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Adult Still's disease complicated with adult respiratory distress.  


A 65-year-old woman with adult Still's disease developed adult respiratory distress syndrome (ARDS), a fatal pulmonary complication. Intravenous administration of cyclophosphamide, 500 mg/d for three days, was much more effective than high doses of corticosteroids in the patient. Interestingly, hypersensitivity to flavoxate hydrochloride seemed to be a precipitating factor, but not a cause, for both a series of characteristic manifestations of adult Still's disease and development of ARDS in our patient. The association of ARDS with adult Still's disease has not yet been reported. Physicians should be aware of this fatal complication in adult Still's disease, especially in the presence of drug hypersensitivities. PMID:3778078

Hirohata, S; Kamoshita, H; Taketani, T; Maeda, S



A case of adult-onset Still’s disease complicated with atypical pulmonary defect  

Microsoft Academic Search

Adult-onset Still’s disease (AOSD) is an uncommon inflammatory condition of unknown origin and pathogenesis. Pulmonary involvement\\u000a is rare and includes pleural effusion and transient pulmonary infiltrates. We describe and discuss difficulties in the diagnosis\\u000a of severe respiratory symptoms with uncommon radiological and histological findings and serious prognostic implication in\\u000a a 24-year-old woman with a severe form of AOSD with destructive

Yousra Ibn Yacoub; Bouchra Amine; Najia Hajjaj-Hassouni



Adult-onset Still’s disease  

Microsoft Academic Search

Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder characterised by high spiking fever, an evanescent\\u000a salmon pink rash and arthritis, frequently accompanied by sore throat, myalgias, lymphadenopathies, splenomegaly and neutrophilic\\u000a leukocytosis. Aetiology is still unknown, however, it seems that an important role is played by various infectious agents,\\u000a which would act as triggers in genetically predisposed hosts. Diagnosis

Valentina Bagnari; Matteo Colina; Giovanni Ciancio; Marcello Govoni; Francesco Trotta



Sensorineural hearing loss in adult onset Still's disease  

Microsoft Academic Search

A 26 year old man with a nine year history of adult onset Still's disease (AOSD) developed sensorineural hearing loss during an exacerbation of his disease. This complication has not previously been described in association with adult onset Still's disease. He responded favourably to steroid treatment.

H M Markusse; B Stolk; A G van der Mey; J M de Jonge-Bok; K J Heering



[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 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



Weight Loss Is Still an Essential Intervention in Obesity and its Complications: A Review  

PubMed Central

The prevalence of obesity is more than 20% in many developed countries and it increases in developing countries. Obesity is associated with metabolic disorders, cardiovascular diseases, pulmonary diseases, digestive diseases, and cancers. Although other specific treatments for these complications exist, weight loss is still an essential intervention in obesity and its complications. Therapeutic life change, behavior modification, pharmacotherapy, and surgery are major approaches to weight loss. In addition, medicine used in diabetes such as Glucagon-like peptide-1 analogues may be a new type of medicine for obesity, at least for those obese patients with diabetes.

Xiao, Jianzhong; Yang, Wenying



A vanishing disease can still happen.  


Lemierre's syndrome is a rare disease in the antibiotic era which is characterised by oropharyngitis, thrombophlebitis and septic metastases, but it can still occur and early recognition of its characteristic features and commencement of appropriate treatment can be life saving. The case history is described of a middle-aged man with Lemierre's syndrome who made an uneventful recovery following treatment with co-amoxiclav and metronidazole for 6 weeks. PMID:19773506

Ramadan, H K



[Lead fracture--a still frequent cardiac pacemaker complication?].  


The frequency of pacemaker complications has decreased during later periods of observations. The rate of pacing lead fractures has been reported to amount to 6.2%. According to our experience and data based on 3607 pacemaker implantations for over 15 years this retrospective study examines the following parameters: patient's data, year of implantation, interval till fracture, implantation vena, localisation of the fracture and therapeutic measures. In 1% (36 cases) of our pacemaker patients repeating operations were necessary due to lead fractures. In electrodes implanted after 1977 no break could be observed. Tested material and production methods as well as save implantation modus, avoidance of bending, coiling with a short radius and also a tied fixation ligature, can improve the results. PMID:6495910

Jaschke, W; Hoellen, I



Intestinal complications of Behçet's disease.  


We report a case of a young female patient with long-standing oral and genital Behçet's disease (BD), who presented with progressive severe colonic inflammation and perforation, requiring multiple laparotomies. The case had ultimately a favourable outcome despite posing a number of diagnostic and therapeutic challenges. Intestinal complications, although rare, should be considered as important differential diagnoses in patients with BD presenting with abdominal pain, and is a difficult-to-prove differential diagnosis to Crohn's disease. PMID:23917369

Kovacs, D Botond; Ray, Dipak K; Dasgupta, Kaushik; Borowski, David W



Adult-onset Still's disease preceding Crohn's disease.  


Concomitant diagnosis of Crohn's disease and juvenile or adult-onset idiopathic arthritis is rare. It is possible that both conditions share some genetic or immunological defects although sufficient data are lacking. We describe herein the first case of a patient with adult-onset Still's disease who was diagnosed on follow up with concomitant Crohn's disease. A 38-year-old man diagnosed with adult onset Still's disease from the age of 24 was admitted in our hospital because of bloody diarrhea. On admission physical examination was unremarkable and all routine laboratory tests were normal except of Hg at 11.3 gr/dl, erythrocyte sedimentation rate at 27 mm/h and C-reactive protein at 14 mg/dl. Ileocolonoscopy revealed small aphthoid ulcers in the terminal ileum and capsule endoscopy revealed the source of bleeding and small aphthoid ulcers starting from the distal jejunum up to the terminal ileum. Terminal ileum biopsies were diagnostic of Crohn's disease and patient had started on therapy with mesalamine 2 gr/day and azathioprine 2mg/kg and is currently on multidisciplinary follow up. We review all literature on co-existence of Crohn's disease with chronic idiopathic arthritis and we discuss the possible difficulties in diagnosis and therapy of those patients also in the view of the new biological agents. PMID:22704661

Katsanos, Konstantinos H; Siozopoulou, Vasiliki; Sigounas, Dimitrios; Tsianos, Vasileios E; Christodoulou, Dimitrios; Mitsi, Vasiliki; Tsianos, Epameinondas V



Biliary Tract Complications after Orthotopic Liver Transplantation: Still the “Achilles Heel”?  

Microsoft Academic Search

Postoperative biliary tract complications after liver transplantation (LT) still lead to early and late morbidity and mortality. Modern interventional endoscopic techniques can replace surgical repair as the first line of treatment. Nevertheless surgical intervention plays an important role in specific situations. We performed a retrospective analysis of patients with biliary complications after LT over a 12-year period. We compared treatment

A. Perrakis; T. Förtsch; V. Schellerer; W. Hohenberger; V. Müller



Abdominal tuberculosis: still a potentially lethal disease.  


The findings in a 4-yr survey of 82 patients with abdominal tuberculosis are described and compared with those encountered in previous surveys. Fourteen cases of intestinal, 11 of mesenteric-lymphnodal, and 57 of peritoneal tuberculosis were identified. The disease occurred essentially in patients living under worsening socioeconomic conditions, and 51 of them had associated pulmonary tuberculosis. Symptoms and clinical findings were again nonspecific, but newer imaging, endoscopic, and other invasive procedures were helpful in establishing a definite diagnosis. In addition, adenosine deaminase determination showed great promise as a noninvasive diagnostic procedure in patients with tuberculous ascites. The six hospital deaths in the series highlight the hazard of potentially lethal delays in early diagnosis and treatment, even in centers with a high awareness of the disease. PMID:8480741

Lingenfelser, T; Zak, J; Marks, I N; Steyn, E; Halkett, J; Price, S K



Neurologic complications of renal disease.  


Renal failure and its treatment are associated with a number of neurologic complications that must be differentiated from the nervous system complications of the disease leading to renal failure. Uremic encephalopathy is characterized by clinical signs of depressed brain function coexisting with excitation, often in the form of generalized epileptic seizures. Peripheral neuropathy, due to axonal involvement, is common and is characterized by ascending sensory and motor dysfunction. The treatment of renal failure also may lead to the development of neurologic abnormalities in the form of dialysis disequilibrium characterized by headache, nausea, irritability that may progress to seizures, coma, and death, which is caused by the entry of free water into the brain and swelling. Dialysis dementia, caused by the toxic effects of aluminum, is now rare. Renal transplant recipients may develop cerebrovascular disease, infections by opportunistic organisms, or malignant neoplasms, particularly primary lymphoma of the brain. As transplant recipients live longer and more operations are performed, additional complications may be seen in the future. PMID:2549362

Lockwood, A H



Chronic Kidney Disease and Its Complications  

PubMed Central

Chronic kidney disease (CKD) is a complex disease impacting more than twenty million individuals in the United States. Progression of CKD is associated with a number of serious complications, including increased incidence of cardiovascular disease, hyperlipidemia, anemia and metabolic bone disease. CKD patients should be assessed for the presence of these complications and receive optimal treatment to reduce their morbidity and mortality. A multidisciplinary approach is required to accomplish this goal.

Thomas, Robert; Kanso, Abbas; Sedor, John R.



[Cardio-respiratory involvement in adult-onset Still's disease].  


Cardiopulmonary involvement in adult-onset Still's disease is not as common as cutaneous and articular involvement. Pleuropericarditis is the most frequent thoracic manifestation. Although difficult, diagnosis of other thoracic manifestations, which may reveal the disease, is crucial, due to the high risk to life and the efficacy of new immunosuppressive agents. The pathophysiology involves essentially immunological factors, Still's disease being increasingly seen as an autoimmune inflammatory disease. Pro-inflammatory cytokines such as interleukine (IL) 1, 6 and 18 play a crucial role in macrophage activation, which is central in the pathophysiology of adult Still's disease. The classification of cardiopulmonary manifestations is based on anatomy. Cardiac lesions may involve all the tissues of the heart and the pulmonary arteries. Respiratory lesions may involve the pleura, the lung parenchyma (organizing pneumonitis, infiltrative lung disease, alveolar damage, amyloidosis), and the respiratory muscles, including the diaphragm. Finally, some manifestations may be provoked by the treatment itself. Steroids, the first-line treatment, are very effective in pleuropericarditis. Methotrexate used to be prescribed when steroids failed, but biotherapies such as IL1 and IL6 inhibitors have transformed the prognosis of forms resistant to these drugs. PMID:23664285

Lethrosne, C; Pernot, B; Diot, P; Diot, E



Adult onset still's disease: Clinical features and course  

Microsoft Academic Search

Summary  Fiftieen patients with adult onset Still's disease are described, all diagnosed according to recognized criteria. Mean delay in reaching a firm diagnosis was 16 months. Besides the typical clinical picture, there was a high frequency of pruriginous rash, one instance of overlapping polymyositis and recurrent systemic manifeistations in most cases. Chronic polyarticular involvement predominated, with radiological progression particularly in wrist,

D. M. Sánchez Loria; M. J. Moreno Alvarez; J. A. Maldonado Cocco; E. J. Scheines; O. D. Messina



Adult-Onset Still's Disease: From Pathophysiology to Targeted Therapies  

PubMed Central

Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder affecting primarily young individuals. The diagnosis is primarily clinical and necessitates the exclusion of a wide range of mimicking disorders. Given the lack of solid data in regard to the underlying pathogenetic mechanisms, treatment of AOSD has been for years largely empirical. Recent advances have revealed a pivotal role of several proinflammatory cytokines such as tumor necrosis factor-? (TNF-?), interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-18 (IL-18) in disease pathogenesis, giving rise to the development of new targeted therapies aiming at optimal disease control.

Mavragani, Clio P.; Spyridakis, Evangelos G.; Koutsilieris, Michael



Chronic Anemia and Thrombocytosis as the Initial Presentation of Still’s Disease in an Elderly Patient  

Microsoft Academic Search

Still’s disease is very rare in elderly patients. We report a case of Still’s disease in an elderly patient that had an atypical initial presentation. A 76-year-old woman developed unexplained chronic anemia and thrombocytosis. Three years later she had acute onset of high fever, arthritis, maculopapular rash, pleuritic chest pain, abdominal pain, lymphadenopathy and elevated erythrocyte sedimentation rate. Rheumatoid factor

Luis M. Vilá; María J. Molina



Do you still need a biopsy to diagnose celiac disease?  

Microsoft Academic Search

Celiac disease is a common and permanent condition caused by an abnormal immune response to ingested gluten in genetically\\u000a susceptible individuals. Its proper diagnosis is very important even in patients presenting with mild symptoms because severe\\u000a and debilitating complications may occur in celiac patients not following a strict gluten-free diet. In the past several years,\\u000a important progress has been made

Stefano Guandalini; Puneet Gupta



Hemophagocytic syndrome secondary to adult-onset still's disease but very similar to lymphoma  

PubMed Central

Hemophagocytic syndrome (HPS) is a clinicopathologic entity characterized by increased proliferation and activation of benign macrophages with hemophagocytosis throughout the reticuloendothelial system. HPS may be primary, or secondary to malignancy, infections, auto-immune diseases and pharmacotherapy. In patients with adult-onset Still’s disease (AOSD), HPS is a rare but life-threatening complication. Herein, we described a female patient with HPS secondary to AOSD. During the therapy, giant gastric ulcer similar to lymphoma developed after treatment with corticosteroid and nonsteroidal anti-inflammatory drugs.

Zhang, Xin-Hua; Han, Yong-Mei; Wang, Wen-Wen; Cheng, Hao; Zhu, Ke-Jian



Pure Red Cell Aplasia with Adult Onset Still's Disease  

PubMed Central

Adult Onset Still's Disease (AOSD) is a rare inflammatory syndrome mostly seen in young adults. Known for its wide range of clinical manifestations, AOSD often presents with nonremitting systemic signs and symptoms. Many rare case associations have been described with AOSD, but only few with pure red cell aplasia (PRCA). We are presenting a fourth known case of a young female adult with AOSD and PRCA in the literature.

Robillard, Nicholas; Nguyen, Paul Van; Wistaff, Robert



Cardiovascular complications of pediatric chronic kidney disease  

PubMed Central

Cardiovascular disease (CVD) mortality is a leading cause of death in adult chronic kidney disease (CKD), with exceptionally high rates in young adults, according to the Task Force on Cardiovascular Disease. Recent data indicate that cardiovascular complications are already present in children with CKD. This review summarizes the current literature on cardiac risk factors, mortality and morbidity in children with CKD.



Renal complications of fabry disease.  


Fabry disease is a progressive devastating disease caused by absent or deficient activity of lysosomal enzyme alphagalactosidase A, with progressive accumulation of globotriaosylceramide (GL-3) within lysosomes in a different cell types. Accumulation of GL-3 and related glycosphingolipids in different cell types may create diverse clinical picture depending on the organ which is dominantly affected. Renal pathology progresses in severity with aging. Globotryaosil ceramide deposits may be found in different cell types within the kidney. Deposition within the glomeruli may be found in endothelial cells, mesangial cells, interstitial cells, with the highest level found within the podocytes. Although Fabry disease is not curable at the moment, availability of enzyme replacement therapy made it possible to treat this group of patients. Two formulations of recombinant human alpha-galactosidase A are present on the market: agalsidase alfa and agalsidase beta. Longer follow-up period is necessary to estimate the impact of ERT on mortality. Patients with end-stage renal disease caused by Fabry disease could be safely treated with enzyme replacement therapy regardless of the method of renal replacement therapy. PMID:23448456

Basic-Jukic, Nikolina; Kes, Petar; Coric, Marijana; Basic-Kes, Vanja



Anti-Interleukin-1 Agents in Adult Onset Still's Disease  

PubMed Central

Interleukin 1? (IL-1?) is emerging as a master mediator of adult onset Still's disease (AOSD) pathogenesis. This pleiotropic cytokine, whose expression is under the control of the inflammasome pathway, has a wide type of effects. As a key mediator of innate immunity is a potent pyrogen and facilitates neutrophilic proliferation and diapedesis into the inflamed tissues, which are key AOSD manifestations. The study of proinflammatory cytokines profiles in sera and pathological tissues of AOSD patients has shown elevated levels of IL-1?, these levels being highly correlated with disease activity and severity. These experimental evidences and the analogy with other autoinflammatory diseases that share with AOSD clinical and biological characteristics have suggested the blockade of IL-1? as a possible new therapeutic option for the AOSD, especially in conventional therapy resistant cases. Anakinra, the first anti-IL-1 agent put on the market, has demonstrated capable to induce a rapid response sustained over time, especially in systemic forms, where anti-TNF? failed to control symptoms. While a growing number of evidences supports the utilisation of anakinra in AOSD, a new generation of anti-IL1? antagonists is developing. Canakinumab and rilonacept, thanks to their higher affinity and longer half-life, could improve the management of this invalidating disease.

Giampietro, Cecilia; Fautrel, Bruno



Anti-Interleukin-1 Agents in Adult Onset Still's Disease.  


Interleukin 1? (IL-1?) is emerging as a master mediator of adult onset Still's disease (AOSD) pathogenesis. This pleiotropic cytokine, whose expression is under the control of the inflammasome pathway, has a wide type of effects. As a key mediator of innate immunity is a potent pyrogen and facilitates neutrophilic proliferation and diapedesis into the inflamed tissues, which are key AOSD manifestations. The study of proinflammatory cytokines profiles in sera and pathological tissues of AOSD patients has shown elevated levels of IL-1?, these levels being highly correlated with disease activity and severity. These experimental evidences and the analogy with other autoinflammatory diseases that share with AOSD clinical and biological characteristics have suggested the blockade of IL-1? as a possible new therapeutic option for the AOSD, especially in conventional therapy resistant cases. Anakinra, the first anti-IL-1 agent put on the market, has demonstrated capable to induce a rapid response sustained over time, especially in systemic forms, where anti-TNF? failed to control symptoms. While a growing number of evidences supports the utilisation of anakinra in AOSD, a new generation of anti-IL1? antagonists is developing. Canakinumab and rilonacept, thanks to their higher affinity and longer half-life, could improve the management of this invalidating disease. PMID:22611515

Giampietro, Cecilia; Fautrel, Bruno



Dermatopathic lymphadenopathy in a patient with adult onset Still's disease.  


Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown cause characterized by high fever accompanied by systemic manifestations. Since AOSD consists of heterogeneous symptoms and has no definite diagnostic tool, the diagnosis is based upon exclusive criteria. Dermatopathic lymphadenopathy (DL) is characterized by a localized paracortical proliferation of histiocytes and deposition of melanin in the lymph nodes. DL is not only a reactive hyperplasia of the lymph nodes, but has also been reported to be associated with hematological malignancies such as cutaneous T cell lymphoma (CTCL) and Hodgkin's lymphoma. It is therefore important to evaluate CTCL or Hodgkin's lymphoma in a patient with DL, in order to both rule out hematological malignancy and diagnose AOSD. In this report, we first describe a 37-year-old patient with AOSD whose biopsy of lymph node was proved to be DL. PMID:17543161

Lee, S-W; Park, M-C; Kim, H; Park, Y-B; Lee, S-K


Complications of Suppurative Otitis Media: Still a Problem in the 21st Century  

Microsoft Academic Search

The purpose of this study was to review the incidence of complicated suppurative otitis media in 10 years at a tertiary referral university hospital. During this period, 3,364 patients with suppurative otitis media (acute and chronic) were admitted to the department. The number of patients presenting with complications was 422 (12.54%). The ratio of extracranial to intracranial complications was nearly

Badr Eldin Mostafa; Lobna M. El Fiky; Mohammed M. El Sharnouby



Complications of gastro-oesophageal reflux disease.  


Gastro-oesophageal reflux disease (GORD) is on the rise with more than 20% of the western population reporting symptoms and is the most common gastrointestinal disorder in the United States. This increase in GORD is not exactly clear but has been attributed to the increasing prevalence of obesity, changing diet, and perhaps the decreasing prevalence of H. pylori infection. Complications of GORD could be either benign or malignant. Benign complications include erosive oesophagitis, bleeding and peptic strictures. Premalignant and malignant lesions include Barrett's metaplasia, and oesophageal cancer. Management of both the benign and malignant complications can be challenging. With the use of proton-pump inhibitors, peptic strictures (i.e., strictures related to reflux) have significantly declined. Several aspects of Barrett's management remain controversial including the stage in the disease process which needs to be intervened, type of the intervention and surveillance of these lesions to prevent development of high grade dysplasia and oesophageal adenocarcinoma. PMID:23998980

Parasa, S; Sharma, P



Q Fever: An Old but Still a Poorly Understood Disease  

PubMed Central

Q fever is a bacterial infection affecting mainly the lungs, liver, and heart. It is found around the world and is caused by the bacteria Coxiella burnetii. The bacteria affects sheep, goats, cattle, dogs, cats, birds, rodents, and ticks. Infected animals shed this bacteria in birth products, feces, milk, and urine. Humans usually get Q fever by breathing in contaminated droplets released by infected animals and drinking raw milk. People at highest risk for this infection are farmers, laboratory workers, sheep and dairy workers, and veterinarians. Chronic Q fever develops in people who have been infected for more than 6 months. It usually takes about 20 days after exposure to the bacteria for symptoms to occur. Most cases are mild, yet some severe cases have been reported. Symptoms of acute Q fever may include: chest pain with breathing, cough, fever, headache, jaundice, muscle pains, and shortness of breath. Symptoms of chronic Q fever may include chills, fatigue, night sweats, prolonged fever, and shortness of breath. Q fever is diagnosed with a blood antibody test. The main treatment for the disease is with antibiotics. For acute Q fever, doxycycline is recommended. For chronic Q fever, a combination of doxycycline and hydroxychloroquine is often used long term. Complications are cirrhosis, hepatitis, encephalitis, endocarditis, pericarditis, myocarditis, interstitial pulmonary fibrosis, meningitis, and pneumonia. People at risk should always: carefully dispose of animal products that may be infected, disinfect any contaminated areas, and thoroughly wash their hands. Pasteurizing milk can also help prevent Q fever.

Honarmand, Hamidreza



Complications of Therapy in Parkinson's Disease  

PubMed Central

Despite several more effective combinations, the incidence of disability and intractable complications from levodopa therapy for Parkinson's disease is unchanged. Many of these appear to be related to the development of denervation hypersensitivity as well as to drug tolerance and loss of effect. They include dyskinesia, `wearing off' phenomenon, `on-off' phenomenon, and various psychic changes. More current forms of therapy with bromocriptine and drug holidays are described, emphasizing methods of preventing and controlling the incapacitating complications associated with long term drug therapy. Some future therapeutic considerations are also described.

Kofman, Oscar S.



Histological healing in inflammatory bowel disease: a still unfulfilled promise.  


Treatment of inflammatory bowel disease (IBD) is traditionally based on several drugs, including salicylates, corticosteroids, and antibiotics; in addition, the therapeutic armamentarium has considerably evolved with the advent of newer, effective therapeutic measures (such as the biological agents) that are able to improve in a considerable manner both the clinical and endoscopic variables. Thus, mucosal healing, at least considered from an endoscopic point of view, is today regarded as the ultimate endpoint for treatment of these conditions. However, it is also increasingly clear that endoscopic healing is not necessarily paralleled by histological healing; There are few doubts that the latter should be considered as a true, objective healing and the ultimate goal to reach when treating patients with IBD. Unfortunately, and surprisingly, only a few, incomplete, and somewhat conflicting data exist on this topic, especially because there is still the need to standardize both histological assessment and the severity grading of these disorders; Issues that have not been yet been resolved for clinical practice and therapeutic trials. Hopefully, with the help of an increased awareness on the clinical researchers' side, and the availability of dedicated pathologists on the other side, this matter will be effectively faced and resolved in the near future. PMID:23467585

Villanacci, Vincenzo; Antonelli, Elisabetta; Geboes, Karel; Casella, Giovanni; Bassotti, Gabrio



Two cases of adult Still’s disease with abnormally high level of telomerase activity in peripheral blood mononuclear cells  

Microsoft Academic Search

We report two patients with adult Still’s disease with an abnormally high level of telomerase activity. The first patient was a 61-year-old woman. The mean telomerase activity value for peripheral blood mononuclear cells of healthy adults measured by our method was 0.13 ± 0.03, whereas that in this patient during the active phase was abnormally high, at more than 27.56.

Daitaro Kurosaka; Jun Yasuda; Isamu Kingetsu; Chiho Yasuda; Ken Yoshida; Yasuhiko Toyokawa; Toru Yokoyama; Akio Yamada



Complications of HIV disease and antiretroviral therapy.  


Studies on the efficacy of and drug interactions with the hepatitis C virus (HCV) direct-acting antivirals (DAAs) in HCV/ HIV coinfection were a highlight of the 2012 Conference on Retroviruses and Opportunistic Infections. The addition of an HCV protease inhibitor (PI) to pegylated interferon alfa/ribavirin increased HCV cure rates by 30% to 35% in HCV genotype 1 treatment-naive HIV-coinfected patients, an increase similar to that observed in HIV-uninfected HCV-infected patients. Drug interactions with antiretrovirals can be complex, and DAAs are recommended for use only with antiretroviral drugs for which pharmacokinetic data are available. Further drug interaction and clinical data are needed to ensure the safe coadminstration of DAAs with antiretroviral therapy. The conference placed continued emphasis on pathogenesis, management, and prevention of the long-term complications of HIV disease and its therapies, including cardiovascular disease, lipodystrophy, renal disease, alterations in bone metabolism, and vitamin D deficiency, along with a growing focus on biomarkers to predict development of end-organ disease. HIV has increasingly been recognized as a disease of accelerated aging, manifested by increased progression of vascular disease, cellular markers of aging, and a heightened risk of certain non-AIDS-defining malignancies. This year's conference also highlighted data on diagnosis, prevention, and complications of tuberculosis coinfection as well as the treatment and prevention of coinfections that are common with HIV, including cryptococcal meningitis, influenza, and varicella zoster. PMID:22710907

Luetkemeyer, Anne F; Havlir, Diane V; Currier, Judith S


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.



Renal complications of Fabry disease in children.  


Fabry disease is an X-linked ?-galactosidase A deficiency, resulting in accumulation of glycosphingolipids, especially globotriaosylceramide, in cells in different organs in the body. Renal failure is a serious complication of this disease. Fabry nephropathy lesions are present and progress in childhood while the disease commonly remains silent by routine clinical measures. Early and timely diagnosis of Fabry nephropathy is crucial since late initiation of enzyme replacement therapy may not halt progressive renal dysfunction. This may be challenging due to difficulties in diagnosis of Fabry disease in children and absence of a sensitive non-invasive biomarker of early Fabry nephropathy. Accurate measurement of glomerular filtration rate and regular assessment for proteinuria and microalbuminuria are useful, though not sensitive enough to detect early lesions in the kidney. Recent studies support the value of renal biopsy in providing histological information relevant to kidney function and prognosis, and renal biopsy could potentially be used to guide treatment decisions in young Fabry patients. This review aims to provide an update of the current understanding, challenges, and needs to better approach renal complications of Fabry disease in children. PMID:22898981

Najafian, Behzad; Mauer, Michael; Hopkin, Robert J; Svarstad, Einar



A case of refractory adult-onset Still's disease treated with anakinra.  


Adult-onset Still's disease (AOSD) often presents both a diagnostic and a therapeutic challenge. We report a 40-year-old Chinese woman, in whom multiple adjustments of drug combinations were required before successful control of the patient's disabling symptoms. The patient failed multiple therapies including non-steroidal anti-inflammatory drugs, glucocorticoid, methotrexate (MTX), cyclosporine, leflunomide and infliximab. Treatment was complicated by hyperglycemia, glucocorticoid-induced osteoporosis, worsening hypertension and vaginal candidiasis. She suffered recurrent hospitalisation for active disease, developed carpal joint erosions and lost her employment over the course of 1 year. In view of refractoriness to multiple conventional therapies, anakinra was initiated in combination with MTX with a rapid and sustained improvement in clinical and laboratory parameters over 12 months. However, radiographic damage ensued despite aggressive therapies. PMID:20704609

Lahiri, Manjari; Teng, Gim-Gee



Antioxidants and cardiovascular disease: Still a topic of interest.  


Cardiovascular disease constitutes a major public health concern in industrialised nations. Over recent decades, a large body of evidence has accumulated indicating that free radicals play a critical role in cellular processes implicated in atherosclerosis. Herein, we present a mechanism of oxidative stress, focusing mainly on the development of an oxidised low density lipoprotein, and the results of a clinical trial of antioxidant therapy and epidemiological studies on the relationships between nutrient antioxidants, such as vitamin E, vitamin C, ?-carotene, coenzyme Q, flavonoids and L-arginine, and coronary events. These studies indicated that a diet high in antioxidants is associated with a reduced risk of cardiovascular disease, but did not confirm a strong causality link. With regard to vitamin E, observational studies suggested that the daily use of at least 400 International Units of vitamin E is associated with beneficial effects on coronary events. However, it is apparently too early to define the clinical benefits of vitamin E for cardiovascular disease. From the results of several randomised interventional trials, it appears that no single antioxidant given to subjects at high doses has substantial benefits, and the question of whether nutrient antioxidants truly protect against cardiovascular disease remains open. This article provides an overview of the epidemiological and clinical studies related to antioxidants and cardiovascular disease. PMID:21432304

Nojiri, Shuko; Daida, Hiroyuki; Inaba, Yutaka



Should diabetes still be considered a coronary artery disease equivalent?  


Diabetes is well established as a cardiovascular risk factor and is currently regarded as a coronary artery disease equivalent. However, some recent data have contradicted the concept. We review the currently available data and usefulness or otherwise of this concept. While the concept of coronary artery disease equivalence has served to highlight the importance of diabetes as a risk factor, it has a number of problems. We propose that it would be more useful to consider diabetes as a myocardial infarction risk equivalent. This is not only more precise and in line with the literature but also conveys better the message that patients with diabetes and one or more previous myocardial infarction(s) are at even higher risk. PMID:22885535

Magri, Caroline J; Fava, Stephen



Antioxidants and cardiovascular disease: Still a topic of interest  

Microsoft Academic Search

Cardiovascular disease constitutes a major public health concern in industrialised nations. Over recent decades, a large body\\u000a of evidence has accumulated indicating that free radicals play a critical role in cellular processes implicated in atherosclerosis.\\u000a Herein, we present a mechanism of oxidative stress, focusing mainly on the development of an oxidised low density lipoprotein,\\u000a and the results of a clinical

Shuko Nojiri; Hiroyuki Daida; Yutaka Inaba



Inflammatory bowel disease in Nigerians: still a rare diagnosis?  


Inflammatory bowel disease (IBD) has been thought to have a low incidence among subSaharan Africans mainly because of the sporadic cases reported from the continent in comparison with the larger numbers reported from North America and Western European countries. Is this difference based on real demographic susceptibilities or a reflection of lower level of healthcare delivery? Three cases of ulcerative colitis and one case of Crohn's disease diagnosed in a tertiary institution in northern Nigeria in the span of three years are reported. Their presentation coincided with the creation of the Gastrointestinal Surgery Unit of our hospital and with it the availability of endoscopic diagnostic procedures. All four patients were indigenous Nigerians. Our findings suggest that IBD may be more common in this part of the world than previously thought. With an increased awareness of the disease in our population, a greater utilization of modern medicine as against alternative medicine and with wider availability of diagnostic tools in our hospitals, it is our guess that more cases may be found in the future to dispel the belief that Africans are somewhat immune to this affliction. PMID:21691027

Ukwenya, A Y; Ahmed, A; Odigie, V I; Mohammed, A


Neurological complications of anderson-fabry disease.  


Characteristic clinical manifestations of AFD such as acroparesthesias, angiokeratoma, corneal opacity, hypo/ and anhidrosis, gastrointestinal symptoms, renal and cardiac dysfunctions can occur in male and female patients, although heterozygous females with AFD usually seem to be less severely affected. The most prominent CNS manifestations consist of cerebrovascular events such as transient ischaemic attacks (TIAs) and (recurrent) strokes. For the most part, CNS complications in AFD have been attributed to cerebral vasculopathy, including anatomical abnormalities. The natural history of Fabry patients includes transitory cerebral ischaemia and strokes, even in very young persons of both genders. The mechanism is partly due to vascular endothelial accumulation of Gb-3. White matter lesions (WML) on occur MRI. Both males and females can be safely treated with enzyme replacement; and thus screening for Fabry disease of young stroke populations should be considered. There are, however, no hard data of treatment effect on mortality and morbidity. Stroke in Anderson-Fabry disease study of 721 patients with cryptogenic stroke, aged 18-55 years, showed a high prevalence of Fabry disease in this group: 5% (21/432) of men and 3% (7/289) of women. Combining results of both sexes showed that 4% of young patients with stroke of previously unknown cause had Fabry disease, corresponding to about 1-2% of the general population of young stroke patients. Cerebral micro- and macro-vasculopathy have been described in Fabry disease. Neuronal globotriaosylceramide accumulation in selective cortical and brain stem areas including the hippocampus has been reported by autopsy studies in FD, but clinical surrogates as well as the clinical relevance of these findings have not been investigated so far. Another Neurologic hallmark of Fabry disease (FD) includes small fiber neuropathy as well as cerebral micro- and macroangiopathy with premature stroke. Cranial MRI shows progressive white matter lesions (WML) at an early age, increased signal intensity in the pulvinar, and tortuosity and dilatation of the larger vessels. Conventional MRI shows a progressive load of white matter lesions (WMLs) due to cerebral vasculopathy in the course of FD. Another study has been conducted to quantify brain structural changes in clinically affected male and female patients with FD. The peripheral neuropathy in Fabry disease manifests as neuropathic pain, reduced cold and warm sensation and possibly gastrointestinal disturbances. Patients with Fabry disease begin having pain towards the end of the first decade of life or during puberty. Children as young as 6 years of age have complained of pain often associated with febrile illnesses with reduced heat and exercise tolerance. The patients describe the pain as burning that is often associated with deep ache or paresthesiae. Some patients also have joint pain. A high proportion of patients with Fabry disease is at increased risk of developing neuropsychiatric symptoms, such as depression and neuropsychological deficits. Due to both somatic and psychological impairment, health-related quality of life (QoL) is considerably reduced in patients with Fabry disease. Targeted screening for Fabry disease among young individuals with stroke seems to disclose unrecognized cases and may therefore very well be recommended as routine in the future. Furthermore, ischemic stroke is related to inflammation and arterial stiffness and no study had addressed this relationship in patients with AF disease and cerebrovascular disease, so this topic could represent a possible future research line. PMID:23448452

Tuttolomondo, Antonino; Pecoraro, Rosaria; Simonetta, Irene; Miceli, Salvatore; Arnao, Valentina; Licata, Giuseppe; Pinto, Antonio



Adamantiades-Behcet's disease-complicated gastroenteropathy  

PubMed Central

Adamantiades-Behcet’s disease (ABD) is a chronic, relapsing, systemic vasculitis of unknown etiology. It is more prevalent in populations along the ancient Silk Road from Eastern Asia to the Mediterranean Basin, and most frequently affects young adults between the second and fourth decades of life. ABD-complicated gastroenteropathy is a significant cause of morbidity and mortality, with abdominal pain as the most common symptom. The ileocecal region is affected predominantly, with ulcerations that may lead to penetration and/or perforation, whereas other parts of the gastrointestinal system including the esophagus and stomach can also be affected. Endoscopy is useful to locate the site and extent of the lesions, and tissue biopsy is often warranted to examine the histopathology that is often suggestive of underlying vasculitis of small veins/venules or, alternatively in some cases, nonspecific inflammation. Bowel wall thickening is the most common finding on computed tomography scan. Treatment is largely empirical since well-controlled studies are difficult to conduct due to the heterogeneity of the disease, and the unpredictable course with exacerbation and remission. Corticosteroids with or without other immunosuppressive drugs, such as cyclophosphamide, azathioprine, sulfasalazine, tumor necrosis factor ? antagonist or thalidomide should be applied before surgery, except in emergency.

Wu, Qing-Jun; Zhang, Feng-Chun; Zhang, Xuan



Adamantiades-Behcet's disease-complicated gastroenteropathy.  


Adamantiades-Behcet's disease (ABD) is a chronic, relapsing, systemic vasculitis of unknown etiology. It is more prevalent in populations along the ancient Silk Road from Eastern Asia to the Mediterranean Basin, and most frequently affects young adults between the second and fourth decades of life. ABD-complicated gastroenteropathy is a significant cause of morbidity and mortality, with abdominal pain as the most common symptom. The ileocecal region is affected predominantly, with ulcerations that may lead to penetration and/or perforation, whereas other parts of the gastrointestinal system including the esophagus and stomach can also be affected. Endoscopy is useful to locate the site and extent of the lesions, and tissue biopsy is often warranted to examine the histopathology that is often suggestive of underlying vasculitis of small veins/venules or, alternatively in some cases, nonspecific inflammation. Bowel wall thickening is the most common finding on computed tomography scan. Treatment is largely empirical since well-controlled studies are difficult to conduct due to the heterogeneity of the disease, and the unpredictable course with exacerbation and remission. Corticosteroids with or without other immunosuppressive drugs, such as cyclophosphamide, azathioprine, sulfasalazine, tumor necrosis factor ? antagonist or thalidomide should be applied before surgery, except in emergency. PMID:22363131

Wu, Qing-Jun; Zhang, Feng-Chun; Zhang, Xuan



Adult-onset Still's disease and pregnancy: about ten cases and review of the literature.  


Little is known about the interactions between adult-onset Still's disease (AOSD) and pregnancy. In an attempt to clarify the link between these 2 conditions, we retrospectively analyzed patients registered as suffering from AOSD seen in our university hospital. A total of 57 patients, among them 30 women, were diagnosed. Ten pregnancies in 8 women were identified. Three cases manifested AOSD in their first trimester, all treated with prednisone. Premature births and flares occurred in 2 patients. One patient developed a monocyclic AOSD during her second pregnancy's postpartum. In the 4 other cases, AOSD was known and quiescent before pregnancy. One patient had 2 pregnancies without any flare or complication. One patient experienced her first pregnancy while under treatment and presented a late flare 8 months after delivery. The third patient developed exacerbation in the first trimester of her second pregnancy which was treated with IgIV alone. The last one presented her first pregnancy 7 years after diagnosis. A prednisone-treated systemic flare occurred during the first trimester without later complication. Based on our own experience and the analysis of only two series of the literature, including, respectively, 4 and 5 patients, we suggest that two settings could be distinguished. First, AOSD can occur during pregnancy and can be responsible for obstetrical complications. Then, in patients with known AOSD, the second trimester and postpartum appear to be periods exposing to disease recurrence. Thus, we recommend a close multidisciplinary monitoring by a rheumatologist and an obstetrician prior to, during and after pregnancies. PMID:23624554

Gerfaud-Valentin, M; Hot, A; Huissoud, C; Durieu, I; Broussolle, C; Seve, P



[Enterocolitis as a complication of late-diagnosed Hirschsprung disease].  


Enterocolitis is the most serious complication of Hirschsprung disease. Early management of these patients can decrease the severity of this complication. Hirschsprung disease is more common in patients with trisomy 21 than in the general population. Furthermore, the risk of developing enterocolitis is higher in this population. We report on an infant with trisomy 21 who developed enterocolitis as a complication of Hirschsprung disease that was diagnosed late when the infant presented with septic shock leading to death of the patient. PMID:22766198

Tournier-Astruc, C; Auber, F; Renolleau, S; de Suremain, N; Bourgain-Nguyen, C; Armengaud, J-B; Delamar, A-L; Batard, C; Agogue, M; Carbajal, R



Crohn's disease complicated by strictures: a systematic review.  


The occurrence of strictures as a complication of Crohn's disease is a significant clinical problem. No specific antifibrotic therapies are available. This systematic review comprehensively addresses the pathogenesis, epidemiology, prediction, diagnosis and therapy of this disease complication. We also provide specific recommendations for clinical practice and summarise areas that require future investigation. PMID:23626373

Rieder, Florian; Zimmermann, Ellen M; Remzi, Feza H; Sandborn, William J



Pulmonary Complications of Collagen Vascular Disease in Pregnancy  

Microsoft Academic Search

Collagen vascular diseases (CVD) are a heterogeneous group of chronic auto-immune diseases frequently complicated by pulmonary\\u000a involvement. The respiratory system may be involved in any of its components: airways, pleura, parenchyma, vessels, or respiratory\\u000a muscles. However, interstitial lung disease and pulmonary hypertension (PH) are the most severe complications. CVD often affects\\u000a childbearing women, thus management of pregnant women with collagen

Stéphanie Pouwels-Fry; Isabelle Tillie-Leblond; Benoît Wallaert


A case of adult onset Still's disease with flare of arthritis.  


Adult onset Still's disease is a febrile illness of unknown aetiology, accounting for about 6% cases of fever of unknown origin. It was first described by Eric GL Bywater in 1971, and since then few case series have been reported from India and other parts of the globe. A case of adult onset Still's disease who presented with fever and polyarthralgia of 18 months duration with flare of joint symptoms during fever spikes has been reported. PMID:24003576

Sen, Krishna; Ghosh, Udas Chandra; Mukherjee, Apurba Kumar; Ghosal, Anirban; Pandey, Umesh Kumar



A case of refractory adult-onset Still’s disease successfully controlled with tocilizumab and a review of the literature  

Microsoft Academic Search

Adult-onset Still’s disease (AOSD) is an uncommon systemic inflammatory disease of unknown aetiology. Up to 80% of AOSD cases\\u000a can be controlled with corticosteroids; however, reports on those unresponsive to corticosteroids, conventional disease modifying\\u000a drugs and biological agents, including anti-IL1 inhibitors, are emerging. We present a case of AOSD with severe poylarthritis\\u000a unresponsive to corticosteroids, methotrexate, anakinra and etanercept, but

Katja Perdan-Pirkmajer; Sonja Praprotnik; Matija Tomši?



Cardiac catheter complications related to left main stem disease.  

PubMed Central

OBJECTIVE: To examine the incidence and outcome of cardiac catheter complications related to left main coronary artery disease or damage using the CECCC (Confidential Enquiry into Cardiac Catheter Complications) database. SETTING: Coordinating centre for national database. DESIGN: Retrospective analysis of reports to a national multicentre database for cardiac catheter complications. Complications involving the left main coronary artery were flagged at entry. Where necessary additional information was sought from participating centres. 112,921 procedures were registered, 12,849 of which were coronary angioplasties and the remainder diagnostic studies. RESULTS: The total number of cases for which complications were recorded was 993 (0.88%). In 61 (6.14%) of the 993 cases complications were associated with left main coronary disease or damage. In 57 (93%) of these 61 cases complications were major, necessitating resuscitation or immediate coronary bypass grafting. Ten patients (16%) died in the catheter laboratory, a further 9 (15%) within 24 hours, and a total of 23 patients (38%) died within one month of the procedure. Left main stem related complications account for 17% of total mortality in the CECCC database. Urgent coronary bypass grafting was attempted in 42 patients, of whom 31 were alive at one month. In all of the six reported PTCA-related complications the cause was traumatic damage to the left main coronary artery. Operators of all grades of seniority experienced complications in similar proportions. CONCLUSIONS: The risk of a complication relating to the left main stem is relatively low, but when such complications occur they tend to be life-threatening and contribute a fifth of total catheter-related mortality. In the absence of a widely available non-invasive investigation with good predictive value for left main stem disease, the best safeguard is careful technique. Patients who do develop complications should have emergency coronary bypass grafting.

Kovac, J. D.; de Bono, D. P.



[Uveitis: late complication of undiagnosed Whipple disease].  


We report a case of severe chronic bilateral uveitis in a 60-year-old white man without neurological manifestations. Spondylarthritis and isolated malabsorption suggested the diagnosis of Whipple's disease. A normal duodenal biopsy delated the diagnosis, who was secondarily demonstrated an adenopathy biopsy and macrophage study on vitrectomy sample (macrophage distended by periodic acid-Schiff positive material). With 1 year follow-up the uveitis was rapidly and completely cured by an antibiotic association (rifampicin and trimethoprim-sulfamethoxazol). The characteristics of ocular involvement in Whipple's disease and treatment of the disease are discussed. PMID:7481157

Wechsler, B; Fior, R; Reux, I; Cassou, N; Phuc, L H; Merle-Beral, H; Ziza, J M; Godeau, P



Celiac disease: how complicated can it get?  

Microsoft Academic Search

In the small intestine of celiac disease patients, dietary wheat gluten and similar proteins in barley and rye trigger an\\u000a inflammatory response. While strict adherence to a gluten-free diet induces full recovery in most patients, a small percentage\\u000a of patients fail to recover. In a subset of these refractory celiac disease patients, an (aberrant) oligoclonal intraepithelial\\u000a lymphocyte population develops into

Jennifer May-Ling Tjon; Jeroen van Bergen; Frits Koning



[Treatment for Pott's disease with neurological complication].  


