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Sample records for intensified case finding

  1. Intensified tuberculosis case finding amongst vulnerable communities in southern India.

    PubMed

    Reddy, K K; Ananthakrishnan, R; Jacob, A G; Das, M; Isaakidis, P; Kumar, A M V

    2015-12-21

    India mainly uses passive case finding to detect tuberculosis (TB) patients through the Revised National Tuberculosis Control Programme (RNTCP). An intensified case finding (ICF) intervention was conducted among vulnerable communities in two districts of Karnataka during July-December 2013; 658 sputum smear-positive TB cases were detected. The number of smear-positive cases detected increased by 8.8% relative to the pre-intervention period (July-December 2012) in intervention communities as compared to an 8.6% decrease in communities without the ICF intervention. ICF activities brought TB services closer to vulnerable communities, moderately increasing TB case detection rates.

  2. Implementing intensified tuberculosis case-finding among street-connected youth and young adults in Kenya

    PubMed Central

    Mercer, T.; Kimani, S.; Braitstein, P.; Buziba, N.; Carter, E. J.

    2016-01-01

    Background: Street-connected youth and young adults (SCY) suffer a myriad of health problems. In Kenya, SCY are at high risk for tuberculosis (TB) due to their congregate living situations. TB screening is not routinely implemented in SCY and there has been no published literature on the burden of TB in SCY in western Kenya. Program description: In 2011, the AMPATH TB Program, an experienced TB screening program, partnered with the Tumaini Center, a trusted street youth organization, to conduct intensified case finding (ICF) for pulmonary TB among SCY. Our program aimed to investigate the numbers of SCY who reported symptoms and those diagnosed with smear-positive pulmonary TB, and link SCY with TB to treatment. Results: Of 116 SCY who were screened, 114 (98%) had a positive questionnaire; 104 (90%) provided a spot sputum sample, 39 (34%) provided a morning sputum sample, and 111 (97%) reported cough of >2 weeks. One street youth tested smear-positive for TB and was treated through to cure. Conclusions: Implementing TB ICF is feasible in low-resource settings through unique collaborations between health care programs and community-based organizations. In addition to identifying smear-positive TB, our program uncovered a high burden of respiratory symptoms among SCY in Eldoret, Kenya. PMID:27358809

  3. Impact of intensified case-finding strategies on childhood TB case registration in Nepal.

    PubMed

    Joshi, B; Chinnakali, P; Shrestha, A; Das, M; Kumar, A M V; Pant, R; Lama, R; Sarraf, R R; Dumre, S P; Harries, A D

    2015-06-21

    Contexte : Sept districts d'intervention avec des stratégies intensifiées de recherche active des cas de tuberculose (TB) mis en œuvre par une organisation non gouvernementale et sept districts témoins gérés par le Programme National Tuberculose au Népal.Objectifs : Evaluer les différences en termes d'enregistrement des cas de TB de l'enfant et de taux d'enregistrement pour 100 000 population entre deux périodes (année 1 = mars 2012 à mars 2013 et année 2 = mars 2013 à mars 2014) dans les districts d'intervention et les districts témoins.Schéma : Revue de dossiers rétrospective grâce aux données recueillies en routine.Résultats : Les cas de TB de l'enfant ont augmenté de 271 à 360 entre l'année 1 et l'année 2 dans les districts d'intervention (le taux d'enregistrement est passé de 18,2 à 24,2/100 000) et de 97 à 113 dans les districts témoins (13,4 à 15,6/100 000) : les augmentations ont été significativement plus importantes dans les districts d'intervention par rapport aux districts témoins. Les augmentations ont également été plus importantes chez les enfants de 0 à 4 ans et chez ceux qui ont eu une TB pulmonaire à frottis négatif et extra-pulmonaire. Parmi diverses stratégies de recherche des cas, le dépistage des contacts familiaux, les services conjoints privés-publics et les camps de santé mobiles pour la TB ont été les plus performants.Conclusion : Un paquet de stratégies intensifiées de recherche des cas a été associé à une augmentation des enregistrements de cas de TB de l'enfant au Népal. Il faut également envisager des approches diagnostiques supplémentaires pour augmenter encore l'enregistrement des cas.

  4. Role of routine abdominal ultrasonography in intensified tuberculosis case finding algorithms at HIV clinics in high TB burden settings.

    PubMed

    Spalgais, Sonam; Agarwal, Upasna; Sarin, Rohit; Chauhan, Devesh; Yadav, Anita; Jaiswal, Anand

    2017-05-18

    High proportion of TB in people living with HIV (PLHIV) is undiagnosed. Due to this active TB case finding is recommended for HIV clinics in high TB burden countries. Presently sputum examination and chest radiography are frontline tests recommended for HIV infected TB presumptives. Abdominal TB which occurs frequently in PLHIV may be missed even by existing programmatic intensified case finding protocols. This study evaluated the routine use of ultrasonography (USG) for active case finding of abdominal TB in HIV clinics. Retrospective analysis of eight years' data from an HIV Clinic in a TB hospital in India. Patients underwent chest x-ray, sputum examination, USG abdomen and routine blood tests at entry to HIV care. Case forms were scrutinized for diagnosis of TB, USG findings and CD4 cell counts. Abdominal TB was classified as probable or possible TB. Probable TB was based on presence of two major USG (abdomen) findings suggestive of active TB, or one major USG finding with at least two minor USG findings or at least two symptoms, or any USG finding with microbiologically confirmed active TB at another site. Possible TB was based on the presence of one major USG finding, or the presence of two minor USG findings with at least two symptoms. Bacteriological confirmation was not obtained. Eight hundred and eighty-nine people PLHIV underwent a baseline USG abdomen. One hundred and thirteen of 340 cases already diagnosed with TB and 87 of the 91 newly diagnosed with TB at time of HIV clinic registration had abdominal TB. Non-abdominal symptoms like weight loss, fever and cough were seen in 53% and 22% cases had no symptoms at all. Enlarged abdominal lymph nodes with central caseation, ascitis, splenic microabsesses, bowel thickening and hepatosplenomegaly were the USG findings in these cases. Abdominal TB is a frequent TB site in PLHIV presenting with non-abdominal symptoms. It can be easily detected on basis of features seen on a simple abdominal ultrasound

  5. Effect of new tuberculosis diagnostic technologies on community-based intensified case finding: a multicentre randomised controlled trial.

    PubMed

    Calligaro, Gregory L; Zijenah, Lynn S; Peter, Jonathan G; Theron, Grant; Buser, Virginia; McNerney, Ruth; Bara, Wilbert; Bandason, Tsitsi; Govender, Ureshnie; Tomasicchio, Michele; Smith, Liezel; Mayosi, Bongani M; Dheda, Keertan

    2017-04-01

    Inadequate case detection results in high levels of undiagnosed tuberculosis in sub-Saharan Africa. Data for the effect of new diagnostic tools when used for community-based intensified case finding are not available, so we investigated whether the use of sputum Xpert-MTB/RIF and the Determine TB LAM urine test in two African communities could be effective. In a pragmatic, randomised, parallel-group trial with individual randomisation stratified by country, we compared sputum Xpert-MTB/RIF, and if HIV-infected, the Determine TB LAM urine test (novel diagnostic group), with laboratory-based sputum smear microscopy (routine diagnostic group) for intensified case finding in communities with high tuberculosis and HIV prevalence in Cape Town, South Africa, and Harare, Zimbabwe. Participants were randomly assigned (1:1) to these groups with computer-generated allocation lists, using culture as the reference standard. In Cape Town, participants were randomised and tested at an Xpert-equipped mobile van, while in Harare, participants were driven to a local clinic where the same diagnostic tests were done. The primary endpoint was the proportion of culture-positive tuberculosis cases initiating tuberculosis treatment in each study group at 60 days. This trial is registered at ClinicalTrials.gov, number NCT01990274. Between Oct 18, 2013, and March 31, 2015, 2261 individuals were screened and 875 (39%) of these met the criteria for diagnostic testing. 439 participants were randomly assigned to the novel group and 436 to the routine group. 74 (9%) of 875 participants had confirmed tuberculosis. If late culture-based treatment initiation was excluded, more patients with culture-positive tuberculosis were initiated on treatment in the novel group at 60 days (36 [86%] of 42 in the novel group vs 18 [56%] of 32 in the routine group). Thus the difference in the proportion initiating treatment between groups was 29% (95% CI 9-50, p=0·0047) and 53% more patients initiated therapy in

  6. Implementing intensified tuberculosis case-finding among street-connected youth and young adults in Kenya.

    PubMed

    Szkwarko, D; Mercer, T; Kimani, S; Braitstein, P; Buziba, N; Carter, E J

    2016-06-21

    Contexte : Les jeunes et les adultes vivant dans la rue (SCY) souffrent d'une myriade de problèmes de santé. Au Kenya, les SCY ont un risque élevé de tuberculose (TB) à cause de la promiscuité de leur habitat. Le dépistage de la TB n'est pas mis en œuvre en routine parmi les SCY et il n'y a eu aucune littérature publiée sur le poids de la TB chez les SCY de l'ouest du Kenya.Description du programme : En 2011, le programme TB AMPATH, un programme de dépistage de TB expérimenté, a établi un partenariat avec le Tumaini Center, une organisation fiable de jeunes de la rue, afin de réaliser une recherche de cas intensifiée (ICF) de la TB pulmonaire parmi les SCY. Notre programme a eu pour but de rechercher le nombre de SCY qui présentaient des symptômes et ceux qui ont eu un diagnostic de TB pulmonaire à frottis positif, et enfin de mettre en contact les SCY avec un site de traitement de la TB.Résultats : De 116 SCY qui ont été dépistés, 114 (98%) ont remis un questionnaire positif, 104 (90%) ont fourni un échantillon de crachats, 39 (34%) un échantillon matinal et 111 (97%) ont fait état d'une toux de >2 semaines. Un jeune de la rue a eu un frottis positif pour la TB et a été traité avec succès.Conclusions: La mise en œuvre de l'ICF de TB est faisable dans un contexte de faibles ressources à travers une unique collaboration entre les programmes de soins de santé et les organisations communautaires. En plus d'identifier la TB à frottis positif, notre programme a révélé un lourd fardeau de symptômes respiratoires parmi les SCY d'Eldoret, au Kenya.

  7. Yield of HIV-associated tuberculosis during intensified case finding in resource-limited settings: a systematic review and meta-analysis

    PubMed Central

    Kranzer, Katharina; Houben, Rein MGJ; Glynn, Judith R; Bekker, Linda-Gail; Wood, Robin; Lawn, Stephen D

    2010-01-01

    Summary Intensified case finding is the regular screening for evidence of tuberculosis in people infected with HIV, at high risk of HIV, or living in congregate settings. We systematically reviewed studies of intensified case finding published between January, 1994, and April, 2009. In 78 eligible studies, the number of people with tuberculosis detected during intensified case finding varied substantially between countries and target groups of patients. Median prevalence of newly diagnosed tuberculosis was 0·7% in population-based surveys, 2·2% in contact-tracing studies, 2·3% in mines, 2·3% in programmes preventing mother-to-child transmission of HIV, 2·5% in prisons, 8·2% in medical and antiretroviral treatment clinics, and 8·5% in voluntary counselling and testing services. Metaregression analysis of studies that included only people with HIV showed that for each increment in national prevalence of tuberculosis of 100 cases per 100 000 population, intensified case finding identified an additional one case per 100 screened individuals (p=0·03). Microbiological sputum examination of all individuals without prior selection by symptom screening yielded an additional four cases per 100 individuals screened (p=0·05). Data on the use of serial screening, treatment outcomes in actively identified cases of tuberculosis, and cost-effectiveness, however, were lacking. Concerted action is needed to develop intensified case finding as an important method for control of tuberculosis. PMID:20113978

  8. Yield of intensified tuberculosis case-finding activities using Xpert® MTB/RIF among risk groups in Nepal

    PubMed Central

    Baral, S.; Shrestha, P.; Puri, M.; Kandel, S.; Lamichanne, B.; Elsey, H.; Brouwer, M.; Goel, S.; Chinnakali, P.

    2016-01-01

    Setting: Twenty-two districts of Nepal, where intensified case-finding (ICF) activities for tuberculosis (TB) were implemented among risk groups under the TB REACH initiative in collaboration with the National TB Programme from July 2013 to November 2015. Objectives: To assess the yield of TB screening using an algorithm with smear microscopy followed by Xpert® MTB/RIF. Design: A descriptive study using routinely collected data. Results: Of 145 679 individuals screened, 28 574 (19.6%) had presumptive TB; 1239 (4.3%) of these were diagnosed with TB and 1195 (96%) were initiated on anti-tuberculosis treatment. The yield of screening was highest among people living with the human immunodeficiency virus (PLHIV) (6.1%), followed by household contacts (3.5%) and urban slum dwellers (0.5%). Among other risk groups, such as prisoners, factory workers, refugees and individuals with diabetes, the yield was less than 0.5%. The number needed to screen to diagnose an active TB case was 17 for PLHIV, 29 for household contacts and 197 for urban slum dwellers. Of 11 525 patients from ICF and the routine programme, 112 (1%) were diagnosed with multidrug-resistant TB. Conclusion: There was a substantial yield of TB cases among risk groups such as PLHIV and household contacts. Although the yield in urban slum dwellers was found to be moderate, some intervention should nonetheless be targeted because of the large population and poor access to care in this group. PMID:27358808

  9. Yield of intensified tuberculosis case-finding activities using Xpert(®) MTB/RIF among risk groups in Nepal.

    PubMed

    Khanal, S; Baral, S; Shrestha, P; Puri, M; Kandel, S; Lamichanne, B; Elsey, H; Brouwer, M; Goel, S; Chinnakali, P

    2016-06-21

    Contexte : Vingt-deux districts du Népal où des activités intensifiées de recherche des cas (ICF) de la tuberculose (TB) ont été mises en œuvre au sein de groupes à risque sous l'égide du projet TB REACH en collaboration avec le programme national TB entre juillet 2013 et novembre 2015.Objectifs : Evaluer le rendement du dépistage de la TB grâce à un algorithme basé sur la microscopie de frottis suivie d'un test Xpert(®) MTB/RIF.Schéma : Etude descriptive basée sur des données recueillies en routine.Résultats : Sur un total de 145 679 individus dépistés, 28 574 (19,6%) ont été présumés atteints de TB ; 1239 (4,3%) d'entre eux ont eu une confirmation du diagnostic de TB ; parmi ces derniers, 1195 (96%) ont mis en route un traitement anti-tuberculose. Le rendement a été le plus élevé parmi les personnes vivant avec le virus l'immunodéficience humaine (PVVIH) (6,1%) suivies par les contacts domiciliaires (3,5%) et les habitants des bidonvilles (0,5%). Dans d'autres groupes à risque comme les prisonniers, les travailleurs d'usine, les réfugiés et les diabétiques, le rendement a été inférieur à 0,5%. Le nombre de personnes à dépister (NNS) pour diagnostiquer un cas de TB active a été de 17 pour les PVVIH, de 29 pour les contacts domiciliaires et de 197 pour les habitants des bidonvilles urbains. Sur 11 525 patients émanant soit du programme ICF soit du dépistage de routine, 112 (1%) ont eu un diagnostic de TB multirésistante.Conclusion : Le rendement en termes de cas de TB dépistés parmi les groupes à risque comme les PVVIH et les contacts domiciliaires a été substantiel. Même si ce rendement a été modeste parmi les habitants des bidonvilles, ceux-ci justifient néanmoins une intervention en raison de leur nombre élevé et de leur médiocre accès aux soins.

  10. Performance of Clinical Screening Algorithms for Tuberculosis Intensified Case Finding among People Living with HIV in Western Kenya.

    PubMed

    Modi, Surbhi; Cavanaugh, Joseph S; Shiraishi, Ray W; Alexander, Heather L; McCarthy, Kimberly D; Burmen, Barbara; Muttai, Hellen; Heilig, Chad M; Nakashima, Allyn K; Cain, Kevin P

    2016-01-01

    To assess the performance of symptom-based screening for tuberculosis (TB), alone and with chest radiography among people living with HIV (PLHIV), including pregnant women, in Western Kenya. Prospective cohort study. PLHIV from 15 randomly-selected HIV clinics were screened with three clinical algorithms [World Health Organization (WHO), Ministry of Health (MOH), and "Improving Diagnosis of TB in HIV-infected persons" (ID-TB/HIV) study], underwent chest radiography (unless pregnant), and provided two or more sputum specimens for smear microscopy, liquid culture, and Xpert MTB/RIF. Performance of clinical screening was compared to laboratory results, controlling for the complex design of the survey. Overall, 738 (85.6%) of 862 PLHIV enrolled were included in the analysis. Estimated TB prevalence was 11.2% (95% CI, 9.9-12.7). Sensitivity of the three screening algorithms was similar [WHO, 74.1% (95% CI, 64.1-82.2); MOH, 77.5% (95% CI, 68.6-84.5); and ID-TB/HIV, 72.5% (95% CI, 60.9-81.7)]. Sensitivity of the WHO algorithm was significantly lower among HIV-infected pregnant women [28.2% (95% CI, 14.9-46.7)] compared to non-pregnant women [78.3% (95% CI, 67.3-86.4)] and men [77.2% (95% CI, 68.3-84.2)]. Chest radiography increased WHO algorithm sensitivity and negative predictive value to 90.9% (95% CI, 86.4-93.9) and 96.1% (95% CI, 94.4-97.3), respectively, among asymptomatic men and non-pregnant women. Clinical screening missed approximately 25% of laboratory-confirmed TB cases among all PLHIV and more than 70% among HIV-infected pregnant women. National HIV programs should evaluate the feasibility of laboratory-based screening for TB, such as a single Xpert MTB/RIF test for all PLHIV, especially pregnant women, at enrollment in HIV services.

  11. The Diagnostic Performance of a Single GeneXpert MTB/RIF Assay in an Intensified Tuberculosis Case Finding Survey among HIV-Infected Prisoners in Malaysia

    PubMed Central

    Al-Darraji, Haider Abdulrazzaq Abed; Razak, Humaira Abd; Ng, Kee Peng; Altice, Frederick L.; Kamarulzaman, Adeeba

    2013-01-01

    Background Delays in tuberculosis (TB) diagnosis, particularly in prisons, is associated with detrimental outcomes. The new GeneXpert MTB/RIF assay (Xpert) offers accurate and rapid diagnosis of active TB, but its performance in improving case detection in high-transmission congregate settings has yet to be evaluated. We assessed the diagnostic accuracy of a single Xpert assay in an intensified case finding survey among HIV-infected prisoners in Malaysia. Methods HIV-infected prisoners at a single site provided two early-morning sputum specimens to be examined using fluorescence smear microscopy, BACTEC MGIT 960 liquid culture and a single Xpert. The sensitivity, specificity, negative and positive predictive values of Xpert were calculated relative to gold-standard results using MGIT 960 liquid culture. Relevant clinical and demographic data were used to examine correlates of active TB disease. Results The majority of enrolled subjects with complete data (N=125) were men (90.4%), age <40 years (61.6%) and had injected drugs (75.2%). Median CD4 lymphocyte count was 337 cells/µL (IQR 149-492); only 19 (15.2%) were receiving antiretroviral therapy. Of 15 culture-positive TB cases, single Xpert assay accurately detected only eight previously undiagnosed TB cases, resulting in a sensitivity, specificity, positive predictive value and negative predictive value of 53.3% (95% CI 30.12-75.2%), 100% (95% CI 96.6-100%), 100% (95% CI 67.56-100%) and 94.0% (95% CI 88.2-97.1%), respectively. Only 1 of 15 (6.7%) active TB cases was smear-positive. The prevalence (12%) of undiagnosed active pulmonary TB (15 of 125 prisoners) was high and associated with longer duration of drug use (AOR 1.14, 95% CI 1.03-1.26, for each year of drug use). Conclusions Single Xpert assay improved TB case detection and outperformed AFB smear microscopy, but yielded low screening sensitivity. Further examination of the impact of HIV infection on the diagnostic performance of the new assay alongside

  12. Intensified Tuberculosis Case-Finding in HIV-Positive Adults Managed at Ethiopian Health Centers: Diagnostic Yield of Xpert MTB/RIF Compared with Smear Microscopy and Liquid Culture

    PubMed Central

    Balcha, Taye T.; Sturegård, Erik; Winqvist, Niclas; Skogmar, Sten; Reepalu, Anton; Jemal, Zelalem Habtamu; Tibesso, Gudeta; Schön, Thomas; Björkman, Per

    2014-01-01

    intensified case finding in patients eligible for ART. However, technical and cost-effectiveness issues relevant for low-income countries warrant further study. PMID:24465572

  13. Intensified tuberculosis case-finding in HIV-positive adults managed at Ethiopian health centers: diagnostic yield of Xpert MTB/RIF compared with smear microscopy and liquid culture.

    PubMed

    Balcha, Taye T; Sturegård, Erik; Winqvist, Niclas; Skogmar, Sten; Reepalu, Anton; Jemal, Zelalem Habtamu; Tibesso, Gudeta; Schön, Thomas; Björkman, Per

    2014-01-01

    Detection of active tuberculosis (TB) before antiretroviral therapy (ART) initiation is important, but optimal diagnostic methods for use in resource-limited settings are lacking. We assessed the prevalence of TB, evaluated the diagnostic yield of Xpert MTB/RIF in comparison with smear microscopy and culture, and the impact of Xpert results on clinical management in HIV-positive adults eligible for ART at health centers in a region of Ethiopia. Participants were prospectively recruited and followed up at 5 health centers. Trained nurses collected data on socio-demographic characteristics, medical history and symptoms, and performed physical examination. Two paired morning sputum samples were obtained, and lymph node aspirates in case of lymphadenopathy. Diagnostic yield of Xpert MTB/RIF in sputum was compared with smear microscopy and liquid culture. TB was diagnosed in 145/812 participants (17.9%), with bacteriological confirmation in 137 (16.9%). Among bacteriologically confirmed cases, 31 were smear-positive (22.6%), 96 were Xpert-positive (70.1%), and 123 were culture-positive (89.8%). Xpert MTB/RIF increased the TB detection rate by 64 cases (47.4%) compared with smear microscopy. The overall sensitivity of Xpert MTB/RIF was 66.4%, and was not significantly lower when testing one compared with two samples. While Xpert MTB/RIF was 46.7% sensitive among patients with CD4 cell counts >200 cells/mm(3), this increased to 82.9% in those with CD4 cell counts ≤100 cells/mm(3). Compared with Xpert-positive TB patients, Xpert-negative cases had less advanced HIV and TB disease characteristics. Previously undiagnosed TB is common among HIV-positive individuals managed in Ethiopian health centers. Xpert MTB/RIF increased TB case detection, especially in patients with advanced immunosuppression. An algorithm based on the use of a single morning sputum sample for individuals with negative sputum smear microscopy could be considered for intensified case finding in patients

  14. Intensified tuberculosis case finding, implementation of isoniazid preventive therapy and associated factors among people living with human immunodeficiency virus at public health facilities of Harari Region, Eastern Ethiopia: A cross-sectional study

    PubMed Central

    Geleto, Ayele; Abate, Degu; Egata, Gudina

    2017-01-01

    Objective: Globally, the number of people living with human immunodeficiency virus (PLHIV) particularly in sub-Saharan Africa is growing. This has been resulted in increased number of tuberculosis (TB) new cases. To control burden of TB among PLHIV, a number of collaborative TB/HIV activities were recommended. However, data about collaborative TB/HIV services in the study area is scarce. The objective of this study is to assess intensified TB case finding, implementation of isoniazid preventive therapy (IPT) and associated factors among PLHIV. Methods: A facility based cross-sectional study design was employed among 419 randomly selected PLHIV from public health facilities of Harari region. Systematic sampling method was used to obtain sample from each health facilities. Interviewer-administered questionnaire was used to collect data. Data were entered into EpiData and analyzed by SPSS statistical software. Multivariate logistic regression analysis was conducted to determine the presence of association between variables using odds ratio with 95% confidence interval and association was declared significant at P ≤ 0.05. Results: One hundred fifteen (75.2%) of the respondents reported that they offered screening for TB during their HIV chronic cares and 94 (29.8%) of them were found to be positive for active TB. Female sex [AOR 2.51; 95%CI (1.52, 6.14)], educated patients [AOR 0.52; 95%CI (0.21, 0.83)], CD4 count greater than 350 cells/dl3 [AOR 0.62; 95%CI(0.22,0.82)], Antiretroviral Therapy (ART) initiation [AOR 0.50; 95%CI (0.35, 0.88)] and missing dose of ART [AOR 2.57; 95%CI (1.21, 5.32)] were significantly associated with TB infection. Nearly four-fifth (78.7 %) of the study participants were provided IPT. Conclusions: Screening of TB among PLHIV and implementation of IPT in the region is lower when compared to the findings of other studies conducted in different parts of the country and needs to be improved through implementation of national and international

  15. The decision to intensify therapy in patients with type 2 diabetes: results from an experiment using a clinical case vignette.

    PubMed

    Grant, Richard W; Lutfey, Karen E; Gerstenberger, Eric; Link, Carol L; Marceau, Lisa D; McKinlay, John B

    2009-01-01

    Lack of medication intensification is a widely recognized but poorly understood barrier to effective diabetes care. We used a video case vignette to assess whether patient or physician demographic variables influence the decision to intensify therapy. One hundred ninety-two US primary care physicians each viewed one case vignette of an actor portraying a patient who had type 2 diabetes and borderline indications for medication intensification. Case vignettes were clinically identical and differed only by patient age (35 or 65 years old); sex; race/ethnicity (white, Hispanic, or black); and socioeconomic status (occupation of lawyer or janitor). After viewing the vignette and indicating their management plans, physicians were also asked to discuss the challenges related to managing such a patient. Just over half (53%) of physicians indicated that they would recommend a medication prescription for the vignette patient. Demographic characteristics (of the patient, physician, or practice) did not significantly influence this decision (P > .1 for all comparisons). Compared with physicians who did not recommend a diabetic-related prescription, physicians recommending therapy more often identified patient medication costs (74% vs 43% of physicians who would not increase therapy); medication adherence (63% vs 49%); and subsequent complications (34% vs 22%) as important clinical issues in managing diabetes. Physicians not intensifying therapy more often indicated that they needed more clinical information (16% vs 9%). Using an experimental design we found that differences in the decision to intensify therapy were not significantly explained by patient, physician, or practice demographic variables. Physicians who intensified therapy were more likely to consider issues such as medication costs, patient adherence, and downstream complications.

  16. Generalization of Findings From Single Case Studies.

    ERIC Educational Resources Information Center

    Kennedy, Mary M.

    Although single case studies might be useful to evaluators for a variety of purposes, there are no generally accepted ways for drawing inferences about the generality of findings from a case study. Single case studies are defined in this paper as either studies of single events, or disaggregated studies of multiple events. The data may be…

  17. FOC/48 Intensifier HV Tests

    NASA Astrophysics Data System (ADS)

    Miebach, Manfred

    1991-07-01

    This is an FOC engineering needed to verify a new HV transition command sequence after the failure of the Intensifier HV Power Supply and tube. SCHEDULING REQUIREMENTS: A time window of 300 min after the transistion to HV must be scheduled providing opportunities to use generic uplinks to execute PSTOL in case the IEHT HV will not come or stay up.

  18. Demography and findings of reported rape cases.

    PubMed

    Quader, M M; Rahman, M H; Kamal, M; Ahmed, A U; Saha, S K

    2010-01-01

    Six hundred and ninety nine cases of alleged rape were studied by the authors during the period from 2007-2008 at the Mymensingh Medical College, Mymensingh. Of these cases, 122 had positive findings of recent sexual intercourse; 250 cases had the positive findings of habituated sexual intercourse, and 327 cases had no findings of sexual intercourse but they complained of forcible sexual intercourse and found no sign of sexual intercourse. Most of the alleged victims of rape were nulliparous 87.12% and parous was only 12.87%. 430 (61.51%) cases of reported victims who were students of schools and colleges were not considered as rape cases considering their victim's history of love affairs, leaving home secretly with their lovers, living with them for many days. Gang rape was not so common (4.29% of raped cases) in our study. Age groups, their occupations, living areas, time of arrival for medico-legal examination have been studied. Most of the cases were students (61.51%). A few numbers of victims were subjected to gang rape. Examination and reporting the cases have been discussed.

  19. Value of intensified nursing

    PubMed Central

    Frank, Wilhelm; Konta, Brigitte; Prusa, Nina; Raymann, Cornelia

    2006-01-01

    The concept "intensified nursing" is mentioned in differentiation to concepts of "nursing care" or "nursing" which intensifies resources or patient contact. Especially psychic and social needs of patients are very appreciated in nursing. A similar type of nursing is known under the concept "advanced nursing practice" (ANP) which means, that a specialised, academically trained nurse offers an extended nursing care in which a focus on the published knowledge of evidence based research is made. From the thin literature to this topic a selection of predetermined topics was analysed where at least two articles with a sufficient high methodical quality were available. The selected topic groups were: „Infant and paediatric nursing", "gerontology" and "oncology". Generally the five publications concerning infant and paediatric nursing could conclusive show a benefit of intensified nursing. Further research is still needed to prove intensified nursing care. Two publications could be found to the gerontological intensified nursing; both used an extended nursing model and an enlarged use of resources. Both studies demonstrated a measurable success in the applied parameters. Two studies also could be analysed in the oncological field in which successes were also provable by the applied parameters. The success was given especially in a higher patient satisfaction, one study showed an improved scheduling (time planning) of nurses. There was not one article concerning economic questions of intensified nursing care. It has to be taken into account that the financial resources have to be used effectively also in nursing nowadays. It has to be assumed that the costs are driven by increased use of resources. Savings can be achieved, however, in the form of avoided therapies and days in hospital by intensified nursing. The intensified nursing can be considered as similar cost-effective as conventional models of nursing. Ethically it is necessary to consider that the possibilities of

  20. Ultrasonography findings of vulvar liposarcoma. Case report.

    PubMed

    Yanik, Bahar; Inceboz, Umit; Bulbul, Erdogan; Demirpolat, Gulen; Uzgoren, Ismail Engin

    2015-09-01

    Liposarcoma (LPS) of vulva is a rare entity. We present the ultrasonographic (US) and color Doppler ultrasonographic (CDUS) findings of a vulvar myxoid LPS. Although LPS cases have been reported in the extremities and trunk, the US or CDUS findings of LPS in vulva have not been described previously. On US the mass appeared as a well-defined, homogeneous hypoechoic structure and on CDUS it was quite hypervascular.

  1. Imagery intensifier for recce

    NASA Astrophysics Data System (ADS)

    Sturz, Richard A.

    1998-11-01

    The image intensifier based night vision goggle which has proven so useful in low light or night observation applications, can be mated to the typical CD video camera for imaging under these adverse lighting conditions. Image intensifiers have specific spectral response, low light sensitivity, resolution, and electronic characteristics to augment standard CCD camera capability and thus provide video suited for reconnaissance. The variety of these devices include the Gen I, Gen II and the Gen II series of image intensifiers. Recent developments have increased the variety of spectral response, quantum efficiencies and spatial resolution within the Gen II and Gen III types. The SPIE Airborne Reconnaissance session paper presented in 1995 entitled 'Advanced in Low Light Level Video Imaging' described the then available image intensifiers. This paper explores and updates the data of the 1995 paper and discusses the changes and improvements in image intensifiers since the original paper. Additional information concerning the CCD camera and image intensification for reconnaissance applications is also presented.

  2. Neutron-image intensifier

    NASA Technical Reports Server (NTRS)

    Berger, H.

    1970-01-01

    Electronic intensifier tube with a demagnification ratio of 9-1 enhances the usefulness of neutron-radiographic techniques. A television signal can be obtained by optical coupling of a small-output phosphor-light image to a television camera.

  3. Magnifying image intensifier

    NASA Technical Reports Server (NTRS)

    Vine, J. (Inventor)

    1978-01-01

    A magnetically focused image intensifier was improved to increase the usable range of magnification without degradation of image quality. The power requirements of the focusing coils are minimal. The arrangement of the focusing coils reverses the direction of the axial magnetic field distribution between the planes of the photocathode and the phosphor screen.

  4. Ultrasonographic findings of intussusception in pediatric cases.

    PubMed

    Ayaz, Umit Yasar; Dilli, Alper; Ayaz, Sevin; Api, Arman

    2011-12-01

    We aimed to characterize, by ultrasonography (US), the aspects, locations and the dimensions of intussusceptions in pediatric cases and to compare these data with the clinical findings and therapeutical outcomes. We retrospectively evaluated abdominal US examinations and clinical data of 13 consecutive pediatric patients with intussusceptions. Patients are grouped according to the type of intussusceptions (ileocolic intussusceptions and intussusceptions with colocolic involvement) and according to the modality of treatment (surgical and non-surgical). Median age was 24 months (range 5-108 months). Eleven cases were surgically treated because of delayed referral. For all cases the mean diameter+/-SD of intussusception was 30+/-5 mm and mean length+/-SD was 59+/-21 mm. For ileocolic intussusceptions (n=9/11), mean diameter+/-SD was 29.1+/-4.4 mm and mean length+/-SD was 61.7+/-18.1 mm. The right upper quadrant of abdomen was the most common location for ileocolic intussusceptions (n=7/9), the rest were located in paraumbilical regions (n=2/9). For two cases of intussusceptions with colocolic involvement (ileocolocolic and colocolic intussusceptions located in right upper quadrant and left lower quadrant, respectively), mean diameter+/-SD was 37.5+/-0.7 mm and mean length+/-SD was 75.5+/-21.9 mm. The difference between mean diameters of ileocolic intussusceptions and intussusceptions with colocolic involvement was statistically significant (p =0.03), whereas the difference between mean lengths of these two groups was not statistically significant (p=0.36). For surgically treated cases (n=11/13), mean diameter+/-SD of intussusception was 30.6+/-5.2 mm and the mean length +/-SD was 64.2+/-18.5 mm. For non-surgically treated cases (n=2/13), with intussusceptions located in right lower quadrant, mean diameter+/-SD of intussusception was 27+/-4.2 mm and the mean length+/-SD was 32.5+/-10.6 mm. The difference between mean diameters of surgically and non-surgically treated

  5. Reporting a Case of Injecting Methylphenidate (Ritalin) Tablets, Intensified Symptoms of Schizoph-renia or Induce Separate Mental Disorder?

    PubMed Central

    Ghaffarinejad, Alireza; Kheradmand, Ali

    2009-01-01

    Background: Methylphenidate is one of the classic amphetamines which can cause or exacerbate psychotic symptoms in schizophrenia patients. Case Report: In this paper, a young man is presented with injection of methylphenidate tablets with acute cellulitis due to this injection and the related symptoms. In the first hospitalization and after recovery from psychotic disorder due to tablet injections, he was under treatment with anti-psychotics because of other symptoms related to schizophrenia. Although the patient was regularly under schizophrenic medication after discharge, he was hospitalized twice more due to psychotic symptoms that appeared after injecting methylphenidate. Conclusion: This report shows psychotic symptoms in schizophrenic patients after injecting methylphenidate. These symptoms cannot be prevented even by anti-psychotic medication of background disease. This case shows the existence of two kinds of psychoses, functional (due to schizophrenia) and organic psychoses (due to methylphenidate use) in the same patient. PMID:24494093

  6. Reporting a Case of Injecting Methylphenidate (Ritalin) Tablets, Intensified Symptoms of Schizoph-renia or Induce Separate Mental Disorder?

    PubMed

    Ghaffarinejad, Alireza; Kheradmand, Ali

    2009-01-01

    Methylphenidate is one of the classic amphetamines which can cause or exacerbate psychotic symptoms in schizophrenia patients. In this paper, a young man is presented with injection of methylphenidate tablets with acute cellulitis due to this injection and the related symptoms. In the first hospitalization and after recovery from psychotic disorder due to tablet injections, he was under treatment with anti-psychotics because of other symptoms related to schizophrenia. Although the patient was regularly under schizophrenic medication after discharge, he was hospitalized twice more due to psychotic symptoms that appeared after injecting methylphenidate. This report shows psychotic symptoms in schizophrenic patients after injecting methylphenidate. These symptoms cannot be prevented even by anti-psychotic medication of background disease. This case shows the existence of two kinds of psychoses, functional (due to schizophrenia) and organic psychoses (due to methylphenidate use) in the same patient.

  7. Identifying dynamic tuberculosis case-finding policies for HIV/TB coepidemics.

    PubMed

    Yaesoubi, Reza; Cohen, Ted

    2013-06-04

    The global tuberculosis (TB) control plan has historically emphasized passive case finding (PCF) as the most practical approach for identifying TB suspects in high burden settings. The success of this approach in controlling TB depends on infectious individuals recognizing their symptoms and voluntarily seeking diagnosis rapidly enough to reduce onward transmission. It now appears, at least in some settings, that more intensified case-finding (ICF) approaches may be needed to control TB transmission; these more aggressive approaches for detecting as-yet undiagnosed cases obviously require additional resources to implement. Given that TB control programs are resource constrained and that the incremental yield of ICF is expected to wane over time as the pool of undiagnosed cases is depleted, a tool that can help policymakers to identify when to implement or suspend an ICF intervention would be valuable. In this article, we propose dynamic case-finding policies that allow policymakers to use existing observations about the epidemic and resource availability to determine when to switch between PCF and ICF to efficiently use resources to optimize population health. Using mathematical models of TB/HIV coepidemics, we show that dynamic policies strictly dominate static policies that prespecify a frequency and duration of rounds of ICF. We also find that the use of a diagnostic tool with better sensitivity for detecting smear-negative cases (e.g., Xpert MTB/RIF) further improves the incremental benefit of these dynamic case-finding policies.

  8. Atmospheric Storm Triggered and Intensified by Geodynamics: Case Studies from Andaman Sea and Bay of Bengal Region in the Indian Ocean

    NASA Astrophysics Data System (ADS)

    Akilan, A.; Azeez, K. K. Abdul; Schuh, H.

    2017-03-01

    The study analyses the possible connection between the onset of cyclone and volcano-tectonic seismicity in the Andaman region. The historical data of the major volcanic, seismic, and atmospheric events from the region show that several of the geodynamic activities were followed by severe atmospheric disturbances over the region. In this study, we consider the case of three recent cyclones (Phailin, Hudhud, and Nilam) that either originated or were intensified over the Andaman Sea and Bay of Bengal, and examine their correlation with the volcano-tectonic seismic events during the cyclone occurrence. The zenith total delay (ZTD) time series, derived from Global Positioning System data from the PBR2 station on Andaman Island, overlapping with the period of the cyclone occurrence were examined to distinguish the onset and intensification of the atmospheric events. The comparison of the sharp changes in ZTD associated with the cyclone and the seismic events during the period indicates that the atmospheric changes almost coincide or follow the geodynamic activity. Our study illustrates that volcano-tectonics of the region plays a role in the triggering of atmospheric disturbances.

  9. Automated intensifier tube measuring system

    NASA Astrophysics Data System (ADS)

    Partee, J.; Paul, C.; Sartor, M.; West, J.; Wichowski, N.; McIntyre, B.

    2008-04-01

    Image Intensifier Tube (IIT) technology remains a critical component of the warfighter's arsenal. However, even after six decades of fielded systems most IIT inspections are accomplished relying on human judgment and round-robin calibration techniques. We report on the Automated Intensifier Measurement System (AIMS), a NIST-traceable, calibratable, machine vision system developed to produce automated, quantifiable, reproducible results on eight of the major IIT inspections: (1) Useful Diameter, (2) Modulation Transfer Function, (3) Gross Distortion, (4) Shear Distortion, (5) Bright Spot, (6) Dark Spot, (7) Gain and (8) Uniformity. The overall architecture of the system and a description of the algorithms required for each test is presented. Translation from the anthropocentric MIL-PRF-A3256363D(CR) OMNI VII Military Specification to measurable quantities (with appropriate uncertainties) is described. The NIST-traceable system uncertainties associated with each measurement is reported; in all cases AIMS measures quantities associated with the above tests to more precision than current industry practice. Issues with the current industry standard equipment and testing methods are also identified. Future work, which will include additional inspections, is discussed.

  10. Pulmonary talcosis: CT findings in three cases.

    PubMed

    Padley, S P; Adler, B D; Staples, C A; Miller, R R; Müller, N L

    1993-01-01

    The authors describe the computed tomographic (CT) appearances in three patients with pulmonary talcosis resulting from chronic intravenous drug abuse. There was widespread ground-glass attenuation in one case and an appearance similar to that of progressive massive fibrosis in two cases. In the latter cases, there were confluent perihilar masses with areas of high attenuation. While the CT appearances may be suggestive of pulmonary talcosis, tissue sampling is required for definitive diagnosis.

  11. Muscular cysticercosis: Case report and imaging findings.

    PubMed

    Olmo, Neide Regina Simões; Fiorio, Ulysses Ferreira; Bastos, Eder Amaral; Clemente, Marcel Andreazza; Mendes, Gustavo Gomes

    2016-11-01

    Cysticercosis is a parasitic disease caused by a worm of the Cestoda class. The most prevalent form affects the nervous system. This case report is from a 78-year-old female patient evaluated at Clínica Mult Imagem, in the city of Santos, Brazil, who presented a form of the disease that differed from the classic neurocysticercosis, in this case muscular cysticercosis. This and other forms of manifestation justify further studies to ensure adequate recognition, diagnosis and treatment of this parasitic disease.

  12. Cytogenetics Findings in a Histiocytic Sarcoma Case

    PubMed Central

    Alonso-Dominguez, J. M.; Calbacho, M.; Talavera, M.; Villalon, C.; Abalo, L.; Garcia-Gutierrez, J. V.; Lozano, S.; Tenorio, M.; Villarrubia, J.; Lopez-Jimenez, J.; Ferro, M. T.

    2012-01-01

    Histiocytic sarcoma (HS) is a neoplasm derived from histiocytes. Its diagnosis was not clear until its immunohistochemistry profile was correctly established. Not much is known about its genetic properties. We report a case of a 48-year-old male patient whose bone marrow was almost completely occupied by monomorphic medium size neoplastic cellularity. Its immunohistochemical profile was CD68+, CD4+, CD45+ with negativity of other dendritic cells, and other lineage markers. Cytogenetic study showed 4 related clones: one with trisomy 8 and extra material on the short arms of chromosome 4; a second line with tetrasomy of chromosome 8, add(4)(p16); the third clone had the same alterations as the previous and deletion of chromosome 3 at q11; the fourth line had tetrasomy 8 and translocation t(3;5)(q25;q35). To our knowledge this is the first HS case showing chromosome 8 trisomy and tetrasomy and the other described alterations. PMID:22937328

  13. High prevalence of pulmonary tuberculosis and inadequate case finding in rural western Kenya.

    PubMed

    van't Hoog, Anna H; Laserson, Kayla F; Githui, Willie A; Meme, Helen K; Agaya, Janet A; Odeny, Lazarus O; Muchiri, Benson G; Marston, Barbara J; DeCock, Kevin M; Borgdorff, Martien W

    2011-05-01

    Limited information exists on the prevalence of tuberculosis and adequacy of case finding in African populations with high rates of HIV. To estimate the prevalence of bacteriologically confirmed pulmonary tuberculosis (PTB) and the fraction attributable to HIV, and to evaluate case detection. Residents aged 15 years and older, from 40 randomly sampled clusters, provided two sputum samples for microscopy; those with chest radiograph abnormalities or symptoms suggestive of PTB provided one additional sputum sample for culture. PTB was defined by a culture positive for Mycobacterium tuberculosis or two positive smears. Persons with PTB were offered HIV testing and interviewed on care-seeking behavior. We estimated the population-attributable fraction of HIV on prevalent and notified PTB, the patient diagnostic rate, and case detection rate using provincial TB notification data. Among 20,566 participants, 123 had PTB. TB prevalence was 6.0/1,000 (95% confidence interval, 4.6-7.4) for all PTB and 2.5/1,000 (1.6-3.4) for smear-positive PTB. Of 101 prevalent TB cases tested, 52 (51%) were HIV infected, and 58 (64%) of 91 cases who were not on treatment and were interviewed had not sought care. Forty-eight percent of prevalent and 65% of notified PTB cases were attributable to HIV. For smear-positive and smear-negative PTB combined, the patient diagnostic rate was 1.4 cases detected per person-year among HIV-infected persons having PTB and 0.6 for those who were HIV uninfected, corresponding to case detection rates of 56 and 65%, respectively. Undiagnosed PTB is common in this community. TB case finding needs improvement, for instance through intensified case finding with mobile smear microscopy services, rigorous HIV testing, and improved diagnosis of smear-negative TB.

  14. Two Cases of Melasma with Unusual Histopathologic Findings

    PubMed Central

    Kang, Won-Hyoung

    2006-01-01

    We reported two cases of clinically typical melasma presenting with unusual histopathologic findings. In one case, the epidermal melanocytes were markedly increased in number and protruded into the dermis, and in the other case, increased epidermal pigmentation as well as dermal melanocytosis were found. We suggested that the various treatment modalities of melasma should be applied depend on its histopathologic finding. PMID:16614533

  15. On the Subjectivity of Intensifiers

    ERIC Educational Resources Information Center

    Athanasiadou, Angeliki

    2007-01-01

    Intensification is a means of indexing the speakers' perspective. This paper attempts to show the semantic development of particular intensifiers following Langacker's framework of subjectivity. In this framework, the focus lies on the way the conceptualizer construes an event or a situation as an observer or as an experiencer with degrees of…

  16. On the Subjectivity of Intensifiers

    ERIC Educational Resources Information Center

    Athanasiadou, Angeliki

    2007-01-01

    Intensification is a means of indexing the speakers' perspective. This paper attempts to show the semantic development of particular intensifiers following Langacker's framework of subjectivity. In this framework, the focus lies on the way the conceptualizer construes an event or a situation as an observer or as an experiencer with degrees of…

  17. School-Based Asthma Case Finding: The Arkansas Experience

    ERIC Educational Resources Information Center

    Vargas, Perla A.; Magee, James S.; Bushmiaer, Margo; Simpson, Pippa M.; Jones, Craig A.; Feild, Charles R.; Jones, Stacie M.

    2006-01-01

    This population-based case-finding study sought to determine asthma prevalence and characterize disease severity and burden among school-aged children in the Little Rock School District. Asthma cases were identified by validated algorithm and parental report of asthma diagnosis. The overall response rate was low. Among schools with greater than…

  18. School-Based Asthma Case Finding: The Arkansas Experience

    ERIC Educational Resources Information Center

    Vargas, Perla A.; Magee, James S.; Bushmiaer, Margo; Simpson, Pippa M.; Jones, Craig A.; Feild, Charles R.; Jones, Stacie M.

    2006-01-01

    This population-based case-finding study sought to determine asthma prevalence and characterize disease severity and burden among school-aged children in the Little Rock School District. Asthma cases were identified by validated algorithm and parental report of asthma diagnosis. The overall response rate was low. Among schools with greater than…

  19. Computed Tomographic Findings of Syphilitic Aortitis: A Case Report

    SciTech Connect

    Kimura, Fumiko; Satoh, Hideyuki; Sakai, Fumikazu; Nishii, Noriko; Tohda, Joe; Fujimura, Mikihiko; Haruta, Shoji; Yamazaki, Kenji; Endo, Masahiro; Sakomura, Yasunari; Kurosama, Hiromi; Kasanuki, Hiroshi

    2004-03-15

    We describe the computerized tomographic (CT) findings of the aortic wall in a case of acute-phase syphilitic arteritis. The delayed phase of the contrast-enhanced CT shows a double-ring configuration of the thick thoracic aortic wall, which is similar to CT findings previously reported for Takayasu arteritis. We speculate that the resemblance of the CT findings for these two diseases accounts for their similar histopathological features.

  20. Finding Control Cases and Maintaining Immersion: Challenges and Opportunities.

    PubMed

    Ehrlich, Lena Theodorou

    2016-10-03

    Given that surveys, as well as frequent observations by institute faculty, indicate that many candidates have difficulty finding control cases and maintaining immersion and that many graduate analysts face similar challenges, it would seem that psychoanalytic training does not prepare candidates adequately for finding patients and practicing analysis while in training and, for many, after they have graduated. Although external challenges are formidable, it is by identifying and making use of internal challenges to finding cases that candidates can develop an analytic mind: the identity, approach, and skills necessary not only to graduate but to have the choice to practice clinical psychoanalysis post-graduation. Some of the internal challenges and their manifestations in different phases of initiating analysis (referrals, initial consultation, recommendation) are discussed and two detailed examples are offered to illustrate the productive use of candidates' countertransferences in finding cases and maintaining immersion. Finally, recommendations for institutional solutions are provided. © 2016 by the American Psychoanalytic Association.

  1. Anatomical facial nerve findings in 209 consecutive atresia cases.

    PubMed

    Goldsztein, Hernan; Roberson, Joseph B

    2013-04-01

    Describe intraoperative facial nerve findings in 209 consecutive atresia cases. Identify preoperative and intraoperative anatomical variants that should alert the surgeon to potential high-risk facial nerve anatomy. Case series with chart review. Tertiary care subspecialty private practice. Retrospective review of 209 consecutive atresia cases treated between 2007 and 2011. Descriptive analysis of intraoperative findings. Logistical regression models with generalized estimating equations were used to examine the effect of preoperative variables over the operative findings. Two hundred and nine consecutive patients (ages 2-48) underwent atresia repair between 2007 and 2011. Preoperative Jahrsdoerfer Scale was 9 (23%), 8 (42%), 7 (19%), 6 (2%), 5 or less (2%). The facial nerve was found to have an abnormal course in 39% of the cases and not identified in 1%. It was congenitally dehiscent in 53% of cases and was surgically exposed in 10%. The most common site of congenital dehiscence was in the tympanic segment (57%). Facial-stapes contact was found in 11% of cases. The stapedius tendon was absent in 30% of cases. A single patient had a mild transient postoperative paresis (House-Brackmann 2). Atresia repair remains one of the most challenging procedures in otology. In spite of modern preoperative imaging, the facial nerve remains at risk. When performing surgery on patients with preoperative facial nerve paresis and/or lower Jahrsdoerfer scores, the surgeon should be aware of a higher incidence of facial nerve abnormalities. Thorough knowledge of anatomical variations and meticulous surgical technique are mandatory to safely perform these surgeries.

  2. [Two cases of herpes encephalitis with normal cerebrospinal fluid findings].

    PubMed

    Avkan Oğuz, Vildan; Yapar, Nur; Sezak, Nurbanu; Alp Cavuş, Sema; Kuruüzüm, Ziya; Sayiner, Arzu; Ada, Emel; Cakir, Nedim; Yüce, Ayşe

    2006-01-01

    In this report, characteristics of two cases of Herpes simplex virus (HSV) encephalitis with normal cerebrospinal fluid (CSF) findings at the time of admission have been discussed and the current literature has been reviewed. The diagnosis of the cases (one was 23 years old male, and the other was 75 years old female patient) was made on the magnetic resonance imaging (MRI) findings concordant with HSV encephalitis, together with HSV-1 DNA positivity by polymerase chain reaction (PCR). Both of the patients were treated with acyclovir (3 x 750 mg/day) lasting for 15 days and 21 days, respectively. The first male patient recovered with mild neurological defects, whereas the second female patient died because of nosocomial pneumonia and septicemia. In conclusion, even the CSF findings are normal, in cases considered to be HSV encephalitis, MRI should be the first radiological diagnostic step and the diagnosis should be confirmed by the detection of HSV DNA in CSF by PCR.

  3. Iniencephaly Clausus: A New Case With Clinical and Imaging Findings.

    PubMed

    Khatami, Alireza; Hasanzadeh, Mohsen; Norouzi, Hedayat; Esfandiari, Ehasn; Mehrafarin, Mastooreh

    2015-07-01

    Iniencephaly is a rare kind of neural tube defect that is classified into two types of iniencephaly apertus and iniencephaly clausus. This anomaly could be diagnosed prenatally by obstetric ultrasonography and terminated by therapeutic abortion; however, it could be undiagnosed until birth similar to our case due to the abnormal position of the fetus or lack of experience of the sonographer. Due to abnormality of the neural tube, which causes abnormal head and neck position, all these cases will die shortly after birth. We hereby introduce the photos and imaging findings of a case of an alive neonate with iniencephaly clausus.

  4. Iniencephaly Clausus: A New Case With Clinical and Imaging Findings

    PubMed Central

    Khatami, Alireza; Hasanzadeh, Mohsen; Norouzi, Hedayat; Esfandiari, Ehasn; Mehrafarin, Mastooreh

    2015-01-01

    Iniencephaly is a rare kind of neural tube defect that is classified into two types of iniencephaly apertus and iniencephaly clausus. This anomaly could be diagnosed prenatally by obstetric ultrasonography and terminated by therapeutic abortion; however, it could be undiagnosed until birth similar to our case due to the abnormal position of the fetus or lack of experience of the sonographer. Due to abnormality of the neural tube, which causes abnormal head and neck position, all these cases will die shortly after birth. We hereby introduce the photos and imaging findings of a case of an alive neonate with iniencephaly clausus. PMID:26528385

  5. Autoimmune Pancreatitis: A Case of Atypical Radiographic Findings

    PubMed Central

    Karimi, Shawhin; Bharill, Parth

    2016-01-01

    Autoimmune pancreatitis (AIP) is a rare pancreatic disorder that can present as a manifestation of a broader systemic inflammatory disease known as immunoglobulin G4-related systemic disease (IGG4-RSD). AIP is divided into two subtypes based on clinical, radiological, and histological findings. The disease can be mistaken for pancreatic cancer because of overlapping clinical and radiological findings, but early recognition can help avoid unnecessary surgery. We present a case of a 65-year-old female with suspected acute gallstone pancreatitis found to have AIP based on serology, radiological findings, and response to steroids. PMID:27920645

  6. Using Death Certificate Reports to Find Severe Leptospirosis Cases, Brazil

    PubMed Central

    Spichler, Anne; Athanazio, Daniel; Buzzar, Marcia; Castro, Bronislawa; Chapolla, Erica; Seguro, Antonio

    2007-01-01

    Severe leptospirosis with pulmonary hemorrhage is emerging globally. Measures to control leptospirosis through sanitation depend on accurate case finding and reporting. Rapid death certificate reporting, plus necropsy of persons who died of leptospirosis, facilitates public health intervention and could provide an important tool in assessing the global burden of leptospirosis. PMID:18258007

  7. Using death certificate reports to find severe leptospirosis cases, Brazil.

    PubMed

    Spichler, Anne; Athanazio, Daniel; Buzzar, Marcia; Castro, Bronislawa; Chapolla, Erica; Seguro, Antonio; Vinetz, Joseph M

    2007-10-01

    Severe leptospirosis with pulmonary hemorrhage is emerging globally. Measures to control leptospirosis through sanitation depend on accurate case finding and reporting. Rapid death certificate reporting, plus necropsy of persons who died of leptospirosis, facilitates public health intervention and could provide an important tool in assessing the global burden of leptospirosis.

  8. Clinicopathological Findings of Suicide in the Elderly: Three Cases

    ERIC Educational Resources Information Center

    Peisah, Carmelle; Snowdon, John; Kril, Jillian; Rodriguez, Michael

    2007-01-01

    The neuropathological correlates of suicide in older persons have received little research attention. Our recent study of elderly suicide victims from an Australian forensic medicine department (n = 143), unlike a previous case-control study, did not find an increased prevalence of Alzheimer's disease (AD) in older persons who committed suicide…

  9. Clinicopathological Findings of Suicide in the Elderly: Three Cases

    ERIC Educational Resources Information Center

    Peisah, Carmelle; Snowdon, John; Kril, Jillian; Rodriguez, Michael

    2007-01-01

    The neuropathological correlates of suicide in older persons have received little research attention. Our recent study of elderly suicide victims from an Australian forensic medicine department (n = 143), unlike a previous case-control study, did not find an increased prevalence of Alzheimer's disease (AD) in older persons who committed suicide…

  10. Endocervical curetting vs. endocervical brushing as case finding methods.

    PubMed

    Maksem, John A

    2006-05-01

    This paper focuses on the performance of endocervical curettage (ECC) and intensive endocervical brushing (ECB) (comprising two or more brushings of the endocervix with liquid-based cytology and cell-block examination) in the course of colposcopic examination for abnormal gynecological cytology. To assess their relative effectiveness in disease detection, we reviewed the outcomes of 1,824 colposcopic biopsy collections from women who had an index cytology diagnosis of LSIL or higher. Our intent was to gauge the relative success of ECC and ECB as case-finding procedures in relation to (1) the original cytological diagnosis and (2) the highest (most abnormal) histological diagnosis of the colposcopy study. Our purpose was to determine whether ECB could effectively replace ECC. One thousand five hundred and seven cases of LSILs or higher cases included an ECC along with two or more colposcopic biopsies and 317 cases included an ECB. ECBs were collected into a liquid fixative and processed as both cytology and cell-block specimens; whereas, ECCs were processed according to standard histological techniques. We found that intensive ECB recapitulates the highest diagnosis of the colposcopy study about 5-8 times as often as that of ECC. Moreover, when calculating the proportion of positive outcomes, we found that cases examined with biopsy and ECC discovered fewer women with CIN 2 or higher among both LSIL and HSIL index cytologies as compared with those of cases examined with biopsy and ECB (9.2% vs. 16.8% for LSIL and 63.7% vs. 72.2% for HSIL cases); and, more negative outcomes were seen among women evaluated with biopsy plus ECC than those with biopsy plus ECB (11.3% vs. 8.1% for LSIL and 4.7% vs. 1.4% for HSIL cases). Our findings suggest that the colposcopic study is optimized when it is performed in conjunction with ECB as opposed to ECC, and that intensive ECB may be superior to ECC.

  11. An unusual case of KBG syndrome with unique oral findings.

    PubMed

    Hafiz, Abdul; Mufeed, Abdulla; Ismael, Mohamad; Alam, Mheboob

    2015-07-17

    KBG syndrome is a condition characterised by macrodontia, neurological disturbance, short stature, a distinct cranio-facial appearance, and skeletal anomalies. The authors describe what appears to be the first case of KBG syndrome reported from the Indian subcontinent. Meticulous evaluation of the dental findings helps to identify such cases which may otherwise remain undiagnosed. Further research is warranted to determine the classic and variant presentations of this condition, with follow-up data providing valuable insights into its natural history and long-term prognosis.

  12. A case of secondary erythromelalgia with unusual histological findings.

    PubMed

    Bakkour, Waseem; Motta, Luisa; Stewart, Elizabeth

    2013-06-01

    Erythromelalgia clinically presents with episodic burning, erythema, and warmth of acral sites. It can be divided into primary and secondary associated with myeloproliferative and autoimmune conditions. Histology commonly shows capillary proliferation, swelling of endothelial cells, perivascular edema, and chronic inflammation with sparse lymphocytic infiltrate. We report a case of a 55-year-old man with classical secondary erythromelalgia clinically; however, he had unusual histological findings on biopsy comprising of acute perivascular infiltrate and perivascular mucin. This is the first report of such findings in the context of secondary erythromelalgia.

  13. Finding meaning in everyday life with dementia: A case study.

    PubMed

    Robertson, Jane M

    2014-07-01

    This paper presents a case study exploring an older woman's perspective on the quality of her life with dementia. The case study establishes the importance of coherence across the life course in understanding how she evaluates her changed situation in the present compared to the past. The metaphoric description of moving from 'up there' to 'down here' represents the perceived struggle to maintain a sense of worth despite a marginalised social position. Being able to define self and social identity in ways that preserve a sense of social status is important to find meaning in everyday life. Finding meaning involves looking backwards to sustain continuity with the past and looking forwards to maintain momentum and keep going. A narrative framework is valuable in showing that quality of life is a dimension of meaning associated with maintaining a sense of social worth.

  14. Image intensifier selection from a user viewpoint

    NASA Astrophysics Data System (ADS)

    Sturz, Richard A.

    2000-11-01

    The image intensifier as we know it today is a direct result of the military need for night vision. The intensifier was developed and produced for that purpose as its primary application. Production of the intensifier therefore is based upon a Military Specification (Mil-Spec) and insures the intensifiers has scientific applications based on its low light sensitivity, spectral response, and gating characteristics. The non-military applications for the image intensifier do not create a large market and therefore these users must adapt the Mil-Spec manufactured device to their specific needs. The intensifier is especially adaptable to the intensified video application when mated to a CCD, CID or CMOS camera. Adapting the intensifier to the video camera creates an indispensable tool for scientific researchers and creates challenges for the camera builder. The military production requirements present many technical specification conflicts for the intensified camera manufacturer and his customers. Properly specifying, selecting and incorporating the image intensifier in the video camera can enhance video camera applications of the image intensifier.

  15. Laryngeal schwannoma: a case report with emphasis on sonographic findings.

    PubMed

    de Souza, Luis Ronan Marquez Ferreira; De Nicola, Harley; Yamasaki, Rosiane; Pedroso, José Eduardo; do Brasil, Osíris de Oliveira Camponês; Yamashita, Hélio

    2014-01-01

    Schwannomas are benign nerve sheath tumors composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral, cranial and autonomic nerves. Twenty-five to forty-five percent of all schwannomas occur in the head and neck region, but location of such tumors in the larynx is rarely observed. The present report is aimed at describing a clinical case of laryngeal schwannoma, with emphasis on sonographic findings.

  16. A new case of Grange syndrome without cardiac findings.

    PubMed

    Wallerstein, Robert; Augustyn, Ann Marie; Wallerstein, Donna; Elton, Leslie; Tejeiro, Beatriz; Johnson, Valerie; Lieberman, Kenneth

    2006-06-15

    Grange syndrome comprises arterial stenoses with hypertension, brachysyndactyly, bone fragility, learning disability, and cardiac defects. To date, we know of two reported families with five affected individuals. We report on one of the youngest cases, in a third family, a 3-year-old girl with brachysyndactyly, renal artery stenosis with hypertension, and bone fragility. She does not have apparent cardiac disease, suggesting cardiac anomalies may not be an obligatory finding in this syndrome. Copyright 2006 Wiley-Liss, Inc.

  17. Laryngeal schwannoma: a case report with emphasis on sonographic findings*

    PubMed Central

    de Souza, Luis Ronan Marquez Ferreira; De Nicola, Harley; Yamasaki, Rosiane; Pedroso, José Eduardo; do Brasil, Osíris de Oliveira Camponês; Yamashita, Hélio

    2014-01-01

    Schwannomas are benign nerve sheath tumors composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral, cranial and autonomic nerves. Twenty-five to forty-five percent of all schwannomas occur in the head and neck region, but location of such tumors in the larynx is rarely observed. The present report is aimed at describing a clinical case of laryngeal schwannoma, with emphasis on sonographic findings. PMID:25741079

  18. A Case of Neurocutaneous Melanosis and Neuroimaging Findings

    PubMed Central

    Gocmen, Rahsan; Guler, Ezgi; Arslan, Elif Acar

    2015-01-01

    Neurocutaneous melanosis is a rare congenital disorder which presents with congenital cutaneous nevi and involvement of the central nervous system. We herein present a rare case of a 2-year-old girl who had central nervous system melanosis and giant congenital melanocytic nevi. Magnetic resonance imaging, especially precontrast T1 images play a crucial role in making the diagnosis combined with the skin findings of physical examination. PMID:25926927

  19. Multidrug-resistant tuberculosis: epidemiology, risk factors and case finding.

    PubMed

    Caminero, J A

    2010-04-01

    Although the multidrug-resistant tuberculosis (MDR-TB) epidemic is a very recent problem, many studies have attempted to understand it. We now have good estimates of the current burden (approximately 500 000 MDR-TB cases worldwide), and following the introduction of potential MDR-TB control strategies projections of these figures are being estimated. The projected trends in tuberculosis (TB) and MDR-TB incidence vary. Risk factors for resistance can be divided into two categories: 1) those facilitating the selection of resistance in the community and 2) the specific conditions that appear to increase some patients' vulnerability to resistance. The epidemiological situation varies greatly across countries, principally due to poor treatment practices and poor implementation of control programmes in the past-and even today, to a lesser degree-and recent data have suggested that national TB programmes that use existing drugs efficiently can postpone and even reverse the MDR-TB epidemic. Other factors that have also contributed to this epidemic situation are analysed in this article. The recognition of factors leading to the epidemic in some regions and the identification of populations at risk will assist in focusing case-finding efforts. From an individual perspective, treatment failures with first-line rifampicin-containing regimens and contacts of MDR-TB cases have the highest rates of resistance. Patients previously treated for TB and the other risk factors analysed in this article should be prioritised in case finding.

  20. Histopatholological Findings in a Fatal Case of Rinkhals Envenomation: A New Forensic Pathology Finding?

    PubMed

    Moar, Jacob Joseph; Hill, Lawrence; Stewart, Michael

    2016-12-01

    Although cobra envenomation continues to pose a threat to life and therefore constitutes a major cause of death in Africa, India, and Sri Lanka, the forensic pathology reports are not always histologically well documented or illustrated. The reports in the literature, although providing graphic evidence of the macroscopic appearances of the bite and its ensuing tissue necrosis, should the victim survive, often do not illustrate the histopathological findings to a sufficient degree. We present an unusual case of fatal envenomation by a rinkhals (Hemachatus haemachatus) in which the victim had been bitten a second time after a previous rinkhals' bite. Two issues therefore arose: (a) whether the histopathological findings in the spleen were an acute reaction to the snake bite or were due to immunostimulation as a consequence of the previously inflicted bite, and (b) the previously undocumented finding of extravasation of erythrocytes into the surrounding Virchow-Robin spaces in the brain, a finding usually associated with blunt head trauma and therefore interpreted as a cortical contusion hemorrhage by forensic pathologists.

  1. Intensified coastal development behind nourished beaches

    NASA Astrophysics Data System (ADS)

    Armstrong, Scott; Lazarus, Eli; Limber, Patrick; Goldstein, Evan; Thorpe, Curtis; Ballinger, Rhoda

    2016-04-01

    Population density, housing development, and property values in coastal counties along the U.S. Atlantic and Gulf Coasts continue to rise despite increasing hazard from storm impacts. Since the 1970s, beach nourishment, which involves importing sand to deliberately widen an eroding beach, has been the main strategy in the U.S. for protecting coastal properties from erosion and flooding hazards. Paradoxically, investment in hazard protection may intensify development. Here, we examine the housing stock of all existing shorefront single-family homes in Florida - a microcosm of U.S. coastal hazards and development - to quantitatively compare development in nourishing and non-nourishing towns. We find that nourishing towns now account for more than half of Florida's coastline, and that houses in nourishing towns are larger and more numerous. Even as the mean size of single-family homes nationwide has grown steadily since 1970, Florida's shorefront stock has exceeded the national average by 34%, and in nourishing towns by 45%. This emergent disparity between nourishing and non-nourishing towns in Florida demonstrates a pattern of intensifying coastal risk, and is likely representative of a dominant trend in coastal development more generally. These data lend empirical support to the hypothesis that US coastal development and hazard mitigation through beach nourishment have become dynamically coupled.

  2. Toxicological findings in three cases of suicidal asphyxiation with helium.

    PubMed

    Oosting, Roelof; van der Hulst, Rogier; Peschier, Leo; Verschraagen, Miranda

    2015-11-01

    Toxicological findings in deaths by asphyxiation due to a pure inert gas like helium are rare. We present three suicide cases of asphyxial death attributed to anoxia caused by inhalation of helium in a plastic bag positioned over the head. In one case, lung tissue, brain tissue and heart blood were obtained during standard autopsy procedures. In two cases, samples were obtained differently: heart blood, femoral blood, brain tissue, lung tissue and/or air from the lungs were directly sealed into headspace vials during autopsy. Air from the lungs was collected using a syringe and transferred into an aluminum gas sampling bag which was heat sealed as soon as possible. Semi-quantitative gas analyses were performed using headspace gas chromatography-thermal conductivity detection (HS-GC/TCD) with a molsieve column capable of separating permanent gasses. Nitrogen was used as carrier gas. In the first case no helium was detected in lung tissue, brain tissue and heart blood. In the second case the presence of helium was detected in lung tissue (approximately 5% helium in gaseous phase) but not in femoral blood. In the third case the presence of helium was detected in air from the lungs (0.05%), lung tissue (0.4%), brain tissue (0.1%) and heart blood (0.04%). Helium is easily lost if sampling is not performed properly. The presented cases suggest that quick sample collection of various matrices during autopsy is suitable to detect gasses like helium in postmortem cases. Use of HS-GC/TCD enables to detect an inert gas like helium. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Aquagenic syringeal acrokeratoderma: report of a case with histologic findings.

    PubMed

    Baldwin, Brooke T; Prakash, Amy; Fenske, Neil A; Messina, Jane L

    2006-05-01

    Aquagenic syringeal acrokeratoderma is a rare acquired condition characterized by painful symmetric swelling and hypopigmentation of the palms and lateral fingers, which develops after brief exposure to water. Histopathologic examination suggests that an aberration in the eccrine sweat gland apparatus may be the underlying cause of this condition. The "hand-in-the-bucket sign," in which patients arrive in their physician's office with their hand in a bucket of water to more readily demonstrate their lesions, is such a common presentation that it almost can be regarded as pathognomonic. All 12 cases reported to date have been in young females. We report a case of aquagenic syringeal acrokeratoderma in a male with unique histologic findings.

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

    PubMed Central

    Afzali, Nargess; Ahmadi, Firoozeh; Akhbari, Farnaz

    2013-01-01

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

  5. On the phonetics of intensifying emphasis in German.

    PubMed

    Niebuhr, Oliver

    2010-01-01

    This paper presents an exploratory study in the field of emphasis in German. It provides a comprehensive acoustic analysis for a type of emphasis that intensifies lexical meanings either positively or negatively. A speech corpus was recorded using an elicitation method adapted to yield natural-sounding, conversational, expressive speech under controlled conditions. Supporting the distinction between positive and negative intensification, two clearly different phonetic profiles emerged. These phonetic profiles of positive and negative intensification involve voice quality as well as the dynamics of the speech signal across its segmental and prosodic layers. By means of these profiles, the intensifying emphases were correctly classified by a discriminant analysis as positive or negative in around 90% of the cases. Moreover, indications were found for a third type of intensifying emphasis, which was called 'reinforcement'. Its multidimensional phonetic profile falls in between the ones of positive and negative intensification. Copyright © 2010 S. Karger AG, Basel.

