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Sample records for international case series

  1. Bisphosphonates in Langerhans Cell Histiocytosis: An International Retrospective Case Series

    PubMed Central

    Chellapandian, Deepak; Makras, Polyzois; Kaltsas, Gregory; van den Bos, Cor; Naccache, Lamia; Rampal, Raajit; Carret, Anne-Sophie; Weitzman, Sheila; Egeler, R. Maarten; Abla, Oussama

    2016-01-01

    Background Bone is the most common organ of involvement in patients with Langerhans cell histiocytosis (LCH), which is often painful and associated with significant morbidity from pathological fractures. Current first-line treatments include chemotherapy and steroids that are effective but often associated with adverse effects, whereas the disease may reactivate despite an initial response to first-line agents. Bisphosphonates are osteoclast inhibitors that have shown to be helpful in treating bone lesions of LCH. To date, there are no large international studies to describe their role in treating bone lesions of LCH. Method We conducted a multicenter retrospective review of 13 patients with histologically proven LCH, who had received bisphosphonates either at diagnosis or at disease reactivation. Results Ten patients (77%) had a single system bone disease, and 3 (23%) had bone lesions as part of multisystem disease. Median follow-up time post-bisphosphonate therapy was 4.6 years (range, 0.8 to 8.2 years). Treatment with bisphosphonates was associated with significant pain relief in almost all patients. Twelve (92%) achieved resolution of active bone lesions, and 10 out of them had no active disease for a median of 3.5 years (range, 0.8 to 5 years). One patient did not respond. No major adverse effects were reported in this series. Conclusion Bisphosphonates are well-tolerated drugs that can significantly improve bone pain and induce remission in active bone LCH. Future prospective studies evaluating the role of bisphosphonates in LCH are warranted. PMID:27413525

  2. Tooth resorption part I - pathogenesis and case series of internal resorption

    PubMed Central

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

    2013-01-01

    Resorption is a pathologic process that often eludes the clinician with its varied etiologic factors and diverse clinical presentations. The key cells involved in tooth resorption are odontoclasts which are multinucleated cells that produce resorption lacunae. Resorption can be classified as internal and external resorption. Internal resorption has been described as a rare occurrence as compared to external resorption. This article describes the pathogenesis of tooth resorption and various forms of internal resorption along with some clinical cases. Early diagnosis is the key factor in the successful management of resorptive lesions. PMID:23349568

  3. Prader-Willi syndrome: causes of death in an international series of 27 cases.

    PubMed

    Schrander-Stumpel, Constance Th R M; Curfs, Leopold M G; Sastrowijoto, Prapto; Cassidy, Suzanne B; Schrander, Jaap J P; Fryns, Jean-Pierre

    2004-02-01

    Prader-Willi syndrome (PWS) is a complex condition with many medical and psychological features. In individuals with this syndrome, causes of death were studied. Data of 27 case reports were collected. Ages at death ranged from neonatal to 68 years. None of the individuals were treated with growth hormone (GH). Most cases were not completely documented and autopsy was performed in a minority of cases only. In five cases, death was considered not to be causally related to PWS. Hypotonia with hypoventilation was noted in the babies, and acute respiratory illness with unexpected sudden death was experienced in young children with PWS. Two young children died after a short period of fever and gastroenteritis. Obesity and its complications leading to death were pronounced in the adult group. One (possibly two) adult(s) died from gastric dilatation and shock. Based on these data, some cautious conclusions can be drawn. In babies with PWS hypoventilation is a risk factor; upper airway infection may be more serious than anticipated and any other clinical features pointing to an infection should be taken very seriously. Therefore, young infants with PWS hospitalized with an upper airway infection and/or hypoventilation or gastroenteritis symptoms, should be closely monitored. Early diagnosis and prevention of overweight is a major factor in preventing early causes of death in individuals with PWS. In the adult group, weight reduction is important but difficult to manage. Sleep apnea should be recognized and treated. Pain in the upper stomach and/or vomiting should be taken as a possible sign of acute intestinal dilatation; intravenous support may be life saving.

  4. Pleural plaques related to “take-home” exposure to asbestos: An international case series

    PubMed Central

    Peretz, Alon; Van Hee, Victor C; Kramer, Mordechai R; Pitlik, Silvio; Keifer, Matthew C

    2008-01-01

    Context: While a large number of studies indicate the risks of high-level exposures to asbestos in the workplace setting, a relatively small number of studies describe the risk of pleural disease related to “take-home” asbestos brought into the household by workers exposed to asbestos. Consequently, the risk of pleural disease in family members of asbestos-exposed workers is likely underappreciated. Case presentations: Two families of siblings, one in Israel and one in the US, were evaluated because of their significant exposures to asbestos brought into the home by family members with heavy occupational exposures. Two of the four children of an asbestos cement debagger in Petach Tikvah, Israel and two children of a pipe lagger in a naval shipyard near Seattle, Washington, manifested benign pleural disease without parenchymal disease, despite having no occupational exposure to asbestos. Discussion: These cases illustrate that “take-home” asbestos exposure may lead to pleural disease at higher rates than commonly realized. Relevance to clinical practice: Providers should recognize that due to the potential for “take-home” exposures, asbestos-related disease in a patient may be a marker for disease in household contacts. Patients with family members heavily exposed to asbestos should be strongly encouraged to quit smoking in an effort to reduce any further carcinogenic exposures. Additionally, workplace control and regulation of asbestos use should be emphasized to protect both workers and their families. PMID:20428401

  5. Propionibacterium endocarditis: a case series from the International Collaboration on Endocarditis Merged Database and Prospective Cohort Study.

    PubMed

    Lalani, Tahaniyat; Person, Anna K; Hedayati, Susan S; Moore, Laura; Murdoch, David R; Hoen, Bruno; Peterson, Gail; Shahbaz, Hasan; Raoult, Didier; Miro, Jose M; Olaison, Lars; Snygg-Martino, Ulrika; Suter, Fredy; Spelman, Dennis; Eykyn, Susannah; Strahilevitz, Jacob; Van der Meer, Jan T; Verhagen, Dominique; Baloch, Khaula; Abrutyn, Elias; Cabell, Christopher H

    2007-01-01

    Propionibacterium species are occasionally associated with serious systemic infections such as infective endocarditis. In this study, we examined the clinical features, complications and outcome of 15 patients with Propionibacterium endocarditis using the International Collaboration on Endocarditis Merged Database (ICE-MD) and Prospective Cohort Study (ICE-PCS), and compared the results to 28 cases previously reported in the literature. In the ICE database, 11 of 15 patients were male with a mean age of 52 y. Prosthetic valve endocarditis occurred in 13 of 15 cases and 3 patients had a history of congenital heart disease. Clinical findings included valvular vegetations (9 patients), cardiac abscesses (3 patients), congestive heart failure (2 patients), and central nervous system emboli (2 patients). Most patients were treated with beta-lactam antibiotics alone or in combination for 4 to 6 weeks. 10 of the 15 patients underwent valve replacement surgery and 2 patients died. Similar findings were noted on review of the literature. The results of this paper suggest that risk factors for Propionibacterium endocarditis include male gender, presence of prosthetic valves and congenital heart disease. The clinical course is characterized by complications such as valvular dehiscence, cardiac abscesses and congestive heart failure. Treatment may require a combination of medical and surgical therapy.

  6. Protostylid: A case series

    PubMed Central

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

    2013-01-01

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

  7. Phocomelia: A Worldwide Descriptive Epidemiologic Study in a Large Series of Cases From the International Clearinghouse for Birth Defects Surveillance and Research, and Overview of the Literature

    PubMed Central

    Bermejo-Sánchez, Eva; Cuevas, Lourdes; Amar, Emmanuelle; Bianca, Sebastiano; Bianchi, Fabrizio; Botto, Lorenzo D.; Canfield, Mark A.; Castilla, Eduardo E.; Clementi, Maurizio; Cocchi, Guido; Landau, Danielle; Leoncini, Emanuele; Li, Zhu; Lowry, R. Brian; Mastroiacovo, Pierpaolo; Mutchinick, Osvaldo M.; Rissmann, Anke; Ritvanen, Annukka; Scarano, Gioacchino; Siffel, Csaba; Szabova, Elena; Martínez-Frías, María-Luisa

    2015-01-01

    Epidemiologic data on phocomelia are scarce. This study presents an epidemiologic analysis of the largest series of phocomelia cases known to date. Data were provided by 19 birth defect surveillance programs, all members of the International Clearinghouse for Birth Defects Surveillance and Research. Depending on the program, data corresponded to a period from 1968 through 2006. A total of 22,740,933 live births, stillbirths and, for some programs, elective terminations of pregnancy for fetal anomaly (ETOPFA) were monitored. After a detailed review of clinical data, only true phocomelia cases were included. Descriptive data are presented and additional analyses compared isolated cases with those with multiple congenital anomalies (MCA), excluding syndromes. We also briefly compared congenital anomalies associated with nonsyndromic phocomelia with those presented with amelia, another rare severe congenital limb defect. A total of 141 phocomelia cases registered gave an overall total prevalence of 0.62 per 100,000 births (95% confidence interval: 0.52–0.73). Three programs (Australia Victoria, South America ECLAMC, Italy North East) had significantly different prevalence estimates. Most cases (53.2%) had isolated phocomelia, while 9.9% had syndromes. Most nonsyndromic cases were monomelic (55.9%), with an excess of left (64.9%) and upper limb (64.9%) involvement. Most nonsyndromic cases (66.9%) were live births; most isolated cases (57.9%) weighed more than 2,499 g; most MCA (60.7%) weighed less than 2,500 g, and were more likely stillbirths (30.8%) or ETOPFA (15.4%) than isolated cases. The most common associated defects were musculoskeletal, cardiac, and intestinal. Epidemiological differences between phocomelia and amelia highlighted possible differences in their causes. PMID:22002800

  8. Household Resources and Their Changing Relationships: Case Studies in Gujarat, India. International Agriculture Publications General Series Number 3.

    ERIC Educational Resources Information Center

    Magrabi, Frances M., Ed.; Verma, Amita, Ed.

    This publication contains case studies based on rural life in northern India. The titles include: (1) "Profiles of Two Indian Rural Settings"; (2) "Visitors View a Village"; (3) "Village Households"; (4) "Agriculture"; (5) "Women's Needs: Health and Nutrition"; (6) "Meal Pattern, Nutrient…

  9. Case Citations 1991. Eleventh Series.

    ERIC Educational Resources Information Center

    Sharp, Linda A., Ed.

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

  10. The Japanese "Internment" Cases Revisited.

    ERIC Educational Resources Information Center

    Robinson, Edward T.

    2003-01-01

    Reviews topics discussed in the OAH article, "Incarcerating Japanese Americans" (Roger Daniels). States that the three internment cases were correct. Asks whether internment could re-occur given the climate in U.S. society since September 11, 2001. (CMK)

  11. SUDEP: The First Case Series in Turkey

    PubMed Central

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

    2016-01-01

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

  12. Hepatic sarcoidosis: a case series

    PubMed Central

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

    2016-01-01

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

  13. Kartagener's syndrome: A case series

    PubMed Central

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

    2012-01-01

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

  14. A Case Series: Congenital Hyperinsulinism

    PubMed Central

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

    2016-01-01

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

  15. Kaposi's varicelliform eruption: A case series

    PubMed Central

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

    2015-01-01

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

  16. Reduction of High Levels of Internal Radio-Contamination by Dietary Intervention in Residents of Areas Affected by the Fukushima Daiichi Nuclear Plant Disaster: A Case Series

    PubMed Central

    Tsubokura, Masaharu; Kato, Shigeaki; Nomura, Shuhei; Gilmour, Stuart; Nihei, Masahiko; Sakuma, Yu; Oikawa, Tomoyoshi; Kanazawa, Yukio; Kami, Masahiro; Hayano, Ryugo

    2014-01-01

    Maintaining low levels of chronic internal contamination among residents in radiation-contaminated areas after a nuclear disaster is a great public health concern. However, the efficacy of reduction measures for individual internal contamination remains unknown. To reduce high levels of internal radiation exposure in a group of individuals exposed through environmental sources, we performed careful dietary intervention with identification of suspected contaminated foods, as part of mass voluntary radiation contamination screenings and counseling program in Minamisoma Municipal General Hospital and Hirata Central Hospital. From a total of 30,622 study participants, only 9 residents displayed internal cesium-137 (Cs-137) levels of more than 50 Bq/kg. The median level of internal Cs-137 contamination in these residents at the initial screening was 4,830 Bq/body (range: 2,130–15,918 Bq/body) and 69.6 Bq/kg (range: 50.7–216.3 Bq/kg). All these residents with high levels of internal contamination consumed homegrown produce without radiation inspection, and often collected mushrooms in the wild or cultivated them on bed-logs in their homes. They were advised to consume distributed food mainly and to refrain from consuming potentially contaminated foods without radiation inspection and local produces under shipment restrictions such as mushrooms, mountain vegetables, and meat of wild life. A few months after the intervention, re-examination of Cs levels revealed remarkable reduction of internal contamination in all residents. Although the levels of internal radiation exposure appear to be minimal amongst most residents in Fukushima, a subset of the population, who unknowingly consumed highly contaminated foodstuffs, experienced high levels of internal contamination. There seem to be similarities in dietary preferences amongst residents with high internal contamination levels, and intervention based on pre- and post-test counseling and dietary advice from medical care

  17. Transvestism as a Symptom: A Case Series

    PubMed Central

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

    2016-01-01

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

  18. Management of velopharyngeal disorders. A case series.

    PubMed

    Anandakrishna, G N; Gali, Sivaranjani

    2010-07-01

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

  19. Endodontic management of nonvital permanent teeth having immature roots with one step apexification, using mineral trioxide aggregate apical plug and autogenous platelet-rich fibrin membrane as an internal matrix: Case series

    PubMed Central

    Sharma, Vivek; Sharma, Sarang; Dudeja, Pooja; Grover, Shibani

    2016-01-01

    A tooth with blunderbuss canal and open apex can be an endodontic challenge because of difficulty in obtaining an apical seal, and existing thin radicular walls which are susceptible to fracture. To overcome the limitations of traditional long-term calcium hydroxide apexification procedures, nonsurgical one step apexification using an array of materials such as mineral trioxide aggregate (MTA) has been suggested. However, adequate compaction of MTA in teeth with wide open apices can be an arduous task, and an internal matrix is required for controlled placement of MTA against which obturating material can be condensed. Platelet-rich fibrin (PRF), a second generation platelet concentrate containing several growth factors that promotes hard and soft-tissue healing, has been used as an internal matrix to create an apical plug of MTA and hence prevent extrusion of filling materials. This case series presents the endodontic management of immature permanent teeth with open apices using internal matrix of autologous PRF membrane and one step apical barrier placement of MTA. PMID:27041904

  20. INTERNAL AUTOSCOPY : A CASE REPORT

    PubMed Central

    Rao, K.N.

    1992-01-01

    Internal autoscopy, a rare special type of visual hallucination, is claimed to have been mainly reported by French psychiatrist who considered it to occur mainly in young female subjects suffering from hysteria. In this report, such a cases is described in a 70 year old male patient suffering from M.D.P. (Depression). Its differential diagnosis and phenomenology is discussed. It is suggested that Internal autoscopy may be cognitive or ideational disturbance, expressed as a perceptual experience. PMID:21776133

  1. Common Carotid Artery Occlusion: A Case Series

    PubMed Central

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

    2013-01-01

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

  2. Pseudocirrhosis: A Case Series and Literature Review

    PubMed Central

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

    2016-01-01

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

  3. INTERNAL HEMIPELVECTOMY: REPORT ONEIGHT CASES

    PubMed Central

    Oliveira, Alexandre Ferreira; Vieira, Leonardo José; do Nascimento, Antônio Carlos Rodrigues; de Paula Fraga, João Baptista; Costa, Rómmel Ribeiro Lourenço; do Nascimento, Luiz Gustavo Rodrigues

    2015-01-01

    Internal hemipelvectomy is a surgical procedure adequate for treatment of certain tumors of the pelvic girdle. Being a lower limb-preserving approach, it is a therapeutic alternative to the classical interilioabdominal amputation and hip joint disarticulation. According to Enneking's classification, there are four types of internal hemipelvectomies, although the association of different types of resection in the same procedure is feasible if necesary. This surgical approach should be correctly indicated to positively affect the patient's morbidity, mortality and quality of life. We report eight cases of internal hemipelvectomy in patients diagnosed with tumors of the pelvic girdle. We also discuss the neoadjuvant and adjuvant treatments used, along with their follow-up. PMID:27047900

  4. Whale's tail technique: A case series

    PubMed Central

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

    2016-01-01

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

  5. Ictal swearing: a case series and review.

    PubMed

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

    2013-12-01

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

  6. Neuromusculoskeletal disorders following SARS: a case series

    PubMed Central

    Stainsby, Brynne; Howitt, Scott; Porr, Jason

    2011-01-01

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

  7. Exact series model of Langevin transducers with internal losses.

    PubMed

    Nishamol, P A; Ebenezer, D D

    2014-03-01

    An exact series method is presented to analyze classical Langevin transducers with arbitrary boundary conditions. The transducers consist of an axially polarized piezoelectric solid cylinder sandwiched between two elastic solid cylinders. All three cylinders are of the same diameter. The length to diameter ratio is arbitrary. Complex piezoelectric and elastic coefficients are used to model internal losses. Solutions to the exact linearized governing equations for each cylinder include four series. Each term in each series is an exact solution to the governing equations. Bessel and trigonometric functions that form complete and orthogonal sets in the radial and axial directions, respectively, are used in the series. Asymmetric transducers and boundary conditions are modeled by using axially symmetric and anti-symmetric sets of functions. All interface and boundary conditions are satisfied in a weighted-average sense. The computed input electrical admittance, displacement, and stress in transducers are presented in tables and figures, and are in very good agreement with those obtained using atila-a finite element package for the analysis of sonar transducers. For all the transducers considered in the analysis, the maximum difference between the first three resonance frequencies calculated using the present method and atila is less than 0.03%.

  8. Treatment of gingival pigmentation: a case series.

    PubMed

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

    2005-01-01

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

  9. Facial Firework Injury: A Case Series

    PubMed Central

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

    2014-01-01

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

  10. Dance-related concussion: a case series.

    PubMed

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

    2014-01-01

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

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

    PubMed Central

    Pavia, Steven; Fischer, Rebecca; Roy, Richard

    2015-01-01

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

  12. Case Citations 1992, Twelfth Series: Employment.

    ERIC Educational Resources Information Center

    Cambron-McCabe, Nelda H., Ed.

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

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

    PubMed

    Rapp, Brenda

    2011-10-01

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

  14. Histopathologic classification of parapharyngeal space tumors: a case series and review of the literature.

    PubMed

    Locketz, Garrett D; Horowitz, Gilad; Abu-Ghanem, Sara; Wasserzug, Oshri; Abergel, Abraham; Yehuda, Moshe; Fliss, Dan M

    2016-03-01

    The objective of the study is to present a large case series of parapharyngeal space tumors (PPST) and the most comprehensive literature review of tumor histopathologic distribution. The study was designed as internal case series and full Pubmed/MEDLINE electronic database review in a tertiary academic medical center. Tumor histopathology and patient demographics were obtained from a comprehensive Pubmed/MEDLINE database review, as well from an internal case series of 117 patients referred to our center between 1993 and 2013. Main outcome and measures of the study were to define the age, gender, and histopathology of PPST within a large internal case series and among the current body of published literature, and to propose a diagnostic and treatment algorithm for these tumors. Our cohort included 117 cases, 58 females and 59 males, with benign tumors comprising 85 % (n = 99) and malignant tumors 15 % (n = 18). A systematic review of published literature from 1963 to the present revealed 37 case series, and when combined with our present series, yielded a total of 2160 cases. Benign tumors are most common (78.8 %), with tumors of salivary gland (44.4 %), neural (34.4 %), and vascular (2.64 %) origin representing the largest subtypes. Pleomorphic adenomas (30.9 %), paragangliomas (13.1 %), and schwannomas (12.3 %) comprised the majority of all cases. Due to their rarity, data regarding the histopathologic distribution of PPST is scarce. We provide one of the largest case series and the most comprehensive review of these tumors in the literature to date, and offer our algorithm for evaluation and treatment.

  15. Internal and External Reconnection Series Homologous Solar Flares

    NASA Technical Reports Server (NTRS)

    Sterling, Alphonse C.; Moore, Ronald L.

    2001-01-01

    Using data from the extreme ultraviolet imaging telescope (EIT) on SOHO and the soft X-ray telescope (SXT) on Yohkoh, we examine a series of morphologically homologous solar flares occurring in National Oceanic and Atmospheric Administration (NOAA) active region 8210 over May 1-2, 1998. An emerging flux region (EFR) impacted against a sunspot to the west and next to a coronal hole to the east is the source of the repeated flaring. An SXT sigmoid parallels the EFR's neutral line at the site of the initial flaring in soft X rays. In EIT each flaring episode begins with the formation of a crinkle pattern external to the EFR. These EIT crinkles move out from, and then in toward, the EFR with velocities approx. 20 km/ s. A shrinking and expansion of the width of the coronal hole coincides with the crinkle activity, and generation and evolution of a postflare loop system begins near the time of crinkle formation. Using a schematic based on magnetograms of the region, we suggest that these observations are consistent with the standard reconnection-based model for solar eruptions but are modified by the presence of the additional magnetic fields of the sunspot and coronal hole. In the schematic, internal reconnection begins inside of the EFR-associated fields, unleashing a flare, postflare loops, and a coronal mass ejection (CME). External reconnection, first occurring between the escaping CME and the coronal hole field and second occurring between fields formed as a result of the first external reconnection, results in the EIT crinkles and changes in the coronal hole boundary. By the end of the second external reconnection, the initial setup is reinstated; thus the sequence can repeat, resulting in morphologically homologous eruptions. Our inferred magnetic topology is similar to that suggested in the "breakout model" of eruptions although we cannot determine if our eruptions are released primarily by the breakout mechanism (external reconnection) or, alternatively

  16. Intra-medullary Tuberculomas: Case Series

    PubMed Central

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

    2017-01-01

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

  17. Case Series Study of Invasive Pulmonary Aspergillosis.

    PubMed

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

    2016-12-02

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

  18. Hepatic inflammatory pseudotumor: A case series

    PubMed Central

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

    2013-01-01

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

  19. Oral syphilis: a series of 5 cases.

    PubMed

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

    2014-02-01

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

  20. Acute eclipse retinopathy: a small case series.

    PubMed

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

    2014-01-01

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

  1. Type II endometrial cancers: A case series

    PubMed Central

    Lobo, Flora D.; Thomas, Eliz

    2016-01-01

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

  2. Rare Mimickers of Exostosis: A Case Series

    PubMed Central

    Perubhotla, Lakshmi Manasa

    2016-01-01

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

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

    PubMed

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

    2016-04-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2015-04-16

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

  6. Congenital Melanocytic Nevus Syndrome: A Case Series.

    PubMed

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

    2017-01-19

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

  7. PLATEAU IRIS SYNDROME--CASE SERIES.

    PubMed

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  10. International Comparisons of Inservice Professional Development. Working Paper Series.

    ERIC Educational Resources Information Center

    Gilford, Dorothy M.

    This report recommends items from international comparative education studies that are related to inservice professional development (IPD) for possible inclusion in the Schools and Staffing Survey of 1999-2000. To justify these recommendations, the value of international comparisons and of state and nation comparisons generally is discussed, along…

  11. Internment of Japanese Americans. Documents from the National Archives Series.

    ERIC Educational Resources Information Center

    National Archives and Records Administration, Washington, DC.

    This booklet provides samples of documents relating to the internment of some 122,000 Japanese Americans during World War II by Executive Order 9066. The documents cover the time span from the Executive Order in 1942 to 1988 when the U.S. government formally acknowledged the injustice of the internment and provided restitution to the victims. The…

  12. Proposal of Classification Method of Time Series Data in International Emissions Trading Market Using Agent-based Simulation

    NASA Astrophysics Data System (ADS)

    Nakada, Tomohiro; Takadama, Keiki; Watanabe, Shigeyoshi

    This paper proposes the classification method using Bayesian analytical method to classify the time series data in the international emissions trading market depend on the agent-based simulation and compares the case with Discrete Fourier transform analytical method. The purpose demonstrates the analytical methods mapping time series data such as market price. These analytical methods have revealed the following results: (1) the classification methods indicate the distance of mapping from the time series data, it is easier the understanding and inference than time series data; (2) these methods can analyze the uncertain time series data using the distance via agent-based simulation including stationary process and non-stationary process; and (3) Bayesian analytical method can show the 1% difference description of the emission reduction targets of agent.

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

    PubMed

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

    2011-10-01

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

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

    PubMed

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

    2016-03-01

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

  15. Physics Case for the International Linear Collider

    SciTech Connect

    Fujii, Keisuke; Grojean, Christophe; Peskin, Michael E.; Barklow, Tim; Gao, Yuanning; Kanemura, Shinya; Kim, Hyungdo; List, Jenny; Nojiri, Mihoko; Perelstein, Maxim; Poeschl, Roman; Reuter, Juergen; Simon, Frank; Tanabe, Tomohiko; Yu, Jaehoon; Wells, James D.; Murayama, Hitoshi; Yamamoto, Hitoshi; /Tohoku U.

    2015-06-23

    We summarize the physics case for the International Linear Collider (ILC). We review the key motivations for the ILC presented in the literature, updating the projected measurement uncertainties for the ILC experiments in accord with the expected schedule of operation of the accelerator and the results of the most recent simulation studies.

  16. A systematic review protocol for reporting deficiencies within surgical case series

    PubMed Central

    Agha, Riaz; Fowler, Alexander J; Lee, Seon-Young; Gundogan, Buket; Whitehurst, Katharine; Sagoo, Hakiran; Jeong, Kyung Jin Lee; Altman, Douglas G; Orgill, Dennis P

    2015-01-01

    Introduction Case series are an important and common study type in surgical literature. There is evidence that key data are excluded from published case series, and currently no reporting guideline exists for case series. There is, therefore, the potential to change practices and improve the reporting of case series. Reporting guidelines have been shown to be efficacious in raising the bar for reporting quality. We present our protocol for the first stage of guideline development—a systematic review of previously identified deficiencies in how surgical case series are reported. Methods and analysis Electronic searches will be conducted on MEDLINE, EMBASE, Cochrane Methods Register, Science Citation Index and Conference Proceedings Citation Index, from the start of indexing until 5 November 2014. The electronic search strategy was developed with an information specialist. Two independent researchers will identify articles for inclusion, specifically those that describe reporting deficiencies within surgical case series. Data will be extracted to specifically focus on the deficiencies of reporting. These will be categorised according to their type, and other identified issues will also be presented. Data will be presented with descriptive statistics to determine frequently missing types of data, and the commonest reporting issues tabulated. Ethics and dissemination The authors hope to disseminate the findings as widely as possible, irrespective of results, as these will add to the wider corpora of information on this subject. The systematic review will be published in a peer-reviewed journal and will be presented at a wide range of national and international conferences. Ultimately, this will inform a Delphi process for the development of a surgical case series reporting guideline. Protocol registration CRD42015016145. PMID:26438134

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

    PubMed

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

    2012-01-01

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

  18. Understanding Canada's International Trade Policy. "Understanding Economics" Series No. 4.

    ERIC Educational Resources Information Center

    Cornell, Peter M.