Tuberculosis of the spine (Pott's disease) is the most common skeletal involvement in tuberculosis, and is often accompanied with neurological deficiency. Surgical treatment was previously the mainstay of therapy in cases of Pott's disease with neurological deficiency, but since clinical recovery was found in patients awaiting surgery, conservative management with antibiotic treatment as a first Line treatment has been advocated. This conservative approach may improve the patients' neurological status while avoiding the morbidity and mortality of surgical treatment. PMID:21678648

Avisar, Erez; Smorgick, Yossi; Mirovsky, Yigal; Gelfer, Yael; Lindner, Dror; Yoram, Anekstein



Adult Onset Still's Disease: A Case Report with a Rare Clinical Manifestation and Pathophysiological Correlations  

PubMed Central

Adult-onset Still's disease is an inflammatory multisystemic disease of unknown etiology. Pleuritis is the most common pulmonary manifestation and pleural effusions are usually exudates with a predominance of neutrophils. We report a case of an eosinophilic pleural effusion as a novel and hitherto unrecognized manifestation of active adult-onset Still's disease. We also observed a marked NLRP3 inflammasome activation with increased production of IL-1? which coincided with the development and resolved upon remission of the pleural effusion suggesting a possible novel pathogenetic pathway for the development of pleural effusions in the context of the auto-inflammatory disorders.

Antoniou, Katerina M.; Margaritopoulos, George A.; Giannarakis, Ioannis; Choulaki, Christianna; Fountoulakis, Nikos; Siafakas, Nikos M.; Sidiropoulos, Prodromos



Neuropsychiatric complications of chronic kidney disease  

Microsoft Academic Search

Evidence is emerging that cognitive impairment, delirium and depression are very common in patients with renal disease. All of these conditions are associated with prolonged hospitalization and an increased risk of mortality. A good understanding of these conditions is key to their prevention, early intervention and management. This Review summarizes the clinical features of various forms of cognitive dysfunction that

Rory McQuillan; Sarbjit V. Jassal



Treatment- and Disease-Related Complications of Prostate Cancer  

PubMed Central

One of the highlights of the 16th International Prostate Cancer Update was a session on treatment- and disease-related complications of prostate disease. It began with presentation of a challenging case of rising prostate-specific antigen levels after radical prostatectomy, followed by an overview of the use of zoledronic acid in prostate cancer, a review of side effects of complementary medicines, an overview of complications of cryotherapy, an assessment of complications of brachytherapy and external beam radiation therapy, and a comparison of laparoscopy versus open prostatectomy.

Simoneau, Anne R



Cardiovascular complications of collagen vascular disease  

Microsoft Academic Search

Opinion statement  \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Collagen vascular diseases commonly affect the heart; cardiovascular events are the major cause of mortality in people with\\u000a these diseases.\\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a A striking feature of the cardiac involvement in individuals with systemic lupus erythematosus (SLE) and rheumatoid arthritis\\u000a is aggressive and accelerated atherosclerosis; women with SLE in the 35-to 44-year-old age group are more than 50 times

Gary E. Sander; Thomas D. Giles



Complications of treatment of Hodgkin's disease in children  

SciTech Connect

An analysis of complications of therapy requires long-term and frequent followup. Reported here is a review of 179 consecutive children with Hodgkin's disease from Stanford University Medical Center who were seen, treated, and followed over a 20-year period. Complications of treatment are related to the extent of disease and the aggressiveness of therapy. Severe complications from radiotherapy are associated with high-dose, extended-field treatment in preadolescent children. Severe chemotherapy-associated complications include immunosuppression, sterility, and secondary oncogenesis. As cure rates are increasingly optimistic among children with Hodgkin's disease, successful treatment with minimal morbidity remains our greatest challenge. Therapy programs require continual refinement utilizing assessment of short- and long-term side effects of treatment.

Donaldson, S.S.; Kaplan, H.S.



Complications and prognostic factors in Vogt-Koyanagi-Harada disease  

Microsoft Academic Search

PURPOSE: To identify associations between complications of disease and final visual acuity in patients with Vogt-Koyanagi-Harada disease and to identify prognostic factors for disease outcome.METHODS: All patients diagnosed with Vogt-Koyanagi-Harada disease at the Doheny Eye Institute or the Los Angeles County\\/University of Southern California Medical Center between 1983 and 1997 were reviewed. Data extracted included initial and final visual acuities,

Russell W Read; Aida Rechodouni; Neil Butani; Richard Johnston; Laurie D LaBree; Ronald E Smith; Narsing A Rao



Still's disease, lupus-like syndrome, and silicone breast implants. A case of 'ASIA' (Shoenfeld's syndrome).  


In recent years, four conditions, siliconosis, Gulf War syndrome (GWS), macrophagic myofasciitis syndrome (MMF) and post-vaccination phenomena, were linked to a previous exposure to an adjuvant, suggesting a common denominator, and it has been proposed to incorporate comparable conditions under a common syndrome entitled Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA). We report a case of a female who at the age of 11 years was diagnosed with Still's disease. At the age of 22 she underwent silicone breast implants and presented with a transient lupus-like syndrome. Then, at 25 years old she had a severe activation of Still's disease in association with rupture of silicone breast implants. When the prostheses were removed, the clinical picture improved. This case fulfills the criteria for ASIA and complements seven previous reports of Still's disease in association with silicone breast implants. PMID:22235044

Jara, L J; Medina, G; Gómez-Bañuelos, E; Saavedra, M A; Vera-Lastra, O



Chronic myeloid leukemia in a woman with Still's disease treated with 198Au synoviorthesis.  


A 32-year-old woman presented with chronic myeloid leukemia 20 years after 2 198Au synoviortheses to her knees for severe juvenile rheumatoid arthritis. She progressed to blast phase of her disease and died from complications of therapy. The literature on rheumatoid arthritis, its therapy, radioisotopes and leukemia is reviewed. PMID:1865420

Lipton, J H; Messner, H A



Late complications of therapy of Hodgkin's disease: prevention and management.  


Patients diagnosed with Hodgkin's disease have a high cure rate. However, long-term survivors of the disease are at significantly increased risk for many late complications. The most serious late effects faced by these patients include the development of a second malignancy or cardiovascular disease. Ongoing trials investigating treatment reduction, including using lower radiation dose, smaller radiation field size, and abbreviated chemotherapy, will hopefully help in limiting the treatment-related complications. Continued long-term follow-up of survivors, careful documentation of the broad range of late effects, identification of risk factors, development and evaluation of screening programs, and preventative therapy for specific late complications are important steps in improving the survival and quality of life of patients who have been cured of Hodgkin's disease. PMID:14695846

Ng, Andrea K; Mauch, Peter M



Ground-glass-like hepatocellular inclusions in the course of adult-onset Still's disease.  


Ground-glass hepatocytes are the cardinal biopsy feature of chronic hepatitis B virus (HBV) infection and may also be present in other specific conditions, including Lafora's disease, cyanamide aversion therapy for alcohol use, patients with transplantation, uremia, and metabolic disorders. In this report, we present the case of a patient with adult-onset Still's disease who underwent percutaneous liver biopsy, which revealed ground-glass-like cytoplasmic inclusions and which is a very unusual finding. PMID:19802652

Sari, Ay?egul; Tunakan, Mine; Ozmen, Mustafa; Turkkan, Ebru



Dermatologic complications of chronic venous disease: medical management and beyond.  


Patients with venous insufficiency commonly develop complications which can result in significant morbidity and occasional mortality. Venous leg ulcers, the most prevalent type of lower extremity ulcer, are the most frequent sequela of venous insufficiency and negatively affect quality of life for the patient. Most have focused on venous ulceration, but other complications may arise including dermatitis, atrophie blanche, lipodermatosclerosis, and malignancy. Contact dermatitis is a common complication seen in the treatment of venous disease. Patients with venous insufficiency have a disrupted epidermal barrier, making them more susceptible than the general population to contact sensitization and subsequent dermatitis. Venous dermatitis is often the first manifestation of venous insufficiency and needs to be addressed promptly. Atrophie blanche, an end point of a variety of conditions, appears as atrophic plaques of ivory white skin with telangiectasias. Lipodermatosclerosis is an indurated plaque in the medial malleolus which can, at times, be quite tender and painful. Malignant degeneration is a rare but important complication of venous disease since tumors which develop in the setting of an ulcer tend to be more aggressive. Pain is a feature of venous disease often overlooked and commonly undertreated. Finally, psychosocial issues such as anxiety and depression are more common in patients with venous disease and should be adequately addressed. Recognizing these complications of chronic venous insufficiency is important as early intervention is the key to preventing unnecessary patient suffering and discomfort. PMID:17823046

Barron, Gregory S; Jacob, Sharon E; Kirsner, Robert S



Extracardiac complications in adults with congenital heart disease.  


With the increasing number of adults living with repaired, or unrepaired, congenital heart disease, there is a growing incidence of extracardiac comorbidities. These comorbidities can affect various organ systems in complex ways, and may have a significant impact on a patient's quality of life and survival. Many of these potential complications may go undiagnosed until there is already a significant bearing on the patient's life. Therefore, it is important for physicians who care for the adult congenital patient to be mindful of these potential extracardiac complications, and actively assess for these complications in their adult congenital practice. Continued research to identify modifiable risk factors is needed so that both preventative and therapeutic management options for these extracardiac complications may be developed. PMID:23663434

Cohen, Scott B; Ginde, Salil; Bartz, Peter J; Earing, Michael G



Osteomalacia can still be a point of attention to celiac disease  

PubMed Central

Summary Celiac disease (CD), a malabsorption syndrome with a genetic base, is a consequence of hypersensitivity to GLUTEN-containing foods. CD can manifest with classic symptoms; however, some unusual features like osteomalacia that has become more and more rare, may be the presenting symptom. We describe here a case of osteomalacia secondary to delayed diagnosis of celiac disease. This patient complained about progressive limping, weakness, short stature, and skeletal deformities. Radiological and laboratory findings were all in favor of osteomalacia. Celiac disease was mentioned according to the history of subtle intermittent diarrhea, abdominal discomfort and confirmed with intestinal biopsy and detection of specific autoantibodies. Improvement of patient’s weakness and laboratory abnormalities was obvious after treatment with gluten free diet, vitamin D, calcium and other trace elements. In conclusion, this case affirms that chronic celiac disease especially untreated one, can lead to irreversible complications like skeletal deformities and short stature.

Sahebari, Maryam; Sigari, Sara Yousefi; Heidari, Hossein; Biglarian, Omid



The Still Divided Academy: How Competing Visions of Power, Politics, and Diversity Complicate the Mission of Higher Education  

ERIC Educational Resources Information Center

|"The Still Divided Academy" is a wonderful examination of the academic community that shows their inner workings by addressing a broad range of issues including: academic politics, tenure, perceived and real political imbalance, academic freedom, and diversity. Administrators, professors, and students have very different priorities, values, and…

Rothman, Stanley; Kelly-Woessner, April; Woessner, Matthew



The Still Divided Academy: How Competing Visions of Power, Politics, and Diversity Complicate the Mission of Higher Education  

ERIC Educational Resources Information Center

"The Still Divided Academy" is a wonderful examination of the academic community that shows their inner workings by addressing a broad range of issues including: academic politics, tenure, perceived and real political imbalance, academic freedom, and diversity. Administrators, professors, and students have very different priorities, values, and…

Rothman, Stanley; Kelly-Woessner, April; Woessner, Matthew



Cardiovascular complications in sickle cell disease: Clinical and echocardiographic features  

Microsoft Academic Search

Sickle cell disease (SCD) is an autossomal recessive disorder and one of the most common genetic disorder in our miscegenated brazilian population. The cardiovascular and pulmonary complications remain the prime cause of morbidity and mortality in SCD. The aim of the study was to report the clinical and echocardiographics features in a population with documented SCD,recruited from the Rio de

João Carlos Tress; Monica A. Oliveira; Lílian S. Costa; Cantidio Drumond Neto; Katia Motta



A Case of Adult-Onset Still's Disease Presenting with Urticated Plaques and Acute Myopericarditis  

PubMed Central

Adult onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown etiology characterized by spiking fever, evanescent skin rash, arthralgia or arthritis, involvement of various organs, and predominantly neutrophilic leucocytosis. AOSD, although uncommon, has a characteristic constellation of clinical and laboratory features and should be considered in the differential diagnosis of pyrexia of unknown origin associated with a rash and arthralgia. The diagnosis is one of clinical suspicion and it is essential that infections, malignancy, and other rheumatic diseases are excluded. We report a case which illustrates the typical features of AOSD that were treated with steroids and azathioprine.

Said, Noor Hanif; Wong, Siew Ngoh; Tan, Wei Hsia



Inflammatory bowel diseases: A disease (s) of modern times? Is incidence still increasing?  

PubMed Central

Inflammatory bowel diseases (IBD) are a heterogeneous group of diseases, not always easy to diagnose, even more difficult to classify, and diagnostic criteria are not always uniform. Well done population-based studies are not abundant, and so comparisons among different geographical areas or populations are not always very reliable. In this article, we have reviewed epidemiological studies available on the world’s population while making a critical review of published data.

Gismera, Cristina Saro; Aladren, Beatriz Sicilia



Kümmell's disease, an uncommon and complicated spinal disorder: a review.  


Kümmell's disease is an uncommon and complicated spinal condition first described in 1891. Patients develop a kyphosis in the lower thoracolumbar spinal region months to years after sustaining an otherwise asymptomatic minor spinal trauma. The patho physiology, clinical presentation, imaging and treatment options of this disease remain controversial. The most widely accepted hypothetical patho physiology is avascular osteonecrosis. The intravertebral vacuum cleft phenomenon is considered a radiographic sign of avascular osteonecrosis of the vertebral body and is highly suggestive of Kümmell's disease. Treatment options include nonsurgical and surgical treatment, and percutaneous vertebral augmentation. The primary aims of surgical treatment of Kümmell's disease are neural decompression and stabilization of the spinal column. Surgery can involve an anterior, posterior, or combined anterior and posterior approach. Surgery and percutaneous vertebral augmentation provide significant symptomatic relief, functional improvement and deformity correction. Treatment of this disease must be individualized according to the stage of disease and the experience and preference of the surgeon. PMID:22613401

Li, H; Liang, C-Z; Chen, Q-X



Vasculature and Kidney Complications in Sickle Cell Disease  

PubMed Central

Recent developments in sickle cell disease include the concept of a vasculopathic state and the classification of sickle cell disease into a hemolysis-endothelial dysfunction phenotype or a viscosity-vasoocclusion phenotype. The hemolysis-endothelial dysfunction phenotype largely reflects deficiency of or resistance to nitric oxide. In addition to discussing these areas, we suggest that the hemolysis-endothelial dysfunction phenotype also reflects the instability of sickle hemoglobin, the release of heme, and the induction of heme oxygenase-1. From these perspectives the renal complications of sickle cell disease are discussed and classified.

Katusic, Zvonimir S.



Ferritin in Adult-Onset Still's Disease: Just a Useful Innocent Bystander?  

PubMed Central

Background. Adult-Onset Still's Disease (AOSD) is an immune-mediated systemic disease with quotidian-spiking fever, rash, and inflammatory arthritis. Hyperferritinemia is a prominent feature, often used for screening. Methods. The key terms “ferritin” and “hyperferritinemia” were used to search PubMed and Medline and were cross-referenced with “Still's Disease.” Results. Hyperferritinemia, although nonspecific, is particularly prevalent in AOSD. While most clinicians associate ferritin with iron metabolism, this is mostly true for the H isoform and not for the L isoform that tends to increase dramatically in hyperferritenemia. In these situations, hyperferritinemia is not associated with iron metabolism and may even mask an underlying iron deficiency. We review, in systematic fashion, the current basic science and clinical literature regarding the regulation of ferritin and its use in the diagnosis and management of AOSD. Conclusion. Serum hyperferritinemia in AOSD has been described for 2 decades, although its mechanism has not yet been completely elucidated. Regulation by proinflammatory cytokines such as interleukin (IL)-1b, IL-6, IL-18, MCSF, and INF-? provides a link to the disease pathogenesis and may explain rapid resolution of hyperferritinemia after targeted treatment and inhibition of key cytokines.

Mehta, Bella; Efthimiou, Petros



Efficacy and Complications of Surgery for Crohn's Disease  

PubMed Central

Patients with Crohn's disease commonly undergo surgery during their lifetime. Indications for surgical intervention include obstruction, intra-abdominal or perianal abscess, enterocutaneous fistulas, and complex perianal disease. As medical therapies continue to improve, it is important that surgical therapies are chosen carefully. This is particularly important in the treatment of perianal fistulas; combined surgical and medical therapy offer the best chance for success. In the treatment of small-bowel disease, bowel preservation is key. For the repair of short strictures, endoscopic dilatation is the preferred method when accessible; strictureplasty has been shown to be safe and effective for increasingly longer segments of disease. Intra-abdominal abscesses should be drained percutaneously, if possible. In the presence of colonic disease, segmental resection is recommended. Unfortunately, refractory disease still frequently requires complete proctectomy and permanent diversion.

Lewis, Robert T.



Transvaginal approach for repair of rectovaginal fistulae complicating Crohn's disease.  

PubMed Central

The management of rectovaginal fistulae complicating Crohn's disease is difficult and often unsatisfactory. Between December 1983 and November 1988, 13 patients with Crohn's disease underwent repair of rectovaginal fistulae via a transvaginal approach. All patients had a diverting intestinal stoma either as part of the initial step in the staged management of intractable perianal disease or concurrent with the repair of the rectovaginal fistula. Each of the patients had low or mid septal fistulae; high fistulae generally are treated transabdominally and are not the focus of this discussion. Fistulae were eradicated in 12 of the 13 women and did not recur during the follow-up period, which averaged 50 months (range, 9 to 68 months). The only treatment failure was a patient who had a markedly diseased colon from the cecum to the rectum and a very low-lying fistula. It is concluded that a modified transvaginal approach is an effective method for repair of rectovaginal fistulae secondary to Crohn's disease.

Bauer, J J; Sher, M E; Jaffin, H; Present, D; Gelerent, I



Gonococcal endocarditis: a rare complication of a common disease  

PubMed Central

This report describes a case of gonococcal endocarditis in a 28 year old male patient with no history of previous valvular heart disease. More cases of gonococcal endocarditis (a rare complication of gonorrhoea) may occur with the increase in the incidence of gonorrhoea and the increase in resistance to ciprofloxacin, which is currently used as the first line agent for the treatment of gonorrhoea in 75% of genitourinary medicine clinics.

Shetty, A; Ribeiro, D; Evans, A; Linnane, S



Cardiovascular complications in autosomal dominant polycystic kidney disease.  


Cardiovascular complications are a major cause of morbidity and mortality in patients with autosomal dominant polycystic kidney disease (ADPKD). Hypertension is a common finding of ADPKD occurring in 50-70% of patients before the impairment of renal function. Stimulation of the renin-angiotensin-aldosterone system plays a major role in the development of hypertension in ADPKD. Hypertension is associated with an increased rate of progression to end-stage renal disease and is the most important potentially treatable variable in these patients. Left ventricular hypertrophy, a major cardiovascular risk factor, is also common in patients with ADPKD. Both hypertension and left ventricular hypertrophy play a crucial role in the development of cardiovascular complications in these patients. Furthermore, endothelial dysfunction, impaired coronary flow velocity reserve, biventricular diastolic dysfunction, increased carotid intima-media thickness, and arterial stiffness are present even in young normotensive patients with ADPKD who have well-preserved renal function. These findings suggest that cardiovascular involvement starts very early in the course of ADPKD. Intracranial and extracranial aneurysms and cardiac valvular defects are other potential cardiovascular problems in patients with ADPKD. A multifactorial approach aiming at all cardiovascular risk factors, such as hypertension, smoking, dyslipidemia and obesity is extremely important in these patients. Early diagnosis and treatment of hypertension, with drugs that block the renin-angiotensin-aldosterone system, has the potential to decrease the cardiovascular complications and slow the progression of renal disease in ADPKD. PMID:23971638

Ecder, Tevfik



[Crohn's disease: a still tourbillon of etiopathogenetic theories and therapeutic strategies. Some implications in the field of urology].  


Despite of scientific efforts over seven decades, the etiopathogenesis of Crohn's disease (CD) remains still unknown. Some conflicting hypotheses are to be settled about etiologic factors as well as on pathogenetic mechanisms. According to some authors, the disease appears to be caused by a congenital lack of patency of mesenteric lymphatic collectors giving rise to lymph-seepage in the corresponding bowel segment with following development of lymphocytic lymphangitis and transparietal phlogosis. Considering this etiopathogenetic philosophy, the surgical therapy has to be performed prompty and has to take the form of segmentary intestinal resection, depending on disease-related intestinal involvement (ileum, ileum plus right colon, ileum plus right and left colon). Other proposed pathogenetic hypotheses for CD refer, instead, to immune-mediated mechanisms, leading to identify this pathology with an abnormal immune inflammatory response in the intestinal wall to one or more undefined antigens, in genetically predisposed person (genetic background). Whereas the prevalent viewpoint is that CD lesions are induced by a dysregulated adaptive-acquired immune system, current studies lead to form the hypothesis that the disease might be initiated by a defective innate immune response. The CD acquired immune profile focuses on T-helper-l (Th1) type, with increasing production of TNF-a, IL-12, Interferon-g and other specific cytokines. In the field of diagnostic imaging, MR findings, 99mTc or 111In labelled autologous leucocyte scintigraphy or 18FDG/PET images strongly correlate with "active" phase of inflammation and contribute to differentiate this condition from established intestinal wall fibrosis, The Montreal classification of inflammatory bowel disease (2005) provides a useful framework for describing CD phenotype and for identifying different serological and genetic markers that may predict the disease course. Urological complications such as renal stones, obstructive uropathy, entero-vescical fistulas, kidney parenchymal disease, are not uncommon. According to immune-mediated pathogenesis-related theories, the basic therapy consist of medical strategies. In the last decades many inflammatory cytokines (TNF-a, IL-12, IL-1, etc.) have been targeted for therapy, particularly in patients with steroid-immunomodulator refractory or fistulizing disease, by achieving a cytokine blockade with monoclonal antibodies. Even regulatory antinflammatory cytokines, such as IL-10 and IL-11, are undergoing trials. In the clinical ground, a better assessment of etiopathogenesis of CD and of the individual case-related evolutive phase, is likely to warrant the selective drug therapies, the avoidance of untimely surgery and the prophylaxis of recurrences. PMID:20426926

Alberti, C



Corticotrophin therapy in juvenile chronic polyarthritis (Still's disease) and effect on growth  

PubMed Central

ACTH therapy will satisfactorily control acute systemic manifestations in Still's disease. In this particular type of patient, ACTH treatment is preferable to oral corticosteroids, because (a) growth can be maintained, and (b) once the acute symptoms are brought under control, ACTH can be withdrawn without difficulty. On the other hand, with ACTH the arthritis is more difficult to control, and here its role may well be as a temporary measure while other drugs, such as gold, can take effect. If corticosteroid therapy cannot be withdrawn well before puberty, then conversion to ACTH should be seriously considered, in order to gain the advantage of the pubertal growth spurt. ACTH dosage should aim to allow endogenous ACTH production to occur. This can be gauged by measuring the 9 a.m. resting plasma cortisol levels 48 hours after ACTH administration. Concurrent use of ACTH and corticosteroids fails to maintain function of the hypothalamic pituitary adrenal axis. ImagesFIG. 7

Zutshi, Derek W.; Friedman, Max; Ansell, Barbara M.



Continuous dopaminergic delivery to minimize motor complications in Parkinson's disease.  


Motor fluctuations and dyskinesias are common sequelae of Parkinson's disease (PD) that may limit function and quality of life. With disease progression, striatal dopamine concentration becomes closely linked to plasma levodopa levels, which vary considerably with standard oral regimens. Exposure of striatal dopamine receptors to wildly fluctuating transmitter levels is thought to contribute to the development of dyskinesias and motor fluctuations. Continuous dopaminergic delivery has been shown to reduce motor complications in advanced PD patients, and has been hypothesized to prevent their incidence when given as early therapy in mild PD. In this article, the authors outline the rationale for continuous dopaminergic delivery and review clinical strategies implementing the concept, including transdermal rotigotine, subcutaneous apomorphine infusion, intraduodenal infusion of levodopa gel and the investigational oral levodopa formulation IPX066. PMID:23739008

Wright, Brenton A; Waters, Cheryl H



Early outcome after emergency gastrectomy for complicated peptic ulcer disease.  


OBJECTIVE. To analyse outcomes of patients who underwent emergency gastrectomy for complicated peptic ulcer disease. DESIGN. Prognostic study on a historical cohort. SETTING. A regional hospital in Hong Kong. PATIENTS. Patients who underwent emergency gastrectomy from 2000 to 2009 in our hospital. MAIN OUTCOME MEASURES. Primary outcome measures were in-hospital mortality and the predictors of such deaths. Secondary outcome measures were 7-day mortality, 30-day mortality, and morbidities. RESULTS. In all, 112 patients had emergency gastrectomies performed for complicated peptic ulcer disease during the study period. In-hospital mortality was 30%. In the univariate analysis, old age, duodenal ulcer, failed primary surgery, gastrojejunostomy anastomosis for reconstruction, hand-sewn technique for duodenal stump closure, use of a sump drain, low haemoglobin level, preoperative blood transfusion, prolonged prothrombin time, and high creatinine or bilirubin levels were associated with an increased risk of in-hospital mortality. In the multivariate analysis, failed primary surgery, old age, and high creatinine level turned out to be independent risk factors. CONCLUSIONS. Emergency gastrectomy should be considered seriously as the primary treatment option in appropriately selected elderly patients, instead of salvage procedures to repair a perforation or control bleeding by plication. PMID:22865172

Cheng, Mina; Li, W H; Cheung, M T



Neurologic Complications of HIV Disease and Their Treatment  

PubMed Central

Substantial work on the peripheral and central nervous system complications of HIV was presented at the 16th Conference on Retroviruses and Opportunistic Infections. Six studies of more than 4500 volunteers identified that distal sensory polyneuropathy remains common, ranging from 19% to 66%, with variation based on disease stage, type of antiretroviral therapy, age, and height. Eight studies of more than 2500 volunteers identified that neurocognitive disorders are also common, ranging from 25% to 69%, with variation based on stage of disease, antiretroviral use, diabetes mellitus, and coinfection with hepatitis viruses. Therapy-focused studies identified that resistance testing of cerebrospinal fluid (CSF)-derived HIV may improve management of people with HIV-associated neurologic complications, that poorly penetrating antiretroviral therapy is associated with persistent low-level HIV RNA in CSF, and that efavirenz concentrations in CSF are low but in the therapeutic range in most individuals. Neuroimaging reports identified that people living with HIV had abnormal findings on magnetic resonance imaging (gray matter atrophy, abnormal white matter), magnetic resonance spectroscopy (lower neuronal metabolites), and blood-oxygen-level dependent functional magnetic resonance imaging (lower cerebral blood flow). Other important findings on the basic neuroscience of HIV and diagnosis and management of neurologic opportunistic infections are discussed.

Letendre, Scott L.; Ellis, Ronald J.; Everall, Ivan; Ances, Beau; Bharti, Ajay; McCutchan, J. Allen



Septic pylephlebitis as a rare complication of Crohn's disease.  


Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn's disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast-enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections. PMID:23624737

Shin, A Ri; Lee, Chang Kyun; Kim, Hyo Jong; Shim, Jae-Jun; Jang, Jae Young; Dong, Seok Ho; Kim, Byung Ho; Chang, Young Woon



GB Virus C/Hepatitis G Virus (GBV-C/HGV): still looking for a disease  

PubMed Central

GB Virus C and Hepatitis G Virus (GBV-C/HGV) are positive, single-stranded flaviviruses. GBV-C and HGV are independent isolates of the same virus. Transmission via the blood-borne route is the commonest mode, although vertical and sexual transmission is well documented. GBV-C/HGV is distributed globally; its prevalence in the general population is 10 fold higher in African countries than in non-African countries. High prevalences of GBV-C/HGV have been found in subjects with frequent parenteral exposure and in groups at high risk of exposure to blood and blood products. The clinical significance of human infection with GBV-C/HGV is currently unclear. The virus can establish both acute and chronic infection and appears to be sensitive to interferon. Only some 12–15% of chronic Non-A, B, C hepatitis cases are infected with GBV-C/HGV. A direct association with liver pathology is still lacking and it is not yet clear as to whether GBV-C/HGV is indeed a hepatotropic virus. Current evidence suggests that the spectrum of association of GBV-C/HGV infection with extrahepatic diseases ranges from haematalogical diseases, aplastic anaemia, human immunodeficiency virus (HIV)-positive idiopathic thrombocytopenia and thalassemia, through to common variable immune deficiency and cryoglobunemia.

Sathar, M A; Soni, P N; York, D



Tocilizumab in the treatment of the adult-onset Still's disease: current clinical evidence.  


This study aimed to review and analyze the effectiveness and safety of tocilizumab in the treatment of patients with adult-onset Still's disease (AOSD). We report on two patients with AOSD who were successfully treated with tocilizumab. All published information on the use of tocilizumab in this disease was also retrieved through a systematic review of the English-language literature. Including our cases, 35 patients were given tocilizumab for AOSD (8 mg/kg/month in 22 patients). The main clinical manifestations were arthritis in all 35 patients and systemic symptoms such as fever or skin rash in 28 (80 %). Thirty-three (94 %) patients had unsuccessfully tried other immunosuppressive agents such as methotrexate, tumor necrosis factor-? blockers, or anakinra. Most of the patients achieved a response with tocilizumab, such as a prompt articular improvement in 30/35 (86 %) patients and a disappearance of systemic symptoms in 27/28 (96 %). Twenty-eight (80 %) patients tapered their steroid intakes, including seven (20 %) who were able to discontinue them. Four (11 %) patients relapsed, and two were successfully retreated with tocilizumab. Regarding safety, tocilizumab is a well-tolerated treatment, but severe side effects such as macrophage activation syndrome or cytomegalovirus reactivation are possible and require ongoing vigilance. Our findings suggest that tocilizumab should probably be proposed in refractory AOSD, as it allows for remission to be induced and the dose of steroid intakes to be reduced. It is a well-tolerated treatment that can be administered according to the therapeutic sequence of rheumatoid arthritis. Further prospective studies are required to assess the better use of this treatment (dosage and duration) and its place among other conventional treatments. PMID:23108887

de Boysson, Hubert; Février, Jérome; Nicolle, Amélie; Auzary, Christophe; Geffray, Loïk





... 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 ...


Two cases of peritonsillar abscess complicated by von Willebrand disease.  


Von Willebrand disease (vWD) is a common hereditary bleeding disorder resulting from a quantitative and/or qualitative deficiency of von Willebrand factor (vWF). We report two cases of peritonsillar abscess complicated by vWD. A 46-year-old Japanese man was intravenously administered factor VIII clotting antigen (500U×3 days)and platelet transfusion (10U), when before puncture was performed. After puncture, his symptoms promptly improved with the administration of the antibiotic doripenem (DRPM, 1.5g/day). He left our facility one week later and had no recurrence of symptoms. A 24-year-old Japanese woman was intravenously administered factor VIII clotting antigen (4500U×3 days) and desmopressin (DDAVP) before undergoing a puncture. Her symptoms promptly improved with DRPM treatment (1.5g/day). The patient left our facility one week later. However, the peritonsillar abscess recurred in three weeks. Afterwards, tonsillectomy was enforced three months later. Intravenous factor VIII clotting antigen (4500U×2 days) and platelet transfusion (10U×1 day) had been used before tonsillectomy. We therefore suggest that a peritonsillar abscess in patients with vWD can be safely treated by factor VIII clotting antigen and DDAVP at the appropriate disease stage and by performing paracentesis for the acute phase or tonsillectomy for the chronic phase. PMID:22075138

Nagano, Hiromi; Harada, Mizue; Umakoshi, Mizuo; Hayamizu, Yoshiko; Yoshifuku, Kosuke; Kurono, Yuichi



Multiple systemic diseases complicated by bisphosphonate osteonecrosis: a case report  

PubMed Central

Summary Aims this work aims at demonstrating that multiple systemic conditions, in association with the development of bisphosphonate associated osteonecrosis of the jaw (ONJ), increase the risk of complications and may lead to hospitalization. For this reason the dental approach to patients with multisystem disease should be carefully managed by a team of specialists. Case report a case of mandibular necrosis associated with intake of oral bisphosphonates in a complex systemic context is described. Results and discussion many different diseases and systemic conditions may draw the line at oral surgery. Multiple treatments (e.g. antithrombotic, calcium channel blockers, diuretics, antibiotics and bisphosphonates) can alter the normal physiological response to tissue healing. Conclusions patients taking bisphosphonates for more than three years (i.e. the term over which the risk of ONJ increases according to the literature, in presence of complex systemic situations, need to be carefully managed during the pre-operative, peri-operative and postoperative phases through a synergistic collaboration among different kind of specialists.

Carini, Fabrizio; Barbano, Lorena; Saggese, Vito; Monai, Dario; Porcaro, Gianluca



Adult-onset Still's disease: can recent advances in our understanding of its pathogenesis lead to targeted therapy?  


Adult-onset Still's disease is a rare systemic inflammatory disease of unknown etiology, characterized by daily high, spiking fevers, evanescent rash, and arthritis. There is no single diagnostic test for adult-onset Still's disease; rather, the diagnosis is based on clinical criteria and necessitates the exclusion of infectious, neoplastic, and other 'autoimmune' diseases. Proinflammatory cytokines such as interleukin (IL)-1, IL-6, and IL-18, interferon-gamma, tumor necrosis factor, and macrophage colony-stimulating factor are elevated in patients with adult-onset Still's disease and are thought to have a major role in the pathogenesis of the disease. Treatment consists of nonsteroidal anti-inflammatory drugs, corticosteroids, immunosuppressants (methotrexate, gold, azathioprine, leflunomide, cyclosporin, and cyclophosphamide), intravenous immunoglobulin, and cytokine (tumor necrosis factor, IL-1 and IL-6) inhibitors. Recent advances in basic immunology have enhanced our ability to hinder the pathogenic mechanisms associated with adult-onset Still's disease and have led to a paradigm shift where targeted treatments have an increasingly important role. PMID:17538564

Efthimiou, Petros; Kontzias, Apostolos; Ward, Carla M; Ogden, Neeta S



Neurological Complications Following Endoluminal Repair of Thoracic Aortic Disease  

SciTech Connect

Open surgery for thoracic aortic disease is associated with significant morbidity and the reported rates for paraplegia and stroke are 3%-19% and 6%-11%, respectively. Spinal cord ischemia and stroke have also been reported following endoluminal repair. This study reviews the incidence of paraplegia and stroke in a series of 186 patients treated with thoracic stent grafts. From July 1997 to September 2006, 186 patients (125 men) underwent endoluminal repair of thoracic aortic pathology. Mean age was 71 years (range, 17-90 years). One hundred twenty-eight patients were treated electively and 58 patients had urgent procedures. Anesthesia was epidural in 131, general in 50, and local in 5 patients. Seven patients developed paraplegia (3.8%; two urgent and five elective). All occurred in-hospital apart from one associated with severe hypotension after a myocardial infarction at 3 weeks. Four of these recovered with cerebrospinal fluid (CSF) drainage. One patient with paraplegia died and two had permanent neurological deficit. The rate of permanent paraplegia and death was 1.6%. There were seven strokes (3.8%; four urgent and three elective). Three patients made a complete recovery, one had permanent expressive dysphasia, and three died. The rate of permanent stroke and death was 2.1%. Endoluminal treatment of thoracic aortic disease is an attractive alternative to open surgery; however, there is still a risk of paraplegia and stroke. Permanent neurological deficits and death occurred in 3.7% of the patients in this series. We conclude that prompt recognition of paraplegia and immediate insertion of a CSF drain can be an effective way of recovering spinal cord function and improving the prognosis.

Morales, J. P.; Taylor, P. R.; Bell, R. E.; Chan, Y. C. [Guy's and St. Thomas' Foundation Hospital NHS Trust, Department of Vascular Surgery (United Kingdom); Sabharwal, T. [Guy's and St. Thomas' Foundation Hospital NHS Trust, Department of Interventional Radiology (United Kingdom); Carrell, T. W. G. [Guy's and St. Thomas' Foundation Hospital NHS Trust, Department of Vascular Surgery (United Kingdom); Reidy, J. F. [Guy's and St. Thomas' Foundation Hospital NHS Trust, Department of Interventional Radiology (United Kingdom)], E-mail:



"Sickle Cell Disease in the Emergency Department: Atypical Complications and Management"  

PubMed Central

Sickle cell disease is the most common inherited blood disorder in the United States. This disorder of hemoglobin structure leads to a chronic hemolytic anemia and complex chronic disease manifested by sudden, severe, and life-threatening complications. These acute complications can occur in any organ system beginning in early childhood and lasting throughout life. The intermittent nature and acuity of these complications lend the emergency department to be an important site of care. The hallmark of sickle cell disease is the vasoocclusive painful event. Other more “typical” complications include fever, acute chest syndrome, priapism, and ischemic stroke. Children with sickle cell disease can also present with other “atypical” complications that can have devastating consequences if they are unrecognized. Detailed discussion of these “atypical” sickle cell disease complications, organized by organ system involved, will be the focus of this article.

Brandow, Amanda M.; Liem, Robert



Increased serum HO1 in hemophagocytic syndrome and adult-onset Still's disease: use in the differential diagnosis of hyperferritinemia  

Microsoft Academic Search

Heme oxygenase-1 (HO-1), an inducible heme-degrading enzyme, is expressed by macrophages and endothelial cells in response to various stresses. Because ferritin synthesis is stimulated by Fe2+, which is a product of heme degradation, we examined the relation between HO-1 and ferritin levels in the serum of patients with hemophagocytic syndrome (HPS), adult-onset Still's disease (ASD), and other diseases that may

Yohei Kirino; Mitsuhiro Takeno; Mika Iwasaki; Atsuhisa Ueda; Shigeru Ohno; Akira Shirai; Heiwa Kanamori; Katsuaki Tanaka; Yoshiaki Ishigatsubo



Successful treatment of a small cohort of patients with adult onset of Still's disease with infliximab: first experiences  

Microsoft Academic Search

OBJECTIVETo test the efficacy of infliximab in the treatment of patients with severe and active adult onset Still's syndrome (AOSD) despite conventional immunosuppressive therapy.PATIENTS AND METHODSSix patients with the diagnosis of AOSD according to the Yamagushi criteria of 1992 were treated with infliximab. All patients had severe disease with high clinical and serological activity. Patients were treated initially with high

H G Kraetsch; C Antoni; J R Kalden; B Manger



Pulmonary vascular complications of chronic liver disease: Pathophysiology, imaging, and treatment  

PubMed Central

To review the pathogenesis of pulmonary vascular complications of liver disease, we discuss their clinical implications, and therapeutic considerations, with emphasis on potential reversibility of the hepatopulmonary syndrome after liver transplantation. In this review, we also discuss the role of imaging in pulmonary vascular complications associated with liver disease.

Khan, Ali Nawaz; Al-Jahdali, Hamdan; Abdullah, Khalid; Irion, Klaus L.; Sabih, Quratulain; Gouda, Alaa



Kidney Diseases Caused by Complement Dysregulation: Acquired, Inherited, and Still More to Come  

PubMed Central

Inherited and acquired dysregulation of the complement alternative pathway plays an important role in multiple renal diseases. In recent years, the identification of disease-causing mutations and genetic variants in complement regulatory proteins has contributed significantly to our knowledge of the pathogenesis of complement associated glomerulopathies. In these diseases defective complement control leading to the deposition of activated complement products plays a key role. Consequently, complement-related glomerulopathies characterized by glomerular complement component 3 (C3) deposition in the absence of local immunoglobulin deposits are now collectively described by the term “C3 glomerulopathies.” Therapeutic strategies for reestablishing complement regulation by either complement blockade with the anti-C5 monoclonal antibody eculizumab or plasma substitution have been successful in several cases of C3 glomerulopathies. However, further elucidation of the underlying defects in the alternative complement pathway is awaited to develop pathogenesis-specific therapies.

Heeringa, Saskia F.; Cohen, Clemens D.



Lifestyle still predicts mortality in older men with established vascular disease  

Microsoft Academic Search

Background.It is uncertain whether accepted associations between health behaviors and mortality are pertinent to elderly people. No previous studies have examined the patterns of lifestyle in elderly men with and without clinically evident vascular disease by using a lifestyle score to predict survival.

Carole A. Spencer; Konrad Jamrozik; Michael Lawrence-Brown; Paul E. Norman



Complications after endovascular stent-grafting of thoracic aortic diseases  

Microsoft Academic Search

BACKGROUND: To update our experience with thoracic aortic stent-graft treatment over a 5-year period, with special consideration for the occurrence and management of complications. METHODS: From December 2000 to June 2006, 52 patients with thoracic aortic pathologies underwent endovascular repair; there were 43 males (83%) and 9 females, mean age 63 ± 19 years (range 17–87). Fourteen patients (27%) were

Gabriele Piffaretti; Matteo Tozzi; Chiara Lomazzi; Nicola Rivolta; Roberto Caronno; Patrizio Castelli



Acute exacerbation of chronic obstructive pulmonary disease and antibiotics: what studies are still needed?  

Microsoft Academic Search

ABSTRACT: The use of antibiotics in acute exacerbations,of chronic bronchitis (AECBs) remains,the subject of controversy,despite considerable medical and socio- economic,implications. First, the contribution of bacterial infection to AECBs is difficult to assess in patients with chronic obstructive pulmonary,disease (COPD) who are chronically colonized with respiratory pathogens. In addition, several studies suggest a major role of viral infections in AECBs. Secondly,

C. Sohy; C. Pilette; M. S. Niederman; Y. Sibille



[Oligohydramnios--perinatal complications and diseases in mother and child].  


In our study, complications of oligohydramnios were examined. In medical records of all 5,210 deliveries of our department between 1987 and 1990 181 cases of oligohydramnios were identified. The diagnosis was confirmed by ultrasound and based on the method described by Mannings and Platt: amniotic fluid depots of less than 1 cm were defined as oligohydramnios. All 181 cases met the above definition, which results in an incidence of 3.5% pregnancies with reduced amniotic fluid. We examined the records of mother and foetus, the delivery and perinatal complications and follow-up of the newborn. In more than 60%, foetal asphyxia, breech position and other anomalies during delivery were followed by Cesarean section or vaginal operative delivery by forceps or vacuum extraction. In 30 cases, oligohydramnios was caused by premature rupture of membranes. In the other cases, the diagnosis based on maternal or foetal complications such as gestosis (n = 7), abruptio placentae (n = 10), foetal growth retardation (n = 47) and malformations or chromosomal anomalies. 89 newborn were transferred to a paediatric hospital immediately after delivery. Potter's syndrome was the main anticipated diagnosed malformation (n = 20). The lack of amniotic fluid was furthermore followed by a higher rate of pulmonary complications such as RDS and hypoplasia of the neonatal lung (n = 21). In conclusion, our study underlines the fact, that oligohydramnios must be regarded as an important reason of high risk pregnancy followed by many complications for foetus and newborn. The incidence of perinatal mortality in our examination was 7.2%. This rate is 10 fold higher than in the total number of deliveries of our department. PMID:8188011

Wolff, F; Schaefer, R



Thoracic irradiation in Hodgkin's disease: Disease control and long-term complications  

SciTech Connect

A total of 590 patients with Stage IA-IIIB Hodgkin's disease received mantle irradiation at the Joint Center for Radiation Therapy between April 1969 and December 1984 as part of their initial treatment. Recurrence patterns as well as pulmonary, cardiac and thyroid complications were analyzed. Pulmonary recurrence was more frequently seen in patients with large mediastinal adenopathy (LMA); 11% of patients with LMA recurred in the lung in contrast to 3.1% with small or no mediastinal disease, p = 0.003. Hilar involvement, when corrected for size of mediastinal involvement, was not predictive of lung relapse. Patients with LMA also had a high rate of nodal relapse above the diaphragm (40%) following radiation therapy (RT) alone as compared to similarly treated patients with small or no mediastinal adenopathy (6.5%), p less than 0.0001. This risk of nodal recurrence was greatly reduced (4.7%) for LMA patients receiving combined radiation therapy and chemotherapy (CMT), p less than 0.0001. Sixty-seven patients (11%) with hilar or large mediastinal involvement received prophylactic, low dose, whole lung irradiation. No decrease in the frequency of lung recurrence was seen with the use of whole lung irradiation. Radiation pneumonitis was seen in 3% of patients receiving radiation therapy alone. In contrast, the use of whole lung irradiation was associated with a 15% risk of pneumonitis, p = 0.006. The risk of pneumonitis was also significantly increased with the use of chemotherapy (11%), p = 0.0001. Cardiac complications were uncommon with pericarditis being the most common complication (2.2%). Thyroid dysfunction was seen in 25% of patients and appeared to be age-related. These data suggest that the long-term complications of mantle irradiation are uncommon with the use of modern radiotherapeutic techniques.

Tarbell, N.J.; Thompson, L.; Mauch, P. (Harvard Medical School, Boston, MA (USA))



Granulomas Formation in Lymph Nodes, Liver and Spleen in Adult-Onset Still's Disease: A Case Report.  