  6. Bilateral invasive lobular breast cancer in a female teenager: a rare finding of a common disease--case report and review of literature.

    PubMed

    Enownchong, Enow-Orock George; Thomas, Egbe Obinchemti; Akum, Achidi Eric; Defang, Asonganyi Etienne; Paul, Ndom; Emmanuel, Fongang; Peter, Ndumbe

    2010-07-19

    Management of cancer patients in low-resource communities presents enormous challenges. Breast cancer is a public health problem in Cameroon and occurs mostly in elderly women. The predominant histological type is a duct carcinoma. Lobular carcinoma in teenagers is rare. In this report we present a case of bilateral invasive lobular carcinoma of the breast that was confirmed on biopsies in a 22-year-old female. We present this rare finding and review the pathological, clinical and radiographic challenges of the disease. Nodules in the breast from patients of any age should be submitted for histology. Public education is beneficial and should be intensified.

  7. Risk Factors for Inadequate TB Case Finding in Rural Western Kenya: A Comparison of Actively and Passively Identified TB Patients

    PubMed Central

    van’t Hoog, Anna H.; Marston, Barbara J.; Ayisi, John G.; Agaya, Janet A.; Muhenje, Odylia; Odeny, Lazarus O.; Hongo, John; Laserson, Kayla F.; Borgdorff, Martien W.

    2013-01-01

    Background The findings of a prevalence survey conducted in western Kenya, in a population with 14.9% HIV prevalence suggested inadequate case finding. We found a high burden of infectious and largely undiagnosed pulmonary tuberculosis (PTB), that a quarter of the prevalent cases had not yet sought care, and a low case detection rate. Objective and methods We aimed to identify factors associated with inadequate case finding among adults with PTB in this population by comparing characteristics of 194 PTB patients diagnosed in a health facility after self-report, i.e., through passive case detection, with 88 patients identified through active case detection during the prevalence survey. We examined associations between method of case detection and patient characteristics, including HIV-status, socio-demographic variables and disease severity in univariable and multivariable logistic regression analyses. Findings HIV-infection was associated with faster passive case detection in univariable analysis (crude OR 3.5, 95% confidence interval (CI) 2.0–5.9), but in multivariable logistic regression this was largely explained by the presence of cough, illness and clinically diagnosed smear-negative TB (adjusted OR (aOR) HIV 1.8, 95% CI 0.85–3.7). Among the HIV-uninfected passive case detection was less successful in older patients aOR 0.76, 95%CI 0.60–0.97 per 10 years increase), and women (aOR 0.27, 95%CI 0.10–0.73). Reported current or past alcohol use reduced passive case detection in both groups (0.42, 95% CI 0.23–0.79). Among smear-positive patients median durations of cough were 4.0 and 6.9 months in HIV-infected and uninfected patients, respectively. Conclusion HIV-uninfected patients with infectious TB who were older, female, relatively less ill, or had a cough of a shorter duration were less likely found through passive case detection. In addition to intensified case finding in HIV-infected persons, increasing the suspicion of TB among HIV-uninfected women

  8. Increased Case Notification through Active Case Finding of Tuberculosis among Household and Neighbourhood Contacts in Cambodia

    PubMed Central

    Morishita, Fukushi; Eang, Mao Tan; Nishikiori, Nobuyuki; Yadav, Rajendra-Prasad

    2016-01-01

    Background Globally, there has been growing evidence that suggests the effectiveness of active case finding (ACF) for tuberculosis (TB) in high-risk populations. However, the evidence is still insufficient as to whether ACF increases case notification beyond what is reported in the routine passive case finding (PCF). In Cambodia, National TB Control Programme has conducted nationwide ACF with Xpert MTB/RIF that retrospectively targeted household and neighbourhood contacts alongside routine PCF. This study aims to investigate the impact of ACF on case notifications during and after the intervention period. Methods Using a quasi-experimental cluster randomized design with intervention and control arms, we compared TB case notification during the one-year intervention period with historical baseline cases and trend-adjusted expected cases, and estimated additional cases notified during the intervention period (separately for Year 1 and Year 2 implementation). The proportion of change in case notification was compared between intervention and control districts for Year 1. The quarterly case notification data from all intervention districts were consolidated, aligning different implementation quarters, and separately analysed to explore the additionality. The effect of the intervention on the subsequent case notification during the post-intervention period was also assessed. Results In Year 1, as compared to expected cases, 1467 cases of all forms (18.5%) and 330 bacteriologically-confirmed cases (9.6%) were additionally notified in intervention districts, whereas case notification in control districts decreased by 2.4% and 2.3%, respectively. In Year 2, 2737 cases of all forms (44.3%) and 793 bacteriologically-confirmed cases (38%) were additionally notified as compared to expected cases. The proportions of increase in case notifications from baseline cases and expected cases to intervention period cases were consistently higher in intervention group than in control

  9. Imaging findings of primary gastric plasmacytoma: a case report.

    PubMed

    Zhao, Zhen-Hua; Yang, Jian-Feng; Wang, Jin-Dao; Wei, Jian-Guo; Liu, Fang; Wang, Bo-Yin

    2014-08-07

    Primary gastric plasmacytoma (GP) is a rare extramedullary plasmacytoma with clinical and imaging features that are common among other gastric tumors, such as gastric adenocarcinomas, gastric stromal tumors, and lymphomas. Here, we present a histologically confirmed case of primary GP examined with biphasic computed tomography (CT), magnetic resonance imaging (MRI), and endosonography. A well-circumscribed extraluminal mass appearing as homogeneous attenuation/intensity with gradual enhancement was identified on biphasic enhancement CT and MRI. This mass was hyperintense on diffusion-weighted imaging and hypointense on the apparent diffusion coefficient map, implying that water diffusion in the mass was restricted. In addition, endosonography indicated a low echogenic mass in the gastric wall. These imaging findings increase the available knowledge about imaging of this disease and provide valuable information for differentiating primary GP from common gastric tumors.

  10. Sprengel deformity: magnetic resonance imaging findings in two pediatric cases.

    PubMed

    Dilli, Alper; Ayaz, Umit Yaşar; Damar, Cagrι; Ersan, Onder; Hekimoglu, Baki

    2011-01-01

    The characteristics of Sprengel deformity, which is also called congenital high scapula, are malposition and dysplasia of the affected scapula, with possible omovertebral connection. The aim of the present study was mainly to present the magnetic resonance imaging (MRI) findings of two pediatric cases of Sprengel deformity. A 7-year-old girl and a 9-year-old boy with deformities in their right shoulder were studied. Plain radiographs were obtained. MRI was performed for both children. The fibrous omovertebral connection is depicted in its longest form in one plane. Omovertebral band is best screened in coronal and axial cross sections. We are introducing a new MRI sign which we named as "Ra's eye" to define the appearance of omovertebral band within the surrounding fat tissue.

  11. Sprengel Deformity: Magnetic Resonance Imaging Findings in Two Pediatric Cases

    PubMed Central

    Dilli, Alper; Ayaz, Umit Yaşar; Damar, Çagrι; Ersan, Önder; Hekimoglu, Baki

    2011-01-01

    The characteristics of Sprengel deformity, which is also called congenital high scapula, are malposition and dysplasia of the affected scapula, with possible omovertebral connection. The aim of the present study was mainly to present the magnetic resonance imaging (MRI) findings of two pediatric cases of Sprengel deformity. A 7-year-old girl and a 9-year-old boy with deformities in their right shoulder were studied. Plain radiographs were obtained. MRI was performed for both children. The fibrous omovertebral connection is depicted in its longest form in one plane. Omovertebral band is best screened in coronal and axial cross sections. We are introducing a new MRI sign which we named as “Ra's eye” to define the appearance of omovertebral band within the surrounding fat tissue. PMID:21977386

  12. Infantile osteopetrosis: a case report on dental findings.

    PubMed

    Droz-Desprez, D; Azou, C; Bordigoni, P; Bonnaure-Mallet, M

    1992-10-01

    In this paper we have described the case of a 7-yr-old Moroccan osteopetrotic boy, who had received a bone marrow transplant (BMT). He was transplanted from his older brother and, despite immunosuppressive therapy, developed chronic graft-versus-host disease and was placed on corticotherapy. Seven months after the bone marrow transplant, graft versus host disease (GVHD) was stabilized, but corticotherapy had inhibited growth. There was evidence of normalizing bone, his hearing was better but he had not recovered vision. Dental findings before the bone marrow transplant revealed some missing teeth, failure of teeth to erupt and decayed teeth but no enamel hypoplasia. The patient had developed one carious lesion on one unerupted tooth: bacteria seem to have found a way through the gubernaculum dentale. The scanning electronmicrographs showed decayed tooth and tissues fitted into each other. Since the bone marrow transplant, no tooth has erupted. We think that, in this case, failure of tooth eruption would be the sign of osteopetrosis.

  13. Findings

    MedlinePlus

    ... Issue All Issues Explore Findings by Topic Cell Biology Cellular Structures, Functions, Processes, Imaging, Stress Response Chemistry ... Glycobiology, Synthesis, Natural Products, Chemical Reactions Computers in Biology Bioinformatics, Modeling, Systems Biology, Data Visualization Diseases Cancer, ...

  14. Fibrodysplasia Ossificans Progressiva - Radiological Findings: A Case Report

    PubMed Central

    Al-Salmi, Ishaq; Raniga, Sameer; Hadidi, Aymen Al

    2014-01-01

    Fibrodysplasia ossificans progressiva formerly known as Myositis ossificans progressiva is a rare hereditary mesodermal disorder. It is characterized by congenital skeletal anomalies and progressive ectopic bone formation in connective tissue, resulting in mature ossification within soft tissues and bridging between osseous structures. It is extremely rare and has an incidence of one in two million people. Usually, it has typical clinical and radiographic features. Here, we present a case of a young patient diagnosed to have an advanced fibrodysplasia ossificans progressiva. Plain radiographs provide characteristic findings, and radiologists may play a major role in diagnosing and preventing invasive procedures or further traumatic insults to the affected patient. Though rare, diagnosis of fibrodysplasia ossificans progressiva should be considered whenever characteristic radiographic features of multifocal heterotopic bone formation is seen along with the valgus deformities of the big toes. Being a rare condition, treatment guidelines are not clear and this condition needs further research. Keywords Myositis ossificans progressiva; Fibrodysplasia ossificans progressiva; Heterotopic ossification; Myositis ossificans. PMID:25337316

  15. Southwest Research Institute intensified detector development capability

    NASA Astrophysics Data System (ADS)

    Wilkinson, Erik; Vincent, Michael; Kofoed, Christopher; Andrews, John; Brownsberger, Judith; Siegmund, Oswald

    2012-09-01

    Imaging detectors for wavelengths between 10 nm and 105 nm generally rely on microchannel plates (MCPs) to provide photon detection (via the photo-electric effect) and charge amplification. This is because silicon-based detectors (CCD or APS) have near zero quantum detection efficiency (QDE) over this wavelength regime. Combining a MCP based intensifier tube with a silicon detector creates a detector system that can be tuned to the wavelength regime of interest for a variety of applications. Intensified detectors are used in a variety of scientific (e.g. Solar Physics) and commercial applications (spectroscopic test instrumentation, night vision goggles, low intensity cameras, etc.). Building an intensified detector requires the mastery of a variety of technologies involved in integrating and testing of these detector systems. We report on an internally funded development program within the Southwest Research Institute to architect, design, integrate, and test intensified imaging detectors for space-based applications. Through a rigorous hardware program the effort is developing and maturing the technologies necessary to build and test a large format (2k × 2k) UV intensified CCD detector. The intensified CCD is designed around a commercially available CCD that is optically coupled to a UV Intensifier Tube from Sensor Sciences, LLC. The program aims to demonstrate, through hardware validation, the ability to architect and execute the integration steps necessary to produce detector systems suitable for space-based applications.

  16. Operational life prediction on gating image intensifier

    NASA Astrophysics Data System (ADS)

    Dong, Yu-hui; Shen, Zhi-guo; Li, Zhong-li

    2009-07-01

    Operational life is one of the important parameters to evaluate second and super second generation image intensifiers. It can be used not only to monitor manufacturing technique in product line, then the technology on photocathode processing, MCP degassing and MCP producing can be adjusted promptly, but also to eliminate the image intensifiers which have hidden risk on operational life as early as possible. Recently gating image intensifiers are used widely, method to estimate the operational life of gating image intensifier related to its practical operate mode and working condition need to be established urgently. The least square method to analyze the operational life test data in product line was introduced in this paper. Now the data can be analyzed with convenient statistic analyze function on Excel. Using "worksheet function" and "chart wizard" and "data analysis" on Excel to do the least square method calculation, spreadsheets are established to do complex data calculation with worksheet functions. Based on them, formulas to monitor the technology parameters were derived, and the conclusion that the operational life was only related to the decrease slope of photocathode exponential fit curve was made. The decrease slope of photocathode sensitivity exponential fit curve and the decrease percent of the exponential fit photocathode sensitivity can be used to evaluate the qualification of the operational life rapidly. The mathematic models for operational life prediction on image intensifier and gating image intensifier are established respectively based on the acceptable values of the decrease percent of the exponential fit photocathode sensitivity and the expecting signal to noise ratio. The equations predicting the operational life related to duty cycle and input light level on gating image intensifier were derived, and the relationship between them were discussed too. The theory foundation were made herein, so the user can select proper gating image

  17. Coeliac disease in primary care: case finding study

    PubMed Central

    Hin, Harold; Bird, Graham; Fisher, Peter; Mahy, Nick; Jewell, Derek

    1999-01-01

    Objectives To provide evidence of underdiagnosis of coeliac disease and to describe the main presenting symptoms of coeliac disease in primary care. Design Case finding in a primary care setting by testing for coeliac disease by using the endomysial antibody test. Setting Nine surgeries in and around a market town in central England, serving a population of 70 000. Participants First 1000 patients screened from October 1996 to October 1997. Outcome measures Determination of endomysial antibody titre of patients fulfilling the study criteria, followed by small intestine biopsy of those with positive results. Results The 30 patients (out of 1000 samples) with positive results on the endomysial antibody test all had histological confirmation on small intestine biopsy. The commonest mode of presentation (15/30) was anaemia of varying severity. Most patients (25/30) presented with non-gastrointestinal symptoms. Specificity of the endomysial antibody test was 30/30. Conclusions Underdiagnosis and misdiagnosis of coeliac disease are common in general practice and often result in protracted and unnecessary morbidity. Serological screening in primary care will uncover a large proportion of patients with this condition and should be made widely available and publicised. Coeliac disease should be considered in patients who have anaemia or are tired all the time, especially when there is a family history of the disease. Key messagesGeneral practitioners currently see many people with undiagnosed coeliac diseaseThe most likely presentation is a combination of microcytic anaemia, past or present, a family history of the disease, and feeling tired all the timeEstimations of endomysial antibody and IgA are reliable diagnostic toolsThe prevalence of coeliac disease in Britain is higher than the accepted figure of 1:1000 populationIncreased awareness of the extra intestinal manifestations of coeliac disease, coupled with a low threshold for serological testing, will uncover a

  18. Cloves syndrome: a case report and perinatal diagnostic findings.

    PubMed

    Puvabanditsin, S; Memon, N; Chekmareva, M; Di Stefano, V; Mehta, R

    2014-01-01

    We report a neonate with prenatal ultrasound imaging features suggestive of CLOVES syndrome, confirmed postnatally by clinical and imaging findings of the constellation of truncal overgrowth, cutaneous capillary malformations, lymphatic and musculoskeletal anomalies. The clinical, radiological and histopathological findings noted in our patient help differentiate from other overgrowth syndromes such as Proteus syndrome. We report perinatal findings and add new clinical findings of this rare syndrome.

  19. Rapidly Intensifying Typhoon Examined By NASA's GPM

    NASA Image and Video Library

    The GPM core observatory satellite flew above Nepartak on July 4 at 2151 UTC (5:51 p.m. EDT). GPM identified very tall thunderstorm towers near the center of the intensifying tropical storm. These ...

  20. [Intensified insulin treatment is cost-effective].

    PubMed

    Reichard, P; Alm, C; Andersson, E; Wärn, I; Rosenqvist, U

    1999-01-20

    Both the Diabetes Control and Complications Trial (DCCT) in USA/Canada, and Stockholm Diabetes Intervention Study (SDIS) showed intensified insulin treatment and reduced glycaemia to prevent complications in patients with insulin-dependent (type I) diabetes mellitus. In the DCCT, the intensified treatment was considered cost-effective. In the SDIS, investigation of the direct increase in costs due to the intensified insulin treatment showed the saving in direct costs due to the reduction in photocoagulation requirements, and in the prevalence of renal insufficiency and of amputation, to correspond to 10 years' intensive insulin treatment. Thus, as intensified insulin treatment in type I diabetes reduces direct suffering at a low cost, it may be regarded as 'evidence-based' and mandatory.

  1. Toxicological findings in cases of sexual assault in the Netherlands.

    PubMed

    Bosman, Ingrid J; Verschraagen, Miranda; Lusthof, Klaas J

    2011-11-01

    Reports on cases of alleged drug-facilitated sexual assault (DFSA) have increased since the mid-1990s. The aim of this study was to identify the extent and types of drugs found in cases of alleged sexual assault (DFSA) in the Netherlands. In total, 135 cases of alleged DFSA were identified. Most of the victims were women (94%), and the mean age of the victims was 25 years. Blood and urine samples were tested for the presence of alcohol, drugs (drugs of abuse and prescription drugs), or both. In 27% of the cases, no alcohol and/or drugs were found. With increasing time delay, more cases were found to be negative. Alcohol is the most commonly found drug followed by nonopiate analgesics, illicit drugs, and benzodiazepines. In some cases, the absence of alcohol and drugs may represent false-negative results owing to the time delay between alleged sexual assault and sampling.

  2. Drivers of Learning Cultures within Organisations: Findings from Case Studies.

    ERIC Educational Resources Information Center

    Johnston, Robyn; Hawke, Geof

    The factors driving learning cultures within organizations were examined in case studies of seven organizations in New South Wales and South Australia. The seven organizations represented the pharmaceutical manufacturing, community services and health, agriculture, information technology, and local government sectors. In some cases, organizations'…

  3. Hypothermia secondary to glioblastoma multiforme? Autopsy findings in two cases.

    PubMed

    Morgan, Matthew; Schwartz, Liliana; Duflou, Johan

    2015-03-01

    Death due to accidental primary hypothermia in cold climates is relatively common, with previous case series reflecting this. In contrast, hypothermia-related death as a result of an underlying medical cause, such as a brain tumor, is rare. The literature clearly illustrates a theoretical causal relationship between brain neoplasms and hypothermia through the infiltration of the hypothalamus; however, the number of reported cases is minimal. Two cases are presented where autopsy confirmed hypothermia as the cause of death with both cases revealing widespread glioblastoma multiforme in the brain. Both decedents were elderly with a number of comorbidities identified during autopsy that could explain death; however, hypothermia was deemed the most likely cause. It is proposed that both decedents died of hypothermia as a result of the tumor's effect on thermoregulation. These cases underline the importance of forensic pathologists to be aware of the relationship between brain tumors and hypothermia and to not dismiss death as being due to other disease processes.

  4. Isolated breast vasculitis manifested as breast edema with suggestive sonographic findings: a case report with imaging findings.

    PubMed

    Lee, Ji Young; Joo, Mee

    2017-04-01

    Early diagnosis of breast vasculitis (BV) is difficult because this condition is rare and occasionally mimics breast cancer clinically or radiologically. It may present as systemic disease or as an isolated lesion in the breast, without systemic evidence. When vasculitis appears in the breast, it also might manifest as a tumor-like lesion, and in previous cases, tissue acquisition was needed for confirmation of the diagnosis because of BV's resemblance to inflammatory breast cancer. We report a case of isolated BV that was suspected of being inflammatory breast cancer clinically, but manifested as bilateral breast edema on mammography. In this case, sonographic findings included not only nonspecific edema findings that might be seen in other cases, but also suggestive findings of hypoechoic circumferential arterial wall thickening with perivascular fat infiltrations that are similar to the halo sign in large arteries but have not been reported in the breast. These are helpful for presumptive diagnosis of BV using ultrasound.

  5. The KBG syndrome, characteristic dental findings: a case report.

    PubMed

    Dowling, P A; Fleming, P; Gorlin, R J; King, M; Nevin, N C; McEntagart, M

    2001-03-01

    Short stature and developmental delay may be observed in many genetic conditions and well-defined syndromes. A 7-year-old girl presented with the non-specific findings of subtle dysmorphism, short stature and developmental delay. Although a genetic syndrome was suspected, a definitive diagnosis was not made until the dental findings of KBG syndrome were recognised, namely grossly enlarged maxillary permanent central incisors and hypodontia.

  6. Medico-Legal Findings, Legal Case Progression, and Outcomes in South African Rape Cases: Retrospective Review

    PubMed Central

    Jewkes, Rachel; Christofides, Nicola; Vetten, Lisa; Jina, Ruxana; Sigsworth, Romi; Loots, Lizle

    2009-01-01

    Background Health services for victims of rape are recognised as a particularly neglected area of the health sector internationally. Efforts to strengthen these services need to be guided by clinical research. Expert medical evidence is widely used in rape cases, but its contribution to the progress of legal cases is unclear. Only three studies have found an association between documented bodily injuries and convictions in rape cases. This article aims to describe the processing of rape cases by South African police and courts, and the association between documented injuries and DNA and case progression through the criminal justice system. Methods and Findings We analysed a provincially representative sample of 2,068 attempted and completed rape cases reported to 70 randomly selected Gauteng province police stations in 2003. Data sheets were completed from the police dockets and available medical examination forms were copied. 1,547 cases of rape had medical examinations and available forms and were analysed, which was at least 85% of the proportion of the sample having a medical examination. We present logistic regression models of the association between whether a trial started and whether the accused was found guilty and the medico-legal findings for adult and child rapes. Half the suspects were arrested (n = 771), 14% (209) of cases went to trial, and in 3% (31) of adults and 7% (44) of children there was a conviction. A report on DNA was available in 1.4% (22) of cases, but the presence or absence of injuries were documented in all cases. Documented injuries were not associated with arrest, but they were associated with children's cases (but not adult's) going to trial (adjusted odds ratio [AOR] for having genital and nongenital injuries 5.83, 95% confidence interval [CI] 1.87–18.13, p = 0.003). In adult cases a conviction was more likely if there were documented injuries, whether nongenital injuries alone AOR 6.25 (95% CI 1.14–34.3, p = 0

  7. Mazabraud's syndrome. New clinical case and review of findings.

    PubMed

    Ramírez Mejía, Alex Roberto; Moreno Casado, María José; Ahumada Pavez, Nicolás Rodrigo; Rojas Soldado, María Ángeles

    Intramuscular myxomas are benign and rare tumors that affects predominantly the lower limbs. The association of myxomas and fibrous dysplasia, usually polyostotic, is rarer. This association is known as Mazabraud's syndrome, of which about 81 cases have been described in the literature. We present a new case of this uncommon association to emphasise the importance of recognizing this syndrome in the diagnosis and appropriate management of the patient. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  8. Tuberculous sacro-ileitis: two cases and radiological findings.

    PubMed

    Sirmatel, Ocal; Yazgan, Pelin; Gursoy, Bensu; Sirmatel, Fatma; Zeyrek, Fadile Yildiz; Ozturk, Adil

    2007-06-01

    Infective sacro-ileitis is due to common bacteria, 25% being tuberculosis and 10% brucellosis. Slow progression characterizes joint tuberculosis, an uncommon variant of this disease. The onset is usually insidious, and early diagnosis requires a high index of clinical suspicion. We report two cases with tuberculous sacro-ileitis which initially mimicked brucellosis infiltration. Diagnosis of tuberculosis of the sacroiliac joint was established by fine-needle aspiration of joint and radiological imaging methods such as computerized tomography, magnetic resonance and three-phase bone scan. The current diagnosis and treatment of this condition is discussed based on these cases and a literature review.

  9. Lipoid proteinosis: A case with ophthalmological and psychiatric findings.

    PubMed

    Bahadir, Sevgi; Cobanoğlu, Umit; Kapicioğlu, Zerrin; Kandil, Sema Tanriöver; Cimşit, Gülseren; Sönmez, Müjgan; Yayli, Savaş

    2006-03-01

    Lipoid proteinosis (LP) is an uncommon, recessively inherited disorder. The disease usually has its onset in the newborn period and is manifested by hoarseness. The skin and mucous membrane involvement arises between the first and second year of age. A 14-year-old male presented with the complaint of blistering on various sites of his skin, from the age of 12 months, resulting in scarring. Ophthalmological and psychiatric findings also appeared during the clinical course. The histological findings of skin biopsy included extensive deposits of amorphous eosinophilic material in the papillary dermis. No known therapy exists for LP.

  10. Discovery and Use of Online Learning Resources: Case Study Findings

    ERIC Educational Resources Information Center

    Recker, Mimi M.; Dorward, James; Nelson, Laurie Miller

    2004-01-01

    Much recent research and funding have focused on building Internet-based repositories that contain collections of high-quality learning resources, often called "learning objects." Yet little is known about how non-specialist users, in particular teachers, find, access, and use digital learning resources. To address this gap, this article…

  11. Case Studies in Science Education, Booklet XIII: Findings II.

    ERIC Educational Resources Information Center

    Illinois Univ., Urbana. Center for Instructional Research and Curriculum Evaluation.

    This booklet is the fourteenth of a series of 16 booklets that together describe and present findings for a study which involved field observations and a survey of science teaching and learning in American public schools during the school year 1976-77. The study was undertaken to provide the National Science Foundation with a portrayal of current…

  12. Case Studies in Science Education, Booklet XIV: Survey Findings.

    ERIC Educational Resources Information Center

    Illinois Univ., Urbana. Center for Instructional Research and Curriculum Evaluation.

    This booklet is the fifteenth of a series of 16 booklets that together describe and present findings for a study which involved field observations and a survey of science teaching and learning in American public schools during the school year 1976-77. The study was undertaken to provide the National Science Foundation with a portrayal of current…

  13. [Ophthalmological findings in pediatric brain neoplasms: 58 cases].

    PubMed

    Santamaría, A; Martínez, R; Astigarraga, I; Etxebarría, J; Sánchez, M

    2008-08-01

    To describe the visual manifestations of brain neoplasms, and to analyze the effect of tumor control on these. This is a descriptive retrospective study, which includes patients under 14 years of age, suffering from different brain neoplasms in our hospital between 1996 and 2005 inclusive. In the group of patients with low visual acuity, 44% had organic amblyopias. In 28% of cases, the amblyopia was secondary to the strabismus/nystagmus produced by the developing tumor. Corrective treatment was successful in some cases of partial or total organic amblyopia. Ophthalmologic evaluation (including perimetry and fundoscopy) enabled detection of 3 tumor relapses. Visual analysis (visual acuity, perimetry, fundoscopy) should be an essential component of assessment during brain neoplasm treatment and follow-up. Corrective treatment is sometimes successful in organic amblyopias

  14. Ischiogluteal bursitis: a report of three cases with MR findings.

    PubMed

    Hitora, Toshiaki; Kawaguchi, Yoji; Mori, Masaki; Imaizumi, Yasuhiko; Akisue, Toshihiro; Sasaki, Kanji; Yamada, Eiji; Yamamoto, Tetsuji

    2009-02-01

    Ischiogluteal bursitis is an uncommon disorder which can be confused with neoplastic conditions in the buttock. Three cases of ischiogluteal bursitis in a 57-year-old man, a 73-year-old woman and a 73-year-old man are presented. All patients presented with a gradually increasing, painful buttock mass. Magnetic resonance imaging (MRI) revealed a soft tissue mass around the ischial tuberosity and showed various features in the three cases. Two patients underwent excision of the lesion, which was histologically diagnosed as ischiogluteal bursitis. One patient was conservatively treated and the symptoms gradually decreased. MRI was very useful in diagnosing and detecting the lesion. Ischiogluteal bursitis should be considered in the differential diagnosis of a buttock mass.

  15. Cheilitis glandularis: Case report with respect to immunohistochemical findings.

    PubMed

    Friedrich, Reinhard E; Löning, Thomas

    2016-01-01

    Cheilitis glandularis (CG) is a rare benign affection of the lip mucosa. The etiology and pathogenesis of CG are unknown. Surgical measures are the leading therapeutic options to treat CG. This case report on a 55-year-old female illustrates the recurrent affection of the lips over several years and local therapy. Furthermore, the study of the resected glands intends to differentiate the lesions with respect to the recently introduced concept of immunoglobulin G4-related diseases.

  16. Fitz-Hugh-Curtis syndrome: CT findings of three cases.

    PubMed

    Cho, Hyeon Je; Kim, Ho Kyun; Suh, Jung Ho; Lee, Ghi Jai; Shim, Jae-Chan; Kim, Young Hwa

    2008-01-01

    Clinical manifestations and computed tomography (CT) findings of Fitz-Hugh-Curtis syndrome (FHCS) are relatively well stabilized as right upper quadrant abdominal pain and hepatic capsular enhancement because of perihepatitis associated with pelvic inflammatory disease caused by N. gonorrhoeae and C. trachomatis. We encountered three patients with serial FHCS associated with pelvic inflammatory disease, who visited the emergency room with right upper quadrant abdominal pain. Abdominal CT revealed hepatic capsular or pericapsular enhancement along the anterior surface of the liver on the arterial phase. Recently, multi-detector CT has evolved as the first-line imaging modality of acute abdomen at the emergency room; we reemphasized the importance of the CT findings of this syndrome for differential diagnosis of right upper quadrant abdominal pain in sexually active young women. Physicians at the emergency room acknowledge the syndrome and should perform dynamic abdominopelvic CT including the arterial phase.

  17. Demountable readout technologies for optical image intensifiers

    NASA Astrophysics Data System (ADS)

    Lapington, J. S.; Howorth, J. R.; Milnes, J. S.

    2007-04-01

    We describe a generic microchannel plate intensifier design for use with a variety of demountable readout devices manufactured using standard multi-layer PCB techniques. We present results obtained using a 50 Ω multi-element design optimized for high speed operation and a four electrode multi-layer device developed from the wedge and strip anode with enhanced image resolution. The benefits of this intensifier design are discussed and a project to develop a detector system for bio-medical applications using a demountable readout device with integrated multi-channel ASIC-based electronics is announced.

  18. A vortex flow intensified by thermal convection

    NASA Astrophysics Data System (ADS)

    Makhmalbaf, M. H.; Liu, Tianshu; Merati, Parviz

    2017-01-01

    This paper describes a thermal-convection-intensified vortex flow within a rotating cylinder with a counter-rotating heated disk located below. This flow tends to mimic certain aspects of the intriguing flow structure of the great red spot in Jupiter by using a simple laboratory setup. Particle image velocimetry measurements reveal the counter-rotating torus vortices in the lower and upper domains and the complex mixing-layer features in the transitional domain between them. In particular, it is found that the vortex structures are significantly intensified by the thermal convection from the heated disk.

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

    PubMed Central

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

    2015-01-01

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

  20. Clinical Needs Finding: Developing the Virtual Experience, A Case Study

    PubMed Central

    Mittal, Vaishali; Thompson, Megan; Altman, Stuart M; Taylor, Peter; Summers, Alexander; Goodwin, Kelsey; Louie, Angelique Y

    2013-01-01

    We describe an innovative program at the University of California, Davis for students to engage in clinical needs finding. Using a team-based approach, students participated in clinical rotations to observe firsthand the needs of clinicians at the university affiliated medical center. The teams were asked to develop documentary-style videos to capture key experiences that would allow future viewers to use the videos as “virtual” clinical rotations. This was conceived as a strategy to allow students in prohibitively large classes, or students in programs at institutions without associated medical or veterinary school programs, to experience clinical rotations and perform needs assessments. The students' perspectives on the experience as well as instructor analysis of best practices for this type of activity are presented and discussed. We found that the internship experience was valuable to the students participating, by not only introducing the practice of needs finding but for increasing the students' confidence in the practice of engineering design and their ability to work independently. The videos produced were of such high quality that instructors from other institutions have requested copies for instructional use. Virtual clinical rotations through video experiences may provide a reasonable substitute for students who do not have the ability to participate in rotations in person. PMID:23483373

  1. Case Report: Incidental Finding of a Giant Cardiac Mass

    PubMed Central

    2014-01-01

    Coronary artery fistula (CAF) is a rare anomalous connection between a coronary artery and another coronary artery, major vessel, or cardiac chamber. Prevalence of CAF is reportedly 1% to 2% in patients who undergo coronary angiography.1 One of the most common complications of CAF is formation of a coronary artery aneurysm (CAA). A study conducted by Said and colleagues in 1995 found that CAA formation was present in 26% of patients who had proven CAF by way of angiography.2 Although a precise definition of the term “giant” CAA is still lacking, it generally refers to a dilatation that exceeds the reference vessel diameter by four times.3 We report an interesting case of a 38-year-old patient who was incidentally found to have a presumed large right ventricular aneurysm, which after an open-heart surgery was identified as a CAF with formation of an unruptured giant CAA. PMID:25114764

  2. Findings from case studies of state and local immunization programs.

    PubMed

    Fairbrother, G; Kuttner, H; Miller, W; Hogan, R; McPhillips, H; Johnson, K A; Alexander, E R

    2000-10-01

    As part of its examination of federal support for immunization services during the past decade, the Institute of Medicine (IOM) Committee on Immunization Finance Policies and Practices (IFPP) commissioned eight case studies of the states of Alabama, Maine, Michigan, New Jersey, North Carolina, Texas, and Washington; and a two-county study of Los Angeles and San Diego in California. Specifically, the IOM Committee and these studies reviewed the use of Section 317 grants by the states. Section 317 is a discretionary grant program that supports vaccine purchase and other immunization-related program activities. These studies afforded the Committee an in-depth look at local policy choices, the performance of immunization programs, and federal and state spending for immunization during the past decade. The case-study reports were developed through interviews with state and local health department officials, including immunization program directors, Medicaid agency staff, budget analysts, and Centers for Disease Control and Prevention public health advisors to the jurisdiction. Other sources included state and federal administrative records and secondary sources on background factors and state-level trends. The case studies were supplemented by site visits to Detroit, Houston, Los Angeles, Newark, and San Diego. The nature of immunization "infrastructure" supported by the Section 317 program is shifting from primarily service delivery to a broader set of roles that puts the public effort at the head of a broad immunization partnership among public health, health financing, and other entities in both the public and private sectors. The rate and intensity of transition vary across the case-study areas. In the emerging pattern, service delivery increasingly takes place in the private sector and is related to managed care. "Infrastructure" is moving beyond supporting a core state staff and local health department service delivery to include such activities as immunization

  3. Imaging findings of swallowed dentures: a case series.

    PubMed

    Chawla, Ashish; Bosco, Jerome; Subramanian, Manickam; Chokkapan, Kabilan; Shenoy, Jagadish; Lim, Tze Chwan

    2015-12-01

    Dental prosthesis is an uncommon ingested non-food foreign body in adults. Once swallowed, it can lead to serious complications and morbidity. Hence, early localization of the offending foreign body is crucial for timely management. As the dentures are usually made up of non-metallic material and often impacted at or below the level of C7 vertebra, conventional radiograph has limited role in their evaluation. We describe the clinical history and imaging findings of swallowed partial dentures in four patients who presented to the emergency department. The dentures were localized using unenhanced CT of the neck that showed the characteristic mildly hyperdense curvilinear or irregular appearance of the dentures within the upper esophagus. Multiplanar CT reconstructions provide an orientation of the ingested denture within the esophagus, thus guiding the endoscopist.

  4. Particle detection with intensified laser beam

    NASA Technical Reports Server (NTRS)

    Knollenberg, R. G.

    1972-01-01

    Application of external and laser output mirrors to produce intensified light beam for measurement of light scattered by dispersed particles is described. Use of fiber optics bundles to collect light is discussed. Diagram of equipment and principles of operation are presented.

  5. Leber's congenital amaurosis. Retrospective review of 43 cases and a new fundus finding in two cases.

    PubMed

    Schroeder, R; Mets, M B; Maumenee, I H

    1987-03-01

    Leber's congenital amaurosis is a hereditary clinical disorder that may be associated with several different diseases. This study consists of a retrospective review of 43 cases. Twenty of our patients had fundus appearances that resembled retinitis pigmentosa. Five had normal-appearing fundi. The remainder had other, previously reported fundus abnormalities, with the exception of two patients who demonstrated a new fundus finding, a nummular pigmentary pattern. Other associated eye anomalies included cataracts, keratoconus, ptosis, and strabismus. The most frequent systemic associations were mental retardation, cystic renal disease, skeletal disorders, and hydrocephalus.

  6. Doppler findings in chronic ectopic pregnancy: case report.

    PubMed

    Abramov, Y; Nadjari, M; Shushan, A; Prus, D; Anteby, S O

    1997-05-01

    Chronic ectopic pregnancy is an uncommon form of tubal pregnancy manifested as a pelvic mass with minimal symptoms and a low or absent titer of human chorionic gonadotropin. For this reason, most of the reported cases have been diagnosed only after explorative laparotomy. The value of Doppler ultrasonography for preoperative diagnosis of this entity has not yet been established. We report on a 36-year-old patient who was admitted for intermittent right lower quadrant abdominal pain of 3 months' duration, and a right adnexal mass found on pelvic examination. On Doppler ultrasonography, a right complex adnexal mass was demonstrated, characterized by extensive external vascularization, aberrant vessels and arteriovenous shunting, but with no internal blood flow. Explorative laparotomy revealed a right tubal mass adherent to the omentum, and covered by numerous enlarged and tortuous blood vessels originating in the omentum. Pathological examination of the mass revealed a chronic ectopic pregnancy. The possible contribution of Doppler-specific characteristics for the diagnosis of chronic ectopic pregnancy is described and discussed.

  7. 5 CFR 890.1039 - Cases where additional fact-finding is required.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Cases where additional fact-finding is... Imposed Against Health Care Providers Suspension § 890.1039 Cases where additional fact-finding is required. (a) Criteria for holding fact-finding proceeding. The debarring official shall request...

  8. A Classic Case of Subcutaneous Cysticercosis: A Rare Case with Sonological Findings and Review of Literature

    PubMed Central

    Naren Satya, Srinivas M.; Mayilvaganan, Kamala Retnam; Amogh, V.N.; Balakrishna, B.V.; Gautam, Munnangi Satya; Prathyusha, Ivvala Sai

    2016-01-01

    Summary Background Cysticercosis is a parasitic infection caused by the larval stages of the pork tapeworm, Taenia solium. The subcutaneous form of the disease is a relatively rare clinical entity. Despite its rarity, it is imperative for a radiologist to be aware of this subcutaneous form of the disease and its various radiological patterns while evaluating any subcutaneous swelling. In this paper, we aimed to describe a typical case of ‘subcutaneous cysticercosis involving the left anterior chest wall’ with high resolution ultrasound findings. We also discussed the role of other imaging modalities in a case of subcutaneous cysticercosis. To the best of our knowledge, our case is only the second documented case report of sonological evaluation of subcutaneous cysticercosis involving the left anterior chest wall and the first case with high resolution ultrasound images of the lesion. Case Report An 11-year-old male presented with a painless, subcutaneous swelling over the left anterior chest wall for the last 2 months. High resolution ultrasound showed a well-defined, thin-walled, cystic lesion with an eccentric, echogenic focus in the subcutaneous plane. On change of the posture of the patient, this focus showed mobility. The hypoechoic area surrounding this cyst showed significant exudative fluid collection with diffuse, floating echoes and thin, incomplete internal septations. The adjacent soft tissues were thickened and irregular, suggestive of edema. This was followed by an excision biopsy. Histopathological examination revealed cysticercus cellulose parasite with an extensive mixed inflammatory cell infiltrate in the surrounding tissue. The patient was also administered oral antihelminthic therapy. Repeat ultrasound examination at the end of this management regimen showed complete healing with no e/o any remnant or recurrent cystic lesion, abscess or edema in the subcutaneous plane. Conclusions Subcutaneous cysticercosis is a relatively rare form of

  9. Case of extra pulmonary, pleuro-pulmonary blastoma in a child: pathological and cytogenetic findings.

    PubMed

    Kelsey, A M; McNally, K; Birch, J; Mitchell, E L

    1997-07-01

    We report the cytogenetic findings in a case of Pleuro-Pulmonary Blastoma of Childhood Type II. This is a rare intrathoracic tumour that can occur in the lungs with up to 25% of cases being extra pulmonary.

  10. Face recognition with intensified NIR imagery

    NASA Astrophysics Data System (ADS)

    Socolinsky, Diego A.; Wolff, Lawrence B.; Lundberg, Andrew J.

    2006-04-01

    This paper presents a systematic study of face recognition performance as a function of light level using intensified near infrared imagery. This technology is the most prevalent in both civilian and military night vision equipment, and provides enough intensification for human operators to perform standard tasks under extremely low-light conditions. We describe a comprehensive data collection effort undertaken by the authors to image subjects under carefully controlled illumination and quantify the performance of standard face recognition algorithms on visible and intensified imagery as a function of light level. Performance comparisons for automatic face recognition are reported using the standardized implementations from the CSU Face Identification Evaluation System. The results contained in this paper should constitute the initial step for analysis and deployment of face recognition systems designed to work in low-light level conditions.

  11. Regeneration system for a hydraulic intensifier unit

    SciTech Connect

    Hall, R. W.; Mahal, H. S.; Sonnenberg, S.

    1985-11-26

    A hydraulic intensifier for oil well fracturing and/or erosion drilling, having a pair of intensifier units including a pair of sequentially operated reciprocating ram assemblies powered by hydraulic cylinder motors which are operated to maintain a substantially uniform output fluid pressure from the intensifier unit. Each cylinder motor is supplied from a main source of hydraulic fluid under high pressure which operates on the working faces of the pistons of the cylinder motors. Hydraulic fluid is also supplied to the return face side of each piston in the hydraulic cylinder motor. The return face side of the pistons have a smaller operative area than the working face sides and each can be connected to the main source of supply of hydraulic fluid to the working faces so that as the pistons are driven to their extended positions by application of hydraulic pressure to the working face, the fluid on the return face side can be expelled from the cylinder motors and returned to the working face side to either reduce the fluid flow from the source while maintaining the same cycling rate or maintaining the same flow from the source by increasing the cycling rate and thus increasing the total volume flow. An adjustable pressure relief valve is provided to permit control of the pressure in the well to a maximum desired limit by relieving pressure of the infeed fluid to the hydraulic cylinder motors.

  12. Detection of subsurface-intensified eddies from observations of the sea-surface: a case study for Mediterranean Water Eddies in a long-term high-resolution simulation

    NASA Astrophysics Data System (ADS)

    Ciani, Daniele; Carton, Xavier; Barbosa Aguiar, Ana Claudia; Peliz, Alvaro; Bashmachnikov, Igor; Ienna, Federico; Chapron, Bertrand

    2017-04-01

    Subsurface-intensified eddies are ubiquitous in the world ocean. They can be generated by exchanges of water masses between semi-enclosed evaporation basins and the open ocean or by deep convection. Past and recent studies have shown that these eddies are carriers of large amounts of heat and salt, that they are coherent over inter-annual timescales and that they can migrate for several thousands of miles from their origination areas towards the open ocean. Hence, subsurface-intensified eddies can influence the three-dimensional distribution of oceanic tracers at global scale. The synoptic knowledge of the eddies positions and mean pathways is then crucial for evaluating temperature and salinity budgets in the world ocean. At present day, satellite sensors constitute the ideal tool for the synoptic and global scale observations of the ocean. Since they only provide informations on the oceanic surface, we characterized the signatures that subsurface eddies generate at the sea-surface, to determine the extent to which they can be isolated from the surrounding surface turbulence and be considered as a trace of an underlying eddy. We studied the surface signature of subsurface-intensified anticyclones (Mediterranean Water Eddies - Meddies) in a realistic, long-term (20 years) and high resolution simulation (dx = 3 km) based on the ROMS model. The novelty and advantage of this approach is given by the simultaneous availability of the full 3D eddies characteristics, the ones of the background ocean and of the sea-surface (in terms of sea-surface height, temperature and salinity). This also allowed us to speculate on a synergy between different satellite observations for the automatic detection of subsurface eddies from space. The along trajectory properties and surface signatures of more than 90 long-lived Meddies were analyzed. We showed that the Meddies constantly generate positive anomalies in sea-surface height and that these anomalies are principally related to the

  13. 5 CFR 890.1025 - Cases where additional fact-finding is not required.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Cases where additional fact-finding is... Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1025 Cases where additional fact-finding is not required. In each contest, the debarring official shall determine whether a further...

  14. Case report. Isolated left ventricular myocardium non-compaction: MR imaging findings from three cases.

    PubMed

    Junqueira, F P; Fernandes, F D B; Coutinho, A C; De Pontes, P V; Domingues, R C

    2009-02-01

    The purpose of this study is to report three cases of left ventricular myocardium non-compaction (LVNC), with emphasis on the MRI findings. From May 2006 to February 2007, three patients -- 2 females (6 years and 42 years of age) and 1 male (18 years of age) -- presented to our radiology department, two of them with fatigue, shortness of breath and episodes of syncope and arrhythmia, for further investigation by cardiac MRI because an apparent asymmetrical pattern of hypertrophy of the left ventricular myocardium was suspected by transthoracic echocardiography. The 18-year-old patient was only experiencing arrhythmia, and arrhythmogenic right ventricular dysplasia was suspected. The images (produced by a 1.5T MRI system) were interpreted by two experienced radiologists and post-processed with Argus software (Siemens, Germany) for ejection fraction calculation. In all three patients, MRI aided in the correct identification of prominent ventricular myocardial trabeculations and deep intertrabecular recesses communicating with the ventricular cavity, as well as areas of hypokinesia with depressed systolic function, and showed the absence of myocardial delayed enhancement and other structural heart defects. In conclusion, cardiac MRI was useful for correctly identifying this rare congenital heart disorder and appears to increase diagnostic accuracy. Although considered a rare anomaly, radiologists should be capable of recognizing LVNC, as current non-invasive imaging methods have increased the frequency of this diagnosis and timely detection is vital in considering early-stage transplantation.

  15. 5 CFR 890.1027 - Cases where an additional fact-finding proceeding is required.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Cases where an additional fact-finding... fact-finding proceeding is required. (a) Criteria for holding fact-finding proceeding. The debarring official shall request another OPM official (“presiding official”) to hold an additional...

  16. Characteristics of a microchannel plate intensifier

    NASA Technical Reports Server (NTRS)

    Sandie, W. G.; Mende, S. B.

    1982-01-01

    A telephoto optical system has been designed for imaging applications involving a use of the spectral region from 2000 to 7500 A. The optics images onto the photocathode of a multichannel plate photomultiplier (PMT). Interference filters are employed to provide spectral selectivity. The PMT consists of three microchannel plate intensifiers (MCP), arranged in a 'Z' configuration. MCP photomultiplier pulse height distributions are discussed along with aspects of spatial distribution, the electron gain pulse height distribution, and the charge loss due to edge effects. Attention is given to the electron gain pulse height distribution obtained from four anodes connected in parallel, taking into account a uniform illumination of the photocathode.

  17. An Empirical Method for Intensifying Communication Skill

    NASA Astrophysics Data System (ADS)

    Harada, Shoji

    Quick globalization increases the necessity of higher communication skill for everybody. However, in reality, modern tools such as mobile and internet spoil the face-to-face communication ability among young people. In this paper, reviewing related books of communication skill in conjunction with speaking, hearing, reading and writing is first done on English as well as on Japanese. Parallel to this, self experience-based method for intensifying communication skill is described. Emphasizing points for improving each communication skill are concretely proposed in the body.

  18. Duodenal fat intensifies the perception of heartburn

    PubMed Central

    Meyer, J; Lembo, A; Elashoff, J; Fass, R; Mayer, E

    2001-01-01

    BACKGROUND—Patients with gastro-oesophageal reflux disease (GORD) frequently report that meals high in fat worsen heartburn. Nevertheless, studies to determine whether high fat meals promote gastro-oesophageal reflux have produced conflicting and equivocal conclusions.
PATIENTS AND METHODS—To determine, alternatively, whether fat in the small intestinal lumen intensifies the perception of heartburn, we studied 11 patients with typical heartburn from GORD. After being placed on omeprazole to suppress endogenous acid, these fasting subjects underwent oesophageal perfusions with graded doses of HCl at pH values of 1.0, 1.5, 2.0, and 2.5. Oesophageal perfusions were conducted while the duodenum was perfused with saline (control) and again with fat at 8 g/h.
RESULTS—Time to onset, intensity, and severity of heartburn varied with dose of oesophageal acid (p<0.01). Time to onset was significantly (p<0.01) shorter, and intensity and severity of heartburn significantly (p<0.05) greater, during duodenal perfusion with fat.
CONCLUSION—We conclude that duodenal fat intensifies the perception of heartburn.


Keywords: gastro-oesophageal reflux disease; heartburn; perception; fat PMID:11600463

  19. Modeling of intensified high dynamic star tracker.

    PubMed

    Yan, Jinyun; Jiang, Jie; Zhang, Guangjun

    2017-01-23

    An intensified high dynamic star tracker (IHDST) is a photoelectric instrument and stably outputs three-axis attitude for a spacecraft at very high angular velocity. The IHDST uses an image intensifier to multiply the incident starlight. Thus, high sensitivity of the star detection is achieved under short exposure time such that extremely high dynamic performance is achieved. The IHDST differs from a traditional star tracker in terms of the imaging process. Therefore, we establish a quantum transfer model of IHDST based on stochastic process theory. By this model, the probability distribution of the output quantum number is obtained accurately. Then, we introduce two-dimensional Lorentz functions to describe the spatial spreading process of the IHDST. Considering the interaction of these two processes, a complete star imaging model of IHDST is provided. Using this model, the centroiding accuracy of the IHDST is analyzed in detail. Accordingly, a working parameter optimizing strategy is developed for high centroiding accuracy and improved dynamic performance. Finally, the laboratory tests and the night sky experiment support the conclusions.

  20. Feeling more together: group attention intensifies emotion.

    PubMed

    Shteynberg, Garriy; Hirsh, Jacob B; Apfelbaum, Evan P; Larsen, Jeff T; Galinsky, Adam D; Roese, Neal J

    2014-12-01

    The idea that group contexts can intensify emotions is centuries old. Yet, evidence that speaks to how, or if, emotions become more intense in groups remains elusive. Here we examine the novel possibility that group attention--the experience of simultaneous coattention with one's group members--increases emotional intensity relative to attending alone, coattending with strangers, or attending nonsimultaneously with one's group members. In Study 1, scary advertisements felt scarier under group attention. In Study 2, group attention intensified feelings of sadness to negative images, and feelings of happiness to positive images. In Study 3, group attention during a video depicting homelessness led to greater sadness that prompted larger donations to charities benefiting the homeless. In Studies 4 and 5, group attention increased the amount of cognitive resources allocated toward sad and amusing videos (as indexed by the percentage of thoughts referencing video content), leading to more sadness and happiness, respectively. In all, these effects could not be explained by differences in physiological arousal, emotional contagion, or vicarious emotional experience. Greater fear, gloom, and glee can thus result from group attention to scary, sad, and happy events, respectively.

  1. Enhancing HIV Testing and Treatment among Men Who Have Sex with Men in China: A Pilot Model with Two-Rapid Tests, Single Blood Draw Session, and Intensified Case Management in Six Cities in 2013

    PubMed Central

    Zhang, Dapeng; Li, Chengmei; Meng, Sining; Fu, Xiaojing; Qi, Jinlei; Wang, Peng; Luo, Mei; Dai, Min; Yip, Ray; Sun, Jiangping; Wu, Zunyou

    2016-01-01

    Objectives To explore models to improve HIV testing, linkage to care and treatment among men who have sex with men (MSM) in cooperation with community-based organizations (CBOs) in China. Methods We introduced a new model for HIV testing services targeting MSM in six cities in 2013.These models introduced provision of rapid HIV testing by CBO staff and streamlined processes for HIV screening, confirmation of initial reactive screening results, and linkage to care among diagnosed people. We monitored attrition along each step of the continuum of care from screening to treatment and compared program performance between 2012 and 2013. According to the providers of two rapid tests (HIV screening), four different services delivery models were examined in 2013: Model A = first screen at CDC, second at CDC (Model A = CDC+CDC), Model B = first and second screens at CBOs (Model B = CBO+CBO), Model C = first screen at CBO, second at Hospital (Model C = CBO+Hosp), and Model D = first screen at CBO, second at CDC (Model D = CBO+CDC). Logistic regressions were performed to assess advantages of different screening models of case finding and case management. Results Compared to 2012, the number of HIV screening tests performed for MSM increased 35.8% in 2013 (72,577 in 2013 vs. 53,455 in 2012). We observed a 5.6% increase in proportion of cases screened reactive receiving HIV confirmatory tests (93.9% in 2013 vs. 89.2% in 2012, χ2 = 48.52, p<0.001) and 65% reduction in loss to CD4 cell count tests (15% in 2013 vs. 43% in 2012, χ2 = 628.85, p<0.001). Regarding linkage to care and treatment, the 2013 pilot showed that the Model D had the highest rate of loss between screening reactive and confirmatory test among the four models, with 18.1% fewer receiving a second screening test and a further 5.9% loss among those receiving HIV confirmatory tests. The Model B and the Model C showed lower losses (0.8% and 1.3%) for newly diagnosed HIV positives receiving CD4 cell count tests, and

  2. Enhancing HIV Testing and Treatment among Men Who Have Sex with Men in China: A Pilot Model with Two-Rapid Tests, Single Blood Draw Session, and Intensified Case Management in Six Cities in 2013.

    PubMed

    Zhang, Dapeng; Lu, Hongyan; Zhuang, Minghua; Wu, Guohui; Yan, Hongjing; Xu, Jun; Wei, Xiaoli; Li, Chengmei; Meng, Sining; Fu, Xiaojing; Qi, Jinlei; Wang, Peng; Luo, Mei; Dai, Min; Yip, Ray; Sun, Jiangping; Wu, Zunyou

    2016-01-01

    To explore models to improve HIV testing, linkage to care and treatment among men who have sex with men (MSM) in cooperation with community-based organizations (CBOs) in China. We introduced a new model for HIV testing services targeting MSM in six cities in 2013.These models introduced provision of rapid HIV testing by CBO staff and streamlined processes for HIV screening, confirmation of initial reactive screening results, and linkage to care among diagnosed people. We monitored attrition along each step of the continuum of care from screening to treatment and compared program performance between 2012 and 2013. According to the providers of two rapid tests (HIV screening), four different services delivery models were examined in 2013: Model A = first screen at CDC, second at CDC (Model A = CDC+CDC), Model B = first and second screens at CBOs (Model B = CBO+CBO), Model C = first screen at CBO, second at Hospital (Model C = CBO+Hosp), and Model D = first screen at CBO, second at CDC (Model D = CBO+CDC). Logistic regressions were performed to assess advantages of different screening models of case finding and case management. Compared to 2012, the number of HIV screening tests performed for MSM increased 35.8% in 2013 (72,577 in 2013 vs. 53,455 in 2012). We observed a 5.6% increase in proportion of cases screened reactive receiving HIV confirmatory tests (93.9% in 2013 vs. 89.2% in 2012, χ2 = 48.52, p<0.001) and 65% reduction in loss to CD4 cell count tests (15% in 2013 vs. 43% in 2012, χ2 = 628.85, p<0.001). Regarding linkage to care and treatment, the 2013 pilot showed that the Model D had the highest rate of loss between screening reactive and confirmatory test among the four models, with 18.1% fewer receiving a second screening test and a further 5.9% loss among those receiving HIV confirmatory tests. The Model B and the Model C showed lower losses (0.8% and 1.3%) for newly diagnosed HIV positives receiving CD4 cell count tests, and higher rates of HIV

  3. [Surgical findings in 260 cases of basilar impression and/or Arnold-Chiari malformation].

    PubMed

    da Silva, J A; Brito, J C; da Nóbrega, P V; Costa, M do D; de Souza, A B

    1994-09-01

    The surgical findings observed in a series of 260 patients with craniovertebral anomaly are presented. There were 29 (11.1%) patients only with basilar impression, 18 (6.9%) cases of pure Arnold-Chiari malformation and 213 (81.9%) cases of basilar impression associated with Chiari malformation. The surgical findings on bone, dura-mater, nervous tissue and blood vessels of this region are reported.

  4. Origin of new leprosy cases during general surveys in relation to previous survey findings.

    PubMed

    Jesudasan, K; Vijayakumaran, P; Manimozhi, N; Bushanam, J D; Kanagarajan, S; Rao, P S

    1996-09-01

    As part of the leprosy control activities in the area of Gudiyatham Thaluk, general surveys are done once every three to five years. The percentage of examination is about 90%. An analysis of all new cases registered for treatment between 1990-94 was done to study whether these cases had been examined in the previous general survey. Of the new cases detected and registered, 566 cases (32.6%) were not examined during the previous survey. The significance of these findings in relationship to cost-effectiveness of general surveys, case-detection methodology and possible continuing of transmission of leprosy are discussed.

  5. Range gated imaging experiments using gated intensifiers

    SciTech Connect

    McDonald, T.E. Jr.; Yates, G.J.; Cverna, F.H.; Gallegos, R.A.; Jaramillo, S.A.; Numkena, D.M.; Payton, J.; Pena-Abeyta, C.R.

    1999-03-01

    A variety of range gated imaging experiments using high-speed gated/shuttered proximity focused microchannel plate image intensifiers (MCPII) are reported. Range gated imaging experiments were conducted in water for detection of submerged mines in controlled turbidity tank test and in sea water for the Naval Coastal Sea Command/US Marine Corps. Field experiments have been conducted consisting of kilometer range imaging of resolution targets and military vehicles in atmosphere at Eglin Air Force Base for the US Air Force, and similar imaging experiments, but in smoke environment, at Redstone Arsenal for the US Army Aviation and Missile Command (AMCOM). Wavelength of the illuminating laser was 532 nm with pulse width ranging from 6 to 12 ns and comparable gate widths. These tests have shown depth resolution in the tens of centimeters range from time phasing reflected LADAR images with MCPII shutter opening.

  6. Electrostatically focused intensified charge coupled devices

    NASA Technical Reports Server (NTRS)

    Walker, J. W.

    1977-01-01

    Work performed to develop intensified charge coupled devices (ICCDs) is presented. Four ICCDs, containing 100 x 160 arrays, were fabricated. Electron gains up to 3200 at 15 keV were achieved. Photocathode sensitivities ranged from 190 to 410 micro A/lumen. Dark currents varied from 11 nA/sq cm to 37 nA/sq cm. There was serious concern about the reliability of the bonding scheme for ICCDs due to occassional bond failure. Two solutions to this problem were developed. One involved a modification of the existing bonding technique, and the other was the development of a protected bond pad employing a barrier metal between the aluminum metallization and the gold bond wire. An accumulation process was characterized with respect to its most critical variable. This characterization led to the achievement of reproducible spectral response and the discovery and elimination of dark current increase associated with this process.

  7. Systemic Shifts in Instructional Technology: Findings of a Comparative Case Study of Two University Mathematics Departments

    ERIC Educational Resources Information Center

    Jarvis, Daniel H.; Lavicza, Zsolt; Buteau, Chantal

    2014-01-01

    This paper reports on the findings of an international case study in which researchers examined two mathematics departments (Canada/UK) in which the sustained use of technology was strategically established in a mathematics degree program. This case study forms part of a larger research initiative which involved an extensive literature review…

  8. Students with Disabilities and Accountability Reform: Findings from the Maryland Case Study

    ERIC Educational Resources Information Center

    Nagle, Katherine M.; McLaughlin, Margaret J.; Nolet, Victor; Malmgren, Kimber

    2007-01-01

    This paper is one of four individual case study reports presenting the qualitative findings from a five-year investigation of the impact of accountability reform on students with disabilities in four states, eight districts, and twenty schools. This case study report presents qualitative data collected over a four-year period--2001-2004--from…

  9. Students with Disabilities and Accountability Reform: Findings from the Texas Case Study

    ERIC Educational Resources Information Center

    Nagle, Katherine M.; McLaughlin, Margaret J.; Nolet, Victor; Malmgren, Kimber

    2007-01-01

    This paper is one of four individual case study reports presenting the qualitative findings from a five-year investigation of the impact of accountability reform on students with disabilities in four states, eight districts, and twenty schools. This case study report presents qualitative data collected over a four-year period--2001-2004--from…

  10. A Transdisciplinary Approach to Training: Preliminary Research Findings Based on a Case Analysis

    ERIC Educational Resources Information Center

    Bimpitsos, Christos; Petridou, Eugenia

    2012-01-01

    Purpose: The purpose of this paper is to discuss the benefits, barriers and challenges of the transdisciplinary approach to training, and to present findings of a case analysis. Design/methodology/approach: The paper is based on the research findings of an experimental training program for Greek local government managers co-funded by the European…

  11. A Simpler Proof Of The Average Case Complexity Of Union-Find WithPath Compression

    SciTech Connect

    Wu, Kesheng; Otoo, Ekow

    2005-04-28

    We present a modified union-find algorithm that represent the data in an array rather than the commonly used pointer-based data structures, and a simpler proof that the average case complexity of the union-find algorithm is linear.

  12. A Transdisciplinary Approach to Training: Preliminary Research Findings Based on a Case Analysis

    ERIC Educational Resources Information Center

    Bimpitsos, Christos; Petridou, Eugenia

    2012-01-01

    Purpose: The purpose of this paper is to discuss the benefits, barriers and challenges of the transdisciplinary approach to training, and to present findings of a case analysis. Design/methodology/approach: The paper is based on the research findings of an experimental training program for Greek local government managers co-funded by the European…

  13. Familial Adult-onset Alexander Disease: Clinical and Neuroradiological Findings of Three Cases

    PubMed Central

    ELMALI, Ayşe Deniz; ÇETİNÇELİK, Ümran; IŞLAK, Civan; UZUN ADATEPE, Nurten; KARAALİ SAVRUN, Feray; YALÇINKAYA, Cengiz

    2016-01-01

    The adult-onset Alexander disease (AOAD) dramatically differs from the early onset AD with respect to clinical and neuroradiological findings. Herein we report the detailed clinical and neuroradiological findings of a Turkish family with AOAD. In all three cases, magnetic resonance imaging revealed marked atrophy of the mesencephalon, bulbus, and cervical spinal cord accompanied with signal abnormalities in the same regions along with supratentorial white matter. Basal ganglia were affected in two cases. Molecular genetic analysis revealed heterozygous mutation in the 8th exon of the glial fibrillary acidic protein gene M451I (c.1245G>A), leading to the diagnosis of AOAD in all cases. PMID:28360791

  14. Primary care physicians’ experiences with case finding for practice-based care management

    PubMed Central

    Freund, Tobias; Wensing, Michel; Geißler, Stefan; Peters-Klimm, Frank; Mahler, Cornelia; Boyd, Cynthia M.; Szecsenyi, Joachim

    2012-01-01

    Objective The identification of patients most likely to benefit from care management programs case finding – is a crucial determinant of their effectiveness regarding improved health outcomes and reduced costs. Until now, research has mainly focused on claims data-based case finding. This study aimed to explore how primary care physicians (PCPs) select patients for practice-based care management and how risk prediction may complement their case finding. Study design Qualitative study Methods We performed 12 semi-structured interviews with PCPs from 10 small- to middle-sized primary care practices in Germany. The interviews focused on their criteria for selecting patients as potential participants of an on-site care management program and how PCPs evaluate claims data-based risk prediction as a case finding tool. All interviews were transcribed verbatim. We performed qualitative content analysis using the ATLAS.ti software. Results Three major categories emerged from the physicians interviewed: 1) the physicians’ interpretation of the program’s eligibility criteria, 2) physician-related criteria and 3) patient-related criteria. The physician-related criteria included “sympathy/aversion” and “knowing the patient”. Patient-related criteria concerned care sensitivity in terms of “willingness to participate”, “ability to participate” (e.g. sufficient language skills, cognitive status) and “manageable care needs”. PCPs believed that their case finding can be supported by additional information from claims-data based risk prediction. Conclusions Case finding for care management programs in primary care may benefit from a structured approach combining clinical judgement by PCPs and claims-data based risk modelling. However, further research is needed to identify the optimal case finding strategy for practice-based care management. PMID:22554041

  15. Reaching the underserved: Active tuberculosis case finding in urban slums in southeastern Nigeria.

    PubMed

    Ogbudebe, Chidubem L; Chukwu, Joseph N; Nwafor, Charles C; Meka, Anthony O; Ekeke, Ngozi; Madichie, Nelson O; Anyim, Moses C; Osakwe, Chijioke; Onyeonoro, Ugochukwu; Ukwaja, Kingsley N; Oshi, Daniel C

    2015-03-01

    Nigeria ranks 10th among 22 high TB burden countries with low TB case detection that relies on passive case finding. Although there is increasing body of evidence that active case finding (ACF) has improved TB case finding in urban slums in some parts of the world, this strategy had not been implemented in Nigeria despite the pervasiveness of urban slums in the country. To assess the yield and profile of TB in urban slums in Nigeria through ACF. A prospective, implementation study was conducted in three urban slums of southeastern Nigeria. Individuals with TB symptoms were identified through targeted screening using a standardized questionnaire and investigated further for TB. Descriptive and bivariate analyses were performed using SPSS. Among 16,743 individuals screened for TB, 6361 (38.0%) were identified as TB suspects; 5894 suspects were evaluated for TB. TB was diagnosed in 1079 individuals, representing 6.4% of the screened population and 18.3% of those evaluated for TB. Of the 1079 cases found, 97.1% (n=1084) had pulmonary TB (PTB), and majority (65%) had new smear-positive TB. Children (<15years) accounted for 6.7% of the cases. Also, 22.6% (216) of the cases were HIV co-infected, among whom 55.1% (n=119) were females. The average number of individuals needed to screen to find a case of TB was 16. There is high prevalence of TB in Nigeria slum population. Targeted screening of out-patients, TB contacts, and HIV-infected patients should be optimized for active TB case finding in Nigeria. Copyright © 2015 Asian African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

  16. Marfan syndrome gene search intensifies following identification of basic defect

    SciTech Connect

    Randall, T.

    1990-10-03

    Somewhere, quite possible along chromosomes 8 and/or 15, the gene(s) for Marfan syndrome will be found. The search is intensifying following a report that faulty scaffolding in the body's connective tissue appears to be the long sought after defect behind the syndrome, and inherited disorder that has caused the premature death of young, healthy-looking individuals. Finding that something in the living masonry of the human body has proven to be a 30-year inquisition of nearly two dozen molecules that has engaged investigators worldwide. Historically, researchers have searched for a structural flaw in one of the collagen molecules to explain the cause of Marfan Syndrome. Using monoclonal antibodies, researchers have implicated microfibrils, the extracellular filaments that provide a matrix for the deposit of elastin during embryonic development.

  17. Evolution of trees and mycorrhizal fungi intensifies silicate mineral weathering

    PubMed Central

    Quirk, Joe; Beerling, David J.; Banwart, Steve A.; Kakonyi, Gabriella; Romero-Gonzalez, Maria E.; Leake, Jonathan R.

    2012-01-01

    Forested ecosystems diversified more than 350 Ma to become major engines of continental silicate weathering, regulating the Earth's atmospheric carbon dioxide concentration by driving calcium export into ocean carbonates. Our field experiments with mature trees demonstrate intensification of this weathering engine as tree lineages diversified in concert with their symbiotic mycorrhizal fungi. Preferential hyphal colonization of the calcium silicate-bearing rock, basalt, progressively increased with advancement from arbuscular mycorrhizal (AM) to later, independently evolved ectomycorrhizal (EM) fungi, and from gymnosperm to angiosperm hosts with both fungal groups. This led to ‘trenching’ of silicate mineral surfaces by AM and EM fungi, with EM gymnosperms and angiosperms releasing calcium from basalt at twice the rate of AM gymnosperms. Our findings indicate mycorrhiza-driven weathering may have originated hundreds of millions of years earlier than previously recognized and subsequently intensified with the evolution of trees and mycorrhizas to affect the Earth's long-term CO2 and climate history. PMID:22859556

  18. Case management for medical aid beneficiaries in Korea: findings from case-control study.

    PubMed

    Shin, Hee-Sun; Oh, Jin-Joo

    2014-12-01

    This study was to evaluate effects of case management provided for 7 months for medical aid in Korea. This study was a retrospective comparative study using secondary data analysis. Data from two pre-existing survey were reanalyzed. The data were collected through door to-door interviews using the structured questionnaire. For the medical service use, claims data from the Korea National Health Insurance Corporation was used. Subjects were 73 in the intervention group and 118 in the control group. There was no significant change in the intervention group in self-care ability (p = .296), medication adherence (p = .194) or quality of life (p = .903) compared to those of the control group. For hospital visiting days, it appeared to decrease in the intervention group (p = .038) but with no significant difference from that of the control group (p = .157). Neither were there significant differences in medical expenditures (p = .605). Although the effect of case management in this study appeared extremely limited, the short intervention period and characteristics of the medical aid beneficiaries and the limit of controlling only the demand side were discussed as factors to be considered. Nurses have been carrying out professional roles in case management in Korea. However more efforts are needed to develop case management as an area for nursing specialization. Copyright © 2014. Published by Elsevier B.V.

  19. Benchmarking Alumni Relations in Community Colleges: Findings from a 2015 CASE Survey. CASE White Paper

    ERIC Educational Resources Information Center

    Paradise, Andrew

    2016-01-01

    Building on the inaugural survey conducted three years prior, the 2015 CASE Community College Alumni Relations survey collected additional insightful data on staffing, structure, communications, engagement, and fundraising. This white paper features key data on alumni relations programs at community colleges across the United States. The paper…

  20. Benchmarking Alumni Relations in Community Colleges: Findings from a 2012 CASE Survey. CASE White Paper

    ERIC Educational Resources Information Center

    Paradise, Andrew; Heaton, Paul

    2013-01-01

    In 2011, CASE founded the Center for Community College Advancement to provide training and resources to help community colleges build and sustain effective fundraising, alumni relations and communications and marketing programs. This white paper summarizes the results of a groundbreaking survey on alumni relations programs at community colleges…

  1. Comparison of symptoms and treatment outcomes between actively and passively detected tuberculosis cases: the additional value of active case finding.