    Written for secondary school Canadian students, the document examines Canada's international trade policy. It is arranged in three sections. Part I discusses the affect of Canada's trade policy on the individual citizen. Tariffs and non-tariff barriers to trade such as import licenses, preferential purchasing agreements, health and safety…

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  1. Indications and Case Series of Intentional Replantation of Teeth

    PubMed Central

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

    2014-01-01

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

  2. American English, An Integrated Series for International Students. Guided Composition Writing.

    ERIC Educational Resources Information Center

    Baskoff, Florence

    This text is the fifth of a comprehensive series of materials designed for teaching English to international students in the American Language Institute of New York University. The series constitutes the Institute's Elementary Program; mastery of its contents is the requisite for undertaking all subsequent work in English at the intermediate and…

  3. EPIDEMIOLOGY AND TREATMENT OF MONTEGGIA LESION IN ADULTS: SERIES OF 44 CASES

    PubMed Central

    Suarez, Roberto; Barquet, Antonio; Fresco, Rodrigo

    2016-01-01

    ABSTRACT Objective: To analyze the epidemiology, treatment and outcome of a series of adult patients with Monteggia lesion treated in Uruguayan institutions. Methods: This is a retrospective article, we retrospectively identified from two Uruguayan institutions 44 adult patients with Monteggia lesion and analyzed their characteristics including Bado classification, associated injuries, treatment modality and outcome (Morrey score). Results: Using Bado classification, 23 cases (52%) were type II, 12 (27%) type I, seven (16%) type IV and two cases (5%) type III. Associated lesions were radial head fractures, found in 15 patients, coronoid ipsilateral fractures in seven patients, and neurological injuries in four. Radial head dislocation was reduced in 93% of the cases with closed maneuvers. Ulna fractures underwent open reduction and internal fixation in all 30 cases using 3.5 mm DCP plates. Complications after surgery occurred in 21 cases. Revision surgery was done in 15 cases. Outcomes after primary and revision surgery were good or excellent in 37 cases. Conclusions: In our series we observed that Monteggia lesion in adults is a serious injury with a high number of complications that often require revision surgeries. Level of Evidence IV, Retrospective Study, Case Series. PMID:26997915

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

    PubMed

    Holoyda, Brian

    2017-03-01

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

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

    PubMed

    Torres, C R G; Borges, A B

    2015-01-01

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

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

    PubMed Central

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

    2017-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  8. Healthcare workforce development through an international workshop series: nursing care of older adults.

    PubMed

    Schoessler, Mary Theresa; Van Son, Catherine; Overall, Judith W; Koleva, Yordanka; Ostrovskaya, Irina; Marriott, Dedre; Surma, Mariya

    2009-01-01

    A critical need exists to educate the international healthcare workforce on the care of the older adult. This article describes an interdisciplinary program to address the nursing needs of older adults via a series of workshops in Russia. Strategies to bridge international healthcare and educational cultures are demonstrated. Implications for international workforce development, such as establishing collaborative partnerships, creating culturally appropriate materials, and modeling active learning strategies, are discussed.

  9. Effect of Internal Pressure and Temperature on Phase Transitions in Perovskite Oxides: The Case of the Solid Oxide Fuel Cell Cathode Materials of the La2-xSrxCoTiO6 Series.

    PubMed

    Gómez-Pérez, Alejandro; Hoelzel, Markus; Muñoz-Noval, Álvaro; García-Alvarado, Flaviano; Amador, Ulises

    2016-12-19

    The symmetry of the room-temperature (RT) structure of title compounds La2-xSrxCoTiO6-δ changes with x, from P21/n (0 ≤ x ≤ 0.2) to Pnma (0.3 ≤ x ≤ 0.5) and to R3̅c (0.6 ≤ x ≤ 1). For x = 1 the three pseudocubic cell parameters become very close suggesting a transition to a cubic structure for higher Sr contents. Similar phase transitions were expected to occur on heating, paralleling the effect of internal pressure induced by substitution of La(3+) by Sr(2+). However, only some of these aforementioned transitions have been thermally induced. The symmetry-adapted modes formalism is used in the structural refinements and fitting of neutron diffraction data recorded from RT to 1273 K. Thus, for x = 1, the out-of-phase tilting of the BO6 octahedra vanishes progressively on heating, and a cubic structure with Pm3̅m symmetry is found at 1073 K. For lower Sr contents this transition is predicted to occur far above the temperature limit of common experimental setups. The analysis of the evolution of the perovskite tolerance factor, t-factor, with both Sr content and temperature indicates that temperature has a limited ability to release structural stress and thus to enable transitions to more symmetric phases. This is particularly true when compared to the effect of internal pressure induced by substitution of La by Sr. The existence of phase transitions in materials for solid oxide fuel cells that are usually exposed to heating-cooling cycles may have a detrimental effect. This work suggests strategies to stabilize the high-symmetry high-temperature phase of perovskite oxides through internal-pressure chemically induced.

  10. REHABILITATION OF SUBACROMIAL PAIN SYNDROME EMPHASIZING SCAPULAR DYSKINESIS IN AMATEUR ATHLETES: A CASE SERIES

    PubMed Central

    Moura, Katherinne F.; Monteiro, Renan L.; Lucareli, Paulo R.G.

    2016-01-01

    ABSTRACT Study design Case series Background and Purpose Scapular dyskinesis has been associated with several shoulder injuries. Recent literature has suggested that a greater activation of the scapular muscles can play an important role in reducing subacromial impingement in patients with shoulder pain. Thus, the purpose of this case series was to describe a rehabilitation program that emphasizes scapular dyskinesis correction for those with clinical evidence of subacromial pain syndrome. Case Descriptions The four amateur athletes in this series showed clinical evidence of subacromial pain syndrome and scapular dyskinesis and each underwent a treatment protocol consisting of three phases. Phase 1 emphasized pain relief, scapular control, and recovery of normal range of motion (ROM), Phase 2 focused on muscular strengthening, and Phase 3 emphasized sensory motor training. Outcomes All subjects demonstrated decreased pain, improved sports performance and function, increased muscular strength for shoulder elevation and external rotation, and increased ROM for internal rotation. Improvement in serratus anterior (SA) activation was also noted. Discussion The results of this case series suggest that subjects with clinical tests positive for subacromial pain syndrome can show significant improvement with an intervention focused on scapular dyskinesis correction. SA activation can play an important role in this process given that all subjects presented with better recruitment after rehabilitation, as measured by electromyography. Levels of Evidence Level 4 PMID:27525180

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

    PubMed

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

    2015-04-01

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

  12. Infiltrating lipomatosis of the face: A case series

    PubMed Central

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

    2013-01-01

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

  13. Determination of internal series resistance of PV devices: repeatability and uncertainty

    NASA Astrophysics Data System (ADS)

    Trentadue, Germana; Pavanello, Diego; Salis, Elena; Field, Mike; Müllejans, Harald

    2016-05-01

    The calibration of photovoltaic devices requires the measurement of their current-voltage characteristics at standard test conditions (STC). As the latter can only be reached approximately, a curve translation is necessary, requiring among others the internal series resistance of the photovoltaic device as an input parameter. Therefore accurate and reliable determination of the series resistance is important in measurement and test laboratories. This work follows standard IEC 60891 ed 2 (2009) for the determination of the internal series resistance and investigates repeatability and uncertainty of the result in three aspects for a number of typical photovoltaic technologies. Firstly the effect of varying device temperature on the determined series resistance is determined experimentally and compared to a theoretical derivation showing agreement. It is found that the series resistance can be determined with an uncertainty of better than 5% if the device temperature is stable within  ±0.1 °C, whereas the temperature range of  ±2 °C allowed by the standard leads to much larger variations. Secondly the repeatability of the series resistance determination with respect to noise in current-voltage measurement is examined yielding typical values of  ±5%. Thirdly the determination of the series resistance using three different experimental set-ups (solar simulators) shows agreement on the level of  ±5% for crystalline Silicon photovoltaic devices and deviations up to 15% for thin-film devices. It is concluded that the internal series resistance of photovoltaic devices could be determined with an uncertainty of better than 10%. The influence of this uncertainty in series resistance on the electrical performance parameters of photovoltaic devices was estimated and showed a contribution of 0.05% for open-circuit voltage and 0.1% for maximum power. Furthermore it is concluded that the range of device temperatures allowed during determination of series

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

    PubMed Central

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

    2017-01-01

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

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

    PubMed

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

    2012-10-01

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

  16. Learning for Change: Approaches to International Development Education. International Development Education Series, Number Five.

    ERIC Educational Resources Information Center

    Stone, Frank Andrews

    This book reflects the views and experiences of mid-career educators representing a number of countries who participated in seminars on international development education at the University of Connecticut (Storrs) from 1979-1988. Chapter 1 defines the concepts of international development and global interaction, considers global images, describes…

  17. 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

  18. Brucella endocarditis – A series of five case reports

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2014-12-01

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

    Christou, Elizabeth M; Wargon, Orli

    2012-08-01

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

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

    PubMed

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

    2016-12-01

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

  7. Hepatotoxicity Due To Hydroxycut®: A Case Series

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2015-10-01

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

  10. Acute sterile endophthalmitis following intravitreal bevacizumab: case series

    PubMed Central

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

    2014-01-01

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

  11. Nystagmus in Enlarged Vestibular Aqueduct: A Case Series

    PubMed Central

    White, Judith; Krakovitz, Paul

    2015-01-01

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

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

    PubMed

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

    2016-08-26

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  15. 75 FR 35354 - Airworthiness Directives; Honeywell International Inc. TPE331-10 and TPE331-11 Series Turboprop...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-22

    ... International Inc. TPE331-10 and TPE331-11 Series Turboprop Engines AGENCY: Federal Aviation Administration (FAA... airworthiness directive (AD) for Honeywell International Inc. TPE331-10 and TPE331-11 series turboprop engines...-15996. Applicability (c) This AD applies to Honeywell International Inc. TPE331-10 and TPE331-11...

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2000-07-01

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

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

    PubMed Central

    Toussirot, E; Dupond, J; Wendling, D

    1997-01-01

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

  19. The Challenges for New Principals in the 21st Century. International Research on School Leadership Series

    ERIC Educational Resources Information Center

    Shoho, Alan R., Ed.; Barnett, Bruce, Ed.; Tooms, Autumn K., Ed.

    2010-01-01

    This book series, "International Research on School Leadership," focuses on how present-day issues affect the theory and practice of school leadership. For this inaugural book, the editors focused on the challenges facing new principals and headteachers. Because the professional lives of school leaders have increasingly impinged on their…

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

    PubMed Central

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

    2016-01-01

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

  1. Growth arrest lines and intra-epiphyseal silhouettes: a case series

    PubMed Central

    2014-01-01

    Background Growth arrest lines can develop within the skeleton after physiological stress or trauma. They are usually evident on radiographs as transverse lines in the metaphyses and have been used in fields from palaeontology to orthopaedics. This report consists of three cases, two of which describe growth arrest lines in an intra-epiphyseal site hitherto rarely documented, and a third demonstrating their clinical application. Case presentation Case 1 describes a 9-year-old who suffered a knee hyperflexion injury requiring anterior cruciate ligament and posterior cruciate ligament reattachments. She subsequently developed a marked distal femoral intra-epiphyseal arrest silhouette, as well as metaphyseal arrest lines in the femur, tibia and fibula. Case 2 describes an 8-year-old who sustained a tibial spine fracture and underwent open reduction and internal fixation. Subsequent imaging shows a further example of femoral intra-epiphyseal arrest silhouette as well as tibia and fibula metaphyseal arrest lines. Case 3 describes a 10-year-old who sustained a distal tibia fracture which was managed with open reduction and internal fixation. Subsequently the metaphyseal growth arrest line was parallel to the physis, suggesting no growth arrest (a danger with such a fracture). Conclusion This case series describes two examples of rarely described intra-epiphyseal growth arrest silhouettes and demonstrates the usefulness of arrest lines when assessing for growth plate damage. PMID:24410952

  2. The laparoscopic management of Swyer syndrome: Case series

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

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

    2006-03-01

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

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

    PubMed

    Porter, C J W; Armstrong, J R

    2004-01-01

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

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

    PubMed

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

    2014-08-01

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

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

    PubMed

    Sangani, Indiya; Watt, Eileen; Cross, David

    2013-03-01

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

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

    PubMed

    Chang, Christopher Y; Thrasher, Richard

    2012-06-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

    Thangavelu, Arthiie; Elavarasu, Sugumari; Jayapalan, Piranitha

    2012-08-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed Central

    Thangavelu, Arthiie; Elavarasu, Sugumari; Jayapalan, Piranitha

    2012-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2011-04-01

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

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

    PubMed Central

    Cramer, Holger; Krucoff, Carol; Dobos, Gustav

    2013-01-01

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

  16. Late-life homicide-suicide: a national case series in New Zealand.

    PubMed

    Cheung, Gary; Hatters Friedman, Susan; Sundram, Frederick

    2016-01-01

    Homicide-suicide is a rare event, but it has a significant impact on the family and community of the perpetrator and victim(s). The phenomenon of late-life homicide-suicide has not been previously studied in New Zealand, and there is only limited data in the international literature. The aim of this study is to systematically review coroners' records of late-life homicide-suicides in New Zealand. After ethics approval was granted, the Coronial Services of New Zealand was approached to provide records of all closed cases with a suicide verdict (age 65+) over a five-year period (July 2007-December 2012). Of the 225 suicides, 4 cases of homicide-suicide were identified (an estimated incidence of 0.12 per 100,000 per persons year). All four perpetrators were men; three had been farmers. Their ages ranged from 65 to 82. One case occurred in the context of an underlying psychiatric illness (psychotic depression in bipolar disorder). Firearms were used in three cases. Two cases were categorized as spousal/consortial subtype, one case as filicide-suicide, and one case as siblicide-suicide. The prospect of major social upheaval in the form of losing their homes was present in all four cases. The findings of this case series were consistent with the limited existing literature on homicide-suicide. Age-related biopsychosocial issues were highlighted in this case series of late-life homicide-suicide. Additionally, evaluating firearm licences in high-risk groups may represent a prevention strategy.

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

    PubMed

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

    2016-07-08

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2017-03-01

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

  20. Face and object imagery in congenital prosopagnosia: a case series.

    PubMed

    Tree, Jeremy J; Wilkie, Jaimie

    2010-10-01

    It has been reported that congenital prosopagnosics may have a general imagery deficit or an imagery deficit specific to faces. However, much of this evidence is based on self-report questionnaires, rather than experimentally based testing (Grüter et al., 2007, 2009). This study tested face and non-face based imagery in a case series of congenital prosopagnosics, utilising both questionnaire based and forced choice accuracy measures. Our findings indicate that all the prosopagnosics showed impaired face based imagery, which contrasted with normal performance on imagery of objects and colours - a pattern that is consistent with reports of acquired prosopagnosia (Barton, 2008; Michelon and Biederman, 2003). Given all our experimentally based testing indicated face imagery impairments, despite no such problems being seen on self-report questionnaires, we would argue that testing based only on the latter must be interpreted with some caution. Overall, we would advocate that our findings demonstrate a category specific visual imagery impairment in congenital prosopagnosia, such that general imagery skill can be intact in such cases.

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

    PubMed

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

    2012-11-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2016-01-01

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

  4. Indoor Air '90: the 5th in a series of international conferences on the indoor environment.

    PubMed

    Walkinshaw, D

    1992-01-01

    The 5th International Conference on Indoor Air Quality and Climate: INDOOR AIR '90 continued a series of international scientific conferences begun in 1978 on a complex, interdisciplinary subject increasingly recognized to be of importance to human comfort, health and productivity, and having important implications for building design and furnishing, office equipment, appliances, cleaning, heating, ventilating, humidifying and air-conditioning. INDOOR AIR '90 constituted a week long program of 542 paper and poster presentations and forum discussions, 100 exhibits, and a public forum. This paper summarizes some of the highlights of this conference and links these to some of the studies reported at earlier INDOOR AIR Conference.

  5. Peroral endoscopic myotomy: a literature review and the first UK case series.

    PubMed

    Gulati, Shraddha; Emmanuel, Andrew; Inoue, Haruhiro; Hayee, Bu'Hussain; Haji, Amyn

    2017-02-01

    Peroral endoscopic myotomy (POEM) is an established treatment for primary achalasia. It has gained endorsement from the American Society for Gastrointestinal Endoscopy with increasing clinical acceptance since the first procedure, performed in Japan in 2008. The first successful POEM in the UK was performed in November 2013 at King's College Hospital and this article presents the first UK case series. Prospective data were collected at 3 and 12-24 months for consecutive patients undergoing POEM. Post-POEM gastro-oesophageal reflux health-related quality of life scale (GORD-HRQoL) score was recorded. Statistical comparisons were made using paired non-parametric testing. In an initial series of 33 consecutive prospectively followed patients (12 female; 49.5±13 years; median follow-up 9 (3-28) months; 58% having had previous intervention), a 91% success rate has been achieved at 3 months. To date, 16 patients have reached the 12-month time point, with 13 (81%) sustaining response. This case series compares well with international cohorts and demonstrates excellent long-term safety and favourable efficacy.

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

    PubMed

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

    2016-04-01

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

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

    PubMed Central

    Nazem, Khalilollah; Fouladi, Arash; Chinigarzadeh, Mozhdeh

    2013-01-01

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

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

    PubMed

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

    2010-07-01

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

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    2009-01-01

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

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

    PubMed Central

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

    2016-01-01

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

  12. Case studies in international tobacco surveillance: cigarette smuggling in Brazil

    PubMed Central

    Shafey, O; Cokkinides, V; Cavalcante, T; Teixeira, M; Vianna, C; Thun, M

    2002-01-01

    Objective: This article is the first in a series of international case studies developed by the American Cancer Society to illustrate use of publicly available surveillance data for regional tobacco control. Design: A descriptive analysis of Brazil and Paraguay cigarette production and trade data from official sources. Methods: Per capita cigarette consumption for Brazil and its neighbour was calculated from 1970 to 1998 using data on production, imports, and exports from NATIONS, the National Tobacco Information Online System. Results: A 63% decrease was observed in the estimate of per capita consumption of cigarettes in Brazil between 1986 and 1998 (from 1913 cigarettes per person in 1986 to 714 cigarettes per person in 1998) and a 16-fold increase in Paraguay was observed during the same period (from 678 cigarettes per person in 1986 to 10 929 cigarettes per person in 1998). Following Brazil's 1999 passage of a 150% cigarette export tax, cigarette exports fell 89% and Brazil's estimated per capita consumption rose to 1990 levels (based on preliminary data). Per capita consumption in Paraguay also fell to 1990 levels. Conclusions: These trends coincide with local evidence that large volumes of cigarettes manufactured in Brazil for export to Paraguay are smuggled back and consumed as tax-free contraband in Brazil. It is hoped that this case study will draw wider public attention to the problems that smuggling presents for tobacco control, help identify other countries confronting similar issues, and stimulate effective interventions. PMID:12198271

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

    DTIC Science & Technology

    2005-04-01

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

  14. Delusional infestations: case series, differential diagnoses, and management strategies.

    PubMed

    Diaz, James H; Nesbitt, Lee T

    2014-01-01

    Physicians are not infrequently consulted by distraught patients with delusions of infestation who believe that they are infested with external or internal parasites and describe a crawling sensation of bugs or worms on or under their skin. Internet search engines were queried with the keywords as search terms to examine the latest articles on delusional infestations in order to describe presenting manifestations, differential diagnoses, and effective management strategies. The demographic and behavioral features of delusional infestations have remained constant and include: (1) onset in well-educated, middle-aged adults who are pet owners; (2) production of purported specimens of causative parasites; (3) pesticide overtreatment of themselves, their households, and pets; (4) excessive cleaning or vacuuming of households; (5) intense anger and resentment directed at physicians failing to confirm their self-diagnoses; and (6) sharing delusional symptoms with spouses or relatives. Although some reports have suggested that cases of delusional infestation are increasing today in the tropics, most studies have confirmed a stable incidence over time and similar disorder demographics worldwide. However, management strategies for delusional infestations have changed significantly over time with second generation, atypical antipsychotics offering safer adverse effect profiles and better prognoses than earlier therapies with first generation, typical antipsychotics. The most effective management strategies for delusional infestations include empathetic history-taking and active listening to the patient, careful exclusion of true parasitoses, and a therapeutic regimen that includes a second generation neuroleptic agent.

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

    PubMed

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

    2015-03-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  19. Revised series of stylized anthropometric phantoms for internal and external radiation dose assessment

    NASA Astrophysics Data System (ADS)

    Han, Eunyoung

    At present, the dosimetry systems of both the International Commission on Radiological Protection, and the Society of Nuclear Medicine's Medical Internal Radiation Dose Committee utilize a series of stylized or mathematical anthropometric models of patient anatomy developed in 1987 at the Oak Ridge National Laboratory (ORNL). In this study, substantial revisions to the ORNL phantom series are reported with tissue compositions, tissue densities, and organ masses adjusted to match their most recent values in the literature. In addition, both the ICRP and MIRD systems of internal dosimetry implicitly consider that electron and beta-particle energy emitted within the source organs of the patient are fully deposited within these organs. With the development of the revised ORNL phantom series, three additional applications were explored as part of this dissertation research. First, the phantoms were used in combination to assess external radiation exposures to family members caring or interacting with patients released from the hospital following radionuclide therapy with I-131. Values of family member effective dose are then compared to values obtained using NRC guidance and based on a simple point-source methodology which ignores the effects of photon attenuation and scatter within both the source individual (patient) and the target individual (family member). Second, the anatomical structures of the extrathoracic airways and thoracic airways (exclusive of the lungs themselves) have been included in the entire revised ORNL phantom series of pediatric individuals. Values of cross-region photon dose are explored for use in radioactive aerosol inhalation exposures to members of the general public, and comparisons are made to values given by the ICRP in which surrogate organ assignments were made in the absence of explicit models of these airways. Finally, the revised ORNL phantoms of the adult male and adult female are used to determine internal photon exposures to

  20. Decompression sickness rates for chamber personnel: case series from one facility.

    PubMed

    Brandt, Megan S; Morrison, Thomas O; Butler, William P

    2009-06-01

    During 2004, a case series of decompression sickness (DCS) meeting the definition of epidemic DCS was observed in the Shaw AFB Physiological Training Program. There were 10 cases of chamber-induced altitude DCS observed. Internal and external investigations focused on time, place, person, and environment. No temporal trend was observed. Chamber, masks, regulators, crew positions, and oxygen sources revealed no defects. Among the cases, mean age was 27 yr. Peak altitude in four cases was 35,000 ft and in the other six cases was 25,000 ft. Six had joint pain, one skin symptoms, and three neurological findings. Four were treated with 100% ground-level oxygen and six with hyperbaric oxygen. Four were students and six were inside observers (IO). Four were women and six men. In the IO, where four of the six were women, no gender effect was seen. Examining the IO monthly exposure load (exposures per month) against DCS suggested a dose-response relationship. This relationship held true when 4 yr of Shaw AFB IO data was studied. Indeed, Poisson regression analysis demonstrated a statistically significant 2.1-fold rise in DCS risk with each monthly exposure. Consequently, the number of exposures per month may need to be considered when devising IO schedules.

  1. The Japanese American Internment, 1942-45: A Lesson from Recent History. Multicultural Education Resource Series.

    ERIC Educational Resources Information Center

    Washington Office of the State Superintendent of Public Instruction, Olympia. Office for Equity Education.

    Designed for secondary school students, this 3-5 day unit focuses on the legal context of the Japanese-American internment during World War II and can be incorporated into a history unit or used as a case study of the American legal system or American race relations. Four lesson plans are provided. In lesson 1, the historical events of the…

  2. Asperger syndrome in India: findings from a case-series with respect to clinical profile and comorbidity.

    PubMed

    Sreedaran, Priya; Ashok, M V

    2015-01-01

    Asperger syndrome (AS) is an autism spectrum disorder with a high rate of psychiatric comorbidity. We describe the clinical profile and psychiatric comorbidity in a series of affected individuals referred to an Indian general hospital psychiatry setting. Gilliam Asperger's disorder scale was used to evaluate the clinical characteristics while Mini-International Neuropsychiatric Interview (MINI)-KID and MINI-PLUS were used to assess psychiatric comorbidity. The profile of subjects with AS in our case-series appears similar to that published elsewhere with high rates of psychiatric comorbidity. Mental health professionals should evaluate for psychiatric comorbidity in individuals with autism spectrum disorders.

  3. Asperger Syndrome in India: Findings from a Case-Series with Respect to Clinical Profile and Comorbidity

    PubMed Central

    Sreedaran, Priya; Ashok, M. V.

    2015-01-01

    Asperger syndrome (AS) is an autism spectrum disorder with a high rate of psychiatric comorbidity. We describe the clinical profile and psychiatric comorbidity in a series of affected individuals referred to an Indian general hospital psychiatry setting. Gilliam Asperger's disorder scale was used to evaluate the clinical characteristics while Mini-International Neuropsychiatric Interview (MINI)-KID and MINI-PLUS were used to assess psychiatric comorbidity. The profile of subjects with AS in our case-series appears similar to that published elsewhere with high rates of psychiatric comorbidity. Mental health professionals should evaluate for psychiatric comorbidity in individuals with autism spectrum disorders. PMID:25969609

  4. The International Higher Education Market: Mexico's Case

    ERIC Educational Resources Information Center

    Andere, Eduardo

    2004-01-01

    For years student scholarship programs to promote knowledge or international cooperation have functioned without question in Mexico. Economics of education literature has questioned the validity of similar programs, and the paradigm is shifting from scholarship support to loan schemes and from merit- to need-based grants. This article, based on…

  5. Collaboration in Distance Education. International Case Studies.

    ERIC Educational Resources Information Center

    Moran, Louise, Ed.; Mugridge, Ian, Ed.