Tissue granulomas formation in adult-onset Still's disease (AOSD) is extremely rare. We describe a case of AOSD associated with formation of granulomatous lesions in lymph nodes, liver and presumably spleen. The high dose steroid-dependent nature of our patient's illness, characterized by disease relapses when methylprednisolone dose was reduced below 10 mg/d, was overwhelmed with institution of anakinra (100 mg/d). The histologic finding of granulomas formation in lymph nodes, liver or spleen should not deter the consideration of AOSD as a potential diagnosis in a compatible clinical context; however, other more common etiologies of tissue granulomas formation should be first excluded. PMID:23519167

Assimakopoulos, Stelios F; Karamouzos, Vassilios; Papakonstantinou, Christos; Zolota, Vassiliki; Labropoulou-Karatza, Chryssoula; Gogos, Charalambos



Vitamin C in human health and disease is still a mystery? An overview.  


Ascorbic acid is one of the important water soluble vitamins. It is essential for collagen, carnitine and neurotransmitters biosynthesis. Most plants and animals synthesize ascorbic acid for their own requirement. However, apes and humans can not synthesize ascorbic acid due to lack of an enzyme gulonolactone oxidase. Hence, ascorbic acid has to be supplemented mainly through fruits, vegetables and tablets. The current US recommended daily allowance (RDA) for ascorbic acid ranges between 100-120 mg/per day for adults. Many health benefits have been attributed to ascorbic acid such as antioxidant, anti-atherogenic, anti-carcinogenic, immunomodulator and prevents cold etc. However, lately the health benefits of ascorbic acid has been the subject of debate and controversies viz., Danger of mega doses of ascorbic acid? Does ascorbic acid act as a antioxidant or pro-oxidant? Does ascorbic acid cause cancer or may interfere with cancer therapy? However, the Panel on dietary antioxidants and related compounds stated that the in vivo data do not clearly show a relationship between excess ascorbic acid intake and kidney stone formation, pro-oxidant effects, excess iron absorption. A number of clinical and epidemiological studies on anti-carcinogenic effects of ascorbic acid in humans did not show any conclusive beneficial effects on various types of cancer except gastric cancer. Recently, a few derivatives of ascorbic acid were tested on cancer cells, among them ascorbic acid esters showed promising anticancer activity compared to ascorbic acid. Ascorbyl stearate was found to inhibit proliferation of human cancer cells by interfering with cell cycle progression, induced apoptosis by modulation of signal transduction pathways. However, more mechanistic and human in vivo studies are needed to understand and elucidate the molecular mechanism underlying the anti-carcinogenic property of ascorbic acid. Thus, though ascorbic acid was discovered in 17th century, the exact role of this vitamin/nutraceutical in human biology and health is still a mystery in view of many beneficial claims and controversies. PMID:14498993

Naidu, K Akhilender



Crohn's Disease in a Saudi Outpatient Population: Is it Still Rare?  

PubMed Central

Background/Aim: To determine the epidemiology of Crohn's disease (CD) in an outpatient clinic and compare it with data previously reported from different centers in the Kingdom of Saudi Arabia and outside. Materials and Methods: The medical records of all patients with CD seen in the clinic in the period from January 1993 through December 2007 were reviewed. The demographic, clinical data and methods of diagnosis were retrieved. Results: Over a period of 15 years, we saw 133 Saudi patients with CD. They were predominantly young, with a median age of 26.2 years and male preponderance (2.3:1). The final diagnosis was established within 1 week of presentation in 47% of the patients. The leading symptoms were abdominal pain (88%), diarrhea (70%), bloating (61%), rectal bleeding (50%), weight loss (33%), constipation (24%) and perianal disease (23%). The diagnosis was established by endoscopy and histopathology. Ileocecal involvement was encountered in 40% of the patients. Conclusion: From the current study, it is obviously possible to diagnose a large proportion of patients with CD in a gastroenterology outpatient clinic. The data revealed a strikingly increased incidence of CD in a mainly young Saudi population in the past few years.

Al-Mofarreh, Mohammad A.; Al Mofleh, Ibrahim A.; Al-Teimi, Ibrahim N.; Al-Jebreen, Abdulrahman M.



Cushing's disease complicated with thrombosis in a dog.  


Thrombosis is a potential complication of hyperadrenocorticism (HAC) in dogs. An 8-year-old male Beagle diagnosed with pituitary-dependent HAC had complicated with thrombosis in the caudal vena cava and abdominal aorta, which was treated by hypophysectomy and antithrombotic therapy. After hypophysectomy, hypercortisolemia disappeared and the general condition was also significantly improved. Ultrasonography after hypophysectomy revealed that the thrombus remained in the abdominal aorta, but the thrombus in the caudal vena cava had disappeared. However 692 days after the hypophysectomy, the dog had an acute onset of dyspnea and died. Postmortem examination revealed the presence of thrombi in the abdominal aorta and the pulmonary artery. Observations from this case show that HAC dogs must be attention to thrombosis. PMID:18525172

Teshima, Takahiro; Hara, Yasushi; Taoda, Takahiro; Koyama, Hidekazu; Takahashi, Kimimasa; Nezu, Yoshinori; Harada, Yasuji; Yogo, Takuya; Nishida, Kouji; Osamura, Robert Y; Teramoto, Akira; Tagawa, Masahiro



Investigating emotions in Parkinson's disease: what we know and what we still don't know.  


Over the last decade, there has been an increasing attention to the role played by emotional processes in Parkinson's disease (PD). However, most of what is known in this area is based on research conducted in laboratory or clinical settings. In this article, the authors underline the need to expand our current knowledge of the psychological correlates of PD by investigating patients' everyday emotions in natural contexts. Specifically, the authors illustrate new research avenues based on the implementation of experience sampling methods. It is argued that these methods could permit future researchers to ecologically assess the frequency and intensity with which parkinsonian patients experience specific emotions (either negative or positive) during their everyday life, providing at the same time precious information on what are the most typical situations in which these emotions occur and on how patients behave in these circumstances. Potential practical implications associated with investigating these issues are discussed. PMID:23772218

Sotgiu, Igor; Rusconi, Maria L



Complications of albendazole treatment in hydatid disease of lung  

Microsoft Academic Search

We present rupture of lung hydatid cyst in a patient with multiple organ involvement during albendazole treatment. The patient was first provided mechanical ventilation than residue cavity and the other intact cyst was treated surgically. We concluded that albendazole should be used in postoperative period in patients with hydatid disease of the lung to prevent recurrent disease.

Ibrahim Can Kurkcuoglu; Atilla Eroglu; Nurettin Karaoglanoglu; Pinar Polat



Managing complicated Crohn's disease in children and adolescents  

Microsoft Academic Search

The natural history of Crohn's disease is characterized by recurrent exacerbations. A small, but significant, number of pediatric patients with Crohn's disease are resistant to standard medical therapies. The goal of therapy in pediatric patients is not only to achieve and maintain clinical remission, but also to promote growth, development and improve quality of life. All of this needs to

Matjaz Homan; Petar Mamula; Robert N Baldassano



Should We Still Subcategorize Helicobacter pylori-Associated Dyspepsia as Functional Disease?  

PubMed Central

Functional dyspepsia is a group of disorders featuring symptoms believed to be derived from the stomach and duodenum such as upper abdominal discomfort, pain, postprandial fullness and early satiety. A key diagnostic requisite is the absence of organic, metabolic, or systemic disorders to explain "dyspeptic symptoms." Therefore, when peptic ulcer diseases (including scars), erosive esophagitis and upper gastrointestinal malignancies are found at endoscopic examinations, the diagnosis of functional dyspepsia is excluded. One notable exception, however, is Helicobacter pylori infection. According to the Rome III definition, H. pylori infection is included in functional dyspepsia. This is an obvious deviation from the diagnostic principle of functional dyspepsia, since H. pylori infection is a definite cause of mucosal inflammation, which affects a number of important gastric physiologies such as acid secretion, gastric endocrine function and motility. The chronic persistent nature of infection also results in more dramatic mucosal changes such as atrophy or intestinal metaplasia, the presence of which in the esophagus (Barrett's esophagus) precludes the diagnosis of functional dyspepsia. Since careful endoscopic examination can diagnose reliably H. pylori infection not only in Japan but also in Western contries, it is now feasible and more logical to exclude patients with chronic gastritis caused by H. pylori infection as having dyspeptic symptoms. It is time to establish the Asian consensus to declare that H. pylori infection should be separated from functional dyspepsia.



Metabolic syndrome in the prevention of cardiovascular diseases and diabetes--still a matter of debate?  


After metabolic syndrome was first introduced to identify persons at greater cardiovascular disease (CVD) risk, it has been associated with an increased risk of CVD and type 2 diabetes (T2D). Obesity has been considered as the fundamental factor in metabolic syndrome and it is thought to be mediated, at least in part by the role of the adipocyte in controlling circulating free fatty acids and the development of insulin resistance. However, the obese population is not perfectly overlapped with the population with metabolic syndrome. Is metabolic syndrome a better predictor than obesity to prevent CVD and T2D? Has metabolic syndrome been considered as a cluster of risk factors or an additional independent risk factor to assess CVD and T2D risk? The debate on the necessity of metabolic syndrome diagnosis seems not to be ended. Various definitions of metabolic syndrome were advocated by different organizations with emphasis on different components, and these definitions have different abilities to predict CVD and T2D among different populations because of fundamental philosophical differences. In the definitions of metabolic syndrome, only the cutoffs of each component were presented but rather continuous values or the degree of the severity of the syndrome with multiple cutoffs. Moreover, metabolic syndrome did not incorporate all the risk factors as known for CVD and T2D, such as physical activity. Future prospective studies with the measurement of sophisticated metabolic markers and of abdominal visceral and subcutaneous adiposity are needed to examine if the metabolic syndrome is a good CVD and T2D risk predictor over obesity and other risk factors. In practice, prevention action should be taken at the stage of obesity and providers need to pay attention to any components in the definition of metabolic syndrome even if the number of positive components has not achieved three or more. PMID:23403882

Ma, X; Zhu, S



[A case in which the subject was affected by Listeia meningoencephalitis during administration of infliximab for steroid-dependent adult onset Still's disease].  


The subject was a 22-year-old woman who developed high fever and arthralgias and eruptions in the extremities around June 2005. She sought medical advice at a nearby dermatology clinic, where hepatic dysfunction was noted on blood testing. The patient was thus hospitalized the next day. Although CRP levels were significantly high, no sign of infection was observed and bone marrow cell differentiation was normal. Adult onset Still's disease was diagnosed based on the observation of persistent high fever >39 degrees C, eruptions, increased leukocytes, pharyngeal pain, splenomegaly, hepatic dysfunction, negative autoantibody results from blood testing, and high serum ferritin levels. Administration of prednisolone 30 mg/day was initiated, but proved ineffective. Steroid pulse therapy was conducted, and the subject was transferred to our medical facility for continued treatment. Attempts were made to control the disease using combined steroid and cyclosporine administration; but exacerbation of high serum ferritin levels and hepatic dysfunctions were observed, so a second course of steroid pulse therapy was conducted. Symptoms improved temporarily, but steroid levels were difficult to reduce. Cyclosporine was therefore replaced by methotrexate, and administration of infliximab was initiated. In the course of treatment, administration of a sulfamethoxazole/trimethoprim combination was initiated, but was discontinued due to suspicion of drug-induced hepatic injury. A second administration of infliximab was conducted in late August, and rapid improvements in clinical symptoms and abnormal test values was observed. However, high fever and headache developed suddenly in early September. Based on the results of spinal fluid testing, blood and spinal fluid cultures and MRI of the head, Listeria meningoencephalitis was diagnosed. Diplopia and impaired consciousness occurred during the disease course, and formation of a brain abscess was observed on imaging. However, symptoms were controlled by long-term combination administration of ampicillin and gentamicin. Administration of infliximab was discontinued for treatment of adult onset Still's disease, and steroid levels were reduced following double-membrane filtration plasma exchange. On follow-up, no relapse of symptoms or abnormalities in blood test values were observed, so the subject was discharged from our medical facility in December 2005. In treatment for rheumatic diseases, a dramatic improvement in treatment results for pathologies displaying tolerance against conventional treatments has been acquired with the development of biological drugs. However, opportunistic infections represent a serious problem, and appropriate preventative measures are required. The present report describes a case in which the subject was affected by Listeria meningoencephalitis during administration of infliximab for steroid-dependent adult Still's disease. Since listeriosis is one of the complications, along with tuberculosis, that warrants precautionary measures, this case is reported and discussed. PMID:16819265

Yamamoto, Motohisa; Takahashi, Hiroki; Miyamoto, Chie; Ohara, Mikiko; Suzuki, Chisako; Naishiro, Yasuyoshi; Yamamoto, Hiroyuki; Shinomura, Yasuhisa; Nonaka, Michio; Imai, Kohzoh



Unknown complicated celiac disease as an unexpected finding in patients investigated with capsule endoscopy for Crohn's disease. A case series.  


Atypical symptoms of celiac disease may cause a late diagnosis, revealed by the onset of complications, which may inaccurately be attributed to Crohn's disease, as manifestations frequently overlap. Assessing the entire small bowel mucosa, capsule endoscopy may be an accurate procedure in these challenging situations. We present four Crohn's disease patients diagnosed with ulcerative jejunoilieitis complicating celiac disease after capsule endoscopy procedure. In three of these patients, the ulcerative jejunoileitis led in time to stricture formation, suggesting Crohn's disease. Administration of non-steroidal anti-inflammatory drugs made the diagnosis even more difficult in one case. In patients with Crohn's disease not responding to immunosuppressive or biological treatment, complicated celiac disease should be considered and capsule endoscopy should be performed for reassessing the diagnosis. PMID:23539398

Ciobanu, Lidia; Pascu, Oliviu; Iobagiu, Silviu; Damian, Dana; Dumitru, Eugen; Tantau, Marcel



Complications of Chronic Kidney Disease Occur Earlier in Children  


... lead to a shift in treatment, the largest prospective study of children with chronic kidney disease (CKD) has ... from these findings.” CKiD is a multi-center, prospective study of children and teenagers ages 1 to 16 ...


Complications of hyperbaric oxygen in the treatment of head and neck disease  

SciTech Connect

Hyperbaric oxygen has been advocated in the treatment of many head and neck diseases. Reports of such treatments have described eustachian tube dysfunction as the only complication. A review of patients receiving hyperbaric oxygen for head and neck diseases at The Mount Sinai Medical Center revealed serious complications, which included seizure, stroke, and myocardial infarction. In addition, follow-up study of these patients demonstrated that 11 patients treated for radiation-induced necrosis had an undiagnosed recurrence of cancer.

Giebfried, J.W.; Lawson, W.; Biller, H.F.



Acute pancreatitis complicating Crohn's disease: mere coincidence or causality?  

PubMed Central

An example of acute pancreatitis developing five weeks after initial treatment with 5-aminosalicylic acid (5-ASA) and methylprednisolone for severe Crohn's disease is reported in a 37 year old female patient. She had undergone cholecystectomy for gall stones some years earlier. There was no evidence of acute or chronic pancreatitis. No morphological changes of the upper gastrointestinal tract were found except for some irregularity of the main pancreatic duct and the secondary ducts on endoscopic retrograde pancreatography. Rechallenge with 5-ASA did not induce recurrent pancreatitis or changes in pancreatic enzymes. This case report supports the concept of an association between acute pancreatitis and Crohn's disease. Images Figure 3

Tromm, A; Huppe, D; Micklefield, G H; Schwegler, U; May, B



Pneumatosis cystoides intestinalis as a complication of celiac disease  

Microsoft Academic Search

Pneumatosis cystoides intestinalis (PCI) is an uncommon but important condition characterized by the presence of gas-filled cysts in the submucosa and subserosa of the gastrointestinal tract. PCI has been associated with several clinical settings. We report a case where PCI developed in a patient with known celiac disease. To our knowledge, this type of coincidence has been described in seven

A. Terzic; F. Holzinger; Ch. Klaiber



Langerhan's cell histiocytosis complicating small bowel Crohn's disease.  

PubMed Central

Langerhan's cell histiocytosis is a rare infiltrative disorder of unknown aetiology. A variety of tissues may be affected, but clinically evident intestinal involvement is unusual. An adult patient is described with Crohn's disease of the terminal ileum who subsequently developed Langerhan's cell histiocytosis with extensive infiltration of the small bowel. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6

Lee-Elliott, C; Alexander, J; Gould, A; Talbot, R; Snook, J A



Motor and nonmotor complications in Parkinson's disease: an argument for continuous drug delivery?  


The complications of long-term levodopa therapy for Parkinson's disease (PD) include motor fluctuations, dyskinesias, and also nonmotor fluctuations-at least equally common, but less well appreciated-in autonomic, cognitive/psychiatric, and sensory symptoms. In seeking the pathophysiologic mechanisms, the leading hypothesis is that in the parkinsonian brain, intermittent, nonphysiological stimulation of striatal dopamine receptors destabilizes an already unstable system. Accordingly, a major goal of PD treatment in recent years has been the attainment of continuous dopaminergic stimulation (CDS)-or, less theoretically (and more clinically verifiable), continuous drug delivery (CDD). Improvements in the steadiness of the plasma profiles of various dopaminergic therapies may be a signal of progress. However, improvements in plasma profile do not necessarily translate into CDS, or even into CDD to the brain. Still, it is reassuring that clinical studies of approaches to CDD have generally been positive. Head-to-head comparative trials have often failed to uncover evidence favoring such approaches over an intermittent therapy. Nevertheless, the findings among recipients of subcutaneous apomorphine infusion or intrajejunal levodopa/carbidopa intestinal gel suggest that nonmotor PD symptoms or complications may improve in tandem with motor improvement. In vivo receptor binding studies may help to determine the degree of CDS that a dopaminergic therapy can confer. This may be a necessary first step toward establishing whether CDS is, in fact, an important determinant of clinical efficacy. Certainly, the complexities of optimal PD management, and the rationale for an underlying strategy such as CDS or CDD, have not yet been thoroughly elucidated. PMID:23456290

Chaudhuri, K Ray; Rizos, Alexandra; Sethi, Kapil D



[Surgical treatment of complicated diverticular disease of the colon].  


The present study analyzes the results obtained by the AA with the different types of surgery adopted in the treatment of the complicated diverticulosis of the colon, highlighting, on the basis of data available in literature, the possible treatments in the different clinical settings. A retrospective study analyzing type of complication, the surgical technique adopted, Hinchey stage, mortality and morbidity rates and average hospital stay correlated with the kind of intervention has been carried out on 83 surgical interventions performed between 1984 and 1988. The results show that 43 R.A.P. (R.A.P. = primitive anastomosis resection) (32 cases at the I-II stage and 11 cases at the III-IV stage), 27 Hartmann (11 at the I-II and 16 at the III-IV), 9 colostomies (2 at the I-II and 7 at the III-IV), 2 esteriorizations and 2 simple drains have been carried out on a total of 44 intestinal perforations, 16 recurrent diverticulitis, 13 intestinal occlusions, 2 fistulae, 5 abscesses and 3 hemorrhages. The total mortality rate amounts to 10.6%; the morbidity rate of the R.A.P. interventions to 14.4 (I-II stage-related morbidity = 15.6%, III-IV stage = 63.6%), Hartmann's to 9.6% and that of the colostomies to 3.6%. Furthermore, in this work, we have considered the cases of riconversation after Hartmann interventions (9 cases): in the second operations the mortality and morbility rate amounts to 0 and the hospital stay to 9 days. The AA analyze on the surgical technique adopted in the different cases and the of choice criteria. According to the data obtained and to current literature, it results that the primitive anastomosis resection represents the first choice intervention at the I-II stage, although, in selected cases, it can be carried out also at the III-IV stage. Hartmann surgery confirms its effectiveness while simple colostomy is no longer accepted in literature. PMID:10793765

Porzio, S; Rossi, S; Lombardi, V; Milito, G


A complication of a dropped appendicolith misdiagnosed as Crohn's disease.  


Appendicoliths are formed by calcium salts and faecal debris layered and lodged within the appendix. They are detected on unenhanced x-rays in less than 10% of patients with appendicitis. When an appendicolith is found extraluminally, it is pathognomonic for perforation of the appendix. Moreover, retained appendicoliths act as a nidus for infection and are likely to be the source of a postoperative intraperitoneal abscess. However, this is very rare with only 30 reported cases of intra-abdominal abscess secondary to an appendicolith in the literature over the past 40 years. Retained, or dropped, appendicoliths most commonly present as an area of high attenuation less than 1cm in diameter with an associated abscess close to the caecum or Morrison's pouch on computed tomography (CT). A study published in 2006 showed that although there is initial success with CT-guided drainage of abscesses secondary to faecaliths, all will recur and formal surgical drainage with removal of the appendicolith is required. This case report highlights not only an unusual complication of a retained appendicolith but also the importance of taking a thorough history and interpreting investigations in the context of the patient's past medical history so as to produce a differential diagnosis and prevent treatment of incorrect conditions. PMID:21929906

Sarkar, S; Douglas, L; Egun, A A



Nephropathic cystinosis: late complications of a multisystemic disease  

Microsoft Academic Search

Cystinosis is a rare autosomal recessive disorder due to impaired transport of cystine out of cellular lysosomes. Its estimated\\u000a incidence is 1 in 100,000 live births. End-stage renal disease (ESRD) is the most prominent feature of cystinosis and, along\\u000a with dehydration and electrolyte imbalance due to renal tubular Fanconi syndrome, has accounted for the bulk of deaths from\\u000a this disorder.

Galina Nesterova; William Gahl



Neoplastic and other complications of inflammatory bowel disease  

Microsoft Academic Search

Patients with inflammatory bowel disease (IBD) have long been known to be at increased risk of development of colorectal cancer;\\u000a however, there are many nuances to cancer prevention strategies in IBD that remain unresolved. During the past year, two publications\\u000a reported on the resection of otherwise typical adenoma-like masses by means of polypectomy, after which these patients were\\u000a followed with

Charles N. Bernstein



Hyaline Membrane Disease and Complications of Its Treatment  

Microsoft Academic Search

\\u000a Hyaline membrane disease (HMD) or idiopathic respiratory distress syndrome (IRDS) affects premature infants, most of those\\u000a concerned being born at less than 36 weeks of gestational age and weighing less than 2.5 kg. Infants of diabetic mothers are\\u000a also more prone to develop the condition (Robert et al. 1976) because foetal hyperinsulinism interferes with the glucocorticoid axis that governs surfactant

Veronica Donoghue


[Schizophrenia complicated by craniocerebral trauma and other diseases of an exogenous and organic nature].  


The authors examined 120 patients with schizophrenia (torpid and paroxysmal-progressive) whose disease at different stages of its course was complicated by exogenous impacts (head trauma in 66 cases, neuroinfection in 15, intoxication in 16 and vascular brain disease in 23). These complications affect the structure of individual psychopathological syndromes on the one hand and the rate of the development of the disease itself (with a faster formation of productive and negative syndromes) on the other. Correlation has been found between the degree of exogenous impact and the severity of asthenic and memory-intellectual disturbances and the disease course on the whole. The therapeutic tactics in these complicated forms of the disease is outlined. PMID:3739486

Golodets, R G; Fedorenko, N A



Hansen's disease (leprosy) complicated by secondary mycobacterial infection.  


A patient with Hansen's disease received corticosteroids for a type 1 leprosy reaction and subsequently developed a new cutaneous lesion at the original biopsy site from which Mycobacterium fortuitum was cultured. A review of the literature found only two other cases of coinfection with atypical mycobacteria and Mycobacterium leprae, although there are many reports of pulmonary tuberculosis in patients with leprosy. This case highlights the diagnostic difficulties encountered when a patient has two different mycobacterial infections of the skin. The published experience emphasizes that such coinfection is remarkably uncommon in leprosy, despite the frequent use of high doses of corticosteroids for leprosy reactions. PMID:20494478

Scollard, David M; Stryjewska, Barbara M; Prestigiacomo, John F; Gillis, Thomas P; Waguespack-Labiche, Jennifer



Neuro-ophthalmologic Complications of Neoplastic Leptomeningeal Disease.  


Neoplastic leptomeningeal disease (NLD), which encompasses both primary and secondary leptomeningeal tumors, has a devastating impact on the life of cancer patients. The present diagnostic technical armamentarium is insufficient for early diagnosis of NLD. However, NLD may present with subtle neuro-ophthalmic features at a time of relatively small tumor burden, which gives the provider first encountering these patients the window of opportunity for early diagnosis and consequently improved life expectancy and quality of life of these patients. Therefore, familiarity with early, often subtle neuro-ophthalmic features is an essential tool for diagnosing these patients prior to the development of fixed deficits, which usually portend a dismal prognosis. Future evolving laboratory and neuroimaging technologies are expected to advance our understanding of underlying pathophysiology and early detection of NLD. This paper provides an up-to-date review and synthesis of the current literature with focus on neuro-ophthalmic features and their underlying pathophysiology. PMID:24158499

Szatmáry, Gabriella



Perianesthetic complications in dogs undergoing magnetic resonance imaging of the brain for suspected intracranial disease.  


Objective-To evaluate the occurrence of perianesthetic complications in dogs undergoing MRI for suspected intracranial disease and identify risk factors associated with observed complications. Design-Retrospective case-control study. Animals-238 client-owned dogs undergoing MRI of the brain. Procedures-Signalment, clinical signs, neurologic examination findings, presumptive diagnosis, anesthesia-related variables, whether CSF was collected and CSF analysis results, severe perianesthetic complications (need for a ventilator following anesthesia or perianesthetic death), and anesthetic recovery time were recorded. Selected factors were compared between dogs with and without intracranial lesions and dogs with and without perianesthetic complications (including severe complications and prolonged anesthetic recovery [> 20 minutes from the end of anesthesia to extubation]). Results-3 of 149 (2%) dogs with and 0 of 89 dogs without intracranial lesions required ventilation following anesthesia; the difference was nonsignificant. Recovery time was significantly longer in dogs with (median, 15 minutes) than in dogs without (10 minutes) intracranial lesions. Abnormal mentation prior to anesthesia was the only clinical sign that differed significantly between dogs with (15/26 [58%]) and without (70/212 [33%]) perianesthetic complications. A significantly larger proportion of dogs with perianesthetic complications had intracranial masses (13/26 [50%]), compared with dogs without these complications (56/212 [26%]). Conclusions and Clinical Relevance-Dogs with complications were more likely to have had intracranial lesions than were dogs without complications, but few dogs had severe complications. Abnormal mentation was more common in dogs with than in dogs without complications. Prospective studies to further evaluate perianesthetic risk factors and procedures for improving outcomes in these patients are warranted. PMID:24134582

Hicks, Jill A; Kennedy, Martin J; Patterson, Edward E



Update on pulmonary hypertension complicating chronic obstructive pulmonary disease  

PubMed Central

Pulmonary hypertension (PH) is the hemodynamic manifestation of various pathological processes that result in elevated pulmonary artery pressures (PAP). The National Institutes of Health Registry defined pulmonary arterial hypertension as the mean PAP of more than 25 mm Hg with a pulmonary capillary wedge pressure or left atrial pressure equal to or less than 15 mm Hg. This definition remains the currently accepted definition of PH that is used to define PH related to multiple clinical conditions including chronic obstructive pulmonary disease (COPD). The estimated US prevalence of COPD by the National Health Survey in 2002 in people aged >25 was 12.1 million. There is a lack of large population-based studies in COPD to document the correct prevalence of PH and outcome. The major cause of PH in COPD is hypoxemia leading to vascular remodeling. Echocardiogram is the initial screening tool of choice for PH. This simple noninvasive test can provide an estimate of right ventricular systolic and right atrial pressures. Right heart catheterization remains the gold standard to diagnose PH. It provides accurate measurement of mean PAP and pulmonary capillary wedge pressure. Oxygen therapy remains the cornerstone therapeutic for hypoxemia in COPD patients. Anecdotal reports suggest utility of PDE5-inhibitors and prostacyclin to treat COPD-related PH. Large randomized clinical trials are needed before the use of these drugs can be recommended.

Jyothula, Soma; Safdar, Zeenat



Screening and surveillance for complications related to gastroesophageal reflux disease.  


Gastroesophageal reflux disease (GERD) and columnar-lined esophagus with intestinal metaplasia (Barrett's esophagus) are the major recognized risk factors for adenocarcinoma of the esophagus. The American College of Gastroenterology recommends that patients with long-standing GERD symptoms (particularly those 50 years of age or older) undergo endoscopic screening to identify Barrett's esophagus and that those patients who have Barrett's esophagus undergo regular endoscopic surveillance. These recommendations are made with the expectation that screening and surveillance will decrease mortality from esophageal cancer, although this association is unclear. Nonetheless, retrospective studies have shown that endoscopic surveillance can detect some early, curable neoplasms in patients with Barrett's esophagus. Dysplasia in Barrett's esophagus is widely regarded as the precursor of invasive malignancy. Although grading dysplastic changes is largely subjective, dysplasia remains the most appropriate biomarker for clinical evaluation of Barrett's esophagus. Flow-cytometric and p53 abnormalities may be earlier and more specific markers for cancer development, but application of these abnormalities is not yet recommended for clinical practice. Endoscopic surveillance also is adversely affected by biopsy sampling error. Techniques that may minimize biopsy sampling error include chromoendoscopy, endosonography, optical coherence tomography, and fluorescence detection techniques. Further studies are needed to clearly define the role of these techniques in surveillance, and none is practical for routine clinical use at this time. Although not specifically recommended, experimental ablative therapies, such as photodynamic therapy, can be considered by physicians for their patients with high-grade dysplasia in Barrett's esophagus, if they are provided as part of an established, approved research protocol. PMID:11749938

Spechler, S J



Solar still  

Microsoft Academic Search

A solar still includes a pair of parallel dikes separated by a ditch, a first sheet overlying the ditch and pair of parallel dikes, the sheet having a pair of edges arranged substantially parallel to, and outside, the dikes, and a second sheet overlying the first sheet, the second sheet having a pair of edges bonded together with the edges




Pictorial review: Imaging features of unusual patterns and complications of hydatid disease  

PubMed Central

Hydatid disease is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm. We demonstrate rare locations and unusual complications of this entity during past 6 years. Rare locations during our observation included lumbar spine, sacral spine, spleen, ovary, abdominal wall, diaphragm, pelvis and right kidney. Unusual complications included formation of bronchopulmonary fistula, complete collapse of left lung secondary to hilar location of Hydatid cyst and hydatiduria.

Amin, Muhammad Umar; Mahmood, Rabia; Shafique, Mobeen; Khan, Muhammad Shoib; Bilal, Aamir; Siddiqi, Hammad Ahmad



Cutaneous nocardiosis complicating management of Crohn's disease with infliximab and prednisone  

PubMed Central

INFLIXIMAB IS A CHIMERIC ANTI-TUMOUR NECROSIS FACTOR-? antibody that is efficacious in treating Crohn's disease. However, its immunomodulatory properties increase susceptibility to opportunistic infections. We present a case of cutaneous Nocardia infection in a patient who was taking infliximab for Crohn's disease. The case illustrates the challenges in the diagnosis and management of this disease and serves as a reminder of the complications associated with the use of immunomodulatory agents.

Singh, Sheldon M.; Rau, Neil V.; Cohen, Lawrence B.; Harris, Howard



Anemia is a new complication in Fabry disease: Data from the Fabry Outcome Survey  

Microsoft Academic Search

Anemia is a new complication in Fabry disease: Data from the Fabry Outcome Survey.BackgroundThe prevalence and causes of anemia among patients with Fabry disease are unknown.MethodsIn a cross-sectional study we examined hemoglobin concentrations of patients with Fabry disease using a large international database, the Fabry Outcome Survey (FOS), and analyzed the association of renal function, heart failure, gastrointestinal symptoms, and




Crohn's disease: Multimodality Imaging of Surgical Indications, Operative Procedures, and Complications  

PubMed Central

Surgical management is considered for specific indications in Crohn's disease and a wide variety of surgeries is performed. The purpose of this pictorial essay is to depict manifestations of Crohn's disease that indicates surgery, various surgical procedures that are performed, and the complications arising from these surgical procedures. Surgical indications including obstruction due to strictures or adhesions, fistulae and abscesses, and surgeries for these conditions, such as, ileocecectomy, stricturoplasty, small bowel resection, fecal diversion, segmental colectomy, and lysis of adhesions and their complications will be discussed and their imaging will also be illustrated.

Kolar, B; Speranza, J; Bhatt, S; Dogra, V



Should We Still Focus That Much on Cardiovascular Mortality in End Stage Renal Disease Patients? The CONvective TRAnsport STudy  

PubMed Central

Background We studied the distribution of causes of death in the CONTRAST cohort and compared the proportion of cardiovascular deaths with other populations to answer the question whether cardiovascular mortality is still the principal cause of death in end stage renal disease. In addition, we compared patients who died from the three most common death causes. Finally, we aimed to study factors related to dialysis withdrawal. Methods We used data from CONTRAST, a randomized controlled trial in 714 chronic hemodialysis patients comparing the effects of online hemodiafiltration versus low-flux hemodialysis. Causes of death were adjudicated. The distribution of causes of death was compared to that of the Dutch dialysis registry and of the Dutch general population. Results In CONTRAST, 231 patients died on treatment. 32% died from cardiovascular disease, 22% due to infection and 23% because of dialysis withdrawal. These proportions were similar to those in the Dutch dialysis registry and the proportional cardiovascular mortality was similar to that of the Dutch general population. cardiovascular death was more common in patients <60 years. Patients who withdrew were older, had more co-morbidity and a lower mental quality of life at baseline. Patients who withdrew had much co-morbidity. 46% died within 5 days after the last dialysis session. Conclusions Although the absolute risk of death is much higher, the proportion of cardiovascular deaths in a prevalent end stage renal disease population is similar to that of the general population. In older hemodialysis patients cardiovascular and non-cardiovascular death risk are equally important. Particularly the registration of dialysis withdrawal deserves attention. These findings may be partly limited to the Dutch population.

den Hoedt, Claire H.; Bots, Michiel L.; Grooteman, Muriel P. C.; Mazairac, Albert H. A.; Penne, E. Lars; van der Weerd, Neelke C.; ter Wee, Piet M.; Nube, Menso J.; Levesque, Renee; Blankestijn, Peter J.; van den Dorpel, Marinus A.



[Behcet's disease complicated by malignant lymphoma: a case report and literature review].  


Malignant lymphoma complicated by Behcet's disease (BD) is a rare clinical entity. We report a case of BD complicated by malignant lymphoma in a 26-year-old male patient. The patient was diagnosed to have terminal ileum extranodal NK/T-cell lymphoma (nasal type) during treatment for BD with cyclophosphamide (CTX), immunoregulants and biological agents. This is the first case reported in China and the second case globally. The pathogenesis of BD complicated by malignant lymphoma remains unclear. We reviewed the relevant literatures to summarize the clinical characteristics of BD complicated by extranodal NK/T-cell lymphoma (nasal type) and discuss the possible pathogenesis in light of immunology, EB virus infection and medications. PMID:23803216

Huang, Qin; Lai, Weinan; Yang, Min



Severe Metabolic Bone Disease as a Long-Term Complication of Obesity Surgery  

Microsoft Academic Search

Background: Metabolic bone disease is a well-documented long-term complication of obesity surgery. It is often undiagnosed,\\u000a or misdiagnosed, because of lack of physician and patient awareness. Abnormalities in calcium and vitamin D metabolism begin\\u000a shortly after gastrointestinal bypass operations; however, clinical and biochemical evidence of metabolic bone disease may\\u000a not be detected until many years later. Case Report: A 57-year-old

Whitney S. Goldner; Thomas M. O'Dorisio; Joseph S. Dillon; Edward E. Mason



Acute Cytomegalovirus Infection Is a Risk Factor in Refractory and Complicated Inflammatory Bowel Disease  

Microsoft Academic Search

The role of cytomegalovirus (CMV) infection in patients with inflammatory bowel disease (IBD) is controversial. Although CMV\\u000a has been specifically associated with refractory disease, the strength and nature of this association have been a subject\\u000a of debate. The aim of this study was to evaluate the prevalence and outcome of acute cytomegalovirus infection in patients\\u000a with severe refractory and complicated

Maha M. Maher; Mahmoud I. Nassar



Natural History, Prognosis, Clinical Features and Complications of Metastatic Bone Disease  

Microsoft Academic Search

The survival and prognosis of patients with metastatic bone disease varies widely and depends on many factors including the\\u000a histologic type and grade of the primary tumor, performance status and age of patients, presence of extraosseus metastases,\\u000a level of tumor markers and extend of skeletal disease. Bone metastases are inevitably associated with considerable morbidity\\u000a and suffering, and severe complications such

Vassilios Vassiliou; Edward Chow; Dimitrios Kardamakis


Central Nervous System Complications of Sickle Cell Disease in Children: An Overview  

Microsoft Academic Search

Complications involving the central nervous system are among the most devastating manifestations of sickle cell disease. Although overt stroke occurs in 1 in 10 children with Hemoglobin SS, “silent cerebral infarcts” are even more frequent. Both are associated with significant neuropsychological deficits. The end result of these effects on the CNS often is diminished school performance. The use of transcranial

Winfred C. Wang



Mechanisms of Disease: pathway-selective insulin resistance and microvascular complications of diabetes  

Microsoft Academic Search

Resistance to the actions of insulin is strongly associated with the microvascular complications of diabetes. To the extent that insulin resistance leads to hyperglycemia, dyslipidemia and hypertension, this association is not surprising. It is now clear that insulin also has direct actions in the microvasculature that influence the development and progression of microvascular disease. In the healthy state, insulin appears

Carol Forsblom; Merlin C Thomas; Per-Henrik Groop



Spontaneous vertebral artery dissection as a complication of autosomal dominant polycystic kidney disease  

Microsoft Academic Search

Autosomal dominant polycystic kidney disease (ADPKD) may be associated with a variety of cardiovascular complications, including intracranial saccular aneurysms. In ADPKD, intracranial saccular aneurysms tend to rupture more frequently and earlier than the sporadic variety with a tendency to cluster in families. In contrast, dissecting intracranial aneurysms are rarely associated with either intracranial saccular aneurysms or ADPKD. We describe an

Jorge Larranaga; Gregory W. Rutecki; Frederick C. Whittier



Management of motor complications in Parkinson disease: current and emerging therapies.  


Motor fluctuations and dyskinesias are common motor complications that manifest within the first few years from the initiation of therapy in patients with Parkinson disease. These complications negatively affect the quality of life and represent an important source of disability. A growing number of therapeutic options including treatments aimed at prolonging the efficacy of levodopa (eg, selective monoamine oxidase-B inhibitors and catechol-O-methyltransferase inhibitors), administration of longer-acting dopamine agonists (eg, rotigotine, sustained-release ropinirole), and continuous administration of intraduodenal levodopa exist or will soon become available. Patients who maintain a good response to levodopa but continue to experience disabling motor complications despite the best medical management may benefit from a regimen of subcutaneous apomorphine, ideally delivered by a subcutaneous pump, or deep-brain stimulation of the subthalamic nucleus or internal portion of the pallidum. Emerging therapies for motor complications are expected to further enhance continuous (physiologic) delivery of dopaminergic drugs and extend the reach of therapies beyond the dopaminergic system to influence not only the motor but also the vast range of nonmotor complications of this multisystemic disease. PMID:20816270

Espay, Alberto J



Role of Adipokines in Atherosclerosis: Interferences with Cardiovascular Complications in Rheumatic Diseases  

PubMed Central

Patients with rheumatic diseases have an increased risk of mortality by cardiovascular events. In fact, several rheumatic diseases such as rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, and ankylosing spondylitis are associated with a higher prevalence of cardiovascular diseases (CVDs). Although traditional cardiovascular risk factors have been involved in the pathogenesis of cardiovascular diseases in rheumatic patients, these alterations do not completely explain the enhanced cardiovascular risk in this population. Obesity and its pathologic alteration of fat mass and dysfunction, due to an altered pattern of secretion of proinflammatory adipokines, could be one of the links between cardiovascular and rheumatic diseases. Indeed, the incidence of CVDs is augmented in obese individuals with rheumatic disorders. Thus, in this paper we explore in detail the relationships among adipokines, rheumatic diseases, and cardiovascular complications by giving to the reader a holistic vision and several suggestions for future perspectives and potential clinical implications.

Scotece, Morena; Conde, Javier; Gomez, Rodolfo; Lopez, Veronica; Pino, Jesus; Gonzalez, Antonio; Lago, Francisca; Gomez-Reino, Juan J.; Gualillo, Oreste



Deep brain stimulation of the subthalamic nucleus in Parkinson's disease: Surgical technique, tips, tricks and complications.  


Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become a frequently performed surgery in patients with advanced Parkinson's disease. The technique has been further refined throughout the years by improved imaging techniques, advanced neurophysiological recording possibilities, and advances in hardware and software technology. In addition, the complications, which can be divided into surgery-related, target-related, and hardware-related complications, were better recognised and managed. In this review, we describe our experience specifically with the surgery of STN DBS in the light of the existing literature. Tips and tricks, complications and their management are the main elements of this article. In addition, we provide scientific information from our research and other groups in specific sections. PMID:24041965

Kocabicak, Ersoy; Temel, Yasin



Reduction of fatal complications from combined modality therapy in Hodgkin's disease  

SciTech Connect

A total of 464 pathologically staged IA through IIIB Hodgkin's disease patients were evaluated for the risk of developing acute nonlymphocytic leukemia, non-Hodgkin's lymphoma, or a fatal infection after treatment with radiation therapy (RT) alone, initial combined radiation therapy and chemotherapy (CMT), or RT with MOPP administered at relapse. Patients received a standard six cycles of MOPP, and additional maintenance chemotherapy was not administered. Patients receiving total nodal irradiation (TNI) and MOPP chemotherapy have an 11. 9% actuarial risk of developing a fatal complication at ten years, as compared to a 0.8% risk for lesser field irradiation and MOPP. The risk with RT alone is 0.6%. Patients 40 years of age or older have a greater risk for complications. These data report a low risk for fatal complication with CMT when less than TNI is administered and when maintenance chemotherapy is not used.

Mauch, P.M.; Canellos, G.P.; Rosenthal, D.S.; Hellman, S.



Treatment of Parkinson disease: a 64-year-old man with motor complications of advanced Parkinson disease.  


In early stages, Parkinson disease typically begins with asymmetric or unilateral motor symptoms due to combinations of mild bradykinesia, rigidity, and tremor. In most cases, with progression, signs of more generalized bradykinesia appear, which include facial masking, reduced voice volume, and slowing of activities of daily living. In more advanced Parkinson disease, other disabling manifestations may follow, such as impaired balance, gait freezing, falls, speech disturbance, and cognitive impairment. Levodopa is the most effective medical treatment for Parkinson disease. However, motor complications uniquely related to levodopa treatment may emerge that may be difficult to manage. These include fluctuating levodopa responses and involuntary movements and postures known as dyskinesia and dystonia. Medication adjustments are usually effective, but in some cases surgical intervention with deep brain stimulation becomes necessary to alleviate motor complications. The case of Mr L, a man with an 11-year history of Parkinson disease, illustrates these emerging motor complications and the manner in which they may be managed both medically and surgically. PMID:22706836

Tarsy, Daniel



Peptic ulcer disease and other complications in patients receiving dexamethasone palliation for brain metastasis  

SciTech Connect

A retrospective analysis was done of 106 patients who received radiation therapy for brain metastasis. Dexamethasone therapy was instituted in 97 patients. Peptic ulcer disease developed in 5 of 89 patients (5.6 percent) who received a dosage of at least 12 mg a day, but did not occur in patients who received a lower dose or in those who did not receive steroids. The interval between institution of dexamethasone therapy and the development of peptic ulcer disease ranged from three to nine weeks. Two patients had perforated ulcers, one of whom required surgical resection. Peptic ulcer disease contributed to the general deterioration and death of three of the five patients. Overall, in 14 of the 89 patients (15.7 percent) a complication of steroid therapy developed in the form of peptic ulcer disease, steroid myopathy or diabetes mellitus (or a combination of these).

Penzner, R.D.; Lipsett, J.A.



Late Complications of Clinical Clostridium Histolyticum Collagenase Use in Dupuytren's Disease  

PubMed Central

Introduction While Dupuytren's disease can cause disabling contractures requiring open surgery, a less-invasive option using Clostridium Histolyticum collagenase (CHC) via percutaneous injection was recently reported. A recent prospective, randomized trial demonstrated few complications during 90 days follow-up, however did not assess any longer term follow-up for these patients. Long-term outcomes in this setting have not been adequately reported, and the current manuscript aims to identify late complications from the clinical use of percutaneous CHC. Methods The current manuscript reports an extended 12-month follow-up for a cohort of twelve of patients enrolled in the original prospective, randomized trial, treated at a single institution. An analysis of complications requiring surgical intervention was undertaken. Results Two of twelve patients reported debilitating pain and triggering requiring surgical intervention. Extensive deep-tissue scarring and adhesions were identified, providing the first visual and qualitative analysis of the pathologic effects of CHC. Conclusion Late complications from CHC use can and have occurred, outside the follow-up period of the initial phase III trials. Longer term follow-up of such patients is thus essential, and further investigation and characterization of the late effects of CHC use is warranted.

