such as MMPI-Wiskad, ACL-37 and 16PF the patterns of psychological needs were studied in postproductive-age subjects with ischaemic heart disease complicated or not with asthenia-depression syndrome and in healthy subjects. Statistical analysis showed that in relation to old people with ischaemic heart disease or without it patients with ischaemic heart disease and depression with asthenia showed a higher psychological sensitivity and their needs were concentrated around the need for self-manifestation, aid-seeking and taking care of oneself. In old people a tendency was maintained for persistence of psychological needs in the previously formulated forms. PMID:1455855

Pecyna, M B



Lemierre syndrome complicating multiple brain abscesses caused by extended-spectrum ?-lactamase-producing Klebsiella pneumoniae cured by fosfomycin and meropenem combination therapy.  


A woman aged 56 years of age had a community-acquired left neck abscess and internal jugular vein thrombosis with septicemia due to extended-spectrum ?-lactamase (ESBL)-producing Klebsiella pneumoniae. Even though she was treated with intravenous meropenem, the bacteremia persisted. She was complicated with multiple brain abscesses, seizure, and leucopenia. After a combination of intravenous fosfomycin and meropenem, her clinical condition became stable. Combination treatment was continued for 2 months and she recovered. In individual cases of Lemierre syndrome with brain abscess caused by ESBL-producing Enterobacteriaceae, fosfomycin combination therapy may be the alternative choice. PMID:22154996

Lee, Wen-Sen; Wang, Fu-Der; Shieh, Ying-Hua; Teng, Sing-On; Ou, Tsong-Yih



Marfan syndrome in children and adolescents: predictive and prognostic value of aortic root growth for screening for aortic complications  

Microsoft Academic Search

ObjectiveTo assess and measure the diagnostic and prognostic value of individual aortic root growth in children and adolescents with Marfan syndrome.DesignFrom 1983 to 1996, 250 children were screened for Marfan syndrome. Serial echocardiographic aortic root measurements of 123 children (57 Marfan, 66 control) were available for evaluation of aortic root growth. Aortic root diameters were correlated with body surface area.

M. Groenink; L. Rozendaal; M. S. J. Naeff; R. C. M. Hennekam; A. A. M. Hart; Wall van der E. E; B. J. M. Mulder



Effect of continuous positive airway pressure therapy on a large hemangioma complicated with obstructive sleep apnea syndrome: a case report  

Microsoft Academic Search

INTRODUCTION: Hemangiomas involving the upper airway can be an uncommon cause of obstructive sleep apnea syndrome. CASE PRESENTATION: A 26-year-old Caucasian man with a known history of a large hemangioma of his head and neck presented with sleep-disordered breathing to the sleep unit of our hospital. Severe obstructive sleep apnea syndrome was revealed on polysomnography. Nasal continuous positive airway pressure

Maria Antoniadou; Paschalis Steiropoulos; Evangelia Serasli; Venetia Tsara



Compartment syndrome as a complication of a stab wound to the thigh: a case report and review of the literature  

PubMed Central

Acute compartment syndrome of the thigh is a rare but potentially devastating condition, in which the pressure within the osseofascial compartment rises above the capillary perfusion gradient, leading to cellular anoxia, muscle ischaemia and death. Early diagnosis and treatment is essential to prevent long term disability. It is most often associated with crush injuries and femoral fracture. We present a previously unreported case of thigh compartment syndrome following a stab injury, treated by emergent fasciotomy.

Gillooly, John J; Hacker, Andrew; Patel, Vipul



Upper extremity compartment syndrome after minor trauma: an imperative for increased vigilance for a rare, but limb-threatening complication  

PubMed Central

Background Compartment syndrome of any extremity is a limb-threatening emergency requiring an emergent surgical management. Thus, ruling out compartment syndrome is often high on the list of priorities when treating high-energy injuries and fractures. However, even in the most seemingly benign injuries, this dangerous diagnosis must always remain on the differential and suspicion must remain high. Case presentation 23-year-old factory worker presents after a low energy entrapment injury to his left forearm. Initial work-up and evaluation noted an isolated radial head dislocation with a normal physical motor and sensory exam. However, maintaining high suspicion for compartment syndrome despite serial normal physical exams, led objective compartment pressure measurement leading to definitive diagnosis. Emergent surgical intervention via compartment fasciotomies was performed, along with closed reduction and ligament repair. At 1 year follow-up, the patient was well-healed, back to work with full range of motion and not activity limitations. Conclusion Despite a seemingly benign injury pattern, and a relatively low energy mechanism, vigilant concern for compartment syndrome following any kind of entrapment injury should initiate serial examinations and compartment pressure measurements especially in circumstances with continued swelling and inability to perform an accurate clinical assessment due to an obtunded or medicated patient.



Wolff-Parkinson-White syndrome (type A) complicated by heart block in both normal and accessory pathways.  

PubMed Central

A 67-year-old man with Wolff-Parkinson-White syndrome type A presented with second degree atrioventricular block in anomalous pathway and complete infra-Hisian block in the His-Purkinje pathway. He had increasingly frequent attacks of dizziness not related to exercise. A permanent ventricular demand pacemaker was successfully implanted following intracardiac electrophysiological studies.

Mackintosh, A F; Chamberlain, D A; Curry, P V



Congestive heart failure complicating non-ST segment elevation acute coronary syndrome: incidence, predictors, and clinical outcomes  

Microsoft Academic Search

There are limited data regarding the incidence and clinical significance of congestive heart failure (CHF) in patients with non-ST segment elevation acute coronary syndromes (ACS). The objectives of this study were to examine the incidence, predictors, and clinical outcomes in patients with ACS without ST elevation who develop CHF. We stud- ied patients with unstable angina or non-ST segment elevation

Shamir R. Mehta; John W. Eikelboom; Catherine Demers; Aldo P. Maggioni; Patrick J. Commerford; Salim Yusuf



Laparoscopic treatment of celiac axis compression syndrome (CACS) and hiatal hernia: Case report with bleeding complications and review?  

PubMed Central

INTRODUCTION Median arcuate ligament (MAL) malposition is a rare cause of celiac axis compression syndrome (CACS) or Dunbar syndrome. PRESENTATION OF CASE A 26-year-old female presented with severe postprandial epigastric pain, weight loss, heartburn and regurgitation unresponsive to medical therapy. CT angiography and duplex ultrasound demonstrated the MAL crossing anterior to the celiac artery (CA). Reconstructions demonstrated CA compression, while the superior mesenteric artery (SMA) was normal. The MAL was laparoscopically divided, releasing the celiac axis. A concomitant Nissen fundoplication was performed. At 3-months follow-up, the CT-scan demonstrated no evidence of CACS with complete symptom resolution. DISCUSSION Dunbar's syndrome can be treated with endovascular surgery, laparoscopic MAL division or vascular surgery.Six anatomical and morphologic variations of aortic and esophageal hiatus are described. The result of the analysis of these anatomical data leads to the conclusion that hiatus hernia, Dunbar's syndrome and GERD have a common etiopathogenesis and physiopathology. CONCLUSION Laparoscopic treatment is useful and feasible in centers with experience in majorlaparoscopic surgery with reduced invasiveness, better cosmetic effect and shorter postoperative course.

di Libero, Lorenzo; Varricchio, Antonio; Tartaglia, Ernesto; Iazzetta, Igino; Tartaglia, Alberto; Bernardo, Antonella; Bernardo, Rosanna; Triscino, Giovangiuseppe; Conte, Domenico Lo



[A case of miliary tuberculosis complicated by disseminated intravascular coagulation and acute respiratory distress syndrome successfully treated with recombinant human soluble thrombomodulin].  


A 67-year-old woman was referred to our hospital for persistent fever and dyspnea. Chest X-ray revealed diffuse reticulonodular shadows and high-resolution computed tomography showed randomly distributed small nodules. Examination of sputum and urine revealed acid-fast bacilli, which were later confirmed as Mycobacterium tuberculosis sensitive to all drugs. Laboratory tests revealed thrombocytopenia, an elevated concentration of fibrin degradation products, and severe hypoxemia. We therefore diagnosed her with miliary tuberculosis complicated by acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC). After admission, her status rapidly worsened and she required mechanical ventilation. Treatment with recombinant human soluble thrombomodulin (rTM) and high-dose methylprednisolone was started in addition to the antituberculosis chemotherapy. The patient's condition gradually improved and she was weaned from ventilation on day 30. She was discharged on day 92. It is generally thought that prognosis of miliary tuberculosis complicated by DIC and ARDS is very poor. A recent report suggested that rTM is effective for DIC and ARDS secondary to sepsis. This is the first report of miliary tuberculosis complicated by DIC and ARDS successfully treated with rTM. PMID:23350518

Shiraishi, Sachiko; Futami, Shinji; Kurahara, Yu; Tsuyuguchi, Kazunari; Hayashi, Seiji; Suzuki, Katsuhiro



HLA-B*5801: utility and cost-effectiveness in the Asia-Pacific Region.  


Gout is a common condition which is mainly treated with the hypo-uricemic agent, allopurinol. Although allopurinol is generally a well-tolerated drug, there is a small risk of developing potentially fatal complications, such as allopurinol hypersensitivity syndrome. Recent advances in pharmacogenomics have made possible the identification of genes which confer susceptibility to specific drugs. A recent multi-national case-control study has reported allopurinol as the most common drug associated with Stevens-Johnson syndrome and toxic epidermal necrolysis. Several studies have established a strong association between the human leukocyte antigen (HLA)-B*5801 gene and development of Stevens-Johnson syndrome and toxic epidermal necrolysis. The allele frequency of HLA-B*5801 is highest in the South East Asian population.Since other hypo-uricemic agents are available, patients may wish to have HLA-B*5801 testing before being started on allopurinol. As the test for HLA-B*5801 is expensive, time-consuming and only available in selected laboratories, there is a need to evaluate the utility and cost-effectiveness of this test in our region. PMID:23981744

Yeo, Siaw Ing



Neonatal urinary ascites complicated by ileal perforation in a recipient of twin-to-twin transfusion syndrome.  


We present a case of iatrogenic neonatal urinary ascites following antenatal amnioreduction in one of the monochorionic diamniotic recipient twin 2 of twin-to-twin transfusion syndrome (TTTS). He had ileal perforation following postnatal abdominal paracentesis. The patient had an uneventful recovery following exploratory laparotomy, resection of perforated segment of ileum with end-to-end anastomosis and open vesicostomy with subsequent closure of the vesicostomy. PMID:23255026

Patel, Ramnik; Frost, Jodie; Ninan, G K



Beneficial Effect of Intravenous Dexamethasone in Children With Mild to Moderately Severe Acute Chest Syndrome Complicating Sickle Cell Disease  

Microsoft Academic Search

Acute chest syndrome (ACS) in patients with sickle cell disease (SCD) has historically been managed with oxygen, antibiotics, and blood transfusions. Recently high-dose corti- costeroid therapy was shown to reduce the duration of hospitalization in children with SCD and vaso-occlusive crisis. Therefore, we chose to assess the use of glucocorti- coids in ACS. We conducted a randomized, double-blind placebo-controlled trial

Juan Carlos Bernini; Zora R. Rogers; Eric S. Sandler; Joan S. Reisch; Charles T. Quinn; George R. Buchanan


Unrelated umbilical cord blood transplantation in infancy for mucopolysaccharidosis type IIB (Hunter syndrome) complicated by autoimmune hemolytic anemia  

Microsoft Academic Search

This report describes unrelated umbilical cord blood transplantation for a 10-month-old infant boy with mucopolysaccharidosis IIB (Hunter syndrome), an X-linked metabolic storage disorder due to deficiency of iduronate sulfatase. Two years after transplant ?55% normal plasma enzyme activity has been restored and abnormal urinary excretion of glycosaminoglycans has nearly completely resolved. The boy has exhibited normal growth and development after

CA Mullen; JN Thompson; LA Richard; KW Chan



Complications of Colles' fractures.  


Patients with Colles' fractures have serious complications more frequently than is generally appreciated. A study of 565 fractures revealed 177 (31 per cent) with such complications as persistent neuropathies of the median, ulnar, or radial nerves (forty-five cases), radiocarpal or radio-ulnar arthrosis (thirty-seven cases), and malposition-malunion (thirty cases). Other complications included tendon ruptures (seven), unrecognized associated injuries (twelve), Volkmann's ischemia (four cases), finger stiffness (nine cases), and shoulder-hand syndrome (twenty cases). In many patients, incomplete restoration of radial length or secondary loss of the reduction position caused the complications. PMID:6155380

Cooney, W P; Dobyns, J H; Linscheid, R L



Occurrence of Guillain-Barre syndrome as an immune mediated complication after thrombolysis with streptokinase for acute anterior wall myocardial infarction: a caution to be vigilant.  


Guillain-Barré syndrome (GBS) constitutes a heterogeneous group of immune-mediated peripheral neuropathic disorders that can be triggered by a variety of antecedent events. Clinical symptoms are thought to result from streptokinase antibody-mediated damage to the local blood-nerve barrier. We report the case of a 50-year-old man with acute anterior wall myocardial infarction who developed GBS as a manifestation of autoimmune hypersensitivity reaction to the drug 17 days after thrombolytic therapy with streptokinase. The patient was treated with a 5-day course of intravenous ? globulin and his symptoms improved and there was no residual deficit. The case forms a reminder of the autoimmune complications of non-fibrin specific agents that can sometimes be catastrophic and require persistent and vigilant in-hospital and immediate postdischarge follow-up and immediate management. PMID:24099761

Kumar, Basant; Agrawal, Navin; Patra, Soumya; Manjunath, C N



Osteo-odonto-keratoprosthesis - a maxillofacial perspective.  


The OOKP (osteo-odonto-keratoprosthesis) is the treatment of choice for conditions like Stevens-Johnson syndrome, ocular cicatricial pemphigoid, trachoma, multiple failed grafts and chemical burns which are not amenable to penetrating keratoplasty. The OOKP is an autograft which replaces the cornea with a polymethacrylate cylinder mounted on a tooth-bone complex. The aim of this paper was to retrospectively analyze the records in 26 patients undergoing OOKP surgery between 2007 and 2011. The paper describes our experience with the procedure, with emphasis on its oral and maxillofacial aspects and management of associated complications. The aetiology of blindness in 23 patients was Stevens-Johnson's syndrome and chemical burns in three. Twenty-two patients had their maxillary canines, two had mandibular canines and two had maxillary first premolars as the choice of donor tooth. An oroantral fistula developed in four patients. One patient needed to undergo a surgical procedure for closure of the same. Roots of adjacent teeth were exposed in 12 patients. Twenty-four patients underwent both stages of the procedure with 19 being visually rehabilitated successfully. There was no improvement in the vision of four patients. One patient was lost to follow-up. Two patients have yet to undergo Stage 2. PMID:22425501

Narayanan, Vinod; Nirvikalpa, Natarajan; Rao, Srinivas K



[Clinical observation on treatment of 40 cases of apoplexy hemiplegia complicated shoulder-hand syndrome with electro-acupuncture].  


The authors treated 40 cases of shoulder-hand syndrome of apoplexy hemiplegia with electro-acupuncture (EA) and filiform needle acupuncture (FNA) respectively. The results showed that EA had better results in treating hand back swelling, hand skin temperature elevating and the bending finger caused pain than that with FNA (P < 0.05). The finger joint and shoulder joint improvement (the functional scoring increased for 3 points or more) in EA was also better than that of FNA (P < 0.05). The total marked effective rate was higher in EA group (75%) than that in FNA (50%), P < 0.05). It suggested that EA produced rhythmic muscle contraction which had a "shoulder-hand pump" like action, and is significant in eliminating hand back swelling and preventing atrophy of hand muscles. PMID:8732146

Guo, Z X; Wang, R S; Guo, X C



Successful treatment with recombinant thrombomodulin for B-cell lymphoma-associated hemophagocytic syndrome complicated by disseminated intravascular coagulation.  


