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1

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

2

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

3

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

PubMed

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

4

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

5

A Comparative Study of Clinicopathological Features between Chronic Cholecystitis Patients with and without Helicobacter pylori Infection in Gallbladder Mucosa  

PubMed Central

Background Helicobacter pylori has been isolated from 10%–20% of human chronic cholecystitis specimens but the characteristics of “Helicobacter pylori positive cholecystitis” remains unclear. This study aims to compare the clinicopathological features between chronic cholecystitis patients with and without Helicobacter pylori infection in gallbladder mucosa. Methods Three hundred and twenty-six chronic cholecystitis patients were divided into two groups according to whether Helicobacter pylori could be detected by culture, staining or PCR for Helicobacter 16s rRNA gene in gallbladder mucosa. Positive samples were sequenced for Helicobacter pylori-specific identification. Clinical parameters as well as pathological characteristics including some premalignant lesions and the expression levels of iNOS and ROS in gallbladder were compared between the two groups. Results Helicobacter pylori infection in gallbladder mucosa was detected in 20.55% of cholecystitis patients. These patients had a higher prevalence of acid regurgitation symptoms (p?=?0.001), more histories of chronic gastritis (p?=?0.005), gastric ulcer (p?=?0.042), duodenal ulcer (p?=?0.026) and higher presence of Helicobacter pylori in the stomach as compared to patients without Helicobacter pylori infection in the gallbladder mucosa. Helicobacter pylori 16s rRNA in gallbladder and gastric-duodenal mucosa from the same individual patient had identical sequences. Also, higher incidences of adenomyomatosis (p?=?0.012), metaplasia (p?=?0.022) and higher enhanced expressions of iNOS and ROS were detected in Helicobacter pylori infected gallbladder mucosa (p<0.05). Conclusions Helicobacter pylori infection in gallbladder mucosa is strongly associated with Helicobacter pylori existed in stomach. Helicobacter pylori is also correlated with gallbladder premalignant lesions including metaplasia and adenomyomatosis. The potential mechanism might be related with higher ROS/RNS production but needs further investigation. PMID:23936177

Wang, Jian-dong; Zhang, Yong; Gong, Wei; Quan, Zhi-wei

2013-01-01

6

[Clinical use of flavonoid enriched biologically active food supplements in patients with chronic atrophic gastritis in combination with chronic cholecystitis or bile ducts dyskinesia].  

PubMed

60 patients with chronic atrophic gastritis and secretory insufficiency allied with chelicobacterial infection in combination with chronic unlithic cholecystitis or diskinesia of choledoch ways were explored with a view to study the efficiency of dietary cure including biologically active food supplements--flavonoids source. Fortification of the patients food intake with flavonoids-containing biologically active food supplements benefits mucous membrane of gastroduodenal zone that is evidenced in decrease of activity of pyloric chelicobacteriosis and resolvent and reparative effect, it also contributes to normalization of hepatobiliaric system condition and antioxidant status. PMID:12664697

Tutel'ian, V A; Vasil'ev, A V; Kochetkov, A M; Pogozheva, A V; Lysikova, S L; Akol'zina, S E; Vorob'eva, L Sh

2003-01-01

7

[Minimally invasive surgical therapy of acute cholecystitis].  

PubMed

Acute cholecystitis is the most common complication of cholecystolithiasis. It develops in about 10?% of symptomatic patients and gangrenous cholecystitis, gallbladder perforation, gallbladder empyema, or abscesses are typical complications. Cholecystectomy is the most relevant therapy to achieve pain reduction, to prevent the progression of inflammation or local complications and to minimize the risk of recurrence. Surgical therapy can be supported by medical and interventional treatment modalities depending on the severity of the disease. The present review summarizes the surgical aspects in acute cholecystitis with a focus on laparoscopic cholecystectomy which is the gold standard of therapy. PMID:23435484

Hartwig, W; Gluth, A; Büchler, M W

2013-03-01

8

[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

9

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

10

Acute Cholecystitis Caused by Ceftriaxone Stones in an Adult  

PubMed Central

Acute cholecystitis is a major health problem. There are multiple etiologies to be considered and early recognition of the condition is important to optimize management and outcome. We report the first case in the medical literature of symptomatic acute cholecystitis triggered by ceftriaxone-associated gallbladder sludge formation and, importantly, solid ceftriaxone gallstone formation in an adult patient with underlying mineral and pigment cholecystolithiasis, necessitating cholecystectomy. This case serves as a reminder for physicians to keep this uncommon cause of cholecystolithiasis and cholecystitis in mind in patients who receive prolonged ceftriaxone therapy. These patients should be cautioned to promptly report to their physicians any signs or symptoms of cholecystitis in order to ensure timely and appropriate evaluation. PMID:19707473

Becker, Christian D.; Fischer, Robert A.

2009-01-01

11

Differentiating acute hepatitis B from the first episode of symptomatic exacerbation of chronic hepatitis B.  

PubMed

In countries with intermediate or high endemicity for chronic hepatitis B virus (HBV) infection, exacerbations of chronic hepatitis B (CHB) are common. We studied the clinical, biochemical, and virologic characteristics of patients first presenting clinically with features of acute icteric hepatitis B, to identify features that might differentiate between acute viral hepatitis B (AVHB) from first episode of exacerbation of chronic hepatitis (ECHB). We retrospectively analyzed 79 patients (mean age 35.4 +/- 14 years; M:F = 60:19) who first presented clinically as AVHB, within 4 weeks of onset of symptoms. Patients who on follow-up cleared HBsAg and/or did not develop any clinical, radiologic, or histologic evidence of chronic liver disease (CLD) were categorized as AVHB (group 1). Patients who had persistence of HBsAg and developed clinical, biochemical, radiologic, or histologic evidence of chronic liver disease were categorized as ECHB (group 2). Forty-nine patients were in group 1 and 30 in group 2. The 2 groups were comparable with respect to prodrome, onset of jaundice, serum bilirubin, ALT, prothrombin time prolongation, serum albumin, and A/G ratio. Among group 1 patients, 78% had IgM anti-HBc positive in titers > 1:1000; in group 2, there were negative or positive in titers < 1:1000 in 70% patients (P < .001). Forty-seven of 49 (95.9%) patients in group 1 had HBV-DNA levels < 0.5 pg/mL, whereas 26 of 30 (86.73%) patients in group 2 had levels > 0.5 pg/mL (P < or = .001). Quantitative HBV DNA and IgM anti-HBc titers at initial presentation can differentiate patients with a true episode of acute hepatitis B from patients with first episode of symptomatic exacerbation of chronic hepatitis B. Clinical and biochemical features do not help in differentiating the two. PMID:16614972

Kumar, Manoj; Jain, Sanjay; Sharma, Barjesh Chander; Sarin, Shiv Kumar

2006-03-01

12

Passive tobacco exposure may impair symptomatic improvement in patients with chronic angina undergoing enhanced external counterpulsation  

PubMed Central

Background The adverse effects of tobacco abuse on cardiovascular outcomes are well-known. However, the impact of passive smoke exposure on angina status and therapeutic response is less well-established. We examined the impact of second-hand smoke (SHS) exposure on symptomatic improvement in patients with chronic ischemic coronary disease undergoing enhanced external counterpulsation (EECP). Methods This observational study included 1,026 non-smokers (108 exposed and 918 not-exposed to SHS) from the Second International EECP Patient Registry. We also assessed angina response in 363 current smokers. Patient demographics, symptomatic improvement and quality of life assessment were determined by self-report prior and after EECP treatment. Results Non-smoking SHS subjects had a lower prevalence of prior revascularization (85% vs 90%), and had an increased prevalence of stroke (13% vs 7%) and prior smoking (72% vs 61%; all p < 0.05) compared to non-smokers without SHS exposure. Despite comparable degrees of coronary disease, baseline angina class, medical regimens and side effects during EECP, fewer SHS non-smokers completed a full 35-hour treatment course (77% vs 85%, p = 0.020) compared to non-smokers without SHS. Compared to non-smokers without SHS, non-smoking SHS subjects had less angina relief after EECP (angina class decreased ? 1 class: 68% vs 79%; p = 0.0082), both higher than that achieved in current smokers (66%). By multivariable logistic regression, SHS exposure was an independent predictor of failure to symptomatic improvement after EECP among non-smokers (OR 1.81, 95% confidence intervals 1.16–2.83). Conclusion Non-smokers with SHS exposure had an attenuated improvement in anginal symptoms compared to those without SHS following EECP. PMID:18798998

Efstratiadis, Stilianos; Kennard, Elizabeth D; Kelsey, Sheryl F; Michaels, Andrew D

2008-01-01

13

Cholelithiasis Presented as Chronic Right Back Pain  

PubMed Central

Chronic right back pain is a symptom in both biliary lithiasis and chronic cholecystitis. Ten percent of the population in the world suffers from biliary lithiasis. Only 20% are symptomatic. The first diagnostic test of choice is an abdominal ultrasound. When a suggestive clinical sign of biliary colic with negative abdominal ultrasound is identified, we should consider the option of carrying out an endoscopic ultrasound in order to rule out microlithiasis. The case discussed in the report presented with chronic right back pain, which is an atypical manifestation of biliary lithiasis and chronic cholecystitis. It is important to know about the atypical manifestations of the prevalent illnesses as well as the limits of the diagnostic tests, in order to avoid diagnostic delays which may cause complications that could worsen a patient's prognosis. This case should contribute to the medical knowledge and must have educational value or highlight the need for a change in clinical practice, especially in primary care. PMID:25657967

Bobé-Armant, Francesc; Buil-Arasanz, Maria Eugenia; Trubat-Muñoz, Griselda; Llor-Vilà, Carles; Vicente-Guillen, Vicente

2014-01-01

14

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

15

Laparoscopic Cholecystectomy for Acute Cholecystitis in Elderly Patients  

PubMed Central

Background: Acute cholecystitis is the major complication of biliary lithiasis, for which laparoscopic treatment has been established as the standard therapy. With longer life expectancy, acute cholecystitis has often been seen in elderly patients (>65 years old) and is often accompanied by comorbity and severe complications. We sought to compare the outcome of laparoscopic treatment for acute cholecystitis with special focus on comparison between elderly and nonelderly patients. Method: This study was a prospective analysis of 190 patients who underwent laparoscopic cholecystectomy due to acute cholecystitis or chronic acute cholecystitis, comparing elderly and nonelderly patients. Results: Of 190 patients, 39 (21%) were elderly (>65 years old) and 151 (79%) were not elderly (?65 years), with conversion rates of 10.3% and 6.6% (P=0.49), respectively. The incidence of postoperative complications in elderly and nonelderly patients were the following, respectively: atelectasis 5.1% and 2.0% (P=0.27); respiratory infection 5.1% and 2.7% (P=0.6); bile leakage 5.1% and 2.0% (P=0.27), and intraabdominal abscess 1 case (0.7%) and no incidence (P=1). Conclusion: According to our data, laparoscopic cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in patients older than 65 years of age. PMID:17575761

Filho, Euler de Medeiros Ázaro; Galvão, Thales Delmondes; Ettinger, João Eduardo Marques de Menezes; Silva Reis, Jadson Murilo; Lima, Marcos; Fahel, Edvaldo

2006-01-01

16

Omental Infarction Mimicking Cholecystitis  

PubMed Central

Omental infarction can be difficult to diagnose preoperatively as imaging may be inconclusive and patients often present in a way that suggests a more common surgical pathology such as appendicitis. Here, a 40-year-old Caucasian man presented to casualty with shortness of breath and progressive right upper abdominal pain, accompanied with right shoulder and neck pain. Exploratory laparoscopy was eventually utilised to diagnose an atypical form of omental infarction that mimics cholecystitis. The vascular supply along the long axis of the segment was occluded initiating necrosis. In this case, the necrotic segment was adherent with the abdominal wall, a pathology not commonly reported in cases of omental infarction. PMID:25737796

Smolilo, David; Lewis, Benjamin C.; Yeow, Marina; Watson, David I.

2015-01-01

17

Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital  

PubMed Central

Background Acute cholecystitis is one of the most common diseases requiring emergency surgery. Ultrasonography is an accurate test for cholelithiasis but has a high false-negative rate for acute cholecystitis. The Murphy sign and laboratory tests performed independently are also not particularly accurate. This study was designed to review the accuracy of ultrasonography for diagnosing acute cholecystitis in a regional hospital. Methods We studied all emergency cholecystectomies performed over a 1-year period. All imaging studies were reviewed by a single radiologist, and all pathology was reviewed by a single pathologist. The reviewers were blinded to each other’s results. Results A total of 107 patients required an emergency cholecystectomy in the study period; 83 of them underwent ultrasonography. Interradiologist agreement was 92% for ultrasonography. For cholelithiasis, ultrasonography had 100% sensitivity, 18% specificity, 81% positive predictive value (PPV) and 100% negative predictive value (NPV). For acute cholecystitis, it had 54% sensitivity, 81% specificity, 85% PPV and 47% NPV. All patients had chronic cholecystitis and 67% had acute cholecystitis on histology. When combined with positive Murphy sign and elevated neutrophil count, an ultrasound showing cholelithiasis or acute cholecystitis yielded a sensitivity of 74%, specificity of 62%, PPV of 80% and NPV of 53% for the diagnosis of acute cholecystitis. Conclusion Ultrasonography alone has a high rate of false-negative studies for acute cholecystitis. However, a higher rate of accurate diagnosis can be achieved using a triad of positive Murphy sign, elevated neutrophil count and an ultrasound showing cholelithiasis or cholecystitis. PMID:24869607

Hwang, Hamish; Marsh, Ian; Doyle, Jason

2014-01-01

18

First detection of acalculous cholecystitis associated with Sarcocystis infection in a patient with AIDS.  

PubMed

Acalculous cholecystitis and cholangitis are increasingly being recognized as complications of AIDS. The opportunistic parasites that have been most commonly associated with these disorders are Cryptosporidium species, Isospora belli, Cyclospora cayetanensis and Enterocytozoon bieneusi. The authors performed a parasitological survey on the gallbladder tissue sections of patients underwent cholecystectomy due to chronic acalculous cholecystitis at the Shiraz University of Medical Sciences, Iran. Light microscopic investigation in more than three hundred archived histopathological slides revealed the presence of sexual stages (i.e., mature sporocysts) of a coccidial protozoan in a patient with AIDS who developed acalculous cholecystitis as confirmed by histological, parasitological and molecular tests in which Sarcocystis species was the only identifiable pathogen in gallbladder sections. In the best of our knowledge it's the first documented case of chronic non-calculous cholecystitis due to Sarcocystis parasite in an Iranian AIDS patient from worldwide. PMID:24827104

Agholi, Mahmoud; Heidarian, Hamid Reza; Moghadami, Mohsen; Hatam, Gholam Reza

2014-06-01

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

Comparative effectiveness of Di'ao Xin Xue Kang capsule and Compound Danshen tablet in patients with symptomatic chronic stable angina.  

PubMed

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

21

Diagnosis of acute cholecystitis using hepatobiliary scan with technetium-99m PIPIDA  

SciTech Connect

Sixty patients were evaluated for acute abdominal pain using technetium-99m PIPIDA hepatobiliary imaging. The sensitivity of the test was 90.6 percent in all patients and the accuracy was 93.3 percent. In the evaluation of acutely ill patients with right upper quadrant pain, fever, nausea and vomiting, hepatobiliary imaging with PIPIDA is the preferred test for diagnosing acute cholecystitis. If the test is positive, disease of the gallbladder and probably acute cholecystitis are present. Early operation can proceed if desirable. If the test is negative and the bilirubin level is less than 5.0 mg/dl, acute cholecystitis is not present. In such cases conservative treatment is appropriate, and follow-up tests should be performed to evaluate the possibility of chronic cholecystitis. When the bilirubin level exceeds 5.0 mg/dl, the test is often indeterminate.

Bennett, M.T.; Sheldon, M.I.; dos Remedios, L.V.; Weber, P.M.

1981-09-01

22

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

23

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

24

Symptomatic response to imatinib mesylate in cutaneous mastocytosis associated with chronic myelomonocytic leukemia  

PubMed Central

Mastocytosis is an uncommon disorder defined by increased and abnormal mast cells in one or more tissues. Cutaneous mastocytosis (cm) is limited to the skin, with varying degrees of rash, pruritus, and disfigurement. Systemic mastocytosis (sm) typically involves the bone marrow, sometimes in association with other bone marrow disorders, including chronic myelomonocytic leukemia (cmml). Mastocytosis has been associated with somatic mutations in the gene encoding the tyrosine kinase Kit, leading to identification of Kit as a therapeutic target. The Kit inhibitor imatinib mesylate is approved for aggressive sm. We present an unusual patient with disabling pruritus from telangiectasia macularis eruptiva perstans, a subtype of cm, and cmml, but with no evidence of systemic mast cell disease. She was treated with imatinib and experienced marked improvement in her pruritus. Concomitant cm and cmml have not previously been reported, and the present report is the first of successful imatinib therapy in an adult patient with cm. PMID:23904774

Vannorsdall, E.J.; Collins, J.A.; Chen, Q.C.; Sarai, G.; Baer, M.R.

2013-01-01

25

Participant Characteristics Associated with Symptomatic Improvement from Yoga for Chronic Low Back Pain  

PubMed Central

Context Studies suggest that yoga is effective for moderate to severe chronic low back pain (cLBP) in diverse predominantly lower socioeconomic status populations. However, little is known about factors associated with benefit from the yoga intervention. Objective Identify factors at baseline independently associated with greater efficacy among participants in a study of yoga for cLBP. Design From September–December 2011, a 12-week randomized dosing trial was conducted comparing weekly vs. twice-weekly 75-minute hatha yoga classes for 95 predominantly low-income minority adults with nonspecific cLBP. Participant characteristics collected at baseline were used to determine factors beyond treatment assignment (reported in the initial study) that predicted outcome. We used bivariate testing to identify baseline characteristics associated with improvement in function and pain, and included select factors in a multivariate linear regression. Setting Recruitment and classes occurred in an academic safety-net hospital and five affiliated community health centers in Boston, Massachusetts. Participants Ninety-five adults with nonspecific cLBP, ages ranging from 20–64 (mean 48) years; 72 women and 23 men. Outcome measures Primary outcomes were changes in back-related function (modified Roland-Morris Disability Questionnaire, RMDQ; 0–23) and mean low back pain intensity (0–10) in the previous week, from baseline to week 12. Results Adjusting for group assignment, baseline RMDQ, age, and gender, foreign nationality and lower baseline SF36 physical component score (PCS) were independently associated with improvement in RMDQ. Greater than high school education level, cLBP less than 1 year, and lower baseline SF36 PCS were independently associated with improvement in pain intensity. Other demographics including race, income, gender, BMI, and use of pain medications were not associated with either outcome. Conclusions Poor physical health at baseline is associated with greater improvement from yoga in back-related function and pain. Race, income, and body mass index do not affect the potential for a person with low back pain to experience benefit from yoga. PMID:25401042

Stein, Kim M; Weinberg, Janice; Sherman, Karen J; Lemaster, Chelsey M; Saper, Robert

2014-01-01

26

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

27

Indications and Surgical Results of Twist-Drill Craniostomy at the Pre-Coronal Point for Symptomatic Chronic Subdural Hematoma Patients  

PubMed Central

Objective Twist-drill craniostomy (TDC) with closed-system drainage and burr-hole drainage (BHD) with a closed system are effective treatment options for chronic subdural hematoma (CSDH). The aim of this study was to analyze clinical data and surgical results from symptomatic CSDH patients who underwent TDC with closed-system drainage at the pre-coronal point (PCP). Methods We analyzed data for 134 symptomatic CSDH patients who underwent TDC at the PCP with closed-system drainage. We defined the PCP for TDC to be 1 cm anterior to the coronal suture at the level of superior temporal line. TDC at the PCP with closed-system drainage was selected in patients with CSDH that extended beyond the coronal suture, confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed retrospectively. Results Of the 134 CSDH patients, 114 (85.1%) showed improved clinical performance and imaging findings after surgery. Catheter failures were seen in two cases (1.4%); the catheters were inserted in the epidural space. Recurrent cases were seen in eight patients (5.6%), and they were improved with a second BHD with a closed-system operation. Conclusion TDC at the PCP with closed-system drainage is safe and effective for patients with symptomatic CSDH whose hematomas extend beyond the coronal suture. PMID:23091672

Lee, Jin-young; Hwang, Sun-Chul; Im, Soo-Bin; Shin, Dong-Seong; Shin, Won-Han

2012-01-01

28

Cholecystitis during pregnancy. A case report and brief review of the literature.  

PubMed

Cholecystitis is an inflammation of the gallbladder caused by obstruction of the cystic duct. A gallstone usually causes the obstruction (calculus cholecystitis). However, in some cases the obstruction may be acalculous or caused by sludge. The clinical course of biliary sludge varies, from complete resolution to gallbladder obstruction. This obstruction can result in gallbladder distension and acute cholecystitis. When inflammation occurs it could either be aseptic or bacterial. Biliary disease during pregnancy is relatively rare and occurs mainly during the last trimester. Whether women who are pregnant or have multiple pregnancies are more likely to develop stones or whether they are simply more symptomatic with stones is unknown. We present a 33-year-old obese pregnant woman with fever, moderately elevated bile acids, and leukocytosis in the 28th week of pregnancy. Since need for surgery in these cases is controversial, the patient has been treated conservatively. In our case cholecystitis responded very well to treatment with amoxicillin, with no detrimental effects for mother and child. A healthy child was born at term. In the differential diagnosis of liver function abnormalities during pregnancy, cholelithiasis should be included. PMID:18225691

Chloptsios, C; Karanasiou, V; Ilias, G; Kavouras, N; Stamatiou, K; Lebren, F

2007-01-01

29

Cholecystectomy due to symptomatic gallbladder disease after orthotopic liver transplantation: report of three cases.  

PubMed

Although biliary stones and sludge are relatively common after liver transplantation (OLT), symptomatic cholecystolithiasis or acute cholecystitis have rarely been reported. Until the early 1990s few transplant centers preserved the donor's gallbladder for transplantation with the liver graft. This technique allows one to perform procedures, such as cholecystojejunostomy or a donor gallbladder conduit for biliary tract reconstruction, to treat posttransplant biliary complications. Herein we have reported three cases of successful either laparoscopic or open cholecystectomy for symptomatic cholecystolithiasis or acute cholecystitis between 14 and 19 years after OLT, as well as a systematic literature review. PMID:23146515

Vernadakis, S; Sotiropoulos, G C; Fouzas, I; Kaiser, G M; Kykalos, S; Juntermanns, B; Paul, A; Treckmann, J

2012-11-01

30

[Acute, non-lithiasic, amebic cholecystitis].  

PubMed

The estimated percentage of non calculous cholecystitis is 2-14%. In most cases it is difficult to identify the cause and in very few cases it is possible to establish the etiology. Few cases are secondary to bacterial infections and the cause is very rarely a parasitic infection. We present a case of acute cholecystitis secondary to Entamoeba histolytica infection; the frequency, etiopathogenic mechanism and treatment are discussed. PMID:2257193

Herrera Fernández, F A; Sarmiento Robles, C; Blasco Carratalá, F; Muñoz Espejo, J; Plaza Moreno, F

1990-07-01

31

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

32

Chronic rapamycin restores brain vascular integrity and function through NO synthase activation and improves memory in symptomatic mice modeling Alzheimer's disease  

PubMed Central

Vascular pathology is a major feature of Alzheimer's disease (AD) and other dementias. We recently showed that chronic administration of the target-of-rapamycin (TOR) inhibitor rapamycin, which extends lifespan and delays aging, halts the progression of AD-like disease in transgenic human (h)APP mice modeling AD when administered before disease onset. Here we demonstrate that chronic reduction of TOR activity by rapamycin treatment started after disease onset restored cerebral blood flow (CBF) and brain vascular density, reduced cerebral amyloid angiopathy and microhemorrhages, decreased amyloid burden, and improved cognitive function in symptomatic hAPP (AD) mice. Like acetylcholine (ACh), a potent vasodilator, acute rapamycin treatment induced the phosphorylation of endothelial nitric oxide (NO) synthase (eNOS) and NO release in brain endothelium. Administration of the NOS inhibitor L-NG-Nitroarginine methyl ester reversed vasodilation as well as the protective effects of rapamycin on CBF and vasculature integrity, indicating that rapamycin preserves vascular density and CBF in AD mouse brains through NOS activation. Taken together, our data suggest that chronic reduction of TOR activity by rapamycin blocked the progression of AD-like cognitive and histopathological deficits by preserving brain vascular integrity and function. Drugs that inhibit the TOR pathway may have promise as a therapy for AD and possibly for vascular dementias. PMID:23801246

Lin, Ai-Ling; Zheng, Wei; Halloran, Jonathan J; Burbank, Raquel R; Hussong, Stacy A; Hart, Matthew J; Javors, Martin; Shih, Yen-Yu Ian; Muir, Eric; Solano Fonseca, Rene; Strong, Randy; Richardson, Arlan G; Lechleiter, James D; Fox, Peter T; Galvan, Veronica

2013-01-01

33

[Acute acalculous cholecystitis: from common to rare causes].  

PubMed

Diagnostic and therapeutic approaches of acute calculous cholecystitis are well defined. Cholecystectomy is among the most frequently performed surgical interventions. In contrast, acute acalculous cholecystitis is a secondary condition; its cause may be difficult to determine and indication for surgical intervention has not been clearly established. The authors summarize the primary causes of acute acalculous cholecystitis and discuss ultrasonographic features which may help the decision to perform cholecystectomy in patients with acalculous cholecystitis. PMID:24412946

Kullmann, Tamás; Issekutz, Ákos; Oláh, Attila; Rácz, István

2014-01-19

34

Cholecystitis, cholelithiasis and common duct stenosis in children and adolescents.  

PubMed Central

A study of 100 patients from 14 months through 18 years of age with extrahepatic biliary tract conditions who have been treated from 1950 through 1979 is reported. For discussion, these have been classified into four groups including acalculous cholecystitis, nonhemolytic cholelithiasis, hemolytic cholelithiasis and stenosis of the common duct. Ninety-nine patients were operated on and there were no deaths. Except for unusual contraindications, cholecystectomy is preferred for acute noncalculous cholecystitis. The largest number having gallstones were those patients (87%) without hemolytic disease. Only 13% had an associated hemolytic disorder. Cholecystectomy is the preferred treatment and common duct exploration is utilized when indicated. Six children with chronic relapsing pancreatitis secondary to stenosis of the ampulla of Vater and two with common duct stenosis are analyzed. Although extrahepatic biliary disorders are usually not considered in the differential diagnosis of children and adolescents with vague abdominal pain, it is evident by this large number of patients that there should be greater emphasis placed on earlier diagnosis in the future. PMID:6989334

Holcomb, G W; O'Neill, J A; Holcomb, G W

1980-01-01

35

Cholecystic adenocarcinoma and pancreatic insulinomas in a goat.  

PubMed

A 13-year-old female Boer goat with a history of chronic arthritis and recurrent episodes of recumbency, increased serum gamma-glutamyl transferase, and complete inability to stand was submitted for necropsy. Gross changes included the presence of a white, firm, smooth, 6 cm × 4 cm × 3 cm mass that diffusely expanded and partially effaced the gall bladder and infiltrated the adjacent hepatic parenchyma. On cut surface, the mass was pale yellow and had small, irregular, dark yellow areas. Scattered through the pancreas were 2 gray, well-demarcated, soft, homogeneous, 1 cm in diameter nodules that bulged out from the capsular surface. The right femoral head had a locally extensive area of cartilage erosion. Histological and immunohistochemical evaluation of the gall bladder and pancreatic nodules revealed a primary cholecystic adenocarcinoma and multifocal insulinomas, respectively. A metastatic focus from the gall bladder neoplasm was observed infiltrating the right adrenal gland medulla. The goat also had mild pulmonary infestation by Muellerius capillaris. Primary hepatobiliary and pancreatic neoplasia is rare in goats, and to the authors' knowledge, neither cholecystic adenocarcinoma nor pancreatic insulinomas have been previously reported in this species. PMID:25274741

Yau, Wilson; Rissi, Daniel R

2014-11-01

36

Pneumomediastinum as a complication of emphysematous cholecystitis: Case report  

PubMed Central

Background Emphysematous cholecystitis is a variant of acute cholecystitis which is generally caused by gas-forming organisms. Emphysematous cholecystitis may cause gas spreading within the subcutaneous tissue, peritoneal cavity and retroperitoneum. Case presentation We present a case of emphysematous cholecystitis in a middle-aged diabetic patient who, postoperatively, presented edema in both flanks and left chest crepitation on palpation, associated with hemodynamic worsening. Computed tomography scan of the chest and abdomen revealed a large pneumomediastinum, pneumoretroperitoneum, gas in subcutaneous tissue and flank abscesses. In both blood and surgical wound exudate cultures, Escherichia coli was found. Conclusion Emphysematous cholecystitis should be considered as a possible cause of pneumomediastinum. PMID:20813063

2010-01-01

37

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

38

Efficacy and safety of omalizumab in patients with chronic idiopathic/spontaneous urticaria who remain symptomatic on H1 antihistamines: a randomized, placebo-controlled study.  

PubMed

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

39

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

40

Perfidious Gallbladders – A Diagnostic Dilemma with Xanthogranulomatous Cholecystitis  

PubMed Central

INTRODUCTION Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis characterised by marked thickening of the gallbladder wall and dense local adhesions. Pre-operative and intra-operative diagnosis is difficult and it often mimics a gallbladder carcinoma (GBC). Laparoscopic cholecystectomy (LC) is frequently unsuccessful with a high conversion rate. A series of patients with this condition led us to review our experience with XGC and to try to develop a care pathway for its management. PATIENTS AND METHODS A retrospective review of the medical records of 1296 consecutive patients who had undergone cholecystectomy between January 2000 and April 2005 at our hospital was performed. Twenty-nine cases of XGC were identified among these cholecystectomies. The clinical, radiological and operative details of these patients have been analysed. RESULTS The incidence of XGC was 2.2% in our study. The mean age at presentation was 60.3 years with a female:male ratio of 1.4:1. Twenty-three patients (79%) required an emergency surgical admission at first presentation. In three patients, a GBC was suspected both radiologically and at operation (10.3%), but was later disproved on histology. Seventeen patients (59%) had obstructive jaundice at first presentation and required an endoscopic retrograde cholangiopancreatography (ERCP) before LC. Of these, five had common bile duct stones. Abdominal ultrasound scan showed marked thickening of the gallbladder wall in 16 cases (55%). LC was attempted in 24 patients, but required conversion to an open procedure in 11 patients (46% conversion rate). A total cholecystectomy was possible in 18 patients and a partial cholecystectomy was the choice in 11 (38%). The average operative time was 96 min. Three patients developed a postoperative bile leak, one of whom required ERCP and placement of a biliary stent. The average length of stay in the hospital was 6.3 days. CONCLUSIONS Severe xanthogranulomatous cholecystitis often mimics a gallbladder carcinoma. Currently, a correct pre-operative diagnosis is rarely made. With increased awareness and a high index of suspicion, radiological diagnosis is possible. Preoperative counselling of these patients should include possible intra-operative difficulties and the differential diagnosis of gallbladder cancer. Laparoscopic cholecystectomy is frequently unsuccessful and a partial cholecystectomy is often the procedure of choice. PMID:17346415

Srinivas, Gandrapu NS; Sinha, Surajit; Ryley, Nick; Houghton, Paul WJ

2007-01-01

41

Timing of laparoscopic cholecystectomy in acute cholecystitis.  

PubMed

Laparoscopic cholecystectomy was performed in 467 patients between November 1989 and April 1991. Fifty-four patients (12%) had acute inflammatory changes. These were divided into three different groups: group 1-13 patients who admitted having an attack of right upper quadrant pain within 24-48 h of their scheduled elective laparoscopic cholecystectomy; group 2-23 patients who had a history of acute cholecystitis treated 4-6 weeks before their elective laparoscopic cholecystectomy; group 3-18 patients who were admitted to the hospital and were diagnosed with acute cholecystitis; they had laparoscopic cholecystectomy performed in the same admission. All patients had a successful laparoscopic removal of their gallbladder except 2 in group 3 who had to be converted to an open procedure. Analysis of the operative time, complications, and hospital stay showed that after adequate experience is gained in performing laparoscopic cholecystectomy, acute cholecystitis is not a contraindication. The procedure is faster and safer if performed in the first 24-48 h of the onset of the symptoms. Different technical maneuvers are needed due to the nature of the disease. PMID:8173120

Hawasli, A

1994-02-01

42

Left paraduodenal hernia combined with acute cholecystitis.  

PubMed

Paraduodenal hernia is a rare congenital malformation. Management consists of reduction of the herniated intestine and repair of the defect. A 74-year-old woman presented to the Emergency Department with persistent right upper quadrant pain that began 3 hours ago. Physical examination revealed tenderness at right upper quadrant of abdomen. Computed tomography revealed multiple gallstones with gallbladder wall thickening, marked dilatation of stomach and duodenum and a sac-like mass of small bowel loops to left of ligament of Treitz suggesting acute cholecystitis and left paraduodenal hernia. Laparoscopic exploration of abdomen was performed and cholecystectomy, bowel reduction, and closure of defect with intracorporeal interrupted suturing were performed. For left paraduodenal hernia without bowel necrosis, laparoscopic reduction of incarcerated bowel and closure of hernial orifice are technically feasible and may be the surgical method of choice because of its minimal invasiveness and aesthetic advantage. PMID:24783182

Lee, Seung Eun; Choi, Yoo Shin

2014-04-01

43

Evaluation of Early versus Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis  

PubMed Central

Background. The role of early laparoscopic cholecystectomy for acute cholecystitis with cholelithiasis is not yet established. The aim of our prospective randomized study was to evaluate the safety and feasibility of early LC for acute cholecystitis and to compare the results with delayed LC. Methods. Between March 2007 to December 2008, 50 patients with diagnosis of acute cholecystitis were assigned randomly to early group, n = 25 (LC within 24?hrs of admission), and delayed group, n = 25 (initial conservative treatment followed by delayed LC, 6–8 weeks later). Results. We found in our study that the conversion rate in early LC and delayed LC was 16% and 8%, respectively, Operation time for early LC was 69.4?min versus 66.4?min for delayed LC, postoperative complications for early LC were 24% versus 8% for delayed LC, and blood loss was 159.6?mL early group versus 146.8?mL for delayed group. However early LC had significantly shorter hospital stay (4.1 days versus 8.6 days). Conclusions. Early LC for acute cholecystitis with cholelithiasis is safe and feasible, offering the additional benefit of shorter hospital stay. It should be offered to the patients with acute cholecystitis, provided that the surgery is performed within 96?hrs of acute symptoms by an experienced surgeon. PMID:25729775

Agrawal, Rati; Sood, K. C.; Agarwal, Bhupender

2015-01-01

44

Severe symptomatic hypomagnesaemia induced by the chronic use of proton pump inhibitors: a case report of a patient with Zollinger-Ellison syndrome.  

PubMed

The association between proton pump inhibitor (PPI) therapy and hypomagnesaemia has been recognized since 2006. We report the case of a 51-year-old woman who developed severe symptomatic hypomagnesaemia after a long-term PPI therapy given for recurrent peptic ulcer disease. Hypomagnesaemia could only partially be resolved during substitution therapy, but was corrected after withdrawal of the PPI. Recurrence of hypomagnesaemia occurred after retreatment with PPIs, supporting the causal relationship. An underlying gastric acid hypersecretion (Zollinger-Ellison syndrome) was highly suspected and eventually controlled by a combination of a histamine 2-receptor antagonist and octreotide, without the need for further PPI therapy after 2 years of follow-up. PMID:24635401

Ströker, E; Leone, L; Vandeput, Y; Borbath, I; Lefebvre, C

2014-01-01

45

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

46

[Surgical tactics in acute cholecystitis in old patients].  

PubMed

Based on some characteristic features of the clinical course of acute cholecystitis and large number of its destructive forms in aged persons, it is recommended to operate patients of this group during 24-28 hours after their admission. 216 aged and senile patients with acute cholecystitis were operated upon, the postoperative mortality being 9.7%. Cholecystectomy is considered to be the operation of choice. In the appropriate indications this operation was associated with drainage of the common bile duct. Cholecystostomy was performed in 10.6%. PMID:1216391

Guzeev, A I

1975-12-01

47

Campylobacter jejuni cholecystitis: a rare but significant clinical entity  

PubMed Central

Cholecystitis caused by Campylobacter is rare with only 14 cases found in the literature. This case describes a 71-year-old man who presented with right hypochondrial abdominal pain due to a gangrenous gallbladder identified at laparotomy. Culture of a bile sample identified a slow-growing gram-negative bacterium identified as Campylobacter jejuni. After a poor clinical response, this identification allowed targeted antibiotic treatment resulting in a slow but successful recovery and discharge 17 days postoperatively. This case demonstrates the importance of considering rare organisms in severe acute cholecystitis and ensuring appropriate cultures are performed, particularly in those who fail to respond to initial antimicrobial treatment. PMID:22485123

Vaughan-Shaw, Peter G; Rees, Jonathan Richard; White, Diana; Burgess, Phillip

2010-01-01

48

Effect of Experimental Acalculous Cholecystitis on Gallbladder Smooth Muscle Contractility  

Microsoft Academic Search

Gallbladder motility is impaired in chroniccholelithiasis but has not been studied in acuteacalculous cholecystitis. The aim of this study was todetermine the effects of acute acalculous inflammation on gallbladder contractility using the commonbile duct ligation (CBDL) model in guinea pigs. Threegroups of guinea pigs were studied: CBDL, normal, andsham surgical controls. Gallbladder dimensions were measured, and muscle strips were used

Henry P. Parkman; Linda J. Bogar; Lori L. Bartula; Anthony P. Pagano; Rebecca M. Thomas; Stuart I. Myers

1999-01-01

49

Acalculous cholecystitis complicating hepatic intraarterial lipiodol: Case report  

Microsoft Academic Search

Hepatic intraarterial injection of Lipiodol has been used by various authors to enhance the diagnostic accuracy of computed\\u000a tomography in hepatic tumors. The technique appears safe and seems free from serious complications when used judiciously.\\u000a We report a case in which injection of hepatic intraarterial Lipiodol precipitated acalculous cholecystitis requiring urgent\\u000a laparotomy.

Eugene Yeung; James Jackson; J. Paul Finn; Michael G. Thomas; Irving S. Benjamin; Andreas Adam

1989-01-01

50

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

51

Symptomatic Nephrolithiasis Complicating Pregnancy  

E-print Network

Objective: To review our experiences with diagnosis and management of symptomatic nephrolithiasis complicating pregnancy and to ascertain the efficacy of renal sonography for initial diagnosis compared with plain x-rays or singleshot intravenous pyelography. Methods: Perinatal outcomes were evaluated for all pregnant women admitted to Parkland Hospital for nephrolithiasis

52

Diagnosis of acute cholecystitis: value of contrast agent in the gallbladder and cystic duct on Gd-EOB-DTPA enhanced MR cholangiography.  

PubMed

To evaluate value of %volume of contrast agent in gallbladder and contrast in cystic duct in diagnosis of acute cholecysititis with Gd-EOB-DTPA MRC obtained 60 min after contrast injection (T1-MRC60min). We included 16 acute cholecystitis (AC), 23 chronic cholecystitis (CC), and 40 healthy volunteers. Receiver operating characteristic analysis showed cutoff value of 30.5% as predictor of AC comparing with healthy volunteers (sensitivity 93.8%, specificity 100%, AUC 0.958) and cutoff of 0% as predictor of AC comparing CC (sensitivity 81.2%, specificity 82.6%, AUC 0.823). In AC absent or obliterated cystic duct on T1-MRC60min showed 81.3%, 100%, sensitivity and specificity, respectively. These can be helpful for diagnosis of AC. PMID:24359644

Choi, In Young; Cha, Sang Hoon; Yeom, Suk Keu; Lee, Seung Wha; Chung, Hwan Hoon; Je, Bo Kyung; Seo, Bo Kyong; Lee, Ki Yeol

2014-01-01

53

Symptomatic rickets in adolescence  

PubMed Central

AIM—To describe 21 cases of symptomatic rickets in adolescents.?METHODS—The setting was a primary and secondary care hospital in Saudi Arabia providing medical care to Saudi Arab company employees and their families. Cases of symptomatic rickets diagnosed between January 1996 and December 1997 in adolescents aged 10 to 15 years were assessed with respect to clinical presentation, biochemical and radiological evaluation, dietary assessment, and estimation of sun exposure.?RESULTS—Symptomatic rickets developed in 21 adolescents (20 females), with a prevalence rate of 68 per 100 000 children years. Presentation included carpopedal spasms (n = 12), diffuse limb pains (n = 6), lower limbs deformities (n = 2), and generalised weakness (n = 1). Biochemical findings included hypocalcaemia (n = 19), hypophosphoraemia (n = 9), raised serum alkaline phosphatase (n = 21) and parathormone (n = 7), and reduced 25-hydroxyvitamin D concentrations (n = 7). Radiological studies were suggestive of rickets in only eight children. All children had an inadequate dietary calcium and vitamin D intake. All but one had less than 60 minutes sun exposure per day.?CONCLUSION—Even in sunny climates, adolescents, especially females, can be at risk of rickets. Hypocalcaemic tetany and limb pains were the most common presenting symptoms. Radiological evidence was not present in every case.?? PMID:11369569

Narchi, H; El Jamil, M; Kulaylat, N

2001-01-01

54

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

55

Chemical ablation of the gallbladder using alcohol in cholecystitis after palliative biliary stenting  

Microsoft Academic Search

Chemical ablation of the gallbladder is effective in patients at high risk of complications after surgery. Percutaneous gallbladder drainage is an effective treatment for cholecystitis; however, when the drain tube cannot be removed because of recurrent symptoms, retaining it can cause problems. An 82-year-old woman presented with cholecystitis and cholangitis caused by biliary stent occlusion and suspected tumor invasion of

Tae Hoon Lee; Sang-Heum Park; Sang Pil Kim; Ji-Young Park; Chang Kyun Lee; Il-Kwun Chung; Hong Soo Kim; Sun-Joo Kim

56

Diagnosis of acute acalculous cholecystitis: a comparison of sonography, scintigraphy, and CT  

Microsoft Academic Search

The clinical and laboratory diagnosis of acute acalculous cholecystitis is difficult, and the reliability of various diagnostic imaging techniques has not been established. The results of several imaging procedures performed over a 6-year period on 56 patients with clinically suspected acute acalculous cholecystitis were evaluated retrospectively. Sonography and CT were both highly sensitive (92% and 100%, respectively) and specific (96%

S. E. Mirvis; Julian R. Vainright; Ava W. Nelson; Gerald S. Johnston; Robert Shorr; Aurelio Rodriguez; N. O. Whitley

1986-01-01

57

Acute acalculous cholecystitis: a rare complication of snake bite.  

PubMed

Snake bite is an environmental and occupational hazard in many tropical and subtropical countries. It demands a high level of knowledge and skill in managing the envenomation syndrome. Herein, we describe a rare case of acute acalculous cholecystitis (AAC) that developed in a 36-year-old man after an Indian cobra (Naja naja) bite in the absence of any other predisposing factors for AAC. The probable mechanisms for the occurrence of AAC have been highlighted. Recognizing the possibility of such a complication after envenomation will definitely aid in early diagnosis and, subsequently, a better outcome. PMID:23473791

Senthilkumaran, Subramanian; Menezes, Ritesh G; Pant, Sadip; Thirumalaikolundusubramanian, Ponniah

2013-09-01

58

Tube Cholecystostomy Before Cholecystectomy for the Treatment of Acute Cholecystitis  

PubMed Central

Background and Objectives: Percutaneous cholecystostomy is currently indicated for patients with cholecystitis who might be poor candidates for operative cholecystectomy. We performed a study to evaluate the long-term outcome of patients undergoing emergent tube cholecystostomy. Methods: This study was a retrospective chart review of patients who underwent tube cholecystostomy from July 1, 2005, to July 1, 2012. Results: During the study period, 82 patients underwent 125 cholecystostomy tube placements. Four patients (5%) died during the year after tube placement. The mean hospital length of stay for survivors was 8.8 days (range, 1–59 days). Twenty-eight patients (34%) required at least 1 additional percutaneous procedure (range, 1–6) for gallbladder drainage. Twenty-nine patients (34%) ultimately underwent cholecystectomy. Surgery was performed a mean of 7 weeks after cholecystostomy tube placement. Laparoscopic cholecystectomy was attempted in 25 operative patients but required conversion to an open approach in 8 cases (32%). In another 4 cases, planned open cholecystectomy was performed. Major postoperative complications were limited to 2 patients with postoperative common bile duct obstruction requiring endoscopic retrograde cholangiopancreatography, 1 patient requiring a return to the operating room for hemoperitoneum, and 2 patients with bile leak from the cystic duct stump. Conclusions: In high-risk patients receiving cholecystostomy tubes for acute cholecystitis, only about one third will undergo surgical cholecystectomy. Laparoscopic cholecystectomy performed in this circumstance has a higher rate of conversion to open surgery and higher hepatobiliary morbidity rate.