Rozen, Warren M.; Edirisinghe, Yasith; Crock, John



Odor Identification Deficits are Associated with Increased Risk of Neuropsychiatric Complications in Patients with Parkinson's Disease  

PubMed Central

Olfactory deficits appear early in the course of Parkinson’s disease (PD) but their prognostic significance is not known. The goal of this study was to determine whether the severity of olfactory impairment is associated with subsequent risk of developing complications of PD. One hundred patients with PD self-administered the University of Pennsylvania Smell Identification Test (UPSIT). Testing was done, on average, 3.6 years from the time of initial diagnosis. The incidence of neuropsychiatric features of PD, including cognitive decline and visual hallucinations, was ascertained through chart review after an average of 6.8 years of follow-up. Incidence of motor outcomes including falls and dyskinesias was also obtained. There was a significant trend for increased risk of neuropsychiatric complications across declining quartiles of olfactory test scores. In addition, subjects in the lowest quartile of olfactory performance had a significantly higher adjusted risk of hallucinations (HR = 4.70, 95% CI 1.64, 13.42) and cognitive decline (HR = 3.10, 95% CI 1.05, 9.21) than those in the reference quartile. There was no association between olfactory dysfunction and dyskinesias, and a very modest association with risk of falls. These findings suggest that severity of olfactory impairment early in the disease course may be a useful marker for the risk of neuropsychiatric complications of PD.

Stephenson, Randolph; Houghton, David; Sundarararjan, Sri; Doty, Richard L.; Stern, Matthew; Xie, Sharon X.; Siderowf, Andrew



Otorrhea in Kawasaki disease diagnosis complicated by an EBV infection: coincidental disease or a true association.  


The Authors report on two children affected by Kawasaki disease (KD). The diagnosis of KD was made after exclusion of conditions with similar presentation. At admission these children (cases 1 and 2) presented fever, purulent caseous pharyngotonsillitis, and cervical bilateral lymphadenopathy, as well as an erythematous non-vesicular rash over the face and trunk, and a mild bilateral non-exudative conjunctivitis in case 1. After respectively three and two days corticosteroid therapy was started without any significant improvement of the general condition and any diminutions of the fever. Two days later in case 1 the child presented a clear otorrhea, a cutaneous non vesicular rash, and soon after all the remaining signs of Kawasaki disease, in case 2 otorrhea was found after 4 days and then the other signs of the KD. These patients were treated with intravenous immunoglobulin (2 g/kg day), with an improvement of their general condition. To our knowledge we report the first cases of otorrhea in the setting of Kawasaki disease. We cannot exclude that the presence of Kawasaki disease in the context of otorrhea in children positive for Epstein-Barr virus (EBV) is merely coincidental. Besides, recent acquisitions show that KD is due to a new virus that could cross-react with the EBV. The Authors conclude that the presence of EBV infection or similar condition in a febrile child may not exclude Kawasaki disease and a differential diagnosis has to be performed for a timely commencement of intravenous immunoglobulin therapy.   PMID:23640449

Pavone, P; Cocuzza, S; Passaniti, E; Longo, M R; Verrotti, A; Serra, A; Romano, C; Nunnari, G; Falsaperla, R



Cardiac risks and management of complications in pregnant women with congenital heart disease.  


There are a growing number of women with congenital heart disease reaching adulthood and contemplating and/or undergoing pregnancy. However, pregnancy imposes hemodynamic stress on the heart and this can result in maternal, fetal and neonatal complications. Most women with congenital heart disease do well during pregnancy, but some women with high-risk cardiac lesions will not tolerate the hemodynamic changes of pregnancy. Physicians must be aware of the potential risks for the mother both during and after pregnancy, the risks to the fetus and neonate, and the risks and benefits of medications and procedures used during pregnancy. For women with complex cardiac conditions, management during pregnancy benefits from multidisciplinary care involving cardiologists with expertise in pregnancy, obstetricians with expertise in maternal fetal medicine, neonatologists and obstetric anesthetists, among others. This review will focus on the cardiac risks faced by women with congenital heart disease; particularly those at high risk, and on management strategies to mitigate risk and address cardiac complications. PMID:22413989

Hatton, Rachael; Colman, Jack M; Sermer, Mathew; Grewal, Jasmine; Silversides, Candice K



Diverticular disease in younger patients - is it clinically more complicated and related to obesity?  


AIM: The aims of this systematic review were to determine the presentations of diverticular disease in patients under 40 years and to assess whether obesity is an important factor. METHOD: The PubMed and EMBASE databases and the Cochrane Library were searched to identify all original articles published between 1990 and 2011 on diverticular disease severity in obese patients (BMI of ?30kg/m(2) ) under 40 years. RESULTS: Twenty three clinical case series (two of which were prospective) were identified plus two large aetiological population-based studies. These reported that young patients with diverticular disease were presenting more frequently and that diverticular disease in this age group was less likely to be complicated but emergency operation rates were higher. The majority (63.1% - 96.5%) of patients under 40 years with diverticular disease were obese. CONCLUSION: The studies suggest that in the young, obese patient with lower abdominal pain, diverticulitis and appendicitis are included in the differential diagnosis. Computerised tomography (CT) and/or laparoscopy should be considered where the diagnosis is in doubt. © 2013 The Authors. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland. PMID:23531175

Pilgrim, S M; Hart, A R; Speakman, C T M



Extraintestinal manifestations in an infant with microvillus inclusion disease: complications or features of the disease?  


Microvillus inclusion disease (MVID), a rare severe congenital enteropathy characterized by intracytoplasmic microvillous inclusions and variable brush border atrophy on intestinal epithelial cells histology, is associated with defective synthesis or abnormal function of the motor protein myosin Vb encoded by the MYO5B gene. Although MYO5B gene is expressed in all epithelial tissues, it is unclear so far whether organs other than intestine are affected in MVID patients. We report a case of an infant with MVID who presented liver dysfunction, hematuria, and Pneumocystis jiroveci pneumonia during the course of the disease. It is discussed whether extraintestinal manifestations in this patient are secondary consequences of MVID or might be features of the disease associated with altered MYO5B function. Conclusions: MVID is classically included in the differential diagnosis of congenital diarrhea of secretory type. Recent advances in our knowledge regarding the role of myosin Vb in the pathophysiology of MVID is expected to clarify the clinical spectrum of the disease and the possible primary involvement of organs other than intestine. PMID:23354788

Siahanidou, Tania; Koutsounaki, Eirini; Skiathitou, Anna-Venetia; Stefanaki, Kalliopi; Marinos, Evangelos; Panajiotou, Ioanna; Chouliaras, Giorgos



Growth failure and inflammatory bowel disease: approach to treatment of a complicated adolescent problem.  


Severe retardation of linear growth occurs in a minority of children with Crohn's disease. It appears to be associated with increased disease activity and decreased caloric intake. Why some children are affected and others are not is unknown, but some degree of growth retardation is probably more prevalent than is generally appreciated. The use of somatomedin-C levels may be of some future value in predicting which children will be affected. Growth failure is often difficult to treat and requires vigorous medical and nutritional support. No current treatment is without attendant problems. Proper and frequent assessment of growth and development will help ensure intervention while growth potential still exists in these children. Large cooperative studies are needed to compare the effects of various treatment plans on the growth velocity and ultimate stature of children with Crohn's disease-related growth retardation. PMID:6412208

Rosenthal, S R; Snyder, J D; Hendricks, K M; Walker, W A



Preoperative Steroid Use and Risk of Postoperative Complications in Patients With Inflammatory Bowel Disease Undergoing Abdominal Surgery  

Microsoft Academic Search

CONTEXT: Corticosteroids are the mainstay of medical therapies to induce remission in acute episodes of inflammatory bowel disease (IBD). However, evidence suggests that this may increase the risk of postoperative complications among patients with IBD who go on to have abdominal surgery.OBJECTIVE:To estimate the risk of postoperative complications following abdominal surgery in patients with IBD on steroids at the time

Venkataraman Subramanian; Sonia Saxena; Jin-Yong Kang; Richard C. G. Pollok



Utility of Serological Markers in Predicting the Early Occurrence of Complications and Surgery in Pediatric Crohn's Disease Patients  

Microsoft Academic Search

BACKGROUND AND OBJECTIVES:Many Crohn's disease (CD) patients develop complications (fistulae and abscesses), and require surgery, often repeatedly and at variable instances. Identifying serological markers that determine their early or repeated manifestation can enable implementing more aggressive preventive strategies. Our objective was to study the ability of serological markers for predicting development of early (first) and recurrent complications or requirement for

Devendra K. Amre; Shou-En Lu; Florin Costea; Ernest G. Seidman



The treatment of internal fistulae that complicate diverticular disease of the sigmoid colon by laparoscopically assisted colectomy  

Microsoft Academic Search

Seven patients with internal fistulae complicating colonic diverticular disease were treated by laparoscopic assisted colectomy over a 24-month period. Prospective review of these patients was carried out to ascertain efficacy of the treatment. No intraoperative complications were encountered and return of gastrointestinal function was apparent within two days in all cases. Postoperative hospital stay was limited to an average of

P. J. Hewett; R. Stitz



Carbimazole-induced myositis in the treatment of Graves' disease: a complication in genetically susceptible individuals?  


A 24-year-old Chinese woman with Graves' disease presented with myositis two months after treatment with carbimazole. The patient's myositis resolved with hydration and cessation of carbimazole. No other causes of myositis were found, and a change in the medication to propylthiouracil was uneventful. Review of the literature suggests a possible genetic susceptibility, as the majority of reported cases are Asian in origin, similar to patients who present with thyroid periodic paralysis. Changing the antithyroid drugs (ATDs) administered, decreasing the dose of pre-existing ATDs in the treatment regimen or addition of levothyroxine has been shown to result in clinical improvement of this complication. These observations suggest various mechanisms of carbimazole-induced myositis in the treatment of Graves' disease, including the direct effect of ATDs on myocytes, immune-related responses secondary to ATDs and rapid decrements in thyroid hormone with ensuing myositis. PMID:23900475

Lim, Adoree Yi Ying; Kek, Peng Chin; Soh, Abel Wah Ek



Psychiatric Disorders and Coronary Heart Disease in Women – A Still Neglected Topic: Review of the Literature from 1971 to 2000  

Microsoft Academic Search

Background: Coronary heart disease (CHD) is the leading cause of death in women aged over 40 years in the United States, for whom it conveys a worse prognosis than for men. Recently, psychosocial factors have been understood to represent significant risk factors for developing CHD, as well as having a worse outcome with established CHD. However, these factors are often

Bettina Bankier; Andrew B. Littman



Screening for Early Alzheimer's Disease: Is There Still a Role for the Mini-Mental State Examination?  

PubMed Central

Background: The objective of this study was to compare the performance of the Mini-Mental State Examination (MMSE) total score as well as item scores in separating 4 groups of elderly (55–85 years of age) subjects—normal controls, subjects with mild cognitive impairment (MCI), subjects with mild Alzheimer's disease, and subjects with depression. Method: The MMSE scores of 86 subjects (25 normal elderly controls, 26 subjects with MCI, 10 subjects with mild Alzheimer's disease, and 25 subjects with depression) were analyzed. Statistically significant differences between groups in both overall MMSE score and individual item scores were documented. Receiver operating characteristic curves were constructed to yield further data. Results: The overall MMSE scores of the mild Alzheimer's disease group were significantly below those of subjects in the control, MCI, and depression groups (p < .001). The overall MMSE scores of MCI subjects were significantly lower than those of control subjects (p = .005) but not different from those of subjects with depression. Furthermore, individual item responses were not significantly different between MCI subjects and controls. The delayed recall item scores were statistically lower in the mild Alzheimer's disease group versus the other 3 groups but did not separate the control, MCI, and depression groups from each other. Conclusion: The MMSE effectively separates those with mild Alzheimer's disease from the other 3 groups and MCI from normal aging, but it is relatively ineffective in separating normal elderly individuals from those with depression and individuals with MCI from those with depression. Measures other than the MMSE may need to be implemented to evaluate mental status to more effectively separate MCI from depression and depression from normal aging.

Benson, Aaron D.; Slavin, Melissa J.; Tran, Thanh-Thu; Petrella, Jeffrey R.; Doraiswamy, P. Murali



Efficacy and long-term follow-up of IL-1R inhibitor anakinra in adults with Still's disease: a case-series study  

PubMed Central

Introduction To assess the efficacy and safety of the interleukin-1 receptor (IL-1R) inhibitor anakinra in adult patients with refractory Still's disease. Methods Twenty-five patients (13 males and 12 females, median age 32 years, median disease duration seven months) with Still's disease were treated with subcutaneous injections of anakinra (100 mg/day). Treatment was given as adjunct therapy in 16 patients and as standalone in 9 patients for a median time of 15 months (range 1.5-71). The clinical and laboratory parameters during follow-up were recorded. Results In 84% of patients the clinical activity resolved completely within a few days (median time 0.2 months), and response was maintained until the last visit in all but one patient. A complete response of all disease-related symptoms (clinical and laboratory) occurred subsequently within a median time of three months in 80% of patients. A partial clinical and laboratory improvement was shown in 12% and 16% of patients, respectively. The Visualized Analogue Scale and Health Assessment Questionnaire scores significantly decreased during treatment. The proportion of patients achieving the American College of Rheumatology 20 (ACR20) score (20% improvement) was 82% at one month and improved to 100% at one year. The mean oral corticosteroid dose was significantly reduced at each visit. Anakinra was discontinued due to unresponsiveness in one patient and due to relapsing disease in another. Treatment was also withdrawn in three patients with severe skin reactions (urticaria). Seven patients experienced an infection during follow-up. Conclusions The rapid and sustained response in the majority of our patients encourages the use of anakinra in adults with Still's disease.



CROI 2013: Complications of HIV disease, viral hepatitis, and antiretroviral therapy.  


Studies with direct-acting antivirals (DAAs) for hepatitis C virus (HCV) monoinfection and HIV coinfection were highlighted at the 2013 Conference on Retroviruses and Opportunistic Infections (CROI). In HCV monoinfected patients, several interferon alfa-sparing, all-oral regimens demonstrated cure rates of greater than 90% with 12 weeks of treatment, including for hard-to-treat patients. Cure rates of 75% were attained in HIV/HCV coinfected patients with the addition of the investigational HCV protease inhibitor (PI) simeprevir to peginterferon alfa and ribavirin. Drug-drug interaction data to inform safe coadminstration of antiretroviral therapy with DAA-based HCV treatment were presented. There was continued emphasis on pathogenesis, management, and prevention of the long-term complications of HIV disease and its therapies, including cardiovascular disease, renal disease, alterations in bone metabolism, and vitamin D deficiency, along with a growing focus on biomarkers to predict development of end-organ disease. Understanding the elevated risk for non-AIDS-defining malignancies in the HIV-infected population and optimal management was a focal point of this year's data. Finally, the conference provided important information on tuberculosis coinfection and cryptococcal meningitis. PMID:23681961

Luetkemeyer, Anne F; Havlir, Diane V; Currier, Judith S


Shoulder capsulitis in type I and II diabetic patients: association with diabetic complications and related diseases.  

PubMed Central

OBJECTIVE: To examine the association between shoulder capsulitis and chronic diabetic complications and diseases closely related to diabetes. METHODS: A cross sectional study in 291 type I [mean (SD) age 33.2 (9.9) years] and 134 type II [61.1 (12.4) years] diabetic patients. The presence of shoulder capsulitis, Dupuytren disease, and limited joint mobility was sought. The patients were assessed for background and proliferative retinopathy, nephropathy, autonomic neuropathy, and peripheral symmetrical somatic polyneuropathy. Diseases closely related to diabetes (hypertension, history of myocardial infarction, coronary heart disease, and peripheral vascular disease) were also recorded. RESULTS: Prevalence of shoulder capsulitis was 10.3% in type I and 22.4% in type II diabetic subjects. Shoulder capsulitis was associated with the age in types I (P < 0.01) and II (P < 0.05) diabetic patients, and with the duration of diabetes in type I patients (P < 0.01). Odds ratios for autonomic neuropathy in type I and type II diabetic subjects with shoulder capsulitis were 4.1 (95% confidence interval, 1.6 to 10.9) and 2.7 (95% CI, 1.1 to 7.0), respectively, after controlling for age and duration of diabetes. Odds ratio for history of myocardial infarction in type I diabetic subjects with shoulder capsulitis was 13.7 (95% CI, 1.3 to 139.5) after controlling for age, duration of diabetes, hypertension, and smoking habits. Other associations between shoulder capsulitis and diabetic complications, related diseases, and other hand abnormalities were fully explained by age and the duration of diabetes. CONCLUSIONS: Shoulder capsulitis is common in type I and type II diabetic patients. It is associated with age in type I and II diabetic patients and with the duration of diabetes in type I patients. It is associated with autonomic neuropathy in type I and II diabetic patients and with history of myocardial infarction in type I diabetic patients, independently of time related variables.

Arkkila, P E; Kantola, I M; Viikari, J S; Ronnemaa, T



Are rare diseases still orphans or happily adopted? The challenges of developing and using orphan medicinal products  

PubMed Central

Orphan medicinal products (OMPs) are targeted at the diagnosis, prevention or treatment of rare diseases and have a special status in European law. This status brings incentives for pharmaceutical companies to invest in OMP development. The goal of the legislation is to encourage the development of more treatments for life-threatening rare disorders, but increased availability of OMPs raises important issues surrounding the public funding of very expensive treatments by national health services. In this article we review OMPs and the incentives for their development and discuss the challenges presented by funding these treatments.

Dear, James W; Lilitkarntakul, Pajaree; Webb, David J



Skeletal Manifestations of Hydatid Disease in Serbia: Demographic Distribution, Site Involvement, Radiological Findings, and Complications  

PubMed Central

Although Serbia is recognized as an endemic country for echinococcosis, no information about precise incidence in humans has been available. The aim of this study was to investigate the skeletal manifestations of hydatid disease in Serbia. This retrospective study was conducted by reviewing the medical database of Institute for Pathology (Faculty of Medicine in Belgrade), a reference institution for bone pathology in Serbia. We reported a total of 41 patients with bone cystic echinococcosis (CE) during the study period. The mean age of 41 patients was 40.9±18.8 years. In 39% of patients, the fracture line was the only visible radiological sign, followed by cyst and tumefaction. The spine was the most commonly involved skeletal site (55.8%), followed by the femur (18.6%), pelvis (13.9%), humerus (7.0%), rib (2.3%), and tibia (2.3%). Pain was the symptom in 41.5% of patients, while some patients demonstrated complications such as paraplegia (22.0%), pathologic fracture (48.8%), and scoliosis (9.8%). The pathological fracture most frequently affected the spine (75.0%) followed by the femur (20.0%) and tibia (5.0%). However, 19.5% of patients didn't develop any complication or symptom. In this study, we showed that bone CE is not uncommon in Serbian population. As reported in the literature, therapy of bone CE is controversial and its results are poor. In order to improve the therapy outcome, early diagnosis, before symptoms and complications occur, can be contributive.

Bracanovic, Djurdja; Sopta, Jelena; Djonic, Danijela; Lujic, Nenad



Skeletal manifestations of hydatid disease in serbia: demographic distribution, site involvement, radiological findings, and complications.  


Although Serbia is recognized as an endemic country for echinococcosis, no information about precise incidence in humans has been available. The aim of this study was to investigate the skeletal manifestations of hydatid disease in Serbia. This retrospective study was conducted by reviewing the medical database of Institute for Pathology (Faculty of Medicine in Belgrade), a reference institution for bone pathology in Serbia. We reported a total of 41 patients with bone cystic echinococcosis (CE) during the study period. The mean age of 41 patients was 40.9±18.8 years. In 39% of patients, the fracture line was the only visible radiological sign, followed by cyst and tumefaction. The spine was the most commonly involved skeletal site (55.8%), followed by the femur (18.6%), pelvis (13.9%), humerus (7.0%), rib (2.3%), and tibia (2.3%). Pain was the symptom in 41.5% of patients, while some patients demonstrated complications such as paraplegia (22.0%), pathologic fracture (48.8%), and scoliosis (9.8%). The pathological fracture most frequently affected the spine (75.0%) followed by the femur (20.0%) and tibia (5.0%). However, 19.5% of patients didn't develop any complication or symptom. In this study, we showed that bone CE is not uncommon in Serbian population. As reported in the literature, therapy of bone CE is controversial and its results are poor. In order to improve the therapy outcome, early diagnosis, before symptoms and complications occur, can be contributive. PMID:24039289

Bracanovic, Djurdja; Djuric, Marija; Sopta, Jelena; Djonic, Danijela; Lujic, Nenad



Capillaroscopic pattern in systemic lupus erythematosus and undifferentiated connective tissue disease: what we still have to learn?  


In rheumatology, specific is the capillaroscopic pattern in systemic sclerosis (SSc), the so-called "scleroderma type". Capillaroscopic pattern in systemic lupus erythematosus (SLE) is less specific and includes a wide range of microvascular changes-"SLE-type" capillaroscopic pattern, non-specific findings and in a small percentage "scleroderma-like" pattern. The latter finding is currently associated with a potential subclinical overlap with SSc. Various microvascular changes have been observed in a different proportion of patients with undifferentiated connective tissue disease (UCTD). The aim of the study was to evaluate the capillaroscopic changes in SLE and UCTD. Patients from the following groups were included in the study: 30 female patients with SLE (mean age, 49 ± 15.4 years), 31 patients with UCTD (mean age, 50 ± 17 years; 30 females and 1 male); 34 age- and sex-matched healthy volunteers were examined as a control group. Nailfold capillaroscopy was performed using videocapillaroscope Videocap 3.0 (DS Medica). Capillaroscopic findings were compared with clinical and laboratory data of the patients. At capillaroscopic examination, the most frequent capillaroscopic changes in SLE patients were the presence of elongated capillaries in 43 % (13/30), an increased tortuosity in 70 % (21/30) and a prominent subpapillary plexus in 60 % (18/30) of the cases. In 80 % (24/30) of the patients, dilated capillaries were found; in 6.6 % (2/30), giant capillary loops; and in 16.6 % (5/30), haemorrhages. In 50 % of the patients, an "SLE-type" capillaroscopic pattern was found. In 30 % (9/30) of the cases the capillaroscopic examination revealed "non-specific changes", in 6.6 % (2/30) of the patients it was found a normal capillaroscopic pattern and in 13.3 % (4/30) a "scleroderma-like" pattern. Positive tests for ANA were detected in 73.3 % (11/15) of the patients with "SLE-type" capillaroscopic pattern. In all the patients with "scleroderma-like" capillaroscopic finding, positive autoantibodies with a high titre were found, without signs for overlap with other connective tissue disease (CTD). In two out of four patients with such capillaroscopic findings, a vasculitis of peripheral vessels was evident and in the other two secondary RP and high immunologic activity. A "scleroderma-like" pattern was found in 38 % (12/31) of the patients with UCTD. In 51 % (16/31) of the patients from this group, "non-specific" capillaroscopic findings were observed. For the evaluation of the predictive value of capillaroscopic pattern for the development of a distinct rheumatic disorder in patients with UCTD, a longer period of follow-up is necessary. In SLE patients, it has been found that capillaroscopic examination reveals microvascular changes also in the absence of RP. Here, the results from the study illustrate the correlation between capillaroscopic changes and immunological profile. "Scleroderma-like" capillaroscopic pattern may be observed in the context of active vasculitis of peripheral vessels as well as in patients with secondary RP and high immunologic activity. It does not have an obligatory association with an overlap syndrome with other CTD. Capillaroscopic findings in UCTD are heterogeneous. The potential of capillaroscopic examination in UCTD for evaluating the prognosis of the disease needs to be revealed through long-term follow-up. PMID:22527142

Lambova, Sevdalina Nikolova; Müller-Ladner, Ulf



Surgical management of complicated small bowel diverticular disease. About 4 clinical reports.  


Diverticula of the small intestine are relatively rare. A retrospective analysis of 4 cases of the practice of Department of General and Hepatopancreatic surgery, University Hospital "Alexandrovska"--Sofia was performed. Two patients are with Meckel diverticulum--the first one with diverticulitis, and the second with perforation and formed abscess cavity. The third case presents a patient with an intestinal loop with diverticula accreted in hernial sack and forth one is with diverticular perforation of the small intestine. All of them underwent surgery. This is accomplished with a literature review presenting the possible diagnostic and treatment modalities applied to this disease. Complications of intestinal diverticulosis often require surgical management in urgent conditions. PMID:23847804

Arabadzhieva, E; Boney, S; Dimitrova, V



The Genetics of Vascular Complications in Autosomal Dominant Polycystic Kidney Disease (ADPKD).  


The most important extra-renal manifestation of autosomal dominant polycystic kidney disease (ADPKD) in terms of debilitating injury and premature death is the development of intracranial aneurysms (IAs) and other vascular complications, resulting in subarachnoid hemorrhage (SAH). IAs are found at a rate approximately five times higher in ADPKD patients than in the general population and in patients with a family history of SAH/IAs the frequency is elevated further three to five times, indicating the importance of genetic factors in its etiology. Expression of the ADPKD gene products, polycystin-1 (PKD1) and polycystin-2 (PKD2), in vascular smooth muscle and the endothelium, and evidence that reduced levels of these proteins leads to IA development in mouse models, suggests a direct role of these proteins in the vascular disease. PKD1 and PKD2 patients seem equally likely to develop IAs, while patients with mutations to the 5' half of PKD1 may more likely have vascular complications. Genome wide association and candidate studies of multiplex families with IAs without ADPKD have identified a number of genes/proteins that may be risk factors for the development of IAs. These candidate proteins largely have roles in the maintenance and remodeling of the arterial wall of small brain arteries. The development of the genetic methodologies of massively parallel sequencing mean it is now possible to test these and other candidates in ADPKD families with multiplex and singleton IA cases. Identifying strong modifiers of this phenotype will be important for prioritizing patients for presymptomatic screening and interventions. PMID:23971643

Rossetti, Sandro; Harris, Peter C



Insights into cerebrovascular complications and Alzheimer disease through the selective loss of GRK2 regulation  

PubMed Central

Alzheimer disease (AD) and stroke are two leading causes of age-associated dementia. Increasing evidence points to vascular damage as an early contributor to the development of AD and AD-like pathology. In this review, we discuss the role of G protein-coupled receptor kinase 2 (GRK2) as it relates to individuals affected by AD and how the cardiovasculature plays a role in AD pathogenesis. The possible involvement of GRKs in AD pathogenesis is an interesting notion, which may help bridge the gap in our understanding of the heart–brain connection in relation to neurovisceral damage and vascular complications in AD, since kinases of this family are known to regulate numerous receptor functions both in the brain, myocardium, and elsewhere. The aim of this review is to discuss our findings of overexpression of GRK2 in the context of the early pathogenesis of AD, because increased levels of GRK2 immunoreactivity were found in vulnerable neurons of AD patients as well as in a two-vessel occlusion (2-VO) mammalian model of ischaemia. Also, we consider the consequences for this overexpression as a loss of G-protein coupled receptor (GPCR) regulation, as well as suggest a potential role for GPCRs and GRKs in a unifying theory of AD pathogenesis, particularly in the context of cerebrovascular disease. We synthesize this newer information and attempt to put it into context with GRKs as regulators of diverse physiological cellular functions that could be appropriate targets for future pharmacological intervention.

Obrenovich, Mark E.; Morales, Ludis A.; Cobb, Celia J.; Shenk, Justin C.; Mendez, Gina M.; Fischbach, Kathryn; Smith, Mark A.; Qasimov, Eldar K.; Perry, George; Aliev, Gjumrakch



Does oxidative stress play a critical role in cardiovascular complications of Kawasaki disease?  


The aim of the present work was to evaluate the contribution of the different reactive oxidizing species to systemic oxidative stress in the whole blood of patients with Kawasaki disease (KD). This is a rare generalized systemic vasculitis typical of the early childhood characterized by inflammation and endothelial dysfunction with a high risk for cardiovascular fatal events. We found that, compared to age-matched healthy donors, blood from KD patients showed increased production of oxygen- and nitrogen-derived species as detected by electron paramagnetic resonance (EPR) spin probing with the cyclic hydroxylamine 1-hydroxy-3-carboxy-pyrrolidine. The (•)NO pathway involvement was also confirmed by the decreased concentrations of the endogenous (•)NO synthase inhibitor asymmetric dimethyl-arginine and the increased amounts of 3-nitrotyrosine in plasma. Further, increased plasma yields of the proinflammatory enzyme myeloperoxidase were also observed. The appearance of circulating red blood cell alterations typically associated with oxidative imbalance and premature aging (e.g., decrease of total thiol content, glycophorin A, and CD47 expression, as well as increase of phosphatidylserine externalization) has also been detected. Collectively, our observations lead to hypothesize that the simultaneous oxidative and nitrative stress occurrence in the blood of KD patients may play a pathogenetic role in the cardiovascular complications often associated with this rare disease. PMID:22578402

Straface, Elisabetta; Marchesi, Alessandra; Gambardella, Lucrezia; Metere, Alessio; Tarissi de Jacobis, Isabella; Viora, Marina; Giordani, Luciana; Villani, Alberto; Del Principe, Domenico; Malorni, Walter; Pietraforte, Donatella



Type 1 diabetes and celiac disease in adults: glycemic control and diabetic complications.  


The prevalence of celiac disease (CD) in patients with type 1 diabetes mellitus (T1DM) is 4.5 %. Objective of the study is to investigate (1) the course of glycemic control at CD diagnosis and after the initiation of a gluten-free diet (GFD) in T1DM patients; (2) the prevalence of diabetic complications in T1DM patients with adult onset of CD. In 20 hospitals in the Netherlands, we identified T1DM patients diagnosed with CD at adult age. We retrospectively collected glycated hemoglobin (HbA1c) levels before CD diagnosis, at CD diagnosis, and the most recent HbA1c levels as well as the presence of nephropathy and retinopathy. The control group consisted of patients with T1DM and negative CD serology matched for age, gender, T1DM duration, and HbA1c levels. Thirty-one patients were eligible with a median duration of T1DM and CD of 27 years (IQR 14-37) and 3 years (IQR 1-8), respectively. The matched control group consisted of 46 patients. HbA1c levels at the moment of CD diagnosis were 7.5 % (IQR 7.1-8) [58 mmol/mol] and at the most recent visit 7.4 % (IQR 6.9-7.9, P = 0.15) [57 mmol/mol] indicating no difference. Prevalence of retinopathy was lower in T1DM + CD group compared with controls, (38.7 vs 67.4 %, P < 0.05), whereas no difference in the prevalence of nephropathy was found between the groups (P = 0.09). In conclusion, T1DM + CD patients have less retinopathy compared to T1DM patients without CD. A GFD possibly favorable affects the development of vascular complications in T1DM patients. PMID:22539236

Bakker, Sjoerd F; Tushuizen, Maarten E; von Blomberg, Mary E; Mulder, Chris J; Simsek, Suat



High Prevalence of Microvascular Complications in Adults With Type 1 Diabetes and Newly Diagnosed Celiac Disease  

PubMed Central

OBJECTIVE The implications of celiac disease (CD) in adult patients with type 1 diabetes are unknown, with respect to diabetes-related outcomes including glycemic control, lipids, microvascular complications, quality of life, and the effect of a gluten-free diet (GFD). We identified CD in adults with type 1 diabetes and investigated the effect of a GFD on diabetes-related complications. RESEARCH DESIGN AND METHODS This was a case-control study conducted at a U.K. teaching hospital. Patients with type 1 diabetes aged >16 years (n = 1,000) were assessed for CD. HbA1c, lipid profile, quality of life, retinopathy stage, nephropathy stage, and degree of neuropathy before and after 1 year on a GFD were assessed. RESULTS The prevalence of CD was 33 per 1,000 subjects (3.3% [95% CI 2.3–4.6]). At diagnosis of CD, adult type 1 diabetic patients had worse glycemic control (8.2 vs. 7.5%, P = 0.05), lower total cholesterol (4.1 vs. 4.9, P = 0.014), lower HDL cholesterol (1.1 vs. 1.6, P = 0.017), and a higher prevalence of retinopathy (58.3 vs. 25%, P = 0.02), nephropathy (41.6 vs. 4.2%, P = 0.009), and peripheral neuropathy (41.6 vs. 16.6%, P = 0.11). There was no difference in quality of life (P > 0.1). After 1 year on a GFD, only the lipid profile improved overall, but in adherent individuals HbA1c and markers for nephropathy improved. CONCLUSIONS Adults with undetected CD and type 1 diabetes have worse glycemic control and a higher prevalence of retinopathy and nephropathy. Treatment with a GFD for 1 year is safe in adults with type 1 diabetes and does not have a negative impact on the quality of life.

Leeds, John S.; Hopper, Andrew D.; Hadjivassiliou, Marios; Tesfaye, Solomon; Sanders, David S.



Trends in morbidity, mortality, and risk factor levels of coronary heart disease in Japan—Are Japanese living in Japan still protected against coronary heart disease?  

Microsoft Academic Search

In accordance with the rapid aging of the Japanese population, the number of patients with stroke and heart disease is expected to increase in the 21st century. Continuing rapid westernization of lifestyle, such as dietary habits along with increased hyperlipidemia and diabetes mellitus, presents another concern about a possible future increase in atherosclerotic disease incidence among the male population.A review

Kazunori Kodama; Fumiyoshi Kasagi



High rate of complicated idiopathic gallstone disease in pediatric patients of a North American tertiary care center  

PubMed Central

AIM: To assess spectrum and etiology of gallstones and biliary sludge in the pediatric population of a North American tertiary care centre. METHODS: Retrospective review of abdominal ultrasounds recorded at Saint Justine Hospital over a period of 24 mo (8/2003 to 8/2005) in patients < 19 years of age. Patients < 2 years of age were analyzed separately. RESULTS: The presence of gallstones was noted in 127 patients. In 107 it was a new diagnosis, in 48/105 (45.7%) patients > 2 years of age idiopathic gallstone disease was found. These 48 patients represent 2.1% of the population who required ultrasound for abdominal pain. Complicated gallstone disease occurred in 28/48 with idiopathic disease, mainly adolescent girls. Patients with hemolytic disorders, cystic fibrosis, oncologic diseases or kidney transplantation and gallstones were asymptomatic and stones were detected during routine abdominal ultrasound. Twenty two patients < 2 years of age not consulting for abdominal pain had gallstone disease of diverse etiology. Biliary sludge was seen in 84 patients, 78.5% on total parenteral nutrition. In 4 patients, sludge progressed to gallstones. CONCLUSION: Idiopathic gallstone disease and its rate of complication are more frequent in our cohort than expected from previous studies. Adolescent girls with abdominal pain and idiopathic gallstones require special attention for complicated disease course.

Herzog, Denise; Bouchard, Guylaine



Management of diabetes across the course of disease: minimizing obesity-associated complications  

PubMed Central

Obesity increases the risk for developing type 2 diabetes mellitus (T2DM) and this in turn correlates with an elevated probability of long-term diabetes complications once diabetes is established. Interventions aimed at lowering weight via changes in diet and lifestyle have repeatedly been shown to improve glycemic control in patients with T2DM and even to reverse early disease. Weight gain, a potential side effect of treatment for patients with T2DM, is also an important concern, and it has been noted that weight increases associated with antidiabetes therapy may blunt cardiovascular risk reductions achieved by decreasing blood glucose. Among older agents, metformin and acarbose have the lowest risk for weight gain, while sulfonylureas, meglitinides, and thiazolidinediones are all associated with weight increases. Clinical trial results have also consistently demonstrated that treatment with glucagon-like peptide-1 receptor agonists and amylin lowers weight, and that dipeptidyl peptidase-4 inhibitors are weight neutral in patients with T2DM. Conventional human insulin formulations are known to increase weight in patients with T2DM. However, some insulin analogs, particularly insulin detemir, have lower liability for this adverse event. The use of both pharmacologic and surgical therapies aimed at treating obesity rather than lowering blood glucose have the potential to improve glycemic control and even resolve T2DM in some patients.

Apovian, Caroline M



Rare association of Hodgkin lymphoma, Graves’ disease and myasthenia gravis complicated by post-radiation neurofibrosarcoma: coincidence or genetic susceptibility?  

Microsoft Academic Search

With Hodgkin lymphoma (HL), other (autoimmune) diseases may occasionally occur or associate, whereas as a late treatment-complication,\\u000a second tumour may develop. In our patient HL was diagnosed in 1996 and consequently received COPP\\/ABV and mantle irradiation.\\u000a Due to the residual mediastinal tumour CRu was declared but later on no progression\\/relapse could be proved by PET. In 2000\\u000a Graves’s disease, in

Zsófia Simon; Zsuzsa Ress; József Toldi; Anita Trauninger; Zsófia Miltényi; Árpád Illés



A Child With Epstein-Barr Virus-associated Hemophagocytic Lymphohistiocytosis Complicated by Coronary Artery Lesion Mimicking Kawasaki Disease.  


There is considerable overlap between hemophagocytic lymphohistiocytosis (HLH) and Kawasaki disease (KD) in terms of aberrant immune response though the etiology of KD remains unknown. We present a case fulfilling the criteria of both HLH and KD complicated by coronary artery dilatation: HLH was confirmed to be triggered by Epstein-Barr virus. This case alarms us the possibility that even patients with HLH may be complicated by coronary artery lesion, which is one of the hallmarks of KD. We would like to draw attention that if features of KD become apparent in patients with HLH, echocardiographic examinations should be performed not to miss coronary artery lesion. PMID:23619112

Kato, Shogo; Yoshimura, Ken; Tanabe, Yuko; Kimata, Takahisa; Noda, Yukihiro; Kawasaki, Hirohide; Kaneko, Kazunari



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



[Is suxamethonium still useful for paediatric anaesthesia?].  


Suxamethonium is the only depolarising neuromuscular blocking agent, which is still being widely used during general anaesthesia. Some of its unique properties rank suxamethonium as an ideal neuromuscular blocking agent i.e. the fast onset of muscle paralysis and spontaneous neuromuscular block reversal. However, the agent may trigger malignant hyperthermia, hyperkaliaemia, severe bradycardia and other complications, which have to be considered. Due to differences in postsynaptic nicotine receptor structure and functional insufficiency of the neuromuscular junction, paediatric patients when compared to adults, are more sensitive to potential side effects when suxamethonium is administered. Malignant hyperthermia is an important risk factor. Ryanidine receptors located in the sarcoplasmic/endoplasmic reticulum membrane are responsible for the release of Ca2+ from intracellular stores and trigger this complication.The risk of hyprethermia increases in children when some neurologic and muscle diseases coexist. Nowadays, in rapid sequence induction of anaesthesia, suxamethonium may be replaced with rocuronium - a non-depolarising muscle relaxant which provides the intubating conditions similar to suxamethonium. The rocuronium-induced neuromuscular blockade, which lasts longer than blockade following suxamethonium, is reversed with sugammadex - a new selective relaxant binding agent. Despite new agents and methods, suxamethonium still remains the drug of choice for muscle relaxation for intubation in children. PMID:22011924

Owczarek, Marcin; Bu?towicz, Robert; Ka?mirczuk, Roman; Sadaj-Owczarek, Kamila; Paciorek, Przemys?aw; Jakubczyk, Marlena; Kupczyk, Kinga; Kusza, Krzysztof


Risk Factors for Neurologic Complications of Hand, Foot and Mouth Disease in the Republic of Korea, 2009  

PubMed Central

In 2009, the first outbreak of hand, foot and mouth disease (HFMD) or herpangina (HP) caused by enterovirus 71 occurred in the Republic of Korea. This study inquired into risk factors associated with complications of HFMD or HP. A retrospective medical records review was conducted on HFMD or HP patients for whom etiologic viruses had been verified in 2009. One hundred sixty-eight patients were examined for this investigation. Eighty patients were without complications while 88 were accompanied by complications, and 2 had expired. Enterovirus 71 subgenotype C4a was the most prevalent in number with 67 cases (54.9%). In the univariate analysis, the disease patterns of HFMD rather than HP, fever longer than 4 days, peak body temperature over 39?, vomiting, headache, neurologic signs, serum glucose over 100 mg/dL, and having an enterovirus 71 as a causative virus were significant risk factors of the complications. After multiple logistic analysis, headache (Odds ratio [OR], 10.75; P < 0.001) and neurologic signs (OR, 42.76; P < 0.001) were found to be the most significant factors. Early detection and proper management of patients with aforementioned risk factors would be necessary in order to attain a better clinical outcome.

Kim, Seong Joon; Kang, Jin-Han; Kim, Dong Soo; Kim, Ki Hwan; Kim, Kyung-Hyo; Kim, Young-Hoon; Chung, Ju-Young; Bin, Joong Hyun; Jung, Da Eun; Kim, Ji Hong; Kim, Hwang Min; Cheon, Doo-Sung; Kang, Byung Hak; Seo, Soon Young



Risk factors for coronary heart disease in type 1 diabetic patients in Europe : The EURODIAB Prospective Complications Study  

Microsoft Academic Search

OBJECTIVE—The goal of the study was to examine risk factors in the prediction of coronary heart disease (CHD) and differences in men and women in the EURODIAB Prospective Complications Study. RESEARCH DESIGN AND METHODS—Baseline risk factors and CHD at follow-up were assessed in 2,329 type 1 diabetic patients without prior CHD. CHD was defined as physician-diagnosed myocardial infarction, angina pectoris,

S. S. Soedamah-Muthu; N. Chaturvedi; M. Toeller; B. Ferriss; P. Reboldi; G. Michel; C. Manes; J. H. Fuller



[The value of quantitative analysis of procalcitonine in diagnostics of septic complications in patients with autoimmune rheumatic diseases].  


The infections very often complicate the course of autoimmune rheumatic diseases. In diagnostic of septic complications in rheumatic patients the new biomarkers of infections can have a decisive importance. The procalciotonine test is one of them. The issue was to evaluate the diagnostic informativity of this test. The sample included 93 patients. The examination was applied to 65 patients with rheumatic diseases. Among them, 13 patients had bacterial infections. The group consisted of 33 patients with rheumatoid arthritis, 11 patients with systemic lupus erythematous, 6 patients with systemic angiitis, and 15 patients with other rheumatic diseases. The comparative group included 27 patients of cardio-therapeutic profile and 8 of these patients had bacterial infections. The procalcitonine test was applied with quantitative electrochemiluminescent technique. In patients with rheumatoid arthritis the mean levels of procalciotonine test consisted 0.10 +/- 0.13 ng/ml; with systemic lupus erythematous--0.08 +/- 0.06 ng/ml; with systemic angiitis--0.22 +/- 0.2 ng/ml; with other rheumatic diseases--0.12 +/- 0.15 ng/ml; of cardio-therapeutic profile without infections--0.08 +/- 0.06 ng/vl/ With threshold of procalcitonine test higher than 0.5/ml the sensitivity to diagnostic of infections consisted of 58%, specificity--94% in the group with rheumatic diseases. The procalciotonine test in case of no infection process with values higher than 0.5 ng/ml was detected in three patients. The evaluation of dependence of sensitivity and specificity for procalciotonine test and C-reactive protein the area under curve of procalcitonine test was larger in patients with rheumatic diseases (0.85 against 0.79) and in patients of cardio-therapeutic profile (0.92 against 0.90). The quantitative procalcitonine test is the best technique to detect septic complications in rheumatic patients. PMID:23807991

Lapin, S V; Maslianski?, A L; Lazareva, N M; Vasil'eva, E Iu; Totolian, A A



Chronic pulmonary diseases are independent risk factors for complications after radical nephrectomy  

Microsoft Academic Search

Aim  We aimed to identify the prognostic factors and the new parameters such as Charlson’s comorbidity index (CCI) that might predict\\u000a postoperative complication rates in a radical nephrectomy cohort. We also evaluated the correlation of CCI with the Clavien\\u000a postoperative complication scale (CPCS).\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  Perioperative characteristics of 47 patients undergoing radical nephrectomy were recorded. Following items were assessed:\\u000a preoperative patient

Hüsnü Tokgöz; Bülent Akduman; ?lker Ünal; Bülent Erol; Ersöz Akyürek; Necmettin Aydin Mungan


Ocular Inflammation in Beh?et's Disease: Incidence of Ocular Complications and of Loss of Visual Acuity  

PubMed Central

Purpose To estimate the risk of structural ocular complications and loss of visual acuity in cases of Behçet’s Disease (BD); to evaluate potential risk and protective factors for these events Design Retrospective cohort study Methods Setting Five academic center ocular inflammation subspecialty practices Study Population A total of 168 consecutive patients with BD-associated ocular inflammation Procedures Clinical data on these patients were ascertained by standardized chart review Outcome Measures Visual acuity, structural ocular complications of inflammation, intraocular pressure (IOP) Results Over a median follow-up of 1.05 years, the incidence of specific structural complications and IOP disturbances were common: the incidence rate of any ocular complication was 0.45/eye-year (EY). Rates of loss of visual acuity to 20/50 or worse and to 20/200 or worse were 0.12/EY and 0.09/EY respectively. Risk factors for loss of visual acuity during follow-up were persistent inflammatory activity, presence of posterior synechiae, presence of hypotony, and presence of elevated IOP. In a time-dependent analysis, current activity of ocular inflammation was associated with an increased risk of loss of visual acuity to 20/50 or worse (RR = 2.45, 95% CI: 1.1–5.5, p = 0.03) and to 20/200 or worse (RR = 2.67, 95% CI: 1.2–5.8, p = 0.01). Conclusions Loss of visual acuity and occurrence of ocular complications were common in patients with ocular inflammation associated with Behçet’s Disease, even with aggressive therapy. Ongoing inflammation during follow-up, presence/occurrence of posterior synechiae, hypotony, and elevated IOP were associated with an increased risk of loss of visual acuity.

