Science.gov

Sample records for case series bcs

  1. Supersymmetric BCS

    NASA Astrophysics Data System (ADS)

    Barranco, Alejandro; Russo, Jorge G.

    2012-06-01

    We implement relativistic BCS superconductivity in {N} = 1 supersymmetric field theories with a U(1) R symmetry. The simplest model contains two chiral superfields with a Kähler potential modified by quartic terms. We study the phase diagram of the gap as a function of the temperature and the specific heat. The superconducting phase transition turns out to be first order, due to the scalar contribution to the one-loop potential. By virtue of supersymmetry, the critical curves depend logarithmically with the UV cutoff, rather than quadratically as in standard BCS theory. We comment on the difficulties in having fermion condensates when the chemical potential is instead coupled to a baryonic U(1) B current. We also discuss supersymmetric models of BCS with canonical Kähler potential constructed by "integrating-in" chiral superfields.

  2. Nonketotic hyperglycinemia case series

    PubMed Central

    Iqbal, Mehtab; Prasad, Manish; Mordekar, Santosh R.

    2015-01-01

    To present three cases who presented with neonatal hiccups and who were later diagnosed with nonketotic hyperglycinemia (NKH). Case series. We present three babies who presented in neonatal life with hiccups who later were diagnosed with NKH. Two babies presented on the 2nd day of life with hypotonia, poor feeding, and abnormal movements including jitteriness, hiccups, and twitching. The third baby only had transient hiccups lasting for a couple of days in the 1st week of life but later presented at 3 months of age with poor feeding, drowsiness, and jerky movements. All three cases needed extensive investigations before reaching the diagnosis including metabolic screen, lumbar puncture, electroencephalography, and computed tomography/magnetic resonance imaging. The first two babies needed intubation on their 2nd day of life because of apneas in whom later, the care was withdrawn after reaching the diagnosis of NKH because of poor prognosis. The third baby was discharged home on oral dextromethorphan and ketogenic diet. We discuss the importance of early recognition of symptoms (frequent hiccups) and investigation needed to reach the diagnosis early as it helps in making decision to either carry on treatment or withdraw care because of poor prognosis. It also helps in genetic counseling and prenatal diagnosis can be offered at the subsequent pregnancy. PMID:26962342

  3. Kleptomania: a case series.

    PubMed

    Saluja, Bharat; Chan, Lai Gwen; Dhaval, Dani

    2014-12-01

    Kleptomania is an enigmatic condition and is among the very few psychiatric disorders in which crime is medicalised and used as a legal defence. The scientific literature on kleptomania is scarce. Early literature and recent studies have shown a female preponderance, with an early age of onset of stealing in people with comorbid personality disorder(s). In a retrospective review of the case notes of theft offenders who had forensic psychiatric evaluations performed in a one-year period in 2010 at the Institute of Mental Health, Singapore, we found three patients who were diagnosed with kleptomania. In this report, we describe the pertinent clinical and sociodemographic characteristics, as well as the diagnostic issues of kleptomania in relation to the three cases.

  4. Kleptomania: a case series

    PubMed Central

    Saluja, Bharat; Chan, Lai Gwen; Dhaval, Dani

    2014-01-01

    Kleptomania is an enigmatic condition and is among the very few psychiatric disorders in which crime is medicalised and used as a legal defence. The scientific literature on kleptomania is scarce. Early literature and recent studies have shown a female preponderance, with an early age of onset of stealing in people with comorbid personality disorder(s). In a retrospective review of the case notes of theft offenders who had forensic psychiatric evaluations performed in a one-year period in 2010 at the Institute of Mental Health, Singapore, we found three patients who were diagnosed with kleptomania. In this report, we describe the pertinent clinical and sociodemographic characteristics, as well as the diagnostic issues of kleptomania in relation to the three cases. PMID:25630329

  5. Protostylid: A case series

    PubMed Central

    Nirmala, S. V. S. G.; Gaddam, Kumar Raja; Vimaladevi, P.; Nuvvula, Sivakumar

    2013-01-01

    Human jaws and teeth display a high degree of morphological individuality as they represent personal, family and population characteristics. A protostylid is a supernumerary or accessory cusp located on the mesial half of the buccal surface on the molars that may seldom pose problems while its presence may not be a cause for alarm in most instances. This case report presents a rare finding of protostylid on the buccal surface of the primary molars in 4 children. From the perspective of forensic dentistry, this morphological feature, though uncommon, may be useful for classification and identification of victims in mass causalities and bite marks on bodies or inanimate objects. PMID:24124302

  6. Gastrointestinal Behavior of Weakly Acidic BCS Class II Drugs in Man--Case Study of Diclofenac Potassium.

    PubMed

    Van Den Abeele, Jens; Brouwers, Joachim; Mattheus, Ruben; Tack, Jan; Augustijns, Patrick

    2016-02-01

    This study aimed to investigate the gastrointestinal supersaturation and precipitation behavior of a weakly acidic Biopharmaceutics Classification System (BCS) Class II drug in healthy volunteers. For this purpose, a tablet containing 50 mg diclofenac potassium (Cataflam(®)) was predissolved in 240 mL of water and this solution was subsequently orally administered to five healthy volunteers under fasted and fed state conditions with or without concomitant use of a proton-pump inhibitor (PPI) (40 mg esomeprazole, Nexiam(®)). Subsequently, total diclofenac content and dissolved intraluminal drug concentrations as well as drug thermodynamic solubility were determined in gastrointestinal aspirates. In all volunteers, gastric supersaturation resulted in precipitation of diclofenac in the stomach. The extent of precipitation correlated well with gastric pH (r = - 0.78). pH dependency of precipitation was corroborated by the absence of precipitate in the stomach after coadministration of a meal and/or a PPI. Diclofenac was found to be fully dissolved in the duodenum in all test conditions. It can be concluded that substantial pH-dependent gastric precipitation of a weakly acidic BCS Class II drug administered as a solution occurs in humans. With regard to its implications for intestinal absorption, results suggest the instantaneous redissolution of gastric drug precipitate upon transfer to the duodenum. Copyright © 2016. Published by Elsevier Inc.

  7. BCS class IV drugs: Highly notorious candidates for formulation development.

    PubMed

    Ghadi, Rohan; Dand, Neha

    2017-02-28

    BCS class IV drugs (e.g., amphotericin B, furosemide, acetazolamide, ritonavir, paclitaxel) exhibit many characteristics that are problematic for effective oral and per oral delivery. Some of the problems associated include low aqueous solubility, poor permeability, erratic and poor absorption, inter and intra subject variability and significant positive food effect which leads to low and variable bioavailability. Also, most of the class IV drugs are substrate for P-glycoprotein (low permeability) and substrate for CYP3A4 (extensive pre systemic metabolism) which further potentiates the problem of poor therapeutic potential of these drugs. A decade back, extreme examples of class IV compounds were an exception rather than the rule, yet today many drug candidates under development pipeline fall into this category. Formulation and development of an efficacious delivery system for BCS class IV drugs are herculean tasks for any formulator. The inherent hurdles posed by these drugs hamper their translation to actual market. The importance of the formulation composition and design to successful drug development is especially illustrated by the BCS class IV case. To be clinically effective these drugs require the development of a proper delivery system for both oral and per oral delivery. Ideal oral dosage forms should produce both a reasonably high bioavailability and low inter and intra subject variability in absorption. Also, ideal systems for BCS class IV should produce a therapeutic concentration of the drug at reasonable dose volumes for intravenous administration. This article highlights the various techniques and upcoming strategies which can be employed for the development of highly notorious BCS class IV drugs. Some of the techniques employed are lipid based delivery systems, polymer based nanocarriers, crystal engineering (nanocrystals and co-crystals), liquisolid technology, self-emulsifying solid dispersions and miscellaneous techniques addressing the P

  8. BCS quantum critical phenomena

    NASA Astrophysics Data System (ADS)

    Tao, Yong

    2017-06-01

    Theoretically, we recently showed that the scaling relation between the transition temperature T c and the superfluid density at zero temperature n s (0) might exhibit a parabolic pattern: Tc\\propto \\sqrt {ns(0)} (Tao Y., Sci. Rep., 6 (2016) 23863). It is significantly different from the linear scaling described by Homes' law, which is well known as a mean-field result. More recently, Božović et al. have observed such a parabolic scaling in the overdoped copper oxides with a sufficiently low transition temperature T c (Božović I. et al., Nature, 536 (2016) 309). They further point out that this experimental finding is incompatible with the standard Bardeen-Cooper-Schrieffer (BCS) description. Here we report that if T c is sufficiently low, applying the renormalization group approach into the BCS action at zero temperature will naturally lead to the parabolic scaling. Our result indicates that when T c sufficiently approaches zero, quantum fluctuations will be overwhelmingly amplified so that the mean-field approximation may break down at zero temperature.

  9. Coronary fistulas: a case series.

    PubMed

    Nada, Fennich; Fedoua, Elouali; Ghita, Saghi; Nadia, Bouzammour; Leila, Haddour; Jamila, Zarzur; Mohamed, Cherti

    2014-01-01

    Coronary artery fistula is an uncommon finding during angiographic exams. We report a case series of five patients with congenital coronary fistulas. The first patient was 56 years old and had a coronary fistula associated with a partial atrio ventricular defect, the second patient was 54 years old and had two fistulas originating from the right coronary artery with a severe atherosclerotic coronary disease, the third patient was 57 years old with a fistula originating from the circumflex artery associated with a rheumatic mitral stenosis, the fourth patient was 50 years old and had a fistulous communication between the right coronary artery and the right bronchial artery, and the last patient was 12 years old who had bilateral coronary fistulas draining into the right ventricle with an aneurismal dilatation of the coronary arteries. Angiographic aspects of coronary fistulas are various; management is controversial and depends on the presence of symptoms.

  10. Coronary Fistulas: A Case Series

    PubMed Central

    Fennich, Nada; Elouali, Fedoua; Saghi, Ghita; Bouzammour, Nadia; Haddour, Leila; Zarzur, Jamila; Cherti, Mohamed

    2014-01-01

    Coronary artery fistula is an uncommon finding during angiographic exams. We report a case series of five patients with congenital coronary fistulas. The first patient was 56 years old and had a coronary fistula associated with a partial atrio ventricular defect, the second patient was 54 years old and had two fistulas originating from the right coronary artery with a severe atherosclerotic coronary disease, the third patient was 57 years old with a fistula originating from the circumflex artery associated with a rheumatic mitral stenosis, the fourth patient was 50 years old and had a fistulous communication between the right coronary artery and the right bronchial artery, and the last patient was 12 years old who had bilateral coronary fistulas draining into the right ventricle with an aneurismal dilatation of the coronary arteries. Angiographic aspects of coronary fistulas are various; management is controversial and depends on the presence of symptoms. PMID:24501660

  11. Conventional BCS, unconventional BCS, and non-BCS hidden dineutron phases in neutron matter

    NASA Astrophysics Data System (ADS)

    Khodel, V. A.; Clark, J. W.; Shaginyan, V. R.; Zverev, M. V.

    2014-09-01

    The nature of pairing correlations in neutron matter is re-examined. Working within the conventional approximation in which the nn pairing interaction is provided by a realistic bare nn potential fitted to scattering data, it is demonstrated that the standard BCS theory fails in regions of neutron number density, where the pairing constant λ, depending crucially on density, has a non-BCS negative sign. We are led to propose a non-BCS scenario for pairing phenomena in neutron matter that involves the formation of a hidden dineutron state. In low-density neutron matter, where the pairing constant has the standard BCS sign, two phases organized by pairing correlations are possible and compete energetically: a conventional BCS phase and a dineutron phase. In dense neutron matter, where λ changes sign, only the dineutron phase survives and exists until the critical density for termination of pairing correlations is reached at approximately twice the neutron density in heavy atomic nuclei.

  12. pH-Dependent Solubility and Dissolution Behavior of Carvedilol--Case Example of a Weakly Basic BCS Class II Drug.

    PubMed

    Hamed, Rania; Awadallah, Areeg; Sunoqrot, Suhair; Tarawneh, Ola; Nazzal, Sami; AlBaraghthi, Tamadur; Al Sayyad, Jihan; Abbas, Aiman

    2016-04-01

    The objective of this study was to investigate the pH-dependent solubility and dissolution of weakly basic Biopharmaceutical Classification Systems (BCS) class II drugs, characterized by low solubility and high permeability, using carvedilol, a weak base with a pK a value of 7.8, as a model drug. A series of solubility and in vitro dissolution studies was carried out using media that simulate the gastric and intestinal fluids and cover the physiological pH range of the GI from 1.2 to 7.8. The effect of ionic strength, buffer capacity, and buffer species of the dissolution media on the solubility and dissolution behavior of carvedilol was also investigated. The study revealed that carvedilol exhibited a typical weak base pH-dependent solubility profile with a high solubility at low pH (545.1-2591.4 μg/mL within the pH range 1.2-5.0) and low solubility at high pH (5.8-51.9 μg/mL within the pH range 6.5-7.8). The dissolution behavior of carvedilol was consistent with the solubility results, where carvedilol release was complete (95.8-98.2% released within 60 min) in media simulating the gastric fluid (pH 1.2-5.0) and relatively low (15.9-86.2% released within 240 min) in media simulating the intestinal fluid (pH 6.5-7.8). It was found that the buffer species of the dissolution media may influence the solubility and consequently the percentage of carvedilol released by forming carvedilol salts of varying solubilities. Carvedilol solubility and dissolution decreased with increasing ionic strength, while lowering the buffer capacity resulted in a decrease in carvedilol solubility and dissolution rate.

  13. The BCS Bose crossover theory

    NASA Astrophysics Data System (ADS)

    Adhikari, S. K.; de Llano, M.; Sevilla, F. J.; Solís, M. A.; Valencia, J. J.

    2007-03-01

    We contrast four distinct versions of the BCS-Bose statistical crossover theory according to the form assumed for the electron-number equation that accompanies the BCS gap equation. The four versions correspond to explicitly accounting for two-hole-(2h) as well as two-electron-(2e) Cooper pairs (CPs), or both in equal proportions, or only either kind. This follows from a recent generalization of the Bose-Einstein condensation (GBEC) statistical theory that includes not boson-boson interactions but rather 2e- and also (without loss of generality) 2h-CPs interacting with unpaired electrons and holes in a single-band model that is easily converted into a two-band model. The GBEC theory is essentially an extension of the Friedberg-Lee 1989 BEC theory of superconductors that excludes 2h-CPs. It can thus recover, when the numbers of 2h- and 2e-CPs in both BE-condensed and non-condensed states are separately equal, the BCS gap equation for all temperatures and couplings as well as the zero-temperature BCS (rigorous-upper-bound) condensation energy for all couplings. But ignoring either 2h- or 2e-CPs it can do neither. In particular, only half the BCS condensation energy is obtained in the two crossover versions ignoring either kind of CPs. We show how critical temperatures Tc from the original BCS-Bose crossover theory in 2D require unphysically large couplings for the Cooper/BCS model interaction to differ significantly from the Tcs of ordinary BCS theory (where the number equation is substituted by the assumption that the chemical potential equals the Fermi energy).

  14. Biowaiver extension potential and IVIVC for BCS Class II drugs by formulation design: Case study for cyclosporine self-microemulsifying formulation.

    PubMed

    Yang, Su-Geun

    2010-11-01

    The objective of this work was to suggest the biowaiver potential of biopharmaceutical classification system (BCS) Class II drugs in self-microemulsifying drug delivery systems (SMEDDS) which are known to increase the solubility, dissolution and oral absorption of water-insoluble drugs. Cyclosporine was selected as a representative BCS Class II drug. New generic candidate of cyclosporine SMEDDS (test) was applied for the study with brand SMEDDS (reference I) and cyclosporine self-emulsifying drug delivery systems (SEDDS, reference II). Solubility and dissolution of cyclosporine from SMEDDS were critically enhanced, which were the similar behaviors with BCS class I drug. The test showed the identical dissolution rate and the equivalent bioavailability (0.34, 0.42 and 0.68 of p values for AUC₀(→)₂₄(h), C(max) and T(max), respectively) with the reference I. Based on the results, level A in vitro-in vivo correlation (IVIVC) was established from these two SMEDDS formulations. This study serves as a good example for speculating the biowaiver extension potential of BCS Class II drugs specifically in solubilizing formulation such as SMEDDS.

  15. Magnetic tuning of the relativistic BCS-BEC crossover

    NASA Astrophysics Data System (ADS)

    Wang, Jin-Cheng; de La Incera, Vivian; Ferrer, Efrain J.; Wang, Qun

    2011-09-01

    The effect of an applied magnetic field in the crossover from Bose-Einstein condensate (BEC) to Bardeen-Cooper-Schrieffer (BCS) pairing regimes is investigated. We use a model of relativistic fermions and bosons inspired by those previously used in the context of cold fermionic atoms and in the magnetic-color-flavor-locking phase of color superconductivity. It turns out that, as with cold atom systems, an applied magnetic field can also tune the BCS-BEC crossover in the relativistic case. We find that no matter what the initial state is at B=0, for large enough magnetic fields the system always settles into a pure BCS regime. In contrast to the atomic case, the magnetic field tuning of the crossover in the relativistic system is not connected to a Feshbach resonance, but to the relative numbers of Landau levels with either BEC or BCS type of dispersion relations that are occupied at each magnetic field strength.

  16. Case Citations 1991. Eleventh Series.

    ERIC Educational Resources Information Center

    Sharp, Linda A., Ed.

    Case citations from five legal areas--college students, liability on campus, sport law, employment, and employment discrimination--are presented in this document. Each section offers brief summaries of cases and concludes with a table of cases. The first section on college students examines litigation involving student finances, disciplinary…

  17. Case Citations 1991. Eleventh Series.

    ERIC Educational Resources Information Center

    Sharp, Linda A., Ed.

    Case citations from five legal areas--college students, liability on campus, sport law, employment, and employment discrimination--are presented in this document. Each section offers brief summaries of cases and concludes with a table of cases. The first section on college students examines litigation involving student finances, disciplinary…

  18. Familial Hypodontia: A Case Series.

    PubMed

    Tangade, S P; Ravishankar, T L; Batra, M; Shah, A F

    2015-01-01

    The phenomenon of congenitally missing teeth has been described with different names: hypodontia, oligodontia, anodontia, congenitally missing teeth and dental agenesis. The present paper reports familial hypodontia, involving two siblings from a single family. Case I reported the absence of 18, 12, 22 and 31 teeth whereas case II reported the absence of 31 and 41. On the evaluation of the two reported cases that were offspring of same parents and absence of any clinical features associated with any syndrome the final diagnosis of non- syndromic familial hypodontia was made. Both the cases presented agenesis of the teeth leading to malocclusion and aesthetic disturbances. Cases were offered a treatment of interdisciplinary dental approach.

  19. Nevus comedonicus: a case series.

    PubMed

    Ferrari, Bruno; Taliercio, Vanina; Restrepo, Paola; Luna, Paula; Abad, María Eugenia; Larralde, Margarita

    2015-01-01

    Twelve previously unreported cases of nevus comedonicus are presented. Characteristic closely grouped dilated follicular openings with horny plugs that mimic comedones led to the diagnosis. One patient had nevus comedonicus syndrome and there were cases with atypical locations and unusual complications of this condition. We also highlight clinical associations and therapeutic options. © 2014 Wiley Periodicals, Inc.

  20. Case Series Investigations in Cognitive Neuropsychology

    PubMed Central

    Schwartz, Myrna F.; Dell, Gary S.

    2011-01-01

    Case series methodology involves the systematic assessment of a sample of related patients, with the goal of understanding how and why they differ from one another. This method has become increasingly important in cognitive neuropsychology, which has long been identified with single-subject research. We review case series studies dealing with impaired semantic memory, reading, and language production, and draw attention to the affinity of this methodology for testing theories that are expressed as computational models and for addressing questions about neuroanatomy. It is concluded that case series methods usefully complement single-subject techniques. PMID:21714756

  1. The BCS-BEC Crossover

    NASA Astrophysics Data System (ADS)

    Parish, Meera M.

    2015-09-01

    This chapter presents the crossover from the Bardeen-Cooper-Schrieffer (BCS) state of weakly correlated pairs of fermions to the Bose-Einstein condensation (BEC) of diatomic molecules in the atomic Fermi gas. Our aim is to provide a pedagogical review of the BCS-BEC crossover, with an emphasis on the basic concepts, particularly those that are not generally known or are difficult to find in the literature. We shall not attempt to give an exhaustive survey of current research in the limited space here; where possible, we will direct the reader to more extensive reviews.

  2. Malignant otitis externa: case series.

    PubMed

    Ali, T; Meade, K; Anari, S; ElBadawey, M R; Zammit-Maempel, I

    2010-08-01

    In the light of current concerns regarding ciprofloxacin resistance and the changing face of malignant otitis externa, we reviewed cases of malignant otitis externa treated in our centre, in order both to evaluate the current epidemiology of the condition and to assess the status of drug resistance in our patient population. Retrospective case review of all malignant otitis externa cases managed in a tertiary referral centre in the north-east of England between 2000 and 2009. Forty-one patients were identified, but the required data were available for only 37 cases. Patients' ages ranged from 51 to 101 years (median, 81 years). Diabetes was present in 51 per cent of patients (19/37), facial nerve palsy in 40 per cent (15/37) and multiple cranial nerve palsy in 24 per cent (9/37). Pseudomonas aeruginosa was the most commonly isolated organism (54 per cent), sensitive to ciprofloxacin in all cases. The incidence of cranial nerve palsy in our study was higher than in previous reports. The incidence of diabetes and Pseudomonas aeruginosa in our cohort was much lower than previously reported. The Pseudomonas aeruginosa strains isolated were all sensitive to ciprofloxacin, despite recent reports on emerging resistance.

  3. Hepatic sarcoidosis: a case series

    PubMed Central

    Ennaifer, Rym; Ayadi, Shema; Romdhane, Hayfa; Cheikh, Myriam; Nejma, Houda Ben; Bougassas, Wassila; Hadj, Najet Bel

    2016-01-01

    Sarcoidosis is a systemic non caseous granulomas disease. Liver is a common location but usually asymptomatic. Evidence based guidelines for this location treatment is lacking and the effect of corticosteroids may be inadequate. The aim of our study was to describe the clinical, biochemical, radiological and therapeutic features of seven patients with systemic sarcoidosis and liver involvement. A retrospective and descriptive monocentric study, over 3 years, including seven patients with systemic sarcoidosis and liver involvement. We included 5 women and 2 men with an average age of 43 years. Hepatic localization revealed sarcoidosis in 5 cases. Hepatomegaly was observed in all patients as well as abnormal serum liver function test reflected by anicteric cholestasis. Liver biopsy, showed in all granulomatous lesions consistent with sarcoidosis and severe fibrosis in 2 cases. Extra-hepatic manifestations were present in all patients represented mainly by pulmonary location. All patients were treated, five by corticosteroid and two with ursodeoxycholic acid (UDCA). Complete response was observed in one case, partial response in another case and corticosteroid refractoriness in one case. In two cases, corticosteroid therapy was introduced for less than 1 month, not allowing assessment of response. Antimalarials in combination with UDCA were used successfully in a patient with steroid-resistant liver disease. Liver involvement can reveal systemic sarcoidois. Given the risk of progression to severe liver disease, it must be screened in all patients with systemic sarcoidosis. Treatment is not systematic, and still based on corticosteroid therapy. In the absence of prospective randomized controlled trials, the efficacy of UDCA need to be proven. PMID:27795804

  4. Hepatic sarcoidosis: a case series.

    PubMed

    Ennaifer, Rym; Ayadi, Shema; Romdhane, Hayfa; Cheikh, Myriam; Nejma, Houda Ben; Bougassas, Wassila; Hadj, Najet Bel

    2016-01-01

    Sarcoidosis is a systemic non caseous granulomas disease. Liver is a common location but usually asymptomatic. Evidence based guidelines for this location treatment is lacking and the effect of corticosteroids may be inadequate. The aim of our study was to describe the clinical, biochemical, radiological and therapeutic features of seven patients with systemic sarcoidosis and liver involvement. A retrospective and descriptive monocentric study, over 3 years, including seven patients with systemic sarcoidosis and liver involvement. We included 5 women and 2 men with an average age of 43 years. Hepatic localization revealed sarcoidosis in 5 cases. Hepatomegaly was observed in all patients as well as abnormal serum liver function test reflected by anicteric cholestasis. Liver biopsy, showed in all granulomatous lesions consistent with sarcoidosis and severe fibrosis in 2 cases. Extra-hepatic manifestations were present in all patients represented mainly by pulmonary location. All patients were treated, five by corticosteroid and two with ursodeoxycholic acid (UDCA). Complete response was observed in one case, partial response in another case and corticosteroid refractoriness in one case. In two cases, corticosteroid therapy was introduced for less than 1 month, not allowing assessment of response. Antimalarials in combination with UDCA were used successfully in a patient with steroid-resistant liver disease. Liver involvement can reveal systemic sarcoidois. Given the risk of progression to severe liver disease, it must be screened in all patients with systemic sarcoidosis. Treatment is not systematic, and still based on corticosteroid therapy. In the absence of prospective randomized controlled trials, the efficacy of UDCA need to be proven.

  5. Ureterovaginal fistula: a case series.

    PubMed

    Shaw, J; Tunitsky-Bitton, E; Barber, M D; Jelovsek, J E

    2014-05-01

    We describe the presentation, diagnosis, and management of ureterovaginal fistula over a 7-year period at a tertiary care center. A retrospective review of ureterovaginal fistula cases between 2003 and 2011 was performed. Demographic information, antecedent event, symptoms, diagnostic modalities, and management strategies were reviewed. Nineteen ureterovaginal fistulas were identified during the 7-year study period. One fistula followed a repeat cesarean section and 18 fistulas followed a hysterectomy (9 total abdominal, 6 total laparoscopic, 3 vaginal hysterectomies). Ureteral injuries were not recognized in any of the patients at the time of index surgery. Computed tomography (CT) urography was the most commonly utilized diagnostic modality (58%). Primary non-surgical management with ureteral stents was attempted and successful in 5 out of 7 cases (71%). There were 14 total surgical repairs, including 2 cases in which stents were successfully placed, but the fistula persisted, and 6 additional cases where attempted stent placement failed. Surgical repair consisted of 10 ureteroneocystostomies performed via laparotomy and 4 performed laparoscopically, 3 of which were robotically assisted. Despite being uncommon, ureterovaginal fistula should remain in the differential diagnosis of new post-operative urinary incontinence after gynecological surgery. Conservative management with ureteral stent appears to be the best initial approach in selected patients, with a success rate of 71%. Minimally invasive approaches to performing ureteroneocystostomy have high success rates, comparable to those of open surgical repair.

  6. Kartagener's syndrome: A case series

    PubMed Central

    Mishra, Mayank; Kumar, Naresh; Jaiswal, Ashish; Verma, Ajay K.; Kant, Surya

    2012-01-01

    Kartagener's syndrome is a rare, autosomal recessive genetic ciliary disorder comprising the triad of situs inversus, chronic sinusitis, and bronchiectasis. The basic problem lies in the defective movement of cilia, leading to recurrent chest infections, ear/nose/throat symptoms, and infertility. We hereby report three unusual cases of this rare entity – an infertile male with azoospermia in whom Bochdalek's diaphragmatic hernia coexisted, another case of an infertile female, and a third of an infertile male with oligospermia. The need for a high index of suspicion to make an early diagnosis cannot be overemphasized in such patients so that wherever possible, options for timely treatment of infertility may be offered and unnecessary evaluation of symptoms is avoided. PMID:23243352

  7. A Case Series: Congenital Hyperinsulinism

    PubMed Central

    Alaei, Mohammad Reza; Akbaroghli, Susan; Keramatipour, Mohammad; Alaei, Ali

    2016-01-01

    Introduction Congenital hyperinsulinism is a rare inherited disease caused by mutations in genes responsible for β-cell’s function in glucose hemostasis leading to profound and recurrent hypoglycemia. The incidence of the disease is about 1 in 50000 newborns. Mutations in at least 8 genes have been reported to cause congenital hyperinsulinism. Mutations in ABCC8 gene are the most common cause of the disease that account for approximately 40% of cases. Less frequently KCNJ11 gene mutations are responsible for the disease. Mutations in other genes such as HADH account for smaller fractions of cases. In nearly half of the cases the cause remains unknown. Case Presentation During the period between 2005 and 2010, a total of six patients with persistent hyperinsulinism were investigated at Mofid Children’s Hospital. In this study all of the patients had early onset hyperinsulinemia. Five patients had consanguineous parents. After failure of medical treatment in three patients, They were undergone pancreatectomy. Two diffuse types and one focal type had been recognized in pathological analysis of intra-operative frozen specimens of pancreas in these patients. Genetic analysis was performed using polymerase chain reaction followed by Sanger sequencing for ABCC8, KCNJ11and HADH genes. In five patients homozygous mutations in these genes were identified that indicated an autosomal recessive pattern of inheritance. In one patient a heterozygous mutation in ABCC8 was identified, indicating possible autosomal dominant inheritance of the disease. Conclusions Congenital hyperinsulinism can have different inheritance pattern. Autosomal recessive inheritance is more common but less frequently autosomal dominant inheritance can be seen. It appears that mutations in ABCC8 gene can show both autosomal recessive and autosomal dominant inheritance of the disease. PCR followed by Sanger sequencing proved to be an efficient method for mutation detection in three investigated genes

  8. Profilin desensitization: A case series.

    PubMed

    Nucera, Eleonora; Aruanno, Arianna; Rizzi, Angela; Pecora, Valentina; Patriarca, Giampiero; Buonomo, Alessandro; Mezzacappa, Simona; Schiavino, Domenico

    2016-09-01

    The role of profilin as an allergen has long been questioned. The capacity of profilin to induce respiratory symptoms has recently been demonstrated; moreover, over 50% of patients sensitized to profilin experienced symptoms after the ingestion of plant-derived foods, suggesting that profilin should be considered as a clinically relevant food allergen.We describe the cases of seven allergic patients with oral allergy syndrome and other adverse reactions after eating plant-derived food, that have been undergone to profilin desensitization treatment.The protocol started with a drop of profilin solution (50 µg/mL) diluted 1:10(18) in water until the highest dose of 10 drops of undiluted solution three times a week. At the end of the treatment we observed a decreased mean diameter of profilin wheal in skin prick test (SPT) in five of the seven participants and in profilin specific IgE values in six patients that repeated the test. Regarding basophil activation test (BAT) and the detection of IgG4, we do not have significant results because the tests have to be repeated in some patients. Regarding the double-blind placebo-controlled challenges, after about 10 months of induction phase all the patients showed tolerance to several foods that they previously did not tolerate.Moreover, the immunotherapy with profilin has proved to be safe because no serious adverse events have been reported in our patients.In summary, the results of this exploratory study of sublingual immunotherapy (SLIT) for profilin allergy show that it can be a promising therapeutic option that could modify the clinical reactivity of the patients to the intake of plant-derived food. © The Author(s) 2015.

  9. Kaposi's varicelliform eruption: A case series

    PubMed Central

    Ferrari, Bruno; Taliercio, Vanina; Luna, Paula; Abad, María Eugenia; Larralde, Margarita

    2015-01-01

    Kaposi's varicelliform eruption is a rare and potentially fatal viral infection caused mainly by reactivation of herpes simplex virus. It concomitantly occurs with pre-existing skin conditions, mostly atopic dermatitis, so it is predominately found in children. We present a case series that includes four adults, familial cases, and previously healthy patients. We also highlight clinical features, associations and therapeutic options. PMID:26753139

  10. Kaposi's varicelliform eruption: A case series.

    PubMed

    Ferrari, Bruno; Taliercio, Vanina; Luna, Paula; Abad, María Eugenia; Larralde, Margarita

    2015-01-01

    Kaposi's varicelliform eruption is a rare and potentially fatal viral infection caused mainly by reactivation of herpes simplex virus. It concomitantly occurs with pre-existing skin conditions, mostly atopic dermatitis, so it is predominately found in children. We present a case series that includes four adults, familial cases, and previously healthy patients. We also highlight clinical features, associations and therapeutic options.

  11. Neuroretinitis in ocular bartonellosis: a case series.

    PubMed

    Raihan, Abdul-Rahim; Zunaina, Embong; Wan-Hazabbah, Wan-Hitam; Adil, Hussein; Lakana-Kumar, Thavaratnam

    2014-01-01

    We report a case series of neuroretinitis in ocular bartonellosis and describe the serologic verification for Bartonella henselae. This is a retrospective interventional case series of four patients who presented in the ophthalmology clinic of Hospital Universiti Sains Malaysia from June 2012 to March 2013. All four patients had a history of contact with cats and had fever prior to ocular symptoms. Each patient presented with neuroretinitis characterized by optic disc swelling with macular star. Serology analysis showed strongly positive for B. henselae in all of the patients. All patients were treated with oral azithromycin (except case 4, who was treated with oral doxycycline), and two patients (case 1 and case 3) had poor vision at initial presentation that warranted the use of oral prednisolone. All patients showed a good visual outcome except case 3. Vision-threatening ocular manifestation of cat scratch disease can be improved with systemic antibiotics and steroids.

  12. Effect of Gastric Fluid Volume on the In Vitro Dissolution and In Vivo Absorption of BCS Class II Drugs: a Case Study with Nifedipine.

    PubMed

    Nader, Ahmed M; Quinney, Sara K; Fadda, Hala M; Foster, David R

    2016-07-01

    Nifedipine is a BCS Class II drug used for treatment of hypertension and preterm labor. Large inter-patient variability in nifedipine absorption results in variable exposure among different patients. We conducted in vitro dissolution studies to compare nifedipine dissolution from immediate release (IR) capsules with different volumes of dissolution media. Results from dissolution studies were used to design a crossover study in healthy volunteers to evaluate the effect of coadministered water volume with nifedipine 10 mg IR capsules on nifedipine pharmacokinetics, especially absorption (C max, t max, and AUC0-6). Dissolution studies demonstrated that larger gastric fluid volumes result in enhanced nifedipine dissolution from 10 mg IR cosolvent capsules (73 vs. 17% in 200 and 100 mL simulated gastric fluid, respectively, at 30 min). The pharmacokinetic crossover study in healthy volunteers (N = 6) did not show a significant effect of the water volume administered with the capsule (50 vs. 250 mL) on C max, t max, or AUC0-6 of orally administered nifedipine IR capsules (10 mg). However, administration of large water volumes resulted in lower variability in nifedipine C max (47 vs. 70% for 250 and 50 mL, respectively). Administration of large water volumes with nifedipine 10 mg IR cosolvent capsules may reduce inter-individual variability in plasma exposure. Evaluation of similar effects in other BCS Class II drugs is recommended.

  13. Effect of Gastric Fluid Volume on the in Vitro Dissolution and in Vivo Absorption of BCS Class II Drugs: A Case Study with Nifedipine

    PubMed Central

    Nader, Ahmed M.; Quinney, Sara K.; Fadda, Hala M.; Foster, David R.

    2016-01-01

    Introduction Nifedipine is a BCS Class II drug used for treatment of hypertension and preterm labor. Large inter-patient variability in nifedipine absorption results in variable exposure among different patients. Methods and Materials We conducted in vitro dissolution studies to compare nifedipine dissolution from immediate release (IR) capsules with different volumes of dissolution media. Results from dissolution studies were used to design a cross-over study in healthy volunteers to evaluate the effect of co-administered water volume with nifedipine 10 mg IR capsules on nifedipine pharmacokinetics, especially absorption (Cmax, tmax, and AUC0–6). Results and Discussion Dissolution studies demonstrated that larger gastric fluid volumes result in enhanced nifedipine dissolution from 10 mg IR cosolvent capsules (73% vs. 17% in 200 and 100 mL simulated gastric fluid, respectively, at 30 min). The pharmacokinetic crossover study in healthy volunteers (N=6) did not show a significant effect of the water volume administered with the capsule (50 vs. 250 ml) on Cmax, tmax, or AUC0–6 of orally administered nifedipine IR capsules (10 mg). However, administration of large water volumes resulted in lower variability in nifedipine Cmax (47% vs.70% for 250 mL and 50 mL, respectively). Conclusion Administration of large water volumes with nifedipine 10 mg IR cosolvent capsules reduces inter-individual variability in plasma exposure. Evaluation of similar effects in other BCS Class-II drugs is recommended. PMID:27106837

  14. Cancer patients treated with the Banerji protocols utilising homoeopathic medicine: a Best Case Series Program of the National Cancer Institute USA.

    PubMed

    Banerji, Prasanta; Campbell, Donald R; Banerji, Pratip

    2008-07-01

    Although many studies have been conducted on the role of alternative medicine in the treatment of cancer, only a few reports have been published regarding the total regression of malignant tumors. At the PBH Research Foundation (PBHRF), two of the authors have used homoeopathic therapy to treat many patients with various malignant tumors. The objective of the present study was to have their treatment procedures evaluated and validated by the United States (US) National Cancer Institute (NCI) Best Case Series (BCS) Program. Lung and oesophageal carcinoma patients were treated with homoeopathic remedies at the PBHRF according to Banerji's protocol until there was complete regression of the tumors. Case records including pathology and radiology reports for 14 patients were submitted for review by the US NCI BCS Program. Four of these cases had an independent confirmation of the diagnosis and radiographic response and were accepted as sufficient information for the NCI to initiate further investigation. These four cases are presented in detail in this report along with follow-up and outcome information. This study describes the process and outcome of a selected case series review through the NCI BCS Program. The results of the review were deemed to be sufficient to warrant NCI-initiated prospective research follow-up in the form of an observational study.

  15. Transvestism as a Symptom: A Case Series

    PubMed Central

    Anupama, M.; Gangadhar, K. H.; Shetty, Vandana B.; Dip, P. Bhadja

    2016-01-01

    Transvestism, commonly termed as cross-dressing, means to dress in the clothing of opposite sex. We describe a series of three cases with transvestism as one of their primary complaints. The discussion sheds light on the various ways in which transvestism as a symptom can present in Psychiatry. In the first two cases, there was lower intelligence. In first and third case, there were other paraphilia along with transvestism. Second case had co-morbid obsessive-compulsive disorder (OCD) and had good response to selective serotonin reuptake inhibitor (SSRI). PMID:27011411

  16. Management of velopharyngeal disorders. A case series.

    PubMed

    Anandakrishna, G N; Gali, Sivaranjani

    2010-07-01

    Patients with acquired defects or congenital malformations of the palate exhibit disturbances in speech, including hypernasality, nasal emission, and decreased intelligibility of speech. Maxillofacial prosthetic treatment can reestablish the palatopharyngeal integrity to provide the potential for acceptable speech. This article describes a case series of patients with palatopharyngeal disorders and their treatment approaches.

  17. Challenges in regenerative endodontics: a case series.

    PubMed

    Petrino, Joseph A; Boda, Kendra K; Shambarger, Sandra; Bowles, Walter R; McClanahan, Scott B

    2010-03-01

    An immature tooth with pulpal necrosis and apical periodontitis presents a unique challenge to the endodontist. Endodontic treatment options consist of apexification, apical barriers, or more recently, revascularization. The purpose of this case series is to report three cases that used revascularization protocol as described by Banchs and Trope. Each case presented its own special circumstances and challenges. The lessons learned from each case provided guidance for more predictable outcomes on subsequent cases. Six immature teeth with apical periodontitis (in three patients) were treated via the revascularization protocol using irrigants, a triple antibiotic paste, and a coronal seal of mineral trioxide aggregate and composite. For follow-up, all six teeth showed resolution of periapical radiolucencies, whereas three of six teeth showed continued root development. Two teeth displayed a positive response to vitality testing. Results from this case series show that revascularization is a technically challenging but effective treatment modality for the immature tooth with apical periodontitis. Based on this case series, the following recommendations are made to help with the revascularization technique: (1) clinicians should consider the use of an anesthetic without a vasoconstrictor when trying to induce bleeding, (2) a collagen matrix is useful for the controlled placement of MTA to a desired and optimal level, (3) patients/parents should be informed about the potential for staining, especially in anterior teeth when the paste contains minocycline, and (4) patient/parent compliance with the necessary multiple appointment treatment plan may be significant for case selection. Copyright (c) 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  18. Common Carotid Artery Occlusion: A Case Series

    PubMed Central

    Bajkó, Zoltán; Bălaşa, Rodica; Moţăţăianu, Anca; Maier, Smaranda; Chebuţ, Octavia Claudia; Szatmári, Szabolcs

    2013-01-01

    Subjects and Methods. We analysed 5000 cerebrovascular ultrasound records. A total of 0.4% of the patients had common carotid artery occlusion (CCAO). Results. The mean age was 59.8 ± 14.2 years, and the male/female ratio was 2.33. The most frequent risk factors were hypertension, ischaemic heart disease, dyslipidemia, diabetes mellitus, and smoking. Right-sided and left-sided CCAO occurred in 65% and 30% of the cases, respectively, and bilateral occlusion was detected in one case (5%). Patent bifurcation was observed in 10 cases of CCAO in which the anterograde flow in the ICA was maintained from the external carotid artery with reversed flow. In two of the cases, the occluded CCA was hypoplastic. The aetiology of CCAO in the majority of cases was the atherosclerosis (15 cases). The male/female ratio was higher in the patients with occluded distal vessels, and the short-term outcome was poorer. Only two cases from this series underwent revascularisation surgery. Spontaneous recanalisation was observed in one case. Conclusions. The most frequent cause of CCAO was atherosclerosis. The outcome is improved in the cases with patent distal vessels, and spontaneous recanalisation is possible. Treatment methods have not been standardised. Surgical revascularisation is possible in cases of patent distal vessels, but the indications are debatable. PMID:24167740

  19. Budd-chiari syndrome causing acute liver failure: A multicenter case series.

    PubMed

    Parekh, Justin; Matei, Vlad M; Canas-Coto, Alejandro; Friedman, Daniel; Lee, William M

    2017-02-01

    Budd-Chiari syndrome (BCS) is a rare disease resulting from obstruction of the hepatic venous outflow tract that typically presents with abdominal pain, jaundice, and ascites without frank liver failure. However, BCS may also evolve more rapidly to acute liver failure (ALF). In this study, we describe the clinical features, treatment, and outcomes of ALF due to BCS and compare our results with those in the published literature. Twenty of the 2344 patients enrolled in the Acute Liver Failure Study Group (ALFSG) registry since 1998 presented with a clinical diagnosis of BCS. An additional 19 patients of ALF-BCS in the English language literature were reviewed and compared with the ALFSG cases. Most ALF-BCS patients were white (84%) and female (84%) in their fourth decade. A hypercoagulable state was noted in 63% of patients. BCS was diagnosed by Doppler ultrasonography or abdominal computed tomography in all patients. Liver biopsies (n = 6) all had evidence of severe pericentral necrosis. Treatments used included most commonly anticoagulation (71%), but also transjugular intrahepatic portosystemic shunt (TIPS; 37%) and orthotopic liver transplantation (37%). In-hospital mortality was approximately 60%. In conclusion, BCS is a rare cause of ALF and mandates prompt diagnosis and management for successful outcomes. Once the diagnosis is confirmed, prompt anticoagulation is recommended in conjunction with evaluation for malignancy or thrombophilic disorder. Mortality may have improved in recent years with use of TIPS and/or orthotopic liver transplantation compared with prior published reports. Liver Transplantation 23 135-142 2017 AASLD.

  20. BCS theory with the external pair potential

    NASA Astrophysics Data System (ADS)

    Grigorishin, Konstantin V.

    2017-09-01

    We consider a hypothetical substance, where interaction between (within) structural elements of condensed matter (molecules, nanoparticles, clusters, layers, wires etc.) depends on state of Cooper pairs: an additional work must be made against this interaction to break a pair. Such a system can be described by BCS Hamiltonian with the external pair potential term. In this model the potential essentially renormalizes the order parameter: if the pairing lowers energy of the structure the energy gap is slightly enlarged at zero temperature and asymptotically tends to zero as temperature rises. Thus the critical temperature of such a superconductor is equal to infinity formally. For this case the effective Ginzburg-Landau theory is formulated, where the coherence length decreases as temperature rises, the GL parameter and the second critical field are increasing functions of temperature unlike the standard theory. If the pairing enlarges energy of the structure then suppression of superconductivity and the first order phase transition occur.

  1. Glomus Tumors in the Foot: Case Series.

    PubMed

    Trehan, Samir K; Soukup, Dylan S; Mintz, Douglas N; Perino, Giorgio; Ellis, Scott J

    2015-12-01

    Glomus tumors are painful, benign neoplasms that frequently are associated with delayed diagnosis. Commonly in the hand, they rarely present in the foot. The purpose of this case series is to characterize the clinical presentation, radiology, pathology, and surgical outcomes associated with foot glomus tumors. We reviewed our pathology database for patients with foot glomus tumors diagnosed between 1995 and 2013. Medical records including physician notes, pathology, and radiology were reviewed. Eleven patients had foot glomus tumors excised at our institution during the study period. The mean age was 45.4 (range = 28-60) years. One patient was lost to follow-up. Mean follow-up for the remaining 10 patients was 44.7 (range = 3-142) months. Ten tumors were located in the subungual region, while 1 was located in the plantar pulp of the distal phalanx. All patients presented with pain. Point tenderness, cold hypersensitivity, and nail abnormalities were variably documented but frequently present. Four patients had had prior surgery for an ingrown toenail prior to presentation at our institution. Six patients had preoperative magnetic resonance imaging studies, which were diagnostic of glomus tumor in all cases except one. Radiographs failed to provide diagnosis in all 8 patients for whom they were obtained. Postoperatively, all patients had complete symptom relief with no recurrences.In conclusion, this case series demonstrates that foot glomus tumors frequently present with classic symptoms including pain, point tenderness, and cold hypersensitivity. When clinically suspected, magnetic resonance imaging should be obtained. Marginal excision results in symptom relief and cure. Therapeutic, Level IV: Case series. © 2015 The Author(s).

  2. Quantitative prediction of formulation-specific food effects and their population variability from in vitro data with the physiologically-based ADAM model: a case study using the BCS/BDDCS Class II drug nifedipine.

    PubMed

    Patel, Nikunjkumar; Polak, Sebastian; Jamei, Masoud; Rostami-Hodjegan, Amin; Turner, David B

    2014-06-16

    Quantitative prediction of food effects (FE) upon drug pharmacokinetics, including population variability, in advance of human trials may help with trial design by optimising the number of subjects and sampling times when a clinical study is warranted or by negating the need for conduct of clinical studies. Classification and rule-based systems such as the BCS and BDDCS and statistical QSARs are widely used to anticipate the nature of FE in early drug development. However, their qualitative rather than quantitative nature makes them less appropriate for assessing the magnitude of FE. Moreover, these approaches are based upon drug properties alone and are not appropriate for estimating potential formulation-specific FE on modified or controlled release products. In contrast, physiologically-based mechanistic models can consider the scope and interplay of a range of physiological changes after food intake and, in combination with appropriate in vitro drug- and formulation-specific data, can make quantitative predictions of formulation-specific FE including the inter-individual variability of such effects. Herein the Advanced Dissolution, Absorption and Metabolism (ADAM) model is applied to the prediction of formulation-specific FE for BCS/BDDCS Class II drug and CYP3A4 substrate nifedipine using as far as possible only in vitro data. Predicted plasma concentration profiles of all three studied formulations under fasted and fed states are within 2-fold of clinically observed profiles. The % prediction error (%PE) in fed-to-fasted ratio of Cmax and AUC were less than 5% for all formulations except for the Cmax of Nifedicron (%PE=-29.6%). This successful case study should help to improve confidence in the use of mechanistic physiologically-based models coupled with in vitro data for the anticipation of FE in advance of in vivo studies. However, it is acknowledged that further studies with drugs/formulations exhibiting a wide range of properties are required to further

  3. Neuroblastoma and pediatric delirium: a case series.

    PubMed

    Traube, Chani; Augenstein, Julie; Greenwald, Bruce; LaQuaglia, Michael; Silver, Gabrielle

    2014-06-01

    Delirium occurs frequently in critically ill children, and children with neuroblastoma may be at particular risk. Early diagnosis and treatment may improve short- and long-term outcomes. In this case series, we present four critically ill children with neuroblastoma who were diagnosed with delirium in the post-operative period. In all four patients, the diagnosis of delirium facilitated targeted intervention and improvement. Heightened awareness by pediatric oncologists, surgeons, and intensivists may lead to earlier diagnosis and improvement in clinical outcomes. © 2013 Wiley Periodicals, Inc.

  4. Pseudocirrhosis: A Case Series and Literature Review

    PubMed Central

    Adike, Abimbola; Karlin, Nina; Menias, Christine; Carey, Elizabeth J.

    2016-01-01

    Pseudocirrhosis describes morphological changes of the liver that closely mimic cirrhosis, without the typical histopathological changes seen in cirrhosis. It most commonly occurs in patients with metastatic breast cancer, although it has been reported in other malignancies as well. Like in cirrhosis, portal hypertension is often seen in patients with pseudocirrhosis. Pseudocirrhosis is a rare but important complication of metastatic cancer. In this case series and literature review, we describe 6 patients with hormone-receptor-positive metastatic breast cancer. We report the significant morbidity associated with pseudocirrhosis in the course of treatment in patients with metastatic breast cancer. PMID:27721722

  5. Neuromusculoskeletal disorders following SARS: a case series

    PubMed Central

    Stainsby, Brynne; Howitt, Scott; Porr, Jason

    2011-01-01

    Objective: To detail the presentation of three health care workers diagnosed with sudden acute respiratory syndrome (SARS) who later presented to a CMCC teaching clinic with neuromusculoskeletal sequelae and underwent conservative treatments. This case series aims to inform practitioners of the potential pathogenesis of these neuromuscular complaints and describes their treatment in a chiropractic practice. Clinical Features: Three patients presented with a variety of neurological, muscular and joint findings. Conservative treatment was aimed at decreasing hypertonic muscles, increasing joint mobility, and improving ability to perform activities of daily living. Intervention and Outcome: The conservative treatment approach utilized in these cases involved spinal manipulative therapy, soft tissue therapy, modalities, and rehabilitation. Outcome measures included subjective pain ratings, disability indices, and return to work. Conclusion: Three patients previously diagnosed with SARS presented with neuromusculoskeletal complaints and subjectively experienced intermittent relief of pain and improvement in disability status after conservative treatments. PMID:21403780

  6. Whale's tail technique: A case series

    PubMed Central

    Mrunal, Deshpande Milind; Jaypal, Jarde Samiksha; Wilson, Rohan Srinivasan; Chatterjee, Anirban

    2016-01-01

    The Whale's tail technique performed to obtain maximum interdental papilla fill in the anterior region after placement of bone grafts. This study aims to assess the clinical efficacy of this new technique. This report describes a series of three cases with a probing depth of 6–7 mm in the maxillary anterior teeth and their treatment with Whale's tail technique to obtain regeneration and maximum papilla preservation. The cases in this report showed a pocket depth reduction of 3-4mm and a clinical attachment gain of 3-4mm. The application of the “Whale's tail” flap leads to clinically significant improvement of hard and soft tissue conditions and allows regeneration of wide intrabony defects involving the maxillary anterior teeth with notable interdental diastemas, maintaining interproximal tissue to recreate a functional attachment with esthetic results. PMID:28298831

  7. Ictal swearing: a case series and review.

    PubMed

    Birca, Veronica; Tayah, Tania; Saint-Hilaire, Jean-Marc; Nguyen, Dang Khoa

    2013-12-01

    Seizures can manifest with ictal swearing but few studies have investigated the localising value of this epileptic manifestation. In this case series and review of the literature, we attempted to determine whether ictal swearing could help localise the epileptic focus. We review two previously published cases and report eight additional epileptic patients with ictal swearing for whom the epileptic focus was determined based on clinical, structural, electrophysiological, and surgical outcome data. Results indicated that ictal swearing occurs more commonly in male subjects and lateralises to the non-dominant hemisphere, but has poor localisation value, arising either from the frontal, parietal, temporal or occipital lobes in different patients. We discuss the significance of these findings. [Published with video sequences].

  8. Neuromusculoskeletal disorders following SARS: a case series.

    PubMed

    Stainsby, Brynne; Howitt, Scott; Porr, Jason

    2011-03-01

    To detail the presentation of three health care workers diagnosed with sudden acute respiratory syndrome (SARS) who later presented to a CMCC teaching clinic with neuromusculoskeletal sequelae and underwent conservative treatments. This case series aims to inform practitioners of the potential pathogenesis of these neuromuscular complaints and describes their treatment in a chiropractic practice. Three patients presented with a variety of neurological, muscular and joint findings. Conservative treatment was aimed at decreasing hypertonic muscles, increasing joint mobility, and improving ability to perform activities of daily living. The conservative treatment approach utilized in these cases involved spinal manipulative therapy, soft tissue therapy, modalities, and rehabilitation. Outcome measures included subjective pain ratings, disability indices, and return to work. Three patients previously diagnosed with SARS presented with neuromusculoskeletal complaints and subjectively experienced intermittent relief of pain and improvement in disability status after conservative treatments.

  9. Acute paediatric paraplegia: a case series review.

    PubMed

    Sharpe, Abigail N; Forsyth, Rob

    2013-11-01

    Paediatric paraplegia resulting from spinal cord pathology of any cause is rare; hence prognostic information for children less than 16 years is limited. This case series review aims to ascertain all cases of paediatric paraplegia from 1997 to 2012 in the former Northern Region of England. Children presenting with sudden paraplegia before the age of 16 years were multiply ascertained from databases in the regional paediatric neurology, neuroradiology, neuro-oncology and adult spinal injuries units. Data were obtained from retrospective case note review. A total of 44 cases (24 female) were identified. The incidence is estimated at 0.49 per 100,000 children under 16/year (95% confidence interval 0.41-0.57). Mean age of onset was 8.8 years and the most common aetiology was inflammatory. Twelve months post presentation, mortality was zero and a good outcome (defined as Gross Motor Function Classification System grades I or II) was seen in 66.6%. Motor outcome at 12 months was associated with the presence of bladder/bowel signs at presentation, previous viral illness and initial severity of paraplegia. Bladder signs at presentation were the strongest predictor of prognosis (OR for poor motor outcome 10.3). We were unable to demonstrate a relationship between aetiology and late outcome. Paediatric paraplegia is rare. Mortality rates are low and 66.6% have a good outcome with fully or nearly independent walking. Bladder signs are the strongest predictor of prognosis. Copyright © 2013 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  10. Nuclear Magnetic Resonance and the BCS Theory

    NASA Astrophysics Data System (ADS)

    Slichter, Charles P.

    The author describes the inspiration for the experiment by Hebel and Slichter to measure the nuclear spin-lattice relaxation time in super-conductors, the design considerations for the experiment, the surprising experimental results, their theoretical treatment using the Bardeen-Cooper-Schrieffer theory, and how comparing the nuclear relaxation results with those for ultrasound absorption confirmed the central idea of the BCS theory, the BCS pair wave function.

  11. BCS versus Overhauser pairing in dense (2+1)-dimensional QCD

    SciTech Connect

    Jaikumar, Prashanth; Zahed, Ismail

    2001-07-01

    We compare the BCS and Overhauser effect as competing mechanisms for the destabilization of the quark Fermi surface at an asymptotically large chemical potential, for the special case of 2 space and 1 time dimensions. We use the framework of perturbative one-gluon exchange, which dominates the pairing at {mu}/g{sup 2}{much_gt}1. With screening in matter, we show that in the weak coupling limit the Overhauser effect can compete with the BCS effect only for a sufficiently large number of colors. Both the BCS and the Overhauser gaps are of order g{sup 4}/{mu} in the Landau gauge.

  12. SUDEP: The First Case Series in Turkey

    PubMed Central

    GÜNGÖR, Mesut; ACAR ARSLAN, Elif; TEZER FİLİK, Fadime İrsel; SAYGI, Serap

    2016-01-01

    Introduction Sudden unexpected death in epilepsy (SUDEP) is defined as the sudden, unexpected, witnessed or unwitnessed, non-traumatic, and non-drowning death of patients with epilepsy with or without evidence of a seizure, excluding documented status epilepticus, and in whom postmortem examinations do not reveal a toxicological or anatomic cause for death. In this study, data on patients who passed away under observation in the epilepsy clinic due to sudden, unexpected death have been compiled, and we also aim to emphasize the importance of SUDEP in Turkey. Methods This study was performed with a total of nine cases. Data were obtained from hospital records, information given by the families of patients, the database of the General Directorate for Civil Services of the Ministry of Internal Affairs of Turkey, and from the Ankara Metropolitan Municipality Cemetery Information System. As the basis of classification and definition, the proposals suggested by Nashef et al., which were made to the International League Against Epilepsy (ILAE) in 2011, were taken into consideration. Results Eight of the patients were classified as probable SUDEP and one of them as possible SUDEP; the mean age at SUDEP was 33 years, and the average follow-up period was 19.7 years. In these cases, except for known risk factors (generalized tonic–clonic seizures, nocturnal seizures, severe epilepsy, more frequent seizures, younger age at the onset of epilepsy, unwitnessed seizures, polytherapy, and mental handicap), a different risk factor was not identified Conclusion This study is the first case series on SUDEP in Turkey. Postmortem studies are the most important shortcoming of the study. However, the importance of the topic is highlighted by presenting the available data. SUDEP deserves more attention during the daily practice of neurologists, pediatric neurologists, forensic physicians, and family physicians. If death is sudden and unexpected in a patient with epilepsy, SUDEP should be

  13. Good Early Results Obtained with a Guided-Motion Implant for Total Knee Arthroplasty: A Consecutive Case Series

    PubMed Central

    Hommel, Hagen; Wilke, Kai

    2017-01-01

    Background: Previous studies have shown a high incidence of complications with a bi-cruciate stabilized (BCS) guided-motion total knee arthroplasty (TKA) design, which led to recent modifications of the design by the manufacturer. Objective: The current study was undertaken to assess whether the use of this TKA system with an extension-first surgical technique is associated with a similar rate of short-term adverse outcome as reported in literature. Material and Methods: This retrospective study enrolled 257 consecutive patients (257 knees) undergoing TKA for osteoarthritis of the knee, with the first 153 receiving cemented Journey BCS I implants and the remaining 104 receiving cemented Journey BCS II implants when these became available. Results: Mean follow-up time for the cohort was 24.5 ± 7.8 months (range, 12 - 36 months). There were no cases of stiffness. Incidence of iliotibial friction syndrome was considered low: three (2.0%) knees in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). Five (2.5%) knees presented with mild instability in midflexion, three (2.0%) in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). One patient with a BCS I implant required reoperation for aseptic loosening 23 months postoperatively. At one-year follow-up, there were no clinically relevant differences in any of the clinical outcomes. Conclusion: When used in combination with an extension-first surgical technique, good early functional results with an acceptable rate of complications were obtained with both the original and the updated Journey BCS knee implant. PMID:28400873

  14. Pediatric temporal bone fractures: A case series.

    PubMed

    Waissbluth, S; Ywakim, R; Al Qassabi, B; Torabi, B; Carpineta, L; Manoukian, J; Nguyen, L H P

    2016-05-01

    Temporal bone fractures are relatively common findings in patients with head trauma. The aim of this study was to evaluate the characteristics of temporal bone fractures in the pediatric population. Retrospective case series. Tertiary care pediatric academic medical center. The medical records of patients aged 18 years or less diagnosed with a temporal bone fracture at the Montreal Children's Hospital from January 2000 to August 2014 were reviewed. Patient demographics, clinical presentation, mechanism of injury and complications were analyzed. Imaging studies and audiograms were also evaluated. Out of 323 patients presenting to the emergency department with a skull fracture, 61 presented with a temporal bone fracture. Of these, 5 presented with bilateral fractures. 47 patients had associated fractures, and 3 patients deceased. We observed a male to female ratio of 2.8:1, and the average age was 9.5 years. Motor vehicle accidents were the primary mechanism of injury (53%), followed by falls (21%) and bicycle or skateboard accidents (10%). The most common presenting signs included hemotympanum, decreased or loss of consciousness, facial swelling and nausea and vomiting. 8 patients had otic involvement on computed tomography scans, and 30 patients had documented hearing loss near the time of accident with a majority being conductive hearing loss. 17 patients underwent surgical management of intracranial pressure. In children, fractures of the temporal bone were most often caused by motor vehicle accidents and falls. It is common for these patients to have associated fractures. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Facial firework injury: a case series.

    PubMed

    Tadisina, Kashyap K; Abcarian, Ariane; Omi, Ellen

    2014-07-01

    Fireworks are used to celebrate a variety of religious, patriotic, and cultural holidays and events around the world. Fireworks are common in the United States, with the most popular holiday for their use being national Independence Day, also known as July Fourth. The use of fireworks within the context of celebrations and holidays presents the ideal environment for accidents that lead to severe and dangerous injuries. Injuries to the face from explosions present a challenging problem in terms of restoring ideal ocular, oral, and facial function. Despite the well documented prevalence of firework use and injury, there is a relatively large deficit in the literature in terms of firework injury that involves the face. We present a unique case series that includes 4 adult male patients all with severe firework injuries to the face that presented at an urban level 1 trauma center. These four patients had an average age of 26.7 years old and presented within 5 hours of each other starting on July Fourth. Two patients died from their injuries and two patients underwent reconstructive surgical management, one of which had two follow up surgeries. We explore in detail their presentation, management, and subsequent outcomes as an attempt to add to the very limited data in the field of facial firework blast injury. In addition, the coincidence of their presentation within the same 5 hours brings into question the availability of the fireworks involved, and the possibility of similar injuries related to this type of firework in the future.

  16. Treatment of gingival pigmentation: a case series.

    PubMed

    Deepak, Prasad; Sunil, S; Mishra, R; Sheshadri

    2005-01-01

    A smile expresses a feeling of joy, success, sensuality, affection and courtesy, and reveals self confidence and kindness. The harmony of the smile is determined not only by the shape, the position and the color of the teeth but also by the gingival tissues. Gingival health and appearance are essential components of an attractive smile. Gingival pigmentation results from melanin granules, which are produced by melanoblasts. The degree of pigmentation depends on melanoblastic activity. Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, complaints of 'black gums' are common particularly in patients having a very high smile line (gummy smile). For depigmentation of gingiva different treatment modalities have been reported like- Bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery and laser. In the present case series bur abrasion, scraping, partial thickness flap (epithelial excision) cryotherapy and electrosurgery have been tried for depigmentation, which are simple, effective and yield good results, along with good patient satisfaction. The problems encountered with some of these techniques have also been discussed.

  17. Facial Firework Injury: A Case Series

    PubMed Central

    Tadisina, Kashyap Komarraju; Abcarian, Ariane; Omi, Ellen

    2014-01-01

    Fireworks are used to celebrate a variety of religious, patriotic, and cultural holidays and events around the world. Fireworks are common in the United States, with the most popular holiday for their use being national Independence Day, also known as July Fourth. The use of fireworks within the context of celebrations and holidays presents the ideal environment for accidents that lead to severe and dangerous injuries. Injuries to the face from explosions present a challenging problem in terms of restoring ideal ocular, oral, and facial function. Despite the well documented prevalence of firework use and injury, there is a relatively large deficit in the literature in terms of firework injury that involves the face. We present a unique case series that includes 4 adult male patients all with severe firework injuries to the face that presented at an urban level 1 trauma center. These four patients had an average age of 26.7 years old and presented within 5 hours of each other starting on July Fourth. Two patients died from their injuries and two patients underwent reconstructive surgical management, one of which had two follow up surgeries. We explore in detail their presentation, management, and subsequent outcomes as an attempt to add to the very limited data in the field of facial firework blast injury. In addition, the coincidence of their presentation within the same 5 hours brings into question the availability of the fireworks involved, and the possibility of similar injuries related to this type of firework in the future. PMID:25035740

  18. Dance-related concussion: a case series.

    PubMed

    Stein, Cynthia J; Kinney, Susan A; McCrystal, Tara; Carew, Elizabeth A; Bottino, Nicole M; Meehan Iii, William P; Micheli, Lyle J

    2014-01-01

    Sport-related concussion is a topic of increasing public and media attention; the medical literature on this topic is growing rapidly. However, to our knowledge no published papers have described concussion specifically in the dancer. This case series involved a retrospective chart review at a large teaching hospital over a 5.5-year period. Eleven dancers (10 female, 1 male) were identified who experienced concussions while in dance class, rehearsal, or performance: 2 in classical ballet, 2 in modern dance, 2 in acro dance, 1 in hip hop, 1 in musical theater, and 3 were unspecified. Dancers were between 12 and 20 years old at the time of presentation. Three concussions occurred during stunting, diving, or flipping. Three resulted from unintentional drops while partnering. Two followed slips and falls. Two were due to direct blows to the head, and one dancer developed symptoms after repeatedly whipping her head and neck in a choreographed movement. Time to presentation in the sports medicine clinic ranged from the day of injury to 3 months. Duration of symptoms ranged from less than 3 weeks to greater than 2 years at last documented follow-up appointment. It is concluded that dancers do suffer dance-related concussions that can result in severe symptoms, limitations in dance participation, and difficulty with activities of daily living. Future studies are needed to evaluate dancers' recognition of concussion symptoms and care-seeking behaviors. Additional work is also necessary to tailor existing guidelines for gradual, progressive, safe return to dance.

  19. Methamphetamine body stuffers: an observational case series.

    PubMed

    West, Patrick L; McKeown, Nathanael J; Hendrickson, Robert G

    2010-02-01

    We describe the demographics, characteristics, treatment, and clinical course of methamphetamine body stuffers. We also determine the clinical characteristics of methamphetamine body stuffers who have severe outcomes. A 6.5-year descriptive nonconcurrent observational case series evaluated methamphetamine body stuffers about whom the Oregon Poison Center was consulted by their primary physicians. Poison center charts were supplemented by completed hospital charts (for 95% of patients). Six hundred forty-eight patients with methamphetamine exposure were identified and reviewed, and 55 charts met the criteria for "methamphetamine body stuffer." We found the following characteristics of methamphetamine body stuffers: mean age 29 years (range 16 to 57 years), men in 44 of 55 cases (80%), mean time to arrival 2.7 hours after ingestion, with a median of 1 hour after ingestion. Ninety-seven percent (53/55) stuffed methamphetamine orally (2/55 rectally). Methamphetamine was most frequently swallowed in baggies, but 25% were unpackaged. The median dose ingested was 3.5 g of methamphetamine in 1 package. Outcome-based analysis revealed 29% (16/55) of patients had severe outcomes, as defined by end-organ toxicity, with agitation requiring intubation the most common severe outcome. There was 1 death reported. Toxicity did not appear to be related to the amount of methamphetamine or number of packets. Patients with severe outcomes had higher mean initial pulse rates and temperatures. Eighty-eight percent (14/16) of patients with severe outcomes had a presenting pulse rate greater than 120 beats/min or a temperature greater than 38 degrees C versus 18% (7/39) patients with a benign outcome. Twenty-four radiographic studies were obtained; none detected packets. Methamphetamine body stuffers have similar demographics to those of body stuffers of other stimulants, but tended to ingest fewer baggies with larger masses, and had a higher percentage of severe outcomes (29%) than

  20. Agitation Rate and Time for Complete Dissolution in BCS Biowaivers Based on Investigation of a BCS Biowaiver for Dexketoprofen Tablets.

    PubMed

    Garcia-Arieta, Alfredo; Gordon, John; Gwaza, Luther; Mangas-Sanjuan, V; Álvarez, Covadonga; Torrado, Juan J

    2015-09-08

    The objective of the present work is to investigate the validity of the existing requirements for BCS biowaivers of immediate release products containing a class I drug in relation to the agitation rate (50 or 75 rpm in the paddle apparatus) and the time limit for complete dissolution (30 min) in the current biowaivers in vitro dissolution tests. Further, the possibility of extensions will be examined since it has been proposed that the time limit for complete dissolution should be revised to 60 min, and also, if cone formation occurs with apparatus 2 at 50 rpm, then a higher agitation rate is acceptable to eliminate it. The development of four generic dexketoprofen immediate release tablets is described. Dexketoprofen is the eutomer of ketoprofen. According to the BCS, dexketoprofen is a class I drug. Three out of the four products failed to show bioequivalence for Cmax in the initial bioequivalence study conducted with the product despite similar but nonrapid dissolution profiles at 50 rpm in the paddle apparatus, or similar and very rapid dissolution profiles at 75 rpm. In conclusion, these data indicate that BCS biowaivers for class I drugs should be granted only when dissolution with the paddle apparatus is complete in 30 min at 50 rpm. The time limit for complete dissolution should not be extended to 60 min. Furthermore, the agitation rate should not be increased to 75 rpm, even in the case of a coning effect.

  1. Case Citations 1992. Thirteenth Series: Pupils.

    ERIC Educational Resources Information Center

    Hartmeister, Fred, Ed.

    Court case citations are organized in six major sections with brief summaries of relevant cases in subcategories followed by a table of cases cited. The major sections are as follows: (1) "Extended School Year (ESY) Services and Disabled Students" (Susan S. Schermerhorn); (2) "Recent Developments in Related Services under the…

  2. Case Citations 1992, Twelfth Series: Employment.

    ERIC Educational Resources Information Center

    Cambron-McCabe, Nelda H., Ed.

    Collected case citations are organized in five major sections with brief summaries of relevant cases in subcategories followed by a table of cases cited. The major sections are as follows: (1) "Employment in General" (William Gordon); (2) "Termination of Employment" (Alan Robertson); (3) "Staff evaluation" (Virginia Helm); (4) "Tort Liability"…

  3. Case Citations 1992, Twelfth Series: Employment.

    ERIC Educational Resources Information Center

    Cambron-McCabe, Nelda H., Ed.

    Collected case citations are organized in five major sections with brief summaries of relevant cases in subcategories followed by a table of cases cited. The major sections are as follows: (1) "Employment in General" (William Gordon); (2) "Termination of Employment" (Alan Robertson); (3) "Staff evaluation" (Virginia Helm); (4) "Tort Liability"…

  4. Case Citations 1996. Eighteenth Series (School Administrators).

    ERIC Educational Resources Information Center

    Evans, William J., Jr., Ed.