    This book contains nine case studies of collaboration in distance education. The case studies focus on such aspects of collaboration in distance education as the following: roles of individual institutional partners; importance of personal relationships; benefits of collaboration to individual partners; conflicts between collaboration and…

  6. Endobronchial cryotherapy facilitates end-stage treatment options in patients with bronchial stenosis: A case series

    PubMed Central

    Fitzmaurice, Gerard J.; Redmond, Karen C.; Fitzpatrick, David A.; Bartosik, Waldemar

    2014-01-01

    In keeping with international trends, lung cancer incidence and mortality are increasing among the Irish population with many patients presenting with advanced disease that excludes the potential for curative management. Consequently palliative treatment options for this patient group are being increasingly explored with various degrees of success. Endobronchial stenosis represents a particularly challenging area of management among these patients and a number of techniques have been described without the identification of a single gold standard. We report our experience of the first time use of endobronchial cryotherapy in Ireland with reference to a case series, including an example of its use in the management of benign disease, in order to support patients with borderline lung function and enable definitive palliative treatment. PMID:24791176

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

    PubMed Central

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

    2016-01-01

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

  8. The case for an international lunar base

    NASA Astrophysics Data System (ADS)

    IAA Ad Hoc Committee "Return to the Moon"

    This report concentrates on strategies and policies, rather than technical details, for the development of a lunar base program, with the goal of exploring the use of extraterrestrial resources for the benefit of humankind, including that of a connection between Earth and Solar System. After answering the WHY (objectives), it deals with the WHAT (lunar surface activities, lunar logistics), and the HOW (economic, political, organizational, aspects). A summary plan of the program is outlined, and an international conference is proposed for July 1989.

  9. [Work-related stress and mobbing: case series and gender differences].

    PubMed

    Tonini, Stefano; Lanfranco, Andrea; Costa, Maria Cristina; Lumelli, Diego; Giorgi, Ines; Mazzacane, Fulvio; Scafa, Fabrizio; Candura, Stefano M

    2011-01-01

    The attention of international agencies and scientific community on mobbing (bullying) and work-related stress is increasing. However, research on gender differences and etiologic agents is still limited. This study describes the gender differences found in victims of mobbing and work-related stress in an Italian case series. Between 2001 and 2009, at the Occupational Medicine Unit of our Institution we examined 345 outpatients (197 women and 148 men) for suspected psychopathological work-related problems. After interdisciplinary diagnostic evaluation, the diagnosis of "mobbing syndrome" was formulated, according to international criteria (ICD-I0 and DSM-IV), in a minority of cases: 35 subjects. In the other workers, we found pre-existing psychiatric conditions (not related to work), or altered relationships dynamics with the colleagues. Significant gender differences emerged among people with "mobbing syndrome": there was a high prevalence of women (65%), with medium to high level of education; the most affected age group was between 34 and 45 years; several occupations were involved, with a clear preponderance of office workers. Women are mostly harassed for personal aspects related to emotional and relational factors; men for the content of their work. The knowledge of the phenomenon is an essential prerogative to contrast mobbing; this can be realized, at a preventive level, only through effective information and training for workers and employers, who have the legal obligation to preserve the integrity of the mental and physical status of their employees during the work.

  10. Case study for international remote machining

    NASA Astrophysics Data System (ADS)

    Lin, Grier C. I.; Kao, Yung-Chou

    1995-08-01

    Owing to the more enhanced networking, the designed data for manufacturing can be transmitted internationally. Therefore, the production of the potential product at one side of the world according to the design requirement at the other side of the world is possible and quicker than ever before. The shipment can be eliminated by producing the product at the potential market place. This paper demonstrates the development of a machining system showing the manufacture of a product based on this idea. Unix, Microsoft Windows, and NFS under the LAN and Internet environment are adopted for data communication and message passing in the devised international remote machining system. The personal computer is the server of the machining center. A C program is developed for the direct control of the machining center through DNC2 interface. The command of machining process is issued from Sun Sparc station to the personal computer through Internet. The devised system structure can also be extended to link with an automatic workpiece loading system, e.g., robot an AGV, to form an automatic machining cell for CIM. The requirements of achieving such an international remote machining cell that links machining center and robot are also discussed.

  11. Removal of Arsenic, Iron, Manganese, and Ammonia in Drinking Water: Nagaoka International Corporation CHEMILES NCL Series Water Treatment System

    EPA Science Inventory

    The Nagaoka International Corporation CHEMILES NCL Series system was tested to verify its performance for the reduction of multiple contaminants including: arsenic, ammonia, iron, and manganese. The objectives of this verification, as operated under the conditions at the test si...

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

    ERIC Educational Resources Information Center

    Russo, Charles J., Ed.

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

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

    ERIC Educational Resources Information Center

    Silver, Isabel

    2014-01-01

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

  14. Helicopter internal noise control: Three case histories

    NASA Technical Reports Server (NTRS)

    Edwards, B. D.; Cox, C. R.

    1978-01-01

    Case histories are described in which measurable improvements in the cabin noise environments of the Bell 214B, 206B, and 222 were realized. These case histories trace the noise control efforts followed in each vehicle. Among the design approaches considered, the addition of a fluid pulsation damper in a hydraulic system and the installation of elastomeric engine mounts are highlighted. It is concluded that substantial weight savings result when the major interior noise sources are controlled by design, both in altering the noise producing mechanism and interrupting the sound transmission paths.

  15. Independent Senior Women Who Travel Internationally: A Collective Case Study

    ERIC Educational Resources Information Center

    Jarrett, Barbara

    2010-01-01

    Nine independent women over age 55 who traveled internationally were investigated through a qualitative case study. The purpose of the study was to explore the women's attitudes, actions, and motivations during and after their international travel experiences. The adult, aging, experiential, and transformational theories of researchers such as…

  16. International photonics training: a case study

    NASA Astrophysics Data System (ADS)

    Sporea, Dan; Massa, Nicholas; Donnelly, Judith F.; Hanes, Fenna

    2007-06-01

    From 2004, the Center for Science Education and Training (CSET) participated to the European Union-funded educational network "Hands-on Science". The aim of the Romanian team was to transform teachers and students from end-users of educational aids to active designers and developers of instructional materials. Several science fields were identified, including photonics. The team at CSET is now focusing on: lasers and their applications, optical fiber communications, solar energy as a sustainable source, and the use of optical spectroscopy in physics and chemistry. CSET initiated an international collaboration with the New England Board of Higher Education (NEBHE) in Boston, Mass., when the Center enrolled an experienced Romanian high school science teacher in a twelve-week "Introduction to Photonics" laboratory-based professional development course. The course was developed by NEBHE through an Advanced Technological Education (ATE) program grant from National Science Foundation and is designed for high school and community college educators from both science and technology instructional areas. The paper reports the experience of this international participation which was made possible since the course is delivered via the Internet by Three Rivers Community College, Norwich, Conn. Its impact on photonics education in Romania and the USA is analyzed, as the participant teacher shares her experiences with teachers and faculty in the "Introduction to Photonics" course and with those enrolled into the Romanian "Hands-on-Science" program.

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

    PubMed

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

    2015-11-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2010-01-01

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

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

    PubMed

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

    2010-10-01

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

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

    PubMed

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

    2017-03-29

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

  2. Pediatric intraventricular meningioma: A series of six cases

    PubMed Central

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

    2016-01-01

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

  3. Guidelines for Analysis of Environmental Health Planning in Developing Countries. Volume 2: Environmental Health Planning. International Health Planning Methods Series.

    ERIC Educational Resources Information Center

    Fraser, Renee White; Shani, Hadasa

    Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this second of ten manuals in the International Health Planning Methods Series deals with assessment, planning, and evaluation in the field of environmental health.…

  4. Guidelines for Analysis of Health Manpower Planning. Volume 3: Health Manpower Planning. International Health Planning Methods Series.

    ERIC Educational Resources Information Center

    Staff, Robert J.; Porter, Dennis R.

    Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this third of ten manuals in the International Health Planning Methods Series deals with health manpower planning and assessment. It provides a conceptual and…

  5. Academic Writing Programs. Case Studies in TESOL Practice Series.

    ERIC Educational Resources Information Center

    Leki, Ilona, Ed.

    This edited volume explores the international role of written English in the academic context and clearly demonstrates how writing is integrated in all aspects of academic communication in English. The 12 programs described in this book differ in context but share basic assumptions about how best to teach second language (L2) writing. In addition…

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

    PubMed Central

    Namitha, Prabhu; Sacchidanand, S

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

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

    PubMed

    Setia, Maninder Singh

    2016-01-01

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

  9. Surgical augmentation of interdental papilla - A case series

    PubMed Central

    Muthukumar, Santhanakrishnan; Rangarao, Suresh

    2015-01-01

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

  10. Building International Sustainable Partnerships in Occupational Therapy: A Case Study.

    PubMed

    Tupe, Debra Ann; Kern, Stephen B; Salvant, Sabrina; Talero, Pamela

    2015-09-01

    Occupational therapy practitioners frequently identify opportunities for international practice. The World Health Organization and the World Federation of Occupational Therapists have encouraged occupational therapists to address transnational issues, social inclusion, and equal access to opportunities grounded in meaningful occupation (WFOT, 2012). This case study describes a partnership between two U.S. schools of occupational therapy and a Cuban community based pediatric clinic. It examines the dynamics that have sustained the partnership despite political, economic, and logistical barriers. The literature is scrutinized to show how this case study fits into other accounts of collaborative international partnerships. Particularly, it investigates structural and institutional conditions that shape international sustainable partnerships. In doing so, we answer the following questions: (1) Under which circumstances do international partnerships emerge and flourish? (2) What structural and institutional conditions shape international sustainable partnerships? And (3) How do partners perceive and experience the bilateral international partnership? It also discusses and illustrates the foundations and development of international partnerships that succeed. Through the use of a case study we illustrate the development of this partnership. Finally, we consider the next steps of this particular sustainable and collaborative international partnership.

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2015-07-01

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

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

    PubMed

    Brown, George R

    2015-03-01

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

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

    PubMed

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

    2001-03-01

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

  15. International standards on mental work-load--the ISO 10,075 series.

    PubMed

    Nachreiner, F

    1999-04-01

    After a short review of the history and an introduction into the background of standardization in the field of mental work-load an overview over the ISO 10,075 series of standards on ergonomic principles related to mental work-load is given. The review also presents relationships of these standards with some other ergonomic standards and some of the problems associated with standardization in the field of mental work-load. The stress-strain model, the concepts and the terminology used in ISO 10,075 are presented in the overview, together with the basic ideas and the frame of reference of the design guidelines provided by ISO 10,075-2. An outline of the state of discussion and possible developments of a working draft for ISO 10,075-3 on diagnostic methods concludes the presentation of the international standards on mental work-load.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2013-01-01

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

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

    PubMed

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

    2007-01-01

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

  1. Conservative management of retrocaval Ureter: A case series

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Austin, Bethany A; Griffin, Brian P

    2008-08-01

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

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

    PubMed

    Patra, Suravi

    2016-01-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2009-02-01

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

  6. Case series of rhinocerebral mucormycosis occurring in diabetic patients

    PubMed Central

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

    2015-01-01

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

  7. Tracheobronchial Amyloidosis-A Series of Two Cases

    PubMed Central

    Raiyani, Palak D; Vyas, Sunil S

    2014-01-01

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

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

    PubMed Central

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

    2008-01-01

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

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

    PubMed

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

    2007-01-01

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

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

    ERIC Educational Resources Information Center

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

    2004-01-01

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

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

    PubMed

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

    2014-06-01

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

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

    ERIC Educational Resources Information Center

    Henrichsen, Lynn E., Ed.

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

  13. Diagnostic Dilemma in Ovarian Pregnancy: A Case Series

    PubMed Central

    Pallavee, P.; Samal, Sunita

    2015-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Kealey, Robert J., Ed.

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

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

    PubMed Central

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

    2011-01-01

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

  17. Performance consistency of international soccer teams in euro 2012: a time series analysis.

    PubMed

    Shafizadeh, Mohsen; Taylor, Marc; Peñas, Carlos Lago

    2013-01-01

    The purpose of this study was to examine the consistency of performance in successive matches for international soccer teams from Europe which qualified for the quarter final stage of EURO 2012 in Poland and Ukraine. The eight teams that reached the quarter final stage and beyond were the sample teams for this time series analysis. The autocorrelation and cross-correlation functions were used to analyze the consistency of play and its association with the result of match in sixteen performance indicators of each team. The results of autocorrelation function showed that based on the number of consistent performance indicators, Spain and Italy demonstrated more consistency in successive matches in relation to other teams. This appears intuitive given that Spain played Italy in the final. However, it is arguable that other teams played at a higher performance levels at various parts of the competition, as opposed to performing consistently throughout the tournament. The results of the cross-correlation analysis showed that in relation to goal-related indicators, these had higher associations with the match results of Spain and France. In relation to the offensive-related indicators, France, England, Portugal, Greece, Czech Republic and Spain showed a positive correlation with the match result. In relation to the defensive-related indicators, France, England, Greece and Portugal showed a positive correlation with match results. In conclusion, in an international soccer tournament, the successful teams displayed a greater degree of performance consistency across all indicators in comparison to their competitors who occasionally would show higher levels of performance in individual games, yet not consistently across the overall tournament. The authors therefore conclude that performance consistency is more significant in international tournament soccer, versus occasionally excelling in some metrics and indicators in particular games.

  18. Handling Europe's first Ebola case: internal hospital communication experience.

    PubMed

    Mosquera, Margarita; Melendez, Victoria; Latasa, Pello

    2015-04-01

    Europe's first Ebola virus disease (EVD) case was diagnosed in our hospital. There was an unjustified panic in the population because of an imbalance of credibility assigned to the media as opposed to scientific information. A reinforcement of hospital internal communication was needed to keep health care workers informed with up-to-date scientific EVD information. The proactive management of information flow to both internal and external actors is required to reduce unjustified fear within the public.

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

    PubMed Central

    Temocin, Fatih; Sari, Tugba; Tulek, Necla

    2016-01-01

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

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

    PubMed Central

    Gola, Mateusz; Potenza, Marc N.

    2016-01-01

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

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

    PubMed

    Gola, Mateusz; Potenza, Marc N

    2016-09-01

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

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

    PubMed

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

    2016-10-01

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

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

    PubMed Central

    Ajaltouni, Jean

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed Central

    Bhandari, Vipul; Ganesh, Sri

    2015-01-01

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

  7. More Distally Located Duodenal Webs: A Case Series

    PubMed Central

    Gupta, Rahul; Mathur, Praveen; Gubbi, Sharanabasappa; Gupta, Pradeep Kumar; Shukla, Ramendra; Bhandari, Anu

    2016-01-01

    Duodenal atresia is a frequent cause of intestinal obstruction in the newborn. Obstruction due to duodenal web is infrequent, but its location other than second part of duodenum is rare with only a few cases reported in the literature. We are reporting three patients where we found duodenal webs at unusual locations. In one neonate the web was located at third part of duodenum and in other two patients the web was present at duodeno-jejunal junction (DJ). PMID:27896164

  8. Case series: Nocardiosis of the brain and lungs

    PubMed Central

    Sud, Seema; Buxi, TBS; Anand, Ish; Rohatgi, Anshu

    2008-01-01

    Localized and multisystem nocardiosis is an opportunistic disease that occurs commonly in immunocompromised patients. Rarely, it is also seen in immunocompetent individuals. The lungs and brain are commonly involved. Typical, but nonspecific, findings are often seen on imaging and the presence of concomitant lesions in these two systems often suggests this diagnosis. We report two cases of cerebral and pulmonary involvement by nocardiosis. PMID:19774160

  9. [Frontal fibrosing alopecia: case series and literature review].

    PubMed

    Tinoco-Fragoso, Fátima; Domínguez-Cherit, Judith; Méndez-Flores, Silvia

    2017-01-01

    Frontal fibrosing alopecia is a disease characterized by a symmetric and progressive loss of hair in the fronto-temporal and fronto-parietal lines that generally affects postmenopausal women. It is considered a variant of lichen planus pilaris for its clinical and histopathological features; although, its etiopathology is still unknown. In this report, we analyzed 4 cases of this disease and we discussed its clinical and histopathological characteristics, as well as their course after initiating treatment.

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

    PubMed Central

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

    2016-01-01

    Kissing molars are a very rare form of inclusion defined as molars included in the same quadrant, with occlusal surfaces contacting each other within a single dental follicle. We present four cases of this pathology: a 35 year-old male, referred to the Oral and Maxillofacial Surgery Department of the Hospital Virgen del Rocio in Seville, and three females of 24, 26, and 31 years, all of which had kissing molars that were treated by tooth extraction. We have found only 10 cases published in the medical literature in which this type of inclusion is briefly described, none of which elaborate on the surgical technique employed. In these cases, the indication for surgery is established when there is a history of recurring infections or cystic lesions associated with dental inclusions. The extraction of kissing molars requires an exhaustive comprehension of the anatomy of the region involved, sufficiently developed surgical abilities, and an extensive planning process. Key words:Impacted molar, kissing molar, surgical extraction. PMID:26855716

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

    PubMed

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

    2014-05-01

    Introduccion. La migraña puede cursar con sintomas autonomicos craneales propios de las cefaleas trigeminoautonomicas, lo que plantea dificultades en el diagnostico. Objetivo. Describir una serie de diez pacientes con edema palpebral asociado a la migraña. Pacientes y metodos. Diez pacientes atendidos en la consulta de cefaleas de tres hospitales (nueve mujeres, un varon; edad: 26-53 años), con edema palpebral recurrente asociado a la migraña. Resultados. Segun los criterios diagnosticos de la Clasificacion Internacional de las Cefaleas (ICHD-III, version beta), ocho pacientes presentaban migraña sin aura, una tenia migraña con aura y otra, migraña cronica. El edema palpebral aparecia durante las crisis de migraña mas intensas, y tenia mayor duracion que la cefalea. Se descartaron causas farmacologicas o sistemicas del edema en todos los casos. Otros sintomas autonomicos asociados fueron la inyeccion conjuntival (n = 3), el lagrimeo (n = 2) y la rinorrea (n = 1). Tanto el dolor como el edema asociado respondieron a los tratamientos sintomaticos y preventivos de la migraña. Conclusiones. El edema palpebral es un posible acompañante de la migraña. Aparece en algunos pacientes con los episodios de mayor intensidad, y responde al tratamiento sintomatico y preventivo de la migraña.

  12. Understanding Resident Learning Preferences Within an Internal Medicine Noon Conference Lecture Series: A Qualitative Study

    PubMed Central

    Sawatsky, Adam P.; Zickmund, Susan L.; Berlacher, Kathryn; Lesky, Dan; Granieri, Rosanne

    2014-01-01

    Background The lecture remains the most common approach for didactic offerings in residency programs despite conflicting evidence about the effectiveness of this format. Objective The purpose of this study was to explore the perspectives of internal medicine residents toward conferences held in the lecture format. Methods The investigators invited internal medicine residents (N  =  144) to participate in focus groups discussing their perspectives about noon conference lectures. The investigators used a semistructured guide to ask about motivations for attendance and effectiveness of noon conferences, transcribed the recordings, coded the discussions, and analyzed the results. Results Seven focus groups with a total of 41 residents were held. This identified 4 major domains: (1) motivations for attendance; (2) appropriate content; (3) effective teaching methods; and (4) perspectives on active participation. Residents' motivations were categorized into external factors, including desire for a break and balance to their workload, and intrinsic attributes, including the learning opportunity, topic, and speaker. Appropriate content was described as clinically relevant, practical, and presenting a balance of evidence. Identified effective teaching methods included shorter teaching sessions focused on high-yield learning points structured around cases and questions. While active participation increases residents' perceived level of stress, the benefits of this format include increased attention and learning. Conclusions This study furthers our knowledge of the learning preferences of internal medicine residents within the changing environment of residency education and can be used in conjunction with principles of adult learning to reform how we deliver core medical knowledge. PMID:24701307

  13. Aseptic Meningitis Caused by Lassa Virus: Case Series Report.

    PubMed

    Okokhere, Peter O; Bankole, Idowu A; Iruolagbe, Christopher O; Muoebonam, Benard E; Okonofua, Martha O; Dawodu, Simeon O; Akpede, George O

    2016-01-01

    The Lassa virus is known to cause disease in different organ systems of the human body, with varying clinical manifestations. The features of severe clinical disease may include bleeding and/or central nervous system manifestations. Whereas Lassa fever encephalopathy and encephalitis are well described in the literature, there is paucity of data on Lassa virus meningitis. We present the clinical description, laboratory diagnosis, and management of 4 consecutive cases of aseptic meningitis associated with Lassa virus infection without bleeding seen in a region of Nigeria known to be endemic for both the reservoir rodent and Lassa fever. The 4 patients recovered fully following intravenous ribavirin treatment and suffered no neurologic complications.

  14. Guillain-Barré syndrome following chickenpox: a case series.

    PubMed

    Tatarelli, P; Garnero, M; Del Bono, V; Camera, M; Schenone, A; Grandis, M; Benedetti, L; Viscoli, C

    2016-01-01

    Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyradiculoneuropathy, usually triggered by an infectious episode, mostly of viral origin. Varicella zoster virus (VZV) is a rare cause of GBS, mainly in the case of latent infection reactivation. We report on three adult patients who developed GBS following chickenpox, after a short period of latency. They were promptly treated with intravenous immunoglobulin, and the first one with plasma exchange additionally. All the patients experienced almost complete clinical recovery. Our experience suggests that primary VZV infection constitutes a GBS triggering event.

  15. Superhero‐related injuries in paediatrics: a case series

    PubMed Central

    Davies, Patrick; Surridge, Julia; Hole, Laura; Munro‐Davies, Lisa

    2007-01-01

    Five cases of serious injuries to children wearing superhero costumes, involving extreme risk‐taking behaviour, are presented here. Although children have always displayed behaviour seemingly unwise to the adult eye, the advent of superhero role models can give unrealistic expectations to the child, which may lead to serious injury. The children we saw have all had to contemplate on their way to hospital that they do not in fact possess superpowers. The inbuilt injury protection which some costumes possess is also discussed. PMID:17337680

  16. Paediatric Post-Traumatic Bladder Neck Distraction Injury: Case Series

    PubMed Central

    Sawant, Ajit S.; Kumar, Vikash; Pawar, Prakash; Tamhankar, Ashwin S.

    2017-01-01

    The bladder neck distraction is a rare posterior urethral injury in paediatric age group. It mostly occurs secondary to road traffic accidents. We report three cases of paediatric bladder neck distraction injury. Three paediatric patients aged between 4 to 7 years (mean 5 year), who presented with post traumatic bladder neck distraction injury but no other major injury, they were treated with early urethro-vesical anastomosis. Postoperatively all patients were continent and with good urine flow rates. In paediatric bladder neck distraction injury, immediate urethro-vesical anastomosis gives good results. PMID:28384935

  17. Esthetic depigmentation of anterior gingiva. A case series.

    PubMed

    Kasagani, Suresh Kumar; Nutalapati, Rajasekhar; Mutthineni, Ramesh Babu

    2012-04-01

    Gingival melanin pigmentation occurs in people of all races. Although clinical melanin pigmentation does not present a medical problem, demand for cosmetic therapy is commonly made by fair-skinned people with gingival melanin pigmentation. This problem is aggravated in patients with a "gummy smile" or excessive gingival display while smiling. Esthetic periodontal plastic surgery is especially successful in individuals with compromised esthetics. Three cases are reported here where gingival depigmentation was done using three different techniques: electrosurgery; scalpel surgery; and surgical abrasion. The clinical results of the three methods have been compared.

  18. Aplasia and hypoplasia of the maxillary sinus: A case series

    PubMed Central

    Jafari-Pozve, Nasim; Sheikhi, Mahnaz; Ataie-Khorasgani, Masoud; Jafari-Pozve, Shahram

    2014-01-01

    Maxillary sinus aplasia and hypoplasia are rare conditions that can cause symptoms such as headaches and voice alteration. The majority of patients are asymptomatic, but these conditions must be noticed for importance of differential diagnosis such as infection and neoplasms. Conventional radiographs could not differentiate between inflammatory mucosal thickening, neoplasm, and hypoplasia of the sinus. Computed tomography (CT) and also cone beam computed tomography (CBCT) are the proper modalities to detect these conditions. In the present study, CBCT findings of three cases with maxillary sinus hypoplasia and aplasia are reported. PMID:25426156

  19. Diffuse HIV-associated seborrheic dermatitis - a case series.

    PubMed

    Forrestel, Amy K; Kovarik, Carrie L; Mosam, Anisa; Gupta, Deepti; Maurer, Toby A; Micheletti, Robert G

    2016-12-01

    Seborrheic dermatitis (SD) is reported to have distinct clinical and histologic presentations in patients with HIV infection. Here we present 20 cases to further define some of these unique characteristics. Common features include erythematous, scaly papules, and plaques involving areas beyond the typical seborrheic distribution; thick, greasy scale on the scalp; and an increased frequency of erythroderma. Histologically, there is widespread parakeratosis, spongiosis, and necrotic keratinocytes. Treatment is often difficult, requiring prolonged use of oral and topical antifungals and corticosteroids as well as antibiotics for bacterial superinfection. SD with these features represents a marker for HIV infection and can aid in early diagnosis.

  20. The radioactive waste management videoconference training series for an international audience

    SciTech Connect

    Callan, C.; Hylko, J.M.

    1996-06-01

    A proven cost-effective method for delivering new educational opportunities to employees in different locations simultaneously is by using the live videoconference format. Also, the videotapes produced from this format allows employees to participate who are not routinely available for traditional classroom training. However, the primary challenge is to design a distance learning series that meets the requirements of a diverse audience. The National Environmental Technology Network (NETN), a program associated with the College of Engineering at the University of New Mexico, has a proven track record in developing and producing effective videoconference and distance learning programs for industry, government, national laboratories, and universities. Specifically, The Radioactive Waste Management Videoconference Training Series is comprised of eight individual programs: (1) Introduction to Radioactive Waste Management, (2) Interactions Between Radiation and Matter; (3) Decommissioning and Decontamination; (4) Transportation; (5) Low-Level Radioactive Waste; (6) High-Level Radioactive Waste; (7) Transuranic Waste; and (8) New and Other Technologies for Radioactive Waste Management. Each program consists of a tiered approach featuring an introduction, case studies, legal and regulatory issues, radioactive waste characteristics, disposal Options, and transfer of technology. The participants receive a packet containing a full outline of the course, including charts and illustrations used by the presenters. At the conclusion of each program, the interactive question/answer period allows viewers to ask pertinent questions and to participate as a group.

