These are representative sample records from Science.gov related to your search topic.
For comprehensive and current results, perform a real-time search at Science.gov.
1

[The effectiveness of spasmolytic therapy in chronic acalculous cholecystitis].  

PubMed

The therapeutic efficacy of duspatalin was evaluated in 69 patients with chronic cholecystitis and dyskinesia of the biliary tract (BT). Supplementation of duspatalin to the combined therapy in the patients with chronic cholecystitis shown to exert a pronounced therapeutic effect. This caused positive changes in clinical symptoms and BT function and quality of life, diminished the lithogenic properties of bile. PMID:19552029

Sha?khutdinova, O V; Galiakberova, A R; Gur'ev, D A; Ionova, S I; Volevach, L V

2009-01-01

2

Fatty meal ultrasonography in chronic acalculous cholecystitis  

PubMed Central

Chronic acalculous cholecystits typically presents with biliary symptoms, normal blood tests and unremarkable ultrasound, computerized tomography and magnetic resonance cholangiopancreatography. However, cholescintigraphy may show reduced gallbladder ejection fraction (GBEF). There are no reports on using ultrasound to measure GBEF in adults. Twenty-eight patients with the above presentation underwent ultrasound before and after ingestion of a standardized fatty meal. Consequently, GBEF was calculated. Seven patients had reduced GBEFs (<38%). Two of these patients underwent cholecystectomy and both were found to have chronic gallbladder inflammation. Three patients with normal GBEFs underwent cholecystectomy and were also found to have chronic gallbladder inflammation. There may be a role for fatty meal ultrasonography in the diagnosis of chronic acalculous cholecystitis, but it should be used more widely in this patient cohort for its role to be established. It ideally needs to performed alongside cholescintigraphy for the comparison of accuracy. PMID:25409675

Donen, Anna; Kantor, Robin

2014-01-01

3

Cholecystitis.  

PubMed

Acute cholecystitis is defined as inflammation of the gallbladder and is usually caused by obstruction of the cystic duct. Cholescintigraphy is the most sensitive imaging modality for cholecystitis. The gold standard treatment of acute cholecystitis is laparoscopic cholecystectomy. Operating early in the disease course decreases overall hospital stay and avoids increased complications, conversion to open procedures, and mortality. Cholecystitis during pregnancy is a challenging problem for surgeons. Operative intervention is generally safe for both mother and fetus, given the improved morbidity of the laparoscopic approach compared with open, although increased caution should be exercised in women with gallstone pancreatitis. PMID:24679431

Knab, Lawrence M; Boller, Anne-Marie; Mahvi, David M

2014-04-01

4

[Application of cholecystectomy in surgical treatment of chronic calculous cholecystitis].  

PubMed

Morphological peculiarities of the excised gallbladder were studied in 106 patients, ageing from 24 to 74 yrs, who were treated for chronic calculous cholecystitis. Interrelationship between results of ultrasound investigation preoperatively and morphologic forms was established, what have permitted to select the operative intervention procedure, including conduction of organ preserving operations--cholecystolithotomy. PMID:25417281

Maksymliuk, V I

2014-08-01

5

Chronic lymphocytic leukemia presenting with cholecystitis-like symptoms and gallbladder wall invasion.  

PubMed

Although infiltration of the gallbladder by lymphoma is rare, it has to be considered in the differential diagnosis of patients presenting with cholecystitis-like symptoms. The most common lymphomas masquerading as acute cholecystitis are mucosa-associated lymphoid tissue lymphoma and large B-cell lymphoma. We describe a 75-year-old patient who presented with an acute cholecystitis-like picture, featuring chronic lymphocytic leukemia (CLL) with gallbladder wall involvement as the initial disease presentation. The cholecystectomy specimen showed perineural invasion present within the gallbladder wall, which likely accounted for the patient's right upper quadrant abdominal tenderness. In this way, we would like to alert clinicians and pathologists alike to CLL as yet another cause of a cholecystitis-like symptomatology. PMID:20375943

Dasanu, Constantin A; Mesologites, Thalia; Homsi, Samer; Ichim, Thomas E; Alexandrescu, Doru T

2010-05-01

6

A rare case report of chronic cholecystitis complicated with incomplete gallbladder volvulus  

PubMed Central

Gallbladder volvulus, or gallbladder torsion, is a rare condition. There have been very few case reports of chronic cholecystitis complicated by incomplete gallbladder volvulus. A 63-year-old woman had suffered recurrent right upper quadrant pain for 3 years, which had grown worse during the past day. She was admitted through the emergency department on February 24, 2012. Laparoscopic exploration revealed approximately 180° torsion of the gallbladder. Postoperative pathologic examination suggested a diagnosis of chronic cholecystitis, without operative complications. Incomplete gallbladder volvulus is associated with anatomic changes to the gallbladder mesentery, constipation, and increased bowel movements. Early diagnosis and laparoscopic exploration are the keys to management. PMID:25419406

Luo, P; Wang, CM; Zhang, GX

2014-01-01

7

Endovascular Recanalization for Chronic Symptomatic Intracranial Vertebral Artery Total Occlusion  

PubMed Central

Purpose. The outcome of recanalization in patients with chronic symptomatic intracranial vertebral artery (ICVA) total occlusion is poor. This paper reports the technical feasibility and long-term outcome of ICVA stenting in patients with chronic symptomatic total occlusion. Methods. Retrospective review of our prospectively maintained intracranial intervention database to identify patients with symptomatic total occlusion of ICVA with revascularization attempted >1 month after index ischemic event. Results. Eight patients (mean age 58 years) were identified. One had stroke and 7 had recurrent transient ischemic attacks. Four had bilateral ICVA total occlusion and 4 had unilateral ICVA total occlusion with severe stenosis contralaterally. Seven of 8 patients underwent endovascular recanalization, which was achieved in 6. Periprocedural complications included cerebellum hemorrhage, arterial dissection, perforation, and subacute in-stent thrombosis which occurred in 3 patients. One patient died of cerebellum hemorrhage. The other patients improved clinically after endovascular therapy. Conclusions. Stent-supported recanalization of ICVA total occlusion is technically feasible, and may become a viable treatment option in selected patients. PMID:25276423

Xu, Ziqi; Ma, Ning; Mo, Dapeng; Wong, Edward Ho chung; Gao, Feng; Jiao, Liqun; Miao, Zhongrong

2014-01-01

8

Xanthogranulomatous cholecystitis mimicking gallbladder cancer.  

PubMed

Xanthogranulomatous cholecystitis (XGC) is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammatory process of the gallbladder (GB). Macroscopically, it appears like yellowish tumour-like masses in the wall of the GB. This article reports on a 74-year-old woman with XGC mimicking GB cancer. PMID:24811556

Ewelukwa, Ofor; Ali, Omair; Akram, Salma

2014-01-01

9

Acute cholecystitis  

PubMed Central

Introduction Of people admitted to hospital for biliary tract disease, 20% have acute cholecystitis. Up to the age of 50 years, acute calculous cholecystitis is three times more common in women than in men, and about 1.5 times more common in women than in men thereafter. About 95% of people with acute cholecystitis have gallstones. Optimal therapy for acute cholecystitis, based on timing and severity of presentation, remains controversial. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute cholecystitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 17 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: early cholecystectomy, laparoscopic cholecystectomy, minilaparoscopic cholecystectomy, observation alone, open cholecystectomy, and percutaneous cholecystostomy. PMID:22186260

2011-01-01

10

Acute cholecystitis  

PubMed Central

Introduction Of people admitted to hospital for biliary tract disease, 20% have acute cholecystitis. Up to the age of 50 years, acute calculous cholecystitis is three times more common in women than in men, and about 1.5 times more common in women than in men thereafter. About 95% of people with acute cholecystitis have gallstones. Optimal therapy for acute cholecystitis, based on timing and severity of presentation, remains controversial. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute cholecystitis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 12 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: early cholecystectomy, laparoscopic cholecystectomy, minilaparoscopic cholecystectomy, observation alone, and open cholecystectomy. PMID:19445789

2008-01-01

11

Characteristics of symptomatic chronic subdural haematomas on high-field MRI  

Microsoft Academic Search

We studied the frequency of various features of the appearances on high-field MRI in symptomatic patients with chronic subdural\\u000a haematomas (CSDH). The ability to predict recurrence after treatment with one burr-hole procedure using MRI was evaluated.\\u000a A total of 40 patients with symptomatic CSDH underwent MRI at 1.5 T. All haematomas were evacuated within a few days of the\\u000a MRI

M. Kaminogo; J. Moroki; A. Ochi; A. Ichikura; M. Onizuka; A. Shibayama; H. Miyake; S. Shibata

1999-01-01

12

[Endoscopic gallbladder stenting for acute cholecystitis].  

PubMed

Acute cholecystitis is an inflammatory disease of the gallbladder. Inflammation often remains in the gallbladder, but some patients may take a fatal course with exacerbation of inflammation. Although laparoscopic cholecystectomy is recommended for moderate and severe acute cystitis, sometimes cholecystectomy is impossible in elder patients. Because many elder patients have bad general conditions, cholecystectomy should not be performed. Such patients are generally treated by percutaneous transhepatic gallbladder drainage (PTGBD), but PTGBD has the risk of intra-abdominal bleeding. In previous reports, endoscopic gallbladder stenting (EGBS) has been shown to be an effective strategy in cirrhosis patients with symptomatic cholelithiasis as a bridge to transplantation. Recent studies on EGBS have demonstrated an effective long-term management of acute cholecystitis in elderly patients who are poor surgical candidates. Here, we reviewed EGBS for the management of acute cholecystitis. PMID:25501758

Maekawa, Satoshi; Nomura, Ryosuke; Murase, Takayuki; Ann, Yasuyoshi; Oeholm, Masayuki; Harada, Masaru

2014-12-01

13

[Histopathological changes of gallbladder and liver parenchyma in symptomatic cholelithiasis].  

PubMed

In a retrospective study of 1101 patients (302 men, 799 women; mean age 56,7 [19-88] years) with symptomatic cholelithiasis who had undergone elective cholecystectomy and intraoperative liver biopsy, histological examination revealed inflammatory changes in the gallbladder in 96.7%, chronic fibrotic cholecystitis in 94.5% and a severe form of cholecystitis in 8.8%. Clinically relevant changes in the liver parenchyma were present in 27.9%, most frequently intrahepatic cholangitis (21.8%). The latter was significantly more common in choledocholithiasis than in isolated cholecystolithiasis. 27 patients had signs of severe liver disease, namely viral hepatitis, cirrhosis or fatty liver. Since the gall-bladder in cholelithiasis is almost always inflamed, cholecystectomy is the treatment of choice. Not uncommonly liver biopsy will reveal clinically relevant changes in the liver parenchyma. This will be useful information, especially in the management of symptoms which persist postoperatively. PMID:8504722

Badke, A; Schwenk, W; Böhm, B; Stock, W

1993-06-01

14

Use of morphine in cholescintigraphy for obstructive cholecystitis  

SciTech Connect

Non-visualization of the gallbladder (GB) during the first hour of cholescintigraphy is observed in cystic duct obstruction (e.g. in acute cholecystitis) but may also occur in chronic cholecystitis, hepatocellular disease, alcoholism and prolonged total parenteral nutrition. Low dose morphine is shown to improve the specificity of the diagnosis of acute cholecystitis (from 85% to 100%) with no loss in sensitivity (98%) at a small cost in terms of additional study time. The authors reviewed 27 selected cholescintigraphic examinations augmented by intravenous (IV) morphine (0.04 mg/Kg). Of the 16 cases with persistent nonvisualization of the GB, ultrasound revealed gallstones in 5 cases, sludge in 4, acalculous cholecystitis in 3, one distended GB, one contracted GB and 2 normal GB's. Of the 4 patients taken to surgery, one with gallstones and one with acalculous cholecystitis were confirmed to have acute cholecystitis while another with gallstones had chronic cholecystitis and the final patient, who was sonographically normal, presented a single common duct stone. The authors conclude that the use of IV morphine is an effective adjunct to cholescintigraphy in the evaluation of gallbladder disease, especially when visualization post morphine rules out acute cholecystitis.

Kim, E.E.; Nguyen, M.; Pjura, G.; Pollack, M.; Gobuty, A.

1985-05-01

15

Atherosclerotic inferior mesenteric artery stenosis resulting in large intestinal hypoperfusion: a paradigm shift in the diagnosis and management of symptomatic chronic mesenteric ischemia.  

PubMed

Symptomatic chronic mesenteric ischemia results from intestinal hypoperfusion and is classically thought to result from involvement of two or more mesenteric arteries. The celiac artery and superior mesenteric artery are most frequently implicated in this disease process, and their involvement usually results in symptoms of small intestinal ischemia. Symptomatic chronic mesenteric ischemia resulting predominantly from inferior mesenteric artery involvement has largely been overlooked but does gives rise to its own, unique clinical presentation with symptoms resulting from large intestinal ischemia. We present four patients with atherosclerotic inferior mesenteric artery stenosis with symptomatic chronic mesenteric ischemia that have unique clinical presentations consistent with large intestinal ischemia that resolved following percutaneous endovascular treatment of the inferior mesenteric artery stenosis. These cases represent a novel approach to the diagnosis and management of this disease process and may warrant a further subclassification of chronic mesenteric ischemia into chronic small intestinal ischemia and chronic large intestinal ischemia. PMID:22407990

Lotun, Kapildeo; Shetty, Ranjith; Topaz, On

2012-11-01

16

[Emphysematous cholecystitis (author's transl)].  

PubMed

A case of emphysematous cholecystitis is reported. The gallblader size in this case was 25 x 12 cms. The patient underwent successful cholecystectomy and responded adequately to cloramphenicol, peniciline and metronidazol. The late antibiotics are usually recommended due to the prevalence of Clostridia and Escherinchia bacterial infections in the gallbladder of patients with this illness. PMID:394266

Corral, R; Mira, J; Fening, J; Casian, C; Uribe, M

1979-01-01

17

Tuberculosis of gallbladder neck: a cause of cholecystitis with cholelithiasis  

PubMed Central

Tuberculosis of gallbladder neck is not a very common problem reported in the literature. Here, we report a case of gallbladder neck tuberculosis complicated with chronic cholecystitis with cholelithiasis in a 55-year-old woman. Diagnosis was made postoperatively on surgical biopsy. PMID:23413288

Verma, S K; Mishra, Ashwini Kumar; Jaiswal, Ashish Kumar

2013-01-01

18

Xanthogranulomatous cholecystitis. A clinical and pathologic study of twelve cases.  

PubMed

Xanthogranulomatous cholecystitis often presents as a severe chronic cholecystitis associated with abdominal pain, fever, and leukocytosis. Gallstones are present in most cases. At operation, there are adhesions to surrounding tissues, and sometimes a mass is found, mimicking tumor of the gallbladder. The gross and microscopic appearances are characteristic with multiple intramural nodules composed of foamy histiocytes and inflammatory cells. Cholesterol contents of these nodules are high. Involvement of the Rokitansky-Aschoff sinuses with liberation of bile lipids into the adjacent tissue is implicated in the pathogenesis of this lesion. PMID:2913907

Dao, A H; Wong, S W; Adkins, R B

1989-01-01

19

Comparative Effectiveness of Di'ao Xin Xue Kang Capsule and Compound Danshen Tablet in Patients With Symptomatic Chronic Stable Angina  

PubMed Central

A high proportion of patients with stable angina remains symptomatic despite multiple treatment options. Di'ao Xinxuekang (XXK) capsule and Compound Danshen (CDS) tablet have been approved for treating angina pectoris for more than 20 years in China. We compare the anti-anginal effectiveness of XXK capsule and CDS tablet in patients with symptomatic chronic stable angina. A randomized, multicenter, double-blind, parallel-group, superiority trial was conducted in 4 study sites. 733 patients with symptomatic chronic stable angina were included in the full analysis set. The primary outcomes were the proportion of patients who were angina-free and the proportion of patients with normal electrocardiogram (ECG) recordings during 20 weeks treatment. Compared with CDS, XXK significantly increased the proportion of angina-free patients, but no significant difference was noted in the proportion of patients with normal ECG recordings. Weekly angina frequency and nitroglycerin use were significantly reduced with XXK versus CDS at week 20. Moreover, XXK also improved the quality of life of angina patients as measured by the SAQ score and Xueyu Zheng (a type of TCM syndrome) score. We demonstrate that XXK capsule is more effective for attenuating anginal symptoms and improving quality of life in patients with symptomatic chronic stable angina, compared with CDS tablet. PMID:25394847

Yu, Yanan; Hu, Siyuan; Li, Guoxin; Xue, Jie; Li, Zhuoming; Liu, Xiangling; Yang, Xiyan; Dong, Bo; Wang, Donghai; Wang, Xiaofeng; Liu, Shurong; Liu, Jun; Chen, Bingwei; Wang, Liying; Liu, Songshan; Chen, Qiguang; Shen, Chunti; Wang, Zhong; Wang, Yongyan

2014-01-01

20

A dose escalation feasibility study of lenalidomide for treatment of symptomatic, relapsed chronic lymphocytic leukemia.  

PubMed

Adequate dosing of lenalidomide in Chronic Lymphocytic Leukemia (CLL) remains unclear. This study determined maximum tolerated dose (MTD) in relapsed CLL patients (Cohort A) and patients achieving a partial response (PR) or better to recent therapy (Cohort B). Thirty-seven patients were enrolled. MTD was 2.5mg followed by 5.0mg continuous. In Cohort A, tumor flare grade 1-2 occurred in 15 patients (50%) and grade 3 in 1 patient (3%). Cohort A had 19 of 23 evaluable (83%) patients, 4 PR (17%) and 15 (65%) stable disease (SD), Cohort B had 6 of 7 patients (86%) with SD. Despite overall response rate not being high, many patients remained on therapy several months with SD. PMID:25082342

Maddocks, Kami; Ruppert, Amy S; Browning, Rebekah; Jones, Jeffrey; Flynn, Joseph; Kefauver, Cheryl; Gao, Yue; Jiang, Yao; Rozewski, Darlene M; Poi, Ming; Phelps, Mitch A; Harper, Erica; Johnson, Amy J; Byrd, John C; Andritsos, Leslie A

2014-09-01

21

A dose escalation feasibility study of lenalidomide for treatment of symptomatic, relapsed chronic lymphocytic leukemia?  

PubMed Central

Adequate dosing of lenalidomide in Chronic Lymphocytic Leukemia (CLL) remains unclear. This study determined maximum tolerated dose (MTD) in relapsed CLL patients (Cohort A) and patients achieving a partial response (PR) or better to recent therapy (Cohort B). Thirty-seven patients were enrolled. MTD was 2.5 mg followed by 5.0 mg continuous. In Cohort A, tumor flare grade 1–2 occurred in 15 patients (50%) and grade 3 in 1 patient (3%). Cohort A had 19 of 23 evaluable (83%) patients, 4 PR (17%) and 15 (65%) stable disease (SD), Cohort B had 6 of 7 patients (86%) with SD. Despite overall response rate not being high, many patients remained on therapy several months with SD. PMID:25082342

Maddocks, Kami; Ruppert, Amy S.; Browning, Rebekah; Jones, Jeffrey; Flynn, Joseph; Kefauver, Cheryl; Gao, Yue; Jiang, Yao; Rozewski, Darlene M.; Poi, Ming; Phelps, Mitch A.; Harper, Erica; Johnson, Amy J.; Byrd, John C.; Andritsos, Leslie A.

2015-01-01

22

Early detection of chronic wasting disease prions in urine of pre-symptomatic deer by real-time quaking-induced conversion assay  

PubMed Central

Chronic wasting disease (CWD) is a prion disease of captive and free-ranging deer (Odocoileus spp), elk (Cervus elaphus nelsonii) and moose (Alces alces shirasi). Unlike in most other prion diseases, in CWD prions are shed in urine and feces, which most likely contributes to the horizontal transmission within and between cervid species. To date, CWD ante-mortem diagnosis is only possible by immunohistochemical detection of protease resistant prion protein (PrPSc) in tonsil or recto-anal mucosa-associated lymphoid tissue (RAMALT) biopsies, which requires anesthesia of animals. We report on detection of CWD prions in urine collected from pre-symptomatic deer and in fecal extracts by using real time quaking-induced conversion (RT-QuIC). This assay can be useful for non-invasive pre-symptomatic diagnosis and surveillance of CWD. PMID:23764839

John, Theodore R.; Schätzl, Hermann M.; Gilch, Sabine

2013-01-01

23

Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Treatment of Venous Symptomatic Chronic Portal Thrombosis in Non-cirrhotic Patients  

Microsoft Academic Search

Purpose: To present a series of cases of non-cirrhotic patients with symptomatic massive portal thrombosis treated by percutaneous techniques. All patients underwent a TIPS procedure in order to maintain the patency of the portal vein by facilitating the outflow. Methods: A total of six patients were treated for thrombosis of the main portal vein (6\\/6); the main right and left

José I. Bilbao; Mariana Elorz; Isabel Vivas; Antonio Martínez-Cuesta; Gorka Bastarrika; Alberto Benito

2004-01-01

24

Left atrial remodelling contributes to the progression of asymptomatic left ventricular systolic dysfunction to chronic symptomatic heart failure  

Microsoft Academic Search

Systolic heart failure (HF) is a progressive disorder that often begins with asymptomatic left ventricular (LV) systolic dysfunction\\u000a and culminates in symptoms from fluid overload and poor end-organ perfusion. The progression to symptomatic HF is accompanied\\u000a by marked activation of neurohormonal and cytokine systems, as well as a series of adaptive LV anatomical and functional changes,\\u000a collectively referred to as

George Karayannis; George Kitsios; Haralambos Kotidis; Filippos Triposkiadis

2008-01-01

25

Intramural gas in stomach along with acute calculus cholecystitis: an unusual association.  

PubMed

Intramural gas in stomach is a rare finding, but differential diagnosis of this condition into gastric emphysema and emphysematous gastritis is clinically important because of vastly different aetiologies and prognosis. Emphysematous gastritis is caused by gas producing micro-organisms inside the stomach wall and is a potentially fatal condition, while, on the other hand, gas enters stomach wall through mucosal breach in the case of gastric emphysema and prognosis is usually good with complete resolution. To date, no case has been reported in the literature showing gas in the stomach wall in a patient with acute calculus cholecystitis. We present a case of a young man with upper abdominal pain, and who, upon diagnostic work up was diagnosed with acute calculus cholecystitis with associated intramural gas in the stomach with no known aetiological factors to be positive. Conservative management with close observation resulted in complete symptomatic resolution. PMID:23645637

Naqvi, Zohaib Gulzar; Shahzad, Noman; Alvi, Abdul Rehman; Effendi, Shahrukh

2013-01-01

26

Efficacy and Safety of Omalizumab in Patients with Chronic Idiopathic/Spontaneous Urticaria Who Remain Symptomatic on H1 Antihistamines: A Randomized, Placebo-Controlled Study  

PubMed Central

ASTERIA I was a 40-week, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of subcutaneous omalizumab as add-on therapy for 24 weeks in patients with chronic idiopathic urticaria/spontaneous urticaria (CIU/CSU) who remained symptomatic despite H1 antihistamine treatment at licensed doses. Patients aged 12–75 years with CIU/CSU who remained symptomatic despite treatment with approved doses of H1 antihistamines were randomized (1:1:1:1) in a double-blind manner to subcutaneous omalizumab 75?mg, 150?mg, or 300?mg or placebo every 4 weeks for 24 weeks followed by 16 weeks of follow-up. The primary end point was change from baseline in weekly itch severity score (ISS) at week 12. Among randomized patients (N=319: placebo n=80, omalizumab 75?mg n=78, 150?mg n=80, 300?mg n=81), 262 (82.1%) completed the study. Compared with placebo (n=80), mean weekly ISS was reduced from baseline to week 12 by an additional 2.96 points (95% confidence interval (CI): ?4.71 to ?1.21; P=0.0010), 2.95 points (95% CI: ?4.72 to ?1.18; P=0.0012), and 5.80 points (95% CI: ?7.49 to ?4.10; P<0.0001) in the omalizumab 75-mg (n=77), 150-mg (n=80), and 300-mg groups (n=81), respectively. The omalizumab 300-mg group met all nine secondary end points, including a significant decrease in the duration of time to reach minimally important difference response (?5-point decrease) in weekly ISS (P<0.0001) and higher percentages of patients with well-controlled symptoms (urticaria activity score over 7 days (UAS7) ?6: 51.9% vs. 11.3% P<0.0001) and complete response (UAS7=0: 35.8% vs. 8.8% P<0.0001) versus placebo. During the 24-week treatment period, 2 (2.9%), 3 (3.4%), 0, and 4 (5.0%) patients in the omalizumab 75-mg, 150-mg, 300-mg, and placebo groups, respectively, experienced a serious adverse event. Omalizumab 300?mg administered subcutaneously every 4 weeks reduced weekly ISS and other symptom scores versus placebo in CIU/CSU patients who remained symptomatic despite treatment with approved doses of H1 antihistamines. PMID:25046337

Saini, Sarbjit S; Bindslev-Jensen, Carsten; Maurer, Marcus; Grob, Jean-Jacques; Bülbül Baskan, Emel; Bradley, Mary S; Canvin, Janice; Rahmaoui, Abdelkader; Georgiou, Panayiotis; Alpan, Oral; Spector, Sheldon; Rosén, Karin

2015-01-01

27

Transjugular Intrahepatic Portosystemic Shunt (TIPS) in the Treatment of Venous Symptomatic Chronic Portal Thrombosis in Non-cirrhotic Patients  

SciTech Connect

Purpose: To present a series of cases of non-cirrhotic patients with symptomatic massive portal thrombosis treated by percutaneous techniques. All patients underwent a TIPS procedure in order to maintain the patency of the portal vein by facilitating the outflow. Methods: A total of six patients were treated for thrombosis of the main portal vein (6/6); the main right and left branches (3/6) and the splenic vein (5/6) and superior mesenteric vein (6/6). Two patients had a pancreatic malignancy; one patient with an orthotopic liver transplant had been surgically treated for a pancreatic carcinoma. Two patients had idiopathic thrombocytosis, and in the remaining patient no cause for the portal thrombosis was identified. During the initial procedure in each patient one or more approaches were tried: transhepatic (5/6), transileocolic (1/6), trans-splenic (1/6) or transjugular (1/6). In all cases the procedure was completed with a TIPS with either ultrasound guidance (3/6), 'gun-shot' technique (2/6) or fluoroscopic guidance (1/6).Results: No complications were observed during the procedures. One patient had a repeat episode of variceal bleeding at 30 months, one patient remained asymptomatic and was lost to follow-up at 24 months, two patients were successfully treated surgically (cephalic duodenopancreatectomy) and are alive at 4 and 36 months. One patient remains asymptomatic (without new episodes of abdominal pain) at 16 months of follow-up. One patient died because of tumor progression at 10 months. Conclusion: Percutaneous techniques for portal recanalization are an interesting alternative even in non-acute thrombosis. Once flow has been restored in the portal vein TIPS may be necessary to obtain an adequate outflow, hence facilitating and maintaining the portal flow.

Bilbao, Jose I., E-mail: jibilbao@unav.es; Elorz, Mariana; Vivas, Isabel; Martinez-Cuesta, Antonio; Bastarrika, Gorka; Benito, Alberto [Universidad de Navarra, Department of Radiology, Clinica Universitaria, Facultad de Medicina (Spain)

2004-09-15

28

Acute cholecystitis associated with Clonorchis sinensis infection  

PubMed Central

Clonorchis sinensis is one of the most common causes of trematodiasis that is caused by the ingestion of raw fish contaminated with infective cysts. The adult flukes are predominantly present in the intrahepatic bile ducts, but occasionally they may be found in the pancreatic duct and extrahepatic bile ducts. The clinical manifestations depend on the number of flukes, the period of infestation, and complications such as pericholangitic abscess, cholangitis, bile duct stones, and cholangiocarcinoma. However, primary acute cholecystitis associated with C. sinensis infection is extremely rare. Herein, we report on a case of primary acute cholecystitis associated with C. sinensis infection. PMID:25114891

Oh, Jung Taek; Jo, Hyang Jeong

2014-01-01

29

Acute cholecystitis associated with Clonorchis sinensis infection.  

PubMed

Clonorchis sinensis is one of the most common causes of trematodiasis that is caused by the ingestion of raw fish contaminated with infective cysts. The adult flukes are predominantly present in the intrahepatic bile ducts, but occasionally they may be found in the pancreatic duct and extrahepatic bile ducts. The clinical manifestations depend on the number of flukes, the period of infestation, and complications such as pericholangitic abscess, cholangitis, bile duct stones, and cholangiocarcinoma. However, primary acute cholecystitis associated with C. sinensis infection is extremely rare. Herein, we report on a case of primary acute cholecystitis associated with C. sinensis infection. PMID:25114891

Oh, Jung Taek; Kang, Dong Baek; Jo, Hyang Jeong

2014-08-01

30

Eosinophilic cholecystitis as a rare manifestation of visceral larva migrans  

PubMed Central

Eosinophilic cholecystitis is an infrequent form of cholecystitis. The etiology of eosinophilic cholecystitis is still obscure, and it is sometimes accompanied with several complications, but a simultaneous onset with pericarditis is very rare. We would like to make an alternative interpretation of our recent report "Kaji K, Yoshiji H, Yoshikawa M, Yamazaki M, Ikenaka Y, Noguchi R, Sawai M, Ishikawa M, Mashitani T, Kitade M, Kawaratani H, Uemura M, Yamao J, Fujimoto M, Mitoro A, Toyohara M, Yoshida M, Fukui H. Eosinophilic cholecystitis along with pericarditis caused by Ascaris lumbricoides: A case report. World J Gastroenterol 2007; 13: 3760-3762." PMID:18023114

Yoshiji, Hitoshi; Yoshikawa, Masahide; Kaji, Kosuke; Fukui, Hiroshi

2007-01-01

31

Xanthogranulomatous cholecystitis: a rare cause of digestive hemorrhage.  

PubMed

Xanthogranulomatous cholecystitis is a rare affection with non-specific symptoms. It is essential to differentiate it from gall bladder adenocarcinoma. Presentation signs include hemorrhage or fistula. This report concerns a patient with pseudotumoral xanthogranulomatous cholecystitis who presented with gastrointestinal hemorrhage. PMID:24411821

Scheiwe, C; Muller, A; Rocas, D; Cotte, E

2014-02-01

32

Relapse of acute myeloid leukemia manifested by cholecystitis: A case report and review of the literature  

PubMed Central

INTRODUCTION AML is the most common form of leukemia in adults. In rare circumstances AML may present in the form of extra-medullary disease. Gallbladder infiltration with myeloblasts is rare and only a few cases exist in the literature describing this entity. PRESENTATION OF CASE We present a rare case of AML relapse in the form of extramedullary infiltration of the gallbladder in a 50-year-old male patient. The leukemic infiltration presented as symptomatic cholecystitis and sepsis. A laparoscopic cholecystectomy was performed and the gallbladder was pathologically examined. Histopathologic examination demonstrated multiple scattered, highly atypical single cells admixed with some plasma cells, small lymphocytes and macrophages consistent with leukemic infiltration. The abnormal cells demonstrated immunohistochemical staining for CD68, CD33 and CD117. The patient did well post-operatively but the relapse precluded him from bone marrow transplantation. DISCUSSION Although AML is relatively common, 3 cases per 100,000 population, extramedullary disease in the form of gallbladder infiltration is exceedingly rare. An extensive review of the literature revealed only four cases of myeloid infiltration of the gallbladder. To our knowledge this is the only case of relapsing disease in the form of gallbladder infiltration presenting as symptomatic cholecystitis in a pre-bone marrow transplantation patient. CONCLUSION This case highlights the importance of maintaining a high index of suspicion of atypical manifestations of AML when managing refractory sepsis. Extramedullary manifestations of AML in the form of gallbladder infiltration must be considered in the differential diagnosis of patients with a history of myeloid malignancies and for patients whom fail conventional non-operative management. PMID:24780774

Azin, Arash; Racz, Jennifer M.; Carolina Jimenez, M.; Sunil, Supreet; Porwit, Anna; Jackson, Timothy; Okrainec, Allan; Quereshy, Fayez

2014-01-01

33

Acute Cholecystitis: The Diagnostic Role for Current Imaging Tests  

PubMed Central

Acute cholecystitis is a relatively common clinical entity characterized histopathologically by obstruction of the cystic duct due to either edema or stone or both. Thorough clinical assessment and selection of the appropriate diagnostic tests are crucial in making an early diagnosis before surgical treatment. Many diagnostic tests are available for imaging the gallbladder. Hepatobiliary imaging using technetium Tc 99m IDA is the test of choice to either exclude or confirm the diagnosis of acute cholecystitis and it carries a discriminating power greater than that of cholecystography or ultrasonography. In most patients the exclusion of the diagnosis of acute cholecystitis can be made as early as 30 minutes and the confirmation within three hours. The confirmation of acute cholecystitis by radionuclide imaging obviates the need for either cholecystography or ultrasonography. ImagesFigure 1. PMID:6753344

Krishnamurthy, Gerbail T.

1982-01-01

34

Laparoscopic cholecystostomy for acute acalculous cholecystitis.  

PubMed

Acute acalculous cholecystitis (AAC) can occur in up to 18% of severely injured patients. Diagnosis is made by positive ultrasound findings of gallbladder sludge, hydrox, and wall thickening. There may also be recent-onset jaundice, positive ultrasound induced Murphy's sign, and unexplained sepsis. Mortality can be as high as 50%. Laparoscopic confirmation was obtained in six ICU trauma patients when omentum was drawn up over a distended gallbladder. Laparoscopic cholecystectomy (LC) was done by first directly decompressing the gallbladder through the fundus. This trocar was replaced by a 16 French Foley catheter passed through an Endoloop into the gallbladder and secured by tightening the loop around a cuff of gallbladder. Sepsis resolved in all cases. Only one required subsequent laparoscopic cholecystectomy. LC has a low morbidity and may be life saving during the early stages of AAC. It is not indicated in gangrene or perforation of the gallbladder. PMID:8662413

Yang, H K; Hodgson, W J

1996-06-01

35

Circulating Endothelial-Derived Apoptotic Microparticles in the Patients with Ischemic Symptomatic Chronic Heart Failure: Relevance of Pro-Inflammatory Activation and Outcomes  

PubMed Central

Background: Endothelial-derived apoptotic microparticles (EMPs) play a pivotal role in endothelial dysfunction in hronic Heart Failure (CHF). Objectives: The present study aimed to evaluate the association between EMPs and pro-inflammatory biomarkers, clinical status, and outcomes in the patients with ischemic CHF. Patients and Methods: This study was conducted on 154 patients with ischemic symptomatic moderate-to-severe CHF on discharge from hospital. The observation period was up to 3 years. Circulating NT-pro-BNP, TNF-alpha, sFas, and sFas ligand were determined at baseline. Flow cytometry analysis was used for quantifying the number of EMPs. All-cause mortality, CHF-related death, and CHD-re-hospitalization rate were examined. The data were analyzed using descriptive statistics, Receive Operation Characteristic Curve (ROC), and logistic regression analysis. Besides, P < 0.05 was considered as statistically significant. Results: During a median follow-up of 2.18 years, 21 participants died and 106 subjects were hospitalized repetitively. The results showed a significant difference between the patients with a large number of EMPs (> 0.514 n/mL) and those with a low level of the biomarker (< 0.514 n/mL) regarding their survival. The number of circulating EPMs independently predicted all-cause mortality (OR = 1.58; 95% CI = 1.20 – 1.88; P = 0.001), CHF-related death (OR = 1.22; 95% CI: 1.12 – 1.36; P < 0.001), and CHF-related re-hospitalization (OR = 1.20; 95% CI: 1.11 – 1.32; P < 0.001). Conclusions: Among the patients with symptoms of CHF, increased number of circulating EMPs was associated with increased 3-year CHF-related death, all-cause mortality, and risk of recurrent hospitalization due to CHF. PMID:25177675

Berezin, Alexander E.; Kremzer, Alexander A.; Samura, Tatayna A.; Martovitskaya, Yulia V.

2014-01-01

36

Upper gastrointestinal bleeding: A rare complication of acute cholecystitis  

PubMed Central

INTRODUCTION Haemobilia is a rare complication of acute cholecystitis and may present as upper gastrointestinal bleeding. PRESENTATION OF CASE We describe two patients with acute cholecystitis presenting with upper gastrointestinal bleeding due to haemobilia. Bleeding from the duodenal papilla was seen at endoscopy in one case but none in the other. CT demonstrated acute cholecystitis with a pseudoaneurysm of the cystic artery in both cases. Definitive control of intracholecystic bleeding was achieved in both cases by embolisation of the cystic artery. Both patients remain symptom free. One had subsequent laparoscopic cholecystostomy and the other no surgery. DISCUSSION Pseudoaneurysms of the cystic artery are uncommon in the setting of acute cholecystitis. OGD and CT angiography play a key role in diagnosis. Transarterial embolisation (TAE) is effective in controlling bleeding. TAE followed by interval cholecystectomy remains the treatment of choice in surgically fit patients. CONCLUSION We highlight an unusual cause of upper GI haemorrhage. Surgeons need to be aware of this rare complication of acute cholecystitis. Immediate non-surgical management in these cases proved to be safe and effective. PMID:23856254

Nana, Gael R.; Gibson, Matthew; Speirs, Archie; Ramus, James R.

2013-01-01

37

Symptomatic cholecystolithiasis after cholecystectomy  

PubMed Central

A 43-year-old woman was admitted to the gastroenterology department with colicky pain in the upper abdomen. Four years earlier, she had undergone a laparoscopic cholecystectomy because of cholecystitis. She recognised her current complaints from that previous episode. An endoscopic retrograde cholangiopancreatography showed a cavity with a diameter of 2?cm which contained multiple concrements near the liver hilus. An elective surgical exploration was performed. Near the clip of the previous cholecystectomy a bulging of the biliary tract with its own duct was visualised and resected. Histological examination of this “neo” gallbladder showed that the bulging was consistent with the formation of a reservoir secondary to bile leakage, probably caused by a small peroperative lesion of the common bile duct during the previous cholecystectomy. In conclusion, our patient presented with colicky pain caused by concrements inside a ‘neo’ gallbladder. PMID:23362056

van Dam, Paul M E L; Alexander, Shandrich M; Degreef, Ellen; Salemans, Jan M J I; Roumen, Rudi M H

2013-01-01

38

Cholescintigraphy in acute cholecystitis: use of intravenous morphine  

SciTech Connect

Conventional cholescintigraphy (60 patients) and a modified protocol (59 patients) were compared in 74 females and 45 males with acute cholecystitis. In the modified protocol, intravenous morphine was administered whenever the gallbladder was not seen 40 minutes after injection of Tc-99m-pyroxylidene-glutamate. Accuracy was 98% with morphine, compared with 88% for the conventional protocol; specificity improved from 83% to 100% with no loss of sensitivity. Low doses of morphine are well tolerated and can result in a highly accurate diagnosis of acute cholecystitis without the need for delayed imaging.

Choy, D.; Shi, E.C.; McLean, R.G.; Hoschl, R.; Murray, I.P.C.; Ham, J.M.

1984-04-01

39

[Leptospirosis with necro-haemorrhagic cholecystitis in a Boxer puppy].  

PubMed

A Boxer puppy from the island of Rügen, which was properly vaccinated according to its age, was presented with acute gastrointestinal symptoms. The presumptive diagnosis of leptospirosis with acute renal failure, hepatic damage, and jaundice was confirmed by seroconversion (increased titre to 1?:?800 in a non-vaccine serogroup 4 weeks after disease onset). Cholecystitis was diagnosed based on clinical symptoms and sonographic results. After an initial improvement, the puppy's condition deteriorated and cholecystectomy was performed. Histopathological diagnosis indicated a haemorrhagic necrotizing cholecystitis. PMID:25423604

Steil, D; Quandt, A; Mayer-Scholl, A; Sie, J M; Löhr, C V; Teifke, J P

2014-12-10

40

Eosinophilic Cystitis with Eosinophilic Cholecystitis: A Rare Association  

PubMed Central

We describe a rare case of eosinophilic cystitis associated with eosinophilic cholecystitis in a 30-year-old patient who underwent bladder biopsy for irritative voiding symptoms and routine elective cholecystectomy for gallstones. Diagnosis was confirmed by histopathological examination. The rarity of this condition prompted us to report this entity in which no specific cause could be found. PMID:24195001

Mallat, F.; Hmida, W.; Mestiri, S.; Ziadi, S.; Sriha, B.; Mokni, M.; Mosbah, F.

2013-01-01

41

Eosinophilic cystitis with eosinophilic cholecystitis: a rare association.  

PubMed

We describe a rare case of eosinophilic cystitis associated with eosinophilic cholecystitis in a 30-year-old patient who underwent bladder biopsy for irritative voiding symptoms and routine elective cholecystectomy for gallstones. Diagnosis was confirmed by histopathological examination. The rarity of this condition prompted us to report this entity in which no specific cause could be found. PMID:24195001

Mallat, F; Hmida, W; Mestiri, S; Ziadi, S; Sriha, B; Mokni, M; Mosbah, F

2013-01-01

42

Multiple sclerosis: symptomatic treatment.  

PubMed

Reports of new therapeutic agents designed to suppress inflammatory processes in multiple sclerosis have excited much interest but, thus far, have had little influence on symptoms, disability and handicap in patients. The clinical application of recent advances in physical, pharmacological and surgical approaches to management will, at least in the medium-term future, therefore offer significantly greater opportunities for improving the quality of life of patients with multiple sclerosis. Here, symptomatic treatment of the whole range of difficulties encountered by patients with multiple sclerosis is reviewed in the context of the multidisciplinary strategy crucial to an optimal outcome. PMID:8865021

Thompson, A J

1996-08-01

43

Acute acalculous cholecystitis after abdominal wall repair (Rives-Stoppa).  

PubMed

Acute acalculous cholecystitis (AAC) is a rare condition normally occurring in critically ill patients. Compared to acute calculous cholecystitis, AAC is associated with complications and has a worse outcome. Hence, knowledge of this condition is very important. We describe a case of a 31-year-old man who developed AAC after abdominal wall repair with mesh (Rives-Stoppa procedure) 1 day after discharge from the hospital. To the best of our knowledge, this is the first paper to report AAC after abdominal incisional hernia repair. Although it is known to be more common in critically ill patients, AAC can also occur postoperatively in outpatients. Early recognition and treatment of AAC may improve outcome. PMID:24739656

Reurings, Jurrian C; Diaz, Ruben P D; Penninga, Luit; Nellensteijn, David R

2014-01-01

44

Recurrent cholecystitis in an elderly mentally retarded patient with pica.  

PubMed

The case of a 64-year-old patient with pica and severe mental retardation who was admitted to our hospital for treatment of recurrent cholecystitis is reported. Abdominal ultrasound showed sludge in the gallbladder, but no stones. Abdominal CT revealed a foreign body in the duodenum resembling a suction cup of the type commonly used in kitchens and bathrooms. The object could not be removed because it was deeply embedded in the hypertrophic intestinal mucosa. A nasogastric tube was inserted for feeding, since the object impeded the passage of solid foods. The patient's fever and abdominal pain subsequently resolved, and laboratory data improved. The indwelling feeding tube prevented recurrence of cholecystitis. Since pica is common not only in patients with mental retardation but also in dementia patients, the present case may also relate to the treatment of acute abdominal conditions in dementia patients. PMID:22151245

Miyakawa, Koichi; Ito, Masanobu; Hatta, Kotaro; Eto, Ko; Arai, Heii

2011-12-01

45

Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: a cohort analysis.  

PubMed

Whether ursodeoxycholic acid (UDCA) therapy alters the long-term clinical course of gallstones (GS) without stone dissolution remains unknown. We aimed to clarify the relationship between long-term UDCA therapy and risks of biliary pain or acute cholecystitis in GS patients. We also aimed to identify factors affecting the natural course, and to explore a simple patient selection criteria for UDCA therapy. A cohort of 527 uncomplicated GS patients with or without UDCA (600 mg/d) followed for up to 18 years was analyzed. Patients who had frequent attacks or were complicated with cholecystitis were converted to cholecystectomy. History and UDCA therapy were identified on Cox analysis as 2 factors affecting the long-term clinical course. In patients without therapy, history was the only predictor of biliary pain among various patient or stone characteristics; biliary pain was rare in asymptomatic patients, while frequent in symptomatic patients (P <.001). UDCA therapy was associated with reduced risk for biliary pain in both symptomatic (62% vs. 92% in untreated patients at 10 years; P <.001; relative risk, 0.19; 95% CI, 0.10-0.34) and asymptomatic patients (6% vs. 12% in untreated patients at 10 years; P =.037; relative risk, 0.19; 95% CI, 0.04-0.91). Risk for the conversion was also reduced in UDCA-treated symptomatic patients (26% vs. 88% in untreated patients at 10 years, P <.001; relative risk, 0.08; 95% CI, 0.03-0.22). These effects were independent of stone dissolution. Three factors were identified on Cox analysis as affecting GS dissolution: radiolucency, small size (<10 mm) of stones, and visualized gallbladder (GB) on cholecystogram. A selection criteria based on these appears to exhibit high sensitivity (74%) and specificity (95%) for dissolution. UDCA therapy might be considered in symptomatic patients fulfilling these criteria, and also in patients who have significant surgical risk, because the longterm therapy is clearly associated with reduced risk of biliary pain and acute cholecystitis. PMID:10385632

Tomida, S; Abei, M; Yamaguchi, T; Matsuzaki, Y; Shoda, J; Tanaka, N; Osuga, T

1999-07-01

46

Symptomatic Treatment of Multiple Sclerosis  

Microsoft Academic Search

Besides immunomodulation and immunosuppression, the specific treatment of symptoms is an essential component of the overall management of multiple sclerosis (MS). Symptomatic treatment is aimed at the elimination or reduction of symptoms impairing the functional abilities and quality of life of the affected patients. Moreover, with symptomatic treatment the development of a secondary physical impairment due to an existing one

T. Henze; P. Rieckmann; K. V. Toyka

2006-01-01

47

Radiofrequency Ablation Treatment in Proximity to the Gallbladder Without Subsequent Acute Cholecystitis  

PubMed Central

Initial reports have suggested that proximity of liver tumors to the gallbladder may increase the risk for cholecystitis after radiofrequency ablation. A colon adenocarcinoma metastasis to the liver in contact with the gallbladder was successfully treated with radiofrequency ablation without subsequent cholecystitis. PMID:14667129

Patti, Jay W.; Neeman, Ziv; Wood, Bradford J.

2008-01-01

48

Percutaneous transhepatic cholecystostomy and delayed laparoscopic cholecystectomy in critically ill patients with acute calculus cholecystitis  

Microsoft Academic Search

Background: The ultimate therapy for acute cholecystitis is cholecystectomy. However, in critically ill elderly patients the mortality of emergency cholecystectomy may reach up to 30%. Open cholecystostomy performed under local anesthesia was considered to be the procedure of choice for treatment of acute cholecystitis in high-risk patients. In recent years, ultrasound- or computed tomography (CT)-guided percutaneous transhepatic cholecystostomy (PTHC) replaced

Ram M Spira; Aviran Nissan; Oded Zamir; Tzeela Cohen; Scott I Fields; Herbert R Freund

2002-01-01

49

Topical tacrolimus in the treatment of symptomatic oral lichen planus: A series of 13 patients  

Microsoft Academic Search

Background: Oral lichen planus (OLP) is a relatively common, chronic inflammatory condition, which frequently presents with symptoms of pain and irritation. OLP is often difficult to manage. Therefore there is a need for more effective and safer therapies for symptomatic OLP. Objective: Our purpose was to determine the effectiveness of topical tacrolimus as therapy for symptomatic OLP. Methods: A retrospective

Todd W. Rozycki; Roy S. Rogers; Mark R. Pittelkow; Marian T. McEvoy; Rokea A. el-Azhary; Alison J. Bruce; Joseph P. Fiore; Mark D. P. Davis

2002-01-01

50

Use of stapling devices for safe cholecystectomy in acute cholecystitis.  

PubMed

Abstract Many techniques are described for the ligation of a difficult cystic duct (CD). The aim of this study is to assess the effectiveness and safety of stapling of a difficult CD in acute cholecystitis using Endo-GIA. From January 2008 to June 2012, 1441 patients with cholelithiasis underwent laparoscopic cholecystectomy (LC) at the Department of General Surgery, Haydarpasa Numune Education and Research Hospital. Of these, 19 (0.62%) were identified as having a difficult CD and were ligated using an Endo-GIA stapler. All patients were successfully treated with a laparoscopic approach. The length of hospital stay was 3.4 days. There were umbilical wound infections in 4 patients (21%). The length of follow-up ranged from 1.0 to 50.4 months. In conclusion, Endo-GIA is a safe and easy treatment method for patients with a dilated and difficult CD. The cystic artery should be isolated and ligated if possible before firing the Endo-GIA stapler. If isolation and stapling are not possible, fibrin sealant can be applied to avoid bleeding. The vascular Endo-GIA can be applied in a large CD, but for acute cholecystitis with an edematous CD, the Endo-GIA roticulator 4.8 or 3.5 stapler is preferred. PMID:25216423

Odabasi, Mehmet; Muftuoglu, M A Tolga; Ozkan, Erkan; Eris, Cengiz; Yildiz, Mehmet Kamil; Gunay, Emre; Abuoglu, Haci Hasan; Tekesin, Kemal; Akbulut, Sami

2014-01-01

51

Porcine cholecyst–derived scaffold promotes full-thickness wound healing in rabbit  

PubMed Central

Graft-assisted healing is an important strategy for treating full-thickness skin wounds. This study evaluated the properties of porcine cholecyst–derived scaffold and its use for treating full-thickness skin wound in rabbit. The physical properties of cholecyst-derived scaffold were congenial for skin-graft application. Compared to a commercially available skin-graft substitute made of porcine small intestinal submucosa, the cholecyst-derived scaffold was rich in natural biomolecules like elastin and glycosaminoglycans. When used as a xenograft, it promoted healing with excess cell proliferation at early phases and acceptable collagen deposition in the later remodelling phases. PMID:24555014

Revi, Deepa; Vineetha, Vadavanath Prabhakaran; Muhamed, Jaseer; Rajan, Akhila

2013-01-01

52

Symptomatic animal models for dystonia  

PubMed Central

Symptomatic animal models have clinical features consistent with human disorders and are often used to identify the anatomical and physiological processes involved in the expression of symptoms and to experimentally demonstrate causality where it would be infeasible in the patient population. Rodent and primate models of dystonia have identified basal ganglia abnormalities, including alterations in striatal GABAergic and dopaminergic transmission. Symptomatic animal models have also established the critical role of the cerebellum in dystonia, particularly abnormal glutamate signaling and aberrant Purkinje cell activity. Further, experiments suggest that the basal ganglia and cerebellum are nodes in an integrated network that is dysfunctional in dystonia. The knowledge gained from experiments in symptomatic animal models may serve as the foundation for the development of novel therapeutic interventions to treat dystonia. PMID:23893454

Wilson, Bethany K.; Hess, Ellen J.

2013-01-01

53

Acute acalculous cholecystitis in a patient with juvenile dermatomyositis.  

PubMed

Juvenile dermatomyositis (JDM) is a rare autoimmune disease, characterised by a systemic capillary vasculopathy that typically affects skin and muscle. Gastrointestinal involvement is relatively rare. We report the case of an 11-year-old girl admitted for investigation of skin rash, progressive symmetric proximal muscle weakness, dysphagia and weight loss. The diagnosis of JDM was confirmed and during hospitalisation the patient developed abrupt and intense right hypocondrium pain associated with nausea and vomiting. Abdominal ultrasound revealed a thick gallbladder wall (8?mm) with pericholecystic fluid and no evidence of gallstones. An acute acalculous cholecystitis was assumed and the patient was started on intravenous fluids, prednisolone and analgaesic therapy. Clinical resolution was verified after 48?h. We hypothesised that the vasculitic process of JDM could have been the basis for this complication as described in other autoimmune diseases. PMID:25239990

Sanches, Bruno Fernandes; Martins, Teresa; Santos, Maria José; Azeredo, Paula

2014-01-01

54

A Rare Case of Cholecystitis Caused by Raoultella planticola  

PubMed Central

A 62-year-old female presented with right upper quadrant pain. Clinical examination and ultrasound scan were consistent with gallstones and acute cholecystitis. She received 3 days of intravenous Co-amoxiclav and was discharged with 5-days of oral antibiotics with arrangements to return for an elective cholecystectomy. This was performed 5 months later which revealed an inflamed gallbladder and a localised abscess secondary to gallbladder perforation. Fluid from the gallbladder was taken which cultured Raoultella planticola, a gram-negative, nonmotile environmental bacteria (Bagley et al. (1981)). This is the first report of biliary sepsis with a primary infection by R. planticola. This patient was treated with a 5-day course of oral Co-amoxiclav and made a full recovery. PMID:22690225

Teo, Isabel; Wild, Jonathan; Ray, Saikat; Chadwick, David

2012-01-01

55

Drainage patterns of the cholecystic vein evaluated by power doppler imaging  

Microsoft Academic Search

Power Doppler imaging (PDI) is a new technique that enhances detection of low-velocity blood flow. We used this modality to\\u000a assess gallbladder vasculature, especially drainage pattern and flow analysis of the cholecystic vein. The power Doppler equipment\\u000a used in this study was the Acuson Sequoia 512 system (Mountain View, California). Subjects were 27 patients with acute cholecystitis,\\u000a 9 with gallbladder

Keisuke Osakabe; Yuji Horiguchi; Hideo Imai; Hiroshi Sakamoto; Tomohiro Suzuki; Hiroshi Kubo; Masanao Uematsu; Fumiyasu Takeuchi; Yuko Nakamura; Takao Hayashi; Masahiro Asano; Toru Nishikawa; Yuko Kushi; Horoshi Nakano

2001-01-01

56

Endoscopic Management of Acute Cholecystitis and Cholangitis Caused by Limy Bile  

PubMed Central

Limy bile is a relatively rare condition in which a radiopaque material is visible in the gallbladder, extending rarely into the bile duct, on plain radiography. Acute cholangitis or cholecystitis caused by limy bile is a very rare condition. There are no definite treatment guidelines for limy bile, but in most cases with cholangitis or cholecystitis, laparoscopic cholecystectomy has been the preferred treatment. We report a case of limy bile with biliary symptoms that was treated only with an endoscopic procedure. PMID:20431775

Lee, Sang Heon; Choi, Hyun Jong; Kim, Hyung Ki; Cho, Young Deok; Lee, Moon Sung; Shim, Chan Sup

2009-01-01

57

Quantitative analysis of troponin I serum values in patients with acute cholecystitis.  

PubMed

The diagnosis and staging of acute cholecystitis, upon a lot of diagnostic methods and some scoring systems, is still a great clinical problem. The aim of the study was to investigate if serum Troponin I is elevated in patients with acute cholecystitis. Following informed consent, 65 patients with clinical and laboratory signs of acute cholecystitis were enrolled. All patients had measured serum Troponin I level and an abdominal ultrasound was done before definitive treatment was performed. Increased serum Troponin I level was found in most patients with severe form of acute cholecystitis (p < 0.00001). It reached sensitivity of 94.5% and specificity of 57.1% of this test. In multiple regression analysis Troponin I significantly correlated (p < 0.05) with the serum aspartate aminotransferase (r = 0.27), gamma-glutamyl transferase (r = 0.25) and gallbladder wall (> 6 mm) thickness (r = 0.58). Our study confirms that in most patients with severe and acute cholecystitis, serum Troponin I is increased. Troponin I level is in a lower range than it would be in patients with cardiac muscle damage or necrosis. Measuring serum Troponin I is a fast, reliable and widely performed test that could, with other routinely measured parameters, help in early diagnosis of the severe form of acute cholecystitis. PMID:22816212

Babi?, Zarko; Bogdanovi?, Zoran; Dorosuli?, Zdravko; Basha, Merita; Krznari?, Zeljko; Sjekavica, Ivo; Kujundzi?, Milan; Tadi?, Mario; Bani?, Marko; Jagi?, Vjekoslav; Marusi?, Marinko

2012-03-01

58

Symptomatic hypocalcemia after intravenous pamidronate.  

PubMed

A 65-year-old woman admitted for palliative care of metastatic renal/bladder carcinoma developed symptomatic hypocalcemia nine days following a single dose of pamidronate. This may have implications for management of patients following discharge from hospital. PMID:8857248

McIntyre, E; Bruera, E

1996-01-01

59

Analysis of clinical manifestations of symptomatic acquired jejunoileal diverticular disease  

PubMed Central

AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatening disease. METHODS: The medical records of patients with surgically confirmed symptomatic jejunoileal diverticular disease were retrospectively reviewed. Data collected included demographic data, laboratory results, clinical course (acute or chronic), preoperative diagnosis, and operative findings. Inclusion criteria were as follows: (1) surgical confirmation of jejunoileal diverticular disease and (2) exclusion of congenital diverticula (e.g. Meckel’s diverticulum). RESULTS: From January 1982 to July 2004, 28 patients with a total of 29 operations met the study criteria. The male:female ratio was 14:14, and the mean age was 62.6±3.5 years. The most common manifestation was abdominal pain. In nearly half of the patients, the symptoms were chronic. Two patients died after surgery. Only four cases were correctly diagnosed prior to surgery, three by small bowel series. CONCLUSION: Symptomatic acquired small bowel diverticular disease is difficult to diagnose. It should be considered in older patients with unexplained chronic abdominal symptoms. A small bowel series may be helpful in diagnosing this potentially life-threatening disease. PMID:16222755

Liu, Chia-Yuan; Chang, Wen-Hsiung; Lin, Shee-Chan; Chu, Cheng-Hsin; Wang, Tsang-En; Shih, Shou-Chuan

2005-01-01

60

Capnocytophaga canimorsus bacteremia presenting with acute cholecystitis after a dog bite.  

PubMed

Capnocytophaga canimorsus is part of normal gingival flora of dogs and cats. The organism can cause septicemia, meningitis, and endocarditis in humans after contact with dogs or cats. In spite of the frequency of gastrointestinal symptoms in C. canimorsus infection patients, specific gastrointestinal disease or clinical images have not been reported. We report a case of C. canimorsus bacteremia presenting with acute cholecystitis in elderly woman. She suffered from general fatigue and right upper abdominal pain. She had leukocytosis and abnormal liver function tests. She showed abnormal findings of the gallbladder by abdominal computed tomography and ultrasonography. She was diagnosed with acute cholecystitis without gallstones and was administered with antibiotics. C. canimorsus was isolated from blood cultures. A history of an insignificant wound secondary to a dog bite was elicited. She recovered completely with antibiotic treatment. This case revealed that C. canimorsus bacteremia can be presented with acute cholecystitis, suggesting that C. canimorsus could cause cholecystitis. And this cholecystitis can be treated with antibiotics without operation. Physicians seeing patients with acute cholecysitis should ask questions regarding animal contact. PMID:25445385

Nishioka, Hiroaki; Kozuki, Tomohiro; Kamei, Hiroki

2015-03-01

61

Morphine-augmented cholescintigraphy in the diagnosis of acute cholecystitis  

SciTech Connect

Cholescintigraphy is a sensitive procedure for diagnosing or excluding acute cholecystitis. However, when rapid diagnosis is critical, the requirement for delayed images (4 hr or more after injection) to minimize the false-positive rate diminishes its utility. We prospectively evaluated 40 cholescintigraphic examinations that did not visualize the gallbladder 1 hr after injection of 99mTc diisopropyliminodiacetic acid. These examinations were then augmented by administration of IV morphine, followed by an additional 30 min of imaging. After the morphine, 18 of these examinations demonstrated visualization of the gallbladder; none subsequently required surgical exploration. Of the remaining 22, who demonstrated persistent nonvisualization of the gallbladder post-morphine, 11 were explored surgically and found to be abnormal. The 11 others were treated medically. Low-dose morphine administered when the gallbladder fails to visualize after 1 hr is a useful adjunct to conventional cholescintigraphy because it reduces the time required to obtain a diagnostic result and decreases the number of false-positive results.

Kim, E.E.; Pjura, G.; Lowry, P.; Nguyen, M.; Pollack, M.

1986-12-01

62

Direct Comparison of B-Type Natriuretic Peptide (BNP) and Amino-Terminal proBNP in a Large Population of Patients with Chronic and Symptomatic Heart Failure: The Valsartan Heart Failure (Val-HeFT) Data  

Microsoft Academic Search

Background: The B-type or brain natriuretic peptides (BNP) and the amino-terminal probrain natriuretic pep- tide (NT-proBNP) are good markers of prognosis and diagnosis in chronic heart failure (HF). It is unclear, however, whether differences in their biological charac- teristics modify their clinical correlates and prognostic performance in HF. This work aimed to provide a direct comparison of the prognostic value

Serge Masson; Roberto Latini; Inder S. Anand; Tarcisio Vago; Laura Angelici; Simona Barlera; Emil D. Missov; Aldo Clerico; Gianni Tognoni; Jay N. Cohn

63

IgG4-related cholecystitis presenting as biliary malignancy: report of three cases.  

PubMed

An increased awareness of IgG4-related diseases has led to an escalation in the number of sites known to be involved by this fibroinflammatory disease. We report three cases of IgG4-related cholecystitis which were thought to represent biliary malignancies both clinically and radiographically. All three cases underwent surgery tailored towards presumed malignant neoplasms. Only following pathologic examination was the true nature of the disease identified. Recognition of the clinical, radiographic, and pathologic presentation of IgG4-related cholecystitis is essential for the consideration of this disease process prior to surgical management for suspected gallbladder malignancies. However, the pre-operative diagnosis remains challenging and extensive surgical intervention is often necessary given the distressing presentation of IgG4-related cholecystitis. PMID:24944152

Feely, Michael M; Gonzalo, David H; Corbera, Montserrat; Hughes, Steven J; Trevino, Jose G

2014-09-01

64

Acute intermittent porphyria caused by novel mutation in HMBS gene, misdiagnosed as cholecystitis  

PubMed Central

Background Acute intermittent porphyria (AIP) is an autosomal dominant neurovisceral inherited disorder due to a defect in the heme biosynthesis pathway. Misdiagnosis of the porphyrias is not uncommon. Case report We present a case of a 26-year-old female with suspected acute cholecystitis, mental status changes, and seizures. Biochemical and molecular investigations confirmed the diagnosis of AIP by findings of elevated urinary porphobilinogen, 5-aminolevulinic acid, and total porphyrins. DNA molecular testing showed a novel heterozygous mutation (c. 760delC p.L254X) in the exon11 of the HMBS gene. To the best of our knowledge, this is the first report of a misdiagnosis of AIP presenting with acute cholecystitis. Conclusion Clinicians are alerted to consider the possibility of AIP in an adult presenting with an acute abdomen, features of cholecystitis, and neuropsychiatric manifestations. PMID:25419136

Alfadhel, Majid; Saleh, Neam; Alenazi, Helal; Baffoe-Bonnie, Henry

2014-01-01

65

Nonvisualization of the gallbladder by 99mTc-HIDA cholescintigraphy as evidence of cholecystitis.  

