Reddy, Sagili Vijaya Bhaskar; Gupta, Sushil Kumar; Jain, Manoj
Dermopathy of Graves' disease is a classical, but uncommon extrathyroidal manifestation of Graves' disease. The images of a typical case of dermopathy of Graves' disease are presented along with clinico-pathological correlation.
Shaw, Phyllis A; Friedman, Erica S
Providing a context for learning information and requiring learners to teach specific content has been demonstrated to enhance knowledge retention. To enhance students' appreciation of the role of science and specifically histology in clinical reasoning, disease diagnosis, and treatment, a new teaching format was created to provide clinical context, promote integration and application of science knowledge, and to foster peer teaching and learning: the Clinico-Histologic Conference (CHC) for the Mount Sinai School of Medicine Histology course. Teams of six students were each assigned specific disease processes and were charged with creating oral presentations and handouts that taught their classmates about the clinical manifestations, etiopathogeneses, diagnoses, and treatments of the assigned processes, along with comparisons of normal histology to the pathology of the disease. Each team also created four questions, some of which were used on Histology written examinations. The physician facilitator evaluated the presentation and handouts. About two-thirds of students agreed the CHC enhanced appreciation of the importance of histology, provided a context for integration and application of basic science to patient care and enhanced their ability to teach their peers. Student feedback demonstrated that the CHCs were successful in promoting teamwork, peer teaching, and the application of histology to diagnose diseases. The authors believe that teaching basic science content in this new format enhanced student learning and application of medical knowledge, and that this new teaching format can be adopted by other medical school courses.
Hada, M S; Sable, M; Kane, S V; Pai, Prathamesh S; Juvekar, S L
The calcifying epithelial odontogenic tumor (CEOT) is a rare benign neoplasm of mandible in adults. The presentation of this entity is varied and often confused with a variety of mucosal and jaw lesions and clinical, radiological, and pathological feature of CEOT often-mimic malignancy. The objective of this report is to highlight the clinical features and radiological findings which should arouse suspicion of a benign lesion and importance of providing adequate clinical information to the pathologist to attain accurate diagnosis.We discussed two cases with tumors located in the maxilla. Both presented as expansile lesions with one biopsy proven squamous cell carcinoma. Both were pursued with clinico-radiological suspicion of benign lesions and confirmed with pathological correlation of histology and immunohistochemistry as CEOT. Therefore a High index of suspicion and clinico-radiological information are the key feature for diagnosis of this rare tumor.
In this paper many critical reflections on diagnosis management of patients affected by dementia have been reported. In particular, the importance of clinico-neuropsychological evaluation of patients with respect to management prevalently based on neuropsychological tests is underlined. In this view a periodic diagnostic exercise with the objective of improving the diagnostic approach of dementias has been proposed to the Alzheimer's disease units (UVA) included in the Cronos Project.
Kashiwagi, Mitsuru; Tanabe, Takuya; Shimakawa, Shuichi; Nakamura, Michiko; Murata, Shinya; Shabana, Kousuke; Shinohara, Jun; Odanaka, Yutaka; Matsumura, Hideki; Maki, Koh; Okumura, Kenichi; Okasora, Keisuke; Tamai, Hiroshi
Recently, many cases of children presenting reversible splenial lesions during febrile illness (RESLEF) have been reported; however, their overall clinico-radiological features are unclear. To describe the clinico-radiological features, we retrospectively reviewed the etiology (pathogen), clinical course, laboratory data, magnetic resonance imaging and electroencephalography (EEG) findings, therapy, and prognosis of 23 episodes in 22 children (1 child recurred) who presented neurological symptoms, with RESLEF. The etiologies (pathogens) varied. Seizure occurred in 7 episodes, disturbance of consciousness (DC) in 13, and delirious behavior in 18. Serum sodium levels <136 mEq/L were observed in 18 episodes. Lesions outside the splenium were found in 4 cases. Slow waves were observed on EEG in 10 episodes. Methylprednisolone pulse therapy was given in 7 cases. No case resulted in neurological sequelae. Among 23 episodes, clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) was diagnosed in 6 episodes, whereas non-MERS was observed in 17 episodes. No difference was observed in almost all the clinico-radiological features' data between the 2 groups. The largest differences were observed in the rate of purposeless movement, DC, extension of the abnormal lesions outside the splenium, and marked slowing of background activity on EEG. RESLEF exhibit a spectrum of clinico-radiological features. These results suggest that non-MERS and MERS both are a part of a larger pathological condition, which we have termed as RESLEF spectrum syndrome. Given the view that such a syndrome exists, the clinical characteristics and position of non-MERS and MERS become clear.
Gusev, E I; Demina, T L; Boĭko, A N; Tatarinova, M Iu
The clinico-immunologic monitoring of 50 patients suffering from genuine multiple sclerosis by means of the clinical, neurophysiological and immunologic methods and NMR tomography attests to the relationship between changes in the clinical and immunologic characteristics. The changes in the immunologic characteristics were found to anticipate the clinical ones. The authors provide evidence for the possibility and necessity of the clinico-immunologic monitoring of the patients' status for predicting the further course of the disease.
Ostroglazov, V G; Lisina, M A
The authors provide the clinico-psychopathological characteristics of mental patients revealed for the first time during a clinico-epidemiological study of the district therapeutic population. The predominance among them of the somatic psychopathological syndromes was established. The overwhelming majority of those conditions were found to belong to multifactorial mental diseases in whose etiology and pathogenesis the key role is played by interaction between exogenous (psychogenous) and endogenous (thymopathic) factors.
Taipa, Ricardo; Pinho, João; Melo-Pires, Manuel
Neurodegenerative dementias are a group of neurological disorders characterized by deterioration in several cognitive domains in which there is selective and progressive loss of specific populations of neurons. The precise neurobiological basis for the different neurodegenerative dementias remains unknown. It is expected that different pathologies reflect different mechanisms, at least early in the neurodegeneration process. The next decades promise treatments directed to causes and mechanisms, bringing an outstanding challenge to clinicians due to heterogeneous clinical presentations with the same molecular pathology. The purpose of this brief review is to describe the key neuropathological features of the most common neurodegenerative dementias (Alzheimer disease, dementia with Lewy bodies and Parkinson’s disease dementia, and frontotemporal lobar degeneration) and the relationship with the clinical syndromes described in clinico-pathological studies. We expect this overview contributes for the understanding of this broad topic integrating the two ends of the spectrum: clinical and pathological. PMID:22557993
Pizzi, Marco; Facchin, Federico; Kohlscheen, Eva; Sartore, Leonardo; Salmaso, Roberto; Bassetto, Franco
Cutaneous syncytial myoepithelioma (CSM) is a very rare tumor belonging to the spectrum of skin myoepithelial lesions. CSM usually affects the upper extremities of young to middle aged patients and is characterized by peculiar morphological and immunohistochemical features. Unlike classic myoepithelioma, CSM is composed by a densely packed proliferation of spindled to histiocytoid cells, which are variably positive for EMA, S100, SMA, and frequently negative for cytokeratins and GFAP. The peculiar histopathology and the extreme rarity of such lesion (less than 40 cases reported in the literature) can make the diagnosis of CSM a true challenge. In the present case, we report the clinico-pathological features of a primary CSM occurring in a 38 year-old Caucasian man. The differential diagnoses of such lesion are also briefly discussed.
Park, Tae Yun; Heo, Eun Young; Chung, Hee Soon; Jin, Kwang Nam
Purpose Because anthracofibrosis (AF) is associated with tuberculosis (TB), detection of AF is clinically relevant in Korea, a TB endemic region. We thus sought to develop and validate a predictive model for AF using clinical radiographic data. Materials and Methods Between January 1, 2008 and March 31, 2014, 3849 adult patients who underwent bronchoscopies were retrospectively included from an observational registry. We dichotomized patients based on the presence (n=167) or absence (n=242) of AF. After analyzing their clinico-radiographic characteristics, a logistic prediction model was developed. An area under the curve (AUC) was drawn using the weighted score in logistic regression model. To evaluate the degree of overfitting of the predictive model, a 5-fold cross-validation procedure was performed. Results In multivariate logistic regression, clinical findings such as age >70 years, female gender, active TB, and computed tomography findings including atelectasis, stenosis, bronchial wall thickening, enlarged and calcified lymph nodes were significant diagnostic predictors for AF. The weighed score had an AUC of 0.939 [95% confidence interval (CI)=0.911–0.960], similar to the AUC obtained from internal validation (AUC=0.926, 95% CI=0.896–0.949). Conclusion The prediction model may be helpful for predicting AF based only on clinical and radiographic findings. However, further external validation is necessary. PMID:28120566
Shimada, Nobuaki; Murata, Hideo; Mikami, Osamu; Yoshioka, Miyako; Guruge, Keerthi S; Yamanaka, Noriko; Nakajima, Yasuyuki; Miyazaki, Shigeru
Genetically modified corn Bt11 is insect-resistant and expresses Cry1Ab toxin, an insecticidal protein, in kernels. Although Bt11 corn is considered safe based on animal performance, there are no reports available on the clinico-biochemical effects of feeding it to cattle. In this study, we evaluated the effects of feeding Bt11 to calves, using blood and ruminal clinico-biochemical parameters. Our three-month-long feeding experiment demonstrated that calves (n=6), fed with a ration containing 43.3% of Bt11 corn kernels as dry matter, did not develop any discernible clinical, hematological, biochemical, or ruminal abnormalities as compared with control calves (n=6) fed non-Bt11 corn. The results suggest that the transgenic Bt11 has no negative clinico-biochemical effects on calves.
Achar, Arun; Rathi, Sanjay K
Background: Melasma is an acquired increased pigmentation of the skin, characterized by gray-brown symmetrical patches, mostly in the sun-exposed areas of the skin. The pathogenesis is unknown, but genetic or hormonal influences with UV radiation are important. Aims: Our present research aims to study the clinico-epidemiological pattern and the precipitating or provocation factors in melasma. Materials and Methods: A total of 312 patients were enrolled for the study over a period of one year. Results: The mean age of patients with melasma was 33.45 years, ranging from 14 to 54 years. There was female preponderance with a female to male ratio of approximately 4 : 1. The mean age of onset was 29.99 years, with the youngest and oldest being 11 and 49 years, respectively. The patients sought medical treatment on an average of 3.59 years after appearance of melasma. About 55.12% of our patients reported that their disease exacerbated during sun exposure. Among 250 female patients, 56 reported pregnancy and 46 reported oral contraceptive as the precipitating factors. Only 34 patients had given history of exacerbation of melasma during pregnancy. A positive family history of melasma was observed in 104 (33.33%) patients. Centrofacial was the most common pattern (55.44%) observed in the present study. Wood light examination showed the dermal type being the most common in 54.48% and epidermal and mixed were seen in 21.47% and 24.03% of the cases, respectively. We tried to find an association with endocrinal diseases and observed that 20 of them had hypothyroidism. Conclusion: The exact cause of melasma is unknown. However, many factors have been implicated in the etiopathogenesis of this disorder. Here we try to identify the causative factors and provocation to develop melasma. PMID:21965843
Elhiblu, M. A.; Dua, K.; Mohindroo, J.; Mahajan, S. K.; Sood, N. K.; Dhaliwal, P. S.
Aim: The aim of this study was to determine the relevant tools in the diagnosis of liver cirrhosis in dogs. Material and Methods: A total of 140 dogs presented at Veterinary Teaching Hospital, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, showing clinical signs of hepatic insufficiency were subjected to clinico-hemato biochemical, urological, ultrasonographic (USG), and USG guided fine-needle biopsy examinations by standard methods. On the basis of these results, 6 dogs out of 140 dogs were found to be suffering from liver cirrhosis. Six clinically healthy dogs constituted the control group. Results: The dogs suffering from liver cirrhosis manifested inappetence, halitosis, abdominal distension, weight loss, melena, icterus, anemia, and neutrophilic leukocytosis with the left shift. Levels of hemoglobin, lymphocytes, packed cell volume, mean corpuscular volume, mean corpuscular Hb (MCH), and platelet count were significantly lower in liver cirrhosis group than control group while total leukocyte count, neutrophils, and MCH concentration were significantly higher. Glucose, total protein, albumin, A/G ratio, and fibrinogen were significantly lower, and creatinine, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, prothrombin time, and APTT were significantly higher than the control values. Ultrasound revealed diffuse increase in echogenicity with rounded and irregular liver margins. Cytological examination of the ascitic fluid and fine-needle aspiration biopsy of liver was not fruitful in the diagnosis of liver cirrhosis. Conclusions: Liver cirrhosis causes clinical and hemo-biochemical alterations, which require special consideration when treating diseased animals. USG, diffuse increase in echogenicity of liver, rounding and irregularity of liver margins and microhepatica were the consistent findings. It is suggested that USG along with hemo-biochemical alterations may be used as a diagnostic tool for liver cirrhosis
Ertunc, Baris; Kaya, Selcuk; Koksal, Iftihar
Objective: The aim of this study was to examine clinico-epidemiological properties of HIV/AIDS patients. Materials and Methods: For this purpose, 115 HIV/AIDS patients monitored in our clinic between January 1, 1998, and December 31, 2013, were retrospectively evaluated. Results: For the 115 patients with a diagnosis of HIV/AIDS that we monitored, the mean age at the time of presentation was 34.5±13.21 (10–79) years. Eighty-nine (76.5%) patients were male and 27 (23.5%), female. In this study, HIV/AIDS was the most prevalent in the young male population with a low educational and sociocultural level. The most common mode of transmission in our patients was heterosexual relations: approximately 1 patient in 3 had a history of traveling to countries with a high prevalence of HIV/AIDS, namely, Russia and Ukraine. The examination of diagnosis with respect to years showed an increase in new cases since 2008. Only 21 (18.3%) of our patients were diagnosed through clinical symptoms, while 91 (81.7%) during routine scanning. At first presentation, 68% of our patients were stage A; 4.7%, stage B; and 27.3%, stage C. The mean length of the monitoring of our patients was 2.74 years (2–180 months). Thirteen (11.3%) patients died due to opportunistic infections and malignities. The most common opportunistic infection was tuberculosis (16.5%), followed by syphilis and HBV. Malignity, most commonly intracranial tumor, was seen in 8.6% patients. Conclusion: The disease was generally seen in the young male population with a low sociocultural level, and it was most frequently transmitted by heterosexual sexual contact. This clearly shows the importance of sufficient, accurate information, and education on the subject of the disease and its prevention. The fact that many of our patients were diagnosed in the late stage due to stigma and that diagnosis was largely made through scanning tests confirms the importance of these tests in early diagnosis. PMID:28149137
Gorbachenko, A V; Shalimov, P M
One hundred and sixty-six young military man with mitral valve prolapse (MVP) aged 19.2+/-0.8 years were examined. Complex system approach to health status was applied to study clinico-functional features of this condition in young military men. The study found that clinico-functional manifestations of MVP in young military men reflected a multifocal character of dysadaptation during the first stages of military service. Conditions of professional military activity potentiate permanent progress of crisp prolapse as well as the severity of mitral regurgitation, structural and functional myocardial alterations, and myocardial electric instability increasing in the presence of abnormal cardiac chords under the influence of a prominent vegetative dysfunction. The reserve of the cardiorespiratory system and the entire organism in military men with MVP was lowered. The study registered inadequate hemodynamic responses to functional orthostatic test and physical load test, typical for hyperventilation syndrome.
Saksena, Annapurna; Mahajan, Nidhi; Agarwal, Shipra; Jain, Shyama
Solitary bone plasmacytoma (SBP) is a rare entity characterized by localized proliferation of monoclonal plasma cells primarily occurring in the axial skeleton without systemic involvement. Involvement of the distal extremity is unusual. In the absence of typical clinical presentation, diagnosis may not be suspected clinico-radiologically; hence, fine-needle aspiration cytology may help in early and definitive diagnosis, hastening meticulous diagnostic workup and appropriate management of these patients. Intracytoplasmic crystalline inclusions (CI) have been reported in multiple myeloma and lymphoproliferative disorders. The present case highlights unusual clinico-cytological features of SBP with primary involvement of humerus, progression to tibia, and presence of extracellular and intracytoplasmic CI in plasma cells, a morphologic finding not reported in SBP earlier.
Martin, Luis; Anguita, Alberto; Graf, Norbert; Tsiknakis, Manolis; Brochhausen, Mathias; Rüping, Stefan; Bucur, Anca; Sfakianakis, Stelios; Sengstag, Thierry; Buffa, Francesca; Stenzhorn, Holger
The challenges regarding seamless integration of distributed, heterogeneous and multilevel data arising in the context of contemporary, post-genomic clinical trials cannot be effectively addressed with current methodologies. An urgent need exists to access data in a uniform manner, to share information among different clinical and research centers, and to store data in secure repositories assuring the privacy of patients. Advancing Clinico-Genomic Trials (ACGT) was a European Commission funded Integrated Project that aimed at providing tools and methods to enhance the efficiency of clinical trials in the -omics era. The project, now completed after four years of work, involved the development of both a set of methodological approaches as well as tools and services and its testing in the context of real-world clinico-genomic scenarios. This paper describes the main experiences using the ACGT platform and its tools within one such scenario and highlights the very promising results obtained.
Buletsa, B A; Lupich, P P; Litvinova, L A
Altogether 225 patients with transitory derangements of cerebral circulation (TDCC) underwent clinico-laboratory examinations. Arterial hypertension and cerebral atherosclerosis turned out to be among most frequently occurring factors of TDCC. The provoking factors included psychoemotional stress and drops of barometric pressure. The course and outcome of TDCC were greatly affected by an increase in blood concentration of catecholamines and thyroid hormones. The high concentration of triiodothyronine in the blood contributed to the development of cerebral stroke.
Rostol'tsev, K V; Burenkov, R A; Kuz'micheva, I A
Clinico-anatomic observation of autosomal-recessive renal cystic disease and congenital hepatic fibrosis at two fetuses from the same family was done. Mutation of His3124Tyr in 58 exon of PKHD1 gene in heterozygous state was found out. The same pathomorphological changes in the epithelium of cystic renal tubules and bile ducts of the liver were noted. We suggest that the autopsy research of fetuses with congenital abnormalities, detected after prenatal ultrasonic screening, has high diagnostic importance.
Kumar, Rajesh; Jaiswal, Shradha; Sharma, Aanchal; Andhare, Vinod; Sabir, Husain
The peripheral odontogenic fibroma (POdF) is a rare gingival neoplasm, characterised by relatively mature collagenous fibrous tissue and varying amounts of odontogenic epithelium. It can be described as a slow growing, firmly attached, solid and smooth gingival mass which may be present asymptomatically for years, which may cause displacement of adjacent teeth. The purpose of this article is to discuss a case of POdF, occurring in the maxillary anterior region, with detailed clinico-pathological differential diagnosis to clarify characteristic features of various gingival overgrowths to enhance easy identification.
Adam, Julien; Baulac, Michel; Hauw, Jean-Jacques; Laplane, Dominique; Duyckaerts, Charles
A 59-year-old patient presented with compulsive behaviors and lasting apathy after carbon monoxide intoxication. The apathy could be overcome by external stimulation (self-activation deficit). There was severe neuronal loss bilaterally in the anterior part of the pallidum and in the substantia nigra, pars reticulata. This first clinico-pathological case of a self-activation deficit illustrates the dissociation between motor and behavioral symptoms in lesions of the pallido-nigral complex, with the behavioral symptoms being related to lesions of the substantia nigra, pars reticulata and of the anterior part of the pallidum.
Korsun', I V
A clinico-genealogic study of 66 patients with neurosis-like schizophrenia showed a certain genetic heterogeneity of schizophrenia with obsessions. In cases of an unfavourable course of the schizophrenic process in a proband (a malignant disease of obsessions), the familial background was largely determined by disturbances of the schizophrenic spectrum. In cases of a slow progression of the disease (slowly progressive pseudoneurotic schizophrenia), the hereditary background was characterized by a great variability of psychopathological manifestations. Along with schizophrenia-related abnormalities, the families of such patients featured the accumulation of constitutional anomalies, neurotic disturbances and subclinical affective disorders.
Liberman, Iu I; Ostroglazov, V G; Lisina, M A; Eliava, V N
A clinico-epidemiological study was made of the incidence of mental diseases among the adult community visiting the therapeutic department of a city polyclinic. Mental patients registered at the PND (41.9 per 1000 population) underwent examinations. A large group of patients, mainly with borderline mental diseases, was additionally revealed (134.4 per 1000 population). Therefore, the total incidence of mental diseases among the adult community amounted to 176.3 per 1000 population. Both groups are compared in terms of the clinical syndromes, sex, age, and the level of social adaptation.
Mariano, F V; Noronha, A L F; Gondak, R O; Altemani, A M de A M; de Almeida, O P; Kowalski, L P
Carcinoma ex pleomorphic adenoma (CXPA) is a rare tumour, with different prevalence rates reported among studies. Epidemiological studies of large series of CXPAs in developing countries are scarce. The aim of the present study was to describe Brazilian patients with CXPA; this was a retrospective study of 38 patients. Demographic and clinico-pathological features were evaluated. No preferential gender was found, and the mean age at diagnosis was 57.6 years. The most commonly involved site was the parotid, followed by the submandibular and the minor salivary glands. A prevalence of clinical stages III and IV was observed at diagnosis. The most common histological subtypes were salivary duct carcinoma, adenocarcinoma not otherwise specified, myoepithelial carcinoma, and epithelial-myoepithelial carcinoma. Moreover, by invasive phase, most were frankly invasive carcinoma. Recurrence was observed in seven out of 24 patients with outcome information available, and all were invasive cases. All seven patients died of causes related to the disease. The distributions of cases according to age, gender, tumour location, and clinical stage were similar to those reported in the literature. Frankly invasive cases presented a worse prognosis. More information is needed to further our understanding of the clinico-pathological aspects of CXPA.
Berrebi, Dominique; Fournet, Jean-Christophe; Boman, Françoise; Fabre, Monique; Philippe-Chomette, Pascale; Branchereau, Sophie; Fréneaux, Paul; Bouron-Dal Soglio, Dorothée; Michon, Jean; Peuchmaur, Michel
Congenital/infantile fibrosarcoma (IFS) is a relatively rare form of fibrosarcoma diagnosed at birth or during early years of life and that differs from its adult counterpart because of a more favorable behavior. IFS is also known as cellular congenital mesoblastic nephroma, when it affects the kidney and is often but not always characterized by the ETV6-NTRK3 fusion transcript. We report herein the first series of an exceptional tumor of the small intestine occurring in newborns. The four patients shared a stereotyped clinico-pathological presentation with early and acute onset, intestinal perforation, and an infiltration by a highly cellular spindle cell tumor within the dilated intestinal wall exhibiting pathologic features typical of IFS. Molecular studies for the ETV6-NTRK3 translocation were negative in the three cases tested. Patients were treated by surgical wide resection alone and are alive and well (follow-up: 36 months-25 years). Thus, this new clinico-pathological entity, even with lack of documented evidence of the ETV6-NTRK3 translocation, should be included in the differential diagnosis of congenital bowel perforation or obstruction and may represent an intestinal counterpart of IFS.
Luca, Mihaela Cătălina; Dorobăţ, Carmen; Corcaci, Carmen; Scurtu, Roxana; Luca, V; Mihalache, Doina
Leptospirosis is a zooantroponosis manifested as an infectious disease with a severe evolution, with liver and renal failure and hemorrhagic manifestation. The aim of this study was to present the clinico-biological investigation and the therapeutical aspects of 256 cases of leptospirosis admitted in the Infectious Diseases Hospital Iasi during 4 years (1998-2001). The diagnosis was based on the study of clinico-biological and therapeutical parameters (risk factors, fever, mialgia, headache, algic, eruptive, meningeal, hepatorenal, hemorrhagic syndromes with the serological evidence of the serotypes of leptospirosis); most of the cases were registered in 1998 (23% cases), in adults (31.2%) and male (75.22%). All the patients were serologic confirmed with leptospirosis (RAL and RFC), and L. icterohaemorhagiae was isolated most frequently. The standard anti-leptospirosis treatment was administered with favorable evolution; 6 deaths were registered from the severe forms of the disease. The leptospirosis is an emergent disease with the possibility of severe evolution in some forms, with liver and renal failure.
Zazgyva, Ancuţa; Gurzu, Simona; Gergely, István; Jung, Ioan; Roman, Ciprian O.; Pop, Tudor S.
Abstract Due to the current lack of standard definitions for rapidly progressive osteoarthritis of the hip (RPOH) in the literature, this observational study aimed to describe new diagnostic criteria and a grading system for the disease. From a consecutive series of patients undergoing total hip replacement, 2 groups were selected: 1 with RPOH and 1 with primary hip osteoarthritis (POH), and their clinical, paraclinical, and demographic data were compared. The newly proposed clinico-radiological diagnostic criteria are based on characteristics of pain, joint mobility, and radiological assessment. The radiological grading system's inter- and intraobserver reliability was assessed through serial evaluations by 2 blinded reviewers. From the total 863 cases, 82 cases (9.5%) of RPOH were identified and compared with 107 cases of POH. Mean age and disease bilaterality were similar, with a predominance of female patients in the RPOH group (P = 0.03). There were significant differences between the 2 groups in disease onset and aggravation, and intraoperative blood loss. The grading system showed significant inter- and intraobserver agreement (weighted kappa 0.93, and 0.89). Our study presents distinctive, easily recognizable clinico-radiological characteristics of RPOH and confirmed the inter- and intraobserver reliability of the newly proposed grading system. PMID:28328832
Bulanova, N A; Stazhadze, L L; Sidorenko, B A
We carried out clinico-economical analysis of 2 tactics of rhythm restoration in patients with paroxysmal atrial fibrillation (AF) lasting less than 48 hours: cardioversion at prehospital stage with intravenous procainamide and inhospital cardioversion with any method. This retrospective study was based on the data from department of urgent aid of an outpatient clinic. The results showed that within 48 hours inhospital was a was more effective, safe, and more economically profitable compared with administration of procainamide at prehospital stage. Intravenous procainamide resulted in effective cardioversion in 70.6% of patients. It was associated with arterial hypotension and proarrhythmogenic action in 14,7% of cases. Patients with effective cardioversion with procainamide had lesser mean values of left ventricular anterior-posterior dimension (echocardiography) and shorter duration of arrhythmia.
Chu, Andrew; Shaharyar, Sameer; Chokshi, Binna; Bhardwaj, Nikhil
Pulmonary alveolar microlithiasis (PAM) is a rare infiltrative lung disease characterized by deposition of spherical calcium phosphate microliths called calcospherites within the alveoli. PAM was first described by Friedrich in 1856 and then by Harbitz in 1918. The disease pathogenesis is based on mutations in the SLC34A2 gene that encodes for the Type IIb sodium-phosphate cotransporter. The majority of the patients are diagnosed at an early age, usually between the ages of 20 and 40 years. The hallmark of this disease is a striking dissociation between the radiological findings and the mild clinical symptoms. We report a case of 35-year-old woman who presented post-motor vehicle accident with back pain and with minimal dyspnea on exertion. The final diagnosis was made after computed tomography and lung biopsy. The present case exhibits the remarkable clinico-radiological dissociation with complete calcification of the lungs on radiographic images with a relatively mild clinical presentation.
Zhizhin, F S; Kapustin, B B
The authors have analyzed the results of resection of the stomach in 106 patients with a complicated course of ulcer disease of the stomach and duodenum. Based on a complex investigation of regeneration of the gastrointestinal anastomoses formed by different methods and a comparison of the endoscopic picture with the clinical course of the early postoperative period the authors propose a clinico-endoscopic classification of acute postgastroresectional anastomosites. Comparison of the frequency and severity of the anastomosites has shown advantages of a one-raw seroserous musculo-submucous suture in the resectional surgery of the stomach when forming gastro-intestinal anastomoses. The classification of acute anastomosites allows the timely detection and correction of the operation complications.
Biswas, Gautam; Das, Anjan; Haldar, Dibakar; Mukherjee, Ankur; Dutta, Sirshak; Sinha, Ramanuj
Neck is the most common site of peripheral lymph node enlargement and is very frequently encountered in oto-laryngological practice. This study was done to delineate distribution of clinico-demographic parameters in patients presenting with cervical lymphadenopathy in the otolaryngology out-patient department of a state hospital in India in a 1 year period and to correlate them with fine needle aspiration cytological diagnosis. Record-based cross sectional study in the department of Otolaryngology and department of Pathology, Calcutta National Medical College and Hospital, Kolkata. Case reports and cytological reports of 423 patients who underwent Fine Needle Aspiration Cytology (FNAC) of cervical lymph nodes between January 2009 and December 2009 were reviewed in relation to their demographic and clinical profiles. The cases were divided into three groups according to age and different parameters were described according to these groups. In the cyto-pathological diagnosis, tubercular lymph-adenitis was most prevalent diagnosis (45.4%). Among the metastatic secondaries, squamous cell carcinoma was most common (8.5%). Non-specific/reactive lymphadenitis was significantly more common in <14 years, TB lymph node in 15-59 years and malignancy among the ≥60 years age group. Jugulo-omohyoid (level III) and Supraclavicular (level VB) groups of Lymph nodes were found significantly more involved by malignancy whereas Jugulo-diagastric (level II), Post-auricular, Submandibular groups (level IB) were more commonly involved in TB. Malignancy patients presented late in respect to the tuberculosis patients. Knowledge about clinico-demographic perspectives of cervical lymphadenopathy in respect to their cytopathological diagnosis will help care giver practioners to detect/refer the respective cases early for investigations and treatment.
Agale, Shubhangi Vinayak; D’Costa, Grace F.; Valand, Arvind G.; Gupta, Vikram Kumar
Introduction Infectious Granulomatous Dermatoses (IGDS) have various aetiological factors with a considerable overlap in the histopathological and clinical features, thus posing a diagnostic dilemma for dermatologists and pathologists. Aim We aimed at determining the histopathological profile of IGDS correlating it with clinical features with an attempt to find the aetiology. Materials and Methods In a cross-sectional study conducted in a tertiary referral center of Mumbai over two years, out of 1872 skin biopsies received, 239 histopathologically diagnosed cases of IGDS were studied for histopathological features of granuloma. A clinico-histopathological correlation was attempted. Chi-square test was used for comparison of proportions of different groups. Results Leprosy (211 cases) and tuberculosis (28 cases) were the commonest histopathologically diagnosed IGDS. Leprosy spectrum included BT (30.33% cases), followed by TT (21.32%), BL and LL and 21.79% cases of lepra reactions. Skin TB biopsies on histopathology showed lupus vulgaris (53.85% cases), scrofuloderma (15.38%), TBVC and papulonecrotic tuberculid (11.54% each). In leprosy maximum clinico-pathological agreement was seen at tuberculoid pole (TT 72.7% and BT 56.6%). Among tuberculosis cases, scrofuloderma (100%) and lupus vulgaris (53.8%) showed maximum agreement. Conclusion Leprosy and skin TB are the commonest IGDS in Mumbai region though difficult to diagnose and subcategorize with certainty during initial stages. Histopathology plays the important role to elucidate the dilemma. This being a single center study, more such studies with a larger sample size are recommended to get more elaborate data and regional prevalence of these IGDS for a better overall approach to prevention, treatment and control. PMID:27190811
Santillo, Alexander Frizell; Lundblad, Karl; Nilsson, Markus; Landqvist Waldö, Maria; van Westen, Danielle; Lätt, Jimmy; Blennow Nordström, Erik; Vestberg, Susanna; Lindberg, Olof; Nilsson, Christer
Disinhibition is an important symptom in neurodegenerative diseases. However, the clinico-anatomical underpinnings remain controversial. We explored the anatomical correlates of disinhibition in neurodegenerative disease using the perspective of grey and white matter imaging. Disinhibition was assessed with a neuropsychological test and a caregiver information-based clinical rating scale in 21 patients with prefrontal syndromes due to behavioural variant frontotemporal dementia (n = 12) or progressive supranuclear palsy (n = 9), and healthy controls (n = 25). Cortical thickness was assessed using the Freesurfer software on 3T MRI data. The integrity of selected white matter tracts was determined by the fractional anisotropy (FA) from Diffusion Tensor Imaging. Disinhibition correlated with the cortical thickness of the right parahippocampal gyrus, right orbitofrontal cortex and right insula and the FA of the right uncinate fasciculus and right anterior cingulum. Notably, no relationship was seen with the thickness of ventromedial prefrontal cortex. Our results support an associative model of inhibitory control, distributed in a medial temporal lobe-insular-orbitofrontal network, connected by the intercommunicating white matter tracts. This reconciles some of the divergences among previous studies, but also questions the current conceptualisation of the “prefrontal” syndrome and the central role attributed to the ventromedial prefrontal cortex in inhibitory control. PMID:27723823
Lathi, A; Syed, M M A; Kalakoti, P; Qutub, D; Kishve, S P
The present study examined the clinico-pathological profile of sinonasal masses in patients attending an Ear Nose Throat clinic of a rural tertiary care hospital of western Maharashtra in India, between May 2007 to June 2009. During the study period, 112 patients presented with sinonasal masses (male 68, female 44; age group 8-70 years). Nasal polyploid masses were non-neoplastic in 80 (71.4%) subjects, and neoplastic in 32 (28.6%) cases. Nasal obstruction was the most common (97.3%) presenting complaint, followed by rhinorrhoea (49.1%), hyposmia (31.25%), intermittent epistaxis (17.9%), headache (16.9%), facial swelling (11.6%) and eye-related symptoms (10.7%). The most common site of origin of polyploid masses was the middle meatus (54.4%) followed by the lateral wall of the nasal cavity (16.1%) and superior meatus (10.7%). Unilateral nasal masses was present in 47.7% patients, while the remaining patients had bilateral nasal masses. Allergic (62.5%) and inflammatory (25%) polyps were the most common non-neoplastic mass. Haemangioma (47.3%) and inverted papilloma (36.8%) were most common benign neoplastic mass; 92.3% of all malignant masses were squamous cell carcinoma. Surgery was the major mode of treatment. It included Caldwell-Luc operation (7.1%), polypectomy (17.8%), excision of mass (25.0%) and functional endoscopic sinus surgery (44.6%). Malignancies were treated with radiotherapy.
Otsuki, Mika; Nakagawa, Yoshitsugu; Mori, Fumiaki; Tobioka, Hirotoshi; Yoshida, Hideaki; Tatezawa, Yoshiharu; Tanigawa, Toshio; Takahashi, Ikuko; Yabe, Ichiro; Sasaki, Hidenao; Wakabayashi, Koichi
Pathological investigation of progressive anterior operculum syndrome has rarely been reported. We describe clinico-pathological findings in a patient with progressive anterior operculum syndrome. A 74-year-old right-handed man had noticed speech and swallowing difficulties 1 year previously. Neurological examinations showed no abnormality other than a slight limitation of upward gaze and slow tongue movement without fibrillation. We investigated the patient using neuroimaging and neuropsychological examinations and observed him for 2 years until his death, at which point we obtained pathological findings. The patient's facial and masseteric muscles seemed hypotonic with drooling, but he could laugh and yawn normally, showing automatic voluntary dissociation. Palatal and pharyngeal reflexes were normal. Magnetic resonance imaging showed cortical atrophy in the temporal lobes bilaterally. (123)IMP single photon emission computed tomography and positron emission tomography showed decreased blood flow and activity in the frontotemporal lobes, predominantly on the left side. Neuropsychological examinations showed no aphasia, dementia or other neuropsychological abnormality. Intubation fiberscopy, laryngoscopy and video fluorography showed no abnormality. After 6 months his anarthria and dysphagia became aggravated. He died of aspiration pneumonia 2 years after onset. Postmortem examination revealed neuronal degeneration with TDP-43-positive inclusions in the frontal, temporal and insular cortices, consistent with frontotemporal lobar degeneration with TDP inclusions (FTLD-TDP). However, neuronal loss with gliosis was more prominent in the inferior part of the motor cortices, bilaterally. Progressive anterior operculum syndrome could be classified as a variant of FTLD-TDP.
Gupta, N; Anshu, A; Dada, R
Literatures on vasculature of upper limbs are crammed with reports of distinctly deviant version of normally prevalent vessels having modified origins, altered branching and odd courses. A unique anatomical variation in vascular pattern was observed during routine dissection of right upper limb in gross anatomy laboratory, AIIMS, New Delhi, India. The brachial artery was placed superficial to median nerve in the arm and therefore it was called superficial brachial artery. In the cubital fossa, 2.8 cm distal to intercondylar line of elbow joint, this superficial brachial artery terminated by trifurcation into radial, common interosseous and ulnar branches. Strikingly the ulnar branch, after its origin ran superficially over the median nerve and epitrochlear superficial flexor group of muscles of forearm in succession for the initial third of its course in the forearm, consequently it was addressed as superficial ulnar artery. The existence of superficial brachial artery in place of normal brachial artery, its termination by trifurcation into radial, common interosseous and superficial ulnar arteries with remarkably different courses, leads to confusing disposition of structures in the arm, cubital fossa and in the forearm and collectively makes this myriad of anatomical variations even rarer. The clinico-embryological revelations for combination of these unconventional observations, apprises and guides the specialized medical personnel attempting blind and invasive procedures in brachium and ante-brachium. This case report depicts the anatomical perspective and clinical implications on confronting a rare variant vasculature architecture pattern of upper limb.
Hussein, Kais; Rath, Berenice; Ludewig, Britta; Kreipe, Hans; Jonigk, Danny
Rare Epstein-Barr virus (EBV)+ smooth muscle tumours (SMT) manifest typically under immunosuppression. Three major subtypes are known: human immunodeficiency virus-associated (HIV-SMT), after transplantation (PTSMT) or associated with congenital immunodeficiency syndromes (CI-SMT). So far, there are no analyses which compare the clinico-pathological characteristics of all three subtypes. Case reports and case series on these three tumour types were collected (1990-2012). Meta-data analysis was performed for identification of similarities and differences. A total of 73 HIV-SMT, 66 PTSMT and 9 CI-SMT were evaluated. There was a slight female predominance (55-67%). Children were affected nearly equally in HIV-SMT (33%) and PTSMT (35%), while all CI-SMT occurred in children. HIV-SMT manifested preferentially in the central nervous system, gut/liver, skin, lungs/larynx/pharynx and adrenal glands. PTSMT were predominantly found in the liver, lungs/larynx/pharynx, gut/spleen and brain. CI-SMT were often found in lungs/larynx, brain, liver, adrenal glands and spleen. Antecedent EBV+ lymphoproliferations manifested more often in PTSMT. In all three tumour subtypes, survival analyses did not show any significant differences regarding surgical therapeutic approaches, the occurrence of multiple tumours, tumour size or sarcoma-like histological features. HIV-SMT had the poorest overall survival, which might be attributed to HIV-associated infectious complications.
Rathore, S K; Dwibedi, B; Kar, S K; Dixit, S; Sabat, J; Panda, M
This study reports clinico-epidemiological features and viral agents causing acute encephalitis syndrome (AES) in the eastern Indian region through hospital-based case enrolment during April 2011 to July 2012. Blood and CSF samples of 526 AES cases were investigated by serology and/or PCR. Viral aetiology was identified in 91 (17·2%) cases. Herpes simplex virus (HSV; types I or II) was most common (16·1%), followed by measles (2·6%), Japanese encephalitis virus (1·5%), dengue virus (0·57%), varicella zoster virus (0·38%) and enteroviruses (0·19%). Rash, paresis and cranial nerve palsies were significantly higher (P < 0·05) with viral AES. Case-fatality rates were 10·9% and 6·2% in AES cases with and without viral aetiology, respectively. Simultaneous infection of HSV I and measles was observed in seven cases. This report provides the first evidence on viral aetiology of AES viruses from eastern India showing dominance of HSV that will be useful in informing the public health system.
Atreya, Alok; Kanchan, Tanuj
Hanging is one of the commonest methods of suicide. Epidemiological data of near-hanging patients from Nepal is limited. The present research from Nepal attempts to review the clinico-epidemiological profile of near-hanging patients. A retrospective review of case records was done for the near hanging patients admitted to a tertiary care teaching hospital in Nepal, between August 2012 and August 2014. Details regarding socio-demographic profile, circumstances of hanging, clinical details, and outcome etc. were obtained and examined. During the study period, 10 near hanging patients were admitted to the hospital. The majority of the patients were below 30 years. Mean age of the study group was 28.8 years. The GCS on arrival ranged between 5/15 and 15/15 with the mean GCS being 9.5/15. Hypoxic encephalopathy and cerebral edema were the only noted complications. None of the patient had a cervical spinal injury. All the patients survived the near hanging episode. The mean ICU and hospital stay were 3.9 days and 6.2 days respectively. Prompt resuscitation, active interventions and intensive care support favors a good prognosis. Psychiatric evaluation and support to the patients and their relatives is the key to preventing such attempts in future.
Shaharyar, Sameer; Chokshi, Binna; Bhardwaj, Nikhil
Pulmonary alveolar microlithiasis (PAM) is a rare infiltrative lung disease characterized by deposition of spherical calcium phosphate microliths called calcospherites within the alveoli. PAM was first described by Friedrich in 1856 and then by Harbitz in 1918. The disease pathogenesis is based on mutations in the SLC34A2 gene that encodes for the Type IIb sodium-phosphate cotransporter. The majority of the patients are diagnosed at an early age, usually between the ages of 20 and 40 years. The hallmark of this disease is a striking dissociation between the radiological findings and the mild clinical symptoms. We report a case of 35-year-old woman who presented post-motor vehicle accident with back pain and with minimal dyspnea on exertion. The final diagnosis was made after computed tomography and lung biopsy. The present case exhibits the remarkable clinico-radiological dissociation with complete calcification of the lungs on radiographic images with a relatively mild clinical presentation. PMID:27688986
Aung, Ar Kar; Teh, Bing Mei; McGrath, Christopher; Thompson, Philip J
Pulmonary infections by Sporothrix spp. manifest radiologically as cavitary or non-cavitary disease depending on whether the infection is primary pulmonary or multifocal sporotrichosis. Despite current guidelines, the optimal management for pulmonary sporotrichosis remains unclear. In order to clarify this, we present two cases of pulmonary sporotrichosis, as well as the results of a comprehensive literature review of treatment outcomes based on clinico-radiological presentation patterns of the disease. A literature search of all case reports in English language over the last 50 years (1960-2010) was conducted. Data on patient characteristics, risk factors, clinico-radiological patterns, treatment modalities and outcomes were collected and analyzed. A total of 86 cases were identified, i.e., 64 (74.4%) primary pulmonary and 22 (25.6%) multifocal sporotrichosis. Radiologically, primary pulmonary disease was commonly characterized by cavity formation which was lacking in multifocal infections (P = 0.0001). Immunosuppressant use was more common in multifocal sporotrichosis (P = 0.0001), while hemoptysis was more common in primary pulmonary form (P = 0.01). No other differences in patient characteristics or risk factors were noted. Extra-pulmonary multifocal sporotrichosis most commonly involved skin (81.8%) and joints (45.4%). For patients with cavitary primary pulmonary sporotrichosis, outcomes from medical therapy alone were inferior to surgical intervention (P = 0.02). However, for both primary pulmonary and multifocal sporotrichosis with non-cavitary disease, medical therapy alone provided good outcomes. Only 12 (16.7%) cases were treated with itraconazole. Treatment of pulmonary sporotrichosis should be guided by the clinico-radiological patterns of presentation. Medical therapy alone is likely sufficient for non-cavitary disease while early surgery should be considered for cavitary primary pulmonary sporotrichosis. The experience in treating cavitary disease
Shogam, I I; Pesochina, E A
As many as 100 patients with late sequelae of closed craniocerebral injuries (CCCI) and 50 healthy persons underwent a clinico-genealogical and phenotypic analysis. Multifactorial diseases (in particular essential hypertension and other cardiovascular diseases) which correlate with the clinical features of late sequelae of CCCI were noted to occur in the patients' pedigree significantly more often as compared to normal persons. The patients manifest a high frequency of the stigmas of dysembryogenesis. After CCCI part of them manifested certain hereditary diseases. Genetic risk factors should be taken into account in forecasting CCCI outcomes and planning follow up measures.
Gahine, Renuka; Hussain, Nighat; Memon, Mohd Jafar
Introduction Ophthalmic lesions show varied distribution on the basis of geographical location. Eye being a unique sensory organ needs to be studied both clinically and pathologically. Aim This study was aimed to evaluate the histomorphological and clinico-pathlological spectrum of ophthalmic lesions at a tertiary care hospital of Central India. Materials and Methods We reviewed all the ophthalmic biopsies performed in the Department of Pathology of our institute between January 2008 and November 2014. Total 488 biopsies of the orbito-ocular region were obtained from patients attending the ophthalmology department. Ophthalmic biopsies were studied as per epidemiological and histomorphological data. Results The patients ranged in age from one month to 85 years with bimodal distribution. With a male to female ratio of 1:1. Ophthalmic lesions were highest (44.8%) in less than 20 years age group. Eyelid (33.6%) was the most commonly involved site. Clinical diagnosis was consistent with histopathological diagnosis in approximately 76% cases. The non-neoplastic, benign and malignant lesions were 61.1%, 7.8% and 31.1% respectively. Retinoblastoma formed 40.1% of all malignant lesions followed by sebaceous carcinoma (19.1%) and Squamous Cell Carcinoma (SCC) (10.5%). Rare lesions were primary neuroblastoma of orbit and rhabdomyosarcoma of eyelid. Conclusion Findings suggest that among neoplastic lesions the most common ophthalmic malignancies were retinoblastoma in children and sebaceous carcinoma in adults. Among non-neoplastic lesions, 89% cases of infectious aetiology were of rhinosporidiosis in our study making it an important differential diagnosis among ophthalmic lesions. PMID:28273971
Yalamanchili, Ravali; Shastry, Veeranna; Betkerur, Jayadev
Background: Melasma is one of the most common and distressing pigmentary disorders presenting to dermatology clinics. The precise cause of melasma remains unknown. It is notably difficult to treat and has a tendency to relapse. Its population prevalence varies according to ethnic composition, skin phototype, and intensity of sun exposure. Due to its frequent facial involvement, the disease has an impact on the quality of life of patients. Aims: To study the clinico-epidemiological pattern, dermascopy, wood's lamp findings and the quality of life in patients with melasma. Settings and Design: Observational/descriptive study. Materials and Methods: Patients with melasma were screened. History, clinical examination, Wood's lamp examination (WLE) and dermoscopy were done. Severity of melasma was assessed by the calculating melasma area severity index (MASI) score. Quality of Life (QOL) was assessed using MELASQOL scale with a standard structured questionnaire. Statistical Analysis: Descriptive, Chi-square test and contingency coefficient analysis. Results: In 140 cases of melasma, 95 (67.9%) were females and 45 (32%) were males. Common age group affected was 31-40 years (65%). Majority were unskilled workers with average sun exposure of more than 4 hours (44%). Family history was observed in 18% cases. Malar type (68%) was the most common pattern observed. Mean MASI score was 5.7. WLE showed dermal type in 69% cases. Common findings on dermoscopy were reticular pigment network with perifollicular sparing and color varying from light to dark brown. Mean MELASQOL score was 28.28, with most patients reporting embarrassment and frustration. Conclusions: This study showed that melasma has a significant negative effect on QOL because though asymptomatic it is disfiguring affecting self-esteem. Dermoscopic examination did not help in differentiating the type of melasma. PMID:26538717
Basu, Sabita; Dhar, Supriya; Mishra, Deepak; Chandy, Mammen
Background: The ABO blood group system is of prime significance in red cell transfusion and organ transplantation. However, ABO compatibility is not critical in allogenic hemopoietic stem cell transplantation (HSCT) and approximately 40-50% of hemopoietic stem cell transplants are ABO incompatible. This incompatibility may be major, minor or bi-directional. Though there are descriptions of transfusion practice and protocols in ABO incompatible HSCT, there are considerable variations and transfusion support in these patients can be very challenging. Aims: The immunohematologic observations in two cases of bi-directional ABO incompatible HSCT have been described, and clinico-serologic correlation has been attempted. Materials and Methods: In both cases, peripheral blood stem cell harvests were obtained using the Cobe spectra cell separator. Immunohematologic assessments in the donor and recipient were done as a part of pre HSCT evaluation. Both the standard tube technique and column agglutination method (Ortho Biovue Micro Bead System) was used. Antibody screen was done by column agglutination method using three cell panel (Surgiscreen cells). Isoagglutinin titration was done by the master dilution method and standard validated techniques were used. Results: The pattern of laboratory findings in the two cases was different and so were the clinical outcomes. Although there was early engraftment in the first case, the second case developed pure red cell aplasia and this was well-reflected in the immunohematologic assessments. Conclusion: Immunohematologic assessment correlated well with the clinical picture and could be used to predict clinical outcome and onset of complications in ABO incompatible HSCT. PMID:26420941
Loupakis, Fotios; Moretto, Roberto; Aprile, Giuseppe; Muntoni, Marta; Cremolini, Chiara; Iacono, Donatella; Casagrande, Mariaelena; Ferrari, Laura; Salvatore, Lisa; Schirripa, Marta; Rossini, Daniele; De Maglio, Giovanna; Fasola, Gianpiero; Calvetti, Lorenzo; Pilotto, Sara; Carbognin, Luisa; Fontanini, Gabriella; Tortora, Giampaolo; Falcone, Alfredo; Sperduti, Isabella; Bria, Emilio
Background: In metastatic colorectal cancer (mCRC), BRAFV600E mutation has been variously associated to specific clinico-pathological features. Methods: Two large retrospective series of mCRC patients from two Italian Institutions were used as training-set (TS) and validation-set (VS) for developing a nomogram predictive of BRAFV600E status. The model was internally and externally validated. Results: In the TS, data from 596 mCRC patients were gathered (RAS wild-type (wt) 281 (47.1%); BRAFV600E mutated 54 (9.1%)); RAS and BRAFV600E mutations were mutually exclusive. In the RAS-wt population, right-sided primary (odds ratio (OR): 7.80, 95% confidence interval (CI) 3.05–19.92), female gender (OR: 2.90, 95% CI 1.14–7.37) and mucinous histology (OR: 4.95, 95% CI 1.90–12.90) were independent predictors of BRAFV600E mutation, with high replication at internal validation (100%, 93% and 98%, respectively). A predictive nomogram was calculated: patients with the highest score (right-sided primary, female and mucinous) had a 81% chance to bear a BRAFV600E-mutant tumour; accuracy measures: AUC=0.812, SE:0.034, sensitivity:81.2% specificity:72.1%. In the VS (508 pts, RAS wt: 262 (51.6%), BRAFV600E mutated: 49 (9.6%)), right-sided primary, female gender and mucinous histology were confirmed as independent predictors of BRAFV600E mutation with high accuracy. Conclusions: Three simple and easy-to-collect characteristics define a useful nomogram for predicting BRAF status in mCRC with high specificity and sensitivity. PMID:26575603
Kumar U, Mahesh; Yelikar, Balasaheb Ramling; Inamadar, Arun C; Umesh, Swaroopa; Singhal, Amrita; Kushtagi, Anirudha V
Introduction: The aim of this article was to study the spectrum of clinico-histopathological lesions with an age and sex distribution in various lichenoid reactions of the skin. The spectrum of clinical diseases which is related to the lichenoid tissue reaction is wider. There is a recent increase in the relatively new subgroups of the lichenoid clinical picture. Material And Methods: This was a one and a half year prospective study which was conducted in the Dermatopathology Section of the Department of Pathology, from January 2011 to June 2012. All the patients who visited the Dermatology Outpatients/ Inpatients Department and presented with lichenoid tissue reactions were included in the study. The selected patients’ clinical findings were noted and their informed consents and an institutional ethical clearance were taken. Light microscopy was used for the histopathological diagnosis. The SPSS, version 14 software was used to analyze the data. Frequencies and percentages were used to describe the data. Results: During the study period, 107 cases were clinically diagnosed as lichenoid reactions, of which 84 cases were concordant on histopathology and 6 cases were diagnosed, solely based on the histology. So, a total of 90 cases were diagnosed histologically, of which 42 were of the Lichen planus type and 48 were lichenoid eruptions. Females were affected more commonly than the males. Conclusion: In our study, the lichenoid reactions were more common in children and the most common prototype was Lichen planus. So, we conclude that histopathology is a dependable tool for identifying the underlying cause in lichenoid reactions. PMID:23543246
Mbaya, A W; Aliyu, M M; Ibrahim, U I
Reports on the clinico-pathology and mechanisms of trypanosomosis in free-living and captive wild animals showed that clinical disease and outbreaks occur more commonly among captive than free-living wild animals. This is because the free-living wild animals co-exist with the disease until subjected to captivity. In exceptional cases however, draught, starvation and intercurrent diseases often compromised trypanotolerance leading to overt trypanosomosis in free-living wild animals. Meanwhile, in captivity, space restriction, reduced social interactions, change in social herd structure, reduced specie-to-specie specific behaviors, altered habitat and translocation were the major stressors that precipitated the disease. The cumulative effect of these factors produced severe physiological and somatic stress leading to diminished immune response due to increased blood cortisol output from adrenal cortex. The major symptoms manifested were pyrexia, innapetence, increased respiration, anaemia, cachexia and death. At necropsy, pulmonary oedema, splenomegally, hepatomegally, lympadenopathy and atrophy of body fats were the gross changes encountered. At the ultra-structural level, the tissues manifested degenerative changes, haemorghages, necrosis and mononuclear cellular infiltrations. The mechanisms of cellular and tissue injuries were primarily associated with physical and metabolic activities of the organisms. From the foregoing, it is evident that stress is the underlying mechanism that compromises trypanotolerance in wild animals leading to severe clinico-pathological effects.
Watson, B; Ellis, M; Mandal, B; Dunbar, E; Whale, K; Brennand, J
The clinico-pathological features of 515 adult patients admitted to a major Regional Infectious Diseases Unit in United Kingdom with the symptom complex of diarrhoea were compared to the pathogens detected in their stool specimens. Routine clinical examination supported by basic pathological and laboratory investigations identified 138 (28%) in whom the cause of diarrhoea was extragastrointestinal or non-infectious gastrointestinal. Of the 351 patients (72%) with infectious gastroenteritis 72 (21%) had campylobacter, 59 (17%) had salmonella (22% bacteraemic) and 16 (5%) shigella. Clostridium difficile toxin accounted for a further 15 (4%)--antibiotics had been the antecedent cause in only one half of these. Routine microscopical examination of the faeces for red and white cells distinguished many with "culture positive" diarrhoea from those with "culture negative" infectious diarrhoea. Although there are no clinico-pathological features which are unique to a particular pathogen and unequivocally suggest a particular pathogen, certain features did tend to present more often in association with particular microorganisms, and this knowledge may suggest a bacterial diagnosis whilst awaiting the definitive results of stool microbiology. These features include prior antimicrobial therapy with positive sigmoidoscopical/histological features: Cl. difficile; protracted diarrhoea in elderly severely dehydrated patients: salmonellosis; foreign travel in males with bloody diarrhoea: shigellosis; abdominal pain in younger patients with a small degree of vomiting: campylobacteriosis. Early diagnosis may then prove useful in rationalizing initial therapy, particularly the appropriate use of antimicrobials.
Chakrabarti, Srabani; Pal, Subrata; Biswas, Biplab Kr; Bose, Kingshuk; Pal, Saswati; Pathak, Swapan
Background: Granulomatous dermatoses are common skin pathology, often need histopathological confirmation for diagnosis. Histologically six sub-types of granulomas found in granulomatous skin diseases- tuberculoid, sarcoidal, necrobiotic, suppurative, foreign body & histoid type. The aims of the present study were clinico-pathological evaluation of granulomatous skin lesions and their etiological classification based on histopathological examination. Methods: It was a five years (Jan 2009- Dec 2013) retrospective study involving all the skin biopsies. Detailed clinical and histopathological features were analyzed and granulomatous skin lesions were categorized according to type of granuloma & etiology. Special stains were used in few cases for diagnostic purpose. Results: Among 1280 skin biopsies, 186 cases (14.53%) were granulomatous skin lesions with a ratio 1:24. In histopathological sub-typing, tuberculoid granuloma was most common type (126 cases, 67.74%). Most common etiology of granuloma in the study was leprosy (107 cases, 57.52%). Other etiologies were cutaneous tuberculosis, foreign body granulomas, fungal lesions, cutaneous leishmaniasis, sarcoidosis and granuloma annulare. Conclusion: Histopathology is established as gold standard investigation for diagnosis, categorization and clinico-pathological correlation of granulomatous skin lesions. PMID:26870144
Kim, Hyojin; Jeon, Yoon Kyung; Lee, Hyun Joo; Kim, Young Tae; Chung, Doo Hyun
Recently, the numbers of lung transplantation (LT) has been increased in Korea. However, post-LT outcome has not been successful in all patients, which may be partially affected by the primary lung disease. Therefore comprehensive understanding in original pathological diagnosis of patients with LT would be needed for achieving better clinical outcome. To address this issue, we performed clinico-pathological analysis of the explanted lungs from 29 patients who underwent LT over a 9-yr period in Seoul National University Hospital. Among them, 26 patients received single (1/26) or double (25/26) LT, while heart-lung transplantation was performed in 3 patients. The final clinico-pathological diagnoses were idiopathic pulmonary fibrosis/usual interstitial pneumonia (UIP) (n = 6), acute interstitial pneumonia (AIP)/diffuse alveolar damage (DAD) (n = 4), AIP/non-specific interstitial pneumonia with DAD (n = 1), collagen vascular disease-related interstitial lung disease (CVD-ILD)/DAD (n = 3), CVD-ILD/UIP (n = 1), lymphangioleiomyomatosis (n = 1), bronchiectasis (n = 4), pulmonary arterial hypertension (n = 2), tuberculosis (n = 1), bronchiolitis obliterans (BO) (n = 1), and lung cancer (n = 1). Moreover, 4 patients who had chemotherapy and hematopoietic stem cell transplantation due to hematologic malignancy showed unclassifiable interstitial pneumonia with extensive fibrosis in the lungs. Our study demonstrates that pathology of the explanted lungs from Korean patients with LT is different from that of other countries except for interstitial lung disease and bronchiectasis, which may be helpful for optimization of selecting LT candidates for Korean patients.
Homolak, Damir; Šitum, Mirna; Čupić, Hrvoje
Sentinel lymph node biopsy (SLNB) is an established method for the assessment of tumor aggressiveness in patients with primary cutaneous melanoma (PCM). To improve the criteria for the selection of SLNB candidates, the aim of our study was to determine clinico-pathohistological parameters that can serve as predictors of metastatic progression. We retrospectively evaluated all available clinico-pathohistological parameters in 844 patients with PCM diagnosed between January 1, 2005 and December 31, 2010. SLNB was conducted in 484 (57.3%) patients, 122 (14.5%) of whom had a positive node. The association between predictors and SLNB outcomes (positive SLNB and metastatic development) was tested using logistic regression analysis. The main predictors of positive SLNB were Breslow thickness (adjusted odds ratio (AOR)=1.22; 95% confidence interval (CI)=1.11-1.33), Clark levels (AOR=1.78; 95% CI=1.31-2.40), ulceration (AOR=3.1; 95% CI=1.65-5.81), microsatellitosis, gender, and tumor localization. The predictors of metastatic spread were Breslow thickness (AOR=1,69; 95% CI=1.51-1.89), Clark level (AOR=3.59; 95% CI=2.79-4.62), nodular type of melanoma (AOR=8.21; 95% CI=1.70-39.53), ulceration, mitotic rate, microsatellitosis, gender, and tumor localization. It seems that these parameters should be taken into consideration when selecting patients for SLNB since tumor thickness is not a sufficient predictor of SLNB outcome, particularly in case of very thin lesions.
Castro-Costa, C M; Oriá, R B; Vale, O C; Arruda, J A; Horta, W G; D'Almeida, J A; Santos, T J; Ramos, R S; Gifoni, M A
In this retrospective (1980-1998) study, we have analyzed clinico-demographically, from the records of the University Hospital of Fortaleza (Brazil), a group of 87 patients showing signs and symptoms of motor neuron diseases (MNDs). Their diagnosis was determined clinically and laboratorially. The WFN criteria were used for amyotrophic lateral sclerosis (ALS) diagnosis. The clinico-demographic analysis of the 87 cases of MNDs showed that 4 were diagnosed as spinal muscular atrophy (SMA), 5 cases as ALS subsets: 2 as progressive bulbar paralysis (PBP), 2 as progressive muscular atrophy (PMA) and 1 as monomelic amyotrophy (MA), and 78 cases of ALS. The latter comprised 51 males and 27 females, with a mean age of 42.02 years. They were sub-divided into 4 groups according to age: from 15 to 29 years (n= 17), 30 to 39 years (n= 18), 40 to 69 years (n= 39) and 70 to 78 years (n= 4). From the 78 ALS patients, 76 were of the classic sporadic form whilst only 2 were of the familial form. The analysis of the 87 patients with MNDs from the University Hospital of Fortaleza showed a predominance of ALS patients, with a high number of cases of juvenile and early onset adult sporadic ALS.
[From classification medicine to clinical medicine (the end of the XVIII century--1870s). Communication 2. The first stage of clinical medicine development: introduction of the method of clinico-anatomic correlations].
The first stage of clinical medicine development is analysed which covers the period from early 1800s to middle 1870s. Considered are basic research achievements associated with introduction of the method of clinico-anatomic correlations into practical medicine.
Kaur, Paramjit; Deshmukh, S; Singh, Rajsukhbir; Bansal, B K; Randhawa, C S; Singla, L D
A rare case of canine hepatozoonosis in a mongrel dog with para-clinico-pathological observations has been reported. The study included detailed haemato-biochemical changes at two stages, i.e. before treatment and after treatment with adopted therapy. Before therapy, blood picture revealed normocytic hypochromic anaemia and neutrophilic leucocytosis with variable counts of platelets. Thirty-seven percent of neutrophils were found infected with gametocytes of Hepatozoon canis. Following treatment, further decrease in haemoglobin value with a relative increase in lymphocyte count was seen. Biochemically, increase in alkaline phosphatase, blood urea nitrogen and creatinine levels along with hyperproteinemia was seen. The 14 days chemotherapy did not bring a respite for the dog and the level of parasitaemia was 33% after the treatment. The alkaline phosphatase and creatinine level further rose up following therapy with sulphadiazine and clindamycin. Continual study is required to explain the best possible therapeutic combination to deal H. canis.
Fraggetta, F; Pepe, P; Giunta, M L; Aragona, F
Malignant tumours of the prostate other than carcinomas are rare. One such malignant tumours arising from the specialised stromal tissue of the prostate is stromal prostatic sarcoma (namely low-grade and high-grade). Herein, we report the clinico-pathological features of a high grade stromal sarcoma of the prostate occurring in a 65-year-old man who presented for urinary obstructive symptoms. The clinical picture suggested a benign prostatic hyperplasia, and surgery consisting in a transcapsular adenomectomy was performed. Following a pathological diagnosis of high grade prostatic stromal sarcoma, a radical cystoprostatectomy and bilateral pelvic node dissection was performed showing residual high grade stromal sarcoma of the prostate and incidental in situ urothelial carcinoma of the bladder. No further medical treatments were planned. One year after surgery the patient is well with no evidence of local disease or distant metastases.
Smirnov, O A; Smirnova, O N
A clinico-morphological analysis of the data available on cases of adeno-squamous carcinoma (72) and endometrial adenocarcinoma (102) pointed to a correlation between the decrease in the degree of cell differentiation in said neoplasms and the decline in the frequency of hyperestrimism and metabolic-endocrine disorders. As a result over 70% of well-differentiated cell tumors were referred to one pathogenetic pattern of endometrial carcinoma (after Bokhman) and more than 50% of poorly-differentiated cell tumors--to another one. These findings further support the rationale for distinguishing the well- and poorly-differentiated cell patterns of adeno-squamous carcinoma. They may be used in establishing individual prognosis as well as choosing optimal scheme of treatment.
Kadam Amare, Pratibha S.; Jain, Hemani; Nikalje, Shraddha; Sengar, Manju; Menon, Hari; Inamdar, Nitin; Subramanian, P. G.; Gujral, Sumeet; Shet, Tanuja; Epari, Sridhar; Nair, Reena
Background & objectives: Multiple myeloma (MM) is a plasma cell malignancy characterized by cytogenetic heterogeneity. In comparison with conventional karyotyping, fluorescence in situ hybridization (FISH) can efficiently detect various genetic changes in non-cycling plasma cells in 50-90 per cent of MM cases. The present study was undertaken in MM patients to evaluate the frequency and clinico-pathological significance of various cytogenetic abnormalities in the Indian population. Methods: Interphase FISH was applied on purified plasma cells of 475 patients with MM using specific probes. Interphase FISH for 1q gain/1q amplification was performed on a separate group of 250 newly diagnosed MM patients. Results: Low frequency of Δ13 [-13/del(13q)] (32%) and t(11;14) (5%) was observed in our 475 patients probably due to ethnic diversity. Clustering of Δ13, del(17) (p13.1) and IgH translocations in non-hyperdiploidy confirmed prognostic significance of ploidy in MM. t(4;14) and del(17) (p13.1) were high-risk groups due to correlation with high serum β2-microglobulin, increased plasma cells and advanced disease. Hyperdiploidy and t(14;16) were associated with higher age group. In a separate group of 250 patients, 1q amplification [amp(1q)] in combination with Δ13 and/or del(17p) with t(4;14) revealed association with adverse clinico-laboratory features, which confirmed progressive role of amp(1q) with adverse prognostic impact. Amp(1q) was clustered at 1q21 and 1q25 loci. Interpretation & conclusions: Based on our findings, it appears that comprehensive analysis of various cytogenetic aberrations by interphase FISH is a powerful strategy being adapted for risk stratification of MM. PMID:28256461
Jagirdar, Jaishree; Chikkamuniyappa, Shylashree; Sirohi, Deepika; McCarthy, Michael J; Peters, Jay I
Pulmonary complications associated with Sjögren syndrome (SS) have attracted attention in recent years. Sjögren syndrome has been associated with small cyst formation in salivary glands, thymus, and lungs and has been recently brought to the forefront by radiologists due to high-resolution techniques. However, pathologists are less aware of this finding unless clinico-radiologic-pathologic correlation is sought. Formation of large bullae in SS is a rare complication with potential for confusion with other diseases. Here, we present the clinical, radiologic, and pathologic findings in 3 patients with SS associated with multiple pulmonary cystic lesions. All 3 patients had a variable mixed restrictive and obstructive component of the disease. There was good correlation with the pulmonary function tests (PFTs), high-resolution computed tomographic scan, and morphology with regard to the restrictive component. The small cysts appear to correlate with the extent of obstructive changes on the PFTs. However, the large bullae do not, implying noncommunication with the conducting airways. This noncorrelation between the PFTs and extent of bullous disease with predominant involvement of lower lobes in SS enables distinction from bullous emphysema. The mechanism of bulla formation in SS appears to be different from bullous emphysema. A check valve mechanism has been proposed previously in SS, which does not explain cyst formation in the thymus. Alternately, inflammation may play a role with the key suspects being CD4 T-helper cells and perhaps NK cells. This is the first report of a clinico-radiologic-pathologic correlation with analysis of lymphocyte subsets.
Lambros, Maryou; Stankiewicz, Elzbieta; Ng, Charlotte K. Y.; Weigelt, Britta; Rajab, Ramzi; Tinwell, Brendan; Corbishley, Cathy; Watkin, Nick; Berney, Dan; Reis-Filho, Jorge S.
Penile squamous cell carcinoma is a rare disease, in which somatic genetic aberrations have yet to be characterized. We hypothesized that gene copy aberrations might correlate with human papillomavirus status and clinico-pathological features. We sought to determine the spectrum of gene copy number aberrations in a large series of PSCCs and to define their correlations with human papillomavirus, histopathological subtype, and tumor grade, stage and lymph node status. Seventy formalin-fixed, paraffin embedded penile squamous cell carcinomas were centrally reviewed by expert uropathologists. DNA was extracted from micro-dissected samples, subjected to PCR-based human papillomavirus assessment and genotyping (INNO-LiPA human papillomavirus Genotyping Extra Assay) and microarray-based comparative genomic hybridization using a 32K Bacterial Artificial Chromosome array platform. Sixty-four samples yielded interpretable results. Recurrent gains were observed in chromosomes 1p13.3-q44 (88%), 3p12.3-q29 (86%), 5p15.33-p11 (67%) and 8p12-q24.3 (84%). Amplifications of 5p15.33-p11 and 11p14.1-p12 were found in seven (11%) and four (6%) cases, respectively. Losses were observed in chromosomes 2q33-q37.3 (86%), 3p26.3-q11.1 (83%) and 11q12.2-q25 (81%). Although many losses and gains were similar throughout the cohort, there were small significant differences observed at specific loci, between human papillomavirus positive and negative tumors, between tumor types, and tumor grade and nodal status. These results demonstrate that despite the diversity of genetic aberrations in penile squamous cell carcinomas, there are significant correlations between the clinico-pathological data and the genetic changes that may play a role in disease natural history and progression and highlight potential driver genes, which may feature in molecular pathways for existing therapeutic agents. PMID:26901676
Chougule, Abhijit; Bal, Amanjit; Das, Ashim; Kohli, Pavneet Singh; Singh, Gurpreet
Attempts at identification of an ideal prognostic/predictive biomarker in phyllodes tumour (PT) have not been fruitful so far. Studies evaluating c-kit expression in PT have shown contradictory results. Recently aldehyde dehydrogenase 1A1 (ALDH1A1) was proposed as a stem cell marker for malignant PT but its expression has not been studied in benign and borderline tumours. We aimed to evaluate expression and prognostic significance of c-kit and ALDH1A1 in different grades of PT. Epithelial and stromal c-kit and ALDH1A1 expression were studied in 104 PT cases (86 primary and 18 recurrent tumours) and compared with different clinico-pathological features and recurrence rates. Stromal c-kit expression at 1 % cutoff correlated with increasing tumour grade, larger tumour size, hypercellularity, nuclear atypia, stromal overgrowth, infiltrative margins and mitotic count. These associations, however, were lost with higher (5 or 10 %) cutoffs. Conversely, decreased c-kit expression in the epithelial component correlated with increasing tumour grade, regardless of the cutoffs used. Stromal ALDH1A1 expression did not have significant associations with tumour grade or other adverse clinico-pathological features, regardless of different cutoffs. None of the cases showed significant epithelial ALDH1A1 expression. Expression of c-kit was associated with poorer overall survival (p = 0.011), while ALDH1A1 expression was associated with shorter recurrence-free survival (p = 0.036). In conclusion, c-kit expression was associated with higher tumour grade and adverse clinico-pathological features. However, these associations are cutoff dependent, partly explaining the variability in previously reported studies. ALDH1A1 expression did not have significant correlations with tumour grade and adverse clinico-pathological variables.
Ahmed, M; Strauss, M; Kassaie, A; Shotelersuk, V; DeGuzman, R
Aplasia of major salivary glands is very rare. Compensatory hypertrophy of the rest of the glands can result in clinico-radiological masses. We present a report of a rare case of non-syndromic bilateral submandibular gland aplasia with hypertrophied sublingual salivary tissue, the latter herniating through mylohyoid boutonnière to present as a palpable mass on the left side with corresponding CT findings. Multiplanar evaluation is emphasised by utilizing multidetector CT.
Anandmay, A. K.; Dass, L. L.; Sharma, A. K.; Gupta, M. K.; Singh, K. K.; Roy, B. K.
Aim: The aim of this study is to find out the effect of propofol and its combination with meperidine and pentazocine lactate on certain clinico-anesthetic profiles in dogs. Materials and Methods: 15 apparently healthy mongrel dogs of either sex of about 1 year of age were randomly divided into three groups of five dogs each. The animals of Group I were administered propofol intravenously alone “to effect,” whereas meperidine at 2 mg/kgb.wt. and pentazocine lactate at 2 mg/kg b.wt. were injected intramuscularly 15 min before propofol “to effect” in Groups II and III, respectively. Atropine sulfate at 0.04 mg/kgb.wt. was injected intramuscularly 20 min before each treatment. Rectal temperature, heart rate, respiration rate, and anesthetic indices were recorded before and at 5, 10, 20, 30, and 60 min of induction. Results: As compared to Group I, the animals of Groups II and III exhibited a significant decrease (p<0.05) in the level of rectal temperature, respiration rate, and heart rate. Duration of recumbency, time of standing, time of recovery as well as the duration of analgesia were longer in pentazocine lactate (Group III) followed by meperidine (Group II) as compared to propofol alone (Group I). Meperidine treated dogs showed defecation and muscle twitching during anesthesia. Conclusion: Meperidine and pentazocine are suitable opioids used in combination with propofol for achieving surgical anesthesia and helpful in reduction of propofol dose. PMID:27956765
Kumar, Mritunjay; Pal, Bhabatosh; Purkayastha, R D; Roy, Joybrath
The objective of the present study was to investigate the clinico-pathological changes and therapeutic evaluation of gamma-benzene hexachloride and cetrimide along with vit A, D3, E and H in Black Bengal goat infested Psoroptes cuniculi mange. The study was conducted on 14 Black Bengal goats; 6 clinically infested with Psoroptes mange (group I) and 8 healthy goats (group II). Haemato-biochemical profile viz., haemoglobulin concentration, packed cell volume, total leukocyte count, albumin and albumin globulin ratio revealed significantly (P < 0.05) decreased level; whereas, globulin, alanine aminotransaminase, aspartate aminotransaminase, serum creatinine and blood urea nitrogen level were significantly (P < 0.05) increased in goats of group I animals as compared to healthy control (group II) on day 0. Gamma-benzene hexachloride and cetrimide along with adjunct therapy (group I) showed parasitological recovery on day 21 while complete elimination of clinical signs observed on day 28 of post-therapy in all clinical cases.