We report here a 47-year-old male with the diagnosis of high-grade B-cell lymphoma and hemophagocytosis accompanying disseminated intravascular coagulation (DIC). Lymphoma-associated hemophagocytic syndrome (LAHS) is a life-threatening disorder, and LAHS secondary to B-cell lymphoma is relatively rare compared to that secondary to T- or NK/T-cell lymphoma in Western countries. T- or NK/T-cell LAHS is sometimes combined with DIC, which makes patients' outcomes even worse, but few reports of B-cell LAHS accompanying DIC has been published so far. We successfully treated a patient with this condition with recombinant thrombomodulin (rTM), a novel agent for DIC. We believe that rTM is a therapeutic option in cases with B-cell LAHS accompanying DIC. PMID:23696942

Uni, Masahiro; Yoshimi, Akihide; Maki, Hiroaki; Maeda, Daichi; Nakazaki, Kumi; Nakamura, Fumihiko; Fukayama, Masashi; Kurokawa, Mineo



Successful treatment with recombinant thrombomodulin for B-cell lymphoma-associated hemophagocytic syndrome complicated by disseminated intravascular coagulation  

PubMed Central

We report here a 47-year-old male with the diagnosis of high-grade B-cell lymphoma and hemophagocytosis accompanying disseminated intravascular coagulation (DIC). Lymphoma-associated hemophagocytic syndrome (LAHS) is a life-threatening disorder, and LAHS secondary to B-cell lymphoma is relatively rare compared to that secondary to T- or NK/T-cell lymphoma in Western countries. T- or NK/T-cell LAHS is sometimes combined with DIC, which makes patients’ outcomes even worse, but few reports of B-cell LAHS accompanying DIC has been published so far. We successfully treated a patient with this condition with recombinant thrombomodulin (rTM), a novel agent for DIC. We believe that rTM is a therapeutic option in cases with B-cell LAHS accompanying DIC.

Uni, Masahiro; Yoshimi, Akihide; Maki, Hiroaki; Maeda, Daichi; Nakazaki, Kumi; Nakamura, Fumihiko; Fukayama, Masashi; Kurokawa, Mineo



Neurological complications in AIDS.  


Neurological complications in the acquired immunodeficiency syndrome (AIDS) are an important aspect of this new infectious disease and occur frequently. The existence of neurotropic variants of the human immunodeficiency virus (HIV), the causative agent of AIDS, is probable. Direct infection of the nervous system with HIV leads to a variety of HIV-induced neurological syndromes, the AIDS dementia complex being its most important representative. In addition, a large number of opportunistic infections and malignancies of the nervous system may complicate the disease. Major aspects of the clinical pictures, rational diagnostic approaches and treatment options of the most important sequels of HIV infection of the nervous system are discussed. PMID:3302120

Fischer, P A; Enzensberger, W



Prevalence of Metabolic Syndrome and its influence on microvascular complications in the Indian population with Type 2 Diabetes Mellitus. Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular Genetic Study (SN-DREAMS, report 14)  

Microsoft Academic Search

BACKGROUND: The Metabolic syndrome (MS) consists of central obesity, glucose intolerance, hyperinsulinemia, low high density lipoproteins, high triglycerides and hypertension. Different studies have observed that MS causes microvascular complications in patients with type 2 diabetes. The aim of the study was to find out the prevalence of MS in the Indian population with type 2 diabetes mellitus in relation to

Rajiv Raman; Aditi Gupta; Swakshyar S Pal; Suganeswari Ganesan; Kadri Venkatesh; Vaitheeswaran Kulothungan; Tarun Sharma



Neurologic Complications of Leukemia  

Microsoft Academic Search

Leukemia affects both the central and peripheral nervous systems. Neurological complications are a consequence of both direct\\u000a leukemic infiltration, as occurs with leukemic meningitis, and complications of either antileukemic treatment (e.g., thrombocytopenic\\u000a or DIC-related intracranial hemorrhage, steroid myopathy, vinca alkaloid peripheral neuropathy, posterior reversible encephalopathy\\u000a syndrome, multifocal necrotizing leuko-encephalopathy) or immune compromise (e.g., Herpes zoster shingles or Aspergillus infection).

Marc C. Chamberlain


Clinical effects of pulse high-volume hemofiltration on severe acute pancreatitis complicated with multiple organ dysfunction syndrome.  


To evaluate the effects of pulse high-volume hemofiltration (PHVHF) on severe acute pancreatitis (SAP) with multiple organ dysfunction syndrome (MODS). Thirty patients were divided into two groups: PHVHF group and continuous venovenous hemofiltration (CVVH) group. They were evaluated in terms of clinical symptoms, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, simplified acute physiology (SAPS) II score and biochemical changes. The levels of IL-6, IL-10 and TNF-? in plasma were assessed by ELISA before and after treatment. The doses of dopamine used in shock patients were also analyzed. In the two groups, symptoms were markedly improved after treatment. Body temperature (BT), breath rate (BR), heart rate (HR), APACHE II score, SOFA score, SAPS II score, serum amylase, white blood cell count and C-reactive protein were decreased after hemofiltration (P < 0.05). The PHVHF group was superior to the CVVH group, especially in APACHE II score, CRP (P < 0.01), HR, temperature, SOFA score and SAPS II score (P < 0.05). The doses of dopamine for shock patients were also decreased in the two groups (P < 0.05), with more reduction in the PHVHF group than the CVVH group (P < 0.05). The levels of IL-6, IL-10 and TNF-? decreased (P < 0.05) in the PHVHF group more significantly than the CVVH group (P < 0.01). PHVHF appears to be superior to CVVH in the treatment of SAP with MODS. PMID:23379498

Chu, La-Ping; Zhou, Jun-Jing; Yu, Ya-Fen; Huang, Yang; Dong, Wen-Xia



The burden of comorbidity and the C-reactive protein levels in nonthyroidal illness syndrome with metabolic syndrome and atherosclerosis-related cardiovascular complications.  


Thyroid hormones undergo significant modifications during severe illnesses, and the low T3 levels are the hallmark of nonthyoidal illness syndrome (NTIS), due to a reduced extrathyroidal conversion from T4. We examined 41 patients with NTIS by a modified cumulative illness rating scale (CIRS) and the measurement of FT3, FT4, TSH, and C-reactive protein (CRP) levels. Fifty-seven control subjects were enrolled. We observed reduced FT3 and increased FT4 levels in NTIS patients (P < 0.05). The CIRS scores (severity and comordity index) were inversely related to FT3 and positively related to FT4 levels (P < 0.05). The CRP and the FT4 concentrations were positively associated (P < 0.01). Our study showed that the reduced FT3 and increased FT4 levels were significantly related to the comorbidity and severity of systemic illnesses, probably as a result of impairment in the peripheral hormonal conversion. The CIRS scale and the CRP are useful tools for a better evaluation of these patients. PMID:20398024

Martocchia, Antonio; Cola, Silvia; Frugoni, Patrizia; Indiano, Ilaria; D'Urso, Rosaria; Falaschi, Paolo



Drug rash with eosinophilia and systemic symptoms vs toxic epidermal necrolysis: the dilemma of classification  

Microsoft Academic Search

According to contemporary vernacular, when the cutaneous manifestations of drug rash with eosinophilia and systemic signs (DRESS) syndrome are those of Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), the condition is defined as “DRESS syndrome with severe cutaneous reactions”. In this article, we have presented arguments for and against including patients with skin lesions of the SJS\\/TEN syndromes who

Ronni Wolf; Hagit Matz; Batsheva Marcos; Edith Orion



Palpable purpura complicated by streptococcal toxic shock syndrome resulting in limb necrosis and amputation: a case of levamisole and cocaine coingestion.  


Palpable purpura resulting from cocaine and levamisole coingestion has been reported with increasing frequency over the last several years as distribution of this drug combination becomes more universal. Toxicity from ingestion of this dangerous combination is difficult to diagnose due to the multitude of possible clinical presentations, variety of possible adulterants, and elusive nature of levamisole given its short half-life and limited availability of detection methods. Levamisole is a chemotherapeutic and immunomodulatory agent currently marketed as a veterinary anthelmintic. We describe the case of a 48-year-old woman admitted to our intensive care unit with a diagnosis of streptococcal toxic shock syndrome (STSS), confirmed from fluid taken from an elbow lesion that grew Streptococcus pyogenes. She was noted to have bullae of the elbow and diffuse purpura with necrotic centers covering a large portion of her body (trunk, legs, arms, back, toes, fingers, and tip of nose). On further evaluation, she was found to have ingested levamisole-tainted cocaine. The patient's complications related to either cocaine and levamisole coingestion or STSS included thrombocytopenia, acute renal failure, and limb necrosis. Thrombocytopenia gradually improved upon treatment with prednisone, and acute renal failure improved with intravenous fluid resuscitation; however, she subsequently required several appendage amputations due to severe gangrene. Clinicians must have high suspicion for ingestion of this drug combination and request prompt testing of urine samples for levamisole if a patient who admits to illicit drug use presents with purpuric or necrotic skin lesions. PMID:22392427

Freyer, Craig W; Peters, Michael



LASIK Complications  

Microsoft Academic Search

Laser in situ keratomileusis (LASIK) is a rapidly evolving ophthalmic surgical procedure. Several anatomic and refractive complications have been identified. Anatomic complications include corneal flap abnormalities, epithelial ingrowth, and corneal ectasia. Refractive complications include unexpected refractive outcomes, irregular astigmatism, decentration, visual aberrations, and loss of vision. Infectious keratitis, dry eyes, and diffuse lamellar keratitis may also occur following LASIK. By

Samir A Melki; Dimitri T Azar



[Complications of liposuction].  


Liposuction is the most frequent aesthetic procedure worldwide for adipose tissue reduction and treatment of lipedema. It is being employed with increasing frequency. In 2010, in the USA more than 200.000 liposuctions were performed. Apart from aesthetic indications, liposuction also is suitable for treatment of benign adipose tissue diseases. This intervention is not a simple procedure but requires extensive knowledge and experience to prevent irreversible medical or aesthetic complications. Severe complications including necrotizing fasciitis, toxic shock syndrome, hemorrhage, perforation of inner organs und pulmonary embolism - some even with lethal outcome - occasionally have been reported. These complications were mostly due to inadequate hygiene measures, inappropriate patient selection, use of excessive local anesthesia during mega-liposuction (tumescent technique) and inadequate post-operative surveillance. The complication rate usually reflects a lack of medical experience as well as technical inadequacies. PMID:23494094

Sattler, G; Eichner, S



Vascular complications (splenic and hepatic artery aneurysms) in the occipital horn syndrome: report of a patient and review of the literature  

Microsoft Academic Search

We report an 18-year-old boy with occipital horn syndrome who developed aneurysms of the splenic and hepatic arteries. Occipital\\u000a horn syndrome, also called X-linked cutis laxa or Ehlers-Danlos syndrome (EDS) type IX, is characterised by a skeletal dysplasia\\u000a which includes occipital horns, broad clavicles, deformed radii, ulnae and humeri, narrow rib cage, undercalcified long bones\\u000a and coxa valga. Distinctive features

Hans-Joachim Mentzel; Jörg Seidel; Susanna Vogt; Lothar Vogt; Werner A. Kaiser



Complicated Grief  


... type of psychological counseling (psychotherapy) called complicated grief therapy. It's similar to psychotherapy techniques used for post-traumatic stress disorder (PTSD). You may explore such topics as grief ...


Mycoplasma pneumoniae preceding Lemierre's syndrome due to Fusobacterium nucleatum complicated by acute Epstein-Barr virus (EBV) infectious mononucleosis in an immunocompetent host.  


We report an unusual case of Lemierre's syndrome due to a rare species of Fusobacterium, that is, Fusobacterium nucleatum preceded by Mycoplasma pneumoniae pharyngitis and followed later by Epstein-Barr virus infectious mononucleosis. PMID:22464641

Klein, Natalie C; Petelin, Andrew; Cunha, Burke A



[Neurologic complications of myocardial infarction].  


Investigated were 275 patients, 30 autopsies and 35 animals with experimental cardiac ischemia and myocardial infarction. Polymorphic neurological complications were detected among which most important were: 1. Cardiocerebral syndromes, crises, strokes; 2. Circulation disorders in anterior and posterior spinal, and posterior radicular arterial beds leading to cardio-spinal crises and spinal strokes; 3. Cardio-brachial, cardio-intercostal, radiculo-cardio-lumbo-sacral, cervico-thoracic, brachio-plantar, brachioscapular syndromes. PMID:2558472

Abdukhakimov, F T; Sadykova, G K



Complicated grief in late life  

PubMed Central

Complicated grief (CG) is a syndrome that affects 10% to 20% of grievers regardless of age, although proportionally more will face the death of loved ones in late life, CG is characterized by preoccupying and disabling symptoms that can persist for decades such as an inability to accept the death, intense yearning or avoidance, frequent reveries, deep sadness, crying, somatic distress, social withdrawal, and suicidal ideation. This syndrome is distinct from major depression and post-traumatic stress disorder, but CG maybe comorbid with each. This communication will focus on the impact of CG in late life (over age 60) and will include a case vignette for illustrating complicated grief therapy.

Miller, Mark D.



Complicated grief in late life.  


Complicated grief (CG) is a syndrome that affects 10% to 20% of grievers regardless of age, although proportionally more will face the death of loved ones in late life, CG is characterized by preoccupying and disabling symptoms that can persist for decades such as an inability to accept the death, intense yearning or avoidance, frequent reveries, deep sadness, crying, somatic distress, social withdrawal, and suicidal ideation. This syndrome is distinct from major depression and post-traumatic stress disorder, but CG maybe comorbid with each. This communication will focus on the impact of CG in late life (over age 60) and will include a case vignette for illustrating complicated grief therapy. PMID:22754292

Miller, Mark D



[Neurologic complications in hemodialysis patients].  


Various neurological complications may occur in patients under haemodialysis for end-stage chronic renal failure. Their frequency has clearly been reduced by improvements in the modalities and techniques of dialysis. Some of these complications are related to uremia and/or to the accumulation of endogenous toxic substances the nature of which has not been elucidated (e.g. uraemic encephalopathy, polyneuropathy), while others are directly due to the haemodialysis itself (e.g. dialysis disequilibrium syndrome, aluminum encephalopathy). PMID:2326590

Goulon-Goeau, C; Saïd, G



Acute complications.  


Critically high or low blood sugar in a patient with diabetes is a medical emergency. You'll need to be able to quickly identify and know how to manage the acute complications of diabetes to help a patient avoid a tragic outcome. Here's how. PMID:12033003

Cypress, M



Chiropractic management of a US Army veteran with low back pain and piriformis syndrome complicated by an anatomical anomaly of the piriformis muscle: a case study  

PubMed Central

Objective The purpose of this article is to present the case of a patient with an anatomical anomaly of the piriformis muscle who had a piriformis syndrome and was managed with chiropractic care. Case Report A 32-year-old male patient presented to a chiropractic clinic with a chief complaint of low back pain that radiated into his right buttock, right posterior thigh, and right posterior calf. The complaint began 5 years prior as a result of injuries during Airborne School in the US Army resulting in a 60% disability rating from the Veterans Administration. Magnetic resonance imaging demonstrated a mildly decreased intradiscal T2 signal with shallow central subligamentous disk displacement and low-grade facet arthropathy at L5/S1, a hypolordotic lumbar curvature, and accessory superior bundles of the right piriformis muscle without morphologic magnetic resonance imaging evidence of piriformis syndrome. Intervention and Outcome Chiropractic treatment included lumbar and sacral spinal manipulation with soft tissue massage to associated musculature and home exercise recommendations. Variations from routine care included proprioceptive neuromuscular facilitation stretches, electric muscle stimulation, acupressure point stimulation, Sacro Occipital Technique pelvic blocking, CranioSacral therapy, and an ergonomic evaluation. Conclusion A patient with a piriformis anomaly with symptoms of low back pain and piriformis syndrome responded positively to conservative chiropractic care, although the underlying cause of the piriformis syndrome remained.

Chapman, Cynthia; Bakkum, Barclay W.



Fever of unknown origin in childhood: difficulties in diagnosis.  

PubMed Central

We have described a child with systemic onset juvenile chronic arthritis who presented initially with fever of unknown origin. Treatment of a presumed infection led to a severe allergic response with Stevens-Johnson syndrome, renal failure and DIC. This reaction obscured the features of the underlying disease and delayed the diagnosis. Images

Martin, K; Davies, E G; Axford, J S



Fluconazole induced toxic epidermal necrolysis: a case report  

Microsoft Academic Search

Drug induced toxic epidermal necrolysis and Stevens Johnson syndrome are more commonly associated with medications such as sulfonamides, penicillin, anticonvulsants, oxicam non-steroidal anti-inflammatory drugs, allopurinol and corticosteroids. Isolated instances secondary to drugs outside of the aforementioned classes have also been reported. We report a case of probable toxic epidermal necrolysis induced by fluconazole in a 52 year old woman.