Kacmaz, R. Oktay; Kempen, John H.; Newcomb, Craig; Gangaputra, Sapna; Daniel, Ebenezer; Levy-Clarke, Grace A.; Nussenblatt, Robert B.; Rosenbaum, James T.; Suhler, Eric B.; Thorne, Jennifer E.; Jabs, Douglas A.; Foster, C. Stephen



MTHFR polymorphic variant C677T is associated to vascular complications in sickle-cell disease.  


Vaso-occlusion is a determinant for most signs and symptoms of sickle-cell anemia (SCA). The mechanisms involved in the pathogenesis of vascular complications in SCA remain unclear. It is known that genetic polymorphisms associated with thrombophilia may be potential modifiers of clinical features of SCA. The genetic polymorphisms C677T and A1298C relating to the enzyme methylenetetrahydrofolate reductase (MTHFR), a clotting Factor V Leiden mutation (1691G?A substitution of Factor V Leiden), and the mutant prothrombin 20210A allele were analyzed in this study. The aim was to find possible correlations with vascular complications and thrombophilia markers in a group of SCA patients in Pernambuco, Brazil. The study included 277 SCA patients, divided into two groups: one consisting of 177 nonconsanguineous SCA patients who presented vascular manifestations of stroke, avascular necrosis, leg ulcers, priapism, and acute chest syndrome (group 1); and the other consisting of 100 SCA patients without any reported vascular complication (group 2). Molecular tests were done using either polymerase chain reaction (PCR) restriction fragment length polymorphism or allele-specific PCR techniques. Comparisons between the groups were made using the ?(2) test. The 677 CT and TT genotypes showed a significant risk of vascular complications (p=0.015). No significant associations between the groups were found when samples were analyzed for the MTHFR A1298C allele (p=0.913), Factor V G1691 (p=0.555), or prothrombin G20210A mutation (p=1.000). The polymorphism MTHFR C677T seemed to be possibly predictive for the development of some vascular complications in SCA patients among this population. PMID:22924497

Hatzlhofer, Betânia L D; Bezerra, Marcos André C; Santos, Magnun N N; Albuquerque, Dulcinéia M; Freitas, Elizabete M; Costa, Fernando F; Araújo, Aderson S; Muniz, Maria Tereza C



Correlation between Ocular Manifestations and Their Complications as Opposed to Visual Acuity and Treatment in Behcet's Disease  

PubMed Central

The aim of this study was to analyze ocular manifestations, their complications, and treatment in a sample of 40 patients with confirmed Behcet's disease. Results. Serofibrinous iridocyclitis was the most common form of uveitis (60%). Retinal periphlebitis manifested in 92.5% of cases, and periphlebitis in conjunction with periarteritis was diagnosed in 72.5% of cases. Macular edema was the most frequent complication on the posterior segment (60%) and it correlated with periphlebitis (P = 0.45) and periphlebitis associated with periarteritis (P = 0.51). Cyclosporine A and corticosteroids were used in the majority of cases (67%). Following six months of therapy, a significant improvement of visual acuity occurred in patients with initial visual acuity >0.5 on both eyes. Level of visual acuity before and after treatment had a strong significant correlation coefficient with various ocular complications. Previously proven significant increase of visual acuity in patients with macular edema depicts effectiveness of treatment in these types of ocular manifestations of Behcet's disease. Conclusions. Significant improvement of visual acuity occurred in patients with initial visual acuity >0.5 on both eyes. The highest increase in visual acuity was achieved by laser photocoagulation in combination with triamcinolone acetonide P = 0.038 < 0.050.

Paovic, Predrag



Serum pepsinogen I in relation to some clinical features and complications of duodenal ulcer disease.  


Fasting serum pepsinogen 1 was assayed in 60 patients seen at the Kenyatta National Hospital with endoscopy - confirmed active duodenal ulceration. Pepsinogen 1 values were also correlated with some clinical features and complications of this disorder. 54 (90%) of the patients had significantly elevated values when compared with age and sex matched controls. Although elevated values were found in patients with chronic dyspepsia, family history of ulcer dyspepsia, history of gastro-duodenal blood loss and in patients with virulent ulcers, this did not show statistical significance. The possibility of using serum pepsinogen I to identify duodenal ulcer patients and to predict the clinical course and complications of this disorder is discussed. PMID:2743907

Faraj, F J; Lule, G N; Mwai, J S



Hydatid Disease of the Femur with an Extraosseous Extent due to a Former Biopsy Complicated by a Pathological Fracture  

PubMed Central

Hydatid disease of the bone represents about 1–2.5% of all human hydatid disease. Spine is the most affected part of the skeleton with 50% incidence of all bone hydatidosis. Extraspinal bone hydatidosis is much rare. Diagnosis is difficult in the bone hydatid disease. Bone tumors, tumor-like lesions, and specific and nonspecific infections should be considered in the differential diagnosis. Radiological, laboratory, and clinical findings combined with strong element of suspicion are the key for diagnosis. Bone biopsies should be avoided because of the danger of anaphylaxis, sensitization, and spread. This paper describes the management of a patient with primary hydatidosis of the femur, which had been complicated by an extraosseous involvement, cortical erosion, and a pathological fracture due to a former needle biopsy.

Ciftdemir, M.; Sezer, A.; Puyan, F. O.; Copuroglu, C.; Ozcan, M.



Behçet's disease complicated by multiple aseptic abscesses of the liver and spleen.  


Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease, especially in Crohn's disease, and in other diseases. However, aseptic abscesses associated with Behçet's disease are extremely rare. We report a Japanese male diagnosed with an incomplete type of Behçet's disease who developed multiple aseptic abscesses of the spleen and liver. In 2002, the spleen abscesses were accompanied by paroxysmal oral aphthous ulcers and erythema nodosum. As the patient's response to antibiotic treatment was inadequate, a splenectomy was performed. Severe inflammatory cell infiltration, largely of polymorphonuclear neutrophils, was observed without evidence of bacterial or fungal growth. Although the patient had no history of ocular symptoms or genital ulcers, a diagnosis of incomplete Behçet's disease was made according to the Japanese diagnostic criteria because of the presence of paroxysmal arthritis and epididymitis since 2002. In 2005, multiple liver abscesses developed with right hypochondrial pain and seemed to be attributed to Behçet's disease because the abscesses yielded negative results during a microbiologic investigation and failed to go into remission under antibiotic therapy. Oral prednisone (15 mg/d) was started in May 2006, and the abscesses dramatically disappeared 4 wk after treatment. Although the patient had a relapse of the liver abscesses in association with the tapering of prednisone, the augmentation of prednisone dosage yielded a response. The abscesses of the liver and spleen were strongly suggested to be attributed to Behçet's disease. Clinician should be aware of the existence of aseptic abscesses as uncommon manifestations of Behçet's disease. PMID:23717000

Maeshima, Keisuke; Ishii, Koji; Inoue, Megumi; Himeno, Katsuro; Seike, Masataka



Cardiovascular disease risk profile and microvascular complications of diabetes: comparison of Indigenous cohorts with diabetes in Australia and Canada  

PubMed Central

Background Indigenous populations of Australia and Canada experience disproportionately high rates of chronic disease. Our goal was to compare cardiovascular (CVD) risk profile and diabetes complications from three recent comprehensive studies of diabetes complications in different Indigenous populations in Australia and Canada. Methods We compared participants from three recent studies: remote Indigenous Australians (2002-2003, n = 37 known diabetes), urban Indigenous Australians (2003-2005, n = 99 known diabetes), and remote Aboriginal Canadians (2001-2002, n = 188 known diabetes). Results The three groups were similar for HbA1c, systolic BP, diabetes duration. Although leaner by body-mass-index criteria, remote Indigenous Australians displayed a more adverse CVD risk profile with respect to: waist-hip-ratio (1.03, 0.99, 0.94, remote Indigenous Australians, urban Indigenous Australians, remote Canadians, p < 0.001); HDL-cholesterol (0.82, 0.96, 1.17 mmol/L, p < 0.001); urine albumin-creatinine-ratio (10.3, 2.4, 4.5 mg/mmol); and C-reactive protein. With respect to diabetes complications, microalbuminuria (50%, 25%, 41%, p = 0.001) was more common among both remote groups than urban Indigenous Australians, but there were no differences for peripheral neuropathy, retinopathy or peripheral vascular disease. Conclusions Although there are many similarities in diabetes phenotype in Indigenous populations, this comparison demonstrates that CVD risk profiles and diabetes complications may differ among groups. Irrespective, management and intervention strategies are required from a young age in Indigenous populations and need to be designed in consultation with communities and tailored to community and individual needs.



[Diabetic microangiopathic hemolytic anemia--rare complication of a common disease].  


It is well-known that long-standing diabetes damages the vasculature. It is less frequently known that the plasticity of red blood cells may also be impaired so that they do not always survive intact in a vasculature roughened by diabetes, but are instead lysed. Lysis of red blood cells results in fragmentation hemolysis, which may lead to anemia if formation of red blood cells is deficient. We describe two patients with this rare complication, both of whom were diagnosed with diabetic microangiopathic hemolytic anemia (DMHA) during pregnancy. PMID:22737788

Laitinen, Kalevi; Anttila, Pekka



Beh?et's disease complicated by multiple aseptic abscesses of the liver and spleen  

PubMed Central

Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease, especially in Crohn’s disease, and in other diseases. However, aseptic abscesses associated with Behçet’s disease are extremely rare. We report a Japanese male diagnosed with an incomplete type of Behçet’s disease who developed multiple aseptic abscesses of the spleen and liver. In 2002, the spleen abscesses were accompanied by paroxysmal oral aphthous ulcers and erythema nodosum. As the patient’s response to antibiotic treatment was inadequate, a splenectomy was performed. Severe inflammatory cell infiltration, largely of polymorphonuclear neutrophils, was observed without evidence of bacterial or fungal growth. Although the patient had no history of ocular symptoms or genital ulcers, a diagnosis of incomplete Behçet’s disease was made according to the Japanese diagnostic criteria because of the presence of paroxysmal arthritis and epididymitis since 2002. In 2005, multiple liver abscesses developed with right hypochondrial pain and seemed to be attributed to Behçet’s disease because the abscesses yielded negative results during a microbiologic investigation and failed to go into remission under antibiotic therapy. Oral prednisone (15 mg/d) was started in May 2006, and the abscesses dramatically disappeared 4 wk after treatment. Although the patient had a relapse of the liver abscesses in association with the tapering of prednisone, the augmentation of prednisone dosage yielded a response. The abscesses of the liver and spleen were strongly suggested to be attributed to Behçet’s disease. Clinician should be aware of the existence of aseptic abscesses as uncommon manifestations of Behçet’s disease.

Maeshima, Keisuke; Ishii, Koji; Inoue, Megumi; Himeno, Katsuro; Seike, Masataka



Solar still. Final report  

SciTech Connect

Passive solar heating was used in a still in which a packed column packed with popped popcorn separates the alcohol and water vapors. The still's performance was not satisfactory, and it is concluded that passive solar heating could have been better used to preheat makeup water for the fermentation process and to maintain proper fermentation temperatures during the winter. (LEW)

Adams, W.D.



Small Bowel Adenocarcinoma Complicating Coeliac Disease: A Report of Three Cases and the Literature Review  

PubMed Central

Coeliac disease is associated with an increased risk of malignancy, not only of intestinal lymphoma but also of small intestinal adenocarcinoma which is 82 times more common in patients with celiac disease than in the normal population. We report three additional cases of a small bowel adenocarcinoma in the setting of coeliac disease in order to underline the epidemiological features, clinicopathological findings, and therapeutic approaches of this entity based on a review of the literature. The three patients underwent a surgical treatment followed by adjuvant chemotherapy based on capecitabine/oxaliplatin regimen, and they have well recovered.

Benhammane, Hafida; El M'rabet, Fatima Zahra; Idrissi Serhouchni, Karima; El yousfi, Mounia; Charif, Ilias; Toughray, Imane; Mellas, Naoufal; Riffi Amarti, Afaf; Maazaz, khalid; Ibrahimi, Sidi Adil; El mesbahi, Omar



In-hospital complications among survivors of admission for congestive heart failure, chronic obstructive pulmonary disease, or diabetes mellitus  

Microsoft Academic Search

OBJECTIVE: To determine the frequency of hospital complications among survivors of inpatient treatment for congestive heart failure\\u000a (CHF), chronic obstructive pulmonary disease (COPD), or diabetes mellitus (DM).\\u000a \\u000a \\u000a DESIGN: Retrospective cohort study.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: Nine Veterans Affairs hospitals in the southern United States.\\u000a \\u000a \\u000a \\u000a \\u000a PATIENTS: 1,837 men veterans discharged alive following hospitalization for CHF, COPD, or DM between January 1987 and December 1989.

Jane M. Geraci; Carol M. Ashton; David H. Kuykendall; Michael L. Johnson; Louis Wu



[Left ventricular noncompaction concurrent with bronchoectatic disease complicated by secondary AA-amyloidosis with renal involvement].  


The paper describes a clinical case of congenital cardiomyopathy (left ventricular noncompaction) concurrent with secondary amyloidosis and renal involvement that develops at the outcome of long existing brochoectatic disease. PMID:20364708

Fomin, V V; Rameev, V V; Sedov, V P; Severova, M M; Svet, A V; Miroshnichenko, N G; Kozlovskaia, L V



Cell and Stem-Cell Therapies of Crohn’s Disease and Complications  

Microsoft Academic Search

Crohn’s disease (CD) is an inflammatory acquired pathological process of the small intestine that occurs in adult men and\\u000a women, with an annual incidence of about 7 new cases in a population of 100,000 [1, 2]. This disease has a significant prevalence in adults between the second and fourth decades of life. It is three times more\\u000a common in individuals

Luca Pierelli; Sergio Rutella; Giuseppina Bonanno


Management of lipid exudates in Coats disease by adjuvant intravitreal triamcinolone: effects and complications  

Microsoft Academic Search

AimTo evaluate the role of intravitreal Triamcinolone (TA) in the early management of Coats disease.MethodsRetrospective, interventional case series.Results15 consecutive cases with Coats disease were managed with 4 mg\\/0.1 ml intravitreal TA injection on presentation and were followed for a minimum of 1 year duration. Additional management strategies including drainage of subretinal fluid through an inferior sclerotomy, peripheral laser ablation and\\/or

Ihab Saad Othman; Magdy Moussa; Manal Bouhaimed



What do adult patients with congenital heart disease know about their disease, treatment, and prevention of complications? A call for structured patient education  

PubMed Central

OBJECTIVE—To assess how much adults with congenital heart disease understand about their heart defect, its treatment, and the preventive measures necessary to avoid complications.?DESIGN—Descriptive, cross sectional study.?SETTING—Adult congenital heart disease programme in one tertiary care centre in Belgium.?PATIENTS—62 adults with congenital heart disease (47 men; 15 women), median age 23 years.?MAIN OUTCOME MEASURES—Patients' knowledge was assessed during an outpatient visit using the Leuven knowledge questionnaire for congenital heart diseases, a 33 item instrument developed for this study.?RESULTS—Patients had adequate knowledge (> 80% correct answers) about their treatment, frequency of follow up, dental practices, occupational choices, appropriateness of oral contraceptives, and the risks of pregnancy. Knowledge about the name and anatomy of the heart defect, the possibility of recurrent episodes of endocarditis during their lifetime, and the appropriateness of different physical activities was moderate (50-80% correct answers). There was poor understanding (< 50% correct answers) about the reasons for follow up, the symptoms of deterioration of the heart disease, the definition, characteristics, and risk factors of endocarditis, the impact of smoking and alcohol on the heart disease, the hereditary nature of the condition, and the suitability of intrauterine devices as contraceptives.?CONCLUSIONS—Adults with congenital heart disease have important gaps in their knowledge about their condition. The results of this study can be used as a basis for developing or optimising structured educational interventions to enhance patients' health behaviour.???Keywords: patient education; congenital heart disease; health behaviour

Moons, P; De Volder, E; Budts, W; De Geest, S; Elen, J; Waeytens, K; Gewillig, M



Chronic necrotizing pulmonary aspergillosis complicated by a cavitary lesion caused by Pulmonary Mycobacterium-avium complex disease.  


A 66-year-old woman who had undergone one year's treatment for pulmonary nontuberculous mycobacterial disease due to Mycobacterium avium (rifampicin, ethambutol, clarithromycin, streptomycin-->levofloxacin) five years earlier was admitted to our hospital because of continuous fever and a newly detected abnormal chest shadow, which was like a fungus ball in the right upper lobe on chest computed tomography in the giant cavitary lesion caused by pulmonary Mycobacterium-avium complex (MAC) disease. A diagnosis of chronic necrotizing pulmonary aspergillosis (CNPA) complicated by pulmonary MAC disease was made because Aspergillus niger was isolated from several sputum specimens, anti-aspergillus antibody was positive, and clinical symptoms such as fever, were disclosed with the radiological finding of a fungus ball-like shadow and an infiltration shadow around the cavity. The patient had received various forms of antifungal chemotherapy, but the clinical effect had been poor. Since then, she had been slowly worsening. Although mycetomas, with the typical appearance of a fungus ball on a chest radiograph, have been reported to easily form in cavitary lesions caused by previous pulmonary tuberculosis, we believe, as illustrated by the present case, that they could also form in such lesions caused by pulmonary MAC disease, since the frequency of pulmonary nontuberculous mycobacterial disease has recently been increasing in comparison with that of pulmonary tuberculosis. PMID:15805716

Kobashi, Yoshihiro; Yoshida, Kouichiro; Miyashita, Naoyuki; Niki, Yoshihito; Matsushima, Toshiharu



[Assessing efficacy of combined use of endovasal laser congulation and echosclerotherapy in comprehensive management of complicated forms of varicose disease].  


The article seals with the findings obtained in management of 96 patients diagnosed with varicose disease in the stage of trophic disordwrs treated by means of rndovasal laser obliteration combined with echosclerotherapy. Presented herein are peculiarities of carrying out laser coagulation of the greater and minor saphenous veins, as well as incomperetent perforating veins without ligation of the sapheno-femoral and sapheno-popliteal junction. The duration of the follow up of the patients amounted oj the patients amounted to three years. In all the cases we managed to achive persistent epitheliali-sation of the ulcerative defect and attain considerable improve-ment of the patients' quality of life by virtue of shortening the terms of medical and social rehabilitation and heightening the cosmetic effect. Endovasal laser coagulation combined with sclertherapy is a method of choice in a comprensive treatment of complication forms of varicose disease. PMID:18382401

Guzhkov, O N



Carcinoma of the small intestine and colon as a complication of Crohn disease: radiologic manifestation  

SciTech Connect

Barium examinations of the large and small bowel were analyzed in six of seven patients who had adenocarcinoma in areas of the intestine affected with Crohn disease; radiographic changes were correlated with clinical, surgical, and pathologic findings. Radiographic examinations were available in five of these patients at the time of diagnosis of tumor. Two of the five patients demonstrated classic radiographic changes associated with carcinoma. In the other three cases, the radiographic changes were atypical for carcinoma and demonstrated progression of disease over time to include more portions of the bowel and presence of fistulas, strictures, and obstruction. The most frequent clinical presentation of adenocarcinoma in these patients was a recrudescence of symptoms after a long quiescent period. In patients with long-standing Crohn disease plus these clinical features and the above radiographic findings, the diagnosis of a coexisting carcinoma should be considered.

Kerber, G.W.; Frank, P.H.



Chronic granulomatous disease: a review of the infectious and inflammatory complications  

PubMed Central

Chronic Granulomatous Disease is the most commonly encountered immunodeficiency involving the phagocyte, and is characterized by repeated infections with bacterial and fungal pathogens, as well as the formation of granulomas in tissue. The disease is the result of a disorder of the NADPH oxidase system, culminating in an inability of the phagocyte to generate superoxide, leading to the defective killing of pathogenic organisms. This can lead to infections with Staphylococcus aureus, Psedomonas species, Nocardia species, and fungi (such as Aspergillus species and Candida albicans). Involvement of vital or large organs can contribute to morbidity and/or mortality in the affected patients. Major advances have occurred in the diagnosis and treatment of this disease, with the potential for gene therapy or stem cell transplantation looming on the horizon.



A case of adult type 1 Gaucher disease complicated by temporal intestinal hemorrhage.  


A 21-year-old man with a history of sudden rectal hemorrhage was referred to our hospital. Examination disclosed thrombocytopenia and hepatosplenomegaly. A liver biopsy specimen demonstrated Gaucher cells in Glisson's capsule. Additional investigations revealed a low level of leukocyte ?-glucosidase activity and common mutations of the glucocerebrosidase gene, L444P/D409H. We diagnosed the patient with Gaucher disease type 1. He underwent enzyme replacement therapy. Thrombocytopenia and hepatosplenomegaly improved at a rate of approximately 50 and 20%, respectively, within 6 months. This case suggests that we must pay attention to adult Gaucher disease as a differential diagnosis for cryptogenic thrombocytopenia. PMID:24019767

Ito, Junitsu; Saito, Takafumi; Numakura, Chikahiko; Iwaba, Akiko; Sugahara, Shinpei; Ishii, Rika; Sato, Chikako; Haga, Hiroaki; Okumoto, Kazuo; Nishise, Yuko; Watanabe, Hisayoshi; Ida, Hiroyuki; Hayasaka, Kiyoshi; Togashi, Hitoshi; Kawata, Sumio; Ueno, Yoshiyuki



Population-Based Incidence of Complicated Diverticular Disease ofthe Sigmoid Colon Based on Gender and Age  

Microsoft Academic Search

PURPOSE: The purpose of this study was to characterize the\\u000agender and age differences in patients with clinically symptomatic\\u000asigmoid diverticular disease requiring surgery.\\u000aMETHODS: All surgical patients hospitalized with proven\\u000adiverticular disease requiring sigmoid resection from January\\u000a1988 to January 1998 were reviewed. RESULTS: A total\\u000aof 934 patients requiring surgical resection for diverticular\\u000adisease were admitted. There were

Elizabeth J. McConnell; Deron J. Tessier; Bruce G. Wolff



A Case of Adult Type 1 Gaucher Disease Complicated by Temporal Intestinal Hemorrhage  

PubMed Central

A 21-year-old man with a history of sudden rectal hemorrhage was referred to our hospital. Examination disclosed thrombocytopenia and hepatosplenomegaly. A liver biopsy specimen demonstrated Gaucher cells in Glisson's capsule. Additional investigations revealed a low level of leukocyte ?-glucosidase activity and common mutations of the glucocerebrosidase gene, L444P/D409H. We diagnosed the patient with Gaucher disease type 1. He underwent enzyme replacement therapy. Thrombocytopenia and hepatosplenomegaly improved at a rate of approximately 50 and 20%, respectively, within 6 months. This case suggests that we must pay attention to adult Gaucher disease as a differential diagnosis for cryptogenic thrombocytopenia.

Ito, Junitsu; Saito, Takafumi; Numakura, Chikahiko; Iwaba, Akiko; Sugahara, Shinpei; Ishii, Rika; Sato, Chikako; Haga, Hiroaki; Okumoto, Kazuo; Nishise, Yuko; Watanabe, Hisayoshi; Ida, Hiroyuki; Hayasaka, Kiyoshi; Togashi, Hitoshi; Kawata, Sumio; Ueno, Yoshiyuki



The role of trophoblast nutrient and ion transporters in the development of pregnancy complications and adult disease.  


Intrauterine growth restriction (IUGR) and fetal overgrowth occur in 15% of all pregnancies and lead to the delivery of a baby with an abnormally low or high birth weight, respectively. Both these conditions of pathological fetal growth increase the risk for perinatal complications and predispose the baby for the development of cardiovascular disease and diabetes in childhood and later in life. Fetal growth is closely related to the capacity of the placenta to transport nutrients and ions, which is dependent of the expression and activity of specific transporter proteins in the plasma membrane of the syncytiotrophoblast, the transporting epithelium of the human placenta. In human IUGR, some trophoblast nutrient and ion transporters are down regulated, whereas fetal overgrowth is associated with an up-regulation of transporters for amino acids and glucose in the placental barrier. Experimental studies have provided evidence to suggest that these changes in placental transport capacity constitute a direct cause of altered fetal growth. Therefore, regulation of placental nutrient transporters play a critical role in determining fetal growth and development, as well as the future health of the baby. This review is focused on the human and (i) summarizes the evidence that changes in the activity and expression of trophoblast nutrient and ion transporters play a central role in determining fetal growth, (ii) discusses the molecular mechanisms regulating trophoblast transporters, and (iii) highlights the implications of these findings for the development of pregnancy complications and fetal programming of cardiovascular and metabolic disease. PMID:19485888

Jansson, Thomas; Myatt, Leslie; Powell, Theresa L



Percutaneous Transsplenic Access to the Portal Vein for Management of Vascular Complication in Patients with Chronic Liver Disease  

SciTech Connect

Purpose: To evaluate the safety and feasibility of percutaneous transsplenic access to the portal vein for management of vascular complication in patients with chronic liver diseases. Methods: Between Sept 2009 and April 2011, percutaneous transsplenic access to the portal vein was attempted in nine patients with chronic liver disease. Splenic vein puncture was performed under ultrasonographic guidance with a Chiba needle, followed by introduction of a 4 to 9F sheath. Four patients with hematemesis or hematochezia underwent variceal embolization. Another two patients underwent portosystemic shunt embolization in order to improve portal venous blood flow. Portal vein recanalization was attempted in three patients with a transplanted liver. The percutaneous transsplenic access site was closed using coils and glue. Results: Percutaneous transsplenic splenic vein catheterization was performed successfully in all patients. Gastric or jejunal varix embolization with glue and lipiodol mixture was performed successfully in four patients. In two patients with a massive portosystemic shunt, embolization of the shunting vessel with a vascular plug, microcoils, glue, and lipiodol mixture was achieved successfully. Portal vein recanalization was attempted in three patients with a transplanted liver; however, only one patient was treated successfully. Complete closure of the percutaneous transsplenic tract was achieved using coils and glue without bleeding complication in all patients. Conclusion: Percutaneous transsplenic access to the portal vein can be an alternative route for portography and further endovascular management in patients for whom conventional approaches are difficult or impossible.

Chu, Hee Ho; Kim, Hyo-Cheol, E-mail:; Jae, Hwan Jun [Seoul National University College of Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, Department of Radiology, Institute of Radiation Medicine, Clinical Research Institute (Korea, Republic of); Yi, Nam-Joon; Lee, Kwang-Woong; Suh, Kyung-Suk [Seoul National University College of Medicine and Seoul National University Hospital, Department of Surgery (Korea, Republic of); Chung, Jin Wook; Park, Jae Hyung [Seoul National University College of Medicine, Seoul National University Medical Research Center, Seoul National University Hospital, Department of Radiology, Institute of Radiation Medicine, Clinical Research Institute (Korea, Republic of)



Epidemiology and Clinical Outcome of Patients Hospitalized With Pelvic Inflammatory Disease Complicated by Tubo-Ovarian Abscess  

PubMed Central

Objective: The purpose of this retrospective study was to compare the clinical outcome and characteristics of pelvic inflammatory disease (PID) complicated by tubo-ovarian abscess (TOA) with PID without TOA. Methods: Chart reviews were performed for all PID admissions to the University of Medicine and Dentistry of New Jersey-University Hospital, Newark, NJ, from January 1, 1992, to December 31, 1993. Results: The incidence in this study of TOA based on sonographic evidence of a complex adnexal mass was 18%. The major differences between the patients with and without TOAs were 1) history of hospitalization for PID: 68% (13/19) vs. 29% (25/85); 2) increased erythrocyte sedimentation rate: 82 vs. 41 mm/h; 3) increased WBC count on admission: 16,200 vs. 14,700/ml; 4) failure to respond to initial antibiotic therapy; and 5) longer hospital stay: 7.8 vs. 4.4 days, respectively. Surgical intervention was required in 3 patients: 2 patients who had TOAs and 1 patient who did not have a TOA by clinical examination or by ultrasound. Conclusions: Despite longer hospital stays and blood tests suggesting more severe disease processes, PID complicated by TOA is usually responsive to intravenous (IV) antibiotic therapy without the need for surgical intervention.

Chan, Ying; Parchment, Winsome; Skurnick, Joan H.; Goldsmith, Laura



Deficient interleukin 2 production in rheumatoid arthritis: association with active disease and systemic complications.  

PubMed Central

Interleukin 2 (IL-2) production and proliferative responses of peripheral blood mononuclear cells (PBMC) stimulated with three concentrations of PHA were measured in 75 patients with rheumatoid arthritis (RA) and 25 normal controls. All patients were on a standard therapeutic regime, and were assessed for disease activity by clinical and laboratory criteria. Rheumatoid cells showed significantly lower IL-2 production and proliferation than normal PBMC at all PHA doses. These differences were not attributable to different kinetics. Within the rheumatoid population, both IL-2 levels and proliferation were lower in patients with active disease than those with inactive RA. Patients with extra-articular disease showed the most pronounced defects. Proliferative responses showed an inverse correlation with clinical indices of disease activity but not with measures of the acute phase response. Rheumatoid patients had higher proportions of CD4+, TFR+ and Tac+ lymphocytes than controls. Both proliferative responses and IL2- levels showed a positive relationship with the proportion of CD4+ cells, and an inverse relationship with Tac+ lymphocytes. Monocyte depletion and partial reconstitution resulted in an increase of both proliferation and IL-2 production, which was more marked in RA patients, suggesting that depressed IL-2 production may relate in part to monocyte effects. However, this cannot completely explain the magnitude of the defects observed, because normal monocytes did not increase the responses of rheumatoid lymphocytes, neither did rheumatoid monocytes suppress the responses of normal lymphocytes.

Kitas, G D; Salmon, M; Farr, M; Gaston, J S; Bacon, P A



Infectious Complications with Anti-TNF? Therapy in Rheumatic Diseases: A Review  

Microsoft Academic Search

TNF? plays a pivotal role not only in the inflammatory process but also in the normal response against pathogens and therefore, interfering with this cytokine may increase the risk of infection. TNF? antagonists are commonly used in daily clinical practice for the treatment of inflammatory rheumatic diseases including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis since the

Eric Toussirot; Gerald Streit; Daniel Wendling



Radiation-induced chondrosarcoma of the clavicle complicating Hodgkin's disease. A case report  

SciTech Connect

Review of the literature reveals that postradiation chondrosarcoma is a rare secondary malignant bone tumor. This case report demonstrates a Grade 1 chondrosarcoma of the proximal right clavicle in a 17-year-old boy, eight years after extensive chemotherapy and radiation therapy for a Stage IIB Hodgkin's disease.

Aprin, H.; Calandra, J.; Mir, R.; Lee, J.Y.



Reversible myocardial dysfunction, a possible complication in critically ill patients without heart disease  

Microsoft Academic Search

Purpose:Reversible myocardial dysfunction or myocardial stunning is frequently described in patients with episodes of acute coronary syndrome and has recently been reported in critically ill patients without ischaemic heart disease. This article presents a study and description of the possible existence of myocardial dysfunction in critically ill patients in our setting who present no acute episode or history of cardiovascular

Manuel Ruiz Bailén; Eduardo Aguayo de Hoyos; Asunción López Mart??nez; Miguel Ángel D??az Castellanos; Silvia Ruiz Navarro; Luis Javier Fierro Rosón; Francisco Javier Gómez Jiménez; Ziad Issa-Masad Khozouz



Gallbladder carcinoma in a pregnant patient with Crohn's disease complicated with gallbladder involvement.  


Primary gallbladder (GB) carcinoma and Crohn's disease (CD) of the GB are individually rare. We present a case of a pregnant woman with CD found to have GB involvement and primary GB carcinoma. A 34-year-old female at 6 wk gestation with a 21 year history of CD of uncertain extent presented with 3 mo of diarrhea, urgency and abdominal pain. During work-up, she was found to have elevated transaminases and an abnormal alkaline phosphatase. Imaging revealed two gallbladder polyps both greater than 1 cm in size. Resection and histological evaluation was consistent with Crohn's involvement of the GB, poorly differentiated adenocarcinoma of the GB with invasion through the muscularis propria and matted lymph nodes in the porta hepatis positive for metastatic carcinoma (stage pT2N1). Six cases of CD involving the GB, two cases of primary GB carcinoma in CD, and ten cases of cholangiocarcinoma in pregnancy have been published. This is the only case that describes all three factors. Common features in CD of the GB include acute cholecystitis, ileal involvement, and presence independent of active intestinal disease. Common features in CD patients with GB malignancy include younger age of detection, a long history of CD, extensive colonic and ileal involvement of disease, the absence of cholelithiasis, and pre-existing gallbladder disease (primary sclerosing cholangitis and gallbladder polyps). Pregnancy is specific to this case. The role of CD in the development of GB malignancy is not well understood nor is the contribution of pregnancy to the spread of disease. Chronic inflammation and immunosuppression compounded by hormonal influence is implicated. PMID:23556054

Attraplsi, Shada; Shobar, Rima M; Lamzabi, Ihab; Abraham, Rana



Septicemia caused by salmonella infection: An overlooked complication of sickle cell disease  

Microsoft Academic Search

Objectives: To describe the characteristics of salmonella infections in sickle cell disease and to compare the features of osteomyelitis and those with bacteremia\\/septicemia without obvious bone changes. To search for risk factors for osteomyelitis, and to draw attention to the frequency and significance of salmonella bacteremia\\/septicemia.Study design: A retrospective review of all salmonella isolations from the blood, pus, or aspirates

Jonathan Wright; Peter Thomas; Graham R. Serjeant



Separate operation for extensive aneurysm (mega-aorta) complicated with ischemic heart disease  

Microsoft Academic Search

A seventy one year-old woman, who had an arch and thoracoabdominal aortic aneurysm (type II according to Crawford classification)\\u000a with ischemic heart disease, underwent a separate operation using the elephant trunk method. At first, she underwent the ascending\\u000a aorta and arch replacement the with elephant trunk technique, and, underwent CABG simultaneously utilizing the separate extra\\u000a corporeal circulation and hypothermic circulatory

Satoshi Yamashiro; Ryuzo Sakata; Yoshihiro Nakayama; Masashi Ura; Yoshio Arai; Akihiro Sugimoto



Clostridium difficile Enteritis: An Early Postoperative Complication in Inflammatory Bowel Disease Patients After Colectomy  

Microsoft Academic Search

Clostridium difficile, the leading cause of hospital-acquired diarrhea, is known to cause severe colitis. C. difficile small bowel enteritis is rare (14 case reports) with mortality rates ranging from 60 to 83%. C. difficile has increased in incidence particularly among patients with inflammatory bowel disease. This case series of six patients\\u000a from 2004 to 2006 is the largest in the

Sarah J. Lundeen; Mary F. Otterson; David G. Binion; Emily T. Carman; William J. Peppard



Second malignant neoplasms complicating Hodgkin's disease: the National Cancer Institute experience  

SciTech Connect

The medical records of all patients treated for Hodgkin's disease during the years 1964-1981 were reviewed. Four hundred seventy-three previously untreated patients were analyzed. Thirty-four subsequent second malignant neoplasms were observed in 33 patients among those treated for Hodgkin's disease. Eight cases of acute nonlymphocyctic leukemia, one case of chronic myeloid leukemia, three cases of non-Hodgkin's lymphoma, three cases of sarcoma, and 19 other tumors were identified. The ten-year estimated risk of leukemia by treatment was the following: radiotherapy only (0), chemotherapy only (0.02), initial combined radiotherapy-chemotherapy (0.06), and salvage combined radiotherapy-chemotherapy (0.09). The ten-year estimated risk of solid tumors was 0.07 overall, with all treatment groups associated with similar risks. Unlike some other reports, a greater risk of leukemia in patients who began treatment for Hodgkin's disease at age 40 or older was not found. However, a positive association was noted between increasing risk of solid tumors and increasing patient age.

Tester, W.J.; Kinsella, T.J.; Waller, B.; Makuch, R.W.; Kelley, P.A.; Glatstein, E.; DeVita, V.T.



Cavernous sinus thrombophlebitis complicating sinusitis  

PubMed Central

Background Thrombophlebitis of the cavernous sinus is a rare but serious disease that most often affects young adults and children. It is associated with significant morbidity or mortality and is often related to local infections of the head. The diagnosis is based on clinical findings and is confirmed by imaging. Case Report: We report the case of a 17-year-old male with a history of recurrent sinusitis, who presented general signs of infection, orbital symptoms, and meningeal involvement. CT and MRI showed thrombosis of the cavernous sinus associated with cerebral ischemic damage. The therapeutic management included empiric antibiotic therapy, drainage of an orbital collection, and anticoagulation. The patient died later secondary to septic shock. Conclusions: Although thrombophlebitis of the cavernous sinus is increasingly rare, it remains a lethal complication of sinusitis, and mortality is still high. The course of this disease can be dramatic due to infectious or vascular neurological complications. Early diagnosis and appropriate treatment are crucial.

Berdai, Adnane Mohamed; Shimi, Abdelkarim; Khatouf, Mohammed



Second malignancies in Hodgkin's disease: a complication of certain forms of treatment.  

PubMed Central

A total of 764 patients with Hodgkin's disease treated with radiotherapy (RT) or chemotherapy or both were reviewed 3-186 months (median 43 months) after initial treatment to assess the incidence of second malignancies. Incidence of solid tumours and acute non-lymphoblastic leukaemia (ANLL) were calculated by a life-table method and percentages of patients affected derived from life-table plots. Within 10 years after initial treatment the overall incidence of second solid tumours was 7.3%, and over a comparable period 2.4% of patients developed ANLL. Solid tumours occurred only in patients given RT with or without adjuvant chemotherapy, and ANLL occurred only after treatment with MOPP (mustine, vincristine, procarbazine, and prednisolone) or modified MOPP regimens. Neither solid tumours nor ANLL occurred in patients given ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine). The highest incidence of leukaemia (5.4%) occurred after treatment with extensive RT plus (5.4%) occurred after treatment with extensive RT plus MOPP; hence the benefits of this approach in Hodgkin's disease must be weighed against its carcinogenic potential.

Valagussa, P; Santoro, A; Kenda, R; Fossati Bellani, F; Franchi, F; Banfi, A; Rilke, F; Bonadonna, G



Adrenal insufficiency due to isolated adrenocorticotropin deficiency complicated by autosomal recessive polycystic kidney disease.  


We describe a 29-old-year Japanese man with autosomal recessive polycystic kidney disease who was frequently hypoglycemic. Insulinoma as a cause of hypoglycemia was denied because the ratio of plasma immunoreactive insulin to glucose was low. Adrenal insufficiency was diagnosed because of the low urinary excretion of 17-hydroxycorticosteroids, and both blunted responses of plasma cortisol to an intravenous injection of adrenocorticotropin and of plasma adrenocorticotropin to an intravenous injection of human corticotropin releasing hormone were observed, although basal plasma concentrations of cortisol and adrenocorticotropin were normal. The elusion profile of plasma sample from our patient chromatographed on a Sephadex G-75 column showed two peaks of (1-39)-ACTH and beta-lipotropin, with no evidence of high molecular weight form of ACTH. The plasma concentrations of thyroid stimulating hormone and growth hormone were within the normal range. These findings indicated that this patient with autosomal recessive polycystic kidney disease was associated with adrenal insufficiency due to isolated adrenocorticotropin deficiency. PMID:12803513

Yonemura, Katushiko; Yasuda, Hideo; Fujigaki, Yoshihide; Oki, Yutaka; Hishida, Akira



Implementation of a Critical Pathway for Complicated Gallstone Disease: Translation of Population-based Data into Clinical Practice  

PubMed Central

BACKGROUND Evidence-based guidelines recommend cholecystectomy during initial hospitalization for complicated gallstone disease. Previous studies as well as quality initiative data from our institution demonstrated that only 40–75% of patients underwent cholecystectomy on index admission. STUDY DESIGN In January 2009, we implemented a critical pathway to improve cholecystectomy rates for all patients emergently admitted for acute cholecystitis, mild gallstone pancreatitis, or common bile duct stones. We compared cholecystectomy rates during initial hospitalization, time to cholecystectomy, length of initial stay (LOS), and readmission rates in pre-pathway (1/05–2/08) and post-pathway patients (1/09–5/10). RESULTS Demographic and clinical characteristics were similar between pre-pathway (n=455) and post-pathway patients (n=112). Cholecystectomy rates during initial hospitalization increased from 48% to 78% after pathway implementation (P<0.0001). There were no differences in operative mortality or operative complications between the two groups. For patients undergoing cholecystectomy on initial hospitalization, the mean LOS decreased after pathway implementation (7.1 days to 4.5 days; P<0.0001), primarily due to a decrease in the time from admission to cholecystectomy (4.1 days to 2.1 days; P<0.0001). 33% of pre-pathway and 10% of post-pathway patients required readmission for gallstone-related problems or operative complications (P<0.0001), and each readmission generated an average of $19,000 in additional charges. CONCLUSIONS Implementation of a multidisciplinary critical pathway improved cholecystectomy rates on initial hospitalization and lowered costs by shortening length of stay and markedly decreasing readmission rates for gallstone-related problems. Broader implementation of similar pathways offers the potential to translate evidence-based guidelines into clinical practice and minimize the cost of medical care.

Sheffield, Kristin M.; Ramos, Kenia E.; Djukom, Clarisse D.; Jimenez, Carlos J.; Mileski, William J.; Kimbrough, Thomas D.; Townsend, Courtney M.; Riall, Taylor S.



Volcano still poses threat  

Microsoft Academic Search

After 6 months of activity, Mount St. Helens still poses potential hazards to the surrounding region, according to a recent report from the U.S. Geological Survey. Among the hazards that remain are explosive lateral and vertical eruptions, flows of hot pyroclastic rock debris, and floods and mudflows triggered by heavy precipitation.Most explosive eruptions probably will be preceded by several hours

Barbara T. Shore



Turnaround Momentum Still Fragile  

ERIC Educational Resources Information Center

The federal program providing billions of dollars to help states and districts close or remake some of their worst-performing schools remains a work in progress after two years, with more than 1,200 turnaround efforts under way but still no definitive verdict on its effectiveness. The School Improvement Grant (SIG) program, supercharged by a…

Klein, Alyson



Encaustic Still Life.  

ERIC Educational Resources Information Center

Presents an art lesson used in an advanced high school art class where students used the encaustic painting technique by melting wax and combining various pigments. Explains that the students painted a still-life of flowers in the style of Vincent van Gogh. (CMK)

Mathes, Len



Encaustic Still Life.  

ERIC Educational Resources Information Center

|Presents an art lesson used in an advanced high school art class where students used the encaustic painting technique by melting wax and combining various pigments. Explains that the students painted a still-life of flowers in the style of Vincent van Gogh. (CMK)|

Mathes, Len



The impact of a regular erythrocytapheresis programme on the acute and chronic complications of sickle cell disease in adults.  


Thirteen adult patients aged 22-63 (median 30) years with sickle cell disease (SCD) were enrolled in a regular erythrocytapheresis (ECP) programme at a single institution between December 1998 and November 2008. The indications for enrolment were recurrent painful crises (PC), acute chest syndrome (ACS), silent cortical ischaemia, pulmonary hypertension, multi-organ crises and pregnancy. Endpoints retrospectively evaluated included the incidence of SCD-related acute events requiring hospitalization following and prior to regular ECP, the development of new and progression of pre-existing related end-organ damage, the effectiveness in reducing HbS levels acutely and prior to the next exchange and the transfusion-related complications. Sixteen acute sickle-related events occurred in five patients in 846 months of patient follow-up. In all patients with reliable data available pre-ECP, the frequency of such events was reduced following commencing regular ECP. No patient experienced stroke, multi-organ crises or developed new and/or progression of end-organ dysfunction. Regular ECP reduced HbS levels to the target of <30% immediately post-exchange. Alloimmunization rates were comparable to the literature and ECP was effective in preventing progressive iron overload. Regular ECP was demonstrated to be an effective, well-tolerated therapy for both acute and chronic complications of SCD in adults. PMID:20346014

Kalff, Anna; Dowsing, Claire; Grigg, Andrew



Second malignancies complicating Hodgkin's disease: a Southwest Oncology Group 10-year followup  

SciTech Connect

Thirty-two second malignancies (21 acute leukemias and 11 solid tumors) were identified among 659 patients with all stages of Hodgkin's disease treated by members of the Southwest Oncology Group. There were no leukemias and one solid tumor among 95 patients treated with radiotherapy alone. The actuarial risk of developing acute leukemia at 7 years was 6.2% for chemotherapy alone, 6.4% for combined modality, and 7.7% for salvage chemotherapy. The incidence of acute leukemia was higher (P . 0.002) among those whose treatment began at greater than or equal to 40 years of age. The actuarial risk of leukemia in that group was 20.7% at 7 years. These data are compatible with the hypothesis that chemotherapy alone, combined modality, and salvage chemotherapy have an equivalent oncogenic potential and that patients greater than or equal to 40 years of age have an enhanced susceptibility to these oncogenic stimuli.

Coltman, C.A. Jr.; Dixon, D.O.



Effect of Aggressively Driven Intravenous Iron Therapy on Infectious Complications in End-Stage Renal Disease Patients on Maintenance Hemodialysis.  