Berns, E M J J; Staveren, I L van; Verhoog, L; Ouweland, A M W van de; Gelder, M Meijer-van; Meijers-Heijboer, H; Portengen, H; Foekens, J A; Dorssers, L C J; Klijn, J G M
About 5–10% of breast cancers are hereditary; a genetically and clinically heterogeneous disease in which several susceptibility genes, including BRCA1, have been identified. While distinct tumour features can be used to estimate the likelihood that a breast tumour is caused by a BRCA1 germline mutation it is not yet possible to categorize a BRCA1 mutated tumour. The aim of the present study is to molecularly classify BRCA1 mutated breast cancers by resolving gene expression patterns of BRCA1 and matched sporadic surgical breast tumour specimens. The expression profiles of 6 frozen breast tumour tissues with a proven BRCA1 gene mutation were weighed against those from 12 patients without a known family history but who had similar clinico-pathological characteristics. In addition two fibroblast cultures, the breast cancer cell-line HCC1937 and its corresponding B-lymphoblastoid cell line (heterozygous for mutation BRCA1 5382insC) and an epithelial ovarian cancer cell line (A2780) were studied. Using a high density membrane based array for screening of RNA isolated from these samples and standard algorithms and software, we were able to distinguish subgroups of sporadic cases and a group consisting mainly of BRCA1-mutated breast tumours. Furthermore this pilot analysis revealed a gene cluster that differentially expressed genes related to cell substrate formation, adhesion, migration and cell organization in BRCA1-mutated tumours compared to sporadic breast tumours. © 2001 Cancer Research Campaign http://www.bjcancer.com PMID:11506493
Demir, Mustafa Kemal; Yapıcıer, Özlem; Onat, Elif; Toktaş, Zafer Orkun; Akakın, Akın; Urgun, Kamran; Kılıç, Türker
There are many kinds of extra-axial brain tumors and tumor-like lesions, and definitive diagnosis is complicated in some cases. In this pictorial essay, we present rare and challenging extra-axial brain lesions including neuroenteric cyst, primary leptomeningeal melanomatosis, isolated dural neurosarcoidosis, intradiploic epidermoid cyst, ruptured dermoid cyst, intraventricular cavernoma, and cavernous hemangioma of the skull with imaging findings and clinico-radiological differential diagnosis, including the pathologic correlation. Familiarity with these entities may improve diagnostic accuracy and patient management. PMID:25010368
Wu, Ching-Yang; Fu, Jui-Ying; Wu, Ching-Feng; Hsieh, Ming-Ju; Liu, Yun-Hen; Wu, Yi-Cheng; Yang, Cheng-Ta; Tsai, Ying-Huang
The current TNM staging system did not provide disease relapse information. The aim of study was try to establish a predictive survival model for disease and overall survival in nonsmall cell lung cancer patients who presented as resectable disease and to develop a reference for follow-up imaging tool selection.From January 2005 to December 2011, 442 patients who initially presented as resectable disease (stages I-IIIa) and received anatomic resection and mediastinal lymph node dissection were included in the study.Medical charts were thoroughly reviewed and clinico-pathologic factors were collected and analyzed.Visceral pleural invasion, tumor size >5 cm, and postoperative adjuvant therapy were identified as risk factors for poorer disease-free survival. The 5-year disease-free survival from score 0 to 3 was 68.7%, 46.6%, 31.9%, and 26.1%, respectively. The disease relapse percentage for scores 0 to 3 were 26.49%, 50.61%, 65.05%, and 73.81%, respectively. For analysis of overall survival, age >60 years, tumor size >3 cm, and total metastatic lymph node ratio >0.05 were correlated to worse overall survival. Because greater age may be correlated with poor general condition, we re-scored risk factors that correlated to disease severity that ranging from 0 to 2. The 5-year overall survival range from score 0 to 2 was 56.3%, 43.1%, and 13.1%, respectively.Poor prognostic factors correlated to disease-free survival were tumor size >5 cm, visceral pleural invasion, and patients needing to receive postoperative adjuvant therapy. Disease-free survival of resectable nonsmall cell lung cancer patients and disease relapse can be stratified by these 3 factors. Chest tomography may be recommended for patients with 1 or more poor disease-free survival risk factors.
Baumann, Tycho; Delgado, Julio; Santacruz, Rodrigo; Martínez-Trillos, Alejandra; Royo, Cristina; Navarro, Alba; Pinyol, Magda; Rozman, María; Pereira, Arturo; Villamor, Neus; Aymerich, Marta; López, Cristina; Carrió, Anna; Montserrat, Emili
We investigated the clinico-biological features, outcomes, and prognosis of 949 patients with chronic lymphocytic leukemia according to age. No biological differences (cytogenetics by fluorescent in situ hybridization, IGHV, ZAP-70, CD38, NOTCH1, SF3B1) were found across age groups. Elderly patients (>70 years; n=367) presented more frequently with advanced disease (Binet C/Rai III-IV: 10/12% versus 5/5%; P<0.001), were treated less frequently (23.8% versus 41.9% at 3 years; P<0.001) and in most cases did not receive highly effective regimens and thus had a lower overall response rate (49% with 14% having complete responses versus 69% with 31% having complete responses; P<0.001). The elderly patients also had a shorter overall survival (6.6 versus 13.3 years; P<0.001) and higher disease-unrelated mortality (34.9% versus 6.9% at 10 years; P<0.001). However, disease-attributable mortality was not significantly different between younger and older patients. A combination of Binet stage, ZAP-70 level, β2-microglobulin concentration and comorbidity identified two risk groups (low-risk: 0-1 parameters; high-risk: 2-4 parameters) with different overall survivals (median: 6.8 versus 11.4 years, P<0.001). In patients requiring treatment, comorbidity at treatment (Cumulative Illness Rating Scale-T>4; hazard ratio 2.2, P<0.001) and response (treatment failure versus response: hazard ratio 1.60, P<0.04) were the most important prognostic factors for overall survival. In conclusion, in our series, elderly patients with chronic lymphocytic leukemia did not present with any biological features distinct from those of younger patients, but did have a poorer clinical outcome. This study highlights the importance of comprehensive medical care, achieving response to therapy, and specific management strategies for elderly patients with chronic lymphocytic leukemia.
Kamal, Atif; Malik, Riffat Naseem; Martellini, Tania; Cincinelli, Alessandra
In this study we investigated the clinico-chemical parameters and the level of exposure of brick kiln workers to polycyclic aromatic hydrocarbons (PAHs) in Punjab (Pakistan). The brick kiln workers and a non-occupationally exposed group were recruited for comparative analysis of urinary biomarkers of PAH exposure (i.e. 1-hydroxypyrene (1-OHPyr), α-naphthol and β-naphthol) and blood level of superoxide dismutase (SOD), as a biomarker of oxidative stress and other hematologic parameters. Questionnaires were used to document information on socio-demographic characteristics of all the subjects. The analysis of urinary biomarkers showed higher median concentrations of 1-OHPyr, and α- and β-naphthols in brick kiln workers (1.53, 3.65 and 1.53 μmol/mol-Cr, respectively) than non-occupationally exposed group (0.62, 0.64 and 0.66 μmol/mol-Cr, respectively). The 1-OHPyr in brick kiln workers was above the occupational exposure level. Among the clinical parameters of brick kiln workers, hemoglobin (Hb) and red blood cells (RBCs) were very low and closely associate with 1-OHPyr and β-naphthol. Additionally, the white blood cells (WBCs) and superoxide dismutase (SOD) were also elevated in brick kiln workers, which suggested inflammatory symptoms and high oxidative stress. The results show that regardless of possibly being affected by the poor nutrition, the anemic state and hematological changes observed in brick kiln workers may be associated with their exposure to smoke present in the environment of brick kilns.
Pelayo-Negro, Ana L; Gallardo, Elena; García, Antonio; Sánchez-Juan, Pascual; Infante, Jon; Berciano, José
The objective of this study was to analyze Charcot-Marie-Tooth disease type 1A (CMT1A) evolution. We conducted a 2-year longitudinal study in 14 CMT1A patients and 14 age- and sex-matched controls. In the patients, we performed neurological examination with hand-held dynamometry, electrophysiology, and lower-limb muscle MRI, both at baseline and 2 years later, while controls were examined at baseline only. Patients' ages ranged from 12 to 51 years. Outstanding manifestations on initial evaluation included pes cavus, areflexia, lower-limb weakness, and foot hypopallesthesia. In evaluating muscle power, good correlation was observed between manual testing and dynamometry. Compared to controls, Lunge, 10-Meter-Walking, and 9-Hole-Peg tests were impaired. Their CMT neuropathy score and functional disability scale showed that patients exhibited mild phenotype and at most slight walking difficulty. Electrophysiology revealed marked nerve conduction slowing and variable compound muscle action potential amplitude reduction. On lower-limb muscle MRI, there was distally accentuated fatty infiltration accompanied by edema in calf muscles. All these clinico-electrophysiological and imaging findings remained almost unaltered during monitoring. Using multivariate analysis, no significant predictors of progression associated to the disease were obtained. We conclude that in the 2-year period of study, CMT1A patients showed mild progression with good concordance between clinico-electrophysiological and imaging findings.
Tomás-Vila, Miguel; Menor, Francisco; Otero-Reigada, M Carmen; Pérez-Tamarit, Amparo; Téllez de Meneses, Montserrat; Pitarch-Castellanos, Inmaculada
Introduccion. La encefalomielitis aguda diseminada (EAD) es un trastorno inflamatorio del sistema nervioso central mediado inmunologicamente y de patogenia desconocida. Puede presentarse en cualquier edad, pero es mucho mas frecuente en niños. La EAD no tiene marcador biologico especifico y el diagnostico se basa en hallazgos clinicos y neurorradiologicos. Objetivo. Mejorar el conocimiento del perfil clinicorradiologico de esta enfermedad. Pacientes y metodos. Estudio retrospectivo con inclusion de pacientes menores de 14 años ingresados en un hospital terciario en los ultimos 15 años con el diagnostico de EAD. Se revisaron antecedentes, signos clinicos de presentacion, datos analiticos en sangre/liquido cefalorraquideo y la semiologia radiologica. En 16 casos se realizo un seguimiento medio de 25 meses. Resultados. Se revisaron 20 pacientes, un 70% niños, con una edad media de 4,4 años. El 40% tuvo un episodio febril previo. El 85% presento fiebre o vomitos, y el 70%, afectacion del estado de consciencia. Predominaron los deficits motores (45%), las convulsiones (35%) y la afectacion de pares craneales (30%). Tres niños presentaron una evolucion recidivante, y otros tres, secuelas motoras. Los estudios de resonancia magnetica mostraron lesiones hiperintensas en secuencias T2, con patron de realce escaso o nulo, que predominaron en los talamos (70%), la medula (67%) y la sustancia blanca subcortical (50%). En dos pacientes se diagnostico EAD hemorragica. Conclusiones. La EAD representa una entidad con importante afectacion general y repercusion neurologica, que muestra un potencial secuelar considerable. Los datos clinicoanaliticos y la resonancia magnetica cerebral y medular son relevantes para el diagnostico inicial y seguimiento de pacientes con EAD.
Rauschka, Helmut; Beutelspacher, Sven; Kukurová, Ivica Just; Valkovič, Ladislav; Khan, Adnan; Prayer, Daniela; Kristoferitsch, Wolfgang
Background To date, no direct scientific evidence has been found linking tissue changes in multiple sclerosis (MS) patients, such as demyelination, axonal destruction or gliosis, with either steady progression and/or stepwise accumulation of focal CNS lesions. Tissue changes such as reduction of the retinal nerve fiber layer (RNFL) and the total macular volume (TMV), or brain- and spinal cord atrophy indicates an irreversible stage of tissue destruction. Whether these changes are found in all MS patients, and if there is a correlation with clinical disease state, remains controversial. The objective of our study was to determine, whether there was any correlation between the RNFL or TMV of patients with MS, and: (1) the lesion load along the visual pathways, (2) the ratios and absolute concentrations of metabolites in the normal-appearing white matter (NAWM), (3) standard brain atrophy indices, (4) disease activity or (5) disease duration. Methods 28 MS patients (RRMS, n = 23; secondary progressive MS (SPMS), n = 5) with moderately-high disease activity or long disease course were included in the study. We utilised: (1) magnetic resonance imaging (MRI) and (2) -spectroscopy (MRS), both operating at 3 Tesla, and (3) high-resolution spectral domain-OCT with locked reference images and eye tracking mode) to undertake the study. Results There was no consistency in the pattern of CNS metabolites, brain atrophy indices and the RNFL/TMV between individuals, which ranged from normal to markedly-reduced levels. Furthermore, there was no strict correlation between CNS metabolites, lesions along the visual pathways, atrophy indices, RNFL, TMV, disease duration or disability. Conclusions Based on the findings of this study, we recommend that the concept of ‘clinico-radiologico paradox’ in multiple sclerosis be extended to CROP–‘clinico-radiologico-ophthalmological paradox’. Furthermore, OCT data of MS patients should be interpreted with caution. PMID:26565967
[Correlation of clinico-neurological peculiarities and morphological signs of small hernias (protrusion) of the lumbar intervertebral discs in formation of discogenic pain syndromes in patients of different age].
Khizhniak, M V; Makeeva, T I; Priĭmak, I V
Morphological signs of small hernias (protrusion) of intervertebral discs (IVD), the results of a neurovisualizing methods of investigation and clinico-neurological features of osteochondrosis as well, were summarized. In young and middle age patients morphological chatacteristics of small hernias (protrusion) of IVD, data of neurovisualizing methods of investigation have had correlated with clinico-neurological features of the disease and were the key determinants while performance of the puncture laser microdiscectomy. In a middle age and elderly patients a weak correlation was noted between the IVD protrusion dimensions and intensity of a lumbar and radicular pain syndromes, functional activity (Osvestry index), what have had permitted to apply a pathogenetically substantiated method of a durable epidural pharmacotherapy. The investigation results witness the necessity of differentiated application of the puncture methods of treatment for the pain discogenic syndromes in patients of different age.
Zampieri, Fabio; Rizzo, Stefania; Thiene, Gaetano; Basso, Cristina
Walter Cannon and Richard Cabot inaugurated the clinico-pathological conference (CPC) at Harvard Medical School at the beginning of the twentieth century, but this approach to anatomo-clinical correlation was first introduced by Giovanni Battista Morgagni at the University of Padua in the eighteenth century. The CPC consists of the presentation of a clinical case, in which past and recent medical histories of the patient, with all relevant information about laboratory tests including biopsy results, therapy and, eventually in a fatal case, the autopsy, are discussed. This is done for an audience of trainees and all physicians involved in the care for the patient. The CPC is still in use in many academic hospitals, as a teaching tool not only for undergraduate and graduate medical trainees, but also for postgraduate continuous medical education, in spite of the progressively declining autopsy rate. CPCs represent the ideal occasion for fruitful discussion between the two "souls" of medicine, i.e., the clinical, with its focus on the patient, and the pathological, with its focus on understanding disease. To discontinue using them would be equal to denying that modern medicine originated in Morgagni's method.
Ziv, G; Shem-Tov, M; Ascher, F
The effects of a single intramuscular injection of a drug product containing ampicillin, colistin and dexamethasone, as a suspension in a diester of propylene glycol of medium-chain fatty acids, on the clinico-pathological course of experimental Escherichia coli-endotoxin mastitis was examined in 30 dairy cows. Cows were divided into five groups, six cows per group, and 24 of them were infused with E. coli endotoxin into two quarters of their udders. The drug product was injected at 25,000 IU colistin sulphate, 10.0 mg ampicillin anhydrate and 0.025 mg dexamethasone acetate.kg-1 body weight as follows: Group 2 cows, immediately post-endotoxin infusion (PEI); Group 3 cows, 2 h PEI and, Group 4 cows, 4 h PEI. Group 1 cows were not treated with the product and served as a positive (endotoxin only) control while Group 5 cows were not challenged with endotoxin and were not treated with the product. A clinical mastitis score (CMS) was developed to quantitatively assess the degree of inflammation. Blood biochemistry and hematological parameters were used to monitor the immediate effects of treatment on several conventional inflammatory markers. Milk somatic cell counts (MSCC), milk electrical conductivity and daily milk production were among the parameters used to monitor systemic and local inflammatory reactions. Administration of the drug product immediately PEI and 2 h PEI clearly nullified some of the most severe early systemic reactions to inflammation but the effect of therapy on the local inflammatory markers was not as obvious. Notewhorthy, however, were the effects of the treatment on reducing the duration of elevated quarter MSCC and the increase in the speed of return to pre-endotoxin challenge daily milk production levels.
Das, Swati; Jhingran, Rajesh; Bains, Vivek Kumar; Madan, Rohit; Srivastava, Ruchi; Rizvi, Iram
Objectives: This study was primarily designed to determine the clinico-radiographic efficacy of platelet-rich fibrin (PRF) and beta-tri-calcium phosphate with collagen (β-TCP-Cl) in preserving extraction sockets. Materials and Methods: For Group I (PRF), residual sockets (n = 15) were filled with autologous PRF obtained from patients' blood; and for Group II (β-TCP-Cl), residual sockets (n = 15) were filled with β-TCP-Cl. For the sockets randomly selected for Group II (β-TCP-Cl), the reshaped Resorbable Tissue Replacement cone was inserted into the socket. Results: Clinically, there was a significantly greater decrease in relative socket depth, but apposition in midcrestal height in Group II (β-TCP-Cl) as compared to Group I (PRF), whereas more decrease in buccolingual width of Group I (PRF) than Group II (β-TCP-Cl) after 6 months. Radiographically, the mean difference in socket height, residual ridge, and width (coronal, middle, and apical third of socket) after 6 months was higher in Group I (PRF) as compared to Group II (β-TCP-Cl). The mean density (in Hounsfield Units) at coronal, middle, and apical third of socket was higher in Group I (PRF) as compared to Group II (β-TCP-Cl). There were statistically significant apposition and resorption for Group I (PRF) whereas nonsignificant resorption and significant apposition for Group II (β-TCP-Cl) in buccal and lingual/palatal cortical plate, respectively, at 6 months on computerized tomography scan. Conclusion: The use of either autologous PRF or β-TCP-Cl was effective in socket preservation. Results obtained from PRF were almost similar to β-TCP-Cl; therefore being autologous, nonimmune, cost-effective, easily procurable regenerative biomaterial, PRF proves to be an insight into the future biofuel for regeneration. PMID:27095909
La Rosa, Stefano; Furlan, Daniela; Franzi, Francesca; Battaglia, Paolo; Frattini, Milo; Zanellato, Elena; Marando, Alessandro; Sahnane, Nora; Turri-Zanoni, Mario; Castelnuovo, Paolo; Capella, Carlo
Sinonasal intestinal-type adenocarcinomas (ITACs) are rare neoplasms histologically resembling intestinal adenocarcinomas. Although a neuroendocrine differentiation in ITACs has been described, true mixed exocrine-neuroendocrine carcinomas, neoplasms in which each component represents at least 30 % of the lesion, are extremely rare and their molecular alterations are largely unknown. We describe herein the clinico-pathologic features, the methylation profile, chromosomal gains and losses, and mutation analysis of KRAS, BRAF and p53 in a nasal mixed exocrine-neuroendocrine carcinoma resected in a 79-year-old man. The tumor was composed of an ITAC and a poorly differentiated neuroendocrine carcinoma. Both exocrine and neuroendocrine components were CK8, CK20, CDX2 and p53 positive, and CK7 and TTF1 negative. The neuroendocrine component also showed immunoreactivity for chromogranin A, synaptophysin, serotonin and glicentin. Gains and losses were found at following chromosome regions: 17p13 (TP53), 14q24 (MLH3), 19q13 (KLK3), 5q21 (APC), 7q21 (CDK6), 9q34 (DAPK1), 12p13 (TNFRSF 1A, CDKN1B), 13q12 (BRCA2), 17p13.3 (HIC1), 18q21 (BCL2), and 22q12 (TIMP3). Aberrant methylation was detected only in the neuroendocrine component and involved APC and DAPK1 genes. No mutation of KRAS (exons 2-4), BRAF (exon 15), and p53 (exons 4-10) was found in both components. The results suggest a monoclonal origin of the tumor from a pluripotent cell undergoing a biphenotypic differentiation and that the neuroendocrine differentiation may be from an exocrine to an endocrine pathway. We have also reviewed the literature on sinonasal mixed exocrine-neuroendocrine carcinomas to give to the reader a comprehensive overview of these very rare tumor types.
Pal, Souren; Sen, Kaushik; Biswas, Nirendra Mohan; Ghosal, Anirban; Rousan Jaman, S. K.; Yashavantha Kumar, K. Y.
Background and Objective: Dengue, an acute viral disease, transmitted by Aedes mosquitoes, has a variable clinical spectrum ranging from asymptomatic infection to life-threatening dengue hemorrhagic fever and dengue shock syndrome. However, neurological complications, in general, are unusual but have been observed more frequently in the recent past, and some studies highlighted varied neurological complications during the course of illness. Although dengue is classically considered a nonneurotropic virus, there is increasing evidence for dengue viral neurotropism. In this study, we have evaluated clinico-radiological profile and outcome of nine serologically confirmed dengue patients having varied manifestations of central nervous system (CNS) involvement. Materials and Methods: All the consecutive patients presented with neurological complications with positive serology for dengue infection (IgM positivity) in Department of Medicine, in a tertiary care hospital in Eastern India from August 2013 to October 2014 were included in the study. These patients were subjected to a detailed clinical evaluation, laboratory assessment including complete hemogram, coagulation profile, liver function test, serum electrolytes, and routine CSF (Cerebrospinal Fluid) study with the exclusion of other common neuroinvasive pathogens. Results: Out of 9 patients with neurological complications associated with confirmed dengue infection, 2 (22%) patients had dengue encephalopathy, 5 (56%) patients have dengue encephalitis, 1 (11%) patient had dengue meningitis, and 1 (11%) patient had postdengue immune-mediated CNS involvement. Conclusion: This case series reaffirms the occurrence of varied CNS manifestations in dengue virus infection and underlines the importance of inclusion of dengue in the differential diagnosis of acute encephalitis syndrome. PMID:26933357
Background Human cutaneous anthrax results from skin exposure to B. anthracis, primarily due to occupational exposure. Bangladesh has experienced a number of outbreaks of cutaneous anthrax in recent years. The last episode occurred from April to August, 2011 and created mass havoc due to its dreadful clinical outcome and socio-cultural consequences. We report here the clinico-demographic profile and treatment outcome of 15 cutaneous anthrax cases attended at the Dermatology Outpatient Department of Rajshahi Medical College Hospital, Bangladesh between April and August, 2011 with an aim to create awareness for early case detection and management. Findings Anthrax was suspected primarily based on cutaneous manifestations of typical non-tender ulcer with black eschar, with or without oedema, and a history of butchering, or dressing/washing of cattle/goat or their meat. Diagnosis was established by demonstration of large gram-positive rods, typically resembling B. anthracis under light microscope where possible and also by ascertaining therapeutic success. The mean age of cases was 21.4 years (ranging from 3 to 46 years), 7 (46.7%) being males and 8 (53.3%) females. The majority of cases were from lower middle socioeconomic status. Types of exposures included butchering (20%), contact with raw meat (46.7%), and live animals (33.3%). Malignant pustule was present in upper extremity, both extremities, face, and trunk at frequencies of 11 (73.3%), 2 (13.3%), 1 (6.7%) and 1 (6.7%) respectively. Eight (53.3%) patients presented with fever, 7 (46.7%) had localized oedema and 5 (33.3%) had regional lymphadenopathy. Anthrax was confirmed in 13 (86.7%) cases by demonstration of gram-positive rods. All cases were cured with 2 months oral ciprofloxacin combined with flucoxacillin for 2 weeks. Conclusions We present the findings from this series of cases to reinforce the criteria for clinical diagnosis and to urge prompt therapeutic measures to treat cutaneous anthrax
Zhou, Jianhua; Huang, Aixia; Liu, Tonglin; Kuang, Yujiu
.6% of IgA nephropathy, among them most showed IgA and IgM and/or C3 deposits, moreover overwhelming IgG deposits and linear IgG deposits couldn't be found in IgA nephropathy. Mean 20 months follow-up showed complete remission in 72.5% of HSPN, but only 19.4% in IgA nephropathy after 34 months follow-up. Moreover, 64.5% of IgA nephropathy had consistent hematuria and proteinuria and 16.1% had active nephritides (P < 0.05). It was concluded that significant clinico-pathological difference was found between HSPN and IgA nephropathy, which didn't support the one disease entity hypothesis. HSPN and IgA nephropathy are probably two diseases with similar immune abnormalities.
An exploratory study of the influence of clinico-demographic variables on swallowing and swallowing-related quality of life in a cohort of oral and oropharyngeal cancer patients treated with primary surgery.
Dwivedi, Raghav C; Chisholm, Edward J; Khan, Afroze S; Harris, Nicholas J; Bhide, Shree A; St Rose, Suzanne; Kerawala, Cyrus J; Clarke, Peter M; Nutting, Christopher M; Rhys-Evans, Peter H; Harrington, Kevin J; Kazi, Rehan
There are insufficient data on swallowing and the consequences of its dysfunction in patients with cancers of the oral cavity (OC) and oropharynx (OP) that are treated with primary surgery. The study attempts to explore the effect of important clinico-demographic variables on post-treatment swallowing and related quality of life (QOL) in post-surgical OC and OP cancer patients. Sixty-two consecutive OC and OP cancer patients completed the MD Anderson Dysphagia Inventory (MDADI) questionnaire. Mean scores were computed. Comparison of scores based on mean ranks were performed using Mann-Whitney U test or Kruskal-Wallis test. Level of significance was set at P ≤ 0.02. Adjustments were made for multiple comparisons. Significantly worse mean (SD) QOL scores were observed in late T-stage (T3/T4) versus early T-stage (T1/T2) patients for global domain, physical domain, functional domain and emotional domains [44.4 (21.9) vs. 78.7 (22.7) (P < 0.001); 50.0 (9.4) vs. 75.9 (16.3), (P < 0.0001); 57.8 (20.6) vs. 84.1 (16.7), (P < 0.001) and 55.2 (18.0) vs. 78.5 (16.3), (P < 0.001)], respectively. Patients undergoing reconstruction versus without reconstruction had worse QOL scores; 58.8 (26.9) versus 79.5 (22.8), (P < 0.01); 61.2 (15.1) versus 76.4 (17.5), (P = 0.002); 65.4 (20.5) versus 86.3 (15.9), (P < 0.0001) and 63.3 (18.8) versus 79.8 (16.3), (P < 0.01), respectively, for global, physical, functional and emotional domains. Advanced T-stage, reconstruction, younger age and base of tongue tumours have a negative impact on post-treatment swallow function and related QOL in these patients.
Bakkali, Adiba; Lemchaheb, Mouna; Had, Nezha; Dehbi, Hind; Benchekroun, Said; Quessar, Asma
La cytogénétique constitue un outil indispensable pour le diagnostic et le pronostic de la leucémie aigue myéloïde (LAM). La t(8;16)(p11;p13) est rare au cours de cette pathologie. Nous décrivons le cas d'une patiente de 22 ans, admise pour un syndrome d'insuffisance médullaire complet associé à une altération de l’état général. L'examen clinique initial montrait un purpura ecchymotique diffus et des adénopathies latérocérvicales centimétriques bilatérales. L'hémogramme avait montré une anémie à 7,6g /dl normochrome normocytaire, des globules blancs à 87,8×109/L, 15% de polynucléaires neutrophiles, 60% de blastes, 24% de lymphocytes, 1% de Monocytes et 65×109/L de plaquettes. Le myélogramme avait objectivé une LAM1. Sur l'immunophenotypage les marqueurs positifs étaient le CD33 (99%), le CD15 (73%), le CD38 (95%) et l'HLA-DR (88%), les marqueurs monocytoïdes CD14 et CD64 étaient positifs, le CD34, les marqueurs lymphopïdes, la MPO (26%) et le CD13 (2%) étaient négatifs. Le caryotype avait montré: t(8,16)(p11, p13) add16 (20/20). L'inversion du chromosome 16 recherchée par FISH était négative. Le traitement avait consisté en 2 cures d'induction et 2 cures de consolidation selon le protocole national de traitement des LAM (Cytarabine, daunorubicine, etoposide), la rémission complète avait été obtenue en fin d'induction I, maintenue 9 mois suivie d'une rechute; Vu l'absence de possibilité d'une allogreffe, un traitement palliatif a été instauré, la malade est décédée de sa maladie un mois après la rechute. Notre cas se présente comme les cas décrits dans la littérature avec des données clinico- biologiques particulières. PMID:26327984
Shaw, Phyllis A.; Friedman, Erica S.
Providing a context for learning information and requiring learners to teach specific content has been demonstrated to enhance knowledge retention. To enhance students' appreciation of the role of science and specifically histology in clinical reasoning, disease diagnosis, and treatment, a new teaching format was created to provide clinical…
Teixeira, F; Alonso, E; Romero, V; Ortíz, A; Martínez, C; Otero, E
The object of this study is to investigate whether or not there are clinical signs and symptoms in patients with dementia that, by themselves or jointly, can be associated with the pathological diagnosis of Alzheimer's disease. Twelve patients with dementia were studied, in whom the clinical diagnosis of Alzheimer's disease was made according to established criteria. A sample of leptomeninges, cortex and subcortical white matter was obtained from each patient and was processed for light and electron microscopy. In the cases in whom neuritic plaques and neurofibrilary tangles were present, pathological changes were quantified. The diagnosis of Alzheimer's disease was confirmed in 5 cases, whereas in 3 patients spongiform encephalopathy was present. In the remaining patients, the number of neuritic plaques was within normal limits for the age of the subjects. Comparison of the data in Alzheimer (n = 5) and non-Alzheimer (n = 7) groups showed an increased, statistically significant incidence of acalculia, abnormalities of judgment, impairment of abstraction and primitive reflexes in the former. Although good fitting models were obtained, none achieved perfect discrimination. The model that included alterations of judgment and acalculia gave the best fit. PMID:7647080
Lese, M; Pop, C; Brânduşe, M; Achim, V; Grigorescu, D; Nemeş, S
In the surgery ward from Baia Mare, in the period 1989-1997 have been operated yearly, on an average, 16-17 acute pancreatitis, out of which 8-9 were necrotic-haemorrhagic acute pancreatitis. The possibility of carrying out the computerized tomography allowed a more precise pre-surgery diagnosis and after surgery was improved observation of evolution of the inflammatory phenomena from the pancreatic zone so that the volume, the structure and the outline of the pancreas, the abdominal or pleural liquid collections and the aspect of the neighboring tissues have been correlated in dynamics, with the clinic aspect of the acute pancreatitis and the prognostic indexes. Even if the computerized tomography allowed a more correct evaluation of the patients suffering of acute pancreatitis, there have been 4-6 decreases due to this affection and its complications, the post-surgery death rate remaining at 17-21%.
Cunha, A S; de Sousa, J F; Garcia, C
Histology records from 63 nephrectomies were reviewed; 22 patients had unilateral totally dysplastic kidneys and 5 had polar or segmental dysplasia. A clinicopathological study of these cases was undertaken. In the first group, there was a slight male preponderance and 75% of the patients presented were under two years of age. Urinary tract infection was the most common complaint. 4 patients were diagnosed in utero by ultrasound and 5 infants presented an abdominal mass. Hypertension was documented in a newborn baby. Ipsilateral lower urinary tract anomalies were found in 12 patients and those of the contralateral kidney in 2 children. There were 3 cases of extrarenal anomalies. Histological examination revealed 13 cases of multicystic dysplasia and 9 of solid dysplasia. Metaplastic cartilage was found in 1 case. In the group of segmental dysplasia, age ranging from 27 weeks' gestation to 8 years, at the time of the diagnosis. They all had duplex kidneys and 4 had ureterocele. Histological study in these cases was similar to the one found in the previous series, although superimposed inflammatory changes were more pronounced. Some of the theories regarding the pathogenesis of this disorder are reviewed and the importance of its diagnosis is emphasised.
Ocampo-Acosta, Fabian; Robledo, Juliana; Aldape-Barrios, Beatriz; Garcia-Vazquez, Francisco J
A 45 years old male patient presented with an asymptomatic right mandibular mass that extended from the angle to the premolar area. It had been present for 3 months at the time of the initial presentation. Panoramic radiograph revealed an ill-defined unilocular radiolucency. Previous dental treatment included molar extractions and antibiotic therapy. Considerable bleeding was encountered during incisional biopsy.
Bakheit, A M; Kennedy, P G; Behan, P O
Three new cases of limbic encephalitis in association with malignancy are reported. The literature on this condition is reviewed and the clinical, laboratory and histopathological features of cases proven at necropsy are correlated. The possible pathogenic mechanism of this disorder is discussed. PMID:1963440
Basra, Baljeet Kumar; Suri, Manav P; Patil, Nilesh; Atha, Ravish; Patel, Natvar; Sachde, Jayesh P; Shaikh, M F
Rescuer burn is a relatively newer terminology introduced to define the burns sustained by a person attempting to rescue a primary burn victim. Few studies have been published thus far on this peculiar type of burns. Due to the general neglect of the rescuer burns victim and discontinuation of treatment in most cases, once the primary victim dies, the rescuer often ends up in badly infected wounds and has a delayed return to work. A prospective study was conducted at the B J Medical College and Civil Hospital, Ahmedabad from January 2009 to December 2012 on the rescuer burns patients treated in its burns and plastic surgery department. 3074 patients of burns received treatment during the period of study. Of these, 48 patients gave the history of sustaining burns while trying to rescue a burns victim. Male to female ratio of rescuers was approximately 7:1. It was significantly higher as compared to the ratio of 1:0.8 of females to male burn victims observed at our centre (p≤0.01). Average age of the rescuers was higher in males as compared to females but the difference was not significant (p≥0.05). Of the 45 cases of female primary burns victims, male rescuer was husband of the primary victim in 41/45 cases (91.1%), mother was rescuer in three cases (6.6% cases) and sister was rescuer in one case. Though multiple people came to rescue a burns victim, in all cases, it was seen that it was the first rescuer who sustained burns himself or herself. None of the rescuers had any knowledge of the techniques and precautions to be taken while performing a rescue operation irrespective of their education status, indirectly pointing to the lack of any teaching on burns rescue in the school education curriculum.
Boyd, Doryck; Laxminarayana, Kumaraswamy Kikeri
Oral exophytic lesions often have proven to be diagnostically challenging due to the varied clinical presentation. The exophytic growth of the oral lesions is due to the type of pathology and histological changes. Careful clinical interpretation with a better histological understanding of exophytic lesions may ease the diagnosis from the differential diagnosis panel. The purpose of proposing classification system is to categorize the exophytic lesions of interest under specific clinical and/or histological explanation; and this will eventually lead to better understanding of the pathological condition that is described. To the best of our knowledge, there is no such classification system available for oral exophytic lesions and hence proposal of classification system is attempted in this study. Further, proposing a new classification system is not just to influence the academic contribution, but also to assist at greatest extent for diagnosis during clinical practice. PMID:26501030
Castiñeiras, J; Varo, C; Sánchez Bernal, C; Juarez, A; Castro, C; López, A; Sánchez-Ferragut, C; Paublete, M C; Rodríguez-Rubio, F
There is a group of malignant intrascrotal tumours which represent a very small number when compared to testicular neoplasias and which are known as paratesticular neoplasias. More than 90% belong to the sarcomatous species. From a clinical point of view and based on the patient's age, two groups can be distinguished: sarcomas affecting children and adolescents (primarily rabdomiosarcomas) and those occurring in adulthood, the more frequent histopathological variants being fibrosarcoma, leiomiosarcoma and liposarcoma. This work contributes five paratesticular sarcomas (two rabdomiosarcomas, one liposarcoma, one leiomiosarcoma and one fibrosarcoma). The features related to histogenesis, diagnosis (revealing signs and clinical examination), natural history (dissemination routes based on histopathology) and treatment are reported. With regard to treatment, both the local surgery (total orchiectomy by inguinoscrotal approach with or without hemiscrotectomy), and indications for lymphadenectomy and radiotherapy in relation to staging are discussed though insisting on the chemotherapy approach.
Tan, Peter T; Wei, Andrew H
Rapid advances in molecular technologies are continually re-shaping the way we view and understand the mechanisms driving oncogenesis. The last decade has witnessed unparalleled change in the biology and therapy of the myelodysplastic syndromes (MDS), a heterogeneous collection of clonal myeloid disorders characterised by ineffective haematopoiesis and susceptibility to acute leukaemia transformation. Pivotal studies demonstrating the positive effects of hypomethylating agents on clinical outcome have brought an 'epigenomics revolution' to this disease, emphasising the importance of epigenetic mechanisms to the underlying pathogenesis of MDS. One of the most important future challenges in the MDS field will be to determine whether epigenetic therapies can be made more 'targeted' through identification of biomarkers which define subsets of patients most likely to benefit from treatment. A wave of novel mutations have recently been reported in MDS and other myeloid disorders, several of which regulate endogenous methylation networks within cells (including TET2, DNMT3A, IDH and EZH2). The relevance of these lesions in being able to predict response to epigenetic modulators and their correlation with epigenetic signatures in MDS are beginning to emerge.
Luvsandagva, E; Altantsétség, Zh; Suvdaa, M; Nortmaa, M
Intestinal disorders in infants are determined in 96.9% of cases by the opportunistic flora with the predominance of Pr. mirabilis (25.5%), E. coli (19.1%), Enterobacter aerogenes (12.6%) and with the less frequent occurrence of Klebsiella (4.1%) and pathogenic staphylococci (5.8%). As a result of the unbased use of antibiotics, the majority of children demonstrate dysbacteriosis and the growth of the number of resistant hospital strains. It is suggested that in children with ARVI, the drugs containing lactic acid bacteria and lactose should be used on a wider basis to prevent dysbacteriosis and reduction of resistant strains.
Santini, L; Pezzullo, L; Caracò, C; Candela, G; Esposito, B
Rectal Prolapse is a rare and distressing condition, with a multifactorial etiopathogenesis. Often, this pathology is associated with fecal incontinence. The recommended approach to the patient with rectal prolapse and fecal incontinence is to repair the prolapse first, then deal particularly with fecal incontinence at a second operation. A retrospective, clinical and manometric study has varying degrees of fecal incontinence. Clinically five of their operation, and a further three patients improved, in two patients the degree of fecal incontinence remained invariable. One patient was worsened after surgery. Manometrically resting and pressure (RAP) was significantly higher in continent patients than in voluntary contraction pressure (MVCP) (p < 0.05) in preoperative testing. Postoperatively, there was a significant increase in the resting anal pressure as well as in maximum voluntary contraction pressure. Patients who remained incontinent had a significantly lower RAP and MVCP than patients who improved our regained continence. In conclusion this study shows an alteration of internal and external sphincteric function in patients with rectal prolapse. The surgical treatment of this disease improves sphincteric function. Incontinent patients with RAP < 10 mmHg and MCVP < 20 mmHg, probably they would be better treated simultaneously either for rectal prolapsus and incontinence. In this kind of patients the perianal proctectomy with total sphincteroplasty could be the elective treatment.
Mercadanti, M; Cavalieri, F; Ferraccioli, G F; Ambanelli, U
Idiopathic hypereosinophilic syndrome is a term labelling clinical illnesses characterized by blood hypereosinophilia and widespread infiltration of organs and tissues by mature eosinophils. Although any tissue can be affected the involvement of the nervous system and of the myocardium usually indicates worse prognosis. Histopathological studies carried out on myocardial tissues of hypereosinophilic patients, suggest that eosinophils are the main inducers of tissue damages. These cells seem to affect first the coronary endothelial cells, so leading to thrombi formation and then fibrosis. Eventually restrictive cardiomyopathy may occur. The pathogenetic events are not fully understood. However several studies have been focused on two eosinophil proteins: the major basic protein (MBP) as possible mediator of tissue damages and the cationic eosinophil protein (ECP) involved in thrombotic events. In the bone marrow a marked hyperplasia of the eosinophil series is usual, while in the blood only mature eosinophils circulate. Non specific abnormalities either of the cellular or humoral immunity have been described. Previous reports of a definitely incurable disease have been improved by modern therapeutic programs.
Panteleeva, G P
Psychopathologic and nosologic issues of acute paranoid and Kandinsky-Clerambault syndromes are discussed on the background of clinical studies of 225 schizophrenic patients with these syndromes being initial manifestations. The data on the syndromes typology, clinical value and prognosis of acute delirious disorders are presented. These are shown to be not confined to progredient schizophrenia, including its paranoid form. Rather, they can manifest a course of the disease unspecific for schizophrenia, the so-called schizophrenic reactions and phasic states thus reflecting the course of latent schizophrenia. A differentiated approach to clinical and psychopathological analysis of acute delirious syndromes in schizophrenia is essential for adequate choice of medicosocial measures and epidemiologic investigations.
Rodríguez-Soto, M E; Fernández-Andreu, C M; Moya Duque, S; Rodríguez Díaz, R M; Martínez-Machín, G
Physical examination of nails was carried out in 210 elderly patients and nail scrapings were obtained from onychomycosis suggested lesions in order to determine their causative agents, incidence and clinical characteristics. Diagnostic was confirmed by the isolation of the agents from 74 patients, mainly from toe-nails (incidence 35.2). Tinea pedis occurred in 25% of the cases and Diabetes mellitus was the most prevalent associated disease and the most frequent clinical characteristics were the thickening, the opacity and the presence of longitudinal strias in the surface of the nails. It was compared the results obtained by microscopic examination and by culture. Trichophyton rubrum was the most common dermatophyte isolated; Candida parapsilosis was dominant among Candida species.
Nagaishi, Masaya; Yokoo, Hideaki; Hirato, Junko; Yoshimoto, Yuhei; Nakazato, Yoichi
Pilomyxoid astrocytoma (PMA) is a newly identified variant of pilocytic astrocytoma (PA). We report three cases of PMA with comparison to seven cases of PA in terms of their clinicopathological features. The three cases occurred at the ages of 2, 36 and 6 years, and their tumors were located in the left basal ganglia, the pineal gland, and the cerebellum, respectively. They were diagnosed PMA by surgical specimens that showed a characteristic monomorphous architecture with an angiocentric growth pattern and myxoid background. One patient developed localized relapse at 6 months after the surgery, but the other patients remained alive without tumor progression more than 5 years after treatment. In analysis of the immunohistochemical association in PMA and PA, no specific staining was found to be useful for differential diagnosis of PMA from PA. The expression of biomarkers including O-6-methylguanine-DNA methyltransferase, p53, MIB-1, and EGF receptor neither distinguished PMA from PA nor correlated with outcome. But almost all PMA and PA that demonstrated prominent positivity for nestin showed a high MIB-1 labelling index (LI), and four of these five patients suffered a relapse in the early phase. These results suggest that immunohistochemical expression of nestin and MIB-1 LI may correlate with the aggressiveness of the tumor in PA and PMA.
Batni, Gaurav; Gaur, Sushil; Sinha, O N; Agrawal, Siddhant Priya; Srivasatva, Abhinav
Cervical lymphadenopathy is one of the commonest presenting complaint of patient in ENT OPD Fine Needle Aspiration Cytology (FNAC) is one of the most reliable, less expensive, and basic diagnostic procedure for the definitive and conclusive diagnosis for the immune system which reciprocates in the form of enlarged lymph nodes. A study was conducted in ENT Department of Santosh Medical College, Ghazibad from August 2015 to May 2016 on 64 patients with enlarged cervical lymph nodes. FNAC was done to make the diagnosis. Out of 64 patients (51.5 %) was reactive non-specific, 28 % tubercular, 3.1 % lymphoma and 17 % were malignant. FNAC is one of the most dependable diagnostic tools in case of cervical lymphadenopathy for early diagnosis and detection for the better management.
Muramatsu, Takashi; Hall, Gillian L; Hashimoto, Sadamitsu; Miyauchi, Jun; Shimono, Masaki
A 13-month-old Japanese boy presented with painless swelling in a left mandible and cheek. Intraoral examination revealed swelling in the left mandible and hemorrhage of oral mucosa due to biting. CT images revealed a wide osteolytic lesion of the left mandible with floating teeth. Biopsy was carried out and histopathological diagnosis was discussed.
Mohan, Raviprakash Sasankoti; Vemanna, Naveen Shanker; Verma, Sankalp; Agarwal, Neha
Crouzon syndrome, also called craniofacial dysostosis, is an autosomal dominant disorder with complete penetrance and variable expressivity. Described by a French neurosurgeon in 1912, it is a rare genetic disorder characterized by premature closure of cranial sutures, midfacial hypoplasia, and orbital defects. Here, we report a case of this rare entity. The patient presented with brachycephaly, maxillary hypoplasia, exophthalmos, mandibular prognathism, along with dental and orbital abnormalities.
Patil, Prashant B; Sreenivasan, V; Goel, Sumit; Nagaraju, K; Vashishth, Shirin; Gupta, Swati; Garg, Kanika
Cowden syndrome (CS) or multiple hamartoma syndrome is an infrequent genodermatoses, which is inherited as an autosomal dominant trait resulting from the mutation in the Phosphatase and Tensin homolog gene on the arm 10q and is principally characterized by multiple hamartomas with an increased risk of development of malignancies. Facial and oral signs are remarkable in the form of multiple papules and trichilemmomas on the face. We report one such rare case of CS in a 19-year-old patient who was diagnosed on the basis of her oral mucosal lesions and was further investigated and diagnosed with other hamartomas. The present case report signifies the responsibility of the oral physician in the early diagnosis of this progressive pathological syndrome as it leaves its footmark in the oral cavity in the form of oral mucosal lesions.
Majumdar, Banashree; Jain, Atul; Sen, Debashis; Bala, Sanchaita; Mishra, Pranshu; Sen, Sumit; Biswyas, Projna; Behra, Akhilesh
We report clinical, radiological, and pathological features of three cases of macrodystrophia lipomatosa, which is characterized by progressive proliferation of all mesenchymal elements, with a disproportionate increase in fibroadipose tissue. The peculiarity in our report is the involvement of contralateral hand and feet in our 1(st) case in contrast to usual presentations of this rare condition, which is often unilateral. In our 2(nd) case, the lateral aspect of foot was involved as against the usual finding of involvement of medial aspect in lower limbs, also another surprising finding in this case is increase in the size of lesion after puberty. Coming to our 3(rd) case, enlargement of almost whole of an upper extremity with profound involvement of middle, ring and little finger along with total sparing of the thumb is in itself an extremely rare occurrence as in upper limb, mainly the lateral aspect of hand and related digits bear the burnt and more over involvement of whole limb is itself an unique phenomenon.
Mohan, Ravi Prakash S; Suma, Gundareddy N; Vashishth, Shirin; Goel, Sumit
Cleidocranial dysplasia is an autosomal dominant condition caused by mutation of RUNX2, characterized by generalized dysplasia of the bones and teeth. Affected individuals have short stature, atypical facial features, and skeletal anomalies affecting mainly the skull and clavicle. The dental manifestations are mainly delayed exfoliation of the primary teeth and delayed eruption of the permanent teeth, with multiple impacted supernumeraries, and absence of cellular cementum. The frequency of this disorder is 1 per million individuals. Here we report a rare case of CCD in a 9-year-old male patient having most of the characteristic features of this syndrome. Interestingly, disorganized dentinal tubules were found in the roots of an extracted deciduous first molar, which seems to be a unique feature not reported previously.
Zharikov, Yu O; Kovalenko, Yu A; Olifir, A A; Kalinin, D V; Czhao, A V
Введение. Разработан способ прогнозирования общей выживаемости у больных воротной холангиокарциномой, перенесших хирургическое вмешательство, в основу которого положены значимые клинико-патологические факторы опухоли. Материал и методы. В анализ включены 55 пациентов с воротной холангиокарциномой, проходивших лечение с 2011 по 2015 г. в Институте хирургии им. А.В.Вишневского. Хирургическое лечение после билиарной декомпрессии было проведено у 37 (67,3%) больных. В отдаленные сроки наблюдались 36 (97,3%) оперированных больных. Проанализирована зависимость общей продолжительности жизни от клинико-патологических факторов опухоли с помощью моно- и полифакторного анализа регрессионной модели пропорционального риска Кокса у всех оперированных больных. Результаты. Общая 1—3-, 5-летняя выживаемость составила 75,1, 60,5, 37,7, 35% соответственно. При монофакторном анализе значимыми прогностическими факторами являются периневральная (p=0,05) и сосудистая инвазия (р=0,049), R1 резекция (p=0,01), стадия заболевания III и выше (p=0,03), инвазия в SI печени (p=0,004), степень дифференцировки клеток опухоли (grade) 2 и выше (p=0,0006). При полифакторном анализе было выявлено, что низкую общую выживаемость обусловливали: периневральная (p = 0,05) и сосудистая инвазия (p=0,008), степень дифференцировки клеток опухоли (p=0,001), стадия заболевания (p=0,05), хирургический край резекции (р=0,0345). Разработанный способ прогнозирования общей выживаемости представляет собой многофакторную балльную оценку факторов прогноза. Выводы. Шкала индивидуального прогноза у больных с опухолями проксимальных желчных протоков, учитывающая как клинические, так и патогистологические характеристики опухоли, может быть полезна для оптимизации лечебной тактики, при принятии решения о проведении оперативного вмешательства и его объема, а также индивидуализировать показания к проведению адъювантной химиолучевой терапии.
Patil, Purva Prakash; Barpande, Suresh Ramchandra; Bhavthankar, Jyoti Dilip; Humbe, Jayanti G.
Introduction: Cleidocranial dysplasia (CCD) is characterized by aplasia or hypoplasia of the clavicles, characteristic craniofacial malformations, and the presence of numerous supernumerary and unerupted teeth. It affects bones derived from both intra-membranous and endochondral ossification. Incidence has been reported as 1 in 10,00,000. It is caused by mutation in the gene encoding transcription factor Core Binding Factor Subunit Alpha l (CBFAl) or Runt related transcription factor 2 (RUNX2). Case Report: This presentation discusses the clinical and radiographic features of a familial case of cleidocranial dysplasia occurring in a father and a child. All the clinical and radiographic features, except that of the chest x-ray, were more prominent in the child than the father. This supports the fact that CCD is transmitted by an autosomal-dominant mode of inheritance with high penetrance and variable expressivity. It is sporadic in about 40% of cases. Each child of an individual with CCD has a 50% chance of in heriting the mutation. Conclusion: Diagnosis is mostly made on the basis of clinical and radiographic features. Molecular genetic testing such as sequence analysis or deletion analysis can be used in cleidocranial dysplasia. Some cases are diagnosed through incidental findings by physicians, treating patients for unrelated conditions. Treatment of these patients requires a multidisciplinary approach which includes orthopaedic and dental corrections along with management of any complications of cleidocranial dysplasia. PMID:27299035
Rammohan, K.; Mundayadan, Shyma M.; Mathew, Robert
Context: Nummular headache (NH) is a primary disorder characterized by head pain exclusively felt in a small-rounded area typically 2–6 cm in diameter. Aims: The aim of this review is to study the clinical and epidemiological features of NH in a patient population of South India and to compare this with that of described in the international literature. Settings and Design: A prospective, observational study conducted in a tertiary care center. Materials and Methods: Patients attending the medicine and neurology outpatient departments of a tertiary referral hospital in South India diagnosed to have NH as per the International Classification of Headache Disorders 3 beta (2013) criteria were studied over 30 months. All of the patients had a normal neurological examination. Neuroimaging findings were normal, except in one patient. Results: A total of 19 females and 10 males were studied. The mean age of onset was 47.62 years (range 36–60). The duration of headache varied from a minimum of 3 months to a maximum of 5 years, with a mean of 24.17 months. The site of headache was predominantly in the parietal area 15 (51.72%), followed by the occipital area 7 (24.13%). The mean diameter of the affected area was 3.23 cm. The intensity of the headache proved to be mild to moderate with a mean visual analog scale score of 5.03. The quality of pain was mainly felt as burning dysesthesia 12 (41.38%). In the majority of patients, i.e. 21 (72.41%), pain was chronic and continuous. None of the patients had any significant trophic change even though paresthesias, dysesthesias, and allodynia were reported by a significant minority of patients, i.e. 9 (31.03%). Only one (3.45%) patient gave a history of head injury. Ten (34.48%) out of 29 patients had other types of concurrent headaches; the majority of which proved to be migrainous, i.e. 7 (24.14%), 2 patients (6.89%) with tension headache, and 1 patient (3.45%) with trigeminal neuralgia. Conclusion: Our study proves the existence of the newly described primary headache syndrome called NH in South Indian population. In comparing our results with the international literature, the number of similarities is much greater than the differences. The etiology of pain in our series appeared to be primarily peripheral with a role for central pain sensitization in some cases due to a variety of concurrent central causes of head pain. PMID:27695232
Ermilova, V D; Krylova, M O
Examinations of 23 specimens of papillary carcinoma of the mammary gland helped single out the basic criteria for the morphologic diagnosis of papillary carcinoma: numbers of cystic dilated ducts with ramified true and epitheliocyte-formed papillae. The cells are monomorphic, medium-sized, with large polymorphous and hyperchromic nuclei. Metastases to the regional lymph nodes were detected in 8.7 percent of cases. Total 3-year, 5-year, and 10-year survival in this form are 95.45 +/- 4.44, 89.09 +/- 7.41, and 89.09 +/- 7.41 percent, respectively. Since the prediction is favorable, radical resection of the mammary gland is recommended for patients with Stages I and II A papillary carcinomas of the mammary gland.
Fusco, Federica; Armando, Tiziana; Storto, Silvana; Mussa, Maria Valentina
Introduzione: Il Peripherally Inserted Central Catheter (PICC) è un catetere venoso centrale adatto per pazienti in regime di Day Hospital. Il suo utilizzo è considerato vantaggioso ma comporta degli oneri di gestione a carico della persona. E' bene formare il paziente ad una corretta gestione domiciliare del presidio attraverso un'educazione strutturata. Obiettivo: In un gruppo di pazienti portatori di PICC, valutare l'efficacia di un intervento educativo mirato attraverso la comparazione di: colloquio informativo, opuscolo cartaceo, video informativo. Metodo: Studio clinico randomizzato e controllato monocentrico, schema comparativo semplice a tre bracci. Popolazione: tutti i pazienti sottoposti all'impianto di PICC nel periodo di osservazione tra Ottobre 2013 e Febbraio 2014 presso l'Unità Operativa Day Hospital Oncologico e Breast Unit, presidio Molinette di Torino. L'intervento educativo standard è erogato attraverso un colloquio con l'infermiere che esegue l'impianto. Il team di impiantatori è costituito da due infermieri con comprovata esperienza in ambito oncologico ed in possesso di Master di I Livello "Gestione degli accessi venosi". I pazienti eleggibili, dopo randomizzazione, sono stati divisi in tre gruppi: gruppo A colloquio informativo; gruppo B opuscolo; gruppo C video. I pazienti dei gruppi B e C hanno ricevuto informazioni standard inte- grate con informazioni audiovisive oppure cartacee, in base al braccio al quale erano stati destinati; il grado di conoscenza raggiunto è stato indagato attraverso la somministrazione di questionari costruiti ad hoc, non vali- dati in quanto non presenti in letteratura. Risultati: Adesione allo studio di 40 pazienti, campione di convenienza costituito da persone di età compresa tra 18 e 75 anni, consenzienti e risiedenti al proprio domicilio. L'analisi delle conoscenze apprese in seguito all'intervento educativo mostra una differenza statisticamente significativa in diversi ambiti necessari per la
Hiremath, Santhosh Kumar S; Kale, Alka D; Charantimath, Seema
Oral cavity is commonly affected by number of lichenoid lesions, whose clinical and histopathologic features overlap due to the presence of inflammatory cells in connective tissue. Segregation of these lichenoid lesions is mandatory as each may embody a distinct disease entity in terms of cause, diagnosis and prognosis. The literature discussed in the article is an attempt to segregate individual lichenoid lesions by defining clinical and histopathologic variations among each other, which avoids the diagnostic problem.
Waghmare, Alka S.; Vhanmane, Priyanka B.; Savitha, B.; Chawla, Ruhee L.; Bagde, Hiroj S.
Background: Bacteremia frequently occurs after treatment procedures such as extractions, scaling, root planing, periodontal surgery. There is currently significant interest in the possibility that bacteremia with oral bacteria may play role in pathogenesis of atherosclerosis. There are well-conducted studies that have determined the frequency of passage of periodontal microorganisms to the bloodstream after periodontal treatment. There is scarce information related to the incidence of periodontopathic microorganisms during bacteremia induced by this procedure. Aim: The aim of this study was to establish the frequency of passage of periodontopathic microorganisms in peripheric blood after scaling and root planing in patients with periodontitis. Materials and Methods: Forty subjects with chronic periodontitis were included in the study. Blood samples were drawn from each patient at following intervals pre-treatment i.e., before SRP (P1), immediately after SRP (P2), and 30 minutes after SRP (P3). Following SRP, blood samples were analyzed for following microorganisms: Porphyromonasgingivalis, Tannerella. forysthus, Eikenellanella. corrodens, Campylobacter species, Micromonas. micros, and Prevotella. intermedia. Statistical Analysis Used: Chi-square test. Results: Bacteremia was found in 70% (28/40) immediately after SRP and after 30 min, it was reduced to 25% (10/40) and 7.5% (3/40) presented bacteremia before SRP. Conclusions: It was concluded that bacteremia frequently occurs immediately after SRP with P. gingivalis showing the highest frequency in blood. PMID:24554880
Sriharibabu, Manne; Himabindu, Yalamanchali; Kabir, Zubair
Background Rheumatic heart disease (RHD) is still a public health issue in many countries in the world, and particularly in Southeast Asia. India, for example, contributes 25%–50% of the global burden of RHD. Clinic-based and epidemiological studies on RHD in India have used different methodologies and clinical criteria to estimate RHD burden in India. The present study employs strict clinical criteria, including echocardiography, to estimate RHD prevalence and associated clinical complications in a large unique rural population in southern India covered through a governmental health insurance scheme. Materials and methods Total 44,164 eligible patients were screened from 238 primary care health centers in rural southern India between October 2007 and March 2012 using strict clinical criteria and objective ascertainment. A total of 403 patients aged 15 years or above were finally analyzed based on both the inclusion and exclusion criteria. Detailed information on both demographic and clinical characteristics was obtained through personal interviews and clinical examinations. Descriptive analyses were performed, including age standardization. Results The age-standardized RHD prevalence rate was 9.7/1000 populations—more common in younger age groups (<44 years) and relatively high among females. Pulmonary hypertension was the most common clinical complication followed by CHF, tricuspid regurgitation, as well as infective endocarditis. More than two-thirds had no past history of RHD or penicillin prophylaxis. Conclusions RHD rates are still high in rural India among populations covered through governmental health insurance scheme. Both primary and secondary preventive measures, including widespread coverage of penicillin prophylaxis, must be considered mainstay tools to both prevent and reduce RHD burden in endemic populations, including rural India. PMID:24023467
Objective: Though both clinical evaluation and MRI are complimentary in detection and precise localization of the level of lesion in patients with cervical myelopathy, there is paucity of data comparing segment specific clinical features with the MRI abnormalities in cervical myelopathy. Materials and Methods: Thirty one patients with cervical myelopathy and abnormal MRI of the cervical spine (signal changes in the cord) admitted to the neurology and neurosurgery wards during the study period were included in the study. The patients were prospectively evaluated by a detailed neurological examination. Clinically, the site of lesion was determined by highest of the pyramidal, sensory or segmental features of involvement. The MRI lesions were categorized based on the vertebral level at which the abnormalities were seen. The patients were divided into three groups according to the site of lesion on MRI: (1) cervico-medullary (foramen magnum to C1) lesions (2) upper cervical (C2-C4) lesions and (3) lower cervical (C5-T1) lesions. Comparisons of clinical symptoms, signs and level of lesion with MRI abnormalities were done and the level of significance was set at p < 0.05. Results: Clinical evaluation showed limb weakness in all, sensory loss in 90%, sphincter disturbances in 67.7%, scissoring gait in 32.2%, diaphragmatic weakness in 12.9% of patients. Based on clinical examination the site of lesion was cervico-medullary in 9, upper cervical region in 4 and lower cervical region of involvement in five patients. The maximal antero-posterior extent of the lesion and neurological deficits were concordant (p-0.05). As compared to pyramidal signs or sensory abnormalities, segmental features – segmental sensory loss, weakness, wasting or ‘reflex’ loss – were most concordant with the MRI level of lesion (p - 0.03). Among ‘motor’, ‘sensory’ and ‘reflex’ levels, the ‘reflex (DTR)’ levels were most concordant with the MRI level of lesion (p – 0.04). Conclusion: Segmental features form the foundation for clinical localization of the level of lesion. Though the clinical level of lesion and MRI level of lesion were discordant in 14 patients, clinical evaluation may still provide useful information. PMID:25738053
Fink, John K.
Hereditary spastic paraplegia (HSP) is a syndrome designation describing inherited disorders in which lower extremity weakness and spasticity are the predominant symptoms. There are more than 50 genetic types of HSP. HSP affects individuals diverse ethnic groups with prevalence estimates ranging from 1.2 to 9.6 per 100,000 [39, 70, 77, 154, 185]. Symptoms may begin at any age. Gait impairment that begins after childhood usually worsens very slowly over many years. Gait impairment that begins in infancy and early childhood may not worsen significantly. Post mortem studies consistently identify degeneration of corticospinal tract axons (maximal in the thoracic spinal cord) and degeneration of fasciculus gracilis fibers (maximal in the cervico-medullary region). HSP syndromes thus appear to involve motor-sensory axon degeneration affecting predominantly (but not exclusively) the distal ends of long central nervous system (CNS) axons. In general, proteins encoded by HSP genes have diverse functions including axon transport (e.g. SPG30/KIF1A, SPG10/KIF5A and possibly SPG4/Spastin); endoplasmic reticulum morphology (e.g. SPG3A/Atlastin, SPG4/Spastin, SPG12/reticulon 2, and SPG31/REEP1, all of which interact); mitochondrial function (e.g. SPG13/chaperonin 60/heat shock protein 60, SPG7/paraplegin; and mitochondrial ATP6; 4) myelin formation (e.g. SPG2/Proteolipid protein and SPG42/Connexin 47); 5) protein folding and ER-stress response (SPG6/NIPA1, SPG8/K1AA0196 (Strumpellin), SGP17/BSCL2 (Seipin) [113-115], “mutilating sensory neuropathy with spastic paraplegia” due to CcT5 mutation and presumably SPG18/ERLIN2); 6) corticospinal tract and other neurodevelopment (e.g. SPG1/L1 cell adhesion molecule and SPG22/thyroid transporter MCT8); 7) fatty acid and phospholipid metabolism (e.g. SPG28/DDHD1, SPG35/FA2H, SPG39/NTE, SPG54/DDHD2, and SPG56/CYP2U1); and 8) endosome membrane trafficking and vesicle formation (e.g. SPG47/AP4B1, SPG48/KIAA0415, SPG50/AP4M1, SPG51/AP4E, SPG52/AP4S1, and VSPG53/VPS37A). The availability of animal models (including bovine, murine, zebrafish, Drosophila, and C. elegans) for many types of HSP permits exploration of disease mechanisms and potential treatments. This review highlights emerging concepts of this large group of clinically similar disorders. For recent review of HSP including historical descriptions, differential diagnosis, and additional references see . PMID:23897027
Krasik, E D; Logvinovich, G V
In 186 patients with paroxysmal schizophrenia the authors analyzed their social relations and functions as compared with a premorbid period. Four compensated and three decompensated levels of social adaptation have been identified. Variants of combination of clinical and social levels of adaptation are systematized in the form of four types. It has been established that integrative and destructive types of adaptation develop in patients with partial or complete correlation of clinical and social characteristics. Extrovert and introvert types reflect contrast combinations of clinical and social levels of adaptation. The results are of interest for examination of the mechanisms of adaptation formation and optimization of rehabilitation programmes.
Introduction: Genital ulcerative diseases are a major public health problem. The advert of human immunodeficiency virus (HIV)/AIDS over the past 25 years has deepened the scope of morbidity, mortality, and various forms of clinical presentations of sexually transmitted diseases (STDs). Materials and Methods: A total of 50 cases having Genital ulcerative diseases and STD reporting to STD clinic during the period of the year from November 2005 to December 2006 were included and detailed history and clinical examination were carried out and provisional diagnosis is made. Laboratory confirmation of clinically diagnosed cases was done using laboratory tests such as S. HIV, venereal disease research laboratory, Tzanck smear, gram stain, and Giemsa stain. Result: In the present study, the incidence of herpes progenitalis was (38%) followed by primary syphilis (32%), chancroid (26%), lymphogranuloma venereum (02%), and genital scabies (02%). HIV sero-positivity was detected in 12% (n = 6) cases. Conclusion: HIV was found to be more common among genital ulcer disease patients, especially syphilis and genital herpes. PMID:24958991
Raza, Faiz Ahmed; Rehman, Shafiq ur; Khalid, Ruqyya; Ahmad, Jameel; Ashraf, Sajjad; Iqbal, Mazhar; Hasnain, Shahida
This cross-sectional study was carried out to explore the epidemiological and clinical features of dengue fever in Faisalabad, Pakistan during 2011 and 2012. During the study period, anti-dengue IgM positive cases were reported in the post-monsoon period during the months of August-December. Certain hotspots for the dengue infection were identified in the city that coincide with the clusters of densely populated urban regions of the city. Out of total 299 IgM positive patients (male 218 and female 81); there were 239 dengue fever (DF) and 60 dengue hemorrhagic fever (DHF) patients. There was decrease in the median age of dengue patients from 31 years in 2011 to 21.5 years in 2012 (p<0.001). Abdominal pain was seen in 35% DHF patients followed by nausea in 28.3%, epistaxis in 25% and rash in 20% patients (p<0.05). Patients reported to be suffering from high-grade fever for an average of 8.83 days in DHF as compared to 5.82 days in DF before being hospitalized. Co-morbidities were found to be risk factor for the development of DHF in dengue patients. Clinical and laboratory features of dengue cases studied could be used for the early identification of patients at risk of severe dengue fever.
Bogousslavsky, J; Miklossy, J; Deruaz, J P; Assal, G; Regli, F
A macular-sparing superior altitudinal hemianopia with no visuo-psychic disturbance, except impaired visual learning, was associated with bilateral ischaemic necrosis of the lingual gyrus and only partial involvement of the fusiform gyrus on the left side. It is suggested that bilateral destruction of the lingual gyrus alone is not sufficient to affect complex visual processing. The fusiform gyrus probably has a critical role in colour integration, visuo-spatial processing, facial recognition and corresponding visual imagery. Involvement of the occipitotemporal projection system deep to the lingual gyri probably explained visual memory dysfunction, by a visuo-limbic disconnection. Impaired verbal memory may have been due to posterior involvement of the parahippocampal gyrus and underlying white matter, which may have disconnected the intact speech areas from the left medial temporal structures. Images PMID:3585386
Liubchenko, L N
Li-Fraumeni syndrome (sarcoma family syndrome, OMIM 151623) is a rare clinically and genetically hetergoeneous autosomal dominant disorder characterized by the evolvement and accumulation of soft-tissue osteogenic sarcomas in members of a family, as well as uni- and bilateral breast cancer in young women, brain tumours, adrenocortical cancer, and lymphoproliferative diseases. Germinal mutations of the TP53 gene constitute the etiological genetic basis of Li-Fraumeni syndrome. American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network developed recommendations for genetic testing and observation of carriers of TP53 mutations. In vitro and in vivo studies demonstrated correlation between the TP53-mutant genotype and resistance to standard therapeutic modalities. This finding gave impetus to the development of new genotherapeutic approaches to the treatment of TP53-associated tumours in patients with Li-Fraumeni syndrome.
Dave, V; Gandhi, S; Mehta, V; Kumar, A; Arora, J; Suri, R K; Rath, G
Extensor tendon injury is a frequent finding in clinical practice. During a routine dissection class of undergraduate medical students examining the extensor aspect of the right hand, they found an interesting pattern of extensor tendons. The extensor digitorum (ED) exhibited three tendons for the middle and ring fingers. The intermediate tendon of the ED was found to pass to the junctura connecting the tendons of the ring and middle fingers. Additionally the Extensor carpi ulnaris displayed two tendinus slips. The lateral slip was inserted on the base of fifth metacarpal as usual, whereas the medial slip divided into two strands- proximal and distal. Apart from the above findings in the current case specimen, there was an accessory muscle belly for the index finger and the extensor digiti minimi bifurcated into two tendinus slips which gained attachment to the dorsal digital expansion of the little finger. These accessory muscle bellies and tendons could possibly be utilized for tendon reconstructions such as repairs, tenoplasties or tendon transfers.
Warrington, E K; James, M
The visuo-perceptual abilities of three cases with unilateral lesions of the right hemisphere selected on the basis of the co-occurrence of impaired performance on a test of visual object perception and normal performance on a test of shape discrimination are reported. Their performance was also impaired on other tests of visual object recognition in which the perceptual difficulty of the task was manipulated by obscuring the salient features of the representation. At the same time it was found that on a variety of other tests of visual-sensory processing their performance was entirely normal, as was their performance on tests of visual semantic knowledge, tests that were failed by a patient with a visual associative agnosia. It is argued that this syndrome has all the hallmarks of an apperceptive agnosia, a failure of perceptual categorisation in which the physical identity of the object is specified. The two discontinuities between visual-sensory processing, perceptual categorisation and visual-semantic processing are discussed in terms of a 2 categorical stage model of object recognition.
Nussenzveig, I; Saldanha, L B; Marcondes, M
From 1976 to December 1984 IgA nephropathy (IgAN) was diagnosed in 40 patients at the Nephrology Division of the Hospital das Clínicas, São Paulo University. In order to estimate the incidence of the disease in our city, we reviewed the kidney biopsies of the year 1984: IgAN constituted 6.5% of all biopsies of primary glomerular nephropathies. Of the 40 patients 67.5% were males and 32.5% females. Their age varied between 4 and 49 years and 72.5% were in the 2nd and 3rd decades of life at the beginning of the disease. From the racial standpoint, 82.5% of the patients were white, 10% were yellow and 7.5% black. The most frequent clinical manifestation, presented by 62.5% of patients, was macroscopic hematuria in close association with an acute infectious process. In the remaining 37.5% of cases the clinical picture of the disease was very variable, and did not evoke the diagnosis of IgAN. The initial laboratory investigation showed proteinuria in 92.5% of patients; it was under 1g/24h in 40%, it ranged from 1 to 3g/day in 37.5% and was over 3.5g/24h in 15% of them. Hematuria was present in all 40 cases and the red cells displayed moderate dismorphism. Glomerular filtration rate, evaluated by creatinine clearance in 39 patients, was over 90 ml/min/1.73m2 in 70%, ranged between 50 and 89 ml/min/1.73m2 in 7.5% and was under 25 ml/min/1.73m2 in 20% of them. Total complement CH50 was found normal in 79.4% and was slightly reduced in 20.6%. The C3 fraction showed slight reduction in 9.5% and C4 was found normal in all instances. Serum IgA was increased in 21% of the cases. All patients were submitted to percutaneous renal biopsy. Proliferative mesangial lesions were found in 82.5% of cases; they were focal in 42.5% and diffuse in 40%. In 15% of the patients, the glomeruli were entirely normal on light microscopy. In one case they were crescent-shaped, exhibiting 82% of the glomeruli this form. The immunofluorescence findings were quite uniform, with granular deposits occupying only the mesangium, with a global and diffuse distribution in all glomeruli. IgA was the dominant immunoglobulin deposited in the 40 cases and C3 was also found in the same localization and distribution in all biopsies, generally with a lesser intensity than IgA. IgG was present in 85% of cases and IgM in 32.5% of the biopsies, in the majority of them with the intensity of traces.(ABSTRACT TRUNCATED AT 400 WORDS)
Galgamuwa, Lahiru Sandaruwan; Sumanasena, Buthsiri; Yatawara, Lalani; Wickramasinghe, Susiji; Iddawela, Devika
Cutaneous leishmaniasis (CL) caused by Leishmania donovani is an endemic vector-borne disease in Sri Lanka. Over 2,500 cases have been reported since 2000 and the number of CL cases has dramatically increased annually. Total 57 clinically suspected CL patients attending the dermatology clinic in Anuradhapura Teaching Hospital were recruited from January to June 2015. Slit skin smears and skin biopsies were taken from each of the subjects. Clinical and epidemiological data were obtained using interviewer administered questionnaire. Forty-three (75.4%) patients among 57 were confirmed positive for L. donovani. The majority of infected patients was males (P=0.005), and the most affected age group was 21–40 years. Soldiers in security forces, farmers, and housewives were identified as high risk groups. The presence of scrub jungles around the residence or places of occupation (P=0.003), the presence of sandflies (P=0.021), and working outsides more than 6 hr per day (P=0.001) were significantly associated with CL. The number of lesions ranged from 1–3, and the majority (76%) of the patients had a single lesion. Upper and lower extremities were the prominent places of lesions, while the wet type of lesions were more prevalent in females (P=0.022). A nodular-ulcerative type lesion was common in both sexes. The presence of sandflies, scrub jungles, and outdoor activities contributed to spread of Leishmania parasites in an endemic pattern. Implementation of vector control programs together with health education with regard to transmission and prevention of CL are necessary to control the spread of this infection. PMID:28285499
Rowland, Agbara; Benjamin, Fomete; Athanasius-Chukwudi, Obiadazie; Uchenna-Kevin, Omeje; Modupeola-Omotara, Samaila
Introduction: Myxomas are a group of benign rare tumors of connective-tissue origin that occur in both hard (central) and soft tissues of the body. The aim of this study is to highlight our experience in the management of central myxoma of the jaw, with emphasis on its clinic-epidemiologic features as seen in our environment. Materials and Methods: All patients who were managed for central myxoma of the jaw at the Oral and Maxillofacial Surgery department of a regional University Teaching Hospital between September 1997 and October 2015 were retrospectively studied. Details sourced included age, sex, site of tumor, duration, signs/symptoms, treatment given, and complications. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2007 (Microsoft, Redmond, WA, USA). Results from descriptive statistics were represented in the form of tables and charts, with a test for significance (ρ) using Pearson Chi-square (χ2) set at 0.05. Results: A total of 16 patients were managed within the period reviewed, consisting of 10 (62.5%) females and six (37.5%) males, giving a male-to-female ratio of 1:1.7. The ages of patients ranged from 5 to 70 years, with a mean of 27.06±15.45 years. The mandible accounted for nine (56.3%) cases and the maxilla for six (37.5%) cases, while a combination of the maxilla and the zygoma were involved in one (6.3%) case. Bucco-lingual or bucco-palatal expansion were the most common presentation (six [46.2%] cases each). Histological assessment of tissue specimens showed that fibromyxoma accounted for seven (43.8%) cases, while the remaining nine (56.3%) cases were diagnosed as myxoma. All patients had jaw resections, and these consisted of mandibulectomies in nine (60.0%) patients and maxillectomies in six (40.0%) patients. The duration of hospital stay ranged from 5 to 29 days, with a mean of 17.86±7.68 days. Complications were noted in three patients, and all were surgical wound infections. Conclusion: Most patients in our environment present late with large tumors and are usually not compliant with follow-up review. Thus, a radical approach is favored in most patients. PMID:28229061
Escobar, A; Aruffo, C
A 27 year old Mexican male addicted for 12 years to glue-sniffing and thinner inhalation developed neurological and behavioural disturbances which led to hospital admission and death. Autopsy disclosed diffuse cerebral and cerebellar cortex atrophy and giant axonopathy both central and peripheral. The corpus callosum was atrophic secondarily to neuron loss in the neocortex. Images PMID:7441282
Romei, Cristina; Elisei, Rossella
Thyroid carcinoma is the most frequent endocrine cancer accounting for 5–10% of thyroid nodules. Papillary histotype (PTC) is the most prevalent form accounting for 80% of all thyroid carcinoma. Although much is known about its epidemiology, pathogenesis, clinical, and biological behavior, the only documented risk factor for PTC is the ionizing radiation exposure. Rearrangements of the Rearranged during Transfection (RET) proto-oncogene are found in PTC and have been shown to play a pathogenic role. The first RET rearrangement, named RET/PTC, was discovered in 1987. This rearrangement constitutively activates the transcription of the RET tyrosine-kinase domain in follicular cell, thus triggering the signaling along the MAPK pathway and an uncontrolled proliferation. Up to now, 13 different types of RET/PTC rearrangements have been reported but the two most common are RET/PTC1 and RET/PTC3. Ionizing radiations are responsible for the generation of RET/PTC rearrangements, as supported by in vitro studies and by the evidence that RET/PTC, and particularly RET/PTC3, are highly prevalent in radiation induced PTC. However, many thyroid tumors without any history of radiation exposure harbor similar RET rearrangements. The overall prevalence of RET/PTC rearrangements varies from 20 to 70% of PTCs and they are more frequent in childhood than in adulthood thyroid cancer. Controversial data have been reported on the relationship between RET/PTC rearrangements and the PTC prognosis. RET/PTC3 is usually associated with a more aggressive phenotype and in particular with a greater tumor size, the solid variant, and a more advanced stage at diagnosis which are all poor prognostic factors. In contrast, RET/PTC1 rearrangement does not correlate with any clinical–pathological characteristics of PTC. Moreover, the RET protein and mRNA expression level did not show any correlation with the outcome of patients with PTC and no correlation between RET/PTC rearrangements and the expression level of the thyroid differentiation genes was observed. Recently, a diagnostic role of RET/PTC rearrangements has been proposed. It can be searched for in the mRNA extracted from cytological sample especially in case with indeterminate cytology. However, both the fact that it can be present in a not negligible percentage of benign cases and the technical challenge in extracting mRNA from cytological material makes this procedure not applicable at routine level, at least for the moment. PMID:22654872
Keszler, A; Gutierrez, R; Dominguez, F V
Thirteen cases of verrucous leucoplakia (VL), 3 of verrucous hyperplasia (VH) and 19 of verrucous carcinoma (VC) were evaluated by means of 4 clinical features, 12 microscopic parameters and 6 epithelial histometric measurements. No significant clinical differences were detected, but histologic data showed that orthokeratinization was more frequent in VL and VH, while parakeratinization proved more common in VC. Sharp epithelial projections predominated in all three lesion types, though lymphoplasmatic infiltration and Russell bodies were more frequent in VH. Histometrically, there were statistical differences between VL or VH vs VC in three parameters, namely connective tissue-epithelial interface (Ice), epithelial height (He) and connective tissue-epithelial interface plus verrucous epithelial surface (Ice + Sve). To conclude, in this series, VH failed to exhibit significant clinical or histologic differences vs VL or VC, but histometric analysis was able to detect epithelial differences between both premalignant lesions and VC.