    PubMed

    den Boon, S; Verver, S; Lombard, C J; Bateman, E D; Irusen, E M; Enarson, D A; Borgdorff, M W; Beyers, N

    2008-10-01

    Passive detection of tuberculosis (TB) cases may lead to delay in treatment which may contribute to increased severity of disease and mortality. Active case finding may be an alternative. In a community survey in Cape Town, South Africa, we actively detected 27 bacteriologically positive TB cases and compared those with 473 passively detected TB cases. Seven of 27 (26%) actively detected TB cases did not start treatment within 2 months and were considered initial defaulters. Those who did start treatment had similar treatment success rates as passively detected TB cases (both 80%) (OR 1.01, CI 0.33-3.09). Passively detected cases reported the presence of the symptoms cough (OR 3.72, 95% CI 1.47-9.39), haemoptysis (OR 3.20, 95% CI 1.03-9.93), night sweats (OR 3.35, 95% CI 1.40-7.99), fever (OR 4.28, 95% CI 1.21-15.14), and weight loss (OR 11.14, 95% CI 4.17-29.74) more often than those detected actively. We conclude that although TB cases detected by a community survey are less symptomatic and are prone to a high initial default rate, active case finding can potentially identify a substantial portion of the existing caseload at an earlier stage of disease, thereby reducing the risk of transmission.

  2. Brachialis periosteal avulsion injury: case report with magnetic resonance imaging findings.

    PubMed

    Lam, Justin Chak Yiu; Lee, Ka Lok Ryan; Griffith, James F

    2016-11-01

    Brachialis periosteal avulsion injury is an uncommon injury occurring in young children. The injury may be misinterpreted or overlooked because of misleading or subtle radiological findings. A case of 7-year-old child with post-traumatic elbow pain and subtle findings on elbow radiography is presented. The injury was initially misinterpreted as an avulsion fracture of the medial epicondyle. Following radiological review, a diagnosis of brachialis periosteal avulsion injury was made. The radiographic and magnetic resonance imaging (MRI) findings of this injury are presented to stress the value of comparing the radiographic findings with previous imaging and to increase awareness of this uncommon injury.

  3. Human water consumption intensifies hydrological drought worldwide

    NASA Astrophysics Data System (ADS)

    Bierkens, M. F. P.; Wada, Y.; Wisser, D.; Wanders, N.; Van Beek, L. P. H.

    2012-04-01

    Drought is a natural phenomenon caused by below-normal precipitation over a prolonged period. Recent studies suggest an intensification of drought events over substantial regions due to anthropogenic global warming. Over the past decades, human water consumption has more than doubled, primarily due to a large increase in irrigation, and substantially reduced streamflow over various regions. It can thus be expected that upstream human water consumption intensifies hydrological drought in many regions of the world. Yet, few studies have investigated this impact up to now. We use the global hydrological model PCR-GLOBWB to simulate surface freshwater availability, i.e. water in rivers, lakes, reservoirs and wetlands, at a 0.5o spatial resolution for the period 1960-2001. We also estimate human water consumption, i.e. water withdrawal minus return flow, from agricultural, industrial and domestic sectors for the same period. Since country statistics on consumptive water use rarely exist, we use available socio-economic data to reconstruct past sectoral water consumption at a 0.5° grid. We then perform two simulation runs in which the impact of upstream human water consumption on downstream surface freshwater availability and resulting hydrological drought is assessed. The first run evaluates streamflow under variable climate inputs and with human water consumption set to the level of 1960. From this run, the Q80 is derived as the onset of hydrological drought following the widely used variable threshold level method. The second run is subject to the reconstructed water consumption over 1960-2001 and the ensuing deficit volume calculated relative to the 1960 reference, which are indicative of the intensification of hydrological drought and its implication for water supply. We standardize deficit volumes to compare the severity of hydrological drought among different catchments. Results show that upstream human water consumption substantially alters downstream water

  4. From Noun to Intensifier: Massa and Massa's in Flemish Varieties of Dutch

    ERIC Educational Resources Information Center

    De Clerck, Bernard; Colleman, Timothy

    2013-01-01

    In this paper a case of synchronic layering is examined in which Dutch "massa" ("mass") and plural "massa's" ("masses") are attested with lexical uses as a collective noun, quantifying uses ("a large quantity of") and intensifying uses ("very")--with plural "massa's" only--in some Flemish varieties of Dutch. Against the background of…

  5. Low input and intensified crop production systems effects on soil health and environment

    USDA-ARS?s Scientific Manuscript database

    The material in this chapter covers the concepts of "low-input" and "intensified" production systems in the context of input intensity and sustainability. Research-based case studies are presented that draw out the practicalities of implementing production practices on an input intensity gradient fr...

  6. From Noun to Intensifier: Massa and Massa's in Flemish Varieties of Dutch

    ERIC Educational Resources Information Center

    De Clerck, Bernard; Colleman, Timothy

    2013-01-01

    In this paper a case of synchronic layering is examined in which Dutch "massa" ("mass") and plural "massa's" ("masses") are attested with lexical uses as a collective noun, quantifying uses ("a large quantity of") and intensifying uses ("very")--with plural "massa's" only--in some Flemish varieties of Dutch. Against the background of…

  7. Active Community-Based Case Finding for Tuberculosis With Limited Resources

    PubMed Central

    Karki, Bindu; Kittel, Guenter; Bolokon, Ignatius; Duke, Trevor

    2016-01-01

    Papua New Guinea is one of the 14 highest-burden countries for tuberculosis (TB) infection, but few community-based studies exist. We evaluated a low-cost method of active community case finding in Kabwum and Wasu in Morobe Province, Papua New Guinea. Over 3 months we visited 26 villages and screened adults and children for symptoms and signs of TB. Sputum samples were examined using smear microscopy. A total of 1700 people had chronic symptoms, of which 267 were suspicious for TB on further examination. Sputum from 230 symptomatic adults yielded 97 samples that were positive for acid-fast bacilli. In addition, 15 cases of extrapulmonary TB in adults and 17 cases of TB in children were identified. One hundred and thirty people were identified with active TB disease among the source population of approximately 17 000, giving an estimated prevalence of 765 per 100 000. One hundred and six (82%) cases were not previously diagnosed. The cost per case identified was US$146. It is feasible to conduct active community-based case finding and treatment initiation for TB with limited resources and in remote areas, and in Papua New Guinea the yield was high. Active case finding and follow-up of treatment in villages is needed to address the hidden burden of TB in Papua New Guinea and other high-burden Asia Pacific countries. PMID:28033717

  8. Active Community-Based Case Finding for Tuberculosis With Limited Resources.

    PubMed

    Karki, Bindu; Kittel, Guenter; Bolokon, Ignatius; Duke, Trevor

    2017-01-01

    Papua New Guinea is one of the 14 highest-burden countries for tuberculosis (TB) infection, but few community-based studies exist. We evaluated a low-cost method of active community case finding in Kabwum and Wasu in Morobe Province, Papua New Guinea. Over 3 months we visited 26 villages and screened adults and children for symptoms and signs of TB. Sputum samples were examined using smear microscopy. A total of 1700 people had chronic symptoms, of which 267 were suspicious for TB on further examination. Sputum from 230 symptomatic adults yielded 97 samples that were positive for acid-fast bacilli. In addition, 15 cases of extrapulmonary TB in adults and 17 cases of TB in children were identified. One hundred and thirty people were identified with active TB disease among the source population of approximately 17 000, giving an estimated prevalence of 765 per 100 000. One hundred and six (82%) cases were not previously diagnosed. The cost per case identified was US$146. It is feasible to conduct active community-based case finding and treatment initiation for TB with limited resources and in remote areas, and in Papua New Guinea the yield was high. Active case finding and follow-up of treatment in villages is needed to address the hidden burden of TB in Papua New Guinea and other high-burden Asia Pacific countries.

  9. Clinical utility of the informant AD8 as a dementia case finding instrument in primary healthcare.

    PubMed

    Chan, Qun Lin; Xu, Xin; Shaik, Muhammad Amin; Chong, Steven Shih Tsze; Hui, Richard Jor Yeong; Chen, Christopher Li-Hsian; Dong, YanHong

    2016-01-01

    The informant AD8 has excellent discriminant ability for dementia case finding in tertiary healthcare settings. However, its clinical utility for dementia case finding at the forefront of dementia management, primary healthcare, is unknown. Therefore, we recruited participants from two primary healthcare centers in Singapore and measured their performance on the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clinical Dementia Rating (CDR), and a local formal neuropsychological battery, in addition to the AD8. Logistic regression was conducted to examine the associations between demographic factors and dementia. Area under the receiver operating characteristics (ROC) curve analysis was used to establish the optimal cut-off points for dementia case finding. Of the 309 participants recruited, 243 (78.7%) had CDR = 0, 22 (7.1%) CDR = 0.5, and 44 (14.2%) CDR ≥1. Age was strongly associated with dementia, and the optimal age for dementia case finding in primary healthcare settings was ≥75 years. In this age group, the AD8 has excellent dementia case finding capability and was superior to the MMSE and equivalent to the MoCA [AD8 AUC (95% CI): 0.95 (0.91-0.99), cut-off: ≥3, sensitivity: 0.90, specificity: 0.88, PPV: 0.79 and NPV: 0.94; MMSE AUC (95% CI): 0.87 (0.79-0.94), p = 0.04; MoCA AUC (95% CI): 0.88 (0.82-0.95), p = 0.06]. In conclusion, the AD8 is well suited for dementia case finding in primary healthcare settings.

  10. Inducible defenses in prey intensify predator cannibalism.

    PubMed

    Kishida, Osamu; Trussell, Geoffrey C; Nishimura, Kinya; Ohgushi, Takayuki

    2009-11-01

    Trophic cascades are often a potent force in ecological communities, but abiotic and biotic heterogeneity can diffuse their influence. For example, inducible defenses in many species create variation in prey edibility, and size-structured interactions, such as cannibalism, can shift predator diets away from heterospecific prey. Although both factors diffuse cascade strength by adding heterogeneity to trophic interactions, the consequences of their interactioh remain poorly understood. We show that inducible defenses in tadpole prey greatly intensify cannibalism in predatory larval salamanders. The likelihood of cannibalism was also strongly influenced by asymmetries in salamander size that appear to be most important in the presence of defended prey. Hence, variation in prey edibility and the size structure of the predator may synergistically affect predator-prey population dynamics by reducing prey mortality and increasing predator mortality via cannibalism. We also suggest that the indirect effects of prey defenses may shape the evolution of predator traits that determine diet breadth and how trophic dynamics unfold in natural systems.

  11. A Case of Bell's Palsy with an Incidental Finding of a Cerebellopontine Angle Lipoma.

    PubMed

    Lagman, Carlito; Choy, Winward; Lee, Seung J; Chung, Lawrance K; Bui, Timothy T; Yang, Isaac; Goldman, Howard W

    2016-08-24

    This case report illustrates the potential fallacy of attributing a patient's symptoms to an incidental finding. Serial imaging of small, asymptomatic cerebellopontine angle (CPA) lipomas is favored. It is imperative to accurately diagnose CPA lipoma on imaging and differentiate it from more common CPA lesions. We herein present a patient with symptoms consistent with Bell's palsy and an incidental finding of a CPA lipoma. Additionally, we performed a review of the literature for case reports of patients presenting with facial symptoms and diagnosed with a CPA lipoma.

  12. A Case of Bell’s Palsy with an Incidental Finding of a Cerebellopontine Angle Lipoma

    PubMed Central

    Choy, Winward; Lee, Seung J; Chung, Lawrance K; Bui, Timothy T; Yang, Isaac; Goldman, Howard W

    2016-01-01

    This case report illustrates the potential fallacy of attributing a patient’s symptoms to an incidental finding. Serial imaging of small, asymptomatic cerebellopontine angle (CPA) lipomas is favored. It is imperative to accurately diagnose CPA lipoma on imaging and differentiate it from more common CPA lesions. We herein present a patient with symptoms consistent with Bell’s palsy and an incidental finding of a CPA lipoma. Additionally, we performed a review of the literature for case reports of patients presenting with facial symptoms and diagnosed with a CPA lipoma. PMID:27733958

  13. Radiologist agreement for mammographic recall by case difficulty and finding type.

    PubMed

    Onega, Tracy; Smith, Megan; Miglioretti, Diana L; Carney, Patricia A; Geller, Berta A; Kerlikowske, Karla; Buist, Diana S M; Rosenberg, Robert D; Smith, Robert A; Sickles, Edward A; Haneuse, Sebastien; Anderson, Melissa L; Yankaskas, Bonnie

    2012-11-01

    The aim of this study was to assess agreement of mammographic interpretations by community radiologists with consensus interpretations of an expert radiology panel to inform approaches that improve mammographic performance. From 6 mammographic registries, 119 community-based radiologists were recruited to assess 1 of 4 randomly assigned test sets of 109 screening mammograms with comparison studies for no recall or recall, giving the most significant finding type (mass, calcifications, asymmetric density, or architectural distortion) and location. The mean proportion of agreement with an expert radiology panel was calculated by cancer status, finding type, and difficulty level of identifying the finding at the patient, breast, and lesion level. Concordance in finding type between study radiologists and the expert panel was also examined. For each finding type, the proportion of unnecessary recalls, defined as study radiologist recalls that were not expert panel recalls, was determined. Recall agreement was 100% for masses and for examinations with obvious findings in both cancer and noncancer cases. Among cancer cases, recall agreement was lower for lesions that were subtle (50%) or asymmetric (60%). Subtle noncancer findings and benign calcifications showed 33% agreement for recall. Agreement for finding responsible for recall was low, especially for architectural distortions (43%) and asymmetric densities (40%). Most unnecessary recalls (51%) were asymmetric densities. Agreement in mammographic interpretation was low for asymmetric densities and architectural distortions. Training focused on these interpretations could improve the accuracy of mammography and reduce unnecessary recalls. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  14. Cost-Effectiveness Analysis of Community Active Case Finding and Household Contact Investigation for Tuberculosis Case Detection in Urban Africa

    PubMed Central

    Sekandi, Juliet N.; Dobbin, Kevin; Oloya, James; Okwera, Alphonse; Whalen, Christopher C.; Corso, Phaedra S.

    2015-01-01

    Introduction Case detection by passive case finding (PCF) strategy alone is inadequate for detecting all tuberculosis (TB) cases in high burden settings especially Sub-Saharan Africa. Alternative case detection strategies such as community Active Case Finding (ACF) and Household Contact Investigations (HCI) are effective but empirical evidence of their cost-effectiveness is sparse. The objective of this study was to determine whether adding ACF or HCI compared with standard PCF alone represent cost-effective alternative TB case detection strategies in urban Africa. Methods A static decision modeling framework was used to examine the costs and effectiveness of three TB case detection strategies: PCF alone, PCF+ACF, and PCF+HCI. Probability and cost estimates were obtained from National TB program data, primary studies conducted in Uganda, published literature and expert opinions. The analysis was performed from the societal and provider perspectives over a 1.5 year time-frame. The main effectiveness measure was the number of true TB cases detected and the outcome was incremental cost-effectiveness ratios (ICERs) expressed as cost in 2013 US$ per additional true TB case detected. Results Compared to PCF alone, the PCF+HCI strategy was cost-effective at US$443.62 per additional TB case detected. However, PCF+ACF was not cost-effective at US$1492.95 per additional TB case detected. Sensitivity analyses showed that PCF+ACF would be cost-effective if the prevalence of chronic cough in the population screened by ACF increased 10-fold from 4% to 40% and if the program costs for ACF were reduced by 50%. Conclusions Under our baseline assumptions, the addition of HCI to an existing PCF program presented a more cost-effective strategy than the addition of ACF in the context of an African city. Therefore, implementation of household contact investigations as a part of the recommended TB control strategy should be prioritized. PMID:25658592

  15. Renal Biopsy Findings in Patients with Hypothyroidism: Report of 16 cases

    PubMed Central

    Singh, Usha; Singh, Rajeev; Santosh, Deepa; Parkash, Jai; Singh, Rana Gopal; Singh, Shivendra

    2016-01-01

    Introduction Hypothyroidism is prevalent in India. Its association with renal diseases though not very common but have been described in many studies. Here we are reporting renal biopsy findings in 16 cases, all of whom were already diagnosed cases of hypothyroidism. Aim To study renal parenchymal diseases associated in patients with hypothyroidism. Materials and Methods Formalin fixed paraffin embedded sections of renal biopsy were examined after staining with H&E, PAS and Acid Fuschin Orange G (AFOG) stain. Serum urea/creatinine measurements done by semi-autoanalysers and urine analysis were done by using urine strips and light microscopy. Results In 16 cases, M:F ratio was 9:7. Duration of disease varied from 6 months to 14 years. Blood urea and serum creatinine were raised in 10 cases (62.5%) and nephrotic range proteinuria was present in 13 cases (81.25%). Two of the patients had co existing systemic lupus erythaematous. Renal pathology revealed membranous glomerulonephritis (GN) in both cases. In renal biopsy seven cases (43.75%) had pure Membranous Glomerulonephritis (MGN), 4 cases (25%) had mixture of Mesan-gial cell proliferation and membranous Glomerulonephritis(GN) also called MembranoProliferative GN (MPGN). Another four cases (25%) had Focal Segmental Glomerulosclerosis (FSGS) with chronic interstitial nephritis and one case was having minimal change disease. Conclusion Thus present study concludes that hypothyroidism can cause renal parenchymal disease like membranous GN, mesangiocapillary GN which is also called as membranoproliferative GN and FSGS. PMID:27656449

  16. A case report of a rare finding of supernumerary primary and permanent canines

    PubMed Central

    Parker, Kate; Hay, Norman

    2014-01-01

    A supernumerary tooth is a tooth that is additional to the normal series of teeth. These can occur anywhere in the primary or permanent dentition and are most commonly found in the anterior maxilla. Supernumerary canines are rare with little available literature and case reports in this area. This case presents a patient with a unilateral maxillary supernumerary deciduous and permanent canine associated with an unusual cleft of the alveolus. How to cite the article: Parker K, Hay N. A case report of a rare finding of supernumerary primary and permanent canines. J Int Oral Health 2014;6(2):129-131. PMID:24876714

  17. Sonographic Findings in Subcoracoid Impingement Syndrome: A Case Report and Literature Review.

    PubMed

    Lappin, Maura; Gallo, Andrew; Krzyzek, Monika; Evans, Korboi; Chen, Yin-Ting

    2017-02-01

    Subcoracoid impingement syndrome is a rare and underrecognized cause of anterior shoulder pain. Currently, subcoracoid impingement syndrome is understood to involve impingement of anatomic structures such as the subcoracoid bursa and subscapularis tendon within the coracohumeral space, and there are no reports of sonographic findings in subcoracoid impingement syndrome other than the impingement of thickened subscapularis bursa. Here we report a case of subcoracoid impingement syndrome, including a novel sonographic finding, arthroscopic findings, and a proposed pathophysiology. V. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  18. Unusual periodontal findings in an AIDS patient with Burkitt's lymphoma. A case report.

    PubMed

    Hernández Vallejo, G; García, M D; López, A; Mendieta, C; Moskow, B S

    1989-12-01

    This report deals with a case of AIDS-related Burkitt's lymphoma in which some of the earliest findings were dental and periodontal in nature. The patient presented initially with painless and extremely loose teeth accompanied by progressive paresthesia of the lower jaw. Unique radiographic findings included extensive periodontal ligament space widening and bulbous, granuloma-like lesions about the apices of the teeth. These findings were associated with progressive tumor infiltration of the mandible and do not appear to be related to other reports of aggressive periodontitis associated with impaired immunologic functions in AIDS patients.

  19. Star centroiding error compensation for intensified star sensors.

    PubMed

    Jiang, Jie; Xiong, Kun; Yu, Wenbo; Yan, Jinyun; Zhang, Guangjun

    2016-12-26

    A star sensor provides high-precision attitude information by capturing a stellar image; however, the traditional star sensor has poor dynamic performance, which is attributed to its low sensitivity. Regarding the intensified star sensor, the image intensifier is utilized to improve the sensitivity, thereby further improving the dynamic performance of the star sensor. However, the introduction of image intensifier results in star centroiding accuracy decrease, further influencing the attitude measurement precision of the star sensor. A star centroiding error compensation method for intensified star sensors is proposed in this paper to reduce the influences. First, the imaging model of the intensified detector, which includes the deformation parameter of the optical fiber panel, is established based on the orthographic projection through the analysis of errors introduced by the image intensifier. Thereafter, the position errors at the target points based on the model are obtained by using the Levenberg-Marquardt (LM) optimization method. Last, the nearest trigonometric interpolation method is presented to compensate for the arbitrary centroiding error of the image plane. Laboratory calibration result and night sky experiment result show that the compensation method effectively eliminates the error introduced by the image intensifier, thus remarkably improving the precision of the intensified star sensors.

  20. 21 CFR 892.1960 - Radiographic intensifying screen.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Radiographic intensifying screen. 892.1960 Section 892.1960 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1960 Radiographic intensifying...

  1. 21 CFR 892.1960 - Radiographic intensifying screen.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Radiographic intensifying screen. 892.1960 Section 892.1960 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1960 Radiographic intensifying...

  2. 21 CFR 892.1960 - Radiographic intensifying screen.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Radiographic intensifying screen. 892.1960 Section 892.1960 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1960 Radiographic intensifying...

  3. 21 CFR 892.1960 - Radiographic intensifying screen.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Radiographic intensifying screen. 892.1960 Section 892.1960 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1960 Radiographic intensifying screen...

  4. 21 CFR 892.1960 - Radiographic intensifying screen.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Radiographic intensifying screen. 892.1960 Section 892.1960 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Diagnostic Devices § 892.1960 Radiographic intensifying screen...

  5. Prenatal Imaging Findings of Pontine Tegmental Cap Dysplasia: Report of Four Cases.

    PubMed

    Blondiaux, Eléonore; Valence, Stéphanie; Friszer, Stéphanie; Rodriguez, Diana; Burglen, Lydie; Ducou le Pointe, Hubert; Blouet, Marie; Garel, Catherine

    2017-07-05

    To describe the prenatal imaging findings in pontine tegmental cap dysplasia (PTCD), a rare congenital malformation of the hindbrain so far reported postnatally only and characterized by a typical appearance of the pons with malformations of the vermis and the cerebellar peduncles. This retrospective multicenter study retrieved 4 cases of PTCD over a 10-year period. Prenatal ultrasonography and fetal magnetic resonance imaging (MRI) findings were reviewed and compared to postnatal or postmortem data. In all cases, the parents were referred between 22 and 27 weeks of gestation for characterization of a small cerebellar diameter <3rd centile. The prenatal diagnosis of PTCD was suspected in 1/4 cases, while in 3/4 cases the suggested prenatal diagnosis was pontocerebellar hypoplasia. In all cases, PTCD was characterized by ventral pontine hypoplasia with absence of bulging of the pons and by the tegmental cap protruding into the fourth ventricle on prenatal MRI. Parents opted for termination of pregnancy in 1 case. In the 3 other cases, the children presented with global developmental delay and multiple cranial nerve impairment. PTCD is a differential diagnosis of pontocerebellar hypoplasia and should be discussed on prenatal MRI in the presence of the tegmental cap protruding into the fourth ventricle. © 2017 S. Karger AG, Basel.

  6. Tuberculosis case finding and isoniazid preventive therapy among people living with HIV at public health facilities of Addis Ababa, Ethiopia: a cross-sectional facility based study.

    PubMed

    Denegetu, Amenu Wesen; Dolamo, Bethabile Lovely

    2014-01-18

    Activities to decrease the burden of tuberculosis (TB) among people living with HIV (PLHIV) include intensified TB case-finding (ICF), Isoniaizid (INH) preventive therapy (IPT) and infection control in health-care and congregate settings (IC). Information about the status of collaborative TB/HIV care services which decreases the burden of TB among PLHIV in Ethiopia is limited. The purpose of the study was to assess TB case finding and provision of IPT among PLHIV in Addis Ababa. A cross sectional, facility-based survey was conducted between June 2011 and August 2011. Data was collected by interviewing 849 PLHIV from ten health facilities in Addis Ababa. Both descriptive and inferential statistics were used to analyze findings and the results are described in this report. The proportion of PLHIV who have been screened for TB during any one of their follow-up cares was 92.8%. Eighty eight (10.4%) of the study participants have been diagnosed for TB during their HIV follow-up cares. PLHIV who had never been diagnosed for TB before they knew their positive HIV status were nearly four times more likely to be diagnosed for TB during follow-up cares than those diagnosed before (AOR [95% CI]: 3.78 [1.69-8.43]). Nearly a third (28.7%) of all interviewed PLHIV self reported that they had been treated with IPT. It can be concluded that ICF for TB and IPT among PLHIV in Addis Ababa need boosting. Hence, it is recommended to put into practice the national and global guidelines to improve ICF and IPT among PLHIV in the city.

  7. Theoretical and Policy Implications of Case Study Findings About Federal Efforts to Improve Public Schools

    ERIC Educational Resources Information Center

    Gross, Neal

    1977-01-01

    Impediments to educational change were identified in six case studies of major innovative efforts in school systems. Their theoretical and policy implications are examined. The findings suggest the need for a reformulation of the theoretical scheme most frequently used to account for the fate of organizational innovations: overcoming resistance to…

  8. 5 CFR 890.1039 - Cases where additional fact-finding is required.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... required. 890.1039 Section 890.1039 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Suspension § 890.1039 Cases where additional fact-finding is...

  9. 5 CFR 890.1037 - Cases where additional fact-finding is not required.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... not required. 890.1037 Section 890.1037 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Suspension § 890.1037 Cases where additional fact-finding is...

  10. Metastatic pulmonary calcification: high-resolution computed tomography findings in 23 cases

    PubMed Central

    Belém, Luciana Camara; Souza, Carolina A.; Souza Jr., Arthur Soares; Escuissato, Dante Luiz; Hochhegger, Bruno; Nobre, Luiz Felipe; Rodrigues, Rosana Souza; Gomes, Antônio Carlos Portugal; Silva, Claudio S.; Guimarães, Marcos Duarte; Zanetti, Gláucia; Marchiori, Edson

    2017-01-01

    Objective The aim of this study was to evaluate the high-resolution computed tomography (HRCT) findings in patients diagnosed with metastatic pulmonary calcification (MPC). Materials and Methods We retrospectively reviewed the HRCT findings from 23 cases of MPC [14 men, 9 women; mean age, 54.3 (range, 26-89) years]. The patients were examined between 2000 and 2014 in nine tertiary hospitals in Brazil, Chile, and Canada. Diagnoses were established by histopathologic study in 18 patients and clinical-radiological correlation in 5 patients. Two chest radiologists analyzed the images and reached decisions by consensus. Results The predominant HRCT findings were centrilobular ground-glass nodules (n = 14; 60.9%), consolidation with high attenuation (n = 10; 43.5%), small dense nodules (n = 9; 39.1%), peripheral reticular opacities associated with small calcified nodules (n = 5; 21.7%), and ground-glass opacities without centrilobular ground-glass nodular opacity (n = 5; 21.7%). Vascular calcification within the chest wall was found in four cases and pleural effusion was observed in five cases. The abnormalities were bilateral in 21 cases. Conclusion MPC manifested with three main patterns on HRCT, most commonly centrilobular ground-glass nodules, often containing calcifications, followed by dense consolidation and small solid nodules, most of which were calcified. We also described another pattern of peripheral reticular opacities associated with small calcified nodules. These findings should suggest the diagnosis of MPC in the setting of hypercalcemia. PMID:28894330

  11. Word-Finding Intervention for Children with Specific Language Impairment: A Multiple Single-Case Study

    ERIC Educational Resources Information Center

    Bragard, Anne; Schelstraete, Marie-Anne; Snyers, Perrine; James, Deborah G. H.

    2012-01-01

    Purpose: This study examined the effectiveness of a combined phonological and semantic intervention for children with specific language impairment who had word-finding difficulties (WFDs). Method: To evaluate the intervention, a multiple single-case design was implemented with 4 children, ages 9;6 (years;months) to 13;9, who had WFDs. Some items…

  12. Case Report: Zika Virus Meningoencephalitis and Myelitis and Associated Magnetic Resonance Imaging Findings.

    PubMed

    Pradhan, Faruq; Burns, Joseph D; Agameya, Ahmed; Patel, Avignat; Alfaqih, Mohammad; Small, Juan E; Ooi, Winnie

    2017-08-01

    Zika virus (ZIKV) has a wide clinical spectrum of associated neurologic disease including microcephaly and Guillain-Barre syndrome but, despite its known neurotropism, ZIKV meningoencephalitis and myelitis have been rare complications. We describe a case of ZIKV meningoencephalitis and probable myelitis and its associated magnetic resonance imaging findings that rapidly resolved during recovery in a previously healthy adult.

  13. Imaging findings in a case of mixed acinar-endocrine carcinoma of the pancreas.

    PubMed

    Chung, Won Jung; Byun, Jae Ho; Lee, Seung Soo; Lee, Moon-Gyu

    2010-01-01

    Mixed acinar-endocrine carcinoma (MAEC) of the pancreas is extremely uncommon. We report here a rare case of MAEC of the pancreas presenting as watery diarrhea. This is the first report in the English-language literature that describes the imaging findings of MAEC of the pancreas, including computed tomography (CT), magnetic resonance (MR) imaging, and MR cholangiopancreatography features.

  14. Alexia with left homonymous hemianopia without agraphia. A case report with autopsy findings.

    PubMed

    Fincham, R W; Nibbelink, D W; Aschenbrener, C A

    1975-12-01

    Unusual findings at autopsy prompted this case report of a patient with the syndrome of alexia without agraphia. The expected disconnection of the left angular gyrus from both visual cortices was not found at postmortem examination. Multiple cerebral metastases were identified, but none were present in the presumed pathways connecting the left occipital lobe and the left angular gyrus.

  15. Surface Signature of Subsurface-Intensified Vortices

    NASA Astrophysics Data System (ADS)

    Ciani, D.; Carton, X. J.; Chapron, B.; Bashmachnikov, I.

    2014-12-01

    The ocean at mesoscale (20-200 km) and submesoscale (0.5-20km) is highly populated by vortices. These recirculating structures are more energetic than the mean flow, they trap water masses from their origin areas and advect them across the ocean, with consequent impact on the 3D distribution of heat and tracers. Mesoscale and submesoscale structures characterize the ocean dynamics both at the sea surface and at intrathermocline depths (0-1500m), and are presently investigated by means of model outputs, in-situ and satellite (surface) data, the latest being the only way to get high resolution and synoptic observations at planetary scale (e.g., thermal-band observations, future altimetric observations given by the SWOT satellite mission). The scientific question arising from this context is related to the role of the ocean surface for inferring informations on mesoscale and submesoscale vortices at depth. This study has also been motivated by the recent detection of subsurface eddies east of the Arabian Peninsula (PHYSINDIEN experiment - 2011).Using analytical models in the frame of the QG theory, we could describe the theoretical altimetric signature of non-drifting and of drifting subsurface eddies. Numerical experiments, using both coupled QG-SQG and primitive equations models, allowed us to investigate the surface expression of intrathermocline eddies interacting with baroclinic currents or evolving under planetary beta-effect. The eddy characteristics (radius, depth, thickness, velocity) were varied, to represent various oceanic examples (Meddies, Swoddies, Reddies, Peddies, Leddies). Idealized simulations with the ROMS model, confirming theoretical estimates, showed that drifting subsurface-intensified vortices can induce dipolar sea level anomalies, up to 3 cm. This result, compatibly with future SWOT measurement accuracies (about 2 cm), is a first step towards systematic and synoptic detection of subsurface vortices.

  16. China intensifies IEC programme for family planning.

    PubMed

    She, W

    1997-10-01

    This article describes the aims of family planning (FP) departments to strengthen IEC for the control of population growth and effective improvement in the quality of human resources in China. The IEC directive was promoted by Madam Peng Peiyun of the State Family Planning Commission in May 1997. In 1996, the birth rate was 16.98/1000. The total fertility rate was below replacement level in 1996. These achievements were accomplished with effective IEC over the past 30 years. The Ninth Five Year Plan for 1996-2000 offers many challenges for the national FP program. The aim is to continue to strictly control population growth in order to keep population below 1.3 billion by the year 2000, and below 1.4 billion by the year 2010. The aim is to improve the quality of life, to improve population structure, to meet the needs of reproductive-age women for services, and to promote socioeconomic and sustainable development. IEC needs to be intensified and to use improved techniques. IEC funding should be increased. Information should be promoted about the importance of educating people about the basic national conditions and the state's basic policies. People need to be informed about the need for a balanced population and socioeconomic development at all cadre levels. FP workers need to be encouraged to serve the people's needs "wholeheartedly." The aim is to provide quality services. People need to be informed that the advantages of fewer births are greater prosperity and comfortable living. FP is an integral part of poverty alleviation. The State Commission plans to conduct a new round of training for cadres.

  17. Methanol mass poisoning in Iran: role of case finding in outbreak management.

    PubMed

    Hassanian-Moghaddam, Hossein; Nikfarjam, Ali; Mirafzal, Amirhossein; Saberinia, Amin; Nasehi, Abbas Ali; Masoumi Asl, Hossein; Memaryan, Nadereh

    2015-06-01

    There are no guidelines addressing the public health aspects of methanol poisoning during larger outbreaks. The current study was done to discuss the role of active case finding and a national guideline that organizes all available resources according to a triage strategy in the successful management of a methanol mass poisoning in Rafsanjan, Iran, in May 2013. A retrospective cross-sectional study was performed reviewing the outbreak Emergency Operation Center files. The objectives were to describe the characteristics, management and outcome of a methanol outbreak using Active Case Finding to trace the victims. A total of 694 patients presented to emergency departments in Rafsanjan after public announcement of the outbreak between 29th May and 3rd June 2013. The announcement was mainly performed via short message service (SMS) and local radio broadcasting. A total of 361 cases were observed and managed in Rafsanjan and 333 were transferred to other cities. Seventy-five and 100 patients underwent hemodialysis (HD), retrospectively. The main indication for HD was refractory metabolic acidosis. Eight patients expired due to the intoxication. Except for the deceased cases, no serum methanol level was available. In developing countries, where diagnostic resources are limited, use of active case finding and developing national guidelines can help in the management of large outbreaks of methanol poisonings. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Diagnosis of Sanfilippo disease correlating clinical, radiological and biochemical findings-a case report.

    PubMed

    Agrawal, Udit; Meshram, Ajay; Vagha, Jayant; Swarnkar, Kirti; Palandurkar, Kamlesh

    2012-10-01

    Mucopolysaccharidoses (MPS) are a group of genetic diseases and its diagnosis is a challenging task due to multiple differential diagnosis. We had combined clinical findings, radiological and ophthalmological features. Biochemical test for urine glycosaminoglycans (GAG) was done for confirmation of diagnosis in the patient. The case of Sanfilippo disease was characterized by slowly progressive, severe CNS involvement with mild somatic disease. Radiological features were suggestive of Sanfilippo disease and urine GAG test for MPS was positive in the case. With the clinical features we had multiple differential diagnoses. The radiological investigations minimized the list and the biochemical test confirmed GAG in urine. In this case the combination of clinical, radiological and biochemical findings confirmed the diagnosis of Sanfilippo disease.

  19. Screening and case-finding instruments for depression: a meta-analysis

    PubMed Central

    Gilbody, Simon; Sheldon, Trevor; House, Allan

    2008-01-01

    Background Screening and case-finding has been proposed as a simple, quick and cheap method to improve the quality of care for depression. We sought to establish the effectiveness of screening in improving the recognition of depression, the management of depression and the outcomes of patients with depression. Methods We performed a Cochrane systematic review of randomized controlled trials conducted in nonmental health settings that included case-finding or screening instruments for depression. We conducted a meta-analysis and explored heterogeneity using meta-regression techniques. Results Sixteen studies with 7576 patients met our inclusion criteria. We found that the use of screening or case-finding instruments were associated with a modest increase in the recognition of depression by clinicians (relative risk [RR] 1.27, 95% confidence interval [CI] 1.02 to 1.59). Questionnaires, when administered to all patients and the results given to clinicians irrespective of baseline score, had no impact on recognition (RR 1.03, 95% CI 0.85 to 1.24). Screening or case finding increased the use of any intervention by a relative risk of 1.30 (95% CI 0.97 to 1.76). There was no evidence of influence on the prescription of antidepressant medications (RR 1.20, 95% CI 0.87 to 1.66). Seven studies provided data on outcomes of depression, and no evidence of an effect was found (standardized mean difference –0.02, 95% CI –0.25 to 0.20). Interpretation If used alone, case-finding or screening questionnaires for depression appear to have little or no impact on the detection and management of depression by clinicians. Recommendations to adopt screening strategies using standardized questionnaires without organizational enhancements are not justified. PMID:18390942

  20. Fatal tolperisone poisoning: autopsy and toxicology findings in three suicide cases.

    PubMed

    Sporkert, Frank; Brunel, Christophe; Augsburger, Marc P; Mangin, Patrice

    2012-02-10

    Tolperisone (Mydocalm) is a centrally acting muscle relaxant with few sedative side effects that is used for the treatment of chronic pain conditions. We describe three cases of suicidal tolperisone poisoning in three healthy young subjects in the years 2006, 2008 and 2009. In all cases, macroscopic and microscopic autopsy findings did not reveal the cause of death. Systematic toxicological analysis (STA) including immunological tests, screening for volatile substances and blood, urine and gastric content screening by GC-MS and HPLC-DAD demonstrated the presence of tolperisone in all cases. In addition to tolperisone, only the analgesics paracetamol (acetaminophen), ibuprofen and naproxen could be detected. The blood ethanol concentrations were all lower than 0.10 g/kg. Tolperisone was extracted by liquid-liquid extraction using n-chlorobutane as the extraction solvent. The quantification was performed by GC-NPD analysis of blood, urine and gastric content. Tolperisone concentrations of 7.0 mg/l, 14 mg/l and 19 mg/l were found in the blood of the deceased. In the absence of other autopsy findings, the deaths in these three cases were finally explained as a result of lethal tolperisone ingestion. To the best of our knowledge, these three cases are the first reported cases of suicidal tolperisone poisonings.

  1. Veterans Health Administration multiple sclerosis surveillance registry: The problem of case-finding from administrative databases.

    PubMed

    Culpepper, William J; Ehrmantraut, Mary; Wallin, Mitchell T; Flannery, Kathleen; Bradham, Douglas D

    2006-01-01

    Establishment of a national multiple sclerosis (MS) surveillance registry (MSSR) is a primary goal of the Department of Veterans Affairs (VA) MS Center of Excellence. The initial query of Veterans Health Administration (VHA) databases identified 25,712 patients (labeled "VHA MS User Cohort") from fiscal years 1998 to 2002 based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code; service-connection for MS; and/or disease-modifying agent (DMA) use. Because of ICD-9-CM limitations, the initial query was overinclusive and resulted in many non-MS cases. Thus, we needed a more rigorous case-finding method. Our gold standard was chart review of the Computerized Patient Record System for the mid-Atlantic VA medical centers. After chart review, we classified patients as not having MS or having MS/possible MS. We also applied a statistical algorithm to classify cases based on service-connection for MS, DMA use, and/or at least one healthcare encounter a year with MS coded as the primary diagnosis. We completed two analyses with kappa coefficient and sensitivity analysis. The first analysis (efficacy) was limited to cases with a definitive classification based on chart review (n = 600). The kappa coefficient was 0.85, sensitivity was 0.93, and specificity was 0.92. The second analysis (effectiveness) included unknown cases that were classified as MS/possible MS (N = 682). The kappa coefficient was 0.82, sensitivity was 0.93, and specificity was 0.90. These findings suggest that the database algorithm reliably eliminated non-MS cases from the initial MSSR population and is a reasonable case-finding method at this intermediate stage of MSSR development.

  2. Various Upper Endoscopic Findings of Acute Esophageal Thermal Injury Induced by Diverse Food: A Case Series

    PubMed Central

    Lee, Yu Mi; Kim, Ji Young; Song, Hyun Jung; Koo, Hoon Sup; Song, Kyung Ho; Kim, Yong Seok; Huh, Kyu Chan

    2014-01-01

    Esophageal thermal injury caused by food has been reported to occur mostly after drinking hot liquid food, and is known to produce alternating white and red linear mucosal bands. In addition, thermal injury caused by ingestion of hot solid foods is documented to be a cause of esophageal ulcers or pseudomembranes. From January 2006 to August 2012, five patients with suspected esophageal thermal injury underwent esophagogastroduodenoscopy with biopsy. A "candy-cane" appearance was observed in one case, pseudomembrane was observed in two cases, an esophageal ulcer was observed in one case, and a friable and edematous mucosa was noted in one case. We believe that the endoscopic findings of esophageal thermal injury depend on the following factors: causative materials, amount of food consumed, exposure period, and time to endoscopy after the incident. Therefore, physicians who encounter patients with suspected esophageal thermal injury should carefully take the patient's history considering these factors. PMID:25325006

  3. Various upper endoscopic findings of acute esophageal thermal injury induced by diverse food: a case series.

    PubMed

    Lee, Yu Mi; Kim, Sun Moon; Kim, Ji Young; Song, Hyun Jung; Koo, Hoon Sup; Song, Kyung Ho; Kim, Yong Seok; Huh, Kyu Chan

    2014-09-01

    Esophageal thermal injury caused by food has been reported to occur mostly after drinking hot liquid food, and is known to produce alternating white and red linear mucosal bands. In addition, thermal injury caused by ingestion of hot solid foods is documented to be a cause of esophageal ulcers or pseudomembranes. From January 2006 to August 2012, five patients with suspected esophageal thermal injury underwent esophagogastroduodenoscopy with biopsy. A "candy-cane" appearance was observed in one case, pseudomembrane was observed in two cases, an esophageal ulcer was observed in one case, and a friable and edematous mucosa was noted in one case. We believe that the endoscopic findings of esophageal thermal injury depend on the following factors: causative materials, amount of food consumed, exposure period, and time to endoscopy after the incident. Therefore, physicians who encounter patients with suspected esophageal thermal injury should carefully take the patient's history considering these factors.

  4. Radiological imaging findings of a case with vertebral osteoid osteoma leading to brachial neuralgia.

    PubMed

    Gokce, Erkan; Ayan, Erdoğan; Celikyay, Fatih; Acu, Berat

    2013-01-01

    Osteoid osteoma is a small, benign osteoblastic tumor consisting of a highly vascularized nidus of connective tissue surrounded by sclerotic bone. Three-quarters of osteoid osteomas are located in the long bones, and only 7-12% in the vertebral column. The classical clinical presentation of spinal osteoid osteoma is that of painful scoliosis. Other clinical features include nerve root irritation and night pain. Osteoid osteoma has characteristic computed tomography (CT) findings. Because magnetic resonance imaging (MRI) findings of the osteoid osteomas causing intense perinidal edema can be confusing, these patients should be evaluated with clinical findings and other imaging techniques. In this study, we present X-ray, CT, and MRI findings of a case with osteoid osteoma located in thoracic 1 vertebra left lamina and transverse process junction leading to brachial neuralgia symptoms.

  5. Radiological Imaging Findings of a Case with Vertebral Osteoid Osteoma Leading to Brachial Neuralgia

    PubMed Central

    Gokce, Erkan; Ayan, Erdoğan; Çelikyay, Fatih; Acu, Berat

    2013-01-01

    Osteoid osteoma is a small, benign osteoblastic tumor consisting of a highly vascularized nidus of connective tissue surrounded by sclerotic bone. Three-quarters of osteoid osteomas are located in the long bones, and only 7-12% in the vertebral column. The classical clinical presentation of spinal osteoid osteoma is that of painful scoliosis. Other clinical features include nerve root irritation and night pain. Osteoid osteoma has characteristic computed tomography (CT) findings. Because magnetic resonance imaging (MRI) findings of the osteoid osteomas causing intense perinidal edema can be confusing, these patients should be evaluated with clinical findings and other imaging techniques. In this study, we present X-ray, CT, and MRI findings of a case with osteoid osteoma located in thoracic 1 vertebra left lamina and transverse process junction leading to brachial neuralgia symptoms. PMID:24404413

  6. Audio Key Finding: Considerations in System Design and Case Studies on Chopin's 24 Preludes

    NASA Astrophysics Data System (ADS)

    Chuan, Ching-Hua; Chew, Elaine

    2006-12-01

    We systematically analyze audio key finding to determine factors important to system design, and the selection and evaluation of solutions. First, we present a basic system, fuzzy analysis spiral array center of effect generator algorithm, with three key determination policies: nearest-neighbor (NN), relative distance (RD), and average distance (AD). AD achieved a 79% accuracy rate in an evaluation on 410 classical pieces, more than 8% higher RD and NN. We show why audio key finding sometimes outperforms symbolic key finding. We next propose three extensions to the basic key finding system—the modified spiral array (mSA), fundamental frequency identification (F0), and post-weight balancing (PWB)—to improve performance, with evaluations using Chopin's Preludes (Romantic repertoire was the most challenging). F0 provided the greatest improvement in the first 8 seconds, while mSA gave the best performance after 8 seconds. Case studies examine when all systems were correct, or all incorrect.

  7. Case-finding options for COPD: Results from the BOLD Study

    PubMed Central

    Jithoo, Anamika; Enright, Paul; Burney, Peter; Buist, A Sonia; Bateman, Eric D; Tan, Wan C; Studnicka, Michael; Mejza, Filip; Gillespie, Suzanne; Vollmer, William M

    2012-01-01

    Aim To compare strategies for COPD case-finding using data from the Burden of Obstructive Lung Disease (BOLD) study. Methods Population-based samples of adults aged ≥40 years (n= 9390) from 14 countries completed a questionnaire and spirometry. We compared the screening efficiency of different staged algorithms that used questionnaire data and/or PEF to identify persons at risk for COPD and hence needing confirmatory spirometry. Separate algorithms were fitted for moderate/severe COPD and for severe COPD. We estimated the cost of each algorithm in 1000 people. Results For moderate/severe COPD, use of questionnaire data alone permitted high sensitivity (97%), but required confirmatory spirometry on 80% of participants. Use of PEF only required confirmatory spirometry in only 19-22% of subjects with 83-84% sensitivity. For severe COPD, use of PEF achieved 91-93% sensitivity, requiring confirmatory spirometry in <9% of participants. Cost analysis suggested that a staged screening algorithm using only PEF initially, followed by confirmatory spirometry as needed, was the most cost-effective case finding strategy. Conclusion Our results support the use of PEF as a simple, cost-effective initial screening tool for conducting COPD case-finding in adults ≥40 years. These findings should be validated in real-world settings such as the primary care environment. PMID:22743668

  8. Feasibility Study of Case-Finding for Breast Cancer by Community Health Workers in Rural Bangladesh.

    PubMed

    Chowdhury, Touhidul Imran; Love, Richard Reed; Chowdhury, Mohammad Touhidul Imran; Artif, Abu Saeem; Ahsan, Hasib; Mamun, Anwarul; Khanam, Tahmina; Woods, James; Salim, Reza

    2015-01-01

    Mortality from breast cancer is high in low- and middle-income countries, in part because most patients have advanced stage disease when first diagnosed. Case-finding may be one approach to changing this situation. We conducted a pilot study to explore the feasibility of population-based case finding for breast cancer by community health workers (CHWs) using different data collection methods and approaches to management of women found to have breast abnormalities. After training 8 CHWs in breast problem recognition, manual paper data collection and operation of a cell-phone software platform for reporting demographic, history and physical finding information, these CHWs visited 3150 women >age 18 and over they could find--from 2356 households in 8 villages in rural Bangladesh. By 4 random assignments of villages, data were collected manually (Group 1), or with the cell-phone program alone (Group 2) or with management algorithms (Groups 3 and 4), and women adjudged to have a serious breast problem were shown a motivational video (Group 3), or navigated/accompanied to a breast problem center for evaluation (Group 4). Only three visited women refused evaluation. The manual data acquisition group (1) had missing data in 80% of cases, and took an average of 5 minutes longer to acquire, versus no missing data in the cell phone-reporting groups (2,3 and 4). One woman was identified with stage III breast cancer, and was appropriately treated. Among very poor rural Bangladeshi women, there was very limited reluctance to undergo breast evaluation. The estimated rarity of clinical breast cancer is supported by these population-based findings. The feasibility and efficient use of mobile technology in this setting is supported. Successor studies may most appropriately be trials focusing on improving the suggested benefits of motivation and navigation, on increasing the numbers of cases found, and on stage of disease at diagnosis as the primary endpoint.

  9. New image intensifier family for military and homeland defense

    NASA Astrophysics Data System (ADS)

    Floryan, Richard F.; DeVoe, Nelson; Peck, Thomas

    2003-09-01

    ITT Industries Night Vision has developed a new high-performance image intensifier for use in existing aviation and ground night vision systems. This intensifier, called the "Pinnacle" by ITT, provides substantial performance increases in low light detection, high light resolution, and intra-scene dynamic range (the ability to see detail in dark areas of a scene where bright cultural lighting is present -- for example, into a dark alley where streetlights are also in the scene). The new Pinnacle intensifier can be used in all aviation and ground systems that currently accept 18 mm image intensifiers. The performance improvements offered in the Pinnacle intensifier are made possible by three factors: (1) a new high-performance micro-channel plate (MCP), (2) a newly designed gating power supply, and (3) manufacturing processes that have been optimized through design-of-experiments and six-sigma methods. With the higher signal-to-noise, resolution, and bright-light halo performance levels, the Pinnacle image intensifier substantially outperforms all previously fielded intensifiers, and greatly enhances the user's ability to operate at night.

  10. An evaluation of clinical, radiological and three-dimensional dental tomography findings in ectodermal dysplasia cases

    PubMed Central

    Doğan, Mehmet-Sinan; Callea, Michele; Aksoy, Orhan; Clarich, Gabriella; Günay, Ayşe; Günay, Ahmet; Güven, Sedat; Maglione, Michele; Akkuş, Zeki

    2015-01-01

    Background This study aimed to review the results related to head and jaw disorders in cases of ectodermal dysplasia. The evaluation of ectodermal dysplasia cases was made by clincal examination and examination of the jaw and facial areas radiologically and on cone-beam 3-dimensional dental tomography (CBCT) images. Material and Methods In the 36 cases evaluated in the study, typical clinical findings of pure hypohidrotic ectodermal displasia (HED) were seen, such as missing teeth, dry skin, hair and nail disorders. CBCT images were obtained from 12 of the 36 cases, aged 1.5- 45 years, and orthodontic analyses were made on these images. Results The clinical and radiological evaluations determined, hypodontia or oligodontia, breathing problems, sweating problems, a history of fever, sparse hair, saddle nose, skin peeling, hypopigmentation, hyperpigmentation, finger and nail deformities, conical teeth anomalies, abnormal tooth root formation, tooth resorption in the root, gingivitis, history of epilepsy, absent lachrymal canals and vision problems in the cases which included to the study. Conclusions Ectodermal dysplasia cases have a particular place in dentistry and require a professional, multi-disciplinary approach in respect of the chewing function, orthognathic problems, growth, oral and dental health. It has been understood that with data obtained from modern technologies such as three-dimensional dental tomography and the treatments applied, the quality of life of these cases can be improved. Key words: Ectodermal dysplasia, three-dimensional dental tomography. PMID:25662550

  11. Impact of medico-legal findings on charge filing in cases of rape in adult women.

    PubMed

    Hagemann, Cecilie T; Stene, Lise E; Myhre, Arne K; Ormstad, Kari; Schei, Berit

    2011-11-01

    To assess the impact of the medical documentation and biological trace evidence in rape cases on the legal process. Retrospective descriptive study. Police-reported cases of rape of women ≥16 years old in the Norwegian county of Sør-Trøndelag from January 1997 to June 2003. Police data were merged with data from the Sexual Assault Center at St Olav's Hospital. Charged and non-charged cases were compared. Medico-legal findings and legal outcome. A total of 185 police-reported cases were identified. Of the 101 cases examined at Sexual Assault Center, charges were filed in 18 cases. Extragenital injuries were documented in 49 women; five were life threatening. Anogenital injuries were documented in 14 women; eight had multiple anogenital injuries. Documentation of injuries was not associated with charge filing. In only 33% of the cases were swabs collected from women's genitals used as trace evidence by the police. When used, this increased the likelihood for charge filing. A DNA profile matching the suspect was identified in four of the 18 charged cases and in only one among the 54 non-charged cases. Half of the women had one or more documented injury. Only one-third of the trace evidence kits collected from the women's anogenital area were analyzed. The analysis of swabs was associated with charge filing, regardless of test results. Increased use of such medical evidence, especially in cases of stranger rape, may ensure women's rights and increase available information to the legal system. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  12. Enhanced tuberculosis case finding through advocacy and sensitisation meetings in prisons of Central India

    PubMed Central

    Mallick, G.; Agrawal, T. K.; Kumar, A. M. V.; Chadha, S. S.

    2017-01-01

    Tuberculosis (TB) in prisons is a major problem. The prisons in Chhattisgarh, India, are overcrowded, and there are no formal efforts to engage them in TB control. In 2014, the International Union Against Tuberculosis and Lung Disease and the state TB programme advocated with state prison authorities to implement an enhanced case-finding strategy in the prisons. Sensitisation meetings (one/quarter/prison) to improve awareness among prisoners about TB symptoms and services were coupled with improved access to diagnosis. Patients with presumptive TB who were examined by sputum microscopy increased by 39% per 100 000 prisoners, and TB case notification rates increased by 38%, in 2014 relative to 2013. PMID:28775946

  13. CT and MRI Findings in a Rare Case of Renal Primitive Neuroectodermal Tumor

    PubMed Central

    Akkaya, Zehra; Peker, Elif; Gulpinar, Basak; Karadag, Hale; Erden, Ayse

    2016-01-01

    Summary Background Primary renal primitive neuroectodermal tumor/extraskeletal Ewing’s sarcoma (PNET/EES) is a very rare renal tumor. Case Report We report a case of primary renal PNET/EES of the kidney in an adult patient and describe its computed tomography and magnetic resonance imaging findings, including diffusion weighted images along with a review of the current medical literature. Conclusions Although very rare, a relatively large renal mass which shows very infiltrative growth pattern on CT and MR imaging and striking diffusion restriction should raise the suspicion of a renal primitive neuroectodermal tumor, in a young adult. PMID:27635170

  14. Basilar impression and Arnold-Chiari malformation. Surgical findings in 209 cases.

    PubMed

    da Silva, J A

    1992-11-01

    The surgical findings observed in a series of 209 consecutive patients with craniovertebral anomaly are presented. The high prevalence of basilar impression in the Northeast of Brazil is noteworthy. There were 28 (13.3%) patients with basilar impression alone, 10 (4.7%) cases of pure Arnold-Chiari malformation and in 171 (81.8%) cases the basilar impression was associated with Arnold-Chiari malformation. This study reflects our surgical experience of the pathology in a 17-year period (1971-1987). It reflects also the peculiarities of neurosurgical practice in an undeveloped region of this Country. The literature is extensively reviewed.

  15. The imaging findings of infratentorial primitive neuroectodermal tumour: A case report.

    PubMed

    Nekitsing, Indima; Wu, Xing; Tang, Guangyu

    2015-12-01

    Central primitive neuroectodermal tumour (cPNET), a rare malignant neoplasm of embryonal origin, often occurs in children younger than 15 years. This is the first case report of the imaging findings of an infratentorial cPNET to be reported in a patient. Here, is reported the case of a 6-year-old boy presenting with symptoms of diplopia for 14 days. Magnetic resonance imaging revealed a solid mass in the fourth ventricle. The postoperative pathological diagnosis was cPNET. To conclude, whenever a child is diagnosed to have an infratentorial solid tumour in the fourth ventricle, cPNET should always be considered despite its rarity.

  16. Migration of intrauterine devices with radiological findings: report on two cases

    PubMed Central

    Gunbey, Hediye Pinar; Tanrivermis Sayit, Asli; Sedakat Idilman, Ilkay; Aksoy, Onur

    2014-01-01

    Intrauterine devices (IUDs) are one of the most reliable and cheapest contraception methods. Our aims are to evaluate misplaced IUDs with radiological findings and to emphasise the importance of radiological imaging. We report two cases with radiological findings, one of complete migration to the abdomen without colonic perforation and one of partial migration to the bladder lumen with pregnancy. Uterine perforation and migration of IUDs are rare and undesirable complications. Suspected intra-abdominal IUDs can be evaluated with CT for precise localisation and possible complications without pregnancy. PMID:24827647

  17. Migration of intrauterine devices with radiological findings: report on two cases.

    PubMed

    Gunbey, Hediye Pinar; Sayit, Asli Tanrivermis; Idilman, Ilkay Sedakat; Aksoy, Onur

    2014-05-14

    Intrauterine devices (IUDs) are one of the most reliable and cheapest contraception methods. Our aims are to evaluate misplaced IUDs with radiological findings and to emphasise the importance of radiological imaging. We report two cases with radiological findings, one of complete migration to the abdomen without colonic perforation and one of partial migration to the bladder lumen with pregnancy. Uterine perforation and migration of IUDs are rare and undesirable complications. Suspected intra-abdominal IUDs can be evaluated with CT for precise localisation and possible complications without pregnancy. 2014 BMJ Publishing Group Ltd.

  18. Brain MRI findings with vigabatrin therapy: case report and literature review.

    PubMed

    Hussain, Kaiser; Walsh, Thomas J; Chazen, J Levi

    2016-01-01

    Infantile spasm or West syndrome is a pediatric epileptic disorder characterized by flexor and/or extensor spasms beginning in childhood. Vigabatrin is an effective medical therapy for infantile spasm but has pronounced, potentially worrisome imaging findings in patients receiving therapy. We present the case of an 8-month-old infant with such brain magnetic resonance imaging findings after treatment initiation. In this article, we highlight the imaging changes and discuss the differential diagnosis along with the required follow-up. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Imaging Findings in Dysgerminoma in a Case of 46 XY, Complete Gonadal Dysgenesis (Swyer syndrome)

    PubMed Central

    Khaladkar, Sanjay; Gujrati, Aditi

    2016-01-01

    A 46 XY pure gonadal dysgenesis also known as Swyer syndrome. These patients are phenotypic females with normal female external genitalia and absent testicular tissue. The patients with swyer syndrome have streak gonads and increased risk of dysgerminoma and gonadoblastoma. We present a case of dysgerminoma in dysgenetic gonads of swyer syndrome. A 23-year-old female had come with complaints of primary amenorrhea, pelvic mass and abdominal pain. Clinical findings, pathology investigation and imaging findings revealed swyer syndrome. On MRI it showed a large lobulated mass in the pelvis. Mass was excised and dysgerminoma was given on the histopathology. PMID:27790550

  20. Beyond early infant diagnosis: case finding strategies for identification of HIV-infected infants and children

    PubMed Central

    Ahmed, Saeed; Kim, Maria H.; Sugandhi, Nandita; Phelps, B. Ryan; Sabelli, Rachael; Diallo, Mamadou O.; Young, Paul; Duncan, Dana; Kellerman, Scott E.

    2014-01-01

    There are 3.4 million children infected with HIV worldwide, with up to 2.6 million eligible for treatment under current guidelines. However, roughly 70% of infected children are not receiving live-saving HIV care and treatment. Strengthening case finding through improved diagnosis strategies, and actively linking identified HIV-infected children to care and treatment is essential to ensuring that these children benefit from the care and treatment available to them. Without attention or advocacy, the majority of these children will remain undiagnosed and die from complications of HIV. In this article, we summarize the challenges of identifying HIV-infected infants and children, review currently available evidence and guidance, describe promising new strategies for case finding, and make recommendations for future research and interventions to improve identification of HIV-infected infants and children. PMID:24361633

  1. Choledochal cyst and biliary atresia in the neonate: Imaging findings in five cases

    SciTech Connect

    Torrisi, J.M.; Haller, J.O.; Velcek, F.T. )

    1990-12-01

    The radiologic findings in five neonates with choledochal cyst associated with extra-hepatic biliary atresia are described. All five patients (age range, 13-72 days) presented with jaundice and acholic stools. In all four patients who underwent sonographic examination, a cystic structure separate from the gallbladder representing the choledochal cyst was shown. The diagnosis of atresia of the distal common bile duct was made preoperatively in all cases by hepatobiliary scintigraphy. Diagnosis was confirmed by surgical findings and was demonstrated by intraoperative cholangiography in four cases. All patients were successfully treated with surgical intervention within 1 month from the time of diagnosis. Early detection of this rare disorder, which may be distinct from choledochal cyst found in children and adults, is important to prevent fatal complications of biliary obstruction. The combined use of sonography and hepatobiliary scintigraphy can correctly identify this subset of patients with persistent neonatal jaundice and provide valuable information for prompt surgical management.

  2. Imaging findings in a case of Gorlin-Goltz syndrome: a survey using advanced modalities.

    PubMed

    Bronoosh, Pegah; Shakibafar, Ali Reza; Houshyar, Maneli; Nafarzade, Shima

    2011-12-01

    Gorlin-Goltz syndrome is an infrequent multi-systemic disease which is characterized by multiple keratocysts in the jaws, calcification of falx cerebri, and basal cell carcinomas. We report a case of Gorlin-Goltz syndrome in a 23-year-old man with emphasis on image findings of keratocyctic odontogenic tumors (KCOTs) on panoramic radiograph, computed tomography, magnetic resonance (MR) imaging, and Ultrasonography (US). In this case, pericoronal lesions were mostly orthokeratinized odontogenic cyst (OOC) concerning the MR and US study, which tended to recur less. The aim of this report was to clarify the characteristic imaging features of the syndrome-related keratocysts that can be used to differentiate KCOT from OOC. Also, our findings suggested that the recurrence rate of KCOTs might be predicted based on their association to teeth.

  3. Unusual findings in inguinal hernia surgery: Report of 6 rare cases

    PubMed Central

    Ballas, K; Kontoulis, Th; Skouras, Ch; Triantafyllou, A; Symeonidis, N; Pavlidis, Th; Marakis, G; Sakadamis, A

    2009-01-01

    Background and aim: To present our experience with unexpected findings during hernia surgery, either unusual hernial contents or pathologic entities, like neoplastic masses, masquerading as a hernia. Patients and methods: We studied retrospectively 856 patients with inguinal hernia who were admitted to our surgical department over a 9-year period. In addition, our study included patients complaining of inguinal protrusion, even without a definitive diagnosis of inguinal hernia upon admission. Results: Five patients presented with unusual hernial contents. Three of them had a vermiform appendix in their sac. Acute appendicitis (Amyands hernia) was found in only one case. One patient had epiploic appendagitis related with a groin hernia. Moreover, an adult woman was diagnosed with ovarian and tubal inguinal hernia. Finally, we report a case of a massive extratesticular intrascrotal lipoma, initially misdiagnosed as a scrotal hernia. Conclusion: a hernia surgeon may encounter unexpected intraoperative findings. It is important to be prepared to detect them and apply the appropriate treatment. PMID:19918306

  4. Review of systems, physical examination, and routine tests for case-finding in ambulatory patients.

    PubMed

    Boland, B J; Wollan, P C; Silverstein, M D

    1995-04-01

    The screening value of the comprehensive review of systems and the complete physical examination in detecting unsuspected diseases for which therapeutic interventions are initiated has not been formally studied in ambulatory patients. The medical records of 100 randomly selected adult patients who had an ambulatory general medical evaluation at the Mayo Clinic in 1990-1991 were surveyed to compare review of systems and physical examination with routine laboratory tests, chest radiography, and electrocardiography as case-finding maneuvers. The main outcome measure was the therapeutic yield of each case-finding maneuver, defined as the proportion of maneuvers leading to a new therapy for a new clinically important diagnosis. The utilization rate of routine tests in the 100 patients (mean age: 59 +/- 16 years; 58% women) was high, ranging from 77 to 98%. Overall, the case-finding maneuvers led to 36 unsuspected clinically important diagnoses and resulted in 25 new therapeutic interventions. Higher therapeutic yield was observed for review of systems (7%), physical examination (5%), and lipid screening (9.2%) than for chemistry group (2.2%), complete blood count (1.8%), thyroid tests (1.5%), urinalysis (1.1%), electrocardiography (0%), or chest radiography (0%). The number of therapeutic interventions was not associated with patient's age (P = 0.55), sex (P = 0.88), comorbidity (P = 0.30) or with the time interval since the last general medical evaluation (P = 0.12). Based on therapeutic yield, these data suggest that review of systems and physical examination are valuable case-finding maneuvers in the periodic medical evaluation of ambulatory patients.

  5. CBCT findings of periapical cemento-osseous dysplasia: A case report.

    PubMed

    Eskandarloo, Amir; Yousefi, Faezeh

    2013-09-01

    Periapical cemento-osseous dysplasia (PCOD) is a subtype of cemento-osseous dysplasia that usually occurs in middle-aged black women. This report described a case of a 45-year-old Iranian woman who was diagnosed with PCOD on the basis of cone beam computed tomographic (CBCT) findings. CBCT enabled detailed visualization of the bone changes. This report described the special radiographic characteristics of PCOD, including discontinuity of the lingual cortex on the CBCT sectional and three-dimensional images.

  6. (18)F-FDG PET/CT findings in a case with HIV (-) Kaposi sarcoma.

    PubMed

    Ozdemir, E; Poyraz, N Y; Keskin, M; Kandemir, Z; Turkolmez, S

    2014-01-01

    Although mucocutaneous sites are the most frequently encountered sites of involvement, Kaposi Sarcoma (KS) may also occasionally involve the breast and the skeletal, endocrine, urinary and nervous systems.. Various imaging modalities may be used to delineate the extent of the disease by detecting unexpected sites of involvement. Herein, we report a case of classical type KS, in whom staging with (18)F-FDG PET/CT imaging disclosed widespread disease and unexpected findings of bone and salivary gland involvement.

  7. Dental findings in patients with West syndrome: a report of two cases.

    PubMed

    Khatri, Amit; Kalra, Namita; Tyagi, Rishi; Baweja, Mani; Khandelwal, Deepak

    2014-01-01

    West syndrome a rare, severe form of epilepsy occurs in early infancy. It is characterized by a triad consisting of infantile spasms that occurs in clusters, arrest of psychomotor development and hypsarrhythmia on electroencephalogram. We present here two cases of west syndrome where patients required dental care due to the presence of certain dental findings. Preventive measurements such as controlled diet and proper oral hygiene along with professional dental management are recommended in patients with west syndrome to avoid dental problems.

  8. Nevoid Basal Cell Carcinoma Syndrome - Clinical and Radiological Findings of Three Cases

    PubMed Central

    Ali, Ibrahim K; Karjodkar, Freny R; Sansare, Kaustubh; Salve, Prashant; Goyal, Shikha

    2016-01-01

    Nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominant disorder, characterized by skeletal anomalies and multiple keratocystic odontogenic tumors of the jaws. The skeletal anomalies of this syndrome are mandibular prognathism, bossing of frontal and parietal bones, high-arched palate, and bifid rib. We report three cases with NBCCS, emphasizing the clinical and radiographic findings, the importance of the early diagnosis of NBCCS, and a preventive multidisciplinary approach in the management of NBCCS. PMID:27630800

  9. [Active community case-finding for uptake of pregnant and postpartum women in Ecuador].

    PubMed

    Roldán, Jakeline Calle; Acuña, Cecilia; Ríos, Paulina

    2017-06-08

    Document and analyze Ecuador's experience using active community case-finding for uptake of pregnant and postpartum women in Ecuador. A cross-sectional descriptive study was conducted of information obtained on active community case-finding of pregnant and postpartum women in the catchment areas of 200 primary care facilities of Ecuador's Ministry of Public Health. Visits were made to 460 451 homes in 20 provinces; 15 622 pregnant women and 4 014 postpartum women were identified. Of the pregnant women, 89% (13 875) had had at least one prenatal check-up, while 70% of postpartum women (4 014) had had at least one post-delivery or post-caesarean check-up. Potential risk was identified in 29% of pregnant women (4 601). Orellana and Sucumbíos provinces had the lowest percentages of pregnant women with at least one prenatal check-up and the lowest percentages of postpartum women with at least one postpartum checkup. A total of 3 951 brigades were formed at the national level for this activity. Active community case-finding was valuable in identifying pregnant and postpartum women who had not been captured by the health system, especially to detect their risk status, in addition to the advantages of participatory uptake, especially with support from universities with health majors. Low coverage for postpartum check-ups underscores the importance of learning why women do not receive this care. Similar experiences need to be systematized to improve the process.

  10. Use of Pap smear in general practice by case finding or screening programme.

    PubMed

    Olesen, F

    1986-02-01

    Two different organizational methods of Pap smear examination in prevention of cancer colli uteri are compared in two Danish counties. In one county the method was planned as a pure case finding model; in the other county a modified screening approach was used. Resources were measured as the number of Pap smear examinations per 1 000 women of risk age (25-54 years). They were nearly identical in the two counties. The number of sufficiently investigated women, defined as examined by a Pap smear at least once within a 3-year period, was much larger in the county using the screening model than in the other county. Furthermore the proportion of women sufficiently investigated varied greatly in the county using the case finding model. Even the most active one-fourth of the doctors in this county did not obtain the same percentage of examined women as the average in percentage of examined women in the county with a regular screening programme, even though this active group of doctors had a resource consumption about twice the average for this county. It is concluded that the Pap smear method when aiming at a maximum interval between smears in individual women of 3 years, can be conveniently carried out in general practice by using a case finding model in combination with a screening programme together with a systematized, centrally computer-surveyed procedure, in order to avoid overlapping and exclude women not examined as well as possible.

  11. Active Surveillance of Hansen's Disease (Leprosy): Importance for Case Finding among Extra-domiciliary Contacts

    PubMed Central

    Moura, Maria L. N.; Dupnik, Kathryn M.; Sampaio, Gabriel A. A.; Nóbrega, Priscilla F. C.; Jeronimo, Ana K.; do Nascimento-Filho, Jose M.; Miranda Dantas, Roberta L.; Queiroz, Jose W.; Barbosa, James D.; Dias, Gutemberg; Jeronimo, Selma M. B.; Souza, Marcia C. F.; Nobre, Maurício L.