Suzuki, Kei; Bower, Margaret; Cassaro, Sebastiano; Patel, Rajesh I.; Karpeh, Martin S.

2015-01-01

59

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

60

Heterogenous wall thickening of gall blabber: xanthogranulomatous cholecystitis or carcinoma, with type 3 choledochal cyst  

PubMed Central

Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterised by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. The authors present a case of xanthogranulomatous cholecystitis with type 3 choledochal cyst in a 20-year-old man who was referred to our hospital with a 1-week history of abdominal pain and fever. He underwent endoscopic sphincterotomy and then open cholecystectomy. A histological diagnosis of xanthogranulomatous cholecystitis was made. PMID:22729338

Darji, Parth; Thakkar, Gurudatt; Prajapati, Sanjay

2012-01-01

61

An unusual cause of acute internal haemorrhage: cystic artery pseudoaneurysm secondary to acute cholecystitis.  

PubMed

Spontaneous cystic artery haemorrhage is a rare complication of acute cholecystitis. Here we describe a case report of this unusual cause of internal haemorrhage, and discuss the pathogenesis and management strategies. PMID:23728766

Fung, A K Y; Vosough, A; Olson, S; Aly, E H; Binnie, N R

2013-05-01

62

Acute Cholecystitis Caused by Malignant Cystic Duct Obstruction: Treatment with Metallic Stent Placement  

SciTech Connect

We report the successful management of acute cholecystitis using cystic duct stent placement in 3 patients with inoperable malignant cystic duct obstruction (2 cholangiocarcinoma and 1 pancreatic carcinoma). All patients underwent stent placement in the bile duct, using an uncovered stent in 2 and a covered stent in 1, to relieve jaundice occurring 8-184 days (mean 120 days) before the development of acute cholecystitis. The occluded cystic duct was traversed by a microcatheter and a stent was implanted 4-17 days (mean 12 days) after cholecystostomy. Acute cholecystitis was improved after the procedure in all patients. Two patients died 3 and 10 months later, while 1 has survived without cholecystitis for 22 months after the procedure to date.

Miyayama, Shiro, E-mail: s-miyayama@fukui.saiseikai.or.jp; Yamashiro, Masashi; Takeda, Taro; Aburano, Hiroyuki [Fukuiken Saiseikai Hospital, Department of Diagnostic Radiology (Japan); Komatsu, Tetsuya [Fukuiken Saiseikai Hospital, Department of Radiation Oncology (Japan); Sanada, Taku; Kosaka, Shotaro; Toya, Daisyu [Fukuiken Saiseikai Hospital, Department of Internal Medicine (Japan); Matsui, Osamu [Kanazawa University Graduate School of Medical Science, Department of Radiology (Japan)

2008-07-15

63

Acute pancreatitis and cholecystitis associated with postpartum HELLP syndrome: a case and review.  

PubMed

We report a case of preeclampsia associated with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome and concomitant nonbiliary acute pancreatitis and cholecystitis in the first postpartum day. A thorough investigation ruled out known etiologies of both pancreatitis and cholecystitis. Following conservative treatment, the patient's HELLP syndrome, pancreatitis, and cholecystitis resolved on the third postpartum day. Preeclampsia is associated with microvascular abnormalities that may involve the splanchnic circulation. These abnormalities may cause not only HELLP syndrome but also pancreatitis and cholecystitis. Recognizing that ischemia can damage not only the liver but also the pancreas and gallbladder, could result in improvements in the diagnosis and management of pancreatitis in patients with preeclampsia. PMID:17454215

Hojo, Satoshi; Tsukimori, Kiyomi; Hanaoka, Mio; Anami, Ai; Nakanami, Naoyuki; Kotoh, Kazuhiro; Nozaki, Masahiro

2007-01-01

64

Gastric perforation due to foreign body ingestion mimicking acute cholecystitis.  

PubMed

An 82-year-old man presented with signs and symptoms that were suggestive of acute cholecystitis. He underwent a laparoscopic cholecystectomy. During the intervention, a wooden foreign body was removed from the infiltrated omentum, probably after it had perforated the gastric antrum. The gastric perforation had led to a secondary infection of the gallbladder. The presumed gastric perforation was treated conservatively, and the patient recovered well and was discharged after 7?days. Secondary inflamed gallbladders are rare; the current case is, to the best of our knowledge, the first case reporting a secondary infection of the gallbladder due to a gastric perforation. Clinicians should be aware of possible ingestion of foreign bodies in elderly patients wearing dental prosthetic devices. PMID:25739796

Henneman, Daniel; Bosman, Willem-Maarten; Ritchie, Ewan D; van den Bremer, Jephta

2015-01-01

65

Accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis: review of the literature  

PubMed Central

Background To evaluate the accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis in comparison with other imaging modalities. Methods The authors performed a search of the Medline/ PubMed (National Library of Medicine, Bethesda, Maryland) for original research and review publications examining the accuracy of ultrasonography in the diagnosis of acute calculous cholecystitis. The search design utilized a single or combination of the following terms : (1) acute cholecystitis, (2) ultrasonography, (3) computed tomography, (4) magnetic resonance cholangiopancreatography and (5) cholescintigraphy. This review was restricted to human studies and to English-language literature. Four authors reviewed all the titles and subsequent the abstract of 198 articles that appeared appropriate. Other articles were recognized by reviewing the reference lists of significant papers. Finally, the full text of 31 papers was reviewed. Results Sonography is still used as the initial imaging technique for evaluating patients with suspected acute calculous cholecystitis because of its high sensitivity at the detection of GB stones, its real-time character, and its speed and portability. Cholescintigraphy still has the highest sensitivity and specificity in patients who are suspected of having acute cholecystitis. However, due to a combination of reasons including logistic drawbacks, broad imaging capability and clinician referral pattern the use of cholescintigraphy is limited in clinical practice. CT is particularly useful for evaluating the many complications of acute calculous cholecystitis. The lack of widespread availability of MRI and the relatively high cost prohibits its primary use in patients with acute calculous cholecystitis. Conclusions US is currently considered the preferred initial imaging technique for patients who are clinically suspected of having acute calculous cholecystitis. PMID:23902680

2013-01-01

66

Discrimination of gangrenous from uncomplicated acute cholecystitis: Accuracy of CT findings  

Microsoft Academic Search

In acute cholecystitis, the presence of gangrene is associated with higher morbidity and mortality and necessitates open surgical\\u000a intervention rather than laparoscopic cholecystectomy. As Murphy’s sign may be absent, gangrene may not be detected ultrasonographically.\\u000a This retrospective study evaluated indications of acute gangrenous cholecystitis on computed tomography (CT) in 25 patients,\\u000a who were proven as having acute cholecysitis surgically and

Cheng-Hsien Wu; Chien-Cheng Chen; Chao-Jan Wang; Yon-Cheong Wong; Li-Jen Wang; Chen-Chih Huang; Wan-Chak Lo; Huan-Wu Chen

2011-01-01

67

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

68

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

69

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

70

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

71

Characterization, treatment, and outcome of bacterial cholecystitis and bactibilia in dogs.  

PubMed

Objective-To characterize historical, clinicopathologic, ultrasonographic, microbiological, surgical, and histopathologic features of bacterial cholecystitis and bactibilia in dogs and evaluate response to treatment and outcomes in these patients. Design-Retrospective case-control study. Animals-40 client-owned dogs (10 with bacterial cholecystitis on histologic analysis or bactibilia on cytologic examination [case dogs] and 30 without bactibilia [controls]) evaluated at a veterinary teaching hospital between 2010 and 2014. Procedures-Signalment, history, clinicopathologic findings, ultrasonographic features, microbiological results, surgical findings, histopathologic changes, treatments, and outcomes of case dogs were derived from medical records and summarized. Demographic and clinicopathologic data and ultrasonographic findings were compared between case and control dogs. Relationships among prior antimicrobial treatment, sediment formation in the gallbladder, presence of immobile biliary sludge, and presence of bactibilia or bacterial cholecystitis were assessed. Results-No finding was pathognomonic for bactibilia or bacterial cholecystitis in dogs. Case dogs were significantly more likely to have immobile biliary sludge and had a greater degree of biliary sediment formation than did control dogs. All case dogs for which gallbladders were examined histologically (6/6) had bacterial cholecystitis. Five of 10 case dogs were Dachshunds. Medical or surgical treatment resulted in good outcomes. Conclusions and Clinical Relevance-Bactibilia and bacterial cholecystitis were important differential diagnoses in dogs with signs referable to biliary tract disease. Dachshunds were overrepresented, which may suggest a breed predisposition. Cytologic evaluation of bile should be considered in the routine assessment of dogs with hepatobiliary disease if immobile biliary sludge is present. (J Am Vet Med Assoc 2015;246:982-989). PMID:25875669

Lawrence, Yuri A; Ruaux, Craig G; Nemanic, Sarah; Milovancev, Milan

2015-05-01

72

Acute acalculous cholecystitis complicating systemic lupus erythematosus: case report and review.  

PubMed Central

A case of acalculous cholecystitis presented as an acute abdominal emergency in a 22 year old woman with severe systemic lupus erythematosus. At the time of presentation the patient was receiving high doses of prednisone and cyclophosphamide to control her underlying disease. Histological examination of the biopsy specimen from the gall bladder showed lupus vasculitis. This complication of systemic lupus erythematosus has not been reported before. Laboratory studies and changes in lupus activity may fail to predict the onset of cholecystitis. Images p252-a PMID:6402058

Swanepoel, C R; Floyd, A; Allison, H; Learmonth, G M; Cassidy, M J; Pascoe, M D

1983-01-01

73

Ranolazine--treatment of ventricular tachycardia and symptomatic ventricular premature beats in ischemic cardiomyopathy.  

PubMed

Premature ventricular complexes (PVCs) are a frequent occurrence in the presence of ischemic heart disease. A very high PVC load can be symptomatic or occasionally result in a cardiomyopathy (CMP). Treatment options include pharmacologic agents and radiofrequency ablation (RFA). RFA has been successful in treating PVCs in symptomatic patients or in the presence of unexplained CMP. Ranolazine is a piperazine derivative used for treating chronic stable angina. It also has antiarrhythmic properties. We report a patient with ischemic CMP, symptomatic PVCs, and monomorphic ventricular tachycardia (VT) despite attempts to control symptoms with two antiarrhythmic drugs. Initiation of ranolazine led to marked reduction in PVCs along with control of VT and symptoms. PMID:20345626

Nanda, Sudip; Levin, Vadim; Martinez, Matthew W; Freudenberger, Ronald

2010-12-01

74

Pathomorphological histochemical changes in acute experimental biliary stasis and calculous cholecystitis  

Microsoft Academic Search

The development of pathomorphologic al and histochemical changes in the liver, kidneys, heart, and spleen in acute experimental biliary stasis and cholecystitis in rabbits is described. Acute biliary stasis was found to cause the development of biliary cirrhosis of the liver as early as at the beginning of the 3rd week of the experiment. Degenerative Changes developed in the kidneys

V. G. Zorya; V. F. Gaevskii; P. F. Shamrai

1973-01-01

75

Early Laparoscopic Cholecystectomy with Continuous Pressurized Irrigation and Dissection in Acute Cholecystitis  

PubMed Central

Background. The aim of this study was to evaluate the preliminary results of a new dissection technique in acute cholecystitis. Material and Method. One hundred and forty-nine consecutive patients with acute cholecystitis were operated on with continuous pressurized irrigation and dissection technique. The diagnosis of acute cholecystitis was based on clinical, laboratory, and radiological evidences. Age, gender, time from symptom onset to hospital admission, operative risk according to the American Society of Anesthesiologists (ASA) score, white blood cell count, C-reactive protein test levels, positive findings of radiologic evaluation of the patients, operation time, perioperative complications, mortality, and conversion to open surgery were prospectively recorded. Results. Of the 149 patients, 87 (58,4%) were female and 62 (41,6%) were male. The mean age was 46.3 ± 6.7 years. The median time from symptom onset to hospital admission 3.2 days (range, 1–6). There were no major complications such as bile leak, common bile duct injury or bleeding. Subhepatic liquid collection occurred in 3 of the patients which was managed by percutaneous drainage. Conversion to open surgery was required in four (2,69%) patients. There was no mortality in the study group. Conclusion. Laparoscopic cholecystectomy with continuous pressurized irrigation and dissection technique in acute cholecystitis seems to be an effective and reliable procedure with low complication and conversion rates. PMID:25810716

Ozsan, I.; Yoldas, O.; Karabuga, T.; Y?ld?r?m, U. M.; Cetin, H. Y.; Alpdo?an, O.; Aydin, U.

2015-01-01

76

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

77

Acute cholecystitis is a common complication after allogeneic stem cell transplantation and is associated with the use of total parenteral nutrition.  

PubMed

The incidence and risk factors for acute cholecystitis after allogeneic hematopoietic stem cell transplantation (HSCT) are not well defined. Of 644 consecutive adult transplants performed at our institution between 2001 and 2011, acute cholecystitis occurred in the first year of transplant in 32 patients (5.0%). We conducted 2 retrospective case-control studies of this population to determine risk factors for cholecystitis after HSCT and to evaluate the performance of different methods of imaging to diagnosis cholecystitis in patients undergoing HSCT compared with non-HSCT patients. In the HSCT population, development of cholecystitis was associated with an increased 1-year overall mortality rate (62.5% versus 19.8%, P < .001). The risk of developing cholecystitis was higher in patients who received total parenteral nutrition (TPN) (adjusted odds ratio, 3.41; P = .009). There was a trend toward more equivocal abdominal ultrasound findings in HSCT recipients with acute cholecystitis compared with nontransplant patients (50.0% versus 30.6%, P = .06). However, hepatobiliary iminodiacetic acid (HIDA) scans were definitively positive for acute cholecystitis in most patients in both populations (80.0% of HSCT recipients versus 77.4% of control subjects, P = .82). In conclusion, acute cholecystitis is a common early complication of HSCT, the risk is increased in patients who receive TPN, and it is associated with high 1-year mortality. In HSCT recipients with findings suggestive of acute cholecystitis, especially those receiving TPN, early use of HIDA scan may be considered over ultrasound. PMID:25543093

Bagley, Stephen J; Sehgal, Alison R; Gill, Saar; Frey, Noelle V; Hexner, Elizabeth O; Loren, Alison W; Mangan, James K; Porter, David L; Stadtmauer, Edward A; Reshef, Ran; Luger, Selina M

2015-04-01

78

Symptomatic vertebral hemangiomas during pregnancy.  

PubMed

Symptomatic vertebral hemangiomas during pregnancy are rare, as only 27 cases have been reported in the literature since 1948. However, symptomatic vertebral hemangiomas can be responsible for spinal cord compression, in which case they constitute a medical emergency, which raises management difficulties in the context of pregnancy. Pregnancy is a known factor responsible for deterioration of these vascular tumors. In this paper, the authors report 2 clinical cases of symptomatic vertebral hemangiomas during pregnancy, including 1 case of spontaneous fracture that has never been previously reported in the literature. The authors then present a brief review of the literature to discuss emergency management of this condition. The first case was a 28-year-old woman at 35 weeks of gestation, who presented with paraparesis. Spinal cord MRI demonstrated a vertebral hemangioma invading the body and posterior arch of T-3 with posterior epidural extension. Laminectomy and vertebroplasty were performed after cesarean section, allowing neurological recovery. The second case involved a 35-year-old woman who presented with spontaneous fracture of T-7 at 36 weeks of gestation, revealing a vertebral hemangioma with no neurological deficit, but it was responsible for pain and local instability. Treatment consisted of postpartum posterior interbody fusion. With a clinical and radiological follow-up of 2 years, no complications and no modification of the hemangiomas were observed. A review of the literature reveals discordant management of these rare cases, which is why the treatment course must be decided by a multidisciplinary team as a function of fetal gestational age and maternal neurological features. PMID:24605997

Moles, Alexis; Hamel, Olivier; Perret, Christophe; Bord, Eric; Robert, Roger; Buffenoir, Kevin

2014-05-01

79

Pregnancy related symptomatic vertebral hemangioma.  

PubMed

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

80

Single-incision vs three-incision laparoscopic cholecystectomy for complicated and uncomplicated acute cholecystitis  

PubMed Central

AIM: To compare the clinical outcome of single-incision laparoscopic cholecystectomy (SILC) and three-incision laparoscopic cholecystectomy (3ILC) for acute cholecystitis. METHODS: From July 2009 to September 2012, 136 patients underwent SILC or 3ILC for acute cholecystitis at a tertiary referral hospital. One experienced surgeon performed every procedure using 5 or 10 mm 30-degree laparoscopes, straight instruments, and conventional ports. Five patients with perforated gallbladder and diffuse peritonitis and 23 patients with mild acute cholecystitis were excluded. The remaining 108 patients were divided into complicated and uncomplicated groups according to pathologic findings. Patient demography, clinical data, operative results and complications were recorded and analyzed. RESULTS: Fifty patients with gangrenous cholecystitis, gallbladder empyema, or hydrops were classified as the complicated group, and 58 patients with acute cholecystitis were classified as the uncomplicated group. Twenty-three (46.0%) of the patients in the complicated group (n = 50) and 39 (67.2%) of the patients in the uncomplicated group (n = 58) underwent SILC; all others underwent 3ILC. The postoperative length of hospital stay (PLOS) was significantly shorter in the SILC subgroups than the 3ILC subgroups (3.5 ± 1.1 d vs 4.6 ± 1.3 d, P < 0.01 in the complicated group; 2.9 ± 1.1 d vs 3.7 ± 1.4 d, P < 0.05 in the uncomplicated group). The maximum body temperature recorded at day 1 and at day 2 following the procedure was lower in the SILC subgroups, but the difference reached statistical significance only in the uncomplicated group (37.41 ± 0.56?°C vs 37.80 ± 0.72?°C, P < 0.05 on postoperative day 1; 37.10 ± 0.43?°C vs 37.57 ± 0.54?°C, P < 0.01 on postoperative day 2). The operative time, estimated blood loss, postoperative narcotic use, total length of hospital stay, conversion rates, and complication rates were similar in both SILC and 3ILC subgroups. The complicated group had longer operative time (122.2 ± 35.0 min vs 106.6 ± 43.6 min, P < 0.05), longer PLOS (4.1 ± 1.3 d vs 3.2 ± 1.2 d, P < 0.001), and higher conversion rates (36.0% vs 19.0%, P < 0.05) compared with the uncomplicated group. CONCLUSION: SILC is safe and efficacious for patients with acute cholecystitis. The main benefit is a faster recovery than that achieved with 3ILC. PMID:24282363

Chuang, Shu-Hung; Chen, Pai-Hsi; Chang, Chih-Ming; Lin, Chih-Sheng

2013-01-01

81

A symptomatic lumbosacral perineural cyst -A case report-.  

PubMed

Lumbosacral perineural cysts are formed by the arachnoid membrane of the nerve root at the lumbosacral level. Most of these cysts are asymptomatic and are found incidentally during computed tomography (CT) or magnetic resonance imaging (MRI) for other causes of chronic lower back pain. This type of cyst requires a differential diagnosis to distinguish it from other causes of radiating pain and neurological symptoms. In the present case, a symptomatic lumbosacral perineural cyst was found, and pain relief was achieved by non-surgical treatment. A lumbosacral perineural cyst was identified from a differential diagnosis of a lumbar disc disorder that presented as radiating pain and neurological symptoms. PMID:22679550

Choi, Byung Hee; Kim, Sae Young; Kim, Jin Mo

2012-05-01

82

A symptomatic lumbosacral perineural cyst -A case report-  

PubMed Central

Lumbosacral perineural cysts are formed by the arachnoid membrane of the nerve root at the lumbosacral level. Most of these cysts are asymptomatic and are found incidentally during computed tomography (CT) or magnetic resonance imaging (MRI) for other causes of chronic lower back pain. This type of cyst requires a differential diagnosis to distinguish it from other causes of radiating pain and neurological symptoms. In the present case, a symptomatic lumbosacral perineural cyst was found, and pain relief was achieved by non-surgical treatment. A lumbosacral perineural cyst was identified from a differential diagnosis of a lumbar disc disorder that presented as radiating pain and neurological symptoms. PMID:22679550

Choi, Byung Hee; Kim, Jin Mo

2012-01-01

83

Optimal Treatment of Symptomatic Hemorrhoids  

PubMed Central

Hemorrhoids are the most common anorectal complaint, and approximately 10 to 20 percent of patients with symptomatic hemorrhoids require surgery. Symptoms of hemorrhoids, such as painless rectal bleeding, tissue protrusion and mucous discharge, vary. The traditional therapeutic strategies of medicine include surgical, as well as non-surgical, treatment. To alleviate symptoms caused by hemorrhoids, oral treatments, such as fiber, suppositories and Sitz baths have been applied to patients. Other non-surgical treatments, such as infrared photocoagulation, injection sclerotherapy and rubber band ligation have been used to fixate the hemorrhoid's cushion. If non-surgical treatment has no effect, surgical treatments, such as a hemorrhoidectomy, procedure for prolapsed hemorrhoids, and transanal hemorrhoidal dearterialization are used. PMID:22259741

Kim, Soung-Ho

2011-01-01

84

Symptomatic sacral perineurial (Tarlov) cysts.  

PubMed

Sacral perineurial (Tarlov) cysts are rare lesions. Over a seven year period 4000 patients underwent surgery for lumbar disk herniation. In three patients neurological symptoms were caused by large sacral perineurial cysts. Methods of choice for diagnosis of Tarlov cysts are lumbosacral magnetic resonance imaging and computerized tomography myelography. The majority of Tarlov cysts are asymptomatic. In case of large (> or = 1.5 cm) and symptomatic perineurial cyst, as in three patients reported in this article, microsurgical treatment was successful. Although rare, perineurial (Tarlov) cysts must be taken into consideration when approaching to patient with low back and radicular pain. Authors review the medical literature, pathological and pathophysiological features and treatment options of sacral perineurial cysts. PMID:20102100

Sajko, Tomislav; Kova?, Damir; Kudeli?, Nenad; Kovac, Lana

2009-12-01

85

Lifetime risk of symptomatic knee osteoarthritis  

Microsoft Academic Search

Objective. To estimate the lifetime risk of symptomatic knee osteoarthritis (OA), overall and stratified by sex, race, education, history of knee injury, and body mass index (BMI). Methods. The lifetime risk of symptomatic OA in at least 1 knee was estimated from logistic regression models with generalized estimating equations among 3,068 participants of the Johnston County Osteoarthritis Project, a longitudinal

Louise Murphy; Todd A. Schwartz; Charles G. Helmick; Jordan B. Renner; Gail Tudor; Gary Koch; Anca Dragomir; William D. Kalsbeek; Gheorghe Luta; Joanne M. Jordan

2008-01-01

86

Severely Symptomatic Craniovertebral Junction Abnormalities in Children  

Microsoft Academic Search

Objectives: The treatment of symptomatic cranio-vertebral junction (CVJ) instability in children affected by CVJ abnormalities is a challenge. A series of severely symptomatic children has been reviewed to understand the controversial long-term effectiveness of the aggressive management of CVJ abnormalities, in terms of clinical improvement, spinal stability and growth. Methods: Three Down syndrome patients, 1 with mucopolysaccharidosis and 1 with

Carlo Giussani; Franck-Emmanuel Roux; Paolo Guerra; David Pirillo; Marco Grimaldi; Giuseppe Citerio; Erik P. Sganzerla

2009-01-01

87

First Report of Human Acute Acalculous Cholecystitis Caused by the Fish Pathogen Lactococcus garvieae  

PubMed Central

We report herein the first case of acute acalculous cholecystitis caused by Lactococcus garvieae, which is known as a fish pathogen. A 69-year-old fisherman underwent laparoscopic cholecystectomy due to severe inflammation in the gallbladder. The isolate obtained from the gallbladder was identified as L. garvieae by 16S rRNA and manganese-dependent superoxide dismutase (sodA) gene sequence analysis. PMID:23241376

Kim, Ji Hyung; Go, Jin; Cho, Chong Rae; Kim, Jae Il

2013-01-01

88

First report of human acute acalculous cholecystitis caused by the fish pathogen Lactococcus garvieae.  

PubMed

We report herein the first case of acute acalculous cholecystitis caused by Lactococcus garvieae, which is known as a fish pathogen. A 69-year-old fisherman underwent laparoscopic cholecystectomy due to severe inflammation in the gallbladder. The isolate obtained from the gallbladder was identified as L. garvieae by 16S rRNA and manganese-dependent superoxide dismutase (sodA) gene sequence analysis. PMID:23241376

Kim, Ji Hyung; Go, Jin; Cho, Chong Rae; Kim, Jae Il; Lee, Myung Soo; Park, Se Chang

2013-02-01

89

[The impact of guidelines for the management of acute cholecystitis in a rural area of Japan].  

PubMed

We monitored the management of acute cholecystitis in a rural area of Japan to determine the effectiveness of new guidelines for the management of acute cholecystitis and cholangitis. Between January 2000 and September 2011, 366 patients were treated for acute cholecystitis. Of these, 59 had common bile duct stones (CBDS) and 307 did not. Patients in both groups were further subdivided into two groups: a before guidelines group (BGG; n=153) and an after guideline group (AGG; n=154). Among the patients without CBDS, early cholecystectomy was more common in the AGG group (n=53) than in the BGG group. Furthermore, the length of hospital stay was four days shorter in the AGG group than in the BGG group (n=23). Among the patients with CBDS, the timing of cholecystectomy after endoscopic retrograde cholangiography was seven days earlier in the AGG group than in the BGG group. Even in a rural area of Japan, early cholecystectomy appears safe and can decrease the length of hospital stay. PMID:24097148

Yamasaki, Yasushi; Takenaka, Ryuta; Okazaki, Noriko; Baba, Yuki; Hamada, Kenta; Takayama, Hiroki; Takemoto, Koji; Taira, Akihiko; Tsugeno, Hirofumi; Kubota, Yasuhiro; Hayashi, Doufu; Fujiki, Shigeatsu

2013-10-01

90

Surgical management of acute cholecystitis. Results of a nation-wide survey among Spanish surgeons.  

PubMed

There is a wide variability in the management of acute cholecystitis. A survey among the members of the Spanish Association of Surgeons (AEC) analyzed the preferences of Spanish surgeons for its surgical management. The majority of the 771 responders didn't declare any subspecialty (41.6%), 21% were HPB surgeons, followed by colorectal and upper-GI specialities. Early cholecystectomy during the first admission is the preferred method of management of 92.3% of surgeons, but only 42.7% succeed in adopting this practice. The most frequent reasons for changing their preferred practice were: Patients not fit for surgery (43.6%) and lack of availability of emergency operating room (35.2%). A total of 88.9% perform surgery laparoscopically. The majority of AEC surgeons advise index admission cholecystectomy for acute cholecystitis, although only half of them succeed in its actual implementation. There is room for improvement in the management of acute cholecystitis in Spanish hospitals. PMID:24857607

Badia, Josep M; Nve, Esther; Jimeno, Jaime; Guirao, Xavier; Figueras, Joan; Arias-Díaz, Javier

2014-10-01

91

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

92

Surgical excision of a symptomatic congenital coracoclavicular joint.  

PubMed

The coracoclavicular joint is a rare anatomic variant that consists of an articulation between the conoid tubercle of the clavicle and the superior surface of the coracoid process of the scapula. The coracoclavicular joint is most often asymptomatic and is found incidentally. A symptomatic coracoclavicular joint is exceedingly rare, with only 17 cases reported from 1915 to 2009. Symptoms may include limited range of motion, paresthesia, and brachialgia with radiation to the ipsilateral extremity. In the case of symptomatic coracoclavicular joints for which treatment data are reported, the response to conservative management with rest, analgesics, and physical therapy has been poor. Operative management resulted in complete resolution of symptoms in most patients and symptomatic improvement in the rest. This article reports the case of a 63-year-old man who presented with chronic left anterior shoulder pain exacerbated by forward flexion and overhead activities. Radiographs and computed tomography scan of the affected shoulder showed a bony articulation between the clavicle and the coracoid process of the scapula. The patient did not achieve long-term relief through conservative measures and corticosteroid injections, so the joint was surgically excised by an open procedure. Intraoperative findings were significant for a fully formed synovial joint with a capsule articulating between the clavicle and the coracoid process. After resection, the patient had minimal residual pain, improved range of motion, and symptomatic improvement with activity. The current case provides further data that the coracoclavicular joint can be the cause of significant shoulder pain and can be treated successfully with total resection of the joint if symptoms do not improve with conservative non-operative measures. PMID:25350628

Gibbs, Stephen; Merriman, Jarrad A; Sorenson, Eric; Rick Hatch, George F

2014-09-01

93

MRI-identified abnormalities and wrist range of motion in asymptomatic versus symptomatic computer users  

PubMed Central

Background Previous work has shown an association between restricted wrist range of motion (ROM) and upper extremity musculoskeletal disorders in computer users. We compared the prevalence of MRI-identified wrist abnormalities and wrist ROM between asymptomatic and symptomatic computer users. Methods MR images at 1.5 T of both wrists were obtained from 10 asymptomatic controls (8 F, 2 M) and 14 computer users (10 F, 4 M) with chronic wrist pain (10 bilateral; 4 right-side). Maximum wrist range of motion in flexion and radioulnar deviation was measured with an electrogoniometer. Results Extraosseous ganglia were identified in 66.6% of asymptomatic wrists and in 75% of symptomatic wrists. Intraosseous ganglia were identified in 45.8% of asymptomatic wrists and in 75% of symptomatic wrists, and were significantly (p < .05) larger in the symptomatic wrists. Distal ECU tendon instability was identified in 58.4% of both asymptomatic and symptomatic wrists. Dominant wrist flexion was significantly greater in the asymptomatic group (68.8 ± 6.7 deg.) compared to the symptomatic group (60.7 ± 7.3 deg.), p < .01. There was no significant correlation between wrist flexion and intraosseous ganglion burden (p = .09) Conclusions This appears to be the first MRI study of wrist abnormalities in computer users. This study demonstrates that a variety of wrist abnormalities are common in computer users and that only intraosseous ganglia prevalence and size differed between asymptomatic and symptomatic wrists. Flexion was restricted in the dominant wrist of the symptomatic group, but the correlation between wrist flexion and intraosseous ganglion burden did not reach significance. Flexion restriction may be an indicator of increased joint loading, and identifying the cause may help to guide preventive and therapeutic interventions. PMID:21108817

2010-01-01

94

Non-operative Management of Symptomatic Cholelithiasis in Pregnancy is Associated with Frequent Hospitalizations.  

PubMed

Symptomatic cholelithiasis (SC) is common in pregnancy. Guidelines recommend laparoscopic cholecystectomy (LC) for SC in pregnancy. Our aim was to evaluate current practice patterns and outcomes for patients undergoing initial non-operative management for uncomplicated SC during pregnancy. We performed a retrospective analysis and telephone survey of all patients presenting in a 42-month period to a tertiary care center for uncomplicated SC during pregnancy. Women with complicated gallstone disease, including cholecystitis, pancreatitis, choledocholithiasis, and cholangitis were excluded. We identified 53 patients with uncomplicated SC during pregnancy. LC was performed in 4 (7.5 %) antepartum and in 28 (51.7 %) postpartum. The majority of LCs (21, 75 %) were performed within 3 months postpartum. Of those with postpartum LC, 22 (78.6 %) had recurrent postpartum symptoms prior to LC, and 14 (50 %) had repeat hospitalizations prior to undergoing surgery. Given the safety of antepartum LC and the frequency of recurrent symptoms and hospitalizations, early surgical intervention during pregnancy may be the optimal strategy to reduce antepartum and early postpartum admissions for uncomplicated SC. PMID:25650166

Jorge, April M; Keswani, Rajesh N; Veerappan, Anna; Soper, Nathaniel J; Gawron, Andrew J

2015-04-01

95

Chronic inflammatory changes seen in gallbladders of patients with pancreatico-biliary malunion years after transduodenal sphincterotomy: is it a precursor for gallbladder carcinoma?  

PubMed

Common pancreaticobiliary channel malunion (PBM) is known to be associated with increased frequency of gallbladder (GB) cancer in adults. Few studies have reported the presence of histological changes in the GB following transduodenal drainage procedures in children with PBM. The aim of this study was to document the histological changes in the GB in children who underwent interval prophylactic cholecystectomy up to 18 years following PBM drainage procedure. All children who underwent open transduodenal sphincterotomy (TDS) for symptomatic PBM followed by prophylactic synchronous (open) and interval (laparoscopic) cholecystectomy between 1987 and 2007 were studied retrospectively. Eight children with PBM were identified. The median age at initial presentation and open transduodenal sphincterotomy was 8 months (1 month-3.5 years). The average interval between open TDS and prophylactic cholecystectomy was 5.5 years (0-18 years). Two children had synchronous TDS and cholecystectomy. At initial presentation, all patients presented with obstructive jaundice. Mild common bile duct dilatation was encountered in all patients. The dilated ducts returned to normal, and remained normal after transduodenal sphincterotomy. Histopathology in seven out of eight GB specimens (87.5%) showed microscopic evidence of chronic inflammation. Chronic cholecystitis (n = 7), Rokitansky-Aschoff sinuses (n = 3), cholesterosis (n = 1) and intestinal metaplasia (n = 1) were observed in the GB biopsies. Only one patient, who had TDS and a synchronous cholecystectomy in the neonatal period, did not have histological changes in the GB. Average follow-up in years ranged between 3 months and 19 years (from TDS) with a median of 8 years, and between 3 months and 6 years (from cholecystectomy) with a median of 2 years. Chronic inflammatory changes were found in seven of eight GB specimens from patients with PBM despite previous drainage procedure in six patients and in one of two patients who underwent synchronous TDS and cholecystectomy. These changes may be the precursor of malignant transformation in GB of patients with PBM. PMID:18668255

Ali, Abdelbasit E; Blythe, Alex I; Ford, William D A

2008-09-01

96

Symptomatic cardiac amyloidosis in an American family  

SciTech Connect

This report describes an American family with a high incidence of symptomatic cardiac amyloidosis among four siblings, and explores the role of echocardiography and technetium pyrophosphate myocardial scintigraphy in the detection of this infiltrative cardiomyopathy within the involved family.

Ruder, M.A.; Alpert, M.A.; Sanfelippo, J.F.; Dix, J.D.; Whiting, R.B.

1984-07-01

97

Gastric Electrical Stimulation in Intractable Symptomatic Gastroparesis  

Microsoft Academic Search

Background: The treatment of gastroparesis remains unsatisfactory despite prokinetic and anti-emetic drugs. Gastric electrical stimulation has been proposed as a therapeutic option. We have assessed the effect of gastric electrical stimulation on symptoms, medical treatment, body weight and gastric emptying in patients with intractable symptomatic gastroparesis in a non-placebo-controlled study. Methods: In this multicenter study, 38 highly symptomatic patients with

Thomas L. Abell; Eric Van Cutsem; Hasse Abrahamsson; Jan D. Huizinga; J. W. Konturek; Jean Paul Galmiche; Guy VoelIer; Ludo Filez; Bernt Everts; William E. Waterfall; W. Domschke; Stanislas Bruley des Varannes; Babajide O. Familoni; Ivan M. Bourgeois; Jozef Janssens; Gervais Tougas

2002-01-01

98

[Tarlov cyst and symptomatic bladder disfuction].  

PubMed

Tarlov cysts or perineural cyst are lesions of the nerve roots located at the sacral level and uncertain aetiology. Most of these cysts remain asymptomatic with no clinical relevance. The symptomatic cysts are uncommon and the usual symptoms are pain or radiculopathy. We report the case of a 53-year-old woman witha symptomatic cyst (with a history of frequency and urgency syndrom), that disappears after surgery. PMID:19143297

Ruibal Moldes, M; Sánchez Rodríguez-Losada, J; López García, D; Casas Agudo, V; Janeiro País, J M; González Martín, M

2008-01-01

99

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

100

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

101

Angioplasty for Symptomatic Intracranial Stenosis Clinical Outcome  

Microsoft Academic Search

Background and Purpose—Medical treatment of symptomatic intracranial stenosis carries a high risk of stroke. This study was done to evaluate the clinical and angiographic outcomes after intracranial angioplasty for this disease. Methods—A total of 120 patients with 124 intracranial stenoses were treated by primary angioplasty. All patients had neurologic symptoms (stroke or transient ischemic attack) attributable to intracranial stenoses 50%.

Michael P. Marks; Joan C. Wojak; Firas Al-Ali; Mahesh Jayaraman; Mary L. Marcellus; John J. Connors; Huy M. Do

2010-01-01

102

Familial symptomatic sinus bradycardia: Autosomal dominant inheritance  

Microsoft Academic Search

Symptomatic sinus bradycardia, due to either sick sinus syndrome or vagotonia, can be familial, affecting several members of a family. We report an 18-year-old male patient with palpitations and limited exercise capacity who was noted to have severe sinus bradycardia. His resting heart rate was 40\\/min, with normal PR and corrected QT intervals, and sinus pauses up to 6 seconds

A. V. Mehta; B. Chidambaram; A. Garrett

1995-01-01

103

Acute acalculous cholecystitis immediately after gastric operation: Case report and literatures review  

PubMed Central

Acute acalculous cholecystitis (AAC) is a rare complication of gastric surgery. The most commonly accepted concepts regarding its pathogenesis are bile stasis, sepsis and ischemia, but it has not been well described how to identify and manage this disease in the early stage. We report three cases of AAC in elderly patients immediately after gastric surgery, which were treated with three different strategies. One patient died 42 d after emergency cholecystectomy, and the other two finally recovered through timely cholecystostomy and percutaneous transhepatic gallbladder drainage, respectively. These cases informed us of the value of early diagnosis and proper treatment for perioperative AAC after gastric surgery. We further reviewed reported cases of AAC immediately after gastric operation, which may expand our knowledge of this disease. PMID:25132787

Liu, Feng-Lin; Li, He; Wang, Xue-Fei; Shen, Kun-Tang; Shen, Zhen-Bin; Sun, Yi-Hong; Qin, Xin-Yu

2014-01-01

104

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

105

[Clinical characteristics of biliary tract infection and acalculous cholecystitis after cardiovascular surgery].  

PubMed

Biliary tract infection (BTI) including acalculous cholecystitis is a rare but life-threatening complication after cardiovascular surgery. The objective of our study was to describe epidemiology, clinical characteristics, and risk factors of BTI after cardiovascular surgery. From January 2007 to December 2011, 586 consecutive patients(age68±11;397 men,189 women)were enrolled in this study. BTI was diagnosed according to Centers for Disease Control and Prevention (CDC) surveillance criteria for healthcare associated infection. Data collection included preoperative, intraoperative, and post-operative variables. The overall incidence of BTI was 3.9%. The mortality in BTI group was significantly higher than that in non-BTI group (17.1% vs 5.5%, p<0.05). Multi-logistic analysis revealed that operation of the thoracic aorta( p<0.05) and massive transfusion(p<0.01) were independent risk factors for BTI after cardiovascular surgery. PMID:25391463

Maekawa, Yoshiyuki; Abe, Shuichi; Yoshimura, Yukihiro; Uchida, Tetsuro; Kim, Cholsu; Kuroda, Yoshinori; Mizumoto, Masahiro; Sadahiro, Mitsuaki; Morikane, Keita

2014-11-01

106

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

107

["Acute cholecystitis"--laparoscopic cholecystectomy is often possible. Results of a multicenter study by the East German Study Group for Performance Assessment and Quality Assurance in Surgery].  

PubMed

With the introduction of laparoscopic cholecystectomy (LCE) the method became very fast successful in clinical practice. To describe the actual situation we initiated in 1994/95 a clinical multicenter study with the name CESAQ. 29 hospitals participated in the study. 4,675 cholecystectomies were performed, a total number of 2,960 patients were operated upon with the laparoscopic and 1,468 with the conventional technique. Furthermore, conversion to open cholecystectomy was necessary in 247 cases. One part of the study focused on the results achieved for patients with acute cholecystitis. 9.4% of the laparoscopic but 37.3% of the conventional cholecystectomies were performed due to acute cholecystitis. We differentiated a simple (adhesions to gallbladder, hydrops) and complicated form (empyema, gangrenous gallbladder) of acute cholecystitis. Treating acute cases the incidence of intraoperative (simple 8.3%, complicated 12.1%) and specific postoperative complications (simple 9.2%, complicated 6.9%) was higher compared to elective procedures (intraoperative 4.6%, specific postoperative 3.7%). This is well known from the experience of open surgery. Nevertheless there were lower general complication rates (simple 5.5%, complicated 5.2%) and no mortality in acute cholecystitis when LCE was performed. Considering an early conversion to open cholecystectomy in cases of severe acute cholecystitis the indication for LCE can be made generously. Great surgical experience in LCE is a requirement for the laparoscopic management of acute cholecystitis. PMID:10919250

Dietzel, M; Lippert, H; Gastinger, I; Schramm, H

2000-01-01

108

Anterior pseudoarthrectomy for symptomatic Bertolotti's syndrome.  

PubMed

Painful L5/S1 pseudoarthrosis has been previously managed with posterior excision and/or lumbar fusion. To our knowledge, the anterior approach for L5/S1 pseudoarthrectomy in the treatment of Bertolotti's syndrome has not been described. We present two patients with severe symptomatic L5/S1 pseudoarthroses that were successfully excised via an anterior retroperitoneal approach with 2 year clinical and radiological follow-up. The literature regarding surgical treatments for Bertolotti's syndrome is reviewed. The technique for an anterior retroperitoneal approach is described. This approach has been safe and effective in providing long term symptomatic relief to our two patients. Further studies comparing the outcomes of anterior versus posterior pseudoarthrectomy will guide the management of this condition. PMID:23969004

Malham, Gregory M; Limb, Rebecca J; Claydon, Matthew H; Brazenor, Graeme A

2013-12-01

109

Symptomatic Tarlov Cyst Following Spontaneous Subarachnoid Hemorrhage  

PubMed Central

Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage. PMID:22053232

Kong, Woo Keun; Hong, Seung-Koan

2011-01-01

110

Management of Symptomatic Sacral Perineural Cysts  

PubMed Central

Background There has been no consensus on the optimal treatment of symptomatic sacral perineural cysts. Most previous reports concerning the management methods were either sporadic case reports or a series of limited cases. This study is to further optimize the management for patients with symptomatic sacral perineural cysts by analyzing the outcomes of a cohort of patients who were treated with different strategies. Methods and Findings We reviewed the outcomes of 15 patients with symptomatic sacral perineural cysts who were managed by three different modalities from 1998 through 2010. Six patients underwent microsurgical cyst fenestration and cyst wall imbrication. Seven patients underwent a modified surgical procedure, during which the cerebrospinal fluid leak aperture was located and repaired. Two patients were treated with medication and physical therapy. Outcomes of the patients were assessed by following up (13 months to 10 years). All of the six patients treated with microsurgical cyst fenestration and cyst wall imbrication experienced complete or substantial relief of their preoperative symptoms. However, the symptoms of one patient reappeared eight months after the operation. Another patient experienced a postoperative cerebrospinal fluid leakage. Six of the seven patients treated with the modified surgical operation experienced complete or substantial resolution of their preoperative symptoms, with only one patient who experienced temporary worsening of his preoperative urine incontinence, which disappeared gradually one month later. No new postoperative neurological deficits, no cerebrospinal fluid leaks and no recurrence were observed in the seven patients. The symptoms of the two patients treated with conservative measures aggravated with time. Conclusions Microsurgical operation should be a treatment consideration in patients with symptomatic sacral perineural cysts. Furthermore, the surgical procedure with partial cyst removal and aperture repair for prevention of cerebrospinal fluid leakage seemed to be more simple and effective. PMID:22768183

Xu, Jianqiang; Sun, Yongdong; Huang, Xin; Luan, Wenzhong

2012-01-01

111

Symptomatic tarlov cyst following spontaneous subarachnoid hemorrhage.  

PubMed

Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage. PMID:22053232

Kong, Woo Keun; Cho, Keun-Tae; Hong, Seung-Koan

2011-08-01

112

Histological alterations of gallbladder mucosa and selected clinical data in young patients with symptomatic gallstones.  