Hernández Vallejo, G; García Rodríguez, M D; Tejerina Lobo, J M; López Sánchez, A F; De la Roca, C
This study was designed to evaluate the significance and interrelationship of clinical parameters and their association with histologic changes in advanced destructive periodontitis. 158 patients with PDI greater than 4 (Ramfjord) were selected, evaluating the size, contouring, bleeding, consistency, colour and gingival pain. Epithelial ulceration of soft periodontal pockets were also evaluated. The results showed a statistically significant association between purplish colour and gingival fibrosis and advanced stage of the disease. Gingival bleeding on probing was the most important clinical parameter in advanced phases of the disease, either alone or in association with other parameters such as the presence of epithelial ulcerations. The Periodontal Disease Index (Ramfjord) has proven effective in the evaluation of generalized patterns of disease.
Pétrus, M; Bonaz, S; Causse, E; Micheau, P; Rhabbour, M; Netter, J C; Bildstein, G
The authors report a sery of 16 cases of intolerance to the benzoates in children. Sixteen children (9 boys and 7 girls) were directed to the Hospital of Tarbes from June 1995 to July 1995, for recurring urticaria (7/16) combined with asthma (1/16), atopic eczema (2/16), dermorespiratory syndrome (2/16) and asthma (1/16). All were subject to an immunological examination comprising alimentation inquiry, prick test, IgE determination, RAST, oral provocation test to benzoates, which establishes the diagnosis, whose confirmation is certified by the benefit of the food eviction. To conclusion, the authors underline several points: the presumable underestimation of the intolerance, the often mentioned atopic familial context, the observed pathology (urticaria, asthma, eczema), the importance of the provocation test. Finally, besides food such as grey shrimps, sodas and antibiotic syrups, one finds benzoates in the antiallergic syrups initially prescribed as a preventive measure.
Jain, PK; Kumra, Madhumani; Rehani, Shweta; Mathias, Yulia; Gupta, Ramakant; Mehendiratta, Monica; Chander, Anil
Introduction Chronic inflammatory periodontal diseases i.e. gingivitis and periodontitis are one of the most common afflictions faced by human beings. Dental plaque, which is a pool of pathogenic microorganisms, remains to be current mainstay in etiopathogenesis. Dental calculus, which is a mineralized product of this plaque remains ignored and is considered merely as an ash heap of minor significance. However, the intriguing array in disease etiopathogenesis bulldozed researchers to suspect the role of calculus in disease chrysalis but still the viability of bacteria inside calculus and thus its pathogenicity remains an intricacy; the answer to which lies in the Pandora’s Box. Aim The present study was undertaken to investigate the viability of bacteria within dental calculus along with their identification. Also, to classify dental calculus on the basis of mineralization and to observe the variation of viable microflora found in dental calculus with the extent of mineralization and disease severity. Materials and Methods A total of 60 samples were obtained, by harvesting two samples of supragingival calculus from each patient having chronic inflammatory periodontal disease. These samples were divided into two groups (Group A and Group B). Samples of Group A were kept non-irradiated and samples of Group B were exposed to UV radiation. The samples were categorized into less, moderately and highly mineralized according to the force required for crushing them. All the crushed calculus samples were then divided into three parts. These were used for dark-field microscopy, gram staining and bacterial cultures. Bacterial identification of the cultures obtained was also carried out by performing various biochemical assays. Results The present study revealed the presence of motile spirochaetes within the samples under dark-field microscope. Gram staining revealed presence of numerous gram positive cocci and gram negative bacilli. Bacterial cultures showed growth of variety of aerobic and capnophilic microorganisms. Conclusion The present study concludes the presence of viable aerobic and capnophilic bacteria inside dental calculus which may reside within the lacunae and channels in the calculus. PMID:27630958
Arduino, Paolo G; Porter, Stephen R
Herpes Simplex Virus Type 1 (HSV-1) is a nuclear replicating enveloped virus, usually acquired through direct contact with infected lesions or body fluids (typically saliva). The prevalence of HSV-1 infection increases progressively from childhood, the seroprevalence being inversely related to socioeconomic background. Primary HSV-1 infections in children are either asymptomatic or following an incubation period of about 1 week gives rise to mucocutaneous vesicular eruptions. Herpetic gingivostomatitis typically affects the tongue, lips, gingival, buccal mucosa and the hard and soft palate. Most primary oro-facial HSV infection is caused by HSV-1, infection by HSV-2 is increasingly common. Recurrent infections, which occur at variable intervals, typically give rise to vesiculo-ulcerative lesions at mucocutaneous junctions particularly the lips (herpes labialis). Recurrent HSV-1 infection within the mouth is uncommon in otherwise healthy patients, although in immunocompromised patients, recurrent infection can be more extensive and/or aggressive. The diagnosis of common herpetic infection can usually be based upon the clinical history and presenting features. Confirmatory laboratory diagnosis is, however, required when patients are, or may be, immunocompromised.
Sahoo, G C
Laryngeal manifestation of allergy though less common than, Rhinosinusitis, tubotympanitis and bronchopulmanary allergy but it is not that uncommon which is usually misdiagnosed and mistreated in children. Hence the importance of larynx as the allergic shock organ in children with spasmodic croup and laryngotracheo bronchits. In the present study in children bellow five years, presenting with stridor and/or hoarsness were evaluated regarding the history of allergy, direct laryngoscopic finding, mesurement of serum 1 g E. Presence of eosinophilia and histopathological examination of laryngeal biopsy. Out of the 80 cases studied 9 cases (11.2%) presented with associated allergic manifestation, 8 cases (10%) having family history of allergy, 4 cases (5%) having raised serum 1 g E, 12 cases (15%) with eosinophilia 3 cases (3.75%) with eosinophilic infiltration on histopathological examination of the biopsy material taken during the direct laryngoscopy.
Domínguez Soto, L; Vega Memije, M E; Arenas, R; Waxtein Morgenstein, L
Ashen dermatosis (D.C.), or dyschromic perstans erythema, is a chronic dermatosis, which is asymptomatic and practically exclusive in Latin-American countries. Its clinical characteristics have been well defined (blue-gray patches), as well as its nonspecific histopathologic patterns; its etiology is unknown. This paper studies 20 patients suffering from ashen dermatitis. There was a majority of female patients, the dermatosis was disseminated, bilateral and symmetric. It is different from pigmented lichen although the histopathologic patterns is similar.
Yadav, Pravesh; Singal, Archana; Pandhi, Deepika; Das, Shukla
Introduction: There is a constant need to define the epidemiological and mycological characteristics of onychomycosis (OM) for optimal management strategies. Objectives: To define the epidemiological and mycological characteristics of patients with dermatophyte toenail OM in a tertiary care hospital. Materials and Methods: Hundred consecutive patients of KOH and culture-positive dermatophyte toenail OM were subjected to detailed history, clinical examination and investigations. Results: Maximum number of patients (40%) belonged to 31-45 years age group and there was a male preponderance (M:F = 6.7:1). The mean duration of disease was 54 months. Thirty-three patients had fingernail involvement in addition to the toenail OM and 37% had co-existent cutaneous dermatophyte infection. Discoloration was the most common symptom (98%). Ninety-four (94%) patients had distal lateral subungual onychomycosis (DSLO) while two had superficial onychomycosis (SO) and only one had proximal superficial onychomycosis (PSO). Trichophyton interdigitale was the most common etiological agent (61%) followed by Trichophyton rubrum and Trichophyton verrucosum. Conclusions: Toenail OM is more common in males. DSLO was the most common clinical variant and T. interdigitale the most common etiological fungus responsible for toenail OM in our region. The importance of early diagnosis and treatment is highlighted as long-standing toenail OM predisposes to fingernail onychomycosis and recurrent tinea pedis. PMID:25814703
Broussolle, E; Tommasi, M; Mauguière, F; Chazot, G
The pathological process and lesion topography in patients with the syndrome of progressive aphasia are heterogeneous and few necropsy examination cases have been investigated. This is a case report of a 53 year old right handed man with progressive anarthria and secondary Parkinsonism over a period of six years. Positron emission tomography (PET) showed a decreased cerebral blood flow and metabolism in the frontal cortex, which was more pronounced on the left. Neuropathology disclosed a spongiform vacuolation in layer II of the frontal cortex, mostly in the Broca area, and neuronal loss in the substantia nigra. This original case reinforces the view that there are different entities of the syndrome of progressive aphasia which can be identified on the basis of clinical, neuroimaging and anatomical data.
Panizo-Santos, A; Lozano, M D; Distefano, S; Inogés, S; Pardo, J
Early cardiac allograft failure (ECAF) was defined as acute allograft failure in the early transplant period. The aim of this study is to elucidate the clinicopathological and immunohistochemical characteristics and the role of apoptosis in ECAF in nine patients. We reviewed preoperative clinical data and morphological data at the time of autopsy or retransplantation. We also performed TUNEL assay and immunohistochemistry to study fibronectin and tubulin beta-II. The average recipient and donor age was 48 +/- 10.3 and 28 +/- 7.11 respectively. Seven patients died at a mean time of 26 hours. The remaining two patients underwent retransplantation and are alive. The mean cold ischemic time was 124. 1 +/- 44.5 minutes. No patient had a panel reactive antibody >15% and lymphocytic crossmatch was positive in one case. All cases had grade 2-3 of coagulative necrosis, which correlated positively with fibonectin accumulation in myocyte cytoplasm, and cytoplasmic tubulin loss (p < 0.05). TUNEL technique showed in all cases some degree of DNA strand breaks in cardiomyocytes. Endothelium DNA strand breaks were seen in seven cases. Patients transplanted because of idiopathic dilated cardiomyopathy had a significantly higher degree of DNA strand breaks in cardiomyocytes and endothelial cells (p = 0.03 and p = 0.02) than those transplanted because of ischemic cardiomyopathy. These results indicate that ECAF may be caused by ischemic-reperfusion damage to the donor heart assessed by myocyte coagulative necrosis, fibronectin accumulation in myocytes, tubulin loss, and DNA strand breaks of cardiomyocytes and endothelium. The use of a combination of these techniques might be appropriate in the diagnosis of ECAF in endomyocardial biopsies when it is suspected clinically.
Bisht, R; Goyal, A; Thakur; Singh, T; Sharma; Vijay; Goyal, B K
Very few immunological studies in vernal catarrh have been conducted in India and abroad, but none in Himachal Pradesh in spite of its high incidence in the State. In the present study 25 patients of vernal catarrh residing at a height ranging between 1000 to 2500 meters above mean sea level have been evaluated. Their immunological status of serum and tears after detailed clinical assessment was studied by single radial immunodiffusion technique of Mancini et al. The values of serum IgA and IgM were significantly higher in patients than in controls. The serum IgE level had no significant difference. The IgG was significantly lower in patients with vernal catarrh. The values of tear IgM, IgE and IgA in these patients were significantly higher than in controls. However, in no case or control group C3C and C4 were detected in tears. The limbal type of vernal catarrh was found to be the most common in this part of the country. No mixed case was seen. Derangement of the immune system in the pathogenesis of vernal catarrh is suggested.
Noronha, Tonita M.; Tophakhane, Raghavendra S.; Nadiger, Shobha
Context: The dermatophytoses constitute a group of superficial fungal infections of keratinized tissues, namely, the epidermis, hair, and nails. The distribution and frequency of dermatophytosis and their etiologic agents vary according to the geographic region studied, the socio-economic level of the population, the time of study, the climatic variations, the presence of domestic animals, and age. Aims: The present study was undertaken to assess the clinical profile of dermatophytic infections and to identify the causative fungal species in the various clinical presentations. Settings and Design: This was a hospital-based observational study. Materials and Methods: One hundred and fifty clinically suspected cases of dermatophytosis attending the outpatient department of a tertiary care hospital were included in the study. History was taken, general physical and cutaneous examination was done and details of skin lesions noted. Direct microscopy in 10% KOH (40% KOH for nail) and fungal culture on SDA with 0.05% chloramphenicol and 0.5% cycloheximide was done in every case. Statistical Analysis Used: Statistical analysis was done using SPSS 17.0 software. Chi-square test and contingency coefficient test were used as significant tests for analysis. Results: Out of 150 patients studied, majority belonged to the age group of 21–30 years (22.7%). Male-to-female ratio was 1.63:1. Tinea corporis (24.7%) was the most common clinical type observed. The overall positivity by culture was 40% and by direct microscopy was 59.3%. Trichophyton mentagrophytes was the predominant species isolated (48.3%). Conclusions: The present study reveals the changing trend in the prevalence of dermatophyte species in this part of Karnataka. PMID:27559499
incidence of Toxocara infection in dogs in these areas. Moreover, Toxocara infection was studied in cases associated with clinical syndromes and also...chances of close contact with infected dogs and the heavy soiling by the ova present in the faeces from a dog with Toxocara , contamination of food of...concluded that the dog is a very important source for Toxocara infection of the human beings by the larval stages, next to follow the contamination soil with T.canis ova. (Author)
Bogousslavsky, J; Miklossy, J; Deruaz, J P; Regli, F; Assal, G
In a patient with a unilateral embolic infarct in the left posterior thalamo-subthalamic paramedian artery territory, neuropathological studies showed involvement of the intralaminar, dorsomedial, and internal part of the ventral posterior nuclei of the thalamus, of the rostral part of the mesencephalic reticular formation, and of the posterior commissure. The patient showed upgaze palsy for voluntary saccades, smooth pursuit and vestibulo-ocular movements, sustained downgaze, right-sided motor hemineglect and facio-brachial hypaesthesia, motor transcortical aphasia and anterograde amnesia. This case confirms that unilateral destruction of the posterior commissure, rostral interstitial nucleus of the MLF and interstitial nucleus of Cajal produces a non-dissociated upgaze palsy. Involvement of the nucleus of Cajal probably produced the sustained downward deviation of the eye, by causing predominance of downward vestibulo-ocular inputs. This case also shows that thalamic aphasia and anterograde amnesia may be related to a paramedian lesion of the thalamus, with special reference to involvement of the dorsomedial nucleus, in the absence of lesion of the pulvinar and mamillo-thalamic tract and of conspicuous involvement of the ventral lateral nucleus. Selective hemineglect for motor tasks may occur in infarction of the dominant thalamus, involving the intralaminar nuclei. Images PMID:3734825
Chandra, Bharat; Balakrishna, Manniganahalli Appaiah; Ramesh, Deepthi Bomman
Background Thyroid enlargement has been a common problem encountered in general surgical practice. Thyroid being an endocrine gland, its involvement has a diverse issue from a meagre cosmetic problem to a more concerned malignancy. Aim This study was conducted to study the age and sex distribution along with the mode of presentation of Multinodular Goitre (MNG). The incidence of malignancy and the surgical complications in the study population were also studied. Materials and Methods In this descriptive study, patients diagnosed with MNG from January 2011 to July 2012 were chosen from the in-patient of our teaching hospital. One hundred such patients who qualified to undergo surgery were included in the study after a detailed history and clinical examination. Patients underwent Fine needle aspiration cytology (FNAC) for preoperative pathological diagnosis and the goitre was confirmed to be benign. Patients diagnosed with malignancy were excluded from the study. Following thyroidectomy, the thyroid specimens were subjected to histopathological examination. Results Among the 100 cases of MNG, 59% patients belonged to 3rd and 4th decade of life, 90% patients were females, 82% presented before 5yrs. The most common symptom at presentation was swelling (100%). Among the patients 80% were in euthyroid state, 19% were hyperthyroid and 1% hypothyroid. Most of the patients were treated with sub-total thyroidectomy (59%), followed by total (20%), near total (11%), and Hemithyroidectomy (10%). Following surgery complications like stridor and laryngeal oedema (3%), wound infection (2%), hypocalcemia (2%), haemorrhage (1%) and seroma (1%) were noted. On Histopathological examination (HPE) of the surgical specimen, 3% were reported to be malignant. Conclusion As noted by this study, Multinodular Goitre is more common among females in the third and fourth decades. Patients can present with various complaints. MNG can present as hyperthyroid, hypothyroid but mostly in euthyroid state. The indication for surgery in patients with MNG includes cosmesis, hyperthyroidism, local compressive symptoms and most importantly malignancy. Subtotal thyroidectomy is the preferred surgery, but a trend towards total and near total thyroidectomy is noticeably replacing the old belief in subtotal thyroidectomy. PMID:26266163
Dash, P.K.; Joshi, H.C.
Acute toxic nephropathy was produced in 6 healthy goats by injecting intravenously 1% uranyl nitrate (UN) (15 mg/kg body weight). The early painful clinical signs simulating shock progressed with subnormal temperature, slow-shallow respiration and arrhythmic pulse followed by death due to respiratory failure within 96 to 120 hr. All the affected goats had normocytic normochromic anemia, leucocytosis, neutrophilia with left shift eosinopenia, decreased monocytes and presence of 1-2% reticulocytes in the peripheral blood smears. On blood chemical analysis, a uniform and continuous rise was seen in serum creatinine with a concomitant daily increase of serum urea and uric acid. Simultaneous analysis of urine indicated polyuria leading to oliguria, acidic pH, albuminuria, glycosuria with presence of neutrophils, RBC's, epithelial and fatty casts, increase of triple phosphate, and cystine crystals reflecting acute damage of kidneys in the affected goats.
Howson, Pamela; Kruijff, Schelto; Aniss, Ahmad; Pennington, Thomas; Gill, Anthony J; Dodds, Tristan; Delbridge, Leigh W; Sidhu, Stan B; Sywak, Mark S
Oxyphil cell parathyroid adenomas (OPA) are considered to be an uncommon cause of primary hyperparathyroidism (PHPT), and were historically thought to be clinically silent. It has been our clinical impression that these adenomas present more often than previously thought and may manifest a more severe form of primary hyperparathyroidism than classical adenoma. The aim of this study was to describe the incidence and clinical presentation of OPA. An observational case-control study was undertaken. The study group comprised patients undergoing parathyroidectomy for PHPT where the final pathology confirmed OPA. The controls were made up of an age- and sex-matched group of patients having parathyroidectomy in the same time period where the final pathology confirmed a classical or non-oxyphil adenoma. OPA were defined as parathyroid tumours containing >75% oxyphilic cells. The OPA cases were obtained by reviewing all histopathology slides over an 11-year period (2002-12) where the reports contained the words 'oxyphil' or 'oxyphilic' parathyroid adenomas. These were then reviewed by two independent pathologists to confirm a diagnosis of OPA. The primary outcome measures were preoperative serum calcium and parathyroid hormone (PTH) levels. Secondary outcome measures were symptoms at presentation, accuracy of preoperative localization studies, parathyroid gland weight following surgery, and type of surgery undertaken. In the period 2002-2012, 2739 patients underwent surgery for PHPT. Following pathological review, 91 cases were confirmed as being OPA and formed the study group. A control group (n = 91) from the same period was selected following matching on the basis of age at presentation and sex. OPA were associated with higher preoperative serum calcium (10.84 versus 10.48 mg/dL, p < 0.001) and parathyroid hormone (139 versus 64 ng/L, p < 0.001). At presentation, a lower proportion of OPA cases had asymptomatic disease (15 versus 29%, p = 0.03). There was a trend toward a higher rate of renal calculi at presentation in the OPA group (9 versus 3%, p = 0.07). Preoperative ultrasound was less accurate in localization of OPA when compared with classical adenoma. The rate of minimally invasive surgery was 67% for OPA and 78% for the control group (p = 0.06). All patients were cured of hypercalcaemia at 6-month follow up. There was no significant difference in the weight of removed parathyroid tissue between the groups (868 mg for OPA versus 789 mg for the control group, p = 0.6). OPA are frequently symptomatic and are associated with higher preoperative serum calcium and parathyroid hormone levels than classical types of parathyroid adenomas. OPA are less likely to be localised on preoperative ultrasound examination.
Dikaia, V I
Acute cases of the Kandinsky-Clerambault syndrome first manifested in adulthood were studied in schizophrenic patients. On the basis of the clinical mechanisms of the development of psychosis and the specific features of acute delirious disturbances in the structure of psychosis 3 clinical variants of the acute syndrome of psychic automatism were identified: developing according to the type of reaction in the structure of acute paranoid (the first variant), according to the regularities of endogenic paroxysm in the picture of acute sensory delirium (the second variant) and according to the mechanism of exacerbation of chronic delirium entering the structure of acute interpretative delirium (the third variant).
Davies, M J; Pomerance, A; Teare, R D
Eleven cases of idiopathic giant cell myocarditis are described, The pathological features are unmistakable with serpiginous areas of myocardial necrosis, at the margins of which giant cells can be seen on histological examination. The aetiology of the condition remains obscure but associated pathology suggests that altered immunity may be a factor. The rapid clinical course is, however, highly suggestive of an infective cause though none has been found. Images PMID:1122272
Miller, Eliza; Becker, Zoe; Shalev, Daniel; Lee, Christopher T; Cioroiu, Comana; Thakur, Kiran
A 55year old woman in New York City presented in May 2016 with progressive weakness, ataxia, paresthesia, and areflexia, shortly after returning from the Dominican Republic. Lumbar puncture revealed cytoalbuminological dissociation. Due to her recent travel, Zika-associated Guillain Barré syndrome (GBS) was suspected and she underwent evaluation for recent flavivirus exposure. Zika virus RNA was not detected in serum, but Zika virus immunoglobulin M (IgM) was detected in both serum and cerebrospinal fluid. Dengue virus IgM in serum was equivocal and dengue virus IgG was detected in the serum. Plaque-reduction neutralization testing showed elevated titers to both Zika virus and dengue virus, providing evidence of recent infection with a flavivirus. The patient was diagnosed with probable Zika virus-associated GBS based on clinical findings, ancillary testing, and laboratory assays according to current guidance from the Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists. Zika virus transmission in the Americas is resulting in increasing numbers of patients presenting with Zika virus-associated neurological syndromes. Clinical and laboratory diagnosis in these cases can be challenging and may be aided by consultation with CDC, and state and local public health agencies.
Barroso Moguel, R; Méndez Armenta, M; Villeda Hernández, J
Industrial solvents mixed from thinner, used in paints, leathers, rubber, varnishes, have neurotoxic action. By laboral inhalation or spontaneously these are absorbed from the lungs, transported by blood and because of this high lipophilic section are retained within the lipid rich nervous system. Euphoric effects appear accompanied with visual and additive halucinations. In chronic abusers it produce schizophrenic-paranoid consequences with encephalic and peripheral neuronal and nervous fibers destruction, accompanied of blindness and paralysis. Cocaine is another neurotoxic drug. At first it produces euphoria, arterial hypertension and symptoms suggestive of underlying psychiatric diseases. The cocaine addicts often suffer depression, paranoia, hallucinations, seizures and suicidal ideation. The morphological base of the symptomatology is the encephalic and peripheral neuronal and nerve fibers destruction.
Díaz Torres, H; Silva Cabrera, E; Rodríguez García, O; Bárcenas Moses, J; Lubián Caballero, A L
The presence of antibodies against the HIV protein of 24 kd was studies by the parallel use of the DAVIH BLOT western blot and of the DAVIH AC P24 ELISA in serum samples from 176 patients at different HIV-1 infection stages. The results were correlated with the clinical classification of the patient at the moment of taking the sample and with the further evolution during 6 months. 57% of the patients with opportunistic minor infections and 96% of AIDS patients had low antibodies titres. Dead patients showed no reactivity or presented very low titres in samples taken before dying. Different titrations were observed in serum groups with an apparently uniform reactivity in the western blot. The results show and adequate clinical and serological correlation. Therefore, the DAVIH AC P24 ELISA could be useful in the clinical follow-up of HIV-1 infected persons.
Herra, S A; Hevia, F J; Vargas, M; Schosinsky, K
In the last eighteen years, from 1972 to 1989, around 150 cases of Wilson's disease have been diagnosed in Costa Rica (6/100.000 inhabitants). In the San Juan de Dios Hospital, 120 cases have been studied during this period, seven of whom died with a picture of acute hepatic insufficiency, hemolytic anemia, encephalopathy, intestinal bleeding and renal insufficiency. In four of the cases, postmortem histopathologic studies were done with high resolution microscopy, which revealed extensive submassive necrosis of the liver, with severe cholestatic, lytic and acidophilic necrosis with nodular, irregular regeneration and specially microvacuolar steatosis, different from that observed in other forms of fulminant hepatitis. With the clinical, laboratory and histopathologic findings, we concluded that fulminant Wilson's disease is a well-defined pathological clinical entity of fatal evolution with no response to therapy, including early treatment with penicillamine and steroids.
Taktak, Aysel; Hakan Demirkan, Tulin; Acar, Banu; Gu R, Gökçe; Köksoy, Adem; Uncu, Nermin; Çaycı, Fatma Ş; Çakar, Nilgu N
The term nutcracker syndrome (NS) refers to the compression of left renal vein between the aorta and the superior mesenteric artery (SMA) causing renal venous hypertension. The symptoms vary from asymptomatic hematuria to severe pelvic congestion. The purpose of this study is to evaluate the clinical characteristics of patients with NS and the correlation between clinical and laboratory findings with Doppler sonographic measurements. Sixty-three patients were evaluated (19 boys and 44 girls) since January 2004 to January 2014. The mean age of the patients was 12.21 ± 3.21 years (range 7-17). Hematuria and proteinuria disappeared during the follow up of 9/63 patients. These nine patients showed statistically significant difference in upright SMA angles (p= 0.035). Doppler sonographic evaluation is a non-invasive method for diagnosis NS. Upright SMA angle measurement is more efficient than supine SMA angle measurement on clinicoradiological correlation.
González Guevara, Martha Beatriz; Torres Tejero, Marco Antonio; Martínez Mata, Guillermo
We carried out a retrospective study on non-neoplastic enlargement of the salivary glands at the Oral Histopathology Diagnostic Center of the Autonomous Metropolitan University at Xochimilco (UAM-Xochimilco) in Mexico during a period of 24 years (1979-2003). From 5,625 biopsies received and analyzed, a total of 461 (8.2%) were non-neoplastic enlargement of the salivary glands; for each case, we registered demographic data as well as clinic characteristics. These lesions were characterized as a heterogeneous group of pathologic entities among which we included local, obstructive, infectious, and immunopathologic lesions. The most frequent lesion was the extravasation cyst in 341 (74%) cases, followed by chronic sialoadenitis and Sjögren's syndrome with 54 (11.7%) and 41 (8.8%) cases, respectively, and at a lesser percentage mucous retention cyst, sialosis, benign lymphoepithelial lesions and those related with sialolytes. Females were affected more frequently; mean age was second to third life decades. These lesions were most frequently localized on inferior labial mucosa.
Briani, C; Santoro, M; Latov, N
Anti-chondroitin sulfates (ChSs) antibodies have been reported in neuropathy and neurodegenerative diseases. Differences in specificities may account for their association with different diseases. Sera from 303 neurological patients were tested for antibodies to ChSs A, B, C. Titers >/=51,200 were found in 16 patients (eight peripheral neuropathy, three motor neuron disease, four multiple sclerosis, one myelitis). Three patients also had anti-sulfatides antibodies, which in two cases cross-reacted with ChSs. By indirect immunofluorescence, positive sera stained nuclei on normal human peripheral nerve sections. These findings indicate that human anti-ChSs antibodies are broadly reactive and not specific to any neurological disease.
Agarwal, Kavita; Umarji, Hemant R; Kadam, Sonali; Agrawal, Neeraj
Due to its location, intra-masseteric venous malformation often mistaken for a parotid swelling and clinical examination alone frequently underestimates the deep extension of the lesion and rarely gives accurate pre-operative diagnosis. But once it is diagnosed, the feasibility of the treatment and the plan of approach depend on accurate delineation of the extent, size and location of the lesion. Therefore, complimentary radiographic studies are essential for its management. In this case report, typical features of venous malformation within the masseter muscle, including clinical findings (turkey wattle sign) and imaging are presented. Ultrasonography and CT scan were non-contributory in the diagnosis, while on MRI, masseteric venous malformations have a typical appearance that allowed early identification, patient education and its management.
Nori, Madhavi; Prasad, Raghavendra G; Reddy, Arvind K; Cheguri, Sandeep Reddy
Sirenomelia is a social curiosity, a medical and diagnostic challenge prenatally compounded by varied diagnostic difficulties. Prenatal diagnosis of sirenomelia was and continues to be a challenge although von klippel et al., described a case at 10 weeks of gestational age. However, they needed a second imaging at 12(th) week for confirmation. First trimester or early second trimester anatomic survey on ultrasound and MRI is accurate for the diagnosis thereby avoiding unnecessary complex pregnancy. We report a case of second trimester diagnosed sirenomelia, with detailed analysis of image findings on ultrasound and fetal MRI.
Mohan, Rahul; Gopakumar, T S
Scedosporium apiospermum is frequently found as a saprophyte in soil, sewage and contaminated water. Its manifestations in immunocompetent patients are usually localised and in immunodeficient patients, it causes invasive systemic diseases. We are reporting the case of a 40-year-old male, who presented with pain, oedema and multiple discharging sinuses over the lateral aspect of the left foot with history of thorn prick. On examination, there were multiple active sinuses with tenderness and local rise in temperature. Calcaneum on palpation showed a thickened and irregular surface with limitation of ankle and subtalar movements. Blood investigations showed a moderate rise in ESR and CRP. X-rays showed typical features of chronic osteomyelitis with sclerosis, cavities and irregular bone contour. CT report showed features of osteomyelitis involving calcaneum, talus, cuneiforms and navicular bone with periarticular soft tissue involvement and mild focal collection in the calcaneum. On repeated culture, it was found to be scedosporium apiospermum fungus. We managed the case with voriconazole therapy and it responded with excellent clinical and radiological improvement by 9 months.
Mugalur, Aakash; Shahane, Sunil M; Samant, Ashwin; Pathak, Aditya C; Reddy, Rajeev
Despite the eradication of smallpox from the world in 1980 the osteo-articular sequelae of smallpox are still occasionally noticed in previously endemic areas. The sequelae of osteomyelitis variolosa may raise a diagnostic challenge to the untrained eyes of the surgeon. We present a case of "osteomyelitis variolosa" in a 70 years old patient. The patient had bilateral dislocation of the elbow joint with multidirectional instability. There was distortion of the articular surfaces and ankylosis of the bilateral proximal radio-ulnar joint. Hypoplasia of the right ulna with short fourth and fifth metacarpals of the left hand and hypoplasia of right fourth metacarpal with cortical thickening was noted radiologically. The patient had minimal disability of his elbows despite the striking radiological abnormality and was functionally independent.
Sung, Tony Ht; Tam, Annie Cw; Khoo, Jennifer Ls
Dermatofibrosarcoma Protuberans (DFSP) is a rare malignant soft-tissue neoplasm which is often misdiagnosed due to its indolent clinical course and non-specific radiological appearances. An observation case series was conducted with retrospective review of clinical and radiological data of DFSP patients presenting to a major tertiary hospital in Hong Kong for radiological assessment between November 2006 and February 2016. Seven patients with confirmed histological diagnosis of DFSP were included. Tumour sizes at presentation ranged from 1 to 5 cm, most commonly (n = 6) occurred over chest wall and abdominal wall. History of previous local trauma or surgery was identified in the majority of cases (n = 4). There was poor correlation between pre-imaging clinical diagnoses and pathological diagnoses. Local recurrence and tumour de-differentiation with sarcomatous changes occurred in the minority of cases (n = 2). A common radiological 'claw' sign at the lesion/skin interface formed by elongated appendages of the tumour superficially was appreciated in most cases (n = 6). A history of previous local trauma or surgery serves as a possible etiological factor for the development of DFSP. High clinical suspicion for the entity is essential in its detection and differentiation from simple wound complications and local recurrence of other benign lesions. The radiological 'claw' sign at the lesion/skin interface might serve as a tell-tale sign for cutaneous tumour involvement. A comprehensive analysis of imaging findings in conjunction with individual clinical presentations is the key to accurate diagnoses and proper management.
Oteri, Giacomo; Lentini, Maria; Pisano, Michele; Cicciù, Marco
The Extraosseous or Peripheral Ameloblastoma (PA) is a rare and benign odontogenic tumour, representing 1% to 5% of all ameloblastomas. It is usually localized in the soft oral tissues, without deep bone involvement. Its biological behaviour is specific, and several authors define PA as a non-infiltrating hamartomatous lesion. Indeed, recurrences rarely occur and progression in malignant tumors appears to be rare. The PA originates from the tooth-forming apparatus and it consists of proliferating odontogenic epithelium, exhibiting the same histological cell types and patterns of the intraosseous counterpart or infiltrating ameloblastoma. The peripheral desmoplastic ameloblastoma (PDA) can be classified as a newly recognized and very rare histological variant. To our knowledge, only a few cases of adult patients affected by PDA have been published. The aim of this paper is to report a case of PDA affecting an adolescent patient. The clinical-pathological and immunohistological features are discussed in order to improve knowledge regarding a correct diagnosis and to differentiate PDA lesions from similar diseases.
Magro, Gaetano; Cavanaugh, Barbara; Palazzo, Juan
We herein report the clinical, radiological, and pathological findings of a rare case of myxoma occurring in the breast parenchyma of a 75-year-old female. The tumor was incidentally detected at a mammographic screening and, ultrasonographically, presented as an ovoid mass. Histologically, an encapsulated hypocellular, myxoid tumor with low vascularization was evident. Neoplastic cells were round- to spindle/stellate-shaped and stained with vimentin and focally with calponin. We emphasize that morphology remains preeminent in the diagnosis of a breast myxoma, while immunohistochemistry may assist in ruling out other tumor entities. Differential diagnosis with all benign and malignant myxoid lesions, primarily occurring in the breast, is provided. The histogenesis of breast myxoma is unknown. The lack of expression of desmin, alpha-smooth muscle actin, CD34, CD99, CD10, bcl-2 protein, and estrogen/progesterone/androgen receptors, all markers characteristically expressed by "the benign spindle cell tumors of the mammary stroma," would suggest that breast myxoma does not fall into this tumor category and that its putative precursor mesenchymal cell resides in the interlobular stroma.
Exarchos, Themis P.; Giannakeas, Nikolaos; Goletsis, Yorgos; Papaloukas, Costas; Fotiadis, Dimitrios I.
Advances in genome technology are playing a growing role in medicine and healthcare. With the development of new technologies and opportunities for large-scale analysis of the genome, genomic data have a clear impact on medicine. Cancer prognostics and therapeutics are among the first major test cases for genomic medicine, given that all types of cancer are related with genomic instability. In this paper we present a novel system for pattern analysis and decision support in cancer. The system integrates clinical data from electronic health records and genomic data. Pattern analysis and data mining methods are applied to these integrated data and the discovered knowledge is used for cancer decision support. Through this integration, conclusions can be drawn for early diagnosis, staging and cancer treatment.
Khaladkar, Sanjay Mhalasakant; Kondapavuluri, Sushen Kumar; Kamal, Anubhav; Kalra, Raghav; Kuber, Rajesh
Pulmonary alveolar microlithiasis (PAM) is a rare chronic lung disease characterized by deposition of intra alveolar calcium and phosphate in bilateral lung parenchyma with predominance in lower and mid zones. Etiology and pathogenesis is not fully understood. However, mutation in SLC34A2 gene that encodes a sodium phosphate co-transporter in alveolar type-II cells resulting in formation and accumulation of microliths rich in calcium phosphate due to impaired clearance is considered the cause of disease. Patients with PAM are asymptomatic till development of hypoxemia and cor pulmonale. It remains static, while in some it progresses to pulmonary fibrosis, respiratory failure and cor pulmonale. We report a case of 44 year old male patient presenting with progressive shortness of breath on exertion for one year in duration with dry cough, more since last six months. Chest radiograph showed dense micronodular opacities giving classical sandstorm appearance. High resolution computed tomography (HRCT) showed microcalcification, subpleural cystic changes and calcified pleura. Lung biopsy showed calcospherites within alveolar spaces.
Khan, Wajihullah; Zakai, Haytham A; Umm-E-Asma
Malaria is one of the most devastating diseases of tropical countries with clinical manifestations such as anaemia, splenomegaly, thrombocytopenia, hepatomegaly and acute renal failures. In this study, cases of thrombocytopenia and haemoglobinemia were more prominent in subjects infected with Plasmodium falciparum (Welch, 1897) than those with Plasmodium vivax (Grassi et Feletti, 1890). However, anaemia, jaundice, convulsions and acute renal failure were significantly high (3-4 times) in subjects infected with P. falciparum than those infected with P. vivax. The incidence of splenomegaly and neurological sequelae were 2 and 6 times higher in P. falciparum infections compared to the infections of P. vivax. Both in P. vivax and P. falciparum malaria, the cases of splenomegaly, jaundice and neurological sequelae were almost double in children (<10 years) compared to older patients. The liver enzymes were generally in normal range in cases of low and mild infections. However, the AST, ALT, ALP activities and serum bilirubin, creatinine, and the urea content were increased in P. falciparum and P. vivax malaria patients having high parasitaemia, confirming liver dysfunction and renal failures in few cases of severe malaria both in India and Saudi Arabia.
Javanbakht, Javad; Hosseini, Ehsan; Karimi, Shahram; Hassan, Mehdi Aghamohammad; Sabbagh, Atefeh; Mousavi, Shadi; Fattahi, Roohollah; Khaki, Fariba; Shafiee, Radmehr
Parasitic diseases of wild birds follows its companion volume, infectious diseases of wild birds, both of which complement the third edition of infectious diseases of wild mammals and second edition of parasitic diseases of wild mammals. In October 2012, a mature black male mynah with lack of balance and ataxia was brought into the birds department of educational hospital in veterinary medicine faculty of Tehran University. Because of no cure in clinical signs after several days of empirical therapy euthanasia and clinical pathology studies were performed. There was no microscopic pathological lesions in brain, bone marrow, heart, lung, liver and the microscopic results were as following; bone marrow: hemophagocytosis reactive macrophages, liver: infiltration of inflammatory cells (hepatitis) and hemosiderin-laden macrophages. Lung: hemosiderin-laden macrophages and spleen findings: infiltration of inflammatory cells, heterophils with phagocytic bacteria. In abdominal cavity two male and one female parasite was detect. Three parasites were cleared with lactophenol and investigated under the light microscopy and important morphological parts of them measured. Also these parasites in serum containing send to the department of parasitology. Based on all collecting data, Spinodiplotriaena (three parasites each by the length of 2/5, 1/7 and 1/5 cm were found) were diagnosed. Report of this case in important because of first report of this infection in a black mynah in Iran.
Dîrnu, Rodica; Secureanu, F A; Neamţu, Carmen; Totolici, B D; Pop, O T; Mitruţ, P; Mălăescu, D Gh; Mogoantă, L
Chronic gastritis has a high incidence in adults, causing progressive destruction of glandular structures, favoring the development of gastric atrophy. The association of chronic gastritis with intestinal type metaplasia of gastric mucosa has a poor outcome as intestinal metaplasia is regarded as a precancerous lesion. Metaplasia is common in patients with Helicobacter pylori infection and also heavy smokers. The aim of our study was to evaluate the relationship between chronic gastritis and intestinal metaplasia. The study was conducted on a total of 1218 patients, aged between 5 and 90 years, who presented for dyspeptic disorders in the period 2007-2010 and were examined clinically and endoscopically. During the gastroscopic examination, fragments of gastric mucosa were collected for the histopathological study and for highlighting the H. pylori infection. For the histopathological study, the Hematoxylin-Eosin and PAS-Alcian Blue stains were performed, while for the immunohistochemical study the anti-TAG72 and anti-PCNA antibodies were used. A diagnosis of gastritis was established in 615 patients, representing approximately 50.5% of all cases. Most cases with gastritis were found in people of middle age. Gastritis was present in almost all age groups, from teenagers to the elders. Of the 615 cases of gastritis, urease test was positive in 353 patients, representing approximately 57.40% of all patients with gastritis. Histopathological examination identified the presence of intestinal metaplasia in 61.60% of patients with chronic gastritis, mostly complete metaplasia. PCNA immunohistochemistry revealed that cell proliferation processes are intensified in intestinal metaplasia. This study highlights the importance of chronic gastritis, intestinal metaplasia, and H. pylori infection in the etiopathogeny of gastric cancer.
Hong, Che Ry; Kang, Hee Gyung; Choi, Hyun Jin; Cho, Min Hyun; Lee, Jung Won; Kang, Ju Hyung; Park, Hye Won; Koo, Ja Wook; Ha, Tae-Sun; Kim, Su-Yung; Il Cheong, Hae
A retrospective genotype and phenotype analysis of X-linked congenital nephrogenic diabetes insipidus (NDI) was conducted on a nationwide cohort of 25 (24 male, 1 female) Korean children with AVPR2 gene mutations, comparing non-truncating and truncating mutations. In an analysis of male patients, the median age at diagnosis was 0.9 years old. At a median follow-up of 5.4 years, urinary tract dilatations were evident in 62% of patients and their median glomerular filtration rate was 72 mL/min/1.73 m2. Weights and heights were under the 3rd percentile in 22% and 33% of patients, respectively. One patient had low intelligence quotient and another developed end-stage renal disease. No statistically significant genotype-phenotype correlation was found between non-truncating and truncating mutations. One patient was female; she was analyzed separately because inactivation and mosaicism of the X chromosome may influence clinical manifestations in female patients. Current unsatisfactory long-term outcome of congenital NDI necessitates a novel therapeutic strategy.
Zubair, Mohammad; Malik, Abida; Ahmad, Jamal
The study was carried out in diabetic patients with foot ulcer to determine the microbiological profile of infected ulcer, antibiotic resistance of the isolates and to find out the potential risk factors for infection with multidrug resistance and the outcome of these infections. A detailed clinical history and physical examination was carried out in each patient. Pus samples for bacterial culture were collected from 102 patients admitted with diabetic foot infections. All patients had ulcer with Texas grades 1-3. Seventeen patients (16.6%) had coexisting osteomyelitis. Aerobic gram negative bacilli were tested for extended spectrum β lactamase (ESBL) production by phenotypic and genotypic methods. Staphylococcus isolates were tested for susceptibility to oxacillin and cefoxitin by disk method. Potential risk factors for MDRO positive samples were explored. Gram negative aerobes were most frequently isolated (63.8%), followed by gram positive aerobes (36.1%) and anaerobes (31.4%). Forty five percent of patients were positive for MDROs. ESBL production and methicillin resistant was noted in 68.5% and 43.2% of bacterial isolates respectively. 34.5% gram negative strains were positive for bla(CTX-M) gene followed by bla(SHV) (23%) and bla(TEM) (7.4%). Among the anaerobic organism 17(31.4%) from 54 patients, most commonly isolated were Peptostreptococcus sp. (35.2%). MDRO positive status was associated with the presence of neuropathy (P<0.001), osteomyelitis (P<0.03), and ulcer size >4 cm(2) (P<0.01) [corrected] but not with patients characteristic, ulcer type and type of diabetes, or duration of hospital stay. Poor glycemic control in 68.6% patients, duration of infection>1 month (36.2%) and ulcer size >4 cm(2) (75.4%) were independently associated with risk of MDR organisms infection.
Kida, M; Tanaka, K; Hattori, F; Kondou, S; Harada, W; Takagi, A; Itou, K; Matsumoto, H; Kojima, K; Taniyama, K
We histologically compared 3 types of adenoma and cancer of the large intestine using 620 adenoma specimens (509 Is type lesions, 83 Ip type lesions, and 28 flat type lesions) and 113 specimens of early stage cancer (51 Is type lesions, 39 Ip type lesions, and 23 flat type lesions) obtained during the past 5-year period at our department. More than 90% of the Is and Ip type polyps were adenoma or carcinoma in adenoma while 25.5% of the flat elevations were m or sm carcinoma. Flat elevations even less than 10 mm in diameter were frequently carcinomas (26.3%) compared with the other types (both Is and Ip types, 6.7%), and all of those 10 mm or more in size were carcinomas. The distribution of the flat type early cancers in the large intestine was similar to that of advanced cancer with high percentages of carcinoma at each site compared with the other types. These results suggest that the carcinogenesis and progression of flat type early stage cancer differ from those of the other types.
Elston, C. W.; Gresham, G. A.; Rao, G. S.; Zebro, T.; Haybittle, J. L.; Houghton, J.; Kearney, G.
Analysis of pathological data in the 10th year of follow-up of a multicentre trial of the management of operable breast cancer has confirmed the correlation of prognosis with tumour grade, tumour size and lymph-node status. For each factor examined there was no difference in survival between the 2 treatment groups ("watch policy" and radiotherapy) but patients in the WP group whose tumours were of Grade II or III or greater than 2 cm, or with lymph-node metastases, had a greater chance of local recurrence. Cellular reaction had no relationship with prognosis, except in patients with Grade III tumours. The clinical relevance and application of these results are discussed. PMID:7044401
Reyes, L; Almaguer, M; Castro, T; Valdivia, J
Urolithiasis is a common clinical disorder. Its frequency has risen with the development of humanity and varies wirl the country, geographic area, etc. It poses health problems in most countries. The urolithiasis has some potential risk factors such as intrinsic and extrinsic epidemiological, metabolic, physic-chemistry of the urine, mechanics and urinary infection. Our objective in this epidemiological study in a general population was to know the frequency, the potential risk factors, the morbidity, and social and economical impact of the urolithiasis in our subtropical Caribbean country. The prevalence was 4.64% and the annual incidence was 0.1%. Both are with in the estimated range of urolithiasis frequency in the world. It mainly started between 20 and 29 years in both genders. The white (5.2%) and the male (6.36%) patients were the most affected. 40% of all patients had a family history of urolithiasis. It was highly associated with diabetes mellitus, ischaemic cardiopathy, urinary tract infection and arterial hypertension. Stone formation was related to the warmer season. High calcium, protein-purine, carbohydrates and oxalic acid intake together with low fluid intake were closely associated with this disorder. 85% of patients had suffered renal colic and 75% of them more than once. Stone recurrence affected 33.8% of patients and 54.5% of them had more than one recurrence. Procedures for stone removal were needed in 33.8% of subjects. 40% of all patients were admitted to hospital due to urolithiasis morbidity. Non-specific medical treatment had been taken by 49.2% of the patients and specific treatment by none. Urolithiasis in this population was the some as has been reported in others studies. It has shown high frequency, increasing incidence, the same risks factors, high morbidity, and high social and economical impact. The low cost treatment is only taken by half of the patients.
Dani, Sneha; Prabhu, Ashwin; Chaitra, K. R.; Desai, N. C.; Patil, Sudhir R.; Rajeev, Ranjan
Background: Dental caries and periodontal disease are most common oral diseases. Streptococcus mutans are considered to be the major pathogens in initiation of dental caries. Evidence shows that periodontal disease and caries share a number of contributory factors. Thus in view of these findings it would be worthwhile to examine whether Streptococcus mutans persist within the saliva and subgingival environment of the periodontitis patients and to determine whether there is any association between Streptococcus mutans colonization, pH of saliva and sub-gingival plaque pH in periodontal diseases before therapy. Methods: The study comprises of 75 subjects aged between 20-70 years, reporting to department of Periodontology, KLEs Institute of Dental Sciences, Bangalore. Subjects were divided into 3 groups of 25 each. Group 1 – Healthy controls, Group 2 – Gingivitis Group, 3 – Chronic periodontitis. Unstimulated saliva was collected in sterile container and immediately pH was evaluated. Subgingival plaque samples were collected from four deepest periodontal pockets in chronic periodontitis and from first molars in healthy subjects using 4 sterile paper points. In gingivitis subjects samples were collected from areas showing maximum signs of inflammation. All paper points and saliva samples were cultured on mitis salivarius agar culture media with bacitracin for quantification of the Streptococcus mutans colonies. Results: Increased colonization of Streptococcus mutans was seen in chronic periodontitis subjects both in saliva and sub-gingival plaque samples. There was also a positive correlation seen with the periodontal parameters. Conclusion: More severe forms of periodontal disease may create different ecological niches for the proliferation of Streptococcus mutans. PMID:27994423
Dubnitskaia, E B; Fil'ts, A O; Chernikova, T S
A genetic correlational analysis of two variants of slowly progressive schizophrenia (SPS) (hysterical schizophrenia--70 families, paranoid schizophrenia--40 families) and hysterical psychopathy (30 families) has demonstrated that there is a definite genetic heterogeneity between nosologically heterogeneous hysterical manifestations in SPS and constitutional psychopathy which reflects the influence of the general constitutional "axis" in systems of genetic determination of these forms. At the same time no significant genetic correlations (according to hysterical predisposition) have been found between the above forms and the paranoid variant of SPS. The results corroborate the hypothesis about a multiaxial structure of hereditary predisposition in SPS.
Using magnetic resonance imaging, it is possible to measure the behavior of diffusing water molecules, and the metrics derived can be used as indirect markers of tissue micro-architectural properties. Numerous reports have demonstrated that patients with temporal lobe epilepsy (TLE) have water diffusion abnormalities in several white matter structures located within and beyond the epileptogenic temporal lobe, showing that TLE is not a focal disorder, but rather a brain network disease. Differences in severity and spatial extent between patients with or without mesial temporal sclerosis (MTS), as well as differences related to hemispheric seizure onset, are suggestive of different pathophysiological mechanisms behind different forms of TLE, which in turn result in specific cognitive disabilities. The biological interpretation of diffusion abnormalities is based on a wealth of information from animal models of white matter damage, and is supported by recent reports that directly correlate diffusion metrics with histological characteristics of surgical specimens of TLE patients. Thus, there is now more evidence showing that the increased mean diffusivity (MD) and concomitant reductions of diffusion anisotropy that are frequently observed in several white matter bundles in TLE patients reflect reduced axonal density (increased extra-axonal space) due to smaller-caliber axons, and abnormalities in the myelin sheaths of the remaining axons. Whether these histological and diffusion features are a predisposing factor for epilepsy or secondary to seizures is still uncertain; some reports suggest the latter. This article summarizes recent findings in this field and provides a synopsis of the histological features seen most frequently in post-surgical specimens of TLE patients in an effort to aid the interpretation of white matter diffusion abnormalities. PMID:25853084
Kumar, Raj; Srivastava, Prakriti; Kumari, Dolly; Fakhr, Hena; Sridhara, S; Arora, Naveen; Gaur, S N; Singh, B P
Sensitization to foods varies in different countries reflecting a possible interaction of genetic factors, cultural and dietary habits. Rice is a major food consumed world wide and needs evaluation for IgE mediated reactions. The present study was carried out to identify rice allergy in patients of rhinitis and asthma and identify the allergenic proteins in raw and cooked rice. Of 1200 patients screened using standard questionnaire, 165 presented with history of rice allergy. Of these, 20 (12.1%) patients demonstrated marked positive skin prick test (SPT) and 13 showed significantly raised specific IgE to rice compared to normal controls. Double blind placebo controlled food challenge (DBPCFC) confirmed rice allergy in 6/10 patients. Immunoblot with hypersensitive individual patients' sera showed 14-16, 33, 56 and 60 kDa proteins as major IgE-binding components in rice. Boiled rice retained four IgE reactive proteins of 16, 23, 33 and 53 kDa. In summary, IgE-mediated rice allergy affects 0.8% [(0.42-1.58) at 95% CI] of asthma and rhinitis cases. The subjects with severe SPT reactions (4 mm or above) and specific IgE, 6.9 ng/ml to rice demonstrated positive blinded food challenge with clinical symptoms.
Karimi-Zarchi, Mojgan; Dehshiri-Zadeh, Najmeh; Sekhavat, Leili; Nosouhi, Fahime
Background: Cancer antigen 125 (CA-125) is a glycoprotein biomarker that is used in women with pelvic masses such as endometriosis and maybe is useful in practice of patients suspicious to endometriosis. Objective: The aim of this study was to evaluate the association between preoperative serum CA-125 levels and clinic pathological characteristic in women with endometriosis, and find out the best serum CA-125 levels cut-off in pre and post menopause women. Materials and Methods: Serum CA-125 levels in 87 women aged 21-54 years suspected to endometriosis with pelvic pain, dysmenorrhea, or dyspareunia were measured preoperatively. Also the association between clinic pathological characteristic and serum CA-125 level were analyzed. Results: The mean age of women was 32.22±6.91. The mean serum CA-125 level was 49.93±4.30 U/mL. There was a significant correlation between the endometriosis stage, lesion size, adhesion score and preoperative CA-125 plasma concentration. However, we did not found significant differences in age, marital status, patient’s complaints, and pelvic pain associated to Ca125 serum level. The suggested preoperative serum cut-off levels in premenopausal and postmenopausal patients were 37 U/ml and 35 U/ml, respectively. Conclusion: According to the results, preoperative serum CA-125 is an important predictor for patients with endometriosis and it should be taken into consideration when surgical management is suspected, especially if stage of disease, lesion size and adhesion score are undertaken. PMID:28008424
Al-Mujaini, Abdullah; Al-Kharusi, Nadia; Thakral, Archana; Wali, Upender K
Bacterial keratitis is an acute or chronic, transient or recurrent infection of the cornea with varying predilection for anatomical and topographical parts of the cornea like marginal or central. It is a potentially sight-threatening corneal infection in humans that is generally found in eyes with predisposing elements, the most common of which is contact lens wear. The epidemiological data reveals the universal occurrence of this disease. With advances in the understanding of its pathogenesis, laboratory investigations like immunohistochemistry, fluorescent microscopy, enzyme immunoassays and molecular biology, and the availability of fourth generation antibiotics, the overall visual outcome in bacterial keratitis has improved with time. Particular attention should be given to this condition as it can progress very rapidly with complete corneal destruction occurring within 24–48 hours. Early diagnosis, which is primarily clinical and substantiated largely by microbiological data, and prompt treatment are needed to minimise the possibility of permanent visual loss and reduce structural damage to the cornea. PMID:21509299
Ostroglazov, V G; Lisina, M A
A total psychiatric examination of the persons, after attempted suicides was performed during a month of stay in the department of resuscitation of the N.V. Sklifosovsky Institute for the Emergency Medical care. In all the patients some mental pathology was found that took place in the moment of suicide and long before it. In most of the cases the disorders of either affective (48.7%) or schizophrenic (38.5%) spectrum were diagnosed. Psychogenic reactions to stress and personality disorders were in only 10.2% of the patients. In most of the patients (74.7%) a mental disease wasn't diagnosed before in spite of its long duration (11.5 years on the average).
Singh, Ajit; Gupta, Lalit Kumar; Khare, Ashok Kumar; Mittal, Asit; Kuldeep, CM; Balai, Manisha
Background: The spectrum of pyoderma changes constantly, and so does the antibiotic susceptibility pattern. Aims: This study was done to assess the magnitude and clinical patterns of pyodermas, their causative micro-organisms, and the antibiotic susceptibility patterns. Materials and Methods: Five hundred consecutive, clinically diagnosed and untreated cases of pyoderma, attending the Dermatology OPD of RNT Medical College and MB Government Hospital, Udaipur, from October 2010 to September 2011 were the subjects of this study. A detailed clinical examination, and relevant investigations including bacterial culture and sensitivity, were carried out and recorded. Statistical Analysis: For statistical analysis of data, the software ‘EPI-INFO Version 6’ was used, and Chi-square (χ2) test was applied. Results: Of 19576 cases attending skin OPD during the study period, pyoderma was seen in 500 patients; the incidence being 2.55%. Males outnumbered females. The highest number of cases (109; 21.8%) was observed in 1st decade. Lower extremities were the commonest site of predilection. Primary pyodermas outnumbered secondary pyodermas. Furuncle (136; 27.2%) and infectious eczematoid dermatitis (62; 12.4%) were the commonest entities among primary and secondary pyoderma respectively. Staphylococcus aureus was the commonest causative agent in both primary and secondary pyoderma. It showed high susceptibility to amoxycillin + sulbactam, aminoglycosides and cefoperazone, moderate susceptibility to linezolid, while low susceptibility to fluoroquinolones and cephalexin. Conclusion: Such studies help to assess the changing trend of bacterial infections, their causative organisms and antibiotic susceptibility pattern. PMID:26538696
Majumdar, Banashree; Jain, Atul; Maiti, Prasanta Kumar; Chatterjee, Gobinda
Introduction Verrucous plaques mimicking chromoblastomycosis are frequently seen in dermatology outpatient departments (OPD). However, no scientific evaluation has been carried out till date from eastern India. So this present endeavour is aimed at a thorough study of those cases to readdress the challenges in diagnosis and management in chromoblastomycosis from this part of the country. Aim The study is to observe the incidence of proved chromoblastomycosis cases from clinically mimicking conditions and to note therapeutic prospects by use of different antifungal agents. Materials and Methods Twenty clinically suspected cases attending dermatology OPD were included in this study. Relevant histories were taken. Apart from routine hematological and biochemical investigations, scrapings from lesions were examined by direct microscopy with KOH wet mount, calcoflour white mount and fungal culture. Histopatholgical examination was also done. Any fungal growth was identified by growth characteristics and morphological features. Results Sclerotic bodies were detected in five samples. Of them three were found to be culture positive. Two growths were identified as Fonsecaea pedrosoi and one as Cladosporium carrionii. Rest 12 cases were diagnosed as either lupus vulgaris (3 cases; 15%), atypical mycobacterial infections (3 cases, 15%), Hypertrophic lichen planus (2, 10%), Hypertrophic DLE plaque (2; 10%), Wart (1, 5%) or fixed cutaneous sporothricosis (1, 5%), zygomycosis (1, 5%). Three cases (15%) were lost in follow up. Cases of chromoblastomycosis were managed with prolonged use of antifungal alone or in combination with saturated solution of potassium iodide and/or debridement. They were followed up for at least six months post treatment. Conclusion A database comprising diagnostic clues and effective therapeutic intervention have been proposed for these rare subcutaneous mycoses. PMID:26816977
Pathak, Priyank; Sahu, Shantanu Kumar; Agrawal, Saurabh
Tuberculosis is one of the earliest diseases affecting the mankind. Abdominal tuberculosis constitutes a common public health issue in developing countries like ours. Gastrointestinal tuberculosis often involves the ileocecal region. Surgery in case of abdominal tuberculosis is required to overcome the deleterious effects of the disease like tissue disorganization, obstruction and perforatio.
Bandhlish, Anshu; Aggarwal, Asok; Koranne, Ravinder V
Background: Macular amyloidosis (MA) is the most subtle form of cutaneous amyloidosis, characterized by brownish macules in a rippled pattern, distributed predominantly over the trunk and extremities. MA has a high incidence in Asia, Middle East, and South America. Its etiology has yet to be fully elucidated though various risk factors such as sex, race, genetic predisposition, exposure to sunlight, atopy and friction and even auto-immunity have been implicated. Aim: This study attempts to evaluate the epidemiology and risk factors in the etiology of MA. Materials and: Methods: Clinical history and risk factors of 50 patients with a clinical diagnosis of MA were evaluated. Skin biopsies of 26 randomly selected patients were studied for the deposition of amyloid. Results: We observed a characteristic female preponderance (88%) with a female to male ratio of 7.3:1, with a mean age of onset of MA being earlier in females. Upper back was involved in 80% of patients and sun-exposed sites were involved in 64% cases. Incidence of MA was high in patients with skin phototype III. Role of friction was inconclusive Conclusion: Lack of clear-cut etiological factors makes it difficult to suggest a reasonable therapeutic modality. Histopathology is not specific and amyloid deposits can be demonstrated only in a small number of patients. For want of the requisite information on the natural course and definitive etiology, the disease MA remains an enigma and a source of concern for the suffering patients. PMID:22837559
Bellotti, R.; De Carlo, F.; Gargano, G.; Tangaro, S.; Cascio, D.; Catanzariti, E.; Cerello, P.; Cheran, S. C.; Delogu, P.; De Mitri, I.; Fulcheri, C.; Grosso, D.; Retico, A.; Squarcia, S.; Tommasi, E.; Golosio, Bruno
A computer-aided detection (CAD) system for the selection of lung nodules in computer tomography (CT) images is presented. The system is based on region growing (RG) algorithms and a new active contour model (ACM), implementing a local convex hull, able to draw the correct contour of the lung parenchyma and to include the pleural nodules. The CAD consists of three steps: (1) the lung parenchymal volume is segmented by means of a RG algorithm; the pleural nodules are included through the new ACM technique; (2) a RG algorithm is iteratively applied to the previously segmented volume in order to detect the candidate nodules; (3) a double-threshold cut and a neural network are applied to reduce the false positives (FPs). After having set the parameters on a clinical CT, the system works on whole scans, without the need for any manual selection. The CT database was recorded at the Pisa center of the ITALUNG-CT trial, the first Italian randomized controlled trial for the screening of the lung cancer. The detection rate of the system is 88.5% with 6.6 FPs/CT on 15 CT scans (about 4700 sectional images) with 26 nodules: 15 internal and 11 pleural. A reduction to 2.47 FPs/CT is achieved at 80% efficiency.
Annadurdyev, O A; Allakov, K A; Mashakova, D Ch; Tashliev, A R; Sakhatova, I N
Analysis of the data of the statistical accounting, mass examinations of the population, observation over the clinical course of the disease and review of the autopsy material attest to the high prevalence of AB and BA in the Southern and South-Eastern parts and the low one in the Western and Northern parts of the republic as well as to their greatest prevalence among the newcomers of the cities. In the newcomers, BA was characterized by its incidence among those over 45 years of age, by the rarity of ABA, predominance of the disease of medium gravity. Meanwhile among the indigenous population, the incidence of IABA, primarily grave course and BA incidence in persons of the young and mature ages were recorded. The lethal outcomes were mainly registered in winter and summer.
Mohan, Ravi Prakash Sasankoti; Gill, Navneet; Verma, Sankalp; Chawa, Venkateshwar Rao; Tyagi, Kuber; Agarwal, Neha
The incidence of multiple myeloma (MM) affecting the jaws is 30% and on rare occasions the oral involvement can be the first indication of the disease. Authors report a case of MM in a 40-year-old woman who presented with a multilocular radiolucent lesion in the left mandible initially mistaken as an ameloblastoma. Conventional radiographs revealed a multilocular lesion on the molar region. Computed tomography (CT) and 3 dimensional CT revealed lytic, space occupying lesion perforating the inferior cortex. Magnetic resonance imaging (MRI) revealed a hypointense lesion on T1 weighted image and hyperintense lesion on T2 weighted image. Histopathological and lab investigations lead to the diagnosis of MM. MRI is superior in depicting the size of the lesion as compared to CT and conventional radiographs. PMID:24932201
Saminathan, R; Babuji, S; Sethupathy, S; Viswanathan, P; Balasubramanian, T; Gopalakrishanakone, P
The venom of the marine snail, Conus loroisii, was studied to assess its risk and lethal factors in regard of human welfare. The lethality of the crude venom (LD50-5.0 mg/kg via i.p.) in mice was associated with reduced motor activity, asphyxiation, followed by respiratory failure. The effects on vital tissues revealed vascular congestion and inflammatory cell infiltration around the portal triad of the liver, spongiosis of the brain, hemorrhages/congested blood vessels in lung and endothelial cells of the renal tubule. Repeated measures of hematological profiles indicated that the venom significantly reduced erythrocytes (P<0.001, GLM repeated measures), followed associated with depletion of hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin and platelet count. Serum enzymes such as, glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, lactate dehydrogenase and alkaline and acid phosphatases were altered significantly (P<0.05, Friedman test), which in turn confirmed the damage of vital organ tissues. Dual effect of the venom on the activity of mouse brain acetylcholinesterase stand for concentration specific, whereas maximal inhibition (60.41%, P<0.05, Wilcoxon signed rank test) in erythrocyte acetylcholinesterase did not show the dual activity observed in brain. The Ciphergen ProteinChip analysis of the envenomed serum further revealed that the venom causes changes in definite molecules involved in inflammatory process and ionic transport. In all, the venom of C. loroisii is potentially lethal to mammals, through its rapid action on the central and peripheral nervous systems by blocking neurotransmission with selective interference of ionic channels/receptors.
Garner, M. M.; Helmick, K.; Ochsenreiter, J.; Richman, L. K.; Latimer, E.; Wise, A. G.; Maes, R. K.; Kiupel, M.; Nordhausen, R. W.; Zong, J. C.; Hayward, G. S.
The first herpesviruses described in association with serious elephant disease were referred to as endotheliotropic herpesviruses (EEHV) because of their ability to infect capillary endothelial cells and cause potentially fatal disease. Two related viruses, EEHV1 and EEHV2, have been described based on genetic composition. This report describes the similarities and differences in clinicopathologic features of 2 cases of fatal endotheliotropic herpesvirus infections in Asian elephants caused by a previously unrecognized virus within the betaherpesvirus subfamily that is markedly divergent from the 2 previously studied fatal probosciviruses, based on polymerase chain reaction sequence analysis of 2 segments of the viral genome. In addition to ascites, widespread visceral edema, petechiae, and capillary damage previously reported, important additional findings with EEHV3 infection were the presence of grossly visible renal medullary hemorrhage, a tropism for larger veins and arteries in various tissues, relatively high density of renal herpetic inclusions, and involvement of the retinal vessels. These findings indicate a less selective organ tropism, and this may confer a higher degree of virulence for EEHV3. PMID:19112123
Factor, S A; Podskalny, G D; Barron, K D
Patients with AIDS dementia complex (ADC) appear to have an increased likelihood of developing acute onset parkinsonism and dystonia when treated with dopamine antagonists. It has been hypothesized, based on clinical evidence, that hypersensitivity to these drugs in ADC is probably related to direct invasion of the basal ganglia by the HIV virus and a secondary alteration in dopaminergic mechanisms. We report the first pathological description of a patient with ADC who developed acute onset, generalized rigidity and dystonia after a brief trial of low dose neuroleptic therapy administered for psychotic symptoms. An unusual clinical feature of this case was the persistence of his movement disorder. Pathological examination revealed a generalized encephalitic process with substantial neuronal loss observed primarily in the medial and lateral globus pallidus. Correlation with a current model of basal ganglia pathophysiology and other disorders with pallidal lesions is discussed. Clinical and pathological features of this case confirm the previous contention and indicate that dopamine antagonists should be utilized with extreme caution in patients with ADC.
Kurbanov, V V; Khmel'kov, V P; Krupina, T N; Kuznetscv, A G; Kuz'min, M P
The paper presents the results of clinical, physiological and biochemical examination of 27 polar explorer--members of the 17th Soviet Antartic Expedition at the Vostok station. It gives data on the morbidity rate and describes the development of the asthenic-neurotic syndrome. On the basis of studies of catecholamines and serotonin, the role of the sympatho-adrenal system in the human adaptation to the harsh environments of the Central Antarctica has been shown.
Leonova, G N; Krugliak, S P; Stepanova, N M; Gorelikov, V N
Analysis of the severity of the clinical course of tick-borne encephalitis (TBE) in the Maritime Territory, 1966-1983, showed a decline in the incidence of the disease by 20% in the group of subjects vaccinated against TBE, whereas the severity of the disease showed no statistically significant difference from that among nonvaccinated subjects. The causes of the poor protective effect of the liquid tissue culture vaccine produced by the Research Institute of Vaccines and Sera, Ministry of Health of the USSR, Tomsk, were demonstrated alongside with the advantages of the lyophilized concentrated vaccine manufactured by the Institute for Poliomyelitis and Viral Encephalitides of the USSR Academy of Medical Sciences, which should be used for prophylactic vaccinations of subjects working in forests who comprised 29% of the vaccines. In this way, TBE incidence in the region could be reduced considerably.
Italia, Khushnooma; Jain, Dipty; Gattani, Sushma; Jijina, Farah; Nadkarni, Anita; Sawant, Pratibha; Nair, Sona; Mohanty, Dipika; Ghosh, Kanjaksha; Colah, Roshan
There is clinical variability in the presentation of sickle cell disease among Indians. Vaso-occlusive crisis is common among non-tribal patients. Hydroxyurea, induces fetal hemoglobin (HbF) synthesis and reduces the clinical severity of sickle cell disease but individual patients have a variable response. This study was undertaken to investigate the efficacy and safety of hydroxyurea in Indians with severe manifestations where the beta(s) gene is linked to the Arab-Indian haplotype and is associated with higher HbF levels. Seventy-seven patients (29 adult sickle homozygous, 25 pediatric sickle homozygous, 23 adult sickle beta-thalassemia) selected for hydroxyurea therapy were evaluated for clinical, hematological, biochemical and genetic parameters and were followed for 24 months. Ninety-eight point seven percent of the sickle chromosomes were linked to the Arab-Indian haplotype, 27% of patients had associated alpha thalassemia and 65% were Xmn I +/+. Seventy-eight percent of the patients had no further crises after starting hydroxyurea. This effect was accompanied by a significant increase in HbF (p<0.001), but this increase was variable in individual cases. There was also an increase in gamma gene mRNA expression in the few cases so studied. Hemoglobin levels increased significantly (p<0.001) resulting in the cessation of blood transfusions. Leucopoenia was observed in one patient. Hydroxyurea was effective in reducing the clinical severity in Indian patients who initially had higher HbF levels and the presence of ameliorating factors, such as alpha-thalassemia and the Xmn I polymorphism. Hydroxyurea therapy with careful monitoring can thus change the quality of life of Indians with sickle cell disease.
Sadek, Abdelrahim Abdrabou; Mohamed, Montaser Mohamed; Sharaf, El-Zahraa El-Said Ahmed; Magdy, Rofaida Mohamed; Allam, Ahmed Ahmed
Introduction Breath-holding spells (BHSs) are involuntary pauses of breathing, sometimes accompanied by loss of consciousness. They usually occur in response to an upsetting or surprising situation. Breath-holding spells are usually caused by either a change in the usual breathing pattern or a slowing of the heart rate. In some children, BHSs may be related to iron deficiency anemia. The aim of the work was to study the clinical and laboratory profile of BPHs in children presented to the Neuropediatric Clinic at Sohag University Hospital. Methods An observational prospective study was done at Sohag University Hospital over a period of one year on children diagnosed as having BHSs by clinical history and laboratory evaluation, including complete blood count (CBC), serum iron, serum ferritin, total iron binding capacity, and Electroencephalography (EEG). Results During the period of study (one year), we reviewed data of 32 children who had been diagnosed as having BHSs. We found that cyanotic spells (71.88%) predominated over pallid spells. There were positive family histories (31.25%) and consanguinity (53.135) in the studied patients. We found a high incidence of iron deficiency anemia (62.5%) in association with BHS. Abnormal EEGs were found in (65.63%) of studied children. Conclusion BHS is a common, important problem associated with iron deficiency anemia, which is, in turn, a common nutritional problem in our country. PMID:27279996
Singh, Y. Damodar; Arya, Rahul Singh
Aim: The present study was undertaken to study the pathology and control of sudden unexplained mortality in wistar rats. Materials and Methods: This study was conducted in a colony of 25 male wistar rats where there was mortality of nine rats. The dead rats were subjected to thorough post-mortem examination and necropsy samples were processed for hematoxylin and eosin staining for histopathological studies. Faecal samples of live rats were studied for the presence of parasitic eggs. Treatment with anthelmintics was given to manage the mortality and infections. Results: The investigation revealed a natural co-infection of Cysticercus fasciolaris and Hymenolepis diminuta in wistar rats, which were pathogenic enough to cause mortality. Typical lesions associated with the parasites were found in the dead rats. The mortality and infection were managed with common anthelmintics. Conclusion: C. fasciolaris and H. diminuta infection can cause mortality in wistar rats even when individually they cause asymptomatic infection. The mortality and infection can be managed with common anthelmintics. PMID:27047007
Kabi, Shobhitendu; Panda, Baikuntha Nath; Kameswari, B.C.; Payal; Behera, Ishwar Chandra; Tripathy, Subrat Kumar; Mahanta, Seemanchana
Introduction Among the modifiable risk factors for stroke, tobacco smoking is well recognized. In some studies the use of Smokeless Tobacco (ST) has also been contributed as a risk factor for ischemic stroke. Use of ST is very common in South-East Asia. The form of ST varies according to the geographical and cultural variation. Aim To study the various clinical symptoms and radiological findings of stroke due to different types of ST. Materials and Methods This was a prospective hospital based study carried out over a period of 2 years. All the cases within age group of 16 – 60 years and with a clinical and radiological diagnosis of acute stroke were included in the study. The Fagerström Test for Nicotine Dependence for ST of more than 6 was taken as the inclusion criteria. Patients having other addictions like smoked tobacco, alcohol, etc., and with important risk factors like hypertension, diabetes, dyslipidemia were excluded. The cases were extensively investigated and followed up for at least 6 months. Analysis was done using the Statistical Package for Social Sciences (SPSS- version 16.0). Descriptive statistics like percentage, mean were used wherever appropriate. Results During a period of 2 years, a total of 54 patients were studied. Forty two (77.7%) were males and 12(22.3%) were females. The mean age at presentation was 42.72(± 8.6) years and among all 96.3% patients were diagnosed as ischemic stroke. Among ST, pan was most commonly used in 21(38.9%) patients with an average of 14.6(±3.27) years of addiction. Hemiplegia was the predominant symptom on presentation (46, 85.2%). According to Oxfordshire Stroke Classification, partial anterior circulation infarct was most common in 20(38.4%). The mean Modified Rankin scale after 5 days of hospital stay was 3.83(±1.03) and after 6 months of follow-up was 2.1(±0.8). Patients were counseled for deaddiction and after 6 months follow-up 48(88.8%) patients had quit ST. Conclusion ST is an important etiological factor for young ischemic stroke. This is the first study depicting clinical symptomatology of ST addicted ischemic stroke patients from India. Considering the increasing prevalence of ST use in south-east Asia, further long term studies are needed from this region. PMID:27891376
Khan, Ahrar; Faridi, Hafiz A M; Ali, Muhammad; Khan, Muhammad Zargham; Siddique, Muhammad; Hussain, Iftikhar; Ahmad, Maqbool
This study was carried out on 30 dwarf bucks to determine the effects of cypermethrin (CY) on clinical, hemato-biochemical and histopathological parameters. Animals were divided randomly into five equal groups, and each group was dipped in 0%, 0.1%, 0.4%, 0.8% or 1.6% CY, on days 0 and 15. Animals were monitored for clinical signs. Blood and serum samples were collected on day 0 and then fortnightly till day 75. Severe clinical signs comprising itching, restlessness, salivation, skin scratching and head shaking appeared at high doses (0.8% and 1.6% CY). Erythrocyte counts, hemoglobin, hematocrit, total protein, globulin and fibrinogen decreased significantly while total leukocyte counts, alanine aminotransferase and aspartate aminotransferase concentration increased significantly in all the treated groups. In the liver, necrosis of hepatocytes along with cytoplasmic vacuolation and fibroblasts proliferation were observed at a high dose of CY (1.6%). Microscopically kidneys showed congestion of parenchyma and condensation of epithelial cells of tubules along with deposition of casts in tubules. Shrinkage of glomerular capillaries and increased urinary spaces were pronounced in the high-dose group. Lungs exhibited accumulation of fibrinous exudation, thickening of alveolar walls, collapse and broken alveoli in animals treated with a high dose of CY. It was concluded that CY caused dose-dependent effects on all parameters studied. High doses of CY (0.8% and 1.6% solution) affected the parameters on erythrocytes and leukocytes for whole evaluation period, while effects on plasma proteins were transient and on ALT, AST and fibrinogen were transient but lasted a few weeks longer.