  1. Levodropropizine-Induced Anaphylaxis: Case Series and Literature Review.

    PubMed

    Song, Jae Won; Jang, Young Sook; Jung, Moon Chan; Kim, Joo Hee; Choi, Jeong Hee; Park, Sunghoon; Hwang, Yong Il; Jang, Seung Hun; Jung, Ki Suck

    2017-05-01

    Levodropropizine is commonly used as an antitussive drug for acute and chronic cough. It is a non-opioid agent with peripheral antitussive action via the modulation of sensory neuropeptide levels in the airways. Thus, levodropropizine has a more tolerable profile than opioid antitussives. However, we experienced 3 cases of levodropropizine-induced anaphylaxis. Three patients commonly presented with generalized urticaria, dyspnea, and collapse after taking cold medication including levodropropizine. To find out the culprit drug, we performed skin tests, oral provocation tests (OPTs), and basophil activation tests (BATs). Two patients were confirmed as having levodropropizine-induced anaphylaxis by OPTs, and one of them showed positive to skin prick tests (SPTs). The other patient was confirmed by skin tests and BATs. When we analyzed pharmacovigilance data related to levodropropizine collected for 5 years, most cases (78.9%) had allergic reactions, such as rash, urticaria, angioedema, and anaphylaxis. Therefore, physicians should consider that levodropropizine can be a culprit drug, when anaphylaxis occurs after taking anti-cough or common cold medication.

  2. Eruption cysts: A series of 66 cases with clinical features

    PubMed Central

    Şen-Tunç, Emine; Şaroğlu-Sönmez, Işıl; Bayrak, Şule; Tüloğlu, Nuray

    2017-01-01

    Background An eruption cyst (EC) is a benign, developmental cyst associated with a primary or permanent tooth. This paper presents 66 ECs in 53 patients who reported to 3 different centers in Turkey between 2014-2015. Material and Methods 53 patients (31 male, 22 female) with 66 ECs were diagnosed and treated over a 1-year period. The mean age of patients was 5.4 years (minimum 5 months, maximum 11 years). Clinical examination and periapical radiographs were used to establish diagnosis. Age, gender, site, history of trauma and type of treatment were recorded. Results Of the 66 ECs diagnosed in 53 patients, more than half (56.6%) were located in the maxilla, with the maxillary first primary molars the teeth most commonly associated with ECs (30.3%). Multiple ECs were diagnosed in 13 of the 53 patients. ECs had previously diagnosed in the primary dentition of 2 patients, 3 patients reported a history of trauma to primary teeth. In the majority of patients (46 cases, 86.8%), no treatment was provided, whereas surgical treatment was provided in the remaining 7 cases (13.2%). Conclusions Eruption cysts are usually asymptomatic and do not require treatment;. however, if the cyst is symptomatic, it should be treated with simple surgical excision. Key words:Odontogenic cyst, children, eruption cyst, oral pathology. PMID:28160586

  3. Aseptic Meningitis Caused by Lassa Virus: Case Series Report

    PubMed Central

    Bankole, Idowu A.; Iruolagbe, Christopher O.; Muoebonam, Benard E.; Okonofua, Martha O.; Dawodu, Simeon O.; Akpede, George O.

    2016-01-01

    The Lassa virus is known to cause disease in different organ systems of the human body, with varying clinical manifestations. The features of severe clinical disease may include bleeding and/or central nervous system manifestations. Whereas Lassa fever encephalopathy and encephalitis are well described in the literature, there is paucity of data on Lassa virus meningitis. We present the clinical description, laboratory diagnosis, and management of 4 consecutive cases of aseptic meningitis associated with Lassa virus infection without bleeding seen in a region of Nigeria known to be endemic for both the reservoir rodent and Lassa fever. The 4 patients recovered fully following intravenous ribavirin treatment and suffered no neurologic complications. PMID:27957363

  4. Treatment of acute erythroleukemia with Azacitidine: A case series

    PubMed Central

    Pierdomenico, Francesca; Almeida, Antonio

    2013-01-01

    Acute erythroleukemia (AEL) is a rare form of acute myeloid leukemia (AML) often associated with a poor prognosis. It is more frequent in elderly patients, limiting the use aggressive therapies. Azacitidine is a hypomethylating agent with recognized efficacy in high risk myelodysplasia and AML in the elderly. Here we report 5 cases of AEL treated with Azacitidine. The cohort included 4 men and 1 woman, median age 70. One patient had been refractory to intensive chemotherapy, the others received Azacitidine as first line. Treatment was well tolerated. Four patients achieved transfusion independence. Two patients achieved complete remission and 1 achieved partial remission. After a median follow up time of 20 months, the median survival of the cohort was 20 months. Three patients died of disease progression. These results confirm the therapeutic value of Azacitidine in AEL. PMID:24371777

  5. Connecting hospitalized patients with their families: case series and commentary.

    PubMed

    Parsapour, Kourosh; Kon, Alexander A; Dharmar, Madan; McCarthy, Amy K; Yang, Hsuan-Hui; Smith, Anthony C; Carpenter, Janice; Sadorra, Candace K; Farbstein, Aron D; Hojman, Nayla M; Wold, Gary L; Marcin, James P

    2011-01-01

    The overall aim of this project was to ascertain the utilization of a custom-designed telemedicine service for patients to maintain close contact (via videoconference) with family and friends during hospitalization. We conducted a retrospective chart review of hospitalized patients (primarily children) with extended hospital length of stays. Telecommunication equipment was used to provide videoconference links from the patient's bedside to friends and family in the community. Thirty-six cases were managed during a five-year period (2006 to 2010). The most common reasons for using Family-Link were related to the logistical challenges of traveling to and from the hospital-principally due to distance, time, family commitments, and/or personal cost. We conclude that videoconferencing provides a solution to some barriers that may limit family presence and participation in care for hospitalized patients, and as a patient-centered innovation is likely to enhance patient and family satisfaction.

  6. Severe periodontal destruction in alpha-mannosidosis: a case series.

    PubMed

    Kalsi, Jagdip S; Auplish, Gita; Johnson, Adele R; Darbar, Ulpee R

    2012-01-01

    Alpha-mannosidosis is a rare genetic lysosomal storage disorder that is inherited in an autosomal recessive pattern. Severe periodontal breakdown in alpha-mannosidosis patients has not previously been reported in the literature. The purposes of this paper are to: present the cases of 2 siblings diagnosed with alpha-mannosidosis, each of whom had varying severity of periodontal destruction; and provide an overview of alpha-mannosidosis, the possible reasons for the periodontal destruction, and the periodontal management in the 2 affected siblings. Both had preventive and nonsurgical periodontal therapy followed by a 5-year period of supportive therapy. Their pattern of bone loss was consistent with those with periodontitis as a manifestation of systemic diseases, with the extent of periodontal destruction being related to the severity of the alpha-mannosidosis. Alpha-mannosidosis patients present with social disfigurements and, to prevent tooth loss that can add to this, early periodontal diagnosis is important to optimize management and intervention.

  7. Influence of female sex hormones on periodontium: A case series

    PubMed Central

    Jafri, Zeba; Bhardwaj, Ashu; Sawai, Madhuri; Sultan, Nishat

    2015-01-01

    Dental plaque is the primary etiologic factor for the periodontal diseases. Although pathogenic bacteria in dental plaque are necessary for the incidence of periodontal disease, but a susceptible host is as important. The susceptibility of the host can be modified by various systemic factors with hormones level being one. The periodontium shows an exaggerated inflammatory response to plaque modified by female sex hormone during puberty, pregnancy, in women taking oral contraceptives and at the postmenopausal stage. This paper presents such few cases where periodontium is influenced by variation in sex steroid hormones of female during different phases of their life time and to discuss how much a same hormone at different age and stage shows an exaggerated gingival response to plaque. PMID:26604605

  8. The female athlete triad: a case series and narrative overview

    PubMed Central

    Laframboise, Michelle A.; Borody, Cameron; Stern, Paula

    2013-01-01

    Objective: To illustrate the varying presentations of the female athlete triad and to inform the practitioner of the potential sequelae of this common condition. Clinical Features: Four patients presented with a variety of signs and symptoms of the female athlete triad including low caloric intake, osteoporosis, amenorrhea and/or endothelial dysfunction. Intervention and Outcome: A conservative treatment approach was utilized in each case including education on the female athlete triad, education on increased caloric intake and a referral to the family physician. Conclusion: Health care practitioners should be aware of the different clinical presentations of the female athlete triad. A narrative review of the literature is provided to educate practitioners on the components of the female athlete triad, proper diagnosis and appropriate management. PMID:24302779

  9. [Late ulnar paralysis. Study of a series of 17 cases].

    PubMed

    Mansat, M; Bonnevialle, P; Fine, X; Guiraud, B; Testut, M F

    1984-02-16

    Seventeen cases of late ulnar paralysis treated by neurolysis-transposition are reported. The clinical characteristics of these paralyses are emphasized: very prolonged symptom free interval, rapid onset and severe involvement. Ulnar transposition was most often done subcutaneously. Cubitus valgus and definite nerve compression proximal to the arcade of the flexor carpi ulnaris muscle are almost always present. The results as regards the neuropathy are undependable: no patient is completely cured and only half are improved. An anatomical study of the nerve path shows the essential role, in the compression of the nerve, of the muscular arcade of the flexor carpi ulnaris muscle which acts in a way similar to the bridge of a violin. Hence, opening it longitudinally is the principal step of neurolysis. This should be routine before the first signs of neuropathy occur in an elbow whose axis is out of alignment as a sequela of a childhood injury.

  10. A Case Series of Gastrointestinal Tuberculosis in Renal Transplant Patients

    PubMed Central

    Freitas, Cristina; Silva, Hugo; Aguiar, Pedro; Farrajota, Pedro; Almeida, Manuela; Pedroso, Sofia; Martins, La Salete; Dias, Leonídio; Vizcaíno, José Ramón; Castro Henriques, António; Cabrita, António

    2013-01-01

    Tuberculosis is a disease relatively frequent in renal transplant patients, presenting a wide variety of clinical manifestations, often involving various organs and potentially fatal. Gastrointestinal tuberculosis, although rare in the general population, is about 50 times more frequent in renal transplant patients. Intestinal tuberculosis has a very difficult investigational approach, requiring a high clinical suspicion for its diagnosis. Therapeutic options may be a problem in the context of an immunosuppressed patient, requiring adjustment of maintenance therapy. The authors report two cases of isolated gastro-intestinal tuberculosis in renal transplant recipients that illustrates the difficulty of making this diagnosis and a brief review of the literature on its clinical presentation, diagnosis, and therapeutic approach. PMID:24558621

  11. [Foreign bodies in esophagus in children: case series].

    PubMed

    Rodríguez, Hugo; Cuestas, Giselle; Botto, Hugo; Nieto, Mary; Cocciaglia, Alejandro; Gregori, Dario

    2013-06-01

    Ingestion of foreign bodies is an avoidable accident that is seen mainly in children under 3 years-old. Most of them pass through the digestive tract without causing clinical manifestations or complications, but a significant percentage is impacted in the esophagus causing vomiting, sore throat, dysphagia and drooling. The most common foreign bodies are coins. Complications usually occur when there is a delay in diagnosis or with large, sharp or potentially toxic objects, as the button battery. It is essential to make differential diagnosis between coin and button battery, since the latter requires urgent removal due to the earliness of the injury caused. We report 115 cases of foreign bodies in the esophagus, and we alert the pediatrician in recognizing and preventing this problem.

  12. Acute Calcific Tendinitis of the Rectus Femoris: A Case Series

    PubMed Central

    Kobayashi, Hideo; Kaneko, Haruka; Homma, Yasuhiro; Baba, Tomonori; Kaneko, Kazuo

    2015-01-01

    Introduction: Periarticular calcific tendinitis is a common cause of Orthopedic outpatient referral. Calcific tendinitis of the rectus femoris, however, is very rare and not well known. Due to its rarity, correct diagnosis and prompt treatment are not fully understood. Case Report: Two females (38 and 40 years old) of acute calcific tendinitis of the rectus femoris with the good clinical course without any operative treatment were presented. The pain was managed with oral non-steroidal antiinflammatory drugs and/or local steroid injection. Interval radiographic assessment showed complete resorption of the calcification. Conclusion: Establishing the correct diagnosis and initiating prompt treatment are shown to be important in achieving resolution of symptoms and in avoiding unnecessary investigations. PMID:27299063

  13. Metronidazole Toxicity in Cockayne Syndrome: A Case Series.

    PubMed

    Wilson, Brian T; Strong, Andrew; O'Kelly, Sean; Munkley, Jennifer; Stark, Zornitza

    2015-09-01

    Cockayne syndrome (CS) is a rare genetic disorder characterized by small stature, intellectual disability, and accelerated pathologic aging. Through the Cockayne Syndrome Natural History Study, we have identified 8 cases of acute hepatic failure after metronidazole administration (8% of our cohort), 3 of which were fatal. The interval between initial administration and death was 6 to 11 days. Two of these patients also experienced acute neurologic deficit. Both hepatotoxicity and acute neurologic deficit have been reported previously as extremely rare adverse events after metronidazole administration. However, we have not identified any patients with CS who have received metronidazole without serious adverse effects. We recommend that a diagnosis of CS be considered an absolute contraindication to the use of metronidazole.

  14. Pseudohypoparathyroidism, an often delayed diagnosis: a case series

    PubMed Central

    Donghi, Valentina; Zamproni, Ilaria; Chiumello, Giuseppe; Weber, Giovanna

    2009-01-01

    Pseudohypoparathyroidism refers to a heterogeneous group of disorders characterized by parathyroid hormone (PTH) resistance. Pseudohypoparathyroidism is an uncommon sporadic or inherited genetic disorder subdivided into several distinct entities (type Ia, Ib, Ic, type II). We report cases of four children (aged 8 to 13 years) in the winter season 2007-'08. The present work highlights the variable mode of presentation of pseudohypoparathyroidism and the difficulty of an early diagnosis. We stress the importance of a complete biochemical investigation of the calcium-phosphate metabolism to recognize typical biochemical alterations associated with this condition (hypocalcaemia, hyperphosphataemia with increased phosphate tubular reabsorption and elevated PTH levels) in spite of a phenotypic aspect that often lacks the presence of all the peculiar clinical features of Albright hereditary osteodistrophy. PMID:19829854

  15. Pediatric non-Helicobacter pylori atrophic gastritis: a case series.

    PubMed

    Pogoriler, Jennifer; Kamin, Daniel; Goldsmith, Jeffrey D

    2015-06-01

    Although autoimmune atrophic gastritis is classically a disease of elderly adults, recent studies have described the disease in younger adults, particularly in those with other autoimmune diseases and iron-deficiency anemia. Atrophic gastritis in pediatrics is a rare and possibly underdiagnosed entity that has been primarily reported as single-case reports. This retrospective study of atrophic gastritis not associated with Helicobacter pylori infection was performed to further expand the knowledge of clinical presentation, pathologic findings, and natural history of this disease in the pediatric population. Twelve patients with a histologic diagnosis of atrophic gastritis were identified, with an age range of 8 months to 18 years. Seven had other autoimmune diseases and/or immunodeficiency. Atrophy was confined to the oxyntic mucosa in 10 patients, with intramucosal inflammation in a diffuse or basal-predominant pattern. Active inflammation was present in 7 patients. Pseudopyloric, intestinal, or squamous/mucinous metaplasia was seen at initial biopsy or on follow-up in 8 patients, and enterochromaffin-like cell hyperplasia was seen in 5. One patient developed an adenocarcinoma during the follow-up period of 10 years. Two false-negative diagnoses were retrospectively identified. In the majority of cases, the possibility of atrophic gastritis was not raised by the submitting physician, and the endoscopic findings were not specific. Therefore, accurate diagnosis requires a high degree of suspicion on the part of the pathologist, and the diagnosis should be considered particularly in patients with a clinical history of other autoimmune diseases or iron-deficiency anemia.

  16. The role of international research projects in the dissemination of innovative technologies in Russia: AgroAtlas case study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This paper uses the AgroAtlas project (www.agroatlas.ru) as a case study to illustrate how international projects can be an important resource to help train teachers and scientists in emerging technology including geographic information systems (GIS) software. The paper discusses a series of 10- day...

  17. Internal and External reconnection in a Series of Homologous Solar Flares

    NASA Technical Reports Server (NTRS)

    Sterling, Alphonse C.; Moore, Ronald L.; Rose, M. Franklin (Technical Monitor)

    2000-01-01

    Using data from the Extreme Ultraviolet Telescope (EIT) on SOHO and the Soft X-ray Telescope (SXT) on Yohkoh, we examine a series of morphologically homologous solar flares occurring in NOAA AR 8210 over May 1-2, 1998. An emerging flux region (EFR) impacted against a sunspot to the west and next to a coronal hole to the east is the source of the repeated flaring. An SXT sigmoid parallels the EFR's neutral line at the site of the initial flaring in soft X-rays. In EIT, each flaring episode begins with the formation of a crinkle pattern external to the EFR. These EIT crinkles move out from, and then in toward, the EFR with velocities approximately 20 km/s. A shrinking and expansion of the width of the coronal hole coincides with the crinkle activity, and generation and evolution of a postflare loop system begins near the. time of crinkle formation. Using a schematic based on magnetograms of the region, we suggest that these observations are consistent with the standard reconnection-based model for solar eruptions, but modified by the presence of the additional magnetic fields of the sunspot and coronal hole. In the schematic, internal reconnection begins inside of the EFR-associated fields, unleashing a flare, postflare loops, and a CME. External reconnection, first occurring between the escaping CME and the coronal hole field, and second occurring between fields formed as a result of the first external reconnection, results in the EIT crinkles and changes in the coronal hole boundary. By the end of the second external reconnection, the initial setup is reinstated; thus the sequence can repeat, resulting in morphologically homologous eruptions. Our inferred magnetic topology is similar to that suggested in the "breakout model" of eruptions [Antiochos, 1998], although we cannot determine if our eruptions are released primarily by the breakout mechanism (external reconnection) or, alternatively, are released primarily by the internal reconnection.

  18. Intestinal Infarction Through Arterial Vascular Obstruction - Case Series from 1st and 3rd Surgery Clinics Cluj-Napoca.

    PubMed

    Jeican, Ionuţ Isaia; Mocan, Mihaela; Gheban, Dan

    2016-01-01

    This article presents a case series of intestinal infarction through obstruction of superior mesenteric artery - two cases of acute mesenteric artery embolism, two cases of acute mesenteric artery thrombosis and a case of volvulus.

  19. AUTOLOGOUS CHONDROCYTE TRANSPLANTATION-SERIES OF 3 CASES

    PubMed Central

    Gobbi, Riccardo Gomes; Demange, Marco Kawamura; Barreto, Ronald Bispo; Pécora, José Ricardo; Rezende, Múrcia Uchõa de; Filho, Tarcisio E.P Barros; Lombello, Christiane Bertachini

    2015-01-01

    Hyaline cartilage covers joint surfaces and plays an important role in reducing friction and mechanical loading on synovial joints such as the knee. This tissue is not supplied with blood vessels, nerves or lymphatic circulation, which may be one of the reasons why joint cartilage has such poor capacity for healing. Chondral lesions that reach the subchondral bone (osteochondral lesions) do not heal and may progress to arthrosis with the passage of time. In young patients, treatment of chondral defects of the knee is still a challenge, especially in lesions larger than 4 cm. One option for treating these patients is autologous chondrocyte transplantation/implantation. Because this treatment does not violate the subchondral bone and repairs the defect with tissue similar to hyaline cartilage, it has the theoretical advantage of being more biological, and mechanically superior, compared with other techniques. In this paper, we describe our experience with autologous chondrocyte transplantation/implantation at the Institute of Orthopedics and Traumatology, Hospital das Clínicas, University of Sâo Paulo, through a report on three cases. PMID:27022579

  20. Lassa fever presenting as acute abdomen: a case series.

    PubMed

    Dongo, Andrew E; Kesieme, Emeka B; Iyamu, Christopher E; Okokhere, Peter O; Akhuemokhan, Odigie C; Akpede, George O

    2013-04-19

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission.

  1. Khat chewing and cirrhosis in Somaliland: Case series

    PubMed Central

    Mahamoud, Hawa D.; Muse, Sabah Mohammed; Roberts, Lewis R.; Torbenson, Michael S.; Fader, Tim

    2016-01-01

    Background Khat chewing is common especially among men in East Africa and Yemen. It is generally viewed by the populace as a benign social custom. Several studies of ethnic Somali immigrants to Western countries suggest an association between khat chewing and hepatotoxicity, but the risk of hepatotoxicity related to khat chewing within African settings is not documented. Aim To identify and describe liver disease without evidence of alcohol exposure or infectious etiology in khat chewers. Settings A university-affiliated teaching hospital in Somaliland. Methods Cases of cirrhosis of unknown cause were identified from the clinical practice of Al Hayatt Hospital in Borama, Somaliland, during 14 months beginning December 2012. Results Eight Somali men aged 27–70 years living in Somaliland were identified with cirrhosis of otherwise unknown cause. All chewed khat habitually for many years (15–128 bundles per day times years of use). A liver biopsy of one man was consistent with khat hepatotoxicity. Four of the eight men died during the study period. Conclusion Khat chewing may be associated with health consequences including severe hepatotoxicity with cirrhosis. PMID:27543281

  2. Patients with Acromegaly Presenting with Colon Cancer: A Case Series

    PubMed Central

    Nakhle, Samer; Ludlam, William H.

    2016-01-01

    Introduction. Frequent colonoscopy screenings are critical for early diagnosis of colon cancer in patients with acromegaly. Case Presentations. We performed a retrospective analysis of the incidental diagnoses of colon cancer from the ACCESS trial (ClinicalTrials.gov identifier: NCT01995734). Colon cancer was identified in 2 patients (4.5%). Case  1 patient was a 36-year-old male with acromegaly who underwent transsphenoidal surgery to remove the pituitary adenoma. After surgery, the patient underwent routine colonoscopy screening, which revealed a 40 mm tubular adenoma in the descending colon. A T1N1a carcinoma was surgically removed, and 1 of 22 lymph nodes was positive for metastatic disease, leading to a diagnosis of stage 3 colon cancer. Case  2 patient was a 50-year-old male with acromegaly who underwent transsphenoidal surgery to remove a 2 cm pituitary adenoma. The patient reported severe cramping and lower abdominal pain, and an invasive 8.1 cm3 grade 2 adenocarcinoma with signet rings was identified in the ascending colon and removed. Of the 37 lymph nodes, 34 were positive for the presence of tumor cells, and stage 3c colon cancer was confirmed. Conclusion. Current guidelines for colonoscopy screening at the time of diagnosis of acromegaly and at appropriate follow-up intervals should be followed. PMID:28025627

  3. Transverse sacral fractures: case series and literature review

    PubMed Central

    Kim, Miriam Y.; Reidy, Declan P.; Nolan, Paul C.; Finkelstein, Joel A.

    2001-01-01

    Objectives To report experience with transverse sacral fracture, an uncommon injury frequently associated with neurologic deficit, and to perform a meta-analysis of the literature in order to define the role of decompression for the management of sacral fractures. Design A review of 7 cases. Setting A university-affiliated tertiary care centre. Patients Seven patients with transverse fractures of the sacrum. The mean follow-up was 13 months. Interventions A review of the clinical data and a search of the literature for studies that reported on 4 or more patients with a transverse sacral fracture. Main outcome measures Mechanism of injury, type of neurologic deficit and its management. Results The most common mechanism in the 7 study patients was a fall from a height. Six patients had neurologic deficits, mostly in the form of bowel or bladder disturbance. Five of these were treated with surgical decompression, and 4 of them had an improvement in neurologic function. The 7 original studies from the literature dealt with a total of 55 patients. As in the study patients, falls from a height and motor vehicle accidents predominated as the mechanisms of injury. In contrast to patients in this study, 20 of 48 patients in the literature review with neurologic deficits were treated conservatively. Conclusions The outcomes in this study are similar to those reported in the literature. The place of surgical decompression for patients with neurologic deficit cannot be clearly determined from the evidence currently available. PMID:11603749

  4. Lassa fever presenting as acute abdomen: a case series

    PubMed Central

    2013-01-01

    Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission. PMID:23597024

  5. Flexible and internal series-connected supercapacitors with high working voltage using ultralight porous carbon nanofilms

    NASA Astrophysics Data System (ADS)

    Li, Xiaoyan; Zhou, Man; Wang, Jun; Ge, Fengyan; Zhao, Yaping; Komarneni, Sridhar; Cai, Zaisheng

    2017-02-01

    Highly flexible carbon nanofibers with hierarchical nanostructure, which provide an excellent distribution of differently functionalized-carbon nanotubes and terephthalic acid, were prepared cost-effectively and demonstrated as binder-free electrodes. Symmetric solid-state supercapacitors were then fabricated and could be operated reversibly in the voltage range of 0-1.8 V with excellent electrochemical performance due to the hierarchical porosity and hybrid architecture. Furthermore, internal series-connected supercapacitors based on the prepared porous carbon nanofibers were designed and fabricated. Such supercapacitors were found to be flexible enough to be rolled up or twisted with constant capacitive performance at a high working voltage of up to 3.6 V and exhibited a 38.9% increase in energy density than that of the single-cell supercapacitor. This one-step approach leads to simplicity of operation and economical efficiency for fabricating lightweight supercapacitors with high working voltage and energy density, which may be beneficial for the development of flexible and wearable energy storage devices.