Uchenna R Ofoma; Edward K Chapnick



Burst fracture of the first lumbar vertebra and conus-cauda syndrome complicating a single convulsive seizure: A challenge of diagnosis in the Emergency Department  

Microsoft Academic Search

Fractures of the thoracic and lumbar vertebrae as a direct consequence of generalized epileptic convulsions are the most common non-traumatic type of fracture complicating epileptic seizures. The majority of these fractures are compression fractures that occur with minimal symptoms and virtually no permanent neurological sequela. Nevertheless, muscle contractions generated during generalized motor seizures can result in severe axial skeletal trauma

Fereydoon Roohi; Andrew Fox



Contemporary management of complicated monochorionic twins.  


Monochorionic twins are at increased risk for unique complications including twin-twin transfusion syndrome (TTTS), selective intrauterine growth restriction (sIUGR), and twin-reversed arterial perfusion (TRAP) sequence. Twin-twin transfusion syndrome is treated with laser photocoagulation whereas selective reduction is an option in previable sIUGR or TRAP sequence. The nurse is integral in the management, education, care and support of women with complicated pregnancies. PMID:22536818

Moise, Karen Y; Kugler, Lisa; Jones, Tyra



Potential complications of segmental hemangiomas of infancy  

Microsoft Academic Search

Although the majority of hemangiomas of infancy can be expected to follow a benign course, a significant subset may result in serious complications. Recently, hemangiomas of segmental morphology, or those which are large, plaque-like, and patterned in distribution, have been recognized as important markers for potential complications. PHACE syndrome represents the best known example of the variety of problems that

Denise W Metry



Abernethy malformation type II with nephrotic syndrome and other multisystemic presentation: an illustrative case for understanding pathogenesis of extrahepatic complication of congenital portosystemic shunt.  


Abernethy malformation, an extrahepatic congenital portosystemic shunt, is more often diagnosed based on associated cardiac or pulmonary malformation. Although predominately a pediatric diagnosis, "late diagnoses" in adulthood have been reported especially in type II malformations that involve only a partial shunt of portal circulation directly into the inferior vena cava. Aside from the cardiac-related presentation, Abernethy malformation is also associated with multiple liver nodules, either benign or malignant, and pulmonary hypertension. In this report, we present immunoglobulin A glomerulonephritis with nephrotic syndrome as a hitherto unrecognized manifestation of this malformation outside the pediatric population, in a patient who also had pulmonary hypertension and multiple liver tumors. We also propose a pathogenetic basis for this multisystemic presentation that includes release into the systemic circulation of unfiltered bacteria, vasoactive substances, and immunoglobulin A-antigen complexes. PMID:23245671

Schaeffer, David F; Laiq, Simin; Jang, Hyun-Jung; John, Rohan; Adeyi, Oyedele A



Influenza-associated neurological complications.  


While mostly diagnosed in the pediatric population, neurological complications of pandemic influenza A infection may affect young and previously healthy adults, and may follow a fulminant, severe, and occasionally fatal course. We reviewed severe neurological complications secondary to influenza infection reported in the literature, in attempt to outline recurrent syndromes that may assist the clinician in making a timely diagnosis. Vigilance and awareness of these clinical entities are key in the neurologist and intensivist's role in surveillance and early recognition of pandemic influenza, and in ensuring improved survival for affected patients. PMID:23138546

Tsai, Jenny P; Baker, Andrew J



[Synchronous appearance and improvement with anticancer chemotherapy of paraneoplastic cerebellar degeneration and Lambert-Eaton myasthenic syndrome complicated with small cell lung cancer].  


A 62-year-old man who had suffered from instability of gait and double vision for two months was admitted to our hospital because of weakness of the extremities and ataxia of the extremities and trunk. Chest X-rays and CT scans showed enlargement of the left hilar lymph nodes and a nodular shadow in the left lung. Transbronchial biopsy revealed small cell lung cancer. We diagnosed the patient with two conditions: paraneoplastic cerebellar degeneration (PCD), based on cerebellar ataxia, the presence of Hu antineuronal antibodies, and the absence of cerebellar atrophy and malignancy; and Lambert-Eaton myasthenic syndrome (LEMS), based on weakness of the extremities, the presence of P/Q-type voltage-gated calcium channel antibodies, and waxing in the evoked electromyogram. Anticancer chemoradiation therapy that was started within three months of symptom onset resulted in reductions in size of the hilar lymph nodes and the nodule. Concurrently, cerebellar ataxia, weakness of the extremities, and double vision all disappeared. Anticancer chemotherapy is effective against LEMS while usually less effective against PCD. Early commencement of anticancer chemotherapy is recommended for the treatment of PCD with LEMS. PMID:23470889

Koriyama, Haruki; Kyoraku, Itaru; Yamashita, Shuichi; Shiomi, Kazutaka; Matsumoto, Nobuhiro; Nakazato, Masamitsu



Neurologic Complications Following Pediatric Renal Transplantation.  


We reviewed neurologic complications after renal transplantation in children over a 20-year period. Neurologic complications were classified as early (within 3 months) and delayed (beyond 3 months). Of 115 children, 10 (8.7%) had complications. Early complications were found in 4.35% of patients: seizures in 4 (posterior reversible leukoencephalopathy syndrome due to immunosuppressant toxicity [2], sepsis/presumed meningitis [1], and indeterminate [1]) and headaches in 1. One patient with seizures received levetiracetam for 6 months and 1 with headaches received amitriptyline prophylaxis. Late complications were noted in 4.35% of patients: seizures in 3 (posterior reversible leukoencephalopathy syndrome due to hypertension [2], hypertensive encephalopathy [1]), headaches in 2, and tremors in 1. Two patients with seizures were treated with anti-epilepsy medications; 1 with migraine received cyproheptadine prophylaxis. Neurologic complications develop in children after renal transplantation. Seizures due to posterior reversible leukoencephalopathy syndrome were the commonest complication. Early detection and appropriate management of these complications is important. PMID:23752071

Ghosh, Partha S; Kwon, Charles; Klein, Melanie; Corder, Julie; Ghosh, Debabrata



Syndromic Craniosynostosis  

PubMed Central

Although most cases of craniosynostosis are nonsyndromic, craniosynostosis is known to occur in conjunction with other anomalies in well-defined patterns that make up clinically recognized syndromes. Patients with syndromic craniosynostoses are much more complicated to care for, requiring a multidisciplinary approach to address all of their needs effectively. This review describes the most common craniosynostosis syndromes, their characteristic features and syndrome-specific functional issues, and new modalities utilized in their management. General principles including skull development, the risk of developing increased intracranial pressure in craniosynostosis syndromes, and techniques to measure intracranial pressure are discussed. Evolving techniques of the established operative management of craniosynostosis are discussed together with more recent techniques including spring cranioplasty and posterior cranial vault distraction osteogenesis.

Derderian, Christopher; Seaward, James



Complicated intestinal atresias.  


In this group of 45 intestinal atresia patients (duodenum, 16; jejunum, 24; ileum five) at the University of Mississippi Medical Center, individual hospitalizations ranged up to 245 days. Twelve patients required multiple operations, and the overall mortality rate was 22% (ten patients). While the patients with duodenal atresia had the greatest incidence of other congenital anomalies, including Down's syndrome, the patients with jejunal atresia presented with the most challenging surgical problems. Of the 24 jejunal atresia patients, only three had a single, simple area of obstruction. The remainder were complicated by other gastrointestinal lesions (five patients), by multiple areas of atresia (seven patients) including those in one surviving patient with 22 separate atretic segments, and by the Christmas tree deformity (nine patients). Intraoperative management of the complicated atresia should include: 1) grouping of multiple atresias during resection, 2) adequate resection of the dilated proximal atonic loop, 3) end-to-end anastomoses, 4) avoidance of intraluminal catheters, 5) additional resection of a segment of the distal loop in the Christmas tree deformity and 6) consideration of the shish kebab technique for multiple atretic webs. Postoperative management should involve early intravenous nutrition and repeated exploration for continued obstruction. PMID:156011

Miller, R C



Complicated Intestinal Atresias  

PubMed Central

In this group of 45 intestinal atresia patients (duodenum, 16; jejunum, 24; ileum five) at the University of Mississippi Medical Center, individual hospitalizations ranged up to 245 days. Twelve patients required multiple operations, and the overall mortality rate was 22% (ten patients). While the patients with duodenal atresia had the greatest incidence of other congenital anomalies, including Down's syndrome, the patients with jejunal atresia presented with the most challenging surgical problems. Of the 24 jejunal atresia patients, only three had a single, simple area of obstruction. The remainder were complicated by other gastrointestinal lesions (five patients), by multiple areas of atresia (seven patients) including those in one surviving patient with 22 separate atretic segments, and by the Christmas tree deformity (nine patients). Intraoperative management of the complicated atresia should include: 1) grouping of multiple atresias during resection, 2) adequate resection of the dilated proximal atonic loop, 3) end-to-end anastomoses, 4) avoidance of intraluminal catheters, 5) additional resection of a segment of the distal loop in the Christmas tree deformity and 6) consideration of the shish kebab technique for multiple atretic webs. Postoperative management should involve early intravenous nutrition and repeated exploration for continued obstruction.

Miller, Richard C.



[Compartment syndrome after cardiopulmonary bypass].  


Compartment syndrome of the lower leg is an occasional complication of prolonged ischemia and reperfusion. We present a patient with compartment syndrome of the ipsilateral thigh after femoral arterial and venous cannulation for cardiopulmonary bypass. PMID:20685185

Guillen, G; Llorente, A M; Maseda, R; Belda, S; Olmedilla, M



Immediate and one-year outcome of patients presenting with Acute Coronary Syndrome complicated by stroke: Findings from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2)  

PubMed Central

Background Stroke is a potential complication of acute coronary syndrome (ACS). The aim of this study was to identify the prevalence, risk factors predisposing to stroke, in-hospital and 1-year mortality among patients presenting with ACS in the Middle East. Methods For a period of 9?months in 2008 to 2009, 7,930 consecutive ACS patients were enrolled from 65 hospitals in 6 Middle East countries. Results The prevalence of in-hospital stroke following ACS was 0.70%. Most cases were ST segment elevation MI-related (STEMI) and ischemic stroke in nature. Patients with in-hospital stroke were 5?years older than patients without stroke and were more likely to have hypertension (66% vs. 47.6%, P?=?0.001). There were no differences between the two groups in regards to gender, other cardiovascular risk factors, or prior cardiovascular disease. Patients with stroke were more likely to present with atypical symptoms, advanced Killip class and less likely to be treated with evidence-based therapies. Independent predictors of stroke were hypertension, advanced killip class, ACS type –STEMI and cardiogenic shock. Stroke was associated with increased risk of in-hospital (39.3% vs. 4.3%) and one-year mortality (52% vs. 12.3%). Conclusion There is low incidence of in-hospital stroke in Middle-Eastern patients presenting with ACS but with very high in-hospital and one-year mortality rates. Stroke patients were less likely to be appropriately treated with evidence-based therapy. Future work should be focused on reducing the risk and improving the outcome of this devastating complication.



Neurological Complications of Solid Organ Transplantation  

PubMed Central

Solid organ transplantation (SOT) is the preferred treatment for an expanding range of conditions whose successful therapy has produced a growing population of chronically immunosuppressed patients with potential neurological problems. While the spectrum of neurological complications varies with the type of organ transplanted, the indication for the procedure, and the intensity of long-term required immunosuppression, major neurological complications occur with all SOT types. The second part of this 2-part article on transplantation neurology reviews central and peripheral nervous system problems associated with SOT with clinical and neuroimaging examples from the authors’ institutional experience. Particular emphasis is given to conditions acquired from the donated organ or tissue, problems specific to types of organs transplanted and drug therapy-related complications likely to be encountered by hospitalists. Neurologically important syndromes such as immune reconstitution inflammatory syndrome (IRIS), posterior reversible encephalopathy syndrome (PRES), and posttransplantation lymphoproliferative disorder (PTLD) are readdressed in the context of SOT.

Pruitt, Amy A.; Graus, Francesc; Rosenfeld, Myrna R.



Pulmonary Complications of Sickle Cell Disease  

PubMed Central

Sickle cell disease (SCD) is a common monogenetic disorder with high associated morbidity and mortality. The pulmonary complications of SCD are of particular importance, as acute chest syndrome and pulmonary hypertension have the highest associated mortality rates within this population. This article reviews the pathophysiology, diagnosis, and treatment of clinically significant pulmonary manifestations of SCD, including acute chest syndrome, asthma, and pulmonary hypertension in adult and pediatric patients. Clinicians should be vigilant in screening and treating such comorbidities to improve patient outcomes.

Miller, Andrew C.



[Puffy hand syndrome].  


Puffy hand syndrome is an unrecognized complication of intravenous drug abuse. This painless syndrome appears during or after a long period of drug addiction. It involves the hands and sometimes the forearms, and may cause functional, aesthetic and social disturbances when the hand volume is important. Physiopathological mechanisms of the puffy hand syndrome are unclear and include venous and lymphatic insufficiencies, infectious complications and direct toxicity of injected drugs and their adulterants. Low-stretch bandage and elastic garment, usually used in lymphedema treatment, are proposed to treat the puffy hand syndrome. PMID:19216010

Arrault, M; Gaouar, F; Vignes, S



The role of the endothelium in the short-term complications of hematopoietic SCT  

Microsoft Academic Search

In this review, we analyse the role of the endothelium in the development of several complications that appear soon after haematopoietic SCT (HSCT). Once it had been demonstrated that sinusoidal damage is the initiating event of the sinusoidal obstruction syndrome, it was considered that other short-term complications with overlapping clinical manifestations, such as capillary leak syndrome, engraftment syndrome, transplant-associated microangiopathy,

E Carreras; M Diaz-Ricart



Lemierre syndrome.  


Lemierre's syndrome is an uncommon complication of pharyngitis in the United States and caused most commonly by the bacterium Fusobacterium necrophorum. The syndrome is characterized by a history of recent pharyngitis followed by ipsilateral internal jugular vein thrombosis and metastatic pulmonary abscesses and is a disease for which patients will seek medical care and advice. As most patients are admitted to the hospital under internal medicine, practitioners should be familiar with the usual signs and symptoms of Lemierre's syndrome along with its diagnosis and treatment. Controversy involves the choice and duration of antimicrobial therapy used for treatment and anticoagulation therapy for internal jugular vein thrombosis. As the diagnosis and management of this syndrome has generated controversy, an updated review of the literature and treatment recommendations may be helpful for providing optimal care for patients with this often unrecognized and confusing infection. PMID:22561543

Wright, William F; Shiner, Christine N; Ribes, Julie A



Hematologic complications of pregnancy.  


Pregnancy induces a number of physiologic changes that affect the hematologic indices, either directly or indirectly. Recognizing and treating hematologic disorders that occur during pregnancy is difficult owing to the paucity of evidence available to guide consultants. This review discusses specifically the diagnosis and management of benign hematologic disorders occurring during pregnancy. Anemia secondary to iron deficiency is the most frequent hematologic complication and is easily treated with oral iron formulations; however, care must be taken not to miss other causes of anemia, such as sickle cell disease. Thrombocytopenia is also a common reason for consulting the hematologist, and distinguishing gestational thrombocytopenia from immune thrombocytopenia (ITP), preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), or thrombotic thrombocytopenic purpura (TTP) is essential since the treatment differs widely. Occasionally the management of mother and infant involves the expeditious recognition of neonatal alloimmune thrombocytopenia (NAIT), a condition that is responsible for severe life-threatening bleeding of the newborn. Additionally, inherited and acquired bleeding disorders affect pregnant women disproportionately and often require careful monitoring of coagulation parameters to prevent bleeding in the puerperium. Finally, venous thromboembolism (VTE) during pregnancy is still largely responsible for mortality during pregnancy, and the diagnosis, treatment options and guidelines for prevention of VTE during pregnancy are explored. PMID:23953339

Townsley, Danielle M



A rare complication of laparoscopic surgery  

PubMed Central

Gallstone disease is one of the most common problems affecting the digestive tract. Symptomatic patients are advised to undergo laparoscopic cholecystectomy (LC), which is considered the gold standard of care in these patients. LC has clear advantages over traditional surgery such as a shorter hospital stay, an earlier return to work and better patient satisfaction. Despite LC being a common surgical procedure, it is not totally free from complications. These include cardiorespiratory problems, biliary leakage, peritonitis, hemorrhage and superior mesenteric artery (SMA) occlusion. We report an unusual and fatal complication of LC, being SMA thrombosis complicated by multiple intra-abdominal collections, abdominal compartment syndrome, multiorgan failure and septic shock.