    2013-01-01

    Hansen's disease (leprosy) remains an important health problem in Brazil, where 34,894 new cases were diagnosed in 2010, corresponding to 15.3% of the world's new cases detected in that year. The purpose of this study was to use home visits as a tool for surveillance of Hansen's disease in a hyperendemic area in Brazil. A total of 258 residences were visited with 719 individuals examined. Of these, 82 individuals had had a previous history of Hansen's disease, 209 were their household contacts and 428 lived in neighboring residences. Fifteen new Hansen's disease cases were confirmed, yielding a detection rate of 2.0% of people examined. There was no difference in the detection rate between household and neighbor contacts (p = 0.615). The two groups had the same background in relation to education (p = 0.510), household income (p = 0.582), and the number of people living in the residence (p = 0.188). Spatial analysis showed clustering of newly diagnosed cases and association with residential coordinates of previously diagnosed multibacillary cases. Active case finding is an important tool for Hansen's disease control in hyperendemic areas, enabling earlier diagnosis, treatment, decrease in disability from Hansen's disease and potentially less spread of Mycobacterium leprae. PMID:23516645

  12. Active surveillance of Hansen's Disease (leprosy): importance for case finding among extra-domiciliary contacts.

    PubMed

    Moura, Maria L N; Dupnik, Kathryn M; Sampaio, Gabriel A A; Nóbrega, Priscilla F C; Jeronimo, Ana K; do Nascimento-Filho, Jose M; Miranda Dantas, Roberta L; Queiroz, Jose W; Barbosa, James D; Dias, Gutemberg; Jeronimo, Selma M B; Souza, Marcia C F; Nobre, Maurício L

    2013-01-01

    Hansen's disease (leprosy) remains an important health problem in Brazil, where 34,894 new cases were diagnosed in 2010, corresponding to 15.3% of the world's new cases detected in that year. The purpose of this study was to use home visits as a tool for surveillance of Hansen's disease in a hyperendemic area in Brazil. A total of 258 residences were visited with 719 individuals examined. Of these, 82 individuals had had a previous history of Hansen's disease, 209 were their household contacts and 428 lived in neighboring residences. Fifteen new Hansen's disease cases were confirmed, yielding a detection rate of 2.0% of people examined. There was no difference in the detection rate between household and neighbor contacts (p = 0.615). The two groups had the same background in relation to education (p = 0.510), household income (p = 0.582), and the number of people living in the residence (p = 0.188). Spatial analysis showed clustering of newly diagnosed cases and association with residential coordinates of previously diagnosed multibacillary cases. Active case finding is an important tool for Hansen's disease control in hyperendemic areas, enabling earlier diagnosis, treatment, decrease in disability from Hansen's disease and potentially less spread of Mycobacterium leprae.

  13. Findings of Florid Cemento-Osseous Dysplasia: a Report of Three Cases

    PubMed Central

    Köse, Onur Dincer; Karabas, Hulya Cakir; Erdem, Tamer Lutfi; Özcan, İlknur

    2013-01-01

    ABSTRACT Background Florid cemento-osseous dysplasia (FCOD) is a benign jaw lesion originating from periodontal ligament tissues usually asymptomatic and diagnosed accidentally at routine dental radiographic examination. The purpose of this paper is to report three cases diagnosed as FCOD with their clinical, radiographic and histological findings. Methods Radiologic and clinical symptoms of three cases diagnosed as FCOD are presented. Serum alkaline phosphatase test and biopsy taken from two of the patients are discussed to eliminate the Paget's disease. Results Three patients diagnosed as FCOD and called for routine follow-up. Because of no sign of infection or osteomyelitis, conservative treatment was applied. Conclusions Radiographic examination is significant for the diagnosis of florid cemento-osseous dysplasia, especially in the asymptomatic cases. The roles of the dentist are to ensure the follow-up of the diagnosed patients and to take the necessary measures for preventing from the infections. PMID:24478914

  14. Experience of active tuberculosis case finding in nearly 5 million households in India.

    PubMed

    Prasad, B M; Satyanarayana, S; Chadha, S S; Das, A; Thapa, B; Mohanty, S; Pandurangan, S; Babu, E R; Tonsing, J; Sachdeva, K S

    2016-03-21

    In India, to increase tuberculosis (TB) case detection under the National Tuberculosis Programme, active case finding (ACF) was implemented by the Global Fund-supported Project Axshya, among high-risk groups in 300 districts. Between April 2013 and December 2014, 4.9 million households covering ~20 million people were visited. Of 350 047 presumptive pulmonary TB cases (cough of ⩾2 weeks) identified, 187 586 (54%) underwent sputum smear examination and 14 447 (8%) were found to be smear-positive. ACF resulted in the detection of a large number of persons with presumptive pulmonary TB and smear-positive TB. Ensuring sputum examination of all those with presumptive TB was a major challenge.

  15. Findings of florid cemento-osseous dysplasia: a report of three cases.

    PubMed

    Köse, Taha Emre; Köse, Onur Dincer; Karabas, Hulya Cakir; Erdem, Tamer Lutfi; Ozcan, Ilknur

    2013-10-01

    Florid cemento-osseous dysplasia (FCOD) is a benign jaw lesion originating from periodontal ligament tissues usually asymptomatic and diagnosed accidentally at routine dental radiographic examination. The purpose of this paper is to report three cases diagnosed as FCOD with their clinical, radiographic and histological findings. Radiologic and clinical symptoms of three cases diagnosed as FCOD are presented. Serum alkaline phosphatase test and biopsy taken from two of the patients are discussed to eliminate the Paget's disease. Three patients diagnosed as FCOD and called for routine follow-up. Because of no sign of infection or osteomyelitis, conservative treatment was applied. Radiographic examination is significant for the diagnosis of florid cemento-osseous dysplasia, especially in the asymptomatic cases. The roles of the dentist are to ensure the follow-up of the diagnosed patients and to take the necessary measures for preventing from the infections.

  16. A retrospective analysis for aetiology and clinical findings of 287 secondary amyloidosis cases in Turkey.

    PubMed

    Tuglular, Serhan; Yalcinkaya, Fatos; Paydas, Saime; Oner, Ayse; Utas, Cengiz; Bozfakioglu, Semra; Ataman, Rezzan; Akpolat, Tekin; Ok, Ercan; Sen, Saniye; Düsünsel, Ruhan; Evrenkaya, Rifki; Akoglu, Emel

    2002-11-01

    Secondary amyloidosis is the most frequent of the various types of systemic amyloidosis, the epidemiology of which is not yet fully known. The aim of our study was to evaluate retrospectively the collective data for the aetiological distribution, clinical findings and approaches to the management of secondary amyloidosis in Turkey. Data from a simple questionnaire addressing aetiology, and demographic and clinical characteristics of patients with biopsy-proven secondary amyloidosis was retrospectively analysed. Eleven nephrology clinics contributed data for this study. The 11 contributing centres provided a total of 287 cases (102 female, 185 male). The aetiological distribution was as follows: familial Mediterranean fever (FMF) 64%, tuberculosis 10%, bronchiectasis and chronic obstructive lung disease 6%, rheumatoid arthritis 4%, spondylarthropathy 3%, chronic osteomyelitis 2%, miscellaneous 4%, unknown 7%. Oedema accompanied by proteinuria was present in 88% of the cases, hepatomegaly in 17%, and splenomegaly in 11%. The mean systolic and diastolic blood pressures were 115+/-26 and 73+/-15 mmHg respectively. The family history was positive in 16%; 73% of the cases were on colchicine treatment when the questionnaire was administered. Thirty-eight per cent of the cases had progressed to ESRD and were on renal replacement therapy. FMF is the leading cause of secondary amyloidosis in Turkey, followed by tuberculosis. Oedema accompanied by proteinuria is the most prominent presenting finding, and hypotension seems to be common among these patients.

  17. Histopathologic findings in uterine biopsy samples from subfertile bitches: 399 cases (1990-2005).

    PubMed

    Gifford, Angela T; Scarlett, Janet M; Schlafer, Donald H

    2014-01-15

    To determine the prevalence of various lesion types detected by histologic evaluation of uterine biopsy samples collected from subfertile bitches. Retrospective case series. 399 sexually intact bitches. Results of histologic evaluation of canine uterine biopsy samples submitted by a single veterinary practice and clinical histories of dogs from which samples were obtained were reviewed. Clinical data including age, reason for biopsy, and histopathologic findings were recorded. The prevalence of specific lesions was determined, categorized by severity and age, and statistically analyzed. Endometritis (170/399 [42.6%] cases) and cystic endometrial changes, including cystic endometrial hyperplasia (133/399 [33.3%]) were the most prevalent lesions in the study population. Eighty-nine of 170 (52.4%) cases of endometritis were characterized as chronic with predominantly lymphocytic or lymphoplasmacytic inflammatory infiltrates, 51 (30.0%) included mixed inflammatory reactions, and 30 (17.6%) were characterized as having acute inflammation with neutrophils, eosinophils, or both. Fibrosis was common (101/399 [25.3%] cases). Eosinophilic endometritis was significantly associated with a history of fetal loss during the same breeding cycle. No significant difference was found in prevalence of lesions among age groups. The high prevalence of endometritis in this population of dogs suggested that acute and chronic endometritis may be related to subfertility in bitches. The association of eosinophilic endometrial infiltrates with a history of fetal loss may be an important diagnostic finding in dogs with endometritis.

  18. Anterior segment optical coherence tomography findings of iris granulomas in Hansen's disease: a case report

    PubMed Central

    2013-01-01

    Background A 50-year-old male was diagnosed to have a right eye sclerouveitis and left eye granulomatous anterior uveitis due to Hansen's disease. We are reporting the anterior segment optical coherence tomography (ASOCT) findings of iris granuloma in this case. Findings Skin biopsy revealed plenty of acid fast bacilli with a bacteriological index of 5 suggestive of multibacillary polar lepromatous leprosy. ASOCT revealed well-demarcated smooth-surfaced nodular lesion with internal hyporeflectivity corresponding to the areas of granuloma which decreased in size following treatment with antileprosy drugs and systemic and topical steroids. Conclusion ASOCT is a non-invasive technique to assess the extent of involvement of anterior segment in Hansen's disease and is a useful tool in follow-up. This is also the first report on ASOCT findings of iris granuloma in Hansen's disease. PMID:23514098

  19. Bone scan findings in Kienböck's disease. A case report with atypical findings and literature review.

    PubMed

    Stuckey, S L; Kalff, V; Hoy, G

    1997-07-01

    The authors present an 18-year-old man who had a 5-month history of a painful left wrist. Despite the prolonged history, discrete photopenia on the blood-pool phase and photopenia relative to the remainder of the ipsilateral carpus on the delayed phase of a bone scan in the region of the lunate was shown. When Kienböck's disease is seen in its late phase, the bone scan findings may be atypical in that they may not show the usual three-phase bone scintigraphic evidence of bone remodeling expected in delayed diagnosis avascular necrosis. A review of the previous literature is presented.

  20. A sensitive image intensifier which uses inert gas

    NASA Technical Reports Server (NTRS)

    Kerns, Q. A.; Miller, H. M.

    1972-01-01

    High gain optical image intensifier utilizes inert gas cavity with copper electrodes to form electron avalanches without excessive pulse voltages. Estimated optical gain for device is two times 10 to the power of seven.

  1. Intensified hemodialysis regimens: neglected treatment options for children and adolescents.

    PubMed

    Müller, Dominik; Zimmering, Miriam; Chan, Christopher T; McFarlane, Philip A; Pierratos, Andreas; Querfeld, Uwe

    2008-10-01

    During recent years, the importance of intensified dialysis regimens has gathered increasing interest, especially after the Hemodialysis (HEMO) Study Group reported that a higher dose of thrice-weekly hemodialysis failed to improve clinical outcomes. Long nocturnal hemodialysis (three to six times per week) or short daily hemodialysis are the currently used forms of intensified dialysis. There is substantial evidence for cardiovascular and quality-of-life improvements as well as financial benefits with intensified hemodialysis. Preliminary experience with daily hemodialysis and hemodiafiltration in children has been reported. Given the continuing shortage of donor organs for kidney transplantation, the increasing incidence of end-stage renal disease (ESRD) and recognition of the deleterious effects of long-lasting ESRD, growth retardation, and poor social rehabilitation, more intensified dialysis regimens are a much-needed therapeutical option in both adults and children.

  2. NASA's GPM Sees Towering Thunderstorms in Intensifying Tropical Storm Earl

    NASA Image and Video Library

    The Global Precipitation Measurement mission, or GPM, core observatory satellite passed over intensifying tropical storm Earl in the Caribbean Sea northeast of Honduras on Aug. 2, 2016 at 11:56 p.m...

  3. Nanosecond gating properties of proximity focused microchannel plate image intensifiers

    NASA Astrophysics Data System (ADS)

    King, N. S. P.; King, N. S. P.; Yates, G. J.; Jaramillo, S. A.; Noel, B. W.; Detch, J. L., Jr.; Ogle, J. W.

    The optical gating properties of Multichannel plate image intensifiers were characterized. Emphasis was placed on parameters relevant to gating speed and correlations between the applied electrical and resultant optical gates.

  4. Improved intensifying screen reduces X-ray exposure

    NASA Technical Reports Server (NTRS)

    Buchanan, R. A.

    1972-01-01

    X-ray intensifying screen may make possible radiographic procedures where detection speed and X-ray tube power have been the limiting factors. Device will reduce total population exposure to harmful radiation in the United States.

  5. Corneal calcification following intensified treatment with sodium hyaluronate artificial tears

    PubMed Central

    Bernauer, W; Thiel, M A; Kurrer, M; Heiligenhaus, A; Rentsch, K M; Schmitt, A; Heinz, C; Yanar, A

    2006-01-01

    Aim To report a potential adverse effect of intensified treatment with sodium hyaluronate artificial tears. Methods Five cases of deep calcium deposition in the cornea associated with ocular surface disease and frequent use of hyaluronic acid artificial tears are described. All patients used one formulation of phosphate buffered hyaluronate eye drops when rapid calcification developed. All eyes required corneal graft surgery for visual rehabilitation. Specimens at keratoplasty were available for light microscopy and investigation by dispersive x ray analysis. The phosphate concentration in the medication used for topical treatment was measured and compared to alternative hyaluronate preparations. Results Light microscopy showed dense mineralisation of the entire stroma. The crystalline deposits consisted of hydroxyapatite, Ca5(PO4)3OH. A 50‐fold higher concentration of phosphate was measured in the sodium hyaluronate eye drops used for treatment (50.9 mmol/l) when compared with normal serum. The other hyaluronate formulations showed phosphate concentrations from <0.1 mmol/l to 10.9 mmol/l. Conclusions The hyaluronate artificial tear formulation “Hylo‐Comod” favours the formation of insoluble crystalline calcium phosphate deposits in presence of epithelial keratopathy. This is because of its high phosphate concentration and typically frequent instillation. Manufacturers and prescribers should be aware that topical preparations may contain considerable amounts of phosphate which may lead to sight threatening corneal complications. PMID:16488945

  6. Agriculture intensifies soil moisture decline in Northern China

    DOE PAGES

    Liu, Yaling; Pan, Zhihua; Zhuang, Qianlai; ...

    2015-07-09

    Northern China is one of the most densely populated regions in the world. Agricultural activities have intensified since the 1980s to provide food security to the country. However, this intensification has likely contributed to an increasing scarcity in water resources, which may in turn be endangering food security. Based on in-situ measurements of soil moisture collected in agricultural plots during 1983–2012, we find that topsoil (0–50 cm) volumetric water content during the growing season has declined significantly (p<0.01), with a trend of -0.011 to -0.015 m3 m-3 per decade. Observed discharge declines for the three large river basins are consistentmore » with the effects of agricultural intensification, although other factors (e.g. dam constructions) likely have contributed to these trends. Practices like fertilizer application have favoured biomass growth and increased transpiration rates, thus reducing available soil water. In addition, the rapid proliferation of water-expensive crops (e.g., maize) and the expansion of the area dedicated to food production have also contributed to soil drying. Adoption of alternative agricultural practices that can meet the immediate food demand without compromising future water resources seem critical for the sustainability of the food production system.« less

  7. Agriculture intensifies soil moisture decline in Northern China

    SciTech Connect

    Liu, Yaling; Pan, Zhihua; Zhuang, Qianlai; Miralles, Diego; Teuling, Adriann; Zhang, Tonglin; An, Pingli; Dong, Zhiqiang; Zhang, Jingting; He, Di; Wang, Liwei; Pan, Xuebiao; Bai, Wei; Niyogi, Dev

    2015-07-09

    Northern China is one of the most densely populated regions in the world. Agricultural activities have intensified since the 1980s to provide food security to the country. However, this intensification has likely contributed to an increasing scarcity in water resources, which may in turn be endangering food security. Based on in-situ measurements of soil moisture collected in agricultural plots during 1983–2012, we find that topsoil (0–50 cm) volumetric water content during the growing season has declined significantly (p<0.01), with a trend of -0.011 to -0.015 m3 m-3 per decade. Observed discharge declines for the three large river basins are consistent with the effects of agricultural intensification, although other factors (e.g. dam constructions) likely have contributed to these trends. Practices like fertilizer application have favoured biomass growth and increased transpiration rates, thus reducing available soil water. In addition, the rapid proliferation of water-expensive crops (e.g., maize) and the expansion of the area dedicated to food production have also contributed to soil drying. Adoption of alternative agricultural practices that can meet the immediate food demand without compromising future water resources seem critical for the sustainability of the food production system.

  8. Agriculture intensifies soil moisture decline in Northern China.

    PubMed

    Liu, Yaling; Pan, Zhihua; Zhuang, Qianlai; Miralles, Diego G; Teuling, Adriaan J; Zhang, Tonglin; An, Pingli; Dong, Zhiqiang; Zhang, Jingting; He, Di; Wang, Liwei; Pan, Xuebiao; Bai, Wei; Niyogi, Dev

    2015-07-09

    Northern China is one of the most densely populated regions in the world. Agricultural activities have intensified since the 1980s to provide food security to the country. However, this intensification has likely contributed to an increasing scarcity in water resources, which may in turn be endangering food security. Based on in-situ measurements of soil moisture collected in agricultural plots during 1983-2012, we find that topsoil (0-50 cm) volumetric water content during the growing season has declined significantly (p < 0.01), with a trend of -0.011 to -0.015 m(3) m(-3) per decade. Observed discharge declines for the three large river basins are consistent with the effects of agricultural intensification, although other factors (e.g. dam constructions) likely have contributed to these trends. Practices like fertilizer application have favoured biomass growth and increased transpiration rates, thus reducing available soil water. In addition, the rapid proliferation of water-expensive crops (e.g., maize) and the expansion of the area dedicated to food production have also contributed to soil drying. Adoption of alternative agricultural practices that can meet the immediate food demand without compromising future water resources seem critical for the sustainability of the food production system.

  9. Agriculture intensifies soil moisture decline in Northern China

    NASA Astrophysics Data System (ADS)

    Liu, Yaling; Pan, Zhihua; Zhuang, Qianlai; Miralles, Diego G.; Teuling, Adriaan J.; Zhang, Tonglin; An, Pingli; Dong, Zhiqiang; Zhang, Jingting; He, Di; Wang, Liwei; Pan, Xuebiao; Bai, Wei; Niyogi, Dev

    2015-07-01

    Northern China is one of the most densely populated regions in the world. Agricultural activities have intensified since the 1980s to provide food security to the country. However, this intensification has likely contributed to an increasing scarcity in water resources, which may in turn be endangering food security. Based on in-situ measurements of soil moisture collected in agricultural plots during 1983-2012, we find that topsoil (0-50 cm) volumetric water content during the growing season has declined significantly (p < 0.01), with a trend of -0.011 to -0.015 m3 m-3 per decade. Observed discharge declines for the three large river basins are consistent with the effects of agricultural intensification, although other factors (e.g. dam constructions) likely have contributed to these trends. Practices like fertilizer application have favoured biomass growth and increased transpiration rates, thus reducing available soil water. In addition, the rapid proliferation of water-expensive crops (e.g., maize) and the expansion of the area dedicated to food production have also contributed to soil drying. Adoption of alternative agricultural practices that can meet the immediate food demand without compromising future water resources seem critical for the sustainability of the food production system.

  10. Intensified deep Pacific inflow and ventilation in Pleistocene glacial times.

    PubMed

    Hall, I R; McCave, I N; Shackleton, N J; Weedon, G P; Harris, S E

    2001-08-23

    The production of cold, deep waters in the Southern Ocean is an important factor in the Earth's heat budget. The supply of deep water to the Pacific Ocean is presently dominated by a single source, the deep western boundary current east of New Zealand. Here we use sediment records deposited under the influence of this deep western boundary current to reconstruct deep-water properties and speed changes during the Pleistocene epoch. In physical and isotope proxies we find evidence for intensified deep Pacific Ocean inflow and ventilation during the glacial periods of the past 1.2 million years. The changes in throughflow may be directly related to an increased production of Antarctic Bottom Water during glacial times. Possible causes for such an increased bottom-water production include increasing wind strengths in the Southern Ocean or an increase in annual sea-ice formation, leaving dense water after brine rejection and thereby enhancing deep convection. We infer also that the global thermohaline circulation was perturbed significantly during the mid-Pleistocene climate transition between 0.86 and 0.45 million years ago.

  11. Agriculture intensifies soil moisture decline in Northern China

    PubMed Central

    Liu, Yaling; Pan, Zhihua; Zhuang, Qianlai; Miralles, Diego G.; Teuling, Adriaan J.; Zhang, Tonglin; An, Pingli; Dong, Zhiqiang; Zhang, Jingting; He, Di; Wang, Liwei; Pan, Xuebiao; Bai, Wei; Niyogi, Dev

    2015-01-01

    Northern China is one of the most densely populated regions in the world. Agricultural activities have intensified since the 1980s to provide food security to the country. However, this intensification has likely contributed to an increasing scarcity in water resources, which may in turn be endangering food security. Based on in-situ measurements of soil moisture collected in agricultural plots during 1983–2012, we find that topsoil (0–50 cm) volumetric water content during the growing season has declined significantly (p < 0.01), with a trend of −0.011 to −0.015 m3 m−3 per decade. Observed discharge declines for the three large river basins are consistent with the effects of agricultural intensification, although other factors (e.g. dam constructions) likely have contributed to these trends. Practices like fertilizer application have favoured biomass growth and increased transpiration rates, thus reducing available soil water. In addition, the rapid proliferation of water-expensive crops (e.g., maize) and the expansion of the area dedicated to food production have also contributed to soil drying. Adoption of alternative agricultural practices that can meet the immediate food demand without compromising future water resources seem critical for the sustainability of the food production system. PMID:26158774

  12. Phosphaturic mesenchymal tumour mixed connective tissue variant: report of three cases with unusual histological findings.

    PubMed

    Shustik, David A; Ng, David Ce; Sittampalam, Kesavan

    2015-01-01

    Phosphaturic mesenchymal tumour mixed connective tissue variant (PMTMCT) is a rare tumour occurring in bone and soft tissue that usually behaves in a benign manner. Elaboration of biologically active substances by this tumour gives rise to a paraneoplastic syndrome known as oncogenic osteomalacia, manifesting clinically as bone pain, generalized weakness and pathological fractures. Recognition of PMTMCT and its associated syndrome is important, as resection of the tumour in most instances results in prompt resolution of symptoms. Previously reported cases of this tumour have emphasized the consistent presence of certain histological features that are considered prerequisite for making the diagnosis of PMTMCT. We describe three cases of PMTMCT, of which two first presented with progressive symptoms of osteomalacia and one remained clinically silent aside from the symptom of a palpable lump. Our cases highlight the wide-ranging histological patterns displayed by these tumours, and draw attention to certain microscopic findings that until now have been given little if any mention. Tentacular growth pattern and satellite nodules appear to be common findings in PMTMCTs, and can make complete surgical excision of these tumours challenging. The ability of this otherwise histologically benign tumour to permeate vascular spaces has to our knowledge never been described previously. One tumour lacked the characteristic calcifying matrix of PMTMCT, suggesting that in some tumours this defining feature may be focal if not entirely absent. PMTMCT shares features with and can resemble a variety of bone and soft tissue neoplasms, requiring the surgical pathologist to be familiar with this entity.

  13. Severe malaria - a case of fatal Plasmodium knowlesi infection with post-mortem findings: a case report

    PubMed Central

    2010-01-01

    Background Zoonotic malaria caused by Plasmodium knowlesi is an important, but newly recognized, human pathogen. For the first time, post-mortem findings from a fatal case of knowlesi malaria are reported here. Case presentation A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo. Four days later, he presented to hospital in a state of collapse and died within two hours. He was hyponatraemic and had elevated blood urea, potassium, lactate dehydrogenase and amino transferase values; he was also thrombocytopenic and eosinophilic. Dengue haemorrhagic shock was suspected and a post-mortem examination performed. Investigations for dengue virus were negative. Blood for malaria parasites indicated hyperparasitaemia and single species P. knowlesi infection was confirmed by nested-PCR. Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages, the liver and spleen were enlarged and lungs had features consistent with ARDS. Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney without evidence of chronic inflammatory reaction in the brain or any other organ examined. Brain sections were negative for intracellular adhesion molecule-1. The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells. The kidney had evidence of acute tubular necrosis and endothelial cells in heart sections were prominent. Conclusions The overall picture in this case was one of systemic malaria infection that fit the WHO classification for severe malaria. Post-mortem findings in this case were unexpectedly similar to those that define fatal falciparum malaria, including cerebral pathology. There were important differences including the absence of coma despite petechial haemorrhages and parasite sequestration in the brain. These results suggest that further study of knowlesi malaria

  14. Active Case Finding of Tuberculosis: Randomized Evaluation of Simple and Infotainment Chest Camps.

    PubMed

    Khan, Muhammad Amir; Anil, Shirin; Ahmed, Maqsood; Athar, Ali; Ghafoor, Abdul; Brouwer, Miranda

    In Pakistan, many tuberculosis (TB) cases are not reported to the national surveillance system. An active case finding strategy in the form of conventional (simple) or innovative (infotainment) chest camps can contribute to diagnosing these missed cases. To compare the yield in terms of TB patients detected at a simple chest camp (SCC) versus an infotainment chest camp (ICC) in rural areas. A cluster randomized controlled trial with 2 parallel arms was conducted in 4 districts of Pakistan from June 2012 to May 2013. Rural neighborhoods (n = 318) were randomly allocated in a ratio of 1:3 to receive either SCC or ICC. Incidence of TB (all forms and sputum smear positive [SS+]) and number needed to screen (NNS) to diagnose 1 TB case were calculated. Cluster analysis was done according to intention to treat and risk ratio (RR), and 95% confidence intervals (CIs) were calculated. A total of 3086 participants were tested at the SCC and 9029 at the ICC, of whom 38.5% were female. Mean age was 37.4 ± 15.9 years. Incidences of previously undiagnosed TB (all forms) for SCC and ICC were 23.6 (95% CI 20.04-27.4) and 22.1 (95% CI 20.3-24.1) per 100,000 population (P = .42), SS+ TB 22.5 (95% CI 19.3-26.1) and 21.6 (95% CI 19.8-23.6) (P = .67), respectively. NNS to diagnose 1 TB case were 260 (95% CI 234.3-289.6) and 258 (95% CI 233.3-287.9) for SCC and ICC, respectively (P = .9). RRs for all forms of TB and SS+ TB in SCC compared to ICC were 0.94 (95% CI 0.73-1.19) and 0.95 (95% CI 0.74-1.22) and P values were .58 and .71, respectively. Both types of chest camps are equally effective in active case finding of previously undiagnosed TB cases in rural areas in 2 provinces in Pakistan. Copyright © 2016. Published by Elsevier Inc.

  15. Increased case finding of tuberculosis from sputum and sputum deposits after magnetic bead concentration of mycobacteria.

    PubMed

    Liu, Jun; Sun, Zhan-Qiang; Pei, Hao; Zhang, Shi-Liang; Zhang, Shu-Lin; Wilson, Stuart; De Smet, Koen; Cerullakandiyil, Noushad; Thayyullathil, Thanveer; Al-Suwaidi, Zubaida; Song, Yan-Zheng

    2013-05-01

    Concentration of mycobacteria from sputum by centrifugation prior to acid-fast microscopy increases case finding compared to direct microscopy of the sputum (direct smear). However, centrifugation has to be performed outside the safety cabinet and many laboratories do not have access to a centrifuge. Magnetic bead extraction of the mycobacteria is an alternative method that can be performed in a cabinet with just a magnet. Magnetic TB-Bead (Microsens Medtech Ltd) extraction of mycobacteria from sputum prior to microscopy was compared to direct smear on 78 sputum samples. Microscopy of the TB-Bead extracts identified all of 26 of the direct smear positive samples either with the same microscopy score or, in 19/27 of samples, with an increased microscopy score which aided microscopy detection. In addition, microscopy of the TB-Bead extracts identified 10 additional positive samples compared to direct smear; which represents a statistically significant increase in case finding of 38% (p = 0.002) compared to direct smear. In a separate study, TB-Beads enabled further 4 positive samples to be detected from 30 centrifuged pellets that were originally smear negative; two of these were subsequently found to be positive when the original deposits were reinvestigated by smear microscopy. By concentrating mycobacteria from sputum and sputum deposits, TB-Beads have been demonstrated to increase the number of positive sputum samples which could increase case-finding. The TB-Bead method is simple and rapid and compatible with use within a safety cabinet. Copyright © 2013 Elsevier B.V. All rights reserved.

  16. Correlation of fine needle aspiration cytology findings with thyroid function test in cases of lymphocytic thyroiditis.

    PubMed

    Sood, Neelam; Nigam, Jitendra Singh

    2014-01-01

    Background. Chronic lymphocytic thyroiditis is the second most common thyroid lesion diagnosed on FNAC after goiter. FNAC is reliable tool in the diagnosis of thyroid lesion. Objective. To correlate FNAC cytologic findings with TFT in the lymphocytic thyroiditis. Methods. 175 patients with thyroid swellings were referred for FNAC as well as TFT during 2011-2013. Fine needle aspiration cytology was performed using non-aspiration or aspiration techniques and TFT performed on Beckman culter access 2. Results. Lymphoid infiltrate was seen in 55 cases. The commonest age group of lymphocytic thyroiditis was 21-30 years with male : female ratio being 1 : 10. Anti-TPO and TSH were elevated in 96.16% (25/26) of cases with grade 3 lymphoid infiltrate, 94.12% (16/17) of cases with grade 2, and 91.67% (11/12) of cases with 1 grade. Increased anti-TPO with raised TSH without any lymphoid infiltrate was seen in 5 cases and 5 cases showed only raised TSH without raised anti-TPO and without any lymphoid infiltrate. We observed that grade 3 lymphocytic infiltration has correlation with anti-TPO and TSH together or TSH alone but not with anti-TPO alone. We also observed that anti-TPO and TSH together are significant even if no lymphocytic infiltration is present. Conclusion. Grade 3 lymphocytic infiltration has statistical correlation with anti-TPO and TSH together or TSH alone but not with anti-TPO alone. Anti TPO was adjunct to TSH in grade 3. The presence of Hurthle cell change, giant cells, and granulomas has no statistical correlation with lymphocytic thyroiditis.

  17. Congenital megalourethra: prenatal diagnosis and postnatal/autopsy findings in 10 cases.

    PubMed

    Amsalem, H; Fitzgerald, B; Keating, S; Ryan, G; Keunen, J; Pippi Salle, J L; Berger, H; Aiello, H; Otaño, L; Bernier, F; Chitayat, D

    2011-06-01

    Congenital megalourethra is a rare urogenital malformation characterized by dilation and elongation of the penile urethra associated with absence or hypoplasia of the corpora spongiosa and cavernosa. Postnatal complications include voiding and erectile dysfunction as well as renal insufficiency and pulmonary hypoplasia. To date, only a few prenatally diagnosed cases have been reported. We report on 10 cases diagnosed prenatally and their postnatal/autopsy findings. The study involved retrospective chart review of all cases diagnosed antenatally in three tertiary care centers over 5 years. Antenatal ultrasound images and medical records from obstetrics, genetics, urology and nephrology were reviewed. Ten fetuses with megalourethra were identified at a median gestational age of 19 (range, 13-24) weeks and all were confirmed postnatally or at autopsy. Three pregnancies were terminated and seven continued. All cases presented with a distended bladder and megalourethra and all cases had normal karyotype. Of seven liveborn babies, one died neonatally of pulmonary hypoplasia. All six infants alive at the time of writing had a dysfunctional urethra and three suffered from impaired or end-stage renal disease. Associated anomalies were found in half of the cases. Congenital megalourethra is caused by abnormal development or hypoplasia of the penile erectile tissue, secondary to distal urethral obstruction. When the amniotic fluid volume is normal, survival is possible. However, all liveborn infants have voiding and renal dysfunction and sexual dysfunction is expected. Megalourethra should be considered in all male fetuses presenting prenatally with megacystis and detailed fetal ultrasonography should look for an elongated and/or distended phallic structure as well as any associated anomalies. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

  18. Neuropsychological findings in a case of punding before and after cessation of pramipexole.

    PubMed

    Larson, Eric R

    2015-01-01

    Clinical neuropsychologists are well trained to recognize neurological and psychiatric conditions that impact behavior, but tend to have less familiarity with iatrogenic consequences of various pharmacological treatments. One such consequence is the development of an impulse control disorder (ICD), which can result from treatment with dopamine agonists. Knowledge of ICDs is important because they can mimic obsessive-compulsive disorder, mania, or the behavioral variant of frontotemporal dementia. The current case examines a patient who developed punding, which is a type of ICD characterized by repetitive behavior, as a result of treatment with pramipexole. Neuropsychological testing was conducted before and after cessation of pramipexole, and showed that the removal of the medication was consistent with improvement in frontal-subcortical-mediated cognitive functions. Findings suggest that neuropsychologists should be familiar with the symptoms of ICDs and incorporate such knowledge into their case conceptualizations.

  19. Barriers to the effective use of medico-legal findings in sexual assault cases worldwide.

    PubMed

    Mont, Janice Du; White, Deborah

    2013-09-01

    Despite the increasing implementation of standardized rape kits across jurisdictions, the medico-legal findings generated by these tools are often not related to positive criminal justice outcomes. Given that there has been no global investigation of the factors that might impede their successful use in cases of sexual assault, we conducted a review of relevant scholarly and "grey" literature from industrialized and less-developed regions. One key theme to emerge from the analysis concerned certain problematic practices and behaviors of professional groups involved in the various stages of the post-sexual assault process. We found that a lack of competence in handling sexual assault cases, contempt for women who have been victimized, and corruption among some forensic examiners, police, scientists, and legal personnel often have shaped the collection, processing, analysis, and use of medico-legal evidence. We discuss recent initiatives and future directions for research that might serve to address these issues.

  20. Accuracy of proactive case finding for mental disorders by community informants in Nepal

    PubMed Central

    Jordans, Mark J. D.; Kohrt, Brandon A.; Luitel, Nagendra P.; Komproe, Ivan H.; Lund, Crick

    2015-01-01

    Background Accurate detection of persons in need of mental healthcare is crucial to reduce the treatment gap between psychiatric burden and service use in low- and middle-income (LAMI) countries. Aims To evaluate the accuracy of a community-based proactive case-finding strategy (Community Informant Detection Tool, CIDT), involving pictorial vignettes, designed to initiate pathways for mental health treatment in primary care settings. Method Community informants using the CIDT identified screen positive (n = 110) and negative persons (n = 85). Participants were then administered the Composite International Diagnostic Interview (CIDI). Results The CIDT has a positive predictive value of 0.64 (0.68 for adults only) and a negative predictive value of 0.93 (0.91 for adults only). Conclusions The CIDT has promising detection properties for psychiatric caseness. Further research should investigate its potential to increase demand for, and access to, mental health services. PMID:26450582

  1. Endobronchial Lipomatous Hamartoma: An Incidental Finding in a Patient with Atrial Fibrillation—A Case Report

    PubMed Central

    Schneider, Friederike; Winter, Hauke; Schwarz, Florian; Niederhagen, Manuel; Arias-Herrera, Vivian; Martens, Eimo; Kääb, Stefan; Theiss, Hans

    2012-01-01

    Introduction. Lung hamartomas are the most common benign tumors of the lung. Typically, they are located in the peripheral lung, while an endobronchial localisation is rare. Case Presentation. We present a case with the rare diagnosis of an endobronchial hamartoma as incidental finding in a 69-year-old male, caucasian patient with atrial fibrillation. At first admission, the patient's exertional dyspnea was caused by atrial fibrillation. Relapse of exertional dyspnea in the absence of arrhythmia was due to postobstructive pneumonia caused by an endobronchial hamartoma. Conclusion. Endobronchial tumors such as endobronchial lipoma or hamartoma should be considered as potential causes of exertional dyspnea and thus as differential diagnosis of atrial fibrillation. Although endobronchial hamartomas are benign, resection is recommended to prevent postobstructive lung damage. PMID:22431943

  2. Anterior segment optical coherence tomography findings of iris granulomas in Hansen's disease: a case report.

    PubMed

    Mahendradas, Padmamalini; Avadhani, Kavitha; Ramachandran, Sarika; Srinivas, Sahana; Naik, Madhavi; Shetty, K Bhujang

    2013-02-11

    A 50-year-old male was diagnosed to have a right eye sclerouveitis and left eye granulomatous anterior uveitis due to Hansen's disease. We are reporting the anterior segment optical coherence tomography (ASOCT) findings of iris granuloma in this case. Skin biopsy revealed plenty of acid fast bacilli with a bacteriological index of 5 suggestive of multibacillary polar lepromatous leprosy. ASOCT revealed well-demarcated smooth-surfaced nodular lesion with internal hyporeflectivity corresponding to the areas of granuloma which decreased in size following treatment with antileprosy drugs and systemic and topical steroids. ASOCT is a non-invasive technique to assess the extent of involvement of anterior segment in Hansen's disease and is a useful tool in follow-up. This is also the first report on ASOCT findings of iris granuloma in Hansen's disease.

  3. MR imaging related to p.m. findings in angiodysgenetic myelomalacia. A case report.

    PubMed

    Terwey, B; Besinger, U; Schuck, M; Vahldiek, G; Kuhn, F; Kuhn, M; Steen, H J

    1993-01-01

    In a 65-year-old patient with slowly progressive myelopathy of the lower spinal cord MRI revealed slight thickening of the conus medullaris and discrete serpiginous areas of low signal intensity in contact to the surface of the myelon. The T2-weighted axial images demonstrated a zone of high signal intensity within the center of the lumbosacral cord. These findings corresponded to the results of autopsy: cord enlargement, dilatation of wall thickened and partially thrombosed pial veins, edema, damage of the myelin sheath with development of foam cells, areas of hemorrhage and necrosis. Although myelography and spinal digital subtraction angiography had been normal in this case we assume that perhaps a spinal dural av-fistula may have been the cause of MR- and pathological findings which indicate an angiodysgenetic myelomalacia (Morbus Foix-Alajouanine). The pathogenesis of spinal dural av-fistulas is discussed in order to explain why angiography has been negative.

  4. Music evoked autobiographical memory after severe acquired brain injury: preliminary findings from a case series.

    PubMed

    Baird, A; Samson, S

    2014-01-01

    Music evoked autobiographical memories (MEAMs) have been characterised in the healthy population, but not, to date, in patients with acquired brain injury (ABI). Our aim was to investigate music compared with verbal evoked autobiographical memories. Five patients with severe ABI and matched controls completed the experimental music (MEAM) task (a written questionnaire) while listening to 50 "Number 1 Songs of the Year" (from 1960 to 2010). Patients also completed the Autobiographical Memory Interview (AMI) and a standard neuropsychological assessment. With the exception of Case 5, who reported no MEAMs and no autobiographical incidents on the AMI and who also had impaired pitch perception, the range of frequency and type of MEAMs in patients was broadly in keeping with their matched controls. The relative preservation of MEAMs in four cases was particularly noteworthy given their impaired verbal and/or visual anterograde memory, and in three cases, autobiographical memory impairment. The majority of MEAMs in both cases and matched controls were of a person/people or a period of life. In three patients music was more efficient at evoking autobiographical memories than the AMI verbal prompts. This is the first study of MEAMs after ABI. The findings suggest that music is an effective stimulus for eliciting autobiographical memories, and may be beneficial in the rehabilitation of autobiographical amnesia, but only in patients without a fundamental deficit in autobiographical recall memory and intact pitch perception.

  5. Radiological Findings and Endovascular Management of Three Cases with Segmental Arterial Mediolysis

    SciTech Connect

    Davran, Ramazan; Cinar, Celal; Parildar, Mustafa; Oran, Ismail

    2010-06-15

    Segmental arterial mediolysis (SAM) is an uncommon self-limited disorder that can cause abdominal catastrophes through massive bleeding or bowel infarction. The former arise from arterial aneurysms, and the latter from arterial stenosis or occlusions. Although this is an acute self-limiting disease, the catastrophic consequence, originating from intra-abdominal hemorrhage (arterial dilatation, aneurysms, dissecting hematomas) or bowel infarction (arterial stenosis, arterial occlusions), is not rare. The identification of these lesions is very important in the differential diagnosis of suspected patients with complaints of abdominal pain with hemorrhage. We report computerized tomography angiography and digital subtraction angiography findings of three cases with abdominal SAM, who were treated with endovascular management due to abdominal bleeding. Angiography showed arterial dilatations, aneurysms, and occlusions of visceral arteries in all three cases, The string-of-beads appearance was present in only one case. Bleeding stopped immediately after embolization of three cases and follow-up revealed no evidence of recurrences at 23, 18, and 15 months, respectively, Arterial coil embolization is an effective treatment modality for bleeding complications of SAM. Close follow-up is recommended, primarily to ascertain the fate of the nontreated arterial lesions.

  6. Radiological findings and endovascular management of three cases with segmental arterial mediolysis.

    PubMed

    Davran, Ramazan; Cinar, Celal; Parildar, Mustafa; Oran, Ismail

    2010-06-01

    Segmental arterial mediolysis (SAM) is an uncommon self-limited disorder that can cause abdominal catastrophes through massive bleeding or bowel infarction. The former arise from arterial aneurysms, and the latter from arterial stenosis or occlusions. Although this is an acute self-limiting disease, the catastrophic consequence, originating from intra-abdominal hemorrhage (arterial dilatation, aneurysms, dissecting hematomas) or bowel infarction (arterial stenosis, arterial occlusions), is not rare. The identification of these lesions is very important in the differential diagnosis of suspected patients with complaints of abdominal pain with hemorrhage. We report computerized tomography angiography and digital subtraction angiography findings of three cases with abdominal SAM, who were treated with endovascular management due to abdominal bleeding. Angiography showed arterial dilatations, aneurysms, and occlusions of visceral arteries in all three cases, The string-of-beads appearance was present in only one case. Bleeding stopped immediately after embolization of three cases and follow-up revealed no evidence of recurrences at 23, 18, and 15 months, respectively, Arterial coil embolization is an effective treatment modality for bleeding complications of SAM. Close follow-up is recommended, primarily to ascertain the fate of the nontreated arterial lesions.

  7. CBCT findings of periapical cemento-osseous dysplasia: A case report

    PubMed Central

    Eskandarloo, Amir

    2013-01-01

    Periapical cemento-osseous dysplasia (PCOD) is a subtype of cemento-osseous dysplasia that usually occurs in middle-aged black women. This report described a case of a 45-year-old Iranian woman who was diagnosed with PCOD on the basis of cone beam computed tomographic (CBCT) findings. CBCT enabled detailed visualization of the bone changes. This report described the special radiographic characteristics of PCOD, including discontinuity of the lingual cortex on the CBCT sectional and three-dimensional images. PMID:24083217

  8. Mucinous borderline ovarian tumor: a case report with diagnostic insights on ultrasound findings

    PubMed Central

    Śniadecki, Marcin; Bianek-Bodzak, Agnieszka; Liro, Marcin; Szurowska, Edyta

    2016-01-01

    Borderline ovarian tumors represent about 10% of all epithelial ovarian cancers, but in contrast to epithelial ovarian cancers, they constitute a group of tumors with a much better prognosis. An assessment of clinical presentation, physical examination, radiological and biochemical findings is necessary to tailor management strategies for patients with ovarian tumors. The article, which is based on a case report, describes different approaches for preoperative diagnosis as well as discusses approaches that might bring some insights on tumor histology. Furthermore, it raises a question about which imaging techniques should be proposed for a reliable diagnosis of borderline ovarian tumors to ensure safe surgery planning. PMID:28138412

  9. Periodic electroencephalogram discharges in a case of Lafora body disease: An unusual finding

    PubMed Central

    Jain, Rajendra Singh; Gupta, Arti; Gupta, Pankaj Kumar; Agrawal, Rakesh

    2016-01-01

    Lafora body disease (LBD) is a form of progressive myoclonic epilepsy, characterized by seizures, myoclonic jerks, cognitive decline, ataxia, and intracellular polyglucosan inclusion bodies (Lafora bodies) in the neurons, heart, skeletal muscle, liver, and sweat gland duct cells. Electroencephalogram (EEG) findings in LBD may include multiple spikes and wave discharges, photosensitivity, multifocal epileptiform discharges, and progressive slowing in background activity. Periodicity in epileptiform discharges has not been frequently depicted in LBD. We herein report an unusual case of LBD who showed generalized periodic epileptiform discharges in EEG. PMID:27293346

  10. Case report. Peripancreatic intranodal haemangioma mimicking pancreatic neuroendocrine tumour: imaging and pathological findings.

    PubMed

    Karaosmanoglu, A D; Arellano, R; Baker, G

    2011-12-01

    Haemangiomas are common benign tumours that are generally detected within the skin, mucosal surfaces and soft tissues. However, intranodal haemangiomas are extremely rare and are among the benign primary vascular abnormalities of the lymph nodes that include lymphangioma, haemangioendothelioma, angiomyomatous hamartoma and haemangiomas. In this case report, we present the imaging and pathological findings of an intranodal haemangioma in the pancreatic head simulating a pancreatic neuroendocrine tumour. To the best of our knowledge, this is the first report of an intranodal haemangioma in this location.

  11. (Manufacturing of the 40/30 mm gated image intensifier tube)

    SciTech Connect

    Vine, B.H.

    1990-04-27

    One of EG G's customers is attempting to find a manufacturer to make the 40/30 mm gated image intensifier tube. A request for quotation had been sent out to a number of manufacturers. The tube performance required was not fully defined and the replies, as expected, came back with caveats to cover the areas of uncertainty. The trip was undertaken to discuss the project, to more clearly define the areas of uncertainty and to evaluate the capabilities of the manufacturers.

  12. Ocular, Neurologic and Systemic Findings of the Cases with Optic Nerve Hypoplasia

    PubMed Central

    Karahan, Eyyup; Tulin Berk, Ayse

    2016-01-01

    Aim: To describe the associated ocular, neurologic, and systemic findings in a population of children with optic nerve hypoplasia (ONH) and to evaluate the relationship between ocular signs and neurologic findings. Method: A retrospective chart review of 53 patients with the diagnosis of ONH seen between December 1998 and September 2012 was performed. All neurodevelopmental anomalies, neuroradiologic findings, endocrinologic and systemic findings were recorded. Poor vision was defined as the visual acuity poorer than logMAR 1.0 or inadequate central steady maintained fixation. Results: Thirty (56.6%) of the 53 children with ONH were boys. Mean age at presentation was 56.2±46.8 months (range; 3 months to 18 years). Poor vision defined for the purpose of this study was found in 47.2% of 53 patients. Thirty-three (62.3%) children had nystagmus. Thirty-four (64.2%) children had strabismus. Thirteen (38.2%) of those with strabismus had esotropia, 20 (58.8%) had exotropia. The total number of the children with neurodevelopmental deficit was 22 (41.5%) in our study. Conclusion: The vision of young children with ONH should be monitored at least annually, and any refractive errors should be treated. Neuroimaging of the brain and endocrinologic evaluation is necessary in all cases with ONH. PMID:27014380

  13. Abdominal ultrasonographic findings associated with feline infectious peritonitis: a retrospective review of 16 cases.

    PubMed

    Lewis, Kristin M; O'Brien, Robert T

    2010-01-01

    The feline infectious peritonitis virus (FIPV) is a mutated form of the feline enteric coronavirus (FeCV) that can present with a variety of clinical signs. The purpose of this retrospective study was to analyze abdominal ultrasonographic findings associated with cats with confirmed FIPV infection. Sixteen cases were included in the study from a review of medical records at two academic institutions; inclusion was based either on necropsy lesions (n=13) or a combination of histopathological, cytological, and clinicopathological findings highly suggestive of FIPV infection (n=3). The liver was judged to be normal in echogenicity in 11 (69%) cats, diffusely hypoechoic in three cats, focally hyperechoic in one cat, and focally hypoechoic in one cat. Five cats had a hypoechoic subcapsular rim in one (n=3) or both (n=2) kidneys. Free fluid was present in the peritoneal cavity in seven cats and in the retroperitoneal space in one cat. Abdominal lymphadenopathy was noted in nine cats. The spleen was normal in echogenicity in 14 cats and was hypoechoic in two. One cat had bilateral orchitis with loss of normal testicular architecture. Although none of these ultrasonographic findings are specific for FIPV infection, a combination of these findings should increase the index of suspicion for FIPV infection when considered along with appropriate clinical signs.

  14. Clinical Findings and Results of Surgical Resection in 19 Cases of Spinal Osteoid Osteoma

    PubMed Central

    Etemadifar, Mohammad Reza

    2015-01-01

    Study Design Descriptive cases series. Purpose To evaluate clinical findings and results of conventional surgery in patients with spinal osteoid osteoma (OO). Overview of Literature OO is a rare benign tumor with spinal involvement rate of about 10%-20%. Methods This descriptive study was conducted on 19 patients (11 males and 8 females with an average age of 19.8 years) with documented histopathological and imaging findings of OO referred to a university hospital. Neurologic symptoms and pain were scored before and after the open surgical excision. Data were analyzed by SPSS ver. 16 software using chi-square and significance level of 0.05. Results The most common complaint was back or neck pain (84.2%) and in 68.4% spinal deformity (mostly scoliosis) shown with an average cobb angle of 21° at presentation. The sites of involvement were 35% in the lumbar, 35% in the thoracic, 25% in the cervical, and 5% in the sacrum. Lamina was the most common site (50%) of involvement with predilection for the right side (p=0.001). All patients were treated by conventional surgical excision with a complete recovery of pain and deformity. No recurrence occurred after a mean follow up of 44.5 months, but 4 of 19 cases instrumented because of induced instability. In one case there were two levels of involvement (C7-T1) simultaneously. Interestingly, 10 out of 19 of our cases belonged to a specific race (Bakhtiari). Conclusions Surgical intra-lesional curettage is potentially an effective method without any recurrence, which can lead to spontaneous scoliosis recovery and pain relief. Race may be a potential risk factor for spinal (OO). PMID:26097653

  15. Toxicological findings in two planned complex suicide cases: ingestion of petroleum distillates and subsequent hanging.

    PubMed

    Martínez, María Antonia; Ballesteros, Salomé

    2009-01-01

    This paper describes two fatal cases of planned complex suicide by two male individuals, 86 and 51 years old, involving ingestion of petroleum distillates and hanging. Remarkable internal findings during autopsy of both cases included the intense odor of petroleum distillates that alerted authorities to the suspicion of ingestion. The initial toxicological screening and quantitation of these compounds were performed by gas chromatography with flame-ionization detection, and confirmation was performed using gas chromatography-mass spectrometry in total ion chromatogram mode after liquid-liquid extraction of biological samples following a previously published analytical method. In Case 1, diesel fuel No. 2 concentrations were < 5 mg/L heart blood and 18,160 mg/L gastric content (total amount 6356 mg); therapeutic concentrations of citalopram were also found in blood. In Case 2, xylene (mixture of isomers) concentrations were 0.3 mg/L in heart blood and 0.1 mg/L in gastric content (total amount 0.006 mg); ethanol (1.12 g/L) and therapeutic concentrations of nordiazepam, oxcarbazepine, ibuprofen, and metamizol were also found in blood. The medical examiners in both cases reported the cause of death as hanging, and based upon examination of the scenes and the anatomopathological and toxicological data, the manners of death were determined to be planned complex suicide. We would like to alert toxicologists of the importance of testing for petroleum distillates when there is a suspicion of ingestion of these products due to the odor observed at the scene of death and/or during autopsy. The results of these toxicological investigations can help to determine the manner of death and the medicolegal interpretation.

  16. Asbestos: a hidden player behind the cholangiocarcinoma increase? Findings from a case-control analysis.

    PubMed

    Brandi, Giovanni; Di Girolamo, Stefania; Farioli, Andrea; de Rosa, Francesco; Curti, Stefania; Pinna, Antonio Daniele; Ercolani, Giorgio; Violante, Francesco Saverio; Biasco, Guido; Mattioli, Stefano

    2013-05-01

    We conducted a case-control analysis to explore the association between occupational exposure to asbestos and cholangiocarcinoma (CC). The study was based on historical data from 155 consecutive patients with CC [69 intrahepatic CC (ICC) and 86 extrahepatic CC (ECC)] referred to Sant'Orsola-Malpighi University Hospital between 2006 and 2010. The cases were individually matched by calendar period of birth, sex, and region of residence to historical hospital and population controls. Occupational exposure to asbestos was retrospectively assessed considering job titles obtained from work histories. Separate conditional logistic regression models were applied for ECC and ICC. Estimates were adjusted for smoking status and socioeconomic class. We matched 149 controls (median birth year: 1947; males: 56 %) to 41 cases of ICC (median birth year: 1946; males: 56 %) and 212 controls (median birth year: 1945; males: 48 %) to 59 cases of ECC (median birth year: 1945; males 51 %); 53 cases were not matched due to residence or birth year. We found an increased risk of ICC in workers exposed to asbestos (adjusted OR 4.81, 95 % CI 1.73-13.33); we also observed suggestive evidence that asbestos exposure might be associated with ECC (adjusted OR 2.09, 95 % CI 0.83-5.27). Sensitivity analysis restricted to patients from the Province of Bologna produced confirmatory figures. Our findings suggest that ICC could be associated with asbestos exposure; a chronic inflammatory pathway is hypothesized. Exposure to asbestos could be one of the determinants of the progressive rise in the incidence of ICC during the last 30 years.

  17. Secretory meningiomas: clinical, radiological and pathological findings in 70 consecutive cases at one institution

    PubMed Central

    Wang, Dai-Jun; Xie, Qing; Gong, Ye; Wang, Yin; Cheng, Hai-Xia; Mao, Ying; Zhong, Ping; Huang, Feng-Ping; Zheng, Kang; Wang, Yong-Fei; Bao, Wei-Min; Yang, Bo-Jie; Chen, Hong; Xie, Li-Qian; Zheng, Ming-Zhe; Tang, Hai-Liang; Zhu, Hong-Da; Chen, Xian-Cheng; Zhou, Liang-Fu

    2013-01-01

    Secretory meningioma (SM) is a rare, benign subtype of meningioma. Between January 2005 and December 2010, 70 SMs were operated on at the Department of Neurosurgery, Huashan Hospital, Fudan University. We retrospectively analyzed the clinical data, radiological and immunohistochemical findings, and patient outcome to discuss the specific features of SMs. Cranial base preference, hyper-signal in T2 weighted MR image, “xenon light” gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) enhancement were frequently observed in the 70 cases. Non-skull base SMs, which received more complete resection (p<0.01) and had better short-term and long-term outcome, were observed with more severe peritumoral brain edema (PTBE) (p<0.001). In follow-up, only 1 cranial base SM case showed tumor progression. 3 cases died after operation, all with cranial base SMs. As for the 10 cases given Simpson grade 3 or 4 resection who were available at follow-up, 3 died, 5 received gamma-knife therapy, and the other 2 cases received no treatment at all. Only one of the 2 residual SMs without postoperative radiation presented minor progression at a median of 48 months follow-up. In conclusion, cranial base preference, hyper-signal T2 weighted MR image and “xenon light” GD-DTPA enhancement are specific for SMs. Prognosis of SMs is related with operation completeness and surgical risks, rather than the extent of PTBE. Residual SM grows slowly and reacts well to gamma-knife therapy. PMID:23412548

  18. Computed tomographic findings in dogs and cats with temporomandibular joint disorders: 58 cases (2006–2011)

    PubMed Central

    Arzi, Boaz; Cissell, Derek D.; Verstraete, Frank J. M.; Kass, Philip H.; DuRaine, Grayson D.; Athanasiou, Kyriacos A.

    2013-01-01

    Objective To describe CT findings in dogs and cats with temporomandibular joint (TMJ) disorders. Design Retrospective case-series. Animals 41 dogs and 17 cats. Procedures Medical records and CT images of the skull were reviewed for dogs and cats that were examined at a dentistry and oral surgery specialty practice between 2006 and 2011. Results Of 142 dogs and 42 cats evaluated, 41 dogs and 17 cats had CT findings consistent with a TMJ disorder. In dogs, the most common TMJ disorder was osteoarthritis; however, in most cases, there were other TMJ disorders present in addition to osteoarthritis. Osteoarthritis was more frequently identified at the medial aspect rather than the lateral aspect of the TMJ, whereas the frequency of osteoarthritic involvement of the dorsal and ventral compartments did not differ significantly. In cats, fractures were the most common TMJ disorder, followed by osteoarthritis. Clinical signs were observed in all dogs and cats with TMJ fractures, dysplasia, ankylosis, luxation, and tumors; however, only 4 of 15 dogs and 2 of 4 cats with osteoarthritis alone had clinical signs. Conclusions and Clinical Relevance Results indicated that TMJ disorders are frequently present in combination. Osteoarthritis was the most common TMJ disorder in dogs and the second most common TMJ disorder in cats. Computed tomography should be considered as a tool for the diagnosis of TMJ disorders in dogs and cats with suspected orofacial disorders and pain. PMID:23234284

  19. [Tuberculosis annual report 2011--(3) case finding and condition of tuberculosis on diagnosis].

    PubMed

    2013-08-01

    Tuberculosis (TB) case findings in 2011 were reviewed, particularly regarding how the cases were detected, the diagnostic delay, the proportion of far-advanced cavitary lesions, coexisting HIV infection and diabetes mellitus (DM), and drug susceptibility testing (DST) using the national TB surveillance database. Among the 22,681 TB patients newly notified in 2011, 82.1 % of the cases were detected when the patient sought healthcare or attended medical facilities because of other chief complaints. Among the 17,519 pulmonary TB patients, 25.6% had only respiratory symptoms, 32.2% had both respiratory and nonrespiratory symptoms, and 17.0% had only non-respiratory symptoms. The rest (24.5%) were asymptomatic. The prevalence of patient's and doctor's delays among the 13,108 symptomatic pulmonary TB cases were analyzed. A large proportion-approximately 25-30%--of symptomatic pulmonary TB patients aged 30-59 years exhibited a total delay (i.e., the sum of the patient's and doctor's delays) of over 3 months. The proportion of patients with a patient's delay of over 2 months exhibited a similar tendency to that of the total delay, decreasing after 60 years of age. Moreover, the proportion of patients aged 65 years or more with a doctor's delay of over 1 month was higher than that of patients aged below 65 years. There was a high proportion-approximately 30%--of symptomatic smear-positive TB patients aged less than 60 years with a total delay of over 3 months, caused by a longer patient's delay. Meanwhile, the proportion of patients--approximately 15%--with a doctor's delay of over 1 month was almost stable across all age groups. The proportion of cases with far-advanced cavities in the lungs of pulmonary TB patients increased from 1.5% in 1975, remained stable at approximately 2% from 1985-2007, and decreased slightly thereafter until 2011 to 1.8%. From 2007-2011, there were 304 newly notified TB cases with HIV infection, 263 (86.5%) and 41 (13.5%) of which were men and

  20. Roberts syndrome: study of 4 new Rgyptian cases with comparison of clinical and cytogenetic findings.

    PubMed

    Temtamy, S A; Ismail, S; Helmy, N A

    2006-01-01

    Roberts syndrome is a rare autosomal recessive genetic disorder (MIM 268300). It is characterized by pre and postnatal growth retardation, severe shortening of limbs with radial defects, oligodactyly and characteristic facial features. The present study reports 4 new cases of Roberts syndrome from 3 families presenting variable phenotypes. Patients were thoroughly investigated clinically and cytogenetically. By reviewing literature, we compared our cases to those previously reported. The rating severity system proposed by Van den Berg and Francke (30) was applied to correlate the phenotypic and cytogenetics changes. We observed more severe reduction defects in the upper limbs than in the lower limbs. While the main reduction defects in the upper limbs involved the thumb and radius ranging to phocomelia, absent or severely hypoplastic fibula was the main lower limb involvement. We emphasize this finding in the present investigation. Heterochromatin repulsion of chromosomes derived from Roberts syndrome patients is a characteristic cytogenetic abnormality. It was a constant finding in our studied patients demonstrated by DABI stain which supports the possibility that mutations in Roberts syndrome lie in centromere related proteins which may also play a role in body patterning. This was proved recently by Vega et al. (31). Application of the clinical rating score and its correlation with cytogenetic changes showed negative results. Cytogenetic studies in normal obligatory heterozygotes parents showed no changes. Phenotypic variability within the same family as well as between different families was observed. The ascertainment of 4 cases with Roberts syndrome from 3 Egyptian consanguineous families during one year in our department may indicate a high frequency of the Roberts syndrome allele among Egyptians. This confirms the need for molecular studies for early and accurate prenatal diagnosis to prevent such dramatic malformation syndrome.

  1. Stratified mucin-producing intraepithelial lesion with invasive carcinoma: 12 cases with immunohistochemical and ultrastructural findings.

    PubMed

    Onishi, Junji; Sato, Yuichiro; Sawaguchi, Akira; Yamashita, Atsushi; Maekawa, Kazunari; Sameshima, Hiroshi; Asada, Yujiro

    2016-09-01

    Stratified mucin-producing intraepithelial lesion (SMILE) is considered to be a variant of adenocarcinoma in situ (defined as intraepithelial malignant glandular epithelium without invasion) or adenosquamous carcinoma in situ of the uterine cervix. However, recent study suggested that SMILE is more similar to high-grade squamous epithelial lesion by their immunohistochemical findings. An invasive form of SMILE "invasive stratified mucin-producing carcinoma (ISMC)" has been also proposed, but immunohistochemical features are not well documented. Therefore, this study aimed to clarify the immunohistochemical characteristics of SMILE and ISMC. Twelve cases of SMILE were found among 445 patients (2.7%) with high-grade intraepithelial lesions or invasive carcinomas, 3 of whom had solely intraepithelial disease with SMILE component (mean age, 37 years; range, 30-48 years) and 9 with invasive carcinomas (mean age, 47 years; range, 37-66 years; including ISMC). Immunohistochemically, SMILE and ISMC were diffusely positive for p16 and CAM5.2, focally for IMP3, and almost negative or only focally positive for p63. Nuclear signals in SMILE and invasive carcinomas were detected by human papillomavirus (HPV) in situ hybridization; 5 cases showed HPV16 and/or HPV18 polymerase chain reaction products. The ultrastructural study of 1 case showed surface microvilli and small vacuolar structure in SMILE; ISMC had mucous-like vacuoles, many mitochondria and intracytoplasmic lumen but lacked tonofilament. These findings were more similar to adenocarcinoma in situ or adenocarcinoma than squamous intraepithelial lesion or squamous cell carcinoma. We suggest that SMILE is an intraepithelial neoplasm and ISMC is an invasive form of SMILE. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Telephone follow-up for case finding of domestic violence in an emergency department.

    PubMed

    Sixsmith, D M; Weissman, L; Constant, F

    1997-04-01

    To determine whether telephone follow-up of selected female patients seen in an urban ED would improve domestic violence (DV) case finding. A prospective, cross-sectional study was conducted on consecutive female patients between the ages of 16 and 65 years treated in an urban trauma center during July and August 1995. Record review identified those patients with conditions suggesting increased risk for DV: injury; substance abuse; complaints or diagnoses related to stress, anxiety, depression, or panic attack; or complaints of headache, nonspecific abdominal pain, generalized fatigue, or numbness lasting > 1 week. Attempts were made to telephone all patients who had high-risk presentations within 3 days of their emergency visits. Patients were contacted by a trained interviewer regarding the circumstances of their visits. There were 142 (9%) high-risk presentations out of 1,500 ED visits by women. Of these high-risk visits, 68 patients denied DV, 19 patients did no speak English, 16 patients gave an incorrect telephone number, 18 patients could not be reached after 3 telephone calls, and 6 patients did not give a telephone number. Of the remaining 15 patients, 5 were diagnosed at the initial visit as having experienced DV, and 10 admitted on the follow-up call that the visit had been related to DV or emotional stress at home. A structured interview, conducted via telephone in follow-up of released ED patients, identified an additional 10 victims out of 142 high-risk presentations and 1,500 total ED presentations. This approach is labor-intensive, with a relatively low yield. Nonetheless, prospective identification of selective high-risk cases by physicians, coupled with subsequent social service telephone contact, may be a complement in department case finding.

  3. [Evaluation of clinical and laboratory findings of adult visceral leishmaniasis cases].

    PubMed

    Ural, Serap; Kaptan, Figen; Sezak, Nurbanu; El, Sibel; Örmen, Bahar; Türker, Nesrin; Demirdal, Tuna; Vardar, İlknur; Özkan Çayıröz, Pınar; Çakalağaoğlu, Fulya

    2015-10-01

    Visceral leishmaniasis (VL, kala-azar) is a zoonotic infection caused by Leishmania species which are transmitted to humans by the bites of infected female phlebotomine sandflies. Leishmania infantum is the responsible species of VL in Aegean, Mediterranean, and Central Anatolia regions of Turkey mainly observed sporadically in pediatric age groups. The aim of this study was to evaluate the clinical and laboratory findings of adult patients with VL who were admitted to our hospital. A total of 10 patients (3 female, 7 male; age range: 18-67 years, mean age: 39.3 ± 16.51) followed in the infectious diseases clinic of the hospital between 2000 and 2013 were evaluated retrospectively. The diagnosis of VL was based on the presence of appropriate clinical and physical examination, as well as biochemical findings, positive serological test results (indirect fluorescent antibody test, and rK39 rapid antigen test) and/or detection of amastigote forms of parasite in the bone marrow aspiration samples. Of the cases three were diagnosed with both bone marrow and serology positivity, five with bone marrow positivity and one of each only with liver biopsy and positive serology result. Time interval from onset of the symptoms until the establishment of the specific clinical diagnosis was ranged from 2 to 12 weeks. The most frequent initial symptoms were fever, fatigue and abdominal distension. None of the patients had immunosupressive conditions such as HIV infection, corticosteroid use, immunosupressive treatment, or transplantation. All the patients were from Aegean region and six were living in rural areas. In all cases, hepatosplenomegaly, increased erythrocyte sedimentation rate, albumin/globulin ratio inversion, anemia, leukopenia and among nine cases trombocytopenia were detected. In one case acute renal failure has been developed before treatment and the patient was admitted to dialysis program. Bacterial superinfection occurred in two cases. Patients were treated with

  4. The Evaluation of the Clinical, Laboratory, and Radiological Findings of 16 Cases of Brucellar Spondylitis

    PubMed Central

    Yang, Baohui; Hu, Hongbo; Chen, Jie; He, Xijing

    2016-01-01

    Objective. To evaluate the clinical, laboratory, and radiological presentation of 16 cases of brucellar spondylitis. Methods. The clinical manifestations, laboratory tests, and imaging findings of 16 patients (aged from 24 to 66 years) with brucellar spondylitis treated between September 2012 and September 2014 at the Second Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China) were retrospectively analyzed. Results. Clinical manifestations included high fever, severe pain, sweating, and fatigue. One patient had epididymitis, and two showed clear signs of spinal nerve damage. Laboratory tests showed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein content. Serum brucella agglutination tests were positive, and 11 brucella blood cultures were positive. Imaging manifestations mainly consisted of abnormal signals in the intervertebral space or abnormal signals in the adjacent vertebral bodies (16/16, 100%) in magnetic resonance imaging (MRI), disc space narrowing (14/16, 88%) in X-ray and MRI, or bone destruction and sclerosis around the damaged zone (13/16, 81%) in computed tomography, with rare cases of psoas abscess (2/16, 13%) and sequestrum (1/16, 6%). Conclusion. Since brucellar spondylitis exhibited characteristic clinical and imaging manifestations, it could be diagnosed with specific laboratory tests. Early MRI examination of suspected cases could improve rapid diagnosis. PMID:27672661

  5. Mobilising elementary and secondary school students for tuberculosis case finding in Anhui, China

    PubMed Central

    Kan, X. H.; Zhang, L. X.; Yang, J. A.; Zhang, J.

    2012-01-01

    Objectives: To evaluate the implementation of a FIDELIS (Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB) project in Anhui Province, China. Design: A survey card was designed for students to identify individuals who might have tuberculosis (TB) in their family. Teachers provided health education on TB before distributing the survey cards. Survey cards identifying individuals with respiratory symptoms for ≥3 weeks were sent by the teachers to village doctors who were trained to visit symptomatic individuals and advise them to undergo sputum examination. Data were routinely collected in the implementation of the FIDELIS project, and quarterly reports from the National Tuberculosis Programme were analysed. The detection of new smear-positive TB cases before and after FIDELIS, as well as with and without FIDELIS, were compared. Results: In the first year, a total of 2 387 405 students were involved and 23 079 symptomatic individuals were examined, among whom 2307 (10.3%) were diagnosed with smear-positive TB. Case detection in FIDELIS counties increased by a factor of 3.5 during the FIDELIS period compared with before FIDELIS, and that in non-FIDELIS counties by a factor of 3.1 (P = 0.001). Conclusion: It was feasible to massively mobilise students for TB case finding through collaboration between the health care and education systems. PMID:26392976

  6. Chronic pancreatitis in dogs: a retrospective study of clinical, clinicopathological, and histopathological findings in 61 cases.