PubMed Central

Cholescintigraphy with N-substituted iminodiacetic acid (HIDA) labelled with technetium-99m is a new noninvasive technique for evaluation of the hepatobiliary system. The significance of nonvisualization of the gallbladder by this method in comparison with standard radiologic examinations was studied. In 43 healthy subjects the gallbladder was visualized by the two methods. By contrast, all 27 patients in whom the gallbladder was not visualized by cholescintigraphy had cholecystitis. When visualization failed to occur, a repeat cholescintigraphic study after an injection of cholecystokinin demonstrated the status of the cystic duct. Visualization excludes cystic duct obstruction and acute cholecystitis, whereas persistent nonvisualization indicates cystic duct obstruction. Images FIG. 1 FIG. 2 PMID:630497

Paré, P.; Shaffer, E. A.; Rosenthall, L.

1978-01-01

66

Pregnancy related symptomatic vertebral hemangioma  

PubMed Central

Vertebral hemangiomas are benign vascular tumors of the spine that remain asymptomatic in most cases and incidentally encountered on imaging. Rarely, altered hemodynamic and hormonal changes during pregnancy may expand these benign lesions resulting in severe cord compression. The management of symptomatic vertebral hemangioma during pregnancy is controversial as modalities like radiotherapy and embolization are not suitable and surgery during pregnancy has a risk of preterm labor. Few cases of pregnancy related symptomatic vertebral hemangioma with marked epidural component have been reported in the literature. We report a case of 23-year-old primigravida who developed rapidly progressive paraparesis at 28 weeks of gestation and spine magnetic resonance imaging (MRI) revealed upper thoracic vertebral hemangioma with extensive extra-osseous extension and spinal cord compression. Laminectomy and surgical decompression of the cord was performed at 32 weeks of the pregnancy. There was significant improvement in muscle power after a week of surgery. Six weeks postoperatively she delivered a full term normal baby with subsequent improvement of neurologic deficit. Repeat MRI of dorsal spine performed at 3 months postoperatively showed reduced posterior and anterior epidural components of vertebral hemangioma. PMID:24753678

Gupta, Meena; Nayak, Rajeev; Singh, Hukum; Khwaja, Geeta; Chowdhury, Debashish

2014-01-01

67

Inflamed symptomatic sellar arachnoid cyst: case report.  

PubMed

Sellar arachnoid cysts are rare; an infected arachnoid cyst is extremely rare as only one case has been reported to date in the literature. Here, we report a patient with an infected or inflamed sellar arachnoid cyst that was successfully treated with transsphenoidal surgery (TSA). A 53-year-old female with a history of chronic sinusitis developed a headache 5 months ago, and one month before admission polyuria, polydipsia, and abnormal vaginal bleeding occurred. The magnetic resonance imaging (MRI) showed a sellar cystic mass with a thickened pituitary stalk. Preoperative hormonal study revealed normal pituitary hormone levels except for a moderate elevation of prolactin. She was diagnosed with diabetes insipidus of the central nervous system origin based on a water-deprivation test. TSA was performed under an impression of symptomatic Rathke's cleft cyst according to the MRI findings. Intraoperative findings showed confirmation of turbid intracystic contents, but micro-organisms were unidentified on microbial culture. Pathology of the cyst wall revealed inflamed meningoepithelial lining cells compatible with an arachnoid cyst. PMID:24904886

Park, Kwang Hyon; Gwak, Ho-Shin; Hong, Eun Kyung; Lee, Sang Hyun

2013-04-01

68

Ursodeoxycholic acid exerts no beneficial effect in patients with symptomatic gallstones awaiting cholecystectomy.  

PubMed

Ursodeoxycholic acid (UDCA) and impaired gallbladder motility purportedly reduce biliary pain and acute cholecystitis in patients with gallstones. However, the effect of UDCA in this setting has not been studied prospectively. This issue is important, as in several countries (including the Netherlands) scheduling problems result in long waiting periods for elective cholecystectomy. We conducted a randomized, double-blind, placebo-controlled trial on effects of UDCA in 177 highly symptomatic patients with gallstones scheduled for cholecystectomy. Patients were stratified for colic number in the preceding year (<3: 32 patients; > or =3: 145 patients). Baseline postprandial gallbladder motility was measured by ultrasound in 126 consenting patients. Twenty-three patients (26%) receiving UDCA and 29 (33%) receiving placebo remained colic-free during the waiting period (89 +/- 4; median [range]: 75[4-365] days) before cholecystectomy (P = .3). Number of colics, non-severe biliary pain, and analgesics intake were comparable. A low number of prior colics was associated with a higher likelihood of remaining colic-free (59% vs. 23%, P < .001), without effects on the risk of complications. In patients evaluated for gallbladder motility, 57% were weak and 43% were strong contractors (minimal gallbladder volume > respectively < or = 6 mL). Likelihood to remain colic-free was comparable in strong and weak contractors (31% vs. 33%). In weak contractors, UDCA decreased likelihood to remain colic-free (21% vs. 47%, P = .02). In the placebo group, 3 preoperative and 2 post-cholecystectomy complications occurred. In contrast, all 4 complications in the UDCA group occurred after cholecystectomy. In conclusion, UDCA does not reduce biliary symptoms in highly symptomatic patients. Early cholecystectomy is warranted in patients with symptomatic gallstones. PMID:16729326

Venneman, Niels G; Besselink, Marc G H; Keulemans, Yolande C A; Vanberge-Henegouwen, Gerard P; Boermeester, Marja A; Broeders, Ivo A M J; Go, Peter M N Y H; van Erpecum, Karel J

2006-06-01

69

Endoscopic ultrasound-guided gallbladder drainage for the management of acute cholecystitis (with video).  

PubMed

Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been introduced as an alternative to percutaneous transhepatic gallbladder drainage for the treatment of acute cholecystitis in non-surgical candidates. A systematic review of the English language literature through PubMed search until June 2014 was conducted. One hundred and fifty-five patients with acute cholecystitis treated with EUS-GBD in eight studies and 12 case reports, and two patients with EUS-GBD for other causes were identified. Overall, technical success was obtained in 153 patients (97.45%) and clinical success in 150 (99.34%) patients with acute cholecystitis. Adverse events developed in less than 8% of patients, all of them managed conservatively. EUS-GBD has been performed with plastic stents, nasobiliary drainage tubes, standard or modified tubular self-expandable metal stents (SEMS) and lumen-apposing metal stents (LAMS) by different authors with apparently similar outcomes. No comparison studies between stent types for EUS-GBD have been reported. EUS-GBD is a promising novel alternative intervention for the treatment of acute cholecystitis in high surgical risk patients. Feasibility, safety and efficacy in published studies from expert centers are very high compared to currently available alternatives. Further studies are needed to establish the safety and long-term outcomes of this procedure in other practice settings before EUS-GBD can be widely disseminated. PMID:25392972

Peñas-Herrero, Irene; de la Serna-Higuera, Carlos; Perez-Miranda, Manuel

2015-01-01

70

[The choice of the endoscopic treatment method in patients with acute cholecystitis, complicated by choledocholithiasis].  

PubMed

Peculiarities of the endoscopic methods application while treating 530 patients, suffering an acute cholecystitis, complicated by choledocholithiasis, were studied. Certain advantages of a two-staged treatment of the patients with initial management of biliary problems, using endoscopic retrograde cholangiography, were established. PMID:25252402

Ohorodnyk, P V; Kolomi?tsev, V I; De?nychenko, A H

2014-07-01

71

Acute Cholecystitis with a Hemocholecyst as an Unusual Presentation of Gallbladder Cancer: Report of a Case  

Microsoft Academic Search

Several atypical presentations of gallbladder carcinoma have been reported, but one of the rarest is intraluminal hemorrhage. We report a case of carcinoma of the gallbladder disclosed by an emergency cholecystectomy, performed for acute cholecystitis caused by a hemocholecyst. The diagnostic approaches and characteristics of a hemocholecyst associated with carcinoma of the gallbladder are discussed.

Joseph Ku; Jacob DeLaRosa; Justin Kang; David Hoyt; Raul Coimbra

2004-01-01

72

Acute cholecystitis with a hemocholecyst as an unusual presentation of gallbladder cancer: report of a case.  

PubMed

Several atypical presentations of gallbladder carcinoma have been reported, but one of the rarest is intraluminal hemorrhage. We report a case of carcinoma of the gallbladder disclosed by an emergency cholecystectomy, performed for acute cholecystitis caused by a hemocholecyst. The diagnostic approaches and characteristics of a hemocholecyst associated with carcinoma of the gallbladder are discussed. PMID:15526137

Ku, Joseph; DeLaRosa, Jacob; Kang, Justin; Hoyt, David; Coimbra, Raul

2004-01-01

73

[Minimally invasive surgical accesses for the treatment of the acute cholecystitis].  

PubMed

The 3-year experience minimally invasive surgery for the treatment of the acute cholecystitis was summarized. Criteria of the access choice and terms of surgery were substantiated. Treatment tactics of the acute cholecystits with the use of minimally invasive surgery were outlined, which allowed to decrease the rate of unreasonable "open" operations. PMID:21311470

Cherepanin, A I; Galliamov, E A; Biriukov, A Iu; Mikaelian, I A; Fedorov, D N

2010-01-01

74

Determination of optimal operation time for the management of acute cholecystitis: a clinical trial  

PubMed Central

Introduction Although all studies have reported that laparoscopic cholecystectomy (LC) is a safe and effective treatment for acute cholecystitis, the optimal timing for the procedure is still the subject of some debate. Aim This retrospective analysis of a prospective database was aimed at comparing early with delayed LC for acute cholecystitis. Material and methods The LC was performed in 165 patients, of whom 83 were operated within 72 h of admission (group 1) and 82 patients after 72 h (group 2) with acute cholecystitis between January 2012 and August 2013. All data were collected prospectively and both groups compared in terms of age, sex, fever, white blood count count, ultrasound findings, operation time, conversion to open surgery, complications and mean hospital stay. Results The study included 165 patients, 53 men and 112 women, who had median age 54 (20–85) years. The overall conversion rate was 27.9%. There was no significant difference in conversion rates (21% vs. 34%) between groups (p = 0.08). The operation time (116 min vs. 102 min, p = 0.02) was significantly increased in group 1. The complication rates (9% vs. 18%, p = 0.03) and total hospital stay (3.8 days vs. 7.9 days, p = 0.001) were significantly reduced in group 1. Conclusions Early LC within 72 h of admission reduces complications and hospital stay and is the preferred approach for acute cholecystitis. PMID:25097711

Ucar, Ahmet Deniz; Yakan, Savas; Carti, Erdem Baris; Coskun, Ali; Erkan, Nazif; Yildirim, Mehmet

2014-01-01

75

Management of acute cholecystitis in critically ill patients: contemporary role for cholecystostomy and subsequent cholecystectomy.  

PubMed

The diagnosis of acute cholecystitis in critically ill patients carries a high mortality rate. Although decompression and drainage of the gallbladder through a cholecystostomy tube may be used as a temporary treatment of acute cholecystitis in this population, there is still some debate about the management of the tube and the subsequent need for a cholecystectomy. This series evaluates the clinical course and outcomes of critically ill patients who underwent the insertion of cholecystostomy tubes for the initial treatment of acute cholecystitis. This is a retrospective review of critically ill patients admitted to the hospital intensive care unit who were diagnosed with acute cholecystitis and underwent a cholecystostomy tube as a temporary treatment for the disease. Patients were identified through the Greenville Hospital System electronic medical records coding database. Medical records were reviewed for demographic data, diagnoses, imaging, complications, and outcomes. From January 2002 through June 2008, 50 patients were identified for the study. The mean age was 72 +/- 11 years, and the majority (66%) were men. The following comorbidities were found: severe cardiovascular disease (40 patients), respiratory failure (30 patients), and multisystem organ dysfunction (30 patients). The mean intensive care unit length of stay (LOS) was 16 +/- 9 days, and the mean hospital LOS was 28 +/- 27 days. At 30 days, the morbidity associated with the cholecystostomy tube itself was 4 per cent, but overall in-hospital morbidity and mortality rates were 62 and 50 per cent, respectively. Of the 25 patients who survived longer than 30 days, 12 retained their cholecystostomy tubes until they underwent cholecystectomy (four open, seven laparoscopic). All of the remaining 13 patients had their cholecystostomy tubes removed, and eight developed recurrent cholecystitis. Of these patients with recurrent of cholecystitis, five had cholecystectomy or repeat cholecystostomy, but the remaining three patients died. Although this is a small patient population, these data suggest that, in critically ill patients, cholecystostomy tubes should remain in place until the patient is deemed medically suitable to undergo cholecystectomy. Removal of the cholecystostomy tube without subsequent cholecystectomy is associated with a high incidence of recurrent cholecystitis and devastating consequences. PMID:20698375

Morse, Bryan C; Smith, J Brandon; Lawdahl, Richard B; Roettger, Richard H

2010-07-01

76

Surgical reduction of symptomatic, circumferential, filtering blebs.  

PubMed

We describe methods and outcomes of surgical reduction of symptomatic, circumferential, filtering blebs after trabeculectomy with antifibrotic agents. The medical records of 15 eyes of 14 patients with symptomatic, circumferential blebs who underwent surgical bleb reduction for bleb dysesthesia under topical anesthesia were reviewed. Each bleb was incised segmentally and the cut edges of the conjunctiva and Tenon capsule were sutured to the underlying sclera. Outcome measures included symptomatic relief, retention of bleb function, and intraocular pressure maintenance. Fourteen eyes had successful reduction of bleb size, symptomatic relief, and cosmetically acceptable appearance. One eye continued to have dysesthesia and 1 had a transient bleb leak that resolved spontaneously. Surgical reduction of circumferential, symptomatic, filtering blebs is a safe and effective technique to reduce bleb dysesthesia and improve cosmesis without loss of bleb function. PMID:16769845

Anis, Sarah; Ritch, Robert; Shihadeh, Wisam; Liebmann, Jeffrey

2006-06-01

77

Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of 46 elderly patients aged 65 years or older  

PubMed Central

Background Endoscopic transpapillary pernasal gallbladder drainage and endoscopic gallbladder stenting (EGS) have recently been reported to be useful in patients with acute cholecystitis for whom a percutaneous approach is contraindicated. The aim of this study was to evaluate the efficacy of permanent EGS for management of acute cholecystitis in elderly patients who were poor surgical candidates. Methods We retrospectively studied 46 elderly patients aged 65 years or older with acute cholecystitis who were treated at Japan Labour Health and Welfare Organization Niigata Rosai Hospital. In 40 patients, acute cholecystitis was diagnosed by transabdominal ultrasonography and computed tomography, while 6 patients were transferred from other hospitals after primary management of acute cholecystitis. All patients underwent EGS, with a 7Fr double pig-tail stent being inserted into the gallbladder. If EGS failed, percutaneous transhepatic gallbladder drainage or percutaneous transhepatic gallbladder aspiration was subsequently performed. The main outcome measure of this study was the efficacy of EGS. Results Permanent EGS was successful in 31 patients (77.5%) with acute cholecystitis, without any immediate postprocedural complications such as pancreatitis, bleeding, perforation, or cholangitis. The most common comorbidities of these patients were cerebral infarction (n=14) and dementia (n=13). In 30 of these 31 patients (96.7%), there was no recurrence of cholecystitis and 29 patients (93.5%) remained asymptomatic until death or the end of the study period (after 1 month to 5 years). Conclusions EGS can be effective for elderly patients with acute cholecystitis who are poor surgical candidates and can provide a solution for several years. PMID:23586815

2013-01-01

78

Churg-Strauss syndrome complicated by colon erosion, acalculous cholecystitis and liver abscesses  

PubMed Central

We report on a case of Churg–Strauss syndrome (CSS) with colon erosion, cholecystitis and liver abscesses. A 21-year-old woman with a history of bronchial asthma for 3 years was admitted with a complaint of abdominal pain. Laboratory findings included remarkable leukocytosis and eosinophilia, and a colonoscopy revealed erosion from the rectum to the ileocecal region. In addition, a colonic biopsy specimen showed necrotizing vasculitis and marked eosinophilic infiltration. On the basis of the clinical features and histopathological findings, she was diagnosed with CSS and subsequently treated with oral prednisolone, after which the eosinophilia and abdominal pain disappeared. However, on the 15th d in hospital she developed cholecystitis and liver abscesses. She was therefore treated with antibiotics and as a result went into clinical remission. PMID:16127765

Suzuki, Msahiro; Nabeshima, Kazuo; Miyazaki, Mitsukazu; Yoshimura, Hitoshi; Tagawa, Shinsei; Shiraki, Katsuya

2005-01-01

79

Streptococcus agalactiae endocarditis presenting as acalculous cholecystitis in a previously well woman  

PubMed Central

This case report describes the unusual presentation of a previously very well woman with Streptococcus agalactiae endocarditis in the emergency department. History, examination and preliminary laboratory and radiological investigations supported a diagnosis of acalculous cholecystitis, for which she was given intravenous broad spectrum antimicrobial therapy. One day following admission, the patient deteriorated and became unresponsive. Subsequent MRI of the brain revealed multiple bihemispheric cerebral emboli and a large, mobile mitral valve thrombus was visualised on her transoesophageal echocardiogram. S agalactiae was cultured from venous blood samples and her antimicrobial cover was adjusted accordingly. Despite her presumed guarded prognosis, this patient made a remarkable recovery. To our knowledge, the association of S agalactiae endocarditis with acalculous cholecystitis has not been previously described. PMID:23405002

Brewer, Linda; Lavan, Amanda Hanora; Cullen, Laura; Duggan, Joseph

2013-01-01

80

Multiple ileal perforations and concomitant cholecystitis with gall bladder gangrene as complication of typhoid fever.  

PubMed

Surgical complications of typhoid fever usually involve the small gut, but infrequently typhoid fever also involves the gallbladder. Complications range from acalculous cholecystitis, gangrene to perforation. Here, we present a case of enteric fever with concomitant complication of multiple ileal perforations at its terminal part with acalculous cholecystistis with gangrenous gall bladder. The primary closure of the perforations and cholecystectomy was performed. Post-operatively patient developed low-output faecal fistula that was managed conservatively. PMID:25037301

Pandove, Paras K; Moudgil, Ashish; Pandove, Megha; Aggarwal, Kamna; Sharda, Divya; Sharda, Vijay K

2014-01-01

81

Multiple ileal perforations and concomitant cholecystitis with gall bladder gangrene as complication of typhoid fever  

PubMed Central

Surgical complications of typhoid fever usually involve the small gut, but infrequently typhoid fever also involves the gallbladder. Complications range from acalculous cholecystitis, gangrene to perforation. Here, we present a case of enteric fever with concomitant complication of multiple ileal perforations at its terminal part with acalculous cholecystistis with gangrenous gall bladder. The primary closure of the perforations and cholecystectomy was performed. Post-operatively patient developed low-output faecal fistula that was managed conservatively. PMID:25037301

Pandove, Paras K.; Moudgil, Ashish; Pandove, Megha; Aggarwal, Kamna; Sharda, Divya; Sharda, Vijay K.

2014-01-01

82

Q Fever with transient antiphospholipid antibodies associated with cholecystitis and splenic infarction.  

PubMed

We describe a case of Q fever associated with the transient presence of antiphospholipid antibodies in a 9-year-old boy presenting with acalculous cholecystitis and splenic infarction. Antiphospholipid antibodies are commonly associated with acute Q fever in adults but have previously been thought to be of little clinical significance. Recent data suggest that antiphospholipid antibodies may be responsible for certain clinical manifestations of acute Q fever. PMID:23271442

Newcombe, James P; Gray, Paul E A; Palasanthiran, Pam; Snelling, Thomas L

2013-04-01

83

Operative Outcome and Patient Satisfaction in Early and Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis  

PubMed Central

Introduction. Early laparoscopic cholecystectomy is usually associated with reduced hospital stay, sick leave, and health care expenditures. Early diagnosis and treatment of acute cholecystitis reduce both mortality and morbidity and the accurate diagnosis requires specific diagnostic criteria of clinical data and imaging studies. Objectives. To compare early versus delayed laparoscopic cholecystectomy regarding the operative outcome and patient satisfaction. Patients and Methods. Patients with acute cholecystitis were divided into two groups, early (A) and delayed (B) cholecystectomy. Diagnosis of acute cholecystitis was confirmed by clinical examination, laboratory data, and ultrasound study. The primary end point was operative and postoperative outcome and the secondary was patient's satisfaction. Results. The number of readmissions in delayed treatment group B was three times in 10% of patients, twice in 23.3%, and once in 66.7% while the number of readmissions was once only in patients in group A and the mean total hospital stays were higher in group B than in group A. The overall patient's satisfaction was 92.66 ± 6.8 in group A compared with 75.34 ± 12.85 in group B. Conclusion. Early laparoscopic cholecystectomy resulted in significant reduction in length of hospital stay and accepted rate of operative complications and conversion rates when compared with delayed techniques. PMID:25197568

Hokkam, Emad N.

2014-01-01

84

Acute cholecystitis with massive upper gastrointestinal bleed: A case report and review of the literature  

PubMed Central

Background Cystic artery pseudoaneurysm is a rare complication following cholecystitis. Its presentation with upper gastrointestinal hemorrhage (UGIH) is even rarer. Thirteen patients with cystic artery pseudoaneurysm have been reported in the literature but only 2 of them presented with UGIH alone. Case presentation We report a 43-year-old woman who developed a cystic artery pseudoaneurysm following an episode of acute cholecystitis. She presented with haematemesis and melaena associated with postural symptoms. Upper gastrointestinal endoscopy revealed a duodenal ulcer with adherent clots in the first part of the duodenum. Ultrasonography detected gallstones and a pseudoaneurysm at the porta hepatis. Selective hepatic angiography showed two small pseudoaneurysms in relation to the cystic artery, which were selectively embolized. However, the patient developed abdominal signs suggestive of gangrene of the gall bladder and underwent an emergency laparotomy. Cholecystectomy with common bile duct exploration along with repair of the duodenal rent, and pyloric exclusion and gastrojejunostomy was done. Conclusion This case illustrates the occurrence of a rare complication (pseudoaneurysm) following cholecystitis with an unusual presentation (UGIH). Cholecystectomy, ligation of the pseudoaneurysm and repair of the intestinal communication is an effective modality of treatment. PMID:17386110

Saluja, Sundeep S; Ray, Sukanta; Gulati, Manpreet S; Pal, Sujoy; Sahni, Peush; Chattopadhyay, Tushar K

2007-01-01

85

Allograft reconstruction for symptomatic chronic complete proximal hamstring tendon avulsion.  

PubMed

Complete proximal hamstring tendon avulsion is an uncommon injury that can cause significant disability in young, athletic individuals. Surgical reattachment is recommended and can be performed on a delayed basis if the tissue is sufficiently mobile. We report 2-year follow up for two cases where interpositional allograft tissue was used for reconstruction because the tendon was too retracted for primary repair. Two 30-year-old patients with complete proximal hamstring avulsion at least 2 years earlier reported severe hamstring weakness and restrictions with respect to sport and recreational activities. Proximal hamstring tendon reconstruction with Achilles tendon allograft was performed for both patients. They were immobilized for 8 weeks with the hip in extension and the knee in flexion using a custom orthosis, followed by physical therapy and weight bearing as tolerated. The patients were followed for over 2 years after the surgery and were evaluated with physical examination, isokinetic strength testing and detailed questions about their function. Following the procedure, both patients returned to a more active lifestyle that was greatly improved with respect to participation in sport and function. This procedure should be considered as a salvage operation as the patients did not return to completely normal function and demonstrated hamstring weakness on the operated side. PMID:18682918

Marx, Robert G; Fives, Gregory; Chu, Samuel K; Daluiski, Aaron; Wolfe, Scott W

2009-01-01

86

How quickly can acute symptomatic hyponatremia be corrected?  

PubMed

The systemic absorption of the flush liquid, including sorbitol, glycine or mannitol, can lead to complications, such as hyponatremia, volume overload and pulmonary or cerebral edema. Acute hyponatremia is defined as a reduction in the plasma sodium level in less than 48 h. Acute symptomatic hyponatremia should be corrected aggressively because it may cause irreversible neurological damage and death. Rapid correction of hyponatremia causes severe neurologic deficits, such as central pontine myelinolysis; thus, the optimal therapeutic approach has been debated. This article examined acute symptomatic hyponatremia in a patient undergoing transcervical myomectomy for a submucosal myoma. A thirty-seven-year-old patient was evaluated in obstetrics and gynecology clinic because of altered mental status and agitation. There was no history of chronic illness or drug use. It was discovered that during the operation, 12 L of the flush fluid, which contained 5 % mannitol, had been infused, but only 7 L of the flush fluid had been collected. On physical examination, the patient's general condition was moderate, her cooperation was limited, she was agitated, and her blood pressure was 120/70 mmHg. The sodium level was 99 mEq/L. Furosemid and 3 % NaCl solution were given. Her serum sodium returned to normal by increasing 39 mEq/L within 14 h. Her recovery was uneventful, and she was discharged 24 h after her serum sodium returned to normal. In conclusion, if there is a difference between the infused and collected volumes of the mannitol irrigant, severe hyponatremia may develop due to the flush fluid used during transcervical hysteroscopy and myomectomy. In these patients, acute symptomatic hyponatremia may be corrected as rapidly as the sodium level dropped. PMID:23054312

Yaprak, Mustafa; Turan, Mehmet Nuri; Tamer, Abdulkerim Furkan; Peker, Nuri; Demirci, Meltem Sezis; Ç?rpan, Teksin; A?ç?, Gülay

2013-12-01

87

Decompression of idiopathic symptomatic epidural lipomatosis of the lumbar spine.  

PubMed

Epidural lipomatosis has been implicated as a cause or contributor of symptomatic lumbar spinal stenosis. Symptomatic spinal epidural lipomatosis (SEL) of the lumbar spine is a rare disease, often associated with steroid overload. Idiopathic lipomatosis is even much less frequent. Signs and symptoms depend upon the level and degree of nerve root compression. Diagnosis is best based on MRI. Weight reduction can be curative, however, after failure of medical treatment or in severe cases surgical decompression should be performed. A 70-year-old man with both lower limb severe paresthesia and radicular symptoms unrelieved with conservative treatments such as medications and physical therapy was treated by surgical decompression. Obesity, endocrinopathic disease, and chronic steroid therapy were excluded. Interlaminar fenestration, lateral recess decompression and fat debulking were applied at all levels through the L2-S1. After surgery there was a gradual improvement in symptoms. We report a rare case of idiopathic SEL which has shown entire evolvement of lumbar spine with specific increase of radiological and clinical severity from L2-3 to L5-S1 in a non-obese patient. PMID:17681857

Min, Woo-Kie; Oh, Chang-Wug; Jeon, In-Ho; Kim, Shin-Yoon; Park, Byung-Chul

2007-10-01

88

Considering symptomatic spinal epidural lipomatosis in the differential diagnosis.  

PubMed

Spinal epidural lipomatosis (SEL) is the abnormal accumulation of normal fat within the spinal canal. It is more frequent in those patients receiving chronic glucocorticoid therapy or in cases of endogenous hypercortisolism states. We report a case of SEL in a patient with metastatic prostate cancer with history of steroid treatment as part of his chemotherapy regimen, presenting with clinical manifestations of partial cord compression. Magnetic resonance imaging images of the lumbar spine revealed the presence of epidural tumor suspicious for metastatic disease. Operative findings were consistent with epidural lipomatosis. Spinal epidural lipomatosis is a rare condition that needs to be included in the differential diagnosis of patients with risk factors, presenting with symptomatic cord compression. PMID:22887695

Alvarez, Adriana; Induru, Raghava; Lagman, Ruth

2013-09-01

89

Elevated plasma visfatin levels correlate with conversion of laparoscopic cholecystectomy to open surgery in acute cholecystitis.  

PubMed

Visfatin correlates with inflammation and its levels in peripheral blood are associated with some inflammatory diseases. This study aimed to assess the relationship between plasma visfatin levels and conversion of laparoscopic cholecystectomy to open surgery in acute cholecystitis. One hundred and forty-six acute cholecystitis patients and 146 sex- and age-matched healthy controls were recruited and their plasma visfatin levels were determined using an enzyme immunoassay. 17 patients (11.6%) underwent conversion. Plasma visfatin levels were statistically significantly elevated in all patients (97.2±41.8ng/mL), those with (161.4±71.3ng/mL) or without conversion (88.7±26.9ng/mL), compared to controls (40.3±13.3ng/mL, all P<0.001). A linear regression analysis showed that plasma visfatin levels were positively associated with plasma C-reactive protein levels (t=0.510, P<0.001). A logistic-regression analysis showed that age [odds ratio (OR) 1.160, 95% confidence interval (CI) 1.011-1.332, P=0.035] and plasma visfatin levels (OR 1.035, 95% CI 1.005-1.066, P=0.022) appeared to be the independent predictors of conversion. A receiver operating characteristic curve analysis found that plasma visfatin levels predicted conversion with high area under curve (AUC) (AUC, 850; 95% CI, 0.781-0.903). The AUC of the visfatin concentration was similar to that of age (AUC, 0.738; 95% CI, 0.659-0.807) (P=0.188). Visfatin improved the AUC of age to 0.914 (95% CI, 0.856-0.954) (P=0.011) using a combined logistic-regression model. Thus, high plasma levels of visfatin are associated with systemic inflammation, and may independently predict conversion of laparoscopic cholecystectomy to open surgery in acute cholecystitis. PMID:25086268

Xie, Kai-Gang; Teng, Xiao-Ping; Zhu, Shui-Yin; Qiu, Xiong-Bo; Ye, Xiao-Ming; Hong, Xiao-Ming

2014-10-01

90

Endovascular treatment of symptomatic intracranial atherosclerotic disease.  

PubMed

Symptomatic intracranial atherosclerotic disease (ICAD) is responsible for approximately 10% of all ischemic strokes in the United States. The risk of recurrent stroke may be as high as 35% in patient with critical stenosis >70% in diameter narrowing. Recent advances in medical and endovascular therapy have placed ICAD at the forefront of clinical stroke research to optimize the best medical and endovascular approach to treat this important underlying stroke etiology. Analysis of symptomatic ICAD studies lead to the question that whether angioplasty and/or stenting is a safe, suitable, and efficacious therapeutic strategy in patients with critical stenoses that are deemed refractory to medical management. Most of the currently available data in support of angioplasty and/or stenting in high risk patients with severe symptomatic ICAD is in the form of case series and randomized trial results of endovascular therapy versus medical treatment are awaited. This is a comprehensive review of the state of the art in the endovascular approach with angioplasty and/or stenting of symptomatic ICAD. PMID:21359195

Short, Jody L; Majid, Arshad; Hussain, Syed I

2011-01-01

91

Mycobacterium paraffinicum Causing Symptomatic Pulmonary Infection  

PubMed Central

Mycobacterium paraffinicum has been newly recognized as a species. A case of symptomatic pulmonary infection caused by M. paraffinicum is described, and as far as we know, this is the first case of the organism as a human pathogen. PMID:24452164

Chan, Austin W.; Kabbani, Sarah; Staton, Gerald

2014-01-01

92

Uterine Artery Embolization for Symptomatic Myomata  

Microsoft Academic Search

Fibroid disease is common and causes significant health problems in women of childbearing age. Over the past several years, uterine artery embolization (UAE) has emerged as a minimally invasive treatment for symptomatic uterine myomata. Embolotherapy is effective in relieving myoma-related symptoms in 80% to 90% of patients. It requires shorter hospitalizations than traditional surgical therapies for myoma disease and is

Robert L. Worthington-Kirsch; Gary P. Siskin

2004-01-01

93

Symptomatic gastroesophageal reflux: Incidence and precipitating factors  

Microsoft Academic Search

The incidence and precipitating factors associated with symptomatic gastroesophageal reflux were evaluated by a questionnaire in 446 hospitalized and 558 nonhospitalized subjects. Of 385 control subjects 7% experienced heartburn daily, 14% noted heartburn weekly, and 15% experienced it once a month, giving a total of 36% of subjects having heartburn at least monthly. Daily heartburn occurred at a significantly greater

Otto T. Nebel; Michael F. Fornes; Donald O. Castell

1976-01-01

94

Endovascular Treatment of Symptomatic Intracranial Atherosclerotic Disease  

PubMed Central

Symptomatic intracranial atherosclerotic disease (ICAD) is responsible for approximately 10% of all ischemic strokes in the United States. The risk of recurrent stroke may be as high as 35% in patient with critical stenosis >70% in diameter narrowing. Recent advances in medical and endovascular therapy have placed ICAD at the forefront of clinical stroke research to optimize the best medical and endovascular approach to treat this important underlying stroke etiology. Analysis of symptomatic ICAD studies lead to the question that whether angioplasty and/or stenting is a safe, suitable, and efficacious therapeutic strategy in patients with critical stenoses that are deemed refractory to medical management. Most of the currently available data in support of angioplasty and/or stenting in high risk patients with severe symptomatic ICAD is in the form of case series and randomized trial results of endovascular therapy versus medical treatment are awaited. This is a comprehensive review of the state of the art in the endovascular approach with angioplasty and/or stenting of symptomatic ICAD. PMID:21359195

Short, Jody L.; Majid, Arshad; Hussain, Syed I.

2011-01-01

95

[Spontaneous regression of symptomatic lumbar disc herniation].  

PubMed

Lumbar disc herniation is very common, sometimes leading to disability of the patient, and in a significant number of cases can only be solved with surgery. This paper reports a case with a large symptomatic disc herniation, which suffered spontaneous regression, and no surgery was necessary. The case is documented on serial MRI, consistent with the clinical improvement of the patient. PMID:22472931

Ribeiro, R Pimenta; Matos, R Milheiro; Vieira, A; Costa, J M; Proença, R; Pinto, R

2011-01-01

96

Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Cancer: Can It Be Diagnosed Preoperatively?  

PubMed Central

Background. Xanthogranulomatous cholecystitis (XGC) is often misdiagnosed as gallbladder cancer (GBC). We aimed to determine the preoperative characteristics that could potentially aid in an accurate diagnosis of XGC masquerading as GBC. Methods. An analysis of patients operated upon with a preoperative diagnosis of GBC between January 2008 and December 2012 was conducted to determine the clinical and radiological features which could assist in a preoperative diagnosis of XGC. Results. Out of 77 patients who underwent radical cholecystectomy, 16 were reported as XGC on final histopathology (Group A), while 60 were GBC (Group B). The incidences of abdominal pain, cholelithiasis, choledocholithiasis, and acute cholecystitis were significantly higher in Group A, while anorexia and weight loss were higher in Group B. On CT, diffuse gallbladder wall thickening, continuous mucosal line enhancement, and submucosal hypoattenuated nodules were significant findings in Group A. CT findings on retrospect revealed at least one of these findings in 68.7% of the cases. Conclusion. Differentiating XGC from GBC is difficult, and a definitive diagnosis still necessitates a histopathological examination. An accurate preoperative diagnosis requires an integrated review of clinical and characteristic radiological features, the presence of which may help avoid radical resection and avoidable morbidity in selected cases. PMID:25404941

Rammohan, Ashwin; Cherukuri, Sathya D.; Sathyanesan, Jeswanth; Palaniappan, Ravichandran; Govindan, Manoharan

2014-01-01

97

Biomaterial properties of cholecyst-derived scaffold recovered by a non-detergent/enzymatic method.  

PubMed

Isolation procedures for the recovery of extracellular matrices (ECMs) from animal organs/tissues that are useful in regenerative medicine involve multiple sequential steps/stages including collection of the source organ at slaughter, their transportation to laboratory, decellularization, decontamination, stabilization, and sterilization. Most of these steps require extensive use of chemicals/reagents/enzymes which may also adversely affect the quality of the scaffold. With an effort to minimize the use of chemicals/reagents/enzymes, while extracting biomaterial-grade ECM from porcine cholecyst (gall bladder), we performed preisolation ex situ incubation of the organ in a stabilizing agent that also caused in situ crosslinking of tissue-components and delaminated the collagen-rich ECM from the tissue-layer beneath the mucosa. The physical, chemical, and biological properties of the isolated scaffolds were similar to that of a commercially available porcine small intestinal submucosa. The cholecyst-derived scaffold not only satisfied preclinical safety-test procedures such as cytotoxicity, local response, and endotoxin load but also showed the potential to promote healing of full-thickness skin wound in a rabbit model. The procedure was also suitable for isolating scaffolds from other hollow organs such as jejunum and urinary bladder. It was concluded that enzyme/detergent treatment may be an avoidable step while isolating biomaterial-grade scaffolds from hollow organs. PMID:24596163

Anilkumar, Thapasimuthu V; Vineetha, Vadavanath P; Revi, Deepa; Muhamed, Jaseer; Rajan, Akhila

2014-10-01

98

A case of symptomatic Rathke's cyst  

PubMed Central

Rathke's cleft cyst is a benign growth found on the pituitary gland in the brain, specifically a fluid-filled cyst in the posterior portion of the anterior pituitary gland. It occurs when the Rathke's pouch does not develop properly, and ranges in size from 2 to 40?mm in diameter. Asymptomatic cysts are common, detected during autopsies of 2–26% of individuals who have died of unrelated causes. Symptomatic cysts are rare and only approximately 150 cases have been reported. Females are twice as likely as males to have a cyst. Symptomatic cysts can trigger visual disturbances, pituitary dysfunction and headaches. Here we present a case of a 40-year-old female patient who presented with complains of visual disturbances, headache and amenorrhoea. On investigations, MRI of brain revealed findings suggestive of Rathke's cleft cyst. PMID:23355555

Naik, Vismay Dinesh; Thakore, Nilay Rajendra

2013-01-01

99

Structural Associations of Symptomatic Knee Osteoarthritis  

PubMed Central

Objective Structural changes of osteoarthritis (OA) may occur in the absence of pain. In this study, we aimed to identify histopathologic features that are associated with symptomatic knee OA. Methods Medial tibial plateaus and synovium samples were obtained at the time of total knee replacement (TKR) surgery for OA (advanced OA group) or were obtained postmortem from subjects who had not sought medical attention for knee pain during the last year of life (non-OA control group). To identify features of OA, we compared the patients with advanced OA with the age-matched non-OA controls (n = 26 per group). To identify OA features associated with symptoms, we compared two additional groups of subjects who were matched for severity of chondropathy (n = 29 per group): patients undergoing TKR for symptomatic OA (symptomatic chondropathy group) and postmortem subjects with similar severity of chondropathy who were asymptomatic during the last year of life (asymptomatic chondropathy group). The histologic features of the samples were graded, and immunoreactivities for macrophages (CD68) and nerve growth factor (NGF) in the synovium were quantified. The cellular localization of synovial NGF was determined by double immunofluorescence analysis. Results Advanced OA cases displayed more severe changes in the synovium (synovitis, increased synovial NGF, and CD68-immunoreactive macrophages) and cartilage (loss of cartilage surface integrity, loss of proteoglycan, tidemark breaching, and alterations in chondrocyte morphology) than did the non-OA controls. Synovial NGF was localized predominantly to fibroblasts and to some macrophages. The symptomatic chondropathy group displayed greater levels of synovitis, synovial NGF, and loss of cartilage integrity, in addition to alterations in chondrocyte morphology, than did the asymptomatic chondropathy group (P < 0.05 for each comparison). Conclusion Synovitis, increased synovial NGF, alterations in chondrocyte morphology, and loss of cartilage integrity are features of knee OA that may be associated with symptoms. PMID:25049144

Stoppiello, Laura A; Mapp, Paul I; Wilson, Deborah; Hill, Roger; Scammell, Brigitte E; Walsh, David A

2014-01-01

100

Outcome of Symptomatic Intracranial Atherosclerotic Disease  

PubMed Central

Background and Purpose Patients with intracranial atherosclerotic disease (ICAD) have a 3.6% to 22% annual risk of stroke. In this study, we sought to evaluate the natural history and prognosis of patients with symptomatic ICAD who received medical therapy versus percutaneous transluminal angioplasty and stenting (PTAS) at our institution. Methods Charts of all patients with symptomatic ICAD from July 2004 to September 2007 were reviewed and assessed for history of transient ischemic attack (TIA) or stroke. Patients were either treated with “best medical therapy” (Medical Therapy Group) or PTAS plus antiplatelet agents (PTAS Group), and followed prospectively. A favorable outcome was defined as the absence of TIAs, strokes or vascular death, modified Rankin Scale of 3 or less and no endovascular re-intervention of symptomatic in-stent restenosis (ISR). Results One hundred eleven patients fulfilled entry criteria, with 58 (52.3%) and 53 patients (47.7%) enrolled in the Medical Therapy and PTAS Groups, respectively. Thirty-eight patients of the Medical Therapy group (65.5%) had a favorable outcome compared to 37 patients of the PTAS group (69.8%). Combined ischemic endpoint data for the occurrence of TIA, stroke and vascular death was similar with 14 (24%) events in the Medical Therapy group versus 15 (28.3%) events in the PTAS group. Conclusion Overall, the combined ischemic endpoint was the same in the Medical Therapy and PTAS groups. PMID:19556534

Samaniego, Edgar A.; Hetzel, Scott; Thirunarayanan, Supriya; Aagaard-Kienitz, Beverly; Levine, Ross

2009-01-01

101

Technique and indications of percutaneous cholecystostomy in the management of cholecystitis in 2014.  

PubMed

The gold standard in treatment of acute cholecystitis is cholecystectomy associated with antibiotics. In certain circumstances, percutaneous cholecystostomy is an interventional alternative. Percutaneous cholecystostomy is usually performed under local anesthesia by the radiologist using ultrasonographic or CT guidance. A drain can be inserted either through a trans-hepatic or a trans-peritoneal approach. Complications occur in nearly 10% of cases including hemorrhage, hemobilia, pneumothorax or bile leaks, depending on whether the approach was trans-hepatic or trans-peritoneal. The main indications for percutaneous cholecystostomy are resistance to medical treatment or severely-ill patients in intensive care. Drains should be maintained 3 to 6 weeks before removal. In patients with good general condition (ASA score I-II), secondary cholecystectomy can be recommended to avoid recurrence. PMID:25168577

Venara, A; Carretier, V; Lebigot, J; Lermite, E

2014-12-01

102

Gall bladder rupture associated with cholecystitis in a domestic ferret (Mustela putorius).  

PubMed

A six-year-old neutered female albino ferret was presented with an acute episode of lethargy and anorexia. Clinical examination revealed marked cranial abdominal pain. A severe neutrophilic leukocytosis was present. Abdominal ultrasound was consistent with a diffuse peritonitis and severe bile duct inflammation. Cytology of the abdominal effusion revealed bile peritonitis. An exploratory laparotomy was performed and the gall bladder appeared inflamed with multiple perforations. A cholecystectomy was performed. The ferret recovered without complication. Bacteriological culture of the bile and gall bladder yielded a pure growth of Pseudomonas aeruginosa. Histopathological analysis of the gall bladder and liver was consistent with a marked cholecystitis and cholangiohepatitis. On the basis of sensitivity testing, the ferret was treated with marbofloxacin for one month. No complications or reoccurrence were seen up to 1?year after the diagnosis. To the author's knowledge, this is the first report of bile peritonitis secondary to gall bladder rupture in a ferret. PMID:25168742

Huynh, M; Guillaumot, P; Hernandez, J; Ragetly, G

2014-09-01

103

Laparoscopic cholecystectomy for acalculous cholecystitis in a neutropenic patient after chemotherapy for acute lymphoblastic leukemia  

PubMed Central

Acute acalculous cholecystitis (ACC) is most frequently reported in critically ill patients following sepsis, extensive injury or surgery. It is rather uncommon as a chemotherapy-induced complication, which is usually life-threatening in neutropenic patients subjected to myelosuppressive therapy. A 23-year-old patient with acute lymphoblastic leukemia was subjected to myelosuppressive chemotherapy (cyclophosphamide, cytarabine, pegaspargase). After the first chemotherapy cycle the patient was neutropenic and feverish; she presented with vomiting and pain in the right epigastrium. Ultrasound demonstrated an acalculous gallbladder with wall thickening up to 14 mm. The ACC was diagnosed. Medical therapy included a broad spectrum antibiotic regimen and granulocyte-colony stimulating factors. On the second day after ACC diagnosis the patient's general condition worsened. Laparoscopic cholecystectomy was performed. The resected gallbladder showed no signs of bacterial or leukemic infiltrates. The postoperative course was uneventful. In the management of neutropenic patients with ACC surgical treatment is as important as pharmacological therapy. PMID:25337176

Ejduk, Anna; Wróblewski, Tadeusz; Szczepanik, Andrzej B.

2014-01-01

104

Global and gene-specific DNA methylation pattern discriminates cholecystitis from gallbladder cancer patients in Chile  

PubMed Central

Aim The aim of the study was to evaluate the use of global and gene-specific DNA methylation changes as potential biomarkers for gallbladder cancer (GBC) in a cohort from Chile. Material & methods DNA methylation was analyzed through an ELISA-based technique and quantitative methylation-specific PCR. Results Global DNA Methylation Index (p = 0.02) and promoter methylation of SSBP2 (p = 0.01) and ESR1 (p = 0.05) were significantly different in GBC when compared with cholecystitis. Receiver curve operator analysis revealed promoter methylation of APC, CDKN2A, ESR1, PGP9.5 and SSBP2, together with the Global DNA Methylation Index, had 71% sensitivity, 95% specificity, a 0.97 area under the curve and a positive predictive value of 90%. Conclusion Global and gene-specific DNA methylation may be useful biomarkers for GBC clinical assessment. PMID:25066711

Kagohara, Luciane Tsukamoto; Schussel, Juliana L; Subbannayya, Tejaswini; Sahasrabuddhe, Nandini; Lebron, Cynthia; Brait, Mariana; Maldonado, Leonel; Valle, Blanca L; Pirini, Francesca; Jahuira, Martha; Lopez, Jaime; Letelier, Pablo; Brebi-Mieville, Priscilla; Ili, Carmen; Pandey, Akhilesh; Chatterjee, Aditi; Sidransky, David; Guerrero-Preston, Rafael

2015-01-01

105

Metastatic carcinoid tumour mimicking cholecystitis, and a rare case of intussusception  

PubMed Central

This report describes an acute presentation of obstructive jaundice, with a clinical picture of cholecystitis. A primary carcinoid tumour in the terminal ileum with hepatic secondaries was found to be the cause. Additionally, in the terminal ileum was a closely associated lipoma leading to an ileo-caecal intussusception. There are few such cases in the literature, particularly in the absence of any changes in bowel habit or lower abdominal pain. The majority of cases of intussusception in clinical practice occur in the paediatric population. Of the small numbers (<5%) that occur in adulthood, the underlying aetiology is most commonly a primary adenocarcinoma, with a far smaller number being attributable to lipoma, lymphoma and polyps. PMID:22707667

Poynter, L R; Tewari, N; Khawaja, H T

2011-01-01

106

The role of prostanoids in the production of acute acalculous cholecystitis by platelet-activating factor.  

PubMed Central

Gallbladder tissue from patients with acute acalculous cholecystitis contains increased amounts of prostanoids when compared to normal gallbladder tissue. Platelet-activating factor (PAF) is a potent stimulus of eicosanoid formation. It has been implicated as a mediator of acute inflammatory processes and systemic responses to shock. In this study the role of PAF in acute acalculous cholecystitis was evaluated. Anesthetized cats underwent gallbladder perfusion with a physiologic buffer solution containing [14C]polyethylene glycol as a nonabsorbable tracer to quantitate mucosal water absorption. Platelet-activating factor was infused into the hepatic artery for 2 hours. Control experiments were performed when vehicle alone was infused. Experiments also were performed when indomethacin was administered intravenously and when indomethacin and PAF were administered. Gallbladder mucosal absorption/secretion and perfusate and tissue prostaglandin E (PGE) and 6 keto prostaglandin F1 alpha (6-keto PGF1 alpha) levels were evaluated. Gallbladder inflammation was evaluated by beta-glucuronidase and myeloperoxidase tissue concentrations and by a histologic scoring system. Platelet-activating factor eliminated gallbladder absorption and produced net fluid secretion associated with dose-related increases in perfusate PGE concentrations and gallbladder tissue PGE and 6 keto PGF1 alpha levels when compared to control values. Platelet-activating factor produced significant inflammation in the gallbladder with increases in the histologic score of inflammation and tissue lysosomal enzyme activities. Indomethacin significantly decreased the fluid secretion, prostanoid levels, and inflammation produced by PAF. The results suggest that PAF may induce acute gallbladder inflammation associated with systemic stress through a prostanoid-mediated mechanism. Images Fig. 2. PMID:2171443

Kaminski, D L; Andrus, C H; German, D; Deshpande, Y G

1990-01-01

107

Uterine artery embolization for symptomatic myomata.  

PubMed

Fibroid disease is common and causes significant health problems in women of childbearing age. Over the past several years, uterine artery embolization (UAE) has emerged as a minimally invasive treatment for symptomatic uterine myomata. Embolotherapy is effective in relieving myoma-related symptoms in 80% to 90% of patients. It requires shorter hospitalizations than traditional surgical therapies for myoma disease and is associated with faster recovery and lower complication risks than surgery. Patient selection, the UAE procedure, and post-UAE management are reviewed. PMID:15035751

Worthington-Kirsch, Robert L; Siskin, Gary P

2004-01-01

108

MRI of symptomatic sacral perineural cyst.  

PubMed

Sacral perineural cyst is a relatively rare condition. To our knowledge, reports of MR findings associated with sacral perineural cyst have been limited to only six cases. We present for the first time high field MR findings in a case of sacral perineural cyst. The cyst appeared as a cystic lesion in the sacral spinal canal and had intermediate signal intensity on T1W images and high signal intensity on T2*W images compared with CSF. Slight erosion remodeling of the sacrum was also seen anteriorly. Our case was symptomatic and present with radiculopathy (sciatic pain). Surgical treatment was done to result in dramatic improvement of the sciatic pain. PMID:1337620

Araki, Y; Tsukaguchi, I; Ishida, T; Ootani, M; Yamamoto, T; Tomoda, K; Mitomo, M

1992-01-01

109

Ponticulus Posticus on the Posterior Arch of Atlas, Prevalence Analysis in Symptomatic and Asymptomatic Patients of Gulbarga Population  

PubMed Central

Aims and Objectives: To investigate the prevalence and morphological features of Ponticulus Posticus (PP) in symptomatic and asymptomatic patients of Gulbarga population, to substantiate whether ponticulus posticus was the possible cause of chronic tension-type headaches and migraine. Material and Methods: Five hundred patients were investigated with digital lateral cephalograms for the presence and type of ponticulus posticus. All the patients in whom ponticulus posticus was present in either partial or complete form were further studied for symptoms like chronic tension type headache, orofacial pain or diagnosed migraine. Results: Among the sample of 500 cases, partial ponticulus posticus was found in 302 patients (60%) (Males 48% and Females 52%). Complete variant was found in 40 cases (8%) (Males 65% and females 35% both, who were in the age group of 16-45 years), with a mean age of 28 years and SD 27.76 ±10.74. In partial PP, 42 patients (14%) were found to be symptomatic. In complete form, 32 patients (78%) were found to be symptomatic. Symptoms were mainly in the form of migraine or chronic type of headache. Conclusion: According to our study, partial form of PP was found to be more prevalent as compared to complete form in Gulbarga population and complete form of ponticulus posticus can be considered as possible cause for chronic tension type headache, orofacial pain and migraine. PMID:24551723

Chitroda, Parita K.; Katti, Girish; Baba, Irfan A.; Najmudin, Mohammad; Ghali, Sreenivas Rao; Kalmath, Bhuvaneshwari; G., Vijay

2013-01-01

110

Clinical outcomes of symptomatic arterioportal fistulas after transcatheter arterial embolization  

PubMed Central

AIM: To evaluate the complications and clinical outcomes of transcatheter arterial embolization (TAE) for symptoms related to severe arterioportal fistulas (APFs). METHODS: Six patients (3 males, 3 females; mean age, 63.8 years; age range, 60-71 years) with chronic liver disease and severe APFs due to percutaneous intrahepatic treatment (n = 5) and portal vein (PV) tumor thrombosis of hepatocellular carcinoma (n = 1) underwent TAE for symptoms related to severe APFs [refractory ascites (n = 4), hemorrhoidal hemorrhage (n = 1), and hepatic encephalopathy (n = 1)]. Control of symptoms related to APFs and complications were evaluated during the follow-up period (range, 4-57 mo). RESULTS: In all patients, celiac angiography revealed immediate retrograde visualization of the main PV before TAE, indicating severe APF. Selective TAE for the hepatic arteries was performed using metallic coils (MC, n = 4) and both MCs and n-butyl cyanoacrylate (n = 2). Three patients underwent repeated TAEs for residual APFs and ascites. Four patients developed PV thrombosis after TAE. During the follow-up period after TAE, APF obliteration and symptomatic improvement were obtained in all patients. CONCLUSION: Although TAE for severe APFs may sometimes be complicated by PV thrombosis, TAE can be an effective treatment to improve clinical symptoms related to severe APFs. PMID:23494252

Hirakawa, Masakazu; Nishie, Akihiro; Asayama, Yoshiki; Ishigami, Kousei; Ushijima, Yasuhiro; Fujita, Nobuhiro; Honda, Hiroshi

2013-01-01

111

Arthroscopic treatment of symptomatic paralabral cysts in the hip.  

PubMed

Acetabular labral tears or paralabral cysts in the hip are frequently detected using magnetic resonance imaging or arthrography. Unlike parameniscal cysts in the knee and paralabral cysts in the shoulder, reports of the outcomes of surgical treatment for paralabral cysts in the hip recalcitrant to conservative management are limited in the literature.The authors report 2 cases of paralabral cysts in the hip that were treated with arthroscopic surgery. The patients presented with chronic hip pain, and preoperative magnetic resonance imaging showed paralabral cysts at the superior aspect of the acetabulum. After failure of conservative management for more than 6 months, arthroscopic surgery was performed while the patients were under general anesthesia and in a supine position on a fracture table. Arthroscopic examination confirmed the preoperative diagnosis of paralabral cysts with degenerative labral fibrillation or tears in both patients. Arthroscopic cyst decompression and debridement of the degenerative labral tissues were performed using an arthroscopic thermal probe and a shaver.Clinical outcomes, determined by the Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index score, and University of California, Los Angeles activity score, were satisfactory for the 2 patients at 2 and 3 years postoperatively, respectively. Magnetic resonance imaging obtained for 1 patient at 6 months postoperatively showed complete decompression of the paralabral cyst. The authors believe that arthroscopic treatment for symptomatic hip paralabral cysts is a safe and effective procedure with excellent clinical outcomes. PMID:23464960

Lee, Keun-Ho; Park, Youn-Soo; Lim, Seung-Jae

2013-03-01

112

Symptomatic Therapy and Rehabilitation in Primary Progressive Multiple Sclerosis  

PubMed Central

Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system and a major cause of chronic neurological disability in young adults. Primary progressive MS (PPMS) constitutes about 10% of cases, and is characterized by a steady decline in function with no acute attacks. The rate of deterioration from disease onset is more rapid than relapsing remitting and secondary progressive MS types. Multiple system involvement at onset and rapid early progression have a worse prognosis. PPMS can cause significant disability and impact on quality of life. Recent studies are biased in favour of relapsing remitting patients as treatment is now available for them and they are more likely to be seen at MS clinics. Since prognosis for PPMS is worse than other types of MS, the focus of rehabilitation is on managing disability and enhancing participation, and application of a “neuropalliative” approach as the disease progresses. This chapter presents the symptomatic treatment and rehabilitation for persons with MS, including PPMS. A multidisciplinary approach optimizes the intermediate and long-term medical, psychological and social outcomes in this population. Restoration and maintenance of functional independence and societal reintegration, and issues relating to quality of life are addressed in rehabilitation processes. PMID:22013521

Khan, Fary; Amatya, Bhasker; Turner-Stokes, Lynne

2011-01-01

113

Association of symptomatic human infection with Toxoplasma gondii with imbalance of monocytes and antigen-specific T cell subsets.  

PubMed

During recent symptomatic toxoplasmosis, alterations in quantity and function of mononuclear cells in peripheral blood were observed. Flow cytofluorometric analysis and differential leukocyte counts revealed increased absolute numbers of T8+ cells, Leu 7+ (natural killer/killer) cells, and monocytes. T4+ cells and HLA-DR+ cells were not significantly changed. T4/T8 cell ratios were reversed in symptomatic toxoplasmosis (0.7 +/- 0.3) and normal in chronic infection (1.7 +/- 0.5). Toxoplasma antigen induced higher numbers of T8+ and TQ1+ cells in four T cell lines from two individuals with symptomatic infection than in five T cell lines from three individuals with asymptomatic infection. Eight cloned T cell lines produced gamma interferon in an antigen-specific fashion and in higher amounts when they originated from an asymptomatic subject than from a symptomatic subject. These results indicate that marked alterations in properties of immunoregulatory cells are characteristic of recent symptomatic toxoplasmosis. The transient immune dysfunction may be a major part of the observed disease and/or a feature of successful parasitism. PMID:2935581

Sklenar, I; Jones, T C; Alkan, S; Erb, P

1986-02-01

114

Laparoscopic cholecystectomy for severe acute cholecystitis in a patient with situs inversus totalis and posterior cystic artery.  

PubMed

Situs inversus totalis is an inherited condition characterized by a mirror-image transposition of thoracic and abdominal organs. It often coexists with other anatomical variations. Transposition of the organs imposes special demands on the diagnostic and surgical skills of the surgeon. We report a case of a 34-year-old female patient presented with left upper quadrant pain, signs of acute abdomen, and unknown situs inversus totalis. Severe acute cholecystitis was diagnosed, and an uneventful laparoscopic cholecystectomy was performed. A posterior cystic artery was identified and ligated. Laparoscopic cholecystectomy is feasible in patients with severe acute calculus cholecystitis and situs inversus totalis; however, the surgeon should be alert of possible anatomic variations. PMID:18493329

Pavlidis, Theodoros E; Psarras, Kyriakos; Triantafyllou, Apostolos; Marakis, Georgios N; Sakantamis, Athanasios K

2008-01-01

115

A MODEL OF SYMPTOMATIC INFANTILE SPASMS SYNDROME  

PubMed Central

Infantile spasms are characterized by age-specific expression of epileptic spasms, hypsarrhythmia and often result in significant cognitive impairment. Other epilepsies or autism often ensue especially in symptomatic IS (SIS). Cortical or subcortical damage, including white matter, have been implicated in the pathogenesis of SIS. To generate a model of SIS, we recreated this pathology by injecting rats with lipopolysaccharide and doxorubicin intracerebrally at postnatal day (P) 3 and with p-chlorophenylalanine intraperitoneally at P5. Spasms occurred between P4–13 and were associated with ictal EEG correlates, interictal EEG abnormalities and neurodevelopmental decline. After P9 other seizures, deficits in learning and memory, and autistic-like behaviors (indifference to other rats, increased grooming) were observed. Adrenocorticotropic hormone (ACTH) did not affect spasms. Vigabatrin transiently suppressed spasms at P5. This new model of SIS will be useful to study the neurobiology and treatment of SIS, including those that are refractory to ACTH. PMID:19945533

Scantlebury, Morris H.; Galanopoulou, Aristea S.; Chudomelova, Lenka; Raffo, Emmanuel; Betancourth, David; Moshé, Solomon L.

2009-01-01

116

[Cannabinoids for symptomatic therapy of multiple sclerosis].  

PubMed

Spasticity represents a common troublesome symptom in patients with multiple sclerosis (MS). Treatment of spasticity remains difficult, which has prompted some patients to self-medicate with and perceive benefits from cannabis. Advances in the understanding of cannabinoid biology support these anecdotal observations. Various clinical reports as well as randomized, double-blind, placebo-controlled studies have now demonstrated clinical efficacy of cannabinoids for the treatment of spasticity in MS patients. Sativex is a 1:1 mix of delta-9-tetrahydocannabinol and cannabidiol extracted from cloned Cannabis sativa chemovars, which recently received a label for treating MS-related spasticity in Germany. The present article reviews the current understanding of cannabinoid biology and the value of cannabinoids as a symptomatic treatment option in MS. PMID:22080198

Husseini, L; Leussink, V I; Warnke, C; Hartung, H-P; Kieseier, B C

2012-06-01

117

Sensitivity of hepatobiliary imaging and real-time ultrasonography in the detection of acute cholecystitis  

SciTech Connect

To determine the sensitivity of hepatobiliary imaging (HBI) and strict- and liberal-criteria real-time ultrasonography (RTUS), the authors retrospectively analyzed 100 cases of pathologically proved acute cholecystitis (AC). A positive HBI was one in which there was nonvisualization of the gallbladder up to four hours after the administration of technetium 99m-disofenin. In the absence of hypoalbuminemia, cirrhosis, or ascites, pathognomonic RTUS findings (strict criteria) for AC were wall edema and/or pericholecystic fluid. Findings indicative of AC (liberal criteria) included the demonstration of stones, a thick gallbladder wall, nonshadowing echoes, or the ultrasonographic Murphy's sign. Of the 100 cases of AC, 91 were calculous, and nine were acalculous. Four of 100 patients had associated choledocholithiasis. The sensitivities in detecting calculous AC were as follows: HBI, 97%; liberal-criteria RTUS, 86%; and strict-criteria RTUS, 24%. The sensitivities in detecting acalculous AC were as follows: HBI, 100%; liberal-criteria RTUS, 89%; and strict-criteria RTUS, 44%.