Shaikh, Nissar; Rahman, Husham Abdul; Hanssens, Yolande; John, Sunil



Serotonin syndrome.  


Serotonin syndrome is a preventable, drug-related complication that results from increased brainstem serotonin activity, usually precipitated by the use of one or more serotonergic drugs. Its clinical presentation consists of autonomic dysfunction, alteration in mental status, and neuromuscular disorder. Early recognition and treatment is important, because this condition is potentially fatal. Management includes withdrawal of causative agents and supportive measures such as hemodynamic stabilization, sedation, temperature control, hydration, and monitoring for complications. Serotonin antagonists, specifically cyproheptadine, have been used, but the documented benefits are purely anecdotal. PMID:16681290

Prator, Bettina C



Complications of Alcohol Withdrawal Pathophysiological Insights  

Microsoft Academic Search

Disease processes or events that accompany acute alcohol withdrawal (AW) can cause significant illness and death. Some patients experience seizures, which may increase in severity with subsequent AW episodes. Another potential AW complication is delirium tremens, characterized by hallucinations, mental confusion, and disorientation. Cognitive impairment and delirium may lead to a chronic memory disorder (i.e., Wernicke-Korsakoff syndrome). Psychiatric problems associated

Louis A. Trevisan; Nashaat Boutros; Ismene L. Petrakis; John H. Krystal


Superior vena cava syndrome.  


Superior vena cava syndrome is a common complication of malignancy. The epidemiology, presentation, and diagnostic evaluation of patients presenting with the syndrome are reviewed. Management options including chemotherapy and radiation therapy and the role of endovascular stents are discussed along with the evidence for each of the therapeutic options. PMID:20488350

Wan, Jonathan F; Bezjak, Andrea



Lemierre syndrome.  


Lemierre syndrome is caused by acute oropharyngeal infections with secondary septic thrombophlebitis of the internal jugular vein and is characterized by frequent metastatic infections. A 56-year-old man presented with severe reddish inflammatory swelling of the right cervical soft tissue. Thrombophlebitis in the right internal jugular vein and multiple pulmonary embolisms were identified on neck and chest computed tomography (CT). He was treated with antibiotics and heparin for 4 weeks and then discharged without other complications. PMID:22324031

Bang, Yun Yi; Kim, Jung-Tae; Chang, Woon-Ha; Oh, Tae Yun; Kong, Joon-Hyuk



Lemierre Syndrome  

PubMed Central

Lemierre syndrome is caused by acute oropharyngeal infections with secondary septic thrombophlebitis of the internal jugular vein and is characterized by frequent metastatic infections. A 56-year-old man presented with severe reddish inflammatory swelling of the right cervical soft tissue. Thrombophlebitis in the right internal jugular vein and multiple pulmonary embolisms were identified on neck and chest computed tomography (CT). He was treated with antibiotics and heparin for 4 weeks and then discharged without other complications.

Bang, Yun Yi; Chang, Woon-Ha; Oh, Tae Yun; Kong, Joon-Hyuk



Le syndrome des grosses mains  

Microsoft Academic Search

Puffy hand syndrome is an unrecognized complication of intravenous drug abuse. This painless syndrome appears during or after a long period of drug addiction. It involves the hands and sometimes the forearms, and may cause functional, aesthetic and social disturbances when the hand volume is important. Physiopathological mechanisms of the puffy hand syndrome are unclear and include venous and lymphatic

M. Arrault; F. Gaouar; S. Vignes



The Diabetic Foot Syndrome  

Microsoft Academic Search

Summary The diabetic foot syndrome (DFS) is an important diabetic complication. The typical lesion is a neuropathic plantar foot ulcer which heals well when treated properly. However, complications resulting from deep infections of soft tissue or bone, together with a reduced peripheral blood flow, may necessitate amputation of the lower limbs. In general, diabetic patients have a 10-fold higher risk

Thomas Kästenbauer; Karl Irsigler



Neuroacanthocytosis Syndromes  

PubMed Central

Neuroacanthocytosis (NA) syndromes are a group of genetically defined diseases characterized by the association of red blood cell acanthocytosis and progressive degeneration of the basal ganglia. NA syndromes are exceptionally rare with an estimated prevalence of less than 1 to 5 per 1'000'000 inhabitants for each disorder. The core NA syndromes include autosomal recessive chorea-acanthocytosis and X-linked McLeod syndrome which have a Huntington´s disease-like phenotype consisting of a choreatic movement disorder, psychiatric manifestations and cognitive decline, and additional multi-system features including myopathy and axonal neuropathy. In addition, cardiomyopathy may occur in McLeod syndrome. Acanthocytes are also found in a proportion of patients with autosomal dominant Huntington's disease-like 2, autosomal recessive pantothenate kinase-associated neurodegeneration and several inherited disorders of lipoprotein metabolism, namely abetalipoproteinemia (Bassen-Kornzweig syndrome) and hypobetalipoproteinemia leading to vitamin E malabsorption. The latter disorders are characterized by a peripheral neuropathy and sensory ataxia due to dorsal column degeneration, but movement disorders and cognitive impairment are not present. NA syndromes are caused by disease-specific genetic mutations. The mechanism by which these mutations cause neurodegeneration is not known. The association of the acanthocytic membrane abnormality with selective degeneration of the basal ganglia, however, suggests a common pathogenetic pathway. Laboratory tests include blood smears to detect acanthocytosis and determination of serum creatine kinase. Cerebral magnetic resonance imaging may demonstrate striatal atrophy. Kell and Kx blood group antigens are reduced or absent in McLeod syndrome. Western blot for chorein demonstrates absence of this protein in red blood cells of chorea-acanthocytosis patients. Specific genetic testing is possible in all NA syndromes. Differential diagnoses include Huntington disease and other causes of progressive hyperkinetic movement disorders. There are no curative therapies for NA syndromes. Regular cardiologic studies and avoidance of transfusion complications are mandatory in McLeod syndrome. The hyperkinetic movement disorder may be treated as in Huntington disease. Other symptoms including psychiatric manifestations should be managed in a symptom-oriented manner. NA syndromes have a relentlessly progressive course usually over two to three decades.



Chickenpox (Varicella) Complications  


... Patients who have had transplants, and People on chemotherapy, immunosuppressive medications, or long-term use of steroids. For more information, see People at High Risk for Varicella Complications . Serious complications from chickenpox include dehydration pneumonia bleeding ...


Complications of Diabetes and Their Implications for Service Providers.  

ERIC Educational Resources Information Center

|This article presents information on the complications of both Type I and Type II diabetes and the implications for the rehabilitation of persons with diabetes and visual impairment. Topics covered include retinopathy, cataracts, glaucoma, peripheral neuropathy, carpal tunnel syndrome, diabetic hand syndrome, neuropathy of the autonomic nervous…

Ponchillia, S. V.



Genetics Home Reference: Klippel-Trenaunay syndrome  


... cause a life-threatening clot known as a pulmonary embolism (PE). Complications of Klippel-Trenaunay syndrome can include ... embolism ; embryonic ; gene ; infection ; lymphedema ; mosaicism ; polydactyly ; pulmonary ; pulmonary embolism ; sporadic ; syndactyly ; syndrome ; thrombosis ; varicose veins ; varicosity ; veins ...


Complications of wrist arthroplasty.  


Total wrist arthroplasty is an alternative for patients with severe wrist arthritis who have specific requirements or desires to preserve motion. However, wrist replacement has its own unique risks and potential complications, and is not appropriate for patients with high physical demands. This article discusses these risks and complications and provides strategies to minimize risks and manage complications. PMID:20494747

Adams, Brian D



Late Complications of Tracheostomy  

Microsoft Academic Search

Tracheostomy may be associated with numerous acute, perioperative complications, some of which continue to be relevant well after the placement of the tracheostomy. A number of clinically important unique late complications have been recognized as well, including the formation of granulation tissue, tracheal stenosis, tracheomalacia, tracheoinnominate-artery fistula, tracheo- esophageal fistula, ventilator-associated pneumonia, and aspiration. The clinical relevance of these complications

Scott K Epstein


Complications of Tumor Ablation  

Microsoft Academic Search

Percutaneous and surgical ablation procedures are flourishing, in large part because of the relative paucity and the acceptability\\u000a of complications. However, serious and fatal complications have occurred, albeit rarely, with ablation. This chapter identifies\\u000a those complications, describes their underlying cause, and, when possible, discusses strategies to avoid them.

Lawrence Cheung; Tito Livraghi; Luigi Solbiati; Gerald D. Dodd; Eric vanSonnenberg


Complications Arising in Twin Pregnancy: Findings of Prenatal Ultrasonography  

PubMed Central

Multifetal gestations are high-risk pregnancies involving higher perinatal morbidity and mortality, and are subject to unique complications including twin oligohydramnios-polyhydramnios sequence, twin-to-twin transfusion syndrome, acardiac twins, conjoined twins, co-twin demise, and heterotopic pregnancies. The purpose of this study is to describe the prenatal ultrasonographic and pathologic findings of these complications.

Kim, Jeong-Ah; Lee, Young Ho; Song, Mi Jin; Min, Jee-Yeon; Lee, Hak Jong; Han, Byoung Hee; Lee, Kyung-Sang; Cho, Byung Jae; Chun, Yi-Kyeong



Risks and complications in rhinoplasty  

PubMed Central

Rhinoplasty is regarded to be associated with many risks as the expectations of patient and physician are not always corresponding. Besides of postoperative deformities many other risks and complications have to be considered. Reduction-rhinoplasty e.g. can cause breathing disturbances which are reported in 70% of all revision-rhinoplasty-patients. One has to be aware however that scars and loss of mucosal-sensation can also give the feeling of a “blocked nose”. The main risks of autogenous transplants are dislocation and resorption, while alloplasts can cause infection and extrusion. In this respect silicone implants can have a complication rate between 5-20%. Less complications are reported with other materials like Gore-Tex. Complications of skin and soft tissues can be atrophy, fibrosis, numbness, cysts originating from displaced mucosa or subcutaneous granulomas caused by ointment material. Postoperative swelling depends mainly on the osteotomy technique. Percutaneous osteotomies cause less trauma, but may result in visible scars. Infections are rare but sometimes life-threatening (toxic-shock-syndrome). The risk is higher, when sinus surgery and rhinoplasty are combined. Osteotomies can also cause injuries of the orbital region. Necrosis of eye-lids by infections and blindness by central artery occlusion are known. There are reports on various other risks like rhinoliquorrhea, brain damage, fistulas between sinus-cavernosus and carotid artery, aneurysms and thrombosis of the cavernous sinus. Discoloration of incisors are possible by damage of vessels and nerves. Rhinoplasty can also become a court-case in dissatisfied patients, a situation that may be called a “typical complication of rhinoplasty”. It can be avoided by proper patient selection and consideration of psychological disturbances. Postoperative deformities are considered as main risks of rhinoplasty, causing revision surgery in 5% to 15% of the cases. The analysis of postoperative deformities allowes the identification of specific risks. The most frequent postoperative deformity is the “pollybeak” when a deep naso-frontal angle, cartilaginous hump and reduced tip projection are present preoperatively. The pollybeak is the indication in about 50% of all revision rhinoplasties. Other frequent postoperative deformities are a pendant and wide nasal tip, retractions of the columella base or irregularities of the nasal dorsum. These deformities are very often combined and caused by a loss of septal support. This is why the stability of the caudal septum in septorhinoplasty is the key for a predictable result. Maintaining the position of the tip and the columella is one of the main issues to avoid typical postoperative deformities. The risks for rhinoplasty-complications can be reduced with increasing experience. A prerequisite is continuing education and an earnest distinction between complication and mistake.

Rettinger, Gerhard



Impact of concurrent naturalistic pharmacotherapy on psychotherapy of complicated grief  

Microsoft Academic Search

Complicated grief (CG) is a debilitating syndrome that can be reliably identified, but there is a paucity of research examining treatment of CG. A targeted psychotherapy for complicated grief (CGT) was recently shown to be efficacious [Shear, K., Frank, E., Houck, P.R., Reynolds, C.F., 3rd, 2005. Treatment of complicated grief: a randomized controlled trial. Journal of the American Medical Association

Naomi M. Simon; M. Katherine Shear; Andrea Fagiolini; Ellen Frank; Alyson Zalta; Elizabeth H. Thompson; Charles F. Reynolds III; Russell Silowash



[Antiphospholipid syndrome and pregnancy].  


Antiphospholipid syndrome is characterized by arterial and venous thromboembolic events and persistent laboratory evidence of antiphospholipid antibodies. Obstetric complications such as recurrent miscarriage, early delivery, oligohydramnios, prematurity, intrauterine growth restriction, fetal distress, fetal or neonatal thrombosis, pre-eclampsia/eclampsia, and HELLP syndrome are also hallmarks of antiphospholipid syndrome. This syndrome is one of the diseases associated with the most severe thrombotic risk. Changes in the hemostatic system during normal pregnancy also result in a hypercoagulable state resulting in elevated thrombotic risk. Thromboembolic events are responsible of the vast majority of maternal and fetal deaths. Administration of appropriate thromboprophylaxis helps prevent thromboembolic complications during pregnancy in women with antiphospholipid syndrome and also give birth to healthy children. It is important to centralize the medication and management of these patients. It helps in the thoughtful care of these pregnant women encountering serious problems. PMID:22846489

Gadó, Klára; Domján, Gyula



[Respiratory complications in patients with nicotine addiction].  


Chronic Obstructive Pulmonary Disease (COPD) is one of major causes of chronic morbidity and mortality both in Poland and throughout the world. Tobacco smoking is one of the best documented risk factors for COPD. In critically ill patients symptoms associated with the withdrawal syndrome are particularly evident during the process of weaning from mechanical ventilation. The present study outlines the case of a patient treated in the anaesthesiology and intensive therapy unit due to respiratory failure secondary to ischaemic stroke, exacerbation of COPD and septic complications, with a documented history of nicotine dependence syndrome. PMID:23421119

Tamowicz, Barbara; Mikstacki, Adam



Complications in Post-Acute Care are Associated with Persistent Delirium  

PubMed Central

Background Delirium is highly prevalent and persistent in post-acute care (PAC). However, few risk factors have been identified for delirium persistence. Objectives To investigate whether complications in PAC are associated with delirium persistence 30 days after PAC admission. Design Observational cohort study Setting 8 Boston-area PAC facilities Participants 350 patients with delirium at PAC admission Measurements We interviewed participants at PAC admission and 30 days later. Delirium presence was determined using the Confusion Assessment Method. We performed medical record reviews to ascertain new cardiac, non-cardiac, and geriatric syndrome complications in PAC. We also determined complication status 30 days after admission or at PAC discharge, whichever came first. Results The participants (mean age 83.6 years, 66% women) experienced the following incidence of PAC complications: cardiac complications 7%, non-cardiac complications 21%, geriatric syndrome complications 39%. Delirium persisted in 56% of participants one month after PAC admission. Neither cardiac nor non-cardiac complications were associated with delirium persistence. Delirium persistence at one month was significantly greater in patients with more geriatric syndrome complications (no complication 51%, one complication 61%, ?2 complications 100%, adjusted p=0.048). There was also a trend toward greater delirium persistence in patients with unresolved geriatric syndrome complications (no complication 51%, resolved complication 61%, unresolved complication 68%, adjusted p=0.1). Conclusion Geriatric syndrome complications are common in patients admitted to post-acute care with delirium, and are associated with the persistence of delirium one month later. Proactively addressing risk factors for geriatric syndromes may improve outcomes of vulnerable patients in post-acute care.

Anderson, Corrie P.; Ngo, Long H.; Marcantonio, Edward R.