  6. A Case Series: Evaluation of the Metabolic Safety of Aripiprazole

    PubMed Central

    De Hert, Marc; Hanssens, Linda; van Winkel, Ruud; Wampers, Martien; Van Eyck, Dominique; Scheen, Andre; Peuskens, Joseph

    2007-01-01

    Metabolic abnormalities occur frequently in patients treated with antipsychotics and are of growing concern to clinicians. This study sought to determine whether antipsychotic-associated metabolic abnormalities identified through intensive monitoring can be reversed by switching to aripiprazole. Recent evidence suggests that aripiprazole may exhibit a favorable metabolic safety profile. The study population is a subset of a large (n > 500) ongoing prospective cohort. Thirty-one consecutive patients with schizophrenia who were started on aripiprazole were included in the study. All patients underwent an extensive metabolic evaluation, including an oral glucose tolerance test, at baseline, at 6 weeks, and at 3 months post switch. Metabolic abnormalities were defined as any of the following: new onset diabetes, impaired fasting glucose, impaired glucose tolerance, metabolic syndrome (MetS) according to various definitions, and dyslipidemia. After 3 months of treatment with aripiprazole (mean daily dose 16.3 mg), there was a significant decrease in body weight, body mass index, and waist circumference. There was a significant reduction in fasting glucose, fasting insulin, insulin resistance index, and serum lipids levels (cholesterol, triglycerides, low-density lipoprotein (LDL), LDL/HDL, Chol/HDL, and non-HDL cholesterol). There was also a significant reduction in prolactin levels. All 7 cases of recent onset diabetes were reversed at 3 months follow-up. The MetS was reversed in 50% of patients at 3 months follow-up. Our results support the reversibility of recent onset diabetes on antipsychotic medication when detected early and followed by a switch to aripiprazole. PMID:16940338

  7. A case series: evaluation of the metabolic safety of aripiprazole.

    PubMed

    De Hert, Marc; Hanssens, Linda; van Winkel, Ruud; Wampers, Martien; Van Eyck, Dominique; Scheen, Andre; Peuskens, Joseph

    2007-05-01

    Metabolic abnormalities occur frequently in patients treated with antipsychotics and are of growing concern to clinicians. This study sought to determine whether antipsychotic-associated metabolic abnormalities identified through intensive monitoring can be reversed by switching to aripiprazole. Recent evidence suggests that aripiprazole may exhibit a favorable metabolic safety profile. The study population is a subset of a large (n > 500) ongoing prospective cohort. Thirty-one consecutive patients with schizophrenia who were started on aripiprazole were included in the study. All patients underwent an extensive metabolic evaluation, including an oral glucose tolerance test, at baseline, at 6 weeks, and at 3 months post switch. Metabolic abnormalities were defined as any of the following: new onset diabetes, impaired fasting glucose, impaired glucose tolerance, metabolic syndrome (MetS) according to various definitions, and dyslipidemia. After 3 months of treatment with aripiprazole (mean daily dose 16.3 mg), there was a significant decrease in body weight, body mass index, and waist circumference. There was a significant reduction in fasting glucose, fasting insulin, insulin resistance index, and serum lipids levels (cholesterol, triglycerides, low-density lipoprotein (LDL), LDL/HDL, Chol/HDL, and non-HDL cholesterol). There was also a significant reduction in prolactin levels. All 7 cases of recent onset diabetes were reversed at 3 months follow-up. The MetS was reversed in 50% of patients at 3 months follow-up. Our results support the reversibility of recent onset diabetes on antipsychotic medication when detected early and followed by a switch to aripiprazole.

  8. Obsessive Compulsive Disorder Treatment in Patients with Down Syndrome: A Case Series

    ERIC Educational Resources Information Center

    Sutor, Bruce; Hansen, Mark R.; Black, John L.

    2006-01-01

    In this case series we report four cases of patients with Down syndrome with symptoms consistent with obsessive compulsive disorder. Each patient experienced substantial reduction in compulsive behaviors with pharmacotherapy of an SSRI alone or with the addition of risperidone to SSRI therapy. None of the patients experienced significant side…

  9. Intensive (Daily) Behavior Therapy for School Refusal: A Multiple Baseline Case Series

    ERIC Educational Resources Information Center

    Tolin, David F.; Whiting, Sara; Maltby, Nicholas; Diefenbach, Gretchen J.; Lothstein, Mary Anne; Hardcastle, Surrey; Catalano, Amy; Gray, Krista

    2009-01-01

    The following multiple baseline case series examines school refusal behavior in 4 male adolescents. School refusal symptom presentation was ascertained utilizing a functional analysis from the School Refusal Assessment Scale (Kearney, 2002). For the majority of cases, treatment was conducted within a 15-session intensive format over a 3-week…

  10. Masseteric-facial nerve neurorrhaphy: results of a case series.

    PubMed

    Biglioli, Federico; Colombo, Valeria; Rabbiosi, Dimitri; Tarabbia, Filippo; Giovanditto, Federica; Lozza, Alessandro; Cupello, Silvia; Mortini, Pietro

    2017-01-01

    OBJECTIVE Facial palsy is a well-known functional and esthetic problem that bothers most patients and affects their social relationships. When the time between the onset of paralysis and patient presentation is less than 18 months and the proximal stump of the injured facial nerve is not available, another nerve must be anastomosed to the facial nerve to reactivate its function. The masseteric nerve has recently gained popularity over the classic hypoglossus nerve as a new motor source because of its lower associated morbidity rate and the relative ease with which the patient can activate it. The aim of this work was to evaluate the effectiveness of masseteric-facial nerve neurorrhaphy for early facial reanimation. METHODS Thirty-four consecutive patients (21 females, 13 males) with early unilateral facial paralysis underwent masseteric-facial nerve neurorrhaphy in which an interpositional nerve graft of the great auricular or sural nerve was placed. The time between the onset of paralysis and surgery ranged from 2 to 18 months (mean 13.3 months). Electromyography revealed mimetic muscle fibrillations in all the patients. Before surgery, all patients had House-Brackmann Grade VI facial nerve dysfunction. Twelve months after the onset of postoperative facial nerve reactivation, each patient underwent a clinical examination using the modified House-Brackmann grading scale as a guide. RESULTS Overall, 91.2% of the patients experienced facial nerve function reactivation. Facial recovery began within 2-12 months (mean 6.3 months) with the restoration of facial symmetry at rest. According to the modified House-Brackmann grading scale, 5.9% of the patients had Grade I function, 61.8% Grade II, 20.6% Grade III, 2.9% Grade V, and 8.8% Grade VI. The morbidity rate was low; none of the patients could feel the loss of masseteric nerve function. There were only a few complications, including 1 case of postoperative bleeding (2.9%) and 2 local infections (5.9%), and a few

  11. Morgellons disease, illuminating an undefined illness: a case series

    PubMed Central

    2009-01-01

    Introduction This review of 25 consecutive patients with Morgellons disease (MD) was undertaken for two primary and extremely fundamental reasons. For semantic accuracy, there is only one "proven" MD patient: the child first given that label. The remainder of inclusive individuals adopted the label based on related descriptions from 1544 through 1884, an internet description quoted from Sir Thomas Browne (1674), or was given the label by practitioners using similar sources. Until now, there has been no formal characterization of MD from detailed examination of all body systems. Our second purpose was to differentiate MD from Delusions of Parasitosis (DP), another "informal" label that fit most of our MD patients. How we defined and how we treated these patients depended literally on factual data that would determine outcome. How they were labeled in one sense was irrelevant, except for the confusing conflict rampant in the medical community, possibly significantly skewing treatment outcomes. Case presentation Clinical information was collected from 25 of 30 consecutive self-defined patients with Morgellons disease consisting of laboratory data, medical history and physical examination findings. Abnormalities were quantified and grouped by system, then compared and summarized, but the numbers were too small for more complex mathematical analysis. The quantification of physical and laboratory abnormalities allowed at least the creation of a practical clinical boundary, separating probable Morgellons from non-Morgellons patients. All the 25 patients studied meet the most commonly used DP definitions. Conclusions These data suggest Morgellons disease can be characterized as a physical human illness with an often-related delusional component in adults. All medical histories support that behavioral aberrancies onset only after physical symptoms. The identified abnormalities include both immune deficiency and chronic inflammatory markers that correlate strongly with

  12. Types of case series--the anatomically based approach: commentary on M. F. Schwartz & G. S. Dell: case series investigations in cognitive neuropsychology.

    PubMed

    Shallice, Tim; Buiatti, Tania

    2011-10-01

    The paper addresses a weakness in the Schwartz and Dell paper (2010)-namely, its discussion of the inclusion criteria for case series. The paper distinguishes the different types that exist and how they constrain the theoretical conclusions that one can draw about the organization of the normal cognitive system. Four different types of inclusion criteria are considered. Two are those treated by Schwartz and Dell-namely, theoretically derived clinical criteria, such as the example of semantic dementia, and broad clinical criteria such as the presence of aphasia. In addition, in the present paper two different types of anatomically based criteria are assessed-those using anatomical regions selected a priori and also regions selected as a result of an anatomical group study analysis. Putative functional syndromes are argued to be the empirical building blocks for cognitive neuropsychology. Anatomically based case series can aid in their construction or in their fractionation.

  13. Reliability Analysis for the Internationally Administered 2002 Series GED Tests. GED Testing Service[R] Research Studies, 2009-3

    ERIC Educational Resources Information Center

    Setzer, J. Carl; He, Yi

    2009-01-01

    Reliability Analysis for the Internationally Administered 2002 Series GED (General Educational Development) Tests Reliability refers to the consistency, or stability, of test scores when the authors administer the measurement procedure repeatedly to groups of examinees (American Educational Research Association [AERA], American Psychological…

  14. Functions and Statistics: International Space Station: Up to Us. NASA Connect: Program 5 in the 2000-2001 Series.

    ERIC Educational Resources Information Center

    National Aeronautics and Space Administration, Hampton, VA. Langley Research Center.

    This teaching unit is designed to help students in grades 5 to 8 explore the concepts of functions and statistics in the context of the International Space Station (ISS). The units in the series have been developed to enhance and enrich mathematics, science, and technology education and to accommodate different teaching and learning styles. Each…

  15. 76 FR 48749 - Airworthiness Directives; Honeywell International Inc. TPE331-10 and TPE331-11 Series Turboprop...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-09

    ... International Inc. TPE331-10 and TPE331-11 Series Turboprop Engines AGENCY: Federal Aviation Administration (FAA.... TPE331-10, -10AV, -10GP, -10GT, -10N, -10P, -10R, -10T, -10U, -10UA, -10UF, -10UG, -10UGR, -10UR,...

  16. 77 FR 6669 - Airworthiness Directives; Honeywell International Inc. TPE331-10 and TPE331-11 Series Turboprop...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-09

    ... International Inc. TPE331-10 and TPE331-11 Series Turboprop Engines AGENCY: Federal Aviation Administration (FAA.... TPE331-10, -10AV, -10GP, -10GT, - 10N, -10P, -10R, -10T, -10U, -10UA, -10UF, -10UG, -10UGR, -10UR,...

  17. Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series.

    PubMed

    Holmes, E A; Bonsall, M B; Hales, S A; Mitchell, H; Renner, F; Blackwell, S E; Watson, P; Goodwin, G M; Di Simplicio, M

    2016-01-26

    Treatment innovation for bipolar disorder has been hampered by a lack of techniques to capture a hallmark symptom: ongoing mood instability. Mood swings persist during remission from acute mood episodes and impair daily functioning. The last significant treatment advance remains Lithium (in the 1970s), which aids only the minority of patients. There is no accepted way to establish proof of concept for a new mood-stabilizing treatment. We suggest that combining insights from mood measurement with applied mathematics may provide a step change: repeated daily mood measurement (depression) over a short time frame (1 month) can create individual bipolar mood instability profiles. A time-series approach allows comparison of mood instability pre- and post-treatment. We test a new imagery-focused cognitive therapy treatment approach (MAPP; Mood Action Psychology Programme) targeting a driver of mood instability, and apply these measurement methods in a non-concurrent multiple baseline design case series of 14 patients with bipolar disorder. Weekly mood monitoring and treatment target data improved for the whole sample combined. Time-series analyses of daily mood data, sampled remotely (mobile phone/Internet) for 28 days pre- and post-treatment, demonstrated improvements in individuals' mood stability for 11 of 14 patients. Thus the findings offer preliminary support for a new imagery-focused treatment approach. They also indicate a step in treatment innovation without the requirement for trials in illness episodes or relapse prevention. Importantly, daily measurement offers a description of mood instability at the individual patient level in a clinically meaningful time frame. This costly, chronic and disabling mental illness demands innovation in both treatment approaches (whether pharmacological or psychological) and measurement tool: this work indicates that daily measurements can be used to detect improvement in individual mood stability for treatment innovation (MAPP).

  18. Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series

    PubMed Central

    Holmes, E A; Bonsall, M B; Hales, S A; Mitchell, H; Renner, F; Blackwell, S E; Watson, P; Goodwin, G M; Di Simplicio, M

    2016-01-01

    Treatment innovation for bipolar disorder has been hampered by a lack of techniques to capture a hallmark symptom: ongoing mood instability. Mood swings persist during remission from acute mood episodes and impair daily functioning. The last significant treatment advance remains Lithium (in the 1970s), which aids only the minority of patients. There is no accepted way to establish proof of concept for a new mood-stabilizing treatment. We suggest that combining insights from mood measurement with applied mathematics may provide a step change: repeated daily mood measurement (depression) over a short time frame (1 month) can create individual bipolar mood instability profiles. A time-series approach allows comparison of mood instability pre- and post-treatment. We test a new imagery-focused cognitive therapy treatment approach (MAPP; Mood Action Psychology Programme) targeting a driver of mood instability, and apply these measurement methods in a non-concurrent multiple baseline design case series of 14 patients with bipolar disorder. Weekly mood monitoring and treatment target data improved for the whole sample combined. Time-series analyses of daily mood data, sampled remotely (mobile phone/Internet) for 28 days pre- and post-treatment, demonstrated improvements in individuals' mood stability for 11 of 14 patients. Thus the findings offer preliminary support for a new imagery-focused treatment approach. They also indicate a step in treatment innovation without the requirement for trials in illness episodes or relapse prevention. Importantly, daily measurement offers a description of mood instability at the individual patient level in a clinically meaningful time frame. This costly, chronic and disabling mental illness demands innovation in both treatment approaches (whether pharmacological or psychological) and measurement tool: this work indicates that daily measurements can be used to detect improvement in individual mood stability for treatment innovation (MAPP

  19. Congenital Malformations of the Inner Ear: Case Series and Review of the Literature.

    PubMed

    Piromchai, Patorn; Kasemsiri, Pornthep; Thanawirattananit, Panida; Yimtae, Kwanchanok

    2015-08-01

    Patients with craniofacial anomalies often present to doctors due to their noticeable disfigurement and are routinely assessed by otolaryngologists for hearing evaluation. However, small percentage of craniofacial anomaly patients may present with delayed speech though they may not have initial obvious external deformation. The objective of case series is to identify the congenital inner ear malformation. The series of clinical presentation, physical examination, investigations, treatments and follow-up results were demonstrated followed by the discussion.

  20. Successful use of right unilateral ECT for catatonia: a case series.

    PubMed

    Cristancho, Pilar; Jewkes, Delaina; Mon, Thetsu; Conway, Charles

    2014-03-01

    Catatonia is a neuropsychiatric syndrome involving motor signs in association with disorders of mood, behavior, or thought. Bitemporal electrode placement electroconvulsive therapy (ECT) is a proven effective treatment for catatonia, and this mode of ECT delivery is the preferred method of treatment in this condition. Studies in major depressive disorder have demonstrated that suprathreshold, nondominant (right) hemisphere, unilateral electrode placement ECT has fewer adverse effects, especially cognitive adverse effects, than bitemporal ECT. This case series describes the use of right unilateral (RUL) ECT in 5 patients with catatonia. Before ECT, all 5 patients in this series initially failed therapy with benzodiazepines and psychotropic medications. Each catatonic patient received a series of 8 to 12 RUL ECT in an every-other-day series. After ECT, 4 of the 5 patients had a full recovery from catatonia. One patient achieved only partial response to RUL ECT, and no additional benefit was obtained with bitemporal ECT. All patients in this case series tolerated RUL ECT without major adverse effects. This case series illustrates successful use of RUL ECT in patients with catatonia and adds to the early literature demonstrating its effective use in treating this complex condition.

  1. Analysis of a case of internal contamination with cobalt radioisotopes.

    PubMed

    Vrba, T; Malatova, I; Jurochova, B

    2007-01-01

    Internal contamination by compounds of cobalt radioisotopes occurs time to time at nuclear power plants. Intakes and committed effective doses are estimated by biokinetic models described in ICRP publications. The paper deals with a case of internal contamination of a worker engaged in a maintenance task at NPP Dukovany. In this case significant discrepancy was observed between intakes based on various datasets (whole body counting, analysis of urine and faeces) when default model setting was used. The reason of this phenomenon was searched for. Three different least square methods of fits were used to find out possible effect of a fitting method. The measured data were fitted by set of biokinetic functions, which covered all intake ways (ingestion and inhalation) and types (M, S, different AMADs and different f1) of the contaminant. The biokinetic model of cobalt needs further improvements as to find better agreement between data fit from direct measurements and bioassay.

  2. Extracorporeal Membrane Oxygenation (ECMO) for Hypothermic Cardiac Deterioration: A Case Series.

    PubMed

    Niehaus, Matthew T; Pechulis, Rita M; Wu, James K; Frei, Steven; Hong, John J; Sandhu, Rovinder S; Greenberg, Marna Rayl

    2016-10-01

    Accidental hypothermia can lead to untoward cardiac manifestations and arrest. This report presents a case series of severe accidental hypothermia with cardiac complications in three emergency patients who were treated with extracorporeal membrane oxygenation (ECMO) and survived after re-warming. The aim of this discussion was to encourage more clinicians to consider ECMO as a re-warming therapy for severe hypothermia with circulatory collapse and to prompt discussion about decreasing the barriers to its use. Niehaus MT , Pechulis RM , Wu JK , Frei S , Hong JJ , Sandhu RS , Greenberg MR . Extracorporeal membrane oxygenation (ECMO) for hypothermic cardiac deterioration: a case series. Prehosp Disaster Med. 2016;31(5):570-571.

  3. The CIQG International Quality Principles: Toward a Shared Understanding of Quality. CIQG Publication Series

    ERIC Educational Resources Information Center

    Uvalic-Trumbic, Stamenka

    2016-01-01

    The idea of developing International Quality Principles emerged from a dialogue and debate among colleagues from many countries at the Council for Higher Education Accreditation (CHEA) International Quality Group (CIQG) 2014 Annual Meeting. The discussion focused on whether a single set of international standards for academic quality in higher…

  4. International Travel by Speakers of Esperanto. Esperanto Documents, New Series, No. 9A.

    ERIC Educational Resources Information Center

    Tyblewski, Tyburcjusz

    This volume considers the value of Esperanto in relation to international tourism, and the characteristics of Esperantist tourists. Esperanto is seen as a solution to problems of language in international relations in general, and thus to international travel as well. The following are some of the general characteristics of the majority of…

  5. Supratentorial cavernous haemangiomas and epilepsy: a review of the literature and case series

    PubMed Central

    Moran, N; Fish, D; Kitchen, N; Shorvon, S; Kendall, B; Stevens, J

    1999-01-01

    OBJECTIVES—To characterise the clinical features and response to treatment of supratentorial cavernomas associated with epilepsy.
METHODS—A systematic review of the literature was carried out and a retrospective case series of patients with cavernoma diagnosed by MRI and/or histology was compiled. Patient selection biases in the literature review were reduced as far as possible by selection of unbiased publications.
RESULTS—In the literature, cavernomas were relatively less common in the frontal lobes. There were multiple cavernomas in 23% of cases. The main clinical manifestations were seizures (79%) and haemorrhage (16%). The annual haemorrhage rate was 0.7%. The outcome after excision was good with improvement in seizures in 92% of patients. In the case series the surgical outcome was less favourable, reflecting inclusion of a higher proportion of patients with intractable epilepsy. In both the literature review and the case series, outcome was poorer in cases with a longer duration of seizures at the time of surgery.
CONCLUSIONS—The good surgical results, particularly in cases treated earlier, and the significant cumulative haemorrhage rate, suggest that excision is the optimum treatment. However, these factors have not been examined prospectively and, despite the availability of several retrospective studies, the optimum treatment, particularly for non-intractable cases, will only be determined by a prospective study.

 PMID:10209164

  6. Rare case-series of electrocautery burn following off-pump coronary artery bypass grafting

    PubMed Central

    Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

    2014-01-01

    Abstract: With an increasing number of off-pump coronary artery surgery procedures in high-risk patients with coagulopathy, including renal failure, hepatic failure and anticoagulant drug-using patients, the frequency of related complications such as repeated exploration for bleeding is also increasing. The associated co-morbidity and repeated use of electrocautery in postoperative bleeding leaves patients susceptible to electrocautery ulcers. In this case series, rare cases of cautery burn with unique causative mechanisms are described. PMID:23669602

  7. Eosinophilic meningitis: a case series and review of literature of Angiostrongylus cantonensis and Gnathostoma spinigerum.

    PubMed

    Shah, I; Barot, S; Madvariya, M

    2015-01-01

    Eosinophilic meningitis is defined as the presence of >10 eosinophils/μL in cerebrospinal fluid (CSF) or at least 10% eosinophils in the total CSF leukocyte count. Eosinophilic meningitis has been reported in two case series and two case reports in India till date and has not been reported in children below 15 years of age. We present two children with eosinophilic meningitis with peripheral eosinophilia and the proposed etiologic agents based on the clinical setting and their response to antihelminthic agents.

  8. Lip repositioning with reversible trial for the management of excessive gingival display: a case series.

    PubMed

    Jacobs, Paul J; Jacobs, Bryan P

    2013-01-01

    Lip repositioning surgery is a largely unknown and underutilized treatment modality for excessive gingival display. It involves precise resection of maxillary mucosal tissues with reattachment of the lip in a more coronal position. This limits lip elevation on smiling and increases lip fullness. While this is an elective treatment, no reported cases have yet offered patients the ability to preview the outcome in a reversible manner. This case series presents seven patients who were successfully managed with trial, and then definitive, lip repositioning.

  9. Manualized Family-Based Treatment for Anorexia Nervosa: A Case Series.

    ERIC Educational Resources Information Center

    Le Grange, Daniel; Binford, Roslyn; Loeb, Katharine L.

    2005-01-01

    Objective: The purpose of this study was to describe a case series of children and adolescents (mean age = 14.5 years, SD = 2.3; range 9-18) with anorexia nervosa who received manualized family-based treatment for their eating disorder. Method: Forty-five patients with anorexia nervosa were compared pre- and post-treatment on weight and menstrual…

  10. Is Family Therapy Useful for Treating Children with Anorexia Nervosa? Results of a Case Series

    ERIC Educational Resources Information Center

    Lock, James; le Grange, Daniel; Forsberg, Sarah; Hewell, Kristen

    2006-01-01

    Objective: Research suggests that family-based treatment (FBT) is an effective treatment for adolescents with anorexia nervosa (AN). This retrospective case series was designed to examine its usefulness with younger children. Method: Data were abstracted from medical records of 32 children with a mean age of 11.9 years (range 9.0-12.9) meeting…

  11. Assessing Outcome in Cognitive Behavior Therapy for Child Depression: An Illustrative Case Series

    ERIC Educational Resources Information Center

    Eckshtain, Dikla; Gaynor, Scott T.

    2009-01-01

    Recent meta-analytic data suggest a need for ongoing evaluation of treatments for youth depression. The present article calls attention to a number of issues relevant to the empirical evaluation of if and how cognitive behavior therapy for child depression works. A case series of 6 children and a primary caregiver received treatment--individual…

  12. Dialectical Behavior Therapy of Anorexia and Bulimia Nervosa among Adolescents: A Case Series

    ERIC Educational Resources Information Center

    Salbach-Andrae, Harriet; Bohnekamp, Inga; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Miller, Alec L.

    2008-01-01

    The aim of this study was to describe a case series of adolescents (mean age = 16.5 years, SD = 1.0) with anorexia nervosa (AN) and bulimia nervosa (BN) who received dialectical behavior therapy (DBT). Twelve outpatients with AN and BN took part in 25 weeks of twice weekly therapy consisting of individual therapy and a skills training group.…

  13. A Case Series of Marijuana Exposures in Pediatric Patients Less than 5 Years of Age

    ERIC Educational Resources Information Center

    Wang, George Sam; Narang, Sandeep K.; Wells, Kathryn; Chuang, Ryan

    2011-01-01

    Objective: In Colorado, there has been a large increase in medical marijuana dispensaries and licenses for the use of medical marijuana over the past year. This is a retrospective case series of marijuana exposures that have presented to the emergency department (ED) in children less than 5 years of age. Methods: We performed a retrospective chart…

  14. Brief Report: Retrospective Case Series of Oxcarbazepine for Irritability/Agitation Symptoms in Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Douglas, Jessica F.; Sanders, Kevin B.; Benneyworth, M. Hannah; Smith, Jessica L.; DeJean, Virginia M.; McGrew, Susan G.; Veenstra-VanderWeele, Jeremy

    2013-01-01

    We examined response to oxcarbazepine prescribed for irritability/agitation symptoms in a retrospective case series of 30 patients with Autism Spectrum Disorder (ASD). The average patient was 12.0 years old (range 5-21) and taking two other psychotropic medications (range 0-4). Fourteen patients (47 %) had a clinical global impression of…

  15. Intervention for Infants at Risk of Developing Autism: A Case Series

    ERIC Educational Resources Information Center

    Green, Jonathan; Wan, Ming Wai; Guiraud, Jeanne; Holsgrove, Samina; McNally, Janet; Slonims, Vicky; Elsabbagh, Mayada; Charman, Tony; Pickles, Andrew; Johnson, Mark

    2013-01-01

    Theory and evidence suggest the potential value of prodromal intervention for infants at risk of developing autism. We report an initial case series (n = 8) of a parent-mediated, video-aided and interaction-focused intervention with infant siblings of autistic probands, beginning at 8-10 months of age. We outline the theory and evidence base…

  16. Inhaled nitric oxide in preterm infants with prolonged preterm rupture of the membranes: a case series.

    PubMed

    Semberova, J; O'Donnell, S M; Franta, J; Miletin, J

    2015-04-01

    The available evidence does not support the routine use of inhaled nitric oxide (iNO) in the care of premature infants. We present a case series of 22 preterm infants born after prolonged preterm premature rupture of membranes and oligohydramnios with respiratory failure. Oxygenation index decreased significantly after commencement of iNO.

  17. Case Studies: Persecution/Genocide. The Human Rights Series. Volume III.

    ERIC Educational Resources Information Center

    Litynsky, Walter; And Others

    A continuation of the study of those factors that lead to persecutions and acts of genocide is presented. As students read the materials included in the case studies, they should be referred to the organizing concepts discussed in "Teaching about the Holocaust and Genocide: Introduction. The Human Rights Series, Volume I." Unit 1 in that…

  18. International Education: What Is It? A Taxonomy of International Education of U.S. Universities. CIEE Occasional Papers on International Educational Exchange No. 23, Forum Series.