Fink-Bennett, D.; Freitas, J.E.; Ripley, S.D.; Bree, R.L.

1985-08-01

118

Hydrophilic but not hydrophobic bile acids prevent gallbladder muscle dysfunction in acute cholecystitis.  

PubMed

The pathogenesis of acute cholecystitis (AC) is controversial. Bile acids may be involved in the pathogenesis of AC because the hydrophobic chenodeoxycholic acid (CDCA) reproduced in vitro the muscle dysfunction observed in AC and was prevented by the hydrophilic ursodeoxycholic acid (UDCA). The present study examined the in vivo effects of UDCA or CDCA on gallbladder muscle dysfunction caused by AC. Guinea pigs were treated with placebo, UDCA, or CDCA for 2 weeks before sham operation or induction of AC by bile duct ligation (BDL) for 3 days. Pretreatment with oral UDCA prevented the defective contraction in response to agonists (acetylcholine [ACh], cholecystokinin 8 [CCK-8], and KCl) that occurs after BDL. Prostaglandin (PG) E(2)-induced contraction remained normal in the placebo and UDCA-treated groups but was impaired in the CDCA-treated group. Treatment with UDCA also prevented the expected increase in the levels of H(2)O(2), lipid peroxidation, and PGE(2) content in the placebo-treated AC group, whereas CDCA caused further increases in these oxidative stress markers. The binding capacity of PGE(2) to its receptors and the activity of catalase were reduced after treatment with CDCA. Treatment with UDCA enriched gallbladder bile acids with its conjugates and reduced the percentage of CDCA conjugates. In contrast, treatment with CDCA significantly decreased the percentage of UDCA in bile. In conclusion, oral treatment with UDCA prevents gallbladder muscle damage caused by BDL, whereas oral treatment with CDCA worsens the defective muscle contractility and the oxidative stress. PMID:12774024

Xiao, Zuo-Liang; Biancani, Piero; Carey, Martin C; Behar, Jose

2003-06-01

119

Echocardiography in Patients with Symptomatic Intracranial Stenosis  

PubMed Central

Background and Purpose Echocardiography is often performed in stroke patients, even when alterative stroke etiologies are identified. We evaluated the utility of echocardiography in patients with TIA or stroke due to stenosis of a major intracranial artery. Methods The Warfarin versus Aspirin for Symptomatic Intracranial Disease (WASID) trial was an NIH-funded randomized, double-blinded, multicenter clinical trial in which 569 patients with TIA or ischemic stroke attributed to angiographically-proven 50–99% stenosis of a major intracranial artery were randomly assigned to warfarin or aspirin. Patients with unequivocal cardiac sources of embolism were excluded. The risk of ischemic stroke, myocardial infarction (MI), and vascular death was compared among patients who had or did not have echocardiography performed prior to enrollment, and Cox proportional hazards models were employed to determine whether echocardiographic abnormalities present in >5% of subjects were associated with these outcomes. Results 264 of 569 patients in WASID had echocardiograms; 37% were transesophageal. Of these 264 patients, 69 suffered subsequent ischemic stroke, MI, or vascular death. Patients who underwent echocardiography had similar event rates to those who did not (p=0.18). Common abnormalities identified on echocardiography were not associated with subsequent risk in this population. Conclusions Among patients with TIA or stroke due to intracranial arterial stenosis, echocardiography appears to offer limited diagnostic and prognostic value. PMID:17845919

Kasner, Scott E.; Lynn, Michael J.; Jackson, Bryon P.; Pullicino, Patrick M.; Chimowitz, Marc I.

2007-01-01

120

Collateral circulation in symptomatic intracranial atherosclerosis.  

PubMed

Collateral circulation in intracranial atherosclerosis has never been systematically characterized. We investigated collaterals in a multicenter trial of symptomatic intracranial atherosclerotic disease. Baseline angiography was reviewed for information on collaterals in stenoses of the internal carotid, middle cerebral, vertebral, and basilar arteries. A battery of angiographic scales was utilized to evaluate lesion site, arterial patency, antegrade flow, downstream territorial perfusion, and collateral circulation, blinded to all other data. Collateral circulation was adequately available for analysis in 287/569 (50%) subjects with proximal arterial stenoses ranging from 50% to 99%. Extent of collaterals was absent or none in 69%, slow or minimal in 10%, more rapid, yet incomplete perfusion of territory in 7%, complete but delayed perfusion in 11%, and rapid, complete collateral perfusion in 4%. Extent of collateral flow correlated with percentage of stenosis (P<0.0001), with more severe stenoses exhibiting greater compensation via collaterals. Overall, collateral grade increased with diminished antegrade flow across the lesion (thrombolysis in myocardial ischemia) and resultant downstream perfusion (thrombolysis in cerebral infarction) (both P<0.001). Our findings provide the initial detailed description of collaterals across a variety of stenoses, suggesting that collateral perfusion is a pivotal component in pathophysiology of intracranial atherosclerosis and implicating the need for further evaluation in ongoing studies. PMID:21157476

Liebeskind, David S; Cotsonis, George A; Saver, Jeffrey L; Lynn, Michael J; Cloft, Harry J; Chimowitz, Marc I

2011-05-01

121

Collateral circulation in symptomatic intracranial atherosclerosis  

PubMed Central

Collateral circulation in intracranial atherosclerosis has never been systematically characterized. We investigated collaterals in a multicenter trial of symptomatic intracranial atherosclerotic disease. Baseline angiography was reviewed for information on collaterals in stenoses of the internal carotid, middle cerebral, vertebral, and basilar arteries. A battery of angiographic scales was utilized to evaluate lesion site, arterial patency, antegrade flow, downstream territorial perfusion, and collateral circulation, blinded to all other data. Collateral circulation was adequately available for analysis in 287/569 (50%) subjects with proximal arterial stenoses ranging from 50% to 99%. Extent of collaterals was absent or none in 69%, slow or minimal in 10%, more rapid, yet incomplete perfusion of territory in 7%, complete but delayed perfusion in 11%, and rapid, complete collateral perfusion in 4%. Extent of collateral flow correlated with percentage of stenosis (P<0.0001), with more severe stenoses exhibiting greater compensation via collaterals. Overall, collateral grade increased with diminished antegrade flow across the lesion (thrombolysis in myocardial ischemia) and resultant downstream perfusion (thrombolysis in cerebral infarction) (both P<0.001). Our findings provide the initial detailed description of collaterals across a variety of stenoses, suggesting that collateral perfusion is a pivotal component in pathophysiology of intracranial atherosclerosis and implicating the need for further evaluation in ongoing studies. PMID:21157476

Liebeskind, David S; Cotsonis, George A; Saver, Jeffrey L; Lynn, Michael J; Cloft, Harry J; Chimowitz, Marc I

2011-01-01

122

Outcome of symptomatic upper lumbar disc herniation.  

PubMed

"Upper" lumbar disc herniations (LDH) are different from the "lower" and possess increased chance of neural compromise and cauda equina syndrome that necessitates operative management despite of contradictory surgical outcome. We underwent the study to assess the clinical and functional outcome of symptomatic upper LDH surgery from July 2003 to June 2012 in BSMMU, Dhaka, Bangladesh. The records of 123 patients (age range, 30-69 years), 56 men and 67 women (mean 52 years) having upper lumbar discectomy were reviewed. The surgical time, intra-operative blood loss, self evaluated back pain and thigh and/or groin pain status [using Visual Analogue Score (VAS)] and the disability status [using Oswestry disability (ODI) questionnaire] was analyzed. Radiological stability (using Posner's criteria), functional outcome [using Japanese Orthopaedic Association (JOA) Score] and overall outcome (using MacNab`s criteria), was calculated. Chi-squared test and z-test using SPSS revealed mean operative time and mean blood loss had no significant (p>0.05) difference. Pain, sensory, motor and reflex status as well as VAS, ODI and all the components of JOA questionnaire had significant (p<0.05) improvement. In spite of intra-operative complications in 20.32% cases, overall satisfactory outcome was achieved in 83.74% cases. The postoperative complications (08.13%) could be managed conservatively. However, carefully decided surgical alternatives resulted in satisfactory clinical and functional outcome in upper LDH surgery. PMID:25481595

Awwal, M A; Ahsan, M K; Sakeb, N

2014-10-01

123

Symptomatic spinal epidural lipomatosis with severe obesity at a young age.  

PubMed

Symptomatic spinal epidural lipomatosis is a rare disorder characterized by overgrowth of fat in the extradural space. Most patients have an underlying endocrine disorder, such as Cushing's syndrome, or have taken exogenous steroids chronically. Although less common, obesity alone is thought to be a cause of spinal epidural lipomatosis, representing <25% of reported cases. Patients rarely become symptomatic before middle age without chronic exogenous steroid use. The usual clinical manifestations are similar to degenerative lumbar stenosis with neurogenic claudication, resulting in decreased walking and standing endurance with variable neurological deficits.This article describes 2 unique cases of spinal epidural lipomatosis, both in young patients with underlying morbid obesity who presented with acute progressive leg weakness and urinary retention. The patients had no underlying endocrinopathy, nor any history of exogenous steroid use. They underwent emergency laminectomy and removal of epidural fat, and histopathological examination confirmed the diagnosis of epidural lipomatosis. Postoperatively, the patients demonstrated significant improvement.We conducted a review of the available English literature and compared the age distribution in each group. Based on our review, our 2 patients are considerably younger than those in past reports, especially in the patient group to which the steroid was not administered. In addition, few cases exist of spinal epidural lipomatosis with acute sphincter dysfunction and paraparesis. Our cases suggest that morbid obesity can lead to juvenile spinal epidural lipomatosis with acute neurological changes. PMID:21667917

Ohba, Tetsuro; Saito, Toshiki; Kawasaki, Nobuchika; Maekawa, Shingo; Haro, Hirotaka

2011-06-01

124

Delayed Laparoscopic Cholecystectomy Is Safe and Effective for Acute Severe Calculous Cholecystitis in Patients with Advanced Cirrhosis: A Single Center Experience  

PubMed Central

Acute calculous cholecystitis is a common disease in cirrhotic patients. Laparoscopic cholecystectomy can resolve this problem but is performed based on the premise that the local inflammation must been controlled. An Initial ultrasound guided percutaneous transhepatic cholecystostomy may reduce the local inflammation and provide advantages in subsequent surgery. In this paper, we detailed our experience of treating acute severe calculous cholecystitis in patients with advanced cirrhosis by delayed laparoscopic cholecystectomy plus initiated ultrasound guided percutaneous transhepatic cholecystostomy and provided the analysis of the treatment effect. We hope this paper can provided a kind of standard procedure for this special disease; however, further prospective comparative randomized trials are needed to assess this treatment in cirrhotic patients with acute cholecystitis. PMID:24772166

Huang, Pingzhu; Chen, Xingui; Yang, Peisheng

2014-01-01

125

Polarization-correlation diagnostics and differentiation of cholelithiasis in patients with chronic cholecystitis combined with diabetes mellitus type 2  

NASA Astrophysics Data System (ADS)

The principles of optical modeling of human bile polycrystalline structure are described. The main types of polycrystalline structures are detailed. It has been proposed and founded the scenarios of formation of bile microscopic images polarization structure in coherent radiation. The results of investigating the interrelation between statistical moments of the 1st-4th order are presented that characterize the coordinate distributions of intensity of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

Marchuk, Yu F.; Fediv, O. I.; Ivashchuk, I. O.; Andriychuk, D. R.

2011-09-01

126

Polarization-phase diagnostics of latent course of cholelithiasis in patients with chronic cholecystitis combined with diabetes mellitus type 2  

NASA Astrophysics Data System (ADS)

The principles of optical model of human bile polycrystalline structure are described. The three optical levels - isotropic, liquid-crystal and solid-crystal have been proposed. It has been introduced and proposed the scenarios of phase distribution formation in the boundary field of laser radiation, transformed by bile layers. The experimental scheme of direct measurement of coordinate phase distributions has been presented. The results of investigating the interrelation between the values of correlation and fractal parameters are presented. They characterize the coordinate distributions of phase shifts between the orthogonal components of the amplitude in the points of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

Fediv, O. I.; Ivashchuk, O. I.; Marchuk, Yu. F.; Andriychuk, D. R.

2012-01-01

127

Polarization-correlation diagnostics and differentiation of cholelithiasis in patients with chronic cholecystitis combined with diabetes mellitus type 2  

NASA Astrophysics Data System (ADS)

The principles of optical modeling of human bile polycrystalline structure are described. The main types of polycrystalline structures are detailed. It has been proposed and founded the scenarios of formation of bile microscopic images polarization structure in coherent radiation. The results of investigating the interrelation between statistical moments of the 1st-4th order are presented that characterize the coordinate distributions of intensity of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

Marchuk, Yu F.; Fediv, O. I.; Ivashchuk, I. O.; Andriychuk, D. R.

2012-01-01

128

Polarization-phase diagnostics of latent course of cholelithiasis in patients with chronic cholecystitis combined with diabetes mellitus type 2  

NASA Astrophysics Data System (ADS)

The principles of optical model of human bile polycrystalline structure are described. The three optical levels - isotropic, liquid-crystal and solid-crystal have been proposed. It has been introduced and proposed the scenarios of phase distribution formation in the boundary field of laser radiation, transformed by bile layers. The experimental scheme of direct measurement of coordinate phase distributions has been presented. The results of investigating the interrelation between the values of correlation and fractal parameters are presented. They characterize the coordinate distributions of phase shifts between the orthogonal components of the amplitude in the points of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

Fediv, O. I.; Ivashchuk, O. I.; Marchuk, Yu. F.; Andriychuk, D. R.

2011-09-01

129

Trichomoniasis as Seen in a Chronic Vaginitis Clinic  

PubMed Central

Objective: We sought to determine the clinical and laboratory features of trichomonas vaginitis (TV) in a chronic vaginitis clinic. Methods: We studied 45 women with symptomatic TV attending a specialty chronic vaginitis clinic. These patients were older than the usual symptomatic patients with TV. They frequently described unusual chronicity of symptoms, half being referred because of clinical resistance and the other half referred because of chronic vaginitis of unknown etiology. Results: In spite of the chronicity of infection, the signs and symptoms of florid inflammation were still evident and high numbers of polymorphonuclear leukocytes and parasitic load were present. Conclusions: A longstanding infection, especially if previously untreated, invariably responded to conventional nitroimidazole therapy. In addition, the majority of patients seen with clinical resistance to the conventional doses of metronidazole responded to high-dose oral metronidazole therapy. Unsuspected TV should always be considered in low-risk patients with chronic vulvovaginal symptoms. PMID:18476071

Dan, Michael

1996-01-01

130

Seroprevalence of Helicobacter pylori infection among family members of infected and non-infected symptomatic children.  

PubMed

This study determined the prevalence of seropositivity of anti-H. pylori IgG antibodies, and evaluated some socio-epidemiologic characteristics among family members of infected and non-infected symptomatic children. One hundred children with upper gastrointestinal symptoms without previous H. pylori eradication treatment were prospectively studied by both upper endoscopy with histopathological biopsies examination, and serum anti-H. pylori IgG test between July 2012 to June 2013. The patients were subdivided into: H. pylori infected children (GI), and H. pylori non-infected children (GII). Also, 320 of their family members were examined for serum anti-H. pylori IgG and stool antigen tests. Sheets were filled out included personal and medical history. The results showed statistically significant difference between both groups as regard dyspepsia, anemia, and histopathological findings (chronic active gastritis, peptic ulcer, and duodenitis). Family members were subdivided into: those of H. pylori infected symptomatic children (165) and those of H. pylori non-infected symptomatic children (155). Anti-H. pylori IgG prevalence was significantly higher in relatives of GI than those of GII (69.1% vs. 29%; p<0.05). The seroprevalence of H.pylori infection in all family members was (49.7%). Mothers of GI showed the highest seroprevalence (39.5%) as compared to fathers and siblings (22.8%, & 37.7%, respectively). Relatives of GI with low socioeconomic status, and lived in rural area showed the highest seroprevalence (82.5%, & 78.1% respectively). PMID:24640875

Hamed, Mohammed E; Hussein, Hatem M; El Sadany, Hosam F; Elgobashy, Ashgan A; Atta, Amal H

2013-12-01

131

Responses to Novelty and Vulnerability to Cocaine Addiction: Contribution of a Multi-Symptomatic Animal Model  

PubMed Central

Epidemiological studies have revealed striking associations between several distinct behavioral/personality traits and drug addiction, with a large emphasis on the sensation-seeking trait and the associated impulsive dimension of personality. However, in human studies, it is difficult to identify whether personality/behavioral traits actually contribute to increased vulnerability to drug addiction or reflect psychobiological adaptations to chronic drug exposure. Here we show how animal models, including the first multi-symptomatic model of addiction in the rat, have contributed to a better understanding of the relationships between different subdimensions of the sensation-seeking trait and different stages of the development of cocaine addiction, from vulnerability to initiation of cocaine self-administration to the transition to compulsive drug intake. We argue that sensation seeking predicts vulnerability to use cocaine, whereas novelty seeking, akin to high impulsivity, predicts instead vulnerability to shift from controlled to compulsive cocaine use, that is, addiction. PMID:23125204

Belin, David; Deroche-Gamonet, Véronique

2012-01-01

132

Symptomatic cholelithiasis and functional disorders of the biliary tract.  

PubMed

Symptomatic cholelithiasis and functional disorders of the biliary tract present with similar signs and symptoms. The functional disorders of the biliary tract include functional gallbladder disorder, dyskinesia, and the sphincter of Oddi disorders. Although the diagnosis and treatment of symptomatic cholelithiasis are relatively straightforward, the diagnosis and treatment of functional disorders can be much more challenging. Many aspects of the diagnosis and treatment of functional disorders are in need of further study. This article discusses uncomplicated gallstone disease and the functional disorders of the biliary tract to emphasize and update the essential components of diagnosis and management. PMID:24679419

Cafasso, Danielle E; Smith, Richard R

2014-04-01

133

Bleomycin Sclerotherapy for Severe Symptomatic and Persistent Pelvic Lymphocele  

PubMed Central

Background. Pelvic lymphoceles are frequently described as a complication of pelvic lymphadenectomy performed for surgical staging of gynaecologic malignancies. Case Report. A 72-year-old woman presented with severe symptomatic and refractory lymphocele associated with persistent lower limb lymphedema and recurrent erysipelas. After four CT fluoroscopy scan guided percutaneous catheter drainages, the lymphocele complicated with infection finally resolved with two sessions of bleomycin sclerotherapy. Conclusion. Symptomatic persistent lymphoceles require treatment and nowadays the first option is interventional radiologic procedures. Bleomycin is a safe and effective sclerosing agent and therefore should be regarded as a first-line treatment choice. PMID:25105040

Fernandes, Ana Sofia; Costa, Antónia; Mota, Raquel; Paiva, Vera

2014-01-01

134

Cryptococcal aortitis presenting as a symptomatic abdominal aortic aneurysm.  

PubMed

We report a case of cryptococcal aortitis in a 59-year-old man presenting as a symptomatic suprarenal abdominal aortic aneurysm (AAA). The patient underwent repair of his aneurysm using a rifampin-soaked graft with omental wrapping. Intraoperative Gram stains showed yeast organisms, the cultures eventually grew Cryptococcus neoformans with results available 43 days postoperatively. He was started on antifungal therapy intraoperatively and will be on lifelong antifungal treatment. Our case is the first report of cryptoccocal aortitis presenting as a symptomatic AAA; the diagnosis of a true mycotic aneurysm was made intraoperatively. PMID:25452084

Karam, Joseph; Tsiouris, Athanasios; Vazquez, Jose; Shepard, Alexander

2015-02-01

135

Sleep-disordered breathing in patients with symptomatic heart failure A contemporary study of prevalence in and characteristics of 700 patients  

Microsoft Academic Search

Aim: Evaluation of the prevalence and nature of sleep-disordered breathing (SDB) in patients with symptomatic chronic heart failure (CHF) receiving therapy according to current guidelines. Methods and results: We prospectively screened 700 patients with CHF (NYHA class ?II, LV-EF ?40%) for SDB using cardiorespiratory polygraphy (Embletta™). Furthermore, echocardiography, cardiopulmonary exercise and 6-min walk testing were performed. Medication included ACE-inhibitors and\\/or

Olaf Oldenburg; Barbara Lamp; Lothar Faber; Helmut Teschler; Dieter Horstkotte; Volker Töpfer

2007-01-01

136

Percutaneous nephrostomy for symptomatic hypermobile kidney: a single centre experience  

PubMed Central

Introduction Symptomatic hypermobile kidney is treated with nephropexy, a surgical procedure through which the floating kidney is fixed to the retroperitoneum. Although both open and endoscopic procedures have a high success rate, they can be associated with risk of complications, relatively long hospital stay and high cost. Aim We describe our percutaneous technique for fixing a hypermobile kidney and evaluate the efficacy of the percutaneous nephrostomy insertion in management of symptomatic nephroptosis. Material and methods Between January 2005 and December 2011, 11 patients diagnosed with a symptomatic right nephroptosis of at least 1 year duration were treated with a single point percutaneous nephrostomy technique. All data were retrieved from patients’ medical records and then retrospectively analysed. Results Nephropexy through a single point percutaneous nephrostomy technique was successfully accomplished in 11 women. The mean operative time was 20 min. The intraoperative estimated blood loss was minimal in all cases. No major or minor intraoperative complications were noted. The average postoperative hospital stay was 2 days. Women returned to their usual activities 14 days following the surgery. Nine women had complete resolution of their pain, and 2 patients continued to complain of discomfort in their lumbar area. One patient was re-operated upon with satisfactory subjective and objective outcomes achieved. One patient refused re-operation. Conclusions Percutaneous nephropexy is simple, inexpensive and effective for treatment of symptomatic hypermobile kidney. It remains a valuable alternative to open, laparoscopic, and robotic methods for fixing a floating kidney.

Starownik, Rados?aw; Bar, Krzysztof; Muc, Kamil; P?aza, Pawe?; Chlosta, Piotr

2014-01-01

137

Quality Improvement Guidelines for Uterine Artery Embolization for Symptomatic Leiomyomata  

Microsoft Academic Search

Uterine artery embolization (UAE) is assuming an important role in the treatment of women with symptomatic uterine leiomyomata worldwide. The following guidelines, which have been jointly published with the Society of Interventional Radiology in the Journal of Vascular and Interventional Radiology, are intended to ensure the safe practice of UAE by identifying the elements of appropriate patient selection, anticipated outcomes,

David M. Hovsepian; Gary P. Siskin; Joseph Bonn; John F. Cardella; Timothy W. I. Clark; Leo E. Lampmann; Donald L. Miller; Reed A. Omary; Jean-Pierre Pelage; Dheeraj Rajan; Marc S. Schwartzberg; Richard B. Towbin; Woodruff J. Walker; David Sacks

2004-01-01

138

Uterine artery embolization for the treatment of symptomatic leiomyomata  

Microsoft Academic Search

Objective: To evaluate uterine artery embolization as an emerging minimally invasive technique in the treatment of patients symptomatic from uterine leiomyomata. Methods: Twenty patients (ages 31–52 years) underwent uterine artery embolization with permanent polyvinyl alcohol particles. Patients were assessed by the same examiner for uterine size and symptomatology. A questionnaire was answered as well as interval ultrasonography to assess uterine

Amy E. Young; L. Russel Malinak; Andrew Harper; Merle H. Barth; George Soltes; Jet Brady

2000-01-01

139

Symptomatic brain involvement as the initial manifestation of neuromyelitis optica.  

PubMed

Neuromyelitis optica (NMO) is an inflammatory demyelinating disorder that predominantly affects the optic nerve and spinal cord; however, symptomatic brain involvement is not rare and is sometimes an initial manifestation in NMO. In this study, we investigated the characteristic features of patients with NMO with symptomatic brain involvement as the initial manifestation of disease (NMO(brain)) compared with patients with NMO who presented initially with optic neuritis or myelitis (NMO(ON/myelitis)). We retrospectively reviewed 27 consecutive Korean patients with NMO with aquaporin-4 antibodies. Patients with NMO(brain) (n=9) initially presented with intractable hiccup/nausea/vomiting and/or encephalopathy at a younger age than the patients with NMO(ON/myelitis) (n=18) (p<0.01). During the disease course, the patients with NMO(brain) continued to show more frequent symptomatic involvement of the brain than the 18 patients with NMO(ON/myelitis) (p<0.05). At the final visit, the mean age was also significantly lower in patients with NMO(brain) than in patients with NMO(ON/myelitis) (p<0.01); however, the Expanded Disability Status Scale scores, used to evaluate disease progression, were not different between the two groups. Our study suggests that patients with NMO who present initially with symptomatic brain involvement may have earlier disease onset and become disabled at a younger age compared to patients with typical NMO. Additional large scale prospective studies are warranted. PMID:23673142

Min, Ju-Hong; Waters, Patrick; Vincent, Angela; Kang, Eun-Suk; Lee, Sujin; Lee, Dong Kyoo; Lee, Kwang Ho; Kim, Byoung Joon

2013-07-01

140

URODYNAMIC CHARACTERIZATION OF NONOBSTRUCTIVE VOIDING DYSFUNCTION IN SYMPTOMATIC ELDERLY MEN  

Microsoft Academic Search

PurposeThe pathogenesis of lower urinary tract symptoms in men without bladder outlet obstruction has not been well characterized. Therefore, we defined the urodynamic abnormalities associated with symptomatic nonobstructive voiding dysfunction, and determined the relationship between age and type of dysfunction.

KANAME AMEDA; MARYROSE P. SULLIVAN; ROBERT J. BAE; SUBBARAO V. YALLA

1999-01-01

141

Chronic arsenic poisoning.  

PubMed

Symptomatic arsenic poisoning is not often seen in occupational exposure settings. Attempted homicide and deliberate long-term poisoning have resulted in chronic toxicity. Skin pigmentation changes, palmar and plantar hyperkeratoses, gastrointestinal symptoms, anemia, and liver disease are common. Noncirrhotic portal hypertension with bleeding esophageal varices, splenomegaly, and hypersplenism may occur. A metallic taste, gastrointestinal disturbances, and Mee's lines may be seen. Bone marrow depression is common. 'Blackfoot disease' has been associated with arsenic-contaminated drinking water in Taiwan; Raynaud's phenomenon and acrocyanosis also may occur. Large numbers of persons in areas of India, Pakistan, and several other countries have been chronically poisoned from naturally occurring arsenic in ground water. Toxic delirium and encephalopathy can be present. CCA-treated wood (chromated copper arsenate) is not a health risk unless burned in fireplaces or woodstoves. Peripheral neuropathy may also occur. Workplace exposure or chronic ingestion of arsenic-contaminated water or arsenical medications is associated with development of skin, lung, and other cancers. Treatment may incklude the use of chelating agents such as dimercaprol (BAL), dimercaptosuccinic acid (DMSA), and dimercaptopanesulfonic acid (DMPS). PMID:11869818

Hall, Alan H

2002-03-10

142

[Surgical treatment of chronic mesenteric ischemia: report of one case].  

PubMed

Although the classic therapy for chronic mesenteric ischemia is surgical revascularization, endovascular therapy is a new therapeutic option. We report a 55 year-old female, with a 2 years history of post prandial abdominal pain, diarrhoea, and weight loss, with occlusion of both mesenteric arteries and critical stenosis of the celiac artery. The initial treatment consisted in angioplasty and celiac artery stent placement in two occasions, with a brief symptomatic relief. Finally, a visceral artery bypass was performed, with good post operative outcome and complete symptomatic resolution at one year follow up. In our opinion endovascular therapy is a good therapeutic option for chronic mesenteric ischemia in high surgical risk patients, specially when dealing with stenotic injuries. It may also be a complement for patients who need to recover their nutritional status prior to revascularization surgery. On the other hand, due to the long term patency and symptomatic relief, surgical treatment is a good option in low risk patients. PMID:17369989

Marín P, Juan; Manríquez C, Luis; Schweizer H, Helmuth; Tellez M, Juan; Rossel D, Gonzalo

2007-01-01

143

Sonographic incidence of tendon microtears in athletes with chronic Achilles tendinosis  

Microsoft Academic Search

OBJECTIVE: To assess the number and distribution of tendon microtears in asymptomatic controls and athletes with chronic Achilles tendinitis or partial thickness tears using high resolution ultrasound. METHODS: The mean number of microtears in three random tendon cross sections were recorded per tendon third in 19 asymptomatic volunteers, 16 athletes with symptomatic chronic Achilles tendinitis, and eight athletes with partial

W. W. Gibbon; J. R. Cooper; G. S. Radcliffe

1999-01-01

144

Regulation of peripheral blood flow in Complex Regional Pain Syndrome: clinical implication for symptomatic relief and pain management  

PubMed Central

Background During the chronic stage of Complex Regional Pain Syndrome (CRPS), impaired microcirculation is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Several mechanisms may be responsible for the ischemia and pain in chronic cold CPRS. Discussion The diminished blood flow may be caused by either sympathetic dysfunction, hypersensitivity to circulating catecholamines, or endothelial dysfunction. The pain may be of neuropathic, inflammatory, nociceptive, or functional nature, or of mixed origin. Summary The origin of the pain should be the basis of the symptomatic therapy. Since the difference in temperature between both hands fluctuates over time in cold CRPS, when in doubt, the clinician should prioritize the patient's report of a persistent cold extremity over clinical tests that show no difference. Future research should focus on developing easily applied methods for clinical use to differentiate between central and peripheral blood flow regulation disorders in individual patients. PMID:19775468

Groeneweg, George; Huygen, Frank JPM; Coderre, Terence J; Zijlstra, Freek J

2009-01-01

145

Venous disease and chronic oedema: treatment and patient concordance.  

PubMed

Compression therapy is the mainstay in the management of chronic venous disease, venous leg ulceration (VLU) and chronic oedema. The management of VLU alone is thought to cost a staggering £400 million per year and accounts for 13% of all district nursing visits. The predicted increase in elderly, obese and chronically ill patients will pose a further strain on already stretched resources. The impact of chronic venous and lymphovenous disease is also costly in terms of physical and psychological terms for patients. Adopting a preventive approach would reduce the financial, workload and symptomatic aspects of this condition. PMID:24820810

Todd, Marie

146

Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): Study protocol for a randomized controlled trial  

PubMed Central

Background Laparoscopic cholecystectomy in acute calculous cholecystitis in high risk patients can lead to significant morbidity and mortality. Percutaneous cholecystostomy may be an alternative treatment option but the current literature does not provide the surgical community with evidence based advice. Methods/Design The CHOCOLATE trial is a randomised controlled, parallel-group, superiority multicenter trial. High risk patients, defined as APACHE-II score 7-14, with acute calculous cholecystitis will be randomised to laparoscopic cholecystectomy or percutaneous cholecystostomy. During a two year period 284 patients will be enrolled from 30 high volume teaching hospitals. The primary endpoint is a composite endpoint of major complications within three months following randomization and need for re-intervention and mortality during the follow-up period of one year. Secondary endpoints include all other complications, duration of hospital admission, difficulty of procedures and total costs. Discussion The CHOCOLATE trial is designed to provide the surgical community with an evidence based guideline in the treatment of acute calculous cholecystitis in high risk patients. Trial Registration Netherlands Trial Register (NTR): NTR2666 PMID:22236534

2012-01-01

147

Chronic hepatitis in childhood: the spectrum of the disease  

Microsoft Academic Search

During a multicentre study of chronic hepatitis in childhood diagnosed by biopsy, the spectrum of the disease has been evaluated in 196 consecutive patients, including 157 from Northern Italy and 39 from Southern Italy. Only 31% of patients in the former group and 27% in the latter were symptomatic when first seen: the majority of cases being seen after familial

F Bortolotti; R Calzia; A Vegnente; P Cadrobbi; M Rugge; M Armigliato; M G Marazzi; R Iorio; C Crivellaro; R Piscopo

1988-01-01

148

Systematic review of the surgical treatment for symptomatic os acromiale  

PubMed Central

The optimal surgical treatment for symptomatic os acromiale that has failed nonoperative management is unclear in the literature. We conducted a systematic review of multiple medical databases for level I–IV evidence. Both radiographic and clinical outcomes were analyzed. Nine studies met the inclusion criteria (118 subjects, 125 shoulders). One hundred and fifteen subjects were treated surgically (122 shoulders). The mean age of the subjects was 49±11 years. The mean preoperative duration of symptoms was 12±8.6 months. Mesoacromiale was the most common type treated (94%). Internal fixation was the most common surgical technique used (60%), followed by excision (27%) and acromioplasty (13%). Rotator cuff repair was the most common concurrent surgical technique (performed in 59% of the surgically treated shoulders), followed by distal clavicle excision (25%). All surgical techniques resulted in improvement in clinical outcomes. Surgical management of symptomatic os acromiale that has failed nonoperative measures may predictably lead to improved outcomes. PMID:21660192

Harris, Joshua D.; Griesser, Michael J.; Jones, Grant L.

2011-01-01

149

Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata.  

PubMed

Uterine artery embolization (UAE) is assuming an important role in the treatment of women with symptomatic uterine leiomyomata worldwide. The following guidelines, which have been jointly published with the Society of Interventional Radiology in the Journal of Vascular and Interventional Radiology, are intended to ensure the safe practice of UAE by identifying the elements of appropriate patient selection, anticipated outcomes, and recognition of possible complications and their timely address. PMID:15346204

Hovsepian, David M; Siskin, Gary P; Bonn, Joseph; Cardella, John F; Clark, Timothy W I; Lampmann, Leo E; Miller, Donald L; Omary, Reed A; Pelage, Jean-Pierre; Rajan, Dheeraj; Schwartzberg, Marc S; Towbin, Richard B; Walker, Woodruff J; Sacks, David

2004-01-01

150

Quality Improvement Guidelines for Uterine Artery Embolization for Symptomatic Leiomyomata  

SciTech Connect

Uterine artery embolization (UAE) is assuming an important role in the treatment of women with symptomatic uterine leiomyomata worldwide. The following guidelines, which have been jointly published with the Society of Interventional Radiology in the Journal of Vascular and Interventional Radiology, are intended to ensure the safe practice of UAE by identifying the elements of appropriate patient selection, anticipated outcomes, and recognition of possible complications and their timely address.

Hovsepian, David M. [Mallinckrodt Institute of Radiology, Division of Vascular and Interventional Radiology (United States)], E-mail: hovsepiand@mir.wustl.edu; Siskin, Gary P. [Albany Medical College, Department of Vascular Radiology (United States); Bonn, Joseph [Thomas Jefferson University Hospital, Department of Radiology (United States)] (and others)

2004-08-15

151

Oxysterols and symptomatic versus asymptomatic human atherosclerotic plaque.  

PubMed

Atherosclerosis is the most common cause of mortality in the Western world, contributing to about 50% of all deaths. Atherosclerosis is characterized by deposition of lipids onto the coronary or carotid arterial wall and formation of an atherosclerotic plaque. Atherosclerotic plaques are categorized into two groups: symptomatic and asymptomatic. The symptomatic plaques tend to be unstable and prone to rupture, and are associated with an increase in ischemic events. Oxysterols, products of cholesterol oxidation, are cytotoxic materials. Their level and type may be associated with plaque formation, development and stability. Oxysterols stimulate the formation of foam cells, advance atherosclerotic plaque progression, and contribute to plaque vulnerability and instability due to their cytotoxicity and their ability to induce cell apoptosis. Studies indicate that plasma 7?-OH CH level can be used as a biomarker for detecting carotid and coronary artery disease. Further clinical studies are needed to evaluate the potential of oxysterols for use as biomarkers for plaque vulnerability and instability. The identification of biomarkers in the blood that can distinguish between symptomatic and asymptomatic plaques remains an unresolved issue. PMID:24393847

Khatib, Soliman; Vaya, Jacob

2014-04-11

152

Treatment options for symptomatic carotid stenosis: Timing and approach.  

PubMed

Stroke is a major cause of morbidity and mortality and up to 15-20% of ischemic strokes can be attributed to atherosclerotic internal carotid artery disease. The treatment of carotid artery disease has been the subject of a wealth of literature in the past twenty years since the publication of the landmark randomized controlled trials, the North American Symptomatic Carotid Endarterectomy Trial and the European Carotid Surgery Trial, in the early 1990s. Although these landmark trials have helped establish the current guidelines for treatment of patients with symptomatic carotid artery disease, there have since been major advancements in the medical treatment of cardiovascular disease and there still remains a great deal of controversy regarding the timing and technical approach to carotid revascularization. In particular, there has been a wealth of literature to determine whether carotid endarterectomy or carotid stenting should be used for revascularization and when this revascularization should occur following onset of symptoms. This update offers an overview of the standards for diagnosis and medical treatment of patients with symptomatic carotid artery disease, the indications for surgical revascularization and a review of the most pertinent literature as it pertains to the more controversial issues of technical approach and timing of surgical revascularization following onset of symptoms in patients with carotid artery disease. PMID:25439169

Vavra, Ashley K; Eskandari, Mark K

2014-11-17

153

Symptomatic versus asymptomatic pyeloplasties: A single institution review  

PubMed Central

Introduction: Historically, pyeloplasties have been performed after symptoms and radiographic confirmation of an ureteropelvic junction obstruction (UPJO). However, with prenatal ultrasonography, the approach to patients has fundamentally changed. Increasingly, patients are diagnosed and treated before the advent of morbidity, based on imaging findings alone. However, optimum screening strategies and thresholds for intervention vary significantly, are controversial, and are not founded on outcome-based evidence. We examined all pyeloplasties performed at our institution and reviewed their indication for surgery. We hypothesized that, despite ubiquitous screening for UPJO, most pyeloplasties had been performed secondary to symptoms and did not benefit from antenatal screening. Methods: A retrospective chart review was performed of all pyeloplasties performed at the Stollery Children’s Hospital, Edmonton, Alberta, over the past 8 years. Patients were categorized according to indication for surgery: symptomatic or asymptomatic. Results: Most (60%) of our pyeloplasties were performed for symptomatic indications. Furthermore, 12% of these patients had antenatally detected hydronephrosis that was thought to have resolved spontaneously during follow-up. Of our symptomatic patients, 37% were undergoing surveillance with the expectation for spontaneous resolution. Of the 29 patients who underwent pyeloplasty, 8 suffered a preoperative loss of function on renal scans; however, only 50% returned to within 90% of their original function. Conclusion: Despite active surveillance of antenatally detected hydronephrosis, most pyeloplasties at our institution were performed for de-novo symptoms. We believe that this simple observation reinforces that our current surveillance strategies are unable to predict and eliminate all morbidity from UPJO. PMID:25553157

Metcalfe, Peter D.; Assmus, Mark; Kiddoo, Darcie

2014-01-01

154

Histopathological analysis of Salmonella chronic carriage in the mouse hepatopancreatobiliary system.  

PubMed

Salmonella Typhi asymptomatic chronic carriage represents a challenge for the diagnosis and prevention of typhoid fever in endemic areas. Such carriers are thought to be reservoirs for further spread of the disease. Gallbladder carriage has been demonstrated to be mediated by biofilm formation on gallstones and by intracellular persistence in the gallbladder epithelium of mice. In addition, both gallstones and chronic carriage have been associated with chronic inflammation and the development of gallbladder carcinoma. However, the pathogenic relationship between typhoid carriage and the development of pre-malignant and/or malignant lesions in the hepatopancreatobiliary system as well as the host-pathogen interactions occurring during chronic carriage remains unclear. In this study, we monitored the histopathological features of chronic carriage up to 1 year post-infection. Chronic cholecystitis and hepatitis ranging from mild to severe were present in infected mice regardless of the presence of gallstones. Biliary epithelial hyperplasia was observed more commonly in the gallbladder of mice with gallstones (uninfected or infected). However, pre-malignant lesions, atypical hyperplasia and metaplasia of the gallbladder and exocrine pancreas, respectively, were only associated with chronic Salmonella carriage. This study has implications regarding the role of Salmonella chronic infection and inflammation in the development of pre-malignant lesions in the epithelium of the gallbladder and pancreas that could lead to oncogenesis. PMID:24349565

Gonzalez-Escobedo, Geoffrey; La Perle, Krista M D; Gunn, John S

2013-01-01

155

Histopathological Analysis of Salmonella Chronic Carriage in the Mouse Hepatopancreatobiliary System  

PubMed Central

Salmonella Typhi asymptomatic chronic carriage represents a challenge for the diagnosis and prevention of typhoid fever in endemic areas. Such carriers are thought to be reservoirs for further spread of the disease. Gallbladder carriage has been demonstrated to be mediated by biofilm formation on gallstones and by intracellular persistence in the gallbladder epithelium of mice. In addition, both gallstones and chronic carriage have been associated with chronic inflammation and the development of gallbladder carcinoma. However, the pathogenic relationship between typhoid carriage and the development of pre-malignant and/or malignant lesions in the hepatopancreatobiliary system as well as the host-pathogen interactions occurring during chronic carriage remains unclear. In this study, we monitored the histopathological features of chronic carriage up to 1 year post-infection. Chronic cholecystitis and hepatitis ranging from mild to severe were present in infected mice regardless of the presence of gallstones. Biliary epithelial hyperplasia was observed more commonly in the gallbladder of mice with gallstones (uninfected or infected). However, pre-malignant lesions, atypical hyperplasia and metaplasia of the gallbladder and exocrine pancreas, respectively, were only associated with chronic Salmonella carriage. This study has implications regarding the role of Salmonella chronic infection and inflammation in the development of pre-malignant lesions in the epithelium of the gallbladder and pancreas that could lead to oncogenesis. PMID:24349565

Gonzalez-Escobedo, Geoffrey; La Perle, Krista M. D.; Gunn, John S.

2013-01-01

156

Chronic Bronchitis  

MedlinePLUS

... Calendar Read the News View Daily Pollen Count COPD Program This program offers comprehensive, individualized care for people with chronic obstructive pulmonary disease (COPD) including emphysema and chronic bronchitis. Learn more. Doctors ...

157

Symptomatic Post-Discectomy Pseudocyst after Endoscopic Lumbar Discectomy  

PubMed Central

Objective The objectives of this study were to determine the frequency of symptomatic postdiscectomy pseudocyst (PP) after endoscopic discectomy and to compare the results of surgical and conservative management of them. Methods Initial study participants were 1,503 cases (1,406 patients) receiving endoscopic lumbar discectomy by 23-member board of neurosurgeons from March 2003 to October 2008. All patients' postoperative magnetic resonance imaging (MRI) scans were evaluated. On the postoperative MRI, cystic lesion of T2W high and T1W low at discectomy site was regarded as PP. Reviews of medical records and radiological findings were done. The PP patients were divided into two groups, surgical and conservative management by treatment modality after PP detection. We compared the results of the two groups using the visual analogue scale (VAS) for low back pain (LBP), VAS for leg pain (LP) and the Oswestry disability index (ODI). Results Among 1,503 cases of all male soldiers, the MRIs showed that pseudocysts formed in 15 patients, about 1.0% of the initial cases. The mean postoperative interval from surgery to PP detection was 53.7 days. Interlaminar approach was correlated with PP formation compared with transforaminal approach (p=0.001). The mean VAS for LBP and LP in the surgical group improved from 6.5 and 4.8 to 2.0 and 2.3, respectively. The mean VAS for LBP and LP in the conservative group improved from 4.4 and 4.4 to 3.9 and 2.3, respectively. There was no difference in treatment outcome between surgical and conservative management of symptomatic PP. Conclusion Although this study was done in limited environment, symptomatic PP was detected at two months' postoperative period in about 1% of cases. Interlaminar approach seems to be more related with PP compared with transforaminal approach. PMID:21494360

Kang, Suk Hyung

2011-01-01

158

The population prevalence of symptomatic radiographic foot osteoarthritis in community-dwelling older adults: cross-sectional findings from the Clinical Assessment Study of the Foot  

PubMed Central

Objectives To estimate the population prevalence of symptomatic radiographic osteoarthritis (OA) affecting the 1st metatarsophalangeal joint (MTPJ), 1st and 2nd cuneometatarsal joints (CMJs), navicular first cuneiform joint (NCJ) and talonavicular joint (TNJ) in community-dwelling older adults. Methods 9334 adults aged ?50?years registered with four general practices were mailed a health survey. Responders reporting foot pain within the last 12?months were invited to undergo weight-bearing dorso-plantar and lateral radiographs of both feet. OA at the 1st MTPJ, 1st and 2nd CMJs, NCJ and TNJ was graded using a validated atlas. Population prevalence estimates for symptomatic radiographic foot OA overall and for each joint were calculated using multiple imputation and weighted logistic regression modelling to account for missing data and non-response. Results 5109 health surveys were received (adjusted response 56%). Radiographs were obtained on 557 participants. Overall population prevalence of symptomatic radiographic OA was 16.7% (95% CI 15.3% to 18.0%), 1st MTPJ 7.8% (6.7% to 8.9%), 1st CMJ 3.9% (2.9% to 4.9%), 2nd CMJ 6.8% (5.7% to 7.8%), NCJ 5.2% (4.0% to 6.4%) and TNJ 5.8% (4.8% to 6.9%). With the exception of the 1st CMJ, prevalence was greater in females than males, increased with age and was higher in lower socioeconomic classes. Three-quarters of those with symptomatic radiographic OA reported disabling foot symptoms. Conclusions While cautious interpretation due to non-response is warranted, our study suggests that symptomatic radiographic foot OA affects one in six older adults and the majority report associated disability. Clinicians should consider OA as a possible cause of chronic foot pain in older people. PMID:24255544

Roddy, Edward; Thomas, Martin J; Marshall, Michelle; Rathod, Trishna; Myers, Helen; Menz, Hylton B; Thomas, Elaine; Peat, George

2015-01-01

159

Tibial tuberosity excision for symptomatic Osgood-Schlatter disease.  

PubMed

A modified Ferciot procedure was used to excise the tibial tubercle in patients with persistently symptomatic Osgood-Schlatter disease. Forty-two knees in 35 patients were reviewed at a mean follow-up of 5 years to assess outcome. The results revealed relief of pain in 95% of patients and reduction of prominence in 85.5% with minimal complication, in particular no evidence of genu recurvatum. The pathogenesis of the condition is outlined, and some of the theories and treatment modalities discussed. Tibial tubercle excision is recommended as the treatment of choice in those few cases that fail with conservative treatment. PMID:7790481

Flowers, M J; Bhadreshwar, D R

1995-01-01

160

The Case for Angioplasty in Patients with Symptomatic Intracranial Atherosclerosis  

PubMed Central

Intracranial atherosclerotic disease (ICAD) is likely the most common cause of stroke worldwide and remains highly morbid even with highly monitored medical therapy. Recent results of the SAMMPRIS trial, which randomized patients to stenting plus aggressive medical management versus aggressive medical management alone have shown that additional treatment of intracranial atherosclerotic lesions with the Wingspan stent is inferior to aggressive medical management alone. In light of these results, there has been renewed interest in angioplasty alone to treat symptomatic ICAD. This article will briefly review the natural history of ICAD and discuss the possible future for endovascular treatment of ICAD with primary intracranial angioplasty in appropriately selected patients. PMID:24782816

McTaggart, Ryan A.; Marks, Michael P.

2014-01-01

161

The case for angioplasty in patients with symptomatic intracranial atherosclerosis.  

PubMed

Intracranial atherosclerotic disease (ICAD) is likely the most common cause of stroke worldwide and remains highly morbid even with highly monitored medical therapy. Recent results of the SAMMPRIS trial, which randomized patients to stenting plus aggressive medical management versus aggressive medical management alone have shown that additional treatment of intracranial atherosclerotic lesions with the Wingspan stent is inferior to aggressive medical management alone. In light of these results, there has been renewed interest in angioplasty alone to treat symptomatic ICAD. This article will briefly review the natural history of ICAD and discuss the possible future for endovascular treatment of ICAD with primary intracranial angioplasty in appropriately selected patients. PMID:24782816

McTaggart, Ryan A; Marks, Michael P

2014-01-01

162

Snapping knee caused by symptomatic fabella in a native knee.  

PubMed

We report a case of a 31-year-old man with a 5-year history of snapping knee syndrome secondary to a single, large symptomatic fabella of the knee. On physical examination, the patient was able to reproduce an audible and palpable snapping with active range of motion. His condition was refractory to physical therapy. He had undergone a prior iliotibial band release at an outside facility. After excision of the fabella, measuring 15 × 8 × 9 mm, the patient's snapping and pain with activity were resolved. PMID:25136872

Hire, Justin M; Oliver, David L; Hubbard, Ryan C; Fontaine, Michelle L; Bojescul, John A

2014-08-01

163

Interventions for chronic blepharitis  

PubMed Central

Background Blepharitis, an inflammatory condition associated with itchiness, redness, flaking, and crusting of the eyelids, is a common eye condition that affects both children and adults. It is common in all ethnic groups and across all ages. Although infrequent, blepharitis can lead to permanent alterations to the eyelid margin or vision loss from superficial keratopathy (abnormality of the cornea), corneal neovascularization, and ulceration. Most importantly, blepharitis frequently causes significant ocular symptoms such as burning sensation, irritation, tearing, and red eyes as well as visual problems such as photophobia and blurred vision. The exact etiopathogenesis is unknown, but suspected to be multifactorial, including chronic low-grade infections of the ocular surface with bacteria, infestations with certain parasites such as demodex, and inflammatory skin conditions such as atopy and seborrhea. Blepharitis can be categorized in several different ways. First, categorization is based on the length of disease process: acute or chronic blepharitis. Second, categorization is based on the anatomical location of disease: anterior, or front of the eye (e.g. staphylococcal and seborrheic blepharitis), and posterior, or back of the eye (e.g. meibomian gland dysfunction (MGD)). This review focuses on chronic blepharitis and stratifies anterior and posterior blepharitis. Objectives To examine the effectiveness of interventions in the treatment of chronic blepharitis. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 1), MEDLINE (January 1950 to February 2012), EMBASE (January 1980 to February 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We searched the reference lists of included studies for any additional studies not identified by the electronic searches. There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 9 February 2012. Selection criteria We included randomized controlled trials (RCTs) and quasi-randomized controlled trials (CCTs) in which participants were adults aged 16 years or older and clinically diagnosed with chronic blepharitis. We also included trials where participants with chronic blepharitis were a subset of the participants included in the study and data were reported separately for these participants. Interventions within the scope of this review included medical treatment and lid hygiene measures. Data collection and analysis Two authors independently assessed search results, reviewed full-text copies for eligibility, examined risk of bias, and extracted data. Data were meta-analyzed for studies comparing similar interventions and reporting comparable outcomes with the same timing. Otherwise, results for included studies were summarized in the text. Main results There were 34 studies (2169 participants with blepharitis) included in this review: 20 studies (14 RCTs and 6 CCTs) included 1661 participants with anterior or mixed blepharitis and 14 studies (12 RCTs and 2 CCTs) included 508 participants with posterior blepharitis (MGD). Due to the heterogeneity of study characteristics among the included studies, with respect to follow-up periods and types of interventions, comparisons, and condition of participants, our ability to perform meta-analyses was limited. Topical antibiotics were shown to provide some symptomatic relief and were effective in eradicating bacteria from the eyelid margin for anterior blepharitis. Lid hygiene may provide symptomatic relief for anterior and posterior blepharitis. The effectiveness of other treatments for blepharitis, such as topical steroids and oral antibiotics, were inconclusive. Authors’ conclusions Despite identifying 34 trials related to treatments for blepharitis, there is no strong evidence for any of the treatments in

Lindsley, Kristina; Matsumura, Sueko; Hatef, Elham; Akpek, Esen K

2012-01-01

164

Exercise capacity after His bundle ablation and rate response ventricular pacing for drug refractory chronic atrial fibrillation  

Microsoft Academic Search

OBJECTIVE: To evaluate exercise capacity of patients with chronic atrial fibrillation in whom His bundle ablation followed by ventricular rate response pacing (VVIR) was carried out because of drug refractoriness. DESIGN: Prospective study. PATIENTS: 25 consecutive patients, all with chronic symptomatic drug refractory atrial fibrillation, underwent His bundle ablation. Before this intervention all patients were on antiarrhythmic drugs to attain

E. M. Buys; N. M. van Hemel; J. C. Kelder; C. A. Ascoop; P. F. van Dessel; L. Bakema; J. H. Kingma

1997-01-01

165

Symptomatic and silent gall stones in the community.  

PubMed Central

The prevalence of gall stone disease in a stratified random sample of 1896 British adults (72.2% of those approached) was established using real time ultrasound. The prevalence rose with age, except in women of 40-49 years, so that at 60-69 years, 22.4% of women and 11.5% of men had gall stones or had undergone cholecystectomy. The cholecystectomy rate of people with gall stone disease was higher in women than in men (43.5% v 24%, p less than 0.05). Very few subjects with gall stones had convincing biliary symptoms. In women, 10.4% had symptoms according to a questionnaire definition of biliary pain and 6.3% according to conventional history taking, while no men at all admitted to biliary pain. Nevertheless, cholecystectomy in men had nearly always been preceded by convincing biliary symptoms. The age at cholecystectomy was, on average, nine years less than the age at detection of silent gall stones in both sexes. It is concluded that either gall stones are especially prone to cause symptoms in younger people or that there are two kinds of cholelithiasis - symptomatic and silent. The lack of symptomatic gall stones in cross sectional surveys is probably due to their rapid diagnosis and treatment. PMID:2013429

Heaton, K W; Braddon, F E; Mountford, R A; Hughes, A O; Emmett, P M

1991-01-01

166

Symptomatic and prophylactic treatment of migraine: a critical reappraisal.  

PubMed

The pharmacologic management of migraine has traditionally focused on two approaches: symptomatic treatment and prophylactic therapy. The objective of symptomatic treatment is to reduce the intensity and duration of pain with its attendant symptoms and to optimize the patient's ability to function normally. The efficacy of most abortive antimigrainous drugs in probably related to their inhibitory effects on neurogenic inflammation mediated through serotoninergic control mechanisms. A variety of treatment strategies provide effective treatment for most attacks of moderate to severe migraine when utilizing one or a combination of the following classes of drugs: simple analgesics, nonsteroidal anti-inflammatory drugs, antiemetics, narcotic analgesics, ergot derivatives, and serotonin1-agonists. The choice of medication for an acute attack depends on factors such as the severity of the attack, the presence or absence of vomiting, time from onset of pain to peak pain level, rate of bioavailability of the drug, comorbid medical conditions, and the side effect profile of the drug. The major objective of prophylactic therapy is the reduction of frequency, duration, and intensity of attacks. Beta-blocking drugs without intrinsic sympathomimetic activity (such as propranolol), amitriptyline, flunarizine, serotonin antagonists (such as methysergide) and nonsteroidal anti-inflammatory drugs (such as naproxen) are the five main classes of drugs or agents that may be used as prophylactics. PMID:9789706

Deleu, D; Hanssens, Y; Worthing, E A

1998-01-01

167

Symptomatic fructose malabsorption in irritable bowel syndrome: A prospective study  

PubMed Central

Introduction Fructose can trigger or worsen symptoms in irritable bowel syndrome (IBS) patients. The aim of this study was to determine the prevalence of symptomatic fructose malabsorption in IBS patients and to test whether the patient's characteristics can help to detect a fructose malabsorption. Materials and methods Ninety Rome III IBS patients (predominant diarrhoea (IBS-D): 31%, predominant constipation (IBS-C): 18%, mixed type (IBS-M): 51%) were included prospectively. After exclusion of a small intestinal bacterial overgrowth by a glucose breath test, fructose malabsorption was assessed by a five-hour breath test, with symptom monitoring, after a 25?g load of fructose. An increase of more than 20?ppm of hydrogen (H2) or methane (CH4) levels in the exhaled air led to the diagnosis of malabsorption. Results Fructose test was abnormal in 20/90 patients among whom only 35% were intolerant, with a simultaneous rise of H2/CH4 levels and the onset of abdominal discomfort or diarrhoea. IBS characteristics were not predictive even if young (p?=?0.031) and male IBS patients (p?=?0.029) were at higher risk of malabsorption. At variance, 18 additional patients experienced intestinal symptoms during the test despite normal fructose absorption. Discussion After a 25?g fructose load, symptomatic fructose malabsorption and intolerance without malabsorption were detected in 22% and 28% of IBS patients respectively. PMID:24918018

Gourcerol, Guillaume; Déchelotte, Pierre; Leroi, Anne-Marie; Ducrotté, Philippe

2014-01-01

168

Treatment of symptomatic congenital cytomegalovirus infection with valganciclovir.  

PubMed

Cytomegalovirus (CMV) is the most common cause of congenital infection in humans. Some congenitally infected infants will develop sequelae later in life, especially sensorineural hearing loss (SNHL) and mental retardation. There is no generally accepted antiviral therapy for the treatment of symptomatic congenital CMV infections yet. We present a neonate with symptomatic congenital CMV infection, who was treated with intravenous (iv) ganciclovir (GCV) during 18 days and subsequently with oral valganciclovir (VGCV) for 5.5 months, in an attempt to prevent development of SNHL. GCV was given intravenously 10 mg/kg/day in two doses and VGCV doses ranged from 280-850 mg/m2 bidaily (bid). Our experience shows that it is not possible to give a fixed dosing regime for VGCV in neonates and that continuous adaptation of dose is necessary to achieve stable target levels of GCV and to keep the viral load in urine at undetectable level. At 18 months of age no hearing deterioration has occurred. While the current findings are encouraging, the limitations of a single case report with a relatively short follow-up emphasizes the need for further prospective randomized studies to evaluate pharmacokinetics, efficacy and safety of VGCV therapy in neonates with congenital CMV infection. PMID:16211780

Meine Jansen, Caroline F; Toet, Mona C; Rademaker, Carin M A; Ververs, Tessa F F; Gerards, Leo J; van Loon, Anton M

2005-01-01

169

Primary symptomatic adrenal insufficiency induced by megestrol acetate.  

PubMed

Megestrol acetate (MA) is a progestational agent for the treatment of metastatic breast cancer and endometrial cancer. MA has also been used to promote weight gain in malnourished elderly patients, in patients with immunodeficiency virus and in cancer-induced cachexia. In addition to thromboembolic disease, MA may induce hyperglycaemia, osteoporosis, suppression of the gonadal axis, and Cushing's syndrome. MA has also been shown to cause symptomatic suppression of the hypothalamic-pituitary-adrenal (HPA) axis owing to its intrinsic glucocorticoid-like effect. Three additional patients are presented who developed symptomatic adrenal insufficiency while they were receiving 160-320 mg MA daily. The patients were treated with cortisone acetate supplements, had clear evidence of HPA-axis suppression but recovered fully after MA was discontinued. Patients receiving MA might have an inadequate adrenal response during stressful conditions, possibly because 160-320 mg MA daily may not provide adequate protection to prevent the symptoms of adrenal insufficiency. The adverse MA effect on the HPA axis is probably not well recognised in clinical practice, and clinicians need an increased awareness of the endocrine complications secondary to MA treatment. PMID:23412818

Delitala, A P; Fanciulli, G; Maioli, M; Piga, G; Delitala, G

2013-01-01

170

Epidural steroid injections in the treatment of symptomatic lumbar spinal stenosis associated with epidural lipomatosis.  

PubMed

Epidural lipomatosis has been implicated as a cause or contributor of symptomatic lumbar spinal stenosis. Although epidural steroid injections have been very successful for symptomatic treatment of spinal stenosis; their role in treatment of symptomatic stenosis secondary to epidural lipomatosis is unclear. A review literature (MEDLINE, PubMed) found no reports justifying the use of steroids. We present two patients with lumbar epidural lipomatosis causing or contributing to symptomatic spinal stenosis. Both patients presented with unilateral lower limb radicular symptoms unrelieved with conservative measures such as medications and physical therapy. They were treated with a single transforaminal epidural steroid injection at the symptomatic level. Both had 80-85% pain relief. These reports suggest a beneficial role of epidural steroid injections for patients with symptomatic lumbar spinal stenosis caused by or contributing to epidural lipomatosis. PMID:15624572

Botwin, Kenneth P; Sakalkale, Durgadas P

2004-12-01

171

Conservative management of symptomatic Carpal Bossing in an elite hockey player: a case report  

PubMed Central

Objective: To present the characteristics and create awareness of symptomatic carpal bossing and discuss potential etiologies and the role of conservative management through the presentation of an athlete with traumatic onset of symptomatic carpal bossing. Clinical features: This case report outlines the presentation and conservative management of an elite eighteen year old hockey player with symptomatic carpal bossing after a traumatic on ice collision. Carpal bossing is a bony, dorsal prominence in the quadrangular joint of the wrist that is inconsistently symptomatic. Intervention and outcome: A conservative treatment plan consisting of education, reassurance, avoidance of aggravation, and soft tissue therapy allowed return to play in two weeks without restrictions or need for surgical consultation. Conclusion: With inconsistent recurrence rates and surgical complications, the role of conservative management for symptomatic carpal bossing deserves further exploration. The conservative practitioner should be aware of the signs and symptoms of symptomatic carpal bossing to institute suitable treatment. PMID:20037693

Kissel, Peter

2009-01-01

172

Association Between Hematological Indices and Coronary Calcification in Symptomatic Patients without History of Coronary Artery Disease  

PubMed Central

Background: Atherosclerotic coronary artery disease (CAD) has long been shown to involve chronic low-grade subclinical inflammation. However, whether there is association between hematological indices assessed by complete blood count (CBC) and coronary atherosclerotic burden has not been well studied. Materials and Methods: Consecutive 868 patients without known CAD who presented with acute chest pain to emergency department and underwent coronary artery calcium (CAC) scoring evaluation by multi-detector cardiac computed tomography were included in our study. Clinical characteristics and CBC indices were compared among different CAC groups. Results: The cohort comprised 60% male with a mean age of 61 (SD = 14) years. Median Framingham risk of CAD was 4% (range 1-16%). Median CAC score was 0 (IQR 0-43). Higher CAC groups had significantly higher Framingham risk of CAD than lower CAC groups (P < 0.001). Among different CAC categories, there was no statistically significant difference in hemoglobin level (p 0.45), mean corpuscular volume (p 0.43), mean corpuscular hemoglobin (p 0.28), mean corpuscular hemoglobin volume (p 0.36), red cell distribution width (0.42), total white blood cell counts (p 0.291), neutrophil counts (p 0.352), lymphocyte counts (p 0.92), neutrophil to lymphocyte ratio (p 0.68), monocyte count (p 0.48), and platelet counts (p 0.25). Conclusion: Our study did not detect significant association between hematological indices assessed with CBC and coronary calcification in symptomatic patients without known CAD. PMID:25317386

Chaikriangkrai, Kongkiat; Kassi, Mahwash; Alchalabi, Sama; Bala, Sayf Khaleel; Adigun, Rosalyn; Botero, Sharleen; Chang, Su Min

2014-01-01

173

Peritraumatic and trait dissociation differentiate police officers with resilient versus symptomatic trajectories of posttraumatic stress symptoms.  

