Interventional Management of Massive Hemothorax Due to Inadvertent Puncture of an Aberrant Right Subclavian Artery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jahnke, Thomas, E-mail: thomas.jahnke@gmx.net; Schaefer, Phillip Jost; Heller, Martin

2008-07-15

We report a case of massive hemothorax due to inadvertent puncture of an aberrant right subclavian artery during central venous access. Iatrogenic laceration at the origin of the right internal thoracic artery was successfully treated with coil embolization of the internal thoracic artery followed by stent-graft placement into the subclavian artery. Due to its elongated and abnormal course, an aberrant right subclavian artery may predispose to inadvertent puncture during vein catheterization and should be recognized as a potential threat for such procedures. Our case emphasizes that ultrasound guidance should be used routinely for central venous lines wherever possible.

Infective endocarditis due to Enterobacter cloacae resistant to third- and fourth-generation cephalosporins.

PubMed

Yoshino, Yusuke; Okugawa, Shu; Kimura, Satoshi; Makita, Eiko; Seo, Kazunori; Koga, Ichiro; Matsunaga, Naohisa; Kitazawa, Takatoshi; Ota, Yasuo

2015-04-01

We report the case of using a long-term combination of meropenem and amikacin to treat infective endocarditis caused by Enterobacter cloacae resistant to third- and fourth-generation cephalosporins. Multi-drug resistant Gram-negative bacilli, such as the E. cloacae in our study, may become possible pathogens of infective endocarditis. Our experience with this case indicates that long-term use of a combination of β-lactam and aminoglycosides might represent a suitable management option for future infective endocarditis cases due to non-Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella spp. (HACEK group) Gram-negative bacilli such as ours. Copyright © 2012. Published by Elsevier B.V.

Breakthrough mucormycosis after voriconazole use in a case of invasive fungal rhinosinusitis due to Curvularia lunata.

PubMed

Gupta, Nitin; Kumar, Arvind; Singh, Gagandeep; Ratnakar, Gogineni; Vinod, Kutty Sharada; Wig, Naveet

2017-01-01

Invasive fungal rhinosinusitis (FRS) is a potentially fatal illness requiring early diagnosis and aggressive treatment with surgery and antifungals. We report a case of chronic FRS in a recently diagnosed diabetic individual due to Curvularia lunata. Imaging revealed extension into the right orbit and right basifrontal lobe. This was further complicated by development of nosocomial mucormycosis which was attributed to voriconazole therapy. The patient responded well to debridement and amphotericin B based therapy. To our knowledge, there are no reported cases of invasive FRS due to Curvularia lunata. Also, breakthrough mucormycosis on voriconazole therapy is rarely seen in non-malignancy, non-transplant settings. The possibility of rare fungal infections (community and nosocomial) should be entertained in developing settings where fungal spores are ubiquitous.

A Motion Simulator Ride Associated With Headache and Subdural Hematoma: First Case Report.

PubMed

Scranton, Robert A; Evans, Randolph W; Baskin, David S

2016-02-01

We report the first case report of symptomatic bilateral subdural hematomas (SDH) associated with riding a centrifugal motion simulator ride. A previously healthy 55-year-old male developed new onset daily headaches 1 week after going on the ride that were due to symptomatic bilateral SDH requiring operative intervention with a full recovery. There was no history of other trauma or other systemic or intracranial abnormality to account for the development of the SDH. We review the headaches and other clinical features associated with chronic SDH. Twelve cases of roller coaster headaches due to SDH associated with riding roller coasters have been reported. The pathophysiology is reviewed, which we believe is the same mechanism that may be responsible in this case. Although it is possible that this neurovascular injury is truly rare, it is also possible that this injury is underreported as patients and physicians may not make the association or physicians have not reported additional cases. The risk of this injury likely increases with age, as the size of the subdural space increases, and may support the maxim that "roller coasters and simulators are for kids." © 2015 American Headache Society.

[Death by erotic asphyxiation (breath control play)].

PubMed

Madea, Burkhard; Hagemeier, Lars

2013-01-01

Most cases of sexual asphyxia are due to autoerotic activity. Asphyxia due to oronasal occlusion is mostly seen in very old or very young victims. Oronasal occlusion is also used in sadomasochistic sexual practices like "breath control play" or "erotic asphyxiation". If life saving time limitations of oronasal occlusion are not observed, conviction for homicide caused by negligence is possible.

[Trochanteric bursitis due to tuberculosis in an immunocompetent young woman].

PubMed

Soro Marín, Sandra; Sánchez Trenado, María Asunción; Mínguez Sánchez, María Dolores; Paulino Huertas, Marcos; García Morales, Paula Virginia; Salas Manzanedo, Verónica

2012-01-01

Soft tissue infection due to Mycobacterium tuberculosis can affect muscle, tendons, fascia, bursa and synovial tissue. Tuberculous trochanteric bursitis is a rare entity that usually affects immunocompromised patients. Manifestations usually occur insidiously, which delays diagnosis and treatment. We present the case of an immunocompetent young woman who came to our department for chronic left hip pain. The study confirms the diagnosis of tuberculous trochanteric bursitis. This case demonstrates the importance of considering a possible infectious origin of bursitis in immunocompetent patients. Copyright © 2010 Elsevier España, S.L. All rights reserved.

Parasystole due to re-entry as the possible mechanism of ventricular parasystole with second-degree entrance block.

PubMed

Kinoshita, Shinji; Katoh, Takakazu; Yoshida, Hiroshi

2010-05-01

In 1974, Kinoshita reported a case of 'irregular parasystole' due to type I second-degree entrance block. Since then, many cases of such 'irregular' parasystole have been reported by us. To explain the mechanism of 'irregular' parasystole, two theories have been suggested, namely, 'electrotonic modulation' by Jalife and Moe, and 'type I second-degree entrance block' by us. On the contrary, in 1960, Kinoshita et al. reported a case of concealed bigeminy for the first time. The electrocardiographic findings in concealed bigeminy have suggested that there are dual re-entrant pathways with markedly long effective refractory periods in the re-entrant pathway. We have suggested that parasystole may be caused by re-entry in such re-entrant pathways. In this article, attempts are made to explain the mechanism of all the electrocardiographic findings in our cases of parasystole by 'parasystole due to re-entry'. Using 24 studies on parasystole and 21 studies on concealed extrasystoles that we have reported over 50 years, as well as three exemplary cases in this article, attempts are made to explain all electrocardiographic findings in parasystole by 'parasystole due to re-entry'. The electrocardiographic findings in our previous clinical cases of parasystole and concealed extrasystoles, as well as exemplary cases and diagrams in the present article, strongly suggest 'parasystole due to re-entry' as the mechanism of ventricular parasystole with second-degree entrance block.

Air bag-mediated fatal craniocervical trauma: a case report.

PubMed

Büyük, Yalçin; Uzün, Ibrahim; Erkol, Zerrin; Ağritmiş, Hasan; Ustündağ, Kasim T

2010-07-01

This case report describes a four-year-old girl (102 cm, 17 kg) who sustained fatal craniocerebral injuries as a result of an inflating automobile air bag. The car struck the lid of the sewer system, which was 15 cm above the ground level, at a low speed, and both the driver and passenger air bags inflated. Despite the fact that air bag usage has lessened both the possibility and severity of occupant injuries in frontal collisions, case reports of serious injuries and even deaths especially in children due to air bag deployment, particularly during low speed impacts, highlight the need for changes in both system design and possibly the threshold speed of air bag deployment.

[Multiresistant tuberculosis in Denmark 1993-1996].

PubMed

Viskum, K; Kok-Jensen, A

1998-05-18

Infections with multiresistant tubercle bacilli have also become a problem in the rich part of the world. The reasons are lack of compliance in patients with life style problems and ineffectiveness of the health system due to lack of fundings. During a four year period, 1993-1996 ten patients were seen in Denmark with tuberculosis due to multiresistant Mycobacterium tuberculosis. Nine were infected abroad, one developed MDR-TB during treatment in Denmark. It is possible to cure these patients, but it is expensive and takes a long time. In the future more cases created within Denmark are likely to be seen due to lack of funding for the tuberculosis programme and, depending on immigration, further cases created abroad are expected.

Prevalence of Autism in an Urban Population of Adults with Severe Intellectual Disabilities--A Preliminary Study

ERIC Educational Resources Information Center

Saemundsen, Evald; Juliusson, H.; Hjaltested, S.; Gunnarsdottir, T.; Halldorsdottir, T.; Hreidarsson, S.; Magnusson, P.

2010-01-01

Background: Research on the prevalence of autism in Iceland has indicated that one possible explanation of fewer autism cases in older age groups was due to an underestimation of autism in individuals with intellectual disabilities (IDs). The present study systematically searched for autism cases in the adult population of individuals with severe…

Liability for Off-Campus Injuries.

ERIC Educational Resources Information Center

Zirkel, Perry A.; Gluckman, Ivan B.

1984-01-01

Liability in cases involving students injured off school property generally hinges on whether districts fail to exercise due care in supervising students while on school premises. Typical activities that may occasion liability for negligence and possible defenses are listed. (MJL)

Multi-organ dysfunction in bodybuilding possibly caused by prolonged hypercalcemia due to multi-substance abuse: case report and review of literature.

PubMed

Schäfer, C N; Guldager, H; Jørgensen, H L

2011-01-01

A 26-year-old male bodybuilder was admitted to the surgical department of a Danish community hospital for hematemesis. During the clinical interview, he revealed that he had recently finished a course of anabolic steroids and erythropoietin. The patient also had a previous history of infections and chronic ulcers due to paraffin-oil injections in both upper arms one year before. Over the course of the next few hours, the patient developed signs of multi-organ dysfunction, including pancreatitis, hemorrhagic gastritis, nephropathy with temporary anuria, and respiratory insufficiency, and was transferred to the ICU. After manometric monitoring on the patient's upper arms proved difficult, invasive blood pressure monitoring was used and revealed that the patient was in a state of hypertensive crisis. This case of multi-organ dysfunction was possibly caused by multi-substance-induced hypercalcemia. © Georg Thieme Verlag KG Stuttgart · New York.

Acute myocardial infarction in a young bodybuilder taking anabolic androgenic steroids: A case report and critical review of the literature.

PubMed

Christou, Georgios A; Christou, Konstantinos A; Nikas, Dimitrios N; Goudevenos, John A

2016-11-01

We describe a case report of a 30-year-old bodybuilder suffering acute myocardial infarction (AMI). He had been taking stanozolol and testosterone for two months. The coronary angiogram showed high thrombotic burden in the left anterior descending artery without underlying atherosclerosis. Few case reports of AMI in athletes taking anabolic androgenic steroids (AASs) have been reported so far. AAS-related AMI is possibly underreported in the medical literature due to the desire of the affected individuals to hide AAS use. Physicians should always consider the possibility of AAS abuse in the context of a young athlete suffering AMI. AASs can predispose to AMI through the acceleration of coronary atherosclerosis. Additionally, thrombosis without underlying atherosclerosis or vasospasm is highly possible to cause AMI in AAS users. Complications after AMI may be more frequent in AAS users. © The European Society of Cardiology 2016.

[Metachronous Bilateral Hemothorax Due to Reverse Chance Type Thoracic Fracture].

PubMed

Fukada, Takehisa; Morita, Katsuhiko; Ueki, Takayuki; Hanaoka, Nobuharu

2017-06-01

Metachronous bilateral hemothorax due to reverse Chance type thoracic fracture is very rare. In this case, we experienced a case of metachronous bilateral hemothorax, triggered by a thoracic fracture in which the anterior component of the spine collapsed, so-called reverse Chance type thoracic fracture. An 83-year-old woman with spinal kyphosis traumatically injured thoracic spine burst fracture, and bone fragments appeared on both sides of the destroyed vertebra. After injury, the left hemothorax also appeared, followed by the right hemothorax causing hemorrhagic shock. In thoracic destructive anterior fracture, we should consider the possibility of metachronous bilateral hemothorax.

[Rectovaginal endometriosis--analysis of 160 cases].

PubMed

Wilczyński, Miłosz; Wiecka-Płusa, Monika; Antosiak, Beata; Maciołek-Blewniewska, Grazyna; Majchrzak-Baczmańska, Dominika; Malinowski, Andrzej

2015-12-01

The aim of the study was a retrospective analysis of the medical records of patients who underwent surgery due to deep infiltrating rectovaginal endometriosis (mainly with the use of the 'shaving' technique). We analysed 160 cases of patients who underwent surgery due to the deep infiltrating rectovaginal endometriosis in our ward between 2003-2014. Depending on lesion localization, disease severity and clinical characteristics, three possible ways of operation were proposed: laparoscopic, vaginal or a combined vagino-laparoscopic approach. A total of 120 patients underwent laparoscopic removal of the endometrial lesions, whereas 17 were operated vaginally and 23 with the use of the combined approach. Nodule resection was successfully performed in all cases. The combined vagino-laparoscopic operations were characterized by the longest operating time. The rate of perioperative complications was low in the group of patients who underwent laparoscopic or combined operations. The necessity of bowel wall suturing occurred in 15 cases. This procedure was performed in order to strengthen the bowel wall (in cases when no perforation occurred) or due to bowel resection during surgery. Unexpected bowel perforation occurred in only 5 cases. Conclusions: Vaginal, laparoscopic and the combined vagino-laparoscopic surgeries can be safely performed in cases of deep rectovaginal endometriosis.

Impurities in radioactive preparations (in German)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Koeppe, P.

1963-01-01

An account is given of some cases of radioactive impurities in radioactive preparations. The possibility that such impurities may be due to long-lived radionuclides must be considered in clinical applications and particularly in dealing with residues and containers (glass-ampulla).

Human Leptospirosis on Reunion Island: Past and Current Burden

PubMed Central

Pagès, Frédéric; Polycarpe, Dominique; Dehecq, Jean-Sébastien; Picardeau, Mathieu; Caillère, Nadège; Jaffar-Bandjee, Marie-Christine; Michault, Alain; Filleul, Laurent

2014-01-01

Since 1953, leptospirosis has been recognized as a public health problem on Reunion Island. In 2004, was implemented a specific surveillance system that included systematic reporting and the realization of environmental investigations around hospitalized cases. Here, we present the synthesis of historical data and the assessment of 9 years of leptospirosis surveillance. From 2004 to 2012, 414 hospitalized cases were reported. Cases of leptospirosis occurred mostly during the rainy season from December to May. Approximately 41% of infections occurred at home, 12% of infections occurred during aquatic leisure and 5% of cases were linked to professional activities. Furthermore, for 41% of cases, the place of infection could not be determined due to the accumulation of residential and non-residential exposure. Most of the cases of leptospirosis were linked to rural areas or traditional, rural occupations. We did not observe a shift to recreational leptospirosis as described in some developed countries. According to the new surveillance system, the number of reported cases has regularly increased since 2004. This situation is in part due to the improvement of the system in the first years but also to a real increase in the number of detected cases due to the introduction of molecular methods and to increased biological investigation into the Dengue-like syndrome by medical practitioners on the island since the Chikungunya crisis in 2006. This increase is probably due to surveillance and diagnosis biases but need to be carefully monitored. Nevertheless, the possibility of an outbreak is always present due to climatic events, such as after the “hyacinth” hurricane in 1980. PMID:24434593

Case of relentless chronic phase of chronic myeloid leukaemia.

PubMed

Chan, Onyee; Chen, Hao; Krishnadasan, Ravitharan; Anwer, Faiz

2016-06-22

Initial treatment of chronic phase chronic myeloid leukaemia is straightforward in today's era of tyrosine kinase inhibitors. However, managing refractory cases remain a major challenge due to the multiple factors that can influence decision-making, including medication tolerance, disease burden, mutation status, comorbidities, availability of donor, and fitness for an ablative conditioning. We report a male patient presenting with chronic phase chronic myeloid leukaemia who was treated with 5 different tyrosine kinase inhibitors either due to intolerance and/or failed response. He subsequently received 2 haploidentical haematopoietic stem cells transplants before achieving complete remission. This case highlights various treatment options, need for vigilant disease monitoring, and the possibility of complete positive response even after many lines of therapy failure. 2016 BMJ Publishing Group Ltd.

Diverticular disease of the colon presenting as pyometra: a case report.

PubMed

Pankaja, Susmita; Rrukaj, Astrit; Bathula, Uma

2014-05-04

Pyometra can be caused by various etiologies. We present a rare case of diverticular disease of the colon presenting as pyometra. This type of presentation can be challenging even for an astute clinician. A 74-year-old Caucasian woman with a history of pyometra was referred to our gynecology clinic as an urgent case. She was obese, diabetic and hypertensive. Due to the patient profile and the clinical presentation, clinicians were misled toward a diagnosis of possible endometrial cancer. After further investigations, she was found to have colouterine fistula secondary to a diverticular abscess of the sigmoid colon. Persistent vaginal discharge due to pyometra can be caused by diverticular disease of the colon. Clinicians should be aware of this important differential diagnosis.

A fatal case of streptococcal toxic shock syndrome due to Streptococcus dysgalactiae subsp. equisimilis possibly caused by an intramuscular injection.

PubMed

Hagiya, Hideharu; Okita, Shunji; Kuroe, Yasutoshi; Nojima, Hiroyoshi; Otani, Shinkichi; Sugiyama, Junichi; Naito, Hiromichi; Kawanishi, Susumu; Hagioka, Shingo; Morimoto, Naoki

2013-01-01

An 88-year-old man died of streptococcal toxic shock syndrome due to a group G streptococcus infection that was possibly caused by an intramuscular injection given 30 hours earlier in his right deltoid muscle. The causative pathogen was later identified to be Streptococcus dysgalactiae subsp. equisimilis (stG485). Although providing intramuscular injections is an essential skill of health care workers that is performed daily worldwide, it may constitute a port of entry for pathogens via skin breaches that can cause life-threatening infections. All invasive procedures should be carefully performed, especially when immunologically compromised patients are involved.

Prolonged disturbance of consciousness caused by severe hypophosphatemia: a report of two cases.

PubMed

Murakami, Takaaki; Yoshida, Masanori; Funazo, Tomoko; Matsuda, Yuki; Matsuo, Koji; Nambu, Takuo; Yonemitsu, Shin; Muro, Seiji; Oki, Shogo

2014-01-01

We herein describe two patients with a prolonged disturbance of consciousness due to severe hypophosphatemia. Case one presented with pneumococcal infection and acute exacerbation of chronic obstructive pulmonary disease and asthma. Case two presented with diabetic foot infections and diabetic ketoacidosis. Both patients responded to initial therapy for their primary diseases, but consciousness became worse in both cases. Their test results for impaired consciousness revealed severe hypophosphatemia; therefore, phosphate replacement therapy was administered, thus resulting in complete alertness. These cases demonstrate that we should consider the possibility of hypophosphatemia in critically ill patients with an altered consciousness.

[Pleural mesothelioma in a school teacher: asbestos exposure due to DAS paste].

PubMed

Barbieri, Pietro Gino; Somigliana, Anna; Girelli, Roberto; Lombardi, Sandra; Sarnico, Michela; Silvestri, Stefano

2016-03-24

Malignant mesothelioma cases among primary school teachers are usually linked with asbestos exposure due to the mineral contained in the building structure. Among the approximately 12,000 cases of mesothelioma described in the fourth report of the National Mesothelioma Register, 11 cases of primary school teachers are reported, in spite of the fact that the "catalogue of asbestos use" does not describe circumstances of asbestos exposure other than or different to that due to asbestos contained in the buildings. Four cases in the Brescia Provincial Mesothelioma Register are identified as teachers, without this circumstance of exposure. To characterize the asbestos concentration and fibre type retained in the lungs of a teacher reported as a new mesothelioma case and preliminarily classified as of unknown asbestos exposure. The mesothelioma case presented here was diagnosed at age 78 and malignant mesothelioma was confirmed at autopsy; the patient was interviewed directly for occupational history. Samples of lung parenchyma from necropsies were collected, stored and analyzed by scanning electron microscope (SEM) and samples of DAS paste were analyzed by SEM to detect asbestos fibre content. It was possible to confirm past exposure to DAS paste in forming and finishing dry items and toys during school recreational activity almost every day from the mid-60s to about the mid-70s. Subsequent SEM analysis showed: i) chrysotile fibres were found in an old and unused pack of DAS paste; ii) a lung burden of 1,400 asbestos bodies, 310.000 total asbestos fibres (33% chrysotile, 67% amphibole) and 210.000 talc fibre per gr/dry lung tissue was detected from necropsies performed on the subject. These results seem to be in agreement with an occupational exposure to asbestos due to past use of DAS paste. After the investigation, this case was reclassified from "unknowun" to " sure" occupational asbestos exposure. The occupational origin of the tumour was recognized by the Italian Workers' Compensation Authority (INAIL). This case suggests i) the need to carry out any possible detailed studies of the circumstances and exposure sources whenever any mesothelioma case is classified as "asbestos exposure unknown", according to the guidelines of the National Mesothelioma Register, ii) handling of DAS paste can be considered as sure asbestos exposure and iii) it should be borne in mind that mesothelioma cases can occur even after cumulative low, occupational exposure, even only to chrysotile.

Severe asphyxia due to delivery-related malpractice in Sweden 1990–2005

PubMed Central

Berglund, S; Grunewald, C; Pettersson, H; Cnattingius, S

2008-01-01

Objective To describe possible causes of delivery-related severe asphyxia due to malpractice. Design and setting A nationwide descriptive study in Sweden. Population All women asking for financial compensation because of suspected medical malpractice in connection with childbirth during 1990–2005. Method We included infants with a gestational age of ≥33 completed gestational weeks, a planned vaginal onset of delivery, reactive cardiotocography at admission for labour and severe asphyxia-related outcomes presumably due to malpractice. As asphyxia-related outcomes, we included cases of neonatal death and infants with diagnosed encephalopathy before the age of 28 days. Main outcome measure Severe asphyxia due to malpractice during labour. Results A total of 472 case records were scrutinised. One hundred and seventy-seven infants were considered to suffer from severe asphyxia due to malpractice around labour. The most common events of malpractice in connection with delivery were neglecting to supervise fetal wellbeing in 173 cases (98%), neglecting signs of fetal asphyxia in 126 cases (71%), including incautious use of oxytocin in 126 cases (71%) and choosing a nonoptimal mode of delivery in 92 cases (52%). Conclusion There is a great need and a challenge to improve cooperation and to create security barriers within our labour units. The most common cause of malpractice is that stated guidelines for fetal surveillance are not followed. Midwives and obstetricians need to improve their shared understanding of how to act in cases of imminent fetal asphyxia and how to choose a timely and optimal mode of delivery. Please cite this paper as:Berglund S, Grunewald C, Pettersson H, Cnattingius S. Severe asphyxia due to delivery-related malpractice in Sweden 1990–2005. BJOG 2008;115:316–323. PMID:18190367

Multiple tendon ruptures of unknown etiology.

PubMed

Axibal, Derek P; Anderson, John G

2013-10-01

Tendon ruptures are common findings in foot and ankle practice. The etiology of tendon ruptures tends to be multifactorial-usually due to a combination of trauma, effects of systemic diseases, adverse effects of medications, and obesity. We present an unusual case of right Achilles tendinitis, left Achilles tendon rupture, bilateral peroneus longus tendon rupture, and left peroneus brevis tendon rupture of unknown etiology. This case report highlights the need for research for other possible, lesser known etiologies of tendon pathology. Therapeutic, Level IV, Case Study.

Spectral properties of all-active InP-based microring resonator devices

NASA Astrophysics Data System (ADS)

Kapsalis, A.; Alexandropoulos, D.; Mikroulis, S.; Simos, H.; Stamataki, I.; Syvridis, D.; Hamacher, M.; Troppenz, U.; Heidrich, H.

2006-02-01

Microring resonators are excellent candidates for very large scale photonic integration due to their compactness, and fabrication simplicity. Moreover a wide range of all-optical signal processing functions can be realized due to the resonance effect. Possible applications include filtering, add/drop of optical beams and power switching, as well as more complex procedures including multiplexing, wavelength conversion, and logic operations. All-active ring components based in InGaAsP/InP are possible candidates for laser sources, lossless filters, wavelength converters, etc. Our work is based on measurement, characterization and proposal of possible exploitation of such devices in a variety of applications. We investigate the spectral characteristics of multi-quantum well InGaAsP(λ=1.55μm)/InP microring structures of various ring diameters and different configurations including racetracks with one or two bus waveguides and MMI couplers. The latter configuration has recently exhibited the possibility to obtain tunable active filters as well as tunable laser sources based on all-active ring-bus-coupler structures. In the case of tunable lasers single mode operation has been achieved by obtaining sufficiently high side mode suppression ratio. The tuning capability is attributed to a coupled cavities effect, resembling the case of multi-section DBR lasers. However, in contrast to the latter, the fabrication of microring resonators is considered an easier task, due to a single step growth procedure, although further investigation must be carried out in order to achieve wide range tunability. Detailed mappings of achievable wavelengths are produced for a wide range of injection current values.

[Limb lengthening in dwarfism].

PubMed

Correll, J; Held, P

2000-09-01

Limb lengthening in dwarfism has become a standardised procedure with a good prognosis. In most cases external fixation is used. Gain of leg length up to 15 cm and more is possible in the lower leg and the femur and 8.5 cm in the humerus. Limb lengthening is useful in many cases of dwarfism due to skeletal dysplasia. There are a number of risks and possible complications involved and the procedure also requires considerable time. We report the results of 48 patients with dwarfism operated on in the Orthopädische Kinderklinik Aschau (Orthopaedic Hospital for Children). It must not be recommended as a normal tool in handling the problems of dwarfism, but it makes sense in some cases of dwarfism. We describe and discuss the prerequisites for the operative treatment.

Repair for mitral stenosis due to pannus formation after Duran ring annuloplasty.

PubMed

Song, Seunghwan; Cho, Seong Ho; Yang, Ji-Hyuk; Park, Pyo Won

2010-12-01

Mitral stenosis after mitral repair with using an annuloplasty ring is not common and it is almost always due to pannus formation. Mitral valve replacement was required in most of the previous cases of pannus covering the mitral valve leaflet, which could not be stripped off without damaging the valve leaflets. In two cases, we removed the previous annuloplasty ring and pannus without leaflet injury, and we successfully repaired the mitral valve. During the follow-up of 4 months and 39 months respectively, we observed improvement of the patients' symptoms and good valvular function. Redo mitral repair may be a possible method for treating mitral stenosis due to pannus formation after ring annuloplasty. Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Idiopathic infantile arterial calcification: a rare cause of sudden unexpected death in childhood.

PubMed

Guimarães, Susana; Lopes, José Manuel; Oliveira, José Bessa; Santos, Agostinho

2010-07-27

Unexpected child death investigation is a difficult area of forensic practice in view of the wide range of possible genetic, congenital, and acquired natural and nonnatural causes. Idiopathic infantile arterial calcification (IIAC) is a rare autosomic recessive disease usually diagnosed postmortem. Inactivating mutations of the ENPP1 gene were described in 80% of the cases with IIAC. We report a case of a 5-year-old girl submitted to a forensic autopsy due to sudden death and possible medical negligence/parents child abuse. Major alterations found (intimal proliferation and deposition of calcium hydroxyapatite around the internal elastic lamina and media of arteries; acute myocardial infarct, stenotic and calcified coronary artery; perivascular and interstitial myocardial fibrosis; and subendocardial fibroelastosis) were diagnostic of IIAC. We reviewed IIAC cases published in the English literature and highlight the importance of adequate autopsy evaluation in cases of sudden child death.

Idiopathic Infantile Arterial Calcification: A Rare Cause of Sudden Unexpected Death in Childhood

PubMed Central

Guimarães, Susana; Lopes, José Manuel; Oliveira, José Bessa; Santos, Agostinho

2010-01-01

Unexpected child death investigation is a difficult area of forensic practice in view of the wide range of possible genetic, congenital, and acquired natural and nonnatural causes. Idiopathic infantile arterial calcification (IIAC) is a rare autosomic recessive disease usually diagnosed postmortem. Inactivating mutations of the ENPP1 gene were described in 80% of the cases with IIAC. We report a case of a 5-year-old girl submitted to a forensic autopsy due to sudden death and possible medical negligence/parents child abuse. Major alterations found (intimal proliferation and deposition of calcium hydroxyapatite around the internal elastic lamina and media of arteries; acute myocardial infarct, stenotic and calcified coronary artery; perivascular and interstitial myocardial fibrosis; and subendocardial fibroelastosis) were diagnostic of IIAC. We reviewed IIAC cases published in the English literature and highlight the importance of adequate autopsy evaluation in cases of sudden child death. PMID:21151691

Long survival in a 69,XXX triploid infant in Greece.

PubMed

Iliopoulos, Dimitrios; Vassiliou, Georgia; Sekerli, Eleni; Sidiropoulou, Vasiliki; Tsiga, Alexandra; Dimopoulou, Despina; Voyiatzis, Nikolaos

2005-12-30

The live birth of a triploidy infant is a very rare event and death usually occurs within the first hours of life. Triploid cases with a survival of more than two months are infrequent. We report on an infant with a 69,XXX chromosome constitution who survived 164 days. Chromosomal analysis demonstrated a 69,XXX karyotype with no evidence of mosaicism. This is the longest survival reported for this condition to date in Greece and the fourth longest worldwide. The infant was admitted to our clinic several times due to respiratory problems, and supplementary oxygen was required. The improved survival of our case was possibly due to better management of respiratory illness and prematurity, and these are essential factors that physicians should consider carefully with such rare cases.

Sibutramine-associated psychotic symptoms and zolpidem-induced complex behaviours: implications for patient safety.

PubMed

Wiglusz, Mariusz S; Cubała, Wiesław Jerzy; Nowak, Paweł; Jakuszkowiak-Wojten, Katarzyna; Landowski, Jerzy; Krysta, Krzysztof

2013-09-01

Sibutramine is a weight loss agent recently withdrawn from the European market due to cardiovascular risk concerns. It was used for long-term obesity treatment. Zolpidem is a short acting hypnotic agent commonly used in the treatment of insomnia. A number of case reports describing psychotic reaction to sibutramine were reported in the literature. We present a case of a 61-year-old Caucasian woman who developed two psychotic episodes related to sibutramine treatment. The second psychotic episode was complicated with complex behaviours after zolpidem use due to insomnia. Sibutramine and zolpidem discontinuation resulted in rapid resolution of psychotic symptoms. This case suggests a possibility of incidence of psychotic symptoms and complex behaviour disturbances in patients prescribed sibutramine or other monoaminergic reuptake inhibitors.

Occipital neuralgia: possible failure of surgical treatment - case report.

PubMed

Andrychowski, Jarosław; Czernicki, Zbigniew; Netczuk, Tomasz; Taraszewska, Anna; Dabrowski, Piotr; Rakasz, Lukasz; Budohoski, Karol

2009-01-01

Surgical intervention in severe cases of occipital neuralgia should be considered if pharmacological and local nerve blocking treatment fail. The literature suggests two types of interventions: surgical decompression of the greater occipital nerve (GON) from the entrapment site, as a less invasive approach, and neurotomy of the nerve trunk, which results in ipsilateral sensation deficits in the GON innervated area of the skull. Due to anatomical variations in the division of the GON trunk, typical neurotomy above the line of the trapezius muscle aponeurosis (TMA) may not result in full recovery. The present study discusses a case of a female treated with GON decompression as a result of occipital neuralgia unresponsive to pharmacotherapy, who thereafter was qualified for two consecutive neurotomies due to severe relapse of pain.

[Skin and Soft Tissue Infections Due to Corynebacterium ulcerans - Case Reports].

PubMed

Jenssen, Christian; Schwede, Ilona; Neumann, Volker; Pietsch, Cristine; Handrick, Werner

2017-10-01

History and clinical findings  We report on three patients suffering from skin and soft tissue infections of the legs due to toxigenic Corynebacterium ulcerans strains. In all three patients, there was a predisposition due to chronic diseases. Three patients had domestic animals (cat, dog) in their households. Investigations and diagnosis  A mixed bacterial flora including Corynebacterium ulcerans was found in wound swab samples. Diphtheric toxin was produced by the Corynebacterium ulcerans strains in all three cases. Treatment and course  In all three patients, successful handling of the skin and soft tissue infections was possible by combining local treatment with antibiotics. Diphtheria antitoxin was not administered in any case. Conclusion  Based on a review of the recent literature pathogenesis, clinical symptoms and signs, diagnostics and therapy of skin and soft tissue infections due to Corynebacterium ulcerans are discussed. Corynebacterium ulcerans should be considered as a potential cause of severe skin and soft tissue infections. Occupational or domestic animal contacts should be evaluated. © Georg Thieme Verlag KG Stuttgart · New York.

Paradoxical undressing associated with subarachnoid hemorrhage in a non-hypothermia case?

PubMed

Descloux, Emilienne; Ducrot, Kewin; Scarpelli, Maria Pia; Lobrinus, Alexander; Palmiere, Cristian

2017-09-01

Paradoxical undressing is a phenomenon characterizing some fatal hypothermia cases. The victims, despite low environmental temperatures, paradoxically remove their clothes due to a sudden feeling of warmth. In this report, we describe a case of suspected paradoxical undressing in a non-hypothermia case. The victim, a 51-year-old Caucasian man, was found dead wearing only sneakers and socks. All other clothing was found in his car. Postmortem investigations allowed the hypothesis of hypothermia to be ruled out and revealed the presence of a ruptured cerebral aneurysm that caused a subarachnoid hemorrhage, the latter responsible for the death. The absence of any elements suggesting a voluntary undressing or any third party's DNA profile or involvement along with the possibility that the subarachnoid hemorrhage might have determined a hypothalamic injury, somehow rendered conceivable the hypothesis of an inappropriate feeling of warmth due to hemorrhage-induced dysregulation of the hypothalamic temperature-regulating centers.

An analysis of possible mechanisms of unexpected death occurring in hydatid disease (echinococcosis).

PubMed

Byard, Roger W

2009-07-01

Most cases of hydatid disease in human populations are due to Echinococcus granulosus. The hydatid life cycle involves passage between definitive hosts such as dogs and intermediate hosts such as sheep. Humans become accidental intermediate hosts following ingestion of food or water contaminated with eggs or by contact with infected dogs. Although hydatid disease may remain asymptomatic, occasional cases of sudden and unexpected death present to autopsy. Causes of rapid clinical decline involve a wide range of mechanisms including anaphylaxis (with or without cyst rupture), cardiac outflow obstruction or conduction tract disturbance, pulmonary and cerebral embolism, pericarditis, cardiac tamponade, myocardial ischemia, pulmonary hypertension, peritonitis, hollow organ perforation, intracerebral mass effect, obstructive hydrocephalus, seizures, cerebral ischemia/infarction, and pregnancy complications. The autopsy assessment of cases therefore requires careful examination of all organ systems for characteristic cystic lesions, as multiorgan involvement is common, with integration of findings so that possible mechanisms of death can be determined. Measurement of serum tryptase and specific IgE levels should be undertaken for possible anaphylaxis.

Mucoepidermoid carcinoma of lung masquerading as urothelial carcinoma of bladder

PubMed Central

Graham, Donna M.; O’Connor, Kate M.; Hinchion, John; Coate, Linda E.; Burke, Louise; Power, Derek G.

2013-01-01

Background Mucoepidermoid carcinoma (MEC) of the lung is a rare subtype of non-small cell lung cancer. There is no consensus regarding optimal management for this disease. Case report We present a case of MEC of the lung in a 75 year-old female with a history of superficial urothelial carcinoma of the bladder. The patient was found to have an asymptomatic lung mass. Initial biopsy suggested metastatic recurrence of urothelial carcinoma and therefore, cisplatin and gemcitabine chemotherapy was administered prior to surgical resection. Pathological analysis of the resected specimen confirmed a diagnosis of stage IIIA MEC with focal high-grade features including transitional cell-like areas. Adjuvant radiotherapy was administered due to a positive microscopic resection margin. No chemotherapy was given due to lack of supporting data. The patient developed widespread metastatic disease 3 months following completion of radiotherapy and died 1 month later. Conclusion This case demonstrates the possibility of dual pathology in cases where metastatic disease is suspected. The use of small tissue samples may complicate diagnosis due to the heterogeneity of malignant tumours. PMID:24936321

A Case of a TSH-secreting Pituitary Adenoma Associated with Evans' Syndrome.

PubMed

Yasuda, Atsushi; Seki, Toshiro; Oki, Masayuki; Takagi, Atsushi; Inomoto, Chie; Nakamura, Naoya; Atsumi, Hideki; Baba, Tanefumi; Matsumae, Mitsunori; Sasaki, Noriko; Suzuki, Yasuo; Fukagawa, Masafumi

2015-06-20

We present a case of a TSH-secreting pituitary adenoma (TSHoma) associated with Evans' syndrome. A 30-year-old woman was referred to our hospital due to purpura and ecchymoses on her limb and body and epistaxis. Evans' syndrome was diagnosed based on idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia. She had a history of malocclusion and thyroid gland enlargement 4 years prior to admission. Endocrinological tests and magnetic resonance imaging also revealed that this patient had hyperthyroidism due to the TSHoma and that this adenoma concomitantly secreted GH. Recently, several cases of Evans' syndrome were associated with hyperthyroidism caused by autoimmune thyroid disease, such as Graves' disease, suggesting that these 2 conditions may have a common immunological basis. To the best of our knowledge, there is no case report of Evans' syndrome associated with hyperthyroidism due to TSHoma. Our report suggests that the excess of thyroid hormone itself promotes autoimmunity in Evans' syndrome. Thus, early treatment for hyperthyroidism is necessary in TSHomas because of the possibility that thyroid hormone normalization may prevent the development of Evans' syndrome.

Possible gasoline-induced chronic liver injury due to occupational malpractice in a motor mechanic: a case report.

PubMed

Gunathilaka, Mahesh Lakmal; Niriella, Madunil Anuk; Luke, Nathasha Vihangi; Piyarathna, Chathura Lakmal; Siriwardena, Rohan Chaminda; De Silva, Arjuna Priyadarshin; de Silva, Hithanadura Janaka

2017-07-03

Hydrocarbon-induced occupational liver injury is a well-known clinical entity among petroleum industry workers. There are many types of hydrocarbon exposure, with inhalation being the most common. Hydrocarbon-induced occupational liver injury is a rarely suspected and commonly missed etiological agent for liver injury. We report a case of a non-petroleum industry worker with chronic liver disease secondary to hydrocarbon-induced occupational liver injury caused by chronic low-grade hydrocarbon ingestion due to occupational malpractice. A 23-year-old Sri Lankan man who was a motor mechanic presented to our hospital with decompensated cirrhosis. He had been chronically exposed to gasoline via inadvertent ingestion due to occupational malpractice. He used to remove gasoline from carburetors by sucking and failed to practice mouth washing thereafter. On evaluation, he had histologically proven established cirrhosis. A comprehensive history and workup ruled out other nonoccupational etiologies for cirrhosis. The patient's long-term occupational gasoline exposure and clinical course led us to a diagnosis of hydrocarbon-induced occupational liver injury leading to decompensated cirrhosis. Hydrocarbon-induced occupational liver injury should be considered as a cause when evaluating a patient with liver injury with possible exposure in relevant occupations.

Sign language aphasia due to left occipital lesion in a deaf signer.

PubMed

Saito, Kozue; Otsuki, Mika; Ueno, Satoshi

2007-10-02

Localization of sign language production and comprehension in deaf people has been described as similar to that of spoken language aphasia. However, sign language employs a visuospatial modality through visual information. We present the first report of a deaf signer who showed substantial sign language aphasia with severe impairment in word production due to a left occipital lesion. This case may indicate the possibility of other localizations of plasticity.

Industrial Relations (The National Shipbuilding Research Program)

DTIC Science & Technology

1981-01-01

permit- ting him so to do, he shall notify his supervisor promptly expost facto . 2. In case of non-attendance due to injury or illness, the mployees shall...this study possible. Special appreciation is due the following individuals who provided. their time and information in the conduct of this study . Aioi...The material contained herein was-developed from the study of the Industrial Relations programs and systems presently in-operation in the shipyards of

Hypopituitarism possibly due to lymphocytic hypophysitis in a patient with type 1 diabetes.

PubMed

Matoba, Keiichiro; Mitsuishi, Sumie; Hayashida, Satoshi; Yamazaki, Hiroyuki

2014-01-01

Hypopituitarism often develops insidiously, and undiagnosed hypopituitarism can influence the glycemic profile of patients with type 1 diabetes. We herein report the case of a 49-year-old man with type 1 diabetes and Hashimoto's thyroiditis who experienced an unexplained improvement in his glycemic level and recurrent severe hypoglycemia, despite a reduction in the dose of insulin. Based on the patient's endocrinological findings, he was diagnosed with hypopituitarism possibly due to lymphocytic hypophysitis, as supported by positive results for human leukocyte antigen A24 and Cw3. Following the administration of hydrocortisone replacement therapy, his insulin requirement increased to a premorbid level, and the severe hypoglycemia resolved.

Hypoinsulinemic hypoglycemia triggered by liver injury in elderly subjects with low body weight: case reports.

PubMed

Anno, Takatoshi; Kaneto, Hideaki; Shigemoto, Ryo; Kawasaki, Fumiko; Kawai, Yasuhiro; Urata, Noriyo; Kawamoto, Hirofumi; Kaku, Kohei; Okimoto, Niro

2018-01-01

Hypoglycemia is induced by many causes, especially over-dose of insulin or oral hypoglycemic agents in diabetic subjects. In such a case, hyperinsulinemic hypoglycemia is usually observed. On the other hand, it is important to classify secondary hypoglycemia and hypoinsulinemic hypoglycemia. Liver injury-induced hypoglycemia is one of the causes of hypoinsulinemic hypoglycemia but rarely observed in clinical practice. Herein, we experienced similar 2 cases of non-diabetic hypoinsulinemic hypoglycemia. Both of them were elderly subjects with low body weight. Furthermore, it is likely that hypoinsulinemic hypoglycemia in both subjects was triggered by severe liver injury, at least in part, due to possible limited liver glycogen store. In elderly subjects with low body weight and/or malnutrition, metabolism in the liver is reduced and glycogen accumulation is decreased. Such alteration brings out acute and marked liver injury, which finally leads to the onset of severe hypoglycemia. It is known that not only liver injury but also multiple organ failure could be induced due to extreme emaciation in subjects. It is likely that in elderly subjects with low body weight and/or malnutrition, multiple organ failure including liver failure could be induced due to the similar reason. Therefore, we should be very careful of such subjects in order to avoid the development of multiple organ failure which leads to life-threatening situations. In conclusion, we should keep in mind the possibility of hypoinsulinemic hypoglycemia when we examine severe liver injury, especially in elderly or starving subjects with low body weight and limited liver glycogen stores. It is important to classify secondary hypoglycemia and hypoinsulinemic hypoglycemia.Liver injury-induced hypoglycemia is one of the causes of hypoinsulinemic hypoglycemia but rarely observed in everyday clinical practice.Herein, we reported similar 2 cases of hypoinsulinemic hypoglycemia without diabetes presumably triggered by severe liver injury.In both cases, hypoglycemia was improved by glucose infusion, although their liver injury was not improved.We should keep in mind the possibility of hypoinsulinemic hypoglycemia when we examine severe liver injury, especially in elderly subjects with low body weight.

Integrated control of Chagas disease for its elimination as public health problem - A Review

PubMed Central

Sosa-Estani, Sergio; Segura, Elsa Leonor

2015-01-01

Chagas disease or American trypanosomiasis is, together with geohelminths, the neglected disease that causes more loss of years of healthy life due to disability in Latin America. Chagas disease, as determined by the factors and determinants, shows that different contexts require different actions, preventing new cases or reducing the burden of disease. Control strategies must combine two general courses of action including prevention of transmission to prevent the occurrence of new cases (these measures are cost effective), as well as opportune diagnosis and treatment of infected individuals in order to prevent the clinical evolution of the disease and to allow them to recuperate their health. All actions should be implemented as fully as possible and with an integrated way, to maximise the impact. Chagas disease cannot be eradicated due because of the demonstrated existence of infected wild triatomines in permanent contact with domestic cycles and it contributes to the occurrence of at least few new cases. However, it is possible to interrupt the transmission of Trypanosoma cruzi in a large territory and to eliminate Chagas disease as a public health problem with a dramatic reduction of burden of the disease. PMID:25993503

Integrated control of Chagas disease for its elimination as public health problem--a review.

PubMed

Sosa-Estani, Sergio; Segura, Elsa Leonor

2015-05-01

Chagas disease or American trypanosomiasis is, together with geohelminths, the neglected disease that causes more loss of years of healthy life due to disability in Latin America. Chagas disease, as determined by the factors and determinants, shows that different contexts require different actions, preventing new cases or reducing the burden of disease. Control strategies must combine two general courses of action including prevention of transmission to prevent the occurrence of new cases (these measures are cost effective), as well as opportune diagnosis and treatment of infected individuals in order to prevent the clinical evolution of the disease and to allow them to recuperate their health. All actions should be implemented as fully as possible and with an integrated way, to maximise the impact. Chagas disease cannot be eradicated due because of the demonstrated existence of infected wild triatomines in permanent contact with domestic cycles and it contributes to the occurrence of at least few new cases. However, it is possible to interrupt the transmission of Trypanosoma cruzi in a large territory and to eliminate Chagas disease as a public health problem with a dramatic reduction of burden of the disease.

Food poisoning associated with ingestion of wild wasp broods in the upstream region of the Lancang river valley, Yunnan province, China.

PubMed

Jiang, Li; Huang, Tian

2018-04-01

Food poisoning due to wild wasp broods ingestion has long been noted in the upstream region of the Lancang river valley, Yunnan province, China. This study describes the epidemiological and clinical features of the poisoning and possible causes. Surveillance data collected between 2008 and 2016 were analyzed to produce demographic data on patients, information on clinical presentations, wasp species identification, and estimations of possible risk factors for symptomatic cases. Eleven poisoning events were associated with the ingestion of wild wasp broods, including 46 exposed persons with 31 symptomatic living cases and 8 deceased cases that were reported in the Yunnan province between 2008 and 2016. Poisoning cases were only detected in the upstream region of the Lancang river valley in the autumn. The severity of the symptoms was correlated with an evident dose-effect relationship regarding the quantity ingested. The mean latent period from wild wasp broods ingestion to the onset of the symptoms was 10 h for symptomatic living cases and 7 h for deceased cases, respectively. Both gastrointestinal and neurological symptoms were commonly observed in the poisoning cases. The toxin source may be indirectly caused by the wasp broods due to the prevalence of local poisonous plants, such as Tripterygium wilfordii Hook F, Tripterygium hypoglaucum Hutch and Vaccinium bracteatum Thunb. Educational programs at the start of wasp harvest season in September in the high-risk area should be carried out to reduce the incidence of poisonings. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Hospital infection due to Serratia marcescens and its sensitivity to antibiotics].

PubMed

Filloy, L; Serrano, D; Borjas, E

1980-01-01

A total of 164 isolations of Serratia marcescens achieved during 1978-1979 at the Hospital Infantil de México in children with various pathology due to this bacteria were studied. Most of the cases were debilitated patients from the newborns and prematures wards and contagious and surgery departments. The most frequent isolations were from wounds and abscesses (76 cases), the same as from meningitis (22 cases) and sepsis (12 patients). Serratia marcescens showed a high degree of resistance (87-100%) to the following antibiotics: carbenicillin, colimycin, chloramphenicol, phosphomicin, ampicillin and cephalothin. To gestamicin and kanamycin, 42% of strains were sensitive. Amikacin was the most effective drug with 92% of strains susceptible to it. The history of this bacteria, its mode of transmission, frequency of infections and resistance to antibiotics found in foreign institutions are commented. Likewise, the difficulty for the precision bacteriologic diagnosis is emphasized as the possible main cause for the ignorance in Mexico of infections due to this bacteria.

[About a fortuitous representation of a case of intestinal malrotation by Wilhem His (1880)].

PubMed

Louryan, S

2011-06-01

In a textbook published in 1882, His exhibits drawings devoted to intestine development. The last figure depicts a typical case of gut malrotation, but there is no comment about this in the text. It could be possible that this omission should be due to the fact that mechanisms of gut development were not totally elucidated at this time. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

[Motor vehicle driving and diabetes mellitus - medical aspects].

PubMed

Brož, Jan; Kriváňová, Lenka Syčová; Fedáková, Zuzana; Petrosyan, Lilit; Kvapil, Milan; Polák, Jan

2016-03-01

Diabetes mellitus is a disease which may affect the eligibility to hold a driving license and increase the risk of a road accident. Hypoglycemia while driving is considered to be the most risky situation, with diabetes increasing the mentioned risk for instance due to impaired vision in the case of possible retinopathy. The group of drivers with diabetes being at the greatest risk as to accidents are those with a case history of severe hypoglycemia or hypoglycemia occurred while driving, or possibly of a road accident. Measuring glycaemia before driving and their knowledge how to prevent and treat hypoglycemia - those are the two crucial preventive elements indispensable for insulin treated diabetes patients in order to secure safe road traffic.

[Complex case with respiratory, endocrine and digestive manifestations--late complications after a colic replacement of the esophagus for lye ingestion].

PubMed

Bolca, Ciprian; Tănăsescu, Mihaela; Dănăilă, Olga; Paleru, Cristian; Cordoş, Ioan

2014-01-01

Long term complications after colic replacement of the esophagus are well known and their managment is known as being difficult, due to multiple associated comorbidities; we present the case of a 26-year-old patient with multiple late complications after a coloesophagoplaty for lye ingestion during childhood. The patient finally died despite all the eforts of treatement during a prolonged hospitalisation. We will try to analyse the key moments on patient's evolution and discuss other possible options in this case.

Shuttle ECLSS ammonia delivery capability

NASA Technical Reports Server (NTRS)

1976-01-01

The possible effects of excessive requirements on ammonia flow rates required for entry cooling, due to extreme temperatures, on mission plans for the space shuttles, were investigated. An analysis of worst case conditions was performed, and indicates that adequate flow rates are available. No mission impact is therefore anticipated.

Lung abscess due to Streptococcus pneumoniae: a case series and brief review of the literature.

PubMed

Nicolini, Antonello; Cilloniz, Catia; Senarega, Renata; Ferraioli, Gianluca; Barlascini, Cornelius

2014-01-01

Anaerobes used to be the most common cause of community-acquired lung abscess, and Streptococcus species used to be the second most common cause. In recent years, this has been changing. Klebsiella pneumoniae is now an increasing cause of community- acquired lung abscess, but Streptococcus species continue to be major pathogens. Necrotizing pneumonia has generally been regarded as a rare complication of pneumococcal infection in adults. Type 3 Streptococcus pneumoniae was the single most common type implicated in necrosis; however, many other serotypes were implicated. This entity predominately infects children, but is present also in adults. Lung abscess in adults due to Streptococcus pneumoniae is not common. In this regard we present a case series of pulmonary cavitation due to Streptococcus pneumoniae and discuss the possible pathogenic mechanism of the disease.

High-voltage electrical burns due to copper theft - Case series.

PubMed

Braga, M J; Oliveira, I; Egipto, P; Silva, A

2016-03-31

Electrical burns are among the most devastating trauma inflicted on the human body. These burns have a higher morbidity, length of stay and a much higher risk of amputation than any other type of burn. Electrical burns affect mostly young, working males because they are more frequently the result of a work accident. However, possibly due to the worldwide economic crisis, we are experiencing a new phenomenon: the theft of high-voltage copper wiring.

Building the Case for Delivering Health Promotion Services within the Vocational Rehabilitation System

ERIC Educational Resources Information Center

Ipsen, Catherine; Seekins, Tom; Ravesloot, Craig

2010-01-01

Research studies report a negative relationship between employment and secondary conditions. Access to health promotion programs to manage secondary conditions, however, is limited for people with disabilities due to employment, financial, and insurance barriers. Vocational rehabilitation (VR) is one possible delivery point to overcome these…

Mental Health Problems of Disaster Victims.

ERIC Educational Resources Information Center

Lima, Bruno R.; And Others

The mental health needs of disaster victims remains a largely neglected area, possibly due to other pressing demands placed on available resources and to the difficulties in correctly detecting psychiatric cases by the general health worker. This study attempted to use a questionnaire suitable to primary care settings for the detection of probable…

Diagnostic Dilemma: Lymphocytopenia in a Patient with Thymoma – Side Effect due to Irradiation Treatment or Development of Good's Syndrome?

PubMed Central

Raaschou-Jensen, Klas; Katzenstein, Terese L.; Marquart, Hanne; Ryder, Lars; Daugaard, Gedske

2010-01-01

A case of persistent B-cell lymphocytopenia in a 40-year-old woman with lymphoid-epithelial thymoma treated with chemotherapy, surgery and irradiation is described. The possible diagnosis of Good's syndrome (hypogammaglobulinaemia and thymoma) is discussed. PMID:20740204

[Pontomedullary lacerations and concomitant injuries: a review of possible underlying mechanisms].

PubMed

Živković, Vladimir; Nikolić, Slobodan

2013-01-01

Anatomically, brainstem is constituted of medulla oblongata, pons and mesencephalon. Traumatic lesions of brainstem most commonly occur on pontomedullary junction. There are several possible mechanisms of pontomedullary lacerations. The first mechanism includes impact to the chin, with or without a skull base fracture, and most often leads to this fatal injury, due to impact force transmission through the jawbone and temporomandibular joint. The second mechanism includes lateral and posterior head impacts with subsequent hinge fractures, where occurrence of pontomedullary lacerations in these cases may depend on the energy of impact, as well as on the exact position of the fracture line, but less so on the head's movement. The third mechanism includes frontoposterior hyperextension of the head, due to frontal impact, concomitant with fractures or dislocations of upper spine. In the fourth mechanism, there is an absence of direct impact to the head, due to the indirect force of action after feet or buttocks-first impact. Most of these cases are accompanied by ring fractures as well. In situations such as these, the impact force is transmitted up the spinal column and upper vertebrae, and telescopically intruded into the skull, causing brainstem laceration. The jawbone and other facial bones can act as shock absorbers, and their fracture could diminish the energy transfer towards the skull and protect the brain and brainstem from injury. In all the cases with pontomedullary laceration posterior neck dissection should be performed during the autopsy, since upper spine injuries are often associated with this type of injury.

An atypical case of late-onset systemic lupus erythematosus with systemic lymphadenopathy and severe autoimmune thrombocytopenia/neutropenia mimicking malignant lymphoma.

PubMed

Tamaki, Keita; Morishima, Satoko; Nakachi, Sawako; Kitamura, Sakiko; Uchibori, Sachie; Tomori, Shouhei; Hanashiro, Taeko; Shimabukuro, Natsuki; Tedokon, Iori; Morichika, Kazuho; Nishi, Yukiko; Tomoyose, Takeaki; Karube, Kennosuke; Fukushima, Takuya; Masuzaki, Hiroaki

2017-04-01

Here, we report a rare case of systemic lupus erythematosus (SLE) with conspicuous manifestation of hematological abnormalities. At onset, the 52-year-old male patient showed systemic lymphadenopathy and splenomegaly, severe autoimmune thrombocytopenia, and autoimmune neutropenia. Bone marrow examination and lymph node biopsy excluded the possibility of malignant lymphoma. Based on laboratory findings, he was finally diagnosed with combined autoimmune cytopenia coupled with SLE. Atypical clinical manifestations of SLE prompted us to explore the possibility of autoimmune lymphoproliferative syndrome (ALPS). However, we did not detect an increased number of CD4 - /CD8 - , CD3 + , TCRαβ + double-negative T cells in the circulating blood or dysfunctional T cell apoptosis in the Fas/Fas ligand pathway due to mutations in the FAS, FASLG or CASP10 genes. Combined autoimmune cytopenia is a rare clinical entity that in some cases co-occurs with other autoimmune diseases. Given that most SLE patients presenting atypical hematological manifestations at an early stage subsequently exhibit typical systemic manifestations, the present case raises the possibility that initial hematological abnormalities may be signs of unexpected SLE manifestations.

[Analysis of nursing students' attitude toward bioethics (3). Attitude toward induced abortion].

PubMed

Nakayama, O; Ishizaka, K; Mizutani, N

1986-04-01

Nursing students were found to be somewhat hesitant and indecisive about induced abortion in general. They are in favor of some cases of abortion but feel that it should be avoided if possible. They agree to abortion in cases of a mother's health being in danger and possible deformity of the child, but are opposed to it for such selfish reasons as parents' sex preference of their child and motherhood's interference with parents' study or career. They are most undecided about abortion because of financial difficulties since each case would be different. Quantitative analysis via computer was made of the results of a questionnaire given to 112 nursing students. The students were encouraged to give their candid opinion in exchange for their complete anonymity. They were asked to respond to the following reasons for having induced abortion by circling agree, somewhat agree, somewhat opposed, or opposed: 1) unexpected pregnancy at financially difficult times, 2) unwanted sex of fetus revealed by amniocentesis, 3) unwanted pregnancy with a possible hereditary disease 4) some disability of the child revealed by the fetal examination, 5) pregnancy due to rape, 6) pregnancy due to wife's adultery, 7) maternal health risk, 8) unwanted pregnancy, 9) teenage pregnancy (junior high age), 10) German measles contracted during the 1st trimester, 11) untimely pregnancy interfering with a woman's career or college studies, and 12) women's freedom of choice. Problems such as 2), 3), and 4) arose only because of advancement in medical technology, i.e., amniocentesis. Induced abortion because of unwanted sex of the fetus revealed by amniocentesis was the most clear-cut case of disapproval by nursing students.

[Morbidity from bilateral tubal ligation, via laparoscopy].

PubMed

Gorozpe Calvillo, J; García Luna, A; Manterola, D; Téllez Martínez, J; Vázquez Cuellar, G

1991-08-01

From January 1, 1987 January 30, 1990, 374 laparoscopic sterilizations using silastic rings (Falope), were carried out. Morbidity and main risk factors, were analyzed. More frequent surgical complications were: mesosalpinx rupture, and fallopian tube rupture in 22 cases (5.8%); abdominal wall emphysema, three cases (0.8%), uterine perforation, two cases (0.5%); other pelvic structures lesions, three cases (0.8%). Morbidity risk factors were: previous abdominal surgery, obesity, salpingitis, use of an uterine mobilizer in a puerperal uterus, and practice of tubal occlusion during the luteal phase of cycle, due to possibility of luteal phase pregnancy; therefore, if a risk factor is present, it is advisable to use other contraceptive technique.

Envenomation by Micrurus coral snakes in the Brazilian Amazon region: report of two cases.

PubMed

Pardal, Pedro Pereira de Oliveira; Pardal, Joseana Silva de Oliveira; Gadelha, Maria Apolônia da Costa; Rodrigues, Líliam da Silva; Feitosa, Darlan Tavares; Prudente, Ana Lúcia da Costa; Fan, Hui Wen

2010-01-01

Two cases of proven coral snake bites were reported in Belém, Pará State, Brazil. The first case was a severe one caused by Micrurus surinamensis. The patient required mechanical ventilation due to acute respiratory failure. The second case showed just mild signs of envenomation caused by Micrurus filiformis. Both patients received specific Micrurus antivenom and were discharged without further complications. Coral snake bites are scarcely reported in the Amazon region and there is a broad spectrum of clinical manifestations, varying from extremely mild to those which may rapidly lead to death if the patient is not treated as soon as possible.

High-voltage electrical burns due to copper theft – Case series

PubMed Central

Braga, M.J.; Oliveira, I.; Egipto, P.; Silva, A.

2016-01-01

Summary Electrical burns are among the most devastating trauma inflicted on the human body. These burns have a higher morbidity, length of stay and a much higher risk of amputation than any other type of burn. Electrical burns affect mostly young, working males because they are more frequently the result of a work accident. However, possibly due to the worldwide economic crisis, we are experiencing a new phenomenon: the theft of high-voltage copper wiring. PMID:27857650

[69-year-old patient with seizure of unknown origin].

PubMed

Riediger, Ch; Iff, S; Stucki, A; Donati, F; Stanga, Z

2007-03-07

Diseases associated with cobalamin deficiency often present a variety of neurological disorders apart from the well known megaloblastic anaemia as haematological manifestation. The peripheral and the central nervous system can be affected in different levels by the metabolic changes due to an impaired Vitamin B12 metabolism. Based upon an observed case we discuss the manifestation of cerebral convulsion possibly due to a secondarily acquired cobalamin deficiency. We conclude that in de novo cerebral convulsion in the elderly a cobalamin deficiency could play an important role.

[Aseptic, simultaneous and bilateral mobilisation due to an acetabular shell fracture in a 43 year-old patient].

PubMed

Ceretti, M; Fanelli, M; Pappalardo, S

2014-01-01

The acetabular shell mobilization is the main long-term complication in total hip replacement. Metal-back fracture has also to be considered among the possible causes of shell mobilization. A case is presented of bilateral acetabular shell mobilization due to the trabecular covering de-soldering from the metal-back in a 43 year-old patient, 13-14 years after the first surgery. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

Three suspected cases of sugammadex-induced anaphylactic shock.

PubMed

Takazawa, Tomonori; Tomita, Yukinari; Yoshida, Nagahide; Tomioka, Akihiro; Horiuchi, Tatsuo; Nagata, Chie; Orihara, Masaki; Yamada, Makiko Hardy; Saito, Shigeru

2014-01-01

Sugammadex has a unique mechanism of action and is widely used because of its safety and efficacy. A few recent reports have described allergic reactions to clinical doses of sugammadex. We hereby describe another series of cases of possible anaphylaxis to sugammadex. We present three suspected cases of sugammadex-induced anaphylactic shock, including a 13-year-old boy who underwent laparoscopic appendectomy, a 75-year-old woman who underwent left knee arthroplasty, and a 34-year-old man who underwent left pansinectomy for sinobronchitis. All three patients received general anesthesia with rocuronium and their tracheas were intubated. Shortly after injection of sugammadex for reversal of rocuronium, all of them experienced a decrease in blood pressure along with mucocutaneous erythema. In the most severe case, reintubation after extubation was required due to difficulty in manual ventilation. All patients recovered with anti-allergic therapy. On later investigation, all three patients had a positive skin reaction to sugammadex. Our results suggest that physicians using sugammadex should be aware of the possibility of sugammadex-induced anaphylaxis.

Significance of Crime Scene Visit by Forensic Pathologist in Cases of Atypical Firearm Injuries.

PubMed

Thejaswi, H T; Kumar, A; Krishna, K

2015-01-01

Deaths due to firearms are some of the interesting and contentious cases that a forensic pathologist/autopsy surgeon encounters in his practice. Whenever there is 'ambiguity' regarding the nature or sequence of events any unnatural deaths including those caused by firearms the practice of visiting crime scene should be encouraged especially in a country like India where autopsy surgeons often neglect it. Here we present a case report in which there were inconsistencies in the autopsy findings with the alleged history. The witnesses heard about four to six gunshot sounds, whereas only two spent cartridge cases were retrieved from the crime scene. Authors identified the atypical nature of firearm injuries sustained by the victims that were possible by just two bullets. Crime scene visit was undertaken where we discovered the possibility of the echo effect behind the production of four to six sounds. Further by using computer software program, positions of the gunman, victims and the bullet trajectory of the two bullets was created.

First case of symmetric drug-related intertriginous and flexural exanthema (sdrife) due to rivastigmine?

PubMed

Allain-Veyrac, Gwenaëlle; Lebreton, Anne; Collonnier, Catherine; Jolliet, Pascale

2011-06-01

The term 'baboon syndrome' was introduced in 1984 to describe a special form of systemic, contact-type dermatitis that occurs after ingestion or systemic absorption of a contact allergen in individuals previously sensitized by topical exposure to the same allergen in the same areas. Its clinical picture presents as an erythema of the buttocks and upper inner thighs resembling the red bottom of baboons. This reaction was originally observed with mercury, nickel, and ampicillin. In 2004, some authors proposed the acronym SDRIFE standing for 'symmetric drug-related intertriginous and flexural exanthema' specifically for cases elicited by systemically administered drugs. Since 1984, about 100 cases have been reported in the literature; for most of the concerned drugs, previous skin sensitization or possible cross-sensitization has not been shown. We report the first case of SDRIFE due to rivastigmine, with the exception of an erythematous maculopapular eruption due to rivastigmine that was previously reported. Rivastigmine is a reversible and noncompetitive acetylcholinesterase inhibitor used for the treatment of Alzheimer disease. SDRIFE is an important condition to keep in mind in order to avoid a misdiagnosis when dealing with other exanthematous disorders and to prevent re-exposure to the responsible allergen in the future.

[Calcium supplementation uncovering lactose intolerance - a case report].