Iacovazzo, Donato; Caswell, Richard; Bunce, Benjamin; Jose, Sian; Yuan, Bo; Hernández-Ramírez, Laura C; Kapur, Sonal; Caimari, Francisca; Evanson, Jane; Ferraù, Francesco; Dang, Mary N; Gabrovska, Plamena; Larkin, Sarah J; Ansorge, Olaf; Rodd, Celia; Vance, Mary L; Ramírez-Renteria, Claudia; Mercado, Moisés; Goldstone, Anthony P; Buchfelder, Michael; Burren, Christine P; Gurlek, Alper; Dutta, Pinaki; Choong, Catherine S; Cheetham, Timothy; Trivellin, Giampaolo; Stratakis, Constantine A; Lopes, Maria-Beatriz; Grossman, Ashley B; Trouillas, Jacqueline; Lupski, James R; Ellard, Sian; Sampson, Julian R; Roncaroli, Federico; Korbonits, Márta
Non-syndromic pituitary gigantism can result from AIP mutations or the recently identified Xq26.3 microduplication causing X-linked acrogigantism (XLAG). Within Xq26.3, GPR101 is believed to be the causative gene, and the c.924G > C (p.E308D) variant in this orphan G protein-coupled receptor has been suggested to play a role in the pathogenesis of acromegaly.We studied 153 patients (58 females and 95 males) with pituitary gigantism. AIP mutation-negative cases were screened for GPR101 duplication through copy number variation droplet digital PCR and high-density aCGH. The genetic, clinical and histopathological features of XLAG patients were studied in detail. 395 peripheral blood and 193 pituitary tumor DNA samples from acromegaly patients were tested for GPR101 variants.We identified 12 patients (10 females and 2 males; 7.8 %) with XLAG. In one subject, the duplicated region only contained GPR101, but not the other three genes in found to be duplicated in the previously reported patients, defining a new smallest region of overlap of duplications. While females presented with germline mutations, the two male patients harbored the mutation in a mosaic state. Nine patients had pituitary adenomas, while three had hyperplasia. The comparison of the features of XLAG, AIP-positive and GPR101&AIP-negative patients revealed significant differences in sex distribution, age at onset, height, prolactin co-secretion and histological features. The pathological features of XLAG-related adenomas were remarkably similar. These tumors had a sinusoidal and lobular architecture. Sparsely and densely granulated somatotrophs were admixed with lactotrophs; follicle-like structures and calcifications were commonly observed. Patients with sporadic of familial acromegaly did not have an increased prevalence of the c.924G > C (p.E308D) GPR101 variant compared to public databases.In conclusion, XLAG can result from germline or somatic duplication of GPR101. Duplication of GPR101 alone is sufficient for the development of XLAG, implicating it as the causative gene within the Xq26.3 region. The pathological features of XLAG-associated pituitary adenomas are typical and, together with the clinical phenotype, should prompt genetic testing.
Gramaglia, Carla; Feggi, Alessandro; Vecchi, Camilla; Di Marco, Sarah; Venesia, Alessandra; Delicato, Claudia; Chieppa, Nunzia; De Marchi, Fabiola; Cantello, Roberto; Zeppegno, Patrizia
RIASSUNTO. Scopo. Descrivere il management di un paziente con malattia di Marchiafava-Bignami (MBD) associata a lesioni frontali corticali, senza sintomi specifici al primo accesso in Pronto Soccorso, e insorgenza tardiva di sintomi psichiatrici atipici. Metodi. Descriviamo il caso di un paziente di 44 anni con storia di abuso cronico di alcol, a cui è stata diagnosticata la MBD. Risultati. La risonanza magnetica ha evidenziato lesioni nello splenio e corpo del corpo calloso e lesioni bilaterali della corteccia frontale. Il paziente ha sviluppato sintomi psichiatrici atipici a insorgenza tardiva, che sono risultati essere resistenti alle terapie farmacologiche impostate. Discussione. Il caso che descriviamo sembra supportare le attuali, ma ancora scarse evidenze che descrivono il coinvolgimento corticale nella MBD, suggerendone l'associazione con una prognosi peggiore. I sintomi psichiatrici possono risultare difficili da trattare a causa della resistenza alle terapie. Conclusione. Il coinvolgimento di psichiatri, radiologi e neurologi secondo un approccio di consultazione-liaison si è dimostrato di fondamentale importanza per la diagnosi e l'impostazione della terapia adeguata al paziente.
Cavaletti, G; Petruccioli, M G; Crespi, V; Pioltelli, P; Marmiroli, P; Tredici, G
Ten patients with essential cryoglobulinaemia type II were examined for peripheral nerve damage. In six cases distal symmetrical nerve involvement was present, while in three other cases abnormalities restricted to single nerves were found. Electrophysiological and morphological data were consistent with axonal damage, the larger myelinated fibres being most affected. Although active signs of vasculitis and immunoperoxidase staining for immunoglobulins were not present, endoneurial vessels were widely damaged, with abnormally thick endothelial cells and redundant basal membranes. These findings, together with a patchy distribution of myelinated fibre loss, suggest ischaemia as a cause of peripheral neuropathy during essential cryoglobulinaemia type II. A follow up examination, performed one year after haematologial remission, revealed that no further peripheral nerve damage had occurred. PMID:2176233
Bernier, G.; Phaneuf, J.-B.; Filion, R.
This study represents an analysis of the principal clinical factors and pathological lesions of 150 cases of necrotic enteritis encountered during 1968 and 1969 in Quebec. Following multiple investigations no common factor was observed which might have explained the pathogenesis of the condition which was observed during every month of the year, especially from May to November. Birds two to four weeks of age were the most susceptible. The main lesion was a fibrino-necrotic enteritis always localized in the small intestine, either in its entire length or just a segment and characterized by the disappearance of the surface epithelium and necrosis of the villi. The lumen was filled with desquamated epithelial cells and bacteria. Foci of coagulation necrosis were observed in the liver and foci of nephrosis in the kidneys. A Gram+ bacillus, strictly anaerobic, was always isolated from the viscera. ImagesPhoto 1.Photo 2.Photo 3.Photo 4.Photo 5.Photo 6.Photo 7. PMID:4277240
Hadi, Ahmed Abdel; Hindawi, Ali El; Hareedy, Amal; Khalil, Heba; Ashiry, Ranya Al; Elia, Shady; Sadek, Ahmed; Magdy, Mona; Atta, Rafatt; Anas, Amgad; Bakr, Hisham; Hammam, Olfat
AIM: Amplification of the Her2/neu gene and overexpression of the Her2/neu protein in gastric carcinoma (GC) is a golden criterion for target therapy with trastuzumab (Herceptin). We aim to evaluate the immunohistochemical protein expression and amplification of the oncogene Her2/neu by FISH technique in the epithelial gastric carcinoma and to compare their association with different clinicopathologic parameters aiming at identifying positive cases that may benefit from targeted therapy. MATERIALS AND METHODS: This study was done on eighty-five tumour tissue samples from patients with GC as well as thirty non-malignant lesions (Gastritis, intestinal metaplasia, adenoma with low-grade dysplasia, adenoma with high-grade dysplasia). All were immunohistochemically stained with Her2/neu antibody. RESULTS: All equivocal and some selected GC cases were submitted for FISH technique to detect Her2/neu gene amplification. By immunohistochemistry twenty-three cases (27%) were defined as positive for Her2/neu gene amplification and/or protein overexpression. The levels of Her2/neu positive (3+), Her2/neu equivocal (2+) and Her2/neu negative (1+/0) were measurable in 14.2%, 32.9% and 52.9% of the samples, respectively. FISH showed that Her2/neu gene was amplified in 22 cases, 10 Her2/neu positive (3+), 11 (39.3%) Her2/neu equivocal (2+) and 1 Her2/neu negative (1+) cases with IHC staining those who can benefit from anti Her2/neu target therapy. Her2/neu was overexpressed positivity (3+) more in intestinal type and mixed carcinoma, and moderately differentiated tumours. None of gastritis, intestinal metaplasia or adenoma with low-grade dysplasia cases showed positivity for Her2/neu (3+). The Her2/neu positivity (3+) was associated with both adenocarcinoma cases and high-grade dysplasia (P = 0.002). CONCLUSIONS: The results highlight the necessity of FISH test for further categorization when gastric cancer cases are equivocal (2+) by IHC to determine eligibility for the targeted therapy. Stepwise increase in the expression of Her2/neu was seen in low-grade dysplasia, high-grade dysplasia and carcinoma cases implying its role in cancer evolution. Overexpression of Her 2/neu in GC patients can be promising in selecting those who can get benefit from anti-Her2/neu target therapy. PMID:28028387
Rathee, Deepti; Arora, Piyush; Meena, Manoj; Sarin, Rohit; Chakraborty, Pitambar; Jaiswal, Anand; Goyal, Mukesh
Introduction: Tuberculosis (TB) is one of the leading causes of death and disease worldwide. Tobacco smoking has been linked as a risk factor for TB. This study was aimed to affirm the strength of association between smoking and pulmonary TB. Materials and Methods: Pulmonary TB patients aged between 18 and 65 years were enrolled and followed-up until treatment completion. Two consecutive sputum smears were examined from each patient for the presence of acid-fast bacilli (AFB) using Ziehl–Neelsen technique. Radiological severity of disease was assessed using guidelines of National TB Association of USA. Sputum smears for AFB were graded for positivity as per WHO Revised National TB Control Programme criteria. Response was determined in terms of sputum conversion at the end of intensive phase and final treatment outcomes. Results: Sputum smear grading of 3+ increased from 12.5% to 68.18% and 66.66% as smoking index increased from <100 to 100–299 and >300 (P < 0.05). In nonsmokers, 79.2% patients had minimal disease while only 4.2% had advanced disease as compared to smokers where 52.4% had moderate disease, 26.2% advanced disease, and 21.4% minimal disease (P < 0.01). Smokers had significantly lower treatment success rate (69%) as against nonsmokers and former smokers (93.8% and 90.9%, respectively, P = 0.001) owing to a higher default rate among smokers (28.5%) than nonsmokers (6.3%) and former smokers (9.1%). Conclusion: Smokers during initial presentation, as well as at end of the treatment demonstrate more radiological findings, cavitary disease, and worse sputum AFB smear grading. Smokers also have a poorer treatment success rate largely due to high percentage of default rate thus suggesting noncompliance as a main confounder to treatment success. Focus needs to be made to reduce defaulters which are more common among smokers. PMID:27625444
Maheu, Veronique; Frappier, Julie; Archambault, Philippe S; Routhier, François
Many activities of daily living, such as picking up glasses, holding a fork or opening a door, which most people do without thinking, can become insurmountable for people who have upper extremity disabilities. The alternative to asking for human help is to use some assistive devices to compensate their loss of mobility; however, many of those devices are limited in terms of functionality. Robotics may provide a better approach for the development of assistive devices, by allowing greater functionality. In this paper, we present results of a study (n=31) which objectives were to evaluate the efficacy of a new joystick-controlled seven-degree of freedom robotic manipulator and assess its potential economic benefits. Results show that JACO is easy to use as the majority of the participants were able to accomplish the testing tasks on their first attempt. The economic model results inferred that the use of the JACO arm system could potentially reduce caregiving time by 41%. These study results are expected to provide valuable data for interested parties, such as individuals with disabilities, their family or caregivers.
Ali Nasir, A.; Younus, M.; Rashid, A.; Abdul Khaliq, S.; Khan, E.; Shah, S. H.; Aslam, A.; Ghumman, M. A.; Joiya, M. H.
The present investigation was conducted to study the effects of experimental Clostridium perfringens type D enterotoxaemia in teddy goats. Clinical signs started to appear after 30 min of experimental infection like anorexia, diarrhea, dehydration, frothing and dyspnea. Gross lesions consisted of severe congestion in tissues of varying intensity with enlarged mesenteric lymph nodes while histological examination revealed edema of lungs, kidney, and lymph nodes and to some extent in brain along with hemorrhages in lungs and intestines. Clostridium perfringens type D carrying alpha and epsilon toxin genes were amplified with amplicon size about 247 bp and 665 bp, respectively. Human erythrocytes showed the highest hemolysis, 68%, followed by mice, 57%, against culture supernatants. The percentage of hemolysis was significantly higher at 37°C as compared to 25°C except for rabbit and dog. PMID:27175159
Rather than a commentary on a specific article, this work contains reflections on the concept of quality in provision of family planning services and its possible use to deflect family planning efforts. Quality is a difficult concept to define precisely. Applied to family planning, it may be defined as the totality of attributes possessed by a program that does not place impediments in the way of comfortable adoption of a contraceptive method. Another definition of quality, achievable only by a long list of ideal characteristics which are often expensive and sometimes unattainable, has been and continues to be used by enemies of family planning to slow its diffusion; they hold that if perfect quality is not offered, it is better to offer nothing. A specific tactic of this group is to oppose the quantity of services with their quality. The hard-fought campaign to discredit the measurement of concrete goals and results is part of this strategy. But it is apparent that without a reasonably satisfactory quality of service, no program would achieve significant growth. People would not continue to come, and in growing numbers, to a program where they received poor quality service. Each goal, each statistic, each percentage represents human problems confronted and resolved by programs and personnel. Profamilia has become 1 of the largest nongovernmental family planning organizations. Profamilia has always paid attention to the quality of its services and has conducted numerous studies to assess results and identify shortcomings. The high percentage of positive results attests to the quality of Profamilia programs. In an age of scarce resources and tight budgets, the objective of family planning programs is to provide an austere but acceptable quality of attention so that the quantity of services will be sufficient to meet demand. Program elements that have a real cost without offering a measurable benefit should be avoided. Another problem is that integrated programs that aim to combine family planning with maternal-child health or other services often end by neglecting the family planning component. Profamilia believes that good information should be provided with services, but it is limited to what is needed for proper and safe use of each method. And integration is not presently needed to disguise or dress up family planning programs. It is justifiable only when for political reasons there is no alternative or when it can provide other resources to subsidize family planning programs.
Subba, Sonu Hangma; Guha, Arunav
Introduction According to the World Health Organization (WHO), mental health disorders are one of the leading causes of disability worldwide and it is as common in children. Anywhere between one to three children may be suffering from psychiatric disorders at any point in time. Aim This study intended to find the pattern of psychiatric disorders and associated sociodemographic factors among children attending the psychiatric department in a tertiary care hospital in Southern India. Materials and Methods An analysis was conducted of patients who attended the psychiatric clinic from April 2012 to March 2013. Disorders were classified according to International Classification of Diseases, 10th edition (ICD-10) criteria. Data obtained was analysed by SPSS 11.5 version. Chi-square test was used to see association and p<0.05 was taken as significant. Results The mean age of the children was 10.9 years (SD=4.3). Predominance of males was noticed. It was seen that the male children, mostly suffered from Pervasive and specific developmental disorders (n=105; 31.1%). While in the female children, a prominence of anxiety, dissociative, stress-related, somatoform and other non-psychotic mental disorders was seen (n=52; 27.1%). Co-morbidity of psychiatric disorders was seen with intellectual disability and a seasonal predominance of psychiatric disorders was seen during autumn. Conclusion Children presenting with psychiatric disorders in the hospital showed a wide age range and among them, males outnumbered females. Psychiatric disorders showed seasonal variation and the types of disorder varied significantly with age, gender and religion. PMID:27134978
Rossi, Elisa; Grisanti, Salvatore; Villanacci, Vincenzo; Della Casa, Domenico; Cengia, Paolo; Missale, Guido; Minelli, Luigi; Buglione, Michela; Cestari, Renzo; Bassotti, Gabrio
Barrett's oesophagus (BO) is the primary precursor lesion for oesophageal adenocarcinoma (ADC). The natural history of metaplasia-dysplasia-carcinoma sequence remains largely unknown. HER2/neu oncogene results overexpressed/amplified in preneoplastic lesions and in ADC of the oesophagus and it has been associated with poor prognosis. Our aim was to evaluate the role of HER2 overexpression/amplification in predicting the conversion from precursor lesions to ADC. We retrospectively evaluated by univariate analysis of single variables clinical records and histological specimens of 21 patients with a confirmed diagnosis of BO and/or oesophageal dysplasia. Clinical variables included age, gender, alcohol and smoking intake, presence of symptoms (pyrosis, disphagia) and endoscopic features (length). HER2 status was studied by immunohistochemistry and fluorescence in situ hybridization (FISH) on paraffin-embedded tissue. The end-points were the occurrence of progression and the time-to-progression (TTP) from the initial histologic lesion to the worst pathological pattern. Median age at diagnosis was 63 years (range 37-84). BO median length was 4.5 cm. Progression occurred in 11 of 21 patients and median TTP was 24 months. HER2 was overexpressed/amplified in 8 of 21 (38%) patients. HER2 overexpression/ amplification and the presence of dysplasia were statistically associated with progression (P= 0.038). This study provides evidence for a possible role of HER2 in the transition from dysplasia to ADC of the oesophagus. This fact could help in identifying patients at high risk of malignant transformation.
The infundibular keratinizing acanthoma (IKA) is a rare epithelial benign keratin-containing neoplasm of hair follicles. The purpose of this study was to evaluate the defining histopathologic architecture of IKA. A typical IKA consisted of a keratin-filled crypt in the dermis and subcutis that opened to the skin surface. Most of this tumor occurred on the back, neck, head, and the shoulders. Microscopically, the dermal nodules were focally contiguous in both the dermis and subcutis. Furthermore, most histological lesions are consistent with a simple or multiloculated cyst filled with keratin and lined by a wall of stratified squamous epithelium; keratin appears as a concentric lamellar mass, with a keratotic pearly aspect. Histological examination of the cutaneous lesions revealed that the growths were comprised of IKA. IKA of man and dog were compared, and it was concluded that although they are similar in many respects, they are not identical entities. To the best of our knowledge, this is the first report on the prevalence of IKAs among the population of owned dogs in Iran. PMID:24890648
Kasera, Ramkrashan; Niphadkar, P V; Saran, Aditya; Mathur, Chandni; Singh, A B
The prevalence of food allergy is reported to be 3-4% in adults and about 6% in children. However food allergy across different countries accounts for 35-50 % all cases of anaphylaxis to foods. In the present study, we have reported a case of anaphylaxis to Amaranth grain (Amaranthus paniculatus) commonly known as Rajgira (Ramdana) in India. A 60 year old female suffered anaphylaxis after consuming Rajgira seed flour generally consumed during fasting. Food allergy to Amaranth seeds is not reported so far. The patient reported to hospital with complaints of itching in mouth, choking throat, redness and swelling of face and burning abdomen within 5 min of consuming Rajgira flour. Clinical and immunological investigations revealed SPT and oral challenge positivity beside high allergen specific IgE in the serum of the patient. Three IgE binding protein fractions were detected in roasted Rajgira seed flour extract which could be considered to be allergenically important for triggering anaphylaxis.
Majewska, H; Skálová, A; Radecka, K; Stodulski, D; Hyrcza, M; Stankiewicz, C; Biernat, W
Metastatic tumors involving salivary glands arising from the non-head and neck area are very rare. Renal cell carcinoma (RCC) is known for its high propensity for metastasis to unusual localizations. RCC metastasis to the maxillofacial area is an uncommon event (16%), but metastasis to salivary glands is extremely rare. We report a series of 9 such cases retrieved from two institutions. The group included 6 females and 3 males. The age at diagnosis ranged from 60 to 97 years (mean 72.6 years). The tumors involved the parotid gland in 7 cases, and the submandibular and small salivary gland of the oral cavity in 1 case each. The size of tumors ranged from 0.4 to 5 cm. Total parotidectomy with selective neck dissection was performed in 4 cases, while superficial parotidectomy was performed in 1 case and simple resection in 3 cases. Histologically, all the tumors were clear cell renal cell carcinomas, and therefore the differential diagnosis mainly included clear cell variants of salivary gland carcinomas. The parotid gland was the initial manifestation of renal malignancy in 4 of the cases, while in the remaining 5 cases a history of RCC had been known. The salivary gland involvement developed from 11 months to 13 years after the time of diagnosis of the primary tumor. In 2 cases it was the first site of dissemination. Pathologists need to maintain a high index of suspicion for the possibility of metastasis when confronted with oncocytic or clear cell neoplasms developing in salivary glands. RCC, although rare, should be included in this differential diagnosis.
Tupaki-Sreepurna, Ananya; Al-Hatmi, Abdullah M S; Kindo, Anupma J; Sundaram, Murugan; de Hoog, G Sybren
In this study, we aimed to present the first molecular epidemiological data from Chennai, India, analyse keratitis cases that have been monitored in a university hospital during 2 years, identify the responsible Fusarium species and determine antifungal susceptibilities. A total of 10 cases of keratitis were included in the study. Fusarium isolates were identified using the second largest subunit of the RNA polymerase gene (RPB2) and the translation elongation factor 1 alpha (TEF1). Antifungal susceptibility was tested by the broth microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) methodology. The aetiological agents belonged to Fusarium solani species complex (FSSC) (n = 9) and Fusarium sambucinum species complex (FSAMSC) (n = 1), and the identified species were Fusarium keratoplasticum (n = 7), Fusarium falciforme (n = 2) and Fusarium sporotrichioides (n = 1). All strains showed multidrug resistance to azoles and caspofungin but exhibited lower minimum inhibitory concentration (MIC) to natamycin and amphotericin B. Fusarium keratoplasticum and Fusarium falciforme belonging to the Fusarium solani species complex were the major aetiological agents of Fusarium keratitis in this study. Early presentation and 5% topical natamycin was associated with better patient outcome. Preventative measures and monitoring of local epidemiological data play an important role in clinical practice.
Akhtar, Mohammad Nasim; Agarwal, Sharat; Athar, Rizwan
A patient of 41 years of age presented with insidious onset atraumatic swelling arising from medial end of right clavicle with apparently normal radiograph. Initial computed tomography ascribed it to benign bony pathology requiring no specific treatment but patient did not respond to symptomatic management. FNAC done elsewhere was inconclusive, with no bacteria on Gram's staining and negative bacterial culture and AFB smear examinations. Patient had possible exposure to tuberculosis and Mantoux skin test done which showed significant induration. Possible differential diagnoses related to clavicle including infective, neoplastic, rheumatological, degenerative and idiopathic conditions considered. Magnetic resonance imaging (MRI) showed focal periosteal reaction with marrow signal changes with sparing of sternoclavicular joint. Correlation between patient's history, clinical findings and investigations done and diagnosis of isolated clavicle tuberculosis was made. Patient showed good response to anti-tubercular chemotherapy. Repeat MRI showed resolution of initial imaging findings. At the end of 2 years patient was completely symptom free.
Tavasoly, Abbas; Gholami, Hossein; Rostami, Amir; Anissian, Ali; Touni, Seyed Rashid; Khaleghian, Pooyan; Mokarizadeh, Aram; Javanbakht, Javad; Nasoori, Alireza
The infundibular keratinizing acanthoma (IKA) is a rare epithelial benign keratin-containing neoplasm of hair follicles. The purpose of this study was to evaluate the defining histopathologic architecture of IKA. A typical IKA consisted of a keratin-filled crypt in the dermis and subcutis that opened to the skin surface. Most of this tumor occurred on the back, neck, head, and the shoulders. Microscopically, the dermal nodules were focally contiguous in both the dermis and subcutis. Furthermore, most histological lesions are consistent with a simple or multiloculated cyst filled with keratin and lined by a wall of stratified squamous epithelium; keratin appears as a concentric lamellar mass, with a keratotic pearly aspect. Histological examination of the cutaneous lesions revealed that the growths were comprised of IKA. IKA of man and dog were compared, and it was concluded that although they are similar in many respects, they are not identical entities. To the best of our knowledge, this is the first report on the prevalence of IKAs among the population of owned dogs in Iran.
Mohan, Ravi Prakash Sasankoti; Gill, Navneet; Verma, Sankalp; Chawa, Venkateshwar Rao; Tyagi, Kuber; Agarwal, Neha
The incidence of multiple myeloma (MM) affecting the jaws is 30% and on rare occasions the oral involvement can be the first indication of the disease. Authors report a case of MM in a 40-year-old woman who presented with a multilocular radiolucent lesion in the left mandible initially mistaken as an ameloblastoma. Conventional radiographs revealed a multilocular lesion on the molar region. Computed tomography (CT) and 3 dimensional CT revealed lytic, space occupying lesion perforating the inferior cortex. Magnetic resonance imaging (MRI) revealed a hypointense lesion on T1 weighted image and hyperintense lesion on T2 weighted image. Histopathological and lab investigations lead to the diagnosis of MM. MRI is superior in depicting the size of the lesion as compared to CT and conventional radiographs.
Gualco, Gabriela; Chioato, Lucimara; Harrington, William J.; Weiss, Lawrence M.; Bacchi, Carlos E.
Breast involvement by non-Hodgkin lymphomas is rare, and exceptional for T-cell lymphomas; we studied the morphologic, immunophenotypic, and clinical features of 11 patients with T-cell non-Hodgkin lymphomas involving the breast. Four cases fulfilled the definition criteria for primary breast lymphomas, 3 females and 1 male, with a median age of 51 years. One primary breast lymphomas was T-cell lymphoma unspecified, other was subcutaneous panniculitis-like T-cell lymphoma, and 2 cases were anaplastic large cell lymphomas. One of the anaplastic large cell lymphoma cases was found surrounding a silicone breast implant and presented as clinically as mastitis; whereas the other case occurred in a man. T-cell lymphoma secondarily involved the breast in 7 patients, all women and 1 bilateral, with a median age of 29 years. These secondary breast lymphomas occurred as part of widespread nodal or leukemic disease. Three patients had adult T-cell leukemia/lymphoma, including the patient with bilateral lesions, 3 others had precursor T-lymphoblastic lymphoma/leukemia, and the other presented with a peripheral-T-cell lymphoma nonotherwise specified type. Breast T-cell lymphomas are very infrequent and are morphologically and clinically heterogeneous. PMID:19318917
Kumar Sahu, Srikant; Das, Sujata; Sharma, Savitri; Sahu, Kalyani
Medical and microbiology records of seventeen patients (17 eyes), diagnosed as scleritis of infectious origin were reviewed; to study clinical features, predisposing risk factors, microbiologic profile and treatment outcome of infectious scleritis. The mean patient age was 52.3 ± 19.75 years. Twelve patients (70.6%) had history of trauma/prior surgery. Isolated organisms included Staphylococcus species (spp) (n = 5), Fungus (n = 4), Nocardia spp (n = 3), two each of atypical Mycobacterium spp and Streptococcus pneumoniae and one Pseudomonas aeruginosa. Treatment included intensive topical antimicrobial in all eyes and systemic medication in 15 (88.2%) patients; surgical exploration was needed for 13 (76.5%) patients and scleral patch graft was done in four (23.5%) patients. Lesions resolved in all patients and none required evisceration. The presenting log MAR visual acuity of 1.77 ± 1.40 and improved to 0.99 ± 0.91. (P ≤ 0.039) after treatment with a mean follow up of 22.57 ± 19.53 weeks. A microbiological confirmation, appropriate medical and/or surgical intervention has a good tectonic and visual outcome. PMID:22164345
Sarkozy, Clémentine; Molina, Thierry; Ghesquières, Hervé; Michallet, Anne-Sophie; Dupuis, Jehan; Damotte, Diane; Morsschauser, Franck; Parrens, Marie; Martin, Laurent; Dartigues, Peggy; Stamatoullas, Aspasia; Hirsch, Pierre; Fabiani, Bettina; Bouabdallah, Krimo; da Silva, Maria Gomes; Maerevoet, Marie; Laurent, Camille; Coiffier, Bertrand; Salles, Gilles; Traverse-Glehen, Alexandra
Mediastinal gray zone lymphoma, B-cell lymphomas with intermediate features between classical Hodgkin lymphoma and primary mediastinal B-cell lymphoma, have not been well described in the literature. We report the clinical characteristics and outcomes of a large retrospective series of 99 cases centrally reviewed by a panel of hematopathologists, with a consensus established for the diagnosis. Cases were defined as classical Hodgkin lymphoma-like morphology (64.6%) with primary mediastinal B-cell lymphoma immunophenotype, primary mediastinal B-cell lymphoma-like morphology (30.3%) with classical Hodgkin lymphoma or composite (5.1%) (synchronous occurrence of classical Hodgkin lymphoma and primary mediastinal B-cell lymphoma). The median age was 32 years (13-83 years); 55% were women. Thirteen of 81 evaluable cases (16%) were Epstein-Barr virus-positive. Twenty-eight percent of patients presented primary refractory disease (progression under first-line treatment or relapse within one year). The 3-year event-free and overall survival rates were 63% and 80%, respectively. Patients treated with a standard regimen (RCHOP/ABVD) had worse event-free survival (P=0.003) and overall survival (P=0.02) than those treated with a dose-intensive chemotherapy (high-dose RCHOP/escalated BEACOPP). Rituximab added to chemotherapy was not associated with better event-free survival (P=0.55) or overall survival (P=0.88). Radiotherapy for patients in complete remission had no impact on event-free survival. In multivariate prognostic analysis, ECOG-PS and anemia were the strongest factors associated with a shorter event-free survival and overall survival, respectively. In conclusion, this report describes the largest series of mediastinal gray zone lymphoma. Our data suggest that a dose-intensive treatment might improve the outcome of this rare and aggressive disease.
Sarkozy, Clémentine; Molina, Thierry; Ghesquières, Hervé; Michallet, Anne-Sophie; Dupuis, Jehan; Damotte, Diane; Morsschauser, Franck; Parrens, Marie; Martin, Laurent; Dartigues, Peggy; Stamatoullas, Aspasia; Hirsch, Pierre; Fabiani, Bettina; Bouabdallah, Krimo; da Silva, Maria Gomes; Maerevoet, Marie; Laurent, Camille; Coiffier, Bertrand; Salles, Gilles; Traverse-Glehen, Alexandra
Mediastinal gray zone lymphoma, B-cell lymphomas with intermediate features between classical Hodgkin lymphoma and primary mediastinal B-cell lymphoma, have not been well described in the literature. We report the clinical characteristics and outcomes of a large retrospective series of 99 cases centrally reviewed by a panel of hematopathologists, with a consensus established for the diagnosis. Cases were defined as classical Hodgkin lymphoma-like morphology (64.6%) with primary mediastinal B-cell lymphoma immunophenotype, primary mediastinal B-cell lymphoma-like morphology (30.3%) with classical Hodgkin lymphoma or composite (5.1%) (synchronous occurrence of classical Hodgkin lymphoma and primary mediastinal B-cell lymphoma). The median age was 32 years (13–83 years); 55% were women. Thirteen of 81 evaluable cases (16%) were Epstein-Barr virus-positive. Twenty-eight percent of patients presented primary refractory disease (progression under first-line treatment or relapse within one year). The 3-year event-free and overall survival rates were 63% and 80%, respectively. Patients treated with a standard regimen (RCHOP/ABVD) had worse event-free survival (P=0.003) and overall survival (P=0.02) than those treated with a dose-intensive chemotherapy (high-dose RCHOP/escalated BEACOPP). Rituximab added to chemotherapy was not associated with better event-free survival (P=0.55) or overall survival (P=0.88). Radiotherapy for patients in complete remission had no impact on event-free survival. In multivariate prognostic analysis, ECOG-PS and anemia were the strongest factors associated with a shorter event-free survival and overall survival, respectively. In conclusion, this report describes the largest series of mediastinal gray zone lymphoma. Our data suggest that a dose-intensive treatment might improve the outcome of this rare and aggressive disease. PMID:27758822
Gaponova, N I; Plavunov, N F; Tereshchenko, S N; Baratashvili, V L; Abdurakhmanov, V R; Komissarenko, I A; Filippov, D V; Podkopaev, D V
Clinicostatistical analysis of arterial hypertension complicated with hypertensive crisis using data of Moscow A.S.Puchkov Station of Urgent and Emergent Medical Aid revealed 14% rise in number of hypertensive crises during the period from 2005 to 2009. Number of hypertensive crises increased among persons of young age (18-35 years). Frequency of cerebrovascular complications of hypertensive crises was age dependent with maximal values among men aged 36-74 years and women older than 75 years.
Singh, Mahendra Pratap; Kumar, Vijay; Agarwal, Akash; Kumar, Rajendra; Bhatt, M.L.B.; Misra, Sanjeev
Introduction Oral squamous cell carcinoma (OSCC) ranks 12th most common cancer in the world. Objective The aim of this study was to retrospectively evaluate the OSCC. Methods A retrospective study of 611 OSCC patients from January 2010 to December 2013 was carried out in Department of Surgical Oncology, King George's Medical University, Lucknow, India. Details of patient's sex, age, tobacco habit and site of cancer were noted. Data were analyzed by Student's t test and chi-squire (χ2) test. Results The prevalence of OSCC was significantly (p < 0.001) higher in males (75.9%) than females (24.1%). The mean age of female patients was higher than males (p < 0.001). In both the genders, the buccal mucosa and gingivobuccal sulcus were found to be the most affected sites. Moreover, the smokeless form of tobacco was found to be significantly associated with OSCC, especially in females. Conclusion The study concluded that OSCC is more common in men as compared to women, probably due to habit of tobacco consumption. Smokeless tobacco use is an important risk factor, especially in females. PMID:26937366
Gupta, Kavita; Sharma, Swati; Kudva, Ranjini; Kumar, Sandeep
Mucinous carcinoma is a less common histologic variant of breast cancer. Cases of mucinous carcinomas in male breast are extremely rare. Here, we describe a case of mixed mucinous carcinoma i.e. mucinous carcinoma with infiltrating ductal carcinoma component and showing apocrine differentiation in a 73-year-old man. This uncommon tumour entity has dismal prognosis and treatment depends largely on the tumour type, size, lymph node involvement and hormonal status.
Burad, Deepak Kalyansingh; Kodiatte, Thomas Alex; Rajeeb, Sayd Mohamed; Goel, Ashish; Eapen, Chundamannil Eapen; Ramakrishna, Banumathi
AIM To study the clinicopathological characteristics of neuroendocrine neoplasms (NEN) on liver samples and apply World Health Organization (WHO) 2010 grading of gastroenteropancreatic (GEP) NEN. METHODS Clinicopathological features of 79 cases of NEN of the liver diagnosed between January 2011 to December 2015 were analyzed. WHO 2010 classification of GEP NEN was applied and the tumors were graded as G1, G2 or G3. Two more categories, D1/2 (discordant 1/2) and D2/3 (discordant 2/3) were also applied. The D1/2 grade tumors had a mitotic count of G1 and Ki-67 index of G2. The D2/3 tumors had a mitotic count of G2 and Ki-67 index of G3. The follow up details which were available till the end of the study period (December 2015) were collected. RESULTS Of the 79 tumors, 16 each were G1 and G2, and 18 were G3 tumors. Of the remaining 29 tumors, 13 were assigned to D1/2 and 16 were D2/3 grade. Male preponderance was noted in all tumors except for G2 neoplasms, which showed a slight female predilection. The median age at presentation was 47 years (range 10-82 years). The most common presentation was abdominal pain (81%). Pancreas (49%) was the most common site of primary followed by gastrointestinal tract (24.4%) and lungs (18%). Radiologically, 87% of the patients had multiple liver lesions. Histopathologically, necrosis was seen in only D2/3 and G3 tumors. Microvascular invasion was seen in all grades. Metastasis occurred in all grades of primary NEN and the grades of the metastatic tumors and their corresponding primary tumors were similar in 67% of the cases. Of the 79 patients, 36 had at least one follow up visit with a median duration of follow up of 8.5 mo (range: 1-50 mo). This study did not show any impact of the grade of tumor on the short term clinical outcome of these patients. CONCLUSION Liver biopsy is an important tool for clinicopathological characterization and grading of NEN, especially when the primary is not identified. Eighty-seven percent of the patients had multifocal liver lesions irrespective of the WHO grade, indicating a higher stage of disease at presentation. Follow up duration was inadequate to derive any meaningful conclusion on long term outcome in our study patients. PMID:27833387
Paviour, Dominic C; Price, Shona L; Jahanshahi, Marjan; Lees, Andrew J; Fox, Nick C
Progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) are neurodegenerative disorders, each with a prevalence of around 5 per 100,000. Regional brain atrophy patterns differ in the two disorders, however, and magnetic resonance imaging is sometimes helpful in distinguishing them in the later stages. We measured whole brain and regional volumes, including cerebellum, pons, midbrain, superior cerebellar peduncle (SCP), and ventricular volumes as well as frontal and posterior-inferior cerebral regions in 18 subjects with PSP, 9 with MSA-P (parkinsonian phenotype), 9 with Parkinson's disease (PD), and 18 healthy controls. Associations between these volumes, cognitive profiles, and clinical measures of disease severity and motor disability were assessed. Mean midbrain volume was 30% smaller in PSP than in PD or controls (P < 0.001) and 15% smaller than in MSA-P (P = 0.009). The mean SCP volume in PSP was 30% smaller than in MSA-P, PD, or controls (P < 0.001). Mean cerebellar volumes in MSA-P were 20% smaller than in controls and PD and 18% smaller than in PSP (P = 0.01). Mean pontine volume in MSA-P was 30% smaller than in PD or controls (P < 0.001) and 25% smaller than in PSP (P = 0.01). Motor disability was most strongly associated with midbrain volume, and more severe executive dysfunction was associated with reduced frontal volume. These distinct patterns of cortical and subcortical atrophy, when considered together rather than independently, better differentiate PSP and MSA-P from each other and also from healthy controls.
Chung, Eric Lim Teik; Abdullah, Faez Firdaus Jesse; Adamu, Lawan; Marza, Ali Dhiaa; Ibrahim, Hayder Hamzah; Zamri-Saad, Mohd; Haron, Abdul Wahid; Saharee, Abdul Aziz; Lila, Mohd Azmi Mohd; Omar, Abdul Rahman; Bakar, Md Zuki Abu; Norsidin, Mohd Jefri
Background: Pasteurella multocida a Gram-negative bacterium has been identified as the causative agent of many economically important diseases in a wide range of hosts. Hemorrhagic septicemia is a disease caused by P. multocida serotype B:2 and E:2. The organism causes acute, a highly fatal septicemic disease with high morbidity and mortality in cattle and more susceptible in buffaloes. Therefore, the aim of this study was to investigate the clinical signs, blood parameters, post mortem and histopathology changes caused by P. multocida Type B:2 infections initiated through the oral and subcutaneous routes. Methods: Nine buffalo heifers were divided equally into 3 treatment groups. Group 1 was inoculated orally with 10 ml of phosphate buffer saline; Groups 2 and 3 were inoculated with 10 ml of 1012 colony forming unit of P. multocida Type B:2 subcutaneously and orally respectively. Results: There was a significant difference (p<0.05) in temperature between the subcutaneous and the control group. The results revealed significant differences (p<0.05) in erythrocytes, hemoglobin, packed cell volume, leukocytes, monocytes, and A: G ratio between the subcutaneous and the control group. Furthermore, there were significant differences (p<0.05) in leukocytes, band neutrophils, segmented neutrophils, lymphocytes, eosinophils, basophils, thrombocytes, plasma protein, icterus index, gamma glutamyl tranferase and A: G ratio between the oral and the control group. The post mortem lesions of the subcutaneous group buffaloes showed generalized hyperemia, congestion and hemorrhage of the immune organs, gastro-intestinal tract organs and vital organs. The oral group buffaloes showed mild lesions in the lung and liver. Histologically, there were significant differences (p<0.05) in hemorrhage and congestion; necrosis and degeneration; inflammatory cells infiltration; and edema in between the groups. Conclusion: This study was a proof that oral route infection of P. multocida Type B:2 can be used to stimulate host cell responses where oral vaccine through feed can be developed in the near future. PMID:27065648
Golik, A N
The influence of heredity and of premorbid personal peculiarities on the psychopathic-like disorders development in schizophrenic patients of adolescent-juvenile age was analysed. Psychopathic-like disturbances were divided into 2 groups exactly with either positive (type I) or negative or type II symptoms predominance in a whole clinical pattern. Symptoms mentioned above were observed in 47 and 53 patients respectively. As well as probands 216 relatives in the range of 1-3 degree of relation were examined too. It was revealed that in patients with type I of disorders schizophrenia debuted in adolescent-juvenile age meanwhile in type II it started in childhood. More severe hereditary loading in the form of various psychic pathologies took place in the case type I patients as compared with type II. Schizotype and hyperthymic personality characteristics prevailed in the first case, just as dissociated and passive features presented in type II.
Jové, J; Sánchez-Tapias, J M; Bruguera, M; Mas, A; Costa, J; Barrera, J M; Rodés, J
The clinical, morphological and evolutive features of 60 patients with chronic hepatitis, presumably caused by non-A, non-B virus infection, have been retrospectively analyzed. In all the cases the disease began as an acute episode of viral hepatitis that was followed by persistently abnormal liver function tests. No patient had evidence of current or past hepatitis B virus infection and other known causes of chronic liver disease were excluded. Thirty patients had received blood transfusions in the recent past, five were drug addicts and the source of the infection was not identified in the remaining 25, in whom the disease was considered to be sporadic. Clinical or biochemical differences between patients with post-transfusional and sporadic non-A, non-B chronic hepatitis were not observed, but liver histology showed a higher proportion of patients with chronic persistent hepatitis in the sporadic (72%) than in the transfusional group (53%). On follow-up, sustained normalization of liver function tests was observed in 46% of the cases with sporadic hepatitis but only in 13% of the cases with post-transfusion hepatitis. These observations suggest that non-A, non-B chronic hepatitis is more severe in patients with transfusion-related infection than in sporadic cases.
Jawade, Sugat A; Chugh, Vishal S; Gohil, Sneha K; Mistry, Amit S; Umrigar, Dipak D
Background: Dermatologic conditions have different presentation and management in pediatric age group from that in adult; this to be studied separately for statistical and population based analysis. Objective: To study the pattern of various dermatoses in infants and children in tertiary health care center in South Gujarat region. Materials and Methods: This is a prospective study; various dermatoses were studied in pediatric patients up to 14 years of age attending the Dermatology OPD of New Civil Hospital, Surat, Gujarat over a period of 12 months from June 2009 to June 2010. All patients were divided into four different study groups: <1 month (neonates), 1 month to 1 year, >1 to 6 years and 7 to 14 years. Results: There were 596 boys and 425 girls in total 1021 study populations. Majority of the skin conditions in neonates were erythema toxicum neonatorum (12.97%), scabies (9.92%), mongolian spot (9.16%), and seborrheic dermatitis (7.63%). In > 1 month to 14 years age group of children among infectious disorder, children were found to be affected most by scabies (24.49%), impetigo (5.96%), pyoderma (5.62%), molluscum contagiosum (5.39%), tinea capitis (4.49%), leprosy (2.02%), and viral warts (1.35%) while among non-infectious disorders, they were affected by atopic dermatitis (4.27%), pityriasis alba (4.16%), seborrheic dermatitis (3.60%), pityriasis rosea (3.15%), others (3.01%), phrynoderma (2.70%), lichen planus (2.58%), contact dermatitis (1.57%) and ichthyosis (1.45%). Conclusion: There is a need to emphasize on training the management of common pediatric dermatoses to dermatologists, general practitioners and pediatricians for early treatment. PMID:26677296
Munjal, Sumit; Munjal, Seema; Hazari, Puja; Mahajan, Harsh; Munjal, Akshay; Mehta, D. S.
Aim: In the less dense bone, it is difficult to obtain implant anchorage. The present study was undertaken to determine the survival rate of Maestro™ implants placed in d3 and d4 bones. Materials and Methods: Fourteen patients (10 males and 4 females) were selected for the study and implants were evaluated for posttreatment changes in at 3, 6, 9 and 12 months from implant placement. The implant probing depth and mobility were recorded 3 and 6 months after prosthesis placement. Also, peri-implant bone level was assessed at the baseline and 12 months postoperatively, followed by a statistical analysis. Results: The mean plaque and gingival indices showed a reduction at repeated intervals. The mean sulcular bleeding showed a slight reduction which was statistically significant. An overall mean bone loss was observed after 12 months follow-up, which was statistically not significant. The overall survival rate of implants was reported as 92.3%. Conclusion: The specific implant used in the study is advantageous in the soft bone condition. Clinical Significance: Although, there is a great evidence of implant failure in compromised jaw quality, the newer designs and approaches suggest that the poor quality is not a contraindication. PMID:25684910
Vasil'ev, A P; Senatorov, Iu N; Strel'tsova, N N; Gorbunova, T Iu
Modification of erythrocytic membrane and the trend in clinicofunctional indices were studied in 90 patients with angina of effort (FC I-IV) in the course of treatment with a combination of membranoprotective drugs (group 1), magneto-laser radiation (group 2) and imitation of laser radiation (group 3). In patients of groups 1 and 2 the treatment resulted in stabilization of cell membrane accompanied with a hypotensive effect and increased exercise tolerance due to more effective cardiac performance.
Rao, Srivatsa Nagaraja; Kumaran, Chandrababu Kadassery; Kochukunju, Bhaskaran Vadakkekottu
Introduction Clinically, subcoracoid impingement is characterized by pain at the anterior aspect of the shoulder that is induced by adduction, internal rotation and forward flexion. This position leads to narrowing of the Coraco-Humeral Interval (CHI)-that is, the space between the coracoid process and the lesser tuberosity of the humerus. Structures in the rotator interval are at greatest risk for impingement which includes the Subscorapularis tendon, tendon of the long head of the biceps, and the middle gleno-humeral ligament. This may result in Rotator interval pathologies such as subscapularis tear and long head of biceps tendon subluxation or fraying. Aim To study the prevalence of radiological evidence of reduced Coraco-Humeral Interval (CHI) in patients with clinically evident Subcoracoid impingement and to examine the presence of Subscapularis tears in these patients. Materials and Methods Twenty four patients (6 males, 18 females, average age 52.83 years) were included in this prospective study who were diagnosed to have rotator cuff tears clinically. Nine of these patients were clinically found to have concomitant subcracoid impingement. All patients were subjected to MRI of shoulder. Measurement of the CHI was done in images with humerus in maximal internal rotation. Presence of subscapularis tear was examined intraoperatively. Statistical evaluation of the data was performed using Student’s t-test and Fisher’s exact test and the results were applied to two cohorts of patients. One cohort consisted of patients who had a CHI value of less than 5.5mm and the other cohort had a CHI value greater than 5.5mm. Average CHI values in patients with and without a subscapularis tear were determined. Results Nine patients who had clinical subcoracoid impingement were found to have an average CHI of 5.33mm. All nine of them had an associated tear of subscapularis with long head of Biceps tendon subluxation and/or fraying. Remaining 15 patients had an average CHI of 10.48 and they did not have either signs of Subcracoid impingement or subscapularis tear but had a tear elsewhere (Supraspinatus or Infraspinatus). Difference between these two groups was found highly significant (p-value<0.001). All patients with a CHI value of equal to, or less than 5.5mm had a subscapularis tear, whereas only 11% of patients with a CHI value more than 5.5mm had a tear (p-value<0.001, highly significant). Conclusion Reduction in the CHI has a significant association with rotator interval pathologies such as subscapularis tears and subluxation or fraying of long head of biceps tendon. Treatment of such patients should include modalities such as coracoplasty or anterior shoulder stabilisation. We recommend that clinical evidence of subcoracoid impingement should lead to further Investigation in the form of MRI and estimation of CHI. A CHI of less than 5.5 mm may indicate subscapulais tear in Indian patients. PMID:27790534
Kumar, Naveen Kommineni; Reddy, Veera Kishore Kasa; Padakandla, Prathyusha; Togaru, Harshini; Kalagatla, Swathi; Reddy, Vinay Chand M.
Background: Chemokines are pro-inflammatory cells that can be induced during an immune response to recruit cells of the immune system to a site of infection. Aim: This study was conducted to detect the presence of chemokines, macrophage inflammatory protein-1α (MIP-1α), and 1β (MIP-1β) and estimate their levels in gingival crevicular fluid (GCF) in children with band and loop space maintainers. Materials and Methods: MIP-1α and MIP-1β levels were estimated in GCF samples from twenty healthy children and twenty children with band and loop space maintainers. Periodontal status was evaluated by measuring gingival index, plaque index, and Russell's periodontal index. The GCF samples were quantified by ELISA, and the levels of MIP-1α and MIP-1β were determined. Results: The mean MIP-1α concentrations in healthy children and those with space maintainers were 395.75 pg/µl and 857.85 pg/µl, respectively, and MIP-1β was 342.55 pg/µl and 685.25 pg/µl, respectively. MIP-1α and MIP-1β levels in GCF from children with space maintainers were significantly higher than in the healthy group, and statistically significant difference existed between these two groups. Conclusion: MIP-1α and MIP-1β can be considered as novel biomarkers in the biological mechanism underlying the pathogenesis of gingival inflammation in children with space maintainers. PMID:27630491
Enos, Daniel; Moreira, José Luis; Alvaredo, Fátima; Oddó, David
Abstract The patient was an 18-year-old man who developed nephrotic syndrome after a ‘wheat spider’ bite (Latrodectus mactans). Due to this atypical manifestation of latrodectism, a renal biopsy was performed showing minimal change disease. The nephrotic syndrome subsided after 1 week without specific treatment. This self-limited evolution suggests that the mechanism of podocyte damage was temporary and potentially mediated by a secondary mechanism of hypersensitivity or direct effect of the α-latrotoxin. The patient did not show signs of relapse in subsequent checkup. This is the first reported case of nephrotic syndrome due to a minimal change lesion secondary to latrodectism.
Berciano, José; Gallardo, Elena; García, Antonio; Ramón, César; Infante, Jon; Combarros, Onofre
Long-term follow-up studies in Charcot-Marie-Tooth disease type 1 duplication (CMT1A) are scanty. Here we describe a longitudinal study in a CMT1A pedigree. Our CMT1A pedigree comprised 11 examined patients, ages between 13 and 83 (median, 36) years, serially evaluated for up to 26 years. In all 11 patients we carried out electrophysiological evaluation, and in three of them magnetic resonance imaging (MRI) of lower-limb musculature. The 54-year-old proband patient, yearly examined as of age 28, developed at age 48 gradual and progressive distal lower-leg weakness ascending to thigh musculature. His serial electrophysiological studies showed diffuse slowing of motor conduction velocity, absence or severe attenuation of distal compound muscle action potentials, and spontaneous muscle activity in the tibialis anterior and rectus femoris. Two MRI studies of lower limbs, at ages 51 and 54, showed extensive fatty atrophy of lower-leg musculature, and progressive and distally accentuated fatty atrophy of anterior and posterior femoral muscles. An outstanding finding in the first MRI was the presence of marked edema of anterior femoral musculature, which to a great degree was replaced by fatty atrophy in the second study. Muscle edema was also noted in lower-leg and posterior femoral musculature. There was minimal fatty atrophy of the gluteus maximus, the remaining pelvic muscles being preserved. The other ten patients showed mild or moderate phenotype, which remained quiescent over the period of observation. Electrophysiological studies disclosed diffuse and uniform slowing of nerve conduction velocities; in no case was spontaneous muscle activity recorded. MRI showed the CMT1A characteristic pattern of distally accentuated fatty atrophy involving foot and lower-leg musculature with preservation of thigh musculature. We conclude that a small proportion of patients with CMT1A develop a late progression of disease manifested with accentuated distal leg weakness ascending to involve thigh musculature, and that long-term follow-up is essential for its detection.
Perayil, Jayachandran; Menon, Keerthy S.; Biswas, Raja; Fenol, Angel; Vyloppillil, Rajesh
Background: This study was performed to evaluate and compare the clinical and antimicrobial efficacy of subgingival irrigation with tetracycline and povidone-iodine as an adjunct to nonsurgical periodontal therapy. Materials and Methods: Twenty subjects with chronic moderate periodontitis were recruited in this split-mouth study with probing pocket depth of >3 and ≤5 mm and clinical attachment loss of 3-4 mm in relation to 16, 36, and 46. In each subject, three selected periodontal pockets were assigned to receive one out of three irrigants (1) sterile water (control) in 16; (2) tetracycline at 10 mg/ml in 36; (3) 2% povidone-iodine in 46, and these sites were designated as Group A, Group B, and Group C, respectively. Plaque score, gingival score, pocket probing depth, and clinical attachment level were evaluated before treatment and at 1 and 3 months posttreatment. Multiplex polymerase chain reaction was used to detect Porphyromonas gingivalis and Tannerella forsythensis which have been implicated as the major risk factors for periodontal disease. Subgingival plaque collected before treatment and at 1 and 3 months posttreatment. Data were analysed using ANOVA and repeated measure ANOVA. Results were considered significant if P < 0.05. Results: Clinical and microbiological parameters were reduced posttreatment, the reduction being significantly higher in Group B compared to Group C. Conclusion: It can be concluded that chemical and mechanical therapies were of slight benefit in the treatment of chronic moderate periodontitis, and there was an adjunctive effect of significance when scaling and root planing was combined with a single subgingival irrigation with tetracycline or povidone-iodine in lower concentration. PMID:27076823
Colaci, M; Sebastiani, M; Manfredi, A; Giuggioli, D; Cassone, G; Manzini, C U; Ghizzoni, C; Cerri, S; Ferri, C
The study investigated the characteristic of interstitial lung disease in a large series of systemic sclerosis (SSc) patients by means of HRCT and the correlations between functional lung parameters, serological features and the extent of lung involvement evaluated by high-resolution computed tomography (HRCT). One hundred and seven SSc patients, consecutively investigated by means of HRCT, standard chest X-ray, and pulmonary function tests, were retrospectively evaluated. Chest radiogram and HRCT scores were strongly associated (Pearson's r=0.82, p < .0001); moreover, the first significantly correlated with spirometric parameters, even if weakly. Anti-Scl70 and anti-centromere antibodies were associated with higher (p=0.01) and lower HRCT score (p=0.0002), respectively. The extension of interstitial lung involvement in SSc evaluated with HRCT is directly proportional to functional lung parameters. HRCT, spirometry and DLco should be considered essential in the core-set of non-invasive diagnostic tools for the first-line assessment of scleroderma lung involvement.
Méndez, Gonzalo P; Enos, Daniel; Moreira, José Luis; Alvaredo, Fátima; Oddó, David
The patient was an 18-year-old man who developed nephrotic syndrome after a 'wheat spider' bite (Latrodectus mactans). Due to this atypical manifestation of latrodectism, a renal biopsy was performed showing minimal change disease. The nephrotic syndrome subsided after 1 week without specific treatment. This self-limited evolution suggests that the mechanism of podocyte damage was temporary and potentially mediated by a secondary mechanism of hypersensitivity or direct effect of the α-latrotoxin. The patient did not show signs of relapse in subsequent checkup. This is the first reported case of nephrotic syndrome due to a minimal change lesion secondary to latrodectism.
Gusev, E I; Burd, G S; Gekht, A B; Skvortsova, V I; Bogomolova, M A; Selikhova, M V; Fidler, S M
Thirty patients with acute ischemic stroke and at early terms of postapoplectic recovery received cerebrolysin in daily doses 10, 20 and 30 ml for 5 days or 10 ml, i. v. for 10 days, respectively. The patients were examined for neurological status and cerebral function. In acute stroke the highest effect occurred in the affection of moderate severity. In severe stroke the drug stimulated recovery of impaired functions which tended to restore more quickly than in control subjects. In early convalescents cerebrolysin improved motor functions. Details of the results of the combined neurophysiological examination in the course of the treatment are discussed.
Shekhawat, Vishal; Banshiwal, Ramesh Chandra; Verma, Rajender Kumar
Introduction The distal humeral fractures are common fractures of upper limb and are difficult to treat. These fractures, if left untreated or inadequately treated, leads to poor outcomes. Management of distal humeral fractures are pertained to many controversies and one among them is position of plates. Aim To compare the clinical and radiological outcomes in patients with intra-articular distal humerus fractures, treated using parallel and perpendicular double plating methods. Materials and Methods A total of 38 patients with distal humerus fractures, 20 in perpendicular plating group (group A) and 18 in parallel plating group (group B), were included in this prospective randomised study. At each follow up patients were evaluated clinically and radiologically for union and the outcomes were measured in terms of Mayo Elbow Performance Score (MEPS) consisting of pain intensity, range of motion, stability and function. MEP score greater than 90 is considered as excellent; Score 75 to 89 is good; Score 60 to 74 is fair and Score less than 60 is poor. Results In our study, 15 patients (75%) in group A, and 13 patients (72.22%) in group B achieved excellent results. Two patients (10%) in group A and 4 patients (22.22%) in group B attained good results. Complications developed in 2 patients in each groups. No significant differences were found between the clinical outcomes of the two plating methods. Conclusion Neither of the plating techniques are superior to the other, as inferred from the insignificant differences in bony union, elbow function and complications between the two plating techniques.
Josephs, Keith A; Murray, Melissa E; Tosakulwong, Nirubol; Whitwell, Jennifer L; Knopman, David S; Machulda, Mary M; Weigand, Stephen D; Boeve, Bradley F; Kantarci, Kejal; Petrucelli, Leonard; Lowe, Val J; Jack, Clifford R; Petersen, Ronald C; Parisi, Joseph E; Dickson, Dennis W
We investigate whether there is any association between the Braak neurofibrillary tangle (NFT) stage and clinical and MRI features in definite primary age-related tauopathy (PART). We analysed 52 cases with a Braak NFT tangle stage >0 and ≤IV, and a Thal phase of 0 (no beta-amyloid present). Twenty-nine (56%) were female. Median age at death was 88 years (IQR 82-92 years). Fifteen (29%) were TDP-positive (75% TDP stage I), 16 (31%) had argyrophilic grain disease and three (6%) had alpha-synuclein-positive Lewy bodies. TDP-43 inclusion when present were rare and predominantly perivascular. Of the 15 with TDP-43, three showed a moderate number of inclusions and also had hippocampal sclerosis, neuronal intranuclear inclusions and fine neurites of the CA1 region of the hippocampus. Four cases (8%) had an apolipoprotein epsilon 4 (APOE4) allele. There was a significant correlation between age at death and Braak NFT stage (r = 0.32, p = 0.02). After accounting for age at clinical examination, there were significant associations between Braak NFT stage, and WAIS-R Block Design and Trail Making Tests A and B, with higher Braak stage associated with poorer performances. Thirty of the 52 cases had completed an antemortem volumetric head MRI. Two separate MRI analyses revealed an association between higher Braak NFT stage and grey matter atrophy in the head of the left hippocampus. There were no significant clinical or radiologic associations with TDP-43. Findings from this study demonstrate that aggregated tau distribution is associated with poorer cognitive performance, as well as atrophy, in the absence of beta-amyloid. These findings support the parcellation of definite PART as a useful construct. The relatively low frequencies of APOE4, TDP-43, Lewy bodies, and hippocampal sclerosis, and the rarity and morphology of TDP-43 lesions are noted contrasts to what is typically observed in Alzheimer's disease of the old.
Kularatne, Senanayake A M; Dinamithra, Nandana P; Sivansuthan, Sivapalan; Weerakoon, Kosala G A D; Thillaimpalam, Bhanu; Kalyanasundram, Vithiya; Ranawana, Kithsiri B
In recent years, stings of a lethal scorpion species were recorded from Jaffna Peninsula in the northern dry zone of Sri Lanka. This species was identified as Hottentotta tamulus (Scorpiones: Buthidae) which is the Indian red scorpion commonly found in Maharashtra, India. The Teaching Hospital, Jaffna recorded 84 H. tamulus stings over a year in 2012 and of them, 23 cases provided offending scorpions (proven cases). Three localities in Jaffna were recorded as hotspots of scorpion stings namely Palali, Achchuvali and Karainagar. Of the proven cases, 13 (57%) and 10 (43%) were males and females respectively and had a mean age of 30 years (SD ± 20 years). Among them, 5 (22%) were children below 12 years. In 13 (57%) patients stings occurred inside their houses including two children (40%). Six (26%) stings occurred at night when the victims were in sleep. Median time taken to arrive at the hospital from the time of stinging was 58 min (range 8-550 min). Signs of over activation of autonomic nervous system predominated the clinical picture-tachycardia in 14 (61%), high blood pressure in 11 (48%), excessive sweating in 9 (39%), excessive salivation in 5 (22%), hypotension in 4 (17%) and piloerection in 3 (13%). Children showed higher predilection to develop tachycardia - 4 (80%) and excessive salivation - 3 (60%). Priapism was not observed and 17 (74%) patients have developed intense pain at the site of sting. The commonest ECG change was tachycardia (73%) and occasional T wave inversion. Prazosin as a treatment was given to 22 (96%) patients. All patients made recovery and 13 (57%) patients left the hospital within two days. In future, there is a potential risk of spreading this species to elsewhere in the country and may disturb the ecological balance.
Angeles-Angeles, A; Quintanilla Martínez, L; Muñoz Fernández, L; Espinoza Vázquez, B; Victoría Peralta, P
Comparison of clinical and autopsy findings of the cases studied between 1984 and 1988, were made at the Department of Pathology of the Instituto Nacional de la Nutricion Salvador Zubiran in Mexico City. The goal was to determine the accuracy of clinical diagnoses. The total number of cases was 429. A decreasing number of autopsies as a function of time was observed. Thus, in 1985, 34.65% of the deaths was autopsied, whereas in 1988, the number dropped to 21.16%, overall mean of 27.31%. In 229 autopsies (53.8%), 353 findings of clinical significance were found; of these, 86 were in the main diagnoses and 267 in the causes of death. There were 171 overdiagnoses with therapeutic implications, 38 in the main diagnoses and 133 in the causes of death. Overdiagnoses and underdiagnoses were most common in infectious diseases, followed by respiratory and digestive diseases, while endocrinologic and rheumatologic diseases had the highest diagnostic concordance. It was also found that the diagnostic accuracy did not improve with time of hospitalization. A brief analyses of the probable causes of the decrease in the number of autopsies is made. It is concluded that, in spite of the great advances in clinical and technological knowledge, the high frequency of disagreements between clinical and anatomical diagnoses, indicate that autopsy continues playing a key role in the quality control of medical practice. This justifies by itself the performance of necropsies.
Rossi, Elisa; Grisanti, Salvatore; Villanacci, Vincenzo; Casa, Domenico Della; Cengia, Paolo; Missale, Guido; Minelli, Luigi; Buglione, Michela; Cestari, Renzo; Bassotti, Gabrio
Barrett’s oesophagus (BO) is the primary precursor lesion for oesophageal adenocarcinoma (ADC). The natural history of metaplasia-dysplasia-carcinoma sequence remains largely unknown. HER2/neu oncogene results overexpressed/amplified in preneoplastic lesions and in ADC of the oesophagus and it has been associated with poor prognosis. Our aim was to evaluate the role of HER2 overexpression/amplification in predicting the conversion from precursor lesions to ADC. We retrospectively evaluated by univariate analysis of single variables clinical records and histological specimens of 21 patients with a confirmed diagnosis of BO and/or oesophageal dysplasia. Clinical variables included age, gender, alcohol and smoking intake, presence of symptoms (pyrosis, disphagia) and endoscopic features (length). HER2 status was studied by immunohistochemistry and fluorescence in situ hybridization (FISH) on paraffin-embedded tissue. The end-points were the occurrence of progression and the time-to-progression (TTP) from the initial histologic lesion to the worst pathological pattern. Median age at diagnosis was 63 years (range 37–84). BO median length was 4.5 cm. Progression occurred in 11 of 21 patients and median TTP was 24 months. HER2 was overexpressed/amplified in 8 of 21 (38%) patients. HER2 overexpression/ amplification and the presence of dysplasia were statistically associated with progression (P= 0.038). This study provides evidence for a possible role of HER2 in the transition from dysplasia to ADC of the oesophagus. This fact could help in identifying patients at high risk of malignant transformation. PMID:19292734
Khlifi, Abdeljalil; Kacem, Olfa; Maroueni, Maher; Elgoul, Leila; Hidar, Samir; Fekih, Meriem; Boughizane, Sassi; Essaidi, Habib; Ben Regaya, Lassad; Bibi, Mohamed; Ajina, Mounir; Khairi, Hedi
Objective To investigate the difference in the outcome of ICSI-ET cycles among respondents patients, taking into account the molecule inducer of controlled ovarian stimulation: HP-hMG ou rFSH. Patients and Methods A comparative retrospective study over 62 months including a total of 1005 infertile couples, divided into two groups: HP-HMG (n=125) and rFSH (n=880). Results - The average numbers of retrieved oocytes and matures oocytes were significantly higher in rFSH group rFSH (7,94 ± 2,49, HP-HMG vs 9,05 ± 3,40, rFSH, p=0.0001and 3±2,68, HP-HMG vs 6,65±3,05 , rFSH, p=0,02 respectively). There was no statistically significant difference in the endometrial thickness and estradiol level on hCG injection day, the total amount of administrated gonadotropin and the duration of stimulation. In addition, we did not find a significant difference between the two groups regarding the fertilization, the maturation, the cleavage, top quality embryo, implantation, clinical pregnancy, multiple pregnancies, live birth and miscarriage rates. There was no case of severe ovarian hyperstimulation syndrome. Conclusion - Inspite of a higher number of retrieved and mature oocytes obtained with rFSH, the latter showed no superiority over HP-hMG which seem to be equally efficient and safe for ICSI treatment cycles.
Jordan, Adam D; Khan, Muhammad E A; Hoey, Edward T; Rassl, Doris; Nashef, Samer A M
Constrictive pericarditis is the commonest cardiac complication of rheumatoid arthritis (RA). Two percent of patients with RA develop significant clinical symptoms of pericarditis, which may not correlate with joint disease duration or severity. Symptoms are often vague and non-specific, which frequently delays the diagnosis and subsequent management. Surgical excision of the pericardium is the only definitive treatment option. We present the case of a 60 year-old lady with RA who presented with symptoms due to pericardial constriction and underwent radical pericardectomy.
Raspollini, Maria Rosaria; Castiglione, Francesca; Cheng, Liang; Montironi, Rodolfo; Lopez-Beltran, Antonio
We report a rare case of synchronous clear cell renal cell carcinoma and multilocular cystic renal cell neoplasia of low malignant potential in the same kidney. The tumors were seen incidentally in a 45-year-old man. Pathologic study revealed that the former tumor was nucleolar grade 2, and the multilocular cystic renal cell neoplasia of low malignant potential was nucleolar grade 1. At immunohistochemistry, the clear cells in both tumors were positive for CD10 and CA IX. Interestingly, these uncommon synchronous tumors showed a different KRAS/NRAS mutation analysis that was characterized by KRAS mutation at codon p.G12C in the clear cell renal cell carcinoma, while this mutation was not present in the case of multilocular cystic renal cell neoplasia of low malignant potential. NRAS mutation was not seen in any of the tumors.
Grigore, Lavinia Elena; Baican, Corina Iulia; Botar-Jid, Carolina; Rogojan, Liliana; Letca, Alina Florentina; Ungureanu, Loredana; Cosgarea, Rodica
There is a large spectrum of tumors presenting as nodular lesions that may affect the subungual space. We report the case of a 62-year-old woman presenting with a rapidly growing nodular lesion under the nail of the first left toe. Non-invasive examinations using dermoscopy, ultrasonography and elastography were performed for the preoperative assessment of the lesion. The biopsy of the lesion revealed superficial acral fibromyxoma, a benign tumor with predisposition for acral sites. The patient underwent radical surgery with wide resection margins. This is the first case report of a superficial acral fibromyxoma affecting the subungual region characterized by dermoscopic, ultrasonographic and elastographic features. We also performed a short review of the literature.
Naqvi, Jawad; Laitt, Roger; Leatherbarrow, Brian; Herwadkar, Amit
A 72-year-old male presented with progressive right axial proptosis and red eye. Catheter angiography demonstrated an intraorbital arteriovenous fistula (IAVF) distal to the central retinal artery (CRA). Transvenous embolisation following direct surgical exposure of the superior ophthalmic vein (SOV) resulted in rapid resolution of his symptoms and signs. Transvenous embolisation via the SOV is a safe, effective alternative to transarterial embolisation for treating spontaneous IAVF where transarterial embolisation poses a risk of CRA occlusion.
Bhattacharyya, Nirupam; Pujar, Muralidhar P.; Chaturvedi, Ashutosh; Kumar, M. Ashvini; Lohith, B. A.; Kumar, K. N. Sunil
Objectives: Wrightia antidysenterica Linn. (WA) is male variety Kutaja stated to be potent therapeutic emetic agent in skin disorders. Expulsion of doshas through oral route is termed as Vamana Karma (VK) (therapeutic emesis). However, so far, its utility for Vamana is not explored in detail, therefore there is a need to revalidate the utility of WA for Vamana. Hence, the above study was conducted to ascertain the efficacy as a therapeutic emetic agent (vamaka yoga) in the management of psoriasis along with quality control and standardization of this herb. Materials and Methods: The drug was standardized as per analytical procedures in Pharmacopeias. Thirty patients of psoriasis fulfilling inclusion criteria were taken for the study and Vamana with WA was conducted. Criteria were prepared to assess the signs and Symptoms of psoriasis. VK was assessed using the classical Lakshanas (features) such as Anthiki shudhi (Ending symptoms of emesis), Vaigiki shudhi (features of vomiting bouts), Maniki shudhi (Quantitative and qualitative purification), complications. Result: VK with WA showed significant relief in parameters of psoriasis such as scaling, itching, candle grease sign (P < 0.001), and psoriasis area and severity index score (P = 0.001). In VK with WA, mean number of Vegas (vomiting bouts) was 6.91. 66% patients showing quantitative purification between 301 and 600 ml. 73.33% showed all Symptoms of purification. 73.33% patients showed Kaphanta vamana (Moderate expulsion of desire humor). In the level of biopurification, 66.66% patients showed moderated purification. No complication was noted with moderate drug palatability. Conclusion: Pharmacopeial analytical study showed its standardized values for testing the drug used for the study. It is proved as potent therapeutic emetic agent with no complication showed its clinical benefits over skin disorder like psoriasis. SUMMARY Seeds of Wrightia antidysenterica (WA) Linn. free from any foreign matter were selected for the study. Loss on drying revealed 6.535% moisture content; total ash indicating of total inorganic content was found to be 5.12%; acid insoluble ash is the acid insoluble part of total ash, mainly silica, WA showed 0.393% acid insoluble ash; ethanol and water soluble extractive is indicative of percentage active constituents were found to be 25.66 and 20.854%, respectively. High-performance thin layer chromatography fingerprinting profiles of WA under 254 nm showed the presence of 7 spots (all in green) at Rf values ranging from 0.21 to 0.88. Under 366 nm there were 4 prominent spots (all in fluorescent) at Rf 0.49 to 0.82 and, when scanned under white light 620 nm following derivatization with vanillin sulfuric acid 6 spots (in different colors) were evident at Rf 0.28 to 0.58. Among these spot with Rf of 0.58 was common when visualized under all the three methods. Rf values by densitometric scan of WA showed 12 peaks at 254 nm and 5 peaks at 366 nm. However, in clinical trial, it was found to be a potent emetic agent without any complication. Abbreviations Used: WA: Wrightia antidysenterica; Linn.; VK: Vamana karma; BT: Before treatment; FP: Freidman's P value; CHS: Chi-square value; NR: Negative ranks; PR: Positive ranks; N: Sample number, AS: Austipz sign; CG: Candle grease test; SSL: Samyak Snigdha Lakshana PMID:27114687
[The clinico-dopplerographic characteristics of the initial manifestations of cerebral circulatory insufficiency in patients with vertebral artery hypoplasia combined with osteochondrosis of the cervical spine].
Gongal'skiĭ, V V; Tsiurko, B O
In the examination of 44 patients with primary hypoplasia of the vertebral artery (less than 2.5 mm in diameter) associated with osteochondrosis of the cervical segment of the vertebral column there have been revealed the following neuropathological manifestations of cerebral circulation insufficiency in the vertebral-basilar basin: cephalalgia, cochlear syndrome, vestibulocerebellar syndrome, vegetovascular dystonia. Ultrasound investigation of the vertebral arteries bloodflow showed a decrease in bloodflow in the intracranial length of the hypoplastic artery and an increase in the resistance to bloodflow in the extracranial segments (V2, V3). Ten patients with functional disorders in the cervical portion of the spine were exposed to orthopedic therapy directed to restoration of mobility and of topography of individual motor segments of the spinal cervical section. The studies made showed that hypoplasia of vertebral arteries can present as cerebral circulatory insufficiency in the vertebral-basilar basin, which tends to increase or reveals itself in a concurrent development of vertebrogenic reflex vasoconstriction. Restoration of the spine function (mobility) is an effective medico-prophylactic measure aimed to resolve the vertebrogenically caused spasm of the artery.
Chung, Eric Lim Teik; Abdullah, Faez Firdaus Jesse; Ibrahim, Hayder Hamzah; Marza, Ali Dhiaa; Zamri-Saad, Mohd; Haron, Abdul Wahid; Lila, Mohd Azmi Mohd; Norsidin, Mohd Jefri
Haemorrhagic septicaemia is a disease caused by Pasteurella multocida serotype B: 2 and E: 2. The organism causes acute, highly fatal septicaemic disease with high morbidity and mortality in cattle and more susceptible in buffaloes. Lipopolysaccharide can be found on the outer cell wall of the organism. Lipopolysaccharide is released during multiplication which leads to inflammatory reaction. It represents the endotoxin of P. multocida type B: 2 and responsible for toxicity in haemorrhagic septicaemia which plays an important role in the pathogenesis of the disease. Therefore, the aim of this study was to investigate the clinical signs, blood parameters, gross post mortem lesions and histopathology changes caused by P. multocida type B:2 immunogen lipopolysaccharide infections initiated through intravenous and oral routes of infection. 9 buffalo heifers were divided equally into 3 treatment groups. Group 1 was inoculated orally with 10 ml of phosphate buffer saline (PBS); Group 2 and 3 were inoculated with 10 ml of lipopolysaccharide broth intravenously and orally respectively. For the clinical signs, there were significant differences (p < 0.05) in temperature between the control, intravenous and oral group. In hematology and biochemistry findings, there were significant differences (p < 0.05) in erythrocytes, haemoglobin, PCV, MCV, lymphocytes, monocytes, eosinophils, GGT and albumin between the control, intravenous and oral group. However, there were no significant differences (p > 0.05) in the MCHC, leukocytes, band neutrophils, basophils, thrombocytes, plasma protein, icterus index, total protein, globulin and A:G ratio between intravenous and oral group. For Group 2 buffaloes, there were gross lesions in the lung, trachea, heart, liver, spleen, and kidney. In contrast, lesions were only observed in the lung, trachea and liver of Group 3 buffaloes. There were significant differences (p < 0.05) in hemorrhage and congestion; necrosis and degeneration; and inflammatory cells infiltration between experimental groups and control group. However, there were no significant differences (p > 0.05) in edema lesion between groups. In conclusion, this study is a proof that oral route infection of P. multocida type B:2 immunogen lipopolysaccharide can be used to stimulate host cell responses where oral vaccine through feed could be developed in the near future.