PubMed

Research has consistently demonstrated that stress reactions to potentially traumatic events do not represent a unified phenomenon. Instead, individuals tend to cluster into prototypical response patterns over time including chronic symptoms, recovery, and resilience. We examined heterogeneity in a posttraumatic stress disorder (PTSD) symptom course in a sample of 178 active-duty police officers following exposure to a life-threatening event using latent growth mixture modeling (LGMM). This analysis revealed 3 discrete PTSD symptom trajectories: resilient (88%), distressed-improving (10%), and distressed-worsening (2%). We further examined whether trait and peritraumatic dissociation distinguished these symptom trajectories. Findings indicate that trait and peritraumatic dissociation differentiated the resilient from the distressed-improving trajectory (trait, p < .05; peritraumatic, p < .001), but only peritraumatic dissociation differentiated the resilient from the distressed-worsening trajectory (p < .001). It is essential to explore heterogeneity in symptom course and its predictors among active-duty police officers, a repeatedly exposed group. These findings suggest that police officers may be a highly resilient group overall. Furthermore, though there is abundant evidence that dissociation has a positive linear relationship with PTSD symptoms, this study demonstrates that degree of dissociation can distinguish between resilient and symptomatic groups of individuals. PMID:21898602

Galatzer-Levy, Isaac R; Madan, Anita; Neylan, Thomas C; Henn-Haase, Clare; Marmar, Charles R

2011-10-01

174

Peritraumatic and Trait Dissociation Differentiate Police Officers With Resilient Versus Symptomatic Trajectories of Posttraumatic Stress Symptoms  

PubMed Central

Research has consistently demonstrated that stress reactions to potentially traumatic events do not represent a unified phenomenon. Instead, individuals tend to cluster into prototypical response patterns over time including chronic symptoms, recovery, and resilience. We examined heterogeneity in a posttraumatic stress disorder (PTSD) symptom course in a sample of 178 active-duty police officers following exposure to a life-threatening event using latent growth mixture modeling (LGMM). This analysis revealed 3 discrete PTSD symptom trajectories: resilient (88%), distressed–improving (10%), and distressed–worsening (2%). We further examined whether trait and peritraumatic dissociation distinguished these symptom trajectories. Findings indicate that trait and peritraumatic dissociation differentiated the resilient from the distressed–improving trajectory (trait, p < .05; peritraumatic, p < .001), but only peritraumatic dissociation differentiated the resilient from the distressed–worsening trajectory (p < .001). It is essential to explore heterogeneity in symptom course and its predictors among active-duty police officers, a repeatedly exposed group. These findings suggest that police officers may be a highly resilient group overall. Furthermore, though there is abundant evidence that dissociation has a positive linear relationship with PTSD symptoms, this study demonstrates that degree of dissociation can distinguish between resilient and symptomatic groups of individuals. PMID:21898602

Galatzer-Levy, Isaac R.; Madan, Anita; Neylan, Thomas C.; Henn-Haase, Clare; Marmar, Charles R.

2013-01-01

175

Unusual shunt for symptomatic portal vein thrombosis after liver transplantation - Clatworthy revisited.  

PubMed

PV thrombosis is not an uncommon occurrence following pediatric LT. Symptomatic PHT following PV thrombosis is treated medically, surgical portosystemic shunting (mesorex, splenorenal, and mesocaval) being reserved for refractory cases. A 10-yr-old boy suffered recurrent malena and hemorrhagic shock because of chronic PV thrombosis following LT nine yr ago (1999). Extensive work-up failed to localize the bleeding source. The liver function remained normal. Initial attempts at surgical shunts failed owing to thrombosis (mesocaval 2001, splenorenal, inferior mesenteric-left renal vein, splenic-left external iliac vein 2008). In this situation, we performed a Clatworthy shunt by anastomosing the divided lower end of the LCIV to the side of SMV. There was a single, large caliber anastomosis. Post-operatively, the malena stopped completely, and clinically, there was no lower limb edema or encephalopathy. Doppler USG revealed persistence of hepatopetal flow within the portal collaterals. Follow-up at two yr reveals stable hepatic function with a patent shunt. To the best of our knowledge, we are not aware of a Clatworthy shunt being performed in a transplant setting. We reviewed the literature pertaining to this shunt in non-transplant patients with PHT. PMID:21834802

Mali, V P; Robless, P A; Aw, M; Loh, D L; Quak, S H; Prabhakaran, K

2012-06-01

176

Sensitization, pathologic, and imaging findings comparing symptomatic and quiescent failed renal allografts.  

PubMed

Late allograft failure (LAF) is a common cause of end stage renal disease. These patients face interrelated challenges regarding immunosuppression management, risk of graft intolerance syndrome (GIS), and sensitization. This retrospective study analyzes sensitization, pathology, imaging, and transfusion requirements in 33 LAFs presenting either with GIS (22) or grafts remaining quiescent (11). All patients underwent immunosuppression weaning to discontinuation at LAF. Profound increases in sensitization were noted for all groups and occurred in the GIS group prior to transplant nephrectomy (TxN). Patients with GIS experienced a major upswing in sensitization at, or before the time of their symptomatic presentation. For both GIS and quiescent grafts, sensitization appeared to be closely linked to immunosuppression withdrawal. Most transfusion naïve patients became highly sensitized. Fourteen patients in the GIS group underwent TxN which revealed grade II acute cellular rejection or worse, with grade 3 chronic active T-cell-mediated rejection. Blinded comparisons of computed tomography scan of GIS group revealed swollen allografts with fluid collections compared with the quiescent allografts (QAs), which were shrunken and atrophic. The renal volume on imaging and weight of explants nearly matched. Future studies should focus on interventions to avoid sensitization and GIS. PMID:25297845

Singh, Pooja; Feld, Rick I; Colombe, Beth W; Farber, John L; Herman, Jay H; Gulati, Rakesh; Maley, Warren R; Frank, Adam M

2014-12-01

177

Symptomatic failure after sirolimus-eluting stent implantation: A rare but challenging condition  

PubMed Central

BACKGROUND: Limited information is available regarding restenosis after implantation of a sirolimus-eluting stent (SES). OBJECTIVE: To report on angiographic characteristics, clinical presentation and treatment of this particularly complex type of coronary lesion. METHODS AND RESULTS: A total of 1424 SES were implanted in 1159 patients (average 1.2 per patient) for chronic or acute coronary syndromes in the University Hospital of Siena (Siena, Italy), which is a tertiary centre. Symptomatic in-SES restenosis was observed in 26 patients (2.2%) at 10±5 months (median eight months, range four to 23 months) following the initial intervention. In-SES restenosis was associated with stable angina in 16 patients, acute myocardial infarction in three patients and unstable angina in seven patients. Two patients had restenosis in two separate SES. Conditions often associated with in-SES restenosis included treatment of chronic total occlusion, geographic miss or in-stent restenosis during the index procedure. Among the first 20 patients, those with focal, in-body SES (type Ic) restenosis received balloon-only angioplasty, and patients with other patterns received repeat SES implantation. Clinical and angiographic follow-up (average 16±7 months) recorded one death (noncardiac) in the balloon-only group and four cases of unstable angina (three due to relapsing in-SES restenosis in the balloon-only group and the fourth due to a de novo lesion). Follow-up quantitative angiography showed a higher incidence of binary restenosis after balloon-only treatment (57% versus 17%; P<0.05), as well as higher lumen loss and loss index (P<0.05). CONCLUSIONS: Restenosis after SES implantation occurs more commonly in a focal pattern in-body or at the proximal edge of the stent. Repeat SES implantation appears to be a safer and more effective therapeutic choice than balloon-only angioplasty. PMID:17311120

Fineschi, Massimo; Gori, Tommaso; Pierli, Carlo; Casini, Stefano; Sinicropi, Giuseppe; Buti, Alberto; Iadanza, Alessandro; Bravi, Achille

2007-01-01

178

The use of laser lithotripsy status post cholecystostomy tube placement without interval cholecystectomy for calculous cholecystitis in a patient unfit for general anesthesia.  

PubMed

Acute cholecystitis in patients unfit for general anesthesia often initially requires cholecystectomy tube placement without cholecystectomy. The best way to definitively manage those patients with irreversible medical conditions, leaving them unable to undergo cholecystectomy, has yet to be defined. Laser lithotripsy is currently used in the management of stones of the genitourinary system. Extracorporeal shock wave cholelithotripsy has been extensively evaluated in Munich, Germany and since then, has been abandoned as an alternative treatment of cholelithiasis. This report discusses a novel approach using established cholecystocutaneous fistula tracts and laser lithotripsy to definitively treat this group of patients. PMID:24300938

Polite, Nathan M; Brown, Roy; Braveman, Joshua

2013-12-01

179

The effect of ‘Candidatus Liberibacter asiaticus’ infection on the proteomic profiles and nutritional status of pre-symptomatic and symptomatic grapefruit (Citrus paradisi) plants  

PubMed Central

Background Huanglongbing (HLB) is a highly destructive citrus disease which threatens citrus production worldwide and ‘Candidatus Liberibacter asiaticus’ (Las), a non-culturable phloem-limited bacterium, is an associated causal agent of the disease. To better understand the physiological and molecular processes involved in host responses to Las, 2-DE and mass spectrometry analyses, as well as ICP spectroscopy analysis were employed to elucidate the global protein expression profiles and nutrient concentrations in leaves of Las-infected grapefruit plants at pre-symptomatic or symptomatic stages for HLB. Results This study identified 123 protein spots out of 191 spots that showed significant changes in the leaves of grapefruit plants in response to Las infection and all identified spots matched to 69 unique proteins/peptides. A down-regulation of 56 proteins including those associated with photosynthesis, protein synthesis, and metabolism was correlated with significant reductions in the concentrations of Ca, Mg, Fe, Zn, Mn, and Cu in leaves of grapefruit plants in response to Las infection, particularly in symptomatic plants. Oxygen-evolving enhancer (OEE) proteins, a PSI 9 kDa protein, and a Btf3-like protein were among a small group of proteins that were down-regulated in both pre-symptomatic and symptomatic plants in response to Las infection. Furthermore, a Las-mediated up-regulation of 13 grapefruit proteins was detected, which included Cu/Zn superoxide dismutase, chitinases, lectin-related proteins, miraculin-like proteins, peroxiredoxins and a CAP 160 protein. Interestingly, a Las-mediated up-regulation of granule-bound starch synthase was correlated with an increase in the K concentrations of pre-symptomatic and symptomatic plants. Conclusions This study constitutes the first attempt to characterize the interrelationships between protein expression and nutritional status of Las-infected pre-symptomatic or symptomatic grapefruit plants and sheds light on the physiological and molecular mechanisms associated with HLB disease development. PMID:23578104

2013-01-01

180

[Holistic therapy of chronic heart failure].  

PubMed

The rising prevalence and increasing disease-related costs render chronic heart failure a rapidly growing socioeconomic challenge. The concerted action of guideline-adjusted therapy and holistic patient care is essential to achieve improvements in mortality, morbidity, functional status and quality of life of patients with symptomatic heart failure. Holistic care strategies comprise consideration of comorbidities and individual needs, lifestyle recommendations and multidisciplinary management programs for high-risk symptomatic patients in addition to basic medication and surgical therapies. For optimal patient care and coaching, seamless interaction is required between in-hospital treatment and outpatient facilities. Moreover, the palliative needs of heart failure patients need to be considered, a topic that is currently not receiving enough attention. PMID:24806269

Feldmann, C; Ertl, G; Angermann, C E

2014-06-01

181

Chronic kidney disease  

MedlinePLUS

Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; Chronic kidney failure; Chronic renal failure ... kidney disease. If it worsens to end-stage renal disease , and how ... Kidney failure is the last stage of chronic kidney disease. ...

182

Cyanotic Congenital Heart Disease (CCHD) with Symptomatic Erythrocytosis  

PubMed Central

Secondary erythrocytosis of cyanotic congenital heart disease (CCHD) is pathologically different from primary erythrocytosis of polycythemia vera (PV). An association between elevated hematocrit and thrombosis has been established in PV patients, and treatment guidelines recommend maintaining hematocrit <45%. Although an association between elevated hematocrit and thrombosis has not been established in CCHD and secondary erythrocytosis, the current clinical practice is to phlebotomize these patients to hematocrit <65%. We report a 21-year-old woman with CCHD who presented with symptomatic erythrocytosis with numbness and tingling with hemoglobin 25.2 g/dl and hematocrit 75.8%. Her symptoms resolved with IV hydration. Other factors, including dehydration and iron deficiency, may precipitate hyperviscosity symptoms. The treatment is volume replacement and low-dose iron therapy, not phlebotomy. Repeated phlebotomy causes iron deficiency with microcytic erythrocytes, which increases the whole blood viscosity and, therefore, can potentially accentuate rather than decrease the risk for a cerebrovascular accident. PMID:17917783

Shah, Ashish A.; Hoover, Donald R.; Saidi, Parvin

2007-01-01

183

Kikuchi-Fujimoto Disease Associated with Symptomatic CD4 Lymphocytopenia  

PubMed Central

Kikuchi-Fujimoto disease is a rare benign condition of necrotising histiocytic lymphadenitis with unknown aetiology. We describe here a 30-year-old African American female who presented with fever, generalized rash, cervical lymphadenopathy, and oral candidiasis and was found to have Kikuchi-Fujimoto disease on lymph node biopsy with low CD4 count. The initial presentation was concerning for acute retroviral infection. Her HIV serology and HIV RNA PCR were negative however she had low CD4 count with reversal of CD4/CD8 ratio. Although low CD4 count has been associated with autoimmune disease, it has not been described with Kikuchi-Fujimoto disease. We report the first case of Kikuchi-Fujimoto disease associated with symptomatic CD4 lymphocytopenia. PMID:25313340

Yogarajah, Meera; Sivasambu, Bhradeev

2014-01-01

184

Immunohistology of tuberculous adenitis in symptomatic HIV infection.  

PubMed

Monoclonal antibodies and immunoperoxidase staining were used to characterize the cellular subpopulations in lymph nodes from 10 patients with tuberculous lymphadenitis, seven of whom had symptomatic human immunodeficiency virus (HIV) infection. CD4+ cells were significantly fewer in nodes of patients with HIV infection than in those of immunocompetent patients. CD8+ cells were distributed throughout the granuloma in patients with HIV infection, but confined to the periphery in normal hosts. Blastoid Ta1+ cells, putatively antigen-reactive T lymphocytes, were seen in immunocompetent patients but not in those with HIV infection, suggesting that these cells fail to mature appropriately in the latter group. The immunopathological features noted above provide preliminary evidence that the cell-mediated immune response to tuberculosis is abnormal in patients with HIV infection, and may in part explain both the severe and the unusual manifestations of tuberculosis in these individuals. PMID:3261659

Shen, J Y; Barnes, P F; Rea, T H; Meyer, P R

1988-05-01

185

Symptomatic cluster headache: a review of 63 cases.  

PubMed

Cluster headache is a primary headache by definition not caused by any known underlying structural pathology. Symptomatic cases have been described, for example tumours, dissections and infections, but a causal relationship between the underlying lesion and the headache is difficult to determine in many cases. The proper diagnostic evaluation of cluster headache is an issue unresolved. The literature has been reviewed for symptomatic cluster headache or cluster headache-like cases in which causality was likely. The review also attempted to identify clinical predictors of underlying lesions in order to formulate guidelines for neuroimaging. Sixty-three cluster headache or "cluster headache-like"/"cluster-like headache" cases in the literature were identified which were associated with an underlying lesion. A majority of the cases had a non-typical presentation that is atypical symptomatology and abnormal examination (including Horner's syndrome). A striking finding in this appraisal was that a significant proportion of CH cases were secondary to diseases of the pituitary gland or pituitary region. Another notable finding was that a proportion of cluster headache cases were associated with arterial dissection. Even typical cluster headaches can be caused by structural lesions and the response to typical cluster headache treatments does not exclude a secondary form. It is difficult to draw definitive conclusions from this retrospective review of case reports especially considering the size of the material. However, based on this review, I suggest that neuroimaging, preferably contrast-enhanced magnetic resonance imaging/magnetic resonance angiography should be undertaken in patients with atypical symptomatology, late onset, abnormal examination (including Horner's syndrome), or those resistant to the appropriate medical treatment. The decision to perform magnetic resonance imaging in cases of typical cluster headache remains a matter of medical art. PMID:24570848

Edvardsson, Bengt

2014-01-01

186

Primary balloon angioplasty for symptomatic, high-grade intracranial stenosis  

PubMed Central

Background: In light of recent controversy about the safety and efficacy of intracranial stenting, we sought to evaluate our experience with primary balloon angioplasty for symptomatic, high-grade intracranial stenosis. Methods: All intracranial angioplasty cases performed at Vanderbilt University Medical Center from 2006 to 2011 were retrospectively reviewed for degree of stenosis pre- and post-procedure. Immediate peri-procedural complications were evaluated as well as one-month and long-term outcomes. Results: A total of 26 patients were included in the study with a mean age of 63.0 years and a mean follow-up of 350.2 days. The average pre-procedure stenosis was 71.2%. The immediate, average post-procedure stenosis was 46.6%, and the average post-procedure stenosis at last angiographic follow-up was 44.5%. Retreatment was required in only 3.8% of patients. The primary end-point of major stroke or death at 30 days was observed in 11.5%, and the overall intra-procedural complication rate was 7.7%. The incidence of stroke or death at last follow-up was 15.4%, which is comparable to the one-year stroke or death rate in the medical arm of the SAMPRISS trial. Conclusions: In this retrospective series, primary balloon angioplasty was found to be effective as a treatment option for symptomatic intracranial stenosis with the risk of stroke or death at 30 days higher than the medical arm of SAMPRIS but lower than the stenting arm. The one-year risk of stroke was comparable to that reported for the one-year outcomes in the SAMPRISS medical arm. PMID:23493431

Tomycz, Luke; Bansal, Neil K.; Lockney, Tim; Strothers, Megan; Connors, John J.; Shay, Scott; Singer, Robert J.

2013-01-01

187

Sialyllactose ameliorates myopathic phenotypes in symptomatic GNE myopathy model mice.  

PubMed

Patients with GNE myopathy, a progressive and debilitating disease caused by a genetic defect in sialic acid biosynthesis, rely on supportive care and eventually become wheelchair-bound. To elucidate whether GNE myopathy is treatable at a progressive stage of the disease, we examined the efficacy of sialic acid supplementation on symptomatic old GNE myopathy mice that have ongoing, active muscle degeneration. We examined the therapeutic effect of a less metabolized sialic acid compound (6'-sialyllactose) or free sialic acid (N-acetylneuraminic acid) by oral, continuous administration to 50-week-old GNE myopathy mice for 30 weeks. To evaluate effects on their motor performance in living mice, spontaneous locomotion activity on a running wheel was measured chronologically at 50, 65, 72 and 80 weeks of age. The size, force production, and pathology of isolated gastrocnemius muscle were analysed at the end point. Sialic acid level in skeletal muscle was also measured. Spontaneous locomotion activity was recovered in 6'-sialyllactose-treated mice, while NeuAc-treated mice slowed the disease progression. Treatment with 6'-sialyllactose led to marked restoration of hyposialylation in muscle and consequently to robust improvement in the muscle size, contractile parameters, and pathology as compared to NeuAc. This is due to the fact that 6'-sialyllactose is longer working as it is further metabolized to free sialic acid after initial absorption. 6'-sialyllactose ameliorated muscle atrophy and degeneration in symptomatic GNE myopathy mice. Our results provide evidence that GNE myopathy can be treated even at a progressive stage and 6'-sialyllactose has more remarkable advantage than free sialic acid, providing a conceptual proof for clinical use in patients. PMID:25062695

Yonekawa, Takahiro; Malicdan, May Christine V; Cho, Anna; Hayashi, Yukiko K; Nonaka, Ikuya; Mine, Toshiki; Yamamoto, Takeshi; Nishino, Ichizo; Noguchi, Satoru

2014-10-01

188

The Warfarin-Aspirin Symptomatic Intracranial Disease Study.  

PubMed

We conducted a retrospective, multicenter study to compare the efficacy of warfarin with aspirin for the prevention of major vascular events (ischemic stroke, myocardial infarction, or sudden death) in patients with symptomatic stenosis of a major intracranial artery. Patients with 50 to 99% stenosis of an intracranial artery (carotid; anterior, middle, or posterior cerebral; vertebral; or basilar) were identified by reviewing the results of consecutive angiograms performed at participating centers between 1985 and 1991. Only patients with TIA or stroke in the territory of the stenotic artery qualified for inclusion in the study. Patients were prescribed warfarin or aspirin according to local physician preference and were followed by chart review and personal or telephone interview. Seven centers enrolled 151 patients; 88 were treated with warfarin and 63 were treated with aspirin. Median follow-up was 14.7 months (warfarin group) and 19.3 months (aspirin group). Vascular risk factors and mean percent stenosis of the symptomatic artery were similar in the two groups, yet the rates of major vascular events were 18.1 per 100 patient-years of follow-up in the aspirin group (stroke rate, 10.4/100 patient-years; myocardial infarction or sudden death rate, 7.7/100 patient-years) compared with 8.4 per 100 patient-years of follow-up in the warfarin group (stroke rate, 3.6/100 patient-years; myocardial infarction or sudden death rate, 4.8/100 patient-years). Kaplan-Meier analysis showed a significantly higher percentage of patients free of major vascular events among patients treated with warfarin (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7644046

Chimowitz, M I; Kokkinos, J; Strong, J; Brown, M B; Levine, S R; Silliman, S; Pessin, M S; Weichel, E; Sila, C A; Furlan, A J

1995-08-01

189

Primary Angioplasty for Symptomatic Atherosclerotic Middle Cerebral Artery Stenosis  

PubMed Central

Objective The objective of this study is to evaluate the clinical and angiographic outcomes after primary balloon angioplasty in patients with symptomatic middle cerebral artery (MCA, M1 segment) stenosis refractory to medical therapy. Materials and Methods Eleven patients with intracranial stenosis were treated with primary balloon angioplasty. All patients had MCA stenosis with recurrent transient ischemic attack (TIA). The indication for balloon angioplasty was patients with significant MCA stenosis: 1) age older than 18 years with recurrent or progressive TIA or infarction despite optimal medical therapy, including anti-coagulation, dual anti-platelet, and anti-lipid medication; 2) previous ischemic events or asymptomatic severe stenosis (more than 50%) with poor collateral cerebral circulation, or diminished cerebral perfusion on single photon emission computed tomography before and after administration of the intravenous dosage of acetazolamide. Results The median age of patients was 53 years (range 44-79). The technical success rate was 100%. Mean pretreatment stenosis degree was 83.63 ± 9.53% and 29.1 ± 15.4% before and after angioplasty, respectively. Procedural-related complications occurred in four of 11 patients (36%), but none of the patients had permanent neurological deficit. All patients were available for an average follow-up period of 19.4 ± 5.1 months. One patient had a stroke in the territory of angioplasty at two months after angioplasty. The stroke free survival rate at 30 days and 12 months was 100% and 91%, respectively. Restenosis over 50% was observed in three of 11 patients (27%); all were asymptomatic. Conclusion Intracranial angioplasty for symptomatic MCA stenosis refractory to medical therapy can be a treatment option to reduce the risk of further TIA or stroke. PMID:25340017

Chang, Youn Hyuk; Kwon, O-Ki

2014-01-01

190

Incidence of Symptomatic Vertebral Fractures in Patients After Percutaneous Vertebroplasty  

SciTech Connect

The aim of this study was to evaluate the incidence of secondary symptomatic vertebral compression fractures (VCFs) in patients previously treated by percutaneous vertebroplasty (VTP). Three hundred sixteen patients with 486 treated VCFs were included in the study according to the inclusion criteria. Patients were kept in regular follow-up using a standardized questionairre before, 1 day, 7 days, 6 months, and 1 year after, and, further on, on a yearly basis after VTP. The incidence of secondary symptomatic VCF was calculated, and anatomical distribution with respect to previous fractures characterized. Mean follow-up was 8 months (6-56 months) after VTP. Fifty-two of 316 (16.4 %) patients (45 female, 7 male) returned for treatment of 69 secondary VCFs adjacent to (35/69; 51%) or distant from (34/69; 49%) previously treated levels. Adjacent secondary VCF occurred significantly more often compared to distant secondary VCF. Of the total 69 secondary VCFs, 35 of 69 occurred below and 27 of 69 above pretreated VCFs. Of the 65 sandwich levels generated, in 7 of 65 (11%) secondary VCFs were observed. Secondary VCF below pretreated VCF occurred significantly earlier in time compared to VCF above and compared to sandwich body fractures. No major complication occurred during initial or follow-up intervention. We conclude that secondary VCFs do occur in individuals after VTP but the rate found in our study remains below the level expected from epidemiologic studies. Adjacent fractures occur more often and follow the cluster distribution of VCF as expected from the natural history of the underlying osteoporosis. No increased rate of secondary VCF after VTP was observed in this retrospective analysis. In accordance with the pertinent literature, short-term and also midterm clinical results are encouraging and provide further support for the usefulness and the low complication rate of this procedure as an adjunct to the spectrum of pain management in patients with severe midline back pain due to osteoporotic spine fractures.

Hierholzer, Johannes, E-mail: jhierholzer@klinikumevb.de; Fuchs, Heiko; Westphalen, Kerstin; Baumann, Clemens; Slotosch, Christine [Klinikum Ernst von Bergmann gGmbH, Academic Teaching Hospital, Charite, University Medicine Berlin, Diagnostic and Interventional Radiology (Germany); Schulz, Rudolf [Klinikum Ernst von Bergmann, Musculoskeletal Surgery (Germany)

2008-11-15

191

Pre-symptomatic Prediction of Plant Drought Stress using Dirichlet-Aggregation Regression on Hyperspectral Images  

E-print Network

Pre-symptomatic Prediction of Plant Drought Stress using Dirichlet-Aggregation Regression. of Geodesy and Geoinformation University of Bonn, Germany Abstract Pre-symptomatic drought stress prediction crop losses in agriculture. It has been esti- mated that drought can cause a depreciation of crop yield

Kersting, Kristian

192

Obstet Gynecol . Author manuscript Symptomatic pelvic organ prolapse at midlife, quality of life, and risk  

E-print Network

Obstet Gynecol . Author manuscript Page /1 9 Symptomatic pelvic organ prolapse at midlife, quality, and risk factors associated with symptomatic pelvic organ prolapse (POP) among middle-aged women. Methods ; Sensitivity and Specificity ; Uterine Prolapse ; diagnosis ; epidemiology Author Keywords Pelvic organ

Boyer, Edmond

193

Recurrence Risk after a First Remote Symptomatic Unprovoked Seizure in Childhood: A Prospective Study  

ERIC Educational Resources Information Center

The aim of this study was to assess recurrence risk after a first remote symptomatic unprovoked seizure in childhood. All consecutive patients younger than 14 years with a first remote symptomatic unprovoked seizure who were seen at our hospital between 1994 and 2006 were included in the study and prospectively followed. Only two patients received…

Ramos-Lizana, J.; Aguirre-Rodriguez, J.; Aguilera-Lopez, P.; Cassinello-Garcia, E.

2009-01-01

194

[Chronic daily headache: management and rehabilitation].  

PubMed

In 2001, WHO evidenced headache among the first twenty disability agents in the world. The International Classification of Headache Disorders, II version (ICHD-II) recognises 24 types of chronic headache and states primary headaches as chronic when attacks appear for more than 15 days per month, for at least three months. Migraine given by drugs overuse, defined by ICDH-II in 2004 (and revised in 2005) as MOH, represents a common and debilitating disorder, which can be defined as generation, perpetuation and persistence of intense chronic migraine caused by the frequent and excessive use of (symptomatic) drugs, giving an immediate relief. MOH is associated with overuse of a combination of analgesics, barbiturates, opiods, Ergot alkaloids, aspirin, FANS, caffeine and triptans. Furthermore, some psychological and behavioural states seem particularly important in promoting and sustaining drugs abuse. The management and rehabilitation of patients affected by CDH, over-using symptomatic drugs, consists in the suspension and gradual reduction of their assumption, because of tolerance and addiction possibilities. Therapeutic success, defined as total absence of headache or frequency reduction over 50% in a period of time from 1 to 6 months, stands around 72-74%. PMID:16817505

de Filippis, S; Salvatori, E; Coloprisco, G; Martelletti, P

2006-01-01

195

Chronic rectal bleeding in Proteus syndrome.  

PubMed

Proteus Syndrome is a rare congenital hamartomatous disorder that typically manifests itself in overgrowth, vascular malformation and disregulation of fatty tissue. The tissues affected are commonly the limbs but can be of any tissue. Vascular anomalies are common and appear at random sites on the body. Diagnosis is often difficult leading to wrong treatment. We describe a case of a 17-year-old girl with Proteus syndrome presented with symptomatic anaemia secondary to chronic rectal bleeding. Computed Tomography Angiogram of Abdomen and Pelvis confirmed the presence of rectal vascular malformations. PMID:21901955

Siow, S L; Sim, N K

2010-12-01

196

Primary biliary cirrhosis: geographical clustering and symptomatic onset seasonality.  

PubMed Central

Patients with primary biliary cirrhosis (primary non-suppurative destructive cholangitis) in the north east region of England were studied over a five year period and, to evaluate epidemicity, compared with two contemporaneous disease series of known occurrence. These were: terminal renal failure, all causes (low or absent epidemicity n = 106) and an outbreak of echovirus 19 disease (high epidemicity n = 201). Eight primary biliary cirrhosis-affected men and 109 women from an estimated catchment population of 2.08 million were identified. The current diagnosis rate was 1.0/100 000 (1.8/100 000 for women of 15 or more). There were 18 deaths, mean survival from diagnosis 4.0 years. Within the region prevalence varied from 3.7/100 000 in rural areas to 14.4/100 000 in industrial urban areas. In the conurbation, prevalence rates varied insignificantly. Here, most cases were concentrated in central districts, where the proportion of asymptomatic presentations was 50%. Outside the conurbation the asymptomatic proportion fell to 21%, suggesting low incidental diagnosis rates. When compared with echovirus 19, primary biliary cirrhosis was of low or absent epidemicity, and similar to renal failure in its uniform geographical distribution and lack of clustering. Forty three patients (37% of the total), however, had significantly seasonal symptomatic presentations (p less than 0.01), although scan statistic testing failed to show clustering of onset in time. Apparently provocative factors associated with primary biliary cirrhosis symptomatic onset were identified in only 11 (9.4%) of patients. Age-specific onset rates rose linearly between ages 35 and 65, and nearly one third of patients presented after 65 years, two thirds of deaths occurring in this age group. There is thus no evidence in north east England of geographical anomalies in the distribution of primary biliary cirrhosis. International differences may be partly explained by environmental factors influencing seasonal presentation, such as sunlight. Diagnosis rates are profoundly influenced by increased medical awareness, especially in the elderly, of this now relatively common disease and increased use of the mitochondrial (AMA) antibody test. PMID:6618273

Hamlyn, A N; Macklon, A F; James, O

1983-01-01

197

Efficacy of Vastarel MR on silent and symptomatic myocardial ischemia  

Microsoft Academic Search

Despite advances in the medical treatment of myocardial ischemia, a large proportion of patients with coronary artery disease suffer from angina and have silent episodes of myocardial ischemia. Chronic repetitive ischemic episodes may lead to ischemic cardiomyopathy. Trimetazidine, the 3-ketoacyl coenzyme A thiolase inhibitor, is a metabolically active agent that is effective, whether alone or in combination with standard therapy,

Giuseppe Camitini; Giuseppe Marazzi; Giuseppe Rosano

198

Low back pain - chronic  

MedlinePLUS

Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... waist, leads to pain. Many people with chronic back pain have arthritis. Or they may have extra wear ...

199

Chronic Diarrhea  

MedlinePLUS

... as: Disorders of the pancreas (e.g. chronic pancreatitis, pancreatic enzyme deficiencies, cystic fibrosis) Intestinal disorders (e. ... Altered immune function (e.g. immunoglobulin deficiencies, AIDS, autoimmune disease) Hereditary disorders (e.g. cystic fibrosis, enzyme ...

200

Chronic Meningitis  

MedlinePLUS

... not infections can cause chronic meningitis. They include sarcoidosis and certain disorders that cause inflammation, such as ... For disorders that are not infections, such as sarcoidosis and Behçet syndrome: Corticosteroids or other drugs that ...

201

[Chronic migraine].  

PubMed

The classification of the International Headache Society (IHS) generally differentiates episodic from chronic headache. Chronic migraine is defined as headache on 15 and more days a month over more than 3 months and headache on 8 days or more fulfils the criteria for migraine or were triptan/ergot-responsive when thought to be migrainous in early stages of the attack. The prevalence of chronic migraine is estimated at 2-4?%. The quality of life is highly compromised in this condition and comorbidities are much more frequent compared to episodic migraine. Data from prospective randomized studies are scarce as most patients with chronic migraine were excluded from previous trials and only few studies were conducted for this condition. The efficacy for prophylactic treatment compared with placebo is proven for topiramate and onabotulinum toxin A. PMID:24337617

Diener, H C; Holle, D; Müller, D; Nägel, S; Rabe, K

2013-12-01

202

Endoscopic therapy in chronic pancreatitis: current perspectives.  

PubMed

Endoscopic therapy in chronic pancreatitis (CP) aims to provide pain relief and to treat local complications, by using the decompression of the pancreatic duct and the drainage of pseudocysts and biliary strictures, respectively. This is the reason for using it as first-line therapy for painful uncomplicated CP. The clinical response has to be evaluated at 6-8 weeks, when surgery may be chosen. This article reviews the main possibilities of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) therapies. Endotherapy for pancreatic ductal stones uses ultrasound wave lithotripsy and sometimes additional stone extractions. The treatment of pancreatic duct strictures consists of a single large stenting for 1 year. If the stricture persists, simultaneous multiple stents are applied. In case of unsuccessful ERCP, the EUS-guided drainage of the main pancreatic duct (MPD) or a rendezvous technique can solve the ductal strictures. EUS-guided celiac plexus block has limited efficiency in CP. The drainage of symptomatic or complicated pancreatic pseudocysts can be performed transpapillarily or transgastrically/transduodenally, preferably by EUS guidance. When the biliary stricture is symptomatic or progressive, multiple plastic stents are indicated. In conclusion, as in many fields of symptomatic treatment, endoscopy remains the first choice, either by using ERCP or EUS-guided procedures, after consideration of a multidisciplinary team with endoscopists, surgeons, and radiologists. However, what is crucial is establishing the right timing for surgery. PMID:25565876

Seicean, Andrada; Vultur, Simona

2015-01-01

203

Endoscopic therapy in chronic pancreatitis: current perspectives  

PubMed Central

Endoscopic therapy in chronic pancreatitis (CP) aims to provide pain relief and to treat local complications, by using the decompression of the pancreatic duct and the drainage of pseudocysts and biliary strictures, respectively. This is the reason for using it as first-line therapy for painful uncomplicated CP. The clinical response has to be evaluated at 6–8 weeks, when surgery may be chosen. This article reviews the main possibilities of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) therapies. Endotherapy for pancreatic ductal stones uses ultrasound wave lithotripsy and sometimes additional stone extractions. The treatment of pancreatic duct strictures consists of a single large stenting for 1 year. If the stricture persists, simultaneous multiple stents are applied. In case of unsuccessful ERCP, the EUS-guided drainage of the main pancreatic duct (MPD) or a rendezvous technique can solve the ductal strictures. EUS-guided celiac plexus block has limited efficiency in CP. The drainage of symptomatic or complicated pancreatic pseudocysts can be performed transpapillarily or transgastrically/transduodenally, preferably by EUS guidance. When the biliary stricture is symptomatic or progressive, multiple plastic stents are indicated. In conclusion, as in many fields of symptomatic treatment, endoscopy remains the first choice, either by using ERCP or EUS-guided procedures, after consideration of a multidisciplinary team with endoscopists, surgeons, and radiologists. However, what is crucial is establishing the right timing for surgery.

Seicean, Andrada; Vultur, Simona

2015-01-01

204

Predictors of symptomatic response to glucosamine in knee osteoarthritis: an exploratory study  

PubMed Central

Objective To evaluate whether patient characteristics and/or radiographic disease patterns predict symptomatic response to treatment with glucosamine in osteoarthritis (OA) of the knee. Design Exploratory prospective correlational study. Setting Institutional. Patients 39 participants with chronic knee pain from the local community. Interventions Glucosamine sulphate (1.5?g/day) for 12?weeks. Main outcome measures Pain and physical function were assessed with visual analogue scales (VASs) and participant?perceived global change scores (GCSs). Regression modelling evaluated the relationship between treatment outcome and age, body mass index (BMI), pain and function self?efficacy and presence/absence of osteophytes in the medial and lateral tibiofemoral joint (TFJ) and patellofemoral joint (PFJ) compartments. Results 13 (33%) participants were men. The mean (SD) age and BMI were 53.6 (13.1)?years and 27.9 (4.6)?kg/m2, respectively. 13 (33%), 19 (49%) and 24 (62%) participants had medial TFJ, lateral TFJ and PFJ osteophytes, respectively. Glucosamine significantly improved pain (mean change on VAS?=? ?1.4, 95% CI ?0.6 to ?2.2; p?=?0.002) and activity restriction (?1.9, 95% CI ?1.0 to ?2.8; p<0.001). At 12?weeks, 30 (77%) and 27 (69%) participants reported improvement in pain and physical function, respectively. Regression modelling showed that no evaluated variables predicted change in pain on VAS. Decreased function self?efficacy, presence of PFJ osteophytes and absence of medial TFJ osteophytes predicted functional improvement on VAS. BMI, pain self?efficacy and function self?efficacy predicted improvement in pain by GCS. Conclusions Although glucosamine significantly improved symptoms, most of the variance in outcome at 12?weeks was unexplained by the predictors evaluated. However, glucosamine may be more effective at improving symptoms in patients with knee OA who have a lower BMI, PFJ osteophytes and lower functional self?efficacy. PMID:17261554

Bennett, Alexander N; Crossley, Kay M; Brukner, Peter D; Hinman, Rana S

2007-01-01

205

Hemoglobin Targets and Blood Transfusions in Hemodialysis Patients without Symptomatic Cardiac Disease Receiving Erythropoietin Therapy  

PubMed Central

Background and objectives: Optimal hemoglobin targets for chronic kidney disease patients receiving erythropoiesis-stimulating agents remain controversial. The effects of different hemoglobin targets on blood transfusion requirements have not been well characterized, despite their relevance to clinical decision-making. Design, setting, participants, & measurements: Five hundred ninety-six incident hemodialysis patients without symptomatic cardiac disease were randomly assigned to hemoglobin targets of 9.5 to 11.5 g/dl or 13.5 to 14.5 g/dl for 96 wk using epoetin alfa as primary therapy and changes in left ventricular structure as the primary outcome (previously reported). Patients were masked to treatment assignment. Blood transfusion data were prospectively collected at 4-wk intervals. Results: The mean age and prior duration of dialysis therapy of the study population were 50.8 and 0.8 yr, respectively. Previously reported mortality was similar in low and high-target subjects, at 4.7 (95% confidence interval 3.0, 7.3) and 3.1 (1.8, 5.4) per hundred patient years, respectively. Transfusion rates were 0.66 (0.59, 0.74) units of blood per year in low and 0.26 (0.22, 0.32) in high-target subjects (P < 0.0001). Hemoglobin level at transfusion (7.7 [7.5, 7.9]) versus 8.1 [7.6, 8.5] g/dl) were similar with both groups. High hemoglobin target was a significant predictor of time to first transfusion independent of baseline associations (hazard ratio = 0.42; 95% confidence interval = 0.26 ? 0.67). Conclusions: In hemodialysis patients with comparatively low mortality risks, normal hemoglobin targets may reduce the need for transfusions. PMID:18922988

Foley, Robert N.; Curtis, Bryan M.; Parfrey, Patrick S.

2008-01-01

206

Conservative management of symptomatic knee osteoarthritis: a flawed strategy?  

PubMed Central

Conservative management of medial compartment knee osteoarthritis (OA) is a misleading term used to describe the application of medical, orthotic, and/or rehabilitative therapies exclusive of surgical interventions. The implication of this nomenclature is that these therapies offer satisfactory symptom relief, alter disease progression, and have limited side effects. Unfortunately, conservative therapeutic options possesses few, if any, characteristics of an ideal treatment, namely one that significantly alleviates pain, improves knee function, and reduces medial compartmental loading without adverse side effects. As uncompensated mechanical loading is a primary culprit in the development and progression of knee OA, we propose that the therapeutic perspective of conservative treatment should shift from pharmacological treatments, which have no influence on joint loading, minimal potential to alter joint function, substantial associated risks, and significant financial costs, towards minimally invasive load absorbing therapeutic interventions. A safe and effective minimally invasive medical device specifically engineered for symptomatic relief of medial knee OA by limiting joint contact forces has the potential to reduce the clinical and economic knee OA burden. This review characterizes the current standard of care recommendations for conservative management of medial compartment knee OA with respect to treatment efficacy, risk profile, and economic burden. PMID:23705060

Crawford, Dennis C.; Miller, Larry E.; Block, Jon E.

2013-01-01

207

Symptomatic foramen of Magendie arachnoid cyst in an elderly patient  

PubMed Central

Background: Arachnoid cysts (ACs) are congenital anomalies of the central nervous system and arise in virtually all locations where the arachnoid membrane exists. Posterior fossa ACs are considered to develop in the posterior aspect of the rhombencephalic roof plate and do not communicate freely with the fourth ventricle or perimedullary subarachnoid space. Although posterior fossa ACs have been reported a number of times, ACs arising from the foramen of Magendie are very rare. Case Description: We report here on a 76-year-old female who presented with progressive gait disturbance. Magnetic resonance imaging of the head showed a large AC in the foramen of Magendie that was compressing the inferior vermis and medial aspects of the cerebellar hemisphere without causing hydrocephalus. Neurological examination revealed cerebellar ataxia without Romberg's sign. A nearly total excision of the cyst was safely performed via a median suboccipital approach. The patient's postoperative course was excellent and her neurological recovery was remarkable. Conclusion: Most cases of ACs located in the foramen of Magendie are reported in children, and it is extremely rare to observe such ACs in the elderly. In fact, to our knowledge, a symptomatic foramen Magendie AC has never been reported previously in an elderly person. Our results indicate that proper surgical intervention can yield highly positive outcomes in such cases.

Hayashi, Yasuhiko; Kita, Daisuke; Watanabe, Takuya; Yoshikawa, Akifumi; Hamada, Jun-ichiro

2015-01-01

208

Symptomatic hyponatraemia: can myelinolysis be prevented by treatment?  

PubMed Central

The treatment of hyponatraemia is controversial because of the risk of causing central or extrapontine myelinolysis (EPM). Rapid correction with hypertonic saline to a low normal sodium level has its proponents; others feel that slow correction to below normal sodium values is preventative. Most investigators feel that overcorrection should be avoided. It is not known whether the magnitude of serum sodium change is more important than the actual rate of correction. We present three patients with hyponatraemia ranging from 103 to 105 mmol/l who were corrected slowly with normal saline, corrected quickly with hypertonic saline, or rapidly overcorrected with hypertonic saline. All became comatose and died; all had EPM with or without central pontine myelinolysis (CPM). The rate of correction, the solution used, or the magnitude of correction did not seem to protect against demyelination. In a review of 67 reported CPM cases since 1983, no patients documented as having CPM or EPM by radiological studies or necropsy were treated with water restriction only. A group of 27 hyponatraemic patients treated only with water restriction and 35 with diuretic cessation alone did not develop CPM or EPM. This may be a reasonable approach to patients with symptomatic hyponatraemia and normal renal function. Images PMID:8509775

Harris, C P; Townsend, J J; Baringer, J R

1993-01-01

209

[Symptomatic cyst of the pancreas and asymptomatic bilateral phaeochromocytoma  

PubMed

Symptomatic cyst of the pancreas and asymptomatic bilateral phaeochromocytoma. HISTORY AND CLINICAL FINDINGS: A 39-year-old woman was admitted to our department of gastroenterology with recurrent epigastrical pain. Ten years previously the diagnosis of von Hippel-Lindau (VHL)-syndrome has been established. Two years before a germ line mutation in exon 3 of the VHL-tumour suppressor gene has been detected. The patient has a healthy son with a normal VHL-gene and four healthy siblings who had refused a genetic blood test. INVESTIGATIONS: At abdominal ultrasound at the head of the pancreas three 4 2 cm large cysts and in the region of the left adrenal gland a 2,9 2,7 cm large tumor were visible. MRI of the abdomen revealed in addition a 2,2 1,5 cm large tumour of the right adrenal gland. An asymptomatic biadrenal phaeochromocytoma was detected by elevated urine catecholamines and 123I-MIBG-scintigraphy. TREATMENT AND COURSE: The cysts of the pancreas were punctured under endosonographical control and analysis of the cyst fluid was not suspicious of a malignant cystic tumour. The patient had no further abdominal complaints. After oral treatment with the alpha-blocker phentolamine the biadrenal phaeochromocytoma was treated by retroperitoneal laparoscopic surgery in an organ-sparing fashion. Postoperatively ACTH-stimulating test revealed a normal cortisol response. CONCLUSION: Adrenocortical function can be preserved by la-paroscopic adrenal-sparing surgery in bilateral phaeochromocytoma. PMID:12751023

Karvar, S; Breidert, M; Nagel, M; Kirsch, C; Pinkert, J; Ehninger, G

2001-01-01

210

Neonatal symptomatic thromboembolism in Germany: two year survey  

PubMed Central

AIMS—To determine the incidence of neonatal thromboembolism in Germany.?METHODS—Diagnostic imaging techniques, therapeutic modalities, and short term outcome were evaluated in a prospective nationwide two year case registry study.?RESULTS—The reported incidence of symptomatic neonatal thromboembolism, diagnosed in most cases with Doppler ultrasonography, was 5.1 per 100 000 births, with a total of 79 cases registered: renal venous thrombosis (n=35); venous thrombosis (n=25); and arterial vascular occlusion (n=19). Fifty seven of 79 thromboses were associated with additional risk factors (central line n=25, asphyxia n=13, septicaemia n=11, dehydration n=6, maternal diabetes n=2, cardiac disease n=1). Inherited thrombophilia was also diagnosed in seven out of 35 cases investigated. Twenty three children received supportive treatment: 42 received heparin and in 13 neonates thrombolytic agents were administered. Most neonates (91%) survived; seven died.?CONCLUSION—Controlled multicentre studies are needed to obtain more information on treatment efficacy.?? Keywords: thromboembolism; Doppler ultrasonography; heparin; thrombolytic agents; Germany PMID:9175945

Nowak-Gottl, U.; von Kries, R.; Gobel, U.

1997-01-01

211

Symptomatic liver involvement in neonatal hereditary hemorrhagic telangiectasia.  

PubMed

High-flow hepatic vascular anomalies with arteriovenous shunting commonly manifest during the neonatal period with signs and symptoms of congestive heart failure, but to our knowledge, they have never been described in patients with hereditary hemorrhagic telangiectasia (HHT). We report here our experience with 3 patients with hepatic arteriovenous malformations (AVMs) who presented with symptoms of high-output congestive heart failure during the neonatal period and were subsequently diagnosed with HHT. Imaging showed large hypervascular lesions and multiple hepatic arteriovenous shunts that differentiated these lesions from liver hemangiomas. Transcatheter embolization was performed in all cases. One infant died of sepsis shortly after embolization; follow-up at the age of 2.5 years of the surviving infants revealed involution of the vascular lesions and no evidence of symptom recurrence. We conclude that severe symptoms related to hepatic AVMs in HHT can occur in the neonatal period and that HHT should therefore be included in the differential diagnosis of symptomatic neonatal hepatic vascular malformations. Imaging plays a key role in differentiating hepatic AVMs from hemangiomas, because the latter require additional pharmacologic treatments. Early transcatheter embolization seems to be effective, but long-term outcomes still need to be assessed. PMID:21536610

Al-Saleh, Suhail; John, Philip R; Letarte, Michelle; Faughnan, Marie E; Belik, Jaques; Ratjen, Felix

2011-06-01

212

Evaluation of suspected ischemic heart disease in symptomatic women.  

PubMed

There is a wealth of evidence about the role of a variety of diagnostic testing modalities to define coronary artery disease (CAD) risk in women presenting for evaluation of suspected myocardial ischemia. The exercise electrocardiogram (ECG) is the core index procedure, which can define risk in women capable of performing maximal exercise. Stress imaging, using echocardiography or myocardial perfusion single-photon emission computed tomography/positron emission tomography, is useful for symptomatic women with an abnormal resting ECG or for those who are functionally disabled. For women with low-risk stress imaging findings, there is a very low risk of CAD events, usually < 1%. There is a gradient relationship between the extent and severity of inducible abnormalities and CAD event risk. Women at high risk are those defined as having moderate to severely abnormal wall motion or abnormal perfusion imaging findings. In addition to stress imaging, the evidence of the relationship between CAD extent and severity and prognosis has been clearly defined with coronary computed tomographic angiography. In women, prognosis for those with mild but nonobstructive CAD is higher when compared with those without any CAD. The current evidence base clearly supports that women presenting with chest pain can benefit from one of the commonly applied diagnostic testing modalities. PMID:24582723

Shaw, Leslee J; Tandon, Suman; Rosen, Stacey; Mieres, Jennifer H

2014-07-01

213

Unusual symptomatic inclusion cysts in a newborn: a case report  

PubMed Central

Introduction Dental lamina cysts are cysts that occur as white or pink small nodules, often multiple, approximately 1 to 3mm in diameter. They are typically located on the midpalatine raphe and less frequently on the maxillary and mandibular alveolar mucosa; in the latter case these can be appear to be neonatal teeth. On microscopic examination, these lesions show a stratified squamous epithelium (two to three cell layers); it is possible to find protein, keratin and/or exfoliated epithelial cells in the lumen of the lesions. Neonatal cysts usually show no particular symptoms. They are associated with an excellent prognosis because they regress spontaneously within a few weeks and are not associated to any complications. However, if pain, bleeding or other symptoms occur, a surgical excision is required. Case presentation In this paper, we present an anomalous case of symptomatic dental lamina cyst which affected a 60-day-old male Caucasian newborn. The surgical treatment was elective in this case and 6-month follow-ups were mandatory. Conclusions We can underline the successful predictability of the surgical approach; however, we consider that the treatment choice should take place in the light of medical history and clinical considerations, and always be evaluated on a case-by-case basis. Further studies and reviews in this field should be performed in order to suggest guidelines for clinicians, although these cases are rare. PMID:25241967

2014-01-01

214

Time Course and Recovery of Exacerbations in Patients with Chronic Obstructive Pulmonary Disease  

Microsoft Academic Search

Although exacerbations of chronic obstructive pulmonary disease (COPD) are associated with symptomatic and physiological deterio- ration, little is known of the time course and duration of these changes. We have studied symptoms and lung function changes as- sociated with COPD exacerbations to determine factors affecting recovery from exacerbation. A cohort of 101 patients with moder- ate to severe COPD (mean

TERENCE A. R. SEEMUNGAL; GAVIN C. DONALDSON; ANGSHU BHOWMIK; DONALD J. JEFFRIES; JADWIGA A. WEDZICHA

2000-01-01

215

Intrahepatic collateral recanalization in symptomatic Budd-Chiari syndrome: a single-center experience.  

PubMed

The authors present a single-institutional experience with intrahepatic collateral vessel recanalization as a treatment option in symptomatic Budd-Chiari syndrome (BCS). Over a period of 26 months, this procedure was performed in four symptomatic patients in whom standard hepatic vein recanalization was not feasible or had failed, with a follow-up duration ranging from 7 to 44 months. Based on these cases, intrahepatic collateral vessel recanalization is a promising treatment option in suitable patients with symptomatic BCS and is deserving of further study. PMID:20537910

Mammen, Thomas; Keshava, Shyamkumar; Eapen, C E; Moses, Vinu; Babu, N R S Surendra; Kurien, George; Chandy, George

2010-07-01

216

Chronic urticaria.  

PubMed Central

OBJECTIVE: To review the pathophysiology of chronic urticaria in light of recent evidence for it being an autoimmune disease, and to recommend appropriate management. QUALITY OF EVIDENCE: An extensive literature review was supplemented with a MEDLINE search. Articles from easily available journals were preferred. These consisted of the most recent basic articles on autoimmunity in relation to chronic urticaria and a selection of previous articles on pathophysiology, which illustrate consistencies with recent evidence. The investigation and management protocol is supported by original and relevant literature. MAIN FINDINGS: The histopathology and immunohistology of chronic urticaria and certain clinical studies were a prelude to definitive evidence that most instances of chronic urticaria are autoimmune. Although allergic and other causes are uncommon, these must be sought because identification can lead to cure or specific treatment. Management of the much more common autoimmune urticaria is based on principles derived from the demonstrated pathogenesis and on results of published clinical trials. CONCLUSIONS: In most instances, chronic urticaria is an autoimmune disease, but uncommon allergic or other causes must be considered. PMID:9805172

Leznoff, A.

1998-01-01

217

Occurrence of anaplastic large cell lymphoma following IgG4-related autoimmune pancreatitis and cholecystitis and diffuse large B-cell lymphoma  

PubMed Central

IgG4-related sclerosing disease is an established disease entity with characteristic clinicopathological features. Recently, the association between IgG4-related sclerosing disease and the risk of malignancies has been suggested. IgG4-related autoimmune pancreatitis with pancreatic cancer has been reported. Further, a few cases of extraocular malignant lymphoma in patients with IgG4-related sclerosing disease have also been documented. Herein, we describe the first documented case of anaplastic large cell lymphoma (ALCL) following IgG4-related autoimmune pancreatitis and cholecystitis and diffuse large B-cell lymphoma (DLBCL). A 61-year-old Japanese male, with a past history of DLBCL, was detected with swelling of the pancreas and tumorous lesions in the gallbladder. Histopathological study of the resected gallbladder specimen revealed diffuse lymphoplasmacytic infiltration with fibrosclerosis in the entire gallbladder wall. Eosinophilic infiltration and obliterative phlebitis were also noted. Immunohistochemically, many IgG4-positive plasma cells had infiltrated into the lesion, and the ratio of IgG4/IgG-positive plasma cells was 71.6%. Accordingly, a diagnosis of IgG4-related cholecystitis was made. Seven months later, he presented with a painful tumor in his left parotid gland. Histopathological study demonstrated diffuse or cohesive sheet-like proliferation of large-sized lymphoid cells with rich slightly eosinophilic cytoplasm and irregular-shaped large nuclei. These lymphoid cells were positive for CD30, CD4, and cytotoxic markers, but negative for CD3 and ALK. Therefore, a diagnosis of ALK-negative ALCL was made. It has been suggested that the incidence of malignant lymphoma may be high in patients with IgG4-related sclerosing disease, therefore, intense medical follow-up is important in patients with this disorder. PMID:24228121

Ishida, Mitsuaki; Hodohara, Keiko; Yoshida, Keiko; Kagotani, Akiko; Iwai, Muneo; Yoshii, Miyuki; Okuno, Hiroko; Horinouchi, Akiko; Nakanishi, Ryota; Harada, Ayumi; Yoshida, Takashi; Okabe, Hidetoshi

2013-01-01

218

Intravascular large B-cell lymphoma manifesting as cholecystitis: report of an Asian variant showing gain of chromosome 18 with concurrent deletion of chromosome 6q  

PubMed Central

Intravascular large B-cell lymphoma (IVLBCL), which involves the lumen of small vessels, is a rare variant of extranodal diffuse large B-cell lymphomas. Herein, we present a case of IVLBCL manifesting as cholecystitis in a 77-year-old Japanese man. He presented with fever, fatigue, and weight loss. Physical examination revealed tenderness of the right upper quadrant. The white blood cell count and C-reactive protein levels were elevated. Computed tomography revealed gallbladder thickening and pericholecystic fluid collection; these observations were consistent with the diagnosis of cholecystitis. Serum soluble interleukin-2 receptor levels were highly elevated, and gallium scintigraphy revealed an abnormal accumulation in the spleen, implying lymphoma. Consequently, G-banding analysis of the patient’s bone marrow aspirates revealed the presence of different abnormal clones, including those with gain of chromosome 18 and deletion of chromosome 6q. As cholecystectomy was necessary, a concurrent splenectomy was performed to diagnose the disease definitively. Histopathologically, atypical large lymphoid cells were observed to be localized in the vasculature in both the spleen and gallbladder; the atypical cells expressed high levels of CD20, CD5, and CD10, immunohistochemically. These findings were consistent with IVLBCL. The patient underwent post-operative treatment with rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone. However, a pancreatic fistula developed during chemotherapy, causing left pleural effusion and peritoneal effusion; the patient developed sepsis from multidrug-resistant microorganisms, and subsequently died of multi-organ failure 6 months after the diagnosis. No obvious recurrence of the tumor was found during autopsy. We discuss the characteristic karyotype and immunohistochemical status observed in this case.

Tajima, Shogo; Waki, Michihiko; Yamazaki, Hiroyuki; Nagata, Yasuyuki; Fukano, Hana; Hossen, Md Amir; Hoshi, Shoji; Takeuchi, Takahiro

2014-01-01

219

A single center experience of stenting in symptomatic intracranial atherosclerosis.  

PubMed

Atherosclerotic intracranial arterial stenosis is an important cause of stroke that is increasingly being treated with percutaneous transluminal angioplasty and stenting (PTAS) to prevent recurrent stroke. However, PTAS has been compared with medical management in a randomized trial (SAMMPRIS), where aggressive medical management was superior to PTAS with the use of the Wingspan stent system, however in our experience we have had good results and have experienced no complications with this therapy. In a retrospective, single-center study we enrolled seven consecutive patients with a symptomatic angiographically proven atherosclerotic intracranial arterial stenosis of the anterior and posterior circulation. All cases received adjuvant therapy (aspirin and clopidogrel or ticlopidine) before and after deployment of the device. The procedures were performed with the patient under general anesthesia. We use the Wingspan stent system. The occlusion site was middle cerebral artery (MCA) in three patients, proximal internal carotid artery (ICA) in one patient and vertebrobasilar artery in three patients. Primary interventional successful revascularization was achieved in all cases. Four patients had no residual stenosis, and the other three had 20%, 30% and 40% residual stenosis (Table 1). All patients showed a clinical improvement after stent deployment. No peri-interventional events or neurologic complications occurred directly related to the technique. Patency rate was 100% at the last examination in six cases, one case had a pre-occlusive stenosis, requiring angioplasty. No patients died during the follow-up period, and 100% of patients showed good functional outcome at three months (modified Rankin Scale score ? 2). Although the SAMMPRIS study showed that aggressive medical management was superior to PTAS, our results suggest that intracranial stenting is safe and effective, probably due to an extraordinary selection of candidates and to an exquisite technique. PMID:24029090

Castaño, C; García-Bermejo, P; García, M R

2012-11-01

220

Clinical Characteristics of Symptomatic Vertebral Artery Dissection. A Systematic Review  

PubMed Central

Background Vertebral artery dissection (VAD) is an important cause of stroke in the young. It can present nonspecifically and may be misdiagnosed with adverse consequences. We assessed the frequency of head/neck pain, other neurological symptoms, and cerebrovascular events in symptomatic VAD. Methods We conducted a systematic review of observational studies, searching electronic databases (MEDLINE, EMBASE) for English-language manuscripts with >5 subjects with clinical or radiological features of VAD. Two independent reviewers selected studies for inclusion; a third adjudicated differences. Studies were assessed for methodological quality and clinical data were abstracted. Pooled proportions were calculated. Results Of 3996 citations, we screened 511manuscripts and selected 75 studies describing 1,972 VAD patients. The most common symptoms were dizziness/vertigo (58%), headache (51%) and neck pain (46%). Stroke was common (63%), especially with extracranial dissections (66% vs. 32%, p<0.0001), while TIA (14%) and subarachnoid hemorrhage (SAH) (10%) were uncommon. SAH was seen only with intracranial dissections (57% vs. 0%, p=0.003). Fewer than half of the patients had obvious trauma, and only 7.9% had a known connective tissue disease. Outcome was good (modified Rankin scale (mRS) 0-1) in 67% and poor (mRS 5-6) in 10%. Conclusion VAD is associated with nonspecific symptoms such as dizziness, vertigo, headache, or neck pain. Ischemic stroke is the most common reported cerebrovascular complication. VAD should be considered in the diagnostic assessment of patients presenting with dizziness or craniocervical pain, even in the absence of other risk factors. Future studies should compare clinical findings as predictors in well-defined, undifferentiated populations of clinical VAD suspects. PMID:22931728

Gottesman, Rebecca F.; Sharma, Priti; Robinson, Karen A.; Arnan, Martinson; Tsui, Megan; Ladha, Karim; Newman-Toker, David E.

2013-01-01

221

Prostate Tissue Composition and Response to Finasteride in Men With Symptomatic Benign Prostatic Hyperplasia  

Microsoft Academic Search

PurposeWe sought to quantify prostate tissue changes induced by finasteride and to identify a predictor of finasteride response in men with symptomatic benign prostatic hyperplasia (BPH) via a randomized, placebo controlled, double-blind clinical trial.