PubMed

Trifina, Eva; Geissler, Dietmar; Zwettler, Elisabeth; Klaushofer, Klaus; Mikosch, Peter

2012-03-01

A 44 yr-old female with osteoporosis had no relevant gastrointestinal symptoms and did not avoid any specific food. However, after prescription of a lactose-rich calcium supplementation, clinical symptoms suspicious for lactose intolerance occurred, which were thereafter confirmed by a lactose tolerance test. Lactose intolerance may present with only slight or subtle symptoms. Drugs containing lactose may induce or increase gastrointestinal symptoms in patients with lactose intolerance. In case of gastrointestinal symptoms occurring after the initiation of drugs containing lactose, the possibility of lactose intolerance should be considered and tested by lactose tolerance test or genetic testing for the LCT (-13910) polymorphism. Due to the prevalence of about 15-25% lactose intolerance in the Austrian population, lactose free drugs should be prescribed as widely as possible.

[Intraoperative frozen sections of the thyroid gland].

PubMed

Synoracki, S; Ting, S; Siebolts, U; Dralle, H; Koperek, O; Schmid, K W

2015-07-01

The goal of evaluation of intraoperative frozen sections of the thyroid gland is to achieve a definitive diagnosis which determines the subsequent surgical management as fast as possible; however, due to the specific methodological situation of thyroid frozen sections evaluation a conclusive diagnosis can be made in only some of the cases. If no conclusive histological diagnosis is possible during the operation, subsequent privileged processing of the specimen allows a final diagnosis at the latest within 48 h in almost all remaining cases. Applying this strategy, both pathologists and surgeons require a high level of communication and knowledge regarding the specific diagnostic and therapeutic peculiarities of thyroid malignancies because different surgical strategies must be employed depending on the histological tumor subtype.

Griseofulvin and/or Terbinafine Induced Toxic Epidermal Necrolysis in an Adult Female Patient - A Case Report.

PubMed

Jadeja, Dharamvirsinh; Jaiswal, Chandra S; Panchasra, Ashwin; Tripathi, Chandrabhanu B

2016-01-01

An 18 years old female patient, who was taking treatment for tinea cruris developed Toxic Epidermal Necrolysis (TEN) due to therapeutic dose of griseofulvin with concomitant use of terbinafine. Both the drugs were stopped; patient's condition was gradually improved after starting the treatment. As per WHO-UMC causality assessment criteria, association between reaction and drug was possible (for both griseofulvin and terbinafine). Griseofulvin and terbinafine, both are widely used as an oral antifungal agent to treat fungal infections, careful monitoring is required in the initial periods of the treatment to prevent such type of serious adverse drug reaction. We report a case of TEN possibly caused by griseofulvin with concomitant use of terbinafine resulting in diagnostic difficulty.

Stanford-Binet & WAIS IQ Differences and Their Implications for Adults with Intellectual Disability (aka Mental Retardation).

PubMed

Silverman, Wayne; Miezejeski, Charles; Ryan, Robert; Zigman, Warren; Krinsky-McHale, Sharon; Urv, Tiina

2010-03-01

Stanford-Binet and Wechsler Adult Intelligence Scale (WAIS) IQs were compared for a group of 74 adults with intellectual disability (ID). In every case, WAIS Full Scale IQ was higher than the Stanford-Binet Composite IQ, with a mean difference of 16.7 points. These differences did not appear to be due to the lower minimum possible score for the Stanford-Binet. Additional comparisons with other measures suggested that the WAIS might systematically underestimate severity of intellectual impairment. Implications of these findings are discussed regarding determination of disability status, estimating prevalence of ID, assessing dementia and aging-related cognitive declines, and diagnosis of ID in forensic cases involving a possible death penalty.

Stanford-Binet & WAIS IQ Differences and Their Implications for Adults with Intellectual Disability (aka Mental Retardation)

PubMed Central

Silverman, Wayne; Miezejeski, Charles; Ryan, Robert; Zigman, Warren; Krinsky-McHale, Sharon; Urv, Tiina

2010-01-01

Stanford-Binet and Wechsler Adult Intelligence Scale (WAIS) IQs were compared for a group of 74 adults with intellectual disability (ID). In every case, WAIS Full Scale IQ was higher than the Stanford-Binet Composite IQ, with a mean difference of 16.7 points. These differences did not appear to be due to the lower minimum possible score for the Stanford-Binet. Additional comparisons with other measures suggested that the WAIS might systematically underestimate severity of intellectual impairment. Implications of these findings are discussed regarding determination of disability status, estimating prevalence of ID, assessing dementia and aging-related cognitive declines, and diagnosis of ID in forensic cases involving a possible death penalty. PMID:20401180

Gastro-pancreaticojejunostomy for treatment of pancreatic ductal obstruction in a post-Whipple procedure patient.

PubMed

Rodrigues-Pinto, Eduardo; Grimm, Ian S; Baron, Todd H

2015-01-01

We report a case of a woman with a medical history of classic Whipple surgery who underwent endoscopic ultrasound (EUS)-guided pancreatic drainage due to smouldering acute pancreatitis secondary to an obstructing pancreatic ductal stone. A gastro-pancreaticojejunostomy anastomosis was created anterogradely, with dilation of both the anastomoses in the same procedure, with subsequent decompression of the pancreatic duct. Endoscopic retrograde pancreatography (ERP) is often impossible to perform in patients with post-Whipple procedure anatomy due to inaccessibility to the pancreaticojejunostomy anastomosis. EUS-guided pancreatic drainage may be offered in these patients in whom the pancreatic duct cannot be accessed at ERP. It has been used as a platform for access to and drainage of the pancreatic duct either by rendezvous or transmural drainage. However, only one of four patients achieve successful completion of the rendezvous procedure. There are limited data regarding safety and long-term outcome of this procedure, as well as scant guidelines on the optimal time for leaving stents in place. We believe definitive endoscopic therapy should be attempted, whenever possible, after relief of obstruction. In our case, we expect that stent occlusion is inevitable and that long-term drainage is possible due to drainage occurring between the stent and the stone.

Adult Hip Flexion Contracture due to Neurological Disease: A New Treatment Protocol—Surgical Treatment of Neurological Hip Flexion Contracture

PubMed Central

Nicodemo, Alberto; Arrigoni, Chiara; Bersano, Andrea; Massè, Alessandro

2014-01-01

Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible. PMID:24707293

Adult Hip Flexion Contracture due to Neurological Disease: A New Treatment Protocol-Surgical Treatment of Neurological Hip Flexion Contracture.

PubMed

Nicodemo, Alberto; Arrigoni, Chiara; Bersano, Andrea; Massè, Alessandro

2014-01-01

Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible.

Mechanisms of Lethal Cerebrovascular Accidents in Turner Syndrome.

PubMed

Byard, Roger W

2016-05-01

A case of intracerebral hemorrhage in Turner syndrome is reported with an analysis of possible causes of cerebrovascular accidents in this condition. A 42-year-old woman with known Turner syndrome died soon after hospital admission having been found unconscious at her home address. At autopsy, she showed typical features of Turner syndrome with short stature, webbing of the neck, underdeveloped breasts, and an increased carrying angle of the arm. Death was due to a large left-sided intracerebral hemorrhage extending from the left basal ganglia into the white matter of the frontal lobe and lateral ventricle. Cases of unexpected death in Turner syndrome may arise from occult cerebrovascular accidents which may be hemorrhagic or nonhemorrhagic. Associated features include hypertension, vascular malformations, accelerated atherogenesis, cystic medial necrosis, and moyamoya syndrome. The possibility of Turner syndrome should be considered in cases where there has been a lethal cerebrovascular event in a younger woman. © 2016 American Academy of Forensic Sciences.

Battered woman syndrome: An unusual presentation of pseudodystonia

PubMed Central

Chandra, Sadanandavalli Retnaswami; Issac, Thomas Gregor

2014-01-01

Pseudodystonia is the term used to define abnormal postures, which are not due to the disorders of the basal ganglia and is encountered very rarely in clinical practice and often difficult to distinguish from true dystonia syndromes. We report a rare case of a battered woman who was managed as restricted resistant dystonia with pharmacotherapy and intrathecal baclofen and referred for considering deep brain stimulation (DBS). The patient turned out to be a case of pseudodystonia due to bilateral hip dislocation. This was due to assault by a close relative and the history was masked by the patient for more than one and a half years. In a patient with late onset dystonia, who is resistant to the recommended treatment for dystonia along with atypical clinical features and electrophysiological parameters, pseudodystonia should always be considered as a possible diagnosis and evaluated for causes of the same. PMID:24966567

Battered woman syndrome: An unusual presentation of pseudodystonia.

PubMed

Chandra, Sadanandavalli Retnaswami; Issac, Thomas Gregor

2014-04-01

Pseudodystonia is the term used to define abnormal postures, which are not due to the disorders of the basal ganglia and is encountered very rarely in clinical practice and often difficult to distinguish from true dystonia syndromes. We report a rare case of a battered woman who was managed as restricted resistant dystonia with pharmacotherapy and intrathecal baclofen and referred for considering deep brain stimulation (DBS). The patient turned out to be a case of pseudodystonia due to bilateral hip dislocation. This was due to assault by a close relative and the history was masked by the patient for more than one and a half years. In a patient with late onset dystonia, who is resistant to the recommended treatment for dystonia along with atypical clinical features and electrophysiological parameters, pseudodystonia should always be considered as a possible diagnosis and evaluated for causes of the same.

Magnetic resonance imaging findings in fatal primary cerebral infection due to Chaetomium strumarium.

PubMed

Aribandi, M; Bazan Iii, C; Rinaldi, M G

2005-04-01

This report describes MRI findings of a rare case of biopsy-proven fatal cerebral infection with Chaetomium strumarium in a 28-year-old man with a history of i.v. drug abuse. Magnetic resonance imaging revealed rapidly progressing lesions with irregular peripheral enhancement, possible central haemorrhage and significant mass effect. Only six cases of cerebral infection with Chaetomium have been reported in the English literature. This is the first report in the radiology literature describing the imaging findings. The previously reported cases of cerebral infection by the Chaetomium species are also reviewed.

A Case Report of Post-Operative Jöd-Basedow Phenomennon Following Oral and IV Iodine Contrast Administration

PubMed Central

Hull, Erroll; Lujan, Eugenio

2014-01-01

This is a case of thyrotoxicosis, due to the Jöd-Basedow phenomenon following administration of oral and IV iodinated contrast in a patient with history of gastrointestinal stromal tumor (GIST) and small bowel obstruction. The patient developed atrial fibrillation and had an extended stay in the intensive care unit. Given the aging population with possible subclinical hyperthyroidism, multinodular goiter, and the rise in contrast administration for routine diagnostic studies, this case serves to raise awareness of the risks of “routine” tests administered to our aging patient population. PMID:24716009

[Imported tropical fish causes ciguatera fish poisoning in Germany].

PubMed

Zimmermann, Katharina; Eisenblätter, Anneka; Vetter, Irina; Ebbecke, Martin; Friedemann, Miriam; Desel, Herbert

2015-01-01

Ciguatera is a seafood-borne illness caused by consumption of tropical fish contaminated with ciguatoxins, lipophilic polyethers that are produced in benthic dinoflagellates and accumulate through the marine food chain. Ciguatera cases in Europe usually occur in travellers returning from tropical and subtropical regions of the Pacific and Carribean, where ciguatera is endemic. In 2012, several cases of ciguatera occurred in Germany due to sale of contaminated fish products originating from the Indian Ocean. Although the symptomatology in these cases were typical of ciguatera, with patients reporting gastrointestinal discomfort including nausea, vomiting and diarrhea as well as neurological effects including widespread intense pruritus, paresthesias, hypothermia or altered temperature sensation and diffuse pain, correct diagnosis was delayed in all cases due to lack of awareness of the treating medical practitioners. In light of increasing global mobility, trade, and occurrence of ciguatoxic fish in previously non-endemic areas, ciguatera should be considered as a possible diagnosis if gastrointestinal and neurological symptoms occur shortly after consumption of fish. Georg Thieme Verlag Stuttgart.

Major thoracic surgery in Jehovah's witness: A multidisciplinary approach case report

PubMed Central

Rispoli, Marco; Bergaminelli, Carlo; Nespoli, Moana Rossella; Esposito, Mariana; Mattiacci, Dario Maria; Corcione, Antonio; Buono, Salvatore

2016-01-01

Introduction A bloodless surgery can be desirable also for non Jehovah’s witnesses patients, but requires a team approach from the very first assessment to ensure adequate planning. Presentation of the case Our patient, a Jehovah’s witnesses, was scheduled for right lower lobectomy due to pulmonary adenocarcinoma. Her firm denies to receive any kind of transfusions, forced clinicians to a bloodless management of the case. Discussion Before surgery a meticulous coagulopathy research and hemodynamic optimization are useful to prepare patient to operation. During surgery, controlled hypotension can help to obtain effective hemostasis. After surgery, clinicians monitored any possible active bleeding, using continuous noninvasive hemoglobin monitoring, limiting the blood loss due to serial in vitro testing. The optimization of cardiac index and delivery of oxygen were continued to grant a fast recovery. Conclusion Bloodless surgery is likely to gain popularity, and become standard practice for all patients. The need for transfusion should be targeted on individual case, avoiding strictly fixed limit often leading to unnecessary transfusion. PMID:27107502

Graves' disease in a 3 year-old patient with agranulocytosis due to anti-thyroid drugs: Radioiodine ablation therapy as an effective alternative.

PubMed

Espinosa-Muñoz, E; Ramírez-Ocaña, D; Martín-García, A M; Ruiz-García, F J; Puentes-Zarzuela, C

The case is presented of a 3 year-old girl with mitochondrial disease (subacute necrotizing encephalomyelopathy of Leigh syndrome), v-stage chronic kidney disease of a diffuse mesangial sclerosis, as well as developmental disorders, and diagnosed with hyperthyroidism Graves-Basedow disease. Six weeks after starting the treatment with neo-carbimazole, the patient reported a serious case of agranulocytosis. This led to stopping the anti-thyroid drugs, and was treated successfully with 131 I ablation therapy. The relevance of the article is that Graves' disease is uncommon in the paediatric age range (especially in children younger than 6 years old), and developing complications due to a possible late diagnosis. Agranulocytosis as a potentially serious adverse effect following the use of anti-thyroid drugs, and the few reported cases of ablation therapy with 131 I at this age, makes this case unique. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

A Unusual Lightning Death in an Indoor Setting: A Case Report.

PubMed

Ventura, Francesco; Barranco, Rosario; Bonsignore, Alessandro; De Stefano, Francesco

2017-03-01

Death due to lightning strikes is infrequent, above all indoors. Some cases may take on a medical legal interest due to the unusual and uncommon circumstances in which they occur. The authors report an extremely rare case of electrocution occurred inside a house in a rural area. A 53-year-old man was reached by an electrical discharge originating from lightning while he was doing renovation work on a cottage. In this case, the correct interpretation of the autopsy and histological aspects and the attentive analysis of the circumstantial and environmental data led to the correct diagnosis of death and to the reconstruction of the dynamics with which it occurred. It was in fact possible to reconstruct that during a violent thunderstorm, lightning, discharging from the bottom upward formed an electric arc. The victim, who was close to metal objects (sawhorses), was struck on the left foot and the current exited from the right hand passing through the heart causing immediate death.

Recurring ventriculitis due to Citrobacter diversus: clinical and bacteriologic analysis.

PubMed

Eppes, S C; Woods, C R; Mayer, A S; Klein, J D

1993-09-01

Neonatal meningitis due to Citrobacter diversus is usually accompanied by the development of brain abscesses and tends to have high rates of morbidity and mortality. We report a case of a newborn with C. diversus meningitis and brain abscesses who relapsed after initial antibiotic therapy and from whom C. diversus was recovered from cerebrospinal fluid 4 years later during a neurosurgical procedure. Genetic differences in the early and late isolates were discovered, and explanations for this phenomenon are suggested. Possible mechanisms for prolonged persistence in the central nervous system are explored. This unusual case and the analysis of the organisms illustrate the unique features of C. diversus as a pathogen and underscore the need for developing optimal therapeutic strategies.

Estimation of true incidence of polio: overcoming misclassification errors due to stool culture insensitivity.

PubMed

Srinivas, V; Puliyel, Jacob M

2007-08-01

The diagnosis of polio dependents on culturing the virus in stool samples of children with AFP. Using data obtained under the "Right to Information Act" of instances where only one of the two samples was positive for polio, it was possible to estimate the sensitivity of the system to detect cases of polio. The calculations suggest that there were 1625 (95% CI 1528 to 1725) cases of polio in India in 2006 rather than the 674 reported widely!

Seat-belt trauma of the breast in a pregnant woman causing milk-duct injury: a case report and review of the literature

PubMed Central

Mistry, P; Harries, S; Clarke, D; Jones, L

2010-01-01

Injury to the milk-duct following a road traffic accident has not been reported in the literature. This case report describes a 25-year-old postpartum lady with massive swelling of the breast due to milk-duct injury and collection of milk within the breast. We describe the possible mechanism of milk-duct injury, its presentation and management, and also review the literature on seat-belt injury to the breast. PMID:20529454

Focal cemento-osseous dysplasia: review and a case report.

PubMed

Salem, Y M Y; Osman, Y I; Norval, E J G

2010-10-01

Focal cemento-osseous dysplasia is a benign fibro-osseous condition that can be seen in dentate and edentulous patients. It is an asymptomatic lesion and needs no treatment; however follow-up is essential due to the possibility that focal cemento-osseous dysplasia can progress to a condition called florid osseous dysplasia that involves multiple sites. A case report is presented here, along with a review of the differential diagnoses considered in order to reach a final diagnosis of focal cemento-osseous dysplasia.

Lost in laterality: interpreting ''preferred side of the head during mobile phone use and risk of brain tumour'' associations.

PubMed

Schüz, Joachim

2009-08-01

Due to the highly localized exposure from mobile phones, the preferred side of the head during their use is important information when investigating a possible link with brain tumour risk, but at the same time, error and bias hamper the assessment of this information in case-control studies. Current studies provide evidence of reporting bias insofar as cases appear to over-report the side of the head where the tumour occurred as the one that they preferred in the past when using mobile phones. More refined methods of analysis among only cases or prospective studies with an assessment of the laterality of mobile phone use before the diagnosis of disease are needed to evaluate whether associations seen in some studies are entirely due to reporting bias or a mixture of reporting bias and a causal effect.

Factors influencing post abortion outcomes among high-risk patients in Zimbabwe.

PubMed

Mudokwenuy-Rawdon, C; Ehlers, V J; Bezuidenhout, M C

2005-11-01

Post abortion complications remain one of the major causes of mortality among women of child bearing age in Zimbabwe. Based on this problem, factors associated with mortalities due to abortion were investigated with the aim of improving post abortion outcomes for Zimbabwe's women, and possibly also for women of other African countries. Cases and controls were selected from 4895 post abortion records to conduct a retrospective case-control study. Significant risk factors identified for reducing mortalities due to post abortion complications included the administration of oxytocic drugs and evacuation of the uterus whilst anaemia and sepsis apparently reduced these women's chances of survival. Women who died (cases) from post abortion complications apparently received better reported quantitative care than controls. Recommendations based on this research report include improved education of health care workers and enhanced in-service training, regular audits of patients' records and changed policies for managing these conditions more effectively in Zimbabwe.

Academic Corrective Action from a Legal Perspective.

ERIC Educational Resources Information Center

Collura, Frank J.

1997-01-01

In cases of cheating, plagiarism, or violations of the law in dental education, a very high level of due process is required. University counsel can help administrators determine whether an accused student is professionally suited to dentistry by characterizing as many corrective actions as possible as academic under the rubric of "suitability to…

Teacher Education Students Using TPACK in Science: A Case Study

ERIC Educational Resources Information Center

Sheffield, Rachel; Dobozy, Eva; Gibson, David; Mullaney, Jim; Campbell, Chris

2015-01-01

Teacher education is in the grip of change. Due to the new Australian Curriculum, no longer is it possible to plan and implement lessons without considering the inclusion of Information and Communication Technologies. Simply knowing about the latest technology gadgets is not enough. Information literacy is essential in today's information-rich…

[Conservative treatment of hepatic amebic abscesses].

PubMed

Garlicki, A; Kluba-Wojewoda, U; Krukowiecki, J; Kowalski, P

1996-04-01

A case is presented of hepatic amebic abscesses in a young man after return from India. After establishing of the aetiology of the disease conservative treatment was started which was completed with success. The authors point to the possibility of transmission of amoeba dysentery to Poland due to journeys to tropical or subtropical countries.

Entropy Generation Minimization in Dimethyl Ether Synthesis: A Case Study

NASA Astrophysics Data System (ADS)

Kingston, Diego; Razzitte, Adrián César

2018-04-01

Entropy generation minimization is a method that helps improve the efficiency of real processes and devices. In this article, we study the entropy production (due to chemical reactions, heat exchange and friction) in a conventional reactor that synthesizes dimethyl ether and minimize it by modifying different operating variables of the reactor, such as composition, temperature and pressure, while aiming at a fixed production of dimethyl ether. Our results indicate that it is possible to reduce the entropy production rate by nearly 70 % and that, by changing only the inlet composition, it is possible to cut it by nearly 40 %, though this comes at the expense of greater dissipation due to heat transfer. We also study the alternative of coupling the reactor with another, where dehydrogenation of methylcyclohexane takes place. In that case, entropy generation can be reduced by 54 %, when pressure, temperature and inlet molar flows are varied. These examples show that entropy generation analysis can be a valuable tool in engineering design and applications aiming at process intensification and efficient operation of plant equipment.

The characteristics of adults with upper gastrointestinal bleeding admitted to Tripoli Medical Center: a retrospective case-series analysis

PubMed Central

Elghuel, Abdulbaset

2011-01-01

Background Acute upper gastrointestinal bleeding (UGIB) is a common reason for hospital admissions worldwide. Aetiological causes of UGIB vary according to geographic region and socioeconomic status. However, despite the implementation of early endoscopy as the standard method for the diagnosis and treatment of UGIB, data on the characteristics of patients with UGIB in Libya are still minimal. In this study, we describe patient demographics, aetiological causes for UGIB, and possible risk factors for upper gastrointestinal bleeding in patients admitted to the Gastroenterology Department at Tripoli Medical Center from January 2001 through June 2006. Method This is a retrospective case-series analysis of all adult patients with upper gastrointestinal bleeding admitted to the Gastroenterology Department at TMC. Patients' medical records were individually reviewed and relevant data abstracted. Results A total of 928 cases with diagnoses of UGIB were admitted to Tripoli Medical Center during the study period. Of these cases, 60.3% were males and 39.7% females (3:2) and males were significantly younger than females (49.6 years vs. 53.9 years, p=0.001). The most common cause of UGIB was peptic ulcer (37.1%) of which duodenal ulcer was the most common (30.7% of all UGIB), especially amongst male patients (36.4%). The second most common cause was bleeding due to varices (29.8%), especially amongst females (35.1%). Additionally, smoking and NSAIDs use were reported by 18.6% and 9.7% of cases and both were significantly associated with bleeding due to peptic ulcers. Conclusion This study has investigated the characteristics of adults with UGIB at a tertiary referral center in Libya. The high frequency of bleeding due to varices amongst females mandates further investigations into the possible underlying hepatic causes and their management, and the potential impact on patient outcome and prognosis. PMID:21526040

[Delayed right hepatic artery haemorrhage after iatrogenic gallbladder by laparoscopic cholecystectomy that required a liver transplant due to acute liver failure: clinical case and review of the literature].

PubMed

Robles Campos, Ricardo; Marín Hernández, Caridad; Fernández Hernández, Juan Angel; Sanchez Bueno, Francisco; Ramirez Romero, Pablo; Pastor Perez, Patricia; Parrilla Paricio, Pascual

2011-12-01

Right hepatic artery (RHA) injury after laparoscopic cholecystectomy (LC) may go unnoticed clinically, but can sometimes cause necrosis of the right lobe. Exceptionally, when the necrosis spreads to segment IV, fulminant liver failure (FLF) may occur, and an urgent liver transplantation (LT) may be required. We provide a review of the literature on patients with indication for an LT due to vascular damage caused by bile duct injury following LC. The case reported herein is the fourth described in the specialized literature of LT due to RHA injury after LC and the second of FLF after RHA injury. LT due to RHA injury was performed in 3 of 13 patients reported in the literature: one LT was performed at 3 months due to FLF, after an extended right hepatectomy was performed, and the remaining two were performed due to secondary biliary cirrhosis. Our patient was transplanted due to FLF 15 days after the injury. RHA injury after LC may require LT due to FLF. Although exceptional, this possibility should be considered when there are RHA complications that may require occlusion. Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.

[Fatal occupational accidents: updating of data from a mortality register].

PubMed

Mantero, Silvia; Baldasseroni, A; Chellini, Elisabetta; Giovanetti, Lucia

2005-01-01

In Italy, almost one thousand deaths due to occupational accidents are usually registered by INAIL each year. Case registration by INAIL has merely administrative purposes and therefore it is necessary to use other sources for case ascertainment in order to better estimate the real number of deaths related to occupational accidents, as shown also by previous papers. Evaluation of the contribution of another data source, namely the Tuscany Regional Mortality Registry, to obtain the correct figure for occupational accident deaths through the use of a place-of-occurrence notation on the death certificate. Cases that occurred in residents in Tuscany in 2000-2001 were considered. They were identified from : a) the Tuscany Regional Mortality Registry (RMR) using the E code of the ICD LX code of death, the year and place of occurrence; b) the INAIL archive using the year of event, the type of definition and management. The INAIL source was without doubt the most informative but was only 51% complete, whereas the RMR source, although less informative, was more complete (82.4%) and allowed identification of cases not registered by INAIL, that had occurred for instance in the Armed Forces and in the National Railway Company. However, the vast majority of RMR extra-cases occurred in subjects aged 65+, in agriculture and in the building industry. It is currently possible to plan a systematic linkage of the two sources due to the new possibilities that are available: the place-of-occurrence in the death certificate and the availability of individual data in the INAIL source.

The etiology of Rubella IgM positivity in patients with rubella-like illness in Iran from 2011 to 2013.

PubMed

Khorrami, Seyed Mahmood Seyed; Mokhtari-Azad, Talat; Yavarian, Jila; Nasab, Gazal Sadat Fatemi; Naseri, Maryam; Jandaghi, Nazanin Zahra Shafiei

2015-11-01

Rubella is a mild self-limiting contagious viral disease caused by the rubella virus (RV). Although symptoms are often mild, the concern is centralized around the possible effect on a fetus growth and development in case of primary infection during early months of pregnancy. Recently acquired rubella is commonly confirmed by RV-specific IgM antibody detection in the serum. However, rubella primary infection is not always the only cause of IgM positivity. Other possible causes of rubella IgM positivity may include IgM persistence following vaccination or naturally acquired infection or even re-infection. Moreover, nonspecific IgM reactivity can cause false-positive results. There are few articles to differentiate the aetiology of rash in rubella-like illnesses. However, limited studies have been conducted on clarifying the source of IgM positivity in these cases. This article reports the study of 10,896 clinical cases demonstrating rubella-like illness between 2011 and 2013 in Iran. The rate of IgM positivity among these cases was 0.52% (57 cases). As predicted based on the high coverage of vaccination in Iran fewer than 16% of cases with ELISA IgM positive result, were due to current rubella primary infections. The greater part of the positive IgM reactions occurred in cross reactivity with other viruses (31.6%) or in prolonged IgM response post vaccination (24.6%). This research confirmed that the positive result of rubella IgM assay in vaccinated individuals is mainly caused by prolonged IgM production, rubella re-infection, and false positivity due to infection with other viruses, rather than the rubella primary infection itself. © 2015 Wiley Periodicals, Inc.

A Comparison of Simulated JWST Observations Derived from Equilibrium and Non-equilibrium Chemistry Models of Giant Exoplanets

NASA Astrophysics Data System (ADS)

Blumenthal, Sarah D.; Mandell, Avi M.; Hébrard, Eric; Batalha, Natasha E.; Cubillos, Patricio E.; Rugheimer, Sarah; Wakeford, Hannah R.

2018-02-01

We aim to see if the difference between equilibrium and disequilibrium chemistry is observable in the atmospheres of transiting planets by the James Webb Space Telescope (JWST). We perform a case study comparing the dayside emission spectra of three planets like HD 189733b, WASP-80b, and GJ 436b, in and out of chemical equilibrium at two metallicities each. These three planets were chosen because they span a large range of planetary masses and equilibrium temperatures, from hot and Jupiter-sized to warm and Neptune-sized. We link the one-dimensional disequilibrium chemistry model from Venot et al. (2012), in which thermochemical kinetics, vertical transport, and photochemistry are taken into account, to the one-dimensional, pseudo line-by-line radiative transfer model, Pyrat bay, developed especially for hot Jupiters, and then simulate JWST spectra using PandExo for comparing the effects of temperature, metallicity, and radius. We find the most significant differences from 4 to 5 μm due to disequilibrium from CO and CO2 abundances, and also H2O for select cases. Our case study shows a certain “sweet spot” of planetary mass, temperature, and metallicity where the difference between equilibrium and disequilibrium is observable. For a planet similar to WASP-80b, JWST’s NIRSpec G395M can detect differences due to disequilibrium chemistry with one eclipse event. For a planet similar to GJ 436b, the observability of differences due to disequilibrium chemistry is possible at low metallicity given five eclipse events, but not possible at the higher metallicity.

Decompression sickness in a vegetarian diver: are vegetarian divers at risk? A case report.

PubMed

van Hulst, Robert A; van der Kamp, Wim

2010-01-01

We present a case of a diver who suffered decompression sickness (DCS), but who also was a strict vegetarian for more than 10 years. He presented with symptoms of tingling of both feet and left hand, weakness in both legs and sensory deficits for vibration and propriocepsis after two deep dives with decompression. The initial clinical features of this case were most consistent with DCS, possibly because of a vulnerable spinal cord due to cobalamin deficiency neuropathy. This case illustrates the similarities between DCS and a clinically defined vitamin B12 deficiency. The pathophysiology of vitamin B12 deficiency and common pathology and symptoms of DCS are reviewed.

Valley-orbit splitting in doped nanocrystalline silicon: k•p calculations

NASA Astrophysics Data System (ADS)

Belyakov, Vladimir A.; Burdov, Vladimir A.

2007-07-01

The valley-orbit splitting in silicon quantum dots with shallow donors has been theoretically studied. In particular, the chemical-shift calculation was carried out within the frames of k•p approximation for single- and many-donor cases. For both cases, the great value of the chemical shift has been obtained compared to its bulk value. Such increase of the chemical shift becomes possible due to the quantum confinement effect in a dot. It is shown for the single-donor case that the level splitting and chemical shift strongly depend on the dot radius and donor position inside the nanocrystal. In the many-donor case, the chemical shift is almost proportional to the number of donors.

Spontaneous spinal epidural hematoma with hemiparesis mimicking acute cerebral infarction: Two case reports

PubMed Central

Matsumoto, Hiroaki; Miki, Takanori; Miyaji, Yuki; Minami, Hiroaki; Masuda, Atsushi; Tominaga, Shogo; Yoshida, Yasuhisa; Yamaura, Ikuya; Matsumoto, Shigeo; Natsume, Shigeatsu; Yoshida, Kozo

2012-01-01

Context Acute hemiparesis is a common initial presentation of ischemic stroke. Although hemiparesis due to spontaneous spinal epidural hematoma (SSEH) is an uncommon symptom, a few cases have been reported and misdiagnosed as cerebral infarction. Design Case reports of SSEH with acute hemiparesis. Findings In these two cases, acute stroke was suspected initially and administration of intravenous alteplase therapy was considered. In one case, the presentation was neck pain and in the other case, it was Lhermitte's sign; brain magnetic resonance imaging (MRI) and magnetic resonance angiography were negative for signs of ischemic infarction, hemorrhage, or arterial dissection. Cervical MRI was performed and demonstrated SSEH. Conclusion Clinicians who perform intravenous thrombolytic treatment with alteplase need to be aware of this possible contraindication. PMID:22925753

Giant scrotal elephantiasis: an idiopathic case.

PubMed

Dianzani, C; Gaspardini, F; Persichetti, P; Brunetti, B; Pizzuti, A; Margiotti, K; Degener, A M

2010-01-01

Scrotal elephantiasis is very rare disease in industrialized countries, where it is mainly due to surgery, irradiation or malignancies. It can be defined as idiopathic only when the possible congenital, infectious and compressive causes are excluded. We report a case of massive scrotal lymphoedema in an adult Caucasian patient, in Italy. He presented an extremely voluminous scrotal mass measuring 50 x 47 x 13 cm (weight 18 kg), which extended below his knees, invalidating all his daily activities. The patient was hospitalized in order to undergo to surgical treatment. Although genetic causes were searched and the possible role of infectious agents and compressive factors was evaluated, no etiology was ascertained. Histopathologic examination showed non-specific chronic inflammation, confirming the diagnosis of idiopathic elephantiasis. One year after surgical treatment, the patient is healthy without recurrence signs.

Possibilities of rock constitutive modelling and simulations

NASA Astrophysics Data System (ADS)

Baranowski, Paweł; Małachowski, Jerzy

2018-01-01

The paper deals with a problem of rock finite element modelling and simulation. The main intention of authors was to present possibilities of different approaches in case of rock constitutive modelling. For this purpose granite rock was selected, due to its wide mechanical properties recognition and prevalence in literature. Two significantly different constitutive material models were implemented to simulate the granite fracture in various configurations: Johnson - Holmquist ceramic model which is very often used for predicting rock and other brittle materials behavior, and a simple linear elastic model with a brittle failure which can be used for simulating glass fracturing. Four cases with different loading conditions were chosen to compare the aforementioned constitutive models: uniaxial compression test, notched three-point-bending test, copper ball impacting a block test and small scale blasting test.

Weather conditions may worsen symptoms in rheumatoid arthritis patients: the possible effect of temperature.

PubMed

Abasolo, Lydia; Tobías, Aurelio; Leon, Leticia; Carmona, Loreto; Fernandez-Rueda, Jose Luis; Rodriguez, Ana Belen; Fernandez-Gutierrez, Benjamin; Jover, Juan Angel

2013-01-01

Patients with rheumatoid arthritis (RA) complain that weather conditions aggravate their symptoms. We investigated the short-term effects of weather conditions on worsening of RA and determined possible seasonal fluctuations. We conducted a case-crossover study in Madrid, Spain. Daily cases of RA flares were collected from the emergency room of a tertiary level hospital between 2004 and 2007. 245 RA patients who visited the emergency room 306 times due to RA related complaints as the main diagnostic reason were included in the study. Patients from 50 to 65 years old were 16% more likely to present a flare with lower mean temperatures. Our results support the belief that weather influences rheumatic pain in middle aged patients. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Organophosphate acetylcholine esterase inhibitor poisoning from a home-made shampoo.

PubMed

Sadaka, Yair; Broides, Arnon; Tzion, Raffi Lev; Lifshitz, Matitiahu

2011-07-01

Organophosphate acetylcholine esterase inhibitor poisoning is a major health problem in children. We report an unusual cause of organophosphate acetylcholine esterase inhibitor poisoning. Two children were admitted to the pediatric intensive care unit due to organophosphate acetylcholine esterase inhibitor poisoning after exposure from a home-made shampoo that was used for the treatment of head lice. Owing to no obvious source of poisoning, the diagnosis of organophosphate acetylcholine esterase inhibitor poisoning in one of these patients was delayed. Both patients had an uneventful recovery. Organophosphate acetylcholine esterase inhibitor poisoning from home-made shampoo is possible. In cases where the mode of poisoning is unclear, direct questioning about the use of home-made shampoo is warranted, in these cases the skin and particularly the scalp should be rinsed thoroughly as soon as possible.

The effect of a defective BSF layer on solar cell open circuit voltage. [Back Surface Field

NASA Technical Reports Server (NTRS)

Weizer, V. G.

1985-01-01

A straightforward analysis of special limiting cases has permitted the determination of the range of possible open circuit voltage losses due to a defective BSF (back surface field) layer. An important result of the analysis is the finding that it is possible to have a fully effective BSF region, regardless of the spatial distribution of the defective areas, as long as the total defective area is reduced below certain limits. Distributed defects were found to be much more harmful than lumped defects.

Hemothorax caused by spontaneous rupture of hepatocellular carcinoma: a case report and review of the literature.

PubMed

Ono, Fuminori; Hiraga, Masaki; Omura, Noriyuki; Sato, Manabu; Yamamura, Akihiro; Obara, Megumi; Sato, Jun; Onochi, Shoichi

2012-10-10

We report a rare case in which hemothorax occurred in addition to hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma (HCC) originating from the caudate lobe of the liver. The case pertains to a 56-year-old female who was transported to our hospital for impaired consciousness due to hemorrhagic shock. Computed tomography (CT) demonstrated ruptured HCC originating from the caudate lobe and accompanying hemoperitoneum and right hemothorax. Hemostasis was carried out by transcatheter arterial embolization (TAE), and surgery was conducted approximately one month after TAE. In the present case, no lesions as possible sources of bleeding were observed inside the pleural cavity, and, moreover, the diaphragm had no abnormalities in the intraoperative findings, suggesting that blood from the ruptured tumor may have traversed the intact diaphragm to enter the right pleural cavity soon after the HCC rupture. However, to the best of our knowledge, no similar cases of HCC have been reported to date, and this case is thus believed to be very rare. This unusual phenomenon may therefore be strongly associated with the location of the ruptured tumor and the formation of a hematoma inside the omental bursa. We discuss the mechanism causing hemothorax in the present case and also review the previously reported cases of ruptured HCC complicated by hemothorax.

Hemothorax caused by spontaneous rupture of hepatocellular carcinoma: a case report and review of the literature

PubMed Central

2012-01-01

We report a rare case in which hemothorax occurred in addition to hemoperitoneum due to spontaneous rupture of hepatocellular carcinoma (HCC) originating from the caudate lobe of the liver. The case pertains to a 56-year-old female who was transported to our hospital for impaired consciousness due to hemorrhagic shock. Computed tomography (CT) demonstrated ruptured HCC originating from the caudate lobe and accompanying hemoperitoneum and right hemothorax. Hemostasis was carried out by transcatheter arterial embolization (TAE), and surgery was conducted approximately one month after TAE. In the present case, no lesions as possible sources of bleeding were observed inside the pleural cavity, and, moreover, the diaphragm had no abnormalities in the intraoperative findings, suggesting that blood from the ruptured tumor may have traversed the intact diaphragm to enter the right pleural cavity soon after the HCC rupture. However, to the best of our knowledge, no similar cases of HCC have been reported to date, and this case is thus believed to be very rare. This unusual phenomenon may therefore be strongly associated with the location of the ruptured tumor and the formation of a hematoma inside the omental bursa. We discuss the mechanism causing hemothorax in the present case and also review the previously reported cases of ruptured HCC complicated by hemothorax. PMID:23046863

Age of Diagnosis of Autism Spectrum Disorder in Latino Children: The Case of Venezuelan Children

ERIC Educational Resources Information Center

Montiel-Nava, Cecilia; Chacín, José A.; González-Ávila, Zoila

2017-01-01

Latino children are diagnosed with autism spectrum disorder later in life, usually with more severe symptoms, and lower IQs, compared with non-Latino children. Possible reasons for such disparities could be due to lower levels of parent education, lower socioeconomic status, limited knowledge of parents about autism spectrum disorder, and…

Investigation of the Regioselectivity of Alkene Hydrations for the Undergraduate Organic Laboratory

ERIC Educational Resources Information Center

Bichler, Katherine A.; Van Ornum, Scott G.; Franz, Margaret C.; Imhoff, Andrea M.

2015-01-01

Due to a lack of time and, thus, an inability to present every possibility in a chemical reaction, organic chemistry professors tend to present each reaction with a single outcome. In practice, this is clearly not the case. A first-semester, three-week laboratory experiment designed for undergraduate organic chemistry students is described in…

[Isolated hyoid bone fracture due to blunt trauma: case report].

PubMed

Erdoğan, Mehmet Ozgür; Koşargelir, Mehmet; Yorulmaz, Rasim; Meriç, Kaan; Erdoğan, Barış

2013-05-01

Fractures of the hyoid bone are very rare. Diagnosis of hyoid fracture is difficult and can be made only with a strong degree of suspicion. We report a case of isolated hyoid bone fracture due to blunt trauma to the neck. A 26-year-old woman was admitted to emergency department for motor vehicle accident. She complained of dysphagia and anterior neck discomfort. Physical examination showed hyperemia and tenderness of neck. A tomographic scan of neck was performed. The findings demonstrated hyoid fracture. Patient was observed with medical therapy for 24 hours and discharged with recommendation of outpatient control.Emergency physician has to be aware of the possibility of hyoid fractures in blunt traumas. Patients with hyoid fracture should be observed for 24 hours. Generally, medical treatment is satisfactory in isolated hyoid fractures.

[Gastrointestinal bleeding--concepts of surgical therapy in the upper gastrointestinal tract].

PubMed

Knoefel, W T; Rehders, A

2006-02-01

Bleeding of the upper gastrointestinal tract is the main symptom of a variety of possible conditions and still results in considerable mortality. Endoscopy is the first diagnostic modality, enabling rapid therapeutic intervention. In case of intractable or relapsing bleeding, surgery is often inevitable. However, emergency operations result in significantly higher mortality rates. Therefore the option of early elective surgical intervention should be considered for patients at increased risk of relapsing bleeding. If bleeding is symptomatic due to a complex underlying condition such as hemosuccus pancreaticus or hemobilia, angiography is now recognized as the definitive investigation. Angiographic hemostasis can be achieved in most cases. Due to the underlying condition, surgical management still remains the mainstay in treating these patients. This paper reviews surgical strategy in handling upper gastrointestinal bleeding.

Severe acute respiratory distress syndrome caused by unintentional sewing machine lubricant ingestion: A case report.

PubMed

Kishore, Sunil; Chandelia, Sudha; Patharia, Neha; Swarnim

2016-11-01

Sewing machine oil ingestion is rare but is possible due to its availability at home. Chemically, it belongs to hydrocarbon family which is toxic if aspirated, owing to their physical properties such as high volatility and low viscosity. On the contrary, sewing machine lubricant has high viscosity and low volatility which makes it aspiration less likely. The main danger of hydrocarbon ingestion is chemical pneumonitis which may be as severe as acute respiratory distress syndrome (ARDS). We report a case of a 5-year-old girl with accidental ingestion of sewing machine lubricant oil, who subsequently developed ARDS refractory to mechanical ventilation. There was much improvement with airway pressure release ventilation mode of ventilation, but the child succumbed to death due to pulmonary hemorrhage.

Severe acute respiratory distress syndrome caused by unintentional sewing machine lubricant ingestion: A case report

PubMed Central

Kishore, Sunil; Chandelia, Sudha; Patharia, Neha; Swarnim

2016-01-01

Sewing machine oil ingestion is rare but is possible due to its availability at home. Chemically, it belongs to hydrocarbon family which is toxic if aspirated, owing to their physical properties such as high volatility and low viscosity. On the contrary, sewing machine lubricant has high viscosity and low volatility which makes it aspiration less likely. The main danger of hydrocarbon ingestion is chemical pneumonitis which may be as severe as acute respiratory distress syndrome (ARDS). We report a case of a 5-year-old girl with accidental ingestion of sewing machine lubricant oil, who subsequently developed ARDS refractory to mechanical ventilation. There was much improvement with airway pressure release ventilation mode of ventilation, but the child succumbed to death due to pulmonary hemorrhage. PMID:27994384

Directional atherectomy of a heavy calcified axillary artery stenosis inducing critical hand ischemia.

PubMed

Anzuini, Angelo; Palloshi, Altin; Aprigliano, Gianfranco; Ielasi, Alfonso

2013-07-01

The presence of a severe calcified peripheral artery lesion is responsible for a poor response to balloon dilation, due to significant acute vessel recoil and frequent flow-limiting dissections requiring stent implantation. This possibility could be associated with very high compression and/or fracture rates particularly in cases of lesion located at the mobile joints. In this setting directional atherectomy offers the theoretical advantages of eliminating stretch injury on arterial walls and reducing the restenosis rate by direct plaque excision. In this report, we present a case of critical hand ischemia due to a heavily calcified axillary artery lesion managed by directional atherectomy and balloon angioplasty followed by immediate angiographic success and sustained clinical benefit up to 3 years of follow-up.

Undifferentiated carcinoma of the pituitary gland: A case report and review of the literature.

PubMed

Lee, Hsun-Hwa; Hung, Shih-Han; Tseng, Te-Ming; Lin, Yun-Ho; Cheng, Ju-Chuan

2014-03-01

Primary pituitary gland cancer is extremely rare. The current study presents the case of a patient diagnosed with pituitary cancer three months after completing surgery and post-operative chemoradiotherapy for hypopharyngeal cancer. In this report we discuss 57-year-old patient who presented with diplopia and ptosis four months following the completion of treatment for hypopharyngeal cancer. A poorly-differentiated pituitary carcinoma was located. Despite aggressive treatment and surgical excision with postoperative chemoradiotherapy, the disease progressed rapidly and the patient succumbed due to multiple metastases and organ failure. This case report indicates a possible correlation between irradiation and the development of pituitary cancer.

Bayesian Source Attribution of Salmonellosis in South Australia.

PubMed

Glass, K; Fearnley, E; Hocking, H; Raupach, J; Veitch, M; Ford, L; Kirk, M D

2016-03-01

Salmonellosis is a significant cause of foodborne gastroenteritis in Australia, and rates of illness have increased over recent years. We adopt a Bayesian source attribution model to estimate the contribution of different animal reservoirs to illness due to Salmonella spp. in South Australia between 2000 and 2010, together with 95% credible intervals (CrI). We excluded known travel associated cases and those of rare subtypes (fewer than 20 human cases or fewer than 10 isolates from included sources over the 11-year period), and the remaining 76% of cases were classified as sporadic or outbreak associated. Source-related parameters were included to allow for different handling and consumption practices. We attributed 35% (95% CrI: 20-49) of sporadic cases to chicken meat and 37% (95% CrI: 23-53) of sporadic cases to eggs. Of outbreak-related cases, 33% (95% CrI: 20-62) were attributed to chicken meat and 59% (95% CrI: 29-75) to eggs. A comparison of alternative model assumptions indicated that biases due to possible clustering of samples from sources had relatively minor effects on these estimates. Analysis of source-related parameters showed higher risk of illness from contaminated eggs than from contaminated chicken meat, suggesting that consumption and handling practices potentially play a bigger role in illness due to eggs, considering low Salmonella prevalence on eggs. Our results strengthen the evidence that eggs and chicken meat are important vehicles for salmonellosis in South Australia. © 2015 Society for Risk Analysis.

[Trichotillomania involving the eyelashes: about a case].

PubMed

Touzani, Khadija Drissi; Lamari, Zineb; Chraibi, Fouad; Abdellaoui, Meryem; Andaloussi, Idriss Benatiya

2017-01-01

Trichotillomania is a neglected psychiatric disorder characterized by the urge to pull out the hair, the eyebrows or any other hair, but rarely the eyelashes. In the Diagnostic and Statistical Manual of Mental Disorders it is defined as habits and pulses disturbance. We here report the case of a girl with trichotillomania involving her left eyelashes due to low self-esteem. The disease may be episodic but it is usually chronic and difficult to treat. Given the possible clinical and psychiatric complications, early and accurate diagnosis is essential. Cognitive-behavioral therapy is the gold standard treatment.

Emerging role of multi-detector computed tomography in the diagnosis of hematuria following percutaneous nephrolithotomy: A case scenario.

PubMed

Sivanandam, S E; Mathew, Georgie; Bhat, Sanjay H

2009-07-01

Persistent hematuria is one of the most dreaded complications following percutanous nephrolithotomy (PCNL). Although invasive, a catheter-based angiogram is usually used to localize the bleeding vessel and subsequently embolize it. Advances in imaging technology have now made it possible to use a non invasive multi-detector computed tomography (MDCT) angiogram with 3-D reconstruction to establish the diagnosis. We report a case of post-PCNL hemorrhage due to a pseudo aneurysm that was missed by a conventional angiogram and subsequently detected on MDCT angiogram.

Binary pulsars as probes of a Galactic dark matter disk

NASA Astrophysics Data System (ADS)

Caputo, Andrea; Zavala, Jesús; Blas, Diego

2018-03-01

As a binary pulsar moves through a wind of dark matter particles, the resulting dynamical friction modifies the binary's orbit. We study this effect for the double disk dark matter (DDDM) scenario, where a fraction of the dark matter is dissipative and settles into a thin disk. For binaries within the dark disk, this effect is enhanced due to the higher dark matter density and lower velocity dispersion of the dark disk, and due to its co-rotation with the baryonic disk. We estimate the effect and compare it with observations for two different limits in the Knudsen number (Kn). First, in the case where DDDM is effectively collisionless within the characteristic scale of the binary (Kn ≫ 1) and ignoring the possible interaction between the pair of dark matter wakes. Second, in the fully collisional case (Kn ≪ 1), where a fluid description can be adopted and the interaction of the pair of wakes is taken into account. We find that the change in the orbital period is of the same order of magnitude in both limits. A comparison with observations reveals good prospects to probe currently allowed DDDM models with timing data from binary pulsars in the near future. We finally comment on the possibility of extending the analysis to the intermediate (rarefied gas) case with Kn ∼ 1.

Forward Compton scattering with weak neutral current: Constraints from sum rules

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gorchtein, Mikhail; Zhang, Xilin

2015-06-09

We generalize forward real Compton amplitude to the case of the interference of the electromagnetic and weak neutral current, formulate a low-energy theorem, relate the new amplitudes to the interference structure functions and obtain a new set of sum rules. Furthermore, we address a possible new sum rule that relates the product of the axial charge and magnetic moment of the nucleon to the 0th moment of the structure function g5(ν, 0). For the dispersive γ Z-box correction to the proton’s weak charge, the application of the GDH sum rule allows us to reduce the uncertainty due to resonance contributionsmore » by a factor of two. Finally, the finite energy sum rule helps addressing the uncertainty in that calculation due to possible duality violations.« less

[Accidental ingestion of dental prostheses; 2 scenarios in the management and outcome. Case reports].

PubMed

Santander-Flores, Selene Artemisa; Mata-Quintero, Carlos Javier; O'Farrill-Anzures, Ricardo; González-Villegas, Paloma; Calvo-Vázquez, Iván; Campos-Serna, Esteban Israel

Foreign body ingestion is the second cause of endoscopic emergency in the elderly, and dentures are the most frequent accidently ingested objects. Once in the stomach, their expulsion can be expected in 4 to 6 days. The treatment is wait and see in asymptomatic patients, but preventive endoscopic removal can also be performed. To present 2 scenarios of the outcome and treatment in patients with foreign body ingestion. Patient under study due to weight loss, with a denture detected by abdominal x-ray, ingested inadvertently a year ago. A laparotomy was required as extraction by colonoscopy failed, due to excessive inflammation. The second case, of 24-hour onset, was due to the ingestion of a partial denture. As duodenal endoscopy extraction was unsuccessful, the patient was kept under observation. When it did not pass the caecum, it was extracted by colonoscopy, with no further complications and shorter hospital stay. Follow-up can be by simple abdominal x-ray, with endoscopic management if there is insufficient progress. In one of our cases, the outcome was unfavourable due to time of ingestion, and endoscopic management was not possible, whereas in the second case colonoscopy was performed early with success. Proper diagnostic and timely treatment mark the difference in the progression and outcome of the ingestion of foreign bodies. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

[Pulmonary and systemic fat embolism as a cause of death in forensic autopsy practice].

PubMed

Akçay Turan, Arzu; Celik, Safa; Karayel, Ferah; Pakiş, Işil; Arican, Nadir

2006-04-01

The aim of this study was to evaluate the possible correlations between the grade of fat embolism and age, gender, severity of trauma and post-traumatic survival time. Thirty-one cases with pulmonary and/or systemic fat embolism, auotopsied at the Morgue Department of Council of Forensic Medicine were evaluated retrospectively. Twenty-eight cases (90%) died due to trauma and its complications. Nineteen cases (61%) were injured in motor vehicle-related accidents. Post-traumatic survival time varied between 0-384 hours (61.6+/-86.2 hours). Abbreviated injury scale (AIS) was 8.1+/-3.9 and injury severity score (ISS) was 26.5+/-19.7 SD. Twenty-four (77%) cases were determined as isolated pulmonary fat embolism and 7 (23%) cases as systemic fat embolism on histopathological examination. Possible correlations between the grade of fat embolism and age, gender, severity of trauma and post-traumatic survival time were evaluated statistically with using Chi-square and Spearman's correlation tests. There were no correlations between the grade of fat embolism and age, gender, the severity of trauma. Post-traumatic survival time and the severity of trauma had a very weak negative correlation without any statistical significance.

Renal flagellate infections in reptiles: 29 cases.

PubMed

Juan-Sallés, Caries; Garner, Michael M; Nordhausen, Robert W; Valls, Xavier; Gallego, Miguel; Soto, Sara

2014-03-01

Renal infection with flagellated protozoa was retrospectively evaluated in 29 reptiles, including 12 turtles, 7 tortoises, and 6 chameleons; overall, 20 species of reptiles were represented. Most cases presented with nonspecific clinical signs or a combination of several concurrent diseases. Nineteen of 29 reptiles had tubulointerstitial nephritis associated with flagellates, and this lesion was considered contributory to death in 15 cases, although concurrent diseases were frequent. Infection was invasive into the renal interstitium in three reptiles due to tubular rupture and in one chameleon also spread to adjacent tissues, coelomic cavity, and blood vessels due to renal rupture. Cytologic or ultrastructural evaluation of trophozoites in two cases was consistent with diplomonad flagellates. Renal disease was often complicated with soft-tissue mineralization and/or gout. Gastrointestinal and cloacal infection with flagellates and inflammation were frequent in reptiles in which the digestive tract was available for histopathologic examination, and this supports the possibility of infections ascending the urinary tract from the cloaca. Renal disease associated with flagellate protozoa is rare in vertebrates but appears to be relevant in reptiles, particularly chelonians and chameleons.

Late-onset renal vein thrombosis: A case report and review of the literature

PubMed Central

Hogan, Jessica L.; Rosenthal, Stanton J.; Yarlagadda, Sri G.; Jones, Jill A.; Schmitt, Timothy M.; Kumer, Sean C.; Kaplan, Bruce; Deas, Shenequa L.; Nawabi, Atta M.

2014-01-01

INTRODUCTION Renal vein thrombosis, a rare complication of renal transplantation, often causes graft loss. Diagnosis includes ultrasound with Doppler, and it is often treated with anticoagulation or mechanical thrombectomy. Success is improved with early diagnosis and institution of treatment. PRESENTATION OF CASE We report here the case of a 29 year-old female with sudden development of very late-onset renal vein thrombosis after simultaneous kidney pancreas transplant. This resolved initially with thrombectomy, stenting and anticoagulation, but thrombosis recurred, necessitating operative intervention. Intraoperatively the renal vein was discovered to be compressed by a large ovarian cyst. DISCUSSION Compression of the renal vein by a lymphocele or hematoma is a known cause of thrombosis, but this is the first documented case of compression and thrombosis due to an ovarian cyst. CONCLUSION Early detection and treatment of renal vein thrombosis is paramount to restoring renal allograft function. Any woman of childbearing age may have thrombosis due to compression by an ovarian cyst, and screening for this possibility may improve long-term graft function in this population. PMID:25528029

Nephrotic syndrome and neoplasm. The findings to date, with practical implications.

PubMed

Papper, S

1984-11-01

The following points should be kept in mind in cases of nephrotic syndrome. Neoplasm (malignant or benign) occurs in approximately 10% of adults with nephrotic syndrome (15% of those over age 60). The neoplasm may be evident before, after, or simultaneously with the development of the nephrotic syndrome. Minimal change lesion in the kidney suggests possible Hodgkin's disease, while membranous nephropathy is more suggestive of possible carcinoma, although there are many exceptions to this generalization. Membrano-proliferative and focal sclerosis renal lesions also occur with diverse tumors. Strong evidence exists that in cases of carcinoma and nephrotic syndrome, the renal lesion is generally due to immune complexes--either tumor-associated antigens, fetal antigens, or viral antigens. In cases involving Hodgkin's disease, T-cell deficiency may be relevant in the genesis of the minimal change lesion and the nephrotic syndrome. Nephrotic syndrome often responds to effective treatment of the tumor and commonly recurs with relapse of the neoplasm. Nephrotic syndrome without apparent cause in an adult compels consideration of an associated neoplasm.

Bipolar disorder and antithyroid antibodies: review and case series.

PubMed

Bocchetta, Alberto; Traccis, Francesco; Mosca, Enrica; Serra, Alessandra; Tamburini, Giorgio; Loviselli, Andrea

2016-12-01

Mood disorders and circulating thyroid antibodies are very prevalent in the population and their concomitant occurrence may be due to chance. However, thyroid antibodies have been repeatedly hypothesized to play a role in specific forms of mood disorders. Potentially related forms include treatment-refractory cases, severe or atypical depression, and depression at specific phases of a woman's life (early gestation, postpartum depression, perimenopausal). With regard to bipolar disorder, studies of specific subgroups (rapid cycling, mixed, or depressive bipolar) have reported associations with thyroid antibodies. Offspring of bipolar subjects were found more vulnerable to develop thyroid antibodies independently from the vulnerability to develop psychiatric disorders. A twin study suggested thyroid antibodies among possible endophenotypes for bipolar disorder. Severe encephalopathies have been reported in association with Hashimoto's thyroiditis. Cases with pure psychiatric presentation are being reported, the antithyroid antibodies being probably markers of some other autoimmune disorders affecting the brain. Vasculitis resulting in abnormalities in cortical perfusion is one of the possible mechanisms.

Simscape Modeling of a Custom Closed-Volume Tank

NASA Technical Reports Server (NTRS)

Fischer, Nathaniel P.

2015-01-01

The library for Mathworks Simscape does not currently contain a model for a closed volume fluid tank where the ullage pressure is variable. In order to model a closed-volume variable ullage pressure tank, it was necessary to consider at least two separate cases: a vertical cylinder, and a sphere. Using library components, it was possible to construct a rough model for the cylindrical tank. It was not possible to construct a model for a spherical tank, using library components, due to the variable area. It was decided that, for these cases, it would be preferable to create a custom library component to represent each case, using the Simscape language. Once completed, the components were added to models, where filling and draining the tanks could be simulated. When the models were performing as expected, it was necessary to generate code from the models and run them in Trick (a real-time simulation program). The data output from Trick was then compared to the output from Simscape and found to be within acceptable limits.

Some Possible Cases of Escape Mimicry in Neotropical Butterflies.

PubMed

Pinheiro, C E G; Freitas, A V L

2014-10-01

The possibility that escape or evasive mimicry evolved in butterflies and other prey insects in a similar fashion to classical Batesian and Müllerian mimicry has long been advanced in the literature. However, there is a general disagreement among lepidopterists and evolutionary biologists on whether or not escape mimicry exists, as well as in which mimicry rings this form of mimicry has evolved. Here, we review some purported cases of escape mimicry in Neotropical butterflies and suggest new mimicry rings involving several species of Archaeoprepona, Prepona, and Doxocopa (the "bright blue bands" ring) and species of Colobura and Hypna (the "creamy bands" ring) where the palatability of butterflies, their ability to escape predator attacks, geographic distribution, relative abundance, and co-occurrence in the same habitats strongly suggest that escape mimicry is involved. In addition, we also indicate other butterfly taxa whose similarities of coloration patterns could be due to escape mimicry and would constitute important case studies for future investigation.

Peripleural lung disease detection based on multi-slice CT images

NASA Astrophysics Data System (ADS)

Matsuhiro, M.; Suzuki, H.; Kawata, Y.; Niki, N.; Nakano, Y.; Ohmatsu, H.; Kusumoto, M.; Tsuchida, T.; Eguchi, K.; Kaneko, M.

2015-03-01

With the development of multi-slice CT technology, obtaining accurate 3D images of lung field in a short time become possible. To support that, a lot of image processing methods need to be developed. Detection peripleural lung disease is difficult due to its existence out of lung region, because lung extraction is often performed based on threshold processing. The proposed method uses thoracic inner region extracted by inner cavity of bone as well as air region, covers peripleural lung diseased cases such as lung nodule, calcification, pleural effusion and pleural plaque. We applied this method to 50 cases including 39 peripleural lung diseased cases. This method was able to detect 39 peripleural lung disease with 2.9 false positive per case.

Spontaneous echocardiographic contrast associated with portosystemic shunt due to persistent patent ductus venosus.

PubMed

Toib, Amir; Goldstein, Seth B; Khanna, Geetika; Canter, Charles E; Lee, Caroline K; Balzer, David T; Singh, Gautam K

2012-01-01

We describe a case of an infant with a single ventricle physiology, who presented with spontaneous microbubbles originating from her inferior vena cava. Imaging revealed a persistent patent ductus venosus, leading to a portosystemic shunt, streaming the microbubbles into the heart. We discuss the possible mechanisms for this rare phenomenon in a child. © 2011 Wiley Periodicals, Inc.

Promoting Respect as a Human Value in a Public School

ERIC Educational Resources Information Center

Corzo, Josefina Quintero; Castañeda, Yeisson Soto

2017-01-01

This is a case study report arising from a series of daily observations of the students' behavior made in a primary public school located near to the capital city, Manizales-Colombia, where it was possible to notice the difficulties students had in order to coexist due to the lack of respect with their classmates, in group activities or actually…

Perinatal Yellow Fever: A Case Report.

PubMed

Diniz, Lilian Martins Oliveira; Romanelli, Roberta Maia Castro; de Carvalho, Andréa Lucchesi; Teixeira, Daniela Caldas; de Carvalho, Luis Fernando Andrade; Cury, Verônica Ferreira; Filho, Marcelo Pereira Lima; Perígolo, Graciele; Heringer, Tiago Pires

2018-04-09

An outbreak of yellow fever in Brazil made it possible to assess different presentations of disease such as perinatal transmission. A pregnant woman was admitted to hospital with yellow fever symptoms. She was submitted to cesarean section and died due to fulminant hepatitis. On the 6th day the newborn developed liver failure and died 13 days later. Yellow fever PCR was positive for both.

Neurological complication after low-voltage electric injury: a case report.

PubMed

Kim, Ha Min; Ko, Yeong-A; Kim, Joon Sung; Lim, Seong Hoon; Hong, Bo Young

2014-04-01

Electrical shock can result in neurological complications, involving both peripheral and central nervous systems, which may present immediately or later on. However, delayed neurological complications caused by low-voltage electric shock are rarely reported. Here, a case of a man suffering from weakness and aphasia due to the delayed-onset of the peripheral nerve injury and ischemic stroke following an electrical shock is presented. Possible mechanisms underlying the neurological complications include thermal injury to perineural tissue, overactivity of the sympathetic nervous system, vascular injury, and histological or electrophysiological changes. Moreover, vasospasms caused by low-voltage alternating current may predispose individuals to ischemic stroke. Therefore, clinicians should consider the possibility of neurological complications, even if the onset of the symptoms is delayed, and should perform diagnostic tests, such as electrophysiology or imaging, when patients present with weakness following an electric injury.

Organophosphate acetylcholine esterase inhibitor poisoning from a home-made shampoo

PubMed Central

Sadaka, Yair; Broides, Arnon; Tzion, Raffi Lev; Lifshitz, Matitiahu

2011-01-01

Organophosphate acetylcholine esterase inhibitor poisoning is a major health problem in children. We report an unusual cause of organophosphate acetylcholine esterase inhibitor poisoning. Two children were admitted to the pediatric intensive care unit due to organophosphate acetylcholine esterase inhibitor poisoning after exposure from a home-made shampoo that was used for the treatment of head lice. Owing to no obvious source of poisoning, the diagnosis of organophosphate acetylcholine esterase inhibitor poisoning in one of these patients was delayed. Both patients had an uneventful recovery. Organophosphate acetylcholine esterase inhibitor poisoning from home-made shampoo is possible. In cases where the mode of poisoning is unclear, direct questioning about the use of home-made shampoo is warranted, in these cases the skin and particularly the scalp should be rinsed thoroughly as soon as possible. PMID:21887044

A case of severe anal injury in an adolescent male due to bestial sexual experimentation.