PubMed

Histological lesions of gallbladder were described mainly in older patients with cholelithiasis (CH). The aim of the study was to analyse morphological alterations in gallbladder mucosa and selected clinical data of young patients with CH. The studies were conducted on 57 patients with CH, subjected to cholecystectomy in the years of 2003-2007. In course of the years, 37 respective young patients (below 25 years of age) were operated. The comparative group included twenty 50-year-old patients with gallstones. The inflammatory activity (grading) was evaluated using a semiquantitative scale on HE-stained gallbladders. In either group, women with chronic cholecystitis and multiple gallstones prevailed. Histological alterations in young patients involved absence of evident epithelial metaplasia traits, low number of foamy cells and prevalence of eosinophils in gallbladder mucosa. Even if a similar grading in gallbladder walls was noted in young and older patients, only in the former ones, a higher grading was detected in patients with an acute clinical course of the gallstone disease. The results point also to a potential role of local accumulation of eosinophils in gallbladder mucosa in pathogenesis of CH in young patients. PMID:21574105

Kasprzak, Aldona; Malkowski, Wojciech; Biczysko, Wies?awa; Seraszek, Agnieszka; Sterzy?ska, Karolina; Zabel, Maciej

2011-01-01

113

Symptomatic dermographism (factitious urticaria)--passive transfer experiments from human to monkey.  

PubMed

Passive transfer experiments were carried out on three species of monkey, Macaca mulatta, Macaca nemestrina and Macaca fascicularis, using human serum from patients affected with severe symptomatic dermographism (factitious urticaria), cholinergic urticaria, chronic idiopathic urticaria and normal subjects. The monkeys were tested for dermographism by means of a calibrated dermographometer 24 h after intradermal injection of the serum, using Evans blue as a marker. Positive responses were seen initially in the M. nemestrina. Four sites injected with serum from patients with severe symptomatic dermographism gave positive responses, one site injected with serum from a normal subject produced a faint response. One of the four responses was reproduced one month later in M. fascicularis. These results indicate that passive transfer of dermographism is possible from human to monkey. PMID:3620341

Murphy, G M; Zollman, P E; Greaves, M W; Winkelmann, R K

1987-06-01

114

Secreted Wnt Modulators in Symptomatic Aortic Stenosis  

PubMed Central

Background Valve calcification and inflammation play key roles in the development of aortic stenosis (AS). The Wnt pathways have been linked to inflammation, bone metabolism, angiogenesis, and heart valve formation. We hypothesized that soluble Wnt modulators may be dysregulated in symptomatic AS. Methods and Results We measured circulating levels (n=136) and aortic valve tissue expression (n=16) of the secreted Wnt modulators secreted frizzled related protein-3, dickkopf-1 (DKK-1), and Wnt inhibitory factor-1 (WIF-1) by enzyme immunoassay, immunostaining, and RT-PCR in patients with symptomatic, severe AS and investigated associations with echocardiographic parameters of AS and cardiac function. Finally, we assessed the prognostic value of these Wnt modulators in relation to all-cause mortality (n=35) during long-term follow-up (median 4.6 years; survivors, 4.8 years; nonsurvivors, 1.9 years) in these patients. Our main findings were: (1) serum levels of all Wnt modulators were markedly elevated in patients with symptomatic AS (mean increase 231% to 278%, P<0.001), (2) all Wnt modulators were present in calcified aortic valves but correlated poorly with systemic levels or degree of AS, (3) some modulators (ie, WIF-1) were associated with the degree of myocardial function and valvular calcification, (4) all Wnt modulators, and DKK-1 in particular, predicted long-term mortality in these patients also after adjusting for conventional predictors including NT-proBNP. Conclusions Together, these in vivo data support the involvement of Wnt signaling in the development of AS and suggest that circulating Wnt modulators should be further investigated as risk markers in larger AS populations, including patients with asymptomatic disease. PMID:23316316

Askevold, Erik Tandberg; Gullestad, Lars; Aakhus, Svend; Ranheim, Trine; Tønnessen, Theis; Solberg, Ole G.; Aukrust, Pål; Ueland, Thor

2012-01-01

115

Symptomatic hypotonic hyponatremia presenting at high altitude.  

PubMed

We present a case of altered mental status and seizure that occurred at an altitude known to cause high altitude-related illnesses. Based on the presenting symptoms, the patient was initially transferred to the hospital with a presumptive diagnosis of high altitude cerebral edema. On review of imaging and laboratory data, she was found to be experiencing symptomatic hypotonic hyponatremia. This case presented an interesting diagnostic challenge and underscores the importance of maintaining a broad differential diagnosis when evaluating a patient with altered mental status from an alpine setting. PMID:24411978

Spano, Susanne J; Reagle, Zacharia; Evans, Timothy

2014-03-01

116

Clinical experience of symptomatic sacral perineural cyst.  

PubMed

Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. He was diagnosed as having a sacral cyst with magnetic resonance imaging. For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patient's symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst. PMID:22787551

Jung, Ki Tae; Lee, Hyun Young; Lim, Kyung Joon

2012-07-01

117

Clinical Experience of Symptomatic Sacral Perineural Cyst  

PubMed Central

Tarlov or perineural cysts are nerve root cysts found most commonly at the sacral spine level arising between covering layers of the perineurium and the endoneurium near the dorsal root ganglion and are usually asymptomatic. Symptomatic sacral perineural cysts are uncommon but sometimes require surgical treatment. A 69-year-old male presented with pain in the buttock. He was diagnosed as having a sacral cyst with magnetic resonance imaging. For the nonoperative diagnosis and treatment, caudal peridurography and block were performed. After the treatment, the patient's symptom was relieved. We suggest a caudal peridural block is effective in relieving pain from a sacral cyst. PMID:22787551

Jung, Ki Tae; Lee, Hyun Young

2012-01-01

118

Symptomatic Epilepsies due to Cerebrovascular Diseases  

PubMed Central

Introduction: Cerebro-vascular diseases (CVD) are the leading cause of symptomatic epilepsies. This study aims to investigate: a) Frequency of epilepsy in patients with CVD; b) Correlation of epilepsy with the type of CVD (ischemic and hemorrhage) and with age. Methodology: It is analyzed medical documentation of 816 hospitalized patients with CVD in the clinic of Neurology in University Clinical Center (UCC) during the period January - December 2010. The study included data on patients presenting with epileptic seizures after CVD, and those with previously diagnosed epilepsy, are not included in the study. The diagnosis of CVD, are established in clinical neurological examination and the brain imaging (computer tomography and magnetic resonance imaging). The diagnosis of epilepsy is established by the criteria of ILAE (International League against Epilepsy) 1983, and epileptic seizures are classified according to the ILAE classification, of 1981. Results: Out of 816 patients with CVD, 692 were with ischemic stroke and 124 with hemorrhage. From 816 patients, epileptic seizures had 81 (10%), of which 9 patients had been diagnosed with epilepsy earlier and they are not included in the study. From 72 (99%) patients with seizures after CVD 25 (33%) have been with ischemia, whereas 47 (67%) with hemorrhage. Conclusion: CVD present fairly frequent cause of symptomatic epilepsies among patients treated in the clinic of Neurology at UCC (about 10%). The biggest number of patients with epilepsy after CVD was with intracerebral hemorrhage. PMID:25685086

Dakaj, Nazim; Shatri, Nexhat; Isaku, Enver; Zeqiraj, Kamber

2014-01-01

119

Treatment of symptomatic AOVMs with radiosurgery.  

PubMed

In spite of great success in the treatment cerebral AVMs with stereotactic radiosurgery, the role of this treatment modality in angiographically occult vascular malformations (AOVMs) is not recognized. Since the installation of the Gamma-knife, we have treated 20 cases of AOVMs by radiosurgery. There were 13 males and 7 females, the age ranged from 3 to 58 years with an average age of 34.0 years. Their clinical presentations at the onset were haemorrhage in 11, convulsive seizure in 7 and progressive neurological deficits in 2. Two cases had multiple lesions. Among 20 symptomatic lesions, 14 were located supratentorially, 4 in the brain stem and 2 in the cerebellar hemispheres. Following localization with MRI and dose planning, the lesions were treated by radiosurgery and the doses ranged from 15 to 20 Gy at the margins. Follow-up studies indicate a significant control of rebleeding as well as of the convulsive seizure. Imaging studies demonstrated the shrinkage of the lesion in 3 and reduced enhancement with Gadolinium-DTPA in some others. Adverse effects, chiefly related to radiation-induced oedema, occurred in 5. But they were generally mild and well controlled by medication. Thus the preliminary results indicate a certain usefulness of radiosurgery in the treatment of symptomatic AOVMs. PMID:7502732

Kida, Y; Kobayashi, T; Tanaka, T

1995-01-01

120

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

121

Enhanced Expression of Cystathionine ?-Synthase and Cystathionine ?-Lyase During Acute Cholecystitis-Induced Gallbladder Inflammation  

PubMed Central

Background Hydrogen sulfide (H2S) has recently been shown to play an important role in the digestive system, but the role of endogenous H2S produced locally in the gallbladder is unknown. The aim of this study was to investigate whether gallbladder possesses the enzymatic machinery to synthesize H2S, and whether H2S synthesis is changed in gallbladder inflammation during acute acalculous cholecystitis (AC). Methods Adult male guinea pigs underwent either a sham operation or common bile duct ligation (CBDL). One, two, or three days after CBDL, the animals were sacrificed separately. Hematoxylin and eosin-stained slides of gallbladder samples were scored for inflammation. H2S production rate in gallbladder tissue from each group was determined; immunohistochemistry and western blotting were used to determine expression levels of the H2S-producing enzymes cystathionine ?-synthase (CBS) and cystathionine ?-lyase (CSE) in gallbladder. Results There was a progressive inflammatory response after CBDL. Immunohistochemistry analysis showed that CBS and CSE were expressed in the gallbladder epithelium, muscular layer, and blood vessels and that the expression increased progressively with increasing inflammation following CBDL. The expression of CBS protein as well as the H2S-production rate was significantly increased in the animals that underwent CBDL, compared to those that underwent the sham operation. Conclusions Both CBS and CSE are expressed in gallbladder tissues. The expression of these enzymes, as well as H2S synthesis, was up-regulated in the context of inflammation during AC. PMID:24349344

Yang, Bin; Xiao, Yong; Yu, Baoping

2013-01-01

122

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

123

Limits and perspective of oral therapy with statins and aspirin for the prevention of symptomatic cholesterol gallstone disease.  

PubMed

The prevalence of gallstones disease in Western countries is 10 - 15%. Gallstones can be one of two types - cholesterol or pigment - with cholesterol gallstones representing nearly the 80% of the total. Cholesterol and pigment gallstones have different predisposing factors: cholesterol gallstones are related to supersaturated bile in cholesterol, whereas black pigment gallstones are related to hyperbilirubinbilia factors (hemolysis, etc.); these are necessary, but not sufficient, factors to produce gallstones in vivo. Gall bladder mucosa factors (gall bladder secretion of mucin, local bile stasis and production of endogenous biliary ?-glucuronidase) may coexist with the aforementioned factors and facilitate gallstone nucleation and growth. The gold-standard treatment for symptomatic gallstones is laparoscopic cholecystectomy. Several studies have reported a significant reduction in the onset of symptomatic gallstones disease in patients undergoing chronic therapy with statins, which can reduce bile cholesterol saturation. Aspirin, which has been shown to reduce the local production of gall bladder mucins (mucosal or parietal factors of gallstone formation) in animal experimental models, does not appear to reduce the risk of symptomatic gallstones disease when tested alone. The new horizon of oral therapy for the prevention of symptomatic gallstone disease needs to evaluate the long-term effect of statins and chronic aspirin administration in patients with dyslipidemia and/or atherosclerosis. PMID:22607008

Cariati, Andrea; Piromalli, Elisa

2012-06-01

124

Prospective evaluation of /sup 99m/Tc-IDA cholescintigraphy and gray-scale ultrasound in the diagnosis of acute cholecystitis  

SciTech Connect

Prospective analysis of the efficacy of /sup 99m/Tc-IDA cholescintigraphy and cholecystosonography showed that both are excellent techniques for assessing patients with suspected acute cholecystitis (accuracy 84.7% and 88.1% respectively). Consequently, the choice of tests selected to evaluate patients with suspected acute cholecystitis depends on several factors including; (a.) quality of equipment available; (b.) capability of the technologist performing the examination; (c.) relative experience of the physician supervising the examination; and (d.) willingness of the surgical consultant to accept a positive examination as sufficient evidence to perform emergency surgery. The authors feel that cholecystosonography should be used to assess the presence of acute cholecystitis in jaundiced patients because of its capability in the assessment of bile duct dilatation, and because of the lower reliability of cholescintigraphy when bile duct obstruction is possible (i.e., in jaundice). Ancillary findings in cholecystosonography and cholescintigraphy can aid in the differential diagnosis of acute right upper quandrant pain syndromes.

Ralls, P.W.; Colletti, P.M.; Halls, J.M.; Siemsen, J.K.

1982-07-01

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.

2012-01-01

126

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

127

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

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

Temporal Dynamics of Host Molecular Responses Differentiate Symptomatic and Asymptomatic Influenza  

E-print Network

Temporal Dynamics of Host Molecular Responses Differentiate Symptomatic and Asymptomatic Influenza to influenza viruses is necessary, but not sufficient, for healthy human hosts to develop symptomatic illness responses that differentiate symptomatic and asymptomatic Influenza A infection, we inoculated 17 healthy

Dobigeon, Nicolas

130

Management of a patient with situs inversus totalis with acute cholecystitis and common bile duct stones: A case report  

PubMed Central

INTRODUCTION The incidence of situs inversus thought to be in the range of 1:10,000–1:20,000 according to Mayo et al. PRESENTATION OF CASE A forty-five year-old lady presented with pain in the left hypochondrium and was diagnosed to have acute cholecystitis with choledocholithiasis in situs inversus totalis. Patient underwent endoscopic sphincterotomy and common bile duct stone extraction in view of choledocholithiasis and after common bile duct cannulation patient taken up for elective laparoscopic cholecystectomy (LC) within 24 h. DISCUSSION The most challenging factor for performing surgery in a patient with situs inversus is dealing with the mirror image anatomy. The first laparoscopic cholecystectomy in situs inversus was reported by Campos et al. in 1991. Since then, 50 other cases have been reported in literature making a point that laparoscopic procedure is not contraindicated. CONCLUSION Acute cholecystitis with choledocholithiasis is extremely rare and requires expert intervention from both the endoscopist and the laparoscopic surgeons because of the reverse anatomy and the fact that both are attuned to the constant practice of the procedures in normal anatomy. PMID:25462042

Reddy, Ashwanth; Paramasivam, Surendran; Alexander, Naveen; Abhilash; Ravisankar, Vigneshwar; Thillai, Manoj

2014-01-01

131

Comparison of Clinical Safety and Outcomes of Early versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Meta-Analysis  

PubMed Central

Objective. To compare the clinical safety and outcomes of early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy for acute cholecystitis. Methods. Pertinent studies were selected from the Medline, EMBASE, and Cochrane library databases, references from published articles, and reviews. Seven randomized controlled trials (early laparoscopic cholecystectomy versus delayed laparoscopic cholecystectomy) were selected. Conventional meta-analysis according to Cochrane Collaboration was used for the pooling of the results. Results. Seven trials with 1106 patients were included. There was no significant difference between the two groups in terms of bile duct injury (Peto odds ratio 0.49 (95% confidence interval 0.05 to 4.72); P = 0.54) or conversion to open cholecystectomy (risk ratio 0.91 (95% confidence interval 0.69 to 1.20); P = 0.50). The total hospital stay was shorter by 4 days for early laparoscopic cholecystectomy (mean difference ?4.12 (95% confidence interval ?5.22 to ?3.03) days; P < 0.00001). Conclusion. Early laparoscopic cholecystectomy during acute cholecystitis is safe and shortens the total hospital stay. PMID:25133217

Zhou, Min-Wei; Gu, Xiao-Dong; Xiang, Jian-Bin; Chen, Zong-You

2014-01-01

132

Symptomatic treatment and management of multiple sclerosis.  

PubMed

The range of symptoms which occur in multiple sclerosis (MS) can have disabling functional consequences for patients and lead to significant reductions in their quality of life. MS symptoms can also interact with each other, making their management challenging. Clinical trials aimed at identifying symptomatic therapies have generally been poorly designed and have tended to be underpowered. Therefore, the evidence base for the management of MS symptoms with pharmacologic therapies is not strong and tends to rely upon open-label studies, case reports, and clinical trials with small numbers of patients and poorly validated clinical outcome measures. Recently, there has been a growing interest in the management of MS symptoms with pharmacologic treatments, and better-designed, randomized, double-blind, controlled trials have been reported. This chapter will describe the evidence base predominantly behind the various pharmacologic approaches to the management of MS symptoms, which in most, if not all, cases, requires multidisciplinary input. Drugs routinely recommended for individual symptoms and new therapies, which are currently in the development pipeline, will be reviewed. More interventional therapies related to symptoms that are refractory to pharmacotherapy will also be discussed, where relevant. PMID:24507534

Toosy, Ahmed; Ciccarelli, Olga; Thompson, Alan

2014-01-01

133

Palliative treatment for symptomatic malignant pericardial effusion†.  

PubMed

Consensus has yet to emerge regarding the optimal choice of therapy in the management of malignant pericardial effusion. We review the literature to evaluate the existing evidence on the clinical effectiveness of surgical and interventional cardiological approaches. A formal literature search for all studies addressing the treatment of pericardial effusion in cancer patients was undertaken using predefined keywords. Abstracts were screened and reviewed, and data extracted. Data on intervention type, number of patients treated, number of patients surviving the procedure, effusion recurrences, need for further interventions and procedure-related complications were obtained from each study and collated in a quantitative synthesis. Of 1181 articles identified, 59 contained sufficient quantitative information to be included in the synthesis. A total of 2322 patients with symptomatic pericardial effusion were identified, of which 1399 patients were reported to have underlying malignancy. Three surgical approaches were described in a total of 19 studies, with overall success rates ranging from 93.3 to 100% and associated complication rates ranging from 4.5 to 10.3%. The remaining 40 studies reported four non-surgical treatment modalities, with success rates of 55.1-90.4% and complication rates of 5.9-32%. Data from the literature suggest that surgical drainage of the pericardium is superior to non-surgical approaches for symptom relief, effusion recurrence and morbidity; however, the lack of randomized controlled trials means that selection bias remains an important limitation to the field and definitive adequately controlled trials should be a priority. PMID:25142067

Jama, Guled M; Scarci, Marco; Bowden, Jack; Marciniak, Stefan J

2014-12-01

134

Percutaneous Fibrin Gel Injection under C-Arm Fluoroscopy Guidance: A New Minimally Invasive Choice for Symptomatic Sacral Perineural Cysts  

PubMed Central

Background Symptomatic sacral perineural cysts are a common cause of chronic pain. Surgery is one choice for symptom relief but has a high risk of cyst recurrence and complications. As a simple and safe method to manage symptomatic sacral perineural cysts, C-arm fluoroscopy-guided fibrin gel injection may represent a new minimally invasive alternative. To evaluate the efficacy of this new method, we conducted a retrospective study of 42 patients. Methods and Findings From June 2009 to August 2012, a total of 42 patients with symptomatic sacral perineural cysts underwent C-arm fluoroscopy-guided percutaneous fibrin gel injection therapy. Patient outcomes in terms of improvements in pain and neurologic function were evaluated during a follow-up period of 13–39 months. The preoperative and postoperative pain severity were assessed according to a 10-cm visual analog pain scale, and imaging changes were evaluated by magnetic resonance imaging. We also assessed postoperative complications. Most patients experienced benefit from the procedure: twenty-five patients (59.5%) reported excellent recovery, eleven (26.2%) reported good recovery, three (7.1%) reported fair recovery, and three (7.1%) reported poor recovery. The overall effectiveness rate (excellent and good recoveries) was 85.7%. No serious postoperative complications were observed. Conclusion Percutaneous fibrin gel injection under C-arm fluoroscopy guidance could be a simple, safe and effective treatment option for symptomatic sacral perineural cysts. PMID:25706639

Jiang, Wei; Qiu, QuanHe; Hao, Jie; Zhang, XiaoJun; Shui, Wei; Hu, ZhenMing

2015-01-01

135

Symptomatic Pericardial Effusion After Chemoradiation Therapy in Esophageal Cancer Patients  

SciTech Connect

Purpose: We investigated clinical and treatment-related factors as predictors of symptomatic pericardial effusion in esophageal cancer patients after concurrent chemoradiation therapy. Methods and Materials: We reviewed 214 consecutive primary esophageal cancer patients treated with concurrent chemoradiation therapy between 2001 and 2010 in our institute. Pericardial effusion was detected on follow-up computed tomography. Symptomatic effusion was defined as effusion ?grade 3 according to Common Terminology Criteria for Adverse Events v4.0 criteria. Percent volume irradiated with 5 to 65 Gy (V5-V65) and mean dose to the pericardium were evaluated employing dose-volume histograms. To evaluate dosimetry for patients treated with two-dimensional planning in the earlier period (2001-2005), computed tomography data at diagnosis were transferred to a treatment planning system to reconstruct three-dimensional plans without modification. Optimal dosimetric thresholds for symptomatic pericardial effusion were calculated by receiver operating characteristic curves. Associating clinical and treatment-related risk factors for symptomatic pericardial effusion were detected by univariate and multivariate analyses. Results: The median follow-up was 29 (range, 6-121) months for eligible 167 patients. Symptomatic pericardial effusion was observed in 14 (8.4%) patients. Dosimetric analyses revealed average values of V30 to V45 for the pericardium and mean pericardial doses were significantly higher in patients with symptomatic pericardial effusion than in those with asymptomatic pericardial effusion (P<.05). Pericardial V5 to V55 and mean pericardial doses were significantly higher in patients with symptomatic pericardial effusion than in those without pericardial effusion (P<.001). Mean pericardial doses of 36.5 Gy and V45 of 58% were selected as optimal cutoff values for predicting symptomatic pericardial effusion. Multivariate analysis identified mean pericardial dose as the strongest risk factor for symptomatic pericardial effusion. Conclusions: Dose-volume thresholds for the pericardium facilitate predicting symptomatic pericardial effusion. Mean pericardial dose was selected based not only on the optimal dose-volume threshold but also on the most significant risk factor for symptomatic pericardial effusion.

Fukada, Junichi, E-mail: fukada@rad.med.keio.ac.jp [Department of Radiology, School of Medicine, Keio University, Tokyo (Japan); Shigematsu, Naoyuki [Department of Radiology, School of Medicine, Keio University, Tokyo (Japan); Takeuchi, Hiroya [Department of Surgery, School of Medicine, Keio University, Tokyo (Japan); Ohashi, Toshio [Department of Radiology, School of Medicine, Keio University, Tokyo (Japan); Saikawa, Yoshiro [Department of Surgery, School of Medicine, Keio University, Tokyo (Japan); Takaishi, Hiromasa [Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo (Japan); Hanada, Takashi; Shiraishi, Yutaka [Department of Radiology, School of Medicine, Keio University, Tokyo (Japan); Kitagawa, Yuko [Department of Surgery, School of Medicine, Keio University, Tokyo (Japan); Fukuda, Keiichi [Department of Cardiology, School of Medicine, Keio University, Tokyo (Japan)

2013-11-01

136

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

137

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

PubMed Central

Background Temporomandibular disorder (TMD) patients might present a number of concurrent clinical diagnoses that may be clustered according to their similarity. Profiling patients’ clinical presentations can be useful for better understanding the behavior of TMD and for providing appropriate treatment planning. The aim of this study was to simultaneously classify symptomatic patients diagnosed with a variety of subtypes of TMD into homogenous groups based on their clinical presentation and occurrence of comorbidities. Methods Clinical records of 357 consecutive TMD patients seeking treatment in a private specialized clinic were included in the study sample. Patients presenting multiple subtypes of TMD diagnosed simultaneously were categorized according to the AAOP criteria. Descriptive statistics and two-step cluster analysis were used to characterize the clinical presentation of these patients based on the primary and secondary clinical diagnoses. Results The most common diagnoses were localized masticatory muscle pain (n?=?125) and disc displacement without reduction (n?=?104). Comorbidity was identified in 288 patients. The automatic selection of an optimal number of clusters included 100% of cases, generating an initial 6-cluster solution and a final 4-cluster solution. The interpretation of within-group ranking of the importance of variables in the clustering solutions resulted in the following characterization of clusters: chronic facial pain (n?=?36), acute muscle pain (n?=?125), acute articular pain (n?=?75) and chronic articular impairment (n?=?121). Conclusion Subgroups of acute and chronic TMD patients seeking treatment can be identified using clustering methods to provide a better understanding of the clinical presentation of TMD when multiple diagnosis are present. Classifying patients into identifiable symptomatic profiles would help clinicians to estimate how common a disorder is within a population of TMD patients and understand the probability of certain pattern of clinical complaints. PMID:22857609

2012-01-01

138

Relative efficacy of pimecrolimus cream and triamcinolone acetonide paste in the treatment of symptomatic oral lichen planus  

PubMed Central

Background and Objectives: Oral lichen planus (OLP) is a relatively common, chronic inflammatory condition that frequently presents with symptoms of pain and burning sensation. It is generally a very unrelenting disorder despite several kinds of treatment. Only symptomatic OLP requires treatment, and it remains a challenging predicament. Efforts are made in a sustained manner for searching for novel therapies for symptomatic OLP. Therefore, this study was aimed to compare the efficacy of treatment with topical pimecrolimus cream 1% with that of triamcinolone acetonide oral paste 0.1% in subjects with symptomatic OLP. Materials and Methods: A prospective, parallel-group, randomized, active control clinical study was conducted among 30 symptomatic OLP subjects (20 females and 10 males, with 15 patients in each treatment group) treated with topical pimecrolimus 1% cream and triamcinolone acetonide 0.1% oral paste four times daily for two consecutive months and treatment-free follow-up was performed for 2 months. Pain or burning sensation, mean clinical score and presence of erythematous areas were assessed. The data obtained were statistically analyzed using Wilcoxon's Rank test and the Mann Whitney test. Results: Subjects in both the groups showed significant improvement in symptom scores; however, the overall treatment response was higher in the pimecrolimus group compared with the triamcinolone acetonide group. On intergroup comparison, there was no statistically significant difference between the groups in the reduction in burning sensation (P = 0.18) and erythematous area (P = 0.07), but there was a statistically highly significant improvement in reduction of clinical scoring (P < 0.01%). Following the termination of the treatment, sustained remission of symptoms and long-lasting therapeutic effects was detected in 93.3% of the patients treated with pimecrolimus. Interpretation and Conclusion: Topical pimecrolimus 1% cream showed better therapeutic response compared with triamcinolone acetonide 0.1% oral paste in subjects with symptomatic OLP.

Arunkumar, Shantala; Kalappanavar, Anupama N; Annigeri, Rajeshwari G; Kalappa, Shakuntala G

2015-01-01

139

[Influence of method of cholecystectomy performance on the central hemodynamics indices in patients with an acute cholecystitis].  

PubMed

There were examined 120 patients, using the method of the integral rheography of the body (according to method of M. I. Tyshchenko), and than operated on for the acute cholecystitis. In 60 patients, constituting the main group, cholecystectomy using minimal approach (CHMA) was done and in 60 (control group)--open cholecystectomy (OCH) using wide laparotomy. After performance of OCH the significant reduction of volumetric indices of blood flow was established. Extremely significant changes of the hemodynamics indices was observed on 1-3 days and than they had slowly improved and on 7-9 day restored, but not completely up to primary data in majority of cases. After performance of CHMA the indices changes were less significant and had restored earlier. PMID:17115608

Kustr'o, V I; Kustr'o, O V

2006-08-01

140

Dealing with symptomatic stenosis of the subclavian artery: Open or endovascular approach? A case report?  

PubMed Central

INTRODUCTION Stenosis of the subclavian artery is uncommon and it rarely causes symptoms. Only symptomatic patients should be treated. PRESENTATION OF CASE We report a case of chronic left upper limb ischemia caused by subclavian artery stenosis after repetitive clavicular fixation. The stenosis was first treated with carotid-subclavian bypass and soon followed by angioplasty and stenting of the subclavian artery because of occlusion of the bypass. Finally, failure of these procedures necessitated a subclavian-axillary crossover bypass. DISCUSSION Both extra-anatomic bypass and percutaneous transluminal angioplasty are safe and effective. If feasible, many authors use endovascular treatment. According to literature, extra-anatomic bypass still remains the first choice of treatment for symptomatic patients. However, the introduction of routine stent implantation is equalling these results. Because of its lower long-term patency rate, endovascular treatment is favorable for patients at high risk. CONCLUSION Our case is a good example of difficulties involved in choosing the best treatment option for subclavian artery stenosis. PMID:24973522

Mufty, Hozan; Janssen, Alfred; Schepers, Stijn

2014-01-01

141

A childhood case of symptomatic essential and psychogenic palatal tremor  

PubMed Central

Palatal tremor is a rare movement disorder characterized by rhythmic contractions of the soft palate. It is most often symptomatic, secondary to brainstem or cerebellar disease and, in rarer cases, is categorized as essential in the absence of documented brain lesions. There have also been reports in the literature of cases of palatal tremor described as psychogenic because they were associated with psychological or psychiatric disorders. We describe the case of a 12-year-old boy with palatal tremor presenting clinical features of symptomatic essential and psychogenic palatal tremor, thus suggesting a neuropsychopathological continuum between the different forms of disease. PMID:21573084

Margari, Francesco; Giannella, Giustina; Lecce, Paola Alessandra; Fanizzi, Piero; Toto, Maddalena; Margari, Lucia

2011-01-01

142

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

143

Prospective evaluation of /sup 99//sup m/Tc-IDA cholescintigraphy and Gray-scale ultrasound in the diagnosis of acute cholecystitis  

SciTech Connect

Prospective analysis of the efficacy of /sup 99//sup m/Tc-IDA cholescintigraphy and cholecystosonography showed that both are excellent techniques for assessing patients with suspected acute cholecystitis (accuracy 84.7% and 88.1% respectively). Consequently, the choice of tests selected to evaluate patients with suspected acute cholecystitis depends on several factors, including; (a.) quality of equipment available; (b.) capability of the technologist performing the examination; (c.) relative experience of the physician supervising the examination; and (d.) willingness of the surgical consultant to accept a positive examination as sufficient evidence to perform emergency surgery. The authors feel that cholecystosonography should be used to asses the presence of acute cholecystitis in jaundiced patients because of its capability in the assessment of bile duct dilation, and because of the lower reliability of cholescintigraphy when bile duct obstruction is possible (i.e., in jaundice). Ancillary findings in cholecystosonography and cholescintigraphy can aid in the differential diagnosis of acute right upper quadrant pain syndromes.

Ralls, P.W.; Colletti, P.M.; Halls, J.M.; Siemsen, J.K.

1982-07-01

144

Histological subtypes of symptomatic central nervous system tumours in Singapore  

Microsoft Academic Search

The objective was to identify the different subtypes of symptomatic CNS tumours that are encountered in Singapore. Our hospital pathology and operative records from 1994 to 1998 were reviewed and information regarding all patients who underwent biopsy or resection as part of their diagnostic and therapeutic evaluation was extracted. Only histologically confirmed tumours were included in this analysis. Meningiomas made

A Das; C A T Chapman; W M Yap

2000-01-01

145

Hypoadiponectinemia is associated with symptomatic atherosclerotic peripheral arterial disease.  

PubMed

There is growing evidence that adiponectin, an adipocytokine with anti-inflammatory and antiatherogenic properties, is involved in the development of atherosclerosis. The aim of the present study was to examine whether serum levels of adiponectin were associated with symptomatic atherosclerotic peripheral arterial disease (PAD). Serum concentrations of adiponectin were measured in 433 patients with symptomatic PAD and 433 controls from the Linz Peripheral Arterial Disease (LIPAD) study. Cases and controls were matched for age, sex and diabetes mellitus. The median serum level of adiponectin was significantly lower in PAD patients than in control subjects (9.5 vs. 10.8 mg/L; p=0.014). After adjustment for several possible confounding variables using multivariable logistic regression, odds ratios for symptomatic PAD were 0.95 (95% CI, 0.64-1.42; p=0.080) and 0.59 (95% CI, 0.36-0.97; p=0.037) in the second and third tertiles for adiponectin serum concentrations, respectively, compared with the first tertile. Low serum levels of adiponectin were associated with the presence of symptomatic atherosclerotic PAD, independent of traditional and non-traditional risk factors, suggesting that hypoadiponectinemia may be a marker for systemic atherosclerotic disease. PMID:16776628

Dieplinger, Benjamin; Poelz, Werner; Haltmayer, Meinhard; Mueller, Thomas

2006-01-01

146

Atherosclerotic plaque rupture in symptomatic carotid artery stenosis  

Microsoft Academic Search

Purpose: Plaque rupture is often the precipitating event in acute coronary syndromes. We hypothesized that a similar process occurs in stenotic carotid plaques in association with ischemic neurologic symptoms. Our purpose was to examine several morphologic features of stenotic carotid plaques and to determine which characteristics are more commonly associated with plaques obtained from patients with symptomatic carotid artery disease

Sandra Carr; Andrew Farb; William H. Pearce; Renu Virmani; James S. T. Yao

1996-01-01

147

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. PMID:25561985

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

2014-01-01

148

Total spondylectomy of a symptomatic hemangioma of the lumbar spine  

Microsoft Academic Search

A vertebral hemangioma with dural compression and neurological deficit is rare. We report a symptomatic lumbar vertebral hemangioma which was successfully managed with total spondylectomy. The patient was a 31-year-old man whose chief complaint was low back pain. He had a slight sensory disturbance in the right thigh. Plain radiography and magnetic resonance imaging (MRI) revealed a tumor in the

Toshiyuki Inoue; Kei Miyamoto; Hirotaka Kodama; Hideo Hosoe; Katsuji Shimizu

2007-01-01

149

Chronic Migraine  

MedlinePLUS

Home » Chronic Migraine Chronic Migraine Submitted by Admin on Thu, 2007-10-25 18:01 Chronic migraine (CM) best characterizes those patients with a history of migraine who experience headache more than half the time. ...

150

The role of tissue pressure measurement in diagnosing chronic anterior compartment syndrome  

Microsoft Academic Search

Pressure studies were performed in 55 patients (24 with chronic anterior leg pain and 31 asymptomatic recreational athletes). Pressure measurements were recorded at rest, during, and after exercise, using the slit catheter system. Seventeen of the twenty-four pa tients with symptomatic anterior leg pain were diag nosed on the basis of tissue pressure studies as having chronic exertional compartment syndrome.

C. H. Rorabeck; R. B. Bourne; P. J. Fowler; J. B. Finlay; Linda Nott

1988-01-01

151

Internal sphincterotomy is superior to topical nitroglycerin in the treatment of chronic anal fissure  

Microsoft Academic Search

PURPOSE: This was a multicenter, randomized, controlled trial to compare the effectiveness of topical nitroglycerin with internal sphincterotomy in the treatment of chronic anal fissure. METHODS: Patients with symptomatic chronic anal fissures were randomly assigned to 0.25 percent nitroglycerintid or internal sphincterotomy. Both groups received stool softeners and fiber supplements and were assessed at six weeks and six months. RESULTS:

C. S. Richard; R. Gregoire; E. A. Plewes; R. Silverman; C. Burul; D. Buie; R. Reznick; T. Ross; M. Burnstein; B. I. O'Connor; D. Mukraj; R. S. McLeod

2000-01-01

152

Treatment of chronic sarcoidosis with an azathioprine\\/ prednisolone regimen  

Microsoft Academic Search

Treatment of chronic sarcoidosis with an azathioprine\\/prednisolone regimen. J. Muller- Quernheim, K. Kienast, M. Held, S. Pfeifer, U. Costabel. #ERS Journals Ltd 1999. ABSTRACT: In a few patients with chronic sarcoidosis, prolonged, unacceptably high doses of corticosteroids are required to achieve symptomatic relief. In these cases, a corticosteroid-sparing drug might be administered to allow long-term treatment without the adverse effects

J. Muller-Quernheim

153

Multinuclide digital subtraction imaging in symptomatic prostnetic joints  

SciTech Connect

One hundred eleven patients with symptomatic prosthetic joints (86 hips, 23 knees, and two shoulders) were evaluated for prosthetic loosening and infection by combined technetium-99m-MDP/gallium-67 digital subtraction imaging. Clinical correlation was based on the assessment of loosening and bacterial cultures obtained at the time of surgery in 54 patients, joint aspiration cultures obtained in 37 patients, and long-term clinical follow-up for greater than 1.5 years in an additional 15 patients. Results revealed an 80-90% predictive value of a positive test for loosening, and a 95% predictive value of a negative test for infection. However, because of the low sensitivities and specificities observed, this approach to the evaluation of symptomatic prosthetic joints does not seem cost effective.

Chafetz, N.; Hattner, R.S.; Ruarke, W.C.; Helms, C.A.; Genant, H.K.; Murray, W.R.

1985-06-01

154

Damp housing, mould growth, and symptomatic health state  

Microsoft Academic Search

OBJECTIVE--To examine the relation between damp and mould growth and symptomatic ill health. DESIGN--Cross-sectional study of random sample of households containing children; separate and independent assessments of housing conditions (by surveyor) and health (structured interview by trained researcher). SETTING--Subjects' homes (in selected areas of public housing in Glasgow, Edinburgh, and London). SUBJECTS--Adult respondents (94% women) and 1169 children living in

S. D. Platt; C. J. Martin; S. M. Hunt; C. W. Lewis

1989-01-01

155

Symptomatic first metatarsocuneiform nonunion revised by arthroscopic lapidus arthrodesis.  

PubMed

Lapidus arthrodesis is indicated for painful, advanced hallux valgus and symptomatic first ray hypermobility with or without arthrosis of the joint. Nonunion of the first metatarsocuneiform joint fusion is the most frequent complication of attempted lapidus arthrodesis. We present a case of painful first metatarsocuneiform nonunion that was successfully treated using arthroscopic revision lapidus arthrodesis to describe this unusual approach to a known postoperative complication. PMID:22819003

Lui, Tun Hing

2012-01-01

156

Human giardiasis in Serbia: asymptomatic vs symptomatic infection*  

PubMed Central

Despite the public health importance of giardiasis in all of Europe, reliable data on the incidence and prevalence in Western Balkan Countries (Serbia, Bosnia and Herzegovina, Croatia, Montenegro and FYR Macedonia) are scarce, and the relative contribution of waterborne and food-borne, or person-to-person and/or animalto- person, transmission of human giardiasis is not yet clear. To provide baseline data for the estimation of the public health risk caused by Giardia, we here review the information available on the epidemiological characteristics of asymptomatic and symptomatic human infection in Serbia. Although asymptomatic cases of Giardia represent a major proportion of the total cases of infection, high rates of Giardia infection were found in both asymptomatic and symptomatic populations. No waterborne outbreaks of giardiasis have been reported, and it thus seems that giardiasis mostly occurs sporadically in our milieu. Under such circumstances, control measures to reduce the high prevalence of giardiasis in Serbia have focused on person-to-person transmission, encouraging proper hygiene, but for more targeted intervention measures, studies to identify other risk factors for asymptomatic and symptomatic infections are needed. PMID:21678797

Nikoli?, A.; Klun, I.; Bobi?, B.; Ivovi?, V.; Vujani?, M.; Živkovi?, T.; Djurkovi?-Djakovi?, O.

2011-01-01

157

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

158

An Ultrasonographic Risk Score For Detecting Symptomatic Carotid Atherosclerotic Plaques.  

PubMed

This paper proposes a risk score computed from ultrasound data that correlates to plaque activity. It has the twofold purpose of detecting symptomatic plaques and estimating the likelihood of the asymptomatic lesion to become symptomatic. The proposed ultrasonographic activity index (UAI) relies on the plaque active profile which is a combination of the most discriminate ultrasound parameter associated with symptoms. These features are extracted by the automatic algorithm and also by the physician from the ultrasound images and from some transformations on it, such as monogenic decomposition which is a novelty in this clinical problem. This information is used to compute a risk score from the conditional probabilities of either symptomatic or asymptomatic groups. Symptom detection performance is evaluated on a transversal dataset of 146 plaques, where UAI obtained 83:5% accuracy, 84:1% sensitivity and 83:7% specificity. Performance is also assessed on a longitudinal study of 112 plaques, where UAI shows a significant improvement over the gold standard degree of stenosis, demonstrating higher power at predicting which asymptomatic plaques developed symptoms in an average follow-up of 10 months. Results suggest that this score could have a positive impact on early stroke prevention and treatment planning. PMID:25252286

Afonso, David; Seabra, Jose; Pedro, Luis; E Fernandes, Jose Fernandes; Sanches, Joao

2014-09-19

159

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

2015-02-01

160

Spectrum of gait impairments in presymptomatic and symptomatic Huntington's disease.  

PubMed

The purpose of this study was to quantify gait impairments in presymptomatic and symptomatic Huntington's disease (HD) subjects, and examine sensitivity of gait measures. Our sample (n = 65) included presymptomatic mutation carriers (PMC) (n = 15), symptomatic HD subjects (SHD) (n = 30) and healthy controls (n = 20). Participants were requested to walk at their preferred speed on a computerized walkway that recorded spatiotemporal variables. We administered the Unified HD Rating Scale (UHDRS) for PMC and SHD. PMC demonstrated decreased gait velocity (P < 0.01), stride length (P < 0.008), and increased time in double support (P < 0.001); and demonstrated higher variability in stride length (P < 0.01) and step time (P < 0.004) compared with controls. These impairments worsened with increasing disease severity for SHD. Gait impairments were correlated with predicted years to onset in PMC (velocity = -0.65; cadence = -0.70, step time = 0.71) and demonstrated high sensitivity and specificity in distinguishing between controls and mutation carriers. In contrast, UHDRS scores did not reveal impairments in gait and balance. Gait bradykinesia and dynamic balance impairments begin in the presymptomatic stage of HD and continue to worsen in the symptomatic stages. Gait measures are sensitive in differentiating between mutation positive and negative individuals even when impairments were not detected by clinical neurological examination. (c) 2008 Movement Disorder Society. PMID:18412252

Rao, Ashwini K; Muratori, Lisa; Louis, Elan D; Moskowitz, Carol B; Marder, Karen S

2008-06-15

161

Chronic sorrow  

Microsoft Academic Search

The concept of chronic sorrow has been used to describe the reaction of parents to the ongoing losses associated with caring for a child with chronic illness or disability. A middle-range theory of chronic sorrow provides a framework for further understanding of this phenomenon. This theory is applied to a case of a family burdened with the unrelenting stress of

Jean M. Scornaienchi

2003-01-01

162

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

163

Symptomatic hemangioma of oral cavity treated with CO2 laser  

NASA Astrophysics Data System (ADS)

The CO2 laser has been used by our group as a secure and efficient tool for the treatment of symptomatic oral cavity hemangiomas which can be responsible for disturbance for swallowing, phonation and in hygienic, besides discomfort and bleeding to patients. During the last four years, twelve patients with symptomatic oral cavity hemangioma were treated at the Laser Unit of our University. The treatment consisted in the application of CO2 laser at medium to low intensity according to characteristics and location of the lesions. For hemangiomas located at sites of easy surgical access such as anterior 1/3 of the tongue, lips, bucal vestibule we use 10 to 37 J/mm2 over the surface of the lesion. When the hemangioma was located at difficult surgical access sites, such as, tonsils, posterior 1/3 of tongue, or at pharyngeal wall we used 3.0 to 4.0 J/mm2 encircling the whole hemangioma. This causes reduction in the size of the lesion throughout sclerosis of nutrition vessels. After this initial procedure we applied 0.8 to 1.0 J/mm2 over the whole extent of the lesion. For both procedures we observed no significant bleeding or inflammatory reaction. The patients referred minimal post-operative discomfort with good cicatricial evolution. The evident reduction in the vascularization and size could be confirmed by photographic documentation. The good results described above, with disappearance of symptoms lead to the conclusion that CO2 laser is an efficient and secure method of treatment for symptomatic hemangioma of the oral cavity.

Nicola, Ester M. D.; Coutinho, Adriana A.; Nicola, Jorge H.; Gusmao, Reinaldo J.

1995-05-01

164

Detection of pyuria and bacteriuria in symptomatic ambulatory women  

Microsoft Academic Search

Objective:To compare the abilities of two methods for rapid detection of pyuria and three methods of urinalysis to predict significant\\u000a bacteriuria in symptomatic ambulatory women.\\u000a \\u000a Design:Prospective simultaneous comparison of the results of dipstick urinalysis, standard microscopic urinalysis, and hemocytometric\\u000a cell counting and Gram staining with the results of a standard urine culture.\\u000a \\u000a \\u000a \\u000a Setting:Two outpatient ambulatory care facilities serving predominantly minority

Raymond N. Blum; Richard A. Wright

1992-01-01

165

Symptomatic cystic seminal vesicle: a laparoscopic approach for effective treatment  

PubMed Central

This case report highlights a symptomatic cystic seminal vesicle lesion, treated laparoscopically. A young adult male known to have congenital right renal agenesis presented with a history of recurrent right iliac fossa pain, as well as deep pelvic discomfort. The preoperative evaluation revealed a 7 × 4.5 × 4 cm cystic seminal vesicle mass. After discovery of the mass, the patient underwent a transperitoneal laparoscopic excision of the lesion. The patient was discharged on the third postoperative day and had an uneventful recovery. There were no complications noted during a routine follow-up. The laparoscopic approach was shown to be effective in the management of this rare condition. PMID:20019960

Nassir, Anmar

2009-01-01

166

Symptomatic adenomyomatosis of the gallbladder--report of a case.  