For treating end-stage renal disease-associated anemia, various strategies to achieve optimal hemoglobin levels with lower erythropoiesis stimulating agent doses are being tried. One of these involves the use of a high dose [transferrin saturation (TSAT) >30%] of intravenous (IV) iron supplementation. However, due to in vitro effects of iron on stimulating bacterial growth, there are concerns of increased risk of infection. The safety of higher iron targets with respect to infectious complications (bacteremias, pneumonias, soft tissue infections, and osteomyelitis) is unknown. This was a retrospective study of patients on maintenance hemodialysis from a single, urban dialysis center to assess the long-term impact of the higher cumulative use of IV iron, on the incidence of clinically important infections. Our iron protocol was modified in June 2010 to aim for TSAT >30% unless serum ferritin levels were >1200 ng/mL. Data from only those patients who had been on dialysis for the whole duration between June 2009 and May 2011 were included. A total of 140 patients with end-stage renal disease on hemodialysis patients were found to be eligible for the study. There was a statistically significant increase in the mean TSAT and mean serum ferritin with the new anemia management protocol with a significant decrease in the mean erythropoiesis stimulating agent dose requirement. There was no statistically significant increase in the incidence of infectious complications. Although in vitro effects of iron are known to stimulate bacterial growth, a higher IV dose of iron may not increase the risk of infection in such patients. PMID:22832501

Bansal, Anip; Sandhu, Gagangeet; Gupta, Isha; Kalahalli, Shriharsha; Nayak, Rushi; Zouain, Eduardo; Chitale, Rohit A; Meisels, Ira; Chan, Germaine



Aldose reductase and cardiovascular diseases, creating human-like diabetic complications in an experimental model  

PubMed Central

Rationale Hyperglycemia and reduced insulin actions affect many biological processes. One theory is that aberrant metabolism of glucose via several pathways including the polyol pathway causes cellular toxicity. Aldose reductase (AR) is a multifunctional enzyme that reduces aldehydes. Under diabetic conditions AR converts glucose into sorbitol, which is then converted to fructose. Objective This article reviews the biology and pathobiology of AR actions. Results AR expression varies considerably among species. In humans and rats, the higher level of AR expression is associated with toxicity. Flux via AR is increased by ischemia and its inhibition during ischemia reperfusion reduces injury. However, similar pharmacologic effects are not observed in mice unless they express a human AR transgene. This is because mice have much lower levels of AR expression, probably insufficient to generate toxic byproducts. Human AR expression in LDL receptor knockout mice exacerbates vascular disease, but only under diabetic conditions. In contrast, a recent report suggests that genetic ablation of AR increased atherosclerosis and increased hydroxynonenal in arteries. It was hypothesized that AR knockout prevented reduction of toxic aldehydes. Conclusion Like many in vivo effects found in genetically manipulated animals, interpretation requires the reproduction of human-like physiology. For AR, this will require tissue specific expression of AR in sites and at levels that approximate those in humans.

Ramasamy, Ravichandran; Goldberg, Ira J.



Role of hydroxycarbamide in prevention of complications in patients with sickle cell disease.  


Sickle cell disease (SCD) is a genetically inherited condition caused by a point mutation in the beta globin gene. This results in the production of the abnormal hemoglobin, sickle hemoglobin (HbS). Hydroxycarbamide, is an antimetabolite/cytotoxic which works by inhibiting ribonucleotide reductase, blocking the synthesis of DNA and arresting cells in the S phase. In sickle cell anemia, it promotes fetal hemoglobin (HbF) synthesis, improves red cell hydration, decreases neutrophil and platelet count, modifies red cell endothelial cell interactions and acts as a nitric oxide donor. Trials have shown the clinical benefit of hydroxycarbamide in a subpopulation of adult patients with SCD, with a 44% reduction in the median annual rate of painful crises, a decrease in the incidence of acute chest syndrome and an estimated 40% reduction in overall mortality over a 9-year observational period. Its use in pediatrics has also been well established; trials have shown it is well tolerated and does not impair growth or development. In addition it decreases the number and duration of hospital attendences. A number of emerging uses of hydroxycarbamide currently are being investigated, such as stroke prevention. PMID:19816573

Wiles, Nm; Howard, J



Aging and antihypertensive medication-related complications in the chronic kidney disease patient  

PubMed Central

Purpose of review We have reviewed the recent literature to describe the potential medication errors and adverse drug events (ADEs) associated with antihypertensives among older adults with chronic kidney disease (CKD). Recent findings Overall, few studies have been published describing ADEs in older adults with CKD. Several examined hyperkalemia associated with angiotensin-converting enzyme (ACE)-inhibitor/angiotensin II receptor blocker (ARB), diuretic (potassium-sparing), and ?-blocker use. Additional studies described acute kidney injury (AKI) most commonly with ACE-inhibitor/ARB therapy. Finally, orthostatic hypotension was evaluated in those taking ACE-inhibitor/ARB, ?-blocker, or calcium-channel blocker therapy. In the absence of robust literature examining these events in this understudied population, one must consider age-related antihypertensive pharmacokinetic/pharmacodynamic profiles concomitantly with the patient’s comorbidities and other medications in order to minimize the risk for potential medication errors, drug–drug interactions, and ADEs. Summary Some of the most common ADEs associated with antihypertensive use in older adults with CKD include hyperkalemia, AKI, and orthostatic hypotension. Diligent monitoring of laboratory data, vital signs, and potential drug–drug interactions may mitigate serious ADEs caused by antihypertensives in this high-risk patient population.

Marcum, Zachary A.; Fried, Linda F.



Role of hydroxycarbamide in prevention of complications in patients with sickle cell disease  

PubMed Central

Sickle cell disease (SCD) is a genetically inherited condition caused by a point mutation in the beta globin gene. This results in the production of the abnormal hemoglobin, sickle hemoglobin (HbS). Hydroxycarbamide, is an antimetabolite/cytotoxic which works by inhibiting ribonucleotide reductase, blocking the synthesis of DNA and arresting cells in the S phase. In sickle cell anemia, it promotes fetal hemoglobin (HbF) synthesis, improves red cell hydration, decreases neutrophil and platelet count, modifies red cell endothelial cell interactions and acts as a nitric oxide donor. Trials have shown the clinical benefit of hydroxycarbamide in a subpopulation of adult patients with SCD, with a 44% reduction in the median annual rate of painful crises, a decrease in the incidence of acute chest syndrome and an estimated 40% reduction in overall mortality over a 9-year observational period. Its use in pediatrics has also been well established; trials have shown it is well tolerated and does not impair growth or development. In addition it decreases the number and duration of hospital attendences. A number of emerging uses of hydroxycarbamide currently are being investigated, such as stroke prevention.

Wiles, NM; Howard, J



Small-Bowel Capsule Endoscopy in Patients with Suspected Crohn's Disease--Diagnostic Value and Complications  

PubMed Central

Background. The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohn's Disease (CD). Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%). The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Conclusions. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy.

Figueiredo, Pedro; Almeida, Nuno; Lopes, Sandra; Duque, Gabriela; Freire, Paulo; Lerias, Clotilde; Gouveia, Hermano; Sofia, Carlos



Distribution of enteroviruses in hospitalized children with hand, foot and mouth disease and relationship between pathogens and nervous system complications  

PubMed Central

Background To explore the relationship between enteroviruses and hospitalized children with hand, foot and mouth disease (HFMD) complicated with nervous system disease. 234 hospitalized HFMD patients treated in Shengjing Hospital, Liaoning Province were analyzed retrospectively. Based on the presence and severity of nervous system disease, the patients were grouped as follows: general patients, severely ill patients, critically ill patients and fatal patients. Based on the detected pathogen, the patients were grouped as follows: Enterovirus 71 (EV71) infection, coxsackie A16 (CA16) infection and other enterovirus (OE) infection. Results Of the 423 hospitalized patients, most were admitted in July 2010(129/423, 30.5%). Enteroviruses were detected in 177(41.8%). 272/423 patients were male (64.3%), and fatal patients had the greatest proportion of male patients (p < 0.05). EV71 infection was found in 89/423 patients (21%). CA16 infection was detected in 8/423 patients (16.1%). Compared to group CA16, patients in group EV71 were hospitalized earlier, and the duration of hospitalization was longer (p < 0.05). Of the 92 patients with nervous system damage, 65 were infected with EV71 and 19 were infected with CA16. Among these CA16 infected patients, 2 had brainstem encephalitis and 1 had AFP. There were more patients with nervous system dysfunction in group EV71 than in groups CA16 or OE (p < 0.05). The 5 fatalities all occurred in group EV71 patients (p < 0.05). Infection with EV71 was most likely to cause neurogenic pulmonary edema (p < 0.05). Patients in group EV71 had a higher rate of suffering from coma and limb movement disorder than patients in groups CA16 or OE (p < 0.05). Conclusion The disease progresses faster in EV71-infected HFMD patients. These patients are more likely to suffer nervous system damage, neurogenic pulmonary edema, severe sequelae or death. CA16 and other enteroviruses can also cause HFMD with severe nervous system complications.



Pediatric Venous Thromboembolism in the United States: A Tertiary Care Complication of Chronic Diseases  

PubMed Central

Background Pediatric venous thromboembolism (VTE) is an increasingly common problem. We hypothesized that VTE occurs most commonly in tertiary care settings and that the pattern of associated illnesses may have changed from earlier reports. Methods The Kids’ Inpatient Database 2006 was utilized to identify children ?18 years old with in-hospital VTE. Children were identified by the presence of thrombosis specific ICD-9-CM diagnosis or procedure codes. Remaining ICD-9-CM codes were utilized to categorize patients by acute or chronic illness. The incidence of in-hospital VTE by hospital type, age, gender, race, and disposition were estimated. Results Over 4,500 children met the inclusion criteria (188/100,000 discharges). Most VTE discharges (67.5%) were from children’s hospitals (RR 5.09; 95% CI 4.76; 5.44). Underlying chronic illnesses were associated with most VTE (76.2%), most commonly: cardiovascular (18.4%), malignancy (15.7%), and neuromuscular disease (9.9%). VTE not associated with chronic illness were most often idiopathic (12.6%), followed by infections (9.5%) and trauma (9.1%). The greatest proportions of children with VTE were infants (23.1%) and adolescents (37.8%). However, when standardized against the entire database of discharges, infants were least likely to develop VTE (RR 0.48; 95% CI 0.43; 0.52), while adolescents were at highest risk (RR 1.89; 95% CI 1.73; 2.07). Hospitalizations ending with death were more likely to include VTE (RR 6.16; 95% CI 5.32; 7.13). Conclusions Pediatric VTE is most commonly seen in tertiary care. Adolescents are at greatest risk to develop in-hospital VTE. Patients whose hospitalization ended with death are at much greater risk to develop VTE.

Setty, Bhuvana A.; O'Brien, Sarah H.; Kerlin, Bryce A.



The Relationship between Hypomagnesemia, Metformin Therapy and Cardiovascular Disease Complicating Type 2 Diabetes: The Fremantle Diabetes Study  

PubMed Central

Background Low serum magnesium concentrations have been associated with cardiovascular disease risk and outcomes in some general population studies but there are no equivalent studies in diabetes. Metformin may have cardiovascular benefits beyond blood glucose lowering in type 2 diabetes but its association with hypomagnesemia appears paradoxical. The aim of this study was to examine relationships between metformin therapy, magnesium homoeostasis and cardiovascular disease in well-characterized type 2 patients from the community. Methods and Findings We studied 940 non-insulin-treated patients (mean±SD age 63.4±11.6 years, 49.0% males) from the longitudinal observational Fremantle Diabetes Study Phase I (FDS1) who were followed for 12.3±5.3 years. Baseline serum magnesium was measured using stored sera. Multivariate methods were used to determine associates of prevalent and incident coronary heart disease (CHD) and cerebrovascular disease (CVD) as ascertained from self-report and linked morbidity/mortality databases. 19% of patients were hypomagnesemic (serum magnesium <0.70 mmol/L). Patients on metformin, alone or combined with a sulfonylurea, had lower serum magnesium concentrations than those on diet alone (P<0.05). There were no independent associations between serum magnesium or metformin therapy and either CHD or CVD at baseline. Incident CVD, but not CHD, was independently and inversely associated with serum magnesium (hazard ratio (95% CI) 0.28 (0.11–0.74); P?=?0.010), but metformin therapy was not a significant variable in these models. Conclusions Since hypomagnesemia appears to be an independent risk factor for CVD complicating type 2 diabetes, the value of replacement therapy should be investigated further, especially in patients at high CVD risk.

Peters, Kirsten E.; Chubb, S. A. Paul; Davis, Wendy A.; Davis, Timothy M. E.



Pluto - Still an enigma after 50 years  

Microsoft Academic Search

Current knowledge of the dynamical and physical properties of Pluto is reviewed, with particular emphasis on those characteristics which are still unknown 50 years after the discovery of the planet. Pluto has been observed to have high orbital eccentricity and inclination, however the determination of its mass and diameter have been complicated by its distance. Recent spectroscopic and speckle interferometric

R. S. Harrington; B. J. Harrington



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



The clinical and imaging presentation of acute "non complicated" pyelonephritis: A new profile for an ancient disease  

PubMed Central

Background Acute pyelonephritis (APN) is differently defined according to imaging or clinical criteria. In adults information on the relationship between imaging and clinical data is lacking. Our study was aimed at analysing the relationship between the clinical and imaging presentation of APN, defined according to imaging criteria (parenchymal involvement at MR or CT scan). Methods All consecutive patients hospitalized for "non-complicated" APN were considered (June 2005-December 2009). Clinical, biochemical and imaging data at hospitalization were analyzed by univariate and logistic regression analysis. Results There were 119 patients, all females, median age 32 years (15-72). At hospitalization, inflammatory markers were elevated (CRP median: 12.1 mg/dL, normal < 0.8). Incomplete presentations were frequent: fever was absent in 6.7%, pain in 17.8%, lower urinary tract symptoms in 52.9%. At CT or MR scan the lesions were bilateral in 12.6%, multiple in 79.8%; abscesses were present in 39.5%. Renal scars were found in 15.1%. Positive cultures were correlated with multiple foci (multivariate OR 4.2; CI 1.139-15.515). No other sign/symptom discriminated between small lesions, abscesses or multifocal involvement. Conclusions APN is a protean disease. In the absence of strict correlation with clinical or biochemical markers, imaging studies are required to assess the severity of kidney involvement.



A case of veno-occlusive disease complicated by severe hemorrhagic cystitis successfully treated with recombinant plasminogen activator.  


Recombinant tissue plasminogen activator (rt-PA) is an effective treatment for veno-occlusive disease (VOD) after bone marrow transplantation (BMT). However rt-PA therapy is limited by the risk of hemorrhagic complications. There is little guidance about the use of rt-PA for patients with severe VOD and severe hemorrhage. We report the case of a 16-year-old woman who developed severe VOD associated with life-threatening hemorrhagic cystitis (HC). A dramatic improvement in VOD was obtained after administration of recombinant tissue plasminogen activator (rt-PA). HC was managed with continuous bladder irrigation and blood transfusions. Administration of rt-PA was followed by a moderate increase in blood transfusion requirement but rt-PA did not cause dramatic aggravation of the HC. We conclude that severe HC might not be a contraindication to rt-PA therapy and such patients can be included in randomized trials conducted to determine the efficacy and risk benefit of rt-PA therapy for VOD. PMID:9352329

Arsène, O; Delain, M; Linassier, C; Bremond, J L; Colombat, P



Are ocular complications of a high-dose glucocorticoid treatment appropriately monitored in patients with rheumatic diseases?  


Glucocorticoid is frequently used in treating various rheumatic conditions. However it is known to cause multiple toxicities including cataract or glaucoma. In this study, we examined whether patients with rheumatic diseases had appropriate ocular monitoring for glucocorticoid toxicities. From rheumatology clinics in South New Jersey of the USA, we retrospectively identified patients with ages between 18 and 60 years old who received a high accumulative dose of glucocorticoid, which was defined as glucocorticoid dose greater than prednisone 7.5mg/day × 6 months = 1,350 mg. We observed rheumatologists recommended eye examinations only in 14/37 (37.8 %) of patients. Family history was present for cataract in 13/37 (35.1 %) patients and for glaucoma in 6/37 (16.2 %) patients. Rheumatologists recommended eye examinations in 4/13 (30.7 %) and 0/6 (0 %) patients in each group. This study suggested that rheumatologists did not appropriately monitor ocular complications of a high dose glucocorticoid, even in patients with a positive family history. PMID:22993076

Han, Bobby Kwanghoon; Yachoui, Ralph; Yi, Kayoung



Cardiac complications of thoracic irradiation.  


Adjuvant radiation therapy in the management of early stage breast cancer, Hodgkin's disease, and to a lesser extent other thoracic malignancies has led to a significant improvement in disease-specific survival. Cardiovascular disease is now the most common nonmalignancy cause of death in radiation-treated cancer survivors, most often occurring decades after treatment. The spectrum of radiation-induced cardiac disease is broad, potentially involving any component of the heart. The relative risk of coronary artery disease, congestive heart failure, valvular heart disease, pericardial disease, conduction abnormalities, and sudden cardiac death is particularly increased. Over the years contemporary techniques have been introduced to reduce cardiac morbidity and mortality in radiation-treated cancer survivors; however, the long-term effects on the heart still remain unclear, mandating longer follow-up. Awareness and early identification of potential cardiac complications is crucial in cancer survivors, with the management often being quite complex. This review examines the epidemiology of radiation-induced cardiac disease together with its pathophysiology and explores the available treatment strategies and the potential utility of various screening strategies for affected cancer survivors. PMID:23583253

Jaworski, Catherine; Mariani, Justin A; Wheeler, Greg; Kaye, David M



Complications of the intrauterine device in nulliparous and parous women  

Microsoft Academic Search

OBJECTIVES: The intrauterine device (IUD) is still related to pelvic inflammatory disease (PID), pregnancy, expulsion, perforation and menstrual problems, particularly in nulliparous women. We aimed to study the complications and symptoms of the intrauterine device in general practice, particularly in nulliparous women. METHODS: We used a retrospective cohort study in four general practices participating in the Nijmegen Continuous Morbidity Registration.

H. M. Veldhuis; A. G. Vos; A. L. M. Lagro-Janssen



Effect of high-dose methyl-prednisolone on brainstem encephalopathy and basal ganglia impairment complicating cat scratch disease.  


Cat scratch disease (CSD) is a zoonotic illness caused by the Gram negative bacillus Bartonella henselae characterized by a small skin lesion at the site of a bite, lick or scratch by a cat, commonly followed by regional lymphadenopathy 1 or 2 weeks later. We report herein on severe neurological complications of CSD combining brainstem encephalopathy and basal ganglia impairment. This 12-year-old female acutely presented to a local hospital with profound coma and a prolonged tonic posturing of extremities. On the neurological examination she was deeply comatose with pin-point pupils and lack of vestibulo-ocular responses, suggestive of brainstem encephalopathy, along with marked rigid hypertonicity suggestive also of basal ganglia impairment. Initially suspecting Herpes simplex encephalitis or acute disseminated encephalomyelitis she was promptly started with high-dose methyl-prednisolone and acyclovir. Her parents apparently reported that she was scratched by a kitten some 4 weeks prior to her present admission and as such, suspecting CSD, she was begun with doxycycline and rifampicin. Her serology had proven positive for IgM antibodies to Bartonella henselae establishing the diagnosis. She regained consciousness after 4 days and the signs of brainstem and extra-pyramidal impairment also gradually abated and disappeared after 10 days. A follow-up exam after a month disclosed mild extra-pyramidal abnormalities which disappeared after 3 months. Although extremely rare, CSD should be also considered in a patient presenting with a severe encephalopathy and associated basal ganglia impairment. The prompt administration of high-dose methyl-prednisolone upon admission may have contributed to the favorable outcome in our patient and therefore should be advocated in any patient presenting with profound encephalopathy regardless the underlying etiology recovered later. PMID:17174500

Genizi, Jacob; Kasis, Imad; Schif, Aharon; Shahar, Eli



Prevalence of diabetic nephropathy complicating non-diabetic renal disease among Chinese patients with type 2 diabetes mellitus  

PubMed Central

Background The incidence of diabetes mellitus (DM) and diabetic nephropathy (DN) have risen rapidly in the past few decades and have become an economic burden to the healthcare system in China. DN is a major complication of DM and is a leading cause of end-stage renal disease (ESRD). The occurrence of non-diabetic renal disease (NDRD) in diabetic patients has been increasingly recognized in recent years. It is generally believed that it is difficult to reverse DN, whereas some cases of NDRD are readily treatable and remittable. However, DN is known to co-exist with NDRD in a poorly defined population of patients with type 2 diabetes mellitus (T2DM). This study estimated the prevalence of co-existing DN and NDRD in Chinese patients. Methods Data were retrospectively analyzed from 244 patients with T2DM who had undergone a renal biopsy between January 2003 and December 2011 at the Nephrology Department, China-Japan Friendship Hospital, China. Male patients numbered 151 (61.9%) of the study population. The biopsies were performed because urinary abnormalities or renal function were atypical of a diagnosis of DN. Biopsy samples were examined using light, immunofluorescence (IF) and electron microscopy (EM). Clinical parameters were recorded for each patient at the time of biopsy. Results Nineteen of 244 diabetic patients (7.8%) had co-existing DN and NDRD. These patients showed clinical features and pathologic characteristics of DN, including a high prevalence of diabetic retinopathy (89.5%), a long duration of diabetes, increased thickness of the glomerular basement membrane (GBM) and mesangial expansion. However, they also presented with clinical findings which were inconsistent with DN, such as hematuria, rapidly progressive renal failure and marked proteinuria. Immunoglobulin A (IgA) nephropathy was apparent in 10 out of the 19 patients (52.6%), tubulointerstitial lesions were found in four patients (21.1%), membrano-proliferative glomerulonephritis (MPGN) in three patients (15.8%) and membranous nephropathy (MN) in two patients (10.5%). Conclusion Retrospective analysis of biopsy data suggests that approximately 8% of Chinese patients with T2DM may have co-existing DN and NDRD. The most common histological diagnosis in our small series was IgA nephropathy.



[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



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



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



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



[Gastrointestinal hemorrhage induced by percussive ventilator in an infant with chronic lung disease complicated after surgery for corrected transposition of the great arteries].  


A newborn patient (birth weight 2,332 g) with corrected transposition of the great arteries developed chronic lung disease due to a severe heart failure and post operative several complications. We applied intrapulmonary percussive ventilation (IPV) to the patient. IPV improved oxygenation concomitant with the improvement of respiratory condition and chest X-ray finding. However, the patient suffered from upper gastrointestinal bleeding 15 days after initiation of IPV therapy. The bleeding was healed several days after temporal termination of IPV, but recurred with resuming IPV therapy. The patient was irritable throughout the IPV therapy, and thus gastrointestinal bleeding of the patient could be due to stress induced by IPV therapy. IPV may be useful for the management of respiratory disturbance, often observed in low birth weight patients with congenital heart defects. However, gastrointestinal bleeding may occur and should be considered as a possible complication associated with IPV therapy. PMID:19280951

Mizuta, K; Ishido, H; Iwamoto, Y; Masutani, S; Tamura, M; Senzaki, H



Is Gastroesophageal Reflux Disease Really a LifeLong Disease: Do Babies Who Regurgitate Grow up to Be Adults with GERD Complications?  

Microsoft Academic Search

There are a number of chronic digestive diseases in adults which have symptom and\\/or disease onset in childhood. Examples of childhood-onset chronic diseases include Helicobacter pylori-associated gastroduodenal disease and gastroesophageal reflux disease (GERD). Unfortunately, there is a paucity of well-designed longitudinal studies that characterize the natural history of each of these conditions and more importantly identify individuals (i.e., children) who

Benjamin D. Gold



Wild Beasts of Still Life  

ERIC Educational Resources Information Center

This article describes a project with a transformative approach to color theory and still life. Students' use of an arbitrary color scheme can open their eyes, push their creativity and produce exciting paintings. Ordinary still-life objects will be transformed into dramatic, vibrant visuals. The Fauve style of painting is a great art history…

Lott, Debra



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 ...


Gastric dysrhythmias occur in gastro-oesophageal reflux disease complicated by food regurgitation but not in uncomplicated reflux  

Microsoft Academic Search

AIMTo investigate gastric pacemaker activity in gastro-oesophageal reflux disease using the electrogastrogram.PATIENTSForty patients with gastro-oesophageal reflux disease (20 with acid reflux, 20 with the additional symptom of food regurgitation) and 30 asymptomatic controls.METHODSPatients were studied using an electrogastrogram, oesophageal manometry, and 24 hour ambulatory oesophageal pH analysis.RESULTSAn abnormal electrogastrogram was recorded in two (7%) controls, two (10%) patients with acid

A Leahy; K Besherdas; C Clayman; I Mason; O Epstein



Defibrotide as salvage therapy for refractory veno-occlusive disease of the liver complicating allogeneic bone marrow transplantation  

Microsoft Academic Search

A 30-year-old woman developed veno-occlusive disease of the liver during an allogeneic BMT for acute leukemia. Treatment with recombinant human tissue plasminogen activator and heparin resulted in an incomplete and transient response followed by progressive disease. The patient was then given defibrotide (DF), a mammalian tissue-derived polydeoxyribonucleotide developed for the treatment of a number of vascular disorders, which has thrombolytic

MM Abecasis; JP Conceição Silva; I Ferreira; A Guimarães; A Machado



No-Tech Still Matters.  

ERIC Educational Resources Information Center

Although online training is causing restructuring in some companies, content is still predominant and can be delivered without the Internet, for example, through self-study books. Companies should deliver training in the best format for their employees. (JOW)

Barbian, Jeff



Solar Still Part II: Juice  

NSDL National Science Digital Library

In this video segment, adapted from a ZOOM television broadcast, cast members repeat an experiment designed to separate fresh water from a liquid solution, this time using colored sugar water in one solar still and orange juice in another. The basic still design they employ traps water vapor that is created when the Sun's heat causes water to evaporate. As the vapor cools, it condenses and trickles down to a collection container. The segment is three minutes fifty-five seconds in length.


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



[Complications of acute otitis media].  


Most cases of acute otitis media (AOM) resolve even without antibiotic treatment. In the pre-antibiotic era, AOM complications were common and could lead to deafness and neurological sequelae. With the use of antibiotics, the complications have become less frequent, but they may still evolve. The possible increase in the occurrence of complications has to be considered if we start treating AOM more conservatively and if bacterial antibiotic resistance situation becomes more problematic. These rare but possibly lethal complications should be diagnosed and treated promptly. The need for cochlear implantation has to be evaluated soon after an episode of meningitis if deafness is suspected. PMID:22667049

Laulajainen-Hongisto, Anu; Lempinen, Laura; Jero, Jussi



A case of extranodal NK/T-cell lymphoma, nasal type mimicking typical manifestations of adult-onset Still's disease (AOSD) with hemophagocytic syndrome: diagnostic consideration between malignant lymphoma without lymphadenopathy and AOSD.  


A 25-year-old Japanese man was suffering from high fever, sore throat, arthralgia, and macular salmon-pink eruption. The superficial lymph node was not palpable, and computed tomographic scans from the neck to pelvis demonstrated hepatosplenomegaly without apparent lymphadenopathy. Therefore, the possibility of malignant lymphoma was considered to be extremely low. Serology for Epstein Barr virus (EBV) and cytomegalovirus showed a postinfectious state, and blood culture was negative. Serum rheumatoid factor and antinuclear antibody were negative. Leukocytopenia (2.4 x 10(3)/mul) was observed, and thus a diagnosis of adult-onset Still's disease (AOSD) with hemophagocytic syndrome (HPS) was made. Fifty-five milligrams of prednisolone daily improved his symptoms and leukocytopenia promptly, but high fever with severe and progressive thrombocytopenia occurred 12 days later. Bone marrow aspiration revealed the presence of lymphoma cells and hemophagocytosis, and the CD45 gating analysis showed expanding population of CD2(+), CD3(-), and CD56(+) cells. Further, mucosal ulceration in the nasal cavity was detected. Therefore, a diagnosis of extranodal natural killer (NK)/T-cell lymphoma, nasal type, concomitant with HPS was made, and treatment with dexamethasone, etoposide, ifosfamide, carboplatin (DeVIC) regimen ameliorated his symptoms and platelet transfusion dependency. Later, a high titer of serum EBV-DNA was detected, which supported the diagnosis. Diagnosing AOSD, extranodal presentation of malignant lymphoma such as extranodal NK/T-cell lymphoma, nasal type, should be carefully considered. PMID:19609486

Kato, Takashi; Tanabe, Juichi; Kanemoto, Motoko; Kobayashi, Chiharu; Morita, Sho; Karahashi, Taro



Outbreaks of hand, foot, and mouth disease by enterovirus 71. High incidence of complication disorders of central nervous system  

Microsoft Academic Search

In Japan we have had two outbreaks of hand, foot, and mouth disease associated with disorders of the central nervous system, one in 1973 and the other in 1978. The isolated virus in both outbreaks was enterovirus 71. Central nervous system disorders were present in 24% of patients in 1973 and in 8% of patients in 1978. These disorders were

Y Ishimaru; S Nakano; K Yamaoka; S Takami



[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



Management strategies in alcoholic liver disease  

Microsoft Academic Search

Alcoholic liver disease (ALD) and its complications is still one of the most frequent causes of death in the Western world. Treatment modalities for both alcoholic steatohepatitis (ASH; the major inflammatory complication of ALD) and alcoholic liver cirrhosis are insufficient. Severe ASH is associated with a high mortality; although glucocorticoid treatment has been reported to improve survival, meta-analyses of clinical

Christopher P Day; Herbert Tilg



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



Symptomatic anti-neutrophil cytoplasmic antibody-positive disease complicating subacute bacterial endocarditis: to treat or not to treat?  


A 54-year-old man was diagnosed with Streptococcus mutans endocarditis of the mitral valve. Serological tests disclosed the presence of multiple autoantibodies including c-ANCA, anti-PR3 and anti-MPO. While the fever subsided with antibiotics, mental status and renal function deteriorated rapidly. Kidney biopsy revealed pauci-immune glomerulonephritis and acute eosinophilic interstitial nephritis. The abnormal clinical features improved rapidly after addition of corticosteroids and cyclophosphamide to the antibiotics. Immunosuppressive agents may be required in a fraction of the patients with infective endocarditis who develop ANCA and ANCA-mediated renal disease. Histological identification of the type of renal disease is imperative for the choice of the treatment. PMID:23197952

Konstantinov, Konstantin N; Harris, Alexis A; Hartshorne, Michael F; Tzamaloukas, Antonios H



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


A Behcet's Disease Patient with Right Ventricular Thrombus, Pulmonary Artery Aneurysms, and Deep Vein Thrombosis Complicating Recurrent Pulmonary Thromboembolism.  


Intracardiac thrombus, pulmonary artery aneurysms, deep vein thrombosis, and pulmonary thromboembolism are rarely seen symptoms of Behcet's disease. A 20-year-old female patient was admitted for complaints of cough, fever, palpitations, and chest pain. On the dynamic thorax computed tomograms (CT) obtained because of significantly enlarged hilar structures seen on chest radiograms, aneurysmal dilatation of the pulmonary artery segments bilaterally, chronic thrombus with collapse, and consolidation substances compatible with pulmonary embolism involving both lower lobes have been observed. It is learned that, four years ago, the patient had been diagnosed with Behcet's disease and received colchicine treatment but not regularly. The patient was hospitalized. On the transthoracic echocardiogram, a thrombosis with a dimension of 4.2?×?1.6?cm was recognized in the right ventricle. On abdomen CT, aneurysmal iliac veins and deep vein thrombus on Doppler ultrasonograms were diagnosed. At the controls after three months of immunosuppressive and anticoagulant therapies, some clinical and radiological improvements were recognized. The patient suspended the treatment for a month and the thrombus recurred. We present our case in order to show the effectiveness of immunosuppressive and anticoagulant therapies and rarely seen pulmonary thromboembolism in recurrent Behcet's disease. PMID:23853733

A?ker, Selvi; A?ker, Müntecep; Gürsu, Ozgür; Mercan, R?dvan; Timuçin, Ozgür Bülent



A Behcet's Disease Patient with Right Ventricular Thrombus, Pulmonary Artery Aneurysms, and Deep Vein Thrombosis Complicating Recurrent Pulmonary Thromboembolism  

PubMed Central

Intracardiac thrombus, pulmonary artery aneurysms, deep vein thrombosis, and pulmonary thromboembolism are rarely seen symptoms of Behcet's disease. A 20-year-old female patient was admitted for complaints of cough, fever, palpitations, and chest pain. On the dynamic thorax computed tomograms (CT) obtained because of significantly enlarged hilar structures seen on chest radiograms, aneurysmal dilatation of the pulmonary artery segments bilaterally, chronic thrombus with collapse, and consolidation substances compatible with pulmonary embolism involving both lower lobes have been observed. It is learned that, four years ago, the patient had been diagnosed with Behcet's disease and received colchicine treatment but not regularly. The patient was hospitalized. On the transthoracic echocardiogram, a thrombosis with a dimension of 4.2?×?1.6?cm was recognized in the right ventricle. On abdomen CT, aneurysmal iliac veins and deep vein thrombus on Doppler ultrasonograms were diagnosed. At the controls after three months of immunosuppressive and anticoagulant therapies, some clinical and radiological improvements were recognized. The patient suspended the treatment for a month and the thrombus recurred. We present our case in order to show the effectiveness of immunosuppressive and anticoagulant therapies and rarely seen pulmonary thromboembolism in recurrent Behcet's disease.

Asker, Selvi; Asker, Muntecep; Gursu, Ozgur; Mercan, R?dvan; Timucin, Ozgur Bulent



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


New still on the market  

NASA Astrophysics Data System (ADS)

A new low-cost multipurpose still useful for water, waste water, or sludge sample preparation or other general laboratory applications has been introduced by Hach Chemical Company. Hach's Universal Still pretreats samples for any of the following tests: fluoride, cyanide, arsenic, selenium, phenols, volatile acids, and nitrogen (both albuminoid and ammonia).The instrument combines a temperature- controlled fast-acting heating mantle and interchangeable glassware assemblies with a simple set-up. The glassware is fastened to illustrated back panels that slide into the fiberglass base. There are three back panel/glassware assemblies to choose from: general purpose, arsenic, and cyanide.


Oral vitamin D, still a viable treatment option for psoriasis.  


Vitamin D as a topical treatment has become one of the mainstays for treatment of psoriasis vulgaris. Oral vitamin D on the other hand has for the most part become a forgotten option. But a review of the literature on oral vitamin D as a treatment for psoriasis reveals that this treatment is efficacious. The main side effect of this therapy is hypercalcemia, which appears to be easily monitored and avoidable with proper dosing and monitoring. The literature also suggests a correlation between low levels of serum vitamin D in this patient population associated with increased severity of disease involvement. In addition, oral vitamin D improves psoriatic arthropathy. Moreover, vitamin D has been proven to have many health benefits such as prevention of cancer, improved cardiovascular health among many others. Psoriatic patients as a population are at increased risk of developing adverse health complications such as cardiovascular disease, and oral vitamin D may prove to be of benefit in this population. Oral vitamin D is inexpensive and easily available. It is still a viable option and should not be forgotten as a possible treatment for psoriasis. PMID:22103655

Kamangar, Faranak; Koo, John; Heller, Misha; Lee, Eric; Bhutani, Tina



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



Comic books still at it  

Microsoft Academic Search

In this letter to the editor, one of the members of the Oregon Committee to Improve Comics informs readers that children are still able to get their hands on inappropriate materials. The writer says that although there are laws in place, parents and the community need to take a more active role in limiting youth access to these materials.

Thomas Binford



Why Are Chimps Still Chimps?  

ERIC Educational Resources Information Center

|Teachers may be posed with such questions as, "If we evolved from chimps, why are there still chimps?" We provide teachers with answers to this and related questions in the context of the latest genetic, fossil, and behavioral evidence. We also provide references they can use to further students' understanding of human evolution and evolution in…

Johnson, Norman A.; Smith, James J.; Pobiner, Briana; Schrein, Caitlin



1996 Budget picture still clouded  

Microsoft Academic Search

Four months and three work stoppages into fiscal 1996, whole departments and agencies of the United States federal government remain in budgetary limbo. Five annual spending bills still await approval, and parts of nine federal departments and several agencies face the possibility of yet another shutdown, as the current continuing resolution for temporary funding expires on March 15.In the wake

Michael Carlowicz



10 years, still shifting gears.  


Ten years into the modern biologics era, access- and cost-management techniques still aren't refined. Why has managing biologics proven so much harder than managing other drugs? What strategies might help payers face the challenges of the future? PMID:22478709

Adams, Katherine T



Syndrome of severe skin disease, eosinophilia, and dermatopathic lymphadenopathy in patients with HTLV-II complicating human immunodeficiency virus infection.  


Two intravenous drug users dually infected with human immunodeficiency virus type 1 (HIV-1) and human T-cell leukemia virus type II (HTLV-II) developed an unusual severe dermatitis characterized by progressive brawny induration, fissuring, and ulceration of the skin, with an associated CD8 cell infiltration in one patient. Both patients had persistent eosinophilia. Lymph node biopsy revealed dermatopathic lymphadenopathy, an unusual pathologic finding in HIV-1 infection but one seen in association with mycosis fungoides and other skin disorders. Two new isolates of HTLV-II virus were established from these patients and were identified as HTLV-II by Southern blotting. This type of skin disease and lymph node pathology has not been found in other intravenous drug users who have been infected with HIV-1 alone or in patients in other risk groups for HIV-1 infection. HTLV-II may play a role in this unique new disease pattern in patients infected with HIV-1. PMID:1892151

Kaplan, M H; Hall, W W; Susin, M; Pahwa, S; Salahuddin, S Z; Heilman, C; Fetten, J; Coronesi, M; Farber, B F; Smith, S



Idiopathic pulmonary fibrosis complicated by acute thromboembolic disease: chest X-ray, HRCT and multi-detector row CT angiographic findings  

PubMed Central

Idiopathic pulmonary fibrosis (IPF) is a chronic diffuse interstitial disease characterized by a predominant reticular pattern of involvement of the lung parenchyma which can be well documented by High Resolution Computed Tomography (HRCT). While almost half of the patients with IPF may develop pulmonary arterial hypertension, the occurrence of superimposed acute thrombo-embolic disease is rare. We describe a case of an 87 yrs old female who was found to have IPF complicated by acute pulmonary thrombo-embolism during the clinical and radiological investigation of a rapidly worsening dyspnea. While chest x-ray findings were initially considered consistent with a congestive heart failure, a bed side echocardiography revealed findings suggestive of pulmonary arterial hypertension and right ventricular failure with enlargement of both right cavities and associated valvular regurgitations. An acute thrombo-embolic disease was initially ruled out by a perfusion lung scintigraphy and subsequently confirmed by contrast-enhanced multi-detector CT which showed an embolus at the emergency of the right inter-lobar artery with associated signs of chronic pulmonary hypertension. However, unenhanced scans performed with both conventional and high resolution techniques also depicted a reticular pattern of involvement of lung parenchyma considered suggestive of IPF despite a atypical upper lobe predominance. IPF was later confirmed by further clinical, serological and instrumental follow-up.

Campanile, Francesco; Imbriaco, Massimo; Ippolito, Renato; Sirignano, Cesare; Santoro, Ciro; Galderisi, Maurizio; Salvatore, Marco



[Lay emphasis on research into prevention and treatment of complications of burns].  


The prevention and treatment of complications are very important aspects in burn treatment. We should pay attention to the fundamental research, clinical prevention and treatment of complications. We have had good grasp of the subjects by fundamental research such as MODS. We must keep complications in mind when signs, symptoms, monitoring index and laboratory reports are inconsistent to the usual course of the injury, and we must guard against the occurrence of complications in the whole course of burn treatment. Consideration must be given to the treatment of both complications and the primary disease in order to slow down deterioration of patient, and guarantee the curative effect. There are still many unknown areas of burn complications for us to explore and discover. PMID:20510025

Zhang, Guo-an



Gradient echo T2*-weighted magnetic resonance imaging revealing cerebral microbleeds in a patient with microscopic polyangiitis complicated by cerebrovascular disease.  


A 67-year-old woman developed alveolar hemorrhage and was positive for the myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA). She was diagnosed as having probable microscopic polyangiitis (MPA) in accordance with the Japanese criteria. Brain computed tomographic and magnetic resonance imaging (MRI) scans revealed asymptomatic chronic cerebral hemorrhage and white matter lesions. She also later developed thalamic infarction. Gradient echo T2-weighted MRI showed cerebral microbleeds. Cerebral microbleeds in our patient represent bleeding-prone necrotizing vasculitis, which is a characteristic pathologic feature of MPA. Although cerebrovascular disease is not major complication of MPA, cerebral hemorrhage occurs more frequently than ischemic infarction, and it can be critical and fatal. Brain MRIs, including gradient echo T2-weighted imaging, should be performed on patients diagnosed as or suspected of having MPA to assess the risk of cerebral hemorrhage. PMID:21640612

Yamashiro, Kazuo; Mori, Akio; Shimada, Yoshiaki; Furuya, Tsuyoshi; Noda, Kazuyuki; Urabe, Takao; Hattori, Nobutaka; Okuma, Yasuyuki



Circulating platelet and erythrocyte microparticles in young children and adolescents with sickle cell disease: Relation to cardiovascular complications.  


Sickle cell disease (SCD) is characterized by a complex vasculopathy, consisting of endothelial dysfunction and increased arterial stiffness, with a global effect on cardiovascular function. The hypercoagulable state may result from chronic hemolysis and circulating cell-derived microparticles (MPs) originating mainly from activated platelets and erythrocytes. We measured the levels of platelet and erythrocyte-derived MPs (PMPs and ErMPs) in 50 young SCD patients compared with 40 age- and sex-matched healthy controls and assessed their relation to clinicopathological characteristics and aortic elastic properties. Patients were studied stressing on the occurrence of sickling crisis, transfusion history, hydroxyurea therapy, hematological, and coagulation profile as well as flow cytometric expression of PMPs (CD41b(+)) and ErMPs (glycophorin A(+)). Echocardiography was performed to assess aortic stiffness and distensibility, left ventricular function and pulmonary artery pressure. Both PMPs and ErMPs were significantly elevated in SCD patients compared with control group (p?disease duration, transfusion index, white blood cell count, HbS, markers of hemolysis, serum ferritin, D-dimer, and vWF Ag, whereas negatively correlated with hemoglobin and HbF levels (p?disease severity in SCD and may be implicated in the pathogenesis of coagulation abnormalities encountered in those patients. Their levels are closely related to sickling crisis, pulmonary hypertension, markers of hemolysis, fibrinolysis, and iron overload. Therefore, quantification of MPs in SCD may provide utility for identifying patients who are at increased risk of thrombotic events or cardiovascular abnormalities and would help to monitor response to hydroxyurea therapy. PMID:23249216

Tantawy, Azza Abdel Gawad; Adly, Amira Abdel Moneam; Ismail, Eman Abdel Rahman; Habeeb, Nevin Mamdouh; Farouk, Amal



[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



Clinical manifestations and complications of childbirth and replacement therapy in 385 Iranian patients with type 3 von Willebrand disease.  


Type 3 is the most severe form of von Willebrand disease (VWD) transmitted as an autosomal recessive trait. We collected data on the clinical manifestations of type 3 VWD by examining 385 patients from 300 Iranian kindreds, who were compared with 100 age-matched patients with severe haemophilia A. Joint and muscle bleeding was less frequent than in haemophiliacs, perhaps because factor VIII levels were in general higher (median value 4% vs. 1% or less). Mucosal tract haemorrhages such as epistaxis and menorrhagia were the most prevalent symptoms in VWD. Post-circumcision and oral cavity bleeding occurred frequently when prophylactic replacement therapy was not carried out or was inadequate. The course of pregnancy was usually uneventful, but increased bleeding occurred at parturition when affected women were treated with replacement therapy for less than 3-4 d. Ten of 385 (2.6%) of these multitransfused patients developed an alloantibody to VWF and 55% are chronically infected with the hepatitis C virus. PMID:11167767

Lak, M; Peyvandi, F; Mannucci, P M



Gastrointestinal complications of oncologic therapy  

Microsoft Academic Search

Gastrointestinal complications are common in patients undergoing various forms of cancer treatment, including chemotherapy, radiation therapy, and molecular-targeted therapies. Many of these complications are life-threatening and require prompt diagnosis and treatment. Complications of oncologic therapy can occur in the esophagus (esophagitis, strictures, bacterial, viral and fungal infections), upper gastrointestinal tract (mucositis, bleeding, nausea and vomiting), colon (diarrhea, graft–versus–host disease, colitis

Marta Davila; Robert S Bresalier



[Timely estimation of risk factors of coronary heart disease as a basis of prevention of its complications].  