    This document contains case citations for 1996 in areas pertaining to school administration. The cases are categorized according to the topics of negligence, workers' compensation, administrator due process, discrimination against school administrators, and discrimination in hiring teachers for administrative positions. Negligence cases cover…

  5. Case Series in Cognitive Neuropsychology: Promise, Perils and Proper Perspective

    PubMed Central

    Rapp, Brenda

    2012-01-01

    Schwartz & Dell (2010) advocated for a major role for case series investigations in cognitive neuropsychology. They defined the key features of this approach and presented a number of arguments and examples illustrating the benefits of case series studies and their contribution to computational cognitive neuropsychology. In the Special Issue on “Case Series in Cognitive Neuropsychology” there are six commentaries on Schwartz and Dell (2010) as well as a response to the six commentaries by Dell and Schwartz. In this paper, I provide a brief summary of the key points made in Schwartz and Dell (2010) and I review the promise and perils of case series design as revealed by the six commentaries. I conclude by placing the set of papers within a broader perspective, providing some clarification of the historical record on case series and single case approaches, raising some cautionary notes for case series studies and situating both case series and single case approaches within the larger context of theory development in the cognitive sciences. PMID:22746685

  6. Case series in cognitive neuropsychology: promise, perils, and proper perspective.

    PubMed

    Rapp, Brenda

    2011-10-01

    Schwartz and Dell (2010) advocated for a major role for case series investigations in cognitive neuropsychology. They defined the key features of this approach and presented a number of arguments and examples illustrating the benefits of case series studies and their contribution to computational cognitive neuropsychology. In the Special Issue on "Case Series in Cognitive Neuropsychology" there are six commentaries on Schwartz and Dell as well as a response to the six commentaries by Dell and Schwartz (2011 this issue). In this paper, I provide a brief summary of the key points made in Schwartz and Dell, and I review the promise and perils of case series design as revealed by the six commentaries. I conclude by placing the set of papers within a broader perspective, providing some clarification of the historical record on case series and single-case approaches, raising some cautionary notes for case series studies and situating both case series and single-case approaches within the larger context of theory development in the cognitive sciences.

  7. Giant fornix syndrome: a case series.

    PubMed

    Turaka, Kiran; Penne, Robert B; Rapuano, Christopher J; Ayres, Brandon D; Abazari, Azin; Eagle, Ralph C; Hammersmith, Kristin M

    2012-01-01

    To describe the demographics, characteristics, and treatment of giant fornix syndrome, a rare cause of chronic purulent conjunctivitis in the elderly. Retrospective chart review of five patients with giant fornix syndrome evaluated by the Cornea Service, Oculoplastics and Orbital Surgery Service and the Department of Pathology at the Wills Eye Institute. The median age of the 5 female patients was 75 years (mean 80, range 70-95). The median duration of eye symptoms before presentation was 2 years (mean 2.4, range 1-4). Before referral, the chronic conjunctivitis was treated with topical antibiotics in all 5 cases and with additional dacryocystorhinostomy in one case. The right eye was affected in 2 cases, and the left eye was affected in the other 3 cases. Floppy eyelids were present in 2 cases. The superior fornix was involved in 4 cases, and the inferior fornix was involved in one case. Pseudomembranes and superficial punctate keratitis (SPK) were seen in 3 cases. Diagnosis of giant fornix syndrome was made in all 5 cases. Conjunctival culture grew methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and S. aureus in singular cases. Case 1 was treated with topical moxifloxacin, Case 2 was treated with topical vancomycin and repair of the upper eyelid, Case 3 was treated with topical besifloxacin, and Case 4 was treated with dacryocystorhinostomy and topical vancomycin. Case 5 was treated with reconstruction of the left upper eyelid. The median duration of follow up was 4 months (mean 21.6, range 1-84). Giant fornix syndrome can lead to chronic relapsing conjunctivitis in the elderly. Deep conjunctival fornices in affected patients can be a site for prolonged sequestration of bacteria causing recurrent infections. Removing the infected debris from the superior fornix and reconstruction of the upper eyelid may prevent the recurrent chronic persistent infection.

  8. BCS wave-function approach to the BEC-BCS crossover of exciton-polariton condensates.

    PubMed

    Byrnes, Tim; Horikiri, Tomoyuki; Ishida, Natsuko; Yamamoto, Yoshihisa

    2010-10-29

    The crossover between low and high density regimes of exciton-polariton condensates is examined using a BCS wave-function approach. Our approach is an extension of the BEC-BCS crossover theory for excitons, but includes a cavity photon field. The approach can describe both the low density limit, where the system can be described as a Bose-Einstein condensate (BEC) of exciton-polaritons, and the high density limit, where the system enters a photon-dominated regime. In contrast to the exciton BEC-BCS crossover where the system approaches an electron-hole plasma, the polariton high density limit has strongly correlated electron-hole pairs. At intermediate densities, there is a regime with BCS-like properties, with a peak at nonzero momentum of the singlet pair function. We calculate the expected photoluminescence and give several experimental signatures of the crossover.

  9. Quantifying the Chasm: Exploring the Impact of the BCS on Total Football Revenues for Division One Football Programs from 2002-2012

    ERIC Educational Resources Information Center

    Caro, Cary A.

    2014-01-01

    The Bowl Championship Series served as a collection of bowl games that were designed to crown the national champion in Division One football. The BCS created two classifications of institutions in Division football, those that were granted automatic access (AQ) to the post-season games, and those that were not (non-AQ). The BCS also generated…

  10. [Imperforate hymen: a series of 13 cases].

    PubMed

    Ben Temime, Riadh; Najar, Ines; Chachia, Abdellatif; Attia, Leila; Makhlouf, Tahar; Koubaa, Abdelhamid

    2010-03-01

    Imperforate hymen is a rare congenital malformation. Patients often remain asymptomatic until puberty and present in early adolescence with cyclic abdominal pain. Early diagnosis and treatment must be performed in order to prevent morbidity. THE AIM of this study was to asses management of this disease. A retrospective study of 13 cases of imporforate hymen diagnosed in the department of obstetrics and gynecology "A" of Charles Nicolle hospital of Tunis from January 1980 to December 2008. The clinical features and the management are discussed. The mean age was 14 years. All patients were single and had primary amenorrhea. They presented with pelvic pain in 9 cases and bladder urinary retention in 4 cases. Secondary sexual characters were present and normal in all cases. Inspection of the vulva could establish the diagnosis in all cases. Pelvic ultrasounds showed the hematocolpos in all cases. The latter was associated to a hematometria and a Douglas pouch liquid in 2 cases. Hematocolpos was evacuated by hymeneotomy under oxytocin infusion in all cases. Eight patients were treated by cruciform incisions and five patients were treated by radial incisions of the hymen. The volume of hematocolpos varied from 250 ml to 2000 ml. One patient underwent surgery twice for restenosis of the imperforate hymen. Imperforate hymen is a rare anomaly. Its diagnosis is simple and could be established at birth by a systematic screening. More frequently, the diagnosis must be suspected in front of a primary amenorrhea associated to abdominal pain in order to prevent complications.

  11. Diagnostic difficulties of plunging ranula: case series.

    PubMed

    Jain, R; Morton, R P; Ahmad, Z

    2012-05-01

    To evaluate common pitfalls in diagnosing complicated plunging ranula, either due to misidentification of plunging ranula or alternative pathology (i.e. false negatives or false positives, respectively). A review of cases of plunging ranula seen in Middlemore Hospital, New Zealand, was performed. Diagnostically uncertain cases were identified and reviewed, taking particular note of clinical, radiological and surgical findings. From our database, 12 cases were found to have had a complicated diagnosis of plunging ranula. Ten cases were false negatives: four were treated as abscesses, four as simple cysts, one as a thyroglossal cyst and one as a cystic hygroma. Two cases were false positives: one was found to be a thyroglossal cyst and the other a lipoma. The diagnosis of plunging ranula is usually straightforward, with simple surgical management. Misdiagnosis can lead to recurrence of symptoms and inappropriate management, with the associated risks, complications and frustrations of surgery.

  12. [Hypophysitis autoimmune. Case series and literature review].

    PubMed

    Pérez, Guadalupe; Almeda-Valdés, Paloma; Cuevas-Ramos, Daniel; Juárez-Comboni, Sonia Citlali; Higuera-Calleja, Jesús; Gómez-Pérez, Francisco Javier

    2013-01-01

    Autoimmune hypophysitis is a rare condition that must be considered in the differential diagnosis of any pituitary tumor. We present a series of nine patients with clinical and radiologic diagnosis of autoimmune hypophysitis that were admitted to the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) in Mexico City between 2000-2012. Clinical, biochemical, imaging features (on MRI), treatment, and follow-up are described, and a review on this disease is presented.

  13. Intra-medullary Tuberculomas: Case Series

    PubMed Central

    Ghorpade, Raviraj; Naik, Ravishankar; Malur, Prakash R

    2017-01-01

    Intramedullary spinal tuberculoma is an extremely rare disease when compared to pulmonary, extrapulmonary and skeletal tuberculosis in developing countries. In the absence of systemic tuberculosis, clinical presentation is non distinctive from other intramedullary lesions. We report two cases of intramedullary tuberculoma both presenting with signs and symptoms of space occupying lesions. Surgical excision was done in both cases following which patients improved neurologically. Histopathological evaluation is essential to provide curative treatment.

  14. Cosmological BCS mechanism and the big bang singularity

    SciTech Connect

    Alexander, Stephon; Biswas, Tirthabir

    2009-07-15

    We provide a novel mechanism that resolves the big bang singularity present in Friedman-Lemaitre-Robertson-Walker space-times without the need for ghost fields. Building on the fact that a four-fermion interaction arises in general relativity when fermions are covariantly coupled, we show that at early times the decrease in scale factor enhances the correlation between pairs of fermions. This enhancement leads to a BCS-like condensation of the fermions and opens a gap dynamically driving the Hubble parameter H to zero and results in a nonsingular bounce, at least in some special cases.

  15. Fatal anorectal injuries: a series of four cases.

    PubMed

    Orr, C J; Clark, M A; Hawley, D A; Pless, J E; Tate, L R; Fardal, P M

    1995-03-01

    Anorectal injuries associated with sexual practices have become more frequently reported in the last decade. Although anorectal injuries are commonly reported in cases of sexual abuse of children, fatalities are very rare. In this series of cases, we report a case of fatal child abuse resulting from anal intercourse. In addition, there are two cases of death in females as a result of heterosexual "fisting" or "handballing." The fourth case of the series is that of a homicidal injury produced by rectal impalement with a 31 inch length of threaded pipe.

  16. Case Series Study of Invasive Pulmonary Aspergillosis.

    PubMed

    Aller-García, Ana I; Castro-Méndez, Carmen; Alastruey-Izquierdo, Ana; Marín-Martínez, Elena M; Breval, Ismail Zakariya-Yousef; Couto-Caro, Carmen; López-Marín, Juan C; Peña-Griñán, Nicolás; Ruiz de Pipaon, Maite; Romero-Mejías, Ana M; Martín-Mazuelos, Estrella

    2016-12-02

    Diagnosis of invasive pulmonary aspergillosis (IPA) is challenging. The objective of the study was to assess the value of microbiological tests to the diagnosis of IPA in the absence of non-specific radiological data. A retrospective study of 23 patients with suspicion of IPA and positivity of some microbiological diagnostic tests was performed. These tests included conventional microbiological culture, detection of Aspergillus galactomannan (GM) antigen and in some patients (1 → 3)-β-D-glucan (BDG) and Aspergillus fumigatus DNA using the LightCycler(®) SeptiFast test. In 10 patients with hematological malignancy, 6 cases were considered 'probable' and 4 'non-classifiable.' In 8 patients with chronic lung disease, 7 cases were classified as 'probable' and 1 as 'proven,' and in 5 patients with prolonged ICU stay (>7 days), there were 2 'proven' cases, 2 'non-classifiable' and 1 putative case. Microbiological culture was positive in 17 cases and 18 Aspergillus spp. were isolated (one mixed culture). A. fumigatus was the most frequent (44.4%) followed by A. tubingensis. The Aspergillus galactomannan (GM) antigen assay was positive in 21 cases (91.3%). The GM antigen and the (1 → 3)-β-D-glucan (BDG) assays were both performed in 12 cases (52.2%), being positive in 9. The SeptiFast test was performed in 7 patients, being positive in 4. In patients with non-classifiable pulmonary aspergillosis and one or more positive microbiological tests, radiological criteria may not be considered a limiting factor for the diagnosis of IPA.

  17. Hepatic inflammatory pseudotumor: A case series

    PubMed Central

    Calomeni, Guilherme D.; Ataíde, Elaine B.; Machado, Ricardo R.; Escanhoela, Cecília A.F.; Costa, Larissa B.E.; Boin, Ilka F.F.

    2013-01-01

    INTRODUCTION Inflammatory pseudotumor (IPT) is a rare lesion consisted of inflammatory and myofibroblastic cells. These lesions may be found in different organs. There are less than 300 described cases. PRESENTATION OF CASE Case 1. 64-year-old cirrhotic male with a palpable epigastric mass. CT showed a lesion in liver segments 2 and 3 and left hepatic artery aneurism. Percutaneous embolization and wide spectrum antibiotics were tried, however the lesion grew. Left lateral hepatectomy was performed, and HIPT diagnosed. The patient died due to multiple organ dysfunction. Case 2. 30-year-old male with abdominal pain and fever. CT showed a hepatic hilar lesion. Surgical resection was performed after an ineffectual antibiotic trial, and HIPT was confirmed. The patient is doing well. Case 3. 73-year-old female with abdominal pain and fever. CT showed a 7 cm lesion in the left liver lobe. Unrewarding cancerous screening was performed, and unsuccessful antibiotic course was tried. Resection was performed, and HIPT diagnosed. The patient is doing well. Case 4. 50-year-old cirrhotic male with abdominal pain. CT showed a segment 6 lesion and portal vein thrombosis. Considering cancer as the first hypothesis and the MELD score of 9, segmentectomy was performed. HIPT was the final diagnosis. The patient died due to abdominal sepsis. DISCUSSION HIPT is a lesion with a vast list of differential diagnosis. Antibiotics are the first line of therapy, although surgery is often necessary. Overall prognosis is good, although comorbidities may worsen it. CONCLUSION HIPT is a rare and misleading entity. PMID:23399515

  18. [Mycetoma in Tunisia: a 15-case series].

    PubMed

    Elgallali, N; El Euch, D; Cheikhrouhou, R; Belhadj, S; Chelly, I; Chaker, E; Ben Osman, A

    2010-06-01

    Mycetoma is a chronic infection of cutaneous and subcutaneous tissue that can be caused by fungi or bacteria. It is endemic in tropical and subtropical areas but rare in Tunisia. The purpose of this report is to describe epidemioclinical features, treatment and outcomes in patients presenting mycetoma in Tunisia. The files of all patients treated for mycetoma in the Dermatology Department of La Rabta Hospital in Tunisia from 1982 to 2006 were retrospectively reviewed. A total of 15 cases of mycetoma were recorded during the study period. There were 6 men and 9 women with a mean age of 53.2 years. The most common clinical presentation was infiltrated erythematous plaques with sinus tracts (fistulas). Lesions were located on the foot in 12 cases. Thirteen patients reported the presence of grains in fluid discharging from fistulas. The cause of mycetoma was actinomycetes, i.e., Actinomadura madurae, in 9 cases and fungus in 6 cases including 3 due to Madurella mycetomi and 2 to Pseudallesheria boydii. Treatment was based on oral antibiotics for actinomycetoma and oral antifungals for eumycetoma. Mycetoma in Tunisia is still uncommon with a slight female predominance. The foot is the most frequent location. Diagnosis can be accomplished by direct mycologic examination, culture, and histololgy. There is no consensus on treatment that is often prolonged with numerous relapses.

  19. Uterine Fibroid (Leiomyoma) with Acute Urinary Retention: A Case Series.

    PubMed

    Singh, Sweta; Jena, Saubhagya Kumar; Naik, Monalisha; Ray, Lipsa; Behera, Satyanarayan

    2016-04-01

    Uterine leiomyomas are an extremely rare cause of acute urinary retention in women. The delay in diagnosing uterine leiomyomas presenting with acute urinary retention further complicates the management. The rarity of the condition makes it difficult to plan either prospective or retrospective trials. Hence, most of the evidence comes from case reports or series. We report a case series of acute urinary retention in women with uterine leiomyomas and discuss the pathophysiology, diagnosis and management options.

  20. Uterine Fibroid (Leiomyoma) with Acute Urinary Retention: A Case Series

    PubMed Central

    Jena, Saubhagya Kumar; Naik, Monalisha; Ray, Lipsa; Behera, Satyanarayan

    2016-01-01

    Uterine leiomyomas are an extremely rare cause of acute urinary retention in women. The delay in diagnosing uterine leiomyomas presenting with acute urinary retention further complicates the management. The rarity of the condition makes it difficult to plan either prospective or retrospective trials. Hence, most of the evidence comes from case reports or series. We report a case series of acute urinary retention in women with uterine leiomyomas and discuss the pathophysiology, diagnosis and management options. PMID:27190903

  1. Acute eclipse retinopathy: a small case series.

    PubMed

    Khatib, Nur; Knyazer, Boris; Lifshitz, Tova; Levy, Jaime

    2014-01-01

    We present four young patients with acute severe solar retinopathy after observation of the total eclipse on January 4, 2011 without appropriate eye protection. Funduscopic findings were accompanied by optical coherence tomography (OCT) investigation of the macula. All our patients were young (range 14-29 years). In three of the four patients we have been able to repeat OCT evaluation revealing that the retinal changes were reversible, but delineating mild pathology in the retinal pigment epithelium and photoreceptors. Best-corrected visual acuity in the fourth case was 6/24. In addition, macular edema, which has been previously described in literature, could not be demonstrated by OCT. In the two cases we performed an early fluorescein angiogram, no pathology was seen. Copyright © 2013 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

  2. Oral syphilis: a series of 5 cases.

    PubMed

    Hertel, Moritz; Matter, Daniel; Schmidt-Westhausen, Andrea M; Bornstein, Michael M

    2014-02-01

    Syphilis is an infectious, usually sexually transmitted, disease caused by Treponema pallidum, subspecies pallidum. Because of the increasing prevalence in Europe during the past few years, dentists could be confronted with patients with oral manifestations of syphilis. Because oral lesions are highly contagious, it is vital to make the correct diagnosis quickly to initiate the proper therapy and to interrupt the chain of infection. We present the cases of 5 patients with syphilis-related oral lesions. These cases are representative because of their clinical presentation, age, and gender distribution and the diagnostic approach. The aim of the present report is to emphasize the importance of the dentist knowing and identifying syphilis in different stages to diagnose the disease and institute treatment at an early stage.

  3. Acute eclipse retinopathy: A small case series

    PubMed Central

    Khatib, Nur; Knyazer, Boris; Lifshitz, Tova; Levy, Jaime

    2014-01-01

    We present four young patients with acute severe solar retinopathy after observation of the total eclipse on January 4, 2011 without appropriate eye protection. Funduscopic findings were accompanied by optical coherence tomography (OCT) investigation of the macula. All our patients were young (range 14–29 years). In three of the four patients we have been able to repeat OCT evaluation revealing that the retinal changes were reversible, but delineating mild pathology in the retinal pigment epithelium and photoreceptors. Best-corrected visual acuity in the fourth case was 6/24. In addition, macular edema, which has been previously described in literature, could not be demonstrated by OCT. In the two cases we performed an early fluorescein angiogram, no pathology was seen. PMID:25323644

  4. Type II endometrial cancers: A case series

    PubMed Central

    Lobo, Flora D.; Thomas, Eliz

    2016-01-01

    Introduction: Endometrial carcinoma ranks 3rd in India among gynecological malignancies. Endometrial cancer (EC) can be classified into two distinct groups – type I and type II, based on histology, which differs in molecular, clinical and histopathological profiles. Type II is nonestrogen dependent, nonendometrioid, more aggressive and carries poor prognosis. Although type II cancers contribute only about 10% of EC incidence, they present at advanced age and cause approximately 50% recurrence and deaths with a low 5-year, overall survival rate. Type II EC are also characterized by genetic alterations in p53, human epidermal growth factor-2/neu, p16 and E-cadherin. Materials and Methods: Endometrial carcinomas diagnosed from endometrial biopsies and hysterectomy specimens received in the Department of Pathology, Kasturba Medical College, Mangalore, from January 2007 to June 2012 were included in the study. Clinicopathological analysis of the 84 cases of EC was done with emphasis on morphology. p53 immunostaining was performed in two cases of serous carcinoma. Results: Out of a total of 84 cases of EC, ten cases were of type II (11.9%). Out of which, eight were serous carcinoma (9.5%) and two clear cell (2.4%). p53 immunostain was strongly positive in the serous papillary carcinomas. The age of the patients ranged from 45 to 75 years. Myometrial invasion was more than half. Treatment was hysterectomy followed by aggressive chemotherapy. Conclusion: Of the type II EC, serous carcinoma is the most common type. Clinical presentation and prognosis differs in comparison to type I EC, thus the recognition of this type of EC is pivotal. PMID:27499593

  5. Rare Mimickers of Exostosis: A Case Series

    PubMed Central

    Perubhotla, Lakshmi Manasa

    2016-01-01

    Exophytic growths from bones are a common entity. Osteochondroma is the most common benign exophytic lesion and we tend to diagnose every benign looking exophytic lesion as osteochondroma. Here we reported two entities of cases, one was Nora’s lesion and another one was supracondylar process of humerus, both of which were mimickers of osteochondroma and their salient and differentiating features from osteochondromas. PMID:27630926

  6. Spontaneous retroclival hematoma: a case series.

    PubMed

    Narvid, Jared; Amans, Matthew R; Cooke, Daniel L; Hetts, Steven W; Dillon, William P; Higashida, Randall T; Dowd, Christopher F; Halbach, Van V

    2016-03-01

    Retroclival hematomas are rare, appearing mostly as posttraumatic phenomena in children. Spontaneous retroclival hematoma (SRH) in the absence of trauma also has few descriptions in the literature. None of the reported clinical cases features the combination of an SRH and intraventricular hemorrhage (IVH). Nevertheless, despite extensive cases of idiopathic or angiographically negative subarachnoid hemorrhage (SAH) of the posterior fossa, only a single case report of a patient with a unique spontaneous retroclival hematoma has been identified. In this study, the authors reviewed the presentation, management, and clinical outcome of this rare entity. The authors performed a retrospective analysis of all patients with diagnosed SRH at their institution over a 3-year period. Collected data included clinical history, laboratory results, treatment, and review of all imaging studies performed. Four patients had SRH. All were appropriately evaluated for coagulopathic and/or traumatic etiologies of hemorrhage, though no etiology could be found. Moreover, all of the patients demonstrated SRH that both clearly crossed the basioccipital synchondrosis and was contained within a nondependent configuration along the retroclival dura mater. Spontaneous retroclival hematoma, often associated with IVH, is a rare subtype of intracranial hemorrhage frequently recognized only when MRI demonstrates compartmentalization of the posterior fossa hemorrhage. When angiography fails to reveal an underlying lesion, SRH patients, like patients with traditional angiographically negative SAH, enjoy a remarkably good prognosis.

  7. Craniofacial fibrous dysplasia: A 10-case series.

    PubMed

    Couturier, A; Aumaître, O; Gilain, L; Jean, B; Mom, T; André, M

    2017-09-01

    Fibrous dysplasia of bone is a rare sporadic benign congenital condition in which normal cancellous bone is replaced by fibro-osseous tissue with immature osteogenesis. Sarcomatous transformation is exceptional. Lesions may involve one bone (monostotic) or several (polyostotic). Fibrous dysplasia may be associated with café-au-lait skin macules and endocrinopathy in McCune-Albright syndrome, or with myxoma in Mazabraud's syndrome. We report ten cases of patients followed up for craniofacial fibrous dysplasia in our center between 2010 and 2015. Mean age was 43 years (range, 10-72 years). Clinical symptoms comprised headache (n=3) and sensorineural disorder: recurrent anterior uveitis (n=1), visual acuity loss, epiphora and vestibular syndrome (n=1), and hearing loss (n=1). All cases were monostotic. The sphenoid bone was most commonly involved (n=5), followed by the ethmoid (n=1), frontal (n=1), fronto-ethmoid (n=1), temporal (n=1) and fronto-ethmoido-sphenoid (n=1) bones. Five patients were treated with intravenous pamidronate, a bisphosphonate: evolution was favorable for 3 of them at 1-6 months after treatment initiation, with resolution of headache or vestibular syndrome; the other 2 patients were stable. Two patients were operated on. Diagnosis of craniofacial fibrous dysplasia should be considered in case of headache, neuralgia, sensory disorder, functional disorder or infectious ENT complications. A medico-surgical approach is useful for these patients. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  8. Dense QCD: Overhauser or BCS pairing?

    SciTech Connect

    Park, Byung-Yoon; Rho, Mannque; Wirzba, Andreas; Zahed, Ismail

    2000-08-01

    We discuss the Overhauser effect (particle-hole pairing) versus the BCS effect (particle-particle or hole-hole pairing) in QCD at large quark density. In weak coupling and to leading logarithm accuracy, the pairing energies can be estimated exactly. For a small number of colors, the BCS effect overtakes the Overhauser effect, while for a large number of colors the opposite takes place, in agreement with a recent renormalization group argument. In strong coupling with large pairing energies, the Overhauser effect may be dominant for any number of colors, suggesting that QCD may crystallize into an insulator at a few times nuclear matter density, a situation reminiscent of dense Skyrmions. The Overhauser effect is dominant in QCD in 1+1 dimensions, although susceptible to quantum effects. It is sensitive to temperature in all dimensions. (c) 2000 The American Physical Society.

  9. [Charles Bonnet syndrome. A 45-case series].

    PubMed

    Santos-Bueso, Enrique; Serrador-García, Mercedes; Porta-Etessam, Jesús; Rodríguez-Gómez, Octavio; Martínez-de-la-Casa, José M; García-Feijoo, Julián; García-Sánchez, Julián

    2015-04-16

    Introduccion. El sindrome de Charles Bonnet (SCB) es un cuadro clinico que se caracteriza por la presencia de alucinaciones visuales, principalmente complejas, en pacientes con estado cognitivo conservado e importante deterioro de la vision. El incremento del SCB se debe al aumento de la esperanza de vida y al desarrollo de patologias asociadas al envejecimiento, como la degeneracion macular asociada a la edad. Pacientes y metodos. Se estudian las caracteristicas de una serie de 45 pacientes diagnosticados de SCB en la unidad de neurooftalmologia del Hospital Clinico San Carlos. Los pacientes procedian de las unidades de patologia macular, glaucoma, superficie ocular y urgencias, en las que fueron diagnosticados de SCB, que se confirmo en la unidad multidisciplinar formada por oftalmologia, neurologia y psiquiatria del mismo hospital. Resultados. El 66,66% eran mujeres, de mas de 80 anos (68,88%), principalmente con degeneracion macular asociada a la edad (37,77%). Las alucinaciones que los pacientes presentaban con mas frecuencia eran personas y caras (35,55%), en color (66,66%), en movimiento (80%), con un tiempo de evolucion de 6-12 meses (26,66%), frecuencia de tres episodios al dia (35,55%) y de 3-5 minutos de duracion (35,55%). Conclusiones. El SCB es un complejo sindrome cuya incidencia se esta incrementando en nuestras consultas y que precisa un abordaje multidisciplinar entre oftalmologos, neurologos y psiquiatras para evitar diagnosticos erroneos y proporcionar un tratamiento adecuado. Son necesarios nuevos estudios para un conocimiento mas profundo y adecuado del SCB.

  10. Scleroderma Induced by Pembrolizumab: A Case Series.

    PubMed

    Barbosa, Naiara S; Wetter, David A; Wieland, Carilyn N; Shenoy, Niraj K; Markovic, Svetomir N; Thanarajasingam, Uma

    2017-07-01

    Immune checkpoint inhibitors are approved for select cancer treatment and have shown survival benefit in patients with advanced melanoma. Adverse events, including immune-related adverse events, are common and potentially life-threatening. We describe cases of 2 patients with scleroderma (patient 1 had diffuse scleroderma, and patient 2 had limited scleroderma) that developed while they were receiving pembrolizumab therapy for metastatic melanoma. Prompt recognition and treatment of immune-related adverse events may improve tolerance to immune checkpoint inhibitors and contribute to an understanding of the manifesting autoimmune disease. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  11. [Cold urticaria: case series and literature review].

    PubMed

    Sánchez, Jorge Mario; Ramírez, Ruth Helena; Tamayo, Liliana María; Chinchilla, Carlos Fernando; Cardona, Ricardo

    2011-06-01

    Cold urticaria is one of the five most common causes of chronic urticaria and is grouped as a physical urticaria. It can occur after exposure to cold, either through solid objects, air or liquids. Patients may have symptoms of urticaria, angioedema, respiratory distress and even anaphylaxis when the skin is exposed to a cold environment, such as handling refrigerated objects, swimming in cold water or entering an air-conditioned room. Five cases of cold urticaria are presented, followed by a brief literature review.

  12. [Insufficiency fractures after irradiation therapy - case series].

    PubMed

    Braun, Karl F; Pohlig, Florian; Lenze, Ulrich; Netter, Clemens; Hadjamu, Miriam; Rechl, Hans; von Eisenhart-Rothe, Rüdiger

    2015-07-01

    Radiation therapy plays an essential part in modern treatment regimes of musculoskeletal tumors. Nevertheless damage to the surrounding tissue does occur inevitably. Postradiogenic changes of bone are associated with decreased stability and an increased fracture rate. The orthopedic surgeon therefore faces a challenging situation with altered bone metabolism, changes in perfusion and soft tissue problems. We present 3 cases of radiation induced fractures during the treatment of soft tissue tumors, all of which received radiation doses of > 58 Gy. All fractures occurred over 1 year after the exposure to radiation in otherwise uneventful follow ups. Postoperative follow up showed fracture healing or in the case of the arthroplasty, osseous integration without further complications. Radiation doses of ≥ 58 Gy are a major risk factor for pathological fractures in long bones. Regardless of their low incidence, fracture rates between 1,2 and 6,4 % prove their importance. Local tumor control has therefore to be weighed against the resulting decrease in bone quality and stability. Treatment options should always take into consideration the increased risk for complications such as infection, pseudarthroses and wound healing disorders. Our results show that substitution of vitamin D and calcium as well as the the use of reamed intramedullary implants benefits the outcome.

  13. Lactulose-associated lithium toxicity: a case series.

    PubMed

    Bregman, Andrew; Fritz, Kathy; Xiong, Glen L

    2014-12-01

    Lactulose is commonly used for constipation and hepatic encephalopathy. Its adverse effects of dehydration and serum electrolyte imbalances are widely known. This study aimed to describe a case series of 3 patients receiving lactulose who developed lithium toxicity. The authors described a case series of 3 patients admitted to a large county psychiatric hospital who developed lithium toxicity while taking lactulose for constipation or hyperammonemia. In all 3 cases of lithium toxicity, the patients were prescribed with lithium for acute mania and lactulose for constipation or hyperammonemia. One case required the patient to be transferred to a local emergency department for further treatment. This case series shows the interaction between lithium and lactulose. It is postulated that lactulose's effects of volume depletion can lead to poor renal excretion of lithium.

  14. PLATEAU IRIS SYNDROME--CASE SERIES.

    PubMed

    Feraru, Crenguta Ioana; Pantalon, Anca Delia; Chiselita, Dorin; Branisteanu, Daniel

    2015-01-01

    Plateau iris is characterized by closing the anterior chamber angle due to a large ciliary body or due to its anterior insertion that alters the position of iris periphery in respect to the trabecular meshwork. There are two aspects that need to be differentiated: plateau iris configuration and plateau iris syndrome. The first describes a situation when the iris root is flat and the anterior chamber is not shallow, the latter refers to a post laser iridotomy condition in which a patent iridotomy has removed the relative pupillary block, but goniscopically confirmed angle closure recurs without central shallowing of the anterior chamber. Isolated plateau iris syndrome is rare compared to plateau iris configuration. We hereby present two case reports of plateau iris syndrome in young patients who came to an ophthalmologic consult by chance.

  15. Congenital Melanocytic Nevus Syndrome: A Case Series.

    PubMed

    Recio, A; Sánchez-Moya, A I; Félix, V; Campos, Y

    2017-01-19

    Congenital melanocytic nevus syndrome (CMNS) is the result of an abnormal proliferation of melanocytes in the skin and central nervous system caused by progenitor-cell mutations during embryonic development. Mutations in the NRAS gene have been detected in many of these cells. We present 5 cases of giant congenital melanocytic nevus, 3 of them associated with CMNS; NRAS gene mutation was studied in these 3 patients. Until a few years ago, surgery was the treatment of choice, but the results have proved unsatisfactory because aggressive interventions do not improve cosmetic appearance and only minimally reduce the risk of malignant change. In 2013, trametinib was approved for use in advanced melanoma associated with NRAS mutations. This drug, which acts on the intracellular RAS/RAF/MEK/pERK/MAPK cascade, could be useful in pediatric patients with CMNS. A better understanding of this disease will facilitate the development of new strategies.

  16. Takotsubo Cardiomyopathy: Case Series and Literature Review

    PubMed Central

    Cavayero, Chase; Kar, Pran; Kar, Sunny

    2016-01-01

    Although originally considered to be uncommon, Takotsubo cardiomyopathy is becoming increasingly visible, annually comprising an increasing portion of suspected diagnoses of acute coronary syndrome. This condition is characterized by reversible left ventricular akinesis without significant coronary artery obstruction. This case study presents five patients diagnosed with Takotsubo cardiomyopathy, as confirmed by echocardiogram and angiography. All of the patients presented with classic myocardial chest pain and elevated troponins. Following diagnosis, they were treated with supportive measures, particularly angiotensin-converting enzyme inhibitors, and beta-blockers. All patients made a full recovery. Though the mechanism of Takotsubo has not been fully elucidated, hypotheses suggest it may be related to excessive catecholamine levels causing either myocardial stunning or coronary vasospasm. Recognition and understanding of this unusual pathology are essential because it can lead to improved clinical management. PMID:27446769

  17. Trends in Energy Management Technology: BCS Integration Technologies - Open Communications Networking

    SciTech Connect

    Webster, Tom

    2002-09-18

    Our overall purpose in writing this series of articles is to provide Federal energy managers some basic informational tools to assist their decision making process relative to energy management systems design, specification, procurement, and energy savings potential. Since Federal buildings rely on energy management systems more than their commercial counterparts, it is important for energy practitioners to have a high level of knowledge and understanding of these complex systems. This is the second article in a series and will focus on building control system (BCS) networking fundamentals and an assessment of current approaches to open communications protocols. This is important because networking is a complex subject and the networks form the basic infrastructure for energy management functions and for integrating a wide variety of OEM equipment into a complete EMCIS. The first article [1] covered enabling technologies for emerging energy management systems. Future topics will concentrate on more practical aspects including applications software, product offerings, networking strategies, and case studies of actual installations. Please refer to the first article for a more complete overview of the purpose and background for this series.

  18. Laparoscopic adrenalectomy for phaeochromocytoma: a case series.

    PubMed

    Hotu, Cheri; Harman, Richard; Cutfield, Richard; Hodges, Nicola; Taylor, Eletha; Young, Simon

    2015-10-16

    To describe our 13-year experience in laparoscopic adrenalectomy for phaeochromocytoma. We performed a retrospective analysis of case notes of 29 patients who underwent laparoscopic adrenalectomy for phaeochromocytoma between 2000 and 2013. Twenty-nine patients (16 female), aged 16 to 67 years, underwent laparoscopic adrenalectomy for phaeochromocytoma. All patients were treated preoperatively with alpha-blocking agents. 80% were prescribed additional preoperative antihypertensive agents. 90% received antihypertensive agents intraoperatively. All patients received intraoperative magnesium sulphate for haemodynamic stabilisation. The mean operative time was 160 minutes. Nearly all of the patients experienced haemodynamic stability during surgery. Two patients required conversion to open adrenalectomy, due to severe intraoperative hypertension during tumour handling, and due to extensive intra-abdominal adhesions. Postoperative complications were minimal, and included blood loss, superior epigastric artery damage, and cellulitis at the laparoscopic port site. There was no perioperative mortality. The median length of stay postoperatively was 4 days. 24% were prescribed antihypertensive medication on discharge. In our experience, favourable perioperative outcomes were achieved, demonstrating that laparoscopic adrenalectomy for phaeochromocytoma is a safe and effective procedure in the setting of experienced and skilled surgical, anaesthetic and medical teams delivering the perioperative care.

  19. Pituitary gigantism: a retrospective case series.

    PubMed

    Creo, Ana L; Lteif, Aida N

    2016-05-01

    Pituitary gigantism (PG) is a rare pediatric disease with poorly defined long-term outcomes. Our aim is to describe the longitudinal clinical course in PG patients using a single-center, retrospective cohort study. Patients younger than 19 years diagnosed with PG were identified. Thirteen cases were confirmed based on histopathology of a GH secreting adenoma or hyperplasia and a height >2 SD for age and gender. Laboratory studies, initial pathology, and imaging were abstracted. Average age at diagnosis was 13 years with an average initial tumor size of 7.4×3.8 mm. Initial transsphenoidal surgery was curative in 3/12 patients. Four of the nine patients who failed the initial surgery required a repeat procedure. Octreotide successfully normalized GH levels in 1/6 patients with disease refractory to surgery (1/6). Two out of five patients received pegvisomant after failing octreotide but only one patient responded to treatment. Five patients were ultimately treated with radiosurgery or radiation patients were followed for an average of 10 years. PG is difficult to treat. In most patients, the initial transsphenoidal surgery failed to normalize GH levels. If the initial surgery was unsuccessful, repeat surgery was unlikely to control GH secretion. Treatment with octreotide or pegvisomant was successful in less than half the patients failing surgery. Radiosurgery was curative, but is not an optimal treatment for pediatric patients. Despite the small sample, our study suggests that the treatment outcome of pediatric PG may be different than adults.

  20. Coccidioidomycosis in infants: A retrospective case series.

    PubMed

    Lee, Jessica M; Graciano, Ana Lia; Dabrowski, Lukasz; Kuzmic, Brenik; Tablizo, Mary Anne

    2016-08-01

    In contrast to adults, coccidioidomycosis is a rare disease in infants and the mechanisms of disease acquisition are not well described in infants. The purpose of this study was to describe the clinical presentation, treatment, and outcome of pulmonary coccidioidomycosis in infants in an endemic area. We performed a retrospective observational study of all patients less than 12 months of age admitted to a tertiary free standing children's hospital from 2003-2012 diagnosed with coccidioidomycosis. Thirteen infants were hospitalized during the study period. The majority of the patients presented with upper and/or lower respiratory tract infection. The most common presenting symptoms included fever (77%), cough (61%), and respiratory distress (38%). Disseminated disease, included pericardial effusion, neck abscess, and lesions in the cerebellum, basal ganglia and left temporoparietal skull. Fluconazole was the initial, antifungal agent used. Amphotericin B was reserved for significant lung disease and disseminated cases. Failed response to fluconazole and amphotericin B were treated with a combination of voriconazole and caspofungin. Average length of treatment was 4 years. All patients survived to hospital discharge. The majority of the patients had resolution of chest radiograph and coccidiodal complement fixing antibody titers. Infant coccidioidomycosis has a non-specific presentation and can mimic common infant respiratory illnesses. In endemic areas, coccidioidomycosis should be considered in the differential diagnosis of infants with pulmonary symptoms unresponsive to conventional treatment. Pediatr Pulmonol. 2016;51:858-862. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  1. A case series of neonatal arrhythmias.

    PubMed

    Isik, Dilek Ulubas; Celik, Istemi Han; Kavurt, Sumru; Aydemir, Ozge; Kibar, Ayse Esin; Bas, Ahmet Yagmur; Demirel, Nihal

    2016-01-01

    Neonatal arrhythmias (NAs) are defined as abnormal heart rates in the neonatal period. They may occur as a result of various cardiovascular, systemic and metabolic problems. A retrospective chart review was performed on newborns who were diagnosed with NA during hospitalization in a neonatal intensive care unit (NICU), or who were admitted to the NICU because of an arrhythmia diagnosis in two NICUs in Turkey from May 2011 to June 2013. Seventeen neonates with arrhythmias were identified. The incidence of NA was 0.4% and 0.3% in the two NICUs, and was 0.37% in the study population as a whole. Mean gestational age was 37 (29-40) weeks. Nine of the infants (53%) were diagnosed with fetal arrhythmia (FA) during the last week of gestation. The distribution of NA types was as follows: six (35%) supraventricular tachycardia (SVT), six (35%) premature atrial contractions (PACs), two (11%) premature ventricular contractions (PVCs), two (11%) multiple arrhythmias such as SVT + PAC and AV block + PVC, and one (5%) AV block. Wolff-Parkinson-White syndrome was present in one patient. An association of NA with congenital heart malformations was identified in five cases. Cardiac arrhythmias are important causes of infant morbidity, and an occasional cause of infant mortality if undiagnosed and untreated. It is important for the physician to be aware of the etiology, development and natural history of arrhythmias in the fetal and neonatal period.

  2. Pica in iron deficiency: a case series

    PubMed Central

    2010-01-01

    Introduction Pica is an unusual condition where patients develop cravings for non-nutritive substances that can cause significant health risks. We report three patients with pica, two of them showing evolutionary changes associated with pica and the third demonstrating a peculiar nature of pica, which has yet to be reported. Case presentation We describe three patients who presented with symptoms of pica. The first patient is a 36-year-old Caucasian woman who had dysfunctional uterine bleeding associated with daily ingestion of two super-sized cups of ice as iced tea. The second patient is a 62-year-old Caucasian man who presented with bleeding from colonic polyps associated with drinking partially frozen bottled water. Lastly, the third patient, a 37-year-old Hispanic woman, presented with dysfunctional uterine bleeding and habitually chewed rubber bands. All three patients presented with hematological parameters diagnostic for iron deficiency anemia. Conclusion Pica has been practiced for centuries without a clear etiology. We have noticed that the younger community of academic and community physicians are not aware of the importance of complaints related to pica. None of our patients we describe here, as well as their primary care physicians, were aware of the importance of their pica related symptoms. Pica symptoms abated in one of our patients upon iron supplementation, while the other two are currently under treatment as of this writing. We believe pica is an important sign of iron deficiency that should never be ignored, and the craving for any unusual substance should compel clinicians to search for occult blood loss with secondary iron deficiency. PMID:20226051

  3. Etiologies of Autism in a Case-Series from Tanzania

    ERIC Educational Resources Information Center

    Mankoski, Raymond E.; Collins, Martha; Ndosi, Noah K.; Mgalla, Ella H.; Sarwatt, Veronica V.; Folstein, Susan E.

    2006-01-01

    Most autism has a genetic cause although post-encephalitis cases are reported. In a case-series (N = 20) from Tanzania, 14 met research criteria for autism. Three (M:F = 1:2) had normal development to age 22, 35, and 42 months, with onset of autism upon recovery from severe malaria, attended by prolonged high fever, convulsions, and in one case…

  4. Varieties of Misdiagnosis in ASD: An Illustrative Case Series

    ERIC Educational Resources Information Center

    Van Schalkwyk, Gerrit I.; Peluso, Francesco; Qayyum, Zheala; McPartland, James C.; Volkmar, Fred R.

    2015-01-01

    The relationship between autism spectrum disorders (ASD) and psychotic disorders (PD) is a focus of continued interest. There are substantial conceptual and clinical difficulties associated with diagnosing comorbid PD in individuals who have ASD. In this case series, we report on five cases where adolescents with previously diagnosed ASD were also…

  5. Varieties of Misdiagnosis in ASD: An Illustrative Case Series

    ERIC Educational Resources Information Center

    Van Schalkwyk, Gerrit I.; Peluso, Francesco; Qayyum, Zheala; McPartland, James C.; Volkmar, Fred R.

    2015-01-01

    The relationship between autism spectrum disorders (ASD) and psychotic disorders (PD) is a focus of continued interest. There are substantial conceptual and clinical difficulties associated with diagnosing comorbid PD in individuals who have ASD. In this case series, we report on five cases where adolescents with previously diagnosed ASD were also…

  6. Etiologies of Autism in a Case-Series from Tanzania

    ERIC Educational Resources Information Center

    Mankoski, Raymond E.; Collins, Martha; Ndosi, Noah K.; Mgalla, Ella H.; Sarwatt, Veronica V.; Folstein, Susan E.

    2006-01-01

    Most autism has a genetic cause although post-encephalitis cases are reported. In a case-series (N = 20) from Tanzania, 14 met research criteria for autism. Three (M:F = 1:2) had normal development to age 22, 35, and 42 months, with onset of autism upon recovery from severe malaria, attended by prolonged high fever, convulsions, and in one case…

  7. Distinguishing between the Permeability Relationships with Absorption and Metabolism To Improve BCS and BDDCS Predictions in Early Drug Discovery

    PubMed Central

    2015-01-01

    The biopharmaceutics classification system (BCS) and biopharmaceutics drug distribution classification system (BDDCS) are complementary classification systems that can improve, simplify, and accelerate drug discovery, development, and regulatory processes. Drug permeability has been widely accepted as a screening tool for determining intestinal absorption via the BCS during the drug development and regulatory approval processes. Currently, predicting clinically significant drug interactions during drug development is a known challenge for industry and regulatory agencies. The BDDCS, a modification of BCS that utilizes drug metabolism instead of intestinal permeability, predicts drug disposition and potential drug–drug interactions in the intestine, the liver, and most recently the brain. Although correlations between BCS and BDDCS have been observed with drug permeability rates, discrepancies have been noted in drug classifications between the two systems utilizing different permeability models, which are accepted as surrogate models for demonstrating human intestinal permeability by the FDA. Here, we recommend the most applicable permeability models for improving the prediction of BCS and BDDCS classifications. We demonstrate that the passive transcellular permeability rate, characterized by means of permeability models that are deficient in transporter expression and paracellular junctions (e.g., PAMPA and Caco-2), will most accurately predict BDDCS metabolism. These systems will inaccurately predict BCS classifications for drugs that particularly are substrates of highly expressed intestinal transporters. Moreover, in this latter case, a system more representative of complete human intestinal permeability is needed to accurately predict BCS absorption. PMID:24628254

  8. Particle-hole duality, integrability, and Russian doll BCS model

    NASA Astrophysics Data System (ADS)

    Bork, L. V.; Pogosov, W. V.

    2015-08-01

    We address a generalized Richardson model (Russian doll BCS model), which is characterized by the breaking of time-reversal symmetry. This model is known to be exactly solvable and integrable. We point out that the Russian doll BCS model, on the level of Hamiltonian, is also particle-hole symmetric. This implies that the same state can be expressed both in the particle and hole representations with two different sets of Bethe roots. We then derive exact relations between Bethe roots in the two representations, which can hardly be obtained staying on the level of Bethe equations. In a quasi-classical limit, similar identities for usual Richardson model, known from literature, are recovered from our results. We also show that these relations for Richardson roots take a remarkably simple form at half-filling and for a symmetric with respect to the middle of the interaction band distribution of one-body energy levels, since, in this special case, the rapidities in the particle and hole representations up to the translation satisfy the same system of equations.

  9. Finite case series or infinite single-case studies? Comments on "Case series investigations in cognitive neuropsychology" by Schwartz and Dell (2010).

    PubMed

    Lambon Ralph, Matthew A; Patterson, Karalyn; Plaut, David C

    2011-10-01

    In this commentary, though acknowledging that a case-series approach in neuropsychology is not always possible, we set out a series of considerations that in our view make this approach generally superior to single-case study. We argue that case-series designs are crucial for theory-testing, assessment of computational models, evaluation of inter-patient variation (including selection criteria, patient homogeneity/heterogeneity, premorbid individual differences, etc.) and to establish solid foundations for the interpretation of behavioural dissociations and associations. We conclude by suggesting that, alongside other neuroscience techniques, case-series cognitive neuropsychology provides a crucial contribution to the future of clinical and cognitive neuroscience.

  10. Multiple Acute Infection by Anisakis: A Case Series.

    PubMed

    Shimamura, Yuto; Ishii, Naoki; Ego, Mai; Nakano, Kaoru; Ikeya, Takashi; Nakamura, Kenji; Takagi, Koichi; Fukuda, Katsuyuki; Fujita, Yoshiyuki

    2016-01-01

    The ingestion of raw seafood infected with nematode larvae of the Anisakidae family can lead to gastric anisakiasis. The majority of the infections involve a single larva, however, there have been instances of multiple infection. The incidence rate and the characteristics of multiple infection by Anisakis remain poorly understood. We herein present a case of parasitization by multiple Anisakis larvae and describe 14 cases of multiple parasitization representing the largest reported case series to date. Endoscopists should therefore be aware of the potential for multiple infection by Anisakis and the need for a thorough inspection of all parts of the stomach when encountering such cases.

  11. [Rapidly involuting congenital hemangiomas: twenty five case series].

    PubMed

    Larralde, Margarita; Solé, Juan Javier; Luna, Paula Carolina; Mosquera, Tomás; Abad, María Eugenia

    2014-04-01

    Rapidly involuting congenital hemangiomas are very rare vascular tumours, that are characterized for being completely developed at birth and for involuting in a short period of time after birth. We describe a case series of 25 patients with rapidly involuting congenital hemangiomas. Twelve patients were male and 13 female; they were all born at term. Lesions were small in 17 cases and big in 8. No patient needed active intervention and all lesions showed a rapid initial involution.

  12. Spontaneous Coronary Artery Dissection: Case Series from a Tertiary Centre.

    PubMed

    Anderson, Robert D; Jayadeva, Pavithra S; Wilson, William M; Iyer, Ravi

    2016-03-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of non-atherosclerotic acute coronary syndrome (ACS). As it is more commonly seen in young women, the diagnosis can be missed. Current evidence is based on case reports and retrospective studies with no consensus recommendations on immediate management and long-term follow-up. We present a case series of four patients to outline clinical presentation, prognosis and long-term management of this rare clinical entity.

  13. Vulvodynia: a case series of a poorly recognized entity.

    PubMed

    Patsatsi, A; Vavilis, D; Theodoridis, T D; Kellartzis, D; Sotiriadis, D; Tarlatzis, B C

    2012-01-01

    Vulvodynia remains a poorly recognized entity with unclear pathogenesis. In a case series of six patients with vulvodynia over a five-year period in a tertiary university hospital, we describe the clinical features, the diagnostic procedures, the impact on each patient's emotional status and discuss the necessity and efficacy of the chosen treatment options in accordance with the current therapeutic guidelines.

  14. Opaque intraocular lens implantation: a case series and lessons learnt.

    PubMed

    Lee, Richard Mh; Dubois, Vincent Djp; Mavrikakis, Ioannis; Okera, Salim; Ainsworth, Gerard; Vickers, Sarah; Liu, Christopher Sc

    2012-01-01

    To report the use of opaque intraocular devices in three patients with complex neuro-ophthalmic symptoms. A case series of three patients with neuro-ophthalmic symptoms requiring occlusion of one eye when alternative methods had failed to control symptoms. Morcher (Stuttgart, Germany) opaque intraocular implants were used in all patients. All three patients observed an improvement in symptoms following opaque intraocular device implantation. One patient (Case 2) required multiple devices for symptom relief. Opaque intraocular occlusive devices are an increasingly popular choice for clinicians in patients with intractable diplopia but we highlight their use in patients with other complex neuro-ophthalmic symptoms. We learned a number of useful lessons in these patients as summarized in this case series.

  15. Imatinib mesylate induced erythroderma: A rare case series.

    PubMed

    Kumar, Sumir; Mahajan, Bharat Bhushan; Kaur, Sandeep; Banipal, Raja Paramjeet Singh; Singh, Amarbir

    2015-01-01

    Imatinib is a tyrosine kinase inhibitor approved as a first line treatment for chronic myeloid leukemia and gastrointestinal stromal tumors. Usually the drug is well-tolerated with hematological adverse effects being most commonly seen. Dermatological side effects are seen in 9.5-69% of patients on imatinib; majority of which are minor and self-limiting. We, hereby, report a case series of erythroderma occurring secondary to imatinib in two patients with chronic myeloid leukemia. Both the patients improved upon the discontinuation of the drug. The literature review revealed only six probable cases of erythroderma due to imatinib. So, this case series is being reported for the rarity of this adverse effect of imatinib.

  16. Treatment of subclavian artery stenosis: A case series.

    PubMed

    Salman, Reem; Hornsby, Jane; Wright, Lucie J; Elsaid, Tarek; Timmons, Grace; Mudawi, Ahmed; Bhattacharya, Vish

    2016-01-01

    In this case series, different modalities of treatment for patients with ischaemic symptoms of subclavian stenosis are described, including the different operative strategies that can be adopted in more challenging cases. This is the first case series describing these four management options. Case 1: A seventy-one year-old female presented with acute on chronic ischaemia of her left arm following a fall and developed dry gangrene of her left thumb. This was initially managed with a heparin infusion followed by stenting of the subclavian artery which relieved her symptoms. Case 2: A fifty-nine year-old male presented with chronic ischemia of the left arm secondary to an occlusion of the left subclavian artery. This was managed by transposition of the left subclavian artery onto the left common carotid artery. Case 3: A sixty-four year-old female presented with left subclavian steal syndrome secondary to subclavian artery stenosis. She underwent carotid subclavian artery bypass. Case 4: A fifty-six year-old female presented with acute left upper limb ischaemia secondary to acutely thrombosed subclavian artery on a CT-angiography. She underwent a carotid to axillary bypass. This case series demonstrates the treatment options available to vascular surgeons when managing symptomatic subclavian artery disease. Symptomatic subclavian artery occlusive disease should be treated with endovascular stenting and angioplasty as first line management. If it is not successful then open surgery should be considered. Bypassing the carotid to the subclavian or to the axillary artery are both good treatment modalities. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. Treatment of subclavian artery stenosis: A case series

    PubMed Central

    Salman, Reem; Hornsby, Jane; Wright, Lucie J.; Elsaid, Tarek; Timmons, Grace; Mudawi, Ahmed; Bhattacharya, Vish

    2015-01-01

    Introduction In this case series, different modalities of treatment for patients with ischaemic symptoms of subclavian stenosis are described, including the different operative strategies that can be adopted in more challenging cases. This is the first case series describing these four management options. Presentation Case 1: A seventy-one year-old female presented with acute on chronic ischaemia of her left arm following a fall and developed dry gangrene of her left thumb. This was initially managed with a heparin infusion followed by stenting of the subclavian artery which relieved her symptoms. Case 2: A fifty-nine year-old male presented with chronic ischemia of the left arm secondary to an occlusion of the left subclavian artery. This was managed by transposition of the left subclavian artery onto the left common carotid artery. Case 3: A sixty-four year-old female presented with left subclavian steal syndrome secondary to subclavian artery stenosis. She underwent carotid subclavian artery bypass. Case 4: A fifty-six year-old female presented with acute left upper limb ischaemia secondary to acutely thrombosed subclavian artery on a CT-angiography. She underwent a carotid to axillary bypass. Discussion and conclusion This case series demonstrates the treatment options available to vascular surgeons when managing symptomatic subclavian artery disease. Symptomatic subclavian artery occlusive disease should be treated with endovascular stenting and angioplasty as first line management. If it is not successful then open surgery should be considered. Bypassing the carotid to the subclavian or to the axillary artery are both good treatment modalities. PMID:26722712

  18. Indications and Case Series of Intentional Replantation of Teeth

    PubMed Central

    Asgary, Saeed; Alim Marvasti, Laleh; Kolahdouzan, Alireza

    2014-01-01

    This case series aims to comprehensively introduce intentional replantation with a focus on its indications and case selection in endodontics. In all represented cases, calcium enriched mixture (CEM) cement is used for root-end filling. This case series demonstrates twenty cases of IR and extraoral root-end resection and filling with CEM cement. All the selected teeth had a failed endodontic treatment and required surgical/nonsurgical endodontic (re)treatment or extraction. Subsequent to gentle tooth extraction, an appropriate root-end cavity was prepared and filled with CEM cement. Then the tooth was replanted; maximun procedure time was 15 min. A total of 18 cases (90%) were successful over a mean follow-up period of 15.5 months. It can be concluded that intentional replantation with careful case selection can have a high success rate over 2 years. Intentional replantation may be a suitable treatment option for both trained general practitioners and specialists provided that the extraction is simple and straightforward. PMID:24396380

  19. Uterine rupture in pregnancies following myomectomy: A multicenter case series

    PubMed Central

    Kim, Hee-Sun; Oh, Soo-Young; Choi, Suk-Joo; Park, Hyun-Soo; Cho, Geum-Joon; Chung, Jin-Hoon; Seo, Yong-Soo; Jung, Sun-Young; Kim, Jung-Eun; Chae, Su-Hyun

    2016-01-01

    Objective The purpose of this case series was to retrospectively examine records of cases with uterine rupture in pregnancies following myomectomy and to describe the clinical features and pregnancy outcomes. Methods This study was conducted as a multicenter case series. The patient databases at 7 tertiary hospitals were queried. Records of patients with a diagnosis of uterine rupture in the pregnancy following myomectomy between January 2012 and December 2014 were retrospectively collected. The uterine rupture cases enrolled in this study were defined as follows: through-and-through uterine rupture or tear of the uterine muscle and serosa, occurrence from 24+0 to 41+6 weeks’ gestation, singleton pregnancy, and previous laparoscopic myomectomy (LSM) or laparotomic myomectomy (LTM) status. Results Fourteen pregnant women experienced uterine rupture during their pregnancy after LSM or LTM. Preterm delivery of less than 34 weeks’ gestation occurred in 5 cases, while intrauterine fetal death occurred in 3, and 3 cases had fetal distress. Of the 14 uterine rupture cases, none occurred during labor. All mothers survived and had no sequelae, unlike the perinatal outcomes, although they were receiving blood transfusion or treatment for uterine artery embolization because of uterine atony or massive hemorrhage. Conclusion In women of childbearing age who are scheduled to undergo LTM or LSM, the potential risk of uterine rupture on subsequent pregnancy should be explained before surgery. Pregnancy in women after myomectomy should be carefully observed, and they should be adequately counseled during this period. PMID:27896247

  20. Congenital vascular malformations: a series of five prenatally diagnosed cases.

    PubMed

    Connell, Fiona; Homfray, Tessa; Thilaganathan, Baskaran; Bhide, Amarnath; Jeffrey, Iona; Hutt, Renata; Mortimer, Peter; Mansour, Sahar

    2008-10-15

    In the literature there are single case reports of mediastinal/chest and limb combined vascular malformations (previously labeled "hemangiolymphangiomas"). A variable outcome in such prenatally diagnosed cases is reported. Presented here is the only series of patients reported with these macrocystic, predominantly lymphatic malformations. Prenatal ultrasound scan and post-mortem examination findings are described. In our experience the outcome has been poor and this highlights the dilemma faced by clinicians and parents when these lesions are diagnosed prenatally. We present a series of five, prenatally diagnosed vascular (combined vascular malformations and simple localized lymphatic malformations) malformations. Three cases had lower leg involvement with extension into the abdomen and two cases had lymphatic malformations of the chest wall with involvement of the upper limb(s). Management of a twin pregnancy, in which one twin was affected, is described. In two cases, termination of pregnancy was undertaken because of the extensive nature of the lesion. One case died in utero and one in the neonatal period. The fifth case is an 11-year-old boy, whose lower limb deformity illustrates the considerable morbidity associated with this condition. 2008 Wiley-Liss, Inc.

  1. Gravitationally bound BCS state as dark matter

    NASA Astrophysics Data System (ADS)

    Alexander, Stephon; Cormack, Sam

    2017-04-01

    We explore the possibility that fermionic dark matter undergoes a BCS transition to form a superfluid. This requires an attractive interaction between fermions and we describe a possible source of this interaction induced by torsion. We describe the gravitating fermion system with the Bogoliubov-de Gennes formalism in the local density approximation. We solve the Poisson equation along with the equations for the density and gap energy of the fermions to find a self-gravitating, superfluid solution for dark matter halos. In order to produce halos the size of dwarf galaxies, we require a particle mass of ~ 200 eV. We find a maximum attractive coupling strength before the halo becomes unstable. If dark matter halos do have a superfluid component, this raises the possibility that they contain vortex lines.

  2. Prenatal diagnosis of biliary atresia: A case series.

    PubMed

    Shen, O; Sela, H Y; Nagar, H; Rabinowitz, R; Jacobovich, E; Chen, D; Granot, E

    2017-08-01

    Biliary atresia is a progressive disease presenting with jaundice, and is the most common indication for liver transplantation in the pediatric population. Prenatal series have yielded conflicting results concerning a possible association between BA and prenatal nonvisualization of the gallbladder. This retrospective case series was performed to assess the association between biliary atresia, prenatal nonvisualization of the gallbladder and other sonographic signs. We identified biliary atresia patients who underwent a Kasai procedure by a single pediatric surgeon and/or follow up by a single pediatric gastroenterologist. Axial plane images and/or video recordings were scrutinized for sonographic signs of biliary atresia on the second trimester anomaly scan. Proportion of biliary atresia cases with prenatal sonographic signs. Twenty five charts of children with biliary and high quality prenatal images were retrieved. 6/25 (24%) of cases analyzed had prenatal nonvisualization of the gallbladder or a small gallbladder on the prenatal scan. Two cases had biliary atresia splenic malformation syndrome. None of the cases had additional sonographic markers of biliary atresia. Our study suggests that in addition to the well-established embryonic and cystic forms, an additional type can be suspected prenatally, which is characterized by prenatal nonvisualization of the gallbladder in the second trimester. This provides additional evidence that some cases of BA are of fetal rather than perinatal onset and may have important implications for prenatal diagnosis, for counseling and for research of the disease's etiology and pathophysiology. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Case series: non vascular considerations in trigeminal neuralgia.

    PubMed

    Balasundram, Sathesh; Cotrufo, Stefano; Liew, Colin

    2012-02-01

    An abnormal vascular course of the superior cerebellar artery is often cited as the cause for trigeminal neuralgia. However, among patients with TN-like symptoms, 6% to 16% are variously reported to have intracranial tumours. Aneurysms, tumours, or other lesions may impinge or irritate the trigeminal nerve along its course. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. We would like to present a series of unusual lesions, all of which initially presented with neuralgic-like symptoms and were refractory to treatment. Collated case series with photographs and imaging are reviewed in this paper. Discussion of case presentation and management are done for evaluation. A wide range of other compressive lesions can cause trigeminal neuralgia. This paper illustrates the clinical presentation of atypical trigeminal neuralgia and emphasises the value of diagnostic imaging in trigeminal neuralgia patient. Suggested algorithm for management of trigeminal neuralgia.

  4. Bestiality in Forensically Committed Sexual Offenders: A Case Series.

    PubMed

    Holoyda, Brian

    2017-03-01

    Although bestiality has occurred since prehistoric times, it remains a poorly understood aspect of human sexuality. Prevalence studies in the mid-20th century suggested that bestiality was a relatively common phenomenon. Since that time, researchers have studied bestiality among specific populations, including self-identified "zoophiles" and inmates who report a history of bestiality. Findings from inmate research suggest that bestiality may represent a risk factor for future interpersonal violence. This study presents a case series of bestiality among sexual offenders committed under forensic commitment schemes. The case series demonstrates the range of animal partners, sexual acts, and comorbid paraphilic and nonparaphilic diagnoses in individuals who report a history of bestiality. In addition, it helps clarify potential motivations for sex with animals and how such motivations may influence the forensic psychiatric assessment of offenders who have sex with animals.

  5. Color masking of developmental enamel defects: a case series.

    PubMed

    Torres, C R G; Borges, A B

    2015-01-01

    Developmental defects involving color alteration of enamel frequently compromise the esthetic appearance of the tooth. The resin infiltration technique represents an alternative treatment for color masking of these lesions and uniformization of tooth color. This technique is considered relatively simple and microinvasive, since only a minimal portion of enamel is removed. This article illustrates the color-masking effect with resin infiltration of fluorosis and traumatic hypomineralization lesions with a case series. The final esthetic outcomes demonstrated the ability of the resin infiltrant to mask the color of white developmental defect lesions, resulting in satisfactory clinical esthetic improvements. However, in more severe cases, the color-masking effect was not complete.

  6. Giant Inguinal Herniae Managed by Primary Repair: A Case Series

    PubMed Central

    Anand, Madhur; Naku, Narang; Hajong, Debobratta; Singh, K Lenish

    2017-01-01

    Giant inguinal hernia are usually found in developing countries due to delay in seeking medical attention. The management of such hernias may sometimes require procedures to increase the intra-peritoneal capacity prior to the repair of the giant hernia. Otherwise patients may develop abdominal compartment syndrome leading to various unwanted complications. Primary repair of giant hernias are possible in some cases without having significant post-operative complications. In this present case series, we have managed a total of four patients of giant inguinal hernia by primary repair without much post-operative complications. PMID:28384934

  7. Moulding Faces at an Early Age-A Case Series

    PubMed Central

    Sunny, Sunil; Mathew, Neethu; Parambath, Anvar Kizhakke; Madhusudanan, Amla

    2016-01-01

    Certain malocclusions have to be treated at an early age to avoid surgeries for the correction in the future. Introduction of functional appliances has reduced the elimination and correction of skeletal as well as dental discrepancies. Proper case selection taking into consideration skeletal and dental age with the use of various diagnostic aids helps us to identify and treat the malocclusions before it is too late. In this case series, we report three patients with skeletal jaw malrelationship treated with functional and orthopaedic appliances. PMID:27656599

  8. Frameless robotic stereotactic biopsies: a consecutive series of 100 cases.

    PubMed

    Lefranc, Michel; Capel, Cyrille; Pruvot-Occean, Anne-Sophie; Fichten, Anthony; Desenclos, Christine; Toussaint, Patrick; Le Gars, Daniel; Peltier, Johann

    2015-02-01

    Stereotactic biopsy procedures are an everyday part of neurosurgery. The procedure provides an accurate histological diagnosis with the least possible morbidity. Robotic stereotactic biopsy needs to be an accurate, safe, frameless, and rapid technique. This article reports the clinical results of a series of 100 frameless robotic biopsies using a Medtech ROSA device. The authors retrospectively analyzed their first 100 frameless stereotactic biopsies performed with the robotic ROSA device: 84 biopsies were performed by frameless robotic surface registration, 7 were performed by robotic bone fiducial marker registration, and 9 were performed by scalp fiducial marker registration. Intraoperative flat-panel CT scanning was performed concomitantly in 25 cases. The operative details of the robotic biopsies, the diagnostic yield, and mortality and morbidity data observed in this series are reported. A histological diagnosis was established in 97 patients. No deaths or permanent morbidity related to surgery were observed. Six patients experienced transient neurological worsening. Six cases of bleeding within the lesion or along the biopsy trajectory were observed on postoperative CT scans but were associated with transient clinical symptoms in only 2 cases. Stereotactic surgery was performed with patients in the supine position in 93 cases and in the prone position in 7 cases. The use of fiducial markers was reserved for posterior fossa biopsy via a transcerebellar approach, via an occipital approach, or for pediatric biopsy. ROSA frameless stereotactic biopsies appear to be accurate and safe robotized frameless procedures.

  9. Posterior Epidural Migration of Sequestrated Cervical Disc Fragment: Case Series

    PubMed Central

    Kumar, Gopalan Senthil; Mahesha, Kanthila Bhat

    2011-01-01

    Study Design A retrospective study was undertaken to delineate the characteristics of non-traumatic sequestrated epidurally migrated cervical disc prolapse. Purpose To present first case series of eight such cases diagnosed preoperatively and to discuss their magnetic resonance imaging (MRI) characteristics and their management. Overview of Literature Non-traumatic spontaneous migration of the sequestrated disc fragment epidurally behind cervical vertebral body is rare. Only ten cases have been reported in literature. Methods Detailed clinico-radiological profiles of these 8 cases are presented. In six cases their clinical picture was suggestive of cervical myelopathy. MRI scan showed single level epidural migrated disc behind body of C4, C6, and C7 in six patients and two cases with multiple levels (C5-C6). In six cases, anterior corpectomy with excision of the disc was performed and the seventh patient underwent dorsal laminectomy. The eighth patient chose not to undergo surgery. Results T1 images of the MRI scan showed an isointense signal in all the 8 cases. T2 images revealed a varying intensity. In six cases who underwent anterior corpectomy, there was a rent in the posterior longitudinal ligament. Among those in two cases multiple disc fragments were seen. In the rest four cases, a single large fragment was observed. These patients improved after anterior corpectomy and disc excision. There was no improvement in the patient who had undergone dorsal laminectomy. The eighth patient who refused surgery progressively deteriorated. Conclusions We opine that MRI scan especially T1 images are useful in these cases. We prefer to treat these cases through anterior corpectomy with excision of the sequestrated disc which proved to result in excellent outcome. PMID:22164316

  10. Posterior epidural migration of sequestrated cervical disc fragment: case series.

    PubMed

    Srinivasan, Uddanapalli Sreeramulu; Kumar, Gopalan Senthil; Mahesha, Kanthila Bhat

    2011-12-01

    A retrospective study was undertaken to delineate the characteristics of non-traumatic sequestrated epidurally migrated cervical disc prolapse. To present first case series of eight such cases diagnosed preoperatively and to discuss their magnetic resonance imaging (MRI) characteristics and their management. Non-traumatic spontaneous migration of the sequestrated disc fragment epidurally behind cervical vertebral body is rare. Only ten cases have been reported in literature. Detailed clinico-radiological profiles of these 8 cases are presented. In six cases their clinical picture was suggestive of cervical myelopathy. MRI scan showed single level epidural migrated disc behind body of C4, C6, and C7 in six patients and two cases with multiple levels (C5-C6). In six cases, anterior corpectomy with excision of the disc was performed and the seventh patient underwent dorsal laminectomy. The eighth patient chose not to undergo surgery. T1 images of the MRI scan showed an isointense signal in all the 8 cases. T2 images revealed a varying intensity. In six cases who underwent anterior corpectomy, there was a rent in the posterior longitudinal ligament. Among those in two cases multiple disc fragments were seen. In the rest four cases, a single large fragment was observed. These patients improved after anterior corpectomy and disc excision. There was no improvement in the patient who had undergone dorsal laminectomy. The eighth patient who refused surgery progressively deteriorated. We opine that MRI scan especially T1 images are useful in these cases. We prefer to treat these cases through anterior corpectomy with excision of the sequestrated disc which proved to result in excellent outcome.