Leonard S. Marks; Alan W. Partin; Glenn J. Gormley; Frederick J. Dorey; Erlinda D. Shery; Joel B. Garris; Eric N. P. Subong; Elizabeth Stoner; Jean B. deKernion

1997-01-01

222

Efficacy of Ibuprofen and Ibuprofen/Acetaminophen on Postoperative Pain in Symptomatic Necrotic Teeth.  

E-print Network

??The purpose of this prospective, randomized, double-blind study was to determine ibuprofen versus ibuprofen/acetaminophen usage for postoperative endodontic pain in symptomatic patients with a pulpal… (more)

Wells, Larry Kevin

2010-01-01

223

Symptomatic spinal epidural hematoma after lumbar spine surgery: the importance of diagnostic skills.  

PubMed

Symptomatic spinal epidural hematoma (SEH) is a rare but serious complication that may occur after lumbar spine surgery. Prompt recognition of this complication depends on the diagnostic skills of perioperative nursing personnel, particularly postanesthesia care unit nurses. Analysis of a composite of patients undergoing spinal surgery suggests that neurological and functional outcomes of patients with symptomatic lumbar SEH often depend on the time interval between symptom onset and surgical evacuation of the hematoma. Clinicians should consider a diagnosis of symptomatic SEH if there is a change in the patient's neurological status during the first several hours after lumbar spine surgery. Suspicion of postoperative symptomatic SEH should prompt clinicians to notify the responsible surgeon without delay. PMID:25537329

Daniels, Alan H; Schiebert, Steven S; Palumbo, Mark A

2015-01-01

224

Pulmonary fibrosis secondary to siderosis causing symptomatic respiratory disease: a case report  

E-print Network

impairment. Although not the first of its kind, we present an unusual case of pulmonary siderosis with symptomatic respiratory disease, most likely secondary to associated fibrosis. Case presentation A 66-year-old Caucasian man was referred to the outpatient...

McCormick, Liam M; Goddard, Martin; Mahadeva, Ravi

2008-08-05

225

Long-term incidence of symptomatic urolithiasis post-bariatric surgery  

PubMed Central

Introduction: The risk of urolithiasis post-Roux-en-Y gastric bypass (RYGB) surgery is higher when compared to the general population. Calcium and vitamin D supplementation is routinely prescribed to these patients, yet compliance with these supplements is unknown. The aim of this study was to assess the incidence of symptomatic de novo urolithiasis post-RYGB and compliance with calcium and vitamin D supplementation. Methods: A standardized telephone questionnaire was administered to patients who underwent RYGB between 1996 and 2011. Personal and medical histories were obtained with emphasis on episodes of symptomatic urolithiasis and calcium and vitamin D supplementation. Results: The response rate was 48% with 478 patients completing the telephone questionnaire. After a mean follow-up of 7.0 years (range: 1–15), the incidence of post-RYGB symptomatic urolithiasis was 7.3%, while the rate of de novo symptomatic urolithiasis was 5%. The overall median time to present with symptomatic urolithiasis was 3.1 years, with 3.3 years for de novo stone-formers, and 2.0 years for recurrent stone-formers (p = 0.38). In de novo stone-formers, 33% presented with symptomatic urolithiasis 4 to 14 years postoperatively. Compliance with calcium and vitamin D supplementation was 56% and 51%, respectively. Conclusions: Despite recall bias and lack of confirmatory imaging studies, a high postoperative incidence of symptomatic urolithiasis was found in a large sample of post-RYGB patients. A third of patients with de novo stones, presented with symptomatic urolithiasis 4 to 14 years postoperatively. Compliance with postoperative calcium and vitamin D supplementation was poor and needs improvement. PMID:25408808

Haddad, Nicholas; Scheffler, Patrick; Elkoushy, Mohamed A.; Court, Olivier; Christou, Nicolas V.; Andersen, Ross E.; Andonian, Sero

2014-01-01

226

Mechanical thrombectomy-assisted thrombolysis for acute symptomatic portal and superior mesenteric venous thrombosis  

PubMed Central

Acute portal vein and mesenteric vein thrombosis (PVMVT) can cause acute mesenteric ischemia and be fatal with mortality rate of 37%-76%. Therefore, early diagnosis and prompt venous revascularization are warranted in patients with acute symptomatic PVMVT. Due to advances in catheter-directed treatment, endovascular treatment has been used for revascularization of affected vessels in PVMVT. We report two cases of symptomatic PVMVT treated successfully by transhepatic percutaneous mechanical thrombectomy-assisted thrombolysis. PMID:24949327

Jun, Kang Woong; Kim, Mi Hyeong; Park, Keun Myoung; Chun, Ho Jong; Hong, Kee Chun; Jeon, Yong Sun; Cho, Soon Gu

2014-01-01

227

Treatment of symptomatic pelvic varices by ovarian vein embolization  

Microsoft Academic Search

Purpose  Pelvic congestion syndrome is a common cause of chronic pelvic pain in women and its association with venous congestion has\\u000a been described in the literature. We evaluated the potential benefits of lumboovarian vein embolization in the treatment of\\u000a lower abdominal pain in patients presenting with pelvic varicosities.\\u000a \\u000a \\u000a \\u000a Methods  Nineteen patients were treated. There were 13 unilateral embolizations, 6 initial bilateral treatments

Patrizio Capasso; Christine Simons; Geneviève Trotteur; Robert F. Dondelinger; Denis Henroteaux; Ulysse Gaspard

1997-01-01

228

Chronic Pain  

Microsoft Academic Search

The primary purposes of acute pain and the reason it is noxious are to interrupt ongoing activity in order to warn the sufferer of tissue damage, to discourage movement that might exacerbate injury or prevent healing, and to teach the organism to avoid the pain-producing circumstances. Therefore, it is no wonder that when pain persists to become chronic, many sufferers

Malcolm H. Johnson

229

Management of Thrombolysis-Associated Symptomatic Intracerebral Hemorrhage  

PubMed Central

Background Symptomatic intracerebral hemorrhage (sICH) is the most devastating complication of thrombolytic therapy for acute stroke. It is not clear whether patients with sICH continue to bleed after diagnosis, nor has the most appropriate treatment been determined. Methods We performed a retrospective analysis of our prospectively collected Get With the Guidelines–Stroke database between April 1, 2003, and December 31, 2007. Radiologic images and all procoagulant agents used were reviewed. Multivariable logistic regression was performed to identify factors associated with in-hospital mortality. Results Of 2362 patients with acute ischemic stroke during the study period, sICH occurred in 19 of the 311 patients (6.1%) who received intravenous tissue plasminogen activator and 2 of the 72 (2.8%) who received intra-arterial thrombolysis. In-hospital mortality was significantly higher in patients with sICH than in those without (15 of 20 [75.0]% vs 56 of 332 [16.9%], P<.001). Eleven of 20 patients (55.0%) received therapy for co-agulopathy: 7 received fresh frozen plasma; 5, cryoprecipitate; 4, phytonadione (vitamin K1); 3, platelets; and 1, aminocaproic acid. Independent predictors of inhospital mortality included sICH (odds ratio, 32.6; 95% confidence interval, 8.8–120.2), increasing National Institutes of Health Stroke Scale score (1.2; 1.1–1.2), older age (1.3; 1.0–1.7), and intra-arterial thrombolysis (2.9; 1.4–6.0). Treatment for coagulopathy was not associated with outcome. Continued bleeding (>33% increase in intracerebral hemorrhage volume) occurred in 4 of 10 patients with follow-up scans available (40.0%). Conclusions In many patients with sICH after thrombolysis, coagulopathy goes untreated. Our finding of continued bleeding after diagnosis in 40.0% of patients suggests a powerful opportunity for intervention. A multicenter registry to analyze management of thrombolysis-associated intracerebral hemorrhage and outcomes is warranted. PMID:20697046

Goldstein, Joshua N.; Marrero, Marisela; Masrur, Shihab; Pervez, Muhammad; Barrocas, Alex M.; Abdullah, Abdul; Oleinik, Alexandra; Rosand, Jonathan; Smith, Eric E.; Dzik, Walter H.; Schwamm, Lee H.

2013-01-01

230

Chronic motor tic disorder  

MedlinePLUS

Chronic vocal tic disorder; Tic - chronic motor tic disorder ... Chronic motor tic disorder is more common than Tourette syndrome . Chronic tics may be forms of Tourette syndrome. Tics usually start ...

231

Chronic obstructive pulmonary disease  

MedlinePLUS

COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic ... Smoking is the main cause of COPD. The more a person smokes, the ... develop COPD. But some people smoke for years and never get ...

232

Chronic Kidney Disease (CKD)  

MedlinePLUS

... www.kidneyfund.org > Kidney Disease > Chronic Kidney Disease Chronic Kidney Disease (CKD) An estimated 31 million people in the United States are living with chronic kidney disease (CKD). What is CKD? The term “chronic kidney ...

233

Chronic Pain Medicines  

MedlinePLUS

MENU Return to Web version Chronic Pain | Chronic Pain Medicines How is chronic pain treated? Treatment of chronic ... or she tells you how to use your pain medicine. If you have questions about side effects or ...

234

Symptomatic atypical femoral fractures are related to underlying hip geometry.  

PubMed

The benefits of bisphosphonates are well documented, but prolonged use has been associated with atypical femur fractures. Radiographic markers for fracture predisposition could potentially aid in safer medication use. In this case-control designed study, we compared hip radiographic parameters and the demographic characteristics of chronic bisphosphonate users who sustained an atypical femoral fracture with a group of chronic bisphosphonate users who did not sustain an atypical femur fracture and also a group who sustained an intertrochanteric hip fracture. Radiographic parameters included were neck-shaft angle (NSA), hip-axis length (HAL) and center-edge angle (CE). Multivariate regression was used to evaluate the relationship between radiographic measures and femur fracture. Receiver-operating characteristic analysis determined cut-off points for neck-shaft angle and risk of atypical femur fracture. Ultimately, pre-fracture radiographs of 53 bisphosphonate users who developed atypical fracture were compared with 43 asymptomatic chronic bisphosphonate users and 64 intertrochanteric fracture patients. Duration of bisphosphonate use did not statistically differ between users sustaining atypical fracture and those without fracture (7.9 [±3.5] vs. 7.7 [±3.3] years, p=0.7). Bisphosphonate users who fractured had acute/varus pre-fracture neck-shaft angles (p<0.001), shorter hip-axis length (p<0.01), and narrower center-edge angles (p<0.01). Regression analysis revealed associations between neck-shaft angle (OR=0.89 [95% CI=0.81-0.97; p=0.01), center edge angle (OR=0.89 [95% CI=0.80-0.99]; p=0.03), and BMI (OR=1.15 [95% CI=1.02-1.31; p=0.03) with fracture development. ROC curve analysis (AUC=0.67 [95% CI=0.56-0.79]) determined that a cut-off point for neck-shaft angle <128.3° yielded 69% sensitivity and 63% specificity for development of atypical femoral fracture. Ultimately, an acute/varus angle of the femoral neck, high BMI, and narrow center-edge angle were associated with development of atypical femur fracture in long-term bisphosphonate users. Patients on long-term bisphosphonates should be regularly radiographically evaluated in order to assess for potential risk of atypical fracture. PMID:24565751

Taormina, David P; Marcano, Alejandro I; Karia, Raj; Egol, Kenneth A; Tejwani, Nirmal C

2014-06-01

235

Alcoholic pancreatitis: mechanisms of viral infections as cofactors in the development of acute and chronic pancreatitis and fibrosis  

Microsoft Academic Search

Acute and chronic pancreatitis is asso- ciated with alcohol abuse, but symptomatic pancre- atitis develops in only a small proportion of persons (10-20%) who abuse alcohol. This apparent par- adox has led to the notion that additional cofactors are involved in the development of alcoholic pan- creatitis. Potential cofactors, such as diet and smoking, have been suggested, but there are

Thomas R. Jerrells; Debbie Vidlak; Jennifer M. Strachota

2007-01-01

236

Activation of innate anti-viral immune response genes in symptomatic benign prostatic hyperplasia  

PubMed Central

Benign Prostatic Hyperplasia (BPH)is the most common urologic disease in men over age 50. Symptoms include acute urinary retention, urgency to urinate and nocturia. For patients with severe symptoms, surgical treatment is used to remove the affected tissue. Interestingly, the presence of histologic BPH does not always correlate with symptoms. The molecular basis of symptomatic BPH and how it differs from asymptomatic BPH is unknown. Investigation into the molecular players involved in symptomatic BPH will likely give insight into novel therapeutic, and potentially preventative, targets. We determined the expression of genes involved in the innate anti-viral immune response in tissues from patients undergoing surgery to alleviate the symptoms of BPH, and compared the results to prostate tissue with histologic BPH, but from patients with few urinary issues (asymptomatic BPH). We found that expression of CFI, APOBEC3G, OAS2, and IFIT1, four genes whose protein products are involved in the innate anti-viral immune response, were significantly transcriptionally upregulated in symptomatic BPH. Additionally we observe hypomethylation and concomitant expression of ancient retroviral-like sequences, the LINE-1 retrotransposons, in symptomatic BPH when compared to normal prostate tissue. These findings merit further investigation into the anti-viral immune response in symptomatic BPH. PMID:22952051

Madigan, Allison A.; Sobek, Kathryn M.; Cummings, Jessica L.; Green, William R.; Bacich, Dean J.; O’Keefe, Denise S.

2012-01-01

237

Differences in autonomic nerve function in patients with silent and symptomatic myocardial ischaemia.  

PubMed Central

BACKGROUND--Autonomic neuropathy provides a mechanism for the absence of symptoms in silent myocardial ischaemia, but characterisation of the type of neuropathy is lacking. AIM--To characterise and compare autonomic nerve function in patients with silent and symptomatic myocardial ischaemia. METHODS AND RESULTS--The Valsalva manoeuvre, heart rate variation (HRV) in response to deep breathing and standing, lower body negative pressure, isometric handgrip, and the cold pressor test were performed by patients with silent (n = 25) and symptomatic (n = 25) ambulatory ischaemia and by controls (n = 21). No difference in parasympathetic efferent function between patients with silent and symptomatic ischaemia was recorded, but both had significantly less HRV in response to standing than the controls (p < 0.005 for silent and p < 0.01 for symptomatic). Patients with silent ischaemia showed an increased propensity for peripheral vasodilatation compared with symptomatic patients (p < 0.02) and controls (p < 0.04). Impaired sympathetic function was found in patients with pure silent ischaemia (n = 4) compared with the remaining patients with silent ischaemia whose pain pathways were presumed to be intact. CONCLUSIONS--Patients with silent ischaemia and pain pathways presumed to be intact have an enhanced peripheral vasodilator response, and if this applied to the coronary vasculature it could provide a mechanism for limiting ischaemia to below the pain threshold. Patients with pure silent ischaemia have evidence of sympathetic autonomic dysfunction. Images PMID:8297687

Shakespeare, C. F.; Katritsis, D.; Crowther, A.; Cooper, I. C.; Coltart, J. D.; Webb-Peploe, M. W.

1994-01-01

238

Dynamic contrast enhanced magnetic resonance imaging in chronic Achilles tendinosis  

PubMed Central

Background Chronic Achilles tendinosis is a common problem. When evaluating and comparing different therapies there is a need for reliable imaging methods. Our aim was to evaluate if chronic Achilles tendinosis affects the dynamic contrast-enhancement in the tendon and its surroundings and if short-term eccentric calf-muscle training normalizes the dynamic contrast-enhancement. Methods 20 patients with chronic Achilles tendinopathy were included. Median duration of symptoms was 31 months (range 6 to 120 months). Both Achilles tendons were examined with dynamic contrast enhanced MRI before and after a 12- week exercise programme of eccentric calf-muscle training. The dynamic MRI was evaluated in tendon, vessel and in fat ventrally of tendon. Area under the curve (AUC), time to peak of signal, signal increase per second (SI/s) and increase in signal between start and peak as a percentage (SI%) was calculated. Pain and performance were evaluated using a questionnaire. Results In the fat ventrally of the tendon, dynamic contrast enhancement was significantly higher in the symptomatic leg compared to the contralateral non-symptomatic leg before but not after treatment. Despite decreased pain and improved performance there was no significant change of dynamic contrast enhancement in symptomatic tendons after treatment. Conclusion In Achilles tendinosis there is an increased contrast enhancement in the fat ventrally of the tendon. The lack of correlation with symptoms and the lack of significant changes in tendon contrast enhancement parameters do however indicate that dynamic enhanced MRI is currently not a useful method to evaluate chronic Achilles tendinosis. PMID:24261480

2013-01-01

239

Shunt malfunction presenting with symptomatic syringomyelia: Demonstrated on contrast ventriculogram.  

PubMed

Ventriculoperitoneal (VP) shunt malfunction commonly presents as raised intracranial pressure. Rarely, when the central canal of the spinal cord communicates with the 4(th) ventricle, shunt malfunction can present as an expanding syrinx. The diagnosis is often delayed, resulting in severe morbidity. Some of these patients undergo repeated syrinx surgeries without much benefits. We report a case of chronic tuberculous meningitis with shunt malfunction presenting as an expanding spinal canal syrinx and quadriparesis. Fourth ventricular communication with syrinx was demonstrated with the help of a contrast ventriculogram. After shunt revision, syrinx resolved completely and the patient made significant improvement in his neurological deficits. The present case illustrates that a historical and rarely used investigation like contrast ventriculogram aids in the diagnosis and management even in the current neurosurgical practice. All patients with late onset syrinx and a previous VP shunt need to be investigated for shunt malfunction before considering syrinx surgery. A simple shunt revision resolves the syrinx in such conditions and avoids more complex procedures like Foramen magnum decompression. Relevant literature has been reviewed; pathophysiology and management options have been discussed. PMID:25250067

Aniruddha, T J; Pruthi, Nupur

2014-05-01

240

Shunt malfunction presenting with symptomatic syringomyelia: Demonstrated on contrast ventriculogram  

PubMed Central

Ventriculoperitoneal (VP) shunt malfunction commonly presents as raised intracranial pressure. Rarely, when the central canal of the spinal cord communicates with the 4th ventricle, shunt malfunction can present as an expanding syrinx. The diagnosis is often delayed, resulting in severe morbidity. Some of these patients undergo repeated syrinx surgeries without much benefits. We report a case of chronic tuberculous meningitis with shunt malfunction presenting as an expanding spinal canal syrinx and quadriparesis. Fourth ventricular communication with syrinx was demonstrated with the help of a contrast ventriculogram. After shunt revision, syrinx resolved completely and the patient made significant improvement in his neurological deficits. The present case illustrates that a historical and rarely used investigation like contrast ventriculogram aids in the diagnosis and management even in the current neurosurgical practice. All patients with late onset syrinx and a previous VP shunt need to be investigated for shunt malfunction before considering syrinx surgery. A simple shunt revision resolves the syrinx in such conditions and avoids more complex procedures like Foramen magnum decompression. Relevant literature has been reviewed; pathophysiology and management options have been discussed. PMID:25250067

Aniruddha, T. J; Pruthi, Nupur

2014-01-01

241

Berberine behind the thriller of marked symptomatic bradycardia.  

PubMed

Patients with chronic aortic dissections are at high risk of catheter-induced complications. We report a Berberine is used in traditional Chinese medicine for the treatment of congestive heart failure, hypertension, diabetes, and dyslipidaemia and has a good safety profile. We report a case of a 53-year-old sportsman referred to our hospital for the onset of fatigue and dyspnoea upon exertion after he started berberine to treat hypercholesterolaemia. An electrocardiogram showed sinus bradycardia (45 bpm), first-degree atrioventricular block, and competitive junctional rhythm. An ergometric stress test showed slightly reduced chronotropic competence and the presence of runs of competitive junctional rhythm, atrial tachycardia, and sinus pauses in the recovery. After 10 d of wash-out from berberine, the patient experienced a complete resolution of symptoms, and an ergometric stress test showed good chronotropic competence. An electrocardiogram Holter showed a latent hypervagotonic state. This is the first case report that shows that berberine could present certain side effects in hypervagotonic people, even in the absence of a situation that could cause drug accumulation. Therefore, berberine's use should be carefully weighed in hypervagotonic people due to the drug's bradycardic and antiarrhythmic properties, which could became proarrhythmic, exposing patients to potential health risks. PMID:23888197

Cannillo, Margherita; Frea, Simone; Fornengo, Cristina; Toso, Elisabetta; Mercurio, Giancarlo; Battista, Stefania; Gaita, Fiorenzo

2013-07-26

242

PET evaluation of cerebral blood flow reactivity in symptomatic and asymptomatic carotid artery stenosis  

SciTech Connect

The purpose of this study was to use acetazolamide (AZ) enhanced O-15 water PET to evaluate cerebral perfusion reserve in symptomatic and asymptomatic carotid artery stenosis. We hypothesized that impaired vasoreactivity would be associated with symptomatic disease and a higher likelihood of future ischemic events. Twenty-two patients with significant (>75%) carotid artery occlusion underwent cerebral blood flow imaging at baseline and following AZ infusion. Paired O-15 data sets were coregistered and globally normalized. Regions of interest were drawn on baseline blood flow images and superimposed upon (AZ - baseline) difference images to derive a % change in regional blood flow after AZ administration. The results showed a significant difference in cerebral perfusion reserve between symptomatic (n=19) and asymptomatic (n=3) carotid artery disease.

Dey, H.M.; Brass, L.; Rich, D. [Yale Univ.-VA PET Center, West Haven, CT (United States)] [and others

1994-05-01

243

Clinical audit and standard setting for symptomatic breast imaging in South Thames region.  

PubMed

Audit is recognized as an important part of the UK National Health Service Breast Screening programme. This paper describes a simple method of auditing breast imaging in symptomatic women which was applied in the South Thames (East) Region of England. No appropriate standards were available before this audit started. Standards were set at the end of the first cycle by the Regional Radiology Audit Committee and these were used in the second cycle of this audit. A comparison between hospitals which organize both breast screening and symptomatic imaging and those with units providing symptomatic breast imaging only shows no significant difference in the accuracy diagnosis and the false negative and false positive rates between the two. However non-screening units, are significantly more likely to issue an equivocal radiology report (P = 0.000001). Measures to reduce the incidence of equivocal reporting, by prospectively issuing an audit grade with the report and double reporting of equivocal images are recommended. PMID:9022582

Mills, P; Foord, K; Trevethick, P

1997-01-01

244

Revascularization for Symptomatic Occlusion of the Anterior Cerebral Artery Using Superficial Temporal Artery  

PubMed Central

Isolated symptomatic occlusion of the anterior cerebral artery (ACA) is a rare condition and until date, only few cases regarding the revascularization of the ACA have been reported. This paper reports on successful attempt to revascularize the ACA using superficial temporal artery (STA) in patient with isolated symptomatic occlusion of the ACA. A 69-year-old man presented with several episodes of transient weakness involving left lower extremity. Cerebral angiography showed occlusion of the right ACA at the A2 segment. After medical treatment failure, the patient underwent STA-ACA bypass surgery. Subsequent to surgery, there was immediate disappearance of transient ischemic attack and follow-up angiography showed favorable revascularization of the ACA territory. Bypass surgery can be considered in the patients with symptomatic occlusion of the ACA, who have experienced failure in medical treatment. PMID:24527195

Lee, Sang Chul; Kang, Hyun-Seung; Kim, Jeong Eun

2013-01-01

245

Chronic Urticaria: Indian Context—Challenges and Treatment Options  

PubMed Central

Urticaria is a common condition that occurs in both children and adults. Most cases have no specific allergic trigger and the aetiology of urticaria remains idiopathic and occasionally spontaneous in nature. Inappropriate advice such as avoidance of foods (milk, egg, prawn, and brinjal) is common place in certain sections of India mostly by nonspecialists that should not be routinely recommended. It is important to look for physical urticarias such as pressure urticaria in chronic cases, which may be present either alone or in combination with other causes. Autoimmune causes for chronic urticaria have been found to play an important role in a significant proportion of patients. Long-acting nonsedating antihistamines at higher than the standard doses is safe and effective. Quality of life is affected adversely in patients with chronic symptomatic urticaria and some may require multidisciplinary management. PMID:24223585

Khan, Sujoy; Maitra, Anirban; Hissaria, Pravin; Roy, Sitesh; Padukudru Anand, Mahesh; Nag, Nalin; Singh, Harpal

2013-01-01

246

Symptomatic hamartoma of the spinal cord associated with neurofibromatosis type 1. Case report.  

PubMed

The authors present a case in which a symptomatic hamartoma was found in the spinal cord of a patient with neurofibromatosis type 1 (NF-1). This 52-year-old woman presented with painful urinary incontinence. Magnetic resonance (MR) imaging revealed an intramedullary lesion within the lower thoracic spinal cord and conus medullaris, which was surgically removed. Pathological investigation showed a hamartomatous lesion consisting of glial cells, ganglion cells, abundant disoriented axons, and thin-walled vessels. This case provides a pathological correlate to the hamartomatous lesions demonstrated on MR imaging in patients with NF-1 and illustrates that these benign lesions may become symptomatic and require neurosurgical intervention. PMID:9609307

Brownlee, R D; Clark, A W; Sevick, R J; Myles, S T

1998-06-01

247

Peripheral Arterial Disease in a Symptomatic Diabetic Population: Prospective Comparison of Rapid Unenhanced MR Angiography (MRA) With Contrast-Enhanced MRA  

PubMed Central

OBJECTIVE The joint guidelines of the American College of Cardiology and American Heart Association support the use of contrast-enhanced MR angiography (CEMRA) to diagnose the location and degree of stenosis in patients with known or suspected peripheral arterial disease (PAD). The high prevalence of chronic renal impairment in diabetic patients with PAD and the need for high doses of gadolinium-based contrast agents place them at risk for nephrogenic systemic fibrosis. The purpose of our study was to evaluate the accuracy of the rapid technique of quiescent-interval single-shot (QISS) unenhanced MR angiography (MRA) compared with CEMRA for the diagnosis in diabetic patients referred with symptomatic chronic PAD. SUBJECTS AND METHODS This prospective two-center study evaluated 25 consecutive diabetic patients with documented or suspected symptomatic PAD. Both centers used identical imaging protocols. Images were independently analyzed by two radiologists. A subgroup analysis was performed of patients who were also assessed with digital subtraction angiography (DSA) as part of the standard-of-care protocol before revascularization. RESULTS For this study, 775 segments were analyzed. On a per-segment basis, the mean values of the diagnostic accuracy of unenhanced MRA compared with reference CEMRA for two reviewers, reviewers 1 and 2, were as follows: sensitivity, 87.4% and 92.1%; specificity, 96.8% and 96.0%; positive predictive value, 90.8% and 94.0%; and negative predictive value, 95.5% and 94.6%. Substantial agreement was found when overall DSA results were compared with QISS unenhanced MRA (? = 0.68) and CEMRA (? = 0.63) in the subgroup of patients who also underwent DSA. There was almost perfect agreement between the two readers for stenosis scores, with Cohen’s kappa values being greater than 0.80 for both MRA techniques. CONCLUSION The results of our study indicate that QISS unenhanced MRA is an accurate noncontrast alternative to CEMRA for showing clinically significant arterial disease in patients with diabetes with symptomatic PAD. PMID:22109304

Hodnett, Philip A.; Ward, Emily V.; Davarpanah, Amir H.; Scanlon, Timothy G.; Collins, Jeremy D.; Glielmi, Christopher B.; Bi, Xiaoming; Koktzoglou, Ioannis; Gupta, Navyash; Carr, James C.; Edelman, Robert R.

2011-01-01

248

Chronic Kidney Disease in Kidney Stone Formers  

PubMed Central

Summary Recent population studies have found symptomatic kidney stone formers to be at increased risk for chronic kidney disease (CKD). Although kidney stones are not commonly identified as the primary cause of ESRD, they still may be important contributing factors. Paradoxically, CKD can be protective against forming kidney stones because of the substantial reduction in urine calcium excretion. Among stone formers, those with rare hereditary diseases (cystinuria, primary hyperoxaluria, Dent disease, and 2,8 dihydroxyadenine stones), recurrent urinary tract infections, struvite stones, hypertension, and diabetes seem to be at highest risk for CKD. The primary mechanism for CKD from kidney stones is usually attributed to an obstructive uropathy or pyelonephritis, but crystal plugs at the ducts of Bellini and parenchymal injury from shockwave lithotripsy may also contribute. The historical shift to less invasive surgical management of kidney stones has likely had a beneficial impact on the risk for CKD. Among potential kidney donors, past symptomatic kidney stones but not radiographic stones found on computed tomography scans were associated with albuminuria. Kidney stones detected by ultrasound screening have also been associated with CKD in the general population. Further studies that better classify CKD, better characterize stone formers, more thoroughly address potential confounding by comorbidities, and have active instead of passive follow-up to avoid detection bias are needed. PMID:21784825

Krambeck, Amy E.; Lieske, John C.

2011-01-01

249

Symptomatic Bradycardia Caused By Premature Atrial Contractions Originating From Right Atrial Appendage  

PubMed Central

Premature atrial contraction is a common form of supraventricular arrhythmias. In rare cases, severe symptoms other than palpitation may occur. In this report, we present a patient with symptomatic bradycardia which developed secondary to blocked premature atrial contractions and was successfully treated with radiofrequency ablation. PMID:23840105

Alper, AT; Gungor, B; Turkkan, C; Tekkesin, AI

2013-01-01

250

Wingspan stent for symptomatic M1 stenosis of middle cerebral artery  

Microsoft Academic Search

ObjectiveStent placement for intracranial atherosclerotic stenosis has become an alternative treatment technique; however, stent placement for middle cerebral artery (MCA) stenosis remains a technical and clinical challenge. Our purpose was to assess the safety and feasibility of Wingspan stent for patients with symptomatic M1 stenosis, and its initial effect on prevention of ischemic events.

Xin-bin Guo; Nan Ma; Xiao-bo Hu; Sheng Guan; Yi-mu Fan

2011-01-01

251

Radiotherapy for Symptomatic Vertebral Hemangiomas: Results of a Multicenter Study and Literature Review  

SciTech Connect

Purpose: The current study analyzes the potential role of radiotherapy (RT) in symptomatic vertebral hemangioma (SVH). Methods and Materials: Seven cooperating German institutions collected clinical information, treatment plans, and outcome data for all patients with SVH referred for local RT. Results: From 1969 to 2008, a total of 84 patients with 96 symptomatic lesions were irradiated for SVH. The primary indication for radiotherapy was pain (97.6%), and 28.6% of patients had additional neurological symptoms. RT was performed at a median total dose of 34 Gy, with a median single dose of 2.0 Gy. After receiving a median follow-up of 68 months, the overall patient response rate was 90.5%. Complete symptom remission occurred in 61.9% of patients, 28.6% of patients had partial pain relief, and 9.5% of patients had no pain relief. In 26.2% of patients, radiological signs of reossification were observed in long-term follow-up but not significantly correlated with pain relief. Most importantly, total doses of >=34 Gy resulted in significantly greater symptomatic relief and control rate than total doses of <34 Gy. Conclusions: This study consists of the largest database of cases reported so far using RT for SVH. RT is easy, safe, and effective for pain relief treatment for SVH. Total doses of at least 34 Gy give the best symptomatic response.

Heyd, Reinhard [Department of Radiotherapy, Offenbach Hospital, Offenbach (Germany); Seegenschmiedt, M. Heinrich [Department of Radiation Oncology, Alfried Krupp Hospital, Essen (Germany); Rades, Dirk [Department of Radiation Oncology, University Hospital Eppendorf, Hamburg (Germany); Winkler, Cornelia [Department of Radiotherapy, Carl Gustav Carus University Hospital, Dresden (Germany); Eich, Hans T. [Department of Radiotherapy, University Hospital, Cologne (Germany); Bruns, Frank [Department of Radiotherapy and Special Oncology, University Hospital, Hannover (Germany); Gosheger, Georg [Department of General and Surgical Orthopedics, University Hospital, Muenster (Germany); Willich, Normann [Department of Radiation Oncology, University Hospital, Muenster (Germany); Micke, Oliver, E-mail: omicke@benign-news.d [Department of Radiation Oncology, University Hospital, Muenster (Germany); Department of Radiotherapy and Radiation Oncology, Franziskus Hospital, Bielefeld (Germany)

2010-05-01

252

Focus on the nurse: ethical dilemmas with highly symptomatic patients dying at home.  

PubMed

Some serious issues face the inexperienced nurse who has the responsibility for either providing the care or directing the care of symptomatic patients dying at home. Inexperience in such care, and lack of competent medical support, can result in the nurse perceiving "ethical dilemmas" in practices which are, in reality, part of good and ethical palliative care. PMID:9248395

Coyle, N

1997-01-01

253

Interventional Treatment of a Symptomatic Neonatal Hepatic Cavernous Hemangioma Using the Amplatzer Vascular Plug  

Microsoft Academic Search

Percutaneous intervention is one treatment option for symptomatic hepatic hemangioma in infants. We report the case of a newborn (birth weight 4060 g) with a large hepatic cavernous hemangioma, which presented early with high cardiac output failure due to arteriovenous shunting and signs of incipient Kasabach-Merritt syndrome. We performed a successful superselective transcatheter coil embolization of three feeding arteries on

Oliver Kretschmar; Walter Knirsch; Vera Bernet

2008-01-01

254

Resistance of uropathogens in symptomatic urinary tract infections in León, Nicaragua  

Microsoft Academic Search

Management of urinary tract infections (UTI) in Central America and especially Nicaragua, is complicated by the lack of knowledge about the antibiotic resistance of uropathogens. We conducted a prevalence study to gain more insight into the aetiology, bacterial resistance and risk factors for symptomatic UTI in the region of León, Nicaragua. In 2002, all consecutive patients with UTI symptoms and

A. J Matute; E Hak; C. A. M Schurink; A McArthur; E Alonso; M Paniagua; E van Asbeck; A. M Roskott; F Froeling; M Rozenberg-Arska; I. M Hoepelman

2004-01-01

255

Factors associated with H pylori epidemiology in symptomatic children in Buenos Aires, Argentina  

Microsoft Academic Search

AIM: To determine prevalence of H pylori infection in symptomatic children in Buenos Aires, Argentina, and to investigate factors associated with H pylori positivity. METHODS: A total of 395 children with upper gastrointestinal symptoms referred to the Gastroente- rology Unit of the Children Hospital \\

Cinthia Goldman; Andrés Barrado; Mariana Janjetic; Norma Balcarce; Eduardo Cueto Rua; Masaru Oshiro; María L Calcagno; Margarita Martinez Sarrasague; Julián Fuda; Ricardo Weill; Marcela Zubillaga; Guillermo I Perez-Perez; José Boccio

2006-01-01

256

Functional Compensation of Motor Function in Pre-Symptomatic Huntington's Disease  

ERIC Educational Resources Information Center

Involuntary choreiform movements are a clinical hallmark of Huntington's disease. Studies in clinically affected patients suggest a shift of motor activations to parietal cortices in response to progressive neurodegeneration. Here, we studied pre-symptomatic gene carriers to examine the compensatory mechanisms that underlie the phenomenon of…

Kloppel, Stefan; Draganski, Bogdan; Siebner, Hartwig R.; Tabrizi, Sarah J.; Weiller, Cornelius; Frackowiak, Richard S. J.

2009-01-01

257

Low-Dose Amiodarone Versus Sotalol for Suppression of Recurrent Symptomatic Atrial Fibrillation  

Microsoft Academic Search

To compare the safety and efficacy of amiodarone and sotalol in the treatment of patients with recurrent symptomatic atrial fibrillation (AF), 70 patients were entered into a randomized, double-blind study. Of these, 35 received amiodarone and 35 sotalol. There were no significant differences in baseline clinical characteristics between groups. Patients with ejection fraction

George E Kochiadakis; Nikos E Igoumenidis; Maria E Marketou; Marios C Solomou; Emmanuel M Kanoupakis; Panos E Vardas

1998-01-01

258

Stenting of symptomatic vertebral artery ostium stenosis with self-expanding stents.  

PubMed

Symptomatic vertebral arterial stenosis carries a stroke risk of 30% at 5 years. The efficacy of stenting with balloon-expandable stents remains questionable due to a high long-term restenosis rate. This study aimed to investigate the feasibility and efficacy of using self-expanding stents to treat symptomatic vertebral artery ostium (VAO) stenosis in selected patients. Clinical and angiographic results were retrospectively reviewed in patients with symptomatic VAO stenosis who underwent stenting with self-expanding stents between June 2008 and December 2011. In total, 32 patients were included. Self-expanding stents (25 tapered and seven non-tapered) were deployed with a modified technique of deploying the stents from the V1 segment to the proximal subclavian artery. The mean degree of stenosis before and after stenting declined from 76.4% to 11.4%. No peri-procedural complications occurred. During the mean clinical follow-up of 18.3 months, no vertebrobasilar stroke, transient ischemic attack or death occurred. During the mean angiographic follow-up of 12.5 months, asymptomatic restenosis occurred in one (3.1%) patient 6 months after the procedure. No stent fracture occurred. The involved subclavian artery was patent and no clinically apparent events occurred in the dependent upper extremity. Stenting with self-expanding stents for symptomatic VAO stenosis is technically feasible and safe, with reduced restenosis and stent fracture rates in selected patients. Long-term investigations are warranted to validate its performance. PMID:24128770

Li, Zifu; Zhang, Yongwei; Hong, Bo; Deng, Benqiang; Xu, Yi; Zhao, Wenyuan; Liu, Jianmin; Huang, Qinghai

2014-02-01

259

Loss of Microstructural Integrity in the Limbic-Subcortical Networks for Acute Symptomatic Traumatic Brain Injury  

PubMed Central

Previous studies reported discrepant white matter diffusivity in mild traumatic brain injury (mTBI) on the base of Glasgow Coma Scale, which are unreliable for some TBI severity indicators and the frequency of missing documentation in the medical record. In the present study, we adopted the Mayo classification system for TBI severity. In this system, the mTBI is also divided into two groups as “probable and symptomatic” TBI. We aimed to investigate altered microstructural integrity in symptomatic acute TBI (<1 week) by using tract-based spatial statics (TBSS) approach. A total of 12 patients and 13 healthy volunteers were involved and underwent MRI scans including conventional scan, and SWI and DTI. All the patients had no visible lesions by using conventional and SWI neuroimaging techniques, while showing widespread declines in the fractional anisotropy (FA) of gray matter and white matter throughout the TBSS skeleton, particularly in the limbic-subcortical structures. By contrast, symptomatic TBI patients showed no significant enhanced changes in FA compared to the healthy controls. A better understanding of the acute changes occurring following symptomatic TBI may increase our understanding of neuroplasticity and continuing degenerative change, which, in turn, may facilitate advances in management and intervention. PMID:24695757

Zhu, Yanan; Li, Zhengjun; Bai, Lijun; Tao, Yin; Sun, Chuanzhu; Li, Min; Zheng, Longmei; Zhu, Bao; Yao, Jun; Zhou, Heping; Zhang, Ming

2014-01-01

260

Prevalence of Symptomatic Intracranial Aneurysm and Ischaemic Stroke in Pseudoxanthoma Elasticum  

Microsoft Academic Search

Background: Pseudoxanthoma elasticum (PXE) is an heritable connective tissue disorder with clinical manifestations of the ocular, dermal, and cardiovascular system. The purpose of this study was to investigate the prevalence of symptomatic intracranial aneurysms (IAs) and ischaemic stroke (IS) in PXE. Methods: The records of 100 patients with PXE were retrieved. All patients were contacted and data on complications were

Jan S. P. van den Berg; Raoul C. M. Hennekam; Jan R. M. Cruysberg; Peter M. Steijlen; Jaap Swart; Nel Tijmes; Martien Limburg

2000-01-01

261

Loss of microstructural integrity in the limbic-subcortical networks for acute symptomatic traumatic brain injury.  

PubMed

Previous studies reported discrepant white matter diffusivity in mild traumatic brain injury (mTBI) on the base of Glasgow Coma Scale, which are unreliable for some TBI severity indicators and the frequency of missing documentation in the medical record. In the present study, we adopted the Mayo classification system for TBI severity. In this system, the mTBI is also divided into two groups as "probable and symptomatic" TBI. We aimed to investigate altered microstructural integrity in symptomatic acute TBI (<1 week) by using tract-based spatial statics (TBSS) approach. A total of 12 patients and 13 healthy volunteers were involved and underwent MRI scans including conventional scan, and SWI and DTI. All the patients had no visible lesions by using conventional and SWI neuroimaging techniques, while showing widespread declines in the fractional anisotropy (FA) of gray matter and white matter throughout the TBSS skeleton, particularly in the limbic-subcortical structures. By contrast, symptomatic TBI patients showed no significant enhanced changes in FA compared to the healthy controls. A better understanding of the acute changes occurring following symptomatic TBI may increase our understanding of neuroplasticity and continuing degenerative change, which, in turn, may facilitate advances in management and intervention. PMID:24695757

Zhu, Yanan; Li, Zhengjun; Bai, Lijun; Tao, Yin; Sun, Chuanzhu; Li, Min; Zheng, Longmei; Zhu, Bao; Yao, Jun; Zhou, Heping; Zhang, Ming

2014-01-01

262

Causes and Severity of Ischemic Stroke in Patients with Symptomatic Intracranial Arterial Stenosis  

PubMed Central

Background and purpose There are limited data on the causes and severity of subsequent stroke in patients presenting initially with TIA or stroke attributed to intracranial arterial stenosis. Methods We evaluated the location, type (lacunar vs. non-lacunar), cause, and severity of stroke in patients who had an ischemic stroke endpoint in the Warfarin Aspirin Symptomatic Intracranial Disease (WASID) trial. Results Of the 569 patients enrolled in the WASID trial, 106 patients (18.6%) had an ischemic stroke during a mean follow-up of 1.8 years. Stroke occurred in the territory of the symptomatic artery in 77 (73%) of 106 patients. Among the 77 strokes in the territory, 70 (91%) were non-lacunar and 34 (44%) were disabling. Stroke out of the territory of the symptomatic artery occurred in 29 (27%) of 106 patients. Among these 29 strokes, 24 (83%) were non-lacunar, 14 (48%) were due to previously asymptomatic intracranial stenosis, and 9 (31%) were disabling. Conclusions Most subsequent strokes in patients with symptomatic intracranial artery stenosis are in the same territory and non-lacunar, and nearly half of the strokes in the territory are disabling. The most commonly identified cause of stroke out of the territory was a previously asymptomatic intracranial stenosis. Penetrating artery disease was responsible for a low number of strokes. PMID:19407228

Famakin, Bolanle M; Chimowitz, Marc I; Lynn, Michael J; Stern, Barney J; George, Mary G.

2009-01-01

263

VISUALLY-SYMPTOMATIC INDIVIDUALS WITH ACQUIRED BRAIN INJURY A RETROSPECTIVE STUDY  

Microsoft Academic Search

We reviewed the records of 220 visually symptomatic, ambulatory patients with acquired brain injury. These patients were examined at the State University of New York, State College of Optometry's Ray- mond J. Greenwald Rehabilitation Cen- ter (RJGRC). The records were divided into sub-groups of mild traumatic brain injury (TBI) and cerebral vascular acci- dent (CVA). The former group accounted for

Ñ Shoshana Craig; O. D. Ñ Neera Kapoor; M. S. Ñ Kenneth; J. Ciuffreda; Irwin B. Suchoff; D. O. S. Ñ Myounghee; Esther Han; O. D. Ñ Daniella

264

Risk of symptomatic heterotopic ossification following plate osteosynthesis in multiple trauma patients: an analysis in a level-1 trauma centre  

Microsoft Academic Search

ABSTRACT: BACKGROUND: Symptomatic heterotopic ossification (HO) in multiple trauma patients may lead to follow up surgery, furthermore the long-term outcome can be restricted. Knowledge of the effect of surgical treatment on formation of symptomatic heterotopic ossification in polytrauma is sparse. Therefore, we test the effects of surgical treatment (plate osteosynthesis or intramedullary nailing) on the formation of heterotopic ossification in

Christian Zeckey; Frank Hildebrand; Philipp Mommsen; Julia Schumann; Michael Frink; Hans-Christoph Pape; Christian Krettek; Christian Probst

2009-01-01

265

Chronic Eosinophilic Leukemia  

MedlinePLUS

Search Español Chronic Myeloproliferative Neoplasms Treatment (PDQ®) Last Modified: November 11, 2014 General Information About Chronic Myeloproliferative Neoplasms Myeloproliferative neoplasms are a group of ...

266

[Pathomechanisms in chronic obstructive pulmonary disease (COPD)].  

PubMed

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases worldwide, and its morbidity and mortality are still increasing. Thus, it is expected that, globally, COPD will be the third most common cause of death by 2020. Moreover, COPD leads to enormous health-economic costs (i. e., outpatient and inpatient treatment, inability to work). Nevertheless, the prevalence of COPD is underestimated also in Germany. This is partly because often, the disease is symptomatic only in its advanced stages and as a result it is not diagnosed until late. In addition, the therapeutic effects on the long-term course and the progression of the disease are limited. Therefore, a much deeper understanding of the manifold and complex pathomechanisms of this pathomorphologically varied disease is needed before new therapeutic strategies can be developed. The aim of this review is to discuss current concepts of the pathophysiology of COPD and their scientific bases. The authors will concentrate mainly on a differentiated description of the pathomechanisms which cause chronic obstructive bronchiolitis and obstructive pulmonary emphysema. PMID:17171318

Glaab, Thomas; Hohlfeld, Jens M; Jörres, Rudolf A; Krug, Norbert; Welte, Tobias

2006-12-15

267

Prognostic value of coping strategies in a community-based sample of persons with chronic symptomatic knee osteoarthritis  

PubMed Central

Radiographic knee osteoarthritis (OA) is a highly prevalent condition that has been the focus of a number of studies identifying factors that are prognostic of continued or worsening pain and function. Although prior prognostic studies have identified a number of demographic, physical, and psychological factors that are predictive of outcome, minimal focus has been placed on pain coping skills as prognostic factors, despite cross-sectional evidence suggesting that pain coping skills are associated with pain and function in knee OA. The present study reports on the use of pain coping skills as prognostic factors for changes in pain and/or function over a 1-year period. Participants were drawn from the Osteoarthritis Initiative, a prospective longitudinal cohort study of persons recruited from the community who either had knee OA or were at high risk for developing knee OA. Data from the Coping Strategies Questionnaire were compared against 1-year change in pain, function, or both, using established criteria for defining whether the patient got better, worse, or stayed the same over the 1-year period. Results revealed a significant effect for praying/hoping, increased behavioral activities, and pain catastrophizing as prognostic of pain outcomes; ignoring pain and praying/hoping were prognostic of function outcomes; and increased behavioral activities and pain catastrophizing were prognostic of a combined pain and function outcome. The findings provide important new evidence regarding the potential clinical relevance of a number of pain coping responses hypothesized to influence future pain and function in persons with arthritis. PMID:23969326

Alschuler, Kevin N.; Molton, Ivan R.; Jensen, Mark P.; Riddle, Daniel L.

2015-01-01

268

Prognostic value of X-chromosome inactivation in symptomatic female carriers of dystrophinopathy  

PubMed Central

Background Between 8% and 22% of female carriers of DMD mutations exhibit clinical symptoms of variable severity. Development of symptoms in DMD mutation carriers without chromosomal rearrangements has been attributed to skewed X-chromosome inactivation (XCI) favouring predominant expression of the DMD mutant allele. However the prognostic use of XCI analysis is controversial. We aimed to evaluate the correlation between X-chromosome inactivation and development of clinical symptoms in a series of symptomatic female carriers of dystrophinopathy. Methods We reviewed the clinical, pathological and genetic features of twenty-four symptomatic carriers covering a wide spectrum of clinical phenotypes. DMD gene analysis was performed using MLPA and whole gene sequencing in blood DNA and muscle cDNA. Blood and muscle DNA was used for X-chromosome inactivation (XCI) analysis thought the AR methylation assay in symptomatic carriers and their female relatives, asymptomatic carriers as well as non-carrier females. Results Symptomatic carriers exhibited 49.2% more skewed XCI profiles than asymptomatic carriers. The extent of XCI skewing in blood tended to increase in line with the severity of muscle symptoms. Skewed XCI patterns were found in at least one first-degree female relative in 78.6% of symptomatic carrier families. No mutations altering XCI in the XIST gene promoter were found. Conclusions Skewed XCI is in many cases familial inherited. The extent of XCI skewing is related to phenotype severity. However, the assessment of XCI by means of the AR methylation assay has a poor prognostic value, probably because the methylation status of the AR gene in muscle may not reflect in all cases the methylation status of the DMD gene. PMID:23092449

2012-01-01

269

Chronic lymphocytic leukemia: state of the art and beyond.  

PubMed

In the treatment of chronic lymphocytic leukemia (CLL), select genomic studies can assist in risk stratification of newly diagnosed patients. Chemoimmunotherapy targeting CD20 offers a survival advantage in symptomatic patients both with and without these high-risk genetic features, though patients with del(17p13.1) have poor outcomes and require specific intervention. Obinutuzumab plus chlorambucil is a treatment standard for untreated elderly patients and is superior to rituximab plus chlorambucil. In the setting of relapsed CLL, the new kinase inhibitors have the potential to completely change the treatment paradigm of CLL. PMID:24853221

Byrd, John C

2014-05-01

270

[Onabotulinumtoxin A in the treatment of chronic migraine].  

PubMed

INTRODUCTION. Chronic migraine is the most frequent complication of migraine. Its management is complex and difficult, and is based essentially on preventive measures. AIM. To analyse the development of the use of Onabotulinumtoxin A (OnabotA) in migraine, especially in its chronic form, the method of administration, its mechanism of action, its safety profile and its possible indications in clinical practice. DEVELOPMENT. The study conducts a thorough review of all the clinical trials in the literature that have used OnabotA in the prevention of migraine, both in its episodic and its chronic forms, and the outcomes in the chronic form are analysed in detail. CONCLUSIONS. In studies in phase III, OnabotA has proved to be effective in the treatment of patients with chronic migraine, with significant reductions in the mean frequency of days with headaches, the number of headache episodes, the days with migraine or the proportion of patients with severe disability, in addition to other parameters. It is also effective in the subgroup of patients with symptomatic headache due to medication abuse. OnabotA has proved to be safe and well tolerated in this indication, with foreseeable, usually mild or moderate, transitory side effects. In sum, OnabotA is a safe, well-tolerated alternative in the preventive treatment of chronic migraine. PMID:22532242

Láinez-Andrés, José M

2012-04-10

271

CHRONIC URTICARIA  

PubMed Central

Chronic urticaria (CU) is a disturbing allergic condition of the skin. Although frequently benign, it may sometimes be a red flag sign of a serious internal disease. A multitude of etiologies have been implicated in the causation of CU, including physical, infective, vasculitic, psychological and idiopathic. An autoimmune basis of most of the ‘idiopathic’ forms is now hypothesized. Histamine released from mast cells is the major effector in pathogenesis and it is clinically characterized by wheals that have a tendency to recur. Laboratory investigations aimed at a specific etiology are not always conclusive, though may be suggestive of an underlying condition. A clinical search for associated systemic disease is strongly advocated under appropriate circumstances. The mainstay of treatment remains H1 antihistaminics. These may be combined with complementary pharmacopeia in the form of H2 blockers, doxepin, nifedipine and leukotriene inhibitors. More radical therapy in the form of immunoglobulins, plasmapheresis and cyclophosphamide may be required for recalcitrant cases. Autologous transfusion and alternative remedies like acupuncture have prospects for future. A stepwise management results in favorable outcomes. An update on CU based on our experience with patients at a tertiary care centre is presented. PMID:22345759

Sachdeva, Sandeep; Gupta, Vibhanshu; Amin, Syed Suhail; Tahseen, Mohd

2011-01-01

272

The nigrostriatal system in the presymptomatic and symptomatic stages in the MPTP monkey model: a PET, histological and biochemical study.  

PubMed

Parkinson's disease (PD) is diagnosed when striatal dopamine (DA) loss exceeds a certain threshold and the cardinal motor features become apparent. The presymptomatic compensatory mechanisms underlying the lack of motor manifestations despite progressive striatal depletion are not well understood. Most animal models of PD involve the induction of a severe dopaminergic deficit in an acute manner, which departs from the typical, chronic evolution of PD in humans. We have used 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) administered to monkeys via a slow intoxication protocol to produce a more gradual development of nigral lesion. Twelve control and 38 MPTP-intoxicated monkeys were divided into four groups. The latter included monkeys who were always asymptomatic, monkeys who recovered after showing mild parkinsonian signs, and monkeys with stable, moderate and severe parkinsonism. We found a close correlation between cell loss in the substantia nigra pars compacta (SNc) and striatal dopaminergic depletion and the four motor states. There was an overall negative correlation between the degree of parkinsonism (Kurlan scale) and in vivo PET ((18)F-DOPA K(i) and (11)C-DTBZ binding potential), as well as with TH-immunoreactive cell counts in SNc, striatal dopaminergic markers (TH, DAT and VMAT2) and striatal DA concentration. This intoxication protocol permits to establish a critical threshold of SNc cell loss and dopaminergic innervation distinguishing between the asymptomatic and symptomatic parkinsonian stages. Compensatory changes in nigrostriatal dopaminergic activity occurred in the recovered and parkinsonian monkeys when DA depletion was at least 88% of control, and accordingly may be considered too late to explain compensatory mechanisms in the early asymptomatic period. Our findings suggest the need for further exploration of the role of non-striatal mechanisms in PD prior to the development of motor features. PMID:22677034

Blesa, J; Pifl, C; Sánchez-González, M A; Juri, C; García-Cabezas, M A; Adánez, R; Iglesias, E; Collantes, M; Peñuelas, I; Sánchez-Hernández, J J; Rodríguez-Oroz, M C; Avendaño, C; Hornykiewicz, O; Cavada, C; Obeso, J A

2012-10-01

273

A systematic review of patient reported nasal obstruction scores: Defining normative and symptomatic ranges in surgical patients  

PubMed Central

Importance A gold standard objective measure of nasal airway obstruction (NAO) does not currently exist, so patient-reported measures are commonly used, particularly the Nasal Obstruction Symptom Evaluation (NOSE) and the visual analog scale (VAS). However, questions remain regarding how best to utilize these instruments. Objectives The goal of this study is to systematically review studies on NOSE and VAS scores in NAO patients and compile and standardize the data to (1) define symptomatic and normative values for (a) pre and post-surgical NAO patients, (b) asymptomatic individuals, and (c) the general population, (2) determine if post-surgery scores are comparable to asymptomatic scores, and (3) determine if there is a clinically useful pre-operative and post-operative score change. Evidence Review A systematic review of the literature was performed through PubMed for studies assessing NOSE and VAS scores in patients with chronic NAO. Strict inclusion criteria were applied to focus on anatomic obstruction only. For statistical analysis, the patients were divided into asymptomatic, pre- and post-surgery NAO, and the general population. Findings The average NOSE and VAS scores for a patient with NAO were 65 ± 22 and 6.9 ± 2.3 respectively. The average post-surgery NOSE score was 23 ± 20 and VAS score was 2.1 ± 2.2. The average asymptomatic individual NOSE score was 15 ± 17, and VAS score was 2.1 ± 1.6. The average NOSE and VAS scores for the general population were 42 ± 27 and 4.6 ± 2.6 respectively. The average pre- to post-surgical change was > 40 for NOSE and > 4 for VAS. Conclusions and Relevance We have shown that normative and abnormal value ranges for NOSE and VAS can be established for clinical use. Given the consistency of both scales, we conclude that these measures should be used as a clinically meaningful measure of successful surgical outcomes. PMID:24604253

Rhee, John S.; Sullivan, Corbin D.; Frank, Dennis O.; Kimbell, Julia S.; Garcia, Guilherme J.M.

2014-01-01

274

For more than 45 years orally dosed levodopa (L-DOPA) has been regarded as the gold standard therapy for symptomatic treatment of Parkinson's disease (Pd) [1].  

E-print Network

as the gold standard therapy for symptomatic treatment of Parkinson's disease (Pd) [1]. However its possible for the symptomatic treatment of Parkinson's disease, as discussed in CHAPTER 1. But further optimization of dopamine agonists and its prodrugs for the symptomatic treatment of Parkinson's disease. To achieve

van den Brink, Jeroen

275

Symptomatic Versus Inapparent Outcome in Repeat Dengue Virus Infections Is Influenced by the Time Interval between Infections and Study Year  

PubMed Central

Four dengue virus serotypes (DENV1-4) circulate globally, causing more human illness than any other arthropod-borne virus. Dengue can present as a range of clinical manifestations from undifferentiated fever to Dengue Fever to severe, life-threatening syndromes. However, most DENV infections are inapparent. Yet, little is known about determinants of inapparent versus symptomatic DENV infection outcome. Here, we analyzed over 2,000 DENV infections from 2004 to 2011 in a prospective pediatric cohort study in Managua, Nicaragua. Symptomatic cases were captured at the study health center, and paired healthy annual samples were examined on a yearly basis using serological methods to identify inapparent DENV infections. Overall, inapparent and symptomatic DENV infections were equally distributed by sex. The mean age of infection was 1.2 years higher for symptomatic DENV infections as compared to inapparent infections. Although inapparent versus symptomatic outcome did not differ by infection number (first, second or third/post-second DENV infections), substantial variation in the proportion of symptomatic DENV infections among all DENV infections was observed across study years. In participants with repeat DENV infections, the time interval between a first inapparent DENV infection and a second inapparent infection was significantly shorter than the interval between a first inapparent and a second symptomatic infection. This difference was not observed in subsequent infections. This result was confirmed using two different serological techniques that measure total anti-DENV antibodies and serotype-specific neutralizing antibodies, respectively. Taken together, these findings show that, in this study, age, study year and time interval between consecutive DENV infections influence inapparent versus symptomatic infection outcome, while sex and infection number had no significant effect. Moreover, these results suggest that the window of cross-protection induced by a first infection with DENV against a second symptomatic infection is approximately 2 years. These findings are important for modeling dengue epidemics and development of vaccines. PMID:23951377

Mercado, Juan Carlos; Williams, Katherine L.; Vargas, Maria José; Gutierrez, Gamaliel; Kuan, Guillermina; Gordon, Aubree; Balmaseda, Angel; Harris, Eva

2013-01-01

276

Treatment of Symptomatic Non-Parasitic Liver Cysts–Surgical Treatment Versus Alcohol Injection Therapy  

PubMed Central

Fourteen patients with benign symptomatic non-parasitic cysts of the liver were either surgically treated, had alcohol injected into the cysts, underwent deroofing of the cyst or in 5, a cystectomy was done. Alcohol was injected into 6 patients and there has been no recurrence for as long as 5 years and 8 months after the treatment. Liver dysfunction occurred in 3 patients given blood transfusion during the surgery and/or postoperative course, an elevated temperature (over 39?) occurred in one patient. Adverse effects of alcohol injections were minor and transient. Based on our experience, the injection of alcohol is an effective treatment for benign symptomatic cyst of the liver. When a malignancy is suspected on imaging and/or cytologic studies, or when alcohol administration is ineffective, then surgery is indicated. PMID:2278926

Yoshida, Yasuhiro; Saku, Motonori; Honda, Hiroshi; Muranaka, Toru; Oshiumi, Yoshihiko; Kanematsu, Takashi; Sugimachi, Keizo

1990-01-01

277

Cartilage Degeneration at Symptomatic Persistent Olecranon Physis in Adolescent Baseball Players  

PubMed Central

Background. Elbow overuse injuries are common in adolescent baseball players, but symptomatic persistent olecranon physis is rare, and its pathogenesis remains unclear. Purpose. To examine the histopathological and imaging findings of advanced persistent olecranon physis. Methods. The olecranon physes of 2 baseball pitchers, aged 14 and 15 years, were examined by preoperative magnetic resonance imaging (MRI), and surgical specimens were examined histologically. Results. T2-weighted MRI revealed alterations in the intrachondral signal intensity possibly related to collagen degeneration and increased free water content. Histological findings of specimens stained with hematoxylin-eosin showed complete disorganization of the cartilage structure, hypocellularity, chondrocyte cluster formation, and moderately reduced staining. All these findings are hallmarks of osteoarthritis and are suggestive of cartilage degeneration. Conclusion. Growth plate degeneration was evident in advanced cases of symptomatic persistent olecranon physis. These findings contribute to understanding the pathogenesis of this disease. PMID:25580304

Enishi, Tetsuya; Matsuura, Tetsuya; Suzue, Naoto; Takahashi, Yoshinori; Sairyo, Koichi

2014-01-01

278

Cyclophosphamide-induced symptomatic hyponatremia, a rare but severe side effect: a case report  

PubMed Central

Cyclophosphamide is commonly used in the treatment of malignant diseases. Symptomatic severe hyponatremia induced by low-dose cyclophosphamide is very uncommon worldwide. We report a case of severe symptomatic hyponatremia that developed in a female breast cancer patient following the first cycle of chemotherapy containing low-dose cyclophosphamide. Her laboratory test showed serum Na of 112 mmol/L. Her hyponatremia was initially treated with sodium bicarbonate. She completely recovered without neurological deficits after slow correction of the serum Na concentration. Although hyponatremia is a rare toxicity it should always be considered during the usage of cyclophosphamide, even if the dosage is low, especially with concurrent use of other medications that impair water excretion, like chlorthalidone. This report describes the first reported case of cyclophosphamide-induced hyponatremia in Qatar. PMID:25336968

Elazzazy, Shereen; Mohamed, Asmaa Elhassan; Gulied, Amaal

2014-01-01

279

[Non-surgical approach for symptomatic fibroids. Physical methods: selective embolization].  