PubMed

Adenomyomatosis of the gallbladder is a benign and degenerative condition of the gallbladder, characterized by proliferation of the mucosa of the gallbladder wall, forming invaginations and diverticula, penetrating a thickened muscular layer: the so-called Rokitansky-Aschoff sinuses (RAS). Most of the patients with adenomyomatosis remain asymptomatic. Hence adenomyomatosis is usually an incidental finding, either on ultrasonography performed for the detection of stones or by histologic examination of surgical gallbladder specimens. Only occasionally does adenomyomatosis not associated with cholelithiasis cause right upper quadrant pain. We report a case of symptomatic adenomyomatosis of the gallbladder. Clinical findings, etiology, diagnosis and therapy are discussed. PMID:12768869

Sermon, A; Himpens, J; Leman, G

2003-04-01

167

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

168

Significance of preoperative ultrasound measurement of gallbladder wall thickness.  

PubMed

Evaluation of patients with signs and symptoms of biliary tract disease usually includes ultrasound assessment of the gallbladder. Does measurement of the thickness of the gallbladder wall yield any significant information to the clinical surgeon? The records of all my patients undergoing cholecystectomy since 1990 were reviewed. The entire series consists of 401 consecutive patients, in whom 388 procedures were completed laparoscopically, with 14 patients requiring conversion to an open cholecystectomy. Each patient's preoperative evaluation included a gallbladder ultrasound, which included measurement of the diameter of the gallbladder wall. The entire series of cholecystectomies was evaluated according to the ultrasound measured diameter of the gallbladder wall. A thin gallbladder wall was less than 3 mm in diameter. A thick gallbladder wall was 3 mm or greater in diameter. Of the 401 consecutive patients who underwent cholecystectomy for symptomatic gallbladder disease, 86 (21.5%) were removed laparoscopically for acalculous disease. Eleven per cent of patients with acalculous cholecystitis had acute cholecystitis and 89 per cent had chronic cholecystitis. Every patient with either a thin or thick gallbladder wall with acalculous cholecystitis had a successful laparoscopic cholecystectomy. Three-hundred fifteen patients had a laparoscopic cholecystectomy for calculous cholecystitis. In patients with calculous cholecystitis, 28.3 per cent had acute cholecystitis and 71.7 per cent had chronic cholecystitis. The gallbladder wall was found to be greater than 3 mm in 38 per cent of patients with acute calculous cholecystitis and greater than 3 mm in 41 per cent of patients with chronic calculous cholecystitis. One-hundred, forty-two patients, out of a series total of 401, had a gallbladder wall thickness greater than 3 mm by preoperative sonography and 14 of these patients (10%) required conversion to an open cholecystectomy. A preoperative gallbladder ultrasound evaluation for symptomatic cholecystitis, which documents a thick gallbladder wall (> or =3 mm) with calculi, is a clinical warning for the laparoscopic surgeon of the potential for a difficult laparoscopic cholecystectomy procedure which may require conversion to an open cholecystectomy procedure. PMID:17939429

Majeski, James

2007-09-01

169

Surgical Intervention for Symptomatic Benign Prostatic Hyperplasia is Correlated With Expression of the AP-1 Transcription Factor Network  

PubMed Central

BACKGROUND Approximately one-third of patients fail medical treatment for benign prostatic hyperplasia and associated lower urinary tract symptoms (BPH/LUTS) requiring surgical intervention. Our purpose was to establish a molecular characterization for patients undergoing surgical intervention for LUTS to address therapeutic deficiencies. METHODS Clinical, molecular, and histopathological profiles were analyzed in 26 patients undergoing surgery for severe LUTS. Incidental transitional zone nodules were isolated from 37 patients with mild symptoms undergoing radical prostatectomy. Clinical parameters including age, prostate volume, medication, prostate specific antigen, symptom score, body mass index, and incidence of diabetes were collected. Multivariate logistic regression analysis with adjustments for potential confounding variables was used to examine associations between patient clinical characteristics and molecular targets identified through molecular profiling. RESULTS Compared to incidental BPH, progressive symptomatic BPH was associated with increased expression of the activating protein-1 transcription factor/chemokine network. As expected, inverse correlations were drawn between androgen receptor levels and age, as well as between 5?-reductase inhibitor (5ARI) treatment and tissue prostate specific antigen levels; however, a novel association was also drawn between 5ARI treatment and increased c-FOS expression. CONCLUSIONS This study provides molecular evidence that a network of pro-inflammatory activating protein-1 transcription factors and associated chemokines are highly enriched in symptomatic prostate disease, a profile that molecularly categorizes with many other chronic autoimmune diseases. Because 5ARI treatment was associated with increased c-FOS expression, future studies should explore whether increased activating protein-1 proteins are causal factors in the development of symptomatic prostate disease, inflammation or resistance to traditional hormonal therapy. PMID:24500928

Lin-Tsai, Opal; Clark, Peter E.; Miller, Nicole L.; Fowke, Jay H.; Hameed, Omar; Hayward, Simon W.; Strand, Douglas W.

2014-01-01

170

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

171

A Symptomatic Spinal Extradural Arachnoid Cyst with Lumbar Disc Herniation  

PubMed Central

Spinal epidural arachnoid cyst (EAC) is a rare, usually asymptomatic condition of unknown origin, which typically involves the lower thoracic spine. We report a case of posttraumatic symptomatic EAC with lumbar disc herniation. A 22-year-old man experienced back pain and sciatica after a traffic accident. Neurological examination revealed a right L5 radiculopathy. Magnetic resonance imaging demonstrated a cystic lesion at the L3 to L5 level and an L4-5 disc herniation; computed tomography myelography showed that the right L5 root was sandwiched between the cyst and the herniation. A dural defect was identified during surgery. The cyst was excised completely and the defect was repaired. A herniation was excised beside the dural sac. Histology showed that the cyst wall consisted of collagen and meningothelial cells. Postoperatively the symptoms resolved. Lumbar spinal EACs are rare; such cysts may arise from a congenital dural crack and grow gradually. The 6 cases of symptomatic lumbar EAC reported in the literature were not associated with disc herniation or trauma. In this case, the comorbid disc herniation was involved in symptom progression. Although many EACs are asymptomatic, comorbid spinal disorders such as disc herniation or trauma can result in symptom progression.

Kadono, Yoshinori; Yuguchi, Takamichi; Ohnishi, Yu-ichiro; Iwatsuki, Koichi; Yoshimine, Toshiki

2015-01-01

172

[Surgical treatment of symptomatic aneurysm of popliteal artery].  

PubMed

The results of treatment of 17 patients, suffering symptomatic aneurysm of popliteal artery (APA) were analyzed. According to angiographic data, the APA thrombosis was revealed in 6 patients, and according to ultrasonographic Doppler scanning data the APA rupture with hematoma in adjacent tissues was diagnosed in 5 patients. The tactics of treatment was established in accordance with the distal blood flow character: the conservative therapy was conducted in the presence of APA up to 40 mm in diameter in condition of the artery passability preservation and poor distal blood flow--in 6 observation operative treatment was conducted in the presence of satisfactory distal blood flow--in 4, according to urgent indications due to critical ischemia--in 2, and for the aneurysm rupture--in 5. Operative treatment of symptomatic APA showed ineffective in presence of thrombotic complications in 23.1% patients. In conservative and surgical treatment of APA, complicated by an acute thrombosis, the poor results (the lower extremity amputation) were noted in 33.3% patients. PMID:19670750

Hupalo, Iu M; Shved, O Ie; Pavliuchyk, A V; Didenko, S M

2009-01-01

173

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

174

[Two cases of symptomatic West syndrome suffering from severe respiratory syncytial virus-induced bronchiolitis].  

PubMed

We report two cases of symptomatic West syndrome with severe respiratory syncytial virus (RSV)-induced bronchiolitis: one was a 9-month-old boy who was hospitalized for shock, and the other was a 15-month-old boy in pre-shock condition. Both cases needed mechanical ventilation for approximately 2 weeks. Seizures from the primary disease worsened in both patients during the infection, and both needed long periods of hospitalization, which resulted in a considerable reduction in their quality of life and that of their families. According to a one-year epidemiological survey of RSV infection conducted in 2004-2005 in Nagano prefecture, 7 of 238 hospitalized RSV cases were found to have basic neuromuscular disorders. Compared to patients with chronic lung disease or other primary diseases, they were older, had higher incidence of mechanical ventilation, and required longer hospitalization. Neuromuscular disorders may thus be an important risk factor for severe forms of RSV infection. Although children with such disorders should be protected from RSV, they are currently excluded from the indication for palivizumab administration as passive immunization against RSV in Japan. PMID:21077358

Higuchi, Tsukasa; Fukuyama, Tetsuhiro; Motobayashi, Mitsuo; Misawa, Yuka; Arai, Fumi; Inaba, Yuji

2010-11-01

175

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

176

Chronic prostatitis: management strategies.  

PubMed

The National Institutes of Health (NIH) has redefined prostatitis into four distinct entities. Category I is acute bacterial prostatitis. It is an acute prostatic infection with a uropathogen, often with systemic symptoms of fever, chills and hypotension. The treatment hinges on antimicrobials and drainage of the bladder because the inflamed prostate may block urinary flow. Category II prostatitis is called chronic bacterial prostatitis. It is characterized by recurrent episodes of documented urinary tract infections with the same uropathogen and causes pelvic pain, urinary symptoms and ejaculatory pain. It is diagnosed by means of localization cultures that are 90% accurate in localizing the source of recurrent infections within the lower urinary tract. Asymptomatic inflammatory prostatitis comprises NIH category IV. This entity is, by definition, asymptomatic and is often diagnosed incidentally during the evaluation of infertility or prostate cancer. The clinical significance of category IV prostatitis is unknown and it is often left untreated. Category III prostatitis is called chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). It is characterized by pelvic pain for more than 3 of the previous 6 months, urinary symptoms and painful ejaculation, without documented urinary tract infections from uropathogens. The syndrome can be devastating, affecting 10-15% of the male population, and results in nearly 2 million outpatient visits each year. The aetiology of CP/CPPS is poorly understood, but may be the result of an infectious or inflammatory initiator that results in neurological injury and eventually results in pelvic floor dysfunction in the form of increased pelvic muscle tone. The diagnosis relies on separating this entity from chronic bacterial prostatitis. If there is no history of documented urinary tract infections with a urinary tract pathogen, then cultures should be taken when patients are symptomatic. Prostatic localization cultures, called the Meares-Stamey 4 glass test, would identify the prostate as the source for a urinary tract infection in chronic bacterial prostatitis. If there is no infection, then the patient is likely to have CP/CPPS. For healthcare providers, the focus of therapy is symptomatic relief. The first therapeutic measure is often a 4- to 6-week course of a fluoroquinolone, which provides relief in 50% of men and is more efficacious if prescribed soon after symptoms begin. Second-line pharmacotherapy involves anti-inflammatory agents for pain symptoms and alpha-adrenergic receptor antagonists (alpha-blockers) for urinary symptoms. Potentially more effective is pelvic floor training/biofeedback, but randomized controlled trials are needed to confirm this. Third-line agents include 5alpha-reductase inhibitors, glycosaminoglycans, quercetin, cernilton (CN-009) and saw palmetto. For treatment refractory patients, surgical interventions can be offered. Transurethral microwave therapy to ablate prostatic tissue has shown some promise. The treatment algorithm provided in this review involves a 4- to 6-week course of antibacterials, which may be repeated if the initial course provides relief. Pain and urinary symptoms can be ameliorated with anti-inflammatories and alpha-blockers. If the relief is not significant, then patients should be referred for biofeedback. Minimally invasive surgical options should be reserved for treatment-refractory patients. PMID:19192937

Murphy, Adam B; Macejko, Amanda; Taylor, Aisha; Nadler, Robert B

2009-01-01

177

Caspofungin irrigation through percutaneous calicostomy catheter combined with oral flucytosine to treat fluconazole-resistant symptomatic candiduria.  

PubMed

Candiduria may be a marker of serious fungal infections such as pyelonephritis. With the exception of fluconazole and flucytosine, antifungals drugs are not excreted into the urine as active drugs, making the management of infection due to fluconazole-resistant Candida difficult. We report a case of recurrent Candida parapsilosis candiduria in a kidney transplant recipient suffering from chronic ureteral obstruction requiring permanent ureteral catheterization (double-J stent). Attempts to remove the stent led to pyelonephritis episodes during which only Candida was isolated from the urine. Following several courses of azole-based therapy, the causative agent became resistant to fluconazole. Clinical and mycological cure were obtained combining irrigations of caspofungin through a percutaneous calicostomy catheter and oral flucytosine. This strategy may represent an interesting therapeutic alternative in case of fluconazole-resistant symptomatic candiduria. PMID:25649231

Garcia, H; Guitard, J; Peltier, J; Tligui, M; Benbouzid, S; Elhaj, S Ait; Rondeau, E; Hennequin, C

2015-03-01

178

Chronic kidney disease  

MedlinePLUS

Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; Chronic kidney failure; Chronic renal failure ... Chronic kidney disease (CKD) slowly gets worse over months or years. you may not notice any symptoms for some ...

179

Symptomatic Early Congenital Syphilis: A Common but Forgotten Disease  

PubMed Central

Congenital syphilis is a severe, disabling infection often with grave consequences seen in infants. It occurs due to the transmission of the disease from an infected mother to the unborn infant through the placenta. This long forgotten disease continues to affect pregnant women resulting in perinatal morbidity and mortality. The continuing prevalence of this disease reveals the failure of control measures established for its prevention. We put forth a case of symptomatic congenital syphilis presenting with skeletal manifestations at birth, a rare finding in literature. The report stresses upon the importance of implementing the World Health Organization's recommendation that all pregnant women should be screened for syphilis in the first antenatal visit in the first trimester and again in the late pregnancy. PMID:23094175

Murali, Machiraju Vasudeva; Nirmala, Cherukuri; Rao, Jampana Venkateswara

2012-01-01

180

[Symptomatic subependymoma of the lateral ventricle in a young female].  

PubMed

We present a case of a symptomatic subependymoma (SE) in a young. The patient was a 20-year-old female who suffered from severe headache and vomiting. Precontrast CT scans revealed a large spotty-calcified isodensity mass lesion in the right anterior lateral ventricle, showing scarce contrast enhancement at the center of the mass and with marked hydrocephalus. MRI demonstrated the lesion as slightly hypo-intensity on T1-weighted image, hyper-intensity on T2-weighted image. On FLAIR imaging, the lesion indicated remarkable hyperintensity and was clearly distinguishable from surrounding brain parenchyma and the cerebrospinal fluid. After Gd-DTPA infusion central vein was revealed, but no tumor enhancement was seen. The tumor was totally extirpated through the transcortical approach. Histological diagnosis was SE, and high MIB-1 staining index (9.3%) was seen. FLAIR imaging is useful for the preoperative diagnosis and the postoperative assessment of SEs. PMID:11806120

Yoshioka, H; Kurisu, K; Arita, K; Sugiyama, K; Yamasaki, F

2001-12-01

181

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

182

[Symptomatic reflux and stenosis of ureteroenteric anastomosis. Diagnostics and therapy].  

PubMed

Stenosis of the ureteroenterostomy and symptomatic reflux are among the most dangerous complications of all forms of urinary diversion. Variations in ureter implantation techniques and different surgical expertises are responsible for the heterogeneity of the available prevalence data. Antirefluxive implantation techniques seem to be more vulnerable to stenosis and obstruction than refluxive techniques, although no difference in kidney function deterioration over time was shown according to the presence or absence of reflux protection. Despite frequent controls, approximately one quarter of all obstructed renal units show a complete loss of function. The reimplantation rate of stenotic ureters exceeds 30%.The development of an implantation stenosis may be silent and subtle. The loss of renal function often remains unnoticed if sonography and creatinine measurements are the only follow-up tools employed. Neither of these tests is reliable in estimating kidney function and may mislead both doctor and patient. DMSA scintigraphy and retrograde contrast studies (conduitogram, pouchogram) are the most sensitive tools available to evaluate a symptomatic reflux, whereas MAG-3 renal scans and antegrade function tests (nephrostogram, renal pelvic pressure measurement) are recommended for investigating ureteric obstruction. Stenosis of the ureteroenterostomy usually occurs within 2 years after urinary diversion; delayed occurrence of ureteric obstruction is indicative of malignant local recurrence or compressive metastases.There are various minimally invasive treatment options such as balloon dilatation, internal ureterotomy, stenting and nephrostomy placement. However, the technical challenge of a ureteroenterostomy should not be a deterrent. In fact, if surgically possible, the patient should be offered open revision, since this is the only way to durably cure the underlying pathology and re-establish the already impaired quality of life of patients with urinary diversion as much as possible. PMID:22419010

Hampel, C; Thomas, C; Thüroff, J W; Roos, F

2012-04-01

183

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

184

Management of Symptomatic BPH in the UK: Who Is Treated and How?  

Microsoft Academic Search

Objective: To review the contemporary management of symptomatic benign prostatic hyperplasia (BPH) in the United Kingdom (UK). Methods: Information was obtained from published scientific articles, IMS market analysis data and surveys among primary care practitioners and urologists. Results: A survey in Stirling (Scotland) identified the number of men aged 40–79 years with symptomatic BPH defined as a prostate size >20

Tom A. McNicholas

1999-01-01

185

Report of laparoscopic ureteropyelostomy for symptomatic “yo-yo” reflux in an adult  

Microsoft Academic Search

Symptomatic presentation of partial duplication of the ureter in adults is rare. However, there are reports of such conditions being treated with surgical correction with varying degrees of success. We present the case of a 23-year-old woman who underwent what is, to our knowledge, the first reported laparoscopic ureteropyelostomy for symptomatic “yo-yo” reflux.

B. Khoubehi; C. R. Woodhouse; E. Rowe; G. Boustead; D. Hrouda

2006-01-01

186

DIFFERENTIAL IMPACT OF SICKLE CELL TRAIT ON SYMPTOMATIC AND ASYMPTOMATIC MALARIA  

PubMed Central

Individuals who carry the sickle cell trait (S-gene) have a greatly reduced risk of experiencing symptomatic malaria infections. However, previous studies suggest that the sickle cell trait does not protect against acquiring asymptomatic malaria infections, although the proportion of symptomatic infections is up to 50% in areas where malaria is endemic. To examine the differential impact of the sickle cell trait on symptomatic and asymptomatic malaria, we developed a mathematical model of malaria transmission that incorporates the evolutionary dynamics of S-gene frequency. Our model indicates that the fitness of sickle cell trait is likely to increase with the proportion of symptomatic malaria infections. Our model also shows that control efforts aimed at diminishing the burden of symptomatic malaria are not likely to eradicate malaria in endemic areas, due to the increase in the relative prevalence of asymptomatic infection, the reservoir of malaria. Furthermore, when the prevalence of symptomatic malaria is reduced, both the fitness and frequency of the S-gene may decrease. In turn, a decreased frequency of the S-gene may eventually increase the overall prevalence of both symptomatic and asymptomatic malaria. Therefore, the control of symptomatic malaria might result in evolutionary repercussions, despite short-term epidemiological benefits. PMID:23311426

Shim, Eunha; Feng, Zhilan; Castillo-Chavez, Carlos

2013-01-01

187

A new arthroscopic technique for revision of the posterior compartment in symptomatic total knee arthroplasty  

Microsoft Academic Search

Arthroscopy is effective in treating the symptomatic knee following total knee arthroplasty. A small number of patients complain about postoperative pain in the posterior compartment. Loose bodies and degenerated remnants of the menisci are the main reasons for this pain. We present a new technique for diagnostic and therapeutic arthroscopy of the posterior compartments in patients with symptomatic total knee

Franz Landsiedl; Nicolas Aigner; Michael Hexel; Christian Krasny; Siegfried Schenk; Gunter Steinböck

2005-01-01

188

Coffee intake is associated with lower risk of symptomatic gallstone disease in women  

Microsoft Academic Search

Background & Aims: Metabolic studies have shown that coffee affects several hepatobiliary processes that are involved in cholesterol lithogenesis. We previously showed that coffee drinking was associated with a lower risk of symptomatic gallstone disease in men. Methods: We prospectively examined the association between coffee drinking and cholecystectomy, a surrogate of symptomatic gallstone disease, in a cohort of 80,898 women

Michael F. Leitzmann; Meir J. Stampfer; Walter C. Willett; Donna Spiegelman; Graham A. Colditz; Edward L. Giovannucci

2002-01-01

189

Differential impact of sickle cell trait on symptomatic and asymptomatic malaria.  

PubMed

Individuals who carry the sickle cell trait (S-gene) have a greatly reduced risk of experiencing symptomatic malaria infections. However, previous studies suggest that the sickle cell trait does not protect against acquiring asymptomatic malaria infections, although the proportion of symptomatic infections is up to 50% in areas where malaria is endemic. To examine the differential impact of the sickle cell trait on symptomatic and asymptomatic malaria, we developed a mathematical model of malaria transmission that incorporates the evolutionary dynamics of S-gene frequency. Our model indicates that the fitness of sickle cell trait is likely to increase with the proportion of symptomatic malaria infections. Our model also shows that control efforts aimed at diminishing the burden of symptomatic malaria are not likely to eradicate malaria in endemic areas, due to the increase in the relative prevalence of asymptomatic infection, the reservoir of malaria. Furthermore, when the prevalence of symptomatic malaria is reduced, both the fitness and frequency of the S-gene may decrease. In turn, a decreased frequency of the S-gene may eventually increase the overall prevalence of both symptomatic and asymptomatic malaria. Therefore, the control of symptomatic malaria might result in evolutionary repercussions, despite short-term epidemiological benefits. PMID:23311426

Shim, Eunha; Feng, Zhilan; Castillo-Chavez, Carlos

2012-10-01

190

Health Coverage and its Relation to the Prevalence and Intensity of Symptomatic Knee Osteoarthritis  

PubMed Central

Objective To determine if health coverage among older adults is associated with 1) the prevalence of symptomatic knee osteoarthritis (OA) and 2) disablement in those with symptomatic knee OA. Methods Data were collected from the Osteoarthritis Initiative (OAI) dataset 5.2.1, a cohort study of subjects with or at risk for knee OA. Prevalence of symptomatic knee OA (knee symptoms on most of the last 30 days and Kellgren-Lawrence grade ?2 on knee radiograph) was compared between those with and without health coverage amongst subjects age 45–65, adjusted for age and BMI. For those with symptomatic knee OA, Physical Activity for the Elderly (PASE) scores, and Knee Osteoarthritis Outcomes Survey (KOOS) function, pain, and quality of life scores were compared between those with and without health coverage before and after adjustment for age and BMI. Results Among subjects with health coverage, 27.8% had symptomatic knee osteoarthritis compared with 36.1% of those without health coverage (p=0.0204 before and >0.24 after adjustment). Among subjects with symptomatic knee OA with and without health coverage physical activity differed significantly (p=0.048), as did pain (p<0.0001), function (p=0.0001), and quality of life (p<0.0001). Conclusion Lack of health coverage was not associated with the prevalence of symptomatic knee OA after adjustment. However, those with symptomatic knee OA without health coverage reported reduced physical activity, greater pain, worse functional limitations, and decreased quality of life. PMID:21712728

Clearfield, Jacob; Segal, Neil A.

2011-01-01

191

The role of palliative radiation therapy in symptomatic locally advanced gastric cancer  

Microsoft Academic Search

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

Jeremy. Tey; Michael F. Back; Thomas P. Shakespeare; Rahul K. Mukherjee; Jiade J. Lu; Khai Mun Lee; Lea Choung Wong; Cheng Nang Leong; Ming Zhu

2007-01-01

192

Chronic atherosclerotic mesenteric ischemia (CMI).  

PubMed

Chronic mesenteric ischemia (CMI) is most likely caused by atherosclerosis and less frequently by external compression and vasculitis. Symptomatic CMI is an uncommon, potentially under-diagnosed condition caused by fixed stenoses or occlusion of, in most conditions, at least two visceral arteries. If only one of the three major bowel-providing arteries - the celiac trunk, and the superior and inferior mesenteric arteries - is affected, the patient is usually asymptomatic due to a tight collateral network. The only exception is the celiac artery compression syndrome which represents primarily a compression syndrome of celiac plexus nerves by the arcuate ligament in conjunction with a compression of the celiac trunk. CMI of atherosclerotic origin is associated with a high morbidity and mortality. During the last decade, endovascular revascularization has replaced surgical revascularization as the therapy of choice in most centers. This article reviews the most relevant clinical aspects of the disease and the current practice of diagnosis and treatment of CMI. PMID:20584821

Zeller, Thomas; Rastan, Aljoscha; Sixt, Sebastian

2010-08-01

193

Chronic pancreatitis  

PubMed Central

Purpose of review We review selected important clinical observations reported in 2012. Recent findings Celiac disease is a risk factor for pancreatitis. Patients with recurrent acute pancreatitis likely have chronic pancreatitis, do not benefit from pancreatic sphincterotomy, and may not benefit from biliary sphincterotomy. Analysis of endoscopic ultrasonography (EUS) images with an artificial neural network (ANN) program may improve chronic pancreatitis diagnosis compared with clinical interpretation of images. In a multicenter, randomized controlled trial of chronic pancreatitis patients, 90 000 USP U of pancreatin with meals decreased fat malabsorption compared with placebo. Detection of visceral pain in chronic pancreatitis predicts pain relief from various treatments, but nonvisceral pain due to altered central pain processing may respond to agents such as pregabalin. Predictors of surgical pain relief include onset of symptoms less than 3 years and preoperatively no opioid use and less than five endoscopic procedures. Total pancreatectomy for presumed painful chronic pancreatitis remains controversial. Summary Celiacs are at risk for pancreatitis. The diagnosis of chronic pancreatitis may be enhanced by ANN analysis of EUS imaging. Treatment of fat malabsorption requires 90 000 USP U of lipase with meals. Relief of pain from organ directed treatment of chronic pancreatitis may depend upon timing of interventions and whether pain is visceral or nonvisceral. PMID:23852141

DiMagno, Matthew J.; DiMagno, Eugene P.

2015-01-01

194

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. PMID:25565876

Seicean, Andrada; Vultur, Simona

2015-01-01

195

Chronic obstructive pulmonary disease  

MedlinePLUS

COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic ... heart swelling and heart failure due to chronic lung disease) Pneumonia Pneumothorax Severe weight loss and malnutrition Thinning ...

196

Effects of Manual Therapy on Craniofacial Pain in Patients With Chronic Rhinosinusitis: A Case Series  

Microsoft Academic Search

ObjectiveChronic rhinosinusitis (CRS) is thought to develop through an inadequate drainage of nasal and sinus secretions and perpetuated by local mechanical and autonomic nervous system factors. Manual therapy may have an effect on these factors providing symptomatic relief of CRS symptoms. The purpose of this prospective case series was to report the results of manual therapy on a set of

Roberto Méndez-Sánchez; Javier González-Iglesias; Ana Silvia Puente-González; Jose Luis Sánchez-Sánchez; Emilio J. Puentedura; César Fernández-de-las-Peñas

197

A comparison of coronary angioplasty and coronary artery bypass grafting outcomes in chronic dialysis patients  

Microsoft Academic Search

The objective of this study was to compare the outcomes of angina, myocardial infarction (MI), cardiac death, and all-cause death following percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG). The study design was based on retrospective, nonrandomized analysis and was set in referral teaching hospitals and community hospitals. Eighty-four chronic dialysis patients with symptomatic coronary artery disease

Ann L. Rinehart; Charles A. Herzog; Allan J. Collins; John M. Flack; Jennie Z. Ma; John A. Opsahl

1995-01-01

198

Vasodilator treatment with isosorbide dinitrate and hydralazine in chronic heart failure  

Microsoft Academic Search

Several reports have suggested that because isosorbide dinitrate and hydralazine have different and additive haemodynamic effects at rest in patients with chronic heart failure, these agents should be administered in combination. Some studies, however, indicate thay they are effective individually as well. Since most patients with heart failure are symptomatic only with activity, we examined the haemodynamic effects of these

B M Massie; B Kramer; E Shen; F Haughom

1981-01-01

199

Conduction block during and after ischaemia in chronic inflammatory demyelinating polyneuropathy  

Microsoft Academic Search

Summary A previous study suggested that axonal hyperpolariza- tion produced by maximal voluntary contraction could accentuate conduction block in symptomatic patients with chronic inflammatory demyelinating polyneuropa- thy (CIDP). If this is so, conduction block should occur with hyperpolarization due to other causes such as the release of ischaemia. The effects of ischaemia on axonal excitability and on impulse conduction were

Cecilia Cappelen-Smith; Cindy S.-Y. Lin; Satoshi Kuwabara; David Burke

2002-01-01

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

ETIOLOGICAL APPROACH TO CHRONIC URTICARIA  

PubMed Central

Background: In 1769, William Cullen introduced the word “urticaria” (transient edematous papules, plaque with itching). Urticaria affects 15-25% of people at least once in their life time. It is a clinical reaction pattern triggered by many factors causing the liberation of vasoactive substances such as histamine, prostaglandins and kinins. Urticaria is classified according to its duration into acute (< 6 weeks duration) and chronic (>6 weeks duration). Various clinical investigations may be initiated to diagnosis the cause. Aims: To evaluate the types of chronic urticaria with reference to etiology from history and investigations. Materials and Methods: A total of 150 patients with chronic urticaria of more than six weeks were studied. Autologous serum skin test (ASST) was performed after physical urticarias were excluded. Standard batteries of tests were performed after ASST in all patients; and other specific investigations were done where necessary. Skin prick test was done in idiopathic urticaria. Results: The study sample consisted of 62 male and 88 female patients with a mean age of 21-40 years. About 50% of patients showed an ASST positive reaction, 3.9% were positive for antinuclear antibody (ANA), IgE titer was elevated in 37%, H. pylori antibodies was positive in 26.7%. Thyroid antibodies were positive in 6.2%. Giardia and entamoeba histolytica was reported in 3.3% on routine stool examination and on urinalysis 8% had elevated WBC counts; 12% showed para nasal sinusitis, with maxillary sinusitis of 7.3%. Random blood sugar was high in 5.3%. Four patients had ASOM, two had positive KOH mount for dermatophytes, abdominal USG showed cholecystitis in two patients. Recurrent tonsillitis was noted in two patients. Urticaria following intake of NSAIDs was observed in four patients and with oral contraceptive pills in one patient. Contact urticaria to condom (latex) was seen in one patient. Cholinergic (4.7%) and dermographic (4.7%) urticaria were the predominant physical urticarias. Prick test was performed in idiopathic urticaria with maximum reactions to food antigens (25%) where brinjal was the commonest, 9% to dust in which spider web was the most common, 8% to pollen where parthenium and amaranthus were the commonest, followed by A. flavus in fungi, pigeon in epithelia and cockroach in insects. Conclusion: Nearly half of the patients had chronic autoimmune urticaria on the basis of ASST. A significant number of them had serological makers of autoimmune activity. ASST provides an easy, inexpensive investigation in CU and helps direct attention to underlying systemic auto immune diseases. The presence of these auto antibodies was significantly associated with more frequent and longer lasting urticarial attacks. Exhaustive work ups with extensive laboratory diagnostics, challenge tests, and prick testing should be reserved for individual cases following detailed history. PMID:20418974

Krupa Shankar, D S; Ramnane, Mukesh; Rajouria, Eliz Aryal

2010-01-01

202

Chronic pain.  

PubMed

Essential facts Chronic pain is pain that persists or recurs for more than three months. It may be related to a condition, or may be pain from an injury or operation that continues after healing would usually take place. According to guidance from the Scottish Intercollegiate Guidelines Network (SIGN), around 18 per cent of Europe's population are currently affected by moderate to severe chronic pain. It has a considerable effect on quality of life, and can cause significant suffering and disability. PMID:25783253

2015-03-18

203

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

204

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

205

Incidence of symptomatic deep venous thrombosis after Achilles tendon rupture.  

PubMed

Deep venous thrombosis (DVT) is a significant source of morbidity and mortality and is associated with many orthopedic procedures. Previous studies have reported highly variable DVT rates in patients with Achilles tendon rupture undergoing operative and nonoperative treatment. We performed a retrospective chart review for all patients who underwent Achilles tendon repair at our institution from January 2006 to February 2012. Patient data were collected from the electronic medical record system. A total of 115 patients were eligible for the present study. Of these patients, 27 (23.47%) with a surgically treated Achilles tendon rupture developed a symptomatic DVT either while waiting for, or after, surgical intervention, with approximately one third of these diagnosed before surgical intervention. Of the 27 patients with DVT, 3 had a proximal DVT and 24 had a distal DVT. One patient developed a pulmonary embolism. The DVT incidence was greater in the 2 older age groups (40 to 59 and 60 to 79 years) compared individually with the younger age group (20 to 39 years; p < .0026 and p < .0014, respectively). We have shown a high incidence of DVT after Achilles tendon rupture. We recommend a high level of suspicion for the signs and symptoms of DVT during the follow-up period. In addition, patient education and early mobilization should be advocated, especially for patients older than 40 years. Additional randomized controlled trials investigating any benefits to pharmaceutical DVT prophylaxis in this population are needed to establish evidence-based recommendations. PMID:23623625

Makhdom, Asim M; Cota, Adam; Saran, Neil; Chaytor, Ruth

2013-01-01

206

Alcohol sclerotherapy in the treatment of symptomatic simple renal cysts.  

PubMed

The aim of this study was to evaluate the results of percutaneous drainage with single-session alcohol sclerotherapy in the treatment of symptomatic simple renal cysts. Thirty patients (16 men and 14 women, average age 54,7+/-11,3 years) with simple renal cysts were treated by ultrasound guided percutaneous aspiration and single-session alcohol sclerotherapy. Patient demographics, clinical characteristics, treatment outcome and complications were analyzed. Average reduction of cyst volume was 91,2%. Complete and partial resolution occurred in 10 (33%) and 14 (47%) cysts, respectively. Six cases were defined as failure with reduction of cyst volume <80%. Flank pain improved in all patients, regardless of complete or partial resolution. Minor complications occurred in 8 patients. The hospital stay was one day for all patients. Treatment of simple renal cysts is indicated when the cysts are sufficiently large and cause complaints or when associated with complications. Percutaneous treatment with alcohol sclerotherapy of benign renal cysts can be performed safely and effectively. PMID:19125704

Omerovi?, Safet; Zerem, Enver

2008-11-01

207

Two cases of symptomatic perineural cysts (tarlov cysts) in one family: a case report.  

PubMed

Symptomatic sacral perineural cysts are uncommon. Several hypotheses have been proposed to explain the etiologies of perineural cysts, but the accurate etiologies remain unclear. We experienced two cases of symptomatic sacral perineural cysts (Tarlov cysts) in one family, who presented with perianal paresthesia. Both of them were operated and postoperatively their symptoms were disappeared immediately. We experienced the excellent treatment outcome with the surgical management of symptomatic perineural cysts in the sacral region. We assume that the theory of congenital origin including a familial tendency is the most plausible of the hypotheses that have been proposed. PMID:19096672

Park, Hyun Jun; Kim, Il Sup; Lee, Sang Won; Son, Byung Chul

2008-09-01

208

Two Cases of Symptomatic Perineural Cysts (Tarlov Cysts) in One Family: A Case Report  

PubMed Central

Symptomatic sacral perineural cysts are uncommon. Several hypotheses have been proposed to explain the etiologies of perineural cysts, but the accurate etiologies remain unclear. We experienced two cases of symptomatic sacral perineural cysts (Tarlov cysts) in one family, who presented with perianal paresthesia. Both of them were operated and postoperatively their symptoms were disappeared immediately. We experienced the excellent treatment outcome with the surgical management of symptomatic perineural cysts in the sacral region. We assume that the theory of congenital origin including a familial tendency is the most plausible of the hypotheses that have been proposed. PMID:19096672

Park, Hyun Jun; Lee, Sang Won; Son, Byung Chul

2008-01-01

209

Chronic cough in preschool children.  

PubMed

Cough may be the first overt sign of disease of the airways or lungs when it represents more than a defense mechanism, and may by its persistence become a helpful pointer of potential disease for both patient and physician. On the other hand, impairment or absence of the coughing mechanism can be harmful and even fatal; this is why cough suppression is rarely indicated in childhood. Pediatricians are concerned more with the etiology of the cough and making the right diagnosis. Whereas chronic cough in adults has been universally defined as a cough that lasts more than 8 weeks, in childhood, different timing has been reported. Many reasons support defining a cough that lasts more than 4 weeks in preschool children as chronic, however; and this is particularly true when the cough is wet. During childhood, the respiratory tract and nervous system undergo a series of anatomical and physiological maturation processes that influence the cough reflex. In addition, immunological response undergoes developmental and memorial processes that make infection and congenital abnormalities the overwhelming causes of cough in preschool children. Cough in children should be treated on the basis of etiology, and there is no evidence in support of the use of medication for symptomatic cough relief or adopting empirical approaches. Most cases of chronic cough in preschool age are caused by protracted bacterial bronchitis, tracheobronchomalacia, foreign body aspiration, post-infectious cough or some combination of these. Other causes of chronic cough, such as bronchiectasis, asthma, gastroesophageal reflux, and upper respiratory syndrome appear to be less frequent in this age group. The prevalence of each depends on the population in consideration, the epidemiology of infectious diseases, socioeconomic aspects, and the local health system. PMID:24008117

Kantar, Ahmad; Bernardini, Roberto; Paravati, Francesco; Minasi, Domenico; Sacco, Oliviero

2013-10-01

210

Cognitive impairment in patients with symptomatic carotid artery occlusion  

Microsoft Academic Search

Background\\u000aAlthough transient ischemic attacks (TIAs) by definition do not cause neurologic deficits, cognitive impairment has been suggested in patients with carotid artery disease (CAD) and ipsilateral TIAs. The cause of this impairment has not been elucidated yet. Thrombo-embolism, but also chronic cerebral hypoperfusion have been suggested to play a role. In this light, surgical interventions that improve the blood

F. C. Bakker

2003-01-01

211

Current status of endotherapy for chronic pancreatitis.  

PubMed

Chronic pancreatitis is associated with varied morphological complications, including intraductal stones, main pancreatic ductal strictures, distal biliary strictures and pseudocysts. Endoscopic therapy provides a less invasive alternative to surgery. In addition, extracorporeal shockwave lithotripsy improves the success rate of endoscopic clearance of intraductal stones. However, recent data from randomised trials have shown better long-term outcomes with surgical drainage for obstructive pancreatic ductal disease. In patients with distal biliary strictures, stent insertion leads to good immediate drainage, but after stent removal, recurrent narrowing is common. Endoscopic drainage of pancreatic pseudocysts has excellent outcome and should be accompanied by pancreatic ductal stenting when a ductal communication is evident. In those who remain symptomatic, endoscopic ultrasonography-guided coeliac plexus block may provide effective but short-term pain relief. In this review, we present the current evidence for the role of endotherapy in the management of patients with chronic pancreatitis. PMID:25630314

Kwek, B E; Ang, T L; Maydeo, A

2014-12-01

212

Pre-symptomatic diagnosis and treatment of filovirus diseases  

PubMed Central

Filoviruses are virulent human pathogens which cause severe illness with high case fatality rates and for which there are no available FDA-approved vaccines or therapeutics. Diagnostic tools including antibody- and molecular-based assays, mass spectrometry, and next-generation sequencing are continually under development. Assays using the polymerase chain reaction (PCR) have become the mainstay for the detection of filoviruses in outbreak settings. In many cases, real-time reverse transcriptase-PCR allows for the detection of filoviruses to be carried out with minimal manipulation and equipment and can provide results in less than 2 h. In cases of novel, highly diverse filoviruses, random-primed pyrosequencing approaches have proved useful. Ideally, diagnostic tests would allow for diagnosis of filovirus infection as early as possible after infection, either before symptoms begin, in the event of a known exposure or epidemiologic outbreak, or post-symptomatically. If tests could provide an early definitive diagnosis, then this information may be used to inform the choice of possible therapeutics. Several exciting new candidate therapeutics have been described recently; molecules that have therapeutic activity when administered to animal models of infection several days post-exposure, once signs of disease have begun. The latest data for candidate nucleoside analogs, small interfering RNA (siRNA) molecules, phosphorodiamidate (PMO) molecules, as well as antibody and blood-product therapeutics and therapeutic vaccines are discussed. For filovirus researchers and government agencies interested in making treatments available for a nation’s defense as well as its general public, having the right diagnostic tools to identify filovirus infections, as well as a panel of available therapeutics for treatment when needed, is a high priority. Additional research in both areas is required for ultimate success, but significant progress is being made to reach these goals.

Shurtleff, Amy C.; Whitehouse, Chris A.; Ward, Michael D.; Cazares, Lisa H.; Bavari, Sina

2015-01-01

213

Epicardial Automatic Implantable Cardiac Defibrillator In A Child With Symptomatic Bugada Syndrome  

PubMed Central

An 18 month old 14 kg male with symptomatic Brugada syndrome underwent placement of an epicardial automatic implantable cardiac defibrillator using a single coil transvenous lead sutured to the anterolateral aspect of the left ventricle. PMID:21760684

Moltedo, Jose M; Abello, Mauricio; Gustavo, Sivori; Javier, Celada; Delucis, Pablo Garcia

2011-01-01

214

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

215

[Chronic trichinellosis and neuromuscular diseases: clinical, serological and therapeutic observations].  

PubMed

In six males with chronic neurological signs who, 14-41 years previously, had an episode of acute trichinellosis cardinal symptoms were chronic muscle pain and lower-neuron damage. Other findings, probably related to trichinellosis, were episodes of pyrexia, chronic gastro-intestinal and cardiac symptoms, and in one case symptomatic epilepsy with psychomotor attacks. Significant laboratory findings were a chronic leukocytosis in one case, repeated elevations of eosinophil count in three. Muscle biopsy in all patients revealed live trichinella and (or) focal myositis. The serological findings did not correlate with the biopsy ones. If the live trichinae are encapsulated, antibody titres may be negative, while they may be markedly elevated when the trichinellae are dead. Whether encapsulated larvae can be influenced by tiabendazol or mebendazol is not clear from these observations. PMID:7117159

Fröscher, W; Gullotta, F; Saathoff, M

1982-09-24

216

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

217

Image-directed stereotactic drainage of the symptomatic cavum septi pellucidi et vergae.  

PubMed

Two rare cases of symptomatic non-communicating cava septi pellucidi et Vergae (CSPV) with successful treatment via image-directed stereotactic internal drainage are reported. Because the management of these benign space-occupying structures by the transcallosal approach bears certain risks, safer methods should be applied. The clinical significance, results, and advantages of the CT-stereotactic procedure are represented. If patients with symptomatic CSPV are scheduled for an operation, stereotactic intervention is proposed as the therapy of choice. PMID:2052124

Krauss, J K; Mohadjer, M; Milios, E; Scheremet, R; Mundinger, F

1991-03-01

218

A Novel Case of Symptomatic BK Viraemia in a Patient Undergoing Treatment for Hodgkin Lymphoma  

PubMed Central

Symptomatic BK viral infection in the immunocompromised host is well described, most commonly seen in renal transplant recipients, bone marrow transplant recipients, and HIV positive patients. The present case describes a novel clinical scenario of symptomatic urological BK virus infection in a patient receiving treatment for Hodgkin lymphoma. This case highlights the importance of casting a wide diagnostic net for adverse events encountered with novel therapeutic agents or regimens. PMID:25057419

Estell, Jane

2014-01-01

219

Management of Symptomatic BPH in France: Who Is Treated and How?  

Microsoft Academic Search

Objective: To review the contemporary management of symptomatic benign prostatic hyperplasia (BPH) in France. Methods: Information was obtained from published scientific articles, IMS market analysis data and community-based surveys among older men. Results: The prevalence of symptomatic BPH in France is relatively high. About 15–20% of men over 50–60 years of age report moderate to severe lower urinary tract symptoms

Bertrand Lukacs

1999-01-01

220

Comparison of BMSs with SES for Symptomatic Intracranial Disease of the Middle Cerebral Artery Stenosis  

Microsoft Academic Search

This study was designed to compare the clinical and angiographic outcomes of patients with symptomatic atherosclerotic middle\\u000a cerebral artery stenosis treated with balloon-mounted stents (BMS) and self-expandable Wingspan system (SES). We reviewed\\u000a the 69 consecutive stent placement procedures for symptomatic atherosclerotic stenosis (?70) in M1 segment of middle cerebral\\u000a artery in 67 patients in 3 years. According to the stent types,

Xuanye YueQin; Qin Yin; Gangming Xi; Wusheng Zhu; Gelin Xu; Renliang Zhang; Zhiming Zhou; Minmin Ma; Guangfu Jin; Xinfeng Liu

2011-01-01

221

Host Genetic Resistance to Symptomatic Norovirus (GGII.4) Infections in Denmark?  