    ERIC Educational Resources Information Center

    Arum, Stephen

    The many facets of international education and the interrelationships within that field are examined in this taxonomy. The concept of international education varies greatly, and a consensus regarding definition and representation is important if the proponents and participants of international education are to speak knowledgeably among themselves.…

  19. NREL Case Study Leads to International Partnership (Fact Sheet)

    SciTech Connect

    Not Available

    2013-12-01

    In 2012, NREL analysts produced a case study, "Integrating Variable Renewable Energy in Electric Power Markets: Best Practices from International Experience," which drew upon dozens of interviews with international experts involved in crafting effective policies and markets. The report proposed a cross-cutting initiative to transform the world's power systems by implementing two complementary strategies: the large‐scale deployment of renewable energy, and a combination of comprehensive energy efficiency and smarter grids. This recommendation led to the launch of the 21st Century Power Partnership in April 2012, and its membership has since grown to include Denmark, Finland, Germany, India, Mexico, Spain, and the United States. NREL, together with its affiliated Joint Institute for Strategic Energy Analysis, are the operating agents.

  20. Applying data mining techniques to medical time series: an empirical case study in electroencephalography and stabilometry.

    PubMed

    Anguera, A; Barreiro, J M; Lara, J A; Lizcano, D

    2016-01-01

    One of the major challenges in the medical domain today is how to exploit the huge amount of data that this field generates. To do this, approaches are required that are capable of discovering knowledge that is useful for decision making in the medical field. Time series are data types that are common in the medical domain and require specialized analysis techniques and tools, especially if the information of interest to specialists is concentrated within particular time series regions, known as events. This research followed the steps specified by the so-called knowledge discovery in databases (KDD) process to discover knowledge from medical time series derived from stabilometric (396 series) and electroencephalographic (200) patient electronic health records (EHR). The view offered in the paper is based on the experience gathered as part of the VIIP project. Knowledge discovery in medical time series has a number of difficulties and implications that are highlighted by illustrating the application of several techniques that cover the entire KDD process through two case studies. This paper illustrates the application of different knowledge discovery techniques for the purposes of classification within the above domains. The accuracy of this application for the two classes considered in each case is 99.86% and 98.11% for epilepsy diagnosis in the electroencephalography (EEG) domain and 99.4% and 99.1% for early-age sports talent classification in the stabilometry domain. The KDD techniques achieve better results than other traditional neural network-based classification techniques.

  1. Modern Spirometry Supports Anesthetic Management in Small Animal Clinical Practice: A Case Series.

    PubMed

    Calice, Ivana; Moens, Yves

    2016-01-01

    Modern spirometry, like no other monitoring technique, allows insight into breath-to-breath respiratory mechanics. Spirometers continuously measure volume, airway pressure, and flow while calculating and continuously displaying respiratory system compliance and resistance in the form of loops. The aim of this case series is to show how observation of spirometric loops, similar to electrocardiogram or CO2 curve monitoring, can improve safety of anesthetic management in small animals. Spirometric monitoring cases described in this case series are based on use of the anaesthesia monitor Capnomac Ultima with a side stream spirometry sensor. The cases illustrate how recognition and understanding of spirometric loops allows for easy diagnosis of iatrogenic pneumothorax, incorrect ventilator settings, leaks in the system, kinked or partially obstructed endotracheal tube, and spontaneous breathing interfering with intermittent positive-pressure ventilation. The case series demonstrates the potential of spirometry to improve the quality and safety of anesthetic management, and, hence, its use can be recommended during intermittent positive-pressure ventilation and procedures in which interference with ventilation can be expected.

  2. Head and neck inflammatory pseudotumor: Case series and review of the literature.

    PubMed

    Kansara, Sagar; Bell, Diana; Johnson, Jason; Zafereo, Mark

    2016-12-01

    Inflammatory pseudotumor (IP) is an uncommon idiopathic lesion that often imitates malignancy clinically and radiologically. Inflammatory pseudotumors have been found to occur in various sites but rarely in the head and neck. The histopathology, imaging, and treatment of three unique cases of head and neck inflammatory pseudotumors are described in this case series. Patients in Cases 1 and 2 presented with right level II neck mass and left parotid tail mass, respectively. The patient in Case 3 presented with otalgia, jaw pain and trismus, and a left parapharyngeal space mass. The tumors in Cases 1 and 3 significantly decreased in size with tapered courses of oral corticosteroids. The tumor in Case 2 was surgically excised without disease recurrence. Malignancy must be ruled out with incisional or excisional biopsy. Treatment includes surgical excision, oral corticosteroids, or both. The literature shows that radiotherapy and small-molecule inhibitors may be promising alternatives.

  3. Principles and Practices for Teaching English as an International Language. ESL & Applied Linguistics Professional Series

    ERIC Educational Resources Information Center

    Allsagoff, Lubna, Ed.; McKay, Sandra Lee, Ed.; Hu, Guangwei, Ed.; Renandya, Willy A., Ed.

    2012-01-01

    What general principles should inform a socioculturally sensitive pedagogy for teaching English as an International Language and what practices would be consistent with these principles? This text explores the pedagogical implications of the continuing spread of English and its role as an international language, highlighting the importance of…

  4. International Education for the Millennium: Toward Access, Equity, and Quality. Harvard Educational Review Reprint Series.

    ERIC Educational Resources Information Center

    Piper, Benjamin, Ed.; Dryden-Peterson, Sarah, Ed.; Kim, Young-Suk, Ed.

    2006-01-01

    This volume sheds light on contemporary theoretical work and research, on a range of national and international polices, and on education reform in developing countries. International Education has become an increasingly prominent and urgent matter in recent decades. Since the 1990 and 2000 Education for All conferences in Thailand, and Senegal,…

  5. Reforming the International Monetary System: From Roosevelt to Reagan. Headline Series No. 281.

    ERIC Educational Resources Information Center

    Hormats, Robert D.

    This book examines the changed, and changing, international monetary system. It describes how the system has evolved under nine Presidents, from Franklin D. Roosevelt to Ronald Reagan. It also discusses the broader evolution of the world economy during this period, including the trade and investment issues to which international monetary policy is…

  6. Leptomeningeal carcinomatosis in esophageal cancer: a case series and systematic review of the literature.

    PubMed

    Lukas, R V; Mata-Machado, N A; Nicholas, M K; Salgia, R; Antic, T; Villaflor, V M

    2015-01-01

    The aim of this study was to more clearly define the clinical course of leptomeningeal carcinomatosis due to esophageal cancer. A single institution retrospective case series was conducted. Additionally, a systematic review of the literature was performed. We present a large case series (n = 7) of leptomeningeal carcinomatosis due to esophageal cancer. Our case series and systematic review of the literature report similar findings. In our series, we report a predominance of male patients (86%) with adenocarcinoma histology (77%). Variable onset of leptomeningeal involvement of esophageal cancer in relation to the original diagnosis of the primary disease (5 months to 3 years and 11 weeks) was noted. Disease progresses quickly and overall survival is poor, measured in weeks (2.5-16 weeks) from the diagnosis of leptomeningeal involvement. Four of our patients initiated whole-brain radiation therapy with only two completing the course prior to clinical deterioration. Our patient with the longest survival (16 weeks) received intrathecal topotecan and oral temozolomide. Leptomeningeal carcinomatosis secondary to esophageal cancer has a poor prognosis. A clearly beneficial treatment modality is lacking.

  7. Conservative chiropractic management of urinary incontinence using applied kinesiology: a retrospective case-series report

    PubMed Central

    Cuthbert, Scott C.; Rosner, Anthony L.

    2012-01-01

    Objective The purpose of this case series is to describe the chiropractic management of 21 patients with daily stress and occasional total urinary incontinence (UI). Clinical Features Twenty-one case files of patients 13 to 90 years of age with UI from a chiropractic clinic were reviewed. The patients had a 4-month to 49-year history of UI and associated muscle dysfunction and low back and/or pelvic pain. Eighteen wore an incontinence pad throughout the day and night at the time of their appointments because of unpredictable UI. Intervention and Outcome Patients were evaluated for muscle impairments in the lumbar spine, pelvis, and pelvic floor and low back and/or hip pain. Positive manual muscle test results of the pelvis, lumbar spine muscles, and pelvic floor muscles were the most common findings. Lumbosacral dysfunction was found in 13 of the cases with pain provocation tests (applied kinesiology sensorimotor challenge); in 8 cases, this sensorimotor challenge was absent. Chiropractic manipulative therapy and soft tissue treatment addressed the soft tissue and articular dysfunctions. Chiropractic manipulative therapy involved high-velocity, low-amplitude manipulation; Cox flexion distraction manipulation; and/or use of a percussion instrument for the treatment of myofascial trigger points. Urinary incontinence symptoms resolved in 10 patients, considerably improved in 7 cases, and slightly improved in 4 cases. Periodic follow-up examinations for the past 6 years, and no less than 2 years, indicate that for each participant in this case-series report, the improvements of UI remained stable. Conclusion The patients reported in this retrospective case series showed improvement in UI symptoms that persisted over time. PMID:22942842

  8. Zygomycetes infections in pediatric hematology oncology patients: a case series and review of the literature.

    PubMed

    Dehority, Walter; Willert, Jennifer; Pong, Alice

    2009-12-01

    Fungi from the Zygomycetes class are increasingly recognized causes of infection in immunosuppressed children, but no comprehensive literature review and few case series have been published on the topic. A case series of 6 pediatric oncology patients with Zygomycetes infections cared for at our institution was constructed, and a concurrent search of the English language literature for Zygomycetes infections in children with oncologic disorders was undertaken. Our case series described 6 patients (5 male) between the ages of 2.5 and 19.5 years. One patient was diagnosed with rhinocerebral disease, 2 with rhinosinusitis, 2 with pulmonary involvement, and 1 with a gastrointestinal presentation. Five patients survived. Our literature review identified 82 cases from 61 studies. The mean subject age was 10.8 years (1.4 to 21.0 y). About 92.7% of all patients suffered from some form of leukemia, with 70.7% suffering from acute lymphoblastic leukemia. Overall, 58.5% of reported patients survived, with individuals with disseminated disease showing the worst prognosis (68.2% mortality) and those with cutaneous disease the best (14.3% mortality). Survival is increasingly reported in the literature, perhaps as a result of improved diagnostic capabilities, increased physician awareness and increased reliance on adjunctive surgical therapy.

  9. 75 FR 78937 - Airworthiness Directives; Honeywell International LTS101 Series Turboshaft Engines and LTP101...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-17

    .... The actions specified by this proposed AD are intended to prevent fracture of the power turbine blade... corrected, could result in fracture of the power turbine blade airfoil, which could result in sudden loss of... fracture of a power turbine airfoil of an LTS101 series turboshaft engine installed on a...

  10. Attention Bias Modification Treatment for children with anxiety disorders who do not respond to cognitive behavioral therapy: a case series.

    PubMed

    Bechor, Michele; Pettit, Jeremy W; Silverman, Wendy K; Bar-Haim, Yair; Abend, Rany; Pine, Daniel S; Vasey, Michael W; Jaccard, James

    2014-03-01

    Evidence is emerging to support the promise of Attention Bias Modification Treatment (ABMT), a computer-based attention training program, in reducing anxiety in children. ABMT has not been tested as an adjuvant for children with anxiety disorders who do not respond to Cognitive-Behavioral Therapy (CBT). This case series presents findings from an open trial of ABMT among six children (four girls; M age = 11.2 years) who completed a CBT protocol and continued to meet diagnostic criteria for an anxiety disorder. All children completed the ABMT protocol with no canceled or missed sessions. Child self-ratings on anxiety symptoms and depressive symptoms significantly decreased from pretreatment to posttreatment, as did parent ratings on child anxiety-related impairment. Parent ratings on child anxiety and internalizing symptoms displayed non-significant decreases from pretreatment to posttreatment. These findings support the potential promise of ABMT as a feasible adjuvant treatment that reduces anxiety and impairment among child anxiety CBT nonresponders.

  11. Revised definition of neuropathic pain and its grading system: an open case series illustrating its use in clinical practice.

    PubMed

    Geber, Christian; Baumgärtner, Ulf; Schwab, Rainer; Müller, Harald; Stoeter, Peter; Dieterich, Marianne; Sommer, Clemens; Birklein, Frank; Treede, Rolf-Detlef

    2009-10-01

    The definition of neuropathic pain has recently been revised by an expert committee of the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (NeuPSIG) as "pain arising as direct consequence of a lesion or disease affecting the somatosensory system," and a grading system of "definite," "probable," and "possible" neuropathic pain has been introduced. This open case series of 5 outpatients (3 men, 2 women; mean age 48 +/- 12 years) demonstrates how the grading system can be applied, in combination with appropriate confirmatory testing, to diagnosis neuropathic conditions in clinical practice. The proposed grading system includes a dynamic algorithm that enhances the physician's ability to determine with a greater level of certainty whether a pain condition is neuropathic. Its clinical use should be further validated in prospective studies.

  12. Complications associated with negative pressure reaming for harvesting autologous bone graft: a case series.

    PubMed

    Lowe, Jason A; Della Rocca, Gregory J; Murtha, Yvonne; Liporace, Frank A; Stover, Michael D; Nork, Sean E; Crist, Brett D

    2010-01-01

    A technical benefit of the reamer-irrigator-aspirator (RIA) system (Synthes, Paoli, PA) is the ability to harvest large volumes (40-90 cm3) of autogenous bone graft. Early evaluations of this technique have reported few problems, all of which were attributed to technical error. This case series reviews 6 RIA-associated complications including 4 fractures and their contributing risk factors. Cases were collected from 4 independent orthopaedic centers, and all patients underwent RIA bone graft harvesting in a lower extremity long bone injuries. In this population, 2 patients experienced acute RIA-associated events, necessitating an additional procedure or altered postoperative rehabilitation, whereas 4 patients fractured through their donor site in the early postoperative period. This series suggests that surgeons should (1) preoperatively assess cortical diameters at long bone harvest sites, (2) carefully monitor intraoperative reaming, and (3) avoid RIA bone graft harvesting in patients with a history of osteoporosis or osteopenia unless postharvest intramedullary stabilization is considered.

  13. A case-series study of cerebral venous thrombosis in women using short course oral contraceptive

    PubMed Central

    Khomand, Payam; Hassanzadeh, Kambiz

    2016-01-01

    Background: We report a case series of cerebral vein thrombosis (CVT) in women who used oral contraceptive pill (OCP) in the Muslims Ramadan and fasting month. Methods: This study was a retrospective case series of 9 patients with diagnosis of CVT, who admitted in the neurology ward of Tohid Hospital of Sanandaj, Iran, in July-August 2014-2015. Results: Patients had no history of thrombosis before. They were treated with oral contraceptive more than 1 month to be able to fast during Ramadan. They did not have other possible risk factors for CVT. A headache was the most common in 9/9 patients (100%) followed by vomiting and vertigo. Conclusion: We found that high rate of CVT in female population during Ramadan indicates that it needs be considered as a specific risk factor and should be considered by healthcare system. PMID:27326364

  14. Resolution of choroidal neovascularization secondary to punctate inner choroidopathy (PIC) with intravitreal anti-VEGF agents: a case series.

    PubMed

    Mangat, Simran S; Ramasamy, B; Prasad, Som; Walters, Gavin; Mohammed, Moin; Mckibbin, Martin

    2011-01-01

    Case series of four patients with CNVM secondary to PIC treated solely with anti VEGF in three cases and in combination with PDT in the other. This series reveals long term follow up (3 months to 28 months) which is currently not described in the literature.

  15. Aripiprazole, a partial dopamine agonist to improve adolescent anorexia nervosa-A case series.

    PubMed

    Frank, Guido K W

    2016-05-01

    Anorexia nervosa (AN) is a severe and complex psychiatric disorder and no medication has been approved for its treatment. This case series in youth with severe, recurrent AN supports the hypothesis that dopamine receptor agonists could be helpful in supporting fear extinction during eating disorder focused psychotherapy and therefore support recovery from AN. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:529-533).

  16. Case series of equine pituitary pars intermedia dysfunction in a tropical climate.

    PubMed

    Spelta, C W; Axon, J E

    2012-11-01

    The clinical manifestations of equine pituitary pars intermedia dysfunction (PPID) in temperate climates are well described. The classic presentation is that of an older animal with hirsutism, laminitis, poor muscle tone, pendulous abdomen and weight loss. This case series highlights the additional clinical signs of anhidrosis and heat stress with secondary exercise intolerance that were seen as primary presenting problems in equids with PPID in the hot, humid conditions of a tropical climate. The clinical signs resolved with medical treatment for PPID.

  17. Management of Lower Extremity and Pelvic Tumors Using Computer Assisted Modeling (CAM) A Case Series.

    PubMed

    Haskoor, John; Sinno, Sammy; Blank, Alan; Saadeh, Pierre; Rapp, Timothy

    2016-06-01

    Computer assisted modeling (CAM) has become an important tool in surgical oncology and reconstructive surgery. The preservation of the limb is an important consideration when approaching the treatment of lower extremity and pelvic tumors. The use of cutting guides allows for optimal conservation of disease-free bone and maintenance of function. We present a small case series that illustrates the use of CAM in patients with lower extremity and pelvic bone tumors.

  18. Preduodenal portal vein: a 3-case series demonstrating varied presentations in infants.

    PubMed

    Kim, Soo-Hong; Cho, Yong-Hoon; Kim, Hae-Young

    2013-10-01

    Preduodenal portal vein, a rare anomaly, could be found in any age groups. In pediatrics it may present with a duodenal obstruction by itself or other coexisting anomalies; however it usually present with an asymptomatic or incidental findings during other surgery in adults. This anomaly has a clinical importance due to the possibility of accidental damage to portal vein. In addition to describing a series of 3 cases with different manifestation in infants, discuss about this anomaly with a review of relevant literature.

  19. Forecasting malaria cases using climatic factors in delhi, India: a time series analysis.

    PubMed

    Kumar, Varun; Mangal, Abha; Panesar, Sanjeet; Yadav, Geeta; Talwar, Richa; Raut, Deepak; Singh, Saudan

    2014-01-01

    Background. Malaria still remains a public health problem in developing countries and changing environmental and climatic factors pose the biggest challenge in fighting against the scourge of malaria. Therefore, the study was designed to forecast malaria cases using climatic factors as predictors in Delhi, India. Methods. The total number of monthly cases of malaria slide positives occurring from January 2006 to December 2013 was taken from the register maintained at the malaria clinic at Rural Health Training Centre (RHTC), Najafgarh, Delhi. Climatic data of monthly mean rainfall, relative humidity, and mean maximum temperature were taken from Regional Meteorological Centre, Delhi. Expert modeler of SPSS ver. 21 was used for analyzing the time series data. Results. Autoregressive integrated moving average, ARIMA (0,1,1) (0,1,0)(12), was the best fit model and it could explain 72.5% variability in the time series data. Rainfall (P value = 0.004) and relative humidity (P value = 0.001) were found to be significant predictors for malaria transmission in the study area. Seasonal adjusted factor (SAF) for malaria cases shows peak during the months of August and September. Conclusion. ARIMA models of time series analysis is a simple and reliable tool for producing reliable forecasts for malaria in Delhi, India.

  20. Treatment of ranula using carbon dioxide laser--case series report.

    PubMed

    Lai, J B; Poon, C Y

    2009-10-01

    Ranulas are mucus extravasation phenomenon formed after trauma to the sublingual gland or mucus retention from the obstruction of the sublingual ducts. There are various methods for treating ranulas, including marsupialization with or without open packing, excision of ranula with or without removal of sublingual gland, and laser excision and vaporization of ranula. The authors present a case series report on the use of carbon dioxide laser treatment for ranula and a literature review of cases treated using carbon dioxide laser. The authors' experience and reports in the literature indicate that carbon dioxide laser excision of ranula is safe with minimal or no recurrence.

  1. Rotational drift of mandibular third molar teeth: a series of four cases.

    PubMed

    Hughes, A J; Vudiniabola, S T; McMillan, B D; Smith, A C

    2009-03-01

    Rotational drift of mandibular third molar teeth is a challenge for clinicians to predict and manage. Evidence on the incidence and degree of rotation is sparse. As the factors influencing rotation are not defined, prediction is impossible. A series of four cases with lower third molar rotation are presented and discussed. Significant rotation can alter the degree of difficulty for an extraction. A lack of well-documented cases has hindered investigation of this phenomenon. Further research is required to identify the aetiology, incidence and increase in risk factors caused by such rotational drift.

  2. Definitive palliation for neoplastic colonic obstruction using enteral stents: Personal case-series with literature review

    PubMed Central

    Piccinni, Giuseppe; Angrisano, Anna; Testini, Mario; Bonomo, G. Martino

    2004-01-01

    Acute colonic obstruction due to malignancies is an emergency that requires surgical treatment. Elderly patients or inoperable tumors require intestinal decompression that is a simple colostomy in almost all cases. This “manoeuvre” leads the patient to a percentage of mortality/morbidity and to a bad quality of life due to acceptance of stoma. The introduction of enteral metal stent inserted endoscopically has, in our opinion, provided a new way to obtaining the definitive palliation of inoperable colo-rectal cancer with a simple method. We reported our case-series and we analyzed the current literature and costs of treatments. PMID:14991956

  3. Sheehan's syndrome with pancytopenia--complete recovery after hormone replacement (case series with review).

    PubMed

    Laway, Bashir Ahmad; Bhat, Javid Rasool; Mir, Shahnaz Ahmad; Khan, Raja Sultan Zaman; Lone, Mohd Iqbal; Zargar, Abdul Hamid

    2010-03-01

    Reports of pancytopenia in patients with Sheehan's syndrome are rare, because the disorder is not commonly seen in western countries. A case series of pancytopenia in three patients of Sheehan's syndrome is presented. Three women aged 22, 30, and 34 years developed Sheehan's syndrome preceded by post partum hemorrhage. During investigations, they were found to have pancytopenia with hypocellular marrow. Treatment with thyroxine and glucocorticoids resulted in complete recovery after attaining euthyroid and eucortisolemic state. Review of literature revealed the rarity of the disorder, with only four cases reported so far. Multiple anterior pituitary hormone deficiencies in Sheehan's syndrome are responsible for pancytopenia; replacement of thyroid and cortisol hormones results in complete recovery.

  4. Perioperative considerations in adult mitochondrial disease: A case series and a review of 111 cases.

    PubMed

    Miyamoto, Yuri; Miyashita, Tetsuya; Takaki, Shunsuke; Goto, Takahisa

    2016-01-01

    Mitochondrial disease has been uncommon conditions, still results in death during childhood in many cases. The ideal anesthetic pharmacological management strategy for adult patients with mitochondrial disease is currently unclear. In this study, we presented features of the anesthesia methods employed and the perioperative complications of patients in our institution and in previously published case reports. We report the use of general anesthesia 7 times in 6 adult patients with mitochondrial disease during 2004-2014. All cases were performed with maintained intravenous anesthesia. One case was reintubated on the day after surgery, but the cause of death was not directly related to anesthesia. One hundred and eleven general anesthesia cases in 97 adult patients with mitochondrial disease were described in 83 the literature. Although several severe perioperative complications and deaths have been reported, malignant hyperthermia had not been reported in adult cases, and metabolic disorder called propofol infusion syndrome had also not been reported in adult patients undergone total intravenous anesthesia. Perioperative complications of lactic acidosis were reported more in inhalation anesthesia than intravenous anesthesia. Therefore we recommended intravenous anesthesia rather than inhalation anesthesia for adult mitochondrial disease.

  5. Inside Thai Private Higher Education: Exploring Private Growth in International Context. PROPHE Working Paper Series. WP No. 12

    ERIC Educational Resources Information Center

    Praphamontripong, Prachayani

    2008-01-01

    This paper examines different institutional characteristics of Thai private higher education in historical-organizational perspective. The analysis applies different conceptual categories of private emergence--Catholic, elite, demand-absorbing--drawn from international literature starting with Levy (1986) to the Thai case. The societal context of…

  6. Bayesian analysis of time-series data under case-crossover designs: posterior equivalence and inference.

    PubMed

    Li, Shi; Mukherjee, Bhramar; Batterman, Stuart; Ghosh, Malay

    2013-12-01

    Case-crossover designs are widely used to study short-term exposure effects on the risk of acute adverse health events. While the frequentist literature on this topic is vast, there is no Bayesian work in this general area. The contribution of this paper is twofold. First, the paper establishes Bayesian equivalence results that require characterization of the set of priors under which the posterior distributions of the risk ratio parameters based on a case-crossover and time-series analysis are identical. Second, the paper studies inferential issues under case-crossover designs in a Bayesian framework. Traditionally, a conditional logistic regression is used for inference on risk-ratio parameters in case-crossover studies. We consider instead a more general full likelihood-based approach which makes less restrictive assumptions on the risk functions. Formulation of a full likelihood leads to growth in the number of parameters proportional to the sample size. We propose a semi-parametric Bayesian approach using a Dirichlet process prior to handle the random nuisance parameters that appear in a full likelihood formulation. We carry out a simulation study to compare the Bayesian methods based on full and conditional likelihood with the standard frequentist approaches for case-crossover and time-series analysis. The proposed methods are illustrated through the Detroit Asthma Morbidity, Air Quality and Traffic study, which examines the association between acute asthma risk and ambient air pollutant concentrations.

  7. Symptomatic infantile Helicobacter pylori gastritis infection in indigenous African infants: a case series.

    PubMed

    Malande, Oliver Ombeva

    2014-01-01

    Helicobacter pylori gastritis infection rate increases with age. Higher rates have however been reported among young people in the developing countries of the world. The infection however has rarely been reported in infants, especially in Africa. This case series describes three cases of Helicobacter pylori gastritis infection as diagnosed in three infants. The goal is to raise the suspicion index of medical practitioners about the possibility of this this infection among infants who present with suggestive symptoms. On three separate occasions in 2012 and 2013, three ill, indigenous, black African female infants aged 4, 6 and 7 months, were brought to hospital with symptoms ranging from fever, refusal to feed, diarrhoea, restlessness, vomiting and irritability. In each case, systemic examination findings were unremarkable. After several laboratory investigations, each infant was found to have Helicobacter pylori infection following positive blood antibody (using Tell Me Fast H. Pylori antibody serum and Plasma test manufactured by Biocan Diagnostics Canada) and fecal HpSA ImmunoCardSTAT antigen tests. Repeat stool antigen test was negative in each case after completion of the recommended triple therapy. Helicobacter pylori infection has been rarely reported among infants. This case series highlights the need for health care providers to have a high index of suspicion so that infants with suggestive symptoms, especially in settings with high Helicobacter pylori colonization prevalence can be evaluated for Helicobacter pylori gastritis infection.