  11. Delusional parasitosis with folie à deux: A case series.

    PubMed

    Sawant, Neena Sanjiv; Vispute, Chetan Dilip

    2015-01-01

    Delusional parasitosis (DP) is characterized by single hypochondriacal delusion in which patient feels he/she is infested with insects. The authors present a case series of three cases of DP with shared psychotic disorder (folie à deux) in which one individual developed a delusional belief in the context of a close relationship with another person or people who already had an established delusional idea. All patients of DP were assessed in the outpatient department of Psychiatry of a tertiary care hospital. Diagnosis of DP was made on detail clinical history and supporting clinical findings. All our primary cases had DP and the accompanying relatives of our patients had folie à deux as they shared the belief of parasite infestation which was firm and persisted despite evidence to the contrary. The primary cases of delusional parasitosis responded well to oral risperidone. The intensity of the belief in the secondary person also reduced with improvement in the symptoms of the patients.

  12. Delusional parasitosis with folie à deux: A case series

    PubMed Central

    Sawant, Neena Sanjiv; Vispute, Chetan Dilip

    2015-01-01

    Delusional parasitosis (DP) is characterized by single hypochondriacal delusion in which patient feels he/she is infested with insects. The authors present a case series of three cases of DP with shared psychotic disorder (folie à deux) in which one individual developed a delusional belief in the context of a close relationship with another person or people who already had an established delusional idea. All patients of DP were assessed in the outpatient department of Psychiatry of a tertiary care hospital. Diagnosis of DP was made on detail clinical history and supporting clinical findings. All our primary cases had DP and the accompanying relatives of our patients had folie à deux as they shared the belief of parasite infestation which was firm and persisted despite evidence to the contrary. The primary cases of delusional parasitosis responded well to oral risperidone. The intensity of the belief in the secondary person also reduced with improvement in the symptoms of the patients. PMID:26257494

  13. Pediatric migraine with aura in an Italian case series.

    PubMed

    Taga, Arens; Russo, Marco; Genovese, Antonio; Paglia, Maria Vittoria; Manzoni, Gian Camillo; Torelli, Paola

    2017-05-01

    The aim of the present study was to describe the characteristics of migraine with aura (MwA) in a case series of patients with headache onset before 12 years of age. We considered all consecutive patients referred to the Parma Headache Centre between 1975 and 2015 affected by MwA, diagnosed by our team of trained neurologists; the cases were subsequently reviewed applying the ICHD3-beta criteria. We then identified those cases with headache age-of-onset <12 years (i.e., "pediatric" cases), which were compared to all remaining cases. We identified 283 cases with pediatric onset (87 males and 196 females). The male-to-female ratio was 1:2.3 in both "pediatric" and "non-pediatric" cases. The time lag between MwA onset and our first evaluation was significantly higher among the pediatric cases (18.7 ± 13.3 vs 10.4 ± 10.4 years). In both groups of patients, visual aura was the most common type of aura, followed by sensory and speech disturbances; however, these two latter aura symptoms were significantly more common among pediatric cases. In this group of patients, aura without headache was significantly less frequent (1.8 vs 5.3%); furthermore, headache had migraine characteristics in a higher proportion of cases (90.1 vs 82.6%). A family history of MwA was significantly more frequent among cases with pediatric onset (31.1 vs 16.9%). Males but not females with pediatric MwA had more frequently a comorbid migraine without aura (27.6 vs 16.8%). Among cases with pediatric onset, we did not find any significant differences between males and females. In conclusion, in our very large case series of MwA, patients with headache onset before 12 years of age seem to have a specific clinical phenotype, without significant gender differences.

  14. Bacteriophage treatment of intransigent diabetic toe ulcers: a case series.

    PubMed

    Fish, R; Kutter, E; Wheat, G; Blasdel, B; Kutateladze, M; Kuhl, S

    2016-07-01

    Diabetic foot ulcer (DFU) infections are a growing public health problem, with increasing prevalence, poor response to antibiotics and bacterial resistance to traditional antimicrobials leading to increased morbidity and mortality. Bacteriophages (phages), the viruses that target specific bacteria, are one option for addressing bacterial infections, especially where antibiotics fail. Of particular value is a class of virulent staphylococcal phages that hit almost all Staphylococcus aureus, including most methicillin-resistant Staphylococcus aureus (MRSA) strains. Here we report a continuous case series assessing the effectiveness of treating infected and poorly vascularised toe ulcers with exposed bone, after failure of recommended antibiotic therapy, using topically applied Staphylococcus aureus-specific phage. This was a compassionate-use case series of nine patients with diabetes and poorly perfused toe ulcers containing culture-proven Staphylococcus aureus infected bone and soft tissue, who had responded poorly to recommended antibiotic therapy. Six representative cases are presented here. The only generally accepted other option in each case was toe amputation. Exposed portions of the infected phalanges were removed in three cases and left in place in two cases. One case presented as a micro-clot induced gangrene following vascular stenting. In this case, phage were used to prevent infection. The phage used was a commercially available fully sequenced preparation of staphylococcal phage Sb-1. Phage solution was applied topically to the ulcerations once weekly, following standard good wound care. The amount of phage solution applied varied from 0.1 to 0.5 cc depending on volume and area of the ulceration. All infections responded to the phage applications and the ulcers healed in an average of seven weeks with infected bone debridement. One ulcer, where vascularity was extremely poor and bone was not removed to preserve hallux function, required 18 weeks of

  15. Infiltrating lipomatosis of the face: A case series

    PubMed Central

    Urs, Aadithya B.; Augustine, Jeyaseelan; Kumar, Priya; Arora, Shelly; Aggarwal, Neha; Sultana, Neha

    2013-01-01

    Infiltrating lipomatosis of the face is a very rare entity which is characterized by the collection of non-encapsulated mature adipocytes infiltrating local tissues, resulting in craniofacial deformities. Psychomotor development of the patients is normal, esthetics often being the primary concern to seek treatment. The presentation is always unilateral with hypertrophy of hard and soft structures on the affected side of the face. The pathogenesis of the condition is unclear. This condition shows a wide phenotypic range, uncertain prognosis with high rates of recurrence after surgery, and variable post-op cosmetic improvement. The condition shows no gender predilection, with most of the cases presenting in and beyond the second decade of life. Here, we present a series of four cases presenting in varying age groups with history of recurrence in three cases. PMID:23633877

  16. Varieties of misdiagnosis in ASD: an illustrative case series.

    PubMed

    Van Schalkwyk, Gerrit I; Peluso, Francesco; Qayyum, Zheala; McPartland, James C; Volkmar, Fred R

    2015-04-01

    The relationship between autism spectrum disorders (ASD) and psychotic disorders (PD) is a focus of continued interest. There are substantial conceptual and clinical difficulties associated with diagnosing comorbid PD in individuals who have ASD. In this case series, we report on five cases where adolescents with previously diagnosed ASD were also diagnosed as psychotic. In each case, we found that these patients' 'psychotic' symptoms could be better understood as a part of their underlying ASD diagnosis, with significant implications for treatment, prognosis, and access to services. This misdiagnosis likely represents a combination of adult psychiatrists being relatively inexperienced with this population, and the system of care requiring providers to apply diagnostic labels to justify inpatient hospitalization.

  17. Recalcitrant Trichomonas vaginalis infection--a case series.

    PubMed

    Waters, L J; Dave, S S; Deayton, J R; French, P D

    2005-07-01

    The objective of this study was (1) to estimate the prevalence of recalcitrant Trichomonas vaginalis (TV) infection in a UK genitourinary medicine clinic; (2) to use a case series and literature review to suggest an algorithm for management of recalcitrant TV (rTV). A retrospective review of laboratory records, case-notes and literature review was conducted. Fifteen patients were studied, representing 1.16% of the cases presenting during the study period. A wide variety of therapeutic agents was used, the treatment regimen differed for each patient. No treatment was universally effective in achieving cure, but the use of acetarsol pessaries vaginally appeared to be the most frequently successful strategy. Based on these results, an algorithm for treatment of rTV is presented, although clinical trials will be needed to elucidate the best clinical approaches to this problem.

  18. Left cardiac sympathetic denervation: case series and technical report.

    PubMed

    McNamara, C; Cullen, P; Rackauskas, M; Kelly, R; O'Sullivan, K E; Galvin, J; Eaton, D

    2017-02-25

    Left cardiac sympathetic denervation (LCSD) is a surgical procedure that has been shown to have an antiarrhythmic and antifibrillatory effect. Evidence indicating its antiarrhythmic effect has been available for over 100 years. It involves the removal of the lower half of the stellate ganglion and T2-T4 of the sympathetic ganglia and is carried out as either a unilateral or bilateral procedure. With advancements in thoracic surgery, it can be safely performed via a minimally invasive Video-Assisted Thoracoscopic Surgery (VATS) approach resulting in significantly less morbidity and a shortened inpatient stay. LCSD provides a valuable treatment option for patients with life-threatening channelopathies and cardiomyopathies. This case series reports the preliminary paediatric and adult experience in the Republic of Ireland with LCSD and describes five cases recently treated in addition to an outline of the operative procedure employed. Of the five cases included, two were paediatric cases and three were adult cases. One of the paediatric patients had a diagnosis of the rare catecholaminergic polymorphic ventricular tachycardia (CPVT) and the other a diagnosis of long-QT syndrome. Both paediatric patients experienced excellent outcomes. Of the three adult patients, two benefitted greatly and remain well at follow-up (one inappropriate sinus tachycardia and one CPVT). One patient with idiopathic ventricular fibrillation unfortunately passed away from intractable VF despite all attempts at resuscitation. In this case series, we highlight that LCSD provides a critical adjunct to existing medical therapies and should be considered for all patients with life-threatening refractory arrhythmias especially those patients on maximal medical therapy.

  19. Cannabis-related stroke: case series and review of literature.

    PubMed

    Singh, Niranjan N; Pan, Yi; Muengtaweeponsa, Sombat; Geller, Thomas J; Cruz-Flores, Salvador

    2012-10-01

    Marijuana, or cannabis, is one of the most commonly used illicit drugs worldwide. Although there are some case reports of stroke associated with cannabis use, there is no information on a causal role of cannabis in stroke. We identified 14 patients admitted to St Louis University Hospital between January 2004 and July 2007 with ischemic stroke who had documented clear exposure to cannabis during or before symptom onset and a positive urine screen for cannabis. We report this series, along with 3 cases previously reported by our group, for a total of 17 patients (13 men and 4 women), with a mean age of 41 years (range, 15-63 years). Nine patients were under age 45 years, 4 had a history of hypertension, and 10 sustained stroke in the posterior circulation. Headache, dysarthria, and ataxia were the most common presenting symptoms. Five patients had recurrent stroke with reexposure to cannabis. No patient had a prothrombotic state or cardiac source of embolism. Autopsy performed in 2 patients revealed hemorrhagic infarct with no evidence of vasculitis or embolus. The absence of other vascular risk factors in most of our patients, the temporal relation of symptom onset to cannabis exposure, and the recurrence of symptoms in a few patients with reexposure suggest a causal role of cannabis in these cases of ischemic stroke. However, this causal association cannot be definitely ascertained, given the descriptive nature of our series. More research is needed to explore this possible causal association.

  20. SLE and Tuberculosis: A Case Series and Review of Literature

    PubMed Central

    Jamil, Md; Roy, Aakash; Talukdar, Kishore Kumar

    2017-01-01

    Systemic Lupus Erythematosus (SLE) and Tuberculosis (TB) are intricately related with an increase in the risk of TB in SLE. Primary mechanisms pertaining to the increased susceptibility for TB are the inherent immunodeficient state of SLE and use of immunosuppressant agents in the treatment of SLE. We report a case series of five female patients of SLE with TB who presented between January 2015 and December 2015 in a tertiary care teaching hospital in North Eastern India. All the patients were young to middle aged females having SLE with or without lupus nephritis who were on immunosuppressive therapy with corticosteroids, mycophenolate mofetil or cyclophosphamide. Two of the cases had sputum positive pulmonary tuberculosis while rest had Extra-Pulmonary TB (EPTB). The response to anti-tubercular therapy led to clinical improvement in all the cases except one who had an adverse outcome. Our series further substantiates the increased risk of TB in SLE thus, prompting further research towards better management of these two disease entities in conjunction.

  1. Toxin-induced chemosensory dysfunction: A case series and review

    PubMed Central

    Smith, Wendy M.; Davidson, Terence M.; Murphy, Claire

    2013-01-01

    Background Toxic chemical exposures are estimated to account for 1–5% of all olfactory disorders. Both olfactory neurons and taste buds are in direct contact with environmental agents because of their relatively unprotected anatomic locations, thereby making them susceptible to damage from acute and chronic toxic exposures. The aim of this study was to illustrate different aspects of the diagnostic and therapeutic approach to this disorder using a series of case reports and review of the literature. Methods Cases were selected for inclusion based on a retrospective chart review of patients who presented to a university-based nasal dysfunction clinic with toxin-induced olfactory or gustatory dysfunction between January 1985 and December 2008. Workup included complete history, otolaryngologic examination, psychophysical testing, and imaging. Results Patient ages ranged from 31 to 67 years (mean, 49.3 years). Etiology of chemosensory impairment included exposure to ammonia, isodecanes, hairdressing chemicals, chemotherapy, gasoline, and intranasal zinc. Five of the seven patients (71%) presented with olfactory dysfunction alone, one patient (14%) presented with dysgeusia alone, and one patient (14%) presented with both smell and taste loss. Only one patient (14%) reported parosmias. Tests of olfaction revealed normosmia in one patient (14%), mild-to-moderate hyposmia in one patient (14%), and severe hyposmia to anosmia in five patients (72%). Both patients who reported taste disorders had hypogeusia on testing. Conclusion This case series illustrates the wide spectrum of this disorder and provides a framework for the workup and treatment of these patients. PMID:19958605

  2. Management of Ectopically Erupting Maxillary Incisors: A Case Series.

    PubMed

    Suresh, Kotumachagi Sangappa; Uma, H L; Nagarathna, J; Kumar, Pravin

    2015-01-01

    Eruption disturbances related to the position include ectopic eruption and transpositions. The occurrence of ectopic eruption is most commonly associated with maxillary incisors. The normal eruption, position and morphology of these teeth are crucial to craniofacial development, facial esthetics as well as phonetics. It is essential that the clinicians have thorough knowledge of the eruption disturbances in order to make an appropriate, as well as timely intervention, as dictated by the complexity of the problem. How to cite this article: Suresh KS, Uma HL, Nagarathna J, Kumar P. Management of Ectopically Erupting Maxillary Incisors: A Case Series. Int J Clin Pediatr Dent 2015;8(3):227-233.

  3. Effect of captopril on infantile haemangiomas: a retrospective case series.

    PubMed

    Christou, Elizabeth M; Wargon, Orli

    2012-08-01

    The mechanism of action of beta adrenergic blockers in the involution of infantile haemangioma (IH) remains unclear. It has been proposed that the renin-angiotensin pathway may play a role. We present a retrospective case series of 17 patients with IH who were treated with oral corticosteroid therapy and developed hypertension requiring treatment with the angiotensin converting enzyme inhibitor, captopril. All patients, with written documentation, demonstrated an improvement in their lesion at the start of oral corticosteroid therapy (n = 14). Captopril alone did not sustain the corticosteroid-induced involution with a documented worsening of infantile haemangioma in seven out of 12 patients (58%).

  4. Phenobarbital-responsive sialadenosis in dogs: case series.

    PubMed

    Alcoverro, Emili; Tabar, Maria Dolores; Lloret, Albert; Roura, Xavier; Pastor, Josep; Planellas, Marta

    2014-12-01

    Phenobarbital-responsive sialadenosis (PRS) is a rare idiopathic disease in dogs. Vomiting, retching, and gulping with bilateral enlargement of the submandibular salivary glands are the more frequent clinical signs. A thorough diagnostic examination must be performed to rule out the most important systemic etiologies involved with chronic vomiting, as there is no specific test to diagnose PRS. Diagnosis is confirmed clinically by a rapid and dramatic improvement of clinical signs after instauration of phenobarbital treatment. The aim of this article is to describe the clinical presentation, diagnostic findings, and outcome of a case series of 4 dogs with presumptive PRS.

  5. Case Series of Synthetic Cannabinoid Intoxication from One Toxicology Center

    PubMed Central

    Katz, Kenneth D.; Leonetti, Adam L.; Bailey, Blake C.; Surmaitis, Ryan M.; Eustice, Eric R.; Kacinko, Sherri; Wheatley, Scott M.

    2016-01-01

    Synthetic cannabinoid use has risen at alarming rates. This case series describes 11 patients exposed to the synthetic cannabinoid, MAB-CHMINACA who presented to an emergency department with life-threatening toxicity including obtundation, severe agitation, seizures and death. All patients required sedatives for agitation, nine required endotracheal intubation, three experienced seizures, and one developed hyperthermia. One developed anoxic brain injury, rhabdomyolysis and died. A significant number were pediatric patients. The mainstay of treatment was aggressive sedation and respiratory support. Synthetic cannabinoids pose a major public health risk. Emergency physicians must be aware of their clinical presentation, diagnosis and treatment. PMID:27330661

  6. Anterior Segment Findings in Vitamin A Deficiency: A Case Series

    PubMed Central

    Rubino, Pierangela; Mora, Paolo; Ungaro, Nicola; Gandolfi, Stefano A.; Orsoni, Jelka G.

    2015-01-01

    Vitamin A deficiency is a rare but vision threatening disorder in the developed world, which can lead to blindness for severe keratomalacia with cornea scarring and perforation or night blindness due to impaired dark adaptation. Conversely, the disease is quite common in developing countries, as a consequence of chronic malnutrition. The correct diagnosis and therapy with prompt vitamin A supplementation avoid blindness. We report a series of 3 local cases with different age and causes for vitamin A deficiency. The diagnostic workup, therapy, and prognosis are discussed. PMID:26509090

  7. Brucella endocarditis – A series of five case reports

    PubMed Central

    Raju, I. Tammi; Solanki, Rachana; Patnaik, A.N.; Barik, R.C.; Kumari, N.R.; Gulati, A.S.

    2013-01-01

    Endocarditis due to brucellosis is considered a rare occurrence involving native, congenital and prosthetic valves. The diagnosis needs high degree of suspicion in culture negative endocarditis especially in those with history of exposure to farm animals. A positive culture in a susceptible patient confirms the diagnosis with 91% sensitivity. An early diagnosis and prompt treatment with appropriate antibiotics can restore the valve structural integrity with minimal damage. Here we present a series of five cases of culture proven Brucella endocarditis (four native valves, one prosthetic valve) and this report discusses the diagnostic and management issues involved. PMID:23438616

  8. Fabry's Disease: Case Series and Review of Literature

    PubMed Central

    Wani, Muzaffar Maqsood; Khan, Imran; Bhat, Riyaz Ahmad; Ahmad, Muzaffar

    2016-01-01

    Fabry's disease is an X-linked lysosomal storage disorder caused by a deficiency of alpha-galactosidase A enzyme with the progressive accumulation of globotriaosylceramide in vascular endothelial cells leading to cardiovascular, renal, gastrointestinal, neuropathic, lenticular, and dermatological manifestations. It is a rare cause of end-stage renal disease. It classically affects males whereas 10–15% of female heterozygote carriers are affected depending on localization. Both the FD and its association with ESRD is rare. With this background, this case series of five patient's along with the review of literature is presented here. PMID:27398254

  9. Gorlin-Goltz syndrome: A series of three cases.

    PubMed

    Patankar, Amod P; Kshirsagar, Rajesh A; Dugal, Arun; Mishra, Akshay; Ram, Hari

    2014-01-01

    The Gorlin-Goltz syndrome (GGS) is also known as nevoid basal cell carcinoma syndrome. It is characterized by multiple keratocystic odontogenic tumors (KCOTs) in the jaw, multiple basal cell nevi carcinomas and skeletal abnormities. The syndrome may be diagnosed early by a dentist during the routine radiographic exams in the first decade of life, since the KCOTs are usually one of the first manifestations of the syndrome. This article reports the series of 3 cases, emphasizing its clinical and radiographic manifestations of GGS.

  10. Management of Ectopically Erupting Maxillary Incisors: A Case Series

    PubMed Central

    Suresh, Kotumachagi Sangappa; Uma, HL; Nagarathna, J

    2015-01-01

    ABSTRACT Eruption disturbances related to the position include ectopic eruption and transpositions. The occurrence of ectopic eruption is most commonly associated with maxillary incisors. The normal eruption, position and morphology of these teeth are crucial to craniofacial development, facial esthetics as well as phonetics. It is essential that the clinicians have thorough knowledge of the eruption disturbances in order to make an appropriate, as well as timely intervention, as dictated by the complexity of the problem. How to cite this article: Suresh KS, Uma HL, Nagarathna J, Kumar P. Management of Ectopically Erupting Maxillary Incisors: A Case Series. Int J Clin Pediatr Dent 2015;8(3):227-233. PMID:26604543

  11. Observed outcomes on the use of oxidized and regenerated cellulose polymer for breast conserving surgery – A case series

    PubMed Central

    Rassu, Pier Carlo

    2015-01-01

    Background Oxidized regenerated cellulose polymer (ORCP) may be used for reshaping and filling lack of volume in breast-conserving surgery (BCS). The study aimed to observe both the aesthetic and diagnostic outcomes in patients with different age, BMI, breast volume, and breast tissue composition over 36 months after BCS with ORCP. Patients and methods 18 patients with early breast cancer and with proliferative benign lesions underwent BCS with ORCP that was layered in three-dimensional wafer, and placed into the Chassaignac space between the mammary gland and the fascia of pectoralis major with no fixation. After surgery, patients started a clinical and instrumental 36-month follow-up with mammography, ultrasonography, magnetic resonance imaging (MRI) and cytological examination with fine needle aspiration when seroma occurred. Results Below the median age of 66 years old no complications were observed even in case both of overweight, and large breasts with low density. Over the median age seromas occurred with either small or large skin retraction, with the exception of 1 patient having quite dense breasts and low BMI, which had no complications. In elderly patients, 1 case with quite dense breasts and high BMI showed severe seroma and skin retraction, while 1 case with low BMI and less dense breasts highlighted milder complications. Conclusion During 36 months after BCS with ORCP, a significant correlation between positive diagnostic and aesthetic outcomes and low age, dense breasts, and low BMI of patient was observed. Despite of the few number of cases, either low BMI, or high breast density improved the aesthetic outcomes and reduced the entity of complications even in the elderly patients. PMID:26865976

  12. Hepatotoxicity Due To Hydroxycut®: A Case Series

    PubMed Central

    Fong, Tse-Ling; Klontz, Karl C.; Canas-Coto, Alejandro; Casper, Steven J.; Durazo, Francisco A.; Davern, Timothy J.; Hayashi, Paul; Lee, William M.; Seeff, Leonard B.

    2013-01-01

    Background Muscletech Hydroxycut® (Iovate Health Sciences Research, Oakville, Ontario) was a popular weight loss supplement that was recalled by the manufacturer in May 2009 based on reports of hepatotoxicity associated with this supplement. Objective To characterize the clinical presentation of Hydroxycut®-associated liver injury and to adjudicate these cases for causal association with Hydroxycut®. Design Case series. Setting Academic tertiary care hospitals and FDA databases. Measurements Assessment of causality and grading of severity of liver injury using methodology developed by the Drug-Induced Liver Injury Network (DILIN) study. Results Eight patients who developed liver injury after taking Hydroxycut treated at different medical centers were identified. All were hospitalized and 3 of 8 patients required liver transplantation. Nine other cases with adequate clinical information were obtained from the FDA MedWatch database including one fatal case of acute liver failure. Usual symptoms were jaundice, fatigue, nausea, vomiting and abdominal pain. Most patients exhibited a hepatocellular pattern of injury. Adjudication for causality revealed 8 cases as definite, 5 highly likely, 2 probable and 2 were considered as possible. Conclusions Hydroxycut® has been clearly implicated as a cause for severe liver injury that may lead to acute liver failure and death. Weight loss supplements represent a class of dietary supplements that should be regarded as capable of causing severe hepatic toxicity when the usual causes of identified liver injury cannot be otherwise elucidated. PMID:20104221

  13. Mini-Implants, Mega Solutions: A Case Series.

    PubMed

    Kumari, Pooja; Verma, Mahesh; Sainia, Vikrant; Gupta, Ankur; Gupta, Rekha; Gill, Shubhra

    2016-12-01

    Dental implants have evolved as a standard of care for replacement of missing teeth. Though this treatment modality promises a high level of patient satisfaction and success, it cannot be performed in all cases. Apart from medically compromised patients, implant use is also restricted whenever there is limited available bone volume at the edentulous site. An example includes the mandibular incisor, the maxillary lateral incisor region, and other sites with reduced interdental spacing and atrophic edentulous maxillary and mandibular ridges. Bone volume at some of these sites can be increased by suitable augmentation procedure for placement of a regular diameter implant (3.75 to 4.2 mm). But many a times such procedure cannot be undertaken either due to financial constraint, risk of subjecting the patient to additional surgical procedure, added time factor, or guarded prognosis of the grafted site. In such cases, mini-implants can be used. In this case series, mini-implants (2.5 to 3 mm) were used to replace teeth in all mouth quadrants and to retain a mandibular overdenture in a compromised case. The implants served well at all the sites with minimal bone loss and a high level of patient satisfaction. Mini-implants hold the potential to serve as an alternate to regular diameter implants in certain situations. Preferably they should be used in multiples to retain fixed dental prostheses and might serve as an efficient, low-cost solution for retaining overdentures in selected cases.

  14. Psychiatric presentation of childhood epilepsy: Case series and review

    PubMed Central

    Saha, Rahul; Srivastava, M. K.; Anand, Kuljeet Singh

    2016-01-01

    Childhood-onset epilepsy has a varied presentation and may have different etiological factors. A multiaxial diagnostic approach should be used before making treatment and management decisions for any individual patient. It is widely accepted that distinction among primary psychiatric disorders, epilepsy, and nonepileptic seizures is a challenge for physicians. This case series demonstrated the identification of three atypical presentations of seizures in children on the basis of detailed history taking and electroencephalogram findings, despite having normal findings in neurological examination and magnetic resonance imaging. We report three rare cases of atypical presentation in epilepsy in patients with symptoms of episodic hallucinations, rage attacks, and secondary enuresis. Clinically, the diagnosis of epilepsy can be strengthened by paying sufficient attention to detailed history and symptom spectrum of partial epilepsy. PMID:28217169

  15. Congenital Chikungunya Virus Infection in Sincelejo, Colombia: A Case Series.

    PubMed

    Villamil-Gómez, Wilmer; Alba-Silvera, Luz; Menco-Ramos, Antonio; Gonzalez-Vergara, Alfonso; Molinares-Palacios, Tatiana; Barrios-Corrales, María; Rodríguez-Morales, Alfonso J

    2015-10-01

    Congenital chikungunya virus (CHIK) infection has been infrequently reported, even more so during the current 2013-15 outbreak in Latin America. In this study, the consequences of CHIK on pregnancy outcomes and particularly consequences in infants born to infected women were assessed in a case series from a single private institution in the north of Colombia. During September 2014 to February 2015, seven pregnant women with serological and reverse transcription-polymerase chain reaction-positive test for CHIK delivered eight infants with CHIK. These newborns required admission to pediatric intensive care, and related support, owing to severe clinical manifestations, which included respiratory distress, sepsis, necrotizing enterocolitis, meningoencephalitis, myocarditis, edema, bullous dermatitis and pericarditis. There were three deaths (case fatality rate of 37.5%). Pregnant women and newborns with CHIK long term should be followed up, given the implications of chronic sequelae (e.g. chronic inflammatory rheumatism in women) as well as recently described neurocognitive impairment in infants.

  16. Acute sterile endophthalmitis following intravitreal bevacizumab: case series

    PubMed Central

    Orozco-Hernández, Axel; Ortega-Larrocea, Ximena; Sánchez-Bermúdez, Gustavo; García-Aguirre, Gerardo; Cantón, Virgilio Morales; Velez-Montoya, Raul

    2014-01-01

    Background Since the ophthalmological community adopted the use of intravitreal bevacizumab as an accepted off-label treatment for neovascular diseases, the amount of knowledge regarding its effects and properties has been increasing continually. In the last few years, there have been an increasing number of reports about sterile intraocular inflammation and intraocular pressure elevations after intravitreal bevacizumab. In the following case series, we describe the clinical presentation and outcomes of ten consecutive cases of patients developing mild-to-severe sterile intraocular inflammation after intravitreal bevacizumab and their management. Methods This report presents a retrospective case series. We reviewed the medical records of ten consecutive patients from a group of 46, in whom repackaged bevacizumab in individual aliquots from two vials from the same batch were used. All surgical procedures were performed using standard sterile techniques in the operating room. At each follow-up visit, patients underwent a complete ophthalmological examination including visual acuity assessment, intraocular pressure, biomicroscopy, and posterior fundus examination. Results Ten patients presented sterile endophthalmitis with an onset time of 3.5±1.95 days. The clinical characteristics were mild pain, slight visual loss, conjunctival hyperemia, and various degrees of intraocular inflammation with microhypopyon. All cultures were negative. All patients were managed with topical steroids and antibiotics, except two, in whom, due to severe vitreous cells, intravitreal antibiotics were used. Three patients showed a transient elevation of intraocular pressure. Only 50% of the patients regained a visual acuity equal or better to the baseline visual acuity on file. Conclusion The increasing number of intravitreal injections of bevacizumab applied every day, due to its widespread acceptance, might be one reason why the number of cases of sterile endophthalmitis is rising. Fast

  17. Nystagmus in Enlarged Vestibular Aqueduct: A Case Series

    PubMed Central

    White, Judith; Krakovitz, Paul

    2015-01-01

    Enlarged vestibular aqueduct (EVA) is one of the commonly identified congenital temporal bone abnormalities associated with sensorineural hearing loss. Hearing loss may be unilateral or bilateral, and typically presents at birth or in early childhood. Vestibular symptoms have been reported in up to 50% of affected individuals, and may be delayed in onset until adulthood. The details of nystagmus in patients with EVA have not been previously reported. The objectives were to describe the clinical history, vestibular test findings and nystagmus seen in a case series of patients with enlarged vestibular aqueduct anomaly. Chart review, included computed tomography temporal bones, infrared nystagmography with positional and positioning testing, caloric testing, rotary chair and vibration testing. Clinical history and nystagmus varied among the five patients in this series. All patients were initially presumed to have benign paroxysmal positional vertigo, but repositioning treatments were not effective, prompting referral, further testing and evaluation. In three patients with longstanding vestibular complaints, positional nystagmus was consistently present. One patient had distinct recurrent severe episodes of positional nystagmus. Nystagmus was unidirectional and horizontal. In one case horizontal nystagmus was consistently reproducible with seated head turn to the affected side, and reached 48 d/s. Nystagmus associated with enlarged vestibular aqueduct is often positional, and can be confused with benign paroxysmal positional vertigo. Unexplained vestibular symptoms in patients with unilateral or bilateral sensorineural hearing loss should prompt diagnostic consideration of EVA. PMID:26557362

  18. Intensive outpatient comprehensive behavioral intervention for tics: A case series.

    PubMed

    Blount, Tabatha H; Lockhart, Ann-Louise T; Garcia, Rocio V; Raj, Jeslina J; Peterson, Alan L

    2014-10-16

    Recent randomized clinical trials have established the efficacy of Comprehensive Behavioral Intervention for Tics (CBIT) in treating children and adults with Tourette syndrome and persistent tic disorders. However, the standard CBIT protocol uses a weekly outpatient treatment format (i.e., 8 sessions over 10 wk), which may be inconvenient or impractical for some patients, particularly patients, who are required to travel long distances in order to receive care. In contrast, an intensive outpatient program may increase accessibility to evidence-based behavioral treatments for Tourette syndrome and other persistent tic disorders by eliminating the necessity of repeated travel. This case series evaluated the use of an intensive outpatient program CBIT (IOP CBIT) for the treatment of 2 preadolescent males (ages 10 and 14 years) with Tourette syndrome. The IOP CBIT treatment protocol included several hours of daily treatment over a 4-d period. Both children evidenced notable reductions in their tics and maintained treatment gains at follow-up. Moreover, both patients and their parents expressed treatment satisfaction with the IOP CBIT format. This case series addresses an important research gap in the behavioral treatment of tic disorders literature. The patients' treatment outcomes indicate that IOP CBIT is a promising treatment that warrants more systematic investigation.

  19. Asthma caused by potassium aluminium tetrafluoride: a case series.

    PubMed

    Laštovková, Andrea; Klusáčková, Pavlina; Fenclová, Zdenka; Bonneterre, Vincent; Pelclová, Daniela

    2015-01-01

    The objective of this study is to describe a case-series of potassium aluminium tetrafluoride (KAlF(4))-induced occupational asthma (OA) and/or occupational rhinitis (OR). The study involves five patients from a heat-exchanger production line who were examined (including specific inhalation challenge tests) for suspected OA and/or OR caused by a flux containing almost 100% KAlF(4) - with fluorides' workplace air concentrations ranging between 1.7 and 2.8 mg/m(3). No subject had a previous history of asthma. All five patients had a positive specific challenge test (three patients were diagnosed with OA alone, one with OR and one with both OR and OA). At the follow-up visit, after three years on average, all patients needed permanent corticosteroid therapy (four topical, one oral). After elimination from the exposure, only one of the observed subjects gave an indication of an improvement, two subjects stabilized and two worsened. Our case series focuses on the correlation between patients' exposure to fluorides in air-conditioner production and the subsequent occurrence of OR/OA. Currently, it is uncertain whether these OR/OA were caused by hypersensitivity or irritation.

  20. Intensive outpatient comprehensive behavioral intervention for tics: A case series

    PubMed Central

    Blount, Tabatha H; Lockhart, Ann-Louise T; Garcia, Rocio V; Raj, Jeslina J; Peterson, Alan L

    2014-01-01

    Recent randomized clinical trials have established the efficacy of Comprehensive Behavioral Intervention for Tics (CBIT) in treating children and adults with Tourette syndrome and persistent tic disorders. However, the standard CBIT protocol uses a weekly outpatient treatment format (i.e., 8 sessions over 10 wk), which may be inconvenient or impractical for some patients, particularly patients, who are required to travel long distances in order to receive care. In contrast, an intensive outpatient program may increase accessibility to evidence-based behavioral treatments for Tourette syndrome and other persistent tic disorders by eliminating the necessity of repeated travel. This case series evaluated the use of an intensive outpatient program CBIT (IOP CBIT) for the treatment of 2 preadolescent males (ages 10 and 14 years) with Tourette syndrome. The IOP CBIT treatment protocol included several hours of daily treatment over a 4-d period. Both children evidenced notable reductions in their tics and maintained treatment gains at follow-up. Moreover, both patients and their parents expressed treatment satisfaction with the IOP CBIT format. This case series addresses an important research gap in the behavioral treatment of tic disorders literature. The patients’ treatment outcomes indicate that IOP CBIT is a promising treatment that warrants more systematic investigation. PMID:25325069

  1. Dofetilide in Overdose: A Case Series from Poison Center Data.

    PubMed

    Hieger, M A; Maskell, K F; Moss, M J; Powell, S W; Cumpston, K L

    2016-08-26

    Dofetilide is a class III antiarrhythmic used for treating atrial dysrhythmias. Though its adverse effects are well described in routine use, very little is known about dofetilide toxicity in overdose. This is a retrospective case series of consecutive patients reported to our poison center after dofetilide overdose. Twenty-seven cases were included. Seventeen patients were treated at a healthcare facility, and of these, eight were admitted. Twenty-one patients took one extra capsule, four took someone else's medication, one took three extra capsules, and one had a large intentional overdose. Ten patients had co-ingestants reported, including three QT-prolonging agents. No one required cardioversion, defibrillation, CPR, or overdrive pacing. The patient who reported taking 90 times his usual dose in suicide attempt was the only patient to have significant clinical effects. He experienced an 8-beat run of non-sustained ventricular tachycardia, frequent multifocal PVCs, and ventricular bigeminy. He received magnesium sulfate and potassium chloride supplementation. In this series, unintentional small overdoses did not result in significant clinical effects and were often managed successfully at home, despite the fact that information showing a single capsule can cause torsades. This study is limited by its small sample size, retrospective design, and reliance on incomplete information.

  2. Asthma caused by potassium aluminium tetrafluoride: a case series

    PubMed Central

    LAŠTOVKOVÁ, Andrea; KLUSÁČKOVÁ, Pavlina; FENCLOVÁ, Zdenka; BONNETERRE, Vincent; PELCLOVÁ, Daniela

    2015-01-01

    The objective of this study is to describe a case-series of potassium aluminium tetrafluoride (KAlF4)-induced occupational asthma (OA) and/or occupational rhinitis (OR). The study involves five patients from a heat-exchanger production line who were examined (including specific inhalation challenge tests) for suspected OA and/or OR caused by a flux containing almost 100% KAlF4 − with fluorides’ workplace air concentrations ranging between 1.7 and 2.8 mg/m3. No subject had a previous history of asthma. All five patients had a positive specific challenge test (three patients were diagnosed with OA alone, one with OR and one with both OR and OA). At the follow-up visit, after three years on average, all patients needed permanent corticosteroid therapy (four topical, one oral). After elimination from the exposure, only one of the observed subjects gave an indication of an improvement, two subjects stabilized and two worsened. Our case series focuses on the correlation between patients’ exposure to fluorides in air-conditioner production and the subsequent occurrence of OR/OA. Currently, it is uncertain whether these OR/OA were caused by hypersensitivity or irritation. PMID:26212411

  3. Chiropractic Treatment of Temporomandibular Dysfunction: A Retrospective Case Series

    PubMed Central

    Pavia, Steven; Fischer, Rebecca; Roy, Richard

    2015-01-01

    Objective The purpose of this study is to describe chiropractic treatment of 14 patients who presented with signs and symptoms of temporomandibular joint dysfunction (TMD). Methods This is a retrospective case series of 14 patients, including 13 adults and 1 child. The majority of these patients were undergoing chiropractic care for spine-related conditions when they presented with additional TMD signs and symptoms. They were evaluated and treated with Activator Methods International published protocols relative to the temporomandibular joint before the addition of treatment to the suprahyoid muscles. Results All pre- and postadjustment assessments were recorded using a numeric pain scale. The resulting average showed a reduction in the patients’ pain scores from the initial visit of 8.3 ± 1.6 to the last visit at 1.4 ± 1.1 with an 80.9% ± 15.4% improvement. The average number of visits was 13.6 ± 8.2. Conclusion All patients selected for this case series showed a reduction of temporomandibular dysfunction symptoms. PMID:26793040

  4. Q fever: a contemporary case series from a Belgian hospital.

    PubMed

    Vanderbeke, Lore; Peetermans, Willy E; Saegeman, Veroniek; De Munter, Paul

    2016-04-27

    Q fever is a global zoonosis that can cause both acute and chronic infections in humans through aerogenic transmission. Although Q fever was discovered already 80 years ago, this infectious disease remains largely unknown. We studied a case series in a Belgian tertiary care hospital. A laboratory and file query at our department was performed to detect patients who were newly diagnosed with Q fever from 01 January 2005 to 01 October 2014. In total, 10 acute Q fever and 5 chronic Q fever infections were identified. An aspecific flu-like illness was the prevailing manifestation of acute Q fever, while this was infective endocarditis in chronic Q fever cases. Noteworthy are the high percentage of myocarditis cases in the acute setting and one case of amyloidosis as a manifestation of chronic Q fever. No evolution from acute to chronic Q fever was noted; overall outcome for both acute and chronic Q fever was favourable with a 94% survival rate. Q fever is an infectious disease characterised by a variable clinical presentation. Detection requires correct assessment of the clinical picture in combination with a laboratory confirmation. Treatment and follow-up are intended to avoid a negative outcome.

  5. [Classification and treatment of symbrachydactyly. A series of 117 cases].

    PubMed

    Foucher, G; Medina, J; Pajardi, G; Navarro, R

    2000-07-01

    In the present study, a modification has been proposed of the Blauth and Gekeler classification, aimed at a more accurate definition of appropriate surgical treatment. An analysis was made of a series of 120 cases of symbrachydactyly (117 patients); however, surgery was only performed in 86 cases (51 toe transfers in 49 patients; mean age at surgery 12 months). Type I included the separation of short and sometimes stiff fingers; type II, the 'pseudo-cleft', could be subdivided into three groups. Type IIA included those hands with more than two long and frequently hypoplastic digits, regarding which a decision had to be made between removal of rudimentary fingers or their stabilization. In type IIB, hand function was good and surgery was rarely needed. Type III (monodactylous) could also be subdivided into two categories, i.e., normal thumb in type IIIA and hypoplasia in IIIB. Finally, in type IVA, toe transfer surgery was performed on condition that wrist mobility was sufficient to compensate for the insufficient mobility of the artificial thumb on the anterior aspect of the radius. In all cases, a weak but useful pincer movement was obtained, with poor cosmetic results. In the case of toe transfers, surgery was advocated before the age of one year; and although mobility was disappointing (35 degrees active motion), good growth and excellent discrimination (5 mm on average) was observed. Symbrachydactyly is a fairly frequent congenital malformation; its diverse clinical features require a precise classification to better determine adequate treatment management.

  6. Intussusception after pancreatic surgery in children: a case series.

    PubMed

    Laje, Pablo; Stanley, Charles A; Adzick, N Scott

    2010-07-01

    Postoperative intussusception (POI) has been described after a wide variety of pediatric surgical procedures, but it has not been reported as a complication after pediatric pancreatic resections. We performed a retrospective review of 5 cases of pancreatectomy-related POI observed between October 1998 and July 2009 within a series of 234 pancreatic resections in children. The incidence of pancreatectomy-related POI was 2.1%. Postoperative intussusception was observed after either partial or near-total pancreatic resections. There was no sex predisposition. All cases occurred within the first 2 postoperative weeks and involved the small bowel exclusively. The outcome after surgery was uneventful in all cases. The overall clinical course in our cases was similar to that described in the literature for POI associated with other surgical procedures. The incidence of POI after pancreatic resections in children is significantly higher than the general incidence reported in the literature (2.1% vs 0.08%-0.25%). Copyright 2010 Elsevier Inc. All rights reserved.

  7. Neurofibromatosis Type 1 Presenting with Ophthalmic Features: A Case Series

    PubMed Central

    Jain, Gunjan; Sharma, Indra Kumar; Sharma, Reena; Saraswat, Neeraj

    2016-01-01

    Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder involving multiple systems and affects approximately 1 out of 3000 persons. Ocular manifestations are lisch nodules, plexiform neurofibroma, optic pathway gliomas. The proper diagnosis of NF-1 is a crucial task for a clinician due to the various clinical manifestations including vision and life threatening malignancies in few patients, which may arise in the different phases of life. The authors report three cases of NF-1, presenting with ophthalmic symptoms in teenager boys. On further ophthalmic and paediatric evaluation the diagnosis of NF-1 was confirmed on the basis of clinical criteria. This series also describe the abnormal facial features like telecanthus and broad nose which has been reported rarely. Case 1 was kept under regular follow-up and Case 2 and Case 3 were planned for the debulking surgery for plexiform neurofibroma of upper eye lid. A multidisciplinary approach is required to diagnose and treat such patients keeping in mind the myriad of clinical manifestations and life-long follow-up is required. PMID:28050470

  8. Spondylodiscitis in SAPHO syndrome. A series of eight cases

    PubMed Central

    Toussirot, E; Dupond, J; Wendling, D

    1997-01-01

    OBJECTIVE—To determine the frequency, clinical features, and radiological and bone scintigraphic changes of spondylodiscitis in patients with SAPHO (synov-itis, acne, pustulosis, hyperostosis, and osteitis).
METHODS—The study was retrospective. Data from patients with the diagnostic criteria of SAPHO syndrome were analysed for clinical features, biological data (HLA B antigen), and pelvic and spine x rays. Spine computed tomography (CT) or magnetic resonance imaging (MRI) were also examined in some cases.
RESULTS—25 patients with a diagnosis of SAPHO were seen since 1985. Eight had spondylodiscitis. These included five with palmoplantar pustulosis, one with pustular psoriasis, one with psoriasis vulgaris, and one with chronic recurrent multifocal osteomyelitis without skin disease. The skin lesion occurred before the spondylodiscitis in four cases. Chest wall involvement was observed in four cases and sacroiliac joint lesions only in the case with osteomyelitis. HLA B27 was always negative and HLA B8 was found in four cases. Radiological findings consisted of erosive or sclerosing remodelling of endplates with a narrowed disc space; a reduced height of the vertebral body was also observed in some cases. These spinal lesions occurred in the three vertebral segments. Multiple sites of spondylodiscitis in the same patient were common. Bone scan showed mildly increased uptake and CT and MRI were useful for detecting signs of infection such as abscess. Enhanced signals on T2 weighted sequence or after injection of gadolinium were often observed. Follow up study of most of these patients suggests that the prognosis of spondylodiscitis in the SAPHO syndrome is favourable.
CONCLUSIONS—Despite few description in the literature, spondylodiscitis in the SAPHO syndrome is common (32% in this series). These radiological findings are similar to the discovertebral changes of spondylodiscitis in ankylosing spondylitis, thus giving support to the relations between

  9. Spline-based self-controlled case series method.

    PubMed

    Ghebremichael-Weldeselassie, Yonas; Whitaker, Heather J; Farrington, C Paddy

    2017-08-30

    The self-controlled case series (SCCS) method is an alternative to study designs such as cohort and case control methods and is used to investigate potential associations between the timing of vaccine or other drug exposures and adverse events. It requires information only on cases, individuals who have experienced the adverse event at least once, and automatically controls all fixed confounding variables that could modify the true association between exposure and adverse event. Time-varying confounders such as age, on the other hand, are not automatically controlled and must be allowed for explicitly. The original SCCS method used step functions to represent risk periods (windows of exposed time) and age effects. Hence, exposure risk periods and/or age groups have to be prespecified a priori, but a poor choice of group boundaries may lead to biased estimates. In this paper, we propose a nonparametric SCCS method in which both age and exposure effects are represented by spline functions at the same time. To avoid a numerical integration of the product of these two spline functions in the likelihood function of the SCCS method, we defined the first, second, and third integrals of I-splines based on the definition of integrals of M-splines. Simulation studies showed that the new method performs well. This new method is applied to data on pediatric vaccines. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  10. Various hysterosalpingography findings of female genital tuberculosis: A case series

    PubMed Central

    Afzali, Nargess; Ahmadi, Firoozeh; Akhbari, Farnaz

    2013-01-01

    Background: Genital tuberculosis is a chorionic disease and mostly occurs by haematogenous spread from extra genital source like lungs, peritoneum, lymph nodes and bones. Transmission through a sexual intercourse is also possible. Since the majority of patients are in reproductive ages, involvement of fallopian tubes and endometrium cause infertility in patients. Cases: Reviewing 4 cases of female genital tuberculosis, which referred to an infertility treatment center with various symptoms, we encountered various appearances on hysterosalpingography (HSG). Conclusion: The genitourinary tract is the most common site of extra pulmonary TB. The primary focus of genital tuberculosis is fallopian tubes, which are almost always affected bilaterally but not symmetrically. Because of common involvement of fallopian tubes and endometrial cavity, disease causes infertility. Diagnosis is not easy because genital tuberculosis has a wide range of clinical and radiological manifestations with slow growing symptoms. Detailed hysterosalpingography finding may be helpful in better diagnosis of the disease. This case series aims to depict the various hystrosalpingographic appearances and pathology produced by tuberculosis and related literatures are reviewed in order to establish a better diagnostic evaluation of genital tuberculosis. PMID:24639787

  11. Gingival fibromatosis with hypertrichosis syndrome: Case series of rare syndrome.

    PubMed

    Balaji, Preetha; Balaji, S M

    2017-01-01

    Gingival fibromatosis with hypertrichosis syndrome is an extremely rare genetic condition characterized by profound overgrowth of hair and gums, as well as other variable features. Gingival fibromatosis is characterized by a large increase in the gingival dimension which extends above the dental crowns, covering them partially or completely. They were found to have a genetic origin, may also occur in isolation or be part of a syndrome, or acquired origin, due to specific drugs administered systemically. Congenital generalized hypertrichosis is a heterogeneous group of diseases with continuing excessive growth of terminal hair without androgenic stimulation. It has informally been called werewolf syndrome because the appearance is similar to that of a werewolf. Various syndromes have been associated with these features such as epilepsy, mental retardation, cardiomegaly, or osteochondrodysplasia. As so far very few cases have been reported in literature, we are reporting a series of three cases with management of the same. The excess gingival tissues, in these cases, were removed by conventional gingivectomy under general anesthesia. The postoperative result was uneventful and the patient's appearance improved significantly. Good esthetic result was achieved to allow patient to practice oral hygiene measures. Though this is not a serious condition clinically, psychosocial trauma cannot be neglected owing to the cosmetic disfigurement it produces.

  12. Glaucoma Surgery in Pregnancy: A Case Series and Literature Review

    PubMed Central

    Razeghinejad, Mohammad Reza; Masoumpour, Masoumeh; Eghbal, Mohammad Hossein; Myers, Jonathan S.; Moster, Marlene R.

    2016-01-01

    Glaucoma management in pregnant patients is a real challenge, especially when the glaucoma is not controlled with medications. We report the results of 6 incisional glaucoma surgeries for the management of medically uncontrolled glaucoma patients during pregnancy. This retrospective, case series was conducted on the 6 eyes of 3pregnant patients with uncontrolled glaucoma using maximum tolerable medications. Details of the glaucoma surgical management of these patients as well as their postoperative care and pregnancy and clinical outcomes on longitudinal follow-up are discussed. All 3 patients had juvenile open-angle glaucoma and were on various anti-glaucoma medications, including oral acetazolamide. The first case described underwent trabeculectomy without antimetabolites in both eyes because of uncontrolled intraocular pressure with topical medications. The surgery was done with topical lidocaine jelly and subconjunctival lidocaine during the second and third trimesters. The second patient had an Ahmed valve implantation in both eyes during the second and third trimesters because of uncontrolled IOP with topical medications and no response to selective laser trabeculoplasty. Surgery was done with topical tetracaine and subconjunctival and sub-Tenon’s lidocaine. The third case had a Baerveldt valve implantation under general anesthesia in the second trimester. In selected pregnant glaucoma patients with medically uncontrolled intraocular pressure threatening vision, incisional surgery may lead to good outcomes for the patient with no risk for the fetus. PMID:27582594

  13. Clinical effectiveness of electroacupuncture in meralgia paraesthetica: a case series.

    PubMed

    Alexander, Rosemary E

    2013-12-01

    Meralgia paraesthetica is a fairly common condition resulting from entrapment of the lateral femoral cutaneous nerve. I have found that acupuncture produces a rapid improvement, sometimes effecting a cure, after only one or two treatments. I therefore invited referrals in order to collect a case series. A series of 10 patients, which included two who had refused surgery, but excluded those with significant lumbar spine problems, were treated. Visual Analogue Scale pain scores and analgesic intake were recorded weekly, starting before treatment. Four patients were receiving high doses of analgesics and the average period of symptoms was 3-4 years. Acupuncture points used were BL25, GB30, GB34, GB31, GB32, Huatuojiaji and ah shi points of the buttock and thigh, up to a depth of 7.5 cm. Electroacupuncture was normally given from the second treatment. Without exception, patients were specifically tender over GB31 before they started treatment. Most were also tender over the upper lumbar spine. An average of four to five sessions of acupuncture was given. The pain scores for all 10 patients improved by at least 50%, including that of a patient with a 20-year history. At follow-up (varying from 3 to 36 months), improvement was nearly 100%. Most patients were able to stop their analgesics. Meralgia paraesthetica appears to respond rapidly to electroacupuncture. A significant trigger point at GB31 was universally present, which may aid diagnosis, although the reason for this is unclear. Further controlled studies are justified.

  14. Hyperammoneic encephalopathy, valproic acid, and benzodiazepine withdrawal: a case series.

    PubMed

    Starer, Jacquelyn; Chang, Grace

    2010-03-01

    Benzodiazepine withdrawal is accompanied by a risk of seizures, delirium, and death. While a gradual outpatient taper off of benzodiazepines is the most commonly recommended method for discontinuation, acute inpatient detoxification and seizure prophylaxis may be necessary for some. Complications related to the use of valproic acid for seizure prophylaxis are presented. The study's objectives are to highlight an uncommon and possibly unrecognized complication of valproic acid when used for seizure prophylaxis during acute inpatient detoxification from benzodiazepines in the context of current practice. Case series. Three patients with hyperammoneic encephalopathy are described. Hyperammoneic encephalopathy can occur as a distinct entity separate from hepatotoxicity with the use of valproic acid and may be an unrecognized complication among patients receiving this drug during benzodiazepine detoxification. A previously unreported complication among the addiction patient population is reported. This underscores the need for a better evidence base regarding the prevention of seizures during acute benzodiazepine detoxification, particularly in terms of indications, safety, and efficacy.

  15. Peripheral Cemento-Ossifying Fibroma: Case Series Literature Review

    PubMed Central

    Ganji, Kiran Kumar; Chakki, ArunKumar Bhimashankar; Nagaral, Sharanbasappa Chandrashekar; Verma, Esha

    2013-01-01

    The concept of fibroosseous lesions of bone has evolved over the last several decades and now includes two major entities: fibrous dysplasia and ossifying fibroma. Peripheral cemento-ossifying fibroma is a relatively rare tumour classified between fibroosseous lesions. It predominantly affects adolescents and young adults, with peak prevalence between 10 and 19 yrs. The cemento-ossifying fibroma is a central neoplasm of bone as well as periodontium which has caused considerable controversy because of confusion regarding terminology and the criteria for its diagnosis. The cemento-ossifying fibroma is odontogenic in origin, whereas ossifying fibroma is of bony origin. Lesions histologically similar to peripheral ossifying fibroma have been given various names in existing literature. Therefore, we present and discuss in this paper a series of cases of peripheral cemento-ossifying fibroma emphasizing the differential diagnosis. PMID:23365762

  16. Peripheral cemento-ossifying fibroma: case series literature review.

    PubMed

    Verma, Esha; Chakki, Arunkumar Bhimashankar; Nagaral, Sharanbasappa Chandrashekar; Ganji, Kiran Kumar

    2013-01-01

    THE CONCEPT OF FIBROOSSEOUS LESIONS OF BONE HAS EVOLVED OVER THE LAST SEVERAL DECADES AND NOW INCLUDES TWO MAJOR ENTITIES: fibrous dysplasia and ossifying fibroma. Peripheral cemento-ossifying fibroma is a relatively rare tumour classified between fibroosseous lesions. It predominantly affects adolescents and young adults, with peak prevalence between 10 and 19 yrs. The cemento-ossifying fibroma is a central neoplasm of bone as well as periodontium which has caused considerable controversy because of confusion regarding terminology and the criteria for its diagnosis. The cemento-ossifying fibroma is odontogenic in origin, whereas ossifying fibroma is of bony origin. Lesions histologically similar to peripheral ossifying fibroma have been given various names in existing literature. Therefore, we present and discuss in this paper a series of cases of peripheral cemento-ossifying fibroma emphasizing the differential diagnosis.

  17. Pink esthetics in periodontics - Gingival depigmentation: A case series.

    PubMed

    Thangavelu, Arthiie; Elavarasu, Sugumari; Jayapalan, Piranitha

    2012-08-01

    Smile expresses a feeling of joy, success, sensuality, affection, and courtesy, and reveals self-confidence and kindness. The harmony of the smile is determined not only by the shape, the position, and the color of the teeth, but also by the gingival tissues. Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, complaints of "black gums" are common, particularly in patients having a very high smile line. Thus, perio-esthetic treatment modalities strive to achieve a harmonious inter-relationship of the pink with white, which is imperative of all treatment procedures. For depigmentation of gingival, different treatment modalities have been reported, such as bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery, and laser. In the present case series, scraping, electrosurgery, and diode laser have been tried for depigmentation, which are simple, effective, and yield good results, along with good patient satisfaction.

  18. Lupus arthropathy: a case series of patients with rhupus.

    PubMed

    Fernández, Andrés; Quintana, Gerardo; Rondón, Federico; Restrepo, José Félix; Sánchez, Alvaro; Matteson, Eric L; Iglesias, Antonio

    2006-03-01

    Among the clinical manifestations of systemic lupus erythematosus (SLE) is an arthropathy, which is usually nonerosive. In many cases the joint involvement is mild. A subset of patients have deforming, nonerosive Jaccoud's arthropathy, and a minority have an arthropathy with clinical findings similar to rheumatoid arthritis (RA) that has been called "rhupus." We report our series of eight patients (seven female, one male) with rhupus arthropathy. Patients were between the ages of 17 and 38 years (average: 30.3 years) at disease onset. All had deforming or Jaccoud's arthropathy, and three had erosive disease. The arthritis was typically the first disease manifestation. Other symptoms of lupus including vasculitis and glomerulonephritis appeared after an average of 2.8 years. All had positive antinuclear antibody and rheumatoid factor. Rhupus arthritis is not a combination of RA and SLE, but should be regarded as a variant of the arthropathy of lupus.

  19. Toe Necrosis, Etiologies and Management, a Case Series

    PubMed Central

    Issa, Abdelfatah Abou; Newman, Mackenzie; Simman, Richard

    2014-01-01

    Toe necrosis may have vast different etiologies. These include ischemia, embolus, and others. (1) The most common etiology is ischemia. It is a reduction in blood supply to a viable tissue that can lead to susceptibility to infection and tissue death. Peripheral ischemia, which is rooted in the lower limbs, is a major risk factor for toe necrosis because the basal metabolic requirements of tissue are not being sufficiently met. As a result, pain, ulcers, and gangrene commonly occur. (2) Other causes of direct and indirect toe necrosis and related lower limb gangrene include mechanical trauma, infectious, pharmacological sensitivity, cancer, blue toe syndrome, and other granulomatous diseases, such as Churg-Strauss syndrome. We present a case series of toes necrosis which resulted from different etiologies and their management. PMID:26199887

  20. Coblation cryptolysis to treat tonsil stones: a retrospective case series.

    PubMed

    Chang, Christopher Y; Thrasher, Richard

    2012-06-01

    We introduce a novel and potentially effective approach in the treatment of tonsil stones using Coblation technology. A retrospective pilot case series was performed demonstrating the effectiveness of a technique that we call Coblation tonsil cryptolysis. This technique is unique in that it can be performed in adult patients without sedation using only local anesthesia, much like laser tonsil cryptolysis. As with laser cryptolysis, pain is significant for only a few days and most adults can resume normal diet and activity within 1 week. In contrast, tonsillectomy entails significant morbidity for several weeks. However, Coblation avoids the significant disadvantages of laser use, including the potential for airway fire, retinal damage from reflected scatter, dealing with plume from vaporized tissues, oral/facial burns, and the high cost of purchasing and maintaining laser equipment. After a single session of Coblation tonsil cryptolysis, a significant decrease and even elimination of tonsil stones can potentially be achieved.

  1. Bivalirudin for treatment of LVAD thrombosis: a case series.

    PubMed

    Sylvia, Lynne M; Ordway, Linda; Pham, Duc T; DeNofrio, David; Kiernan, Michael

    2014-01-01

    Both platelet- and fibrin-rich thrombi have been described in patients with pump thrombosis associated with continuous flow left ventricular assist devices (LVADs). Bivalirudin is a direct thrombin inhibitor that also inhibits platelet adhesion. Compared to heparin, this hirudin analog is less immunogenic, binds to both free- and clot-bound fibrin, and has a lower risk of major bleeding. In a recently published algorithm on the step-wise approach to the diagnosis and management of LVAD thrombosis, direct thrombin inhibitors were included as a treatment option in the setting of persistent hemolysis, power spikes, and heart failure symptoms. Evidence to support the use of a direct thrombin inhibitor for LVAD thrombosis is limited and anecdotal. We describe the first case series to date of the use of bivalirudin as an alternative to heparin in six hemodynamically stable patients with a total of ten hospitalizations for HeartMate II LVAD thrombosis.

  2. Naltrexone implant treatment for buprenorphine dependence--Mauritian case series.

    PubMed

    Jhugroo, Anil; Ellayah, Darmen; Norman, Amanda; Hulse, Gary

    2014-08-01

    Although substitution therapy with opiate agonist treatments such as methadone and buprenorphine has resulted in a reduction of illicit drug use related harm, such treatment has also resulted in severe problems in some countries where opioid-dependent individuals now inject illicitly sold buprenorphine or buprenorphine-naloxone instead of heroin. There is no approved treatment for buprenorphine dependence. Naltrexone is an opioid antagonist which has been used for the treatment of both alcohol and opioid dependencies. Although both buprenorphine and heroin resemble each other concerning their effects, buprenorphine has a higher affinity to opioid receptors than heroin. Therefore, it is not known if naltrexone can block the psychoactive effects of buprenorphine as it does for heroin. This paper presents observational case series data on the use of a sustained-release naltrexone implant for the treatment of buprenorphine dependence. To the authors' knowledge this is the first use of sustained-release naltrexone for this indication.

  3. Central serous retinopathy complicating systemic lupus erythematosus: a case series.

    PubMed

    Khng, C G; Yap, E Y; Au-Eong, K G; Lim, T H; Leong, K H

    2000-08-01

    Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder with widespread manifestations including the eye. Central serous retinopathy (CSR) has been associated as a complicating event in SLE, although it is uncommon. We present a case series of four female Chinese SLE patients who developed CSR during the course of their systemic disease. All four presented clinically with typical CSR. Angiographic findings did not show evidence of choroidal ischaemia or delayed choroidal filling. Resolution of the serous retinal detachment occurred in all four patients. Recovery of vision was seen in three patients. The clinical outcome was similar to that occurring in the usual male population. Central serous retinopathy as a manifestation of SLE may be caused by various factors. These include SLE-associated choroidopathy, systemic hypertension, renal disease, retinal pigment epithelial dysfunction and glucocorticoid therapy.

  4. Computational Drug Repositioning Using Continuous Self-Controlled Case Series

    PubMed Central

    Kuang, Zhaobin; Thomson, James; Caldwell, Michael; Peissig, Peggy; Stewart, Ron; Page, David

    2016-01-01

    Computational Drug Repositioning (CDR) is the task of discovering potential new indications for existing drugs by mining large-scale heterogeneous drug-related data sources. Leveraging the patient-level temporal ordering information between numeric physiological measurements and various drug prescriptions provided in Electronic Health Records (EHRs), we propose a Continuous Self-controlled Case Series (CSCCS) model for CDR. As an initial evaluation, we look for drugs that can control Fasting Blood Glucose (FBG) level in our experiments. Applying CSCCS to the Marshfield Clinic EHR, well-known drugs that are indicated for controlling blood glucose level are rediscovered. Furthermore, some drugs with recent literature support for the potential effect of blood glucose level control are also identified. PMID:28316874

  5. Necrotizing ulcerative gingivitis and the orthodontic patient: a case series.

    PubMed

    Sangani, Indiya; Watt, Eileen; Cross, David

    2013-03-01

    Necrotizing ulcerative gingivitis (NUG) can be a painful periodontal disease that can lead to loss of the interdental papillae. It is usually accompanied by systemic signs of fever, malaise and cervical and submandibular lymphadenopathy. It is caused by the profileration of anaerobic bacteria and has been linked to smoking and immunosuppression. This case series reports the occurrence of NUG in orthodontic patients and demonstrates that there is a varying scale of severity of the condition. Orthodontists should be aware of the clinical signs of NUG to ensure early detection and treatment of their patients in order to prevent irreversible loss of the interdental papillae and reduce the likelihood of recurrence. A treatment regime is suggested.

  6. Hemifacial Microsomia: A Series of Three Case Reports

    PubMed Central

    Mishra, Lora; Misra, Satya Ranjan; Kumar, Manoj; Tripathy, Ramanupam

    2013-01-01

    Hemifacial Microsomia (HFM) is an asymmetric craniofacial malformation which results in hypoplasia of the components of the first and second branchial arches. There can be various anomalies, which include conductive hearing loss which is caused by external and middle ear deformities. HFM is the second most common congenital facial anomaly which is seen after cleft lip/palate. For the pre-surgical evaluation of this anomaly, diagnostic imaging and classification of the facial structures, based on OMENS classification, is of prime importance. The management of this developmental malformation is multidisciplinary. We are presenting a series of three cases with diverse clinical and radiographic features which ranged from mild facial asymmetry and ear malformation to facial paralysis. PMID:24298537

  7. Pink esthetics in periodontics – Gingival depigmentation: A case series

    PubMed Central

    Thangavelu, Arthiie; Elavarasu, Sugumari; Jayapalan, Piranitha

    2012-01-01

    Smile expresses a feeling of joy, success, sensuality, affection, and courtesy, and reveals self-confidence and kindness. The harmony of the smile is determined not only by the shape, the position, and the color of the teeth, but also by the gingival tissues. Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, complaints of “black gums” are common, particularly in patients having a very high smile line. Thus, perio-esthetic treatment modalities strive to achieve a harmonious inter-relationship of the pink with white, which is imperative of all treatment procedures. For depigmentation of gingival, different treatment modalities have been reported, such as bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery, and laser. In the present case series, scraping, electrosurgery, and diode laser have been tried for depigmentation, which are simple, effective, and yield good results, along with good patient satisfaction. PMID:23066249

  8. Patient-specific gingiva-colored abutments: a case series.

    PubMed

    Sumi, Takashi; Takeshita, Kenji; Takeichi, Takuro; Coelho, Paulo G; Jimbo, Ryo

    2014-01-01

    The purpose of this report is to present a case series of gingiva-colored abutments utilized to meet patients, esthetic needs. The color of the abutment was determined by evaluating the color of the patients, marginal gingiva using a digital shade guide. Thereafter, anodic oxidation was performed on computer-aided design/computer-assisted manufacture abutments. The baseline digital color information was compared with the color of the gingiva after 1.5 years in three patients. The gingival colors as well as the marginal bone and soft tissue levels after 1.5 years were comparable to the baseline values. Thus, the gingiva-colored abutments obtained by anodic oxidation provided improved esthetics, especially for patients with thin gingival biotypes.

  9. Burns from illegal drug manufacture: case series and management.

    PubMed

    Porter, C J W; Armstrong, J R

    2004-01-01

    This case series presents our experience with burns sustained while manufacturing illegal drugs. All adult burn admissions in an 18-month period were retrospectively reviewed. All patients suspected of sustaining burns from illegal drug manufacture were contacted. Information regarding the burn mechanism was sought. Nine of the 64 adult burn admissions were caused by explosions during the manufacture of cannabis oil. Young males with hand and face burns were heavily represented. First-aid treatment was often ignored in favor of hiding incriminating evidence. Only two patients gave honest admission histories. Illegal drug manufacture is becoming more common as synthetic drugs become more consumer desirable. Burns sustained may be thermal and/or chemical. Dishonest patient histories negatively influence burn management. A high level of suspicion is required for diagnosing and treating burns from illegal drug manufacture. Public education is unlikely to be effective as the financial rewards outweigh the perceived risks.

  10. The laparoscopic management of Swyer syndrome: Case series

    PubMed Central

    Malhotra, Neena; Dadhwal, Vatsla; Sharma, Kandala Aparna; Gupta, Deepika; Agarwal, Sumita; Deka, Dipika

    2015-01-01

    Swyer syndrome, also known as 46 XY pure gonadal dysgenesis, is a rare endocrine disorder. Affected individuals are phenotypically female with female genitalia, normal Mullerian structures, absent testicular tissue, and a 46 XY chromosomal constitution. We report a series of eight cases of Swyer syndrome, of which six were managed by laparoscopic gonadectomy. The two other cases had to undergo an exploratory laparotomy in view of their presentation with adnexal masses. Two of the girls were siblings. The chief presenting complaint was primary amenorrhea. Four girls also presented with a history of poor development of secondary sexual characters. The average age at presentation was 16.19±2.85 years. The average height was 158.33 ±4.63 cm, and the average weight was 49.33±8.44 kg. Breast development was either Tanner 2 or 3 in four girls, whereas three girls had a Tanner 1 underdeveloped breasts. Axillary and pelvic hair was sparse in all the girls. The vagina was well canalized in all the girls. Hormonal evaluation revealed hypergonadotropic hypogonadism with a mean follicle-stimulating hormone (FSH) level of 95.81 mIU/L and a mean luteinizing (LH) level of 24.15 mIU/L. Imaging analysis revealed the presence of a small uterus in all the cases, except one. Bilateral ovaries were either not visualized or streak gonads were present. Adnexal mass was detected in two of the six cases with raised carcinoembryonic antigen (CA) 125 levels in one case. Genetic analysis revealed a karyotype of 46 XY in six girls, 46 XY/45 X in one, and the culture repeatedly failed in one girl. Because of the risk of malignancy, bilateral gonadectomy was performed in all cases. Histopathological analysis revealed that three of the six cases had dysgerminoma. The patients have been started on hormone replacement therapy. Laparoscopy is a minimally invasive modality for the definitive diagnosis and treatment of cases with Swyer syndrome. An early diagnosis of Swyer syndrome is possible

  11. Case series of pediatric systemic lupus erythematosus from Kerala: comparison with other Indian series.

    PubMed

    Kumar, Sharath; Nair, Sathyajith; Rajam, Lalitha

    2010-10-01

    To determine the clinical and laboratory characteristics of patients diagnosed with pediatric systemic lupus erythematosus (pSLE) in the general pediatrics department of a tertiary level hospital in southern India and compare them to data of case series from other parts of the country. Retrospective chart review by two independent reviewers. All patients diagnosed with SLE in the pediatrics department of the Amrita Institute of Medical Sciences hospital between 1 January 2004 and 31 September 2008, were included in the study. Twenty children were diagnosed with pSLE in the above-mentioned period (female : male ratio 2.3 : 1.0). Fever (75% of patients) and arthralgia (65%) were the most common clinical presenting features. Many patients who were referred as 'Fever of unknown origin' (37.5%) or 'idiopathic thrombocytopenic purpura' (15%) fulfilled the diagnosis of SLE on detailed evaluation. Renal manifestations were present in 11 patients, seven of whom underwent a biopsy. Class IV lupus nephritis was the most common finding (4/7). A very high percentage of our patients had hypocomplementemia (85%). The statistical significance of the differences between our cohort and previously reported cohorts could not be determined. pSLE patients in our series, compared to previous literature from India had a much higher incidence of fever, thrombocytopenia and hypocomplementemia at presentation and much lower incidence of arthritis. It is unclear whether these differences represent unique characteristics of ethnically dissimilar subsets of the Indian population. A high index of suspicion should be maintained in order to make an early diagnosis of pSLE, since the most common presenting features in our cohort were arthralgia and fever.