PubMed Central

A total of 61 individuals involved in five norovirus outbreaks in Denmark were genotyped at nucleotides 428 and 571 of the FUT2 gene, determining secretor status, i.e., the presence of ABH antigens in secretions and on mucosa. A strong correlation (P = 0.003) was found between the secretor phenotype and symptomatic disease, extending previous knowledge and confirming that nonsense mutations in the FUT2 gene provide protection against symptomatic norovirus (GGII.4) infections. PMID:17537929

Kindberg, Elin; Åkerlind, Britt; Johnsen, Christina; Knudsen, Jenny Dahl; Heltberg, Ole; Larson, Göran; Böttiger, Blenda; Svensson, Lennart

2007-01-01

222

Host genetic resistance to symptomatic norovirus (GGII.4) infections in Denmark.  

PubMed

A total of 61 individuals involved in five norovirus outbreaks in Denmark were genotyped at nucleotides 428 and 571 of the FUT2 gene, determining secretor status, i.e., the presence of ABH antigens in secretions and on mucosa. A strong correlation (P = 0.003) was found between the secretor phenotype and symptomatic disease, extending previous knowledge and confirming that nonsense mutations in the FUT2 gene provide protection against symptomatic norovirus (GGII.4) infections. PMID:17537929

Kindberg, Elin; Akerlind, Britt; Johnsen, Christina; Knudsen, Jenny Dahl; Heltberg, Ole; Larson, Göran; Böttiger, Blenda; Svensson, Lennart

2007-08-01

223

[Chronic diarrhea].  

PubMed

Defined by lasting more than four weeks - is a common but often challenging clinical scenario. It is important to be aware that diarrhoea means different things to different patients. The evaluation of chronic diarrhoea depends on taking an excellent history and careful physical examination as well as planning investigations thoughtfully. Functional diarrhea ist the most common cause of chronic diarrhea in the developed countries and motility disorders are more common than inflammatory, osmotic or secretory causes. In some cases categorizing patients by their stool characteristics can be helpful in directing further evaluation. PMID:25154689

Stelzer, Teresa; Heuss, Ludwig Theodor

2014-09-01

224

Widespread Hypermetabolism in Symptomatic and Asymptomatic Episodes in Kleine-Levin Syndrome  

PubMed Central

Background No reliable biomarkers are identified in KLS. However, few functional neuroimaging studies suggested hypoactivity in thalamic and hypothalamic regions during symptomatic episodes. Here, we investigated relative changes in regional brain metabolism in Kleine-Levin syndrome (KLS) during symptomatic episodes and asymptomatic periods, as compared to healthy controls. Methods Four drug-free male patients with typical KLS and 15 healthy controls were included. 18-F-fluorodeoxy glucose positron emission tomography (PET) was obtained in baseline condition in all participants, and during symptomatic episodes in KLS patients. All participants were asked to remain fully awake during the whole PET procedure. Results Between state-comparisons in KLS disclosed higher metabolism in paracentral, precentral, and postcentral areas, supplementary motor area, medial frontal gyrus, thalamus and putamen during symptomatic episodes, and decreased metabolism in occipital and temporal gyri. As compared to healthy control subjects, KLS patients in the asymptomatic phase consistently exhibited significant hypermetabolism in a wide cortical network including frontal and temporal cortices, posterior cingulate and precuneus, with no detected hypometabolism. In symptomatic KLS episodes, hypermetabolism was additionally found in orbital frontal and supplementary motor areas, insula and inferior parietal areas, and right caudate nucleus, and hypometabolism in the middle occipital gyrus and inferior parietal areas. Conclusion Our results demonstrated significant hypermetabolism and few hypometabolism in specific but widespread brain regions in drug-free KLS patients at baseline and during symptomatic episodes, highlighting the behavioral state-dependent nature of changes in regional brain activity in KLS. PMID:24699677

Dauvilliers, Yves; Bayard, Sophie; Lopez, Régis; Comte, Frederic; Zanca, Michel; Peigneux, Philippe

2014-01-01

225

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

226

Percutaneous disc decompression for the treatment of chronic atypical cervical discogenic pain.  

PubMed

Percutaneous disc decompression with the radiofrequency coblation technique has been described to treat contained, symptomatic lumbar disc herniations. In symptomatic cervical disc herniations it has been used very selectively. We report a 42-year-old female with cervical disc pathology, predominantly at C6/C7, treated with percutaneous disc decompression using coblation technology. Her complaint of cervicogenic cephalgia completely resolved, along with an 85% reduction of neck pain and upper extremity pain 6-months post-operatively. This is the first case report of chronic cervical discogenic pain being treated with this technique. PMID:16868623

Singh, Vijay

2004-01-01

227

EARLY VERSUS DELAYED CAROTID ENDARTERECTOMY IN SYMPTOMATIC PATIENTS  

PubMed Central

Background Delayed carotid endarterectomy (CEA) after a stroke or transient ischemic attack (TIA) is associated with risks of recurrent neurologic symptoms. In an effort to preserve cerebral function, urgent early CEA has been recommended in many circumstances. We analyzed outcomes of different time intervals in early CEA in comparison with delayed treatment. Study Design Retrospective chart review from a single university hospital tertiary care center between April 1999 and November 2010 revealed 312 patients who underwent CEA following stroke or TIA. Of these 312 patients, 69 received their CEA within 30 days of symptom onset and 243 received their CEA after 30 days from symptom onset. The early CEA cohort was further stratified according to the timing of surgery: Group A (27 patients), within 7 days; Group B (17), between 8 and 14 days; Group C (12), between 15 and 21 days; and Group D (12), between 22 and 30 days. Demographic data as well as 30-day (mortality, stroke, TIA, and myocardial infarction) and long-term (all-cause mortality and stroke) adverse outcome rates were analyzed for each group. These were also analyzed for the entire early CEA cohort and compared against the delayed CEA group. Results Demographics and co-morbid conditions were similar between groups. For 30-day outcomes, there were no deaths, 1 stroke (1.4%), 0 TIAs, and 0 myocardial infarctions in the early CEA cohort; in the delayed CEA cohort, there were 4 (1.6%), 4 (1.6%), 2 (0.8%), and 2 (0.8%) patients with these outcomes, respectively (p > 0.05 for all comparisons). Over the long-term, the early group had 1 ipsilateral stroke at 17 months and the delayed group had 2 ipsilateral strokes at 3 and 12 months. For long-term outcomes, there were 16 deaths in the early CEA cohort (21%) and 74 deaths in the delayed CEA cohort (30%, p > 0.05). Mean follow-up times were 4.5 years in the early CEA cohort and 5.8 years in the delayed CEA cohort. Conclusion There were no differences in 30-day and long-term adverse outcome rates between the early and delayed CEA cohorts. In symptomatic carotid stenosis patients without evidence of intracerebral hemorrhage, carotid occlusion, or permanent neurologic deficits early carotid endarterectomy can be safely performed and is preferred over delaying operative treatment. PMID:22857812

Annambhotla, Suman; Park, Michael S; Keldahl, Mark L; Morasch, Mark D; Rodriguez, Heron E; Pearce, William H; Kibbe, Melina R; Eskandari, Mark K

2012-01-01

228

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

229

Chronic Fatigue Syndrome  

MedlinePLUS

... she had chronic fatigue syndrome. What Is Chronic Fatigue Syndrome? Chronic fatigue syndrome (CFS) is a complicated disease for doctors ... this and CFS. Continue Who Gets CFS? Chronic fatigue syndrome can affect people of all ages and ...

230

Chronic Eosinophilic Leukemia  

MedlinePLUS

... Español Chronic Myeloproliferative Neoplasms Treatment (PDQ®) Chronic Eosinophilic Leukemia Key Points for This Section Chronic eosinophilic leukemia ... include fever and feeling very tired. Chronic eosinophilic leukemia is a disease in which too many white ...

231

Chronic pain - resources  

MedlinePLUS

Pain - resources; Resources - chronic pain ... The following organizations are good resources for information on chronic pain: American Chronic Pain Association - www.theacpa.org National Fibromyalgia and Chronic Pain Association - www.fmcpaware.org ...

232

Ear infection - chronic  

MedlinePLUS

Middle ear infection - chronic; Otitis media - chronic; Chronic otitis media; Chronic ear infection ... Kerschner JE. Otitis media. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders ...

233

An atypical presentation of intrahepatic perforated cholecystitis: a modern indication to open cholecystectomy. Report of a case  

PubMed Central

Background Intrahepatic gallbladder perforation with chronic liver abscess formation was anecdotically reported in the literature. The aim of this work is to report a case of intrahepatic gallbladder perforation and its atypical clinical presentation. Case presentation A 62-year-old male patient came to our observation; his medical history showed intermittent fever up to 39-40°C of about 2 weeks and anorexia, with an overall weight loss of about 12 Kg. Physical examination of the abdomen was negative. An ultrasound of the liver and an abdominal CT angiogram detected a disomogeneous hypoechoic-hypodense area in the 5th segment of the liver. Differential diagnosis between hepatic abscess or gallbladder cancer remained open. A surgical exploration was planned. After laparoscopic exploration, a conversion to open procedure with an atypical resection of the 5th hepatic segment was performed. Histologic examination of the specimen showed an intrahepatic chronic perforation of the gallbladder with intrahepatic abscess. Conclusion To the best of our knowledge, 18 cases have been reported in the literature as a Niemeier type I perforation. Clinical presentation, even in its extreme rarity, is more often acute. Differential diagnosis between gallbladder cancer versus liver abscess remains controversial. Open approach is mandatory in such cases. PMID:24468118

2014-01-01

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

Advanced Age and Disease Predict Lack of Symptomatic Improvement after Endovascular Iliac Treatment in Male Veterans  

PubMed Central

Background: Endovascular angioplasty and stent placement is currently the most frequent treatment for iliac artery occlusive disease. However, despite a successful endovascular procedure, some patients do not experience symptomatic improvement and satisfaction with their care. This study seeks to identify patient-related factors associated with lack of symptomatic improvement after endovascular iliac artery treatment in male veterans. Methods: Retrospective review of patients treated with endovascular methods for iliac artery occlusive disease between January 2008 and July 2012 at VA Connecticut Healthcare System. Symptomatic improvement on the first post-operative visit was evaluated, with bilateral treatments counted separately. Results: Sixty-two patients had 91 iliac arteries treated with angioplasty and stent placement. Forty-seven (52 percent) legs had critical limb ischemia, and 77 (85 percent) had at least two-vessel distal runoff. Angiographic success was 100 percent. Patient-reported symptomatic improvement at the first post-operative visit was 55 percent (50/91). Lack of symptomatic improvement correlated with older age (OR 1.09 [1.03-1.17], p = 0.008), presence of critical limb ischemia (OR 3.03 [1.09-8.65], p = 0.034), and need for additional surgical intervention (OR 5.61 [1.65-17.36], p = 0.006). Survival, primary and secondary patency, and freedom from restenosis were comparable between patients who reported symptomatic improvement and those who did not. Conclusions: Despite angiographically successful revascularization, patients who are older or have critical limb ischemia who are treated with isolated endovascular iliac artery intervention are more likely to require additional interventions and less likely to experience symptomatic improvement. These patients may need more extensive infra-inguinal revascularization than isolated iliac angioplasty and stent placement, despite a preserved ankle-brachial index. Quality of life needs to be measured with formal instruments after iliac artery endovascular treatment, especially to determine long term outcomes. PMID:25745377

Assi, Roland; Brownson, Kirstyn E.; Hall, Michael R.; Kuwahara, Go; Vasilas, Penny; Dardik, Alan

2015-01-01

236

Chronic urticaria.  

PubMed Central

Urticaria affects 15% to 20% of the population once or more during a lifetime. Chronic urticaria is a frequent recurrent eruption over a period greater than 6 weeks; the cause remains a mystery in more than 75% of cases. Urticaria and angioedema may be produced by immunologic or nonimmunologic means. Urticarial vasculitis, contact urticaria, mastocytosis, physical urticarias, dermatographism, cholinergic urticaria, localized heat urticaria, cold urticaria, aquagenic urticaria, and vibratory angioedema all require specific evaluation and treatment. Chronic idiopathic urticaria is usually controlled by antihistamines; depending on the circadian rhythm of the eruption, sedative or nonsedative antihistamines are prescribed. Some patients will require a combination of H1 and H2 antagonists, or even parenteral corticosteroids. PMID:1970697

Burrall, B. A.; Halpern, G. M.; Huntley, A. C.

1990-01-01

237

Chronic Diseases  

Microsoft Academic Search

Although diabetes mellitus, cardiovascular disease, and human immunodeficiency virus infection are three separate entities,\\u000a each has causal and non-causal risk factors that are common in the stage 5 chronic kidney disease population. The medical\\u000a nutrition therapies are similar, which emphasize adequate protein and energy intakes, fluid control, and possibly carbohydrate\\u000a and fat modifications. Each patient requires an individualized evaluation, taking

Sharon R. Schatz

238

Chronic berylliosis  

Microsoft Academic Search

1.The key cases in terms of which the concept chronic berylliosis originally was formulated have been reviewed.2.Of 58 cases there was acceptable proof of exposure to beryllium agents in only 40.3.Beryllium was found in the lungs in only 20 instances, but had previously been reported in 8 additional cases.4.New diagnoses have been suggested for the remaining 30 of the original

G. W. H. Schepers

1962-01-01

239

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

240

Intraventricular hemorrhage is associated with early hydrocephalus, symptomatic vasospasm, and poor outcome in aneurysmal subarachnoid hemorrhage.  

PubMed

Objective?We hypothesized that the subset of patients with early hydrocephalus following aneurysmal subarachnoid hemorrhage may represent a subset of patients with a more vehement inflammatory reaction to blood products in the subarachnoid space. We thus examined risk factors for early hydrocephalus and examined the relationship between early hydrocephalus and symptomatic vasospasm as well as clinical outcome. Methods?We retrospectively analyzed all patients presenting to our institution with subarachnoid hemorrhage over a 7-year period. We examined for risk factors, including early hydrocephalus, for poor clinical outcome and symptomatic vasospasm. Results?We found intraventricular hemorrhage to be strongly associated with the development of early hydrocephalus. In univariate analysis, early hydrocephalus was strongly associated with both poor functional outcome and symptomatic vasospasm. In multivariate analysis, intraventricular hemorrhage and tobacco use were associated with symptomatic vasospasm; intraventricular hemorrhage, intraparenchymal hemorrhage, and symptomatic vasospasm were associated with poor functional outcome. Conclusions?We found that intraventricular hemorrhage was strongly associated with early hydrocephalus. Further exploration of the mechanistic explanation is needed, but we suggest this may be from a combination of obstruction of cerebrospinal fluid pathways by blood products and inflammation in the choroid plexus resulting in increased cerebrospinal fluid production. Further, we suggest that both early hydrocephalus and cerebral vasospasm may be parts of the overall inflammatory cascade that occurs with intraventricular hemorrhage and ultimately results in a poorer clinical outcome. PMID:25545809

Wilson, Thomas J; Stetler, William R; Davis, Matthew C; Giles, David A; Khan, Adam; Chaudhary, Neeraj; Gemmete, Joseph J; Xi, Guohua; Thompson, B Gregory; Pandey, Aditya S

2015-03-01

241

Surgical Treatment for Chronic Pelvic Pain  

PubMed Central

The source of chronic pelvic pain may be reproductive organ, urological, musculoskeletal - neurological, gastrointestinal, or myofascial. A psychological component almost always is a factor, whether as an antecedent event or presenting as depression as result of the pain. Surgical interventions for chronic pelvic pain include: 1) resection or vaporization of vulvar/vestibular tissue for human papillion virus (HPV) induced or chronic vulvodynia/vestibulitis; 2) cervical dilation for cervix stenosis; 3) hysteroscopic resection for intracavitary or submucous myomas or intracavitary polyps; 4) myomectomy or myolysis for symptomatic intramural, subserosal or pedunculated myomas; 5) adhesiolysis for peritubular and periovarian adhesions, and enterolysis for bowel adhesions, adhesiolysis for all thick adhesions in areas of pain as well as thin ahesions affecting critical structures such as ovaries and tubes; 6) salpingectomy or neosalpingostomy for symptomatic hydrosalpinx; 7) ovarian treatment for symptomatic ovarian pain; 8) uterosacral nerve vaporization for dysmenorrhea; 9) presacral neurectomy for disabling central pain primarily of uterine but also of bladder origin; 10) resection of endometriosis from all surfaces including removal from bladder and bowel as well as from the rectovaginal septal space. Complete resection of all disease in a debulking operation is essential; 11) appendectomy for symptoms of chronic appendicitis, and chronic right lower quadrant pain; 12) uterine suspension for symptoms of collision dyspareunia, pelvic congestion, severe dysmenorrhea, cul-desac endometriosis; 13) repair of all hernia defects whether sciatic, inguinal, femoral, Spigelian, ventral or incisional; 14) hysterectomy if relief has not been achieved by organ-preserving surgery such as resection of all endometriosis and presacral neurectomy, or the central pain continues to be disabling. Before such a radical step is taken, MRI of the uterus to confirm presence of adenomyosis may be helpful; 15) trigger point injection therapy for myofascial pain and dysfunction in pelvic and abdominal muscles. With application of all currently available laparoscopic modalities, 80% of women with chronic pelvic pain will report a decrease of pain to tolerable levels, a significant average reduction which is maintained in 3-year follow-up. Individual factors contributing to pain cannot be determined, although the frequency of endometriosis dictates that its complete treatment be attempted. The beneficial effect of uterosacral nerve ablation may be as much due to treatment of occult endometriosis in the uterosacral ligaments as to transection of the nerve fibers themselves. The benefit of the presacral neurectomy appears to be definite but strictly limited to midline pain. Appendectomy, herniorraphy, and even hysterectomy are all appropriate therapies for patients with chronic pelvic pain. Even with all laparoscopic procedures employed, fully 20% of patients experience unsatisfactory results. In addition, these patients are often depressed. Whether the pain contributes to the depression or the depression to the pain is irrelevant to them. Selected referrals to an integrated pain center with psychologic assistance together with judicious prescription of antidepressant drugs will likely benefit both women who respond to surgical intervention and those who do not. A maximum surgical effort must be expended to resect all endometriosis, restore normal pelvic anatomy, resect nerve fibers, and treat surgically accessible disease. In addition, it is important to provide patients with chronic pelvic pain sufficient psychologic support to overcome the effects of the condition, and to assist them with underlying psychologic disorders. PMID:9876726

1998-01-01

242

Amygdalar atrophy in symptomatic Alzheimer's disease based on diffeomorphometry: the BIOCARD cohort.  

PubMed

This article examines the diffeomorphometry of magnetic resonance imaging-derived structural markers for the amygdala, in subjects with symptomatic Alzheimer's disease (AD). Using linear mixed-effects models we show differences between those with symptomatic AD and controls. Based on template centered population analysis, the distribution of statistically significant change is seen in both the volume and shape of the amygdala in subjects with symptomatic AD compared with controls. We find that high-dimensional vertex based markers are statistically more significantly discriminating (p < 0.00001) than lower-dimensional markers and volumes, consistent with comparable findings in presymptomatic AD. Using a high-field 7T atlas, significant atrophy was found to be centered in the basomedial and basolateral subregions, with no evidence of centromedial involvement. PMID:25444602

Miller, Michael I; Younes, Laurent; Ratnanather, J Tilak; Brown, Timothy; Trinh, Huong; Lee, David S; Tward, Daniel; Mahon, Pamela B; Mori, Susumu; Albert, Marilyn

2015-01-01

243

Spontaneous resolution of severe, symptomatic mesocolic panniculitis: a case report  

PubMed Central

Background Mesenteric panniculitis is a rare chronic fibrosing inflammatory disease that typically affects the adipose tissue and mesentery of the small intestine but may also affect the mesosigmoid and the mesocolon. The pathology of this disease remains unclear despite association with some malignancies or inflammatory disorders. We report a case of mesocolic panniculitis and a literature review of its clinical presentation, imaging findings, associated conditions and treatment options. Case presentation A 64?year-old Caucasian man was admitted to the gastroenterology department for severe weakness, left lower quadrant abdominal pain, weight loss and diarrhoea. Physical examination revealed a palpable firm mass occupying the entire left part of the abdomen. Abdominal CT-scan showed fatty infiltration of the mesosigmoid and left mesocolic fat which was strongly suggestive of panniculitis. Laparoscopic surgery revealed an inflamed and edematous mesocolon and mesosigmoid; the sigmoid mucosa appeared petechial which was suggestive of venous ischemia. Histological examination of surgical biopsies revealed mesocolic panniculitis. Despite exhaustive investigation, no associated conditions were found and the cause was classified as idiopathic. Surprisingly, the patient clinically improved without therapeutic intervention other than supportive care. Conclusion Although mesenteric panniculitis is most often a radiographic diagnosis without clinical symptomatology, it can also present with significant general status alteration. We report a case of mesocolic panniculitis complicated by development of an inflammatory mass associated with ischemic colitis. Mesenteric panniculitis is a difficult diagnosis to make which typically requires histologic confirmation. The overall prognosis is good with supportive treatment. PMID:22672224

2012-01-01

244

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

245

Chronic urticaria: Indian context-challenges and treatment options.  

PubMed

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

Impact of screening versus symptomatic measurement of deep vein thrombosis in a national quality improvement registry  

PubMed Central

Background Deep vein thrombosis (DVT) is a quality measure recorded by initiatives such as the National Surgical Quality Improvement Program (NSQIP). However, because surveillance-detected DVT rates may be higher than symptomatic DVT rates, we examined how differences in the method of DVT detection may affect the use of this quality measure. Methods Using the NSQIP database (2007–2009), we compared DVT rates of vascular (amputation, open aortic procedures, and lower extremity bypass) and nonvascular (prostatectomy, gastric bypass [GBP], and hip arthroplasty) operations. Using a predefined literature search strategy, we compared the incidence of DVT in NSQIP to the incidence of DVT reported in published literature, diagnosed by symptomatic status or by surveillance studies. Results Within NSQIP, the overall incidence of postoperative DVT was 0.7%. This varied from 0.3% after GBP to 1.8% after open aortic surgery. Across all procedures except amputation, the incidence of DVT in NSQIP was similar to the incidence of DVT reported in our literature survey of “symptomatic” DVTs. The relative rate (RR) of literature-derived symptomatic DVTs to NSQIP ranged from 0.7 for aortic cases (95% confidence interval [CI], 0.3–1.7) to 1.4 (95% CI, .7–3.1) for GBP. Overall, surveillance studies had 11.6 higher RR of DVT compared to NSQIP (95% CI, 10.5–13), ranging from 2.6 for GBP (95% CI, 1.4–5) to 14 .5 for hip arthroplasty (95% CI, 10.5–20). Conclusions The incidence of DVT reported in NSQIP is similar to the reported incidence of symptomatic DVT for many high-risk procedures but is much lower than rates of DVT reported in surveillance studies. Clear delineation of symptomatic vs surveillance detection of DVT would improve the usefulness of this measurement in quality improvement registries. PMID:22832263

De Martino, Randall R.; Beck, Adam W.; Edwards, Matthew S.; Corriere, Matthew A.; Wallaert, Jessica B.; Stone, David H.; Cronenwett, Jack L.; Goodney, Philip P.

2013-01-01

247

Symptomatic and asymptomatic benign prostatic hyperplasia: Molecular differentiation by using microarrays  

NASA Astrophysics Data System (ADS)

Benign prostatic hyperplasia (BPH) is a disease of unknown etiology that significantly affects the quality of life in aging men. Histologic BPH may present itself either as symptomatic or asymptomatic in nature. To elucidate the molecular differences underlying BPH, gene expression profiles from the prostate transition zone tissue have been analyzed by using microarrays. A set of 511 differentially expressed genes distinguished symptomatic and asymptomatic BPH. This genetic signature separates BPH from normal tissue but does not seem to change with age. These data could provide novel approaches for alleviating symptoms and hyperplasia in BPH.

Prakash, Kulkarni; Pirozzi, Gregorio; Elashoff, Michael; Munger, William; Waga, Iwao; Dhir, Rajiv; Kakehi, Yoshiyuki; Getzenberg, Robert H.

2002-05-01

248

Symptomatic intercostal lung hernia secondary to sternal dehiscence surgery  

PubMed Central

Patient: Male, 60 Final Diagnosis: Iatrogenic intercostal lung hernia Symptoms: — Medication: No medication Clinical Procedure: Surgically cerrected Specialty: Thoracic surgery Objective: Unusual clinical course Background: Iatrogenic intercostal lung hernia is a rare thoracic pathology. Injury of intercostal muscles and costocondral separation during median sternotomy and sternal dehiscence surgery are important factors in the development of hernia. We report for the first time a case of a 60-year-old man with acquired lung hernia after sternal dehiscence surgery, presenting as chest pain and exertional dyspnea. Case Report: A 60-year-old man presented with a 6-week history of progressive exertional dyspnea, particularly following vigorous coughing. Past medical history included slight chronic obstructive pulmonary disease and coronary artery bypass grafting surgery 8 weeks previously, using the left internal mammary artery for the left anterior descending artery via median sternotomy and sternal dehiscence by the Robicsek method. A chest X-ray showed intact sternal and parasternal wires, but the bilateral lung parenchyma appeared normal. A spiral computed tomography scan of the chest found intercostal herniation of the anterior segment of the left upper lobe. The lung hernia was repaired surgically to relieve exertional dyspnea and incarceration, and to improve respiratory function. The postoperative course was uneventful and the patient recovered well. Conclusions: Intercostal lung hernia after median sternotomy and sternal dehiscence surgery is rare, and it has been previously reported on. Preventive techniques include gentle manipulation of the sternal retractor, avoidance of rib fractures, and using a protective method of intercostal arteries and nerves such as Sharma technique. Thoracic surgeons should be aware of this rare complication in sternal dehiscence surgery. PMID:23826467

Çelik, Sezai; Aydemir, Cüneyt; Gürer, Onur; I??k, Ömer

2013-01-01

249

Chronic pancreatitis.  

PubMed

Chronic pancreatitis is a progressive fibroinflammatory disease that exists in large-duct (often with intraductal calculi) or small-duct form. In many patients this disease results from a complex mix of environmental (eg, alcohol, cigarettes, and occupational chemicals) and genetic factors (eg, mutation in a trypsin-controlling gene or the cystic fibrosis transmembrane conductance regulator); a few patients have hereditary or autoimmune disease. Pain in the form of recurrent attacks of pancreatitis (representing paralysis of apical exocytosis in acinar cells) or constant and disabling pain is usually the main symptom. Management of the pain is mainly empirical, involving potent analgesics, duct drainage by endoscopic or surgical means, and partial or total pancreatectomy. However, steroids rapidly reduce symptoms in patients with autoimmune pancreatitis, and micronutrient therapy to correct electrophilic stress is emerging as a promising treatment in the other patients. Steatorrhoea, diabetes, local complications, and psychosocial issues associated with the disease are additional therapeutic challenges. PMID:21397320

Braganza, Joan M; Lee, Stephen H; McCloy, Rory F; McMahon, Michael J

2011-04-01

250

Selection criteria for anterior rectal wall repair in symptomatic rectocele and anterior rectal wall prolapse  

Microsoft Academic Search

PURPOSE: This study was undertaken to determine the outcome and changes produced by an endorectal anterior wall repair in objective functional parameters using anorectal manometry and defecography and to asses their usefulness in the selection of patients for the operation. METHODS: Between 1986 and 1990, we performed a prospective study of 76 consecutive patients with symptomatic rectocele and\\/or an anterior

Lucas W. M. Janssen; Cornells F. van Dijke

1994-01-01

251

Femoral Artery Puncture Site Pseudoaneurysm Formation Following Uterine Artery Embolization for Symptomatic Fibroids: A Case Report  

Microsoft Academic Search

Background: Uterine artery embolization (UAE) is a safe and durable alternative to hysterectomy for the treatment of fibroids. Complications arising in the femoral artery puncture site such as infection, bleeding, and hematoma formation have been reported. This is the first report of pseudoaneurysm formation following UAE. Case: A 46-year-old primiparous woman with multiple symptomatic fibroids became hypertensive during transfemoral UAE.

George A. Vilos; Ramona Urian; Paul Chang; Roman Kozak

252

Juxtalumenal location of plaque necrosis and neoformation in symptomatic carotid stenosis  

Microsoft Academic Search

Purpose: The structural features that underlie carotid plaque disruption and symptoms are largely unknown. We have previously shown that the chemical composition and structural complexity of critical carotid stenoses are related to plaque size regardless of symptoms. To further determine whether the spatial distribution of individual plaque components in relation to the lumen corresponds to symptomatic outcome, we evaluated 99

Hisham S. Bassiouny; Yashuhiro Sakaguchi; Susanne A. Mikucki; James F. McKinsey; Giancarlo Piano; Bruce L. Gewertz; Seymour Glagov

1997-01-01

253

Treatment of a symptomatic forearm muscle herniation with a mesh graft.  

PubMed

Symptomatic muscle herniations are an unusual cause of upper extremity pain in the athlete that is rarely reported in the literature. Out of 18 reported cases of upper extremity herniations, only 3 were caused by strenuous exertion. This article describes a successful repair of a 21-year-old rock climber's ventral forearm herniation with polypropylene mesh. PMID:23016006

Sanders, Brett S; Bruce, Jeremy; Robertson, Jason

2011-03-01

254

Symptomatic fracture incidence in elderly men and women: The Dubbo osteoporosis epidemiology study (DOES)  

Microsoft Academic Search

This longitudinal population-based study documents the incidence of all symptomatic fractures from 1989 to 1992 in an elderly, predominantly Caucasian population of males and females (?60 years as at 1 January 1989) living in the geographically isolated region of the city of Dubbo, NSW, Australia. Fractures were ascertained by reviewing reports from all radiology services in the region. There were

G. Jones; T. Nguyen; P. N. Sambrook; P. J. Kelly; C. Gilbert; J. A. Eisman

1994-01-01

255

Identity and potential pathogenicity of Phytophthora species found on symptomatic Rhododendron plants in a Finnish nursery  

Microsoft Academic Search

In this study, microbial isolations were made from symptomatic Rhododendron plants from a large Finnish nursery, known to be harbouring Phytophthora based on PCR screenings. The nearby waterways were also sampled. A diversity of common Nordic plants was screened for Phytophthora susceptibility. Isolates recovered from Rhododendron plants included P. ramorum, P. cactorum, P. plurivora, P. pini and Pestalotiopsis sp. Baits

A. Rytkönen; A. Lilja; A. Vercauteren; S. Sirkiä; P. Parikka; M. Soukainen; J. Hantula

2012-01-01

256

The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction  

Microsoft Academic Search

OBJECTIVESThe present analysis examines the prognostic implications of moderate renal insufficiency in patients with asymptomatic and symptomatic left ventricular systolic dysfunction.BACKGROUNDChronic elevations in intracardiac filling pressures may lead to progressive ventricular dilation and heart failure progression. The ability to maintain fluid balance and prevent increased intracardiac filling pressures is critically dependent on the adequacy of renal function.METHODSThis is a retrospective

Daniel L Dries; Derek V Exner; Michael J Domanski; Barry Greenberg; Lynne W Stevenson

2000-01-01

257

Epidemiology of Tuberculosis in a High HIV Prevalence Population Provided with Enhanced Diagnosis of Symptomatic Disease  

Microsoft Academic Search

BackgroundDirectly observed treatment short course (DOTS), the global control strategy aimed at controlling tuberculosis (TB) transmission through prompt diagnosis of symptomatic smear-positive disease, has failed to prevent rising tuberculosis incidence rates in Africa brought about by the HIV epidemic. However, rising incidence does not necessarily imply failure to control tuberculosis transmission, which is primarily driven by prevalent infectious disease. We

Elizabeth L. Corbett; Tsitsi Bandason; Yin Bun Cheung; Shungu Munyati; Peter Godfrey-Faussett; Richard Hayes; Gavin Churchyard; Anthony Butterworth; Peter Mason

2007-01-01

258

Management of Symptomatic BPH in Italy: Who Is Treated and How?  

Microsoft Academic Search

Objective: To investigate the management of symptomatic benign prostatic hyperplasia (BPH) in Italy. Methods: Information on diagnosis, medical and surgical treatment was obtained from two different questionnaires independently mailed to urological centers in Italy. Data on drug treatments were obtained from a national database. General practitioner (GP) clinical practice patterns were obtained from a panel discussion between general practitioners and

Andrea Tubaro; Emanuele Montanari

1999-01-01

259

Management of Symptomatic BPH in the US: Who Is Treated and How?  

Microsoft Academic Search

Objective: To review the contemporary management of symptomatic benign prostatic hyperplasia (BPH) in North America. Methods: Information was obtained from published scientific articles, lay press articles, Medicare outcomes data, IMS market analysis data and surveys among primary care practitioners and urologists. Results: A survey in Olmsted County in the US identified the number of men with an I-PSS score >7

Reginald Bruskewitz

1999-01-01

260

Ultrasonographic and histologic characteristics of symptom-free and symptomatic carotid plaque  

Microsoft Academic Search

The purpose of the study was to determine the reliability of ultrasonography in assessing plaque pathology and to relate it to clinical symptoms. Ten symptom-free patients and 26 with symptomatic carotid plaques with a stenosis >70%, as detected by arteriography, were assessed by duplex. The findings were compared with the clinical presentation and plaque pathology. Pathological specimens of the plaque

D. G. Kardoulas; A. N. Katsamouris; P. Th. Gallis; Th. Ph. Philippides; N. K. Anagnostakos; D. S. Gorgoyannis; N. C. Gourtsoyannis

1996-01-01

261

Symptomatic Renal Obstruction or Urosepsis During Pregnancy: Treatment by Sonographically Guided Percutaneous Nephrostomy  

Microsoft Academic Search

Seven pregnant women with symptomatic hydronephrosis had sonographically guided percutaneous nephrostomy for pyosepsis (five patients) or for pain with azotemia (two patients with renal transplants). Antibiotics had been ineffective in controlling pyosepsis in each patient; retrograde ureteral catheterization via cystoscopy was unsuccessful in one patient. After percutaneous nephrostomy, prompt clinical improvement was ob- served in all patients (i.e., sepsis was

ERIC VANSONNENBERG; GIOVANNA CASOLA; LEE B. TALNER; GERHARD R. WITTICH; ROBERT R. VARNEY

1992-01-01

262

Endovascular treatment of symptomatic vestibular aqueduct dehiscence as a result of jugular bulb abnormalities.  

PubMed

A new endovascular treatment consisting of stent-assisted coil implantation is described for jugular bulb abnormalities causing symptomatic vestibular aqueduct dehiscence. Three patients presenting with vertigo associated with pulsatile tinnitus or hearing loss were treated. This technique cured the vertigo and pulsatile tinnitus in all patients and preserved normal cerebral venous drainage with no side effects. PMID:25442142

Thénint, Marie-Aude; Barbier, Charlotte; Hitier, Martin; Patron, Vincent; Saleme, Suzana; Courthéoux, Patrick

2014-11-01

263

Neuropsychological outcome after a first symptomatic ischaemic stroke with good recovery  

E-print Network

after a first symptomatic stroke without previous cognitive decline and with a good motor, lin- guistic been shown that, after stroke, on average, 30% of patients are cognitively impaired at 3 months, mainly such as depression [2]. The concept of Ã?post-stroke cognitive impairmentÃ? has emerged [3] but it is unclear whether

Barbeau, Emmanuel J.

264

Dysgeusia in symptomatic syndrome of inappropriate antidiuretic hormone secretion: think of lung cancer  

PubMed Central

The case of a 60-year-old woman who presented with marked dysgeusia to all food and symptomatic syndrome of inappropriate antidiuretic hormone secretion (SIADH) is described. She eventually turned out to have metastatic small cell lung cancer. The case study explores the interesting constellation of dysgeusia, SIADH and lung cancer. PMID:21686989

Singh, Nishith K; Hayes, Shelbi; Hahs, Seth; Varney, Andrew

2009-01-01

265

Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion  

Microsoft Academic Search

Recent studies have concluded that most individuals who sustain minor head injury are free of persistent neuropsychological dysfunction. Nevertheless, a subgroup of patients experience continuing post-concussive difficulties and neuropsychological deficits. This study examined 53 symptomatic minor head injury patients referred for neuropsychological evaluation between one and 22 months after injury. These individuals performed significantly poorer than uninjured controls on four

B E Leininger; S E Gramling; A D Farrell; J S Kreutzer; E A Peck

1990-01-01

266

Functional abnormalities in symptomatic concussed athletes: an fMRI study  

Microsoft Academic Search

Our aim was to quantify with functional magnetic resonance imaging (fMRI) changes in brain activity in concussed athletes and compare the results with those of normal control subjects. Regional brain activations associated with a working memory task were obtained from a group of concussed athletes (15 symptomatic, 1 asymptomatic) and eight matched control subjects, using blood oxygen level dependent (BOLD)

J.-K Chen; K. M Johnston; S Frey; M Petrides; K Worsley; A Ptito

2004-01-01

267

Evaluating imaging biomarkers for neurodegeneration in pre-symptomatic Huntington's disease using machine learning techniques  

E-print Network

Evaluating imaging biomarkers for neurodegeneration in pre-symptomatic Huntington's disease using 27 April 2010 Accepted 30 April 2010 Available online xxxx Keywords: Huntington's disease Biomarker-positive for Huntington's disease yet exhibit few or no clinical symptoms of the disease (pre-HD). We acquired structural

Aron, Adam

268

The surgical treatment of symptomatic nonunions of the proximal (metaphyseal) fifth metatarsal in athletes  

Microsoft Academic Search

Eight athletes developed symptomatic nonunions of the base of the proximal fifth metatarsal in the metaphyseal region. All of the athletes were initially treated conserv atively without success. We reviewed their case histo ries and outlined a simple, effective, low morbidity surgical management of these lesions. Two nonunions successfully healed with internal fixation with an intra medullary compression screw. Five

Arthur C. Rettig; K. Donald Shelbourne; John Wilckens

1992-01-01

269

Extracorporeal Shock-Wave Lithotripsy for Small Symptomatic Renal Calculi: Is It Effective?  

Microsoft Academic Search

Renal calculi with a diameter of less than 5 mm can pass spontaneously. However, some patients have small symptomatic renal calculi for more than 3 months. We evaluated the results of extracorporeal shock-wave lithotripsy in 38 patients with such stones. Patients presented with loin pain, hematuria, infection, or a combination of complaints. Average stone size was 18 mm2. After a

A. J. M. Hendrikx; A. F. Bierkens; F. M. J. Debruyne

1991-01-01

270

Coloured Filters Improve Exclusion of Perceptual Noise in Visually Symptomatic Dyslexics  

ERIC Educational Resources Information Center

Previous studies of visually symptomatic dyslexics have found that their contrast thresholds for pattern discrimination are the same as non-dyslexics. However, when noise is added to the stimuli, contrast thresholds rise markedly in dyslexics compared with non-dyslexics. This result could be due to impaired noise exclusion in dyslexics. Some…

Northway, Nadia; Manahilov, Velitchko; Simpson, William

2010-01-01

271

Repair of Symptomatic Forearm Hernias Using Acellular Dermal Matrix– Two Case Reports  

PubMed Central

Symptomatic forearm hernias are troublesome conditions that are infrequently presented in the literature. We describe a novel approach using cadaveric acellular dermal matrix in an inlay technique to restore fascia integrity. In two patients who perform heavy labor, this technique resolved their hernia related complaints and allowed them to resume their work activities. PMID:20961702

Kozlow, Jeffrey H.; Beil, Richard J.; Chung, Kevin C.

2015-01-01

272

Clinical relevance of symptomatic superficial-vein thrombosis extension: lessons from the CALISTO study.  

PubMed

The clinical relevance of symptomatic extension of spontaneous, acute, symptomatic, lower-limb superficial-vein thrombosis (SVT) is debated. We performed a post hoc analysis of a double-blind trial comparing fondaparinux with placebo. The main study outcome was SVT extension by day 77, whether to ? 3 cm or > 3 cm from the sapheno-femoral junction (SFJ). All events were objectively confirmed and validated by an adjudication committee. With placebo (n = 1500), symptomatic SVT extension to ? 3 cm or > 3 cm from the SFJ occurred in 54 (3.6%) and 56 (3.7%) patients, respectively, inducing comparable medical resource consumption (eg, anticoagulant drugs and SFJ ligation); subsequent deep-vein thrombosis or pulmonary embolism occurred in 9.3% (5/54) and 8.9% (5/56) of patients, respectively. Fondaparinux was associated with lower incidences of SVT extension to ? 3 cm (0.3%; 5/1502; P < .001) and > 3 cm (0.8%; 12/1502; P < .001) from the SFJ and reduced related use of medical resources; no subsequent deep-vein thrombosis or pulmonary embolism was observed in fondaparinux patients. Thus, symptomatic extensions are common SVT complications and, whether or not reaching the SFJ, are associated with a significant risk of venous thromboembolic complications and medical resource consumption, all reduced by fondaparinux. PMID:23821661

Leizorovicz, Alain; Becker, François; Buchmüller, Andrea; Quéré, Isabelle; Prandoni, Paolo; Decousus, Hervé

2013-09-01

273

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

274

Spinal cord compression caused by vertebral hemangioma being symptomatic during pregnancy  

Microsoft Academic Search

BackgroundHemangioma is one of the most common benign tumors of the spine, and it remains silent in the vast majority of subjects afflicted. Pregnancy is a known risk factor for symptomatic conversion of the previously silent vertebral hemangiomas. However, the occurrence is rare with only 26 cases reported in the English medical literature.

Yilmaz Kiroglu; Berk Benek; Baki Yagci; Bayram Cirak; Kadir Tahta

2009-01-01

275

Oral Antimycobacterial Therapy in Chronic Cutaneous Sarcoidosis  

PubMed Central

IMPORTANCE Sarcoidosis is a chronic granulomatous disease for which there are limited therapeutic options. This is the first randomized, placebo-controlled study to demonstrate that antimycobacterial therapy reduces lesion diameter and disease severity among patients with chronic cutaneous sarcoidosis. OBJECTIVE To evaluate the safety and efficacy of once-daily antimycobacterial therapy on the resolution of chronic cutaneous sarcoidosis lesions. DESIGN AND PARTICIPANTS A randomized, placebo-controlled, single-masked trial on 30 patients with symptomatic chronic cutaneous sarcoidosis lesions deemed to require therapeutic intervention. SETTING A tertiary referral dermatology center in Nashville, Tennessee. INTERVENTIONS Participants were randomized to receive either the oral concomitant levofloxacin, ethambutol, azithromycin, and rifampin (CLEAR) regimen or a comparative placebo regimen for 8 weeks with a 180-day follow-up. MAIN OUTCOMES AND MEASURES Participants were monitored for absolute change in lesion diameter and decrease in granuloma burden, if present, on completion of therapy. OBSERVATIONS In the intention-to-treat analysis, the CLEAR-treated group had a mean (SD) decrease in lesion diameter of ?8.4 (14.0) mm compared with an increase of 0.07 (3.2) mm in the placebo-treated group (P = .05). The CLEAR group had a significant reduction in granuloma burden and experienced a mean (SD) decline of ?2.9 (2.5) mm in lesion severity compared with a decline of ?0.6 (2.1) mm in the placebo group (P = .02). CONCLUSIONS AND RELEVANCE Antimycobacterial therapy may result in significant reductions in chronic cutaneous sarcoidosis lesion diameter compared with placebo. These observed reductions, associated with a clinically significant improvement in symptoms, were present at the 180-day follow-up period. Transcriptome analysis of sarcoidosis CD4+ T cells revealed reversal of pathways associated with disease severity and enhanced T-cell function following T-cell receptor stimulation. PMID:23863960

Drake, Wonder P.; Oswald-Richter, Kyra; Richmond, Bradley W.; Isom, Joan; Burke, Victoria E.; Algood, Holly; Braun, Nicole; Taylor, Thyneice; Pandit, Kusum V.; Aboud, Caroline; Yu, Chang; Kaminski, Naftali; Boyd, Alan S.; King, Lloyd E.

2014-01-01

276

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

277

Inferior vena cava filter presenting as chronic low back pain.  