Allo-limbal transplantation in patients with limbal stem cell deficiency  

Microsoft Academic Search

AIMTo report the outcome of a series of patients with stem cell deficiency who underwent allo-limbal transplantation and to describe a technique for this procedure.METHODSSix consecutive patients underwent allo-limbal stem cell transplantation. The primary diagnosis included alkali burn (n=2), trachoma (n=1), chronic rosacea blepharitis and keratoconjunctivitis (n=1), aniridia (n=1), and Stevens–Johnson syndrome (n=1). The limbal rim consisted of peripheral cornea

Harminder S Dua; Augusto Azuara-Blanco; DENNIS S C LAM; M. L SLOPER



Life-threatening acute adverse cutaneous drug reactions  

Microsoft Academic Search

Adverse cutaneous reactions to drugs are frequent, affecting 2% to 3% of all hospitalized patients. Fortunately, only about 2% of adverse cutaneous reactions are severe and very few are fatal.Stevens-Johnson syndrome and toxic epidermal necrolysis are severe life-threatening diseases with a mortality rate reaching 30%, and only prompt recognition and diagnosis, withdrawal of the offensive drug, and referral to an

Ronni Wolf; Edith Orion; Batsheva Marcos; Hagit Matz



Side effects of benoxaprofen  

Microsoft Academic Search

A study was made of adverse dermatological reactions to the non-steroidal anti-inflammatory agent benoxaprofen. Photosensitivity was seen in several patients, confined to wavelengths less than 340 nm. Other cutaneous side effects were erythema multiforme, the Stevens-Johnson syndrome, milia, and onycholysis. One case of pancytopenia and toxic epidermal necrolysis was reported. patients were not rechallenged with the drug, but these reactions

Brian Diffey; Colin Hindson; F Lawlor



"Cutaneous adverse drug reactions" are not always drug-induced.  


Cutaneous adverse drug reactions present as many different clinical symptoms which may be induced by triggers other than drugs. This review focuses on the non-drug causes of fixed "drug" eruptions, acute generalized erythematous pustulosis (AGEP), "drug" reactions with eosinophilia and systemic symptoms (DRESS) and Stevens-Johnson syndrome/toxic epidermal necrolysis (TEN), which may be induced by foods, xenobiotics, venoms etc... PMID:24007777

Raison-Peyron, Nadia



Gastrointestinal Complications (PDQ)  


... Fecal impaction. Bowel obstruction . Diarrhea . Radiation enteritis . This summary is about GI complications in adults with cancer. Treatment of ... Other Versions: Mobile | Español U.S. Department of ...


[Complications of mechanical ventilation].  


Mechanical ventilation of the lungs, as an important therapeutic measure, cannot be avoided in critically ill patients. However, when machines take over some of vital functions there is always a risk of complications and accidents. Complications associated with mechanical ventilation can be divided into:1) airway-associated complications; 2) complications in the response of patients to mechanical ventilation; and 3) complications related to the patient's response to the device for mechanical ventilation. Complications of artificial airway may be related to intubation and extubation or the endotracheal tube. Complications of mechanical ventilation, which arise because of the patient's response to mechanical ventilation, may primarily cause significant side effects to the lungs. During the last two decades it was concluded that mechanical ventilation can worsen or cause acute lung injury. Mechanical ventilation may increase the alveolar/capillary permeability by overdistension of the lungs (volutrauma), it can exacerbate lung damage due to the recruitment/derecruitment of collapsed alveoli (atelectrauma) and may cause subtle damages due to the activation of inflammatory processes (biotrauma). Complications caused by mechanical ventilation, beside those involving the lungs, can also have significant effects on other organs and organic systems, and can be a significant factor contributing to the increase of morbidity and mortality in critically ill of mechanically ventilated patients. Complications are fortunately rare and do not occur in every patient, but due to their seriousness and severity they require extensive knowledge, experience and responsibility by healthcare workers. PMID:22070009

Draškovi?, Biljana; Raki?, Goran


Tattoo-associated complications.  


Tattoo rates in the United States have been rising in recent years, with an expected concomitant rise in tattoo-associated complications. Tattoo complications range from cutaneous localized and generalized inflammatory eruptions, to local bacterial or viral infections, and finally to infectious endocarditis and hepatitis. Many complications may be avoided with proper counseling prior to tattoo placement, especially in high risk individuals. It is important for physicians to be able to recognize and diagnose complications from tattoos to avoid morbidity and possible mortality. PMID:23287600

Juhas, Elizabeth; English, Joseph C



Management of Cardiopulmonary Complications of Cirrhosis  

PubMed Central

Advanced portal hypertension accompanying end-stage liver disease results in an altered milieu due to inadequate detoxification of blood from splanchnic circulation by the failing liver. The portosystemic shunts with hepatic dysfunction result in an increased absorption and impaired neutralisation of the gastrointestinal bacteria and endotoxins leads to altered homeostasis with multiorgan dysfunction. The important cardiopulmonary complications are cirrhotic cardiomyopathy, hepatopulmonary syndrome, portopulmonary hypertension, and right-sided hydrothorax.

Sawant, Prabha; Vashishtha, C.; Nasa, M.



Sotos syndrome.  


Sotos syndrome is an overgrowth condition characterized by cardinal features including excessive growth during childhood, macrocephaly, distinctive facial gestalt and various degrees of learning difficulty, and associated with variable minor features. The exact prevalence remains unknown but hundreds of cases have been reported. The diagnosis is usually suspected after birth because of excessive height and occipitofrontal circumference (OFC), advanced bone age, neonatal complications including hypotonia and feeding difficulties, and facial gestalt. Other inconstant clinical abnormalities include scoliosis, cardiac and genitourinary anomalies, seizures and brisk deep tendon reflexes. Variable delays in cognitive and motor development are also observed. The syndrome may also be associated with an increased risk of tumors. Mutations and deletions of the NSD1 gene (located at chromosome 5q35 and coding for a histone methyltransferase implicated in transcriptional regulation) are responsible for more than 75% of cases. FISH analysis, MLPA or multiplex quantitative PCR allow the detection of total/partial NSD1 deletions, and direct sequencing allows detection of NSD1 mutations. The large majority of NSD1 abnormalities occur de novo and there are very few familial cases. Although most cases are sporadic, several reports of autosomal dominant inheritance have been described. Germline mosaicism has never been reported and the recurrence risk for normal parents is very low (<1%). The main differential diagnoses are Weaver syndrome, Beckwith-Wiedeman syndrome, Fragile X syndrome, Simpson-Golabi-Behmel syndrome and 22qter deletion syndrome. Management is multidisciplinary. During the neonatal period, therapies are mostly symptomatic, including phototherapy in case of jaundice, treatment of the feeding difficulties and gastroesophageal reflux, and detection and treatment of hypoglycemia. General pediatric follow-up is important during the first years of life to allow detection and management of clinical complications such as scoliosis and febrile seizures. An adequate psychological and educational program with speech therapy and motor stimulation plays an important role in the global development of the patients. Final body height is difficult to predict but growth tends to normalize after puberty. PMID:17825104

Baujat, Geneviève; Cormier-Daire, Valérie



Complications of chronic use of skin lightening cosmetics.  


Skin lightening (bleaching) cosmetics and toiletries are widely used in most African countries. The active ingredients in these cosmetic products are hydroquinone, mercury and corticosteroids. Several additives (conconctions) are used to enhance the bleaching effect. Since these products are used for long duration, on a large body surface area, and under hot humid conditions, percutaneous absorption is enhanced. The complications of these products are very serious and are sometimes fatal. Some of these complications are exogenous ochronosis, impaired wound healing and wound dehiscence, the fish odor syndrome, nephropathy, steroid addiction syndrome, predisposition to infections, a broad spectrum of cutaneous and endocrinologic complications of corticosteroids, including suppression of hypothalamic-pituitary-adrenal axis. In this era of easy travels and migration, African patients with these complications can present to physicians anywhere in the world. It is therefore critical for every practicing physician to be aware of these complications. PMID:18377596

Olumide, Yetunde M; Akinkugbe, Ayesha O; Altraide, Dan; Mohammed, Tahir; Ahamefule, Ngozi; Ayanlowo, Shola; Onyekonwu, Chinwe; Essen, Nyomudim



Anastomotic Complications after Esophagectomy  

Microsoft Academic Search

Anastomotic complications after esophagectomy continue to be a burden jeopardizing the quality of life and of swallowing. However, incidence, mortality and morbidity of anastomotic complications have substantially decreased in recent years. It seems that this is not so much related to the use of a particular conduit, approach or route for reconstruction, but rather related to refinement in anastomotic techniques

T. Lerut; W. Coosemans; G. Decker; P. De Leyn; P. Nafteux; D. Van Raemdonck



Complications of endoscopic neurosurgery  

Microsoft Academic Search

Neuroendoscopy is rapidly becoming an essential part of the neurosurgeon's repertoire. Currently, very few studies have identified the complications of this new technique, yet many have warned of the steep learning curve associated with its practice. We have reviewed the last 173 neuroendoscopic procedures performed by one surgeon and identified two distinct groups of complications: those that have clinically significant

Charles Teo; Salim Rahman; Frederick A. Boop; Bruce Cherny



Complications of enteral nutrition.  

PubMed Central

Complications may arise during enteral feeding that are usually related to the diameter and rigidity of the tube or the delivery, composition, and sterility of the feed uses. By using a soft, fine bore tube to deliver a sterile feed of known composition, by continuous infusion rather than as a bolus, most of these complications can be avoided.

Bastow, M D



[Overlapping syndrome].  


Overlapping syndrome (OS) is usually used as the term of the combinations of three connective tissue diseases, i.e., systemic lupus erythematosus (SLE), progressive systemic sclerosis (PSS) and polymyositis (PM) or dermatomyositis (DM). OS is sometimes confused with mixed connective tissue disease (MCTD) since the definitions of the both diseases have not been established yet. Rheumatoid arthritis (RA) is a distinct disease and only exceptionally associated with the other CTD. These rare cases include destructive arthritis of SLE and PSS, multiple peripheral type of psoriatic arthritis, and arthritis associated with X-linked hypogammaglobulinemia and selective IgA deficiency. The conditions complicated with RA are not uncommon. They are osteoporosis, Sjogren's syndrome, amyloidosis and so on. There are some rare conditions or diseases which will be able to develop to RA. These peculiar cases include juvenile rheumatoid arthritis, adult onset Still's disease, polymyalgia rheumatica and palindromic rheumatism. PMID:1588760

Tanimoto, K



Genetics Home Reference: Proteus syndrome  


... and cause a life-threatening complication called a pulmonary embolism. Pulmonary embolism is a common cause of death in people ... incidence ; lesion ; mosaicism ; mutation ; neurological ; ovarian ; proliferation ; pulmonary ; pulmonary embolism ; sporadic ; syndrome ; thrombosis ; tissue ; tumor ; vascular ; veins You ...


Hodgkin's Lymphoma: A Review of Neurologic Complications  

PubMed Central

Hodgkin's lymphoma is a hematolymphoid neoplasm, primarily of B cell lineage, that has unique histologic, immunophenotypic, and clinical features. Neurologic complications of Hodgkin's Lymphoma can be separated into those that result directly from the disease, indirectly from the disease, or from its treatment. Direct neurologic dysfunction from Hodgkin's Lymphoma results from metastatic intracranial spinal disease, epidural metastases causing spinal cord/cauda equina compression, leptomeningeal metastases, or intradural intramedullary spinal cord metastases. Indirect neurologic dysfunction may be caused by paraneoplastic disorders (such as paraneoplastic cerebellar degeneration or limbic encephalitis) and primary angiitis of the central nervous system. Hodgkin's lymphoma treatment typically includes chemotherapy or radiotherapy with potential treatment-related complications affecting the nervous system. Neurologic complications resulting from mantle-field radiotherapy include the “dropped head syndrome,” acute brachial plexopathy, and transient ischemic attacks/cerebral infarcts. Chemotherapy for Hodgkin's lymphoma may cause cerebral infarction (due to emboli from anthracycline-induced cardiomyopathy) and peripheral neuropathy.

Grimm, Sean; Chamberlain, Marc



Hodgkin's Lymphoma: A Review of Neurologic Complications.  


Hodgkin's lymphoma is a hematolymphoid neoplasm, primarily of B cell lineage, that has unique histologic, immunophenotypic, and clinical features. Neurologic complications of Hodgkin's Lymphoma can be separated into those that result directly from the disease, indirectly from the disease, or from its treatment. Direct neurologic dysfunction from Hodgkin's Lymphoma results from metastatic intracranial spinal disease, epidural metastases causing spinal cord/cauda equina compression, leptomeningeal metastases, or intradural intramedullary spinal cord metastases. Indirect neurologic dysfunction may be caused by paraneoplastic disorders (such as paraneoplastic cerebellar degeneration or limbic encephalitis) and primary angiitis of the central nervous system. Hodgkin's lymphoma treatment typically includes chemotherapy or radiotherapy with potential treatment-related complications affecting the nervous system. Neurologic complications resulting from mantle-field radiotherapy include the "dropped head syndrome," acute brachial plexopathy, and transient ischemic attacks/cerebral infarcts. Chemotherapy for Hodgkin's lymphoma may cause cerebral infarction (due to emboli from anthracycline-induced cardiomyopathy) and peripheral neuropathy. PMID:20975772

Grimm, Sean; Chamberlain, Marc



Neonatal Outcome in Pregnancies after Preterm Delivery for HELLP Syndrome  

Microsoft Academic Search

Objective: To compare neonatal outcome after preterm delivery of infants where pregnancy had been complicated by the HELLP syndrome. Study Design: The maternal and neonatal charts of 475 consecutive pregnancies complicated by hypertensive disorders at our perinatal unit were reviewed. The HELLP syndrome was defined by previously published laboratory criteria. 93 women fulfilled the criteria and constituted our HELLP syndrome

Halil Aslan; Ahmet Gul; Altan Cebeci



Complications of arthrography.  


Arthrography is considered extremely safe since reactions to intraarticular contrast media are rare. We have only seen one severe complication in the performance of more than 2,000 arthrographic procedures. To determine the incidence of complications, a questionnaire was sent to 84 radiologists experienced in arthrography. The 57 respondents had performed more than 126,000 arthrographic procedures, and findings of the survey indicate no deaths, three cases of infection, and 61 cases of hives. Other acute reactions included hypotension, seizures, air embolism, and laryngeal edema. Related complications included sterile chemical synovitis, severe pain after the procedure, and vasovagal reactions. PMID:4001360

Newberg, A H; Munn, C S; Robbins, A H



The Parkinsonism-Hyperpyrexia Syndrome  

Microsoft Academic Search

The parkinsonism-hyperpyrexia syndrome (PHS) is a rare but potentially fatal complication seen in Parkinson’s disease (PD)\\u000a patients, most commonly following reduction or cessation of antiparkinson medications. Clinically it resembles neuroleptic\\u000a malignant syndrome with rigidity, pyrexia, and reduced conscious level. There may be features of autonomic instability, and\\u000a serum creatine kinase (CK) may be elevated. Complications of PHS include acute renal

Edward J. Newman; Donald G. Grosset; Peter G. E. Kennedy



Freeman-Sheldon Syndrome (Whistling Face Syndrome) and Cranio-Vertebral Junction Malformation Producing Dysphagia and Weight Loss  

Microsoft Academic Search

The whistling face syndrome has been reported, with complications of the respiratory system and feeding problems due to microstomia, since 1938. Dysphagia, however, has not previously been reported as a complication of whistling face syndrome. We report a 13-year-old with the whistling face syndrome and dysphagia of late onset who has the typical whistling face, scoliosis and multiple joint contractures.

Hae-Ryong Song; John F. Sarwark; Sarah Sauntry; John Grant



[Prader-Willi syndrome].  