  12. Adverse Events Associated with Yoga: A Systematic Review of Published Case Reports and Case Series

    PubMed Central

    Cramer, Holger; Krucoff, Carol; Dobos, Gustav

    2013-01-01

    While yoga is gaining increased popularity in North America and Europe, its safety has been questioned in the lay press. The aim of this systematic review was to assess published case reports and case series on adverse events associated with yoga. Medline/Pubmed, Scopus, CAMBase, IndMed and the Cases Database were screened through February 2013; and 35 case reports and 2 case series reporting a total of 76 cases were included. Ten cases had medical preconditions, mainly glaucoma and osteopenia. Pranayama, hatha yoga, and Bikram yoga were the most common yoga practices; headstand, shoulder stand, lotus position, and forceful breathing were the most common yoga postures and breathing techniques cited. Twenty-seven adverse events (35.5%) affected the musculoskeletal system; 14 (18.4%) the nervous system; and 9 (11.8%) the eyes. Fifteen cases (19.7%) reached full recovery; 9 cases (11.3%) partial recovery; 1 case (1.3%) no recovery; and 1 case (1.3%) died. As any other physical or mental practice, yoga should be practiced carefully under the guidance of a qualified instructor. Beginners should avoid extreme practices such as headstand, lotus position and forceful breathing. Individuals with medical preconditions should work with their physician and yoga teacher to appropriately adapt postures; patients with glaucoma should avoid inversions and patients with compromised bone should avoid forceful yoga practices. PMID:24146758

  13. Failure of tension band plating: a case series.

    PubMed

    Masquijo, Julio J; Firth, Gregory B; Sepúlveda, Dalia

    2016-07-08

    Growth modulation with tension band plates (TBP) has been shown to be a very useful method for the treatment of angular deformities in growing children. Recently, we have observed cases of failure where the epiphyseal screw was drawn through the physis into the metaphysis. This study describes a series of children who developed this complication. Patients who developed TBP failure after operative treatment of lower limb angular deformities were identified from the databases at four institutions over a 5-year period. The medical records were reviewed to record demographics, primary diagnoses, details of the operative procedure, development of physeal arrest, and recurrence of the original deformity. Six patients (five girls) with nine implant failures were identified. The mean age of the children at the time of implant insertion was 7.2 years (range, 4-10 years). The primary diagnoses included hypophosphatemic rickets (n=7), congenital pseudoarthrosis of the tibia associated with neurofibromatosis 1 (n=1), and post-traumatic malunion after distal tibial fracture (n=1). Of the nine TBP that presented with the complication, four were inserted into the medial distal femur (one bilateral case), two into the medial proximal tibia (one bilateral case), two into the lateral distal tibia, and one into the medial distal tibia. None of these patients developed physeal growth arrest at the last follow-up as assessed on the latest radiographs. The use of TBP for guided growth in patients younger than 10 years old with rickets, neurofibromatosis, or other conditions that produce osteopenia leads to an increased risk for implant failure. In these cases, it is important to confirm that the epiphyseal screw has good purchase. Patients with these features should be monitored closely for early detection of this complication.

  14. BcsKC is an essential protein for the type VI secretion system activity in Burkholderia cenocepacia that forms an outer membrane complex with BcsLB.

    PubMed

    Aubert, Daniel; MacDonald, Douglas K; Valvano, Miguel A

    2010-11-12

    The type VI secretion system (T6SS) contributes to the virulence of Burkholderia cenocepacia, an opportunistic pathogen causing serious chronic infections in patients with cystic fibrosis. BcsK(C) is a highly conserved protein among the T6SSs in Gram-negative bacteria. Here, we show that BcsK(C) is required for Hcp secretion and cytoskeletal redistribution in macrophages upon bacterial infection. These two phenotypes are associated with a functional T6SS in B. cenocepacia. Experiments employing a bacterial two-hybrid system and pulldown assays demonstrated that BcsK(C) interacts with BcsL(B), another conserved T6SS component. Internal deletions within BcsK(C) revealed that its N-terminal domain is necessary and sufficient for interaction with BcsL(B). Fractionation experiments showed that BcsK(C) can be in the cytosol or tightly associated with the outer membrane and that BcsK(C) and BcsL(B) form a high molecular weight complex anchored to the outer membrane that requires BcsF(H) (a ClpV homolog) to be assembled. Together, our data show that BcsK(C)/BcsL(B) interaction is essential for the T6SS activity in B. cenocepacia.

  15. Different phenotypes in identical twins with cerebrotendinous xanthomatosis: case series.

    PubMed

    Zádori, Dénes; Szpisjak, László; Madar, László; Varga, Viktória Evelin; Csányi, Bernadett; Bencsik, Krisztina; Balogh, István; Harangi, Mariann; Kereszty, Éva; Vécsei, László; Klivényi, Péter

    2017-03-01

    Cerebrotendinous xanthomatosis (CTX) is a rare, genetically determined error of metabolism. The characteristic clinical symptoms are diarrhea, juvenile cataracts, tendon xanthomas and neuropsychiatric alterations. The aim of this study is to present a pair of identical adult twins with considerable differences in the severity of phenotype. With regards to neuropsychiatric symptoms, the predominant features were severe Parkinsonism and moderate cognitive dysfunctions in the more-affected individual, whereas these alterations in the less-affected patient were only very mild and mild, respectively. The characteristic increase in the concentrations of serum cholestanol and the lesion volumes in dentate nuclei in the brain assessed with magnetic resonance imaging were quite similar in both cases. The lifestyle conditions, including eating habits of the twin pair, were quite similar as well; therefore, currently unknown genetic modifiers or certain epigenetic factors may be responsible for the differences in severity of phenotype. This case series serves as the first description of an identical twin pair with CTX presenting heterogeneous clinical features.

  16. Alkali-related ocular burns: a case series and review.

    PubMed

    Bunker, Daniel J L; George, Robert J; Kleinschmidt, Andrew; Kumar, Rohit J; Maitz, Peter

    2014-01-01

    Alkali burns are known to possess high pathological potential because of their inherent ability to lyse cell membranes and penetrate intraocular structures with devastating results. The authors aimed to evaluate the most common cause of this presentation, the current treatment approaches to injury, and eventual outcome as related to severity. The authors performed a retrospective review of all patients who sustained chemical-related ocular injuries seen at the Concord Hospital Burns Unit, Australia between January 2005 and March 2012. Management was based on cooperation between ophthalmic staff and the burns unit, with emphasis on early aggressive intervention and rigorous follow-up. The records of 39 patients who presented with chemical-related injury were assessed, 12 of whom had confirmed alkali burns involving the cornea. The most commonly implicated agent was sodium hydroxide, usually in the context of otherwise trivial domestic accidents. Acute medical management included copious irrigation and the use of analgesics, cycloplegics, and topical antibiotics. In half the cases, steroid drops and oral vitamin C were also used. Ten of the 12 patients (83%) had return to premorbid visual acuity. Complications included cicatrical ectropion (n = 1), pseudoexfoliative syndrome (n = 1), and symblepharon (n = 1). Surgical correction was needed in the one patient with cicatrical ectropion. This case series shows that appropriate acute management minimizes the potentially devastating sequelae of ocular alkali burns. Emphasis should be placed on prevention of domestic and workplace injuries when using alkaline products.

  17. Colonoscopic diagnosis of amebiasis: a case series and systematic review.

    PubMed

    Lee, Ko-Chao; Lu, Chien-Chang; Hu, Wan-Hsiang; Lin, Shung-Eing; Chen, Hong-Hwa

    2015-01-01

    Nonspecific gastrointestinal symptoms make diagnosis of amebiasis difficult. Certain colonoscopic findings predict amebic colitis while others suggest different diagnoses. We aimed to evaluate the diagnostic capability of colonic evaluation of amebiasis. We retrospectively reviewed data of all amebiasis cases admitted to our institution between 2003 and 2012. Cases were diagnosed by clinical presentation, laboratory examinations, and colonoscopy with biopsy and microscopic examination. Patients were stratified as right-sided colitis and proctosigmoiditis. A systematic review was conducted by searching Medline, Cochrane, EMBASE, and Google Scholar using key words amebiasis, amebic colitis, amebic proctosigmoiditis, colonoscopy, and Entamoeba histolytica. Data were extracted from articles meeting the inclusion criteria. Colonoscopic findings were described and studies were assessed for quality. The current series included 20 patients (5 male, 15 female, median age 51), 7 with amebic liver abscess and 13 with amebic colitis. Colonoscopic findings of right-sided colitis included aphthae or erosions, ulcers, exudates, or edematous swollen mucosa in cecum, and findings for proctosigmoiditis were edematous swollen mucosa with bloody exudate. In 25 studies, colonoscopic findings of 41 patients (36 male, 5 female, median age 43.39 years) included mainly ulcers in the cecum and rectum, ulcerated mass, and edematous mucosa; and in fewer patients, submucosal invasion suggestive of colon cancer, bleeding ulcers, proctitis, and ulcers with aphthae in rectum. Colonic evaluation of suspected amebiasis is of diagnostic value when accompanied by biopsy and microscopic identification of Entamoeba species. Colonoscopic manifestations vary between right-sided colitis and proctosigmoiditis.

  18. Ambulatory surgery for primary hyperparathyroidism: A 67-case series.

    PubMed

    Culié, D; Pescetto, B; Dassonville, O; Guevara, N; Benisvy, D; Santini, J

    2017-10-01

    Surgery for primary hyperparathyroidism, targeted by ultrasound and scintigraphy, satisfies the theoretical criteria allowing ambulatory surgery. The purpose of this study was to validate this strategy on a homogeneous case series assessed by this imaging strategy. All patients operated for primary hyperparathyroidism by ambulatory surgery from 01/01/13 to 30/04/15 were included in this retrospective study. The usual endpoints of ambulatory surgery were evaluated. A total of 144 patients were operated for primary hyperparathyroidism during the study period. Ambulatory surgery was possible in 67 patients, who all had a preoperative diagnosis of parathyroid adenoma. All patients were assessed by ultrasound and 66 patients were assessed by sestamibi scintigraphy, resulting in targeted unilateral neck surgery in 98.5% of cases. Two patients had to be hospitalised overnight due to minor complications. Surgery for primary hyperparathyroidism can be performed with short operating times in carefully selected patients with a low complication rate, thereby allowing ambulatory surgery. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. Outcomes of trophectoderm biopsy on cryopreserved blastocysts: a case series.

    PubMed

    Lathi, Ruth B; Massie, Jamie A M; Gilani, Morgan; Milki, Amin A; Westphal, Lynn M; Baker, Valerie L; Behr, Barry

    2012-11-01

    Preimplantation genetic diagnosis (PGD) is an increasingly common adjunct to IVF. The information gained from PGD may be used to reduce the incidence of chromosomally abnormal pregnancies and augment the current selection process of embryos. As such, patients may choose to utilize PGD in either fresh or cryopreserved IVF cycles. It is a common practice to cryopreserve excess embryos at the blastocyst stage. In these cases, trophectoderm biopsy is the only technique available for PGD. This articles reports this study centre's experience with trophectoderm biopsies of cryopreserved blastocysts in 12 patients who underwent 13 cycles of PGD. The implantation rate per embryo transferred was 46% and the ongoing pregnancy rate per embryo transfer was 63%. The results from this case series demonstrate that trophectoderm biopsy on cryopreserved blastocysts to perform PGD is logistically feasible. In addition, the rate of implantation and ongoing pregnancy were maintained within a reasonable range to justify the procedure. Preimplantation genetic diagnosis (PGD) is an increasingly common adjunct to IVF and is used to evaluate the genetic makeup of the embryo prior to transfer of the embryo into the uterus. The information gained from PGD may be used to identify single-gene disorders that result in genetic disease, reduce the incidence of chromosomally abnormal pregnancies and/or augment the selection process of embryos to be transferred. In order to perform PGD, a biopsy of the embryo is the performed and cells are removed for testing. PGD may be performed in either fresh or frozen (cryopreserved) IVF cycles. Patients who have cryopreserved embryos remaining in storage from a previous fresh cycle may wish to have these embryos tested with PGD. Many embryos are frozen on day 5 of development, referred to as the blastocyst stage. At this stage of development, embryo biopsy is performed via a technique known as 'trophectoderm biopsy', in which 1-3 of the cells destined to

  20. Orbitofrontal epilepsy: Case series and review of literature.

    PubMed

    Chibane, Imane Samah; Boucher, Olivier; Dubeau, François; Tran, Thi Phuoc Yen; Mohamed, Ismail; McLachlan, Richard; Sadler, R Mark; Desbiens, Richard; Carmant, Lionel; Nguyen, Dang Khoa

    2017-09-16

    Orbitofrontal epilepsy (OFE) is less known and is poorly characterized in comparison with temporal lobe epilepsy, partly because it is rare and possibly because it is unrecognized and therefore underestimated. This paper aimed to better characterize seizure semiology, presurgical findings, and surgical outcomes in patients with OFE. We retrospectively reviewed all confidently established OFE cases from six Canadian epilepsy monitoring units between 1988 and 2014, and in the literature between 1972 and 2017. Inclusion criteria were identification of an epileptogenic lesion localized in the OFC or if the patient was seizure-free after surgical removal of the OFC in nonlesional cases. Sixteen cases were identified from our databases. Fifty percent had predominantly sleep-related seizures; 56% had no aura (the remaining had nonspecific or vegetative auras), and 62.5% featured hypermotor (mostly hyperkinetic) behaviors. Interictal epileptiform discharges over frontal and temporal derivations always allowed lateralization. Magnetic resonance imaging (MRI) identified an orbitofrontal lesion in 8/16, positron emission tomography (PET) identified a hypometabolism extending outside the orbital cortex in 4/9, ictal single-photon emission computed tomography (SPECT) identified an orbital hyperperfusion in 1/5, magnetoencephalography (MEG) identified lateral orbital sources in 2/4, and intracranial electroencephalography (EEG) identified an orbitofrontal onset in 9/10. Fourteen patients underwent surgery, all reaching a favorable outcome (71.4% Engel 1; 28.6% Engel 2; mean FU=5.6years). Pre- and postoperative neuropsychological assessments revealed heterogeneous findings. Our review of literature identified 71 possible cases of OFE, 32 with confident focus localization. Extracted data from these cumulated cases supported observations made from our case series. Orbitofrontal epilepsy should be suspected with sleep-related, hyperkinetic seizures with no specific aura, and

  1. The role of the chemical potential in the BCS theory

    NASA Astrophysics Data System (ADS)

    Anghel, Dragoş-Victor; Nemnes, George Alexandru

    2016-12-01

    We study the effect of the chemical potential on the results of the BCS theory of superconductivity. We assume that the pairing interaction is manifested between electrons of single-particle energies in an interval [ μ - ħωc , μ + ħωc ] , where μ and ωc are parameters of the model- μ need not be equal to the chemical potential of the system, denoted here by μR. The BCS results are recovered if μ =μR. If μ ≠μR the physical properties change significantly: the energy gap Δ is smaller than the BCS gap, a population imbalance appears, and the superconductor-normal metal phase transition is of the first order. The quasiparticle imbalance is an equilibrium property that appears due to the asymmetry with respect to μR of the single-particle energy interval in which the pairing potential is manifested. For μR - μ taking values in some ranges, the equation for Δ may have more than one solution at the same temperature, forming branches of solutions when Δ is plotted vs. μR - μ at fixed T. The solution with the highest energy gap, which corresponds to the BCS solution when μ =μR, ceases to exist if | μ -μR | ≥ 2Δ0 (Δ0 is the BCS gap at zero temperature). Therefore the superconductivity is conditioned by the existence of the pairing interaction and also by the value of μR - μ.

  2. Are Staphylococcus intermedius Infections in Humans Cases of Mistaken Identity? A Case Series and Literature Review

    PubMed Central

    Viau, Roberto; Hujer, Andrea M.; Hujer, Kristine M.; Bonomo, Robert A.; Jump, Robin L.P.

    2015-01-01

    Staphylococcus intermedius and Staphylococcus pseudintermedius are difficult to distinguish using conventional microbiological methods. Molecular diagnostic tools change our understanding of the epidemiology of these 2 organisms. In this study, we present (1) a detailed review of the current literature on molecular diagnostics and (2) a case series in which misidentification was proven in 1 case. We conclude that S pseudintermedius is a more common human pathogen than previously recognized. PMID:26509181

  3. [Pediatric case series in an ophthalmic camp in Turkana (Kenya)].

    PubMed

    Noval, S; Cabrejas, L; Jarrín, E; Ruiz-Guerrero, M; Ciancas, E

    2013-12-01

    Turkana is the largest district in Kenya, situated in the Northwest of the country. It features a semi-nomadic population of 850,000. Around 60% of population lives below the poverty threshold. The ratio of doctors is 1:75,000 inhabitants. Five ophthalmologists took part in the last deployment in November. Local staff had previously selected the patients from the rural areas, as well as in Lodwar, the capital of the district. Of the 371 patients who attended the clinic, 128 required surgery. To describe the pediatric population attended to in the last «Turkana Eye Project» Camp. Description of the ophthalmic pathologies of the children seen in the clinic in this surgical camp, and the diagnostic and therapeutic options according to the limitations of the environment. Of the 371 patients, 54 were younger than 15 years old (14.5%). Four children had surgery (3.25% of the 128 patients). In 2 more cases surgery was the indicated but not performed. Therefore, of the total of 54 cases, 6 could be considered as surgical (11.1%), and 17 suffered ophthalmic problems other than refraction defects, or mild ocular surface pathologies: traumatic cataracts, neuropathies, impetigo, exophthalmos, retinal dystrophies, dermoid cysts, or nyctalopia. The etiology was traumatic in four of the 17 children (23.5%). Surgical camps are increasing in the developing countries. They are usually focused on particular pathologies, such as cataracts or trachoma. Our case series shows the importance of pediatric teams and the need to be prepared to face complex pediatric pathologies. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  4. Emergency Department Wounds Managed by Combat Medics: A Case Series.

    PubMed

    Schauer, Steven G; Pfaff, James A

    2017-03-01

    Combat medics are an integral part of their unit helping to conserve the fighting strength. Minor wounds are a common problem in the deployed settings that affect a soldier's ability to partake in operations. While the medics often manage wound care, there is very little data on the outcomes. Cases were acquired as part of a quality assurance project providing training feedback to medics on wound management. Laceration management is delegated to the medic at the direction of the provider. Follow-up included a series of short questions regarding wound outcomes: infection, revision, and cosmetic outcome (extremely satisfied = 1, unsatisfied = 5). Chart review was used when direct follow-up with the patient was not available for the remainder of the wounds. The project period was from May 2014 to June 2015. During this time there were 30 wound repairs documented. Direct contact follow-up was available for 57% of the encounters, the remainder was via chart review. The location of the wounds were as follows: facial 5, head/neck 0, upper extremity (excluding hand) 3, hand 16, lower extremity 5, and trunk 1. The average wound length was 2.98 cm (range, 0.8-8.0 cm). No wounds became infected. No wounds required revision. The average cosmetic rating was 1.8 (95% confidence interval = 1.48-2.12). In this series of wounds closed by medics in the emergency department no complications or revisions were necessary. Further research is needed to determine if this can be extrapolated to other military settings. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

  5. Clinical effectiveness of electroacupuncture in meralgia paraesthetica: a case series

    PubMed Central

    Alexander, Rosemary E

    2013-01-01

    Background Meralgia paraesthetica is a fairly common condition resulting from entrapment of the lateral femoral cutaneous nerve. I have found that acupuncture produces a rapid improvement, sometimes effecting a cure, after only one or two treatments. I therefore invited referrals in order to collect a case series. Methods A series of 10 patients, which included two who had refused surgery, but excluded those with significant lumbar spine problems, were treated. Visual Analogue Scale pain scores and analgesic intake were recorded weekly, starting before treatment. Four patients were receiving high doses of analgesics and the average period of symptoms was 3–4 years. Acupuncture points used were BL25, GB30, GB34, GB31, GB32, Huatuojiaji and ah shi points of the buttock and thigh, up to a depth of 7.5 cm. Electroacupuncture was normally given from the second treatment. Results Without exception, patients were specifically tender over GB31 before they started treatment. Most were also tender over the upper lumbar spine. An average of four to five sessions of acupuncture was given. The pain scores for all 10 patients improved by at least 50%, including that of a patient with a 20-year history. At follow-up (varying from 3 to 36 months), improvement was nearly 100%. Most patients were able to stop their analgesics. Conclusions Meralgia paraesthetica appears to respond rapidly to electroacupuncture. A significant trigger point at GB31 was universally present, which may aid diagnosis, although the reason for this is unclear. Further controlled studies are justified. PMID:24152611

  6. Case series: toxicity from 25B-NBOMe--a cluster of N-bomb cases.

    PubMed

    Gee, Paul; Schep, Leo J; Jensen, Berit P; Moore, Grant; Barrington, Stuart

    2016-01-01

    Background A new class of hallucinogens called NBOMes has emerged. This class includes analogues 25I-NBOMe, 25C-NBOMe and 25B-NBOMe. Case reports and judicial seizures indicate that 25I-NBOMe and 25C-NBOMe are more prevalently abused. There have been a few confirmed reports of 25B-NBOMe use or toxicity. Report Observational case series. This report describes a series of 10 patients who suffered adverse effects from 25B-NBOMe. Hallucinations and violent agitation predominate along with serotonergic/stimulant signs such as mydriasis, tachycardia, hypertension and hyperthermia. The majority (7/10) required sedation with benzodiazepines. Analytical method 25B-NBOMe concentrations in plasma and urine were quantified in all patients using a validated liquid chromatography-tandem mass spectrometry (LC-MS/MS) method. Peak plasma levels were measured between 0.7-10.1 ng/ml. Discussion The NBOMes are desired by users because of their hallucinogenic and stimulant effects. They are often sold as LSD or synthetic LSD. Reported cases of 25B- NBOMe toxicity are reviewed and compared to our series. Seizures and one pharmacological death have been described but neither were observed in our series. Based on our experience with cases of mild to moderate toxicity, we suggest that management should be supportive and focused on preventing further (self) harm. High doses of benzodiazepines may be required to control agitation. Patients who develop significant hyperthermia need to be actively managed. Conclusions Effects from 25B-NBOMe in our series were similar to previous individual case reports. The clinical features were also similar to effects from other analogues in the class (25I-NBOMe, 25C-NBOMe). Violent agitation frequently present along with signs of serotonergic stimulation. Hyperthermia, rhabdomyolysis and kidney injury were also observed.

  7. Ginzburg-Landau expansion in BCS-BEC crossover region of disordered attractive Hubbard model

    NASA Astrophysics Data System (ADS)

    Kuchinskii, E. Z.; Kuleeva, N. A.; Sadovskii, M. V.

    2017-01-01

    We have studied disorder effects on the coefficients of Ginzburg-Landau expansion for attractive Hubbard model within the generalized DMFT+Σ approximation for the wide region of the values of attractive potential U—from the weak-coupling limit, where superconductivity is described by BCS model, towards the strong coupling, where superconducting transition is related to Bose-Einstein condensation (BEC) of compact Cooper pairs. For the case of semi-elliptic initial density of states disorder influence on the coefficients A and B before the square and the fourth power of the order parameter is universal for at all values of electronic correlations and is related only to the widening of the initial conduction band (density of states) by disorder. Similar universal behavior is valid for superconducting critical temperature Tc (the generalized Anderson theorem) and specific heat discontinuity at the transition. This universality is absent for the coefficient C before the gradient term, which in accordance with the standard theory of "dirty" superconductors is strongly suppressed by disorder in the weak-coupling region, but can slightly grow in BCS-BEC crossover region, becoming almost independent of disorder in the strong coupling region. This leads to rather weak disorder dependence of the penetration depth and coherence length, as well as the slope of the upper critical magnetic field at Tc, in BCS-BEC crossover and strong coupling regions.

  8. Blood flow restriction rehabilitation for extremity weakness: a case series.

    PubMed

    Hylden, Christina; Burns, Travis; Stinner, Daniel; Owens, Johnny

    2015-01-01

    Blood flow restricted (BFR) training, the brief and partial restriction of venous outflow of an extremity during low load resistance exercises, is a safe and effective method of improving strength in healthy, active individuals. A relatively unexplored potential of this adjunctive modality lies in treating patients with severe musculoskeletal trauma, persistent chronic quadriceps and hamstring weakness despite traditional therapy, and low improvement during early postoperative strengthening. This case series describes patients with chronic quadriceps and hamstring weakness who received an intervention of BFR at low loads, 20% of 1 repetition max (1RM), to restore strength. A case series was conducted of seven patients, all located at one hospital and all with traumatic lower extremity injuries. The seven patients were treated at the same medical center and with the same BFR protocol. All seven patients had isokinetic dynamometer testing that showed persistent thigh muscle weakness despite previous rehabilitation with traditional therapy and 35% to 75% peak torque deficit in either knee extension or flexion compared with the contralateral lower extremity. Patients underwent 2 weeks of BFR training therapy using a pneumatic tourniquet set at 110mmHg while performing leg extensions, leg presses, and reverse leg presses. All affected extremities were retested after 2 weeks (six treatment sessions). Dynamometer measurements were done with flexion and extension at two speeds: 90° and 300°/sec. The data recorded included peak torque normalized for body weight, average power, and total work. All seven patients demonstrated improvements in peak torque, average power, and total work for both knee flexion and extension, with power being the most improved overall. Peak torque improved an average of 13% to 37%, depending on contraction direction and speed. Average power improved an average of 42% to 81%, and total work improved an average of 35% to 55%. BFR therapy at low

  9. Acute interstitial pneumonitis. Case series and review of the literature.

    PubMed

    Vourlekis, J S; Brown, K K; Cool, C D; Young, D A; Cherniack, R M; King, T E; Schwarz, M I

    2000-11-01

    Acute interstitial pneumonitis (AIP) is an acute, idiopathic interstitial lung disease characterized by rapidly progressive diffuse pulmonary infiltrates and hypoxemia requiring hospitalization. The case-fatality ratio is high. Previous reports suggested that survivors of the acute event have a favorable outcome. We undertook this study to examine the natural history of survivors. We had observed several patients who experienced recurrent episodes of AIP and chronic progressive interstitial lung disease. We sought to determine longitudinal survival in these patients and to compare our experience with that in the medical literature. Overall, we identified 13 biopsy-proven cases of AIP. The mean patient age was 54 years in our review, which is identical to previous reports. Twelve patients were hospitalized and all 12 required mechanical ventilation. Overall hospital survival was 67%. All patients demonstrated abnormalities in gas exchange at presentation. Radiographs typically demonstrated bilateral patchy densities that progressed to a diffuse alveolar filling pattern in nearly all cases. All biopsy specimens showed organizing diffuse alveolar damage. Longitudinal data were available for 7 patients. Two died of AIP recurrences. A third died of complications of heart failure shortly after hospital discharge. One patient progressed to end-stage lung disease and required lung transplantation. Two patients experienced persistent pulmonary symptoms, accompanied in 1 by progressive lung fibrosis. One patient had nearly complete recovery of lung function 2 years following AIP. (Follow-up information was unavailable for 2 survivors.) In our literature review, 5 of 7 patients reported experienced some recovery of lung function. One case of progressive interstitial lung disease requiring lung transplantation was reported. The reported mortality was much higher than in our experience (74% versus 33%). The mean time from symptom onset to death was 26 days, compared with 34

  10. Scale Invariance in 2D BCS-BEC Crossover

    NASA Astrophysics Data System (ADS)

    Sensarma, Rajdeep; Taylor, Edward; Randeria, Mohit

    2013-03-01

    In 2D BCS-BEC crossover, the frequency of the breathing mode in a harmonic trap, as well as the lower edge of the radio frequency spectroscopy response, show remarkable scale-invariance throughout the crossover regime, i.e. they are independent of the coupling constant. Using functional integral methods, we study the behaviour of these quantities in the 2D BCS-BEC crossover and comment on the possible reasons for this scale independence. RS was supported by DAE, Govt. of India. MR was supported by NSF Grant No. DMR-1006532. ET was supported by NSERC and the Canadian Institute for Advanced Research.

  11. Double tibial osteotomy for bow leg patients: A case series

    PubMed Central

    Nazem, Khalilollah; Fouladi, Arash; Chinigarzadeh, Mozhdeh

    2013-01-01

    Background: High tibia osteotomy (HTO) is a common surgical operation for correction of genu varum deformity. In some patients, there are concurrent tibia vara and genu varum (bow leg). This study aimed to consider the possibility of better correction of bow leg deformity after double level tibial osteotomy (DLTO). Materials and Methods: A case series of 10 patients of genu varum in addition to tibia vara (bow leg) deformity who were referred to orthopedic ward of an academic hospital of Isfahan- Iran during 2009–2011 were included in the study. The mean age was 17.3 ± 3.1 years and all of them underwent DLTO. The results of treatment have been assessed based on clinical and radiological parameters before and after surgery. Results: The mean pre- and post operative values for Tibia-Femoral Angle, Medial Proximal of Tibia Angle (MPTA), and Lateral Distal of Tibia Angle (LDTA) were 18.13 ± 3.05° vs. 3.93 ± 0.66°, 79.13 ± 3.4° vs. 89.7 ± 1.8° and 96.40 ± 1.8° vs. 88.73 ± 3.0° respectively (P < 0.05). Improvement of all radiological parameters was meaningful. Seventy three percent of patients had normal mechanical axis of limb after surgery. The remaining cases had varus deformity in distal femur that was corrected by valgus supracondylar osteotomy in an additional operation. Limited range of motion (ROM) near knee and ankle was not observed. Conclusion: DLTO correct bow leg deformity in the point of alignment of limb and paralleling of knee and ankle joint more effectively. This method can be used in metabolic and congenital bow leg which deformities are present in throughout of the lower limb. We described this technique for the first time. PMID:24523802

  12. Breast carcinoma and phyllodes tumour: a case series.

    PubMed

    Sin, Eliza I-Lin; Wong, Chow Yin; Yong, Wei Sean; Ong, Kong Wee; Madhukumar, Preetha; Tan, Veronique Kiak Mien; Thike, Aye Aye; Tan, Puay Hoon; Tan, Benita Kiat Tee

    2016-04-01

    Malignant transformation of the epithelial component of phyllodes tumours (PT) is rare and only reported in literature as sporadic cases of carcinoma associated with PTs. We report the clinicopathological characteristics of in situ and invasive carcinoma coexisting with PT in 10 patients treated in our institution over an 11-year period from 1992 to 2012. Ten patients with coexisting PT and in situ or invasive carcinoma were identified from our records. Six had carcinoma found within the PT. All were female with a median age of 47 (43-72) years. One patient had a history of PT in the same breast while another had a history of PT in the same breast as well as invasive ductal carcinoma in the contralateral breast. The rest did not have any risk factors of breast cancer. Five patients had a preoperative core needle biopsy performed with the report of a fibroepithelial lesion. The rest of the patients had surgery upfront for their breast masses. Two patients who had ER/PR positive invasive carcinoma received adjuvant hormonal therapy. Patients were followed up for a mean of 3.6 years (9 months-10 years) and all patients were alive and recurrence free. PT associated with carcinoma is rare, and we present a series of cases that add to the limited current literature. It is often difficult to detect the presence of the carcinomatous component preoperatively. Hence, close examination of resected PT specimens must be carried out to allow prompt detection of any associated carcinomas, however rare, such that adequate treatment can be given.

  13. A clinicopathologic series of 22 cases of tonsillar granulomas.

    PubMed

    Kardon, D E; Thompson, L D

    2000-03-01

    Tonsils are uncommonly affected by granulomatous inflammation, often with an obscure cause. This study attempts to elucidate the nature of tonsillar granulomatous inflammation. Retrospective clinicopathologic review. Twenty-two cases of tonsillar granulomas diagnosed between 1940 and 1999 were retrieved from the files of the Armed Forces Institute of Pathology. H&E slides and a series of histochemical stains were reviewed, and patient follow-up was obtained. There were 11 males and 11 females, aged 7 to 64 years (mean, 29.9 y). Most of the cases presented bilaterally (n = 19) with sore throat, dysphagia, and/or nasal obstruction. The clinical differential included chronic tonsillitis, tuberculosis, nonspecific infection, sarcoidosis, and a neoplasm. Histologically, the granulomas were focal and scattered, or diffuse, identified in the interfollicular zones (n = 16) and/or the germinal centers (n = 13), and occasionally associated with necrosis (n = 6). Based on histochemical and clinical follow-up information, the etiology of the granulomas included sarcoidosis (n = 8), tuberculosis (n = 3), Hodgkin's lymphoma (n = 2), toxoplasmosis (n = 1), squamous cell carcinoma (n = 1), and no specific known cause (n = 7). Twelve patients were either alive at last follow-up or had died with no evidence of disease (mean, 12.4 y), and 9 were either alive at last follow-up or had died with disease (mean, 24.9 y). One patient was alive with unknown disease status (lost to follow-up after 13.3 y). Although a cause for tonsillar granulomas is frequently identified, a number may not develop an identifiable etiology, with the granulomas probably representing an exaggerated immune response to chronic tonsillitis. However, a careful work-up must be conducted to exclude specific causes and avoid clinical mismanagement.

  14. Matrix Regeneration Therapy: A Case Series of Corneal Neurotrophic Ulcers.

    PubMed

    Arvola, Riku P J; Robciuc, Alexandra; Holopainen, Juha M

    2016-04-01

    Treating corneal neurotrophic ulcers is challenging. Topical application of matrix regeneration therapy (RGTA), which is a dextran derivative polymer and heparan sulfate analog, is a promising regenerative therapy and an alternative or additional therapeutic regimen when corneal healing is compromised. The aim of this study was to evaluate the efficacy of RGTA (Cacicol) in the treatment of 6 patients with severe neurotrophic ulcers. We present an uncontrolled prospective case series of 6 patients (6 eyes) with severe corneal neurotrophic ulcers. Patients were treated with topical RGTA at a dose of 1 drop every second day. The main outcome measure was complete corneal epithelialization. We measured corneal thickness by anterior segment swept-source optical coherence tomography. Two patients (33%) showed complete corneal healing, one at 6 weeks and the other at 10 weeks. Treatment was considered failure in 4 patients (67%), and 1 patient had corneal perforation. None of the patients showed improvement in best-corrected visual acuity. There were no RGTA-related local or systemic side effects. Based on previous studies, RGTA seems to be a promising therapeutic agent for controlling ocular surface inflammation and promoting corneal healing. In this study, the efficacy of RGTA did not match the encouraging results from previous reports.

  15. [Migraine with prolonged eyelid edema: a series of 10 cases].

    PubMed

    Toribio-Díaz, M E; Cuadrado-Pérez, M L; Peláez, A; Aledo-Serrano, Angel; Pedraza, M Isabel; Porta-Etessam, Jesús; Guerrero-Peral, Angel L

    2014-05-01

    Migraine may present with cranial autonomic symptoms typical of trigeminal-autonomic cephalalgias, thus posing diagnostic difficulties. AIM. To report a series of patients with prominent eyelid oedema associated with migraine. Ten patients attending the headache offices in three hospitals (nine women, one man; age: 26-53 years-old) with recurrent eyelid oedema as a migraine accompaniment. According to the diagnostic criteria of the International Classification of Headache Disorders (ICHD-III, beta version), eight patients had migraine without aura, one had migraine with aura, and one had chronic migraine. Eyelid oedema appeared during the most severe headache attacks, and had longer duration than the pain. Pharmacological or systemic causes of the oedema were ruled out in all cases. Other associated autonomic symptoms were conjunctival injection (n = 3), lacrimation (n = 2) and rhinorrhoea (n = 1). Both the pain and the oedema improved with symptomatic and preventive therapies for migraine. Eyelid oedema may occasionally be a migraine accompaniment. It appears in some patients during their most severe migraine attacks, and may improve with the acute and preventive treatment for migraine.

  16. Liquid Nitrogen Cryotherapy for Conjunctival Lymphangiectasia: A Case Series

    PubMed Central

    Fraunfelder, Frederick W.

    2009-01-01

    Purpose: To report a case series of conjunctival lymphangiectasia treated with liquid nitrogen cryotherapy. Methods: A 1.5-mm Brymill cryoprobe was applied in a double freeze-thaw method after an incisional biopsy of a portion of the conjunctiva in patients with conjunctival lymphangiectasia. Freeze times were 1 to 2 seconds with thawing of 5 to 10 seconds between treatments. Patients were reexamined at 1 day, 2 weeks, 3 months, 6 months, and yearly following cryotherapy. Results: Five eyes of 4 patients (3 male and 1 female) with biopsy-proven conjunctival lymphangiectasia underwent liquid nitrogen cryotherapy. The average patient age was 53 years. Ocular examination revealed large lymphatic vessels that were translucent and without conjunctival injection. Subjective symptoms included epiphora, ocular irritation, eye redness, and occasional blurred vision. After treatment with liquid nitrogen cryotherapy, the patients’ symptoms and signs resolved within 2 weeks. Lymphangiectasia recurred twice in one patient, at 1 and 3 years postoperatively. In another patient, lymphangiectasia recurred at 6 months. The average time to recurrence in these 3 eyes was 18 months. Average length of follow-up was 24.5 months for all subjects. Conclusion: Liquid nitrogen cryotherapy may be an effective surgical alternative in the treatment of conjunctival lymphangiectasia. Cryotherapy may need to be repeated in some instances. PMID:20126499

  17. A case series of proton pump inhibitor-induced hypomagnesemia.

    PubMed

    Hoorn, Ewout J; van der Hoek, Joost; de Man, Rob A; Kuipers, Ernst J; Bolwerk, Clemens; Zietse, Robert

    2010-07-01

    Proton pump inhibitor (PPI)-induced hypomagnesemia has been recognized since 2006. Our aim was to further characterize the clinical consequences and possible mechanisms of this electrolyte disorder using 4 cases. Two men (aged 63 and 81 years) and 2 women (aged 73 and 62 years) had been using a PPI (esomeprazole, pantoprazole, omeprazole, and rabeprazole, 20-40 mg) for 1-13 years. They developed severe hypomagnesemia (magnesium, 0.30 +/- 0.28 mEq/L; reference, 1.40-2.10 mEq/L) with hypocalcemia (calcium, 6.4 +/- 1.8 mg/dL), relative hypoparathyroidism (parathyroid hormone, 43 +/- 6 pg/mL), and extremely low urinary calcium and magnesium excretion. One patient was admitted with postanoxic encephalopathy after a collapse likely caused by arrhythmia. The others had electrocardiogram abnormalities (prolonged QT interval, ST depression, and U waves). Concomitant hypokalemia (potassium, 2.8 +/- 0.1 mEq/L) was considered the trigger for these arrhythmias. Hypomagnesemia-induced kaliuresis (potassium excretion, 65 +/- 24 mEq/L) was identified as the cause of hypokalemia. This series of PPI-induced hypomagnesemia shows that this is a generic effect. It also indicates that hypomagnesemia may occur within 1 year of PPI therapy initiation and can have serious clinical consequences, likely triggered by the associated hypokalemia. A high index of suspicion is required in PPI users for unexplained hypomagnesemia, hypocalcemia, hypokalemia, or associated symptoms.

  18. Idiopathic intracranial hypertension in pediatric population: case series from India.

    PubMed

    Roy, Arun Grace; Vinayan, Kollencheri Puthenveettil; Kumar, Anand

    2013-01-01

    Idiopathic intracranial hypertension (IIH) is a well described entity in adults. In pediatric age group the presentation of disease can vary depending on the age of patients and is less frequently reported. The aim of this study is to describe the clinical features, investigations, treatment and outcome of IIH in pediatric population (age <18 years). This retrospective hospital based study was carried out on 25 children with diagnosis of IIH based on modified Dandys criteria. Their clinical, investigation, treatment, outcome and follow-up for 2 year period were analyzed. Out of the 25 children, the youngest child was 4-month-old infant. The commonest symptom was headache (76%) followed by vomiting and papilledema (72%). The mean cerebrospinal fluid (CSF) pressure was 330 mm of H 2 O. In Infants irritability and bulging anterior fontanelle was seen. A total of 24 patients showed a complete resolution of symptom. None of patient had recurrence over a period of 2 years follow-up. IIH can present at any age group. This is the largest series of IIH reported in pediatric population in India. The clinical features are similar to adult patients except in infants. Absence of papilledema does not exclude the diagnosis of IIH. CSF pressure monitoring is needed in suspected cases of IIH. Early and prompt treatment can prevent deficits.

  19. Symptomatic thoracic spinal cord herniation: case series and technical report.

    PubMed

    Hawasli, Ammar H; Ray, Wilson Z; Wright, Neill M

    2014-09-01

    Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on the treatment algorithm and surgical technique, and there are few data on clinical outcomes. In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomatology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially because of multiple sclerosis. Finally, compared with compressive myelopathy in the thoracic spine, surgical treatment of ISCH led to rapid improvement despite a long duration of symptoms. Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair.

  20. Symptomatic Thoracic Spinal Cord Herniation: Case Series and Technical Report

    PubMed Central

    Hawasli, Ammar H.; Ray, Wilson Z.; Wright, Neill M.

    2014-01-01

    Background and Importance Idiopathic spinal cord herniation (ISCH) is an uncommon condition located predominantly in the thoracic spine and often associated with a remote history of a major traumatic injury. ISCH has an incompletely described presentation and unknown etiology. There is no consensus on treatment algorithm and surgical technique, and there is little data on clinical outcomes. Clinical Presentation In this case series and technical report, we describe the atypical myelopathy presentation, remote history of traumatic injury, radiographic progression, treatment, and outcomes of 5 patients treated at Washington University for symptomatic ISCH. A video showing surgical repair is presented. In contrast to classic compressive myelopathy symptomology, ISCH patients presented with an atypical myelopathy, characterized by asymmetric motor and sensory deficits and early-onset urinary incontinence. Clinical deterioration correlated with progressive spinal cord displacement and herniation observed on yearly spinal imaging in a patient imaged serially due to multiple sclerosis. Finally compared to compressive myelopathy in the thoracic spine, surgical treatment of ISH led to rapid improvement despite long duration of symptoms. Conclusion Symptomatic ISCH presents with atypical myelopathy and slow temporal progression and can be successfully managed with surgical repair. PMID:24871148

  1. Percutaneous Liver Biopsies Guided with Ultrasonography: A Case Series

    PubMed Central

    Cakmakci, Emin; Caliskan, Kosti Can; Tabakci, Omer Naci; Tahtabasi, Mehmet; Karpat, Zeki

    2013-01-01

    Background Although liver biopsy is an easy procedure for hospitalized patients and outpatients, some complications may occur. Objectives To evaluate the efficiency, complications, safety and clinicopathological utility of ultrasonographic-guided percutaneous liver biopsy in diffuse liver disease. Patients and Methods In our retrospective study, we evaluated ultrasound-assisted needle biopsies that were performed in outpatients from October 2006 to July 2010. The liver biopsies were performed following one-night fasting using the tru-cut biopsy gun (18-20 gauge) after marking the best seen and hypovascular part of the liver, distant enough from the adjacent organs. Results A total of 1018 patients were referred to our radiology department. Most of the patients had hepatitis B (60.6%). The biopsy specimens were recorded and sent to our pathology department for histopathological examination. Conclusion According to the results of our series, percutaneous liver biopsy using the tru-cut biopsy gun guided by ultrasonography can be performed safely. We resolve that routine ultrasound of the puncture site is a quick, effective and safe procedure. The complication rate is very low. The US-assisted percutaneous liver biopsy should be used for all cases. PMID:24348609

  2. Cerebral Venous Thrombosis and Headache--A Case-Series.

    PubMed

    Sparaco, Marco; Feleppa, Michele; Bigal, Marcelo E

    2015-06-01

    Headache happens in the majority of patients with Cerebral Venous Thrombosis (CVT) being sometimes the sole manifestation of the disease. Herein we report a case-series of CVT, focusing on headache characteristics. Etiological, clinical, and radiological features of 25 consecutive adult patients with CVT were compiled from August 2005 to December 2013. Diagnosis of CVT was confirmed by brain magnetic resonance imaging and magnetic resonance venography. All patients underwent extensive systematic etiological and genetic work-up at admission. A structured questionnaire about the characteristics of headache was responded by all participants. Headache was reported by 23 out of 25 (92%) of participants, being by far the most frequent symptom. It was the sole manifestation in nearly one third of the patients (8/25, 32.0%). Headache was typically severe (19/23, 82.6%) and throbbing (16/23, 69.5%), with sudden onset (13/23, 56.5%) and non-remitting (20/23, 86.9%) characteristics. The sinus most frequently involved was the transverse sinus (24/25, 96.0%), either alone or in association with other sinuses. Headache is the most frequent symptom and sometimes the sole presentation of CVT. © 2015 American Headache Society.

  3. Incontinence--an aggressive approach to treatment: a case series.

    PubMed

    Dornan, P R

    2005-12-01

    Recent evidence suggests that, for some, leaking urine may be a barrier to physical activity. Although important from a lifestyle point of view, bladder problems and incontinence also affect both men and women socially, psychologically and economically. For example, it can be particularly distressing when incontinence occurs post-prostate surgery, especially if these patients were continent before surgery. This case series outlines an aggressive, innovative, exercise-based approach to the management of stress incontinence post-prostatectomy. The program attempts to enhance neuromuscular and vascular systems associated with continence, with emphasis placed on the abdominal and pelvic floor muscles. The program was undertaken by 14 incontinent post-prostatectomy patients (mean age 63.5 y, using a mean of 3.5 sanitary pads per day). The program was initiated a mean of two months post-op and had a mean duration of six months. Upon completion of the program. 10 patients were found to be completely dry with three retaining a small leakage (a few drops). The 14th could not comply with the program because of illness. The results of this study appear promising in this patient population. There are indications for further research.

  4. [Osteogenesis imperfecta: Treatment and results of a case series].

    PubMed

    Escribano-Rey, R J; Duart-Clemente, J; Martínez de la Llana, O; Beguiristáin-Gúrpide, J L

    2014-01-01

    To describe our experience in the management of patients with osteogenesis imperfect (OI). We conducted a retrospective study of a series of cases affected with OI treated in the Clínica Univesidad de Navarra from 1980 to 2007, with a mean follow up of 17.3 years (7-27 years). We collected descriptive data of the sample, the fractures and the deformities, and the treatments given. The complications presented and the functional outcomes at the end of follow-up were also reviewed. The sample included ten patients. Approximately two-thirds (65%) of fractures were sustained in the lower limbs. One patient received medical treatment only. Three patients had combined medical and surgical treatment. Some type of surgical treatment was performed on 6 patients. The most common surgery was the Sofield-Millar performed on 37 occasions, with a third of them requiring revision surgery due to migration of the nails. There were 17 episodes of re-fracture. Complications such as non-union, iatrogenic fractures, and infections, were also observed. The functional outcome, according to the Hoffer-Bullock scale, at the end of follow-up was grade I/II in 7 patients. Despite the need for multiple interventions and complications presented during follow up, the appropriate treatment of patients with OI can provide acceptable functional outcomes. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  5. Video Game Rehabilitation of Velopharyngeal Dysfunction: A Case Series.

    PubMed

    Cler, Gabriel J; Mittelman, Talia; Braden, Maia N; Woodnorth, Geralyn Harvey; Stepp, Cara E

    2017-06-22

    Video games provide a promising platform for rehabilitation of speech disorders. Although video games have been used to train speech perception in foreign language learners and have been proposed for aural rehabilitation, their use in speech therapy has been limited thus far. We present feasibility results from at-home use in a case series of children with velopharyngeal dysfunction (VPD) using an interactive video game that provided real-time biofeedback to facilitate appropriate nasalization. Five participants were recruited across a range of ages, VPD severities, and VPD etiologies. Participants completed multiple weeks of individual game play with a video game that provides feedback on nasalization measured via nasal accelerometry. Nasalization was assessed before and after training by using nasometry, aerodynamic measures, and expert perceptual judgments. Four participants used the game at home or school, with the remaining participant unwilling to have the nasal accelerometer secured to his nasal skin, perhaps due to his young age. The remaining participants showed a tendency toward decreased nasalization after training, particularly for the words explicitly trained in the video game. Results suggest that video game-based systems may provide a useful rehabilitation platform for providing real-time feedback of speech nasalization in VPD. https://doi.org/10.23641/asha.5116828.

  6. Adverse clinical sequelae after skin branding: a case series

    PubMed Central

    2009-01-01

    Introduction Branding refers to a process whereby third degree burns are inflicted on the skin with a hot iron rod or metallic object. Branding employs the phenomenon of "counter irritation," and is widely used by faith healers in developing countries for therapeutic purposes. Some methods, which are very crude and inhuman, carry a large risk of complications. The purpose of this study is to present a series of complications and to familiarize clinicians with this dangerous method of treatment. Case presentation Four Pakistani patients, three male and one female, ranging from 25 to 60 years of age "branded" with a red hot iron rod for various medical reasons presented with severe medical complications to our tertiary care hospital. The mean duration between the procedure and presentation to the hospital was 6 days. At the time of admission, two patients had septic shock, one patient had cavernous sinus thrombosis and one patient had multiple splenic abscesses. All patients received standard care for wound management and systemic infections. Two patients eventually died during the course of treatment. Conclusion Severe complications from branding are troublesome and the potential risks of this treatment outweigh its benefits. Globally, there is a great need for heightened awareness about the dangers of branding among patients and physicians, as this will have an important effect on patients who seek branding for various medical conditions. PMID:19166615

  7. Congenital Zika syndrome with arthrogryposis: retrospective case series study.

    PubMed

    van der Linden, Vanessa; Filho, Epitacio Leite Rolim; Lins, Otavio Gomes; van der Linden, Ana; Aragão, Maria de Fátima Viana Vasco; Brainer-Lima, Alessandra Mertens; Cruz, Danielle Di Cavalcanti Sousa; Rocha, Maria Angela Wanderley; Sobral da Silva, Paula Fabiana; Carvalho, Maria Durce Costa Gomes; do Amaral, Fernando José; Gomes, Joelma Arruda; Ribeiro de Medeiros, Igor Colaço; Ventura, Camila V; Ramos, Regina Coeli

    2016-08-09

    To describe the clinical, radiological, and electromyographic features in a series of children with joint contractures (arthrogryposis) associated with congenital infection presumably caused by Zika virus. Retrospective case series study. Association for Assistance of Disabled Children, Pernambuco state, Brazil. Seven children with arthrogryposis and a diagnosis of congenital infection presumably caused by Zika virus during the Brazilian microcephaly epidemic. Main clinical, radiological, and electromyographic findings, and likely correlation between clinical and primary neurological abnormalities. The brain images of all seven children were characteristic of congenital infection and arthrogryposis. Two children tested positive for IgM to Zika virus in the cerebrospinal fluid. Arthrogryposis was present in the arms and legs of six children (86%) and the legs of one child (14%). Hip radiographs showed bilateral dislocation in seven children, subluxation of the knee associated with genu valgus in three children (43%), which was bilateral in two (29%). All the children underwent high definition ultrasonography of the joints, and there was no evidence of abnormalities. Moderate signs of remodeling of the motor units and a reduced recruitment pattern were found on needle electromyography (monopolar). Five of the children underwent brain computed tomography (CT) and magnetic resonance imaging (MRI) and the remaining two CT only. All presented malformations of cortical development, calcifications predominantly in the cortex and subcortical white matter (especially in the junction between the cortex and white matter), reduction in brain volume, ventriculomegaly, and hypoplasia of the brainstem and cerebellum. MRI of the spine in four children showed apparent thinning of the cord and reduced ventral roots. Congenital Zika syndrome should be added to the differential diagnosis of congenital infections and arthrogryposis. The arthrogryposis was unrelated to the abnormalities

  8. Congenital Zika syndrome with arthrogryposis: retrospective case series study

    PubMed Central

    Filho, Epitacio Leite Rolim; Lins, Otavio Gomes; Aragão, Maria de Fátima Viana Vasco; Brainer-Lima, Alessandra Mertens; Cruz, Danielle Di Cavalcanti Sousa; Rocha, Maria Angela Wanderley; Sobral da Silva, Paula Fabiana; Carvalho, Maria Durce Costa Gomes; do Amaral, Fernando José; Gomes, Joelma Arruda; Ribeiro de Medeiros, Igor Colaço; Ventura, Camila V; Ramos, Regina Coeli

    2016-01-01

    Objective To describe the clinical, radiological, and electromyographic features in a series of children with joint contractures (arthrogryposis) associated with congenital infection presumably caused by Zika virus. Design Retrospective case series study. Setting Association for Assistance of Disabled Children, Pernambuco state, Brazil. Participants Seven children with arthrogryposis and a diagnosis of congenital infection presumably caused by Zika virus during the Brazilian microcephaly epidemic. Main outcome measures Main clinical, radiological, and electromyographic findings, and likely correlation between clinical and primary neurological abnormalities. Results The brain images of all seven children were characteristic of congenital infection and arthrogryposis. Two children tested positive for IgM to Zika virus in the cerebrospinal fluid. Arthrogryposis was present in the arms and legs of six children (86%) and the legs of one child (14%). Hip radiographs showed bilateral dislocation in seven children, subluxation of the knee associated with genu valgus in three children (43%), which was bilateral in two (29%). All the children underwent high definition ultrasonography of the joints, and there was no evidence of abnormalities. Moderate signs of remodeling of the motor units and a reduced recruitment pattern were found on needle electromyography (monopolar). Five of the children underwent brain computed tomography (CT) and magnetic resonance imaging (MRI) and the remaining two CT only. All presented malformations of cortical development, calcifications predominantly in the cortex and subcortical white matter (especially in the junction between the cortex and white matter), reduction in brain volume, ventriculomegaly, and hypoplasia of the brainstem and cerebellum. MRI of the spine in four children showed apparent thinning of the cord and reduced ventral roots. Conclusions Congenital Zika syndrome should be added to the differential diagnosis of congenital

  9. Case Series Investigation of Amyotrophic Lateral Sclerosis (ALS) Among Former Kelly Air Force Base Workers

    DTIC Science & Technology

    2005-04-01

    3 Causes of ALS .............................................. I...Overlap Between Mortality Study and Case Series Investigation, W ith Underlying Causes of Death...ALS series and the general population. o Cases reported a low prevalence of obesity-related diseases. o Cases were also athletic; 6 of the 93 PALS

  10. Temporary Diverting Ileostomy via the Umbilicus: a Small Case Series

    PubMed Central

    Mushaya, C. D.; Chandra, Raaj; Sansom, Wendy; Keck, James

    2015-01-01

    The umbilicus, a natural orifice, which is used as an access port during laparoscopic surgery, can be used as a stoma site with potential superior cosmetic results as one less incision is then required. Our objective was to assess the efficacy and safety of the umbilical stoma in a selected group of patients. This is a prospective case series in hospital patients admitted as emergency or elective. Patients who underwent laparoscopic colorectal surgery with a planned ileostomy at Box Hill Hospital were approached and invited to participate in the study, with the stoma being fashioned on the umbilicus. Outcomes of interest included demographics, the details regarding the original indication for operation, operative and hospital related outcomes, postoperative bowel related complications, and other surgical and medical complications. Outcomes of a total of 10 (5 males) patients who underwent umbilical covering ileostomy during the study period were analyzed. Two patients with ulcerative colitis had the second stage of their operation converting their end stomas to loop stoma. These were counted twice, totaling 12 stomas in 10 patients. Three patients had their umbistomas after receiving neoadjuvant treatment for rectal cancer. The median period patients have had umbistomas is 113 days. Overall morbidity during the initial operation was low, except for 1 patient who had a small bowel injury. There was no mortality. Minor peristomal skin changes were the most common postoperative complication. Three patients had their stomas reversed with excellent cosmesis. Umbistomas appear to be a safe and effective way to fashion covering stomas post laparoscopic surgery and save the patient an added incision with excellent cosmetic results. PMID:25785324

  11. WIRELESS TENSION BAND WIRING FOR OLECRANON FRACTURES. Case Series.

    PubMed

    Roukoz, Sami; Bayoud, Wael

    2016-01-01

    This retrospective study evaluates the results of wireless tension band wire (WTBW) which is a modified technique of tension band wires (TBW) for Mayo type II A and III A olecranon fractures. In this technique the K-wires of the TBW are replaced by a cerclage wire while keeping the figure of eight wiring. We reviewed retrospectively our WTBW cases done between 2000 and 2015 where we replaced the K-wires by a cerclage wire. In this technique no hardware migration is possible. Patients were evaluated clinically, radiographicaly and a DASH score was measured. Seventeen patients were reviewed with a mean age of 58.5 years. The mean follow-up period was 58.5 months. The mean DASH score was 12 with 7 patients having a DASH score of zero. Joint mobility was near normal compared to the other side with loss of a mean of 4º in elbow extension and a mean of 3º in elbow flexion. In comparison with other series, in addition to good results, hardware removal for medical reasons was the lowest in our technique. It was needed in three patients for pain on elbow contact and in one with ulnar nerve irritation. This represents a rate of 23.5%. Undesirable events related to the use of K-wires in standard tension band wiring, such as wire migration, wire protrusion through the skin and wire impingement, are absent in the wireless tension band wiring. The high rate of patient satisfaction, good clinical results as well as low rate of needed hardware removal make this technique preferable for fixing Mayo Type II A olecranon fractures.

  12. Photofunctionalized dental implants: a case series in compromised bone.

    PubMed

    Funato, Akiyoshi; Ogawa, Takahiro

    2013-01-01

    Ultraviolet (UV) light treatment of titanium, or photofunctionalization, has been shown to enhance its osteoconductivity in animal and in vitro studies, but its clinical performance has yet to be reported. This clinical case series sought to examine the effect of photofunctionalization on implant success, healing time, osseointegration speed, and peri-implant marginal bone level changes at 1 year after restoration. Four partially edentulous patients were included in the study. Seven implants with identical microroughened surfaces were photofunctionalized with UV light for 15 minutes. Osseointegration speed was calculated by measuring the increase in implant stability quotient (ISQ) per month. Marginal bone levels were evaluated radiographically at crown placement and at 1 year. All implants placed into fresh extraction sockets, vertically augmented bone, simultaneously augmented sinuses, or the site of a failing implant remained functional and healthy at 1 year, even with an earlier loading protocol (2.1 to 4.5 months). ISQs of 48 to 75 at implant placement had increased to 68 to 81 at loading. In particular, implants with low primary stability (initial ISQ < 70) showed large increases in ISQ. The speed of osseointegration of photofunctionalized implants was considerably greater than that of as-received implants documented in the literature. Mean marginal bone levels were -0.35 ± 0.71 mm at crown placement and had significantly increased to 0.16 ± 0.53 mm at 1 year, with coronal gains in marginal bone level that surpassed the implant platform. No implants showed marginal bone loss. Within the limits of this study, photofunctionalization expedited and enhanced osseointegration of commercial dental implants in various clinically challenging/compromised bone conditions. Photofunctionalization resulted in preservation--and often a gain--of marginal bone level, and long-term large-scale clinical validation is warranted.

  13. Ayurvedic Therapy (Shirodhara) for Insomnia: A Case Series

    PubMed Central

    Vinjamury, Manjusha; der Martirosian, Claudia; Miller, Judith

    2014-01-01

    Background: Insomnia is one of the most common complaints faced by primary care practitioners after pain. Non-pharmacological management of Insomnia that is noninvasive is gaining interest among patients with insomnia. Purpose: To determine the feasibility of recruiting and retaining participants in a clinical trial on shirodhara, Ayurvedic oil dripping therapy, for insomnia in the United States and also to investigate the therapeutic usefulness of Shirodhara for insomnia using standardized outcome measures. Design: Case series. Study Intervention and Data Collection: Shirodhara with Brahmi oil was done for 45 minutes on each participant for 5 consecutive days. Insomnia Severity Index (ISI) was used to evaluate the severity of insomnia as well as to determine the response to Shirodhara therapy. Data were collected at baseline, end of the treatment (day 5) and 1 week after the treatment ended (follow-up). Results: Two males and eight females with a mean age of 40 years (range 23 to 72), SD ± 14.2, were enrolled in the study. One dropped out of the study, but all remaining nine participants experienced improvement at the end of treatment. The percentage of improvement range varied from 3.85% to 69.57%. At follow-up, most participants continued to improve. Comparison of means between baseline and day 5 indicated an overall significant improvement (P < .005), but in a comparison of baseline vs 1 week posttreatment the improvement was not significant (P < .089). No adverse events were reported during the study. Conclusion: Shirodhara with Brahmi oil may be beneficial for moderate to severe insomnia. It is feasible to recruit and retain participants for such therapies in the United States. It is important to validate these findings and investigate the mechanism of action using a larger sample and rigorous research design. PMID:24753997

  14. Anesthetic management of neurosurgical procedures during pregnancy: a case series.

    PubMed

    Kazemi, Pooya; Villar, Giselle; Flexman, Alana M

    2014-07-01

    Neurosurgical disorders are rare during pregnancy and challenge the anesthesiologist with conflicting anesthetic considerations and little evidence to guide decision-making. Our objective was to review the anesthetic management of pregnant patients undergoing intracranial neurosurgery at our institution and to describe the perioperative complications and outcomes. We used our institutional Discharge Abstract Database to identify patients assigned both neurological and obstetrical International Classification of Disease 10-A codes between April 1, 2001 and March 1, 2012. Pregnant patients who underwent intracranial neurosurgical procedures underwent a detailed chart review to extract demographic data and details about their anesthetic management and outcome. Nine patients underwent full chart review with a median age of 28 (range, 17 to 35) years and a gestational age of 23 (range, 7 to 30) weeks. Patients underwent a craniotomy for vascular lesions (4), neoplasms (3), and traumatic brain injuries (2). One patient was hyperventilated (PaCO2 28 mmHg), and mannitol and furosemide were used in 6 and 3 patients, respectively, without complication. Maternal neurological outcomes were good in 5 patients (Glasgow Outcome Scale of >3), poor in 3 patients (Glasgow Outcome Scale 3), and 1 patient died. Fetal outcomes were good in 5 patients and poor in 4 patients (1 therapeutic abortion, 3 intrauterine fetal demises). All cases of fetal distress or demise were either remote or occurred before the anesthetic management. Pregnant patients undergoing neurosurgery experience a high rate of morbidity and mortality. There were no adverse outcomes directly attributed to the use of osmotic diuretics and hyperventilation in our series.

  15. FUNCTIONAL OUTCOMES AFTER DISTAL BICEPS BRACHII REPAIR: A CASE SERIES

    PubMed Central

    Morris, Tim; Otto, Charissa; Zerella, Tanisha; Semmler, John G; Human, Taaibos; Phadnis, Joideep; Bain, Gregory I

    2016-01-01

    Objectives To investigate outcomes after surgical repair of distal biceps tendon rupture and the influence of arm dominance on isokinetic flexion and supination results. Background/Purpose While relatively uncommon, rupture of the distal biceps tendon can result in significant strength deficits, for which surgical repair is recommended. The purpose of this study was to assess patient reported functional outcomes and muscle performance following surgery. Methods A sample of 23 participants (22 males, 1 female), who had previously undergone surgical repair of the distal biceps tendon, were re-examined at a minimum of one year after surgery. Biodex isokinetic elbow flexion and supination testing was performed to assess strength (as measured by peak torque) and endurance (as measured by total work and work fatigue). The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Mayo Elbow Performance Scale (MEPS) were used to assess participants' subjectively reported functional recovery. Results At a mean of 7.6 years after surgical repair, there were no differences between the repaired and uninvolved elbows in peak torque (p = 0.47) or total work (p = 0.60) for flexion or supination. There was also no difference in elbow flexion work fatigue (p = 0.22). However, there was significantly less work fatigue in supination, which was likely influenced by arm dominance, as most repairs were to the dominant arm, F(1,22)=5.67, p = 0.03. Conclusion The long-term strength of the repaired elbow was similar to the uninvolved elbow after surgery to the distal biceps tendon. Endurance of the repaired elbow was similar in flexion but greater in supination, probably influenced by arm dominance. Study design Retrospective case series Level of Evidence Level 4 PMID:27904798

  16. Relativistic corrections to the Cooperon mass: BCS versus BEC picture

    NASA Astrophysics Data System (ADS)

    Lipavský, P.

    2017-02-01

    Relativistic corrections to the Cooperon mass are discussed for preformed Cooper pairs that become superconductive via the Bose-Einstein condensation (BEC) and for Cooperons in the Bardeen-Copper-Schrieffer (BCS) condensate. The distinction explains experimental results of Tate et al. (1989).

  17. Recovery from AKI Following Multiple Wasp Stings: A Case Series

    PubMed Central

    Zhang, Ling; Yang, Yingying; Tang, Yi; Zhao, Yuliang; Cao, Yu; Su, Baihai

    2013-01-01

    Summary Background and objective To observe the outcomes of AKI following multiple wasp stings. Design, setting, participants, & measurements Eighty-one patients (mean age ± SD, 45.5±14.7 years; 55 men and 26 women; mean Acute Physiology and Chronic Health Evaluation II score, 16.85±2.78) with AKI following multiple wasp stings between 1997 and 2011 were retrospectively analyzed. Data on their demographic characteristics, initial modalities of renal replacement therapy (RRT), urine output, serum creatinine, bilirubin, myoglobin, and other variables were collected. Renal outcomes included complete recovery of kidney function, CKD, and death. Subgroup analysis was performed according to initial modality of RRT in the first 48 hours, including continuous veno-venous hemofiltration (CVVH), intermittent hemodialysis (IHD), and CVVH plus plasma exchange (PE). Results Of the 75 patients available for follow-up, 7 (9.3%) died, and 8 (10.7%, all in the IHD group) developed CKD. The average RRT time was 18.2±8.4 days, and the average kidney function recovery time was 36.0 (29.0, 41.0) days. Subgroup analysis showed no difference in the mortality rates between the CVVH, CVVH + PE, and IHD groups (8.0%, 7.1%, and 11.1%, respectively; P>0.99). The recovery time for kidney function was significantly shorter in the CVVH and CVVH + PE groups than in the IHD group (31.9±8.5 days, 28.6±9.4 days, and 41.6±8.1 days, respectively; P<0.001). Conclusions This is a large case series report on the outcomes of patients with AKI following multiple wasp stings. Most patients survived with complete recovery of their kidney function. Despite the lack of difference in mortality rates, the patients who began RRT with CVVH and CVVH + PE experienced a better and more rapid recovery of kidney function than those initiated with IHD. PMID:24009218

  18. Conversion (dissociative) symptoms as a presenting feature in early onset bipolar disorder: a case series

    PubMed Central

    Ghosal, Malay Kumar; Guha, Prathama; Sinha, Mausumi; Majumdar, Debabrata; Sengupta, Payel

    2009-01-01

    We present three cases of early onset bipolar disorder where dissociative (conversion) symptoms preceded the onset of mania. This case series underscores the significance of dissociative/conversion symptoms as an early atypical presentation in juvenile bipolar disorder. PMID:21687018

  19. Pure spinal epidural cavernous hemangioma: A case series of seven cases

    PubMed Central

    Esene, Ignatius Ngene; Ashour, Ahmed M; Marvin, Eric; Nosseir, Mohamed; Fayed, Zeiad Y; Seoud, Khaled; El Bahy, Khaled

    2016-01-01

    Introduction: Pure spinal epidural cavernous hemangiomas (PSECHs) are rare vascular lesions with about 100 cases reported. Herein, we present a case series of 7 PSECHs discussing their clinical presentation, radiological characteristics, surgical technique and intraoperative findings, pathological features, and functional outcome. Materials and Methods: We retrieved from the retrolective databases of the senior authors, patients with pathologically confirmed PSECH operated between January 2002 and November 2015. From their medical records, the patients’ sociodemographic, clinical, radiological, surgical, and histopathological data were retrieved and analyzed. Results: The mean age of the seven cases was 50.3 years. Four were females. All the five cases (71.4%) in the thoracic spine had myelopathy and the 2 (28.6%) lumbar cases had sciatica. Local pain was present in all the cases. All the lesions were isointense on T1-weighted images, hyperintense on T2-weighted images, and in five cases there was strong homogeneous enhancement. In six cases (85.7%), classical laminectomy was done; lesions resected in one piece in five cases. Total excision was achieved in all the cases. Lesions were thin-walled dilated blood vessels, lined with endothelium, and engorged with blood and with scanty loose fibrous stroma. The median follow-up was 12 months (range: 1–144 months). All patients gradually improved neurologically and achieved a good outcome with no recurrence at the last follow-up. Conclusion: PSECH although rare is increasing reported and ought to be included in the differential diagnosis of spinal epidural lesions. Early surgical treatment with total resection is recommended as would result in a good prognosis. PMID:27630480

  20. Case series and descriptive cohort studies in neurosurgery: the confusion and solution.

    PubMed

    Esene, Ignatius N; Ngu, Julius; El Zoghby, Mohamed; Solaroglu, Ihsan; Sikod, Anna M; Kotb, Ali; Dechambenoit, Gilbert; El Husseiny, Hossam

    2014-08-01

    Case series (CS) are well-known designs in contemporary use in neurosurgery but are sometimes used in contexts that are incompatible with their true meaning as defined by epidemiologists. This inconsistent, inappropriate and incorrect use, and mislabeling impairs the appropriate indexing and sorting of evidence. Using PubMed, we systematically identified published articles that had "case series" in the "title" in 15 top-ranked neurosurgical journals from January 2008 to December 2012. The abstracts and/or full articles were scanned to identify those with descriptions of the principal method as being "case series" and then classified as "true case series" or "non-case series" by two independent investigators with 100 % inter-rater agreement. Sixty-four articles had the label "case series" in their "titles." Based on the definition of "case series" and our appraisal of the articles using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, 18 articles (28.13 %) were true case series, while 46 (71.87 %) were mislabeled. Thirty-five articles (54.69 %) mistook retrospective (descriptive) cohorts for CS. CS are descriptive with an outcome-based sampling, while "descriptive cohorts" have an exposure-based sampling of patients, followed over time to assess outcome(s). A comparison group is not a defining feature of a cohort study and distinguishes descriptive from analytic cohorts. A distinction between a case report, case series, and descriptive cohorts is absolutely necessary to enable the appropriate indexing, sorting, and application of evidence. Researchers need better training in methods and terminology, and editors and reviewers should scrutinize more carefully manuscripts claiming to be "case series" studies.