We compared the prevalence and duration of action of common risk factors (RF) of arterial hypertension (AH), smoking, alcohol abuse, excess consumption of animal fats and carbohydrates, psychoemotional stress, inherited risk of coronary heart disease (CHD), AH, diabetes mellitus (DM), overweight/obesity, hypercholesterolemia (HC) and hypertriglyceridemia (HTG) contributing to combined cardiovascular pathology. In addition, RF of myocardial infarction (MI) were elucidated. The study involved 190 patients with CHD including 82 (43.2%) and 108 (56.8%) (mean age 53. 0 +/- 0.6 yr) suffering functional class I-III angina of effort (AE), metabolic syndrome and DM2. A combination of such RF as AH, HC, and HTG, psychoemotional stress, unhealthy diet, overweight/obesity DM2, smoking, and alcohol abuse were found to be associated with CHD and MI. Four RF were identified in 37.4 and 31.1% of the men and women respectively, 5 FR in 33.1 and 39.5%, 6 RF in 29.5 and 15.3%; 7 RF were revealed in 14.1% of the men. The history of IM was documented in 101 (53.2%) patients, Q-wave IM in 55 (28.9%), non-Q-wave MI in 46 (24.3%). Q-wave MI occurred in 142 and 14.7% of men and women respectively; non-Q-wave MI occurred 1.2 times more frequently in women than in men. It is concluded that early diagnosis of RF in young and middle-aged subjects may promote prevention or slow down progression of metabolic syndrome, AH, CHD, and DM2. PMID:23516847

Matveeva, S A



Systemic JIA Treatment and Complications  

Center for Biologics Evaluation and Research (CBER)

Text Version... PAH, ILD and AP are highly fatal complications of ... patients with severe uncontrolled systemic disease • Prospective, systematic surveillance of ... More results from


Is working memory still working?  


The current state of A. D. Baddeley and G. J. Hitch's (1974) multicomponent working memory model is reviewed. The phonological and visuospatial subsystems have been extensively investigated, leading both to challenges over interpretation of individual phenomena and to more detailed attempts to model the processes underlying the subsystems. Analysis of the controlling central executive has proved more challenging, leading to a proposed clarification in which the executive is assumed to be a limited capacity attentional system, aided by a newly postulated fourth system, the episodic buffer. Current interest focuses most strongly on the link between working memory and long-term memory and on the processes allowing the integration of information from the component subsystems. The model has proved valuable in accounting for data from a wide range of participant groups under a rich array of task conditions. Working memory does still appear to be working. PMID:11785152

Baddeley, A D



Soviet Union targets still beckon  

SciTech Connect

The excitement generated by the opening of the Soviet Union to Western oil companies has not waned since that first overture by the Soviet oil ministries and, considering the potential opportunities, sustained enthusiasm is understandable. A significant portion of the world's largest country remains virtually untouched by a drill bit, and even the mature regions are still prospective particularly with state-of-the-art Western technologies. The exploration history of the USSR is a testament to the potential that remains in new basins and plays. Estimates of Soviet proved reserves range from 50 to 80 billion barrels of oil, the largest concentration outside the Persian Gulf. Also, the country has estimated proved reserves of 1,500 trillion cubic feet of natural gas, which is over 38% of the worldwide total. This paper briefly describes each of the five currently mapped oil regions which is based on geography, geology, and exploration maturity. It also provides historical information on the USSR oil industry.

Shirley, K.



1996 Budget picture still clouded  

NASA Astrophysics Data System (ADS)

Four months and three work stoppages into fiscal 1996, whole departments and agencies of the United States federal government remain in budgetary limbo. Five annual spending bills still await approval, and parts of nine federal departments and several agencies face the possibility of yet another shutdown, as the current continuing resolution for temporary funding expires on March 15.In the wake of the recent three-week shutdown of the federal government, congressional leaders worked in January to ease future political pain by funding a list of “essential services” for the remainder of the fiscal year. Deemed essential were government programs with the most immediate and conspicuous public impact, such as the National Parks Service and the Passport Services Office. Included on that list of essential services was the National Institutes of Health (NIH), which not only received full funding for the entire fiscal year but also got a 5.7% increase over its 1995 budget.

Carlowicz, Michael


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



Oral Complications of HIV Disease  

PubMed Central

Oral lesions are among the early signs of HIV infection and can predict its progression to acquired immunodeficiency syndrome (AIDS). A better understanding of the oral manifestations of AIDS in both adults and children has implications for all health care professionals. The knowledge of such alterations would allow for early recognition of HIV-infected patients. The present paper reviews epidemiology, relevant aspects of HIV infection related to the mouth in both adults and children, as well as current trends in antiretroviral therapy and its connection with orofacial manifestations related to AIDS.

Leao, Jair C.; Ribeiro, Camila M. B.; Carvalho, Alessandra A. T.; Frezzini, Cristina; Porter, Stephen



Respiratory failure in chronic obstructive pulmonary disease  

Microsoft Academic Search

Respiratory failure is still an important complication of chronic obstructive pulmonary disease (COPD) and hospitalisation with an acute episode being a poor prognostic marker. However, other comorbid conditions, especially cardiovascular disease, are equally powerful predictors of mortality. The physiological basis of acute respiratory failure in COPD is now clear. Significant ventilation\\/perfusion mismatching with a relative increase in the physiolo- gical

P. M. A. Calverley



Prospective population-based study on the burden of disease from post-streptococcal glomerulonephritis of hospitalised children in New Zealand: Epidemiology, clinical features and complications.  


AIM: A nationwide 24-month study was conducted (2007-2009), via the New Zealand Paediatric Surveillance Unit to define epidemiology and clinical features of acute poststreptococcal glomerulonephritis (APSGN) in children hospitalised with the illness. METHODS: Paediatricians (n = 215) were requested to report new hospitalised cases fulfilling a case definition of definite (haematuria with low C3 and high streptococcal titres or biopsy proven APSGN) or probable (haematuria with low C3 or high streptococcal titres). RESULTS:?: A total of 176 cases were identified (definite: n = 138, probable: n = 38) with 63% residing in the Auckland metropolitan region. Sixty-seven percent were in the most deprived quintile. Annual incidence (0-14 years) was 9.7/100?000 (Pacific 45.5, Maori 15.7, European/other 2.6 and Asian 2.1/100?000). Annual incidence was highest in the South Auckland Metropolitan region (31/100?000), Central Auckland 14.9, West/North Auckland metropolitan region 5.9 and for the remainder of New Zealand 5.5/100?000. Age-specific incidence was highest in age 5-9 years (15.1/100?000). Reduced serum complement C3, gross haematuria, hypertension, impairment of renal function and heavy proteinuria were present in 93%, 87%, 72%, 67% and 44% of patients, respectively. Severe hypertension was closely associated with either symptoms of an acute encephalopathy or congestive heart failure. CONCLUSIONS: New Zealand children carry a significant disease burden of hospitalised APSGN with socio-economically deprived; Pacific and Maori children are being over-represented. Significant short-term complications were observed in hospitalised children with APSGN. Persistently very low rates in European/other suggest a preventable disease. PMID:23782011

Wong, William; Lennon, Diana R; Crone, Sonja; Neutze, Jocelyn M; Reed, Peter W



Complications of gastroesophageal reflux disease. Role of the lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and duodenogastric reflux.  

PubMed Central

The factors contributing to the development of esophageal mucosal injury in gastroesophageal reflux disease (GERD) are unclear. The lower esophageal sphincter, esophageal acid and acid/alkaline exposure, and the presence of excessive duodenogastric reflux (DGR) was evaluated in 205 consecutive patients with GERD and various degrees of mucosal injury (no mucosal injury, n = 92; esophagitis, n = 66; stricture, n = 19; Barrett's esophagus, n = 28). Manometry and 24-hour esophageal pH monitoring showed that the prevalence and severity of esophageal mucosal injury was higher in patients with a mechanically defective lower esophageal sphincter (p less than 0.01) or increased esophageal acid/alkaline exposure (p less than 0.01) as compared with those with a normal sphincter or only increased esophageal acid exposure. Complications of GERD were particularly frequent and severe in patients who had a combination of a defective sphincter and increased esophageal acid/alkaline exposure (p less than 0.01). Combined esophageal and gastric pH monitoring showed that esophageal alkaline exposure was increased only in GERD patients with DGR (p less than 0.05) and that DGR was more frequent in GERD patients with a stricture or Barrett's esophagus. A mechanically defective lower esophageal sphincter and reflux of acid gastric juice contaminated with duodenal contents therefore appear to be the most important determinants for the development of mucosal injury in GERD. This explains why some patients fail medical therapy and supports the surgical reconstruction of the defective sphincter as the most effective therapy.

Stein, H J; Barlow, A P; DeMeester, T R; Hinder, R A



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



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



Fractional CO2 Laser Resurfacing Complications  

PubMed Central

Fractionated CO2 laser technology has allowed physicians to resurface patients with a lower rate of complications than nonfractionated ablative laser treatment. Unfortunately, adverse effects can still occur even with the best technology and physician care. Complication prevention, detection, and treatment are an important part of a physician's ability to provide the best result when treating a patient with fractionated CO2 resurfacing.

Ramsdell, William M.



Surgery for inflammatory bowel disease  

PubMed Central

Despite the new and ever expanding array of medications for the treatment of inflammatory bowel disease (IBD), there are still clear indications for operative management of IBD and its complications. We present an overview of indications, procedures, considerations, and controversies in the surgical therapy of IBD.

Hwang, John M; Varma, Madhulika G



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



Combined esophageal multichannel intraluminal impedance and pH monitoring (MII -pH) in the diagnostics and treatment of gastroesophageal reflux disease and its complications.  


The technique of 24-hour esophageal multichannel intraluminal impedance monitoring combined with pH-metry (MII-pH) is currently considered to be the golden standard in the diagnostics of gastroesophageal reflux disease (GERD). The technique allows for differentiation of gas and liquid reflux as well as detection of non-acid reflux, which cannot be detected with other techniques that are based only on measuring the pH of gastric contents.THE AIM OF THE STUDY was to assess the usefulness of MII-pH in the diagnostics and treatment of GERD and its complications. MATERIAL AND METHODS. A group of 213 patients referred to II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Uk?adu Pokarmowego Uniwersytetu Medycznego w Lublinie [the Second Faculty and Clinic of General and Gastrointestinal Surgery and Gastrointestinal Oncology at Medical University of Lublin] due to persistent symptoms of GERD and 21 volunteers without any clinical evidence of GERD underwent esophageal monitoring via MII-pH. The results were correlated with those of upper gastrointestinal tract endoscopy. The data gathered during MII-pH and endoscopy as well as information from questionnaires were entered into an MS Excel spreadsheet and subsequently analyzed with STATISTICA PL software. RESULTS AND CONCLUSIONS. MII-pH proved to be considerably more useful than conventional pHmetry in recording acid reflux. The sensitivity of pH-metry based on the MII-pH technique was established at 74%. GERD-induced changes in the esophageal mucosa result in decreased impedance baseline. The presence and severity of inflammatory esophageal lesions was proven to be associated with acid reflux episodes and proximal reflux episodes. No direct relationship between the grade of GERD and the occurrence of non-acid reflux episodes was confirmed. Non-acid reflux episodes were shown to predispose to non-erosive reflux disease (NERD). The results of this study confirm that MIIpH is an essential technique in the diagnostics, as well as in assessment of the course of treatment and the severity of GERD. PMID:22166737

Masiak, Wioletta; Wallner, Grzegorz; Wallner, Jan; Pedowski, Tomasz; Solecki, Micha?



Management and complications of stomas.  


Stomas are created for a wide range of indications such as temporary protection of a high-risk anastomosis, diversion of sepsis, or permanent relief of obstructed defecation or incontinence. Yet this seemingly benign procedure is associated with an overall complication rate of up to 70%. Therefore, surgeons caring for patients with gastrointestinal diseases must be proficient not only with stoma creation but also with managing postoperative stoma-related complications. This article reviews the common complications associated with ostomy creation and strategies for their management. PMID:23177069

Bafford, Andrea C; Irani, Jennifer L



Direct medical cost of pelvic inflammatory disease and its sequelae: decreasing, but still substantial 1 1 The authors thank Anne Haddix, PhD, and Guoyu Tao, PhD, for their methodologic advice  

Microsoft Academic Search

Objective: To estimate direct medical costs and average lifetime cost per case of pelvic inflammatory disease (PID).Methods: We estimated the direct medical expenditures for PID and its three major sequelae (chronic pelvic pain, ectopic pregnancy, and infertility) and determined the average lifetime cost of a case of PID and its sequelae. We analyzed 3 years of claims data of privately

David B Rein; William J Kassler; Kathleen L Irwin; Lara Rabiee



Paget’s disease of bone: Diagnosis and treatment update  

Microsoft Academic Search

Paget’s disease is a metabolic bone disease characterized by excessive bone resorption and formation due to activated osteoclasts.\\u000a Although Paget’s disease is a high bone turnover state, the excess bone that is formed lacks the structural stability of normal\\u000a bone. Complications from Paget’s disease include deformity, fracture, and pain. Although still unclear, both prevalence and\\u000a severity of Paget’s disease seem

Mustafa Noor; Dolores Shoback



Bilateral Empyema Caused by Adult-Onset Still’s Disease  

Microsoft Academic Search

Empyemas are usually of infectious origin. Noninfectious causes of empyema may be a considerable diagnostic challenge, as exemplified in the present case report. A 21-year-old male presented with high fever, sore throat and myalgias of 1 week duration. In the following days, bilateral pleural effusions developed, with cellular counts in the pleural fluid up to 117 × 109\\/liter (98% neutrophils).

M. Mattiuzzo; M. Del Forno; B. Branca; V. Moretti; M. Pirisi



[Complicated gastroduodenal ulcers in rheumatology patients].  


An analysis of observations of 250 patients with different rheumatological diseases has shown that 18% of the patients had ulcer disease with complications. The greatest risk of bleedings and perforations took place during the first year of treatment with nonsteroidal antiinflammatory drugs. The main risk factors of complications were determined. They are: male sex, high parameters of gastric secretion. PMID:9825433

Barashkov, V G; Shemerovskaia, T G; Sergeev, P V; Bokovanov, V E



The impact of mathematical modeling on the understanding of diabetes and related complications  

PubMed Central

Diabetes is a chronic and complex multifactorial disease caused by persistent hyperglycemia and for which underlying pathogenesis is still not completely understood. The mathematical modeling of glucose homeostasis, diabetic condition, and its associated complications is rapidly growing and provides new insights into the underlying mechanisms involved. Here, we discuss contributions to the diabetes modeling field over the past five decades, highlighting the areas where more focused research is required.

Ajmera, I; Swat, M; Laibe, C; Novere, N Le; Chelliah, V



Gaining insight into the health effects of soy but a long way still to go: commentary on the fourth International Symposium on the Role of Soy in Preventing and Treating Chronic Disease.  


Research into the health effects of soyfoods and soybean constituents has increased at a phenomenal pace over the past decade. This research includes a wide range of areas, such as cancer, coronary heart disease, osteoporosis, cognitive function, menopausal symptoms and renal function. Importantly, there are an increasing number of clinical studies being conducted in this field, which was quite evident from the findings presented at the Fourth International Symposium on the Role of Soy in Preventing and Treating Chronic Disease, November 4-7, 2001, in San Diego, California. There is no doubt that progress in understanding the health effects of soy is being made, but much of the data are frustratingly inconsistent. For example, there were conflicting results presented at the symposium on the role of isoflavones in bone health. Similarly, presentations painted an unclear picture of the role of isoflavones in cholesterol reduction. The relatively short duration and small sample size of many of the human studies in this field likely contribute to the inconsistent results. Although there are some controversies regarding the safety of soy for certain subsets of the population, special sessions at the symposium on breast cancer and cognitive function did much to alleviate concerns that soy could have detrimental effects in these areas. Furthermore, published data and new research presented at this meeting suggest that the consumption of even 10 g (typical of Asian intake) of isoflavone-rich soy protein per day may be associated with health benefits. If this modest amount of soy protein were to be incorporated in the American diet, it would represent only approximately 15% of total U. S. protein intake. PMID:11880591

Messina, Mark; Gardner, Christoper; Barnes, Stephen



Neurological complications of vasculitis.  


The vasculitides are a group of disorders that include the polyarteritis nodosa group of systemic necrotizing vasculitides, hypersensitivity vasculitis, Wegener's granulomatosis, lymphomatoid granulomatosis, giant cell arteritis, Behçet's disease, and isolated angiitis of the central nervous system. Classification is based on clinical, angiographic, and histological features. The frequency and distribution of neurological involvement vary with the underlying disorder and may provide the initial symptoms. Polyarteritis nodosa and Wegener's granulomatosis may affect both the central and peripheral nervous systems, whereas isolated angiitis of the central nervous system and Behçet's disease affect the central nervous system alone. Neurological dysfunction occurs in 80% of patients with polyarteritis nodosa and fewer than 10% of patients with hypersensitivity vasculitis. The mechanism of neurological dysfunction in the vasculitides is tissue ischemia. The clinical effects of ischemia vary, and symptoms may be transient or prolonged. Mononeuritis multiplex, polyneuropathy, and stroke are frequent complications, but encephalopathies, cranial neuropathies, and brachial plexopathies are seen as well. The occurrence of symptoms late in the course of a disease suggests ischemia resulting from healed, scarred vessels as well as from those that are acutely inflamed; this is the case in Takayasu's arteritis and possibly also in polyarteritis nodosa. Treatment is based on identifying and removing the sensitizing agent when possible. Wegener's granulomatosis requires therapy with cyclophosphamide; temporal arteritis, with corticosteroids. In other vasculitides a balance must be reached between the progression of the disease and the side effects of immunosuppression. PMID:6137994

Moore, P M; Cupps, T R



Epidemiology of Micro- and Macrovascular Complications of Type 2 Diabetes in Korea  

PubMed Central

The prevalence of diabetes in Korea has increased six- to sevenfold over the past 40 years with its complications becoming major causes of morbidity and mortality. The rate of death among patients with diabetes is about twice as high as that among persons without diabetes and the most common cause of death is cardiovascular disease (30.6%). Despite the seriousness of diabetic complications, 30 to 70% of patients receive inadequate care, and only 40% of treated diabetic patients achieve the optimal control with HbA1c level <7% in Korea. In 2006, over 30 to 40% of patients with diabetes have microvascular complications and around 10% of them have macrovascular complications from our national data. Despite there are some debates about intensive glycemic control resulting in the deterioration of macrovascular complication, multifactorial treatment approaches including proper glycemic control are important to prevent diabetic complications. There have been needs for finding proper biomarkers for predicting diabetic complications properly but we still need more longitudinal studies to find this correlation with causal relationship. In this article, we wanted to review the recent status of micro- and macrovascular complications of type 2 diabetes in Korea from integration of many epidemiologic studies.

Kim, Jung Hee; Kim, Dae Jung; Jang, Hak Chul



Abnormal Bidirectional Plasticity-Like Effects in Parkinson's Disease  

ERIC Educational Resources Information Center

|Levodopa-induced dyskinesia is a major complication of long-term dopamine replacement therapy for Parkinson's disease that becomes increasingly problematic in advanced Parkinson's disease. Although the cause of levodopa-induced dyskinesias is still unclear, recent work in animal models of the corticostriatal system has suggested that…

Huang, Ying-Zu; Rothwell, John C.; Lu, Chin-Song; Chuang, Wen-Li; Chen, Rou-Shayn



Abnormal Bidirectional Plasticity-Like Effects in Parkinson's Disease  

ERIC Educational Resources Information Center

Levodopa-induced dyskinesia is a major complication of long-term dopamine replacement therapy for Parkinson's disease that becomes increasingly problematic in advanced Parkinson's disease. Although the cause of levodopa-induced dyskinesias is still unclear, recent work in animal models of the corticostriatal system has suggested that…

Huang, Ying-Zu; Rothwell, John C.; Lu, Chin-Song; Chuang, Wen-Li; Chen, Rou-Shayn



Cerebral complications of hypertension.  


Ischaemic and degenerative brain diseases are a major health problem leading to a devastating loss of autonomy. Hypertension has been shown to carry an increased risk not only for cerebrovascular morbidity and mortality but also for cognitive impairment and dementia. Although diastolic blood pressure is considered an important risk factor, it is now clear that isolated systolic hypertension and elevated pulse pressure also play an important role in the development of brain complications. Therefore the treatment of these conditions must urgently become a widespread tool of prevention. All the randomised placebo-controlled trials completed for the last 30 years have shown a reduction in fatal and/or non-fatal strokes. In the most recent trials in isolated systolic hypertension in older patients, the benefit was even greater because of the higher risk in these populations. The new classes of drugs, in particular, calcium-channels blockers and angiotensin-converting enzyme inhibitors, have been shown to be as effective as the originally used diuretics and beta-blockers. Active treatment in the Syst-Eur trial based on nitrendipine as first step, possibly associated with enalapril and/or hydrochlorthiazide reduced not only stroke and cardiovascular complications but also the incidence of dementia including Alzheimer's disease. This important finding must be confirmed by further trials specifically focusing on the prevention of dementia. In addition, the importance of pulse pressure as a risk factor, underlines the need for new drugs which could increase aortic distensibility and decrease systolic blood pressure without greatly reducing diastolic pressure. Improving the management of hypertension offers new opportunities to reduce age-related disease in older people and to promote healthy aging. PMID:11095154

Rigaud, A S; Seux, M L; Staessen, J A; Birkenhäger, W H; Forette, F


The role of transjugular intrahepatic portosystemic shunt for treatment of portal hypertension and its complications: A conference sponsored by the National Digestive Diseases Advisory Board  

Microsoft Academic Search

TIPS is a new and exciting modality for treatment of portal hypertension and its complications. Indications for TIPS remain to be better defined in terms of efficacy and cost-benefit in relationship to other established modes of therapy of portal hypertension. Prospective, randomized controlled trials are needed for these comparisons. Until the role of TIPS in the routine management of the

Mitchell L. Shiffman; Lennox Jeffers; Jay H. Hoofnagle; Tommie Sue Tralka



Crohn's Disease: A Surgeon's Perspective  

PubMed Central

Crohn’s disease (CD) is known for wide anatomic distribution, different presentations, life-threatening complications, and multiple modalities of management. Its multiple implications are still unaddressed. Since all the patients do not show a good response to medical modalities of treatment, a significant percentage of these patients are referred to the surgeon for the palliation of complications or for the ultimate curative treatment. Since most surgeons come across such patients only rarely, it is sometimes difficult for them to choose the appropriate procedure at the time of need. Moreover, the various surgical modalities available for the different presentations and complications of the disease have not been adequately discussed. The aim of this review is to offer insight and a detailed account of the management of CD from a surgical perspective. This review offers an overview of the various surgical options available, their utility in context, and an approach to various scenarios of complicated CD.

Parray, Fazl Q.; Wani, Mohd Lateef; Bijli, Akram H.; Thakur, Natasha; Irshad, Ifat; Nayeem-ul-Hassan



Study of Pulmonary Complications in Pediatric Patients With Storage Disorders Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

I Cell Disease; Fucosidosis; Globoid Cell Leukodystrophy; Adrenoleukodystrophy; Mannosidosis; Niemann-Pick Disease; Pulmonary Complications; Mucopolysaccharidosis I; Mucopolysaccharidosis VI; Metachromatic Leukodystrophy; Gaucher's Disease; Wolman Disease



[Antibiotics for pancreatitis--still controversial?].  


Summary. Infection frequently complicates the course of severe acute pancreatitis and might manifest as infected pancreatic necrosis, pancreatic abscess or an infected peripancreatic fluid collection. Pancreatic necrosis occurs in roughly 21% of all cases of pancreatitis. In patients with necrosis involving more than one-half of the pancreas, the incidence of subsequent infection is as high as 40%-70%. More than 50% of these infection yield a polymicrobial isolate with predominance of enteric bacteria but recently, the microbiologic pattern has shifted toward more resistant gram-negative bacilli, gram-positive cocci and yeast, a reflection of exposure to broad-spectrum antimicrobial agents. Given the morbidity associated with infection, many commentators have advocated prophylactic antimicrobial therapy in patients with necrosis to the point that this measure has been incorporated into routine practice. However, there is controversy over the risks and potential benefit. Currently, advise against the routine use of prophylactic systemic antibiotics and antifungals (side-effect selection of resistant microbes and fungi). However, there may be some patients who benefit from prophylaxis, and additional studies and investigations are ongoing. Antibiotics should not be given early in the disease course because most symptoms are due to the inflammatory response, not an infectious etiology. Antibiotics are indicated when CT scans indicate a pancreatic phlegmon, empirically in the case of severe pancreatitis associated with septic shock, or with documented fine - needle aspiration biopsy identification of bacteria. Under those circumstances, antibiotic coverage is warranted to prevent systemic gram-negative sepsis. Infected pancreatic necrosis should be treated with carbapenems because they can effectively penetrate pancreatic tissue. Other conditions, such as biliary pancreatitis associated with cholangitis, mandate antibiotic coverage. PMID:23120850

Skrlin, Jasenka



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


Appendicitis complicating pregnancy.  


Thirty-four pregnant women with acute appendicitis presented at Parkland Memorial Hospital during a 15-year period. Abdominal pain, usually accompanied by nausea with or without vomiting, was the most common presenting symptom. Anorexia was less constant, and its occurrence decreased with advancing gestation. Physical findings usually included direct abdominal tenderness and, less often, rebound tenderness. Leukocytosis and/or a "left shift" were common laboratory findings, and the urinalysis was normal in most cases. Diagnosis was increasingly difficult as gestation progressed. This was reflected both by the increasing severity of the disease process found at surgery and by increasing fetal loss. If the diagnosis of appendicitis is suspected in the gravid patient, immediate surgical intervention is indicated to prevent the catastrophic complications associated with procrastination in diagnosis and treatment. PMID:1121371

Cunningham, F G; McCubbin, J H



[Antibodies to Chlamydia pneumoniae in blood serum of patients with ischemic heart disease and presence of complicated lesions in coronary arteries].  


Levels of IgM, IgG and IgA antibodies to Chlamydia pneumoniae were measured in 107 patients (age 33-75 years) with documented coronary atherosclerosis and 39 subjects with intact coronary arteries. Rates of seropositivity to C. pneumoniae were 77.6 and 25.6% in patients and "healthy" subjects, respectively (p<0.05). Seropositive (n=83) compared with seronegative (n=24) patients had higher prevalence of complicated lesions (p<0.05). PMID:16474303

Vlasova, E E; Belokon', E V; Rudenko, B A; Pichuzhkin, K V; Egorov, A M; Akchurin, R S



Forward\\/Backward - Living\\/Still  

Microsoft Academic Search

Let's step back a moment and try a transhistorical thought experiment: What if we considered nowadays art that deals with biological systems as a contemporary vanitas version of yesteryears tradition of Still Life? At first sight, this approach may seem awkward. Of course, Still Life - the depreciative French term for it is nature morte, dead nature - consists in

Jens Hauser


Still Life with Fruit and Seashell  

ERIC Educational Resources Information Center

|Henri Matisse's painting, "Sideboard," opens the door to the author's first-grade students' lesson on still life. This lesson is about the process of designing, the act of making decisions, and the knowledge of one's own preferences. In this article, the author describes how the students made still life with fruit and seashells.|

Gojeski, Laura



32 CFR 705.10 - Still photography.  

Code of Federal Regulations, 2010 CFR

...2009-07-01 2009-07-01 false Still photography. 705.10 Section 705.10 National...AFFAIRS REGULATIONS § 705.10 Still photography. (a) Policy and procedures on...are set forth in the Manual of Naval Photography, OPNAVINST 3150.6D. (c)...



32 CFR 705.10 - Still photography.  

Code of Federal Regulations, 2010 CFR

...2010-07-01 2010-07-01 false Still photography. 705.10 Section 705.10 National...AFFAIRS REGULATIONS § 705.10 Still photography. (a) Policy and procedures on...are set forth in the Manual of Naval Photography, OPNAVINST 3150.6D. (c)...



Beyond One Still Image: Face Recognition from Multiple Still Images or Video Sequence  

Microsoft Academic Search

While face recognition from a single still image has been ext ensively studied over a decade, face recognition based on a group of still images (also refer red as multiple still images) or a video sequence is an emerging topic. Although a group of sti ll images or a video sequence can be treated as a single still image in

Shaohua Kevin Zhou; Rama Chellappa


Complications of radiation therapy  

SciTech Connect

The skeletal effects of radiation are dependent upon many variables, but the pathologic features are consistent. Radiation may cause immediate or delayed cell death, cellular injury with recovery, arrest of cellular division, or abnormal repair with neoplasia. Radiation necrosis and radiation-induced neoplasm still occur despite the use of supervoltage therapy. Complications of radiotherapy are well known and have led to more judicious use of this therapeutic modality. With few exceptions, benign bone tumors are no longer treated with irradiation. Radiation necrosis may be difficult to differentiate from sarcoma arising in irradiated bone. They both occur within the field of irradiation. Radiation necrosis often has a long latent period which is, of course, the rule in radiation-induced neoplasia. A soft tissue mass favors the diagnosis of neoplasia, while its absence suggests radiation necrosis. Lack of pain favors necrosis. Calcification may occur in radiation necrosis and does not indicate neoplasia. A lack of progression on serial roentgenograms also favors radiation necrosis. 76 references.

Dalinka, M.K.; Mazzeo, V.P. Jr.



Treatment of laser complications.  


Modern lasers and light-based sources that were developed based on the theory of selective photothermolysis are capable of destroying specific tissue targets while minimizing the risk of scarring and pigmentary changes. This is accomplished through the use of a wavelength and pulse duration that is best absorbed by a specific chromophore such as melanin or hemoglobin. However, not all lasers and light sources adhere to this principle. Continuous wave (CW) lasers are least selective and may produce unwanted tissue damage and scarring through heat conduction to normal skin. Quasi-CW lasers limit excessive thermal destruction by delivery of a series of brief laser pulses but still pose a higher risk of nonspecific tissue damage and thermal injury. The pulsed and Q-switched (QS) systems adhere most closely to the principles of selective photothermolysis and result in the highest degree of selective destruction with the lowest risk of scarring from excessive thermal diffusion. Certainly, any laser system potentially can result in scarring and tissue damage when used incorrectly; therefore, adequate operator education and skill are essential. Side effects and complications that occur as a consequence of laser treatment can be significantly reduced if diagnosed and treated in an expeditious manner. PMID:20024873

Alster, Tina S; Khoury, Randa R



Surgical Complications of Gynecologic Surgery  

PubMed Central

Complications of gynecological surgery are considerable and when reviewed in detail are almost frightening. There is no substitute for experience and intimate knowledge of the intricate pelvic structures in health and disease. Anyone who is active in the field is sooner or later going to experience some difficulty whether it be due to his miscalculation or to innate conditions in the patient which are beyond his/her control. It is the responsibility of the pelvic surgeon to recognize the complication and apply proper corrective measures. The patient should not be given false hopes of sure success nor should she be deprived of whatever hope for success does exist.

Weekes, Leroy R.; Gandhi, Shobhana Anil; Gandhi, Anil Krishnakumar



Complications of small joint arthroplasty.  


Arthritis in the small joints of the hand can be treated with arthrodesis or arthroplasty. Arthrodesis has known risks of infection, pain, and nonunion. Distal interphalangeal (DIP) arthroplasty has been successful in preserving motion and alleviating pain for distal DIP, proximal interphalangeal, and metacarpophalangeal joints. Unfortunately, complications arise that limit the success of surgery. Silicone implants have been reliable for many years but still present with the risks of infection, implant breakage, stiffness, and pain. Newer implant designs may limit some of these complications, but present with unique problems such as dislocations and loosening. It is not yet clear as to which type of implant provides the most reliable results, although implant arthroplasty appears to give better function than arthrodesis. Silicone arthroplasty does not lead to silicone synovitis and is a reliable procedure. Pyrocarbon implants are showing some promise, particularly in the osteoarthritic patient. PMID:20494746

Drake, Matthew L; Segalman, Keith A



Avoiding complications in esophageal cancer surgery.  


Modern handling of esophageal cancer patients is based on a multidisciplinary concept, but surgery remains the primary curative treatment modality. Improvements in the perioperative care have reduced the overall morbidity and mortality, but 2-7% of the patients may still die within 30 days as a direct consequence of complications related to the esophagectomy procedure. Primarily based on results from randomized studies published after 2000 this review describes some of the factors that may contribute to the development of postoperative complications following esophageal cancer surgery as well as studies intended to finding ways of reducing the complication rate. PMID:24019042

Bau Mortensen, M



Editorial Infectious diseases in children-still leads  

Microsoft Academic Search

Typhoid accounts for more than 12 million cases per year with more than 60% being from Asia. Of these a large majority are children with the peak incidence between 3-19 years. In Pakistan 40% of the bed occupancy is due to water borne infections, typhoid having one with the longest bed occupancy period. Vaccine against typhoid is available and is

Aisha Mehnaz


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 ...


Analysis of assisted coupled solar stills  

SciTech Connect

The potential of coupled solar stills as a mean for improving solar distillation yield is investigated. A model for a simple solar still assisted by an external solar collector is presented. The governing coupled heat and momentum balance equations are solved for a quasi-steady-state condition with temperature dependent physical properties. The results show that for coupled stills the fresh water productivity increases as the solar collector area of the assisting device increases. For an ideal system, neglecting the thermal inertia, the yield is linearly dependent upon the solar insolation. The thermal inertia causes a significant drop in the system yield and deviation from linearity. The net efficiency of the coupled system is higher than that of a similar simple still by a value that depends mainly upon the system configuration and independent of the meteorological conditions. Comparison of the analysis with experimental data is satisfactory. 36 refs., 8 figs., 1 tab.

Zaki, G.M.; Radhwan, A.M. (King Abdulaziz Univ., Jeddah (Saudi Arabia)); Balbeid, A.O. (Yanbit Oil Co., Yanbu (Saudi Arabia))



Pap Smear: Still Necessary after Hysterectomy?  


... an important screening test for early diagnosis of cervical cancer. If you had a partial hysterectomy — when the ... and you're not at high risk of cervical cancer. If you're unsure whether you still need ...


Solar Still Part 1: Salt Water  

NSDL National Science Digital Library

The water cycle is the process that moves water around Earth. In this video segment adapted from ZOOM, cast members use a homemade solar still to mimic this natural process, separating pure water from a saltwater mixture.

Foundation, Wgbh E.



Complications of stomas: their aetiology and management.  


The formation of a stoma is an essential part of many colorectal operations. Despite the frequency with which these surgeries are performed and the number of specialists involved in stoma care, complications are still common. This article investigates the most common complications, explains the reasons for their occurrence and suggests potential management options. Common stoma complications were identified by the colorectal/ stoma clinical nurse specialist (CSCNS) and a literature search was performed using a variety of online databases, including Medline and CINAHL using the keywords stoma, complications, prolapse, ischaemia, retraction, hernia and stenosis. Articles used were selected on the basis of relevance to the topic. The commonest complications of stomas included skin irritation, prolapse, retraction, ischaemia, hernia and stenosis. PMID:23653957

Watson, Angus J M; Nicol, Laura; Donaldson, Susan; Fraser, Cathie; Silversides, Andrew



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


A newborn case with perinatal-lethal Gaucher disease due to R463H homozygosity complicated by C677T homozygosity in the MTHFR gene.  


Perinatal-lethal Gaucher disease is very rare and is considered a variant of type 2 Gaucher disease that occurs in the neonatal period. The most distinct features of perinatal-lethal Gaucher disease are non-immune hydrops fetalis, in utero fetal demise and neonatal distress. In some cases without hydrops, neurological signs occur in the first week of life and lead to death within 3 months. Less common signs of the disease are hepatosplenomegaly, ichthyosis, arthrogryposis and facial dysmorphy. We describe a preterm neonate with Gaucher disease homozygous for R463H mutation in GBA gene who showed severe neurologic signs in addition to refractory thrombocytopenia, hepatosplenomagaly, direct hyperbilirubinemia, facial dysmorphy and ichthyosiform skin abnormalities in addition to having thrombosis in portal and splenic veins possibly due to homozygosity for C677T mutation in MTHFR gene. To the best of our knowledge, this is the first case homozygous for the GBA R463H mutation resulting in Gaucher disease with a concomitant homozygous MTHFR C677T mutation. PMID:21823541

Akdag, Arzu; O?uz, Serife Suna; Ezgü, Fatih; Erdeve, Omer; Ura?, Nurdan; Dilmen, U?ur



Investigation on Ocular Complication of Diabetes.  

National Technical Information Service (NTIS)

A five year study on the ocular complications of diabetes compared results of eye examinations and biochemical analyses of diabetics with eye disease to nondiabetics with the same prognoses. For the same two populations, results of cataract surgery and po...

T. H. Kirmani



Acute polyradiculoneuropathy complicating systemic lupus erythematosus.  

PubMed Central

Two elderly patients with systemic lupus erythematosus (SLE) are presented. Both developed an acute polyradiculoneuropathy which is an unusual complication of this disease. Features of their presentation are discussed.

Morgan, S. H.; Kennett, R. P.; Dudley, C.; Mackworth-Young, C.; Hull, R.; Hughes, G. R.



Complications of Anterior Skull Base Surgery  

PubMed Central

The complications associated with anterior skull base surgery were reviewed in 49 consecutive patients treated between November 1986 and August 1993. All procedures involved a combined otolaryngologic and neurosurgical approach, and the senior otolaryngologist was the same. Fifty-two procedures were completed; 37 for malignant disease and 15 for benign disease. Twenty-one of the 52 procedures had postoperative complications, a 40% complication rate. One postoperative death occurred from a myocardial infarction, for a 2% mortality rate. Infections complications were the most common, occurring in 19% of cases. The one case of meningitis responded to antibiotic therapy, without neurologic sequelae. Seven cerebrospinal fluid leaks occurred (13%); five resolved with conservative management, and two required reoperation. There was no significant difference between complication rates for patients with previous craniotomy, radiation therapy, or chemotherany compared with those with no prior therapy (p > .05). More complications occurred in patients with malignant disease than in those with benign disease (46% vs 27%), but this was not statistically significant (p > .05). Anterior and anterolateral skull base resection as part of a multidisciplinary approach to diseases of this region may provide improved palliation and may offer possible improved survival with acceptable surgical mortality. Although only 6% of patients were left with permanent neurologic sequelse in this series, the risks of serious complications are considerable. ImagesFigure 1p116-bFigure 2Figure 3

Deschler, Daniel G.; Gutin, Philip H.; Mamelak, Adam N.; McDermott, Michael W.; Kaplan, Michael J.



Arguments for and against the Role of Glucose Variability in the Development of Diabetes Complications  

PubMed Central

There is now unequivocal evidence that improving glycemic control in both type 1 and type 2 diabetes reduces the likelihood of developing the micro- and macrovascular complications of the disease. However, it is still unclear whether a patient with very variable glucose is at any different a risk of these problems than someone who has the same mean glucose but much more stable glycemia. This article reviews the evidence that exists to both support and refute the claim that increased glucose variability should be regarded as an independent risk factor for the development of diabetic vascular disease.

S. Kilpatrick, Eric



Cardiac complications of oncologic therapy.  


As survival rates continue to increase for patients with childhood and adult malignancies, imaging utilization in these patients will likely increase substantially. It is important to detect disease recurrence and to recognize the potential complications that occur after treatment with oncologic medications and therapeutic radiation. The most common cardiotoxic side effect of the anthracycline drug class is a dose-dependent decline in ejection fraction, which may result in dilated cardiomyopathy. Multiple-uptake gated acquisition (MUGA) scanning plays an important role in diagnosis of this subclinical cardiac dysfunction. Other less common cardiotoxic side effects of chemotherapeutic medications include arrhythmia, myocarditis, coronary artery disease, tamponade, pericarditis, and pericardial effusion. Radiation therapy can also lead to cardiotoxicity when the heart or pericardium is included in the radiation portal. Radiation-induced conditions include pericardial disease, coronary artery disease, valvular disease, and cardiomyopathy. Many of these side effects are asymptomatic until late in the course of the disease. With imaging, these pathologic conditions can often be diagnosed before symptom onset, which may allow early intervention. Radiologists should be familiar with the current knowledge and pathophysiology regarding cardiac complications related to chemotherapy and radiation therapy of malignant neoplasms and the appearances of treatment-related cardiotoxicity that can be found at radiography, nuclear medicine examinations, and cross-sectional imaging. Supplemental material available at © RSNA, 2013. PMID:24108563

Walker, Christopher M; Saldaña, David A; Gladish, Gregory W; Dicks, Demetrius L; Kicska, Gregory; Mitsumori, Lee M; Reddy, Gautham P



The costs of diabetes and its complications  

Microsoft Academic Search

Diabetes mellitus is a disease with major long-term implications, not only for the health and well-being of affected individuals, but also for costs to the National Health Service. Treatment of the disease and its complications takes up 4-5% of total health care expenditure in the U.K. These costs are dominated by in-patient care for the complications arising from diabetes. This

Brenda Leese



A Case of Left Main Coronary Artery Disease in an Octogenarian Treated Surgically and Complicated by Myocardial Infarction: Decisions, Techniques, Rescue and Final Outcome  

PubMed Central

We report on an octogenarian patient presenting with an acute coronary syndrome due to significant left main coronary artery disease and severe ostial stenosis of the left anterior descending artery disease. Emergent bypass graft performed with “beating heart” consisted of left internal mammary graft to the mid left anterior descending artery with an “over-stent” anastomosis. The immediate post-operative phase was simple, however the patient presented on post-operative day 8 with extensive anterior myocardial infarction and cardiogenic shock. Emergent coronary angiogram showed subocclusive anastomotic stenosis. Percutaneous coronary intervention was performed on left main, proximal left anterior descending, and proximal circumflex arteries. Subsequently, the patient restored a satisfactory hemodynamic condition. A focus on the importance of decision for management of left main disease especially in octogenarian is presented, along with a review of the pertinent literature.

Kossaify, Antoine; Grollier, Gilles



Physiopathologie de la maladie de Still de l'adulte  

Microsoft Academic Search

Purpose. – Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder of unknown origin. It is characterized by hectic fever, evanescent rash, polyarthralgias or polyarthritis, sore throat, hepatosplenomegaly, lymphadenopathy, polynuclear leukocytosis, liver cytolysis, and high serum level of ferritin with low glycosylated fraction.Current kwowledge and key points. – An increased serum level of ferritin, IL-8, IL-6, IL-18 and TNF-?

J. B. Arlet; D. Boutin-Le Thi Huong; J. Pouchot; J. C. Piette



Photographic prints from digital still cameras  

NASA Astrophysics Data System (ADS)

The expansion of digital still cameras into the consumer market has provided opportunities for photographic amateurs to enjoy new digital imaging. Fuji Photo Film Co., Ltd. has started the Fiji Digital Imaging Service (F-DI) from 1997. The F-DI DSC print service is one of the features which provides photographic prints from the data obtained by digital still cameras. Below, the concept of the F-DI DSC print service is described and the algorithm adopted for printing is discussed. Since digital still cameras are developed such that the images will originally be displayed on CRT monitors, it is necessary to achieve new technical development for this particular service. New algorithms including the scene color balance algorithm and the density correction algorithm are described. The conditions necessary to obtain excellent prints are also explained.

Takemura, Kazuhiko



Simple control system for automated, multistage stills  

SciTech Connect

Described briefly is a sample, inexpensive system which uses light emitting diodes (LEDs) to sense the water level in the still and to control the rate of heat input to the still heating jackets. A sealed glass float, similar in shape to a hygrometer, contains in its neck blackened sections which interrupt the light emitted from the LED in the normal operating state. A change of the water level in the still will at a predetermined point allow the transmission of light from the LED to its detector and the consequent energization of a circuit switching 120 V power lines. The operation of a two-stage system is outlined. The principle may be extended to any number of stages. 3 references.

Uphaus, R.A.; Kostka, A.G.



Amyopathic Dermatomyositis Complicated by Pneumomediastinum  

PubMed Central

Dermatomyositis is an inflammatory disease of unclear etiology with characteristic cutaneous and musculoskeletal findings. Amyopathic dermatomyositis is a subtype without musculoskeletal involvement. Many cases of dermatomyositis are associated with underlying malignancy, but pulmonary manifestations can also be seen, the most common of which is interstitial lung disease. Pneumomediastinum is a rare complication that is important for clinicians to recognize, as it may be fatal if left untreated. The sudden onset of facial edema and shortness of breath in the setting of dermatomyositis should raise the suspicion of this condition.

Tang, Randy; Green, Justin J.



Complications of ascending phlebography of the leg.  

PubMed Central

Forty patients were studied prospectively for complications of ascending phlebography. The commonest immediate complication was pain at the site of injection and the commonest delayed complication pain in the foot or calf. Out of 30 patients with pain in the foot and calf, 15 had venous thrombosis. Review of 200 case notes disclosed only one recorded complication--namely, necrosis of the dorsal skin of the foot. Complications of the procedure reported by referring clinicians over 10 years comprised four cases of necrosis of the dorsum of the foot and two of gangrene of the foot, in one of which the gangrene spread to the leg. Major complications of ascending phlebography are rare, though when they occur may cause serious morbidity. If a scrupulous technique is used contrast phlebography remains the most accurate method of diagnosing venous disease of the leg.

Thomas, M L; MacDonald, L M



[Perianal disease in Crohn disease].  