PubMed

Blevins, Roger O

2009-10-01

This report delineates a case of anal injury in a 12-year-old boy who gave a detailed history of bestial behavior with a male bulldog. The child described how he had seen this behavior modeled on the internet and subsequently initiated contact with his own dog, causing the dog to penetrate him anally. This type of juvenile bestial behavior with injury has only been reported once previously in the medical literature. Zoophilia, along with a number of other paraphilias, frequently has its onset in the adolescent age group. Adolescents evidencing paraphilic behaviors require thorough psychological evaluation. Spontaneous sexual assault of a human by a canine has never been described in the human or veterinary medical literature, nor is such a thing likely. A clinician involved in evaluating serious ano-genital injury in a child reportedly due to spontaneous canine sexual assault must consider other possible traumatic etiologies including sexual abuse. Investigation in any such case is essential. 2009 Elsevier Ltd and Faculty of Forensic and Legal Medicine.

Squeezing the Efimov effect

NASA Astrophysics Data System (ADS)

Sandoval, J. H.; Bellotti, F. F.; Yamashita, M. T.; Frederico, T.; Fedorov, D. V.; Jensen, A. S.; Zinner, N. T.

2018-03-01

The quantum mechanical three-body problem is a source of continuing interest due to its complexity and not least due to the presence of fascinating solvable cases. The prime example is the Efimov effect where infinitely many bound states of identical bosons can arise at the threshold where the two-body problem has zero binding energy. An important aspect of the Efimov effect is the effect of spatial dimensionality; it has been observed in three dimensional systems, yet it is believed to be impossible in two dimensions. Using modern experimental techniques, it is possible to engineer trap geometry and thus address the intricate nature of quantum few-body physics as function of dimensionality. Here we present a framework for studying the three-body problem as one (continuously) changes the dimensionality of the system all the way from three, through two, and down to a single dimension. This is done by considering the Efimov favorable case of a mass-imbalanced system and with an external confinement provided by a typical experimental case with a (deformed) harmonic trap.

Treatment of Paroxysmal Perceptual Alteration in Catatonic Schizophrenia by Switching to Aripiprazole from Risperidone: A Case Report.

PubMed

Yamashita, Satoko; Miyaoka, Tsuyoshi; Nagahama, Michiharu; Ieda, Masa; Tsuchie, Keiko; Wake, Rei; Horiguchi, Jun

2016-01-01

Paroxysmal perceptual alteration (PPA) is the occurrence of brief and recurrent episodes of perceptual changes. It is mainly caused by the treatment of schizophrenia patients with antipsychotics. However, diagnosis of PPA is not very prevalent among psychiatrists, partly due to underrecognition or misunderstanding that it is a worsening of psychiatric symptoms. If psychiatrists do not understand PPA, they cannot treat it appropriately, and the patient's quality of life is impaired. We present a case of PPA in catatonic schizophrenia that was successfully treated by switching to aripiprazole from risperidone. We suggest that the disappearance of PPA in our case was due to both discontinuing risperidone, which completely blocks D2 receptors, and replacing it with aripiprazole, which is characterized as a partial agonist of D2 receptors. Treatment of PPA will improve medication adherence and quality of life. It is important to recognize PPA as a possible side effect of treatment with antipsychotics.

Identical twins with mature cystic teratomas treated with laparoscopic surgery: Two case reports.

PubMed

Mabuchi, Yasushi; Ota, Nami; Kobayashi, Aya; Tanizaki, Yuko; Minami, Sawako; Ino, Kazuhiko

2017-02-01

Mature cystic teratomas are the most common among all ovarian neoplasms, representing 30-40% of the cases. However, to the best of our knowledge, there have been only two reports of mature cystic teratomas occurring in identical twins to date. We herein report a case of identical twins with mature cystic teratomas who were treated with laparoscopic surgery. A 32-year-old woman was referred to our hospital due to a tumor in the right ovary. The patient underwent laparoscopic resection of the ovarian tumor and the pathological diagnosis was benign mature cystic teratoma. Two years later, the identical twin of the abovementioned patient was referred to our hospital also due to a right ovarian tumor. The patient underwent laparoscopic resection of the ovarian tumor and the pathological diagnosis was benign mature cystic teratoma. Therefore, for early diagnosis, it may be important to consider the possibility of mature cystic teratoma in the identical twin of a patient, even in the absence of symptoms.

Hypopituitarism Presenting as Adrenal Insufficiency and Hypothyroidism in a Patient with Wilson's Disease: a Case Report

PubMed Central

2016-01-01

Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism. Brain MRI showed T2 hyperintense signals in both basal ganglia and midbrain but the pituitary imaging was normal. She is currently receiving chelation therapy along with thyroid hormone and steroid replacement. There may be a relationship between Wilson's disease and hypopituitarism. Copper deposition or secondary neuronal damage in the pituitary may be a possible explanation for this theory. PMID:27478349

Hypopituitarism Presenting as Adrenal Insufficiency and Hypothyroidism in a Patient with Wilson's Disease: a Case Report.

PubMed

Lee, Hae Won; Kang, Jin Du; Yeo, Chang Woo; Yoon, Sung Woon; Lee, Kwang Jae; Choi, Mun Ki

2016-08-01

Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism. Brain MRI showed T2 hyperintense signals in both basal ganglia and midbrain but the pituitary imaging was normal. She is currently receiving chelation therapy along with thyroid hormone and steroid replacement. There may be a relationship between Wilson's disease and hypopituitarism. Copper deposition or secondary neuronal damage in the pituitary may be a possible explanation for this theory.

[Anesthetic infiltration of the spermatic cord in surgery for voluminous hydrocele].

PubMed

Reale, C; Corinti, R; Galullo, B; Borgonuovo, P; Borgonuovo, P

1998-06-01

The use of a new technique in spermatic cord block in surgical treatment of large hydroceles is reported. Identification of the cord in these cases is often difficult due to the presence of the hydrocele. The reported technique consists in the percutaneous drainage of the hydrocele prior to the block, in order to allow an easier identification of the cord. The block is then performed by the usual method. 108 patients with large hydroceles (above 250 mls) underwent surgical repair employing this approach. In only one case the cord was not identified even after drainage due to the effects of a previous hernioplasty. In the remaining 107 patients the cord was easily identified and blocked. The excellent results obtained with this approach, show that cord block is possible in all patients, even when a large hydrocele is present.

Development of a Test Facility for Air Revitalization Technology Evaluation

NASA Technical Reports Server (NTRS)

Lu, Sao-Dung; Lin, Amy; Campbell, Melissa; Smith, Frederick

2006-01-01

An active fault tolerant control (FTC) law is generally sensitive to false identification since the control gain is reconfigured for fault occurrence. In the conventional FTC law design procedure, dynamic variations due to false identification are not considered. In this paper, an FTC synthesis method is developed in order to consider possible variations of closed-loop dynamics under false identification into the control design procedure. An active FTC synthesis problem is formulated into an LMI optimization problem to minimize the upper bound of the induced-L2 norm which can represent the worst-case performance degradation due to false identification. The developed synthesis method is applied for control of the longitudinal motions of FASER (Free-flying Airplane for Subscale Experimental Research). The designed FTC law of the airplane is simulated for pitch angle command tracking under a false identification case.

Gain-Scheduled Fault Tolerance Control Under False Identification

NASA Technical Reports Server (NTRS)

Shin, Jong-Yeob; Belcastro, Christine (Technical Monitor)

2006-01-01

An active fault tolerant control (FTC) law is generally sensitive to false identification since the control gain is reconfigured for fault occurrence. In the conventional FTC law design procedure, dynamic variations due to false identification are not considered. In this paper, an FTC synthesis method is developed in order to consider possible variations of closed-loop dynamics under false identification into the control design procedure. An active FTC synthesis problem is formulated into an LMI optimization problem to minimize the upper bound of the induced-L2 norm which can represent the worst-case performance degradation due to false identification. The developed synthesis method is applied for control of the longitudinal motions of FASER (Free-flying Airplane for Subscale Experimental Research). The designed FTC law of the airplane is simulated for pitch angle command tracking under a false identification case.

Life-threatening Arrhythmias in a Becker Muscular Dystrophy Family due to the Duplication of Exons 3-4 of the Dystrophin Gene.

PubMed

Ishizaki, Masatoshi; Fujimoto, Akiko; Ueyama, Hidetsugu; Nishida, Yasuto; Imamura, Shigehiro; Uchino, Makoto; Ando, Yukio

2015-01-01

We herein present a report of three patients with Becker muscular dystrophy in the same family who developed complete atrioventricular block or ventricular tachycardia with severe cardiomyopathy. Our cases became unable to walk in their teens, and were introduced to mechanical ventilation due to respiratory muscle weakness in their twenties and thirties. In all three cases, a medical device such as a permanent cardiac pacemaker or an implantable cardiac defibrillator was considered to be necessary. The duplication of exons 3-4 in the dystrophin gene was detected in two of the patients. In patients with Becker muscular dystrophy, complete atrioventricular block or ventricular tachycardia within a family has rarely been reported. Thus attention should be paid to the possibility of severe arrhythmias in the severe phenotype of Becker muscular dystrophy.

Chloroquine-resistant falciparum malaria in Madagascar and Kenya.

PubMed

Aronsson, B; Bengtsson, E; Björkman, A; Pehrson, P O; Rombo, L; Wahlgren, M

1981-08-01

3 African cases of chloroquine-resistent (RI) P. falciparum malaria, proved by recrudescences after administration of recommended doses and adequate serum levels of chloroquine, are described. The 3 patients, Swedish women aged 43, 27, and 41, had never visited areas where chloroquine-resistent P. falciparum is known to exist. 2 patients had taken regular prophylaxis with chloroquine, while the 3rd had interrupted chloroquine use with temporary use of pyrimethamine. All 3 were treated with chloroquine and had serum levels well above those considered necessary for cure of malaria due to sensitive strains of P. falciparum. All had recrudescences, ranging from 13 to 41 days after the previous chloroquine treatment. Reinfection was not possible for any of the patients and none took other drugs during the study period. In 2 cases the Rieckmann in vitro test for resistence failed. In 1 case from Madagascar the in vitro method described by Nguyen-Dinh and Trager produced results indicating resistence and in another case from Madagascar the results indicated probable resistence, but the procedure failed in the case from Kenya. The 2 cases mark the 1st time resistence has been reported from Madagascar. In vivo tests in all cases and in vitro results in 2 cases, together with the adequate serum levels of chloroquine, confirm that malaria due to chloroquine-resistent P. falciparum is being transmitted in some parts of Africa.

[Difficulties in the epidemiological surveillance of measles in Africa: exemplified by the Ivory Coast].

PubMed

Rey, J L; Trolet, C; Soro, B; Cunin, P; Merouze, F

1991-06-01

In tropical areas measles cases often are under-reported but the authors comment here two epidemics which had at first been considered as outbreaks of measles but were not. The first epidemic resembled a Chikungunya virus outbreak with important rashes, hyperthermia and pain attacks and was due to Igbo-Ora arbovirus. In the second epidemic children were having rashes with hyperthermia and adenopathy evoking rubella. The authors consider the possibility of over-reporting in view of the surveillance of measles, the target-disease in EPI (Expanded Programme on Immunization). This hypothesis is confirmed by the distribution of reported cases at national level with a high rate of out-season cases and among adults.

A case of gastrointestinal bleeding due to right hepatic artery pseudoaneurysm following total remnant pancreatectomy: A case report.

PubMed

Fujio, Atsushi; Usuda, Masahiro; Ozawa, Yohei; Kamiya, Kurodo; Nakamura, Takanobu; Teshima, Jin; Murakami, Kazushige; Suzuki, On; Miyata, Go; Mochizuki, Izumi

2017-01-01

Pseudoaneurysm is a serious complication after pancreatic surgery, which mainly depends on the presence of a preceding pancreatic fistula. Postpancreatectomy hemorrhage following total pancreatectomy is a rare complication due to the absence of a pancreatic fistula. Here we report an unusual case of massive gastrointestinal bleeding due to right hepatic artery (RHA) pseudoaneurysm following total remnant pancreatectomy. A 75-year-old man was diagnosed with intraductal papillary mucinous carcinoma recurrence following distal pancreatectomy and underwent total remnant pancreatectomy. After discharge, he was readmitted to our hospital with melena because of the diagnosis of gastrointestinal bleeding. Gastrointestinal endoscopy was performed to detect the origin of bleeding, but an obvious bleeding point could not be detected. Abdominal computed tomography demonstrated an expansive growth, which indicated RHA pseudoaneurysm. Emergency angiography revealed gastrointestinal bleeding into the jejunum from the ruptured RHA pseudoaneurysm. Transcatheter arterial embolization was performed; subsequently, bleeding was successfully stopped for a short duration. Because of improvements in his general condition, the patient was discharged. To date, very few cases have described postpancreatectomy hemorrhage following total remnant pancreatectomy. We suspect that the aneurysm ruptured into the jejunum, possibly because of the scarring and inflammation associated with his two complex surgeries. Pseudoaneurysm should be considered when the fragility of blood vessels is suspected, despite no history of anastomotic leak and intra-abdominal abscess. Our case also highlighted that detecting gastrointestinal bleeding is necessary to recognize sentinel bleeding if the origin of bleeding is undetectable.

Total Artificial Heart and Chronic Haemodialysis: A Possible Bridge to Transplantation?

PubMed

Demiselle, Julien; Besson, Virginie; Sayegh, Johnny; Subra, Jean-François; Augusto, Jean-François

2016-01-01

Total artificial heart (TAH) device is sometimes necessary to treat end stage heart failure (HF). After surgery, renal impairment can occur with the need of renal replacement therapy. We report the case of a 51-year-old man who was treated with conventional hemodialysis (HD) while on support with TAH. The patient underwent HD while on TAH support during 14 months. He benefited from conventional HD, 6 sessions per week. HD sessions were well tolerated, and patient's condition and quality of life improved significantly. The main difficulty was to maintain red blood cell level because of chronic hemolysis due to TAH, which required repetitive blood transfusions, resulting in a high rate of human leukocyte antigen sensitization. Unfortunately, the patient died of mesenteric ischemia due to anticoagulation under dosing. We conclude that HD treatment is possible despite TAH and should be considered in patients with both end stage renal and HF. © 2016 S. Karger AG, Basel.

New Perspectives for Didactical Engineering: An Example for the Development of a Resource for Teaching Decimal Number System

ERIC Educational Resources Information Center

Tempier, Frédérick

2016-01-01

Many studies have shown the difficulties of learning and teaching the decimal number system for whole numbers. In the case of numbers bigger than one hundred, complexity is partly due to the multitude of possible relationships between units. This study was aimed to develop conditions of a resource which can help teachers to enhance their teaching…

Fatal tiger attack: a case report with emphasis on typical tiger injuries characterized by partially resembling stab-like wounds.

PubMed

Pathak, Hrishikesh; Borkar, Jaydeo; Dixit, Pradeep; Dhawane, Shailendra; Shrigiriwar, Manish; Dingre, Niraj

2013-10-10

Fatalities due to attacks by tigers on humans are uncommon and are rarely described in the medico-legal literature. We herein present a forensic investigation in a unique case of a fatal tiger attack in the wild on a 35 year old female in India by an Indian Bengal tiger (Panthera tigris tigris). The attack resulted in two pairs of puncture wounds over the nape area with occult cervical spine injuries resulting from transfixing of spine due to the tiger canines; multiple puncture wounds, numerous scratches and abrasions consistent with the tiger claw injuries and injury to the right jugulocarotid vessels. This case outlines the characteristic injury pattern from such an attack along with the multiple sources of the tiger injuries. The analysis of these injuries might reveal the motivation behind the attack and the big cat species involved in the attack. A tiger injury is sometimes compared with a stab injury, as the patterned injuries due to a tiger bite are characterized by multiple penetrating, stab-like wounds. So, a special attention is paid toward establishment of the cause of death from bites by the animal teeth under unknown circumstances of trauma and to exclude the possibility of a homicide beyond reasonable doubt in such cases. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis.

PubMed

Oray, Merih; Tuğal-Tutkun, İlknur

2016-04-01

Pediatric uveitis may be a serious health problem because of the lifetime burden of vision loss due to severe complications if the problem is not adequately treated. Juvenile idiopathic arthritis (JIA)-associated uveitis is characterized by insidious onset and potentially blinding chronic anterior uveitis. Periodic ophthalmologic screening is of utmost importance for early diagnosis of uveitis. Early diagnosis and proper immunomodulatory treatment are essential for good visual prognosis. The goal of treatment is to achieve enduring drug-free remission. The choice of therapeutic regimen needs to be tailored to each individual case. One must keep in mind that patients under immunomodulatory treatment should be monitored closely due to possible side effects. Local and systemic corticosteroids have long been the mainstay of therapy; however, long-term corticosteroid therapy should be avoided due to serious side effects. Steroid-sparing agents in the treatment of JIA-associated uveitis include antimetabolites and biologic agents in refractory cases. Among the various immunomodulatory agents, methotrexate is generally the first choice, as it has a well-established safety and efficacy profile in pediatric cases and does not appear to increase the risk of cancer. Other classic immunomodulators that may also be used in combination with methotrexate include azathioprine, mycophenolate mofetil, and cyclosporin A. Biologic agents, primarily tumor necrosis factor alpha inhibitors including infliximab or adalimumab, should be considered in cases of treatment failure with classic immunomodulatory agents.

The Trade-Off Between Privacy and Geographic Data Resolution. a Case of GPS Trajectories Combined with the Social Survey Results

NASA Astrophysics Data System (ADS)

Sila-Nowicka, K.; Thakuriah, P.

2016-06-01

Trajectory datasets are being generated in great volumes due to high levels of Global Positioning System (GPS) and Location-Based Services (LBS) use. Such data are increasingly being collected for a variety of academic, industrial and recreational reasons, sometimes together with other strands of personal data such as socio-demographic, social survey and other sensor data carried/worn by the person. In such cases, not only are movement data of a person available but also data on potentially a wide variety of other personal and household attributes. Making such person-level data available for analytics opens up the possibility of new directions in analysing, studying and understanding human behaviour, which is typically not possible with GPS trajectory datasets alone. At the same time, the GPS data should be released in a privacy-preserving way that takes into account the possibility of re-identification of individuals from quasi-identifiers available from other data strands. De-identification in these strands may be risked due to uniquely identifiable information on significant locations and other spatial behaviours and choices detected from GPS trajectories. Using a multimodal dataset that includes a GPS archive from 358 individuals, and by considering a number of alternative privacy-enhancing approaches, we look at the potential for privacy preservation when personally-identifiable data are available from multiple data strands, for the specific purpose of data to be released for transport research.

Two cases of malignant hypertension with reversible diffuse leukoencephalopathy exhibiting a reversible nocturnal blood pressure "riser" pattern.

PubMed

Eguchi, Kazuo; Kasahara, Kentaro; Nagashima, Akinori; Mor, Tadashi; Nii, Takanobu; Ibaraki, Kazuo; Kario, Kazuomi; Shimada, Kazuyuki

2002-05-01

We report two cases of malignant hypertension with reversible diffuse leukoencephalopathy demonstrating a nocturnal blood pressure (BP) rising pattern ("riser" pattern). Case 1 was a 54-year-old man diagnosed with malignant hypertension who presented with diffuse leukoencephalopathy and nocturnal BP rise during the acute phase. These abnormal findings diminished after treatment of hypertension. Case 2 was a 50-year-old woman diagnosed with malignant hypertension in association with leukoencephalopathy, heart failure and acute renal failure. She also presented with a "riser" pattern during the acute phase. In contrast to case 1, the leukoencephalopathy and "riser" pattern in case 2 were not improved even after 1 month of treatment. Following intensive antihypertensive treatment, renal failure was improved in case 1, but renal failure was not improved after 1 month in case 2. In conclusion, a possible explanation of this phenomenon is that a causative volume overload due to renal dysfunction produced the temporal leukoencephalopathy-like brain edema and "riser" pattern in these cases.

Performance and role of the breast lesion excision system (BLES) in small clusters of suspicious microcalcifications.

PubMed

Scaperrotta, Gianfranco; Ferranti, Claudio; Capalbo, Emanuela; Paolini, Biagio; Marchesini, Monica; Suman, Laura; Folini, Cristina; Mariani, Luigi; Panizza, Pietro

2016-01-01

To assess the diagnostic performance of the BLES as a biopsy tool in patients with ≤ 1 cm clusters of BIRADS 4 microcalcifications, in order to possibly avoid surgical excision in selected patients. This is a retrospective study of 105 patients undergone to stereotactic breast biopsy with the BLES. It excises a single specimen containing the whole mammographic target, allowing better histological assessment due to preserved architecture. Our case series consists of 41 carcinomas (39%) and 64 benign lesions (61%). Cancer involved the specimen margins in 20/41 cases (48.8%) or was close to them (≤ 1 mm) in 14 cases (34.1%); margins were disease-free in only 7 DCIS (17.1%). At subsequent excision of 39/41 malignant cases, underestimation occurred for 5/32 DCIS (15.6%), residual disease was found in 15/39 cancers (38.5%) and no cancer in 19/39 cases (48.7%). For DCIS cases, no residual disease occurred for 66.7% G1-G2 cases and for 35.3% G3 cases (P=0.1556) as well as in 83.3%, 40.0% and 43.8% cases respectively for negative, close and positive BLES margins (P=0.2576). The BLES is a good option for removal of small clusters of breast microcalcifications, giving better histological interpretation, lower underestimation rates and possibly reducing the need of subsequent surgical excision in selected patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Ventricular assist device implantation in a young patient with non-compaction cardiomyopathy and hereditary spherocytosis.

PubMed

Huenges, Katharina; Panholzer, Bernd; Cremer, Jochen; Haneya, Assad

2018-04-01

A case of a 15-year-old female patient with acute heart failure due to non-compaction cardiomyopathy and hereditary anaemia (hereditary spherocytic elliptocytosis) requiring ventricular assist device implantation as a bridge to transplantation is presented. The possible effects of mechanical stress on erythrocytes potentially induced by mechanical circulatory support remains unclear, but it may lead to haemolytic crisis in patients suffering from hereditary anaemia. In our case, ventricular assist device therapy was feasible, and haematological complications did not occur within 6 weeks of bridging our patient to heart transplantation.

[Spleen autotransplant. Natural history and description of a case].

PubMed

Ceccherini, E; Sereni, P; Ferrari, F; Fagioli Zucchi, A; Croce, F; Di Maggio, G; Vattimo, A; Mancini, S

1989-09-30

After considering the natural history of spleen auto-transplant, a clinical case followed up for seven months with instrumental (echography, scintigraphy) and humoral (Jolly bodies, Heinz bodies, reticulocytes, platelets, complement, immune globulin) examinations has been considered so as to verify "take" and function. One months after reimplantation the patient was again operated on for the onset of an intestinal occlusion due to adherences. On that occasion it was possible to control that the implant had taken. It is concluded that personally used parameters proved to be well correlated and that scintigraphy and echography are two complementary, effective techniques for monitoring auto-transplants.

[Clinical experiences with Climen in peri- and postmenopausal women].

PubMed

Husmann, F

1997-01-01

42 women with signs of androgenization were treated with Climen in the peri- and postmenopause for a period longer than 12 months. The effect on most typical climacteric syndromes was comparable to other free available compounds. Concerning our patients, Climen was more effective than other compounds. In no case the withdrawal of Climen due to side-effects was necessary. Surprisingly an androgenetical loss of hair was stopped in 9 out of 10 cases. Climen widens essentially the therapeutical possibilities concerning hormone replacement in peri- and postmenopausal women and should not only be used in women with signs of androgenization.

Discussions On Worst-Case Test Condition For Single Event Burnout

NASA Astrophysics Data System (ADS)

Liu, Sandra; Zafrani, Max; Sherman, Phillip

2011-10-01

This paper discusses the failure characteristics of single- event burnout (SEB) on power MOSFETs based on analyzing the quasi-stationary avalanche simulation curves. The analyses show the worst-case test condition for SEB would be using the ion that has the highest mass that would result in the highest transient current due to charge deposition and displacement damage. The analyses also show it is possible to build power MOSFETs that will not exhibit SEB even when tested with the heaviest ion, which have been verified by heavy ion test data on SEB sensitive and SEB immune devices.

Heterotaxy syndrome with severe pulmonary hypertension in an adult.

PubMed

Brandenburg, Vincent M; Krueger, Stefan; Haage, Patrick; Mertens, Peter; Riehl, Jochen

2002-05-01

Heterotaxy syndrome is a rare clinical entity in adults, characterized by situs ambiguus, congenital heart defects, and splenic malformations. We report the case of an adult with heterotaxy syndrome (including situs ambiguus, bilateral superior vena cava, hypoplastic right-sided spleen and portosystemic shunts) presenting with dyspnea due to severe pulmonary hypertension. Vasodilatory therapy was initiated, leading to marked reduction of clinical symptoms. This case exhibits 2 particular and partially novel features: primary diagnosis of heterotaxy syndrome may be delayed until adulthood, and heterotaxy syndrome may be associated with pulmonary hypertension, possibly on the basis of longstanding portosystemic shunts.

Ventricular fibrillation associated with early repolarization in a patient with thyroid storm.

PubMed

Ueno, Akira; Yamamoto, Takeshi; Sato, Naoki; Tanaka, Keiji

2010-11-01

We present a case of a 69-year-old male who was hospitalized for the treatment of thyroid storm due to Grave's disease, who presented with unexpected ventricular fibrillation (VF). The possible etiology was early repolarization (ER), characterized by J-point elevation in inferior and posterolateral leads, unmasked by the attenuation of beta-adrenergic effect with normalization of thyroid hormones and following the administration of a beta-blocker. Our case focuses attention on the occurrence of VF in a patient with ER during the treatment of hyperthyroidism, which to our knowledge is the first such report.

A rare presentation of histologically proven sarcoidosis of the knee: A case report and brief review of the literature.

PubMed

Deschuyteneer, Evan; Rongé, R; Riffi, A; De Pierre, K; Vandenbroucke, F; Boulet, C; Goossens, A; Vincken, W

2017-06-01

We here report a patient with histologically proven sarcoidosis of the knee, a rare localization of sarcoidosis, which usually presents itself as a pulmonary disease. Case reports of radiological images that suggest osseous sarcoidosis of the appendicular skeleton are not so rare, however few are histologically proven. Since in our patient MRI could not distinguish between sarcoidosis and another (possibly malignant) disease, histological proof was obtained through a CT-guided biopsy. Imaging and treatment guidelines for extrapulmonary sarcoidosis are inexistent, due to lack of randomized trials.

Total knee arthroplasty and Crigler-Najjar syndrome: a case report.

PubMed

Walmsley, David; Alzaharani, Khalid; Coke, William J; Gandhi, Rajiv

2010-06-01

Crigler-Najjar (CN) syndrome is a rare genetic disease characterized by hyperbilirubinemia due to a deficiency in the hepatic enzyme UDP-glucuronosyl-transferase. We describe the first case of total knee arthroplasty in a patient with CN syndrome (type II). This procedure was complicated by kernicterus 1 week after hospital discharge. He also developed Klebsiella bacteremia and sepsis, requiring a brief ICU stay. He was discharged in good condition 2 months later. It is evident that physicians involved in the care of patients with CN syndrome in the peri-operative period need to have a high index of suspicion for the development of severe hyperbilirubinemia and kernicterus in order to appropriately manage and, possibly, prevent this complication. A literature review and intra-operative observations provide insight into the possible relationship between hyperbilirubinemia and osteoarthritis as well as the peri-operative considerations to be made for this group of patients.

[Right atrial appendage thrombosis during atrial fibrillation: an element to look for].

PubMed

Barbati, Giovanni; De Domenico, Renato; Rossi, Stefania; Vecchiato, Elena; Zeppellini, Roberto

2017-03-01

Oral anticoagulant therapy (OAT) is a mainstay of atrial fibrillation (AF) pharmacological treatment. Left atrial appendage closure is a possible treatment, when feasible, in patients with intracerebral hemorrhage during OAT. We report a case of right atrial appendage thrombosis in a patient with chronic AF admitted for syncope due to diuretic-induced orthostatic hypotension. Two years previously, he had undergone left atrial appendage closure with the Amplatzer Cardiac Plug device because of intracerebral hemorrhage during OAT. After neurological consult, OAT was resumed with apixaban 5 mg twice daily, and transesophageal echocardiography performed two months later showed complete resolution of the right atrial appendage thrombosis. This particular case underlines the importance of searching for a possible right atrial appendage thrombosis in patients affected by AF, and suggests that left atrial appendage closure in AF patients not suitable for OAT does not fully eliminate the risk of thromboembolism.

Intracranial meningioma causing partial amaurosis in a cat.

PubMed

Goulle, Frédéric; Meige, Frédéric; Durieux, Franck; Malet, Christophe; Toulza, Olivier; Isard, Pierre-François; Peiffer, Robert L; Dulaurent, Thomas

2011-09-01

To describe a case of intracranial meningioma causing visual impairment in a cat, successfully treated by surgery. An adult neutered male domestic cat was referred with a 10-month history of progressive visual impairment and altered behavior. Investigations included physical, ophthalmologic and neurological examinations as well as hematology, serum biochemistry and CT scan of the head. The menace response was absent in the left eye and decreased in the right eye. Electroretinograms were normal on both eyes, as was ophthalmic examination, ruling out an ocular cause and allowing a presumptive diagnosis of partial amaurosis due to a post-retinal lesion. CT scan demonstrated a large sessile extra axial mass along the right parietal bone and thickening of the adjacent bone. Cerebrospinal fluid was not collected because high intracranial pressure represented a risk for brain herniation. A right rostrotentorial craniectomy was performed to remove the tumor. Ten days after surgery, vision was improved, neurological examination was normal and normal behavior was restored. Ten months after surgery, ophthalmological examination showed no visual deficit and CT scan did not reveal any sign of recurrence. Advanced imaging techniques allow veterinarians to detect early cerebral diseases and to provide specific treatment when it is possible. In cases of feline amaurosis due to intracranial meningioma, the vital prognosis is good while the visual prognosis is more uncertain, but recovery of normal vision and normal behavior is possible as demonstrated in the present case. © 2011 American College of Veterinary Ophthalmologists.

The evolution of invasive cerebral vasospasm treatment in patients with spontaneous subarachnoid hemorrhage and delayed cerebral ischemia-continuous selective intracarotid nimodipine therapy in awake patients without sedation.

PubMed

Paľa, Andrej; Schneider, Max; Brand, Christine; Pedro, Maria Teresa; Özpeynirci, Yigit; Schmitz, Bernd; Wirtz, Christian Rainer; Kapapa, Thomas; König, Ralph; Braun, Michael

2018-05-26

Cerebral vasospasm (CV) and delayed cerebral ischemia (DCI) are major factors that limit good outcome in patients with spontaneous subarachnoid hemorrhage (SAH). Continuous therapy with intra-arterial calcium channel blockers has been introduced as a new step in the invasive treatment cascade of CV and DCI. Sedation is routinely necessary for this procedure. We report about the feasibility to apply this therapy in awake compliant patients without intubation and sedation. Out of 67 patients with invasive endovascular treatment of cerebral vasospasm due to spontaneous SAH, 5 patients underwent continuous superselective intracarotid nimodipine therapy without intubation and sedation. Complications, neurological improvement, and outcome at discharge were summarized. Very good outcome was achieved in all 5 patients. The Barthel scale was 100 and the modified Rankin scale 0-1 in all cases at discharge. We found no severe complications and excellent neurological monitoring was possible in all cases due to patients' alert status. Symptoms of DCI resolved within 24 h in all 5 cases. We could demonstrate the feasibility and safety of selective intracarotid arterial nimodipine treatment in awake, compliant patients with spontaneous SAH and symptomatic CV and DCI. Using this method, an excellent monitoring of neurological function as well as early detection of other complications is possible. It might be an important step in the risk reduction of invasive CV therapy to improve the outcome with CV and DCI after SAH in selected patients.

Pathological Gambling Associated With Aripiprazole or Dopamine Replacement Therapy

PubMed Central

Grall-Bronnec, Marie; Sauvaget, Anne; Perrouin, Fanny; Leboucher, Juliette; Etcheverrigaray, François; Challet-Bouju, Gaëlle; Gaboriau, Louise; Derkinderen, Pascal; Jolliet, Pascale; Victorri-Vigneau, Caroline

2016-01-01

Background In the last 10 years, dopamine replacement therapy (DRT) has become a well-known risk factor for developing an impulse control disorder, such as gambling disorder (GD). Another medication, aripiprazole (ARI), has been more recently identified as another risk factor. Dopamine replacement therapy and ARI share a dopamine agonist action. Our work aimed at comparing patients with PG according to their treatment with DRT or ARI. Methods Two methods were combined—a systematic review concentrated on case reports and the analysis of a French disordered gamblers cohort focused on patients using ARI or DRT at inclusion. Results We reported 48 cases of GD possibly due to DRT and 17 cases of GD possibly due to ARI. Because of their standardized assessment, only the EVALJEU patients could be compared. Two clinical patterns emerged. Patients in the ARI group were young, impulsive, and high novelty seekers and had a history of substance misuse. Their first gambling experience occurred during adolescence. Conversely, patients in the DRT group were old, and they began gambling late in life. They showed low levels of gambling-related cognition. Conclusions Patients in the ARI group seemed to be more severe pathological gamblers than patients in the DRT group. Aripiprazole is a partial D2 receptor agonist, whereas DRT includes full D2 receptor agonist. The trigger mechanism of PG development is complex and cannot only be attributed only to the pharmacodynamic effects of dopaminergic drugs. Indeed, individual vulnerability factors and environmental factors need to be considered. PMID:26658263

Prospective evaluation of fever of unknown origin in patients infected with the human immunodeficiency virus. Grupo Andaluz para el Estudio de las Enfermedades Infecciosas.

PubMed

Lozano, F; Torre-Cisneros, J; Bascuñana, A; Polo, J; Viciana, P; García-Ordóñez, M A; Hernández-Quero, J; Márquez, M; Vergara, A; Díez, F; Pujol, E; Torres-Tortosa, M; Pasquau, J; Hernández-Burruezo, J J; Suárez, I

1996-09-01

The aim of this study was to determine the frequency and aetiology of fever of unknown origin (FUO) in patients infected with the human immunodeficiency virus (HIV), to assess the value of the tests used in its diagnosis, and to evaluate possible models of diagnosis for the causes found most frequently. One hundred twenty-eight (3.5%) of 3603 hospitalised HIV-positive patients evaluated from October 1992 to December 1993 had FUO, defined by established criteria. Eighty-six percent of patients with FUO had previously progressed to AIDS. The median CD4+ cell count was 46/mm3. A definite diagnosis was made in 96 (75%) of the 128 patients and a possible diagnosis in 24 (18.7%). whilst no diagnosis was made in eight cases (6.2%). Tuberculosis (48.3%), visceral leishmaniasis (16%), and infection by Mycobacterium avium complex (6.9%) were the diseases found most frequently. The most useful diagnostic tests were liver biopsy (68.9%) and bone marrow aspirate/biopsy (39.7%). It is not possible to predict clinically the cases of FUO due to tuberculosis, whilst thrombocytopaenia < 100,000 cells/mm3 alone is useful for differentiating the cases of visceral leishmaniasis, with a negative predictive value of 95.2%.

Beauty parlor stroke syndrome due to a bone fragment from an osteophyte of the atlas: case report.

PubMed

Kameda, Takuya; Otani, Koji; Tamura, Takamitsu; Konno, Shinichi

2018-04-01

Beauty parlor stroke syndrome (BPSS) is a rare condition characterized by mechanical impingement of a vertebral artery (VA) during neck rotation and/or hyperextension followed by vertebrobasilar insufficiency. However, there have been no reports of BPSS in which the cause of mechanical impingement was identified and no cases for which surgical treatment was reported. The authors report the case of a 56-year-old Japanese man who presented with presyncope that occurred during cervical extension. Given the possibility of vertebrobasilar insufficiency, digital subtraction angiography and CT angiography were performed. These studies revealed that the right VA was hypoplastic and the left VA was dominant. Moreover, in the position of cervical extension, the dominant left VA showed constriction caused by a bone fragment of an osteophyte of the atlas. Removal of the bone fragment was performed. Postoperative left vertebral angiography showed improvement of blood flow in the extended position, and the presyncope completely disappeared. The pathomechanism of this case was a bone fragment compressing the left VA in the C-1 groove during neck extension. In BPSS patients with recurrent transient symptoms, the possibility of this mechanism of VA constriction by a free bone fragment should be considered.

Melioidosis: A Rare Cause of Liver Abscess

PubMed Central

Teh, Catherine S. C.; Casupang, Ma. Amornetta J.

2016-01-01

Case Presentation. This is a case of a 44-year-old male, farmer, known to be diabetic, presenting with two-week history of vague abdominal pain associated with high grade fever. Abdominal CT scan showed localized liver abscess at segment 8 measuring 7.5 × 6.8 × 6.1 cm. Patient subsequently underwent laparoscopic ultrasound guided pigtail insertion for drainage of abscess. Culture studies showed moderate growth of Burkholderia pseudomallei in which the patient completed seven days of IV Meropenem. On follow-up after 12 weeks of oral Sulfamethoxazole/Trimethoprim, taken twice a day, the patient remained asymptomatic with no residual findings based on the abdominal ultrasound. Discussion. Diagnosis of melioidosis, a known “great masquerader,” relies heavily on culture studies. Consensus with regard to the management of liver abscess caused by Burkholderia pseudomallei has not yet been established due to the rarity of cases. Surgical intervention through either a percutaneous or open drainage has shown good outcomes compared to IV antibiotics alone. In Philippines, the possibility of underreporting is highly plausible. This write-up serves not only to report a rare presentation of melioidosis but also to add to the number of cases reported in the country, possibly indicative of disease emergence. PMID:27529039

Melioidosis: A Rare Cause of Liver Abscess.

PubMed

Martin, Peter Franz M San; Teh, Catherine S C; Casupang, Ma Amornetta J

2016-01-01

Case Presentation. This is a case of a 44-year-old male, farmer, known to be diabetic, presenting with two-week history of vague abdominal pain associated with high grade fever. Abdominal CT scan showed localized liver abscess at segment 8 measuring 7.5 × 6.8 × 6.1 cm. Patient subsequently underwent laparoscopic ultrasound guided pigtail insertion for drainage of abscess. Culture studies showed moderate growth of Burkholderia pseudomallei in which the patient completed seven days of IV Meropenem. On follow-up after 12 weeks of oral Sulfamethoxazole/Trimethoprim, taken twice a day, the patient remained asymptomatic with no residual findings based on the abdominal ultrasound. Discussion. Diagnosis of melioidosis, a known "great masquerader," relies heavily on culture studies. Consensus with regard to the management of liver abscess caused by Burkholderia pseudomallei has not yet been established due to the rarity of cases. Surgical intervention through either a percutaneous or open drainage has shown good outcomes compared to IV antibiotics alone. In Philippines, the possibility of underreporting is highly plausible. This write-up serves not only to report a rare presentation of melioidosis but also to add to the number of cases reported in the country, possibly indicative of disease emergence.

Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 series.

PubMed

Brown, Amy Christine

2017-09-01

No online current list of potentially life-threatening, hepatotoxic herbs and dietary supplements based on PubMed case reports exists in a summarized tabular form. Documented case reports of herbs or dietary supplements (DS; includes herbs) appearing to contribute to liver injury were used to create an online "DS Toxic Table" of potentially hepatotoxic herbs and dietary supplements (PubMed, 1966 to June, 2016, and cross-referencing). The spectrum of DS induced liver injuries (DSILI) included elevated liver enzymes, hepatitis, steatosis, cholestasis, hepatic necrosis, hepatic fibrosis, hepatic cirrhosis, veno-occlusive disease, acute liver failure requiring a liver transplant, and death. Over the past 50 years, approximately 21 herbs (minus germander and usnic acid that are no longer sold) and 12 dietary supplements (minus the nine no longer sold and vitamin A & niacin due to excess intake) posed a possible risk for liver injures in certain individuals. The herbs with the most number of reported publications (but not cases studies) in descending order, were germander, black cohosh, kava extract, and green tea extract. These online DS Toxic Tables will contribute to continued Phase IV post marketing surveillance to detect possible liver toxicity cases and serve to forewarn consumers, clinicians, and corporations. Copyright © 2017 Elsevier Ltd. All rights reserved.

Physical examination-indicated cerclage in singleton and twin pregnancies: maternal-fetal outcomes.

PubMed

Bernabeu, Andrea; Goya, Maria; Martra, Miquel; Suy, Anna; Pratcorona, Laia; Merced, Carme; Llurba, Elisa; Casellas, Manel; Carreras, Elena; Cabero, Luis

2016-01-01

To study maternal and perinatal outcomes after physical examination-indicated cerclage in both singleton and twin pregnancies and evaluate the possible risk factors associated. Retrospective review of all women undergoing physical examination-indicated cerclage at the Hospital Vall d'Hebro, Barcelona from January 2009 to December 2012 after being diagnosed with cervical incompetence and risk of premature birth. During the study period, 60 cases of women diagnosed with cervical incompetence who were carrying live and morphologically-normal fetuses (53 singleton and 7 twin pregnancies), and who had an imminent risk of premature birth were evaluated. Mean gestational age until birth was 35 weeks in singleton and 32 weeks in twin pregnancies. Four cases (7.5%) of immature births and one case (2.0%) of neonatal death were recorded in singleton pregnancies. No cases of immature births or neonatal deaths were recorded in twin pregnancies. Diagnostic amniocentesis was performed IN all cases to rule out possible chorioamnionitis. Physical examination-indicated cerclage for cervical incompetence in women at risk for immature or preterm birth demonstrates good perinatal prognosis without increasing maternal morbidity in either singleton or twin pregnancies. The increase in gestation time in our study may also have been due to the fact that patients with subclinical chorioamnionitis were excluded by diagnostic amniocentesis.

Isolated dorsal column dysfunction due to an intraspinal Osteolipoma - Case report and review of literature.

PubMed

Aiyer, Siddharth N; Shetty, Ajoy Prasad; Kanna, Rishi; Maheswaran, Anupama; Rajasekaran, S

2016-01-01

Osteolipoma is a rare variant of the ubiquitous lipoma. Published literature appears in the form of isolated case reports affecting soft tissue structures in the head, neck and rarely affecting the spine. We present a unique instance of an intraspinal osteolipoma in the cervical spine, without evidence of accompanying spinal dysraphism and an atypical clinical presentation of isolated dorsal column dysfunction. We describe the clinical presentation, operative procedure and post-operative outcomes with histopathological findings of this rare entity. A 61-year-old male presented with impaired dorsal column sensation due to an intraspinal extradural ossifying lesion in the cervical spinal canal. The patient underwent excision of the lesion with complete resolution of symptoms. Ossifying lesion in the spinal canal may be frequent finding on radiological imaging but presence of possible adipose tissue in the lesion should raise suspicion of rare clinical scenario of an osteolipoma.

[Fatal outcome of an hydrogen sulfide poisoning].

PubMed

Querellou, E; Jaffrelot, M; Savary, D; Savry, C; Perfus, J-P

2005-10-01

We report a case of fatal outcome poisoning by massive exposure to hydrogen sulfide of a sewer worker. This rare event was associated with a moderate intoxication of two members of the rescue team. The death was due to asystole and massive lung oedema. Autopsy analysis showed diffuse necrotic lesions in lungs. Hydrogen sulfide is a direct and systemic poison, produced by organic matter decomposition. The direct toxicity mechanism is still unclear. The systemic toxicity is due to an acute toxicity by oxygen depletion at cellular level. It is highly diffusable and potentially very dangerous. At low concentration, rotten egg smell must trigger hydrogen sulfide suspicion since at higher concentration it is undetectable, making intoxication possible. In case of acute intoxication, there is an almost instantaneous cardiovascular failure and a rapid death. Hydrogen sulfide exposure requires prevention measures and more specifically the use of respiratory equipment for members of the rescue team.

Sudden Bilateral Sensorineural Hearing Loss Following Postpartum Hemorrhage: A Case Report

PubMed Central

Mirzaeian, Sara; Ayati, Sedigheh; Maleki, Asieh

2017-01-01

The prevalence of bilateral sudden sensorineural hearing loss (SSNHL) is less than 5% and the etiology of most cases is unknown. Due to many structural and functional similarities between the kidney and inner ear, many conditions, diseases, and drugs have both renal and cochlear effects and toxicities. There are several reports of SSNHL in patients with CRF, uraemic patient, hemodialysis treatment, and ARF. Here, we report a rare manifestation of SSNHL following severe postpartum hemorrhage that has simultaneous renal failure and cochlear impairment. The patient was a 22-year-old primigravida woman with term pregnancy who after delivery and episiotomy hematoma and postpartum hemorrhage subsequently suffered from kidney failure, oliguria, and SSNHL that occurred after 3 days of delivery. In conditions such as severe postpartum bleeding leading to acute renal involvement, the possibility of simultaneous involvement of cochlea due to hypoxia or received drugs should be considered. PMID:28761208

Pathological fracture of the patella due to an atypical located aneurysmal bone cyst: verification by means of ultrasound-guided biopsy.

PubMed

Plaikner, Michaela; Gruber, Hannes; Henninger, Benjamin; Gruber, Leonhard; Kosiol, Juana; Loizides, Alexander

2016-03-01

We report on a rare case of an atypical located aneurysmal bone cyst (ABC) in the patella presenting with pathological fracture after trauma. Using all available diagnostic modalities and by means of ultrasound-guided core-needle biopsy an unclear and suspected pathological fractured cystic bone lesion in the patella of a young man could be further clarified. The acquired images suggested the diagnosis of a pathological fractured aneurysmal bone cyst after mild trauma. However, due to the extraordinary location and clinical presentation the diagnosis was secured by means of ultrasound-guided biopsy through a small cortical gap. As shown in this rare case of an atypical aneurysmal bone cyst of the patella, the quite seldom but sometimes possible ultrasound-guided biopsy of intraosseous lesions can help to achieve the diagnostic clarification and should also be taken into account as a non-standard procedure.

[Replantation at lower leg level].

PubMed

Daigeler, A; Fansa, H; Westphal, T; Schneider, W

2003-11-01

Replantation in reconstructive surgery is an established procedure due to microsurgical techniques. It can be routinely performed in unilateral lower leg amputation. In some cases of bilateral amputation, in which orthotopic replantation is not possible due to the complex trauma, heterotopic replantation is a therapeutic option. This avoids prosthetic fitting. We report five cases of orthotopic and two of heterotopic lower limb replantations. Functional outcome concerning sensibility, mobility, pain, and aesthetic result were assessed clinically and using a questionnaire. Functional outcome and patient satisfaction were good. The psychological situation of the patients as well as mobility and stability of the replanted limbs were satisfying. Heterotopically replanted patients found the replanted legs superior to the prostheses. We conclude that, in lower leg amputation, attempts should be made to replant the extremity. In bilateral lower leg amputations, at least one limb should be reconstructed, even if "only" a heterotopic replantation can be performed.

Factors associated with adult poisoning in northern Malaysia: a case-control study.

PubMed

Fathelrahman, A I; Ab Rahman, A F; Zain, Z Mohd; Tengku, M A

2006-04-01

Data on adult risk factors associated with drug or chemical poisonings in Malaysia are scarce. The objective of the study was to identify possible risk factors associated with adult admissions to the Penang General Hospital (PGH) due to chemical poisoning and/or drug overdose. The present study was a case-control study, conducted over 18 weeks. One hundred acutely poisoned adult patients admitted to PGH during the period from September 2003 to February 2004 were considered as cases. Two hundred patients admitted to the same medical wards for other illnesses, during the same period, were matched for age and gender with the poisoned cases and thus selected as controls. McNemar test and binary logistic were used for univariate analysis and logistic regression analysis for multivariate analyses. The odds ratio (OR) and its 95% confidence interval (95% CI) were calculated for each predictor variable. Positive histories of psychiatric illness and previous poisoning, problems in boy/girl friend relationships, family problems, marital problems, Indian ethnicity, Chinese ethnicity, living in rented houses and living in a household with less than five people were significant risk factors associated with adult admissions due to poisoning.

Splenic infarction associated with acute infectious mononucleosis due to Epstein-Barr virus infection.

PubMed

Heo, Dae-Hyuk; Baek, Dae-Youb; Oh, Sang-Min; Hwang, Joo-Hee; Lee, Chang-Seop; Hwang, Jeong-Hwan

2017-02-01

The purpose of this study was to report a case of a previously healthy 20-year-old woman diagnosed with splenic infarction following infectious mononucleosis (IM) by Epstein-Barr virus (EBV) infection and to perform the first systematic review of the clinical characteristics of splenic infarction associated with IM. A systematic review was conducted using English, French, and Japanese literatures of splenic infarction associated with IM due to EBV infection published between 1961 and 2015 in PubMed Medline. A total of 19 cases were extracted from the collected articles. Left upper quadrant (LUQ) pain was observed in 15 (79%) patients. Splenectomy was performed in five (26%) cases, among which four patients presented with stable vital signs. Splenic rupture was accompanied in two (10%) patients. The median time from the onset of IM symptoms to the diagnosis of splenic infarction was 5 days (range, 1-25 days). Fourteen (74%) of 19 patients experienced improvement through medical treatment, and there were no deaths. Splenic infarction associated with IM due to EBV infection can show a favorable clinical outcome after medical treatment. Clinicians should consider the possibility of splenic infarction when patients with IM experience LUQ pain. J. Med. Virol. 89:332-336, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Catch me if you can--the use of image guidance in the radiotherapy of an unusual case of esophageal cancer.

PubMed

Jensen, Alexandra D; Grehn, Christian; Nikoghosyan, Anna; Thieke, Christian; Krempien, Robert; Huber, Peter E; Debus, Jürgen; Münter, Marc W

2009-07-01

Despite maximum therapy the prognosis of esophageal carcinoma still remains extremely poor. New treatment strategies including improved radiation therapy techniques promise better outcome by improving local control through precise dose delivery due to higher conformality. A 62-year-old patient with locally advanced carcinoma of the gastroesophageal junction underwent definitive radiochemotherapy with intensity-modulated radiation therapy (IMRT). On positioning control with the in-room CT, the distal esophagus, and hence the tumor, was found to be highly mobile exhibiting changes in position of up to 4 cm from fraction to fraction. IMRT plans were created for various positions establishing a plan library to choose from as appropriate. CT scans were performed prior to each treatment fraction to clarify esophagus position in order to choose the adequate treatment plan. Image guidance was crucial in this unusual case of esophageal carcinoma. Without the information from position control CTs, the tumor would have received only about half the prescribed dose due to variations in position. For this specific case, in-room CT scans are probably superior to kilo- or megavoltage CTs due to the higher soft-tissue contrast enabling detection of positioning variation of the organ and offering the possibility to use the CT for treatment planning.

Advances of human bone marrow-derived mesenchymal stem cells in the treatment of cartilage defects: a systematic review.

PubMed

Gopal, Kaliappan; Amirhamed, Haji Alizadeh; Kamarul, Tunku

2014-06-01

Mesenchymal stem cell (MSC)-based therapies represent a new option for treating damaged cartilage. However, the outcomes following its clinical application have seldom been previously compared. The present paper presents the systematic review of current literatures on MSC-based therapy for cartilage repair in clinical applications. Ovid, Scopus, PubMed, ISI Web of Knowledge and Google Scholar online databases were searched using several keywords, which include "cartilage" and "stem cells". Only studies using bone marrow-derived MSC (BM-MSC) to treat cartilage defects clinically were included in this review. The clinical outcomes were compared, and the quality of the tissue repair was analysed where possible. Of the 996 articles, only six (n = 6) clinical studies have described the use of BM-MSC in clinical applications. Two studies were cohort observational trials, three were case series, and one was a case report. In the two comparative trials, BM-MSCs produced superior repair to cartilage treatment without cells and have comparable outcomes to autologous chondrocyte implantation. The case series and case-control studies have demonstrated that use of BM-MSCs resulted in better short- to long-term clinical outcomes with minimal complications. In addition, histological analyses in two studies have resulted in good repair tissue formation at the damaged site, composed mainly of hyaline-like cartilage. Although results of the respective studies are highly indicative that BM-MSC-based therapy is superior, due to the differences in methods and selection criteria used, it was not possible to make direct comparison between the studies. In conclusion, published studies do suggest that BM-MSCs could provide superior cartilage repair. However, due to limited number of reports, more robust studies might be required before a definitive conclusion can be drawn.

[Clinical score to rule out pneumonia due to Mycoplasma pneumoniae].

PubMed

Rodríguez de Ita, J; Torres-Quintanilla, A; Paláu-Dávila, L; Silva-Gburek, J C; Ortiz de Elguea-Lizarraga, J; Chávez Caraza, K L; Santos-Guzman, J

2014-10-01

The gold standard for the diagnosis of pneumonia secondary to Mycoplasma pneumoniae is the serial measurement of IgM, since an isolated test for IgM has a poor sensitivity of 31.8%. A pneumonia due to Mycoplasma pneumoniae could be of clinically different origins, thus it is possible to perform a clinical score for its early diagnosis. To develop a clinical score in order to rule out a pneumoniae secondary to Mycoplasma pneumoniae. A total of 302 patients from 0 to 18 years-old, with a diagnosis of pneumonia were evaluated and divided into two groups: Mycoplasma positive and Mycoplasma negative. Using different variables in the medical records a clinical score was calculated. Of the 302 cases studied, 34 were classified as Mycoplasma positive and 268 as Mycoplasma negative. The variables relevant to the calculation of the score were age, days with fever, and days with cough, thus providing the CAF (Cough, Age, Fever) score. Ranges were assigned for each variable and points were given for each range. A value greater than or equal to 5 meant a positive score. The CAF score was applied to the 302 cases, resulting in 164 cases of Mycoplasma positive and 138 cases of Mycoplasma negative. The CAF score had a sensitivity of 85% and specificity of 49%. The CAF score had better sensitivity than other clinical diagnostic tools. With a negative predictive value of 96% it is possible to rule out a pneumonia secondary to M. pneumoniae. The study requires a prospective study to verify the usefulness of our score. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Adverse Effects of Plant Food Supplements Self-Reported by Consumers in the PlantLIBRA Survey Involving Six European Countries

PubMed Central

Restani, Patrizia; Di Lorenzo, Chiara; Garcia-Alvarez, Alicia; Badea, Mihaela; Ceschi, Alessandro; Egan, Bernadette; Dima, Lorena; Lüde, Saskia; Maggi, Franco M.; Marculescu, Angela; Milà-Villarroel, Raimon; Raats, Monique M.; Ribas-Barba, Lourdes; Uusitalo, Liisa; Serra-Majem, Lluís

2016-01-01

Background The use of food supplements containing botanicals is increasing in European markets. Although intended to maintain the health status, several cases of adverse effects to Plant Food Supplements (PFS) have been described. Objectives To describe the self-reported adverse effects collected during the European PlantLIBRA PFS Consumer Survey 2011–2012, with a critical evaluation of the plausibility of the symptomatology reported using data from the literature and from the PlantLIBRA Poisons Centers' survey. Subjects/Setting From the total sample of 2359 consumers involved in the consumers' survey, 82 subjects reported adverse effects due to a total of 87 PFS. Results Cases were self-reported, therefore causality was not classified on the basis of clinical evidence, but by using the frequency/strength of adverse effects described in scientific papers: 52 out of 87 cases were defined as possible (59.8%) and 4 as probable (4.6%). Considering the most frequently cited botanicals, eight cases were due to Valeriana officinalis (garden valerian); seven to Camellia sinensis (tea); six to Ginkgo biloba (Maidenhair tree) and Paullinia cupana (guarana). Most adverse events related to the gastrointestinal tract, nervous and cardiovascular systems. Conclusions Comparing the data from this study with those published in scientific papers and obtained by the PlantLIBRA Poisons Centers' survey, some important conclusions can be drawn: severe adverse effects to PFS are quite rare, although mild or moderate adverse symptoms can be present. Data reported in this paper can help health professionals (and in particular family doctors) to become aware of possible new problems associated with the increasing use of food supplements containing botanicals. PMID:26928206

[Progressive renal insufficiency in a 55-year-old man with psoriasis].

PubMed

Herfurth, K; Busch, M; Gröne, H J; Wolf, G

2018-06-05

Treatment with tumor necrosis factor alpha (TNF-α) inhibitors is a well-established therapeutic strategy for various autoimmune diseases. However, little is known about renal complications and possible causality of renal injury due to this treatment. The following case of a patient with psoriasis demonstrates the difficulties in classifying renal complications of anti-TNF-α therapy versus kidney involvement caused by the underlying disease.

Rhinocerebral Mucormycosis Among Diabetic Patients: An Emerging Trend.

PubMed

Reddy, Sujatha S; Rakesh, N; Chauhan, Pallavi; Sharma, Shivani

2015-12-01

Mucormycosis is an acute necrotic fungal infection with a fulminant course. Earlier considered a rare entity, mucormycosis is being reported with increasing frequency in recent years, possibly due to the increase in immunocompromised population especially diabetic patients. We report three cases of rhinocerebral mucormycosis among poorly controlled diabetic patients. This article emphasizes the need for further awareness of this disease, early diagnosis, and treatment to counter this opportunistic infection.

Dermal necrosis following coumarin: is it immunologically induced?

PubMed

Hislop, I G; Zilko, P J; Petersen, M; Ahmed, N

1980-02-01

Two patients with dermal necrosis due to anticoagulation therapy with warfarin are reported. Both patients demonstrated some disturbance in immunological function. It appears possible that warfarin may act as a hapten in the induction of hypersensitivity to the drug. It is recommended that future cases should be studied to determine whether there is a defect in immunoregulation, and whether circulating immune complexes are responsible for the typical skin lesions.

Insider Threat Detection on the Windows Operating System using Virtual Machine Introspection

DTIC Science & Technology

2012-06-14

by a malicious insider. HBSS systems running on a user’s workstation could be disabled either due to misconfiguration, privilege escalation , or by a...potential malicious insider threat, organizations must develop use cases which categorize possible attack techniques, such as data exfiltration via...hardware and contain any type of data an attacker may be looking for. Minimal Resources Since honeypots do not provide any network services, they

Cosmic Ray Induced Neutron Irradiation

NASA Astrophysics Data System (ADS)

Overholt, Andrew

2011-11-01

After cancer studies performed on flight crews during the 1970s, it was found that cosmic rays produce a signficant flux of thermal neutrons at airplane altitudes. In the case of high energy cosmic rays these biologically threatening neutrons are increased at ground level. Our work models the flux of neutrons produced by high energy cosmic rays, exploring the possibility of biological impact due to extended periods of increase high energy cosmic ray flux.

Parsing Flowcharts and Series-Parallel Graphs

DTIC Science & Technology

1978-11-01

descriptions of the graph. This possible multiplicity is undesirable in most practical applications, a fact that makes parti%:ularly useful reduction...to parse TT networks, some of the features that make this parsing method useful in other cases are more natually introduced in the context of this...as Figure 4.5 shows. This multiplicity is due to the associativity of consecutive Two Terminal Series and Two Terminal Parallel compositions. In spite

Stanford-Binet and WAIS IQ Differences and Their Implications for Adults with Intellectual Disability (aka Mental Retardation)

ERIC Educational Resources Information Center

Silverman, Wayne; Miezejeski, Charles; Ryan, Robert; Zigman, Warren; Krinsky-McHale, Sharon; Urv, Tiina

2010-01-01

Stanford-Binet and Wechsler Adult Intelligence Scale (WAIS) IQs were compared for a group of 74 adults with intellectual disability (ID). In every case, WAIS Full Scale IQ was higher than the Stanford-Binet Composite IQ, with a mean difference of 16.7 points. These differences did not appear to be due to the lower minimum possible score for the…

Posttraumatic Progressive Vertebral Hemangioma Induced by a Fracture

PubMed Central

Unal, Emre; Toktas, Zafer Orkun; Aker, Fugen Vardar; Akakın, Akın; Kilic, Türker

2017-01-01

The authors present an extremely rare case of an aggressive and progressive vertebral capillary hemangioma of the lumbar spine secondary to a trauma. A 40-year-old man who complained of back and leg pain due to a hemangioma of L1 that had begun a year after the fracture of the same vertebra was subsequently operated on. Due to the profuse bleeding, only a subtotal removal was possible. Histopathological diagnosis of the lesion revealed a capillary hemangioma. Postoperative control MRI taken at eight months showed that the lesion and destruction of the L1 vertebra were progressive. A second embolization procedure was performed and this time the hemangioma was totally removed via an anterior approach and corpectomy. Fusion was achieved by Th12-L2 graft and plaque. In the fourteenth year of follow-up, he was symptom-free and radiologically clear of this lesion. We propose that progressive hemangioma is extremely rare and that its cure is possible by total surgical removal of the lesion. This case is the second extradural capillary hemangioma secondary to spinal trauma ever to have been documented in English literature. The emergence of a hemangioma in a fractured vertebra suggests that its pathogenesis can be related to the deviation of the angiogenetic pathways from the normal healing process. PMID:28713608

Thermosolutal Marangoni convection short-time regimes - Proposals for drop tower experiments and real time computer simulation

NASA Astrophysics Data System (ADS)

Polezhaev, V. I.; Ermakov, M. K.

1992-12-01

Results are presented of a parametrical study of flow patterns, heat transfer, and time scales of thermosolutal Marangoni convection in a cavity with temperature and solutal gradients along the free surface and adiabatic bottom for the case of zero gravity. Nusselt number, concentration difference across the cavity, and flow/temperature fields for the different regimes are presented; they show the possibility to use Drop Tower 'Bremen' for measuring the developed secondary flow and heat/mass transfer due to thermosolutal Marangoni convection as well as the possibility to analyze and plan the drop tower for such experiments using the COMGA PC-based system.

Frozen gene pools - A future for species otherwise destined for extinction

USGS Publications Warehouse

Gee, G.F.

1986-01-01

Conclusion: Semen banks and ova and embryo banks can be practical methods to maintain gene pools. Gene pool preservation is desperately needed today due to the rapid decline in number of species and their habitat, a matter that is of concern to.biologists, economists, and politicians worldwide. Techniques are available for the cryopreservation of semen from many animals (and embryos from a few mammals) and adaptations of these techniques to other animals should be possible. A frozen gene pool in conjunction with existing programs makes it possible to preserve gene pools at less cost or in.some cases where no other alternative to extinction existed.

Cutaneous drug toxicity from 2,4-dinitrophenol (DNP): Case report and histological description.

PubMed

Le, Patricia; Wood, Benjamin; Kumarasinghe, Sujith Prasad

2015-11-01

The use of 2,4-dinitrophenol (DNP) has regained popularity as a weight loss aid in the last two decades due to increased marketing to bodybuilders and the increasing availability of this banned substance via the Internet. 2,4-DNP is a drug of narrow therapeutic index and toxicity results in hyperthermia, diaphoresis, tachycardia, tachypnoea and possible cardiac arrest and death. Skin toxicity from 2,4-DNP has not been reported since the 1930s. We report a case of a 21-year-old bodybuilding enthusiast who presented with a toxic exanthem after taking 2,4-DNP, and describe the first skin biopsy findings in a case of 2,4-DNP toxicity. © 2014 The Australasian College of Dermatologists.

A case report of the clear cell variant of gallbladder carcinoma.

PubMed

Maharaj, Ravi; Cave, Christo; Sarran, Kevin; Bascombe, Nigel; Dan, Dilip; Greaves, Wesley; Warner, Wayne A

2017-01-01

Clear cell gallbladder carcinoma accounts for less than 1% of all gallbladder malignancies and demonstrates its unique histopathological characteristics in patients with no prior medical illness or familial predisposition. Here we present a case of a 56-year-old female, with no prior medical conditions presented with a 2-month history of upper abdominal pain. Routine hematological and biochemical tests were unremarkable. An abdominal ultrasound revealed the presence of a gallbladder calculi, and a fundic mass while magnetic resonance cholangiopancreatography revealed a 8.0cm×3.5cm gallbladder mass. Computed tomography imaging excluded any distant haematogenous metastases. An open cholecystectomy with lymphadenectomy was proceeded by staging laparoscopy. Upon pathologic investigation, the morphologic and immunophenotypic features supported a diagnosis of clear cell variant of gallbladder carcinoma. Pathological prognostications for primary clear cell gall bladder carcinomas are not well defined due to the rarity of cases and possible misidentification as secondary metastases. Foci of adenocarcinoma within the tumor along with immunohistochemical staining probes can be informative in consideration of differential diagnosis. In these cases, clinical case management should be personalized for increased survival with the possible incorporation of next generation sequencing approaches to guide therapeutic algorithms. We discuss this exceedingly rare case of the clear cell variant of gallbladder carcinoma in detail, highlighting some of the diagnostic, and clinical challenges. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Iowa Case Management for Rural Drug Abuse

PubMed Central

Hall, James A.; Sarrazin, Mary S. Vaughan; Huber, Diane L.; Vaughn, Thomas; Block, Robert I.; Reedy, Amanda R.; Jang, MiJin

2011-01-01

Objective The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. Method 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual (TAU), or to a fourth condition of TAU only. All were assessed at intake and followed at 3, 6, and 12 months. Results Clients in all four conditions significantly decreased substance use by 3 months after intake and maintained most gains over time. However, the addition of ICM to TAU did not improve substance use outcomes. Conclusion Overall, the addition of case management did not significantly improve drug treatment as hypothesized by both researchers and clinicians. Some results were mixed, possibly due to the heterogeneous sample, wide range of case management activities, or difficulty retaining participants over time. PMID:22065018

Intestinal obstruction management in patients with advanced abdominal neoplasia.