PubMed

Our purpose is to report a rare complication of an inferior vena cava (IVC) filter with vertebral bone penetration, interval fracture, subsequent endovascular management and outcome. We report a case of an IVC filter embedded within the second lumbar vertebral body and in which one of the primary struts fractured, which presented as chronic low back pain. The filter was retrieved percutaneously approximately 2 years after placement. A fractured small strut remained within the vertebral bone; patient's pain resolved. Symptomatic filter in situ should be retrieved even when fractured. PMID:22542386

Kendirli, Mustafa T; Sildiroglu, Onur; Cage, Dorothy L; Turba, Ulku C

2012-01-01

278

One in four people may develop symptomatic hip osteoarthritis in his or her lifetime  

PubMed Central

Summary Objective To estimate the lifetime risk of symptomatic hip osteoarthritis (OA). Design We analyzed data from the Johnston County Osteoarthritis Project (a longitudinal population-based study of OA in North Carolina, United States [n=3,068]). The weighted baseline sample comprised 18% blacks and 54% women, and the mean age was 63 years (range=45-93). Symptomatic hip OA was defined as a Kellgren-Lawrence (K-L) radiographic score of ?2 (anterior-posterior pelvis x-rays) and pain, aching or stiffness on most days, or groin pain, in the same hip. Lifetime risk, defined as the proportion who developed symptomatic hip OA in at least one hip by age 85, among people who live to age 85, was modeled using logistic regression with repeated measures (through generalized estimating equations). Results Lifetime risk of symptomatic hip OA was 25.3% (95% confidence interval [CI] = 21.3–29.3). Lifetime risk was similar by sex, race, highest educational attainment, and hip injury history. We studied lifetime risk by body mass index (BMI) in three forms: at age 18; at baseline and follow-up; and at age 18, baseline and follow-up and found no differences in estimates. Conclusion The burden of symptomatic hip OA is substantial with one in four people developing this condition by age 85. The similar race-specific estimates suggest that racial disparities in total hip replacements are not attributable to differences in disease occurrence. Despite increasing evidence that obesity predicts an increased risk of both hip OA and joint replacement, we found no association between BMI and lifetime risk. PMID:20713163

Murphy, Louise B; Helmick, Charles G.; Schwartz, Todd A; Renner, Jordan B; Tudor, Gail; Koch, Gary G; Dragomir, Anca D; Kalsbeek, William D; Luta, Gheorghe; Jordan, Joanne M

2010-01-01

279

Role of Coflex as an Adjunct to Decompression for Symptomatic Lumbar Spinal Stenosis  

PubMed Central

Study Design Prospective cohort study. Purpose To assess whether additional implantation of Coflex following spinal decompression provided better clinical outcomes compared to decompression alone for symptomatic lumbar spinal stenosis (LSS) and to determine whether improvement in clinical outcomes correlated with changes in the radiological indices studied. Overview of Literature Literature on benefits of additional Coflex implantation compared to decompression alone for symptomatic LSS is limited. Methods Patients with symptomatic LSS who met the study criteria were offered spinal decompression with Coflex implantation. Those patients who accepted Coflex implantation were placed in the Coflex group (n=22); while those opting for decompression alone, were placed in the comparison group (n=24). Clinical outcomes were assessed preoperatively, six-months, one-year and two-years postoperatively, using the Oswestry disability index, 100 mm visual analogue scale (VAS)-back pain and VAS-leg pain, and short form-36 (SF-36). Radiological indices (disc height, foraminal height and sagittal angle) were assessed preoperatively, six months, one year, and two years postoperatively. Results Both groups showed statistically significant (p<0.001) improvement in all the clinical outcome indicators at all points in time as compared to the preoperative status. However, improvement in the Coflex group was significantly greater (p<0.001) than the comparison group. Changes in the radiological indices did not correlate significantly with the improvement in clinical outcome indicators. Conclusions Additional Coflex implantation after spinal decompression in symptomatic LSS offers better clinical outcomes than decompression alone in the short-term. Changes in radiological indices do not correlate with the improvements in clinical outcomes after surgery for symptomatic LSS. PMID:24761198

Shah, Siddarth M; Ng, Yau Hong; Pannierselvam, Vinodh Kumar; DasDe, Sudeep; Shen, Liang

2014-01-01

280

Common lung conditions: chronic obstructive pulmonary disease.  

PubMed

The etiology of chronic obstructive pulmonary disease (COPD) is chronic lung inflammation. In the United States, this inflammation most commonly is caused by smoking. COPD is diagnosed when an at-risk patient presents with respiratory symptoms and has irreversible airway obstruction indicated by a forced expiratory volume in 1 second/forced vital capacity ratio of less than 0.7. Management goals for COPD include smoking cessation, symptom reduction, exacerbation reduction, hospitalization avoidance, and improvement of quality of life. Stable patients with COPD who remain symptomatic despite using short-acting bronchodilators should start inhaled maintenance drugs to reduce symptoms and exacerbations, avoid hospitalizations, and improve quality of life. A long-acting anticholinergic or a long-acting beta2-agonist (LABA) can be used for initial therapy; these drugs have fewer adverse effects than inhaled corticosteroids (ICS). If patients remain symptomatic despite monotherapy, dual therapy with a long-acting anticholinergic and a LABA, or a LABA and an ICS, may be beneficial. Triple therapy (ie, a long-acting anticholinergic, a LABA, and an ICS) also is used, but it is unclear if triple therapy is superior to dual therapy. Roflumilast, an oral selective inhibitor of phosphodiesterase 4, is used to manage moderate to severe COPD. Continuous oxygen therapy is indicated for patients with COPD who have severe hypoxemia (ie, PaO2 less than 55 mm Hg or an oxygen saturation less than 88% on room air). Nonpharmacologic strategies also are useful to improve patient outcomes. Pulmonary rehabilitation improves dyspnea and quality of life. Pulmonary rehabilitation after an acute exacerbation reduces hospitalizations and mortality, and improves quality of life and exercise capacity. Smoking cessation is the most effective management strategy for reducing morbidity and mortality in patients with COPD. Lung volume reduction surgery, bullectomy, and lung transplantation are surgical interventions that are appropriate for some patients with COPD. PMID:23767419

Delzell, John E

2013-06-01

281

Late manifestation of chronic liver disease in adults with alpha-1-antitrypsin deficiency  

Microsoft Academic Search

A review of 19 adult patients with alpha-1-antitrypsin deficiency (A1AT deficiency) and chronic liver disease revealed a late onset of symptomatic hepatic abnormalities in this condition. Thirteen patients (68%) were 60 years or older when the liver disease was discovered. The mean age of the patients with the ZZ, SZ, and MZ phenotypes was 58, 66, and 72.5 years, respectively;

Jorge Rakela; Markus Goldschmiedt; Jurgen Ludwig

1987-01-01

282

Rapid spontaneous closure and remodelling of a medium-sized symptomatic congenital coronary artery fistula in an infant before the age of 3 months.  

PubMed

It is controversial to observe or close symptomatic congenital coronary artery fistula in infants. We herein describe a medium-sized symptomatic congenital coronary artery fistula that underwent rapid spontaneous closure in an infant aged <3 months. PMID:24955570

Lu, Wen-Hsien; Huang, Ta-Cheng; Hsieh, Kai-Sheng

2015-04-01

283

Chronic Pancreatitis  

PubMed Central

Purpose of review We review important new clinical observations in chronic pancreatitis (CP) reported in 2011. Recent findings Smoking increases the risk of non-gallstone acute pancreatitis (AP) and the progression of AP to CP. Binge drinking during Oktoberfest did not associate with increased hospital admissions for AP. The unfolded protein response is an adaptive mechanism to maintain pancreatic health in response to noxious stimuli such as alcohol. Onset of diabetes mellitus in CP is likely due to progressive disease rather than individual variables. Insufficient pancreatic enzyme dosing is common for treatment of pancreatic steatorrhea; 90,000 USP U of lipase should be given with meals. Surgical drainage provides sustained, superior pain relief compared to endoscopic treatment in patients advanced CP with a dilated main duct +/? pancreatic stones. The central acting gabapentoid pregabalin affords a modest 12% pain reduction in patients with CP but ~30% of patients have significant side effects. Summary Patients with non-gallstone related AP or CP of any etiology should cease smoking. Results of this year’s investigations further elucidated the pancreatic pathobiology due to alcohol, onset of diabetes mellitus in CP, and the mechanisms and treatment of neuropathic pain in CP. PMID:22782018

DiMagno, Matthew J.; DiMagno, Eugene P.

2012-01-01

284

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

285

Pneumobilia, chronic diarrhea, vitamin K malabsorption: A pathognomonic triad for cholecystocolonic fistulas  

PubMed Central

Cholecystocolonic fistula (CF) is an uncommon type of internal biliary-enteric fistulas, which comprise rare complications of cholelithiasis and acute cholecystitis, with a prevalence of about 2% of all biliary tree diseases. We report a case of a spontaneous CF in a 75-year-old diabetic male admitted to hospital for the investigation of chronic watery diarrhea and weight loss. Massive pneumobilia demonstrated on abdominal ultrasound and computerized tomography, along with chronic, bile acid-induced diarrhea and a prolonged prothrombin time due to vitamin K malabsorption, led to the clinical suspicion of the fistula. Despite further investigation with barium enema and magnetic resonance cholangio-pancreatography, diagnosis of the fistulous tract between the gallbladder and the hepatic flexure of the colon could not be established preoperatively. Open cholecystectomy with fistula resection and exploration of the common bile duct was the preferred treatment of choice, resulting in an excellent postoperative clinical course. The incidence of biliary-enteric fistulas is expected to increase due to the parallel increase of iatrogenic interventions to the biliary tree with the use of endoscopic retrograde cholangio-pancreatography and the increased rate of cholecystectomies performed. Taking into account that advanced imaging techniques fail to demonstrate the fistulas tract in half of the cases, and that CFs usually present with non-specific symptoms, our report could assist physicians to keep a high index of clinical suspicion for an early and valid diagnosis of a CF. PMID:19705508

Savvidou, Savvoula; Goulis, John; Gantzarou, Alexandra; Ilonidis, George

2009-01-01

286

Chronic hyperalgesia and skin warming caused by sensitized C nociceptors.  

PubMed

A patient suffering from an acquired painful syndrome, due to injury to primary somatic afferent units, was studied. Clinical features included chronic spontaneous burning pain in one hand, abnormal painful response to nonnoxious cutaneous stimuli, and deviation of temperature and dystrophic changes in symptomatic skin. Diagnostic stellate ganglion blocks did not improve spontaneous or stimulus-induced pains, and observation of sympathetic efferent neural activity and vasomotor effector responses revealed no abnormality, failing to support an autonomic contribution to the pathogenesis of the pains. A quantitative psychophysical assessment documented exaggerated magnitude of pain in response to noxious stimuli in symptomatic skin, together with abnormal painful quality and prolongation of sensation induced by nonnoxious tactile or warm stimuli. Such mechanical and thermal hyperalgesia persisted during A fibre blocks, suggesting transmission by primary afferents with unmyelinated C fibres and implying sensitization of C polymodal nociceptors. Direct microneurographic recordings of single, identified C polymodal nociceptors from symptomatic skin confirmed the presence of units with pathologically enhanced receptor responses: lowered threshold and very prolonged afterdischarges. While bypassing skin receptors, strongly intraneural microstimulation in fascicles supplying symptomatic or control skin evoked equivalent magnitudes and temporal profiles of pain from both sides. Thus secondary CNS dysfunction need not be postulated to explain the painful syndrome. Skin grafted onto the affected region partially recovered tactile and thermal sensation (but not pain) without expressing the painful syndrome. This supports the overall conclusion that in this patient A fibres are not involved as primary carriers of input decoded as pain. Sensitization of C polymodal nociceptors is consistent with the features of hyperalgesia in this patient: pain evoked by nonnoxious stimuli, exaggerated pain magnitude, and abnormally prolonged aftersensation of pain. This is the first documentation of chronic sensitization of human C polymodal nociceptors as a symptom of disease. In the context of sensitized C nociceptors and in the absence of sympathetic vasoconstrictor deficit, the abnormally elevated temperature in symptomatic skin is interpreted as due to antidromic vasodilatation triggered by neurosecretion from hyperactive nociceptors.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:2731024

Cline, M A; Ochoa, J; Torebjörk, H E

1989-06-01

287

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

288

Symptomatic remission and patient quality of life in an observational study of schizophrenia: is there a relationship?  

PubMed

This analysis aimed to examine the association between remission and quality of life (QOL) in schizophrenia. In post-hoc analyses of the 3-year, prospective, observational Schizophrenia Outpatients Health Outcomes (SOHO) study, we compared the QOL of patients who achieved symptomatic and clinical remission with those who did not, and the factors associated. Symptomatic remission was defined as achieving a score of ?3 on the Clinical Global Impression-Schizophrenia (CGI-SCH) scale, maintained for 6 months and without hospitalization. QOL was patient self-rated using the European-QOL. Of the 6516 patients analyzed, 38% were in symptomatic remission 12 months post-baseline and 52% at 36 months. Functional remission remained fairly constant from 12 months to 36 months (22.4% at both time points). At all visits from 12 to 36 months, patient QOL and social functioning were significantly higher for patients in symptomatic remission. QOL was higher in patients in functional remission. Patients with maintained symptomatic remission over the 3-year follow-up had a much greater improvement in QOL than patients with no symptomatic remission or symptomatic remission for part of the period. Factors associated with a better QOL also included paid employment, socially active, a higher CGI-SCH cognitive score, good compliance, and a better baseline QOL. PMID:25194449

Haro, Josep M; Novick, Diego; Perrin, Elena; Bertsch, Jordan; Knapp, Martin

2014-12-15

289

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

290

Increased Frequency of Tim-3 Expressing T Cells Is Associated with Symptomatic West Nile Virus Infection  

PubMed Central

More than a decade after West Nile virus (WNV) entered North America, and despite a significant increase in reported cases during the 2012 and 2013 seasons, no treatment or vaccine for humans is available. Although antiviral T cells contribute to the control of WNV, little is known about their regulation during acute infection. We analyzed the expression of Tim-3 and PD-1, two recently identified T cell negative immune checkpoint receptors, over the course of WNV infection. Symptomatic WNV+ donors exhibited higher frequencies of Tim-3+ cells than asymptomatic subjects within naïve/early differentiated CD28+/–CD57–CD4+ and differentiated CD28–CD57–CD8+ T cells. Our study links Tim-3-expression on T cells during acute WNV infection with the development of symptomatic disease, suggesting Tim-3 and its ligands could be targeted therapeutically to alter anti-WNV immunity and improve disease outcome. PMID:24642562

Lanteri, Marion C.; Diamond, Michael S.; Law, Jacqueline P.; Chew, Glen M.; Wu, Shiquan; Inglis, Heather C.; Wong, Derek; Busch, Michael P.

2014-01-01

291

Frontotemporal dementia treatment: current symptomatic therapies and implications of recent genetic, biochemical, and neuroimaging studies.  

PubMed

Frontotemporal dementia (FTD) is a common cause of dementia that encompasses 3 clinical subtypes: a behavioral/dysexecutive (frontal) variant and 2 variants with prominent language impairments. There are currently no Food and Drug Administration-approved medications for FTD although symptomatic treatments such as selective serotonin reuptake inhibitors and atypical antipsychotic agents are frequently used to manage behavioral abnormalities associated with this disorder. Evidence for the use of currently available symptomatic treatments in each FTD clinical subtype is reviewed. In addition, the implications of new genetic and neuropathologic information about FTD for the design of future clinical trials and the eventual development of FTD-specific disease-modifying treatments are discussed. PMID:18090429

Boxer, Adam L; Boeve, Bradley F

2007-01-01

292

Histological assessment of cholecystectomy specimens performed for symptomatic cholelithiasis: routine or selective?  

PubMed

Traditionally, all cholecystectomy specimens resected for symptomatic cholelithiasis were sent for histological evaluation. The objectives of such evaluation are to confirm the clinicoradiological diagnosis, identification of unsuspected findings including incidental gallbladder malignancy, audit and research purposes, and quality control issues. Currently, there is a developing trend to consider selective histological evaluation of surgical specimens removed for clinically benign disease. This article discusses the need for routine or selective histopathological evaluation of gallbladder specimens following cholecystectomy. Although several retrospective studies have suggested selective histological evaluation of cholecystectomy specimens performed for symptomatic cholelithiasis, the evidence is not adequate at present to recommend selective histological evaluation globally. However, it may be appropriate to consider selective histological evaluation on a regional basis in areas of extremely low incidence of gallbladder cancer only after unanimous agreement between the governing bodies of surgical and histopathological expertise. PMID:23838492

Jayasundara, J A S B; de Silva, W M M

2013-07-01

293

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

294

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

295

Endometrial pathology in postmenopausal tamoxifen treatment: comparison between gynaecologically symptomatic and asymptomatic breast cancer patients.  

PubMed Central

AIMS: To evaluate whether endometrial pathology is more likely to be diagnosed in gynaecologically symptomatic rather than in gynaecologically asymptomatic postmenopausal breast cancer patients with tamoxifen treatment; and to evaluate the possible influence of various clinical factors on the incidence of endometrial pathology. METHODS: Endometrial histological findings, transvaginal ultrasonographic endometrial thickness, demographic characteristics, health habits, and risk factors for endometrial cancer were compared between 14 gynaecologically symptomatic (group I) and 224 gynaecologically asymptomatic (group II) postmenopausal breast cancer patients with tamoxifen treatment. RESULTS: Overall, 28.6% of the study population had endometrial pathology. The incidence of overall positive endometrial histological findings was significantly higher in group I than in group II (92.9% v 24.6%, p < 0.0001). Atrophic endometrium was more common in group II than in group I (75.3% v 7.1%, p < 0.0001). Most other endometrial pathology was significantly more common in group I than in group II (endometrial hyperplasia, 35.7% v 5.6%, p < 0.0001; endometrial polyps, 35.7% v 13.4%, p < 0.0111; endometrial carcinoma, 21.5% v 0.9%, p < 0.0001). Endometrial pathology appeared considerably later in the gynaecologically asymptomatic patients than in gynaecologically symptomatic patients (p = 0.0002). Vaginal bleeding or spotting occurred exclusively in group I. The incidence of endometrial pathology in the entire study population was consistent with that reported elsewhere, and higher than that reported for healthy postmenopausal women. CONCLUSIONS: Endometrial pathology is more likely to be diagnosed in gynaecologically symptomatic postmenopausal breast cancer patients with tamoxifen treatment, and after a shorter duration of time, than in gynaecologically asymptomatic patients. PMID:10474520

Cohen, I; Perel, E; Flex, D; Tepper, R; Altaras, M M; Cordoba, M; Beyth, Y

1999-01-01

296

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

297

Living with a symptomatic rotator cuff tear ‘bad days, bad nights’: a qualitative study  

PubMed Central

Background Rotator cuff tears are a common cause of shoulder pain. There is an absence of information about symptomatic rotator cuffs from the patients’ perspective; this limits the information clinicians can share with patients and the information that patients can access via sources such as the internet. This study describes the experiences of people with a symptomatic rotator cuff, their symptoms, the impact upon their daily lives and the coping strategies utilised by study participants. Methods An interpretive phenomenological analysis approach was used. 20 participants of the UKUFF trial (The United Kingdom Rotator Cuff Surgery Trial) agreed to participate in in-depth semi-structured interviews about their experiences about living with a symptomatic rotator cuff tear. Interviews were digitally recorded and fully transcribed. Field notes, memos and a reflexive diary were used. Data was coded in accordance with interpretive phenomenological analysis. Peer review, code-recode audits and constant comparison of data, codes and categories occurred throughout. Results The majority of patients described intense pain and severely disturbed sleep. Limited movement and reduced muscle strength were described by some participants. The predominantly adverse impact that a symptomatic rotator cuff tear had upon activities of daily living, leisure activities and occupation was described. The emotional and financial impact and impact upon caring roles were detailed. Coping strategies included attempting to carry on as normally as possible, accepting their condition, using their other arm, using analgesics, aids and adaptions. Conclusions Clinicians need to appreciate and understand the intensity and shocking nature of pain that may be experienced by participants with known rotator cuff tears and understand the detrimental impact tears can have upon all areas of patient’s lives. Clinicians also need to be aware of the potential emotional impact caused by cuff tears and to ensure that patients needing help for conditions such as depression are speedily identified and provided with support, explanation and appropriate treatment. PMID:25008095

2014-01-01

298

Symptomatic migraine and sensitization of trigeminal nociception associated with contralateral pontine cavernoma  

Microsoft Academic Search

A 38-year-old woman is described with symptomatic strictly right-sided migraine associated with a pontine cavernoma affecting the contralateral (left) nucleus raphe magnus. A persistent facilitation of the right-sided trigeminal nociception was detected interictally using the ‘nociception specific’ blink reflex, which was more pronounced during the acute attack. This case shows for the first time, an impairment of the anti-nociceptive brainstem

Zaza Katsarava; Thomas Egelhof; Holger Kaube; Hans-Christoph Diener; Volker Limmroth

2003-01-01

299

Experimental pain sensitivity differs as a function of clinical pain severity in symptomatic knee osteoarthritis  

PubMed Central

Objective Pain in knee osteoarthritis (OA) has historically been attributed to peripheral pathophysiology; however, the poor correspondence between objective measures of disease severity and clinical symptoms suggests that non-local factors, such as altered central processing of painful stimuli, also contribute to clinical pain in knee OA. Consistent with this notion, recent evidence demonstrates that patients with knee OA exhibit increased sensitivity to painful stimuli at body sites unaffected by clinical pain. Design In order to further investigate the contribution of altered pain processing to knee OA pain, the current study tested the hypothesis that symptomatic knee OA is associated with enhanced sensitivity to experimental pain stimuli at the knee and at remote body sites unaffected by clinical pain. We further anticipated that pain sensitivity would differ as a function of the OA symptom severity. Older adults with and without symptomatic knee OA completed a series of experimental pain assessments. A median split of the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) was used to stratify participants into low vs. high OA symptom severity. Results Compared to controls and the low symptom group, individuals in the high symptom group were more sensitive to suprathreshold heat stimuli, blunt pressure, punctuate mechanical, and cold stimuli. Individuals in the low symptomatic OA group subgroup exhibited experimental pain responses similar to the pain-free group on most measures. No group differences in endogenous pain inhibition emerged. Conclusions These findings suggest that altered central processing of pain is particularly characteristic of individuals with moderate to severe symptomatic knee OA. PMID:23973137

King, Christopher D.; Sibille, Kimberly T.; Goodin, Burel R.; Cruz-Almeida, Yenisel; Glover, Toni L.; Bartley, Emily; Riley, Joseph L.; Herbert, Matthew S.; Sotolongo, Adriana; Schmidt, Jessica; Fessler, Barri J.; Redden, David T.; Staud, Roland; Bradley, Laurence A.; Fillingim, Roger B.

2013-01-01

300

Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology and potential for perimenopause  

PubMed Central

Perimenopause, women’s normal midlife reproductive transition, is highly symptomatic for about 20% of women who are currently inaccurately counseled and inappropriately treated with oral contraceptives, menopausal hormone therapy or hysterectomy. About 80% of perimenopausal women experience vasomotor symptoms (VMS), 25% have menorrhagia, and about 10% experience mastalgia. The majority of women describe varying intensities of sleep, coping or mood difficulties. Women are more symptomatic because common knowledge inaccurately says that estradiol (E2) levels are dropping/deficient. Evidence shows that with disturbed brain-ovary feedbacks, E2 levels average 26% higher and soar erratically – some women describe feeling pregnant! Also, ovulation and progesterone (P4) levels become insufficient or absent. The most symptomatic women have higher E2 and lower P4 levels. Because P4 and E2 complement/counterbalance each other’s tissue effects, oral micronized P4 (OMP4 300 mg at bedtime) is a physiological therapy for treatment-seeking, symptomatic perimenopausal women. Given cyclically (cycle d 14-27, or 14 on/off) in menstruating midlife women, OMP4 decreases cyclic VMS, improves sleep and premenstrual mastalgia. Menorrhagia is treated with ibuprofen 200mg/6h plus OMP4 cycle d 4-28. For insulin resistance, metformin plus cyclic or daily OMP4 decreases insulin resistance and weight gain. Non-responsive migraines need daily OMP4 plus usual therapies. VMS and insomnia in late perimenopause respond to daily OMP4. In summary, OMP4 is a physiology-based therapy that improves sleep, treats VMS, does not increase breast proliferation or cancer risk, increases bone formation and has beneficial cardiovascular effects. A controlled trial is testing OMP4 for perimenopausal VMS – more evidence-based data are needed. PMID:24753856

Prior, J.C.

2011-01-01

301

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

302

Factors associated with time delay to carotid stenting in patients with a symptomatic carotid artery stenosis  

Microsoft Academic Search

Treatment of a symptomatic stenosis is known to be most beneficial within 14 days after the presenting event but this can\\u000a frequently not be achieved in daily practice. The aim of this study was the assessment of factors responsible for this time\\u000a delay to treatment. A retrospective analysis of a prospective two-center CAS database was carried out to investigate the potential

Klaus Gröschel; Sonja Schnaudigel; Katrin Wasser; Sara M. Pilgram-Pastor; Ulrike Ernemann; Michael Knauth; Andreas Kastrup

303

Treatment of a symptomatic forearm muscle herniation with a wrap-around fascia lata graft  

Microsoft Academic Search

Muscle herniation in the extremity is a well-recognized cause of symptomatic pain on exertion. Only 17 cases involving the\\u000a upper limb has been previously described, 11 of them involving the anterior compartment of the forearm and only 2 were caused\\u000a by strenuous exertion. Treatment for this condition ranged from nonsurgical, primary closure with palmaris longus interweave,\\u000a formal fasciotomy, to closure

Kamarul A. Khalid; Edward T. Mah

2009-01-01

304

A case of symptomatic cervical perineural (Tarlov) cyst: clinical manifestation and management  

Microsoft Academic Search

Perineural (Tarlov) cysts are most often found in the sacral region and are rare in the cervical spine. Although they are\\u000a usually asymptomatic, a small number of those at the lumbosacral level have been known to produce localized or radicular pain.\\u000a Few reports are available on symptomatic perineural cysts in the cervical spine and it has not been discussed how

Keewon Kim; Se Woong Chun; Sun G. Chung

305

Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature  

Microsoft Academic Search

The objective of this study is to evaluate the effectiveness and safety of total disc replacement surgery compared with spinal\\u000a fusion in patients with symptomatic lumbar disc degeneration. Low back pain (LBP), a major health problem in Western countries,\\u000a can be caused by a variety of pathologies, one of which is degenerative disc disease (DDD). When conservative treatment fails,\\u000a surgery

Karin D. van den Eerenbeemt; Raymond W. Ostelo; Barend J. van Royen; Wilco C. Peul; Maurits W. van Tulder

2010-01-01

306

Factors affecting risk of symptomatic temporal lobe necrosis: significance of fractional dose and treatment time  

Microsoft Academic Search

Purpose: To study the factors affecting the risk of symptomatic temporal lobe necrosis after different fractionation schedules.Methods and Materials: One thousand thirty-two patients with T1-2 nasopharyngeal carcinoma treated with radical radiotherapy in Hong Kong during 1990–1995 were studied. They were treated at four different centers with similar techniques but different fractionation schedules: 984 patients were given 1 fraction daily throughout

Anne W. M Lee; Dora L. W Kwong; Sing-Fai Leung; Stewart Y Tung; Wai-Man Sze; Jonathan S. T Sham; Peter M. L Teo; To-Wai Leung; Po-Man Wu; Rick Chappell; Lester J Peters; John F Fowler

2002-01-01

307

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

308

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

309

Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases  

PubMed Central

AIM: To study the results for the treatment of symptomatic hemorrhoids using rubber band ligation (RBL) method. METHODS: A retrospective study for 750 patients who came to the colorectal unit from June, 1998 to September, 2006, data was retrieved from archived files. RBL was performed using the Mc Gown applicator on an outpatient basis. The patients were asked to return to out-patient clinic for follow up at 2 wk, 1 mo, 6 mo and through telephone call every 6 mo for 2 years). RESULTS: After RBL, 696 patients (92.8%) were cured with no difference in outcome for second or third degree hemorrhoids (P = 0.31). Symptomatic recurrence was detected in 11.04% after 2 years. A total of 52 patients (6.93%) had 77 complications from RBL which required no hospitalization. Complications were pain, rectal bleeding and vaso-vagal symptoms (4.13%, 4.13% and 1.33% of patients, respectively). At 1 mo there were a significant improvement in mean SF-36 scores over baseline in five items, while after 2 years there were improvement in all items over baseline, but not significant. No significant manometric changes after band ligation. CONCLUSION: RBL is a simple, safe and effective method for treating symptomatic second and third degree hemorrhoids as an out patient procedure with significant improvement in quality of life. RBL doesn’t alter ano-rectal functions. PMID:19030206

Nakeeb, Ayman M El; Fikry, Amir A; Omar, Waleed H; Fouda, Elyamani M; Metwally, Tito A El; Ghazy, Hosam E; Badr, Sabry A; Elkhar, Mohmed Y Abu; Elawady, Salih M; Elmoniam, Hisham H Abd; Khafagy, Waiel W; Morshed, Mosaad M; Lithy, Ramadan E El; Farid, Mohamed E

2008-01-01

310

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

311

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

312

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

313

Symptomatic Abdominal Simple Cysts: Is Percutaneous Sclerotherapy with Hypertonic Saline and Bleomycin a Treatment Option?  

PubMed Central

Aim. To evaluate the feasibility of percutaneous sclerotherapy of symptomatic simple abdominal cysts, using hypertonic saline and bleomycin, as an alternative to surgery. Materials and Methods. This study involved fourteen consecutive patients (ten women, four men, mean age: 59.2?y) with nineteen symptomatic simple cysts (liver n = 14, kidney n = 3, and adrenal n = 2) treated percutaneously using a modified method. Initially CT-guided drainage was performed; the next day the integrity of the cyst/exclusion of extravasation or communications was evaluated under fluoroscopy, followed by two injections/reabsorptions of the same quantity of hypertonic NaCl 15% solution and three-time repetition of the same procedure with the addition of bleomycin. The catheter was then removed; the patients were hospitalized for 12 hours and underwent follow-ups on 1st, 3rd, 6th, and 12th months. Cyst's volumes and the reduction rate (%) were calculated in each evaluation. Results. No pain or complications were noted. A significant cyst's volume reduction was documented over time (P < 0.001). On the 12th month 17 cysts disappeared and two displayed a 98.7% and 68.9% reduction, respectively. Conclusion. This percutaneous approach constitutes a very promising nonsurgical alternative for patients with symptomatic simple cyst, without complications under proper precautions, leading to eliminating the majority of cysts.

Souftas, V. D.; Kosmidou, M.; Karanikas, M.; Souftas, D.; Menexes, G.; Prassopoulos, P.

2015-01-01

314

Tolerance of an Aquatic Power Training Program by Older Adults with Symptomatic Knee Osteoarthritis  

PubMed Central

Objective. To determine the tolerance and feasibility of aquatic-based power training for improving lower limb muscle power, impairments, and mobility in adults with symptomatic knee OA. Participants. Twenty-nine adults, age 50 years and over, with symptomatic knee OA (ACR clinical criteria) and mobility limitation (400-meter walk time slower than median for sex and decade) completed 45-minute aquatic power training sessions twice weekly for 6 weeks. Main Outcome Measurements. Prospective outcomes included tolerance of the program, as well as change in stair climb power, 400-meter walk time, overall and knee-specific pain, activities of daily living (ADL), quality of life (QOL), and lower limb function at 6- and 12-week follow-up. Results. The training intensity required modification for 9 of the 29 participants. Lower limb muscle power, ADL, QOL, and overall pain were improved immediately and 6 weeks following completion (all P < 0.05). However, 400-meter walk times, and lower limb function did not differ from baseline. Conclusions. A 6-week aquatic rehabilitation program appears to be well tolerated by adults with symptomatic knee OA with mobility limitations and may result in improved lower limb muscle power, symptoms, ADL, and QOL. However, this intervention may have insufficient specificity or intensity for improving physical function. PMID:23008770

Segal, Neil A.; Wallace, Robert

2012-01-01

315

Incidence of symptomatic venous thromboembolism in oncological oral and maxillofacial operations: retrospective analysis.  

PubMed

We retrospectively analysed the incidence of symptomatic venous thromboembolism (VTE) and associated risk factors in operations under general anaesthesia for cancer of the oral cavity. To identify symptoms related to deep venous thrombosis (DVT) and pulmonary embolism (PE), together with associated risk factors, we reviewed medical records of patients operated on in the department of oral and maxillofacial surgery at the Queen Elizabeth Hospital, Birmingham, United Kingdom, between June 2007 and October 2012. All patients were categorised according to their level of risk of VTE. The incidence of VTE was calculated with univariate associations and odds ratios with related 95% confidence intervals, where possible. In total, 233 patients were included, comprising 244 operations (mean (SD) age at operation 60.9 (13) years). Almost all patients (97%) were classified as having the highest risk of VTE. Swelling of an extremity, expectoration of blood, and tightness of the chest were the most common symptoms for suspected cases. An incidence of 0.41% was found for symptomatic VTE; one man developed a PE 2 days after operation. Associations between the analysed factors and symptomatic VTE were not significant. The development of the complication in oncological oral and maxillofacial operations seems to be rare, even in patients with a high risk. We cannot recommend the use of routine thromboprophylaxis, but it could be advocated in patients with obvious serious risk factors. PMID:25640701

Lodders, J N; Parmar, S; Stienen, N L M; Martin, T J; Karagozoglu, K H; Heymans, M W; Forouzanfar, T

2015-03-01

316

Symptomatic bone langerhans cell histiocytosis treated at diagnosis or after reactivation with indomethacin alone.  

PubMed

This study evaluated the outcome of patients with symptomatic bone Langerhans cell histiocytosis (LCH) treated with indomethacin alone, either at diagnosis or after reactivation (after recurrence with previous therapies). We evaluated the nonrandomized use of oral indomethacin (2 mg/kg/d) in patients with symptomatic single-system bone LCH. From 1997 to 2012, 38 sequential patients were treated for a median of 4 months. Criteria of nonactive disease (NAD) after initial treatment (8 wk) were: no pain, no soft tissue involvement, no increase of size, or no new bone lesions. Twenty-two patients were treated at diagnosis: 18 showed NAD after initial treatment (2 patients who had bone reactivations were retreated with indomethacin and remain with NAD). Three patients improved and they are with NAD after treatment with indomethacin, steroids, or radiotherapy. One patient developed progressive bone disease and he is with NAD after treatment with steroids and chemotherapy. Sixteen patients were treated after reactivation, and all were with NAD after initial treatment: 5 reactivated and 4 remain with NAD after retreatment with indomethacin. Toxicity was not significant. We conclude that indomethacin is a well tolerated and active drug in patients with symptomatic bone disease. The results support the concept that chemotherapy may not be necessary for limited bone disease. PMID:24977402

Braier, Jorge; Rosso, Diego; Pollono, Daniel; Rey, Guadalupe; Lagomarsino, Eduardo; Latella, Antonio; Zubizarreta, Pedro

2014-07-01

317

Recurrence risk after a first remote symptomatic unprovoked seizure in childhood: a prospective study.  

PubMed

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 antiepileptic treatment. Sixty-three children were included, with 35 males and 28 females. Mean age at first seizure was 4 years (SD 3y 5mo). Kaplan-Meier estimate of recurrence risk was 59% (95% confidence interval [CI] 47-71), 76% (95% CI 65-87), 85% (95% CI 76-94), and 87% (95% CI 78-96) at 6, 12, 18, and 24 months respectively. A total of 55 children out of 63 were affected by a static encephalopathy of pre- or perinatal origin. In this subgroup, recurrence risk at 12 and 24 months was 79% (95% CI 68-90) and 89% (95% CI 80-98). Univariable analysis using the Cox proportional hazards model showed that presence of global developmental delay/intellectual disability and Todd's paresis were associated with a significant increase in recurrence risk. In multivariable analysis, only Todd's paresis was significantly associated. Recurrence risk after a first remote symptomatic unprovoked seizure in childhood is much higher than what some previous studies suggests. PMID:19021679

Ramos-Lizana, J; Aguirre-Rodríguez, J; Aguilera-López, P; Cassinello-García, E

2009-01-01

318

Symptomatic Patients with Intraluminal Carotid Thrombus: Outcome with a Strategy of Initial Anticoagulation  

PubMed Central

Background Optimal treatment for patients with symptomatic intraluminal carotid thrombus (ICT) remains poorly defined. Methods We performed a retrospective chart review of patients presenting to our institution between 2001 and 2011 with symptomatic ICT. Results Twenty-four patients (16 males, 8 females) with ICT presented with ischemic stroke (n=18) or TIA (n=6). All were treated initially with anticoagulation ± antiplatelet drugs. Eight of these patients had no or mild carotid stenosis on initial angiography and were treated with medical management alone. The remaining 16 patients had moderate or severe carotid stenosis on initial angiography. Of these, 10 underwent delayed revascularization (endarterectomy, n=8; angioplasty and stenting, n=2), 2 refused revascularization, and 4 were treated with medical therapy alone. One patient had multiple TIAs despite medical therapy and eventually underwent CEA; the remaining 23 patients had no TIAs. No patient suffered ischemic or hemorrhagic stroke while on anticoagulation, during the perioperative period or in long-term follow up; one patient died of an unrelated condition (mean follow-up = 16.4 months). Conclusion Our results suggest that initial anticoagulation of symptomatic ICT results in a low rate of recurrent ischemic events and that carotid revascularization, if indicated, can be safely performed in a delayed manner. PMID:23061393

Vellimana, Ananth K.; Kadkhodayan, Yasha; Rich, Keith M.; Cross, Dewitte T.; Moran, Christopher J.; Zazulia, Allyson R.; Lee, Jin-Moo; Chicoine, Michael R.; Dacey, Ralph G.; Derdeyn, Colin P.; Zipfel, Gregory J.

2013-01-01

319

Symptomatic abdominal simple cysts: is percutaneous sclerotherapy with hypertonic saline and bleomycin a treatment option?  

PubMed

Aim. To evaluate the feasibility of percutaneous sclerotherapy of symptomatic simple abdominal cysts, using hypertonic saline and bleomycin, as an alternative to surgery. Materials and Methods. This study involved fourteen consecutive patients (ten women, four men, mean age: 59.2?y) with nineteen symptomatic simple cysts (liver n = 14, kidney n = 3, and adrenal n = 2) treated percutaneously using a modified method. Initially CT-guided drainage was performed; the next day the integrity of the cyst/exclusion of extravasation or communications was evaluated under fluoroscopy, followed by two injections/reabsorptions of the same quantity of hypertonic NaCl 15% solution and three-time repetition of the same procedure with the addition of bleomycin. The catheter was then removed; the patients were hospitalized for 12 hours and underwent follow-ups on 1st, 3rd, 6th, and 12th months. Cyst's volumes and the reduction rate (%) were calculated in each evaluation. Results. No pain or complications were noted. A significant cyst's volume reduction was documented over time (P < 0.001). On the 12th month 17 cysts disappeared and two displayed a 98.7% and 68.9% reduction, respectively. Conclusion. This percutaneous approach constitutes a very promising nonsurgical alternative for patients with symptomatic simple cyst, without complications under proper precautions, leading to eliminating the majority of cysts. PMID:25878660

Souftas, V D; Kosmidou, M; Karanikas, M; Souftas, D; Menexes, G; Prassopoulos, P

2015-01-01

320

A symptomatic Fabry disease mouse model generated by inducing globotriaosylceramide synthesis.  

PubMed

Fabry disease is a lysosomal storage disorder in which neutral glycosphingolipids, predominantly Gb3 (globotriaosylceramide), accumulate due to deficient ?-Gal A (?-galactosidase A) activity. The GLAko (?-Gal A-knockout) mouse has been used as a model for Fabry disease, but it does not have any symptomatic abnormalities. In the present study, we generated a symptomatic mouse model (G3Stg/GLAko) by cross-breeding 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-fold 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

2013-12-15

321

Chronic daily headache in a patient with cavum septum pellucidum and cavum verge.  

PubMed

Cavum septum pellucidum (CSP) and cavum Vergae (CV) are unusual variants and usually asymptomatic, but their expansion or inside lesions can produce symptoms by mass effect. A 46-year-old female Taiwanese worker presented with chronic daily headaches for eight years. Magnetic resonance imaging revealed coexistent CSP and CV. She declined surgical drainage recommended by a neurosurgeon and thus visited our clinic for a second opinion. Physical examination did not show any abnormality. With the help of the patient's one-month headache diary, she was diagnosed with chronic migraine according to the International Classification of Headache Disorders, 2(nd) edition, with further modification in 2006. In addition, hypertension was also identified. Over the following week, taking a daily selective ?1-antagonist relieved the headache and hypertension. The medication was continued and the following year was uneventful. Therefore, the chronic daily headache was ascribed to chronic migraine, rather than symptomatic CSP and CV. PMID:23661856

Chen, J-Jy; Chen, D-L

2013-03-01

322

Tiotropium (Spiriva): a once-daily inhaled anticholinergic medication for chronic obstructive pulmonary disease  

PubMed Central

Tiotropium represents a new generation of inhaled therapy. No other inhaled product has demonstrated effectiveness with once-daily dosing. Treatment has been associated with improved lung function, decrease in the number of exacerbations, increase in the time to first exacerbation, and improved quality of life. Adverse effects appear to be mild in nature, and the only significant adverse effect is dry mouth. Clinical trials show that tiotropium is more effective than placebo. When compared with current treatment for chronic obstructive pulmonary disease, tiotropium is at least as effective as salmeterol and more effective than ipratropium; moreover, the once-a-day dosing increases the likelihood of patient compliance. The guidelines of the Global Initiative for Chronic Obstructive Lung Disease recommend bronchodilator medications as first-line therapy in the symptomatic management of chronic obstructive pulmonary disease. Tiotropium, an anticholinergic bronchodilator, should be considered a first-line agent for patients with chronic obstructive pulmonary disease. PMID:16200123

2004-01-01

323

A case of chronic subdural hematoma with anxiety states and concomitant regression-like symptoms.  

PubMed

The authors described an epileptic suffering from head trauma in whom anxiety states and concomitant regression-like symptoms masked the diagnosis of chronic subdural hematoma. Along with the occurrence of chronic subdural hematoma, psychic symptoms were manifested including the anxiety and regression of personality. However, after the chronic subdural hematoma was neurosurgically evacuated, these psychic symptoms gradually disappeared. In the study of organic and symptomatic psychosis, Mackenzie and Popkin (1983) have proposed the concept of an organic anxiety syndrome on the ground that DSM-III provides no organic equivalent for anxiety disorders. Therefore, we presented a case of chronic subdural hematoma in which the direct effect on CNS of this pathological condition was considered to bring about the above-mentioned anxiety disorders with regression-like symptoms. PMID:3134566

Sato, T; Takeichi, M

1987-12-01

324

Acute and chronic presentation of intestinal nonrotation in adults.  