  1. Authors@UF Campus Conversation Series: A Case Study

    ERIC Educational Resources Information Center

    Silver, Isabel

    2014-01-01

    The Authors@UF program series emerged to showcase the scholarship and creativity of faculty, creating an intellectual forum within the academic library, and providing informal, extra-curriculum, academic engagement between students and faculty outside the classroom. This article identifies steps to launch an author program, and considerations in…

  2. Case Citations 1994. Seventeenth Series (Violence and School Safety).

    ERIC Educational Resources Information Center

    Russo, Charles J., Ed.

    Case citations from federal and state court decisions concerning violence and school safety are organized in five major sections with brief summaries of relevant cases in subcategories followed by a table of cases cited. The major sections are as follows (1) "Assaults on School Personnel" (Michael L. Yates); (2) "The Fourth Amendment: Search and…

  3. Primary hyperaldosteronism in the cat: a series of 13 cases.

    PubMed

    Ash, Roderick Andrew; Harvey, Andrea M; Tasker, Séverine

    2005-06-01

    Thirteen cases of feline primary hyperaldosteronism were diagnosed based on clinical signs, serum biochemistry, plasma aldosterone concentration, adrenal imaging and histopathology of adrenal tissue. Two cases presented with blindness caused by systemic hypertension, whilst the remaining 11 cases showed weakness resulting from hypokalaemic polymyopathy. Elevated concentrations of plasma aldosterone and adrenocortical neoplasia were documented in all cases. Seven cases had adrenal adenomas (unilateral in five and bilateral in two) and six had unilateral adrenal carcinomas. Three cases underwent medical treatment only with amlodipine, spironolactone and potassium gluconate; two cases survived for 304 and 984 days until they were euthanased because of chronic renal failure, whilst the third case was euthanased at 50 days following failure of the owner to medicate the cat. Ten cases underwent surgical adrenalectomy following a successful stabilisation period on medical management. Five cases remain alive at the time of writing with follow-up periods of between 240 and 1803 days. Three cases were euthanased during or immediately following surgery because of surgical-induced haemorrhage. One cat was euthanased 14 days after surgery because of generalised sepsis, whilst the remaining cat was euthanased 1045 days after surgery because of anorexia and the development of a cranial abdominal mass. It is recommended that primary hyperaldosteronism should be considered as a differential diagnosis in middle-aged and older cats with hypokalaemic polymyopathy and/or systemic hypertension and should no longer be considered a rare condition.

  4. Isospin Dependent Pairing Interactions and BCS-BEC crossover

    SciTech Connect

    Sagawa, H.; Margueron, J.; Hagino, K.

    2008-11-11

    We propose new types of density dependent contact pairing interaction which reproduce the pairing gaps in symmetric and neutron matters obtained by a microscopic treatment based on the realistic nucleon-nucleon interaction. The BCS-BEC crossover of neutrons pairs in symmetric and asymmetric nuclear matters is studied by using these contact interactions. It is shown that the bare and screened pairing interactions lead to different features of the BCS-BEC crossover in symmetric nuclear matter. We perform Hartree-Fock-Bogoliubov (HFB) calculations for semi-magic Calcium, Nickel, Tin and Lead isotopes and N = 20, 28, 50 and 82 isotones using these density-dependent pairing interactions. Our calculations well account for the experimental data for the neutron number dependence of binding energy, two neutrons separation energy, and odd-even mass staggering of these isotopes. Especially the interaction IS+IV Bare without the medium polarization effect gives satisfactory results for all the isotopes.

  5. Description of C isotopes within RMF+BCS approach

    SciTech Connect

    Saxena, G.; Singh, D.; Kaushik, M.

    2013-06-03

    In the present investigations we have employed relativistic mean-field plus BCS (RMF + BCS) approach to carry out a systematic study for the ground state properties of even-even C Isotopes. One of the prime reason of this study has been to look into the role of low lying states in neutron rich reason near neutron drip line. It is found that irrespective of whether any resonant state exists or not, the occupancy of weakly bound neutron single particle states having low orbital angular momentum, (l = 0 or 1), with a well spread wave function due to the absence or very small strength of centrifugal barrier, helps to cause the occurrence of nuclei with widely extended neutron density. Such nuclei are found to have characteristically very small two-neutron separation energy and large neutron rms radius akin to that observed in weakly bound systems.

  6. A revision of the quality of life-breast cancer survivors (QOL-BCS) instrument.

    PubMed

    Azuero, Andres; Su, Xiaogang; McNees, Patrick; Meneses, Karen

    2013-08-01

    The importance of quality of life (QOL) measurement among breast cancer survivors (BCS) is well-recognized by researchers and clinicians. With data from 427 rural BCS, the authors used a combination of clinical expertise and statistical analysis to revise a 48-item measure of QOL specific to BCS. The revised 15-item measure showed adequate psychometric properties and provides the basis for a brief yet comprehensive multidimensional measure of QOL applicable to most BCS. Future work includes fine-tuning the measurement model and examining its generalizability among non-rural BCS.

  7. Case-control study and case series of pseudohyperphosphatemia during exposure to liposomal amphotericin B.

    PubMed

    Bohm, Nicole M; Hoover, Katherine C; Wahlquist, Amy E; Zhu, Yusheng; Velez, Juan Carlos Q

    2015-11-01

    Pseudohyperphosphatemia due to an interaction between liposomal amphotericin B and the Beckman Coulter PHOSm assay occurs sporadically and remains underrecognized in clinical practice. This retrospective case-control study compares the incidences of hyperphosphatemia in adult inpatients exposed to liposomal amphotericin B or a triazole. A case series of patients with confirmed pseudohyperphosphatemia is described. A total of 80 exposures to liposomal amphotericin B and 726 exposures to triazoles were identified. Among subjects without chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia occurred more often during liposomal amphotericin B therapy than during triazole therapy (40% [14/35 cases] versus 10% [47/475 cases] of cases; P < 0.01; adjusted odds ratio, 5.2 [95% confidence interval {CI}, 2.3 to 11.9]). Among individuals with chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia also occurred more often during liposomal amphotericin B exposure (59% [10/17 cases] versus 20% [34/172 cases] of cases; P < 0.01; adjusted odds ratio, 6.0 [95% CI, 2.0 to 18.0]). When acute kidney injury occurred during antifungal exposure, the frequencies of hyperphosphatemia were not different between treatments. Seven episodes of unexpected hyperphosphatemia during liposomal amphotericin B exposure prompted a confirmatory test using an endpoint-based assay that found lower serum phosphorus levels (median difference of 2.5 mg/dl [range, 0.6 to 3.6 mg/dl]). Liposomal amphotericin B exposure confers a higher likelihood of developing hyperphosphatemia than that with exposure to a triazole antifungal, which is likely attributable to pseudohyperphosphatemia. Elevated phosphorus levels in patients receiving liposomal amphotericin B at institutions using the Beckman Coulter PHOSm assay should be interpreted cautiously.

  8. Projected BCS-Tamm-Dancoff approximation with blocking effect

    NASA Astrophysics Data System (ADS)

    Dias, H.; Krmpotić, F.

    1982-05-01

    The blocking effect is introduced through a canonical transformation in the projected BCS-Tamm-Dancoff approximation. It is suggested that the blocking effect may play an important role in the description of the low-lying states in odd-mass nuclei. Present address: Departamento de Física, Facultad de Ciencias Exactas, Universidad Nacional de La Plata, 1900 La Plata, Argentina. Member of Carrera de Investigador Científico, CONICET, Argentina. Sponsored by Financiadora de Estudos e Projetos (FINEP), Brasil.

  9. Flow equations for the BCS-BEC crossover

    SciTech Connect

    Diehl, S.; Gies, H.; Pawlowski, J. M.; Wetterich, C.

    2007-08-15

    The functional renormalization group is used for the BCS-BEC crossover in gases of ultracold fermionic atoms. In a simple truncation, we see how universality and an effective theory with composite bosonic diatom states emerge. We obtain a unified picture of the whole phase diagram. The flow reflects different effective physics at different scales. In the BEC limit as well as near the critical temperature, it describes an interacting bosonic theory.

  10. Design considerations for case series models with exposure onset measurement error.

    PubMed

    Mohammed, Sandra M; Dalrymple, Lorien S; Sentürk, Damla; Nguyen, Danh V

    2013-02-28

    The case series model allows for estimation of the relative incidence of events, such as cardiovascular events, within a pre-specified time window after an exposure, such as an infection. The method requires only cases (individuals with events) and controls for all fixed/time-invariant confounders. The measurement error case series model extends the original case series model to handle imperfect data, where the timing of an infection (exposure) is not known precisely. In this work, we propose a method for power/sample size determination for the measurement error case series model. Extensive simulation studies are used to assess the accuracy of the proposed sample size formulas. We also examine the magnitude of the relative loss of power due to exposure onset measurement error, compared with the ideal situation where the time of exposure is measured precisely. To facilitate the design of case series studies, we provide publicly available web-based tools for determining power/sample size for both the measurement error case series model as well as the standard case series model.

  11. Design considerations for case series models with exposure onset measurement error

    PubMed Central

    Mohammed, Sandra M.; Dalrymple, Lorien S.; Şentürk, Damla; Nguyen, Danh V.

    2014-01-01

    Summary The case series model allows for estimation of the relative incidence of events, such as cardiovascular events, within a pre-specified time window after an exposure, such as an infection. The method requires only cases (individuals with events) and controls for all fixed/time-invariant confounders. The measurement error case series model extends the original case series model to handle imperfect data, where the timing of an infection (exposure) is not known precisely. In this work, we propose a method for power/sample size determination for the measurement error case series model. Extensive simulation studies are used to assess the accuracy of the proposed sample size formulas. We also examine the magnitude of the relative loss of power due to exposure onset measurement error, compared to the ideal situation where the time of exposure is measured precisely. To facilitate the design of case series studies, we provide publicly available web-based tools for determining power/sample size for both the measurement error case series model as well as the standard case series model. PMID:22911898

  12. Adverse effects of aromatherapy: a systematic review of case reports and case series.

    PubMed

    Posadzki, Paul; Alotaibi, Amani; Ernst, Edzard

    2012-01-01

    This systematic review was aimed at critically evaluating the evidence regarding the adverse effects associated with aromatherapy. Five electronic databases were searched to identify all relevant case reports and case series. Forty two primary reports met our inclusion criteria. In total, 71 patients experienced adverse effects of aromatherapy. Adverse effects ranged from mild to severe and included one fatality. The most common adverse effect was dermatitis. Lavender, peppermint, tea tree oil and ylang-ylang were the most common essential oils responsible for adverse effects. Aromatherapy has the potential to cause adverse effects some of which are serious. Their frequency remains unknown. Lack of sufficiently convincing evidence regarding the effectiveness of aromatherapy combined with its potential to cause adverse effects questions the usefulness of this modality in any condition.

  13. Difficult Cases of Pain and Nonpain Symptoms in Intractable Spinal Infections: A Case Series

    PubMed Central

    Olsen, Molly L.; Havyer, Rachel D. A.; Smith, Thomas J.; Swetz, Keith M.

    2014-01-01

    In the modern age of advanced surgical techniques and pharmacologic management, bacterial spinal infections (SIs) can be managed (either eradicated or suppressed) in many hosts. However, the optimal management of SIs may be limited by patient comorbidities, which do not allow for surgical management, or limited by antimicrobial options due to side effects, toxicities, or emerging drug resistance. In these settings, frank and honest discussion regarding risks and benefits of treatment should be pursued, including that the SI may be a terminal illness. In this case series, we present 3 patients who had bacterial SIs whose treatments were limited by the above-mentioned factors. Furthermore, each case presented challenges regarding optimal medical management of somatic and neuropathic pain associated with the SI. PMID:22144661

  14. Focal fibrous overgrowths: A case series and review of literature

    PubMed Central

    Kolte, Abhay P.; Kolte, Rajshri A.; Shrirao, Tushar S.

    2010-01-01

    Intraoral fibrous overgrowths of the soft tissues are relatively common and may be benign reactive or neoplastic lesions. A series of 10 lesions is presented which included pyogenic granuloma, fibroma and peripheral ossifying fibroma. Almost all the lesions occurred in the second and third decades and were present in the anterior segment of the jaws, with a distinct female predilection. Majority of these lesions were asymptomatic and the patients reported for treatment only due to the discomfort during function. Histopathologic examinations were done for diagnosis of these lesions. Surgical excision along with removal of causative irritants remains the treatment of choice. The extent of excision should depend on the severity of the lesion, as some of these lesions have a tendency for recurrence. All the patients in this series were closely followed up for a period of 2 years and showed no signs of recurrence. PMID:22114437

  15. Focal fibrous overgrowths: a case series and review of literature.

    PubMed

    Kolte, Abhay P; Kolte, Rajshri A; Shrirao, Tushar S

    2010-10-01

    Intraoral fibrous overgrowths of the soft tissues are relatively common and may be benign reactive or neoplastic lesions. A series of 10 lesions is presented which included pyogenic granuloma, fibroma and peripheral ossifying fibroma. Almost all the lesions occurred in the second and third decades and were present in the anterior segment of the jaws, with a distinct female predilection. Majority of these lesions were asymptomatic and the patients reported for treatment only due to the discomfort during function. Histopathologic examinations were done for diagnosis of these lesions. Surgical excision along with removal of causative irritants remains the treatment of choice. The extent of excision should depend on the severity of the lesion, as some of these lesions have a tendency for recurrence. All the patients in this series were closely followed up for a period of 2 years and showed no signs of recurrence.

  16. [Gastroschisis repair under caudal anesthesia: a series of three cases].

    PubMed

    Kasat, Neha; Dave, Nandini; Shah, Harick; Mahajan, Swapnil

    2017-03-29

    Gastroschisis is a congenital anomaly characterized by a defect in the anterior abdominal wall with protrusion of abdominal viscera. Perioperative mortality is very high in these patients. Traditionally gastroschisis repair has been performed under general anesthesia with endotracheal intubation, requiring postoperative intensive care admission and mechanical ventilation. Caudal block is an attractive alternative to general anesthesia. We present a series of three neonates with gastroschisis, repaired solely under caudal anesthesia.

  17. Pediatric intraventricular meningioma: A series of six cases

    PubMed Central

    Dash, Chinmaya; Pasricha, Ribhav; Gurjar, Hitesh; Singh, Pankaj Kumar; Sharma, Bhawani Shankar

    2016-01-01

    Objective: Meningiomas in children is a rare occurrence. Primary intraventricular meningiomas (IVMs) are even rarer with reported incidence of 0.5%–5% of all meningiomas. The aim of the study was to describe the demographic profile, location, surgical approach, complications, and histopathology of six pediatric patients with IVM. Materials and Methods: We retrospectively analyzed all intraventricular tumors operated at our Institute from January 2010 till July 2015. Patients' clinical details and follow-up were obtained from hospital records and scans were obtained from picture archiving and communication system. Results: We found 6 pediatric patients (age ≤18 years) with histopathologically proven IVM. The mean age in this series was 14.6 years. Tumor was most commonly approached through the superior parietal lobule in this series. Gross total excision was achieved in all patients. The blood loss in the series was in the range of 600–2000 ml with a mean of 1100 ml. All were grade 1 meningioma on histopathological examination. Transitional meningioma was the most common histological subtype. None of the patients had a recurrence at last follow-up. Conclusions: Pediatric IVMs are rare tumors. They tend to have a male preponderance in contrast to adults which have a preference for females. Parietooccipital transcortical, transcallosal approach, middle/inferior temporal gyrus approach are the described techniques to tackle such tumors depending on the location of such tumors. Surgeons should watch out for massive blood loss during surgery, especially via the parietooccipital transcortical approach. PMID:27857785

  18. Editors' Introduction to the Hawthorne Case Study Series.

    ERIC Educational Resources Information Center

    Stringfield, Samuel C.; Hollifield, John H.

    1996-01-01

    Introduces three perspectives on the Hawthorne Elementary School (Houston, Texas) reform effort. The case studies indicate that successful restructuring of schools serving highly disadvantaged communities is possible. (GR)

  19. Case Series: Outbreak of Conversion Disorder among Amish Adolescent Girls.

    ERIC Educational Resources Information Center

    Cassady, Joslyn D.; Kirschke, David L.; Jones, Timothy F.; Craig, Allen S.; Bermudez, Ovidio B.; Schaffner, William

    2005-01-01

    Objective: Outbreak investigations are challenging in a cross-cultural context, and outbreaks of psychiatric disease are rare in any community. We investigated a cluster of unexplained debilitating illness among Amish girls. Method: We reviewed the medical records of cases, consulted with health care providers, performed active case finding,…

  20. Methodology Series Module 2: Case-control Studies.

    PubMed

    Setia, Maninder Singh

    2016-01-01

    Case-Control study design is a type of observational study. In this design, participants are selected for the study based on their outcome status. Thus, some participants have the outcome of interest (referred to as cases), whereas others do not have the outcome of interest (referred to as controls). The investigator then assesses the exposure in both these groups. The investigator should define the cases as specifically as possible. Sometimes, definition of a disease may be based on multiple criteria; thus, all these points should be explicitly stated in case definition. An important aspect of selecting a control is that they should be from the same 'study base' as that of the cases. We can select controls from a variety of groups. Some of them are: General population; relatives or friends; and hospital patients. Matching is often used in case-control control studies to ensure that the cases and controls are similar in certain characteristics, and it is a useful technique to increase the efficiency of the study. Case-Control studies can usually be conducted relatively faster and are inexpensive - particularly when compared with cohort studies (prospective). It is useful to study rare outcomes and outcomes with long latent periods. This design is not very useful to study rare exposures. Furthermore, they may also be prone to certain biases - selection bias and recall bias.

  1. Dyschromias: A Series of Five Interesting Cases from India

    PubMed Central

    Namitha, Prabhu; Sacchidanand, S

    2015-01-01

    Dyschromatosis is a pigmentary genodermatosis which presents with hyper and hypopigmented skin lesions giving a mottled appearance. It is a rare entity in India reported mainly in the East Asian population. Classically, two forms have been described; dyschromatosis universalis hereditaria (DUH) and dyschromatosis symmetrica hereditaria. Here we report four cases of DUH and one case of dyschromatosis symmetrica hereditaria from India. PMID:26677297

  2. Case Series: Outbreak of Conversion Disorder among Amish Adolescent Girls.

    ERIC Educational Resources Information Center

    Cassady, Joslyn D.; Kirschke, David L.; Jones, Timothy F.; Craig, Allen S.; Bermudez, Ovidio B.; Schaffner, William

    2005-01-01

    Objective: Outbreak investigations are challenging in a cross-cultural context, and outbreaks of psychiatric disease are rare in any community. We investigated a cluster of unexplained debilitating illness among Amish girls. Method: We reviewed the medical records of cases, consulted with health care providers, performed active case finding,…

  3. Defying standard criteria for digital replantation: A case series

    PubMed Central

    Casal, Diogo; Gomez, Manuel Macemino; Antunes, Paula; Candeias, Henrique; Almeida, Maria Angélica

    2013-01-01

    INTRODUCTION There is much controversy regarding the current indications and contraindications for digital replantation. PRESENTATION OF CASE Three patients with absolute contraindications for digital replantation according to classical criteria are presented (Case 1: multilevel amputation of the hand and fingers; Case 3: avulsion of the thumb; Case 4: index amputation proximal to the insertion of the flexor digitorum superficialis). In addition a patient with a very distal digital amputation (Case 2), whose indication for replantation is controversial is also presented. In all cases, the patients were replanted and showed good functional and aesthetical results. DISCUSSION Most authors advocate that the classical indications for replantation have been validated by experience, are predicated on the potential for long-term function, and should be followed in most if not all cases. However, some surgeons have been adopting a more liberal attitude with good results. CONCLUSION The clinical cases presented in this paper suggest that the standard criteria for digital replantation should not be followed rigidly but instead should be regarded as a general guide. PMID:23702366

  4. Surgical augmentation of interdental papilla - A case series

    PubMed Central

    Muthukumar, Santhanakrishnan; Rangarao, Suresh

    2015-01-01

    Formation of black triangles between teeth due to loss of interdental palpilla is one of the common problems encountered in routine clinical practice, as extreme importance is given to esthetics. This paper discusses two different surgical approaches in treating three cases with papillary loss in the first case the reconstruction of papilla was achieved by using a semilunar coronally repositioned papilla technique and in second and the third case reconstruction of the papilla was achieved by modification of Nodland's microsurgical technique. In all the three cases a free connective tissue graft was used to reconstruct the lost volume of interdental papilla. Complete reconstruction of the lost papilla was achieved in all the three cases 6 months postoperatively. PMID:26604592

  5. [Etiology of endocrine arterial hypertensions: about a series of cases].

    PubMed

    Bouznad, Naima; El Mghari, Ghizlane; El Ansari, Nawal

    2016-01-01

    Arterial hypertensions (HTA) of endocrine origin are a rare cause of hypertension; HTA overall prevalence don't exceed 4% of hypertensive patients. Research interest in endocrine HTA is due to the severity of some life-threatening, potentially curable and reversible forms of HTA. The aim of our study was to determine the clinical, paraclinical, etiological and therapeutic profile of secondary HTA of endocrine origin in patients treated in endocrinology department at the University Hospital Mohamed VI in Marrakech. We conducted a prospective, descriptive study spanned 4 years, enrolling 45 patients with endocrine HTA. The average age was 44.89 years, with a clear predominance of women (sex ratio 0.49). Etiology of endocrine HTA was dominated by pheochromocytoma (17 cases), hypercorticism (11 cases) and acromegaly (8 cases). HTA were paroxysmal in 24.4%. HTA were immediately classified as grade 3 severe in 40% of cases. HTA were complicated by heart disease in 24% of cases and by renal disease in 20% of cases. Curative treatment cleared up HTA in 60% of cases (27 cases). The diagnosis of secondary endocrine HTA is sometimes difficult because of the lack of clinical specificity. It is not unusual for HTA to be the only manifestation of the disease. In our study we noted the paroxysmal and severe nature of HTA. The potentially curable nature of HTA in more than two thirds of cases, demostrates the importance of early diagnosis of each severe HTA resistant to treatment or in the presence of suggestive clinical, biological or radiological signs.

  6. BACLOFEN IN THE TREATMENT OF PERSISTENT HICCUP: A CASE SERIES

    PubMed Central

    Mirijello, Antonio; Addolorato, Giovanni; D'Angelo, Cristina; Ferrulli, Anna; Vassallo, Gabriele; Antonelli, Mariangela; Leggio, Lorenzo; Landolfi, Raffaele

    2016-01-01

    Background Persistent hiccup is a worrying symptom both for patients, because of reduced quality of life, and for physicians, because of frustration for unsuccessful treatments. Aim To test baclofen administration for the treatment of persistent hiccup. Methods We report a series of seven patients affected by persistent hiccup successfully treated with baclofen. Results Hiccup stopped in all patients after a single administration of the drug. Conclusions Baclofen is a GABAB receptor agonist. It is conceivable that the reduction of dopamine release by GABAB receptor stimulation is able to interrupt hiccup's reflex arc. PMID:23834241

  7. Complications Associated With Arthroscopic Labral Repair Implants: A Case Series.

    PubMed

    Felder, Jerrod J; Elliott, Michael P; Mair, Scott D

    2015-07-01

    Arthroscopic labral repair in the shoulder has become commonplace in recent years. A variety of implants have evolved in parallel with arthroscopic techniques. Any orthopedic implant that is placed in close proximity to the joint has the potential to cause subsequent damage to the articular surface if it is left prominent or dislodges secondary to improper surgical technique. This article focuses on a series of implant-related complications of labral surgery and their subsequent management. Additionally, correct patient selection and surgical technique are discussed. Copyright 2015, SLACK Incorporated.

  8. Tooth resorption part II - external resorption: Case series.

    PubMed

    Fernandes, Marina; de Ataide, Ida; Wagle, Rahul

    2013-03-01

    External tooth resorption usually follows trauma to the periodontal ligament. It can be classified into five categories based on its clinical and histological manifestations. Calcium hydroxide has long been used as an intracanal medicament to slow down the resorption process due to its alkaline pH. A combination of both external and internal resorptions can also occur on the same tooth, making the management more complex. Five case reports of external resorption have been presented in this article along with pertinent review of literature. Successful management was possible in two cases, while extractions had to be advised in 3 cases due to advanced nature of the lesions.

  9. "Spiritual starvation?": a case series concerning christianity and eating disorders.

    PubMed

    Morgan, J F; Marsden, P; Lacey, J H

    2000-12-01

    We describe the cases of four patients with eating disorders in whom complex interactions occurred among religious faith, pathogenesis of the eating disorder, and clinical management. In some of the cases, religious beliefs seemed to provide a containment of maladaptive behaviors, partly through prayer and through a sense of belonging to the religious community. In other cases, it proved difficult to separate the concept of a punitive God from the illness process. The cases are discussed with reference to a limited empirical literature. Similarities are noted between some religious institutions and eating disorder treatment regimes. This paper explores management issues, including the use of pastoral counseling and the ethics of addressing religious beliefs in therapy. We note the benefits of a rapprochement between psychiatry and religion. Copyright 2000 by John Wiley & Sons, Inc.

  10. Autoimmune pancreatitis: case series and review of the literature.

    PubMed

    Shakov, Rada; DePasquale, Joseph R; Elfarra, Hossam; Spira, Robert S

    2009-01-01

    Autoimmune pancreatitis (AuP) is a chronic pancreatic inflammation secondary to an underlying autoimmune mechanism. After early reports of a particular type of pancreatitis associated with hypergammaglobulinemia, others asserted that there is an autoimmune mechanism involved in some patients with chronic pancreatitis. In 1995 AuP was first described as a distinct clinical entity. Since then, there have been many documented cases of AuP in Japan, and now, perhaps due to increased awareness, more cases are being reported in Europe and the United States. Herein we present our experience with 3 cases of AuP and we review the relevant literature. These 3 cases demonstrate the difficulties that exist in making the diagnosis of AuP and the impact that the diagnosis can have on patient management.

  11. Suicide by hara-kiri: a series of four cases.

    PubMed

    Di Nunno, N; Costantinides, F; Bernasconi, P; Di Nunno, C

    2001-03-01

    The authors describe four cases of suicide by hara-kiri. This very painful form of suicide consists of self-inflicting a wound in the abdomen using a sharp instrument. It was first reported in 988 A.D. in the East but has now become rare in both the East and West. These four cases occurred over a 40-year period in the Trieste and Bari medicolegal area. In two of our cases the victims were afflicted with mental illness, whereas the other two suffered from depression. In cases of death by hara-kiri, it is important to establish a differential diagnosis between suicide and homicide; the presence of trial wounds (inflicted by the victim as a form of practice to overcome any hesitation before stabbing the abdomen with the cutting weapon) can prove very helpful.

  12. Breast Cancer in Transgender Veterans: A Ten-Case Series.

    PubMed

    Brown, George R

    2015-03-01

    All known cases of breast cancer in patients with a diagnosis consistent with transgender identification were identified in the Veterans Health Administration (1996-2013). Ten cases were confirmed: seven birth sex females and three birth sex males. Of the three birth sex males, two identified as gender dysphoric male-to-female and one identified as transgender with transvestic fetishism. The birth sex males all presented with late-stage disease that proved fatal, whereas most of the birth sex female transgender veterans presented with earlier stage disease that could be treated. These cases support the importance of screening for breast cancer using standard guidelines in birth sex males and females. Family history of breast cancer should be obtained from transgender people as part of routine care. This report expands the known cases of breast cancer in transgender persons from 5 to 12 (female-to-male) and from 10 to 13 (male-to-female).

  13. Epidermoid cysts: an exclusive palatal presentation and a case series.

    PubMed

    Ravindranath, Abhilash Pasare; Ramalingam, Karthikeyan; Natesan, Anuja; Ramani, Pratibha; Premkumar, Priya; Thiruvengadam, Chandrasekar

    2009-04-01

    Epidermoid cysts (EC) can occur anywhere in the body. In the head and neck region, they more often present in the midline between the submental region and the supra sternal notch. EC in the oral cavity are extremely rare and present as benign, slow growing lesions. Records from College of Dental Surgery, Saveetha University, from 2002 to 2006 were searched for cases coded as EC. The study included 13 cases within the oral and maxillofacial region. Of the 13 cases, 11 occurred in male patients and 2 in female patients. Specific anatomic locations included posterior auricular region (n = 2), forehead region (n = 2), lateral side of the face (n = 3), chin (n = 1), gingiva (n = 3), intraosseous within the anterior maxilla (n = 1), and hard palate (n = 1). Besides the previously reported locations, we present the first case occurring in the hard palate, measuring 5 x 3 cm in size along with melanin pigmentation.

  14. Sentinel lymph node biopsy in paediatric melanoma. A case series.

    PubMed

    Sánchez Aguilar, M; Álvarez Pérez, R M; García Gómez, F J; Fernández Ortega, P; Borrego Dorado, I

    2015-01-01

    The incidence of melanoma in children is uncommon, being particularly rare in children under 10 years-old. However, this disease is increasing by a mean of 2% per year. As in adults, the lymph node status is the most important prognostic factor, crucial to performing the selective sentinel lymph node biopsy (SLNB). We report 3 cases of paediatric patients of 3, 4 and 8 years-old, in which SLNB was performed for malignant melanoma. Paediatric age implies greater technical difficulty to the scintigraphy scan due to poor patient cooperation, with mild sedation required in some cases, and only being able to acquire planar images in other cases. SPECT/CT was only performed in the oldest patient. In our cases, SLNB was useful for selecting the least invasive surgery in order to reduce morbidity. Copyright © 2014 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  15. Proximal Interruption of the Pulmonary Artery: A Case Series

    PubMed Central

    Anand, S.H.; Mani, Sunithi Elizabeth; Joseph, Elizabeth; Mathai, John

    2015-01-01

    We present a few cases of Proximal Interruption of the Pulmonary Artery, an uncommon developmental anomaly associated with congenital heart disease. The cases had varied clinical presentations. Chest radiograph showed a hypoplastic lung with an ipsilateral small hilum on the side of the interruption and hyperinflation of the contralateral lung. Contrast CT confirmed the diagnosis, demonstrating non-visualization of the left or right pulmonary artery, and other related findings. PMID:26816968

  16. Paracetamol overdose secondary to dental pain: a case series.

    PubMed

    Siddique, I; Mahmood, H; Mohammed-Ali, R

    2015-09-25

    There have been documented cases of serious and life-threatening health effects due to patients taking unintentional analgesia overdose secondary to dental pain. We aimed to determine firstly what proportion of unintentional paracetamol overdose cases admitted to an acute medical assessment unit (MAU) were secondary to dental pain, secondly what proportion of such cases encountered barriers to accessing emergency dental care and finally what clinical burden such cases placed on the hospital services. The clinical coding department provided information to allow appropriate identification and data collection from patient discharge summaries and case notes of all unintentional paracetamol overdose cases secondary to dental pain over a 24 month period (1 March 2012 to 28 February 2014). One hundred and sixteen admissions were identified specifically for unintentional paracetamol overdose. Dental pain accounted for 48 (41%) of all cases. Females (67%) were twice as likely to be admitted, compared to males (33%), with a mean age of 36 years and four months. Thirty-two (63%) non-dentally registered and all nine (100%) registered patients were unable to access timely emergency dental care before their admission. Forty cases (83%) were referred to the hospital oral and maxillofacial services (OMFS). Thirty-seven (93%) patients underwent elective outpatient dental extractions and the remaining three (7%) patients were admitted for intravenous antibiotics, incision and drainage and dental extractions. All patients were treated under local anaesthetic. Dental pain is the single most common cause of acute medical admission secondary to unintentional paracetamol overdose. Patients registered with a general dental practitioner (GDP), as well as those not registered with a GDP, had difficulty accessing timely emergency primary dental care.

  17. [Analysis of a series pheochromocytoma cases over 15 years].

    PubMed

    Rojo Alvaro, J; Toni, M; Ollero, Md; Pineda, Jj; Munárriz, P; Anda, E

    2012-01-01

    The pheochromocytoma is a catecholamine secreting tumour derived from chromaffin cells of the sympathetic nervous system. Eighty to eighty-five percent of these tumours are localized in the adrenal medulla. When pheocromocytomas are found outside the adrenal gland they are referred to as extra-adrenal pheochromocytomas or paragangliomas. The diagnosis is confirmed by elevation of catecholamines and the metanephrines in blood plasma and urine. Localization of the tumour should be done following biochemical diagnosis by means of CT scan and/or MRI. The treatment of choice is tumour resection by laparoscopic surgery. A review was made of all patient medical histories diagnosed with pheochromocytoma confirmed by the pathology reports of Pathological anatomy of the Navarre hospital Complex (Anatomía patológica del Complejo hospitalario de Navarra A y B) between 1996 to 2010. Descriptive analysis was made using the IBM SPSS statistics program. Our series consists of 43 patients diagnosed with pheochromocytoma over a span of 15 years. The average age on presentation was 47 years. Among the younger patients specific genetic syndromes were found. Computerized tomography was the most widely used method of localization. Contradictory results were found regarding perioperative medical management protocols. All pheocromocytoma tumours in this series were benign. It is advisable to carry out a genetic study on patients under twenty. The biochemical indicators with the greatest diagnostic sensitivity were the levels of normetanephrine and metanephrine in urine. Surgery was the only treatment option.

  18. Endodontic management of dens invaginatus Type IIIb: Case series

    PubMed Central

    Martins, Jorge N. R.; da Costa, Rui Pereira; Anderson, Craig; Quaresma, Sérgio André; Corte-Real, Luís S. M.; Monroe, Adam D.

    2016-01-01

    Dens invaginatus may be seen as a developmental malformation. It is characterized by an invagination of the enamel and dentin, creating a lumen inside the affected tooth, which may extend as deep as the apical foramen. Oehlers Type IIIb is considered the most challenging clinical conditions. The purpose of this study is to discuss the nonsurgical endodontic management of vital and necrotic dens invaginatus Type IIIb cases. Due to the complex anatomical consideration of dens invaginatus Type IIIb, endodontic treatment is extremely technique sensitive. A conservative approach was used in a vital case to treat the invaginated lumen only, to preserve the vitality of the pulp, and a more invasive approach was used in a necrotic case to debride the lumen and necrotic pulp for proper disinfection of the root canal system. Although different, all the approaches were successful. The clinical signs and symptoms were resolved. The vital case remains vital after 19 months, and the recall radiographs were able to show satisfactory periapical healing both in vital and necrotic cases. Due to the highly complex anatomy of dens invaginatus Type IIIb, the decision of preserving the pulp vitality may not be related only to pulpal diagnosis but also to the technical requirements of the treatment. Although very technically sensitive, it may be possible to treat the invaginated lumen exclusively, while preserving the vitality of the pulp. Necrotic cases may require a more aggressive approach to achieve a favorable prognosis. PMID:28042276

  19. Treatment of epidermoid tumors with gamma knife radiosurgery: Case series

    PubMed Central

    Vasquez, Javier A. Jacobo; Fonnegra, Julio R.; Diez, Juan C.; Fonnegra, Andres

    2016-01-01

    Background: Epidermoid tumors (ETs) are benign lesions that are treated mainly by means of surgical resection, with overall good results. External beam radiotherapy is an alternative treatment for those recurrent tumors, in which a second surgery might not be the best choice for the patient. A little information exists about the effectiveness of gamma knife radiosurgery for the treatment of newly diagnosed and recurrent ETs. We present three cases of ETs treated with gamma knife radiosurgery. Case Description: Case 1 is a 21-year-old female with an ET located in the left cerebellopontine angle (CPA) with symptoms related to VIII cranial nerve dysfunction. Symptom control was achieved and maintained after single session radiosurgery with gamma knife. Case 2 is a 59-year-old female patient with the history of trigeminal neuralgia secondary to a recurrent ET located in the left CPA. Significant pain improvement was achieved after treatment with gamma knife radiosurgery. Case 3 is a 29-year-old male patient with a CPA ET causing long lasting trigeminal neuralgia, pain relief was achieved in this patient after gamma knife radiosurgery. Conclusion: Long-term symptom relief was achieved in all three cases proving that gamma knife radiosurgery is a good and safe alternative for patients with recurrent or nonsurgically treated ETs. PMID:26958427

  20. Digoxin-Specific Antibody Fragment Dosing: A Case Series.

    PubMed

    Chhabra, Neeraj; Valento, Matthew; Bryant, Sean M; Aks, Steven E

    Digoxin-specific antibody fragments (DSFab) are used for the treatment of poisoning by cardiac glycosides, such as pharmaceutical digoxin. Dosing of this therapy for chronic and acute poisonings is based on the steady-state serum concentrations of digoxin, historical data in acute ingestions, or empiric regimens purportedly based on the average requirements. Empiric dosing for adult patients involves utilization of 3-6 vials for chronic poisoning and 10-20 vials for acute poisoning. The aim of this study was to describe the average dosing requirements based on the steady-state serum concentration of digoxin or historical data and compare this with the empiric dosing regimens. We performed a retrospective analysis of cases over an 11-year period presented to the Illinois Poison Center where administration of DSFab was recommended. We identified 140 cases of chronic digoxin poisoning and 26 cases or acute digoxin poisoning for analysis. The average dose of DSFab recommended in the cases of chronic digoxin poisoning was 3.05 vials (SD ± 1.31). The average dose of DSFab recommended in the cases of acute digoxin poisoning was 6.33 vials (SD ± 5.26). These values suggest that empiric dosing regimens may overestimate the need for DSFab in cases of both chronic and acute poisonings of pharmaceutical digoxin.

  1. Endodontic management of dens invaginatus Type IIIb: Case series.

    PubMed

    Martins, Jorge N R; da Costa, Rui Pereira; Anderson, Craig; Quaresma, Sérgio André; Corte-Real, Luís S M; Monroe, Adam D

    2016-01-01

    Dens invaginatus may be seen as a developmental malformation. It is characterized by an invagination of the enamel and dentin, creating a lumen inside the affected tooth, which may extend as deep as the apical foramen. Oehlers Type IIIb is considered the most challenging clinical conditions. The purpose of this study is to discuss the nonsurgical endodontic management of vital and necrotic dens invaginatus Type IIIb cases. Due to the complex anatomical consideration of dens invaginatus Type IIIb, endodontic treatment is extremely technique sensitive. A conservative approach was used in a vital case to treat the invaginated lumen only, to preserve the vitality of the pulp, and a more invasive approach was used in a necrotic case to debride the lumen and necrotic pulp for proper disinfection of the root canal system. Although different, all the approaches were successful. The clinical signs and symptoms were resolved. The vital case remains vital after 19 months, and the recall radiographs were able to show satisfactory periapical healing both in vital and necrotic cases. Due to the highly complex anatomy of dens invaginatus Type IIIb, the decision of preserving the pulp vitality may not be related only to pulpal diagnosis but also to the technical requirements of the treatment. Although very technically sensitive, it may be possible to treat the invaginated lumen exclusively, while preserving the vitality of the pulp. Necrotic cases may require a more aggressive approach to achieve a favorable prognosis.

  2. Acute appendicitis in pregnancy: Case series and review

    PubMed Central

    Burcu, Busra; Ekinci, Ozgur; Atak, Tuba; Orhun, Kivilcim; Eren, Turgut Tunc; Alimoglu, Orhan

    2016-01-01

    OBJECTIVE: Acute appendicitis is one of the most common acute surgical pathology we encountered. In this study we investigated our pregnant cases of appendicitis, and reviewed literature. METHODS: A total of 21 pregnant women who underwent appendectomy with the initial diagnosis of acute appendicitis in Istanbul Medeniyet University Clinics of General Surgery between January 2012, and December 2014 were retrospectively analyzed. The patients’s ages, trimesters, complaints, abdominal examination, laboratory, and ultrasonographic findings, surgical techniques, complications and hospital stay were noted. RESULTS: The patients were in their first (n=12; 57.1%), second (n=5; 23.8%), and third trimesters (n=4; 19.0%) of their pregnancies Median age was 23.9 years. All of the patients had abdominal pain. Median value of WBC count was 13.297/mm³. Ultrasound was positive in 12 patients (57.1%). In 14 (66.6%) patients McBurney incision, and in 6 (28.6%) cases right paramedian incision were used. One patient (4.8%) underwent laparoscopic appendectomy. Nineteen cases were acute appendicitis (90.5%), and two cases were perforated appendicitis (9.5%). Average hospital stay was 3.8 days. Two cases with perforated acute appendicitis developed wound infection and treated conservatively. There were no fetomaternal mortality. CONCLUSION: Physiologically anatomic and biochemical changes occurring during pregnancy can delay the diagnosis of acute appendicitis threaten the lives of both the mother and the fetus Therefore, rapid diagnosis and appropriate treatment convey importance. PMID:28058387

  3. Acute appendicitis in pregnancy: Case series and review.

    PubMed

    Burcu, Busra; Ekinci, Ozgur; Atak, Tuba; Orhun, Kivilcim; Eren, Turgut Tunc; Alimoglu, Orhan

    2016-01-01

    Acute appendicitis is one of the most common acute surgical pathology we encountered. In this study we investigated our pregnant cases of appendicitis, and reviewed literature. A total of 21 pregnant women who underwent appendectomy with the initial diagnosis of acute appendicitis in Istanbul Medeniyet University Clinics of General Surgery between January 2012, and December 2014 were retrospectively analyzed. The patients's ages, trimesters, complaints, abdominal examination, laboratory, and ultrasonographic findings, surgical techniques, complications and hospital stay were noted. The patients were in their first (n=12; 57.1%), second (n=5; 23.8%), and third trimesters (n=4; 19.0%) of their pregnancies Median age was 23.9 years. All of the patients had abdominal pain. Median value of WBC count was 13.297/mm³. Ultrasound was positive in 12 patients (57.1%). In 14 (66.6%) patients McBurney incision, and in 6 (28.6%) cases right paramedian incision were used. One patient (4.8%) underwent laparoscopic appendectomy. Nineteen cases were acute appendicitis (90.5%), and two cases were perforated appendicitis (9.5%). Average hospital stay was 3.8 days. Two cases with perforated acute appendicitis developed wound infection and treated conservatively. There were no fetomaternal mortality. Physiologically anatomic and biochemical changes occurring during pregnancy can delay the diagnosis of acute appendicitis threaten the lives of both the mother and the fetus Therefore, rapid diagnosis and appropriate treatment convey importance.

  4. Treatment of epidermoid tumors with gamma knife radiosurgery: Case series.

    PubMed

    Vasquez, Javier A Jacobo; Fonnegra, Julio R; Diez, Juan C; Fonnegra, Andres

    2016-01-01

    Epidermoid tumors (ETs) are benign lesions that are treated mainly by means of surgical resection, with overall good results. External beam radiotherapy is an alternative treatment for those recurrent tumors, in which a second surgery might not be the best choice for the patient. A little information exists about the effectiveness of gamma knife radiosurgery for the treatment of newly diagnosed and recurrent ETs. We present three cases of ETs treated with gamma knife radiosurgery. Case 1 is a 21-year-old female with an ET located in the left cerebellopontine angle (CPA) with symptoms related to VIII cranial nerve dysfunction. Symptom control was achieved and maintained after single session radiosurgery with gamma knife. Case 2 is a 59-year-old female patient with the history of trigeminal neuralgia secondary to a recurrent ET located in the left CPA. Significant pain improvement was achieved after treatment with gamma knife radiosurgery. Case 3 is a 29-year-old male patient with a CPA ET causing long lasting trigeminal neuralgia, pain relief was achieved in this patient after gamma knife radiosurgery. Long-term symptom relief was achieved in all three cases proving that gamma knife radiosurgery is a good and safe alternative for patients with recurrent or nonsurgically treated ETs.

  5. Cutaneous and disseminated blastomycosis: a pediatric case series.

    PubMed

    Brick, Katherine E; Drolet, Beth A; Lyon, Valerie B; Galbraith, Sheila S

    2013-01-01

    Blastomycosis is a rare fungal infection that most often initially infects the lungs and can progress to disseminated involvement of the skin, bones, and central nervous system (CNS). Pediatric blastomycosis constitutes a small portion of total cases, but delay in diagnosis may result in significant morbidity. Seventeen pediatric cases of blastomycosis were identified at Children's Hospital of Wisconsin from 1999 to 2009 through retrospective chart review; 53% had evidence of dissemination (bone, skin, or CNS) confirmed by culture. Six cases presented with cutaneous lesions, and five of these were found to have other systemic involvement. These five nonimmunosuppressed cases of primary pulmonary disease with cutaneous involvement plus dissemination to bone or the CNS are reported in detail. The diagnosis of blastomycosis in children is often delayed, and dissemination by the time of diagnosis may be more common than in adults. Cutaneous dissemination may occur in immunocompetent children, may indicate underlying systemic involvement, and can be more readily identified than symptoms of bony or neurologic involvement. These reported cases indicate the importance of dermatologists recognizing and investigating all potentially involved organ systems when a patient presents with characteristic skin lesions with or without a history of respiratory illness. © 2012 Wiley Periodicals, Inc.

  6. [Analysis of a case series of workers with mobbing syndrome].

    PubMed

    Marinoni, B; Minelli, C M; Franzina, B; Martellosio, V; Scafa, F; Giorgi, I; Mazzacane, F; Stancanelli, M; Mennoia, N V; Candura, S M

    2007-01-01

    Mobbing represents nowadays a major challenge for Occupational Medicine. We examined, during the last seven years, 253 patients who asked medical assistance for psychopathological problems by them ascribed to mobbing in the working environment. All patients underwent occupational health visit, psychological counselling (including personality tests administration), and psychiatric evaluation. A clinical picture probably due to mobbing was diagnosed in 37 workers: 2 cases of Post-Traumatic Stress Disorder (PTSD), 33 of Adjustment Disorder (AD), and 2 of anxiety disorder. Regarding mobbing typology, we found 19 cases of vertical mobbing (by an employer/manager to employees), 14 cases of strategic mobbing, 3 cases of horizontal mobbing (among colleagues), and one non intentional mobbing. In conclusion, a pure mobbing syndrome was diagnosed in a lower proportion than that reported by other investigators. The described interdisciplinary approach appears useful for the diagnostic assessment of suspect mobbing cases, that in turn is crucial for prognosis and treatment, as well as in relation to medico-legal issues and work-related compensation claims.

  7. Subdural Hematoma Associated With Labor Epidural Analgesia: A Case Series.

    PubMed

    Lim, Grace; Zorn, Jamie M; Dong, Yuanxu J; DeRenzo, Joseph S; Waters, Jonathan H

    2016-01-01

    This report aimed to describe the characteristics and impact of subdural hematoma (SDH) after labor epidural analgesia. Eleven obstetric patients had SDHs associated with the use of labor epidural analgesia over 7 years at a tertiary care hospital. Ten of 11 patients had signs consistent with postdural puncture headache before the diagnosis of SDH. Five patients (45%) had a recognized unintentional dural puncture, 1 (9%) had a combined spinal-epidural with a 24-gauge needle, and 5 (45%) had no recognized dural puncture. For 10 of the 11 cases, SDH was diagnosed at a mean of 4.1 days (range, 1-7 days) after performance of labor epidural analgesia; one case was diagnosed at 25 days. Ten (91%) of 11 cases had a second hospital stay for a mean of 2.8 days (range, 2-4 days) for observation, without further requirement for neurosurgical intervention. One case (9%) had decompressive hemicraniectomy after becoming unresponsive. The observed rate of labor epidural analgesia-associated SDH was 0.026% (11 in 42,969, approximately 1:3900), and the rate of SDH was 1.1% (5 in 437, approximately 1:87) if a recognized dural puncture occurred during epidural catheter placement. Subdural hematoma after labor epidural anesthesia is rare but potentially more common than historically estimated. Cases of postdural puncture headache after labor epidural anesthesia should be monitored closely for severe neurologic signs and symptoms that could herald SDH.

  8. Orthopedic Manifestations of Mobius Syndrome: Case Series and Survey Study

    PubMed Central

    McClure, Philip; Booy, David; Katarincic, Julia; Eberson, Craig

    2016-01-01

    Background. Mobius Syndrome is a rare disease defined by bilateral congenital 7th nerve palsy. We focus on reporting the prevalence of orthopedic disease in this population. Methods. Twenty-three individuals with Mobius Syndrome underwent orthopedic physical examination, and additional 96 patients filled out a survey for self-reported orthopedic diagnoses. Results. Clubfoot was present in 60% of individuals in the physical exam series and 42% of those in the survey. Scoliosis was present in 26% and 28%, respectively. Poland's Syndrome was present in 17% and 30%. In addition to these findings, 27% of patients reported having difficulty with anesthesia, including difficulty in intubation and airway problems. Conclusion. An increased prevalence of scoliosis, clubfoot, transverse limb deficiencies, and Poland's Syndrome is identified in the setting of Mobius Syndrome. In the setting of several deformities often requiring surgical correction, a high incidence of anesthetic difficulty is noted and should be discussed with patients and other providers during surgical planning. PMID:26977161

  9. Understanding time series networks: a case study in rule extraction.

    PubMed

    Craven, M W; Shavlik, J W

    1997-08-01

    A significant limitation of neural networks is that the representations they learn are usually incomprehensible to humans. We have developed an algorithm, called TREPAN, for extracting comprehensible, symbolic representations from trained neural networks. Given a trained network, TREPAN produces a decision tree that approximates the concept represented by the network. In this article, we discuss the application of TREPAN to a neural network trained on a noisy time series task: predicting the Dollar-Mark exchange rate. We present experiments that show that TREPAN is able to extract a decision tree from this network that equals the network in terms of predictive accuracy, yet provides a comprehensible concept representation. Moreover, our experiments indicate that decision trees induced directly from the training data using conventional algorithms do not match the accuracy nor the comprehensibility of the tree extracted by TREPAN.

  10. Kissing molars extraction: Case series and review of the literature.

    PubMed

    Arjona-Amo, Manuel; Torres-Carranza, Eusebio; Batista-Cruzado, Antonio; Serrera-Figallo, Maria-Angeles; Crespo-Torres, Santos; Belmonte-Caro, Rodolfo; Albisu-Andrade, Claudio; Torres-Lagares, Daniel; Gutiérrez-Pérez, José-Luis

    2016-02-01

    Kissing molars are a very rare form of inclusion defined as molars included in the same quadrant, with occlusal surfaces contacting each other within a single dental follicle. We present four cases of this pathology: a 35 year-old male, referred to the Oral and Maxillofacial Surgery Department of the Hospital Virgen del Rocio in Seville, and three females of 24, 26, and 31 years, all of which had kissing molars that were treated by tooth extraction. We have found only 10 cases published in the medical literature in which this type of inclusion is briefly described, none of which elaborate on the surgical technique employed. In these cases, the indication for surgery is established when there is a history of recurring infections or cystic lesions associated with dental inclusions. The extraction of kissing molars requires an exhaustive comprehension of the anatomy of the region involved, sufficiently developed surgical abilities, and an extensive planning process. Impacted molar, kissing molar, surgical extraction.

  11. Conservative management of retrocaval Ureter: A case series

    PubMed Central

    Yen, Jia Min; Lee, Lui Shiong; Cheng, Christopher Wai Sam

    2015-01-01

    Introduction Retrocaval ureter is a rare congenital anomaly with the ureter passage posterior to the inferior vena cava. Surgical repair is suggested for patients with significant functional obstruction. However, there is little literature to suggest the management of asymptomatic patients. Case presentation Case 1 patient is a 29 year-old Indonesian man and case 2 patient is a 41 year-old Malay man. Both patients were asymptomatic and well. Discussion This report is the short follow-up, therefore making it impossible to elucidate the natural history of uncorrected retrocaval ureters. Conclusion At 8 month and 6 month respectively, they remained well without symptoms. Our report suggests that immediate surgical repair is not always needed. Longer follow-up with larger patient population is needed to formally elucidate the natural history of this uncommon condition. PMID:26322820

  12. Pulmonary artery intimal sarcoma: a brief case series.

    PubMed

    Austin, Bethany A; Griffin, Brian P

    2008-08-01

    Primary pulmonary artery intimal sarcomas are often diagnosed only at the time of surgery or autopsy as a result of few specific findings both clinically and on imaging studies. We report two cases of this rare and lethal malignancy, both of which were initially thought to be manifestations of thromboembolic disease. In the case of one man, the diagnosis was delayed several months, at which point attempted surgical resection was not feasible. In the second case the echocardiographic and computed tomographic results generated further evaluation. This led to a more prompt diagnosis and treatment extending the patient's survival. In addition, we describe the echocardiographic findings that lent support to the need for surgical intervention and histologic diagnosis.

  13. Tardive Dyskinesia and Covert Dyskinesia with Aripiprazole: A Case Series.

    PubMed

    Patra, Suravi

    2016-01-01

    Aripiprazole, a dopamine stabilizing atypical antipsychotic is used in treatment of tardive dyskinesia caused by other neuroleptics. Tardive dyskinesia is rarely caused by Aripiprazole and has only been documented in high risk patients i.e., female gender, advanced age, affective illness, coexisting neurological disorders. Here the author describes two atypical cases of tardive dyskinesia associated with Aripiprazole. First case of tardive dyskinesia was observed in a neuroleptic naïve young adult male with paranoid illness after six months of treatment with Aripiprazole upon addition of Fluoxetine and the second case was a middle aged female with affective illness where dyskinetic movements appeared after stopping Aripiprazole. The role of Fluoxetine in causing tardive dyskinesia with Aripiprazole and covert dyskinesia due to Aripiprazole with appropriate management is discussed.

  14. [Painful tic convulsif: Case series and literature review].

    PubMed

    Revuelta-Gutiérrez, Rogelio; Velasco-Torres, Héctor Sebastián; Vales Hidalgo, Lourdes Olivia; Martínez-Anda, Jaime Jesús

    The coexistence of hemifacial spasm and trigeminal neuralgia, a clinical entity known as painful tic convulsive, was first described in 1910. It is an uncommon condition that is worthy of interest in neurosurgical practice, because of its common pathophysiology mechanism: Neuro-vascular compression in most of the cases. To present 2 cases of painful tic convulsive that received treatment at our institution, and to give a brief review of the existing literature related to this. The benefits of micro-surgical decompression and the most common medical therapy used (botulin toxin) are also presented. Two cases of typical painful tic convulsive are described, showing representative slices of magnetic resonance imaging corresponding to the aetiology of each case, as well as a description of the surgical technique employed in our institution. The immediate relief of symptomatology, and the clinical condition at one-year follow-up in each case is described. A brief review of the literature on this condition is presented. This very rare neurological entity represents less than 1% of rhizopathies and in a large proportion of cases it is caused by vascular compression, attributed to an aberrant dolichoectatic course of the vertebro-basilar complex. The standard modality of treatment is micro-vascular surgical decompression, which has shown greater effectiveness and control of symptoms in the long-term. However medical treatment, which includes percutaneous infiltration of botulinum toxin, has produced similar results at medium-term in the control of each individual clinical manifestation, but it must be considered as an alternative in the choice of treatment. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  15. [Bacterial dermohypodermitis and necrotizing fascitis: 104-case series from Togo].

    PubMed

    Saka, B; Kombaté, K; Mouhari-Toure, A; Akakpo, S; Boukari, T; Pitché, P; Tchangaï-Walla, K

    2011-04-01

    The purpose of this retrospective study was to obtain data on the epidemiology, clinical features, and outcome of bacterial dermohypodermitis (BDH) observed in a hospital setting hospital in Lomé, Togo. Cases of BDH treated in dermatology and internal medicine of the Lomé university hospital center from January 1999 to December 2009 were reviewed. A total of 104 patients were hospitalized for BDH during the study period. Mean patient age was 42.9 +/- 16.1 years and sex ratio (M/F) was 0.89. Infection by HIV was detected in 10 of 37 patients in whom serology was performed. The site of erysipelas was located on the legs and feet in 93 cases (89.4%), entire lower limb in 4 (3.9%), upper limbs in 4 (3.9%), thighs in 2 (1.9%), and buttock in 1 (0.9%). The main local and systemic risk factors were existence of an entry site in 89 cases, use of depigmenting drugs in 11, HIV infection in 10, previous history of erysipelas in 9 cases, and lymphoedema in 8. First-line treatment used penicillin G in 90 cases. Seven patients presented necrotizing fasciitis. Necrotizing fasciitis was associated with HIV infection in 2 cases, use of non-steroidal anti-inflammatory drugs (NSAID) in 2, and use of depigmenting drugs in one. Two deaths were recorded in the necrotizing fasciitis group including one HIV-infected patient. Recurrence was observed in 8 patients and secondary complications such as lower limb elephantiasis occurred in 7 patients.

  16. Atypical forms of lupus vulgaris - a case series.

    PubMed

    Saritha, Mohanan; Parveen, Basheer Ahamed; Anandan, Venkatesan; Priyavathani, Malathy R; Tharini, Karuvelan G

    2009-02-01

    Atypical presentations of cutaneous tuberculosis are not so uncommon and are frequently overlooked in clinical practice, leading to late diagnosis and increased morbidity. We report three cases of lupus vulgaris with atypical presentations. The cases mimicked other chronic skin lesions like actinomycosis, mycetoma, and so on. Strong clinical suspicion, histopathology, and response to antituberculous treatment led to the diagnosis and all three had excellent response to treatment. Today, when tuberculosis threatens to burst into pandemics again, early diagnosis and treatment are more important than ever for control and prevention of morbidity.

  17. Case series of rhinocerebral mucormycosis occurring in diabetic patients

    PubMed Central

    Mohammadi, Rasoul; Meidani, Mohsen; Mostafavizadeh, Kamyar; Iraj, Bijan; Hamedani, Pooria; Sayedain, Sayed Mohammad Amin; Mokhtari, Mojgan

    2015-01-01

    Background: Rhinocerebral mucormycosis is a fatal infection typically affecting diabetic or immunosuppressed patients. In most cases, infection is caused by inhalation of fungal spores. Mortality rate of patients is very high (40-85%). Case Presentation: In this study, three diabetic patients with rhinocerebral mucormycosis were presented. The etiologic agents of mucormycosis in two patients were isolated and identified by sequence analysis and data were registered in Gene bank database. Conclusion: In patients with mucoreosis, early detection, surgical excision and appropriate debridement, suitable antifungal therapy, and control of risk factors like diabetes mellitus are the main parameters of successful management of this lethal infection. PMID:26644901

  18. Epidermolysis Bullosa Pruriginosa: Case Series and Review of the Literature.

    PubMed

    Kim, Whan B; Alavi, Afsaneh; Pope, Elena; Walsh, Scott

    2015-06-01

    Epidermolysis bullosa (EB) pruriginosa is a rare clinical subtype of dystrophic epidermolysis bullosa (DEB) that is characterized by intense pruritus resulting in hypertrophic, lichenified, prurigo-like plaques and nodules secondary to scratching. The variability in the age of onset, rarity of intact bullae, histologic ambiguities, and close resemblance to other conditions such as acquired inflammatory dermatoses may make diagnosis difficult for this unusual condition, for which fewer than 100 cases have been documented. In this report, we describe 3 cases of EB pruriginosa and review the current literature. © The Author(s) 2015.

  19. Post-operative Abdominal Wall Mucormycosis-a Case Series.

    PubMed

    Nain, Prabhdeep Singh; Matta, Harish; Singh, Kuldip; Chhina, Deepinder; Trehan, Munish; Batta, Nishant

    2015-12-01

    Mucormycosis is caused by saprophtytic fungi which cause acute invasive zygomycosis. It clinically presents with necrosis, and on histopathology, acute and chronic infiltrates are seen. It rarely infects a healthy host, but is devastating in an immunocompromised host. We studied five cases with post-operative abdominal wall mucormycosis, three females and two males. Three patients were post-operative while the other two had mucormycosis following trauma and infection was found in sutured wound. All were initially diagnosed as cases of necrotizing fasciitis. Two patients eventually survived after intensive medical therapy and extensive debridements.

  20. [Eye and cat scratch disease: A case series].

    PubMed

    Deschasse, C; Bielefeld, P; Muselier, A; Bour, J B; Besancenot, J F; Garcher, C C; Bron, A M

    2016-02-01

    Cat scratch disease is a pleiomorphic condition, sometimes with isolated ophthalmic involvement. We report the clinical observations of seven cases with ophthalmologic manifestations of cat scratch disease. There were seven patients, with a median age of 52 years, of whom five were women and three had unilateral involvement. Six exhibited Leber's stellate neuroretinitis, an incomplete syndrome in two cases, and one associated with chorioretinal foci. One patient had isolated retinal infiltrates. The diagnosis of cat scratch disease was confirmed by Bartonella henselae serology, positive in all cases. All patients received treatment with doxycycline. Ocular complications (with optic atrophy and macular retinal pigment epithelial changes) were noted in five cases. Ocular bartonellosis is an atypical clinical form. It requires a directed ancillary work-up with serology or PCR, which has the peculiarity of being highly specific if not very sensitive. Treatment is above all preventive. Antibiotics may be initiated. Cat scratch disease must be excluded in the work-up of posterior uveitis. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  1. Spontaneous retroclival hematoma in pituitary apoplexy: case series.

    PubMed

    Azizyan, Avetis; Miller, Joseph M; Azzam, Ramzi I; Maya, Marcel M; Famini, Pouyan; Pressman, Barry D; Moser, Franklin G

    2015-09-01

    Pituitary apoplexy is a rare and potentially life-threatening disorder that is most commonly characterized by a combination of sudden headache, visual disturbance, and hypothalamic/hormonal dysfunction. In many cases, there is hemorrhagic infarction of an underlying pituitary adenoma. The resulting clinical symptoms are due to compression of the remaining pituitary, cavernous sinuses, or cranial nerves. However, there are only 2 case reports in the literature describing spontaneous retroclival expansion of hemorrhage secondary to pituitary apoplexy. Ten cases of this entity with a review of the literature are presented here. This is a single-institution retrospective review of 2598 patients with sellar and parasellar masses during the 10-year period between 1999 and 2009. The pituitary and brain MRI and MRI studies were reviewed by 2 neuroradiologists for evidence of apoplexy, with particular attention given to retroclival extension. Eighteen patients (13 men and 5 women; mean age 54 years) were identified with presenting symptoms of sudden onset of headache and ophthalmoplegia, and laboratory findings consistent with pituitary apoplexy. Ten of these patients (8 men and 2 women; mean age 55 years) had imaging findings consistent with retroclival hematoma. Retroclival hemorrhage was seen in the majority of cases of pituitary apoplexy (56%), suggesting that it is more common than previously thought.

  2. [The traffic elbow. A series of 9 cases].

    PubMed

    Sané, A-D; Ndaw, M; Diémé, C; Coulibaly-Ndiaye, N F; Ndiaye, A; Sy, M H; Mbaye, B; Sèye, S I L

    2007-01-01

    "Traffic elbow" is a condition occurring when high energy trauma involves a patient's elbow resting on the window of the car or completely outside it. This is a prospective study over 30 months of 9 patients with "traffic elbow" and therefore sufferring complex open trauma to the elbow. There were 8 men and 1 woman with a median delay of 4 hours before arrival in hospital. The dominant member was affected in 3 cases. The severity of the lesions, using the Mangled Extremity Severity Score (MESS), was more than 7, comprising lesions corresponding to type 1 of the complex trauma of the superior member (TCMS) in 2 patients and a MESS score of between 3 and 6 corresponding to types 2 or 3 of the TCMS for the other 7 patients. The therapeutic possibilities are limited considering the frequent context of polytrauma. In 4 cases we performed a debridement and external humero-ulnar fixation, in 3 cases a debridement and stabilization with Kirschner's wires completed by a fenestrated cast, and in 2 cases a lifesaving amputation. All patients, except those that had had amputation, developed deep sepsis that resolved after adequate treatment. Assessment of the non-amputee patients according to the Mayo Performance Score, yielded more than 70% of bad results. The authors stress the gravity of these lesions whose prognosis is guarded both concerning mobility of the elbow and the frequent neurovascular complications.

  3. Looking for Childhood Schizophrenia: Case Series of False Positives.

    ERIC Educational Resources Information Center

    Stayer, Catherine; Sporn, Alexandra; Gogtay, Nitin; Tossell, Julia; Lenane, Marge; Gochman, Peter; Rapoport, Judith L.

    2004-01-01

    Extensive experience with the diagnosis of childhood-onset schizophrenia indicates a high rate of false positives. Most mislabeled patients have chronic disabling, affective, or behavioral disorders. The authors report the cases of three children who passed stringent initial childhood-onset schizophrenia "screens" but had no chronic psychotic…

  4. Tracheobronchial Amyloidosis-A Series of Two Cases

    PubMed Central

    Raiyani, Palak D; Vyas, Sunil S

    2014-01-01

    Amyloidosis is a rare disorder characterised by accumulation of insoluble fibrillar proteins in extracellular space. Respiratory amyloidosis presents as two tracheobronchial forms (local and diffuse) and two parenchymal forms (nodular and diffuse), of which diffuse tracheobronchial amyloidosis is the least common. We herein present two cases of tracheobronchial amyloidosis. PMID:25386446

  5. Distance-Learning Programs. Case Studies in TESOL Practice Series.

    ERIC Educational Resources Information Center

    Henrichsen, Lynn E., Ed.

    The 14 cases in this book show how distance learning takes a variety of forms in teaching English to speakers of other languages (TESOL). The 15 chapters include the following: (1) "Beyond Adding Telecommunications to a Traditional Course: Insights into Human and Instructional Factors Affecting Distance Learning in TESOL" (Lynn E.…

  6. Diagnostic Dilemma in Ovarian Pregnancy: A Case Series

    PubMed Central

    Pallavee, P.; Samal, Sunita

    2015-01-01

    Ovarian pregnancy is a rare form of ectopic pregnancy but it is the most common type of nontubal ectopic pregnancy. Many times it is operated with a misdiagnosis of ruptured tubal ectopic pregnancy or hemorrhagic corpus luteum. The high resolution transvaginal ultrasonography is a valuable tool for diagnosis of ectopic pregnancy but ovarian pregnancy still remains a diagnostic problem and a continuous challenge to the gynecologist. The correct diagnosis is made at the time of surgery and confirmation is by histopathological report. Here we report three cases of primary ovarian ectopic pregnancies, consistent with the Spiegelberg’s criteria. Out of this, two cases have corroboration of ovarian ectopic pregnancy with use of intrauterine contraceptive device and one case by chance without any preexisting risk factors, probably due to interference in the release of ovum from the follicle. In all the three cases, emergency laparotomy was done for ruptured tubal ectopic pregnancy and the diagnosis of ruptured primary ovarian pregnancy was made at the time of surgery, this was subsequently confirmed by histopathology report. In the era where wider usage of intrauterine devices, ovulatory drugs and assisted reproductive techniques are rife, there is a possibility of an increase in the incidence of this rare entity, so ovarian ectopic pregnancy should be kept in mind as a possibility. Thereby early diagnosis by high resolution transvaginal ultrasound and laparoscopy can decrease the risk of complications like rupture, secondary implantation, hemorrhagic shock and maternal mortality. PMID:26023609

  7. Distance-Learning Programs. Case Studies in TESOL Practice Series.

    ERIC Educational Resources Information Center

    Henrichsen, Lynn E., Ed.

    The 14 cases in this book show how distance learning takes a variety of forms in teaching English to speakers of other languages (TESOL). The 15 chapters include the following: (1) "Beyond Adding Telecommunications to a Traditional Course: Insights into Human and Instructional Factors Affecting Distance Learning in TESOL" (Lynn E.…

  8. Takotsubo Cardiomyopathy: A Case Series and Review of the Literature

    PubMed Central

    Merchant, Emily E.; Johnson, Sara W.; Nguyen, Phu; Kang, Christopher; Mallon, William K.

    2008-01-01

    Takotsubo cardiomyopathy (TCM) is an unusual form of acute cardiomyopathy showing left ventricular apical ballooning. It is often triggered by intense physical or emotional distress. We report here four cases of TCM and a review of the literature on the topic. PMID:19561716

  9. Looking for Childhood Schizophrenia: Case Series of False Positives.

    ERIC Educational Resources Information Center

    Stayer, Catherine; Sporn, Alexandra; Gogtay, Nitin; Tossell, Julia; Lenane, Marge; Gochman, Peter; Rapoport, Judith L.