Prader-Willi syndrome (PWS) is the most frequent cause of secondary obesity, characterized by neonatal hypotonia, dysmorphic facies, acromicria, hypogonadism, stunted growth, obesity, behavioural disturbances and cognitive impairment. Clinical diagnosis is confirmed by alteration of imprinted genes on the proximal long arm of chromosome 15 (15q11-13) for deletion, translocation, uniparental disomy for maternal chromosome 15 or imprinting center defect. Methylation test is the most reliable test for diagnosis. This issue explains diagnostic tests, clinical, metabolic, endocrinological features, and the most frequent complications observed in this syndrome. Precocious diagnosis and multidisciplinary approach allow in these patients to prevent the severe obesity and linked complications. PMID:10645655

Beccaria, L; Bosio, L; Benzi, F; Bregani, P; Achutegui, I; Chiumello, G; Livieri, C; Trifirò, G; de Toni, T; Iughetti, L; Ragusa, L; Salvatoni, A; Tonini, G; Corrias, A; Crinò, A



Lemierre's Syndrome Mimicking Leptospirosis  

PubMed Central

Lemierre's syndrome is a suppurative thrombophlebitis involving the internal jugular vein, most commonly associated with Fusobacterium necrophorum, usually a complication of oropharyngeal infections. This syndrome is rare and is often overlooked. We present a case of sepsis mimicking initially severe leptospirosis (Weil's disease) due to acute febrile illness with multiorgan failure and hyperbilirubinemia. Finally, blood cultures revealed Fusobacterium necrophorum and computed tomography (CT) demonstrated bilateral pulmonary nodules and a thrombus in the right internal jugular vein. Early clinical suspicion is crucial so that appropriate diagnostic investigation and antibiotic therapy can be initiated to minimize the risk of life-threatening complications.

Suwantarat, Nuntra; Young, Royden S



Tetanus: Symptoms and Complications  


... of the muscles of the jaw, or "lockjaw". Tetanus symptoms include: Headache Jaw cramping Sudden, involuntary muscle ... sweating High blood pressure and fast heart rate Tetanus complications include: Uncontrolled/involuntary muscular contraction of the ...


[Complications of celiac disease].  


Numerous complications can occur in celiac disease, nutritional (growth failure in children, malnutrition, vitamin deficiencies), hematologic (anaemia), bone disease (osteoporosis, fracture), gynaecologic (hypo fertility), cardiovascular (coronaropathy, venous thrombosis), neurological (peripheral neuropathy), hepatic (cytolysis, cirrhosis). Celiac disease is associated with an increased risk of autoimmune diseases (type 1 diabetes, thyroiditis), and cancer (upper digestive tract, hepatocellular carcinoma, lymphoma). The main digestive complications are microscopic colitis and refractory sprue, which are resistant to gluten-free diet. It can be associated with a monoclonal proliferation of intraepithelial lymphocytes (type 2 refractory sprue), which may be considered as a cryptic lymphoma and can lead to invasive T lymphoma, which occurs in one celiac patient in 1000. Gluten-free diet protects from the occurrence of most complications and correct the over-mortality related to these complications. PMID:21621350

Cosnes, J; Nion-Larmurier, I



Complications of transradial catheterization.  


Cardiac catheterization via the transradial approach has increased in the United States over the past few years; however, wide-scale adoption still lags in comparison to many international health care systems. Transradial catheterization has a unique set of complications and risks that each operator must appreciate. Radial artery spasm and radial artery occlusion are the most common complications, while bleeding complications such as hematomas and perforations are much less frequent. Each of these issues can be managed successfully with minor changes to one's practice. In this review of the current state of the art, the reader will develop an appreciation for the prevalence of each of the common complications as well as the less common, but potentially highly morbid, events. Throughout this evidence-based review, practical prevention strategies and specific treatment pathways are described for each issue that is covered. PMID:22115936

Dandekar, Vineet K; Vidovich, Mladen I; Shroff, Adhir R



Complications of Urethroplasty  

Microsoft Academic Search

\\u000a Urethroplasty has excellent success rates against urethral stricture that far exceed that found with direct visual internal\\u000a urethrotomy (DVIU) and dilation. Different forms of urethroplasty were employed including, buccal mucosal (BM), fasciocutaneous\\u000a and anastomotic urethroplasty. Complications of urethroplasty are directly related to location of stricture, surgical technique,\\u000a type of substitution tissue, and length of stricture. These complications range from mild

Hosam S. Al-Qudah; Osama Al-Omar; Richard A. Santucci


On complicity theory  

Microsoft Academic Search

The received account of whistleblowing, developed over the last quarter century, is identified with the work of Norman Bowie\\u000a and Richard DeGeorge. Michael Davis has detailed three anomalies for the received view: the paradoxes of burden, missing harm\\u000a and failure. In addition, he has proposed an alternative account of whistleblowing, viz., the Complicity Theory. This paper\\u000a examines the Complicity Theory.

A. David Kline



Scheie syndrome  


... also: MPS I H (Hurler syndrome) MPS II, Hunter syndrome MPS IV Morquio syndrome MPS III (Sanfilippo ... syndrome is the mildest form of mucopolysaccharidosis type 1. The syndrome is transmitted as an autosomal recessive ...


On complicity theory.  


The received account of whistleblowing, developed over the last quarter century, is identified with the work of Norman Bowie and Richard DeGeorge. Michael Davis has detailed three anomalies for the received view: the paradoxes of burden, missing harm and failure. In addition, he has proposed an alternative account of whistleblowing, viz., the Complicity Theory. This paper examines the Complicity Theory. The supposed anomalies rest on misunderstandings of the received view or misreadings of model cases of whistleblowing, for example, the Challenger disaster and the Ford Pinto. Nevertheless, the Complicity Theory is important for as in science the contrast with alternative competing accounts often helps us better understand the received view. Several aspects of the received view are reviewed and strengthened through comparison with Complicity Theory, including why whistleblowing needs moral justification. Complicity Theory is also critiqued. The fundamental failure of Complicity Theory is its failure to explain why government and the public encourage and protect whistleblowers despite the possibility of considerable harm to the relevant company in reputation, lost jobs, and lost shareholder value. PMID:16609713

Kline, A David



Complications of auricular correction  

PubMed Central

The risk of complications of auricular correction is underestimated. There is around a 5% risk of early complications (haematoma, infection, fistulae caused by stitches and granulomae, allergic reactions, pressure ulcers, feelings of pain and asymmetry in side comparison) and a 20% risk of late complications (recurrences, telehone ear, excessive edge formation, auricle fitting too closely, narrowing of the auditory canal, keloids and complete collapse of the ear). Deformities are evaluated less critically by patients than by the surgeons, providing they do not concern how the ear is positioned. The causes of complications and deformities are, in the vast majority of cases, incorrect diagnosis and wrong choice of operating procedure. The choice of operating procedure must be adapted to suit the individual ear morphology. Bandaging technique and inspections and, if necessary, early revision are of great importance for the occurence and progress of early complications, in addition to operation techniques. In cases of late complications such as keloids and auricles that are too closely fitting, unfixed full-thickness skin flaps have proved to be the most successful. Large deformities can often only be corrected to a limited degree of satisfaction.

Staindl, Otto; Siedek, Vanessa



Clinical and pathophysiological aspects of neurological complications in renal failure.  


A review of the neurological complications presenting in uremia and an account of their presumed pathophysiology is given. With the introduction of different dialytic procedures during the last twenty years, the incidence and severity of neurological complications have declined. Nevertheless, some disturbances related to the uremic syndrome fail to respond to dialytic therapy and these therapeutic measures may even be responsible for the appearance of some new abnormalities. The clinical manifestations of uremic encephalopathy and polyneuropathy are presented. The review of the presumed pathophysiology of these syndromes illustrates the still existing controversies. Nevertheless, some promising new lines of research are reviewed. In addition, some complications of uremic treatment, including dialysis disequilibrium syndrome and dialysis encephalopathy are presented. PMID:1332359

De Deyn, P P; Saxena, V K; Abts, H; Borggreve, F; D'Hooge, R; Marescau, B; Crols, R



Exfoliation syndrome and exfoliation glaucoma  

Microsoft Academic Search

Exfoliation syndrome—abnormal deposition in the anterior segment of the eye of an unknown substance thought to be related to elastic fibres and basement membrane components—is associated with accelerated cataract progression, increased frequency of intraoperative and postoperative complications and increased risk for glaucoma and, therefore, is a clinically important finding. A clear association has been shown with age. The syndrome occurs

Eija Vesti; Tero Kivelä



Pregnancy and Catastrophic Antiphospholipid Syndrome  

Microsoft Academic Search

Antiphospholipid syndrome (APS) is clearly related to maternal morbidity. The most characteristic feature is pregnancy loss;\\u000a however, several other serious complications had been reported including fetal growth restriction, uteroplacental insufficiency,\\u000a fetal distress, pre-eclampsia, and HELLP syndrome. Herein, we review the different aspects of obstetric APS features, with\\u000a special emphasis on its life-threatening variant known as catastrophic APS (Asherson’s syndrome) and

Jose A. Gómez-Puerta; Jose Sanin-Blair; Claudio Galarza-Maldonado



Complicated monochorionic twin pregnancies: Experience with bipolar cord coagulation  

Microsoft Academic Search

Objective: The purpose of the study was to evaluate our experience with ultrasound-guided bipolar diathermy forceps for cord occlusion in complicated monochorionic twin pregnancies. Study Design: Seventeen consecutive cases were included: 9 cases were twin-to-twin transfusion syndrome; 2 cases were twin reversed arterial perfusion syndrome, and 6 cases were discordant for fetal abnormality. Bipolar diathermy was performed under local anesthetic

Umberto Nicolini; Andres Poblete; Chiara Boschetto; Francesca Bonati; Alistair Roberts



[Crush syndrome].  


Crush injuries and crush syndrome are common after natural (e.g. earthquake, land-slide, tornadoes, tsunami) or man-made catastrophes (e.g. wars, terrorist attacks), in fact the history of this disease is well reported both in earthquake rescue reviews and in military literature. However, there are instances due to conventional causes, such as building collapses, road traffic accident, accident at work or altered level of consciousness after stroke or drug overdose. These situations of ''big or small'' catastrophes can occur at any time and anywhere, for this reason every clinician should be prepared to address issues of crush syndrome quickly and aggressively. The treatment has to manage and to predict clinical conditions before they present themselves. In particular, acute renal failure is one of the few life-threatening complications that can be reversed. This article reviews the various evidences and summarizes the treatment strategies available. Fundamental targets in crush syndrome management are early aggressive hydration, urine alkalinization and, when possible, forced diuresis. Since electrolyte imbalance may be fatal due to arrhythmias secondary to hyperkalemia (especially associated with hypocalcemia), it's necessary to correct these abnormalities using insulin-glucose solution and/or potassium binders, and if nevertheless serum potassium levels remain high this serious disease will necessitate dialysis, which is often a vital procedure. PMID:17641588

Scapellato, S; Maria, S; Castorina, G; Sciuto, G



Dialysis disequilibrium syndrome.  


The dialysis disequilibrium syndrome is a rare but serious complication of hemodialysis. Despite the fact that maintenance hemodialysis has been a routine procedure for over 50 years, this syndrome remains poorly understood. The signs and symptoms vary widely from restlessness and headache to coma and death. While cerebral edema and increased intracranial pressure are the primary contributing factors to this syndrome and are the target of therapy, the precise mechanisms for their development remain elusive. Treatment of this syndrome once it has developed is rarely successful. Thus, measures to avoid its development are crucial. In this review, we will examine the pathophysiology of this syndrome and discuss the factors to consider in avoiding its development. PMID:22710692

Zepeda-Orozco, Diana; Quigley, Raymond



Complicated monochorionic twin pregnancies: updates in fetal diagnosis and treatment.  


Monochorionic (MC) twin pregnancies may develop significant complications, and twin-to-twin transfusion syndrome (TTTS) has become among the best known to obstetricians and patients alike. A significant percentage of patients referred for suspected TTTS have a different underlying pathologic condition, however, and differentiating the subcategories of MC pathophysiologic conditions may change treatment course and outcome. The key to understanding complicated MC pregnancies lies in the placental angioarchitecture and intertwin vascular communications between the fetuses. PMID:19559328

Rand, Larry; Lee, Hanmin



Dental Complications of Eating Disorders  


... Dental Complications of Eating Disorders Dental Complications of Eating Disorders Dietary habits can and do play a role ... associated with dental complications that causes individuals with eating disorders to seek treatment. Signs & Symptoms Loss of tissue ...


Tattoos: dermatological complications.  


From the Eskimo in Greenland to the tribes in Polynesia-the whole world knows the art of tattoo. Despite their wide popularity the relation between the skin diseases and the tattooed pictures aren't studied in depth. With the appearance of professional tattoo studios, the risk of infectious complications was reduced. Simultaneously, on a global scale there has been an increase in pseudolymphoma and allergic reactions caused by the introduction of an exogenous pigment into the dermis. The results of our clinical and therapeutic research and review of literature on the subject outline the major problems related to tattoos, i.e. clinical complications. The summarized data showed infectious diseases transmitted through the process of tattooing and many allergic reactions, granulomas and tumors as complications of a tattoo. PMID:17697920

Kazandjieva, Jana; Tsankov, Nikolai


Complications of ear disease.  


Forty-seven patients with acute mastoiditis were treated in our hospital over a 2 and a half year period. Seven patients were symptomatic for a short period only. The other 40 gave a history of chronic ear disease, 22 of them with cholesteatoma. Post auricular swelling is an important sign of acute mastoiditis but was found in only 64% of the patients. Forty-five percent of our patients were found to have infection spread beyond the mastoid. Meningitis was the most common complication (13 patients). Most of the patients who presented without post auricular swelling were diagnosed as a result of having one or more complications. We believe that in cases of intracranial pathology or septic fever associated with ear disease, the diagnosis of mastoiditis is most likely. Early operation combined with appropriate antibiotic treatment can prevent further complications and fatal outcome. PMID:3243012

Yaniv, E; Pocock, R



Lemierre's syndrome: the forgotten disease.  


Lemierre's syndrome is an often un-diagnosed disease seen in previously healthy young subjects, presenting with symptoms of pharyngitis, fever and elevated markers of inflammation. The syndrome is characterised by infectious thrombosis of the jugular vein due to infection with Fusobacteria, causing a variety of infectious complications. Rapid diagnosis and treatment is necessary to avoid severe complications or death. Close collaboration with local microbiologist is pivotal. Treatment consists of longterm treatment with penicillin and metronidazole. This is a case report of Lemierre's syndrome. PMID:23686643

Johannesen, Katrine; Bødtger, Uffe; Heltberg, Ole



[Complications using the laser].  


In this paper we analyze the complications of various applications of laser in urology. The search of a minor aggression trying to diminish complications have lead the development of the use of this energy in the most frequent urologic pathologies. Its use in the fragmentation of ureteral stones has modified the therapeutic algorithms. In prostatic diseases we analyze the various options from enucleation (HoLEP) to green laser photovaporization, reviewing the bibliographic references and comparing them with our experience. There are other therapeutic applications that use this energy as a cutting instruments for urethral, ureteral, ureteropyelic junction stenosis, or bladder neck section. PMID:19140597

López García, Juan Antonio; Crespo Crespo, Iciar; Aguirreazaldegui García, Lore; Oyarzabal Pérez, Igor



Umbilical Complications of Malignancy  

Microsoft Academic Search

Introduction  Cancer patients may manifest a variety of intraabdominal complications occurring during various phases of their illness; however,\\u000a little in the literature exists regarding umbilical abnormalities in this population.\\u000a \\u000a \\u000a \\u000a Discussion  Umbilical metastases (Sister Mary Joseph’s sign) are the most common malignant complication involving the umbilicus and may\\u000a be the presenting manifestation of visceral malignancy. Cancer patients may occasionally experience periumbilical ecchymosis\\u000a (Cullen’s

Mark A. Marinella



EMPACT syndrome associated with phenobarbital.  