Kumar, Neeraj; Malhotra, Hardeep Singh; Gupta, Rakesh Kumar; Verma, Rajesh; Sharma, Praveen Kumar
Objective To evaluate the role of advanced magnetic resonance (MR) sequences (fast imaging employing steady-state acquisition (FIESTA), T2 star-weighted angiography (SWAN) and spoiled gradient recalled echo (SPGR)) in patients with single small enhancing computed tomography lesions and scolex demonstration in typical and atypical parenchymal neurocysticercosis. Methods In this study, 59 patients of new-onset seizures with single small enhancing computed tomography lesions of the brain were included. Along with routine MR sequences, advanced MR sequences, like SWAN, FIESTA, and pre and post-contrast SPGR, were performed. Follow-up MR studies focussing on the morphology of the lesions and demonstration of scolex were performed 6 monthly for 3 years. Results The majority of patients (62.7%) were men with partial seizure as the most common manifestation. On SPGR, contrast lesions were identified as either ‘typical’ (42, 71.2%) or ‘atypical’ (17, 28.8%). In the typical lesion group, SWAN and FIESTA sequences detected scolex in 30 (71.4%) and 32 (76.2%), respectively. The combination of SPGR-contrast, FIESTA and SWAN sequences detected scolex in 35 (83.3%) patients compared to 19 (45.2%) by routine sequences (P < 0.001). In the atypical lesion group, SWAN and FIESTA sequences detected scolex in 15 (88.2%) and 16 (94.1%) patients, respectively. The combination of SPGR-contrast, FIESTA and SWAN sequences detected scolex in 16 (94.1%) patients compared to 10 (58.8%) by routine sequences (P < 0.001). Follow-up showed greater resolution with lesser calcification in the typical group compared to the atypical group. Conclusion This study provides an insight into the natural course of typical and atypical solitary cysticercus granuloma lesions, and the utility of SPGR-contrast, FIESTA and SWAN MR sequences in scolex demonstration and identification of atypical lesions. PMID:26659345
Bhardwaj, Isha; Bhushan, Anoop; Baiju, Chandrababu Sudha; Bali, Shweta; Joshi, Vaibhav
Background: One-stage nonsubmerged protocol which can achieve success rates comparable to implants placed in a two-staged submerged procedure also the preconditions for periimplant bone regeneration has lead to more refined concepts of implant loading. Materials and Methods: Twenty sites with single missing tooth were included in this study. Clinical parameters included sulcus bleeding index (sBI), probing pocket depth (PD), and papilla index (PI) and radiographic parameters included crestal bone level were assessed for a period of 9 months. Results: The crestal bone loss showed mean value ranging from baseline 0.25 ± 0.11 to 0.31 ± 0.08 at 3 weeks, to 0.67 ± 0.13 at 3 months, to 0.85 ± 0.09 at 6 months, and to 0.88 ± 0.12 at 9 months. Probing PD, the mean value for probing PD at 3 weeks 1.20 ± 0.83, 3 months 1.60 ± 1.1, at 6 months 1.40 ± 1.14, and at 9 months 1.20 ± 1.0. sBI, mean value for sBI at 3 weeks 0.00 ± 0.00, 3 months 0.3 ± 0.11, at 6 months 0.09 ± 0.25, and at 9 months 0.08 ± 0.24. PI, showed a significant difference among at different points of time with P = 0.000. Conclusion: The dental implants showed <1 mm of crestal bone loss at 9 months follow-up, clinically significant marginal bone loss occurred between the time of implant placement and 3 months. Subsequent to that, bone loss observed around the implant up to 9 months was minimal. The periimplant soft tissue maturity was maintained throughout the study. PMID:27041836
Bhat, Pragathi Raghavendra; Thakur, Srinath Lakshman; Kulkarni, Sudhindra Sushilendra
Background: The peri-implant mucosa undergoes surgical and bacterial assaults in various stages of implant therapy, however, the literature on changes occurring in the peri-implant mucosa is minimal. This study was thus conducted to evaluate the change in the peri-implant mucosal thickness and its effect on the marginal bone levels around dental implants treated in a conventional two-stage implant therapy. Materials and Methods: A total of 36 implants were placed in 22 subjects. Two subjects dropped out. Thirty-three implants in 20 subjects were then evaluated. Initial mucosal thickness, marginal bone levels on radiographs, pain, and exudation were evaluated. All these parameters were recorded at the time of implant placement, at the time of cementation of final restoration, 6 months and 12 months post cementation/restoration. Results: The peri-implant mucosal thickness reduced from implant placement to second stage and till restorations and was statistically significant, in both the thick and thin biotypes, however, at 12 months there was a rebound of the tissue thickness, which was more in the thick biotype (P < 0.05). At 1-year follow-up, there was a reduction in the marginal bone levels, which was more in the thick biotype as compared to the thin biotype (P < 0.05). Conclusion: The mucosa at implant sites undergoes a reduction in thickness from the time of implant placement till the placement of final restorations. The placement of the final restorations and then end of active therapy leads to a rebound of the tissue thickness. Sites with thicker tissues preoperatively have a lesser bone loss and better rebound as compared to thinner tissues. PMID:26941514
Bhandary, Rahul; Thomas, Biju; Ramesh, Amitha
Introduction Magnesium is an essential cation playing a crucial role in many physiological functions and its imbalance is associated with greater number of pathological situations. Oxidative stress is usually increased due to decreased essential nutrients. Hence, any imbalance of essential nutrients like serum magnesium can significantly play a role in the pathobiology of periodontitis in the presence of diabetes, as diabetes and chronic periodontitis are two chronic diseases that have been biologically linked. Aim To evaluate the association of serum magnesium in type 2 diabetes mellitus and chronic periodontitis patients, also to evaluate and associate the influence of serum magnesium on periodontal health. Materials and Methods A single blinded, randomized study was conducted that comprised of 120 subjects divided into four groups. Individuals with periodontitis and type 2 diabetes mellitus formed the test group. Subjects with chronic periodontitis diagnosed clinically according to 1999 American Academy of Periodontology classification, without any medical history and drug history were included as the study subjects. Gingival Index and Plaque Index were scored for all the groups at baseline and after 21 days of scaling and root planing. Scaling and root planing was done only in the test group. Blood was drawn from the patients at baseline and 21 days after scaling and root planning and estimation of serum magnesium level was done using semi-autoanalyzer. Data obtained was statistically analyzed using the paired t-test, one-way ANOVA, post-hoc test. Results The result of the present study showed that mean serum magnesium among healthy was 1.40±0.565mmol/l as compared to 1.01±0.287mmol/l among subjects with periodontitis, 0.920±0.23mmol/l among diabetics with periodontitis and 0.93±0.29mmol/l among diabetics without periodontitis. Serum magnesium was significantly decreased in chronic periodontitis and diabetic patients with and without chronic periodontitis as compared to controls. Conclusion Imbalance of serum magnesium level was seen in patients with chronic periodontitis and type 2 diabetes mellitus. Hence, it can be a biomarker which can predict the occurrence of type 2 diabetes mellitus and chronic periodontitis. PMID:28209006
Mubarak, Suhayla; Hmud, Ali; Chandrasekharan, Suresh; Ali, Aiman A.
Background: Heterogeneous groups of oral lesions are likely to develop among denture wearers. The objectives of this study were to determine the exact prevalence of oral lesions among denture wearers attending the clinics of the College of Dentistry, University of Dammam. Materials and Methods: All denture wearers attending the dental clinics in the period between January 2012 and April 2013 were included in this study. Of the total 210 patients, 166 (79%) were males and 44 (21%) were females. Comprehensive oral examination was performed for all patients. Any denture-induced lesion was biopsied. Data collected were analyzed using SPSS program. Results: Oral lesions were found in 20.5% of the cases under study (43 out of the total 210 denture wearers). Denture-induced fibrous hyperplasia was the most common type of lesion detected (41.9%). A significant correlation (P = 0.004) was found between the type of denture and oral lesions in this study. Conclusion: The prevalence of denture-induced oral lesions was found to differ significantly from that reported in other studies. The diversity of these lesions among different studies depends on the quality and materials of dentures delivered, the techniques used, and the methods of patients’ instructions adopted. PMID:26759806
Andujar, Pascal; Lecomte, Céline; Renier, Annie; Fleury-Feith, Jocelyne; Kheuang, Laurence; Daubriac, Julien; Janin, Anne; Jaurand, Marie-Claude
Although human malignant mesothelioma (HMM) is mainly caused by asbestos exposure, refractory ceramic fibres (RCFs) have been classified as possibly carcinogenic to humans on the basis of their biological effects in rodents’ lung and pleura and in cultured cells. Hence, further investigations are needed to clarify the mechanism of fibre-induced carcinogenicity and to prevent use of harmful particles. In a previous study, mesotheliomas were found in hemizygous Nf2 (Nf2+/−) mice exposed to asbestos fibres, and showed similar alterations in genes at the Ink4 locus and in Trp53 as described in HMM. Here we found that Nf2+/− mice developed mesotheliomas after intra-peritoneal inoculation of a RCF sample (RCF1). Clinical features in exposed mice were similar to those observed in HMM, showing association between ascite and mesothelioma. Early passages of 12 mesothelioma cell cultures from ascites developed in RCF1-exposed Nf2+/− mice demonstrated frequent inactivation by deletion of genes at the Ink4 locus, and low rate of Trp53 point and insertion mutations. Nf2 gene was inactivated in all cultures. In most cases, co-inactivation of genes at the Ink4 locus and Nf2 was found and, at a lower rate, of Trp53 and Nf2. These results are the first to identify mutations in RCF-induced mesothelioma. They suggest that nf2 mutation is complementary of p15Ink4b, p16Ink4a and p19Arf or p53 mutations and show similar profile of gene alterations resulting from exposure to ceramic or asbestos fibres in Nf2+/− mice, also consistent with the one found in HMM. These somatic genetic changes define different pathways of mesothelial cell transformation. PMID:17272307
Andujar, Pascal; Lecomte, Céline; Renier, Annie; Fleury-Feith, Jocelyne; Kheuang, Laurence; Daubriac, Julien; Janin, Anne; Jaurand, Marie-Claude
Although human malignant mesothelioma (HMM) is mainly caused by asbestos exposure, refractory ceramic fibres (RCFs) have been classified as possibly carcinogenic to humans on the basis of their biological effects in rodents' lung and pleura and in cultured cells. Hence, further investigations are needed to clarify the mechanism of fibre-induced carcinogenicity and to prevent use of harmful particles. In a previous study, mesotheliomas were found in hemizygous Nf2 (Nf2(+/-)) mice exposed to asbestos fibres, and showed similar alterations in genes at the Ink4 locus and in Trp53 as described in HMM. Here we found that Nf2(+/-) mice developed mesotheliomas after intra-peritoneal inoculation of a RCF sample (RCF1). Clinical features in exposed mice were similar to those observed in HMM, showing association between ascite and mesothelioma. Early passages of 12 mesothelioma cell cultures from ascites developed in RCF1-exposed Nf2(+/-) mice demonstrated frequent inactivation by deletion of genes at the Ink4 locus, and low rate of Trp53 point and insertion mutations. Nf2 gene was inactivated in all cultures. In most cases, co-inactivation of genes at the Ink4 locus and Nf2 was found and, at a lower rate, of Trp53 and Nf2. These results are the first to identify mutations in RCF-induced mesothelioma. They suggest that nf2 mutation is complementary of p15(Ink4b), p16(Ink4a) and p19(Arf) or p53 mutations and show similar profile of gene alterations resulting from exposure to ceramic or asbestos fibres in Nf2(+/-) mice, also consistent with the one found in HMM. These somatic genetic changes define different pathways of mesothelial cell transformation.
Kudva, Praveen; Tabasum, Syeda Tawkhira; Garg, Nidhi
Aim: To evaluate the clinical and metabolic changes following nonsurgical periodontal therapy of type-2 diabetic patients and nondiabetic patients. Materials and Methods: Fifteen nondiabetics and fifteen type-2 diabetics with moderate to severe periodontitis were selected after meeting inclusion and exclusion criteria. Periodontal pocket probing was performed using a Williams graduated periodontal probe and comparisons of the clinical and biochemical parameters like plaque index, gingival index, probing depth, glycated hemoglobin, and lipid profile (total cholesterol, high density lipoprotein, low density lipoprotein, triglycerides and very low density lipoprotein) were done between and within two groups at baseline and 3 month. Results: A correlation was observed between clinical and biochemical parameters between and within two groups at baseline and 3 month. The P value of diabetic group was<0.001 in all clinical parameters (plaque index PI, Gingival index GI, and Probing Pocket Depth PPD) in diabetic and nondiabetic group, showed statistically highly significant difference in GI, PI, PPD, <.01 in Glycated Hemoglobulin (HbAlc1) in test group and<0.05 in control group showed statistically significant difference. The P value of test group was >0.05 in Lipid profile (total cholesterol, low density lipoprotein, high density lipoprotein, serum triglyceride, very low density lipoprotein) that showed no significant difference and in control group<0.05 in total Cholesterol, high density lipoprotein and <0.01 in Low density lipoprotein, Very Low Density Lipoprotein, and Serum Triglyceride, respectively, showed statistically significant in Total cholesterol, Low density lipoprotein, Very Low Density Lipoprotein, and Serum Triglyceride, not significant in high density lipoprotein. The P value >0.05 showed no statistical significance of correlation between the test and control groups. Conclusion: Both groups of patients showed an improvement in clinical and metabolic parameters assessed at 3 months after nonsurgical periodontal therapy. PMID:21731253
West, A F; O'Donnell, M; Charlton, R G; Neal, D E; Leung, H Y
Vascular endothelial growth factor (VEGF) mediates neo-angiogenesis during tumour progression and is known to cooperate with the fibroblast growth factor (FGF) system to facilitate angiogenesis in a synergistic manner. In view of this, we have investigated VEGF expression in 67 cases of prostate cancer previously characterized for fibroblast growth factor-8 (FGF-8) expression. Cytoplasmic VEGF staining was detected in malignant cells in 45 out of 67 cases. Cytoplasmic staining was found in adjacent stromal cells in 32 cases, being particularly strong around nests of invasive tumour. Positive VEGF immunoreactivity in benign glands was restricted to basal epithelium. A significant association was observed between tumour VEGF and FGF-8 expression (P = 0.004). We identified increased VEGF immunoreactivity in both malignant epithelium and adjacent stroma and both were found to be significantly associated with high tumour stage (P = 0.0047 and P = 0.0002, respectively). VEGF expression also correlated with increased serum PSA levels (P = 0.01). Among positively stained tumours, VEGF expression showed a significant association with Gleason score (P = 0.04). Cases showing positive VEGF immunoreactivity in the stroma had a significantly reduced survival rate compared to those with negative staining (P = 0.037). Cases with tumours expressing both FGF-8 in the malignant epithelium and VEGF in the adjacent stroma had a significantly worse survival rate than those with tumours negative for both, or only expressing one of the two growth factors (P = 0.029). Cox multivariate regression analysis of survival demonstrated that stromal VEGF and tumour stage were the most significant independent predictors of survival. In conclusion, we report for the first time a correlation of both tumour and stromal VEGF expression in prostate cancer with clinical parameters as well as its correlation to FGF-8 expression. © 2001 Cancer Research Campaign http://www.bjcancer.com PMID:11506499
Gibbels, E; Behse, F; Kentenich, M; Haupt, W F
We present data of 2 patients suffering from chronic motor-sensory multifocal neuropathy with persistent conduction block. The first case concerns a 9-year follow-up of a female, aged 24 years at onset with persistent multiple conduction blocks and a tendency towards generalization of clinical deficits. Eight years after onset sural nerve biopsy revealed extreme interfascicular variations of de/remyelination, onion bulb formation, fiber loss, edema, and proliferation of basal lamina of endoneurial capillaries. Serum antibodies against GM1 gangliosides were not detected. The second case, a 29-year-old Yemenitic male with a 5-year history, exhibited conduction blocks in motor and sensory fibers, and a normal sural nerve biopsy. Our results are discussed with respect to those of some 30 cases individually reported in the literature.
Gomez-Moreta, Juan A.; Hernandez-Vicente, Javier
Background We present our experience in the treatment of patients with isthmic or degenerative spondylolisthesis, by means of a posterior lumbar interbody fusion (PLIF) and instrumented posterolateral fusion (IPLF), and we compare them with those published in the literature. We analyse whether there exists any statistical association between the clinical characteristics of the patient, radiological characteristics of the disease and our surgical technique, with the complications and the clinical-radiological prognosis of the cases. Method We designed a prospective study. A total of 36 cases were operated. The patients included were 14 men and 22 women, with an average age of 57.17±27.32 years. Our technique consists of PLIF+IPLF, using local bone for the fusion. The clinical results were evaluated with the Visual Analogical Scale (VAS) and the Kirkaldy-Willis criteria. The radiological evaluation followed the Bratingan (PLIF) and Lenke (IPLF) methodology. A total of 42 variables were statistically analysed by means of SPSS18. We used the Paired Student's T-test, logistic regression and Pearson's Chi-square-test. Results The spondylolisthesis was isthmic in 15 cases and degenerative in 21 cases. The postoperative evaluations had excellent or good results in 94.5% (n = 34), with a statistically significant improvement in the back pain and sciatica (p < 0.01). The rate of circumferential fusion reached was approximately 92%. We had 13.88% of transitory morbility and 0% of mortality associated with our technique. A greater age, degree of listhesis or length of illness before the intervention, weakly correlated with worse clinical results (p< -0.2). In our series, the logistical regression showed that the clinical characteristics of the patient, radiological characteristics of the lesion and our surgical technique were not associated with greater postoperative complications. Conclusion Although a higher level of training is necessary, we believe that the described technique is a very effective decision in cases of spondylolisthesis, isthmic or degenerative, refractory to conservative treatment, for the obtaining the best clinical results and rates of fusion, with similar risks to those of the other published techniques. Our statistical analysis could contribute to improve outcomes after surgery. PMID:26196029
Gekht, A B; Vialkova, A B; Galanov, D V
A study of betahistine (betaserc) in 65 patients aged 59,48 +/- 8,63 years with vertigo in early rehabilitation period of ischemic stroke has been carried out. Thirty-five patients got atiplatelet and antihypertensive therapy and were also treated by betaserc--8-16 mg 3 times per day for 14 days per os, after meals. The control group of 30 patients received only atiplatelet and antihypertensive therapy. Both groups were similar in demographic and clinical characteristics. The treatment with betahistine reduced the intensity and duration of vertigo, led to improvement of coordination and equilibrium, increase stability of a vertical posture that was accompanied by significant (p<0,05) improvement of the values on the Hoffenberth and Bohannon scales. Betahistine treatment also resulted in marked authentic (p<0,05) improvement of stabilometric parameters in biological feedback task that might be explained by activation of the mechanisms maintaining vertical balance. An improvement of clinical and neurophysiologic traits was more pronounced in the group treated with betaserc as compared to the control group.
Granov, A M; Aiskhanov, S K; Nikolaev, L I; Smirnova, N A
The complex of conservative measures for noncomplicated peptic ulcers included curative endoscopy in 105 patients, in 61 of them Aevitum was used as an application with additional injections of Solcoseryl around the ulcers. In 44 patients Aevitum was used along with Solcoseryl which was injected into the submucous layer around the pathological focus of the stomach and duodenum. The results obtained gave a convincing evidence of advantages of interstitial administration of Aevitum allowing to considerably shorten time of treatment (up to 10-12 days) of noncomplicated ulcers of the stomach and duodenum.
Shahi, Shipra; Katiyar, Raj Kishore; Gaur, Shailendra; Jain, Vikram
Background Rapeseed-mustard is the second most important source of edible oil in India. Several species of Brassica are grown in different parts of country for its oilseeds. Objective The objective was to investigate allergenicity to antigenic extracts of pollen of 4 species of Brassica. Methods Brassica campestris, Brassica juncea, Brassica nigra, and Brassica napus were selected for the detailed investigation. Pollen samples from each of the four species were collected from the polliniferous materials. The antigenic and allergenic profiles of these extracts were evaluated by means of sodium dodecyl sulfate-polyacrylamide gel electrophoresis, Skin prick test, enzyme linked immuno sorbent assay and Western blot on atopic individuals. Results Out of the 159 atopic subjects tested, 21.38% were positive to at least one or other species of Brassica pollen, with highest skin positivity (13.20%) to B. campestris extract. Raised IgE with significant linear correlation with intensity of skin reactions was obtained. Protein fractions of 20, 25, 32, 37, 56, and 90 kDa were recognized by B. campestris and B. juncea whereas 56, 76, 87, and 90 kDa were recognized by B. nigra and B. napus as major IgE binding protein fractions. The patients also showed positivity to other inhalant pollen allergens tested. Conclusion IgE mediated hypersensitivity varied from 4.40% to 13.20% in Indian atopic subjects to pollen of one or the other species of Brassica. Protein fractions of 47, 56, 76, 87, and 90 kDa were identified as IgE binding by all the four species, however individual heterogeneity exists. Thus a local species may be more pertinent for immunotherapy. The major allergen needs to be further characterized. PMID:25379479
De Nunzio, Giorgio; Tommasi, Eleonora; Agrusti, Antonella; Cataldo, Rosella; De Mitri, Ivan; Favetta, Marco; Maglio, Silvio; Massafra, Andrea; Quarta, Maurizio; Torsello, Massimo; Zecca, Ilaria; Bellotti, Roberto; Tangaro, Sabina; Calvini, Piero; Camarlinghi, Niccolò; Falaschi, Fabio; Cerello, Piergiorgio; Oliva, Piernicola
A fully automated and three-dimensional (3D) segmentation method for the identification of the pulmonary parenchyma in thorax X-ray computed tomography (CT) datasets is proposed. It is meant to be used as pre-processing step in the computer-assisted detection (CAD) system for malignant lung nodule detection that is being developed by the Medical Applications in a Grid Infrastructure Connection (MAGIC-5) Project. In this new approach the segmentation of the external airways (trachea and bronchi), is obtained by 3D region growing with wavefront simulation and suitable stop conditions, thus allowing an accurate handling of the hilar region, notoriously difficult to be segmented. Particular attention was also devoted to checking and solving the problem of the apparent 'fusion' between the lungs, caused by partial-volume effects, while 3D morphology operations ensure the accurate inclusion of all the nodules (internal, pleural, and vascular) in the segmented volume. The new algorithm was initially developed and tested on a dataset of 130 CT scans from the Italung-CT trial, and was then applied to the ANODE09-competition images (55 scans) and to the LIDC database (84 scans), giving very satisfactory results. In particular, the lung contour was adequately located in 96% of the CT scans, with incorrect segmentation of the external airways in the remaining cases. Segmentation metrics were calculated that quantitatively express the consistency between automatic and manual segmentations: the mean overlap degree of the segmentation masks is 0.96 ± 0.02, and the mean and the maximum distance between the mask borders (averaged on the whole dataset) are 0.74 ± 0.05 and 4.5 ± 1.5, respectively, which confirms that the automatic segmentations quite correctly reproduce the borders traced by the radiologist. Moreover, no tissue containing internal and pleural nodules was removed in the segmentation process, so that this method proved to be fit for the use in the
Novikova, S G
The clinico-pharmacological description of nooclerin is given. The premedication effectiveness in patients with various individual typological features in out-patient stomatologic treatment was studied.
Pishel', V Ia
A clinical and paraclinical examination was done in 120 individuals with neurosis-like disorders, who had taken part in the elimination of the aftermath of the Chernobyl Nuclear Power Plant breakdown. A complex of etiological factors in the disorder has been identified. The most important syndrome was cerebral asthenia associated with depressive disorders and apparent vegetovascular dysfunction. Cerebral influences were implicated in the origination and development of neurosis-like disorders, with functional inadequacies having been disclosed in the patients' bodily catecholamine and immune systems.
Coordinator(a) de Servicios Clinicos. Parte I (Unidad I-IV). Parte II (Unidad V-VI). Guia. Documento de Trabajo (Clinical Services Coordinator. Part I. Units I-IV. Part II. Units V-VI. Guide. Working Document).
Puerto Rico State Dept. of Education, Hato Rey. Area for Vocational and Technical Education.
This guide is intended for instructing secondary students in the occupation of clinical services coordinator in a hospital. The first part contains four units on the following subjects: the occupation of clinical services coordinator; interpersonal relationships; ethical/legal aspects; and communications (telephone, intercom, and others). For each…
Fatima, Ghousia; Shivamurthy, Ravindra; Thakur, Srinath; Baseer, Mohammad Abdul
Background: Various bone graft materials have been used in the treatment of periodontal defects. A synthetic bone substitute material composed of P-15 with anorganic bone mineral has been scantly studied. Hence, the present study was aimed to evaluate and compare the efficacy of anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) in human periodontal infrabony defects with that of open flap debridement (OFD) alone. Materials and Methods: A split-mouth, randomized controlled clinical study was designed to investigate the efficacy of ABM/P-15. In this clinical trial, 10 patients having bilateral periodontal infrabony defects were treated either with ABM/P-15 or OFD and followed for a period of 9 months. At baseline and at 9 months probing pocket depth (PPD), relative attachment level (RAL), depth of a defect, and radiographic bone level were measured; and compared between test and control sites. Results: A statistically significant reduction (P < 0.001) in PPD was observed in test sites compared to control sites. Both sites showed a gain in RAL without any significant difference. Similarly, the radiographic evaluation revealed significantly higher radiographic defect fill in test sites as compared to control sites (P < 0.001). Conclusion: ABM/P-15 bone graft material appears to be useful and beneficial in the treatment of human periodontal infrabony defects. PMID:26941516
Diagnosis, classification and grading of canine mammary tumours as a model to study human breast cancer: an Clinico-Cytohistopathological study with environmental factors influencing public health and medicine
Background The human “Elston and Ellis grading method” was utilized in dogs with mammary tumor to examine its relation to prognosis in this species, based on a 2-year follow-up period. Although cytopathology is widely used for early diagnosis of human neoplasms, it is not commonly performed in veterinary medicine. Our objectives in this study were to identify cytopathology criteria of malignancy for canine mammary tumors and the frequency of different types of mammary lesions and their relationship with histologic grade was investigated. Another aim of this study was to differentiate the simple and adenocarcinoma tumors from the complex or mixed tumor described by Elston and Ellis grading method. Methods The study was performed in 15 pure or mixed-breed female dogs submitted to surgical resections of mammary tumours. The mammary tumours were excised by simple mastectomy or regional mastectomy, with or without the superficial inguinal lymph nodes. Female dogs were mainly terriers (9 dogs) or mixed (3 dogs), the 3 other animals were a German shepherd, Dachshund and Pekingese. Before surgical excision of the tumour, FNAC was performed using a 0.6 mm diameter needle attached to a 10 ml syringe held in a standard metal syringe holder. The cytological sample was smeared onto a glass slide and either air-dried for May-Grünwald-stain, or ethanol-fixed for Papanicolaou stain and masses were surgically removed, the tumours were grossly examined and tissue samples were fixed in 10%-buffered-formalin and embedded in paraffin. Sections 4 μm thick were obtained from each sample and H&E stained. Results We obtained a correct cytohistological correlation in 14/15 cases (93.3%) when all cytopathological examinations were considered. Of the 15 cases examined, 2(13.3%) had well-differentiated (grade I), 6(40%) had moderately differentiated (grade II) and 7(46.7%) had poorly differentiated (grade III) tumours. Classification of all canine mammary gland lesions revealed 13(86.7%) malignant and 2(13.3%) benign tumors. The histological examination showed that the most common tumor types of mammary glands in bitches were: complex carcinoma, adenocarcinoma, malignant mixed tumour, benign mixed tumour, simple carcinoma– (5/15; 33.3%), (3/15; 20%), (3/15; 20%) and (2/15;13.3%), respectively. Simple carcinoma and cystic hyperplasia were less common - (1/15; 6.7%), and (1/15; 6.7%), respectively. Moreover, the most often tumors occur in inguinal mammary (60%) and abdominal (27%) glands. Conclusions Our results demonstrate that, because of the similarity of the cytohistopathological findings in the human and canine mammary gland tumours, it is possible to use the same cytopathological criteria applied in human pathology for the diagnosis of canine mammary gland tumours. Furthemoer, routine use of this human grading method would help the clinician to make a more accurate prognosis in the interests of post-surgical management in dogs with mammary carcinomas. Furthermore, this research will allow a more discriminating classification of mammary tumors and probably has a bearing on cytohistopathology, epidemiology, pathogenesis and prognosis. The most often tumors occur in inguinal mammary (60%) and abdominal (27%) glands. This interesting regional difference may be due to a) the duration of the growth before the diagnosis; b) the age of the dogs; and c) high prevelance of unspayed animals. Moreover, the most common type of tumor was complex carcinoma – 33.3% (5 cases). PMID:23937693
Magnani, Daniela; Di Lorenzo, Rosaria; Bari, Alessia; Pozzi, Samantha; Del Giovane, Cinzia; Ferri, Paola
Introduzione: Per divenire dei professionisti qualificati, gli studenti infermieri sperimentano diverse esperienze di tirocinio clinico. L’opinione dello studente può essere considerata un indicatore della qualità dell’insegnamento e una percezione positiva dell’esperienza di tirocinio si correla strettamente ad un apprendimento efficace. La scala CLES+T (Clinical Learning Environment and Supervision plus Nurse Teacher) è lo strumento psicometrico “gold standard” per valutare la qualità dell’ambiente di apprendimento clinico. Scopo: Valutare la qualità dell’ambiente di apprendimento clinico mediante la scala (CLES+T) ed evidenziare significative correlazioni inerenti le caratteristiche degli studenti, del modello tutoriale e dell’ambiente clinico. Metodo: Il 4 marzo 2013, durante una convocazione plenaria, è stata somministrata la scala CLES+T ai 242 studenti del 2° e 3° anno del Corso di Laurea in Infermieristica di Modena (Università di Modena e Reggio Emilia). Tutti i risultati sono stati statisticamente analizzati (Test della mediana). Risultati: Tutti i valori mediani si sono attestati ad un livello “4” (scala di Likert). La valutazione ottenuta dallo studente al termine del tirocinio clinico è l’unica variabile statisticamente correlata ai punteggi della scala, più il voto è basso peggiore risulta la valutazione dell’esperienza di tirocinio. In base all’opinione degli studenti le aree cliniche pediatriche e critiche hanno valutazioni più elevate. Conclusioni: Le valutazioni degli studenti erano uniformemente positive ed erano correlate al voto finale di tirocinio. Un clima di apprendimento positivo è stato considerato molto importante in questo studio. Questi risultati suggeriscono che un ambiente di apprendimento clinico favorevole e non ostile può influenzare gli esiti dell’apprendimento degli studenti. Concludiamo affermando che la scala CLES+T può essere uno strumento utile per esplorare il clima in tutte le
Comparcini, Dania; Simonetti, Valentina; Tomietto, Marco; Galli, Francesco; Fiorani, Catia; Di Labio, Luisa; Cicolini, Giancarlo
Background. Gli ambienti di apprendimento clinico sono definiti come una rete di fattori interagenti nel contesto, in grado di influenzare gli esiti dell’apprendimento degli studenti. La soddisfazione degli studenti è considerata un indicatore del raggiungimento degli esiti dell’apprendimento ed è determinante a partire dalla prima esperienza di tirocinio. Scopo. Analizzare l’esperienza di apprendimento clinico degli studenti infermieri del primo anno di corso dopo il primo tirocinio clinico ed identificare i principali determinanti della soddisfazione degli studenti. Metodo. Lo studio osservazionale è stato realizzato in cinque sedi universitarie italiane del Corso di Laurea in Infermieristica. 420 studenti hanno compilato la versione italiana della “Clinical Learning Environment, Supervision and plus Nurse Teacher (CLES+T) scale” al termine del primo tirocinio clinico. Risultati. I punteggi medi assegnati alle dimensioni della scala variano da 4.02 (clima di apprendimento) a 3.30 (relazione di tutorato). La maggior parte degli studenti è soddisfatto della propria esperienza di tirocinio (75.6%), ma sono emerse differenze in relazione alle diverse sedi di tirocinio clinico. Discussione. I principali determinanti della soddisfazione sono lo stile di leadership del coordinatore infermieristico e l’integrazione teoria-pratica nella relazione fra tutor clinico, universitario e studente. Conclusioni. I risultati dello studio contribuiscono alla comprensione della prima esperienza di tirocinio degli studenti. Tuttavia, sono necessarie ulteriori ricerche per determinare le variabili organizzative specifiche e i modelli tutoriali in grado di aumentare la soddisfazione degli studenti, per sviluppare strategie formative basate sull’integrazione tra tutor universitari e guide di tirocinio.
Palumbo, Piergaspare; Perotti, Bruno; Amatucci, Chiara; Pangrazi, Maria Pia; Leuzzi, Barbara; Vietri, Francesco; Illuminati, Giulio
La soddisfazione dei pazienti assume particolare importanza nell’attività chirurgica in Day Surgery, al fine di mantenere ed incrementare la domanda di prestazioni da parte dell’utenza ed inoltre di valutare le abilità e le competenze dello staff clinico dedicato. Sono stati valutati i risultati di un questionario somministrato dal 2007 al 2012, divisi in due gruppi, alla dimissione e a 30 giorni dall’intervento. Tali risultati hanno permesso di valutare i principali vantaggi e limiti del questionario in termini di comprensibilità, di corretto timing di somministrazione, e di utilità per lo staff clinico.
Poggiani, C; Laiolo, A; Bellini, M; Cavalli, P
Sommario INTRODUZIONE: Vengono descritti il caso clinico e le anomalie ecografiche cerebrali di un neonato affetto da sclerosi tuberosa complessa, quadro malformativo raro con interessamento neurocutaneo e implicazioni genetiche. La diagnosi si basa sull'esame clinico, sulle indagini per imaging. METODI: Vengono confrontati i risultati ottenuti con le metodiche di indagine di riferimento (RM e US). Gli autori enfatizzano il fatto che, in assenza di una segnalazione ecografica prenatale, è importante fare affidamento sui segni clinici e impostare un corretto completamento diagnostico in epoca neonatale. CONCLUSIONI: L'ecografia transfontanellare occupa un ruolo importante anche nel neonato a termine.
utilisation systdmatique chez le brOld sauf chez les patients A bolism: A clinico -pathological study in injured and burned patients. thromoemblie.Br. J...fueron identificados como casos de tromboembolismo, complications in the surgical patient. Ann. Surg. 186:669, 1977 pulmonar significativo. En s6lo tres
Dasgupta, K S; Lanjewar, K Y; Joshi, S V
Foreign bodies in the air passage are familiar otolaryngological emergencies. The diagnosis and management in most cases is based on clinico-radiological findings. Here, we are reporting three cases of open safety pin at various locations in the respiratory tract i.e. in the nose, nasopharynx and larynx. Their clinical presentation and management are described in detail.
Jain, Puneet; Sharma, Suvasini; Patra, Bijoy; Aneja, Satinder
A 7-year-old boy presented with episodic blindness for the last 2 months with occipital paroxysms and fixation-off sensitivity on electroencephalography (EEG). The clinico-EEG features were suggestive of idiopathic childhood occipital epilepsy of Gastaut. The interesting phenomenon of fixation-off sensitivity is discussed.
Sokolova, G B; Krasnov, V A; Reĭkhrud, T A; Tsybanev, A A
Clinico-roentgenologic and bacteriologic efficacy and safety of rifapex (rifapentin) were investigated in the complex therapy of 90 patients with newly recorded drug-susceptible tuberculosis. Pifapex was shown to be effective in the treatment of the patients during the acute phase of the disease, during the treatment completeness and during the short preoperative period.
Chatel, M.; Darcel, F.; Pecker, J.
The book's contents are as follows: Part I: Oncogenesis. Part II: Neuropathology. Part III: Tumoral Immunobiology and Oncobiology. Part IV: Biological and Diagnostic Imaging. Part V: Clinico-Pathological Studies. Part VI: Neurosurgical Procedures and Radiotherapy Trends. Part VII: Chemotherapy and Immunotherapy.
Vietri, Maria Teresa; Riegler, Gabriele; Pellino, Gianluca; Molinari, Anna Maria; Cioffi, Michele
dominio ricco di proline del gene Tp53. Tale polimorfismo può determinare lo sviluppo di diversi tipi di cancro, quali il tumore della mammella, del polmone, della cervice, del colon-retto e del fegato. Studi precedenti hanno riportato un’associazione tra omozigosi Pro72 ed il decorso clinico della Colite Ulcerosa (CU).
Combined genetic and epigenetic analysis of sporadic colon cancer suggest that it can no longer be viewed as a single disease. There are at least three different subsets with distinct clinico-pathologic features, with important implications for preventions, screening, and therapy.
Grigor'eva, N V
Halotherapy was applied for non-puncture treatment of 45 patients with acute purulent maxillary sinusitis. The response was evaluated by changes in clinico-immunological, cytological, x-ray and bacteriological parameters. Halotherapy was found effective in the treatment of acute purulent maxillary sinusitis without puncture.
Słodkowska, J; Słupek, A; Burakowski, J; Bestry, I; Filipecki, S; Radomski, P
The authors present a case of Kartagener syndrome complicated by pulmonary hypertension accompanied by the lung capillaries haemangiomatous proliferation (post mortem diagnosis). Review of a literature (23 published cases) of the haemangiomatous proliferation of lung capillaries emphasizes clinico-pathological aspects and differential diagnosis. A rarity of Kartagener syndrome is another interesting point of a published case.
Public Health Service (DHEW), Washington, DC. Bureau of Community Environmental Management.
This annotated bibliography of 247 entries is divided into the following categories: (a) general aspects and reviews; (b) sources of poisoning, epidemiology, and pica studies; (c) clinico-pathological studies; (d) diagnosis and screening; (e) laboratory methods; and (f) treatment and prevention. A subject and author index is included. (PD)
Margallo-Lana, M. L.; Moore, P. B.; Kay, D. W. K.; Perry, R. H.; Reid, B. E.; Berney, T. P.; Tyrer, S. P.
Background: The clinical and neuropathological features associated with dementia in Down's syndrome (DS) are not well established. Aims: To examine clinico-pathological correlations and the incidence of cognitive decline in a cohort of adults with DS. Method: A total of 92 hospitalized persons with DS were followed up from 1985 to December 2000.…
Kalaniti, Kaarthigeyan; Sandhya, V
Fraser syndrome (FS) is a rare disorder characterized by a combination of acrofacial and urogenital malformations with or without cryptophthalmos. We report a newborn and its two elder siblings who had multiple congenital anomalies and clinico-radiological features consistent with FS.
To characterize the clinico-pathological characteristics of recently-described genotypes of Newcastle disease virus (NDV), one representative strain of genotype XIV and two of genotype XVII, all isolated from West Africa, were used to infect four-week-old, specific pathogen free (SPF) chickens. The ...
A poultry outbreak of Newcastle disease (ND) was reported in Belize in 2008. The characteristics of three virulent Newcastle Disease Virus (NDV) isolates from this outbreak (NDV-Belize-3/08, NDV-Belize-12/08, NDV-Belize-4/08) were assessed by genomic analysis and by clinico-pathological characteriz...
Canal-Bedia, R; Magan-Maganto, M; Bejarano-Martin, A; De Pablos-De la Morena, A; Bueno-Carrera, G; Manso-De Dios, S; Martin-Cilleros, M V
Introduccion. La intervencion temprana en los niños con un trastorno del espectro autista (TEA) depende de una deteccion precoz y fiable. Aunque de manera general se habla de un diagnostico estable, se ha evidenciado la necesidad de profundizar mas en los factores que influyen en dicha estabilidad. Pacientes y metodos. Los participantes de la muestra fueron 142 menores con TEA (118 varones y 24 mujeres), con una mediana de 33 meses y un recorrido intercuartilico de 12 en la primera evaluacion, y con una mediana de 47 meses y un recorrido intercuartilico de 29 en el seguimiento. Los diagnosticos se realizaron con las siguientes pruebas: escala Merrill-Palmer revisada, escala de Leiter revisada, escala de inteligencia de Wechsler para preescolar y primaria III y escala de inteligencia de Wechsler para niños revisada y IV; ademas de la escala Vineland y la escala de observacion diagnostica del autismo generica (ADOS-G), basandose el diagnostico clinico en los criterios diagnosticos del Manual diagnostico y estadistico de los trastornos mentales, cuarta edicion, texto revisado (DSM-IV-TR), y quinta edicion (DSM-5). Para la evaluacion de la estabilidad diagnostica, se realizaron tablas de contingencia para las valoraciones del diagnostico en funcion del juicio clinico y los resultados de la ADOS-G. Resultados. El diagnostico clinico basado en los criterios del DSM-IV-TR, el DSM-5 y el juicio clinico se mantiene estable a traves del tiempo en un 96% de los casos. Si se valora la estabilidad diagnostica teniendo en cuenta los resultados del ADOS-G (n = 30), el 87% de los casos mantiene el diagnostico. El ANOVA muestra diferencias estadisticamente significativas para las medidas del factor intrasujeto del cociente intelectual y la edad social global, pero no para el diagnostico. Conclusiones. La estabilidad diagnostica se beneficia de un uso informado del criterio clinico y de la participacion de un equipo multidisciplinar.
Thavaraj, Selvam; Cobb, Alistair; Kalavrezos, Nicholas; Beale, Timothy; Walker, Donald Murray; Jay, Amrita
Carcinoma cuniculatum (CC) is a rare, distinct clinico-pathological variant of squamous cell carcinoma (SCC) that is defined histologically by the characteristic infiltrative pattern of a deep, broad, and complex proliferation of stratified squamous epithelium with keratin cores and keratin-filled crypts. Herein, we present a case report of CC of the oral tongue and discuss its diagnosis, management, and outcome, as well as briefly review the world literature. To our knowledge, this is the first documented case of CC of the tongue to be reported in the English literature. We draw attention to its clinico-pathological features and highlight that awareness of this entity as a distinct variant of SCC facilitates its correct management.
Remiche, Gauthier; Kadhim, Hazim; Abramowicz, Marc; Mavroudakis, Nicolas; Monnier, Nicole; Lunardi, Joël
We report a novel and particularly unusual type of mutation, namely, large deletion in the RYR1 gene, in a Belgian family with myopathy: Patients were found to be compound heterozygous and presented a clinico-pathological phenotype characterized by late-onset and recessive myopathy with cores. We depict the clinical, electrophysiological, pathological and molecular genetic characteristics of family members. To date, large deletions in the RYR1 gene have been reported in only two cases. Both involved different mutations and, in sharp contrast to our cases, presented with a very early-onset, neonatal, and a very severe or lethal phenotype. Overview of reported clinico-pathologic phenotypes, also highlights the rarity of combined late-onset/recessive co-occurrence in this group of myopathies with cores. Finally, this report underlines the broadening spectrum in this group of myopathologic disorders and highlights the concept of 'RYR1-associated/related core myopathies'.
Tarasova, L A; Lagutina, G N; Komleva, L M; Suvorov, G A; Starozhuk, I A; Filatova, O V
The clinico-functional examination of agricultural machine-operators, truck drivers, excavator and boring machine operators revealed that, under low-frequency general vibration, polymorphic pathologic changes occur in human organism. Those include peripheral vascular and neuritic disorders and changes in the vertebral column. The most peculiar symptoms of VD are dealt with. The data obtained show to the importance of further elaboration of differential diagnostic criteria of VD, specifying its pathogenic mechanisms and prevention measures working out.
Grigor'ev, A V; Bondarenko, V M; Abramov, N A; Murashova, A O; Feklisova, L V; Chuprinina, R P
A new probiotic "Bifidumbacterin forte" containing bifidobacteria immobilized on carbon sorbent has been developed. The results of extensive clinical observation on the use of the preparation in patients (children and adults) with the infectious and surgical pathology of the gastrointestinal tract are presented. The clinico-bacteriological effect thus obtained makes it possible to recommend this new probiotic "Bifidumbacterin forte" for medical practice for the complex treatment of children and adults with acute and chronic diseases of the gastrointestinal tract.
Kan'shina, N F; Rykov, V A; Lakhno, P A
Clinico-anatomical data of a rare condition congenital oligomeganephronic renal hypoplasia with a glomerulonephritis as a complication are available for a 13-year-old girl who died of chronic renal failure. Large aglomerular zones consisting of primitive canaliculi in a loose stroma were observed in kidneys that were decreased in size. The glomeruli were few in number, some of them of a large size (2-2.5-fold), firmly attached to the capsule, with pronounced extracapillary proliferation.
Mitra, A; Conway, C; Walker, C; Cook, M; Powell, B; Lobo, S; Chan, M; Kissin, M; Layer, G; Smallwood, J; Ottensmeier, C; Stanley, P; Peach, H; Chong, H; Elliott, F; Iles, M M; Nsengimana, J; Barrett, J H; Bishop, D T; Newton-Bishop, J A
Background: To optimise predictive models for sentinal node biopsy (SNB) positivity, relapse and survival, using clinico-pathological characteristics and osteopontin gene expression in primary melanomas. Methods: A comparison of the clinico-pathological characteristics of SNB positive and negative cases was carried out in 561 melanoma patients. In 199 patients, gene expression in formalin-fixed primary tumours was studied using Illumina's DASL assay. A cross validation approach was used to test prognostic predictive models and receiver operating characteristic curves were produced. Results: Independent predictors of SNB positivity were Breslow thickness, mitotic count and tumour site. Osteopontin expression best predicted SNB positivity (P=2.4 × 10−7), remaining significant in multivariable analysis. Osteopontin expression, combined with thickness, mitotic count and site, gave the best area under the curve (AUC) to predict SNB positivity (72.6%). Independent predictors of relapse-free survival were SNB status, thickness, site, ulceration and vessel invasion, whereas only SNB status and thickness predicted overall survival. Using clinico-pathological features (thickness, mitotic count, ulceration, vessel invasion, site, age and sex) gave a better AUC to predict relapse (71.0%) and survival (70.0%) than SNB status alone (57.0, 55.0%). In patients with gene expression data, the SNB status combined with the clinico-pathological features produced the best prediction of relapse (72.7%) and survival (69.0%), which was not increased further with osteopontin expression (72.7, 68.0%). Conclusion: Use of these models should be tested in other data sets in order to improve predictive and prognostic data for patients. PMID:20859289
Caranci, Ferdinando; Belfiore, Maria Paola; Manzi, Francesca; Pagliano, Pasquale; Cirillo, Sossio
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological condition, generally observed in conjunction with severe and acute hypertension, that involves mainly the posterior head areas (occipital and temporal lobes) and anterior “watershed” areas. In this syndrome it is rare to observe a predominant involvement of the brainstem. We describe the clinical and radiological findings in a patient with brainstem involvement, discussing its pathophysiological features and possible differential diagnosis. PMID:26515750
Tortora, Fabio; Caranci, Ferdinando; Belfiore, Maria Paola; Manzi, Francesca; Pagliano, Pasquale; Cirillo, Sossio
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological condition, generally observed in conjunction with severe and acute hypertension, that involves mainly the posterior head areas (occipital and temporal lobes) and anterior "watershed" areas. In this syndrome it is rare to observe a predominant involvement of the brainstem. We describe the clinical and radiological findings in a patient with brainstem involvement, discussing its pathophysiological features and possible differential diagnosis.
Santos, A B; de Souza, M M; Andrade, Z A
Experimental pipestem fibrosis of the liver developed more frequently (69.2%) in mice submitted to repeated infections with Schistosoma mansoni, than with single infection (11.1%). The counting of eggs in the liver revealed no significant differences between the two experimental groups. Although the reason why multiple infections favor the development of pipestem fibrosis has not been elucidated, the data obtained represent an experimental support to clinico-epidemiological claims that repeated infections play a role in pathogenesis of hepatosplenic schistosomiasis
1332 Arch Pathol Lab Med—Vol 133, August 2009 Lymph Node Melanosis With Metastatic Melanoma—Malafronte & Sorrells Case Report Lymph Node Melanosis in...lignant melanoma, exhibiting a spectrum of clinico - pathologic features. Partially regressed melanomas most often present clinically as either...tumoral or nodular melanosis, is considered and treated as a variant of com- pletely regressed melanoma.4 Only a small number of cases of tumoral melanosis
Cecchi, Paolo C.; Kluge, Reinhard; Schwarz, Andreas
Hematogenous bone metastases from endometrial carcinoma are not frequent and their treatment is a matter of debate. We describe an extremely rare case of calvarial metastasis from endometrial carcinoma in an 80-year-old woman treated by means of one-step surgical radical resection and heterologous cranioplasty, along with a review of the literature regarding epidemiology, clinico-radiological features, prognosis, and management of skull metastases. PMID:25685234
Isaĭchev, B A; Chikaleva, V I
Investigations were performed in experiments on 36 dogs. Clinico-morphological results of plasty of artificial defects of the anterior abdominal wall by demineralized matrix of a flat allogeneic bone have shown good taking by tissues. In clinic the demineralized matrix of flat allogeneic bone (scapula, skull fornix) was used in ventral hernias in 36 patients. No recurrent hernias were noted in these patients within 20 months after operation.
Kalinichenko, L V; Vesnin, A G; Murenkov, O V; Kochnev, V A
Clinico-roentgenologic data on 33 cases of aneurysmal cyst of the bone (flat bones--12, spinal cord--21) were assessed. Such peculiarities of the aneurysmal cyst of flat bones as large size, cellular--trabecular structure and a peripheral periosteal "shell" were identified. Vertebral cysts involved processes, arches and body resulting in compression fracture. They sometimes extended to adjacent vertebrae and ribs. Vertebral cysts should be differentiated mainly from giant-cell tumors, metastases and myeloma.
Iudin, V E; Liamin, M V; Iaroshenko, V P
The goal of research is the study of the peculiarities of clinico- psychopathologic varients of development of mental disorders and life quality in military personnel, wounded in local military conflicts in conditions of multidisciplinary military hospital. 317 patients aged 19-45 with mine-explosive wounds got in the Chechen Republic and Dagestan were examined. Analysis performed in early and secondary post stress period showed the predominance of border-line psychopathologic disorders and detected some peculiarities.
Muñoz, Abián; Cabrera-López, José C; Santana-Rodríguez, Alfredo; Toledo-Bravo de Laguna, Laura; Santana-Artiles, Alexandre; Sebastián-García, Irma
Introduccion. La paraplejia espastica hereditaria (PEH) representa un conjunto de cuadros clinicos neurodegenerativos que se caracteriza por perdida progresiva de fuerza en los miembros inferiores con espasticidad. Esto se debe a una lesion axonal en los haces corticoespinales. La de tipo 1, conocida como SPG1, es la forma mas comun de PEH ligada al cromosoma X. Esta se produce por una mutacion en el gen de la molecula de adhesion celular L1 (L1CAM). La SPG1 se manifiesta con el sindrome CRASH (corpus callosum hypoplasia, retardation, adducted thumbs, spasticity and hydrocephalus). Casos clinicos. Tres varones, dos hermanos y un primo (materno), con un cuadro clinico de discapacidad intelectual, paraparesia espastica, piramidalismo, dismorfias faciales y pulgares en aduccion. La neuroimagen mostro agenesia del cuerpo calloso y ventriculomegalia en los tres. Los estudios neurofisiologico y metabolico fueron normales. El estudio genetico evidencio en todos ellos una mutacion concreta en el gen L1CAM (Xq28). Conclusion. Se describen los hallazgos clinicorradiologicos de tres varones afectos de sindrome CRASH por mutacion c.516G>A en el exon 5 del gen L1CAM. Estos parecen ser los primeros casos descritos en España segun la bibliografia actual. Recomendamos sospechar este sindrome cuando se asocian paraparesia espastica, discapacidad intelectual y pulgares aductos.
Egea-Lucas, I; Martinez-Mondejar, E; Piqueres-Vidal, C F; Frutos-Alegria, M T
Introduccion. Las crisis gelasticas son crisis epilepticas poco frecuentes en las que la risa inapropiada es la manifestacion principal. Su etiologia es diversa. No hemos encontrado en la bibliografia ningun caso de risa patologica claramente epileptica relacionada con ictus, aunque hay multiples descripciones de risa patologica no epileptica como sintoma prodromico en pacientes con ictus (fou rire prodromique). Presentamos un caso de infarto del giro cingulado que curso con crisis gelasticas al inicio y durante la evolucion del proceso clinico. Caso clinico. Mujer de 81 años, que bruscamente presento episodios de dificultad para la expresion verbal con desconexion del medio, acompañados de accesos de risa inmotivada e incontrolable de duracion inferior a cinco minutos. Tras los episodios, tenia bajo nivel de consciencia. Coincidiendo con alguno de ellos, se observaron tambien movimientos involuntarios de los miembros superiores. La resonancia desvelo la existencia de una lesion isquemica aguda del territorio del giro cingulado izquierdo y el electroencefalograma puso de manifiesto la existencia de actividad epileptogena frontal y temporal anterior izquierda. Conclusiones. El perfil clinico, los resultados de las exploraciones complementarias y la respuesta al tratamiento antiepileptico permiten afirmar que los episodios descritos en esta paciente corresponden a crisis gelasticas relacionadas con una lesion isquemica aguda del giro cingulado izquierdo.
Lisalde-Rodríguez, María Elena; Garcia-Fernández, José Antonio
Introduccion. La terapia de espejo es una intervencion relativamente nueva, cada vez mas utilizada y de facil acceso para el tratamiento rehabilitador del paciente hemiplejico. El paciente moviliza el miembro sano frente a un espejo, de modo que mira el reflejo del movimiento del lado sano como si fuera el lado afectado. Objetivo. Analizar el efecto de la terapia de espejo en el paciente hemiplejico en cuanto a funcion sensitivomotora, heminegligencia y actividades de la vida diaria. Desarrollo. Se definio una estrategia de busqueda bibliografica en Medline, EMBASE, PEDro y Cochrane Central Register of Controlled Trials de ensayos clinicos aleatorizados llevados a cabo con pacientes hemiplejicos en los que se utilizara como intervencion rehabilitadora principal la terapia de espejo. Siete estudios cumplieron los criterios de inclusion con nivel medio-alto de calidad metodologica. La mayoria de los estudios valora el efecto de la terapia de espejo sobre el deficit motor, con mejorias significativas. Se encontraron tres ensayos clinicos aleatorizados que evaluan el efecto de la terapia de espejo sobre la heminegligencia, con beneficios tambien significativos. Conclusiones. La terapia de espejo combinada con una rehabilitacion convencional es efectiva sobre todo en la funcion motora y no tanto en la funcion sensitiva y en la funcionalidad global del paciente hemiplejico. En la heminegligencia se obtienen resultados tambien beneficiosos, aunque se basan en pocos ensayos clinicos aleatorizados y con muestras de pacientes reducidas, por lo que los resultados, aunque prometedores, son poco concluyentes.
Castrillo-Sanz, Ana; Mendoza, Amelia; Gutiérrez-Ríos, Raúl; Zamora, M Isabel; Morollón, Noemí; Rodríguez-Sanz, M Fernanda; Duarte, Jacinto
Introduccion. El sindrome de encefalopatia posterior reversible (SEPR) es un sindrome clinico-radiologico de presentacion aguda o subaguda que se caracteriza por la presencia de cefalea, vomitos, crisis epilepticas, trastornos visuales y alteracion del nivel de conciencia asociado a lesiones localizadas fundamentalmente en la sustancia blanca de regiones posteriores cerebrales. Caso clinico. Mujer de 32 años que desarrollo un SEPR en el periodo posparto secundario a eclampsia tardia. La paciente presento 10 dias despues del parto un cuadro clinico consistente en cefalea, crisis epilepticas, ceguera y deterioro del nivel de conciencia. El estudio de imagen con resonancia magnetica confirmo la afectacion de la sustancia blanca de predominio posterior. Conclusiones. Aunque la eclampsia es una entidad tipica del embarazo y puerperio inmediato, es necesario recordar que tambien puede producirse de forma tardia tras el parto y que puede ser la causa de otros sindromes, como el SEPR. Aunque en estos casos el pronostico suele ser favorable, el tratamiento debe ser precoz, efectuando un rapido control de la tension arterial y las convulsiones con el fin de evitar un daño cerebral permanente. Es necesario considerar siempre este sindrome en mujeres con crisis epilepticas u otros sintomas neurologicos durante el posparto.
León-Ruiz, Moisés; Benito-León, Julián; Sierra-Hidalgo, Fernando; García-Soldevilla, Miguel Ángel; Izquierdo-Esteban, Laura; Tejeiro-Martínez, José; Cabrera-Valdivia, Francisco; García-Albea Ristol, Esteban
Introduccion. El mieloma multiple es la neoplasia de celulas plasmaticas mas frecuente. Al ser incurable, el tratamiento persigue obtener el mayor tiempo de supervivencia libre de clinica. Constituye una causa extremadamente rara de afectacion de los nervios craneales y es producido habitualmente por un plasmocitoma intracraneal. Presentamos un caso de mieloma multiple, que asociaba un plasmocitoma intracraneal y que comenzo clinicamente con paralisis aislada, completa y fluctuante del III nervio craneal. Caso clinico. Mujer de 63 años que acudio a urgencias por presentar un cuadro clinico oscilante, consistente en diplopia binocular horizontal y, posteriormente, cefalea. La exploracion neurooftalmologica revelo una paralisis completa del III nervio craneal derecho. Se solicito una tomografia axial computarizada craneal urgente, que revelo multiples lesiones osteoliticas diploicas, asociando una de ellas componente de partes blandas en la hendidura esfenoidal derecha. La paciente fue ingresada, y se le diagnostico posteriormente un mieloma multiple IgA-kappa. Tras recibir induccion quimioterapica y ser sometida a un trasplante autologo de progenitores hematopoyeticos, alcanzo la remision completa. Conclusiones. El mieloma multiple es un trastorno raro de los nervios craneales, una causa muy infrecuente de paralisis aislada y completa del III nervio craneal y menos aun fluctuante, y no se ha encontrado ningun caso publicado con este inicio clinico. Tener en cuenta las posibles manifestaciones neurooftalmologicas del mieloma multiple puede contribuir a un diagnostico precoz y a una incidencia positiva sobre el curso de esta enfermedad.
de Quevedo, Francisco Vázquez
The history of the hospitals and general surgeons that best represent the centres in Madrid are here in reviewed, comprising the period between 1940 and the closure of the Hospital Clinico (1957) as well as the Hospital General (General Hospital) (1967), both in Atocha. Other hospitals which are reviewed and highlighted are: the H. de la Princesa (the Princess Hospital), the H. del Nifio Jesus (Hospital of the Child Jesus), the H. Militar (Military Hospital) and the Cruz Roja (Red Cross). Data is provided on the permanent surgeons in the following centres: H. General: J. Goyanes, J. Die, J. de la Villa, T. Rodriguez, E. Diaz, G. Bueno e H. Huerta; H. Clinico: L. de la Peña, L. Cardenal, L. Olivares, R. Argüelles, J. Estella y M. F. Zumel; H. Militar: M. G. Ulla, M. Bastos, M. G. Durán, J. S. Galindo, y A. G. Durán; Hospital de la Cruz Roja: V. M. Noguera, L. Serrada, F. Luque y L. L. Durán; H. de la Princesa: P. Cifuentes, P. G. Duarte, L. Estella y R. Aiguabella; H. del Niño Jesús: J. Garrido Lestache; H. Clinico, last time, Atocha: F. M. Lagos, R. Vara y A. de la Fuente.
Roncalés-Samanes, P; Peña-Segura, J L; Fernando-Martínez, R; Fuertes-Rodrigo, C; García-Oguiza, A; López-Pisón, J
Introduccion. El sindrome de Gorlin (SG) es un trastorno de herencia autosomica dominante asociado a mutaciones en el gen PTCH1, cuya principal caracteristica es la aparicion de carcinomas basocelulares, unido a anomalias esqueleticas, queratoquistes odontogenicos y tumores intracraneales. Caso clinico. Niña de 3 años y 10 meses, ingresada por ataxia aguda. Destacan como antecedentes personales retraso psicomotor y como antecedentes familiares la sospecha de SG en la madre por quiste maxilar. En la exploracion, se aprecia macrocefalia con frente prominente e hipertelorismo, asi como nevo. Se solicita estudio genetico de SG, en el que se detecta la mutacion c.930delC en el exon 6 del gen PTCH1 en heterocigosis. Conclusiones. En el SG hay un aumento de la susceptibilidad al desarrollo de carcinomas basocelulares y es preciso un estrecho control dermatologico. Es necesario un seguimiento neurologico clinico y de imagen, mediante resonancia magnetica, para el diagnostico precoz de tumores intracraneales, fundamentalmente el meduloblastoma. Tambien son caracteristicos los queratoquistes odontogenicos, otras alteraciones cutaneas, fibromas cardiacos y ovaricos, asi como anomalias esqueleticas, que precisan controles clinicos y de imagen periodicos, y tratamiento en caso de ser necesarios, pero debe evitarse la radiacion. El SG es un trastorno poco frecuente, que se debe sospechar ante la presencia de alteraciones caracteristicas. Es necesario un seguimiento multidisciplinar, asi como establecer un protocolo de actuacion, para un temprano diagnostico y tratamiento de las complicaciones potencialmente graves derivadas de esta enfermedad.
[Adaptation and validation of CAMDEX-DS (Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and others with intellectual disabilities) in Spanish population with intellectual disabilities].
Esteba-Castillo, Susanna; Dalmau-Bueno, Albert; Ribas-Vidal, Núria; Vilà-Alsina, Marta; Novell-Alsina, Ramon; García-Alba, Javier
Introduccion. La demencia causada por la enfermedad de Alzheimer afecta comunmente a la poblacion adulta con sindrome de Down. Esta poblacion presenta dos rasgos clinicos caracteristicos: la presencia de demencia con semiologia distinta a la enfermedad de Alzheimer tipica y deficits intelectuales previos que pueden confundir el diagnostico clinico. Existe una evidente necesidad de validar instrumentos especificos en castellano adaptados a esta poblacion. Objetivo. Adaptar y validar el Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS) en poblacion española. Pacientes y metodos. Se consideraron 146 pacientes con discapacidad intelectual (leve-moderada). Se realizo un estudio de validacion de tipo observacional, transversal y multicentrico. Se administraron los siguientes tests: CAMDEX-DS, test breve de inteligencia de Kaufman y Dementia Questionnaire for Persons with Mental Retardation. Se calculo la fiabilidad test-retest, la fiabilidad interjueces, la concordancia del CAMDEX-DS para el diagnostico clinico y la validez. Resultados. La fiabilidad test-retest e interjueces obtuvo un coeficiente kappa de 0,92 y 0,91, respectivamente. El indice kappa del CAMDEX-DS para el diagnostico clinico respecto al resto de los criterios clinicos utilizados fue alto: CAMDEX-DS frente a DSM-IV (kappa = 0,95; p < 0,001); CAMDEX-DS frente a Clasificacion Internacional de Enfermedades, decima revision (kappa = 0,97; p = 0,000). Todas las correlaciones item-test oscilaban entre 0,31 y 0,69. La fiabilidad interna calculada mediante el alfa de Cronbach fue de 0,93. Conclusiones. La version española del CAMDEX-DS es un instrumento valido, de alta aplicabilidad a personas con discapacidad intelectual, que muestra buenas propiedades psicometricas. El Cambridge Cognitive Examination for Older Adults with Down's Syndrome (CAMCOG-DS) permite establecer dos puntos de corte para la sospecha de deterioro
Florido-Rodriguez, A; Eiris-Punal, J; Barros-Angueira, F; Toledo-Bravo de Laguna, L; Santana-Artiles, A; Sebastian-Garcia, I; Santana-Rodriguez, A; Cabrera-Lopez, J C
Introduccion. El sindrome de Aicardi-Goutieres es una rara encefalopatia subaguda progresiva de inicio precoz –generalmente en el primer año de vida– caracterizada por retraso psicomotor, microcefalia, alteraciones en la sustancia blanca cerebral, calcificaciones intracraneales, pleocitosis y niveles elevados de interferon alfa en el liquido cefalorraquideo. Asocia un incremento en la expresion de los genes estimulados por interferon en la sangre periferica, hecho conocido como interferon signature. Los niveles de genes estimulados por interferon se han postulado como un buen biomarcador, pues se mantienen elevados en la sangre periferica en el tiempo y son mas sensibles, en comparacion con las determinaciones de interferon alfa y neopterinas en el liquido cefalorraquideo, las cuales descienden a partir del año de vida. Hasta la fecha se han descrito mutaciones en siete genes que sobreestimulan la via del interferon alfa, y el ultimo en descubrirse ha sido el IFIH1 (interferon induced with helicase C domain 1), con un patron de herencia autosomico dominante. Caso clinico. Se presenta el primer caso descrito en la bibliografia hispana debido a mutacion de novo en el gen IFIH1. Se expone el cuadro clinico, los estudios realizados y la revision de los aspectos clinicos, neurorradiologicos y geneticos. Conclusiones. La herencia de las mutaciones descritas para el sindrome de Aicardi-Goutieres era clasicamente autosomica recesiva, pero estos hallazgos muestran que mutaciones autosomicas dominantes en el gen IFIH1 pueden causar la enfermedad. Como hallazgo de neuroimagen no descrito previamente, presenta una lesion de encefalomalacia quistica en la protuberancia.
Araya-Quintanilla, F; Celis-Rosati, A; Rodriguez-Leiva, C; Silva-Navarro, C; Silva-Pinto, Y; Toro-Jeria, B
Introduccion. La epilepsia es una patologia cerebral que afecta tanto a niños como a adultos. Desde los años veinte, la dieta cetogenica ha ganado prestigio como otra opcion de tratamiento en pacientes con epilepsia refractaria. Sujetos y metodos. Se realiza una sintesis de la evidencia a traves de una revision sistematica de ensayos clinicos aleatorizados que hayan comparado una dieta cetogenica sola con otros tipos de dieta para el tratamiento de estos pacientes. Objetivo. Determinar la efectividad de la dieta cetogenica en la disminucion de los episodios de convulsiones en pacientes con epilepsia refractaria. La estrategia de busqueda incluyo ensayos clinicos aleatorizados y ensayos clinicos controlados. Las bases de datos usadas fueron: Medline, LILACS, Central y CINAHL. Resultados. Se obtuvieron seis articulos que cumplian con los criterios de elegibilidad. Conclusiones. Existe evidencia limitada de que la dieta cetogenica en comparacion con la dieta de trigliceridos de cadena media es mas efectiva en disminuir la frecuencia de las convulsiones. Existe evidencia moderada de que la dieta cetogenica clasica en comparacion con la dieta gradual (2,5:1 y 3:1) es mas efectiva para disminuir las crisis epilepticas. Existe evidencia moderada de que la dieta cetogenica clasica en comparacion con la dieta Atkins es mas efectiva para disminuir la frecuencia de convulsiones en tres meses. La decision de aplicar este tipo de dietas tambien debe basarse en costes, preferencias y seguridad del tratamiento. Ademas, debe considerarse la probabilidad de que algunos estudios, por problemas de indizacion, hayan quedado fuera de la revision.
Natera-De Benito, Daniel; Poo, Pilar; Gean, Esther; Vicente-Villa, Asunción; García-Cazorla, Angels; Fons-Estupiña, M Carmen
Introduccion. El mosaicismo diploide/triploide es una alteracion cromosomica poco frecuente. La produce un fallo en la division poscigotica durante el desarrollo embrionario. Da lugar a la coexistencia de dos lineas celulares con diferente constitucion cromosomica (46,XX y 69,XXX) en un mismo individuo. Su fenotipo clinico es caracteristico. Las alteraciones pigmentarias con un patron de distribucion que sigue las lineas de Blaschko son el principal signo guia, asi como las alteraciones de otros tejidos derivados del ectodermo. Casos clinicos. Describimos las caracteristicas clinicas de tres pacientes afectos de mosaicismo diploide/triploide y realizamos una comparacion de su fenotipo clinico con el de los casos publicados previamente en la bibliografia. Las alteraciones observadas con mayor frecuencia fueron alteraciones cutaneas, discapacidad intelectual, obesidad troncular, talla baja, hemihipertrofia, y manos pequeñas y estrechas con clino y camptodactilia. Las caracteristicas fenotipicas de nuestros pacientes fueron similares a las de los casos comunicados previamente. Aunque no existe un fenotipo unico y especifico asociado al mosaicismo diploide/triploide, existen malformaciones caracteristicas que conforman un sindrome malformativo bien definido. El cariotipo realizado en linfocitos de sangre periferica en las tres pacientes fue normal, y se logro el diagnostico mediante cariotipo en fibroblastos cultivados tras biopsia de piel hipopigmentada. Conclusiones. La presencia de discapacidad intelectual asociada a obesidad troncular, talla baja, hemihipertrofia o clino y camptodactilia, ademas de las alteraciones cutaneas, debe hacer pensar en la posible existencia de un mosaicismo diploide/triploide. En la mayoria de los casos, es necesario el estudio del cariotipo en los fibroblastos para llegar al diagnostico.
Fortes Almeida, Alessandra; Lima Gusmão-Sena, Maria Helena; Gonzaga Oliveira, Layne Carla; Santana Gomes, Tarcisio; Neves do Nascimento, Thais Vitorino; Nunes Gobatto, André Luiz; Ramos Sampaio, Lilian; Barreto-Medeiros, Jairza María
Introducción: la inflamacion es un problema frecuente en pacientes con enfermedad renal cronica (ERC) y se debe relacionar con el estado clinico y nutricional de estos. Objetivo: evaluar si existe una asociacion entre la inflamacion y los parametros clinicos y nutricionales en los pacientes con ERC. Material y métodos: fueron evaluados 92 pacientes con ERC. Se utilizo la proteina C reactiva (PCR) como marcador de la inflamacion. Los parametros nutricionales evaluados fueron antropometria y examenes bioquimicos. Los parametros clinicos evaluados fueron comorbilidades, caracteristicas de la ERC, perfil lipidico, hipolipemiantes, urea, creatinina y leucocitos totales. Para analizar las diferencias entre los grupos (con o sin inflamacion) se utilizo el test t de Student o el test de Chi-cuadrado. Resultados: 15 pacientes (16,3%) presentaban PCR ≥ 10,0 mg/dL y tenian inflamacion. De estos, 05 (33%) tuvieron hipoalbuminemia, en comparacion con 05 (6,5%) en el grupo sin inflamacion (p = 0,002). Los valores de lipidos fueron inferiores en el grupo con inflamacion, con colesterol total medio de 171 mg/dL (} 41,2) e LDL-C medio de 95 mg / dL (} 31,2) en comparacion con aquellos sin inflamacion con medias de 198 mg / dL (} 46) y 124 mg/dL (} 40,1), respectivamente. No se encontraron otras diferencias significativas entre los grupos. Conclusión: la inflamacion se ha asociado con modificaciones en el colesterol total, LDL e hipoalbuminemia. Se concluye que la albumina serica solo se debe utilizar para evaluar el estado nutricional en ausencia de inflamacion. El nivel de PCR es un marcador sensible de la inflamacion y debe ser empleado en la interpretacion del estado nutricional en pacientes con ERC.
Medicine's inability to humanely respond to the concerns of its patients has often been attributed to its Cartesian dualism of mind and body. More recently, this inability has been ascribed to medicine's penchant for isolating biological disease as its sole proper concern to the exclusion of experienced illness. This dualism of disease and illness is claimed to be an outgrowth of the Cartesian dualism but the differences and similarities between these two forms of dualism is not clear. This paper seeks to clarify their relationship through an examination of their historical origins. Disease is currently identified and characterized by a process of clinico-pathological correlation. By this means clinical impressions are corrected in light of autopsy findings. Our current mode of clinico-pathological correlation originated in Paris in the early nineteenth century with the work of Xavier Bichat and others. The theory of knowledge implicit within this clinico-pathological approach to the body is described and compared to that of Descartes. Though medicine does pursue certain Cartesian goals for knowledge, such as knowledge of the patient that does not rely upon his candor, it ultimately espouses neither a Cartesian theory of knowledge nor a Cartesian theory of the body. With pathological inquiry modeled after the autopsy as the final word in the identification and characterization of disease, the patient's capacity for self-knowledge and interpretation--not an entity called mind--is isolated away from his body. This approach to the body means that objective evidence of disease is valued to the exclusion of subjective evidence. If the shortcomings of modern biomedicine are to be effectively addressed, not only must the interdependence of disease and illness be acknowledged. The very canons of medical evidence must be revised. Subjective evidence must be rehabilitated and rejuvenated with better methods of subjective clinical investigation. Host factors relevant to the
Blanco-Cantó, M Empar; Dávila-González, Pablo; López de Silanes, Carlos; Cuadrado-Pérez, M Luz; Ortega, Gloria; Porta-Etessam, Jesús
Introduccion. Las patologias relacionadas con la infiltracion de linfocitos y celulas inflamatorias se clasifican, segun su topografia, en patologia orbitaria idiopatica, paquimeningitis hipertrofica idiopatica, sindrome de Tolosa-Hunt e hipofisitis linfocitaria. Presentamos a una paciente que comenzo con una hipofisitis linfocitaria hace ocho años y ha presentado varios episodios de paquimeningitis hipertrofica variables en su localizacion. Caso clinico. Mujer de 55 años, en seguimiento por cefalea de dos meses de evolucion, que ingreso por empeoramiento clinico con paralisis del III par derecho completo, lagrimeo y rinorrea. Se realizo una resonancia magnetica cerebral que demostro la presencia de una lesion sellar compatible con hipofisitis linfocitaria. Se inicio tratamiento con corticoides con mejoria inicial, pero, tras dos años, la paciente presento empeoramiento clinico con cefalea y parestesias perioculares derechas. Se repitio la resonancia, donde se observaron varias lesiones extraaxiales, siendo el resto de estudios normales, por lo que se diagnostico paquimeningitis hipertrofica idiopatica y se inicio tratamiento de nuevo con corticoides. En el seguimiento posterior, la paciente presento nuevas lesiones en diferentes localizaciones y mal control algico, por lo que se añadio tratamiento inmunomodulador. Ante la asociacion de hipofisitis linfocitaria y paquimeningitis hipertrofica, se completo el estudio con determinacion de la IgG4 en el suero, que resulto negativa. Conclusiones. La asociacion de hipofisitis linfocitaria y paquimeningitis hipertrofica con las patologias relacionadas con la IgG4 se ha descrito recientemente. A pesar de que en nuestra paciente no se ha confirmado el diagnostico, se debe considerar esta relacion en aquellos casos idiopaticos y, sobre todo, si se asocian otras manifestaciones sistemicas.