    2004-01-01

    Extensive experience with the diagnosis of childhood-onset schizophrenia indicates a high rate of false positives. Most mislabeled patients have chronic disabling, affective, or behavioral disorders. The authors report the cases of three children who passed stringent initial childhood-onset schizophrenia "screens" but had no chronic psychotic…

  10. Supratentorial cortical ependymoma: case series and review of the literature.

    PubMed

    Liu, Zhiguo; Li, Jing; Liu, Zhiyan; Wang, Qian; Famer, Peter; Mehta, Ashesh; Chalif, David; Wang, Yunyan; Li, Jian Yi

    2014-06-01

    Supratentorial cortical ependymoma (CE), a rare type of ependymoma, is located in the superficial cortex. We reported 11 patients (six female and five male) with CE. The age of the patients ranged from 2 to 63 years old with a median age of 47 years at the time of diagnosis. On MRI, enhancement was noted in all cases with solid appearance in six cases, and solid and cystic appearance in five cases. The frontal and parietal regions were the most common locations for CE. On histology, two were low-grade (WHO grade II) and nine were WHO grade III anaplastic ependymomas. Some tumors exhibited clear cell, spindle (tanycytic) and giant cell morphologies, as well as the classic ependymoma morphology. Dura-based tumor nodules and even tumor dissemination along the dura can be seen in CEs. Low grade CEs have a higher likelihood to present with seizures, a lower likelihood to cause brain edema, tumor recurrence and lower mortality than anaplastic ependymomas. While difficult, anaplastic CEs may be distinguished from glioblastoma by a clear interface between tumor and adjacent brain tissue, relative uniformity of tumor cell nuclei and immunopositivity for epithelial membrane antigen and/or CD99. As is the case for ependymomas in general, gross total resection is still the treatment of choice for CEs.

  11. Opening a New Catholic School: A Series of Case Studies.

    ERIC Educational Resources Information Center

    Kealey, Robert J., Ed.

    During the last 10 years, almost 200 new Catholic schools have opened across the United States. This booklet presents nine case studies that provide ideas about how to open new Catholic schools. The schools include: (1) Diocese of Arlington, Virginia; (2) St. John Neuman Regional Catholic School, Archdiocese of Atlanta, Georgia; (3) Charlotte…

  12. Spontaneous coronary artery dissection: a case series and literature review

    PubMed Central

    Garcia, Nelson A. Telles; Khan, Abul N.; Boppana, Ratna C.; Smith, Hayden L.

    2014-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare and often lethal cause of acute coronary syndrome, which typically affects young women and otherwise healthy individuals. SCAD can be diagnosed in patients undergoing coronary angiography and can be underestimated. Special techniques such as optical coherence tomography (OCT) and intravascular ultrasound should be used when there is suspicion of the condition. In the majority of cases, the left anterior descending (LAD) artery is involved; however, a few cases of the right coronary artery (RCA) involvement have been reported. This article describes three cases of SCAD in women of different ages, all presenting with chest pain. Coronary angiography in conjunction with OCT was used for diagnosis in two of the cases. One of the patients had involvement of the proximal RCA and underwent percutaneous coronary intervention, whereas the other two patients had mid-LAD disease and were treated conservatively with medical therapy. Presently, there are no specific guidelines for the treatment of SCAD, and therapy is individualized according to extent and severity of the condition. PMID:25317273

  13. Cases Series of Malignant Lymphohematopoietic Disorder in Korean Semiconductor Industry

    PubMed Central

    Lee, Hye-Eun; Ryu, Hyung-Woo; Park, Seung-Hyun; Kang, Seong-Kyu

    2011-01-01

    Objectives Seven cases of malignant lymphohematopoietic (LHP) disorder were claimed to have developed from occupational exposure at two plants of a semiconductor company from 2007 to 2010. This study evaluated the possibility of exposure to carcinogenic agents for the cases. Methods Clinical courses were reviewed with assessing possible exposure to carcinogenic agents related to LHP cancers. Chemicals used at six major semiconductor companies in Korea were reviewed. Airborne monitoring for chemicals, including benzene, was conducted and the ionizing radiation dose was measured from 2008 to 2010. Results The latency of seven cases (five leukemiae, a Non-Hodgkin's lymphoma, and an aplastic anemia) ranged from 16 months to 15 years and 5 months. Most chemical measurements were at levels of less than 10% of the Korean Occupational Exposure Limit value. No carcinogens related to LHP cancers were used or detected. Complete-shielded radiation-generating devices were used, but the ionizing radiation doses were 0.20-0.22 uSv/hr (background level: 0.21 µSv/hr). Airborne benzene was detected at 0.31 ppb when the detection limit was lowered as low as possible. Ethylene oxide and formaldehyde were not found in the cases' processes, while these two were determined to be among the 263 chemicals in the list that was used at the six semiconductor companies at levels lower than 0.1%. Exposures occurring before 2002 could not be assessed because of the lack of information. Conclusion Considering the possibility of exposure to carcinogenic agents, we could not find any convincing evidence for occupational exposure in all investigated cases. However, further study is needed because the semiconductor industry is a newly developing one. PMID:22953195

  14. [Percutaneous catheterization for extracorporeal membrane oxygenation: a retrospective case series].

    PubMed

    Li, X Y; He, H Y; Tang, X; Wang, R; Zhang, C Y; Wang, S Q; Sun, B; Tong, Z H

    2017-09-12

    Objective: To review the experience of percutaneous catheterization for extracorporeal membrane oxygenation (ECMO) by respiratory intensivists at a single institution. Methods: A retrospective review of 87 patients undergoing percutaneous catheterization for ECMO in Department of Respiratory and Critical Care Medicine of Beijing Chaoyang Hospital from November 2009 to January 2017. Subject demographics, type of support, cannulation configuration, types of cannulas, use of imaging modalities, and complications were recorded and summarized. Results: The 87 patients consisted of 61 males and 26 females. The average age was (47±16)years (range 15-82 years ). Fifty-six patients were given ECMO therapy because of acute respiratory distress syndrome(ARDS), and 16 were treated as a bridge for lung transplantation and 15 for other causes. Eighty-one cases were given VV-ECMO support, and 6 cases were given VA-ECMO support. The most commonly used cannulas were 15-17 F arterial cannulas and 21-23 F venous cannulas. Preinsertion ultrasound was performed in 62 patients (71%) . Bedside chest radiography was used to help adjust the position of the end of the cannula in 11 patients (13%). Percutaneous catheterization was successful in 85 cases (97%) , while it failed in 2 female patients due to thick subcutaneous fat layer, and open surgical approach was used. Percutaneous femoral artery collateral circulation was established by ourselves in 5 cases. One patient with femoral artery catheterization without collateral circulation had gangrene of limbs. The complications included 9 cases of catheter site hemorrhage, 4 catheter-related bloodstream infection and 1 pulmonary embolism during ECMO weaning. Conclusion: Percutaneous catheterization for ECMO can be performed with a high rate of success and a low rate of complications.

  15. Ketogenic diet therapy for epilepsy during pregnancy: A case series.

    PubMed

    van der Louw, Elles J T M; Williams, Tanya J; Henry-Barron, Bobbie J; Olieman, Joanne F; Duvekot, Johannes J; Vermeulen, Marijn J; Bannink, Natalja; Williams, Monique; Neuteboom, Rinze F; Kossoff, Eric H; Catsman-Berrevoets, Coriene E; Cervenka, Mackenzie C

    2017-02-01

    Evaluation of ketogenic diet (KD) therapies for seizure control during pregnancy when safety and appropriate management become considerations. Until now, no information has been available on seizure reduction and human pregnancy related outcomes in women treated with KD therapies. We describe two cases of pregnant women with epilepsy treated with KD therapy either as monotherapy (Case 1) or as adjunctive therapy (Case 2). Case 1: A 27 year old woman, gravida1, started the classic KD with medium chain triglyceride (MCT) emulsion and 75g carbohydrate-restriction, later reduced to 47g. Glucose levels were 4-6mmol/L and blood ketone levels ranged from 0.2 to 1.4mmol/L. Seizure frequency decreased and seizure-free days increased. Mild side effects included intolerance to MCT, reduced serum carnitine and vitamin levels, and mild hyperlipidemia. Fetal and neonatal growth was normal as was growth and development at 12 months. Case 2: A 36 year-old nulliparous woman was treated with a 20 gram carbohydrate-restricted Modified Atkins Diet (MAD) and lamotrigine, resulting in reduction of seizure frequency to once per month prior to pregnancy. Once pregnant, carbohydrates were increased to 30g. When seizures increased, lamotrigine dose was doubled. Urine ketones trended down during second trimester. A male was born with bilateral ear deformities of unknown significance. The child had a normal neurodevelopment at eight months. Non-pharmacological epilepsy therapies like KD and MAD may be effective during human pregnancy. However, safety still has to be established. Further monitoring to identify potential long term side effects is warranted. Copyright © 2017 British Epilepsy Association. All rights reserved.

  16. Quantum and thermal fluctuations in the BCS-BEC crossover with unequal mass fermions

    NASA Astrophysics Data System (ADS)

    Diener, Roberto; Zhou, Qi; Randeria, Mohit

    2008-03-01

    A lot of progress has been done in the study of the BCS-BEC crossover for equal-mass fermions in recent years by both theory and experimental groups. An extension of this problem which is starting to receive more attention is the study of mixtures of fermions with different masses, such as a mixture of ^40K and ^6Li. Using our functional integral method, which we have previously used to study the equal-mass case and which includes the effect of collective excitations (see R. B. Diener et al, cond-mat/0709.2653), we have studied the properties of a fermionic gas with unequal masses across the BCS-BEC crossover. We will present results for different thermodynamical quantities as a function of mass ratio and interaction strength: e.g. the beta parameter at unitarity, the ground state energy as a function of 1/(kFas), as well as the dimer scattering in the BEC limit as a function of mass ratio which agrees to within 20% with the exact four-body calculation of D. Petrov et al., J. Phys. B At. Mol. Opt. Phys. 38, S645 (2005).

  17. Contact Intensity and Extended Hydrodynamics in the BCS-BEC Crossover

    NASA Astrophysics Data System (ADS)

    Salasnich, Luca

    In the first part of this chapter we analyze the contact intensity C, which has been introduced by Tan (Ann Phys 323:2952 (2008)) and appears in several physical observables of the strongly correlated two-component Fermi gas. We calculate the contact C in the full BCS-BEC crossover for a uniform superfluid Fermi gas by using an efficient parametetrization of the ground-state energy. In the case of harmonic confinement, within the Thomas-Fermi approximation, we derive analytical formulas of C in the three relevant limits of the crossover. In the second part of this chapter we discuss the extended superfluid hydrodynamics we have recently proposed to describe static and dynamical collective properties of the Fermi gas in the BCS-BEC crossover. In particular we show the relation with the effective theory for the Goldstone field derived by Son and Wingate (Ann Phys 321, 197 (2006)) on the basis of conformal invariance. By using our equations of extended hydrodynamics we determine nonlinear sound waves, static response function and structure factor of a generic superfluid at zero temperature.

  18. Autoimmune diseases and pregnancy: analysis of a series of cases.

    PubMed

    Gomes, Vânia; Mesquita, Alexandra; Capela, Carlos

    2015-06-04

    An autoimmune disease is characterized by tissue damage, caused by self-reactivity of different effector mechanisms of the immune system, namely antibodies and T cells. All autoimmune diseases, to some extent, have implications for fertility and obstetrics. Currently, due to available treatments and specialised care for pregnant women with autoimmune disease, the prognosis for both mother and child has improved significantly. However these pregnancies are always high risk. The purpose of this study is to analyse the fertility/pregnancy process of women with systemic and organ-specific autoimmune diseases and assess pathological and treatment implications. The authors performed an analysis of the clinical records and relevant obstetric history of five patients representing five distinct autoimmune pathological scenarios, selected from Autoimmune Disease Consultation at the Hospital of Braga, and reviewed the literature. The five clinical cases are the following: Case 1-28 years old with systemic lupus erythematosus, and clinical remission of the disease, under medication with hydroxychloroquine, prednisolone and acetylsalicylic acid, with incomplete miscarriage at 7 weeks of gestation without signs of thrombosis. Case 2-44 years old with history of two late miscarriages, a single preterm delivery (33 weeks) and multiple thrombotic events over the years, was diagnosed with antiphospholipid syndrome after acute myocardial infarction. Case 3-31 years old with polymyositis, treated with azathioprine for 3 years with complete remission of the disease, took the informed decision to get pregnant after medical consultation and full weaning from azathioprine, and gave birth to a healthy term new-born. Case 4-38 years old pregnant woman developed Behcet's syndrome during the final 15 weeks of gestation and with disease exacerbation after delivery. Case 5-36 years old with autoimmune thyroiditis diagnosed during her first pregnancy, with difficult control over the thyroid

  19. Pituitary apoplexy in pregnancy: A case series and literature review

    PubMed Central

    Grand'Maison, Sophie; Weber, Florence; Bédard, Marie-Josée; Mahone, Michele

    2015-01-01

    Background Severe headache during pregnancy is a challenging condition that may rarely imply endocrine disturbances. Rapid recognition of pituitary apoplexy is needed to improve pregnancy outcome. Objective To review and compare maternal and fetal outcomes after pituitary apoplexy. Methods Four cases of pituitary apoplexy during pregnancy in our centre are reported and literature review covering the past 54 years was performed. Results In the four cases presented and the 33 reported in the literature, most women presented with severe headaches and systemic symptoms. Overall, 42% were treated surgically, 31% received bromocriptine or cabergoline and 61% were given hormone replacement. No major obstetrical complication was reported and all babies were healthy. Conclusion Pituitary apoplexy is a rare cause of sudden and severe headache during pregnancy. Rapid identification of this condition with potentially associated endocrine disturbances is important to ensure maternal and fetal well-being. A multidisciplinary team approach seems to reduce morbidity and mortality. PMID:27512477

  20. Corneal Hydrops in Pellucid Marginal Degeneration: A Case Series

    PubMed Central

    Bhandari, Vipul; Ganesh, Sri

    2015-01-01

    Purpose To report an unusual presentation of pellucid marginal degeneration (PMD) and its management by using air injection and tension sutures. Case Report We report 2 cases with a history of acute pain and loss of vision. Examination revealed hydrops at the 6–9 o'clock meridian with Descemet's membrane detachment and tear at the same area and advanced PMD in the other eye. Discussion Air injection with suturing to treat the hydrops in PMD and crescentic excision with lamellar grafting instead of lamellar keratoplasty lead to better results than conservative management. Conclusion Corneal hydrops and perforation in patients with PMD is a rare presentation and can be managed by tension sutures and air injection. PMID:26265904

  1. Sexually transmitted penile amoebiasis in Iran: a case series.

    PubMed

    Abdolrasouli, Alireza; de Vries, Henry J C; Hemmati, Yahya; Roushan, Azita; Hart, Jason; Waugh, Michael Anthony

    2012-12-01

    Four cases of penile amoebiasis (PA) presenting as genital ulceration seen among men who practiced unprotected insertive anal intercourse in Tehran are described. PA was confirmed by observation of motile trophozoites of Entamoeba histolytica from lesions examined by wet mount microscopy. Ulcers were solitary, painful, irregular, discharging and increasing in size. Three heterosexuals and one bisexual had practised insertive anal intercourse in the 2 weeks before diagnosis. Bilateral inguinal lymphadenitis occurred in one case. Direct examination of lesions was positive for the presence of amoebic trophozoites. Complete resolution occurred after treatment with oral metronidazole 800 mg three times daily for 7-10 days. Clinicians need to be aware of cutaneous amoebiasis in sexually active men who practice unprotected insertive anal sex where intestinal amoebiasis is endemic. Wet mount microscopy is a rapid and useful diagnostic test.

  2. Paroxetine Treatment of Problematic Pornography Use: A Case Series.

    PubMed

    Gola, Mateusz; Potenza, Marc N

    2016-09-01

    Background How best to conceptualize problematic pornography use (PPU) and intervene most effectively remain debated, with obsessive-compulsive disorder (OCD) and addiction frameworks. We investigated the efficacy of the serotonin-reuptake inhibitor paroxetine in combination with cognitive-behavioral therapy in the treatment of problematic pornography use (PPU). Case presentation Three heterosexual males with PPU were treated with cognitive-behavioral therapy and paroxetine. Frequency of pornography use, other sexual behaviors, and anxiety were assessed during treatment. Discussion Paroxetine treatment, although seemingly initially effective in reducing pornography use and anxiety, appeared related to new compulsive sexual behaviors after 3 months. Conclusions Paroxetine may hold promise for short-term reduction of PPU and related anxiety, but new potentially distressing sexual behaviors may emerge. The cases suggest that PPU may arise from multiple domains. We propose an explanation of the effects based on recent neuroscientific research on sexual behaviors and alcohol use.

  3. AZF gene microdeletions: case series and literature review.

    PubMed

    Gallego, A; Rogel, R; Luján, S; Plaza, B; Delgado, F; Boronat, F

    2014-12-01

    Aproximately 10% of patients with non-obstructive azoospermia and 5% with non-obstructive severe oligozoospermia carry AZF region microdeletions (AZoospermic Factor) in the Y chromosome. The aim of this study is to analize the clinical and pathological findings in this group of patients and compare them with the previous evidence. Retrospective study of 11 patients with diagnosis of azoospermia or oligozoospermia and the presence of AZFa, AZFb, AZFc microdeletions or any combination of them. Microdeletions of AZFc region were found in 45% of cases, AZFa in 33% and a 10% showed a deletion of the three regions (a,b and c). 91% of them demonstrated azoospermia with low testicular volume in 62,5% cases. Microdeletions of AZF regions are associated with azoospermia and a low expectation of sperm retrieval in testicular biopsy. On the other hand, they seem not related with significative modifications on the hormone profile. Copyright © 2014 AEU. Published by Elsevier Espana. All rights reserved.

  4. Interdisciplinary Management of Gingivitis Artefacta Major: A Case Series

    PubMed Central

    Pattnaik, Naina; Satpathy, Anurag; Mohanty, Rinkee; Nayak, Rashmita; Sahoo, Surjeet

    2015-01-01

    Cases described here discuss interdisciplinary (periodontal and behavioral) approach in the management of rare and difficult to diagnose self-inflicted injuries of gingiva such as gingivitis artefacta major. Self-inflicted injuries to the gingiva are rare and their management by periodontal therapy alone is inadequate. Proper management of this condition requires early detection and effective psychological treatment through behavioral therapy in addition to the treatment of dental lesion. Three male patients in their twenties presented with traumatic injuries of gingiva with history of self-injury and underlying emotional disturbances. Following basic periodontal intervention, their self-inflicting behavior was confirmed on psychiatric consultation. All of them underwent cognitive behavior therapy and were able to successfully curb their self-inflicting behavior prior to any definitive dental procedures. These cases illustrate the essentiality of behavioral intervention in addition to periodontal procedures in the management of such lesions. PMID:26664762

  5. Paroxetine Treatment of Problematic Pornography Use: A Case Series

    PubMed Central

    Gola, Mateusz; Potenza, Marc N.

    2016-01-01

    Background How best to conceptualize problematic pornography use (PPU) and intervene most effectively remain debated, with obsessive–compulsive disorder (OCD) and addiction frameworks. We investigated the efficacy of the serotonin-reuptake inhibitor paroxetine in combination with cognitive-behavioral therapy in the treatment of problematic pornography use (PPU). Case presentation Three heterosexual males with PPU were treated with cognitive-behavioral therapy and paroxetine. Frequency of pornography use, other sexual behaviors, and anxiety were assessed during treatment. Discussion Paroxetine treatment, although seemingly initially effective in reducing pornography use and anxiety, appeared related to new compulsive sexual behaviors after 3 months. Conclusions Paroxetine may hold promise for short-term reduction of PPU and related anxiety, but new potentially distressing sexual behaviors may emerge. The cases suggest that PPU may arise from multiple domains. We propose an explanation of the effects based on recent neuroscientific research on sexual behaviors and alcohol use. PMID:27440474

  6. [Experience in thyroglossal duct pathology: clinical case series].

    PubMed

    Cieri, Patricio; Udaquiola, Julia E; Calello, Santiago E; Libero, Daniel H

    2016-10-01

    The thyroglossal duct cyst pathology represents the second cause of bening cervical anomalies in childhood. Diagnosis is mainly clinical. Sistrunk (1920) proposed a surgical technique that is still considered the gold standard for definitive treatment of this condition. A retrospective study was made including patients who underwent surgery for thyroglossal duct cyst pathology in our department between June 2008 and August 2015. In this period, we performed 54 procedures in 45 patients (39 primary cases). Median age was 4.7 years; 14/39 patients (31.1%) had pre-operative infection. All patients were studied with neck ultrasound. A Sistrunk's procedure was performed in all cases. The global recurrence rate was 17.8% (8/45).

  7. Probable Nootropicinduced Psychiatric Adverse Effects: A Series of Four Cases

    PubMed Central

    Ajaltouni, Jean

    2015-01-01

    The misuse of nootropics—any substance that may alter, improve, or augment cognitive performance, mainly through the stimulation or inhibition of certain neurotransmitters—may potentially be dangerous and deleterious to the human brain, and certain individuals with a history of mental or substance use disorders might be particularly vulnerable to their adverse effects. We describe four cases of probable nootropic-induced psychiatric adverse effects to illustrate this theory. To the best of our knowledge this has not been previously reported in the formal medical literature. We briefly describe the most common classes of nootropics, including their postulated or proven methods of actions, their desired effects, and their adverse side effects, and provide a brief discussion of the cases. Our objective is to raise awareness among physicians in general and psychiatrists and addiction specialists in particular of the potentially dangerous phenomenon of unsupervised nootropic use among young adults who may be especially vulnerable to nootropics’ negative effects. PMID:27222762

  8. Sandfly Fever with Skin Lesions: A Case Series from Turkey

    PubMed Central

    Temocin, Fatih; Sari, Tugba; Tulek, Necla

    2016-01-01

    Sand fly fever (SF) is an arthropod-borne viral disease, also known as “Phlebotomus fever”, “mosquito fever”, three-day fever or “Papatacci fever”. It is transmitted by Phlebotomus papatasi, starts with acute onset of high fever, and lasts for three days. We present first cases in a different district of Turkey with the clinical findings of fever, myalgia-arthralgia, headache, gastrointestinal symptoms such as diarrhoea and nausea-vomiting and skin lesions (in two of them). All the patients were treated symptomatically and discharged with complete cure. These cases are indicating that sand fly fever is more common than we thought. It should be considered in the differential diagnosis in patients presenting with fever, arthralgia-myalgia and skin lesions, especially it is important to be aware of this disease in travellers returning from endemic areas. PMID:28032114

  9. [Renal Cell Carcinoma metastases in the maxillofacial area: Case series.

    PubMed

    Ruiz-Oslé, Sara; Prol, Carlos; Lardies, Rosa; Gaafar, Ayman; Barbier, Luis; Arruza, Antón

    2017-10-01

    Renal cell carcinoma is an unpredictable malignancy. Sometimes, metastases are the disease debut. On the other hand, metastases could present years after treatment of the primary tumor. Four clinical cases of atypical metastases in the head and neck location are presented: parotid gland, mandibular bone, attached molar gingiva and masticator space. Physiopathology, clinics, histology and management of metastatic renal cell carcinoma at those anatomical regions are reviewed.

  10. [Frontal fibrosing alopecia: case series and literature review].

    PubMed

    Tinoco-Fragoso, Fátima; Domínguez-Cherit, Judith; Méndez-Flores, Silvia

    2017-01-01

    Frontal fibrosing alopecia is a disease characterized by a symmetric and progressive loss of hair in the fronto-temporal and fronto-parietal lines that generally affects postmenopausal women. It is considered a variant of lichen planus pilaris for its clinical and histopathological features; although, its etiopathology is still unknown. In this report, we analyzed 4 cases of this disease and we discussed its clinical and histopathological characteristics, as well as their course after initiating treatment.

  11. More Distally Located Duodenal Webs: A Case Series

    PubMed Central

    Gupta, Rahul; Mathur, Praveen; Gubbi, Sharanabasappa; Gupta, Pradeep Kumar; Shukla, Ramendra; Bhandari, Anu

    2016-01-01

    Duodenal atresia is a frequent cause of intestinal obstruction in the newborn. Obstruction due to duodenal web is infrequent, but its location other than second part of duodenum is rare with only a few cases reported in the literature. We are reporting three patients where we found duodenal webs at unusual locations. In one neonate the web was located at third part of duodenum and in other two patients the web was present at duodeno-jejunal junction (DJ). PMID:27896164

  12. Case series: Nocardiosis of the brain and lungs

    PubMed Central

    Sud, Seema; Buxi, TBS; Anand, Ish; Rohatgi, Anshu

    2008-01-01

    Localized and multisystem nocardiosis is an opportunistic disease that occurs commonly in immunocompromised patients. Rarely, it is also seen in immunocompetent individuals. The lungs and brain are commonly involved. Typical, but nonspecific, findings are often seen on imaging and the presence of concomitant lesions in these two systems often suggests this diagnosis. We report two cases of cerebral and pulmonary involvement by nocardiosis. PMID:19774160

  13. [Meralgia paraesthetica: a report on a series of 140 cases].

    PubMed

    Martínez-Salio, A; Moreno-Ramos, T; Díaz-Sánchez, M; Porta-Etessam, J; González de la Aleja, J; Gutiérrez-Gutiérrez, G; Calandre-Hoenigsfeld, L

    Meralgia paraesthetica is a pathology that is frequently seen in visits to extra-hospital neurology services. Nevertheless, the diagnosis, treatment and prognosis of this condition remain somewhat unclear. A retrospective study was conducted involving 140 patients. Data were collected concerning demographic aspects, clinical picture, diagnostic study, aetiology, treatment and progression. There was a predominance of males, with a mean age of 54 years. The mean follow-up time was 25 months. The symptoms that were reported were as follows: numbness, burning pain, tingling or prickling in the nerve territory. Hypaesthesia was the most frequent sign found in the examination. History of another compressive neuropathy was present in 13.6% of patients. The diagnosis was based on the patient record and the neurological examination. The neurophysiological study and complementary tests were reserved for atypical cases. The most common causation was spontaneous and only three cases were found to be secondary to a structural lesion. A third of the patients were receiving pharmacological treatment. Although the clinical picture was benign, in most cases it tended to become chronic. Patients treated pharmacologically did not show a significant improvement in comparison to those who were not given treatment. The most important data for forecasting improvement of the clinical picture were the identification and correction of the factors precipitating compression of the nerve. Meralgia paraesthetica is a frequent, benign pathology but with a tendency to become chronic that responds poorly to pharmacological treatment. It is important to identify and correct mechanical factors and only in exceptional cases is it secondary to a structural lesion.

  14. Adverse clinical sequelae after skin branding: a case series.

    PubMed

    Raza, Shahzad; Mahmood, Khalid; Hakeem, Abdul; Polsky, Sylvie; Haemel, Anna; Rai, Soniya; Ali Baig, Mahadi

    2009-01-23

    Branding refers to a process whereby third degree burns are inflicted on the skin with a hot iron rod or metallic object. Branding employs the phenomenon of "counter irritation," and is widely used by faith healers in developing countries for therapeutic purposes. Some methods, which are very crude and inhuman, carry a large risk of complications. The purpose of this study is to present a series of complications and to familiarize clinicians with this dangerous method of treatment. Four Pakistani patients, three male and one female, ranging from 25 to 60 years of age "branded" with a red hot iron rod for various medical reasons presented with severe medical complications to our tertiary care hospital. The mean duration between the procedure and presentation to the hospital was 6 days. At the time of admission, two patients had septic shock, one patient had cavernous sinus thrombosis and one patient had multiple splenic abscesses. All patients received standard care for wound management and systemic infections. Two patients eventually died during the course of treatment. Severe complications from branding are troublesome and the potential risks of this treatment outweigh its benefits. Globally, there is a great need for heightened awareness about the dangers of branding among patients and physicians, as this will have an important effect on patients who seek branding for various medical conditions.

  15. Scleroderma in the Caribbean: characteristics in a Dominican case series.

    PubMed

    Gottschalk, Paola; Vásquez, Ricardo; López, Persio David; Then, Jossiell; Tineo, Carmen; Loyo, Esthela

    2014-01-01

    Scleroderma is a rare disease with limited data in Latin America. Preliminary genetic studies suggest a strong African ascendance in the Dominican Republic, which could modulate the expression of the disease. The objective of this study is to describe the clinical and demographic characteristics of scleroderma in a series of 26 Dominican patients. Patients who fulfilled the EULAR/ACR criteria for scleroderma were selected from the Rheumatology Department of a tertiary health center; systemic sclerosis subtypes were defined according to the EULAR classification. Clinical and demographic information was obtained retrospectively from clinical records. Mean age at time of onset was 32.6±15 years; 68% of patients had 40 years of age or less. 73% of patients was feminine, with a female:male ratio of 2.7:1. The most affected systems were pulmonary and gastrointestinal; renal affection was scarce. Anti-Scl-70 antibodies were positive in 64% of patients, sometimes in coexistence with anti-centromere antibodies. The prevalence of systemic sclerosis is lower in the Dominican population than the reported elsewhere. The age of onset of the disease seems to be lower in the Dominican population than that reported in literature. A different pattern of autoantibodies is observed in this population. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  16. Bisphosphonates in Langerhans Cell Histiocytosis: An International Retrospective Case Series

    PubMed Central

    Chellapandian, Deepak; Makras, Polyzois; Kaltsas, Gregory; van den Bos, Cor; Naccache, Lamia; Rampal, Raajit; Carret, Anne-Sophie; Weitzman, Sheila; Egeler, R. Maarten; Abla, Oussama

    2016-01-01

    Background Bone is the most common organ of involvement in patients with Langerhans cell histiocytosis (LCH), which is often painful and associated with significant morbidity from pathological fractures. Current first-line treatments include chemotherapy and steroids that are effective but often associated with adverse effects, whereas the disease may reactivate despite an initial response to first-line agents. Bisphosphonates are osteoclast inhibitors that have shown to be helpful in treating bone lesions of LCH. To date, there are no large international studies to describe their role in treating bone lesions of LCH. Method We conducted a multicenter retrospective review of 13 patients with histologically proven LCH, who had received bisphosphonates either at diagnosis or at disease reactivation. Results Ten patients (77%) had a single system bone disease, and 3 (23%) had bone lesions as part of multisystem disease. Median follow-up time post-bisphosphonate therapy was 4.6 years (range, 0.8 to 8.2 years). Treatment with bisphosphonates was associated with significant pain relief in almost all patients. Twelve (92%) achieved resolution of active bone lesions, and 10 out of them had no active disease for a median of 3.5 years (range, 0.8 to 5 years). One patient did not respond. No major adverse effects were reported in this series. Conclusion Bisphosphonates are well-tolerated drugs that can significantly improve bone pain and induce remission in active bone LCH. Future prospective studies evaluating the role of bisphosphonates in LCH are warranted. PMID:27413525

  17. Peribulbar anaesthesia for penetrating keratoplasty. A case series.

    PubMed

    Agrawal, Vinay; Tharoor, Madhusoodan

    2002-12-01

    To prospectively analyse the efficacy and safety of peribulbar anaesthesia for penetrating keratoplasty through a noncomparative, consecutive series. One hundred twenty-four (91.1%) of 136 patients undergoing penetrating keratoplasty (PK) from January 1997 to December 2001, were administered peribulbar anaesthesia. The anaesthetic mixture consisted 5 ml of lignocaine, bupivacaine, and hyaluronidase (to avoid evaluation bias) in the peribulbar space. A repeat injection of 3 ml was used if the primary injection was inadequate. Digital ocular compression was done for 10-15 minutes after the first injection. Each patient was analysed for degree of akinesia, subjective patient comfort, analgesia, subjective surgeon comfort, and types of surgical conditions. The age ranged from 19 to 86 years. Forty-nine of 124 patients (39.5%) received PK only and remaining 75 patients (60.5%) received additional procedures. A single injection was sufficient to achieve adequate akinesia (grade II and III) in 114 (92%) patients and 120 (97%) of patients were satisfied (graded pain as < or = grade II). During surgery, 6 (5%) phakic eyes developed episodes of positive intraocular pressure and 5 eyes (4%) developed chemosis. There were no other local or systemic adverse events. The surgeon level comfort was (grade II or more) 98% (122 of 124). One-point, low volume, peribulbar anaesthesia for penetrating keratoplasty is safe and efficacions.

  18. Dyke-Davidoff-Masson Syndrome: Time to Revisit Case Series.

    PubMed

    Shubhakaran; Bhushan, Bharat

    2015-09-01

    We read a case report by Manghera et al (JAPI, Vol 62 page No. 76-67), which was in response to an earlier case report by Ola et al.1 Here we would like to share our experience and views as under- The authors in the correspondence have said that crossed cerebellar atrophy is an unusual and rare finding. We in our study of 28 patients of DDMS, have found cerebellar atrophy in nine patients along with cerebral atrophy.2 Out of nine patients with cerebellar atrophy three patients had diffuse bilateral atrophy, only one patient had unilateral cerebellar atrophy which was controlateral to left cerebral hemiatrophy (CHA). This is similar to the findings of the authors and the patho-physiology quoted by authors is worth appreciation. Other parenchymal changes observed in our study were cerebral peduncle atrophy in three patients, and thalamic atrophy with lentiform nucleus hypoplasia in 11 patients. Seven cases of CHA were associated with ipsilateral large schizencephalic cleft with absence of the septum pellucidum whereas two had porencephaly. Five patients had left-sided hippocampal sclerosis (HS), four were concordant and one was discordant. © Journal of the Association of Physicians of India 2011.

  19. Cleft lip and palate: series of unusual clinical cases.

    PubMed

    Paranaíba, Lívia Máris Ribeiro; Miranda, Roseli Teixeira de; Martelli, Daniella Reis Barbosa; Bonan, Paulo Rogério Ferreti; Almeida, Hudson de; Orsi Júnior, Julian Miranda; Martelli Júnior, Hercílio

    2010-01-01

    Cleft lip and/or palate (CL/P) represent the most common congenital anomalies of the face, corresponding to approximately 65% of all malformations of the craniofacial region. to describe unusual clinical cases of non-syndromic CL/P (CL/PNS), diagnosed in a reference service in Minas Gerais, Brazil, and correlate these alterations with possible risk factors. we carried out a retrospective study, between the years of 1992 and the 1st half of 2009, from medical records. Among the 778 cases of CL/PNS diagnosed in the period of 17 years, 5 (0.64%) were unusual CL/PNS, and all patients were male. It was found that among the 5 patients, 2 had incomplete right cleft lip with incomplete cleft palate, 2 were affected by left incomplete cleft lip and incomplete cleft palate, and 1 had a cleft lip and palate associated with complete right cleft palate. Risk factors such as consanguinity, maternal smoking and alcohol consumption, medication usage during pregnancy, history of abortion and/or stillbirths and maternal diseases were not associated with unusual CL/PNS. This study described 5 unusual cases of CL/PNS in a Brazilian population; no associations with the risk factors analyzed were seen. It also confirmed the unusualness of the prevalence of such alterations.

  20. Kissing molars extraction: Case series and review of the literature

    PubMed Central

    Arjona-Amo, Manuel; Torres-Carranza, Eusebio; Batista-Cruzado, Antonio; Serrera-Figallo, Maria-Angeles; Crespo-Torres, Santos; Belmonte-Caro, Rodolfo; Albisu-Andrade, Claudio; Gutiérrez-Pérez, José-Luis

    2016-01-01

    Kissing molars are a very rare form of inclusion defined as molars included in the same quadrant, with occlusal surfaces contacting each other within a single dental follicle. We present four cases of this pathology: a 35 year-old male, referred to the Oral and Maxillofacial Surgery Department of the Hospital Virgen del Rocio in Seville, and three females of 24, 26, and 31 years, all of which had kissing molars that were treated by tooth extraction. We have found only 10 cases published in the medical literature in which this type of inclusion is briefly described, none of which elaborate on the surgical technique employed. In these cases, the indication for surgery is established when there is a history of recurring infections or cystic lesions associated with dental inclusions. The extraction of kissing molars requires an exhaustive comprehension of the anatomy of the region involved, sufficiently developed surgical abilities, and an extensive planning process. Key words:Impacted molar, kissing molar, surgical extraction. PMID:26855716

  1. Applying Bayesian Compressed Sensing (BCS) for sensitivity analysis ofclimate model outputs that depend on a high-dimensional input space

    NASA Astrophysics Data System (ADS)

    Chowdhary, K.; Guo, Z.; Wang, M.; Lucas, D. D.; Debusschere, B.

    2014-12-01

    High-dimensional parametric uncertainty exists in many parts of atmospheric climatemodels. It is computationally intractable to fully understand their impact on the climatewithout a significant reduction in the number of dimensions. We employ Bayesian CompressedSensing (BCS) to perform adaptive sensitivity analysis in order to determine whichparameters affect the Quantity of Interest (QoI) the most and the least. In short, BCSfits a polynomial to the QoI via a Bayesian framework with an L1 (Laplace) prior. Thus,BCS tries to find the sparsest polynomial representation of the QoI, i.e., the fewestterms, while still trying to retain high accuracy. This procedure is adaptive in the sensethat higher order polynomial terms can be added to the polynomial model when it is likely thatparticular parameters have a significant effect on the QoI. This helps avoid overfitting and is much more computationally efficient. We apply the BCS algorithm to two sets of single column CAM (Community Atmosphere Model)simulations. In the first application, we analyze liquid cloud fraction as modeled byCLUBB (Cloud Layers Unified By Binormals), an atmospheric cloud and turbulence model.This liquid cloud fraction QoI depends on 29 different input parameters. We compare mainSobol sensitivity indices obtained with the BCS algorithm for the liquid cloud fraction in6 cases, with a previous approach to sensitivity analysis using deviance. We show BCS canprovide almost identical sensitivity analysis results. Additionally, BCS can provide animproved, lower-dimensional, higher order model for prediction. In the secondapplication, we study the time averaged ozone concentration, at varying altitudes, as afunction of 95 photochemical parameters, in order to study the sensitivity to theseparameters. To further improve model prediction, we also explore k-fold cross validationto obtain a better model for both liquid cloud fraction in CLUBB and ozone concentrationin CAM. This material is based upon work

  2. BCS as Foundation and Inspiration: the Transmutation of Symmetry

    NASA Astrophysics Data System (ADS)

    Wilczek, Frank

    The BCS theory injected two powerful ideas into the collective consciousness of theoretical physics: pairing and spontaneous symmetry breaking. In the 50 years since the seminal work of Bardeen, Cooper and Schrieffer, those ideas have found important use in areas quite remote from the stem application to metallic superconductivity. This is a brief and eclectic sketch of some highlights, emphasizing relatively recent developments in QCD and in the theory of quantum statistics, and including a few thoughts about future directions. A common theme is the importance of symmetry transmutation, as opposed to the simple breaking of electromagnetic U(1) symmetry in classic metallic superconductors.

  3. BCS as Foundation and Inspiration:. the Transmutation of Symmetry

    NASA Astrophysics Data System (ADS)

    Wilczek, Frank

    The BCS theory injected two powerful ideas into the collective consciousness of theoretical physics: pairing and spontaneous symmetry breaking. In the 50 years since the seminal work of Bardeen, Cooper and Schrieffer, those ideas have found important use in areas quite remote from the stem application to metallic superconductivity. This is a brief and eclectic sketch of some highlights, emphasizing relatively recent developments in QCD and in the theory of quantum statistics, and including a few thoughts about future directions. A common theme is the importance of symmetry transmutation, as opposed to the simple breaking of electromagnetic U(1) symmetry in classic metallic superconductors.

  4. Histopathologic classification of parapharyngeal space tumors: a case series and review of the literature.

    PubMed

    Locketz, Garrett D; Horowitz, Gilad; Abu-Ghanem, Sara; Wasserzug, Oshri; Abergel, Abraham; Yehuda, Moshe; Fliss, Dan M

    2016-03-01

    The objective of the study is to present a large case series of parapharyngeal space tumors (PPST) and the most comprehensive literature review of tumor histopathologic distribution. The study was designed as internal case series and full Pubmed/MEDLINE electronic database review in a tertiary academic medical center. Tumor histopathology and patient demographics were obtained from a comprehensive Pubmed/MEDLINE database review, as well from an internal case series of 117 patients referred to our center between 1993 and 2013. Main outcome and measures of the study were to define the age, gender, and histopathology of PPST within a large internal case series and among the current body of published literature, and to propose a diagnostic and treatment algorithm for these tumors. Our cohort included 117 cases, 58 females and 59 males, with benign tumors comprising 85 % (n = 99) and malignant tumors 15 % (n = 18). A systematic review of published literature from 1963 to the present revealed 37 case series, and when combined with our present series, yielded a total of 2160 cases. Benign tumors are most common (78.8 %), with tumors of salivary gland (44.4 %), neural (34.4 %), and vascular (2.64 %) origin representing the largest subtypes. Pleomorphic adenomas (30.9 %), paragangliomas (13.1 %), and schwannomas (12.3 %) comprised the majority of all cases. Due to their rarity, data regarding the histopathologic distribution of PPST is scarce. We provide one of the largest case series and the most comprehensive review of these tumors in the literature to date, and offer our algorithm for evaluation and treatment.

  5. Imatinib in advanced chordoma: A retrospective case series analysis.

    PubMed

    Hindi, Nadia; Casali, Paolo G; Morosi, Carlo; Messina, Antonella; Palassini, Elena; Pilotti, Silvana; Tamborini, Elena; Radaelli, Stefano; Gronchi, Alessandro; Stacchiotti, Silvia

    2015-11-01

    Imatinib showed activity in 50 chordoma patients treated within a Phase II study. In that study, 70% of patients remained with stable disease (SD), median progression free survival (PFS) was 9 months and median overall survival (OS) was 34 months. We now report on a retrospective series of PDGFB/PDGFRB positive advanced chordoma patients treated with imatinib as a single agent within a compassionate-use programme at Istituto Nazionale Tumori, Milan, Italy (INT) between August 2002 and November 2010, when the programme was closed. 48 patients were consecutively treated with imatinib 800 mg/d. All patients had inoperable and progressive disease before starting imatinib. Demographics, treatment duration, toxicity and response rate by Response Evaluation Criteria in Solid Tumors (RECIST) were retrospectively recorded. The median duration of therapy was 7 months (1-46.5). No patient is on therapy at present. 46 patients were evaluable for response. No partial responses were detected. Best response was: stable disease 34 (74%), progressive disease 12 (26%). At a median follow-up of 24.5 months (0.5-117), median PFS was 9.9 months (95% confidence interval (CI) 6.7-13). Eight patients (16.5%) remained on therapy >18 months and 10 patients (21%) remained progression-free >18 months. Median OS was 30 months (95% CI 20-40), with 24 (50%) patients dead at the time of the present analysis. We confirm the activity of imatinib in locally advanced and metastatic chordoma, in terms of >70% tumour growth arrest in previously progressive patients. Median duration of response lasted almost 10 months, with >20% of patients progression-free at 18+ months. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Supratrochlear Neuralgia: A Prospective Case Series of 15 Patients.

    PubMed

    Pareja, Juan A; López-Ruiz, Pedro; Mayo, Diego; Villar-Quiles, Rocío-Nur; Cárcamo, Alba; Gutiérrez-Viedma, Álvaro; Lastarria, Carlo P; Romeral, María; Yangüela, Julio; Cuadrado, María-Luz

    2017-10-01

    The aim of this study was to describe clinical features unique to supratrochlear neuralgia. The supratrochlear nerve supplies the medial aspect of the forehead. Due to the intricate relationship between supraorbital and supratrochlear nerves, neuralgic pain in this region has been traditionally attributed to supraorbital neuralgia. No cases of supratrochlear neuralgia have been reported so far. From 2009 through 2016, we prospectively recruited patients with pain confined to the territory of the supratrochlear nerve. Fifteen patients (13 women, 2 men; mean age 51.4 years, standard deviation 14.9) presented with pain in the lower paramedian forehead, extending to the eyebrow in two patients and to the internal angle of the orbit in another. Pain was unilateral in 11 patients (six on the right, five on the left), and bilateral in four. Six patients had continuous pain and nine described intermittent pain. Palpation of the supratrochlear nerve at the medial third of the supraorbital rim resulted in hypersensitivity in all cases. All but one patient exhibited sensory disturbances within the painful area. Fourteen patients underwent anesthetic blockades of the supratrochlear nerve, with immediate relief in all cases and long-term remission in three. Six of them had received unsuccessful anesthetic blocks of the supraorbital nerve. Five patients were treated successfully with oral drugs and one patient was treated with radiofrequency. Supratrochlear neuralgia is an uncommon disorder causing pain in the medial region of the forehead. It may be differentiated from supraorbital neuralgia and other similar headaches and neuralgias based on the topography of the pain and the response to anesthetic blockade. © 2017 American Headache Society.

  7. Esthetic depigmentation of anterior gingiva. A case series.

    PubMed

    Kasagani, Suresh Kumar; Nutalapati, Rajasekhar; Mutthineni, Ramesh Babu

    2012-04-01

    Gingival melanin pigmentation occurs in people of all races. Although clinical melanin pigmentation does not present a medical problem, demand for cosmetic therapy is commonly made by fair-skinned people with gingival melanin pigmentation. This problem is aggravated in patients with a "gummy smile" or excessive gingival display while smiling. Esthetic periodontal plastic surgery is especially successful in individuals with compromised esthetics. Three cases are reported here where gingival depigmentation was done using three different techniques: electrosurgery; scalpel surgery; and surgical abrasion. The clinical results of the three methods have been compared.

  8. Paediatric Post-Traumatic Bladder Neck Distraction Injury: Case Series

    PubMed Central

    Sawant, Ajit S.; Kumar, Vikash; Pawar, Prakash; Tamhankar, Ashwin S.

    2017-01-01

    The bladder neck distraction is a rare posterior urethral injury in paediatric age group. It mostly occurs secondary to road traffic accidents. We report three cases of paediatric bladder neck distraction injury. Three paediatric patients aged between 4 to 7 years (mean 5 year), who presented with post traumatic bladder neck distraction injury but no other major injury, they were treated with early urethro-vesical anastomosis. Postoperatively all patients were continent and with good urine flow rates. In paediatric bladder neck distraction injury, immediate urethro-vesical anastomosis gives good results. PMID:28384935

  9. Guillain-Barré syndrome following chickenpox: a case series.

    PubMed

    Tatarelli, P; Garnero, M; Del Bono, V; Camera, M; Schenone, A; Grandis, M; Benedetti, L; Viscoli, C

    2016-01-01

    Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy, usually triggered by an infectious episode, mostly of viral origin. Varicella zoster virus (VZV) is a rare cause of GBS, mainly in the case of latent infection reactivation. We report on three adult patients who developed GBS following chickenpox, after a short period of latency. They were promptly treated with intravenous immunoglobulin, and the first one with plasma exchange additionally. All the patients experienced almost complete clinical recovery. Our experience suggests that primary VZV infection constitutes a GBS triggering event.

  10. Aseptic Meningitis Caused by Lassa Virus: Case Series Report.

    PubMed

    Okokhere, Peter O; Bankole, Idowu A; Iruolagbe, Christopher O; Muoebonam, Benard E; Okonofua, Martha O; Dawodu, Simeon O; Akpede, George O

    2016-01-01

    The Lassa virus is known to cause disease in different organ systems of the human body, with varying clinical manifestations. The features of severe clinical disease may include bleeding and/or central nervous system manifestations. Whereas Lassa fever encephalopathy and encephalitis are well described in the literature, there is paucity of data on Lassa virus meningitis. We present the clinical description, laboratory diagnosis, and management of 4 consecutive cases of aseptic meningitis associated with Lassa virus infection without bleeding seen in a region of Nigeria known to be endemic for both the reservoir rodent and Lassa fever. The 4 patients recovered fully following intravenous ribavirin treatment and suffered no neurologic complications.

  11. Superhero‐related injuries in paediatrics: a case series

    PubMed Central

    Davies, Patrick; Surridge, Julia; Hole, Laura; Munro‐Davies, Lisa

    2007-01-01

    Five cases of serious injuries to children wearing superhero costumes, involving extreme risk‐taking behaviour, are presented here. Although children have always displayed behaviour seemingly unwise to the adult eye, the advent of superhero role models can give unrealistic expectations to the child, which may lead to serious injury. The children we saw have all had to contemplate on their way to hospital that they do not in fact possess superpowers. The inbuilt injury protection which some costumes possess is also discussed. PMID:17337680

  12. Metformin-induced lactic acidosis: a case series

    PubMed Central

    Silvestre, Joana; Carvalho, Susana; Mendes, Vitor; Coelho, Luis; Tapadinhas, Camila; Ferreira, Pedro; Povoa, Pedro; Ceia, Fatima

    2007-01-01

    Introduction Unlike other agents used in the treatment of type 2 diabetes mellitus, metformin has been shown to reduce mortality in obese patients. It is therefore being increasingly used in higher doses. The major concern of many physicians is a possible risk of lactic acidosis. The reported frequency of metformin related lactic acidosis is 0.05 per 1000 patient-years; some authors advocate that this rate is equal in those patients not taking metformin. Case presentation We present two case reports of metformin-associated lactic acidosis. The first case is a 77 year old female with a past medical history of hypertension and type 2 diabetes mellitus who had recently been prescribed metformin (3 g/day), perindopril and acetylsalicylic acid. She was admitted to the emergency department two weeks later with abdominal pain and psychomotor agitation. Physical examination revealed only signs of poor perfusion. Laboratory evaluation revealed hyperkalemia, elevated creatinine and blood urea nitrogen and mild leukocytosis. Arterial blood gases showed severe lactic acidemia. She was admitted to the intensive care unit. Vasopressor and ventilatory support was initiated and continuous venovenous hemodiafiltration was instituted. Twenty-four hours later, full clinical recovery was observed, with return to a normal serum lactate level. The patient was discharged from the intensive care unit on the sixth day. The second patient is a 69 year old male with a past medical history of hypertension, type 2 diabetes mellitus and ischemic heart disease who was on metformin (4 g/day), glycazide, acetylsalicylic acid and isosorbide dinitrate. He was admitted to the emergency department in shock with extreme bradycardia. Initial evaluation revealed severe lactic acidosis and elevated creatinine and urea. The patient was admitted to the Intensive Care Unit and commenced on continuous venovenous hemodiafiltration in addition to other supportive measures. A progressive recovery was observed

  13. Levodropropizine-Induced Anaphylaxis: Case Series and Literature Review

    PubMed Central

    Song, Jae-Won; Jang, Young-Sook; Jung, Moon-Chan; Choi, Jeong-Hee; Park, Sunghoon; Hwang, Yong Il; Jang, Seung Hun; Jung, Ki-Suck

    2017-01-01

    Levodropropizine is commonly used as an antitussive drug for acute and chronic cough. It is a non-opioid agent with peripheral antitussive action via the modulation of sensory neuropeptide levels in the airways. Thus, levodropropizine has a more tolerable profile than opioid antitussives. However, we experienced 3 cases of levodropropizine-induced anaphylaxis. Three patients commonly presented with generalized urticaria, dyspnea, and collapse after taking cold medication including levodropropizine. To find out the culprit drug, we performed skin tests, oral provocation tests (OPTs), and basophil activation tests (BATs). Two patients were confirmed as having levodropropizine-induced anaphylaxis by OPTs, and one of them showed positive to skin prick tests (SPTs). The other patient was confirmed by skin tests and BATs. When we analyzed pharmacovigilance data related to levodropropizine collected for 5 years, most cases (78.9%) had allergic reactions, such as rash, urticaria, angioedema, and anaphylaxis. Therefore, physicians should consider that levodropropizine can be a culprit drug, when anaphylaxis occurs after taking anti-cough or common cold medication. PMID:28293935

  14. Levodropropizine-Induced Anaphylaxis: Case Series and Literature Review.

    PubMed

    Song, Jae Won; Jang, Young Sook; Jung, Moon Chan; Kim, Joo Hee; Choi, Jeong Hee; Park, Sunghoon; Hwang, Yong Il; Jang, Seung Hun; Jung, Ki Suck

    2017-05-01

    Levodropropizine is commonly used as an antitussive drug for acute and chronic cough. It is a non-opioid agent with peripheral antitussive action via the modulation of sensory neuropeptide levels in the airways. Thus, levodropropizine has a more tolerable profile than opioid antitussives. However, we experienced 3 cases of levodropropizine-induced anaphylaxis. Three patients commonly presented with generalized urticaria, dyspnea, and collapse after taking cold medication including levodropropizine. To find out the culprit drug, we performed skin tests, oral provocation tests (OPTs), and basophil activation tests (BATs). Two patients were confirmed as having levodropropizine-induced anaphylaxis by OPTs, and one of them showed positive to skin prick tests (SPTs). The other patient was confirmed by skin tests and BATs. When we analyzed pharmacovigilance data related to levodropropizine collected for 5 years, most cases (78.9%) had allergic reactions, such as rash, urticaria, angioedema, and anaphylaxis. Therefore, physicians should consider that levodropropizine can be a culprit drug, when anaphylaxis occurs after taking anti-cough or common cold medication. Copyright © 2017 The Korean Academy of Asthma, Allergy and Clinical Immunology · The Korean Academy of Pediatric Allergy and Respiratory Disease.

  15. Acral self-healing collodion baby: A case series.

    PubMed

    Ferrari, Bruno; Martínez, Juan Pablo; Luna, Paula Carolina; Larralde, Margarita

    2016-12-01

    Collodion baby is a term used to describe a phenotype characterized by the presence of a tight, translucent membrane that covers the entire skin at birth. This membrane usually sheds around 10 to 14 days and reveals the underlying disease (mainly different types of Recessive Ichthyosis or other infrequent disorders). A rare variant of this phenotype is known as acral self-healing collodion baby whereby the patients are born with the typical membrane but limited to the hands and feet only, and after it sheds, the skin appears completely normal. We report five cases of this very rare subtype of collodion baby. All the patient cases that are presented involved both hands and feet. One of the patients also had the umbilicus embedded in a subtle collodion membrane. None of the patients had a family history of the same entity or any other type of ichthyosis. In all patients, the condition resolved spontaneously within a few weeks and no patients developed any other manifestation. Although no molecular analysis was performed, we contribute to the knowledge of the clinical features of this extremely uncommon and benign entity, since to the best of our knowledge there are only two previous reports available in literature.

  16. Eruption cysts: A series of 66 cases with clinical features

    PubMed Central

    Şen-Tunç, Emine; Şaroğlu-Sönmez, Işıl; Bayrak, Şule; Tüloğlu, Nuray

    2017-01-01

    Background An eruption cyst (EC) is a benign, developmental cyst associated with a primary or permanent tooth. This paper presents 66 ECs in 53 patients who reported to 3 different centers in Turkey between 2014-2015. Material and Methods 53 patients (31 male, 22 female) with 66 ECs were diagnosed and treated over a 1-year period. The mean age of patients was 5.4 years (minimum 5 months, maximum 11 years). Clinical examination and periapical radiographs were used to establish diagnosis. Age, gender, site, history of trauma and type of treatment were recorded. Results Of the 66 ECs diagnosed in 53 patients, more than half (56.6%) were located in the maxilla, with the maxillary first primary molars the teeth most commonly associated with ECs (30.3%). Multiple ECs were diagnosed in 13 of the 53 patients. ECs had previously diagnosed in the primary dentition of 2 patients, 3 patients reported a history of trauma to primary teeth. In the majority of patients (46 cases, 86.8%), no treatment was provided, whereas surgical treatment was provided in the remaining 7 cases (13.2%). Conclusions Eruption cysts are usually asymptomatic and do not require treatment;. however, if the cyst is symptomatic, it should be treated with simple surgical excision. Key words:Odontogenic cyst, children, eruption cyst, oral pathology. PMID:28160586

  17. Five Year Retrospective Case Series of Adnexal Torsion

    PubMed Central

    Joy, Smitha; Nayar, Jayashree

    2014-01-01

    Aims and Objectives: Adnexal torsion is a rare gynaecological emergency that requires an early surgical intervention to save the adnexa from irreversible damage .Our study is about clinical presentation and management approach of adnexal torsion in a tertiary care centre. Study Design: Retrospective study. Materials and Methods: Review of case records during the five years of 2008 November -2013 November in Amrita Institute of Medical Sciences, Kochi, India. Results: Adnexal torsion was found mainly in the reproductive age. Ultrasound was the most commonly used imaging modality. Benign tumours predispose to torsion. Torsion occurred during postovulatory period in many cases. Polycystic ovaries were a risk factor for unexplained torsion in younger age groups. Diagnosis of adnexal torsion was mostly intra operative by direct visualisation of the rotated adnexa. Laparoscopy was the preferred method of surgical intervention. Ovarian conservation was tried in majority of the child bearing age groups. Conclusion: Adnexal torsion is a rare emergency which requires a high index of clinical suspicion for diagnosis as the symptoms are non specific. Imaging helps in diagnosis but most of them are diagnosed intra operatively. Laparoscopic conservative surgery is the preferred surgical approach especially in younger age groups. An early surgical intervention helps in salvaging the adnexa and prevents further complications. PMID:25653994

  18. APLASIA CUTIS CONGENITA TYPE I - A CASE SERIES.

    PubMed

    Wollina, U; Chokoeva, A; Verma, Sh; Tchernev, G; Handjani, F

    2017-03-01

    Aplasia Cutis Congenita is a rare disorder with circumscribed, partial or widespread absence of skin and subcutaneous soft tissue; in about 20% it also causes skull defects. The disease is heterogeneous in its clinical presentation with nine major subtypes. Type I represents nonsyndromic Aplasia Cutis Congenita. We report 5 infants with skin defects of the scalp and limbs presented to dermatologists. Pediatric workup ruled out any other malformations or genetic disorders. All patients were treated by conservative wound and skin care without complications. In one case the formation of milia has been observed - an outcome not described before. Therapeutic approach and differential diagnoses are described. Topical wound and skin care resulted in complete closure of the defects. Skin appendages did not recover, leaving hairless areas on the scalp and limbs. Aplasia Cutis Congenita type I is a rare disorder in newborns with >85% of all solitary lesions occurring on the scalp. Conservative treatment is a simple and safe option in many cases. Exposed large veins and sagittal plexus demand urgent surgical approaches to prevent fatal hemorrhages or infections.

  19. Teratoma of the nervous system: A case series.

    PubMed

    Algahtani, Hussein; Shirah, Bader; Abdullah, Ahad; Bazaid, Abdulrahman

    2017-05-10

    Teratoma is a common form of germ cell tumors composed of multiple tissues foreign to the site in which arise with a histological representation of all three germ cell layers. Intracranial teratomas are very rare. In this study, we report three cases of intracranial teratomas with an interesting clinical course, neuroradiology, and outcome. In addition, we review the literature and convey important messages to the neuroscience community regarding issues related to the management of these rare tumors. The present cases are interesting examples of intracranial teratoma in terms of location of the tumor and neuroimaging findings. Delay in surgical intervention may complicate the course of the disease with progressive enlargement of tumors and development of complication including hydrocephalus. Using endoscopic surgical techniques may emerge as the preferred intervention option as compared to other traditional methods. We recommend the establishment of a national and international registry for intracranial tumors. Copyright © 2017 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Metformin-induced lactic acidosis: a case series.

    PubMed

    Silvestre, Joana; Carvalho, Susana; Mendes, Vitor; Coelho, Luis; Tapadinhas, Camila; Ferreira, Pedro; Povoa, Pedro; Ceia, Fatima

    2007-10-31

    Unlike other agents used in the treatment of type 2 diabetes mellitus, metformin has been shown to reduce mortality in obese patients. It is therefore being increasingly used in higher doses. The major concern of many physicians is a possible risk of lactic acidosis. The reported frequency of metformin related lactic acidosis is 0.05 per 1000 patient-years; some authors advocate that this rate is equal in those patients not taking metformin. We present two case reports of metformin-associated lactic acidosis. The first case is a 77 year old female with a past medical history of hypertension and type 2 diabetes mellitus who had recently been prescribed metformin (3 g/day), perindopril and acetylsalicylic acid. She was admitted to the emergency department two weeks later with abdominal pain and psychomotor agitation. Physical examination revealed only signs of poor perfusion. Laboratory evaluation revealed hyperkalemia, elevated creatinine and blood urea nitrogen and mild leukocytosis. Arterial blood gases showed severe lactic acidemia. She was admitted to the intensive care unit. Vasopressor and ventilatory support was initiated and continuous venovenous hemodiafiltration was instituted. Twenty-four hours later, full clinical recovery was observed, with return to a normal serum lactate level. The patient was discharged from the intensive care unit on the sixth day. The second patient is a 69 year old male with a past medical history of hypertension, type 2 diabetes mellitus and ischemic heart disease who was on metformin (4 g/day), glycazide, acetylsalicylic acid and isosorbide dinitrate. He was admitted to the emergency department in shock with extreme bradycardia. Initial evaluation revealed severe lactic acidosis and elevated creatinine and urea. The patient was admitted to the Intensive Care Unit and commenced on continuous venovenous hemodiafiltration in addition to other supportive measures. A progressive recovery was observed and he was discharged from the

  1. The female athlete triad: a case series and narrative overview

    PubMed Central

    Laframboise, Michelle A.; Borody, Cameron; Stern, Paula

    2013-01-01

    Objective: To illustrate the varying presentations of the female athlete triad and to inform the practitioner of the potential sequelae of this common condition. Clinical Features: Four patients presented with a variety of signs and symptoms of the female athlete triad including low caloric intake, osteoporosis, amenorrhea and/or endothelial dysfunction. Intervention and Outcome: A conservative treatment approach was utilized in each case including education on the female athlete triad, education on increased caloric intake and a referral to the family physician. Conclusion: Health care practitioners should be aware of the different clinical presentations of the female athlete triad. A narrative review of the literature is provided to educate practitioners on the components of the female athlete triad, proper diagnosis and appropriate management. PMID:24302779

  2. A Case Series of Gastrointestinal Tuberculosis in Renal Transplant Patients

    PubMed Central

    Freitas, Cristina; Silva, Hugo; Aguiar, Pedro; Farrajota, Pedro; Almeida, Manuela; Pedroso, Sofia; Martins, La Salete; Dias, Leonídio; Vizcaíno, José Ramón; Castro Henriques, António; Cabrita, António

    2013-01-01

    Tuberculosis is a disease relatively frequent in renal transplant patients, presenting a wide variety of clinical manifestations, often involving various organs and potentially fatal. Gastrointestinal tuberculosis, although rare in the general population, is about 50 times more frequent in renal transplant patients. Intestinal tuberculosis has a very difficult investigational approach, requiring a high clinical suspicion for its diagnosis. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring adjustment of maintenance therapy. The authors report two cases of isolated gastro-intestinal tuberculosis in renal transplant recipients that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach. PMID:24558621

  3. Metronidazole Toxicity in Cockayne Syndrome: A Case Series.

    PubMed

    Wilson, Brian T; Strong, Andrew; O'Kelly, Sean; Munkley, Jennifer; Stark, Zornitza

    2015-09-01

    Cockayne syndrome (CS) is a rare genetic disorder characterized by small stature, intellectual disability, and accelerated pathologic aging. Through the Cockayne Syndrome Natural History Study, we have identified 8 cases of acute hepatic failure after metronidazole administration (8% of our cohort), 3 of which were fatal. The interval between initial administration and death was 6 to 11 days. Two of these patients also experienced acute neurologic deficit. Both hepatotoxicity and acute neurologic deficit have been reported previously as extremely rare adverse events after metronidazole administration. However, we have not identified any patients with CS who have received metronidazole without serious adverse effects. We recommend that a diagnosis of CS be considered an absolute contraindication to the use of metronidazole.

  4. Influence of female sex hormones on periodontium: A case series

    PubMed Central

    Jafri, Zeba; Bhardwaj, Ashu; Sawai, Madhuri; Sultan, Nishat

    2015-01-01

    Dental plaque is the primary etiologic factor for the periodontal diseases. Although pathogenic bacteria in dental plaque are necessary for the incidence of periodontal disease, but a susceptible host is as important. The susceptibility of the host can be modified by various systemic factors with hormones level being one. The periodontium shows an exaggerated inflammatory response to plaque modified by female sex hormone during puberty, pregnancy, in women taking oral contraceptives and at the postmenopausal stage. This paper presents such few cases where periodontium is influenced by variation in sex steroid hormones of female during different phases of their life time and to discuss how much a same hormone at different age and stage shows an exaggerated gingival response to plaque. PMID:26604605

  5. [Occupational diseases: considerations on a clinical case series].

    PubMed

    Candura, F; Biscaldi, G; Malamani, T; Fonte, R; Lodigiani, L; Lenoci, A

    1988-05-01

    The authors examine cases of occupational diseases diagnosed between 1982 and 1988 in patients admitted to "Divisione di Medicina del Lavoro I Sezione di medicina del Lavoro del Dipartimento di Medicina preventiva, occupazionale e di comunità dell'Università di Pavia". The most frequent syndromes concerns the auditory apparatus (having losses or deafness due to noise) and the respiratory system, whereas new safety regulations have given rise to the disappearance of benzene-induced hematologic abnormalities. Most of, the "classical" features of occupational diseases have disappeared, since early diagnosis has permitted the adoption of opportune technical and sanitary measures. The authors emphasize the necessity for role of Occupational Medicine (ever following the sentences 179 and 206 of the "Corte Costituzionale") to be not prevention, but also diagnosis, treatment and rehabilitation; therefore there is a need, all over the country, for adequate structures for the diagnosis and treatment of the occupational diseases.

  6. Ultrastructural pathology of nephropathies with organized deposits: a case series

    PubMed Central

    Fabbian, Fabio; Stabellini, Nevio; Galdi, Adriana; Sartori, Sergio; Aleotti, Arrigo; Catizone, Luigi

    2008-01-01

    Renal organized or structured deposits are much less frequent than those with usual type immunocomplex deposits and are encountered in a wide variety of primary and systemic disorders. It has been suggested that immunoglobulins (Igs) are responsible for organized deposits. We report 5 cases who have been diagnosed and treated in our hospital. Patients were aged 52 to 72 years, three of them were males and had variable degree of renal function, from normal serum creatinine to uraemia. Proteinuria was detected in all patients while monoclonal component was present only in the serum of one subject. Ultrastructural analysis of renal specimens revealed organized deposits. Diagnoses that were made are the following: membranoproliferative glomerulonephritis with finger print, immunotactoid glomerulopathy, membranoproliferative glomerulonephritis with arched deposits, primary amyloidosis and light chain deposition disease. In systemic disorders ultrastructural pathology could be particularly valuable for correct deposits classification, precise localization and pattern of deposition of Igs. PMID:18817550

  7. Pontine warning syndrome: case series and review of literature.

    PubMed

    Muengtaweepongsa, Sombat; Singh, Niranjan N; Cruz-Flores, Salvador

    2010-01-01

    Crescendo transient ischemic attacks (TIAs) are defined as repeated frequent short-lasting episodes of focal neurologic deficit due to cerebral ischemia. The capsular warning syndrome, a subset of crescendo TIA, consists of repetitive episodes of motor dysfunction due to ischemia in the region of internal capsule. It is not clear that patients with ischemia in the pons can have a similar clinical presentation and course. We report 11 cases presenting with crescendo TIA in the form of pure motor hemiparesis or ataxic hemiparesis that later proved to have a paramedian pontine infarct. The presumed mechanism of these infarcts is penetrating basilar artery branch occlusion at their origin, also called basilar branch disease. Copyright (c) 2010 National Stroke Association. All rights reserved.

  8. [Late ulnar paralysis. Study of a series of 17 cases].

    PubMed

    Mansat, M; Bonnevialle, P; Fine, X; Guiraud, B; Testut, M F

    1984-02-16

    Seventeen cases of late ulnar paralysis treated by neurolysis-transposition are reported. The clinical characteristics of these paralyses are emphasized: very prolonged symptom free interval, rapid onset and severe involvement. Ulnar transposition was most often done subcutaneously. Cubitus valgus and definite nerve compression proximal to the arcade of the flexor carpi ulnaris muscle are almost always present. The results as regards the neuropathy are undependable: no patient is completely cured and only half are improved. An anatomical study of the nerve path shows the essential role, in the compression of the nerve, of the muscular arcade of the flexor carpi ulnaris muscle which acts in a way similar to the bridge of a violin. Hence, opening it longitudinally is the principal step of neurolysis. This should be routine before the first signs of neuropathy occur in an elbow whose axis is out of alignment as a sequela of a childhood injury.

  9. Aseptic Meningitis Caused by Lassa Virus: Case Series Report

    PubMed Central

    Bankole, Idowu A.; Iruolagbe, Christopher O.; Muoebonam, Benard E.; Okonofua, Martha O.; Dawodu, Simeon O.; Akpede, George O.

    2016-01-01

    The Lassa virus is known to cause disease in different organ systems of the human body, with varying clinical manifestations. The features of severe clinical disease may include bleeding and/or central nervous system manifestations. Whereas Lassa fever encephalopathy and encephalitis are well described in the literature, there is paucity of data on Lassa virus meningitis. We present the clinical description, laboratory diagnosis, and management of 4 consecutive cases of aseptic meningitis associated with Lassa virus infection without bleeding seen in a region of Nigeria known to be endemic for both the reservoir rodent and Lassa fever. The 4 patients recovered fully following intravenous ribavirin treatment and suffered no neurologic complications. PMID:27957363

  10. Connecting hospitalized patients with their families: case series and commentary.

    PubMed

    Parsapour, Kourosh; Kon, Alexander A; Dharmar, Madan; McCarthy, Amy K; Yang, Hsuan-Hui; Smith, Anthony C; Carpenter, Janice; Sadorra, Candace K; Farbstein, Aron D; Hojman, Nayla M; Wold, Gary L; Marcin, James P

    2011-01-01

    The overall aim of this project was to ascertain the utilization of a custom-designed telemedicine service for patients to maintain close contact (via videoconference) with family and friends during hospitalization. We conducted a retrospective chart review of hospitalized patients (primarily children) with extended hospital length of stays. Telecommunication equipment was used to provide videoconference links from the patient's bedside to friends and family in the community. Thirty-six cases were managed during a five-year period (2006 to 2010). The most common reasons for using Family-Link were related to the logistical challenges of traveling to and from the hospital-principally due to distance, time, family commitments, and/or personal cost. We conclude that videoconferencing provides a solution to some barriers that may limit family presence and participation in care for hospitalized patients, and as a patient-centered innovation is likely to enhance patient and family satisfaction.