Intracranial malignancies can be complicated by seizure activity, and anticonvulsants such as phenytoin are usually administered to prevent this neurological kind of complication. Cranial radiation therapy is instead the treatment of choice when the tumor is unresectable. Anyway, the combination of phenytoin and cranial radiation therapy can lead to a rare and severe mucocutaneous complication called EMPACT syndrome. It is composed of "erythema (E) multiforme (M) associated with phenytoin (P) and (A) cranial radiation (C) therapy (T)." Herein, we report 2 cases of EMPACT syndrome related to the use of phenobarbital instead of phenytoin as usually described in literature. PMID:23340399

Fabbrocini, Gabriella; Panariello, Luigia; Pensabene, Matilde; Lauria, Rossella; Matano, Elide; Martellotta, Donata; Bianca, Dario; De Placido, Sabino; Ayala, Fabio


Hypoglycemia: The neglected complication  

PubMed Central

Hypoglycemia is an important complication of glucose-lowering therapy in patients with diabetes mellitus. Attempts made at intensive glycemic control invariably increases the risk of hypoglycemia. A six-fold increase in deaths due to diabetes has been attributed to patients experiencing severe hypoglycemia in comparison to those not experiencing severe hypoglycemia Repeated episodes of hypoglycemia can lead to impairment of the counter-regulatory system with the potential for development of hypoglycemia unawareness. The short- and long-term complications of diabetes related hypoglycemia include precipitation of acute cerebrovascular disease, myocardial infarction, neurocognitive dysfunction, retinal cell death and loss of vision in addition to health-related quality of life issues pertaining to sleep, driving, employment, recreational activities involving exercise and travel. There is an urgent need to examine the clinical spectrum and burden of hypoglycemia so that adequate control measures can be implemented against this neglected life-threatening complication. Early recognition of hypoglycemia risk factors, self-monitoring of blood glucose, selection of appropriate treatment regimens with minimal or no risk of hypoglycemia and appropriate educational programs for healthcare professionals and patients with diabetes are the major ways forward to maintain good glycemic control, minimize the risk of hypoglycemia and thereby prevent long-term complications.

Kalra, Sanjay; Mukherjee, Jagat Jyoti; Venkataraman, Subramanium; Bantwal, Ganapathi; Shaikh, Shehla; Saboo, Banshi; Das, Ashok Kumar; Ramachandran, Ambady



Radiology of cholecystectomy complications.  


Postoperative problems following simple removal of the gallbladder are infrequent. Radiographic studies may be valuable in suggesting or confirming the diagnosis when not clinically evident. Plain films, contrast studies, ultrasound, and computed tomography (CT) all can be useful modalities in this area. Several examples of complications related specifically to the operative field in cholecystectomy are reviewed. PMID:761742

Love, L; Kucharski, P; Pickleman, J



Treatment of complicated grief  

PubMed Central

Following the death of a loved one, a small group of grievers develop an abnormal grieving style, termed complicated or prolonged grief. In the effort to establish complicated grief as a disorder in DSM and ICD, several attempts have been made over the past two decades to establish symptom criteria for this form of grieving. Complicated grief is different from depression and PTSD yet often comorbid with other psychological disorders. Meta-analyses of grief interventions show small to medium effect sizes, with only few studies yielding large effect sizes. In this article, an integrative cognitive behavioral treatment manual for complicated grief disorder (CG-CBT) of 25 individual sessions is described. Three treatment phases, each entailing several treatment strategies, allow patients to stabilize, explore, and confront the most painful aspects of the loss, and finally to integrate and transform their grief. Core aspects are cognitive restructuring and confrontation. Special attention is given to practical exercises. This article includes the case report of a woman whose daughter committed suicide.

Rosner, Rita; Pfoh, Gabriele; Kotoucova, Michaela



Waveriders of complicated shape  

Microsoft Academic Search

The shape of a waverider formed by streamsurfaces behind oblique shocks and rarefaction waves is complicated by equipping\\u000a the lifting body with a wing and fins. The joining of the wing to the body and the possibility of reducing the wave drag are\\u000a considered.

G. I. Maikapar



Complications of cyclosporin therapy  

Microsoft Academic Search

Cyclosporin (CsA) therapy has improved the outcome of allotransplants. Because of a relatively selective action on T lymphocytes, CsA therapy causes fewer immunosuppressive complications of infection or malignancy compared to previous chemical agents, which were relatively nonspecific in their spectrum of action on lymphoid versus nonlymphoid cells. Gastrointestinal complaints after oral administration and vasomotor reactions after intravenous administration represent pharmacologic

Barry D. Kahan; Stuart M. Flechner; Marc I. Lorber; Chris Jensen; Debbie Golden; Charles T. Van Buren



Complicating Visual Culture  

ERIC Educational Resources Information Center

|Arguing for complicating the study of visual culture, as advocated by James Elkins, this article explicates and explores Lacanian psychoanalytic theory and pedagogy in view of its implications for art education practice. Subjectivity, a concept of import for addressing student identity and the visual, steers the discussion informed by pedagogical…

Daiello, Vicki; Hathaway, Kevin; Rhoades, Mindi; Walker, Sydney



Tattoos: dermatological complications  

Microsoft Academic Search

From the Eskimo in Greenland to the tribes in Polynesia­the whole world knows the art of tattoo. Despite their wide popularity the relation between the skin diseases and the tattooed pictures aren't studied in depth. With the appearance of professional tattoo studios, the risk of infectious complications was reduced. Simultaneously, on a global scale there has been an increase in

Jana Kazandjieva; Nikolai Tsankov



Predictors of complicated grief  

Microsoft Academic Search

This study examined whether process variables predict an outcome of complicated grief. A turbulent and prolonged grief was predicted to occur after the death of a spouse in subjects who had self-blame, used the deceased for an extension of self, had ambivalence toward the deceased, or overcontrolled emotional responses. Ninety subjects were examined at 6, 14, and 25 months after

Mardi Horowitz; Constance Milbrath; George A. Bonanno; Nigel Field; Charles Stinson; Are Holen



Drug-Induced Hematologic Syndromes  

PubMed Central

Objective. Drugs can induce almost the entire spectrum of hematologic disorders, affecting white cells, red cells, platelets, and the coagulation system. This paper aims to emphasize the broad range of drug-induced hematological syndromes and to highlight some of the newer drugs and syndromes. Methods. Medline literature on drug-induced hematologic syndromes was reviewed. Most reports and reviews focus on individual drugs or cytopenias. Results. Drug-induced syndromes include hemolytic anemias, methemoglobinemia, red cell aplasia, sideroblastic anemia, megaloblastic anemia, polycythemia, aplastic anemia, leukocytosis, neutropenia, eosinophilia, immune thrombocytopenia, microangiopathic syndromes, hypercoagulability, hypoprothrombinemia, circulating anticoagulants, myelodysplasia, and acute leukemia. Some of the classic drugs known to cause hematologic abnormalities have been replaced by newer drugs, including biologics, accompanied by their own syndromes and unintended side effects. Conclusions. Drugs can induce toxicities spanning many hematologic syndromes, mediated by a variety of mechanisms. Physicians need to be alert to the potential for iatrogenic drug-induced hematologic complications.

Mintzer, David M.; Billet, Shira N.; Chmielewski, Lauren



Two unusual complications after surgical interruption of an accessory pathway.  


In a patient with the Wolff-Parkinson-White syndrome, Ebstein's anomaly of the tricuspid valve, a right atrial Chiari net and a patent foramen ovale two unusual complications developed after surgical epicardial dissection combined with cryoablation of the anomalous pathway. The first complication was that ablation of the right atrial wall led to changes in interatrial pressure gradients and the development of a right to left shunt necessitating surgical closure of the atrial septal defect. The second complication was the development of a thrombotic mass in the Chiari net simulating on intracavity tumour, which also had to be removed surgically. PMID:8260281

Cheriex, E C; Smeets, J L; Wellens, H J



Pulmonary Complications in Patients with Severe Brain Injury  

PubMed Central

Pulmonary complications are prevalent in the critically ill neurological population. Respiratory failure, pneumonia, acute lung injury and the acute respiratory distress syndrome (ALI/ARDS), pulmonary edema, pulmonary contusions and pneumo/hemothorax, and pulmonary embolism are frequently encountered in the setting of severe brain injury. Direct brain injury, depressed level of consciousness and inability to protect the airway, disruption of natural defense barriers, decreased mobility, and secondary neurological insults inherent to severe brain injury are the main cause of pulmonary complications in critically ill neurological patients. Prevention strategies and current and future therapies need to be implemented to avoid and treat the development of these life-threatening medical complications.

Lee, Kiwon; Rincon, Fred



Respiratory failure complicating rubeola.  


We reviewed the charts of 19 patients with the diagnosis of measles who were admitted to the pediatric intensive care unit for respiratory failure requiring intubation and mechanical ventilation. Patients studied were admitted during the period June 1989 to June 1990. The mean age was 19 months (range, 3 to 51 months). The cause for respiratory failure fell into two groups: 47 percent developed pneumonitis and refractory hypoxemia. Patients with pneumonitis and hypoxemic respiratory failure had a 56 percent mortality. An oxygenation index of greater than 40 for 4 h separated survivors from nonsurvivors (oxygenation index = [mean airway pressure x FIo2/PaO2 x 100]). Patients with tracheitis alone all survived. In these patients the organism primarily responsible was Staphylococcus aureus (70 percent). Two of the seven patients with S aureus tracheitis had signs and symptoms of toxic shock syndrome and we subsequently demonstrated toxic shock syndrome toxin 1 in both patients. PMID:8252964

Swift, J D; Barruga, M C; Perkin, R M; van Stralen, D



Takayasu's arteritis: oral complications and dental guidelines.  


Takayasu's arteritis (TA) is an inflammatory disease with an unknown cause. It is also known as aortic arch syndrome and pulseless disease. Complications of TA often include cerebral infarct, valvular heart disease, intracranial hemorrhage, congestive heart failure, seizures, retinopathy, and renovascular hypertension. We report a case of an 18-year-old female patient with TA who presented with a severe oral infection associated with a mandibular third molar. Such a complication in patients with TA is rare and this is probably the first reported case in the English medical literature. The patient was managed satisfactorily, with due precautions and no recurrence. More so, as the prognosis of TA has improved, the chances of dental treatments of patients afflicted with the same are likely to increase. In addition, this article highlights the guidelines for the management of patients in various dental specialties. PMID:22901643

Gupta, Anand; Bhutia, Ongkila; Roychoudhury, Ajoy



Ehlers-Danlos syndrome.  


Two cases of Ehlers-Danlos Syndrome (EDS) are discussed. The first case illustrates some of the classic findings and complications often seen in this rare, inherited, connective tissue disorder. The second case illustrates a much less severe presentation in which the diagnosis of Ehlers-Danlos syndrome is equivocal. A review of the pertinent literature offers an understanding of the pathophysiology, clinical presentation, radiological findings, differential diagnosis and complications of this condition. It is essential for practitioners to understand the indications and contraindications for various treatment and diagnostic procedures such as angiography, surgery and joint manipulation. Due to the severity of potential complications to the skin, bones, joints, cardiovascular, visceral and ocular structures, accurate diagnosis is essential. PMID:2376721

Taylor, J A; Greene-Deslauriers, K; Tanaka, D I



Neuromuscular complications in HIV.  


HIV affects many organs of the body, including the nervous system. As a result, a series of neurologic complications have created challenges for scientists and clinicians alike. Among these, HIV-associated neuropathy and myopathy may occur at all stages of the disease process. Of the neuropathies, distal symmetrical polyneuropathy is the most common form. The pathogenesis of primary HIV neuropathy is unknown. Other types of neuropathy seen in HIV-infected subjects include toxic neuropathy, inflammatory demyelinating polyneuropathy, progressive polyradiculopathy, and mononeuritis multiplex. In this review, we present the clinical manifestations, pathogenesis, diagnosis, and management of different types of neuropathy in HIV infection. Myopathy, another complication of HIV, is not associated with any particular stage of immunosuppression. Symptoms include symmetrical weakness of the proximal muscles in the extremities. Serum creatine kinase levels are often moderately elevated. Electromyography and muscle biopsy are helpful tests for diagnosis. Treatment of HIV myopathy includes corticosteroids, nonsteroidal anti-inflammatory agents, and intravenous immunoglobulin. PMID:14683631

Verma, Susama; Micsa, Elena; Estanislao, Lydia; Simpson, David



Immediate postpartum complications.  


Two hundred and sixty-nine (5.4%) of the 4,998 patients who delivered in Westmead Hospital, New South Wales in 1985 had immediate postpartum complications. This analysis was compared with figures from a major institution in another state of Australia. Early detection and prompt management without procrastination was the key to a successful outcome in the fourth stage of labour (i.e. within 24 hours of delivery). Nearly three-quarters of the complications were due to postpartum haemorrhage (PPH). The contributory factors are analysed and discussed. Reappraisal of the indications for induction of labour, epidural analgesia and forceps delivery is necessary to reduce the incidence of postpartum haemorrhage. The study reinforces the need for undiminished vigilance in the fourth stage of labour even if the first 3 stages are uncomplicated. PMID:2346452

St George, L; Crandon, A J



Drug complications in outpatients  

Microsoft Academic Search

OBJECTIVE: Outpatient drug complications have not been well studied. We sought to assess the incidence and characteristics of outpatient\\u000a drug complications, identify their clinical and nonclinical correlates, and evaluate their impact on patient satisfaction.\\u000a \\u000a \\u000a DESIGN: Retrospective chart reviews and patient surveys.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: Eleven Boston-area ambulatory clinics.\\u000a \\u000a \\u000a \\u000a \\u000a PATIENTS: We randomly selected 2,248 outpatients, 20 to 75 years old.\\u000a \\u000a \\u000a \\u000a \\u000a MEASUREMENTS AND MAIN

Tejal K. Gandhi; Helen R. Burstin; E. Francis Cook; Ann L. Puopolo; Jennifer S. Haas; Troyen A. Brennan; David W. Bates



Subdural empyema complicating sinusitis.  


Acute sinusitis is a common childhood illness most often involving the ethmoid and maxillary sinuses. Diagnosis is usually based on a history of an upper respiratory tract infection lasting longer than 7 days with a prominent nasal component. Treatment involves 10-14 days of antibiotics. Intracranial complications of pediatric sinusitis are rare, but potentially life-threatening. These include cavernous sinus thrombosis, orbital and intracranial extension, and meningitis. Children with these complications may experience significant morbidity from their infection. In such cases, delay in diagnosis and treatment may lead to irreparable brain damage or death. We report a case of sinusitis causing a subdural empyema in an otherwise healthy immunocompetent adolescent boy. PMID:18155385

Waseem, Muhammad; Khan, Saqiba; Bomann, Scott



Halifax clamps: efficacy and complications in posterior cervical stabilization  

Microsoft Academic Search

BACKGROUND Trauma, neoplasia, rheumatoid arthritis. Down's syndrome, and inflammatory conditions are well-known causes of spinal instability. The Halifax clamp is a method of posterior cervical stabilization that is attached to the adjoining laminae and tightened until no movement between involved vertebrae is possible. Our experience with cases that have utilized Halifax interlaminar clamps, their results and complications are presented.METHODS We

Allen H. Maniker; Michael Schulger; Harry L. Duran



Low incidence of pulmonary complications following nonmyeloablative stem cell transplantation  

Microsoft Academic Search

Low incidence of pulmonary complications following nonmyeloablative stem cell transplantation. S. Nusair, R. Breuer, M.Y. Shapira, N. Berkman, R. Or. #ERS Journals Ltd 2004. ABSTRACT: Bone marrow transplantation is associated with pulmonary opportunistic infections and immune-mediated pulmonary processes such as idiopathic pneumonia syndrome and bronchiolitis obliterans. The aim of the present study was to test the hypothesis that nonmyeloablative stem

S. Nusair; R. Breuer; M. Y. Shapira; N. Berkman



Bickerstaff's brainstem encephalitis complicating Salmonella Paratyphi A infection  

Microsoft Academic Search

Patients with enteric fever frequently develop neurological complications during their illness. Among them, majority has encephalopathy, but focal deficits or peripheral nervous involvements are occasionally encountered. We describe a young woman who developed a neurological syndrome consistent with Bickerstaff's brainstem encephalitis, with symptoms and signs including convulsion, impaired consciousness, external ophthalmoplegia, ataxia, bulbar palsy and pyramidal signs, following Salmonella Paratyphi

Bun Sheng; Wing Sze Ho; Kwok Kwong Lau; Dilys Choi Yu Lui; Bosco Hoi Shiu Lam; Eric Yuk Tat Chan



Treating complicated grief and substance use disorders: A pilot study  

Microsoft Academic Search

Empirically supported treatments for co-occurring substance use disorders (SUDs) and grief problems are lacking, despite the salience of grief pathology in substance abusers. Identification of a syndrome of complicated grief, distinct from bereavement-related depression and anxiety, led to the development of a targeted treatment, but this treatment has not been tried with persons with SUDs. We recruited 16 adults with

Allan Zuckoff; Katherine Shear; Ellen Frank; Dennis C. Daley; Karen Seligman; Russell Silowash



Neuromuscular complications in HIV  

Microsoft Academic Search

HIV affects many organs of the body, including the nervous system. As a result, a series of neurologic complications have\\u000a created challenges for scientists and clinicians alike. Among these, HIV-associated neuropathy and myopathy may occur at all\\u000a stages of the disease process. Of the neuropathies, distal symmetrical polyneuropathy is the most common form. The pathogenesis\\u000a of primary HIV neuropathy is

Susama Verma; Elena Micsa; Lydia Estanislao; David Simpson



Neurologic Complications of Sarcoma  

Microsoft Academic Search

Sarcomas are a heterogeneous group of tumors that rarely involve the nervous system. Neurologic effects of sarcoma are more\\u000a often due to tumors outside of the central nervous system. However, as long-term survival rates in childhood sarcoma improves,\\u000a reports of late neurologic complications have increased. With recent advances in treating local sarcomas with targeted molecular\\u000a therapies, the incidence of late

Santosh Kesari; Lara J. Kunschner


Muscle Injury and Complications  

Microsoft Academic Search

\\u000a Muscle injuries are common in the sporting population. Imaging plays a vital role in the detection and\\/or characterization\\u000a of the injury pattern as well as assessing complications. More recently, research has shown that imaging can be used as a\\u000a prognostic indicator for return to play and risk of recurrence. This chapter describes the imaging techniques and anatomical\\u000a characteristics of normal

Abhijit Datir; David A. Connell


[Stomatitis in childhood, not always benign].  