Saravu, Kavitha; Somavarapu, Vasanth; Shastry, Ananthkrishna B.; Kumar, Rishikesh
Objective: We undertook this study to assess the clinical profile and outcome determinants of different snake envenomation as well as to assign species-specific severity grade to different cases based on clinico – laboratory evidence scale. Materials and Methods: A prospective clinico – epidemiologic evaluation for outcome determinants of snakebite envenomation was carried out based on a clinico – laboratory severity grading scale, among 76 patients over a period of 2 years, in a tertiary care hospital in southern India. Results: Majority of patients were male agricultural workers (53.9%) followed by housewives (19.7%), and students (9.2%). Occurrence of viper snake envenomation with hemotoxic syndrome (73.68%) was highest followed by cobra and krait envenomation with neurotoxic (19.73%) and hemo – neurotoxic (5.3%) syndrome, respectively. On the contrary, maximum mortality and severity was seen in krait (60%) followed by cobra (13.33%) and viper (8.9%) envenomation. The average dose of anti-snake venom (ASV) administered varied from 9.83 (±7.22) to 20.25 (±4.92) vials throughout grade I to IV in all snake species envenomation. An increase in severity grade, ASV dose, and mortality were observed with the corresponding delay in ‘bite to needle time.’ Also, initial traditional treatments and krait species envenomation were significantly associated with higher grades of severity and mortality. Conclusion: There is an urgent need to spread awareness among the community for avoidance of traditional treatment and any delay in medical intervention in snakebite incidents. PMID:23559724
Crespo-Eguilaz, N; Magallon, S; Sanchez-Carpintero, R; Narbona, J
Introduccion. La Children's Communication Checklist (CCC) de Bishop es una prueba util para la valoracion de la pragmatica verbal en los escolares. El objetivo del trabajo es comprobar la fiabilidad y la validez de esta escala en castellano. Sujetos y metodos. Se analiza la CCC contestada por los padres de 360 niños/as de 4-12 años, con inteligencia normal, 160 controles y 200 de cuatro grupos clinicos: trastorno por deficit de atencion/hiperactividad (n = 68), trastorno de aprendizaje no verbal procedimental (n = 77), trastorno de la comunicacion social (n = 25) y trastornos del espectro autista de nivel 1 (n = 30). Se realizan analisis: factorial para agrupar los items del cuestionario, de fiabilidad de las nuevas escalas y discriminante para comprobar si clasifica bien a los afectos de dificultades en el uso del lenguaje. Resultados. Se obtienen siete factores (Kaiser-Meyer-Olkin: 0,852) con moderada similitud a las de la CCC original: relaciones sociales, intereses y otros cinco que constituyen pragmatica (habilidades conversacionales, coherencia-comprension, compenetracion, comunicacion no verbal y pertinencia). La correlacion es significativa entre todos ellos, en el grupo control, y entre los cinco que configuran pragmatica, en los grupos clinicos (r de Pearson). La fiabilidad de las escalas es buena (alfa de Cronbach: 0,914). El cuestionario clasifica bien al 98,9% de los casos agrupados con y sin trastorno pragmatico; y al 78% de los participantes en sus correspondientes grupos clinicos. Ademas, permite diferenciar las patologias segun la presencia e intensidad de los sintomas. Conclusiones. Esta version española de la CCC es altamente valida y fiable. Los estadisticos aportados pueden utilizarse como valores de referencia.
Pato-Pato, A; Midaglia, L; Costa-Arpin, E; Rodriguez-Regal, A; Puy-Nunez, A; Rodriguez-Rodriguez, M; Lopez-Real, A; Llaneza-Gonzalez, M A; Garcia-Estevez, D A; Moreno-Carretero, M J; Escriche-Jaime, D; Aguado-Valcarcel, M L; Munoz, D; Prieto, J M; Lorenzo-Gonzalez, J R; Amigo-Jorrin, M C
Introduccion. La efectividad y seguridad del fingolimod en pacientes con esclerosis multiple remitente recurrente (EMRR) se demostro en ensayos clinicos. Sin embargo, por las limitaciones de estos, es importante saber como se comporta en condiciones de practica clinica habitual. Asi, el objetivo de este estudio es evaluar la efectividad y seguridad del fingolimod despues de 12 meses de uso en la practica clinica en Galicia. Pacientes y metodos. Estudio retrospectivo y multicentrico (n = 8) de pacientes con EMRR y tratados con una o mas dosis de fingolimod, 0,5 mg/dia. Se evaluo la efectividad –tasa anualizada de brotes (TAB), cambio en la puntuacion de la escala expandida del estado de discapacidad (EDSS), porcentaje de pacientes libres de brotes, libres de progresion de discapacidad y libres de actividad en resonancia– para el total de pacientes y segun tratamiento previo. Se evaluo la seguridad a partir del porcentaje de pacientes que discontinuaron y que presentaron efectos adversos. Resultados. Despues de 12 meses de uso, el fingolimod redujo un 87% la TAB (de 1,7 a 0,23; p < 0,0001) y, en consecuencia, un 81% de pacientes estuvo libre de brotes. La puntuacion de la EDSS disminuyo un 9%. Un 91% de pacientes estuvo libre de progresion de discapacidad y un 72%, libre de actividad en resonancia. En el 43% de los pacientes no se evidenciaron signos de la actividad de la enfermedad. La mayoria de los beneficios del fingolimod difirieron segun el tratamiento previo. Alrededor de un tercio de los pacientes comunicaron efectos adversos, pero solo el 2% discontinuo debido a ellos. Conclusiones. La mayoria de los resultados de efectividad de los ensayos clinicos del fingolimod se observa durante los 12 primeros meses de tratamiento en la practica clinica. Se observo un mejor perfil de seguridad al comunicado en los ensayos clinicos.
Summa, M; Perrone, F; Priora, F; Testa, S; Quarati, R; Spinoglio, G
Sommario SCOPO: L'appendicite acuta è una delle urgenze chirurgiche addominali più comuni. Se non trattata, può rapidamente progredire verso complicanze severe, quali la perforazione e la peritonite. Spesso i chirurghi optano per un intervento chirurgico precoce anche in caso di diagnosi solo probabile, con il rischio di eseguire una quota importante di appendicectomie inutili. Lo scopo dello studio è di analizzare la nostra esperienza con la diagnosi integrata clinico-ultrasonografica dell'appendicite acuta. MATERIALI E METODI: Durante il periodo gennaio 1999-dicembre 2006 1447 pazienti sono stati sottoposti a valutazione clinica, a conta leucocitaria, dosaggio della proteina C reattiva ed ecografia addominale. È stata utilizzata la tecnica ecografia di compressione graduale, con sonda ad alta frequenza. RISULTATI: È stata formulata diagnosi ecografica di appendicite acuta in 368 pazienti (25%). Ulteriori 8 pazienti sono stati operati sulla base del solo giudizio clinico. Abbiamo osservato 7 casi di falsi positivi ecografici. In 1079 (75% del totale) pazienti è stato espresso un giudizio diagnostico negativo per appendicite acuta: in 173 di essi (12%) è stata formulata una diagnosi diversa. I restanti 906 pazienti sono stati sottoposti a controllo clinico fino alla risoluzione della sintomatologia, senza alcuna complicanza. I nostri risultati hanno dimostrato una sensibilità dell'ecografia del 98%, una specificità del 99%, un valore predittivo positivo del 98% e un valore predittivo negativo del 99%. L'accuratezza diagnostica globale è stata del 99%. CONCLUSIONI: La diagnosi integrata (clinica, di laboratorio ed ecografica) dell'appendicite acuta consente una diagnosi sicura, con risparmio di risorse evitando il ricorso ad appendicectomie inutili.
Pesántez-Ríos, Gabriela; Martínez-Bermejo, Antonio; Arcas, Joaquín; Merino-Andreu, Milagros; Ugalde-Canitrot, Arturo
Introduccion. Las evoluciones atipicas de la epilepsia rolandica son parte de un espectro clinico de fenotipos variables, idiopaticos, dependientes de la edad y con una predisposicion geneticamente determinada. Objetivo. Estudiar las caracteristicas electroclinicas sugestivas de una evolucion atipica en la epilepsia rolandica. Pacientes y metodos. Se realizo una busqueda retrospectiva de 133 niños diagnosticados de epilepsia focal benigna atipica (EFBA), sindrome de Landau-Kleffner y epilepsia de punta-onda continua durante el sueño (POCS). Se seleccionaron nueve pacientes que, en el trascurso de su epilepsia rolandica, presentaron un cuadro clinico atipico y un patron electroencefalografico (EEG) de estado epileptico electrico durante el sueño (ESES). Resultados. El inicio de la epilepsia rolandica fue, en promedio, a los 5 años. Los pacientes presentaron un empeoramiento clinico y del EEG año y medio mas tarde en promedio. En tres pacientes se observaron caracteristicas de EFBA, y en seis, de POCS. No se encontraron casos de sindrome de Landau-Kleffner. El EEG en vigilia mostro una focalidad centrotemporal izquierda en seis pacientes, y derecha, en tres. Todos los pacientes presentaron un ESES en el EEG de sueño. En tres de ellos se observo un patron atipico de ESES regional. Ademas, se detectaron alteraciones cognitivas y conductuales por deficits en areas especificas del aprendizaje, como lenguaje, memoria, atencion e inquietud. Conclusiones. El inicio precoz de la epilepsia rolandica, la aparicion de nuevas crisis con un incremento en su frecuencia y una focalidad frontocentrotemporal en el EEG, que aumenta en frecuencia, tanto en vigilia como en sueño, son caracteristicas electroclinicas sugerentes de una evolucion atipica.
Herrero-San Martín, Alejandro; Villarejo-Galende, Alberto; Rábano-Gutiérrez, Alberto; Guerrero-Márquez, Carmen; Porta-Etessam, Jesús; Bermejo-Pareja, Félix
Introduccion. La enfermedad de Alzheimer (EA) es la causa mas frecuente de demencia en nuestro medio. En la mayoria de los pacientes, las manifestaciones iniciales consisten en una afectacion selectiva y progresiva de la memoria. Sin embargo, no se trata de un proceso homogeneo y, en algunos casos, el modo de presentacion puede ser atipico. La presentacion de la EA en forma de alteracion precoz de la personalidad, el comportamiento y las funciones ejecutivas se ha denominado variante frontal de la EA. En nuestro caso, su diagnostico definitivo solo fue posible mediante el estudio histologico, pues los criterios clinicos vigentes resultaron entonces insuficientes para el diagnostico de esta forma atipica de la EA. Casos clinicos. Dos pacientes, una mujer y un hombre de 60 y 52 años respectivamente, presentaron un cuadro progresivo de deterioro cognitivo con afectacion inicial de las funciones ejecutivas y cambio de personalidad, junto con alteraciones del estado de animo, por lo que se realizo el diagnostico inicial de probable demencia frontotemporal. No obstante, en ambos casos, la autopsia revelo datos compatibles con el diagnostico de EA, con una distribucion de la patologia que afectaba fundamentalmente a los lobulos frontales. Conclusiones. La EA tiene una forma heterogenea de presentacion, lo que puede originar errores en su diagnostico inicial, dado que los criterios clinicos actuales no recogen de modo suficiente esta variabilidad clinica. Por ello, consideramos importante prestar atencion a las formas atipicas de la EA con el objeto de desarrollar nuevos metodos diagnosticos que permitan diferenciar la EA del resto de procesos degenerativos.
Sahasrabudhe, Neil S; Jadhav, M V; Deshmukh, S D; Holla, V V
Involvement of the myocardium by Toxoplasma gondii is seen in patients of acquired immunodeficiency syndrome (AIDS), mostly in association with toxoplasma encephalitis. Only few patients die as a direct result of cardiac dysfunction. Clinico-pathological findings of three cases of toxoplasma myocarditis are reported, one of which presented and died due to massive pericardial effusion. All cases showed diffuse myocarditis with parasites on histopathological examination. Incidence of toxoplasma myocarditis in patients dying with AIDS was 8.3% (3 out of 36 cases).
Khaled, Hussein M
Bladder cancer is still the most frequent malignant tumor among Egyptian males. It has a peculiar biologic, clinico-pathologic features and responsiveness to chemotherapy profile than that observed in Western countries. The current review aims to demonstrate the present state-of- art in using systemic therapy as part of the management options available to treat such patients at different stages of their disease. Individualizing therapy for these patients based on more rationale basis is the challenge that oncologists must face in the near future.
Babahabib, Moulay Abdellah; Abdillahi, Ibrahima; Kassidi, Farid; Kouach, Jaouad; Moussaoui, Driss; Dehayni, Mohammed
Posterior reversible encephalopathy syndrome (PRES) is a rare clinico-neuroradiologic condition, not commonly reported in the literature. PRES is an uncommon complication of severe preeclampsia/eclampsia. We report the management of one patient with postpartum preeclampsia as an association of HELLP syndrome presenting with status-epileptics. Early diagnosis along with timely supportive therapy resulted in the successful management of this challenging case. Recent understanding on the pathophysiology of this uncommon condition is discussed. We highlight the importance to obstetricians, intensive-care physicians and anesthesiologists of recognizing such cases.
Dosoretz, D.E.; Blitzer, P.H.; Russell, A.H.; Wang, C.C.
We examined the records of 33 patients who presented with the clinico-radiological diagnosis of solitary brain metastasis and no other evidence of tumor dissemination. Length of survival of patients and patterns of treatment failure were analyzed according to the treatment modalities that were used. Both groups were comparable regarding major parameters that affect response and survival in patients with brain metastasis. There did not appear to be any significant advantage to the use of irradiation following excision, at least at the doses employed in this study. We advocate the use of higher doses of irradiation in any curative attempt following total excision of a solitary brain metastasis.
Mishra, Anupam; Mishra, Subhash Chandra
This report describes the third case of a true bilateral Juvenile nasopharyngeal angiofibroma (JNA), i.e. two separate JNA arising from both sides simultaneously. The associated multiple recurrences in such a case have not yet been reported. A 21-year-man underwent transpalatal excision and recurred twice. The last 'neo-occurrence' encountered after 2 years was at a different site and was subsequently managed by post-embolization endoscopic resection. A complete report of its clinico-radiological features and management outcome is discussed.
Arévalo-Sáenz, Alejandra; Torres, Cristina V; Pastor, Jesús; Alonso-Cerezo, Concepción; Sola, Rafael G
Introduccion. El sindrome del cromosoma 20 en anillo es una alteracion genetica infrecuente, con un diagnostico tardio. Caso clinico. Mujer de 43 años con epilepsia farmacorresistente desde los 6 años, tratada mediante estimulacion cerebral profunda del nucleo centromediano y con un cromosoma 20 en anillo. Conclusiones. Del estudio se extrae la conclusion de la inefectividad de la estimulacion cerebral profunda del nucleo centromediano en pacientes con cromosoma en anillo, pero se apunta la importancia de la caracterizacion genetica para el manejo de la epilepsia farmacorresistente.
Pumar, José M; Banguero, Alexandra; Arias-Rivas, Susana; Blanco, Miguel; Rodríguez-Yáñez, Manuel; Sucasas, Paula; Blanco, Miguel; Castiñeira-Mourenza, José A; Vázquez-Herrero, Fernando
Introduccion. La trombosis aguda intrastent es una complicacion potencialmente grave en el stenting intracraneal. Es primordial determinar cual es la terapia mas adecuada en las trombosis intrastent. Caso clinico. Mujer de 58 años, el primer caso de trombosis aguda de un stent intracraneal, que fue tratada con exito mediante fibrinolisis tras la implantacion de un dispositivo diversificador de flujo (Silk) en un aneurisma basilar fusiforme. Conclusion. La administracion de abciximab como tratamiento de rescate parece segura en los casos de formaciones de trombos agudos intrastent.
van Roosmalen, J
Prolonged labour was the most frequent cause of perinatal death in a rural hospital in the south western highlands of Tanzania. After the introduction of an obstetric policy aiming to prevent prolonged labour by making use of the guidelines of the partogram, perinatal mortality was reduced from 71 to 39 per 1000 births. Baird's clinico-pathological classification is still considered a useful instrument for the discovery of avoidable factors in perinatal deaths. The concept of the partogram should be an integral part of the training of medical auxiliaries in the field of maternal and child health (MCH).
Shimotake, Akihiro; Fujita, Youshi; Ikeda, Akio; Tomimoto, Hidekazu; Takahashi, Jun; Takahashi, Ryosuke
A 34-year-old man with astrocytoma in the left parietal lobe had symptomatic partial epilepsy, and he presented transient episodes of acalculia, agraphia and finger agnosia. Occasionally he had difficulty in finding appropriate letters when making an e-mail, and difficulty in writing and calculation. Neurological examinations revealed ictal symptoms of Gerstmann's syndrome without right to left disorientation. No other higher cortical dysfunction or neurological deficits were noted. Scalp EEGs showed frequent, regional ictal discharges in the left parietal area lasting for 60-240 seconds. These clinico-electrographical observations strongly support that epileptic seizures produced a loss of cortical higher function manifesting Gerstmann's syndrome.
Figueiredo, Nigel Roque; Dinkar, Ajit Dattatray; Khorate, Manisha Maruti
Glandular Odontogenic Cyst is a relatively rare cyst of odontogenic origin, which shows glandular or salivary features that are thought to indicate the pluripotentiality of odontogenic epithelium. It is seen in middle-aged adults, and commonly involves the anterior region of the jaws, especially the mandible. It shows non-specific clinico-radiographic findings which may resemble other lesions, but has characteristic histopathologic features which help in its diagnosis. This paper reports an unusual presentation of a glandular odontogenic cyst which was diagnosed in a 64-year old female in the posterior maxilla, along with a literature review of this cyst, especially the cases reported in India in the past.
Kumar, A; Moulik, N Roy; Kishore, J; Kumar, A; Jain, A
Parvovirus B19 (B19V) has been associated with a wide spectrum of clinico-pathological disorders in human beings depending upon the host immunity. The present report describes a child with chronic myeloid leukemia ( CML) on hydroxyurea in haematological remission, who developed profound erythroid suppression following B19V infection requiring multiple transfusions and withdrawal of hydroxyurea. Despite being off-therapy the child remained in complete clinical and haematological remission till anti B19V antibodies appeared. This case illustrates the ability of B19V infection in suppressing neoplastic myeloid clone, a phenomenon not described earlier.
Arroyo-Carrera, Ignacio; de Zaldívar-Tristancho, M Solo; Martín-Fernández, Rebeca; Hernández-Martín, Raquel; López-Lafuente, Amparo; Rodríguez-Revenga, Laia
Introduccion. El gen SOX5 codifica un factor de transcripcion implicado en la regulacion de la condrogenia y el desarrollo del sistema nervioso. Caso clinico. Niña de 10 anos con discapacidad intelectual, alteracion conductual y malformaciones menores de este nuevo sindrome con alteracion en el neurodesarrollo, con una delecion 12p12 que incluye el gen SOX5. Conclusiones. Se revisan los casos publicados tanto de deleciones intragenicas de SOX5 como de deleciones mas grandes que incluyen este gen, y se analizan las correlaciones genotipo-fenotipo y los genes implicados en esta paciente.
Gasanova, T A
The complex clinico-laboratory examination of 120 infertile married couples and 120 couples with habitual miscarriage was made. For control, 96 healthy married couples were used. The microbiological risk factors of chronic pelvic inflammatory diseases were determined, namely: mixed parasitocenosis, including active anaerobic, viral and fungal components, as well as Chlamydia trachomatis. As shown in this study, metabolically active forms of chlamydial infection were characteristic of infertile married women and persistent forms of C. trachomatis, for pregnant women. At the same time chlamydial infection did not cause infertility in males. The use two of levels of laboratory tests for qualitative, quantitative and functional evaluation of parasitocenoses were proposed.
Arevalo-Saenz, A; Pedrosa-Sanchez, M; Sola, R G
Introduccion. El mutismo acinetico se considera una alteracion del estado motivacional de la persona, por el cual el paciente es incapaz de iniciar respuestas verbales o motoras de caracter voluntario, aun teniendo preservadas las funciones sensomotoras y de vigilancia. Caso clinico. Varon de 43 años, intervenido de una fistula arteriovenosa del cerebelo complicada con hidrocefalia, que respondio espectacularmente al tratamiento con bromocriptina. Conclusion. Tipicamente se ha descrito el mutismo acinetico como una complicacion transitoria de las cirugias de la fosa posterior. Sin embargo, tambien puede aparecer tras multiples fallos valvulares en pacientes con hidrocefalia.
119 and 432 are greater among Blacks (Pɘ.001) whereas the 453 variant is predominant in Whites (Pɘ.001). Within race, a case control study show the...the 432G-449C haplotype was observed to be a risk for PC (Pɘ.05). In a sampling of cases , no differences were observed between stages (<T2c vs >T2c...hypertrophy (BPH). Relevant clinico -pathologi c data (age, Gleason grade, and tum or-node- 6 metastasis stage) were collected from the patie nt files. The
Selva, R La; Violetti, S Alberti; Delfino, C; Grandi, V; Cicchelli, S; Tomasini, C; Fierro, M T; Berti, E; Pimpinelli, N; Quaglino, P
The term “Primary Cutaneous B-Cell Lymphoma” (PCBCL) comprehends a variety of lymphoproliferative disorders characterized by a clonal proliferation of B-cells primarily involving the skin. The absence of evident extra-cutaneous disease must be confirmed after six-month follow-up in order to exclude a nodal non-Hodgkin's lymphoma (NHL) with secondary cutaneous involvement, which may have a completely different clinical behavior and prognosis. In this article, we have summarized the clinico-pathological features of main types of PCBCL and we outline the guidelines for management based on a review of the available literature.
Quatresooz, P; Piérard, G E; Piérard-Franchimont, C
In a manichean ideal, one expects unreservedly a clear-cut distinction between benign melanocytic neoplasms and the malignant ones. Such a distinction is commonly established by a clinico-pathologic confrontation for the majority of neoplasms. However, the boundaries may be blurred and uncertain for some lesions. We present an exploratory clinicopathologic algorithm of the border area between seemingly benign and seemingly malignant melanocytic neoplasms. The concept of a group of neoplasms called skin melanocytomas shed some light on such quandaries where the risk of misdiagnosis is quite high.
İpek, Mehmet Sah; Akgul Ozmen, Cihan
Abstract Skeletal dysplasias are a heterogeneous group of conditions associated with various abnormalities of the skeleton. Some of them are perinatally lethal and can be diagnosed at birth. Lethality is usually due to thoracic underdevelopment and lung hypoplasia. A correct diagnosis and typing of the skeletal disorder is essential for the prognosis as is genetic counseling of the family. A retrospective review of 12 cases of clinico-radiologic diagnosis of skeletal dysplasia, leading to thoracic insufficiency, was conducted. We aimed to make differential diagnosis with special emphasis on radiological findings, and to emphasize the importance of parental counseling. PMID:27057899
Fridman, M V; Demidchik, Iu E; Papok, V E; Savva, N N; Zborovskaia, A A; Spivak, L V; Schmid, K W
The clinico-morphological investigations of 117 children and adolescences with papillary thyroid carcinoma, surgically treated in the Republic Centre for Thyroid Tumors, Minsk, Belarus in 1995-2009 and dutifully followed-up have been studied. Ninety -five observations of all cases were sporadic, but 22 patients had been treated earlier from other neoplasm (Hodgkin's diseases, malignant lymphoma, leukemia, sarcoma, medulloblastoma). Epidemiologic, clinical and pathological peculiarities of thyroid carcinoma in Belarus were analyzed. A number of features distinguished "cryptogenic" and "iatrogenic" papillary thyroid carcinoma in children and adolescents were found out.
Nguyên, D T
Trachoma was severe in Viet-Nam before 2nd World War and was still severe a long time after. Years of fight allowed to ameliorate noticeably the state of this important blinding endemic disease. From 1986, according to the data, Trachoma decreased noticeably as, generally speaking, the prevalence of this illness cases is decreasing progressively. Trachoma also lose its intensity, its clinical picture becoming more moderated, its complications being less frequent. In this text, you will find some aquisitions in the study of the Trachoma in Viet-Nam on epidemiologic, clinico-pathologic and therapeutic points of view and concerning the various stages of Vietnamese experience in front of Trachoma.
Hueto-Perez-de-Heredia, J J; Dominguez-del-Valle, F J; Garcia, E; Gomez, M L; Gallego, J
We report on a case of Churg-Strauss syndrome in a 30 year old male with a history of perennial rhinitis. The syndrome began nine months earlier with clinico-radiological features typical of chronic eosinophilic pneumonia. Diagnosis of vasculitis was made by skin biopsy, and at that time there was multisystemic involvement with pulmonary, cardiac, renal, cutaneous and muscular disease, and right vocal chord paralysis, which improved with corticosteroids and cyclophosphamide. This case report illustrates the possible overlap of chronic eosinophilic pneumonia and the Churg-Strauss syndrome.
Cardinale, A; Lagalla, R; Davì, G; Davì, F
Early clinico-experimental findings with real-time B-mode Echography of the odontological district are reported. On the basis of previous in vitro application references and using a unidimensional A-Mode technique, preliminary data of in vivo ultrasound semeiotics regarding the tooth and its periodontal structures are outlined experimentally. Although current "in vivo" experience relates exclusively to front central and para-central teeth, it can be hypothesised that further technical and methodological developments of echographic instruments may permit systematic employment of ultrasound diagnosis in the odontological sector.
Galán-Sánchez, Francisco; Esteban-Cantó, Vanessa; Blaya-Fernández, Pedro; Jadraque-Rodríguez, Rocío; Manchón-Trives, Irene; Alcaraz-Más, Luis
Objetivo. Aportar datos sobre el fenotipo determinado por las microdeleciones de los exones alfa del gen NRXN1. Casos clinicos. Se estudian tres casos neuropediatricos con microdeleciones intragenicas NRXN1 alfa. El fenotipo en estos tres casos es inespecifico, con retraso mental leve-moderado, trastornos de comportamiento y escasos rasgos dismorficos o malformaciones. Conclusion. El fenotipo encontrado en las microdeleciones de los exones alfa del gen NRXN1 es claramente distinguible del fenotipo encontrado en las microdeleciones de los exones beta, con macrocefalia, epilepsia y retraso mental.
Lochner, Michelle L; Wolf, Andrea
Human immunodeficiency virus-associated nephropathy (HIVAN) is a very distinct, unique, clinico-pathological syndrome, and a structural type of renal failure that is the most common cause of chronic renal failure in patients who are HIV-seropositive. Early referral and a long-term, primary care approach can improve patient outcomes. Careful adjustments of prescription doses with regularly scheduled, and at times frequent, laboratory testing will yield, optimal health, improve the quality of life, and most importantly, will decrease the incidence of morbidity and mortality in those individuals afflicted with both HIV and HIVAN.
Qi, Da; King, Ross D; Hopkins, Andrew L; Bickerton, G Richard J; Soldatova, Larisa N
The paper presents an ontology for the description of Drug Discovery Investigation (DDI).This has been developed through the use of a Robot Scientist "Eve", and in consultation with industry. DDI aims to define the principle entities and the relations in the research and development phase of the drug discovery pipeline. DDI is highly transferable and extendable due to its adherence to accepted standards, and compliance with existing ontology resources. This enables DDI to be integrated with such related ontologies as the Vaccine Ontology, the Advancing Clinico-Genomic Trials on Cancer Master Ontology, etc. DDI is available at http://purl.org/ddi/wikipedia or http://purl.org/ddi/home.
Ostroglazov, V G; Lisina, M A
The study of clinical picture and the course of unclear pathological states simulating the vertebral pathology suggested that the major signs were centered around the primary general and muscular sensory disorders. These served as a basis for development of more complicated psychosensory and psychomotor disorders and creation of an interpretative hypochondriac++ delirium system. Domination of psychomotor disorders led to a high incidence of social and labor dysadaptation of the patients. Thus, the study of this unclear mental pathology has a major theoretic, clinico-psychopathological and also practical medico-social importance.
Machado, Raquel Rodrigues Campos; Caruso, Lúcia; Lima, Patricia de Azevedo; Damasceno, Nágila Raquel Teixeira; Soriano, Francisco Garcia
Introducción: la respuesta inflamatoria causada por sepsis provoca cambios metabolicos que pueden provocar una perdida de masa magra significativa en pacientes septicos. Debido a ello, cuando el tracto digestivo es funcional la terapia nutricional (NT) debe iniciarse dentro de las 48 horas de tratamiento intensivo para reducir la perdida de proteina. Objetivo: evaluar la terapia nutricional enteral (TNE) en pacientes septicos adultos con TNE exclusivo para ≥ 72 horas y duracion de ≥ 7 dias de estancia en la Unidad de Cuidados Intensivos y su relacion con el pronostico clinico. Métodos: se analizaron prospectivamente la adecuacion de la nutricion enteral administrada, los factores asociados con la falta de conformidad, la tolerancia gastrointestinal y el resultado. Se utilizaron pruebas estadisticas de chi-cuadrado y la t de Student, asi como las correlaciones de Mann-Whitney y Spearman y Pearson (p < 0,05). Se ha realizado un modelo de regresion logistica multiple mediante el metodo paso a paso para evaluar la asociacion entre factores de prediccion de la evolucion clinica. Resultados: 53 pacientes, 67,9% hombres y 52,8% ancianos se inscribieron en este estudio. El tiempo promedio para el inicio de ENT fue de 30 (23,5) horas, y el 88,7% de los pacientes alcanzaron el objetivo nutricional en 48 horas. El volumen medio entregado en relacion con el prescrito fue 78,9%. Cuando la muestra se estratifico segun calorias prescritas/administradas, los pacientes que recibieron < 80% tenian una tasa de mortalidad mas alta (p = 0,001) y el consumo de calorias ≥ 80% fue el factor determinante en el pronostico clinico de los pacientes (p = 0,021). Conclusión: los pacientes septicos recibieron nutricion enteral precoz. El objetivo nutricional y el volumen medio entregado en relacion con el volumen prescrito cumplen las directrices de cuidados intensivos. El soporte nutricional se asocio con el resultado clinico y la ingesta calorica ≥ 80% para determinar el pronostico
del Saz-Saucedo, Pablo; Alfaya-Muñoz, Laura Blanca; Recio-Bermejo, Marta; Lara-Medina, Francisco Javier; García-Chiclano, Amalia; Ortega-León, Teresa; Rueda-Medina, Ignacio; Domínguez-Fernández, María José; Madrid-Muñiz, Carmen; Franco-Huerta, María
Introduccion. La epiteliopatia pigmentaria placoide multifocal posterior aguda (EPPMPA) es una enfermedad inflamatoria rara, generalmente de etiologia indeterminada, de la coriocapilar, el epitelio pigmentario y la retina externa. Afecta predominantemente a pacientes jovenes y en algunos casos puede involucrar al sistema nervioso central en forma de ictus o de meningoencefalitis. Presentamos el caso clinico de una mujer joven con EPPMPA complicada con ictus e hipertension intracraneal. Caso clinico. Mujer de 16 anos que comienza con cefalea intensa sugestiva de hipertension intracraneal, asi como con un deficit agudo hemisferico izquierdo. La resonancia magnetica craneal ponia de manifiesto lesiones embolicas o vasculiticas en diferentes territorios. No se evidenciaron datos de meningoencefalitis en el estudio del liquido cefalorraquideo, pero si de hipertension intracraneal asociada. La presencia de lesiones muy especificas en el polo ocular posterior permitio el diagnostico de EPPMPA complicada con ictus isquemico, probablemente por mecanismo vasculitico. Un amplio estudio etiologico fue negativo para identificar un factor desencadenante claro del proceso. Se inicio tratamiento corticoideo con buena evolucion clinica y radiologica. Conclusiones. La EPPMPA es una entidad rara que generalmente entrana buen pronostico; sin embargo, en algunos casos puede complicarse con afectacion del sistema nervioso central, y el ictus isquemico secundario a vasculitis es la complicacion mas grave. Ante un paciente joven con ictus que presente sintomatologia visual y lesiones coriorretinianas, debe considerarse la EPPMPA en su diagnostico etiologico.
Mazzeo, Carmelo; Gammeri, Emanuele; Foti, Agata; Rossitto, Maurizio; Cucinotta, Eugenio
L’endometriosi è una patologia non ancora del tutto conosciuta che colpisce il 6-10% della popolazione femminile generare e il 35-50% della popolazione femminile affetta da dolore pelvico e infertilità. La sede più frequente di malattia è rappresentata dall’ovaio e ciò sostiene l’ipotesi patogenetica della mestruazione retrograda. Viene descritto un caso di non comune localizzazione vulvare di endometriosi riscontrata in una paziente precedentemente operata per una cisti di Nuck. La donna aveva notato da qualche mese l’insorgenza di una tumefazione nella regione vulvare che le causava dolore e dispareunia che si accentuavano nel periodo mestruale. Il sospetto clinico di endometriosi non aveva avuto conferma negli esami strumentali preoperatori che non avevano evidenziato alterazioni patognomoniche, nè differenze dei reperti in fase pre mestruale e mestruale. Solo l’esame istologico della neoformazione asportata ha confermato la diagnosi. Inoltre gli Autori con la presente nota desiderano sottolineare come nella patogenesi dell’endometriosi vulvare debba essere tenuta in considerazione la presenza della pervietà del dotto peritoneovaginale o dotto di Nuck. Nel caso clinico descritto, infatti, la paziente era stata sottoposta due anni prima ad asportazione di una cisti di Nuck con obliterazione del dotto peritoneovaginale. Tuttavia già in quella fase clinica poteva essersi determinato un impianto endometriosico, che si era poi evidenziato con la formazione del nodulo in sede vulvare asportato chirurgicamente.
Pardal-Fernandez, J M; Ezsol-Lendvai, S; Rodriguez-Vazquez, M; Agudo-Mena, J L; Godes-Medrano, B
Introduccion. La lepra es una enfermedad infecciosa causada por la bacteria Mycobacterium leprae. Presenta especial avidez por la piel y los troncos nerviosos, y, de hecho, ambos se afectan en la mayor parte de los infectados. Se trasmite por exposicion con enfermos y en ocasiones por reactivacion. Una posibilidad inhabitual es la lepra neural pura, caracterizada por neuropatia, pero sin lesiones en la piel. Se describe un paciente con lepra neural pura y se revisan los aspectos diagnosticos. Caso clinico. Varon de 40 años, inmigrante, diagnosticado y tratado de lepra 20 años antes. Acudio por parestesias y disestesias dolorosas en las manos y las piernas sin lesiones en la piel. Se demostro mononeuritis multiple aguda con principal afectacion de cubitales. La enfermedad, tipificada como tuberculoide paucibacilar, se trato y en pocas semanas la mejoria fue evidente. Conclusiones. En este caso de lepra neural pura por reactivacion, el diagnostico temprano permitio un rapido tratamiento. Es recomendable la evaluacion de la neuropatia integrada con criterios clinicos, electrofisiologicos y ecograficos. De este modo se consigue una alta sensibilidad y especialmente una precocidad en el diagnostico y la instauracion del tratamiento, y por consecuencia una mejor recuperacion funcional.
Lusenti, T; Fiorini, F; Barozzi, L
Sommario INTRODUZIONE: Tra le fistole arterovenose (FAV) acquisite vi sono quelle che si formano quale complicanza dell’esecuzione di una biopsia renale. CASO CLINICO: Gli autori riportano il caso di una paziente giunta in ambulatorio di ecografia nefrologica per l’esecuzione di un’ecografia dei reni e delle vie urinarie per un’ipertensione sistolica di I grado di recente insorgenza. Negli esami di laboratorio era presente microematuria con proteinuria <0.5 g/24 ore. La funzionalità renale risultava ai limiti inferiori della norma (FG 58 mL/min secondo la formula MDRD). L’esame ecografico evidenziava una formazione anecogena “arboriforme” centropielica a livello del rene sinistro suggestiva per idronefrosi. Il color Doppler mostrava viceversa presenza di flusso turbolento all’interno dell’area anecogena stessa, con flusso arterioso elevato e arterializzazione del flusso venoso all’analisi spettrale. La successiva angiografia renale selettiva confermava il sospetto ecografico di FAV mediorenale sinistra con pseudoaneurisma, conseguente ad una biopsia renale effettuata più di 10 anni prima presso altro Centro. Essendo la paziente in pieno benessere veniva consigliato un più stretto follow-up clinico-ecografico. DISCUSSIONE: Tra le malformazioni vascolari renali di non rara osservazione sono le FAV. Il caso descritto ribadisce l’importanza dell’impiego dell’eco color Doppler (ECD) nel sospetto di uropatia ostruttiva, per diagnosticare una FAV, specialmente nei pazienti già sottoposti a biopsia renale.
Espinosa-Sánchez, Juan M; Heitzmann-Hernández, Teresa; López-Escámez, José A
Introduccion. El 5-15% de la poblacion general presenta acufenos cronicos, que afectan de manera grave a la calidad de vida del 1% de los casos. El tratamiento farmacologico es una de las opciones terapeuticas en el abordaje de pacientes con acufenos, aunque su eficacia es controvertida. Objetivo. Evaluar el nivel de evidencia que sustenta el uso de diferentes farmacos para reducir la intensidad de los acufenos. Desarrollo. Se han revisado varios grupos farmacologicos incluyendo anestesicos, antiepilepticos, antidepresivos, antihistaminicos, benzodiacepinas, diureticos, corticoides y otras sustancias. La lidocaina intravenosa parece ser eficaz aunque la breve duracion de su efecto y la aparicion de reacciones adversas han llevado a descartarla. La carbamacepina y la gabapentina no han mostrado eficacia frente a placebo, si bien podrian ser eficaces en algunos pacientes con compresion neurovascular o mioclonias. Los antidepresivos triciclicos no son mas eficaces que el placebo aunque pueden mejorar una depresion coexistente. La evidencia es insuficiente para evaluar la eficacia de los inhibidores selectivos de la recaptacion de serotonina y las benzodiacepinas. El acamprosato podria reducir la intensidad de los acufenos, aunque el nivel de evidencia es bajo. No disponemos de resultados consistentes para el tratamiento de los acufenos de la enfermedad de Meniere empleando gentamicina intratimpanica o corticoides. Conclusiones. La utilizacion de medicamentos para reducir la intensidad de los acufenos no esta bien apoyada por ensayos clinicos controlados, aleatorizados y prospectivos. Algunos farmacos son eficaces en algunos estudios, pero la evidencia es limitada. Se necesitan ensayos clinicos aleatorizados mas amplios.
Salvado, Maria; Boronat-Guerrero, Susanna; Hernández-Vara, Jorge; Álvarez-Sabin, José
Introduccion. El corea por mutacion en el gen TITF1, tambien denominado corea hereditario benigno, es un trastorno autosomico dominante que suele iniciarse antes de los 5 anos. En la mayoria de casos, el corea tiende a mejorar con la edad. Puede asociar hipotiroidismo y problemas respiratorios, como el sindrome de distres respiratorio alveolar neonatal o la enfermedad pulmonar intersticial, ya que TITF1 es un factor de transcripcion esencial para el desarrollo del cerebro, tiroides y pulmon. Casos clinicos. Presentamos el fenotipo clinico de una familia con corea, en la cual dos hermanas presentan hipotiroidismo congenito, y una de ellas, sindrome de distres respiratorio alveolar. En ambas se identifico una mutacion en TITF1 (c.825delC) y se observo mejoria clinica en respuesta al tratamiento con levodopa-carbidopa en dosis bajas. Conclusiones. El corea por mutacion de TITF1 es una causa infradiagnosticada de corea en ninos. Debido a la posibilidad de realizar diagnostico genetico, creemos indicado realizarlo siempre en casos familiares dominantes, teniendo en cuenta la penetrancia variable, asi como en pacientes que presenten afectacion concomitante de pulmon o hipotiroidismo. En casos esporadicos, puede ser recomendable en coreas de causa no filiada, lo que nos permitira evitar otras pruebas, dar un pronostico no degenerativo, permitir un consejo genetico, y hacer ensayos terapeuticos mas dirigidos y eficaces. Por el momento, la levodopa parece el tratamiento sintomatico de eleccion.
Salamone, Giuseppe; Licari, Leo; Agrusa, Antonino; Romano, Giorgio; Cocorullo, Gianfranco; Falco, Nicolò; Tutino, Roberta; Gulotta, Gaspare
Una delle principali e più temute complicanze della resezione anteriore di retto è stata ed è la deiscenza anastomotica. Solitamente, sia essa una scelta di principio od a discrezione del chirurgo operatore, viene confezionata una ileostomia laterale di sicurezza con lo scopo di prevenire tale circostanza. Scopo di tale studio è stato quello di investigare circa la utilità della stomia laterale di sicurezza quale strumento di prevenzione della deiscenza anastomotica, mettendo a paragone il decorso post-operatorio dei paziente con e senza stomia laterale. Le evidenze hanno portato alla conclusione che il confezionamento della stomia laterale di sicurezza è fattore di protezione non tanto dell’evento deiscenza anastomotica in senso stretto, quanto delle complicanze e della evoluzione clinica della stessa, vedasi ad esempio tasso di ricorrenza di deiscenza/quadro clinico in corso di deiscenza/ tempi di degenza, pur rendendosi necessario sottolineare l’assenza di significatività statistica nel tasso di mortalità nei due gruppi in studio. Cosi detto appare dunque sinottico affermare che il confezionamento di ileostomia laterale di sicurezza in corso di resezione anteriore di retto non determina una diretta azione sull’evento “deiscenza anastomotica” né “morte”, purtuttavia modifica certamente in positivo il decorso clinico ed evolutivo dell’evento “deiscenza anastomotica”.
Ledesma-Montes, Constantino; Vega-Memije, Elisa; Garcés-Ortíz, Maricela; Cardiel-Nieves, Maritza; Juárez-Luna, Claudia
Multifocal epithelial hyperplasia (MEH) is also known as focal epithelial hyperplasia, Heck's disease or multifocal papillomavirus-induced epithelial hyperplasia. It is characterised by the presence of multiple lesions in the oral mucosa of children and it has been associated with the presence of the human papillomavirus. The aim of this study was to determine the clinico-pathological features of the cases diagnosed as MEH in the Service of Dermatology of the Hospital Manuel Gea González (SDHMGG). The files of the SDHMGG were reviewed and all cases diagnosed as MEH were retrieved. Nine MEH cases were found. Most of the patients were 20 year-old or younger (67%) and females were more commonly affected (78%). All patients presented multiple lesions and always, close relatives with similar lesions were found. Lesions were located most commonly in the buccal mucosa, lower lip and commissures. MEH is a soft tissue intraoral condition that needs treatment solely of the traumatised lesions or those with cosmetic problems. Remaining lesions will disappear with the age of the patients. It is suggested that this entity should be named multifocal epithelial hyperplasia since this name describes better the clinico-pathological and microscopic features of the disease.
Romera-De Francisco, L; Jimenez-Del Barrio, S
Introduccion. La electroestimulacion funcional es una de las tecnicas fisioterapicas empleadas en la actualidad para el abordaje de los pacientes que han sufrido un ictus. Objetivo. Conocer la efectividad de la electroestimulacion funcional en las capacidades generales, la marcha y la calidad de vida de los pacientes con ictus mediante una revision sistematica. Como objetivo secundario se planteo conocer el mejor metodo de aplicacion de esta tecnica. Pacientes y metodos. Se ha realizado una busqueda bibliografica en las bases de datos Medline, PEDro y Biblioteca Cochrane. Se han incluido ensayos clinicos y revisiones sistematicas de los ultimos cinco años que valorasen la efectividad de la electroestimulacion funcional en pacientes tras sufrir un ictus. Resultados. Se incluyeron 10 ensayos clinicos y una revision sistematica con metaanalisis, de los cuales se extrajeron los datos mas relevantes, se analizaron y se compararon. Conclusiones. La electroestimulacion funcional puede ayudar en la mejora de la calidad de vida, las capacidades motoras y la funcionalidad de la marcha en pacientes que han sufrido un ictus. No se puede afirmar que por si sola aporte mejores resultados que otras tecnicas convencionales de fisioterapia, y se observa una mayor efectividad con la aplicacion de electroestimulacion funcional asociada a otras tecnicas de fisioterapia. El mejor abordaje de la aplicacion con electroestimulacion funcional es el realizado en mas de un grupo muscular, desencadenando los impulsos mediante movimientos activos y en combinacion con otras intervenciones fisioterapicas.
Katakam, Bhumesh Kumar; Kiran, Geeta; Kumar, Udaya
Background: Herpes zoster (HZ) is a dermatomal viral infection, caused by reactivation of varicella zoster virus (VZV) that persists in the posterior root ganglion. HZ is uncommonly reported in immunocompetent children. It may be due to intrauterine VZV infection or secondary to postnatal exposure to VZV at an early age. Aims: Our study was to review clinico-epidemiological data for HZ in children for early diagnosis and treatment to prevent complications. Materials and Methods: A prospective observational study was conducted from January 2013 to December 2014. Consecutive cases clinically diagnosed as HZ in the pediatric age group were taken up. Results: We report the clinico-epidemiological study of 26 cases of HZ, their benign course and recovery among children. Conclusions: HZ is a rare disease in childhood. Varicella in early childhood is a risk factor of HZ in immunocompromised and immunocompetent children. Childhood zoster occurs in either healthy or underlying immunodeficient children. The appearance of HZ in a young child does not always imply an underlying immunodeficiency or malignancy. But the identification of HZ with or without immunodeficiency is of prime importance from the treatment and prognostic point of view and should be considered in the differential diagnosis of vesicular eruptions. The prognosis is generally good in healthy children. PMID:27688444
Cheng, Q; Jiang, G X; Press, R; Andersson, M; Ekstedt, B; Vrethem, M; Liedholm, L J; Lindsten, H; Brattström, L; Fredrikson, S; Link, H; de Pedro-Cuesta, J
We described clinical manifestations, outcomes, prognostic indicators and clinico-epidemiological subgroups for 53 adult patients with Guillain-Barré syndrome (GBS) in Sweden during the period 1996-97. These patients were identified from a population of 2.8 million inhabitants and prospectively followed up for one year by a network of neurologists. An additional 10 cases, of whom five were adults who had not been prospectively followed up, were not included in the analyses. At 6 months after onset 80% of the patients could walk without aid, while at 1 year 46% were fully recovered, 42% had mild residual signs or symptoms, 4% had moderate and 6% severe disabilities, and 2% had died. Intravenous human immunoglobulin or plasmapheresis were used in 72% of the patients. The sum of the Medical Research Council (MRC) score at nadir was found as the only significant predictor for residual signs at 1 year in a multivariate model. Three subgroups, with different clinico-epidemiological characteristics, were identified by using cluster analysis. In conclusion, GBS in Sweden is frequently preceded by a respiratory infection, is often treated with immunomodulatory therapies, and exhibits a high recovery rate and a low fatality rate.
Arroyo-Carrera, I; Solo de Zaldivar-Tristancho, M; Martin-Fernandez, R; Vera-Torres, M; Gonzalez de Buitrago-Amigo, J F; Botet-Rodriguez, J
Introduccion. El sindrome de Noonan es el mas frecuente del grupo de los sindromes malformativos congenitos originados por mutaciones germinales en genes de la via RAS/MAPK, denominados genericamente RAS-opatias, uno de los grupos mas comunes de alteraciones geneticas congenitas en la practica clinica. Recientemente se han descrito mutaciones en el gen RIT1 en pacientes con sindrome de Noonan. Caso clinico. Nina de 7 anos con diagnostico clinico de sindrome de Noonan, que entre sus manifestaciones clinicas incluye miocardiopatia hipertrofica, en la que se ha identificado una mutacion de novo en heterocigosis, en RIT1, c.295T>C (p.Phe99Leu), no descrita previamente, probablemente causal. Conclusiones. RIT1 comparte homologia con otras proteinas RAS y la expresion de alelos mutantes origina un efecto de ganancia de funcion que apoya su papel causal en el sindrome de Noonan. Podemos estimar actualmente que es responsable de un 3-5% de los casos del sindrome. Estos casos con sindrome de Noonan, respecto a los que presentan mutaciones en otros genes, se caracterizan por una mayor frecuencia de alteraciones prenatales, alta frecuencia de miocardiopatia hipertrofica y menor frecuencia de talla baja y deformidad toracica. Destaca la importancia de incorporar los nuevos genes identificados en los paneles diagnosticos.
Ramos-Zúñiga, Rodrigo; Pérez-Gómez, Héctor R; Gaytán-Martínez, Luis A; Vega-Ruiz, Brenda; Soto-Rodríguez, Sofía; Rochín-Mozqueda, Alejandro
Introduccion. Existen pocas evidencias notificadas de casos de epilepsia del lobulo temporal asociadas a cisticercosis activa en su fase quistica. El objetivo es presentar la correlacion entre cisticercosis activa en zonas topograficas asociadas a epilepsia del lobulo temporal, con las manifestaciones neuropsiquiatricas y el patron de crisis parciales secundariamente generalizadas. Casos clinicos. Dos casos de pacientes adultos con manifestaciones neuropsiquiatricas de un año de evolucion, refractarios a tratamiento farmacologico antipsicotico, y en quienes posteriormente aparecen crisis convulsivas parciales secundariamente generalizadas de inicio tardio. Se identifica la presencia de cisticercosis activa en el lobulo temporal en un paciente, y en la insula, en el otro. Buen control clinico posterior al tratamiento con albendazol, pero se mantiene el mismo tratamiento anticonvulsionante para considerar la pertinencia de su retirada farmacologica. Conclusiones. La neurocisticercosis activa puede ser causa de trastornos neuropsiquiatricos adquiridos y de epilepsia del lobulo temporal de inicio tardio cuando su topografia se encuentra en el circuito mesolimbico. El diagnostico etiologico oportuno y el tratamiento apropiado permiten el control adecuado de su sintomatologia y, potencialmente, su curacion definitiva.
Barragan-Martinez, D; Nunez-Enamorado, N; Berenguer-Potenciano, M; Villora-Morcillo, N; Martinez de Aragon, A; Camacho-Salas, A
Introduccion. La cerebelitis aguda es una de las principales causas de sindrome cerebeloso en la infancia. Entre un amplio elenco de manifestaciones, en el que predominan la cefalea y la ataxia, podemos encontrar otras menos habituales, aunque interesantes, como las alteraciones del lenguaje, mas alla de la bien conocida disartria cerebelosa. Las diferentes combinaciones en que pueden aparecer los sintomas, especialmente cuando no se acompañan de ataxia, hacen de este cuadro un verdadero reto para el clinico. Casos clinicos. Se presentan dos pacientes, de 2 y 4 años, con clinica, pruebas de laboratorio y neuroimagen compatibles con cerebelitis aguda parainfecciosa, que asociaron una llamativa alteracion del lenguaje, uno en forma de mutismo cerebeloso y otro en forma de hipofluencia y agramatismo, y este ultimo cursaba ademas en ausencia de ataxia. La evolucion de ambos casos fue buena, y persistieron leves alteraciones del habla en el seguimiento posterior. Conclusiones. Casos como estos amplian el espectro de manifestaciones clinicas de la cerebelitis aguda. Cada vez cobra mayor importancia la participacion del cerebelo en procesos neurocognitivos como el lenguaje y, aunque muchos aspectos son aun especulativos, alcanzar a definir su verdadero papel tendra una repercusion en el diagnostico, el tratamiento y el pronostico a largo plazo de estos pacientes.
Fuellgraf, Hannah; Schilling, Oliver; Lai, Zon Weng; Kulemann, Birte; Timme, Sylvia; Makowiec, Frank; Shahinian, Jasmin H.; Hoeppner, Jens; Werner, Martin; Hopt, Ulrich T.; Wellner, Ulrich F.; Bronsert, Peter
Background: Carcinoembryonic antigen cell adhesion molecule (CEA) is a commonly immunohistochemically used antibody in pathological routine diagnostics with an overexpression in different cancers. We aimed to examine the immunohistochemically detectable CEA level in ampullary cancer and to correlate it with clinico-pathological data. Methods: Shot-gun proteomics revealed CEA in undifferentiated ampullary cancer cell lines. Next, tumor tissue of 40 ampullary cancers of a retrospective single center cohort of 40 patients was stained immunohistochemically for CEA; CEA expression was determined and correlated with clinico-pathological data. Results: Thirty-six patient specimens were included in statistical analysis. CEA expression and lymph node ratio (LNR) were the only independent predictors of overall survival in multivariate analysis. Conclusion: To our knowledge, cell line and patient cohorts are the largest and characterized cohorts examined for CEA so far. Hereby, CEA expression in ampullary cancer cells permits an estimation of outcome and suggests an opportunity for individualized CEA-directed therapy. Further trials with larger cohorts are needed to verify our results and to integrate CEA immunohistochemistry into clinical routine. PMID:28367245
Zeggai, Soumia; Tou, Abdelnacer; Sellam, Feriel; Mrabent, Meriem N.; Salah, Rachida
Background This study aimed to clarify the Ki-67 distribution, p53 expression and their relationship with clinico-pathologic features of gastric B cell lymphoma from Northern African population. Methods Twenty paraffin blocks of gastric lymphoma were retrieved from the archival materials of Department of Pathology, Central University Hospital of Sidi Bel Abbes (Western Algeria) from 2007 to 2013. Four µm section specimens were stained by immunohistochemical (IHC) technique with Ki-67 and p53 tumor markers. P values <0.05 were considered statistically significant. Results Expression of p53 proteins and the mean proliferative index (PI) were compared between high grade gastric B cell lymphomas (DLBCL) and low grade gastric B cell lymphomas (gastric MALTs). p53 overexpression (P=0.007) and a high proliferation index Ki-67 (P=0.001) were significantly associated with gastric DLBCL. We found also a statistically significant correlation between p53 and Ki-67 (P=0.007) but no obvious relationships were found between Ki-67 PI and p53 expression as well as clinico-pathological features (age, sex, location, macroscopic type). Conclusions The IHC studies of Ki-67 and p53 expression in gastric B cell lymphoma can help in monitoring of patients at risk, and to give suitable treatment and management of patients. PMID:27284480
Kazarian, Anna; Blyuss, Oleg; Metodieva, Gergana; Gentry-Maharaj, Aleksandra; Ryan, Andy; Kiseleva, Elena M; Prytomanova, Olga M; Jacobs, Ian J; Widschwendter, Martin; Menon, Usha; Timms, John F
Background: Breast cancer is a leading cause of morbidity and mortality worldwide. Although mammography screening is available, there is an ongoing interest in improved early detection and prognosis. Herein, we have analysed a combination of serological biomarkers in a case–control cohort of sera taken before diagnosis. Methods: This nested case–control study within the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) used serum samples from 239 women who subsequently developed breast cancer and 239 matched cancer-free controls. Sera were screened by ELISA for 9 candidate markers. Univariate and multivariate analyses were performed to examine associations with clinico-pathological features and between case controls in different time groups before diagnosis. Results: Significant associations with clinico-pathological features related to prognosis were found for several candidates (CA15-3, HSP90A and PAI-1). However, there were no consistent differences between cases and controls for any candidate in the lead up to diagnosis. Whilst combination models outperformed single markers, there was no increase in performance towards diagnosis. Conclusions: This study using unique pre-diagnosis samples shows that CA15-3, HSP90A and PAI-1 have potential as early prognostic markers and warrant further investigation. However, none of the candidates or combinations would be useful for screening. PMID:28081538
Kim, Yeon Sook
Ameloblastomas and adenomatoid odontogenic tumors (AOTs) are common epithelial tumors of odontogenic origin. Ameloblastomas are clinico-pathologically classified into solid/multicystic, unicystic, desmoplastic, and peripheral types, and also divided into follicular, plexiform, acanthomatous, granular types, etc., based on their histological features. Craniopharyngiomas, derived from the remnants of Rathke's pouch or a misplaced enamel organ, are also comparable to the odontogenic tumors. The malignant transformation of ameloblastomas results in the formation of ameloblastic carcinomas and malignant ameloblastomas depending on cytological dysplasia and metastasis, respectively. AOTs are classified into follicular, extrafollicular, and peripheral types. Ameloblastomas are common, have an aggressive behavior and recurrent course, and are rarely metastatic, while AOTs are hamartomatous benign lesions derived from the complex system of the dental lamina or its remnants. With advances in the elucidation of molecular signaling mechanisms in cells, the cytodifferentiation of epithelial tumor cells in ameloblastomas and AOTs can be identified using different biomarkers. Therefore, it is suggested that comprehensive pathological observation including molecular genetic information can provide a more reliable differential diagnosis for the propagation and prognosis of ameloblastomas and AOTs. This study aimed to review the current concepts of ameloblastomas and AOTs and to discuss their clinico-pathological features relevant to tumorigenesis and prognosis. PMID:23837011
Chavez-Uribe, Elisabet; Rodriguez, Beatriz Fernandez; Muñoz, Catuxa Celeiro; Redondo, Carmen M.; Fernandez, Maite Peña; Dominguez, Alejandro Novo; Pereira, Carina Doris; Martínez, María Elena; García-Caballero, Tomás; Rodriguez, Máximo Fraga; Antúnez, José; Carracedo, Angel; Forteza-Vila, Jerónimo; Gago-Dominguez, Manuela
Background Breast cancer is a heterogenous disease that impacts racial/ethnic groups differently. Differences in genetic composition, lifestyles, reproductive factors, or environmental exposures may contribute to the differential presentation of breast cancer among Hispanic women. Materials and Methods A population-based study was conducted in the city of Santiago de Compostela, Spain. A total of 645 women diagnosed with operable invasive breast cancer between 1992 and 2005 participated in the study. Data on demographics, breast cancer risk factors, and clinico-pathological characteristics of the tumors were collected. Hormone receptor negative tumors were compared with hormone receptor postive tumors on their clinico-pathological characteristics as well as risk factor profiles. Results Among the 645 breast cancer patients, 78% were estrogen receptor-positive (ER+) or progesterone receptor-positive (PR+), and 22% were ER−&PR−. Women with a family history of breast cancer were more likely to have ER−&PR− tumors than women without a family history (Odds ratio, 1.43; 95% confidence interval, 0.91–2.26). This association was limited to cancers diagnosed before age 50 (Odds ratio, 2.79; 95% confidence interval, 1.34–5.81). Conclusions An increased proportion of ER−&PR− breast cancer was observed among younger Spanish women with a family history of the disease. PMID:22238615
Poma, S; Longo, A
mammaria la diagnosi e la terapia di tale patologia sono state a totale appannaggio del chirurgo, situazione che è proseguita fino a qualche decennio fa. Il recente progresso tecnologico ha modificato, in parte, questa situazione e il clinico può entrare nel percorso diagnostico o terapeutico in qualsiasi momento. Se è il primo coinvolto, dopo l'esame e dopo un'ipotesi diagnostica, dovrà, quasi sempre, orientarsi verso indagini strumentali in relazione al sospetto, all'età della paziente ecc., se è l'ultimo anello deve arrivare a una conclusione mettendo insieme tutte le informazioni. L'esame clinico è composto di varie fasi: anamnesi, ispezione, palpazione, ognuna essenziale. Ogni singola fase va affrontata con metodo e tecnica appropriata. La capacità diagnostica dell'esame clinico è influenzata dalla costituzione della mammella, ma ancor di più è condizionata da uno stretto rapporto tra paziente e medico che deve conoscere molto la paziente che gli sta davanti e che non solo deve "visitare", ma capire, spiegare, accertarsi che si abbia capito, convincere. È inoltre indispensabile che il clinico sia in grado di esaminare le indagini strumentali e non limitarsi a leggere i referti, quindi interagire con gli altri specialisti. L'epoca del clinico o del radiologo o dell'ecografista che lavora da solo credendo che il proprio esame sia sufficiente o sganciato da altri contesti è finita da tempo, tutti hanno bisogno di tutti. È però vero che ciascuno deve essere estremamente competente nel suo settore e deve conoscere i limiti e le aspettative di chi collabora in altre specialità, come rimane valida la regola che la clinica resta comunque il momento centrale, non fosse altro perché poi deve affrontare la terapia.
Lo Giudice, V; Bruni, A; Corcioni, E; Corcioni, B
Sommario PREMESSA: L'ecografia del torace soltanto di recente ha assunto una sua completa dignità di metodica diagnostica: esperti ecografisti, con esperienza pneumologica, hanno, infatti, dimostrato la possibilità di una applicazione degli ultrasuoni in ambito toraco-polmonare, soprattutto in situazioni critiche, quali quelle emergenti in urgenza, in terapia intensiva o in ambito pediatrico o in corso di gravidanze. SCOPO: Da queste premesse si origina il lavoro, che si propone di individuare, se esistenti, gli aspetti ultrasonografici delle polmoniti interstiziali a genesi infettiva, e il ruolo di supporto (alla radiologia) degli ultrasuoni anche in questo ambito. MATERIALI E METODI: Sono stati studiati 55 soggetti afferiti, nel quinqennio 2001–2006, alla UOS di Ecografia toracica (UOC Pneumologia I) dell'Ospedale M. Santo e dell'UOS di Ecografia Internistica (UOC di Medicina Generale) dell'Ospedale di Rogliano dell'AO di Cosenza, perché affetti da sospetta patologia infettiva respiratoria virale o simil-virale. Tali pazienti sono stati valutati con indagini clinico-funzionali e strumentali (anamnesi + es. obiettivo + esami ematochimici + prove di funzionalità respiratoria + broncoscopia + Rx e HRTC del torace) e con esame ecografico, in cieco, del torace. RISULTATI: Dalla valutazione comparativa tra dati clinico-laboratoristico-strumentali e dati ecografici è emerso che i 55 soggetti studiati sono risultati affetti da polmonite interstiziale. In tali soggetti la diagnosi è stata formulata con l'ausilio delle comuni tecniche di studio, ma anche l'esame US ha permesso la individuazione di segni considerati diagnostici (Lichtenstein) di patologia interstiziale. Dei soggetti esaminati, infatti, 31 (56,36%) hanno mostrato all'ecografia la presenza di artefatti a coda di cometa (>5 per lato) nelle regioni anteriore e laterale del polmone (dato patognomico di patologia interstiziale) e 24 (46,64%) di “quadri misti” (aree di addensamento
Sharma, S; Manchanda, V; Gupta, R
Testicular microlithiasis (TM) is a rare benign condition with presence of multiple small microcalcifications in the seminiferous tubules. Though the aetiology is unknown, TM has been described in association with a variety of urological conditions. We report the clinico-pathological features of a 12-year-old male child who underwent orchidectomy for undescended testis. Histopathological examination of the excised testis showed multiple small intratubular calcifications without any evidence of testicular neoplasia. TM is an unusual phenomenon that should be kept in mind while evaluating testicular biopsies. Though it behaves in a benign manner in most of the cases, patients with positive family history of testicular cancer should be followed-up for testicular tumour.
Marx, Alexander; Porubsky, Stefan; Belharazem, Djeda; Saruhan-Direskeneli, Güher; Schalke, Berthold; Ströbel, Philipp; Weis, Cleo-Aron
Thymoma-associated Myasthenia gravis (TAMG) is one of the anti-acetylcholine receptor MG (AChR-MG) subtypes. The clinico-pathological features of TAMG and its pathogenesis are described here in comparison with pathogenetic models suggested for the more common non-thymoma AChR-MG subtypes, early onset MG and late onset MG. Emphasis is put on the role of abnormal intratumorous T cell selection and activation, lack of intratumorous myoid cells and regulatory T cells as well as deficient expression of the autoimmune regulator (AIRE) by neoplastic thymic epithelial cells. We review spontaneous and genetically engineered thymoma models in a spectrum of animals and the extensive clinical and immunological overlap between canine, feline and human TAMG. Finally, limitations and perspectives of the transplantation of human and murine thymoma tissue into nude mice, as potential models for TAMG, are addressed.
Lucchese, Alberta; Guida, Agostino; Petruzzi, Massimo; Capone, Giovanni; Laino, Luigi; Serpico, Rosario
The oral cavity is home to numerous viruses and micro-organisms recognized as having a role in various oral diseases as well as in infections in other parts of the body. Indeed, in general a microbial infection underlies or is believed to underlie the ample spectrum of oral diseases, from tooth enamel decay to periodontal lesions, from candidiasis to virus-induced oral squamous cell carcinomas, and bullous autoimmune oral disorders. This clinico-pathological context stresses the need of targeted therapies to specifically kill infectious agents in a complex environment such as the oral cavity, and explains the current interest in exploring peptide-based therapeutic approaches in oral and dental research. Here, we review the therapeutic potential of antimicrobial peptides such as LL-37, beta defensins, adrenomedullin, histatins, and of various peptides modulating gene expression and immuno-biological interaction(s) in oral diseases.
Diagnosing a peripheral neuropathy is sometimes challenging, as the causes are diverse and the clinical pictures heterogeneous. Overall, diagnosing a patient with peripheral neuropathy will require some knowledge in almost every field of medicine. Therefore, it appears crucial to adopt a diagnostic strategy that is based on solid clinical and neurophysiological grounds. The present paper describes a three-step diagnostic strategy: (1) to delineate a clinico-pathologic entity from clinical and electrodiagnostic findings; (2) to propose a list of plausible causes based on step one, history and clinical context; (3) to use appropriate workup in order to determine the cause or mechanism of the neuropathy. The three steps of this diagnostic strategy necessitate a high level of expertise and interaction between physicians is highly desirable. Finally, an aggressive course and a severe impairment should lead to relentlessly look for a curable cause.
Mejia, P; Piedra, L M; Merchan-Del Hierro, X
Introduccion. Las demencias rapidamente progresivas son un grupo poco frecuente de enfermedades caracterizadas por un deterioro cognitivo y otras alteraciones neurologicas que evolucionan en el transcurso de semanas a meses. Su etiologia es diversa e incluye un gran numero de condiciones neurodegenerativas, toxicas, metabolicas, autoinmunes, infecciosas y vasculares. Caso clinico. Varon de 69 años, que ingreso por demencia rapidamente progresiva y parkinsonismo causado por multiples fistulas arteriovenosas durales tratadas exitosamente mediante terapia endovascular. Conclusion. Las fistulas arteriovenosas durales son conexiones anomalas entre las arterias durales y los senos venosos o venas corticales que constituyen una causa inusual de demencia rapidamente progresiva, pero que debe considerarse, dada la disponibilidad de un tratamiento especifico con reversion de los sintomas.
TAKAGI, Mitsuhiro; KOHYAMA, Moeko; ONO, Tetsushi; ADACHI, Satoshi; SHIRAO, Daiji; TAMURA, Hidenori; TANIGUCHI, Masayasu; YABUKI, Akira; YAMATO, Osamu
One Holstein cow housed with 21 other cows exhibited clinical signs of pyrexia, anorexia and diarrhea along with severe hemoglobinuria. Hematological and biochemical analyses conducted before and after antibiotic therapy indicated severe hemolytic anemia and disruption of hepatic function. A general improvement in conditions was observed after an 11-day program of treatment comprising a regular dose of antibiotics and prescribed supportive therapies. A tentative diagnosis of bacillary hemoglobinuria was made based on the clinical and clinico-pathologic features on day 7. A molecular diagnosis was made by a PCR amplification of the flagellin gene of Clostridium haemolyticum using DNA extracted from the whole blood. The cow was diagnosed with the first recorded occurrence of bacillary hemoglobinuria of Holstein cattle in Japan. PMID:27498996
Background The receptor tyrosine kinase RON exhibits increased expression during pancreatic cancer progression and promotes migration, invasion and gemcitabine resistance of pancreatic cancer cells in experimental models. However, the prognostic significance of RON expression in pancreatic cancer is unknown. Methods RON expression was characterized in several large cohorts, including a prospective study, totaling 492 pancreatic cancer patients and relationships with patient outcome and clinico-pathologic variables were assessed. Results RON expression was associated with outcome in a training set, but this was not recapitulated in the validation set, nor was there any association with therapeutic responsiveness in the validation set or the prospective study. Conclusions Although RON is implicated in pancreatic cancer progression in experimental models, and may constitute a therapeutic target, RON expression is not associated with prognosis or therapeutic responsiveness in resected pancreatic cancer. PMID:22958871
Feller, L; Khammissa, R A G; Wood, N H; Marnewick, J C; Meyerov, R; Lemmer, J
Human papillomavirus (HPV) is strictly epitheliotropic, infecting stratified squamous cutaneous and mucosal epithelial cells. Oral HPV infection may be subclinical or putatively associated with benign or malignant oral neoplasms. The benign HPV-associated oral lesions, focal epithelial hyperplasia (Heck disease), oral squamous cell papilloma, oral verruca vulgaris (common wart) and oral condyloma acuminatum, are collectively referred to as oral warts. Oral warts are usually asymptomatic, may be persistent or uncommonly, may regress spontaneously. HPV-associated oral warts have a prevalence of 0.5% in the general population, occur in up to 5% of HIV-seropositive subjects, and in up to 23% of HIV-seropositive subjects on highly active antiretroviral therapy. This paper is a clinico-pathological review of HPV-associated oral warts.
Sineva, E L; Preobrazhenskaia, E A; Izmaĭlova, O A; Tedeev, A Iu
The objective of this work was to evaluate the health status and hearing function in the workers employed in experimental mechanical engineering and exposed to the combined effect of noise and occupational psychoemotional stress. The authors describe specific clinico-audiological characteristics of hearing disturbances diagnosed with the help up-to-date highly informative and objective methods for the evaluation of the function of acoustic analyzer, such as impedancometry, threshold tonal high-frequency audiometry, registration of distortion product otoacoustic emission. Criteria for the early diagnosis of neurosensory loss of hearing of
Kazeko, N I; Zhmurov, V A; Borovskiĭ, A A; Oskolkov, S A; Mariupol'skiĭ, A A; Dobrovol'skaia, M D; Evlochko, A S
The immunological status was studied in 335 patients with urolithiasis and pyelonephritis. The techniques used for assessment of the immunological status provided a multifactorial control over immune system function in inflammation and urolithiasis: registered a significant rise of the level of proinflammatory and anti-inflammatory mediators of the immune response (IL-1beta, IL-4, IL-6, TNF), of neutrophil metabolic activity with parallel suppression of neutrophil phagocytic and absorbing functions, inhibition of bactericidal activity of the serum, a significant fall in the number of mature T-lymphocytes (CD3+) and T-helpers (CD4+). The immune status indices in urolithiasis patients with secondary pyelonephritis are closely linked with clinico-laboratory manifestations of the inflammatory process and renal function. Thus, the results of the study give grounds for developing indications for use of immunomodulating drugs in patients with secondary pyelonephritis associated with urolithiasis.
Bubendorf, L; Nocito, A; Moch, H; Sauter, G
Tissue microarray (TMA) technology allows a massive acceleration of studies correlating molecular in situ findings with clinico-pathological information. In this technique, cylindrical tissue samples are taken from up to 1000 different archival tissue blocks and subsequently placed into one empty 'recipient' paraffin block. Sections from TMA blocks can be used for all different types of in situ tissue analyses including immunohistochemistry and in situ hybridization. Multiple studies have demonstrated that findings obtained on TMAs are highly representative of their donor tissues, despite the small size of the individual specimens (diameter 0.6 mm). It is anticipated that TMAs will soon become a widely used tool for all types of tissue-based research. The availability of TMAs containing highly characterized tissues will enable every researcher to perform studies involving thousands of tumours rapidly. Therefore, TMAs will lead to a significant acceleration of the transition of basic research findings into clinical applications.
Das, Biplab; Goyal, Manoj Kumar; Modi, Manish; Mehta, Sahil; Chakravarthi, Sudheer; Lal, Vivek; Vyas, Sameer
Objectives: Subacute sclerosing panencephalitis (SSPE) is rare chronic, progressive encephalitis that affects primarily children and young adults, caused by a persistent infection with measles virus. No cure for SSPE exists, but the condition can be managed by medication if treatment is started at an early stage. Methods and Results: Heterogeneity of imaging findings in SSPE is not very uncommon. But pial and gyral enhancements are very rarely noticed. Significant asymmetric onset as well as pial-gyral enhancements is not reported. Herein we present a case of 16 years adolescent of SSPE having remarkable asymmetric pial-gyral enhancements, which were misinterpreted as tubercular infection. Conclusion: Early diagnosis and treatment is encouraging in SSPE, although it is not curable with current therapy. Clinico-radiological and electrophysiological correlation is very important in diagnosis of SSPE, more gravely in patients having atypical image findings as in our index case. PMID:27293348
Leonova, G N
The use of different vaccines manufactured in the USSR under the condition of the Far East has revealed that killed vaccines do not produce a protective effect, sufficient for the prophylaxis of tick-borne encephalitis (TBE). This is probably due to the circulation of a highly virulent population of TBE virus at the Territory. This virus population may produce a severe course of infection and aggravate the clinico-epidemiological characteristics of the effectiveness of vaccines. Besides, low levels of specific and nonspecific humoral resistance factors in the residents of the Far East, especially in spring and summer, contribute to this fact. The negative effect of specific serotherapy for persons over 40 years of age has been established.
Oliynyk, Sergiy; Oh, Seikwan
Actoprotectors are preparations that enhance body stability against physical loads without increasing oxygen consumption or heat production. Or, in short, actoprotectors are synthetic adaptogens with a significant capacity to improve physical performance. This paper explores the history of actoprotectors'development, their pharmacological properties, mechanism of action, and practical application to the improvement of mental and physical performance. A brief summary of the clinico-pharmacological characteristics of the main representatives of this class (bemitil and bromantane) is provided. Some other synthesized compounds, and even natural ones such as ginseng, also are regarded as potential actoprotectors, and these are treated herein as well. Actoprotectors, owing to their wide-ranging pharmacological activities, high efficiency and safety, can be applied under either normal or extreme conditions.
Figueiredo, Nigel Roque; Dinkar, Ajit Dattatray; Khorate, Manisha Maruti
Glandular Odontogenic Cyst is a relatively rare cyst of odontogenic origin, which shows glandular or salivary features that are thought to indicate the pluripotentiality of odontogenic epithelium. It is seen in middle-aged adults, and commonly involves the anterior region of the jaws, especially the mandible. It shows non-specific clinico-radiographic findings which may resemble other lesions, but has characteristic histopathologic features which help in its diagnosis. This paper reports an unusual presentation of a glandular odontogenic cyst which was diagnosed in a 64-year old female in the posterior maxilla, along with a literature review of this cyst, especially the cases reported in India in the past. PMID:28292079
Buzan, Maria T A; Pop, Carmen Monica
The interstitial lung diseases (ILDs) are a diverse group of disorders characterized by a varying combination of inflammation and fibrosis of the pulmonary parenchyma. Treatment and prognosis of ILD typically depend on the underlying ILD subtype, highlighting the importance of accurate classification and diagnosis. Besides a thorough history and clinical examination, the protocol should include a 6-minute walk test, chest radiography, high-resolution computed tomography, biochemical analysis, pulmonary function tests, blood gas analysis, bronchoalveolar lavage, and, when necessary, a lung biopsy. The final diagnosis of ILD entities requires dynamic interaction between clinicians, radiologists and pathologists to reach a clinico-radiologic-pathologic diagnosis, the gold standard no longer being the histology but rather a multidisciplinary approach.
Shah, R K
A pilot survey of 55 persons from the traditional patuka-wearing population in the central region of Nepal was conducted during May 1991 to study the significance of the traditional use of the patuka around the waist as related to the prevention of back pain. The hypothesis that a patuka functions like a spinal support and hence prevents back pain in the workers and porters in Nepal appears to be supported by the results of this epidemio-clinico-radiological pilot research. Hence its traditional use in Nepal appears to be justified on scientific grounds and it seems rational to recommend the use of this indigenous, simple and cost-effective spinal support to people facing the risk of back pain. However, only a broad epidemiological survey and/or double-blind study can establish reliably its role in clinical or ergonomic application.