PubMed

Simion, L; Straja, Nd; Alecu, M; Poroch, V; Moşoiu, D; Panti, C; Grigorean, V; Brătucu, E

2014-01-01

The present study describes the difficulties encountered in the diagnostic process and treatment of intestinal obstruction developed by patients with advanced abdominal neoplasia. This unicentric and retrospective study evaluates patients suffering from intestinal occlusion operated on at the First Surgical Clinic of the Oncology Institute in Bucharest, over a period of 4 years (2010 - 2013). Of these, 61 cases in which the occlusion occurred on the background of an advanced abdominal neoplasia were selected. We considered as advanced those cases of abdominal cancer where curative oncologic treatment is no longer possible due to the evolution stage. The random selection of the study period, the introduction of all the patients identified with this type of pathology, as well as the concentration of advanced abdominal neoplasia at the Oncology Institute in Bucharest are the elements that allow us to state that the results of this study are representative. Particularities related to the clinical aspects of the intestinal occlusion in these patients, as well as difficulties in establishing the correct diagnosis were encountered.Surgical cure of the occlusion, with palliative aim of course,was possible in only 47 cases (representing 77.05%). A standard treatment course cannot be devised for this type of patients. Palliative care, indispensable in cases of advanced neoplastic disease, remains the sole therapeutic method available for patients with no surgical cure for the obstruction. The main objective, for the entire study lot, was to ensure an as high as possible quality of life,a factor we must bear in mind as often as possible when choosing a surgical solution. Of course, when surgical treatment can be applied, overcoming the occlusive episode prolongs these patients' life and can even allow for other courses of complementary treatment to be undertaken. Celsius.

[Peritoneal gliomatosis].

PubMed

Sánchez-Cifuentes, Angela; Gonzalez-Valverde, Francisco Miguel; Vicente-Ruiz, María; Peña-Ros, Emilio; Pastor-Quirante, Francisco; Albarracín-Marín-Blázquez, Antonio; Escamilla-Segade, Concepción

2014-01-01

Peritoneal gliomatosis is characterized by the presence of miliary implants of mature glia on the peritoneum of patients with ovarian teratomas, usually immature. We report the case of a woman operated on 5 years earlier due to a right mature ovarian teratoma. When she was operated on due to left ovarian tumor she presented a miliary glial dissemination in omentum and peritoneum. The association of peritoneal gliomatosis ovarian teratomas is rare. Although the primary treatment and patient monitoring is focused on the teratoma, control should be maintained of peritoneal implants because of the possibility of malignancy. We believe it would be beneficial to establish a protocol for monitoring these lesions.

Familial cardiofaciocutaneous syndrome in a father and a son with a novel MEK2 mutation.

PubMed

Karaer, Kadri; Lissewski, Christina; Zenker, Martin

2015-02-01

Cardiofaciocutaneous (CFC) syndrome is a rare genetic disorder belonging to the group of RASopathies. It is typically characterized by congenital heart defects, short stature, dysmorphic craniofacial features, intellectual disability, failure to thrive, and ectodermal abnormalities such as hyperkeratosis and sparse, brittle, curly hair. CFC syndrome is caused by dominant mutations in one of the four genes BRAF, MEK1, MEK2, and KRAS. Only three familial cases of CFC syndrome have been reported to date, whereas the vast majorities are sporadic cases due to de novo mutations. We report on a fourth familial case with transmission of CFC syndrome from father to son due to a novel heterozygous sequence change c.376A>G (p.N126D) in exon 3 of MEK2 gene. This observation further documents the possibility of vertical transmission of CFC syndrome, which appears to be associated with rare mutations and relatively mild intellectual disability in affected individual. The hypomorphic effect of specific mutations particularly regarding neurocognitive issues may be related to the variable fertility of affected individuals. © 2014 Wiley Periodicals, Inc.

Tinea corporis due to Trichophyton rubrum in a woman and Tinea capitis in her 15-day-old baby: molecular evidence of vertical transmission.

PubMed

Mapelli, E T M; Borghi, E; Cerri, A; Sciota, R; Morace, G; Menni, S

2012-03-01

We report a case of a 40-year-old Caucasian woman who came under our observation with a 7-year history of a chronic erythematous scaly dermatitis, diagnosed as psoriasis, involving gluteal area and thighs, and treated with topical steroids without benefit. During pregnancy, a progressive worsening of her condition and an extension of cutaneous lesions were observed. Her newborn, a 15-day-old girl, presented a similar scaly and squamous lesion on her scalp. Mycological examination was positive for Trichophyton rubrum in both cases, and random amplified polymorphic DNA analysis confirmed the isogenicity of the two isolates. We performed a diagnosis of T. rubrum tinea corporis and tinea capitis. The case we describe illustrates an unusual clinical presentation of tinea corporis with remarkable extension of cutaneous lesions due to the diagnostic delay and the continuous use of local steroids, together with a rare tinea capitis in the newborn. Our experience highlights the possibility of mother-child transmission and the importance of an early diagnosis.

Late-onset renal vein thrombosis: A case report and review of the literature.

PubMed

Hogan, Jessica L; Rosenthal, Stanton J; Yarlagadda, Sri G; Jones, Jill A; Schmitt, Timothy M; Kumer, Sean C; Kaplan, Bruce; Deas, Shenequa L; Nawabi, Atta M

2015-01-01

Renal vein thrombosis, a rare complication of renal transplantation, often causes graft loss. Diagnosis includes ultrasound with Doppler, and it is often treated with anticoagulation or mechanical thrombectomy. Success is improved with early diagnosis and institution of treatment. We report here the case of a 29 year-old female with sudden development of very late-onset renal vein thrombosis after simultaneous kidney pancreas transplant. This resolved initially with thrombectomy, stenting and anticoagulation, but thrombosis recurred, necessitating operative intervention. Intraoperatively the renal vein was discovered to be compressed by a large ovarian cyst. Compression of the renal vein by a lymphocele or hematoma is a known cause of thrombosis, but this is the first documented case of compression and thrombosis due to an ovarian cyst. Early detection and treatment of renal vein thrombosis is paramount to restoring renal allograft function. Any woman of childbearing age may have thrombosis due to compression by an ovarian cyst, and screening for this possibility may improve long-term graft function in this population. Published by Elsevier Ltd.

Recurrent Streptococcus agalactiae Toxic Shock Syndrome Triggered by a Tumor Necrosis Factor-α Inhibitor

PubMed Central

Yoshida, Masataka; Takazono, Takahiro; Tashiro, Masato; Saijo, Tomomi; Morinaga, Yoshitomo; Yamamoto, Kazuko; Nakamura, Shigeki; Imamura, Yoshifumi; Miyazaki, Taiga; Sawai, Toyomitsu; Nishino, Tomoya; Izumikawa, Koichi; Yanagihara, Katsunori; Mukae, Hiroshi; Kohno, Shigeru

2016-01-01

Streptococcal toxic shock syndrome caused by group B streptococcus (GBS) is a rare, but lethal disease. We experienced a 45-year-old woman with pustular psoriasis who developed toxic shock-like syndrome during infliximab treatment. Surprisingly, similar episodes recurred three times in one year with restarting of infliximab treatments. In the third episode, GBS were detected in blood, urine, and vaginal secretion cultures. These episodes of shock syndrome were possibly due to GBS. To the best of our knowledge, this is the first case report of recurrent streptococcal toxic shock syndrome possibly caused by GBS which was induced by anti-TNF-α inhibitor therapy. The restarting of biological agents in patients with a history of toxic shock syndrome should therefore be avoided as much as possible. PMID:27803422

Recurrent Streptococcus agalactiae Toxic Shock Syndrome Triggered by a Tumor Necrosis Factor-α Inhibitor.

PubMed

Yoshida, Masataka; Takazono, Takahiro; Tashiro, Masato; Saijo, Tomomi; Morinaga, Yoshitomo; Yamamoto, Kazuko; Nakamura, Shigeki; Imamura, Yoshifumi; Miyazaki, Taiga; Sawai, Toyomitsu; Nishino, Tomoya; Izumikawa, Koichi; Yanagihara, Katsunori; Mukae, Hiroshi; Kohno, Shigeru

Streptococcal toxic shock syndrome caused by group B streptococcus (GBS) is a rare, but lethal disease. We experienced a 45-year-old woman with pustular psoriasis who developed toxic shock-like syndrome during infliximab treatment. Surprisingly, similar episodes recurred three times in one year with restarting of infliximab treatments. In the third episode, GBS were detected in blood, urine, and vaginal secretion cultures. These episodes of shock syndrome were possibly due to GBS. To the best of our knowledge, this is the first case report of recurrent streptococcal toxic shock syndrome possibly caused by GBS which was induced by anti-TNF-α inhibitor therapy. The restarting of biological agents in patients with a history of toxic shock syndrome should therefore be avoided as much as possible.

Possible detection of an emission feature near 584 A in the direction of G191-B2B

NASA Technical Reports Server (NTRS)

Green, James; Bowyer, Stuart; Jelinsky, Patrick

1990-01-01

A possible spectral emission feature is reported in the direction of the nearby hot white dwarf G191-B2B at 581.5 + or - 6 A with a significance of 3.8 sigma. This emission has been identified as He I 584.3 A. The emission cannot be due to local geocoronal emission or interplanetary backscatter of solar He I 584 A emission because the feature is not detected in a nearby sky exposure. Possible sources for this emission are examined, including the photosphere of G191-B2B, the comparison star G191-B2A, and a possible nebulosity near or around G191-B2B. The parameters required to explain the emission are derived for each case. All of these explanations require unexpected physical conditions; hence we believe this result must receive confirming verification despite the statistical likelihood of the detection.

Iris alterations after DSAEK.

PubMed

Del Hierro Zarzuelo, A; Boto de Los Bueis, A

2016-09-01

To evaluate a series of case that developed iris changes after performing Descemet's stripping automated endothelial keratoplasty (DSAEK). Retrospective study of eyes that developed iris abnormalities, such as pupil ovalisation, iris atrophy, iridocorneal synechiae, mydriatic pupil, and pigmentary changes after performing DSAEK in a tertiary hospital. In a series of the first 32 DSAEK procedures performed, new single or mixed iris alterations were observed in 12 eyes (37.5%). Iris-corneal synechiae were observed in 7 eyes, corectopias in 9 eyes, iris atrophy in 3 cases, and one case developed an areflexic mydriatic pupil. Long-term pigment dispersion at the edge of the lenticule was observed in 12 eyes. The alterations occurred after three months from the surgery. In the evaluation of the associated factors, malignant glaucoma had occurred in 1 case, 2 eyes had required a second surgery, one case by re-DSAEK, and the other one by removing the intraocular lens due to lens opacification. Two cases had a shallow anterior chamber. No relationship was found between the thickness of the peripheral lenticule and the presence of synechiae. Iris changes regarding DSAEK are possible. A discussion is presented on the relationship between increased intraocular pressure due to air in anterior chamber and its relationship with ischaemia and secondary alterations in the iris. Copyright © 2016 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

[Indigenous, introduced and airport malaria in Europe.].

PubMed

Danis, M; Mouchet, M; Giacomini, T; Guillet, P; Legros, F; Belkaïd, M

1996-04-01

Mainly due to P. vivax, the autochtonous malaria - sometimes caused by P. malaria, scarcely by P. falciparum - is spread in the whole Europe until the 18th century, decreasingly during the second part of the 19th century, while the latest documented cases were noticed in Macedonia, 1974. In France malaria spontaneously disappeared in 1943 on the mainland, and after, DDT house-spraying, in Corsica, 1959-60 (in spite of a temporarily reintroduction run in 1970). Malaria is now eradicated from Europe officially since 1975. Since 1969, approximatively 60 cases of autochtonous "airborne or airport malaria" have been officially reported from various European countries : Belgium, Germany, Italy, Netherlands, United Kingdom, Spain, Swiss, and France. Most of the 23 cases run into France were due to P. falciparum and appeared during summer. All patients were living, working or both, in the vicinity of an international airport or harbour (2 cases). Few of theses cases queerly involved a second-step carriage of Anopheles. The illness is usually severe and case fatality rate is therefore high, because of the subject's absence of premunition and no history of tropical travel, and then, the infection may be unfortunately misdiagnosed. According to the International Health Regulations, disinsection of aircrafts must be systematically done and even enhanced as soon as possible. On the other hand some of new methods for the aircraft disinsection and improved international vector control must be developped.

Euthanasia in patients dying at home in Belgium: interview study on adherence to legal safeguards

PubMed Central

Smets, Tinne; Bilsen, Johan; Van den Block, Lieve; Cohen, Joachim; Van Casteren, Viviane; Deliens, Luc

2010-01-01

Background Euthanasia became legal in Belgium in 2002. Physicians must adhere to legal due care requirements when performing euthanasia; for example, consulting a second physician and reporting each euthanasia case to the Federal Review Committee. Aim To study the adherence and non-adherence of GPs to legal due care requirements for euthanasia among patients dying at home in Belgium and to explore possible reasons for non-adherence. Design of study Large scale, retrospective study. Setting General practice in Belgium. Method A retrospective mortality study was performed in 2005–2006 using the nationwide Belgian Sentinel Network of General Practitioners. Each week GPs reported medical end-of-life decisions taken in all non-sudden deaths of patients in their practice. GP interviews were conducted for each euthanasia case occurring at home. Results Interviews were conducted for nine of the 11 identified euthanasia cases. Requirements concerning the patient's medical condition were met in all cases. Procedural requirements such as consultation of a second physician were sometimes ignored. Euthanasia cases were least often reported (n = 4) when the physician did not regard the decision as euthanasia, when only opioids were used to perform euthanasia, or when no second physician was consulted. Factors that may contribute to explaining non-adherence to the euthanasia law included: being unaware of which practices are considered to be euthanasia; insufficient knowledge of the euthanasia law; and the fact that certain procedures are deemed burdensome. Conclusion Substantive legal due care requirements for euthanasia concerning the patient's request for euthanasia and medical situation were almost always met by GPs in euthanasia cases. Procedural consultation and reporting requirements were not always met. PMID:20353662

Radiation-induced temporo-mandibular joint disorder in post-radiotherapy nasopharyngeal carcinoma patients: assessment and treatment.

PubMed

Wu, Vincent W C; Lam, Ying-Na

2016-06-01

Nasopharyngeal carcinoma (NPC) is endemic in southern China, and its incidence in Hong Kong is relatively high. Radiotherapy is the mainstay treatment for NPC due to its relatively high radiosensitivity and deep-seated anatomical position, which is not readily accessible by surgery. Although the technique of radiotherapy in NPC has been advancing and offers promising treatment outcome, complications around the irradiation areas are inevitable and the quality of life of the post-radiotherapy patients is often compromised. Trismus, which is defined as the restricted mouth opening or jaw movement due to the disorder of temporo-mandibular joint (TMJ), is one of the possible late complications for radiotherapy of NPC and is found in 5-17% of the post-radiotherapy (post-RT) patients. Trismus at early stage may only affect the speech, but in severe cases nutritional intake and oral hygiene condition may deteriorate seriously. This article reviewed the possible causes of radiation-induced TMJ damage, the various assessments including imaging modalities and possible treatments. The conclusion is that the availability of simple, yet effective examinations for trismus is essential for delaying the progression and restoring TMJ functions. Although there is no absolutely effective treatment for trismus, many supportive, restorative and palliative management are possible under different clinical situations.

An improved interim therapeutic restoration technique for management of anterior early childhood caries: report of two cases.

PubMed

Nelson, Travis

2013-01-01

Early childhood caries presents unique treatment challenges that often require advanced behavior management techniques, such as general anesthesia or procedural sedation. In some cases, use of these pharmacologic adjuncts is undesirable or not possible. The interim therapeutic restoration is a treatment method that, while sometimes employed in such cases, can often produce unsatisfactory results in primary anterior teeth. This is often due to insufficient bulk of material and lack of retention. The purpose of this report was to describe a simple alternative technique (resin modified glass ionomer strip crowns) that may be employed to deliver esthetic anterior restorations to marginally cooperative children in the dental clinic setting and to report on two cases in which it was successfully used. \\\\\\Department of Pediatric Dentistry, University of Washington, Seattle, Wash., USA. tmnelson@uw.edu

Brain abscesses as a metastatic manifestation of strangles: symptomatology and the use of magnetic resonance imaging as a diagnostic aid.

PubMed

Spoormakers, T J P; Ensink, J M; Goehring, L S; Koeman, J P; Ter Braake, F; van der Vlugt-Meijer, R H; van den Belt, A J M

2003-03-01

The occurrence of unexpectedly high numbers of horses with neurological signs during two outbreaks of strangles required prompt in-depth researching of these cases, including the exploration of magnetic resonance imaging (MRI) as a possible diagnostic technique. To describe the case series and assess the usefulness of MRI as an imaging modality for cases suspected of space-occupying lesions in the cerebral cavity. Four cases suspected of suffering from cerebral damage due to Streptococcus equi subsp. equi infection were examined clinically, pathologically, bacteriologically, by clinical chemistry (3 cases) and MRI (2 cases). In one case, MRI findings were compared to images acquired using computer tomography (CT). In all cases, cerebral abscesses positive for Streptococcus equi subsp. equi were found, which explained the clinical signs. Although the lesions could be visualised with CT, MRI images were superior in representing the exact anatomic reality of the soft tissue lesions. The diagnosis of bastard strangles characterised by metastatic brain abscesses was confirmed. MRI appeared to be an excellent tool for the imaging of cerebral lesions in the horse. The high incidence of neurological complications could not be explained but possibly indicated a change in virulence of certain strains of Streptococcus equi subsp. equi. MRI images were very detailed, permitting visualisation of much smaller lesions than demonstrated in this study and this could allow prompt clinical intervention in less advanced cases with a better prognosis. Further, MRI could assist in the surgical treatment of brain abscesses, as has been described earlier for CT.

Anterior transarticular C1-C2 fixation with contralateral screw insertion: a report of two cases and technical note.

PubMed

Lvov, Ivan; Grin, Andrey; Kaykov, Aleksandr; Smirnov, Vladimir; Krylov, Vladimir

2017-08-08

Anterior transarticular fixation of the C1-C2 vertebrae is a well-known technique that involves screw insertion through the body of the C2 vertebra into the lateral masses of the atlas through an anterior transcervical approach. Meanwhile, contralateral screw insertion has been previously described only in anatomical studies. We describe two case reports of the clinical application of this new technique. In Case 1, the patient was diagnosed with an unstable C1 fracture. The clinical features of the case did not allow for any type of posterior atlantoaxial fusion, Halo immobilization, or routine anterior fixation using the Reindl and Koller techniques. The possible manner of screw insertion into the anterior third of the right lateral mass was via a contralateral trajectory, which was performed in this case. Case 2 involved a patient with neglected posteriorly dislocated dens fracture who could not lie in the prone position due to concomitant cardiac pathology. Reduction of atlantoaxial dislocation was insufficient, even after scar tissue resection at the fracture, while transdental fusion was not possible. Considering the success of the previous case, atlantoaxial fixation was performed through the small approach, using the Reindl technique and contralateral screw insertion. These two cases demonstrate the potential of anterior transarticular fixation of C1-C2 vertebrae in cases where posterior atlantoaxial fusion is not achievable. This type of fixation can be performed through a single approach if one screw is inserted using the Reindl technique and another is inserted via a contralateral trajectory.

[Hepatotoxicity associated with the use of Herbalife].

PubMed

Jóhannsson, Magnús; Ormarsdóttir, Sif; Olafsson, Sigurdur

2010-03-01

Many herbal products are known to be hepatotoxic. In a recent survey in Iceland concerning adverse reactions related to herbal medicines, Herbalife products were implicated in the majority of the reported cases of hepatotoxicity. The clinical presentations of five cases of Herbalife related liver injury during the period of 1999-2008 are analysed. Causality was assessed by using the WHO-UMC system for causality assessment and the RUCAM method. Of the five cases there were four females and one male; median age was 46 years (range 29-78). Herbalife had been used for 1 to 7 months prior to presentation. Four patients presented with a hepatocellular and one with a cholestatic reaction. Median values were for bilirubin 190 micromol/L (range: 26-311; ref. < 20 micromol/L), ALP 407 U/L (range: 149-712; ref. 35-105 U/L) and ALT 24 87 U/L (range: 456-2637; ref. 70 and 45 U/L for males and females, respectively). Liver biopsy was performed in 2 patients and was consistent with toxic hepatitis in both cases. Other causes of hepatitis were excluded by appropriate serological testing and ultrasound. Causality assessment according to RUCAM was probable in three cases and possible in two. Using the WHO-UMC criteria causality was certain in one case, probable in two and possible in two cases. Hepatotoxicity is probably associated with the use of Herbalife products. Hepatotoxicity due to herbal remedies is an important differential diagnosis in the diagnostic work-up of liver injury.

Dilemma of treating schizophrenia during pregnancy: a Case series and a review of literature.

PubMed

Teodorescu, Andreea; Ifteni, Petru; Moga, Marius Alexandru; Burtea, Victoria; Bigiu, Nicusor

2017-08-29

The choice of antipsychotic treatment during pregnancy remains controversial, mainly due to a lack of exposure and outcome data. Randomized clinical trials are practically impossible due to ethical reasons. Our reports describe three cases of closely monitored female patients with schizophrenia who were treated with olanzapine during pregnancy. The novelty of reports is that all patients were previously treated with olanzapine long acting injectable (LAI) for an average period of 3.8 years. During the LAI treatment period they were in remission and then refused to continue with LAI mainly due to treatment modality (injectable administration). The patients were relatively young, diagnosed with schizophrenia and were previously successfully treated with long acting injectable. The women were pregnant for the first time. In two cases, the patients had become pregnant during remission and they continued treatment with oral olanzapine. In the third case, olanzapine treatment was initiated during admission for a relapse. There are no controlled studies for the use of olanzapine therapy in pregnant women. More studies are needed to determine the effects of antipsychotics, including olanzapine, on pregnant women and the developing fetus. Schizophrenia relapse during pregnancy may expose the mother and the fetus to high risk if olanzapine is stopped. It is important to assess the risks and benefits of treating pregnant or breastfeeding women with antipsychotics, and weigh these against possible risks of anomalies and developmental problems to the fetus or child.

Pairing states of superfluid 3He in uniaxially anisotropic aerogel

NASA Astrophysics Data System (ADS)

Aoyama, Kazushi; Ikeda, Ryusuke

2006-02-01

Stable pairing states of superfluid 3He in aerogel are examined in the case with a global uniaxial anisotropy which may be created by applying a uniaxial stress to the aerogel. Due to such a global anisotropy, the stability region of an Anderson-Brinkman-Morel (ABM) pairing state becomes wider. In a uniaxially stretched aerogel, the pure polar pairing state with a horizontal line node is predicted to occur, as a three-dimensional superfluid phase, over a measurable width just below the superfluid transition at Tc (P) . A possible relevance of the present results to the case with no global anisotropy is also discussed.

Moyamoya disease and artery tortuosity as rare phenotypes in a patient with an elastin mutation.

PubMed

Ishiwata, Tsukasa; Tanabe, Nobuhiro; Shigeta, Ayako; Yokota, Hajime; Tsushima, Kenji; Terada, Jiro; Sakao, Seiichiro; Morisaki, Hiroko; Morisaki, Takayuki; Tatsumi, Koichiro

2016-07-01

Sporadic and familial elastin mutations can occur in large vessel stenosis such as supravalvular aortic stenosis and narrowing of the descending aorta. However, there are very few reports regarding the arteriopathy of cerebral, pulmonary or abdominal arteries in elastin mutations. We herein report the case of a Japanese female patient presenting with multiple arteriopathy including moyamoya disease, a tortuosity of abdominal arteries and pulmonary hypertension due to peripheral pulmonary artery stenosis. This case suggests the possible progression of cerebral arteriopathy including moyamoya disease in patients with elastin mutations. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Spectroscopic techniques (Mössbauer spectrometry, NMR, ESR,…) as tools to resolve doubtful NMR images: Study of the craniopharyngioma tumor

NASA Astrophysics Data System (ADS)

Rimbert, J. N.; Dumas, F.; Lafargue, C.; Kellershohn, C.; Brunelle, F.; Lallemand, D.

1990-07-01

Craniopharyngioma, an intracranial tumor, exhibits hyperintensity in the Spin-Echo-T2-NMR image and a hyposignal in the SE-T1-image. However, in some cases (15-20% cases), hypersignals are seen in both SE-T1 and T2-MRI. Using spectroscopic techniques, Mössbauer spectrometry in particular, we have demonstrated that the T1 hypersignal is due to ferritin, dissolved in the cystic liquid, after tumor cell lysis, in the course of time. Other possible reasons inducing a shortening of the T1 relaxation time (presence of lipids, intratumoral hemorrhage) have been rejected.

Abdominal compartment syndrome related to noninvasive ventilation.

PubMed

De Keulenaer, Bart L; De Backer, Adelard; Schepens, Dirk R; Daelemans, Ronny; Wilmer, Alexander; Malbrain, Manu L N G

2003-07-01

To study the effects of noninvasive positive pressure ventilation (NIPPV) on intra-abdominal pressure. Single case report from a tertiary teaching hospital. A 65-year-old man who experienced a sudden respiratory and cardiovascular collapse during NIPPV. This was caused by gastric overdistension due to aerophagia followed by raised intra-abdominal pressure leading to intra-abdominal hypertension and abdominal compartment syndrome. The respiratory and cardiovascular problems resolved immediately after the introduction of a nasogastric tube. This resulted in normalization of IAP. This is the first case reported of an abdominal compartment syndrome related to NIPPV. Clinicians should be aware of this possible complication while using NIPPV.

WATER HAMMER OSCILLATIONS IN THE IRRIGATION FACILITIES

NASA Astrophysics Data System (ADS)

Kurata, Kouichi; Sasaki, Katsuhito; Makihata, Toshiaki

In case a gate installed at the end of discharge conduit is vibrating during discharge, or an air valve is vibrating during water-filling operation into the conduit pipe between main gate and auxiliary gate, and vibration period tv is larger than tc (water hammer propagation time) that is equivalent to the phenomenon of slow closure, there is a possibility that water hammer oscillation in the discharge conduit could be induced. In this paper, by using two case examples, vibration phenomena transmitted to each part are analyzed, on the basis of water pressure fluctuation and pressure wave propagation due to occurrence of water hammer oscillation.

Case Report of a Pressure Ulcer Occurring Over the Nasal Bridge Due to a Non-Invasive Ventilation Facial Mask.

PubMed

Rathore, Farooq A; Ahmad, Faria; Zahoor, Muhammad Umar U

2016-10-03

Non-invasive ventilation (NIV) is used in patients with respiratory failure, sleep apnoea, and dyspnoea related to pulmonary oedema. NIV is provided through a facial mask. Many complications of NIV facial masks have been reported, including the breakdown of facial skin. We report a case of an elderly male admitted with multiple co-morbidities. The facial mask was applied continuously for NIV, without any relief or formal monitoring of the underlying skin. It resulted in a Grade II pressure ulcer. We discuss the possible mechanism and offer advice for prevention of such device-related pressure ulcers.

Electrostatic and electromagnetic gyroharmonic emissions due to energetic electrons in magnetospheric plasma

NASA Technical Reports Server (NTRS)

Curtis, S. A.; Wu, C. S.

1979-01-01

The paper derives the growth rates and growth lengths of the electrostatic emission for spatially homogeneous and inhomogeneous energetic electrons, and numerically evaluates the growth rate and growth length spectra for several parameter sets representative of magnetospheric plasmas. In addition, the growth rates are derived for the case of electromagnetic emission modeled by the ordinary mode. The numerical results of the electromagnetic and electrostatic cases are compared with observations made by satellites in the earth's magnetosphere. It is concluded that the electrostatic gyroharmonic excitation is possible without the cold composition of plasma which is often postulated in the existing literature.

Congenital juvenile granulosa cell tumor of the testis in newborns.

PubMed

Zugor, Vahudin; Labanaris, Apostolos P; Witt, Jörn; Seidler, Alexander; Weingärtner, Karl; Schott, Günter E

2010-05-01

Granulosa cell tumor of the testis is a rare intermediate stromal cell tumor that can be distinguished in the adult and juvenile type. The juvenile type is the most common reason for scrotal swelling in newborns under the age of six months. Less than fifty cases of this disease entity have been reported in the literature. In the following article, two newborn patients with scrotal swelling and a histological confirmation of juvenile granulosa cell tumor of the testis will be presented. Case 1: A newborn patient presented with massive scrotal swelling. Sonography of the testicle exhibited a multiple septic and cystic enlargement of the testicle without distinction of the testicular parenchyma being possible. The laboratory findings demonstrated normal testosterone levels, beta-HCG and inhibin-B levels as well as an increased alpha-fetoprotein level of 35.350 ng/dl. Due to clinical and sonographic findings, an inguinal exploration and later, due to the impossibility of distinction of the testicular parenchyma, an inguinal orchiectomy of the right testicle was performed. Case 2: The clinical and sonographic examination of a newborn patient demonstrated a suspicious process of the left testicle. Sonography exhibited an enlarged testicle with cystic formations with the distinction of the testicular parenchyma not being possible. The laboratory findings demonstrated normal testosterone levels, beta-HCG and inhibin-B levels as well as an increased alpha-fetoprotein level of 9.038 ng/dl and LDH of 768 U/I. An inguinal orchiectomy of the left testicle was performed. In both cases, a histological diagnosis of juvenile granulosa cell tumor of the testis was made. These two aforementioned cases demonstrate that juvenile granulosa cell tumor of the testis is a benign disease encountered in newborns, which exhibits an excellent prognosis. Inguinal orchiectomy is the therapy of choice. After surgical removal of the involved testicle is performed no further management is required.

Herbal and dietary supplements related to diarrhea and acute kidney injury: a case report.

PubMed

Wanitsriphinyo, Suphamat; Tangkiatkumjai, Mayuree

2017-03-01

Background There is very little evidence relating to the association of herbal medicine with diarrhea and the development of acute kidney injury (AKI). This study reports a case of diarrhea-induced AKI, possibly related to an individual ingesting copious amounts of homemade mixed fruit and herb puree. Case presentation A 45-year-old Thai man with diabetes had diarrhea for 2 days, as a result of taking high amounts of a puree made up of eight mixed fruits and herbs over a 3-day period. He developed dehydration and stage 2 AKI, with a doubling of his serum creatinine. He had been receiving enalapril, as a prescribed medication, over one year. After he stopped taking both the puree and enalapril, and received fluid replacement therapy, within a week his serum creatinine had gradually decreased. The combination of puree, enalapril and AKI may also have induced hyperkalemia in this patient. Furthermore, the patient developed hyperphosphatemia due to his worsening kidney function, exacerbated by regularly taking some dietary supplements containing high levels of phosphate. His serum levels of potassium and phosphate returned to normal within a week, once the patient stopped both the puree and all dietary supplements, and had begun receiving treatment for hyperkalemia. Results The mixed fruit and herb puree taken by this man may have led to his diarrhea due to its effect; particularly if the patient was taking a high concentration of such a drink. Both the puree and enalapril are likely to attenuate the progression of kidney function. The causal relationship between the puree and AKI was probable (5 scores) assessed by the modified Naranjo algorithm. This is the first case report, as far as the authors are aware, relating the drinking of a mixed fruit and herbal puree to diarrhea and AKI in a patient with diabetes. Conclusions This case can alert health care providers to the possibility that herbal medicine could induce diarrhea and develop acute kidney injury.

An Exceptional Case of Suture Granuloma 30 Years Following an Open Repair of Achilles Tendon Rupture: A Case Report.

PubMed

Ergin, Ömer Naci; Demirel, Mehmet; Özmen, Emre

2017-01-01

Rupture of the Achilles' tendon is a common injury occurring particularly in middle-aged men due to sports trauma. Operative treatment is preferred generally due to lower risk of re-rupture. Possible complications of the operation include suture granulomas. Suture granulomas might represent a foreign body reaction, which itself is the end-stage response of the inflammatory wound-healing process to biomaterials. It may occur with both absorbable and non-absorbable suture materials such as silk in our case. The aim of this study is to present a case of a delayed foreign body reaction 30 years after open repair of the Achilles tendon with silk sutures. Our case is a 38-year-old male who presented to our outpatient clinic with complaints of swelling and pain around the posterior region of the ankle for the past 3 months. He had a history of open Achilles tendon repair at the age of 3 at the site of complaints. Physical examination was positive for a mass under the incision scar. Magnetic resonance imaging report was positive for a granulomatosis formation. The patient was booked for an operation to remove the mass. Suture granuloma represents a tissue reaction against the suture material. Orthopedic literature is sparse for such cases and case reports. Both because of its rarity in orthopedic literature and the amount of time between the surgery and reaction, our report is a valuable addition to the literature.

Malaria morbidity and temperature variation in a low risk Kenyan district: a case of overdiagnosis?

NASA Astrophysics Data System (ADS)

Njuguna, John; Muita, James; Mundia, George

2009-05-01

Diagnosis of malaria using only clinical means leads to overdiagnosis. This has implications due to safety concerns and the recent introduction of more expensive drugs. Temperature is a major climatic factor influencing the transmission dynamics of malaria. This study looked at trends in malaria morbidity in the low risk Kenyan district of Nyandarua, coupled with data on temperature and precipitation for the years 2003-2006. July had the highest number of cases (12.2% of all cases) followed by August (10.2% of all cases). July and August also had the lowest mean maximum temperatures, 20.1 and 20.2 °C respectively. April, July and August had the highest rainfall, with daily means of 4.0, 4.3 and 4.9 mm, respectively. Observation showed that the coldest months experienced the highest number of cases of malaria. Despite the high rainfall, transmission of malaria tends to be limited by low temperatures due to the long duration required for sporogony, with fewer vectors surviving. These cold months also tend to have the highest number of cases of respiratory infections. There is a possibility that some of these were misdiagnosed as malaria based on the fact that only a small proportion of malaria cases were diagnosed using microscopy or rapid diagnostic tests. We conclude that overdiagnosis may be prevalent in this district and there may be a need to design an intervention to minimise it.

[Early macular edema after phacoemulsification and suspected overdose of cefuroxime: report of six cases].

PubMed

Le Dû, B; Pierre-Kahn, V

2014-03-01

Antibiotic prophylaxis by intracameral cefuroxime injection, 1mg/0.1 mL after cataract surgery is increasing in popularity. Several cases of early postoperative macular edema have recently been reported after cefuroxime injection, most of them due to accidental cefuroxime overdose. We report six additional cases of macular involvement after cataract surgery, with intracameral cefuroxime injection imputed to cause retinal toxicity. Formal proof of cefuroxime overdose has never been possible, due to rapid wash-out in a few hours and the diagnosis of the macular edema the day after surgery or within a few days. Thus, this strong suspicion is based on clinical, pharmacokinetic, tomographic and retinographic criteria. In our series of six cases, the first four patients involved the same surgeon in the same hospital, and two of them on the same day. For the sixth case, the diagnosis was made retrospectively and based on history and medium-term tomographic characteristics. All the patients underwent optical coherence tomography (OCT) relatively early. As early as day one after surgery, there is macular edema predominantly in the outer retinal layers associated with serous retinal detachment, similar to the cases described in the literature. In the late stage, three patients had functional impairment related to photoreceptor damage on OCT. Three cases are described with additional retinal imaging (angiography, autofluorescence) to better characterize this macular toxicity associated with cefuroxime. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Listeria monocytogenes endophthalmitis - case report and review of risk factors and treatment outcomes.

PubMed

Bajor, Anna; Luhr, Anke; Brockmann, Dorothee; Suerbaum, Sebastian; Framme, Carsten; Sedlacek, Ludwig

2016-07-16

The majority of cases of endophthalmitis are caused by exogenous pathogens; only 5-10 % are of endogenous origin. One cause of these rare cases of endogenous endophthalmitis is Listeria monocytogenes. Twenty-six cases of endophthalmitis due to this pathogen have been published over the last twenty years. The aim of this review is to summarize the main risk factors and common clinical findings of endogenous endophthalmitis due to Listeria monocytogenes. We report on a 62-year-old female presenting with a sterile hypopyon iritis with secondary glaucoma and an underlying rheumatoid disease. In microbiological analysis we identified Listeria monocytogenes. Further we searched through all published cases for typical signs, risk factors, details of medical and surgical treatment and outcome of endogenous endophthalmitis due to this rare pathogen. Ocular symptoms in almost all of these published cases included pain, redness of the eye, and decreased vision. Main clinical features included elevated intraocular pressure and fibrinous anterior chamber reaction, as well as a dark hypopyon. While the infection is typically spread endogenously, neither an exogenous nor endogenous source of infection could be identified in most cases. Immunocompromised patients are at higher risk of being infected than immunocompetent patients. The clinical course of endophthalmitis caused by Listeria monocytogenes had different visual outcomes. In some cases, the infection led to enucleation, blindness, or strong visual loss, whereas most patients showed a tendency of visual improvement during therapy. Early diagnosis and treatment initiation are crucial factors in the outcome of endogenous endophthalmitis caused by Listeria monocytogenes. This possible differential diagnosis should be kept in mind while treating patients with presumable sterile hypopyon and anterior uveitis having a high intraocular pressure. A bacterial source should be considered with a prompt initiation of systemic antibiotic treatment, mainly in immunocompromised patients, who develop endogenous anterior uveitis. An appropriate microbiological sampling is essential to detect atypical microorganisms and to choose an effective antibiotic treatment.

ACCESS: A Communicating and Cooperating Expert Systems System.

DTIC Science & Technology

1988-01-31

therefore more quickly accepted by programmers. This is in part due to the already familiar concepts of multi-processing environments (e.g. semaphores ...Di68] and monitors [Br75]) which can be viewed as a special case of synchronized shared memory models [Di6S]. Heterogeneous systems however, are by...locality of nodes is not possible and frequent access of memory is required. Synchronization of processes also suffers from a loss of efficiency in

Spine SBRT using VMAT

NASA Astrophysics Data System (ADS)

Goddard, L.; Bodner, W.; Brodin, N. P.; Garg, M.; Lee, A.; Mani, K.; Tomé, W. A.

2017-01-01

Metastases of the spinal column are common amongst cancer patients with approximately 18,000 new cases in North America each year that require urgent treatment. Historically radiation therapy doses have been limited due to the proximity of the spinal cord. However as image guidance and localization techniques have improved it has become possible to deliver higher radiation doses to the tumour whilst sparing the spinal cord. This paper presents some of the techniques undertaken at our center.

Metallurgical Examination of Failed T-158 Cast Austempered Ductile Iron (CADI) Track Shoes

DTIC Science & Technology

1994-06-01

hardness testing, fracture toughness testing and Charpy impact testing were performed. In each case, the largest possible specimens were fabricated...However, due to geometrical restrictions, the tensile, fracture toughness and impact specimens were subsized . Tensile Testing Tensile coupons were...at 5OOoF for 4 hours. Mag. 1000x. 36 ‘_ Fracture Face A bolt holes Fracture Face C T = Tensile FT = Fracture Toughness NC =Notched Charpy Impact UN

Continuous Minor Bleeding from Tumor Surface in Patients with Craniopharyngiomas: Case Series of Nonobstructive Hydrocephalus.

PubMed

Shoji, Takuhiro; Kawaguchi, Tomohiro; Ogawa, Yoshikazu; Watanabe, Mika; Fujimura, Miki; Tominaga, Teiji

2018-06-05

Nonobstructive hydrocephalus in patients with craniopharyngiomas is uncommon. We describe our surgical series of 25 consecutive patients with craniopharyngioma who presented with hydrocephalus. Obstructive hydrocephalus was evident in most cases, and nonobstructive hydrocephalus was revealed in three cases. Even after improvement of cerebrospinal fluid (CSF) pathway obstruction by tumor removal, 10 patients (40%) required CSF diversion. Preoperative imaging study revealed thin intraventricular hemorrhage or superficial siderosis in five cases, and CSF examination revealed hemosiderin-laden phagocytes in one case. These findings indicate continuous bleeding into the CSF that might be associated with CSF malabsorption. We also describe a representative case of craniopharyngioma associated with nonobstructive hydrocephalus due to continuous minor bleeding from the tumor surface in a 62-year-old man with a complaint of disorientation and a decline in daily living activity.Our study demonstrated that minor bleeding into the CSF is a possible mechanism of the development of nonobstructive hydrocephalus in patients with craniopharyngiomas. Georg Thieme Verlag KG Stuttgart · New York.

Downscattering due to Wind Outflows in Compact X-ray Sources: Theory and Interpretation

NASA Technical Reports Server (NTRS)

Titarchuk, Lev; Shrader, Chris

2004-01-01

A number of recent lines of evidence point towards the presence of hot, outflowing plasma from the central regions of compact Galactic and extragalactic X-ray sources. Additionally, it has long been noted that many of these sources exhibit an "excess" continuum component, above approx. 10 keV, usually attributed to Compton Reflection from a static medium. Motivated by these facts, as well as by recent observational constraints on the Compton reflection models - specifically apparently discrepant variability timescales for line and continuum components in some cases - we consider possible of effects of out-flowing plasma on the high-energy continuum spectra of accretion powered compact objects. We present a general formulation for photon downscattering diffusion which includes recoil and Comptonization effects due to divergence of the flow. We then develop an analytical theory for the spectral formation in such systems that allows us to derive formulae for the emergent spectrum. Finally we perform the analytical model fitting on several Galactic X-ray binaries. Objects which have been modeled with high-covering-fraction Compton reflectors, such as GS1353-64 are included in our analysis. In addition, Cyg X-3, is which is widely believed to be characterized by dense circumstellar winds with temperature of order 10(exp 6) K, provides an interesting test case. Data from INTEGRAL and RXTE covering the approx. 3 - 300 keV range are used in our analysis. We further consider the possibility that the widely noted distortion of the power-law continuum above 10 keV may in some cases be explained by these spectral softening effects.

An approach to the determination of the enantiomeric excess at the extreme case by capillary electrophoresis.

PubMed

Xiao, Hongting; Fu, Xia; Liang, Shuang; Li, Youxin; Bao, James J; Zhang, Yong

2015-08-21

Capillary electrophoresis (CE) has been applied to determine the percentage of enantiomeric excess (ee%) of chiral compounds. In such assays, the quality of chiral selectors (CSs) plays vital roles in resolving the enantiomers for accurate determination of the ee%. Selecting an efficient CS is usually by trial and error, and is, if ever possible, time-consuming and costly. Here we propose a new approach by using the velocity gap mode of CE (VGCE) method, to simplify the method development process for ee% determination. With VGCE, it is still possible to measure ee% even when the CS has a weak resolving power. This is especially important at the extreme cases where one of the enantiomers is significantly higher than the other one. The key point of VGCE in this case is to fractionate the small part of the mixture containing both enantiomers from the major component of the enantiomer, which is already enantiopure. Baseline separations can be achieved between the two enantiomers for the small mixture due to less longitudinal dispersion, making it possible to determine the ee%. The feasibility of this VGCE approach was confirmed by the ee% measurements of amlodipine and ofloxacin, respectively. And the practical application of VGCE was tested by analyzing levamlodipine besylate tablet. Copyright © 2015 Elsevier B.V. All rights reserved.

Audit of litigation against the accident and emergency radiology department.

PubMed

Cantoni, S; De Stefano, F; Mari, A; Savaia, F; Rosso, R; Derchi, L

2009-09-01

The aims of this study were to reduce and monitor litigation due to failure to diagnose a fracture, to evaluate whether the cases were due to radiological error or other problems in the diagnostic and therapeutic management of patients and to identify organisational, technical or functional changes or guidelines to improve the management of patients with suspected fracture and their expectations. We analysed the litigation database for the period 2004-2006 and extracted all episodes indicating failure to diagnose a fracture at the accident and emergency radiology department of our centre. The radiographs underwent blinded review by two experts, and each case was jointly analysed by a radiologist and a forensic physician to see what led to the compensation claim. We identified 22 events (2004 seven cases; 2005 eight cases; 2006 seven cases). Six cases were unrelated to radiological error. Six were due to imperceptible fractures at the time of the examination. These were accounted for by the presence of a major lesion distracting the examiner's attention from a less important associated lesion in one case, a false negative result in a patient examined on a incompletely radiolucent spinal board and underexposure of the coccyx region in an obese patient. Six cases were related to an interpretation error by the radiologist. In the remaining cases, the lesion being referred to in the compensation claim could either not be established or the case was closed by the insurance company without compensation. Corrective measures were adopted. These included planning the purchase of a higher performance device, drawing up a protocol for imaging patients on spinal boards, reminding radiologists of the need to carefully scrutinise the entire radiogram even after having identified a lesion, and producing an information sheet explaining to patients the possibility of false negative results in cases of imperceptible lesions and inviting them to return to the department if symptoms persist. We believe the clinical and administrative analysis we performed is useful. It reviewed some administrative practices and identified critical features. We identified tools that we trust will reduce litigation.

Li-Ion Battery By-Pass Removal Qualification

NASA Astrophysics Data System (ADS)

Borthomieu, Y.; Pasquier, E.

2005-05-01

The reasons of the by-pass use on Space batteries is to avoid open circuit, short-circuit and dramatic performances drift on the power system. By-pass diodes are currently used in NiH2 batteries due to the high probability of open circuit at cell level. This probability is mainly linked to the possibility to have a hydrogen leak within the pressure vessel due to the high operating pressure (70 bars) that can induce cell open circuit.For the Lithium-Ion batteries, first items had bypass implemented by similarity, but:All the cell failure cases have been analyzed at battery level:- Cell Open circuit:In contrast to NiCd and NiH2 cells, Li-Ion cells can be put in parallel due to the fact the open circuit voltage (OCV) is linked to the State Of Charge (SOC).With cells in parallel, a battery open circuit failure can never be encountered even with a cell in open circuit.- Cell Short circuit:In case of cell short, the entire cells within the module will be shorted.- Cell capacity spread:If the capacities of cells in series are strongly diverging, the worst module limits the battery. In case the battery is no more able to deliver the requested power for which it was designed, the worst module has to be reversed. In reversal, a Li-Ion cell is self-shorted. So, the strong capacity decrease in one module leads to the short of this module.These three failure cases cover all the possible Li-Ion failure root causes.Considering these three events, the analysis demonstrates that the Li-Ion battery still functions in any case without any by-pass system because the design of the battery size always takes into account the loss of one module.Nevertheless, the by-pass removal should allow to:- Improve the battery reliability as each bypass unit represents a single - Reduce by at least 30 % of the total price of the battery,- Reduce significant weight at battery level,- Shorten the battery manufacturing lead time (at least8 months for by-pass purchasing), - Avoid US export licenses.A formal qualification of a Li-Ion battery without by- pass system is on going in the frame of an ESA ARTES 3 contract.

Persistent Mullerian Duct Syndrome: a rare entity with a rare presentation in need of multidisciplinary management.

PubMed

Da Aw, Lin; Zain, Murizah M; Esteves, Sandro C; Humaidan, Peter

2016-01-01

A typical male looking adolescent with a legal female gender assignment presented with haematuria. Investigations led to the diagnosis of Persistent Mullerian Duct Syndrome. The condition is indeed a rare entity that needs a multidisciplinar team management. Case hypothesis: A case of Persistent Mullerian Duct Syndrome undiagnosed at birth because karyotyping was defaulted, thus resulting in a significant impact on the legal gender assignment and psychosocial aspects. Promising future implications: The reporting of this case is important to create awareness due to its rarity coupled with the rare presentation with hematuria as a possible masquerade to menstruation. There were not only medical implications, but also psychosocial and legal connotations requiring a holistic multidisciplinary management. Copyright® by the International Brazilian Journal of Urology.

Dens invaginatus in primary maxillary molar: a rare case report and review of literature.

PubMed

Bansal, Arpana V; Bansal, Abhinav; Kulkarni, Vinaya Kumar; Dhar, Reema Sharma

2012-05-01

Dens invaginatus is a rare developmental anomaly. It is unusual to find this anomaly in primary dentition. Diagnosis of this dens invaginatus is important due to possible pulpal involvement. Not only that, simultaneous presence of other dental anomaly may require long-term treatment planning. Dens invaginatus can be detected clinically in the tooth presenting unusual crown morphology or radiographically as radiopacity within tooth. This article describes one of the first case reports of dens invaginatus in primary maxillary second molar in a 5-year-old female patient. How to cite this article: Bansal AV, Bansal A, Kulkarni VK, Dhar RS. Dens Invaginatus in Primary Maxillary Molar: A Rare Case Report and Review of Literature. Int J Clin Pediatr Dent 2012;5(2):139-141.

Renal manifestations of human brucellosis: First report of minimal change disease.

PubMed

Sabanis, Nikolaos; Gavriilaki, Eleni; Paschou, Eleni; Tsotsiou, Eleni; Kalaitzoglou, Asterios; Kavlakoudis, Christos; Vasileiou, Sotirios

2016-05-01

Human brucellosis is considered a great example of the complexity of clinical manifestations possibly affecting multiple organs or systems. Renal manifestations of human brucellosis have been documented in few case reports and one case series. Herein, we present a case of Nephrotic syndrome (NS) due to minimal change disease in the course of acute brucellosis. A 53-year-old male farmer was admitted to our department with acute brucellosis and NS. Renal biopsy revealed minimal change disease. Combined treatment with prednisone (1 mg/kg), rifampicin (600 mg/day), and doxycycline (200 mg/day) was initiated. Complete remission of NS was achieved at the end of the fourth week. One year later, the patient remained in complete remission of NS without any sign of relapse of brucellosis.

Post-traumatic tricuspid insufficiency: a case report.

PubMed

Tütün, Ufuk; Aksöyek, Ayşen; Parlar, Ali Ihsan; Cobanoğlu, Adnan

2011-11-01

Post-traumatic tricuspid insufficiency is a rare complication of chest trauma. An 18-year-old male patient was injured in a bicycle accident from his abdominal and anterior chest wall. The tear on the inferior diaphragmatic surface of the heart was repaired with primary sutures by the attending surgeon. Eighteen years later, he was admitted to the hospital with severe tricuspid regurgitation (3+/4+). During the operation, the valve was determined unsuitable for repair and was replaced with a bioprosthesis. The hemodynamic aberrations relevant to an isolated tricuspid valve injury are very often well-tolerated. Reconstructive surgery may be possible in the early period. In the late cases, repair is sometimes not feasible due to degeneration of the valvular apparatus. Replacement with a biological prosthesis may give the best long-term results in longstanding cases.

The rules of drug taking: wine and poppy derivatives in the Ancient World. VIII. Lack of evidence of opium addiction.

PubMed

Nencini, P

1997-09-01

The widespread therapeutic use of opium and its probable ritual use is faced with the absence of any explicit description of cases of opium dependence. It is possible that this was due to a lack of diagnostic capability. However, even the attempt to uncover cases of opium dependence by systematically analyzing the literary passages in which poppies, opium, and meconium are quoted are unsuccessful. The only two cases of suspected opium addiction that can be selected in this way are those of the Emperor Marcus Aurelius and Ovid. The most parsimonious interpretation is the lack of an hedonic use of poppy derivatives, being that this kind of use is the most frequently connected with the development of addiction.

An increase in the number of admitted patients with exercise-induced rhabdomyolysis.

PubMed

Aalborg, Christian; Rød-Larsen, Cecilie; Leiro, Ingjerd; Aasebø, Willy

2016-10-01

Rhabdomyolysis may lead to serious complications, and treatment is both time-consuming and costly. The condition can be caused by many factors, including intense exercise. The purpose of this study was to investigate whether the number of hospitalisations due to exercise-induced rhabdomyolysis has changed in recent years. We describe the disease course in hospitalised patients, and compare disease course in individuals with exercise-induced rhabdomyolysis and rhabdomyolysis due to other causes. The study is a systematic review of medical records from Akershus University Hospital for the years 2008 and 2011 – 14. All hospitalised patients with diagnostic codes M62.8, M62.9 and T79.6 and creatine kinase levels > 5 000 IU/l were included. The cause of the rhabdomyolysis was recorded in addition to patient characteristics and the results of various laboratory tests. Of 161 patients who were hospitalised with rhabdomyolysis during the study period, 44 cases (27  %) were classified as exercise-induced. In 2008 there were no admissions due to exercise-induced rhabdomyolysis; in 2011 and 2012 there were six and four admissions respectively, while in 2014 there were 22. This gives an estimated incidence of 0.8/100 000 in 2012 and 4.6/100 000 in 2014. Strength-training was the cause of hospitalisation in 35 patients (80  % of the exercise-induced cases). Three patients (7  % of the exercise-induced cases) had transient stage 1 kidney injury, but there were no cases with stage 2 or stage 3 injury. By comparison, 52  % of patients with rhabdomyolysis due to another cause had kidney injury, of which 28  % was stage 2 or 3. The number of persons hospitalised with exercise-induced rhabdomyolysis has increased four-fold from 2011 to 2014, possibly due to changes in exercise habits in the population. None of the patients with exercise-induced rhabdomyolysis had serological signs of kidney injury upon hospital discharge.

Top-Down Computerized Cognitive Remediation in Schizophrenia: A Case Study of an Individual with Impairment in Verbal Fluency

PubMed Central

Masson, Marjolaine; Wykes, Til; Maziade, Michel; Reeder, Clare; Gariépy, Marie-Anne; Roy, Marc-André; Ivers, Hans; Cellard, Caroline

2015-01-01

The objective of this case study was to assess the specific effect of cognitive remediation for schizophrenia on the pattern of cognitive impairments. Case A is a 33-year-old man with a schizophrenia diagnosis and impairments in visual memory, inhibition, problem solving, and verbal fluency. He was provided with a therapist delivered cognitive remediation program involving practice and strategy which was designed to train attention, memory, executive functioning, visual-perceptual processing, and metacognitive skills. Neuropsychological and clinical assessments were administered at baseline and after three months of treatment. At posttest assessment, Case A had improved significantly on targeted (visual memory and problem solving) and nontargeted (verbal fluency) cognitive processes. The results of the current case study suggest that (1) it is possible to improve specific cognitive processes with targeted exercises, as seen by the improvement in visual memory due to training exercises targeting this cognitive domain; (2) cognitive remediation can produce improvements in cognitive processes not targeted during remediation since verbal fluency was improved while there was no training exercise on this specific cognitive process; and (3) including learning strategies in cognitive remediation increases the value of the approach and enhances participant improvement, possibly because strategies using verbalization can lead to improvement in verbal fluency even if it was not practiced. PMID:25949840

Intersubject variability of near-infrared spectroscopy signals during sensorimotor cortex activation.

PubMed

Sato, Hiroki; Fuchino, Yutaka; Kiguchi, Masashi; Katura, Takusige; Maki, Atsushi; Yoro, Takeshi; Koizumi, Hideaki

2005-01-01

We investigate the intersubject signal variability of near-infrared spectroscopy (NIRS), which is commonly used for noninvasive measurement of the product of the optical path length and the concentration change in oxygenated hemoglobin (DeltaC'oxy) and deoxygenated hemoglobin (DeltaC'deoxy) and their sum (DeltaC'total) related to human cortical activation. We do this by measuring sensorimotor cortex activation in 31 healthy adults using 24-measurement-position near-infrared (NIR) topography. A finger-tapping task is used to activate the sensorimotor cortex, and significant changes in the hemisphere contralateral to the tapping hand are assessed as being due to the activation. Of the possible patterns of signal changes, 90% include a positive DeltaC'oxy, 76% included a negative DeltaC'deoxy, and 73% included a positive DeltaC'total. The DeltaC'deoxy and DeltaC'total are less consistent because of a large intersubject variability in DeltaC'deoxy; in some cases there is a positive DeltaC'deoxy. In the cases with no positive DeltaC'oxy in the contralateral hemisphere, there are cases of other possible changes for either or both hemispheres and no cases of no change in any hemoglobin species in either hemisphere. These results suggest that NIR topography is useful for observing brain activity in most cases, although intersubject signal variability still needs to be resolved.

Intrinsic errors in transporting a single-spin qubit through a double quantum dot

NASA Astrophysics Data System (ADS)

Li, Xiao; Barnes, Edwin; Kestner, J. P.; Das Sarma, S.

2017-07-01

Coherent spatial transport or shuttling of a single electron spin through semiconductor nanostructures is an important ingredient in many spintronic and quantum computing applications. In this work we analyze the possible errors in solid-state quantum computation due to leakage in transporting a single-spin qubit through a semiconductor double quantum dot. In particular, we consider three possible sources of leakage errors associated with such transport: finite ramping times, spin-dependent tunneling rates between quantum dots induced by finite spin-orbit couplings, and the presence of multiple valley states. In each case we present quantitative estimates of the leakage errors, and discuss how they can be minimized. The emphasis of this work is on how to deal with the errors intrinsic to the ideal semiconductor structure, such as leakage due to spin-orbit couplings, rather than on errors due to defects or noise sources. In particular, we show that in order to minimize leakage errors induced by spin-dependent tunnelings, it is necessary to apply pulses to perform certain carefully designed spin rotations. We further develop a formalism that allows one to systematically derive constraints on the pulse shapes and present a few examples to highlight the advantage of such an approach.

Telemedicine in general neurology: use of audiovisual consultation for on call back-up service in an acute care hospital.

PubMed

Janssen, Frank; Awadallah, Mohammed; Alhalabi, Awed; Körber, Barbara; Lang, Reinhard; Scibor, Mateusz; Handschu, René

2018-04-01

While telemedicine is in expanding use in acute stroke care, little is known about its use in general neurology, especially in acute care. We sought to investigate the feasibility and possible effects of a telemedicine device within the neurological back-up service of an acute care hospital. In a 450 bed academic teaching hospital an experienced neurologist (EN) is on call to support the junior doctor at the hospital. Support was possible whether by standard telephone advice (TA) or by audiovisual consultations (AVC). In AVC the expert used a mobile telemedicine device and so he could establish audiovisual contact from his home to the emergency room and examine newly admitted patients. Technical and patient details including timing and diagnosis were recorded. Video and audio quality as well as impact of AVC on diagnosis was rated by the EN. Out of about 1200 cases in off peak times, during the study period, 164 AVC including remote video examination were done (13.6%). Also 48 cases were documented by pure TA. Video quality was rated to a medium of 1.7, audio quality to 2.1. In 36 cases the audiovisual consultation was influenced by technical issues leading to cessation of AVC in 8 cases. Duration of teleconsultation was 17.3 min in AVC compared to 8.7 min for TA. The consultation diagnosis in AVC was confirmed in 74.4% of all cases compared to 57.7% in TA. AVC was rated as a valuable contribution to the diagnostic workup in 74.3% of all cases seen. In about 40% of all cases AVC was not possible due to technical or organizational reasons. Audiovisual consultation seems to be a feasible and useful support in routine neurology back-up service of an acute care hospital. Better mobility of devices and flexibility of service is needed to improve availability and quality of this valuable tool.

Acquired ectropion uveae and secondary glaucoma due to trauma: report of 3 cases.

PubMed

Markovic, Vujica; Vukovic, Dragan; Radosavljevic, Aleksandra; Marjanovic, Ivan

2017-01-19

To investigate the possible association between acquired ectropion uveae and blunt trauma to the eye. We present 3 cases of acquired ectropion uveae that occurred after blunt trauma to the eye. There are no previously published data on possible association of these conditions. A retrospective review was conducted of patients with ectropion uveae and eye injury at University Eye Hospital over a 10-year period (2006-2016). We analyzed medical records and clinical findings. Three eyes of 3 male patients with ocular trauma and ectropion uveae, ages 71, 68, and 5 years, were reviewed. The period between the eye injury and the diagnosis of ectropion uveae ranged from 10 to 36 months. All 3 eyes developed clinical evidence of secondary glaucoma with moderately to severely elevated intraocular pressure (IOP) (ranging from 29 to 48 mm Hg). Surgical treatment (trabeculectomy) was needed in 2 cases in order to control secondary glaucoma and conservative treatment was sufficient in 1 case. Mean patient follow-up was 19.3 ± 4.6 months. Trauma can be considered as a cause of acquired ectropion uveae. Acquired ectropion uveae following eye trauma may be associated with significant increase in IOP. All patients in our series had secondary glaucoma and 2 of 3 required surgical treatment for IOP control.

[Terminal home care "Ikigai no Yoake--The real aim of our life"--case report].

PubMed

Funato, T; Funato, H; Kato, A; Matsuoka, Y; Shibuya, R; Usui, Y; Niwa, Y

1998-12-01

It is difficult to provide home care especially for terminal cancer patients as their physical conditions deteriorate due to the cancer. It is important to enhance the will of home care providers to make this possible. Although a universal method has been worked out, personal and religious beliefs have made it difficult to create an effective method. We would like to introduce our experience in the paper entitled "Ikigai no Yoake" and subtitled "Influence of scientific study of reincarnation on view of life" by Fumihiko Ida of Fukushima University. It has encouraged home care providers and made it possible to provide home care to terminal patients along with benefits.

Improving Multiple Fault Diagnosability using Possible Conflicts

NASA Technical Reports Server (NTRS)

Daigle, Matthew J.; Bregon, Anibal; Biswas, Gautam; Koutsoukos, Xenofon; Pulido, Belarmino

2012-01-01

Multiple fault diagnosis is a difficult problem for dynamic systems. Due to fault masking, compensation, and relative time of fault occurrence, multiple faults can manifest in many different ways as observable fault signature sequences. This decreases diagnosability of multiple faults, and therefore leads to a loss in effectiveness of the fault isolation step. We develop a qualitative, event-based, multiple fault isolation framework, and derive several notions of multiple fault diagnosability. We show that using Possible Conflicts, a model decomposition technique that decouples faults from residuals, we can significantly improve the diagnosability of multiple faults compared to an approach using a single global model. We demonstrate these concepts and provide results using a multi-tank system as a case study.

[Possibilities and prospects of three-dimensional bioprinting in vascular surgery].

PubMed

Gavrilenko, A V; Khesuani, Yu J; Kalinin, V D

2016-01-01

Rapid development of tissue engineering is gradually changing the approach to patient care. Despite the fact that the use of an autograft or transplantation of an artificial prosthesis is preferred in most cases, this is frequently impossible due to shortage of suitable material or the patient's condition. Regenerative medicine and tissue engineering make it possible to reduce the terms of treatment and restoration after vascular operations, as well as complications rate. At the present moment there is a lot of information about methods of biofabrication and multiple techniques of using stem cells. Nevertheless, clinical efficacy of these methods requires further detailed examination. The review of literature contains the data concerning modern achievements in the area of bioprinting.

A prospective outcomes analysis of palliative procedures performed for malignant intestinal obstruction due to recurrent ovarian cancer.

PubMed

Chi, Dennis S; Phaëton, Rebecca; Miner, Thomas J; Kardos, Steven V; Diaz, John P; Leitao, Mario M; Gardner, Ginger; Huh, Jae; Tew, William P; Konner, Jason A; Sonoda, Yukio; Abu-Rustum, Nadeem R; Barakat, Richard R; Jaques, David P

2009-08-01

To obtain prospective outcomes data on patients (pts) undergoing palliative operative or endoscopic procedures for malignant bowel obstruction due to recurrent ovarian cancer. An institutional study was conducted from July 2002 to July 2003 to prospectively identify pts who underwent an operative or endoscopic procedure to palliate the symptoms of advanced cancer. This report focuses on pts with malignant bowel obstruction due to recurrent ovarian cancer. Procedures performed with an upper or lower gastrointestinal (GI) endoscope were considered "endoscopic." All other cases were classified as "operative." Following the procedure, the presence or absence of symptoms was determined and followed over time. All pts were followed until death. Palliative interventions were performed on 74 gynecologic oncology pts during the study period, of which 26 (35%) were for malignant GI obstruction due to recurrent ovarian cancer. The site of obstruction was small bowel in 14 (54%) cases and large bowel in 12 (46%) cases. Palliative procedures were operative in 14 (54%) pts and endoscopic in the other 12 (46%). Overall, symptomatic improvement or resolution within 30 days was achieved in 23 (88%) of 26 patients, with 1 (4%) postprocedure mortality. At 60 days, 10 (71%) of 14 pts who underwent operative procedures and 6 (50%) of 12 pts who had endoscopic procedures had symptom control. Median survival from the time of the palliative procedure was 191 days (range, 33-902) for those undergoing an operative procedure and 78 days (range, 18-284) for those undergoing an endoscopic procedure. Patients with malignant bowel obstructions due to recurrent ovarian cancer have a high likelihood of experiencing relief of symptoms with palliative procedures. Although recurrence of symptoms is common, durable palliation and extended survival are possible, especially in those patients selected for operative intervention.