The treatment of perianal disease by Morbus Crohn belongs to a general conceptional therapy of this disease and requires close cooperation between gastro-enterologist and surgeon. Primary role in the treatment belongs to the internist, surgeon intervenes only in case of complications or during failure of the conservative treatment. Simple, asymptomatic fistulas are treated conservatively. The fistulas with trouble requires local surgical treatment. In case complicated, multiplied of the fistulas is indicated curative resection of the bowel, if it is indicated from another reasons, in dependence on classical criterions. Temporary derivative colostomy is applied in case, where curative resection is not indicated or if the rectum is not affected or if curative resection and local surgical treatment were ineffective. Proctectomy is applied only during massive affection of rectum and destruction of spincters. Our work confirms that the mentioned surgical methods in treatment of perianal disorder accompanying Morbus Crohn are still valid and the improvement of results in treatment this disease could be expected rather on the field of farmacotherapy. PMID:7992020

Klofanda, J



Prediction of radiation-induced liver disease by Lyman normal-tissue complication probability model in three-dimensional conformal radiation therapy for primary liver carcinoma  

SciTech Connect

Purpose: To describe the probability of RILD by application of the Lyman-Kutcher-Burman normal-tissue complication (NTCP) model for primary liver carcinoma (PLC) treated with hypofractionated three-dimensional conformal radiotherapy (3D-CRT). Methods and Materials: A total of 109 PLC patients treated by 3D-CRT were followed for RILD. Of these patients, 93 were in liver cirrhosis of Child-Pugh Grade A, and 16 were in Child-Pugh Grade B. The Michigan NTCP model was used to predict the probability of RILD, and then the modified Lyman NTCP model was generated for Child-Pugh A and Child-Pugh B patients by maximum-likelihood analysis. Results: Of all patients, 17 developed RILD in which 8 were of Child-Pugh Grade A, and 9 were of Child-Pugh Grade B. The prediction of RILD by the Michigan model was underestimated for PLC patients. The modified n, m, TD{sub 5} (1) were 1.1, 0.28, and 40.5 Gy and 0.7, 0.43, and 23 Gy for patients with Child-Pugh A and B, respectively, which yielded better estimations of RILD probability. The hepatic tolerable doses (TD{sub 5}) would be MDTNL of 21 Gy and 6 Gy, respectively, for Child-Pugh A and B patients. Conclusions: The Michigan model was probably not fit to predict RILD in PLC patients. A modified Lyman NTCP model for RILD was recommended.

Xu ZhiYong [Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai (China); Department of Oncology, Shanghai Medical School, Fudan University, Shanghai (China); Liang Shixiong [Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai (China); Department of Radiation Oncology, Cancer Hospital, Guangxi Medical University, Nanning (China); Zhu Ji [Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai (China); Department of Oncology, Shanghai Medical School, Fudan University, Shanghai (China); Zhu Xiaodong [Department of Radiation Oncology, Cancer Hospital, Guangxi Medical University, Nanning (China); Zhao Jiandong [Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai (China); Department of Oncology, Shanghai Medical School, Fudan University, Shanghai (China); Lu Haijie [Department of Radiation Oncology, Cancer Hospital, Guangxi Medical University, Nanning (China); Yang Yunli [Department of Radiation Oncology, Cancer Hospital, Guangxi Medical University, Nanning (China); Chen Long [Department of Radiation Oncology, Cancer Hospital, Guangxi Medical University, Nanning (China); Wang Anyu [Department of Radiation Oncology, Cancer Hospital, Guangxi Medical University, Nanning (China); Fu Xiaolong [Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai (China); Department of Oncology, Shanghai Medical School, Fudan University, Shanghai (China); Jiang Guoliang [Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai (China) and Department of Oncology, Shanghai Medical School, Fudan University, Shanghai (China)]. E-mail:



Osteonecrosis of the jaw complicating bisphosphonate treatment for bone disease in multiple myeloma: an overview with recommendations for prevention and treatment.  


Osteonecrosis of the Jaw (ONJ) is a recently recognised and potentially highly morbid complication of bisphosphonate therapy in the setting of metastatic malignancy, including myeloma. Members of the Medical and Scientific Advisory Group of the Myeloma Foundation of Australia formulated guidelines for the management of bisphosphonates around the issue of ONJ, based on the best available evidence in June 2008. Prior to commencement of therapy, patients should have an oral health assessment and be educated about the risks of ONJ. Dental assessment should occur 6 monthly during therapy. If tooth extraction is required, sufficient time should be allowed for complete healing to occur prior to commencement of bisphosphonate. As the risk of ONJ increases with duration of bisphosphonate therapy, we recommend annual assessment of dose with modification to 3 monthly i.v. therapy or to oral therapy with clodronate for those with all but the highest risk of skeletal-related event. Established ONJ should be managed conservatively; a bisphosphonate "drug holiday" is usually indicated and invasive surgery should generally be avoided. These recommendations will assist with clinical decision making for myeloma patients who are at risk of bisphosphonate-associated ONJ. PMID:19220531

Dickinson, M; Prince, H M; Kirsa, S; Zannettino, A; Gibbs, S D J; Mileshkin, L; O'Grady, J; Seymour, J F; Szer, J; Horvath, N; Joshua, D E



A case of Dunnigan-type familial partial lipodystrophy (FPLD) due to lamin A/C (LMNA) mutations complicated by end-stage renal disease.  


Dunnigan-type familial partial lipodystrophy (FPLD) is a rare monogenic adipose tissue disorder in which the affected subjects have increased predisposition to insulin resistance and related metabolic complications, such as glucose intolerance, diabetes, dyslipidemia, and hepatic steatosis. Our patient was a 35-year-old female who had been receiving insulin injection therapy for diabetes mellitus and was transferred to our hospital. She was diagnosed with FPLD on the basis of the following symptoms: increase in subcutaneous fat in the face, neck, and upper trunk; loss of subcutaneous fat in the lower limbs and the gluteal region. We found a heterozygous CGG to CAG transition in codon 482 of exon 8 in the gene encoding lamin A/C (LMNA), which leads to an arginine to glutamine substitution (R482Q). At the time of admission, her serum creatinine level was 8.4 mg/dl, and her blood urea nitrogen (BUN) level was 81 mg/dl. Her serum creatinine level was elevated and hemodialysis was performed twice every week. However, she died of cerebral hemorrhage 9 months after hemodialysis. Although it is uncommon for patients with FPLD to exhibit renal dysfunction and require hemodialysis, this case suggests the need for careful analysis of renal function in a patient with FPLD. PMID:19011997

Imachi, Hitomi; Murao, Koji; Ohtsuka, Shouji; Fujiwara, Mako; Muraoka, Tomie; Hosokawa, Hitoshi; Ishida, Toshihiko



Neurologic complications after liver transplantation.  


Neurologic complications are relatively common after solid organ transplantation and affect 15%-30% of liver transplant recipients. Etiology is often related to immunosuppressant neurotoxicity and opportunistic infections. Most common complications include seizures and encephalopathy, and occurrence of central pontine myelinolysis is relatively specific for liver transplant recipients. Delayed allograft function may precipitate hepatic encephalopathy and neurotoxicity of calcineurin inhibitors typically manifests with tremor, headaches and encephalopathy. Reduction of neurotoxic immunosuppressants or conversion to an alternative medication usually result in clinical improvement. Standard preventive and diagnostic protocols have helped to reduce the prevalence of opportunistic central nervous system (CNS) infections, but viral and fungal CNS infections still affect 1% of liver transplant recipients, and the morbidity and mortality in the affected patients remain fairly high. Critical illness myopathy may also affect up to 7% of liver transplant recipients. Liver insufficiency is also associated with various neurologic disorders which may improve or resolve after successful liver transplantation. Accurate diagnosis and timely intervention are essential to improve outcomes, while advances in clinical management and extended post-transplant survival are increasingly shifting the focus to chronic post-transplant complications which are often encountered in a community hospital and an outpatient setting. PMID:24023979

Zivkovi?, Saša A



Enhanced endothelial delivery and biochemical effects of ?-galactosidase by ICAM-1-targeted nanocarriers for Fabry disease  

Microsoft Academic Search

Fabry disease, due to the deficiency of ?-galactosidase A (?-Gal), causes lysosomal accumulation of globotriaosylceramide (Gb3) in multiple tissues and prominently in the vascular endothelium. Although enzyme replacement therapy (ERT) by injection of recombinant ?-Gal improves the disease outcome, the effects on the vasculopathy associated with life-threatening cerebrovascular, cardiac and renal complications are still limited. We designed a strategy to

Janet Hsu; Daniel Serrano; Tridib Bhowmick; Kishan Kumar; Yang Shen; Yuan Chia Kuo; Carmen Garnacho; Silvia Muro



High rate solar still and process  

Microsoft Academic Search

A solar still apparatus is described which consists of: (a) an elongated salt gradient solar pond defining a heat storage section containing a hot liquid; (b) an evaporator module supported within the solar pond for rotation about a substantially horizontal axis and submerged within the heat storage section thereof; (c) influent conduit means for directing feedwater into the distribution shaft




Proanthocyanidin biosynthesis – still more questions than answers?  

Microsoft Academic Search

Proanthocyanidins, also known as condensed tannins, are oligomers or polymers of flavan-3-ol units. In spite of important breakthroughs in our understanding of the biosynthesis of the major building blocks of proanthocyanidins, (+)-catechin and (?)-epicatechin, important questions still remain to be answered as to the exact nature of the molecular species that undergo polymerization, and the mechanisms of assembly. We review

De-Yu Xie; Richard A. Dixon



Canadian Adult Education: Still a Movement  

ERIC Educational Resources Information Center

Writing recently in this journal, two of Canada's veteran adult educators contemplated the "death" of the Canadian adult education movement. I disagree and argue that adult education in Canada is as vital an activity as ever and one that still fully justifies being called a movement. Specifically, Selman and Selman (2009) list five trends that…

Nesbit, Tom



Drawing Ready-Made Still Lifes  

ERIC Educational Resources Information Center

Observational drawing is one of the most important skills art students need; however, it can be difficult to put a new spin on an otherwise old concept. In this article, the author relates how she had used a new approach--ready-made still lifes--to observational drawing in her art class. This approach requires the artist to discover ready-made…

Brisco, Nicole D.



Solar Still Part I: Salt Water  

NSDL National Science Digital Library

The water cycle is the process that moves water around Earth. In this video segment, adapted from a ZOOM television broadcast, cast members use a homemade solar still to mimic the natural processes of evaporation and condensation, separating pure water from a saltwater mixture. The segment is three minutes thirty-two seconds in length.


States Still Grappling with Multicultural Curricula  

ERIC Educational Resources Information Center

A debate over a New York state commission formed to study how slavery was portrayed in schools showed that after more than a decade of adding multicultural curricula, educators there were still at odds over how the distinctive experiences of racial and ethnic groups should be taught, and who should decide. While some educators and observers in the…

Zehr, Mary Ann



Mammary augmentation--surgical techniques, evaluation of results, and complications.  


Mammary augmentation is the procedure of choice in all forms of breast underdevelopment, atrophy or absence due to disease (subcutaneous or radical mastectomy), or trauma (burns of the thoracic region). Old reconstructive methods employing autogenous tissues have no substitute in special cases, but they are used less and less in favor of the new alloplastic materials (silicones) introduced as implants under the mammary gland. These implants have been shown to be permanently accepted by body tissues, the aesthetic results are good, and the operation is easier, faster, and less dangerous. Complications, however, do exist and the most frequent is the constriction of the fibrous envelope surrounding the implant. The etiology of this complication is still unknown. The patient should be advised of such a possibility. Circular incision of the fibrous envelope seems to be the best treatment for this complication. Silicone implants do not modify the physiology of the mammary gland and there is no reason to believe they have any influence on the incidence of breast cancer. PMID:770052

Planas, J



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



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



Thoracic complications of esophageal disorders.  


Abnormalities of the esophagus are common, and complications associated with these disorders and diseases can involve the mediastinum, tracheobronchial tree, and lungs. The most common complications include mediastinitis secondary to esophageal perforation or postoperative anastomotic leak, or both; empyema due to fistula formation; and aspiration pneumonia. The authors reviewed the radiologic appearances of those and other common thoracic complications associated with esophageal disorders to facilitate early detection, diagnosis, and management. Computed tomographic (CT) findings of acute mediastinitis secondary to esophageal perforation may include esophageal thickening, extraluminal gas, pleural effusion, single or multiple abscesses, and extraluminal contrast medium. The radiologic manifestations of pneumonia secondary to tracheoesophageal fistula are variable, depending on the spread and severity of the aspiration. The most common radiographic pattern is that of bronchopneumonia with scattered air-space opacities. CT has been regarded as the imaging modality of choice for the evaluation of suspected esophagopleural fistula, because the site of communication between the pleural space and the esophagus can often be seen. An awareness of the radiologic manifestations of these complications is thus required to facilitate early diagnosis. PMID:12376614

Giménez, Ana; Franquet, Tomás; Erasmus, Jeremy J; Martínez, Santiago; Estrada, Pilar



[Complications in children with measles].  


Ongoing immunization campaigns have significantly reduced the incidence of measles. To evaluate the efficacy of vaccination policies, however, it is necessary to analyze disease indicators of mortality and of morbidity such as medical complications and sequelae. We reviewed the hospital experience at Hospital Infantil de Mexico regarding children with measles who necessitated hospitalization between January 1976 and December 1989. During this 14 year period, 176 patients with measles were hospitalized; the majority of the cases corresponded to the period between 1985 and 1989. Fifty five percent of the cases corresponded to children under one year of age. Of those older than 12 months, 81% lacked an immunization history. Eighty percent were from Mexico city or from the neighboring state of Mexico. The mayor complications included: respiratory tract infections such as pneumonia (50.8%), diarrhea (18.2%), and less frequent: laringotracheitis, otitis media, myocarditis and pyodermitis. More than 70% were significantly (grade II or III) malnourished. Twenty three patients died, for a mortality of 13%. The factors more likely related to measles mortality were; age less than two years, undernutrition, and more than two medical complications associated. This report emphasizes that medical complications and mortality are more likely to occur in very young unimmunized, malnourished children. PMID:2206420

Avila-Figueroa, C; Navarrete-Navarro, S; Martínez-Aguilar, M; Ruiz-Gutiérrez, E; Santos, J I



Lumbar sympathectomy in obliterative arteriosclerosis. Should it still be performed?  


During the years 1967-1976, bilateral lumbar sympathectomy was performed in 241 patients with arteriosclerotic occlusions. A questionnaire was completed by 137 patients. Of the total, 68% seem to have improved in some way postoperatively. The material was analyzed with regard to age, sex, diabetes and regarding the effects on pregangrene, established gangrene, amputation, claudication and skin temperature. The operative mortality was 2.1% and postoperative complications were few. Bilateral operation in one stage does not give a higher postoperative mortality than unilateral procedures. Postoperative side-effects, such as neuritic pains, sexual and urological dysfunctions, are considered. Bilateral lumbar sympathectomy still seems to be an alternative procedure, which may be offered some patients with marginal peripheral circulation, when reconstructive arterial surgery is not feasible. PMID:575577

Erichsen, H G



Precise endoscopic and pathologic features in a Crohn's disease case with two fistula-associated small bowel adenocarcinomas complicated by an anal canal adenocarcinoma.  


The patient was a 40-year-old man who had suffered from Crohn's disease (CD) for 19 years and developed an intractable perianal fistula and two strictures in the small bowel. Dilatation of the two strictures using double-balloon endoscopy did not improve the subileus symptoms. An anal canal adenocarcinoma was also detected using double-balloon endoscopy. The ileum and rectoperianal area were partially resected, and a precise immunohistochemical pathologic assessment revealed that all three lesions were fistula-associated adenocarcinomas. Accumulating endoscopic findings of CD-associated cancer and precise pathologic diagnostic findings will help to establish a suitable surveillance method. PMID:23411699

Sogawa, Mitsue; Watanabe, Kenji; Egashira, Yutaro; Maeda, Kiyoshi; Morimoto, Kenichi; Noguchi, Atsushi; Kamata, Noriko; Yamagami, Hirokazu; Watanabe, Toshio; Tominaga, Kazunari; Fujiwara, Yasuhiro; Oshitani, Nobuhide; Arakawa, Tetsuo



Livewire based single still image segmentation  

NASA Astrophysics Data System (ADS)

In the application of the video contactless measurement, the quality of the image taken from underwater is not very well. It is well known that automatic image segmental method cannot provide acceptable segmentation result with low quality single still image. Snake algorithm can provide better result in this case with the aiding of human. However, sometimes the segmental result of Snake may far from the initial segmental contour drawn by user. Livewire algorithm can keep the location of the seed points that user selected nailed from the beginning to the end. But the contour may have burrs when the image's noise is quite high and the contrast is low. In this paper, we modified the cost function of Livewire algorithm and proposed a new segmentation method that can be used for single still image segmentation with high noise and low contrast.

Zhang, Jun; Yang, Rong; Liu, Xiaomao; Yue, Hao; Zhu, Hao; Tian, Dandan; Chen, Shu; Li, Yiquan; Tian, Jinwen



Challenges Still to Be Appropriately Addressed  

NASA Astrophysics Data System (ADS)

This section includes a heteroclite set of questions and comments of colleagues, which have still to be fully answered. Progress in science occurs not only with a few spectacular achievements that are generally cleverly advertised by funding agencies and the prestigious journals, but also by incessant questioning. They remain in the shadow for a while because you have to wait for an answer that might never come.

Maurette, Michel


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



[Cardiac complications of dermatopolymyositis. Apropos of 56 cases].  


A retrospective study was conducted on 58 patients hospitalized for dermato- or polymyositis between 1967 and 1986, with the view of determining the cardiovascular complications specific to these diseases. The patients' mean age was 51 years, less than 6 months had elapsed between first symptoms and diagnosis, and 31 p. 100 of the patients had died. The electrocardiogram was considered normal in 46 patients, none of whom presented with the slighted clinical evidence of cardiovascular involvement. ECG abnormalities were present in 10 cases, including 5 with disorders of conduction. Five cases of cardiovascular pathology with clinical manifestations were discovered. A 36-year old woman had severe myocardial pathology with marked rhabdomyolysis (CPK greater than 100,000) and complete atrio-ventricular block requiring emergency pacemaker implantation. Three years after the onset of the disease, and whilst the clinical signs of polymyositis had regressed, this patient still had complete AVB and moderately dilated congestive cardiomyopathy. This study shows that cardiac complications of dermato-polymyositis are rare and predominantly consist of disorders of conduction which may become permanent and associated with alterations of left ventricular kinetics. The authors suggest that a high-risk category for patients with disorders of conduction and cardiomyopathy can be identified by echocardiography, but this examination needs mainly be performed in cases when ECG abnormalities are present, since no clinical cardiac pathology was observed in patients of this series with normal electrocardiogram. PMID:3118837

Brottier, L; Coste, P; Combe, C; Bruchère, C; Bonnet, J; Bricaud, H



[Complications of surgical treatment of hypospadia].  


127 new cases of hypospadia were treated in 1980-2002. A total of 348 operations including urethroplasty by Duplay and Cecil were made. 78 of the operations were followed by complications out of which 26 were corrected in the postoperative period and had no effect on the treatment results. The first stage of surgical correction of hypospadia (89 operations) brought complications in 13.48% cases. Recurrent distortion of the cavernous bodies was most typical complication at this stage. In most cases development of scarry deformation was due to inflammatory changes early after surgery. Derivatives of prednisolone proved effective in the treatment of hypertrophic scars. This complication correlated with skin plastic repair (longitudinal suturing or creation of oncoming triangular flaps) to correct the defect. The second stage of hypospadia surgery was urethroplasty made in 196 cases. It was accompanied with complications in 13.25 patients. Fistulas of newly-created urethra (11.73%) were the most typical and frequent complication. The number of postoperative complications varied greatly depending on the disease form and method of urethral reconstruction. Cecil urethroplasty brought complications in 7.94% cases. Efficacy of neurourethra creation by Duplay varied greatly depending on the length of the created neourethral portion and the number of local skin resources (8-33-83.33% complications). PMID:15199814

Romanov, D V; Korol'kova, I A


SARS: Down But Still a Threat.  

National Technical Information Service (NTIS)

This Intelligence Community Assessment (ICA) highlights the evolution of Severe Acute Respiratory Syndrome (SARS) and the potential implications of the disease for the United States under future scenarios. Even though SARS has infected and killed far fewe...

K. Monaghan



Complications of Corneal Collagen Cross-Linking  

PubMed Central

Cross-linking of corneal collagen (CXL) is a promising approach for the treatment of keratoconus and secondary ectasia. Several long-term and short-term complications of CXL have been studied and documented. The possibility of a secondary infection after the procedure exists because the patient is subjected to epithelial debridement and the application of a soft contact lens. Formation of temporary corneal haze, permanent scars, endothelial damage, treatment failure, sterile infiltrates, and herpes reactivation are the other reported complications of this procedure. Cross-linking is a low-invasive procedure with low complication and failure rate but it may have direct or primary complications due to incorrect technique application or incorrect patient's inclusion and indirect or secondary complications related to therapeutic soft contact lens, patient's poor hygiene, and undiagnosed concomitant ocular surface diseases.

Dhawan, Shikha; Rao, Kavita; Natrajan, Sundaram



Veritas Asteroid Family Still Holds Secrets?  

NASA Astrophysics Data System (ADS)

Veritas asteroid family has been studied for about two decades. These studies have revealed many secrets, and a respectable knowledge about this family had been collected. Here I will present many of these results and review the current knowledge about the family. However, despite being extensively studied, Veritas family is still a mystery. This will be illustrated through the presentation of the most interesting open problems. Was there a secondary collision within this family? Does asteroid (490) Veritas belong to the family named after it? How large was the parent body of the family? Finally, some possible directions for future studies that aims to address these questions are discussed as well.

Novakovic, B.



Lorentzian wormholes generalize thermodynamics still further  

NASA Astrophysics Data System (ADS)

This paper deals with some thermodynamical aspects of Lorentzian wormholes, including the formulation of the three main laws and the consideration of a possible thermal emission made up of some sort of phantom radiation coming out from the wormhole at a negative temperature. In order for these topics to be consistently developed we have used a 2+2 formalism first advanced by Hayward for spherically symmetric spacetimes, where a generalized surface gravity is defined on the trapping horizon. Our results generalize still further those of the already generalized gravitational thermodynamics.

Martín-Moruno, Prado; González-Díaz, Pedro F.



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



Noninfectious pulmonary complications after bone marrow transplantation  

Microsoft Academic Search

Bone marrow transplantation (BMT) is a successful and recognised treatment option for patients with a number of haematological and non-haematological malignant and non-malignant conditions. Pulmonary complications both infectious and non-infectious are common after BMT. Multiple factors are thought to contribute to pulmonary complications, including the type and duration of immunological defects produced by the underlying disease and treatment, the development

I Khurshid; L C Anderson



[Hematologic malignant complications after transplantation].  


Post-transplant hemopathies are a serious complication of organ transplantation. They include several entities: non-hodgkin lymphoma, Hodgkin disease and myeloma. The pathophysiology, clinical and histological features, treatment and evolution of these diseases are different, but share some similarities. Among factors involved in lymphomagenesis, the role of Epstein Barr virus and immunosuppression are central. EBV primo-infection or reactivation together with a deep depression of T-cell immunity is at particular risk of lymphoma development. The clinical expression and outcome of lymphomas are varied. Assays for EBV replication quantification have been developed leading to immunosuppression decreasing and antiviral therapy when the replication increases. Treatment of post-transplant lymphoproliferations consists mainly in immunotherapy and chemotherapy. Hodgkin disease and myeloma are rare after transplantation; their management is close to the one of immunocompetent patients. The recurrence of myeloma, amyloidosis or light chain deposition disease seems frequent after transplantation and only patients with disappearance of monoclonal component should be proposed for transplantation. On the opposite, the risk of recurrence appears lower for Hodgkin disease; therefore the transplantation of patients with a history of Hodgkin disease looks possible. PMID:21531185

Caillard, Sophie; Imhoff, Olivier; Moulin, Bruno



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



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 ...


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


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



An experimental study of a new solar still - The wiping spherical still  

NASA Astrophysics Data System (ADS)

Theoretical and experimental results of the functioning of a spherical solar water distiller which includes a curved, turning glass wiper are presented. A review of past and present solar still apparatus is presented, along with an analytical examination of insolation characteristics. Numerical models are constructed of the performance of solar stills, noting the enhanced gain with less materials available by using spherically shaped plexiglass for the transparent upper surface. Attachment of a curved glass wiper, which extends from the top center of the dome to the collector tray and is made to revolve around the dome's inner surface by either an electric motor, or a wind-powered shaft, or by means of a motor driven by solar cells, is shown to keep the transparency higher and thus augment the efficiency of the still to 14 percent better performance than with a flat plate solar still.

Makki, A.


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



Intentions make a difference: Infant responses to still-face and modified still-face conditions  

Microsoft Academic Search

In two studies, 3-, 6- and 9-month-old infants interacted with their mothers during natural, still-face, and modified still-face (i.e., mothers wearing a mask, or drinking from bottle) conditions. Infants were also presented with matching doll conditions to control for the possibility that their responses might be due to changes in superficial perceptual features. Regardless of age, infants displayed negative affect

Maria Legerstee; Gabriela Markova



Food-borne botulism: still actual topic.  


Even though since the mid-1990s the number of food-borne botulism cases has systematically decreased and it now occurs in Poland relatively rarely, it is still a real epidemiological problem. There are about 30 cases of botulism in Poland a year, which ranks Poland the first among the European Union. In most cases the symptomatology of botulism is typical, however it does not always fully coincide with the one described in medical manuals which emphasise the dramatic clinical course of botulism with its frequent fatal consequences. Diagnosis of botulism may be difficult because of its rare prevalence and a variable clinical course, especially in old patients. Authors of this paper describe two cases of botulism and diagnostic problems associated with it. PMID:23391950

Brola, Waldemar; Fudala, Malgorzata; Gacek, Szymon; Gruenpeter, Pawel



The peroxisome: still a mysterious organelle  

PubMed Central

More than half a century of research on peroxisomes has revealed unique features of this ubiquitous subcellular organelle, which have often been in disagreement with existing dogmas in cell biology. About 50 peroxisomal enzymes have so far been identified, which contribute to several crucial metabolic processes such as ?-oxidation of fatty acids, biosynthesis of ether phospholipids and metabolism of reactive oxygen species, and render peroxisomes indispensable for human health and development. It became obvious that peroxisomes are highly dynamic organelles that rapidly assemble, multiply and degrade in response to metabolic needs. However, many aspects of peroxisome biology are still mysterious. This review addresses recent exciting discoveries on the biogenesis, formation and degradation of peroxisomes, on peroxisomal dynamics and division, as well as on the interaction and cross talk of peroxisomes with other subcellular compartments. Furthermore, recent advances on the role of peroxisomes in medicine and in the identification of novel peroxisomal proteins are discussed.

Fahimi, H. Dariush



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



Vinyl chloride: still a cause for concern.  

PubMed Central

Vinyl chloride (VC) is both a known carcinogen and a regulated chemical, and its production capacity has almost doubled over the last 20 years, currently 27 million tons/year worldwide. According to recent reports it is still a cause for concern. VC has been found as a degradation product of chloroethylene solvents (perchloroethylene and trichloroethylene) and in landfill gas and groundwater at concentrations up to 200 mg/m(3) and 10 mg/L, respectively. Worldwide occupational exposure to VC still seems to be high in some countries (e.g., averages of approximately 1,300 mg/m(3) until 1987 in one factory), and exposure may also be high in others where VC is not regulated. By combining the most relevant epidemiologic studies from several countries, we observed a 5-fold excess of liver cancer, primarily because of a 45-fold excess risk from angiosarcoma of the liver (ASL). The number of ASL cases reported up to the end of 1998 was 197 worldwide. The average latency for ASL is 22 years. Some studies show a small excess risk for hepatocellular carcinoma, and others suggest a possible risk of brain tumors among highly exposed workers. Lung cancer, lymphomas, or leukemia do not seem to be related to VC exposure according to recent results. The mutation spectra observed in rat and human liver tumors (ASL and/or hepatocellular carcinoma) that are associated with exposure to VC are clearly distinct from those observed in sporadic liver tumors or hepatic tumors that are associated with other exposures. In rats, the substitution mutations found at A:T base pairs in the ras and p53 genes are consistent with the promutagenic properties of the DNA adduct 1,N(6)-ethenoadenine formed from VC metabolites. Risk assessments derived from animal studies seem to overestimate the actual risk of cancer when comparing estimated and reported cases of ASL. Images Figure 1 Figure 2

Kielhorn, J; Melber, C; Wahnschaffe, U; Aitio, A; Mangelsdorf, I



Rotator cuff injury: still a clinical controversy?  

Microsoft Academic Search

The rotator cuff mechanism is the primary stabiliser of the gleno-humeral joint and is vulnerable to considerable morbidity because of its anatomy and function. Both intrinsic and extrinsic factors are responsible for rotator cuff pathology, which is a disease spectrum ranging from inflammation to full thickness tears. The most notable extrinsic factors are impingement and demographic variables, whereas age-related degeneration

P. Hardy; S. Sanghavi



Chagas Disease  


... the disease has affected your intestines and heart. Medicines can kill the parasite, especially early on. You can also treat related problems. For example, a pacemaker helps with certain heart complications. Centers for Disease Control and Prevention


Complications following pancreatic transplantations: imaging features  

Microsoft Academic Search

Whole organ vascularized pancreatic transplant is a recognized treatment for diabetes and is increasingly being performed\\u000a worldwide. The procedure itself is complex and is associated with significant mortality and morbidity. Despite improvements\\u000a in surgical techniques, postoperative complications of pancreatic transplantation are still common and include graft rejection,\\u000a pancreatitis, peripancreatic fluid collections, exocrine leaks, vascular thrombosis, and hemorrhage. In this pictorial

S. Y. Liong; R. E. Dixon; N. Chalmers; A. Tavakoli; T. Augustine; S. O’Shea



Fourth International Symposium on the Role of Soy in Preventing and Treating Chronic Disease Gaining Insight into the Health Effects of Soy but a Long Way Still to Go: Commentary on the Fourth International Symposium on the Role of Soy in Preventing and Treating Chronic Disease1  

Microsoft Academic Search

Research into the health effects of soyfoods and soybean constituents has increased at a phenom- enal pace over the past decade. This research includes a wide range of areas, such as cancer, coronary heart disease, osteoporosis, cognitive function, menopausal symptoms and renal function. Importantly, there are an increasing number of clinical studies being conducted in this field, which was quite

Mark Messina; Christoper Gardner; Stephen Barnes


Nepal's rapid population growth still a concern.  


The Nepal representative of the Economic and Social Commission for Asia and the Pacific (ESCAP) noted at the 194 ESCAP Commission meeting in Beijing that rapid population growth was still a problem: 2.1% per year. The annual average income growth rate was only 3.5% and poverty was widespread. The combination of poverty and rapid population growth were contributing to environmental damage. Sustainable solutions were needed for dealing with all three aforementioned issues. A high priority was already attached to population control programs, because population growth was linked to raising the standard of living and solving environmental problems. Women need to be placed in prominent positions in development efforts and given equality with men. Nepal representatives did attend the preparatory meeting on April 22, 1994, to the International Conference on Population and Development (ICPD) to be held in Cairo in September. The Preparatory Committee will be developing a report for the Conference. Solutions to population issues were seen as instrumental to achieving poverty alleviation and high economic growth. PMID:12288618



Quality criterion for digital still camera  

NASA Astrophysics Data System (ADS)

The main quality requirements for a digital still camera are color capturing accuracy, low noise level, and quantum efficiency. Different consumers assign different priorities to the listed parameters, and camera designers need clearly formulated methods for their evaluation. While there are procedures providing noise level and quantum efficiency estimation, there are no effective means for color capturing accuracy estimation. Introduced in this paper criterion allows to fill this gap. Luther-Ives condition for correct color reproduction system became known in the beginning of the last century. However, since no detector system satisfies Luther-Ives condition, there are always stimuli that are distinctly different for an observer, but which detectors are unable to distinguish. To estimate conformity of a detector set with Luther-Ives condition and calculate a measure of discrepancy, an angle between detector sensor sensitivity and Cohen's Fundamental Color Space may be used. In this paper, the divergence angle is calculated for some typical CCD sensors and a demonstration provided on how this angle might be reduced with a corrective filter. In addition, it is shown that with a specific corrective filter Foveon sensors turn into a detector system with a good Luther-Ives condition compliance.

Bezryadin, Sergey



Low light performance of digital still cameras  

NASA Astrophysics Data System (ADS)

The major difference between a dSLR camera, a consumer camera, and a camera in a mobile device is the sensor size. The sensor size is also related to the over all system size including the lens. With the sensors getting smaller the individual light sensitive areas are also getting smaller leaving less light falling onto each of the pixels. This effect requires higher signal amplification that leads to higher noise levels or other problems that may occur due to denoising algorithms. These Problems become more visible at low light conditions because of the lower signal levels. The fact that the sensitivity of cameras decreases makes customers ask for a standardized way to measure low light performance of cameras. The CEA (Consumer Electronics Association) together with ANSI has addressed this for camcorders in the CEA-639 [1] standard. The ISO technical committee 42 (photography) is currently also thinking about a potential standard on this topic for still picture cameras. This paper is part of the preparation work for this standardization activity and addresses the differences compared to camcorders and also potential additional problems with noise reduction that have occurred over the past few years. The result of this paper is a proposed test procedure with a few open questions that have to be answered in future work.

Wueller, Dietmar



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 ...


Study design and rationale of 'Influence of Cilostazol-based triple anti-platelet therapy on ischemic complication after drug-eluting stent implantation (CILON-T)' study: A multicenter randomized trial evaluating the efficacy of Cilostazol on ischemic vascular complications after drug-eluting stent implantation for coronary heart disease  

PubMed Central

Background Current guidelines recommend dual anti-platelet therapy, aspirin and clopidogrel, for patients treated with drug-eluting stent for coronary heart disease. In a few small trials, addition of cilostazol on dual anti-platelet therapy (triple anti-platelet therapy) showed better late luminal loss. In the real-world unselected patients with coronary heart disease, however, the effect of cilostazol on platelet reactivity and ischemic vascular events after drug-eluting stent implantation has not been tested. It is also controversial whether there is a significant interaction between lipophilic statin and clopidogrel. Methods/Design CILON-T trial was a prospective, randomized, open-label, multi-center, near-all-comer trial to demonstrate the superiority of triple anti-platelet therapy to dual anti-platelet therapy in reducing 6 months' major adverse cardiovascular/cerebrovascular events, composite of cardiac death, nonfatal myocardial infarction, target lesion revascularization and ischemic stroke. It also tested whether triple anti-platelet therapy is superior to dual anti-platelet therapy in inhibiting platelet reactivity in patients receiving percutaneous coronary intervention with drug-eluting stent. Total 960 patients were randomized to receive either dual anti-platelet therapy or triple anti-platelet therapy for 6 months and also, randomly stratified to either lipophilic statin (atorvastatin) or non-lipophilic statin (rosuvastatin) indefinitely. Secondary endpoints included all components of major adverse cardiovascular/cerebrovascular events, platelet reactivity as assessed by VerifyNow P2Y12 assay, effect of statin on major adverse cardiovascular/cerebrovascular events, bleeding complications, and albumin-to-creatinine ratio to test the nephroprotective effect of cilostazol. Major adverse cardiovascular/cerebrovascular events will also be checked at 1, 2, and 3 years to test the 'legacy' effect of triple anti-platelet therapy that was prescribed for only 6 months after percutaneous coronary intervention. Discussion CILON-T trial will give powerful insight into whether triple anti-platelet therapy is superior to dual anti-platelet therapy in reducing ischemic events and platelet reactivity in the real-world unselected patients treated with drug-eluting stent for coronary heart disease. Also, it will verify the laboratory and clinical significance of drug interaction between lipophilic statin and clopidogrel. Trial Registration National Institutes of Health Clinical Trials Registry ( identifier# NCT00776828).



MicroRNAs and diabetic complications.  


Both Type 1 and Type 2 diabetes can lead to debilitating microvascular complications such as retinopathy, nephropathy and neuropathy, as well as macrovascular complications such as cardiovascular diseases including atherosclerosis and hypertension. Diabetic complications have been attributed to several contributing factors such as hyperglycemia, hyperlipidemia, advanced glycation end products, growth factors, and inflammatory cytokines/chemokines. However, current therapies are not fully efficacious and hence there is an imperative need for a better understanding of the molecular mechanisms underlying diabetic complications in order to identify newer therapeutic targets. microRNAs (miRNAs) are short non-coding RNAs that repress target gene expression via post-transcriptional mechanisms. Emerging evidence shows that they have diverse cellular and biological functions and play key roles in several diseases. In this review, we explore the role of miRNAs in the pathology of diabetic complications and also discuss the potential use of miRNAs as novel diagnostic and therapeutic targets for diabetic complications. PMID:22552970

Natarajan, Rama; Putta, Sumanth; Kato, Mitsuo



MicroRNAs and Diabetic Complications  

PubMed Central

Both Type 1 and Type 2 diabetes can lead to debilitating microvascular complications such as retinopathy, nephropathy and neuropathy, as well as macrovascular complications such as cardiovascular diseases including atherosclerosis and hypertension. Diabetic complications have been attributed to several contributing factors such as hyperglycemia, hyperlipidemia, advanced glycation end products, growth factors and inflammatory cytokines/chemokines. However, current therapies are not fully efficacious and hence there is an imperative need for a better understanding of the molecular mechanisms underlying diabetic complications in order to identify newer therapeutic targets. microRNAs (miRNAs) are short non-coding RNAs that repress target gene expression via post-transcriptional mechanisms. Emerging evidence shows that they have diverse cellular and biological functions and play key roles in several diseases. In this review, we explore the role of miRNAs in the pathology of diabetic complications and also discuss the potential use of miRNAs as novel diagnostic and therapeutic targets for diabetic complications.

Natarajan, Rama; Putta, Sumanth; Kato, Mitsuo



More answers to the still unresolved question of nitrate tolerance.  


Organic nitrates are traditionally felt to be a safe adjuvant in the chronic therapy of patients with coronary artery disease. Despite their long use, progress in the understanding of the pharmacology and mechanism of action of these drugs has been achieved only in the last two decades, with the identification of the role of oxidative stress in the pathophysiology of nitrate tolerance, with, the discovery of the ancillary effects of nitrates, and with the demonstration that nitrate therapy has important chronic side effects that might modify patients' prognosis. These advances are however mostly confined to the molecular level or to studies in healthy volunteers, and the true impact of organic nitrates on clinical outcome remains unknown. Complicating this issue, evidence supports the existence of important differences among the different drugs belonging to the group, and there are reasons to believe that the nitrates should not be treated as a homogeneous class. As well, the understanding of the effects of alternative nitric oxide (NO) donors is currently being developed, and future studies will need to test whether the properties of these new medications may compensate and prevent the abnormalities imposed by chronic nitrate therapy. Intermittent therapy with nitroglycerin and isosorbide mononitrate is now established in clinical practice, but they should neither be considered a definitive solution to the problem of nitrate tolerance. Both these strategies are not deprived of complications, and should currently be seen as a compromise rather than a way fully to exploit the benefits of NO donor therapy. PMID:23864131

Münzel, Thomas; Daiber, Andreas; Gori, Tommaso



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



27 CFR 26.222 - Still wines containing carbon dioxide.  

Code of Federal Regulations, 2013 CFR

...false Still wines containing carbon dioxide. 26.222 Section 26.222...222 Still wines containing carbon dioxide. (a) General. Still wines...contain not more than 0.392 gram of carbon dioxide per 100 milliliters of...



27 CFR 26.52 - Still wines containing carbon dioxide.  

Code of Federal Regulations, 2013 CFR

...false Still wines containing carbon dioxide. 26.52 Section 26.52...52 Still wines containing carbon dioxide. (a) General. Still wines...contain not more than 0.392 gram of carbon dioxide per 100 milliliters of...



Penile calciphylaxis in end stage renal disease.  


Calciphylaxis, better described as "Calcific uremic arteriolopathy" (CUA), involves about 1-4% of hemodialysis patients all around the world with high mortality rates. We describe a rare clinical case of CUA in peritoneal dialysis patient associated with urological disease. Penile calciphylaxis represents rare clinical complication, and an early diagnosis and multidisciplinary approach are requested. Pathogenesis is still unclear, and therapeutic approaches need more long-term clinical trials to test their efficacy and safety. PMID:23841013

Barbera, Vincenzo; Di Lullo, Luca; Gorini, Antonio; Otranto, Giovanni; Floccari, Fulvio; Malaguti, Moreno; Santoboni, Alberto



Penile Calciphylaxis in End Stage Renal Disease  

PubMed Central

Calciphylaxis, better described as “Calcific uremic arteriolopathy” (CUA), involves about 1–4% of hemodialysis patients all around the world with high mortality rates. We describe a rare clinical case of CUA in peritoneal dialysis patient associated with urological disease. Penile calciphylaxis represents rare clinical complication, and an early diagnosis and multidisciplinary approach are requested. Pathogenesis is still unclear, and therapeutic approaches need more long-term clinical trials to test their efficacy and safety.

Di Lullo, Luca; Otranto, Giovanni; Floccari, Fulvio; Malaguti, Moreno; Santoboni, Alberto



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



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



Should scrotal calcinosis still be termed idiopathic?  


We observed so-called idiopathic scrotal calcinosis in a 36-year-old man who was cured successfully by simple excision of the affected skin. Histologically, the nodular lesions consisted of calcified amorphous basophilic masses and small granules within the dermis. One rounded aggregate of calcified basophilic material showed a slight positivity on immunostaining for cytokeratin. Some intact epidermoid cysts were also present, suggesting that dystrophic calcification, and possibly inflammation and rupture of epidermoid cysts, may be the main pathogenetic mechanism of the disease in most reported cases. In our opinion, the term idiopathic should refer to the individual cases that are etiologically undefined rather than the whole category of scrotal calcinosis. PMID:9700381

Dini, M; Colafranceschi, M



Smallpox: can we still learn from the journey to eradication?  

PubMed Central

One of the most celebrated achievements of immunology and modern medicine is the eradication of the dreaded plague smallpox. From the introduction of smallpox vaccination by Edward Jenner, to its popularization by Louis Pasteur, to the eradication effort led by Donald Henderson, this story has many lessons for us today, including the characteristics of the disease and vaccine that permitted its eradication, and the obviousness of the vaccine as a vector for other intractable Infectious diseases. The disease itself, interpreted in the light of modern molecular immunology, is an obvious immunopathological disease, which occurs after a latent interval of 1-2 weeks, and manifests as a systemic cell-mediated delayed type hypersensitivity (DTH) syndrome. The vaccine that slayed this dragon was given the name vaccinia, and was thought to have evolved from cowpox virus, but is now known to be most closely related to a poxvirus isolated from a horse. Of interest is the fact that of the various isolates of orthopox viruses, only variola, vaccinia and monkeypox viruses can infect humans. In contrast to the systemic disease of variola, vaccinia only replicates locally at the site of inoculation, and causes a localized DTH response that usually peaks after 7-10 days. This difference in the pathogenicity of variola vs. vaccinia is thought to be due to the capacity of variola to circumvent innate immunity, which allows it to disseminate widely before the adaptive immune response occurs. Thus, the fact that vaccinia virus is attenuated compared to variola, but is still replication competent, makes for its remarkable efficacy as a vaccine, as the localized infection activates all of the cells and molecules of both innate and adaptive immunity. Accordingly vaccinia itself, and not modified replication incompetent vaccina, is the hope for use as a vector in the eradication of additional pathogenic microbes from the globe.

Smith, Kendall A.



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


Pericarditis with pericardial effusion complicating chickenpox  

Microsoft Academic Search

A girl with chickenpox is presented. She developed arthritis, pericarditis with pericardial effusion and meningism during the course of her illness. Pericarditis is an unusual complication of this disease, and in this instance was associated with characteristic electrocardiographic changes. Aspects of her case history are discussed.

D. J. Seddon



Complications and hazards of gastrointestinal endoscopy  

Microsoft Academic Search

The diagnostic and therapeutic contribution of fiberoptic endoscopy to the advancement of the knowledge of gastrointestinal disease and to its proper management is already established. Technical refinements in the new instruments and extensive acceptance of the advantages of the method makes fiberendoscopy a procedure widely used throughout the world. Therefore, the appreciation of its potential risk of complications and hazards

Angelita Habr-Gama; Jerome D. Waye



The medical complications of narcotic addiction. I.  


The major medical complications of needle addiction are reviewed. The problem of overdose, and diseases of the skin, lung and kidney are discussed in detail. The importance and prevalence of infections are emphasized, with special reference to infective endocarditis and viral hepatitis. The work is introduced with a historical review. PMID:327220

Ostor, A G



Surgical complications of typhoid fever: Enteric perforation  

Microsoft Academic Search

Typhoid fever remains a prevalent disease in developing nations as the result of adverse socioeconomic factors. The most frequent complication, and principal cause of mortality, is perforation of the terminal ileum. This report presents our experience with 96 patients surgically treated at Cayetano Heredia University Hospital in Lima, Peru from 1972 to 1986. The clinical characteristics and the diverse surgical

Miguel Santillana



Atovaquone ameliorate gastrointestinal Toxoplasmosis complications in a pregnancy model  

PubMed Central

Summary Background Toxoplasma is an important source of foodborne hospitalization with no safe and effective therapy against chronic or congenital Toxopalsmosis. Atovaquone is a drug of choice but not approved for use in congenital Toxoplasmosis. We hypothesized atovaquone to be safe and effective against feto-maternal Toxoplasmosis. M