  11. [Foreign bodies in esophagus in children: case series].

    PubMed

    Rodríguez, Hugo; Cuestas, Giselle; Botto, Hugo; Nieto, Mary; Cocciaglia, Alejandro; Gregori, Dario

    2013-06-01

    Ingestion of foreign bodies is an avoidable accident that is seen mainly in children under 3 years-old. Most of them pass through the digestive tract without causing clinical manifestations or complications, but a significant percentage is impacted in the esophagus causing vomiting, sore throat, dysphagia and drooling. The most common foreign bodies are coins. Complications usually occur when there is a delay in diagnosis or with large, sharp or potentially toxic objects, as the button battery. It is essential to make differential diagnosis between coin and button battery, since the latter requires urgent removal due to the earliness of the injury caused. We report 115 cases of foreign bodies in the esophagus, and we alert the pediatrician in recognizing and preventing this problem.

  12. Severe periodontal destruction in alpha-mannosidosis: a case series.

    PubMed

    Kalsi, Jagdip S; Auplish, Gita; Johnson, Adele R; Darbar, Ulpee R

    2012-01-01

    Alpha-mannosidosis is a rare genetic lysosomal storage disorder that is inherited in an autosomal recessive pattern. Severe periodontal breakdown in alpha-mannosidosis patients has not previously been reported in the literature. The purposes of this paper are to: present the cases of 2 siblings diagnosed with alpha-mannosidosis, each of whom had varying severity of periodontal destruction; and provide an overview of alpha-mannosidosis, the possible reasons for the periodontal destruction, and the periodontal management in the 2 affected siblings. Both had preventive and nonsurgical periodontal therapy followed by a 5-year period of supportive therapy. Their pattern of bone loss was consistent with those with periodontitis as a manifestation of systemic diseases, with the extent of periodontal destruction being related to the severity of the alpha-mannosidosis. Alpha-mannosidosis patients present with social disfigurements and, to prevent tooth loss that can add to this, early periodontal diagnosis is important to optimize management and intervention.

  13. Acute Calcific Tendinitis of the Rectus Femoris: A Case Series

    PubMed Central

    Kobayashi, Hideo; Kaneko, Haruka; Homma, Yasuhiro; Baba, Tomonori; Kaneko, Kazuo

    2015-01-01

    Introduction: Periarticular calcific tendinitis is a common cause of Orthopedic outpatient referral. Calcific tendinitis of the rectus femoris, however, is very rare and not well known. Due to its rarity, correct diagnosis and prompt treatment are not fully understood. Case Report: Two females (38 and 40 years old) of acute calcific tendinitis of the rectus femoris with the good clinical course without any operative treatment were presented. The pain was managed with oral non-steroidal antiinflammatory drugs and/or local steroid injection. Interval radiographic assessment showed complete resorption of the calcification. Conclusion: Establishing the correct diagnosis and initiating prompt treatment are shown to be important in achieving resolution of symptoms and in avoiding unnecessary investigations. PMID:27299063

  14. Primary hyperparathyroidism in pregnancy: a case series and literature review.

    PubMed

    Gokkaya, Naile; Gungor, Adem; Bilen, Arzu; Bilen, Habib; Gviniashvili, Darina; Karadeniz, Yusuf

    2016-10-01

    Primary Hyperparathyroidism (PHP) in pregnancy constitutes a serious danger to mother and fetus. The diagnosis of PHP in pregnancy presents a challenge, and PHP commonly goes unidentified and untreated in pregnancy. We present four case reports about patients having PHP, which is very rare condition in pregnancy and their treatment modalities. Three patients, not to be controlled biochemically, denied the parathyroidectomy operation although they are informed about the details of their disease. They are followed up with medical therapy. The first one had no maternal or fetal complications, the second one acquired nephrolithiasis crisis in the last trimester and the third one gave birth to a premature baby who succumbed to tetany. The fourth patient who underwent parathyroidectomy operation in the second trimester had no maternal or fetal complications. PHP in pregnancy is a preventable cause of fetal and maternal mortality and morbidity. Thus, suspecting from PHP during the pregnancy and early diagnosis is critically important in terms of maternal and fetal wellness.

  15. Surgical Treatment of Solitary Plasmocytoma of the Spine: Case Series

    PubMed Central

    Mendoza, Sergio; Urrutia, Julio; Fuentes, Dennis

    2004-01-01

    The mean survival of patients with skeletal solitary plasmocytoma is 75% at 5-year follow-up.2 This highly osteolytic tumor may compromise spinal stability. Radiotherapy is effective in local control of the disease, however, it is not effective in restoring spinal stability. Fracture risk and progressive vertebral collapse persist. For this reason, we must consider the need to establish the probability of progressive vertebral collapse, based on the degree of involvement of the vertebral body at the time of diagnosis. We used parameters described by Taneishi and Kaneda, as well as those of Heller and Boden to predict progressive vertebral collapse.4 Three cases are presented and their treatment is described. PMID:15296213

  16. Treatment of acute erythroleukemia with Azacitidine: A case series

    PubMed Central

    Pierdomenico, Francesca; Almeida, Antonio

    2013-01-01

    Acute erythroleukemia (AEL) is a rare form of acute myeloid leukemia (AML) often associated with a poor prognosis. It is more frequent in elderly patients, limiting the use aggressive therapies. Azacitidine is a hypomethylating agent with recognized efficacy in high risk myelodysplasia and AML in the elderly. Here we report 5 cases of AEL treated with Azacitidine. The cohort included 4 men and 1 woman, median age 70. One patient had been refractory to intensive chemotherapy, the others received Azacitidine as first line. Treatment was well tolerated. Four patients achieved transfusion independence. Two patients achieved complete remission and 1 achieved partial remission. After a median follow up time of 20 months, the median survival of the cohort was 20 months. Three patients died of disease progression. These results confirm the therapeutic value of Azacitidine in AEL. PMID:24371777

  17. Pseudohypoparathyroidism, an often delayed diagnosis: a case series

    PubMed Central

    Donghi, Valentina; Zamproni, Ilaria; Chiumello, Giuseppe; Weber, Giovanna

    2009-01-01

    Pseudohypoparathyroidism refers to a heterogeneous group of disorders characterized by parathyroid hormone (PTH) resistance. Pseudohypoparathyroidism is an uncommon sporadic or inherited genetic disorder subdivided into several distinct entities (type Ia, Ib, Ic, type II). We report cases of four children (aged 8 to 13 years) in the winter season 2007-'08. The present work highlights the variable mode of presentation of pseudohypoparathyroidism and the difficulty of an early diagnosis. We stress the importance of a complete biochemical investigation of the calcium-phosphate metabolism to recognize typical biochemical alterations associated with this condition (hypocalcaemia, hyperphosphataemia with increased phosphate tubular reabsorption and elevated PTH levels) in spite of a phenotypic aspect that often lacks the presence of all the peculiar clinical features of Albright hereditary osteodistrophy. PMID:19829854

  18. Pediatric non-Helicobacter pylori atrophic gastritis: a case series.

    PubMed

    Pogoriler, Jennifer; Kamin, Daniel; Goldsmith, Jeffrey D

    2015-06-01

    Although autoimmune atrophic gastritis is classically a disease of elderly adults, recent studies have described the disease in younger adults, particularly in those with other autoimmune diseases and iron-deficiency anemia. Atrophic gastritis in pediatrics is a rare and possibly underdiagnosed entity that has been primarily reported as single-case reports. This retrospective study of atrophic gastritis not associated with Helicobacter pylori infection was performed to further expand the knowledge of clinical presentation, pathologic findings, and natural history of this disease in the pediatric population. Twelve patients with a histologic diagnosis of atrophic gastritis were identified, with an age range of 8 months to 18 years. Seven had other autoimmune diseases and/or immunodeficiency. Atrophy was confined to the oxyntic mucosa in 10 patients, with intramucosal inflammation in a diffuse or basal-predominant pattern. Active inflammation was present in 7 patients. Pseudopyloric, intestinal, or squamous/mucinous metaplasia was seen at initial biopsy or on follow-up in 8 patients, and enterochromaffin-like cell hyperplasia was seen in 5. One patient developed an adenocarcinoma during the follow-up period of 10 years. Two false-negative diagnoses were retrospectively identified. In the majority of cases, the possibility of atrophic gastritis was not raised by the submitting physician, and the endoscopic findings were not specific. Therefore, accurate diagnosis requires a high degree of suspicion on the part of the pathologist, and the diagnosis should be considered particularly in patients with a clinical history of other autoimmune diseases or iron-deficiency anemia.

  19. Bcs-Bec Crossover Without Appeal to Scattering Length Theory

    NASA Astrophysics Data System (ADS)

    Malik, G. P.

    2014-01-01

    BCS-BEC (an acronym formed from Bardeen, Cooper, Schrieffer and Bose-Einstein condensation) crossover physics has customarily been addressed in the framework of the scattering length theory (SLT), which requires regularization/renormalization of equations involving infinities. This paper gives a frame by frame picture, as it were, of the crossover scenario without appealing to SLT. While we believe that the intuitive approach followed here will make the subject accessible to a wider readership, we also show that it sheds light on a feature that has not been under the purview of the customary approach: the role of the hole-hole scatterings vis-à-vis the electron-electron scatterings as one goes from the BCS to the BEC end. More importantly, we show that there are critical values of the concentration (n)and the interaction parameter (λ) at which the condensation of Cooper pairs takes place; this is a finding in contrast with the view that such pairs are automatically condensed.

  20. Caco-2 cells, biopharmaceutics classification system (BCS) and biowaiver.

    PubMed

    Smetanová, Libuse; Stĕtinová, Vĕra; Svoboda, Zbynek; Kvetina, Jaroslav

    2011-01-01

    Almost all orally administered drugs are absorbed across the intestinal mucosa. The Caco-2 monolayers are used as an in vitro model to predict drug absorption in humans and to explore mechanism of drug absorption. The Caco-2 cells are derived from a human colon adenocarcinoma and spontaneously differentiate to form confluent monolayer of polarized cells structurally and functionally resembling the small intestinal epithelium. For studying drug permeability, Caco-2 cells are seeded onto the Transwell inserts with semipermeable membrane and grown to late confluence (21 days). After determination of cell viability, the integrity of monolayer is checked by phenol red permeability and by 14C-mannitol permeability. The transport from apical to basolateral (AP-BL) and basolateral to apical (BL-AP) is studied by adding the diluted drug on the apical or basolateral side and withdrawing the samples from the opposite compartment, respectively, for HPLC analysis or liquid scintillation spectrometry. Ca2+ -free transport medium is used to determine paracellular component of the drug transport. On the basis of permeability and solubility, drugs can be categorized into four classes of Biopharmaceutics Classification System (BCS). For certain drugs, the BCS-based biowaiver approach can be used which enables to reduce in vivo bioequivalence studies.

  1. Nuclear pairing correlations within and beyond HFB-BCS models

    NASA Astrophysics Data System (ADS)

    Gambacurta, Danilo; Lacroix, Denis

    2015-02-01

    Pairing correlations in nuclear systems play a crucial role in several aspects, i.e. binding energies and odd-even effects, superfluid phenomena and pair transfer mechanisms, just to quote few of them. On the theoretical side, the standard description of these features is done by using BCS or HFB models which allow to describe in a simple way pairing effects. However, due to the explicit breaking of the particle number, these theories present some limitations which can be cured by using particle number projection techniques. In this paper, we will show the merits of these techniques and their accuracy in treating pairing correlations. First, a beyond BCS-HFB method is introduced where the effect of four quasi-particle states is included perturbatively and subsequently the particle number is restored. We will then show the need of restoring the good particle number also for excited states that are essential in the pair transfer process between superfluid systems. Applications to the Richardson model are shown and discussed.

  2. BcsA and BcsB form the catalytically active core of bacterial cellulose synthase sufficient for in vitro cellulose synthesis

    PubMed Central

    Omadjela, Okako; Narahari, Adishesh; Strumillo, Joanna; Mélida, Hugo; Mazur, Olga; Bulone, Vincent; Zimmer, Jochen

    2013-01-01

    Cellulose is a linear extracellular polysaccharide. It is synthesized by membrane-embedded glycosyltransferases that processively polymerize UDP-activated glucose. Polymer synthesis is coupled to membrane translocation through a channel formed by the cellulose synthase. Although eukaryotic cellulose synthases function in macromolecular complexes containing several different enzyme isoforms, prokaryotic synthases associate with additional subunits to bridge the periplasm and the outer membrane. In bacteria, cellulose synthesis and translocation is catalyzed by the inner membrane-associated bacterial cellulose synthase (Bcs)A and BcsB subunits. Similar to alginate and poly-β-1,6 N-acetylglucosamine, bacterial cellulose is implicated in the formation of sessile bacterial communities, termed biofilms, and its synthesis is likewise stimulated by cyclic-di-GMP. Biochemical studies of exopolysaccharide synthesis are hampered by difficulties in purifying and reconstituting functional enzymes. We demonstrate robust in vitro cellulose synthesis reconstituted from purified BcsA and BcsB proteins from Rhodobacter sphaeroides. Although BcsA is the catalytically active subunit, the membrane-anchored BcsB subunit is essential for catalysis. The purified BcsA-B complex produces cellulose chains of a degree of polymerization in the range 200–300. Catalytic activity critically depends on the presence of the allosteric activator cyclic-di-GMP, but is independent of lipid-linked reactants. Our data reveal feedback inhibition of cellulose synthase by UDP but not by the accumulating cellulose polymer and highlight the strict substrate specificity of cellulose synthase for UDP-glucose. A truncation analysis of BcsB localizes the region required for activity of BcsA within its C-terminal membrane-associated domain. The reconstituted reaction provides a foundation for the synthesis of biofilm exopolysaccharides, as well as its activation by cyclic-di-GMP. PMID:24127606

  3. Intestinal Infarction Through Arterial Vascular Obstruction - Case Series from 1st and 3rd Surgery Clinics Cluj-Napoca.

    PubMed

    Jeican, Ionuţ Isaia; Mocan, Mihaela; Gheban, Dan

    2016-01-01

    This article presents a case series of intestinal infarction through obstruction of superior mesenteric artery - two cases of acute mesenteric artery embolism, two cases of acute mesenteric artery thrombosis and a case of volvulus.

  4. Khat chewing and cirrhosis in Somaliland: Case series

    PubMed Central

    Mahamoud, Hawa D.; Muse, Sabah Mohammed; Roberts, Lewis R.; Torbenson, Michael S.; Fader, Tim

    2016-01-01

    Background Khat chewing is common especially among men in East Africa and Yemen. It is generally viewed by the populace as a benign social custom. Several studies of ethnic Somali immigrants to Western countries suggest an association between khat chewing and hepatotoxicity, but the risk of hepatotoxicity related to khat chewing within African settings is not documented. Aim To identify and describe liver disease without evidence of alcohol exposure or infectious etiology in khat chewers. Settings A university-affiliated teaching hospital in Somaliland. Methods Cases of cirrhosis of unknown cause were identified from the clinical practice of Al Hayatt Hospital in Borama, Somaliland, during 14 months beginning December 2012. Results Eight Somali men aged 27–70 years living in Somaliland were identified with cirrhosis of otherwise unknown cause. All chewed khat habitually for many years (15–128 bundles per day times years of use). A liver biopsy of one man was consistent with khat hepatotoxicity. Four of the eight men died during the study period. Conclusion Khat chewing may be associated with health consequences including severe hepatotoxicity with cirrhosis. PMID:27543281

  5. Patients with Acromegaly Presenting with Colon Cancer: A Case Series

    PubMed Central

    Nakhle, Samer; Ludlam, William H.

    2016-01-01

    Introduction. Frequent colonoscopy screenings are critical for early diagnosis of colon cancer in patients with acromegaly. Case Presentations. We performed a retrospective analysis of the incidental diagnoses of colon cancer from the ACCESS trial (ClinicalTrials.gov identifier: NCT01995734). Colon cancer was identified in 2 patients (4.5%). Case  1 patient was a 36-year-old male with acromegaly who underwent transsphenoidal surgery to remove the pituitary adenoma. After surgery, the patient underwent routine colonoscopy screening, which revealed a 40 mm tubular adenoma in the descending colon. A T1N1a carcinoma was surgically removed, and 1 of 22 lymph nodes was positive for metastatic disease, leading to a diagnosis of stage 3 colon cancer. Case  2 patient was a 50-year-old male with acromegaly who underwent transsphenoidal surgery to remove a 2 cm pituitary adenoma. The patient reported severe cramping and lower abdominal pain, and an invasive 8.1 cm3 grade 2 adenocarcinoma with signet rings was identified in the ascending colon and removed. Of the 37 lymph nodes, 34 were positive for the presence of tumor cells, and stage 3c colon cancer was confirmed. Conclusion. Current guidelines for colonoscopy screening at the time of diagnosis of acromegaly and at appropriate follow-up intervals should be followed. PMID:28025627

  6. [Drug allergy assessed by modified Shelley's test. A case series].

    PubMed

    Mora Nieto, Alejandra; Segura Méndez, Nora Hilda; Almeida Arvizu, Victor; Díaz Torres, Maria Teresa; Martínez Pérez, Teresa

    2006-01-01

    The frequency of allergy to drugs is 5-10% in the general population, The Shelley's test is a method in vitro for its diagnosis and it is considered positive when it is equal o greater than 20%. To show the allergy to drugs frequency evaluated by the Shelley's Modified Test. We included 165 patients with clinical diagnosis of allergy to drugs to those who the test of Shelley's was applied modified test for one or several medicines. The study was made in the period of January 1st to December 3st 2002. 88% (145 patients) were positive, and 12% (20 patients) were negative in correlation with clinical findings. The female was more determinant (2:1 relation), with an average age of 45 years. The drugs that caused reactions of allergy in were the antibiotics (sulfas, penicillin, quinolones), analgesic (ASA, naproxen, diclofenac), antihypertensive (enalapril, captopril, verapamil) and others with 95, 170, 48 and 97 cases respectively. The most frequent clinical features were urticaria, angioedema, anaphylactic shock and erythema. The Shelley's test is useful to support the diagnosis of allergy to drugs, although does not exclude it. The antibiotics intake is the most common cause and the most common clinical manifestation was urticaria.

  7. Cognitive behavior therapy for stuttering: a case series.

    PubMed

    Reddy, R P; Sharma, M P; Shivashankar, N

    2010-01-01

    The present investigation was aimed at studying the efficacy of cognitive behavior therapy (CBT) in reducing the symptoms of stuttering and dysfunctional cognitions and in enhancing assertiveness and quality of life in clients with stuttering. Five clients with stuttering who met the inclusion criteria (male clients with diagnosis of stuttering) and exclusion criteria (clients with brian damage), substance abuse or mental retardation were enrolled for the study. A single-case design was adopted. The pre-, mid- and post-assessment were carried out using Stuttering Severity Scale (SSI), Perception of Stuttering Inventory (PSI), Beck's Anxiety Inventory (BAI), Dysfunctional Attitude (DAS), Fear of Negative Evaluation (FNE), Assertiveness Scale (AS), Rosenberg's Self-Esteem Scale (RSES), and World Health Organization - Quality of Life Scale (WHO-QOL). Five clients received cognitive behavioral intervention comprising of psycho-education, relaxation, deep breathing, humming, prolongation, cognitive restructuring, problem-solving strategies and assertiveness. At post-treatment assessment, there was improvement. The findings of the study are discussed in the light of available research work, implications, limitations of the study and suggestions for future research.

  8. Suicide attempt by hanging in preadolescent children: a case series.

    PubMed

    Omigbodun, O O; Adejumo, O A; Babalola, O O

    2008-10-01

    Suicide is now among the five top causes of death in youth worldwide. However, during the preadolescent period, suicidal behaviour is rare and difficult to define because the cognitive level of young children limits their ability to plan and understand the consequences or the finality of suicide. There is virtually no information about preadolescent suicidal behaviour in Nigeria. To illustrate the presentation and psychosocial issues associated with preadolescent suicidal attempt using the 'hanging' method in Nigeria. Three case scenarios of suicide attempt by hanging in preadolescents seen at the University College Hospital, Ibadan between 2005 and 2006 were interviewed in detail along with mental state and physical examination. Family and individual therapies were embarked upon. Types of psychopathology found in the preadolescents include depressive symptoms, conduct and oppositional defiant disorder and impulse control problems. Stressful life events such as family disruption, physical abuse, and bullying at school were factors associated with suicidal behaviour. The influence of the media in providing information about 'hanging' as a method of suicide was evident. Therapy yield varying results. High risk parameters for suicide in children should be known to all health professionals. The importance of intervention strategies particularly media education, monitoring systems and further research on suicidal behaviour in this environment is apparent.

  9. Delusional infestations: case series, differential diagnoses, and management strategies.

    PubMed

    Diaz, James H; Nesbitt, Lee T

    2014-01-01

    Physicians are not infrequently consulted by distraught patients with delusions of infestation who believe that they are infested with external or internal parasites and describe a crawling sensation of bugs or worms on or under their skin. Internet search engines were queried with the keywords as search terms to examine the latest articles on delusional infestations in order to describe presenting manifestations, differential diagnoses, and effective management strategies. The demographic and behavioral features of delusional infestations have remained constant and include: (1) onset in well-educated, middle-aged adults who are pet owners; (2) production of purported specimens of causative parasites; (3) pesticide overtreatment of themselves, their households, and pets; (4) excessive cleaning or vacuuming of households; (5) intense anger and resentment directed at physicians failing to confirm their self-diagnoses; and (6) sharing delusional symptoms with spouses or relatives. Although some reports have suggested that cases of delusional infestation are increasing today in the tropics, most studies have confirmed a stable incidence over time and similar disorder demographics worldwide. However, management strategies for delusional infestations have changed significantly over time with second generation, atypical antipsychotics offering safer adverse effect profiles and better prognoses than earlier therapies with first generation, typical antipsychotics. The most effective management strategies for delusional infestations include empathetic history-taking and active listening to the patient, careful exclusion of true parasitoses, and a therapeutic regimen that includes a second generation neuroleptic agent.

  10. Delayed recurrence of acute retinal necrosis (ARN): A case series.

    PubMed

    Donovan, Christopher P; Levison, Ashleigh L; Lowder, Careen Y; Martin, Daniel F; Srivastava, Sunil K

    2016-07-01

    To report five cases of acute retinal necrosis (ARN) that reactivated in the same eye or presented in the contralateral eye between two and nineteen years after the initial episode of acute retinal necrosis. Five patients with a previous history of ARN developed recurrent ARN infection following a lengthy latency period. In all five patients who initially presented with unilateral disease, four developed infection in the contralateral eye and one developed recurrent infection in the ipsilateral eye. Latency periods ranged from two to nineteen years, and final visual acuity in the affected eyes ranged from 20/30 to no light perception. Each patient was treated with antiviral medication for both the initial infection and for subsequent reactivations, but was not on long-term prophylaxis at the time of recurrent disease. Although rare, delayed onset reactivation of ARN can occur in either the same eye or contralateral eye despite adequate treatment. While contralateral spread of initial infection is fairly common, these reactivations rarely occur more than six weeks after initial infection. Currently there are no guidelines for use of prophylactic antiviral medication to prevent late recurrence of ARN. Copyright © 2016. Published by Elsevier B.V.

  11. AUTOLOGOUS CHONDROCYTE TRANSPLANTATION-SERIES OF 3 CASES

    PubMed Central

    Gobbi, Riccardo Gomes; Demange, Marco Kawamura; Barreto, Ronald Bispo; Pécora, José Ricardo; Rezende, Múrcia Uchõa de; Filho, Tarcisio E.P Barros; Lombello, Christiane Bertachini

    2015-01-01

    Hyaline cartilage covers joint surfaces and plays an important role in reducing friction and mechanical loading on synovial joints such as the knee. This tissue is not supplied with blood vessels, nerves or lymphatic circulation, which may be one of the reasons why joint cartilage has such poor capacity for healing. Chondral lesions that reach the subchondral bone (osteochondral lesions) do not heal and may progress to arthrosis with the passage of time. In young patients, treatment of chondral defects of the knee is still a challenge, especially in lesions larger than 4 cm. One option for treating these patients is autologous chondrocyte transplantation/implantation. Because this treatment does not violate the subchondral bone and repairs the defect with tissue similar to hyaline cartilage, it has the theoretical advantage of being more biological, and mechanically superior, compared with other techniques. In this paper, we describe our experience with autologous chondrocyte transplantation/implantation at the Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of Sâo Paulo, through a report on three cases. PMID:27022579

  12. Lassa fever presenting as acute abdomen: a case series.

    PubMed

    Dongo, Andrew E; Kesieme, Emeka B; Iyamu, Christopher E; Okokhere, Peter O; Akhuemokhan, Odigie C; Akpede, George O

    2013-04-19

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission.

  13. Cognitive Behavior Therapy for Stuttering: A Case Series

    PubMed Central

    Reddy, R. P.; Sharma, M. P.; Shivashankar, N.

    2010-01-01

    The present investigation was aimed at studying the efficacy of cognitive behavior therapy (CBT) in reducing the symptoms of stuttering and dysfunctional cognitions and in enhancing assertiveness and quality of life in clients with stuttering. Five clients with stuttering who met the inclusion criteria (male clients with diagnosis of stuttering) and exclusion criteria (clients with brian damage), substance abuse or mental retardation were enrolled for the study. A single-case design was adopted. The pre-, mid- and post-assessment were carried out using Stuttering Severity Scale (SSI), Perception of Stuttering Inventory (PSI), Beck's Anxiety Inventory (BAI), Dysfunctional Attitude (DAS), Fear of Negative Evaluation (FNE), Assertiveness Scale (AS), Rosenberg's Self-Esteem Scale (RSES), and World Health Organization - Quality of Life Scale (WHO-QOL). Five clients received cognitive behavioral intervention comprising of psycho-education, relaxation, deep breathing, humming, prolongation, cognitive restructuring, problem-solving strategies and assertiveness. At post-treatment assessment, there was improvement. The findings of the study are discussed in the light of available research work, implications, limitations of the study and suggestions for future research. PMID:21799560

  14. Kluyvera ascorbata infections in children: a case series

    PubMed Central

    Öncel, Eda Karadağ; Özsürekci, Yasemin; Akyön, Yakut; Gür, Deniz; Cengiz, Ali Bülent; Kara, Ateş

    2015-01-01

    Kluyvera is a relatively newly described member of the Enterobacteriaceae family that rarely causes infections in humans. In the pediatric population, it is described in association with clinically significant infections ranging from urinary tract infections to sepsis with multiorgan failure. Our aim is to determine the clinical significance of K. ascorbata infections in the pediatric population at our institution. We retrospectively analyzed clinical microbiology data as from 2006 and identified four clinically significant isolates in this period. The isolates were from four cases who presented with sepsis, bacteremia associated with central venous catheter, pyelonephritis and intraabdominal collection. The ages of these patients ranged between seven months to 17 years. All patients received prompt antimicrobial treatment on the basis of susceptibility testing and good clinical response was obtained in all patients. Successful treatment options include third-generation cephalosporins, aminoglycosides, betalactams with beta-lactamase inhibitors and carbapenems. Clinicians should be aware of the spectrum of disease and increasing clinical importance associated with this pathogen. PMID:26265898

  15. Hydrogel-impregnated dressings for graft fixation: a case series.

    PubMed

    Choi, J-S; Lee, J-H; Kim, S-M; Kim, Y-J; Choi, J-Y; Jun, Y-J

    2015-07-01

    Infection is the second most common cause of graft loss after skin grafting. Cutimed Sorbact is a range of dressings coated with a hydrophobic fatty acid that irreversibly binds to the bacterial surface and mechanically removes bacteria from the wound. The dressing is a hydrogel-impregnated material, which prevents wounds from drying. Here, we report on cases in which we used the gel instead of the widely used petrolatum gauze or paraffin gauze in a tie-over dressing for the fixation of grafted skin. Patients treated for skin grafting between March 2013 and July 2013 were treated with the hydrogel-impregnated dressings and a tie over dressing. The wounds were opened five days after treatment. In total seven patients were treated with an age range of 23-86 years old. No infections were seen and the method was effective regardless of wound size, the thickness of the skin harvested and condition of the defect. Using this hydrogel-impregnated dressings, provide antibacterial and moisturising effects simultaneously, which a petrolatum or paraffin gauze cannot provide. There were no external sources of funding for this study. The authors have no conflicts of interest to declare.

  16. Driving under the influence of synthetic phenethylamines: a case series.

    PubMed

    Maas, Alexandra; Wippich, Cornelia; Madea, Burkhard; Hess, Cornelius

    2015-09-01

    New psychoactive drugs, so-called legal highs, have gained more and more popularity during the last years. One of the most important groups of these legal high substances are the synthetic phenethylamines that share a common phenethylamine moiety. Based on certain structural characteristics, these synthetic phenethylamines can be divided into further subclasses, among which the synthetic cathinones ('bath salts') are particularly noteworthy. Synthetic cathinones are characterized by an additional carbonyl group attached at the beta position on the amino alkyl chain. Consumption of synthetic phenethylamines can lead to impairments similar to those observed after the use of, for instance, amphetamine or 3,4-methylenedioxy-N-methylamphetamine (MDMA, 'ecstasy'). These impairments include diverse neurological and psychological symptoms which can affect a safe driving behaviour. Although several reports on clinical symptoms and poisonings due to these substances have been published, most of these publications do not contain any analytical data. Additionally, there is still a lack of information concerning pharmacological and toxicological effects of these rather new psychoactive substances. In particular, the knowledge of the impact on the ability to drive following consumption of synthetic phenethylamines is relevant for the police as well as for forensic toxicologists. In this publication, several cases of individuals driving under the influence (DUI) of synthetic phenethylamines (4-fluoroamphetamine, mephedrone (4-methylmethcathinone, 4-MMC), 2-DPMP (desoxypipradol), methylenedioxypyrovalerone (MDPV), benzedrone, N-ethylamphetamine (etilamfetamine), 3-methylmethcathinone (3-MMC)) are presented, focusing on analytical results and signs of impairment.

  17. Severe burns due to biofuel heater injury: A case series.

    PubMed

    Heald, Alicia; Muller, Michael

    2016-03-01

    Biofuel heaters are a new form of flame heating for indoor and outdoor use. Fuelled by methylated spirits, they are simple structures with few safety features, and can be associated with severe burn. We report five cases of severe burns in adults that occurred when refilling these heaters. We undertook a retrospective audit of all adults presenting to the Royal Brisbane and Women's Hospital (RBWH) with a biofuel heater-related burn between 20 and 30th June 2014. Five patients required admission for management of their burns. Three were admitted to ICU for greater than 3 weeks, and remained inpatients for up to 78 days. Two did not require ICU and were managed in the burns unit. Average total body surface area (TBSA) burned was 24.7%, and patients went to theatre up to seven times for debridement and skin grafting. Average length of stay was 41.8 days. Biofuel heaters are easily accessible yet there is no Australian Standard to ensure they are safe or perform in the way they were intended. As such, people using them are at undue risk of severe burn, even when following the operating instructions. These products should be removed from the market to prevent further harm and potential mortality. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  18. Lassa fever presenting as acute abdomen: a case series

    PubMed Central

    2013-01-01

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission. PMID:23597024

  19. Transverse sacral fractures: case series and literature review

    PubMed Central

    Kim, Miriam Y.; Reidy, Declan P.; Nolan, Paul C.; Finkelstein, Joel A.

    2001-01-01

    Objectives To report experience with transverse sacral fracture, an uncommon injury frequently associated with neurologic deficit, and to perform a meta-analysis of the literature in order to define the role of decompression for the management of sacral fractures. Design A review of 7 cases. Setting A university-affiliated tertiary care centre. Patients Seven patients with transverse fractures of the sacrum. The mean follow-up was 13 months. Interventions A review of the clinical data and a search of the literature for studies that reported on 4 or more patients with a transverse sacral fracture. Main outcome measures Mechanism of injury, type of neurologic deficit and its management. Results The most common mechanism in the 7 study patients was a fall from a height. Six patients had neurologic deficits, mostly in the form of bowel or bladder disturbance. Five of these were treated with surgical decompression, and 4 of them had an improvement in neurologic function. The 7 original studies from the literature dealt with a total of 55 patients. As in the study patients, falls from a height and motor vehicle accidents predominated as the mechanisms of injury. In contrast to patients in this study, 20 of 48 patients in the literature review with neurologic deficits were treated conservatively. Conclusions The outcomes in this study are similar to those reported in the literature. The place of surgical decompression for patients with neurologic deficit cannot be clearly determined from the evidence currently available. PMID:11603749

  20. A systematic review protocol for reporting deficiencies within surgical case series

    PubMed Central

    Agha, Riaz; Fowler, Alexander J; Lee, Seon-Young; Gundogan, Buket; Whitehurst, Katharine; Sagoo, Hakiran; Jeong, Kyung Jin Lee; Altman, Douglas G; Orgill, Dennis P

    2015-01-01

    Introduction Case series are an important and common study type in surgical literature. There is evidence that key data are excluded from published case series, and currently no reporting guideline exists for case series. There is, therefore, the potential to change practices and improve the reporting of case series. Reporting guidelines have been shown to be efficacious in raising the bar for reporting quality. We present our protocol for the first stage of guideline development—a systematic review of previously identified deficiencies in how surgical case series are reported. Methods and analysis Electronic searches will be conducted on MEDLINE, EMBASE, Cochrane Methods Register, Science Citation Index and Conference Proceedings Citation Index, from the start of indexing until 5 November 2014. The electronic search strategy was developed with an information specialist. Two independent researchers will identify articles for inclusion, specifically those that describe reporting deficiencies within surgical case series. Data will be extracted to specifically focus on the deficiencies of reporting. These will be categorised according to their type, and other identified issues will also be presented. Data will be presented with descriptive statistics to determine frequently missing types of data, and the commonest reporting issues tabulated. Ethics and dissemination The authors hope to disseminate the findings as widely as possible, irrespective of results, as these will add to the wider corpora of information on this subject. The systematic review will be published in a peer-reviewed journal and will be presented at a wide range of national and international conferences. Ultimately, this will inform a Delphi process for the development of a surgical case series reporting guideline. Protocol registration CRD42015016145. PMID:26438134

  1. Synthetic Cannabinoid Abuse in Adolescents: A Case Series.

    PubMed

    Besli, Gulser Esen; Ikiz, Mehmet Alper; Yildirim, Sema; Saltik, Selcuk

    2015-11-01

    Synthetic cannabinoids, referred to as "Bonzai" in Turkey, are relatively new recreational drugs of abuse. Although the use of synthetic cannabinoids has been dramatically increasing in young populations in many countries, their adverse effects are not well known. To report on the clinical features and social history of pediatric patients with a diagnosis of synthetic cannabinoid intoxication and to highlight the dangers of these drugs to public health. We retrospectively reviewed 16 cases presenting to our Emergency Department (ED) with synthetic cannabinoid intoxication in the last 10 months. Usage characteristics and the psychoactive, physical, and metabolic effects of synthetic cannabinoids were analyzed. The mean age of the 16 patients with a diagnosis of synthetic cannabinoid intoxication was 15.4 ± 1.7 years (15 males, 1 female). The most common physical symptoms were eye redness, nausea/vomiting, sweating, and altered mental status; the main psychoactive findings were agitation, anxiety, hallucinations, and perceptual changes. We observed hypotension and bradycardia in 8 (50%) and 5 (31.3%) of the patients, respectively. Although most patients were discharged from the ED, 25% were transferred to an intensive care unit. They all had reduced school attendance and performance. The rates of cigarette smoking and alcohol drinking were also significantly higher. Synthetic cannabinoids are unsafe and potentially harmful drugs of abuse; they may even cause life-threatening effects. It is important for pediatricians to be familiar with the signs and symptoms of consumption of synthetic cannabinoid products. Education of parents, teachers, and adolescents about the potential health risks of using these products is essential. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. A Case Series: Evaluation of the Metabolic Safety of Aripiprazole

    PubMed Central

    De Hert, Marc; Hanssens, Linda; van Winkel, Ruud; Wampers, Martien; Van Eyck, Dominique; Scheen, Andre; Peuskens, Joseph

    2007-01-01

    Metabolic abnormalities occur frequently in patients treated with antipsychotics and are of growing concern to clinicians. This study sought to determine whether antipsychotic-associated metabolic abnormalities identified through intensive monitoring can be reversed by switching to aripiprazole. Recent evidence suggests that aripiprazole may exhibit a favorable metabolic safety profile. The study population is a subset of a large (n > 500) ongoing prospective cohort. Thirty-one consecutive patients with schizophrenia who were started on aripiprazole were included in the study. All patients underwent an extensive metabolic evaluation, including an oral glucose tolerance test, at baseline, at 6 weeks, and at 3 months post switch. Metabolic abnormalities were defined as any of the following: new onset diabetes, impaired fasting glucose, impaired glucose tolerance, metabolic syndrome (MetS) according to various definitions, and dyslipidemia. After 3 months of treatment with aripiprazole (mean daily dose 16.3 mg), there was a significant decrease in body weight, body mass index, and waist circumference. There was a significant reduction in fasting glucose, fasting insulin, insulin resistance index, and serum lipids levels (cholesterol, triglycerides, low-density lipoprotein (LDL), LDL/HDL, Chol/HDL, and non-HDL cholesterol). There was also a significant reduction in prolactin levels. All 7 cases of recent onset diabetes were reversed at 3 months follow-up. The MetS was reversed in 50% of patients at 3 months follow-up. Our results support the reversibility of recent onset diabetes on antipsychotic medication when detected early and followed by a switch to aripiprazole. PMID:16940338

  3. A case series: evaluation of the metabolic safety of aripiprazole.

    PubMed

    De Hert, Marc; Hanssens, Linda; van Winkel, Ruud; Wampers, Martien; Van Eyck, Dominique; Scheen, Andre; Peuskens, Joseph

    2007-05-01

    Metabolic abnormalities occur frequently in patients treated with antipsychotics and are of growing concern to clinicians. This study sought to determine whether antipsychotic-associated metabolic abnormalities identified through intensive monitoring can be reversed by switching to aripiprazole. Recent evidence suggests that aripiprazole may exhibit a favorable metabolic safety profile. The study population is a subset of a large (n > 500) ongoing prospective cohort. Thirty-one consecutive patients with schizophrenia who were started on aripiprazole were included in the study. All patients underwent an extensive metabolic evaluation, including an oral glucose tolerance test, at baseline, at 6 weeks, and at 3 months post switch. Metabolic abnormalities were defined as any of the following: new onset diabetes, impaired fasting glucose, impaired glucose tolerance, metabolic syndrome (MetS) according to various definitions, and dyslipidemia. After 3 months of treatment with aripiprazole (mean daily dose 16.3 mg), there was a significant decrease in body weight, body mass index, and waist circumference. There was a significant reduction in fasting glucose, fasting insulin, insulin resistance index, and serum lipids levels (cholesterol, triglycerides, low-density lipoprotein (LDL), LDL/HDL, Chol/HDL, and non-HDL cholesterol). There was also a significant reduction in prolactin levels. All 7 cases of recent onset diabetes were reversed at 3 months follow-up. The MetS was reversed in 50% of patients at 3 months follow-up. Our results support the reversibility of recent onset diabetes on antipsychotic medication when detected early and followed by a switch to aripiprazole.

  4. The biowaiver extension for BCS class III drugs: the effect of dissolution rate on the bioequivalence of BCS class III immediate-release drugs predicted by computer simulation.

    PubMed

    Tsume, Yasuhiro; Amidon, Gordon L

    2010-08-02

    The Biopharmaceutical Classification System (BCS) guidance issued by the FDA allows waivers for in vivo bioavailability and bioequivalence studies for immediate-release (IR) solid oral dosage forms only for BCS class I drugs. However, a number of drugs within BCS class III have been proposed to be eligible for biowaivers. The World Health Organization (WHO) has shortened the requisite dissolution time of BCS class III drugs on their Essential Medicine List (EML) from 30 to 15 min for extended biowaivers; however, the impact of the shorter dissolution time on AUC(0-inf) and C(max) is unknown. The objectives of this investigation were to assess the ability of gastrointestinal simulation software to predict the oral absorption of the BCS class I drugs propranolol and metoprolol and the BCS class III drugs cimetidine, atenolol, and amoxicillin, and to perform in silico bioequivalence studies to assess the feasibility of extending biowaivers to BCS class III drugs. The drug absorption from the gastrointestinal tract was predicted using physicochemical and pharmacokinetic properties of test drugs provided by GastroPlus (version 6.0). Virtual trials with a 200 mL dose volume at different drug release rates (T(85%) = 15 to 180 min) were performed to predict the oral absorption (C(max) and AUC(0-inf)) of the above drugs. Both BCS class I drugs satisfied bioequivalence with regard to the release rates up to 120 min. The results with BCS class III drugs demonstrated bioequivalence using the prolonged release rate, T(85%) = 45 or 60 min, indicating that the dissolution standard for bioequivalence is dependent on the intestinal membrane permeability and permeability profile throughout the gastrointestinal tract. The results of GastroPlus simulations indicate that the dissolution rate of BCS class III drugs could be prolonged to the point where dissolution, rather than permeability, would control the overall absorption. For BCS class III drugs with intestinal absorption patterns

  5. Obsessive Compulsive Disorder Treatment in Patients with Down Syndrome: A Case Series

    ERIC Educational Resources Information Center

    Sutor, Bruce; Hansen, Mark R.; Black, John L.

    2006-01-01

    In this case series we report four cases of patients with Down syndrome with symptoms consistent with obsessive compulsive disorder. Each patient experienced substantial reduction in compulsive behaviors with pharmacotherapy of an SSRI alone or with the addition of risperidone to SSRI therapy. None of the patients experienced significant side…

  6. Obsessive Compulsive Disorder Treatment in Patients with Down Syndrome: A Case Series

    ERIC Educational Resources Information Center

    Sutor, Bruce; Hansen, Mark R.; Black, John L.

    2006-01-01

    In this case series we report four cases of patients with Down syndrome with symptoms consistent with obsessive compulsive disorder. Each patient experienced substantial reduction in compulsive behaviors with pharmacotherapy of an SSRI alone or with the addition of risperidone to SSRI therapy. None of the patients experienced significant side…

  7. Point-of-Care Ultrasonography for the Rapid Diagnosis of Intussusception: A Case Series.

    PubMed

    Doniger, Stephanie J; Salmon, Margaret; Lewiss, Resa E

    2016-05-01

    We present a case series describing an infant and a child who presented with abdominal discomfort and their conditions were diagnosed with intussusception by point-of-care ultrasound. These cases illustrate how point-of-care ultrasound led to the expeditious diagnosis of intussusception.

  8. Intensive (Daily) Behavior Therapy for School Refusal: A Multiple Baseline Case Series

    ERIC Educational Resources Information Center

    Tolin, David F.; Whiting, Sara; Maltby, Nicholas; Diefenbach, Gretchen J.; Lothstein, Mary Anne; Hardcastle, Surrey; Catalano, Amy; Gray, Krista

    2009-01-01

    The following multiple baseline case series examines school refusal behavior in 4 male adolescents. School refusal symptom presentation was ascertained utilizing a functional analysis from the School Refusal Assessment Scale (Kearney, 2002). For the majority of cases, treatment was conducted within a 15-session intensive format over a 3-week…

  9. Evolution of the vortex state in the BCS-BEC crossover of a quasi two-dimensional superfluid Fermi gas

    NASA Astrophysics Data System (ADS)

    Luo, Xuebing; Zhou, Kezhao; Zhang, Zhidong

    2016-11-01

    We use the path-integral formalism to investigate the vortex properties of a quasi-two dimensional (2D) Fermi superfluid system trapped in an optical lattice potential. Within the framework of mean-field theory, the cooper pair density, the atom number density, and the vortex core size are calculated from weakly interacting BCS regime to strongly coupled while weakly interacting BEC regime. Numerical results show that the atoms gradually penetrate into the vortex core as the system evolves from BEC to BCS regime. Meanwhile, the presence of the optical lattice allows us to analyze the vortex properties in the crossover from three-dimensional (3D) to 2D case. Furthermore, using a simple re-normalization procedure, we find that the two-body bound state exists only when the interaction is stronger than a critical one denoted by G c which is obtained as a function of the lattice potential’s parameter. Finally, we investigate the vortex core size and find that it grows with increasing interaction strength. In particular, by analyzing the behavior of the vortex core size in both BCS and BEC regimes, we find that the vortex core size behaves quite differently for positive and negative chemical potentials. Project supported by the National Natural Science Foundation of China (Grant Nos. 51331006, 51590883, and 11204321) and the Project of Chinese Academy of Sciences (Grant No. KJZD-EW-M05-3).

  10. Types of case series--the anatomically based approach: commentary on M. F. Schwartz & G. S. Dell: case series investigations in cognitive neuropsychology.

    PubMed

    Shallice, Tim; Buiatti, Tania

    2011-10-01

    The paper addresses a weakness in the Schwartz and Dell paper (2010)-namely, its discussion of the inclusion criteria for case series. The paper distinguishes the different types that exist and how they constrain the theoretical conclusions that one can draw about the organization of the normal cognitive system. Four different types of inclusion criteria are considered. Two are those treated by Schwartz and Dell-namely, theoretically derived clinical criteria, such as the example of semantic dementia, and broad clinical criteria such as the presence of aphasia. In addition, in the present paper two different types of anatomically based criteria are assessed-those using anatomical regions selected a priori and also regions selected as a result of an anatomical group study analysis. Putative functional syndromes are argued to be the empirical building blocks for cognitive neuropsychology. Anatomically based case series can aid in their construction or in their fractionation.

  11. Masseteric-facial nerve neurorrhaphy: results of a case series.

    PubMed

    Biglioli, Federico; Colombo, Valeria; Rabbiosi, Dimitri; Tarabbia, Filippo; Giovanditto, Federica; Lozza, Alessandro; Cupello, Silvia; Mortini, Pietro

    2017-01-01

    OBJECTIVE Facial palsy is a well-known functional and esthetic problem that bothers most patients and affects their social relationships. When the time between the onset of paralysis and patient presentation is less than 18 months and the proximal stump of the injured facial nerve is not available, another nerve must be anastomosed to the facial nerve to reactivate its function. The masseteric nerve has recently gained popularity over the classic hypoglossus nerve as a new motor source because of its lower associated morbidity rate and the relative ease with which the patient can activate it. The aim of this work was to evaluate the effectiveness of masseteric-facial nerve neurorrhaphy for early facial reanimation. METHODS Thirty-four consecutive patients (21 females, 13 males) with early unilateral facial paralysis underwent masseteric-facial nerve neurorrhaphy in which an interpositional nerve graft of the great auricular or sural nerve was placed. The time between the onset of paralysis and surgery ranged from 2 to 18 months (mean 13.3 months). Electromyography revealed mimetic muscle fibrillations in all the patients. Before surgery, all patients had House-Brackmann Grade VI facial nerve dysfunction. Twelve months after the onset of postoperative facial nerve reactivation, each patient underwent a clinical examination using the modified House-Brackmann grading scale as a guide. RESULTS Overall, 91.2% of the patients experienced facial nerve function reactivation. Facial recovery began within 2-12 months (mean 6.3 months) with the restoration of facial symmetry at rest. According to the modified House-Brackmann grading scale, 5.9% of the patients had Grade I function, 61.8% Grade II, 20.6% Grade III, 2.9% Grade V, and 8.8% Grade VI. The morbidity rate was low; none of the patients could feel the loss of masseteric nerve function. There were only a few complications, including 1 case of postoperative bleeding (2.9%) and 2 local infections (5.9%), and a few

  12. Morgellons disease, illuminating an undefined illness: a case series

    PubMed Central

    2009-01-01

    Introduction This review of 25 consecutive patients with Morgellons disease (MD) was undertaken for two primary and extremely fundamental reasons. For semantic accuracy, there is only one "proven" MD patient: the child first given that label. The remainder of inclusive individuals adopted the label based on related descriptions from 1544 through 1884, an internet description quoted from Sir Thomas Browne (1674), or was given the label by practitioners using similar sources. Until now, there has been no formal characterization of MD from detailed examination of all body systems. Our second purpose was to differentiate MD from Delusions of Parasitosis (DP), another "informal" label that fit most of our MD patients. How we defined and how we treated these patients depended literally on factual data that would determine outcome. How they were labeled in one sense was irrelevant, except for the confusing conflict rampant in the medical community, possibly significantly skewing treatment outcomes. Case presentation Clinical information was collected from 25 of 30 consecutive self-defined patients with Morgellons disease consisting of laboratory data, medical history and physical examination findings. Abnormalities were quantified and grouped by system, then compared and summarized, but the numbers were too small for more complex mathematical analysis. The quantification of physical and laboratory abnormalities allowed at least the creation of a practical clinical boundary, separating probable Morgellons from non-Morgellons patients. All the 25 patients studied meet the most commonly used DP definitions. Conclusions These data suggest Morgellons disease can be characterized as a physical human illness with an often-related delusional component in adults. All medical histories support that behavioral aberrancies onset only after physical symptoms. The identified abnormalities include both immune deficiency and chronic inflammatory markers that correlate strongly with

  13. More is Different:. 50 Years of Nuclear BCS

    NASA Astrophysics Data System (ADS)

    Broglia, R. A.

    2013-01-01

    At the basis of BCS theory, and associated symmetry breaking phenomena in gauge space, one finds Cooper pair binding. A major question in the nuclear case concerning this issue, regards the relative role played by the bare nucleon-nucleon force and by the interaction induced by the exchange of vibrations between members of Cooper pairs. The exotic nucleus 113Li8 in which two neutrons forming an extended halo, bind weakly to the 9Li core, provides an excellent testing ground to try to shed light on this issue. Theory finds that, in this case, the exchange of collective vibrations associated with the core and with the halo fields, provides an important fraction of the glue binding the pair. Inverse kinematics and active detector based experiments, combined with a quantitative description (based on absolute differential cross sections) of single Cooper pair tunneling, the specific probe of pairing in nuclei, which forces the virtual phonon into a real final state, have tested these predictions with positive results. The extension of structure and reaction studies to open shell (superfluid) nuclei (Sn-isotopes), displaying a strong alignment of quasispin in gauge space, and associated domain wall, as testified by pairing rotational bands excited in terms of single Cooper pair tunneling, provides an overall description of the data within experimental errors. This is also true in connection with pairing vibrations as observed in closed shell nuclei. Many of the concepts which are at the basis of the development associated with a quantitative treatment of the variety of phenomena associated with the spontaneous breaking of gauge symmetry in nuclei have been instrumental in connection with novel studies of soft matter, namely of protein evolution and protein folding. Although the route to these subjects and associated development does not necessarily imply the nuclear physics connection, such a connection has proven qualitatively and quantitatively inspiring. In particular

  14. Congenital Malformations of the Inner Ear: Case Series and Review of the Literature.

    PubMed

    Piromchai, Patorn; Kasemsiri, Pornthep; Thanawirattananit, Panida; Yimtae, Kwanchanok

    2015-08-01

    Patients with craniofacial anomalies often present to doctors due to their noticeable disfigurement and are routinely assessed by otolaryngologists for hearing evaluation. However, small percentage of craniofacial anomaly patients may present with delayed speech though they may not have initial obvious external deformation. The objective of case series is to identify the congenital inner ear malformation. The series of clinical presentation, physical examination, investigations, treatments and follow-up results were demonstrated followed by the discussion.

  15. Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series.

    PubMed

    Holmes, E A; Bonsall, M B; Hales, S A; Mitchell, H; Renner, F; Blackwell, S E; Watson, P; Goodwin, G M; Di Simplicio, M

    2016-01-26

    Treatment innovation for bipolar disorder has been hampered by a lack of techniques to capture a hallmark symptom: ongoing mood instability. Mood swings persist during remission from acute mood episodes and impair daily functioning. The last significant treatment advance remains Lithium (in the 1970s), which aids only the minority of patients. There is no accepted way to establish proof of concept for a new mood-stabilizing treatment. We suggest that combining insights from mood measurement with applied mathematics may provide a step change: repeated daily mood measurement (depression) over a short time frame (1 month) can create individual bipolar mood instability profiles. A time-series approach allows comparison of mood instability pre- and post-treatment. We test a new imagery-focused cognitive therapy treatment approach (MAPP; Mood Action Psychology Programme) targeting a driver of mood instability, and apply these measurement methods in a non-concurrent multiple baseline design case series of 14 patients with bipolar disorder. Weekly mood monitoring and treatment target data improved for the whole sample combined. Time-series analyses of daily mood data, sampled remotely (mobile phone/Internet) for 28 days pre- and post-treatment, demonstrated improvements in individuals' mood stability for 11 of 14 patients. Thus the findings offer preliminary support for a new imagery-focused treatment approach. They also indicate a step in treatment innovation without the requirement for trials in illness episodes or relapse prevention. Importantly, daily measurement offers a description of mood instability at the individual patient level in a clinically meaningful time frame. This costly, chronic and disabling mental illness demands innovation in both treatment approaches (whether pharmacological or psychological) and measurement tool: this work indicates that daily measurements can be used to detect improvement in individual mood stability for treatment innovation (MAPP).

  16. Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series

    PubMed Central

    Holmes, E A; Bonsall, M B; Hales, S A; Mitchell, H; Renner, F; Blackwell, S E; Watson, P; Goodwin, G M; Di Simplicio, M

    2016-01-01

    Treatment innovation for bipolar disorder has been hampered by a lack of techniques to capture a hallmark symptom: ongoing mood instability. Mood swings persist during remission from acute mood episodes and impair daily functioning. The last significant treatment advance remains Lithium (in the 1970s), which aids only the minority of patients. There is no accepted way to establish proof of concept for a new mood-stabilizing treatment. We suggest that combining insights from mood measurement with applied mathematics may provide a step change: repeated daily mood measurement (depression) over a short time frame (1 month) can create individual bipolar mood instability profiles. A time-series approach allows comparison of mood instability pre- and post-treatment. We test a new imagery-focused cognitive therapy treatment approach (MAPP; Mood Action Psychology Programme) targeting a driver of mood instability, and apply these measurement methods in a non-concurrent multiple baseline design case series of 14 patients with bipolar disorder. Weekly mood monitoring and treatment target data improved for the whole sample combined. Time-series analyses of daily mood data, sampled remotely (mobile phone/Internet) for 28 days pre- and post-treatment, demonstrated improvements in individuals' mood stability for 11 of 14 patients. Thus the findings offer preliminary support for a new imagery-focused treatment approach. They also indicate a step in treatment innovation without the requirement for trials in illness episodes or relapse prevention. Importantly, daily measurement offers a description of mood instability at the individual patient level in a clinically meaningful time frame. This costly, chronic and disabling mental illness demands innovation in both treatment approaches (whether pharmacological or psychological) and measurement tool: this work indicates that daily measurements can be used to detect improvement in individual mood stability for treatment innovation (MAPP

  17. Successful use of right unilateral ECT for catatonia: a case series.

    PubMed

    Cristancho, Pilar; Jewkes, Delaina; Mon, Thetsu; Conway, Charles

    2014-03-01

    Catatonia is a neuropsychiatric syndrome involving motor signs in association with disorders of mood, behavior, or thought. Bitemporal electrode placement electroconvulsive therapy (ECT) is a proven effective treatment for catatonia, and this mode of ECT delivery is the preferred method of treatment in this condition. Studies in major depressive disorder have demonstrated that suprathreshold, nondominant (right) hemisphere, unilateral electrode placement ECT has fewer adverse effects, especially cognitive adverse effects, than bitemporal ECT. This case series describes the use of right unilateral (RUL) ECT in 5 patients with catatonia. Before ECT, all 5 patients in this series initially failed therapy with benzodiazepines and psychotropic medications. Each catatonic patient received a series of 8 to 12 RUL ECT in an every-other-day series. After ECT, 4 of the 5 patients had a full recovery from catatonia. One patient achieved only partial response to RUL ECT, and no additional benefit was obtained with bitemporal ECT. All patients in this case series tolerated RUL ECT without major adverse effects. This case series illustrates successful use of RUL ECT in patients with catatonia and adds to the early literature demonstrating its effective use in treating this complex condition.

  18. [Management of horseshoe kidney based on a series of 36 cases].

    PubMed

    Fekak, Hamid; Mezzour, Mohamed Hicham; Rabii, Redouane; Joual, Abdenbi; Bennani, Saâd; El Mrini, Mohamed

    2004-09-01

    Horseshoe kidney is a malformation of the upper urinary tract that usually remains asymptomatic. The authors report the various therapeutic modalities for urological diseases associated with horseshoe kidney. Review of a series of 36 pathological horseshoe kidneys, associated with renal stones in 19 cases, ureteropelvic junction syndrome in 8 cases, tumour in 5 cases, pyonephrosis in 2 cases and trauma in 2 cases. The authors stress the very specific characteristics of this rare malformation and review the therapeutic approach to each type of urological disease associated with horseshoe kidney. The topographic and vascular characteristics must be taken into account before treating any urological disease associated with horseshoe kidney.

  19. Resonant electronic Raman scattering: A BCS-like system

    NASA Astrophysics Data System (ADS)

    Rodrigues, Leonarde N.; Arantes, A.; Schüller, C.; Bell, M. J. V.; Anjos, V.

    2016-05-01

    In this paper we investigate the resonant intersubband Raman scattering of two-dimensional electron systems in GaAs-AlGaAs single quantum wells. Self-consistent calculations of the polarized and depolarized Raman cross sections show that the appearance of excitations at the unrenormalized single-particle energy are related to three factors: the extreme resonance regime, the existence of degeneracy in intersubband excitations of the electron gas, and, finally, degeneracy in the interactions between pairs of excitations. It is demonstrated that the physics that governs the problem is similar to the one that gives rise to the formation of the superconducting state in the BCS theory of normal metals. Comparison between experiment and theory shows an excellent agreement.

  20. Strong-coupling BCS models of Josephson qubits.

    PubMed

    Alicki, R; Miklaszewski, W

    2013-01-23

    The strong-coupling version of the BCS theory for superconductors is used to derive microscopic models for all types of small Josephson junctions--charge qubit, flux qubit and phase qubit. Applied to Josephson qubits it yields a more complicated structure of the lowest-lying energy levels than that obtained from phenomenological models based on quantization of the Kirchhoff equations. In particular, highly degenerate levels emerge, which act as probability sinks for the qubit. The alternative formulae concerning spectra of superconducting qubits are presented and compared with the experimental data. In contrast to the existing theories those formulae contain microscopic parameters of the model. In particular, for the first time, the density of Cooper pairs at zero temperature is estimated for an Al-based flux qubit. Finally, the question whether small Josephson junctions can be treated as macroscopic quantum systems is briefly discussed.

  1. A case series review of spinal cord stimulation migration rates with a novel fixation device.

    PubMed

    Justiz, Rafael; Bentley, Ishmael

    2014-01-01

    A retrospective review of a consecutive case series of 66 permanent spinal cord stimulation implants utilizing a novel tissue fixation device was performed. The purpose of this case series review is to examine the impact of a novel lead anchor to tissue fixation system and determine if it is a viable alternative to standard tissue fixation methods. Sixty-six cases were performed utilizing a novel method of lead anchor tissue fixation. Cases performed included cervical and thoracolumbar. For the majority of the 66 cases, two spinal cord stimulator leads and two SwiftLock lead anchors in conjunction with the novel method of tissue fixation were utilized. A retrospective review indicated no reports of lead migration during this case series, the mean follow-up time being 38 weeks (range 10-68 weeks). In addition, there were zero reported complications or untoward effects due to use of the novel device and technique. Overall complication rates for SCS have been reported in the range of 30-40%, with hardware-related complications contributing a significant percentage to the overall complication rate. Lead anchoring techniques still rely heavily on the experience and skill of the implanting physician. The novel device and method utilized in this case series to aid in anchoring leads demonstrated good results with no observed postoperative complications. These data suggest this novel method of tissue fixation may be a viable alternative for fixation of spinal cord stimulator leads to soft tissue. In this case series there were no reported incidents of migration or complications related to the novel device. © 2013 International Neuromodulation Society.

  2. History of Soil Survey and Evolution of the Brazilian Soil Classification System - SiBCS

    NASA Astrophysics Data System (ADS)

    Cunha dos Anjos, Lúcia Helena; Csekö Nolasco de Carvalho, Claudia; Homem Antunes, Mauro Antonio; Muggler, Cristine Carole

    2014-05-01

    national soil classification was presented by Marcelo Camargo (Embrapa Soils) and Jacob Bennema (FAO adviser). When Soil Taxonomy was first published in 1975, a field workshop was held in Brazil, and the system was not accepted by the country scientists; one main reason was the usage of climate as a main attribute for suborders. In 1978, the first national soil field correlation meeting was held with the goal of developing the national system, giving origin to the Brazilian Soil Classification System (SiBCS). In 1980, a working group was created by Embrapa Soils and other institutes resulting in four approximations of the system. In 1999, the first edition of the SiBCS was released, followed by a second edition in 2006 and the third in 2013. The SiBCS is a hierarchic system, based on morphogenetic soil attributes, with six categorical levels: order, suborder, great group, subgroup, family, and series. It has 13 soil orders, and it is structured as a key down to subgroup level. Many soil attributes are based on concepts adopted by the Soil Taxonomy (United States) and by the World Reference Base for Soil Resources (WRB - FAO). The development of the SiBCS is supervised by a national executive committee, and information is available at http://www.cnps.embrapa.br/sibcs (in Portuguese).

  3. EPIDEMIOLOGY AND TREATMENT OF MONTEGGIA LESION IN ADULTS: SERIES OF 44 CASES

    PubMed Central

    Suarez, Roberto; Barquet, Antonio; Fresco, Rodrigo

    2016-01-01

    ABSTRACT Objective: To analyze the epidemiology, treatment and outcome of a series of adult patients with Monteggia lesion treated in Uruguayan institutions. Methods: This is a retrospective article, we retrospectively identified from two Uruguayan institutions 44 adult patients with Monteggia lesion and analyzed their characteristics including Bado classification, associated injuries, treatment modality and outcome (Morrey score). Results: Using Bado classification, 23 cases (52%) were type II, 12 (27%) type I, seven (16%) type IV and two cases (5%) type III. Associated lesions were radial head fractures, found in 15 patients, coronoid ipsilateral fractures in seven patients, and neurological injuries in four. Radial head dislocation was reduced in 93% of the cases with closed maneuvers. Ulna fractures underwent open reduction and internal fixation in all 30 cases using 3.5 mm DCP plates. Complications after surgery occurred in 21 cases. Revision surgery was done in 15 cases. Outcomes after primary and revision surgery were good or excellent in 37 cases. Conclusions: In our series we observed that Monteggia lesion in adults is a serious injury with a high number of complications that often require revision surgeries. Level of Evidence IV, Retrospective Study, Case Series. PMID:26997915

  4. Prediction of solubility and permeability class membership: provisional BCS classification of the world's top oral drugs.

    PubMed

    Dahan, Arik; Miller, Jonathan M; Amidon, Gordon L

    2009-12-01

    The Biopharmaceutics Classification System (BCS) categorizes drugs into one of four biopharmaceutical classes according to their water solubility and membrane permeability characteristics and broadly allows the prediction of the rate-limiting step in the intestinal absorption process following oral administration. Since its introduction in 1995, the BCS has generated remarkable impact on the global pharmaceutical sciences arena, in drug discovery, development, and regulation, and extensive validation/discussion/extension of the BCS is continuously published in the literature. The BCS has been effectively implanted by drug regulatory agencies around the world in setting bioavailability/bioequivalence standards for immediate-release (IR) oral drug product approval. In this review, we describe the BCS scientific framework and impact on regulatory practice of oral drug products and review the provisional BCS classification of the top drugs on the global market. The Biopharmaceutical Drug Disposition Classification System and its association with the BCS are discussed as well. One notable finding of the provisional BCS classification is that the clinical performance of the majority of approved IR oral drug products essential for human health can be assured with an in vitro dissolution test, rather than empirical in vivo human studies.

  5. Extracorporeal Membrane Oxygenation (ECMO) for Hypothermic Cardiac Deterioration: A Case Series.

    PubMed

    Niehaus, Matthew T; Pechulis, Rita M; Wu, James K; Frei, Steven; Hong, John J; Sandhu, Rovinder S; Greenberg, Marna Rayl

    2016-10-01

    Accidental hypothermia can lead to untoward cardiac manifestations and arrest. This report presents a case series of severe accidental hypothermia with cardiac complications in three emergency patients who were treated with extracorporeal membrane oxygenation (ECMO) and survived after re-warming. The aim of this discussion was to encourage more clinicians to consider ECMO as a re-warming therapy for severe hypothermia with circulatory collapse and to prompt discussion about decreasing the barriers to its use. Niehaus MT , Pechulis RM , Wu JK , Frei S , Hong JJ , Sandhu RS , Greenberg MR . Extracorporeal membrane oxygenation (ECMO) for hypothermic cardiac deterioration: a case series. Prehosp Disaster Med. 2016;31(5):570-571.

  6. BCS MPI: N new approach i the system software design for large-scale parallel computers

    SciTech Connect

    Fernández, J. C.; Petrini, F.; Frachtenberg, E.

    2003-01-01

    Buffered Co-Scheduled (BCS) MPI proposes a new approach to design the communication libraries for large-scale parallel machines. The emphasis of BCS MPI is on the global coordination of a large number of processes rather than in the traditional optimization of the local performance of a pair of communicating processes. BCS MPI delays the interprocessor communication in order to schedule globally the communication pattern and it is designed on top of a minimal set of collective communication primitives. In this paper we describe a prototype implementation of BCS MDI and its Communication protocols. The experimental results, executed on a set of scientific applications representative of the ASCI workload, show that BCS MPI is only marginally slower than the production-level MPI, but much simpler to implement, debug and analyze.

  7. BCS MPI: a new approach in the software design for large-scale parallel computers

    SciTech Connect

    Peinador, J. F.; Petrini, F.

    2003-01-01

    BCS MPI proposes a new approach to design the communication libraries for large scale parallel machines. The emphasis of BCS MPI is on the global coordination of the potentially large number of processes and in the reduction of the non determinism rather than in the traditional optimization of the local performance of a pair of communicating processes. BCS MPI delays the interprocessor communication in order to schedule globally the communication pattern and it is designed on top of a minimal set of collective communication primitives. In this paper we describe a prototype implementation of BCS MPI and its communication protocols. The experimental results, executed on a set of scientific applications representative of the ASCI workload, show that BCS MPI is only marginally slower than the production-level MPI, but much simpler to implement, debug and analyze.

  8. Supratentorial cavernous haemangiomas and epilepsy: a review of the literature and case series

    PubMed Central

    Moran, N; Fish, D; Kitchen, N; Shorvon, S; Kendall, B; Stevens, J

    1999-01-01

    OBJECTIVES—To characterise the clinical features and response to treatment of supratentorial cavernomas associated with epilepsy.
METHODS—A systematic review of the literature was carried out and a retrospective case series of patients with cavernoma diagnosed by MRI and/or histology was compiled. Patient selection biases in the literature review were reduced as far as possible by selection of unbiased publications.
RESULTS—In the literature, cavernomas were relatively less common in the frontal lobes. There were multiple cavernomas in 23% of cases. The main clinical manifestations were seizures (79%) and haemorrhage (16%). The annual haemorrhage rate was 0.7%. The outcome after excision was good with improvement in seizures in 92% of patients. In the case series the surgical outcome was less favourable, reflecting inclusion of a higher proportion of patients with intractable epilepsy. In both the literature review and the case series, outcome was poorer in cases with a longer duration of seizures at the time of surgery.
CONCLUSIONS—The good surgical results, particularly in cases treated earlier, and the significant cumulative haemorrhage rate, suggest that excision is the optimum treatment. However, these factors have not been examined prospectively and, despite the availability of several retrospective studies, the optimum treatment, particularly for non-intractable cases, will only be determined by a prospective study.

 PMID:10209164

  9. BCS Biowaivers: Similarities and Differences Among EMA, FDA, and WHO Requirements.

    PubMed

    Davit, Barbara M; Kanfer, Isadore; Tsang, Yu Chung; Cardot, Jean-Michel

    2016-05-01

    The Biopharmaceutics Classification System (BCS), based on aqueous solubility and intestinal permeability, has enjoyed wide use since 1995 as a mechanism for waiving in vivo bioavailability and bioequivalence studies. In 2000, the US-FDA was the first regulatory agency to publish guidance for industry describing how to meet criteria for requesting a waiver of in vivo bioavailability and bioequivalence studies for highly soluble, highly permeable (BCS Class I) drugs. Subsequently, the World Health Organization (WHO) and European Medicines Agency (EMA) published guidelines recommending how to obtain BCS biowaivers for BCS Class III drugs (high solubility, low permeability), in addition to Class I drugs. In 2015, the US-FDA became better harmonized with the EMA and WHO following publication of two guidances for industry outlining criteria for obtaining BCS biowaivers for both Class I and Class III drugs. A detailed review and comparison of the BCS Class I and Class III criteria currently recommended by the US-FDA, EMA, and WHO revealed good convergence of the three agencies with respect to BCS biowaiver criteria. The comparison also suggested that, by applying the most conservative of the three jurisdictional approaches, it should be possible for a sponsor to design the same set of BCS biowaiver studies in preparing a submission for worldwide filing to satisfy US, European, and emerging market regulators. It is hoped that the availability of BCS Class I and Class III biowaivers in multiple jurisdictions will encourage more sponsors to request waivers of in vivo bioavailability/bioequivalence testing using the BCS approach.

  10. Eosinophilic meningitis: a case series and review of literature of Angiostrongylus cantonensis and Gnathostoma spinigerum.

    PubMed

    Shah, I; Barot, S; Madvariya, M

    2015-01-01

    Eosinophilic meningitis is defined as the presence of >10 eosinophils/μL in cerebrospinal fluid (CSF) or at least 10% eosinophils in the total CSF leukocyte count. Eosinophilic meningitis has been reported in two case series and two case reports in India till date and has not been reported in children below 15 years of age. We present two children with eosinophilic meningitis with peripheral eosinophilia and the proposed etiologic agents based on the clinical setting and their response to antihelminthic agents.