Body-packing as cause of unexpected sudden death.

PubMed

Heinemann, A; Miyaishi, S; Iwersen, S; Schmoldt, A; Püschel, K

1998-03-02

Four fatalities related to smuggling of drugs by body-packing were investigated. The victims were examined at the Institute of Forensic Medicine of Hamburg University between 1983 and 1995, two of them due to "sudden" unknown cause of death. All victims were male. Two of them were found already dead in a backyard and in a hotel, two other were emergency cases and died at a hospital. Smuggled substances included cocaine (two cases), heroin and amphetamine/caffeine. In all cases, the cause of death was intoxication caused by torn packages which were detected at autopsy. The maximum weight of the packet's contents was 630 g divided in 90 packages. Only one victim was apparently an intravenous drug-abuser. Hair analysis was performed in three cases and revealed in one case a difference between a concealed and a habitually consumed drug. Toxicological analysis revealed that the substances were quite pure and provided evidence that rather long survival was possible following intoxication in three cases, in two cases supported by hospital treatment in the final stage. The procedural regimen in cases of suspected body-packing is discussed.

Familial translocation t(6;20)(p21;p13) resulting in partial trisomy 6p and partial monosomy 20p: report of a new case and review of the literature.

PubMed

Berner, A L; Bağci, S; Wohlleber, E; Engels, E; Müller, A; Bartmann, P; Weber, R G; Reutter, H

2012-01-01

Carriers of completely balanced chromosomal translocations have all necessary genetic information. Nevertheless, because of the possibility of maldistribution during gametogenesis, they are at increased risk for infertility, miscarriage, stillbirth or having a child with congenital anomalies including mental retardation. As postnatal clinical reports are infrequent, prediction of clinical course for specific unbalanced karyotypes diagnosed during pregnancy remains difficult. Here, we report the 6th case of partial trisomy 6p and partial monosomy 20p due to an unbalanced adjacent-1 segregation of the rare familial translocation t(6;20)(p21;p13). We give a thorough clinical description of the present case, demonstrating broad phenotypic overlap with the 5 previously published cases reviewed here, providing important data on postnatal outcome. Copyright © 2012 S. Karger AG, Basel.

The spectrum of respiratory pathogens among returning Hajj pilgrims: myths and reality.

PubMed

Gautret, Phillipe; Benkouiten, Samir; Al-Tawfiq, Jaffar A; Memish, Ziad A

2016-06-01

Enhanced surveillance systems have been implemented recently in many countries in order to rapidly detect and investigate any possible cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection among travellers returning from the Middle East, including notably Hajj pilgrims. According to the available surveillance data, only a few sporadic travel-associated MERS-CoV cases have been reported outside the Arabian Peninsula so far, mainly in Europe, North Africa, and Asia. These have resulted in no cases, or limited numbers of secondary cases except in Korea. The vast majority of viral respiratory infections in pilgrims returning home have been due to seasonal influenza viruses, rhinoviruses, and other known coronaviruses distinct from the MERS coronavirus. Influenza vaccination should be a priority for all Hajj pilgrims, as recommended by experts. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

[Foreign body in the tricuspid valve with valvular insufficiency and right-left shunt].

PubMed

Delebarre, P; Augustin-Normand, C; Capronier, C; Cramer, J; Godeau, P; Letac, B; Forman, J; Maurice, P; Ourbak, P

1987-05-01

We present the case of a 50-year old man who progressively developed tricuspid valve insufficiency with opening of a patent foramen ovale responsible for right-to-left shunt with polycythaemia. The tricuspid valve insufficiency was due to a foreign body, probably of surgical origin as suggested by its radiological image and by the patient's previous history. It would have been introduced, far away from the tricuspid valve (compound fracture of the wrist), several years previously. At surgery, we found the foreign body embedded in the valve system. As a possible mechanism for the mutilation, an undiagnosed endocarditis was suspected but could not be confirmed. Three cases tricuspid endocarditis (with foreign bodies in the right ventricle) and 3 cases of asymptomatic tricuspid valve foreign bodies have been published. Fifty-five cases of foreign bodies introduced peripherally and migrated into the heart, the pericardium and the pulmonary artery are reviewed.

Unusual presentation of death due to carbon monoxide poisoning. A report of two cases.

PubMed

Ruszkiewicz, A; de Boer, B; Robertson, S

1997-06-01

Two cases are reported representing opposite ends of the spectrum of death as a result of carbon monoxide poisoning from car exhaust fumes. In one case, a women was reported to be found dead in bed early in the morning by her husband. The cause of her death, established by autopsy, was carbon monoxide poisoning. Toxicology examination indicated a car engine as the possible source of carbon monoxide. The mode of administration was never established. In the second case, a women was found in a car located in her garage with a hose leading from the exhaust pipe to the interior of the sealed vehicle. Autopsy revealed negligible carboxyhemoglobin saturation of the blood, bilateral infarction of the globus pallidus, and extensive bronchopneumonia. It was concluded that inhalation of carbon monoxide resulted in sublethal hypoxia with subsequent exhalation of carbon monoxide and a delayed death.

Structural parallels between terrestrial microbialites and Martian sediments: are all cases of `Pareidolia'?

NASA Astrophysics Data System (ADS)

Rizzo, Vincenzo; Cantasano, Nicola

2017-10-01

The study analyses possible parallels of the microbialite-known structures with a set of similar settings selected by a systematic investigation from the wide record and data set of images shot by NASA rovers. Terrestrial cases involve structures both due to bio-mineralization processes and those induced by bacterial metabolism, that occur in a dimensional field longer than 0.1 mm, at micro, meso and macro scales. The study highlights occurrence on Martian sediments of widespread structures like microspherules, often organized into some higher-order settings. Such structures also occur on terrestrial stromatolites in a great variety of `Microscopic Induced Sedimentary Structures', such as voids, gas domes and layer deformations of microbial mats. We present a suite of analogies so compelling (i.e. different scales of morphological, structural and conceptual relevance), to make the case that similarities between Martian sediment structures and terrestrial microbialites are not all cases of `Pareidolia'.

[Aircraft crashes in sky sports. Report of two autopsy cases and review of the accidents during 1981 to 1997 in Japan].

PubMed

Hamada, K; Kibayashi, K; Ng'walali, P M; Honjyo, K; Tsunenari, S

2000-08-01

The authors report two forensic autopsy cases of pilots who died in glider and ultra-light plane crashes in Aso, Kumamoto and review sky sports accidents in Japan (1981-1997). In the glider crash, sharp abdominal pain due to gallstones in a 78-year-old pilot was a possible cause of the accident. In the ultra-light plane crash, unskillful control of the plane by a 38-year-old pilot was the cause of the accident. The incidence of sky sports accidents increased from 12 cases in 1981 to 62 cases in 1997. The mortality rate of the victims of the accidents is very high. Investigation of natural diseases in pilots as a cause of accidents and the mechanisms of fatal injuries will help to assess preventive measures against sky sports accidents.

Thoracoscopic pulmonary resection in two cases using an endoscopic linear stapler and loop ligature.

PubMed

Yoshida, K; Fujikawa, T; Nishida, Y; Kushida, N; Okabe, N

1993-01-01

Recent advances in rigid endoscopic imaging capabilities, light sources, and instrumentation have dramatically expanded the potential role of laparoscopic and thoracoscopic surgery. Moreover, the recent introduction of an endoscopic linear stapling device and loop ligature has made thoracoscopic pulmonary resection possible. We present herein two cases of peripheral pulmonary lesions which were resected thoracoscopically. Case 1 was a 19-year-old man with a history of recurrent pneumothorax due to a left apical bulla who underwent thoracoscopic lung resection using a new stapling device, and Case 2 was a 46-year-old man with a small pulmonary lesion on the left basal segment (S8) who underwent thoracoscopic lung resection using loop ligature. Postoperatively, there was no evidence of air leak in either patient and both were discharged 6 days after surgery. The technical procedures for thoracoscopic lung resection and the clinical courses of both patients are described in this paper.

A Case Report of Salmonella muenchen Enteritis Causing Rhabdomyolysis and Myocarditis in a Previously Healthy 26-Year-Old Man.

PubMed

Chapple, Will; Martell, Jon; Wilson, Joy S; Matsuura, Don T

2017-04-01

This case report examines an unusual presentation of a non-typhoidal Salmonella serovar with limited prevalence in the literature. This is the first case report to associate specifically the Salmonella muenchen serovar with rhabdomyolysis and myocarditis. This case report reviews the diagnostic criteria for myocarditis and explores the diagnostic dilemma of troponin elevation in the setting of rhabdomyolysis. It demonstrates that Salmonella muenchen has the ability to present in a broad range of individuals with complications extending beyond classical gastrointestinal symptoms. This report also concludes that diagnosis of the many possible complications from non-typhoidal Salmonella infections can be difficult due to patient comorbidities, variability in the severity of the illnesses, laboratory test limitations, and imaging limitations. When a patient presents with elevated troponins in the setting of rhabdomyolysis a careful workup should be done to evaluate for ischemic causes, myocarditis, or false elevation secondary to rhabdomyolysis.

Generalized Bloch theorem and topological characterization

NASA Astrophysics Data System (ADS)

Dobardžić, E.; Dimitrijević, M.; Milovanović, M. V.

2015-03-01

The Bloch theorem enables reduction of the eigenvalue problem of the single-particle Hamiltonian that commutes with the translational group. Based on a group theory analysis we present a generalization of the Bloch theorem that incorporates all additional symmetries of a crystal. The generalized Bloch theorem constrains the form of the Hamiltonian which becomes manifestly invariant under additional symmetries. In the case of isotropic interactions the generalized Bloch theorem gives a unique Hamiltonian. This Hamiltonian coincides with the Hamiltonian in the periodic gauge. In the case of anisotropic interactions the generalized Bloch theorem allows a family of Hamiltonians. Due to the continuity argument we expect that even in this case the Hamiltonian in the periodic gauge defines observables, such as Berry curvature, in the inverse space. For both cases we present examples and demonstrate that the average of the Berry curvatures of all possible Hamiltonians in the Bloch gauge is the Berry curvature in the periodic gauge.

[Sodium valproate as a cause of acute pancreatitis: a case report].

PubMed

Barreda, Luís; Rosas, Johana; Milian, William; Valdivia, Duilio; Targarona, Javier

2006-01-01

Valproic acid (VPA) is a commonly used medication approved by the U.S. FDA for the treatment of epilepsy, migraines and bipolar disorders. Adverse effects associated with VPA are typically benign, but there are more serious effects that are less frequent. These effects include hepatotoxicity, teratogenicity, possible polycystic ovaries with a potential sterile effect and acute pancreatitis. Even though acute pancreatitis is an adverse effect of very low frequency, it is very important due to the high mortality rate of patients with acute pancreatitis as a consequence of the use of valproic acid. In medical literature, by 2005, 80 cases of acute pancreatitis caused by valproic acid were reported, 33 of these cases were patients under the age of 18. This is a description of the clinical case of a 16 year old patient with necrotic pancreatitis caused by VPA, who was treated at the Acute Pancreatitis Unit of Edgardo Rebagliati Martins National Hospital.

Diagnosis of Swimming Induced Pulmonary Edema—A Review

PubMed Central

Grünig, Hannes; Nikolaidis, Pantelis T.; Moon, Richard E.; Knechtle, Beat

2017-01-01

Swimming induced pulmonary edema (SIPE) is a complication that can occur during exercise with the possibility of misdiagnosis and can quickly become life threatening; however, medical literature infrequently describes SIPE. Therefore, the aim of this review was to analyse all individual cases diagnosed with SIPE as reported in scientific sources, with an emphasis on the diagnostic pathways and the key facts resulting in its diagnosis. Due to a multifactorial and complicated pathophysiology, the diagnosis could be difficult. Based on the actual literature, we try to point out important findings regarding history, conditions, clinical findings, and diagnostic testing helping to confirm the diagnosis of SIPE. Thirty-eight cases from seventeen articles reporting the diagnosis of SIPE were selected. We found remarkable differences in the individual described diagnostic pathways. A total of 100% of the cases suffered from an acute onset of breathing problems, occasionally accompanied by hemoptysis. A total of 73% showed initial hypoxemia. In most of the cases (89%), an initial chest X-Ray or chest CT was available, of which one-third (71%) showed radiological signs of pulmonary edema. The majority of the cases (82%) experienced a rapid resolution of symptoms within 48 h, the diagnostic hallmark of SIPE. Due to a foreseeable increase in participation in swimming competitions and endurance competitions with a swimming component, diagnosis of SIPE will be important, especially for medical teams caring for these athletes. PMID:28912730

[Botulism in infancy - survey of literature based on a case report].

PubMed

Berkes, Andrea; Szegedi, István; Szikszay, Edit; Gulyás, Márta; Oláh, Eva

2007-06-17

The authors have drawn attention to a rare disease called infant botulism, which raises some difficulties with regard to differential diagnosis. In the case of the six-month-old infant portrayed, infant botulism and food-born botulism appeared together. As a result of the severity of the disease and due to its rapid course observed in the presented case as well, the diagnosis has to be raised relying on the accurate patient's history and on the clinical examination, then it should be confirmed by appropriate examinations. In relation to presenting a case, the authors examine the microbiological background of the disease, its symptomatology, its epidemiological characteristics, the appropriate methods of electrophysiological examination and laboratory analysis as recommended in current literature, together with the difficulties that arise in differential diagnosis and also the possibilities of treatment. They pay special attention to the particular characteristics of the infant form of the disease, to the difficulties of making a diagnosis due to the characteristics of the age group and also to the questions in relation to the guiding principles of therapy. The rapid and fatal process observed in the presented case warns us that serious complications can occur even when up-to-date therapy is used. Therefore, despite the improvement in prognosis we have to strive to prevent the disease by spreading the proper regulations of nutritional hygiene.

Severe bleeding complications other than intracranial hemorrhage in neonatal alloimmune thrombocytopenia: a case series and review of the literature.

PubMed

Winkelhorst, Dian; Kamphuis, Marije M; de Kloet, Liselotte C; Zwaginga, Jaap Jan; Oepkes, Dick; Lopriore, Enrico

2016-05-01

The most feared bleeding complication in fetal and neonatal alloimmune thrombocytopenia (FNAIT) is an intracranial hemorrhage (ICH). However, FNAIT may also lead to other severe bleeding problems. The aim was to analyze this spectrum and evaluate the occurrence of severe hemorrhages other than ICH in fetuses or neonates with FNAIT. A retrospective chart analysis of cases of FNAIT presenting with severe bleeding complications other than ICH at our institution from 1990 to 2015 was conducted. Additionally, a review of the literature was performed to identify case reports and case series on FNAIT presenting with extracranial hemorrhage. Of 25 fetuses or neonates with severe bleeding due to FNAIT, three had isolated severe internal organ hemorrhage other than ICH, two pulmonary hemorrhages and one gastrointestinal hemorrhage. Two of these three neonates died due to this bleeding. Eighteen cases of extracranial bleeding complications as a first presentation of FNAIT were found in the literature, including ocular, gastrointestinal, spinal cord, pulmonary, renal, subgaleal, and genitourinary hemorrhages. Bleeding complications other than ICH may be more extensive, and the presentation of FNAIT may have a greater spectrum than previously described. A high index of suspicion on the possible diagnosis of FNAIT with any bleeding complication in a fetus or neonate may enable adequate diagnostics, adequate treatment, and appropriate follow-up in future pregnancies, as is especially relevant for FNAIT. © 2016 AABB.

The angular electronic band structure and free particle model of aromatic molecules: High-frequency photon-induced ring current

NASA Astrophysics Data System (ADS)

Öncan, Mehmet; Koç, Fatih; Şahin, Mehmet; Köksal, Koray

2017-05-01

This work introduces an analysis of the relationship of first-principles calculations based on DFT method with the results of free particle model for ring-shaped aromatic molecules. However, the main aim of the study is to reveal the angular electronic band structure of the ring-shaped molecules. As in the case of spherical molecules such as fullerene, it is possible to observe a parabolic dispersion of electronic states with the variation of angular quantum number in the planar ring-shaped molecules. This work also discusses the transition probabilities between the occupied and virtual states by analyzing the angular electronic band structure and the possibility of ring currents in the case of spin angular momentum (SAM) or orbital angular momentum (OAM) carrying light. Current study focuses on the benzene molecule to obtain its angular electronic band structure. The obtained electronic band structure can be considered as a useful tool to see the transition probabilities between the electronic states and possible contribution of the states to the ring currents. The photoinduced current due to the transfer of SAM into the benzene molecule has been investigated by using analytical calculations within the frame of time-dependent perturbation theory.

Acute neurological symptoms during hypobaric exposure: consider cerebral air embolism.

PubMed

Weenink, Robert P; Hollmann, Markus W; van Hulst, Robert A

2012-11-01

Cerebral arterial gas embolism (CAGE) is well known as a complication of invasive medical procedures and as a risk in diving and submarine escape. In the underwater environment, CAGE is caused by trapped air, which expands and leads to lung vessel rupture when ambient pressure decreases during ascent. Pressure decrease also occurs during hypobaric activities such as flying and, therefore, CAGE may theoretically be a risk in hypobaric exposure. We reviewed the available literature on this subject. Identified were 12 cases of CAGE due to hypobaric exposure. Based on these cases, we discuss pathophysiology, diagnosis, and treatment of CAGE due to hypobaric exposure. The low and slow pressure decrease during most hypobaric activities (as opposed to diving) account for the low incidence of CAGE during these exposures and suggest that severe air trapping must be present to cause barotrauma. This is also suggested by the large prevalence of air filled cysts in the case reports reviewed. We recommend considering CAGE in all patients presenting with acute central neurological injury during or shortly after pressure decrease such as flying. A CT scan of head and chest should be performed in these patients. Treatment with hyperbaric oxygen therapy should be initiated as soon as possible in cases of proven or probable CAGE.

Recurrent intestinal volvulus in midgut malrotation causing acute bowel obstruction: A case report

PubMed Central

Sheikh, Fayed; Balarajah, Vickna; Ayantunde, Abraham Abiodun

2013-01-01

Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd’s procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality. PMID:23556060

Recurrent intestinal volvulus in midgut malrotation causing acute bowel obstruction: A case report.

PubMed

Sheikh, Fayed; Balarajah, Vickna; Ayantunde, Abraham Abiodun

2013-03-27

Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd's procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality.

Could visual neglect induce amblyopia?

PubMed

Bier, J C; Vokaer, M; Fery, P; Garbusinski, J; Van Campenhoudt, G; Blecic, S A; Bartholomé, E J

2004-12-01

Oculomotor nerve disease is a common cause of diplopia. When strabismus is present, absence of diplopia has to induce the research of either uncovering of visual fields or monocular suppression, amblyopia or blindness. We describe the case of a 41-year-old woman presenting with right oculomotor paresis and left object-centred visual neglect due to a right fronto-parietal haemorrhage expanding to the right peri-mesencephalic cisterna caused by the rupture of a right middle cerebral artery aneurysm. She never complained of diplopia despite binocular vision and progressive recovery of strabismus, excluding uncovering of visual fields. Since all other causes were excluded in this case, we hypothesise that the absence of diplopia was due to the object-centred visual neglect. Partial internal right oculomotor paresis causes an ocular deviation in abduction; the image being perceived deviated contralaterally to the left. Thus, in our case, the neglect of the left image is equivalent to a right monocular functional blindness. However, bell cancellation test clearly worsened when assessed in left monocular vision confirming that eye patching can worsen attentional visual neglect. In conclusion, our case argues for the possibility of a functional monocular blindness induced by visual neglect. We think that in presence of strabismus, absence of diplopia should induce the search for hemispatial visual neglect when supratentorial lesions are suspected.

[Anesthetic management of a Dialysis Patient with Chronic Inflammatory Demyelinating Polyneuropathy].

PubMed

Takahashi, Yoshihiro; Hara, Koji; Sata, Takeyoshi

2015-11-01

We report the successful management of anesthesia in a 46-year-old male dialysis patient with chronic inflammatory demyelinating polyneuropathy (CIDP). He underwent an osteosynthesis of the ankle joint using general anesthesia combined with epidural anesthesia. The anesthetic concerns in patients with CIDP are the possibility of postoperative respiratory dysfunction due to anesthetics or muscle relaxants and that of postoperative neurological deterioration due to spinal or epidural anesthesia. In this case, sevoflurane (1.5-2%) did not cause respiratory dysfunction postoperatively and muscle relaxant effect of rocuronium was effectively reversed by sugammadex. Epidural anesthesia using ropivacaine (0.2-0.375%) and fentanyl did not worsen the neurological symptoms of CIDP post-operatively.

Cascades in interdependent flow networks

NASA Astrophysics Data System (ADS)

Scala, Antonio; De Sanctis Lucentini, Pier Giorgio; Caldarelli, Guido; D'Agostino, Gregorio

2016-06-01

In this manuscript, we investigate the abrupt breakdown behavior of coupled distribution grids under load growth. This scenario mimics the ever-increasing customer demand and the foreseen introduction of energy hubs interconnecting the different energy vectors. We extend an analytical model of cascading behavior due to line overloads to the case of interdependent networks and find evidence of first order transitions due to the long-range nature of the flows. Our results indicate that the foreseen increase in the couplings between the grids has two competing effects: on the one hand, it increases the safety region where grids can operate without withstanding systemic failures; on the other hand, it increases the possibility of a joint systems' failure.

Pseudo-hemothorax at computed tomography due to residual contrast media.

PubMed

Romero, Matías; Bächler, Pablo

2014-01-01

Pleural effusion is a clinical problem that has many causes, with hemothorax being one of them. Computed tomography readily characterizes pleural fluid with determination of the attenuation value, helping to distinguish hemothorax from other types of effusion. Herein, we report the case of a 67-year-old man with end-stage renal disease in which a high-density pleural effusion due to residual contrast media was misinterpreted as hemothorax. Radiologists should consider the possibility of contrast media retention when interpreting a high-density pleural effusion in patients with end-stage renal disease. Recognition of this entity is crucial to avoid misdiagnosis, which might lead to unnecessary testing or procedures. Copyright © 2014 Elsevier Inc. All rights reserved.

Hear ye? Hear ye! Successful auditory aging.

PubMed Central

Gates, G A; Rees, T S

1997-01-01

Age-related hearing loss (presbycusis) is a multifactorial process that affects nearly all people in their senior years. Most cases are due to a loss of cochlear hair cell function and are well mediated by communication courtesy and modern amplification technology. Severe hearing loss is generally due to cochlear problems or age-related diseases and may require speech reading, assistive listening devices, and cochlear implants, depending on the degree of loss. Presbycusis may seriously impair communication and contribute to isolation, depression, and possibly dementia. Accurate diagnosis and prompt remediation are widely available but are frequently underused. Geriatric health care and well-being is enhanced by the detection and remediation of communication disorders. PMID:9348755

A rare cause of hypophysitis: tuberculosis.

PubMed

Ates, Ihsan; Katipoglu, B; Copur, B; Yilmaz, N

2017-10-26

Hypophysitis is a heterogeneous inflammatory disease of pituitary gland. As it causes headache and visual defects, it mimics sellar tumors in clinical and radiological aspects. It may occur due to primary or secondary causes. Tuberculosis is one of the rare secondary causes of the hypophysitis. Subject and Results. A 30-year-old male patient presented with fatigue and headache. Panhypopituitarism was considered due to the results and the diagnostic magnetic resonance (MR) imaging revealed sagittal section diamater of pituitary gland higher than normal. Biopsy of the pituitary gland was concordant with the granulomatous hypophysitis. Other possible diagnosis was excluded. The tubercular hypophysitis, as a result of performed tests, is discussed hereby, in the case report.

Periodontitis and periimplantitis: one and the same?

PubMed

Meffert, R M

1993-12-01

Research shows that the same anaerobic, gram-negative pathogens are present in the periodontal and implant pocket or crevice. The implants in a partially edentulous case are probably more at risk due to the bacteria being more pathogenic and a seeding mechanism from the tooth pocket to the implant crevice. In the face of a normal microbial flora, retrograde periimplantitis or radiographic bone loss without gingival changes may be due to trauma because of overloading, loading too soon, and/or loading in a lateral direction. Finally, the combination of an infective process (periimplantitis) and noninfective or traumatic process (retrograde periimplantitis) will result in rapid osseous destruction and, possibly, loss of the implant fixture(s).

An unusual case of prolonged post-endoscopic retrograde cholangiopancreatography jaundice.

PubMed

Tziatzios, Georgios; Gkolfakis, Paraskevas; Papanikolaou, Ioannis S; Dimitriadis, George; Triantafyllou, Konstantinos

2016-04-01

Despite the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for the treatment of choledocholithiasis, various complications have been described. We herein report the first case of prolonged post-ERCP jaundice due to toxicity of the contrast agent Iobitridol (®XENETIX, Guerbet, Roissy CdG Cedex, France) in a patient who underwent ERCP with sphincterectomy and common bile duct stone removal. While clinical improvement and normalization of aminotransferases and cholestatic enzymes after the procedure, an unexplained increase of direct bilirubin was noticed. A second ERCP was performed one week later, excluding possible remaining choledocholithiasis. Nevertheless, serum direct bilirubin increased further up to 15 mg/dL. Other potential causes of direct hyperbilirubinemia were ruled out and patient's liver biopsy was compatible with drug-induced liver toxicity. Additionally, the cause-result time connection between the use of Iobitridol and bilirubin increase indicated the possibility of a toxic effect related to the repeated use of the particular contrast agent. Iobitridol, a contrast agent, can induce prolonged direct hyperbilirubinemia.

Veterans treatment courts: A case study of their efficacy for Veterans' needs.

PubMed

Erickson, John W

Veterans Treatment Courts (VTCs) were created to: (1) address issues unique to U.S. Military Veterans; and, (2) where possible, avoid punishing veterans for crimes that may have been committed as a direct result of their mental conditions (e.g., Posttraumatic Stress Disorder (PTSD) and/or Traumatic Brain Injury (TBI)). Little research has been undertaken to ascertain whether VTCs are accomplishing their intended goals. To that end, the present case study examined three operating VTCs in order to determine if they are meeting their objectives. The research provides further information about VTC operations and recidivism rates. The research further reveals that, while the three VTCs examined are arguably benefitting veterans, they are not reaching a greater part of the population due largely to the gatekeeping role of VTC prosecutors, and the rigid eligibility requirements established by the three VTCs for veteran participation. Consequently, it's possible that the low recidivism rates reported by the three VTCs examined are inflated or constitute false positives. Copyright © 2016 Elsevier Ltd. All rights reserved.

Preliminary investigation of bottlenose dolphins (Tursiops truncatus) for hfe gene-related hemochromatosis.

PubMed

Phillips, Brianne E; Venn-Watson, Stephanie; Archer, Linda L; Nollens, Hendrik H; Wellehan, James F X

2014-10-01

Hemochromatosis (iron storage disease) has been reported in diverse mammals including bottlenose dolphins (Tursiops truncatus). The primary cause of excessive iron storage in humans is hereditary hemochromatosis. Most human hereditary hemochromatosis cases (up to 90%) are caused by a point mutation in the hfe gene, resulting in a C282Y substitution leading to iron accumulation. To evaluate the possibility of a hereditary hemochromatosis-like genetic predisposition in dolphins, we sequenced the bottlenose dolphin hfe gene, using reverse transcriptase-PCR and hfe primers designed from the dolphin genome, from liver of affected and healthy control dolphins. Sample size included two case animals and five control animals. Although isotype diversity was evident, no coding differences were identified in the hfe gene between any of the animals examined. Because our sample size was small, we cannot exclude the possibility that hemochromatosis in dolphins is due to a coding mutation in the hfe gene. Other potential causes of hemochromatosis, including mutations in different genes, diet, primary liver disease, and insulin resistance, should be evaluated.

Palliative sedation until death: an approach from Kant's ethics of virtue.

PubMed

Hasselaar, Jeroen G J

2008-01-01

This paper is concerned with the moral justification for palliative sedation until death. Palliative sedation involves the intentional lowering of consciousness for the relief of untreatable symptoms. The paper focuses on the moral problems surrounding the intentional lowering of consciousness until death itself, rather than possible adjacent life-shortening effects. Starting from a Kantian perspective on virtue, it is shown that continuous deep sedation until death (CDS) does not conflict with the perfect duty of moral self-preservation because CDS does not destroy capacities for agency. In addition, it is argued that CDS can frustrate the imperfect duty of self-cultivation by reducing consciousness permanently. Nevertheless, there are cases where CDS is morally acceptable, namely, cases where the agent has already permanently lost the possibility for free action in advance of sedation--for example, due to excruciating and ongoing pain. Because the latter can be difficult to diagnose properly, safeguards may be needed in order to prevent the application of CDS for the wrong reasons.

Guillain-Barré syndrome and other neurological manifestations possibly related to Zika virus infection in municipalities from Bahia, Brazil, 2015.

PubMed

Malta, Juliane Maria Alves Siqueira; Vargas, Alexander; Leite, Priscila Leal E; Percio, Jadher; Coelho, Giovanini Evelim; Ferraro, Andréa Helena Argolo; Cordeiro, Tânia Maria de Oliveira; Dias, Jesângeli de Sousa; Saad, Eduardo

2017-01-01

to describe the reported cases of Guillain-Barré Syndrome (GBS) and other neurological manifestations with a history of dengue, chikungunya or Zika virus infections, in the Metropolitan Region of Salvador and in the municipality of Feira de Santana, Brazil. this is a descriptive study with data of an investigation conducted by the epidemiological surveillance from March to August 2015; to confirm the neurological manifestations, medical diagnosis records were considered, and to prior infection, clinical and laboratory criteria were used. 138 individuals were investigated, 57 reported infectious process up to 31 days before neurological symptoms - 30 possibly due to Zika, 13 to dengue, 8 to chikungunya and 6 were inconclusive -; GBS was the most frequent neurological condition (n=46), with predominance of male sex (n=32) and the median age was 44. most cases reported a clinical picture consistent with acute Zika virus disease, which preceded the occurrence of neurological symptoms.

Obesity interacts with infectious mononucleosis in risk of multiple sclerosis.

PubMed

Hedström, A K; Lima Bomfim, I; Hillert, J; Olsson, T; Alfredsson, L

2015-03-01

The possible interaction between adolescent obesity and past infectious mononucleosis (IM) was investigated with regard to multiple sclerosis (MS) risk. This report is based on two population-based case-control studies, one with incident cases (1780 cases, 3885 controls) and one with prevalent cases (4502 cases, 4039 controls). Subjects were categorized based on adolescent body mass index (BMI) and past IM and compared with regard to occurrence of MS by calculating odds ratios with 95% confidence intervals (CIs) employing logistic regression. A potential interaction between adolescent BMI and past IM was evaluated by calculating the attributable proportion due to interaction. Regardless of human leukocyte antigen (HLA) status, a substantial interaction was observed between adolescent obesity and past IM with regard to MS risk. The interaction was most evident when IM after the age of 10 was considered (attributable proportion due to interaction 0.8, 95% CI 0.6-1.0 in the incident study, and attributable proportion due to interaction 0.7, 95% CI 0.5-1.0 in the prevalent study). In the incident study, the odds ratio of MS was 14.7 (95% CI 5.9-36.6) amongst subjects with adolescent obesity and past IM after the age of 10, compared with subjects with none of these exposures. The corresponding odds ratio in the prevalent study was 13.2 (95% CI 5.2-33.6). An obese state both impacts the cellular immune response to infections and induces a state of chronic immune-mediated inflammation which may contribute to explain our finding of an interaction between adolescent BMI and past IM. Measures taken against adolescent obesity may thus be a preventive strategy against MS. © 2014 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.

Precocious pseudopuberty due to an autonomous ovarian follicular cyst: case report with a review of literatures

PubMed Central

2013-01-01

Background Small follicular cysts are commonly found in the ovaries of prepubertal girls, and in most cases, they are of no clinical importance. These cysts are usually self-limiting and resolve spontaneously. However, occasionally, these cysts may enlarge and continue to produce estrogen, resulting in signs of sexual precocity. Here, we report a case of precocious pseudopuberty associated with an autonomous ovarian follicular cyst. Case presentation A 5.9-year-old girl initially presented to a local clinic with vaginal bleeding and a large unilateral ovarian cyst. At 6 months after the initial acute episode, the patient visited our hospital as the ovarian cyst had persisted and increased in size. Endocrinological examination showed elevated estrogen levels and suppressed gonadotropin levels on GnRH stimulation test. Also, no skin pigmentation or bone anomaly was noted. Based on these observations, laparoscopic cystectomy was performed, and histologic analysis confirmed the diagnosis of a follicular cyst. After the laparoscopic cystectomy, the patient’s hormone levels returned to normal and no ovarian cyst was detected by ultrasound. Conclusions As autonomous ovarian cysts are usually self-limiting disorder, no treatment is necessary. Therefore, surgical management should be deferred as long as possible to avoid the risk of repeat surgery, as pseudoprecocious puberty due to autonomous ovarian cysts can resolve spontaneoulsy and frequently recurs. Precocious pseudopuberty with an ovarian cyst may be due to granulosa cell tumor or may be one symptom of the McCune-Albright Syndrome (MAS). A careful longer-term follow up of patients with autonomous ovarian cysts and/or molecular studies may be necessary in such cases. PMID:23937919

Persistence of Mycoplasma hyopneumoniae sequence types in spite of a control program for enzootic pneumonia in pigs.

PubMed

Overesch, Gudrun; Kuhnert, Peter

2017-09-15

Enzootic pneumonia (EP) in pigs caused by Mycoplasma (M.) hyopneumoniae has successfully been combatted in Switzerland. A control program was fully implemented in 2004 which is based on total depopulation strategies of affected fattening farms as well as partial depopulation on breeding farms. Thereby, the number of cases has dropped drastically from more than 200 in 2003 to two cases in 2013. Currently monitoring is done based on clinical observation and subsequent diagnostic of coughing pigs. Moreover, in case of more than 10% gross pathological lesions per slaughter batch laboratory confirmation for EP is compulsory. Despite these strict measures it was not possible to eliminate M. hyopneumoniae from Swiss pig production. In fact, during the last few years the number of EP cases has slightly increased. Therefore, genotyping of the involved M. hyopneumoniae strains was conducted in order to elucidate possible sources and routes of infection. All available and typeable samples from totally 22 cases during the period 2014-2016 were investigated by extended multilocus sequence typing (MLST). A total of 16 cases, including eight from 2014, five from 2015 and three from 2016 could thereby be included in the study. MLST revealed that the majority of cases in 2014/2015 were due to two major spread scenarios, i.e. two M. hyopneumoniae sequence types, each scenario involving six individual production farms in five to six different Cantons (states), respectively. Moreover, by comparison of archived sequences some sequence types were observed over ten years demonstrating their persistence over a long time and the possible partial failure of elimination measures in Switzerland. Insufficient sanitation on affected farms and subsequent animal transport of symptomless infected pigs could lead to recurrent cases. Wild boar harbor identical strains found with EP but solid data are missing to assign a role as reservoir to this wild animal. Implementing a monitoring scheme for M. hyopneumoniae in wild boar in combination with genotyping of all available samples from domestic pigs could direct responsible authorities to possible gaps and deficiencies of control measures taken for combating enzootic pneumonia. With the newly installed PubMLST database sequence types for M. hyopneumoniae are now available and allow tracing back strains on the international level. Copyright © 2017 Elsevier B.V. All rights reserved.

Lightning safety of animals.

PubMed

Gomes, Chandima

2012-11-01

This paper addresses a concurrent multidisciplinary problem: animal safety against lightning hazards. In regions where lightning is prevalent, either seasonally or throughout the year, a considerable number of wild, captive and tame animals are injured due to lightning generated effects. The paper discusses all possible injury mechanisms, focusing mainly on animals with commercial value. A large number of cases from several countries have been analyzed. Economically and practically viable engineering solutions are proposed to address the issues related to the lightning threats discussed.

Precut prepackaged lettuce: a risk for listeriosis?

PubMed

Hanning, Irene B; Johnson, Michael G; Ricke, Steven C

2008-12-01

The most recent outbreaks of listeriosis have been traced back to contaminated ready-to-eat (RTE) poultry and meat products. However, Listeria monocytogenes can be isolated from every food group, including fresh vegetables. This review is focused on one of the most popular RTE vegetable products, precut prepackaged lettuce. The available literature concerning Listeria contamination of vegetables is reviewed, and possible reasons why no recent outbreaks or sporadic cases of listeriosis due to contaminated precut prepackaged lettuce are explored.

Transient pituitary enlargement with central hypogonadism secondary to bilateral cavernous sinus thrombosis: pituitary oedema?

PubMed

Joubert, Michael; Verdon, Renaud; Reznik, Yves

2009-05-01

Design We report the case of an incidental pituitary mass discovered in the context of bilateral cavernous sinus thrombosis due to a bacterial pansinusitis. Conclusions Magnetic resonance imaging features of the pituitary lesion, together with transient central hypogonadism and total regression of the mass after anticoagulation and antimicrobial therapy, suggest that this lesion is a pituitary oedema of vascular mechanism. Other possible causes of pituitary mass in such a situation are also discussed.

[Sensorineural hearing loss due to neonatal hyperbilirubinemia].

PubMed

Clarós, P; Turcanu, D; Caballero, M; Costa, C; Clavería, M A; Clarós, A; Clarós, A

2003-01-01

In this article, the sensorineural hearing loss is presented as a possible sequelae of neonatal hyperbilirubinemia. In our program of early hipoacusia detection, 241 babies were examined from January 1996 until November 1999; 7 cases had a history of hyperbilirubinemia in the neonatal period and 2 of them were diagnosed of sensorineural hearing loss. We discuss how the bilirubin or any other associated factor might have been the cause and this could explain the selective affectation of some children.

2005 Tri-Service Infrastructure Systems Conference and Exhibition. Volume 7, Tracks 7 and 8

DTIC Science & Technology

2005-08-04

dense soils have the potential to wash-out and erode with fluid rotary methods and over excavation and hydraulic fracturing can result. Short...circuiting is possible outside of the temporary or outer casing or through weak soils to grade. Hydraulic fracturing may take place due to soil properties...prevented the potential for hydraulic fracturing of the sensitive dam prior to grouting. Sonic drilling was selected from a ran of proposed

Association of DD genotype of angiotensin-converting enzyme gene (I/D) polymorphism with hypertension among a North Indian population.

PubMed

Rana, Garima; Yadav, Suniti; Joshi, Shipra; Saraswathy, K N

2018-01-01

Hypertension, a major risk factor for cardiovascular diseases, is among the leading causes of morbidity and mortality worldwide. Genetic predisposition to the risk of developing hypertension due to angiotensin-converting enzyme (ACE) gene insertion(I)/deletion(D) polymorphism (through altered serum ACE activity) is well documented among various populations. The present study investigated the possible association between ACE (DD) genotype and hypertension using a nested case-control study design including 451 individuals (of either sex in the age group 30-65 years) from a rural North Indian population practicing agriculture and lacto-vegetarianism. Blood Pressure was classified using JNC-7 criterion. Age- and sex-matched individuals were selected from normotensive (N-122), pre-hypertensive (N-123), hypertensive not on medication (N-122), and hypertensive on medication (N-84) categories. Amplification of DNA and genotyping of PCR product was done using standard protocols. From the analysis, comparatively higher frequency of individuals with DD genotype in the hypertensive category was observed, indicating a possible relation between DD genotype and hypertension. The odds ratio analysis revealed 2.225 (1.13-4.37)-fold significant increased risk for hypertension among cases, validating the vulnerability of individuals with DD genotype towards hypertension. Thus, the present study highlights the increased risk for developing hypertension due to ACE DD genotype in the studied population.

[Illegal professional conflict of interest from the viewpoint of the attorney].

PubMed

Broglie, M G

1998-10-01

Since the so called "heart-valve scandal" occurred in Germany, the practice of financially or otherwise supported hospitals and practicing doctors has to be critically re-examined and may be changed. The practice and acceptance of support is common in many areas of our daily life, however, due to governmental social laws regulating the flow of money and due to the various financial forms of support for the health care system, criminal violations and sanctions may arise. Aside from the existing standard criminal violations, a new law, as of has been enacted August 13, 1997-this law specifically deals with bribery and the acceptance of such illegal payments. Proving that such a criminal violation was committed by a physician can be very difficult for the prosecutor. The mass of procedural laws--aside from the substantive law requirements--cause problems for the state. It is also very difficult to determine the exact amount of damages or that a physician has gained an illegal advantage. In these specific and other general cases, a professional defense by a competent attorney is absolutely essential to prevent an unpleasant suit or to resolve charges outside of court. In some cases, it may even be possible to persuade the prosecutor to only levy a fine, if it is not possible to persuade him to drop the charges all together--for lack of good evidence.

Secondary pseudohypoaldosteronism caused by urinary tract infection associated with urinary tract anomalies: case reports.

PubMed

Torun-Bayram, Meral; Soylu, Alper; Kasap-Demir, Belde; Alaygut, Demet; Türkmen, Mehmet; Kavukçu, Salih

2012-01-01

Secondary pseudohypoaldosteronism type 1 develops due to transient aldosterone resistance in renal tubules and is characterized by renal sodium loss, hyponatremia, hyperkalemia and high plasma aldosterone levels. Although many reasons are described, urinary tract infections and/or urinary tract anomalies are the most common causes. Although the cause of the tubular resistance is not known exactly, renal scar development due to obstruction and reduced sensitivity of mineralocorticoid receptors due to cytokines such as transforming growth factor (TGF)-beta are the possible mechanisms. It is seen especially within the first three months of life and the frequency decreases with age. The treatment is usually elimination of the underlying cause. In this article, we present four patients with several urinary tract anomalies and concomitant urinary tract infection who developed transient secondary pseudohypoaldosteronism.

[Cardiac arrest due to accidental hypothermia and prolonged cardiopulmonary resuscitation].

PubMed

Kot, P; Botella, J

2010-11-01

In cardiac arrest produced by accidental hypothermia, cardiopulmonary resuscitation must be prolonged until normal body temperature is achieved. There are different rewarming methods. In theory, the more invasive ones are elective in patients with cardiac arrest because of their higher rewarming speed. However, it has not been proven that these methods are better than the non-invasive ones. We present a case report of a patient with cardiac arrest due to accidental hypothermia who was treated without interruption for three hours with heart massage. This is the longest successful cardiopulmonary resuscitation known up-to-date in Spain. In order to rewarm the body, a combination of non-invasive methods was used: active external rewarming with convective warm air, gastric and bladder lavage with warm saline solution and intravenous warm saline infusion. This case shows that it is possible to treat hypothermic cardiac arrest successfully through these rewarming methods, which are both easy to apply and feasible in any hospital. Copyright © 2009 Elsevier España, S.L. y SEMICYUC. All rights reserved.

Vulval Elephantiasis: A Case Report

PubMed Central

Mohan, Harsh; Bisht, Bhumika; Goel, Poonam; Garg, Geeta

2012-01-01

Introduction. Elephantiasis is a chronic manifestation of filariasis; it commonly affects limbs, scrotum, and trunk. Females have lower incidence of filarial infection. Vulval elephantiasis due to filariasis is still rarer. It is difficult to make the diagnosis on histopathology alone, more so in view of the fact that the parasite is usually not identified in tissue sections. Identification of microfilariae in night samples of peripheral blood or seropositivity for filarial antigen is requisite for the correct diagnosis. Case Presentation. A young female presented with progressively increasing vulval swelling over a period of two years. The swelling was soft and measured 5 × 6 cm. Other possible differential diagnoses were excluded, and ancillary tests were performed to reach a conclusive diagnosis of vulval elephantiasis on histopathology. Conclusion. Vulval elephantiasis due to filariasis is rare. Its diagnosis on histopathology is more often by exclusion. High index of suspicion on microscopic findings and corelation with relevant diagnostic tests are required to reach the correct diagnosis. PMID:23198192

A Rare Case of Pancreas Divisum Accompanied by Acute Pancreatitis Following Endoscopic Hemostasis for Duodenal Ulcer Bleeding.

PubMed

Choi, Yong Hyeok; Yoon, Soon Man; Kim, Eun Bee; Oh, Youngmin; Kim, Keunmo; Lee, Jisun; Park, Seon Mee; Youn, Sei Jin

2017-04-25

Peptic ulcer bleeding is treated using endoscopic hemostasis using clips or bands. Pancreas divisum (PD), a congenital anomaly of the pancreas, usually has no clinical symptoms; however, pancreatitis may occur if there are disturbances in the drainage of pancreatic secretions. We report an unusual case of PD accompanied by acute pancreatitis, following endoscopic band ligation for duodenal ulcer bleeding. A 48-year-old woman was admitted to our hospital due to melena. An upper endoscopy revealed a small ulcer with oozing adjacent minor papilla. An endoscopic band ligation was performed on this lesion. Acute pancreatitis developed suddenly 6 hours after the band ligation and improved dramatically after removal of the band. Magnetic resonance cholangiopancreatography was performed, revealing complete PD. Endoscopic band ligation is known as the effective method for peptic ulcer bleeding; however, it should be used carefully in duodenal ulcer bleeding near the minor duodenal papilla due to the possibility of PD.

Bridging knee arthrodesis for limb salvage using an intramedullary cemented nail: a retrospective outcome analysis of a case series.

PubMed

Neuerburg, Carl; Bieger, Ralf; Jung, Sebastian; Kappe, Thomas; Reichel, Heiko; Decking, Ralf

2012-08-01

Failed total knee replacement with compromised bone and soft-tissues can be challenging. In these situations, arthrodesis remains a treatment option of a limb-saving procedure. We investigated the outcome of treatment with an intramedullary cemented knee arthrodesis nail implanted in 22 consecutive patients with forlorn situations after failed total knee replacement. There were three major complications due to re-infection and two minor complications due to wound-healing disturbances that healed with the implant retained after an average follow-up of 3.4 years. Clinical examination, Short Form-36 and Oxford knee scores revealed low pain levels, safe implant anchorage, and improved stability of the knee, whilst autonomous mobility utilizing walking aids was still possible. Bridging knee arthrodesis with an intramedullary nail is a valuable salvage procedure with acceptable clinical results. As recurring infection remains the most challenging complication, regular clinical and radiological follow-up examinations are necessary following implant-related knee arthrodesis to allow timely intervention in case of loosening.

Effect of Cosmological Neutrinos on Discrimination Between the Two Enantiomers of a Chiral Molecule

NASA Astrophysics Data System (ADS)

Bargueño, Pedro; Gonzalo, Isabel

2006-04-01

In the framework of an extraterrestrial origin of biological homochirality, universal mechanisms are of particular interest. In this sense we consider the weak parity-violating neutrino-electron interaction through weak charged currents W ± between the relic flux of cosmological neutrinos and the electrons of a chiral molecule. We use the known theoretical result of the split in energy of the two helicity sates of an electron in the cosmic neutrino bath, due to weak charged currents. In the case that electrons of a chiral molecule are submitted to a helicoidal potential due to the nuclear conformation, these electrons have opposite helicities for the two enantiomers of the molecule and consequently the mentioned neutrino-electron interaction would produce a splitting in energy between the two enantiomers. An estimation of this energy for the case of a single electron yields a small value of the order of 10-26 eV. This value results amplified by the contribution of all the molecular electrons having helicity and other possible mechanisms.

Salmonellosis outbreaks in the United States due to fresh produce: sources and potential intervention measures.

PubMed

Hanning, Irene B; Nutt, J D; Ricke, Steven C

2009-01-01

Foodborne Salmonella spp. is a leading cause of foodborne illness in the United States each year. Traditionally, most cases of salmonellosis were thought to originate from meat and poultry products. However, an increasing number of salmonellosis outbreaks are occurring as a result of contaminated produce. Several produce items specifically have been identified in outbreaks, and the ability of Salmonella to attach or internalize into vegetables and fruits may be factors that make these produce items more likely to be sources of Salmonella. In addition, environmental factors including contaminated water sources used to irrigate and wash produce crops have been implicated in a large number of outbreaks. Salmonella is carried by both domesticated and wild animals and can contaminate freshwater by direct or indirect contact. In some cases, direct contact of produce or seeds with contaminated manure or animal wastes can lead to contaminated crops. This review examines outbreaks of Salmonella due to contaminated produce, the potential sources of Salmonella, and possible control measures to prevent contamination of produce.

Endogenous Klebsiella endophthalmitis associated with liver abscess: first case report from iran.

PubMed

Dehghani, A R; Masjedi, A; Fazel, F; Ghanbari, H; Akhlaghi, M; Karbasi, N

2011-01-07

To report the first case of endogenous Klebsiella endophthalmitis associated with liver abscess in Iran. A 79-year-old man was referred to our hospital due to severe pain and visual loss in the left eye. On physical examination, conjunctival hyperemia, corneal edema, hypopyon and severe vitreous cellular reaction were identified in the left eye; however, yellowish conjunctival discoloration was more apparent in the right eye. Abdominal CT scan showed a right liver lobe abscess that was confirmed by sonographically guided percutaneous liver mass biopsy. Blood, vitreous and liver mass aspirate cultures revealed Klebsiella pneumoniae growth. The patient was thus diagnosed with endogenous Klebsiella endophthalmitis secondary to bacteremia associated with liver abscess. This report suggests that, rather than being confined to Taiwan, endogenous endophthalmitis secondary to a liver abscess due to K. pneumoniae may be a global problem. Therefore, physicians should be aware of the possibility of endophthalmitis whenever a patient with K. pneumoniae liver abscess complains of ocular symptoms.

Sound-induced facial synkinesis following facial nerve paralysis.

PubMed

Ma, Ming-San; van der Hoeven, Johannes H; Nicolai, Jean-Philippe A; Meek, Marcel F

2009-08-01

Facial synkinesis (or synkinesia) (FS) occurs frequently after paresis or paralysis of the facial nerve and is in most cases due to aberrant regeneration of (branches of) the facial nerve. Patients suffer from inappropriate and involuntary synchronous facial muscle contractions. Here we describe two cases of sound-induced facial synkinesis (SFS) after facial nerve injury. As far as we know, this phenomenon has not been described in the English literature before. Patient A presented with right hemifacial palsy after lesion of the facial nerve due to skull base fracture. He reported involuntary muscle activity at the right corner of the mouth, specifically on hearing ringing keys. Patient B suffered from left hemifacial palsy following otitis media and developed involuntary muscle contraction in the facial musculature specifically on hearing clapping hands or a trumpet sound. Both patients were evaluated by means of video, audio and EMG analysis. Possible mechanisms in the pathophysiology of SFS are postulated and therapeutic options are discussed.

Oral Midazolam Sedation For Uncooperative Children In Outpatient Paedodontics: Time For Reappraisal.

PubMed

Kapur, Aditi; Jain, Kajal; Goyal, A; Mahoney, Greg

2016-01-01

Sedation is frequently desired to facilitate dental procedures in uncooperative paediatric patients. Oromucosal Midazolam sedation is a popular choice among paediatric dentists world wide due to its many advantages such as ease of administration, good efficacy, presence of reversal agents and a wide margin of safety. On the other hand, many investigators have reported that midazolam sedation may not be successful for carrying out all types of dental procedures. This may be attributed to diverse nature of various treatment plans coupled with the extent of behavioural changes in the child and operator's experience. Due to the heterogeneity involved in treatment of paediatric dental procedures, the specific indications for oral midazolam use that ensure its success rate, probably need to be defined. This may enable the clinicians to have a convenient and quicker option for managing the cases rather than facing sedation failure or at times, ending up giving general anaesthetics. This article therefore brings forth the possible causes of midazolam sedation failure and proposes a 'case selection criterion'.

In vivo antiviral activity of telbivudine against HIV-1: a case report.

PubMed

Gentile, Ivan; Bonadies, Giovanni; Carleo, Maria Aurora; Buonomo, Antonio Riccardo; Borrelli, Francesco; Portella, Giuseppe; Borgia, Guglielmo

2013-09-01

The treatment of HBV infection in patients with HIV co-infection presents several peculiar features: some drugs active against HBV are also active against HIV. This precludes their use in monotherapy in HIV-HBV co-infected patients due to the potential risk of selecting HIV-resistant strains. Telbivudine seemed to be a candidate for exclusive anti-HBV therapy because it exerts no significant in vitro activity against HIV. In this context, we describe the case of a HIV-HBV co-infected patient who presented indication for treatment only for HBV infection. After a short course of interferon treatment withdrawn due to adverse events, adefovir monotherapy was started. Since no significant viral drop was achieved during adefovir treatment, telbivudine was added. This treatment was associated with a complete virological response on HBV. It is noteworthy that after two months of this treatment even the HIV viral load presented a significant reduction. Our findings pose concerns of possible antiviral activity of telbivudine against HIV and therefore of selecting resistant mutations.

Retrospective evaluation of ProcalAmine administration in a population of hospitalized ICU dogs: 36 cases (2010-2013).

PubMed

Olan, Natasha V; Prittie, Jennifer

2015-01-01

To describe the use of ProcalAmine as a source of parenteral nutrition in hospitalized dogs and to report complications possibly referable to its use. Retrospective study. Private veterinary teaching hospital. Thirty-six dogs hospitalized in ICU receiving ProcalAmine between October 2010 and March 2013. None. The most common underlying disease process in this population of dogs was trauma (n = 8). Median duration of administration was 4 days and median resting energy requirement provided via ProcalAmine was 33%. ProcalAmine was administered via central catheters in 86% of cases and via peripheral catheters in 14% of cases. The overall mechanical complication rate was 19%. Metabolic complications possibly associated with ProcalAmine administration were documented in 12/36 dogs. Hyponatremia was most commonly identified (n = 6) followed by hyperglycemia (n = 4), hypochloremia (n = 2), azotemia (n = 2), metabolic alkalosis (n = 2), hyperchloremia (n = 1), and metabolic acidosis (n = 1). ProcalAmine appears to be relatively safe and a viable option for parenteral nutrition in ill and injured dogs. Due to the potential for electrolyte derangements and other metabolic complications, daily monitoring of these parameters is advisable. © Veterinary Emergency and Critical Care Society 2015.

[Trichophyton tonsurans associated with non-albicans Candida species in hands onychomycosis about a Moroccan case].

PubMed

Kouara, S; Ait Hlilou, B; Abbadi, A; Khalki, H; Benbella, I; Lahmadi, K; Er-Rami, M

2017-03-01

Trichophyton tonsurans is an anthropophilic dermatophyte, frequent in the USA and in Asia where it is responsible for causing tinea capitis. At present, we attend an emergence of this species in certain regions where it was not or little met. Here, we report a case of onychomycosis of the hand due to T. tonsurans associated with non-albicans Candida species at an adult woman. The patient is a 62-year-old woman, with hypertension and diabetes. She reports the rather frequent use of chemical cleaners for the housework. She presented one year previously a distal onycholysis of the last four fingers of the left hand. The clinical examination objectified a presence of intertrigo in the second interdigital space. The mycological examination showed at the direct examination mycelial elements and the culture allowed the isolation of T. tonsurans associated with non-albicans Candida species. Our observation highlights especially the identification of a species, which has been described only once in Morocco about a case with onychomycosis of the feet. A possible emergence of this species in our country is not far from being possible. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

False positive 18FDG PET-CT results due to exogenous lipoid pneumonia secondary to oily drug inhalation: A case report.

PubMed

Chardin, David; Nivaggioni, Guillaume; Viau, Philippe; Butori, Caherine; Padovani, Bernard; Grangeaon, Caroline; Razzouk-Cadet, Micheline

2017-06-01

Exogenous lipoid pneumonia is a rare condition due to abnormal presence of oily substances in the lungs. It is a rarely known cause for false positive FDG PET-CT results and can sometimes lead to invasive investigations. Searching and finding the source of the oily substance is one of the keys to the diagnosis. Inhalation of oily drugs during snorting has rarely been described. A patient with well controlled HIV infection was referred for an FDG PET-CT to assess extension of Kaposi's disease, recently removed from his right foot. The patient had no particular symptoms. Abnormal uptake of FDG was found in a suspicious lung nodule. An experienced radiologist thought the nodule was due to lipoid pneumonia. Bronchoalveolar lavage fluid did not contain lipid-laden macrophages but bronchoscopy showed violet lesions resembling Kaposi's disease lesions. Lobectomy was performed after a multidisciplinary discussion. Anatomopathological analysis revealed the nodule was due to lipoid pneumonia. The patient's quality of life did not diminish after the operation and he is still in good health. The source of the oily substance causing lipoid pneumonia was found after the surgery: the patient used to snort oily drugs. The presence of a suspicious lung nodule possibly due to lipoid pneumonia in a patient with known Kaposi's disease was difficult to untangle and lead to invasive surgery. It is possible that if a source of exogenous lipoid pneumonia had been found beforehand, surgery could have been prevented.

A new data-processing approach to study particle motion using ultrafast X-ray tomography scanner: case study of gravitational mass flow

NASA Astrophysics Data System (ADS)

Waktola, Selam; Bieberle, Andre; Barthel, Frank; Bieberle, Martina; Hampel, Uwe; Grudzień, Krzysztof; Babout, Laurent

2018-04-01

In most industrial products, granular materials are often required to flow under gravity in various kinds of silo shapes and usually through an outlet in the bottom. There are several interrelated parameters which affect the flow, such as internal friction, bulk and packing density, hopper geometry, and material type. Due to the low-spatial resolution of electrical capacitance tomography or scanning speed limitation of standard X-ray CT systems, it is extremely challenging to measure the flow velocity and possible centrifugal effects of granular materials flow effectively. However, ROFEX (ROssendorf Fast Electron beam X-ray tomography) opens new avenues of granular flow investigation due to its very high temporal resolution. This paper aims to track particle movements and evaluate the local grain velocity during silo discharging process in the case of mass flow. The study has considered the use of the Seramis material, which can also serve as a type of tracer particles after impregnation, due to its porous nature. The presented novel image processing and analysis approach allows satisfyingly measuring individual particle velocities but also tracking their lateral movement and three-dimensional rotations.

Extensive bilateral corneal edema 6 weeks after cataract surgery: Keratopathy due to Asclepias physocarpa: a case report.

PubMed

Matsuura, Kazuki; Hatta, Shiro; Terasaka, Yuki; Inoue, Yoshitsugu

2017-01-18

Surgeons may be unaware of the ability of plant toxins to cause corneal damage. Therefore, corneal damage following intraocular surgery due to plant toxins may be misdiagnosed as postoperative infection. A 74-year-old man presented with hyperemia and reduced visual acuity in both eyes 6 weeks after uneventful cataract surgery. We observed extensive hyperemia and corneal stromal edema with Descemet's folds in both eyes. After obtaining a detailed patient history, we diagnosed plant toxin-induced corneal edema due to Asclepias physocarpa, which can induce corneal edema by inhibiting the Na + /K + ATPase activity of the corneal endothelium. Antimicrobial and steroid eye drops and an oral steroid were prescribed accordingly. Symptons began to improve on day 3 and had almost completely resolved by day 6. At 1 month, the patient had fully recovered without any sequelae. The correct diagnosis was possible in the present case as symptoms were bilateral and the patient was able to report his potential exposure to plant toxins. However, if the symptoms had been unilateral and the patient had been unaware of these toxins, he may have undergone unnecessary surgical interventions to treat non-existent postoperative endophthalmitis.

Resistance to antitumor chemotherapy due to bounded-noise-induced transitions

NASA Astrophysics Data System (ADS)

D'Onofrio, Alberto; Gandolfi, Alberto

2010-12-01

Tumor angiogenesis is a landmark of solid tumor development, but it is also directly relevant to chemotherapy. Indeed, the density and quality of neovessels may influence the effectiveness of therapies based on blood-born agents. In this paper, first we define a deterministic model of antiproliferative chemotherapy in which the drug efficacy is a unimodal function of vessel density, and then we show that under constant continuous infusion therapy the tumor-vessel system may be multistable. However, the actual drug concentration profiles are affected by bounded even if possibly large fluctuations. Through numerical simulations, we show that the tumor volume may undergo transitions to the higher equilibrium value induced by the bounded noise. In case of periodically delivered boli-based chemotherapy, we model the fluctuations due to time variability of both the drug clearance rate and the distribution volume, as well as those due to irregularities in drug delivery. We observed noise-induced transitions also in case of periodic delivering. By applying a time dense scheduling with constant average delivered drug (metronomic scheduling), we observed an easier suppression of the transitions. Finally, we propose to interpret the above phenomena as an unexpected non-genetic kind of resistance to chemotherapy.

Heterophilic antibody interference affecting multiple hormone assays: Is it due to rheumatoid factor?

PubMed

Mongolu, Shiva; Armston, Annie E; Mozley, Erin; Nasruddin, Azraai

2016-01-01

Assay interference with heterophilic antibodies has been well described in literature. Rheumatoid factor is known to cause similar interference leading to falsely elevated hormone levels when measured by immunometric methods like enzyme-linked immunosorbent assay (ELISA) or multiplex immunoasays (MIA). We report a case of a 60-year-old male patient with a history of rheumatoid arthritis referred to our endocrine clinic for investigation of hypogonadism and was found to have high serum levels of LH, FSH, SHBG, Prolactin, HCG and TSH. We suspected assay interference and further tests were performed. We used Heteroblock tubes and PEG precipitation to eliminate the interference and the hormone levels post treatment were in the normal range. We believe the interference was caused by high serum levels of rheumatoid factor. Although he was treated with thyroxine for 3 years, we believe he may have been treated inappropriately as his Free T4 level was always normal despite high TSH due to assay interference. Our case illustrates the phenomenon of heterophilic antibody interference likely due to high levels of rheumatoid factor. It is essential for clinicians and endocrinologists in particular to be aware of this possibility when making treatment decisions in these groups of patients.

Epidemiology of Breast Cancer among Females in Basrah.

PubMed

S Habib, Omran; A Hameed, Lamis; A Ajeel, Narjis; Al-Hawaz, Mazin H; Al-Faddagh, Zaki A; N Nasr, Ghalib; Al-Sodani, Ali H; A Khalaf, Asaad; M Hasson, Hasson; Lname, Aida A; Abdul-Samad, Fname

2016-01-01

Breast cancer is the most frequent cancer in females. Its incidence is higher in developed countries than in developing ones partly due to variation in risk exposure and partly due to better detection methods. Scattered evidence in Basrah, Iraq, suggests that breast cancer has been increasing at a significant pace in recent years. This study aimed to measure the current level of risk of breast cancer among females in Basrah and to describe the time trend over almost a decade of years. Data on breast cancer cases from all sources of cancer registration in Basrah governorate were compiled for the years 2005-2012. The data for each year were first checked separately for duplicate reporting of cases among various sources. Then the eight files were pooled together and checked again for any duplicate cases among years of registration. The final set of data contained 2,284 cases of breast cancer (2,213 female cases and 71 male cases). All patients were inhabitants of Basrah governorate at the time of diagnosis. Figures on the Basrah population were obtained from various sources including the Ministry of Health, Ministry of Planning and Developmental Collaboration and local household surveys. It was possible to have total population estimates for each year and by age and sex. The data were imported into SPSS (version 17) software. Age specific and year specific incidence rates were calculated. The age standardized incidence rate was also calculated using world population as the standard population to be 34.9 per 100,000 females. Age-wise, no case was reported among children aged less than 15 years and the incidence increased with advancing age reaching a peak of 123.8/100,000 females at the age range of 50-54 years. The time trend of the crude incidence rate showed only modest increased risk with passage of years and no age shift could be documented in this study. Breast cancer in females in Basrah is a significant health problem. The current incidence rate (crude, 23.7/100,000, age-standardized, 34.9/100,000) is high and justifies intensive efforts to improve early detection of cases, provide better treatment amenities and introduce long term preventive measures. Using the age standardized incidence rate as reported in this paper, it is possible to put the risk in Basrah within a regional and international context.

On KEK B-Factory

NASA Astrophysics Data System (ADS)

Sugawara, H.

2009-07-01

There are two principles which the management of a research institute like KEK must respect when dealing with such big project as B-Factory. One is the scientific merit of the project and the other is the organizational consideration which includes financial, human, technical and historical elements. Ideally, the two principles are to be fully taken into account. But, in many cases, one or the other is only partially fulfilled due to unavoidable circumstances. The lack of flexibility to respond to all possible situations is more dangerous and may lead to a disaster as in the case of SSC. I will describe the process which lead to the successful construction, operation and physics presentations of KEK B-Factory following faithfully the official records.