PubMed

The approach to symptomatic uterine fibroids has seen a marked evolution in recent years thanks to the emergence of minimally invasive techniques that allow for uterine preservation. Selective uterine artery embolization (UAE) consists of the complete occlusion of the 2 uterine arteries with embolic particles in order to produce ischemic necrosis of the fibroids without permanently affecting the normal uterine tissue. This technique significantly reduces the amount of bleeding and causes a reduction in uterine volume at 3 months postprocedure, which is maintained over time, allowing for 70% of patients to avoid surgery. Moreover, UAE entails shorter surgical times, reduced hospital stays and fewer days needed to return to work when compared with traditional surgical techniques (hysterectomy and fibroidectomy), without any differences in the quality-of-life scales at 5 years. UAE should therefore be included in the therapeutic options offered to patients with symptomatic fibroid uteri. PMID:24314563

Tarriel, Josep Estadella; Moreno, Cristina Soler; Ajenjo, Marta Campillo; Vara, Rubén Guerrero

2013-07-01

280

A Critical Protection Level Derived from Dengue Infection Mathematical Model Considering Asymptomatic and Symptomatic Classes  

NASA Astrophysics Data System (ADS)

In this paper we formulate a model of dengue fever transmission by considering the presence of asymptomatic and symptomatic compartments. The model takes the form as a system of differential equations representing a host-vector SIR (Susceptible - Infective -Recovered) disease transmission. It is assumed that both host and vector populations are constant. It is also assumed that reinfection of recovered hosts by the disease is possible due to a wanning immunity in human body. We analyze the model to determine the qualitative behavior of the model solution and use the concept of effective basic reproduction number (fraktur Rp) as a control criteria of the disease transmission. The effect of mosquito biting protection (e.g. by using insect repellent) is also considered. We compute the long-term ratio of the asymptomatic and symptomatic classes and show a condition for which the iceberg phenomenon could appear.

Anggriani, N.; Supriatna, A. K.; Soewono, E.

2013-04-01

281

Endoscopic Surgery for Symptomatic Unicameral Bone Cyst of the Proximal Femur  

PubMed Central

Recently, surgical treatment of a symptomatic unicameral cyst of the proximal femur has been achieved with less invasive procedures than traditional open curettage with an autologous bone graft. In this article we introduce endoscopic surgery for a symptomatic unicameral cyst of the proximal femur. The presented technique, which includes minimally invasive endoscopic curettage of the cyst and injection of a bone substitute, not only minimizes muscle damage around the femur but also enables sufficient curettage of the fibrous membrane in the cyst wall and the bony septum through direct detailed visualization by an endoscope. Furthermore, sufficient initial strength after curettage can be obtained by injecting calcium phosphate cement as a bone substitute. PMID:24892010

Miyamoto, Wataru; Takao, Masato; Yasui, Youichi; Miki, Shinya; Matsushita, Takashi

2013-01-01

282

Video-assisted thoracoscopic surgery with talc pleurodesis in the management of symptomatic hepatic hydrothorax  

Microsoft Academic Search

OBJECTIVES:Video-assisted thoracoscopic surgery with talc pleurodesis is a therapeutic option for patients with hepatic hydrothorax that is refractory to medical therapy. We report the outcomes of 15 patients who underwent this procedure for significantly symptomatic disease.METHODS:Data on 15 consecutive patients presenting to our institution between November, 1996, and June, 2000, with refractory hepatic hydrothorax was retrospectively collected. Baseline demographical and

Dino Ferrante; Miguel R Arguedas; Robert J Cerfolio; Barry G Collins; Dirk J van Leeuwen

2002-01-01

283

Interventional Treatment of a Symptomatic Neonatal Hepatic Cavernous Hemangioma Using the Amplatzer Vascular Plug  

Microsoft Academic Search

Percutaneous intervention is one treatment option for symptomatic hepatic hemangioma in infants. We report the case of a newborn\\u000a (birth weight 4060 g) with a large hepatic cavernous hemangioma, which presented early with high cardiac output failure due\\u000a to arteriovenous shunting and signs of incipient Kasabach-Merritt syndrome. We performed a successful superselective transcatheter\\u000a coil embolization of three feeding arteries on

Oliver Kretschmar; Walter Knirsch; Vera Bernet

2008-01-01

284

Superior Achilles Tendon Microcirculation in Tendinopathy Among Symptomatic Female Versus Male Patients  

Microsoft Academic Search

Background: Higher estrogen levels in women seem to play a role regarding an increased ligament and tendon injury rate among women. However, gender differences of tendon microcirculation have not yet been reported.Hypothesis: Female patients suffering Achilles tendinopathy have worse tendon and paratendon microcirculation than symptomatic male patients.Study Design: Cross-sectional study; Level of evidence, 2.Methods: A total of 139 Achilles tendinopathy

Karsten Knobloch; Louisa Schreibmueller; Rupert Meller; Kay H. Busch; Marcus Spies; Peter M. Vogt

2008-01-01

285

Clinical outcome data for symptomatic breast cancer: the breast cancer clinical outcome measures (BCCOM) project  

Microsoft Academic Search

Background:Data collection for screen-detected breast cancer in the United Kingdom is fully funded, which has led to improvements in clinical practice. However, data on symptomatic cancer are deficient, and the aim of this project was to monitor the current practice.Methods:A data set was designed together with surrogate outcome measures to reflect best practice. Data from cancer registries initially required the

T Bates; O Kearins; I Monypenny; C Lagord; G Lawrence

2009-01-01

286

Rabeprazole for the prevention of pathologic and symptomatic relapse of erosive or ulcerative gastroesophageal reflux disease  

Microsoft Academic Search

OBJECTIVE:We evaluated the effectiveness and safety profile of 10 and 20 mg of rabeprazole, a new proton pump inhibitor, once daily versus placebo in preventing endoscopic and symptomatic relapse for up to 1 yr among patients with healed erosive or ulcerative gastroesophageal reflux disease (GERD).METHODS:The 52-wk trial used a multicenter, randomized, double-blind, parallel-group design in which 209 men and women

Antonio Caos; Morry Moskovitz; Yogeshwar Dayal; Carlos Perdomo; Robert Niecestro; Jay Barth

2000-01-01

287

The Role of Esophageal pH Monitoring in Symptomatic Patients on PPI Therapy  

Microsoft Academic Search

BACKGROUND:Ambulatory pH monitoring while on therapy is often recommended in gastroesophageal reflux disease (GERD) patients with continued symptoms. However, to date, little data exist to justify this indication.AIM:To assess the role of pH monitoring in symptomatic patients despite aggressive therapy with typical or extra esophageal GERD.METHODS:Retrospective review of 2,291 ambulatory pH tracings (1999–2003) identified subgroup of studies performed on proton

Samer Charbel; Farah Khandwala; Michael F. Vaezi

2005-01-01

288

A case series of the management of symptomatic azole-resistant candida.  

PubMed

Patients with symptomatic azole-resistant Candida albicans or non-albicans candida are difficult to manage. Treatment is largely anecdotal due to the relatively small number of patients. We present six case reports which highlight our own observation in clinical practice including four patients who were treated successfully with topical amphotericin B/flucytosine vaginal gel for 14 days (Stoke-on-Trent formula). PMID:22648899

Challenor, R; Pinsent, S; Ekanayaka, R

2012-05-01

289

The Long-term Natural History of the Weekly Symptomatic Status of Bipolar I Disorder  

Microsoft Academic Search

Background: To our knowledge, this is the first pro- spective natural history study of weekly symptomatic sta- tus of patients with bipolar I disorder (BP-I) during long- term follow-up. Methods: Analyses are based on ongoing prospective follow-up of 146 patients with Research Diagnostic Cri- teria BP-I, who entered the National Institute of Mental Health (Bethesda, Md) Collaborative Depression Study from

Lewis L. Judd; Hagop S. Akiskal; Pamela J. Schettler; Jean Endicott; Jack Maser; David A. Solomon; Andrew C. Leon; John A. Rice; Martin B. Keller

2002-01-01

290

A symptomatic Fabry disease mouse model generated by inducing globotriaosylceramide synthesis  

PubMed Central

Synopsis Fabry disease is a lysosomal storage disorder in which neutral glycosphingolipids, predominantly globotriaosylceramide (Gb3), accumulate due to deficient ?-galactosidase A (?-Gal A) activity. The ?-Gal A-knockout (GLAko) mouse has been used as a model for Fabry disease, but it does not have any symptomatic abnormalities. In this study, we generated a symptomatic mouse model (G3Stg/GLAko) by crossbreeding GLAko mice with transgenic mice expressing human Gb3 synthase. G3Stg/GLAko mice had high Gb3 levels in major organs, and their serum Gb3 level at 5–25 weeks of age was 6–10 times higher than that in GLAko mice of the same age. G3Stg/GLAko mice showed progressive renal impairment, with albuminuria at 3 weeks of age, decreased urine osmolality at 5 weeks, polyuria at 10 weeks, and increased blood urea nitrogen at 15 weeks. The urine volume and urinary albumin concentration were significantly reduced in the G3Stg/GLAko mice when human recombinant ?-Gal A was administered intravenously. These data suggest that Gb3 accumulation is a primary pathogenic factor in the symptomatic phenotype of G3Stg/GLAko mice, and that this mouse line is suitable for studying the pathogenesis of Fabry disease and for preclinical studies of candidate therapies. PMID:24094090

Taguchi, Atsumi; Maruyama, Hiroki; Nameta, Masaaki; Yamamoto, Tadashi; Matsuda, Junichiro; Kulkarni, Ashok B.; Yoshioka, Hidekatsu; Ishii, Satoshi

2014-01-01

291

Nimesulide Improves the Symptomatic and Disease Modifying Effects of Leflunomide in Collagen Induced Arthritis  

PubMed Central

Nimesulide is a COX-2 inhibitor used for symptomatic relief of rheumatoid arthritis. Leflunomide is an anti-pyrimidine used to manage the progression of rheumatoid arthritis. Herein we studied the influence of nimesulide and leflunomide combination in terms of disease symptoms and progression using collagen-induced arthritis model in mice, as a model for rheumatoid arthritis. Collagen induced arthritis was induced by immunization with type II collagen. Assessment of joint stiffness and articular hyperalgesia were evaluated using a locomotor activity cage and the Hargreaves method, respectively. Disease progression was assessed via arthritic index scoring, X-ray imaging, myeloperoxidase enzyme activity and histopathologic examination. Nimesulide induced only transient symptomatic alleviation on the top of decreased leucocytic infiltration compared to arthritis group. However, nimesulide alone failed to induce any significant improvement in the radiological or pathological disease progression. Leflunomide alone moderately alleviates the symptoms of arthritis and moderately retarded the radiological and pathological disease progression. Combination of nimesulide and leflunomide significantly improved symptomatic (analgesia and joint stiffness) and arthritic disease progression (radiological, pathological and Myeloperoxidase enzyme activity) in collagen induced arthritis animal model. PMID:25375820

Al-Abd, Ahmed M.; Al-Abbasi, Fahad A.; Nofal, Salwa M.; Khalifa, Amani E.; Williams, Richard O.; El-Eraky, Wafaa I.; Nagy, Ayman A.; Abdel-Naim, Ashraf B.

2014-01-01

292

Nimesulide improves the symptomatic and disease modifying effects of leflunomide in collagen induced arthritis.  

PubMed

Nimesulide is a COX-2 inhibitor used for symptomatic relief of rheumatoid arthritis. Leflunomide is an anti-pyrimidine used to manage the progression of rheumatoid arthritis. Herein we studied the influence of nimesulide and leflunomide combination in terms of disease symptoms and progression using collagen-induced arthritis model in mice, as a model for rheumatoid arthritis. Collagen induced arthritis was induced by immunization with type II collagen. Assessment of joint stiffness and articular hyperalgesia were evaluated using a locomotor activity cage and the Hargreaves method, respectively. Disease progression was assessed via arthritic index scoring, X-ray imaging, myeloperoxidase enzyme activity and histopathologic examination. Nimesulide induced only transient symptomatic alleviation on the top of decreased leucocytic infiltration compared to arthritis group. However, nimesulide alone failed to induce any significant improvement in the radiological or pathological disease progression. Leflunomide alone moderately alleviates the symptoms of arthritis and moderately retarded the radiological and pathological disease progression. Combination of nimesulide and leflunomide significantly improved symptomatic (analgesia and joint stiffness) and arthritic disease progression (radiological, pathological and Myeloperoxidase enzyme activity) in collagen induced arthritis animal model. PMID:25375820

Al-Abd, Ahmed M; Al-Abbasi, Fahad A; Nofal, Salwa M; Khalifa, Amani E; Williams, Richard O; El-Eraky, Wafaa I; Nagy, Ayman A; Abdel-Naim, Ashraf B

2014-01-01

293

Facial affect recognition in symptomatically remitted patients with schizophrenia and bipolar disorder.  

PubMed

Both schizophrenia and bipolar disorder (BD) have consistently been associated with deficits in facial affect recognition (FAR). These impairments have been related to various aspects of social competence and functioning and are relatively stable over time. However, individuals in remission may outperform patients experiencing an acute phase of the disorders. The present study directly contrasted FAR in symptomatically remitted patients with schizophrenia or BD and healthy volunteers and investigated its relationship with patients' outcomes. Compared to healthy control subjects, schizophrenia patients were impaired in the recognition of angry, disgusted, sad and happy facial expressions, while BD patients showed deficits only in the recognition of disgusted and happy facial expressions. When directly comparing the two patient groups individuals suffering from BD outperformed those with schizophrenia in the recognition of expressions depicting anger. There was no significant association between affect recognition abilities and symptomatic or psychosocial outcomes in schizophrenia patients. Among BD patients, relatively higher depression scores were associated with impairments in both the identification of happy faces and psychosocial functioning. Overall, our findings indicate that during periods of symptomatic remission the recognition of facial affect may be less impaired in patients with BD than in those suffering from schizophrenia. However, in the psychosocial context BD patients seem to be more sensitive to residual symptomatology. PMID:24361305

Yalcin-Siedentopf, Nursen; Hoertnagl, Christine M; Biedermann, Falko; Baumgartner, Susanne; Deisenhammer, Eberhard A; Hausmann, Armand; Kaufmann, Alexandra; Kemmler, Georg; Mühlbacher, Moritz; Rauch, Anna-Sophia; Fleischhacker, W Wolfgang; Hofer, Alex

2014-02-01

294

Long-term psychological consequences of symptomatic pulmonary embolism: a qualitative study  

PubMed Central

Objective To explore the psychological consequences of experiencing symptomatic pulmonary embolism (PE). Design Qualitative interview-based study using interpretative phenomenological analysis. Setting Outpatients who attended an anticoagulation clinic in a district general hospital. Participants Patients attending an anticoagulation clinic following hospital admission for symptomatic PE were approached to participate. A total of 9 (4 women, 5 men) of 11 patients approached agreed to be interviewed. Participants were aged between 26 and 72?years and had previously experienced a PE between 9 and 60?months (median=26?months, mean=24?months). Intervention Audiotaped semistructured qualitative interviews were undertaken to explore participants experiences of having a PE and how it had affected their lives since. Data were transcribed and analysed using interpretative phenomenological analysis to identify emergent themes. Results Three major themes with associated subthemes were identified. Participants described having a PE as a life-changing experience comprising initial shock, followed by feeling of loss of self, life-changing decisions and behaviour modification. Features of post-traumatic stress disorder (PTSD) were described with flashbacks, hypervigilance and intrusive thoughts being most prevalent. Participants identified several areas of support needed for such patients including easier access to support through information giving and emotional support. Conclusions Long-term consequences of venous thromboembolism go beyond the physical alone. Patients describe experiencing symptomatic PE to be a life-changing distressing event leading to behaviour modification and in some PTSD. It is likely that earlier psychological intervention may reduce such long-term sequelae. PMID:24694625

Noble, Simon; Lewis, Rhian; Whithers, Jodie; Lewis, Sarah; Bennett, Paul

2014-01-01

295

Risk of Cerebral Angiography in Patients with Symptomatic Intracranial Atherosclerotic Stenosis  

PubMed Central

Background A well-defined rate of adverse events following cerebral angiography in patients with symptomatic intracranial atherosclerosis would be useful to physicians making decisions regarding imaging and treatment of these patients. We report the adverse events associated with angiography in patients who underwent single-vessel cerebral angiography as part of the study protocol in the Warfarin-Aspirin for Symptomatic Intracranial Arterial Stenosis trial. Methods Single-vessel cerebral angiography was performed to specifically define the degree of stenosis in 196 patients suspected of having intracranial atherosclerotic stenosis on noninvasive tests. Adverse events that occurred within 24 h of cerebral angiography were reported by the sites performing the angiography. Results Overall, neurological adverse events occurred in 4 patients (2.0%; 95% CI: 0.6–5.1%), and nonneurological adverse events occurred in 12 patients (6.1%; 95% CI: 3.2–10.5%). All of the neurological adverse events were transient. Conclusions The risk of permanent neurological adverse events associated with single-vessel cerebral angiography in patients with symptomatic intracranial atherosclerosis is relatively low. The quantification of the risk of cerebral angiography in patients with intracranial atherosclerosis provides useful information to consider when evaluating noninvasive imaging techniques for their relative value. PMID:21487224

Cloft, Harry J.; Lynn, Michael J.; Feldmann, Edward; Chimowitz, Marc

2011-01-01

296

Symptomatic improvement in uterine myomas after MRgFUS: 4 year follow up  

NASA Astrophysics Data System (ADS)

Objective: To assess the long-term improvement in symptoms after magnetic resonance-guided focused ultrasound surgery (MRgFUS) for uterine myomas. Methods: Japanese women with symptomatic myomas underwent MRgFUS using the ExAblate 2000 system. The symptom severity score (SSS) was examined before and after the treatment at 3, 6, 12, 24, and 48 months. Simultaneously, we asked the patients' satisfaction level regarding the overall change of subjective symptoms: symptom free, improved a great deal, improved to some extent, no change, or worsened. The myoma volumes were measured at 6, 12, 24, 36 and 48 months after MRgFUS. Results: No severe adverse event occurred with any of the patients. The mean SSS value before treatment was 38.3±21.5 (n = 106), which diminished significantly during follow-up for 3-48 months after treatment. Patients' satisfaction level was favorable, although the response rate was low. Over 80% of the patients replied that their symptoms were improved to at least some extent, and over 50% of the patients replied that their symptoms were improved a great deal. This trend continued throughout this follow up period. The mean myoma volume was also decreased from the pretreatment volume in this follow up period. Conclusion: MRgFUS is an effective and safe method for treating symptomatic uterine myomas. Long-term symptomatic improvement is promising.

Funaki, Kaoru; Fukunishi, Hidenobu

2011-09-01

297

[Correlation between radiologic and ultrasonographic patterns and clinical manifestations in symptomatic hip osteoarthritis].  

PubMed

Increasing amounts of data have recently been published regarding ultrasonographic (US) findings of osteoarthritic joints, but very few data concern hip joints. In the current study we described US patterns concerning 490 patients affected by symptomatic hip osteoarthritis (OA) who underwent to intra-articular injections of hyaluronic products under US guidance. All patients were studied by US and X-ray of hip, clinical evaluation was assessed by the followings indexes: Lequesne, pain VAS, ICED, Global Physician Assessment and Global Patient Assessment. US findings were summarized in four main patterns, effusion and synovial proliferation were also detected. The aim of this study was to correlate US findings with clinical assessment and radiographic findings (according to Kellgren-Lawrence classification). Pearson's r correlation coefficient were computed and come out significant and positive between X ray and US patterns and between clinical indexes and US patterns. Also the correlation between K-L score and US patterns showed a significant positive correlation indicating that higher K-L scores are associated with increasing abnormal US findings. Our data suggest that ultrasonography of the hip may give useful information about the state of synovial membrane, synovial fluid, joint margins and bone profile in hip OA. Further studies are needed to evaluate their prevalence in hip OA symptomatic and not-symptomatic patients and their correlation to treatment outcome. PMID:17435843

Migliore, A; Tormenta, S; Iannessi, F; Mascheroni, E; Barbati, E; Capuano, A; Diaco, M; Massafra, U; Padalino, C; Vacca, F; Alimonti, A; Martin, L S; Granata, M

2007-01-01

298

Blastocystis hominis among symptomatic and asymptomatic individuals in Talkha Center, Dakahlia Governorate, Egypt.  

PubMed

Blastocystis hominis is now getting acceptance as an agent of human intestinal disease. B. hominis in stool samples of symptomatic and asymptomatic individuals was evaluated as a possible cause of gastro-intestinal troubles. B. hominis was found in 106 (10.1%) out of 1050 individuals examined from six villages and one city in Talkha Center, Dakahlia Governorate. The highest infection rate was in Manshayt El-Badawy village (25.47%), whereas Talkha City showed the lowest rate (4.73%). Age group 10-20 years had higher infection (13.3%). In twenty-three symptomatic patients, B. hominis represented the only causative parasitic agent. The most common symptoms were diarrhoea (30.4%), abdominal pain (26.1%), flatulence (21.7%). vomiting (13.1%) and fatigue (8.7%). High concentrations of B. hominis were found in symptomatic patients than in asymptomatic ones with statistical significant difference (8.2 cells/100 x field versus 3.8 respectively). The mean number of B. hominis was significantly high in patients complaining of diarrhoea and abdominal pain. PMID:16083074

El-Shazly, Atef M; Abdel-Magied, Aida A; El-Beshbishi, Samar N; El-Nahas, Hala A; Fouad, Mahmoud A H; Monib, Mohamed S M

2005-08-01

299

Changes in memory performance over a 12-month period in relation to achieving symptomatic remission after a first-episode psychosis.  

PubMed

With the introduction of a clear definition of symptomatic remission from the Remission in Schizophrenia Working Group (RSWG), studies have sought to characterize cognitive functioning in remitted and non-remitted schizophrenia patients. However, most investigations of cognition and remission are cross-sectional or have studied samples of chronically ill patients. Therefore, the aim of this study was to compare cognitive performance between remitted and non-remitted first-episode psychosis (FEP) patients longitudinally. Seventy patients were categorized as remitted (n=17) or non-remitted (n=53) using the full RSWG criteria after being treated for approximately 15months, during which cognition was evaluated twice. Since our previous investigations in FEP have isolated verbal memory as a potential cognitive marker of symptomatic remission, analyses were limited to verbal, visual and working memory. We have found that non-remitted patients had a significantly worse verbal memory performance than remitted patients after 3months (F(1,68)=6.47, p=0.006) and 15months of treatment (F(1,68)=19.49, p<0.001). Visual memory was also significantly lower in non-remitted patients compared to those in remission but only at initial assessment (F(1,68)=8.21, p=0.003) while working memory performance was similar at both time points. Our findings suggest that verbal memory may be a specific and stable marker of clinical remission in FEP patients. This cognitive domain can easily be evaluated at treatment intake in the hope of identifying early on patients who are less likely to remit. PMID:24512651

Benoit, Audrey; Bodnar, Michael; Malla, Ashok K; Joober, Ridha; Bherer, Louis; Lepage, Martin

2014-03-01

300

Glycopyrronium bromide for the treatment of chronic obstructive pulmonary disease.  

PubMed

Glycopyrronium bromide is a new long-acting muscarinic antagonist to be used once-daily, which is approved as a bronchodilator for the symptomatic maintenance treatment of adult patients with chronic obstructive pulmonary disease (COPD). In the Glycopyrronium bromide in chronic Obstructive pulmonary disease airWays trials, treatment with inhaled glycopyrronium bromide at 50 ?g once daily achieved a significantly better lung function than placebo, as measured by the trough forced expiratory volume in 1 s in patients with moderate-to-severe COPD. The lung function improvement was maintained for up to 52 weeks. Other improved indexes were dyspnea scores, health status, exacerbation rates and time of exercise endurance. Studies comparing the efficacy of glycopyrronium versus tiotropium bromide found substantial equivalence of the two drugs. Glycopyrronium was generally well tolerated. These data add inhaled glycopyrronium bromide to the treatment of patients with moderate to severe COPD as an effective once-daily LAMA. PMID:25547422

Riario-Sforza, Gian Galeazzo; Ridolo, Erminia; Riario-Sforza, Edoardo; Incorvaia, Cristoforo

2015-02-01

301

Symptomatic knee disorders in floor layers and graphic designers. A cross-sectional study  

PubMed Central

Background Previous studies have described an increased risk of developing tibio-femoral osteoarthritis (TF OA), meniscal tears and bursitis among those with a trade as floor layers. The purpose of this study was to analyse symptomatic knee disorders among floor layers that were highly exposed to kneeling work tasks compared to graphic designers without knee-demanding work tasks. Methods Data on the Knee injury and Osteoarthritis Outcome Score (KOOS) were collected by questionnaires. In total 134 floor layers and 120 graphic designers had a bilateral radiographic knee examination to detect TF OA and patella-femoral (PF) OA. A random sample of 92 floor layers and 49 graphic designers had Magnetic Resonance Imaging (MRI) of both knees to examine meniscal tears. Means of the subscales of KOOS were compared by analysis of variance. The risk ratio of symptomatic knee disorders defined as a combination of radiological detected knee OA or MRI-detected meniscal tears combined with a low KOOS score was estimated by logistic regression in floor layers with 95% confidence interval (CI) and adjusted for age, body mass index, traumas, and knee-straining sports activities. Symptomatic knee OA or meniscal tears were defined as a combination of low KOOS-scores and radiographic or MRI pathology. Results Symptomatic TF and medial meniscal tears were found in floor layers compared to graphic designers with odds ratios 2.6 (95%CI 0.99-6.9) and 2.04 (95% CI 0.77-5.5), respectively. There were no differences in PF OA. Floor layers scored significantly lower on all KOOS subscales compared to graphic designers. Significantly lower scores on the KOOS subscales were also found for radiographic TF and PF OA regardless of trade but not for meniscal tears. Conclusions The study showed an overall increased risk of developing symptomatic TF OA in a group of floor layers with a substantial amount of kneeling work positions. Prevention would be appropriate to reduce the proportion of kneeling postures e.g. by working with tools used from a standing working position. PMID:23009280

2012-01-01

302

A haemodynamic study of pulmonary hypertension in chronic hypersensitivity pneumonitis.  

PubMed

Chronic hypersensitivity pneumonitis is a common fibrotic interstitial lung disease. The prevalence of pulmonary hypertension diagnosed by right heart catheterisation and its cardiopulmonary function findings in patients with chronic hypersensitivity pneumonitis are unknown. Consecutive symptomatic patients with chronic hypersensitivity pneumonitis were prospectively evaluated. All patients were submitted to right heart catheterisation, pulmonary function testing, a 6-min walk test, echocardiography, blood gas determination and N-terminal pro-brain natriuretic peptide analyses. Nonhypoxaemic patients also underwent incremental cardiopulmonary exercise testing. 50 patients underwent right heart catheterisation; 25 (50%) of these had pulmonary hypertension and 22 (44%) had a pre-capillary haemodynamic pattern. The patients with pre-capillary pulmonary hypertension had lower forced vital capacity (mean ± sd 50 ± 17% versus 69 ± 22% predicted, p<0.01), carbon monoxide diffusing capacity (37 ± 12% versus 47 ± 14% predicted, p<0.01), arterial oxygen tension (median (interquartile range) 59.0 (47.8-69.3) versus 73.0 (62.2-78.5) mmHg, p<0.01) and saturation after the 6-min walk test (78 ± 8% versus 86 ± 7%, p<0.01). In pre-capillary pulmonary hypertension, oxygen uptake was also lower at the anaerobic threshold (41 ± 11% versus 50 ± 8% predicted, p=0.04) and at peak exercise (12.8 ± 1.6 versus 15.0 ± 2.5 mL · kg(-1) · min(-1), p=0.02). Pre-capillary pulmonary hypertension is common in symptomatic chronic hypersensitivity pneumonitis and is related to interstitial lung disease severity. Additionally, pulmonary hypertension is more prevalent in hypoxaemic patients with impaired lung function and exercise capacity. PMID:24743965

Oliveira, Rudolf K F; Pereira, Carlos A C; Ramos, Roberta P; Ferreira, Eloara V M; Messina, Carolina M S; Kuranishi, Lilian T; Gimenez, Andrea; Campos, Orlando; Silva, Célia M C; Ota-Arakaki, Jaquelina S

2014-08-01

303

Low dose amiodarone and sotalol in the treatment of recurrent, symptomatic atrial fibrillation: a comparative, placebo controlled study  

Microsoft Academic Search

OBJECTIVETo assess and compare the safety and efficacy of amiodarone and sotalol in the treatment of patients with recurrent symptomatic atrial fibrillation.DESIGNProspective, randomised, single blind, placebo controlled study.SETTINGTertiary cardiac referral centre.PATIENTS186 consecutive patients (97 men, 89 women; mean (SD) age, 63 (10) years) with recurrent, symptomatic atrial fibrillation.INTERVENTIONS65 patients were randomised to amiodarone, 61 to sotalol, and 60 to placebo.

G E Kochiadakis; N E Igoumenidis; M E Marketou; M D Kaleboubas; E N Simantirakis; P E Vardas

2000-01-01

304

Understanding Chronic Bronchitis  

MedlinePLUS

... Stop Smoking Get Involved Donate Lung Disease Asthma COPD Influenza Lung Cancer Disparities Reports Lung Disease Finder ... commonly referred to as Chronic Obstructive Pulmonary Disease (COPD). How Serious is Chronic Bronchitis? People often ignore ...

305

Conceptualizing Chronic Poverty  

Microsoft Academic Search

This paper provides a meaning for the term chronic poverty “in a nutshell” and explores the concepts of poverty, vulnerability and poverty dynamics that underpin this meaning. Subsequently, it reviews “who” is chronically poor, “why” they stay poor and what is known about policies to reduce chronic poverty. Despite the limited knowledge available it is clear that hundreds of millions

Andrew Shepherd

2003-01-01

306

Self-Rated Health and Symptomatic Knee Osteoarthritis Over Three Years: Data from the Osteoarthritis Initiative  

PubMed Central

Objective To determine if a previously published model of the influence of self-rated health on physical, mental and social health among patients with joint replacement surgery could be generalized to persons with symptomatic knee OA. Our second purpose was to determine if self-rated health mediated changes in physical, mental and social health. Methods Persons with symptomatic knee OA (n = 1,127) who participated in the Osteoarthritis Initiative completed the required measures at baseline, 1-, 2-, and 3-year intervals. The key variable of interest was a single-item self-rated health measure. In addition, measures of physical, mental and social health and a set of covariate measures over the 3-year period were analyzed. Structural equation modeling was used to test interrelationships among variables as well as predictive and mediational relationships among self-rated health and mental, physical and social health after adjusting for baseline covariates. Results The full model demonstrated good statistical fit. Prior self-rated health consistently predicted current mental health and social health. Prior social health predicted current self-rated health. Self-rated health also mediated changes in mental health and social health. Only social health changes were mediated by self-rated health over all time periods. Conclusion Self-rated health predicts a variety of outcomes of symptomatic knee OA. In addition, self-rated health mediates changes in social health and mental health. The use of self-rated health as a simple and efficient clinical assessment has potential for clinical utility because of its predictive capability and association with multiple health domains. PMID:22392799

Riddle, Daniel L.; Dumenci, Levent

2012-01-01

307

Population-Based Age Group Specific Annual Incidence Rates of Symptomatic Age-Related Macular Degeneration  

PubMed Central

Purpose To study the population-based annual incidence rates of exudative, dry and all cases of symptomatic age-related macular degeneration (AMD) in different age and sex groups. Methods. This is a one year, prospective, population-based study on all consecutive new patients with AMD in the hospital district of Central Finland. The diagnosis was confirmed in all patients with slit lamp biomicroscopy, optical coherence tomography (OCT) using a Spectralis HRA + OCT device, and the Heidelberg Eye Explorer 1.6.2.0 program. Fluorescein angiograms were taken when needed. Results. The population-based annual incidence rates of all cases of symptomatic AMD increased from 0.03% (95% CI, 0.01-0.05%) in the age group 50-59 years to 0.82% (95% CI, 0.55-1.09%) in the age group 85-89 years and were 0.2% (95% CI, 0.17-0.24%) in exudative, 0.11% (95% CI, 0.09-0.14%) in dry, and 0.32% (95% CI, 0.28-0.36%) in all cases of AMD in the age group 60 years and older. During the next 20 years in Central Finland the population-based annual incidence rates can be estimated to increase to 0.27% (95% CI, 0.24-0.30%) in exudative, to 0.13% (95% CI, 0.11-0.15%) in dry, and to 0.41% (95% CI, 0.37-0.45%) in all cases of AMD in the age group 60 years and older. The population-based annual incidence of AMD did not show statistically significant differences between males and females (p>0.1). Conclusion: The population-based age-group specific annual incidence rates of symptomatic AMD of this study may help to plan health care provision for patients of AMD. PMID:25674187

Saari, Jukka M

2014-01-01

308

Symptomatic cavernous malformations of the brainstem: functional outcome after microsurgical resection.  

PubMed

Brainstem cavernous malformations are associated with a considerable risk of hemorrhage and subsequent morbidity. This study provides a detailed work-up of clinical and radiological outcome as well as identification of prognostic factors in patients who had suffered from symptomatic hemorrhages. Patients who had undergone surgery of symptomatic BSCMs were evaluated pre- and postoperatively both neurologically and neuroradiologically supplemented by telephone interviews. Additionally, patients were scored according to the Scandinavian Stroke Scale. Multiple uni- and multivariate analyses of possible clinical and radiological prognostic factors were conducted. The study population comprised 35 patients. Mean age at operation was 39.3 ± 13.0 years with microsurgical resection of a total of 37 different BSCMs between 2002 and 2011. Median clinical follow-up was 44.0 months (range 8-116 months). Postoperative MRI showed eventually complete resection of all BSCMs. Postoperative overall outcome revealed complete resolution of neurological symptoms for 5/35 patients, 14/35 improved and 9/35 remained unchanged. 7/35 suffered from a postoperative new and permanent neurological deficit, mostly affecting the facial nerve or hemipareses with mild impairment. Pre- and postoperative Scandinavian Stroke Scale scores were 11.0 ± 2.4 and 11.4 ± 2.2 (p = 0.55). None of the analyzed factors were found to significantly correlate with patients' clinical outcome. Complete resection of brainstem cavernous malformations can be achieved with an acceptable risk for long-term morbidity and surgery-related new deficits (~20 %). Neurological outcome is mainly determined within the first 6 months after surgery. Surgical treatment of brainstem cavernous malformations is recommended in symptomatic patients, in whom the lesion is accessible for surgery. PMID:23974645

Schwartz, Christoph; Grillhösl, Andreas; Schichor, Christian; Suchorska, Bogdana; Romagna, Alexander; Tonn, Jörg-Christian; Zausinger, Stefan

2013-11-01

309

Rotavirus Shedding in Symptomatic and Asymptomatic Children using Reverse Transcription-Quantitative PCR  

PubMed Central

Reverse transcription-real time polymerase chain reaction (RT-qPCR) for the VP6 gene was used to study group A rotavirus shedding in children with symptomatic and asymptomatic rotavirus infection. Sequential stool samples (n=345) from ten children with rotavirus associated diarrhea and from five children (n=161) with asymptomatic rotavirus infection were collected over a period of two months. A RT-qPCR assay on the samples using a rotavirus VP6 plasmid standard demonstrated high reproducibility, with an inter-assay coefficient of variation (CV) of 1.40–2.97% and an intra-assay CV of 0.03–3.03%. The median duration of shedding was longer in children with diarrhea compared to asymptomatic children (24 days vs. 18 days) (p=0.066). The median quantitation cycle (Cq) at presentation in symptomatic children was 17.21 compared to 30.98 in asymptomatic children (p=0.086). The temporal pattern in symptomatic children consisted of a high initial viral shedding coinciding with the duration of diarrhea, followed by a rapid fall, and then a small increase in secondary shedding 21 days later. Compared to children with rotavirus diarrhea, those with asymptomatic infection shed lower quantities of virus throughout the observation period. No difference was noted between the G and P genotypes of samples collected at onset of infection and during the shedding period. Shedding was intermittent in a subset of children in both groups. RT-qPCR is a useful method to characterize shedding patterns. PMID:23775335

Mukhopadhya, Indrani; Sarkar, Rajiv; Menon, Vipin Kumar; Babji, Sudhir; Paul, Anu; Rajendran, Priya; Sowmyanarayanan, Thuppal V.; Moses, Prabhakar D.; Iturriza-Gomara, Miren; Gray, James J.; Kang, Gagandeep

2013-01-01

310

Deuk Laser Disc Repair® is a safe and effective treatment for symptomatic cervical disc disease  

PubMed Central

Background: Deuk Laser Disc Repair® is a new full-endoscopic surgical procedure to repair symptomatic cervical disc disease. Methods: A prospective cohort of 66 consecutive patients underwent cervical Deuk Laser Disc Repair® for one (n = 21) or two adjacent (n = 45) symptomatic levels of cervical disc disease and were evaluated postoperatively for resolution of headache, neck pain, arm pain, and radicular symptoms. All patients were candidates for anterior cervical discectomy and fusion (ACDF) or arthroplasty. The Mann–Whitney Wilcoxon test was used to calculate P values. Results: All patients (n = 66) had significant improvement in preoperative symptoms with an average symptom resolution of 94.6%. Fifty percent (n = 33) had 100% resolution of all preoperative cervicogenic symptoms. Only 4.5% (n = 3) had less than 80% resolution of preoperative symptoms. Visual analog scale (VAS) significantly improved from 8.7 preoperatively to 0.5 postoperatively (P < 0.001) for the cohort. Average operative and recovery times were 57 and 52 minutes, respectively. There were no perioperative complications. Recurrent disc herniation occurred in one patient (1.5%). Average postoperative follow-up was 94 days and no significant intergroup difference in outcomes was observed (P = 0.111) in patients with <90 days (n = 52) or >90 days (n = 14, mean 319 days) follow-up. No significant difference in outcomes was observed (P = 0.774) for patients undergoing one or two level Deuk Laser Disc Repair®. Patients diagnosed with postoperative cervical facet syndrome did significantly worse (P < 0.001). Conclusion: Deuk Laser Disc Repair® is a safe and effective alternative to ACDF or arthroplasty for the treatment of one or two adjacent symptomatic cervical disc herniations with an overall success rate of 94.6%. PMID:23776754

Deukmedjian, Ara J.; Jason Cutright, S. T.; Augusto Cianciabella, PA-C; Deukmedjian, Arias

2013-01-01

311

Effect of gender, biochemical parameters & parathyroid surgery on gastrointestinal manifestations of symptomatic primary hyperparathyroidism  

PubMed Central

Background & objectives: Information on gastrointestinal manifestations and then response after curative parathyroid surgery is scarce in symptomatic primary hyperparathyroidism (PHPT). This study was carried out to analyse gastrointestinal manifestations in patients with PHPT and their associations with biochemical parameters. Methods: This retrospective study included 153 patients with symptomatic primary hyperparathyroidism (PHPT). The signs and symptoms pertaining to gastrointestinal system were analyzed. The difference of symptoms between men and women and difference in biochemical parameters in presence of different symptoms were evaluated. The relationship between serum calcium, phosphate and parathyroid hormone (PTH) levels with presence of gallstone and pancreatitis was also studied. Result: Of the 153 patients, 46 (30%) were men. The mean age was 39.2 ± 13.9 yr. Nearly 80 per cent of PHPT patients had at least one symptom/ sign related to gastrointestinal system. The most common gastrointestinal manifestations were abdominal pain 66 (43%), constipation 55 (36%), and nausea/or vomiting 46 (30%). Nearly one-fourth 34 (22%) of patients had a history of either gallstone disease or cholecystectomy or both. The prevalence of gallstone disease was higher in women (P<0.05). Imaging and biochemical evidence of pancreatitis was found in 27 (18%) patients. Pancreatitis was more common in men compared to women (P<0.05) despite the higher prevalence of gallstones in women. Serum calcium, phosphate or PTH levels were not associated with high risk for gallstone disease, however, serum calcium (P<0.05) was associated with 1.3 times higher risk of developing pancreatitis. In majority of patients, gastrointestinal manifestations resolved within three months of curative parathyroidectomy. Except two patients, none had recurrence of pancreatitis. Interpretation & conclusions: The study revealed that the gastrointestinal symptoms were common in patients with symptomatic PHPT. There was not much gender difference in gastrointestinal symptoms except higher occurrence of gallstones in women and pancreatitis in men. There was no difference in biochemical profile between those who had and did not have gastrointestinal symptoms. PMID:24718404

Shah, Viral N.; Bhadada, Sanjay Kumar; Bhansali, Anil; Behera, A.; Bhattacharya, Anish; Nahar, Uma; Bhasin, Deepak; Vadera, Bhavin

2014-01-01

312

Risk factors and outcome of patients with symptomatic intracranial stenosis presenting with lacunar stroke  

PubMed Central

Background and Purpose We hypothesized that patients with intracranial stenosis with lacunar stroke presentations would face lower risks of recurrent stroke than those with index non-lacunar strokes, and that their recurrent strokes would predominantly be lacunar. Methods We analyzed subjects enrolled with an index stroke into the Warfarin Aspirin Symptomatic Intracranial Disease (WASID) trial. The index stroke was classified as lacunar or non-lacunar. The primary endpoint was recurrent ischemic stroke. Cox proportional hazard models were generated with stratification for severity of stenosis. Results 347 subjects were enrolled after an index stroke, 38 were lacunar and 309 were non-lacunar. Over a mean follow-up of 1.8 years there was no significant difference in stroke recurrence between patients whose index stroke was lacunar (7/38; 18%) vs. non-lacunar (69/309; 22%) (HR 0.79, 95%CI:0.36–1.71). Further, no significant differences were found when groups were stratified by 50–69% stenosis (HR 0.50, 95%CI:0.12–2.1) and ?70% stenosis (HR 0.87, 95%CI:0.34–2.2). Of the 7 recurrent strokes in patients whose index stroke was lacunar, all 7 were non-lacunar and 3 were in the territory of the stenotic artery. Conclusions In patients with symptomatic intracranial stenosis, the risk of recurrent stroke was similar in patients who presented with lacunar and non-lacunar strokes, and recurrent strokes in patients presenting with lacunar stroke were typically non-lacunar. These findings suggest that the pathophysiology of these strokes is related to the stenosis rather than small vessel disease. Patients presenting with lacunar strokes should be included in trials investigating secondary prevention for symptomatic intracranial stenosis. PMID:22363054

Khan, Amir; Kasner, Scott E.; Lynn, Michael J.; Chimowitz, Marc I.

2012-01-01

313

Protocol for a prospective, multicentre registry study of stenting for symptomatic intracranial artery stenosis in China  

PubMed Central

Introduction The SAMMPRIS trial suggested that aggressive treatment was superior to endovascular stenting in patients with severe symptomatic intracranial atherosclerotic stenosis (ICAS) due to high complication rates in patients in the stenting group. Given that 12.2% patients failed aggressive medical therapy in the SAMMPRIS study, it is imperative to perform a multicentre prospective registry study of stenting for patients with ICAS in China. This study aims to evaluate the safety and efficacy of endovascular stenting for patients with symptomatic intracranial artery stenosis and poor collaterals in China and to identify the characteristics of the population that would benefit the most from endovascular stenting in Chinese patients. Methods and analysis This multicentre prospective registry study will involve 20 stroke centres in China, and plans to recruit 300 patients into the registry. Patients with ?70% stenosis and symptomatic intracranial atherosclerotic disease caused by hypoperfusion combined with poor collaterals who met the inclusion criteria and exclusion criteria would be enrolled for this study. The primary outcome is the target vessel stroke event (including haemorrhagic or ischaemic stroke) or death within 30?days after stenting. The secondary outcomes include the successful recanalisation rate, the incidence of recurrent ischaemic stroke in the territory of the stented artery between 30?days and 1?year postoperatively, the restenosis rate and health-related quality of life. Ethics and dissemination The protocol is approved by the ethics committee at the coordinating centre and by the local institutional review board at each participating centre. Findings will be shared with participating hospitals, policymakers and the academic community to promote quality monitoring, quality improvement and the efficient allocation and use of cerebral catheterisation and intracranial artery stenting in China. Trial registration number http://www.clinicaltrials.gov (NCT01968122). PMID:25107437

Wang, Yilong; Miao, Zhongrong; Wang, Yongjun; Zhao, Xingquan; Gao, Peiyi; Liu, Liping; Wang, Feng; Liu, Yajie; Ma, Ning; Xu, Ziqi; Mo,, Dapeng; Gao, Feng

2014-01-01

314

Outcomes Research Branch | Collecting Patient Reports of Symptoms and Symptomatic Adverse Events During Cancer Treatment  

Cancer.gov

There is growing awareness that collecting symptom data directly from patients using patient-reported outcome (PRO) tools can improve the precision and efficiency of symptomatic adverse event (AE) data collection. The Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) is a system that provides a library of validated questions and a web-based platform for collecting patient reports of the symptoms they are experiencing while undergoing treatment, for the purpose of enhancing AE reporting.

315

Wingspan Stent for High-Grade Symptomatic Vertebrobasilar Artery Atherosclerotic Stenosis  

Microsoft Academic Search

Purpose  This study was designed to present the treatment outcomes with Wingspan stent angioplasty of high-grade intracranial vertebrobasilar\\u000a artery (VBA) stenosis in symptomatic patients.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Between 2007 and 2010, the records of 30 patients with 31 intracranial high-grade VBA stenoses (all?70%) who underwent elective\\u000a stenting due to the failure of medical therapy were retrospectively reviewed. Clinical evaluation was performed based on the

Jian Li; Zhen-Wei Zhao; Guo-Dong Gao; Jian-Ping Deng; Jia Yu; Li Gao; Yang Yuan; You-Zhi Qv

316

[Some practical questions on chronic stipsis treatment with prucalopride].  

PubMed

Chronic constipation is a frequent pathological condition bearing relevant socioeconomic burdens, mainly due to uncertain management and unsatisfactory response to traditional laxatives. Prucalopride is a novel enterokinetic drug, that has been demonstrated to improve bowel functions and relieve a broad spectrum of digestive symptoms in patients with severe chronic constipation who had failed to respond to various traditional laxatives. In this paper we discussed the practical aspects of chronic constipation treatment, in particular focusing on some questions about the practical use of prucalopride. Prucalopride is a potent, selective, high-affinity agonist of the 5-HT4 receptors widely expressed in the gastrointestinal tract. Unlike other 5-HT4 agonists, such as cisapride and tegaserod, it is devoid of adverse cardiovascular effects. Furthermore, it is characterized by a low potential for interactions with other drugs, due to its pharmacokinetic characteristics. Prucalopride was approved, in 2009, by the European Medicines Agency for the symptomatic treatment of chronic constipation in women in whom laxatives fail to provide adequate relief, however, there are ongoing studies to extend the use of the drug even to males. PMID:24632771

Bellacosa, L; Cogliandro, R; Cremon, C; De Giorgio, R; Barbara, G; Stanghellini, V

2014-03-01

317

Contact laser prostatectomy in a patient on chronic anticoagulation  

NASA Astrophysics Data System (ADS)

The `gold standard' therapy for patients with symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia has always been electrocautery TURP. However, in patients with medical problems requiring chronic anticoagulation, this procedure is contraindicated due to the extreme risk of hemorrhage, both during the procedure and the immediate post operative period. With the recent development of contact laser prostatectomy the patient on chronic anticoagulation can safely undergo the procedure. Herein, I present a case of a 60 year old with significant bladder outlet obstruction yielding an AUA symptom score of 18. The patient had a history of multiple episodes of deep venous thrombosis of the left leg with three prior pulmonary emboli. He was maintained on chronic anticoagulation with alternating days of 3.5 mg. and 5.0 mg. of warfarin sodium (coumadin). Preoperative cystoscopy showed a 4 cm prostatic fossa obstructed by tri-lobar hypertrophy, with large kissing lateral lobes and visual obstruction from the verumontanum. The patient underwent a contact laser prostatectomy with the SLT Nd:YAG laser at 50 watts. There was minimal bleeding both during the procedure and in the immediate postoperative period. At three months post-op the AUA symptom score had decreased to 2. This case demonstrated that contact laser prostatectomy can be safely and effectively performed in patients on chronic anticoagulation.

Mueller, Edward J.

1995-05-01

318

Improvement of Vergence Movements by Vision Therapy Decreases K-ARS Scores of Symptomatic ADHD Children  

PubMed Central

[Purpose] To determine whether the improvement of vergence movements by vision therapy can decrease the K-ARS scores of symptomatic ADHD children. [Methods] Eighty-one out of 1,123 children surveyed using the K-ARS, a parents’-reported questionnaire, led to 16 of these 81 children being showed scores of ?19, and measurement of binocular function diagnosed as having convergence insufficiency. The 16 children were divided equally into a control group and a vision therapy group. [Results] After vision therapy for 12 weeks, near point convergence (4.38±0.69?cm) significantly neared compared to the near point convergence before vision therapy (11.50±2.28?cm), and both the break point (32.38±2.53 ?) and recovery point (19.75±2.11 ?) of near positive fusional vergence significantly improved compared to their values before vision therapy (15.88±2.64 ?, 6.38±6.70 ?, respectively). Near exophoria after vision therapy (7.81±2.00 ? BI) significantly decreased compared to its value before vision therapy (12.00±1.16 ? BI). The K-ARS scores referring to symptomatic ADHD significantly decreased after vision therapy (17.13±2.84) compared to before vision therapy (23.25±1.49). [Conclusions] Convergence insufficiency symptoms are closely related to symptoms screened for ADHD, and vision therapy to improve vergence movements is an effective method of decreasing the K-ARS scores. PMID:24648636

Lee, Sun Haeng; Moon, Byeong-Yeon; Cho, Hyun Gug

2014-01-01

319

Arthroscopic rotator interval closure by purse string suture for symptomatic inferior shoulder instability.  

PubMed

Multidirectional instability of the shoulder is a complex condition that can be difficult to diagnose and treat. Clinically, it is characterized by symptomatic global laxity of the glenohumeral joint and may present either traumatically or atraumatically, unilaterally or bilaterally, and with or without generalized joint laxity. Capsular plication is a primary treatment option in these patients and is used to tension the redundant or lax capsule. We evaluated the role of rotator interval closure in restoring stability as a primary procedure in patients with multidirectional instability and a positive and painful sulcus sign.Twenty adult patients (16 men and 4 women) presenting with multidirectional instability were evaluated clinically and radiologically to assess the degree and direction of instability, were treated by arthroscopic rotator interval closure and inferior capsular plication, and were followed up for a minimum of 2 years. Clinical and functional results were excellent at 2-year follow-up. The results of the study indicate that the closure of the rotator interval in patients with symptomatic inferior instability will have a long-lasting effect on the stability and function of the shoulder, as the closure improves not only the static restraints but also the dynamic restraints of the shoulder through the improved proprioception secondary to restoration of the rotator interval structures. PMID:21469638

Moon, Young Lae; Singh, Harpreet; Yang, Hun; Chul, Lee Kwang

2011-04-01

320

Level and Determinants of Knowledge of Symptomatic Knee Osteoarthritis among Railway Workers in Malaysia  

PubMed Central

Background. Symptomatic knee osteoarthritis, an ancient malady greatly impairing modern population quality of life, has stimulated global attention to find effective modes of prevention and intervention. Purpose. This study aimed to assess factors affecting knowledge of symptomatic knee osteoarthritis (knee OA) among Malaysian railway workers. Methods. A cross-sectional study was conducted among 513 railway workers involving eight major states within Peninsular Malaysia using population-based sampling. The assessment instrument was a face-validated, prepiloted, self-administered instrument with sociodemographics and knowledge items on knee OA. Results. Mean (±SD) age of the respondents was 41.4 (±10.7), with the majority aged 50 years or older (34.9%). Of the total respondents, 53.6% had low levels of knowledge of knee OA disease. Multivariate analysis found that four demographic predictors, age ?50 years, family history of knee OA, self-awareness, and clinical diagnosis of the disease entity, were significantly associated with knowledge scores. Conclusion. The finding of a low level knee OA knowledge among Malaysian railway workers points to an urgent need for massive information to be disseminated among the workers at risk to foster primary prevention and self-care. PMID:24701573

Menke, J. Michael; Challakere Ramaswamy, Vasudeva Murthy; Abdul Manaf, Rizal; Alabsi, Aied M.; Al-Dubai, Sami Abdo Radman

2014-01-01

321

Effect of statin use on outcome of symptomatic cholelithiasis: a case-control study  

PubMed Central

Background Statins can modify bile cholesterol and, thus, the formation of gallstones. We examined whether statin use also modifies the severity of symptomatic gallstone disease and its treatment. Methods A total of 1,140 consecutive patients with symptomatic gallstone disease were recruited during 2008-2010 at Kuopio university hospital, Finland. Case-control analysis matched the patients using (n?=?272) or not using (n?=?272) statins by age and sex. The baseline characteristics of the patients, need and type of surgical treatment, duration of operation, perioperative bleeding, postoperative complications and overall mortality rate were compared statistically between the study groups. Results Morbidity and subsequent polypharmacy occurred more frequently among the patients with statins compared to the patients without statins. There were no significant differences between the statin users and non-users regarding surgical treatment (open vs. laparoscopic cholecystectomy). The mean operation time for laparoscopic cholecystectomy was 10% shorter for the patients with statin use than for the patients without. In addition, there was a non-significant tendency for statin users to bleed less during laparoscopic operations than the non-users. There were no differences in other procedure-related parameters (e.g., operation urgency, conversions, choledochotomies, complications and mortality) in patients with or without statins. Conclusions Compared to no treatment, statin treatment was associated with a shorter operation time for laparoscopy cholecystectomy. Other surgical outcome parameters were similar in patients with or without statins, although statin users had more polypharmacy and circulatory illnesses than non-users. PMID:24993977

2014-01-01

322

Hysteroscopic treatment of symptomatic caesarean-induced isthmocele: a prospective study.  

PubMed

Isthmocele, also known as caesarean scar defect (CSD), is an emerging condition that typically affects women with a history of previous caesarean section, and its presence is a novel under recognized cause of postmenstrual abnormal uterine bleeding and/or pelvic pain. The incidence of symptoms and their resolution following hysteroscopic surgery were evaluated prospectively in 120 consecutive isthmocele patients. Patients included only symptomatic premenopausal women. Transvaginal ultrasound and office hysteroscopy were used to diagnose isthmocele. Operative hysteroscopy was performed to correct the CSD, and histologic findings were evaluated. Correction of isthmocele via operative hysteroscopy was successful in all cases evaluated. Isthmoplasty resulted in resolution of postmenstrual abnormal uterine bleeding and suprapubic pelvic pain in 80% of patients. In the remaining cases, 7% of patients had an improvement of symptoms whereas 13% did not obtain any relief. Considering the recent diagnostic recognition of isthmocele, we conclude that surgical treatment of this pathology by operative hysteroscopy may represent the best choice in symptomatic women because of its minimal invasiveness and beneficial therapeutic results. PMID:25285773

Raimondo, G; Grifone, G; Raimondo, D; Seracchioli, R; Scambia, G; Masciullo, V

2014-10-01

323

A Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children  

PubMed Central

Objective To compare home-based pencil push-ups (HBPP), home-based computer vergence/accommodative therapy and pencil push-ups (HBCVAT+), office-based vergence/accommodative therapy with home reinforcement (OBVAT), and office-based placebo therapy with home reinforcement (OBPT) as treatments for symptomatic convergence insufficiency (CI). Methods In a randomized clinical trial, 221 children 9 to 17 years with symptomatic CI were assigned to one of four treatments. Main Outcome Measures Convergence Insufficiency Symptom Survey (CISS) score after 12 weeks of treatment. Secondary outcomes were near point of convergence (NPC) and positive fusional vergence at near (PFV). Results After 12 weeks of treatment the OBVAT group’s CISS score (15.1) was statistically significantly lower than the HBCVAT+, HBPP, and OBPT groups’ scores of 21.3, 24.7, and 21.9, respectively (P < 0.001). The OBVAT group also demonstrated a significantly improved NPC and PFV compared with the other groups (P <= 0.005). A successful or improved outcome for the OBVAT, HBPP, HBCVAT+, and OBPT groups was found in 73%, 43%, 33%, and 35%, respectively. Conclusion Twelve weeks of OBVAT results in a significantly greater improvement in symptoms and clinical measures of NPC and PFV and a greater percentage of patients reaching pre-determined criteria of success when compared with HBPP, HBCVAT+, or OBPT. PMID:18852411

2009-01-01

324

Symptomatic schwannoma of the abdominal wall: A case report and review of the literature  

PubMed Central

Schwannoma is a rare, benign tumor that arises from the nerve sheath. This tumor usually involves the extremities, but can also be found in the head and neck, trunk, pelvis, retroperitoneum, mediastinum and gastrointestinal tract. In numerous cases, the tumors are asymptomatic and are identified incidentally on physical examination or imaging. Occasionally, schwannoma is symptomatic due to compression of surrounding large nerves. In the present study, a 57-year-old female presented to the surgical outpatient’s department due to a well-localized parietal pain in the left lower quadrant. The onset of the pain occurred three years prior to presentation, without apparent cause and in the absence of other symptoms. Ultrasound and a computed tomography scan revealed a small solid tumor in the anterior abdominal wall, which was dimensionally stable over time, but was not noted in a preliminary analysis by a radiologist. The lesion was surgically removed using an anterior surgical approach. Histopathology revealed the tumor to be benign schwannoma. The painful symptoms completely disappeared. To the best of our knowledge, this is the third case of an abdominal wall benign schwannoma in the medical literature, and the first symptomatic case.

BALZAROTTI, RUBEN; RONDELLI, FABIO; BARIZZI, JESSICA; CARTOLARI, ROBERTO

2015-01-01

325

Current status of the prospective, randomized trials of symptomatic carotid bifurcation disease.  

PubMed

Three contemporary trials that are studying patients who have symptomatic carotid disease have proven beyond doubt that CE is extremely beneficial in reducing the risk of future stroke in patients with high-grade stenosis (greater than 70%). The relative risk of major stroke is reduced by at least 80% at 2 years of follow-up. That such a remarkably positive result for surgery was not predicted is a consequence of the unanticipated malignant natural history of TIAs and minor stroke in severe carotid disease. Previous epidemiological studies had underestimated the risk of future stroke by almost threefold. The current studies also highlight the remarkable power of prospective clinical trials to evaluate the effectiveness of a surgical procedure. In the case of NASCET, only 659 patients were required to prove the benefit of CE, whereas, innumerable previous anecdotal cases had failed to provide a convincing answer. However it must be remembered that the benefit from CE is dependent on a low rate of perioperative morbidity and mortality, a strict measure of the degree of stenosis on angiography, recency of ischemic events, and unequivocal carotid symptoms. The ongoing study of patients with moderate degrees of carotid stenosis holds the promise that in the very near future precise guidelines, which have been properly evaluated by careful scientific scrutiny,, will be available to guide surgeons in the proper management of all patients who present with symptomatic carotid disease. PMID:7757274

Ferguson, G G

1995-03-01

326

T-cell activation discriminates subclasses of symptomatic primary humoral immunodeficiency diseases in adults  

PubMed Central

Background Symptomatic Primary Humoral Immunodeficiency Diseases (PHID) constitute a highly heterogeneous group of diseases characterized by a shared hypogammaglobulinemia, resulting in increased risk of recurrent or severe infections. Associations have been described with a variety of immunological abnormalities involving B and T-cell differentiation, T-cell activation and innate immunity. However, PHID discrimination remains based on B-lymphocyte abnormalities and other components of the immune system have not been sufficiently taken into account. We carried out unsupervised and supervised methods for classification in a cohort of 81 symptomatic PHID patients to evaluate the relative importance of 23 immunological parameters and to select relevant markers that may be useful for diagnosis and prognosis. Results We identified five groups of patients, among which the percentage of PHID complications varied substantially. Combining the set of markers involved in PHID supported the existence of two distinct mechanisms associated with complications. Switched memory B-cell attrition and CD8+ HLA-DR?+?activated T-cell increase were the prominent abnormalities observed in PHID complications. Furthermore, in a subgroup of 57 patients with common variable immunodeficiency, the classification that added CD8+ HLA-DR?+?to the consensual EUROclass classification was better than the EUROclass model in predicting complications. Conclusion These results highlight the importance of T-cell activation that may improve discrimination of PHID patients in specific subgroups and help to identify patients with different clinical outcomes. PMID:24621280

2014-01-01

327

A novel technique of arthroscopic excision of a symptomatic os trigonum.  

PubMed

We describe a new arthroscopic excision technique for a symptomatic os trigonum. With the patient lying in a prone position, a posterolateral portal just lateral to the Achilles tendon, at the 5-mm level proximal to the tip of the fibula, is used for the arthroscope and an accessory posterolateral portal just posterior to the peroneal tendon at the same level is used for instruments. The synovial tissues are then debrided with a power shaver through the accessory posterolateral portal for better visualization. An elevator is used to release the fibrous tissue between the os trigonum and the talus. The os trigonum is completely excised with a grasper to visualize the flexor hallucis longus tendon. Radiographic control is helpful to check the position of the arthroscope if it happens to be inserted into the ankle joint as a result of the reduced subtalar joint space. Postoperatively, no immobilization is necessary, and full weight-bearing is allowed as tolerated. Three of us have performed 11 procedures with excellent results and no cases of complications. This arthroscopic excision technique for the symptomatic os trigonum is a safe and effective procedure. PMID:18182212

Horibe, Shuji; Kita, Keisuke; Natsu-ume, Takashi; Hamada, Masayuki; Mae, Tatsuo; Shino, Konsei

2008-01-01

328

Hybrid pharmacological and ablative therapy for the management of symptomatic atrial fibrillation  

PubMed Central

Background Hybrid therapy for atrial fibrillation class 1C and class III antiarrhythmic drugs (AAD) can convert atrial fibrillation (AF) into an isthmus-dependent atrial flutter (AFL) in more than 10% of patients. Hybrid pharmacological and ablative therapy offers a safe and effective approach to achieving and maintaining sinus rhythm. We evaluated the efficacy of this hybrid approach in the management of paroxysmal or persistent AF. Methods Eighteen patients with symptomatic AF treated with AAD and typical anticlockwise/clockwise AFL underwent radiofrequency (RF) ablation of AFL with an anatomical approach. Results RF ablation was successful in all patients. All but one patient continued with AAD. Four patients (22%) had recurrences of AFL. Two of them also had a recurrence of AF. Another three patients had recurrences of AF only, and finally, one patient developed an atrial tachycardia more than one year after the procedure. In conclusion, 11 patients (61%) did not experience recurrences of AF/AFL after tricuspid valve annulus (TV)-inferior caval vein (IVC) isthmus ablation with continuing antiarrhythmic drugs. Conclusion Hybrid pharmacological and ablative therapy is a safe and effective treatment for the management of patients with symptomatic AF.