  11. Lip repositioning with reversible trial for the management of excessive gingival display: a case series.

    PubMed

    Jacobs, Paul J; Jacobs, Bryan P

    2013-01-01

    Lip repositioning surgery is a largely unknown and underutilized treatment modality for excessive gingival display. It involves precise resection of maxillary mucosal tissues with reattachment of the lip in a more coronal position. This limits lip elevation on smiling and increases lip fullness. While this is an elective treatment, no reported cases have yet offered patients the ability to preview the outcome in a reversible manner. This case series presents seven patients who were successfully managed with trial, and then definitive, lip repositioning.

  12. Rare case-series of electrocautery burn following off-pump coronary artery bypass grafting

    PubMed Central

    Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

    2014-01-01

    Abstract: With an increasing number of off-pump coronary artery surgery procedures in high-risk patients with coagulopathy, including renal failure, hepatic failure and anticoagulant drug-using patients, the frequency of related complications such as repeated exploration for bleeding is also increasing. The associated co-morbidity and repeated use of electrocautery in postoperative bleeding leaves patients susceptible to electrocautery ulcers. In this case series, rare cases of cautery burn with unique causative mechanisms are described. PMID:23669602

  13. A Case Series of Marijuana Exposures in Pediatric Patients Less than 5 Years of Age

    ERIC Educational Resources Information Center

    Wang, George Sam; Narang, Sandeep K.; Wells, Kathryn; Chuang, Ryan

    2011-01-01

    Objective: In Colorado, there has been a large increase in medical marijuana dispensaries and licenses for the use of medical marijuana over the past year. This is a retrospective case series of marijuana exposures that have presented to the emergency department (ED) in children less than 5 years of age. Methods: We performed a retrospective chart…

  14. REHABILITATION OF SUBACROMIAL PAIN SYNDROME EMPHASIZING SCAPULAR DYSKINESIS IN AMATEUR ATHLETES: A CASE SERIES

    PubMed Central

    Moura, Katherinne F.; Monteiro, Renan L.; Lucareli, Paulo R.G.

    2016-01-01

    ABSTRACT Study design Case series Background and Purpose Scapular dyskinesis has been associated with several shoulder injuries. Recent literature has suggested that a greater activation of the scapular muscles can play an important role in reducing subacromial impingement in patients with shoulder pain. Thus, the purpose of this case series was to describe a rehabilitation program that emphasizes scapular dyskinesis correction for those with clinical evidence of subacromial pain syndrome. Case Descriptions The four amateur athletes in this series showed clinical evidence of subacromial pain syndrome and scapular dyskinesis and each underwent a treatment protocol consisting of three phases. Phase 1 emphasized pain relief, scapular control, and recovery of normal range of motion (ROM), Phase 2 focused on muscular strengthening, and Phase 3 emphasized sensory motor training. Outcomes All subjects demonstrated decreased pain, improved sports performance and function, increased muscular strength for shoulder elevation and external rotation, and increased ROM for internal rotation. Improvement in serratus anterior (SA) activation was also noted. Discussion The results of this case series suggest that subjects with clinical tests positive for subacromial pain syndrome can show significant improvement with an intervention focused on scapular dyskinesis correction. SA activation can play an important role in this process given that all subjects presented with better recruitment after rehabilitation, as measured by electromyography. Levels of Evidence Level 4 PMID:27525180

  15. Inhaled nitric oxide in preterm infants with prolonged preterm rupture of the membranes: a case series.

    PubMed

    Semberova, J; O'Donnell, S M; Franta, J; Miletin, J

    2015-04-01

    The available evidence does not support the routine use of inhaled nitric oxide (iNO) in the care of premature infants. We present a case series of 22 preterm infants born after prolonged preterm premature rupture of membranes and oligohydramnios with respiratory failure. Oxygenation index decreased significantly after commencement of iNO.

  16. Brief Report: Retrospective Case Series of Oxcarbazepine for Irritability/Agitation Symptoms in Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Douglas, Jessica F.; Sanders, Kevin B.; Benneyworth, M. Hannah; Smith, Jessica L.; DeJean, Virginia M.; McGrew, Susan G.; Veenstra-VanderWeele, Jeremy

    2013-01-01

    We examined response to oxcarbazepine prescribed for irritability/agitation symptoms in a retrospective case series of 30 patients with Autism Spectrum Disorder (ASD). The average patient was 12.0 years old (range 5-21) and taking two other psychotropic medications (range 0-4). Fourteen patients (47 %) had a clinical global impression of…

  17. Dialectical Behavior Therapy of Anorexia and Bulimia Nervosa among Adolescents: A Case Series

    ERIC Educational Resources Information Center

    Salbach-Andrae, Harriet; Bohnekamp, Inga; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Miller, Alec L.

    2008-01-01

    The aim of this study was to describe a case series of adolescents (mean age = 16.5 years, SD = 1.0) with anorexia nervosa (AN) and bulimia nervosa (BN) who received dialectical behavior therapy (DBT). Twelve outpatients with AN and BN took part in 25 weeks of twice weekly therapy consisting of individual therapy and a skills training group.…

  18. Intervention for Infants at Risk of Developing Autism: A Case Series

    ERIC Educational Resources Information Center

    Green, Jonathan; Wan, Ming Wai; Guiraud, Jeanne; Holsgrove, Samina; McNally, Janet; Slonims, Vicky; Elsabbagh, Mayada; Charman, Tony; Pickles, Andrew; Johnson, Mark

    2013-01-01

    Theory and evidence suggest the potential value of prodromal intervention for infants at risk of developing autism. We report an initial case series (n = 8) of a parent-mediated, video-aided and interaction-focused intervention with infant siblings of autistic probands, beginning at 8-10 months of age. We outline the theory and evidence base…

  19. Brief Report: Retrospective Case Series of Oxcarbazepine for Irritability/Agitation Symptoms in Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Douglas, Jessica F.; Sanders, Kevin B.; Benneyworth, M. Hannah; Smith, Jessica L.; DeJean, Virginia M.; McGrew, Susan G.; Veenstra-VanderWeele, Jeremy

    2013-01-01

    We examined response to oxcarbazepine prescribed for irritability/agitation symptoms in a retrospective case series of 30 patients with Autism Spectrum Disorder (ASD). The average patient was 12.0 years old (range 5-21) and taking two other psychotropic medications (range 0-4). Fourteen patients (47 %) had a clinical global impression of…

  20. Assessing Outcome in Cognitive Behavior Therapy for Child Depression: An Illustrative Case Series

    ERIC Educational Resources Information Center

    Eckshtain, Dikla; Gaynor, Scott T.

    2009-01-01

    Recent meta-analytic data suggest a need for ongoing evaluation of treatments for youth depression. The present article calls attention to a number of issues relevant to the empirical evaluation of if and how cognitive behavior therapy for child depression works. A case series of 6 children and a primary caregiver received treatment--individual…

  1. A Case Series of Marijuana Exposures in Pediatric Patients Less than 5 Years of Age

    ERIC Educational Resources Information Center

    Wang, George Sam; Narang, Sandeep K.; Wells, Kathryn; Chuang, Ryan

    2011-01-01

    Objective: In Colorado, there has been a large increase in medical marijuana dispensaries and licenses for the use of medical marijuana over the past year. This is a retrospective case series of marijuana exposures that have presented to the emergency department (ED) in children less than 5 years of age. Methods: We performed a retrospective chart…

  2. Single-Case Time Series with Bayesian Analysis: A Practitioner's Guide.

    ERIC Educational Resources Information Center

    Jones, W. Paul

    2003-01-01

    This article illustrates a simplified time series analysis for use by the counseling researcher practitioner in single-case baseline plus intervention studies with a Bayesian probability analysis to integrate findings from replications. The C statistic is recommended as a primary analysis tool with particular relevance in the context of actual…

  3. Case Studies: Persecution/Genocide. The Human Rights Series. Volume III.

    ERIC Educational Resources Information Center

    Litynsky, Walter; And Others

    A continuation of the study of those factors that lead to persecutions and acts of genocide is presented. As students read the materials included in the case studies, they should be referred to the organizing concepts discussed in "Teaching about the Holocaust and Genocide: Introduction. The Human Rights Series, Volume I." Unit 1 in that…

  4. Dialectical Behavior Therapy of Anorexia and Bulimia Nervosa among Adolescents: A Case Series

    ERIC Educational Resources Information Center

    Salbach-Andrae, Harriet; Bohnekamp, Inga; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Miller, Alec L.

    2008-01-01

    The aim of this study was to describe a case series of adolescents (mean age = 16.5 years, SD = 1.0) with anorexia nervosa (AN) and bulimia nervosa (BN) who received dialectical behavior therapy (DBT). Twelve outpatients with AN and BN took part in 25 weeks of twice weekly therapy consisting of individual therapy and a skills training group.…

  5. Manualized Family-Based Treatment for Anorexia Nervosa: A Case Series.

    ERIC Educational Resources Information Center

    Le Grange, Daniel; Binford, Roslyn; Loeb, Katharine L.

    2005-01-01

    Objective: The purpose of this study was to describe a case series of children and adolescents (mean age = 14.5 years, SD = 2.3; range 9-18) with anorexia nervosa who received manualized family-based treatment for their eating disorder. Method: Forty-five patients with anorexia nervosa were compared pre- and post-treatment on weight and menstrual…

  6. Is Family Therapy Useful for Treating Children with Anorexia Nervosa? Results of a Case Series

    ERIC Educational Resources Information Center

    Lock, James; le Grange, Daniel; Forsberg, Sarah; Hewell, Kristen

    2006-01-01

    Objective: Research suggests that family-based treatment (FBT) is an effective treatment for adolescents with anorexia nervosa (AN). This retrospective case series was designed to examine its usefulness with younger children. Method: Data were abstracted from medical records of 32 children with a mean age of 11.9 years (range 9.0-12.9) meeting…

  7. Intervention for Infants at Risk of Developing Autism: A Case Series

    ERIC Educational Resources Information Center

    Green, Jonathan; Wan, Ming Wai; Guiraud, Jeanne; Holsgrove, Samina; McNally, Janet; Slonims, Vicky; Elsabbagh, Mayada; Charman, Tony; Pickles, Andrew; Johnson, Mark

    2013-01-01

    Theory and evidence suggest the potential value of prodromal intervention for infants at risk of developing autism. We report an initial case series (n = 8) of a parent-mediated, video-aided and interaction-focused intervention with infant siblings of autistic probands, beginning at 8-10 months of age. We outline the theory and evidence base…

  8. Paracetamol effectiveness, safety and blood level monitoring during patent ductus arteriosus closure: a case series.

    PubMed

    Kessel, Irena; Waisman, Dan; Lavie-Nevo, Karen; Golzman, Marcelo; Lorber, Avraham; Rotschild, Avi

    2014-11-01

    Paracetamol was reported to be effective for patent ductus arteriosus (PDA) closure. We present a case series of PDA closure by paracetamol in seven premature infants. During the treatment, paracetamol blood levels did not exceed the recommended levels for analgesia and hyperthermia in six tested infants. None of the patients demonstrated significant disturbances of liver function.

  9. Case Studies: Persecution/Genocide. The Human Rights Series. Volume III.

    ERIC Educational Resources Information Center

    Litynsky, Walter; And Others

    A continuation of the study of those factors that lead to persecutions and acts of genocide is presented. As students read the materials included in the case studies, they should be referred to the organizing concepts discussed in "Teaching about the Holocaust and Genocide: Introduction. The Human Rights Series, Volume I." Unit 1 in that…

  10. Assessing Outcome in Cognitive Behavior Therapy for Child Depression: An Illustrative Case Series

    ERIC Educational Resources Information Center

    Eckshtain, Dikla; Gaynor, Scott T.

    2009-01-01

    Recent meta-analytic data suggest a need for ongoing evaluation of treatments for youth depression. The present article calls attention to a number of issues relevant to the empirical evaluation of if and how cognitive behavior therapy for child depression works. A case series of 6 children and a primary caregiver received treatment--individual…

  11. Manualized Family-Based Treatment for Anorexia Nervosa: A Case Series.

    ERIC Educational Resources Information Center

    Le Grange, Daniel; Binford, Roslyn; Loeb, Katharine L.

    2005-01-01

    Objective: The purpose of this study was to describe a case series of children and adolescents (mean age = 14.5 years, SD = 2.3; range 9-18) with anorexia nervosa who received manualized family-based treatment for their eating disorder. Method: Forty-five patients with anorexia nervosa were compared pre- and post-treatment on weight and menstrual…

  12. Is Family Therapy Useful for Treating Children with Anorexia Nervosa? Results of a Case Series

    ERIC Educational Resources Information Center

    Lock, James; le Grange, Daniel; Forsberg, Sarah; Hewell, Kristen

    2006-01-01

    Objective: Research suggests that family-based treatment (FBT) is an effective treatment for adolescents with anorexia nervosa (AN). This retrospective case series was designed to examine its usefulness with younger children. Method: Data were abstracted from medical records of 32 children with a mean age of 11.9 years (range 9.0-12.9) meeting…

  13. Applying data mining techniques to medical time series: an empirical case study in electroencephalography and stabilometry.

    PubMed

    Anguera, A; Barreiro, J M; Lara, J A; Lizcano, D

    2016-01-01

    One of the major challenges in the medical domain today is how to exploit the huge amount of data that this field generates. To do this, approaches are required that are capable of discovering knowledge that is useful for decision making in the medical field. Time series are data types that are common in the medical domain and require specialized analysis techniques and tools, especially if the information of interest to specialists is concentrated within particular time series regions, known as events. This research followed the steps specified by the so-called knowledge discovery in databases (KDD) process to discover knowledge from medical time series derived from stabilometric (396 series) and electroencephalographic (200) patient electronic health records (EHR). The view offered in the paper is based on the experience gathered as part of the VIIP project. Knowledge discovery in medical time series has a number of difficulties and implications that are highlighted by illustrating the application of several techniques that cover the entire KDD process through two case studies. This paper illustrates the application of different knowledge discovery techniques for the purposes of classification within the above domains. The accuracy of this application for the two classes considered in each case is 99.86% and 98.11% for epilepsy diagnosis in the electroencephalography (EEG) domain and 99.4% and 99.1% for early-age sports talent classification in the stabilometry domain. The KDD techniques achieve better results than other traditional neural network-based classification techniques.

  14. Histologic Evaluation of Sinus Grafting Materials After Peri-implantitis-Induced Failure: A Case Series.

    PubMed

    Scarano, Antonio; Cholakis, Anastasia Kelekis; Piattelli, Adriano

    This human case series presents the clinical and histologic results of five cases of peri-implantitis with subsequent sinus graft infections. Complications may follow maxillary sinus augmentation procedures. It is possible to have an inflammatory reaction, movement of the implant inside the sinus, formation of an insufficient quantity of osseous tissue, and the production of an oroantral fistula. Complications following maxillary subantral augmentation procedures are relatively rare; however, the risks and benefits of any surgery must be carefully evaluated at the onset. In this case series, bacterial proliferation from infected implants into the grafted biomaterial in sinus cavities was examined. In five cases, removal of infected implants from augmented sinuses did not result in resolution of the infection, but rather in persistence of the infection in the area of the sinus augmentation procedure. Intraoral examination revealed edema/redness in two cases and edema and sinus tract formation in another case. In all cases, surgical curettage of the affected maxillary sinuses was performed. The inserted biomaterials and the accompanying inflammatory tissue infiltrate were totally removed with curettes. The sample was sent for a histopathologic examination. The maxillary sinuses were filled with an autologous platelet gel. Necrotic bone was found lining the different biomaterial grafts. Macrophages were observed around the grafted particles. No blood vessels were observed. This case series is the first to document the spread of infection from an implant surface to the entirety of the graft in the maxillary antrum. Complete removal of all infected bone graft material is the treatment of choice in such cases.

  15. Modern Spirometry Supports Anesthetic Management in Small Animal Clinical Practice: A Case Series.

    PubMed

    Calice, Ivana; Moens, Yves

    2016-01-01

    Modern spirometry, like no other monitoring technique, allows insight into breath-to-breath respiratory mechanics. Spirometers continuously measure volume, airway pressure, and flow while calculating and continuously displaying respiratory system compliance and resistance in the form of loops. The aim of this case series is to show how observation of spirometric loops, similar to electrocardiogram or CO2 curve monitoring, can improve safety of anesthetic management in small animals. Spirometric monitoring cases described in this case series are based on use of the anaesthesia monitor Capnomac Ultima with a side stream spirometry sensor. The cases illustrate how recognition and understanding of spirometric loops allows for easy diagnosis of iatrogenic pneumothorax, incorrect ventilator settings, leaks in the system, kinked or partially obstructed endotracheal tube, and spontaneous breathing interfering with intermittent positive-pressure ventilation. The case series demonstrates the potential of spirometry to improve the quality and safety of anesthetic management, and, hence, its use can be recommended during intermittent positive-pressure ventilation and procedures in which interference with ventilation can be expected.

  16. Head and neck inflammatory pseudotumor: Case series and review of the literature.

    PubMed

    Kansara, Sagar; Bell, Diana; Johnson, Jason; Zafereo, Mark

    2016-12-01

    Inflammatory pseudotumor (IP) is an uncommon idiopathic lesion that often imitates malignancy clinically and radiologically. Inflammatory pseudotumors have been found to occur in various sites but rarely in the head and neck. The histopathology, imaging, and treatment of three unique cases of head and neck inflammatory pseudotumors are described in this case series. Patients in Cases 1 and 2 presented with right level II neck mass and left parotid tail mass, respectively. The patient in Case 3 presented with otalgia, jaw pain and trismus, and a left parapharyngeal space mass. The tumors in Cases 1 and 3 significantly decreased in size with tapered courses of oral corticosteroids. The tumor in Case 2 was surgically excised without disease recurrence. Malignancy must be ruled out with incisional or excisional biopsy. Treatment includes surgical excision, oral corticosteroids, or both. The literature shows that radiotherapy and small-molecule inhibitors may be promising alternatives.

  17. (Meth)Acrylate Occupational Contact Dermatitis in Nail Salon Workers: A Case Series.

    PubMed

    DeKoven, Samuel; DeKoven, Joel; Holness, D Linn

    Recently, many cases of acrylate-associated allergic contact dermatitis have appeared among nail salon workers. Common acrylate-containing products in nail salons include traditional nail polish, ultraviolet-cured shellac nail polish, ultraviolet-cured gel nails, and press-on acrylic nails. Nail salon technicians seen in the occupational medicine clinic in 2015 and 2016 were identified, and their patch test results and clinical features were summarized. Patch testing was done with the Chemotechnique (Meth)Acrylate nail series, and either the North American Standard series or the North American Contact Dermatitis Group screening series. Six patients were identified, all women, ages 38 to 58. Common presentations included erythematous dermatitis of the dorsa of the hands, palms, and forearms and fissures on the fingertips. Less common sites of eruptions included the periorbital region, cheeks, posterior ears, neck, sacral area, lateral thighs, and dorsa of the feet. All patients reacted to hydroxyethyl methacrylate, and 5 patients reacted to ethyl acrylate. Each patient also reacted to (meth)acrylates that are not found on either standard series, including ethyleneglycol dimethacrylate, 2-hydroxypropyl methacrylate, and 2-hydroxyethyl acrylate. The authors report 6 cases of allergic contact dermatitis to acrylates in nail technicians seen over the past year, representing a new trend in their clinic. These cases are reflective of a growing trend of nail technicians with allergic contact dermatitis associated with occupational (meth)acrylate exposure. Efforts to improve prevention are needed.

  18. Aqueous Chlorhexidine for Intravitreal Injection Antisepsis: A Case Series and Review of the Literature.

    PubMed

    Merani, Rohan; McPherson, Zachary E; Luckie, Alan P; Gilhotra, Jagjit S; Runciman, Jim; Durkin, Shane; Muecke, James; Donaldson, Mark; Aralar, Albert; Rao, Anupam; Davies, Peter E

    2016-12-01

    To determine the incidence of endophthalmitis in a large clinical series using aqueous chlorhexidine for antisepsis before intravitreal injection and to review the ophthalmic literature regarding chlorhexidine efficacy and safety. Multicenter retrospective case series. All patients receiving intravitreal injections from 7 retinal specialists. An audit of intravitreal injections performed by retinal specialists who exclusively used aqueous chlorhexidine 0.05% or 0.1% for prophylaxis of infective endophthalmitis was undertaken. The incidence of endophthalmitis was determined from August 1, 2011, to February 28, 2015. A literature review was performed to critically appraise the ocular safety and efficacy of aqueous chlorhexidine. Incidence of endophthalmitis after intravitreal injections. A total of 40 535 intravitreal injections were performed by 7 retinal specialists across 3 centers. Chlorhexidine was well tolerated, and only 1 patient with a suspected allergic reaction was noted. Three cases of endophthalmitis were identified with 1 culture-positive case. The 0.0074% (1 in 13 512) per-injection rate of endophthalmitis in this series compares favorably with previous series in which povidone-iodine has been used. Aqueous chlorhexidine was associated with a low rate of postinjection endophthalmitis and was well tolerated by patients. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  19. Conservative chiropractic management of urinary incontinence using applied kinesiology: a retrospective case-series report

    PubMed Central

    Cuthbert, Scott C.; Rosner, Anthony L.

    2012-01-01

    Objective The purpose of this case series is to describe the chiropractic management of 21 patients with daily stress and occasional total urinary incontinence (UI). Clinical Features Twenty-one case files of patients 13 to 90 years of age with UI from a chiropractic clinic were reviewed. The patients had a 4-month to 49-year history of UI and associated muscle dysfunction and low back and/or pelvic pain. Eighteen wore an incontinence pad throughout the day and night at the time of their appointments because of unpredictable UI. Intervention and Outcome Patients were evaluated for muscle impairments in the lumbar spine, pelvis, and pelvic floor and low back and/or hip pain. Positive manual muscle test results of the pelvis, lumbar spine muscles, and pelvic floor muscles were the most common findings. Lumbosacral dysfunction was found in 13 of the cases with pain provocation tests (applied kinesiology sensorimotor challenge); in 8 cases, this sensorimotor challenge was absent. Chiropractic manipulative therapy and soft tissue treatment addressed the soft tissue and articular dysfunctions. Chiropractic manipulative therapy involved high-velocity, low-amplitude manipulation; Cox flexion distraction manipulation; and/or use of a percussion instrument for the treatment of myofascial trigger points. Urinary incontinence symptoms resolved in 10 patients, considerably improved in 7 cases, and slightly improved in 4 cases. Periodic follow-up examinations for the past 6 years, and no less than 2 years, indicate that for each participant in this case-series report, the improvements of UI remained stable. Conclusion The patients reported in this retrospective case series showed improvement in UI symptoms that persisted over time. PMID:22942842

  20. Conservative chiropractic management of urinary incontinence using applied kinesiology: a retrospective case-series report.

    PubMed

    Cuthbert, Scott C; Rosner, Anthony L

    2012-03-01

    The purpose of this case series is to describe the chiropractic management of 21 patients with daily stress and occasional total urinary incontinence (UI). Twenty-one case files of patients 13 to 90 years of age with UI from a chiropractic clinic were reviewed. The patients had a 4-month to 49-year history of UI and associated muscle dysfunction and low back and/or pelvic pain. Eighteen wore an incontinence pad throughout the day and night at the time of their appointments because of unpredictable UI. Patients were evaluated for muscle impairments in the lumbar spine, pelvis, and pelvic floor and low back and/or hip pain. Positive manual muscle test results of the pelvis, lumbar spine muscles, and pelvic floor muscles were the most common findings. Lumbosacral dysfunction was found in 13 of the cases with pain provocation tests (applied kinesiology sensorimotor challenge); in 8 cases, this sensorimotor challenge was absent. Chiropractic manipulative therapy and soft tissue treatment addressed the soft tissue and articular dysfunctions. Chiropractic manipulative therapy involved high-velocity, low-amplitude manipulation; Cox flexion distraction manipulation; and/or use of a percussion instrument for the treatment of myofascial trigger points. Urinary incontinence symptoms resolved in 10 patients, considerably improved in 7 cases, and slightly improved in 4 cases. Periodic follow-up examinations for the past 6 years, and no less than 2 years, indicate that for each participant in this case-series report, the improvements of UI remained stable. The patients reported in this retrospective case series showed improvement in UI symptoms that persisted over time.

  1. BCS-BEC crossover with unequal-mass fermions

    SciTech Connect

    Diener, Roberto B.; Randeria, Mohit

    2010-03-15

    We investigate the crossover from BCS pairing to molecular Bose-Einstein condensation (BEC) in an atomic gas with two fermion species with masses m{sub {up_arrow}{ne}m{down_arrow}}tuned through a Feshbach resonance. We present results for the T=0 equation of state as a function of the scattering length including the effects of Gaussian fluctuations about the mean field ground state. We compute the ground state energy as a function of m{sub {up_arrow}/}m{sub {down_arrow}}at unitarity and find excellent agreement with the quantum Monte Carlo result for m{sub {up_arrow}/}m{sub {down_arrow}=}6.67 for a {sup 40}K-{sup 6}Li mixture. We show that the dimer scattering length in the BEC limit as a function of m{sub {up_arrow}/}m{sub {down_arrow}}compares well with the exact four-body results of Petrov et al. [J. Phys. B 38, S645 (2005)]. We also derive the condition for trapping frequencies to obtain an unpolarized gas in a harmonic trap.

  2. Robotics in hepatobiliary surgery-initial experience, first reported case series from India.

    PubMed

    Goja, S; Singh, M K; Soin, A S

    2017-01-01

    Robotic surgical system's ability to perform complex hepatobiliary surgeries is gaining momentum with outcomes similar to open surgery and advantages of minimal access surgery. The authors present their initial experience of a heterogenous spectrum of robotic hepatobiliary cases and the first reported case series from India. Retrospective review of hepatobiliary cases done robotically from February 2015 to January 2016 was done. The series has ten patients; with median age of 45 years (range 15-72). Etiologies were choledochal cyst type IVa, benign lower end common bile duct stricture (biliary reconstruction group); incidental gallbladder carcinoma, hepatocellular carcinoma, recurrent pyogenic cholangitis, polycystic liver disease, hemangioma, liver metastases, hydatid cyst (resection group). Median operative duration was 510min; one patient needed intra-operative blood transfusion and there were no conversions to open surgery. One patient developed bile leak which was managed by biliary stenting and another thrombotic thrombocytopenic purpura during post-operative period. Median length of hospital stay was 6days with average cost of robotic surgery being $1700 USD more for major hepatectomy and $900 USD more for biliary reconstruction compared to open procedure. This initial series adds to existing data on the feasibility of robotic hepatobiliary cases with inherent advantages of minimal invasive surgery, however with limitation of availability and use of devices like cavitron ultrasonic surgical aspirator (CUSA) and higher operative cost. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  3. Zygomycetes infections in pediatric hematology oncology patients: a case series and review of the literature.

    PubMed

    Dehority, Walter; Willert, Jennifer; Pong, Alice

    2009-12-01

    Fungi from the Zygomycetes class are increasingly recognized causes of infection in immunosuppressed children, but no comprehensive literature review and few case series have been published on the topic. A case series of 6 pediatric oncology patients with Zygomycetes infections cared for at our institution was constructed, and a concurrent search of the English language literature for Zygomycetes infections in children with oncologic disorders was undertaken. Our case series described 6 patients (5 male) between the ages of 2.5 and 19.5 years. One patient was diagnosed with rhinocerebral disease, 2 with rhinosinusitis, 2 with pulmonary involvement, and 1 with a gastrointestinal presentation. Five patients survived. Our literature review identified 82 cases from 61 studies. The mean subject age was 10.8 years (1.4 to 21.0 y). About 92.7% of all patients suffered from some form of leukemia, with 70.7% suffering from acute lymphoblastic leukemia. Overall, 58.5% of reported patients survived, with individuals with disseminated disease showing the worst prognosis (68.2% mortality) and those with cutaneous disease the best (14.3% mortality). Survival is increasingly reported in the literature, perhaps as a result of improved diagnostic capabilities, increased physician awareness and increased reliance on adjunctive surgical therapy.

  4. Antipsychotic drugs and risks of myocardial infarction: a self-controlled case series study.

    PubMed

    Brauer, Ruth; Smeeth, Liam; Anaya-Izquierdo, Karim; Timmis, Adam; Denaxas, Spiros C; Farrington, C Paddy; Whitaker, Heather; Hemingway, Harry; Douglas, Ian

    2015-04-21

    Antipsychotics increase the risk of stroke. Their effect on myocardial infarction remains uncertain because people prescribed and not prescribed antipsychotic drugs differ in their underlying vascular risk making between-person comparisons difficult to interpret. The aim of our study was to investigate this association using the self-controlled case series design that eliminates between-person confounding effects. All the patients with a first recorded myocardial infarction and prescription for an antipsychotic identified in the Clinical Practice Research Datalink linked to the Myocardial Ischaemia National Audit Project were selected for the self-controlled case series. The incidence ratio of myocardial infarction during risk periods following the initiation of antipsychotic use relative to unexposed periods was estimated within individuals. A classical case-control study was undertaken for comparative purposes comparing antipsychotic exposure among cases and matched controls. We identified 1546 exposed cases for the self-controlled case series and found evidence of an association during the first 30 days after the first prescription of an antipsychotic, for first-generation agents [incidence rate ratio (IRR) 2.82, 95% confidence interval (CI) 2.0-3.99] and second-generation agents (IRR: 2.5, 95% CI: 1.18-5.32). Similar results were found for the case-control study for new users of first- (OR: 3.19, 95% CI: 1.9-5.37) and second-generation agents (OR: 2.55, 95% CI: 0.93-7.01) within 30 days of their myocardial infarction. We found an increased risk of myocardial infarction in the period following the initiation of antipsychotics that was not attributable to differences between people prescribed and not prescribed antipsychotics. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology.

  5. Late-life homicide-suicide: a national case series in New Zealand.

    PubMed

    Cheung, Gary; Hatters Friedman, Susan; Sundram, Frederick

    2016-01-01

    Homicide-suicide is a rare event, but it has a significant impact on the family and community of the perpetrator and victim(s). The phenomenon of late-life homicide-suicide has not been previously studied in New Zealand, and there is only limited data in the international literature. The aim of this study is to systematically review coroners' records of late-life homicide-suicides in New Zealand. After ethics approval was granted, the Coronial Services of New Zealand was approached to provide records of all closed cases with a suicide verdict (age 65+) over a five-year period (July 2007-December 2012). Of the 225 suicides, 4 cases of homicide-suicide were identified (an estimated incidence of 0.12 per 100,000 per persons year). All four perpetrators were men; three had been farmers. Their ages ranged from 65 to 82. One case occurred in the context of an underlying psychiatric illness (psychotic depression in bipolar disorder). Firearms were used in three cases. Two cases were categorized as spousal/consortial subtype, one case as filicide-suicide, and one case as siblicide-suicide. The prospect of major social upheaval in the form of losing their homes was present in all four cases. The findings of this case series were consistent with the limited existing literature on homicide-suicide. Age-related biopsychosocial issues were highlighted in this case series of late-life homicide-suicide. Additionally, evaluating firearm licences in high-risk groups may represent a prevention strategy.

  6. Thumb reconstruction without formal pollicization in mirror hand deformity: a series of four cases.

    PubMed

    Al-Qattan, M M; Al-Kahtani, A R; Al-Sharif, E M; Al-Otaibi, N J

    2013-11-01

    Thumb reconstruction in mirror hands is usually done by pollicization. However, objective pinch strength and power grip data in mirror hands following pollicization are lacking. Alternative thumb reconstruction techniques include doing nothing, rotation osteotomy or syndactylization of the radial digits. In this article, we report a series of four cases of mirror hand deformity where the thumb was not reconstructed by formal pollicization. Two cases had non-classic mirror hand deformity (the forearm contained a radius and an ulna) and the other two had classic ulnar dimelia. In all cases, thumb reconstruction was done by keeping one of the radial fingers in place (without pollicization) as the new thumb; and then (if required) performing a secondary osteotomy procedure to rotate the new thumb into pronation. The four cases were recalled back to the clinic for functional assessment at ages 20 years, 5 years, 4 years and 2 years, respectively. The overall hand function was considered 'fair' in the case with concurrent unique features, and was considered 'excellent' in the other three cases. It was concluded that the technique of thumb reconstruction used in the current series is an acceptable option. However, objective measurements, especially with regards to pinch strength and power grip, need to be compared with the pollicization technique.

  7. A case-series study of cerebral venous thrombosis in women using short course oral contraceptive

    PubMed Central

    Khomand, Payam; Hassanzadeh, Kambiz

    2016-01-01

    Background: We report a case series of cerebral vein thrombosis (CVT) in women who used oral contraceptive pill (OCP) in the Muslims Ramadan and fasting month. Methods: This study was a retrospective case series of 9 patients with diagnosis of CVT, who admitted in the neurology ward of Tohid Hospital of Sanandaj, Iran, in July-August 2014-2015. Results: Patients had no history of thrombosis before. They were treated with oral contraceptive more than 1 month to be able to fast during Ramadan. They did not have other possible risk factors for CVT. A headache was the most common in 9/9 patients (100%) followed by vomiting and vertigo. Conclusion: We found that high rate of CVT in female population during Ramadan indicates that it needs be considered as a specific risk factor and should be considered by healthcare system. PMID:27326364

  8. Complications associated with negative pressure reaming for harvesting autologous bone graft: a case series.

    PubMed

    Lowe, Jason A; Della Rocca, Gregory J; Murtha, Yvonne; Liporace, Frank A; Stover, Michael D; Nork, Sean E; Crist, Brett D

    2010-01-01

    A technical benefit of the reamer-irrigator-aspirator (RIA) system (Synthes, Paoli, PA) is the ability to harvest large volumes (40-90 cm3) of autogenous bone graft. Early evaluations of this technique have reported few problems, all of which were attributed to technical error. This case series reviews 6 RIA-associated complications including 4 fractures and their contributing risk factors. Cases were collected from 4 independent orthopaedic centers, and all patients underwent RIA bone graft harvesting in a lower extremity long bone injuries. In this population, 2 patients experienced acute RIA-associated events, necessitating an additional procedure or altered postoperative rehabilitation, whereas 4 patients fractured through their donor site in the early postoperative period. This series suggests that surgeons should (1) preoperatively assess cortical diameters at long bone harvest sites, (2) carefully monitor intraoperative reaming, and (3) avoid RIA bone graft harvesting in patients with a history of osteoporosis or osteopenia unless postharvest intramedullary stabilization is considered.

  9. Buprenorphine/naloxone therapy for opioid refractory neuropathic pain following traumatic amputation: a case series.

    PubMed

    Licina, Lauren; Hamsher, Carlyle; Lautenschager, Karl; Dhanjal, Sandeep; Williams, Necia; Spevak, Christopher

    2013-07-01

    Phantom limb pain is a common consequence of limb amputation and is prevalent among the service members sustaining traumatic battlefield limb injuries during the conflicts in Iraq and Afghanistan. Current treatment to relieve phantom limb pain consists of physical, behavioral, and medical modalities including opioids and adjunct medications. Treatment failure resulting in persistent pain and disability may result. This case series describes four previously healthy service members who developed phantom limb pain following traumatic amputation successfully treated with buprenorphine/naloxone after failing traditional treatment. This is the first reported case series of patients expressing improved pain control with decreased frequency of phantom limb pain with the use of buprenorphine/naloxone instead of traditional opioid agonists. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

  10. Law enforcement-applied tourniquets: a case series of life-saving interventions.

    PubMed

    Callaway, David W; Robertson, Joshua; Sztajnkrycer, Matthew D

    2015-01-01

    Although the epidemiology of civilian trauma is distinct from that encountered in combat, in both settings, extremity hemorrhage remains a major preventable cause of potential mortality. The current paper describes the largest case series in the literature in which police officers arriving prior to emergency medical services applied commercially available field tourniquets to civilian victims of violent trauma. Although all 3 patients with vascular injury arrived at the receiving emergency department in extremis, they were successfully resuscitated and survived to discharge without major morbidity. While this outcome is likely multifactorial and highlights the exceptional care delivered by the modern trauma system, tourniquet application appears to have kept critically injured patients alive long enough to reach definitive trauma care. No patient had a tourniquet-related complication. This case series suggests that law enforcement officers can effectively identify indications for tourniquets and rapidly apply such life-saving interventions.

  11. Resolution of choroidal neovascularization secondary to punctate inner choroidopathy (PIC) with intravitreal anti-VEGF agents: a case series.

    PubMed

    Mangat, Simran S; Ramasamy, B; Prasad, Som; Walters, Gavin; Mohammed, Moin; Mckibbin, Martin

    2011-01-01

    Case series of four patients with CNVM secondary to PIC treated solely with anti VEGF in three cases and in combination with PDT in the other. This series reveals long term follow up (3 months to 28 months) which is currently not described in the literature.

  12. The FDA should eliminate the ambiguities in the current BCS biowaiver guidance and make public the drugs for which BCS biowaivers have been granted.

    PubMed

    Benet, L Z; Larregieu, C A

    2010-09-01

    Although US Food and Drug Administration (FDA)-approved Biopharmaceutics Classification System (BCS) class 1 drugs are designated as high-permeability drugs, in fact, the criterion utilized is high extent of absorption. This ambiguity should be eliminated, and the FDA criterion should explicitly be stated as > or =90% absorption based on absolute bioavailability or mass balance. Maintaining confidentiality regarding the drugs for which the FDA has approved BCS waivers of in vivo bioequivalence studies is not good public policy and should be reversed.

  13. Preduodenal portal vein: a 3-case series demonstrating varied presentations in infants.

    PubMed

    Kim, Soo-Hong; Cho, Yong-Hoon; Kim, Hae-Young

    2013-10-01

    Preduodenal portal vein, a rare anomaly, could be found in any age groups. In pediatrics it may present with a duodenal obstruction by itself or other coexisting anomalies; however it usually present with an asymptomatic or incidental findings during other surgery in adults. This anomaly has a clinical importance due to the possibility of accidental damage to portal vein. In addition to describing a series of 3 cases with different manifestation in infants, discuss about this anomaly with a review of relevant literature.

  14. Aripiprazole, a partial dopamine agonist to improve adolescent anorexia nervosa-A case series.

    PubMed

    Frank, Guido K W

    2016-05-01

    Anorexia nervosa (AN) is a severe and complex psychiatric disorder and no medication has been approved for its treatment. This case series in youth with severe, recurrent AN supports the hypothesis that dopamine receptor agonists could be helpful in supporting fear extinction during eating disorder focused psychotherapy and therefore support recovery from AN. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:529-533).

  15. Management of Lower Extremity and Pelvic Tumors Using Computer Assisted Modeling (CAM) A Case Series.

    PubMed

    Haskoor, John; Sinno, Sammy; Blank, Alan; Saadeh, Pierre; Rapp, Timothy

    2016-06-01

    Computer assisted modeling (CAM) has become an important tool in surgical oncology and reconstructive surgery. The preservation of the limb is an important consideration when approaching the treatment of lower extremity and pelvic tumors. The use of cutting guides allows for optimal conservation of disease-free bone and maintenance of function. We present a small case series that illustrates the use of CAM in patients with lower extremity and pelvic bone tumors.

  16. Case series of equine pituitary pars intermedia dysfunction in a tropical climate.

    PubMed

    Spelta, C W; Axon, J E

    2012-11-01

    The clinical manifestations of equine pituitary pars intermedia dysfunction (PPID) in temperate climates are well described. The classic presentation is that of an older animal with hirsutism, laminitis, poor muscle tone, pendulous abdomen and weight loss. This case series highlights the additional clinical signs of anhidrosis and heat stress with secondary exercise intolerance that were seen as primary presenting problems in equids with PPID in the hot, humid conditions of a tropical climate. The clinical signs resolved with medical treatment for PPID.

  17. Hypothalamic-pituitary sarcoidosis with vision loss and hypopituitarism: case series and literature review.

    PubMed

    Anthony, Jeremy; Esper, Gregory J; Ioachimescu, Adriana

    2016-02-01

    Hypothalamic-pituitary (HP) neurosarcoidosis (NS) accounts for 0.5 % cases of sarcoidosis and 1 % of HP masses. Correlative data on endocrine and neurological outcomes is lacking. Retrospective case series and literature review of presentation, treatment and outcome of HP NS. Our series includes 4 men, ages 34-59, followed for a median of 7.3 years (range 1.5-17). All had optic neuropathy, multiple pituitary hormone abnormalities (PHAs) and other organ involvement by sarcoidosis (lung, sino-nasal, brain/spine and facial nerve). Two patients had central diabetes insipidus and one impaired thirst with polydipsia. After treatment with high-dose glucocorticoids, optic neuropathy improved in one case and stabilized in the others. After treatment, HP lesions improved radiologically, but PHAs persisted in all cases. Review of four published series on HP NS in addition to ours yielded 46 patients, age 37 ± 11.8 years, 65 % male. PHAs consisted of anterior hypopituitarism (LH/FSH 88.8 %, TSH 67.4 %, GH 50.0 %, ACTH 48.8 %), hyperprolactinemia (48.8 %) and diabetes insipidus (65.2 %). PHAs were the first sign of disease in 54.3 % patients. Vision problems occurred in 28.3 % patients, but optic neuropathy was not well documented in previous series. Most patients (93.5 %) received high-dose glucocorticoids followed by taper; 50 % also received other immunomodulators, including methotrexate, mycophenolate mofetil, cyclosporine, azathioprine, infliximab and hydrochloroquine. Only 13 % patients showed improvement in PHAs. All-cause mortality was 8.7 %. HP NS is a serious disease requiring multidisciplinary treatment and lifelong follow-up. Prospective multicentric studies are needed to determine a more standardized approach to HP NS and outline predictors of disease outcome.

  18. Clinical outcomes following manual physical therapy and exercise for hip osteoarthritis: A case series.

    PubMed

    MacDonald, Cameron W; Whitman, Julie M; Cleland, Joshua A; Smith, Marcia; Hoeksma, Hugo L

    2006-08-01

    Case series describing the outcomes of individual patients with hip osteoarthritis treated with manual physical therapy and exercise. Seven patients referred to physical therapy with hip osteoarthritis and/or hip pain were included in this case series. All patients were treated with manual physical therapy followed by exercises to maximize strength and range of motion. Six of 7 patients completed a Harris Hip Score at initial examination and discharge from physical therapy, and 1 patient completed a Global Rating of Change Scale at discharge. Three males and 4 females with a median age of 62 years (range, 52-80 years) and median duration of symptoms of 9 months (range, 2-60 months) participated in this case series. The median number of physical therapy sessions attended was 5 (range, 4-12). The median increase in total passive range of motion of the hip was 82 degrees (range, 70 degrees-86 degrees). The median improvement on the Harris Hip Score was 25 points (range, 15-38 points). The single patient who completed the Global Rating of Change Scale at discharge reported being "a great deal better." Numeric pain rating scores decreased by a mean of 5 points (range, 2-7 points) on 0-to-10-point scale. All patients exhibited reductions in pain and increases in passive range of motion, as well as a clinically meaningful improvement in function. Although we can not infer a cause and effect relationship from a case series, the outcomes with these patients are similar to others reported in the literature that have demonstrated superior clinical outcomes associated with manual physical therapy and exercise for hip osteoarthritis compared to exercise alone.

  19. Effective palliative radiofrequency ablation for tumors causing pain, numbness and motor function disorders: case series.

    PubMed

    Hamamoto, Shinichi; Matsuoka, Toshiyuki; Okuma, Tomohisa; Yamamoto, Akira; Hamuro, Masao; Miki, Yukio

    2014-10-28

    We present a case series of a palliative radiofrequency ablation (RFA) for the tumors that lead to the resolution of pain and motor function disorders. RFA is widely used on tumors in various organs and often reported in good outcome. There are some reports that RFA was performed as a palliative treatment but a few reports of RFA that performed for lung tumor as a palliative treatment. This case series includes two cases, palliative RFA for a sacrum and a lung tumor. The results of this case series presented that a palliative RFA is effective in improving the symptoms of patients. Case 1. A 64-year-old Japanese woman with a chordoma at her sacrum presented with pain in her left leg and claudication. Though operations, radiation therapy and GS-TAE (gelatin sponge-transarterial embolization, via the L5 lumbar artery) were performed, the size of the tumor leading pain and claudication increased. RFA was performed for the sacral tumor, and these symptoms resolved one year after the procedure. Case 2. A 68-year-old Japanese man with a leiomyosarcoma at the apex of left lung presented with pain and motor function disorders of the left upper limb. Dissemination in the pleura was appeared after the operation for a leiomyosarcoma at the mediastinum. Though radiation therapy and a second operation were performed, the tumor at the apex of the left lung increased and pain and numbness of the left upper limb were appeared after the second operation. RFA was performed for the left lung tumor, and the symptoms resolved 3 months after RFA. RFA is effective as a palliative treatment and has a potential to salvage the patients from the symptoms of the tumors when conventional palliative treatments such as surgery, radiation therapy, and chemotherapy are difficult or contraindicated.

  20. Infrequent Reservoir‐Related Complications of Urologic Prosthetics: A Case Series and Literature Review

    PubMed Central

    Terlecki, Ryan; Mirzazadeh, Majid

    2015-01-01

    Abstract Introduction and Aim Complications related to inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) reservoirs are rare, potentially life threatening, and poorly described in the literature. As more devices are implanted, the incidence of reservoir‐related complications may increase, and it will be important to recognize the relevant signs and symptoms. Methods and Main Outcome Measures We present a case series of reservoir‐related complications presenting to our institution for treatment. We also reviewed all accounts of reservoir‐related complications within the urologic literature Results Three cases of reservoir‐related complications are presented. Case 1 involves erosion of an intact AUS reservoir into the cecum of a patient with a history of myelomeningocele and bladder augmentation. Case 2 involves an IPP reservoir causing vascular compression, resulting in open exploration and repositioning of the reservoir. Case 3 involves intraperitoneal migration of a retained IPP reservoir to a subhepatic area, which was then removed laparoscopically. Literature review yielded descriptions of eight cases of intestinal complications, five cases of vascular complications, but zero reports of migration to a subhepatic area. Other notable complications include 20 reported cases of reservoir erosion into the bladder and inguinal herniation of the reservoir. Conclusion Complications involving urologic prosthesis reservoirs, although rare, can have serious implications for patients. A high index of suspicion and familiarity with treatment options is required in order to allow timely diagnosis and appropriate treatment. Patients with prior major abdominal surgeries seem to be more prone to intestinal complications of reservoirs and warrant special concern. Cui T, Terlecki R, and Mirzazadeh M. Infrequent reservoir‐related complications of urologic prosthetics: A case series and literature review. Sex Med 2015;3:334–338. PMID:26797069

  1. Infrequent Reservoir-Related Complications of Urologic Prosthetics: A Case Series and Literature Review.

    PubMed

    Cui, Tao; Terlecki, Ryan; Mirzazadeh, Majid

    2015-12-01

    Complications related to inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) reservoirs are rare, potentially life threatening, and poorly described in the literature. As more devices are implanted, the incidence of reservoir-related complications may increase, and it will be important to recognize the relevant signs and symptoms. We present a case series of reservoir-related complications presenting to our institution for treatment. We also reviewed all accounts of reservoir-related complications within the urologic literature. Three cases of reservoir-related complications are presented. Case 1 involves erosion of an intact AUS reservoir into the cecum of a patient with a history of myelomeningocele and bladder augmentation. Case 2 involves an IPP reservoir causing vascular compression, resulting in open exploration and repositioning of the reservoir. Case 3 involves intraperitoneal migration of a retained IPP reservoir to a subhepatic area, which was then removed laparoscopically. Literature review yielded descriptions of eight cases of intestinal complications, five cases of vascular complications, but zero reports of migration to a subhepatic area. Other notable complications include 20 reported cases of reservoir erosion into the bladder and inguinal herniation of the reservoir. Complications involving urologic prosthesis reservoirs, although rare, can have serious implications for patients. A high index of suspicion and familiarity with treatment options is required in order to allow timely diagnosis and appropriate treatment. Patients with prior major abdominal surgeries seem to be more prone to intestinal complications of reservoirs and warrant special concern. Cui T, Terlecki R, and Mirzazadeh M. Infrequent reservoir-related complications of urologic prosthetics: A case series and literature review. Sex Med 2015;3:334-338.

  2. Successful Rituximab Therapy in Steroid-Resistant, Cryptogenic Organizing Pneumonia: A Case Series.

    PubMed

    Shitenberg, Dorit; Fruchter, Oren; Fridel, Ludmila; Kramer, Mordechai R

    2015-01-01

    Cryptogenic organizing pneumonia (COP) is an interstitial lung disease that is usually responsive to corticosteroid treatment. The treatment of COP has not been studied in randomized controlled trials; thus, treatment decisions are based on practice guidelines. We herein present, for the first time, 4 cases of patients with biopsy-proven COP who did not respond to corticosteroids but benefited from rituximab therapy. This report consists of a retrospective case series of patients who experienced steroid-resistant, biopsy-proven COP. Patients included in this case series suffered from acute or chronic COP and did not respond to corticosteroid treatment for a few weeks to months but later responded to rituximab. In a series of 4 patients, 1 patient had a complete radiological and clinical response after rituximab therapy, and the steroids could be gradually tapered. Three patients had a chronic course but had been able to lower steroid dosage or even discontinue the drug after being treated with rituximab. Since 40% of the patients with COP do not respond to or stay dependent on steroids, we think that even the ability to lower the steroid dosage by using rituximab as a steroid-sparing agent with a good safety profile is worth the effort. However, further studies are warranted. © 2015 S. Karger AG, Basel.

  3. Forecasting malaria cases using climatic factors in delhi, India: a time series analysis.

    PubMed

    Kumar, Varun; Mangal, Abha; Panesar, Sanjeet; Yadav, Geeta; Talwar, Richa; Raut, Deepak; Singh, Saudan

    2014-01-01

    Background. Malaria still remains a public health problem in developing countries and changing environmental and climatic factors pose the biggest challenge in fighting against the scourge of malaria. Therefore, the study was designed to forecast malaria cases using climatic factors as predictors in Delhi, India. Methods. The total number of monthly cases of malaria slide positives occurring from January 2006 to December 2013 was taken from the register maintained at the malaria clinic at Rural Health Training Centre (RHTC), Najafgarh, Delhi. Climatic data of monthly mean rainfall, relative humidity, and mean maximum temperature were taken from Regional Meteorological Centre, Delhi. Expert modeler of SPSS ver. 21 was used for analyzing the time series data. Results. Autoregressive integrated moving average, ARIMA (0,1,1) (0,1,0)(12), was the best fit model and it could explain 72.5% variability in the time series data. Rainfall (P value = 0.004) and relative humidity (P value = 0.001) were found to be significant predictors for malaria transmission in the study area. Seasonal adjusted factor (SAF) for malaria cases shows peak during the months of August and September. Conclusion. ARIMA models of time series analysis is a simple and reliable tool for producing reliable forecasts for malaria in Delhi, India.

  4. CASE SERIES: CLINICAL SALMONELLOSIS IN FOUR BLACK RHINOCEROS (DICEROS BICORNIS) CALVES.

    PubMed

    Love, David; Madrigal, Rodolfo; Cerveny, Shannon; Raines, Janis; Rideout, Bruce; Lung, Nancy P

    2017-06-01

    Although Salmonella spp. infection has been identified in captive and free-ranging rhinoceros, clinical cases in black rhinoceros ( Diceros bicornis ) calves have not been described. This case series describes clinical salmonellosis in four black rhinoceros calves. Two calves developed self-limiting diarrhea, recovering after treatment. The other two cases were fatal. One of the fatal cases had a short clinical course, whereas the other case was protracted, with signs reflecting multiple organ system involvement. In all cases, diagnosis was by fecal culture and/or quantitative polymerase chain reaction. A variable clinical presentation, which is typical for salmonellosis in domestic hoofstock, was a feature of these rhinoceros cases. Similarly, postmortem pathology in black rhinoceros calves was consistent with domestic neonatal ungulates with salmonellosis. Potential predisposing factors for infection were considered to be primiparity of the dam and failure of passive transfer in the calf. The case investigation included attempts to identify the source of infection, which was aided by organism serotyping. In one case, the patient's dam and another conspecific in the facility were shown to be asymptomatic shedders of the organism strain responsible for disease in the calf. Further surveillance of captive rhinoceros Salmonella spp. carrier status is needed to inform screening recommendations for this taxa.

  5. Treatment of ranula using carbon dioxide laser--case series report.

    PubMed

    Lai, J B; Poon, C Y

    2009-10-01

    Ranulas are mucus extravasation phenomenon formed after trauma to the sublingual gland or mucus retention from the obstruction of the sublingual ducts. There are various methods for treating ranulas, including marsupialization with or without open packing, excision of ranula with or without removal of sublingual gland, and laser excision and vaporization of ranula. The authors present a case series report on the use of carbon dioxide laser treatment for ranula and a literature review of cases treated using carbon dioxide laser. The authors' experience and reports in the literature indicate that carbon dioxide laser excision of ranula is safe with minimal or no recurrence.

  6. Preamputation mirror therapy may prevent development of phantom limb pain: a case series.

    PubMed

    Hanling, Steven R; Wallace, Scott C; Hollenbeck, Kerry J; Belnap, Brian D; Tulis, Matthew R

    2010-02-01

    We report the cases of 4 patients who performed daily mirror therapy for 2 wk before undergoing elective limb amputation. One patient experienced no phantom limb pain (PLP). Two patients experienced rare episodes of mild PLP without effect on their participation in physical therapy (PT) or their quality of life. One patient reported daily, brief episodes of moderate PLP without effect on his participation in PT or his stated quality of life. These results indicate that preoperative mirror therapy may improve postamputation PT compliance and decrease the incidence of PLP. Future prospective studies are needed to confirm the results of this case series.

  7. Case series of three different scenarios with drug-induced Brugada patterns: fact or fiction?

    PubMed

    Asil, Serkan; Canpolat, Uğur; Kaya, Ergün Barış; Aytemir, Kudret; Kabakçı, Giray

    2017-10-01

    Brugada syndrome is an inherited cardiac arrhythmia condition characterized by coved-type ST elevation and J point elevation of at least 2 mm in at least 2 of the right precordial electrocardiogram (ECG) leads (V1-3). An increasing number of noncardiac agents, including psychotropic and anesthetic drugs, have been shown to induce a characteristic Brugada ECG pattern, predisposing the patient to fatal ventricular arrhythmias. However, there are scarce data regarding the clinical significance. In this case series, a typical Brugada pattern was unmasked by lithium, valproic acid, and thiocolchicoside; however, the clinical scenario was different in all 3 cases, ranging from an asymptomatic patient to sudden cardiac arrest.

  8. Definitive palliation for neoplastic colonic obstruction using enteral stents: Personal case-series with literature review

    PubMed Central

    Piccinni, Giuseppe; Angrisano, Anna; Testini, Mario; Bonomo, G. Martino

    2004-01-01

    Acute colonic obstruction due to malignancies is an emergency that requires surgical treatment. Elderly patients or inoperable tumors require intestinal decompression that is a simple colostomy in almost all cases. This “manoeuvre” leads the patient to a percentage of mortality/morbidity and to a bad quality of life due to acceptance of stoma. The introduction of enteral metal stent inserted endoscopically has, in our opinion, provided a new way to obtaining the definitive palliation of inoperable colo-rectal cancer with a simple method. We reported our case-series and we analyzed the current literature and costs of treatments. PMID:14991956

  9. Rotational drift of mandibular third molar teeth: a series of four cases.

    PubMed

    Hughes, A J; Vudiniabola, S T; McMillan, B D; Smith, A C

    2009-03-01

    Rotational drift of mandibular third molar teeth is a challenge for clinicians to predict and manage. Evidence on the incidence and degree of rotation is sparse. As the factors influencing rotation are not defined, prediction is impossible. A series of four cases with lower third molar rotation are presented and discussed. Significant rotation can alter the degree of difficulty for an extraction. A lack of well-documented cases has hindered investigation of this phenomenon. Further research is required to identify the aetiology, incidence and increase in risk factors caused by such rotational drift.

  10. Sheehan's syndrome with pancytopenia--complete recovery after hormone replacement (case series with review).

    PubMed

    Laway, Bashir Ahmad; Bhat, Javid Rasool; Mir, Shahnaz Ahmad; Khan, Raja Sultan Zaman; Lone, Mohd Iqbal; Zargar, Abdul Hamid

    2010-03-01

    Reports of pancytopenia in patients with Sheehan's syndrome are rare, because the disorder is not commonly seen in western countries. A case series of pancytopenia in three patients of Sheehan's syndrome is presented. Three women aged 22, 30, and 34 years developed Sheehan's syndrome preceded by post partum hemorrhage. During investigations, they were found to have pancytopenia with hypocellular marrow. Treatment with thyroxine and glucocorticoids resulted in complete recovery after attaining euthyroid and eucortisolemic state. Review of literature revealed the rarity of the disorder, with only four cases reported so far. Multiple anterior pituitary hormone deficiencies in Sheehan's syndrome are responsible for pancytopenia; replacement of thyroid and cortisol hormones results in complete recovery.

  11. Perioperative considerations in adult mitochondrial disease: A case series and a review of 111 cases.

    PubMed

    Miyamoto, Yuri; Miyashita, Tetsuya; Takaki, Shunsuke; Goto, Takahisa

    2016-01-01

    Mitochondrial disease has been uncommon conditions, still results in death during childhood in many cases. The ideal anesthetic pharmacological management strategy for adult patients with mitochondrial disease is currently unclear. In this study, we presented features of the anesthesia methods employed and the perioperative complications of patients in our institution and in previously published case reports. We report the use of general anesthesia 7 times in 6 adult patients with mitochondrial disease during 2004-2014. All cases were performed with maintained intravenous anesthesia. One case was reintubated on the day after surgery, but the cause of death was not directly related to anesthesia. One hundred and eleven general anesthesia cases in 97 adult patients with mitochondrial disease were described in 83 the literature. Although several severe perioperative complications and deaths have been reported, malignant hyperthermia had not been reported in adult cases, and metabolic disorder called propofol infusion syndrome had also not been reported in adult patients undergone total intravenous anesthesia. Perioperative complications of lactic acidosis were reported more in inhalation anesthesia than intravenous anesthesia. Therefore we recommended intravenous anesthesia rather than inhalation anesthesia for adult mitochondrial disease.

  12. Symptomatic infantile Helicobacter pylori gastritis infection in indigenous African infants: a case series.

    PubMed

    Malande, Oliver Ombeva

    2014-01-01

    Helicobacter pylori gastritis infection rate increases with age. Higher rates have however been reported among young people in the developing countries of the world. The infection however has rarely been reported in infants, especially in Africa. This case series describes three cases of Helicobacter pylori gastritis infection as diagnosed in three infants. The goal is to raise the suspicion index of medical practitioners about the possibility of this this infection among infants who present with suggestive symptoms. On three separate occasions in 2012 and 2013, three ill, indigenous, black African female infants aged 4, 6 and 7 months, were brought to hospital with symptoms ranging from fever, refusal to feed, diarrhoea, restlessness, vomiting and irritability. In each case, systemic examination findings were unremarkable. After several laboratory investigations, each infant was found to have Helicobacter pylori infection following positive blood antibody (using Tell Me Fast H. Pylori antibody serum and Plasma test manufactured by Biocan Diagnostics Canada) and fecal HpSA ImmunoCardSTAT antigen tests. Repeat stool antigen test was negative in each case after completion of the recommended triple therapy. Helicobacter pylori infection has been rarely reported among infants. This case series highlights the need for health care providers to have a high index of suspicion so that infants with suggestive symptoms, especially in settings with high Helicobacter pylori colonization prevalence can be evaluated for Helicobacter pylori gastritis infection.

  13. High-Resolution Optical Coherence Tomography Retinal Imaging: A Case Series Illustrating Potential and Limitations

    PubMed Central

    Puzyeyeva, Olena; Lam, Wai Ching; Flanagan, John G.; Brent, Michael H.; Devenyi, Robert G.; Mandelcorn, Mark S.; Wong, Tien; Hudson, Christopher

    2011-01-01

    Purpose. To present a series of retinal disease cases that were imaged by spectral domain optical coherence tomography (SD-OCT) in order to illustrate the potential and limitations of this new imaging modality. Methods. The series comprised four selected cases (one case each) of age-related macular degeneration (ARMD), diabetic retinopathy (DR), central retinal artery occlusion (CRAO), and branch retinal vein occlusion (BRVO). Patients were imaged using the Heidelberg Spectralis (Heidelberg Engineering, Germany) in SD-OCT mode. Patients also underwent digital fundus photography and clinical assessment. Results. SD-OCT imaging of a case of age-related macular degeneration revealed a subfoveal choroidal neovascular membrane with detachment of the retinal pigment epithelium (RPE) and neurosensory retina. Using SD-OCT, the cases of DR and BRVO both exhibited macular edema with cystoid spaces visible in the outer retina. Conclusions. The ability of SD-OCT to clearly and objectively elucidate subtle morphological changes within the retinal layers provides information that can be used to formulate diagnoses with greater confidence. PMID:21969910

  14. Bayesian analysis of time-series data under case-crossover designs: posterior equivalence and inference.

    PubMed

    Li, Shi; Mukherjee, Bhramar; Batterman, Stuart; Ghosh, Malay

    2013-12-01

    Case-crossover designs are widely used to study short-term exposure effects on the risk of acute adverse health events. While the frequentist literature on this topic is vast, there is no Bayesian work in this general area. The contribution of this paper is twofold. First, the paper establishes Bayesian equivalence results that require characterization of the set of priors under which the posterior distributions of the risk ratio parameters based on a case-crossover and time-series analysis are identical. Second, the paper studies inferential issues under case-crossover designs in a Bayesian framework. Traditionally, a conditional logistic regression is used for inference on risk-ratio parameters in case-crossover studies. We consider instead a more general full likelihood-based approach which makes less restrictive assumptions on the risk functions. Formulation of a full likelihood leads to growth in the number of parameters proportional to the sample size. We propose a semi-parametric Bayesian approach using a Dirichlet process prior to handle the random nuisance parameters that appear in a full likelihood formulation. We carry out a simulation study to compare the Bayesian methods based on full and conditional likelihood with the standard frequentist approaches for case-crossover and time-series analysis. The proposed methods are illustrated through the Detroit Asthma Morbidity, Air Quality and Traffic study, which examines the association between acute asthma risk and ambient air pollutant concentrations.

  15. Provision of pandemic disease information by health sciences librarians: a multisite comparative case series.

    PubMed

    Featherstone, Robin M; Boldt, R Gabriel; Torabi, Nazi; Konrad, Shauna-Lee

    2012-04-01

    The research provides an understanding of pandemic information needs and informs professional development initiatives for librarians in disaster medicine. Utilizing a multisite, comparative case series design, the researchers conducted semi-structured interviews and examined supplementary materials in the form of organizational documents, correspondence, and websites to create a complete picture of each case. The rigor of the case series was ensured through data and investigator triangulation. Interview transcripts were coded using NVivo to identify common themes and points of comparison. Comparison of the four cases revealed a distinct difference between "client-initiated" and "librarian-initiated" provision of pandemic information. Librarian-initiated projects utilized social software to "push" information, whereas client-initiated projects operated within patron-determined parameters to deliver information. Health care administrators were identified as a key audience for pandemic information, and news agencies were utilized as essential information sources. Librarians' skills at evaluating available information proved crucial for selecting best-quality evidence to support administrative decision making. Qualitative analysis resulted in increased understanding of pandemic information needs and identified best practices for disseminating information during periods of high organizational stress caused by an influx of new cases of an unknown infectious disease.

  16. A PARAMETRIC STUDY OF BCS RF SURFACE IMPEDANCE WITH MAGNETIC FIELD USING THE XIAO CODE

    SciTech Connect

    Reece, Charles E.; Xiao, Binping

    2013-09-01

    A recent new analysis of field-dependent BCS rf surface impedance based on moving Cooper pairs has been presented.[1] Using this analysis coded in Mathematica TM, survey calculations have been completed which examine the sensitivities of this surface impedance to variation of the BCS material parameters and temperature. The results present a refined description of the "best theoretical" performance available to potential applications with corresponding materials.

  17. Prosthetic joint infection caused by Pasteurella multocida: a case series and review of literature.

    PubMed

    Honnorat, Estelle; Seng, Piseth; Savini, Hélène; Pinelli, Pierre-Olivier; Simon, Fabrice; Stein, Andreas

    2016-08-20

    Pasteurella multocida is a well-recognized zoonotic agent following dog or cat bites or scratches. Nevertheless, prosthetic joint infection caused by P. multocida are rarely reported. We report here a series of six cases of prosthetic joint infection caused by P. multocida managed at a referral centre for the treatment of bone and joint infection in southern France. We also reviewed the 26 cases reported in literature. The mean age of our cases was 74 years [±8.2, range 63-85]. In majority of our cases (5 cases) were associated with knee prostheses and one case with a hip prosthesis. Most of cases occurred after cat or dog scratches or licks or contact. Diagnoses of prosthetic joint infection caused by P. multocida were made by positive cultures of surgical biopsies or needle aspiration. Mean time delay between prosthetic joint implantation and infection onset was 7.6 years (±5.12 years, range 2-17). Local inflammation, which occurred in all six cases, was the most frequent clinical symptom, followed by pain in five cases, fever and swollen joints in four cases, and a fistula with purulent discharge inside the wound in two cases. The mean time of antibiotic therapy was 8 months. Surgical treatment with prosthesis removal was performed in three cases. Six of our cases were in remission without apparent relapse at 3 years after end of treatment. Prosthetic joint infections caused by P. multocida usually occur after animal scratches or bites, but can occasionally occur after a short animal lick. These infections are usually resulting from a contiguous infection and localized in the knee. An early antibiotic therapy after surgical debridement could avoid prosthetic withdrawal, notably in elderly patients. Patients with prosthetic joints should be warned that animals are potential sources of serious infection and urgent medical advice should be sought if they are bitten or scratched.

  18. Nail gun injuries to the head with minimal neurological consequences: a case series.

    PubMed

    Makoshi, Ziyad; AlKherayf, Fahad; Da Silva, Vasco; Lesiuk, Howard

    2016-03-16

    An estimated 3700 individuals are seen annually in US emergency departments for nail gun-related injuries. Approximately 45 cases have been reported in the literature concerning nail gun injuries penetrating the cranium. These cases pose a challenge for the neurosurgeon because of the uniqueness of each case, the dynamics of high pressure nail gun injuries, and the surgical planning to remove the foreign body without further vascular injury or uncontrolled intracranial hemorrhage. Here we present four cases of penetrating nail gun injuries with variable presentations. Case 1 is of a 33-year-old white man who sustained 10 nail gunshot injuries to his head. Case 2 is of a 51-year-old white man who sustained bi-temporal nail gun injuries to his head. Cases 3 and 4 are of two white men aged 22 years and 49 years with a single nail gun injury to the head. In the context of these individual cases and a review of similar cases in the literature we present surgical approaches and considerations in the management of nail gun injuries to the cranium. Case 1 presented with cranial nerve deficits, Case 2 required intubation for low Glasgow Coma Scale, while Cases 3 and 4 were neurologically intact on presentation. Three patients underwent angiography for assessment of vascular injury and all patients underwent surgical removal of foreign objects using a vice-grip. No neurological deficits were found in these patients on follow-up. Nail gun injuries can present with variable clinical status; mortality and morbidity is low for surgically managed isolated nail gun-related injuries to the head. The current case series describes the surgical use of a vice-grip for a good grip of the nail head and controlled extraction, and these patients appear to have a good postoperative prognosis with minimal neurological deficits postoperatively and on follow-up.

  19. ‘Look Beyond Skin’: Psychogenic Excoriation - A Series of Five Cases

    PubMed Central

    Nirmal, Balakrishnan; Shenoi, Shrutakirthi D; Rai, Shweta; Sreejayan, Kongasseri; Savitha, Soman

    2013-01-01

    Psychogenic excoriation is a condition where the patient picks the skin repetitively to produce excoriations. Treating this clinical entity is challenging as these patients often have an associated psychological abnormality. The five cases in this case series include two children and three adults. They presented with skin lesions ranging from excoriations and ulcers to scars and pigmentation. Detailed evaluation was done by clinical psychologist. Two cases had anxiety traits, one had alcohol dependence, one had difficult temperament and one had depressive symptoms. Habit reversal was introduced. Psychiatry referral was given for three cases and started on selective serotonin reuptake inhibitors. On follow-up, the urge to scratch reduced substantially and skin lesions were also improving. It is important to identify the underlying psychological disorder accounting for skin picking behavior. Incorporating psychotherapeutic techniques into clinical practice will improve the quality of life of many of these patients. PMID:23723517

  20. [Tuberculous spondylitis in adults: a case series from a reference hospital in Lima, Peru].

    PubMed

    Castillo-Angeles, Manuel; De la Cruz Luque, Celso; Zelada, Henry; Vilela-Sangay, Ana Rosa; Samalvides, Frine; Málaga, Germán

    2011-06-01

    We describe the demographic and clinical characteristics of adult patients with tuberculous spondylitis as well as an exploratory analysis that seeked to establish patient characteristics that contributed to the development of this disorder at a reference hospital in Lima. This is a case-series descriptive study where data collection from 33 medical records of patients from 1999 to 2009 was done. Eighteen (55%) were male. Median age was 31 years (IQR 23 to 51 years). Median time of symptoms was 3 months (IQR 1 to 8 months). The most frequent symptom was back pain in 28 (85%). The most frequently affected areas were the thoracic spine involved in 28 (60%) cases and lumbar spine in 13 (28%). Pulmonary tuberculosis was present in fourteen (42%) cases. Twenty four (73%) patients received first line treatment. Treatment duration was 10.5 ± 4.2 months. Clinical and diagnostic characteristics were similar to previous Peruvian case reports and current literature.