Cocaine-related oronasal communication and hard palate destruction.

PubMed

Silvestre, Francisco Javier; Salort-Llorca, Cesar; Mínguez-Serra, Maria Paz; Silvestre-Rangil, Javier

2012-05-01

Four cases of midpalatal perforation in cocaine abusers are presented. Other potential etiological processes are discussed to establish an adequate differential diagnosis. These patients were treated at our department, due to the drawback promoted by the establishment of oronasal communication that was provided after an accurate diagnosis. Histopathological evaluation of the lesion margins were conducted in two of the four cases, and yielded no evidence of vasculitis or active cocaine abuse. Therapeutic approach consisted of reconstructive surgeries and/or sealing prostheses. Histological assessment of oronasal communication margins could be useful in establishing the persistence of active addiction, and also as a complementary tool for planning possible treatment. © 2011 Blackwell Publishing Asia Pty Ltd.

A Comparative Study Environmental and Radiological Causes Of Cancer In River Nile State, Sudan

NASA Astrophysics Data System (ADS)

Hamid, Eyad; Khair, Hatim

The causes of cancer in River Nile state are differ between environmental and radiological, this paper tried to make comparison between the two causes, to determine the real cause behind the large rising of cancer cases in this state, considering the daily habits for the patients and the possible contamination in the natural resources around them. The noticeable thing that most of cancer cases are might be due to the high concentration of nitrate pollutant detected in natural resources such as drinking water; also by looking to the radioactive elements we see there's high concentration of some radioactive elements specially the K-40 which found in Portulaca Oleracea.

Dissociative Identity Disorders in Korea: Two Recent Cases.

PubMed

Kim, Ilbin; Kim, Daeho; Jung, Hyun-Jin

2016-03-01

Although dissociative identity disorder (DID), the most severe of the dissociative disorders, has retained its own diagnostic entity since its introduction in the DSM-III, cases of DID are rarely seen in South and East Asia, likely due to the higher prevalence of possession disorder. We report two patients with DID who were recently admitted to our inpatient psychiatric unit and demonstrated distinct transitions to several identities. Their diagnoses were confirmed through a structured interview for dissociative disorders and possible differential diagnoses were ruled out by psychological, neuroimaging, and laboratory tests. The rapid transition to a Westernized, individualized society along with an increase in child abuse, might contribute to an increase in DID, previously under-diagnosed in this region.

Diagnosis of gynecological pseudoaneurysms and embolization with cyanoacrylate.

PubMed

Fernández Bermúdez, M J; Fernández Martínez, A M; Domitrovic, L A; Balboa Arregui, Ó

Pseudoaneurysms of the uterine artery are an uncommon cause of severe gynecological bleeding secondary to surgical manipulation of the pelvis or to instrumental delivery. The different imaging techniques are of vital importance in the diagnosis. Angiography is the technique used for confirmation and also for treatment in many cases. Endovascular treatment by embolizing the pseudoaneurysm has become established as the treatment of choice, making it possible to avoid hysterectomy in women of childbearing age. This article presents two cases of gynecological bleeding due to pseudoaneurysms (one secondary to surgery and one secondary to childbirth) that were embolized in a novel way using cyanoacrylate. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

A fatal trip with ecstasy: a case of 3,4-methylenedioxymethamphetamine/3,4- methylenedioxyamphetamine toxicity.

PubMed Central

Coore, J R

1996-01-01

Since the late 1980s there have been a number of reports about the complications associated with using the designer drug 3,4-methylenedioxymethamphetamine (MDMA) or 'ecstasy'. Although this drug has been widely abused in the past, the potentially fatal complications have arisen recently mainly due to the circumstances of its use at all-night dance sessions or 'raves'. A combination of direct toxicity and strenuous physical exertion can lead to hyperthermia and its attendant complications. The following case illustrates some of the possible consequences following ingestion of 'ecstasy', and reiterates the importance of prompt recognition and treatment in preventing the development of irreversible sequelae. PMID:8709087

Allergic axillary dermatitis due to hydrogenated castor oil in a deodorant.

PubMed

Taghipour, Kathy; Tatnall, Frances; Orton, David

2008-03-01

We present a case of axillary dermatitis caused by hydrogenated castor oil (HCO) in a commercially available deodorant. Patch testing with constituents obtained from the manufacturer showed allergic reaction to HCO 'as is', whereas there was no reaction to HCO 30% in pet. Testing 10 controls with HCO 'as is' did not cause irritant contact dermatitis. Allergic contact dermatitis to non-HCO in cosmetics has been described previously but sensitization to HCO seems to be rare. Most common allergens identified in deodorants are fragrances, and this case illustrates that HCO is another possible allergen found in this group of personal care products. It is important that it is tested 'as is' to avoid false-negative results.

[The management of asymptomatic bacteriuria in different patient population].

PubMed

Ivanov, M-L; Malinverni, R

2008-11-12

Who should be screened for asymptomatic bacteriuria (AB) and who should be treated? This review updates some aspects of the management of AB in different patient populations. A systematic screening for AB is recommended for pregnant women because of a significant risk of complications. In these cases as well as before any uro-gynecologic surgical procedure treatment of AB is strongly recommended. The management of AB in immunosuppressed or transplanted patients is more controversial. In other populations treating AB is not recommended and the outcome seems to be worse in case of treatment due to possible side effects and selection of resistant organisms. Recent studies have shown a considerable gap between clinical practice and recommendations.

[Neonatal diabetes mellitus].

PubMed

Gurgel, Lucimary C; Moisés, Regina S

2008-03-01

Neonatal diabetes is a rare condition characterized by hyperglycemia, requiring insulin treatment, diagnosed within the first months of life. The disorder may be either transient, resolving in infancy or early childhood with possible relapse later, or permanent in which case lifelong treatment is necessary. Both conditions are genetically heterogeneous; however, the majority of the cases of transient neonatal diabetes are due to abnormalities of an imprinted region of chromosome 6q24. For permanent neonatal diabetes, the most common causes are heterozygous activating mutations of KCNJ11, the gene encoding the Kir6.2 sub-unit of the ATP-sensitive potassium channel. In this article we discuss the clinical features of neonatal diabetes, the underlying genetic defects and the therapeutic implications.

Adult-onset demodicosis in two dogs due to Demodex canis and a short-tailed demodectic mite.

PubMed

Saridomichelakis, M; Koutinas, A; Papadogiannakis, E; Papazachariadou, M; Liapi, M; Trakas, D

1999-11-01

Infestation with a short-tailed demodectic mite and Demodex canis was diagnosed in both a six-and-a-half-year-old and a four-year-old dog. The clinical picture was compatible with generalised demodicosis complicated by staphylococcal pyoderma (case 1), or localised demodicosis (case 2). In both cases, the short-tailed demodectic mite outnumbered D canis in superficial skin scrapings. The laboratory findings (lymphopenia, eosinopenia, increased serum alkaline phosphatase and alanine aminotransferase activities, diluted urine and proteinuria) and the results of a low dose dexamethasone suppression test were suggestive of underlying hyperadrenocorticism in the first case. Hypothyroidism was considered a possibility in the second case, owing to the sustained bradycardia and the extremely low basal total thyroxine value. Systemic treatment with ivermectin and cephalexin (case 1), or topical application of an amitraz solution in mineral oil, along with sodium levothyroxine replacement therapy (case 2), resulted in a complete resolution of the skin lesions and the disappearance of both types of demodectic mite after two and one and a half months, respectively.

Conjoined twins and legal authorization for abortion.

PubMed

Nomura, Roseli Mieko Yamamoto; Brizot, Maria de Lourdes; Liao, Adolfo Wenjaw; Hernandez, Wagner Rodrigues; Zugaib, Marcelo

2011-01-01

To describe pregnancies with conjoined twins according to the request for legal termination of pregnancy. Retrospective review of pregnancies with conjoined twins, with no possibility of extrauterine survival or postnatal surgical separation, observed at a tertiary teaching hospital, between 1998 and 2010. Amongst 30 cases seen during the study period, six (20.0%) couples decided to continue with the pregnancy, termination of pregnancy was not requested due to advanced gestational age (> 25 weeks) in 5 cases (16.7%). Legal authorization to terminate the pregnancy was requested in 19 (63.3%) cases: permission was granted in 12 (63.2%), denied in five (26.3%) and information was missing in two (10.5%) cases. A successful vaginal delivery was performed in 83.3% of the cases undergoing termination of pregnancy and a cesarean section was performed in all the remaining cases (p < 0.01). In pregnancies with conjoined twins and without fetal prognosis, legal termination of the pregnancy is an alternative. Moreover, a successful vaginal delivery can be performed in most cases before the third trimester, further reducing maternal risks and parental suffering.

Low-grade extraskeletal osteosarcoma of the chest wall: case report and review of literature.

PubMed

Sabatier, Renaud; Bouvier, Corinne; de Pinieux, Gonzague; Sarran, Anthony; Brenot-Rossi, Isabelle; Pedeutour, Florence; Chetaille, Bruno; Viens, Patrice; Weiller, Pierre-Jean; Bertucci, François

2010-11-24

Low-grade extraskeletal osteosarcomas (ESOS) are extremely rare. We present the first case of low-grade ESOS of the chest wall, which occurred in a 30-year-old man. Because of initial misdiagnosis and patient's refusal of surgery, the diagnosis was done after a 4-year history of a slowly growing mass in soft tissues, leading to a huge (30-cm diameter) calcified mass locally extended over the left chest wall. Final diagnosis was helped by molecular analysis of MDM2 and CDK4 oncogenes. Unfortunately, at this time, no surgical treatment was possible due to loco-regional extension, and despite chemotherapy, the patient died one year after diagnosis, five years after the first symptoms. We describe the clinical, radiological and bio-pathological features of this unique case, and review the literature concerning low-grade ESOS. Our case highlights the diagnostic difficulties for such very rare tumours and the interest of molecular analysis in ambiguous cases.

An autopsy case of acetyl fentanyl intoxication caused by insufflation of 'designer drugs'.

PubMed

Takase, Izumi; Koizumi, Takako; Fujimoto, Ihoko; Yanai, Aya; Fujimiya, Tatsuya

2016-07-01

We present a fatal case of intoxication due to insufflation of acetyl fentanyl. His blood concentration of acetyl fentanyl was 270ng/mL, and the manner of death was classified as an accident. This is the first report of an autopsy case of acetyl fentanyl delivered by insufflation, rather than intravenous administration. He had been snoring loudly for at least 12h prior to death, and transport to a hospital during this time and treatment with naloxone may have saved his life. In this sense, it can be said that his death was preventable. This case reemphasizes the risk of death associated with drug overdose and the narrow range of acetyl fentanyl between the effective dose (ED50) and lethal dose (LD50). The case should also raise awareness among medical professionals of the effectiveness of naloxone and the need to establish a comprehensive system for toxicological analysis while keeping the possibility of use of 'designer drugs' in mind. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Plasmapheresis for Preventing Complication of Hypertriglyceridemia: A Case Report and Review of Literature.

PubMed

Costantini, Nicoletta; Mameli, Antonella; Marongiu, Francesco

2016-01-01

Severe hypertriglyceridemia is a common indication for the need of plasma exchange in treatment of hypertriglyceridemic-induced pancreatitis when normal therapies fail to garner a response. Application of plasmapheresis to prevent complication of hypertriglyceridemia is limited because of its cost and availability. We present a case of a 44-year-old man with metabolic syndrome and a medical history of secondary polycythemia in obesity hypoventilation syndrome, whose laboratory tests revealed a triglycerides value of 3965 mg/dL. To prevent the complication of pancreatitis due to hypertriglyceridemia, we performed plasma exchange 3 times when conventional treatments did not sufficiently reduce the high level of triglycerides. A review of the current available literature was therefore conducted to provide an overview of the present data on apheretic treatment for patients with severe hypertriglyceridemia. Several case reports and case series have used plasmapheresis in acute treatment of hypertriglyceridemia pancreatitis related. In our case, the choice of plasmapheresis was applied in prevention of possible complications of hypertriglyceridemia.

Antiviral therapy in cytomegalovirus-positive ulcerative colitis: A systematic review and meta-analysis

PubMed Central

Kopylov, Uri; Eliakim-Raz, Noa; Szilagy, Andrew; Seidman, Ernest; Ben-Horin, Shomron; Katz, Lior

2014-01-01

AIM: To evaluate the impact of antiviral treatment on cytomegalovirus (CMV)-positive ulcerative colitis patients. METHODS: We performed a systematic review and meta-analysis (MA) of comparative cohort and case-control studies published between January 1966 and March 2013. Studies focusing on colectomy series and studies including only less than 3 patients in the treated or non-treated arm were excluded. The primary outcome was colectomy within 30 d of diagnosis. Secondary outcomes included colectomy during the follow-up period Subgroup analyses by method of detection of CMV, study design, risk of bias and country of origin were performed. Quality of studies was evaluated according to modified New-Castle Ottawa Scale. RESULTS: After full-text review, nine studies with a total of 176 patients were included in our MA. All the included studies were of low to moderate quality. Patients who have received antiviral treatment had a higher risk of 30-d colectomy (OR = 2.40; 95%CI: 1.05-5.50; I2 = 37.2%). A subgroup analysis including only patients in whom CMV diagnosis was based did not demonstrate a significant difference between the groups (OR = 3.41; 95%CI: 0.39-29.83; I2 = 56.9%). Analysis of long-term colectomy rates was possible for 6 studies including 110 patients. No statistically significant difference was found between the treated and untreated groups (OR = 1.71; 95%CI: 0.71-4.13; 6 studies, I2 = 0%). Analysis of mortality rate was not possible due to a very limited number of cases. Stratification of the outcomes by disease severity was not possible. CONCLUSION: No positive association between antiviral treatment and a favorable outcome was demonstrated. These findings should be interpreted cautiously due to primary studies’ quality and potential biases. PMID:24627606

Antiviral therapy in cytomegalovirus-positive ulcerative colitis: a systematic review and meta-analysis.

PubMed

Kopylov, Uri; Eliakim-Raz, Noa; Szilagy, Andrew; Seidman, Ernest; Ben-Horin, Shomron; Katz, Lior

2014-03-14

To evaluate the impact of antiviral treatment on cytomegalovirus (CMV)-positive ulcerative colitis patients. We performed a systematic review and meta-analysis (MA) of comparative cohort and case-control studies published between January 1966 and March 2013. Studies focusing on colectomy series and studies including only less than 3 patients in the treated or non-treated arm were excluded. The primary outcome was colectomy within 30 d of diagnosis. Secondary outcomes included colectomy during the follow-up period Subgroup analyses by method of detection of CMV, study design, risk of bias and country of origin were performed. Quality of studies was evaluated according to modified New-Castle Ottawa Scale. After full-text review, nine studies with a total of 176 patients were included in our MA. All the included studies were of low to moderate quality. Patients who have received antiviral treatment had a higher risk of 30-d colectomy (OR = 2.40; 95%CI: 1.05-5.50; I² = 37.2%). A subgroup analysis including only patients in whom CMV diagnosis was based did not demonstrate a significant difference between the groups (OR = 3.41; 95%CI: 0.39-29.83; I² = 56.9%). Analysis of long-term colectomy rates was possible for 6 studies including 110 patients. No statistically significant difference was found between the treated and untreated groups (OR = 1.71; 95%CI: 0.71-4.13; 6 studies, I² = 0%). Analysis of mortality rate was not possible due to a very limited number of cases. Stratification of the outcomes by disease severity was not possible. No positive association between antiviral treatment and a favorable outcome was demonstrated. These findings should be interpreted cautiously due to primary studies' quality and potential biases.

[Sudden death due to acute coronary insufficiency].

PubMed

Mazur, N A; Zhukov, V N

1976-01-01

The study was conducted in the course of 2 years in accordance with the programme of myocardial infarction register of all mortality cases among the inhabitants of one of the Moscow districts. In conformity with the criteria recommended by the WHO Expert Committee, general figures of sudden death incidence at the age of 20 to 64 years comprised 80.3--76.2 and 32.7--34.5 per 100,000 males and females, respectively, during the 1st and 2nd year of observation. Autopsies performed in 89.5% of the mortality cases established that only in 39.8% of the cases death ensued in the presence of fresh foci of necrosis in the myocardium, while in the rest no myocardial infarction was found. In an overwhelming majority of the dying patients severe stenoses or occlusions of the coronary arteries were seen, and only 13% had no stenoses. However, the latter group showed fresh necroses or postinfarction cicatrices in the myocardium. The obtained data indicate that sudden death occupies an important place in the structure of mortality in ischaemic heart disease. It has been demonstrated that no reduction of general mortality due to myocardial infarction is possible without effective measures against this kind of death.

Rare angioproliferative tumors mimicking aggressive spinal hemangioma with epidural expansion.

PubMed

Kulcsár, Zsolt; Veres, Róbert; Hanzély, Zoltán; Berentei, Zsolt; Marosfoi, Miklós; Nyáry, István; Szikora, István

2012-01-30

We present two cases of angio-proliferative tumors that were misdiagnosed and treated as typical hemangiomas with epidural expansion. Two middle-aged women presented with symptoms and radiological signs characteristic for aggressive hemangioma with epidural expansion. In the first case preoperative embolization and decompressive surgery with open transpedicular vertebroplasty was performed. Within less than a year, epidural recurrence of the tumor prompted for radical excision and corpectomy. The diagnosis after the histological studies and the further clinical evolution was metastasizing leiomyomatosis. No further recurrence occured during the next 6 years. In the second case percutaneous vertebroplasty was performed and complicated by epidural polymethyl-methacrylcate (PMMA) leakage, requiring urgent decompressive surgery. Histological study of the lesion raised the possibility of myopericytoma. This was confirmed 16 months later when complete vertebrectomy was performed due to severe epidural propagation of the recurring tumor. No further recurrence occurred in next the two years. Rare angio-proliferative tumors, like benign metastasizing leiomyoma and myopericytoma radiologically may resemble aggressive vertebral hemangiomas of the spine. Unlike hemangiomas, such tumors require radical removal due to their likely recurrence. As imaging studies may not be able to completely exclude such pathologies, bone biopsy and thorough histopathological studies are warranted prior to the therapeutic decision.

Sudden perinatal death due to rupture of congenital cardiac diverticulum. Pathological findings and medico-legal investigations in malpractice charge.

PubMed

Marchesi, Matteo; Boracchi, Michele; Gentile, Guendalina; Maghin, Francesca; Zoja, Riccardo

2017-09-01

Congenital diverticula of the left ventricle, very rare malformations, are determined by an abnormal embryonic development of the ventricular wall and can be isolated or associated to other cardiac anomalies. In most of the cases, these pathologies are not symptomatic and in some patients can be associated to ventricular arrhythmia, cardiac rupture with tamponade and sudden death. Authors are presenting the case of a sudden death in an 8-weeks-old newborn due to rupture of a cardiac congenital diverticulum of the left ventricle, discovered only at the moment of the autopsic examination. The parents of the victim pressed charges against the medical staff that was appointed to the cares, blaming them with malpractice. The missed diagnosis of a cardiac congenital diverticulum of the left ventricle, a rare pathology, reflects the trickiness of the medical management that can lead to medico-legal controversies and, even though such rare conditions must be always taken into consideration when investigating possible dysfunction causing the death, diagnostic difficulties, in the case in exam, justify the missed diagnosis intra-vitam of cardiac ventricular diverticulum. Copyright © 2017 Elsevier B.V. All rights reserved.

Dual-wavelength recording, a simple algorithm to eliminate interferences due to UV-absorbing substances in capillary electrophoresis.

PubMed

Seaux, Liesbeth; Van Houcke, Sofie; Dumoulin, Els; Fiers, Tom; Lecocq, Elke; Delanghe, Joris R

2014-08-01

Analytical interferences have been described due to the presence of various exogenous UV-absorbing substances in serum. Iodine-based X-ray contrast agents and various antibiotics have been reported to interfere with interpretation of serum protein pherograms, resulting in false diagnosis of paraproteinemia. In the present study, we have explored the possibility of measuring UV absorbance at two distinct wavelengths (210 and 246 nm) to distinguish between true and false paraproteins on a Helena V8 clinical electrophoresis instrument. This study demonstrates that most substances potentially interfering with serum protein electrophoresis show UV-absorption spectra that are distinct from those of serum proteins. Scanning at 246 nm allows detection of all described interfering agents. Comparing pherograms recorded at both wavelengths (210 and 246 nm) enables to distinguish paraproteins from UV-absorbing substances. In case of a true paraprotein, the peak with an electrophoretic mobility in the gamma-region decreases, whereas the X-ray contrast media and antibiotics show an increased absorption when compared to the basic setting (210 nm). The finding of iodine-containing contrast media interfering with serum protein electrophoresis is not uncommon. In a clinical series, interference induced by contrast media was reported in 54 cases (of 13 237 analyses), corresponding with a prevalence of 0.4%. In the same series, 1631 true paraproteins (12.3%) were detected. Implementation of the proposed algorithm may significantly improve the interpretation of routine electrophoresis results. However, attention should still be paid to possible interference due to presence of atypical proteins fractions (e.g., tumor markers, C3). © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

[Pregnancy (conception) in hyper- or hypothyroidism].

PubMed

Corssmit, E P; Wiersinga, W M; Boer, K; Prummel, M F

2001-04-14

Pregnancy is accompanied by changes in thyroid function. Due to the increased synthesis of thyroid binding globulin and the thyroid-stimulating effect of human chorionic gonadotrophin (hCG), serum concentrations of thyroid hormones will increase in the first trimester of pregnancy (total T4, T3). Free T4 levels decrease during the latter half of pregnancy. Hyperthyroidism during pregnancy is usually due to Graves' disease. Definitive therapy may be considered for cases prior to pregnancy, although a medical management as would be given during pregnancy is an equally good option. The medical management of hyperthyroidism consists of a monotherapy with thyreostatics in which the recommended dose needs to be adjusted on the basis of free T4 in the high-normal and thyroid stimulating hormone (TSH) in the low-normal area so as to minimise the risk of foetal hypothyroidism. The transplacental passage of maternal TSH receptor stimulating antibodies may cause foetal hyperthyroidism. Another cause of maternal hyperthyroidism during pregnancy is 'gestational transient thyrotoxicosis', which is associated with high hCG levels during the first trimester of pregnancy. It is nearly always accompanied by hyperemesis gravidarum. Hypothyroidism in pregnancy has negative consequences for the foetus. If the hypothyroidism is apparent prior to pregnancy, it should be corrected before conception (target TSH value of 1 mU/l). If discovered during pregnancy, treatment with levothyroxine should be started as soon as possible. In the case of a pre-existing hypothyroidism a 25-50% increase in the levothyroxine dosage is often needed during the first trimester of pregnancy. This is possibly due to an increased requirement. An adequate serum concentration of T4 is necessary for foetal brain development.

A rockfall hazard assessment for a residential area by using 2D and 3D simulation models: A case study from North Turkey

NASA Astrophysics Data System (ADS)

Akgün, Aykut; Yakut, Mehmet

2017-04-01

Rockfalls are one of the most common and important mass movement type encountered throughout both the World and Turkey. In Turkey, especially in Black Sea Region, rock fall cases frequently occur due to the steep topography, lithological characteristics, improper land use and structural elements such as discontinuity density. As a consequence of rock fall cases, serious injury and loss of lives can be observed in the area. In this study, a residential area located in Trabzon city (Northeast part of Black Sea Region, Turkey) was handled in point of rock fall hazard assessment. In the area, several rock fall cases occurred, and one of them occurred in year of 2009, resulted two people died. The last one also occurred in year of 2016, and the source of both cases are the same location. In the area, several houses and working places are available, and up to now any effective protection measurements have been installed. The area is also located near a highway connecting Trabzon city to the southeast region of Turkey, and daily vehicle number is highly considerable. Due to all these sensitive issues, the area was selected to be study location. In order to make a rock fall hazard assessment in the area to determine and propose an effective mitigation system, a 2D and 3D simulation models were applied. Initially a digital elevation model (DEM) of the area was obtained by a 1:1000 scale digital topographical sheets. By using the obtained digital terrain data, detailed cross sections of the slope profiles were created. Then, a detailed field and photo survey was carried out to detect the dangerous and hanging rock blocks that may be source for a possible rock fall cases. The physico-mechanical properties of the intact rock material were determined so that they can be used to be input parameters for the rock fall simulation models. To create simulation models, Rocfall 6.0®, Rockfall Analyst for ArcGIS and CONEFALL softwares were used. Using the Rockfall Analyst extension for ArcGIS and CONEFALL software, propagation and runout distances of possible rock fall cases were evaluated. By Rocfall 6.0® software, possible rock fall paths and proper mitigation measurements such as protection barriers or ditches were also assessed. At the end of the assessment processes, a detailed rock fall hazard map was produced for the area. With the help of this map, an important extent of area was determined to be under rock fall threat. This obtained map is also expected to be considered by the local governmental authorities to make persistent hazard mitigation measurements in the area. Keywords: Rock fall, simulation, hazard, Turkey

Human rabies due to lyssavirus infection of bat origin.

PubMed

Johnson, N; Vos, A; Freuling, C; Tordo, N; Fooks, A R; Müller, T

2010-05-19

Rabies is a fatal viral encephalitis and results from infection with viruses belonging to the genus Lyssavirus. Infection usually results from a bite from a dog infected with classical rabies virus. However, a small number of cases result from contact with bats. It is within bats that most lyssavirus variants, referred to as genotypes, are found. The lyssaviruses found in bats have a distinct geographical distribution and are often restricted to specific bat species. Most have been associated with rabies in humans and in some cases spill-over to domestic animals. Many diagnostic techniques are unable to differentiate rabies virus from other genotypes so it is possible that some human and animal cases go unreported. Furthermore, current vaccines have limited efficacy against some genotypes. Crown Copyright 2010. Published by Elsevier B.V. All rights reserved.

[Hyperkalemia-induced failure of pacemaker capture and sensing: a case report].

PubMed

Wang, Y P; Chen, B X; Su, K J; Sun, L J; Zhang, Y; Guo, L J; Gao, W

2014-12-18

Hyperkalemia may induce serious cardiac arrhythmia, with possible life-threatening effects. It may cause cardiac pacemaker (PMK) malfunctioning due to a reduction of the electronegativity of the resting myocardial potential. We report the case of a 71-year-old woman who had a previous history of chronic heart failure, chronic renal failure and DDI pacemaker. She was admitted for disturbance of consciousness. During hospitalization, she was observed for extreme hypotension, acute hyperkalemia, ventricular escape rhythm, associated with failure of pacemaker capture and sensing. She was treated with calcium chloride injection, followed by insulin/glucose and sodium bicarbonate infusions; the electrocardiogram recordings showed an correction of the PMK malfunctioning and serial improvement of the intraventricular conduction. This case supports that hyperkalemia should be closely monitored in the chronic heart failure patients combined with chronic renal failure.

Evolutionary dynamics of paroxysmal nocturnal hemoglobinuria.

PubMed

Mon Père, Nathaniel; Lenaerts, Tom; Pacheco, Jorge M; Dingli, David

2018-06-01

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal blood disorder characterized by hemolysis and a high risk of thrombosis, that is due to a deficiency in several cell surface proteins that prevent complement activation. Its origin has been traced to a somatic mutation in the PIG-A gene within hematopoietic stem cells (HSC). However, to date the question of how this mutant clone expands in size to contribute significantly to hematopoiesis remains under debate. One hypothesis posits the existence of a selective advantage of PIG-A mutated cells due to an immune mediated attack on normal HSC, but the evidence supporting this hypothesis is inconclusive. An alternative (and simpler) explanation attributes clonal expansion to neutral drift, in which case selection neither favours nor inhibits expansion of PIG-A mutated HSC. Here we examine the implications of the neutral drift model by numerically evolving a Markov chain for the probabilities of all possible outcomes, and investigate the possible occurrence and evolution, within this framework, of multiple independently arising clones within the HSC pool. Predictions of the model agree well with the known incidence of the disease and average age at diagnosis. Notwithstanding the slight difference in clonal expansion rates between our results and those reported in the literature, our model results lead to a relative stability of clone size when averaging multiple cases, in accord with what has been observed in human trials. The probability of a patient harbouring a second clone in the HSC pool was found to be extremely low ([Formula: see text]). Thus our results suggest that in clinical cases of PNH where two independent clones of mutant cells are observed, only one of those is likely to have originated in the HSC pool.

A systematic review of NSAIDs withdrawn from the market due to hepatotoxicity: lessons learned from the bromfenac experience.

PubMed

Goldkind, Lawrence; Laine, Loren

2006-04-01

Drug-induced hepatotoxicity is the leading cause of acute liver failure (ALF) in the US and the most common adverse event causing drug non-approval and drug withdrawal by the U.S. Food and Drug Administration (FDA). Three different nonsteroidal anti-inflammatory drugs (NSAIDs) have been withdrawn in the UK and/or the US due to hepatotoxicity (bromfenac, ibufenac, and benoxaprofen). A systematic review of clinical trials data for these drugs was performed in an effort to identify possible early signals that could have predicted post-marketing serious hepatoxicity. There were very limited published data on benoxaprofen and none on ibufenac or bromfenac. The publicly accessible archives of the FDA provided information on bromfenac. Flu-like symptoms associated with hepatic enzyme elevation and a case of possible drug-related hepatocellular jaundice may in retrospect have been signals for serious hepatotoxicity in the database of 1195 subjects reviewed by the FDA. Following approval, rates of acute liver failure for bromfenac were estimated to be in the range of 1:10 000. In addition, the safety databases of several drugs also accessed through FDA archives have been reviewed (simvastatin, tacrine, troglitazone, and ximelagatran). These data suggest that while ALT elevations alone do not reliably signal serious hepatotoxicity, elevated transaminases in association with symptomatic hepatitis or jaundice may be predictors of an increased risk of ALF. At present, however, pre-approval databases are generally not large enough to rule out low rates of serious hepatotoxicity. Therefore, it remains critical that clinicians report such cases to the FDA through the MEDWATCH system and that active post-marketing monitoring studies be used to identify potential rare cases of hepatotoxicity. Copyright (c) 2006 John Wiley & Sons, Ltd.

Cross-border cooperation potential in fostering redevelopment of degraded border areas - a case study approach.

NASA Astrophysics Data System (ADS)

Alexandre Castanho, Rui; Ramírez, Beatriz; Loures, Luis; Fernández-Pozo, Luis; Cabezas, José

2017-04-01

Border interactions have reached unprecedented levels in recent decades, not only due to their potential for territorial integration but also considering their role in supranational processes, such as landscape reclamation, infrastructure development and land use planning on European territory. In this scenario, successful examples related to the redevelopment of degraded areas have been showing positive impacts at several levels, such as the social, economic, environmental and aesthetic ones which have ultimately related this process, positively, to sustainability issues. However, concerning to border areas, and due to their inherent legislative and bureaucratic conflicts, the intervention in these areas is more complex. Still, and taking into account previously developed projects and strategies of cross-border cooperation (CBC) in European territory it is possible to identified that the definition of common master plans and common objectives are critical issues to achieve the desired territorial success. Additionally, recent studies have put forward some noteworthy ideas highlighting that it is possible to establish a positive correlation between CBC processes and an increasing redevelopment of degraded border areas, with special focus on the reclamation of derelict landscapes fostering soil reuse and redevelopment. The present research, throughout case study analysis at the Mediterranean level - considering case studies from Portugal, Spain, Monaco and Italy - which presents specific data on border landscape redevelopment, enables us to conclude that CBC processes have a positive influence on the potential redevelopment of degraded border areas, considering not only urban but also rural land. Furthermore, this paper presents data obtained through a public participation process which highlights that these areas present a greater potential for landscape reclamation, fostering resource sustainability and sustainable growth. Keywords: Spatial planning; Land degradation; Redevelopment; Cross-border cooperation (CBC); Land use.

[Myeloproliferative disorders due to the use of gasoline as a solvent: report of three cases].

PubMed

Bernardini, P; Giannandrea, F; Voso, Maria Teresa; Sica, Simona

2005-01-01

Health effects of occupational exposure to benzene are currently a problem, despite the fact that preventive measures have been in existence in Italy for more than 40 years. To describe three recent cases of severe haematological disease presumably induced by an occupational exposure to benzene. Exposure occurred as a result of contact with ordinary automobile petrol used as a solvent-degreaser for metal parts. Clinical diagnosis was performed using standard immuno-phenotypic and morphological criteria; the hypothesis of an occupational origin was derived from analysis of the occupational histories. The first case was a 59 year-old blacksmith suffering from acute myeloid leukaemia (AML) FAB M2, who had used petrol for 36 years to degrease the forged metal parts before painting them. The second was a 53 year-old mechanic with AML FAB M3 who had used petrol for 15 years to degrease mechanical parts of tanker motors. The third was an 82 year-old car mechanic suffering from idiopathic myelofibrosis since the age of 75, who had used petrol to degrease mechanical car motor parts for 42 years. In all three cases, the environmental hygiene measures necessary to limit inhalation or skin contact were not followed and, at times, in the case of the two mechanics, the petrol was siphoned by mouth; so there was substantial exposure to the 1-5% benzene present in the petrol. Latency of the disease was between 30-50 years from start of exposure, and between 3-17 years following cessation of exposure. The cases described indicate that the myelotoxic effects of benzene are still a problem. They were the consequence of improper use of petrol, due to total misinformation of the risks involved in such use. It is not possible to ascertain whether the cases presented are a casual aggregation or if the use of petrol as a solvent is more common than is normally believed; in the latter case two questions must be asked: is a "normal" occupational history able to discover such an uncommon risky condition of exposure? If it cannot, how many cases of benzene-related diseases escape aetiological diagnosis? It is not possible to provide precise answers but efforts should be made to improve the quality of information about the risks of petrol. Furthermore, in all cases of haematological disease potentially related to benzene, any form of contact with petrol, even if uncommon, should be carefully researched.

Treatment of elephantiasis of the leg by fasciotomy and lymphangiectomy with skin preservation in a resource-limited setting: a case report and review.

PubMed

Kibadi, K

2018-02-01

The author reports the surgical management of a patient with elephantiasis of the leg in the Democratic Republic of Congo. A fasciotomy and lymphangiectomy with skin preservation, combined with compression therapy, resulted in significant cosmetic, functional, and social improvement. Although challenging in a resource-limited setting, development of surgical management may make it possible to reduce beliefs that elephantiasis is incurable or due to witchcraft and may reduce time to consultation.

Red Eccrine Chromhidrosis with Review of Literature

PubMed Central

Jaiswal, Ashok Kumar; Ravikiran, Shilpashree P; Roy, Prasoon Kumar

2017-01-01

A 22-year-old male presented with reddish discoloration of the vest following perspiration for 6 months. He was a habituated consumer of cranberry juice. The peak absorption on spectrophotometric analysis of the extracted sweat coincided approximately with the peak absorption of diluted distillate of the juice. A diagnosis of eccrine chromhidrosis, probably due to the coloring agents in the juice, was considered. This rare case report emphasizes the possible side effect of the various coloring agents used as food additives. PMID:29263551

Multidetector CT diagnosis of massive hemobilia due to gallbladder polyposis in a child with metachromatic leukodystrophy.

PubMed

Wanner, Matthew R; Karmazyn, Boaz; Fan, Rong

2015-12-01

Hemobilia secondary to gallbladder polyposis is rare in children but has been reported in a few children with metachromatic leukodystrophy. We present a case with preoperative multidetector computed tomography (MDCT) diagnosis of massive hemobilia caused by gallbladder polyposis in a patient with metachromatic leukodystrophy. Our report highlights the importance of both awareness of the association of gallbladder polyposis with other syndromes such as metachromatic leukodystrophy as well as the possibility of this entity presenting with life-threatening bleeding.

Malignant mixed Mullerian tumour of uterus secondary to tamoxifen therapy for hormone responsive breast cancer.

PubMed

Gupta, Mayank; Kiruthiga, Kala Gnanasekaran

2015-06-29

Tamoxifen is used in the treatment of hormone responsive breast cancer because of its antiestrogenic effect. However, it also has an estrogenic effect on the uterus, thereby increasing the risk of endometrial hyperplasia, endometrial polyp and endometrial neoplasms such as endometrial adenocarcinoma and malignant mixed Mullerian tumour (MMMT). This case describes the possible pathogenesis and risk of developing MMMT due to long-term tamoxifen intake in hormone responsive breast cancer. 2015 BMJ Publishing Group Ltd.

Lymphoedema of the upper limb: a rare complication of thyroid surgery?

PubMed Central

Stephen, Christopher; Munnoch, David Alexander

2016-01-01

A 40-year-old woman underwent an elective thyroidectomy for a non-toxic, multinodular goitre. In the early postoperative period, the patient developed a significant unilateral swelling of the right upper limb, which was subsequently confirmed to be lymphoedema. This was eventually treated successfully using liposuction and compression garment therapies. We report the case due to its rarity and present a possible explanation for such an unexpected complication based on known anatomical variations of lymphatic drainage of the upper limb. PMID:27090542

Eddy current NDE performance demonstrations using simulation tools

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maurice, L.; Costan, V.; Guillot, E.

2013-01-25

To carry out performance demonstrations of the Eddy-Current NDE processes applied on French nuclear power plants, EDF studies the possibility of using simulation tools as an alternative to measurements on steam generator tube mocks-up. This paper focuses on the strategy led by EDF to assess and use code{sub C}armel3D and Civa, on the case of Eddy-Current NDE on wears problem which may appear in the U-shape region of steam generator tubes due to the rubbing of anti-vibration bars.

Percutaneous Radiofrequency Ablation of Lung Tumors in Contact with the Aorta: Dangerous and Difficult but Efficient: A Report of Two Cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thanos, Loukas, E-mail: loutharad@yahoo.co; Mylona, Sofia; Giannoulakos, Nikolaos

Percutaneous imaging-guided tumor ablation is a widely accepted method for the treatment of primary and secondary lung tumors. Although it is generally feasible and effective for local tumor control, some conditions may affect its feasibility and effectiveness. Herein the authors report their experience with two patients with lung malignancies contiguous to the aorta who were successfully treated with radiofrequency ablation, even though it initially appeared highly risky due to the possible fatal complications.

Harlequin color change after abdominal paracentesis in a newborn with neonatal hemochromatosis.

PubMed

Cizmeci, Mehmet N; Alagoz, Demet; Avsar, Mehmet I; Alis, Gulten; Tutanc, Murat

2014-01-01

Harlequin color change is a distinctive cutaneous phenomenon presenting as a well-demarcated color change, with half of the body displaying erythema and the other half pallor. Only a few cases have been reported, possibly because of under-recognition. Recognition of this benign, self-limited condition may enable physicians to avoid unnecessary interventions. Herein we describe a neonate with nonimmune hydrops fetalis due to neonatal hemochromatosis who developed Harlequin color change after abdominal paracentesis. © 2014 Wiley Periodicals, Inc.

Gastrointestinal symptoms resembling ulcerative proctitis caused by larvae of the drone fly Eristalis tenax.

PubMed

Desoubeaux, Guillaume; Gaillard, Julien; Borée-Moreau, Diane; Bailly, Éric; Andres, Christian R; Chandenier, Jacques

2014-04-01

We report a case of facultative intestinal myiasis due to larvae of the drone fly Eristalis tenax, also named the rat-tailed maggots. The development of larvae in the lower bowel was responsible for non-specific gastrointestinal symptoms that resembled ulcerative proctitis. The diagnosis was established upon the observation of four spontaneously excreted mobile larvae. The definite identification of the E. tenax species was made possible by scanning electron microscopy. The clinical outcome was satisfactory.

Gastrointestinal symptoms resembling ulcerative proctitis caused by larvae of the drone fly Eristalis tenax

PubMed Central

Desoubeaux, Guillaume; Gaillard, Julien; Borée-Moreau, Diane; Bailly, Éric; Andres, Christian R; Chandenier, Jacques

2014-01-01

We report a case of facultative intestinal myiasis due to larvae of the drone fly Eristalis tenax, also named the rat-tailed maggots. The development of larvae in the lower bowel was responsible for non-specific gastrointestinal symptoms that resembled ulcerative proctitis. The diagnosis was established upon the observation of four spontaneously excreted mobile larvae. The definite identification of the E. tenax species was made possible by scanning electron microscopy. The clinical outcome was satisfactory. PMID:24766340

Anti-MuSK myasthenia gravis presenting with Epstein-Barr virus-associated mononucleosis and immune-mediated diabetes mellitus.

PubMed

Bhibhatbhan, Arunee; Kline, Gregory; Vincent, Angela; Toth, Cory

2007-08-01

We report a young woman with the abrupt onset of infectious mononucleosis due to Epstein-Barr virus associated with a subsequent autoimmune form of diabetes mellitus and myasthenia gravis with anti-muscle-specific kinase (MuSK) antibodies. The simultaneous onset of these two autoimmune diseases preceded by a systemic viral illness supports a causal relationship between MuSK antibodies and myasthenia gravis and suggests the possibility of a viral trigger in some cases.

Missed Total Occlusion Due to the Occipital Artery Arising from the Internal Carotid Artery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ustunsoz, Bahri, E-mail: bustunsoz2000@yahoo.com; Gumus, Burcak; Koksal, Ali

2007-02-15

A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagnosis of right proximal internal carotid artery (ICA) stenosis for possible carotid artery stenting. DSA revealed total occlusion of the ICA and an occipital artery arising from the stump and simulating continuation of the ICA. An ascending pharyngeal artery also arose from the same occipital artery. This case is of interest because this is a rare variation besides being a cause of misdiagnosis at carotid ultrasound.

The Method of Manufacturing Nonmetallic Test-Blocks on Different Sensitivity Classes

NASA Astrophysics Data System (ADS)

Kalinichenko, N. P.; Kalinichenko, A. N.; Lobanova, I. S.; Zaitseva, A. A.; Loboda, E. L.

2016-01-01

Nowadays in our modern world there is a vital question of quality control of details made from nonmetallic materials due to their wide spreading. Nondestructive penetrant testing is effective, and in some cases it is the only possible method of accidents prevention at high- risk sites. A brief review of check sample necessary for quality evaluation of penetrant materials is considered. There was offered a way of making agents for quality of penetrant materials testing according to different liquid penetrant testing sensibility classes.

Arterio-venous malformations in childhood: clinical presentation, results after operative treatment and long-term follow-up.

PubMed

Kahl, W; Kessel, G; Schwarz, M; Voth, D

1989-01-01

In a series of 182 arterio-venous malformations (AVM) recently published we found 33 children aged 1 to 16 years. In 28 cases, the admitting condition was hemorrhage. For 31 AVMs total excision was possible. We observed one postoperative death accounting for a mortality of 3%. All children but two were followed-up by personal examination. Two were not able to work due to severe neurological deficits and seven had not been able to get into their intended occupation.

A thermodynamic analysis of propagating subcritical cracks with cohesive zones

NASA Technical Reports Server (NTRS)

Allen, David H.

1993-01-01

The results of the so-called energetic approach to fracture with particular attention to the issue of energy dissipation due to crack propagation are applied to the case of a crack with cohesive zone. The thermodynamic admissibility of subcritical crack growth (SCG) is discussed together with some hypotheses that lead to the derivation of SCG laws. A two-phase cohesive zone model for discontinuous crack growth is presented and its thermodynamics analyzed, followed by an example of its possible application.

Product-oriented Software Certification Process for Software Synthesis

NASA Technical Reports Server (NTRS)

Nelson, Stacy; Fischer, Bernd; Denney, Ewen; Schumann, Johann; Richardson, Julian; Oh, Phil

2004-01-01

The purpose of this document is to propose a product-oriented software certification process to facilitate use of software synthesis and formal methods. Why is such a process needed? Currently, software is tested until deemed bug-free rather than proving that certain software properties exist. This approach has worked well in most cases, but unfortunately, deaths still occur due to software failure. Using formal methods (techniques from logic and discrete mathematics like set theory, automata theory and formal logic as opposed to continuous mathematics like calculus) and software synthesis, it is possible to reduce this risk by proving certain software properties. Additionally, software synthesis makes it possible to automate some phases of the traditional software development life cycle resulting in a more streamlined and accurate development process.

Possible induction of West syndrome by oxcarbazepine therapy in a patient with complex partial seizures.

PubMed

Veerapandiyan, Aravindhan; Singh, Piyush; Mikati, Mohamad A

2012-03-01

Oxcarbazepine has been reported to precipitate myoclonic, generalised tonic-clonic, absence, and complex partial seizures, and carbamazepine to precipitate absences, myoclonic seizures and spasms. Here, we report a one-year, six-month-old girl with complex partial seizures who developed infantile spasms, developmental regression, and hypsarrhythmia during the two weeks directly following initiation of oxcarbazepine (14 mg/kg/day). All of these resolved within a few days after discontinuation of this medication. Although we cannot rule out that the above association may have been coincidental, or that the improvement may have been due to concurrent therapy, this case raises the possibility that oxcarbazepine, like carbamazepine, may precipitate infantile spasms and West syndrome.

The possibility of establishing causes of death on the basis of the exhumed remains of prisoners executed during the communist regime in Poland: the exhumations at Powązki Military Cemetery in Warsaw.

PubMed

Szleszkowski, Łukasz; Thannhäuser, Agata; Szwagrzyk, Krzysztof; Jurek, Tomasz

2015-07-01

This study presents the results of the analysis of forensic examinations of the remains of 194 prisoners exhumed at Powązki Military Cemetery in Warsaw. In all probability, most of those buried there were judicially sentenced to death by firing squad or hanging in connection with activities of the Polish independence underground in its struggles with the postwar communist regime. Forensic medical research focussed on determining causes of death and reconstructing the mechanisms of injury leading to death. Most probable causes of death were found in 108 of 194 cases; of these, 76 were isolated gunshot wounds to the head, mostly directed to the occipital region. In 29 of 194 cases, only extensive skull fractures were observed, making it impossible to determine the mechanism of injury. The condition of these skulls do not permit the exclusion of injuries due to gunshots, which were very likely given the historical context of the studied location. In one case, it is assumed that the cause of death could be blunt force trauma to the head. In 86 of 194 cases, it was not possible to determine the cause of death. Of these cases, 20 skeletons were in such poor condition that erosive changes could have completely obliterated even very extensive head injuries leading to death. No injuries were observed that could be associated with execution by hanging.

Diagnostic dilemma in ovarian pregnancy: a case series.

PubMed

Begum, Jasmina; Pallavee, P; Samal, Sunita

2015-04-01

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.

Death from Barotrauma Due to Compressed Air: A Medico-legal Analysis.

PubMed

Giugliano, Pasquale; Massoni, Francesco; Crisci, Antonello; Ricci, Serafino

2016-11-01

Lesions of the digestive tract due to barotrauma resulting from compressed air application are not common, are rarely lethal, and largely affect the sigmoid and descending colon. Moreover, their pathogenic mechanism is a topic of discussion because these lesions have multiple characteristics. Here, the authors describe an autoptic case of death from lesions of the ascending and transverse segments, with perforations and bleeding suffusions as well as ischemic areas covered the colonic wall that was extremely thinned, congested, and hemorrhagic, with considerable flattening leading to disappearance of the mucosal folds and with numerous petechial hemorrhages. The pathological framework of lung congestion made it possible to identify the mechanism responsible for this death as depletion of the heart's pumping function, which contributed significantly to the acute respiratory failure due to respiratory distress as well as to reduced mobility of the diaphragm due to intestinal distension. Acute heart failure played an important role in this death. © 2016 American Academy of Forensic Sciences.

Progress and future prospect of in vitro spermatogenesis

PubMed Central

Ibtisham, Fahar; Wu, Jiang; Xiao, Mei; An, Lilong; Banker, Zachary; Nawab, Aamir; Zhao, Yi; Li, Guanghui

2017-01-01

Infertility has become a major health issue in the world. It affects the social life of couples and of all infertility cases; approximately 40–50% is due to “male factor” infertility. Male infertility could be due to genetic factors, environment or due to gonadotoxic treatment. Developments in reproductive biotechnology have made it possible to rescue fertility and uphold biological fatherhood. In vitro production of haploid male germ cell is a powerful tool, not only for the treatment of infertility including oligozoospermic or azoospermic patient, but also for the fertility preservation in pre-pubertal boys whose gonadal function is threatened by gonadotoxic therapies. Genomic editing of in-vitro cultured germ cells could also potentially cure flaws in spermatogenesis due to genomic mutation. Furthermore, this ex-vivo maturation technique with genomic editing may be used to prevent paternal transmission of genomic diseases. Here, we summarize the historical progress of in vitro spermatogenesis research by using organ and cell culture techniques and the future clinical application of in vitro spermatogenesis. PMID:29029549

Massive pericardial effusion without cardiac tamponade due to subclinical hypothyroidism (Hashimoto's disease).

PubMed

Papakonstantinou, Panteleimon E; Gourniezakis, Nikolaos; Skiadas, Christos; Patrianakos, Alexandros; Gikas, Achilleas

2018-05-01

Hypothyroidism is a significant cause of pericardial effusion. However, large pericardial effusions due to hypothyroidism are extremely rare. Hormone replacement therapy is the cornerstone of treatment for hypothyroidism and regular follow-up of patients after initiation of the therapy is indicated. Herein, the case of a 70-year-old woman with a massive pericardial effusion due to Hashimoto's disease is presented. A 70-year-old female from a rural village on the island of Crete, Greece, was admitted to our hospital due to a urinary tract infection. She was under hormone replacement therapy with levothyroxine 100 µg once a day for Hashimoto's disease. Two years previously, the patient had had an episode of pericarditis due to hypothyroidism and had undergone a computed tomography-guided pericardiocentesis. The patient did not have regular follow-up and did not take the hormone replacement therapy properly. On admission, the patient's chest X-ray incidentally showed a possible pericardial effusion. The patient was referred for echocardiography, which revealed a massive pericardial effusion. Beck's triad was absent. Thyroid hormones were consistent with subclinical hypothyroidism: thyroid-stimulating hormone (TSH) 30.25 mIU/mL (normal limits: 0.25-3.43); free thyroxin 4 0.81 ng/dL (normal limits: 0.7-1.94). The patient had a score of 5 on the scale outlined by the European Society of Cardiology (ESC) position statement on triage strategy for cardiac tamponade and, despite the absence of cardiac tamponade, a pericardiocentesis was performed after 48 hours. The patient was treated with 125 µg levothyroxine orally once daily. This was a rare case of an elderly female patient from a rural village with chronic massive pericardial effusion due to subclinical hypothyroidism without cardiac tamponade. Hypothyroidism should be included in the differential diagnosis of pericardial effusion, especially in a case of unexplained pericardial fluid. Initiation of hormone replacement therapy should be personalised in elderly patients. TSH levels >10 mU/L usually require therapy with levothyroxine in order to prevent adverse events. Rural patients usually do not have regular follow-up after the initiation of hormone replacement therapy. Pericardial effusions due to hypothyroidism grow slowly and subclinical hypothyroidism rarely shows signs and symptoms and can be underdiagnosed. The ESC position statement on triage strategy for pericardial diseases is a valuable clinical tool to estimate the necessity for pericardial drainage in such cases.

Bacteremia due to viridans streptococcus in neutropenic patients with cancer: clinical spectrum and risk factors.

PubMed

Bochud, P Y; Eggiman, P; Calandra, T; Van Melle, G; Saghafi, L; Francioli, P

1994-01-01

Between 1988 and 1991, 26 episodes of bacteremia due to viridans streptococci occurred in 25 neutropenic patients undergoing intensive chemotherapy for hematologic malignancies. Complications related to the bacteremia were observed in 10 episodes: unilateral pulmonary infiltrates (4), acute respiratory distress syndrome (ARDS) (4), hypotension (3), and endocarditis (2). All patients with ARDS had received high doses of cytosine arabinoside and had bacteremia due to Streptococcus mitis. Death occurred in three patients (12%) but was possibly related to bacteremia in only one case. Case patients who had received prophylaxis with quinolones were compared with matched control patients who received similar prophylaxis but who did not have bacteremia due to viridans streptococci. Multivariate analysis of predisposing factors showed that high doses of cytosine arabinoside (P = .01), the presence of mucositis (P = .02), and the absence of previous therapy with parenteral antibiotics (P = .01) were independent risk factors for the development of viridans streptococcal bacteremia. Of 259 patients who had received quinolone prophylaxis during the study period, 22 (8.5%) developed an episode of viridans streptococcal bacteremia as compared with three episodes (3.7%) in 82 patients who had received a quinolone and penicillin (P = .07). However, the latter three episodes were caused by strains with decreased susceptibility to penicillin, thus suggesting that resistance to penicillin might limit the use of this antibiotic as a prophylactic agent in the future.

[Intrauterine devices in the immediate, early and late postabortion period].

PubMed

Nun, S

1971-01-01

2146 cases of IUD insertions after hospitalization for abortion at a hospital in Chile were studied. In 1514 cases the IUDs were inserted immediately after abortion, in 430 cases between 1-5 days after the operation, and in 202 cases between 5-40 days after. It is concluded that immediate or early insertion results in a somewhat lower retention rate, but offers the advantage of making it possible to treat a greater number of patients, many of whom would not return later to have the IUD inserted. The incidence of removal for medical causes was very low and immediate insertion was found to be harmless. The medical causes of removal were the usual ones of bleeding, pain, and infection; the most frequent cause of interruption of use was expulsion, which tends to occur during the 1st few months of use and among younger women. The probability of failure due to pregnancy was somewhat higher than in the case of insertion during the intermenstrual period. Cases of voluntary removal tend to increase after prolonged use, and a study to analyze the actual reasons for this fact is necessary.

Apoptosis in subicular neurons: A comparison between suicide and Addison's disease

PubMed Central

Printha, K.; Hulathduwa, S. R.; Samarasinghe, K.; Suh, Y. H.; De Silva, K. R. D.

2009-01-01

Background: Stress and depression shows possible links to neuronal death in hippocampus. Subiculum plays a prominent role in limbic stress integration and direct effect of corticosteroids on subicular neurons needs to be defined to assess its subsequent impact on hippocampal plasticity. Aim: This study was intended to assess apoptosis in subicular neurons of a young depressed suicide victim, where presumably stress induced excess of corticosteroids and a case of young Addison's disease with low level of corticosteroids. Materials and Method: Both bilateral adrenal glands (Addison's) and subiculum (both cases) were initially stained with hematoxylin and eosin; subicular neurons of both cases were examined for the degree of apoptosis using ‘ApopTag Kit’. Apoptotic cell counts were expressed as average number of labeled cells/mm2 and the results were analysed statistically using a non-parametric Mann–Whitney U test. Result: Apoptotic neurons were detected in the subicular region of both suicide and Addison victims, and it is statistically significant in both right and left between the cases (P < 0.05). In suicide victim, the neuronal apoptosis is considerably significant between the two hemispheres (P < 0.05), in contrast to Addison disease where the number of neuronal cell death between right and left was statistically insignificant (P > 0.05). Conclusion: The present study confirms the vulnerability of the subicular neurons to apoptosis, possibly due to corticosteroids in both ends of spectrum. PMID:20048453

Study of VLCC tanker ship damage stability during off-shore operation

NASA Astrophysics Data System (ADS)

Hanzu-Pazara, R.; Arsenie, P.; Duse, A.; Varsami, C.

2016-08-01

Today, for the carriage of crude oil on sea are used larger tanker ships, especially from VLCC class. The operation of this type of ships requires in many cases special conditions, mainly related to water depth in the terminal area and enough maneuvering space for entrance and departure. Because, many ports from all over the world don't have capacity to operate this type of ships inside, in designed oil terminal, have chosen for development of outside terminals, off-shore oil terminals. In case of this type of terminals, the problems of water depth and manoeuvring space are fixed, but other kind of situations appears, regarding the safety in operation and environment factors impact on ship during mooring at oil transfer buoy. In the present paper we intend to show a study made using simulation techniques about VLCC class tanker ship in case of a damage condition resulted after a possible collision with another ship during loading operation at an off-shore terminal. From the beginning, we take in consideration that the ship intact stability, during all loading possible situations, has to be high enough, so that in case of some damage with flooding of different compartments due to hypothetical dimension water hole, the ship stability in the final stage of flooding to correspond to the requirements for damage stability and, also, to complementary requirements for damage ship stability.

Repeated Duodenal Stump Perforation Using a Stapling Device Following Subtotal Gastrectomy With Roux-en-Y Reconstruction for Advanced Gastric Cancer: Lessons From a Rare Case.

PubMed

Furihata, Tadashi; Furihata, Makoto; Satoh, Naoki; Kosaka, Masato; Ishikawa, Kunibumi; Kubota, Keiichi

2015-04-01

Closure of the duodenal stump using a stapling device is commonly applied in Roux-en-Y reconstruction after gastrectomy. However, serious and possibly fatal duodenal stump perforation can develop in extremely rare cases. We describe a case of subtotal gastrectomy with Roux-en-Y reconstruction followed by repeated duodenal stump perforations. A 79-year-old man with a long history of diabetes and hypertension was admitted to our institution with epigastralgia and right hypochondralgia. Computed tomography and an upper gastrointestinal imaging series revealed remarkable wall thickening of the gastric antrum and corpus. Upper endoscopy also showed a giant ulcerative lesion in the same area. The lesion was confirmed by histology to be poorly differentiated adenocarcinoma. The patient underwent open subtotal gastrectomy with Roux-en-Y reconstruction. However, duodenal stump perforation occurred repeatedly on postoperative days 1, 3, and 19, which caused peritonitis. The patient was kept alive through duodenal stump repair, an additional resection using a stapling device, and repeated drainage treatments; but he suffered considerable morbidity due to these complications. We report a case of a life-threatening duodenal stump perforation after subtotal gastrectomy, highlighting lessons learned from the profile and clinical course. Abdominal surgeons should be aware of the possibility of this serious complication of duodenal stump perforation, and be able to perform immediate interventions, including life-saving reoperation.

Accuracy of gravitational physics tests using ranges to the inner planets

NASA Technical Reports Server (NTRS)

Ashby, N.; Bender, P.

1981-01-01

A number of different types of deviations from Kepler's laws for planetary orbits can occur in nonNewtonian metric gravitational theories. These include secular changes in all of the orbital elements and in the mean motion, plus additional periodic perturbations in the coordinates. The first order corrections to the Keplerian motion of a single planet around the Sun due to the parameterized post Newtonian theory parameters were calculated as well as the corrections due to the solar quadrupole moment and a possible secular change in the gravitational constant. The results were applied to the case of proposed high accuracy ranging experiments from the Earth to a Mercury orbiting spacecraft in order to see how well the various parameters can be determined.

[Risk of inffective breast-feeding: a nursing diagnosis].

PubMed

Viera, Cláudia Silveira

2004-01-01

This study is aimed at presenting the 'risk of ineffective breast-feeding' nursing diagnosis regarding mothers of premature infants who are hospitalized in a neonatal Intensive Care Unit. The case study outlined the methodology of the study, and the sample is composed of 35 mothers. Such a diagnosis was detected in 100% of the sample and the risk factors are prematureness; insufficient opportunity to breast-feed due to the newborn's hospitalization; lack of knowledge regarding the maintenance of lactation; maternal fear; inconstancy of breast suction due to separation; and artificial feeding of the newborn. It is believed that the identification of the risks of ineffective breast-feeding during the newborn's hospitalization period makes possible a nursing care focused on the prevention of an 'ineffective breast-feeding' diagnosis.

Magnonic crystal as a delay line for low-noise auto-oscillators

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bankowski, Elena; Meitzler, Thomas; Khymyn, Roman S., E-mail: khiminr@gmail.com

2015-09-21

It is demonstrated that a delay line based on a one-dimensional magnonic crystal used in a feedback loop of a microwave auto-oscillator can substantially reduce the phase noise figure and improve other vital performance characteristics of the auto-oscillator. The advantage is achieved due to the increase of the effective delay time in the magnonic crystal, compared to the case of an un-patterned yttrium iron garnet (YIG) film, and improvement of the power-handling characteristics due to the now possible increase of the YIG film thickness. The internal modes of a magnonic crystal caused by the periodic energy exchange between the incidentmore » and reflected spin waves play the dominant role in the described effect.« less

Evaluation of mine fires due to spontaneous combustion in the mechanized faces of Middle Anatolian Lignite mine (OAL), case studies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gueyagueler, T.; Karaman, H.

1995-12-31

In this paper fires due to spontaneous combustion in Middle Anatolian Lignite mine (OAL) which is the first fully mechanized underground lignite mine in Turkey, are studied. Since the installation of mechanization, due to spontaneous heating, four panel fires namely, AO1, AO2, AO3 and AO4 have broken out. During these fires, the concentrations of carbon monoxide, methane and the velocity of air are measured continuously by the Micro Minos Environmental monitoring system. For each fire, the environment where fire has started is examined and the possible causes of the fire are investigated. Also the precautions taken to extinguish the firemore » at different stages are described and the importance of the early detection of mine fire are discussed together with the limitations of the monitoring system the practical difficulties observed during the fire.« less

Spontaneous uterine perforation due to clostridial gas gangrene associated with endometrial carcinoma.

PubMed

Kurashina, Ryuhei; Shimada, Hiromi; Matsushima, Takashi; Doi, Daisuke; Asakura, Hirobumi; Takeshita, Toshiyuki

2010-06-01

Few cases of clostridial gas gangrene associated with uterine malignancy have been reported. We report on a 46-year-old woman with clostridial sepsis. On the day of admission due to severe abdominal pain, peritonitis was diagnosed, and computed tomography showed free air in the abdomen. At emergency laparotomy, perforation of the necrotic uterine wall was observed. During hysterectomy, septic shock developed, and life-saving therapy was performed in the intensive care unit after surgery. Pathological examination of the necrotic uterine wall showed grade III endometrial adenocarcinoma of the uterine endometrium (International Federation of Gynecology and Obstetrics stage IIIa) with gas gangrene due to Clostridium perfringens. This report aims to alert gynecologists to the possibility that clostridial gas gangrene of the uterus can occur in patients with peritonitis and intra-abdominal free air. Early recognition and aggressive therapy can save patients' lives.

[Oxidative power and intracellular distribution of mitochondria control cell oxygen regime when arterial hypoxemia occurs].

PubMed

Liabakh, E G; Lissov, P N

2012-01-01

The regulatory impact of the mitochondria spatial distribution and enlargement in their oxidative power qO2 on the tissue oxygenation of skeletal muscle during hypoxia were studied. Investigations were performed by the mathematical modeling of 3D O2 diffusion-reaction in muscle fiber. The oxygen consumption rate VO2 and tissue pO2 were analyzed in response to a decrease in arterial blood oxygen concentration from 19.5 to 10 vol. % at a moderate load (3.5 ml/min per 100 g). The cells with evenly (case 1) and unevenly (case 2) distributed mitochondria were considered. According to calculations due to a rise in mitochondria oxidative power from 3.5 to 6.5 ml/min. per 100 g of tissue it is possible to maintain muscle oxygen V(O2) at constant level of 3.5 ml/min per 100 g despite a decrease in O2 delivery. Minimum value of tissue pO2 was about 0 and an area of hypoxia appeared inside the cell in case 1. But hypoxia disappeared and minimum value of pO2 increased from 0 to 4 mm Hg if mitochondria were distributed unevenly (case 2). It is shown that the possibilities of such regulation were limited and depended on the ratio of "the degree of hypoxemia--the level of oxygen delivery." It was assumed that an increase in mitochondria enzyme activity and mitochondria migration to the places of the greatest oxygen consumption rate can improve oxygen regime in the cells in terms of their adaptation to hypoxia. It is possible that changes in mitochondrial oxidative power and their intracellular redistribution may be considered as a new dimension in regulation of cell oxygen regime.

Identifying seismic electirc signals upon significant periodic data loss. The case of Japan

NASA Astrophysics Data System (ADS)

Varotsos, P.; Skordas, E. S.; Sarlis, N. V.; Lazaridou, M. S.