Cystic degeneration of the adventitia of the popliteal artery is a rare clinico-angiographic diagnosis in the chronic ischaemia syndrome of the lower extremity. If the three cardinal signs occur concomitantly, namely, intermittent ischaemia syndrome, unilocular manifestation near the joint and clearly limited filling defect in the arteriogram, diagnosis can be made with a high measure of certainty. Among our angiographically examined patients, we observed, in the course of one year, three male patients who presented the full picture of the disease with regard to clinic, localisation and angiographic findings. Intraoperatively it was not possible to establish a connection between adventitia cyst and neighbouring articular capsule; this applies, in fact, to all our cases. Histologically we found in one case, in the hollow spaces of the adventitia, an indication of the possible existence of a synovial recess, so that the scattering of mucine-secreting endothelium of the joint into the vascular adventitia is again brought up for discussion.
Lakhtakia, Ritu; Burney, Ikram; Qureshi, Asim; Al-Azawi, Sinan; Al-Badi, Hamid; Al-Hajri, Shaikha
This article narrates a multifaceted educational journey undertaken by a medical student through a weekly SCRAPS (surgery, clinical disciplines, radiology, anatomy, psychiatry and laboratory sciences) clinico-pathological meeting held in the College of Medicine & Health Sciences at Sultan Qaboos University in Muscat, Oman. Through a presentation titled ‘Unveiling Cancer’, the multidisciplinary and interprofessional audience witnessed a simulated interaction between a medical student, a technologist peer and tutors in medicine, pathology and radiology. The presentation was based on the complexities of presentation, diagnosis and management of a patient with anaplastic large cell lymphoma, a rare type of non-Hodgkin lymphoma, in the aftermath of a bone marrow transplantation. After describing the case, the student shared with the audience a spectrum of learning objectives, which included integration in the complex world of contemporary medicine, insight into the triumphs and travails of technology (immunohistochemistry) and peer collaboration, communication and mentorship. PMID:26355844
Mulero, Patricia; Cortijo-García, Elisa; Ruiz-Piñero, Marina; Pérez-Fernández, Santiago; Arenillas-Lara, Juan F; Martínez-Galdámez, Mario
Introduccion. Aunque la arterioesclerosis intracraneal es una causa importante de ictus, la actitud terapeutica no esta claramente establecida. En este sentido, el estudio SAMMPRIS comparo el tratamiento medico intensivo con la angioplastia y colocacion de stent, con resultados favorables al tratamiento farmacologico. Estos resultados podrian, en parte, deberse al dispositivo utilizado (stent Wingspan ®). Caso clinico. Varon de 71 años con una estenosis grave de la arteria basilar, en quien se repetian episodios de focalidad neurologica transitoria a pesar del tratamiento con doble antiagregacion y estatinas. En estas circunstancias se decidio realizar una arteriografia terapeutica con angioplastia y colocacion de un stent Solitaire ® para optimizar resultados y se logro una estenosis residual del 40%. La evolucion fue favorable y los controles posteriores muestran una minima progresion. Conclusion. Segun nuestro conocimiento, este es el primer caso publicado de tratamiento de una estenosis critica de la arteria basilar mediante la colocacion de un stent Solitaire ®.
Sarks, J P; Sarks, S H; Killingsworth, M C
The aim of this study was to trace the evolution of geographic atrophy (GA) by clinical documentation and by clinico-morphological correlation in representative eyes. Geographic atrophy commonly commenced within a parafoveal band of incipient atrophy of varying width, characterised by semisolid drusen and a microreticular pigment pattern. Progression of atrophy mostly skirted fixation and visual acuity was a poor guide to the functional impact, an estimate of the percentage of fovea involved proving a more useful clinical parameter. The rate of progression slowed once GA had involved all the retina affected by incipient atrophy and the risk of choroidal neovascularization appeared to decline. An earlier histological classification of the evolution of GA is revised according to the ultrastructural findings. Membranous debris was not previously recognised and its contribution to the findings in incipient atrophy and to dot-like drusen is described.
Catani, Marco; Bambini, Valentina
In humans, brain connectivity implements a system for language and communication that spans from basic pre-linguistic social abilities shared with non-human primates to syntactic and pragmatic functions particular to our species. The arcuate fasciculus is a central connection in this architecture, linking regions devoted to formal aspects of language with regions involved in intentional and social communication. Here, we outline a new anatomical model of communication that incorporates previous neurofunctional accounts of language with recent advances in tractography and neuropragmatics. The model consists of five levels, from the representation of informative actions and communicative intentions, to lexical/semantic processing, syntactic analysis, and pragmatic integration. The structure of the model is hierarchical in relation to developmental and evolutionary trajectories and it may help interpreting clinico-anatomical correlation in communication disorders.
Respondek, G; Höglinger, G U
Traditionally, the clinical picture of progressive supranuclear palsy (PSP) was defined by early postural instability with falls, supranuclear vertical gaze palsy, symmetric akinesia and rigidity, frontal and subcortical dementia, and pseudobulbar palsy, leading to death after a mean disease duration of approximately six years. A definite diagnosis of PSP depends on neuropathological confirmation. In recent years, clinico-pathological studies have drawn attention to various "atypical" clinical manifestations of PSP. In these, a clinical diagnosis of PSP is delayed or never accomplished. Comprehensive understanding of the natural history of PSP is required to permit an early and accurate diagnosis. Based on current evidence, this review provides an update on the clinical spectrum of PSP.
Barman, Sandip; Diwaker, Preeti; Bansal, Divya; Wadhwa, Neelam; Singh, Gurvinder
Chondroblastoma is an uncommon benign bone tumour, involvement of epiphysis of long bones is typical. Chondroblastoma of the calcaneum is uncommon and its association with secondary aneurysmal bone cyst is even rarer. Only two cases of calcaneal chondroblastoma associated with secondary aneurysmal bone cyst have been reported till date. A 22-year-old male presented to the department of orthopaedics with complains of pain and swelling in the left heel since the last 10 months. On clinico-radiological grounds differentials considered were giant cell tumour of bone and aneurysmal bone cyst. In view of the histopathological findings of bone curettage and results of special stain and immunohistochemical marker, final diagnosis of chondroblastoma with secondary aneurysmal bone cyst, left calcaneum was rendered. Although rare, chondroblastoma should always be considered in osteolytic lesions of calcaneum. The identification of secondary aneurysmal bone cyst component is important as it has higher chances of recurrence than usual chondroblastoma.
Barman, Sandip; Bansal, Divya; Wadhwa, Neelam; Singh, Gurvinder
Chondroblastoma is an uncommon benign bone tumour, involvement of epiphysis of long bones is typical. Chondroblastoma of the calcaneum is uncommon and its association with secondary aneurysmal bone cyst is even rarer. Only two cases of calcaneal chondroblastoma associated with secondary aneurysmal bone cyst have been reported till date. A 22-year-old male presented to the department of orthopaedics with complains of pain and swelling in the left heel since the last 10 months. On clinico-radiological grounds differentials considered were giant cell tumour of bone and aneurysmal bone cyst. In view of the histopathological findings of bone curettage and results of special stain and immunohistochemical marker, final diagnosis of chondroblastoma with secondary aneurysmal bone cyst, left calcaneum was rendered. Although rare, chondroblastoma should always be considered in osteolytic lesions of calcaneum. The identification of secondary aneurysmal bone cyst component is important as it has higher chances of recurrence than usual chondroblastoma. PMID:27504302
Santín-Amo, José M; Rico-Cotelo, María; Serramito-García, Ramón; Gelabert-González, Miguel; Allut, Alfredo G
Introduccion. El tratamiento quirurgico de la hidrocefalia es uno de los procedimientos quirurgicos mas habituales en la neurocirugia pediatrica, y las derivaciones ventriculoperitoneales constituyen una herramienta fundamental en el tratamiento de la hidrocefalia tanto infantil como del adulto. Las complicaciones de las valvulas son relativamente frecuentes, sobre todo en la poblacion pediatrica, y, entre estas, las mas habituales incluyen: las obstrucciones, las desconexiones, el hiperdrenaje y las infecciones. Caso clinico. Niña de 7,5 años, portadora de una valvula ventriculoperitoneal, que presentaba cefalea intermitente. Un estudio con tomografia computarizada demostro una lesion quistica temporal derecha. Tras la revision valvular, la tomografia computarizada evidencio la reduccion del quiste. Conclusiones. La formacion de una cavidad porencefalica es una complicacion poco frecuente. Se relaciona con problemas en el cateter distal en pacientes con ventriculos dilatados y de las que existen escasas referencias en la bibliografia.
Kay, Kevin R.; Smith, Colin; Wright, Ann K.; Serrano-Pozo, Alberto; Pooler, Amy M.; Koffie, Robert; Bastin, Mark E.; Bak, Thomas H.; Abrahams, Sharon; Kopeikina, Katherine J.; McGuone, Declan; Frosch, Matthew P.; Gillingwater, Thomas H.; Hyman, Bradley T.; Spires-Jones, Tara L.
Postmortem studies of synapses in human brain are problematic due to the axial resolution limit of light microscopy and the difficulty preserving and analyzing ultrastructure with electron microscopy. Array tomography overcomes these problems by embedding autopsy tissue in resin and cutting ribbons of ultrathin serial sections. Ribbons are imaged with immunofluorescence, allowing high-throughput imaging of tens of thousands of synapses to assess synapse density and protein composition. The protocol takes approximately 3 days per case, excluding image analysis, which is done at the end of the study. Parallel processing for transmission electron microscopy (TEM) using a protocol modified to preserve structure in human samples allows complimentary ultrastructural studies. Incorporation of array tomography and TEM into brain banking is a potent way of phenotyping synapses in well-characterized clinical cohorts to develop clinico-pathological correlations at the synapse level. This will be important for research in neurodegenerative disease, developmental diseases, and psychiatric illness. PMID:23787894
Moffie, D; Hamburger, H L
We report a patient with a Wallenberg's lateral medullary syndrome in which pain was a prominent feature. This led to substitution of the original and correct diagnosis by that of a thalamic syndrome for which a prefrontal leucotomy was performed. The patient died some years later from a myocardial infarction and autopsy was performed. In the dorsolateral part of the medulla oblongata a cavity was found in which aberrant nerve fibres with neuroma-like formations could be seen. These fibres coursed along blood vessels, and penetrated from the surface of the medulla oblongata. On the base of the clinico-pathological correlations, it is conjectured that destruction of the lateral reticular formation cannot be the sole cause of the severe pain.
The etiology of sarcoidosis is still unclear. It belongs to the most frequent lung diseases; but also nearly all other tissues and organs may be established. One third of the diseases runs under the picture of the acute form of the course (Loefgren's syndrome). A histologic ascertainment is to be striven for. The tendency to spontaneous remission is great. This is still additionally supported by the application of cortison derivatives. In the individual case the indication to medicamentous therapy results from the tendency of the course of the disease, from the degree of the affection of organs and the clinico-functional disturbance. In 80 patients with Loefgren's syndrome the author adopts a definite attitude to diagnostics and therapy.
Salas, S; Agut, T; Rovira, C; Canizo, D; Lavarino, C; Garcia-Alix, A
Introduccion. El glioblastoma multiforme congenito representa solo el 3% de los tumores congenitos del sistema nervioso central, y su ubicacion infrantentorial es excepcional. Caso clinico. Recien nacido con un glioblastoma multiforme congenito sin mutacion en el gen TP53 ni inmunorreactividad nuclear p53, que infiltraba practicamente todo el tronco cerebral e invadia tambien estructuras supratentoriales. Conclusiones. Hasta donde sabemos, solo se han referido previamente cuatro casos de localizacion infratentorial, tres en el cerebelo y uno en el tronco del encefalo. La biologia del glioblastoma multiforme congenito no se conoce bien y, a diferencia del glioblastoma multiforme en la edad adulta, las mutaciones en el gen TP53 son poco frecuentes, sin que eso parezca implicar un mejor pronostico. Estas observaciones sugieren que el glioblastoma multiforme con origen en la vida fetal tiene una biologia diferente del que se presenta en otras etapas de la vida.
Kolotilin, G F; Vasil'ev, V D
Using clinico-psychopathological methods of examination the authors studied 93 schizophrenics with a delirious variant of the Kandinsky-Clérambaut syndrome who had committed violent antisocial actions (VAA). It has been ascertained that peculiarities of the clinical course at the time when the VAA was committed reflect the stages of the development of the syndrome: the initial stage, the stage of delirious personification of psychic automatisms and the stage of involution of the delirious variant of the Kandinsky-Clérambaut syndrome. It has been established that the more acute the psychosis the higher the significance in the psychopathological mechanisms of VAA of clinical manifestations of the syndrome and lower the role of social and personality factors.
Rassulova, M A
Clinico-laboratory, functional and bronchoscopic examinations were performed in 120 patients with chronic obstructive pulmonary disease. 50 patients (41.7%) were in stage of low-intensity exacerbation, 70 patients (58.3%)--in remission stage. 55 patients (45.8%) had I degree respiratory failure, 65 patients (54.2%)--II degree respiratory failure. Easy degree of disease was detected in 58 patients (48.3%), mid degree--in 62 patients (51.7%). Possibility and reasonability of the use of artificial sylvinite speleotherapy and general chloride sodium baths in patients with chronic obstructive pulmonary disease were proved. Clinical results were confirmed by data of blood morphology and biochemical analysis, microscopy of sputum, spirometry, bronchoscopy, dynamics of immunological indices.
Zinebi, Ali; Rkiouak, Adil; Akhouad, Youssef; Reggad, Ahmed; Kasmy, Zohor; Boudlal, Mostapha; Rabhi, Monsef; Ennibi, Khalid; Chaari, Jilali
La tuberculose hépatique nodulaire est rare. Nous rapportons une forme pseudo-tumorale dont le tableau clinico-biologique et radiologique initial était aspécifique. Il s'agit d'un jeune marocain suivi pour maladie de Wilson et présentant une fièvre au long cours. L'imagerie met en évidence une lésion nodulaire hépatique non spécifique. L'examen anatomo-pathologique au cours d'une biopsie écho guidée du nodule hépatique permit de porter le diagnostic. L’évolution clinique est favorable sous traitement spécifique. PMID:24932333
Housawi, F M T; Abu Elzein, E M E; Ramadan, R O; Gameel, A A; Al-Afaleq, A I; Al-Mousa, J
A wave of abortions, stillbirths and deformities in sheep occurred at the Al-Ahsa oasis in the eastern region of Saudi Arabia in the second half of 1999. The abortions were recorded in August and September and stillbirths and deformities in neonates were observed in October. Adult sheep were clinically normal. A virus was isolated in chicken embryos, adapted to Vero cell culture and further identified as bluetongue (BT) virus. The virus isolated was not neutralised by the Akabane virus. Reference hyperimmune serum against antibodies to BT virus detected in the sera of the dams gave positive results for BT but negative results for both Akabane and bovine viral diarrhoea virus. It was concluded that the outbreak was caused by a virus of the BT serogroup. The authors present the clinico-pathological and epidemiological situation of the disease outbreak.
Lombardi, Mariano; Valli, Mirca; Brisigotti, Massimo; Rosai, Juan
The aims of this paper were to review the literature of Spermatocytic Seminoma (SS) updating its clinico-pathological features and to present a new case of the exceptionally rare variant of this tumor known as anaplastic which only five cases have been reported. Many studies have confirmed that SS is a distinct neoplasm both clinically and pathologically from classical Seminoma and it differs from the latter especially in regard to behavior, characterized by an almost complete inability to metastasize with only very few convincing examples described with metastatic behavior. There is general agreement that orchidectomy is sufficient therapy for SS and that surveillance following surgery is the preferred management option. Surprisingly, the presence of an anaplastic component does not seem to impact on this excellent prognosis. Very different is the case of sarcomatous transformation, for which further therapy after orchiectomy is advisable.
Andrade, Z A
Specific chemotherapy against schistosomiasis together with environmental changes occurring in endemic areas of Brazil are causing a revolution in the clinico-pathological presentation of the disease when comparing to date from 10 to 15 years ago. To update the subject, an inquiry was made among the most experienced Brazilian investigators in this field. They agree that a decrease of about 50 to 70% in prevalence, and an even higher decrease in incidence are taking place in Brazil today. The prevalence of schistosome-infection has decreased in some areas and increased in other, with spreading sometimes occurring to peri-urban regions, indicating that schistosomiasis control depends on the application of multiple measures. General clinical and pathological manifestations related to hepatosplenic disease, such as ascites, gastric hemorrhages, big-spleen syndrome, cor pulmonale, glomerulopathy, etc. are also less severe nowadays than they used to be in the past.
Baldini, L; Guffanti, A; Cro, L; Fracchiolla, N S; Colombi, M; Motta, M; Maiolo, A T; Neri, A
We have recently reported a series of 15 non-villous splenic marginal zone lymphoma patients, six of whom showed p53 mutations (40%). This molecular alteration did not correlate with any particular clinico-pathologic feature at diagnosis. After a median follow-up of 56 months, four cases evolved into aggressive fatal non-Hodgkin's lymphoma (NHL) and two had refractory progressive disease; interestingly, p53 mutations were demonstrated in five of these patients at diagnosis. As the patients with wild-type p53 presented responsive or indolent disease, this genetic alteration may be an early marker of aggressive transformation or refractoriness. p53 evaluation at diagnosis could be advisable in this particular subset of NHL.
Beltrão, E I C; Medeiros, P L; Rodrigues, O G; Figueredo-Silva, J; Valença, M M; Coelho, L C B B; Carvalho, L B
Lectins have been intensively used in histochemical techniques for cell surface characterization. These proteins are involved in several biological processes and their use as histochemical markers have been evaluated since they can indicate differences in cell surfaces. Parkia pendula lectin (PpeL) was evaluated as histochemical marker for meningothelial meningioma biopsies. Tissue slices were incubated with PpeL conjugated to horseradish peroxidase (PpeL-HRP) and Concanavalin A-HRP (ConA-HPR) and the binding visualized with diaminobenzidine and hydrogen peroxide. The lectin-tissue binding was inhibited with D-glucose. PpeL showed to be a useful tool for the characterization of meningothelial tumour and clinico-pathological diagnosis.
References…………………………………………………………………………….2 Appendices……………………………………………………………………………2 1 INTRODUCTION: Currently used clinico ...prostate cancer recurrence nested case -control study (Brady study; in part with prior DOD funding to Dr. Platz at Hopkins) and associated tissue...524 cases and 524 controls) and cut and mounted the sections (Task 4b completed) for staining for telomere-specific FISH, cytokeratin 903
Coli, A; Parente, P; Bigotti, G
Pulmonary artery sarcoma is an exceptionally rare tumor which must be considered in the differential diagnosis of pulmonary thromboembolism. We report the case of a 36-year-old woman and review 100 cases published in the literature between 1988 and 2005. The patient presented with a history of dyspnea, fatigue, fever, night sweats and anemia that did not respond to antibiotic therapy. She also had hemoptysis. Transvenous catheter biopsy was indicative of sarcoma. A left pneumonectomy was performed, followed by five cycles of chemotherapy. Histological and immunohistochemical studies documented an intimal sarcoma with myofibroblastic differentiation. The patient is alive and well 20 months after surgery. The clinico-pathological features of pulmonary artery sarcoma are described.
Sánchez-Fayos Calabuig, Paloma; Martín Relloso, María Jesús; González Guirado, Agustina; Porres Cubero, Juan Carlos
Because of their biological affinity for normal gastrointestinal (GI) mucosa, eosinophilic granulocytes are "normal residents" in the mucosa. This physiological GI eosinophilia translates into a state of "permanent normal inflammation", which means that the mucosa's local immune system is constantly confronted by dietary proteins and indigenous microorganisms. This eosinophilic infiltration of the GI mucosa is increased, reactively, in the course of local inflammatory processes, collagenosis, infections (especially helminthic infections), vasculitis, neoplasms and IgE-dependent allergic reactions to food. Lastly, GI eosinophilia that is clearly aggressive, both because of its intensity and its persistence, is what characterizes eosinophilic gastroenteritis. In the present article, we summarize the ethiopathogenic and clinico-epidemiological features of this process, as well as its position within the field of immunopathologic food intolerance.
Cholangiocarcinoma (CC) arises from the biliary epithelium and in most cases represents adenocarcinoma. Pathomorphological evaluation is of decisive impact for the prognosis and management of CC. Morphological subtyping (histotype; hilar vs peripheral type), TNM classification, lymphatic spread, and resection margin status are of prognostic relevance. Distinction from hepatic metastases may be aided by immunohistology and clinico-pathological correlation. There is convincing evidence of the development of CC via premalignant lesions, especially biliary intraepithelial neoplasia, although further knowledge about the biology and diagnostic definition of these lesions has to be accumulated. Currently, there are no established molecular markers of prognosis or therapeutic target structures to be evaluated at the tissue level. Future progress is needed and expected in novel differential diagnostic and predictive markers, in uniform definition of resection margin status and further understanding of molecular and morphological changes in the development of CC. PMID:18773061
Kakar, S; Bhalla, P; Maria, A; Rana, M; Chawla, R; Mathur, N B
Chlamydia trachomatis is considered a major aetiological agent of conjunctivitis in newborns. The objective of the present study was to determine the aetiology of neonatal conjunctivitis and clinico-epidemiological correlates of chlamydial ophthalmia neonatorum. Fifty-eight newborns with signs and symptoms of conjunctivitis were studied. Conjunctival specimens were subjected to Gram staining, routine bacteriological culture, culture for Neisseria gonorrhoeae and direct fluorescent antibody (DFA) staining for diagnosis of C. trachomatis infection. C. trachomatis was detected in 18 (31%) neonates. Findings suggest that since C. trachomatis is the most common cause of neonatal conjunctivitis, routine screening and treatment of genital C. trachomatis infection in pregnant women and early diagnosis and treatment of neonatal Chlamydial conjunctivitis may be considered for its prevention and control.
Tavolaro, Simona; Peragine, Nadia; Chiaretti, Sabina; Ricciardi, Maria Rosaria; Raponi, Sara; Messina, Monica; Santangelo, Simona; Marinelli, Marilisa; Di Maio, Valeria; Mauro, Francesca Romana; Del Giudice, Ilaria; Foà, Robin; Guarini, Anna
Gene profile and functional changes upon IgD cross-linking were evaluated in chronic lymphocytic leukemia (CLL). Microarrays highlighted responsiveness to IgD in all cases, independently of clinico-biological characteristics. Stimulated samples exhibited the down-regulation of transcripts of B-cell receptor signaling and cell-adhesion at 24h and the up-modulation of differentiation and apoptosis genes at 48 h. A significant increase in apoptosis upon ligation was also documented. Furthermore, comparison between IgD and IgM stimulation displayed a differential transcriptional/functional response. In conclusion, CLL respond to IgD displaying expression changes and cell-death enhancement, indicating the apoptosis induction via-IgD as an alternative approach for CLL management.
Montine, Thomas J; Phelps, Creighton H; Beach, Thomas G; Bigio, Eileen H; Cairns, Nigel J; Dickson, Dennis W; Duyckaerts, Charles; Frosch, Matthew P; Masliah, Eliezer; Mirra, Suzanne S; Nelson, Peter T; Schneider, Julie A; Thal, Dietmar Rudolf; Trojanowski, John Q; Vinters, Harry V; Hyman, Bradley T
We present a practical guide for the implementation of recently revised National Institute on Aging-Alzheimer's Association guidelines for the neuropathologic assessment of Alzheimer's disease (AD). Major revisions from previous consensus criteria are: (1) recognition that AD neuropathologic changes may occur in the apparent absence of cognitive impairment, (2) an "ABC" score for AD neuropathologic change that incorporates histopathologic assessments of amyloid β deposits (A), staging of neurofibrillary tangles (B), and scoring of neuritic plaques (C), and (3) more detailed approaches for assessing commonly co-morbid conditions such as Lewy body disease, vascular brain injury, hippocampal sclerosis, and TAR DNA binding protein (TDP)-43 immunoreactive inclusions. Recommendations also are made for the minimum sampling of brain, preferred staining methods with acceptable alternatives, reporting of results, and clinico-pathologic correlations.
Agarwal, Arjit; Chandak, Shruti; Joon, Pawan
Hirayama disease is a rare type of neurological disease commonly manifesting as brachial monomelic amyotrophy in young males of Asian origin, easily understood as juvenile non-progressive cervical amyotrophy. The first case was reported by Hirayama in 1959. The pathogenesis is attributed towards chronic compression of cervical spinal cord during flexion movements of neck in cases where there is detachment of posterior dura mater. This chronic event, invariably leads to features of cord atrophy along with other MRI features. We report a case of 21-year-old male who presented with atrophy of distal muscles of his right hand and was sent for MRI of cervical spine which revealed prominent posterior epidural venous plexus without significant cord atrophy. Clinico-radiologic profile of the patient leads toward the diagnosis of Hirayama disease which was considered as borderline because of asymmetrical cord atrophy which is a not a routine imaging feature of the entity.
Chandak, Shruti; Joon, Pawan
Hirayama disease is a rare type of neurological disease commonly manifesting as brachial monomelic amyotrophy in young males of Asian origin, easily understood as juvenile non-progressive cervical amyotrophy. The first case was reported by Hirayama in 1959. The pathogenesis is attributed towards chronic compression of cervical spinal cord during flexion movements of neck in cases where there is detachment of posterior dura mater. This chronic event, invariably leads to features of cord atrophy along with other MRI features. We report a case of 21-year-old male who presented with atrophy of distal muscles of his right hand and was sent for MRI of cervical spine which revealed prominent posterior epidural venous plexus without significant cord atrophy. Clinico-radiologic profile of the patient leads toward the diagnosis of Hirayama disease which was considered as borderline because of asymmetrical cord atrophy which is a not a routine imaging feature of the entity. PMID:26436018
Siddiqi, Zeba; Karoli, Ritu; Fatima, Jalees; Dey, Rahul; Kazmi, Khursheed
A 37 year old man presented with progressive dysarthria for 2 weeks. A week later he developed ataxia and bilateral cerebellar signs including intention tremors, dysmetria and dysdiadokokinesia. During evaluation for aetiology of cerebellar dysarthria, MRI brain revealed asymmetric altered signal intensities in bilateral cerebellar hemispheres and right side of pons suggesting demyelinating lesions. ELISA for Human Immune Deficiency virus-1 was positive. We kept a presumptive diagnosis of Progressive Multifocal Leukoencephalopathy (PML) on the basis of clinico-radiological picture. PML is an under investigated and under diagnosed CNS infection seen in HIV patients with advanced disease. We present an unusual case report where isolated cerebellar involvement occurred as the first AIDS defining event in the absence of appreciable immunodeficiency in a patient with previously undiagnosed HIV infection.
Gelabert-Gonzalez, M; Aran-Echabe, E; Pita-Buezas, L
Introduccion. Los quistes aracnoideos bilaterales del angulo pontocerebeloso son excepcionales, y unicamente existen tres casos publicados en la bibliografia. Caso clinico. Niña de 14 años, previamente sana, que acude a consultas por presentar cefalea bifrontal de seis semanas de evolucion. La exploracion clinica era normal y la resonancia magnetica craneal mostraba dos lesiones extraaxiales localizadas en ambos angulos pontocerebelosos, siendo ligeramente mayor la izquierda. Las lesiones se comportaban como homogeneamente intensas en T1 e hiperintensas en T2, no captaban contraste y no existia restriccion en las secuencias de difusion. No se indico tratamiento quirurgico. Conclusiones. Los quistes aracnoideos bilaterales situados en el angulo pontocerebeloso son excepcionales. La principal indicacion para el tratamiento quirurgico es la presencia de sintomas o signos neurologicos coincidentes con la localizacion de los quistes.
Jacobson, Elliott R.; Berry, Kristin H.
We performed clinico-pathological evaluations of 11 wild Agassiz's desert tortoises (Gopherus agassizii) from a translocation project in the central Mojave Desert, California, USA. Group 1 consisted of nine tortoises that were selected primarily due to serologic status, indicating exposure to Mycoplasma testudineum (seven) or both M. agassizii and M. testudineum (two), and secondarily due to clinical signs of upper respiratory tract disease (URTD). Group 2 consisted of two tortoises that were antibody-negative for Mycoplasma and had no clinical signs of URTD, but did have other signs of illness. Of the Group 1 tortoises, M. testudineum, but not M. agassizii, was amplified by polymerase chain reaction and DNA fingerprinted from two tortoises. Using light microscopy, mild to severe pathologic changes were observed in one or more histologic sections of either one or both nasal cavities of each tortoise in Group 1. Our findings support a causal relationship between M. testudineum and URTD in desert tortoises.
Quintela, I; Barros-Angueira, F; Perez-Gay, L; Dacruz, D; Castro-Gago, M; Carracedo, A; Eiris-Punal, J
Introduccion. Los sindromes de microdelecion y microduplicacion 3q29 se caracterizan por una marcada heterogeneidad fenotipica, y el retraso del desarrollo y la discapacidad intelectual de grado leve-moderado son las manifestaciones clinicas mas frecuentes. Casos clinicos. Dos pacientes con aberraciones cromosomicas reciprocas en la region 3q29. La paciente con la microdelecion 3q29 presenta dificultades de aprendizaje, microcefalia limite, dismorfismo facial leve, deficit atencional e impulsividad, y rasgos ansiosos y obsesivos. El paciente con la microduplicacion 3q29 reciproca presenta dificultades de aprendizaje, dismorfismo facial leve y un perfil conductual disruptivo no asociado previamente con esta duplicacion. Conclusion. Se comparan los fenotipos de estos pacientes y se revisa la bibliografia de pacientes pediatricos con microdeleciones y microduplicaciones 3q29.
Ruggieri, V L
In the past decade, notable advances have been made with regard to understanding the clinical, biological and epidermological aspects of the basic disorders of development (TPD), particularly autism. Nevertheless, our knowledge of the neurobiological basis is still limited. This has impeded the development of drugs which correct the defect and cure the illness. Although there is no perfect drug, in recent years clinico-pharmacological research has made it possible to use drugs which have been very helpful in correcting the symptoms associated with these disorders. These drugs have permitted a better therapeutic approach and improved family and social integration of these children (in the family and in society). We will proceed to analyze some of the drugs shown to be useful for treatment of children with TPD.
Genova, G; Arena, N; Guddo, F; Vita, C; Reitano, R; Nagar, C; Tralongo, V
Collagenous colitis is a clinico-pathological entity characterized by chronic diarrhoeas and deposition of collagen beneath the epithelium surface of large bowel. We revised 265 endoscopy biopsy specimens of the large bowel from 198 consecutive patients with "aspecific chronic colitis". Morphometric study showed that were not significant differences among various tracts in the same patients regarding to the thickness of basament membrane. It was more than 11.9 +/- 0.49 mu only in 13 pts (6.6%), while it was 3.96 +/- 1.4 mu in the others. Immunohistochemistry study confirmed the normality of subepithelial basement membrane and the below deposition of the large quantity of collagen IV.
Arevalo, A; Pulido-Rivas, P; Gilo-Arrojo, F; Sola, R G
Introduccion. Los quistes pineales son un hallazgo incidental relativamente frecuente en las pruebas de imagen; sin embargo, la apoplejia pineal se considera rara y se asocia a sintomas graves. Casos clinicos. Varon de 25 a˜os y mujer de 15 a˜os, que acudieron a urgencias con clinica de hipertension intracraneal; mediante pruebas de imagen se confirmo la existencia de una hemorragia pineal. Se les trato con exito mediante microcirugia. Conclusion. En nuestra experiencia, y avalado por la bibliografia, creemos que el mejor tratamiento de esta infrecuente patologia es el abordaje microquirurgico. Sin embargo, no se excluye la posibilidad de que, en un futuro, las tecnicas endoscopicas puedan tener un lugar importante en el tratamiento de la apoplejia pineal.
Dvirskiĭ, A E; Shevtsov, A G
A study was made of the effect of hereditary loading with schizophrenia on the clinical characteristics of epilepsy. In the population sample of epileptic patients (n = 3489), hereditary loading with schizophrenia was revealed in 4.7% of the patients, among whom loading with both schizophrenia and epilepsy was recorded in 0.6% of the cases. The clinical manifestations of epilepsy were compared in 143 patients loaded with schizophrenia and in 158 patients without hereditary loading with mental diseases. It has been established that in epileptic patients, the factor of hereditary loading with schizophrenia exerts a modifying effect on the premorbid characteristics, increasing the rate of schizoepileptoid, schizoid, and astheno-neurotic++ personality traits, and contributes to a favorable course of the disease. The data obtained standpoint of the previously advanced ++clinico-genetic concept of combined psychoses.
Kenchadze, R L; Ivereli, M B; Geladze, N M; Khachapuridze, N S; Bakhtadze, S Z
The aim of the research was to detect the stomatologic, endocrine and psycho-neurologic status in patients with burning mouth syndrome, elaborate different diagnostic criteria and effective therapy for the patients with burning mouth syndrome. 92 patients with burning mouth syndrome were studied. Patients ranged in age from 28 to 72 years. The conducted studies gave the possibility to make conclusions, the most important of which are: burning mouth syndrome (BMS) is not only stomatologic problem; this psychosomatic syndrome belongs to gerontologic disease and tendency of its "rejuvenation" was revealed as well (in the current study --2 women (28 and 32 year old, and 38 year old man); degree of revelation of the symptoms of depression, anxiety, obsession and somatization is closely related with duration of the diseases. These symptoms are progressing together with aging and reach the peak at 60-70 years old. Individual scheme of therapy was developed on the background of clinico-paraclinical study.
Zanini, G M
Switzerland has recently issued regulations designed to control all trials with drugs in human subjects, namely the 'Regolamento dell'Ufficio Intercantonale per il controllo dei medicamenti in fase di studio clinico' (Intercantonal Regulations Controlling Drugs used in Clinical Trials), which have been operating since 1st January 1995. These new regulations are generally consistent with other international regulations and have introduced the concept of good clinical practice (GCP) into Switzerland. There are other regulations in Switzerland, such as Federal regulations on immunobiological products, special rules governing the administration of radiolabelled drugs to humans, drugs of abuse and medical devices. Any gap in the central regulations must be filled by cantonal regulations, where they exist. This is a comprehensive review of the regulations governing clinical trials in Switzerland, with special attention being devoted to trials with therapeutic compounds and to compatibility between Swiss and international procedures.
Sherigar, Jagannath M; Fazio, Richard; Zuang, Minsheng; Arsura, Edward
Nitrofurantoin has been in use since 1953 as an effective agent for the prevention of recurrent urinary tract infection. It is associated with a wide range of adverse drug reactions. Chronic active hepatitis has increasingly been observed and many cases have been reported with case fatalities. We present a case of nitrofurantoin induced chronic active hepatitis and briefly review the serology and clinico pathological features of 57 similar cases reported in English literature. The consistent presence of antinuclear antibody, anti smooth muscle antibody, elevated immunoglobulin and pathological feature suggests an immunologic mechanism. Complete recovery is possible in most cases if medication is discontinued in time. Steroids may play a role in management if no improvement occurs despite discontinuation of medication. We suggest all patients who are on prolonged nitrofurantoin therapy be followed up with anti nuclear antibody, anti smooth muscle antibody, serum immunoglobulin and hepatic panel every three months.
Opaleva-Stegantseva, V A; Rybkin, I A; Protopopova, A N; Litvintseva, G A; Ratovskaia, V I
The data on the dynamics of prehospital mortality in acute coronary failure (ACF) and myocardial infarction (MI) depending on the improvement in medical service in the prehospital stage of treatment are presented. The research showed that prehospital mortality in ACF and MI accounts for 75% of the total mortality. Among deaths registered in the prehospital stage 73.7% were sudden. As the result of improvements in prehospital medical service due to the training of physicians of the emergency medical service, the organization of cardiologic emergency aid teams, clinico-pathologic conferences held at the emergency medical service stations, etc. extrahospital mortality dropped from 45.6% (1963) to 26.2% (1975) with simultaneous drop in total mortality from 61.9% (1963) to 37.4% (1975).
RÍOS, Elvio E.; CHOLICH, Luciana A.; CHILESKI, Gabriela; GARCÍA, Enrique N.; LÉRTORA, Javier; GIMENO, Eduardo J.; GUIDI, María G.; MUSSART, Norma; TEIBLER, Gladys P.
This study describes an occurrence of pink morning glory (Ipomoea carnea) intoxication in goats in northern Argentina. The clinical signs displayed by the affected animals were ataxia, lethargy, emaciation, hypertonia of the neck muscles, spastic paresis in the hind legs, abnormal postural reactions and death. The clinico-pathologic examination revealed that the affected animals were anemic and their serum level of aspartate aminotransferase was significantly increased. Cytoplasmic vacuolation in the Purkinje cells and pancreatic acinar cells was observed by histological examination. The neuronal lectin binding pattern showed a strong positive reaction to WGA (Triticum vulgaris), sWGA (succinylated T. vulgaris) and LCA (Lens culinaris). Although I. carnea is common in tropical regions, this is the first report of spontaneous poisoning in goats in Argentina. PMID:25728544
Sarkar, Supriya; Saha, Kaushik
Rhupus syndrome, the overlap of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), is an extremely uncommon condition. Organ damages found due to SLE are usually mild in rhupus. Lupus pneumonitis in rhupus syndrome has not been reported worldwide. We are reporting a 23-year-old female with bilateral symmetric erosive arthritis, oral ulcer, alopecia, polyserositis, anemia, leucopenia, positive RA-factor, anti nuclear antibody (ANA) and anti ds-DNA. She presented with acute onset dyspnea, high fever, chest pain, tachycardia, tachypnea, hypoxia and respiratory alkalosis. High resolution computed tomography (HRCT)-thorax showed bilateral, basal consolidation with air bronchogram. Repeated sputum and single broncho alveolar lavage (BAL) fluid examination revealed no organism or Hemosiderin-laden macrophage. The diagnosis of rhupus was confirmed by combined manifestations of RA and SLE, and the diagnosis of acute lupus pneumonitis was established by clinico-radiological picture and by excluding other possibilities.
Hashimoto, S; Tatsumi, K; Osamu, O; Tanabe, N; Kimura, H; Kuriyama, T; Tamakoshi, A; Kawamura, T; Ohno, Y
To estimate the number of patients with intractable respiratory diseases, we conducted a two-stage nationwide epidemiological survey in 1997. The first survey was performed at randomly sampled hospitals to identify the number of patients treated. The second survey sought detailed clinico-epidemiological data on the patients reported in the first survey. The response rates were 54% for the first survey and 62% for the second. Based on the survey findings, we derived the following nationwide estimates: 450 patients (95% confidence interval: 360-530) with chronic thromboembolic pulmonary hypertension; 230 (200-260) with primary pulmonary hypertension; 180 (150-210) with obesity-associated hypoventilation syndrome; 40 (30-50) with primary alveolar hypoventilation syndrome; 160 (140-180) with histiocytosis X; and 190 (150-230) with juvenile pulmonary emphysema.
Oliynyk, Sergiy; Oh, Seikwan
Actoprotectors are preparations that enhance body stability against physical loads without increasing oxygen consumption or heat production. Or, in short, actoprotectors are synthetic adaptogens with a significant capacity to improve physical performance. This paper explores the history of actoprotectors’development, their pharmacological properties, mechanism of action, and practical application to the improvement of mental and physical performance. A brief summary of the clinico-pharmacological characteristics of the main representatives of this class (bemitil and bromantane) is provided. Some other synthesized compounds, and even natural ones such as ginseng, also are regarded as potential actoprotectors, and these are treated herein as well. Actoprotectors, owing to their wide-ranging pharmacological activities, high efficiency and safety, can be applied under either normal or extreme conditions. PMID:24009833
Queraltó, J M
Clinical biochemistry in Spain was first established in 1978 as an independent specialty. It is one of several clinical laboratory sciences specialties, together with haematology, microbiology, immunology and general laboratory (Clinical analysis, análisis clinicos). Graduates in Medicine, Pharmacy, Chemistry and Biological Sciences can enter post-graduate training in Clinical Chemistry after a nation-wide examination. Training in an accredited Clinical Chemistry department is 4 years. A national committee for medical and pharmacist specialties advises the government on the number of trainees, program and educational units accreditation criteria. Technical staff includes nurses and specifically trained technologists. Accreditation of laboratories is developed at different regional levels. The Spanish Society for Clinical Biochemistry and Molecular Pathology (SECQ), the national representative in the IFCC, has 1600 members, currently publishes a scientific journal (Química Clinica) and a newsletter. It organizes a continuous education program, a quality control program and an annual Congress.
Glushchenko, V V
We have studied 128 adolescents, aged 15-16 years, with attention-deficit hyperactivity disorder (ADHD) using clinico-psychopathological, psychometric and electroencephalographic methods. Taking into account the age dynamics, the following components of ADHD have been singled out: motor (impulsivity-hyperactivity), subjective-cognitive (attention deficit) and somato-autonomic. The significance of subjective-cognitive disturbances, along with neurophysiological dysfunction, in the ADHD pathogenesis has been proved. Quantitative (productivity deficit) and qualitative (concentration deficit) disorders have been assessed. Author substantiated the deficit of emotional-motivational self-regulation measured by the M. Luscher test and the Self-assessment scale. The specific for ADHD pattern of alpha-rhythm reactivity has been found in EEG.
Cahana-Amitay, Dalia; Albert, Martin L
Aphasia therapy, while demonstrably successful, has been limited by its primary focus on language, with relatively less attention paid to nonlinguistic factors (cognitive, affective, praxic) that play a major role in recovery from aphasia. Neuroscientific studies of the past 15-20 years have opened a breach in the wall of traditional clinico-anatomical teachings on aphasia. It is not an exaggeration to talk of a paradigm shift. The term "neural multifunctionality" denotes a complex web of neural networks supporting both linguistic and nonlinguistic functions in constant and dynamic interaction, creating language as we know it and contributing to recovery from aphasia following brain damage. This paper reviews scientific underpinnings of neural multifunctionality and suggests ways in which this new approach to understanding the neural basis of language can lead to meaningful, practical steps for improvements in aphasia therapy.
Caudle, W. Michael; Guillot, Thomas S.; Lazo, Carlos R.; Miller, Gary W.
The exposure of the human population to environmental contaminants is recognized as a significant contributing factor for the development of Parkinson’s disease (PD) and other forms of parkinsonism. While pesticides have repeatedly been identified as risk factors for PD, these compounds represent only a subset of environmental toxicants that we are exposed to on a regular basis. Thus, non-pesticide contaminants, such as metals, solvents, and other organohalogen compounds have also been implicated in the clinical and pathological manifestations of these movement disorders and it is these non-pesticide compounds that are the subject of this review. As toxic exposures to these classes of compounds can result in a spectrum of PD or PD-related disorders, it is imperative to appreciate shared clinico-pathological characteristics or mechanisms of action of these compounds in order to further delineate the resultant disorders as well as identify improved preventive strategies or therapeutic interventions. PMID:22309908
López-Marín, Laura; Martín-Belinchón, Mónica; Gutiérrez-Solana, Luis G; Morte-Molina, Beatriz; Duat-Rodríguez, Anna; Bernal, Juan
Introduccion. El MCT8 es un transportador especifico para las hormonas tiroideas T4 y T3, que permite su entrada en el cerebro y otros organos. La deficiencia de MCT8, o sindrome de Allan-Herndon-Dudley, es un trastorno ligado a X que, generalmente, se presenta como un cuadro neurologico grave de inicio precoz, con un perfil tiroideo caracteristico (aumento de T3 y disminucion de T4 y rT3). Objetivo. Se presenta el primer caso diagnosticado en España con este sindrome y se revisa la bibliografia publicada, las distintas formas de presentacion clinica, los avances geneticos, el diagnostico diferencial y las perspectivas terapeuticas, y se propone un algoritmo diagnostico. Caso clinico. Varon de 5 años con un cuadro clinico compatible con una enfermedad de Pelizaeus-Merzbacher. La secuenciacion del gen PLP1 no mostro alteraciones. Todos los estudios metabolicos y geneticos realizados fueron normales. Finalmente, un estudio completo del perfil tiroideo revelo alteraciones compatibles con una deficiencia del transportador MCT8. La secuenciacion del gen SLC16A2 (MCT8) mostro una mutacion en el exon 3 y el estudio celular confirmo que esta mutacion cambia las propiedades de la proteina. Conclusiones. En los ultimos años se han multiplicado las publicaciones sobre este sindrome, con la identificacion de mas de 50 familias en el mundo. Es importante conocer este sindrome y sospecharlo, porque el diagnostico es facil, economico y accesible (perfil tiroideo), y, aunque no tiene tratamiento especifico, el diagnostico precoz evita pruebas innecesarias y permite ofrecer consejo genetico a las familias afectadas.
Spalgais, Sonam; Gothi, Dipti; Jaiswal, Anand; Gupta, Kumud
Background: Nonoccupational anthracosis and silicosis has been reported from various parts of the world including Ladakh in Jammu and Kashmir, India; however, anthracosilicosis has only been reported in industrial workers till date. Materials and Methods: Six cases from the Ladakh region in Jammu and Kashmir, India with similar clinico-radiological-pathological features, i.e., anthracosilicosis/anthracofibrosis have been analyzed. Of these, four were analyzed retrospectively and two prospectively. Result: All the patients were homemakers and resided in Ladakh in Jammu and Kashmir, India since birth with an age range of 42–62 years and an average age of 56 years. Their average duration of symptoms was 4 years. Spirometry showed small and/or large airway disease in 5/6 cases. On computed tomography (CT), 4/6 cases showed progressive massive fibrosis (PMF) with calcified mediastinal lymph nodes. There were random or centrilobular nodules in all the six cases. Bronchoscopy in 5/6 cases showed multiple anthracotic pigments with narrowing and distortion of the bronchus (anthracofibrosis). Malignancy was suspected clinico-radiologically in four cases and pathologically in two cases. On histopathology, anthracosis was demonstrated in all and silicosis in three cases. Conclusion: Anthracosilicosis can occur due to environmental exposure. Ladakh in Jammu and Kashmir, India is the only place across the globe with unique environmental features having the presence of both free silica and biomass fuel. The disease was observed predominantly in older women. Awareness would prevent unnecessary investigation for malignancy. Treatment with the bronchodilator is useful as it has evidence of airway disease. Finally, environmental measures and a proper study need to be undertaken for knowing the relative role of silica versus soot in causing the lung disease and preventing this irreversible condition. PMID:26957815
Oczko-Wojciechowska, Małgorzata; Barczyński, Marcin
Papillary thyroid cancer (PTC) offers excellent prognosis, however relapse risk or persistent disease is related to ~30%. Currently, attention is paid to the possibility of patient group selection of different risk of unfavorable outcome to match a particular therapeutic approach. Therefore, interest in new prognostic and predictive markers known preoperatively is observed. BRAF V600E mutation is such a marker. Many studies analyzing the prevalence of the mutation and its relationship with other clinico-pathological risk factors were reported but with controversial conclusions. The prognostic significance of BRAF mutation was confirmed by some single centre studies, a few meta-analyses and a large multicenter retrospective international study. They confirmed a correlation between the mutation and the risk of recurrence. The strongest argument against using BRAF mutation as an independent prognostic and predictive factor in PTC is its high prevalence (30–80%). At present it seems that BRAF mutation is one of the factors influencing the prognosis and it should be analyzed in correlation with other prognostic factors. The most recent ATA recommendations do not indicate a routine application of BRAF status for initial risk stratification in differentiated thyroid cancer due to a lack of evident confirmation of a direct influence of mutation on the increase in relapse risk. However, ATA demonstrates the continuous risk scale for the relapse risk assessment, considering BRAF and/or TERT status. At present, researchers are working on determining the role of BRAF mutation in patients from a low-risk group and its correlations with others molecular events. Currently, BRAF mutation cannot be used as a single, independent predictive factor. However, its usefulness in the context of other molecular and clinico-pathological risk factors cannot be excluded. They may be used to make modern prognostic scales of relapse risk and be applied to individualized diagnostic and
Josephs, Keith A.; Duffy, Joseph R.; Strand, Edyth A.; Whitwell, Jennifer L.; Layton, Kenneth F.; Parisi, Joseph E.; Hauser, Mary F.; Witte, Robert J.; Boeve, Bradley F.; Knopman, David S.; Dickson, Dennis W.; Jack, Clifford R.; Petersen, Ronald C.
Apraxia of speech (AOS) is a motor speech disorder characterized by slow speaking rate, abnormal prosody and distorted sound substitutions, additions, repetitions and prolongations, sometimes accompanied by groping and trial-and error articulatory movements. Although AOS is frequently subsumed under the heading of aphasia, and indeed most often co-occurs with aphasia, it can be the predominant or even the sole manifestation of a degenerative neurologic disease. In this study we determined whether the clinical classifications of aphasia and AOS correlated with pathological diagnoses and specific biochemical and anatomical structural abnormalities. Seventeen cases with initial diagnoses of a degenerative aphasia or AOS were reclassified independently by two speech-language pathologists — blinded to pathologic and biochemical findings - into one of five operationally defined categories of aphasia and AOS. Pathological diagnoses in the 17 cases were progressive supranuclear palsy in six, corticobasal degeneration in five, frontotemporal lobar degeneration with ubiquitin-only-immunoreactive changes in five, and Pick’s disease in one. Voxel-based morphometry and SPECT were completed, blinded to the clinical diagnoses, and clinico-imaging and clinico-pathological associations were then sought. Interjudge clinical classification reliability was 87% (κ =0.8) for all evaluations. Eleven cases had evidence of AOS, of which all (100%) had a pathological diagnosis characterized by underlying tau biochemistry, while five of the other six cases without AOS did not have tau biochemistry (p=0.001). A majority of the 17 cases had more than one yearly evaluation, demonstrating the evolution of the speech and language syndromes, as well as motor signs. Voxel-based morphometry revealed the premotor and supplemental motor cortices to be the main cortical regions associated with AOS, while the anterior peri-sylvian region was associated with non-fluent aphasia. Refining the
Villar-Quiles, R N; Porta-Etessam, J
Introduccion. La neurosifilis puede ocurrir en cualquier momento tras la infeccion por Treponema pallidum y su incidencia esta aumentando en los ultimos años. El patron epidemiologico y clinico ha experimentado un cambio sustancial en la era postantibiotica. Objetivo. Describir y analizar la poblacion de pacientes con diagnostico de neurosifilis de un hospital terciario de Madrid desde enero de 2008 a mayo 2015. Pacientes y metodos. Se analizaron retrospectivamente datos demograficos, clinicos, pruebas complementarias –serologia, liquido cefalorraquideo (LCR), neuroimagen– y evolucion de 28 pacientes diagnosticados entre 2008 y 2015. Resultados. La mayoria fueron varones (89,3%), españoles (60,7%), con una edad media de 53 ± 16,4 años. Lo mas frecuente fueron las formas asintomaticas (39,3%), seguidas de sifilis ocular (21%), formas no clasicas (14,3%), deterioro cognitivo y alteraciones neuropsiquiatricas (11%). El 50% presentaba infeccion concomitante por virus de la inmunodeficiencia humana, la mayoria asintomaticos, con una correlacion significativa entre linfocitos T CD4+ y neurosifilis asintomatica. Unicamente el 50% presento VDRL+ en el LCR, basandose el diagnostico en la clinica, la serologia y las alteraciones en el LCR (citobioquimicas o serologicas). La neuroimagen fue inespecifica en la mayoria de los casos. Las formas tempranas y las formas oculares se asociaron a una mejor evolucion clinica. Conclusiones. Respecto a la era preantibiotica, se observa un descenso muy importante en las formas tardias, asi como la aparicion de formas no clasicas que pueden simular otras entidades, como encefalitis viricas. El diagnostico es complejo y se basa en la clinica, la serologia y el estudio del LCR, a menudo con una interpretacion compleja, por lo que la sospecha clinica es fundamental en el diagnostico.
Beneto, A; Soler-Algarra, S; Salavert, V
Introduccion. Recientemente se han propugnado criterios restrictivos para definir el sindrome de apnea/hipopnea obstructiva ligado al sueño REM y persisten interrogantes sobre su trascendencia nosologica y manejo clinico. Objetivo. Evaluar los criterios definitorios de la apnea del sueño REM, su relacion con la comorbilidad cardiometabolica y los aspectos relacionados con su diagnostico. Pacientes y metodos. Estudio observacional retrospectivo sobre datos clinicos y polisomnograficos de pacientes ambulatorios. Se incluyo a 525 pacientes mayores de 18 años que tenian un indice apnea/hipopnea (IAH) por hora de sueño = 5 (total, o parcial en REM o no REM). Resultados. Se han configurado subgrupos 'dependientes de la fase' utilizando un criterio basado en la 'proporcion = 2' y otro 'estricto' basado en uno de los IAH parciales = 5 frente al otro IAH < 5 (en REM o en no REM). En el subgrupo 'apnea del sueño REM estricto', la mitad de los pacientes muestra un IAH global < 5 y menos gravedad en los parametros respiratorios, pero sin menores porcentajes de comorbilidad. Con los criterios diagnosticos actuales quedarian excluidos del diagnostico de sindrome de apnea/hipopnea obstructiva del sueño (SAHOS). Conclusiones. Aplicar un criterio estricto para detectar apnea del sueño REM permite filtrar formas muy leves de SAHOS asociadas a comorbilidad cardiometabolica en porcentajes no diferentes significativamente de otras formas mas graves. Para evitar el infradiagnostico del SAHOS seria oportuno revisar los criterios diagnosticos actuales y las indicaciones de las tecnicas reducidas.
McGlynn, Liane M.; McCluney, Simon; Jamieson, Nigel B.; Thomson, Jackie; MacDonald, Alasdair I.; Oien, Karin; Dickson, Euan J.; Carter, C. Ross; McKay, Colin J.; Shiels, Paul G.
Purpose The sirtuin gene family has been linked with tumourigenesis, in both a tumour promoter and suppressor capacity. Information regarding the function of sirtuins in pancreatic cancer is sparse and equivocal. We undertook a novel study investigating SIRT1-7 protein expression in a cohort of pancreatic tumours. The aim of this study was to establish a protein expression profile for SIRT1-7 in pancreatic ductal adenocarcinomas (PDAC) and to determine if there were associations between SIRT1-7 expression, clinico-pathological parameters and patient outcome. Material and Methods Immunohistochemical analysis of SIRT1-7 protein levels was undertaken in a tissue micro-array comprising 77 resected PDACs. Statistical analyses determined if SIRT1-7 protein expression was associated with clinical parameters or outcome. Results Two sirtuin family members demonstrated significant associations with clinico-pathological parameters and patient outcome. Low level SIRT3 expression in the tumour cytoplasm correlated with more aggressive tumours, and a shorter time to relapse and death, in the absence of chemotherapeutic intervention. Low levels of nuclear SIRT7 expression were also associated with an aggressive tumour phenotype and poorer outcome, as measured by disease-free and disease-specific survival time, 12 months post-diagnosis. Conclusions Our data suggests that SIRT3 and SIRT7 possess tumour suppressor properties in the context of pancreatic cancer. SIRT3 may also represent a novel predictive biomarker to determine which patients may or may not respond to chemotherapy. This study opens up an interesting avenue of investigation to potentially identify predictive biomarkers and novel therapeutic targets for pancreatic cancer, a disease that has seen no significant improvement in survival over the past 40 years. PMID:26121130
Travaglini, Grazia; Biagetti, Simona; Alfonsi, Simona; Bearzi, Italo; Marmorale, Cristina
Il caso clinico che vi presentiamo riguarda la straordinaria localizzazione intra-addominale di un sinovial-sarcoma. Questo tumore dei tessuti molli generalmente interessa le piccole e grandi articolazioni. Sono state descritte altre localizzazioni a livello intra-addominale e retroperitoneale. La nostra paziente si ricovera per una tumefazione dolente dell’addome, alla TC addome si evidenzia una voluminosa massa intra-addominale che comprime e disloca i parenchimi e visceri circostanti e che affiora ai tessuti più superficiali della parete addominale. La biopsia eco-guidata della lesione, insieme allo studio immunoistochimico, permette di porre la diagnosi di sinovial-sarcoma. La paziente viene candidata ad un trattamento chemioterapico a scopo neoadiuvante. Per il sopraggiungere di anemizzazione da sanguinamento della neoplasia, valutata anche la risposta parziale al trattamento sistemico, si pone indicazione all’intervento chirurgico. La massa con peduncolo vascolare maggiore costituito dai vasi gastroepiploici di destra, viene completamente asportata. L’esame definitivo conferma la diagnosi di Sinovial-Sarcoma bifasico. L’indagine genetica condotta sul campione conservato in formalina non ha permesso, a causa della difficoltà di estrarre ed amplificare un quantitativo adeguato di RNA, di identificare la traslocazione (X; 18) (p 11.2; q 11.2) specifica del Sinovial-Sarcoma. La paziente è stata dimessa dopo un decorso clinico regolare. Il follow-up ad un anno non ha mostrato ripresa di malattia ma dopo 18 mesi alla TC torace-addome di rivalutazione si evidenzia la ripresa di malattia a livello intra-addominale e la presenza di metastasi polmonari bilaterali.
Hervás-García, José V; Grau-López, Laia; Doménech-Puigcerver, Sira; Ramo-Tello, Cristina
Introduccion. La neuromielitis optica (NMO) o enfermedad de Devic es un trastorno autoinmune, inflamatorio y desmielinizante del sistema nervioso central, que afecta principal y caracteristicamente al nervio optico y a la medula espinal. Los anticuerpos antiacuaporina-4 (AQ-4) son un biomarcador especifico de esta entidad y, desde su descubrimiento, se ha ampliado el numero de sintomas y datos radiologicos de la enfermedad y se ha definido el concepto de espectro clinico de NMO. Caso clinico. Mujer de 66 años diagnosticada de NMO por haber sufrido brotes de neuritis optica y mielitis de repeticion junto con anticuerpos AQ-4 positivos. Presento un cuadro de disminucion del nivel de conciencia, con resonancia magnetica cerebral que mostro multiples lesiones en la sustancia blanca, sin realce de contraste, que se resolvio sin tratamiento. Un mes despues, sufrio empeoramiento del estado general, sindrome confusional y ceguera. En la resonancia magnetica cerebral se observaron nuevas lesiones en la sustancia blanca y aumento del tamaño de otras ya existentes. Se emitio el diagnostico de encefalopatia en el contexto de NMO y se trato a la paciente con corticoides e inmunoglobulinas intravenosas, con lo que se produjo mejoria clinica y radiologica. Conclusiones. Desde el descubrimiento de los anticuerpos AQ-4, ha aumentado el numero de manifestaciones clinicas y radiologicas de la NMO mas alla de la afectacion del nervio optico y de la medula espinal, entre ellas las manifestaciones cerebrales. Reconocerlas es muy importante para hacer un diagnostico precoz, evitar pruebas complementarias no necesarias e instaurar el tratamiento adecuado.
Martinez-Cayuelas, E; Herraiz-Martinez, M; Villacieros-Hernandez, L; Cean-Cabrera, L; Martinez-Salcedo, E; Alarcon-Martinez, H; Domingo-Jimenez, R; Perez-Fernandez, V
Introduccion. Las convulsiones febriles son una de las causas mas frecuentes de consulta. Hasta ahora, los pacientes con convulsiones febriles complejas (CFC) deben ingresar, dado el mayor porcentaje de epilepsia y complicaciones agudas descrito clasicamente. En la actualidad hay estudios que apoyan ser menos invasivos en el abordaje de estos pacientes. Objetivo. Describir las caracteristicas de los pacientes ingresados por CFC y proponer un nuevo protocolo de actuacion. Pacientes y metodos. Analisis retrospectivo de historias clinicas de ingresados por CFC (enero de 2010-diciembre de 2013). Se ofrecen datos epidemiologicos, clinicos, pruebas complementarias y evolucion. Resultados. Las CFC suponian un 4,2% de los ingresos de neuropediatria (n = 67). Edad media al evento: 25 meses. El 47% tenia antecedentes familiares patologicos, y el 31%, antecedentes personales de convulsion febril previa. En el 54% de los pacientes, la CFC duro menos de cinco minutos; hubo recurrencia, la mayoria con un total de dos crisis y durante el primer dia (las CFC por recurrencia son las mas frecuentes). De las pruebas complementarias realizadas, ninguna de ellas sirvio como apoyo diagnostico en el momento agudo. Durante su seguimiento, cinco pacientes presentaron complicaciones. Los pacientes con antecedentes familiares de convulsiones febriles presentan mayor riesgo de epilepsia o recurrencia (p = 0,02), sin diferencias significativas respecto a la edad, numero de crisis, intervalo de fiebre, estado epileptico o tipo de CFC. Conclusiones. Las CFC no asocian mayores complicaciones agudas; las exploraciones complementarias no permiten discriminar precozmente a los pacientes de riesgo. Su ingreso podria evitarse en ausencia de otros signos clinicos y limitarse a casos seleccionados.
Detection of human papillomavirus in esophageal and gastroesophageal junction tumors: A retrospective study by real-time polymerase chain reaction in an instutional experience from Turkey and review of literature.
Türkay, Düriye Özer; Vural, Çiğdem; Sayan, Murat; Gürbüz, Yeşim
Esophageal cancer is a poor-prognosis malignancy that ranks eighth among all cancer types, and its prevalence shows differences among geographical regions. Although the most important risk factors for esophageal carcinoma are alcohol and smoking, viral infections, particularly HPV infection, are also considered among etiological agents. Our study aims to detect the presence of HPV in esophageal cancers in our patient population and to investigate its correlation with clinico-pathological parameters. We investigated the presence of HPV-DNA by real-time polymerase chain reaction in a total of 52 patients with esophageal cancer. Subtype analysis was performed in positive cases and was correlated with selected clinico-pathological parameters. Five (9.6%) of 52 tumor samples, 3 squamous cell carcinomas (3/33 cases) and 2 adenocarcinomas (2/19 cases), were HPV-DNA-positive. Subtype analysis could be performed in four HPV-DNA-positive cases, of which three were HPV type-39 and 1 was type-16. The Marmara region, where the present study was carried out, is a region with low-moderate risk for esophageal cancer, and the prevalence of HPV-DNA in these tumors is similar to the prevalence of HPV-DNA reported in the literature for regions with similar risk. In conclusion, we detected HPV DNA in a subset of esophageal and gastroesophageal junction tumors. HPV infection may have a role in esophageal carcinogenesis and high-risk HPV subtypes can particularly be considered among risk factors since the prevalence of high risk HPV infection has also been found to be increased in regions with a high risk for esophageal cancer compared to low-moderate risk regions.
Bermejo, Pedro E; Torres, Cristina V; Sola, Rafael G
Introduccion. La estimulacion de nervios occipitales (ENO) es un tratamiento preventivo de la migraña cronica refractaria que esta adquiriendo una importancia creciente en los ultimos años. Objetivo. Evaluar el mecanismo de accion, estudios clinicos, tecnica de implantacion y criterios de inclusion de la ENO en el tratamiento preventivo de la migraña. Desarrollo. Se realiza una revision no sistematica de la bibliografia sobre los aspectos anteriormente expuestos en la ENO como tratamiento para la migraña cronica. Esta patologia afecta aproximadamente al 2% de la poblacion y da lugar a una importante disminucion de la calidad de vida e interferencia con las actividades laborales y sociales. La ENO es una terapia emergente y prometedora para el tratamiento de la migraña cronica que ha demostrado una disminucion superior al 50% en el dolor en la mayoria de los estudios abiertos y ensayos clinicos publicados. Aunque el mecanismo de accion es desconocido, parece existir una neuromodulacion de la informacion nociceptiva trigeminal en el nucleo caudal del trigemino explicada mediante la teoria de la puerta de entrada de Melzack y Wall. La ENO es un tratamiento seguro y bien tolerado, y los efectos secundarios son habitualmente locales, como desplazamiento de los electrodos o infecciones de la herida quirurgica, que habitualmente no requieren su retirada. Conclusiones. La ENO es un tratamiento eficaz, bien tolerado y seguro en la prevencion de la migraña cronica, y supone una opcion util para aquellos pacientes con migraña cronica refractaria a los tratamientos medicos convencionales.
Kottadamane, Manasa R.; Dhaliwal, Pritpal Singh; Singla, Lachhman Das; Bansal, Baljinder Kumar; Uppal, Sanjeev Kumar
Aim: As in India especially, the Punjab state sero-prevalence and distribution of ehrlichiosis in relation to clinico-hematobiochemical response remains largely unexplored. Thus, this study was designed to determine the prevalence of vector (tick)-borne tropical canine pancytopenia caused by Ehrlichia canis through enzyme labeled ImmunoComb® (IC) assay in dogs from in and around Ludhiana, Punjab. Correlation of prevalence was made with various clinico-hematobiochemical parameters. Materials and Methods: Seroprevalence study was carried out using IC® test kit (Biogal, Galed Labs). The study was conducted in 84 dogs presented to the Small Animal Clinics, Teaching Veterinary Clinical Complex, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab. Results: Out of 84 suspected dogs for ehrlichiosis, based on peripheral thin blood smear examination 12 (14.28%) cases were positive for the morulae of E. canis and 73 (86.90%) dogs were found positive to E. canis antibodies through IC® canine Ehrlichia antibody test kit, respectively. Among the different age groups 1-3 years of aged group showed highest prevalence (41.09%), followed by the 3-6 years age group (32.87%), infection levels were lower in the <1 year of age group dogs (13.69%) and more than 6 years age group dogs (12.32%). The highest prevalence was seen in Labrador retriever. This study indicates that season plays a very important role in the prevalence of ehrlichiosis. The most common findings observed were anemia, leukocytosis, neutropenia, lymphopenia, thrombocytopenia, eosinophilia followed by hyperbilirubinemia, increased levels of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase, hypoalbuminemia, hyperglobulinaemia, decrease in albumin and globulin ratio, increase in blood urea nitrogen and creatinine. Conclusions: Serological techniques like IC® are more useful for detecting chronic and subclinical infections and are ideally suited to epidemiological
Introduccion. Las malformaciones arteriovenosas (MAV) se pueden encontrar en el 0,1% de la poblacion, y la forma de presentacion mas frecuente es la hemorragia intracraneal. Objetivo. Analisis descriptivo de una serie de MAV operadas por un neurocirujano. Pacientes y metodos. De un registro hospitalario se han seleccionado los casos de MAV cerebrales operados por el autor en el periodo 1990-mayo 2014, revisando los aspectos clinicos, demograficos y angiograficos, y los resultados clinicorradiologicos seis meses despues de la cirugia. Resultados. De los 400 pacientes tratados en el mismo periodo, 121 fueron intervenidos por el autor, con una media de edad de 34,3 años (rango: 5-75 años). El 61,7% de los pacientes se diagnostico por una hemorragia cerebral, y la segunda forma de presentacion mas frecuente, el 19,8%, por crisis epilepticas. La localizacion superficial supratentorial, en 97 casos (80,2%), fue la mas frecuente. Mas de la mitad de los enfermos presentaba una MAV de grados bajos, I-II, segun la escala de Spetzler y Martin. Doce pacientes (10%) tenian aneurismas no intranidales asociados. En la mayoria de los casos, 109 (90,1%), se realizo cirugia electiva. La reseccion completa de la MAV despues del ultimo examen angiografico se obtuvo en 118 pacientes (97,5%). Los resultados clinicos fueron buenos (buena recuperacion y moderada incapacidad) en 114 casos (95%), y malos (gran incapacidad y muerte), en seis (5%). Conclusiones. La cirugia para las MAV cerebrales, con un criterio de seleccion apropiado, es la mejor opcion terapeutica para muchos pacientes.
Gómez-Andrés, David; Pulido-Valdeolivas, Irene; Martín-Gonzalo, Juan Andrés; López-López, Javier; Martínez-Caballero, Ignacio; Gómez-Barrena, Enrique; Rausell, Estrella
Introduccion. Unos 23.000 pacientes con espasticidad han optado voluntariamente por la miofibrotomia multiple (MFM), una tecnica alternativa consistente en seccionar tejidos blandos para liberar restricciones articulares. Iniciada por Ulzibat (Rusia), se realiza fuera de controles clinicos ortodoxos. Objetivo. Evaluar externamente los efectos de la MFM sobre la funcionalidad motora y la marcha. Pacientes y metodos. Estudio observacional autocontrolado que evalua cambios en variables funcionales –Gross Motor Function Classification System, dimension E de la Gross Motor Function Measure (GMFM) y Functional Mobility Scale– y 32 parametros de marcha (medidos mediante analisis instrumental) en 22 escolares con diplejia espastica (edad mediana: 9 años y 6 meses; Q1-Q3: 7 años y 11 meses a 11 años y 6 meses) cuyos padres optaron por una MFM (mediana de observacion: 4 meses; rango: 3-7 meses). Resultados. El analisis de conglomerados jerarquicos utilizado para determinar patrones topograficos de cortes en los pacientes detecto que los cirujanos aplicaban a cada paciente uno de tres conjuntos de cortes. Analizados los tres grupos de pacientes, se observo que un grupo empeoro globalmente y una mejora significativa general en la dimension E del GMFM (diferencia de mediana: 4,86%; intervalo de confianza al 95% = 0-6,94%) tras la MFM. Algunos parametros de la marcha se normalizaron significativamente (izquierda: rango flexion-cadera, maxima dorsiflexion en apoyo; derecha: velocidad, rotacion pelvica media en apoyo y maxima dorsiflexion en apoyo). Conclusiones. Estos resultados no apoyan ni justifican el uso de la MFM como opcion para el tratamiento de la espasticidad. Insistimos en que esta tecnica debe evitarse fuera de protocolos de estudio. Sin embargo, los resultados asientan una base objetiva para justificar la realizacion de un ensayo clinico y estudios observacionales a largo plazo.
Fernandez-Garcia, M A; Garcia-Penas, J J; Gomez-Martin, H; Perez-Sebastian, I; Garcia-Esparza, E; Sirvent-Cerda, S
Introduccion. La vigabatrina (VGB) es un farmaco de primera linea para el tratamiento de espasmos infantiles. Diversos estudios han hallado anomalias en la resonancia magnetica (RM) cerebral, que afectaban particularmente a los ganglios de la base, y especialmente en secuencias de difusion, en lactantes con espasmos que recibian VGB en altas dosis (> 100 mg/kg/dia), y se ha observado la desaparicion de las lesiones tras la retirada de dicho tratamiento. Casos clinicos. Se presentan dos casos clinicos con inicio de una encefalopatia epileptica en el primer año de vida y crisis en forma de espasmos infantiles. Ambos recibieron tratamiento con distintos farmacos, entre ellos VGB hasta dosis de 200 mg/kg/dia. Con 11 y 28 meses de vida, respectivamente, aparecian imagenes en la RM cerebral con una marcada hiperintensidad de señal en secuencias ponderadas en T2 en ambos palidos, talamos, porcion posterior del tronco encefalico y nucleos dentados, que asociaban restriccion en secuencias de difusion. Ambos disponian de estudios previos de RM, sin alteraciones. Tras excluir una metabolopatia subyacente, se decidio la retirada de la VGB y tres meses despues, en una RM de control, se aprecio la total reversibilidad de dichas lesiones. Conclusiones. Deben evaluarse con cautela los hallazgos de la RM cerebral en lactantes que reciban VGB en altas dosis para el tratamiento de espasmos. Su aparente efecto citotoxico sobre los ganglios de la base podria simular metabolopatias/enfermedades mitocondriales. Conocer este efecto de la VGB y sus caracteristicas tipicas en la RM puede evitar pruebas innecesarias, como una biopsia muscular o un nuevo cribado metabolico.
Germline mutations of BRCA1 gene exon 11 are not associated with platinum response neither with survival advantage in patients with primary ovarian cancer: understanding the clinical importance of one of the biggest human exons. A study of the Tumor Bank Ovarian Cancer (TOC) Consortium.
Dimitrova, Desislava; Ruscito, Ilary; Olek, Sven; Richter, Rolf; Hellwag, Alexander; Türbachova, Ivana; Woopen, Hannah; Baron, Udo; Braicu, Elena Ioana; Sehouli, Jalid
Germline mutations in BRCA1 gene have been reported in up to 20 % of epithelial ovarian cancer (EOC) patients. Distinct clinical characteristics have been attributed to this special EOC population. We hypothesized that mutations in different BRCA1 gene exons may differently affect the clinical course of the disease. The aim of this study was to analyze, in a large cohort of primary EOCs, the clinical impact of mutations in BRCA1 gene exon 11, the largest exon of the gene sequence encoding the 60 % of BRCA1 protein. Two hundred sixty-three primary EOC patients, treated between 2000 and 2008 at Charité University Hospital of Berlin, were included. Patients' blood samples were obtained from the Tumor Ovarian Cancer (TOC) Network ( www.toc-network.de ). Direct sequencing of BRCA1 gene exon 11 was performed for each patient to detect mutations. Based on their BRCA1 exon 11 mutational status, patients were compared regarding clinico-pathological variables and survival. Mutations in BRCA1 exon 11 were found in 18 out of 263 patients (6.8 %). Further 10/263 (3.8 %) cases showed variants of uncertain significance (VUS). All exon 11 BRCA1-positive tumors (100 %) were Type 2 ovarian carcinomas (p = 0.05). Age at diagnosis was significantly younger in Type 2 exon 11 mutated patients (p = 0.01). On multivariate analysis, BRCA1 exon 11 mutational status was not found to be an independent predictive factor for optimal cytoreduction, platinum response, or survival. Mutations in BRCA1 gene exon 11 seem to predispose women to exclusively develop a Type 2 ovarian cancer at younger age. Exon 11 BRCA1-mutated EOC patients showed distinct clinico-pathological features but similar clinical outcome with respect to sporadic EOC patients.
Sconfienza, L M; Perrone, N; Delnevo, A; Lacelli, F; Murolo, C; Gandolfo, N; Serafini, G
Sommario INTRODUZIONE: La ricchezza della componente vascolare dei tumori ginecologici influenza le caratteristiche dell'imaging diretto, utilizzando metodiche che evidenziano la componente macrovascolare delle lesioni (color e power Doppler), e di quello indiretto, mediante somministrazione di mezzi di contrasto (MdC) per lo studio del microcircolo e della perfusione interstiziale. Lo scopo di questo lavoro è di valutare l'aggiunta di informazioni diagnostiche fornite dalla valutazione ecografica con MdC nello studio delle lesioni ovariche. MATERIALI E METODI: Abbiamo valutato 72 lesioni annessiali in 61 pazienti con lesioni ovariche di incerta interpretazione mediante somministrazione di 4,8 ml di MdC ecoamplificatore di II generazione. Per ogni lesione, abbiamo valutato la morfologia basale, quella contrastografica e le curve intensità/tempo. RISULTATI: La valutazione post-contrasto confrontata con la basale non ha apportato informazioni aggiuntive morfovascolari in 8 pazienti (13,1%); in 38 pazienti (62,3%) ha apportato informazioni senza modifiche del comportamento clinico; in 15 soggetti (24,6%) ha apportato elementi che hanno modificato il comportamento clinico. Le lesioni maligne presentavano valori di tempo massimo di enhancement significativamente minori (11,9 ± 3,1 s vs 19,8 ± 4,0 s p < 0,01) e intensità di picco massimo significativamente maggiore (24,7 ± 4,2 dB vs 17,8 ± 3,3 dB p < 0,01) rispetto alle lesioni benigne. CONCLUSIONI: La CEUS consente di migliorare la confidenza diagnostica nelle lesioni liquide corpuscolate in cui l'indagine convenzionale non risulta dirimente, proponendosi nella diagnosi differenziale di un limitato numero di lesioni complesse, in alternativa a TC ed RM. Le informazioni ottenute influenzano tuttavia il successivo iter diagnostico e terapeutico in una limitata percentuale di casi (24,6%).