Kimman, G.P.; Szili-Torok, T.; Nieuwdorp, M.; Theuns, D.A.M.J.; Scholten, M.; Jordaens, L.

2002-01-01

329

Long-Term Durability of Percutaneous Transluminal Angioplasty in Patients with Symptomatic Middle Cerebral Artery Stenosis  

PubMed Central

Background and purpose Percutaneous transluminal angioplasty (PTA) is being increasingly used in the treatment of symptomatic middle cerebral artery (MCA) stenosis. We evaluated the long-term durability after PTA for symptomatic MCA stenosis. Methods We analyzed consecutive patients included in our stroke database who were treated with angioplasty alone. The subjects without major periprocedural complications were followed up for at least 42 months. Recurrent ischemic symptoms were defined as newly developed episodes of transient ischemic attack or ischemic stroke in the territory of the treated vessel. Stroke was defined as ischemic stroke in any vessel. Results PTA was technically successful in 37 of the 40 included patients. Thirty-two of the 37 patients were followed up at regular intervals of 1 to 6 months in the outpatient clinic of our institution for at least 42 months. Restenosis occurred in 3 of the 32 patients (9.4%) within 2 years of PTA, and no restenosis was identified thereafter. Two of the three patients with restenosis had asymptomatic complications such as dissection and vasospasm during the intervention. The ischemic area was in the treated vessel in 1 of the 32 patients and in other vessels in 3 of the 32 patients (9.4%). Conclusions Successful PTA can result in a low rate of recurrent ischemic symptoms, and restenosis during a long-term follow-up appears to be more frequent in the early period. PMID:19513330

Kim, Joon-Tae; Lee, Seung-Han; Choi, Seong-Min; Kim, Byeong-Chae; Yoon, Woong; Kim, Jae-Kyu; Kim, Myeong-Kyu; Cho, Ki-Hyun

2009-01-01

330

Evaluation of symptomatic slow-acting drugs in osteoarthritis using the GRADE system  

PubMed Central

Background Symptomatic slow-acting drugs (SYSADOA) have been largely studied over the last decade. The objective of this study is to prepare a document providing recommendations for the use of SYSADOA in osteoarthritis (OA). Methods The following interventions were taken into consideration: avocado/soybean unsaponifiables, chondroitin sulfate, diacereine, glucosamine sulfate, hyaluronic acid, oral calcitonin, risedronate, strontium ranelate. Recommendations were based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The GRADE system is based on a sequential assessment of the quality of evidence, followed by assessment of the balance between benefits versus downsides and subsequent judgment about the strength of recommendations. Results Chondroitin sulfate, diacereine, glucosamine sulfate, avocado/soybean unsaponifiables and hyaluronic acid have demonstrated pain reduction and physical function improvement with very low toxicity, with moderate to high quality evidence. Even if pre-clinical data and some preliminary in vivo studies have suggested that oral calcitonin and strontium ranelate could be of potential interest in OA, additional well-designed studies are needed. Conclusion In the benefit/risk ratio, the use of chondroitin sulfate, diacereine, glucosamine sulfate, avocado/soybean unsaponifiables and hyaluronic acid could be of potential interest for the symptomatic management of OA. PMID:19087296

Bruyère, Olivier; Burlet, Nansa; Delmas, Pierre D; Rizzoli, René; Cooper, Cyrus; Reginster, Jean-Yves

2008-01-01

331

Comparative study between immunohistochemical grading and giardia genotyping among symptomatic and asymptomatic humans.  

PubMed

In the last years, multiple studies indicated the potential effectiveness of the polymerase chain reaction (PCR) for detection of Giardia in pathological specimens. By using the difference at the triose phosphate isomerase (tpi) gene locus, we investigated the genotype groups of Giardia lamblia isolated directly from fecal specimens collected from humans living in Dakahlia Governorate, Egypt. Immunohistochemical staining for detection of Giardia local antigenic and cellular immune-determinants focusing on CD4 and CD8 T-lymphocytes was also applied. The sensitivity of the ABC (avidine-biotin-peroxidase complex) immunoperoxidase technique for detection of the antigen was 97.3% and the specificity was 100%. Our study clearly demonstrated a highly significant difference between patients and controls as regards the grade of CD4 and CD8 lymphocyte infiltration (p < 0.001 for each correlation) but no significant difference was found between Giardia symptomatic and asymptomatic patients. Using the PCR technique, 89.3% sensitivity, 100% specificity and diagnostic accuracy of 92% were reached. Nevertheless, there was statistically insignificant difference between symptomatic and asymptomatic groups regarding the prevalence of different Giardia genotypes and the prevalence of CD4 and CD8 lymphocyte infiltration grading in different Giardia genotypes. PMID:20306658

Handousa, Aya E; Azab, Manar S; El-Beshbishi, Samar N; El-Nahas, Hala A; Abd El-Hamid, Mahmoud A

2007-01-01

332

Levonorgestrel-releasing intrauterine system use in premenopausal women with symptomatic uterine leiomyoma: a systematic review.  

PubMed

A systematic review is done to determine the efficacy and safety of levonorgestrel-releasing intrauterine systems as a treatment using in premenopausal women with symptomatic uterine leiomyoma. We searched the Medline, Central and ICTRP databases for all articles published from inception through July 2013 that examined the following outcomes: uterine volume, uterine leiomyoma volume, endometrial thickness, then menstrual blood loss, blood haemoglobin, ferritin and hematocrit levels, treatment failure rate, device expulsion rate, hysterectomy rate and side effects. From 645 studies, a total of 11 studies met our inclusion criteria with sample sizes ranging from 10 to 104. Evidence suggested that levonorgestrel-releasing intrauterine systems could decrease uterine volume and endometrial thickness, significantly reduce menstrual blood loss, and increase blood haemoglobin, ferritin and hematocrit levels. There was no evidence for decreasing uterine leiomyoma volume. There were no adverse effects on the ovarian function except for ovarian cysts. Device expulsion rates were low, which associated with leiomyoma size (larger than 3cm) but not with leiomyoma location. Irregular bleeding/spotting was observed at the beginning of the follow-up period and then decreased progressively. Results of this systematic review indicate that levonorgestrel-releasing intrauterine systems may be effective and safe treatment for symptomatic uterine leiomyoma in premenopausal women. PMID:24832215

Jiang, Wenxiao; Shen, Qi; Chen, Miaomiao; Wang, Ying; Zhou, Qingfeng; Zhu, Xuejie; Zhu, Xueqiong

2014-08-01

333

Evaluation of Fixation Disparity Curve Parameters With the Modified Near Mallett Unit in Symptomatic and Asymptomatic University Students  

PubMed Central

Background Research suggests that fixation disparity data are extremely useful in the assessment of the binocular and accommodative systems. Objectives The purpose of this study was to evaluate fixation disparity curve (FDC) parameters with a modified near Mallett unit in symptomatic and asymptomatic students of Paramedical Sciences School of Mashhad University of Medical Sciences in 2007. Patients and Methods In this analytical-descriptive study, 100 students were selected randomly and divided into symptomatic and asymptomatic groups. Fixation disparity curve parameters were determined for each subject and compared in symptomatic and asymptomatic groups. Results There were more subjects with exo fixation disparity than eso fixation disparity in the study sample. The means for fixation disparity, fixation disparity curve x-intercept, and slope with the modified Mallett unit were each significantly different by Mann-Whitney U test in the symptomatic and asymptomatic groups. Also there was a significant difference in the distributions of fixation disparity curve types in the two symptom groups by Chi-square test. Conclusions The X-intercepts (point at which the FDC crosses the X-axis) were on average more in the base-in direction, Y-intercepts (point at which the FDC crosses the Y-axis) were shifted in the exo direction, and slopes were steeper in the symptomatic group. PMID:24719687

Momeni Moghadam, Hamed; A Goss, David; Yekta, Abbas A; Ehsani, Marzieh

2013-01-01

334

Ureteroscopy and holmium:YAG laser lithotripsy: an emerging definitive management strategy for symptomatic ureteral calculi in pregnancy  

NASA Astrophysics Data System (ADS)

Objectives: Symptomatic urolithiasis in pregnancy that does not respond to conservative measures has traditionally been managed with ureteral stent insertion or percutaneous nephrostomy (PCN). Holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy using state-of-the-art ureteroscopes represents an emerging strategy for definitive stone management in pregnancy. The purpose of this study was to review the results of holmium laser lithotripsy in a cohort of patients who presented with symptomatic urolithiasis in pregnancy. Methods: A retrospective analysis was conducted at 2 tertiary stone centers from January 1996 to August 2001 to identify pregnant patients who were treated with ureteroscopic holmium laser lithotripsy for symptomatic urolithiasis or encrusted stents. Eight patients with a total of 10 symptomatic ureteral calculi and 2 encrusted ureteral stents were treated. Mean gestational age at presentation was 22 weeks. Mean stone size was 8.1 mm. Stones were located in the proximal ureter/ureteropelvic junction (UPJ) (3), mid ureter (1), and distal ureter (6). Results: Complete stone fragmentation and/or removal of encrusted ureteral stents were achieved in all patients using the holmium:YAG laser. The overall procedural success rate was 91%. The overall stone-free rate was 89%. No obstetrical or urological complications were encountered. Conclusions: Ureteroscopy and holmium laser lithotripsy can be performed safely in all stages of pregnancy providing definitive management of symptomatic ureteral calculi. The procedure can be done with minimal or no fluoroscopy and avoids the undesirable features of stents or nephrostomy tubes.

Watterson, James D.; Girvan, Andrew R.; Beiko, Darren T.; Nott, Linda; Wollin, Timothy A.; Razvi, Hassan A.; Denstedt, John D.

2003-06-01

335

Bevacizumab treatment of symptomatic pseudoprogression after boron neutron capture therapy for recurrent malignant gliomas. Report of 2 cases  

PubMed Central

Background Bevacizumab, an anti–vascular endothelial growth factor antibody, has been used for the treatment of radiation necrosis. Thus far, however, there has been no definitive report on its use for the treatment of symptomatic pseudoprogression. Here we report 2 cases of successful treatment with bevacizumab for symptomatic pseudoprogression after boron neutron capture therapy (BNCT) was applied for recurrent malignant gliomas. Methods Two recurrent malignant gliomas received BNCT. Both cases were treated with intravenous administration of bevacizumab at the deterioration that seemed to be symptomatic pseudoprogression. Results The first case was recurrent glioblastoma multiforme and the second was recurrent anaplastic oligoastrocytoma. Both cases recurred after standard chemoradiotherapy and were referred to our institute for BNCT, which is tumor-selective particle radiation. Just prior to neutron irradiation, PET with an amino acid tracer was applied in each case to confirm tumor recurrence. Both cases showed deterioration in symptoms, as well as on MRI, at intervals of 4 months and 2 months, respectively, after BNCT. For the first case, a second PET was applied in order to confirm no increase in tracer uptake. We diagnosed both cases as symptomatic pseudoprogression and started the intravenous administration of 5 mg/kg bevacizumab biweekly with 6 cycles. Both cases responded well to this, showing rapid and dramatic improvement in neuroimaging and clinical symptoms. No tumor progression was observed 8 months after BNCT. Conclusions Bevacizumab showed marked effects on symptomatic pseudoprogression after BNCT. BNCT combined with bevacizumab may prolong the survival of patients with recurrent malignant gliomas. PMID:23460324

Miyatake, Shin-Ichi; Furuse, Motomasa; Kawabata, Shinji; Maruyama, Takashi; Kumabe, Toshihiro; Kuroiwa, Toshihiko; Ono, Koji

2013-01-01

336

Diminished Omega-3 Fatty Acids are Associated with Carotid Plaques from Neurologically Symptomatic Patients: Implications for Carotid Interventions  

PubMed Central

The omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are prevalent in fish oil and their cardioprotective effects are thought to be mediated by anti-inflammatory mechanisms. The aim of this study is to determine whether omega-3 fatty acids are associated with carotid plaques from neurologically symptomatic patients. Plaques were obtained from 41 patients (mean age 62 [44 – 84]; 24-asymptomatic, 17-symptomatic). Intra-plaque lipids were assessed with mass spectrometry. Compared to asymptomatic patients, significantly diminished omega-3 fatty acids DHA (545.8 ± 98 ng/g vs. 270.7 ± 19.6 ng/g, p=0.0096) and EPA (385.9 ± 68 ng/g vs. 216.4 ± 17.6 ng/g, p=0.0189) were found in carotid plaques from neurologically symptomatic patients. However, no differences were found in the levels of the omega-6 fatty acid arachidonic acid (p=0.2003). Immunohistochemistry and ELISA analysis (CD68+ cells, 0.461 ± 0.04 vs. 0.312 ± 0.03, p=0.003) demonstrated an increased inflammatory infiltrate in plaques from neurologically symptomatic, compared to asymptomatic, patients. Carotid plaques from neurologically symptomatic patients are inflammatory and have decreased intra-plaque levels of omega-3 fatty acids. Future trials will determine whether interventions that increase omega-3 fatty acid incorporation into carotid plaques prevent stroke and improve the safety of carotid interventions. PMID:19733689

Bazan, Hernan A.; Lu, Yan; Thoppil, Deepu; Fitzgerald, Tamara N.; Hong, Song; Dardik, Alan

2009-01-01

337

A study of haematological and bone marrow changes in symptomatic patients with human immune deficiency virus infection with special mention of functional iron deficiency, anaemia of critically ill and haemophagocytic lymphohistiocytosis  

PubMed Central

Background Haematological abnormalities are among the most common complications of HIV. These involve all lineages of blood cells. Bone marrow studies form integral part of complete workup of the HIV positive patients specially when they present as case of pyrexia of unknown origin (PUO), refractory anaemia and pancytopenia. Method 55 HIV infected symptomatic patient requiring bone marrow examination were included in the study. Relevant clinical history, baseline haematological investigations including full blood count, CD4 cell counts using flow cytometry were recorded. Results Median ANC values in males were found to be significantly lower than females (p = 0.046). CD4 cell count statistically significantly correlated with age, TLC, ANC & platelet count. Anaemia was present in 45 patients and out of which 66.66% patients had normocytic normochromic anaemia. Iron deficiency anaemia was present in (37.77%) patients and anaemia of chronic disease in (62.22%) patients. 2 patients had anaemia of the critically ill. Two patients had non-Hodgkin's lymphoma (NHL) and showed lymphoma deposit in the bone marrow. Gelatinous degeneration was seen in 3 patients. Ill formed epithelioid cell granulomas were seen in 7 cases, and 2 cases were positive for acid fast bacilli (AFB). Haemophagocytosis was seen in 8 cases; two cases later diagnosed as a case of infection induced HLH. Leishmania donovani (LD) bodies seen in 2 cases. Conclusions Bone marrow study is an important investigation in HIV infected symptomatic patients with peripheral haematological abnormalities. PMID:24600136

Kotwal, Jyoti; Singh, Vikram; Kotwal, Anupam; Dutta, Vibha; Nair, Velu

2013-01-01

338

Adenosine A2A Receptors Activation Facilitates Neuromuscular Transmission in the Pre-Symptomatic Phase of the SOD1(G93A) ALS Mice, but Not in the Symptomatic Phase  

PubMed Central

Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease leading to motor neuron dysfunction resulting in impairment of neuromuscular transmission. A2A adenosine receptors have already been considered as a potential therapeutical target for ALS but their neuromodulatory role at the neuromuscular junction in ALS remains to be clarified. In the present work, we evaluated the effects of A2A receptors on neuromuscular transmission of an animal model of ALS: SOD1(G93A) mice either in the pre-symptomatic (4–6 weeks old) or in the symptomatic (12–14 weeks old) stage. Electrophysiological experiments were performed obtaining intracellular recordings in Mg2+ paralyzed phrenic nerve-hemidiaphragm preparations. Endplate potentials (EPPs), quantal content (q. c.) of EPPs, miniature endplate potentials (MEPPs) and giant miniature endplate potential (GMEPPs) were recorded. In the pre-symptomatic phase of the disease (4–6 weeks old mice), the selective A2A receptor agonist, CGS 21680, significantly enhanced (p<0.05 Unpaired t-test) the mean amplitude and q.c. of EPPs, and the frequency of MEPPs and GMEPPs at SOD1(G93A) neuromuscular junctions, the effect being of higher magnitude (p<0.05, Unpaired t-test) than age-matched control littermates. On the contrary, in symptomatic mice (12–14 weeks old), CGS 21680 was devoid of effect on both the amplitude and q.c. of EPPs and the frequency of MEPPs and GMEPPs (p<0.05 Paired t-test). The results herein reported clearly document that at the neuromuscular junction of SOD1(G93A) mice there is an exacerbation of A2A receptor-mediated excitatory effects at the pre-symptomatic phase, whereas in the symptomatic phase A2A receptor activation is absent. The results thus suggest that A2A receptors function changes with ALS progression. PMID:25093813

Nascimento, Filipe; Pousinha, Paula A.; Correia, Alexandra M.; Gomes, Rui; Sebastião, Ana M.; Ribeiro, Joaquim A.

2014-01-01

339

[Bilateral corneal ulceration as a result of caloric-protein malnutrition and vitamin A deficit in a patient with chronic alcoholism, chronic pancreatitis and cholecystostomy].  

PubMed

Since the discovery of vitamins, there has been an increasing interest at relating vitamins with particular diseases. In particular, for vitamin A its singular importance has been determined in multiple vital functions, and its relationship with diseases, both in deficit and in excess, is nowadays completely demonstrated. In developed countries, vitamin deficiency-related diseases have been greatly reduced; however, in some patients with particular features they must be kept in mind. This is the case of a 45 year-old man, with a history of chronic alcoholism, non insulin-dependent diabetes meIlitus and cholecystectomy with a high biliary drainage secondary to emphysematous cholecystitis and perivesicular abscess. He complains of bilateral ocular pain, photophobia, and decreased visual acuity besides a history of pasty, sticky and foul-smelling feces. He is admitted in the Ophthalmology Department and bilateral corneal ulceration is diagnosed. A consultation to the Nutrition Department is made because of cachexia. Severe caloric and mil protein hyponutrition is observed with a BMI of 18.2 and a 23% weight loss for the last 6 months, fat-soluble vitamins (A, D and E) deficit, mild fat malabsorption, and macrocytic and hypochromic anemia. The patient's diet is supplemented with a special hyperproteinic and hypercaloric diet for diabetics, deficient vitamins and pancreatic enzymes to improve absorption are administered, and glycemia is controlled with insulin. Four months later, the patient is assessed and has a BMI of 20, anemia has resolved and from an ophthalmologic viewpoint the course is favorable, the ulcers improve and visual acuity is almost completely recovered. In chronic alcoholic patients with a low dietary intake and clinical complications with nutritional repercussions (pancreatitis that produces malabsorption or cholecystectomy with biliary percutaneous drainage) we should not forget that micronutrients deficits may explain the etiology of other associated diseases, in the present case corneal ulceration. PMID:16045134

Benítez Cruz, S; Gómez Candela, C; Ruiz Martín, M; Cos Blanco, A I

2005-01-01

340

Characteristics and risk factors for symptomatic Giardia lamblia infections in Germany  

PubMed Central

Background In developed countries, giardiasis is considered a travel related disease. However, routine surveillance data from Germany indicate that >50% of infections were acquired indigenously. We studied the epidemiological characteristics of symptomatic Giardia infections acquired in Germany and abroad, and verified the proportion of cases acquired in Germany in order to investigate risk factors for sporadic autochthonous Giardia infections. Methods We identified Giardia cases notified by 41 local health authorities between February 2007 and January 2008 and interviewed them on their clinical symptoms, underlying morbidities, travel abroad and potential risk factors for the disease. We conducted a case-control-study including laboratory-confirmed (microscopy or antigen-test) autochthonous Giardia cases with clinical manifestations (diarrhoea, cramps, bloating) and randomly selected controls from the local population registry matched by county of residence and age-group (0-5, 6-19, ?20 years). Secondary cases, controls with diarrhoea and persons who had travelled outside Germany in the three weeks prior to disease onset (exposure period) were excluded. We calculated adjusted odds ratios (aOR) with 95% confidence intervals (CI) using conditional logistic regression. Results Of 273 interviewed cases, 131 (48%) had not travelled abroad during the defined exposure period. Of these 131, 85 (65%) were male, 68 (54%) were living in communities with >100,000 inhabitants and 107 (83%) were aged 20 years or older. We included 120 cases and 240 controls in the case-control study. Cases were more likely to be male (aOR 2.5 CI 1.4-4.4), immunocompromised (aOR 15.3 CI 1.8-127) and daily consumers of green salad (aOR 2.9 CI 1.2-7.2). Contact with animals (pets/farm animals) and exposure to surface water (swimming/water sports) were not associated with symptomatic disease. Conclusions A substantial proportion of Giardia lamblia cases in Germany are indigenously acquired. Symptomatic cases are significantly more likely to be immunocompromised than control persons from the general population. Physicians should consider Giardia infections among patients with no recent history of travel abroad, particularly if they have immune deficiencies. Green salads may be an important vehicle of infection. Information campaigns highlighting this food-borne risk should emphasise the risk to persons with immune deficiencies. PMID:20105338

2010-01-01

341

Chronic Pain and Fatigue  

E-print Network

Chronic Pain and Fatigue Research Center Department of Anesthesiology 24 Frank Lloyd Wright Dr, information regarding this condition The UMHS Chronic Pain and Fatigue Research Center (CPFRC) offers of other pain syndromes such as irritable bowel, pelvic pain, and headaches. The FM Workshop is conducted

Shyy, Wei

342

Chronic pelvic pain.  

PubMed

Chronic pelvic pain is pain lasting longer than 6 months and is estimated to occur in 15% of women. Causes of pelvic pain include disorders of gynecologic, urologic, gastroenterologic, and musculoskeletal systems. The multidisciplinary nature of chronic pelvic pain may complicate diagnosis and treatment. Treatments vary by cause but may include medicinal, neuroablative, and surgical treatments. PMID:24280400

Stein, Sharon L

2013-12-01

343

Interventional treatment of a symptomatic neonatal hepatic cavernous hemangioma using the Amplatzer vascular plug.  

PubMed

Percutaneous intervention is one treatment option for symptomatic hepatic hemangioma in infants. We report the case of a newborn (birth weight 4060 g) with a large hepatic cavernous hemangioma, which presented early with high cardiac output failure due to arteriovenous shunting and signs of incipient Kasabach-Merritt syndrome. We performed a successful superselective transcatheter coil embolization of three feeding arteries on the seventh day of life. Because of remaining diffuse very small arteries causing a relevant residual shunt, additional occlusion of the three main draining veins was necessary with three Amplatzer vascular plugs. Cardiac failure resolved immediately. Without any additional therapy the large venous cavities disappeared within the following months. The tumor continues to regress in size 8 months after the intervention. PMID:17031730

Kretschmar, Oliver; Knirsch, Walter; Bernet, Vera

2008-01-01

344

High-fibre diet and Lactobacillus paracasei B21060 in symptomatic uncomplicated diverticular disease  

PubMed Central

AIM: To investigate in symptomatic uncomplicated diverticular disease the efficacy of symbiotics associated with a high-fibre diet on abdominal symptoms. METHODS: This study was a multicentre, 6-mo randomized, controlled, parallel-group intervention with a preceding 4-wk washout period. Consecutive outpatients with symptomatic uncomplicated diverticular disease, aged 40-80 years, evaluated in 4 Gastroenterology Units, were enrolled. Symptomatic uncomplicated diverticular disease patients were randomized to two treatment arms A or B. Treatment A (n = 24 patients) received 1 symbiotic sachet Flortec© (Lactobacillus paracasei B21060) once daily plus high-fibre diet for 6 mo. Treatment B (n = 21 patients) received high-fibre diet alone for 6 mo. The primary endpoint was regression of abdominal symptoms and change of symptom severity after 3 and 6 mo of treatment. RESULTS: In group A, the proportion of patients with abdominal pain < 24 h decreased from 100% at baseline to 35% and 25% after 3 and 6 mo, respectively (P < 0.001). In group B the proportion of patients with this symptom decreased from 90.5% at baseline to 61.9% and 38.1% after 3 and 6 mo, respectively (P = 0.001). Symptom improvement became statistically significant at 3 and 6 mo in group A and B, respectively. The proportion of patients with abdominal pain >24 h decreased from 60% to 20% then 5% after 3 and 6 mo, respectively in group A (P < 0.001) and from 33.3% to 9.5% at both 3 and 6 mo in group B (P = 0.03). In group A the proportion of patients with abdominal bloating significantly decreased from 95% to 60% after 3 mo, and remained stable (65%) at 6-mo follow-up (P = 0.005) while in group B, no significant changes in abdominal bloating was observed (P = 0.11). After 6 mo of treatment, the mean visual analogic scale (VAS) values of both short-lasting abdominal pain (VAS, mean ± SD, group A: 4.6 ± 2.1 vs 2.2 ± 0.8, P = 0.02; group B: 4.6 ± 2.9 vs 2.0 ± 1.9, P = 0.03) and abdominal bloating (VAS, mean ± SD, group A: 5.3 ± 2.2 vs 3.0 ± 1.7, P = 0.005; group B: 5.3 ± 3.2 vs 2.3 ± 1.9, P = 0.006) decreased in both groups, whilst the VAS values of prolonged abdominal pain decreased in the Flortec© group, but remained unchanged in the high-fibre diet group (VAS, mean ± SD, group A: 6.5 ± 1.5 vs 4.5 ± 2.1, P = 0.052; group B: 4.5 ± 3.8 vs 5.5 ± 3.5). CONCLUSION: A high-fibre diet is effective in relieving abdominal symptoms in symptomatic uncomplicated diverticular disease. This treatment may be implemented by combining the high-fibre diet with Flortec©. PMID:23139608

Lahner, Edith; Esposito, Gianluca; Zullo, Angelo; Hassan, Cesare; Cannaviello, Claudio; Paolo, Maria Carla Di; Pallotta, Lorella; Garbagna, Nicoletta; Grossi, Enzo; Annibale, Bruno

2012-01-01

345

Value of low-power lasers in the treatment of symptomatic spondilosis  

NASA Astrophysics Data System (ADS)

Low power laser (LPL) use in the treatment of arthrosic rheumatism is well known. From a total number of 280 patients with symptomatic spondylosis we finally selected 66, with changes of the EEG color mapping. These investigation was done before and after treatment in order to obtain an objective method to appreciate these results. The patients were splitted in laser group (36 patients treated with HeNe and IR diode LPL) and control group (30 patients treated with placebo laser). The results indicate a significant improvement of the symptoms at 77% of the patients from laser group as compared with 33% favorable results at the placebo laser. The EEG mapping improved at 58% patients from laser group as compared with 20% at the control group.

Antipa, Ciprian; Moldoveanu, Vladimir; Rusca, Nicolae; Bruckner, Ion I.; Vlaiculescu, Mihaela; Ionescu, Elena; Vasiliu, Virgil V.

1998-07-01

346

Differences in access to zidovudine (AZT) among symptomatic HIV-infected persons  

Microsoft Academic Search

Object:To evaluate socioeconomic factors that determine whether symptomatic HIV-infected persons are offered zidovudine (AZT).\\u000a \\u000a Design:Cross-sectional survey conducted as part of the Robert Wood Johnson Foundation’s AIDS Health Services Program.\\u000a \\u000a \\u000a \\u000a Setting:Public hospital clinics and community-based AIDS organizations in nine American cities.\\u000a \\u000a \\u000a \\u000a Patients:880 HIV-seropositive outpatients interviewed between October 1988 and May 1989.\\u000a \\u000a \\u000a \\u000a Main results:Males were more likely to have been offered AZT

Michael D. Stein; John Piette; Vincent Mor; Tom J. Wachtel; John Fleishman; Kenneth H. Mayer; Charles C. J. Carpenter

1991-01-01

347

Symptomatic Spinal Epidural Lipomatosis After a Single Local Epidural Steroid Injection  

SciTech Connect

Spinal epidural lipomatosis is a rare disorder that can manifest with progressive neurological deficits. It is characterized by abnormal accumulation of unencapsulated epidural fat commonly associated with the administration of exogenous steroids associated with a variety of systemic diseases, endocrinopathies, and Cushing syndrome (Fogel et al. Spine J 5:202-211, 2005). Occasionally, spinal epidural lipomatosis may occur in patients not exposed to steroids or in patients with endocrinopathies, primarily in obese individuals (Fogel et al. Spine J 5:202-211, 2005). However, spinal lumbar epidural lipomatosis resulting from local steroid injection has rarely been reported. We report the case of a 45-year-old diabetic man with claudication that was probably due to symptomatic lumbar spinal lipomatosis resulting from a single local epidural steroid injection.

Tok, Chung Hong, E-mail: rogertok@gmail.com; Kaur, Shaleen [University of Malaya, Department of Biomedical Imaging, Faculty of Medicine (Malaysia); Gangi, Afshin [University Hospital of Strasbourg, Department of Radiology B (France)

2011-02-15

348

Symptomatic spinal epidural lipomatosis after a single local epidural steroid injection.  

PubMed

Spinal epidural lipomatosis is a rare disorder that can manifest with progressive neurological deficits. It is characterized by abnormal accumulation of unencapsulated epidural fat commonly associated with the administration of exogenous steroids associated with a variety of systemic diseases, endocrinopathies, and Cushing syndrome (Fogel et al. Spine J 5:202-211, 2005). Occasionally, spinal epidural lipomatosis may occur in patients not exposed to steroids or in patients with endocrinopathies, primarily in obese individuals (Fogel et al. Spine J 5:202-211, 2005). However, spinal lumbar epidural lipomatosis resulting from local steroid injection has rarely been reported. We report the case of a 45-year-old diabetic man with claudication that was probably due to symptomatic lumbar spinal lipomatosis resulting from a single local epidural steroid injection. PMID:20859631

Tok, Chung Hong; Kaur, Shaleen; Gangi, Afshin

2011-02-01

349

What is the best initial therapy for a patient with symptomatic low-grade follicular lymphoma?  

PubMed

Follicular lymphoma is a diverse disease, both biologically and clinically. Patients may present with symptomatic or asymptomatic disease and with high or low tumor burden. Decisions to treat in the frontline are made based on histology, presence or absence of symptoms, disease burden, comorbidities, patient age, and patient preferences. As most patients with follicular lymphoma will eventually have a relapse, preservation of downstream treatment options also warrants consideration. One must be cognizant of toxicities and how these toxicities may influence later treatments. Given the number of variables, the decision making is often complex, and a certain amount of individualization is required. The goals of this review were to provide a framework for decision making and review the literature supporting the various options. PMID:23006941

Kenkre, Vaishalee P; Kahl, Brad S

2012-01-01

350

Management of symptomatic ascites in hospice patients with paracentesis: a case series report.  

PubMed

Refractory ascites causes significant distress to patients and can be managed in various ways. In hospice patients where the goal of care is to preserve comfort and foster better quality of life, diuretics should be tried first; however, in resistant cases, home-based paracentesis should be entertained. Home-based paracentesis is a safe and simple procedure that can be done blindly, if done under standard precautions there is minimal associated risk of bleeding, infection or perforation and no need for pre or post-laboratory testing or the correction of high international normalization ratio or thrombocytopenia. Home-based paracentesis is cost effective, provides immediate symptomatic relief, good patient and caregiver satisfaction and obviates the associated distress to the patient and family of transporting the patient for either outpatient or inpatient paracentesis. PMID:21998439

Zama, Ivan N; Edgar, Millicent

2012-08-01

351

Effectiveness of intravenous ilomedin infusion and smoking cessation in the treatment of acutely symptomatic buerger disease.  

PubMed

We assessed the effectiveness of iloprost treatment in the management of symptomatic Buerger disease (BD) and assessed smoking cessation compliance, based on a single-center experience. Thirteen patients with BD were treated with sessions of intravenous (IV) Ilomedin infusion. At 1-year follow-up, pain status alteration, number of analgesics required, ankle-brachial index (ABI) change, compliance with supervised smoking cessation, and amputation-free rate were recorded. The pain status improved considerably according to a visual analog scale, the number of analgesics required was significantly reduced, and all patients improved their pain-free walking distance, the ABI, and their self-reported quality of life. Only 2 patients required minor amputations. Combination of IV Ilomedin infusion, supervised smoking cessation, and a specific follow-up protocol may lead to improvement in pain-free walking distance, pain status, quality of life, and substantial reduction in amputation risk. PMID:24366824

Spanos, Kostas; Georgiou, Evangelia; Saleptsis, Vassileios; Athanasoulas, Athanasios; Sakkas, Lazaros; Giannoukas, Athanasios D

2015-02-01

352

Raising cut-off value of prostate specific antigen (PSA) for biopsy in symptomatic men in India to reduce unnecessary biopsy  

PubMed Central

Background & objectives: The characteristics of prostate specific antigen (PSA) for trans-rectal ultrasonography guided prostate biopsy in men with lower urinary tract symptoms (LUTS) are not well defined. This study was carried out to analyse the threshold of PSA for biopsy in symptomatic men in India. Methods: From January 2000 to June 2011, consecutive patients who had digital rectal examination (DRE) and PSA testing done for LUTS were included in this study. PSA was done with ELISA technique. Patients with acute or chronic prostatitis, prostatic abscess, history of surgery on prostate within the previous three months and patients on 5?-reductase inhibitors or on urethral catheter were excluded. Results: Of the 4702 patients evaluated, 70.9 per cent had PSA of less than 4 ng/ml and 29.1 per cent had PSA of more than 4 ng/ml. Of these, 875 men with a mean age of 65.72±7.4 (range 50-75 yr) had trans rectal ultrasonography (TRUS) guided biopsy. Twenty five men had biopsy at PSA level of <4 ng/ml due to positive DRE, 263 at 4.1-10ng/ml, 156 at 10.1-20 ng/ml and 431 at >20 ng/ml. Positive predictive value of PSA in ranges of 4.1-10, 10.1-20, >20 ng/ml was 15.2, 24 and 62.6 per cent, respectively with negative DRE. PSA cut-off to do biopsy was derived by ROC curve as 5.82 ng/ml for all the men. When the subjects were further stratified on the basis of DRE findings, a cut-off of 5.4 ng/ml was derived in men with normal DRE. Interpretation & conclusions: A cut-off for biopsy in symptomatic men with negative DRE could safely be raised to 5.4 ng/ml, which could avoid subjecting 10 per cent of men to undergo unnecessary biopsy. PMID:25109719

Agnihotri, Shalini; Mittal, R.D.; Kapoor, R.; Mandhani, Anil

2014-01-01

353

The clinical application of monoclonal antibodies in chronic lymphocytic leukemia  

PubMed Central

Chronic lymphocytic leukemia (CLL) represents the most prevalent adult leukemia. Treatment with chemotherapy over the past 3 decades has been palliative. The introduction of therapeutic antibodies has increased the number of treatment options for this disease. Despite this increase, our true understanding of the mechanism of action of antibody therapy in CLL remains limited. Rituximab, a CD20 antibody, is currently widely used in combination-based strategies for both previously untreated symptomatic CLL and as salvage therapy. Recent data suggest that the addition of rituximab to fludarabine with or without cyclophosphamide prolongs survival in younger patients with CLL. Other improved CD20 antibodies with promising clinical activity, including ofatumumab and GA-101, are coming forward. Alemtuzumab, a CD52 antibody, likewise has demonstrated benefit in both symptomatic, previously untreated CLL and in patients with relapsed disease but has less selectivity. Development of other therapeutic antibodies targeting alternative B-cell–specific antigens in CLL has been less successful, although many promising candidate antibodies and/or small modular immune pharmaceuticals (SMIPs) are coming forward. In addition, recent efforts to combine currently applied therapeutic antibodies with other biologic and targeted therapies with efficacy in CLL offers the potential to move toward alternative non–chemotherapy-based treatment approaches. PMID:20610811

Jaglowski, Samantha M.; Alinari, Lapo; Lapalombella, Rosa; Muthusamy, Natarajan

2010-01-01

354

Chronic daily headaches  

PubMed Central

Chronic Daily Headache is a descriptive term that includes disorders with headaches on more days than not and affects 4% of the general population. The condition has a debilitating effect on individuals and society through direct cost to healthcare and indirectly to the economy in general. To successfully manage chronic daily headache syndromes it is important to exclude secondary causes with comprehensive history and relevant investigations; identify risk factors that predict its development and recognise its sub-types to appropriately manage the condition. Chronic migraine, chronic tension-type headache, new daily persistent headache and medication overuse headache accounts for the vast majority of chronic daily headaches. The scope of this article is to review the primary headache disorders. Secondary headaches are not discussed except medication overuse headache that often accompanies primary headache disorders. The article critically reviews the literature on the current understanding of daily headache disorders focusing in particular on recent developments in the treatment of frequent headaches. PMID:23024563

Ahmed, Fayyaz; Parthasarathy, Rajsrinivas; Khalil, Modar

2012-01-01

355

Electrogastrography associated with symptomatic changes after prokinetic drug treatment for functional dyspepsia  

PubMed Central

AIM: To evaluate the effect of prokinetic drugs on electrogastrography (EGG) parameters according to symptomatic changes in patients with functional dyspepsia (FD). METHODS: Seventy-four patients with FD were prospectively enrolled in this study between December 2006 and December 2010. We surveyed the patients using a questionnaire on dyspeptic symptoms before and after an 8-wk course of prokinetic drug treatment. We also measured cutaneous pre-prandial and post-prandial EGG recordings including percentage of gastric waves (normogastria, bradygastria, tachygastria), dominant frequency (DF), dominant power (DP), dominant frequency instability coefficient (DFIC), dominant power instability coefficient (DPIC), and the ratio of post-prandial to fasting in DP before and after the 8-wk course of prokinetic drug treatment. RESULTS: Fifty-two patients (70%) achieved symptomatic improvement after prokinetic drug treatment. Patients who had normal gastric slow waves showed symptom improvement group after treatment. Post-prandial DF showed a downward trend in the symptom improvement group, especially in the itopride group. Post-prandial DP was increased regardless of symptom improvement, especially in the itopride group and mosapride group. Post-prandial DFIC and DPIC in the symptom improvement group were significantly increased after the treatment. The EGG power ratio was increased after treatment in the symptom improvement group (0.50 ± 0.70 vs 0.93 ± 1.77, P = 0.002), especially in the itopride and levosulpiride groups. CONCLUSION: Prokinetics could improve the symptoms of FD by regulating gastric myoelectrical activity, and EGG could be a useful tool in evaluating the effects of various prokinetics. PMID:23139612

Lim, Hyun Chul; Lee, Sang In; Chen, Jiande DZ; Park, Hyojin

2012-01-01

356

Association of Dynamic Joint Power With Functional Limitations in Older Adults With Symptomatic Knee Osteoarthritis  

PubMed Central

Objectives To determine which lower-limb joint moments and powers characterize the level of gait performance of older adults with symptomatic knee osteoarthritis (OA). Design Cross-sectional observational study. Setting University motion analysis laboratory. Participants Community-dwelling adults (N=60; 27 men, 33 women; age 50–79y) with symptomatic knee OA. Interventions Not applicable. Main Outcome Measures Physical function was measured using the long-distance corridor walk, the Short Physical Performance Battery, and the Late Life Function and Disability Instrument (LLFDI Function). Joint moments and power were estimated using an inverse dynamics solution after 3-dimensional computerized motion analysis. Results Subjects aged 64.2±7.4 years were recruited. Ranges (mean ± SD) for the 400-m walk time and the LLFDI Advanced Lower-Limb Function score were 215.3 to 536.8 (304.1±62.3) seconds and 31.5 to 100 (57.0±14.9) points, respectively. In women, hip abductor moment (loading response), hip abductor power (midstance), eccentric hamstring moment (terminal stance), and power (terminal swing) accounted for 41%, 31%, 14%, and 48% of the variance in the 400-m walk time, respectively (model R2=.61, P<.003). In men, plantar flexor and hip flexor power (preswing) accounted for 19% and 24% of the variance in the 400-m walk time, respectively (model R2=.32, P=.025). Conclusions There is evidence that men and women with higher mobility function tend to rely more on an ankle strategy rather than a hip strategy for gait. In higher functioning men, higher knee extensor and flexor strength may contribute to an ankle strategy, whereas hip abductor weakness may bias women with lower mobility function to minimize loading across the knee via use of a hip strategy. These parameters may serve as foci for rehabilitation interventions aimed at reducing mobility limitations. PMID:19887204

Segal, Neil A.; Yack, H. John; Brubaker, Morgan; Torner, James C.; Wallace, Robert

2010-01-01

357

Comparison of BMSs with SES for Symptomatic Intracranial Disease of the Middle Cerebral Artery Stenosis  

SciTech Connect

This study was designed to compare the clinical and angiographic outcomes of patients with symptomatic atherosclerotic middle cerebral artery stenosis treated with balloon-mounted stents (BMS) and self-expandable Wingspan system (SES). We reviewed the 69 consecutive stent placement procedures for symptomatic atherosclerotic stenosis ({>=}70) in M1 segment of middle cerebral artery in 67 patients in 3 years. According to the stent types, the patients were classed as BMS and SES groups. The demographic characteristics, conventional risk factors of ischemic stroke, degree of stenosis, periprocedural complications, stent types, and clinical and angiographic outcomes were analyzed. There were 39 patients in the BMS group and 28 patients in the SES group. The demographic characteristics, conventional risk factors, and periprocedural complications were similar but different in residual stenosis after stenting in both groups (5.9% {+-} 9.9% vs. 14.4% {+-} 14.6%; P = 0.01). For the overall cohort, the rate of stroke or death and restenosis was 10.9% (7/66) and 24.5% (14/57), respectively. The frequency of restenosis was higher in the SES group than in the BMS group (log-rank, P = 0.04; crude hazard ratio = 3.03; 95% confidence interval (CI), 1.01-9.15; P = 0.049; and adjusted hazard ratio = 3.61; 95% CI, 1.06-12.27; P = 0.04); however, there was no difference in clinical outcomes (log-rank, P = 0.51; crude hazard ratio = 1.66; 95% CI, 0.36-7.61; P = 0.51; and adjusted hazard ratio = 0.59; 95% CI, 0.04-7.89; P = 0.69). The corrected degree of restenosis was higher in the SES than the BMS group. The prevalence of restenosis was higher in the SES than the BMS group, but the perioperative complications and follow-up clinical outcomes had no significant difference.

Yue Xuanye; Yin Qin [Nanjing University School of Medicine, Department of Neurology, Jinling Hospital (China); Xi Gangming [Yunyang Medical College, Department of Neurology, Shiyan People Hospital (China); Zhu Wusheng; Xu Gelin; Zhang Renliang; Zhou Zhiming; Ma Minmin [Nanjing University School of Medicine, Department of Neurology, Jinling Hospital (China); Jin Guangfu [Nanjing Medical University, Department of Epidemiology and Biostatistics, School of Public Health (China); Liu Xinfeng, E-mail: xfliu2@yahoo.com.cn [Nanjing University School of Medicine, Department of Neurology, Jinling Hospital (China)

2011-02-15

358

A randomized trial comparing primary angioplasty versus stent placement for symptomatic intracranial stenosis  

PubMed Central

Background: Both primary angioplasty alone and angioplasty with a self-expanding stent have been compared in non-randomized concurrent clinical studies that suggest equivalent results. However, there is no randomized trial that has compared the two procedures in patients with symptomatic high grade intracranial stenosis. Objective: The primary aim of the randomized trial was to compare the clinical and angiographic efficacy of primary angioplasty and angioplasty followed by stent placement in preventing restenosis, stroke, requirement for second treatment, and death in patients with symptomatic intracranial stenosis. Methods: The study prospectively evaluated efficacy and safety of the two existing neurointerventional techniques for treatment of moderate intracranial stenosis (stenosis ? 50%) with documented failure of medical treatment or severe stenosis (?70%) with or without failure of medical treatment. Results: A total of 18 patients were recruited in the study (mean age [±SD] was 64.7 ± 15.1 years); out of these, 12 were men. Of these 18, 10 were treated with primary angioplasty and 8 were treated with angioplasty followed by self-expanding stent. The technical success rates of intracranial angioplasty and stent placements defined as ability to achieve <30% residual stenosis when assessed by immediate post-procedure angiography was 5 of 10 and 5 of 8 patients, respectively. The total fluoroscopic time (mean [±SD]) was lower in patients undergoing primary angioplasty 37 [±11] min versus those undergoing angioplasty followed by self-expanding stent 42 [±15] min, P = 0.4321. The stroke and death rate within 1 month was very low in both patient groups (1 of 10 versus 0 of 8 patients). One patient randomized to stent placement continued to have recurrent ischemic symptoms requiring another angioplasty in the vertebral artery on post-procedure Day 2. Conclusions: The trial suggests that a randomized trial comparing primary angioplasty to angioplasty followed by stent placement is feasible. The immediate procedural outcomes with primary angioplasty are comparable to stent placement and warrant further studies. PMID:24358415

Qureshi, Adnan I; Chaudhry, Saqib A; Siddiq, Farhan; Majidi, Shahram; Rodriguez, Gustavo J; Suri, M Fareed K

2013-01-01

359

Comparison of BMSs with SES for symptomatic intracranial disease of the middle cerebral artery stenosis.  

PubMed

This study was designed to compare the clinical and angiographic outcomes of patients with symptomatic atherosclerotic middle cerebral artery stenosis treated with balloon-mounted stents (BMS) and self-expandable Wingspan system (SES). We reviewed the 69 consecutive stent placement procedures for symptomatic atherosclerotic stenosis (?70) in M1 segment of middle cerebral artery in 67 patients in 3 years. According to the stent types, the patients were classed as BMS and SES groups. The demographic characteristics, conventional risk factors of ischemic stroke, degree of stenosis, periprocedural complications, stent types, and clinical and angiographic outcomes were analyzed. There were 39 patients in the BMS group and 28 patients in the SES group. The demographic characteristics, conventional risk factors, and periprocedural complications were similar but different in residual stenosis after stenting in both groups (5.9% ± 9.9% vs. 14.4% ± 14.6%; P = 0.01). For the overall cohort, the rate of stroke or death and restenosis was 10.9% (7/66) and 24.5% (14/57), respectively. The frequency of restenosis was higher in the SES group than in the BMS group (log-rank, P = 0.04; crude hazard ratio = 3.03; 95% confidence interval (CI), 1.01-9.15; P = 0.049; and adjusted hazard ratio = 3.61; 95% CI, 1.06-12.27; P = 0.04); however, there was no difference in clinical outcomes (log-rank, P = 0.51; crude hazard ratio = 1.66; 95% CI, 0.36-7.61; P = 0.51; and adjusted hazard ratio = 0.59; 95% CI, 0.04-7.89; P = 0.69). The corrected degree of restenosis was higher in the SES than the BMS group. The prevalence of restenosis was higher in the SES than the BMS group, but the perioperative complications and follow-up clinical outcomes had no significant difference. PMID:20458585

Yue, Xuanye; Yin, Qin; Xi, Gangming; Zhu, Wusheng; Xu, Gelin; Zhang, Renliang; Zhou, Zhiming; Ma, Minmin; Jin, Guangfu; Liu, Xinfeng

2011-02-01

360

Women seeking second opinion for symptomatic uterine leiomyoma: role of comprehensive fibroid center  

PubMed Central

Objective The objective of the study was to describe our early experience with a comprehensive uterine fibroid center and report our results in women seeking a second opinion for management of symptomatic uterine leiomyoma. Methods We performed a HIPAA-complaint, IRB-approved retrospective study of women seeking second opinion for management of uterine fibroids at our multidisciplinary fibroid treatment center in a tertiary care facility from July 2008 to August 2011. After a review of patients’ history, physical examination, and magnetic resonance imaging (MRI) findings, treatment options were discussed which included conservative management, uterine-preserving options, and hysterectomy. We performed Fisher’s exact test for categorical variables between the cohort that did or did not undergo a uterine-preserving treatment. Differences were considered significant at p?symptomatic fibroid treatment. PMID:25512867

2014-01-01

361

Ovarian Artery Embolization in Patients With Collateral Supply to Symptomatic Uterine Leiomyomata  

SciTech Connect

Purpose: To evaluate the safety and outcome of ovarian artery embolization (OAE) in patients with collateral supply to symptomatic uterine leiomyomata. Materials and Methods: Thirteen patients with relevant leiomyoma perfusion by way of enlarged ovarian arteries underwent additional OAE during the same (N = 10) or a second procedure (N = 3). Uterine artery embolization (UAE) was performed bilaterally in 10 and unilaterally in 2 patients with a single artery. One patient had no typical uterine arteries but bilaterally enlarged ovarian arteries, prompting bilateral OAE. OAE was accomplished with coil embolization in one and particle embolization in 12 patients. Symptoms before therapy and clinical outcome were assessed using a standardized questionnaire. Contrast-enhanced magnetic resonance (MR) imaging after embolization was available in 11 of 13 patients and was used to determine the percentage of fibroid infarction. Results: UAE and OAE were technically successful in all patients. One patient experienced prolonged irritation at the puncture site. Median clinical follow-up time was 16 months (range 4-37). Ten of 13 patients showed improvement or complete resolution of clinical symptoms. One patient reported only slight improvement of her symptoms. These women presented with regular menses. Two patients (15%), 47 and 48 years, both with unilateral OAE, reported permanent amenorrhea directly after embolization. Their symptoms completely resolved. Seven patients showed complete and 4 showed >90% fibroid infarction after embolization therapy. Conclusions: OAE is technically safe and effective in patients with ovarian artery collateral supply to symptomatic uterine leiomyomata. The risk of permanent amenorrhea observed in this study is similar to the reported incidence after UAE.

Scheurig-Muenkler, C., E-mail: christian.scheurig@charite.de; Poellinger, A., E-mail: alexander.poellinger@charite.de; Wagner, M., E-mail: moritz.wagner@charite.de; Hamm, B., E-mail: bernd.hamm@charite.de; Kroencke, T. J., E-mail: thomas.kroencke@charite.de [Charite-Universitaetsmedizin Berlin, Department of Radiology (Germany)

2011-12-15

362

Anisodamine accelerates spontaneous passage of single symptomatic bile duct stones ? 10 mm  

PubMed Central

AIM: To investigate the rate of spontaneous passage of single and symptomatic common bile duct (CBD) stones ? 10 mm in diameter in 4 wk with or without a 2-wk course of anisodamine. METHODS: A multicenter, randomized, placebo-controlled trial was undertaken. A total of 197 patients who met the inclusion criteria were enrolled. Ninety-seven patients were assigned randomly to the control group and the other 100 to the anisodamine group. The anisodamine group received intravenous infusions of anisodamine (10 mg every 8 h) for 2 wk. The control group received the same volume of 0.9% isotonic saline for 2 wk. Patients underwent imaging studies and liver-function tests every week for 4 wk. The rate of spontaneous passage of CBD stones was analyzed. RESULTS: The rate of spontaneous passage of CBD stones was significantly higher in the anisodamine group than that in the control group (47.0% vs 22.7%). Most (87.2%, 41/47) stone passages in the anisodamine group occurred in the first 2 wk, and passages in the control group occurred at a comparable rate each week. Factors significantly increasing the possibility of spontaneous passage by univariate logistic regression analyses were stone diameter (< 5 mm vs ? 5 mm and ? 10 mm) and anisodamine therapy. Multivariate logistic regression analyses revealed that these two factors were significantly associated with spontaneous passage. CONCLUSION: Two weeks of anisodamine administration can safely accelerate spontaneous passage of single and symptomatic CBD stones ? 10 mm in diameter, especially for stones < 5 mm. PMID:24151390

Gao, Jun; Ding, Xue-Mei; Ke, Shan; Zhou, Yi-Ming; Qian, Xiao-Jun; Ma, Rui-Liang; Ning, Chun-Min; Xin, Zong-Hai; Sun, Wen-Bing

2013-01-01

363

?2?Microglobulin, Cystatin C, and Creatinine and Risk of Symptomatic Peripheral Artery Disease  

PubMed Central

Background ?2?Microglobulin and cystatin C may have advantages over creatinine in assessing risk associated with kidney function. We therefore investigated whether emerging filtration markers, ?2?microglobulin and cystatin C, are prospectively associated with risk of the development of peripheral artery disease (PAD). Methods and Results We conducted nested case?control studies among women within the Nurses’ Health Study (1990–2010) and among men within the Health Professionals Follow?up Study (1994–2008) with the use of archived blood samples collected before PAD diagnosis. During follow?up, symptomatic PAD was confirmed in 144 women and 143 men. Controls were matched 3:1 based on age, race, smoking status, fasting status, and date of blood sampling. Conditional logistic regression models were used to estimate relative risks (RRs) and were adjusted for plasma creatinine and cardiovascular risk factors. In women, the RRs (95% CI) per 1?SD) increment were 1.16 (0.85 to 1.58) for ?2?microglobulin and 0.94 (0.69 to 1.28) for cystatin C. Corresponding RRs in men were 1.50 (1.08 to 2.09) for ?2?microglobulin and 1.54 (1.07 to 2.22) for cystatin C. There was no association between creatinine and PAD risk in women, whereas the association in men (RR 1.41, 95% CI 1.10 to 1.81) disappeared after adjustment for either ?2?microglobulin or cystatin C. In pooled analyses of men and women, only ?2?microglobulin was associated with PAD risk (RR 1.31, 95% CI 1.04 to 1.64). Conclusions In pooled analyses, ?2?microglobulin was associated with an increased risk of symptomatic PAD; a similar association with cystatin C was observed only in men. The findings suggest that ?2?microglobulin may capture the atherosclerosis?promoting or atherosclerosis?related elements of kidney dysfunction better than creatinine. PMID:24980133

Joosten, Michel M.; Pai, Jennifer K.; Bertoia, Monica L.; Gansevoort, Ron T.; Bakker, Stephan J. L.; Cooke, John P.; Rimm, Eric B.; Mukamal, Kenneth J.

2014-01-01

364

Failure of antithrombotic therapy and risk of stroke in patients with Symptomatic Intracranial Stenosis  

PubMed Central

Background and Purpose We sought to determine if patients with intracranial stenosis who have a TIA or stroke on antithrombotic therapy are at particularly high risk for recurrent stroke. Methods We compared baseline features and the rates of stroke or vascular death and stroke in the territory of the symptomatic artery between patients ON (n=299) vs. OFF (n=269) antithrombotics at the time of their qualifying event for the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. Results In univariate analyses, there was no difference in the rates of stroke or vascular death (21 vs. 23%, HR (ON/OFF) = 0.91 (95%CI: 0.64–1.29), p= 0.59) or stroke in territory (13 vs. 14%, HR (ON/OFF) = 0.90 (95%CI: 0.57–1.39), p=0.61) between patients ON vs. OFF antithrombotics at the time of their qualifying event. A multivariable analysis adjusted for the difference in risk factors between patients ON and OFF antithrombotic therapy also showed no significant differences in the combined endpoint of stroke or vascular death (HR (ON/OFF) = 0.86, 95%CI: 0.55–1.34, p=0.51) or stroke in territory (HR (ON/OFF) = 1.01., 95%CI: 0.58–1.77, p=0.97) between patients ON vs. OFF antithrombotic therapy at the time of qualifying event. Conclusions Intracranial stenosis patients who fail antithrombotic therapy are not at higher risk of stroke than those who do not fail antithrombotic therapy. Given our finding that patients ON and OFF antithrombotic therapy are both at high risk for stroke in the territory, intracranial stenting trials should not be limited to just those who fail antithrombotic therapy. PMID:19095991

Turan, Tanya N.; Maidan, Lucian; Cotsonis, George; Lynn, Michael J.; Romano, Jose G.; Levine, Steven R.; Chimowitz, Marc I.

2009-01-01

365

Symptomatic hypothalamic-pituitary dysfunction in nasopharyngeal carcinoma patients following radiation therapy: a retrospective study  

SciTech Connect

Endocrine assessment was performed in 32 relapse-free southern Chinese patients 5-17 years following radiation therapy (RT) alone for early nasopharyngeal carcinoma (NPC). Initial screening was done using questionnaires emphasizing impaired sexual function and menstrual disturbance plus measurement of serum levels of thyroxine, free thyroxine index, thyrotropic hormone, prolactin, and additionally testosterone for males only. Those showing abnormalities were subjected to detailed pituitary function tests. Hypothalamic-pituitary dysfunction was found in 7 female patients and only 1 male patient. A delayed TSH response to thyrotropin releasing hormone suggesting a hypothalamic disorder was seen in 6 of the affected female patients, and hyperprolactinaemia in also 6. None of the patients had evidence of diabetes insipidus. Hypopituitarism became symptomatic 2-5 years after RT with a mean latent interval of 3.8 years. A practical protocol for regular endocrine assessment for NPC patients after RT has been proposed. Multiple linear regression analysis of the radiotherapeutic data from the 11 female patients indicates that the likelihood of late occurrence of symptomatic hypothalamic-pituitary dysfunction following RT is dependent on the TDF of the target dose to the nasopharyngeal region and the height of the upper margin of the opposed lateral facial fields above the diaphragma sellae (coefficient of multiple correlation = 0.9025). Except when the sphenoid sinus or the middle cranial fossa is involved, it is advisable to set the height of the upper margin of the lateral facial field at a level no higher than the diaphragma sellae. The hypothalamus and possibly the pituitary stalk as well may sustain permanent damage by doses of radiation within the conventional radiotherapeutic range for carcinomas.

Lam, K.S.; Ho, J.H.; Lee, A.W.; Tse, V.K.; Chan, P.K.; Wang, C.; Ma, J.T.; Yeung, R.T.

1987-09-01

366

Symptomatic carotid atherosclerotic disease: correlations between plaque composition and ipsilateral stroke risk  

PubMed Central

BACKGROUND AND PURPOSE For symptomatic patients with carotid artery stenosis the risk-benefit for surgical intervention may vary among patient groups. Various modalities of plaque imaging have been promoted as potential tools for additional risk stratification, particularly in patients with moderate stenosis. However, it remains uncertain to what extent carotid plaque components predict risk of future ipsilateral ischaemic stroke. METHODS In two large atherosclerotic carotid plaque biobank studies, we related histological characteristics of 1640 carotid plaques with a validated risk model for the prediction of individual 1- and 5-year stroke risk. RESULTS No significant heterogeneity between the studies was found. Predicted 5-year stroke risk (top versus bottom quartile) was related to plaque thrombus (OR=1.42, 95%CI 1.11-1.89, p=0.02), fibrous content (0.65, 0.49-0.87, p=0.004), macrophage infiltration (1.41, 1.05-1.90, p=0.02), high micro-vessel density (1.49, 1.05-2.11, p=0.03), and overall plaque instability (1.40, 1.05-1.87,p=0.02). This association was not observed for cap thickness, calcification, intra-plaque haemorrhage, or lymphocyte infiltration. Plaques removed within 30-days of most recent symptomatic event were most strongly correlated with predicted stroke risk. CONCLUSIONS Features of ‘the vulnerable carotid plaque’ including plaque thrombus, low fibrous content, macrophage infiltration and microvessel density correlate with predicted stroke risk. This study provides a basis for plaque imaging studies focused on stroke risk stratification. PMID:25477221

Rothwell, Peter M; Redgrave, Jessica N; Moll, Frans L; de Vries, Jean-Paul PM; de Kleijn, Dominique PV; den Ruijter, Hester M; de Borst, Gert Jan; Pasterkamp, Gerard

2014-01-01

367

Ulipristal acetate: a novel option for the medical management of symptomatic uterine fibroids.  

PubMed

Fibroids, the most common tumor in women of reproductive age, impact negatively on women's health and quality of life, and have significant cost implications for their management. The current mainstay treatments are surgical (myomectomy and hysterectomy) and more recently radiological (UAE and focused ultrasound surgery). Hysterectomy is curative but precludes future fertility, whereas the impact of the other treatments on reproduction is uncertain. With women in Western societies deferring childbearing to their 30s and 40s, when fibroids are most symptomatic, there is a pressing need for a uterus-sparing medical therapy that is cheap, effective, and enhances reproductive potential. Serendipity and meticulous translational research has shown that progesterone augments fibroid proliferation, raising the possibility that progesterone receptor modulators could inhibit fibroid growth; this research has culminated in the emergence of ulipristal acetate (UA), a first-in-class, oral selective progesterone receptor modulator (SPRM) that has successfully completed phase III clinical trials. It has been licensed in Western Europe for short-term clinical use prior to surgery, and has shown efficacy with a significant reduction in uterine bleeding, fibroid volume, and improved quality of life, without the side effects associated with other medications such as gonadotropin-releasing hormone (GnRH) agonists. As with all new medicines, there are concerns surrounding UA, not least its effect on the endometrium and the long-term impact on general health and reproduction. Research to date has tended to be industry led, and therefore, there is a need for researcher/clinician-led studies to address the wider issues concerning SPRMs. UA may not turn out to be the "Holy Grail" of medical therapy in the treatment of symptomatic uterine fibroids, but it has rightly given cause for a huge optimism. Further laboratory and clinical research into PRMs and related compounds will no doubt lead to more refined medications. PMID:22903240

Talaulikar, Vikram S; Manyonda, Isaac T

2012-08-01

368

Diversity of Babesia and Theileria species in symptomatic and asymptomatic dogs in Croatia.  