2011-12-01

In many cases of geophysical interest, it happens that for substantial parts of the time of data collection, high noise prevents any attempt for extracting a useful signal. Data for such time segments are removed from further analysis. This is the case, for example, in the geoelectrical field measurements at some sites in Japan, where high noise - due mainly to leakage currents from DC driven trains - prevails almost during 70% of the 24 hour operational time. In particular, the low noise time occurs from 00:00 to 06:00 and from 22:00 to 24:00 local time (LT) when nearby DC driven trains cease service, i.e., almost only 30% of the 24 h. Thus, the question arises whether it is still possible to identify seismic electric signals [P. Varotsos and K. Alexopoulos, Tectonophysics 110 (1984) 73-98; 99-125] upon removing the noisy data segments lasting for the period 06:00 to 22:00 every day. We show that even in such a case, the identification of seismic electric signals, which are long-range correlated signals [PA Varotsos, NV Sarlis and ES Skordas, Phys. Rev. E 66 (2002), 011902], may be possible[PA Varotsos, NV Sarlis and ES Skordas, Tectonophysics 503 (2011) 189-194]. The key point is the use of the following two modern methods: The natural time analysis [PA Varotsos, NV Sarlis and ES Skordas, Natural Time Analysis: The new view of time (2011) Springer-Verlag Berlin-Heidelberg] of the remaining data and the Detrended Fluctuation Analysis (DFA). Our main conclusion states that the distinction between seismic electric signal activities (critical dynamics) and artificial noise becomes possible even after removing periodically a significant portion of the data.

Should religious beliefs be allowed to stonewall a secular approach to withdrawing and withholding treatment in children?

PubMed

Brierley, Joe; Linthicum, Jim; Petros, Andy

2013-09-01

Religion is an important element of end-of-life care on the paediatric intensive care unit with religious belief providing support for many families and for some staff. However, religious claims used by families to challenge cessation of aggressive therapies considered futile and burdensome by a wide range of medical and lay people can cause considerable problems and be very difficult to resolve. While it is vital to support families in such difficult times, we are increasingly concerned that deeply held belief in religion can lead to children being potentially subjected to burdensome care in expectation of 'miraculous' intervention. We reviewed cases involving end-of-life decisions over a 3-year period. In 186 of 203 cases in which withdrawal or limitation of invasive therapy was recommended, agreement was achieved. However, in the 17 remaining cases extended discussions with medical teams and local support mechanisms did not lead to resolution. Of these cases, 11 (65%) involved explicit religious claims that intensive care should not be stopped due to expectation of divine intervention and complete cure together with conviction that overly pessimistic medical predictions were wrong. The distribution of the religions included Protestant, Muslim, Jewish and Roman Catholic groups. Five of the 11 cases were resolved after meeting religious community leaders; one child had intensive care withdrawn following a High Court order, and in the remaining five, all Christian, no resolution was possible due to expressed expectations that a 'miracle' would happen.

[Failure to Attend Child Preventive Examination as a Possible Indication of Risk to Children's Welfare: Retrospective Analysis of 605 Cases Reported to the Child Protection Services].

PubMed

Hock, S; Graul, C; Herb, S; Nötzel, G; Kieslich, M

2017-04-01

Objective: The extent to which childrens's welfare is compromised when they do not attend compulsory prevention medical check-ups is yet to be determined. Together with the Hessen Prevention Center for Children (Hessisches Kindervorsorgezentrum), the Child Protection Services in the Main-Taunus district have conducted a study to investigate failure to attend child preventive examinations as a possible indication of risk to the welfare of such children. Method: 605 notifications of child preventive examinations that were not carried out, sent in 2012 to the Child Protection Services by the Hessen Prevention Center for Children, were analyzed retrospectively. Each case was recorded using a standardized questionnaire and, cases that were passed on to General Social Services within Child Protection Services were investigated with an additional interview with the employee responsible. Results: In 60 (10%) cases there was no certificate to show that the check-up had been conducted, while in 165 (27%) cases the check-up was conducted late, i. e. only after being contacted by the Child Protection Services. In 9 of the 605 cases (1.5%), the families involved were already known to Child Protection Services due to previous proceedings against them under endangering children's welfare act (known as § 8a cases). No new case of a risk to children's welfare was detected. In 58 cases, families gave reasons for the missed or late check-up. Reasons included being abroad and moving house (20 cases), forgetting (14 cases) and illness (11 cases), as well as lack of knowledge of the law (6 cases), lack of health insurance (4 cases), lack of language skills (2 cases) and objection to the law in principle (1 case). It was notable that, in 57% of the cases notified, documentary evidence could be provided by the end of the case work that the check-up had taken place within the recommended period (including additional discretionary period). The majority of these notifications of failure to attend can be prevented by an upstream clearing procedure. © Georg Thieme Verlag KG Stuttgart · New York.

Is There a Risk of Suburban Transmission of Malaria in Selangor, Malaysia?

PubMed Central

Braima, Kamil A.; Sum, Jia-Siang; Ghazali, Amir-Ridhwan M.; Muslimin, Mustakiza; Jeffery, John; Lee, Wenn-Chyau; Shaker, Mohammed R.; Elamin, Alaa-Eldeen M.; Jamaiah, Ibrahim; Lau, Yee-Ling; Rohela, Mahmud; Kamarulzaman, Adeeba; Sitam, Frankie; Mohd-Noh, Rosnida; Abdul-Aziz, Noraishah M.

2013-01-01

Background The suburban transmission of malaria in Selangor, Malaysia’s most developed and populous state still remains a concern for public health in this region. Despite much successful control efforts directed at its reduction, sporadic cases, mostly brought in by foreigners have continued to occur. In addition, cases of simian malaria caused by Plasmodium knowlesi, some with fatal outcome have caused grave concern to health workers. The aim of this study was to investigate the possibility of local malaria transmission in suburban regions of Selangor, which are adjacent to secondary rainforests. Findings A malaria survey spanning 7 years (2006 - 2012) was conducted in Selangor. A total of 1623 laboratory confirmed malaria cases were reported from Selangor’s nine districts. While 72.6% of these cases (1178/1623) were attributed to imported malaria (cases originating from other countries), 25.5% (414/1623) were local cases and 1.9% (31/1623) were considered as relapse and unclassified cases combined. In this study, the most prevalent infection was P. vivax (1239 cases, prevalence 76.3%) followed by P. falciparum (211, 13.0%), P. knowlesi (75, 4.6%), P. malariae (71, 4.4%) and P. ovale (1, 0.06%). Mixed infections comprising of P. vivax and P. falciparum were confirmed (26, 1.6%). Entomological surveys targeting the residences of malaria patients’ showed that the most commonly trapped Anopheles species was An. maculatus. No oocysts or sporozoites were found in the An. maculatus collected. Nevertheless, the possibility of An. maculatus being the malaria vector in the investigated locations was high due to its persistent occurrence in these areas. Conclusions Malaria cases reported in this study were mostly imported cases. However the co-existence of local cases and potential Plasmodium spp. vectors should be cause for concern. The results of this survey reflect the need of maintaining closely monitored malaria control programs and continuous extensive malaria surveillance in Peninsula Malaysia. PMID:24194901

Is there a risk of suburban transmission of malaria in Selangor, Malaysia?

PubMed

Braima, Kamil A; Sum, Jia-Siang; Ghazali, Amir-Ridhwan M; Muslimin, Mustakiza; Jeffery, John; Lee, Wenn-Chyau; Shaker, Mohammed R; Elamin, Alaa-Eldeen M; Jamaiah, Ibrahim; Lau, Yee-Ling; Rohela, Mahmud; Kamarulzaman, Adeeba; Sitam, Frankie; Mohd-Noh, Rosnida; Abdul-Aziz, Noraishah M

2013-01-01

The suburban transmission of malaria in Selangor, Malaysia's most developed and populous state still remains a concern for public health in this region. Despite much successful control efforts directed at its reduction, sporadic cases, mostly brought in by foreigners have continued to occur. In addition, cases of simian malaria caused by Plasmodium knowlesi, some with fatal outcome have caused grave concern to health workers. The aim of this study was to investigate the possibility of local malaria transmission in suburban regions of Selangor, which are adjacent to secondary rainforests. A malaria survey spanning 7 years (2006 - 2012) was conducted in Selangor. A total of 1623 laboratory confirmed malaria cases were reported from Selangor's nine districts. While 72.6% of these cases (1178/1623) were attributed to imported malaria (cases originating from other countries), 25.5% (414/1623) were local cases and 1.9% (31/1623) were considered as relapse and unclassified cases combined. In this study, the most prevalent infection was P. vivax (1239 cases, prevalence 76.3%) followed by P. falciparum (211, 13.0%), P. knowlesi (75, 4.6%), P. malariae (71, 4.4%) and P. ovale (1, 0.06%). Mixed infections comprising of P. vivax and P. falciparum were confirmed (26, 1.6%). Entomological surveys targeting the residences of malaria patients' showed that the most commonly trapped Anopheles species was An. maculatus. No oocysts or sporozoites were found in the An. maculatus collected. Nevertheless, the possibility of An. maculatus being the malaria vector in the investigated locations was high due to its persistent occurrence in these areas. Malaria cases reported in this study were mostly imported cases. However the co-existence of local cases and potential Plasmodium spp. vectors should be cause for concern. The results of this survey reflect the need of maintaining closely monitored malaria control programs and continuous extensive malaria surveillance in Peninsula Malaysia.

Hyperbaric oxygen therapy (HBOT) in case of hemorrhagic cystitis after radiotherapy

PubMed Central

Klejnotowska, Alicja; Matuszewski, Marcin; Sicko, Zdzislaw; Markuszewski, Marcin; Krajka, Kazimierz

2012-01-01

Introduction We present the effect of hyperbaric oxygen therapy (HBOT) after radiotherapy for cancer in the pelvic cavity resulting in hematuria. Increasing the pressure of oxygen (PO2) in ischemic tissues favors the formation of new blood vessels and increases the secretion of collagen. Material and methods We evaluated 10 patients who were treated with HBOT from October 2006 to December 2010 due to persistent radiation damage to the lining of the bladder leading to recurrent hematuria. The study group was comprised of seven men and three women. In the case of cervical and endometrial cancers, 30 Gy of brachytherapy with 45-50 Gy of teleradiotherapy were used. In prostate cancer (PCa), we applied 50 Gy of teleradiotherapy with an additional dose of 20-24 Gy, and in the case of bladder cancer (BCa), 50 Gy of teleradiotherapy was applied with an additional dose of 16 Gy. HBOT consisted of 60 HBO2 treatments, in which patients were administered 100% oxygen at a pressure of 2.5 atm. Results The group effect of total or partial resolution was observed in six patients. In one case, treatment was discontinued due to an increase in hematuria and the consequent suspicion of bladder tumor recurrence. While in and additional three cases, the treatment did not produce the desired result. Conclusions Treatment of hemorrhagic cystitis is a difficult therapeutic challenge. One possible method is the implementation of HBOT. In very difficult cases, HBO2 treatment appears to be effective in giving more than half of patients a chance of getting better. PMID:24578962

The epidemiology of listeriosis in the United States--1986. Listeriosis Study Group.

PubMed

Gellin, B G; Broome, C V; Bibb, W F; Weaver, R E; Gaventa, S; Mascola, L

1991-02-15

To determine the morbidity and mortality due to listeriosis in the United States, the authors undertook an active surveillance project in 1986 to identify all cases in which Listeria monocytogenes was isolated from cultures of ordinarily sterile sites in a population of 34 million persons. The authors estimated that at least 1,700 cases of listeriosis and 450 deaths occurred in the United States in 1986; 27% of these cases occurred in pregnant women, with 22% of perinatal cases resulting in stillbirths or neonatal deaths. The risk of listeriosis in adults (0.5 per 100,000 population) was similar in all regions studied; the incidence of perinatal listeriosis was three times higher in Los Angeles County, California, than in the other areas (24.3/100,000 live births vs. 7.8/100,000 live births). Geographic variation may have resulted from underdiagnosis of perinatal listeriosis in five of the study areas. Multilocus electrophoretic enzyme typing was useful for elucidating the molecular epidemiology of L. monocytogenes; perinatal listeriosis was significantly associated with one group of related strains. Multilocus electrophoretic enzyme typing also identified three clusters representing possible common-source outbreaks. These findings document the substantial morbidity due to listeriosis in the United States; to the extent that sporadic listeriosis is foodborne, this morbidity could be reduced by appropriate preventive measures, particularly in persons known to be at increased risk of infection.

Tetrodotoxin – Distribution and Accumulation in Aquatic Organisms, and Cases of Human Intoxication

PubMed Central

Noguchi, Tamao; Arakawa, Osamu

2008-01-01

Many pufferfish of the family Tetraodontidae possess a potent neurotoxin, tetrodotoxin (TTX). In marine pufferfish species, toxicity is generally high in the liver and ovary, whereas in brackish water and freshwater species, toxicity is higher in the skin. In 1964, the toxin of the California newt was identified as TTX as well, and since then TTX has been detected in a variety of other organisms. TTX is produced primarily by marine bacteria, and pufferfish accumulate TTX via the food chain that begins with these bacteria. Consequently, pufferfish become non-toxic when they are fed TTX-free diets in an environment in which the invasion of TTX-bearing organisms is completely shut off. Although some researchers claim that the TTX of amphibians is endogenous, we believe that it also has an exogenous origin, i.e., from organisms consumed as food. TTX-bearing animals are equipped with a high tolerance to TTX, and thus retain or accumulate TTX possibly as a biologic defense substance. There have been many cases of human intoxication due to the ingestion of TTX-bearing pufferfish, mainly in Japan, China, and Taiwan, and several victims have died. Several cases of TTX intoxication due to the ingestion of small gastropods, including some lethal cases, were recently reported in China and Taiwan, revealing a serious public health issue. PMID:18728726

V-Y and rotation flap for reconstruction of the epicanthal fold.

PubMed

Shin, Yong Ho; Hwang, Pil Joong; Hwang, Kun

2012-07-01

Epicanthoplasty is commonly performed on Asian eyelids. Consequently, overcorrection may appear. The aim of this study was to introduce a method of reconstructing the epicanthal fold and to apply this method to the patients. A V flap with an extension (eagle beak shaped) was designed on the medial canthal area. The upper incision line started near the medial end of the double-fold line, and it followed its curvature inferomedially. For the lower incision, starting at the tip (medial end) of the flap, a curvilinear incision was designed first diagonally and then horizontally along the lower blepharoplasty line. The V flap was elevated as thin as possible. Then, the upper flap was deeply undermined to make it thick. The lower flap was made a little thinner than the upper flap. Then, the upper and lower flaps were approximated to form the anteromedial surface of the epicanthal fold in a fashion sufficient to cover the red caruncle. The V flap was rotated inferolaterally over the caruncle. The tip of the V flap was sutured to the medial one-third point of the lower margin. The inferior border of the V flap and the residual lower margin were approximated. Thereafter, the posterolateral surface of the epicanthal fold was made. From 1999 to 2011, 246 patients were operated on using this method. Among them, 62 patients were followed up. The mean intercanthal distance was increased from 31.7 to 33.8 mm postoperatively. Among the 246 patients operated on, reoperation was performed for 6 patients. Among the 6 patients reoperated on, 3 cases were due to epicanthus inversus, 1 case was due to insufficient reconstruction, 1 case was due to making an infold, and 1 case was due to reopening the epicanthal fold.This V-Y and rotation flap can be a useful method for reconstruction of the epicanthal fold.

Failure Analysis for Composition of Web Services Represented as Labeled Transition Systems

NASA Astrophysics Data System (ADS)

Nadkarni, Dinanath; Basu, Samik; Honavar, Vasant; Lutz, Robyn

The Web service composition problem involves the creation of a choreographer that provides the interaction between a set of component services to realize a goal service. Several methods have been proposed and developed to address this problem. In this paper, we consider those scenarios where the composition process may fail due to incomplete specification of goal service requirements or due to the fact that the user is unaware of the functionality provided by the existing component services. In such cases, it is desirable to have a composition algorithm that can provide feedback to the user regarding the cause of failure in the composition process. Such feedback will help guide the user to re-formulate the goal service and iterate the composition process. We propose a failure analysis technique for composition algorithms that views Web service behavior as multiple sequences of input/output events. Our technique identifies the possible cause of composition failure and suggests possible recovery options to the user. We discuss our technique using a simple e-Library Web service in the context of the MoSCoE Web service composition framework.

Generic legislation of new psychoactive drugs.

PubMed

van Amsterdam, Jan; Nutt, David; van den Brink, Wim

2013-03-01

New psychoactive drugs (NPDs, new psychoactive substances) enter the market all the time. However, it takes several months to ban these NPDs and immediate action is generally not possible. Several European countries and drug enforcement officers insist on a faster procedure to ban NPDs. Introduction of generic legislation, in which clusters of psychotropic drugs are banned in advance, has been mentioned as a possible solution. Here we discuss the pros and cons of such an approach. First, generic legislation could unintentionally increase the expenditures of enforcement, black market practices, administrative burden and health risks for users. Second, it may have a negative impact on research and the development of new treatments. Third, due to the complexity of generic legislation, problems in the enforcement are anticipated due to lack of knowledge about the chemical nomenclature. Finally, various legal options are already available to ban the use, sale and trade of NPDs. We therefore conclude that the currently used scientific benefit-risk evaluation should be continued to limit the adverse health effects of NPDs. Only in emergency cases, where fatal incidents (may) occur, should this approach be overruled.

Restriction endonuclease analysis of chloroplast DNA in interspecies somatic Hybrids of Petunia.

PubMed

Kumar, A; Cocking, E C; Bovenberg, W A; Kool, A J

1982-12-01

Restriction endonuclease cleavage pattern analysis of chloroplast DNA (cpDNA) of three different interspecific somatic hybrid plants revealed that the cytoplasms of the hybrids contained only cpDNA of P. parodii. The somatic hybrid plants analysed were those between P. parodii (wild type) + P. hybrida (wild type); P. parodii (wild type)+P. inflata (cytoplasmic albino mutant); P. parodii (wild type) + P. parviflora (nuclear albino mutant). The presence of only P. parodii chloroplasts in the somatic hybrid of P. parodii + P. inflata is possibly due to the stringent selection used for somatic hybrid production. However, in the case of the two other somatic hybrids P. parodii + P. hybrida and P. parodii + P. parviflora it was not possible to determine whether the presence of only P. parodii chloroplasts in these somatic hybrid plants was due to the nature of the selection schemes used or simply occurred by chance. The relevance of such somatic hybrid material for the study of genomic-cytoplasmic interaction is discussed, as well as the use of restriction endonuclease fragment patterns for the analysis of taxonomic and evolutionary inter-relationships in the genus Petunia.

SERPINE 1 Links Obesity and Diabetes: A Pilot Study

PubMed Central

Kaur, Punit; Reis, Michael D.; Couchman, Glen R.; Forjuoh, Samuel N.; Greene, John F.; Asea, Alexzander

2010-01-01

In the past decade there has been a dramatic increase in the number of Americans considered obese. Over this same period, the number of individuals diagnosed with diabetes has increased by over 40%. Interestingly, in a great number of cases individuals considered obese develop diabetes later on. Although a link between obesity and diabetes has been suggested, conclusive scientific evidence is thus far just beginning to emerge. The present pilot study is designed to identify a possible link between obesity and diabetes. The plasma proteome is a desirable biological sample due to their accessibility and representative complexity due, in part, to the wide dynamic range of protein concentrations, which lead to the discovery of new protein markers. Here we present the results for the specific depletion of 14 high-abundant proteins from the plasma samples of obese and diabetic patients. Comparative proteomic profiling of plasma from individuals with either diabetes or obesity and individuals with both obesity and diabetes revealed SERPINE 1 as a possible candidate protein of interest, which might be a link between obesity and diabetes. PMID:21113241

SERPINE 1 Links Obesity and Diabetes: A Pilot Study.

PubMed

Kaur, Punit; Reis, Michael D; Couchman, Glen R; Forjuoh, Samuel N; Greene, John F; Asea, Alexzander

2010-06-01

In the past decade there has been a dramatic increase in the number of Americans considered obese. Over this same period, the number of individuals diagnosed with diabetes has increased by over 40%. Interestingly, in a great number of cases individuals considered obese develop diabetes later on. Although a link between obesity and diabetes has been suggested, conclusive scientific evidence is thus far just beginning to emerge. The present pilot study is designed to identify a possible link between obesity and diabetes. The plasma proteome is a desirable biological sample due to their accessibility and representative complexity due, in part, to the wide dynamic range of protein concentrations, which lead to the discovery of new protein markers. Here we present the results for the specific depletion of 14 high-abundant proteins from the plasma samples of obese and diabetic patients. Comparative proteomic profiling of plasma from individuals with either diabetes or obesity and individuals with both obesity and diabetes revealed SERPINE 1 as a possible candidate protein of interest, which might be a link between obesity and diabetes.

PDT: special cases in front of legal regulations

NASA Astrophysics Data System (ADS)

Fischer, E.; Wegner, A.; Pfeiler, T.; Mertz, M.

2002-10-01

Introduction: The classic indication for photodynamic therapy (PDT) in ophthalmology is currently represented by classic subfoveal choroidal neovascularisation (CNV) due to age-related macular degeneration (AMD). PDT is a method, which almost selectively causes endothelial damage in neovascular lesions, followed by vascular occlusion and involution of the CNV. The mechanistic aspect suggests that non AMD-related choroidal neovascularisations might also benefit from PDT. PDT in AMD: Within the German health system, PDT indications follow the criteria based on the inclusion criteria of the TAP studies. For instance the CNV should be predominantly classic and located under the center of the foveal avascular zone. In the diagnosis and follow-up of exudative AMD, visual acuity measurements and fluorescein angiography are the established parameters. Retinal thickness analyzer (RTA) measurements might give further information. Before PDT, they show a significant retinal thickening due to intra- and subretinal exudation. Following PDT, early RTA follow-ups show a clear decrease in retinal thickening accompanies by increasing or stable acuity. PDT in CNV of other origins than AMD: New studies support a new spectrum of indications for PDT, hopefully leading to general cost reimbursement for patients. PDT should be viewed as a general method for vascular occlusion and does not represent a causal therapy for progressive exudative AMD. We present patients with CNV due to pathologic myopia, angioid streaks and POHS. Conclusion: The selective vascular occlusion caused by PDT, besides CNV associated with AMD and pathologic myopia, may also allow the treatment of choroidal neovascularisations based on other entities. Careful individual evaluation of those cases is recommended. Despite this wide array of possible indications, cost reimbursement has been limited to classic subfoveal CNV in AMD, although single case reimbursements in choroidal neovascular lesions due to pathologic myopia have been observed.

Diagnosis of penile fracture in primary care: a case report

PubMed Central

Akpinar, Ersin

2009-01-01

Introduction Penile fracture has been reported with sexual intercourse, masturbation, rolling over or falling on to the erect penis. Classically the history is with a sudden snap, pain, detumescence and a hematoma of the penis with deformity. Immediate surgical treatment is recommended. The patients may delay the admission due to fear and embarrassment or the condition may usually be underreported. Case presentation A 32-year-old man presented to primary care complaining of discoloration of penis without any significant history or symptom. Physical examination revealed swollen, ecchymotic, and deviated circumcised penis. Conclusion Although frequent and common diseases represent the majority of daily work, the primary care physician should be alert for possible unexpected history or symptom of a rare and often serious condition. PMID:19830047

Robust registration in case of different scaling

NASA Astrophysics Data System (ADS)

Gluhchev, Georgi J.; Shalev, Shlomo

1993-09-01

The problem of robust registration in the case of anisotropic scaling has been investigated. Registration of two images using corresponding sets of fiducial points is sensitive to inaccuracies in point placement due to poor image quality or non-rigid distortions, including possible out-of-plane rotations. An approach aimed at the detection of the most unreliable points has been developed. It is based on the a priori knowledge of the sequential ordering of rotation and scaling. A measure of guilt derived from the anomalous geometric relationships is introduced. A heuristic decision rule allowing for deletion of the most guilty points is proposed. The approach allows for more precise evaluation of the translation vector. It has been tested on phantom images with known parameters and has shown satisfactory results.

Deferasirox-induced urticarial vasculitis in a patient with myelodysplastic syndrome.

PubMed

Polat, Asude Kara; Belli, Asli Akin; Karakus, Volkan; Dere, Yelda

2017-01-01

Deferasirox is an iron chelator agent used in the treatment of diseases with iron overload, such as thalassemia and myelodysplastic syndrome. Although the majority of adverse reactions of deferasirox involve gastrointestinal symptoms and increase in serum creatinine and transaminases, skin rashes, such as maculopapular and urticarial eruptions, have also been reported. This study reports a case of myelodysplastic syndrome with urticarial vasculitis due to deferasirox therapy. Drug eruption was been confirmed by means of a challenge test, together with histopathological and clinical findings. To the best of our knowledge, we report the first case of deferasirox-induced urticarial vasculitis. Physicians should be aware of the possibility of urticarial vasculitis on deferasirox therapy and the fact that the discontinuation of the drug generally results in improvement.

Lymphoepithelioma-like carcinoma of the vulva, an underrecognized entity? Case report with a single inguinal micrometastasis detected by sentinel node technique.

PubMed

Bösmüller, Hans; Haitchi-Petnehazy, Sophie; Gruber, Christine; Roithmeier, Franz; Stummvoll, Wolfgang; Webersinke, Gerald

2011-01-10

This report describes an unusual EBV-negative lymphoepithelioma-like carcinoma of the vulva in a 73-year-old patient. The lesion was localised at the right minor labium and was resected by partial vulvectomy. A synchronous sentinel lymph node biopsy revealed a single micrometastasis in the right inguinal region, which prompted local radiotherapy. Follow-up nine months later showed only slight vulvar atrophy, without signs of local recurrence or distant metastases.Although lymphoepithelioma-like carcinomas of the skin and the female genital tract are presumed to have a better prognosis than their counterparts in the upper aerodigestive tract, possibly due to earlier detection and therapy, this case documents their potential for early metastasis.

Two unusual anatomic variations create a diagnostic dilemma in distal ulnar nerve compression.

PubMed

Kiehn, Mark W; Derrick, Allison J; Iskandar, Bermans J

2008-09-01

Diagnosis of peripheral neuropathies is based upon patterns of functional deficits and electrodiagnostic testing. However, anatomic variations can lead to confounding patterns of physical and electrodiagnostic findings. Authors present a case of ulnar nerve compression due to a rare combination of anatomic variations, aberrant branching pattern, and FCU insertion at the wrist, which posed a diagnostic and therapeutic dilemma. The literature related to isolated distal ulnar motor neuropathy and anatomic variations of the ulnar nerve and adjacent structures is also reviewed. This case demonstrates how anatomic variations can complicate the interpretation of clinical and electrodiagnostic findings and underscores the importance of thorough exploration of the nerve in consideration for possible variations. (c) 2008 Wiley-Liss, Inc.

Acute postoperative obstruction of extracardiac conduit due to separation of thin fibrous peel.

PubMed

Agarwal, K C; Edwards, W D; Puga, F J; Mair, D D

1982-03-01

Late postoperative obstruction of extracardiac conduits may occur in some patients and may result from one of several mechanisms. Severe intraoperative or early postoperative obstruction of such conduits is very rare. Herein we describe a case of acute, severe, early postoperative obstruction of an extracardiac conduit; this followed partial excision and replacement of a Hancock conduit in which late postoperative calcific valvular stenosis had occurred. Unexpectedly elevated right ventricular pressure should suggest the possibility of acute conduit obstruction. In cases with partial conduit replacement, the remaining segment should be carefully inspected for the presence of a peel; if a peel is present, it should be removed from the conduit even if it is considered thin and nonobstructive.

[Babies with cranial deformity].

PubMed

Feijen, Michelle M W; Claessens, Edith A W M Habets; Dovens, Anke J Leenders; Vles, Johannes S; van der Hulst, Rene R W J

2009-01-01

Plagiocephaly was diagnosed in a baby aged 4 months and brachycephaly in a baby aged 5 months. Positional or deformational plagio- or brachycephaly is characterized by changes in shape and symmetry of the cranial vault. Treatment options are conservative and may include physiotherapy and helmet therapy. During the last two decades the incidence of positional plagiocephaly has increased in the Netherlands. This increase is due to the recommendation that babies be laid on their backs in order to reduce the risk of sudden infant death syndrome. We suggest the following: in cases of positional preference of the infant, referral to a physiotherapist is indicated. In cases of unacceptable deformity of the cranium at the age 5 months, moulding helmet therapy is a possible treatment option.

A survey of warning colours of pesticides.

PubMed

Thierauf, Annette; Weinmann, Wolfgang; Auwärter, Volker; Vennemann, Benedikt; Bohnert, Michael

2010-12-01

Pesticides are used to protect plants all over the world. Their increasing specificity has been due to utilization of differences in biochemical processes, and has been accompanied by lower human toxicity. Nevertheless cases of poisoning are still observed. While certain toxic substances are provided with characteristic dyes or pigments to facilitate easy identification, no overview of pesticide colors exists. The lack of available product information prompted us to explore the colors and dyes of pesticides registered in Germany, most of which are commercially available worldwide. A compilation of the colors and odors of 207 pesticide products is presented. While some of the substances can be identified by their physical characteristics, in other cases, the range of possibilities can be narrowed by their nature and color.

Heat stress disorders and headache: a case of new daily persistent headache secondary to heat stroke.

PubMed

Di Lorenzo, C; Ambrosini, A; Coppola, G; Pierelli, F

2009-01-01

Headache is considered as a common symptom of heat stress disorders (HSD), but no forms of secondary headache from heat exposure are reported in the International Classification of Headache Disorders-2 Edition (ICHD-II). Heat-stroke (HS) is the HSD most severe condition, it may be divided into two forms: classic (due to a long period environmental heat exposure) and exertional (a severe condition caused by strenuous physical exercises in heat environmental conditions). Here we report the case of a patient who developed a headache clinical picture fulfilling the diagnostic criteria for new daily persistent headache (NDPH), after an exertional HS, and discuss about possible pathophysiological mechanisms and classification aspects of headache induced by heat conditions.

Heat stress disorders and headache: a case of new daily persistent headache secondary to heat stroke

PubMed Central

Di Lorenzo, C; Ambrosini, A; Coppola, G; Pierelli, F

2009-01-01

Headache is considered as a common symptom of heat stress disorders (HSD), but no forms of secondary headache from heat exposure are reported in the International Classification of Headache Disorders-2 Edition (ICHD-II). Heat-stroke (HS) is the HSD most severe condition, it may be divided into two forms: classic (due to a long period environmental heat exposure) and exertional (a severe condition caused by strenuous physical exercises in heat environmental conditions). Here we report the case of a patient who developed a headache clinical picture fulfilling the diagnostic criteria for new daily persistent headache (NDPH), after an exertional HS, and discuss about possible pathophysiological mechanisms and classification aspects of headache induced by heat conditions. PMID:21686677

Transfundal puncture of a large ovarian cyst with hysteroscopic and ultrasonographic guidance.

PubMed

Zolnierczyk, Piotr; Cendrowski, Krzysztof; Sawicki, Wlodzimierz

2015-01-01

This paper describes the case of an 83-year-old patient with hypertension, diabetes, obesity (body mass index - 38), congestive heart failure, and history of cardiac surgery, who was referred for a diagnostic-therapeutic decompression of a large, symptomatic ovarian cyst. Due to anatomical conditions, the only safe way was a transfundal puncture under mini-hysteroscopic and ultrasound guidance. A puncture with aspiration of 300 mL of serous fluid from the cyst was performed without technical problems and complications. Cytology showed no cancer cells in the examined liquid. Relief from pain and compression discomfort was achieved in the patient. This case shows the possibility of combining ultrasound and minimally invasive diagnostic methods like hysteroscopy in selected clinical situations.

Transfundal puncture of a large ovarian cyst with hysteroscopic and ultrasonographic guidance

PubMed Central

Zolnierczyk, Piotr; Cendrowski, Krzysztof; Sawicki, Wlodzimierz

2015-01-01

This paper describes the case of an 83-year-old patient with hypertension, diabetes, obesity (body mass index – 38), congestive heart failure, and history of cardiac surgery, who was referred for a diagnostic–therapeutic decompression of a large, symptomatic ovarian cyst. Due to anatomical conditions, the only safe way was a transfundal puncture under mini-hysteroscopic and ultrasound guidance. A puncture with aspiration of 300 mL of serous fluid from the cyst was performed without technical problems and complications. Cytology showed no cancer cells in the examined liquid. Relief from pain and compression discomfort was achieved in the patient. This case shows the possibility of combining ultrasound and minimally invasive diagnostic methods like hysteroscopy in selected clinical situations. PMID:25999768

EBV driven natural killer cell disease of the central nervous system presenting as subacute cognitive decline.

PubMed

Brett, Francesca M; Flavin, Richard; Chen, Daphne; Loftus, Teresa; Looby, Seamus; McCarthy, Allan; de Gascun, Cillian; Jaffe, Elaine S; Nor, Nurul; Javadpour, Mohsen; McCabe, Dominick

2017-11-01

Brain biopsy in patients presenting with subacute encephalopathyis never straightforward and only undertaken when a 'treatable condition' is a realistic possibility. This 63 year old right handed, immunocompetent Caucasian woman presented with an 8 month history of rapidly progressive right-sided hearing impairment, a 4 month history of intermittent headaches, tinnitus, 'dizziness', dysphagia, nausea and vomiting, with the subsequent evolution of progressive gait ataxia and a subacute global encephalopathy. The possibility of CJD was raised. Brain biopsy was carried out. Western blot for prion protein was negative. She died 9 days later and autopsy brain examination confirmed widespread subacute infarction due to an EBV positive atypical NK/T-cell infiltrate with positivity for CD3, CD56, granzyme B, perforin and EBER with absence of CD4, CD5 and CD8 expression. Molecular studies for T-cell clonality were attempted but failed due to insufficient DNA quality. Serology was consistent with past EBV infection (EBV VCA and EBNA IgG Positive). There was no evidence of disease outside the CNS. Primary central nervous system NK/T-cell lymphoma is extremely rare. The rare reported cases all present with a discrete intracranial mass, unlike the diffuse infiltrative pattern in this case. Whilst the diffuse interstitial pattern is reminiscent of chronic active EBV infection (CAEBV) seen in other organ systems such as the liver and bone marrow, the clinical presentation and epidemiologic profile are not typical for CAEBV.

EBV driven natural killer cell disease of the central nervous system presenting as subacute cognitive decline

PubMed Central

Brett, Francesca M.; Flavin, Richard; Chen, Daphne; Loftus, Teresa; Looby, Seamus; McCarthy, Allan; de Gascun, Cillian; Jaffe, Elaine S.; Nor, Nurul; Javadpour, Mohsen; McCabe, Dominick

2017-01-01

Brain biopsy in patients presenting with subacute encephalopathyis never straightforward and only undertaken when a ‘treatable condition’ is a realistic possibility. This 63 year old right handed, immunocompetent Caucasian woman presented with an 8 month history of rapidly progressive right-sided hearing impairment, a 4 month history of intermittent headaches, tinnitus, ‘dizziness’, dysphagia, nausea and vomiting, with the subsequent evolution of progressive gait ataxia and a subacute global encephalopathy. The possibility of CJD was raised. Brain biopsy was carried out. Western blot for prion protein was negative. She died 9 days later and autopsy brain examination confirmed widespread subacute infarction due to an EBV positive atypical NK/T-cell infiltrate with positivity for CD3, CD56, granzyme B, perforin and EBER with absence of CD4, CD5 and CD8 expression. Molecular studies for T-cell clonality were attempted but failed due to insufficient DNA quality. Serology was consistent with past EBV infection (EBV VCA and EBNA IgG Positive). There was no evidence of disease outside the CNS. Primary central nervous system NK/T-cell lymphoma is extremely rare. The rare reported cases all present with a discrete intracranial mass, unlike the diffuse infiltrative pattern in this case. Whilst the diffuse interstitial pattern is reminiscent of chronic active EBV infection (CAEBV) seen in other organ systems such as the liver and bone marrow, the clinical presentation and epidemiologic profile are not typical for CAEBV. PMID:28845389

Space Flows and Disturbances Due to Bodies in Motion Through the Magnetoplasma

NASA Astrophysics Data System (ADS)

Ponomarjov, Maxim G.

2000-10-01

In this paper a method is concerned which makes it possible to describe numerically and analytically the most famous structures in the non-equilibrium ionosphere, such as stratified and yacht sail like structures, flute jets, wakes and clouds. These problems are of practical interest in space sciences, astrophysics and in turbulence theory, and also of fundamental interest since they enable one to concentrate on the effects of the ambient electric and magnetic fields. Disturbances of charged particle flows due to the ambient flow interactions with bodies are simulated with taking into account the ambient magnetic field effect. The effects of interactions between solid surfaces and the flows was simulated by making use of an original image method. The flow disturbances were described by the Boltzmann equation. In the case of the ambient homogeneous magnetic field the Boltzmann equation is solved analytically. The case of diffuse reflection of particles by surface is considered in detail. The disturbances of charged particle concentration are calculated in 3D space. The contours of constant particle concentration obtained from numerical simulations illustrate the dynamics of developing stratifications and flute structures in charged particle jets and wakes under the ambient magnetic field effect. The basic goal of this paper is to present the method and to demonstate its possibility for simulations of turbulence, plasma jets, wakes and clouds in the ionosphere and Space when effects of electric and magnetic fields are taken into account.

The Effects of Different Electrode Types for Obtaining Surface Machining Shape on Shape Memory Alloy Using Electrochemical Machining

NASA Astrophysics Data System (ADS)

Choi, S. G.; Kim, S. H.; Choi, W. K.; Moon, G. C.; Lee, E. S.

2017-06-01

Shape memory alloy (SMA) is important material used for the medicine and aerospace industry due to its characteristics called the shape memory effect, which involves the recovery of deformed alloy to its original state through the application of temperature or stress. Consumers in modern society demand stability in parts. Electrochemical machining is one of the methods for obtained these stabilities in parts requirements. These parts of shape memory alloy require fine patterns in some applications. In order to machine a fine pattern, the electrochemical machining method is suitable. For precision electrochemical machining using different shape electrodes, the current density should be controlled precisely. And electrode shape is required for precise electrochemical machining. It is possible to obtain precise square holes on the SMA if the insulation layer controlled the unnecessary current between electrode and workpiece. If it is adjusting the unnecessary current to obtain the desired shape, it will be a great contribution to the medical industry and the aerospace industry. It is possible to process a desired shape to the shape memory alloy by micro controlling the unnecessary current. In case of the square electrode without insulation layer, it derives inexact square holes due to the unnecessary current. The results using the insulated electrode in only side show precise square holes. The removal rate improved in case of insulated electrode than others because insulation layer concentrate the applied current to the machining zone.

Breakdown in helium in high-voltage open discharge with subnanosecond current front rise

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schweigert, I. V., E-mail: ischweig@itam.nsc.ru; Alexandrov, A. L.; Bokhan, P. A.

Investigations of high-voltage open discharge in helium have shown a possibility of generation of current pulses with subnanosecond front rise, due to ultra-fast breakdown development. The open discharge is ignited between two planar cathodes with mesh anode in the middle between them. For gas pressure 6 Torr and 20 kV applied voltage, the rate of current rise reaches 500 A/(cm{sup 2} ns) for current density 200 A/cm{sup 2} and more. The time of breakdown development was measured for different helium pressures and a kinetic model of breakdown in open discharge is presented, based on elementary reactions for electrons, ions andmore » fast atoms. The model also includes various cathode emission processes due to cathode bombardment by ions, fast atoms, electrons and photons of resonant radiation with Doppler shift of frequency. It is shown, that the dominating emission processes depend on the evolution of the discharge voltage during the breakdown. In the simulations, two cases of voltage behavior were considered: (i) the voltage is kept constant during the breakdown; (ii) the voltage is reduced with the growth of current. For the first case, the exponentially growing current is maintained due to photoemission by the resonant photons with Doppler-shifted frequency. For the second case, the dominating factor of current growth is the secondary electron emission. In both cases, the subnanosecond rise of discharge current was obtained. Also the effect of gas pressure on breakdown development was considered. It was found that for 20 Torr gas pressure the time of current rise decreases to 0.1 ns, which is in agreement with experimental data.« less

Obesity interacts with infectious mononucleosis in risk of multiple sclerosis

PubMed Central

Hedström, A K; Lima Bomfim, I; Hillert, J; Olsson, T; Alfredsson, L

2015-01-01

Background and purpose The possible interaction between adolescent obesity and past infectious mononucleosis (IM) was investigated with regard to multiple sclerosis (MS) risk. Methods This report is based on two population-based case–control studies, one with incident cases (1780 cases, 3885 controls) and one with prevalent cases (4502 cases, 4039 controls). Subjects were categorized based on adolescent body mass index (BMI) and past IM and compared with regard to occurrence of MS by calculating odds ratios with 95% confidence intervals (CIs) employing logistic regression. A potential interaction between adolescent BMI and past IM was evaluated by calculating the attributable proportion due to interaction. Results Regardless of human leukocyte antigen (HLA) status, a substantial interaction was observed between adolescent obesity and past IM with regard to MS risk. The interaction was most evident when IM after the age of 10 was considered (attributable proportion due to interaction 0.8, 95% CI 0.6–1.0 in the incident study, and attributable proportion due to interaction 0.7, 95% CI 0.5–1.0 in the prevalent study). In the incident study, the odds ratio of MS was 14.7 (95% CI 5.9–36.6) amongst subjects with adolescent obesity and past IM after the age of 10, compared with subjects with none of these exposures. The corresponding odds ratio in the prevalent study was 13.2 (95% CI 5.2–33.6). Conclusions An obese state both impacts the cellular immune response to infections and induces a state of chronic immune-mediated inflammation which may contribute to explain our finding of an interaction between adolescent BMI and past IM. Measures taken against adolescent obesity may thus be a preventive strategy against MS. PMID:25530445

Tobramycin-induced hepatotoxicity.

PubMed

Nisly, Sarah A; Ray, Shaunta' M; Moye, Robert A

2007-12-01

To report a case of tobramycin-induced hepatotoxicity. A 20-year-old female was hospitalized for treatment of Pseudomonas aeruginosa bacteremia and osteomyelitis. Empiric intravenous antibiotic therapy with piperacillin/tazobactam, vancomycin, and ciprofloxacin was started, and based on the results of culture and sensitivity testing, was changed to intravenous ceftazidime and tobramycin 70 mg every 8 hours on hospital day 3. Liver enzyme levels then increased over days 3-6. Tests for hepatitis A, B, and C were all nonreactive, and HIV testing was negative. On day 8, therapy was changed from ceftazidime to piperacillin/tazobactam and the tobramycin dose was increased to 100 mg every 8 hours. Due to a continued increase in total bilirubin, aspartate aminotransferase, and alanine aminotransferase, piperacillin/tazobactam was discontinued and aztreonam was started on day 10. All antibiotics were stopped on day 12 and the elevated liver parameters began to decrease. Aztreonam and ciprofloxacin were restarted on day 16, and most laboratory test results returned to baseline levels by day 19; total bilirubin and alkaline phosphatase decreased to lower than baseline values. This case illustrates a possible occurrence of tobramycin-induced hepatotoxicity. Liver enzymes rose when tobramycin therapy was initiated, markedly increased when the tobramycin dose was increased, then resolved upon discontinuation of therapy. Other medication-related causes were ruled out by temporal relationship or rechallenge (aztreonam). Use of the Naranjo probability scale indicated a possible relationship between hepatotoxicity and tobramycin therapy. Other adverse reaction scales specific for evaluation of drug-induced liver disease were also used. Both the Council for International Organizations of Medical Sciences and Maria and Victorino scales indicated a probable likelihood of tobramycin-induced hepatotoxicity. This patient was not rechallenged with tobramycin due to the highly suggestive timeline present, lack of specific symptoms, and unnecessary risk to the patient. Although no other case reports on this interaction have been published through October 9, 2007, historical data from tertiary sources reveal the possibility of aminoglycoside-induced hepatotoxicity; therefore, tobramycin-induced hepatotoxicity cannot be ruled out in this patient. Clinicians should be aware of this adverse event.

Tubular House - Form Follows Technology, Concrete Shell Structure with Inner Thermal Insulation

NASA Astrophysics Data System (ADS)

Idem, Robert; Kleczek, Paweł; Pawłowski, Krzysztof; Chudoba, Piotr

2017-10-01

The aim of this paper is the theoretical analysis of the possibilities and limitations of using an unconventional technology and the original architectural form stemming from it - the building with external construction and internal insulation. In Central European climatic conditions, the traditional solution for the walls of heated buildings relies on using external thermal insulation. This stems from building physics: it prevents interstitial condensation of water vapour in the wall. Internal insulation is used exceptionally. This is done e.g. in historical buildings undergoing thermal modernization (due to the impossibility of interfering with facade). In such cases, a thermal insulation layer is used on the internal wall surface, along with an additional layer of vapour barrier. The concept of building concerns the intentional usage of an internal insulation. In this case, the construction is a tight external reinforced concrete shell. The architectural form of such building is strongly interrelated with the technology, which was used to build it. The paper presents the essence of this concept in descriptive and drawing form. The basic elements of such building are described (the external construction, the internal insulation and ventilation). As a case study, authors present a project of a residential building along with the description of the applied materials and installation solutions, and the results obtained from thermal, humidity and energetic calculations. The discussion presents the advantages and disadvantages of the proposed concept. The basic advantage of this solution is potentially low building cost. This stems from minimizing the ground works, the simplicity of the joints and the outer finish, as well as from the possibility of prefabrication of the elements. The continuity of the thermal insulation allows to reduce the amount of thermal bridges. The applied technology and form are applicable most of all for small buildings, due to limited possibilities of lighting the interior. The disadvantage of this technology is low heat accumulation of walls. A building in the proposed technology requires constant, forced ventilation. Further theoretical and practical research towards applying this concept would be necessary.

Layering of stomach contents in drowning cases in post-mortem computed tomography compared to forensic autopsy.

PubMed

Gotsmy, Walther; Lombardo, Paolo; Jackowski, Christian; Brencicova, Eva; Zech, Wolf-Dieter

2018-04-24

In forensic autopsy, the analysis of stomach contents is important when investigating drowning cases. Three-layering of stomach contents may be interpreted as a diagnostic hint to drowning due to swallowing of larger amounts of water or other drowning media. The authors experienced frequent discrepancies of numbers of stomach content layering in drowning cases between post-mortem computed tomography (PMCT) and autopsy in forensic casework. Therefore, the goal of this study was to compare layering of stomach contents in drowning cases between PMCT and forensic autopsy. Drowning cases (n = 55; 40 male, 15 female, mean age 45.3 years; mean amount of stomach content 223 ml) that received PMCT prior to forensic autopsy were retrospectively analyzed by a forensic pathologist and a radiologist. Number of layers of stomach content in PMCT were compared to number of layers at forensic autopsy. In 28 of the 55 evaluated drowning cases, a discrepancy between layering of stomach contents at autopsy compared to PMCT was observed: 1 layer at autopsy (n = 28): 50% discrepancy to PMCT, 2 layers (n = 20): 45% discrepancy, and 3 layers (n = 7): 71.4% discrepancy. Sensitivity of correctly determining layering (as observed at forensic autopsy) in PMCT was 52% (positive predictive value 44.8%). Specificity was 46.6% (negative predictive value 53.8%). In a control group (n = 35) of non-drowning cases, three-layering of stomach contents was not observed. Discrepancies of observed numbers of stomach content layers between PMCT and forensic autopsy are a frequent finding possibly due to stomach content sampling technique at autopsy and movement of the corpse prior to PMCT and autopsy. Three-layering in PMCT, if indeed present, may be interpreted as a hint to drowning.

Identical fracture patterns in combat vehicle blast injuries due to improvised explosive devices; a case series

PubMed Central

2012-01-01

Background In November 2008, a surgical team from the Red Cross Hospital Beverwijk, the Netherlands, was deployed in Afghanistan for three months to attend in the army hospital of Kandahar. During their stay, four incidents of armored personnel carriers encountering an improvised explosive device were assessed. In each incident, two soldiers were involved, whose injuries were strikingly similar. Case presentation The described cases comprise paired thoracic vertebral fractures, radial neck fractures, calcaneal fractures and talar fractures. Moreover, the different types of blast injury are mentioned and related to the injuries described in our series. Acknowledging the different blast mechanisms is important for understanding possible injury patterns. Conclusion From this case series, as well as the existing literature on injury patterns caused by blast injuries, it seems appropriate to pay extra attention to bodily areas that were injured in other occupants of the same vehicle. Obviously, the additional surveillance for specific injuries should be complementary to the regular trauma work-up (e.g., ATLS). PMID:23051981

Possibilities of post-mortem diagnostics, including immunodiagnostics, in cases of sudden death due to anaphylactic and anaphylactoid reactions.

PubMed

Kobek, M; Jankowski, Z; Chowaniec, C; Chowaniec, M; Jabłoński, C; Skowronek, R

Postmortem diagnostics of anaphylactic and anaphylactoid reaction as the cause of death in cases of sudden deaths without witnesses, as well as those in which circumstances of sudden disease and then death are known, seems to be very difficult. This is caused by the lack of characteristic macro- or microscopic changes to internal organs resulting from a short, or even very short time, that elapses from the action of the etiological factor till death. In the above mentioned cases it is often impossible to establish univocally the cause of death, despite considering information on the cause of disease and its clinical symptoms. On the basis of 2 cases of sudden deaths resulted from the intake of hazel nuts, and the administration of contrast agent before radiological examination, the authors discuss the usefulness of postmortem determinations of tryptase and IgE in blood for diagnostics of deaths resulting from anaphylactic and anaphylactoid reaction, respectively.

[Measles in Germany: An Epidemiological Analysis and First Measures for Containment].

PubMed

Matysiak-Klose, Dorothea; Wicker, Sabine

2017-11-01

Measles are one of the most contagious diseases of mankind. Measles incidence has declined worldwide since the introduction of vaccinations. Due to low numbers of measles cases in countries with high vaccination rates the population is not aware of possible complications of measles any more. Measles elimination is an important goal set by all regions of the World Health Organization. However, it remains a challenge for Germany and other European countries. Because of a high proportion of susceptibles in specific population and age groups outbreaks take place in Germany every year after importation of the virus. More than 50 % of measles cases are 20 years and older. However, the highest incidences have been seen in two-year-olds since several years. In addition to epidemiological findings such as case numbers and risk groups, genotyping permits e. g. an assessment of the endemic circulation of viruses. Suspicion of a measles case should result in immediate and consistent measures. © Georg Thieme Verlag KG Stuttgart · New York.

Changes in bacterial meningitis.

PubMed Central

Carter, P E; Barclay, S M; Galloway, W H; Cole, G F

1990-01-01

In 1964, one of us (WHG) undertook a retrospective study of bacterial meningitis in childhood in the north east of Scotland during the period 1946-61. We have recently carried out a similar review of cases occurring during 1971-86, to compare the incidence, mortality, and bacteriological patterns. During the earlier period 285 cases occurred, a total incidence of 16.9/100,000 children per year. In the later period 274 children were affected, an annual incidence of 17.8/100,000. The overall mortality rate fell dramatically from 11.9% to 1.8%, the latter figure comparing favourably with recent published studies from Scandinavia and the United States. There was a change in the bacteriological profile in the second period with a significant rise in cases due to Haemophilus influenzae at all ages. A fall in cases of meningococcal meningitis was significant in infants under 1 year of age only. Possible reasons for the change in the bacteriological pattern are discussed. PMID:2357086

Near-death experience and out of body phenomenon during torture--a case report.

PubMed

Cooper, Maxwell J F

2011-01-01

A case of a near death experience (NDE) associated with an "Out of body" phenomenon in an African man as a result of torture is presented. Although NDEs occur in approximately ten per cent of survivors of cardiac arrest, case reports emerging from the medical examination of torture victims are lacking. This may be due to cultural/linguistic barriers and fear of disbelief. Low NDE incidence during torture would suggest that torture techniques rarely induce the critical brain ischaemia considered necessary to provoke an NDE. Alternatively psychological or physical characteristics of torture may render NDE harder to recall. Proof of low incidence during torture would counter the theory that NDEs are a psychological response to perceived threat of death. NDEs often induce transformational benefits in patients' lives and for this reason the author urges physicians to consider the possibility of NDE amongst torture victims under their care. A request for information about similar cases is made.

Small supernumerary marker chromosomes 1 with a normal phenotype.

PubMed

Liehr, Thomas; Wegner, Rolf-Dieter; Stumm, Markus; Martin, Thomas; Gillessen-Kaesbach, Gabriele; Kosyakova, Nadezda; Ewers, Elisabeth; Hamid, Ahmed Basheer; von Eggeling, Ferdinand; Hentschel, Julia; Ziegler, Monika; Weise, Anja

2010-04-01

Small supernumerary marker chromosomes (sSMCs) are a major problem in prenatal cytogenetic diagnostics. Over two-thirds of cases carrying an sSMC derived from chromosome 1 are associated with clinical abnormalities. We report 3 further cases of such sSMCs that did not show any clinical abnormalities. All 3 sSMCs studied were detected prenatally and characterized comprehensively for their genetic content by molecular cytogenetics using subcentromere-specific multicolor fluorescence in situ hybridization, and for a possibly associated uniparental disomy. After exclusion of additional euchromatin due to the presence of sSMCs and a uniparental disomy, parents opted for continuation of the pregnancies and healthy children were born in all 3 cases. It is important to quickly and clearly characterize prenatal sSMCs. Also, all available sSMC cases need to be collected on a homepage such as the Jena Institute of Human Genetics and Anthropology sSMC homepage (http://www.med.uni-jena.de/fish/sSMC/00START.htm). Copyright 2010 Elsevier. Published by Elsevier B.V. All rights reserved.

Recurrent hyperparathyroidism: a study of 3 cases with evaluation of some pathogenetic and clinical aspects.

PubMed Central

Mazzuoli, G.; Minisola, S.; Scarda, A.; De Matteis, A.; Tabolli, S.; Bigi, F.; Valtorta, C.; D'Erasmo, E.

1987-01-01

Three patients with recurrent hyperparathyroidism (15, 8 and 3 years respectively, after the first operation) are described in order to establish the causes and define the clinical characteristics of the disease. The observation that in the present series recurrent hyperparathyroidism was associated either with an adenoma (two cases) or a carcinoma (one case), appears to stress the possibility of the pathological involvement of one gland even though recurrent hyperparathyroidism should be considered due to the chronic extrinsic stimulation of the parathyroid glands. The severity of the clinical and metabolic picture observed at the time of the first diagnosis and/or at the time of recurrence together with the simultaneous presence of bone and stone disease in the patients described is of particular interest. The cases reported underline the importance of carrying out careful metabolic investigations in patients with hyperparathyroidism not only before but also for a prolonged period of time after operation. PMID:3671259

Tactics and strategies for managing Ebola outbreaks and the salience of immunization.

PubMed

Getz, Wayne M; Gonzalez, Jean-Paul; Salter, Richard; Bangura, James; Carlson, Colin; Coomber, Moinya; Dougherty, Eric; Kargbo, David; Wolfe, Nathan D; Wauquier, Nadia

2015-01-01

We present a stochastic transmission chain simulation model for Ebola viral disease (EVD) in West Africa, with the salutary result that the virus may be more controllable than previously suspected. The ongoing tactics to detect cases as rapidly as possible and isolate individuals as safely as practicable is essential to saving lives in the current outbreaks in Guinea, Liberia, and Sierra Leone. Equally important are educational campaigns that reduce contact rates between susceptible and infectious individuals in the community once an outbreak occurs. However, due to the relatively low R 0 of Ebola (around 1.5 to 2.5 next generation cases are produced per current generation case in naïve populations), rapid isolation of infectious individuals proves to be highly efficacious in containing outbreaks in new areas, while vaccination programs, even with low efficacy vaccines, can be decisive in curbing future outbreaks in areas where the Ebola virus is maintained in reservoir populations.

CASE REPORT OF SEVERE PROLIFERATIVE RETINOPATHY IN A PATIENT WITH CONGENITAL LIPODYSTROPHY.

PubMed

Rosin, Boris; Jaouni, Tareq

2017-08-21

A case report of a patient with severe proliferative retinopathy due to congenital lipodystrophy. We reviewed the medical history, imaging, and surgical procedures of a 25-year-old woman with a history of congenital lipodystrophy, presenting with bilateral combined tractional and exudative retinal detachment, poorly controlled diabetes mellitus, and extreme dislipidemia. The patient underwent retinal detachment repair surgery both eyes. On the last follow-up, both retinae were flat, and visual acuity had improved in the right eye to J3 for near and finger counting 3 m for distance. Surgery combining pars plana vitrectomy and scleral bucking successfully flattened both retinae and significantly improved visual acuity in one eye in this case of bilateral retinal detachment with combined tractional and exudative components in a patient with congenital lipodystrophy. Surgical control of retinal complications is thus possible, provided there is adequate control of the underlying risk factors.

Same dog bite and different outcome in two cases - case report.

PubMed

Rd, Gadekar; Vk, Domple; If, Inamdar; Nr, Aswar; Mk, Doibale

2014-06-01

There is still no cure for rabies and survival from clinical rabies is extremely rare. It is a preventable disease if the post exposure prophylaxis is initiated in time and administered as per WHO guidelines including administration of rabies immunoglobulin. The role of passive rabies immunization products is to provide the immediate availability of neutralizing antibodies at the site of the exposure before it is physiologically possible for the patient to begin producing his or her own antibodies after vaccination. In this case report, the same dog has bitten to a boy and to an adult. Local wound treatment and use of human rabies immunoglobulin as well as gluteal region as a site of bite were the probable reasons for survival of the boy. On the other hand no local wound treatment, no use of rabies immunoglobulin and finger as a site of bite are the probable reasons for death of an adult due to rabies.

Accidental injections of dexamethasone intravitreal implant (Ozurdex) into the crystalline lens.

PubMed

Coca-Robinot, Javier; Casco-Silva, Bruno; Armadá-Maresca, Felix; García-Martínez, Jesús

2014-01-01

To describe the side effects and management after inadvertent injection of a dexamethasone implant (Ozurdex) into the crystalline lens. Two case reports. Two patients with macular edema due to unilateral retinal vein occlusion were scheduled for an intravitreal injection of Ozurdex. During the procedure, the implant was accidentally injected into the crystalline lens. Both patients developed cataracts during the course of several weeks and in both there was an intraocular pressure (IOP) increase, which required treatment with topical hypotensives. Macular edema improved only slightly. Cataract surgery with uneventful removal of the implant was performed 3 (case 1) and 6 months (case 2) after the injection. After inadvertent injection of Ozurdex into the crystalline lens, cataract surgery with removal of the implant should be performed as soon as possible in order to avoid IOP increase and so that the underlying condition may be treated adequately.

Aesthetically and functionally satisfying reconstruction of an Achilles tendon and overlying skin defect in a 15 year old girl: a case report.

PubMed

Wurzer, Paul; Eberl, Robert; Kamolz, Lars-Peter; Parvizi, Daryousch; Rappl, Thomas; Spendel, Stephan

2015-03-01

Achilles tendon and overlying soft tissue reconstruction presents an interdisciplinary challenge. In the literature many possible procedures are described, but each reconstruction in this region has its specific demands. Single stage reconstruction is normally pursued, but it is not always the best procedure for the patient, either aesthetically or functionally. We present a case of a 15 year old girl who suffered a soft tissue defect of 10cm×6cm in size at the area of the Achilles tendon due to a contact burn by an exhaust pipe during a motorcycle accident. For this case, reconstruction of the soft tissue defect using a free temporoparietal fascial flap (TPFF) and a full-thickness skin autograft was the best means to provide a satisfying result for both the patient and the surgeon. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Predictors of obstetric intervention rates: case-mix, staffing levels and organisational factors of hospital of birth.

PubMed

Joyce, Rachel; Webb, R; Peacock, Janet

2002-11-01

We performed a cross-sectional study of all Thames maternity units, 1994-96, including 540,834 live and stillbirths. In contrast to recent media speculation, no association of caesarean section rates with midwifery staffing levels was found after adjustment for confounders. The only association with staffing was with levels of junior obstetric staffing, which could be a reflection of less experienced management of labour. Caesarean section rates were also associated positively with the levels of delivery beds, which could be a reflection of the closer monitoring of labour that may result from increased bed availability. Both caesarean section and instrumental vaginal delivery rates were associated with epidural rates, which was expected from the literature. Variations in epidural rates were mainly associated with variations in demographic case-mix, due possibly to patient demand. Demographic case-mix was also associated with instrumental vaginal deliveries but not the caesarean section rate.

Listening to the patient as a possible route to cost-effective rehabilitation: a case report.

PubMed

Grandi, Attilia; Mazzola, Marcella; Angelini, Lucia; Chiappedi, Matteo

2012-01-17

Adolescents with cerebral palsy often do not need a specific rehabilitative treatment; however, when specific needs are expressed, clinicians should listen and try to answer them. We present the case of a 17-year-old Italian male patient with hemiplegia who had received standard physiotherapy and, ultimately, after a period of adapted physical activity performed in a group, was under consideration for discharge. However, due to unsatisfactory hand control, he asked for help to reach a personal goal, the ability to drive a motorbike, without surgery. Functional taping showed efficacy, but was neither cost-effective nor practical for the patient and his family; by contrast, a dynamic orthosis associated with training in a real-life environment was instead successful. The present case underlines the importance of considering solutions involving the motivation and compliance of the patient in order to improve his activity and participation.

The case for regulating collaborative reproduction: a children's rights perspective.

PubMed

Alvare, Helen M

2003-01-01

There is little regulation of collaborative reproduction--the use of the eggs, sperm, or embryos of a third party to create a child biologically unrelated to at least one intending parent. This Article argues that the dearth of regulation should be assessed from a children's rights perspective and accordingly adjusted. After examining the effects of the experimental reproductive technologies, it concludes that traditional family law preferences and policies are undercut by the deliberate creation of collaboratively reproduced children. The lack of regulation might stem from constitutional protection afforded parents in the right of privacy and substantive due process cases. The author, however, contends that collaborative reproduction implicates the rights of children and requires a separate balancing of rights not contemplated in other cases. Collaborative reproduction also requires regulation because of its spill over effects on the acceptability of cloning. The Article concludes by offering several possible regulatory responses to the problems posed by collaborative reproduction.

On the consistency of Reynolds stress turbulence closures with hydrodynamic stability theory

NASA Technical Reports Server (NTRS)

Speziale, Charles G.; Abid, Ridha; Blaisdell, Gregory A.

1995-01-01

The consistency of second-order closure models with results from hydrodynamic stability theory is analyzed for the simplified case of homogeneous turbulence. In a recent study, Speziale, Gatski, and MacGiolla Mhuiris showed that second-order closures are capable of yielding results that are consistent with hydrodynamic stability theory for the case of homogeneous shear flow in a rotating frame. It is demonstrated in this paper that this success is due to the fact that the stability boundaries for rotating homogeneous shear flow are not dependent on the details of the spatial structure of the disturbances. For those instances where they are -- such as in the case of elliptical flows where the instability mechanism is more subtle -- the results are not so favorable. The origins and extent of this modeling problem are examined in detail along with a possible resolution based on rapid distortion theory (RDT) and its implications for turbulence modeling.

Chylous Ascites: Evaluation and Management

PubMed Central

Al-Busafi, Said A.; Ghali, Peter; Deschênes, Marc; Wong, Philip

2014-01-01

Chylous ascites refers to the accumulation of lipid-rich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to traumatic injury or obstruction. Worldwide, abdominal malignancy, cirrhosis, and tuberculosis are the commonest causes of CA in adults, the latter being most prevalent in developing countries, whereas congenital abnormalities of the lymphatic system and trauma are commonest in children. The presence of a milky, creamy appearing ascitic fluid with triglyceride content above 200 mg/dL is diagnostic, and, in the majority of cases, unless there is a strong suspicion of malignancy, further investigations are not required in patients with cirrhosis. If an underlying cause is identified, targeted therapy is possible, but most cases will be treated conservatively, with dietary support including high-protein and low-fat diets supplemented with medium-chain triglycerides, therapeutic paracentesis, total parenteral nutrition, and somatostatins. Rarely, resistant cases have been treated by transjugular intrahepatic portosystemic shunt, surgical exploration, or peritoneovenous shunt. PMID:27335837

Endoscopic transpterygoidal repair of a large cranial defect with cerebrospinal fluid leak in a patient with extensive osteoradionecrosis of the skull base: case report and technical note.

PubMed

Brand, Y; Lim, E; Waran, V; Prepageran, N

2015-12-01

Endoscopic endonasal techniques have recently become the method of choice in dealing with cerebrospinal fluid leak involving the anterior cranial fossa. However, most surgeons prefer an intracranial approach when leaks involve the middle cranial fossa. This case report illustrates the possibilities of using endoscopic techniques for cerebrospinal fluid leaks involving the middle fossa. A 37-year-old male patient presented with multiple areas of cranial defect with cerebrospinal fluid leak due to osteoradionecrosis following radiation for nasopharyngeal carcinoma 4 years earlier. Clinical examination showed involvement of all cranial nerves except the IInd and XIth nerves on the left side. A prior attempt to repair the cerebrospinal fluid leak with craniotomy was not successful. This case demonstrates the successful endoscopic repair of a large cranial defect with cerebrospinal fluid leak.