PubMed

Intestinal nonrotation has been recognized as a cause of obstruction in neonates and children and may be complicated by volvulus and intestinal necrosis. It is very rarely seen in the adult and may present acutely as a bowel obstruction and intestinal ischemia associated with midgut or ileocecal volvulus, or chronically as vague intermittent abdominal pain. The purpose of this communication is to reveal the pathogenesis and the surgical significance of intestinal nonrotation in adults and to review the English and German language literature since 1923 to establish the optimal therapeutic management. Between 1983 and 1992, we have managed and observed prospectively 10 adults with intestinal nonrotation. In four patients the nonrotation has been detected at emergency laparotomy owing to midgut or ileocecal volvulus. Four patients suffered from chronic symptoms of intermittent volvulus or small bowel obstruction and in two patients the nonrotation has been noted as an incidental finding at laparotomy for another condition. A survey of the literature from 1923 to 1992 revealed 40 adults with symptomatic intestinal nonrotation to which we contribute nine patients. We establish that in the acute symptomatic pattern, only emergency laparotomy can provide the correct diagnosis and decrease the risk of bowel disturbance. In the chronic situation, barium studies of the upper and lower gastrointestinal tract reveal varying degrees of midgut malrotation and confirm the nonrotation in each case. Also, in these forms the explorative laparotomy with a consequent staging of the abdominal situs is to be recommended. All reported cases at our institutions are without complaints after surgery. Adult patients with intestinal nonrotation and acute or chronic obstructive symptoms or those detected incidentally at laparotomy for other conditions should undergo a Ladd procedure because of the risk of midgut volvulus. In this operation, the nonrotation is left in place and the ascending colon is sutured at the colon descendens and sigmoideum. After this procedure the mesenteric pedicle is fixed and the risk of midgut torsion remains minimal. PMID:8306846

von Flüe, M; Herzog, U; Ackermann, C; Tondelli, P; Harder, F

1994-02-01

325

Enhanced Expression of Lp-PLA2 and Lysophosphatidylcholine in Symptomatic Carotid Atherosclerotic Plaques  

PubMed Central

Background and Purpose Circulating lipoprotein-associated phospholipase A2 (Lp-PLA2) has emerged as a novel biomarker for cardiovascular diseases. However, the correlation between the plaque expression of Lp-PLA2 and plaque oxidative stress, inflammation, and stability as well as the clinical presentation remains poorly defined, especially for cerebrovascular disease. Therefore, this study was performed to test the hypothesis that Lp-PLA2 expression is higher in symptomatic than in asymptomatic carotid plaques of patients undergoing carotid endarterectomy. Methods The expression of Lp-PLA2 in 167 carotid artery plaques was determined by immunoblotting and immunostaining. Plaque oxidative stress, inflammation, and stability were quantified by NAD(P)H oxidase p67phox and MMP-2 immunoblotting, oxidized LDL (oxLDL) immunoreactivity, macrophage and Sirius red collagen staining. Lysophosphatidylcholine 16:0 (lysoPC) concentration was measured in 55 plaques using liquid chromatography tandem mass spectrometry. Results Lp-PLA2 expression was significantly higher in plaques of symptomatic patients than asymptomatic patients (1.66±0.19 versus 1.14±0.10, P<0.05) and localized mainly to shoulder and necrotic lipid core areas in colocalization with oxLDL and macrophage content. Similarly, Lp-PLA2 expression was related to collagen content, which was lower in plaques from symptomatic patients than in plaques from asymptomatic patients (9.1±2.2 versus 18.5±1.7% of staining/field, P<0.001). LysoPC plaque concentration was significantly higher in plaques of symptomatic than asymptomatic patients (437.0±57.91 versus 228.84±37.00 mmol/L, P<0.05). Conclusions Symptomatic carotid artery plaques are characterized by increased levels of Lp-PLA2 and its product lysoPC in correlation with markers of tissue oxidative stress, inflammation, and instability. These findings strongly support a role for Lp-PLA2 in the pathophysiology and clinical presentation of cerebrovascular disease. PMID:18356547

Mannheim, Dallit; Herrmann, Joerg; Versari, Daniele; Gössl, Mario; Meyer, Fredric B.; McConnell, Joseph P.; Lerman, Lilach O.; Lerman, Amir

2015-01-01

326

Symptomatic Presentation of Carotid Sinus Hypersensitivity Is Associated With Impaired Cerebral Autoregulation  

PubMed Central

Background Carotid sinus hypersensitivity (CSH) is associated with syncope, unexplained falls, and drop attacks in older people but occurs asymptomatically in 35% of community?dwelling elders. We hypothesized that impaired cerebral autoregulation is associated with the conversion of asymptomatic CSH to symptomatic CSH. We therefore conducted a case–control study evaluating individuals with CSH with and without the symptoms of syncope or unexplained falls, as well as non?CSH controls, to determine whether the blood pressure and heart rate changes associated with CSH are associated with symptoms only when cerebral autoregulation is altered. Methods and Results Bilateral middle cerebral artery blood flow velocities (BFV) were measured in consecutive patients with symptomatic CSH (n=22) and asymptomatic controls with (n=18) and without CSH (n=14) using transcranial Doppler ultrasonography during lower body negative pressure?induced systemic hypotension. Within?group comparisons revealed significantly lower cerebrovascular resistance index (CVRi) at nadir for the asymptomatic CSH group (right, mean [95% CI]: 2.2 [1.8, 2.8] versus 2.6 [2.2, 3.0]; P=0.005; left: 2.8 [2.4, 3.3] versus 3.1 [2.7, 3.8]; P=0.016). Between?group comparisons showed higher mean BFV (right: estimated mean difference, B=5.49 [1.98, 8.80], P=0.003; left: 4.82 [1.52, 8.11], P=0.005) and lower CVRi (right: B=0.08 [0.03, 0.12], P=0.003, left: B=0.07 [0.02, 0.12], P=0.006) in asymptomatic CSH versus symptomatic CSH groups. There were no significant differences in bilateral mean BFV or right CVRi between the non?CSH and symptomatic CSH groups but differences were present for left CVRi (B=0.07 [0.02, 0.013], P=0.015). Conclusion Cerebral autoregulation is altered in symptomatic CSH and therefore appears to be associated with the development of hypotension?related symptoms in individuals with CSH. PMID:24947997

Tan, Maw Pin; Chadwick, Tom J.; Kerr, Simon R. J.; Parry, Steve W.

2014-01-01

327

Prognostic significance of calcified plaque among symptomatic patients with nonobstructive coronary artery disease  

PubMed Central

Background Coronary artery calcium (CAC) is a well-established predictor of clinical outcomes for population screening. Limited evidence is available as to its predictive value in symptomatic patients without obstructive coronary artery disease (CAD). The aim of the current study was to assess the prognostic value of CAC scores among symptomatic patients with nonobstructive CAD. Methods From the COronary Computed Tomographic Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 7,200 symptomatic patients with nonobstructive CAD (<50% coronary stenosis) on coronary-computed tomographic angiography were prospectively enrolled and followed for a median of 2.1 years. Patients were categorized as without (0% stenosis) or with (>0% but <50% coronary stenosis) a luminal stenosis. CAC scores were calculated using the Agatston method. Univariable and multivariable Cox proportional hazard models were employed to estimate all-cause mortality and/or myocardial infarction (MI). Four-year death and death or MI rates were 1.9% and 3.3%. Results Of the 4,380 patients with no luminal stenosis, 86% had CAC scores of <10 while those with a luminal stenosis had more prevalent and extensive CAC with 31.9% having a CAC score of ?100. Among patients with no luminal stenosis, CAC was not predictive of all-cause mortality (P = .44). However, among patients with a luminal stenosis, 4-year mortality rates ranged from 0.8% to 9.8% for CAC scores of 0 to ?400 (P < .0001). The mortality hazard was 6.0 (P = .004) and 13.3 (P < .0001) for patients with a CAC score of 100–399 and ?400. In patients with a luminal stenosis, CAC remained independently predictive in all-cause mortality (P < .0001) and death or MI (P < .0001) in multivariable models containing CAD risk factors and presenting symptoms. Conclusions CAC allows for the identification of those at an increased hazard for death or MI in symptomatic patients with nonobstructive disease. From the CONFIRM registry, the extent of CAC was an independent estimator of long-term prognosis among symptomatic patients with luminal stenosis and may further define risk and guide preventive strategies in patients with nonobstructive CAD. PMID:24683047

Shah, Sana; Bellam, Naveen; Leipsic, Jonathon; Berman, Daniel S.; Quyyumi, Arshed; Hausleiter, Jörg; Achenbach, Stephan; Al-Mallah, Mouaz; Budoff, Matthew J.; Cademartiri, Fillippo; Callister, Tracy Q.; Chang, Hyuk-Jae; Chow, Benjamin J. W.; Cury, Ricardo C.; Delago, Augustin J.; Dunning, Allison L.; Feuchtner, Gudrun M.; Hadamitzky, Martin; Karlsberg, Ronald P.; Kaufmann, Philipp A.; Lin, Fay Y.; Chinnaiyan, Kavitha M.; Maffei, Erica; Raff, Gilbert L.; Villines, Todd C.; Gomez, Millie J.; Min, James K.; Shaw, Leslee J.

2015-01-01

328

Entrapment neuropathies in chronic stroke patients.  

PubMed

Stroke is the third most common cause of mortality and is one of the most common causes of morbidity in the world. Entrapment neuropathies may cause morbidity after stroke. In this study, we aimed to evaluate the development of entrapment neuropathies in severe stroke patients within the chronic stages of the event. Thirty-two patients with first ever ischemic or hemorrhagic stroke were included in the study. The nerve conduction studies were performed at least 6 months after the event. Ten age- and sex-matched healthy subjects were evaluated as control subjects. Twelve patients (37.5%) had median nerve neuropathy at the wrist, and 12 patients (37.5%) had ulnar nerve neuropathy at the elbow in the symptomatic extremities. Eight patients (25%) had median nerve neuropathy at the wrist, and 6 patients (18.7%) had ulnar nerve neuropathy at the elbow in the asymptomatic extremities. Our results confirm that in chronic stroke patients, the entrapment neuropathies may be an important cause for morbidity, and these entrapment neuropathies could be seen bilaterally but more prominent in the paretic sides. PMID:22353993

Hunkar, Remziye; Balci, Kemal

2012-02-01

329

Midgut malrotation with chronic abdominal pain.  

PubMed

Abnormalities in midgut rotation occur during the physiological herniation of midgut between the 5(th) and 10(th) week of gestation. The most significant abnormality is narrow small bowel mesentery which is prone to volvulus. This occurs most frequently in the neonatal period, less commonly midgut malrotation presents in adulthood with either acute volvulus or chronic abdominal symptoms. It is the latter group that represents a diagnostic challenge. We report a case of a 17-year-old male patient who presented with 10-year history of nonspecific gastro-intestinal symptoms. After extensive investigation the patient was diagnosed with midgut malrotation following computed tomography of abdomen. The patient was treated with a laparoscopic Ladd's procedure and at 3 months he was gaining weight and had stopped vomiting. A laparoscopic Ladd's procedure is an acceptable alternative to the open technique in treating symptomatic malrotation in adults. Midgut malrotation is a rare congenital anomaly which may present as chronic abdominal pain. Abdominal CT is helpful for diagnosis. PMID:22536565

Wanjari, Anil K; Deshmukh, Arjun J; Tayde, Parimal S; Lonkar, Yashwant

2012-04-01

330

Eosinophilic inflammation is associated with elevation of interleukin-5 in the airways of patients with spontaneous symptomatic asthma  

Microsoft Academic Search

In vitro and in vivo studies have shown an important role for interleukin-5 (IL-5) in regulating eosinophil proliferation, survival, and effector function. Because eosinophilic inflammation is an important component of symptomatic episodes of asthma, we have investigated whether increased levels of IL-5 protein are present in bronchoalveolar lavage (BAL) fluid of patients with spontaneously symptomatic asthma (FEV1, 61% predicted; FEF25%-75%,

Sanjiv Sur; Gerald J. Gleich; Mark C. Swanson; Kathleen R. Bartemes; David H. Broide

1995-01-01

331

Frequency and predictors of symptomatic intracranial hemorrhage after intravenous thrombolysis for acute ischemic stroke in a Brazilian public hospital  

PubMed Central

OBJECTIVE: Scarce data are available on the occurrence of symptomatic intracranial hemorrhage related to intravenous thrombolysis for acute stroke in South America. We aimed to address the frequency and clinical predictors of symptomatic intracranial hemorrhage after stroke thrombolysis at our tertiary emergency unit in Brazil. METHOD: We reviewed the clinical and radiological data of 117 consecutive acute ischemic stroke patients treated with intravenous thrombolysis in our hospital between May 2001 and April 2010. We compared our results with those of the Safe Implementation of Thrombolysis in Stroke registry. Univariate and multiple regression analyses were performed to identify factors associated with symptomatic intracranial transformation. RESULTS: In total, 113 cases from the initial sample were analyzed. The median National Institutes of Health Stroke Scale score was 16 (interquartile range: 10-20). The median onset-to-treatment time was 188 minutes (interquartile range: 155-227). There were seven symptomatic intracranial hemorrhages (6.2%; Safe Implementation of Thrombolysis in Stroke registry: 4.9%; p?=?0.505). In the univariate analysis, current statin treatment and elevated National Institute of Health Stroke Scale scores were related to symptomatic intracranial hemorrhage. After the multivariate analysis, current statin treatment was the only factor independently associated with symptomatic intracranial hemorrhage. CONCLUSIONS: In this series of Brazilian patients with severe strokes treated with intravenous thrombolysis in a public university hospital at a late treatment window, we found no increase in the rate of symptomatic intracranial hemorrhage. Additional studies are necessary to clarify the possible association between statins and the risk of symptomatic intracranial hemorrhage after stroke thrombolysis. PMID:22892916

Cougo-Pinto, Pedro Telles; dos Santos, Bruno Lopes; Dias, Francisco Antunes; Fabio, Soraia Ramos Cabette; Werneck, Ilana Vaula; Camilo, Millene Rodrigues; Abud, Daniel Giansante; Leite, João Pereira; Pontes-Neto, Octavio Marques

2012-01-01

332

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

Microsoft Academic Search

Objectives. To review the results of holmium laser lithotripsy in a cohort of patients who presented with symptomatic urolithiasis in pregnancy. Symptomatic urolithiasis in pregnancy that does not respond to conservative measures has traditionally been managed with ureteral stent insertion or percutaneous nephrostomy. Holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy using state-of-the-art ureteroscopes represents an emerging strategy for definitive stone management in pregnancy.Methods.

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

2002-01-01

333

Treating symptomatic hyperprolactinemia in women with schizophrenia: presentation of the ongoing DAAMSEL clinical trial (Dopamine partial Agonist, Aripiprazole, for the Management of Symptomatic ELevated prolactin)  

PubMed Central

Prolactin elevations occur in people treated with antipsychotic medications and are often much higher in women than in men. Hyperprolactinemia is known to cause amenorrhea, oligomenorrhea, galactorrhea and gynecomastia in females and is also associated with sexual dysfunction and bone loss. These side effects increase risk of antipsychotic nonadherence and suicide and pose significant problems in the long term management of women with schizophrenia. In this manuscript, we review the literature on prolactin; its physiology, plasma levels, side effects and strategies for treatment. We also present the rationale and protocol for an ongoing clinical trial to treat symptomatic hyperprolactinemia in premenopausal women with schizophrenia. More attention and focus are needed to address these significant side effects and help the field better personalize the treatment of women with schizophrenia. PMID:23968123

2013-01-01

334

Symptomatic myoclonus.  

PubMed

A huge number of neurological disorders are associated with myoclonus. This paper describes these disorders whose diagnosis partly relies on the presence of myoclonus. The diagnostic approach is related to certain clinical features of myoclonus, which, after their integration in the clinical context, help orientate towards diagnosis. Myoclonus is frequent during dementia. Although its presence is well-known to take part in the diagnosis of Creutzfeldt-Jakob disease (CJD), myoclonus can also be present to a significant degree in Alzheimer's disease and Lewy body dementia (LBD), which raises a diagnostic issue. Both its clinical and electrophysiological features may help differential diagnosis, given that myoclonus with fast-evolving dementia and focal neurological signs should favor the diagnosis of CJD. Myoclonus in a context of progressive ataxia suggests one clinical form of the Ramsay-Hunt syndrome (progressive myoclonic ataxia, PMA), whose most frequent causes are: coeliac disease, mitochondriopathies, some spino-cerebellar degenerations, and some late metabolic disorders. In addition to ataxia and myoclonus, the presence of opsoclonus directs diagnosis toward the opsoclonus-myoclonus syndrome (OMS), whose origin, in adult, is idiopathic or paraneoplastic. Palatal tremor (myoclonus) with ataxia may represent either a sporadic pattern, which often reflects the evolution of degenerative or lesional disorders, or a familial pattern in some degenerative affections or metabolic diseases. Of more recent knowledge is the association of progressive ataxia, myoclonus, and renal failure, which corresponds to a recessive autosomic disease. In a context of encephalopathy, myoclonus is frequent in metabolic or hydro-electrolytic disorders, and in brain anoxia. One should distinguish these various forms of myoclonus which may occur in the acute post-anoxic phase, from those occurring as sequels at a later stage, i.e. the Lance and Adams syndrome whose clinical aspects are also multiple. Myoclonus is less frequent during toxic or drug exposures. Irrespective of its acute or insidious onset, Hashimoto's encephalopathy is accompanied by myoclonus and tremor. Myoclonus may also be present during encephalic and/or spinal infectious disorders. Myoclonus with focal neurological signs may be observed in thalamic lesions, responsible for unilateral asterixis or unilateral myoclonus superimposed on dystonic posture. Segmental spinal myoclonus or propriospinal myoclonus may be associated with several spinal-cord disorders. Myoclonus associated with peripheral nerve lesions is exceptional or even questionable for some of these. PMID:17336775

Borg, M

2006-01-01

335

Chronic Conditions and School  

MedlinePLUS

... Issues Listen Chronic Conditions and School Article Body My child has a chronic health condition. What do ... the school right away when contact information has changed. Make a health plan . If your child takes ...

336

Chronic fatigue syndrome - resources  

MedlinePLUS

Resources - chronic fatigue syndrome; CFS resources ... The following organizations provide information on chronic fatigue syndrome : CFIDS Association of America - www.cfids.org U.S. Centers for Disease Control and Prevention - www.cdc.gov/cfs

337

Chronic fatigue syndrome  

MedlinePLUS

CFS; Fatigue - chronic; Immune dysfunction syndrome; Myalgic encephalomyelitis (ME) ... The exact cause of chronic fatigue syndrome (CFS) is unknown. Some theories suggest CFS may be due to: Epstein-Barr virus or human herpes virus-6 (HHV- ...

338

Understanding Chronic Bronchitis  

MedlinePLUS

... news is that chronic bronchitis can be found early and there is much that can be done to treat and help manage the disease. What Causes Chronic Bronchitis? Cigarette smoking is by far the most common cause of ...

339

Sleep and Chronic Disease  

MedlinePLUS

... visit this page: About CDC.gov . Sleep and Sleep Disorders Share Compartir Sleep and Chronic Disease As chronic ... of depression be monitored among persons with a sleep disorder. 4, 5 References Knutson KL, Ryden AM, Mander ...

340

Chronic Urticaria (Hives)  

MedlinePLUS

... chronic hives may be diagnosed with Chronic Idiopathic Urticaria (CIU). Angioedema is a form of hives where ... hour after exposure. For example: people with pressure urticaria get hives on certain parts of the body ...

341

Chronic myelogenous leukemia (CML)  

MedlinePLUS

... leukemia is grouped into several phases: Chronic Accelerated Blast crisis The chronic phase can last for months ... a swollen spleen . Untreated CML leads to the blast crisis phase. Bleeding and infection may occur due ...

342

Chronic Kidney Diseases  

MedlinePLUS

... for a long time, doctors call it a chronic kidney disease. Children's kidney problems may be congenital (say: kun- ... Do Doctors Treat Kidney Problems? The treatment for chronic kidney ... bone disease. Sometimes unhealthy kidneys have problems producing a hormone ...

343

Cholelithiasis and cholecystitis in children  

Microsoft Academic Search

With advances in medical technology, including intensive care, new medications, alterations in the composition of parenteral nutrition, and the institution of minimally invasive surgery, our understanding of the spectrum of diseases of the gallbladder resulting in stone formation or inflammation, and the management of these disorders has changed over the past few decades. The discussion herein focuses on our thinking

Thom E Lobe

2000-01-01

344

Hyperventilation and asymptomatic chronic asthma  

PubMed Central

BACKGROUND—We have consistently argued that mild asthma is an important underlying aetiological factor in patients with severe symptomatic hyperventilation. While hyperventilation has been demonstrated in acute asthma, there have been few studies in mild chronic asthma, and mechanisms are uncertain.?METHODS—Twenty three currently asymptomatic chronically asthmatic patients (occasional use of bronchodilators, normal lung function, hyperresponsive to methacholine) were studied and 17 matched normal subjects acted as controls. Ventilation, pattern of breathing, arterial carbon dioxide and oxygen tensions (PaCO2, PaO2), end tidal PCO2 (PETCO2), standard lung function, airway responsiveness to methacholine, airway inflammation assessed by eosinophils in induced sputum, and psychiatric morbidity (Spielberger STAI-Y and Beck Depression Inventory) were measured.?RESULTS—Despite the absence of current asthmatic symptoms, no clinical evidence of hyperventilation, and normal lung function in the patients with asthma, PaCO2 and PETCO2 were significantly (p<0.01) lower in the patients than in the control group (mean (SD) PaCO2 4.96 (0.43) kPa for patients versus 5.27 (0.38) kPa for controls (mean difference 0.31 kPa, 95% confidence interval (CI) 0.06 to 0.56, p<0.02)). PETCO2 was very similar to PaCO2 in both groups (mean (SD) PETCO2 4.89 (0.47) kPa for the patients and 5.28 (0.40) for the controls (mean difference 0.39 kPa, 95% CI 0.12 to 0.66,p<0.01)). There was no significant difference in ventilation or respiratory pattern between the two groups. The reduced PaCO2 in the asthmatic patients correlated significantly with the concentration of methacholine provoking a fall in FEV1 of more than 20% (PC20) (r = 0.56, p<0.01) but not with any aspect of lung function, eosinophil count, or anxiety/depression.?CONCLUSION—Mild asymptomatic asthma is not associated with clinically significant hyperventilation but is associated with a significant reduction in both arterial and end tidal PCO2 which relates to airway hyperresponsiveness rather than to the degree of airway obstruction or mucosal inflammation. Anxiety and depression appear not to be implicated.?? PMID:11083886

Osborne, C; O'Connor, B; Lewis, A; Kanabar, V; Gardner, W

2000-01-01

345

What Is Chronic Myeloid Leukemia?  

MedlinePLUS

... about chronic myeloid leukemia? What is chronic myeloid leukemia? Chronic myeloid leukemia (CML), also known as chronic ... is the same as for adults. What is leukemia? Leukemia is a cancer that starts in the ...

346

Transcatheter thrombolytic therapy for symptomatic thrombo-occlusion of inferior vena cava filter  

PubMed Central

Thrombus within an inferior vena cava (IVC) filter reduces filter patency and venous return from the lower extremities, and may progress to complete IVC occlusion. The clinical experiences and outcomes of transcatheter thrombolytic therapy for symptomatic IVC thrombosis following filter implantation have not been widely reported. The aim of the current study was to evaluate the efficiency and safety of trans-catheter thrombolysis for the treatment of symptomatic IVC thrombosis in patients with implanted IVC filters. Transcatheter thrombolysis was used to treat 5 patients with thrombosis of the filter-bearing IVC causing symptoms in 10 limbs from October 2005 to September 2010. The patients were implanted with a second IVC filter through the right internal jugular vein, followed by recanalization of the occluded IVC and intravenous transcatheter thrombolysis. The IVC filters were retrieved through the femoral or right internal jugular vein after the thrombus had dissolved. Technical and clinical outcome, complications and postoperative pulmonary embolism were monitored. A total of 5 filters were implanted and 6 filters were retrieved later. Technically and clinically successful recanalization and thrombolysis were achieved in 5 of 5 patients and 10 of 10 symptomatic limbs. The median thrombolysis period was 13 days (range, 8–14 days). The median dwell time for the filters that were removed was 50.5 days (range, 14–73 days). No major bleeding occurred during the current study. During clinical follow-up, no clinically detectable pulmonary embolism was observed. Endovascular recanalization and transcatheter thrombolysis of IVC thrombosis are efficient, feasible and safe in the presence of an IVC filter. PMID:23403505

XIAO, LIANG; SHEN, JING; TONG, JIA-JIE; ZHANG, ZHE; MU, XIAO-LIN; YI, ZHENG-JIA; BAI, SHUO; XU, KE

2013-01-01

347

Transcatheter thrombolytic therapy for symptomatic thrombo-occlusion of inferior vena cava filter.  

PubMed

Thrombus within an inferior vena cava (IVC) filter reduces filter patency and venous return from the lower extremities, and may progress to complete IVC occlusion. The clinical experiences and outcomes of transcatheter thrombolytic therapy for symptomatic IVC thrombosis following filter implantation have not been widely reported. The aim of the current study was to evaluate the efficiency and safety of trans-catheter thrombolysis for the treatment of symptomatic IVC thrombosis in patients with implanted IVC filters. Transcatheter thrombolysis was used to treat 5 patients with thrombosis of the filter-bearing IVC causing symptoms in 10 limbs from October 2005 to September 2010. The patients were implanted with a second IVC filter through the right internal jugular vein, followed by recanalization of the occluded IVC and intravenous transcatheter thrombolysis. The IVC filters were retrieved through the femoral or right internal jugular vein after the thrombus had dissolved. Technical and clinical outcome, complications and postoperative pulmonary embolism were monitored. A total of 5 filters were implanted and 6 filters were retrieved later. Technically and clinically successful recanalization and thrombolysis were achieved in 5 of 5 patients and 10 of 10 symptomatic limbs. The median thrombolysis period was 13 days (range, 8-14 days). The median dwell time for the filters that were removed was 50.5 days (range, 14-73 days). No major bleeding occurred during the current study. During clinical follow-up, no clinically detectable pulmonary embolism was observed. Endovascular recanalization and transcatheter thrombolysis of IVC thrombosis are efficient, feasible and safe in the presence of an IVC filter. PMID:23403505

Xiao, Liang; Shen, Jing; Tong, Jia-Jie; Zhang, Zhe; Mu, Xiao-Lin; Yi, Zheng-Jia; Bai, Shuo; Xu, Ke

2013-02-01

348

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

349

Dentate gyrus network dysfunctions precede the symptomatic phase in a genetic mouse model of seizures  

PubMed Central

Neuronal circuit disturbances that lead to hyperexcitability in the cortico-hippocampal network are one of the landmarks of temporal lobe epilepsy. The dentate gyrus (DG) network plays an important role in regulating the excitability of the entire hippocampus by filtering and integrating information received via the perforant path. Here, we investigated possible epileptogenic abnormalities in the function of the DG neuronal network in the Synapsin II (Syn II) knockout mouse (Syn II?/?), a genetic mouse model of epilepsy. Syn II is a presynaptic protein whose deletion in mice reproducibly leads to generalized seizures starting at the age of 2 months. We made use of a high-resolution microelectrode array (4096 electrodes) and patch-clamp recordings, and found that in acute hippocampal slices of young pre-symptomatic (3–6 week-old) Syn II?/? mice excitatory synaptic output of the mossy fibers is reduced. Moreover, we showed that the main excitatory neurons present in the polymorphic layer of the DG, hilar mossy cells, display a reduced excitability. We also provide evidence of a predominantly inhibitory regulatory output from mossy cells to granule cells, through feed-forward inhibition, and show that the excitatory-inhibitory ratio is increased in both pre-symptomatic and symptomatic Syn II?/? mice. These results support the key role of the hilar mossy neurons in maintaining the normal excitability of the hippocampal network and show that the late epileptic phenotype of the Syn II?/? mice is preceded by neuronal circuitry dysfunctions. Our data provide new insights into the mechanisms of epileptogenesis in the Syn II?/? mice and open the possibility for early diagnosis and therapeutic interventions. PMID:24009558

Toader, Oana; Forte, Nicola; Orlando, Marta; Ferrea, Enrico; Raimondi, Andrea; Baldelli, Pietro; Benfenati, Fabio; Medrihan, Lucian

2013-01-01

350

Randomized Withdrawal Study of Patients With Symptomatic Neurogenic Orthostatic Hypotension Responsive to Droxidopa  

PubMed Central

Abstract— We evaluated whether droxidopa, a prodrug converted to norepinephrine, is beneficial in the treatment of symptomatic neurogenic orthostatic hypotension, which results from failure to generate an appropriate norepinephrine response to postural challenge. Patients with symptomatic neurogenic orthostatic hypotension and Parkinson disease, multiple system atrophy, pure autonomic failure, or nondiabetic autonomic neuropathy underwent open-label droxidopa titration (100–600 mg, 3× daily). Responders then received an additional 7-day open-label treatment at their individualized dose. Patients were subsequently randomized to continue with droxidopa or withdraw to placebo for 14 days. We then assessed patient-reported scores on the Orthostatic Hypotension Questionnaire and blood pressure measurements. Mean worsening of Orthostatic Hypotension Questionnaire dizziness/lightheadedness score from randomization to end of study (the primary outcome; N=101) was 1.9±3.2 with placebo and 1.3±2.8 units with droxidopa (P=0.509). Four of the other 5 Orthostatic Hypotension Questionnaire symptom scores and all 4 symptom-impact scores favored droxidopa, with statistical significance for the patient’s self-reported ability to perform activities requiring standing a short time (P=0.033) and standing a long time (P=0.028). Furthermore, a post hoc analysis of a predefined composite score of all symptoms (Orthostatic Hypotension Questionnaire composite) demonstrated a significant benefit for droxidopa (P=0.013). There was no significant difference between groups for standing systolic blood pressure (P=0.680). Droxidopa was well tolerated. In summary, this randomized withdrawal droxidopa study failed to meet its primary efficacy end point. Additional clinical trials are needed to confirm that droxidopa is beneficial in symptomatic neurogenic orthostatic hypotension, as suggested by the positive secondary outcomes of this trial. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00633880. PMID:25350981

Freeman, Roy; Mathias, Christopher J.; Low, Phillip; Hewitt, L. Arthur; Kaufmann, Horacio

2015-01-01

351

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

352

Symptomatic contralateral subdural hygromas after decompressive craniectomy: plausible causes and management protocols.  

PubMed

OBJECT Contralateral subdural hygromas are occasionally observed after decompressive craniectomies (DCs). Some of these hygromas are symptomatic, and the etiology and management of these symptomatic contralateral subdural collections (CLDCs) present surgical challenges. The authors share their experience with managing symptomatic CLSDCs after a DC. METHODS During a 10-month period, 306 patients underwent a DC. Of these patients, 266 had a head injury, 25 a middle cerebral artery infarction (that is, a thrombotic stroke), and 15 an infarction due to a vasospasm (resulting from an aneurysmal subarachnoid hemorrhage [SAH]). Seventeen patients (15 with a head injury and 2 with an SAH) developed a CLSDC, and 7 of these patients showed overt symptoms of the fluid collection. These patients were treated with a trial intervention consisting of bur hole drainage followed by cranioplasty. If required, a ventriculo- or thecoperitoneal shunt was inserted at a later time. RESULTS Seven patients developed a symptomatic CLSDC after a DC, 6 of whom had a head injury and 1 had an SAH. The average length of time between the DC and CLSDC formation was 24 days. Fluid drainage via a bur hole was attempted in the first 5 patients. However, symptoms in these patients improved only temporarily. All 7 patients (including the 5 in whom the bur hole drainage had failed and 2 directly after the DC) underwent a cranioplasty, and the CLSDC resolved in all of these patients. The average time it took for the CLSDC to resolve after the cranioplasty was 34 days. Three patients developed hydrocephalus after the cranioplasty, requiring a diversion procedure, and 1 patient contracted meningitis and died. CONCLUSIONS Arachnoid tears and blockage of arachnoid villi appear to be the underlying causes of a CLSDC. The absence of sufficient fluid pressure required for CSF absorption after a DC further aggravates such fluid collections. Underlying hydrocephalus may appear as subdural collections in some patients after the DC. Bur hole drainage appears to be only a temporary measure and leads to recurrence of a CLSDC. Therefore, cranioplasty is the definitive treatment for such collections and, if performed early, may even avert CLSDC formation. A temporary ventriculostomy or an external lumbar drainage may be added to aid the cranioplasty and may be removed postoperatively. Ventriculoperitoneal or thecoperitoneal shunting may be required for patients in whom a hydrocephalus manifests after cranioplasty and underlies the CLSDC. PMID:25495740

Salunke, Pravin; Garg, Ravi; Kapoor, Ankur; Chhabra, Rajesh; Mukherjee, Kanchan K

2015-03-01

353

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.

354

Selective arterial embolisation of bilateral angiomyolipomata in a symptomatic pregnant female.  

PubMed

Renal angiomyolipoma (RA) is a rare benign tumour that can expand rapidly during pregnancy due to oestrogen and other hormonal factors. Complications associated with expanding renal angiomyolipomata are spontaneous retroperitoneal haemorrhage secondary to acute rupture and thrombosis of the renal vein or inferior vena cava. MRI is recommended for diagnostic purposes in pregnancy; however, this modality is not always readily available. In the present report, we describe the first case of bilateral selective arterial embolisation for renal angiomyolipomata presenting symptomatically in a previously healthy pregnant female. PMID:24259526

Davis, Niall F; Kelly, Rory; Lee, Michael J; Mohan, Ponnusamy

2013-01-01

355

Ultrasound, CT and MRI Appearances of a Rare Symptomatic Laryngeal Chondrometaplasia: A Case Report  

PubMed Central

Symptomatic laryngeal chondrometaplasia is rare. To the best of our knowledge, there are only few case reports on laryngeal chondrometaplasia. The imaging appearance of this uncommon disease is even more rarely described. There are only two case reports describing its appearances in computed tomography (CT) and magnetic resonance imaging (MRI). Ultrasound (US) features have not been reported so far. This case report is to show the US, CT and MRI features of this disease entity to stress the role of imaging in this disease. PMID:25901266

Lee, Ryan Ka Lok; Hok Yuen, Edmond Yuen; Abdullah, Victor James; Ping Lee, Yolanda Yim; Ahuja, Anil Tejbhan

2015-01-01

356

Transcriptome analysis of symptomatic and recovered leaves of geminivirus-infected pepper (Capsicum annuum)  

PubMed Central

Background Geminiviruses are a large and important family of plant viruses that infect a wide range of crops throughout the world. The Begomovirus genus contains species that are transmitted by whiteflies and are distributed worldwide causing disease on an array of horticultural crops. Symptom remission, in which newly developed leaves of systemically infected plants exhibit a reduction in symptom severity (recovery), has been observed on pepper (Capsicum annuum) plants infected with Pepper golden mosaic virus (PepGMV). Previous studies have shown that transcriptional and post-transcriptional gene silencing mechanisms are involved in the reduction of viral nucleic acid concentration in recovered tissue. In this study, we employed deep transcriptome sequencing methods to assess transcriptional variation in healthy (mock), symptomatic, and recovered pepper leaves following PepGMV infection. Results Differential expression analyses of the pepper leaf transcriptome from symptomatic and recovered stages revealed a total of 309 differentially expressed genes between healthy (mock) and symptomatic or recovered tissues. Computational prediction of differential expression was validated using quantitative reverse-transcription PCR confirming the robustness of our bioinformatic methods. Within the set of differentially expressed genes associated with the recovery process were genes involved in defense responses including pathogenesis-related proteins, reactive oxygen species, systemic acquired resistance, jasmonic acid biosynthesis, and ethylene signaling. No major differences were found when compared the differentially expressed genes in symptomatic and recovered tissues. On the other hand, a set of genes with novel roles in defense responses was identified including genes involved in histone modification. This latter result suggested that post-transcriptional and transcriptional gene silencing may be one of the major mechanisms involved in the recovery process. Genes orthologous to the C. annuum proteins involved in the pepper-PepGMV recovery response were identified in both Solanum lycopersicum and Solanum tuberosum suggesting conservation of components of the viral recovery response in the Solanaceae. Conclusion These data provide a valuable source of information for improving our understanding of the underlying molecular mechanisms by which pepper leaves become symptomless following infection with geminiviruses. The identification of orthologs for the majority of genes differentially expressed in recovered tissues in two major solanaceous crop species provides the basis for future comparative analyses of the viral recovery process across related taxa. PMID:23185982

2012-01-01

357

Efficacy of terazosin and finasteride in symptomatic benign prostatic hyperplasia: A comparative study.  

PubMed

Medical treatment for symptomatic Benign Prostatic Hyperplasia (BPH) has become popular for the last few years. This study was designed to find out and compare the efficacy of terazosin, a alpha1 adrenoceptor blocker and finasteride, a 5alpha-reductase inhibitor in symptomatic BPH. A total of 60 patients (30 in terazosin group and 30 finasteride group) of symptomatic BPH were selected. Terazosin group received 1 mg daily at bedtime for 3 days, 2 mg at bedtime for 7 days, thereafter 5 mg at bedtime daily for 6 months. Finasteride group received 5 mg once daily. In terazosin treated patients, improvement after 3 months were as follows, IPSS 3.93 +/- .74 points reduction, Qmax 2.13 +/- .68 ml/s increase, post-voided residual urine volume (PVR) 20.67 +/- 10.56 ml reduction (significant, p<0.001) and prostate volume 0.57 +/- 1.54 ml reduction (not significant). Similar statistical differences were observed at 6 months follow up. In finasteride treated patients, improvements after 3 months were as follows, International Prostate Symptom Score (IPSS) 1.38 +/- .63 points reduction, Qmax 0.55 +/- 0.78 ml/s increase, PVR 5.93 +/- 7.64 ml reduction (significant, p<0.001) and prostate volume 0.17 +/- 5.6 ml reduction (non-significant). At 6 month follow up statistical differences were significant in all parameters including prostate volume 4.57 +/- 5.30 ml reduction (p<0.001). In comparison, statistically significant superiority of terazosin over finasteride was found in improving IPSS, Qmax and PVR in both follow up visits. But terazosin had nonsignificant effect in reducing prostate volume; in contrast, finasteride had significant effect in second visit. It can be concluded from this study that terazosin 5mg once daily is effective in mild to moderate cases of symptomatic BPH. On the other hand, finasteride 5mg once daily may be useful in large prostate and to be given for at least 6 months. PMID:16967810

Anwarul Islam, A K M; Kashem, M A; Shameem, I A; Kibria, S A M G

2005-08-01

358

The Angelchik prosthesis for gastro-oesophageal reflux: symptomatic and objective assessment.  

PubMed Central

Twenty-three patients with intractable gastro-oesophageal reflux were treated by insertion of the Angelchik antireflux prosthesis. Good symptomatic relief was achieved in over 80% of patients reviewed up to 28 months after operation and there was marked resolution of oesophagitis as seen on endoscopy. Oesophageal manometry and pH studies performed preoperatively and at 3 and 12 months after operation, showed a significant increase in lower oesophageal sphincter pressure with decreased acid reflux. Some technical problems were encountered, but the prosthesis is potentially a simple and effective means of controlling gastro-oesophageal reflux. Images Fig. 1 PMID:4051424

Weaver, R. M.; Temple, J. G.

1985-01-01

359

Bilateral Symptomatic Discoid Medial Meniscus of the Knee: A Case Report and Review of Literature  

PubMed Central

Introduction: A discoid medial meniscus is a rare pathology of the knee joint, and is even rarer when it presents bilaterally with clinical symptoms. Case Presentation: We present the case of a 38-year-old female with symptomatic bilateral discoid medial meniscus. Magnetic Resonance Imaging (MRI) showed complete discoid meniscus in one knee and incomplete, on the other side. The MRI findings were confirmed on arthroscopy, with horizontal cleavage tear in both knees. Arthroscopic partial meniscectomies of both menisci were performed. Conclusions: The patient had an excellent functional outcome at the most recent follow-up, with no recurrence of symptoms and full range of movements. PMID:25834792

Kini, Sunil Gurpur; Walker, Peter; Bruce, Warwick

2015-01-01

360

Treatment of symptomatic uterine fibroids with green tea extract: a pilot randomized controlled clinical study  

PubMed Central

Background Uterine fibroids (UFs, also known as leiomyoma) affect 70% of reproductive-age women. Imposing a major burden on health-related quality-of-life (HRQL) of premenopausal women, UF is a public health concern. There are no effective medicinal treatment options currently available for women with symptomatic UF. Objectives To evaluate the efficacy and safety of green tea extract (epigallocatechin gallate [EGCG]) on UF burden and quality of life in women with symptomatic UF, in a double-blinded, placebo-controlled randomized clinical trial. Methods A total of 39 reproductive-age women (age 18–50 years, day 3 serum follicle-stimulating hormone <10 \\U/mL) with symptomatic UF were recruited for this study. All subjects had at least one fibroid lesion 2 cm3 or larger, as confirmed by transvaginal ultrasonography. The subjects were randomized to oral daily treatment with either 800 mg of green tea extract (45% EGCG) or placebo (800 mg of brown rice) for 4 months, and UF volumes were measured at the end, also by transvaginal ultrasonography. The fibroid-specific symptom severity and HRQL of these UF patients were scored at each monthly visit, using the symptom severity and quality-of-life questionnaires. Student’s t-test was used to evaluate statistical significance of treatment effect between the two groups. Results Of the final 39 women recruited for the study, 33 were compliant and completed all five visits of the study. In the placebo group (n = 11), fibroid volume increased (24.3%) over the study period; however, patients randomized to green tea extract (n = 22, 800 mg/day) treatment showed significant reduction (32.6%, P = 0.0001) in total UF volume. In addition, EGCG treatment significantly reduced fibroid-specific symptom severity (32.4%, P = 0.0001) and induced significant improvement in HRQL (18.53%, P = 0.01) compared to the placebo group. Anemia also significantly improved by 0.7 g/dL (P = 0.02) in the EGCG treatment group, while average blood loss significantly decreased from 71 mL/month to 45 mL/month (P = 0.001). No adverse effects, endometrial hyperplasia, or other endometrial pathology were observed in either group. Conclusion EGCG shows promise as a safe and effective therapeutic agent for women with symptomatic UFs. Such a simple, inexpensive, and orally administered therapy can improve women’s health globally. PMID:23950663

Roshdy, Eman; Rajaratnam, Veera; Maitra, Sarbani; Sabry, Mohamed; Allah, Abdou S Ait; Al-Hendy, Ayman

2013-01-01

361

Transmission of calicivirus by a foodhandler in the pre-symptomatic phase of illness.  

PubMed Central

After a Christmas party in a restaurant, 48 (68%) of the 82 guests contracted calicivirus gastroenteritis. The epidemiological investigation showed that salad was strongly associated with the disease episode (RR = 2.43, P = 0.0005). Similar symptoms occurred among other customers who had had a meal at the same restaurant on the same evening. A foodhandler who had only prepared salad and appetizers became sick about 30 min after the end of his shift. He had been free of symptoms while preparing food. Few outbreak investigations have shown calicivirus transmission by foodhandlers some hours before becoming symptomatic. PMID:10694160

Gaulin, C.; Frigon, M.; Poirier, D.; Fournier, C.

1999-01-01

362

360° laparoscopic fundoplication with tension-free hiatoplasty in the treatment of symptomatic gastroesophageal reflux disease  

Microsoft Academic Search

Background: Since laparoscopic Nissen fundoplication was first described by Cuschieri in 1989 and later by Dallemagne in 1991, this procedure\\u000a has been widely employed for the treatment of symptomatic gastroesophageal reflux disease (GERD) and\\/or hiatal hernia. However,\\u000a a relatively high incidence (7–11%) of intrathoracic Nissen valve migration\\/paraesophageal hernia following laparoscopic fundoplication\\u000a has recently been reported.\\u000a \\u000a \\u000a \\u000a \\u000a Methods: Between November 1992 and

N. Basso; A. De Leo; A. Genco; P. Rosato; S. Rea; E. Spaziani; A. Primavera

2000-01-01

363

High-resolution MRI of the vessel wall in patients with symptomatic atherosclerotic stenosis of the middle cerebral artery.  

PubMed

Intracranial atherosclerosis is associated with recurrent ischemic stroke. High-resolution MRI (HR MRI) can provide information about atheroma in vivo. We aimed to analyze and compare vascular wall imaging characteristics between patients with symptomatic and asymptomatic atherosclerotic stenosis of the middle cerebral artery (MCA) using 3.0 Tesla HR MRI. The HR MRI protocol included four different scans: black blood T1-weighted, T2-weighted and proton density-weighted MRI, as well as three-dimensional turbo spin echo imaging techniques with multiplanar reconstruction. Plaque characteristics, including location, morphology, and signal intensity, were analyzed in 51 patients (29 symptomatic, 22 asymptomatic) with atherosclerotic stenosis of the middle cerebral artery. The vessel wall area, lumen area, and plaque area (PA) were also calculated and compared between the symptomatic and asymptomatic groups. We found that PA, remodeling index (RI), and positive remodeling (PR) prevalence were significantly greater in the symptomatic group than in the asymptomatic group (PA: p=0.033; RI: p=0.020; PR: p=0.032). Plaque location in the superior aspect of the vessel wall and irregular plaque surface were more frequently observed in the symptomatic group than in the asymptomatic group (superior location: p=0.031; irregular surface: p=0.036). Moreover, multivariate logistic regression identified plaque location on the superior wall as an independent predictor of symptomatic MCA stenosis (odds ratio: 4.471; p=0.039). Therefore, we can conclude that patients with symptomatic atherosclerotic stenosis of the MCA are more likely to have larger plaques, PR, superiorly located plaques, and irregular plaque surface. These characteristics are promising factors for stratifying stroke risk. PMID:25744074

Zhao, Deng-Ling; Deng, Gang; Xie, Bo; Ju, Shenghong; Yang, Ming; Chen, Xiao-Hui; Teng, Gao-Jun

2015-04-01

364

Eosinophilic inflammation is associated with elevation of interleukin-5 in the airways of patients with spontaneous symptomatic asthma.  