    PubMed

    Bostrom, Brier M; Xenoulis, Panagiotis G; Newman, Shelley J; Pool, Roy R; Fosgate, Geoffrey T; Steiner, Jörg M

    2013-01-01

    The objective of this study was to characterize the clinical, clinicopathological, and histopathological findings of dogs with chronic pancreatitis. The necropsy database at Texas A&M University was searched for reports of dogs with histological evidence of chronic pancreatitis defined as irreversible histologic changes of the pancreas (i.e. fibrosis or atrophy). A reference necropsy population of 100 randomly selected dogs was used for signalment and concurrent disease comparisons. Cases were categorized as clinical or incidental chronic pancreatitis based on the presence of vomiting, decreased appetite, or both vs. neither of these signs. All archived pancreas samples were scored histologically using a published scoring system. Sixty-one dogs with chronic pancreatitis were included. The most frequent clinical signs were lethargy, decreased appetite, vomiting, and diarrhea. Compared to the reference necropsy population, chronic pancreatitis cases were more likely to be older, neutered, of the non-sporting/toy breed group, and to have concurrent endocrine, hepatobiliary, or neurological disease. Clinical cases had significantly higher histological scores for pancreatic necrosis and peripancreatic fat necrosis, and were significantly more likely to have hepatobiliary or endocrine disease as well as increased liver enzyme activities, or elevated cholesterol and bilirubin concentrations. In conclusion, clinical disease resulting from chronic pancreatitis might be related to the presence of pancreatic necrosis and pancreatic fat necrosis. The signalment, presentation, and concurrent diseases of dogs with chronic pancreatitis are similar to those previously reported for dogs with acute pancreatitis.

  7. Toxicological investigation of drug-related cases in Greece: interpretation of analytical findings.

    PubMed

    Stefanidou, Maria; Maravelias, Constantine; Dona, Artemis; Athanaselis, Sotiris; Spiliopoulou, Hara

    2007-01-01

    The process of toxicological analysis of postmortem specimens can reveal some special difficulty compared to the clinically derived specimens. Many drugs are not stable and the chemical changes that occur in the specimens, due to the hydrolysis processing, the time passed, the drug metabolism, and matrix effect, even when the postmortem interval is short, may affect the interpretation of the toxicological results. This interpretation may be critical, not only to the thorough investigation of different kind of forensic cases, but also to clinical or other cases as it provides very significant challenges to the scientists. This article reviews (a) particular toxicological issues associated with some toxic substances responsible for common lethal or nonlethal poisonings, such as opiates, cannabis, and cocaine and the vast number of factors that affect drug concentration; and (b) focuses on toxicological issues associated with the analytical findings of certain postmortem specimens. The toxic substances cited in the present paper are the most commonly found in forensic cases in Greece. The investigation of these drug-related deaths has revealed that heroin, alone or in combination with other psychoactive substances, such as cannabis and cocaine, is the main drug involved in these deaths.

  8. The role of US in finding intussusception and alternative diagnosis: a report of 100 pediatric cases.

    PubMed

    Ja Lim, Kyoung; Lee, Kwanseop; Yoon, Dae Young; Moon, Jin Hee; Lee, Hyun; Kim, Min-Jeong; Kim, Sam Soo

    2015-02-01

    The clinical diagnosis of intussusception remains challenging, because many children with intussusception may present with non-specific signs and symptoms, which overlap with other conditions. Therefore imaging, in particular ultrasonography (US), plays a significant role in the management of these patients. To evaluate how US can contribute to the diagnosis in clinically suspected intussusception and finding alternative diagnosis. We retrospectively reviewed reports of US examinations and medical records of 100 patients (51 boys, 49 girls; mean age, 23.0 ± 12.1 months) who underwent abdominal US for clinically suspected intussusception. Each US study was assessed for the presence or absence of intussusception and for a possible alternative diagnosis in cases interpreted as negative for intussusception. Thirty-seven patients had US findings consistent with intussusception, which was confirmed by air enema. In seven patients, US studies were normal. Alternative diagnoses were identified by US for each of the remaining 56 patients, including ileocolitis (n = 20), terminal ileitis (n = 18), mesenteric lymphadenitis (n = 13), choledochal cyst (n = 1), accessory spleen torsion (n = 1), small bowel ileus (n = 1), midgut volvulus with bowel ischemia (n = 1), and hydronephrosis (n = 1). With the high sensitivity and specificity of this study we conclude that US is valuable in detecting intussusception and finding the alternative diagnosis. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  9. A case of severe sepsis presenting marked decrease of neutrophils and interesting findings on dynamic CT.

    PubMed

    Makino, Isamu; Tajima, Hidehiro; Kitagawa, Hirohisa; Nakagawara, Hisatoshi; Miyashita, Tomoharu; Nakanuma, Shinichi; Hayashi, Hironori; Takamura, Hiroyuki; Fushida, Sachio; Ohta, Tetsuo

    2015-05-28

    In a patient with severe sepsis, we sometimes observe immediate decrease of the counts of white blood cells (WBCs) and neutrophils, which is known as an indicator for poor prognosis. We observed marked decrease of white blood cells and neutrophils on blood examination and interesting findings on dynamic CT. Here, we present the case of a patient with severe postoperative sepsis occurring after major abdominal surgery and we discuss the mechanism of such clinical presentations. A 60-year-old man received pancreatoduodenectomy with colectomy for pancreatic cancer. He developed a high fever on postoperative day 3. We observed marked decrease of WBCs and neutrophils on blood examination. We also observed slight swelling of the liver, inhomogeneous enhancement of liver parenchyma in arterial phase, and periportal low density in the Glisson capsule in portal phase, without any findings indicating infectious complications on dynamic CT. WBCs and neutrophils increased above normal range in just 6 hours. Blood culture examination performed while the patient had a high fever was positive for Aeromonas hydrophila. After receiving intensive care, he promptly recovered from severe sepsis. The CT findings disappeared on second dynamic CT examination performed 3 days after the first examination. We treated a patient with severe sepsis after major abdominal surgery who presented very rapid change of the counts of WBCs and neutrophils and interesting CT findings in the liver. We rescued him from a critical situation by prompt and intensive treatment. Research is needed to accumulate and analyze data from more patients who present a similar clinical course to better understand their pathophysiological conditions.

  10. Measured responsivities of generation II and hybrid image intensifiers

    SciTech Connect

    Yates, G.J.; King, N.S.P.; Thomas, M.C.

    1995-07-01

    We have measured the absolute and coupled system responsivities of several image intensifier types at several wavelengths in the visible spectrum. Intensifiers characterized include microchannel plate (MCP) generation II proximity-focused and hybrid generation I/generation II electrostatic-focused designs. Configurations including single plate, double plate, nominal and high strip current MCPs, and standard S20 and super generation II enhanced S-20 photocathodes were evaluated. Absolute responsivity measurements were performed using NIST-traceable radiometry instrumentation. The normalized relative sensitivities and overall optical luminous gain performance provided by individual intensifiers when similarly coupled to either high resolution 10-bit RS-170 CCD or FPS cameras are presented along with their radiometric data.

  11. Fluid flow intensifier for tide, current or wind generator

    SciTech Connect

    Thompson, J.E.

    1980-09-23

    A method is described of intensifying a relatively slow speed natural substantially horizontal flow of a natural fluid, such as a tidal flow, as opposed to a tidal rise, or a river flow, the natural flow being used to turn about a substantially horizontal axis rotary means arranged to act directly on a working fluid, which may be the natural fluid, where the latter is a liquid, or a separate liquid, and force it through a pipe system to a flow intensifier in the form of a constriction. The working liquid is forced through the pipe system without the formation of an head, and can be used to drive means for generating electricity. Flow intensifying apparatus is also described using seawater as the natural fluid and either fresh water or the seawater as the working fluid. Several of the apparatus may be disposed to cause a vortex or maelstrom which then serves to drive the apparatus.

  12. A survived case of diabetic nonclostridial gas gangrene and the review of the literatures on microbiological findings.

    PubMed

    Yasuda, K; Hayashi, M; Takeda, N; Goshima, E; Miura, K

    1986-05-01

    Nonclostridial gas gangrene in diabetics results in poor prognosis. In this paper, a survived case of diabetic nonclostridial gas gangrene caused by Proteus vulgaris and Streptococcus faecalis is described and microbiological findings of 31 cases of the literatures including our own case were reviewed. Twenty of 31 cases died (64.5%). The microbiological findings in 30 cases revealed an average of 1.8 organism per case. Predominant aerobes were E. Coli (56.7%), Streptococcus faecalis (16.7%), aerobic Streptococcus and Proteus (both 13.3%) in that order. Anaerobes were found in 12 of 20 cases and isolated anaerobes were Bacteroides (8 cases) and Peptococcus (4 cases). The role of specific bacteria in causing severe form of nonclostridial gas gangrene in diabetics was suggested.

  13. Medical Image Intensifier In 1980 (What Really Happened)

    NASA Astrophysics Data System (ADS)

    Baiter, Stephen; Kuhl, Walter

    1980-08-01

    In 1972, at the first SPIE seminar covering the application of optical instrumentation in medicine, Balter and Stanton presented a paper forecasting the status of x-ray image intensifiers in the year 1980. Now, eight years later, it is 1980, and it seems a good idea to evaluate these forecasts in the light of what has actually happened. The x-ray sensitive image intensifier tube (with cesium iodide as an input phosphor) is used nearly universally. Input screen sizes range from 15 cm to 36 cm in diameter. Real time monitoring of both fluoroscopic and fluorographic examinations is generally performed via closed circuit television. Archival recording of images is carried out using cameras with film formats of approximately 100 mm for single exposure or serial fluorography and 35 mm for cine fluorography. With the detective quantum efficiency of image intensifier tubes remaining near 50% throughout the decade, the noise content of most fluorographic and fluoroscopic images is still determined by the input exposure. Consequently, patient doses today, in 1980, have not substantially changed in the last ten years. There is, however, interest in uncoupling the x-ray dose and the image brightness by providing a variable optical diaphragm between the output of the image intensifier tube and the recording devices. During the past eight years, there has been a major philosophical change in the approach to imaging systems. It is now realized that medical image quality is much more dependent on the reduction of large area contrast losses than on the limiting resolution of the imaging system. It has also been clear that much diagnostic information is carried by spatial frequencies in the neighborhood of one line pair per millimeter (referred to the patient). The design of modern image intensifiers has been directed toward improvement in the large area contrast by minimizing x-ray and optical scatter in both the image intensifier tube and its associated components.

  14. Does GRACE see the water cycle 'intensifying'?

    NASA Astrophysics Data System (ADS)

    Eicker, Annette; Kusche, Jürgen; Forootan, Ehsan; Springer, Anne; Schumacher, Maike; Ohlwein, Christian

    2014-05-01

    Several researchers have postulated that, under a changing climate due to anthropogenic forcing, an intensification of the water cycle is already under way (Huntington, 2006). This is usually related to increases in hydrological fluxes such as precipitation (P), evapotranspiration (E), and river discharge (R). It is under debate, however, whether such observed or reconstructed flux changes are real and on what scales. Large-scale increase or decrease of the flux deficit (P-E) would lead to acceleration or deceleration of water storage anomalies possibly visible in GRACE time series, when discharge variability is small or properly accounted for. We investigate to what extent such accelerations, which are indeed found in maps of global gridded GRACE water storage anomalies, can be explained using output fields derived from global and regional atmospheric (re-)analyses and from hydrological models. We find this analysis challenging, since the GRACE time series is short and dominated by ENSO-type natural variability. Observed accelerations strongly depend on the analysis time frame, and may be explained to a large percentage by natural variability, thus masking a possible anthropogenically driven intensification of the terrestrial water cycle. This motivates us to apply statistical decomposition techniques in order to identify modes of natural variabilities and to remove them from the GRACE time series prior to the estimation of accelerations. Huntington T.G. (2006): Evidence for intensification of the global water cycle: Review and synthesis. J. Hydrology, 319:83-95

  15. [Tuberculosis annual report 2012--(3). Case finding and condition of tuberculosis on diagnosis].

    PubMed

    2014-10-01

    Tuberculosis (TB) case findings from 2012 nationwide TB surveillance data in Japan were reviewed for diagnosis delay, proportion of far-advanced cavitary lesions, coexisting human immunodeficiency virus (HIV) infection and diabetes mellitus (DM), and drug susceptibility'testing (DST). Among 21,283 new TB cases in 2012, 82.4% were detected when patients sought medical attention for TB symptoms or visited medical facilities for other chief complaints. Among 16,432 patients with pulmonary TB, 25.8% had only respiratory symptoms, 31.7% had both respiratory and non-respiratory symptoms, 16.7% had only non-respiratory symptoms, and 0.6% had unknown symptoms. The rest (25.2%) were asymptomatic. The proportion of patient and doctor delays among 12,197 symptomatic pulmonary TB cases was analyzed. A large proportion--approximately 25-30%--of patients aged 35-64 years with symptomatic pulmonary TB exhibited a patient delay of 2 months. Like patient delay, the proportion of patients with a total delay (i.e., the sum of the patient and doctor delays) of ≥ 3 months decreased after 55 years of age. Moreover, the proportion of patients aged ≥ 65 years with a doctor delay of ≥ 1 month was higher than patients aged < 65 years. A large proportion--approximately 30%--of patients with symptomatic smear-positive TB were < 60 years of age with a total delay of ≥ 3 months due to longer patient delays. Meanwhile, the proportion of patients-approximately 15%--with a doctor delay ≥ 1 month was relatively stable across all age groups. The proportion of patients with pulmonary TB with advanced lung cavities increased from 1.5% in 1975 to approximately 2% and remained stable from 1985 to 2007. From 2007 to 2012, 366 patients with HIV infection had newly notified TB, 314 (85.8%) and 52 (14.2%) men and women, respectively, including 76 (20.8%) non-Japanese patients. Newly notified TB cases with DM comprised 14.3% (3,036/ 21,283) of the total cases in 2012 : 16.4% (2,127/12,988) of men

  16. Two novel cases of compound heterozygous mutations in mitofusin2: Finding out the inheritance.

    PubMed

    Geroldi, Alessandro; Lastella, Patrizia; Patruno, Margherita; Gotta, Fabio; Resta, Nicoletta; Devigili, Grazia; Sabbà, Carlo; Gulli, Rossella; Lamp, Merit; Origone, Paola; Mandich, Paola; Bellone, Emilia

    2017-04-01

    MFN2 is the major gene involved in the axonal form of Charcot-Marie-Tooth disease. It usually has an autosomal dominant pattern of inheritance, but a few cases of homozygous or compound heterozygous mutations have been described. These patients usually present an earlier onset, more severe phenotype and their inheritance pattern can span from autosomal recessive to semidominant. Here we report two unrelated patients carrying two compound heterozygous MFN2 mutations. Both present a pure axonal neuropathy without any additional features. The first patient presents a mild clinical phenotype with onset in the 2nd decade, while the second patient shows a severe, early onset phenotype with loss of independent ambulation. Only a careful clinical examination as well as neurophysiological and genetic studies allowed us to establish the role and the transmission pattern of the identified variants. We discuss practical consequences of this finding in genetic counseling. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. A Case of Metastatic Esophageal Carcinoma in a Pregnant Woman with Radiologic Findings

    PubMed Central

    Akdemir, Zülküf; Arslan, Harun; Çalli, Iskan; Akdeniz, Hüseyin

    2016-01-01

    The incidence of all malignant tumours during pregnancy is extremely rare and esophageal carcinoma ranges from 0.07 to 0.1% of all malignant neoplasms. The physiological changes during pregnancy frequently mask the complaints and symptoms related to the disease. The physical and physiological clinical conditions limit the diagnostic approaches. Therefore, the stage of cancer at the time of diagnosis is usually advanced. The management with cancer surgery and chemotherapy regimens must be modified in pregnant women in order to minimize fetal and maternal risks. Here, we report a very rare case of metastatic esophagus cancer in a 39-year-old woman with 28 weeks of pregnancy and aim to show the ultrasound (USG) and magnetic resonance imaging (MRI) findings with treatment and follow up management. PMID:26894146

  18. Renal medullary carcinoma as an incidental finding in a horseshoe kidney: case report and literature review.

    PubMed

    Molgat, Gilles; Afrouzian, Marjan; Trpkov, Kiril

    2005-10-01

    Renal medullary carcinoma is rare and extremely aggressive neoplasm that typically affects young patients of African decent who demonstrate sickle cell trait or disease. Since the original description in 1995, only few cases have been reported outside the United States. A 29 year-old Canadian male of Afro-Caribbean decent with sickle cell trait developed right-sided hemiparesis due to brain infarct. During the clinical work-up, a 3 cm renal tumor was detected in a horseshoe kidney. The patient died suddenly 2 weeks after the presentation of massive non-neoplastic pulmonary thromboembolism, confirmed at autopsy. The final diagnosis of renal medullary carcinoma was established after the autopsy. Due to the small size of the tumor and the limited metastatic spread only to the regional lymph nodes, the tumor was considered an incidental finding, and not the primary cause of patient's death.

  19. Computer Tomography Imaging Findings of Abdominal Follicular Dendritic Cell Sarcoma: A Report of 5 Cases.

    PubMed

    Li, Jing; Geng, Zhi-Jun; Xie, Chuan-Miao; Zhang, Xin-Ke; Chen, Rui-Ying; Cai, Pei-Qiang; Lv, Xiao-Fei

    2016-01-01

    Follicular dendritic cell sarcoma (FDCS) is a neoplasm that arises from follicular dendritic cells. FDCSs originating in the abdomen are extremely rare. Clinically, they often mimic a wide variety of other abdominal tumors, and correct preoperative diagnosis is often a challenging task. To date, only scattered cases of abdominal FDCS have been reported and few data are available on their radiological features. Here we present the computer tomography imaging findings of 5 patients with surgically and pathologically demonstrated abdominal FDCS. An abdominal FDCS should be included in the differential diagnosis when single or multiple masses with relatively large size, well- or ill-defined borders, complex internal architecture with marked internal necrosis and/or focal calcification, and heterogeneous enhancement with "rapid wash-in and slow wash-out" or "progressive enhancement" enhancement patterns in the solid component are seen.

  20. [A case of MELAS associated with histochemical findings of muscles characteristic of MERRF].

    PubMed

    Suzuki, Hidefumi; Ono, Michio; Kojima, Yasuhiro; Kanda, Masutaro; Shibasaki, Hiroshi; Oki, Mituaki; Nakano, Satoshi

    2016-01-01

    We here report a 39-year-old woman of short stature with sensorineural deafness, who suddenly developed status epilepticus. T2-weighed image of brain magnetic resonance imaging (MRI) revealed a high signal lesion in the left temporal area, the distribution of which was not compatible with any particular arterial supply. Lactate and pyruvate were elevated in the serum and cerebrospinal fluid. As the mitochondrial gene analysis revealed the m.3243A>G mutation, diagnosis of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episode (MELAS) was made. In the histochemical study of a biopsied muscle, the intramuscular blood vessels reacted strongly with SDH (SSV), but the SSV was negative for cytochrome c oxidase (COX), the findings characteristic of myoclonic epilepsy with ragged-red fibers (MERRF). This is the first case of MELAS in which the muscle histochemistry showed positive SSV unassociated with increased COX.

  1. Diffuse storage of vegetal wax hydrocarbons of dietary origin. Pathologic and chemical findings in a case.

    PubMed

    Duboucher, C; Rocchiccioli, F; Lageron, A; Nègre, A; Salvayre, R; Bouissou, H

    1989-04-01

    A 55-year-old man died suddenly, after presenting with unstable angina and an asymptomatic micronodular pulmonary pattern. Autopsy revealed storage of a crystallized fatty substance in the lymph nodes, liver, spleen, adrenal glands, and lungs. In the latter organ, the deposition formed foreign body granulomas, accounting for the radiographic appearance. Mass spectrometry identified the fatty substance as straight-chain saturated hydrocarbons (n-alkanes) of carbon-29 and carbon-31 atoms, which are naturally present in the cuticular wax of many vegetals. The case history and the elimination as causal agent of products manipulated in the patient's work led to the conclusion that the storage was due to excessive consumption of apples, and to a lesser degree of Brussels sprouts. We present the light-microscopic findings and the principal biochemical results. Pathogenic mechanisms are described. As far as we are aware, this is the only observation of vegetal alkane storage to be described to date.

  2. Analysis regarding the transport network models. Case study on finding the optimal transport route

    NASA Astrophysics Data System (ADS)

    Stîngă, V.-G.

    2017-08-01

    Transport networks are studied most of the time from a graph theory perspective, mostly studied in a static way, in order to emphasize their characteristics like: topology, morphology, costs, traffic flows etc. There are many methods used to describe these characteristics at local and global level. Usually when analysing the transport network models, the aim is to achieve minimum capacity transit or minimum cost of operating or investment. Throughout this paper we will get an insight into the many models of the transport network that were presented over the years and we will try to make a short analysis regarding the most important ones. We will make a case study on finding the optimal route by using one of the models presented within this paper.

  3. When You Can't Find the Perfect Match: Using the Accumulated Most Similar Design in Case Studies

    ERIC Educational Resources Information Center

    Quinn, John James

    2009-01-01

    What happens when you want to use a most similar case study design for a small-N study, but you cannot find a particular pair of cases where all of the relevant, competing explanations are held constant? It is proposed here that scholars and teachers could employ or teach the "accumulated most-similar/crucial case design." This design…

  4. Integrating clinical trial findings into practice through risk stratification: the case of heart failure management.

    PubMed

    Smith, David H; Johnson, Eric S; Thorp, Micah L; Crispell, Kathy A; Yang, Xiuhai; Petrik, Amanda F

    2010-06-01

    Heart failure case management programs have been shown in clinical trials to be highly effective at preventing future hospitalizations. But the absolute benefits of these programs depend on the baseline risk of outcome in the treated population. Because baseline risks of hospitalization in trials are often higher than community-based samples, translating trial results to the community setting may be misleading. One solution is to identify subgroups for intervention that have sufficiently high baseline risk. Using estimates of hospitalizations averted from a previously published systematic review of heart failure management, we estimated a program's efficiency based on level of predicted risk. Medical history and demographic data on heart failure patients from a large integrated US health plan were used to build a logistic regression-based prognostic risk score for cardiovascular-related hospitalization over 1 year. We calculated the crude rate of hospitalizations for comparison with trial data. We also calculated the program's potential dollar savings from averting hospitalizations. The average risk of hospitalization in the systematic review's trials was 45%; our population's average observed risk was 18% and the risk among the highest risk patients was 33%. After accounting for the assumed annual intervention cost of $700, the base-case analysis (at $6000 per hospitalization) shows a savings of $122/patient at highest risk; failing to intervene according to predicted risk (no targeting) would actually cost $211/patient. Our findings illustrate how clinical trial findings can be efficiently integrated into community settings by using a prognostic risk score to focus attention on high-risk subgroups.

  5. Case-Finding for Persistent Airway Obstruction in Farmers: A Questionnaire With Optimal Diagnosis Criteria.

    PubMed

    Guillien, Alicia; Soumagne, Thibaud E; Puyraveau, Marc; Berger, Patrick; Guillot, Stéphanie L; Rannou, Fabrice; Jouneau, Stéphane; Mauny, Frédéric J; Laplante, Jean-Jacques; Dalphin, Jean-Charles; Degano, Bruno

    2017-08-14

    Appropriate identification of subjects who are candidates for spirometry through case-finding questionnaires may help solve the problem of chronic obstructive pulmonary disease misdiagnosis. The performance of case-finding questionnaires depends at least partially on the characteristics of the population used for their development. The use of an accurate threshold for the forced expiratory volume in 1 second / forced vital capacity ratio to define persistent airway obstruction is also vital in ascertaining chronic obstructive pulmonary disease. Using a population examined between October 2012 and May 2013 that included a large subset of agricultural workers both exposed and unexposed to tobacco smoking, the authors aimed to select a combination of items that would identify persons most likely to have persistent airway obstruction defined as forced expiratory volume in 1 second / forced vital capacity less than the lower limit of normal according to the Global Lung Initiative-2012 equations. Two thirds of the population (n=3,397) were randomly selected to develop a questionnaire, and one third (n=1,698) was reserved for questionnaire validation. Statistical analysis was performed in 2016. The selected items were sex, dyspnea, BMI, tobacco smoking habits, age, history of respiratory diseases, and history of occupation at risk. The C-index of the model was 0.84 (95% CI=0.80, 0.88) for the development population and 0.76 (95% CI=0.66, 0.86) for the validation population. Using the selected items in combination, the sensitivity and specificity in identifying persistent airway obstruction were 76% and 77%, respectively, in the development population (and 68% and 73%, respectively, in the validation population) for a threshold value of 2.50%. This seven-item questionnaire is the first developed from a population comprising a large subset of agricultural workers and using the Global Lung Initiative-2012 equations. Copyright © 2017 American Journal of Preventive Medicine

  6. Analog signal processing for a spaceborne Digicon image intensifier

    NASA Astrophysics Data System (ADS)

    Oberlack, N.; Klein, J. W.; Tueg, H.

    The paper presents the Digicon image intensifier, which uses a multidetector arrangement. The general instrument movement and electronic requirements are reviewed. A circuit diagram is used to illustrate circuit arrangement, and the technological state-of-the-art of multiple-thickness-configurations is discussed. Possible modifications in the image intensifier are considered, and technical parameters of the analog electronics (one channel) include a conversion factor of 1.9 microA/keV, a power requirement of 4.1 mW, a working temperature range of -55 to +125 C, and a dimension of 25.4 x 4.5 sq mm.

  7. Persistence of phosphor glow in microchannel plate image intensifiers

    NASA Technical Reports Server (NTRS)

    Torr, M. R.

    1985-01-01

    Image intensifier tubes using microchannel plate amplification stages and phosphor output stages are being increasingly used in various detection applications. In this paper, measurements of the decay times of what are attributed to be the P20 phosphors in various image intensifiers are reported. It is found that the long tail on the decay curve of the phosphor following illumination can be a limitation for certain observations. In addition, the background level of phosphor glow (which is seen by the subsequent detection system as a light signal) continues to build with continuing illumination.

  8. Descriptive epidemiology of injury cases: findings from a pilot injury surveillance system in Abu Dhabi.

    PubMed

    Rahman, M Hafizur; Allen, Katharine A; Hyder, Adnan A

    2016-01-01

    Considering the high burden of injuries, the Health Authority-Abu Dhabi developed a draft electronic and paper-based injury and poisoning notification system (IPNS) to generate better data on the nature and severity of injuries. The pilot testing and evaluation of IPNS was conducted with the specific objectives to (1) identify the characteristics of injury cases, (2) explore potential risk factors, (3) illustrate the nature and type of data, and (4) the working mechanism of data collection. Data were collected from selected hospitals on patient demographics, injury information and clinical assessment. Descriptive, bivariate and multivariate analyses were conducted. Of 4226 injury cases, nearly three-fourths were male, majority were non-UAE nationals, and the mean age was 21.9. Multivariate findings suggested that compared to UAE nationals, non-UAE nationals were 27% more likely to experience fatal, severe or moderate injuries (p = 0.01). Individuals with health insurance were 31% less likely to suffer a fatal, severe or moderate injury compared to those having no health insurance (p < 0.001). This is the first systematically standardised collection of injury data across three facilities in Abu Dhabi, and provides initial information on characteristics and injury risk factors that will help identify the need for evidence-based intervention for injury prevention and control.

  9. Hepatoblastoma. Report of a case with cytologic, histologic and ultrastructural findings.

    PubMed

    Cangiarella, J; Greco, M A; Waisman, J

    1994-01-01

    Hepatoblastoma, although rare, is the most common primary malignant neoplasm of the liver in children. In this paper we describe a case of hepatoblastoma with unusual cytologic features and present the histologic, immunocytochemical and ultrastructural features of this neoplasm. A 7-month-old girl presented with a large hepatic mass and metastatic nodules in both lungs. Intraoperative biopsy revealed a hepatoblastoma. Aspiration biopsy yielded a highly cellular aspirate with cords of pleomorphic cells embedded in a mucoid matrix. Histologic sections showed a diffusely infiltrative neoplasm composed of sheets and cords of highly pleomorphic cells. The neoplastic cells stained strongly positive for cytokeratin CAM 5.2 and AE1 and focally positive for alpha-fetoprotein, ferritin, carcinoembryonic antigen and vimentin. Ultrastructurally, the neoplastic cells had abundant intercellular junctions and intracytoplasmic aggregates of intermediate filaments. A mucoid matrix, to our knowledge, has not been reported as a finding on aspiration biopsy. This patient presented with pulmonary metastases, and thus we think the mucoid matrix may be a marker of a more aggressive variant of hepatoblastoma. This case illustrates additional cytologic features of hepatoblastoma and the usefulness of aspiration biopsy in the rapid diagnosis of this rare tumor.

  10. Septic osteitis of the distal phalanx: findings and surgical treatment in 18 cases.

    PubMed

    Cauvin, E R; Munroe, G A

    1998-11-01

    Eighteen cases of septic osteitis of the distal phalanx were diagnosed clinically and confirmed at surgery over a 6 year period (1990-1996). Focal bone lysis was the most common radiographic finding. Sequestra were identified in 4 horses, one of which was associated with a fractured plantar process. All the horses were treated surgically with open debridement. The septic process recurred in 4 horses: one was subjected to euthanasia due to navicular bursa infection, secondary to a pathological fracture, the other 3 horses responded to further debridement. A pathological fracture occurred in another horse. All the survivors were not lame 3 months post operatively, although complete healing took 1-12 months. Long term follow up was available in 14 cases. One was retired, all the other horses were back in work at a similar level of performance. This series indicates that surgical treatment of septic pedal osteitis carries a fair to good prognosis despite a high rate of post operative complications and convalescence period of up to 12 months.

  11. Anderson-Fabry disease: a case-finding study among male kidney transplant recipients in Austria.

    PubMed

    Kleinert, Julia; Kotanko, Peter; Spada, Marco; Pagliardini, Severo; Paschke, Eduard; Paul, Karl; Voigtländer, Till; Wallner, Manfred; Kramar, Reinhard; Stummvoll, Hans-Krister; Schwarz, Christoph; Horn, Sabine; Holzer, Herwig; Födinger, Manuela; Sunder-Plassmann, Gere

    2009-03-01

    The diagnosis of Anderson-Fabry disease is often delayed or even missed. As severe renal manifestations are a hallmark of alfa-galactosidase A (AGAL) deficiency, we tested the hypothesis that Anderson-Fabry disease is under-recognized among male kidney transplant recipients. This nation-wide study in Austria enrolled 1306 patients (ca 65% of all kidney transplanted males) from 30 kidney centers. AGAL activity was determined from filter paper dried blood spots by a fluorescence assay. A positive screening test was defined by an AGAL activity below 1.5 nmol/h/ml. In patients with a positive blood spot-screening test, AGAL activity was re-examined in peripheral blood leukocytes. Genetic testing for mutations in the GLA gene was performed by sequencing to confirm the diagnosis of Anderson-Fabry disease. Two previously not recognized cases with Anderson-Fabry disease were identified. Our study is the first showing that a diagnosis of Anderson-Fabry disease can be missed even in patients who undergo kidney transplantation. Case-finding strategies may be considered a useful tool for diagnosis of this rare disease that may be somewhat more prevalent among kidney transplant recipients compared with dialysis populations.

  12. Proximal ureteral atresia, a rare congenital anomaly—incidental finding: a case report

    PubMed Central

    Conighi, Maria Luisa; Fasoli, Lorella; Bucci, Valeria; Battaglino, Francesco; Chiarenza, Salvatore Fabio

    2017-01-01

    Ureteral atresia is a rare disease usually associated with a non-functioning dysplastic kidney. The condition may be unilateral or bilateral; focal, short or long and may involve any part of the ureter. Association with other urinary anomalies is rare. We report the case of a 10-month-old boy with prenatal diagnosis of multicystic right kidney. This suspicion was confirmed after birth by ultrasound and static scintigraphy; a right vesicoureteral reflux (VUR) was recorded at cystography. The boy presented a regular renal function but was hospitalized twice for suspected pyelonephritis between the 8th and the 10th month of life and were recorded occasional mild changes in blood pressure. Antibiotic prophylaxis was administered until surgery. When he was 10-month underwent retroperitoneoscopy to perform a nephroureterectomy finding a complete atresia of the upper third of the ureter with the blind end at the level of the uretero-pelvic-junction. The programmed surgery was performed. By a revision of literature, only few cases of imperforate distal ureter have been described. This condition is associated with a kidney dysplasia. The atresia of the ureter with no signs of infection in the dysplastic kidney may be unknown up to adulthood or throughout one’s life. Prognosis usually depends on the severity of the obstruction. PMID:28164035

  13. Proximal ureteral atresia, a rare congenital anomaly-incidental finding: a case report.

    PubMed

    Bleve, Cosimo; Conighi, Maria Luisa; Fasoli, Lorella; Bucci, Valeria; Battaglino, Francesco; Chiarenza, Salvatore Fabio

    2017-01-01

    Ureteral atresia is a rare disease usually associated with a non-functioning dysplastic kidney. The condition may be unilateral or bilateral; focal, short or long and may involve any part of the ureter. Association with other urinary anomalies is rare. We report the case of a 10-month-old boy with prenatal diagnosis of multicystic right kidney. This suspicion was confirmed after birth by ultrasound and static scintigraphy; a right vesicoureteral reflux (VUR) was recorded at cystography. The boy presented a regular renal function but was hospitalized twice for suspected pyelonephritis between the 8th and the 10th month of life and were recorded occasional mild changes in blood pressure. Antibiotic prophylaxis was administered until surgery. When he was 10-month underwent retroperitoneoscopy to perform a nephroureterectomy finding a complete atresia of the upper third of the ureter with the blind end at the level of the uretero-pelvic-junction. The programmed surgery was performed. By a revision of literature, only few cases of imperforate distal ureter have been described. This condition is associated with a kidney dysplasia. The atresia of the ureter with no signs of infection in the dysplastic kidney may be unknown up to adulthood or throughout one's life. Prognosis usually depends on the severity of the obstruction.

  14. Clinical features and imaging findings in a case of Capgras syndrome

    PubMed Central

    Luca, Maria; Bordone, Andrea; Luca, Antonina; Patti, Andrea; Sortino, Giuseppe; Calandra, Carmela

    2013-01-01

    Capgras syndrome consists of the delusional belief that a person or persons have been replaced by doubles or impostors. It can occur in the context of both psychiatric and organic illness, and seems to be related to lesions of the bifrontal and right limbic and temporal regions. Indeed, magnetic resonance imaging has revealed brain lesions in patients suffering from Capgras syndrome. This case study reports the findings of a thorough diagnostic evaluation in a woman suffering from Capgras syndrome and presenting with the following clinical peculiarities: obsessive modality of presentation of the delusional ideation, intrusiveness of such ideation (that even disturbed her sleep), as well as a sense of alienation and utter disgust towards the double. These characteristics bring to mind the typical aspects of obsessive-compulsive disorder. Neuroanatomic investigation, through magnetic resonance imaging, performed on this patient showed alteration of the bilateral semioval centers, which are brain regions associated with the emotion of disgust and often show alterations in subjects suffering from obsessive-compulsive disorder. Hence, neuroimaging allows researchers to put forward the hypothesis of a common neuroanatomic basis for Capgras syndrome and obsessive-compulsive disorder, at least for cases in which the delusional ideation is associated with deep feelings of disgust and presents with a certain pervasiveness. PMID:23950650

  15. Enterobius vermicularis in tubo-ovarian abscess: A rare and interesting incidental finding - A case Report.

    PubMed

    Saleem, Faryal; Malik, Faizan; Fatima, Saira

    2017-04-01

    Enterobius vermicularis is a common intestinal nematode; however, rare extraintestinal Enterobius infections have been reported from different parts of the world. Here, we present a case of tubo-ovarian abscess in an otherwise healthy young sexually active female with no known comorbids with history of on and off lower abdominal pain for one year and high grade fever for one month. On the basis of further workup and radiological evaluation, a preoperative diagnosis of right sided tubo-ovarian abscess was made and salpingo-oophorectomy was performed laproscopically in July 2015. Histopathology of the resected tissue revealed necrosis and in one area Enterobius vermicularis was identified surrounded by neutrophils and eosinophil rich abscess. A final diagnosis of severe acute and chronic salpingo-oophoritis with abscess formation, secondary to Enterobius vermicularis was made. Signs and symptoms of parasitic involvement in tubo-ovarian abscesses are not much different than usual presentations of pelvic inflammatory diseases and identification of a parasite in a tubo-ovarian tissue sample is a rare clinical finding. A high index of suspicion on the part of histopathologist as well as clinician is important for timely diagnosis and effective management of such cases.

  16. Medical Findings and Toxicological Analysis in Infant Death by Balloon Gas Asphyxia: A Case Report.

    PubMed

    Cuypers, Eva; Rosier, Elien; Loix, Sara; Develter, Wim; Van Den Bogaert, Wouter; Wuestenbergs, Joke; Van de Voorde, Wim; Tytgat, Jan

    2017-05-01

    In recent years, the increasing number of asphyxiation cases due to helium inhalation is remarkable. All described cases in the literature where diagnosed as suicide. In this article, however, we describe a triple infant homicide in which helium, as balloon gas, was administered to three young children after sedation causing asphyxiation and death through the medical findings and toxicological analysis. During autopsy, in addition to standard toxicological samples, gas samples from lungs as well as lung tissue itself were directly collected into headspace vials. Besides routine toxicological analysis, which revealed toxic levels of doxylamine, qualitative analysis on gas and lung samples was performed using headspace gas chromatography-mass spectrometry. As carrier gas, the commonly used helium was replaced by nitrogen. In gas samples from lungs of all three children, no helium was found. Nevertheless, lung tissue samples were found positive on helium. Therefore, sedation followed by asphyxia due to helium inhalation can strongly be assumed as the cause of death of all three children. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Meconium pseudocyst with particular pathologic findings: a case report and review of the literature.

    PubMed

    Minato, Masashi; Okada, Tadao; Miyagi, Hisayuki; Honda, Shohei; Takazawa, Kei; Kubota, Kanako C; Todo, Satoru

    2012-04-01

    Meconium peritonitis is a sterile chemical peritonitis caused by bowel perforation with intraperitoneal extravasation of the meconium in utero. When the inflamed intestinal loops become fixed, meconium peritonitis leads to a cystic cavity with a fibrous wall, and the result is termed cystic-type meconium peritonitis. On the contrary, a meconium pseudocyst has a muscle layer continuous with the normal intestine and is distinguished from cystic-type meconium peritonitis based on the histopathologic findings. This report describes the rare case of a neonate complicated by a meconium pseudocyst, which was successfully treated with 1-stage resection and primary anastomosis. There have been few cases of meconium pseudocysts reported in the literature. Meconium peritonitis should be considered in the differential diagnosis in patients who develop large abdominal cysts with air and fluid content. Cystic-type meconium peritonitis is usually treated using drainage with subsequent elective surgery. However, for a meconium pseudocyst, 1-stage intestinal resection with primary anastomosis may be recommended. A meconium pseudocyst may be treatable using 1-stage resection based on histopathologic features.

  18. A case of pigmentary orthochromatic leukodystrophy with findings of proton MR spectroscopy and serial brain MRIs.

    PubMed

    Sohn, Sung-Yeon; Ko, Young-Jin; Hong, Ji Man; Kim, Se-Hyuk; Kim, Ho-Sung; Kim, Jang-Hee; Chi, Je-Geun; Moon, So Young

    2010-08-15

    Despite a few case reports over the last 60 years, little progress has been made in defining the phenotype, genotype and pathophysiological mechanisms involved in pigmentary orthochromatic leukodystrophy (POLD). Furthermore, there is currently no data available regarding MRI in patients in the relatively early stages of POLD. Here, we present a 37 year old male patient with brain biopsy-proven POLD who had brain MRIs three times during the first year of his clinical course and proton MR spectroscopy (MRS) throughout his diagnostic evaluation. This patient with POLD was clinically characterized by seizures, rapidly progressive frontally predominant dementia and gait disturbance. The brain MRIs taken serially over the first year revealed progressive development of frontal-predominant white matter changes in the periventricular areas during the earlier periods, which later spread into the deep white matter. His MRS was helpful in the diagnostic approach because the results enabled demyelinating changes to be distinguished from other disease processes such as ischemia, gliosis or tumors. The MRS findings also reflected the disease dynamics because metabolic derangement was observed, even in the white matter that appeared normal. The findings presented here provide insight into the dynamics of POLD.

  19. Ophthalmic findings in acute mercury poisoning in adults: A case series study.

    PubMed

    Aslan, Lokman; Aslankurt, Murat; Bozkurt, Selim; Aksoy, Adnan; Ozdemir, Murat; Gizir, Harun; Yasar, Ibrahim

    2015-08-01

    The aim of this study is to report ophthalmic findings of acute mercury poisoning in 48 adults referred to emergency department. Full ophthalmologic examination including the best corrected visual acuity, external eye examination, reaction to light, a slit-lamp examination, funduscopy, intraocular pressure measurements, and visual field (VF) and color vision (CV) tests were performed at the presentation and repeated after 6 months. The parametric values of VF test, the mean deviation (MD), and pattern standard deviation (PSD) were recorded in order to compare patients and the 30 healthy controls. The mean parameter of color confusion index in patients was found to be statistically different than controls (p < 0.01). The MD and PSD in patients were different from controls statistically significant (p < 0.01 and p < 0.01, respectively). There was no correlation between the ocular findings and the urine and blood mercury levels. Methyl mercury, held in the school laboratory for experimental purpose, may be a source of poisoning. In this case series, we showed that acute exposure to mercury had hazardous effect on the visual system, especially CV and VF. We propose that emphasizing the public education on the potential hazards of mercury is crucial for preventive community health.

  20. Case report: clinical and postmortem findings in four cows with rib fracture.

    PubMed

    Braun, Ueli; Warislohner, Sonja; Hetzel, Udo; Nuss, Karl

    2017-02-06

    Published reports of rib fractures in adult cattle are limited to the occurrence of chronic rib swellings caused by calluses, which are unremarkable from a clinical standpoint, whereas studies identifying clinical signs of rib fractures were not found in a literature search. This report describes the clinical and postmortem findings in four cows with rib fractures. The 13th rib was fractured in three cows and the 11th rib in the remaining cow; three fractures were on the right and one on the left side. Clinical and postmortem findings varied considerably, and percussion of the rib cage elicited a pain response in only one cow. One cow had generalised peritonitis because of perforation of the rumen by the fractured rib. One cow was recumbent because of pain and became a downer cow, and two other cows had bronchopneumonia, which was a sequel to osteomyelitis of the fracture site in one. In the absence of a history of trauma, the diagnosis of rib fracture based on clinical signs alone is difficult. Although rib fractures undoubtedly are very painful, the four cases described in this report suggest that they are difficult to diagnose in cattle because associated clinical signs are nonspecific.

  1. Death following the ingestion of detergent: an autopsy case with special regard to the histochemical findings.

    PubMed

    Kawamoto, Osamu; Ishikawa, Takaki; Oritani, Shigeki; Kuramoto, Yuko; Michiue, Tomomi; Maeda, Hitoshi

    2013-06-01

    We report an autopsy case of death due to accidental ingestion of a liquid laundry detergent with special regard to the histochemical findings. A female inpatient suffering from schizophrenia in a psychiatric institution, was found unconscious lying on the floor of her room, with a container of detergent nearby, and died despite intensive life-support measures. At autopsy, the stomach and duodenum contained whitish translucent foamy viscous fluid, and the mucous membranes, from the esophagus to the duodenum, had diffuse erosions with congestion and edema. There was otherwise no significant pathology other than signs of acute death and hemolysis. Toxicological investigations detected 1-methyl-4-prop-1-en-2-ylcyclohexene (detergent additive) in the gastric contents using headspace-gas chromatography/mass spectrometry, and a nonionic surfactant by a color identification test. Although these substances could not be detected in the blood, body fluid or viscera, histochemical examination using Oil red O demonstrated droplet-like staining in the pulmonary alveoli, suggesting aspiration of detergent, and similar staining in the vasculature of the lung, Kupffer cells of the liver, Bowman capsules of the kidney, and capillaries of the brain, suggesting the systemic effect of ingested/aspirated detergent. These findings were in keeping with death from ingestion of detergent and demonstrated the importance of preventing accidents such as this in healthcare facilities for elderly people.

  2. Cutaneous mucormycosis and motor vehicle accidents: Findings from an Australian case series.

    PubMed

    Ingram, Paul R; Suthananthan, Arul E; Rajan, Ruben; Pryce, Todd M; Sieunarine, Kishore; Gardam, Dianne J; Heath, Christopher H

    2014-11-01

    Cutaneous disease is the third most frequent manifestation of mucormycosis. The clinical manifestations of and subsequent mortality due to cutaneous mucormycosis are dependent on the mode of acquisition and the host immune status. Here, we describe the epidemiology, clinical presentation, microbiology, and outcomes of 16 cutaneous mucormycosis infections managed in an Australian tertiary hospital over a 15-year period. The proportion with localized (56%), deep (38%), and disseminated (6%) cutaneous disease as well as the overall mortality (25%) were consistent with findings reported in the published literature. Two novel forms of hospital-acquired infection were reported following a sacral pressure sore and insertion of a foreign body during a bone graft procedure. The majority of patients were immunocompetent (75%) and/or suffered trauma (56%) with associated environmental contamination. A novel finding was that motor vehicle accidents (MVAs) accounted for 78% of all trauma-related cases, suggesting MVAs should receive greater recognition as a potential precipitant of cutaneous mucormycosis. Aggressive decontamination and debridement of devitalized tissue following trauma is therefore likely to play an important role in the prevention of this rare but potentially devastating infection. © The Author 2014. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. [Case finding in early prevention networks - a heuristic for ambulatory care settings].

    PubMed

    Barth, Michael; Belzer, Florian

    2016-06-01

    One goal of early prevention is the support of families with small children up to three years who are exposed to psychosocial risks. The identification of these cases is often complex and not well-directed, especially in the ambulatory care setting. Development of a model of a feasible and empirical based strategy for case finding in ambulatory care. Based on the risk factors of postpartal depression, lack of maternal responsiveness, parental stress with regulation disorders and poverty a lexicographic and non-compensatory heuristic model with simple decision rules, will be constructed and empirically tested. Therefore the original data set from an evaluation of the pediatric documentary form on psychosocial issues of families with small children in well-child visits will be used and reanalyzed. The first diagnostic step in the non-compensatory and hierarchical classification process is the assessment of postpartal depression followed by maternal responsiveness, parental stress and poverty. The classification model identifies 89.0 % cases from the original study. Compared to the original study the decision process becomes clearer and more concise. The evidence-based and data-driven model exemplifies a strategy for the assessment of psychosocial risk factors in ambulatory care settings. It is based on four evidence-based risk factors and offers a quick and reliable classification. A further advantage of this model is that after a risk factor is identified the diagnostic procedure will be stopped and the counselling process can commence. For further validation of the model studies, in well suited early prevention networks are needed.

  4. [Case of spontaneous ventriculocisternostomy: with special reference to a CT finding].

    PubMed

    Yamane, K; Yoshimoto, H; Harada, K; Uozumi, T; Kuwabara, S

    1983-05-01

    Spontaneous ventriculocisternostomy rarely occurs in obstructive hydrocephalus. The authors experienced a case of spontaneous ventriculocisternostomy diagnosed by CT scan with metrizamide and Conray. Patient was 23-year-old male who had been in good health until one month before admission, when he began to have headache and tinnitus. He noticed bilateral visual acuity was decreased about one week before admission and vomiting appeared two days before admission. He was admitted to our hospital because of bilateral papilledema and remarkable hydrocephalus diagnosed by CT scan. On admission, no abnormal neurological signs except for bilateral papilledema were noted. Immediately, right ventricular drainage was performed. Pressure of the ventricle was over 300 mmH2O and CSF was clear. PVG and PEG disclosed an another cavity behind the third ventricle, which was communicated with the third ventricle, and occlusion of aqueduct of Sylvius. Metrizamide CT scan and Conray CT scan showed a communication between this cavity and quadrigeminal and supracerebellar cisterns. On these neuroradiological findings, the diagnosis of obstructive hydrocephalus due to benign aqueduct stenosis accompanied with spontaneous ventriculocisternostomy was obtained. Spontaneous ventriculocisternostomy was noticed to produce arrest of hydrocephalus, but with our case, spontaneous regression of such symptoms did not appeared. In the literature, arrest of hydrocephalus was noted in 50 per cent of 14 cases of obstructive hydrocephalus with spontaneous ventriculocisternostomy. By surgical ventriculocisternostomy (method by Torkildsen, Dandy, or Scarff), arrest of hydrocephalus was seen in about 50 to 70 per cent, which was the same results as those of spontaneous ventriculocisternostomy. It is concluded that VP shunt or VA shunt is thought to be better treatment of obstructive hydrocephalus than the various kinds of surgical ventriculocisternostomy.

  5. Do findings differ across research design? The case of antidepressant use in pregnancy and malformations.

    PubMed

    Einarson, Thomas R; Kennedy, Deborah; Einarson, Adrienne

    2012-01-01

    Many studies examining the teratogenic potential of antidepressants have been published. A variety of observational designs have been used with apparent conflicting results, although odds ratios were rarely >2. To examine whether these apparent differences were associated with research methods such as model, comparison groups, data source, data collection procedures, definition of malformations, outcome ascertainment or management of confounders. Medline and Embase were searched using terms: pregnancy, antidepressants, serotonin uptake inhibitors OR SSRI, AND embryonic structures OR congenital malformations OR fetal development for observational studies with original data. Data were analyzed using a structured approach and narrative review. Designs that were compared, included prospective cohort, retrospective cohort, and case-control studies. Rates of major malformations and cardiac malformations were combined by study type using random effects meta-analytic models. We identified 150 papers; 127 were rejected, 23 were analyzed: 9 prospective cohort, 8 retrospective cohort, and 6 case-control studies. Sample sizes were large (1,818 exposed in case-control and 16,824 in cohort studies), providing relatively robust findings. Overall Odds Ratios for major malformations ranged from 1.03-1.24 and 0.81-1.32 for cardiac malformations. No discrepancies among research designs were identified. Diverse observational models with differing strengths and weaknesses produced remarkably similar non-significant results. Perceived conflicting results may be due to subsequent dissemination of results with attention given to small statistically differences with negligible clinical importance. Improved methods of knowledge transfer and translation are required to provide sound evidence-based information to assist in decision-making surrounding the use of antidepressants in pregnancy.

  6. Report of a new case with pentasomy X and novel clinical findings

    PubMed Central

    Demirhan, O; Tanriverdi, N; Yilmaz, MB; Kocaturk-Sel, S; Inandiklioglu, N; Luleyap, U; Akbal, E; Comertpay, G; Tufan, T; Dur, O

    2015-01-01

    Pentasomy X is an extremely rare sex chromosome abnormality, a condition that only affects females, in which three more X chromosomes are added to the normally present two chromosomes in females. We investigated the novel clinical findings in a 1-year-old female baby with pentasomy X, and determined the parental origins of the X chromosomes. Our case had thenar atrophy, postnatal growth deficiency, developmental delay, mongoloid slant, microcephaly, ear anomalies, micrognathia and congenital heart disease. A conventional cytogenetic technique was applied for the diagnosis of the polysomy X, and quantitative fluorescent polymerase chain reaction (QF-PCR) using 11 inherited short tandem repeat (STR) alleles specific to the chromosome X for the determination of parental origin of X chromosomes. A cytogenetic evaluation revealed that the karyotype of the infant was 49,XXXXX. Comparison of the infant’s features with previously reported cases indicated a clinically recognizable specific pattern of malformations referred to as the pentasomy X syndrome. However, to the best of our know-ledge, this is the first report of thenar atrophy in a patient with 49,XXXXX. The molecular analysis suggested that four X chromosomes of the infant originated from the mother as a result of the non disjunction events in meiosis I and meiosis II. We here state that the clinical manifestations seen in our case were consistent with those described previously in patients with pentasomy X. The degree of early hypotonia constitutes an important early prognostic feature in this syndrome. The pathogenesis of pentasomy X is not clear at present, but it is thought to be caused by successive maternal non disjunctions. PMID:26929910

  7. Clinical and laboratory findings in chronic conjunctivitis in cats: 91 cases (1983-1991).

    PubMed

    Nasisse, M P; Guy, J S; Stevens, J B; English, R V; Davidson, M G

    1993-09-15

    Clinical findings and laboratory test results from 91 cats with chronic conjunctivitis were studied to determine the causes of the disease and the sensitivity of diagnostic procedures used, and to identify correlations between results of various diagnostic procedures and clinical or signalment variations. Mean age of affected cats was 2.9 +/- 2.7 years (+/- SD), with a range from 1 month to 11 years. Conjunctivitis was more likely to be bilateral (56 cats) than unilateral (35 cats). In cats tested for FeLV or feline immunodeficiency virus infection, 15 and 8.5%, respectively, of the results were positive, compared with 4 and 2.6% for the general hospital population. Culturing or immunofluorescent assay (IFA) for feline herpesvirus 1 (FHV-1) and Chlamydia psittaci IFA resulted in identification of pathogens (positive test results) in 19% (FHV-1) and 18% (C psittaci) of tested cats. For FHV-1, culturing was more sensitive than was IFA, yielding positive results in 19 vs 8.8% of cases. In only 1 cat were FHV-1 and chlamydiae recovered. The probability of positive test results for FHV-1 or chlamydiae was unrelated to concurrent corneal disease, unilateral vs bilateral involvement, or age. Cause of conjunctivitis could not be definitively determined in the remaining 35 cases tested for both agents. Bacterial species considered to be potentially pathogenic were isolated from conjunctival sac specimens in only 1 of 38 attempts. Cytologic changes considered compatible with chlamydial or FHV-1 infection (intracytoplasmic inclusions or multinucleated epithelial cells, respectively) were found in 8 and 5 cases, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Postmortem findings in a case of variant Creutzfeldt-Jakob disease treated with intraventricular pentosan polysulfate

    PubMed Central

    Newman, P K; Todd, N V; Scoones, D; Mead, S; Knight, R S G; Will, R G; Ironside, J W

    2014-01-01

    Background A small number of patients with variant Creutzfeldt-Jakob disease (vCJD) have been treated with intraventicular pentosan polysulfate (iPPS) and extended survival has been reported in some cases. To date, there have been no reports on the findings of postmortem examination of the brain in treated patients and the reasons for the extended survival are uncertain. We report on the neuropathological findings in a case of vCJD treated with PPS. Methods Data on survival in vCJD is available from information held at the National CJD Research and Surveillance Unit and includes the duration of illness in 176 cases of vCJD, five of which were treated with iPPS. One of these individuals, who received iPPS for 8 years and lived for 105 months, underwent postmortem examination, including neuropathological examination of the brain. Results The mean survival in vCJD is 17 months, with 40 months the maximum survival in patients not treated with PPS. In the 5 patients treated with PPS survival was 16 months, 45 months, 84 months, 105 months and 114 months. The patient who survived 105 months underwent postmortem examination which confirmed the diagnosis of vCJD and showed severe, but typical, changes, including neuronal loss, astrocytic gliosis and extensive prion protein (PrP) deposition in the brain. The patient was also given PPS for a short period by peripheral infusion and there was limited PrP immunostaining in lymphoreticular tissues such as spleen and appendix. Conclusions Treatment with iPPS did not reduce the overall neuropathological changes in the brain. The reduced peripheral immunostaining for PrP may reflect atrophy of these tissues in relation to chronic illness rather than a treatment effect. The reason for the long survival in patients treated with iPPS is unclear, but a treatment effect on the disease process cannot be excluded. PMID:24554103

  9. Feedback circuit design of an auto-gating power supply for low-light-level image intensifier

    NASA Astrophysics Data System (ADS)

    Yang, Ye; Yan, Bo; Zhi, Qiang; Ni, Xiao-bing; Li, Jun-guo; Wang, Yu; Yao, Ze

    2015-11-01

    This paper introduces the basic principle of auto-gating power supply which using a hybrid automatic brightness control scheme. By the analysis of current as image intensifier to special requirements of auto-gating power supply, a feedback circuit of the auto-gating power supply is analyzed. Find out the reason of the screen flash after the auto-gating power supply assembled image intensifier. This paper designed a feedback circuit which can shorten the response time of auto-gating power supply and improve screen slight flicker phenomenon which the human eye can distinguish under the high intensity of illumination.

  10. Thermal neutron image intensifier tube provides brightly visible radiographic pattern

    NASA Technical Reports Server (NTRS)

    Berger, H.; Kraska, I.; Niklas, W.; Schmidt, A.

    1967-01-01

    Vacuum-type neutron image intensifier tube improves image detection in thermal neutron radiographic inspection. This system converts images to an electron image, and with electron acceleration and demagnification between the input target and output screen, produces a bright image viewed through a closed circuit television system.

  11. Final Report for the Intensified Career Exploration Program.

    ERIC Educational Resources Information Center

    McCauley, Lynne D.; Rusling, Diane E.

    An intensified Career Exploration Program was evaluated through an analysis of the cognitive and affective learning resulting from ninth- and tenth-grade students' participation in the program. Designed to supplement the existing ninth- and tenth-grade components of the Ohio Career Development Program, this three-year program offered additional…

  12. The Effect of Intensified Language Exposure on Accommodating Talker Variability

    ERIC Educational Resources Information Center

    Antoniou, Mark; Wong, Patrick C. M.; Wang, Suiping

    2015-01-01

    Purpose: This study systematically examined the role of intensified exposure to a second language on accommodating talker variability. Method: English native listeners (n = 37) were compared with Mandarin listeners who had either lived in the United States for an extended period of time (n = 33) or had lived only in China (n = 44). Listeners…

  13. Image intensifier monitoring of power line insulator leakage

    SciTech Connect

    Lowther, F.E.

    1992-10-20

    This patent describes a method for detecting incipient flashover of a power line insulator. It comprises: using an image intensifier to observe an electrical insulator in an energized power line, and while observing the insulator, illuminating the electrical insulator with an ultraviolet laser beam, whereby generation of detectable electromagnetic radiation from the insulator in response to the illumination indicates incipient flashover.

  14. Statistical performance of the intensified charged coupled device

    NASA Technical Reports Server (NTRS)

    Sandel, B. R.; Broadfoot, A. L.

    1986-01-01

    The first analysis of the statistical performance of the intensified charge coupled device (CCD) is presented. The Poisson statistics of the arriving photons, the exponential pulse height distribution of the microchannel plate in the image intensifier, and the effects of discrete digitization of the charge in reading the CCD are included. A range of intensifier gains from the high levels that permit pulse counting to the low levels that can be used with the accumulation of charge on the CCD is considered. As a tool for this analysis, an analytical model of the performance of the detector system that is generally useful for predicting many aspects of system performance under a wide range of conditions is developed. The statistical penalty for operating the intensified CCD in the charge accumulation mode is not severe, and in some applications it may be desirable to accept this penalty to gain the advantages of increased dynamic range through charge accumulation. This investigation has revealed no pathological aspects of the operation of the detector system.

  15. Final Report for the Intensified Career Exploration Program.

    ERIC Educational Resources Information Center

    McCauley, Lynne D.; Rusling, Diane E.

    An intensified Career Exploration Program was evaluated through an analysis of the cognitive and affective learning resulting from ninth- and tenth-grade students' participation in the program. Designed to supplement the existing ninth- and tenth-grade components of the Ohio Career Development Program, this three-year program offered additional…

  16. The Effect of Intensified Language Exposure on Accommodating Talker Variability

    ERIC Educational Resources Information Center

    Antoniou, Mark; Wong, Patrick C. M.; Wang, Suiping

    2015-01-01

    Purpose: This study systematically examined the role of intensified exposure to a second language on accommodating talker variability. Method: English native listeners (n = 37) were compared with Mandarin listeners who had either lived in the United States for an extended period of time (n = 33) or had lived only in China (n = 44). Listeners…

  17. Physician perspectives on de-intensifying diabetes medications

    PubMed Central

    Genere, Natalia; Sargis, Robert M.; Masi, Christopher M.; Nathan, Aviva G.; Quinn, Michael T.; Huang, Elbert S.; Laiteerapong, Neda

    2016-01-01

    Abstract Guidelines for diabetes care recommend that physicians select individualized glycemic goals based on life expectancy, diabetes duration, comorbidity, and resources/support. When patients have stable hemoglobin A1C (HbA1C) levels, guidelines lack recommendations on when diabetes medications should be de-intensified. To understand physicians’ perspectives on de-intensifying diabetes medications in patients with type 2 diabetes. Cross-sectional survey, (February–June, 2015). Academic medical center and suburban integrated health system. Primary care and endocrinology physicians. Physicians’ self-reported: awareness, agreement, and frequency of individualizing HbA1C goals; practice of de-intensifying diabetes medications; HbA1C values at which physicians de-intensify diabetes medications; and other patient factors physicians consider when de-intensifying diabetes medications. Response rate was 73% (156/213). Most physicians (78%) responded they were familiar with recommendations to individualize HbA1C goals. For patients with stable HbA1C levels, 80% of physicians reported they had initiated conversations about stopping medications; however, physicians differed in predefined HbA1C levels used to initiate conversations (HbA1C < 5.7%: 14%; HbA1C < 6.0%: 31%; HbA1C < 6.5%: 22%; individualized level: 21%). In multiple logistic regression, women physicians (odds ratio [OR] 3.0; confidence interval [CI] 1.1–8.2; P = 0.03) and physicians practicing fewer than 20 years (OR 2.8; CI 1.01–7.7; P = 0.048) were more likely to report de-intensifying diabetes medications. Individualizing glycemic goals and de-intensifying treatments are concepts well accepted by physicians in our sample. However, physicians vary considerably in reporting how they carry out recommendations to individualize and may be missing opportunities to stop or taper diabetes medications based on patients’ individualized glycemic goals. PMID:27861373

  18. [TUBERCULOSIS ANNUAL REPORT 2013--(3) Case Finding and Condition of Tuberculosis on Diagnosis].

    PubMed

    2015-06-01

    In 2013, tuberculosis (TB) case findings from the nationwide TB surveillance data in Japan were reviewed with regard to the mode of detection, symptom at diagnosis, diagnostic delay, proportion of far-advanced cavitary lesions, co-existence of human immunodeficiency virus (HIV) infection and diabetes mellitus (DM), and drug susceptibility testing (DST). Among the 20,495 new TB cases in 2013, 83.1% were diagnosed when the patients sought medical attention for TB symptoms or attended medical facilities because of other chief complaints. Among the 15,972 patients with pulmonary TB, 26.4% had only respiratory symptoms, 30.5% had respiratory and non-respiratory symptoms, 17.8% had only non-respiratory symptoms, and 24.5% were asymptomatic. The proportion of patient and doctor delays among the 11,933 symptomatic pulmonary TB cases was analyzed. A large proportion--around 30%--of patients aged 45-54 years with symptomatic pulmonary TB exhibited a patient delay of ≥ 2 months. The proportion of patients with a total delay (i.e., the sum of patient and doctor delays) of ≥ 3 months exhibited a similar tendency to that of those with a patient delay. The proportion of patients aged ≥ 65 years with a doctor delay of ≥ 1 month surpassed that of age-matched patients with a patient delay. Among symptomatic smear-positive TB, a patient delay of ≥ 2 months exhibited a bimodal distribution, and its peak was > 35%. The proportion of patient delay in those aged 30-39 years decreased compared to that of recent years. Meanwhile, the proportion of patients--approximately 15%--with a doctor delay of ≥ 1 month was relatively stable across all the age groups. The proportion of patients with pulmonary TB who had far-advanced cavities in the lungs increased from 1.5% in 1975 to approximately 2% and then remained stable from 1985 to 2013. Among the 50 new TB cases with HIV in 2013, 5 occurred in women and 10 in foreigners. From 2007 to 2013, there were 416 patients with newly

  19. Mitigating Financial Burden of Tuberculosis through Active Case Finding Targeting Household and Neighbourhood Contacts in Cambodia

    PubMed Central

    Morishita, Fukushi; Yadav, Rajendra-Prasad; Eang, Mao Tan; Saint, Saly; Nishikiori, Nobuyuki

    2016-01-01

    Background Despite free TB services available in public health facilities, TB patients often face severe financial burden due to TB. WHO set a new global target that no TB-affected families experience catastrophic costs due to TB. To monitor the progress and strategize the optimal approach to achieve the target, there is a great need to assess baseline cost data, explore potential proxy indicators for catastrophic costs, and understand what intervention mitigates financial burden. In Cambodia, nationwide active case finding (ACF) targeting household and neighbourhood contacts was implemented alongside routine passive case finding (PCF). We analyzed household cost data from ACF and PCF to determine the financial benefit of ACF, update the baseline cost data, and explore whether any dissaving patterns can be a proxy for catastrophic costs in Cambodia. Methods In this cross-sectional comparative study, structured interviews were carried out with 108 ACF patients and 100 PCF patients. Direct and indirect costs, costs before and during treatment, costs as percentage of annual household income and dissaving patterns were compared between the two groups. Results The median total costs were lower by 17% in ACF than in PCF ($240.7 [IQR 65.5–594.6] vs $290.5 [IQR 113.6–813.4], p = 0.104). The median costs before treatment were significantly lower in ACF than in PCF ($5.1 [IQR 1.5–25.8] vs $22.4 [IQR 4.4–70.8], p<0.001). Indirect costs constituted the largest portion of total costs (72.3% in ACF and 61.5% in PCF). Total costs were equivalent to 11.3% and 18.6% of annual household income in ACF and PCF, respectively. ACF patients were less likely to dissave to afford TB-related expenses. Costs as percentage of annual household income were significantly associated with an occurrence of selling property (p = 0.02 for ACF, p = 0.005 for PCF). Conclusions TB-affected households face severe financial hardship in Cambodia. ACF has the great potential to mitigate the costs

  20. Methamphetamine in hair and interpretation of forensic findings in a fatal case.

    PubMed

    Beránková, Katerina; Habrdová, Vilma; Balíková, Marie; Strejc, Premysl

    2005-10-04

    Hair analysis for drugs has been developing and is considered a significant tool for distinguishing between recent and long-term drug abuse in forensic and clinical toxicology. Chronic consumption of drugs can gradually induce certain harmful effects on the human organism and can exacerbate some pre-existing diseases. Analysis for drugs in blood or urine in isolation does not provide sufficient information about the history of drug-use by a person and their results cannot be correlated directly with the toxic effects displayed. The chronic abuse of methamphetamine is known to be associated with cardiovascular diseases. During or after autopsy certain types of morphologic alterations are found in the hearts of stimulant addicts. The rapid increase in blood pressure after an intravenous methamphetamine dose can be risky for addicts with arteriosclerosis. However, the anamnestic data about a deceased person may not always be available to explain the pathological findings and to classify the cause of death correctly. The aim of this study was to demonstrate the value of hair analysis for drugs in the context of explaining pathological cardiovascular alterations observed during the autopsy in a case where methamphetamine consumption was involved. In this case, only methamphetamine and metabolites were detected with traces of ephedrine. Ephedrine is the precursor chemical in the illicit synthesis of methamphetamine (known in the Czech Republic as "Pervitin"). The femoral blood level of methamphetamine was 1500 ng/ml. It was documented by a witness that the 31-year-old man died within 1h after an intravenous injection of the drug. The cause of death was established as cerebral edema due to cerebellar bleeding shortly after an intravenous dose of methamphetamine. Findings of methamphetamine in the first three 2-cm hair segments (numbered from the roots) were nearly equal (132+/-9 ng/mg). In the fourth 2-cm segment, it was approximately one-half of previous values. In the

  1. Targeted case finding for dementia in primary care: Surrey Downs dementia diagnosis project

    PubMed Central

    Kallumpuram, Sen; Sudhir Kumar, CT; Khan, Bilal; Gavins, Victoria; Khan, Aalia; Iliffe, Steve

    2015-01-01

    Currently less than half of the estimated number of people with dementia in England receive a formal diagnosis of dementia or have contact with specialist dementia services. Case finding focused on high risk groups may be an effective way to identify the undiagnosed. This joint Surrey Downs Clinical Commissioning Group and Surrey and Borders NHS Foundation Trust quality improvement project aimed to increase the rate of dementia diagnosis across Surrey Downs using specialist link nurses (SLNs). Thirty three GP surgeries covering the entire Surrey Downs area took part in the project. Individuals at high risk of developing dementia were identified from GP electronic disease registers, and were offered screening at their GP practices by SLNs, using a combination of mini cognitive test (Mini-Cog) and functional assessment questionnaire (FAQ). Suitable individuals who screened positive were seen by their GP and where appropriate referred to secondary care services for further evaluation. Based on the presence of risk factors, 6657 (11.9%) people were identified from a total population of 55 845 over 65s, and 1980 (29.7%) completed the screening assessment. Three hundred and fifty eight (18.1%) individuals screened positive and were referred to their GP, who referred 205 (57.2%) of them to the memory services for further assessment. Of those referred, 164 (80%) had a comprehensive specialist assessment. Forty one (20%) declined further assessment, and their GPs were informed. The mean age of the cohort who completed the comprehensive assessment was 82.3 years (SD=4.26), and were predominantly white and male. Fifty four (32.9%) had mild cognitive disorder (MCD), and 101 (61.6%) patients were diagnosed with dementia. The most common dementia was mixed type (43; 42.6%), followed by Alzheimer's dementia (32; 31.7%). The most common risk factor among patients with cognitive impairment (MCD or dementia) was hypertension (69; 44.5 %), followed by ischemic heart disease (64, 41

  2. Mitigating Financial Burden of Tuberculosis through Active Case Finding Targeting Household and Neighbourhood Contacts in Cambodia.