Macale, Loreana; Vellone, Ercole; Scialò, Gennaro; Iossa, Mauro; Cristofori, Elena; Alvaro, Rosaria
Scopo. La valutazione della formazione accademica è diventata fondamentale nell'Unione Europea da quando il Processo di Bologna ha incoraggiato tutte le università europee a raggiungere elevati standard di qualità nella formazione. Anche se diversi studi sono stati condotti sulla qualità della formazione negli studenti di infermieristica, pochi hanno esplorato questa tematica dalla prospettiva degli studenti. Lo scopo di questo studio è stato di descrivere l'esperienza della qualità formativa negli studenti del corso di laurea in infermieristica. Metodo. E’ stato utilizzato il metodo fenomenologico per studiare 55 studenti (età media 24 anni; 73% donne) che frequentavano il corso di laurea in infermieristica in tre università del centro Italia. Risultati. Dall'analisi fenomenologica sono emersi i seguenti cinque temi: 1) Qualità dei docenti: capacità di insegnamento, preparazione, sensibilità per gli studenti, autodisciplina; 2) Integrazione teoria-pratica e comunicazione tra l'insegnamento e l'area clinica; 3) gestione generale e organizzazione del corso; 4) la qualità delle infrastrutture: biblioteche, aule, tecnologie dell'informazione, servizi, amministrazione, comunicazione; e 5) tutorato clinico: umanità, relazioni e capacità del tutor clinico di guidare e supportare lo studente. Conclusione. I risultati di questo studio forniscono una comprensione nuova e più approfondita sul significato della qualità della formazione negli studenti di infermieristica. Gli studenti ritenevano che la qualità della formazione consistesse nella sensibilità dei docenti verso i loro problemi e nell’umanità, capacità interpersonali, guida e supporto dei tutor cli.
Santos-Bueso, Enrique; Serrador-García, Mercedes; Porta-Etessam, Jesús; Rodríguez-Gómez, Octavio; Martínez-de-la-Casa, José M; García-Feijoo, Julián; García-Sánchez, Julián
Introduccion. El sindrome de Charles Bonnet (SCB) es un cuadro clinico que se caracteriza por la presencia de alucinaciones visuales, principalmente complejas, en pacientes con estado cognitivo conservado e importante deterioro de la vision. El incremento del SCB se debe al aumento de la esperanza de vida y al desarrollo de patologias asociadas al envejecimiento, como la degeneracion macular asociada a la edad. Pacientes y metodos. Se estudian las caracteristicas de una serie de 45 pacientes diagnosticados de SCB en la unidad de neurooftalmologia del Hospital Clinico San Carlos. Los pacientes procedian de las unidades de patologia macular, glaucoma, superficie ocular y urgencias, en las que fueron diagnosticados de SCB, que se confirmo en la unidad multidisciplinar formada por oftalmologia, neurologia y psiquiatria del mismo hospital. Resultados. El 66,66% eran mujeres, de mas de 80 anos (68,88%), principalmente con degeneracion macular asociada a la edad (37,77%). Las alucinaciones que los pacientes presentaban con mas frecuencia eran personas y caras (35,55%), en color (66,66%), en movimiento (80%), con un tiempo de evolucion de 6-12 meses (26,66%), frecuencia de tres episodios al dia (35,55%) y de 3-5 minutos de duracion (35,55%). Conclusiones. El SCB es un complejo sindrome cuya incidencia se esta incrementando en nuestras consultas y que precisa un abordaje multidisciplinar entre oftalmologos, neurologos y psiquiatras para evitar diagnosticos erroneos y proporcionar un tratamiento adecuado. Son necesarios nuevos estudios para un conocimiento mas profundo y adecuado del SCB.
Escudero Vilaplana, Belén; Almodóvar Carretón, María José; Herrero Hernández, Silvia
Objetivo: La diabetes mellitus tipo 2 (DM2) es uno de los principales problemas sociosanitarios a nivel mundial, para la que existen multitud de tratamientos. Recientemente, se ha aprobado el primer farmaco de una nueva familia de antidiabeticos orales (ADO): la dapagliflozina. Nuestro objetivo es revisar la evidencia cientifica disponible sobre la dapagliflozina, con el fin de analizar su eficacia, seguridad y coste y poder estimar su papel en la farmacoterapia actual de la DM2. Métodos: La eficacia y seguridad de la dapagliflozina se analizaron mediante una evaluacion de la evidencia cientifica. El coste de los diferentes ADO se calculo en base a sus dosis diarias definidas (DDD) y al precio de venta del laboratorio. Resultados: Se identificaron 7 ensayos clinicos aleatorizados: 2 en monoterapia (840 pacientes) y 5 en terapia combinada con otros antidiabeticos (3184 pacientes). En los 7 ensayos, la dapagliflozina redujo la concentracion de HbA1c; en todos se comparo con placebo, salvo en un estudio en terapia combinada que se comparo frente a farmaco activo (glipizida). Entre los efectos adversos mas frecuentes se detectaron infecciones genitourinarias e hipotension, aunque se debe prestar especial atencion al incremento del cancer de vejiga. Junto con los inhibidores de la DPP-4, la dapagliflozina es uno de los ADO de mayor coste (coste anual de DDD=729,3 euros). Conclusiones: La dapagliflozina no aporta ventajas respecto a la farmacoterapia de la DM2 ya existente. Su falta de experiencia de uso, la ausencia de importantes beneficios clinicos y su elevado coste hacen necesario restringir su utilizacion.
Simoni, F; Vitturi, N; Tagliente, M; Soattin, M; Realdi, G
Sommario INTRODUZIONE: L’ecografia dell’addome sta acquistando un ruolo sempre maggiore nell’iter diagnostico del dolore addominale, tuttavia il suo ruolo nella diagnosi di alcuni importanti quadri di dolore addominale è ancora in corso di studio. Scopo del nostro studio è stato valutare il ruolo dell’ecografia nella diagnosi differenziale di dolore addominale in un reparto di medicina interna. Materiali e metodi: Abbiamo condotto un’analisi retrospettiva di 248 ecografie addominali eseguite per dolore addominale nel nostro centro. Per ogni esame, sono stati registrati i dati inseriti nel modulo di richiesta e i reperti ecografici che potevano essere considerati correlati a dolore addominale. Risultati: In 105 pazienti (42%) l’ecografia dell’addome ha rilevato un reperto ecografico rilevante ed è stata quindi considerata positiva. Un’alta percentuale di pazienti era anziana (>65 anni, 52%) e grande anziana (>80 anni, 24%): questi soggetti avevano percentuale significativamente maggiore di esami ecografici positivi. La percentuale di indagini positive non è risultata significativamente diversa tra quelle eseguite per dolore addominale localizzato e non localizzato. Specifiche localizzazioni di dolore addominale erano associate a determinati reperti ecografici, come masse epatiche, masse ovariche e calcolosi renale, mentre dolore addominale non localizzato era associato a reperti ecografici di versamento liquido addominale e anse intestinali distese da fluido. DISCUSSIONE: Un’alta percentuale di indagini ecografiche ha identificato condizioni che potrebbero causare dolore addominale. Il valore diagnostico dell’ecografia addominale è stato maggiore in pazienti anziani e grandi anziani. Quando viene richiesta un’ecografia addominale, l’esame dovrebbe sempre essere valutato nell’ambito nel contesto clinico. Il clinico dovrebbe essere consapevole della grande potenzialità dell’ecografia addominale nella diagnosi delle diverse cause di
Mallada, J; Perez-Carmona, N; Berenguer-Ruiz, L; Sanchez-Perez, R; Martin-Gonzalez, R; Sola-Martinez, D; Mola, S; Lopez-Arlandis, J M; Vela-Yebra, R; Gabaldon-Torres, L; Freire-Alvarez, E; Garcia-Escriva, A; Sempere, A P
Introduccion. Los estudios postautorizacion son importantes para confirmar si los resultados de los ensayos clinicos se reproducen en la practica clinica habitual. Objetivo. Evaluar la efectividad y seguridad del fingolimod en la practica clinica en la provincia de Alicante. Pacientes y metodos. Estudio multicentrico retrospectivo de pacientes con esclerosis multiple remitente tratados con fingolimod. Se recogen las caracteristicas demograficas, clinicas y farmacologicas. Se describe la efectividad del farmaco –tasa anualizada de brotes (TAB) y porcentaje de pacientes libres de brotes– al año y a los dos años de tratamiento en relacion con el año previo y datos de efectos secundarios. Resultados. Se incluyo a 89 pacientes. El tratamiento previo fue inmunomodulador (interferon beta o acetato de glatiramero) en 54 pacientes y natalizumab en 32. Cincuenta pacientes cambiaron por fracaso con el inmunomodulador y 31 por serologia positiva del virus JC (VJC+). La TAB global disminuyo el 67,3% el primer año (p < 0,0001) y el 84,1% el segundo (p = 0,0078). Disminuyo en los pacientes con fracaso del inmunomodulador (el 85,6% el primer año, p < 0,0001; el 88,9% el segundo año, p = 0,0039) y aumento de forma no significativa en los pacientes VJC+ en el primer año. El porcentaje de pacientes libres de brotes en la poblacion global aumento del 32,6 al 68,1% en el primer año (p < 0,0019) y al 82,6% en el segundo (p = 0,0215). Este aumento no se observo en los pacientes VJC+. Trece pacientes tuvieron efectos secundarios, que obligaron a la retirada del farmaco en dos de ellos. Conclusion. En la practica clinica de la provincia de Alicante, el fingolimod mostro una efectividad y una seguridad ligeramente superiores a las de los ensayos clinicos.
Pias-Peleteiro, L; Pias-Peleteiro, J M; Arias, M
Introduccion. El virus linfotropo humano de celulas T tipo 1 (HTLV-1) es el agente causal de la paraparesia espastica tropical. Su prevalencia, elevada en determinadas areas tropicales, es baja en Europa y Norteamerica. Casos clinicos. Se describen dos casos de paraparesia espastica tropical en varones naturales y residentes en Galicia. Se realizaron estudios analiticos en la sangre y el liquido cefalorraquideo (LCR), examenes neurofisiologicos y resonancia magnetica craneal y medular. En ambos pacientes, la presentacion clinica fue la de una mielopatia cronica, con cuadro torpido y progresivo que evoluciono a paraparesia espastica. Un paciente desarrollo uveitis antes de la clinica neurologica. En los dos casos, el estudio del LCR demostro leve pleocitosis linfoide, ligera hiperproteinorraquia, bandas oligoclonales negativas y anticuerpos anti-HTLV-1 positivos. La reaccion en cadena de la polimerasa para HTLV-1 resulto positiva en ambos casos. La resonancia magnetica raquidea resulto normal en un paciente y mostro en el otro hiperseñal medular dorsal, que desaparecio tras el tratamiento. No se demostraron datos de polineuropatia periferica. Recibieron corticoides e interferon alfa, con leve mejoria y estabilizacion del cuadro clinico. La anamnesis dirigida revelo antecedentes de contactos sexuales de riesgo en regiones endemicas de HTLV-1. Conclusiones. La uveitis asociada a HTLV-1 podria ser predictora de paraparesia espastica tropical. Esta es probablemente una entidad infradiagnosticada (alto porcentaje de portadores asintomaticos, clinica insidiosa y bajo indice de sospecha en areas no endemicas). Debe considerarse su diagnostico en zonas no tropicales que reciben inmigrantes de areas endemicas y tambien en regiones con una tradicional emigracion a regiones tropicales.
Koziel, Dorota; Gluszek, Stanislaw; Osuch, Martyna Gluszek
Negli anni recenti in molti paesi europei si è dimostrata una crescente incidenza della pancreatite acuta (AP), ed alcuni studi indicano un aumento di rischio di AP nei pazienti diabetici. Questo studio è pertanto finalizzato a valutare il decorso clinico della AP nei pazienti diabetici. Sono stati studiati tutti i pazienti curati in reparto chirurgico per una diagnosi di AP identificando come pazienti diabetici quelli che all’anamnesi hanno confermato essere affetti da diabete di tipo 1 o di tipo 2 prima di essere ricoverati per AP. I pazienti ricoverati per AP, ed arruolati nello studio sono stati 963, e tra essi vi erano 87 (9%) diabetici. Tra questi ultimi erano più numerosi quelli portatori di calcolosi biliare quale causa della pancreatite (46% vs 32%). Nella maggioranza dei casi il decorso della AP è stato di gravità moderata, ma comunque nel 10,3% dei pazienti con diabete il decorso della malattia è stato moderatamente grave, e nel 12,7% decisamente grave. Non sono state osservate differenze nella mortalità da AP in entrambi i gruppi. Insufficienza sistemica è stata osservata più frequentemente nel gruppo dei diabetici di tipo 2 (5,4%) e 23,1% in quelli di tipo 2, a fronte del 5,1% dei pazienti non diabetici, con differenze statisticamente non significative. In conclusione l’incidenza della AP nei pazienti diabetici aumenta con l’età, ed è più spesso correlata con la calcolosi biliare. In questo gruppo di pazienti in decorso clinico è èiù frequentemente grave, con insufficienza sistemica nei diabetici di tipo 1.
Paladino, Nunzia Cinzia; Lowery, Aoife; Guérin, Carole; Taïeb, David; Sebag, Frédéric
I feocromocitomi bilaterali sono rari; nella maggior parte dei casi presentano origine ereditaria e sono legati a mutazioni germinali relative ai geni RET, VHL o SDHx, tuttavia in altri casi non viene ritrovata alcuna eziologia. A tal proposito riportiamo il caso clinico di una donna di 76 anni, giunta alla nostra osservazione per malessere generale sopravvenuto in concomitanza di crisi ipertensive responsabili di ospedalizzazione. Il profilo ormonale realizzato in tale occasione, era suggestivo di feocromocitoma (metanefrine plasmatiche ed urinarie 10 volte superiori al range di normalità). Gli esami radiologici (TC e RMN) rivelavano due lesioni surrenaliche bilaterali di diametro rispettivamente a destra di 47 mm ed a sinistra di 26 mm. Mentre la TC definiva le dimensioni di queste lesioni, il loro carattere eterogeneo e la loro ipervascolarizzazione oltre ai rapporti con gli organi adiacenti, la RMN si esprimeva già in favore di feocromocitoma bilaterale. La scintigrafia alla MIBG mostrava una iperfissazione a carico della lesione surrenalica destra mentre sulla surrenale controlaterale evidenziava una fissazione limitata, relativa alla midollare normale. Tenuto conto del forte sospetto di feocromocitoma bilaterale, veniva eseguita una TEP alla 18F-FDOPA che mostrava un intenso ipermetabolismo a carico della massa surrenalica destra, mentre controlateralmente una fissazione simile a quella del fegato e pertanto non sospetta, nonostante molti studi sostengano una sensibilità uguale o addirittura superiore della TEP alla 18-FDOPA rispetto alla scintigrafia MIBG nei pazienti con feocromocitoma o paraganglioma. In un primo tempo veniva eseguita una surrenalectomia destra per via laparoscopica. In fase post-operatoria, in seguito alla constatazione del persistente incremento delle metanefrine plasmatiche ed urinarie, veniva realizzata una TEP alla 18 FDG che confermava la presenza di un’area di ipermetabolismo intenso a carico della lesione surrenalica sinistra
Patel, Pankaj R; Dave, Bharat R; Deliwala, Ujjval H; Krishnan, Ajay
Background: Magnetic resonance myelography (MRM) after lumbar discectomy is all too often an unrewarding challenge. A constellation of findings are inevitable, and determining their significance is often difficult. MRM is a noninvasive technique that can provide anatomical information about the subarachnoid space. Until now, there is no study reported in literature showing any clinico-radiological correlation of post operative MRM. The objective of this study was to prospectively evaluate the diagnostic effectiveness of MRM for the demonstration of decompression in operated discectomy patients and its correlation with subjective and objective outcome (pain and SLR) in immediate postoperative period. Materials and Methods: Fifty three patients of single level lumbar disc herniation (LDH) justifying the inclusion criteria were operated for discectomy. All patients underwent MRM on second/third postoperative day. The pain relief and straight leg raise sign improvement was correlated with the postoperative MRM images to group the patients into: A- Subjective Pain relief, SLR improved and MRM image showing myelo regression; B- Subjective Pain relief, SLR improved and MRM image showing no myelo regression; C- No Subjective Pain relief, no SLR improved and MRM image showing myelo regression and; D- No Subjective Pain relief, no SLR improved and MRM image showing no myelo regression. Results: The result showed that Group A had 46 while Group B, C and Group D had 4, 2 and one patients respectively. Clinico-radiological correlation (Clinically diagnosed patient and findings with MRM correlation) was present in 47 patients (88.68%) which includes both A and D groups. The MRM specificity and sensitivity were 92% and 33.33% respectively. Conclusion: MRM is a non-invasive, efficient and reliable tool in confirming postoperative decompression in lumbar discectomy patients, especially when economic factors are to be considered and the required expertise to reliably read a complex
Liu, Wen-Lou; Wang, Lin-Wei; Chen, Jia-Mei; Yuan, Jing-Ping; Xiang, Qing-Ming; Yang, Gui-Fang; Qu, Ai-Ping; Liu, Juan; Li, Yan
Multispectral imaging (MSI) based on imaging and spectroscopy, as relatively novel to the field of histopathology, has been used in biomedical multidisciplinary researches. We analyzed and compared the utility of multispectral (MS) versus conventional red-green-blue (RGB) images for immunohistochemistry (IHC) staining to explore the advantages of MSI in clinical-pathological diagnosis. The MS images acquired of IHC-stained membranous marker human epidermal growth factor receptor 2 (HER2), cytoplasmic marker cytokeratin5/6 (CK5/6), and nuclear marker estrogen receptor (ER) have higher resolution, stronger contrast, and more accurate segmentation than the RGB images. The total signal optical density (OD) values for each biomarker were higher in MS images than in RGB images (all P < 0.05). Moreover, receiver operator characteristic (ROC) analysis revealed that a greater area under the curve (AUC), higher sensitivity, and specificity in evaluation of HER2 gene were achieved by MS images (AUC = 0.91, 89.1 %, 83.2 %) than RGB images (AUC = 0.87, 84.5, and 81.8 %). There was no significant difference between quantitative results of RGB images and clinico-pathological characteristics (P > 0.05). However, by quantifying MS images, the total signal OD values of HER2 positive expression were correlated with lymph node status and histological grades (P = 0.02 and 0.04). Additionally, the consistency test results indicated the inter-observer agreement was more robust in MS images for HER2 (inter-class correlation coefficient (ICC) = 0.95, r s = 0.94), CK5/6 (ICC = 0.90, r s = 0.88), and ER (ICC = 0.94, r s = 0.94) (all P < 0.001) than that in RGB images for HER2 (ICC = 0.91, r s = 0.89), CK5/6 (ICC = 0.85, r s = 0.84), and ER (ICC = 0.90, r s = 0.89) (all P < 0.001). Our results suggest that the application of MS images in quantitative IHC analysis could obtain higher accuracy, reliability, and more
Milara, Javier; Outeda-Macias, Maria; Aumente-Rubio, M Dolores; Más-Serrano, Patricio; Aldaz, Azucena; Calvo, M Victoria; García-Simón, M Sergia; Martin-Barbero, Marisa; Padullés-Zamora, Núria; Schoenenberger, Juan Antonio; Saavedra-Aldrich, Marianne; Tévar-Alfonso, Enrique; Saval, Ana; Pastor-Clerigues, Alfonso; García, Marta; Margusino-Framiñan, Luis; Montero-Alvarez, Jose Luis; Merino, Esperanza; Herrero, Jose Ignacio; Beunza, Mónica; Conesa-Zamora, Pablo; Gimenez-Manzorro, Alvaro; Comas-Sugrañes, Dolors; Cano-Marron, Manuel; Jiménez-Mutiloa, Elena; Díaz-Ruíz, Pilar; Cortijo, Julio
Objetivo: El interferon-pegilado (IFN-PEG) junto a ribavirina ha sido el principal tratamiento de la infeccion por el virus de la hepatitis C (VHC) de la ultima decada. Los agentes antivirales de accion directa actuales han mejorado los resultados de la terapia, pero tambien han aumentado el costo y la gestion de la complejidad del tratamiento. El presente estudio analiza factores geneticos de los pacientes, asi como predictores virales y clinicos de respuesta sostenida viral (RSV) al tratamiento con IFN-PEG y ribavirina en poblacion Espanola. Métodos: Estudio farmacogenetico, multicentrico, prospectivo, observacional de cohortes realizado en 12 hospitales diferentes de 12 comunidades autonomas diferentes. Se incluyeron un total de 98 pacientes con RVS y 106 sin SVR al tratamiento con IFNPEG y ribavirina. Se seleccionaron 33 polimorfismos de nucleotido unico ubicados en 24 genes diferentes relacionados con la respuesta inflamatoria, inmunologica y viral. Los datos clinicos y virales tambien se analizaron como candidatos predictores de RVS. Resultados: Los genotipos IL-28B (rs12979860, rs7248668, rs8105790, rs8099917) y TNFRSF1B (rs1061622), asi como los haplotipos TNFRSF1B / IL-10 / TNF(-308) no-TTG y TNFRSF1B / IL-10 / IL-4 no-TTC junto con la menor edad, menor carga de ARN-VHC basal, valores elevados de colesterol LDL en suero basal, genotipos VHC2 y 3 y bajo grado de fibrosis basal (0-2) se asociaron con una RVS en el analisis univariante. Los predictores independientes de RVS en el analisis multivariante fueron el genotipo IL-28B rs12979860 CC, el haplotipo TNFRSF1B / IL-10 / IL-4 no-TTC junto con los bajos niveles basales de VHCARN y los genotipos virales VHC2 y 3. Conclusiones: El genotipo IL-28B rs12979860 CC, el haplotipo TNFRSF1B / IL-10 / IL-4 haplotipos no-TTC, la carga viral basal baja y los genotipos del VHC2 y 3 pueden ayudar a predecir una buena respuesta a la terapia con IFN-PEG y ribavirina en poblacion espanola.
Chowdhury, Joyeeta; Datta, Pijush Kanti; Chowdhury, Satyendra Nath; Das, Nilay Kanti
Background: Pemphigus is a group of chronic autoimmune vesico-bullous disorders in which the epidermis and the basement membrane zone are the focus of attack resulting in cutaneous and mucosal blister formation. Direct immunofluorescence (DIF) test is a very sensitive test for the diagnosis Aim: To study the clinico histopathological patterns of pemphigus in eastern India. The study also aims to correlate DIF with clinical and histologic findings as well as severity of skin involvement [scoring systems]. Materials and Methods: Total 41 patients were studied over a period of 1 year in the Post-graduate centre of Dermatology in Eastern India. DIF, histopathology and clinical data were correlated. Results: In our study Pemphigus vulgaris (PV) was the predominant type with 32 cases followed by 8 cases of pemphigus foliaceus (PF) and a single case of IgA pemphigus. Mean age at presentation was late middle age. Majority of the patients, 26 (63.41%) initially had cutaneous involvement followed by mucosal involvement. In this study group 36 (87.80%) patients showed acantholytic cells on histopathological examination. Most patients of PV showed suprabasal blister 20 (62.50%) followed by intraspinous 5 (15.62%) and subcorneal 5 (15.62%) blister. In majority 28 (87.50%) of the PV patients IgG and C3 antibodies were deposited throughout the epidermis. The strength of antibody positivity was strong in most of the patients (71.87%). In cases of PF mostly IgG 6 (75%) antibodies were deposited in the upper epidermis. DIF intensity had poor correlation with disease activity/severity except in PF. Conclusion: Almost 85.36% cases of pemphigus were diagnosed clinicopathologically. But 6 cases couldn’t be diagnosed accurately on clinicopathological basis and in them DIF was confirmatory. Two cases of pure mucosal PV and 1 case of IgA pemphigus was confirmed by DIF. Two cases of bullous pemphigoid clinico-histologically mimicking PV were also excluded by DIF. So it appears from our
Farouk, Omar; Ebrahim, Mohamed A; Senbel, Ahmad; Emarah, Ziad; Abozeed, Waleed; Seisa, Mohamed O; Mackisack, Summer; Abdel Jalil, Salah; Abdelhady, Safaa
Background Breast cancer in very young patients represents a unique issue that needs more attention as the number of cases is increasing and it has special characteristics at presentation, diagnosis, and biologic behaviors which reflect on both treatment strategies and survival. The aim of the current study was to analyze and report the clinico-pathological characteristics and treatment procedures used for breast cancer in very young patients over the last decade in a single Egyptian cancer center. Patients and methods A retrospective study was conducted in the Oncology Center – Mansoura University, where the data of all breast cancer patients, between September 2006 and August 2015, were reviewed. Among 4,628 patients who were diagnosed with breast cancer during this period, only 300 patients aged ≤35 years had complete registry data. Clinico-pathological characteristics, therapeutic procedures, and survival outcome were reported. Results Three hundred and seventy-nine patients (8.19%) were aged ≤35 years at the time of presentation. The age ranged between 21 and 35 years, and the mean age was 31 years (±3 standard deviation). Positive family history of breast cancer was found in 12.3%, and metastatic presentation was seen in 4.7%. The rate of axillary lymph nodes involvement was 75.7%. The estrogen receptor-negative disease was found in 51%, and among 217 patients who did HER2 test, 82 patients (37.8%) were HER2 positive, while triple-negative subtype was found in 57 patients (26.4%). Ki 67 percentage ranged between 3% and 66% (median was 35%). The median disease-free survival was 61 months (95% confidence interval 44–78 months); the 3-year and 5-year disease-free survival were 58% and 50%, respectively. The 3-year and 5-year overall survival were 88% and 68%, respectively. Conclusion Very young Egyptian patients with breast cancer should be given focus and specially studied as the presentation has more aggressive biologic behavior at advanced stages, so
The Schnitzler syndrome is a rare and underdiagnosed entity which is considered today as being a paradigm of an acquired/late onset auto-inflammatory disease. It associates a chronic urticarial skin rash, corresponding from the clinico-pathological viewpoint to a neutrophilic urticarial dermatosis, a monoclonal IgM component and at least 2 of the following signs: fever, joint and/or bone pain, enlarged lymph nodes, spleen and/or liver, increased ESR, increased neutrophil count, abnormal bone imaging findings. It is a chronic disease with only one known case of spontaneous remission. Except of the severe alteration of quality of life related mainly to the rash, fever and pain, complications include severe inflammatory anemia and AA amyloidosis. About 20% of patients will develop a lymphoproliferative disorder, mainly Waldenström disease and lymphoma, a percentage close to other patients with IgM MGUS. It was exceedingly difficult to treat patients with this syndrome until the IL-1 receptor antagonist anakinra became available. Anakinra allows a complete control of all signs within hours after the first injection, but patients need continuous treatment with daily injections. In many aspects, the Schnitzler syndrome resembles the genetically determined auto-inflammatory syndromes involving activating mutations of the NLRP3 inflammasome. This latter point and its consequences will be addressed. PMID:21143856
Carter, Melody C; Metcalfe, Dean D; Clark, Alicia S; Wayne, Alan S; Maric, Irina
The diagnostic criteria for paediatric mastocytosis are largely based on adult studies and bone marrow findings are not well described in children. We evaluated use of the World Health Organization (WHO) criteria for the diagnosis of systemic disease in paediatric mastocytosis. In addition, we identified unique clinico-histopathological features within the biopsies. One hundred and thirteen children with paediatric mastocytosis were evaluated at the National Institutes of Health between 1986 and 2013. Complete bone marrow evaluations were performed in 50 cases. Seven children had repeat procedures. Bone marrows were analysed by histopathology, flow cytometry and for KIT D816V. Bone marrow biopsies displayed mild atypical haematopoietic maturation, increased haematogones and hypocellularity in a sub-set of patients with urticaria pigmentosa, diffuse cutaneous mastocytosis and indolent systemic mastocytosis. Hypocellularity was most pronounced in those with urticaria pigmentosa. Haematogones were highest, on average, in patients with diffuse cutaneous mastocytosis or mastocytomas. There was no evidence of peripheral blood cytopenias, myelodysplastic syndrome, myeloproliferative neoplasm or leukaemia within this cohort. The WHO criteria are applicable for the diagnosis of systemic mastocytosis in paediatrics. Although unsuspected bone marrow findings typically seen in myeloproliferative disorders are frequent in paediatric mastocytosis, patients within this study remained clinically stable without progression to a more aggressive variant.
Elizagaray-Garcia, Ignacio; Muriente-Gonzalez, Jorge; Gil-Martinez, Alfonso
Objetivo. Analizar la efectividad de la educacion al paciente con fibromialgia sobre el dolor, calidad de vida y funcionalidad. Sujetos y metodos. La busqueda de articulos se realizo utilizando bases de datos electronicas. Los criterios de inclusion fueron: estudios clinicos aleatorizados y controlados (ECA), realizados en pacientes con fibromialgia, donde la intervencion terapeutica se basara en la educacion al paciente, y publicados en ingles y castellano. Dos revisores independientes analizaron la calidad metodologica utilizando la escala PEDro. Resultados. Se seleccionaron cinco ECA, de los cuales cuatro presentaron una calidad metodologica buena. En tres de los estudios, la educacion al paciente, en combinacion con otra intervencion basada en ejercicio terapeutico, mejoro los resultados en las variables que evaluaron el dolor y la calidad de vida en comparacion con las mismas intervenciones realizadas por separado. Ademas, un ECA de buena calidad metodologica mostro que la educacion al paciente activo vias neurales inhibitorias descendentes del dolor. El analisis cualitativo muestra evidencia fuerte-moderada acerca de que la educacion al paciente, en combinacion con otras intervenciones de ejercicio terapeutico, ofrece resultados positivos en las variables de dolor, calidad de vida y funcionalidad. Conclusiones. La educacion al paciente por si sola no ha mostrado ser efectiva sobre el dolor, la calidad de vida ni la funcionalidad en pacientes con fibromialgia. Existe evidencia fuerte de la efectividad de la combinacion de educacion al paciente con ejercicio y estrategias activas de afrontamiento sobre el dolor, la calidad de vida y la funcionalidad a corto, medio y largo plazo en pacientes con fibromialgia.
Sánchez-Cruz, Gilberto; Milián-Rodríguez, Lismary
Introduccion. Las celulas madre constituyen una alternativa terapeutica que se encuentra en fase de experimentacion para el infarto cerebral. Objetivo. Mostrar la evidencia cientifica existente sobre el potencial terapeutico de las celulas madre de la medula osea en esta enfermedad. Desarrollo. El infarto cerebral representa el 80% de las enfermedades cerebrovasculares. La trombolisis constituye la unica terapia aprobada, pero, por su estrecha ventana terapeutica, solo se aplica a un bajo porcentaje de los pacientes. De manera alternativa, los tratamientos neurorrestauradores, como el de celulas madre, pueden aplicarse en periodos mas prolongados. Por esta razon se efectuo una busqueda bibliografica en PubMed con el empleo de las palabras clave 'stem cells', 'bone marrow derived mononuclear cells' y 'stroke'. Se encontraron evidencias de seguridad y eficacia de dichas celulas en diferentes momentos evolutivos del infarto cerebral. Se identificaron estudios que en clinica y preclinica las recolectaron por puncion medular y en sangre periferica, y las trasplantaron directamente en el area infartada o por via intravascular. El efecto terapeutico se relaciona con sus propiedades de plasticidad celular y liberacion de factores troficos. Conclusiones. El concentrado de celulas mononucleares autologas, obtenido en sangre periferica o por puncion de la medula osea, y trasplantado por via intravenosa, es una factible opcion metodologica que permitira rapidamente incrementar el numero de ensayos clinicos en diferentes etapas evolutivas del infarto cerebral. Esta terapia muestra seguridad y eficacia; sin embargo, deben ampliarse las evidencias que avalen su generalizacion en humanos.
Ruiz-Granados, Velvet J; Márquez-Romero, Juan M
Objetivo. Determinar la frecuencia de acidosis metabolica y sus factores relacionados en pacientes tratados con topiramato solo o como adyuvante para el tratamiento de epilepsia. Pacientes y metodos. Analisis transversal de la gasometria arterial de pacientes epilepticos que recibieron topiramato durante 2010 en la clinica de epilepsia del Centro Medico Nacional 20 de Noviembre en Mexico. Se registraron datos clinicos concernientes a la epilepsia y su tratamiento, asi como de los sintomas comunes de acidosis metabolica. Resultados. Se estudiaron 32 adultos con epilepsia, quienes recibieron topiramato en monoterapia o en combinacion por lo menos durante un mes. Se encontro acidosis metabolica en todos los pacientes (HCO3 < 22 Eq/L); nueve tomaron solo topiramato y 23 tomaron por lo menos dos farmacos antiepilepticos (FAE). Todos los pacientes fueron asintomaticos. No se encontro correlacion entre los niveles de bicarbonato y la dosis del medicamento o la duracion del tratamiento. La dosis fue significativamente mayor en el grupo de monoterapia y el nivel de bicarbonato fue mas bajo en los pacientes que tomaban mas de un FAE. Conclusiones. El uso concomitante de FAE incrementa los efectos conocidos del topiramato sobre los niveles sericos de bicarbonato y la presencia de acidosis metabolica; estos efectos parecen ser independientes del numero de FAE utilizados.
Martinez-Ricarte, F; Martinez-Saez, E; Cicuendez, M; Cordero, E; Auger, C; Toledo, M; Radoi, A; Sahuquillo, J
Introduccion. Los gangliogliomas son tumores raros que afectan a pacientes jovenes, aparecen predominantemente en el lobulo temporal y suelen comenzar con crisis epilepticas. Histologicamente corresponden a un grado I de malignidad, con una forma anaplasica catalogada como de grado III en la clasificacion de la Organizacion Mundial de la Salud (OMS) de 2007. Sin embargo, existen tumores que no cumplen criterios de uno u otro grado y que presentan claras diferencias pronosticas respecto a los de grado I. Estos tumores corresponderian a gangliogliomas atipicos (grado II), no contemplados en la citada clasificacion. Desde el punto de vista molecular, la alteracion mas conocida en los gangliogliomas es la mutacion de BRAF V600E, que confiere peor pronostico a la lesion. La posibilidad de utilizar tratamientos dirigidos a esta proteina mutada otorga una especial relevancia a esta alteracion. Caso clinico. Varon de 21 años, intervenido de un ganglioglioma en dos ocasiones, en el que el examen neuropatologico objetivo caracteristicas histologicas compatibles con un grado de malignidad intermedio (grado II) con mutacion positiva a BRAF. Conclusiones. El caso presentado, junto con los descritos previamente en la bibliografia, reabre las controversias sobre la definicion de los gangliogliomas en la clasificacion de la OMS de 2007, y apoya el hecho de que la proxima clasificacion de la OMS deberia volver a incluir los gangliogliomas atipicos (grado II) e integrar posibles mutaciones geneticas y alteraciones moleculares.
Aransay-Garcia, A; Villarejo-Ortega, F J
Introduccion. Los pacientes con craneosinostosis complejas o unisuturales presentan frecuentemente malformacion de Chiari y siringomielia. El tratamiento quirurgico de la siringomielia en estos pacientes es controvertido. Caso clinico. Niña de 3 años con craneosinostosis compleja no corregida quirurgicamente. Permanecio asintomatica a pesar de que en la resonancia magnetica craneal se evidencio una malformacion de Chiari y un año despues desarrollo una siringomielia cervicodorsolumbar. Se le realizo una craniectomia suboccipital descompresiva, pero posteriormente sufrio un empeoramiento de la siringomielia. El registro de presion intracraneal resulto patologico, por lo que se decidio realizar una craneotomia descompresiva frontoparietotemporal bilateral y remodelacion de la boveda craneal, con lo que se consiguio una disminucion significativa de la siringomielia. Conclusiones. Tras la revision de la bibliografia, se observa que actualmente no existe un consenso sobre el tratamiento de la siringomielia en los pacientes con craneosinostosis y malformacion de Chiari. Algunos autores recomiendan la simultanea descompresion quirurgica suboccipital y de la boveda craneal, otros solo la descompresion de la boveda craneal, y otros la ampliacion de la fosa posterior con distractores. En los casos en los que se realizo primero la descompresion suboccipital no se consiguio resolver ni estabilizar la siringomielia. Concluimos que el tratamiento mas eficaz para los pacientes con siringomielia y craneosinostosis es la remodelacion descompresiva de la boveda craneal, ya que el principal factor causante de la siringomielia es la hipertension intracraneal y la falta de distensibilidad del craneo.
Papi, Simona; Pecchini, Francesca; Gelmini, Roberta
L’appendicite del moncone rappresenta una rara ma importante complicanza che può fare seguito a un intervento di appendicectomia, sia laparoscopica che laparotomica, e rappresenta un’eventualità nosologica da tenere presente, e da includere nella diagnosi differenziale dell’addome acuto di un paziente già appendicectomizzato. I casi riportati in letteratura non sono numerosi, probabilmente però come risultato di una sottostima. Il caso clinico riportato riguarda un uomo di 43 anni operato tre mesi prima di appendicectomia laparoscopica e ricoverato con un tipico caso di addome acuto. L’ecografia si è dimostrata non efficace per la diagnosi, mentre la TC ha definito con sufficiente chiarezza la situazione, ponendo l’indicazione ad una laparotomia esplorativa, nel corso della quale si è proceduto all’asportazione del residuo appendicolare. L’esame istologico ha poi in seguito confermato la diagnosi di appendicite acuta perforata del moncone. A conclusione si è proceduto ad un’analisi di 87 casi analoghi presenti nella letteratura di lingua Inglese per evidenziare le caratteristiche anatomo-chirurgiche ed anatomo- patologiche dei diversi casi, e l’esperienza diagnostica nella definizione del singolo caso. Si conclude con i suggerimenti tecnici per prevenire l’evenienza di tali “appendiciti” ricorrenti sia con la tecnica laparoscopica che laparotomica, e stimolando la consapevolezza di tale eventualità.
Ramírez-Zamora, Mauricio; Ortez-González, Carlos Ignacio
Introduccion. La hemiplejia alternante de la infancia (HAI) es una enfermedad rara, caracterizada por episodios repetidos de hemiplejia que afectan alternativamente a un hemicuerpo, son de inicio preferente antes de los 18 meses, duran de minutos a varios dias, e incluso pueden dejar tetraplejico durante un tiempo al lactante, si antes de que se acabe un episodio comienza otro o si estos ocurren de manera simultanea. La descripcion clinica incluye, ademas de estos ataques plejicos, otras manifestaciones paroxisticas presentes practicamente en todos los niños diagnosticados de este trastorno y que son, ademas, de aparicion mas precoz. Consisten en ataques tonicos, ataques distonicos, movimientos oculares anormales y trastornos autonomicos. El hecho de que estos sintomas precedan a la clinica tipica provoca en bastantes ocasiones un retraso en el diagnostico definitivo. Caso clinico. Varon de un año y nueve meses que inicia clinica de crisis tonicas a las dos semanas de vida, posteriormente episodios de hemiplejia que se manifiestan de forma alternante a los 11 meses de vida, y ademas presenta retraso psicomotor global. Al principio de los sintomas se diagnostico epilepsia, no respondio a multiples farmacos antiepilepticos, y el electroencefalograma, la neuroimagen y las pruebas complementarias en sangre y orina fueron normales/negativos. Presento respuesta favorable a la flunaricina. Conclusion. Es el primer paciente descrito de HAI en El Salvador. El diagnostico precoz y acertado de HAI es fundamental para iniciar farmacoterapia y mejorar el pronostico y calidad de vida de los pacientes y sus familias.
Delgado-Fernandez, Juan; Penanes, Juan R; Torres, Cristina V; Gordillo-Velez, Carlos H; Manzanares-Soler, Rafael; Sola, Rafael G
Introduccion. Los angioleiomiomas intracraneales son lesiones muy poco frecuentes. Solo se han descrito 22 casos en la bibliografia hasta la actualidad, unicamente tres de ellos de localizacion infratentorial. Caso clinico. Varon de 43 años con un angioleiomioma infratentorial descubierto de forma incidental tras la realizacion de una tomografia computarizada por hipoacusia. La resonancia magnetica mostro una tumoracion de 1,4 cm, descrita inicialmente como un meningioma, con un realce progresivo tras la administracion de gadolinio, un aumento del coeficiente de difusion aparente y un descenso generalizado de metabolitos en la espectroscopia. La lesion se reseco quirurgicamente mediante un abordaje suboccipital con buena evolucion y sin complicaciones postoperatorias. En el estudio histologico, la lesion presentaba un abundante componente vascular, y en la tincion inmunohistoquimica era positiva para actina y caldesmona. Dos años despues de la cirugia, el paciente no presentaba recurrencia en la resonancia magnetica de control. Conclusion. El diagnostico de los angioleiomiomas puede ser complejo, pero algunas de sus caracteristicas radiologicas pueden facilitarlo. Los angioleiomiomas son tumores benignos asociados con un resultado funcional favorable tras su reseccion completa, que en nuestro caso no presento un alto riesgo de sangrado.
Martí, Glòria; Río, Jordi; Rovira, Àlex; Auger, Cristina; Tintoré, Mar; Sastre-Garriga, Jaume; Vidal, Anka; Castilló, Joaquín; Montalban, Xavier
Introduccion. El natalizumab es un farmaco utilizado en la esclerosis multiple (EM), cuyo principal efecto adverso es el desarrollo de una leucoencefalopatia multifocal progresiva (LMP). Como esta es potencialmente mortal o discapacitante, el tratamiento debe suspenderse inmediatamente ante su sospecha, teniendo en cuenta el posible desarrollo posterior de un sindrome de reconstitucion inmune o rebrote de la EM. Caso clinico. Se describe un caso de LMP, inicialmente asintomatico, en el contexto del tratamiento con natalizumab en una paciente con EM. Como factores de riesgo se determinaron titulos altos de anticuerpos contra el virus John Cunningham (VJC) y mas de dos años de tratamiento. La reaccion en cadena de la polimerasa para el VJC en el liquido cefalorraquideo resulto negativa en dos determinaciones. El periodo entre el diagnostico radiologico y el inicio de la clinica fue de dos meses. Durante el curso de la enfermedad, la paciente desarrollo un sindrome inflamatorio de reconstitucion inmune y rebrotes de su EM. Presento una buena respuesta tras el inicio de tratamiento con fingolimod, una vez estabilizada la LMP. Conclusion. Este caso ilustra la importancia de una estrecha vigilancia clinicorradiologica en pacientes con EM tratados con natalizumab, sobre todo cuando presentan factores de riesgo para el desarrollo de LMP, asi como su potencial incidencia en la supervivencia y estado funcional final.
Filippín, Federico A; Alfonso, Alejandra; López-Presas, Héctor
Introduccion. La enfermedad celiaca es una enteropatia inducida por el gluten por mecanismos inmunes, que puede presentar afectacion sistemica y producir un amplio espectro de manifestaciones neurologicas, que van desde polineuropatia periferica, ataxia, epilepsia y migraña hasta encefalitis. El objetivo es informar de un caso de posible encefalitis refractaria por enfermedad celiaca. Caso clinico. Varon de 45 años con diagnostico histopatologico de enfermedad celiaca y anticuerpos anticeliaquia negativos que intercurre con encefalitis, manifestaciones del tronco encefalico y del sistema nervioso periferico, entre las que se incluyen deterioro cognitivo y convulsiones, diplopia y ataxia, y polirradiculopatia y polineuropatia, respectivamente; liquido cefalorraquideo inflamatorio y multiples lesiones corticosubcorticales supratentoriales y en el tronco encefalico con leve realce con contraste. Los deficits neurologicos progresan a pesar de una dieta libre de gluten y el tratamiento farmacologico inmunosupresor. Durante el curso de la enfermedad se estudian patologias con afectacion simultanea intestinal y del sistema nervioso, como sarcoidosis, lupus eritematoso sistemico, enfermedad de Sjogren, sindrome paraneoplasico, sida, enfermedad de Whipple y deficit de vitamina B12. Conclusion. La encefalitis es una manifestacion clinica infrecuente en la enfermedad celiaca, con pocos casos notificados a pesar de la alta prevalencia de la enfermedad. Los diagnosticos diferenciales son dificiles y exigen una alta sospecha diagnostica, por lo que es un reto terapeutico.
Blanco-Martin, E; Del Mazo-Sanchez, S; Molano-Salazar, A; Bereincua-Gandarias, R; Llorens-Abando, V; Fernandez-Martinez, M
Introduccion. Las lesiones vasculares talamicas que se comportan como ictus estrategicos pueden causar amnesia, disfunciones ejecutivas o disfasia, asi como sintomas comportamentales o psicologicos, y causar una demencia vascular. Caso clinico. Mujer de 58 años, hipertensa y dislipidemica, que, tras una hemorragia talamica izquierda que evoluciono radiologicamente de manera favorable, presento un sindrome amnesico grave y otras alteraciones sutiles en la orientacion y el lenguaje, dificultades en el manejo del dinero y sintomas depresivos que precisaron tratamiento ansiolitico y antidepresivo, todo lo cual fue causa de limitaciones para el normal desempeño de su trabajo. Seguida en la consulta de neurologia, se le practico una tomografia por emision de positrones/tomografia axial computarizada con 18F-2-fluoro-2-desoxi-D-glucosa, donde se aprecio un hipometabolismo en el talamo izquierdo y, ademas, en la region frontal inferior ipsilateral, que se explicaria mediante el fenomeno de diasquisis. Conclusiones. El fenomeno de diasquisis es un hallazgo de neuroimagen y fisiopatologico por el cual los ictus talamicos o de los ganglios basales causan hipoperfusion/hipometabolismo en la corteza ipsilateral o contralateral, y que puede explicar sintomas a distancia corticales. El presente caso evidencia la presencia de conexiones talamocorticales, lo cual ayuda a comprender los circuitos de la memoria y a explicar la asociacion en el de otros sintomas corticales, como la disfasia o las alteraciones ejecutivas.
Kumar, Smriti Nanda; Mani, Uliyar Vitaldas; Mani, Indirani
Diabetes mellitus is a complex metabolic disorder characterized by chronic hyperglycemia, and associated with long-term damage and dysfunction of various organs. Management of diabetes is therefore vital and involves maintaining euglycemia as much as possible by reducing blood glucose and by increasing insulin sensitivity and peripheral glucose uptake. Ayurveda has promoted the management of diabetes by regulating carbohydrate metabolism using several medicinal herbs, one of which is Gymnema sylvestre (GS). GS has been used in parts of India as a hypoglycemic agent and the results have been encouraging. Accordingly, we planned a quasi-experimental study to investigate the efficacy of the herb among type 2 diabetics. Patients enrolled from free-living population were purposively assigned to experimental or control groups, based on their willingness to participate in the study. The experimental group was supplemented with 500 mg of the herb per day for a period of 3 months, and the efficacy of the herb was assessed through a battery of clinical and biochemical tests. Supplementation of the diet with GS reduced polyphagia, fatigue, blood glucose (fasting and post-prandial), and glycated hemoglobin and there was a favorable shift in lipid profiles and in other clinico-biochemical tests. These findings suggest a beneficial effect of GS in the management of diabetes mellitus.
Hinojosa-Mateo, C M; Reche-Sainz, J A; Hernandez-Nunez, A; Ramos-Lopez, M; Arpa-Fernandez, A; Natera-de Benito, D
Introduccion. La neurofibromatosis de tipo 2 (NF2) es un trastorno neuroectodermico con patron de herencia autosomico dominante que condiciona una predisposicion para desarrollar tumores de varios tipos en el sistema nervioso central y periferico. Se asocia tambien con alteraciones oculares y cutaneas. Caso clinico. Varon de 12 años con diagnostico de NF2 de acuerdo con los criterios de Baser et al e inicio en la infancia. Se realiza una revision bibliografica sobre la evolucion de los criterios diagnosticos en los niños. Conclusiones. El modo de presentacion de la NF2 en la infancia difiere de la presentacion en los adultos. Las manifestaciones iniciales de NF2 en los niños son las alteraciones oculares y cutaneas, no las auditivas. La clinica de inicio mas frecuente en la edad pediatrica es la triada de cataratas subcapsulares posteriores, lesiones intracutaneas en forma de placa o tumores nodulares subcutaneos, y sintomas neurologicos secundarios a la afectacion de pares craneales distintos al VIII par, tronco encefalico o medula espinal. Debido a que los criterios diagnosticos de NF2 son menos sensibles en los pacientes pediatricos, los niños con cataratas congenitas o de aparicion precoz y manifestaciones cutaneas tipicas de NF2 deben ser seguidos estrechamente.
Li, Chunrong; Wu, Xiujuan; Qi, Hehe; Cheng, Yanwei; Zhang, Bing; Zhou, Hongwei; Lv, Xiaohong; Liu, Kangding; Zhang, Hong-Liang
Abstract Background: Reversible splenial lesion syndrome (RESLES) is a rare clinico-radiological disorder with unclear pathophysiology. Clinically, RESLES is defined as reversible isolated splenial lesions in the corpus callosum, which can be readily identified by magnetic resonance imaging (MRI) and usually resolve completely over a period of time. RESLES could be typically triggered by infection, antiepileptic drugs (AEDs), poisoning, etc. More factors are increasingly recognized. Methods and results: We reported herein an 18-year-old female patient with lobar pneumonia who developed mental abnormalities during hospitalization. An isolated splenial lesion in the corpus callosum was found by head MRI and the lesion disappeared 15 days later. Based on her clinical manifestations and radiological findings, she was diagnosed with lobar pneumonia associated RESLES. We further summarize the up-to-date knowledge about the etiology, possible pathogenesis, clinical manifestations, radiological features, treatment, and prognosis of RESLES. Conclusion: This report contributes to the clinical understanding of RESLES which may present with mental abnormalities after infection. The characteristic imaging of reversible isolated splenial lesions in the corpus callosum was confirmed in this report. The clinical manifestations and lesions on MRI could disappear naturally after 1 month without special treatment. PMID:27684805
Ruiz-Sánchez de León, José M; Pedrero-Pérez, Eduardo J; Gálvez, S; Fernández-Méndez, Laura M; Lozoya-Delgado, Paz
Introduccion. Las alteraciones cognitivas, emocionales y comportamentales secundarias al daño cerebral adquirido y las demencias degenerativas pueden valorarse cuantitativa y cualitativamente mediante la administracion de autoinformes que interroguen –a pacientes e informadores fiables– sobre las dificultades de los pacientes en la vida cotidiana. Sujetos y metodos. Se administro el inventario de sintomas prefrontales (ISP) y el cuestionario de fallos de memoria en la vida cotidiana modificado (MFE-30) a 174 participantes emparejados: 87 pacientes con daño cerebral o demencias degenerativas y sus 87 informadores fiables. Se exploro, junto con la bondad psicometrica de las pruebas, la utilidad clinica de la aplicacion de estos cuestionarios a pacientes e informadores para obtener un indice de discrepancia de las puntuaciones como medida de la anosognosia. Resultados. Los resultados muestran como aplicar el ISP-20 (20 items) o el ISP (46 items), sean o no administrados conjuntamente con el MFE-30 (30 items), resulta un procedimiento muy util para la valoracion de la sintomatologia en los individuos con daño cerebral adquirido o demencias degenerativas, al proporcionar una gran cantidad de informacion sobre las dificultades de los pacientes en la vida cotidiana. Conclusiones. Se recomienda, junto con la obligada evaluacion neuropsicologica, la cumplimentacion de cuestionarios o inventarios de sintomas como los propuestos, dado que presentan ventajas desde el punto de vista clinico, ademas de resultar eficaces, efectivos y eficientes en terminos economicos.
Larrea Masvidal, E; García Serrano, C; Hernández Silverio, D; Castillo Rodriguez, M; Valdes Gómez, A C; Báez Hernández, D; Ramirez Hernández, L
From a series of 5000 cases that had undergone extracorporeal shock wave lithotripsy at the Hospital Clinico Quirúrgico "Hermanos Ameijeiras" from March, 1986 to April, 1988, 220 cases that required percutaneous nephrostomy due to obstructive hydronephrosis from stone fragments were studied. We analyzed the clinical, radiological and ultrasound features of these cases, as well as the criteria for performing percutaneous nephrostomy. We identified the risk factors that made the procedure necessary, particularly urinary tract infection. No important complications ascribable to the foregoing procedure were observed. Performing the procedure early improved patient clinical course and reduced cost of treatment. To eliminate stone fragments completely, percutaneous nephrostomy was combined with other procedures in 198 cases (90%). The stone fragments were passed spontaneously in 10 cases (4.5%) following diversion. At 2 months 190 cases (86%) were completely stone free, 18 (8%) had residual stones and 12 (6%) required open surgery. The foregoing results show that percutaneous nephrostomy is a very useful procedure in septic-obstructive complications following extracorporeal shock wave lithotripsy and acquiring the skill to perform it is essential.
Thakur, Chitra; Chen, Fei
Mineral dust-induced gene, mdig has recently been identified and is known to be overexpressed in a majority of human cancers and holds predictive power in the poor prognosis of the disease. Mdig is an environmentally expressed gene that is involved in cell proliferation, neoplastic transformation and immune regulation. With the advancement in deciphering the prognostic role of mdig in human cancers, our understanding on how mdig renders a normal cell to undergo malignant transformation is still very limited. This article reviews the current knowledge of the mdig gene in context to human neoplasias and its relation to the clinico-pathologic factors predicting the outcome of the disease in patients. It also emphasizes on the promising role of mdig that can serve as a potential candidate for biomarker discovery and as a therapeutic target in inflammation and cancers. Considering the recent advances in understanding the underlying mechanisms of tumor formation, more preclinical and clinical research is required to validate the potential of using mdig as a novel biological target of therapeutic and diagnostic value. Summary Expression level of mdig influences the prognosis of several human cancers especially cancers of the breast and lung. Evaluation of mdig in cancers can offer novel biomarker with potential therapeutic interventions for the early assessment of cancer development in patients. PMID:26413213
Radic, Marko; Herrmann, Martin; van der Vlag, Johan; Rekvig, Ole Petter
In the 53 years since the discovery of anti-DNA autoantibodies in lupus [1, 2, 3] , recalcitrant questions have been pondered and possible answers have been debated. The discovery of anti-DNA autoantibodies presented many puzzles: How is immunological tolerance to native B-form DNA broken? What elicits characteristic systemic lupus erythematosus (SLE) autoantibodies? Which of the diverse anti-nuclear reactivities are pathogenic? What is the role of autoantibodies in the clinical presentation of disease? How do genetic predisposition and environmental triggers contribute to SLE? These questions were brought into focus by Professor David Stollar in an introductory presentation to an intense, three-day meeting set among the rugged and inspiring scenery of the Norwegian arctic coastline (the Scientific Program is included as supplemental File 1). Other participants presented and discussed topics directed to understanding the origin and clinico-pathological impact of autoantibodies to chromatin and phospholipid antigens. In the following, several aspects of the workshop are discussed.
Jang, Minjeong; Koh, Ilkyoo; Lee, Seok Jae; Cheong, Jae-Ho; Kim, Pilnam
Gastric cancer (GC) is a common aggressive malignant tumor with high incidence and mortality worldwide. GC is classified into intestinal and diffuse types according to the histo-morphological features. Because of distinctly different clinico-pathological features, new cancer therapy strategies and in vitro preclinical models for the two pathological variants of GC is necessary. Since extracellular matrix (ECM) influence the biological behavior of tumor cells, we hypothesized that GC might be more similarly modeled in 3D with matrix rather than in 2D. Herein, we developed a microfluidic-based a three-dimensional (3D) in vitro gastric cancer model, with subsequent drug resistance assay. AGS (intestinal type) and Hs746T (diffuse type) gastric cancer cell lines were encapsulated in collagen beads with high cellular viability. AGS exhibited an aggregation pattern with expansive growth, whereas Hs746T showed single-cell-level infiltration. Importantly, in microtumor models, epithelial-mesenchymal transition (EMT) and metastatic genes were upregulated, whereas E-cadherin was downregulated. Expression of ß-catenin was decreased in drug-resistant cells, and chemosensitivity toward the anticancer drug (5-FU) was observed in microtumors. These results suggest that in vitro microtumor models may represent a biologically relevant platform for studying gastric cancer cell biology and tumorigenesis, and for accelerating the development of novel therapeutic targets. PMID:28128310
Braggio, Esteban; Keats, Jonathan J; Leleu, Xavier; Van Wier, Scott; Jimenez-Zepeda, Victor H; Valdez, Riccardo; Schop, Roelandt FJ; Price-Troska, Tammy; Henderson, Kimberly; Sacco, Antonio; Azab, Feda; Greipp, Philip; Gertz, Morie; Hayman, Suzanne; Rajkumar, S Vincent; Carpten, John; Chesi, Marta; Barrett, Michael; Stewart, A Keith; Dogan, Ahmet; Bergsagel, P Leif; Ghobrial, Irene M; Fonseca, Rafael
Waldenström’s macroglobulinemia (WM) is a distinct clinico-biological entity defined as a B-cell neoplasm characterized by a lymphoplasmacytic infiltrate in the bone marrow (BM) and immunoglobulin M paraprotein production. Cytogenetic analyses were historically limited by the difficulty in obtaining tumor metaphases and the genetic basis of the disease remains poorly defined. Here we performed a comprehensive analysis in 42 WM patients by using high-resolution, array-based comparative genomic hybridization approach to unravel the genetic mechanisms associated with WM pathogenesis. Overall, 83% of patients have chromosomal abnormalities, with a median of three abnormalities per patient. Gain of 6p was the second most common abnormality (17%) and its presence was always concomitant with 6q loss. A minimal deleted region, including MIRN15A and MIRN16-1, was delineated on 13q14 in 10% of patients. Of interest, we reported biallelic deletions and/or inactivating mutations with uniparental disomy in TRAF3 and TNFAIP3, two negative regulators of the NF-kB signaling pathway. Furthermore, we confirmed the association between TRAF3 inactivation and increased transcriptional activity of NF-kB target genes. Mutational activation of the NF-kB pathway, which is normally activated by ligand-receptor interactions within the BM microenvironment, highlights its biologic importance, and suggests a therapeutic role for inhibitors of NF-kB pathway activation in the treatment of Waldenström’s macroglobulinemia. PMID:19351844
Harikrishnan, Ramasamy; Jin, Chang-Nam; Kim, Ju-Sang; Balasundaram, Chellam; Heo, Moon-Soo
Philasterides dicentrarchi is a histophagous scuticociliate infecting Korean olive flounder farms in Jeju Island, South Korea, where it causes significant economic losses. However, the route of entry of these parasites in olive flounder is currently unknown. In the present study, we attempted experimental infection with different doses (concentrations) of P. dicentrarchi by intraperitoneal (IP) injection; maximum cumulative mortality of 95% was recorded on the administration of 2.1×10(8) ciliates/ml. In small size group (3 cm length, 24±2 gwt) the ciliates were found in connective tissues of muscle, fins, and nervous tissue while in large size group (5 cm length, 47±3 gwt), the ciliates were predominantly occurred with associated symptoms of liquefaction in the central nervous system. The major clinico-pathological manifestations were loss of scales, appearance of bleached spots that coalesced to form brownish patches, hemorrhagic, and severe dermal necrotic lesion. In addition there was degeneration of muscle fibers, necrosis of the hepatic parenchyma, and severe edema of the intestinal walls, extensive fouling, necrotic degeneration and hyperplasia in the gill bronchial epithelium. In this study, many ciliates were found in the blood vessel, brain, dorsal fins, muscle, kidney, and vertebra of infected flounder. The histopathological investigations are of significant importance in view of possible routes of entry into the host and doses of ciliates that trigger fast infection for potential utility of drugs as a strategy for the control of P. dicentrarchi in farmed olive flounder.
Martin Fernandez-Mayoralas, D; Fernandez-Perrone, A L; Munoz-Jareno, N; Fernandez-Jaen, A
Introduccion. El trastorno por deficit de atencion/hiperactividad (TDAH) es uno de los trastornos del neurodesarrollo mas frecuentes en la poblacion infantil. Su tratamiento es complejo y debe incluir medidas psicoeducativas, ambientales y farmacologicas. En los ultimos años, las principales novedades respecto a su tratamiento farmacologico son la aparicion de la lisdexanfetamina y la guanfacina de liberacion retardada. Objetivo. El aumento del numero de farmacos disponibles para el tratamiento del TDAH permite tratar y cubrir situaciones clinicas muy diversas. El proposito de la presente revision es realizar un analisis de la bibliografia sobre ambos farmacos. Desarrollo. Se establecen los puntos fuertes de ambos tratamientos, atendiendo especialmente a su mecanismo de accion, a su tolerabilidad y a su eficacia. Conclusiones. La guanfacina de liberacion retardada permite tratar situaciones escasamente cubiertas con los estimulantes, tales como los niños con irritabilidad y tics, con un perfil significativo de moderada eficacia y una buena tolerabilidad y seguridad. La aparicion de la lisdexanfetamina ha supuesto un cambio muy importante porque, segun la bibliografia, se trataria de un farmaco completo y efectivo, desde el punto de vista clinico, para mejorar los sintomas del TDAH. Ademas, posee un buen perfil de seguridad.
Diaz-Orueta, U; Fernandez-Fernandez, M A; Morillo-Rojas, M D; Climent, G
Introduccion. La lisdexanfetamina (LDX) es el farmaco para el trastorno por deficit de atencion/hiperactividad (TDAH) con mayor volumen de investigacion de los ultimos años. No obstante, no hay estudios que certifiquen su utilidad para la mejoria del funcionamiento cognitivo en el TDAH. Objetivo. Evaluar la eficacia de la LDX en la mejora sintomatica conductual y cognitiva en un grupo de pacientes con TDAH. Dicha eficacia fue medida mediante la administracion del test AULA Nesplora de realidad virtual antes de la prescripcion del tratamiento farmacologico y despues del tratamiento con LDX. Pacientes y metodos. La muestra estaba compuesta por 85 pacientes de 6-16 años, con diagnostico clinico de TDAH y que asistian a tratamiento en una consulta de neuropediatria. Todos los pacientes iniciaron el tratamiento farmacologico con la correspondiente dosis de LDX tras la entrevista clinica y la primera administracion del test AULA. Tras un tratamiento medio de 7,5 meses, se les administro AULA nuevamente y se valoro el progreso del tratamiento farmacologico sobre la sintomatologia cognitiva y motora. Resultados. Se apreciaron mejorias muy significativas en la atencion selectiva y sostenida, la calidad del foco atencional y la hiperactividad, mejorias moderadas en la impulsividad, y una incidencia casi nula en la velocidad de procesamiento. Conclusiones. La LDX constituye un tratamiento adecuado para la mejora sustancial de la atencion e hiperactividad, y dicha mejora puede monitorizarse de forma precisa mediante el test de realidad virtual AULA.
Albert, J; Fernandez-Jaen, A; Martin Fernandez-Mayoralas, D; Lopez-Martin, S; Fernandez-Perrone, A L; Calleja-Perez, B; Jimenez-De la Pena, M; Recio-Rodriguez, M
Introduccion. El desarrollo de la resonancia magnetica estructural y de nuevos metodos de analisis ha permitido examinar, como nunca antes, las bases neuroanatomicas del trastorno por deficit de atencion/hiperactividad (TDAH). No obstante, poco se sabe todavia sobre la relacion de los sintomas clinicos y las disfunciones neuropsicologicas caracteristicas del TDAH con las alteraciones neuroanatomicas observadas. Objetivo. Explorar la relacion entre neuroanatomia, clinica y neuropsicologia en el TDAH. Desarrollo. A nivel de grupo, existen diferencias marcadas entre el cerebro de niños adolescentes y adultos con TDAH y el cerebro de personas con desarrollo tipico. Estas diferencias se observan transversal y longitudinalmente en todas las medidas, tanto de la sustancia gris como de la sustancia blanca. Aunque todavia escasa, cada vez existe mayor evidencia que señala que estas diferencias se relacionan con los sintomas nucleares del trastorno y con el grado de disfuncion clinica. Tambien parecen asociarse con el funcionamiento cognitivo (principalmente, atencion y control inhibitorio). Conclusiones. La relacion entre los distintos niveles de analisis de estudio del TDAH acerca la investigacion a la clinica y permite comprender y tratar mejor el trastorno. Aunque el avance en este campo es innegable, todavia son muchas las cuestiones que hay que explorar y profundizar en mayor detalle. Se requiere comprender mejor la asociacion entre las medidas neuroanatomicas y cada dimension sintomatologica, y la relacion con otros procesos neuropsicologicos tambien implicados en el trastorno.
Fernandez-Jaen, A; Lopez-Martin, S; Albert, J; Martin Fernandez-Mayoralas, D; Fernandez-Perrone, A L; Calleja-Perez, B; Lopez-Arribas, S
Introduccion. Los trastornos del neurodesarrollo engloban a un grupo heterogeneo de trastornos como la discapacidad intelectual, el trastorno del espectro autista o los trastornos especificos del aprendizaje, entre otros. La reciente inclusion en las clasificaciones internacionales del trastorno por deficit de atencion/hiperactividad (TDAH) dentro de los trastornos del neurodesarrollo parece claramente justificada atendiendo a variables neurobiologicas y clinicas. Desarrollo. El caracter dimensional y la distribucion de diferentes sintomas en la poblacion caracterizan a la mayoria de los trastornos del neurodesarrollo. Se revisan estos aspectos, particularmente desde la sintomatologia y neuropsicologia en el TDAH. El caracter sintomatico dimensional del TDAH contrasta con los criterios diagnosticos de este trastorno de acuerdo a diferentes clasificaciones o guias clinicas. Contrasta igualmente con los datos recogidos a traves de diferentes exploraciones complementarias (escalas, tests...). Conclusiones. El entendimiento del continuo clinico dentro de cada trastorno del neurodesarrollo (incluido el TDAH), entre los diferentes trastornos del neurodesarrollo, y entre los trastornos del neurodesarrollo y la normalidad, es esencial para la investigacion, el diagnostico y el abordaje de todos ellos. El desarrollo de instrumentos que avalen este componente dimensional es igualmente trascendental.
Murray, Samuel; Bobos, Mattheos; Angouridakis, Nikolaos; Nikolaou, Angelos; Linardou, Helena; Razis, Evangelia; Fountzilas, George
Background and Aim. EGFR is commonly expressed in cancers of the head and neck (H and N), and anti-EGFR agents have demonstrated improvements in outcomes (TTP and OS). The aim of this study was to determine EGFR gene status in H and N cancer patients treated with gefitinib and to correlate mutational status with clinico-pathological data and response. Patients and Methods. Patients with histologically confirmed H and N cancer having failed prior treatment for advanced disease entered this compassionate-use-program. Nineteen patients received gefitinib. EGFR expression was assessed by IHC, gene copy number by FISH, and mutation analysis was conducted for EGFR (18-21), KRAS, BRAF (V600E), and HER-2 exon 20. An additional TKI naive cohort of 73 patients was also screened. Results. Mutations were detected in 6/19 patients (3× EGFR, 1× KRAS, and 2× HER2-exon 20). There were no significant differences in TTP or OS for patients with somatic EGFR mutations. No BRAF mutations were detected. Conclusions. The incidence of EGFR mutations in H and N cancer in this study was 5.3%. No statistically relevant correlations between mutation or gene gain and response or survival were observed. Due to the limited number of patients and low incidence of genetic aberrations in the genes analyzed, additional studies are warranted. PMID:21274259
Lan, Nguyen Thi; Yamaguchi, Ryoji; Kawabata, Atsushi; Uchida, Kazuyuki; Sugano, Sumio; Tateyama, Susumu
To compare the molecular and growth properties of two newly isolated canine distemper virus strains in the Asia 1 and 2 groups with clinico-pathological findings in dogs, nucleotide and predicted amino acid sequence comparisons of genes H and P were performed together with comparative growth profiling. The predicted amino acid sequences of the H gene contained 12 cysteine residues that were conserved among the examined Asia 1 and Asia 2 viruses. The hydrophobic region in the H gene of the Asia 2 isolates was one amino acid longer than that of the Asia 1 group. The H gene of the Asia 1 group had nine putative asparagine (N)-linked glycosylation sites, while there were eight sites in the Asia 2 group. The titers of the cell-associated viruses for the Asia 1 strains were higher than those of the released viruses and were opposite to those of the Asia 2 strains in a previous study. The molecular and growth properties of the Asia 1 and Asia 2 groups seem to vary, although no significant differences were observed in the clinical signs and pathological findings between the two groups.
Del Pilar-Morales, Esteban A; Cali, Ignazio; Chapas, Javier; Bertrán-Pasarell, Jorge; Puoti, Gianfranco; Gambetti, Pierluigi; Nobo, Ulises
The diagnosis of Creutzfeldt-Jakob disease (CJD) is often a challenge for most physicians given its extremely low incidence and different clinico-pathological presentations. We report the case of a 56-year old patient native to Puerto Rico suspected of sporadic Creutzfeldt-Jakob disease (sCD). The symptoms at onset were notorious for bilateral cortical blindness followed by rapidly progressive cognitive decline, visual deficit, increased levels of CSF 14-3-3 and tau along with positive brain MRI and EEG, are highly indicative of CJD. The definite diagnosis was confirmed by the National Prion Disease Pathology Surveillance Center (NPDPSC), in Cleveland, Ohio, USA. Lack of genetic mutations in the prion protein (PrP) gene, widespread histopathological changes and the accumulation of scrapie PrP (PrPSc) in the brain confirmed the diagnosis of sCJD. The patient, admitted to our institution in 2011, represents the first detailed report of sCJD in a native Puerto Rican patient living in Puerto Rico.
Wieneke, Christina; Martersteck, Adam; Whitney, Kristen; Weintraub, Sandra; Mesulam, M.-Marsel; Rogalski, Emily
Objectives: This study examines the anatomical correlates of naming vs recognizing faces using a novel measure that utilizes culturally relevant and age-appropriate items, the Northwestern University Famous Faces (NUFFACE) Test, in primary progressive aphasia (PPA), a syndrome characterized by progressive language deficits and associated with cortical atrophy in areas important for word and object representations. Methods: NUFFACE Test performance of 27 controls (mean age 62.3 years) was compared with that of 30 patients with PPA (mean age 62 years). Associations between NUFFACE Test performance and cortical thickness measures were quantified within the PPA group. Results: Patients with PPA displayed significant impairment on the NUFFACE Test, demonstrating that it is a useful measure of famous-face identification for individuals with relatively young-onset dementias. Despite widespread distribution of atrophy in the PPA group, face naming impairments were correlated with atrophy of the left anterior temporal lobe while face recognition impairments were correlated with bitemporal atrophy. Conclusions: In addition to their clinical relevance for highlighting the distinction between face naming and recognition impairments in individuals with young-onset dementia, these findings add new insights into the dissociable clinico-anatomical substrates of lexical retrieval and object knowledge. PMID:23940020
Muthusamy, Karthik; Bandla, Bhavagna; Sudhakar, Sniya Valsa; Thomas, Maya
Moya Moya Disease (MMD) is characterised by idiopathic vasculopathy affecting the terminal internal carotid arteries resulting in the formation of extensive collaterals at the base of the brain, leptomeninges and parenchymal regions with resultant infarcts and bleeds. Four children presented with clinico-radiological features suggestive of Moyamoya disease/syndrome. This includes global developmental delay, recurrent seizures, transient ischaemic attacks and impaired vision. The first patient had vision of 6/15 in both eyes with bilateral optic disc pallor. Second case also had bilateral optic disc pallor with arteriolar attenuation, but had vision of perception of light only in both eyes. The third child had vision of 6/60 with alternate divergent squint and clinical features suggestive of Neurofibromatosis 1 (NF 1). Fourth patient presented with poor fixation in both eyes with bilateral total cataract. He underwent bilateral cataract surgery with intraocular lens implantation and vision improved to 2/60 with good fixation. We also describe their medical and neurosurgical interventions in this report. PMID:27437259
Mast Cells Density Positive to Tryptase Correlate with Microvascular Density in both Primary Gastric Cancer Tissue and Loco-Regional Lymph Node Metastases from Patients That Have Undergone Radical Surgery.
Ammendola, Michele; Sacco, Rosario; Zuccalà, Valeria; Luposella, Maria; Patruno, Rosa; Gadaleta, Pietro; Zizzo, Nicola; Gadaleta, Cosmo Damiano; De Sarro, Giovambattista; Sammarco, Giuseppe; Oltean, Mihai; Ranieri, Girolamo
Mast Cells (MCs) play a role in immune responses and more recently MCs have been involved in tumoral angiogenesis. In particular MCs can release tryptase, a potent in vivo and in vitro pro-angiogenic factor via proteinase-activated receptor-2 (PAR-2) activation and mitogen-activated protein kinase (MAPK) phosphorylation. MCs can release tryptase following c-Kit receptor activation. Nevertheless, no data are available concerning the relationship among MCs Density Positive to Tryptase (MCDPT) and Microvascular Density (MVD) in both primary gastric cancer tissue and loco-regional lymph node metastases. A series of 75 GC patients with stage T2-3N2-3M₀ (by AJCC for Gastric Cancer Seventh Edition) undergone to radical surgery were selected for the study. MCDPT and MVD were evaluated by immunohistochemistry and by image analysis system and results were correlated each to other in primary tumor tissue and in metastatic lymph nodes harvested. Furthermore, tissue parameters were correlated with important clinico-pathological features. A significant correlation between MCDPT and MVD was found in primary gastric cancer tissue and lymph node metastases. Pearson t-test analysis (r ranged from 0.74 to 0.79; p-value ranged from 0.001 to 0.003). These preliminary data suggest that MCDPT play a role in angiogenesis in both primary tumor and in lymph node metastases from GC. We suggest that MCs and tryptase could be further evaluated as novel targets for anti-angiogenic therapies.
Duyckaerts, Charles; Delatour, Benoît; Potier, Marie-Claude
The lesions of Alzheimer disease include accumulation of proteins, losses of neurons and synapses, and alterations related to reactive processes. Extracellular Abeta accumulation occurs in the parenchyma as diffuse, focal or stellate deposits. It may involve the vessel walls of arteries, veins and capillaries. The cases in which the capillary vessel walls are affected have a higher probability of having one or two apoepsilon 4 alleles. Parenchymal as well as vascular Abeta deposition follows a stepwise progression. Tau accumulation, probably the best histopathological correlate of the clinical symptoms, takes three aspects: in the cell body of the neuron as neurofibrillary tangle, in the dendrites as neuropil threads, and in the axons forming the senile plaque neuritic corona. The progression of tau pathology is stepwise and stereotyped from the entorhinal cortex, through the hippocampus, to the isocortex. The neuronal loss is heterogeneous and area-specific. Its mechanism is still discussed. The timing of the synaptic loss, probably linked to Abeta peptide itself, maybe as oligomers, is also controversial. Various clinico-pathological types of Alzheimer disease have been described, according to the type of the lesions (plaque only and tangle predominant), the type of onset (focal onset), the cause (genetic or sporadic) and the associated lesions (Lewy bodies, vascular lesions, hippocampal sclerosis, TDP-43 inclusions and argyrophilic grain disease).