  8. ‘Look Beyond Skin’: Psychogenic Excoriation - A Series of Five Cases

    PubMed Central

    Nirmal, Balakrishnan; Shenoi, Shrutakirthi D; Rai, Shweta; Sreejayan, Kongasseri; Savitha, Soman

    2013-01-01

    Psychogenic excoriation is a condition where the patient picks the skin repetitively to produce excoriations. Treating this clinical entity is challenging as these patients often have an associated psychological abnormality. The five cases in this case series include two children and three adults. They presented with skin lesions ranging from excoriations and ulcers to scars and pigmentation. Detailed evaluation was done by clinical psychologist. Two cases had anxiety traits, one had alcohol dependence, one had difficult temperament and one had depressive symptoms. Habit reversal was introduced. Psychiatry referral was given for three cases and started on selective serotonin reuptake inhibitors. On follow-up, the urge to scratch reduced substantially and skin lesions were also improving. It is important to identify the underlying psychological disorder accounting for skin picking behavior. Incorporating psychotherapeutic techniques into clinical practice will improve the quality of life of many of these patients. PMID:23723517

  9. Promoting Creativity in International Business Education: A Protocol for Student-Constructed Cases

    ERIC Educational Resources Information Center

    Riordan, Diane A.; Sullivan, M. Cathy; Fink, Danny

    2003-01-01

    Case studies, including "archival cases," "documentary cases," "living cases," and "learner-generated cases," are popular teaching methods in the international business curriculum. In this paper we present a protocol for student-constructed cases, an extension of the learner-generated case, and provide an example using foreign currency exchange…

  10. Epilepsy and violence: case series concerning physical trauma in children of persons with epilepsy

    PubMed Central

    Gauffin, Helena; Landtblom, Anne-Marie

    2014-01-01

    Historically, epilepsy has been associated with violence, but more recent studies have emphasized genetic and psychosocial factors as more important. The case series presented here aim to highlight the difficult situation the affected children are in. We report on three cases when children have been traumatized and, in one case, even been killed by their parent who was diagnosed with epilepsy. In the first case, we describe a woman with juvenile myoclonic epilepsy who was sentenced to forensic psychiatry care for killing her child. She lived under difficult psychosocial circumstances and a suicide attempt contributed to what happened. The second case describes a man with post-traumatic seizures who was sentenced for child abuse. Ictal or postictal violence was considered in these two cases but a causal link between the violence and epilepsy has not been established. In the third case, we describe a woman with focal epilepsy and psychogenic non-epileptic seizures (PNESs). Her child was hurt and frightened in relation to violent seizures, which were regarded as PNESs. This case series demonstrates that children of parents with epilepsy can be in a vulnerable situation. No causality has been established between the seizures and these events, so consequently other factors such as psychosocial stress, low cognitive function, and a suicide attempt must also be considered as important. When a child is hurt by a parent with epilepsy the patient must be closely examined to determine the role of the seizures. Children can also be affected by PNESs. It is essential to notice especially those children of parents with epilepsy who live under difficult psychosocial circumstances and offer extra support when necessary. PMID:25484586

  11. Health and Social Services among International Labor Migrants: A Comparative Perspective. CMAS Border & Migration Studies Series.

    ERIC Educational Resources Information Center

    Ugalde, Antonio, Ed.; Cardenas, Gilberto, Ed.

    Eleven papers from a workshop titled "International Migration: Health and Social Policies" focus on common concerns and problems in providing social and health services to labor migrants and immigrants in the United States and the European Union. Following an introduction (Antonio Ugalde, Gilberto Cardenas), the papers are: (1)…

  12. International Workforce Initiatives: Definitions, Design Options, and Project Profiles. Working Paper Series. No. 1

    ERIC Educational Resources Information Center

    Wright, J.W., Jr.

    2010-01-01

    This publication is intended for three primary audiences: international development professionals who want to define "workforce" for program design purposes, those who seek information about field activities, and those who want to reflect on the implementation of successful, high impact programs--whether they were broad-based or…

  13. International Perspectives on Quality in Higher Education. EPI Monograph Series on Higher Education.

    ERIC Educational Resources Information Center

    Janosik, Steven M., Ed.; Creamer, Don G., Ed.; Alexander, M. David, Ed.

    This monograph contains the invited papers of the major speakers at the Educational Policy Institutes Second Annual International Conference in Quality in Higher Education held at Exeter College, University of Oxford, England in the summer of 2001. The purpose of the conference was to discuss how quality is being defined, measured, and ensured in…

  14. International Service Learning: Conceptual Frameworks and Research. IUPUI Series on Service Learning Research 1

    ERIC Educational Resources Information Center

    Bringle, Robert G., Ed.; Hatcher, Julie A., Ed.; Jones, Steven G., Ed.

    2010-01-01

    This book focuses on conducting research on International Service Learning (ISL), which includes developing and evaluating hypotheses about ISL outcomes and measuring its impact on students, faculty, and communities. The book argues that rigorous research is essential to improving the quality of ISL's implementation and delivery, and providing the…

  15. 76 FR 64293 - Airworthiness Directives; CFM International, S. A. Model CFM56-5B Series Turbofan Engines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-18

    ...) This AD applies to CFM International, S.A. CFM56-5B1/3, CFM56-5B2/3, CFM56-5B3/3, CFM56-5B4/3, CFM56-5B5/3, CFM56-5B6/3, CFM56-5B7/3, CFM56-5B8/3, CFM56-5B9/3, CFM56-5B3/3B1, and CFM56-5B4/ 3B1 engines..., S. A. Model CFM56-5B Series Turbofan......

  16. Subacute motor neuron hyperexcitability with mercury poisoning: a case series and literature review.

    PubMed

    Zhou, Zhibin; Zhang, Xingwen; Cui, Fang; Liu, Ruozhuo; Dong, Zhao; Wang, Xiaolin; Yu, Shengyuan

    2014-01-01

    Motor neuron hyperexcitability (MNH) indicates a disorder characterized by an ectopic motor nerve discharge on electromyogram (EMG). Here, we present a series of three cases of subacute MNH with mercury poisoning. The first case showed hyperhidrosis, insomnia, generalied myokymia, cramps, tremor, weight loss, and myokymic and neuromyotonic discharges, followed by encephalopathy with confusion, hallucinations, and memory decrease. The second case was similar to the former but without encephalopathic features. The third case showed widespread fasciculation, fatigue, insomnia, weight loss, and autonomic dysfunction, including constipation, micturition difficulty, and impotence, with multiple fibrillation, unstable fasciculation, widened motor neuron potential, and an incremental response at high-rate stimulation in repetitive nerve stimulation. Based on the symptoms, the three cases were diagnosed as Morvan's syndrome, Isaacs' syndrome, and Lambert-Eaton myasthenic syndrome with ALS-like syndrome, respectively. Mercury poisoning in the three cases was confirmed by analysis of blood and urine samples. All cases recovered several months after chelation therapy and were in good condition at follow-up. Very few cases of MNH linked with mercury exposure have been reported in the literature. The mechanism of mercury-induced MNH may be associated with ion channel dysfunction.

  17. Spinal epidural abscess in hemodialysis patients: a case series and review.

    PubMed

    Wong, San S; Daka, Smitha; Pastewski, Andrew; Kyaw, Win; Chapnick, Edward; Sepkowitz, Douglas

    2011-06-01

    Spinal epidural abscess (SEA) is a rare but potentially devastating condition. We noticed an increase in the number of cases of SEA, with the majority in hemodialysis (HD) patients. This prompted a retrospective chart review of all cases of SEA admitted from 2000 to 2005 and a literature search of similar cases. We identified 19 SEA cases treated at Long Island College Hospital during this 6-year period, of which six were on HD: four were dialyzed via catheter, one via arteriovenous fistula, and in one the method of dialysis was not documented. Four patients had bacteremia with Staphylococcus aureus. Four patients presented with paresis or paralysis; only one improved. The mortality rate was 33% (2/6). We found 30 other cases of SEA in patients on HD from the literature. These 36 HD cases were compared with 85 SEA cases that were not on HD (13 from our study and 72 described in two large case series). The mortality rate was noted to be much higher in HD patients (23% [6/26] versus 7% [6/85]). Neurologic deficit at presentation was noted in 47% (17/36) of HD patients versus 69% (59/85) of non-HD patients, but neurologic improvement was higher in non-HD patients (71% [42/59] versus 29% [5/17]). This is the largest literature review of SEA in patients on HD. When compared with non-HD patients, HD patients had a higher mortality rate and were less likely to improve neurologically.

  18. Ocular adnexal and orbital amyloidosis: a case series and literature review.

    PubMed

    Mora-Horna, Eduardo R; Rojas-Padilla, Rubí; López, Vianhi G; Guzmán, Martín J; Ceriotto, Ariel; Salcedo, Guillermo

    2016-04-01

    The purpose of the study was to describe the main clinical and epidemiologic characteristics, treatment options, and outcome in a large series of patients with periocular and orbital amyloidosis. This is a retrospective, descriptive, observational study of a case series of 14 patients with periocular and orbital amyloidosis and is a review of previously published cases with this diagnosis between September 2004 and January 2015. In this study, we analyzed our 14 patients in conjunction with 69 well-documented cases of orbital and/or periocular amyloidosis previously reported, with a total of 83. Of these, 54 were female (65.1 %), 28 male (33.7 %), and one with unspecified gender. The mean age at diagnosis was 54.9 years (range, 18-87). The localization of the amyloidosis was classified as superficial, deep and combined, with involvement of 53 (63.9 %), 26 (31.3 %), and four cases (4.8 %) in each group, respectively. The main findings in superficial amyloidosis were mass or tissue infiltration (84.9 %) and ptosis (30.2 %) and, in the cases with deep involvement, mass (65.4 %), proptosis (57.7 %), limited ocular movements (34.6 %), ocular displacement (30.8 %), and ptosis (26.9 %). The cases with combined involvement presented with signs and symptoms of the two groups. Regarding the outcome, 43 patients were reported stable after the diagnosis and 21 had recurrence or required new surgical procedures. Periocular and orbital amyloidosis is a rare disease that can present with a variety of symptoms and signs depending on the localization and extension of involvement. Its prompt recognition is important in order to investigate systemic disease, which will affect the prognosis of each case.

  19. Case series of familial frontal fibrosing alopecia and a review of the literature.

    PubMed

    Navarro-Belmonte, María Rogelia; Navarro-López, Vicente; Ramírez-Boscà, Ana; Martínez-Andrés, Ma Asunción; Molina-Gil, Consuelo; González-Nebreda, Miguel; Asín-Llorca, Manuel

    2015-03-01

    Frontal fibrosing alopecia (FFA) is a distinctive form of scarring alopecia presenting with partial eyebrow loss and frontal temporal parietal recession of the hairline. Its etiology remains unknown, and there is no definitive treatment. Information in familial cases of FFA is scarce. We conducted a retrospective cohort study describing the mean clinical findings, treatment, and also the mean differences between premenopausal and postmenopausal cases of familiar FFA. Data analysis from case was performed on eight patients with a familiar history and diagnosis of FFA seen at the Alicante Aesthetic Dermatology Centre between January 2009 and June 2014. All patients in this cohort were females. Mean age at onset was 65 year (range 60-75) in the postmenopausal patients and 39 year (range 33-47) in the premenopausal women. All menopausal patients were in an advanced stage when the disease had already developed in the frontal and/or temporal parietal hairline region. However, the daughters, all of them premenopausal age, attended the consultation with mild involvement of the eyebrows in all four cases and mild impairment of the frontal hairline in three of them. Specific clinical findings in familial FFA are poorly communicated until nowadays although the number of familial cases arises until 8% in the main case series published in recent years. Early diagnosis in premenopausal stage is frequent in our case series and allows us to begin the protocol treatment in the first stage of the disease, but long-term progression will remain uncertain until a definitive treatment could be established by multicenter randomized controlled trials.

  20. Realistic reference adult and paediatric phantom series for internal and external dosimetry.

    PubMed

    Stabin, M G; Emmons, M A; Segars, W P; Fernald, M J

    2012-03-01

    A new generation of realistic, image-based anthropomorphic phantoms has been developed based on the reference masses and organ definitions given in the International Commission on Radiological Protection Publication 89. Specific absorbed fractions for internal radiation sources have been calculated for photon and electron sources for many body organs. Values are similar to those from the previous generation of 'stylized' (mathematical equation-based) models, but some differences are seen, particularly at low particle or photon energies, due to the more realistic organ geometries, with organs generally being closer together, and with some touching and overlapping. Extension of this work, to use these phantoms in Monte Carlo radiation transport simulation codes with external radiation sources, is an important area of investigation that should be undertaken.

  1. Early Head Tremor in Essential Tremor: A Case Series and Commentary

    PubMed Central

    Louis, Elan D.; Badejo, Funmi M.; Cristal, Ashley D.; Meyers, James; Hernandez, Nora; Chen, Karen P.; Naranjo, Kelly V.; Park, Jemin; Clark, Lorraine N.

    2017-01-01

    Background Classically, the onset of head tremor in essential tremor (ET) patients follows that of hand tremor, such that there is a somatotopic spread of involved areas. Here we present a series of seven self‐reportedly “unaffected” relatives of ET cases. These seven were clinically asymptomatic and had normal levels of arm tremor on examination, yet each evidenced a transient head wobble on examination. We estimate the prevalence of this phenotype within the two studies from which cases were ascertained. Methods ET cases and their self‐reportedly affected and unaffected relatives, enrolled in two family studies, underwent a medical history and videotaped neurological examination. Results In seven self‐reportedly “unaffected” relatives, a transient and subtle head wobble was seen, always during sustained phonation, speech, or reading aloud. Total tremor score (a measure of arm tremor) ranged from 5 to 12 (i.e., mild tremor within the range of normal). The prevalence of this phenotype of early head tremor was 3.7% in one study and 23.1% in the other. Discussion We present a series of seven individuals who had early head tremor in an evolving transition state from normal to ET. These cases raise a number of broad clinical, phenotypic, and pathophysiological issues about ET. PMID:28373926

  2. Mobilization and Defense Management Technical Reports Series. International Terrorism: The DOD Approach.

    DTIC Science & Technology

    1983-05-01

    intimidate a target group wider than the Lnmediate victims. 3 Publications of DOS reflect that during the period 1968 to 1981, victims of international...suggested that the disproportionate share of American victims reflects the view that Americans are seen as symols of wealth and power targeted as an...in that order. Significantly, attacks against military persomel are increasing at the greatest rate at this time. Statistics for U.S. citizen targets

  3. Robotic-assisted simple prostatectomy: a systematic review and report of a single institution case series.

    PubMed

    Banapour, P; Patel, N; Kane, C J; Cohen, S A; Parsons, J K

    2014-03-01

    Open simple prostatectomy (OSP) is an effective treatment for patients with symptomatic BPH and larger volume prostates; however, it is associated with substantial risks of bleeding, transfusion and prolonged hospital length of stay (LOS). Robotic-assisted simple prostatectomy (RASP) potentially offers improved perioperative outcomes for these patients. We systematically reviewed published data on RASP outcomes and analyzed our experience at the University of California San Diego (UCSD). We identified eight published studies, all non-comparative case series (Level 3 evidence), reporting a total of 109 RASP cases from 2008 to 2012. Indications included acute urinary retention (n=48), persistent obstructive symptoms (n=51), failure of medical management (n=9) and recurrent urinary tract infections (n=2). The mean ages ranged from 65 to 77 years. More than 75% of the studies reported a mean LOS <3 days and a transfusion prevalence of 0%. The mean resected prostate weights ranged from 51 to 301 g. For UCSD, indications for surgery included urinary retention (n=11) and failure of medical management (n=5). The mean age was 68 years, transfusion prevalence 0%, mean resected prostate weight 94 g and mean LOS 1 day. All nine series observed substantial postoperative improvements in urinary symptoms and retention. These data suggest that RASP is a safe and efficacious treatment for BPH in select patients with larger prostates. Although LOS and transfusion prevalence for RASP are markedly lower than the published OSP series, comparative studies are needed to verify these results.

  4. Physicians as leaders in improving health care: a new series in Annals of Internal Medicine.

    PubMed

    Berwick, D M; Nolan, T W

    1998-02-15

    Searching for one word to describe the state of mind of the physician in the United States today, we might choose beleaguered. Threats appear from all sides--from payers, would-be managers of care, the growth of technology, and even patients. The rhetoric is one of siege and battle, and the dynamic seems to be a clash of values from which only one winner can emerge. But scientific and health services research suggest otherwise. Science suggests that health care could, indeed, perform a great deal better than it does today and that a shared aim of improving health outcomes for patients at a cost that society can afford is sensible and within reach. However, achievement of these improvements will require of physicians not handwringing and resistance to change but concerted, positive, capable leadership. The goal of this series in Annals is to describe a new knowledge base that will help physicians participate effectively in the redesign of the health care system. The series is intended to raise the curiosity of physicians about the skills they will need to become more active and influential citizens of the health care community in accomplishing improvements. These skills will help physicians better deploy their clinical expertise and professional purpose in a debate that has heretofore been informed primarily by economics.

  5. Fatal overdoses involving hydromorphone and morphine among inpatients: a case series

    PubMed Central

    Lowe, Amanda; Hamilton, Michael; Greenall BScPhm MHSc, Julie; Ma, Jessica; Dhalla, Irfan; Persaud, Nav

    2017-01-01

    Background: Opioids have narrow therapeutic windows, and errors in ordering or administration can be fatal. The purpose of this study was to describe deaths involving hydromorphone and morphine, which have similar-sounding names, but different potencies. Methods: In this case series, we describe deaths of patients admitted to hospital or residents of long-term care facilities that involved hydromorphone and morphine. We searched for deaths referred to the Patient Safety Review Committee of the Office of the Chief Coroner for Ontario between 2007 and 2012, and subsequently reviewed by 2014. We reviewed each case to identify intervention points where errors could have been prevented. Results: We identified 8 cases involving decedents aged 19 to 91 years. The cases involved errors in prescribing, order processing and transcription, dispensing, administration and monitoring. For 7 of the 8 cases, there were multiple (2 or more) possible intervention points. Six cases may have been prevented by additional patient monitoring, and 5 cases involved dispensing errors. Interpretation: Opioid toxicity deaths in patients living in institutions can be prevented at multiple points in the prescribing and dispensing processes. Interventions aimed at preventing errors in hydromorphone and morphine prescribing, administration and patient monitoring should be implemented and rigorously evaluated.

  6. Commandant’s International Technical Series. Volume 9. International Regulations on the Prevention of Pollution from Ships Carrying Hazardous Chemicals in Bulk.

    DTIC Science & Technology

    1985-12-01

    8217- line draining and stripping or blowing arrangements; and - quantity and pressure of nitrogen or air required for line blowing if applicable. LA-- . MEPC...response to resolution 15 of the International Confecence on Marine Polution , 1973, the Marine Environment Protection Committee at its twenty-second...content of these spaces should be maintained below 2%. Portable sampling equipment is satisfactory. * 15.8.19 In no case should air be allowed to

  7. Contribution of arthroscopy in case of septic appearance arthritis of the wrist: a nine cases series.

    PubMed

    Hariri, A; Lebailly, F; Zemirline, A; Hendriks, S; Facca, S; Liverneaux, P

    2013-09-01

    Septic arthritis of the wrist is a diagnostic and therapeutic emergency. Synovectomy and lavage by arthrotomy is often followed by stiffness. The purpose of this study was to evaluate the diagnostic and therapeutic contribution of emergency arthroscopic synovectomy with intraarticular lavage. Nine patients were operated on for wrist pathology with septic appearance. All had signs of local inflammation, three showed locoregional inflammation, three were febrile. In one patient several joints were involved. Seven patients presented with inflammatory or degenerative arthritis. All patients underwent emergency surgery using radiocarpal joint puncture, arthroscopic exploration, intraarticular lavage and synovectomy at both the radiocarpal and midcarpal joints. The results were evaluated by pain, Quick DASH, grip strength, and wrist range of motion. In three cases, joint fluid appeared clear, in three it was turbid, and in three purulent. Gram stain and culture revealed bacteria in four cases. Synovitis was radiocarpal four times, radiocarpal and midcarpal once. In one case, there was radiocarpal and midcarpal chondritis. Average pain was 5.3/10 preoperatively and 2/10 at the last clinical follow-up visit. Mean grip strength was 23.3 kg on the involved side vs. 33.5 kg on the opposite one. Mean flexion was 55° for the involved wrist vs. 68°; mean extension was 52° for the affected wrist vs. 59°. No patient was reoperated on. In all cases, there was no sign of local inflammation, regional lymphadenopathy or systemic infection at the last follow-up. One patient died of colon metastatic cancer. Another patient developed a severe Complex Regional Pain Syndrome type I (CRPS1). Our results suggest three principles of management of wrist arthritis with septic appearance: extended surgical indication, emergency operation and arthroscopic procedure.

  8. Treatment of Catatonia With Ultrabrief Right Unilateral Electroconvulsive Therapy: A Case Series.

    PubMed

    Kugler, Joseph L; Hauptman, Aaron J; Collier, Samuel J; Walton, Amy E; Murthy, Smitha; Funderburg, Linda G; Garcia, Keith S

    2015-09-01

    Catatonia is a syndrome heterogeneous with regard to presentation and etiology. Electroconvulsive therapy (ECT) remains the first-line treatment for catatonia. Literature review reveals only a few published case reports on the use of right unilateral (RUL) ECT in catatonia, 1 case report on ultrabrief RUL ECT, and an absence of evidence on the relative effectiveness and tolerability of RUL versus bilateral ECT in treating catatonia. In contrast, there are multiple reports in the literature of robustly dosed bilateral ECT, often administered on consecutive days. Reasons for choosing this intervention over the better-tolerated RUL treatment include assumptions about its relative speed and/or breadth of efficacy. Here we present a case series of 13 catatonic patients treated in an academic center over the course of the last 3 years. Our experience suggests that ultrabrief RUL ECT can rapidly and effectively treat catatonia from diverse etiologies.

  9. Tuboplasty as a reversal macrosurgery for tubal ligation, is pregnancy possible? A case series

    PubMed Central

    Yassaee, Fakhrolmolouk

    2014-01-01

    Background: Reversal of tubal ligation is requested by some women for various reasons. The present study aims to determine the rate of pregnancy after tubal ligation reversal. Case: In these case series, we reported fifteen women who requested tuboplasty after tubal ligation. In these cases reversal of tubal ligation was done in 15 women. Pregnancy occurred in 4 women (26.6%). Two term pregnancy and 2 abortions were determined. Conclusion: The success rate of pregnancy after macro surgical reversal of tubal ligation is good and can be considered before in vitro fertilization. The type of tubal ligation and the procedure used will determine the best procedure for reversal and have a major impact on chance of success for reversal surgery. PMID:25031582

  10. Direct Cranial Nerve Involvement by Gliomas: Case series and review of the literature

    PubMed Central

    Mabray, Marc C.; Glastonbury, Christine M.; Mamlouk, Mark D.; Punch, Gregory E.; Solomon, David A.; Cha, Soonmee

    2017-01-01

    Malignant gliomas are characterized by infiltrative growth of tumor cells, including along white matter tracts. This may result in clinical cranial neuropathy due to direct involvement of a cranial nerve rather than by leptomeningeal spread along cranial nerves. Gliomas directly involving cranial nerves III-XII are rare with only eleven cases reported in the literature prior to 2014, including eight with imaging. We present eight additional cases demonstrating direct infiltration of a cranial nerve by glioma. Asymmetric cisternal nerve expansion as compared to the contralateral nerve was noted with a mean length of involvement of 9.4 mm. Based on our case series, the key imaging feature to recognize direct cranial nerve involvement by a glioma is the detection of an intra-axial mass in the pons or midbrain that is directly associated with expansion, signal abnormality, and/or enhancement of the adjacent cranial nerve(s). PMID:25857757

  11. Pulmonary Cryptococcosis in HIV- sero-negative patients: case series from India.

    PubMed

    Chopra, Shimpi; Capoor, Malini R; Mallik, Rupali; Gupta, Sonal; Ray, Animesh; Khanna, Geetika; Suri, J C; Bhattacharya, D; Raghavan, Samudrala

    2015-05-01

    Pulmonary cryptococcosis is likely to be misdiagnosed due to relatively non-specific clinical and radiological features. It is more frequently associated with immuno-suppressed conditions especially acquired immuno-deficiency syndrome (AIDS) and pulmonary tuberculosis (PTB). Four cases of pulmonary cryptococcosis were diagnosed over a period of eleven years. All patients in this case series were human immune-deficiency virus (HIV)-negative. The predisposing factors in these patients were diabetes mellitus (DM), acute lymphoblastic leukaemia (ALL), post-partum and pregnancy in one each of the patients. Relapse was seen in two cases. All the patients survived due to strict follow-up. Pulmonary cryptococcosis is common in non-AIDS patients and it warrants rapid diagnosis, treatment and follow-up to prevent relapse.

  12. Incomplete deployment of the Vena Tech LP filter--case series and concerns.

    PubMed

    Contractor, Sohail; Esmaeili, Azadeh; Reina, Diego; Deitch, Edwin

    2011-05-01

    The Vena Tech LP vena cava filter (B Braun, Evanston, Illinois) has been FDA approved since 2001 and is a permanent vena cava filtration device. It replaced the previous Vena tech LGM filter also manufactured by B Braun. The LGM filter had 2 case series reporting a high incidence of incomplete deployment of the filter, especially when placed from a jugular approach. Design changes were made to this device and the LP filter introduced. The LP filter has also been reported to have incompletely deployed both in peer reviewed literature as well as the FDA MAUDE website. We present here 3 cases of incomplete deployment of the Vena Tech LP filter and review the cases previously described as well as attempt to present possible etiologies for incomplete deployment.