    PubMed

    Morishita, Fukushi; Yadav, Rajendra-Prasad; Eang, Mao Tan; Saint, Saly; Nishikiori, Nobuyuki

    2016-01-01

    Despite free TB services available in public health facilities, TB patients often face severe financial burden due to TB. WHO set a new global target that no TB-affected families experience catastrophic costs due to TB. To monitor the progress and strategize the optimal approach to achieve the target, there is a great need to assess baseline cost data, explore potential proxy indicators for catastrophic costs, and understand what intervention mitigates financial burden. In Cambodia, nationwide active case finding (ACF) targeting household and neighbourhood contacts was implemented alongside routine passive case finding (PCF). We analyzed household cost data from ACF and PCF to determine the financial benefit of ACF, update the baseline cost data, and explore whether any dissaving patterns can be a proxy for catastrophic costs in Cambodia. In this cross-sectional comparative study, structured interviews were carried out with 108 ACF patients and 100 PCF patients. Direct and indirect costs, costs before and during treatment, costs as percentage of annual household income and dissaving patterns were compared between the two groups. The median total costs were lower by 17% in ACF than in PCF ($240.7 [IQR 65.5-594.6] vs $290.5 [IQR 113.6-813.4], p = 0.104). The median costs before treatment were significantly lower in ACF than in PCF ($5.1 [IQR 1.5-25.8] vs $22.4 [IQR 4.4-70.8], p<0.001). Indirect costs constituted the largest portion of total costs (72.3% in ACF and 61.5% in PCF). Total costs were equivalent to 11.3% and 18.6% of annual household income in ACF and PCF, respectively. ACF patients were less likely to dissave to afford TB-related expenses. Costs as percentage of annual household income were significantly associated with an occurrence of selling property (p = 0.02 for ACF, p = 0.005 for PCF). TB-affected households face severe financial hardship in Cambodia. ACF has the great potential to mitigate the costs incurred particularly before treatment. Social

  3. Active case finding strategy for chronic obstructive pulmonary disease with handheld spirometry.

    PubMed

    Kim, Joo Kyung; Lee, Chang Min; Park, Ji Young; Kim, Joo Hee; Park, Sung-Hoon; Jang, Seung Hun; Jung, Ki-Suck; Yoo, Kwang Ha; Park, Yong Bum; Rhee, Chin Kook; Kim, Deog Kyeom; Hwang, Yong Il

    2016-12-01

    The early detection and diagnosis of chronic obstructive pulmonary disease (COPD) is critical to providing appropriate and timely treatment. We explored a new active case-finding strategy for COPD using handheld spirometry.We recruited subjects over 40 years of age with a smoking history of more than 10 pack-years who visited a primary clinic complaining of respiratory symptoms. A total of 190 of subjects were enrolled. Medical information was obtained from historical records and physical examination by general practitioners. All subjects had their pulmonary function evaluated using handheld spirometry with a COPD-6 device. Because forced expiratory volume in 6 seconds (FEV6) has been suggested as an alternative to FVC, we measured forced expiratory volume in 1 second (FEV1)/FEV6 for diagnosis of airflow limitation. All subjects were then referred to tertiary referral hospitals to complete a "Could it be COPD?" questionnaire, handheld spiromtery, and conventional spirometry. The results of each instrument were compared to evaluate the efficacy of both handheld spirometry and the questionnaire.COPD was newly diagnosed in 45 (23.7%) patients. According to our receiver-operating characteristic (ROC) curve analysis, sensitivity and specificity were maximal when the FEV1/FEV6 ratio was less than 77%. The area under the ROC curve was 0.759. The sensitivity, specificity, positive predictive value, and negative predictive value were 72.7%, 77.1%, 50%, and 90%, respectively. The area under the ROC curve of respiratory symptoms listed on the questionnaire ranged from 0.5 to 0.65, which indicates that there is almost no difference compared with the results of handheld spirometry.The present study demonstrated the efficacy of handheld spirometry as an active case-finding tool for COPD in a primary clinical setting. This study suggested that physicians should recommend handheld spirometry for people over the age of 40, who have a smoking history of more than 10 pack

  4. Active case finding strategy for chronic obstructive pulmonary disease with handheld spirometry

    PubMed Central

    Kim, Joo Kyung; Lee, Chang Min; Park, Ji Young; Kim, Joo Hee; Park, Sung-hoon; Jang, Seung Hun; Jung, Ki-Suck; Yoo, Kwang Ha; Park, Yong Bum; Rhee, Chin Kook; Kim, Deog Kyeom; Hwang, Yong Il

    2016-01-01

    Abstract The early detection and diagnosis of chronic obstructive pulmonary disease (COPD) is critical to providing appropriate and timely treatment. We explored a new active case-finding strategy for COPD using handheld spirometry. We recruited subjects over 40 years of age with a smoking history of more than 10 pack-years who visited a primary clinic complaining of respiratory symptoms. A total of 190 of subjects were enrolled. Medical information was obtained from historical records and physical examination by general practitioners. All subjects had their pulmonary function evaluated using handheld spirometry with a COPD-6 device. Because forced expiratory volume in 6 seconds (FEV6) has been suggested as an alternative to FVC, we measured forced expiratory volume in 1 second (FEV1)/FEV6 for diagnosis of airflow limitation. All subjects were then referred to tertiary referral hospitals to complete a “Could it be COPD?” questionnaire, handheld spiromtery, and conventional spirometry. The results of each instrument were compared to evaluate the efficacy of both handheld spirometry and the questionnaire. COPD was newly diagnosed in 45 (23.7%) patients. According to our receiver-operating characteristic (ROC) curve analysis, sensitivity and specificity were maximal when the FEV1/FEV6 ratio was less than 77%. The area under the ROC curve was 0.759. The sensitivity, specificity, positive predictive value, and negative predictive value were 72.7%, 77.1%, 50%, and 90%, respectively. The area under the ROC curve of respiratory symptoms listed on the questionnaire ranged from 0.5 to 0.65, which indicates that there is almost no difference compared with the results of handheld spirometry. The present study demonstrated the efficacy of handheld spirometry as an active case-finding tool for COPD in a primary clinical setting. This study suggested that physicians should recommend handheld spirometry for people over the age of 40, who have a smoking history of more than

  5. Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies

    PubMed Central

    LaFond, Anne; Kanagat, Natasha; Steinglass, Robert; Fields, Rebecca; Sequeira, Jenny; Mookherji, Sangeeta

    2015-01-01

    There is limited understanding of why routine immunization (RI) coverage improves in some settings in Africa and not in others. Using a grounded theory approach, we conducted in-depth case studies to understand pathways to coverage improvement by comparing immunization programme experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana). Drawing on positive deviance or assets model techniques we compared the experience of districts where diphtheria–tetanus–pertussis (DTP3)/pentavalent3 (Penta3) coverage improved with districts where DTP3/Penta3 coverage remained unchanged (or steady) over the same period, focusing on basic readiness to deliver immunization services and drivers of coverage improvement. The results informed a model for immunization coverage improvement that emphasizes the dynamics of immunization systems at district level. In all districts, whether improving or steady, we found that a set of basic RI system resources were in place from 2006 to 2010 and did not observe major differences in infrastructure. We found that the differences in coverage trends were due to factors other than basic RI system capacity or service readiness. We identified six common drivers of RI coverage performance improvement—four direct drivers and two enabling drivers—that were present in well-performing districts and weaker or absent in steady coverage districts, and map the pathways from driver to improved supply, demand and coverage. Findings emphasize the critical role of implementation strategies and the need for locally skilled managers that are capable of tailoring strategies to specific settings and community needs. The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunization system performance. PMID:24615431

  6. Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies.

    PubMed

    LaFond, Anne; Kanagat, Natasha; Steinglass, Robert; Fields, Rebecca; Sequeira, Jenny; Mookherji, Sangeeta

    2015-04-01

    There is limited understanding of why routine immunization (RI) coverage improves in some settings in Africa and not in others. Using a grounded theory approach, we conducted in-depth case studies to understand pathways to coverage improvement by comparing immunization programme experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana). Drawing on positive deviance or assets model techniques we compared the experience of districts where diphtheria-tetanus-pertussis (DTP3)/pentavalent3 (Penta3) coverage improved with districts where DTP3/Penta3 coverage remained unchanged (or steady) over the same period, focusing on basic readiness to deliver immunization services and drivers of coverage improvement. The results informed a model for immunization coverage improvement that emphasizes the dynamics of immunization systems at district level. In all districts, whether improving or steady, we found that a set of basic RI system resources were in place from 2006 to 2010 and did not observe major differences in infrastructure. We found that the differences in coverage trends were due to factors other than basic RI system capacity or service readiness. We identified six common drivers of RI coverage performance improvement-four direct drivers and two enabling drivers-that were present in well-performing districts and weaker or absent in steady coverage districts, and map the pathways from driver to improved supply, demand and coverage. Findings emphasize the critical role of implementation strategies and the need for locally skilled managers that are capable of tailoring strategies to specific settings and community needs. The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunization system performance. Published by Oxford University Press in association with The London

  7. Malabsorption syndrome with cow's milk intolerance. Clinical findings and course in 54 cases.

    PubMed Central

    Kuitunen, P; Visakorpi, J K; Savilahti, E; Pelkonen, P

    1975-01-01

    Fifty-four infants with the malabsorption syndrome and cow's milk intolerence seen during 1962-1971 were investigated. All had diarrhoea and failed to thrive. Most had vomiting and about 20% had atopic eczema and recurrent respiratory infections. Laboratory investigations revealed malabsorption, raised serum IgA, and precipitins to cow's milk. Biopsies showed that the jejunal mucosa was damaged, and in about half the cases was flat. The patient did well on human milk but reacted clinically to cow's milk challenge, either in a few hours or gradually during 3-4 weeks. Some patients showed first a quick, but later a slow, reaction. Clinical symptoms of cow's milk intolerance disappeared at the age of about one year. At that time 81% had normal faecal fat, but only 29% had a normal proximal jejunal mucosa. Many of the patients developed intolerances to other food proteins, such as soya and wheat, if these were given during the sensitive period. Forty-two patients have been followed up for 2 years on a normal gluten-containing diet. Of these, 37 have a normal or nearly normal jejunal mucosa and 5 (12%) have subtotal villous atrophy indicative of coeliac disease. It is concluded that the malabsorption syndrome with cow's milk intolerance is a clear-cut clinical entity. However, the symptomatology, results of laboratory tests, and jejunal biopsy findings closely resemble those of other entities where damage to the intestinal mucosa causes a malabsorption snydrome. Follow-up studies showed that the disease is transient, but about 10% of the patients have coeliac disease, regarded in such cases as the primary disorder. PMID:1242623

  8. Magnetic resonance imaging findings of extraventricular anaplastic ependymoma: A report of 11 cases

    PubMed Central

    Leng, Xi; Tan, Xin; Zhang, Chi; Lin, Huan; Qiu, Shijun

    2016-01-01

    Anaplastic ependymomas are rare malignant tumors of the central nervous system. Few studies are available regarding their neuroradiological characteristics. The present study aimed to retrospectively review a series of patients with extraventricular anaplastic ependymoma and to analyze the magnetic resonance imaging (MRI) characteristics to distinguish anaplastic ependymoma from other intracranial tumors. The clinical and pathological images of 11 patients who presented with histologically proven anaplastic ependymoma at Nanfang Hospital (Southern Medical University, Guangzhou, Guangdong, China) between September 2004 and March 2015 were retrospectively reviewed. MRI scans were obtained in all 11 cases. Computed tomography scans were obtained in only 3 cases. In total, 8 tumors were located at the supratentorial parenchyma, and 3 tumors were derived from the cerebellar hemisphere. Images displayed quasi-circular (4/11), irregularly-lobulated (7/11) variable-intensity masses. The masses presented with cysts or necrosis (8/11), hemorrhage (7/11), marked (9/11) or mild (2/11) enhancement, and moderate (4/11), mild (3/11) or absent (4/11) peritumoral edema. The tumors were also frequently closely associated with the lateral ventricle (6/11). Tumors appeared isointense to hypointense on T1-weighted imaging (T1WI) and heterogeneously hyperintense or hypointense on T2WI, demonstrating wreath-like and ring-like characteristics, with intratumoral nodules (3/11) or marked flake-like inhomogeneous (6/11) enhancement on post-contrast MRI. Only 2 solid lesions showed mild enhancement (2/11). Although the MRI features of the extraventricular anaplastic ependymomas varied and were non-specific, these characteristic MRI findings, combined with the locations of the lesions, the age of onset and the short disease course, could be useful in differentiating anaplastic ependymomas from other intracranial neoplasms in the future. PMID:27602137

  9. Mortality at Music Festivals: Academic and Grey Literature for Case Finding.

    PubMed

    Turris, Sheila A; Lund, Adam

    2017-02-01

    Deaths at music festivals are not infrequently reported in the media; however, the true mortality burden is difficult to determine as the deaths are not yet systematically documented in the academic literature. This was a literature search for case examples using academic and gray literature sources, employing both retrospective and prospective searches of media sources from 1999-2014. The gray literature documents a total of 722 deaths, including traumatic (594/722; 82%) and non-traumatic (128/722; 18%) causes. Fatalities were caused by trampling (n=479), motor-vehicle-related (n=39), structural collapses (n=28), acts of terror (n=26), drowning (n=8), assaults (n=6), falls (n=5), hanging (n=2), and thermal injury (n=2). Non-traumatic deaths included overdoses (n=96/722; 13%), environmental causes (n=8/722; 1%), natural causes (n=10/722; 1%), and unknown/not reported (n=14/722; 2%). The majority of non-trauma-related deaths were related to overdose (75%). The academic literature documents trauma-related deaths (n=368) and overdose-related deaths (n=12). One hundred percent of the trauma-related deaths reported in the academic literature also were reported in the gray literature (n=368). Mortality rates cannot be reported as the total attendance at events is not known. The methodology presented in this manuscript confirms that deaths occur not uncommonly at music festivals, and it represents a starting point in the documentation and surveillance of mortality. Turris SA , Lund A . Mortality at music festivals: academic and grey literature for case finding. Prehosp Disaster Med. 2017;32(1):58-63.

  10. Malabsorption syndrome with cow's milk intolerance. Clinical findings and course in 54 cases.

    PubMed

    Kuitunen, P; Visakorpi, J K; Savilahti, E; Pelkonen, P

    1975-05-01

    Fifty-four infants with the malabsorption syndrome and cow's milk intolerence seen during 1962-1971 were investigated. All had diarrhoea and failed to thrive. Most had vomiting and about 20% had atopic eczema and recurrent respiratory infections. Laboratory investigations revealed malabsorption, raised serum IgA, and precipitins to cow's milk. Biopsies showed that the jejunal mucosa was damaged, and in about half the cases was flat. The patient did well on human milk but reacted clinically to cow's milk challenge, either in a few hours or gradually during 3-4 weeks. Some patients showed first a quick, but later a slow, reaction. Clinical symptoms of cow's milk intolerance disappeared at the age of about one year. At that time 81% had normal faecal fat, but only 29% had a normal proximal jejunal mucosa. Many of the patients developed intolerances to other food proteins, such as soya and wheat, if these were given during the sensitive period. Forty-two patients have been followed up for 2 years on a normal gluten-containing diet. Of these, 37 have a normal or nearly normal jejunal mucosa and 5 (12%) have subtotal villous atrophy indicative of coeliac disease. It is concluded that the malabsorption syndrome with cow's milk intolerance is a clear-cut clinical entity. However, the symptomatology, results of laboratory tests, and jejunal biopsy findings closely resemble those of other entities where damage to the intestinal mucosa causes a malabsorption snydrome. Follow-up studies showed that the disease is transient, but about 10% of the patients have coeliac disease, regarded in such cases as the primary disorder.

  11. Retrospective case series of the imaging findings of facial nerve hemangioma.

    PubMed

    Yue, Yunlong; Jin, Yanfang; Yang, Bentao; Yuan, Hui; Li, Jiandong; Wang, Zhenchang

    2015-09-01

    The aim was to compare high-resolution computed tomography (HRCT) and thin-section magnetic resonance imaging (MRI) findings of facial nerve hemangioma. The HRCT and MRI characteristics of 17 facial nerve hemangiomas diagnosed between 2006 and 2013 were retrospectively analyzed. All patients included in the study suffered from a space-occupying lesion of soft tissues at the geniculate ganglion fossa. Affected nerve was compared for size and shape with the contralateral unaffected nerve. HRCT showed irregular expansion and broadening of the facial nerve canal, damage of the bone wall and destruction of adjacent bone, with "point"-like or "needle"-like calcifications in 14 cases. The average CT value was 320.9 ± 141.8 Hu. Fourteen patients had a widened labyrinthine segment; 6/17 had a tympanic segment widening; 2/17 had a greater superficial petrosal nerve canal involvement, and 2/17 had an affected internal auditory canal (IAC) segment. On MRI, all lesions were significantly enhanced due to high blood supply. Using 2D FSE T2WI, the lesion detection rate was 82.4 % (14/17). 3D fast imaging employing steady-state acquisition (3D FIESTA) revealed the lesions in all patients. HRCT showed that the average number of involved segments in the facial nerve canal was 2.41, while MRI revealed an average of 2.70 segments (P < 0.05). HRCT and MR findings of facial nerve hemangioma were typical, revealing irregular masses growing along the facial nerve canal, with calcifications and rich blood supply. Thin-section enhanced MRI was more accurate in lesion detection and assessment compared with HRCT.

  12. Case finding for hypertension in young adult patients attending a missionary hospital in Nigeria.

    PubMed

    Ekore, R I; Ajayi, I O; Arije, A

    2009-09-01

    Nigeria, should pay attention to case finding for hypertension in this age group.

  13. Mammary analogue secretory carcinoma: the first submandibular case reported including findings on fine needle aspiration cytology.

    PubMed

    Petersson, Fredrik; Lian, Derrick; Chau, Yuk Ping; Yan, Benedict

    2012-03-01

    We present the first case (male, 35 years old) of a mammary analogue secretory carcinoma occurring in a submandibular gland and document findings on fine needle aspiration cytology. On histology, the tumor displayed characteristic features: circumscribed nodules composed of bland, pink to light red neoplastic cells with low proliferative/mitotic activity arranged in tubular, vaguely cribriform, and microcystic structures containing Periodic acid Schiff-positive, diastase-resistant secretory material. Immunohistochemistry showed strong and diffuse positivity for cytokeratin 7, S100 protein, and vimentin, as well as moderate to strong immunoreactivity for c-kit in the majority of tumor cells. A rearrangement of the ETV6 gene on fluorescence in situ hybridization was documented. The patient underwent an ipsilateral selective (levels I-IV) neck dissection which showed metastasis in 3 out of 36 lymph nodes (levels 1-3). Adjuvant radiotherapy was administered. No local recurrence or metastatic disease has been detected during a follow up period of 28 months.

  14. Cytopathological findings of primary pulmonary Ewing family of tumors with EWSR1 translocation: A case report.

    PubMed

    Mizuguchi, Keishi; Minato, Hiroshi; Onishi, Hitomi; Mitani, Yuki; Kawai, Jun

    2016-09-01

    Primary pulmonary neoplasms of the Ewing family of tumors (EFT) are extremely rare and usually occur in adolescents or young adults. Only about 40 cases of pulmonary EFT have been reported in English literature, and no cytological studies have been documented. In this report, we describe the cytopathological findings of a primary pulmonary EFT in an elderly patient. A 70-year-old man sought care because of a progressing cough and dyspnea. Chest computed tomography revealed a circumscribed mass of 6 cm in the left upper lobe. Fine needle aspiration cytology and core needle biopsy revealed uniform round cell proliferation. The predominant population consisted of cells with thickened nuclear membranes, finely dispersed chromatin, single distinct nucleoli, and indistinct cytoplasm. The other population consisted of smaller cells with darker chromatin. The cytoplasm stained positive for periodic acid-Schiff stain and was digested by diastase. Immunohistochemistry showed positivity for MIC2 (CD99), and focal positivity for neuron specific enolase, synaptophysin, and chromogranin A. Fluorescence in situ hybridization (FISH) revealed EWSR1 translocation. Although rare, pulmonary EFT cannot be disregarded, regardless of age. When two populations of uniform, round cells are observed, immunohistochemistry with MIC2 (CD99) and cytogenetic analysis by reverse transcription polymerase chain reaction or FISH should be considered. Cytological diagnosis may play an important role in the early diagnosis and treatment of pulmonary EFT. © 2016 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

  15. Active Tuberculosis Case Finding Interventions Among Immigrants, Refugees and Asylum Seekers in Italy

    PubMed Central

    Schepisi, Monica Sañé; Gualano, Gina; Piselli, Pierluca; Mazza, Marta; D’Angelo, Donatella; Fasciani, Francesca; Barbieri, Alberto; Rocca, Giorgia; Gnolfo, Filippo; Olivani, Piefranco; Ferrarese, Maurizio; Codecasa, Luigi Ruffo; Palmieri, Fabrizio; Girardi, Enrico

    2016-01-01

    In Italy tuberculosis (TB) is largely concentrated in vulnerable groups such as migrants and in urban settings. We analyzed three TB case finding interventions conducted at primary centers and mobile clinics for regular/irregular immigrants and refugees/asylum seekers performed over a four-year period (November 2009-March 2014) at five different sites in Rome and one site in Milan, Italy. TB history and presence of symptoms suggestive of active TB were investigated by verbal screening through a structured questionnaire in migrants presenting for any medical condition to out-patient and mobile clinics. Individuals reporting TB history or symptoms were referred to a TB clinic for diagnostic workup. Among 6347 migrants enrolled, 891 (14.0%) reported TB history or symptoms suggestive of active TB and 546 (61.3%) were referred to the TB clinic. Of them, 254 (46.5%) did not present for diagnostic evaluation. TB was diagnosed in 11 individuals representing 0.17% of those screened and 3.76% of those evaluated. The overall yield of this intervention was in the range reported for other TB screening programs for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population. PMID:27403270

  16. Dental findings and rehabilitation in familial osteodysplasia (Anderson type): a case report.

    PubMed

    Deger, S; Tabar, G; Sermet, B; Tanyeri, H; Kurklu, E

    2006-03-01

    Familial osteodysplasia is a disorder of osteogenesis with an autosomal recessive pattern of inheritance which predominantly affects facial bones. No recent case had been reported, particularly from a dental point of view since the syndrome was first described by Anderson et al (JAMA 1972;220:1687-93). A 23-year-old male with familial osteodysplasia was presented in maxillofacial and dental aspects with clinical and radiological manifestations including malocclusion, abnormal teeth alignment, impacted teeth, shape disturbances including uncompleted coronal formation, root shortening with bulbous form, high angled mandible and elongation of the corpus of mandible. Recognition of the syndromal features prior to any dental intervention is of paramount importance because of increased inclination to spontaneous mandibular fractures. Hence, no surgical intervention was performed for impacted teeth. Following the extractions of severely mobile teeth, a definitive restoration was fabricated as distal-extension removable partial dentures with conus crown telescopic system. The aesthetic and functional outcome was satisfactory for the patient. In conclusion, dentists appear to play an important role in the recognition of familial osteodysplasia, based on maxillofacial and dentoalveolar findings. Awareness of the syndromal features, especially of spontaneous fractures, would detect the limitations for dental interventions and treatment planning.

  17. Synthetic cathinone pharmacokinetics, analytical methods, and toxicological findings from human performance and postmortem cases.

    PubMed

    Ellefsen, Kayla N; Concheiro, Marta; Huestis, Marilyn A

    2016-05-01

    Synthetic cathinones are commonly abused novel psychoactive substances (NPS). We present a comprehensive systematic review addressing in vitro and in vivo synthetic cathinone pharmacokinetics, analytical methods for detection and quantification in biological matrices, and toxicological findings from human performance and postmortem toxicology cases. Few preclinical administration studies examined synthetic cathinone pharmacokinetic profiles (absorption, distribution, metabolism, and excretion), and only one investigated metabolite pharmacokinetics. Synthetic cathinone metabolic profiling studies, primarily with human liver microsomes, elucidated metabolite structures and identified suitable biomarkers to extend detection windows beyond those provided by parent compounds. Generally, cathinone derivatives underwent ketone reduction, carbonylation of the pyrrolidine ring, and oxidative reactions, with phase II metabolites also detected. Reliable analytical methods are necessary for cathinone identification in biological matrices to document intake and link adverse events to specific compounds and concentrations. NPS analytical methods are constrained in their ability to detect new emerging synthetic cathinones due to limited commercially available reference standards and continuous development of new analogs. Immunoassay screening methods are especially affected, but also gas-chromatography and liquid-chromatography mass spectrometry confirmation methods. Non-targeted high-resolution-mass spectrometry screening methods are advantageous, as they allow for retrospective data analysis and easier addition of new synthetic cathinones to existing methods. Lack of controlled administration studies in humans complicate interpretation of synthetic cathinones in biological matrices, as dosing information is typically unknown. Furthermore, antemortem and postmortem concentrations often overlap and the presence of other psychoactive substances are typically found in combination

  18. Engagement and opportunity in clinical learning: findings from a case study in primary care.

    PubMed

    Pearson, David J; Lucas, Beverley J

    2011-01-01

    This article explores in a primary care setting how clinical learning occurs across a range of professional groups and levels of learner experience, both undergraduate and postgraduate. To explore how clinical learning occurs in a primary care workplace from a socio-cultural perspective. A single case study approach using interview data from 33 participants and strengthened through direct and indirect observations and documentary evidence. Clinical learning occurs through engagement and opportunity. Engagement in learning appeared to be developed through four elements: recognition, respect, relevance and emotion. Opportunity includes the availability of patient encounters (made meaningful through the immediacy of hearing patient narratives de novo and the authenticity arising from the social context of illness) and the ability to learn with peers and professional colleagues. These findings support and develop existing literature on learning in other clinical settings. They are consistent with socio-cultural theories of learning, but develop this literature within the context of clinical education. Engagement and learning occurred in transient learners in the absence of prolonged participation, belonging or a clear trajectory of learning. The study offers evidence from multiple learner perspectives as to how the learning environment might be enhanced in all educational settings.

  19. Giant mesenteric cyst of gastric origin: a case report with imaging findings.

    PubMed

    Ayaz, Umit Yaşar; Dilli, Alper; Api, Arman

    2011-01-01

    We present a very rare case of a giant gastric mesenteric cyst with ultrasonography (US) and computed tomography (CT) findings. An eight-year-old boy was referred for treatment of an intraabdominal cyst, known to exist for six years. On abdominal US, a giant, thin-walled, unilocular intraabdominal cyst was demonstrated, extending from the epigastric region to the pelvis and measuring 18 x 15 x 6 cm. In contrast-enhanced abdominal CT, the cyst was demonstrated as a giant, unilocular, hypodense, non-enhancing structure, located dominantly on the right side of the abdomen. During open surgery, the cyst was found to originate from the mesentery-serosa of the gastric antrum and was filled with serous fluid. The cyst was excised totally. Both surgery and pathology confirmed the diagnosis of mesenteric cyst, originating from the stomach. The patient was discharged in good health. US and CT were effective in defining the features of the giant gastric mesenteric cyst and in narrowing the differential diagnosis in favor of mesenteric cyst.

  20. Epidermoid cyst in Meckel's cave with unusual computed tomography and magnetic resonance imaging findings. Case report.

    PubMed

    Arai, Atsushi; Sasayama, Takashi; Koyama, Junji; Fujita, Atsushi; Hosoda, Kohkichi; Kohmura, Eiji

    2010-01-01

    A 27-year-old woman presented with headache and occasional numbness over her right face. Computed tomography revealed a hypodense mass in the middle cranial fossa and another adjacent hyperdense mass in the posterior fossa with erosion of the right petrous apex. Magnetic resonance imaging revealed the lesion in the middle cranial fossa as iso- to hypointense on T(1)-weighted and hyperintense on T(2)-weighted imaging, with peripheral enhancement after gadolinium administration, and the adjacent lesion in the posterior fossa as hyperintense on T(1)-weighted and hypointense on T(2)-weighted imaging. During surgery, these lesions mimicking two adjacent distinct tumors were revealed to connect through Meckel's cave. The hypodense lesion in the middle cranial fossa consisted of pearly-like solid contents, and the hyperdense lesion in the posterior cranial fossa consisted of viscid dark-green materials. The tumors were gross totally resected with endoscopic assistance. Histological examination confirmed that the tumor was an epidermoid cyst. The present case cyst indicates that although the diffusion-weighted imaging sequence is useful for detection of intracranial epidermoid cysts, epidermoid cysts including viscous materials with unusual radiological findings could complicate the preoperative diagnosis.

  1. An evaluation of the additional benefit of population screening for dementia beyond a passive case-finding approach.

    PubMed

    Mate, Karen E; Magin, Parker J; Brodaty, Henry; Stocks, Nigel P; Gunn, Jane; Disler, Peter B; Marley, John E; Pond, C Dimity

    2017-03-01

    General practitioners (GPs) fail to identify more than 50% of dementia cases using the existing passive case-finding approach. Using data from the "Ageing in General Practice" study, we sought to establish the additional benefit of screening all patients over the age of 75 for dementia beyond those patients already identified by passive case-finding. Patients were classified as "case-finding" (n = 425) or "screening" (n = 1006) based on their answers to four subjective memory related questions or their GP's clinical judgement of their dementia status. Cognitive status of each patient was formally assessed by a research nurse using the Cambridge Cognition Examination (CAMCOG-R). Patients then attended their usual GP for administration of the GP assessment of Cognition (GPCOG) dementia screening instrument, and follow-up care and/or referral as necessary in light of the outcome. The prevalence of dementia was significantly higher in the case-finding group (13.6%) compared to the screening group (4.6%; p < 0.01). The GPCOG had a positive predictive value (PPV) of 61% in the case-finding group and 39% in the screening group; negative predictive value was >95% in both groups. GPs and their patients both found the GPCOG to be an acceptable cognitive assessment tool. The dementia cases missed via case-finding were younger (p = 0.024) and less cognitively impaired (p = 0.020) than those detected. There is a very limited benefit of screening for dementia, as most people with dementia could be detected using a case-finding approach, and considerable potential for social and economic harm because of the low PPV associated with screening. Copyright © 2016 John Wiley & Sons, Ltd.

  2. Finding a Balance: Fifteen Institutional Case Studies on the Relationship between Part-Time Work and Advanced Level Study. Report.

    ERIC Educational Resources Information Center

    Hodgson, Ann, Ed.; Spours, Ken, Ed.

    This document presents and discusses case studies that examined the relationship between part-time employment and advanced level study at 15 schools in Essex, England. "Foreword" (David Jones) provides a brief overview of the project. "Finding a Balance--Fifteen Institutional Case Studies on the Relationship between Part-time Work…

  3. How did soil dryness intensify recent European heatwaves?

    NASA Astrophysics Data System (ADS)

    Miralles, Diego; Teuling, Ryan; van Heerwaarden, Chiel; Vilá-Guerau de Arellano, Jordi

    2014-05-01

    In August 2010 a mega-heatwave hit large parts of Eastern Europe and Russia, breaking the historical records from the 2003 event in Western Europe. While such heatwaves are predicted to become common by the end of this century, our understanding of the physics behind these phenomena is still imperfect, and so is their representation in climate models. In this presentation we will provide new evidence of how land-atmosphere feedbacks contribute to the development of the extreme temperatures based on satellite observations, climate model reanalyses data (ERA Interim), balloon sounding measurements, soil moisture-temperature coupling diagnostics and mechanistic modelling of the lower atmosphere. Results of our analyses show that in both European mega-heatwaves, persistent synoptic conditions favored evaporation and intensified soil desiccation. As a consequence of soil dryness, a deep residual atmospheric boundary layer (ABL) developed, which allowed the multi-day storage of heat coming from: (a) large-scale horizontal advection, (b) intense warming from the land surface associated to the increasingly dry soils, and (c) enhanced warm air entrainment from the top of the ABL (which counteracted the dilution effect of the gradually deeper layer). This progressive storage of heat in the residual ABL played a crucial role in the escalation of temperatures, and therefore in the regulation and intensification of land feedbacks. Soil moisture deficits have both direct and indirect effects in all these processes, effects that have not been scrutinized separately in previous model studies. This suggests the need of revisiting the traditional view of the soil moisture-temperature coupling during mega-heatwaves, in which only the direct impact of dry soils on the surface energy balance is explicitly considered. Reinforced by our findings, a more complete conceptualization can be provided, with dry soils enhancing diurnal warm air entrainment and leading to the formation of

  4. Clinical presentation and laboratory findings for the first autochthonous cases of dengue fever in Madeira island, Portugal, October 2012.

    PubMed

    Alves, M J; Fernandes, P L; Amaro, F; Osório, H; Luz, T; Parreira, P; Andrade, G; Zé-Zé, L; Zeller, H

    2013-02-07

    An outbreak of dengue fever in Madeira island was reported in 2012. Clinical and laboratory findings of the first two laboratory-confirmed autochthonous cases are reported. Both cases had fever (≥38 °C) and petechial rash. Symptoms also included myalgia, asthenia, nausea, vomiting, anorexia, diffuse abdominal pain, and diarrhoea. The two cases were confirmed by serology and one tested positive for a dengue viral sequence. Dengue virus serotype DEN-1 was identified with probable Central or South American origin.

  5. Implementation practices in school health promotion: findings from an Austrian multiple-case study.

    PubMed

    Adamowitsch, Michaela; Gugglberger, Lisa; Dür, Wolfgang

    2017-04-01

    Since the 1980s, schools have been recognized as an ideal setting to promote students' and teachers' health. Three decades after the development of the Health Promoting Schools (HPS) approach, however, there is still only limited knowledge about the implementation of health promotion (HP) activities in this setting. Some studies indicate that schools change original concepts significantly when adapting them to local context in the course of implementation. In this paper, we pursue the question how HP is practiced in schools that have agreed to implement HPS concepts from regional service providers (SPs), using data from a multiple-case study conducted in an Austrian province. Furthermore, we explored the HP activities chosen for implementation and the decision-making leading to their implementation. We draw on 22 interviews with members of the school community and provincial HP SPs, 9 group discussions, and 10 observations we have carried out within three schools between November 2010 and January 2012, supplemented by a variety of documents. We have identified 40 different HP activities, of which most targeted students, while mostly focusing on physical activity and/or psychosocial health. Planning, coordination and cooperation at the school level were minimal. Decisions for or against activities were seldom taken together, but taken individually due to personal knowledge, interests and experiences, perceived needs and problems, already existing activities and external influences. The findings suggest that schools rather remain with a traditional topic-based approach instead of realizing an integrated whole-school approach and indicate a need for more support especially during the early phases of implementation. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. Pulmonary tuberculosis incidence in Turkish prisons: importance of screening and case finding strategies.

    PubMed

    Öngen, Gül; Börekçi, Şermin; İçmeli, Özlem Saniye; Birgen, Nur; Karagül, Gülsüm; Akgün, Salih; Kılıçaslan, Zeki; Umut, Sema

    2013-01-01

    The purpose of this study was to evaluate the burden of pulmonary tuberculosis in 10 prisons mostly located in the Marmara Region of Turkey, and to compare them with the country incidence. All the inmates in ten prisons mostly located in the four cities in the Marmara Region of Turkey were enrolled in this study. Tuberculosis screening was done between January 2006-January 2007. Radiological screening for tuberculosis was performed by the mobile X-ray system and it was followed by bacteriological analysis of sputum for tuberculosis suspects. Four physicians evaluated the X-rays independently. Four thousand six hundred and fifteen prisoners were detected by radiological screening. Three hundred and one (7%) of them were female and 4314 (93%) were male, age range was between 14-72 years. Age ranges of female and male prisoners were 16-59 and 14-72 respectively. 398/4615 (8.6%) were young adults inmates with an age range of 14-18. Radiological abnormalities consistent with tuberculosis were found in 130 chest X-rays and followed by sputum bacteriology. Smear and culture positive pulmonary tuberculosis diagnosed in five out of 130, were all male with mean age 33 ± 10 years. Tuberculosis prevalence in the prisons was found to be 108/100.000 which was four times higher than the overall incidence of tuberculosis in Turkey in the year which the present study was conducted. Prisoners are one of the most important risk groups with high burden of tuberculosis in Turkey. This result highlights the need for adequate case- finding strategies in prisons.

  7. Active Tuberculosis Case Finding in Port-au-Prince, Haiti: Experiences, Results, and Implications for Tuberculosis Control Programs

    PubMed Central

    Delva, Guesly J.; Fort, Dumesle St.

    2016-01-01

    Background. Haiti has the highest tuberculosis (TB) prevalence in the Americas with 254 cases per 100,000 persons. Case detection relies on passive detection and TB services in many regions suffer from poor diagnostic and clinical resources. Methods. Mache Chache (“Go and Seek”) was a TB REACH Wave 3 funded TB case finding project in Port-au-Prince between July 2013 and September 2014, targeting four intervention areas with insufficient TB diagnostic performance. Results. Based on a verbal symptom screen emphasizing the presence of cough, the project identified 11,150 (11.75%) of all screened persons as TB subjects and 2.67% as smear-positive (SS+) TB cases. Enhanced case finding and strengthening of laboratory services led to a 59% increase in bacteriologically confirmed cases in the evaluation population. In addition, smear grades dropped significantly, suggesting earlier case detection. Xpert® MTB/RIF was successfully introduced and improved TB diagnosis in HIV-infected, smear-negative clinic patients, but not in HIV-negative, smear-negative TB suspects in the community. However, the number needed to screen for one additional SS+ case varied widely between clinic and community screening activities. Conclusion. Enhanced and active TB case finding in Haiti can improve TB diagnosis and care. However, screening algorithms have to be tailored to individual settings, necessitating long-term commitment. PMID:27668093

  8. Narrative-Based Intervention for Word-Finding Difficulties: A Case Study

    ERIC Educational Resources Information Center

    Marks, Ian; Stokes, Stephanie F.

    2010-01-01

    Background: Children with word-finding difficulties manifest a high frequency of word-finding characteristics in narrative, yet word-finding interventions have concentrated on single-word treatments and outcome measures. Aims: This study measured the effectiveness of a narrative-based intervention in improving single-word picture-naming and…

  9. Development of seals for a geothermal downhole intensifier. Progress report

    SciTech Connect

    Captain, K.M.; Harvey, A.C.; Caskey, B.C.

    1985-08-01

    A system using high-velocity fluid jets in conjunction with a rotary diamond bit is currently considered as the best candidate for reducing the cost of drilling geothermal wells. Technical, safety and cost considerations indicate that the required jet supply pressure can best be established by a downhole pressure intensifier. Key intensifier components are the check valve and plunger seals, which must prevent leakage of the high-pressure, high-temperature abrasive fluid (drilling mud). To achieve the required performance, novel ceramic seals are currently being developed. The check valve seal includes a tapered polymeric plug and ceramic stop acting against a ceramic seat. The ceramic plunger seal is a variant of the ''stepped-joint'' piston ring and is designed to minimize contact pressure and abrasive wear. Initial testing of these seals in the laboratory shows encouraging results; design refinement and further testing is in progress. 2 refs., 6 figs., 3 tabs.

  10. Collimator application for microchannel plate image intensifier resolution improvement

    DOEpatents

    Thomas, Stanley W.

    1996-02-27

    A collimator is included in a microchannel plate image intensifier (MCPI). Collimators can be useful in improving resolution of MCPIs by eliminating the scattered electron problem and by limiting the transverse energy of electrons reaching the screen. Due to its optical absorption, a collimator will also increase the extinction ratio of an intensifier by approximately an order of magnitude. Additionally, the smooth surface of the collimator will permit a higher focusing field to be employed in the MCP-to-collimator region than is currently permitted in the MCP-to-screen region by the relatively rough and fragile aluminum layer covering the screen. Coating the MCP and collimator surfaces with aluminum oxide appears to permit additional significant increases in the field strength, resulting in better resolution.

  11. Collimator application for microchannel plate image intensifier resolution improvement

    DOEpatents

    Thomas, S.W.

    1996-02-27

    A collimator is included in a microchannel plate image intensifier (MCPI). Collimators can be useful in improving resolution of MCPIs by eliminating the scattered electron problem and by limiting the transverse energy of electrons reaching the screen. Due to its optical absorption, a collimator will also increase the extinction ratio of an intensifier by approximately an order of magnitude. Additionally, the smooth surface of the collimator will permit a higher focusing field to be employed in the MCP-to-collimator region than is currently permitted in the MCP-to-screen region by the relatively rough and fragile aluminum layer covering the screen. Coating the MCP and collimator surfaces with aluminum oxide appears to permit additional significant increases in the field strength, resulting in better resolution. 2 figs.

  12. Some improvements on the auto-gated power for low-light level image intensifier

    NASA Astrophysics Data System (ADS)

    Yang, Ye; Yan, Bo; Zhi, Qiang; Yao, Ze; Li, Jun-guo; Fu, Ling-yun; Yuan, Yuan; Deng, Guang-xu

    2014-09-01

    The basic principle and formation of the auto-gated power using hybrid automatic brightness control scheme were described in detail. The auto-gated power supply in the application process because the device precision and the low-light level image intensifier between individual differences, fall may cause some products in some cases the SNR and resolution, and decrease the consistency of the product. This paper puts forward the corresponding solutions to these problems. And through experiments on the improved auto gated power supply with automatic gated power has not been improved compared. Applications of the auto-gated power in military, police and civil area were forecasted.

  13. [Impaired hemostasis as a cause of intensified bleeding after heart surgery with extracorporeal blood circulation].

    PubMed

    Morozov, Iu A; Charnaia, M A; Gladysheva, V G

    2004-01-01

    The paper contains the results of a retrospective analysis of causes for an intensified bleeding in patients operated on the heart with artificial blood circulation. An affected hemostasis plasma chain, i.e. insufficiency of blood coagulation factors due to hemodelution, hypofibrinogenemia etc., provoked the above disorder in 39% of patients with a higher postoperative bleeding. Additional reasons for the impaired hemostasis chain included: the "heparin-rebound" phenomenon (3.4%), activation of the secondary fibrinolysis (3.4%) and disseminated intravascular coagulation (DIC) (0.14%). Finally, an undiagnosed inadequate surgical hemostasis provoked an intense bleeding in 19.5% of cases.

  14. Multiexposure imaging and parameter optimization for intensified star trackers.

    PubMed

    Yu, Wenbo; Jiang, Jie; Zhang, Guangjun

    2016-12-20

    Due to the introduction of the intensified image detector, the dynamic performance of the intensified star tracker is effectively improved. However, its attitude update rate is still seriously restricted by the transmission and processing of pixel data. In order to break through the above limitation, a multiexposure imaging approach for intensified star trackers is proposed in this paper. One star image formed by this approach actually records N different groups of star positions, and then N corresponding groups of attitude information can be acquired. Compared with the existing exposure imaging approach, the proposed approach improves the attitude update rate by N times. Furthermore, for a dim star, the proposed approach can also accumulate the energy of its N positions and then effectively improve its signal-to-noise ratio. Subsequently, in order to obtain the optimal performance of the proposed approach, parameter optimization is carried out. First, the motion model of the star spot in the image plane is established, and then based on it, all the key parameters are optimized. Simulations and experiments demonstrate the feasibility and effectiveness of the proposed approach and parameter optimization.

  15. Characterization of domestic and foreign image intensifier tubes

    NASA Astrophysics Data System (ADS)

    Bender, Edward J.; Wood, Michael V.; Hosek, Daniel J.; Hart, Steve D.

    2013-06-01

    The market for military-use Generation 2 and Generation 3 image intensifier (I2) tubes has become truly global, with major manufacturers and customers spanning five continents. This worldwide market is becoming increasingly important to U.S. manufacturers, with the majority of U.S. Army intensifier fielding having been completed in 2012. Given this keen global competition, it is not surprising that the advertised tube performance of a given source is often discounted by competitors, and the customers have no objective "honest broker" to determine the relative accuracy of these claims. To help fill this void, the U.S. Army RDECOM CERDEC NVESD recently measured a number of domestic and foreign image intensifier tubes, using consistent test equipment/procedures with which the U.S. industry must correlate for Army tube deliveries. Data and analysis will be presented for the major tube parameters of luminance gain, equivalent background input (EBI), signal-to-noise ratio (SNR), limiting resolution, halo, and modulation transfer function (MTF). The bright-light resolution provided by various auto-gated and non-gated tubes will also be addressed, since this area has been an important factor in the international market. RDECOM CERDEC NVESD measurement data will be compared to the corresponding manufacturer specifications whenever possible.

  16. Tuberculosis Case Finding in Benin, 2000–2014 and Beyond: A Retrospective Cohort and Time Series Study

    PubMed Central

    Ade, Serge; Békou, Wilfried; Adjobimey, Mênonli; Adjibode, Omer; Ade, Gabriel; Harries, Anthony D.; Anagonou, Séverin

    2016-01-01

    Objective. To determine any changes in tuberculosis epidemiology in the last 15 years in Benin, seasonal variations, and forecasted numbers of tuberculosis cases in the next five years. Materials and Methods. Retrospective cohort and time series study of all tuberculosis cases notified between 2000 and 2014. The “R” software version 3.2.1 (Institute for Statistics and Mathematics Vienna Austria) and the Box-Jenkins 1976 modeling approach were used for time series analysis. Results. Of 246943 presumptive cases, 54303 (22%) were diagnosed with tuberculosis. Annual notified case numbers increased, with the highest reported in 2011. New pulmonary bacteriologically confirmed tuberculosis (NPBCT) represented 78%  ± SD 2%. Retreatment cases decreased from 10% to 6% and new pulmonary clinically diagnosed cases increased from 2% to 8%. NPBCT notification rates decreased in males from 2012, in young people aged 15–34 years and in Borgou-Alibori region. There was a seasonal pattern in tuberculosis cases. Over 90% of NPBCT were HIV-tested with a stable HIV prevalence of 13%. The ARIMA best fit model predicted a decrease in tuberculosis cases finding in the next five years. Conclusion. Tuberculosis case notifications are predicted to decrease in the next five years if current passive case finding is used. Additional strategies are needed in the country. PMID:27293887

  17. Ultrasonographic findings of placenta lacunae and a lack of a clear zone in cases with placenta previa and normal placenta.

    PubMed

    Hamada, Shoko; Hasegawa, Junichi; Nakamura, Masamitsu; Matsuoka, Ryu; Ichizuka, Kiyotake; Sekizawa, Akihiko; Okai, Takashi

    2011-11-01

    To evaluate whether the frequencies of placenta lacunae and lack of a clear zone are higher in cases of placenta previa compared with those without it. Ultrasonographic findings just before delivery, including placenta lacunae and lack of a clear zone were prospectively evaluated in consecutive subjects. After collection, a case-control study with 1:5 matched pairs was conducted. The frequencies of ultrasonographic findings were analyzed in cases with placenta previa and normal placenta. Seventy cases with placenta previa and 350 cases with normal placentas were observed. Five and zero cases with abnormal placental adherence were observed in cases with placenta previa and normal placenta, respectively. Lack of a clear zone was observed in 60 and 1.5% of cases with and without the placental adherence (p = 0.001). Placenta lacunae and lack of a clear zone were observed in 31.4 and 9.7% of cases with and without placenta previa [odds ratio (OR) 4.2]. Lack of a clear zone was observed in 5.7 and 0.9% of cases with and without placenta previa (OR 7.0). Placenta lacunae and lack of a clear zone are frequently observed in placenta previa even when there is no adherence of the placenta. Copyright © 2011 John Wiley & Sons, Ltd.

  18. Tuberculosis Case Finding in Benin, 2000-2014 and Beyond: A Retrospective Cohort and Time Series Study.

    PubMed

    Ade, Serge; Békou, Wilfried; Adjobimey, Mênonli; Adjibode, Omer; Ade, Gabriel; Harries, Anthony D; Anagonou, Séverin

    2016-01-01

    Objective. To determine any changes in tuberculosis epidemiology in the last 15 years in Benin, seasonal variations, and forecasted numbers of tuberculosis cases in the next five years. Materials and Methods. Retrospective cohort and time series study of all tuberculosis cases notified between 2000 and 2014. The "R" software version 3.2.1 (Institute for Statistics and Mathematics Vienna Austria) and the Box-Jenkins 1976 modeling approach were used for time series analysis. Results. Of 246943 presumptive cases, 54303 (22%) were diagnosed with tuberculosis. Annual notified case numbers increased, with the highest reported in 2011. New pulmonary bacteriologically confirmed tuberculosis (NPBCT) represented 78%  ± SD 2%. Retreatment cases decreased from 10% to 6% and new pulmonary clinically diagnosed cases increased from 2% to 8%. NPBCT notification rates decreased in males from 2012, in young people aged 15-34 years and in Borgou-Alibori region. There was a seasonal pattern in tuberculosis cases. Over 90% of NPBCT were HIV-tested with a stable HIV prevalence of 13%. The ARIMA best fit model predicted a decrease in tuberculosis cases finding in the next five years. Conclusion. Tuberculosis case notifications are predicted to decrease in the next five years if current passive case finding is used. Additional strategies are needed in the country.

  19. Prenatal findings in a case of massive fetomaternal hemorrhage associated with intraplacental choriocarcinoma.

    PubMed

    Aso, Kaai; Tsukimori, Kiyomi; Yumoto, Yasuo; Hojo, Satoshi; Fukushima, Kotaro; Koga, Takaomi; Sueishi, Katsuo; Takahata, Yasushi; Hara, Toshiro; Wake, Norio

    2009-01-01

    We describe biochemical assessment of maternal circulation in a case of massive fetomaternal hemorrhage at term associated with intraplacental choriocarcinoma. Markedly elevated maternal serum hCG level at 37 weeks of gestation suggested choriocarcinoma as a cause of fetomaternal hemorrhage in this case. Measurement of maternal hCG may be a useful parameter when intraplacental choriocarcinoma is in the differential diagnosis. In addition, the placenta should be examined in all cases of fetomaternal hemorrhage.

  20. Building Strong Geoscience Departments: Case Studies and Findings from Six Years of Programming

    NASA Astrophysics Data System (ADS)

    Iverson, E. A.; Lee, S.; Ormand, C. J.; Feiss, P. G.; Macdonald, H.; Manduca, C. A.; Richardson, R. M.

    2011-12-01

    Begun in 2005, the Building Strong Geoscience Departments project sought to help geoscience departments respond to changes in geosciences research, academic pressures, and the changing face of the geosciences workforce by working as a team, planning strategically, and learning from the experiences of other geoscience departments. Key strategies included becoming more central to their institution's mission and goals; articulating the department's learning goals for students; designing coordinated curricula, co-curricular activities, and assessments to meet these goals; and recruiting students effectively. A series of topical workshops identified effective practices in use in the U.S. and Canada. These practices were documented on the project website and disseminated through a national workshop for teams of faculty, through activities at the AGU Heads and Chairs workshops, and in a visiting workshop program bringing leaders to campuses. The program has now involved over 450 participants from 185 departments. To understand the impact of the program, we engaged in ongoing discussion with five departments of various sizes and institutional types, and facing a variety of immediate challenges. In aggregate they made use of the full spectrum of project offerings. These departments all reported that the project brought an important new perspective to their ability to work as a department: they have a better understanding of how their departments' issues relate to the national scene, have more strategies for making the case for the entire department to college administrators, and are better poised to make use of campus resources including the external review process. These results were consistent with findings from end-of-workshop surveys. Further they developed the ability to work together as a team to address departmental challenges through collective problem solving. As a result of their workshop participation, two of the departments who considered their department to be

  1. Depression Case Finding in Individuals with Dementia: A Systematic Review and Meta-Analysis.

    PubMed

    Goodarzi, Zahra S; Mele, Bria S; Roberts, Derek J; Holroyd-Leduc, Jayna

    2017-05-01

    To compare the diagnostic accuracy of depression case finding tools with a criterion standard in the outpatient setting among adults with dementia. Systematic review and meta-analysis. Studies of older outpatients with dementia. Elderly outpatients (clinic and long-term care) with dementia (N = 3,035). Prevalence of major depression and diagnostic accuracy measures including sensitivity, specificity, and likelihood ratios. From the 11,539 citations, 20 studies were included for qualitative synthesis and 15 for a meta-analysis. Tools included were the Montgomery Åsberg Depression Rating Scale, Cornell Scale for Depression in Dementia (CSDD), Geriatric Depression Scale (GDS), Center for Epidemiologic Studies Depression Scale (CES-D), Hamilton Depression Rating Scale (HDRS), Single Question, Nijmegen Observer-Rated Depression Scale, and Even Briefer Assessment Scale-Depression. The pooled prevalence of depression in individuals with dementia was 30.3% (95% CI = 22.1-38.5). The average age was 75.2 (95% CI = 71.7-78.7), and mean Mini-Mental State Examination scores ranged from 11.2 to 24. The diagnostic accuracy of the individual tools was pooled for the best-reported cutoffs and for each cutoff, if available. The CSDD had a sensitivity of 0.84 (95% CI = 0.73-0.91) and a specificity of 0.80 (95% CI = 0.65-0.90), the 30-item GDS (GDS-30) had a sensitivity of 0.62 (95% CI = 0.45-0.76) and a specificity 0.81 (95% CI = 0.75-0.85), and the HDRS had a sensitivity of 0.86 (95% CI = 0.63-0.96) and a specificity of 0.84 (95% CI = 0.76-0.90). Summary statistics for all tools across best-reported cutoffs had significant heterogeneity. There are many validated tools for the detection of depression in individuals with dementia. Tools that incorporate a physician interview with patient and collateral histories, the CSDD and HDRS, have higher sensitivities, which would ensure fewer false-negatives. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics

  2. Effectiveness of case finding strategies for COPD in primary care: a systematic review and meta-analysis

    PubMed Central

    Haroon, Shamil MM; Jordan, Rachel E; O’Beirne-Elliman, Joanne; Adab, Peymane

    2015-01-01

    Background: Chronic obstructive pulmonary disease (COPD) is widely underdiagnosed, but the most effective approach for identifying these patients is unknown. Aims: The aim of this study was to summarise and compare the effectiveness of different case finding approaches for undiagnosed COPD in primary care. Methods: A systematic review of primary studies of any design evaluating case finding strategies for COPD in primary care among individuals aged ⩾35 years with no prior diagnosis was conducted. Medline, Embase and other bibliographic databases were searched from 1997 to 2013, and methodological quality was assessed using standard tools. Results were described and meta-analysis of the uptake and yield from different approaches was performed where there was sufficient homogeneity. Results: Three randomised controlled trials (RCTs), 1 controlled trial and 35 uncontrolled studies were identified that assessed the identification of new cases of COPD through systematic case finding. A range of approaches were used including pre-screening with questionnaires (n=13) or handheld flow meters (n=5) or direct invitation to diagnostic spirometry (n=30). Overall, any approach identified more undiagnosed COPD compared with usual care. Targeting those at higher risk (e.g., smokers) and pre-screening (e.g., using questionnaires) is likely to increase the yield. However, studies were heterogeneous and were limited by a lack of comparison groups, inadequate reporting and diversity in the definition of COPD, which limited our ability to draw firm conclusions. Conclusions: There is extensive heterogeneity among studies evaluating case finding strategies for COPD, with few RCTs. Well-conducted RCTs comparing case finding approaches are needed to identify the most effective target population, recruitment strategy and screening tests, using a clinical definition of COPD, and addressing the limitations highlighted in this review. There is also a need to evaluate the impact of case

  3. Active Case Finding Among Homeless People as a Means of Reducing the Incidence of Pulmonary Tuberculosis in General Population.

    PubMed

    Romaszko, J; Siemaszko, A; Bodzioch, M; Buciński, A; Doboszyńska, A

    2016-01-01

    The incidence of tuberculosis (TB) declined more than two-fold, compared with the national average, in the northeastern region of Poland in the period of 2003-2012. During that time, four programs of active case finding of TB were conducted as part of which a total of 944 homeless individuals were examined and 21 cases of active TB were detected. The objective of the present study was to find out whether the observed beneficial epidemiological trend could be a result of those programs. We addressed the issue of how the active case finding programs in the homeless community affected the TB incidence in the general population using a modified crisscross SIS-type (Susceptible - Infected - Susceptible) model which describes the dynamics of TB spread between the homeless and non-homeless populations. The values calculated from our model proved highly congruent with the actual epidemiological data. Our analysis showed a significant decline in TB incidence within 1 year of completion of each active case finding program. The model shows that each identified and cured case in the homeless community reduced the number of new cases in the general population by 3-4 within 1 year and by up to 20 within 5 years.

  4. Student Perceptions of Peer versus Instructor Facilitation of Asynchronous Online Discussions: Further Findings from Three Cases

    ERIC Educational Resources Information Center

    Hew, Khe Foon

    2015-01-01

    This study aims to extend a previous work on the role of peer facilitation of asynchronous online discussions. Specifically, in this paper I report three cases that examine students' preference for peer or instructor facilitation of online discussion forums, as well as their respective reasons for it. These three cases involved the following…

  5. Child Find Activities under the Individuals with Disabilities Education Act: Recent Case Law

    ERIC Educational Resources Information Center

    Ennis, Robin Parks; Blanton, Kimberly; Katsiyannis, Antonis

    2017-01-01

    Since the enactment of the Education for All Handicapped Children Act (IDEA's forerunner) in 1975, an important requirement has been Child Find activities. According to Shapiro and Derrington (2004), Child Find is broadly defined as the entire range of activities, including public awareness, identification, referral, eligibility determination, and…

  6. Case Studies on the Symbolism of Difference-Finding Problems in First Grade.

    ERIC Educational Resources Information Center

    Hasegawa, Junichi

    2002-01-01

    Discusses a class on subtraction or difference-finding, problems such as "There are eight white flowers and five red flowers, how many more white flowers are there than red flowers?" used in the teaching of Japanese first grade children. Describes three instances of introductory teaching of "difference-finding" problems in the…

  7. You Could Never Find This in a Shop!: Using Measurement Skills to Make Pencil Cases

    ERIC Educational Resources Information Center

    Goral, Mary Barr; Gilderbloom, Patty

    2008-01-01

    Measurement is a mathematics skill students encounter often in their daily lives. The act of measuring involves the use of concrete, hands-on materials that students find engaging and appealing. According to Martinie (2004), the best way to teach measurement "is to find or create situations in which students need to measure and let them…

  8. Case Studies on the Symbolism of Difference-Finding Problems in First Grade.

    ERIC Educational Resources Information Center

    Hasegawa, Junichi

    2002-01-01

    Discusses a class on subtraction or difference-finding, problems such as "There are eight white flowers and five red flowers, how many more white flowers are there than red flowers?" used in the teaching of Japanese first grade children. Describes three instances of introductory teaching of "difference-finding" problems in the…

  9. Chest Radiograph Findings in Childhood Pneumonia Cases From the Multisite PERCH Study.

    PubMed

    Fancourt, Nicholas; Deloria Knoll, Maria; Baggett, Henry C; Brooks, W Abdullah; Feikin, Daniel R; Hammitt, Laura L; Howie, Stephen R C; Kotloff, Karen L; Levine, Orin S; Madhi, Shabir A; Murdoch, David R; Scott, J Anthony G; Thea, Donald M; Awori, Juliet O; Barger-Kamate, Breanna; Chipeta, James; DeLuca, Andrea N; Diallo, Mahamadou; Driscoll, Amanda J; Ebruke, Bernard E; Higdon, Melissa M; Jahan, Yasmin; Karron, Ruth A; Mahomed, Nasreen; Moore, David P; Nahar, Kamrun; Naorat, Sathapana; Ominde, Micah Silaba; Park, Daniel E; Prosperi, Christine; Wa Somwe, Somwe; Thamthitiwat, Somsak; Zaman, Syed M A; Zeger, Scott L; O'Brien, Katherine L

    2017-06-15

    Chest radiographs (CXRs) are frequently used to assess pneumonia cases. Variations in CXR appearances between epidemiological settings and their correlation with clinical signs are not well documented. The Pneumonia Etiology Research for Child Health project enrolled 4232 cases of hospitalized World Health Organization (WHO)-defined severe and very severe pneumonia from 9 sites in 7 countries (Bangladesh, the Gambia, Kenya, Mali, South Africa, Thailand, and Zambia). At admission, each case underwent a standardized assessment of clinical signs and pneumonia risk factors by trained health personnel, and a CXR was taken that was interpreted using the standardized WHO methodology. CXRs were categorized as abnormal (consolidation and/or other infiltrate), normal, or uninterpretable. CXRs were interpretable in 3587 (85%) cases, of which 1935 (54%) were abnormal (site range, 35%-64%). Cases with abnormal CXRs were more likely than those with normal CXRs to have hypoxemia (45% vs 26%), crackles (69% vs 62%), tachypnea (85% vs 80%), or fever (20% vs 16%) and less likely to have wheeze (30% vs 38%; all P < .05). CXR consolidation was associated with a higher case fatality ratio at 30-day follow-up (13.5%) compared to other infiltrate (4.7%) or normal (4.9%) CXRs. Clinically diagnosed pneumonia cases with abnormal CXRs were more likely to have signs typically associated with pneumonia. However, CXR-normal cases were common, and clinical signs considered indicative of pneumonia were present in substantial proportions of these cases. CXR-consolidation cases represent a group with an increased likelihood of death at 30 days post-discharge.

  10. Active case finding for pulmonary tuberculosis using mobile digital chest radiography: an observational study.

    PubMed

    Story, A; Aldridge, R W; Abubakar, I; Stagg, H R; Lipman, M; Watson, J M; Hayward, A C

    2012-11-01

    Mobile digital chest radiography (CXR) is used routinely to screen for pulmonary tuberculosis (PTB) in London among homeless populations, persons accessing drug treatment services and prisoners. 1) To establish the sensitivity and specificity of mobile digital CXR, and 2) to test the hypothesis that actively identified cases have reduced odds of sputum smear positivity vs. those presenting passively to health care services from the same populations. Sensitivity and specificity were calculated using a gold standard comparator of culture-confirmed cases of PTB reported to the national surveillance system within 90 days of screening. Logistic regression was used to determine whether actively detected cases had reduced odds of smear positivity compared to passively detected cases after adjustment for confounding. The intervention had a sensitivity of 81.8% (95%CI 64.5-93.0) and a specificity of 99.2% (95%CI 99.1-99.3). After adjusting for confounding, there was evidence that cases identified through screening were less likely to be smear-positive than passively identified cases (OR 0.34, 95%CI 0.14-0.85; likelihood ratio test P = 0.022). Digital CXR achieves a high level of sensitivity and specificity in an operational setting; targeted mobile radiographic screening can reduce the risk of onward transmission by identifying cases before they become infectious.

  11. Clinicopathological findings of focal organizing pneumonia: a retrospective study of 37 cases.

    PubMed

    Huo, Zhen; Feng, Ruie; Tian, Xinlun; Zhang, Haibo; Huo, Li; Liu, Hongrui

    2015-01-01

    Focal organizing pneumonia (FOP) is an uncommon disease. The etiology, and in particular the disease's relationship with infection and the incidence of idiopathic FOP, is relatively unknown. The aim of this study is to review clinical, radiological and pathological features of patients with organizing pneumonia (OP) presenting solitary lesions and to analyze possible causes. We retrospectively reviewed 37 surgical lung biopsy or resection cases of pathologically confirmed FOP over a period of 10 years. Microscopically, 17 cases showed OP with neutrophilic infiltration or abscess, 11 with epithelioid cell granulomas or scattered multinucleated giant cells, 2 with greater eosinophilic infiltration, and the remaining 7 cases met the diagnostic criteria for pathological cryptogenic OP (COP). The 37 cases of FOP included 22 men and 15 women, aged 29-76 years, and 17 cases had a history of smoking. Cough, fever, sputum, chest or back pain and hemoptysis were the main symptoms. Seven cases were asymptomatic. The diameters of the lesions ranged from 0.2-6.0 cm (median, 3.0 cm). Fever (9/30), high-sensitivity C-reactive protein elevation (9/17) and abnormalities in pulmonary function test (8/24) existed in focal secondary OP (FSOP) patients, but these symptoms were rarely observed in focal COP (FCOP) (0/7, 1/7 and 0/7 cases, respectively). However, no statistically significant differences were found between the FSOP and FCOP. Histologically, secondary factors exist in the majority of FOP cases. Idiopathic FOP is found in a minority. With respect to secondary FOP, acute infection and granulomatous inflammation are the main causes. Surgical resection alone appears sufficient for the management of FOP.

  12. Perception of the acoustic environment and neuroimaging findings: a report of six cases with a history of closed head injury.

    PubMed

    Bergemalm, Per-Olof; Hennerdal, Sture; Persson, Birger; Lyxell, Björn; Borg, Erik

    2009-07-01

    The main finding was the relation between difficulty in determining the direction of movement of a sound source and frontal lesions and poor working memory. Poor correspondence in some cases between functional findings and imaging findings can be due to the possibility of axonal degeneration as well as plastic reorganization. The purpose of the present investigation of six cases was to identify auditory, cognitive and neuroimaging long-term sequelae of closed head injury (CHI) with particular focus on environmental sound recognition and moving sound sources. Six subjects who had experienced CHI were investigated with auditory tests. Four subjects also completed cognitive testing. CT and MRI were performed. There was a large individual variability of the test results with respect to morphological findings. In five cases with central auditory processing disorders morphological brain damage was demonstrated. Two cases with shortcomings on cognitive testing and with frontal brain lesions demonstrated problems in determining the direction of movement of a sound source. The results may indicate that basal frontal lobe structures play a role in following and determining the direction of movement of a sound source. Two cases had problems with environmental sound recognition; in one left temporal brain lesions were demonstrated.

  13. Retrospective study of sonographic findings in bone involvement associated with rotator cuff calcific tendinopathy: preliminary results of a case series*

    PubMed Central

    Nogueira-Barbosa, Marcello H.; Gregio-Junior, Everaldo; Lorenzato, Mario Muller

    2015-01-01

    Objective The present study was aimed at investigating bone involvement secondary to rotator cuff calcific tendonitis at ultrasonography. Materials and Methods Retrospective study of a case series. The authors reviewed shoulder ultrasonography reports of 141 patients diagnosed with rotator cuff calcific tendonitis, collected from the computer-based data records of their institution over a four-year period. Imaging findings were retrospectively and consensually analyzed by two experienced musculoskeletal radiologists looking for bone involvement associated with calcific tendonitis. Only the cases confirmed by computed tomography were considered for descriptive analysis. Results Sonographic findings of calcific tendinopathy with bone involvement were observed in 7/141 (~ 5%) patients (mean age, 50.9 years; age range, 42-58 years; 42% female). Cortical bone erosion adjacent to tendon calcification was the most common finding, observed in 7/7 cases. Signs of intraosseous migration were found in 3/7 cases, and subcortical cysts in 2/7 cases. The findings were confirmed by computed tomography. Calcifications associated with bone abnormalities showed no acoustic shadowing at ultrasonography, favoring the hypothesis of resorption phase of the disease. Conclusion Preliminary results of the present study suggest that ultrasonography can identify bone abnormalities secondary to rotator cuff calcific tendinopathy, particularly the presence of cortical bone erosion. PMID:26811551

  14. Retrospective study of sonographic findings in bone involvement associated with rotator cuff calcific tendinopathy: preliminary results of a case series.

    PubMed

    Nogueira-Barbosa, Marcello H; Gregio-Junior, Everaldo; Lorenzato, Mario Muller

    2015-01-01

    The present study was aimed at investigating bone involvement secondary to rotator cuff calcific tendonitis at ultrasonography. Retrospective study of a case series. The authors reviewed shoulder ultrasonography reports of 141 patients diagnosed with rotator cuff calcific tendonitis, collected from the computer-based data records of their institution over a four-year period. Imaging findings were retrospectively and consensually analyzed by two experienced musculoskeletal radiologists looking for bone involvement associated with calcific tendonitis. Only the cases confirmed by computed tomography were considered for descriptive analysis. Sonographic findings of calcific tendinopathy with bone involvement were observed in 7/141 (~ 5%) patients (mean age, 50.9 years; age range, 42-58 years; 42% female). Cortical bone erosion adjacent to tendon calcification was the most common finding, observed in 7/7 cases. Signs of intraosseous migration were found in 3/7 cases, and subcortical cysts in 2/7 cases. The findings were confirmed by computed tomography. Calcifications associated with bone abnormalities showed no acoustic shadowing at ultrasonography, favoring the hypothesis of resorption phase of the disease. Preliminary results of the present study suggest that ultrasonography can identify bone abnormalities secondary to rotator cuff calcific tendinopathy, particularly the presence of cortical bone erosion.

  15. [Radiographic diagnosis of abdominal diseases in foals and ponys. II. Pathologic findings in 60 cases].

    PubMed

    Gerhards, H; Klein, H J; Offeney, F

    1990-08-01

    A diagnostic approach based on clinical and radiographic examinations for evaluation of young foals and small ponies with acute abdominal discomfort is presented. Standing right to left lateral abdominal radiographs were taken of 54 foals and 6 ponies using a previously described technique. Interpretation of the radiographs was in conjunction with all clinical and laboratory findings and patient management. Using this approach, the site and cause of acute abdominal discomfort could be diagnosed accurately in 55 of 60 (91%) patients as confirmed by clinical, surgical or necropsy findings. Typical radiographs and photographs taken at surgery or at necropsy are presented. Typical radiographic findings, their interpretation and possible underlying gastrointestinal diseases are listed. The incorporation of standing lateral abdominal radiography in the clinical evaluation of foals and ponies with acute abdominal diseases gives findings of high diagnostic significance and should contribute to clinical decision-making. Abdominal radiography can replace data from rectal palpation in foals and ponies.