Acquired drug resistance conferred by a KRAS gene mutation following the administration of cetuximab: a case report

PubMed Central

2013-01-01

Background Although a number of studies have reported acquired drug resistance due to administration of epidermal growth factor receptor antibody inhibitors, the underlying causes of this phenomenon remain unclear. Case presentation Here we report a case of a 75-year-old man with liver metastasis at 3 years after a successful transverse colectomy to treat KRAS wild-type colorectal cancer. While initial administration of epidermal growth factor receptor inhibitors proved effective, continued use of the same treatment resulted in new peritoneal seeding. An acquired KRAS mutation was found in a resected tissue specimen from one such area. This mutation, possibly caused by administration of epidermal growth factor receptor inhibitors, appears to have conferred drug resistance. Conclusion The present findings suggest that administration of epidermal growth factor receptor inhibitors results in an acquired KRAS mutation that confers drug resistance. PMID:24304820

[Gigantism with low serum level of growth hormone: a case report].

PubMed

Ran, X; Zhang, L; Xiong, P; Zhao, T; Tong, N; Li, X

2001-12-01

Gigantism with low or normal basal concentrations of growth hormone (GH) is a rare condition, possibly due to abnormal GH secretory patterns, enhanced tissue sensitivity to GH, or the existence of an unidentified growth promoting factor. Here we report an 11 year-old female case of gigantism with a normal pituitary gland. Her height was 181 cm, body weight 77 kg, and bone age 11.1 years. Her basal serum GH levels were lower than 1 ng/ml. The levels of T3, T4, FT3, FT4, TSH, E2, LH, FSH, PRL, PTC and ACTH were normal. Serum GH response to insulin-induced hypoglycemia or arginine stimulation tests was blunted. In this case, non-pulsatile GH secretion and enhanced tissue sensitivity to GH may induce hypersecretion of IGF-1 and the existence of an unidentified growth promoting factor or biologically active anti-GH receptor antibodies may cause clinical gigantism.

An unusual cause of intractable heel pain.

PubMed

Ghani, Samuel; Fazal, Muhammad Ali

2011-01-01

We report a case of severe heel pain that did not respond to noninvasive measures. Magnetic resonance imaging scans revealed a soft tissue mass that after complete surgical excision was found to be an epidermal cyst. The patient experienced full resolution of the symptoms after excision of the epidermal cyst. To our knowledge, intractable heel pain due to an epidermal cyst is rare. We were unable to identify a previous publication describing the presence of an epidermal cyst localized to the heel without a history of previous trauma. From our experience with the present case, we believe that clinicians should consider the possibility of an epidermal inclusion cyst and should have a low threshold for obtaining magnetic resonance imaging scans, in particular, before the initiation of invasive treatment, in the case of intractable heel pain. Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Patient Mobility in Times of Austerity: A Legal and Policy Analysis of the Petru Case.

PubMed

Frischhut, Markus; Fahy, Nick

2016-03-01

The case-law of the Court of Justice (ECJ) on patient mobility was recently challenged by a ruling that a patient could go to Germany for treatment when facilities in Romanian hospitals were inadequate. Given the reported impact of austerity measures in the field of health care this raises the question; what is the impact of the ECJ's ruling on how Member States can manage expenditure and limit outflows of patients and how should such measures be legally evaluated? The objective of this article is to analyse potential impact on health systems in the context of increasing pressure on public financing for health. While the ECJ mainly referred to the requirement of treatment in due time, we also analyse possible austerity reductions of the basket of care against the background of EU law (i.e., EGJ case-law, patient mobility directive, Charter of Fundamental rights and social security regulation).

Current challenges in monitoring, discrimination, and management of induced seismicity related to underground industrial activities: A European perspective

NASA Astrophysics Data System (ADS)

Grigoli, Francesco; Cesca, Simone; Priolo, Enrico; Rinaldi, Antonio Pio; Clinton, John F.; Stabile, Tony A.; Dost, Bernard; Fernandez, Mariano Garcia; Wiemer, Stefan; Dahm, Torsten

2017-06-01

Due to the deep socioeconomic implications, induced seismicity is a timely and increasingly relevant topic of interest for the general public. Cases of induced seismicity have a global distribution and involve a large number of industrial operations, with many documented cases from as far back to the beginning of the twentieth century. However, the sparse and fragmented documentation available makes it difficult to have a clear picture on our understanding of the physical phenomenon and consequently in our ability to mitigate the risk associated with induced seismicity. This review presents a unified and concise summary of the still open questions related to monitoring, discrimination, and management of induced seismicity in the European context and, when possible, provides potential answers. We further discuss selected critical European cases of induced seismicity, which led to the suspension or reduction of the related industrial activities.

Effective theory of monolayer TMDC double quantum dots

NASA Astrophysics Data System (ADS)

David, Alessandro; Burkard, Guido; Kormányos, Andor

2018-07-01

Monolayer transition metal dichalcogenides (TMDCs) are promising candidates for quantum technologies, such as spin qubits in quantum dots, because they are truly two-dimensional semiconductors with a direct band gap. In this work, we analyse theoretically the behaviour of a double quantum dot (DQD) system created in the conduction band of these materials, with two electrons in the (1,1) charge configuration. Motivated by recent experimental progress, we consider several scenarios, including different spin–orbit splittings in the two dots and including the case when the valley degeneracy is lifted due to an insulating ferromagnetic substrate. Finally, we discuss in which cases it is possible to reduce the low energy subspace to the lowest Kramers pairs. We find that in this case the low energy model is formally identical to the Heisenberg exchange Hamiltonian, indicating that such Kramers pairs may serve as qubit implementations.

Specimen Identification Errors in Breast Biopsies: Age Matters. Report of Two Near-Miss Events and Review of the Literature.

PubMed

Tozbikian, Gary; Gemignani, Mary L; Brogi, Edi

2017-09-01

The consequences of patient identification errors due to specimen mislabeling can be deleterious. We describe two near-miss events involving mislabeled breast specimens from two patients who sought treatment at our institution. In both cases, microscopic review of the slides identified inconsistencies between the histologic findings and patient age, unveiling specimen identification errors. By correlating the clinical information with the microscopic findings, we identified mistakes that had occurred at the time of specimen accessioning at the original laboratories. In both cases, thanks to a timely reassignment of the specimens, the patients suffered no harm. These cases highlight the importance of routine clinical and pathologic correlation as a critical component of quality assurance and patient safety. A review of possible specimen identification errors in the anatomic pathology setting is presented. © 2017 Wiley Periodicals, Inc.

The risks of self-made diets: the case of an amateur bodybuilder.

PubMed

Della Guardia, Lucio; Cavallaro, Maurizio; Cena, Hellas

2015-01-01

Following DIY (do it yourself) diets as well as consuming supplements exceeding by far the recommended daily intake levels, is common among athletes; these dietary habits often lead to an overconsumption of some macro and/or micronutrients, exposing athletes to potential health risks. The aim of this study is to document the development of possible adverse effects in a 33 year-old amateur bodybuilder who consumed for 16 years a DIY high protein diet associated to nutrient supplementation. Body composition, biochemical measures and anamnestic findings were evaluated. We present this case to put on alert about the possible risks of such behavior repeated over time, focusing on the adverse gastrointestinal effects. We discuss the energy and nutrient composition of his DIY diet as well as the use of supplements. This study provides preliminary data of the potential risks of a long-term DIY dietary supplementation and a high protein diet. In this case, permanent abdominal discomfort was evidenced in an amateur body builder with an intake exceeding tolerable upper limit for vitamin A, selenium and zinc, according to our national and updated recommendations. As many amateur athletes usually adopt self-made diets and supplementation, it would be advisable for them to be supervised in order to prevent health risks due to a long-term DIY diet and over-supplementation.

Down syndrome and ionizing radiation.

PubMed

Verger, P

1997-12-01

This review examines the epidemiologic and experimental studies into the possible role ionizing radiation might play in Down Syndrome (trisomy 21). It is prompted by a report of a temporal cluster of cases of this chromosomal disorder observed in West Berlin exactly 9 mo after the radioactive cloud from Chernobyl passed. In approximately 90% of cases, Down Syndrome is due to the nondisjunction of chromosome 21, most often in the oocyte, which may be exposed to ionizing radiation during two separate periods: before the completion of the first meiosis or around the time of ovulation. Most epidemiologic studies into trisomies and exposure to ionizing radiation examine only the first period; the Chernobyl cluster is related to the second. Analysis of these epidemiologic results indicates that the possibility that ionizing radiation might be a risk factor in Down Syndrome cannot be excluded. The experimental results, although sometimes contradictory, demonstrate that irradiation may induce nondisjunction in oogenesis and spermatogenesis; they cannot, however, be easily extrapolated to humans. The weaknesses of epidemiologic studies into the risk factors for Down Syndrome at birth (especially the failure to take into account the trisomy cases leading to spontaneous abortion) are discussed. We envisage the utility and feasibility of new studies, in particular among women exposed to prolonged or repeated artificially-produced ionizing radiation.

Lack of Utility of the Lysis-Centrifugation Blood Culture Method for Detection of Fungemia in Immunocompromised Cancer Patients

PubMed Central

Creger, Richard J.; Weeman, Kisa E.; Jacobs, Michael R.; Morrissey, Anne; Parker, Pamela; Fox, Robert M.; Lazarus, Hillard M.

1998-01-01

We retrospectively compared the utility of a fungal isolation device (Isolator) versus conventional techniques for recovering fungal organisms from blood cultures obtained from neutropenic cancer patients. Positive cultures were deemed true pathogens, possible pathogens, or contaminants according to laboratory and clinical criteria. Fifty-three patients had 66 positive blood cultures for fungi, nine on multiple occasions. In 20 episodes true pathogens were recovered, 6 from broth medium alone, 4 from the Isolator system alone, and 10 from both systems. False-negative cultures were noted in 4 of 20 (20%) cases in which broth medium was used and in 6 of 20 (30%) cases in which the Isolator system was used. Possible pathogens were detected in 4 of 66 blood culture-positive cases. Forty-two positive cultures were considered contaminants, 1 collected from standard medium and 41 of 42 (98%) which grew only in Isolators. Eleven of 18 patients with true fungal infections expired as a result of infection, while 4 of 33 patients with a contaminant expired, none from a fungal cause. We do not advocate the routine use of Isolator tubes in the evaluation of the febrile, neutropenic patient due to the high rates of false positives and of contamination. PMID:9431970

[Heart surgery in Brazilian Indians].

PubMed

Gomes, W J; Carvalho, A C; Vieira Filho, J P; Souza, R B; Palma, J H; Maluf, M A; Branco, J N; Buffolo, E

1997-01-01

Our experience with surgical treatment of heart diseases in Indians living in the Amazon rain forest in primitive stages was reviewed. From 1988 to 1995, 18 patients underwent cardiovascular surgical procedures at the São Paulo Hospital of the Escola Paulista de Medicina. Seven patients had valvar disease, nine congenital heart defects, one submitral aneurysm and one arrhythmia. Thirteen Indians came from tribes of the Amazon rain forest area: three from the Xavante, two from Waiapi, two from Tucano, two from Macuxi, two from Mayoruna, and one of each tribe of Xikrin, Guajajara, Terena, Surui, Galibi, Cinta-Larga and Pataxó. We performed 22 operations, with two hospital deaths. Follow-up was possible in 87.5% of cases, with one late death. The majority of cases were due to congenital heart defects and in this series it was noted the absence of operations to treat coronary artery disease. The incidence of valve disease was higher in accultured or semi-accultured Indians. The surgical treatment of cardiovascular disease has made possible to the surviving indians to return to and be accepted by their fellow tribesmen.

An 11-Year Analysis of Emergency Presentations of Melioidosis in Northeastern Malaysia.

PubMed

Yazid, Mohd Boniami; Fauzi, Mohd Hashairi; Hasan, Habsah; Md Noh, Abu Yazid; Deris, Zakuan Zainy

2017-06-01

A neglected tropical disease, melioidosis is known to have variability in clinical presentations. Here, we described clinical features that should alert the physicians on the possibility of melioidosis. In this review of 86 cases from 2001 to 2011, the common presentations of melioidosis in the Emergency Department (ED), Hospital Universiti Sains Malaysia were; male gender (79.1 %), in working age group (47.8 ± 15.2 year-old), worked in contact with soil (73.3 %), presented with fever (91.9 %), in rainy season (55.8 %), have underlying diabetes mellitus (79.1 %), have leukocytosis (67.4 %) and high blood glucose (62.8 %) during presentation. In 34.9 % of cases, the antimicrobials were initiated at the ED and only 10.5 % include antimelioid drugs. Thirty-one patients (36.0 %) died due to melioidosis and 51.6 % of this were within 48 h of admission. Despite high mortality rate, the clinical awareness on the possibility of melioidosis among emergency physicians is still low and need to be strengthened.

Possible Very Distant or Optically Dark Cluster of Galaxies

NASA Technical Reports Server (NTRS)

Vikhlinin, Alexey; Mushotzky, Richard (Technical Monitor)

2003-01-01

The goal of this proposal was an XMM followup observation of the extended X-ray source detected in our ROSAT PSPC cluster survey. Approximately 95% of extended X-ray sources found in the ROSAT data were optically identified as clusters of galaxies. However, we failed to find any optical counterparts for C10952-0148. Two possibilities remained prior to the XMM observation: (1) This is was a very distant or optically dark cluster of galaxies, too faint in the optical, in which case XMM would easily detect extended X-ray emission and (2) this was a group of point-like sources, blurred to a single extended source in the ROSAT data, but easily resolvable by XMM due to a better energy resolution. The XMM data have settled the case --- C10952-0148 is a group of 7 relatively bright point sources located within 1 square arcmin. All but one source have no optical counterparts down to I=22. Potentially, this can be an interesting group of quasars at a high redshift. We are planning further optical and infrared followup of this system.

ELECTRON THERMAL CONDUCTION AS A POSSIBLE PHYSICAL MECHANISM TO MAKE THE INNER HELIOSHEATH THINNER

DOE Office of Scientific and Technical Information (OSTI.GOV)

Izmodenov, V. V.; Alexashov, D. B.; Ruderman, M. S., E-mail: izmod@ipmnet.ru

2014-11-01

We show that electron thermal conductivity may strongly affect the heliosheath plasma flow and the global pattern of the solar wind's interaction with the local interstellar medium. In particular, it leads to strong reduction of the inner heliosheath thickness, which makes it possible to explain (qualitatively) why Voyager 1 (V1) has crossed the heliopause at an unexpectedly small heliocentric distance of 122 AU. To estimate the effect of thermal conductivity, we consider a limiting case when thermal conduction is very effective. To do that, we assume the plasma flow in the entire heliosphere is nearly isothermal. Due to this effect,more » the heliospheric distance of the termination shock has increased by about 15 AU in the V1 direction compared with the adiabatic case with γ = 5/3. The heliospheric distance of the heliopause has decreased by about 27 AU. As a result, the thickness of the inner heliosheath in the model has decreased by about 42 AU and has become equal to 32 AU.« less

Pre-storm NmF2 enhancements at middle latitudes: delusion or reality?

NASA Astrophysics Data System (ADS)

Mikhailov, A. V.; Perrone, L.

2009-03-01

A critical analysis of recent publications devoted to the NmF2 pre-storm enhancements is performed. There are no convincing arguments that the observed cases of NmF2 enhancements at middle and sub-auroral latitudes bear a relation to the following magnetic storms. In all cases considered the NmF2 pre-storm enhancements were due to previous geomagnetic storms, moderate auroral activity or they presented the class of positive quiet time events (Q-disturbances). Therefore, it is possible to conclude that there is no such an effect as the pre-storm NmF2 enhancement as a phenomenon inalienably related to the following magnetic storm. The observed nighttime NmF2 enhancements at sub-auroral latitudes may result from plasma transfer from the plasma ring area by meridional thermospheric wind. Enhanced plasmaspheric fluxes into the nighttime F2-region resulted from westward substorm-associated electric fields is another possible source of nighttime NmF2 enhancements. Daytime positive Q-disturbances occurring under very low geomagnetic activity level may be related to the dayside cusp activity.

Influence of prestress and periodic corrugated boundary surfaces on Rayleigh waves in an orthotropic medium over a transversely isotropic dissipative semi-infinite substrate

NASA Astrophysics Data System (ADS)

Gupta, Shishir; Ahmed, Mostaid

2017-01-01

The paper environs the study of Rayleigh-type surface waves in an orthotropic crustal layer over a transversely isotropic dissipative semi-infinite medium under the effect of prestress and corrugated boundary surfaces. Separate displacement components for both media have been derived in order to characterize the dynamics of individual materials. Suitable boundary conditions have been employed upon the surface wave solutions of the elasto-dynamical equations that are taken into consideration in the light of corrugated boundary surfaces. From the real part of the sixth-order complex determinantal expression, we obtain the frequency equation for Rayleigh waves concerning the proposed earth model. Possible special cases have been envisaged and they fairly comply with the corresponding results for classical cases. Numerical computations have been performed in order to graphically demonstrate the role of the thickness of layer, prestress, corrugation parameters and dissipation on Rayleigh wave velocity. The study may be regarded as important due to its possible applications in delay line services and investigating deformation characteristics of solids as well as typical rock formations.

[Psychiatric polypharmacy: hazard through drug-drug-interaction and possibilities for prevention].

PubMed

Hahn, M; Braus, D F

2012-09-01

Psychiatric diseases and comorbidity have increased over the past years. Commonly used psychotropic drugs contain a high risk of drug interactions and adverse drug events (ADE). With a frequency of 10-12% psychotropic drugs are, among all pharmaceuticals, the most common cause of hospitalisation due to ADE. During a hospital stay the application of psychotropic drugs can also lead to adverse drug events--sometimes due to drug interactions. Currently, ADEs and drug interactions are the most frequent cause of death for in-patients (18% of all causes of death) with an overall mortality of 0.95%. As studies have shown, hospitals as well as insurers could save a considerable amount of resources by implementing a system with on-ward pharmacists, hereby reducing ADE and re-hospitalisation rates. In recent studies a large amount of current ADEs were rated as preventable. Patient impairment due to ADE is leading to an increase in liability cases with an expected 5% increase of compensation payments in 2011. To evaluate these ADE-related cases, a pharmaceutical assessment should be included in the expert trials, especially since a lack of awareness of medication errors is prevalent. When aiming towards a successful drug therapy, physicians must also consider that cheaper substances may often have an unfavourable drug interaction profile.

Postoperative elevation of CA15-3 due to pernicious anemia in a patient without evidence of breast cancer recurrence.

PubMed

Adachi, Yayoi; Kikumori, Toyone; Miyajima, Noriyuki; Inaishi, Takahiro; Onishi, Eiji; Shibata, Masahiro; Nakanishi, Kenichi; Takeuchi, Dai; Hayashi, Hironori; Kodera, Yasuhiro

2015-12-01

Cancer antigen 15-3 (CA15-3) is considered as a marker for breast cancer recurrence. However, we encountered a case where the patient showed postoperative elevation of the CA15-3 level due to pernicious anemia without evidence of breast cancer recurrence. The patient was a 60-year-old postmenopausal woman. She had undergone partial mastectomy and sentinel lymph node biopsy (SLNB) for her T1 left breast cancer. SLNB had indicated no lymph node metastases. The tumor was positive for hormone receptors and negative for human epidermal growth factor receptor 2. Therefore, an aromatase inhibitor and external beam irradiation had been administered as adjuvant therapy. However, the CA15-3 level was found to be elevated at 6 months postoperatively. Although imaging studies did not indicate breast cancer recurrence, CA15-3 levels continued to increase. Based on the findings of blood tests and gastroendoscopy, a diagnosis of pernicious anemia due to vitamin B12 deficiency was finally confirmed at 2 years and 6 months postoperatively. The CA15-3 level returned to normal after vitamin B12 administration. The possibility of pernicious anemia should be considered in cases of postoperative elevated CA15-3 levels with no evidence of recurrence in patients with early breast cancer.

Orofacial pain of cardiac origin: Review literature and clinical cases

PubMed Central

Garcia-Vicente, Laia; Jané-Salas, Enric; Estrugo-Devesa, Albert; Chimenos-Küstner, Eduardo; Roca-Elias, Josep

2012-01-01

The most common types of orofacial pain originate at the dental or periodontal level or in the musculoskeletal structures. However, the patient may present pain in this region even though the source is located elsewhere in the body. One possible source of heterotopic pain is of cardiac origin. Objectives: Report two cases of orofacial pain of cardiac origin and review the clinical cases described in the literature. Study Design: Description of clinical cases and review of clinical cases. Results and conclusions: Nine cases of atypical pain of cardiac origin are recorded, which include 5 females and 4 males. In craniofacial structures, pain of cardiac origin is usually bilateral. At the craniofacial level, the most frequent location described is in the throat and jaw. Pain of cardiac origin is considered atypical due to its location, although roughly 10% of the cases of cardiac ischemia manifest primarily in craniofacial structures. Finally, the differential diagnosis of pain of odontogenic origin must be taken into account with pain of non-odontogenic origin (muscle, psychogenic, neuronal, cardiac, sinus and neurovascular pain) in order to avoid diagnostic errors in the dental practice as well as unnecessary treatments. Key words:Orofacial pain, ischemic heart disease, heterotopic pain, odontalgia. PMID:22322488

Progressing the state of knowledge on the human influence on hydrological droughts through case studies

NASA Astrophysics Data System (ADS)

Rangecroft, Sally; Van Loon, Anne; Bosman, Marianne; Wanders, Niko; Di Baldassarre, Giuliano; AghaKouchak, Amir

2017-04-01

Human activities can have a large influence on changes in the hydrological system and hydrological extremes, more than climate variability and climate change in some cases. However, there are currently only a limited number of studies which aim to quantify the human impact on hydrological droughts. Here we present a synthesis study of existing and new results that aims to summarize and quantify the anthropogenic impact on hydrological drought from case studies and observations. By combining a large number of case studies, we allow conclusions to be drawn about the effects of different human activities. This work suggests ways forward to increase our understanding on how human activities are influencing drought characteristics; invaluable information for water resource management and adaptation. During this project, the impact of different human activities (e.g. water abstraction, reservoir building, urbanisation, etc) on drought frequency, duration and deficit has been calculated in a consistent manner, allowing for an improved understanding to how they have impacted droughts. This consistent methodology is a necessary element for this comparative hydrology exercise, yet we use one which is flexible and applicable to different case study set ups and data availability. The methodology used here depends on available observation data, with three possible approaches: i) paired catchment approach; ii) upstream-downstream comparison; iii) observation modelling framework. The synthesised results of the existing and new case studies cover a number of human activities, hydro-climatic and socio-economic contexts. In particular, we remove the climate dependency in the results by using case studies from multiple climatic regions, including UK, Italy, US, Australia, Mexico and Chile. For groundwater abstraction, it is clear across all the relevant case studies that abstraction activities worsen drought events. This is especially prominent in the deficit volumes, with nearly all results showing at least a 50% increase in deficit compared to the natural situation due to the human activity. However, for the reservoir case studies we find mixed results with some catchments showing drought alleviation and others demonstrating an aggravation of drought. These results show us that the impact of reservoirs on droughts downstream is dependent on reservoir management and purpose. From the urbanised case studies we find urbanisation to be a more difficult human activity to quantify and analyse. Mixed results indicate possible conflicting processes occurring due to urbanisation, and the need for further case studies and discussions. This is the first step towards quantifying the human influence on drought on the global scale using catchment scale observation-based studies, which will provide important information for global scale modellers, water managers and drought policy makers.

MHD heat flux mitigation in hypersonic flow around a blunt body with ablating surface

NASA Astrophysics Data System (ADS)

Bityurin, V. A.; Bocharov, A. N.

2018-07-01

One of the possible applications of magnetohydrodynamic flow control is considered. Namely, the surface heat flux mitigation by means of magnetohydrodynamic (MHD) interaction in hypersonic flow around a blunt body. The 2D computational model realizes a coupled solution of chemically non-equilibrium ionized airflow in magnetic field. Heat- and mass-transfer due to the ablation of materials from the body surface is taken into account. Two cases of free-stream flow conditions are considered: moderate free-stream velocity (7500 m s‑1) case and high free-stream velocity (11 000 m s‑1) case. It is shown that the first flow case results in moderate ionization in the shock layer, while the second flow case results in high ionization. In the first case, the Hall effect is significant, and effective electrical conductivity in the shock layer is rather low. In the second case, the Hall effect reduces, and effective conductivity is high. Even if the Hall effect is strong, as in the first case, intensive MHD deceleration of the flow behind the shock is provided due to the presence of insulating boundaries, the bow shock front and non-conductive wall of the blunt body. In the second case, high effective conductivity provides a high intensity of MHD flow deceleration. In both cases, a strong effect of MHD interaction on the flow structure is observed. As a consequence, a noticeable reduction of the surface heat flux is revealed for reasonable values of magnetic induction. The new treatment of mechanism for the surface heat flux reduction is proposed, which is different from commonly used one assuming that MHD interaction increases the bow shock stand-off distance, and, consequently results in a decrease of the mean temperature drop across the shock layer. The new effect of ‘saturation of heat flux’ is discussed.

Spin State Equilibria of Asteroids due to YORP Effects

NASA Astrophysics Data System (ADS)

Golubov, Oleksiy; Scheeres, Daniel J.; Lipatova, Veronika

2016-05-01

Spins of small asteroids are controlled by the Yarkovsky--O'Keefe--Radzievskii--Paddack (YORP) effect. The normal version of this effect has two components: the axial component alters the rotation rate, while the obliquity component alters the obliquity. Under this model the rotation state of an asteroid can be described in a phase plane with the rotation rate along the polar radius and the obliquity as the polar angle. The YORP effect induces a phase flow in this plane, which determines the distribution of asteroid rotation rates and obliquities.We study the properties of this phase flow for several typical cases. Some phase flows have stable attractors, while in others all trajectories go to very small or large rotation rates. In the simplest case of zero thermal inertia approximate analytical solutions to dynamics equations are possible. Including thermal inertia and the Tangential YORP effect makes the possible evolutionary scenarios much more diverse. We study possible evolution paths and classify the most general trends. Also we discuss possible implications for the distribution of asteroid rotation rates and obliquities.A special emphasis is put on asteroid (25143) Itokawa, whose shape model is well determined, but who's measured YORP acceleration does not agree with the predictions of normal YORP. We show that Itokawa's rotational state can be explained by the presence of tangential YORP and that it may be in or close to a stable spin state equilibrium. The implications of such states will be discussed.

A likelihood-based approach to identifying contaminated food products using sales data: performance and challenges.

PubMed

Kaufman, James; Lessler, Justin; Harry, April; Edlund, Stefan; Hu, Kun; Douglas, Judith; Thoens, Christian; Appel, Bernd; Käsbohrer, Annemarie; Filter, Matthias

2014-07-01

Foodborne disease outbreaks of recent years demonstrate that due to increasingly interconnected supply chains these type of crisis situations have the potential to affect thousands of people, leading to significant healthcare costs, loss of revenue for food companies, and--in the worst cases--death. When a disease outbreak is detected, identifying the contaminated food quickly is vital to minimize suffering and limit economic losses. Here we present a likelihood-based approach that has the potential to accelerate the time needed to identify possibly contaminated food products, which is based on exploitation of food products sales data and the distribution of foodborne illness case reports. Using a real world food sales data set and artificially generated outbreak scenarios, we show that this method performs very well for contamination scenarios originating from a single "guilty" food product. As it is neither always possible nor necessary to identify the single offending product, the method has been extended such that it can be used as a binary classifier. With this extension it is possible to generate a set of potentially "guilty" products that contains the real outbreak source with very high accuracy. Furthermore we explore the patterns of food distributions that lead to "hard-to-identify" foods, the possibility of identifying these food groups a priori, and the extent to which the likelihood-based method can be used to quantify uncertainty. We find that high spatial correlation of sales data between products may be a useful indicator for "hard-to-identify" products.

Drug-induced liver injury: present and future

PubMed Central

Suk, Ki Tae

2012-01-01

Liver injury due to prescription and nonprescription medications is a growing medical, scientific, and public health problem. Worldwide, the estimated annual incidence rate of drug-induced liver injury (DILI) is 13.9-24.0 per 100,000 inhabitants. DILI is one of the leading causes of acute liver failure in the US. In Korea, the annual extrapolated incidence of cases hospitalized at university hospital is 12/100,000 persons/year. Most cases of DILI are the result of idiosyncratic metabolic responses or unexpected reactions to medication. There is marked geographic variation in relevant agents; antibiotics, anticonvulsants, and psychotropic drugs are the most common offending agents in the West, whereas in Asia, 'herbs' and 'health foods or dietary supplements' are more common. Different medical circumstances also cause discrepancy in definition and classification of DILI between West and Asia. In the concern of causality assessment, the application of the Roussel Uclaf Causality Assessment Method (RUCAM) scale frequently undercounts the cases caused by 'herbs' due to a lack of previous information and incompatible time criteria. Therefore, a more objective and reproducible tool that could be used for the diagnosis of DILI caused by 'herbs' is needed in Asia. In addition, a reporting system similar to the Drug-Induced Liver Injury Network (DILIN) in the US should be established as soon as possible in Asia. PMID:23091804

Iatrogenic osteomalacia: report of two cases.

PubMed

Yamamoto, Sunao; Okada, Yosuke; Mori, Hiroko; Kurozumi, Akira; Torimoto, Keiichi; Arao, Tadashi; Tanaka, Yoshiya

2013-03-01

CASE 1: An 80-year-old man presented at our hospital with pain in both knees.He had received continuous intravenous administration of saccharated ferric oxide (SFO) over a period of five years following a diagnosis of iron-deficiency anemia.Blood tests revealed hypophosphatemia (1.4 mg/dl) and high circulating levels of fibroblast growth factor 23 (FGF23) at 248.8 mg/dl.These findings led to the diagnosis of FGF23-related osteomalacia due to SFO administration.Accordingly, the treatment plan was first to discontinue SFO, which led to a decrease in pain and normalization of phosphorus and FGF23 after 1 month.CASE 2: A 63-year-old woman presented at our hospital with leg pain.She had undergone total gastrectomy for gastric cancer at 36 years of age.Blood tests revealed hypocalcemia (8.3 mg/dl) and hypophosphatemia (2.2 mg/dl), and 25(OH)D at no more than 5 pg/ml.Bone X-rays showed significantly diminished bone shadowing.These findings led to a diagnosis of vitamin D-deficient osteomalacia due to impaired absorption following total gastrectomy.For therapy, she was treated with 1 μg/day oral alfacalcidol.Two months after initiating treatment, the pain improved. When a patient is diagnosed with unexplained pain, it is important to pay attention to the possibility of an iatrogenic etiology.

[A Case of Clinically Mild Encephalitis/encephalopathy with a Reversible Splenial Lesion due to Dengue Fever].

PubMed

Saito, Nobuo; Kitashouji, Emi; Kojiro, Maiko; Furumoto, Akitugu; Morimoto, Konosuke; Morita, Kouichi; Ariyoshi, Koya

2015-07-01

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) has been recently proposed as a clinical-radiological syndrome. Several causes of MERS have been reported including infectious diseases. We present herein on a case of MERS induced by dengue fever in a Japanese traveler. A 48-year-old male returning from Thailand and Cambodia was admitted for an unknown fever. Following admission, the dengue virus was diagnosed with a positive RT-PCR result. On day 5 of the illness, regardless of reduced fever, weakness suddenly developed in both upper limbs. A cerebral MRI showed hyperintensities in the splenium of the corpus callosum on T2-weighted and diffusion-weighted images. The symptoms resolved completely within two days of onset. The patient was diagnosed as having MERS due to the MRI features and the mild clinical course. Although only a few cases of MERS caused by dengue fever have been reported, the condition is possibly underdiagnosed. It is hypothesized that dengue fever can induce MERS as dengue fever can cause increased endothelium permeability and hypo-sodium which have been proposed in the pathogenesis of MERS. However, there is currently limited evidence for this. Further research is recommended to demonstrate a causal association between dengue fever and MERS.

Preliminary studies on the planetary entry to Jupiter by aerocapture technique

NASA Astrophysics Data System (ADS)

Aso, Shigeru; Yasaka, Tetsuo; Hirayama, Hiroshi; Poetro, Ridanto Eko; Hatta, Shinji

2006-10-01

Preliminary studies on the planetary entry to Jupiter by aerocapture technique are studied in order to complete technological challenges to deliver scientific probe with low cost and smaller mass of the spacecraft to Jupiter. Jupiter aerocapture corridor determination based on maximum deceleration limit of 5g (lower corridor) and aerocapture capability (upper corridor) at Jupiter are carefully considered and calculated. The results show about 1700 m/s of saving velocity due to aerocapture could be possible in some cases for the spacecraft to be captured by Jovian gravitational field. However, the results also show that Jovian aerocapture is not available in some cases. Hence, careful selection is needed to realize Jovian aerocapture. Also the numerical simulation of aerodynamic heating to the spacecraft has been conducted. DSMC method is used for the simulation of flow fields around the spacecraft. The transient changes of drag due to Jovian atmosphere and total heat loads to the spacecraft are obtained. The results show that the estimated heat loads could be within allowable amount heat load when some ablation heat shield technique is applied.

Preliminary studies on the planetary entry to Jupiter by aerocapture technique

NASA Astrophysics Data System (ADS)

Aso, Shigeru; Yasaka, Tetsuo; Hirayama, Hiroshi; Eko Poetro, Ridanto; Hatta, Shinji

2003-11-01

Preliminary studies on the planetary entry to Jupiter by aerocapture technique are studied in order to complete technological challenges to deliver scientific probe with low cost and smaller mass of the spacecraft to Jupiter. Jupiter aerocapture corridor determination based on maximum deceleration limit of 5g (lower corridor) and aerocapture capability (upper corridor) at Jupiter are carefully considered and calculated. The results show about 1700 m/s of saving velocity due to aerocapture could be possible in some cases for the spacecraft to be captured by Jovian gravitational field. However, the results also show that Jovian aerocapture is not available in some cases. Hence, careful selection is needed to realise Jovian aerocapture. Also the numerical simulation of aerodynamic heating to the spacecraft has been conducted. DSMC method is used for the simulation of flow fields around the spacecraft. The transient changes of drag due to Jovian atmosphere and total heat loads to the spacecraft are obtained. The results show the estimated heat loads could be within allowable amount heat load when some ablation heat shield technique is applied.

Cystadenocarcinoma of the appendix: an incidental imaging finding in a patient with adenocarcinomas of the ascending and the sigmoid colon

PubMed Central

Pitiakoudis, Michail; Argyropoulou, Paraskevi I; Tsaroucha, Alexandra K; Prassopoulos, Panos; Simopoulos, Constantinos

2003-01-01

Background Primary adenocarcinomas of the appendix are uncommon. Mucoceles that result from mucinous adenocarcinomas of the appendix may be incidentally detected on imaging. Case presentation A case of a mucocele of the appendix, due to cystadenocarcinoma, is presented as an incidental imaging finding in a female, 86-year-old patient. The patient was admitted due to rectal hemorrhage and underwent colonoscopy, x-ray, US and CT. Adenocarcinoma of the ascending colon, adenomatous polyp of the sigmoid colon and a cystic lesion in the right iliac fossa were diagnosed. The cystic lesion was characterized as mucocele. The patient underwent right hemicolectomy, excision of the mucocele and sigmoidectomy. She recovered well and in two-year follow-up is free from cancer. Conclusions Preoperative diagnosis of an underlying malignancy in a mucocele is important for patient management, but it is difficult on imaging studies. Small lymph nodes or soft tissue stranding in the surrounding fat on computed tomography examination may suggest the possibility of malignancy. PMID:14572318

[The water supply of a pediatric hospital as a possible source of an outbreak of diarrhea due to Microsporidium spp. in immunocompromised patients].

PubMed

Coria, Paulina; Urízar, Claudia; Alba, Andrea; Noemí, Isabel; Pino, Anita; Cerva, José Luis

2016-08-01

The hospital water supply is a reservoir of a variety of potentially pathogenic microorganisms that can particularly affect children and immunocompromised patients. Potentially pathogenic Microsporidium spp. have been identified in water. Microsporidiosis is an emerging parasitic and opportunistic infection in immunocompromised patients. to describe an outbreak of nosocomial diarrhea due to Microsporidium, species Encephalitozoon intestinalis. Seven cases of E. intestinalis associated diarrhea were reported between november 2012 and february 2013, in a unit of immunocompromised patients in L. Calvo Mackenna Children's Hospital. Microsporidium spp. was found in the hospital water supply and water reservoir tank. Secondary cases were transmitted by contact. Control measures included contact precautions, not to use faucet water for hand washing, bottled water for drinking and water reservoir tank sanitation. This research is about a nosocomial outbreak associated with water supply. Water quality in Chilean hospitals is an unresolved issue, especially in immunocompromised patient areas. Compliance of cleaning and disinfection of water supply systems in hospitals must be ensured.

Radiologically occult medulloblastoma with hydrocephalus: case report.

PubMed

Honma, Hirokuni; Ogiwara, Hideki

2017-09-01

There have been no reports of occult medulloblastoma nor noncommunicating hydrocephalus due to radiologically occult brain tumors. Herein, we report radiologically occult medulloblastoma with noncommunicating hydrocephalus. A 3-year-old boy presented with macrocephaly, visual field constriction, and papilledema. Neuroimagings showed enlargement of the ventricles without any mass lesions. The CT cisternography did not show influx of the contrast into the ventricles, which suggested local cerebrospinal fluid (CSF) circulatory disturbance at the outlet of the fourth ventricle. Due to possible obstructive nature of hydrocephalus, endoscopic third ventriculostomy (ETV) was performed. Three months after the ETV, he presented with repeated vomiting. Neuroimagings showed a 3-cm fourth ventricular mass with progressive hydrocephalus. Surgical resection was performed, which revealed the pathology was medulloblastoma. We report the case of radiologically occult medulloblastoma which was demonstrated radiologically in the follow-up period of ETV for noncommunicating hydrocephalus of uncertain etiology. This is the first description of a radiologically occult medulloblastoma and also the first description of an occult brain tumor with noncommunicating hydrocephalus. The occult brain tumor may be included in the etiology of hydrocephalus.

Osteogenesis Imperfecta: A Review with Clinical Examples

PubMed Central

van Dijk, F.S.; Cobben, J.M.; Kariminejad, A.; Maugeri, A.; Nikkels, P.G.J.; van Rijn, R.R.; Pals, G.

2011-01-01

Osteogenesis imperfecta (OI) is characterized by susceptibility to bone fractures, with a severity ranging from subtle increase in fracture frequency to prenatal fractures. The first scientific description of OI dates from 1788. Since then, important milestones in OI research and treatment have, among others, been the classification of OI into 4 types (the ‘Sillence classification’), the discovery of defects in collagen type I biosynthesis as a cause of most cases of OI and the use of bisphosphonate therapy. Furthermore, in the past 5 years, it has become clear that OI comprises a group of heterogeneous disorders, with an estimated 90% of cases due to a causative variant in the COL1A1 or COL1A2 genes and with the remaining 10% due to causative recessive variants in the 8 genes known so far, or in other currently unknown genes. This review aims to highlight the current knowledge around the history, epidemiology, pathogenesis, clinical/radiological features, management, and future prospects of OI. The text will be illustrated with clinical descriptions, including radiographs and, where possible, photographs of patients with OI. PMID:22570641

Prepatellar bursitis due to Brucella abortus: case report and analysis of the local immune response.

PubMed

Wallach, Jorge C; Delpino, M Victoria; Scian, Romina; Deodato, Bettina; Fossati, Carlos A; Baldi, Pablo C

2010-12-01

A case of prepatellar bursitis in a man with chronic brucellosis is presented. Brucella abortus biotype 1 was isolated from the abundant yellowish fluid obtained from the bursa. Clinical and epidemiological data did not suggest a direct inoculation of the agent in the bursa. However, the patient mentioned occasional local trauma due to recreational sports, which may have constituted a predisposing factor. As determined by ELISA, there were higher levels of IgG against Brucella LPS and cytosolic proteins detected in the patient's bursal synovial fluid when compared with serum. Levels of proinflammatory cytokines (tumour necrosis factor alpha, interleukin 1 beta, gamma interferon, interleukin 8 and MCP-1) were higher than in synovial fluids obtained from patients with rheumatoid arthritis and a patient with septic arthritis, and a zymographic analysis revealed a gelatinase of about 92 kDa. These findings indicate that it may be possible to diagnose brucellar bursitis by measuring specific antibodies in the bursal synovial fluid. In addition, our findings suggest a role of increased local levels of proinflammatory cytokines and gelatinases in the inflammatory manifestations of brucellar bursitis.

Analysis of the relative movement between mirrors and detectors for the next generation x-ray telescopes

NASA Astrophysics Data System (ADS)

Civitani, Marta

2009-08-01

Focusing X-ray telescopes with imaging capabilities, like SIMBOL-X, HEXISAT and IXO, are characterized by very long focal lengths, greater than 10m. The constraints posed by the launchers on the maximum dimensions of a payload, make necessary using alternatives to monolithic telescopes. One possibility is that the mirror and the detectors are carried by two separate spacecrafts that fly in formation. Another is placing the detector module on a bench that will be extended once in final orbit. In both the case the system will be subjected to deformation due the relative movement of the mirrors with respect to detectors. In one case the deformation will be due to the correction on the position and attitude of the detector spacecraft to maintain the formation with the mirror spacecraft, while in the other to oscillations of the detectors on the top of the bench. The aim of this work is to compare the behavior of the system in the two different configurations and to evaluate the performances of the on board metrology systems needed not to degrade the telescope angular resolution.

Incidental detection of congenital Robertsonian translocation at diagnosis of Philadelphia chromosome-positive acute lymphocytic leukemia.

PubMed

Yamaguchi, Tsukasa; Igarashi, Aiko; Kawamura, Machiko; Ozasa, Yuka; Yoshida, Masayuki; Kakihana, Kazuhiko; Sakamaki, Hisashi; Ohashi, Kazuteru

2015-05-01

A man in his early forties who had undergone 3 years of unsuccessful treatment for infertility due to oligospermia and asthenospermia developed fever and bone pain in December 20XX. He was subsequently diagnosed with acute lymphocytic leukemia. Conventional cytogenetic analysis revealed Robertsonian translocation (RT) with der(13;14)(q10;q10) in addition to the Philadelphia (Ph) chromosome. Dasatinib and prednisolone induced complete remission (CR) with disappearance of the Ph chromosome. However, RT persisted despite achieving CR. We speculate that RT is possibly congenital in our present case and might also have been responsible for the aforementioned infertility. Hematologists should be aware of the possibility that congenital chromosomal disorders might be found incidentally through diagnostic chromosome analysis for leukemia.

A skeletal case of hypertrophic osteoarthropathy from the Canary Islands dating from 1000 BP.

PubMed

González-Reimers, Emilio; Trujillo-Mederos, Aioze; Machado-Calvo, Manuel; Castañeyra-Ruiz, María; Ordóñez, Alejandra C; Arnay-de-la-Rosa, Matilde

2015-12-01

A left tibia, the distal right tibia, and the proximal four fifths of the right ulna and radius, probably belonging to an adult prehispanic man (antiquity of ≈1000 years BP) were found among commingled bone remains in a collective burial cave of the island of El Hierro, in the Canary Archipelago. All four bones show an intense periosteal bone formation, encrusting the preserved cortical bone of the diaphyses. Differential diagnosis include melorheostosis, syphilis, and leprosy, although the most likely diagnosis is hypertrophic osteoarthropathy, which is usually associated with lung neoplasm or non-malignant diseases leading to chronic hypoxemia. The marked bone proliferation, possibly due to a chronic condition, suggests that possibly the underlying illness was a non-malignant one. Copyright © 2015 Elsevier Inc. All rights reserved.

Intraoral frostbite and Leidenfrost effect.

PubMed

Divya, V C; Saravanakarthikeyan, B

2018-04-21

Current lifestyle trends encouraging the rise in use of liquid nitrogen in food and beverages may eventually increase the episodes of injuries reported as well. Here, we report the first case of intraoral frostbite as a result of direct injury to the tissues due to ingestion of liquid nitrogen. The mechanism of injury to the oral mucosa in the absence of any injury to the gastric mucosa is explained correlating it to the Leidenfrost phenomenon. Awareness and proper regulations for the use of liquid nitrogen are unavailable and must be created in order to avoid any potential mortality. The diagnostician must consider the possibility of a chemical agent such as liquid nitrogen, which is so widely being used in the food and beverage industry, as a possible aetiological factor of oral mucosal injury. © 2018 Australian Dental Association.

Selection bias due to differential participation in a case-control study of mobile phone use and brain tumors.

PubMed

Lahkola, Anna; Salminen, Tiina; Auvinen, Anssi

2005-05-01

To evaluate the possible selection bias related to the differential participation of mobile phone users and non-users in a Finnish case-control study on mobile phone use and brain tumors. Mobile phone use was investigated among 777 controls and 726 cases participating in the full personal interview (full participants), and 321 controls and 103 cases giving only a brief phone interview (incomplete participants). To assess selection bias, the Mantel-Haenszel estimate of odds ratio was calculated for three different groups: full study participants, incomplete participants, and a combined group consisting of both full and incomplete participants. Among controls, 83% of the full participants and 73% of the incomplete participants had regularly used a mobile phone. Among cases, the figures were 76% and 64%, respectively. The odds ratio for brain tumor based on the combined group of full and incomplete participants was slightly closer to unity than that based only on the full participants. Selection bias tends to distort the effect estimates below unity, while analyses based on more comprehensive material gave results close to unity.

Breast myofibroblastoma in a young woman: a case report.

PubMed

D'Ambrosio, Giancarlo; De Laurentis, Francesca; Scoglio, Daniele; Balla, Andrea; Quaresima, Silvia; Mattei, Fabrizio; Lezoche, Emanuele

2013-09-03

Myofibroblastoma (MFB) is an uncommon benign mesenchymal tumor that may arise in several organs and tissue. Although most of reported cases were located in the breast, it is extremely rare, representing less than 1% of breast tumor. MFB has predominantly seen in elderly men, but some cases have been described in menopausal women. This lesion is a stromal tumor which has many morphologic variants including cellular, collagenized, epithelioid, palisaded, lipomatous, hemangiopericytoma-like, and infiltrant features. Even if its incidence has recently increased due to the mammary screening, only few cases have been reported in Literature and even less in young women. Physical examination discloses a solitary, unilateral, painless, freely movable, usual firm in consistency, non-tender nodule. Imaging investigations usually are not specific to establish the right diagnosis. Furthermore, findings from Fine-Needle Aspiration (FNA) may be confusing and nonspecific, making diagnosis of MFB possible only after surgical operation. Not evidence of malignant transformation, recurrence or distant metastasis after a follow-up period of 15 years have been reported in Literature when resection margins are free. Hereby the authors describe a rare case of breast MFB in a young woman.

Dermal reaction and bigeminal premature ventricular contractions due to neostigmine: a case report.

PubMed

Yousefshahi, Fardin; Anbarafshan, Mohammad; Khashayar, Patricia

2011-02-25

Neostigmine is a frequently used acetylcholinesterase inhibitor administered to reverse muscular relaxation caused by nondepolarizing neuromuscular relaxants in patients recovering from general anesthesia. Severe allergic reactions and urticaria are rarely reported following the use of neostigmine bromide, and never with methylsulfate-containing drugs. In this case, bigeminal premature ventricular contractions added to urticaria provides a warning about the possibility of a life-threatening situation. We report the case of a 23-year-old Persian woman who presented with bigeminal premature ventricular contractions along with urticarial lesions on her arm and trunk as soon as she was administered neostigmine methylsulfate after undergoing a laparoscopy for ectopic pregnancy. This case report could be of value not only for anesthesiologists who routinely use neostigmine but also for others who administer the pharmaceutical preparation in other situations. The report presents a rare case of drug reaction following neostigmine use. As a result, one should consider any drug a probable cause of drug reaction. The preparation of resuscitative facilities, therefore, is necessary prior to the prescription of the medication.

Health risk assessment as an approach to manage an old landfill and to propose integrated solid waste treatment: A case study in Italy.

PubMed

Paladino, O; Massabò, M

2017-10-01

The aim of the present paper is to show how an approach based on human health risk analysis can be used as a decisional tool for the evaluation of impacts on population and for deciding between different waste treatment processes. The situation in which the increasing production of solid wastes cannot be confined in the old existing Municipal Solid Waste landfill (settled in Genoa, Liguria Region, Italy) is used as a case study. Risk assessment for human health due to air, surface water, groundwater and soil contamination is performed in different scenarios for the old landfill and compared with alternative Waste-to-Energy management solutions that consider thermal treatment by gasification of the total waste or gasification of the dry fraction coupled with anaerobic digestion of the wet fraction, plus biogas combustion with or without sludge and bottom ash/slag disposal in the old landfill. Hazard Index (HI) and Cancer Risk (CR) in case of operating landfill and under the suspected situation of failure of the sealing system, were respectively 1.15 and 1.1∗10 -7 . Unacceptable HI were found due to groundwater contamination, while HI due to river pollution was slightly under the threshold. Vegetables ingestion was the most important pathway and ammonia the most responsible of toxic adverse effects. Fish ingestion and dermal contact with contaminated water were found to be the most important exposure pathways for carcinogenic risk, due mainly to BTEX. HI and CR in the supposed scenario of total waste gasification were respectively 9.4∗10 -1 and 1.1∗10 -5 while they were respectively 3.2∗10 -1 and 6∗10 -6 in case of gasification of the dry fraction. CR in both scenarios was over the threshold mainly due to dioxins, where milk and meat ingestion were found to be the highest risk pathways. Inhalation resulted as the highest not-carcinogenic risk exposure pathway, mainly due to NOx. Decision making was made by weighing up the different scenarios, and results suggested to definitively close the landfill and to eliminate gasification of the total waste as a possible waste treatment process. Copyright © 2017 Elsevier Ltd. All rights reserved.

The potential effect of population development, smoking and antioxidant supplementation on the future epidemiology of age-related macular degeneration in Switzerland.

PubMed

Bauer, P; Barthelmes, D; Kurz, M; Fleischhauer, J C; Sutter, F K

2008-05-01

Due to the predicted age shift of the population an increase in the number of patients with late AMD is expected. At present smoking represents the only modifiable risk factor. Supplementation of antioxidants in patients at risk is the sole effective pharmacological prevention. The aim of this study is to estimate the future epidemiological development of late AMD in Switzerland and to quantify the potential effects of smoking and antioxidants supplementation. The modelling of the future development of late AMD cases in Switzerland was based on a meta-analysis of the published data on AMD-prevalence and on published Swiss population development scenarios until 2050. Three different scenarios were compared: low, mean and high. The late AMD cases caused by smoking were calculated using the "population attributable fraction" formula and data on the current smoking habits of the Swiss population. The number of potentially preventable cases was estimated using the data of the Age-Related Eye Disease Study (AREDS). According to the mean population development scenario, late AMD cases in Switzerland will rise from 37 200 cases in 2005 to 52 500 cases in 2020 and to 93 200 cases in 2050. Using the "low" and the "high" scenarios the late AMD cases may range from 49 500 to 56 000 in 2020 and from 73 700 to 118 400 in 2050, respectively. Smoking is responsible for approximately 7 % of all late AMD cases, i. e., 2600 cases in 2005, 3800 cases in 2020, 6600 cases in 2050 ("mean scenario"). With future antioxidant supplementation to all patients at risk another 3100 cases would be preventable until 2020 and possibly 23 500 cases until 2050. Due to age shift in the population a 2.5-fold increase in late AMD cases until 2050 is expected, representing a socioeconomic challenge. Cessation of smoking and supplementation of antioxidants to all patients at risk has the potential to reduce this number. Unfortunately, public awareness is low. These data may support health-care providers and public opinion leaders when developing public education and prevention strategies.

Orbit-associated tumors: navigation and control of resection using intraoperative computed tomography.

PubMed

Terpolilli, Nicole A; Rachinger, Walter; Kunz, Mathias; Thon, Niklas; Flatz, Wilhelm H; Tonn, Jörg-Christian; Schichor, Christian

2016-05-01

OBJECT Treatment of skull base lesions is complex and usually requires a multidisciplinary approach. In meningioma, which is the most common tumor entity in this region, resection is considered to be the most important therapeutic step to avoid tumor recurrence. However, resection of skull base lesions with orbital or optic nerve involvement poses a challenge due to their anatomical structure and their proximity to eloquent areas. Therefore the main goal of surgery should be to achieve the maximum extent of resection while preserving neurological function. In the postoperative course, medical and radiotherapeutic strategies may then be successfully used to treat possible tumor residues. Methods to safely improve the extent of resection in skull base lesions therefore are desirable. The current study reports the authors' experience with the use of intraoperative CT (iCT) combined with neuronavigation with regard to feasibility and possible benefits of the method. METHODS Those patients with tumorous lesions in relationship to the orbit, sphenoid wing, or cavernous sinus who were surgically treated between October 2008 and December 2013 using iCT-based neuronavigation and in whom an intraoperative scan was obtained for control of resection were included. In all cases a second iCT scan was performed under sterile conditions after completion of navigation-guided microsurgical tumor resection. The surgical strategy was adapted accordingly; if necessary, resection was continued. RESULTS Twenty-three patients (19 with WHO Grade I meningioma and 4 with other lesions) were included. The most common clinical symptoms were loss of visual acuity and exophthalmus. Intraoperative control of resection by iCT was successfully obtained in all cases. Intraoperative imaging changed the surgical approach in more than half (52.2%) of these patients, either because iCT demonstrated unexpected residual tumor masses or because the second scan revealed additional tumor tissue that was not detected in the first scan due to overlay by osseous tumor parts; in these cases resection was continued. In the remaining cases resection was concluded as planned because iCT verified the surgeon's microscopic estimation of tumor resection status. Postoperative visual outcome was favorable in more than 80% of patients. CONCLUSIONS Intraoperative CT allows control of resection in case of uncertainty and can help to improve the extent of maximal safe resection, especially in case of osseous tumor parts and masses within the orbit.

Human tuberculosis due to Mycobacterium bovis in the United States, 1995-2005.

PubMed

Hlavsa, Michele C; Moonan, Patrick K; Cowan, Lauren S; Navin, Thomas R; Kammerer, J Steve; Morlock, Glenn P; Crawford, Jack T; Lobue, Philip A

2008-07-15

Understanding the epidemiology of human Mycobacterium bovis tuberculosis (TB) in the United States is imperative; this disease can be foodborne or airborne, and current US control strategies are focused on TB due to Mycobacterium tuberculosis and airborne transmission. The National TB Genotyping Service's work has allowed systematic identification of M. tuberculosis-complex isolates and enabled the first US-wide study of M. bovis TB. Results of spacer oligonucleotide and mycobacterial interspersed repetitive units typing were linked to corresponding national surveillance data for TB cases reported for the period 2004-2005 and select cases for the period 1995-2003. We also used National TB Genotyping Service data to evaluate the traditional antituberculous drug resistance-based case definition of M. bovis TB. Isolates from 165 (1.4%) of 11,860 linked cases were identified as M. bovis. Patients who were not born in the United States, Hispanic patients, patients <15 years of age, patients reported to be HIV infected, and patients with extrapulmonary disease each had increased adjusted odds of having M. bovis versus M. tuberculosis TB. Most US-born, Hispanic patients with TB due to M. bovis (29 [90.6%] of 32) had extrapulmonary disease, and their overall median age was 9.5 years. The National TB Genotyping Service's data indicated that the pyrazinamide-based case definition's sensitivity was 82.5% (95% confidence interval; 75.3%-87.9%) and that data identified 14 errors in pyrazinamide-susceptibility testing or reporting. The prevalence of extrapulmonary disease in the young, US-born Hispanic population suggests recent transmission of M. bovis, possibly related to foodborne exposure. Because of its significantly different epidemiologic profile, compared with that of M. tuberculosis TB, we recommend routine surveillance of M. bovis TB. Routine surveillance and an improved understanding of M. bovis TB transmission dynamics would help direct the development of additional control measures.

[Surgical managment of colorectal liver metastasis].

PubMed

Prot, Thomas; Halkic, Nermin; Demartines, Nicolas

2007-06-27

Surgery offer the only curative treatment for colorectal hepatic metastasis. Nowadays, five-year survival increases up to 58% in selected cases, due to the improvement and combination of chemotherapy, surgery and ablative treatment like embolisation, radio-frequency or cryoablation. Surgery should be integrated in a multi disciplinary approach and initial work-up must take in account patient general conditions, tumor location, and possible extra hepatic extension. Thus, a surgical resection may be performed immediately or after preparation with chemotherapy or selective portal embolization. Management of liver metastasis should be carried out in oncological hepato-biliary centre.

[Splenic rupture in infectious mononucleosis].

PubMed

Basan, B; Lafrenz, M; Ziegler, K; Klemm, G

1995-12-01

A 22 year old male with infectious mononucleosis, who stated a history of trauma to his left thoracic wall, developed an acute abdomen with symptoms of shock. A ruptured spleen was suspected. This working diagnosis, which was supported by ultrasound led to a splenectomy the initial diagnosis. The case report of this rare complication--due to the increased vulnerability of the spleen capsula in infectious mononucleosis--is highlighting the possible danger of splenic rupture. As of today, emergency splenectomy without any compromise ist still the safest state of the art therapy.

Inadvertent transposition of defibrillator coil terminal pins causing inappropriate ICD therapies.

PubMed

Issa, Ziad F

2008-06-01

We report the case of a 65-year-old man with chronic atrial fibrillation (AF) and severe ischemic cardiomyopathy who underwent implantation of a prophylactic single-chamber implantable cardioverter-defibrillator (ICD). The patient experienced inappropriate ICD therapies due to oversensing of pectoral muscle myopotential secondary to reversal of the defibrillator coil terminal pins in the ICD header. Recognizing this possibility is important to avoid misinterpretation of spontaneous oversensing as hardware failure (e.g., lead fracture or insulation breech) and potentially unnecessary ICD system surgical intervention, including lead extraction.

Renal artery aneurysm in hand-assisted laparoscopic donor nephrectomy: case report.

PubMed

Maciel, R F; Branco, A J; Branco, A W; Guterres, J C; Silva, A E; Ramos, L B; Rost, C; Vieira, C A; Cicogna, P E S; Daudt, C A; Deboni, L M; Vieira, M A; Luz, H A; Vieira, J A

2003-12-01

We report a living donor who underwent laparoscopic nephrectomy using a hand-assisted device (HALD). At preoperative arteriography the donor showed a renal artery aneurysm. The patient was a 37-year-old female, 166 cm height, white, weighing 87 kg, HLA identical to the recipient. HALD was indicated due to the better visualization of renal pedicle and greater security in an obese patient. Renal artery aneurysm is a rare condition, with many possible complications. The method proved to be adequate and safe for donor nephrectomy, despite a renal artery aneurysm.

Enterococcus faecalis endocarditis following percutaneous manipulation of a biliary tract calculus and ERCP

PubMed Central

Ronald, Allan R; Pattullo, Andrew LS

1990-01-01

A case of Enterococcus faecalis endocarditis followed endoscopic retrograde cholangiopancreatography and percutaneous extraction of a biliary calculus is reported. The most likely cause of endocarditis, though unproven, is the latter procedure, as the bile is often infected during biliary tract obstruction, and bacteremia is frequent during percutaneous manipulations. Initial therapy with vancomycin was unsuccessful in clearing the bacteremia, possibly due to vancomycin tolerance of the isolate and lack of an aminoglycoside in the initial regimen. Cure was obtained when therapy with ampicillin and gentamicin was undertaken. PMID:22553458

Kidney stones: pathophysiology, diagnosis and management.

PubMed

Cunningham, Priscilla; Noble, Helen; Al-Modhefer, Abdul-Kadhum; Walsh, Ian

2016-11-10

The prevalence of kidney stones is increasing, and approximately 12 000 hospital admissions every year are due to this condition. This article will use a case study to focus on a patient diagnosed with a calcium oxalate kidney stone. It will discuss the affected structures in relation to kidney stones and describe the pathology of the condition. Investigations for kidney stones, differential diagnosis and diagnosis, possible complications and prognosis, will be discussed. Finally, a detailed account of management strategies for the patient with kidney stones will be given, looking at pain management, medical procedures and dietary interventions.

Development of High Temperature (3400F) and High Pressure (27,000 PSI) Gas Venting Process for Nitrogen Batch Heater

DTIC Science & Technology

2018-01-01

for Mach 14 possibly degrading seals ability to contain pressure due to exposure to high temperatures. A different solution for Mach 14 case will be...AEDC-TR-18-H-1 Development of High Temperature (3400°F) and High Pressure (27,000 PSI) Gas Venting Process for Nitrogen Batch...Development of High Temperature (3400°F) and High Pressure (27,000 PSI) Gas Venting Process for Nitrogen Batch Heater FA9101-10-D-0001-0010 5b. GRANT

Photoionisation of molecular wavepackets - the NaK( C1Σ +) case

NASA Astrophysics Data System (ADS)

Andersson, Renée; Kadi, Malin; Davidsson, Jan; Hansson, Tony

2002-01-01

The ultrafast photoionisation dynamics of NaK molecules in the C(3) 1Σ + state is investigated by pump-probe spectroscopy. The results are consistent with decreasing electronic transition dipole moment for photoionisation of the C state with increasing internuclear separation, due to increasing Na +K - ion pair character of the C state at the outer turning point of the wavepacket trajectory. Effects of a possible low-lying superexcited state cannot be ruled out, though, and in general future studies on ultrafast photoionisation processes need to address in more detail such effects.

[Visual impairment in juvenile diabetes mellitus due to optic atrophy: Wolfram's syndrome].

PubMed

Immink, Annelies; Reeser, H Maarten; Brus, Frank

2010-01-01

Wolfram's syndrome is a rare neurodegenerative disorder, which usually first manifests itself around the age of 6 years. The diagnosis can be made based on the characteristics incorporated in the 'DIDMOAD' acronym: diabetes insipidus, diabetes mellitus, optic atrophy and deafness. We present 2 boys, diagnosed with diabetes mellitus at the age of 5 and 4 years respectively. Both children developed optic atrophy over the years. These 2 cases illustrate that alongside diabetic retinopathy, possible syndromes, such as Wolfram's syndrome, should also be considered in children with diabetes mellitus and visual impairment.

Focal cemento-osseous dysplasia masquerading as a residual cyst

PubMed Central

Bhandari, Rajat; Sandhu, Simarpreet V.; Bansal, Himanta; Behl, Rashi; Bhullar, Ramanpreet Kaur

2012-01-01

Focal cemento-osseous dysplasia (FCOD) is a benign fibroosseous condition that can be seen in dentulous and edentulous patients. It is an asymptomatic lesion and needs no treatment; however, follow-up is essential due to the possibility that it can progress to a condition called florid cemento-osseous dysplasia. We report a case of FCOD of mandible in a 25-year-old female. Clinically, the lesion resembled periapical pathosis of odontogenic origin. An attempt has been made to discuss the clinical and histopathologic features along with differential diagnosis of cemento-osseous dysplasia. PMID:22629069

Focal cemento-osseous dysplasia masquerading as a residual cyst.

PubMed

Bhandari, Rajat; Sandhu, Simarpreet V; Bansal, Himanta; Behl, Rashi; Bhullar, Ramanpreet Kaur

2012-04-01

Focal cemento-osseous dysplasia (FCOD) is a benign fibroosseous condition that can be seen in dentulous and edentulous patients. It is an asymptomatic lesion and needs no treatment; however, follow-up is essential due to the possibility that it can progress to a condition called florid cemento-osseous dysplasia. We report a case of FCOD of mandible in a 25-year-old female. Clinically, the lesion resembled periapical pathosis of odontogenic origin. An attempt has been made to discuss the clinical and histopathologic features along with differential diagnosis of cemento-osseous dysplasia.

Paroxysmal cold haemoglobinuria in an adult with chicken pox.

PubMed

Papalia, M A; Schwarer, A P

2000-05-01

Paroxysmal cold haemoglobinuria (PCH) is an autoimmune disorder characterized by intravascular haemolysis causing haemoglobinuria. It is due to a biphasic haemolysin known as the Donath-Landsteiner antibody, which binds specifically to the P antigen of red blood cells at low temperatures, leading to complement activation and red cell lysis at 37 degrees C. PCH is a rare disease which predominantly affects the paediatric population, occurring mostly during viral infections. We report on what is possibly the first case of PCH in an adult to be precipitated by chicken pox infection.