PubMed

In vitro and in vivo studies have shown an important role for interleukin-5 (IL-5) in regulating eosinophil proliferation, survival, and effector function. Because eosinophilic inflammation is an important component of symptomatic episodes of asthma, we have investigated whether increased levels of IL-5 protein are present in bronchoalveolar lavage (BAL) fluid of patients with spontaneously symptomatic asthma (FEV1, l61% predicted; FEF25%-75%, 30% predicted) compared with patients with asymptomatic asthma (FEV1, 88% predicted; FEF25%-l75%, 76% predicted). The percent of BAL eosinophils (10.5% vs 0.6]) (p = 0.0001) and eosinophil-derived neurotoxin (386.0 ng/ml vs 6.3 ng/ml) (p = 0.0001) was greater in BAL fluids derived from patients with symptomatic asthma compared with patients with asymptomatic asthma. Levels of IL-5 measured with an immunoradiometric assay were significantly higher in patients with symptomatic asthma (n = 26) compared with those with asymptomatic asthma (n = 18) (274 pg/ml vs < pg/ml) (p = 0.02). The increased IL-5 levels were noted in a subset of patients with symptomatic asthma with BAL absolute eosinophil counts greater than 10(6) (IL-5, 664 pg/ml; n = 10) as opposed to patients with symptomatic asthma with BAL eosinophil counts less than 10(6) (IL-5, < 13 pg/ml; n = 16) (p = 0.005). This study suggests that IL-5 is not only induced in experimental models of allergen-induced asthma but can also be detected as asthma progresses from the asymptomatic to the clinically symptomatic state in subjects with significant BAL eosinophilia. PMID:7499683

Sur, S; Gleich, G J; Swanson, M C; Bartemes, K R; Broide, D H

1995-11-01

365

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

366

High Prevalence of Symptomatic Hepatitis A Infection in Rural Area of Chaharmahal VA Bakhtiari Province, Iran  

PubMed Central

Introduction: Hepatitis A virus (HAV) is the most common cause of hepatitis during childhood and is an important public health problem. Therefore, the aim of this study was to investigate an outbreak of symptomatic viral hepatitis in children and in young adults in a rural area from Chaharmahal Va Bakhtiari Province, Iran. Materials and Methods: Serum samples from the 70 patients with icterus, who were suspected for HAV infection, referred to a therapeutic center in a central province of Iran from February to July, 2010 were tested for IgM specific antibody to HAV, using Enzyme linked Fluorscent assay (ELFA) Kit (General Biological Corp., Hsinchu, Taiwan). Results: All of the 70 children had jaundice. The ELFA results showed that 48 out of 70 (68.6%) tested positive for anti-HAV specific antibody (IgM). The mean age of the individuals were 12.81+12.2 and 23 of them (32.8%) were females. There was significant relationship between seropositivity for IgM anti-HAV antibody and age group in the patients studied (p<0.05). Conclusion: The high number of cases identified, may indicate an outbreak of hepatitis A in this region with the children as the most susceptible age group to this symptomatic infection. PMID:25859451

Karimi, Ali; Mortazaei, Seifollah

2015-01-01

367

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

368

Long-term outcome and efficacy of endoscopic hemorrhoid ligation for symptomatic internal hemorrhoids  

PubMed Central

AIM: To assess the long-term outcome of endoscopic hemorrhoid ligation (EHL) for the treatment of symptomatic internal hemorrhoids. METHODS: A total of 759 consecutive patients (415 males and 344 females) were enrolled. Clinical presentations were rectal bleeding (593 patients) and mucosal prolapse (166 patients). All patients received EHL at outpatient clinics. Hemorrhoid severity was classified by Goligher’s grading. The mean follow-up period was 55.4 mo (range, 45-92 mo). RESULTS: The number of band ligations averaged 2.35 in the first session for bleeding and 2.69 for prolapsed patients. Bleeding was controlled in 587 (98.0%) patients, while prolapse was reduced in 137 (82.5%) patients. After treatment, 93 patients experienced anal pain and 48 patients had mild bleeding. Patient subjective satisfaction was 93.6%. Repeat treatment or surgery was performed if symptoms were not relieved in the first session. In the bleeding group, the recurrence rate was 3.7% (22 patients) at 1 year, and 6.6% and 13.0% at 2 and 5 years. In the prolapsed group, the recurrence rate was 3.0%, 9.6% and 16.9% at 1, 2 and 5 years, respectively. CONCLUSION: EHL is an easy and well-tolerated procedure for the treatment of symptomatic internal hemorrhoids, with good long-term results. PMID:21633644

Su, Ming-Yao; Chiu, Cheng-Tang; Lin, Wei-Pin; Hsu, Chen-Ming; Chen, Pang-Chi

2011-01-01

369

Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review  

PubMed Central

Background: It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. Methods: Systematic review of the literature and narrative synthesis. Results: We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. Conclusions: This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers. PMID:25734382

Neal, R D; Tharmanathan, P; France, B; Din, N U; Cotton, S; Fallon-Ferguson, J; Hamilton, W; Hendry, A; Hendry, M; Lewis, R; Macleod, U; Mitchell, E D; Pickett, M; Rai, T; Shaw, K; Stuart, N; Tørring, M L; Wilkinson, C; Williams, B; Williams, N; Emery, J

2015-01-01

370

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

371

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. PMID:25663862

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

2015-01-01

372

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

373

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

374

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. PMID:25696026

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

2002-01-01

375

Laparoscopic Cholecystectomy in Patients With Cirrhosis of the Liver and Symptomatic Cholelithiasis  

PubMed Central

Background: The indications and benefits of laparoscopic cholecystectomy (LC) in patients with liver cirrhosis and symptomatic cholelithiasis have not been satisfactorily documented. The aim of this study was to investigate its efficacy and safety in such patients. Methods: Medical records of 38 patients with liver cirrhosis (stages Child-Pugh A and B) who underwent LC were retrospectively reviewed. Demographic characteristics and other parameters including initial presentation, conversion rate, complication rate, mortality, and duration of hospital stay were investigated and compared with noncirrhotic patients' parameters in our database. Results: Cirrhotic patients who underwent LC were older than noncirrhotic patients (P=0.021). Both the conversion rate (15.78%) and the duration of hospital stay were increased in the cirrhotic group, but without significant differences. Major complications occurred more often in the cirrhotic group (P=0.027), increasing morbidity; however, the mortality was zero. Conclusions: LC can be safely performed in Child-Pugh A and B cirrhotic patients with symptomatic gallstone disease, with acceptable complication and conversion rates. The increased risk for a major complication, however, demands more attention than usual. PMID:19793474

Symeonidis, Nikolaos G.; Psarras, Kyriakos; Skouras, Christos; Kontoulis, Theodoros M.; Ballas, Konstantinos; Rafailidis, Savas F.; Marakis, Georgios N.; Sakantamis, Athanasios K.

2009-01-01

376

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

PubMed

[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

2014-02-01

377

A case of symptomatic cervical perineural (Tarlov) cyst: clinical manifestation and management.  

PubMed

Perineural (Tarlov) cysts are most often found in the sacral region and are rare in the cervical spine. Although they are usually asymptomatic, a small number of those at the lumbosacral level have been known to produce localized or radicular pain. Few reports are available on symptomatic perineural cysts in the cervical spine and it has not been discussed how they should be managed. We present here a case of cervical perineural cysts with persistent radicular pain where the pain was adequately managed with repetitive transforaminal epidural steroid injection (TFESI). The patient had experienced intractable pain in the posterior neck and left upper extremity for more than 7 years. The nature of the pain was cramping and a tingling sensation, which was aggravated in the supine position. Magnetic resonance imaging revealed a perineural cyst in the neural foramen of left C7 root. The patient underwent three repetitive TFESIs targeted at the root. Each injection provided incremental relief, which lasted more than 6 months. Follow-up image revealed shrinkage of the cyst. This case illustrates in detail the clinical manifestation of a rare symptomatic perineural cyst in the cervical region and to our knowledge is the first to report the beneficial effect of repetitive TFESI. PMID:21830055

Kim, Keewon; Chun, Se Woong; Chung, Sun G

2012-01-01

378

Reappraisal of Primary Balloon Angioplasty without Stenting for Patients with Symptomatic Middle Cerebral Artery Stenosis.  

PubMed

There is a controversy regarding the safety and efficacy of intracranial stenting. We describe our experience with primary balloon angioplasty without stenting for symptomatic middle cerebral artery (MCA) stenosis. All patients who underwent balloon angioplasty without stenting for MCA stenosis between 1996 and 2010 were retrospectively reviewed. We evaluated technical success rates, degrees of stenosis, and stroke or death within 30 days. Among patients who were followed-up for > 1 year we evaluated latest functional outcomes, stroke recurrence at 1 year, and restenosis. In total 45/47 patients (95.7%) were successfully treated. Average pre- and postprocedure stenosis rates were 79.9% and 39.5%, respectively. Three neurological complications occurred within 30 days: one thromboembolism during the procedure; one lacunar infarction; and one fatal intraparenchymal hemorrhage after the procedure. Stroke or death rate within 30 days was 6.4%. Thirty-three patients were available for follow-up analysis with a mean period of 51.5 months. The combined rate of stroke or death within 30 days and ipsilateral ischemic stroke of the followed-up patients within 1 year beyond 30 days was 9.4%. Restenosis was observed in 26.9% of patients and all remained asymptomatic. In our retrospective series, balloon angioplasty without stenting was a safe, effective modality for symptomatic MCA stenosis. For patients refractory to medical therapy, primary balloon angioplasty may offer a better supplemental treatment option. PMID:25746307

Okada, Hideo; Terada, Tomoaki; Tanaka, Yuko; Tomura, Nagatsuki; Kono, Kenichi; Yoshimura, Ryo; Shintani, Aki

2015-02-15

379

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

380

Association of host, agent and environment characteristics and the duration of incubation and symptomatic periods of norovirus gastroenteritis.  

PubMed

SUMMARY We analysed the reported duration of incubation and symptomatic periods of norovirus for a dataset of 1022 outbreaks, 64 of which reported data on the average incubation period and 87 on the average symptomatic period. We found the mean and median incubation periods for norovirus to be 32·8 [95% confidence interval (CI) 30·9-34·6] hours and 33·5 (95% CI 32·0-34·0) hours, respectively. For the symptomatic period we found the mean and median to be 44·2 (95% CI 38·9-50·7) hours and 43·0 (95% CI 36·0-48·0) hours, respectively. We further investigated how these average periods were associated with several reported host, agent and environmental characteristics. We did not find any strong, biologically meaningful associations between the duration of incubation or symptomatic periods and the reported host, pathogen and environmental characteristics. Overall, we found that the distributions of incubation and symptomatic periods for norovirus infections are fairly constant and showed little differences with regard to the host, pathogen and environmental characteristics we analysed. PMID:25483148

Devasia, T; Lopman, B; Leon, J; Handel, A

2014-12-01

381

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

382

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

383

Chronic Urticaria: Recent Advances  

Microsoft Academic Search

Chronic urticaria is an umbrella term, which encompasses physical urticarias, chronic “idiopathic” urticaria and urticarial\\u000a vasculitis. It is important to recognize patients with physical urticarias as the investigation and treatment differs in important\\u000a ways from patients with idiopathic chronic urticaria or urticarial vasculitis. Although relatively uncommon, urticarial vasculitis\\u000a is an important diagnosis to make and requires histological confirmation by biopsy.

Malcolm W. Greaves; Kian Teo Tan

2007-01-01

384

[Chronic wounds: differential diagnosis].  

PubMed

Wound is a disruption of anatomic and physiologic continuity of the skin. According to the healing process, wounds are classified as acute and chronic wounds. A wound is considered chronic if standard medical procedures do not lead to the expected healing, or if the wound does not heal within six weeks. Chronic wounds are classified as typical and atypical. Typical wounds include ischemic, neurotrophic and hypostatic wounds. Diabetic foot and decubitus ulcers stand out as a specific entity among typical wounds. About 80 percent of chronic wounds localized on lower leg are the result of chronic venous insufficiency, in 5-10 percent the cause is of arterial etiology, whereas the remainder are mostly neuropathic ulcers. About 95 percent of chronic wounds manifest as one of the above-mentioned entities. Other forms of chronic wounds are atypical chronic wounds, which can be caused by autoimmune disorders, infectious diseases, vascular diseases and vasculopathies, metabolic and genetic diseases, neoplasm, external factors, psychiatric disorders, drug related reactions, etc. Numerous systemic diseases can present with atypical wounds. The primary cause of the wound can be either systemic disease itself (Crohn's disease) or aberrant immune response due to systemic disease (pyoderma gangrenosum, paraneoplastic syndrome). Although atypical wounds are a rare cause of chronic wounds, it should always be taken in consideration during diagnostic procedure. PMID:24371971

Situm, Mirna; Koli?, Maja

2013-10-01

385

Chronic thyroiditis (Hashimoto disease)  

MedlinePLUS

Hashimoto thyroiditis; Chronic lymphocytic thyroiditis; Autoimmune thyroiditis ... cases, the condition is called type 2 polyglandular autoimmune syndrome (PGA II). Less commonly, Hashimoto disease occurs ...

386

Differentiation between Symptomatic and Asymptomatic Extraforaminal Stenosis in Lumbosacral Transitional Vertebra: Role of Three-Dimensional Magnetic Resonance Lumbosacral Radiculography  

PubMed Central

Objective To investigate the role of lumbosacral radiculography using 3-dimentional (3D) magnetic resonance (MR) rendering for diagnostic information of symptomatic extraforaminal stenosis in lumbosacral transitional vertebra. Materials and Methods The study population consisted of 18 patients with symptomatic (n = 10) and asymptomatic extraforaminal stenosis (n = 8) in lumbosacral transitional vertebra. Each patient underwent 3D coronal fast-field echo sequences with selective water excitation using the principles of the selective excitation technique (Proset imaging). Morphologic changes of the L5 nerve roots at the symptomatic and asymptomatic extraforaminal stenosis were evaluated on 3D MR rendered images of the lumbosacral spine. Results Ten cases with symptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. On 3D MR lumbosacral radiculography, indentation of the L5 nerve roots was found in two cases, while swelling of the nerve roots was seen in eight cases at the exiting nerve root. Eight cases with asymptomatic extraforaminal stenosis showed hyperplasia and degenerative osteophytes of the sacral ala and/or osteophytes at the lateral margin of the L5 body. Based on 3D MR lumbosacral radiculography, indentation or swelling of the L5 nerve roots was not found in any cases with asymptomatic extraforaminal stenosis. Conclusion Results from 3D MR lumbosacral radiculography Indicate the indentation or swelling of the L5 nerve root in symptomatic extraforaminal stenosis. Based on these findings, 3D MR radiculography may be helpful in the diagnosis of the symptomatic extraforaminal stenosis with lumbosacral transitional vertebra. PMID:22778561

Kim, Jae Woon; Lee, Jae Kyo

2012-01-01

387

Supportive Care for Chronic Lymphocytic Leukemia  

MedlinePLUS

... lymphocytic leukemia treated? Chemotherapy for chronic lymphocytic leukemia Monoclonal antibodies for chronic lymphocytic leukemia Targeted therapy for chronic lymphocytic leukemia Surgery for chronic lymphocytic ...

388

[Conservative Management of Symptomatic or Asymptomatic Urinoma after Grade III Blunt Renal Trauma : A Report of Three Cases].  

PubMed

The management of urinoma after blunt renal trauma is still controversial, ranging from percutaneous drainage or ureteral stent placement for the symptomatic urinoma and waiting for spontaneous vanishment of the asymptomatic urinoma. We present two cases of symptomatic urinoma and a case of asymptomatic urinoma after renal laceration. All patients underwent selective renal arterial embolization for vascular complications, including active bleeding, pseudoaneurysm and arteriovenous fistula. Urinomas, which had been observed in all cases gradually reduced and vanished 1-24 months later. All cases were successfully managed without catheterization or percutaneous drainage for urinoma. PMID:25602477

Kikuchi, Mina; Kameyama, Koji; Horie, Kengo; Mizutani, Kosuke; Seike, Kensaku; Kato, Taku; Sugawara, Takashi; Tsuchiya, Tomohiro; Yasuda, Mitsuru; Yokoi, Shigeaki; Nakano, Masahiro; Deguchi, Takashi; Kondo, Hiroshi; Moriyama, Yoji; Ehara, Hidetoshi

2014-12-01

389

Assessment of MMP-9, TIMP-1, and COX2 in normal tissue and in advanced symptomatic and asymptomatic carotid plaques  

Microsoft Academic Search

Background  Mature carotid plaques are complex structures, and their histological classification is challenging. The carotid plaques of\\u000a asymptomatic and symptomatic patients could exhibit identical histological components.\\u000a \\u000a \\u000a \\u000a \\u000a Objectives  To investigate whether matrix metalloproteinase 9 (MMP-9), tissue inhibitor of MMP (TIMP), and cyclooxygenase-2 (COX-2) have\\u000a different expression levels in advanced symptomatic carotid plaques, asymptomatic carotid plaques, and normal tissue.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Thirty patients admitted for carotid

Liz Andréa V Baroncini; Lia S Nakao; Simone G Ramos; Antonio Pazin Filho; Luiz Otávio Murta Jr; Max Ingberman; Cristiane Tefé-Silva; Dalton B Précoma

2011-01-01

390

Severe Symptomatic Hypermagnesemia Associated with Over-the-Counter Laxatives in a Patient with Renal Failure and Sigmoid Volvulus  

PubMed Central

Hypermagnesemia is an uncommon but a potentially serious clinical condition. Over-the-counter magnesium containing products are widely used as antacids or laxatives. Although generally well tolerated in patients with normal renal function, their unsupervised use in the elderly can result in severe symptomatic hypermagnesemia, especially in those patients with concomitant renal failure and bowel disorders. We report a case of severe symptomatic hypermagnesemia associated with over-the-counter laxatives in a 70-year-old male patient with renal failure and sigmoid volvulus, who was successfully treated with hemodialysis. PMID:24563801

Khairi, Talal; Amer, Syed; Spitalewitz, Samuel; Alasadi, Lutfi

2014-01-01

391

Phase 1 safety and tolerability study of BMP-7 in symptomatic knee osteoarthritis  

PubMed Central

Background There are no proven therapies that modify the structural changes associated with osteoarthritis (OA). Preclinical data suggests that intra-articular recombinant human BMP-7 (bone morphogenetic protein-7) has reparative effects on cartilage, as well as on symptoms of joint pain. The objective of this study was to determine the safety and tolerability as well as dose-limiting toxicity and maximal tolerated dose of intra-articular BMP-7. The secondary objectives were to determine the effect on symptomatic responses through 24 weeks. Methods This was a Phase 1, double-blind, randomized, multi-center, placebo-controlled, single-dose escalation safety study consisting of 4 dosing cohorts in participants with knee OA. Each cohort was to consist of 8 treated participants, with treatment allocation in a 3:1 active (intra-articular BMP-7) to placebo ratio. Eligible participants were persons with symptomatic radiographic knee OA over the age of 40. The primary objective of this study was to determine the safety and tolerability of BMP-7 including laboratory assessments, immunogenicity data and radiographic assessments. Secondary objectives were to determine the proportion of participants with a 20%, 50%, and 70% improvement in the WOMAC pain and function subscales at 4, 8, 12, and 24 weeks. Other secondary outcomes included the change from baseline to 4, 8, 12, and 24 weeks for the OARSI responder criteria. Results The mean age of participants was 60 years and 73% were female. All 33 participants who were enrolled completed the study and most adverse events were mild or moderate and were similar in placebo and BMP-7 groups. The 1 mg BMP-7 group showed a higher frequency of injection site pain and there was no ectopic bone formation seen on plain x-rays. By week 12, most participants in both the BMP-7 and placebo groups experienced a 20% improvement in pain and overall the BMP-7 group was similar to placebo with regard to this measurement. In the participants who received 0.1 mg and 0.3 mg BMP-7, there was a trend toward greater symptomatic improvement than placebo. The other secondary endpoints showed similar trends including the OARSI responder criteria for which the BMP-7 groups had more responders than placebo. Conclusions There was no dose limiting toxicity identified in this study. The suggestion of a symptom response, together with the lack of dose limiting toxicity provide further support for the continued development of this product for the treatment of osteoarthritis. PMID:20932341

2010-01-01

392

Left ventricular diastolic function in asymptomatic and symptomatic human immunodeficiency virus carriers: an echocardiographic study.  

PubMed

Acquired immunodeficiency syndrome (AIDS) is a systemic illness affecting multiple organs, including the heart. Left ventricular (LV) diastolic dysfunction has been reported as the first echocardiographically detectable abnormality in several cardiovascular disorders. We tested the hypothesis that Human Immunodeficiency Virus (HIV) carriers have LV diastolic impairment when studied early in the clinical course of the infection. Doppler echocardiographic and computerized time-motion parameters of LV diastolic function were obtained in 51 HIV patients and in 25 age- and sex-matched healthy controls. The HIV population consisted of 28 totally asymptomatic subjects and 23 patients with incipient AIDS. As compared to controls, the HIV group had similar heart rate, blood pressure level, LV dimensions and fractional shortening, but increased isovolumetric relaxation time (P = 0.03), early filling duration (P < 0.001) and decreased early mitral flow peak velocity (E) (P = 0.02) and EF slope (P < 0.001). HIV patients also showed lower values for posterior wall thinning (PWT, P < 0.01) and peak lengthening velocity of the posterior wall (PVL, P < 0.05), and a trend to a decreased peak rate of LV enlargement in diastole (D+, P = 0.05). Doppler-derived parameters of diastolic function were significantly altered in the asymptomatic HIV group vs controls. The LV diastolic indices were similar in symptomatic and asymptomatic HIV patients except for PWT, which was lower in the symptomatic HIV group (P = 0.04). Since mild and focal wall motion abnormalities were detected in 11 HIV carriers (22%), comparison of LV diastolic indexes between HIV patients and controls was also performed in two subgroups; these included asymptomatic (n = 26) and symptomatic (n = 14) patients with normal contractile state. The two subgroups had abnormalities of diastolic function similar to those of the HIV group as a whole, but with somewhat lower levels of statistical significance. Our data strongly suggest that there is myocardial involvement at the early stage of HIV infection; however, its impact on the clinical course of the disease remains to be clarified. PMID:7737224

Coudray, N; de Zuttere, D; Force, G; Champetier de Ribes, D; Pourny, J C; Antony, I; Lecarpentier, Y; Chemla, D

1995-01-01

393

Symptomatic venous thromboembolism and mortality in orthopaedic surgery – an observational study of 45 968 consecutive procedures  

PubMed Central

Background Little information exists on the presentation of symptomatic venous thromboembolism (VTE) in orthopaedic surgery when a defined protocol for thromboprophylaxis is used. The objective with this study was to establish the VTE rate and mortality rate in orthopaedic surgery. Methods We performed a prospective, single centre observational cohort study of 45 968 consecutive procedures in 36 388 patients over a 10 year period. Follow-up was successful in 99.3%. The primary study outcome was the incidence of symptomatic deep vein thrombosis (DVT), symptomatic pulmonary embolism (PE) and mortality at 6 weeks, specified for different surgical procedures. The secondary outcome was to describe the DVT distribution in proximal and distal veins and the proportion of VTEs diagnosed after hospital discharge. For validation purposes, a retrospective review of VTEs diagnosed 7–12 weeks postoperatively was also performed. Results In total, 514 VTEs were diagnosed (1.1%; 95% CI: 1.10-1.14), the majority (84%) after hospital discharge (432 out of 514).With thromboprophylaxis, high incidence of VTE was found after internal fixation (IF) of pelvic fracture (12%; 95% CI: 5–26), knee replacement surgery (3.7%; 95% CI: 2.8-5.0), after internal fixation (IF) of proximal tibia fracture (3.8%; 95% CI: 2.3-6.3) and after IF of ankle fracture (3.6%; 95% CI: 2.9-4.4). Without thromboprophylaxis, high incidence of VTE was found after Achilles tendon repair (7.2%; 95% CI: 5.5-9.4). In total 1094 patients deceased (2.4%; 95% confidence interval (CI): 2.33- 2.44) within 6 weeks of surgery. Highest mortality was seen after lower limb amputation (16.3%, CI: 13.8-19.1) and after hip hemiarthroplasty due to hip fracture (9.6%, CI; 7.6-12.1). Conclusion The overall incidence of VTE is low after orthopaedic surgery but our study highlights surgical procedures after which the risk for VTE remains high and improved thromboprophylaxis is needed. PMID:23734770

2013-01-01

394

Symptomatic Dengue Infection during Pregnancy and Infant Outcomes: A Retrospective Cohort Study  

PubMed Central

Background Dengue is a mosquito-borne disease that is common in many tropical and subtropical areas. Dengue infections can occur at any age and time in the lifespan, including during pregnancy. Few large scale studies have been conducted to determine the risk of preterm birth (PTB) and low birthweight (LBW) for infants born to women who had symptomatic dengue infection during pregnancy. Methodology/Principal Findings This study is a retrospective cohort study using medical records from 1992–2010 from pregnant women who attended a public regional referral hospital in western French Guiana. Exposed pregnancies were those with laboratory confirmed cases of dengue fever during pregnancy. Each of the 86 exposed infants was matched to the three unexposed births that immediately followed them to form a stratum. Conditional logistic regression was used to analyze these matched strata. Three groups were examined: all infants regardless of gestational age, only infants>?=?17 weeks of gestational age and their strata, and only infants>?=?22 weeks of age and their strata. Odds ratios were adjusted (aOR) for maternal age, maternal ethnicity, maternal gravidity, interpregnancy interval and maternal anemia. There was an increased risk of PTB among women with symptomatic dengue; (aOR all infants: 3.34 (1.13, 9.89), aOR 17 weeks: 1.89 (0.61, 5.87), aOR 22 weeks: 1.41 (0.39, 5.20)) but this risk was only statistically significant when all infants were examined (p value?=?0.03). Adjusted results for LBW were similar, with an increased risk in the exposed group (aOR All infants: 2.23 (1.01, 4.90), aOR 17 weeks: 1.67 (0.71, 3.93), aOR 22 weeks: 1.43 (0.56, 3.70)) which was only statistically significant when all infants were examined (p value?=?0.05). Conclusions/Significance Symptomatic dengue infection during pregnancy may increase the risk of PTB and LBW for infants. More research is needed to confirm these results and to examine the role of dengue fever in miscarriage. PMID:25299383

Friedman, Eleanor E.; Dallah, Fadi; Harville, Emily W.; Myers, Leann; Buekens, Pierre; Breart, Gerard; Carles, Gabriel

2014-01-01

395

Chronic Disease Indicators  

NSDL National Science Digital Library

The Chronic Disease Indicators (CDI) is a cross-cutting set of 97 indicators that were developed by consensus and that allows states and territories and large metropolitan areas to uniformly define, collect, and report chronic disease data that are important to public health practice and available for states, territories and large metropolitan areas. 

Center for Disease Control

396

Chronic Lymphocytic Leukemia (CLL)  

MedlinePLUS

What is chronic lymphocytic leukemia (CLL)? The most common type of leukemia, this slow-growing cancer is a blood and bone marrow disease. About 15, ... and Lymphoma Society). Type the keywords chronic lymphocytic leukemia into the search box. What kinds of questions ...

397

Lactoferrin in Chronic Pancreatitis  

Microsoft Academic Search

Summary The present review is focused on the clinical significance of lactoferrin in pancreatic secretions and stone formation in chronic pancreatitis, and of serum anti-lactoferrin antibody in autoimmune pancreatitis. Lactoferrin secretion is increased in pancreatic secretions in calcified and non-calcified chronic pancreatitis. Lactoferrin, pancreatic stone protein and trypsin are present in pancreatic stones. We cannot conclude which protein is more

Chun Xiang Jin; Tetsuo Hayakawa; Motoji Kitagawa; Hiroshi Ishiguro

2009-01-01

398

Symptomatic Extensive Thoracolumbar Epidural Hematoma Following Lumbar Disc Surgery Treated by Single Level Laminectomy  

PubMed Central

Spinal epidural hematomas (SEHs) are rare complications following spine surgery, especially for single level lumbar discectomies. The appropriate surgical management for such cases remains to be investigated. We report a case of an extensive spinal epidural hematoma from T11-L5 following a L3-L4 discectomy. The patient underwent a single level L4. A complete evacuation of the SEH resulted in the patient's full recovery. When presenting symptoms limited to the initial surgical site reveal an extensive postoperative SEH, we propose: to tailor the surgical exposure individually based on preoperative findings of the SEH; and to begin the surgical exposure with a limited laminectomy focused on the symptomatic levels that may allow an efficient evacuation of the SEH instead of a systematic extensive laminectomy based on imaging. PMID:22708022

Ali, Youssef; Roux, François-Xavier; Meder, Jean-François

2012-01-01

399

Morphology and immunohistochemistry of a symptomatic septum pellucidum cavum Vergae cyst in man.  

PubMed

The cavum septi pellucidi (CSP) and cavum Vergae (CV) are persistent, primitive, or acquired, midline structures of adult human brain. It is customary to distinguish between the non-communicating and the communicating cava, depending on whether the cavum communicates with the cerebral ventricular system or not. Only a few cases of symptomatic non-communicating cava, called septum pellucidum and cavum Vergae cysts, have been described in the literature. In this study, the authors describe the morphological, histological and histo-immunological characteristics of an additional case of septum pellucidum-cavum Vergae cyst in a forty-year-old man who died the day following a ventriculo-peritoneal shunt. We have found a communication between the CSP and the leptomeningeal space of the anterior interhemispheric fissure, in the absence of subarachnoid haemorrhage. The authors discuss the origin of the intracystic fluid and the classification of the CSP. PMID:9202780

Ronsin, E; Grosskopf, D; Perre, J

1997-01-01

400

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

401

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

SciTech Connect

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.

Kretschmar, Oliver, E-mail: oliver.kretschmar@kispi.unizh.ch; Knirsch, Walter [University Children's Hospital Zurich, Division of Pediatric Cardiology (Switzerland); Bernet, Vera [University Children's Hospital Zurich, Division of Neonatology and Pediatric Intensive Care (Switzerland)

2008-03-15

402

Corrective otoplasty for symptomatic prominent ears in U.S. soldiers.  

PubMed

The purpose of this investigation was to evaluate U.S. Army soldiers who presented to the plastic surgery service with the inability to properly wear a government-issued Kevlar field helmet because of their prominent ear deformity. Between September 2000 and April 2002, four patients with prominent ears and helical rim skin abrasions with breakdown attributable to abutment from their helmets underwent open otoplasty with conchal bowl resection via a posterior approach. Symptomatic relief and cosmetic improvement were obtained, with no incidence of complications or recurrence during the follow-up period, which ranged from 9 to 22 months. All patients were able to wear their Army-issued Kevlar helmets without difficulty after surgery. Otoplasty is an effective, reliable procedure that has now been performed to alleviate symptoms in an otherwise asymptomatic patient population. PMID:16578981

Salgado, Christopher J; Mardini, Samir

2006-02-01

403

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

404

[Endocavitary surgical procedures, an alternative to myomectomy in patients with symptomatic fibroids].  

PubMed

Endometrial ablation can be used in heavy menstrual bleeding due to symptomatic submucosal myomas in women without desire of pregnancy. Those methods used alone, lead to an improvement on bleeding but results are not as good as in women without myomas. They can be associated with hysteroscopic myomectomy and, then, the results on bleeding are better than myomectomy alone. Second generation endometrial ablation methods must be used preferentially as they present less surgical complications than first generation methods. As the pregnancies that may occur after endometrial ablation have high risk of complications, a contraceptive mean is highly recommended after surgery. Transcervical sterilisation by intratubal insert (Essure) can also be proposed, but for women with Essure placed before endometrial ablation, only Thermachoice and bipolar resection have proven their safety. Finally, economical outcomes of endometrial ablation in myomas haven't been assessed yet. PMID:22100862

De Jesus, I

2011-12-01

405

What Is Chronic Lymphocytic Leukemia?  

MedlinePLUS

... key statistics for chronic lymphocytic leukemia? What is chronic lymphocytic leukemia? Chronic lymphocytic leukemia (CLL) is a type of ... and other tissues. Are there different types of CLL? Doctors have found that there seem to be ...

406

?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

407

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

408

Pharmacokinetics and safety of dexlansoprazole MR in pediatric patients with symptomatic gastroesophageal reflux disease  

PubMed Central

Objective To evaluate the safety and pharmacokinetic profile of dexlansoprazole modified-release (MR) capsules in pediatric patients with symptomatic gastroesophageal reflux disease (GERD). Methods This Phase I, open-label study enrolled male and female patients (1 to 11 years of age) with GERD. Patients received dexlansoprazole MR 15 mg, 30 mg, or 60 mg (according to weight) once daily for 7 days. Blood samples for the measurement of plasma dexlansoprazole concentrations were collected for 24 hours after the day 7 dose. Dexlansoprazole plasma concentrations and pharmacokinetic parameters were summarized by dose group. Safety assessments included adverse events (AEs), clinical laboratory evaluations, fasting gastrin concentrations, physical examinations, electrocardiograms, and vital signs. Results Thirty-six patients received study drug (12 per dose group), and 31 had evaluable pharmacokinetic data. There was a significant effect of weight on dose-normalized area under the curve (AUC, P=0.003) and dose-normalized maximum plasma concentration (Cmax) (P=0.013), indicating that for a given dose, dexlansoprazole exposure decreases as body weight increases. After adjusting for body weight, both dexlansoprazole Cmax and AUC increased in an approximately dose-proportional manner with increasing dexlansoprazole dose. A total of ten of 36 patients reported at least one treatment-emergent AE, with most events considered mild in intensity. The most common AEs were vomiting, abdominal pain, diarrhea, and nausea. Conclusion In 1- to 11-year-old patients with symptomatic GERD, weight-adjusted dexlansoprazole AUC and Cmax increased approximately dose-proportionally. However, for a given dose, dexlansoprazole exposure decreased with increasing body weight. Dexlansoprazole MR was well tolerated, and the incidence of AEs did not increase with increasing dose. PMID:25525378

Kukulka, Michael; Nudurupati, Sai; Perez, Maria Claudia

2014-01-01

409

CT-Guided Radioactive {sup 125}I Seed Implantation Therapy of Symptomatic Retroperitoneal Lymph Node Metastases  

SciTech Connect

PurposeThis study explored the clinical efficacy of CT-guided radioactive {sup 125}I seed implantation in treating patients with symptomatic retroperitoneal lymph node metastases.MethodsTwenty-five patients with pathologically confirmed malignant tumors received CT-guided radioactive {sup 125}I seed implantation to treat metastatic lymph nodes. The diameter of the metastatic lymph nodes ranged from 1.5 to 4.5 cm. Treatment planning system (TPS) was used to reconstruct the three-dimensional image of the tumor and then calculate the corresponding quantity and distribution of {sup 125}I seeds.ResultsFollow-up period for this group of patients was 2–30 months, and median time was 16 months. Symptoms of refractory pain were significantly resolved postimplantation (P < 0.05), and Karnofsky score rose dramatically (P < 0.05). Most patients reported pain relief 2–5 days after treatment. Follow-up imaging studies were performed 2 months later, which revealed CR in 7 patients, PR in 13 patients, SD in 3 patients, and PD in 2 patients. The overall effective rate (CR + PR) was 80 %. Median survival time was 25.5 months. Seven patients died of recurrent tumor; 16 patients died of multiorgan failure or other metastases. Two patients survived after 30 months follow-up. Two patients reported localized skin erythema 1 week postimplantation, which disappeared after topical treatment.ConclusionsCT-guided radioactive {sup 125}I seed implantation, which showed good palliative pain relief with acceptable short-term effects, has proved in our study to be a new, safe, effective, and relatively uncomplicated treatment option for symptomatic retroperitoneal metastatic lymph nodes.

Wang, Zhongmin, E-mail: wzm0722@hotmail.com [Shanghai Jiaotong University School of Medicine, Department of Nuclear Medicine, Renji Hospital (China); Lu, Jian; Gong, Ju; Zhang, Liyun [Shanghai Jiaotong University School of Medicine, Department of Radiology, Ruijin Hospital Luwan Branch (China); Xu, Yingjia [Shanghai Jiao Tong University, Department of Cardiology, Shanghai Chest Hospital (China); Song, Shaoli [Shanghai Jiaotong University School of Medicine, Department of Nuclear Medicine, Renji Hospital (China); Chen, Kemin [Shanghai Jiaotong University School of Medicine, Department of Radiology, Ruijin Hospital (China); Liu, Fenju [Soochow University, School of Radiation Medicine and Public Health (China); Gang, Huang, E-mail: huanggang0722@hotmail.com [Shanghai Jiaotong University School of Medicine, Department of Nuclear Medicine, Renji Hospital (China)

2013-04-12

410

Wingspan Stent for High-Grade Symptomatic Vertebrobasilar Artery Atherosclerotic Stenosis  

SciTech Connect

Purpose: This study was designed to present the treatment outcomes with Wingspan stent angioplasty of high-grade intracranial vertebrobasilar artery (VBA) stenosis in symptomatic patients. Methods: Between 2007 and 2010, the records of 30 patients with 31 intracranial high-grade VBA stenoses (all{>=}70%) who underwent elective stenting due to the failure of medical therapy were retrospectively reviewed. Clinical evaluation was performed based on the modified Rankin scale and the National Institutes of Health Stroke Scale. Results: In all cases, the stent deployment was technically successful. The mean stenosis decreased significantly from 82.28 {+-} 8.02% (range, 72-99%) to 11.18 {+-} 7.28% (range, 0-25%) after stent-assisted angioplasty (P < 0.05). Periprocedure complications occurred in 3 (10%) of 30 patients; there were 2 cases of perforator strokes and 1 case of transient flow insufficiency with stent overlap. Clinical follow-up (mean, 17.81 {+-} 11.49 months; range, 5-40 months) was available for 27 patients, and angiographic follow-up (mean, 9.95 {+-} 5.74 months, range, 5-20 months) was available for 19 patients. Only one case demonstrated recurrent symptoms with restenosis ({>=}50%). There were no recurrent ischemic events and no cases of restenosis in the other patients. Conclusions: According to our data, the Wingspan stent for symptomatic intracranial VBA stenoses is a safe and efficacious treatment alternative in cases with recurrent symptoms despite medical therapy. However, the improvement of outcome requires the reduction in the rate of procedure-related complications and long-term outcomes still have to be demonstrated.

Li Jian, E-mail: ns981212@yahoo.com.cn; Zhao Zhenwei, E-mail: zzwzc@sina.com; Gao Guodong, E-mail: gaoguo_dong@163.com; Deng Jianping [Tangdu Hospital, The Fourth Military Medical University, Team of Neurovascular Angioplasty, Department of Interventional Neuroradiology and Neurosurgery (China); Yu Jia [Tangdu Hospital, The Fourth Military Medical University, Department of Neurology (China); Gao Li; Yuan Yang; Qv Youzhi [Tangdu Hospital, The Fourth Military Medical University, Department of Neuroradiology (China)

2012-04-15

411

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

412

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

413

Association Between Chair Stand Strategy and Mobility Limitations in Older Adults with Symptomatic Knee Osteoarthritis  

PubMed Central

OBJECTIVE To determine which lower limb strength and joint kinetic and kinematic parameters distinguish sit-to-stand (STS) performance of older adults with symptomatic knee osteoarthritis (OA) with higher and lower chair stand time. DESIGN Cross-sectional SETTING Motion analysis laboratory. PARTICIPANTS Age 50–79 years with radiographic knee OA and daily symptoms, stratified by chair stand times. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Lower limb strength and STS strategy. RESULTS Data were available for 49 participants (26M/23F) age 64.7±8.1 years. The respective mean±SD for chair stand times in the high, moderate and low functioning groups in men were 6.5±0.7, 8.6±0.7, and 11.5±1.3sec and in women were 7.6±1.2, 10.0±0.5, and 12.8±1.8sec. Chair stand time (p=0.0391) and all measures of lower limb strength (all p<0.0001) differed by sex. In men, no strength measure differed between groups, whereas in women hip abductor strength on the more affected side differed between groups. In men, sagittal hip ROM (p=0.0122) differed between groups and there was a trend towards a difference in sagittal knee power (p=0.0501) during STS, while, in women, only sagittal knee ROM (p=0.0392) differed between groups. CONCLUSION(S) Higher and lower functioning adults with symptomatic knee OA appear to use different strategies when standing from a chair. Higher functioning men flexed more at the hip and produced greater knee power than lower functioning men. Higher functioning women used less knee flexion than lower functioning women. As STS is an important mobility task, these parameters may serve as foci for rehabilitation aimed at reducing mobility limitations. PMID:23063791

Segal, Neil A.; Boyer, Elizabeth R.; Wallace, Robert; Torner, James C.; Yack, H. John

2013-01-01

414

Scolopendra subspinipes mutilans attenuates neuroinflammation in symptomatic hSOD1G93A mice  

PubMed Central

Background Amyotrophic lateral sclerosis (ALS) is a progressive, adult-onset neurodegenerative disorder characterized by selective motor neuron death in the spinal cord, brainstem, and motor cortex. Neuroinflammation is one of several pathological causes of degenerating motor neurons and is induced by activated microglial cells and astrocytes in ALS. Scolopendra subspinipes mutilans (SSM) is utilized in traditional Chinese and Korean medicine for the treatment of a variety of diseases, such as cancer, apoplexy, and epilepsy. However, the mechanisms underlying the effects of SSM are currently unclear, even though SSM increases immune and antibiotic activity. Methods To determine the effects of SSM on symptomatic hSOD1G93A transgenic mice, SSM (2.5 ??/g) was injected bilaterally at the Zusanli (ST36) acupoint three times per week for two weeks. The effects of SSM treatment on anti-neuroinflammation in the brainstem and spinal cord of hSOD1G93A mice were assessed via Nissl and Fluoro-Jade B (FJB) staining, and immunohistochemistry using Iba-1, CD14, HO1, and NQO1 proteins was evaluated by Western blotting. Results In this study, we investigated whether SSM affects neuroinflammation in the spinal cord of symptomatic hSOD1G93A transgenic mice. We found that SSM treatment attenuated the loss of motor neurons and reduced the activation of microglial cells and astrocytes. Furthermore, we demonstrated that SSM administration in this animal model of ALS suppressed oxidative stress in the brainstem and spinal cord by 1.6- and 1.8-fold, respectively. Conclusions Our findings suggest that SSM, which has previously been used in complementary and alternative medicine (CAM), might also be considered as an anti-neuroinflammatory therapy for neurodegenerative diseases. PMID:24168240

2013-01-01

415

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

416

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

417

Tripod Index: Diagnostic Accuracy in Symptomatic Flatfoot and Cavovarus Foot: Part 2  

PubMed Central

Background The Tripod Index (TI) has been created to allow assessment of complex foot deformities. It utilizes tripod relationship between center of the heel, medial/lateral borders of the forefoot, and compare it to the center of the talar head. This study aimed to verify diagnostic accuracy of the TI in symptomatic flatfoot and cavovarus foot. Methods Weightbearing radiographs including foot AP with a hemispherical marker around the heel, lateral, and hindfoot alignment views were obtained on 91 patients (110 feet) presenting with medial foot and ankle pain and on 89 patients (90 feet) presenting with lateral foot and ankle pain between June 2010 and May 2011. Radiographs were evaluated blindly for the TI, AP talonavicular coverage angle, lateral talo-first metatarsal angle, calcaneal pitch angle, medial cuneiform-fifth metatarsal height, and coronal plane hindfoot alignment. The sensitivity, specificity, likelihood ratios, and predictive values were calculated. Clinically diagnosed flatfoot and cavovarus foot deformity indicated for surgical reconstruction by one of our foot and ankle orthopaedic surgeons was used as the accepted standard for diagnosis. Results In flatfoot, sensitivity of the TI was 100%, comparable with lateral talo-first metatarsal angle (100%), and medial cuneiform-fifth metatarsal height (100%). Specificity of the TI was 93%, comparable with coronal plane hindfoot alignment (98%), but superior to other parameters. Positive likelihood ratio of the TI was 14.29, which was less than coronal plane hindfoot alignment (47.5), but more than other parameters. In cavovarus foot, sensitivity of the TI was 96%, comparable with coronal plane hindfoot alignment (100%), but superior to other parameters. Specificity of the TI was 95%, comparable with lateral talo-first metatarsal angle (94%), but superior to other parameters. Positive likelihood ratio of the TI was 19.2, which was more than other parameters. Conclusion The Tripod Index showed high accuracy as a quantitative assessment in diagnosis of a symptomatic flatfoot and cavovarus foot. PMID:24027460

Arunakul, Marut; Amendola, Annunziato; Gao, Yubo; Goetz, Jessica E.; Femino, John E.; Phisitkul, Phinit

2013-01-01

418

Effects of symptomatic treatments on cutaneous hyperalgesia and laser evoked potentials during migraine attack.  

PubMed

Previously an amplitude enhancement of laser evoked potentials (LEPs) was detected during migraine attack: we further examined pain threshold to CO2 laser stimuli and LEPs during attacks, evaluating the effect of almotriptan, lysine-acetylsalicylate and placebo treatment on cutaneous hyperalgesia to thermal stimuli delivered by CO2 laser and on LEP components. Eighteen patients suffering from migraine without aura were analysed. They were divided into three groups of six patients each, randomly assigned to lysine acetyl-salicylate, almotriptan or placebo treatments. The supraorbital zones and the dorsum of the hand were stimulated on both the symptomatic and not symptomatic side in all patients. The LEPs were recorded by 25 scalp electrodes. During attacks, the P2 wave was significantly enhanced; the amplitude of the P2 component obtained by the stimulation of the supraorbital zone during the attack on the side of the headache was significantly correlated with the intensity of pain and the frequency of headache. Both almotriptan and lysine acetyl-salicylate significantly reduced the P2 amplitude but they showed no effects on hyperalgesia to laser stimulatio