  16. Phenazepam abuse in Finland: findings from apprehended drivers, post-mortem cases and police confiscations.

    PubMed

    Kriikku, Pirkko; Wilhelm, Lars; Rintatalo, Janne; Hurme, Jukka; Kramer, Jan; Ojanperä, Ilkka

    2012-07-10

    Phenazepam is a long-acting benzodiazepine that, unlike other benzodiazepines, is currently not scheduled as a narcotic in Finland, most other European countries or the USA. It is used as an anxiolytic, sedative-hypnotic and anti-epileptic, mainly in Russia. In Finland, as well as in some other countries, an increase in the unauthorized use of phenazepam has been observed in recent years. In the one year period between July 1, 2010 and June 30, 2011 the prevalence of phenazepam in Finland was assessed among drivers apprehended for driving under the influence of drugs (DUID), in medico-legal autopsy cases and in police confiscations of illicit drugs. In DUID cases an LC-MS/MS method preceded by solid phase extraction was used for the determination of phenazepam. In the post-mortem investigations the sample preparation consisted of liquid-liquid extraction followed by derivatization and the determination was carried out by GC-MS. The police confiscations were analysed by GC-MS. There were 141 positive phenazepam cases among apprehended drivers, representing approximately 3.5% of all confirmed drug cases (n=4007) in this time period. The median (range) phenazepam blood concentration in DUID cases was 0.061 mg/L (0.004-3.600 mg/L). The median phenazepam concentration in cases with no concomitant stimulant use was significantly higher than the overall median concentration. Phenazepam was found in 17 medico-legal autopsy cases and the median (range) blood concentration was 0.048 mg/L (0.007-1.600 mg/L). Phenazepam was not considered by the medico-legal team to be the sole cause of death in any of the cases, the majority of them being accidental opiod overdoses. There were 26 seizures of phenazepam by the Police in the time period studied, some of the batches consisted of a mixture of phenazepam and stimulant designer drugs. The data show that phenazepam abuse is a widespread phenomenon in Finland. A typical user was a male multi-drug user in his 30s. The concentration

  17. Childhood Leukemia and 50 Hz Magnetic Fields: Findings from the Italian SETIL Case-Control Study

    PubMed Central

    Salvan, Alberto; Ranucci, Alessandra; Lagorio, Susanna; Magnani, Corrado

    2015-01-01

    We report on an Italian case-control study on childhood leukemia and exposure to extremely low frequency magnetic fields (ELF-MF). Eligible for inclusion were 745 leukemia cases, aged 0–10 years at diagnosis in 1998–2001, and 1475 sex- and age-matched population controls. Parents of 683 cases and 1044 controls (92% vs. 71%) were interviewed. ELF-MF measurements (24–48 h), in the child’s bedroom of the dwelling inhabited one year before diagnosis, were available for 412 cases and 587 controls included in the main conditional regression analyses. The magnetic field induction was 0.04 μT on average (geometric mean), with 0.6% of cases and 1.6% of controls exposed to >0.3 μT. The impact of changes in the statistical model, exposure metric, and data-set restriction criteria was explored via sensitivity analyses. No exposure-disease association was observed in analyses based on continuous exposure, while analyses based on categorical variables were characterized by incoherent exposure-outcome relationships. In conclusion, our results may be affected by several sources of bias and they are noninformative at exposure levels >0.3 μT. Nonetheless, the study may contribute to future meta- or pooled analyses. Furthermore, exposure levels among population controls are useful to estimate attributable risk. PMID:25689995

  18. Swap intensified WDR CMOS module for I2/LWIR fusion

    NASA Astrophysics Data System (ADS)

    Ni, Yang; Noguier, Vincent

    2015-05-01

    The combination of high resolution visible-near-infrared low light sensor and moderate resolution uncooled thermal sensor provides an efficient way for multi-task night vision. Tremendous progress has been made on uncooled thermal sensors (a-Si, VOx, etc.). It's possible to make a miniature uncooled thermal camera module in a tiny 1cm3 cube with <1W power consumption. For silicon based solid-state low light CCD/CMOS sensors have observed also a constant progress in terms of readout noise, dark current, resolution and frame rate. In contrast to thermal sensing which is intrinsic day&night operational, the silicon based solid-state sensors are not yet capable to do the night vision performance required by defense and critical surveillance applications. Readout noise, dark current are 2 major obstacles. The low dynamic range at high sensitivity mode of silicon sensors is also an important limiting factor, which leads to recognition failure due to local or global saturations & blooming. In this context, the image intensifier based solution is still attractive for the following reasons: 1) high gain and ultra-low dark current; 2) wide dynamic range and 3) ultra-low power consumption. With high electron gain and ultra low dark current of image intensifier, the only requirement on the silicon image pickup device are resolution, dynamic range and power consumption. In this paper, we present a SWAP intensified Wide Dynamic Range CMOS module for night vision applications, especially for I2/LWIR fusion. This module is based on a dedicated CMOS image sensor using solar-cell mode photodiode logarithmic pixel design which covers a huge dynamic range (> 140dB) without saturation and blooming. The ultra-wide dynamic range image from this new generation logarithmic sensor can be used directly without any image processing and provide an instant light accommodation. The complete module is slightly bigger than a simple ANVIS format I2 tube with <500mW power consumption.

  19. Enigmatic Inv(9): A Case Report on Rare Findings in Hematological Malignancies

    PubMed Central

    Vijay, Sangeetha; Narayanan, Geetha; Sarojam, Santhi; Raveendran, Suresh Kumar; Hariharan, Sreedharan

    2016-01-01

    Introduction Inversion of chromosome 9 had been widely discussed among geneticists and evolutionary biologists because of its significant impact on various hereditary disorders and in the evolution of man. The role of such inversions in human disease evolution is an area hitherto unclear. Case Presentation We present the case of a chronic myeloid leukemia (CML) patient who showed intermittent relapse on treatment, with a rare appearance of clones with dual inversion (9) breakpoints [inv(9)(p22q34); inv(9)(p11q21)]. We also present the first report of inv(9)(p11,q13) as the sole abnormality in a patient with chronic myeloproliferative disorder(CMPD). Both the patients registered in 2012 and were from Kerala, India. Conclusions Both the cases discussed in our study have inv(9) as the sole abnormality and are found to confer a relatively poor prognosis. PMID:27280043

  20. Laboratory findings in four cases of adult botulism suggest colonization of the intestinal tract.

    PubMed Central

    McCroskey, L M; Hatheway, C L

    1988-01-01

    There was laboratory evidence of intestinal colonization in four cases of adult botulism confirmed by the Centers for Disease Control. No performed toxin was detected in available foods, but Clostridium botulinum was isolated from foods in two instances. Botulinal toxin was detected in the sera of all four patients, in one case at 47 days after ingestion of suspected food. C. botulinum was demonstrated in the stool of all four patients and persisted for 119 days after the onset of illness in one patient. Two patients had surgical alterations of the gastrointestinal tract, which may have promoted the colonization. The apparent lack of ingestion of performed toxin in these cases and the persistence of botulinal toxin or C. botulinum, or both, for long periods in three of the patients suggest that colonization of the intestinal tract occurred. PMID:3290234

  1. Tuberculosis case-finding through a village outreach programme in a rural setting in southern Ethiopia: community randomized trial.

    PubMed Central

    Shargie, Estifanos Biru; Mørkve, Odd; Lindtjørn, Bernt

    2006-01-01

    OBJECTIVE: To ascertain whether case-finding through community outreach in a rural setting has an effect on case-notification rate, symptom duration, and treatment outcome of smear-positive tuberculosis (TB). METHODS: We randomly allocated 32 rural communities to intervention or control groups. In intervention communities, health workers from seven health centres held monthly diagnostic outreach clinics at which they obtained sputum samples for sputum microscopy from symptomatic TB suspects. In addition, trained community promoters distributed leaflets and discussed symptoms of TB during house visits and at popular gatherings. Symptomatic individuals were encouraged to visit the outreach team or a nearby health facility. In control communities, cases were detected through passive case-finding among symptomatic suspects reporting to health facilities. Smear-positive TB patients from the intervention and control communities diagnosed during the study period were prospectively enrolled. FINDINGS: In the 1-year study period, 159 and 221 cases of smear-positive TB were detected in the intervention and control groups, respectively. Case-notification rates in all age groups were 124.6/10(5) and 98.1/10(5) person-years, respectively (P = 0.12). The corresponding rates in adults older than 14 years were 207/10(5) and 158/10(5) person-years, respectively (P = 0.09). The proportion of patients with >3 months' symptom duration was 41% in the intervention group compared with 63% in the control group (P<0.001). Pre-treatment symptom duration in the intervention group fell by 55-60% compared with 3-20% in the control group. In the intervention and control groups, 81% and 75%, respectively of patients successfully completed treatment (P = 0.12). CONCLUSION: The intervention was effective in improving the speed but not the extent of case finding for smear-positive TB in this setting. Both groups had comparable treatment outcomes. PMID:16501728

  2. Evidence of disturbed sleep and mood state in well-trained athletes during short-term intensified training with and without a high carbohydrate nutritional intervention.

    PubMed

    Killer, S C; Svendsen, I S; Jeukendrup, A E; Gleeson, M

    2017-07-01

    Few studies have investigated the effects of exercise training on sleep physiology in well-trained athletes. We investigated changes in sleep markers, mood state and exercise performance in well-trained cyclists undergoing short-term intensified training and carbohydrate nutritional intervention. Thirteen highly-trained male cyclists (age: 25 ± 6y, [Formula: see text]O2max: 72 ± 5 ml/kg/min) participated in two 9-day periods of intensified training while undergoing a high (HCHO) or moderate (CON) carbohydrate nutritional intervention before, during and after training sessions. Sleep was measured each night via wristwatch actigraphy. Mood state questionnaires were completed daily. Performance was assessed with maximal oxygen uptake ([Formula: see text]. Percentage sleep time fell during intensified training (87.9 ± 1.5 to 82.5 ± 2.3%; p < 0.05) despite an increase in time in bed (456 ± 50 to 509 ± 48 min; p = 0.02). Sleep efficiency decreased during intensified training (83.1 ± 5.3 to 77.8 ± 8.6%; p < 0.05). Actual sleep time was significantly higher in CON than HCHO throughout intensified training. Mood disturbance increased during intensified training and was higher in CON than HCHO (p < 0.05). Performance in the [Formula: see text] exercise protocol fell significantly with intensified training. The main findings of this study were that 9-days of intensified training in highly-trained cyclists resulted in significant and progressive declines in sleep quality, mood state and maximal exercise performance.

  3. Multichannel intensified photodiode for near infrared single photon detection

    NASA Astrophysics Data System (ADS)

    Aebi, Verle W.; Sykora, Derek F.; Jurkovic, Michael J.; Costello, Kenneth A.

    2011-05-01

    An overview of the Intensified Photodiode (IPD) is presented with an emphasis on IPDs optimized for use in the 950nm to 1350nm spectral range for single photon detection applications. The theory of operation of the IPD, two different electron optics designs, and device performance for a multichannel, 4x4 pixel array, low jitter IPD optimized for operation at 1060nm are presented in this paper. Key results include greater than 15% quantum efficiency, large active area, and less than 550ps impulse response.

  4. Dosimetry of portable image intensifiers in pacemaker insertions.

    PubMed

    Hayt, D B; Malsky, S J; Blatt, C J; Greenberg, E I; Pochaczevsky, R; Simon, D F; Perez, L A

    1975-01-01

    With the increased utilization of portable image intensifiers for pacemaker insertions, an investigation of the radiation hazards to operative personnel was undertaken. The personnel were tested first utilizing a Rando phantom and later during actual pacemaker insertions. Studies of medical personnel show the critical organs to be the thyroid (approximately 15mR per procedure) and the lens of the eye (approximately 13mR per procedure). While the MPD/week was not exceeded, the radiation dosage was substantial and could increase under operating conditions other than those measured. Recommendations to insure safer operation of this equipment are presented.

  5. Autopsy findings in AIDS--a histopathological analysis of fifty cases.

    PubMed

    Falk, S; Schmidts, H L; Müller, H; Berger, K; Schneider, M; Schlote, W; Helm, E B; Stille, W; Hübner, K; Stutte, H J

    1987-07-15

    Fifty consecutive AIDS autopsy cases were evaluated. All subjects showed one or more opportunistic infections and malignancies included in the AIDS case definition with cytomegalovirus and Kaposi's sarcoma being most prevalent. Mycobacterial and cryptococcal infections occurred only infrequently. Most patients of our series after successful treatment of Pneumocystis carinii pneumonia or cerebral toxoplasmosis later succumbed to less treatable conditions like disseminated cytomegalovirus or fungal infections or malignant lymphoma. In the absence of specific treatment for the HIV infection leading to these lethal complications special emphasis must be put on the prevention of HIV transmission and spread.

  6. Industrial neuropathy due to n-hexane. Clinical and morphological findings in three cases.

    PubMed

    Scelsi, R; Poggi, P; Fera, L; Gonella, G

    1981-12-01

    Three cases of motor polyneuropathy due to industrial exposure to an adhesive agent containing 80.4% of n-hexane as the volatile substance are described. Histological and ultrastructural studies on sural nerve reveal alterations of both myelin sheaths and axons of large diameter fibers, with segmental swelling and increase of neurofilaments. In the muscle specimens there is a pattern of denervation atrophy with focal degenerative-inflammatory changes. Some differences between the present cases and those previously described in the literature are discussed.

  7. Clinical and oral findings in an Afro-Brazilian family with Gorlin-Goltz syndrome: case series and literature review.

    PubMed

    da Silva Pierro, Viviane Santos; Marins, Marcello Roter; Borges de Oliveira, Renata Cabral; Cortezzi, Wladimir; Janini, Maria Elisa; Maia, Lucianne Cople

    2015-01-01

    Gorlin-Goltz syndrome (GGS) seems to be unusual in black persons. The authors present an Afro-Brazilian family case report of GGS. The main complaint of the index case was a painless swelling of the left mandible, which was diagnosed as an odontogenic keratocyst. Further classical features of the Syndrome were present in this patient. Other two family members were diagnosed as cases of GGS and one of them presented 11 clinical findings characteristic of the syndrome. From the three cases reported, two of them presented five major diagnostic criteria for the GGS, and the diagnosis was only made because of an oral complaint. This case series emphasizes the importance of carefully examining the patient and close relatives for signs of GGS, even if they belong to an ethnic group in which this diagnosis is unusual.

  8. Analysis of 756 cases of sexual assault in Tours (France): medico-legal findings and judicial outcomes.

    PubMed

    Saint-Martin, Pauline; Bouyssy, Marie; O'Byrne, Patrick

    2007-10-01

    We describe the medico-legal findings in a population of sexual assault cases assessed in an urban French referral centre, analyse the subsequent legal dispositions in each case and determine whether the characteristics of the assault and the medico-legal findings were associated with conviction of the assailant. We performed a retrospective study of medicolegal reports in all the sexual assault cases reported in Tours (France) during a seven-year period. We defined two groups of victims: children under 15 years old and victims aged 15 years or more. Legal outcomes were obtained from courtroom proceedings. The relationship between the outcomes and the circumstances of the case was analyzed by logistic regression. We enrolled a total of 756 cases during the study period. The mean age of the study population was 16.5 years and 68.3% of the cases involved children under 15 years old. In 57% of these cases, the assailant was a family member. 31.7% of all the victims were aged 15 years or more. The assailant was an acquaintance of the victim in 62.2% of the cases. Drug-facilitated assault was suspected in 2.9% of the cases. In 46.2% of the cases, formal criminal charges were not filed due to insufficient evidence; 36.3% of the assailants were convicted. Examination at the request of the police authorities and previous acquaintance of the assailant by the victim were significantly associated with conviction. Allegations of penetration, the presence of general body trauma and the presence of genital trauma were not necessarily associated with conviction. Medical examiners need to be circumspect when they record non-medical variables. Physical evidence of trauma was neither predictive nor essential for conviction. Successful prosecution depends on the quality of the testimony provided by the victim.

  9. Finding Boundaries Inside Prison Walls: Case Study of a Terminally Ill Inmate

    ERIC Educational Resources Information Center

    O'Connor, Mary-Frances

    2004-01-01

    The number of terminally ill prison inmates rises each year. Mental health professionals are uniquely prepared to provide therapy during the end-of-life process with their assessment, training, empathy, and communication skills. This case study examines the six-month therapy of one terminally ill inmate, using a client-centered approach. Drawing…

  10. 5 CFR 890.1027 - Cases where an additional fact-finding proceeding is required.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... proceeding is required. 890.1027 Section 890.1027 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1027 Cases where an additional...

  11. 5 CFR 890.1025 - Cases where additional fact-finding is not required.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... not required. 890.1025 Section 890.1025 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM Administrative Sanctions Imposed Against Health Care Providers Permissive Debarments § 890.1025 Cases where additional fact...

  12. Problems Teachers Face When Doing Action Research and Finding Possible Solutions: Three Cases

    ERIC Educational Resources Information Center

    Zhou, Jun

    2012-01-01

    Through case studies, this paper explores problems teachers face when doing action research: for instance, teachers may misunderstand the research, mistrust university researchers, lack the time or adequate library resources to conduct research, lack theoretical guidance or knowledge of research methodology, and feel pressure or frustration during…

  13. Brief communication: unusual finding at Pueblo Bonito: multiple cases of hyperostosis frontalis interna.

    PubMed

    Mulhern, Dawn M; Wilczak, Cynthia A; Dudar, J Christopher

    2006-08-01

    Hyperostosis frontalis interna (HFI) is a disease characterized by excess bone growth on the internal lamina of the frontal bone and, occasionally, other cranial bones. Although the disease is fairly common in modern populations, its etiology is poorly understood. Hyperostosis frontalis interna has been identified in antiquity, primarily in the Old World, but with a much lower frequency than in modern groups. The purpose of the present study is to report multiple cases of HFI at Pueblo Bonito (Chaco Canyon, New Mexico). Twelve out of 37 adults with observable frontal bones exhibited HFI, ranging from mild to severe, including 11 females and one male. This is the first published case report of HFI in archaeological remains from the New World having a frequency comparable with modern groups. Most archaeological cases of HFI are isolated, so comparative data for multiple cases at one site are rare. The results of this study emphasize the importance of looking for HFI in archaeological remains, although it is rarely observed. Possible genetic and environmental factors for the high frequency of HFI at Chaco Canyon are considered, but additional research is needed to discover the etiology and to better understand why HFI sometimes occurs at modern frequencies in ancient populations.

  14. Imaging Findings of Follicular Dendritic Cell Sarcoma: Report of Four Cases

    PubMed Central

    Long-Hua, Qiu; Qin, Xiao; Jian, Wang; Xiao-Yuan, Feng

    2011-01-01

    Follicular dendritic cell sarcoma is a rare malignant neoplasm and little is known about its radiological features. We present here four cases of follicular dendritic cell sarcomas and we provide the image characteristics of these tumors to help radiologists recognize this entity when making a diagnosis. PMID:21228948

  15. Imaging findings of follicular dendritic cell sarcoma: report of four cases.

    PubMed

    Long-Hua, Qiu; Qin, Xiao; Ya-Jia, Gu; Jian, Wang; Xiao-Yuan, Feng

    2011-01-01

    Follicular dendritic cell sarcoma is a rare malignant neoplasm and little is known about its radiological features. We present here four cases of follicular dendritic cell sarcomas and we provide the image characteristics of these tumors to help radiologists recognize this entity when making a diagnosis.

  16. Grammatical Constructions in Cri du Chat Syndrome--Findings from a Case Study

    ERIC Educational Resources Information Center

    Kristoffersen, Kristian Emil

    2009-01-01

    The literature on grammatical skills in persons with Cri du chat syndrome (CCS) is very limited, and the need for more knowledge in this area is thus evident, in particular for speech and language therapists working with individuals with this syndrome. This case study report describes the syntactic skills of a 14-year-old Norwegian girl with CCS.…

  17. Finding the Keys to Educational Progress in Urban Youth: Three Case Studies.

    ERIC Educational Resources Information Center

    Babbitt, Susan; Byrne, Maureen

    2000-01-01

    Presents case studies of three 13-year-olds receiving individual after-school instruction from a certified reading specialist in a reading program that is part of an urban multidisciplinary mental health agency. Describes students' level of academic functioning and emotional situation and how their needs were met. Shows successes and failures over…

  18. Clinical, Microscopic and Ultrastructural Findings in a Case of Short Anagen Syndrome.

    PubMed

    Martin, Jose M; Montesinos, Encarnacion; Sanchez, Sara; Torres, Catalina; Ramon, Dolores

    2017-07-01

    Short anagen syndrome is an uncommon and recently described disease characterized by many telogen hairs and short maximum hair length. We report here the case of a 3-year-old girl whose short, sparse, fine hair since birth was consistent with short anagen syndrome. X-ray microanalysis demonstrated normal composition of the main bioelements of her hairs. © 2017 Wiley Periodicals, Inc.

  19. Finding a (W)hole in the Text: A Case Study of Four Readers Reading.

    ERIC Educational Resources Information Center

    Nance, Mary Moore

    The purpose of the study was to examine: (1) which perspectives of Reader Response Theory were most applicable in this study; (2) which factors influenced reader responses; and (3) how readers' responses changed over time. The four participants for this case study were chosen from a subject pool of 10 initiate adult full-time divinity students in…

  20. Creating a College-Ready System: Findings from Four Case Studies

    ERIC Educational Resources Information Center

    Ramsey, Brinton S.

    2009-01-01

    This is an analytical report that looks across four district case studies (published between 2007 and 2009 by the Small Schools Project) to reflect on what happens when a district commits to the goal of graduating each student ready for college, career, and citizenship. The report describes four challenge areas--differentiation and…

  1. Problems Teachers Face When Doing Action Research and Finding Possible Solutions: Three Cases

    ERIC Educational Resources Information Center

    Zhou, Jun

    2012-01-01

    Through case studies, this paper explores problems teachers face when doing action research: for instance, teachers may misunderstand the research, mistrust university researchers, lack the time or adequate library resources to conduct research, lack theoretical guidance or knowledge of research methodology, and feel pressure or frustration during…

  2. Clinical relevance of cytogenetics to pediatric practice. Postnatal findings of Patau syndrome - Review of 5 cases.

    PubMed

    Plaiasu, Vasilica; Ochiana, Diana; Motei, Gabriela; Anca, Ioana; Georgescu, Adrian

    2010-07-01

    Patau syndrome (trisomy 13) is one of the most common chromosomal anomalies clinically characterized by the presence of numerous malformations with a limited survival rate for most cases. Babies are usually identified at birth and the diagnosis is confirmed with genetic testing. In this review we outline the clinical and cytogenetic aspects of trisomy 13 and associated phenotypes for 5 cases analyzed in the last 3 years, referred to our Clinical Genetics Department. For each child cytogenetic analysis was performed to determine the genetic variant; also, the patients were investigated for other associated malformations (cardiac, cerebral, renal, ocular anomalies). All 5 cases presented multiple malformations, including some but not all signs of the classical clinical triad suggestive of Patau syndrome. The cytogenetic investigation confirmed for each case the suspected diagnosis and also indicated the specific genetic variant, this being a valuable information for the genetic counselling of the families. The application of genetic analysis can increase diagnosis and prognosis accuracy and have an impact on clinical management.

  3. Case report: Portal and systemic venous gas in a patient with perforated duodenal ulcer: CT findings

    PubMed Central

    Fam, Maged Nassef Abdalla; Attia, Khaled Mostafa Elgharib; Khalil, Safaa Maged Fathelbab

    2014-01-01

    Gas within the portal circulation has been known to be associated with a number of conditions most commonly mesenteric ischemia and necrosis. Systemic venous gas is described with few conditions and is mostly iatrogenic in nature. We describe a case of combined portal and systemic venous gas detected by computed tomography in a patient with perforated duodenal ulcer. PMID:25426236

  4. Grammatical Constructions in Cri du Chat Syndrome--Findings from a Case Study

    ERIC Educational Resources Information Center

    Kristoffersen, Kristian Emil

    2009-01-01

    The literature on grammatical skills in persons with Cri du chat syndrome (CCS) is very limited, and the need for more knowledge in this area is thus evident, in particular for speech and language therapists working with individuals with this syndrome. This case study report describes the syntactic skills of a 14-year-old Norwegian girl with CCS.…

  5. Student reflections following exposure to a case-based interprofessional learning experience: Preliminary findings.

    PubMed

    Goldberg, Lynette R; Brown, Gina R; Mosack, Victoria A; Fletcher, Phyllis A

    2015-01-01

    This study analyzed students' written reflections following their initial exposure to interprofessional teamwork in case-based problem-solving. A three-hour seminar featuring three sequenced scenarios was developed and offered 12-times over two semesters. A total of 305 students from a variety of healthcare programs worked together with standardized patients in an on-campus laboratory simulating hospital ward and rehabilitation settings. A thematic analysis of students' reflections showed that they valued the shared learning and realistic case study. However, they felt the experience would be strengthened by working in smaller, more representative teams that included students from medicine, psychology, and social work to enable more effective communication and comprehensive case discussion. While useful for future planning, the identified themes did not enable a comparative statistical analysis of what students found helpful and difficult and a re-coding of students' responses now is underway. Implications for measuring the effectiveness of future interprofessional case-based learning center on addressing the identified weaknesses, and establishing a research design that enables a comparison of pre- and post-seminar data, and the effectiveness of the IPE experience compared to profession-specific experiences.

  6. Abusive head trauma: differentiation between impact and non-impact cases based on neuroimaging findings and skeletal surveys.

    PubMed

    Sieswerda-Hoogendoorn, T; Robben, S G F; Karst, W A; Moesker, F M; van Aalderen, W M; Laméris, J S; van Rijn, R R

    2014-03-01

    To determine whether imaging findings can be used to differentiate between impact and non-impact head trauma in a group of fatal and non-fatal abusive head trauma (AHT) victims. We included all AHT cases in the Netherlands in the period 2005-2012 for which a forensic report was written for a court of law, and for which imaging was available for reassessment. Neuroradiological and musculoskeletal findings were scored by an experienced paediatric radiologist. We identified 124 AHT cases; data for 104 cases (84%) were available for radiological reassessment. The AHT victims with a skull fracture had fewer hypoxic ischaemic injuries than AHT victims without a skull fracture (p=0.03), but the relative difference was small (33% vs. 57%). There were no significant differences in neuroradiological and musculoskeletal findings between impact and non-impact head trauma cases if the distinction between impact and non-impact head trauma was based on visible head injuries, as determined by clinical examination, as well as on the presence of skull fractures. Neuroradiological and skeletal findings cannot discriminate between impact and non-impact head trauma in abusive head trauma victims. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  7. Open market customer: Volume 1 -- Methods and case findings. Final report

    SciTech Connect

    Kotowski, J.; Wikler, G.; Milward, R.; Gudger, K.

    1998-06-01

    The Open Market Customer (OMC) report categorized nine specific choices by annual industry revenue; developed some of the inter-relationships between the various customer choices; and predicted how the customers, suppliers, technologies, energy products, and services may change given the basic restructuring of the industry. Gellings and Gudger estimate that the OMC market has annual expenditures of $780 billion and over $2 trillion in total investment. The purposes of this study were to illustrate the OMC principle and improve upon its numeric precision, develop a methodology for conducting an OMC assessment, and develop baseline data for future OMC assessments. The approach involved carrying out eight case study assessments of various commercial/industrial facilities. For each OMC case study, the annual energy expenditures and total investments for energy-related capital were determined for all types of fuel used at the facility. Annual expenditures include both the cost of energy, maintenance of the energy-related equipment, and labor. All annual expenditures and investments were assigned to one of nine business function areas depending on the function of the expenditure or investment. Eight types of commercial and industrial facilities were characterized. Four case studies were of actual facilities; four were of prototype facilities. The actual case studies consisted of Logan International Airport, Boston, MA; Washington University, St. Louis, MO; Cook County Hospital, Chicago, IL; and Sierra Pine Limited (a medium-density fiberboard manufacturer), Rocklin, CA. The four prototype case studies consisted of a 7,000 square foot retail building; a 3,500 square foot sit-down restaurant; and 50,000 square foot primary school; and a 782 home, 160 acre planned residential community.

  8. Anatomic findings in revision endoscopic sinus surgery: Case series and review of contributory factors

    PubMed Central

    Bewick, Jessica; Egro, Francesco M.; Masterson, Liam; Javer, Amin R.

    2016-01-01

    Background: It is recognized that patients who undergo endoscopic sinus surgery (ESS) do not always achieve control of their disease. The causes are multifactorial; variations in surgical practice have been identified as possible factors in refractory disease. Objective: To reflect on the frequent anatomic findings of patients with chronic rhinosinusitis (CRS) who require revision ESS. Methods: A retrospective review of patients who required revision ESS at a tertiary institution over a 3-year period. Patients for whom maximal medical therapy failed for CRS underwent computed tomography of the paranasal sinuses and image-guided surgery. Surgical records of anatomic findings were reviewed and analyzed. Results: Over 3 years, a total of 75 patients underwent revision procedures, 28% of all ESS performed in the unit. The most frequent finding was a residual uncinate process in 64% of the patients (n = 48); other findings included a maxillary antrostomy not based on the natural ostium of the maxillary sinus in 47% (n = 35), an oversized antrostomy in 29% (n = 22), resected middle turbinates in 35% (n = 26), middle meatal stenosis in 15% (n = 11), synechiae in 29% (n = 22), and osteitic bone that required drilling in 13% (n = 10). Conclusion: Surgical technique can give rise to anatomic variations that may prevent adequate mucociliary clearance and medication delivery, which leads to failure in ESS in patients with CRS. This study demonstrated the surgical findings encountered in revision ESS that should be highlighted in the training of Ear, Nose and Throat surgeons to help prevent primary failure and reduce health care costs. PMID:28107148

  9. Radiologic Findings of Primary Mucinous Cystadenocarcinoma of the Breast: A Report of Two Cases and a Literature Review.

    PubMed

    Seong, Minjung; Ko, Eun Young; Han, Boo-Kyung; Cho, Soo Youn; Cho, Eun Yoon; Lee, Se Kyung; Lee, Jeong Eon

    2016-09-01

    Primary mucinous cystadenocarcinoma (MCA) of the breast is a rare but pathologically distinct breast tumor. There have been some case reports on primary MCA of the breast; however, they have all focused on pathologic findings. Here, we report the radiologic findings of two cases of MCA along with a review of the literature. Breast MCA shows a circumscribed mass with some calcifications on mammography, an intracystic solid mass without increased vascularity or a vascular stalk on ultrasound, and a heterogeneously enhancing mass within a rim-enhancing cyst with intermediate signal intensity on T2-weighted magnetic resonance imaging. These radiologic findings and the presence of mucin in the percutaneous biopsy specimen should suggest the possibility of MCA in the differential diagnosis of a breast tumor.

  10. Thrombotic Thrombocytopenic Purpura with Reversible Neurological Features: Brain Diffusion MRI with ADC Map, Spect and EEG Findings. A Case Report.

    PubMed

    Yerdelen, D; Göksel, B K; Yıldırım, T; Karataş, M; Karaca, S; Reyhan, M; Ozdoğu, H

    2006-11-30

    Although nervous system involvement is common in thrombotic thrombocytopenic purpura (TTP), abnormalities on computerized tomography, magnetic resonance imaging and electroencephalography are not encountered so frequently and if present, these abnormalities are often reversible. We describe a 39-year-old woman with recurring transient focal neurological findings found to have laboratory findings consistent with TTP. In cerebral diffusion weighted images (DWI), diffuse cortical hyperintensity was noted in right frontal lobe, but the ADC (apparent diffusion coefficient) map was normal. Electroencephalography demonstrated lateralized slowing and repeated DWI showed diffuse cortical hyperintensity in the right hemisphere. SPECT showed luxury perfusion in the right hemisphere areas. The patient's condition resolved with plasmapheresis. Our patient illustrates that diffuse hemispheric involvement can be seen in DWI and EEG, and SPECT may show luxury perfusion after resolution of neurological findings in TTP cases. To our knowledge, this is the first TTP case in which the ADC map was normal.

  11. Incidental finding of two rare developmental anomalies: Fusion and dilaceration: A case report and literature review

    PubMed Central

    Sultan, Nishat

    2015-01-01

    A number of developmental anomalies of morphology are there. However, as compared to the more common oral diseases like caries or periodontal problems, they account for a relatively lower number. When present, they may pose various problems of esthetic, function, malocclusion, or possible disposition to other oral problems. Hence, though rare, their timely diagnosis is very vital in proper treatment planning to avoid unseen complications during extractions, endodontic or orthodontic treatment. The present case is of a patient reporting with two very rare developmental anomalies, that is, fusion and root dilaceration, in contralateral sides of the same patient. To the knowledge of the author, reportedly it is the first such case. The terminologies, etiology, and epidemiology of both these anomalies are also discussed. PMID:26604610

  12. Cone Beam Computed Tomography Findings in Calcifying Cystic Odontogenic Tumor Associated with Odontome: A Case Report

    PubMed Central

    Phulambrikar, Tushar; Vilas Kant, Sanchita; Kode, Manasi; Magar, Shaliputra

    2015-01-01

    The calcifying cystic odontogenic tumor (CCOT) is a rare cystic odontogenic neoplasm frequently found in association with odontome. This report documents a case of CCOT associated with an odontome arising in the anterior maxilla in a 28-year-old man. Conventional radiographs showed internal calcification within the lesion but were unable to visualize its relation with the adjacent structures and its accurate extent. In this case cone beam computed tomography (CBCT) could accurately reveal the extent and the internal structure of the lesion which aided the presumptive diagnosis of the lesion as CCOT. This advanced imaging technique proved to be extremely useful in the radiographic assessment and management of this neoplasm of the maxilla. PMID:26636128

  13. Ultrasonographic imaging of the temporomandibular joint in healthy cattle and pathological findings in one clinical case.

    PubMed

    Borges, N C; Weissengruber, G E; Huber, J; Kofler, J

    2016-11-01

    To describe the normal ultrasonographic appearance of the temporomandibular joint (TMJ) in cattle, and to describe the ultrasonographic pathology of the TMJ as assessed in one cow with TMJ disease. The TMJ of 12 healthy Holstein-Friesian cows were examined using a portable ultrasonographic unit with a 7.5 MHz linear probe and a 6.0 MHz convex probe. Each TMJ was scanned in a rostrolateral, lateral and caudolateral plane. In addition, the TMJ of one 2-year-old cow with clinical signs of food retention in the mouth, head tilt, swelling and pain in the right TMJ region and an infected horn fracture was examined ultrasonographically. The bone surfaces of the temporal process, the zygomatic process and the temporal bone, the larger muscles of the TMJ region, the superficial temporal vein, and the parotid salivary gland could be imaged in all normal healthy cattle. Using the linear probe, the joint capsule was visible in 17/24 (71%) cases in the caudolateral plane, but the articular disc could not be visualised. With the convex probe, the joint capsule could be imaged in all cases in the caudolateral plane, and the articular disc in 13/24 (54%) cases in the caudolateral plane. It was never possible to see the synovial pouch in healthy cattle using either probe. By contrast, in the cow diagnosed with septic arthritis of the right TMJ, a marked anechoic and heterogeneous hypoechoic effusion of the TMJ with distension of the joint capsule was visualised. The results of this descriptive study serve to provide a reference for ultrasonography of pathological conditions of the TMJ region in cattle. As many veterinarians are equipped with ultrasound machines with 5-8 MHz linear rectal probes, the authors recommend using these probes for further investigation of clinical cases with swelling of the TMJ region and/or masticatory problems of unclear origin to exclude or diagnose TMJ disorders.

  14. A Constellation of Rare Findings in a Case of Goldenhar Syndrome.

    PubMed

    Bedi, Mitesh; Jain, Rakesh Kumar; Barala, Vipin Kumar; Singh, Abhimanyu; Jha, Hiranmayi

    2017-01-01

    An 18-month-old child presented with right macrostomia, bilateral preauricular skin tags, bilateral CTEV, squint in bilateral eyes, thoracic vertebral anomalies, right sided aortic arch, and associated left pulmonary agenesis. The patient did not have any associated respiratory symptoms. Ipsilateral pulmonary agenesis is considered as a rare association with Goldenhar syndrome and a case of contralateral pulmonary aplasia has been described as an even rarer association.

  15. Advanced MRI applications and findings of malignant phyllodes tumour: review of two cases.

    PubMed

    Alhabshi, Sharifah Majedah Idrus; Rahmat, Kartini; Abu Hassan, Hasyma; Westerhout, Caroline Judy; Chandran, Patricia Ann

    2013-05-01

    Phyllodes tumour or cystosarcoma phyllodes is a rare stromal breast tumour that is usually benign but on rare occasions can turn malignant. Non-specificity of the imaging features on sonography and mammography makes it difficult to distinguish malignant from benign counterparts solely based on imaging. The final diagnosis is still highly dependent on histopathological assessment. Herein, we describe two cases of malignant phyllodes tumour with emphasis on magnetic resonance (MR) imaging features using advanced MR applications.

  16. Intensified Fischer-Tropsch Synthesis Process with Microchannel Catalytic Reactors

    SciTech Connect

    Cao, Chunshe; Hu, Jianli; Li, Shari; Wilcox, Wayne A.; Wang, Yong

    2009-02-28

    A microchannel catalytic reactor with improved heat and mass transport has been used for Fischer-Tropsch synthesis to produce fuels and chemicals. This type of novel reactor takes advantages of highly active and selective catalysts with increased site density so that the FT synthesis process can be intensified. It was demonstrated that this microchannel reactor based process can be carried out at gas hourly space velocity (GHSV) as high as 60,000 hr-1 to achieve greater than 60% of one-pass CO conversion while maintaining low methane selectivity (<10%) and high chain growth probability(>0.9). Such superior FT synthesis performance has not ever been reported in the prior open literatures. The overall productivity to heavy hydrocarbons has been significantly improved over the conventional reactor technology. In this study, performance data were obtained in a wide range of pressure (10atm-35atm) and hydrogen to carbon monoxide ratio (1-2.5). The catalytic system was characterized by BET, scanning electron microcopy (SEM), transmission electron microcopy(TEM), and H2 chemisorption. A three dimensional pseudo-homogeneous model were used to simulate temperature profiles in the exothermic reaction system in order to optimize the reactor design and intensify the synthesis process. Intraparticle non-isothermal characteristics are also analyzed for the FT synthesis catalyst.

  17. [Intensified smoking cessation for diabetic patients--preliminary results].

    PubMed

    Brath, H; Lasar, D; Buchhäusl, I; Kästenbauer, T; Binter, E

    1999-01-01

    Cigarette smoking is the most prominent yet avoidable cause of illness in the general population as well as in patients with diabetes. The danger of developing late complications is much higher for smoking than for non-smoking diabetic patients. The aim of this study was to determine whether an intensified smoking cessation program for patients with diabetes, including an initial 3 week-period of inpatient cessation, is effective and more successful than a mere outpatient program. The outpatient program consisted of at least 7 consultations within 2 years, and included nicotine replacement therapy, steps for modifying the smokers' behavioural patterns, advice in dietary and exercise as well as measurements of amounts of exhaled carbonmonoxide and lung function. In the inpatient program the patients passed the first 3 cessation weeks in a specialised clinic providing a similar, but intensified program, aside from daily life and professional routine. The following consultations corresponded to those of the outpatient program. Altogether we analysed 89 patients (64 in the outpatient and 25 in the inpatient program).

  18. Incidental imaging findings of congenital rib abnormalities - a case series and review of developmental concepts.

    PubMed

    Aignătoaei, Anda Maria; Moldoveanu, Cristina Elena; Căruntu, Irina Draga; Giușcă, Simona Eliza; Partene Vicoleanu, Simona; Nedelcu, Alin Horațiu

    2017-09-04

    Congenital rib abnormalities are found in approximately 2% of the general population. Usually, they occur in isolation, when they are rarely symptomatic, but they can also associate with other malformations. We reviewed imaging examinations performed over a period of two years (2014-2015), enabling us to identify isolated rib abnormalities in six adult patients. The case series consisted in three cases with bilateral cervical ribs and one case each with bifid rib, costal fusion and rib pseudarthrosis. In all patients, the costal anomalies were discovered incidentally. All rib malformations were detected at thoracic radiography, except for the rib pseudarthrosis, which was identified at CT scan. Differential diagnosis was made between cervical ribs and abnormalities of the C7 transverse process and of the first rib, while the other costal malformations were distinguished from tumoral, traumatic or inflammatory lesions of the chest wall, lung and pleura. Considering the existing knowledge on rib development, we suggest a classification of the most common types of rib malformations in three categories: (I) results of homeotic transformation, referring to numerical aberrations; (II) segmentation errors, including costal fusion and bridging; (III) anomalies of resegmentation, resulting in bifid ribs. It is important that radiologists are familiarized with the imaging features of rib abnormalities, since these anomalies can be misinterpreted as lesions with different implications. We aim that the developmental classification proposed in this paper can contribute to a better understanding of this pathology.

  19. Sonographic findings in a case of polyneuropathy associated with POEMS syndrome.

    PubMed

    Yanik, Bahar; Conkbayir, Isik; Keyik, Bahri; Yoldas, Tahir Kurtulus

    2011-10-01

    Polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes (POEMS) syndrome is a rare multi-system disease. We describe the ultrasonography (US) and color Doppler ultrasonography (CDUS) findings of peripheral neuropathy in a patient with POEMS syndrome. In US examination, peripheral nerves were found to be diffusely thickned in both upper limbs. CDUS imaging showed arterial blood flow with low systolic peaks on the nerves. Copyright © 2011 Wiley Periodicals, Inc.

  20. Case Example of Dose Optimization Using Data From Bortezomib Dose-Finding Clinical Trials

    PubMed Central

    Backenroth, Daniel; Cheung, Ying Kuen Ken; Hershman, Dawn L.; Vulih, Diana; Anderson, Barry; Ivy, Percy; Minasian, Lori

    2016-01-01

    Purpose The current dose-finding methodology for estimating the maximum tolerated dose of investigational anticancer agents is based on the cytotoxic chemotherapy paradigm. Molecularly targeted agents (MTAs) have different toxicity profiles, which may lead to more long-lasting mild or moderate toxicities as well as to late-onset and cumulative toxicities. Several approved MTAs have been poorly tolerated during long-term administration, leading to postmarketing dose optimization studies to re-evaluate the optimal treatment dose. Using data from completed bortezomib dose-finding trials, we explore its toxicity profile, optimize its dose, and examine the appropriateness of current designs for identifying an optimal dose. Patients and Methods We classified the toxicities captured from 481 patients in 14 bortezomib dose-finding studies conducted through the National Cancer Institute Cancer Therapy Evaluation Program, computed the incidence of late-onset toxicities, and compared the incidence of dose-limiting toxicities (DLTs) among groups of patients receiving different doses of bortezomib. Results A total of 13,008 toxicities were captured: 46% of patients’ first DLTs and 88% of dose reductions or discontinuations of treatment because of toxicity were observed after the first cycle. Moreover, for the approved dose of 1.3 mg/m2, the estimated cumulative incidence of DLT was > 50%, and the estimated cumulative incidence of dose reduction or treatment discontinuation because of toxicity was nearly 40%. Conclusions When considering the entire course of treatment, the approved bortezomib dose exceeds the conventional ceiling DLT rate of 20% to 33%. Retrospective analysis of trial data provides an opportunity for dose optimization of MTAs. Future dose-finding studies of MTAs should take into account late-onset toxicities to ensure that a tolerable dose is identified for future efficacy and comparative trials. PMID:26926682

  1. Case Example of Dose Optimization Using Data From Bortezomib Dose-Finding Clinical Trials.

    PubMed

    Lee, Shing M; Backenroth, Daniel; Cheung, Ying Kuen Ken; Hershman, Dawn L; Vulih, Diana; Anderson, Barry; Ivy, Percy; Minasian, Lori

    2016-04-20

    The current dose-finding methodology for estimating the maximum tolerated dose of investigational anticancer agents is based on the cytotoxic chemotherapy paradigm. Molecularly targeted agents (MTAs) have different toxicity profiles, which may lead to more long-lasting mild or moderate toxicities as well as to late-onset and cumulative toxicities. Several approved MTAs have been poorly tolerated during long-term administration, leading to postmarketing dose optimization studies to re-evaluate the optimal treatment dose. Using data from completed bortezomib dose-finding trials, we explore its toxicity profile, optimize its dose, and examine the appropriateness of current designs for identifying an optimal dose. We classified the toxicities captured from 481 patients in 14 bortezomib dose-finding studies conducted through the National Cancer Institute Cancer Therapy Evaluation Program, computed the incidence of late-onset toxicities, and compared the incidence of dose-limiting toxicities (DLTs) among groups of patients receiving different doses of bortezomib. A total of 13,008 toxicities were captured: 46% of patients' first DLTs and 88% of dose reductions or discontinuations of treatment because of toxicity were observed after the first cycle. Moreover, for the approved dose of 1.3 mg/m(2), the estimated cumulative incidence of DLT was > 50%, and the estimated cumulative incidence of dose reduction or treatment discontinuation because of toxicity was nearly 40%. When considering the entire course of treatment, the approved bortezomib dose exceeds the conventional ceiling DLT rate of 20% to 33%. Retrospective analysis of trial data provides an opportunity for dose optimization of MTAs. Future dose-finding studies of MTAs should take into account late-onset toxicities to ensure that a tolerable dose is identified for future efficacy and comparative trials. © 2016 by American Society of Clinical Oncology.

  2. Spontaneous intracranial hypotension: clinical and neuroimaging findings in six cases with literature review.

    PubMed

    Haritanti, A; Karacostas, D; Drevelengas, A; Kanellopoulos, V; Paraskevopoulou, E; Lefkopoulos, A; Economou, I; Dimitriadis, A S

    2009-02-01

    Spontaneous intracranial hypotension (SIH) is an uncommon but increasingly recognized syndrome. Orthostatic headache with typical findings on magnetic resonance imaging (MRI) are the key to diagnosis. Delayed diagnosis of this condition may subject patients to unnecessary procedures and prolong morbidity. We describe six patients with SIH and outline the important clinical and neuroimaging findings. They were all relatively young, 20-54 years old, with clearly orthostatic headache, minimal neurological signs (only abducent nerve paresis in two) and diffuse pachymeningeal gadolinium enhancement on brain MRI, while two of them presented subdural hygromas. Spinal MRI was helpful in detecting a cervical cerebrospinal fluid leak in three patients and dilatation of the vertebral venous plexus with extradural fluid collection in another. Conservative management resulted in rapid resolution of symptoms in five patients (10 days-3 weeks) and in one who developed cerebral venous sinus thrombosis, the condition resolved in 2 months. However, this rapid clinical improvement was not accompanied by an analogous regression of the brain MR findings that persisted on a longer follow-up. Along with recent literature data, our patients further point out that SIH, to be correctly diagnosed, necessitates increased alertness by the attending physician, in the evaluation of headaches.

  3. Two forensic autopsy cases of death due to upper gastrointestinal hemorrhage: a comparison of postmortem computed tomography and autopsy findings.

    PubMed

    Suzuki, Hideto; Hasegawa, Iwao; Hoshino, Norio; Fukunaga, Tatsushige

    2015-05-01

    In this report, we describe two autopsy cases of death due to upper gastrointestinal hemorrhage (Case 1: gastric ulcer, Case 2: aortoduodenal fistula). Postmortem computed tomography (CT) images from both cases revealed pooling of gastric fluid, which contained high attenuation areas, although these images also mirrored the different sources of the gastrointestinal hemorrhage. Fluid collection was observed in the small intestine for both cases, although the high attenuation areas were only remarkable in Case 2. The autopsy in Case 1 revealed a peptic ulcer, with small vessels exposed on the surface of the ulcer. Melena was also observed throughout the intestine, although clotting was only observed inside the stomach. The autopsy in Case 2 revealed diffuse massive clotting from the stomach to the upper portion of the ileum, which was due to a primary aortoduodenal fistula. Given our autopsy findings, the extent of the high attenuation areas in the digestive tract during postmortem CT scanning may be correlated with the speed of the gastrointestinal hemorrhage before death. Carefully evaluating the radiodensity of the gastrointestinal contents during postmortem CT scanning may indicate the primary site of the hemorrhage before the autopsy, thereby facilitating the accurate identification of the cause of death during forensic autopsy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Risk Factors for Stillbirth: Findings from a Population-Based Case-Control Study, Haryana, India.

    PubMed

    Neogi, Sutapa Bandyopadhyay; Negandhi, Preeti; Chopra, Sapna; Das, Ankan Mukherjee; Zodpey, Sanjay; Gupta, Ravi Kant; Gupta, Rakesh

    2016-01-01

    Stillbirth is a prevalent adverse outcome of pregnancy in India despite efforts to improve care of women during pregnancy. Risk factors for stillbirths include sociodemographic factors, medical complications during pregnancy, intake of harmful drugs, and complications during delivery. The objective of the study was to examine the risk factors for stillbirth with a focus on sex selection drugs (SSDs). A population-based case-control study was undertaken in Haryana. Cases of stillbirths were identified from the Maternal Infant Death Review System portal of Haryana state for the months of August-September 2014. A consecutive birth from the same geographical area as the case was selected as the control. The sample size was 325 per group. Mothers were interviewed using a validated tool. Bivariate analyses and logistic regression were conducted to examine the association between risk factors and stillbirth. Attributable risk proportions (ARP) and population attributable risk proportions (PARP) were estimated. The sociodemographic profiles of the cases and controls were similar. History of intake of SSDs [adjusted odds ratio (OR) 2.6, 95% confidence interval (CI) 1.5, 4.5] emerged as a risk factor. Other significant factors were preterm <37 weeks (OR 3.5, 95% CI 2.1, 6.0), history of previous stillbirths (OR 4.0, 95% CI 2.1, 7.8), and complications during labour (OR 3.3, 95% CI 2.1, 5.3). Estimates of the ARP and PARP for intake of SSDs were 0.60 (95% CI 0.32, 0.77) and 0.1 (95% CI -0.13, 0.28), respectively. SSDs could be attributed as a risk factor in a fifth of the cases of stillbirths. The number needed to harm for the use of SSDs in causing adverse effect of stillbirths was 5, suggesting thereby that for every five mothers exposed to SSDs, one would have stillbirth. Greater efforts are required to inform people about the harmful effects of SSD consumption during pregnancy. © 2015 John Wiley & Sons Ltd.

  5. Tuberculosis case-finding through a village outreach programme in a rural setting in southern Ethiopia: community randomized trial.

    PubMed

    Shargie, Estifanos Biru; Mørkve, Odd; Lindtjørn, Bernt

    2006-02-01

    To ascertain whether case-finding through community outreach in a rural setting has an effect on case-notification rate, symptom duration, and treatment outcome of smear-positive tuberculosis (TB). We randomly allocated 32 rural communities to intervention or control groups. In intervention communities, health workers from seven health centres held monthly diagnostic outreach clinics at which they obtained sputum samples for sputum microscopy from symptomatic TB suspects. In addition, trained community promoters distributed leaflets and discussed symptoms of TB during house visits and at popular gatherings. Symptomatic individuals were encouraged to visit the outreach team or a nearby health facility. In control communities, cases were detected through passive case-finding among symptomatic suspects reporting to health facilities. Smear-positive TB patients from the intervention and control communities diagnosed during the study period were prospectively enrolled. In the 1-year study period, 159 and 221 cases of smear-positive TB were detected in the intervention and control groups, respectively. Case-notification rates in all age groups were 124.6/10(5) and 98.1/10(5) person-years, respectively (P = 0.12). The corresponding rates in adults older than 14 years were 207/10(5) and 158/10(5) person-years, respectively (P = 0.09). The proportion of patients with >3 months' symptom duration was 41% in the intervention group compared with 63% in the control group (P<0.001). Pre-treatment symptom duration in the intervention group fell by 55-60% compared with 3-20% in the control group. In the intervention and control groups, 81% and 75%, respectively of patients successfully completed treatment (P = 0.12). The intervention was effective in improving the speed but not the extent of case finding for smear-positive TB in this setting. Both groups had comparable treatment outcomes.

  6. Tuberculosis among drug users and homeless persons: impact of voluntary X-ray investigation on active case finding.

    PubMed

    Goetsch, U; Bellinger, O K; Buettel, K-L; Gottschalk, R

    2012-08-01

    Illicit drug use and homelessness are major contributors to the incidence of tuberculosis (TB) among inhabitants of major cities. The primary objective of this study was to establish a sustainable low-threshold chest X-ray screening programme for pulmonary TB among illicit drug users and homeless persons and to integrate this into the existing public health programme for active case finding. A secondary objective was to estimate the coverage of the programme, assess other risk factors and determine TB rates and treatment outcome in these two groups. Illicit drug users and homeless persons were asked to voluntarily participate in an X-ray screening programme. The coverage of the intervention, total number and characteristics of cases and the follow-up of treatment were assessed. A total of 4,529 chest radiographs were made from 3,477 persons, of whom 66% were homeless and 34% were illicit drug users, between May 2002 and April 2007. Coverage for screening once every 2 years ranged between 18 and 26%. Thirty-nine TB cases (14 drug users, 25 homeless persons) were identified, representing 8.7% of the total case load of 448 notified cases of pulmonary TB in Frankfurt during this period. Among the drug users, human immunodeficiency virus coinfection (10/14) seemed to play a key role in the development of TB. The case-finding rate of 861/100,000 radiographs (1,122/100,000 persons) is as high as that in routine contact investigations (1,078/100,000). Among all individuals with TB, 76% completed treatment. A novel targeted TB screening approach with voluntary radiographic examination of illicit drug users and homeless persons can be integrated into the existing public TB prevention programme and provides a high case-finding rate.

  7. A Recurrent Case of Pentalogy of Cantrell: A Rare Case with Sonological Findings and Review of Literature

    PubMed Central

    Naren Satya, Srinivas M.; Mayilvaganan, Kamala Retnam; Prathyusha, Ivvala Sai; Gautam, Munnangi Satya; Raidu, Deepthi; Amogh, V.N.

    2017-01-01

    Summary Background Pentalogy of Cantrell (POC) is an extremely rare and complex congenital anomaly. Ultrasound is a valuable, safe, nonionizing, cost effective, widely available, and easily reproducible imaging tool and is indispensible in the diagnosis of POC. Despite the rarity of POC, it is imperative for a radiologist to be aware of its wide spectrum of presentation on ultrasound in first trimester of gestation. Most reported cases in literature till now have been sporadic. In this paper, we aimed to report for the first time in literature, a recurrent case of POC detected in the first trimester in a mother whose previous pregnancy also was terminated in the second trimester medically due to the ultrasound diagnosis of POC. We also discuss the role of ultrasound and other imaging modalities in a case of POC as well as the differential diagnoses which can mimic POC. Case Report A 23-year-old G2P0A1 (Gravida2, para0, abortion1) woman with a gestational age of around 12 weeks was referred for a routine first trimester ultrasound scan. The antenatal ultrasound scan showed a single, live, intrauterine gestation corresponding to a gestational age of 11 weeks and 5 days. The fetal heart was visualized outside the chest through a defect in the lower sternum in association with anterior diaphragmatic and ventral abdominal wall defects suggestive of thoraco-abdominal variety of ectopia cardis. There was a membrane covered, midline, abdominal wall defect at the base of the umbilical cord insertion containing the herniated abdominal organs including the liver, bowel loops and the ectopic cardia. There was a breach in the normal outline of the lower sternum indicating a sternal deficiency. The fetal pericardium was absent. The nuchal translucency was grossly increased. Pentalogy of Cantrell was diagnosed on ultrasound and the patient was explained about the poor prognosis of this condition. An informed consent was obtained after she opted for medical termination of

  8. Acute calcific tendinitis of the rectus femoris associated with intraosseous involvement: a case report with serial CT and MRI findings.

    PubMed

    Kim, Young Sung; Lee, Ho Min; Kim, Jong Pil

    2013-11-01

    Acute calcific tendinitis of the shoulder is a well-known condition, but it is rare in the rectus femoris origin. Mostly reported cases were occurred in the reflected head of the rectus femoris, and only few cases were in the direct head of the rectus femoris. Intraosseous marrow involvement of calcific tendinitis is a more rare condition; it often goes misdiagnosed as an infection or a neoplasm. We report a rare, unusual case of acute calcific tendinitis of the direct head of the rectus femoris associated with intraosseous marrow involvement of calcification in anterior inferior iliac spine with serial CT and MRI findings. Aggressive osseous change may occur in acute calcific tendinitis of the rectus femoris as in this case which should be made an appropriate diagnosis to avoid unnecessary investigation and overtreatment like a surgery.

  9. Headache secondary to sleep-related bruxism: A case with polysomnographic findings

    PubMed Central

    Das, Sourav; Gupta, Ravi; Dhyani, Mohan; Goel, Deepak

    2015-01-01

    Sleep-related bruxism may present with headache. However, in clinical practice it may be difficult to differentiate from other causes of headache, especially in subjects with substance abuse. We are presenting a case of sleep-related bruxism that presented with headache and sleep-related symptoms in the presence of substance abuse. Polysomnography was used to ascertain cause of headache. How the other possible causes of headache ruled out is also discussed in report. In short, Sleep-related bruxism can cause headache that is worse in the morning. It is associated with poor quality sleep. PMID:25883492

  10. Mucinous Cystadenoma of the Testis: A Case Report with Immunohistochemical Findings

    PubMed Central

    Kim, Gilhyang; Kwon, Dohee; Na, Hee Young; Kim, Sehui; Moon, Kyung Chul

    2017-01-01

    Mucinous cystadenoma of the testis is a very rare tumor. Herein, we report a case of mucinous cystadenoma arising in the testis of a 61-year-old man, along with a literature review. Computed tomography showed a 2.5-cm-sized poorly enhancing cystic mass. Grossly, the tumor was a unilocular cystic mass filled with mucinous material and confined to the testicular parenchyma. Histologically, the cyst had a fibrotic wall lined by mucinous columnar epithelium without atypia. Immunohistochemical staining was positive for cytokeratin 20 and CDX2, as well as focally positive for cytokeratin 7. The pathologic diagnosis was mucinous cystadenoma. PMID:28189139

  11. Benign mesothelioma of the appendix: an incidental finding in a case of sigmoid diverticular disease

    PubMed Central

    Bansal, A; Zakhour, H D

    2006-01-01

    Benign multicystic mesothelioma is a well recognised but rare entity. The aim of this report is to describe a case of a small mesothelial proliferation of the peritoneum. A 58 year old postmenopausal woman presented with left sided abdominal pain and altered bowel habit. Radiological investigations (barium enema and computed tomography scan of the abdomen and pelvis) were undertaken. An operation was performed for symptomatic sigmoid diverticular disease. Unusually, the appendix was adherent to the sigmoid colon. Microscopy revealed a benign mesothelioma. The patient remains symptom free to date. PMID:16394291

  12. Clinical, Radiologic, and Pathologic Findings of Subdural Osteoma: A Case Report

    PubMed Central

    Kim, Eun Young; Hyun, Dong Keun; Park, Hyeonseon; Oh, Se Yang; Yoon, Seung Hwan

    2016-01-01

    We present a case of a subdural osteoma. A 29-year-old female presented with a 3-year history of headaches. Computed tomography scan revealed a homogeneous high-density lesion isolated from the inner table of the frontal bone (a lucent dural line) in the right frontal convexity. Magnetic resonance imaging revealed an extra-axial lesion with a broad base without dural tail sign and punctate enhancement pattern characteristic of abundant adipose tissue. Upon surgical excision, we found a hard bony mass clearly demarcated from the dura. The mass displayed characteristics of an osteoma upon histological examination. The symptom was relieved after operation. PMID:27195262

  13. Clinical, radiographic, and histological findings of florid cemento-osseous dysplasia: a case report.

    PubMed

    Kim, Jeong-Hee; Song, Byeong-Chul; Kim, Sun-Ho; Park, Yang-Soon

    2011-09-01

    Cemento-osseous dysplasias are a group of disorders known to originate from periodontal ligament tissue and involve, essentially, the same pathological process. They are usually classified into three main groups: periapical, florid, and focal cemental dysplasias depending on their extent and radiographic appearances. Radiographically, florid cementoosseous dysplasia (FCOD) appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. The best management for the asymptomatic FCOD patient consists of regular recall examinations with prophylaxis. The management of the symptomatic patient is more difficult. A case of FCOD occurring in a 52-year-old edentulous Korean female is reported which is rare with regard to race and sex.

  14. Scintigraphic and CT findings of Tietze's syndrome: Report of a case and review of the literature

    SciTech Connect

    Honda, N.; Machida, K.; Mamiya, T.; Takahashi, T.; Takishima, T.; Hasegawa, N.; Kamano, T.; Hashimoto, M.; Ohno, K.; Itoyama, S.; )

    1989-08-01

    A case of Tietze's syndrome is reported. A 43-year-old woman, who had experienced right anterior chest pain and tender swelling of the right first costosternal junction for seven months, showed increased accumulation of the right first, the right fourth, and the left first costochondral junction on bone imaging. Ga-67 imaging showed increased accumulation at the right first costosternal junction. CT showed sclerosis of the sternal manubrium, partial calcification of costal cartilage, and soft tissue swelling. Biopsy of the right first costal cartilage showed chronic inflammation with fibrosis and ossification. Increased uptake of bone gallium imaging is consistent with Tietze's syndrome.15 references.

  15. Imaging Findings of Castleman's Disease Localized in the Axilla: A Case Report

    PubMed Central

    Oh, Yu Whan; Cho, Kyu Ran; Lee, Nam Joon; Kim, Jung Hyuk; Kim, In Sun; Cho, Seong Jin; Bae, Jeoung Won

    2002-01-01

    Castleman's disease is a rare benign lymphoproliferative disorder of uncertain origin which most commonly involves the mediastinum but rarely affects the axilla. We report a case of localized Castleman's disease involving the axillary lymph node. Mammography revealed a well-defined, homogeneously dense ovoid mass, 3 cm in size, in the left axilla, while gray-scale ultrasonography (US) demonstrated a well-defined, uniformly hypoechoic ovoid mass with good through transmission. Peripheral hypervascularity was observed at power Dopper US, and early rapid homogeneous enhancement at contrast-enhanced dynamic CT. PMID:12087205

  16. Pulmonary Alveolar Microlithiasis: A Case Report with Emphasis on Imaging Findings

    PubMed Central

    Abdalla, Guilherme; Marchiori, Edson; Zanetti, Gláucia; Mucillo, Antonio; Pereira, Mariana Leite; Ventura, Nina; Martins, Pedro; Constantino, Carolina Pesce Lamas; Canellas, Rodrigo; Brandão, Viviane; Varella de Oliveira, Romulo

    2010-01-01

    Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by the presence of small calculi in the alveolar space. The authors report a case of a 21-year-old man with a 2-year history of shortness of breath on exertion and dry cough. Physical examination was altered only for crackles at auscultation. Pulmonary function revealed a mild restrictive ventilatory defect and the chest radiograph demonstrated paracardiac confluence of dense micronodular infiltrate. High-resolution CT scan revealed diffuse ground glass attenuation and septal thickening, more pronounced in lower pulmonary regions, with calcifications along the interlobar septa and subpleural regions. A transbronchial lung biopsy confirmed the diagnosis of PAM. PMID:20671919

  17. Intraosseous pneumatocyst of the ilium: CT findings in two cases and literature review.

    PubMed

    Catalano, O; De Rosa, F; Muto, M

    1997-01-01

    Intraosseous pneumatocyst of the ilium is a rare lesion of uncertain origin. It predilects male subjects and may be associated or not with sacroiliac joint degenerative disease, intra-articular gas, sacral pneumatocyst, and communication with the articular space. To our knowledge, only 16 observations have been reported in the literature. We have evaluated with plain radiographs and CT two additional cases. Plain films frequently identify these lesions, but CT is the method of choice in demonstrating their air density and assessing the possible abnormalities of the surrounding bone and sacroiliac joints.

  18. Institutional Capacity for Natural Disasters: Findings from Case Studies in Africa

    DTIC Science & Technology

    2013-03-01

    2013 Robert S. Strauss Center for International Security and Law. All rights reserved. S T R A U S S C E N T E R . O R G / C C A P S Photo Credit...Case Studies in Africa,” CCAPS Research Brief No. 9 (Austin: Robert S. Strauss Center for International Security and Law, 2013). 4 United Nations...Shocks and Conflict Management in Senegal,” Paper presented at the Robert S. Strauss Center’s Climate Change and African Political Stability program’s

  19. Novel imaging findings in two cases of biotinidase deficiency-a treatable metabolic disorder.

    PubMed

    Bhat, Maya Dattatraya; Bindu, P S; Christopher, Rita; Prasad, Chandrajit; Verma, Abha

    2015-10-01

    Biotinidase deficiency is one of the few treatable inborn errors of metabolism. We describe unique MRI features in two patients with biotinidase deficiency. Brain MRI in case one demonstrated symmetrical diffusion restriction in bilateral hippocampi, parahippocampal gyri, central tegmental tracts, and cerebellar white matter besides other structures that have been reported previously. The second patient was noted to have bilateral symmetrical T2 hyperintensities involving the anterior, lateral and posterior columns of the entire spinal cord on MRI. Knowledge of the varied MRI features of biotinidase deficiency will aid the prompt diagnosis and treatment of a potentially disabling illness, especially in countries where newborn screening is not routinely performed.

  20. A case of intussusception of the appendix secondary to endometriosis: US and CT findings.

    PubMed

    Lee, Dong Jun; Kim, Hyun Cheol; Yang, Dal Mo; Kim, Sang Won; Ryu, Jung Kyu; Won, Kyu Yeoun; Lee, Suk Hwan

    2015-09-01

    Intussusception of the appendix is an uncommon condition that is difficult to diagnose with radiology. Endometriosis causing appendiceal intussusception is a rare condition that has only been reported a few times in the literature. Here, we report a case of appendiceal intussusception caused by endometriosis in a 33-year-old woman who presented with intermittent right lower abdominal pain. Sonography revealed a hypoechoic mass invaginating into the cecum, which was covered by echogenic cecal wall with central dimpling indicating the appendiceal orifice. On CT, the mass was identified as an enhancing mass invaginating into the cecum at the level the appendiceal orifice. © 2014 Wiley Periodicals, Inc.

  1. Congenital gluteus maximus contracture syndrome - a case report with review of imaging findings

    PubMed Central

    Kotha, Vamshi Krishna; Reddy, Rajasekhar; Reddy, M. Venkateshwar; Moorthy, Rangubatla Sathyanrayana; Kishan, Tatikonda Venkat

    2014-01-01

    Although the clinical features of gluteus maximus contracture syndrome have been frequently described, imaging features have been seldom described. Most commonly reported cases are those following intramuscular injection in the gluteal region although congenital contracture is an uncommon but important occurrence. This condition has most often been reported in children of school going age. These patients often present with difficulty in squatting, limitation of hip motion or specific deformities and often require surgical correction. We describe the plain radiography, ultrasonography (USG) and magnetic resonance imaging (MRI) features of this condition in a patient with no previous known history of intramuscular injections. PMID:24967033

  2. Congenital gluteus maximus contracture syndrome--a case report with review of imaging findings.

    PubMed

    Kotha, Vamshi Krishna; Reddy, Rajasekhar; Reddy, M Venkateshwar; Moorthy, Rangubatla Sathyanrayana; Kishan, Tatikonda Venkat

    2014-04-01

    Although the clinical features of gluteus maximus contracture syndrome have been frequently described, imaging features have been seldom described. Most commonly reported cases are those following intramuscular injection in the gluteal region although congenital contracture is an uncommon but important occurrence. This condition has most often been reported in children of school going age. These patients often present with difficulty in squatting, limitation of hip motion or specific deformities and often require surgical correction. We describe the plain radiography, ultrasonography (USG) and magnetic resonance imaging (MRI) features of this condition in a patient with no previous known history of intramuscular injections.

  3. Pulmonary computed tomography findings in 39 cases of Streptococcus pneumoniae pneumonia.

    PubMed

    Haroon, Attiya; Higa, Futoshi; Fujita, Jiro; Watanabe, Akira; Aoki, Nobuki; Niki, Yoshihito; Kadota, Jun-ichi; Yanagihara, Katsunori; Kaku, Mitsuo; Hori, Seiji; Cash, Haley L; Kohno, Shigeru

    2012-01-01

    The main objective of our study was to describe the pulmonary distribution of consolidation and ground-glass opacity (GGO) in chest computed tomography (CT) scans of Streptococcus pneumoniae pneumonia. In addition, the percentage of other pulmonary abnormalities was also reported. We retrospectively evaluated chest CT examinations performed between November 2008 and January 2010 in 39 patients with S. pneumoniae pneumonia. Eight patients with Haemophilus influenzae pneumonia were also included for comparison. There were 19 women and 28 men with clinical symptoms of fever and productive cough and laboratory findings of leukocytosis with markedly high C-reactive protein levels. Chest X-ray scores before and after treatment were calculated. The average score before treatment was 4. The average score after treatment was 0. Parenchymal abnormalities were evaluated along with the presence of enlarged lymph nodes and pleural effusions. The distribution of parenchymal disease was also analyzed. The chest CT findings in the patients with S. pneumoniae pneumonia consisted primarily of consolidation (56.4%), ground-glass opacity (71.7%), interlobular reticular opacity (69.2%), centrilobular nodules (53.8%), interlobular septal thickening (46.6%), bronchial wall thickening (46.6%), lymph node enlargement (10.2%) and pleural effusion (10.2%). Segmental distribution (65.7%) was seen more frequently than non-segmental distribution (35.9%). Abnormal findings were noticed bilaterally in 14 patients and unilaterally in 25 patients. On both the right and left sides, predominant zonal distributions were seen in the lower lobes. In contrast, among the eight patients with H. influenzae pneumonia, one patient had both segmental and non-segmental distributions and the remaining seven patients had only segmental distributions. In conclusion, segmental distributions of parenchymal abnormalities are more common than non-segmental distributions on chest CT scans of patients with S. pneumoniae

  4. [MRI findings of brain-stem tuberculoma in a case of tuberculous meningitis].

    PubMed

    Kubota, A; Takahashi, T; Suzuki, Y; Hasegawa, O

    1992-08-01

    A 54-year-old woman developed headache and slight fever. When she consulted a physician, she could not move either of her eyes to the right. Cranial CT scan revealed no significant findings. Lumbar puncture was performed and CSF examination showed the cell count of 10,304/mm3, glucose level of 10 mg/dl, and total protein value of 270 mg/dl. Her symptoms and laboratory findings suggested meningitis and she was admitted to our hospital. Neurological examination revealed bilateral dilated pupils with sluggish light reflex, right gaze palsy, and hypesthesia of the left side of her face. A diagnosis of tuberculous meningitis was established by a positive test for acid-fast bacillus in CSF, and anti-tuberculous therapy was started at once. One month after the onset of symptoms, her main complaints were double vision and cerebellar ataxia. Both CT and MRI revealed a right brain-stem lesion. Pre-contrast CT could not clearly visualize the lesion but with contrast medium a homogeneously-enhanced circular lesion was shown. MRI on T2WI demonstrated the right brain-stem lesion to have a central bright core with hypointense periphery, which in turn was surrounded by hyperintensity. The lesion appeared isointense with cerebral white matter and the "central bright core" area was demonstrated to be slightly hypointense on T1WI. On post-contrast T1WI (with Gd-DTPA), the lesion showed strong homogeneous enhancement. The CT and MRI findings indicated a brain-stem tuberculoma, which was regarded as the cause of the ocular movement paralysis and cerebellar ataxia. As the clinical symptoms gradually resolved with anti-tuberculous treatment, the MRI appearance of the lesion also improved.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. An Enhanced Seasonal Transition that Intensified Summer Drought in the Central U.S.