Two boys of 1 and 16 year had painful buccal lesions and were admitted for dehydration. The younger had finger and toe blisters; the older, severely ill, had conjunctivitis, urethritis and skin lesions. Only symptomatic treatment with lidocaine gel and paracetamol gave good recovery. A 5-year-old Turkish girl had recurrent painful buccal ulcers which each time cleared up spontaneously. Stomatitis is common in childhood. Viral infections are the most common causes of stomatitis, in particular infections with herpes simplex virus (herpes gingivostomatitis), Coxsackie virus (herpangina, hand-foot-mouth-disease), chickenpox and infectious mononucleosis. Bacterial infections are rare and mostly secondary to the viral infections. In infants oral candidiasis (thrush) is a common cause of stomatitis. Most infections are self-limiting and reassurance of parents is important. Dehydration is a common complication and admission to hospital can be prevented by analgesics. The most important non-infectious conditions that cause stomatitis in children are recurrent aphthous stomatitis, erythema multiforme major (Stevens-Johnson syndrome), Behçet's disease, malignancy (leukaemia), immune-mediated disorders (agranulocytosis, cyclic neutropenia), traumata, blistering disorders of the skin and lichen planus. A complete history and a thorough physical examination usually give the correct diagnosis and further investigations are seldom necessary. PMID:11072515

Oudshoorn, A M; Ramaker, C



Mycoplasma pneumoniae-associated mucositis with minimal skin manifestations.  


Mycoplasma pneumoniae-associated mucositis is a rarely described complication of M. pneumoniae infection presenting with ocular, oral, and genital involvement but without the typical skin lesions seen in Stevens-Johnson syndrome. A 27-year-old man with a past history of asthma presented at the emergency room with a 1-week history of cough (initially non-productive but subsequently associated with non-bloody mucopurulent sputum), fever, myalgias, headache, and progressive dyspnea. Two days before admission he had commenced amoxicillin/clavulanic acid with no improvement. The patient reported bilateral conjunctival injection and hemorrhagic ulcers on the lips commencing the day prior to admission. Physical examination revealed fever (39 degrees C), bilateral exudative conjunctivitis, painful hemorrhagic ulcers on the lips, tongue, and oral mucosa, small scrotal erosions, erythema of the penile meatus, and small erythematous bullae on the dorsum of each hand; subsequently, the patient developed bullae at the venipuncture site on his right arm. Laboratory tests revealed positive IgM serology for M. pneumoniae, with titer elevation. The patient was successfully treated with levofloxacin and prednisolone. Our case appears to be the first adult patient described with M. pneumoniae-associated mucositis, which has previously been reported only in pediatric patients. This is also the first reported instance of a case of M. pneumoniae-associated mucositis treated with levofloxacin and prednisolone. M. pneumoniae infection should be considered in all cases of mucositis, and treatment of this condition with levofloxacin and prednisolone seems to be effective. PMID:18973408

Figueira-Coelho, João; Lourenço, Sofia; Pires, Ana Cristina; Mendonça, Paula; Malhado, José António



[Emergencies related to visceral and genital drepanocytic thrombotic complications (author's transl)].  


Thrombotic complications in drepanocytemia may induce 3 main syndromes: splenic infarctions and abscesses; severe and uncontrollable hematurias; priapism. Clinical features and surgical treatments are described with detailed procedures for priapism surgery. PMID:723571

Carayon, A; Ferro, R


Bickerstaff's brainstem encephalitis complicating Salmonella Paratyphi A infection.  


Patients with enteric fever frequently develop neurological complications during their illness. Among them, majority has encephalopathy, but focal deficits or peripheral nervous involvements are occasionally encountered. We describe a young woman who developed a neurological syndrome consistent with Bickerstaff's brainstem encephalitis, with symptoms and signs including convulsion, impaired consciousness, external ophthalmoplegia, ataxia, bulbar palsy and pyramidal signs, following Salmonella Paratyphi A infection. This is the first case report of this syndrome after S. Paratyphi A infection, and it is the second case of Bickerstaff's brainstem encephalitis complicating enteric fever reported in the literature. This case also demonstrated, for the first time, a positive anti-GQ1b IgG response in a patient with Bickerstaff's brainstem encephalitis and related disorders that appear as complications during enteric fever. PMID:21232772

Sheng, Bun; Ho, Wing Sze; Lau, Kwok Kwong; Lui, Dilys Choi Yu; Lam, Bosco Hoi Shiu; Chan, Eric Yuk Tat



Sheehan's syndrome.  


Sheehan's syndrome (SS) is characterized by various degrees of hypopituitarism, and develops as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. Increased pituitary volume, small sella size, disseminated intravascular coagulation and autoimmunity are the proposed factors in the pathogenesis of SS. Hormonal insufficiencies, ranging from single pituitary hormone insufficiency to total hypopituitarism, are observed in patients. The ?rst most important issue in the diagnosis is being aware of the syndrome. Lack of lactation and failure of menstrual resumption after delivery that complicated with severe hemorrhage are the most important clues in diagnosing SS. The most frequent endocrine disorders are the deficiencies of growth hormone and prolactin. In patients with typical obstetric history, prolactin response to TRH seems to be the most sensitive screening test in diagnosing SS. Other than typical pituitary deficiency, symptoms such as anemia, pancytopenia, osteoporosis, impairment in cognitive functions and impairment in the quality of life are also present in these patients. Treatment of SS is based on the appropriate replacement of deficient hormones. Growth hormone replacement has been found to have positive effects; however, risk to benefit ratio, side effects and cost of the treatment should be taken into account. PMID:23245206

Kilicli, Fatih; Dokmetas, Hatice Sebila; Acibucu, Fettah



Renal transplant complications.  


Clinical monitoring and appropriate imaging have played an important role to ensure a successful outcome for renal transplant patients. A variety of imaging options now exist, and they are routinely used in these patients. Ultrasound is the most frequent first-line imaging method in the post-operative period and for long-term follow-up. For specific indications, magnetic resonance imaging, computed tomography, and nuclear medicine examinations are often helpful. This article will review the imaging findings of the most commonly encountered complications of renal transplantation. PMID:23793411

Weber, Therese M; Lockhart, Mark E



Complications of pancreatic surgery  

PubMed Central

Pancreatic resection is the only treatment option that can lead to a meaningful prolonged survival in pancreatic cancer and, in some instances, perhaps a potential chance for cure. With the advent of organ and function preserving procedures, its use in the treatment of chronic pancreatitis and other less common benign diseases of the pancreas is increasing. Furthermore, over the past two decades, with technical advances and centralization of care, pancreatic surgery has evolved into a safe procedure with mortality rates of <5%. However, postoperative morbidity rates are still substantial. This article reviews the more common procedure-related complications, their prevention and their treatment.

Ho, Choon-Kiat; Kleeff, Jorg; Friess, Helmut



Complication with Intraosseous Access: Scandinavian Users' Experience  

PubMed Central

Introduction: Intraosseous access (IO) is indicated if vascular access cannot be quickly established during resuscitation. Complication rates are estimated to be low, based on small patient series, model or cadaver studies, and case reports. However, user experience with IO use in real-life emergency situations might differ from the results in the controlled environment of model studies and small patient series. We performed a survey of IO use in real-life emergency situations to assess users’ experiences of complications. Methods: An online questionnaire was sent to Scandinavian emergency physicians, anesthesiologists and pediatricians. Results: 1,802 clinical cases of IO use was reported by n=386 responders. Commonly reported complications with establishing IO access were patient discomfort/pain (7.1%), difficulties with penetration of periosteum with IO needle (10.3%), difficulties with aspiration of bone marrow (12.3%), and bended/broken needle (4.0%). When using an established IO access the reported complications were difficulties with injection fluid and drugs after IO insertion (7.4%), slow infusion (despite use of pressure bag) (8.8%), displacement after insertion (8.5%), and extravasation (3.7%). Compartment syndrome and osteomyelitis occurred in 0.6% and 0.4% of cases respectively. Conclusion: In users’ recollection of real-life IO use, perceived complications were more frequent than usually reported from model studies. The perceived difficulties with using IO could affect the willingness of medical staff to use IO. Therefore, user experience should be addressed both in education of how to use, and research and development of IOs.

Hallas, Peter; Brabrand, Mikkel; Folkestad, Lars



Intracranial complications following mastoidectomy.  


Mastoidectomy is a common surgical procedure in otology. However, postoperative complications of various degrees of severity may occur. We present 4 children who underwent mastoidectomy for middle ear and mastoid disease and developed postoperative intracranial complications. One child was operated on for brain abscess 1 week after the initial mastoidectomy. Another child appeared with seizures 5 days after the initial mastoidectomy and a subdural empyema was drained during revision surgery. Large bone defects with exposed middle cranial fossa dura were found at revision surgery in both cases and Proteus vulgaris and methicillin-resistant Staphylococcus aureus were isolated from the mastoid and abscess cavities in these children. A small epidural collection was diagnosed in the third patient 2 days after initial mastoid surgery and was managed with intravenous antibiotics only. The other child was found to have sigmoid sinus thrombosis the day after mastoidectomy that was performed for nonresponsive acute mastoiditis. This child received both intravenous antibiotics and anticoagulants. Timely revision surgery, combinations of third- or fourth-generation cephalosporins with vancomycin or metronidazole and the addition of anticoagulants in cases of sinus thrombosis can lead to full recovery. PMID:15689642

Migirov, Lela; Eyal, Ana; Kronenberg, Jona


Gastrointestinal complications of diabetes.  


Gastrointestinal complications of diabetes include gastroparesis, intestinal enteropathy (which can cause diarrhea, constipation, and fecal incontinence), and nonalcoholic fatty liver disease. Patients with gastroparesis may present with early satiety, nausea, vomiting, bloating, postprandial fullness, or upper abdominal pain. The diagnosis of diabetic gastroparesis is made when other causes are excluded and postprandial gastric stasis is confirmed by gastric emptying scintigraphy. Whenever possible, patients should discontinue medications that exacerbate gastric dysmotility; control blood glucose levels; increase the liquid content of their diet; eat smaller meals more often; discontinue the use of tobacco products; and reduce the intake of insoluble dietary fiber, foods high in fat, and alcohol. Prokinetic agents (e.g., metoclopramide, erythromycin) may be helpful in controlling symptoms of gastroparesis. Treatment of diabetes-related constipation and diarrhea is aimed at supportive measures and symptom control. Nonalcoholic fatty liver disease is common in persons who are obese and who have diabetes. In persons with diabetes who have elevated hepatic transaminase levels, it is important to search for other causes of liver disease, including hepatitis and hemochromatosis. Gradual weight loss, control of blood glucose levels, and use of medications (e.g., pioglitazone, metformin) may normalize hepatic transaminase levels, but the clinical benefit of aggressively treating nonalcoholic fatty liver disease is unknown. Controlling blood glucose levels is important for managing most gastrointestinal complications. PMID:18619079

Shakil, Amer; Church, Robert J; Rao, Shobha S



Acute appendicitis complicating Mitrofanoff procedure.  


The Mitrofanoff urinary diversion is fraught with the complication of cutaneous stomal stenosis, which prevents catheterization. The authors report another sequel of stomal stenosis-acute appendicitis, a complication not reported hitherto. PMID:15300552

Sarin, Yogesh Kumar; Sinha, Arvind



Tobacco-alcohol amblyopia: A rare complication of prolonged alcohol abuse  

PubMed Central

Tobacco-alcohol amblyopia is rare, however, extremely disabling complication seen in patient with alcohol dependence syndrome, which if not addressed properly and at the right time may lead to persisting deficits. We here report a patient of alcohol-dependence syndrome who presented with significant diminution of vision bilaterally in the background of excess alcohol consumption.

Prakash, Jyoti; Ryali, VSSR; Srivastava, K.; Bhat, P. S.; Shashikumar, R.; Singal, A.



Complications of Carotid Artery Stenting  

Microsoft Academic Search

It is important for operators of carotid artery stenting (CAS) to have a thorough understanding of potential complications\\u000a associated with CAS, and strategies to prevent and manage these complications. With improvements in technology and equipments,\\u000a periprocedural complications related to CAS has progressively diminished, especially since the introduction of emboli protection\\u000a devices. The most devastating complications of CAS are stroke and

Jacqueline Saw


Genetics Home Reference: Recombinant 8 syndrome  


... Some affected individuals have recurrent ear infections (otitis media) or hearing loss. Many children with recombinant 8 syndrome do not survive past early childhood, usually due to complications related to their heart ...


Klippel-Trenaunay Syndrome and Pregnancy  

PubMed Central

Klippel-Trenaunay syndrome is a rare congenital vascular disorder, and only few cases have been described in pregnancy. We describe two cases, in one patient without complications, the other patient developed postpartum deep venous thrombosis.

Gungor Gundogan, Tugba; Jacquemyn, Y.



Acute buried bumper syndrome: an endoscopic peg tube salvage approach.  


Acute buried bumper syndrome is an uncommon complication of percutaneous endoscopic gastrostomy (PEG) tube placement. If not recognized and treated appropriately, it can lead to serious complications including death. We report a case of an acute buried bumper syndrome, successfully managed with PEG tube repositioning through the original tract, without the need of replacement. PMID:22842323

Bhat, Ganesh; Suvarna, Deepak; Pai, Cannanore Ganesh



Spontaneous uterine rupture during pregnancy after treatment of Asherman's syndrome.  


The treatment of Asherman's syndrome is often complicated by uterine perforation during hysteroscopic correction. We describe the first reported case of spontaneous uterine rupture with resultant hemorrhage during pregnancy after surgical treatment of Asherman's syndrome. This complication mandates close monitoring of these patients during pregnancy. PMID:2729381

Deaton, J L; Maier, D; Andreoli, J



Fat embolism after liposuction in Klippel-Trenaunay syndrome.  


Fat embolism syndrome (FES) is a rare but potentially fatal postoperative complication from liposuction. We present the case of a 24-year-old woman with Klippel-Trenaunay syndrome who developed FES as a complication of lower extremity liposuction. There may be an increased risk of FES in patients with vascular malformations undergoing liposuction. PMID:23851798

Zeidman, Michael; Durand, Paul; Kundu, Neilendu; Doumit, Gaby



Hypocomplementemic Urticarial Vasculitis Syndrome  

PubMed Central

Hypocomplementemic urticarial vasculitis syndrome, as opposed to urticarial vasculitis or urticarial vasculitis syndrome, is a rare disease process where the exact pathophysiology remains unknown. This article discusses the case of a 34-year-old Hispanic man with an ongoing history of chronic urticaria comprising episodes induced by low ambient temperatures, emotional stress, and spontaneous occurrences. This article serves as a consolidated reference for specialists to comprehensively review the plethora of systemic manifestations that may accompany urticarial vasculitis and highlights new systemic complications reported in association with this disease which are also observed in this case.

Christensen, Jim; McCarty, Morgan