PubMed

Babesiosis, the disease caused by tick-borne hematozoan parasites of the genus Babesia, is particularly common in dogs, and is caused by several "large" species of Babesia, as well as by an increasing number of "small" species of Babesia, some of which appear to be more closely related to members of the genus Theileria. In this work, blood samples were collected from 848 randomly selected, asymptomatic dogs and from 81 symptomatic dogs, microscopically positive for Babesia, and characterised by PCR and sequence analysis of a fragment of the ssrRNA gene. A prevalence of 3.42% (29 of 848) was found in asymptomatic dogs and sequence analysis revealed the presence of Babesia canis canis in 20 dogs (69%), Babesia gibsoni in six dogs (21%), Babesia canis vogeli in two dogs (7%) and Theileria annae in one dog (3%). In the group of symptomatic dogs, which were all positive by PCR, B. canis canis was the predominant species (78 dogs, or 96%), followed by single infections with B. canis vogeli, Babesia caballi and Theileria equi. Our study has confirmed that dogs are infected with a wide range of both large and small piroplasm species and subspecies, including B. caballi and T. equi, two parasites usually found in horses. The detection of the pathogenic species B. canis canis and B. gibsoni in asymptomatic dogs indicates that the relationship between parasite species/subspecies and clinical signs of infection in dogs deserves further investigation. Finally, the identities of the tick vectors transmitting T. annae and B. caballi remain to be elucidated. PMID:19367832

Beck, Relja; Vojta, Lea; Mrljak, Vladimir; Marinculi?, Albert; Beck, Ana; Zivicnjak, Tatjana; Cacciò, Simone M

2009-06-01

369

The role of palliative radiation therapy in symptomatic locally advanced gastric cancer  

SciTech Connect

Purpose: To review the outcome of palliative radiotherapy (RT) alone in patients with symptomatic locally advanced or recurrent gastric cancer. Methods and Materials: Patients with symptomatic locally advanced or recurrent gastric cancer who were managed palliatively with RT at Cancer Institute, Singapore were retrospectively reviewed. Study end points included symptom response, median survival, and treatment toxicity (retrospectively scored using the Common Toxicity Criteria v3.0 [CTC]). Results: Between November 1999 and December 2004, 33 patients with locally advanced or recurrent gastric cancer were managed with palliative intent using RT alone. Median age was 76 years (range, 38-90 years). Twenty-one (64%) patients had known distant metastatic disease at time of treatment. Key index symptoms were bleeding (24 patients), obstruction (8 patients), and pain (8 patients). The majority of patients received 30 Gy/10 fractions (17 patients). Dose fractionation regimen ranged from an 8-Gy single fraction to 40 Gy in 16 fractions. Median survival was 145 days, actuarial 12-month survival 8%. A total of 54.3% of patients (13/24) with bleeding responded (median duration of response of 140 days), 25% of patients (2/8) with obstruction responded (median duration of response of 102 days), and 25% of patients (2/8) with pain responded (median duration of response of 105 days). No obvious dose-response was evident. One Grade 3 CTC equivalent toxicity was recorded. Conclusion: External beam RT alone is an effective and well tolerated modality in the local palliation of gastric cancer, with palliation lasting the majority of patients' lives.

Tey, Jeremy [Department of Radiation Oncology, Cancer Institute, National University Hospital (Singapore) and Department of Radiation Oncology, Cancer Institute, Tan Tock Seng Hospital (Singapore)]. E-mail: Jeremy_Tey@mail.nhg.com.sg; Back, Michael F. [Department of Radiation Oncology, Cancer Institute, National University Hospital (Singapore); Department of Radiation Oncology, Cancer Institute, Tan Tock Seng Hospital (Singapore); Shakespeare, Thomas P. [Department of Radiation Oncology, Cancer Institute, National University Hospital (Singapore); Department of Radiation Oncology, Cancer Institute, Tan Tock Seng Hospital (Singapore); North Coast Cancer Institute, Port Macquarie, New South Wales (Australia); Mukherjee, Rahul K. [Department of Radiation Oncology, Cancer Institute, National University Hospital (Singapore); Department of Radiation Oncology, Cancer Institute, Tan Tock Seng Hospital (Singapore); Lu, Jiade J. [Department of Radiation Oncology, Cancer Institute, National University Hospital (Singapore); Lee, Khai Mun [Department of Radiation Oncology, Cancer Institute, National University Hospital (Singapore); Department of Radiation Oncology, Cancer Institute, Tan Tock Seng Hospital (Singapore); Wong, Lea Choung [Department of Radiation Oncology, Cancer Institute, National University Hospital (Singapore); Leong, Cheng Nang [Department of Radiation Oncology, Cancer Institute, National University Hospital (Singapore); Department of Radiation Oncology, Cancer Institute, Tan Tock Seng Hospital (Singapore); Zhu Ming [Clinical Trials and Epidemiology Research Unit, Ministry of Health (Singapore)

2007-02-01

370

Prucalopride. In chronic constipation: poorly documented risks.  

PubMed

Constipation is a frequent complaint, especially in women and the elderly. It is sometimes drug-induced, and is only occasionally secondary to a functional or organic disorder. The risks associated with constipation are often overestimated. Prucalopride, a 5-HT4 serotonin receptor agonist, chemically related to some neuroleptics, has been authorised in the European Union for symptomatic treatment of chronic constipation in women dissatisfied with laxatives. A combined analysis of 3 randomised double-blind trials in a total of 1999 patients (87.9% women) complaining of chronic constipation showed that about 36% of women considered it effective at a dose of 2 or 4 mg/day, versus 18% of women receiving placebo. Normal bowel movements resumed in respectively 23.6% and 24.7% of patients taking 2 and 4 mg/day prucalopride, versus 11.3% of patients on placebo (p < 0.001). No statistically significant difference was found between the 2 doses of prucalopride. Palpitations were more frequent in patients treated with prucalopride. The incidence of ischaemic cardiovascular events was 0.2% with prucalopride versus 0.1% with placebo. Increases in heart rate and blood pressure were observed in pigs and dogs treated with prucalopride. Prucalopride seems to increase prolactin levels. Tumours of the liver and thyroid were observed in rats. Prucalopride also carries a risk of poorly defined pharmacokinetic and pharmacodynamic interactions. Prucalopride may reduce the efficacy of oral contraceptives. Miscarriages were reported in clinical trials. Prucalopride should not be taken during pregnancy. In addition, all women of child-bearing age should use effective contraception while taking prucalopride. In practice, prucalopride should be avoided. It is better to focus on lifestyle and behavioural changes, and rational use of laxatives. PMID:21648173

2011-05-01

371

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)  

MedlinePLUS

NINDS Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Information Page Table of Contents (click to jump to sections) What is Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)? Is there any treatment? ...

372

Methamphetamine exposure and chronic illness in police officers  

PubMed Central

Background: The medical literature reports health hazards for law enforcement personnel from repeated exposure to methamphetamine and related chemical compounds. Most effects appear transitory, but some Utah police officers with employment-related methamphetamine exposures developed chronic symptoms, some leading to disability. This report is of an uncontrolled retrospective medical chart evaluation of symptomatic officers treated with a sauna detoxification protocol designed to reduce the chronic symptoms and improve the quality of life. Methods: Sixty-nine officers consecutively entering the Utah Meth Cops Project were assessed before and after a treatment program involving gradual exercise, comprehensive nutritional support and physical sauna therapy. Evaluations included pre- and post-treatment scores of the Research and Development Corporation (RAND) 36-item Short Form Health Survey (SF-36) in comparison with RAND population norms, pre- and post-treatment symptom score intensities, neurotoxicity scores, Mini-Mental Status Examination, presenting symptom frequencies and a structured evaluation of treatment program safety. Results: Statistically significant health improvements were seen in the SF-36 evaluations, symptom scores and neurotoxicity scores. The detoxification protocol was well tolerated, with a 92.8% completion rate. Conclusions: This investigation strongly suggests that utilizing sauna and nutritional therapy may alleviate chronic symptoms appearing after chemical exposures associated with methamphetamine-related law enforcement activities. This report also has relevance to addressing the apparent ill effects of other complex chemical exposures. In view of the positive clinical outcomes in this group, broader investigation of this sauna-based treatment regimen appears warranted. PMID:22089658

Ross, Gerald H; Sternquist, Marie C

2012-01-01

373

The validity of the PTSD checklist as a measure of symptomatic change in combat-related PTSD  

Microsoft Academic Search

Little research to date has examined the ability of self-report measures to assess changes in symptom severity and diagnostic status as a function of treatment. This study investigated the validity of the posttraumatic stress disorder (PTSD) checklist (PCL) as a measure of symptomatic change following programmatic treatment. A sample of 97 Vietnam veterans with combat-related PTSD was assessed using the

David Forbes; Mark Creamer; Dirk Biddle

2001-01-01

374

First Molecular Identification and Phylogeny of a Babesia sp. from a Symptomatic Sow (Sus scrofa Linnaeus 1758)?  

PubMed Central

Porcine babesiosis is a widespread yet overlooked disease causing economic losses in many regions of the world. To date, the etiological agent of porcine babesiosis has not been molecularly characterized. Here, we provide the first molecular characterization of a piroplasm detected in a symptomatic sow, phylogenetically closely related to the Ungulibabesids. Results pave the way for future molecular epidemiology studies. PMID:21490184

Zobba, Rosanna; Parpaglia, Maria Luisa Pinna; Spezzigu, Antonio; Pittau, Marco; Alberti, Alberto

2011-01-01

375

Symptomatic and neurophysiological responses of paclitaxel- or cisplatin-induced neuropathy to oral acetyl- l-carnitine  

Microsoft Academic Search

Acetyl-l-carnitine (ALC) improves non-oncological neuropathies. We tested oral ALC (1 g tid) for 8 weeks in 25 patients with neuropathy grade ?3 (common toxicity criteria – CTC) during paclitaxel or cisplatin therapy, or grade ?2 persisting for at least three months after discontinuing the drugs. An independent neurologist assessed patients before and after ALC. All patients except one reported symptomatic

Giulia Bianchi; Giordano Vitali; Augusto Caraceni; Sabrina Ravaglia; Giuseppe Capri; Sante Cundari; Claudio Zanna; Luca Gianni

2005-01-01

376

fMRI Reveals Distinct CNS Processing during Symptomatic and Recovered Complex Regional Pain Syndrome in Children  

ERIC Educational Resources Information Center

Complex regional pain syndrome (CRPS) in paediatric patients is clinically distinct from the adult condition in which there is often complete resolution of its signs and symptoms within several months to a few years. The ability to compare the symptomatic and asymptomatic condition in the same individuals makes this population interesting for the…

Lebel, A.; Becerra, L.; Wallin, D.; Moulton, E. A.; Morris, S.; Pendse, G.; Jasciewicz, J.; Stein, M.; Aiello-Lammens, M.; Grant, E.; Berde, C.; Borsook, D.

2008-01-01

377

Vestibular rehabilitation ameliorates chronic dizziness through the SIRT1 axis  

PubMed Central

Dizziness is a common clinical symptom frequently referred to general neurologists and practitioners. Exercise intervention, in the form of vestibular rehabilitation, is known as an effective clinical management for dizziness. This intervention is reported to have a functional role in correcting dizziness, improving gaze stability, retraining balance and gait, and enhancing physical fitness. Dizziness is known to be highly related to inflammation and oxidative stress. SIRT1 is a major molecule for the regulation of inflammation and mitigation of oxidative stress in chronic diseases such as atherosclerosis and chronic obstructive pulmonary disease. However, the bio-molecular roles of SIRT1 involved in the pathogenesis of dizziness are still largely unclear. In this study, a total of 30 subjects were recruited (15 patients with chronic dizziness, and 15 age/gender matched non-dizzy control subjects). The dizzy subjects group received 18 sessions of 30-min vestibular training. We found that the mRNA and protein expression levels of SIRT1 in the blood samples of chronic dizzy patients were repressed compared with those of healthy controls. After vestibular training, the dizzy patients had significant symptomatic improvements. The SIRT1 expression and its downstream genes (PPAR-? and PGC-1?) were upregulated after vestibular exercises in dizzy subjects. Notably, the catalytic activity of SIRT1, NADPH and antioxidant enzyme activities were also activated in dizzy patients after vestibular training. Furthermore, vestibular exercise training reduced oxidative events and p53 expression in patients with dizziness. This study demonstrated that vestibular exercise training improved dizziness symptoms, and mechanisms for alleviation of chronic dizziness may partly involve the activation of the SIRT1 axis and the repression of redox status. PMID:24624081

Kao, Chung-Lan; Tsai, Kun-Ling; Cheng, Yuan-Yang; Kuo, Chia-Hua; Lee, Shin-Da; Chan, Rai-Chi

2014-01-01

378

Absence of Genetic Differences among G10P[11] Rotaviruses Associated with Asymptomatic and Symptomatic Neonatal Infections in Vellore, India  

PubMed Central

ABSTRACT Rotaviruses (RVs) are leading causes of severe diarrhea and vomiting in infants and young children. RVs with G10P[11] genotype specificity have been associated with symptomatic and asymptomatic neonatal infections in Vellore, India. To identify possible viral genetic determinants responsible for differences in symptomology, the genome sequences of G10P[11] RVs in stool samples of 19 neonates with symptomatic infections and 20 neonates with asymptomatic infections were determined by Sanger and next-generation sequencing. The data showed that all 39 viruses had identical genotype constellations (G10-P[11]-I2-R2-C2-M2-A1-N1-T1-E2-H3), the same as those of the previously characterized symptomatic N155 Vellore isolate. The data also showed that the RNA and deduced protein sequences of all the Vellore G10P[11] viruses were nearly identical; no nucleotide or amino acid differences were found that correlated with symptomatic versus asymptomatic infection. Next-generation sequencing data revealed that some stool samples, both from neonates with symptomatic infections and from neonates with asymptomatic infections, also contained one or more positive-strand RNA viruses (Aichi virus, astrovirus, or salivirus/klassevirus) suspected of being potential causes of pediatric gastroenteritis. However, none of the positive-strand RNA viruses could be causally associated with the development of symptoms. These results indicate that the diversity of clinical symptoms in Vellore neonates does not result from genetic differences among G10P[11] RVs; instead, other undefined factors appear to influence whether neonates develop gastrointestinal disease symptoms. IMPORTANCE Rotavirus (RV) strains have been identified that preferentially replicate in neonates, in some cases, without causing gastrointestinal disease. Surveillance studies have established that G10P[11] RVs are a major cause of neonatal infection in Vellore, India, with half of infected neonates exhibiting symptoms. We used Sanger and next-generation sequencing technologies to contrast G10P[11] RVs recovered from symptomatic and asymptomatic neonates. Remarkably, the data showed that the RNA genomes of the viruses were virtually indistinguishable and lacked any differences that could explain the diversity of clinical outcomes among infected Vellore neonates. The sequencing results also indicated that some symptomatic and some asymptomatic Vellore neonates were infected with other enteric viruses (Aichi virus, astrovirus, salvirus/klassevirus); however, none could be correlated with the presence of symptoms in neonates. Together, our findings suggest that other poorly defined factors, not connected to the genetic makeup of the Vellore G10P[11] viruses, influence whether neonates develop gastrointestinal disease symptoms. PMID:24899175

Libonati, Margaret H.; Dennis, Allison F.; Ramani, Sasirekha; McDonald, Sarah M.; Akopov, Asmik; Kirkness, Ewen F.; Kang, Gagandeep

2014-01-01

379

A case of Ross syndrome presented with Horner and chronic cough  

PubMed Central

Ross syndrome is a rare sweating disorder associated with Adie's tonic pupil, decreased or diminished tendon reflex and unknown etiology. Although autonomic disturbances affecting sudomotor and vasomotor functions are seen commonly, they are rarely symptomatic. While Ross syndrome is typically characterized with dilated tonic pupil, it may be rarely manifested with miotic pupils (little old Adie's pupil), which can make diagnosis difficult. In this article, we aim to specify the atypical clinical manifestations of syndrome by means of Ross syndrome manifested by autonomic symptoms, Horner syndrome, chronic cough together with bilateral little old Adie's pupil. PMID:25288844

Baran, Aslihan; Balbaba, Mehmet; Demir, Caner F.; Özdemir, Hasan H.

2014-01-01

380

Endovascular treatment of chronic mesenteric ischemia in an adolescent male: case report  

PubMed Central

Chronic mesenteric ischemia (CMI) is a condition characterized by inadequate blood flow to the bowel resulting from stenosis of one or more of the three mesenteric arteries. Fibromuscular dysplasia is the most common cause in children and young adults; whereas atherosclerosis is the most common cause in the elderly. Treatment is mandatory in symptomatic patients, because it may lead to malnutrition, bowel infarction or even death.Herein, we present the case of a 14-year old male, diagnosed with CMI who underwent percutaneous balloon angioplasty (PTA) followed by stent placement with immediate positive results. PMID:25075283

Al-Hammash, Sadiq Muhammed; Al-Ethawi, Abd El-Salam Dawood; Ismail, Kasim Abbas

2013-01-01

381

A case of Ross syndrome presented with Horner and chronic cough.  

PubMed

Ross syndrome is a rare sweating disorder associated with Adie's tonic pupil, decreased or diminished tendon reflex and unknown etiology. Although autonomic disturbances affecting sudomotor and vasomotor functions are seen commonly, they are rarely symptomatic. While Ross syndrome is typically characterized with dilated tonic pupil, it may be rarely manifested with miotic pupils (little old Adie's pupil), which can make diagnosis difficult. In this article, we aim to specify the atypical clinical manifestations of syndrome by means of Ross syndrome manifested by autonomic symptoms, Horner syndrome, chronic cough together with bilateral little old Adie's pupil. PMID:25288844

Baran, Aslihan; Balbaba, Mehmet; Demir, Caner F; Ozdemir, Hasan H

2014-10-01

382

Chronic Arsenic poisoning.  

PubMed

Chronic Arsenic Toxicity may have varied clinical presentations ranging from non-cancerous manifestations to malignancy of skin and different internal organs. Dermal lesions such as hyper pigmentation and hyperkeratosis, predominantly over palms and soles are diagnostic of Chronic Arsenicosis. We report two cases from a family living in Sukkur who presented with classical skin lesions described in Chronic Arsenicosis. The urine, nail and hair samples of these patients contained markedly elevated levels of arsenic. Also the water samples from their household and the neighbouring households were found to have alarming levels of inorganic Arsenic. PMID:19260576

Ahsan, Tasnim; Zehra, Kaneez; Munshi, Alia; Ahsan, Samiah

2009-02-01

383

INTRODUCTION Chronic prostatitis/chronic pelvic pain syndrome  

E-print Network

INTRODUCTION · Chronic prostatitis/chronic pelvic pain syndrome affects 5-10% of men pathophysiological correlates of CP/CPPS pain (prostate inflammation, endocrine abnormalities, pelvic floor muscle in Chronic Prostatitis / Chronic Pelvic Pain Syndrome M. A. Farmer1, M. L. Chanda1, E. L. Parks1, M. N

Apkarian, A. Vania

384

Supportive Care for Chronic Lymphocytic Leukemia  

MedlinePLUS

... lymphocytic leukemia Radiation therapy for chronic lymphocytic leukemia Leukapheresis for chronic lymphocytic leukemia Supportive care for chronic ... treatment information about chronic lymphocytic leukemia Previous Topic Leukapheresis for chronic lymphocytic leukemia Next Topic Stem cell ...

385

Anemia of chronic disease  

MedlinePLUS

Anemia of inflammation; AOCD; ACD ... Anemia is a lower-than-normal number of red blood cells in the blood. Some conditions can lead to anemia of chronic disease include: Autoimmune disorders , such as ...

386

Chronic myelogenous leukemia (CML)  

MedlinePLUS

Chronic myelogenous leukemia (CML) is cancer that starts inside bone marrow. This is the soft tissue in the center of bones that helps form all blood cells. CML causes an uncontrolled growth of immature cells that make ...

387

Chronic Kidney Disease  

MedlinePLUS

You have two kidneys, each about the size of your fist. Their main job is to filter wastes and excess water out of ... help control blood pressure, and make hormones. Chronic kidney disease (CKD) means that your kidneys are damaged ...

388

[Angiosarcoma in chronic lymphedema].  

PubMed

Angiosarcoma that develops on a limb with chronic lymphedema is called Stewart-Treves syndrome. This typically appears as a complication of a long course lymphedema located on the arm, after mastectomy and/or radiotherapy due to breast cancer. There are cases of Stewart-Treves syndrome in chronic lymphedema in the upper limb contralateral to the breast treated for cancer and in chronic lymphedema of the leg. We present two cases of this syndrome. The first corresponds to a typical syndrome of Stewart-Treves in an 83-year-old woman who was diagnosed of angiosarcoma in a chronic lymphedema territory secondary to mastectomy and radiotherapy due to breast cancer. The second case is much rarer, since it is a case of diffuse angiosarcoma of the leg in a 42-year-old man with a history of lymphedema. Due to the aggressive nature of this syndrome, knowledge and research on its treatment are necessary. PMID:17067532

Rodríguez-Bujaldón, Alfonso; Vázquez-Bayo, Maria Carmen; Galán-Gutiérrez, Manolo; Jiménez-Puya, Rafael; Vélez García-Nieto, Antonio; Moreno-Giménez, José Carlos; Vidal-Jiménez, Alfredo; Barroso-Casamitjana, Elisa

2006-10-01

389

Cortical pathophysiology of chronic pain  

E-print Network

Cortical pathophysiology of chronic pain A. Vania Apkarian Department of Physiology multiple non-invasive brain imaging techniques to study the characteristics of patients with chronic pain in chronic pain are summarized, emphasizing the unique role of the prefrontal cortex in chronic, especially

Apkarian, A. Vania

390

Comparing the Bacterial Diversity of Acute and Chronic Dental Root Canal Infections  

PubMed Central

This study performed barcoded multiplex pyrosequencing with a 454 FLX instrument to compare the microbiota of dental root canal infections associated with acute (symptomatic) or chronic (asymptomatic) apical periodontitis. Analysis of samples from 9 acute abscesses and 8 chronic infections yielded partial 16S rRNA gene sequences that were taxonomically classified into 916 bacterial species-level operational taxonomic units (OTUs) (at 3% divergence) belonging to 67 genera and 13 phyla. The most abundant phyla in acute infections were Firmicutes (52%), Fusobacteria (17%) and Bacteroidetes (13%), while in chronic infections the dominant were Firmicutes (59%), Bacteroidetes (14%) and Actinobacteria (10%). Members of Fusobacteria were much more prevalent in acute (89%) than in chronic cases (50%). The most abundant/prevalent genera in acute infections were Fusobacterium and Parvimonas. Twenty genera were exclusively detected in acute infections and 18 in chronic infections. Only 18% (n?=?165) of the OTUs at 3% divergence were shared by acute and chronic infections. Diversity and richness estimators revealed that acute infections were significantly more diverse than chronic infections. Although a high interindividual variation in bacterial communities was observed, many samples tended to group together according to the type of infection (acute or chronic). This study is one of the most comprehensive in-deep comparisons of the microbiota associated with acute and chronic dental root canal infections and highlights the role of diverse polymicrobial communities as the unit of pathogenicity in acute infections. The overall diversity of endodontic infections as revealed by the pyrosequencing technique was much higher than previously reported for endodontic infections. PMID:22132218

Santos, Adriana L.; Siqueira, José F.; Rôças, Isabela N.; Jesus, Ederson C.; Rosado, Alexandre S.; Tiedje, James M.

2011-01-01

391

In vivo topographic analysis of lumbar facet joint space width distribution in healthy and symptomatic subjects  

PubMed Central

Study Design In vivo three-dimensional facet joint space width measurement. Objective To determine lumbar facet joint space width within clinically relevant topographical zones in vivo and its correlations with age, level and presence of lower back pain symptoms. Summary of Background Data Narrowing of the facet joint gap, articular cartilage thinning, and subarticular cortical bone hypertrophy are frequently observed age-related changes. Facet joint space width is a well-defined parameter to evaluate osteoarthritis. To the best of our knowledge, there is no other study that quantifies three-dimensional facet joint space width distribution in vivo. Methods Three-dimensional measurement to quantify facet joint space width distribution based on five clinically relevant topographic zones in a cohort of healthy and symptomatic low-back-pain volunteers using subject-based three-dimensional CT models with respect to spinal level, subject age, gender and presence/absence of lower back pain. Results Facet joint space width was 1.93±0.51 (mean ± standard deviation) mm for the central zone, 1.75±0.48 mm for the superior zone, 1.63±0.49 mm for the inferior zone, 1.48±0.44 mm for the medial and 1.65±0.48 mm for the lateral zone, respectively. There were no significant differences between right and left facet joints. Males showed larger space width than females. Overall, space width of symptomatic subjects was significantly narrower when compared against the asymptomatic group. Facet joints in the peripheral zones were narrower than in the central zone. Age-group comparisons showed local narrowing occurring as early as in the third decade at the inferior zone of L5/S1 with all the remaining zones implicated after the fourth decade. Conclusions This in vivo study shows variations in facet joint space width narrowing with spinal level and region within the facet joint and in vivo evidence of localized, age-influenced facet cartilage thinning. Techniques developed in this study may be applied in the detection of early osteoarthritis-related changes in the facet joints. PMID:22433501

Simon, Peter; Espinoza Orías, Alejandro A.; Andersson, Gunnar B. J.; An, Howard S.; Inoue, Nozomu

2013-01-01

392

Patients with nodding syndrome in Uganda improve with symptomatic treatment: a cross-sectional study  

PubMed Central

Objectives Nodding syndrome (NS) is a poorly understood neurological disorder affecting thousands of children in Africa. In March 2012, we introduced a treatment intervention that aimed to provide symptomatic relief. This intervention included sodium valproate for seizures, management of behaviour and emotional difficulties, nutritional therapy and physical rehabilitation. We assessed the clinical and functional outcomes of this intervention after 12?months of implementation. Design This was a cross-sectional study of a cohort of patients with NS receiving the specified intervention. We abstracted preintervention features from records and compared these with the current clinical status. We performed similar assessments on a cohort of patients with other convulsive epilepsies (OCE) and compared the outcomes of the two groups. Participants Participants were patients with WHO-defined NS and patients with OCE attending the same centres. Outcome measures The primary outcome was the proportion of patients with seizure freedom (?1?month without seizures). Secondary outcome measures included a reduction in seizure frequency, resolution of behaviour and emotional difficulties, and independence in basic self-care. Results Patients with NS had had a longer duration of symptoms (median 5 (IQR 3, 6) years) compared with those with OCE (4 (IQR 2, 6) years), p<0.001. The intervention resulted in marked improvements in both groups; compared to the preintervention state, 121/484 (25%) patients with NS achieved seizure freedom and there was a >70% reduction in seizure frequency; behaviour and emotional difficulties resolved in 194/327 (59%) patients; 193/484 (40%) patients had enrolled in school including 17.7% who had earlier withdrawn due to severe seizures, and over 80% had achieved independence in basic self-care. These improvements were, however, less than that in patients with OCE of whom 243/476 (51.1%) patients were seizure free and in whom the seizure frequency had reduced by 86%. Conclusions Ugandan children with NS show substantial clinical and functional improvements with symptomatic treatments suggesting that NS is probably a reversible encephalopathy. PMID:25398677

Idro, Richard; Namusoke, Hanifa; Abbo, Catherine; Mutamba, Byamah B; Kakooza-Mwesige, Angelina; Opoka, Robert O; Musubire, Abdu K; Mwaka, Amos D; Opar, Bernard T

2014-01-01

393

Cost-effectiveness analysis of intracranial stent placement versus contemporary medical management in patients with symptomatic intracranial artery stenosis  

PubMed Central

Background: Intracranial angioplasty and stent placement has been increasingly evaluated as a new method for treatment of symptomatic intracranial stenosis in select patients. The Food and Drug Administration (FDA) has approved intracranial stent treatment of symptomatic atherosclerotic intracranial lesions. Purpose: To determine the cost-effectiveness of intracranial artery stent placement compared with contemporary medical management for secondary stroke prevention among patients with symptomatic intracranial stenosis. Methods: Clinical outcome data were obtained from the aspirin treatment arm of the Comparison of Warfarin and Aspirin for Symptomatic Intracranial Disease (WASID) trial (n = 280) and 12 case series (n = 216) of patients who underwent stent placement of symptomatic intracranial stenosis with comparable characteristics. Total cost of procedure and medical management-only was calculated using the rates of major stroke, minor stroke, or death in each group. All costs are expressed in 2010 US$. The quality-adjusted life-year (QALY) of each intervention strategy was estimated using the frequency of the outcomes of major and minor stroke, death, and baseline health. An incremental cost-effectiveness ratio (ICER) was formulated for a 1-year period. Results: The total rate of stroke at one year was 10.2% (6.1–14.2%) and the rate of all-cause mortality was 3.7% (1.2–6.2%) in the stent group. The corresponding annualized rates of stroke and all-cause mortality in the medical management-only group were 15% (10.8–19.2%) and 2.4% (0.6–4.2%), respectively. The calculated net costs at one year for intracranial stent placement and contemporary medical management were US$16,898 and US$3,468, respectively. Overall, QALYs for the two groups were 0.82 and 0.81 (in a range of 0 to 0.89 corresponding to death and baseline health), respectively. The cost per QALY gained after intracranial stent placement and contemporary medical therapy was US$20,542 and US$4,265, respectively. The corresponding ICER for stent versus medical treatment alone was US$1,416,268. Conclusion: The reduced risk of stroke following intracranial stent placement is offset by significantly higher procedure-associated net costs. Select procedures in patients with symptomatic stenosis of 70% or greater are more likely to be cost-effective. PMID:24358413

Khan, Amir; Hassan, Ameer; Suri, Fareed; Qureshi, Adnan

2013-01-01

394

Ocriplasmin for symptomatic vitreomacular adhesion: an evidence-based review of its potential  

PubMed Central

Vitreomacular traction is a multicategory entity that may cause substantial visual loss due to the formation of a macular hole or traction-induced tissue distortion. The advent of optical coherent tomography (OCT) has demonstrated the anatomic features of persistent vitreomacular attachment (VMA) more definitively, including in many asymptomatic or minimally symptomatic patients. The indications for intervention are unclear, since it is not possible to predict which eyes might be likely to develop progressive visual loss. This has been especially important since for many years, the only treatment option involved surgical intervention (vitrectomy) to release the persistent VMA. Recently, a pharmacolytic agent, ocriplasmin, has become available after many years of development and investigation, and may offer a feasible alternative to surgery, or even a risk/benefit ratio sufficiently favorable to offer intervention at an earlier stage of VMA. Several studies, including a large, prospective clinical trial, have established the foundation of its rationale and efficacy, providing the basis of its approval. The role for ocriplasmin in clinical practice is in the process of being determined. This paper summarizes current knowledge and status of investigations regarding ocriplasmin-induced pharmacologic vitreolysis, and offers some evidence-based considerations for its use. PMID:24711777

Song, Su Jeong; Smiddy, William E

2014-01-01

395

Large symptomatic simple hepatic cyst with gastric compression treated with percutaneous drainage.  

PubMed

Nonparasitic hepatic cysts consist of a heterogeneous group of disorders, which differ in etiology, prevalence, and manifestations. Simple hepatic cysts are considered nonparasitic ones. These are a result of congenital anomalies of the biliary system, and these may be single or multiple. Generally, hepatic cysts are incidentally found during occasional laparotomy or laparoscopy, necropsy, and even during routine ultrasound or computerized tomography (CT) scan. Nowadays, with improving diagnostic techniques, hepatic cysts are becoming more common. Generally these lesions are asymptomatic. However, if they grow, they may become symptomatic. Symptoms depend on the size and location. When symptoms developed, these must be treated. Compressive complications due to local "liver mass" effect include: portal hypertension, edema due to caval compression, jaundice and arrhythmia and duodenal obstruction. Gastric extrinsic compression by liver cysts has been poorly described. Herein, we present a case of a female in whom percutaneous drainage of a large simple hepatic cysts not complicated was performed in order to reduce signs of gastric compression. PMID:24770829

Zippi, M; Bruni, A; Scevola, G; Pica, R; Cassieri, C; Marzano, C; Paoluzi, P

2014-01-01

396

Risk Factors for Acute Symptomatic Seizure in Bacterial Meningitis in Children.  

PubMed

The aim of this study was to investigate the association between clinical and laboratory parameters at admission and the occurrence of in-hospital symptomatic seizures in children with acute bacterial meningitis in Brazil. A retrospective case-control study in 270 children with confirmed bacterial meningitis, aged from 1 month to 14 years, was conducted between January 2004 and December 2008. Associations with the occurrence of in-hospital epileptic seizures were adjusted using stepwise multiple logistic regression analysis. Sixty-seven children suffered at least one in-hospital epileptic seizure. After multivariate analysis, the independent predictors considered for in-hospital epileptic seizures were as follows: age less than 2 years (odds ratio = 0.97; 95% confidence interval 0.97-0.98), pneumococcal etiology (odds ratio = 4.55; 95% confidence interval 1.88-11.0); altered mental status (odds ratio = 3.47; 95% confidence interval 1.66-7.26) and cerebrospinal fluid leukocyte count below 1000 cells (odds ratio = 2.14; 95% confidence interval 0.99-4.60). Mortality was higher in patients with intrahospital epileptic seizures compared to those without (25/67 [37.3%] vs 9/203 [4.43%], P < .001]. PMID:25387548

Corrêa-Lima, Ana Rosa Melo; Miranda-Filho, Demócrito de Barros; Valença, Marcelo Moraes; Andrade-Valença, Luciana

2014-11-10

397

The Clinical Problem of Symptomatic Alzheimer Disease and Mild Cognitive Impairment  

PubMed Central

Alzheimer disease (AD) is the most common cause of dementia in the elderly. Clinicopathological studies support the presence of a long preclinical phase of the disease, with the initial deposition of AD pathology estimated to begin approximately 10–15 years prior to the onset of clinical symptoms. The hallmark clinical phenotype of AD is a gradual and progressive decline in two or more cognitive domains, most commonly involving episodic memory and executive functions, that is sufficient to cause social or occupational impairment. Current diagnostic criteria can accurately identify AD in the majority of cases. As disease-modifying therapies are being developed, there is growing interest in the identification of individuals in the earliest symptomatic, as well as presymptomatic, stages of disease, because it is in this population that such therapies may have the greatest chance of success. The use of informant-based methods to establish cognitive and functional decline of an individual from previously attained levels of performance best allows for the identification of individuals in the very mildest stages of cognitive impairment. PMID:22553492

Tarawneh, Rawan; Holtzman, David M.

2012-01-01

398

Brenneria populi sp. nov., isolated from symptomatic bark of Populus×euramericana canker.  

PubMed

Five Gran-stain-negative, facultatively anaerobic, motile, bacterial strains were isolated from symptomatic bark tissue of Populus×euramericana canker. Strains grew at 4-41 °C, pH 4-10 and 0-6?% (w/v) salinity. They were positive with respect to catalase activity and negative for oxidase activity, nitrate reduction and the Voges-Proskauer reaction. Analysis of 16S rRNA gene sequences indicated that these five poplar isolates belong to the genus Brenneria, having highest sequence similarity of 95.98?% with Brenneria goodwinii LMG 26270(T). These five isolates formed a single cluster based on multilocus sequence analysis, indicating that they all belong to a single taxon within the genus Brenneria, which was confirmed by DNA-DNA hybridization. The DNA G+C content was 54.9-55.7 mol%, and the main fatty acids were C16?:?0, C18?:?1?7c, C17?:?0 cyclo and C16?:?1?7c/iso-C15?:?0 2-OH. Based on these results, we describe a novel species of the genus Brenneria with the proposed name Brenneria populi sp. nov. The type strain is D9-5(T) (?=?CFCC 11963(T)?=?KCTC 42088(T)). PMID:25385993

Li, Yong; Fang, Wei; Xue, Han; Liang, Wen-Xing; Wang, Lai-Fa; Tian, Guo-Zhong; Wang, Xi-Zhuo; Lin, Cai-Li; Li, Xia; Piao, Chun-Gen

2015-02-01

399

Thalidomide, clarithromycin, lenalidomide and dexamethasone therapy in newly diagnosed, symptomatic multiple myeloma.  

PubMed

Abstract We studied T-BiRD (thalidomide [Thalomid(®)], clarithromycin [Biaxin(®)], lenalidomide [Revlimid(®)] and dexamethasone) in symptomatic, newly diagnosed multiple myeloma. In 28-day cycles, patients received dexamethasone 40 mg/day on days 1, 8, 15, 22, clarithromycin 500 mg twice daily on days 1-28; lenalidomide 25 mg/day on days 1-21; and thalidomide 100 mg/day (50 mg/day on days 1-7 of cycle 1 only) on days 1-28. Twenty-six patients received a median of 6 cycles (range 0-41). Overall response rate (ORR) was 80% for the group and 100% in 11 patients who underwent autologous stem cell transplantation as part of first-line therapy. The 4-year overall survival rate was 74.9%, and the median progression-free survival was 35.6 months. Eight patients discontinued due to regimen toxicity. Grade 3 non hematologic toxicity affected 12 patients (46.2%). T-BiRD is a highly active regimen with potential toxicity limitations. ClinicalTrials.gov identifier: NCT00538733. PMID:24576165

Mark, Tomer M; Bowman, Isaac A; Rossi, Adriana C; Shah, Manan; Rodriguez, Melissa; Quinn, Ryann; Pearse, Roger N; Zafar, Faiza; Pekle, Karen; Jayabalan, David; Ely, Scott; Coleman, Morton; Chen-Kiang, Selina; Niesvizky, Ruben

2014-12-01

400

Symptomatic Models of Parkinson's Disease and L-DOPA-Induced Dyskinesia in Non-human Primates.  

PubMed

Models of Parkinson's disease (PD) can be produced in several non-human primate (NHP) species by applying neurotoxic lesions to the nigrostriatal dopamine pathway. The most commonly used neurotoxin is MPTP, a compound accidentally discovered as a contaminant of street drugs. Compared to other neurotoxins, MPTP has the advantage of crossing the blood-brain barrier and can thus be administered systemically. MPTP-lesioned NHPs exhibit the main core clinical features of PD. When treated with L-DOPA, these NHP models develop involuntary movements resembling the phenomenology of human dyskinesias. In old-world NHP species (macaques, baboons), choreic and dystonic dyskinesias can be readily distinguished and quantified with specific rating scales. More recently, certain non-motor symptoms relevant to human PD have been described in L-DOPA-treated MPTP-NHPs, including a range of neuropsychiatric abnormalities and sleep disturbances. The main shortcomings of MPTP-NHP models consist in a lack of progression of the underlying neurodegenerative lesion, along with an inability to model the intracellular protein-inclusion pathology typical of PD. The strength of MPTP-NHP models lies in their face and predictive validity for symptomatic treatments of parkinsonian motor features. Indeed, these models have been instrumental to the development of several medical and surgical approaches that are currently applied to treat PD. PMID:25158623

Johnston, Tom M; Fox, Susan H

2014-08-27

401

Intracranial Stenting for Severe Symptomatic Stenosis: Self-Expandable versus Balloon-Expandable Stents  

PubMed Central

Summary Intracranial atherosclerosis against optimal medical treatment requires reperfusion therapy to improve the clinical outcome. We compared outcomes between self-expandable stent (SES) and/or balloon-expandable stent (BES) and present the potential advantages of using each stent. During the same time frame before and after Wingspan introduction to our institute, 115 consecutive patients underwent intracranial stenting for symptomatic severe intracranial stenosis against optimal medical treatment using BES alone (n = 71) vs. BES or SES (n = 44). We analyzed 15 factors including outcome related to an adverse event (AE), modified Rankin Scale (mRS) and restenosis at six months and retrospectively compared the potential advantages of using each stent. BES or SES groups had a significantly lower AE rate (2.3%) than the BES only group (14%) (P = 0.049) revealing mRS of ? 2 in all patients at six months compared to 93% of the patients in the BES group. Analysis of BES or SES subgroups revealed that BES was associated with less residual stenosis after stenting than SES (18 vs. 32%; P < 0.001). Both SES and BES can improve the clinical outcome of intracranial stenting especially with a selective choice of SES or BES. Further study is needed to analyse the difference in long-term outcome and the restenosis rate between SES and BES. PMID:24070075

Park, Soonchan; Kim, Jae-Hyuk; Kwak, Jae Kyun; Baek, Hye Jin; Kim, Bo Hyun; Lee, Dong-geun; Lee, Deok Hee; Kim, Jong Sung; Suh, Dae Chul

2013-01-01

402

Intracranial stenting for severe symptomatic stenosis: self-expandable versus balloon-expandable stents.  

PubMed

Intracranial atherosclerosis against optimal medical treatment requires reperfusion therapy to improve the clinical outcome. We compared outcomes between self-expandable stent (SES) and/or balloon-expandable stent (BES) and present the potential advantages of using each stent. During the same time frame before and after Wingspan introduction to our institute, 115 consecutive patients underwent intracranial stenting for symptomatic severe intracranial stenosis against optimal medical treatment using BES alone (n = 71) vs. BES or SES (n = 44). We analyzed 15 factors including outcome related to an adverse event (AE), modified Rankin Scale (mRS) and restenosis at six months and retrospectively compared the potential advantages of using each stent. BES or SES groups had a significantly lower AE rate (2.3%) than the BES only group (14%) (P = 0.049) revealing mRS of ? 2 in all patients at six months compared to 93% of the patients in the BES group. Analysis of BES or SES subgroups revealed that BES was associated with less residual stenosis after stenting than SES (18 vs. 32%; P < 0.001). Both SES and BES can improve the clinical outcome of intracranial stenting especially with a selective choice of SES or BES. Further study is needed to analyse the difference in long-term outcome and the restenosis rate between SES and BES. PMID:24070075

Park, Soonchan; Kim, Jae-Hyuk; Kwak, Jae Kyun; Baek, Hye Jin; Kim, Bo Hyun; Lee, Dong-Geun; Lee, Deok Hee; Kim, Jong Sung; Suh, Dae Chul

2013-09-01

403

Norepinephrine as a Potential Aggravator of Symptomatic Cerebral Vasospasm: Two Cases and Argument for Milrinone Therapy  

PubMed Central

Background. During hypertensive therapy for post-subarachnoid hemorrhage (SAH) symptomatic vasospasm, norepinephrine is commonly used to reach target blood pressures. Concerns over aggravation of vasospasm with norepinephrine exist. Objective. To describe norepinephrine temporally related deterioration in neurological examination of two post-SAH patients in vasospasm. Methods. We retrospectively reviewed two charts of patients with delayed cerebral ischemia (DCI) post-SAH who deteriorated with norepinephrine infusions. Results. We identified two patients with DCI post-SAH who deteriorated during hypertensive therapy with norepinephrine. The first, a 43-year-old male presented to hospital with DCI, failed MABP directed therapy with rapid deterioration in exam with high dose norepinephrine and MABP of 140–150?mm?Hg. His exam improved on continuous milrinone and discontinuation of norepinephrine. The second, a 39-year-old female who developed DCI on postbleed day 8 responded to milrinone therapy upfront. During further deterioration and after angioplasty, norepinephrine was utilized to drive MABP to 130–140?mm?Hg. Progressive deterioration in examination occurred after angioplasty as norepinephrine doses escalated. After discontinuation of norepinephrine and continuation of milrinone, function dramatically returned but not to baseline. Conclusions. The potential exists for worsening of DCI post-SAH with hypertensive therapy directed by norepinephrine. A potential role exists for vasodilation and inotropic directed therapy with milrinone in the setting of DCI post-SAH. PMID:25431686

Zeiler, F. A.; Silvaggio, J.; Kaufmann, A. M.; Gillman, L. M.; West, M.

2014-01-01

404

Factors associated with H pylori epidemiology in symptomatic children in Buenos Aires, Argentina  

PubMed Central

AIM: To determine prevalence of H pylori infection in symptomatic children in Buenos Aires, Argentina, and to investigate factors associated with H pylori positivity. METHODS: A total of 395 children with upper gastrointestinal symptoms referred to the Gastroente-rology Unit of the Children Hospital “Sor Maria Ludovica” were evaluated for the presence of H pylori by the 13C-Urea Breath Test (13C-UBT). A questionnaire was applied to the recruited population. RESULTS: Prevalence of H pylori infection was 40.0% in this population (mean age 9.97 ± 3.1 years). The factors associated with H pylori positivity were number of siblings (P < 0.001), presence of pet cats (P = 0.03) and birds (P = 0.04) in the household, and antecedents of gastritis among family members (P = 0.01). After multivariate analysis, number of siblings [Odds ratio (OR) = 1.39; 95% CI, 1.20-1.61] and contact with pet cats (OR = 1.76; 95% CI, 1.00-3.09) remained as variables associated with H pylori infection. CONCLUSION: The prevalence of H pylori infection in children with upper gastrointestinal symptoms in Argentina was similar to that reported in developed countries. Children from families with a higher crowding index and presence of pet cats have a higher risk of being colonized with H pylori. PMID:16981273

Goldman, Cinthia; Barrado, Andrés; Janjetic, Mariana; Balcarce, Norma; Rua, Eduardo Cueto; Oshiro, Masaru; Calcagno, María L; Sarrasague, Margarita Martinez; Fuda, Julián; Weill, Ricardo; Zubillaga, Marcela; Perez-Perez, Guillermo I; Boccio, José

2006-01-01

405

Intravenous Flat-Detector Computed Tomography Angiography for Symptomatic Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

The study evaluated the diagnostic accuracy of intravenous flat-detector computed tomography (IV FDCT) angiography in assessing hemodynamically significant cerebral vasospasm in patients with subarachnoid hemorrhage (SAH) with digital subtraction angiography (DSA) as the reference. DSA and IV FDCT were conducted concurrently in patients suspected of having symptomatic cerebral vasospasm postoperatively. The presence and severity of vasospasm were estimated according to location (proximal versus distal). Vasospasm >50% was defined as having hemodynamic significance. Vasospasms <30% were excluded from this analysis to avoid spectrum bias. Twenty-nine patients (311 vessel segments) were measured. The intra- and interobserver agreements were excellent for depicting vasospasm (k = 0.84 and 0.74, resp.). IV FDCT showed a sensitivity of 95.7%, specificity of 92.3%, positive predictive value of 93.6%, and negative predictive value of 94.7% for detecting vasospasm (>50%) with DSA as the reference. Bland-Altman plots revealed good agreement of assessing vasospasm between the two tests. The discrepancy of vasospasm severity was more noted in the distal location with high-severity. However, it was not statistically significant (Spearman's rank test; r = 0.15, P = 0.35). Therefore, IV FDCT could be a feasible noninvasive test to evaluate suspected significant vasospasm in SAH. PMID:25383367

Jeon, Jin Pyeong; Sheen, Seung Hun; Cho, Yong-Jun

2014-01-01

406

Distribution pattern of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs in males  

PubMed Central

Background: The pattern of distribution of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs has been published, though scantily, especially in males. We decided to look at our own series, compare and contrast ours with some of those published. Materials and Methods: We treated 88 locations of this lesion in 68 males. The clinical features were those of lower back pains, with or without radiation into the lower extremities, sensory loss and paresis of the limbs. There was a case of loss of urinary bladder and ano-rectal control. All lesions were confirmed through cauda-equinograms and treated under general anaesthesia in knee-chest position (MECCA position). The patients were followed up for 3-6 months post-operatively. Results: There were 88 locations in 68 males of 21-70 years of age, with 29 prolapses occurring during the age range 31-40 years, while 54 locations were on the left and 48 at L4/5. The procedures were well tolerated by all patients and there were no post-operative complications. Conclusion: This lesion in our series occurred mostly on the left, at the L4/5 level and peaked at 31-40 years age range. The predictability of occurrence of this disease, using side, level and age is still not feasible in males from our series. PMID:24403714

Nnamdi, Ibe Michael Onwuzuruike

2013-01-01

407

Symptomatic and complicated nonhereditary developmental liver cysts: cross-sectional imaging findings.  

PubMed

Commonly encountered in the general population, in the vast majority of cases nonhereditary developmental liver cysts are asymptomatic, not associated with altered hepatic function and confidently diagnosed on imaging studies, and do not require further workup, follow-up, or treatment. However, particularly in women, simple hepatic cysts may reach large sizes and cause symptoms and signs resulting from mass effect, vascular compression, and biliary obstruction. Furthermore, although rarely compared to the incidence observed in patients with adult polycystic kidney and liver disease, sporadic hepatic cysts sometimes undergo life-threatening complications such as intracystic hemorrhage, infection, or rupture, which require prompt imaging triage and appropriate interventional, laparoscopic, or open surgical treatment. This pictorial essay reviews with examples the cross-sectional imaging findings of symptomatic and complicated nonhereditary liver cysts, aiming to provide radiologists with an increased familiarity with these uncommon, challenging occurrences. Emphasis is placed on the role of MRI as a useful problem-solving modality to elucidate the complex imaging appearances resulting from intracystic bleeding and superinfection, and to differentiate complicated cysts from other hemorrhagic liver lesions and biliary cystic tumors. PMID:24249390

Tonolini, Massimo; Rigiroli, Francesca; Bianco, Roberto

2014-06-01

408

Incidence and Risk Factors of Symptomatic Peripartum Diastasis of Pubic Symphysis  

PubMed Central

This study was undertaken to determine incidence, associated risk factors, and clinical outcomes of a diastasis of pubic symphysis. Among 4,151 women, who delivered 4,554 babies at the Department of Obstetrics of Seoul National University Bundang hospital from January 2004 to December 2006, eleven women were diagnosed as having a symptomatic diastasis of pubic symphysis. We estimated the incidence of the diastasis and identified the associated risk factors. To evaluate the pain relief and reduction of diastasis we followed up the 11 diastatic patients. The incidence of the diastasis was 1/385. Primiparity (P = 0.010) and twin gestation (P = 0.016) appeared as risk factors for diastasis by univairable analysis; and twin gestation appeared to be the only risk factor (P = 0.006) by logistic analysis. Two patients were operated due to intractable pain; and the remaining nine patients were treated conservatively. The diastatic gap decreased to less than 1.5 cm by 2 to 6 weeks after the diagnosis and then remained stationary. At a mean follow-up of 22.1 months (range, 12 to 47 months), five of 11 patients had persistent symphysis pubis dysfunction. Diastasis is more frequent than generally acknowledged. Pregnant women with multiple gestations should be informed about the potential risk of pubic symphysis diastasis. PMID:24550659

Yoo, Jeong Joon; Lee, Young-Kyun; Hong, Joon Seok; Kang, Bun-Jung; Koo, Kyung-Hoi

2014-01-01

409

Andersen-Tawil syndrome: Report of 3 novel mutations and high risk of symptomatic cardiac involvement.  

PubMed

Introduction: Andersen-Tawil syndrome (ATS) is a potassium channelopathy affecting cardiac and skeletal muscle. Periodic paralysis is a presenting symptom in some patients, whereas, in others, symptomatic arrhythmias or prolongation of QT in echocardiographic recordings will lead to diagnosis of ATS. Striking intrafamilial variability of expression of KCNJ2 mutations and rarity of the syndrome may lead to misdiagnosis. Methods: We report 15 patients from 8 Polish families with ATS, including 3 with novel KCNJ2 mutations. Results: All patients had dysmorphic features; periodic paralysis affected males more frequently than females (80% vs. 20%), and most attacks were normokalemic. Two patients (with T75M and T309I mutations) had aborted sudden cardiac death. An implantable cardioverter-defibrillator was utilized in 40% of cases. Conclusion: KCNJ2 mutations cause a variable phenotype, with dysmorphic features seen in all patients studied, a high penetrance of periodic paralysis in males and ventricular arrhythmia with a risk of sudden cardiac death. Muscle Nerve, 2014. PMID:24861851

Kostera-Pruszczyk, Anna; Potulska-Chromik, Anna; Pruszczyk, Piotr; Bieganowska, Katarzyna; Miszczak-Knecht, Maria; Bienias, Piotr; Szcza?uba, Krzysztof; Lee, Hsien-Yang; Quinn, Emily; Ploski, Rafal; Kaminska, Anna; Ptá?ek, Louis J

2014-05-23

410

[Respiratory symptomatics among patients at primary health clinics in Vitória, Espírito Santo State, Brazil].  

PubMed

The aim of this study was to estimate the rate of positive respiratory symptomatics among patients seeking treatment at primary health clinics in Vitória, Espírito Santo State, Brazil. This cross-sectional study included 603 individuals that answered a questionnaire with socio-demographic data and a question on cough in the previous three weeks. The prevalence ratio was calculated with 5% significance. The proportion of patients with positive respiratory symptoms in the municipality was 4%, varying from 1.6 to 11.7% between regions. The majority (71%) did not report cough as the reason for coming to the health clinic. Variables significantly associated with respiratory symptoms were: shortness of breath (PR = 6.29; 95%CI: 2.22-21.81) and lack of appetite (PR = 2.75; 95%CI: 1.08-6.82). Among patients with respiratory symptoms, cough was the principal reason for seeking treatment. This condition was only associated with two variables, thus demonstrating the need to adopt different strategies to identify these individuals among the daily patient flow in primary health clinics. PMID:21229220

Moreira, Claudia Maria Marques; Zandonade, Eliana; Lacerda, Thamy; Maciel, Ethel Leonor Noia

2010-08-01

411

Intravascular Ultrasound of Symptomatic Intracranial Stenosis Demonstrates Atherosclerotic Plaque with Intraplaque Hemorrhage: A Case Report  

PubMed Central

BACKGROUND Intracranial artery stenosis is assumed to represent atherosclerotic plaque. Catheter cerebral arteriography shows that intracranial stenosis may progress, regress, or remain unchanged. It is counterintuitive that atherosclerotic plaque should spontaneously regress, raising questions about the composition of intracranial stenoses. Little is known about this disease entity in vivo. We provide the first demonstration of in vivo atherosclerotic plaque with intraplaque hemorrhage using intravascular ultrasound (IVUS). CASE DESCRIPTION A 35-year-old man with multiple vascular risk factors presented with recurrent stroke failing medical therapy. Imaging demonstrated left internal carotid artery occlusion, severe intracranial right internal carotid artery stenosis, and cerebral perfusion failure. Cerebral arteriography with IVUS confirmed 85% stenosis of the petrous right carotid artery due to atherosclerotic plaque with intraplaque hemorrhage. Intracranial stent-supported angioplasty was performed with IRB approval. The patient recovered without complication. CONCLUSIONS This case supports the premise that symptomatic intracranial stenosis can be caused by atherosclerotic plaque complicated by intraplaque hemorrhage similar to coronary artery plaque. IVUS provides additional characteristics that define intracranial atherosclerosis and high-risk features. To our knowledge, this is the first report of stroke due to unstable atherosclerotic plaque with intraplaque hemorrhage in vivo. PMID:19021843

Meyers, Philip M.; Schumacher, H. Christian; Gray, William A.; Fifi, Johanna; Gaudet, John G.; Heyer, Eric J.; Chong, Ji Y.

2009-01-01

412

Enhancement of femtosecond lenticule extraction for visual symptomatic eye after myopia correction  

PubMed Central

Background The novel Femtosecond lenticule extraction (FLEx) procedure has been considered safe, predictable, and effective in treating myopia and myopic astigmatism, with few complications. However, an enhancement procedure after FLEx may be required in some cases, but has not been reported in detail. Case presentation A 24-year-old woman who had undergone bilateral FLEx with the VisuMax femtosecond laser treatment for myopic astigmatism complained of double vision in her left eye after the operation. The manifest refraction was ?0.50/-1.25?×?180°. The corneal topography showed a central-inferior steepened zone. The ocular wavefront measurements displayed a high value of total aberrations as well as coma. She was scheduled for an enhancement procedure and it was performed by relifting the primary FLEx flap in the left eye four months later. Ablation was made with the Mel-80 excimer laser. After retreatment, the corresponding aberrations were diminished and the corneal topography turned flattened. Her symptom resolved completely with good visual outcomes. Conclusion This first detailed case report demonstrates the feasibility and efficacy of enhancement after FLEx for visual symptomatic eye after myopia correction. An analysis of more cases would be necessary to determine a more definite profile. PMID:24884873

2014-01-01

413

Progesterone and progesterone receptor modulators in the management of symptomatic uterine fibroids.  

PubMed

The majority of symptomatic uterine fibroids are currently treated by surgical interventions (myomectomy or hysterectomy) or radiological treatments (uterine artery embolisation or focussed ultrasound surgery). None of these treatments is a panacea, and what is conspicuous is the lack of an effective long-term medical therapy for a disorder so common among women of reproductive age. It has been known for some time that progesterone and its receptors enhance proliferative activity in fibroids and this has raised the possibility that anti-progestins and (PRMs) could be useful in the medical management of fibroids. Some of the compounds which have produced promising results in recent clinical trials or research studies include mifepristone, CDB-4124 (telapristone), CP-8947, J-867 (asoprisnil) and CDB-2914 (ulipristal acetate or UA). UA has recently completed Phase III clinical trials with very encouraging results, and has now acquired a licence for clinical use in Europe. While considerable research has yet to be done on the long-term safety and efficacy of UA there is nevertheless good reason for optimism on the emergence of effective medical therapy in the form of UA and possibly other PRMs. PMID:22901974

Talaulikar, Vikram Sinai; Manyonda, Isaac

2012-12-01

414

Alcohol Ablation Therapy of an Atypically Located Symptomatic Bronchogenic Cyst: A Case Report  

SciTech Connect

Bronchogenic cyst is a rare developmental lesion. It is usually asymptomatic and most frequently located in the middle mediastinum and lung parenchyma. It can cause symptoms only when infected or pressing on neighboring structures. The MRI findings in a 34-year-old woman with an 8 months history of back pain were evaluated and revealed a cystic lesion in the left paravertebral area. The histopathologic evaluation of the material aspirated with CT guidance was reported to be bronchogenic cyst. A simultaneous alcohol ablation was accomplished. After the procedure the patient's pain disappeared and the follow-up MRI scan 1 year later revealed no relapse. Paravertebrally located bronchogenic cysts are very rare and only 3 cases were found to be reported in the medical literature prior to this one. While aspiration alone is sufficient for diagnosis, it is insufficient to treat the lesion and prevent the recurrences. This paper reports a paravertebral bronchogenic cyst which was symptomatic despite of its small size. CT-guided aspiration was accomplished and simultaneous alcohol ablation was carried out to prevent recurrences.

Lakadamyali, Hatice, E-mail: lakadamyali@mynet.com; Ergun, Tarkan [Alanya Teaching and Medical Research Center, Baskent University, Department of Radiology (Turkey); Lakadamyali, Huseyin [Alanya Teaching and Medical Research Center, Baskent University, Department of Pulmonary Diseases (Turkey); Oguzkurt, Levent [Adana Teaching and Medical Research Center, Baskent University, Department of Radiology (Turkey)

2007-11-15

415

Management of Chronic Paronychia  

PubMed Central

Chronic paronychia is an inflammatory disorder of the nail folds of a toe or finger presenting as redness, tenderness, and swelling. It is recalcitrant dermatoses seen commonly in housewives and housemaids. It is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens. Repeated bouts of inflammation lead to fibrosis of proximal nail fold with poor generation of cuticle, which in turn exposes the nail further to irritants and allergens. Thus, general preventive measures form cornerstone of the therapy. Though previously anti-fungals were the mainstay of therapy, topical steroid creams have been found to be more effective in the treatment of chronic paronychia. In recalcitrant cases, surgical treatment may be resorted to, which includes en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail plate removal. Newer therapies and surgical modalities are being employed in the management of chronic paronychia. In this overview, we review recent epidemiological studies, present current thinking on the pathophysiology leading to chronic paronychia, discuss the challenges chronic paronychia presents, and recommend a commonsense approach to management. PMID:24470654

Relhan, Vineet; Goel, Khushbu; Bansal, Shikha; Garg, Vijay Kumar

2014-01-01

416

Symptomatic carotid ischaemic events: safest and most cost effective way of selecting patients for angiography, before carotid endarterectomy.  

PubMed Central

OBJECTIVE: To determine the safest, least costly, and most effective way to select patients with symptomatic carotid ischaemic events for carotid angiography before carotid endarterectomy. DESIGN: Prospective cohort study. SETTING: University departments of clinical neurosciences and clinical neurology. PATIENTS: 485 Patients with carotid territory transient ischaemic attacks of the brain (n = 224) or eye (n = 162) or retinal infarction (n = 99) were referred to a single neurologist between 1976 and 1986. INTERVENTIONS: Clinical examination by auscultation over the precordium, supraclavicular fossae, and neck vessels (all patients). Cerebral angiography of patients suitable for carotid endarterectomy. MAIN OUTCOME MEASURES: Financial cost and number of disabling strokes after angiography. RESULTS: 296 Patients were investigated by cerebral angiography. Ischaemic symptoms had occurred in the distribution of 298 internal carotid arteries (symptomatic) that were imaged, two patients having bilateral symptoms. The presence or absence of a carotid bruit and the maximum percentage diameter stenosis of the origin of the symptomatic internal carotid artery were correlated. The prevalence of mild disease (diameter stenosis greater than or equal to 25%) of the symptomatic internal carotid artery was 57%, and if an ipsilateral carotid bruit was heard the probability of mild stenosis rose to 92%. The prevalence of moderate disease of the symptomatic internal carotid artery (stenosis greater than or equal to 50%) was 39%, and if a bruit was heard the probability doubled to 78%. The prevalence of severe internal carotid disease (stenosis greater than or equal to 75%) was 22%, and if a bruit was heard the probability was more than double, at 49%. The direct cost to both the NHS and the private health sector of investigating patients with symptomatic carotid ischaemia was estimated for several strategies of carotid artery imaging and expressed in terms of financial cost and number of strokes after angiography incurred in detecting all patients with diameter stenosis of the symptomatic internal carotid artery of greater than or equal to 25%, 50%, or 75%. To detect diameter stenosis of the internal carotid artery of greater than or equal to 25% it is most cost effective to proceed directly to cerebral angiography in patients with a carotid bruit over the symptomatic carotid bifurcation and to screen patients without a carotid bruit by duplex carotid ultrasonography; patients in whom duplex ultrasonography discloses stenosis of greater than or equal to 25% are then referred for cerebral angiography. To detect only more severe internal carotid disease (stenosis of greater than or equal to 50%) the same policy applies, unless the local duplex ultrasonographic service is particularly efficient and reliable, when it is probably most cost effective and safer to screen all patients by this method irrespective of the findings on cervical auscultation. To detect stenosis of 75% or greater it is most cost effective to screen all patients with duplex ultrasonography, whether a carotid bruit is present or not, because this approach reduces the number of angiograms required, is the least expensive, and results in the least number of strokes after angiography. CONCLUSIONS: Patients selection for cerebral angiography before carotid endarterectomy needs to be appropriate and cost effective. Sound clinical evaluation and duplex carotid ultrasound are required. The findings of this study should not be applied to other medical centres without first considering possible differences in the prevalence of carotid artery disease, the efficiency and reliability of duplex ultrasonography, the local complication rates of cerebral angiography, and the local costs of the imaging procedures. PMID:2115384

Hankey, G J; Warlow, C P