    NASA Technical Reports Server (NTRS)

    Wang, S.-Y.Simon; Santanello, Joseph; Wang, Hailan; Barandiaran, Daniel; Pinker, Rachel; Schubert, Siegfried; Gillies, Robert R.; Oglesby, Robert; Hilburn, Kyle; Kilic, Ayse; Houser, Paul

    2015-01-01

    Precipitation in the central U.S. decreases by about 25% during the seasonal transition from June to July, and this precipitation decrease has been observed to have intensified since 1979. Such an intensification could enhance future spring drought occurrences such as was the case in the 2012 "flash drought" in the Midwestern U.S., where conditions evolved quickly from being abnormally dry to exceptionally dry within a mere month from June to July. In this study, various atmospheric and land reanalysis datasets were analyzed to examine the trend calculated from 1979 to 2012 in the June-to-July seasonal transition. It was found that the change in precipitation deficit was accompanied by increased downward shortwave radiation flux and tropospheric subsidence, enhanced evaporative fraction, as well as an elevated planetary boundary layer height. The change in the tropospheric circulation encompassed an anomalous ridge over the western U.S. and a trough on either side; this wave-form circulation pattern is known to induce dry conditions in the central U.S. Possibly, the trends in the June-to-July seasonal shifts in precipitation, drought severity and tropospheric circulation intensified the 2012 "flash drought" in timing and extent. The knowledge of the trends allows one to anticipate the evolution of spring onset of drought into the summer.

  6. Continuous Production of Biodiesel Via an Intensified Reactive/Extractive Process

    SciTech Connect

    Tsouris, Costas; McFarlane, Joanna; Birdwell Jr, Joseph F; Jennings, Hal L

    2008-01-01

    Biodiesel is considered as a means to diversify our supply of transportation fuel, addressing the goal of reducing our dependence on oil. For a number of reasons ranging from production issues to end use, biodiesel represents only a small fraction of the transportation fuel used worldwide. This work addresses the aspect of biodiesel production that limits it to a slow batch process. Conventional production methods are batch in nature, based on the assumption that the rates of the key chemical reactions are slow. The hypothesis motivating this work is that the reaction kinetics for the transesterification of the reagent triglyceride is sufficiently fast, particularly in an excess of catalyst, and that interfacial mass transfer and phase separation control the process. If this is the case, an intensified two-phase reactor adapted from solvent extraction equipment may be utilized to greatly increase biodiesel production rates by increasing interphase transport and phase separation. To prove this idea, we are investigating two aspects: (1) determining the rate-limiting step in biodiesel production by evaluating the reaction kinetics, and (2) enhancing biodiesel production rates by using an intensified reactor. A centrifugal contactor combining interphase mass transfer, chemical reaction, and phase separation is employed for process intensification.

  7. Histopathologic findings of spontaneous osteonecrosis of the knee at an early stage: a case report.

    PubMed

    Hatanaka, Hiroyuki; Yamamoto, Takuaki; Motomura, Goro; Sonoda, Kazuhiko; Iwamoto, Yukihide

    2016-05-01

    We histopathologically examined a surgically resected full specimen obtained from an early-stage spontaneous osteonecrosis of the knee (SPONK). On a mid-coronal cut section of the resected medial femoral condyle, a linear fracture line paralleling the subchondral bone endplate was found. Histopathologically, prominent callus formation was seen comprising of reactive woven bone and granulation tissue on both sides of the fracture. Fracture-related bone debris was focally observed at the osteochondral side of the fracture. Definitive features of antecedent bone infarction such as creeping substitution and bone marrow necrosis were not detected. These findings suggested that SPONK was the result of a subchondral fracture rather than primary osteonecrosis.

  8. Case study findings of PHOTON problem-based learning (PBL) with high school photonics outreach programs

    NASA Astrophysics Data System (ADS)

    Hilliard-Clark, Joyce; Gilchrist, Pamela; Allgood, Sherri

    2009-08-01

    Using the Photonics Leaders program model, recruitment and retention, photonics content, parental engagement, internship, and PHOTON PBL challenges, the session's goal is to inform educators of strategies that can be used to motivate and develop cognitive skills in the discipline of Physics. The program caters to ethnically diverse students who traditionally lack experiences in the discipline. This paper discusses the initial findings of the National Science Foundation (NSF) Innovative Technology Experiences for Students and Teachers (ITEST) program through which high school students and teachers were given the opportunity to participate in shared lessons, and coordinate projects through cooperative learning at The Science House at North Carolina State University.

  9. Organisational readiness and Lean Thinking implementation: findings from three emergency department case studies in New Zealand.

    PubMed

    Rees, Gareth H

    2014-01-01

    This paper describes and contrasts the implementation of Lean Thinking – a quality methodology that emphasises waste reduction and performing at higher levels of productivity with the same or less resources – into New Zealand's healthcare system. As the field is relatively new, three literature-based exemplar cases were developed to provide an analysis framework to analyse the three New Zealand research sites, which had activities, teamwork, leadership and sustainability as its core themes. Each research site's case was developed from primary data gathered through interviews, augmented by secondary data from project reports, District Health Board websites and media stories. The results highlight the benefits of a supportive quality-focussed organisational culture, executive management involvement and cross-functional teams as enablers. Further, work intensification and workplace resistance were also evident in varying levels within the sites. The study, while reiterating the problems of introducing quality methods from other domains into healthcare, presents the New Zealand context and reinforces that organisational preparedness as a significant factor which contributes to implementation success. This study goes beyond investigations of the use of Lean tools, changing improvement metrics and descriptive statistics to identify the contexts and variables which surround quality and process improvement implementations. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  10. Incidental finding of a true human tail in an adult: a case report.

    PubMed

    Robinson, Caitlin G; Duke, Taylor C; Allison, Ashley W

    2017-01-01

    True human tails are rare vestigial structures that are typically removed in childhood. Here a case is presented in which an inconspicuous sacrococcygeal tail was incidentally discovered in late adulthood. A 56-year-old man with no significant past medical history presented to a dermatology clinic with a chief complaint of a hyperpigmented lesion on his central back. However, on full body skin exam, a separate flesh-colored 0.7 cm × 0.5 cm appendage was discovered in the midline sacrococcygeal region. This lesion had been present and unchanged since childhood. This particular lesion was removed via shave biopsy. Microscopic exam found it to be consistent with a diagnosis of a true human tail. There were no apparent involved spinal cord structures, and no further treatment was thought to be necessary. Human tails are congenital anomalies associated with occult spinal lesions in about 50% of cases. Therefore, it is in these patients' best interest to thoroughly evaluate for spinal cord involvement prior to biopsy. There is a relative lack of literature published on the topic, and a greater awareness of human tails would be helpful to ensure their inclusion in a differential diagnosis for persistent sacrococcygeal lesions in patients of any age.

  11. Intramedullary spinal cord ganglioglioma presenting as hyperhidrosis: unique symptoms and magnetic resonance imaging findings: case report.

    PubMed

    Murakami, Tomohiro; Koyanagi, Izumi; Kaneko, Takahisa; Yoneta, Akihiro; Keira, Yoshiko; Wanibuchi, Masahiko; Hasegawa, Tadashi; Mikuni, Nobuhiro

    2013-02-01

    Hyperhidrosis is caused by a sympathetic dysfunction of the central or peripheral nervous system. Intramedullary spinal cord lesions can be a cause of hyperhidrosis. The authors report a rare case of intramedullary thoracic spinal cord ganglioglioma presenting as hyperhidrosis. This 16-year-old boy presented with abnormal sweating on the right side of the neck, chest, and the right arm that had been occurring for 6 years. Neurological examination revealed mild motor weakness of the right lower extremity and slightly decreased sensation in the left lower extremity. Hyperhidrosis was observed in the right C3-T8 dermatomes. Magnetic resonance imaging showed an intramedullary tumor at the right side of the spinal cord at the T2-3 level. The tumor showed partial enhancement after Gd administration. The patient underwent removal of the tumor via hemilaminectomy of T2-3. Only subtotal resection was achieved because the margins of the tumor were unclear. Histopathological examination revealed ganglioglioma. Hyperhidrosis gradually improved after surgery. Hyperhidrosis is a rare clinical manifestation of intramedullary spinal cord tumors, and only a few cases have been reported in the literature. The location of the tumor origin, around the right gray matter of the lateral spinal cord, may account for the hyperhidrosis as the initial symptom in this patient. Physicians should examine the spinal cord using MRI studies when a patient has hyperhidrosis with some motor or sensory symptoms of the extremities.

  12. Equine phacoclastic uveitis: the clinical manifestations, light microscopic findings, and therapy of 7 cases.

    PubMed Central

    Grahn, B H; Cullen, C L

    2000-01-01

    This retrospective clinical study describes the clinical manifestations, light microscopic findings, and diagnosis and treatment of acute and chronic lens rupture in the horse. Rupture of the lens capsule in the horse usually results in a chronic, blinding inflammation (phacoclastic uveitis) unless prompt surgical and medical therapies are implemented. The clinical manifestations of acute lens capsule rupture included: cataract; intralenticular displacement of iridal pigment; lens cortical fragments attached to the perforated lens capsule, iris, and corneal endothelium; miosis; aqueous flare; and usually a corneal or scleral perforation with ulceration or focal full thickness corneal edema and scarring. The clinical signs of chronic phacoclastic uveitis include blindness, phthisis bulbi, and generalized corneal opacification related to scarring, vascularization, pigmentation, and edema. In one horse, acute phacoclastic uveitis was successfully treated with phacoemulsification to remove the ruptured lens and medical therapy to control the accompanying inflammation. The affected eyes of the horses with chronic phacoclastic uveitis were enucleated because of persistent clinical signs of nonulcerative keratitis and uveitis, despite long-term medical management. The clinical manifestations and lack of improvement with medical therapy are similar in the horse, dog, cat, and rabbit. However, the histologic findings in equine phacoclastic uveitis differ significantly from those in the dog, and rabbit. Images Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. Figure 8. PMID:10816830

  13. Case finding with incomplete administrative data: observations on playing with less than a full deck.

    PubMed

    Holmes, Ann M; Ackermann, Ronald T; Katz, Barry P; Downs, Stephen M; Inui, Thomas S

    2010-12-01

    Capacity constraints and efficiency considerations require that disease management programs identify patients most likely to benefit from intervention. Predictive modeling with available administrative data has been used as a strategy to match patients with appropriate interventions. Administrative data, however, can be plagued by problems of incompleteness and delays in processing. In this article, we examine the effects of these problems on the effectiveness of using administrative data to identify suitable candidates for disease management, and we evaluate various proposed solutions. We build prospective models using regression analysis and evaluate the resulting stratification algorithms using R² statistics, areas under receiver operator characteristic curves, and cost concentration ratios. We find delays in receipt of data reduce the effectiveness of the stratification algorithm, but the degree of compromise depends on what proportion of the population is targeted for intervention. Surprisingly, we find that supplementing partial data with a longer panel of more outdated data produces algorithms that are inferior to algorithms based on a shorter window of more recent data. Demographic data add little to algorithms that include prior claims data, and are an inadequate substitute when claims data are unavailable. Supplementing demographic data with additional information on self-reported health status improves the stratification performance only slightly and only when disease management is targeted to the highest risk patients. We conclude that the extra costs associated with surveying patients for health status information or retrieving older claims data cannot be justified given the lack of evidence that either improves the effectiveness of the stratification algorithm.

  14. A case of associative visual agnosia: neuropsychological findings and theoretical considerations.

    PubMed

    Kawahata, N; Nagata, K

    1989-10-01

    A 61-year-old right-handed man fell downstairs and was found unconscious. There was no abnormality in the general physical examinations. Neurological examinations revealed a quadrantanopia. Neuropsychological examination revealed an impairment in recent verbal memory, alexia, agraphia, object agnosia, color naming difficulty, prosopagnosia, and visuospatial constructional disability. CT scan demonstrated subcortical hematomas in the temporo-occipital regions of both hemispheres. MRI demonstrated extensive low-intensity lesions in the lingual, fusiform and posterior inferior temporal gyri on both hemispheres. Both inferior longitudinal fasciculi were also affected. His neuropsychological deficits seem best described as a typical form of associative visual agnosia. From the results of neuroradiological findings, the authors emphasize that associative visual agnosia might be produced by an intrahemispheric disconnection between the visual cortices and the temporal lobes which are supposed to be the storage site of the engrams of visual memories. Moreover, the neuropsychological findings suggest that the visuo-constructional ability to convert the two-dimensional input to the three-dimensional construction and the capacity of three-dimensional imagination were severely impaired in our patient. It was considered that these neuropsychological features play an important role in the recognition difficulties of associative visual agnosia.

  15. A case of bilateral patellar osteochondrosis and fracture in a cat. Clinical and histological findings.

    PubMed

    Palierne, S; Palissier, F; Raymond-Letron, I; Autefage, A

    2010-01-01

    Fracture of the patella associated with bilateral osteochondrosis of the superior pole of the patella in a 14-week-old cat is reported with histological findings. Patellar osteochondrosis has been described in humans, horses, pigs, and dogs and is characterised by incomplete union of the ossification centres related to an abnormal process of endochondral ossification. However this disease has not yet been described in cats. Macroscopically, two main fragments separated by interposed tissue were identified on the left patella. In contrast, no fracture but only a fissuration of the articular cartilage was observed on the right patella. Bilateral partial patellectomy was performed. Histological examination of the excised fragments from the left patella revealed two main areas of trabecular bone separated by a wide irregular band of hyaline cartilage. The microscopic aspect of the right patella was similar to that of the left. Serial sections showed the initial appearance of an area of necrosis in the central band of hyaline cartilage, and that this hyaline cartilage was subsequently replaced by fibrovascular connective tissue. These findings indicate that some patellar fractures may be due to patellar osteochondrosis.

  16. Contrast-associated transient cortical blindness: three cases with MRI and electrophysiology findings.

    PubMed

    Baguma, Marius; Younan, Nadia; London, Frédéric; Ossemann, Michel; Vandermeeren, Yves

    2017-03-01

    Transient cortical blindness (TCB) is a rare but striking complication following contrast agent injection. TCB might be secondary to a direct toxicity of the contrast agent, leading to an osmotic disruption of the blood-brain barrier (BBB), with a preferential involvement of the posterior circulation and occipital cortex. We report a series of three patients with contrast medium-associated TCB (intra-arterial injection of non-ionic contrast agent during diagnostic cerebral angiography for two of them and coronary angioplasty for the other one). In two patients, the magnetic resonance imaging (MRI) was unremarkable; in the other patient, typical MRI findings were observed, with FLAIR hyperintensities in the right occipital cortex and decreased apparent diffusions coefficient (ADC). Interestingly, this patient also presented posterior rhythmic epileptiform activities on electroencephalogram during the first 36 h. Visual evoked potentials (VEPs) showed normal retinal potential, but a massive destructuration of the later potentials of the cortical origin. To our knowledge, this is the first time that VEPs acquired during TCB are reported. We discuss these findings with respect to the pathophysiology of TCB.

  17. Merosin-deficient congenital muscular dystrophy (MDCMD): a case report with MRI, MRS and DTI findings.

    PubMed

    Ip, Janice J K; Hui, Peter K T; Chau, M T; Lam, Wendy W M

    2012-08-01

    Congenital muscular dystrophy (CMD) comprises a heterogeneous group of disorders present at birth with muscle weakness, hypotonia and contractures. Congenital muscular dystrophy (CMD) comprises a heterogeneous group of disorders with muscle weakness, hypotonia and contractures present at birth. A particular subset of classic CMD is characterized by a complete absence of merosin. Merosin-deficient congenital muscular dystrophy (MDCMD) is a rare genetic disease involving the central and peripheral nervous system in the childhood. High signal intensities are often observed throughout the centrum semiovale, periventricular, and sub-cortical white matters on T2-weighted images in MRI brain in children with MDCMD. Apparent diffusion coefficient (ADC) map may reveal increased signal intensity and apparent diffusion coefficient values in the periventricular and deep white matters. These white matter findings, observed in late infancy, decrease in severity with age. The pathogenesis of these changes remains uncertain at present. In this article, we outline the specific MR imaging findings seen in a patient with documented MDCMD and also suggest the causes.

  18. Canine immune-mediated polyarthritis: Clinical and laboratory findings in 83 cases in western Canada (1991–2001)

    PubMed Central

    Stull, Jason W.; Evason, Michelle; Carr, Anthony P.; Waldner, Cheryl

    2008-01-01

    A hospital-based, case-control study was used to describe clinical and laboratory findings in 83 dogs diagnosed with noninfectious, nonerosive, immune-mediated polyarthritis (IMPA) in western Canada. Case medical records were reviewed. Cases were analyzed as total IMPA cases and as subgroups [breed, systemic lupus erythematosus (SLE), reactive, and idiopathic] and compared with the general canine hospital population. Dogs with IMPA differed in age (P = 0.004) and weight (P = 0.01) from other hospital admissions. Idiopathic IMPA cases were older (4–10 y; P < 0.05), compared with the general canine hospital population, and their common laboratory abnormalities included the following: leukocytosis, nonregenerative anemia, increased alkaline phosphatase, and hypoalbuminemia. The SLE cases were seen more often in summer and fall (P = 0.04), raising concern of an undiagnosed etiologic agent. The hock joint appeared to be the most reliable for diagnosis of IMPA, and arthrocentesis of both hock joints may aid in case identification. PMID:19252711

  19. [A case of lichenoid sarcoidosis with characteristic clinical and histopathological findings].

    PubMed

    Sanchez-Lopez, Josefa; Porriño-Bustamante, Ma Librada; Aneiros-Fernández, Jose; Naranjo-Sintes, Ramon; Fernández-Pugnaire, Ma Antonia

    2014-04-16

    Sarcoidosis is a multisystem inflammatory disease characterized by the formation of noncaseating granulomas in various organs and tissues. The majority of patients with systemic sarcoidosis will present with lung and lymph node involvement. In addition, 20% have skin involvement that may be the only manifestation of the disease or may be an important prognostic marker for involvement of other organs. There are multiple forms of presentation of cutaneous sarcoidosis, which may be a true challenge.We report a patient with a one month history of an eruption of skin colored papules. Some were grouped in a symmetrical distribution on the trunk, inner arms, and lumbar region. Pathologic examination revealed an infiltrate in the papillary dermis showing a band of noncaseating granulomas along with disruption of the basal lamina and lichenoid changes. The clinicopathological correlation confirmed the diagnosis of lichenoid sarcoidosis. We consider our case interesting owing to the clinical presentation and the lichenoid distribution of granulomas.

  20. Coma blisters after poisoning caused by central nervous system depressants: case report including histopathological findings.

    PubMed

    Branco, Maira Migliari; Capitani, Eduardo Mello De; Cintra, Maria Letícia; Hyslop, Stephen; Carvalho, Adriana Camargo; Bucaretchi, Fabio

    2012-01-01

    Blister formation and eccrine sweat gland necrosis is a cutaneous manifestation associated with states of impaired consciousness, most frequently reported after overdoses of central nervous system depressants, particularly phenobarbital. The case of a 45-year-old woman who developed "coma blisters" at six distinct anatomic sites after confirmed (laboratory) phenobarbital poisoning, associated with other central nervous system depressants (clonazepam, promethazine, oxcarbazepine and quetiapine), is presented. A biopsy from the left thumb blister taken on day 4 revealed focal necrosis of the epidermis and necrosis of sweat gland epithelial cells; direct immunofluorescence was strongly positive for IgG in superficial blood vessel walls but negative for IgM, IgA, C3 and C1q. The patient was discharged on day 21 with no sequelae.

  1. Perinatal autopsy findings in three cases of jugular lymphatic obstruction sequence and cardiac polyvalvular dysplasia.

    PubMed

    Bendon, Robert; Asamoah, Alexander

    2008-01-01

    Three infants with a prenatal diagnosis of Noonan's syndrome suffered fetal hydrops and immediate neonatal death. The infants all had the external appearance of jugular lymphatic obstruction sequence with wide-spaced nipples, redundant posterior nuchal skin, and edema of the dorsa of the feet and hands. All 3 demonstrated thick, redundant leaflets of all 4 cardiac valves, and 2 had a membranous ventricular septal defect. One female infant had a mutation of the PTPN11 gene. Two males had no common mutation of PTPN11. The males demonstrated other abnormalities in common, including small penis, testicular malformation, rosette-like appearance of the pituicytes, and an eosinophil infiltration of the pancreatic islets with islet cell hypertrophy. Detailed anatomy of cases of lymphatic obstruction sequence fetuses can be correlated with an increasing number of genetic mutations associated with Noonan's syndrome and related syndromes in mice and humans.

  2. Grammatical constructions in Cri du chat syndrome--findings from a case study.

    PubMed

    Kristoffersen, Kristian Emil

    2009-12-01

    The literature on grammatical skills in persons with Cri du chat syndrome (CCS) is very limited, and the need for more knowledge in this area is thus evident, in particular for speech and language therapists working with individuals with this syndrome. This case study report describes the syntactic skills of a 14-year-old Norwegian girl with CCS. The theoretical framework is construction grammar. Data for the study were collected in a diary by the author over a period of 4 months and make up a corpus of 552 utterances. These utterances are described in terms of MLU, diversity of argument structure constructions, proportion and types of complex utterances, use of auxiliaries, as well as deviant word order patterns, types of omissions, and use of prefabricated units. The primary aim of the study is to identify strengths and weaknesses in syntactic skills, which provide the basis for future research on grammatical skills in persons with CCS.

  3. Clinical and Radiological Findings of Autosomal Dominant Osteopetrosis Type II: A Case Report

    PubMed Central

    Kant, Priyanka; Sharda, Neelkamal; Bhowate, Rahul R.

    2013-01-01

    Osteopetrosis is a rare inherited genetic disease characterized by sclerosis of the skeleton caused by the absence or malfunction of osteoclasts. Three distinct forms of the disease have been recognized, autosomal dominant osteopetrosis being the most common. Autosomal dominant osteopetrosis exhibits a heterogeneous trait with milder symptoms, often at later childhood or adulthood. The aim of this case report is to present the clinical and radiographic features of a 35-year-old female patient with autosomal dominant osteopetrosis type II who exhibited features of chronic generalised periodontitis, and the radiographs revealed generalised osteosclerosis and hallmark radiographic features of ADO type II, that is, “bone-within-bone appearance” and “Erlenmeyer-flask deformity.” PMID:24260721

  4. Ejaculatory frequency and the risk of aggressive prostate cancer: Findings from a case-control study.

    PubMed

    Papa, Nathan P; MacInnis, Robert J; English, Dallas R; Bolton, Damien; Davis, Ian D; Lawrentschuk, Nathan; Millar, Jeremy L; Pedersen, John; Severi, Gianluca; Southey, Melissa C; Hopper, John L; Giles, Graham G

    2017-08-01

    Recent literature reports inverse associations with ejaculator frequency and prostate cancer (PC). We sought to explore the relationship between ejaculatory frequency from ages 20 to 50 and subsequent development of aggressive PC. We conducted a case-control study sampling 2,141 men from private urology practices in Victoria, Australia. Cases were defined as men with high grade or high stage PC and controls being biopsy negative men. Ejaculation frequency recalled at age decades 20, 30, and 40 second was assessed by questionnaire. Unconditional multivariable logistic regression models were used to generate odds ratios (ORs). An inverse association with ejaculatory frequency at age 30 to 39 was observed (OR per 5-unit increase per week = 0.83, 95% CI: 0.72-0.96) but not at ages 20 to 29 (OR = 1.01, 95% CI: 0.89-1.14) or ages 40 to 49 (OR = 0.95, 95% CI: 0.81-1.12). This result differed between men with new sexual partners after age 30 (OR = 0.77, P = 0.009) and those with no new partners (OR = 0.97, P = 0.8) though the test for a difference between these estimates was not significant (P = 0.11). We found only weak evidence of an inverse association between ejaculatory frequency in the fourth decade of life and advanced PC, which was not significantly modified by number of new sexual partners. No relationship was found for ejaculatory frequency in the third and fifth decades of life. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Case series: clinical findings and oral rehabilitation of patients with amelogenesis imperfecta.

    PubMed

    Markovic, D; Petrovic, B; Peric, T

    2010-08-01

    Children with amelogenesis imperfecta (AI) experience many oral difficulties including sensitivity and aesthetics. The methods of treating AI children are limited and therefore a program of care was evaluated in order to assess the clinical efficacy of providing preventive and restorative treatments. A non-randomised convenience sample of 12 patients with AI was evaluated. A comprehensive patient history was recorded, followed by a clinical and radiographic assessment of oral health. In 8/12 patients a hypoplastic form of AI was diagnosed, in 2/12 cases hypomaturation and in 2/12 cases hypocalcified form were noted. Chief complaints were mainly related to unsatisfactory aesthetics and dental sensitivity. In 8 patients there was active dental caries. Most of the patients had gingivitis and showed fair oral hygiene. The presence of non-enamel dental anomalies was recorded in 9 patients. All patients received meticulous preventive care. Initial treatment depended on AI type and oral health of the patient. During the transition period, both conventional and resin modified glassionomer cements, as well as composite resin materials, were used to restore posterior teeth. Direct composite resin restorations were used to improve the appearance of anterior teeth. In 4 patients a long-lasting interdisciplinary approach including orthodontics, metal-ceramic crowns and fixed partial dentures, and direct composite restorations was required. Follow-up periods varied between 2-11 years. All children have been regularly recalled at 3 monthly intervals. Caries prevalence has remained low during the follow-up postoperative period and patients have reported satisfaction with the treatment they have received. AI is associated with multiple non-enamel anomalies and requires a complex treatment. Treatment planning is related to the age of the patient, the type and severity of the disorder, and the oral health of the patient. Early diagnosis, preventive care and timely treatment are of

  6. A case-crossover study of occupational laceration injuries in pork processing: methods and preliminary findings.

    PubMed

    Lander, Lina; Sorock, Gary S; Stentz, Terry L; Eisen, Ellen A; Mittleman, Murray; Hauser, Russ; Perry, Melissa J

    2010-10-01

    Meatpacking remains a hazardous and largely unexamined industry. Despite prevention efforts, laceration injuries, among others, remain high. We estimated the magnitude of associations between transient exposures such as equipment malfunction, performing an unusual work task, rushing, and occurrence of laceration injuries. Injured workers were recruited from two pork-processing plants, one in Iowa and one in Nebraska. A telephone interview was conducted within 7 days of the injury, on average to collect information on fixed and transient exposures preceding the injury event. Case-crossover methodology was used to evaluate case and control data within the same subject, thus controlling for between-subject confounding. A Mantel-Haenszel estimator for person-time data was used to estimate the relative risks of injury and transient exposures of interest. Of the 362 workers with lacerations between April 2006 and October 2007, 153 (42%) were interviewed (74% male, 41% Hispanic). Forty-eight per cent were injured by a knife or a knife-like object such as scissors or a band saw. Other sources of lacerations included sharp edges and hooks. Tool sharpening was associated with the highest RR of laceration (RR 8.4, 95% CI 5.4 to 12.8) followed by slipping (RR 74.8, 95% CI 30.5 to 183.3), equipment malfunction (RR 3.8, 95% CI 2.8 to 5.3), and performing an unusual task (RR 3.7, 95% CI 2.6 to 5.2). Being tired, distracted, or rushing were not significant risk factors for a laceration. Aspects of the physical environment and work practices appear to be significant risk factors for laceration injury in meatpacking. Personal risk factors were less significant in this study.

  7. Comparing treatment-seeking codeine users and strong opioid users: Findings from a novel case series.

    PubMed

    Nielsen, Suzanne; Murnion, Bridin; Dunlop, Adrian; Degenhardt, Louisa; Demirkol, Apo; Muhleisen, Peter; Lintzeris, Nicholas

    2015-05-01

    Few studies have described those seeking treatment for codeine dependence. This study aimed to compare patients presenting for treatment where either codeine or a strong pharmaceutical opioid (oxycodone or morphine) was the principal drug of concern to understand if codeine users may have unique treatment needs. Retrospective case review of 135 patients from three geographical areas in New South Wales, Australia. Cases where the principal drug of concern was codeine (n = 53) or a strong pharmaceutical opioid (oxycodone or morphine, n = 82) were compared. Differences in demographic characteristics, pain history, mental health, substance use history and, subsequently, the treatment that was received were examined. People whose principal drug of concern was codeine were more likely to be female (66% vs. 37%, P < 0.001), employed (43% vs. 22%, P < 0.01) and use only one pharmaceutical opioid (91% vs. 49%, P < 0.001). There was no difference in age between the codeine group (mean 38.6 years) and the strong opioid group (39.3 years). Opioid substitution therapy was the most common treatment received by both groups although codeine patients were more likely to be treated with buprenorphine than methadone (odds ratio = 7.7, 95% confidence interval 2.2-27.2, P < 0.001) and more likely to attempt withdrawal (odds ratio = 2.6, 95% confidence interval 1.2-5.3, P = 0.010). There are important differences between codeine-dependent patients and strong prescription opioid-dependent patients. Further work should explore the outcomes of withdrawal versus maintenance treatment for codeine users. © 2014 Australasian Professional Society on Alcohol and other Drugs.

  8. Glycogen Storage Disease Type IV: A Case With Histopathologic Findings in First-Trimester Placental Tissue.

    PubMed

    Bendroth-Asmussen, Lisa; Aksglaede, Lise; Gernow, Anne B; Lund, Allan M

    2016-01-01

    A 30-yr-old woman presented with 2 consecutive miscarriages within 7 mo. Histopathologic examination of the placental tissue showed intracytoplasmic inclusion vacuoles with a strong reaction in Periodic acid-Schiff staining and a slightly pallor reaction in alcian blue staining. Additional molecular genetic analyses confirmed glycogen storage disease Type IV with the finding of compound heterozygosity for 2 mutations (c.691+2T>C and c.1570C>T, p.R524X) in the GBE1 gene. We conclude that glycogen storage disease Type IV can cause early miscarriage and that diagnosis can initially be made on histopathologic examination. Genetic analysis is required to confirm the diagnosis and to offer prenatal genetic testing in future pregnancies.

  9. A case of Mikulicz's disease complicated by malignant lymphoma: a postmortem histopathological finding.

    PubMed

    Uehara, Takeshi; Ikeda, Shu-ichi; Hamano, Hideaki; Kawa, Shigeyuki; Moteki, Hideaki; Matsuda, Kazuyuki; Kaneko, Yasunori; Hara, Eiji

    2012-01-01

    A 66-year-old Japanese man with an 11-year history of Mikulicz's disease (MD) received continuous corticosteroid administration. At age 58, a left renal pelvic mass was identified and diagnosed as an IgG4-related inflammatory pseudotumor. The patient underwent an operation to remove the tumor. Subsequently, he contracted repeated pulmonary infections and eventually died of severe gastrointestinal bleeding. Autopsy revealed systemic lymph node swelling and infiltration in some organs, and diffuse large B-cell lymphoma (DLBCL) was diagnosed. These findings suggest that an IgG4-related disease can be causally related to the development of malignant lymphoma through the occurrence of mucosa-associated lymphoid tissue lymphoma.

  10. Squash cytology findings of subependymomas: A report of three cases and differential diagnosis.

    PubMed

    Tokumitsu, Takako; Sato, Yuichiro; Fukushima, Tsuyoshi; Takeshima, Hideo; Sato, Shinya; Asada, Yujiro

    2017-10-12

    Subependymomas are slowly growing glial tumors, corresponding to WHO grade I. Few descriptions of the cytologic features of this neoplasm are available. This study describes the cytologic features of three subependymomas, as well as their differential diagnosis based on cytology. Three men, aged 52, 56, and 63 years, presented with headache. Magnetic resonance imaging revealed a nodular intraventricular mass in all three patients. Intraoperative squash cytology specimens from the three intraventricular tumors showed nodular clusters with microcystic changes. Nuclei were round to oval in shape, but showed no evidence of severe nuclear atypia or mitoses. Histological examination showed features of subependymoma. Squash cytology findings, including nodular clusters, mild cellular atypia, microcystic changes, and mucoid material, are useful in the rapid intraoperative diagnosis of subependymoma. © 2017 Wiley Periodicals, Inc.

  11. Finding orbital motion of sub-stellar companions - the case of TWA 5B

    NASA Astrophysics Data System (ADS)

    Schmidt, T.; Neuhäuser, R.; Mugrauer, M.

    2008-07-01

    TWA 5B is a brown dwarf companion of H=12 mag, 2″ off the ~5 mag brighter triple star CoD-33° 7795 (=TWA 5), a member of the TW Hydrae association of T Tauri stars at ~55 pc. This object is the first brown dwarf around a pre-main-sequence star (confirmed by common proper motion) ever found. In the last year we have newly reduced VLT NaCo data originally taken in 2003 and combined it with all the available astrometric data of the system to investigate possibly detectable orbital motion of the system. Indeed we were able to find linear orbital motion of the system combining data from HST, VLT and Gemini-North.

  12. Postpartum bilateral transient osteoporosis of the hip: MR imaging findings in three cases.

    PubMed

    Xyda, A; Mountanos, I; Natsika, M; Karantanas, A H

    2008-08-01

    Transient osteoporosis of the hip (TOH), associated with pregnancy, is a self-limiting skeletal disorder affecting women, usually in the third trimester, which resolves spontaneously within few months postpartum. Bilateral involvement is rare. Involvement postpartum has not been described. We report three patients with postpartum presentation of bilateral TOH. Three pregnant women who presented with acute bilateral hip pain just after delivering their first child are reported. None of them had any past history of joint problems, recent injury, alcohol abuse or corticosteroid administration. Magnetic resonance (MR) imaging examinations were performed on 1.5-Tesla magnets using standard protocols. Bone marrow oedema, with normal joint space and intact articular surfaces, was depicted in all six hips. MR imaging findings with clinical correlation confirmed the diagnosis of TOH. TOH associated with pregnancy does not necessarily occur in the third trimester of pregnancy and may be bilateral.

  13. Acrodermatitis chronica atrophicans: histopathologic findings and clinical correlations in 111 cases.

    PubMed

    Brehmer-Andersson, E; Hovmark, A; Asbrink, E

    1998-05-01

    We studied 111 consecutive, untreated and serologically confirmed patients with acrodermatitis chronica atrophicans. Emphasis was on the histopathologic patterns of erythematous and fibrous lesions, and on an assay used to correlate histopathologic findings with such clinical features as fibrous nodules, ulnar bands and the pain reaction allodynia. There was a significant correlation between allodynia and signs of marked inflammation, but not between allodynia and neural and perineural cell infiltrates or fibrosis. Moreover, there was no significant correlation between serum IgG titers to Borrelia and the density of inflammatory cell infiltrates or the proportion of plasma cells in tissue. Histopathologic examination did not reveal any important differences between fibrous nodules, ulnar bands and sclerodermatous lesions. The histopathologic pattern is not diagnostic per se, but characteristic enough to alert the experienced pathologist.

  14. Magnetic resonance imaging findings in epileptic cats with a normal interictal neurological examination: 188 cases.

    PubMed

    Raimondi, F; Shihab, N; Gutierrez-Quintana, R; Smith, A; Trevail, R; Sanchez-Masian, D; Smith, P M

    2017-06-24

    Epilepsy is a common neurological condition in dogs and cats. Although an increased likelihood of significant brain lesions with age has been identified in neurologically normal dogs with epileptic seizures, the underlying aetiology of epileptic seizures in cats that present with normal physical and neurological examinations remains unknown. In this cross-sectional study, the authors examined MRI findings in a large population of cats with a normal interictal physical and neurological examination. They hypothesised that age would have an impact on the prevalence of detectable lesions. First, following the guidelines for dogs and in accordance with previous studies, the authors divided the cats into three age groups (aged one year or younger, between one and six, and older than six) and calculated the proportion of cats with a detectable lesion on MRI in these groups. In the first group, 3/32 cats (9.4 per cent) had significant MRI abnormalities that were all consistent with congenital malformation; in the second group, only 5/92 (5.4 per cent) MRI scans were abnormal and in the third group, 15/ 65 (23.1 per cent) cats showed abnormal findings that were predominantly lesions of neoplastic origin. Second, to investigate the impact of age further, data were investigated as a continuous variable using receiver operating characteristic analysis. This indicated an optimal cut-off age of five years, above which MRI abnormalities were more likely, with an increase in the odds of a significant structural lesion increasing by 14 per cent per year. British Veterinary Association.

  15. Hematological and serum biochemical findings in clinical cases of cattle naturally infected with lumpy skin disease.

    PubMed

    Abutarbush, Sameeh M

    2015-03-15

    Lumpy skin disease (LSD) is an acute viral disease of cattle that is currently emerging in the Middle East region and poses a serious threat to Europe and the rest of the world. The objective of this study was to describe hematological and serum biochemical findings associated with natural clinical infection of LSD in cattle. A total of 129 animals clinically infected with LSD were enrolled in the study. Venous blood sample were collected from study animals, and hematological and serum biochemical parameters were measured. Leukocytopenia was found in 8.7%, while leucocytosis was found in 18.2% of affected cattle. Decreased hematocrit concentration was seen in 18.3%. Most affected cattle had reduced mean corpuscular volume (43.7%), mean corpuscular hemoglobin (14.3%), and mean corpuscular hemoglobin concentration (11.5%). All cattle with abnormal platelets count had thrombocytopenia. Hyperfibrinogenemia, hyperproteinemia, and hyperalbuminemia were found in 69%, 59.6%, and 37.2% of affected cattle, respectively. Decreased creatinine concentration was seen in 65.8%. Hyperkalemia and hyperchloremia was found in 9.6% and 10.4% of the affected cattle, respectively. LSD appears to be associated with inflammatory leukogram, anemia, thrombocytopenia, hyperfibrinogenemia, hyperproteinemia, decreased creatinine concentration, hyperchloramia, and hyperkalemia. These are likely due to the associated severe inflammatory process and disease complications such as anorexia and reduced muscle mass. This is the first study that documents hematological and serum biochemical findings associated with LSD infection. Understanding the blood profile picture may give further insight to the pathogenesis of the disease and help in treatment of individual cattle.

  16. Arthroscopic grafting of scaphoid nonunion - surgical technique and preliminary findings from 23 cases.

    PubMed

    Cognet, J-M; Louis, P; Martinache, X; Schernberg, F

    2017-02-01

    We report our experience with the arthroscopic treatment of 23 cases of scaphoid nonunion. We explain the surgical technique and describe the different steps needed to achieve bone union. We report our initial clinical and radiological results. This was a prospective non-randomized study. Inclusion criteria were a scaphoid nonunion without radiocarpal arthritis, without any time limit and without any selection as to nonunion location. Before the operation, patients underwent an X-Ray and CT scan or MRI. Schernberg's classification was used to evaluate the location of the nonunion. Internal fixation was performed with a screw or K-wires. Bone grafts were taken from the dorsal side of the distal radius using a T-Lok™ bone marrow biopsy needle (Argon Medical Devices, Plano, TX, USA). A CT scan was performed 3 months after the operation to determine whether union was achieved. Pain, strength and range of motion were evaluated before and after the operation. The patients' smoking habits were also documented. The average follow-up was 17.3 months (4-41). There were 20 men and 3 women with an average age of 26 years (17-63). The average duration of nonunion before the operation was 17 months (6-60). Based on Schernberg's classification, there was one type I, 12 type II and 10 type III nonunions. Wrist strength increased from 32 to 41kg. Union was obtained in all patients after an average of 4 months (3-12). Numerous treatments have been described for treating scaphoid nonunion: Matti-Russe, Fisk-Fernadez bone graft, vascularized bone graft, bone substitutes, etc. The success rate varies depending on the technique and study design. We have described an arthroscopic technique for treating scaphoid nonunion with very promising preliminary results. Arthroscopic debridement is needed to ensure good quality bone at the graft site, while preserving extrinsic vascularization. Traction is used during the operation to restore the scaphoid height, once debridement has been

  17. Interpretation of hair findings in children: about a case involving carbamazepine.

    PubMed

    Kintz, Pascal

    2014-06-01

    This office has been recently involved in a case dealing with child custody, where the final outcome was difficult to establish. The following concentrations were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in the hair of a 21-month-old girl: 154 (0-1 cm), 198 (1-2 cm), 247 (2-3 cm), and 368 pg/mg (3-4 cm) after decontamination. Obviously, the concentrations measured in the hair were much lower than those observed in patients under daily treatment. In this sense, the frequency of exposures appears as infrequent (low level of exposure), with marked decrease in the more recent period. However, the girl was never prescribed carbamazepine and the mother, who was under carbamazepine therapy, denied any administration. The Judge asked if this could result from a single exposure and at which period. At least, three possible interpretations of the measured carbamazepine concentrations were addressed: (1) decrease in administration in the more recent period; (2) increase of body weight due to growing, so the same dosage will result in lower concentrations in hair; and (3) sweat contamination from the mother at the time the girl is with her in bed, the older hair being in contact longer with the bedding. In this case, it was impossible to conclude that the child was deliberately administered carbamazepine. The results of the analysis of hair could indicate that she was in an environment where carbamazepine was being used and where the drug was not being handled and stored with appropriate care. There are many differences between the hair from children and those from adults: hair from children is thinner and more porous, the ratio anagen and catagen phases are not maintained, and the growth rate can be different, at some periods, from the usual 1 cm/month. These differences, together with the influence of PK-PD parameters are reviewed in this paper, as a basis for suitable interpretation. In view of these results it is proposed that a single hair

  18. Intensifying weathering and land use in Iron Age Central Africa.

    PubMed

    Bayon, Germain; Dennielou, Bernard; Etoubleau, Joël; Ponzevera, Emmanuel; Toucanne, Samuel; Bermell, Sylvain

    2012-03-09

    About 3000 years ago, a major vegetation change occurred in Central Africa, when rainforest trees were abruptly replaced by savannas. Up to this point, the consensus of the scientific community has been that the forest disturbance was caused by climate change. We show here that chemical weathering in Central Africa, reconstructed from geochemical analyses of a marine sediment core, intensified abruptly at the same period, departing substantially from the long-term weathering fluctuations related to the Late Quaternary climate. Evidence that this weathering event was also contemporaneous with the migration of Bantu-speaking farmers across Central Africa suggests that human land-use intensification at that time had already made a major impact on the rainforest.

  19. Clear-Cell Meningioma: CT and MR Imaging Findings in Two Cases Involving the Spinal Canal and Cerebellopontine Angle

    PubMed Central

    Yu, Ki Bong; Kim, Hyung Jin; Suh, Chang Hae; Park, Hyung Chun; Kim, Eun Young; Han, Hye Seung

    2002-01-01

    Clear-cell meningioma is a rare subtype of meningioma which occurs at a younger age and has a higher recurrence rate than other subtypes. We report two cases of clear-cell meningioma, one in the thoracolumbar spinal canal and the other in the cerebellopontine angle. Though the CT and MR imaging findings were not different from those of ordinary meningioma, after surgical removal the condition recurred repeatedly in the patient with spinal canal involvement. PMID:12087202

  20. An unusual case of disseminated toxoplasmosis in a previously healthy pregnant patient: radiographic, CT, and MRI findings.

    PubMed

    Paruthikunnan, Samir; Shankar, Balasubramanyam; Kadavigere, Rajagopal; Prabhu, Mukhyaprana; Narayanan, Ramakrishna; Jain, Harshwardhan

    2014-11-01

    Toxoplasmosis is a ubiquitous protozoal infection that during pregnancy commonly affects the fetus severely, with maternal infection usually being mild self-limiting. Disseminated toxoplasmosis in a healthy pregnant woman has, to the best of our knowledge, not been reported before. We present a case of disseminated toxoplasmosis involving pulmonary, central nervous system, and lymph nodes in a pregnant woman and imaging findings on radiography, computed tomography, and magnetic resonance imaging.

  1. Amplitude-integrated electroencephalography and MRI findings in a case of severe neonatal methicillin-resistant Staphylococcus aureus meningitis

    PubMed Central

    Olischar, Monika; Hunt, Rod W; Daley, Andrew J; Clifford, Vanessa; Tingay, David G

    2010-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) can cause serious infection among hospitalised patients. The emergence of community acquired strains of MRSA (CA-MRSA) increases the potential exposure of newborns. The high incidence of reported meningitis in neonates in large CA-MRSA outbreaks suggests increased virulence in the neonatal population. The authors describe a case of severe meningitis due to MRSA in a previously healthy neonate and include findings from amplitude-integrated electroencephalography (aEEG) and MRI. PMID:22802366

  2. Intravascular papillary endothelial hyperplasia: report of 4 cases with immunohistochemical findings.

    PubMed

    Campos, Marcia-Sampaio; Garcia-Rejas, Roberto-A; Pinto, Décio-Santos; de Sousa, Suzana-C O M; Nunes, Fabio-Daumas

    2009-10-01

    Intravascular papillary endothelial hyperplasia (IPEH) is a benign endothelial proliferation, usually intravascular, that may mimic angiosarcoma. In this report, four new cases of IPEH involving the oral region are described. The affected sites were the lower lip, labial comissure and the submandibular region. After clinical evaluation, the complete removal of the lesions showed a circumscribed and soft mass. Histologically, the major feature was a reactive proliferation of endothelial cells composed of small papillary structures with hypocellular and hyalinized cores arising in an organized thrombus. Immunohistochemical staining for CD34 was strongly positive in endothelial cells. Vimentin and laminin immunolabelling were also consistent with a vascular origin. In order to verify the proliferative potential of the lesions, the Ki-67 antibody was used, revealing low percentage of labeled cells (<20%). No immunoreactivity for GLUT-1 was observed. Since the complete removal is curative, no additional treatment was necessary, and no signs of recurrence had been observed until now. Due to the particular features of IPEH, it is important for pathologists and clinicians to become familiar with this lesion. Additionally, the specific histological arrangement, including the absence of cellular pleomorphism, mitotic activity and necrosis, represents a guide to help in the differential diagnosis. Moreover, the vascular origin and the proliferative index should be assessed by immunohistochemistry in order to provide an accurate diagnosis.

  3. Complex Odontoma: A Case Report with Micro-Computed Tomography Findings

    PubMed Central

    Santos, L. A. N.; Roque-Torres, G. D.; Oliveira, V. F.; Freitas, D. Q.

    2016-01-01

    Odontomas are the most common benign tumors of odontogenic origin. They are normally diagnosed on routine radiographs, due to the absence of symptoms. Histopathologic evaluation confirms the diagnosis especially in cases of complex odontoma, which may be confused during radiographic examination with an osteoma or other highly calcified bone lesions. The micro-CT is a new technology that enables three-dimensional analysis with better spatial resolution compared with cone beam computed tomography. Another great advantage of this technology is that the sample does not need special preparation or destruction in the sectioned area as in histopathologic evaluation. An odontoma with CBCT and microtomography images is presented in a 26-year-old man. It was first observed on panoramic radiographs and then by CBCT. The lesion and the impacted third molar were surgically excised using a modified Neumann approach. After removal, it was evaluated by histopathology and microtomography to confirm the diagnostic hypothesis. According to the results, micro-CT enabled the assessment of the sample similar to histopathology, without destruction of the sample. With further development, micro-CT could be a powerful diagnostic tool in future research. PMID:27293913

  4. Posterior cortical atrophy: variant of Alzheimer's disease? A case series with PET findings.

    PubMed

    Schmidtke, Klaus; Hüll, Michael; Talazko, Jochen

    2005-01-01

    Nine patients with posterior cortical atrophy (PCA), a rare degenerative brain disease of unclear etiology and nosology, were followed over a mean time of 7.4 years. The mean age at onset was low (56.2 years). At onset, eight patients had visuo-spatial and eight had memory impairment. A minority showed early signs of occipital lobe involvement with visual agnosia or hemianopia. Eight patients developed dementia after a mean course of five years. 18F-FDG-PET data of six patients were analysed with statistical parametric mapping. They showed hypometabolism centred on the lateral and medial parietal associative cortex, with variable involvement of the adjacent temporal and occipital associative cortex. A minority showed involvement of the frontal lobes, possibly related to deafferenting of areas related to the control of eye movements. Atrophy and hypometabolism were markedly asymmetric in a subset of cases. Autopsy was performed in one patient. Presenile onset, location, and asymmetry of atrophy suggest that PCA represents a biologically separable variant of Alzheimer's disease.

  5. Clinical and Laboratory Findings in Patients with δ-Storage Pool Disease: A Case Series.

    PubMed

    Selle, Fabien; James, Chloé; Tuffigo, Marie; Pillois, Xavier; Viallard, Jean-François; Alessi, Marie-Christine; Fiore, Mathieu

    2017-02-01

    Platelet δ-storage pool disease (δ-SPD) is a platelet function disorder characterized by a reduction in the number or content of dense granules. Reports on δ-SPD are mostly limited to case presentations. We aimed to retrospectively describe a series of patients with δ-SPD to better characterize the disease. We studied 16 patients with congenital or acquired δ-SPD. Lumiaggregometry, α- and δ-granules content, platelet ultrastructure, αIIbβ3 integrin, and glycoprotein Ib (GPIb) activation were assessed. Most of the patients generally demonstrate mild to moderate bleeding diathesis. Platelet aggregation studies showed moderate abnormalities with variable profiles, while all the individuals had almost complete absence of adenosine triphosphate release. Mepacrine capture, CD63 expression, and study of dense granules by electron microscopy enabled to distinguish different subtypes of δ-SPD with quantitative or qualitative defect. Surprisingly, significantly decreased GPIb expression levels after platelet activation with thrombin receptor activating peptide 50 μM were found, suggesting that GPIb-impaired mobilization may represent an additional feature of the disorder. In conclusion, δ-SPD represents a complex disorder with various clinical and biological aspects, requiring a great deal of expertise to be properly diagnosed.

  6. CT and MRI findings of a solitary extramedullary plasmacytoma of the oropharynx: case report.

    PubMed

    Narumi, Tomohiko; Kozawa, Eito; Heshiki, Atsuko; Tomoda, Megumi; Shimizu, Yoshihiko

    2005-12-01

    We report a case of solitary extramedullary plasmacytoma (SEP) of the oropharynx. A 53-year-old man presented who had had bloody phlegm and a sore throat for a few days. A mass was endoscopically detected in his right posterior oropharyngeal wall, and biopsy revealed a neoplasm consisting of a uniform population of plasma cells. Computed tomography (CT) showed a broad-based papillary soft tissue density mass projecting into the oropharynx from the right posterior wall of the pharynx, and post-contrast CT showed marked enhancement of the tumor. The tumor showed slightly higher signal intensity compared with surrounding muscle on MR Tl-weighted images (T1WI) and high signal intensity on MR T2-weighted images (T2WI). The mass showed homogeneous enhancement on post-contrast T1WI. Further clinical examination showed an absence of multiple myeloma (MM). The patient was diagnosed as having SEP. Following radiation therapy, a reduction in tumor size was observed. Although SEP is a rare tumor, it should be included in the differential diagnosis of tumors of the oropharynx because of its imaging similarities to other, more common malignant tumors, such as squamous cell carcinoma and lymphoma.

  7. Tuberculosis case finding based on symptom screening among immigrants, refugees and asylum seekers in Rome.

    PubMed

    Sañé Schepisi, Monica; Gualano, Gina; Fellus, Claudia; Bevilacqua, Nazario; Vecchi, Marco; Piselli, Pierluca; Battagin, Giuliana; Silvestrini, Giulia; Attanasio, Andrea; Vela, Alberto; Rocca, Giorgia; Rinaldi, Alessandro; Benedetti, Pietro; Geraci, Salvatore; Lauria, Francesco Nicola; Girardi, Enrico

    2013-09-22

    In Italy the proportion of cases of tuberculosis in persons originating from high-prevalence countries has been increasing in the last decade. We designed a study to assess adherence to and yield of a tuberculosis screening programme based on symptom screening conducted at primary care centres for regular and irregular immigrants and refugees/asylum seekers. Presence of symptoms suggestive of active tuberculosis was investigated by verbal screening in migrants presenting for any medical condition to 3 free primary care centres in the province of Rome. Individuals reporting at least one symptom were referred to a tuberculosis clinic for diagnostic workup. Among 2142 migrants enrolled, 254 (11.9%) reported at least one symptom suggestive of active tuberculosis and 176 were referred to the tuberculosis clinic. Of them, 80 (45.4%) did not present for diagnostic evaluation. Tuberculosis was diagnosed in 7 individuals representing 0.33% of those screened and 7.3% of those evaluated for tuberculosis. The overall yield of this intervention was in the range reported for other tuberculosis screening programmes for migrants, although we recorded an unsatisfactory adherence to diagnostic workup. Possible advantages of this intervention include low cost and reduced burden of medical procedures for the screened population. Further evaluation of this approach appears to be warranted.

  8. Pathological and toxicological findings in glyphosate-surfactant herbicide fatality: a case report.

    PubMed

    Sribanditmongkol, Pongruk; Jutavijittum, Prapan; Pongraveevongsa, Pattaravadee; Wunnapuk, Klintean; Durongkadech, Piya

    2012-09-01

    Glyphosate herbicide is promoted by the manufacturer as having no risks to human health, with acute toxicity being very low in normal use. In Thailand, however, poisoning from glyphosate agricultural herbicides has been increasing. A case of rapid lethal intoxication from glyphosate-surfactant herbicide involved a 37-year-old woman, who deliberately ingested approximately 500 mL of concentrated Roundup formulation (41% glyphosate as the isopropylamine salt and 15% polyoxyethylene amine; Mosanto Company). The postmortem examination revealed that the stomach contained 550 mL of yellow fluid. The gastric mucosa of anterior fundus revealed hemorrhage and the small intestines had marked dilatation and thin walls. We used the high-performance liquid chromatography method for determination of serum and gastric content levels of glyphosate. The glyphosate levels of serum and gastric content were 3.05 and 59.72 mg/mL, respectively. Toxic effects of polyoxyethylene amine and Roundup were caused by their ability to erode tissues including mucous membranes and linings of the gastrointestinal and respiratory tracts. A mild degree of pulmonary congestion and edema was observed in both lungs. We proposed that the characteristic picture of microvesicular steatosis of the hepatocytes, seen predominantly in centrilobular zones of the liver, resembled drug-induced hepatic toxicity or secondary hypoxic stress.

  9. Feline lungworm Oslerus rostratus (Strongylida: Filaridae) in Italy: first case report and histopathological findings.

    PubMed

    Brianti, Emanuele; Gaglio, Gabriella; Napoli, Ettore; Falsone, Luigi; Giannelli, Alessio; Annoscia, Giada; Varcasia, Antonio; Giannetto, Salvatore; Mazzullo, Giuseppe; Otranto, Domenico

    2014-10-01

    Oslerus rostratus syn. Anafilaroides rostratus (Strongylida: Filaroididae) is a metastrongyloid transmitted by snails, which localizes in peri-bronchial tissues and in the lung parenchyma of wild as well as domestic cats. In Europe, this nematode has been reported only on two occasions, being diagnosed in cats from Majorca Island and in northern Spain. Here, we describe a case of O. rostratus infection in a necropsied 4-year-old cat in Sicily (southern Italy). At the inspection of lungs, slender and greyish nematodes (four females and two males) were found embedded in the peri-bronchial tissues and in the bronchial walls. Parasites were morphological and molecularly identified as O. rostratus, with their 18S sequences being identical among them and showing a high homology (99%) with those available in public databases. At the histology, nematodes were encapsulated in a pseudo-cystic formation surrounded by an interstitial inflammatory process and fibrous tissue. Lung lesions were mainly represented by peri-luminal fibrosis, hyperplasia and hypertrophy of the bronchial mucosa and glands, respectively. This first record of O. rostratus infection from Italy indicates that this parasite should be included in the differential diagnosis of feline of lungworm infection.

  10. From struggles to resource gains in interprofessional service networks: Key findings from a multiple case study.

    PubMed

    Toiviainen, Hanna; Kira, Mari

    2017-07-01

    In interprofessional service networks, employees cross professional boundaries to collaborate with colleagues and clients with expertise and values different from their own. It can be a struggle to adopt shared work practices and deal with "multivoicedness." At the same time, networks allow members to engage in meaningful service provision, gain a broader understanding of the service provided, and obtain social support. Intertwined network struggles and resource gains have received limited attention in the interprofessional care literature to date. The aim of the study was to investigate the learning potential of the co-existing struggles and resource gains. This article reports findings from two interprofessional networks. Interviews were conducted with 19 employees and thematically analysed. Three types of struggles and six types of resource gains of networking were identified. The struggles relate, first, to the assumptions of networking following similar practices to those in a home organisation; second, to the challenges of dealing with the multivoicedness of networking; and, third, to the experienced gap between the networking ideals and the reality of cooperation. At the same time, the network members experience gains in emotional resources (e.g., stronger sense of meaningfulness at work), cognitive resources (e.g., understanding the customer needs from alternative perspectives), and social resources (e.g., being able to rely on other professionals' competence). Learning potential emerged from the dynamics between coexisting struggles and resource gains.

  11. Echocardiographic findings in infants with presumed congenital Zika syndrome: Retrospective case series study

    PubMed Central

    Santos, Cleusa C.; Feitosa, Fabiana G.; Ribeiro, Maria C.; Menge, Paulo; Lira, Izabelle M.

    2017-01-01

    Objective To report the echocardiographic evaluation of 103 infants with presumed congenital Zika syndrome. Methods An observational retrospective study was performed at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Brazil. 103 infants with presumed congenital Zika syndrome. All infants had microcephaly and head computed tomography findings compatible with congenital Zika syndrome. Zika IgM antibody was detected in cerebrospinal fluid samples of 23 infants. In 80 infants, the test was not performed because it was not available at that time. All infants had negative serology for HIV, syphilis, rubella, cytomegalovirus and toxoplasmosis. A complete transthoracic two-dimensional, M-mode, continuous wave and pulsed wave Doppler and color Doppler echocardiographic (PHILIPS HD11XE or HD15) examination was performed on all infants. Results 14/103 (13.5%) echocardiograms were compatible with congenital heart disease: 5 with an ostium secundum atrial septal defect, 8 had a hemodynamically insignificant small apical muscular ventricular septal defect and one infant with dyspnea had a large membranous ventricular septal defect. The echocardiograms considered normal included 45 infants with a persistent foramen ovale and 16 with a minimum patent ductus arteriosus. Conclusions Preliminarily this study suggests that congenital Zika syndrome may be associated with an increase prevalence of congenital heart disease. However the types of defects noted were septal defects, a proportion of which would not be hemodynamically significant. PMID:28426680

  12. Clinical findings associated with prairie rattlesnake bites in dogs: 100 cases (1989-1998).

    PubMed

    Hackett, Tim B; Wingfield, Wayne E; Mazzaferro, Elisa M; Benedetti, Joanna S

    2002-06-01

    To identify clinically relevant variables and treatments for dogs bitten by prairie rattlesnakes (Crotalus viridis viridis). Retrospective study. 100 client-owned dogs. Records of dogs evaluated for rattlesnake envenomation from 1989 to 1998 were reviewed. Analysis was performed to test for significant associations among clinical variables or treatments and cell counts, costs, and duration of hospitalization. Most prairie rattlesnake bites occurred between May and September. Dogs were 3 months to 12 years old (median, 3.7 years); most were bitten on the head in the late afternoon. There was no sex predilection. Median time to evaluation was 1 hour (range, 15 minutes to 13 hours). Swelling in the area of the bite was the primary physical abnormality. Principal initial laboratory findings were echinocytosis, thrombocytopenia, leukocytosis, and prolonged activated clotting time. Ninety-four dogs were hospitalized; 48 were discharged the following day. Antimicrobials and crystalloid fluids, glucocorticoids, antihistamines, and antivenin administered i.v. were the most commonly used treatments. One dog died, and small dogs were hospitalized longer than large dogs. Antivenin administration was not significantly associated with duration of hospitalization but was associated with higher platelet counts after treatment and higher total hospital costs. Prairie rattlesnake envenomation in dogs is associated with high morbidity rate but low mortality rate. The efficacy of administration of antivenin for dogs with bites from this snake species is questionable.

  13. A Case of ADEM Mimicking Cerebral Adrenoleukodystrophy Based on Supratentorial MRI Findings

    PubMed Central

    BEYAZAL, Mehmet; ÜNAL, Özkan; YILMAZ, Sanem; BORA, Aydın

    2014-01-01

    A 9-year-old male admitted for syncope also had the complains of pain and numbness in his legs and frequent falling down. There was a history of upper respiratory tract infection 10 days before. On neurologic examination, paraparesia and fall a sleep were identified. On magnetic resonance imaging, the symetric signal increases were seen in biparieto-occipital white matter intented to corpus callosum at T2-weighted sequences and cytotoxic edema was seen at diffusion-weighted images. Heterogeneous contrast enhancement was seen on these areas. In addition, at the C7-Th5 vertebrae levels, spinal cord had diffuse increased signal intensity and contrast enhancement. Acute disseminated encephalomyelitis was thought based on clinical and radiological findings. Steroid therapy was started. Significant improvement was shown after treatment. On 2-year follow-up, there was no recurrence. In conclusion, it must be kept in mind that acute disseminated encephalomyelitis can rarely present with biparieto-occipital involvement which extends to corpus callosum and can mimic adrenoleukodystrophy. For the differential diagnosis butterfly glioma, tumefactive demyelinating lesions or multiple sclerosis should be considered.

  14. [MRI and SPECT findings in a case of metronidazole-induced reversible acute cerebellar ataxia].

    PubMed

    Takase, Kei-ichiro; Santa, Yo; Ohta, Sumio; Yoshimura, Takeo

    2005-05-01

    A 69-year-old man was referred to our department because of acute onset nausea, vomiting, dysphagia, dysarthria and gait disturbance. He had a 50-day-history of amebic dysentery and had been treated with 1,500 mg metronidazole per day. Neurological examination revealed dysphagia, ataxic speech, ataxia of the left extremities and the trunk, and hyperactive deep tendon reflexes in all extremities. Sensory impairment of all modalities was apparent in a glove and stocking pattern, with mild paresthesia. Brain MRI showed T2 high signal lesions in the bilateral cerebellar dentate nuclei, more markedly on the left. On brain SPECT, obvious low blood perfusion was observed in the left cerebellar hemisphere. These findings well explained the ataxia of the left limbs. One month after discontinuing metronidazole, the cerebellar ataxia, dysphagia and MRI abnormalities completely cleared. Therefore, central nervous system damage induced by metronidazole is considered reversible. In spite of the presence of the MRI lesion in the right dentate nucleus, the patient had no ataxia of the right extremities and there was no hypoperfusion in the right cerebellar hemisphere. Thus, metronidazole does not appear to have a direct neurotoxic effect on the central nervous system. On the other hand, nerve conduction studies showed axonal polyneuropathy, which was not improved one month after cessation of the drug; thus metronidazole seems to exert more damage on peripheral nerves.

  15. Canine dilated cardiomyopathy: a retrospective study of prognostic findings in 367 clinical cases.

    PubMed

    Martin, M W S; Stafford Johnson, M J; Strehlau, G; King, J N

    2010-08-01

    To review the association between clinical signs and diagnostic findings and the survival time of dogs with dilated cardiomyopathy (DCM), and any influence of treatment prescribed. A retrospective observational study of 367 dogs with DCM. Survival times until death or euthanasia for cardiac reasons were analysed using the Kaplan-Meier method plus univariate and multivariate Cox proportional hazards models. Two-tailed P values less than 0.05 were considered statistically significant. In the multivariate model, left ventricular diameter (LVDs)-index (P=0.0067), presence of pulmonary oedema on radiography (P=0.043), presence of ventricular premature complexes (VPCs) (P=0.0012), higher plasma creatinine (P=0.0002), lower plasma protein (P=0.029) and great Dane breed (P=0.0003) were negatively associated with survival. Most dogs were treated with angiotensin-converting enzyme inhibitors (93%) or furosemide (86%), and many received digoxin (50%) and/or pimobendan (30%). Thirteen dogs were lost to follow-up. No conclusions could be made in this study on the association between use of drugs and survival. The LVDs-index was the single best variable for assessing the prognosis in this group of dogs with DCM. Other variables that were negatively associated with survival were presence of pulmonary oedema on radiography, presence of VPCs, higher plasma creatinine, lower plasma protein and great Dane breed.

  16. Finding retrieval-induced forgetting in recognition tests: a case for baseline memory strength

    PubMed Central

    Spitzer, Bernhard

    2014-01-01

    Retrieval practice of previously studied material can impair subsequent memory for related unpracticed material. An emerging view holds that such retrieval-induced forgetting (RIF) may affect episodic recollection, but not the context-free familiarity of the affected items. Here, a survey of accruing recent findings of RIF in recognition tests shows that the impairment of unpracticed material depends vitally on baseline memory strength. Therein, the absence of RIF under specific conditions, previously taken as evidence for the immunity of familiarity, can be predicted on grounds of exceedingly low baseline levels. Similarly, differential RIF effects on the parameters of dual-process recognition models can be explained by baseline differences, suggesting that RIF might impair any sub-process that substantially contributes to overall recognition accuracy. By contrast, the strengthening of practiced material appears independent of baseline levels and does not predict the magnitude of RIF, in accordance with an inhibitory causation of the forgetting. In summary, the inventory presents RIF in recognition as a subtle proportional impairment, future illumination of which may demand increased attention to baseline memory levels. PMID:25324808

  17. Finding retrieval-induced forgetting in recognition tests: a case for baseline memory strength.

    PubMed

    Spitzer, Bernhard

    2014-01-01

    Retrieval practice of previously studied material can impair subsequent memory for related unpracticed material. An emerging view holds that such retrieval-induced forgetting (RIF) may affect episodic recollection, but not the context-free familiarity of the affected items. Here, a survey of accruing recent findings of RIF in recognition tests shows that the impairment of unpracticed material depends vitally on baseline memory strength. Therein, the absence of RIF under specific conditions, previously taken as evidence for the immunity of familiarity, can be predicted on grounds of exceedingly low baseline levels. Similarly, differential RIF effects on the parameters of dual-process recognition models can be explained by baseline differences, suggesting that RIF might impair any sub-process that substantially contributes to overall recognition accuracy. By contrast, the strengthening of practiced material appears independent of baseline levels and does not predict the magnitude of RIF, in accordance with an inhibitory causation of the forgetting. In summary, the inventory presents RIF in recognition as a subtle proportional impairment, future illumination of which may demand increased attention to baseline memory levels.

  18. Chemoradiotherapy of Newly Diagnosed Glioblastoma With Intensified Temozolomide

    SciTech Connect

    Weiler, Markus; Hartmann, Christian; Wiewrodt, Dorothee; Herrlinger, Ulrich

    2010-07-01

    Purpose: To evaluate the toxicity and efficacy of chemoradiotherapy with temozolomide (TMZ) administered in an intensified 1-week on/1-week off schedule plus indomethacin in patients with newly diagnosed glioblastoma. Patients and Methods: A total of 41 adult patients (median Karnofsky performance status, 90%; median age, 56 years) were treated with preirradiation TMZ at 150 mg/m{sup 2} (1 week on/1 week off), involved-field radiotherapy combined with concomitant low-dose TMZ (50 mg/m{sup 2}), maintenance TMZ starting at 150 mg/m{sup 2} using a 1-week on/1-week off schedule, plus maintenance indomethacin (25 mg twice daily). Results: The median follow-up interval was 21.7 months. Grade 4 hematologic toxicity was observed in 15 patients (36.6%). Treatment-related nonhematologic Grade 4-5 toxicity was reported for 2 patients (4.9%). The median progression-free survival was 7.6 months (95% confidence interval, 6.2-10.4). The 1-year survival rate was 73.2% (95% confidence interval, 56.8-84.2%). The presence of O{sup 6}-methylguanine-DNA methyltransferase (MGMT) gene promoter methylation in the tumor tissue was associated with significantly superior progression-free survival. Conclusion: The dose-dense regimen of TMZ administered in a 1-week on/1-week off schedule resulted in acceptable nonhematologic toxicity. Compared with data from the European Organization for Research and Treatment of Cancer/National Cancer Institute of Canada trial 26981-22981/CE.3, patients with an unmethylated MGMT gene promoter appeared not to benefit from intensifying the TMZ schedule regarding the median progression-free survival and overall survival. In contrast, data are promising for patients with a methylated MGMT promoter.

  19. Incidental finding of carcinoid tumor on Meckel’s diverticulum: case report and literature review, should prophylactic resection be recommended?

    PubMed Central

    2014-01-01

    Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and is caused by incomplete obliteration of the vitelline duct during intrauterine life. MD affects less than 2% of the population. In most cases, MD is asymptomatic and the estimated average complication risk of MD carriers, which is inversely proportional to age, ranges between 2% and 4%. The most common MD-related complications are gastrointestinal bleeding, intestinal obstruction and acute phlogosis. Excision is mandatory in the case of symptomatic diverticula regardless of age, while surgical treatment for asymptomatic diverticula remains controversial. According to the majority of studies, the incidental finding of MD in children is an indication for surgical resection, while the management of adults is not yet unanimous. In this case report, we describe the prophylactic resection of an incidentally detected MD, which led to the removal of an occult mucosal carcinoid tumor. In literature, the association of MD and carcinoid tumor is reported as a rare finding. Even though the strategy for adult patients of an incidental finding of MD during surgery performed for other reasons divides the experts, we recommend prophylactic excision in order to avoid any further risk. PMID:24884768

  20. Incidental finding of carcinoid tumor on Meckel's diverticulum: case report and literature review, should prophylactic resection be recommended?

    PubMed

    Caracappa, Daniela; Gullà, Nino; Lombardo, Francesco; Burini, Gloria; Castellani, Elisa; Boselli, Carlo; Gemini, Alessandro; Burattini, Maria Federica; Covarelli, Piero; Noya, Giuseppe

    2014-05-08

    Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and is caused by incomplete obliteration of the vitelline duct during intrauterine life. MD affects less than 2% of the population. In most cases, MD is asymptomatic and the estimated average complication risk of MD carriers, which is inversely proportional to age, ranges between 2% and 4%. The most common MD-related complications are gastrointestinal bleeding, intestinal obstruction and acute phlogosis. Excision is mandatory in the case of symptomatic diverticula regardless of age, while surgical treatment for asymptomatic diverticula remains controversial. According to the majority of studies, the incidental finding of MD in children is an indication for surgical resection, while the management of adults is not yet unanimous. In this case report, we describe the prophylactic resection of an incidentally detected MD, which led to the removal of an occult mucosal carcinoid tumor. In literature, the association of MD and carcinoid tumor is reported as a rare finding. Even though the strategy for adult patients of an incidental finding of MD during surgery performed for other reasons divides the experts, we recommend prophylactic excision in order to avoid any further risk.