  13. Hepatitis E in Singapore: A Case-Series and Viral Phylodynamics Study.

    PubMed

    Teo, Esmeralda Chi-Yuan; Tan, Boon-Huan; Purdy, Michael A; Wong, Pui-San; Ting, Pei-Jun; Chang, Pik-Eu Jason; Oon, Lynette Lin-Ean; Sue, Amanda; Teo, Chong-Gee; Tan, Chee-Kiat

    2017-01-16

    The incidence of hepatitis E in Singapore appears to be increasing. A retrospective case-series study of patients diagnosed with hepatitis E in a tertiary hospital from 2009 to 2013 was conducted. Of 16 cases, eight (50%) were solid-organ transplant recipients (SOTRs), and 14 (88%) were found infected by genotype 3 hepatitis E virus (HEV-3). Bayesian inferences based on HEV subgenomic sequences from seven cases suggest that HEV-3 strains were introduced to Singapore as two principal lineages. Within limitations of the study, it can be inferred that one lineage, in the 3efg clade, emerged about 83 years ago, probably originating from Japan, whereas the other, in the 3abchij clade, emerged about 40 years ago, from the United States. Establishment and subsequent transmissions of strains from these two lineages likely contribute to the current endemicity of hepatitis E in Singapore.

  14. The Contribution of International Educational Exchange to the International Education of Americans: Projections for the Year 2000. Occasional Papers on International Education Exchange. Forum Series 26.

    ERIC Educational Resources Information Center

    Burn, Barbara B.

    This paper attempts to forecast the scope and profile of educational exchanges between the United States and other countries in the year 2000 as one approach to assessing the contribution of those exchanges to the international education of U.S. citizens. The forecasts are based in part on predictions relating to political stability, economic…

  15. Low-Dose Acetazolamide in the Treatment of Premenstrual Dysphoric Disorder: A Case Series

    PubMed Central

    Kotzalidis, Georgios D.; Panaccione, Isabella; Simonetti, Alessio; De Chiara, Lavinia; Del Casale, Antonio; Ambrosi, Elisa; Napoletano, Flavia; Janiri, Delfina; Danese, Emanuela; Girardi, Nicoletta; Rapinesi, Chiara; Serata, Daniele; Manfredi, Giovanni; Koukopoulos, Alexia E.; Angeletti, Gloria; Nicoletti, Ferdinando; Girardi, Paolo

    2014-01-01

    The treatment of premenstrual dysphoric disorder (PMDD) is far from satisfactory, as there is a high proportion of patients who do not respond to conventional treatment. The antidiuretic sulfonamide, acetazolamide, inhibits carbonic anhydrase and potentiates GABAergic transmission; the latter is putatively involved in PMDD. We therefore tried acetazolamide in a series of women with intractable PMDD. Here, we describe a series of eight women diagnosed with DSM-IV-TR PMDD, five of whom had comorbidity with a mood disorder and one with an anxiety disorder, who were resistant to treatment and responded with symptom disappearance after being added-on 125 mg/day acetazolamide for 7-10 days prior to menses each month. Patients were free from premenstrual symptoms at the 12-month follow-up. We suggest that acetazolamide may be used to improve symptoms of PMDD in cases not responding to other treatments. GABAergic mechanisms may be involved in counteracting PMDD symptoms. PMID:24605130

  16. Failed operative treatment in two cases of pseudarthrosis of the clavicle using internal fixation and bovine cancellous xenograft (Tutobone).

    PubMed

    Elliot, Robin R; Richards, Robert H

    2011-09-01

    The most commonly reported technique of reconstructive surgery for congenital pseudarthrosis of the clavicle involves resection of the pseudarthrosis, insertion of autologous iliac crest bone graft and internal fixation. In an attempt to avoid the potential complications of iliac crest bone graft harvest we used bovine cancellous xenograft (Tutobone). Two cases of pseudarthrosis of the clavicle treated with resection of the pseudarthrosis, Tutobone graft and internal fixation are presented. Both cases resulted in treatment failures, which were associated with significant osteolysis and failure of incorporation of the graft material. This required removal of the loose metal work and debridement of the failed graft material. We would caution surgeons against the use of Tutobone as a graft material in the surgical management of pseudarthrosis of the clavicle. The level of evidence was level IV case series.

  17. Selected Bibliographies and State-of-the-Art Review for Health Manpower Planning. Volume 3: Health Manpower Planning References. International Health Planning Reference Series.

    ERIC Educational Resources Information Center

    White (E.H.) Co., San Francisco, CA.

    Intended as a companion piece to volume 3 in the Method Series, Health Manpower Planning (CE 024 231), this third of six volumes in the International Health Planning Reference Series is a combined literature review and annotated bibliography dealing with health manpower planning for developing countries. The review identifies literature relevant…

  18. Selected Bibliographies and State-of-the-Art Review for Environmental Health. Volume 2: Environmental Health References. International Health Planning Reference Series.

    ERIC Educational Resources Information Center

    Fraser, Renee White; Shani, Hadasa

    Intended as a companion piece to volume 2 in the Method Series, Environmental Health Planning (CE 024 230), this second of six volumes in the International Health Planning Reference Series is a combined literature review and annotated bibliography dealing with environmental factors in health planning for developing countries. The review identifies…

  19. Effects of Neuromuscular Reeducation on Hip Mechanics and Functional Performance in Patients after Total Hip Arthroplasty: A Case Series

    PubMed Central

    Judd, Dana L.; Winters, Joshua D.; Stevens-Lapsley, Jennifer E.; Christiansen, Cory L.

    2016-01-01

    Background Following total hip arthroplasty, patients demonstrate compensatory movement strategies during activities of daily living such as walking and stair climbing. Movement compensations are important markers of functional decline in older adults and are related to poor functional capacity. Despite increased utilization of hip arthroplasty, persistent movement compensation, and functional performance deficits, no consensus on postoperative rehabilitation exists. Neuromuscular reeducation techniques offer a strategy to improve movement quality by emphasizing hip abductor performance and pelvic stability. This case series illustrates changes in movement strategy around the hip in response to targeted neuromuscular reeducation techniques after hip arthroplasty. Methods Five participants received an 8-week exercise program following total hip arthroplasty, emphasizing targeted neuromuscular reeducation techniques hallmarked by specific, weight-bearing exercise to improve hip abductor performance and pelvic stability. Five additional participants were supervised and followed for comparison. Findings Participants in the neuromuscular reeducation program improved their internal hip abductor moments and vertical ground reaction forces during walking and stair climbing. They also improved their functional performance and hip abductor strength outcomes. Interpretation Targeted neuromuscular reeducation techniques after total hip arthroplasty provided a positive effect on biomechanical outcomes, functional performance, and muscle strength. Through focused use of the hip abductor muscles, increased internal hip abductor moments were observed. This intervention potentially promotes pelvic stability, and may contribute to improved performance on tasks such as stair climbing, fast walking, and balance. The results suggest that neuromuscular reeducation offers a unique effect on movement strategy and function for patients following total hip arthroplasty. PMID:26802531

  20. Treatment strategy for guided tissue regeneration in various class II furcation defect: Case series.

    PubMed

    Verma, Pushpendra Kumar; Srivastava, Ruchi; Gupta, K K; Chaturvedi, T P

    2013-09-01

    Periodontal regeneration is a main aspect in the treatment of teeth affected by periodontitis. Periodontal regeneration in furcation areas is quite challenging, especially when it is in interproximal region. There are several techniques used alone or in combination considered to achieve periodontal regeneration, including the bone grafts or substitutes, guided tissue regeneration (GTR), root surface modification, and biological mediators. Many factors may account for variability in response to regenerative therapy in class II furcation. This case series describes the management of class II furcation defect in a mesial interproximal region of a maxillary tooth and other with a buccal class II furcation of mandibular tooth, with the help of surgical intervention including the GTR membrane and bone graft materials. This combined treatment resulted in healthy periodontium with a radiographic evidence of alveolar bone gain in both cases. This case series demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the combined treatment modalities will restore health and function of the tooth with the severe attachment loss.

  1. Metacognitive therapy in recurrent depression: a case replication series in Denmark.

    PubMed

    Callesen, Pia; Jensen, Anne Backhausen; Wells, Adrian

    2014-02-01

    Metacognitive therapy (MCT) for depression is derived from the Wells and Matthews (1994) self-regulatory model, in which a Cognitive-Attentional Syndrome (CAS) is the cause of psychological disorders. MCT for depression focuses on identifying patients' CAS and helps them to stop it. The CAS consists of worry, rumination and dysfunctional coping strategies. The focus in MCT is on removing the CAS by challenging positive and negative metacognitive beliefs and eliminating dysfunctional behaviors. In this case series, MCT was delivered to four depressed Danes and treatment was evaluated in 5-11 sessions of up to one hour each. An A-B design with follow-up at 3 and 6 months was conducted and the primary outcome was Beck's Depression Inventory II (BDI-II). We measured CAS processes with the Major depressive Disorder Scale (MDD-S). The results of the case series showed clinically significant improvements in depressive symptoms, rumination and metacognitive beliefs and the effects were still present at follow-up for all patients. The small number of patients and decreasing baselines observed in some cases limits the conclusions. However, the results suggest that this treatment is feasible and was associated with large improvements in symptoms when delivered away from its point of origin and in a Danish help-seeking sample.

  2. Molluscum Contagiosum Treated with Dilute Povidone-Iodine: A Series of Cases

    PubMed Central

    Capriotti, Kara; Stewart, Kevin; Pelletier, Jesse

    2017-01-01

    Objective: To report our experience using a broad spectrum antimicrobial, povidone-iodine, as a novel at-home prescription treatment for molluscum contagiosum. Design/Setting: A systematic review of cases presenting to one of the author’s private dermatology clinics from January to July of 2015 identified 12 patients with molluscum contagiosum seeking treatment. Participants: The population was pediatric, with six males and six female patients included (age range 2–17 years, mean age 6 years). Measurements: Patients were evaluated at baseline and returned to the office for evaluation at four-week intervals until resolution or failure to show for appointments, with number and location of lesions being recorded at each visit. Adverse effects were evaluated at each visit. Results: All 12/12 (100%) patients demonstrated complete or partial resolution. There were a total of 115 lesions treated in the case series, and 103/115 (90%) resolved. Complete resolution occurred in 8/12 (67%) patients. Of the 8/12 with complete resolution, 4/8 (50%) patients showed complete resolution at the four-week follow-up visit and 4/8 (50%) showed complete resolution at the eight-week follow-up. Of the 4/12 (33%) patients who failed to demonstrate complete resolution, 4/4 (100%) showed partial resolution. Conclusion: This case series demonstrates considerable success for treatment of molluscum contagiosum with a dilute povidone-iodine preparation. The treatment was well-tolerated, with minimal side effects. PMID:28360968

  3. Chiropractic care of interstitial cystitis/painful bladder syndrome associated with pelvic lumbar spine dysfunction: a case series

    PubMed Central

    Cashley, Mark A.P.; Cashley, Marie A.

    2012-01-01

    Objective The purpose of this case series is to describe findings for patients with bladder pain syndrome (BPS) or interstitial cystitis (IC) who responded positively under chiropractic care. Clinical Features Eight cases were selected retrospectively reviewed from 2 independent chiropractic clinics in Scotland. Cases were selected if patients reported bladder dysfunction problems and responded positively to chiropractic care. The cases in this report describe the range of patients affected by this condition. Each patient was treated using chiropractic methods that were specific to the individual case. Intervention and Outcomes The patients selected for this case series showed positive response to chiropractic care over various lengths of time and numbers of treatments. Some of the chiropractic patients who had chronic spinal conditions had reoccurrence of bladder symptoms during an exacerbation of mechanical spinal problems. Conclusion This case series highlights that bladder and urinary problems may be associated with spinal dysfunction for some patients. PMID:23843758

  4. Feasibility of piezoelectric tiles adoption: A case study at Kuala Lumpur International Airport (KLIA) Malaysia

    NASA Astrophysics Data System (ADS)

    Chew, Boon Cheong; Loo, Heoy Shin; Bohari, Izyan Adilah; Hamid, Syaiful Rizal; Sukri, Fatin Hafizah; Kusumarwadani, Rini

    2017-03-01

    The basic function of an international airport is an aerodrome, provides not only the facilities for flights management, but also for customs and passport control. Nowadays, most of the international airports have established commercial outlets for food, products and services. As such, these airports are built with larger scale and more sophisticated on both infrastructure and infostructure which aim to be the most extensive air-travel service providers that connect the nations to the international gateways. Looking at the daily operations of an international airport, the energy consumption is apprehended to be enormous. Besides, knowing the fact that reliance on fossil fuels to power the airport buildings and to run the operations daily, this has led to many negative socioenvironmental implications. To date, some of the world major international airports have begun in renewable energy adoption-which mainly focused on solar energy as a way to reduce fossil energy consumption and towards greenhouse gases reduction. Inspired by thinking differently since solar energy has been adopted in Kuala Lumpur International Airport (KLIA) in 2014, through this study we proposed another form of renewable energy-piezoelectric technology adoption into our KLIA as a feasibility study. We believe that piezoelectric technology could complement the renewable energy mix, by tapping the crowd kinetic energy gathered internally in the airport buildings particularly at a few main entrances. Hence, the objectives of this study are (a) to examine the potential factors that will foster piezoelectric tiles adoption at KLIA and (b) to propose the ways for KLIA in speeding up piezoelectric tiles adoption within the airport terminals. The case study on the Malaysia Airports Holding Berhad (MAHB which manages the KLIA) was based on primary data collected through a series of qualitative focus group conducted on 14 (8 senior managers and 6 technical professionals) who were interested and supportive

  5. Case Series of First Metatarsophalangeal Joint Injuries in Division 1 College Athletes

    PubMed Central

    Faltus, John; Mullenix, Kerry; Moorman, Claude T.; Beatty, Kyle; Easley, Mark E.

    2014-01-01

    Context: Injuries of the first metatarsophalangeal (hallux MP) joint can be debilitating in the athletic population. Turf toe and plantar plate injuries are typically diagnosed similarly. However, variance in injury mechanism as well as compromised integrity of soft tissue and ligamentous structures make it difficult to accurately diagnose specific hallux MP injuries. Recent literature has supported the use of both radiographic imaging and the Lachman test as reliable indicators of joint instability in the presence of hallux MP injuries. To date, research supporting specific rehabilitation interventions and return-to-play decision making for hallux MP injuries has been limited to case studies and suggested guidelines from literature reviews. There is limited evidence suggesting specific criteria for surgical and nonsurgical decision making in conjunction with rehabilitation progressions to return an athlete to sport when managing hallux MP injuries. Evidence Acquisition: A literature search was performed using Medline, PubMed, and Google Scholar to find and review articles from 1970 to 2013 that addressed the basic anatomy of the plantar plate, injuries to this anatomical structure, and the evaluation, diagnosis, surgical and nonsurgical management, and rehabilitation of these injuries, specifically in the athletic population. Medical information for each case was gathered from electronic medical records from the individual athletes cited in this case series, which included imaging reports, rehabilitation documentation, and both evaluation and surgical reports. No statistical analysis was used. Study Design: Case series. Level of Evidence: Level 4. Results: Treatment plans for each case varied depending on surgical and nonsurgical intervention and rehabilitation outcomes. However, each athlete was able to return to sports-specific activities. Conclusion: Successful outcomes for hallux MP injuries are contingent on thorough evaluation, appropriate clinical decision

  6. Sternoclavicular septic arthritis: a series of 5 cases and review of the literature.

    PubMed

    Guillén Astete, Carlos; Aranda García, Yolanda; de la Casa Resino, Cristina; Carpena Zafrilla, María; Braña Cardeñosa, Adela; Roldan Moll, Fernando; Carballo, César; Zea Mendoza, Antonio

    2015-01-01

    Infectious arthritis is a medical emergency whose prognosis, in terms of general morbidity and the final functionality of the joint, depends on rapid diagnosis and treatment. The sternoclavicular joint is an area of low prevalence of this type of arthritis, although its frequency is often concentrated in immunosuppressed patients, users of parenteral drugs or after traumatic events. We present a series of 5 microbiologically documented cases of sternoclavicular septic arthritis, 3 of which occurred in immunocompetent patients, and a short review of this pathology.

  7. Kerato-lenticular ocular deposits and visual impairment with prolonged chlorpromazine use: A case series.

    PubMed

    Gowda, Guru S; Hegde, Aditya; Shanbhag, Vandita; Narayanaswamy, Janardhanan C; Jaisoorya, T S

    2017-02-01

    Chlorpromazine is a low potency "typical" antipsychotic agent used to treat schizophrenia. It continues to be prescribed frequently in India owing to its lower cost. There have been previous reports of ocular adverse effects with prolonged use of chlorpromazine. We report three patients who developed corneal and lenticular opacities secondary to prolonged chlorpromazine use leading to visual impairment. Early detection of ocular deposits and switching over to risperidone from chlorpromazine helped in the reversal of chlorpromazine- induced ocular side effects in one of them. The case series further adds evidence to the causative relationship between chlorpromazine and ocular side effects.

  8. Clinical experience with Leptospermum honey use for treatment of hard to heal neonatal wounds: case series.

    PubMed

    Boyar, V; Handa, D; Clemens, K; Shimborske, D

    2014-02-01

    Preterm, critically ill neonates represent a challenge in wound healing. Many factors predispose infants to skin injuries, including decreased epidermal-dermal cohesion, deficient stratum corneum, relatively alkaline pH of skin surface, impaired nutrition and presence of multiple devices on the skin. We present a case series describing the use of medical-grade honey-Leptospermum honey (Medihoney), for successful treatment of slowly healing neonatal wounds, specifically stage 3 pressure ulcer, dehiscent and infected sternal wound, and full-thickness wound from an extravasation injury.

  9. Microsurgical endodontic retreatment of post restored posterior teeth: a case series.

    PubMed

    Kahler, Bill

    2010-12-01

    Post-treatment apical periodontitis may persist due to biological factors as outlined by Nair or when treatment procedures have been ineffective in eliminating the intraradicular infection. This case series reports on the management of five posterior teeth restored with posts where microsurgical techniques were employed utilising the operating microscope, ultrasonics, micro-instrumentation and mineral trioxide aggregate as a root-end filling material. Healing was evident at 12-month review appointments. Microsurgical techniques have significantly improved the outcomes for healing of periapical lesions when compared to traditional approaches to endodontic surgery. Success rates have been shown to be comparable with conventional orthograde treatment.

  10. Preduodenal portal vein: a 3-case series demonstrating varied presentations in infants

    PubMed Central

    Kim, Soo-Hong; Kim, Hae-Young

    2013-01-01

    Preduodenal portal vein, a rare anomaly, could be found in any age groups. In pediatrics it may present with a duodenal obstruction by itself or other coexisting anomalies; however it usually present with an asymptomatic or incidental findings during other surgery in adults. This anomaly has a clinical importance due to the possibility of accidental damage to portal vein. In addition to describing a series of 3 cases with different manifestation in infants, discuss about this anomaly with a review of relevant literature. PMID:24106688

  11. Intrathecal baclofen for the treatment of spinal myoclonus: a case series

    PubMed Central

    Chiodo, Anthony E.; Saval, April

    2012-01-01

    Context/objective To demonstrate the utility of intrathecal baclofen in the treatment of secondary myoclonus of spinal origin. Design Case series. Setting University medical center. Participants Two patients with spinal myoclonus who required the use of an assistive device because of difficulty walking resulting in falls. Interventions Intrathecal baclofen management. Outcome measures Symptom management and mobility function. Results Both experienced resolution of their spinal myoclonus and became community-level ambulators without the need of an assistive device. Conclusion Intrathecal baclofen is an effective treatment of secondary myoclonus of spinal origin. PMID:22330193

  12. Sacroiliac joint radiofrequency ablation with a multilesion probe: a case series of 60 patients.

    PubMed

    Schmidt, Peter C; Pino, Carlos A; Vorenkamp, Kevin E

    2014-08-01

    This retrospective case series of patients with refractory sacroiliac joint (SIJ) pain presents our first 77 SIJ radiofrequency ablation (RFA) procedures performed with a multilesion probe. Of these, 16 (20.8%) provided no relief; 55 (71.4%) provided >50% pain relief at 6 weeks; 42 (54.5%, 95% confidence interval, 42.8%-65.8%) provided >50% pain relief at 6 months; and 12 (15.6%) continued to provide >50% pain relief at 1 year. These results compare favorably to those published using other RFA techniques. In conclusion, more than half of our patients with refractory SIJ pain received some pain relief for at least 6 months after RFA.

  13. Myasthenia gravis mimicking stroke: a case series with sudden onset dysarthria.

    PubMed

    Tremolizzo, Lucio; Giopato, Federico; Piatti, Maria Luisa; Rigamonti, Andrea; Ferrarese, Carlo; Appollonio, Ildebrando

    2015-06-01

    Myasthenia gravis (MG) is an immune-mediated disorder characterized by fluctuating fatigue of skeletal muscles, often involving extrinsic ocular or bulbar districts. Myasthenia gravis in the elderly is an under-recognized condition, sometimes confused with cerebrovascular disease. Here we present a case series of myasthenia patients which onset was characterized by sudden dysarthria, clearly raising this diagnostic dilemma. In the workout of sudden onset isolated dysarthria, MG should be always considered. In fact, even if myasthenia is a rare condition, lacunar stroke only with this clinical presentation is also unusual, and significant risks may arise (e.g., unexpected myasthenic crisis).

  14. Treatment outcome with guiding flange prosthesis in hemimandibulectomy patients: Case series of three patients

    PubMed Central

    Kar, Sushil; Tripathi, Arvind; Madhok, Riti

    2015-01-01

    There are various indications that may necessitate partial or complete resection of the mandible, from trauma to congenital deformities. However, the most prevalent indication that requires surgical resection of the mandible along with the involved adjacent oral structures is the presence of a locally aggressive neoplastic growth. The resultant continuity defect leads to an alteration in the range and direction of mandibular movement, impedes clear articulation of syllables and cosmetic disfigurement. The role of a prosthodontist is paramount in bringing about the restoration of the esthetic and functional dysfunction. This article discusses a series of hemimandibulectomy cases wherein mandibular deviation was successfully corrected using guide-flange prosthesis. PMID:26981486

  15. Erythema Nodosum in Association with Idiopathic Granulomatous Mastitis: A Case Series and Review of the Literature.

    PubMed

    Fruchter, R; Castilla, C; Ng, E; Pomeranz, M K; Femia, A N

    2017-03-08

    Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory disease characterized by tender, erythematous, indurated breast plaques with associated edema, drainage, and scar formation.(1) IGM is often mistaken for breast carcinoma or infectious mastitis.(1,2) Histopathology readily distinguishes IGM from breast carcinoma, as the primary finding in IGM is granulomas centered around mammary lobules.(3) Nevertheless, differentiating IGM from bacterial mastitis and other mimickers, such as atypical mycobacterial infections or sarcoidosis, can be more difficult.(4) Herein, we report the largest case series of concurrent IGM and erythema nodosum (EN). This article is protected by copyright. All rights reserved.

  16. The versatility of intraosseous vascular access in perioperative medicine: a case series.

    PubMed

    Anson, Jonathan A; Sinz, Elizabeth H; Swick, John T

    2015-02-01

    Intraosseous vascular access is a time-tested procedure that is reemerging in popularity. This is primarily a result of the emphasis on intraosseous access in the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Advanced Cardiac Life Support. Modern intraosseous insertion devices are easy to learn and use, suggesting the possibility of use beyond the resuscitation setting. We present a case series of recent intraosseous insertions for a variety of indications by anesthesiologists at our institution to demonstrate the potential utility of this alternative access technique.

  17. A case series of patients with cor triatriatum dexter: unique cause of neonatal cyanosis.

    PubMed

    Mackman, Chad A; Liedel, Jennifer L; Woods, Ronald K; Samyn, Margaret M

    2015-01-01

    Cor triatriatum dexter is a rare congenital heart defect that can lead to cyanosis in a newborn with an otherwise normal exam. The initial evaluation of these patients typically focuses on searching for a pulmonary etiology for arterial desaturation, which often leads to a negative work up. When cardiac evaluation is performed, it may be challenging because the heart lesion can be difficult to visualize on an echocardiogram. The diagnosis requires a high index of suspicion and thorough echocardiographic imaging. Once diagnosed, surgical repair can alleviate the shunt created by the defect. This case series describes all patients (3) with cor triatriatum dexter seen at Children's Hospital of Wisconsin from 2000 to 2013.

  18. Improving patient's home cooking - A case series of participation in a remote culinary coaching program.

    PubMed

    Polak, Rani; Pober, David M; Budd, Maggi A; Silver, Julie K; Phillips, Edward M; Abrahamson, Martin J

    2017-04-04

    This case series describes and examines the outcomes of a remote culinary coaching program, aimed at improving nutrition through home cooking. Participants (n=4) improved attitudes about the perceived ease of home cooking (p<0.01) and self-efficacy to perform various culinary skills (p=0.02); and also in confidence to continue e-learning culinary skills and consume healthier food. We believe this program might be a viable response to the need for effective and scalable health related culinary interventions.

  19. Anatomical features and management of bioresorbable vascular scaffolds failure: A case series from the GHOST registry.

    PubMed

    Longo, Giovanni; Granata, Francesco; Capodanno, Davide; Ohno, Yohei; Tamburino, Claudia Ina; Capranzano, Piera; La Manna, Alessio; Francaviglia, Bruno; Gargiulo, Giuseppe; Tamburino, Corrado

    2015-06-01

    The Absorb bioresorbable vascular scaffold (Absorb BVS, Abbott Vascular, Santa Clara, California) promises to address some of the residual shortcomings of existing metallic stents, such as late events induced by permanent caging of the coronary vessel. Scaffold restenosis (ScR) of BVS has been poorly described so far and treatment strategies for this event remain to be codified. We report on a case series of 14 lesions in 12 patients presenting with ScR and discuss their anatomical features and management strategies. © 2015 Wiley Periodicals, Inc.

  20. Bronchiectasis following treatment for high-risk neuroblastoma: A case series.

    PubMed

    Adams, Madeleine; Traunecker, Heidi; Doull, Iolo; Cox, Rachel

    2017-03-10

    High-risk (HR) neuroblastoma remains a very challenging disease to treat and long-term cure is only possible with intensive, multimodal treatment including chemotherapy, high-dose therapy, radiotherapy, surgery, and immunotherapy. As a result, treatment-related morbidity and late effects are common in survivors. This report outlines a case series of six patients who developed a chronic productive cough following treatment for HR neuroblastoma. High-resolution computed tomography scanning confirmed the diagnosis of bronchiectasis. Two of the patients who have undergone immunological testing demonstrate hypogammaglobulinaemia and impaired vaccine response. Persistent cough in patients treated for neuroblastoma warrants investigation and consideration of immunological referral.

  1. Guidelines for Analysis of Communicable Disease Control Planning in Developing Countries. Volume 1: Communicable Diseases Control Planning. International Health Planning Methods Series.

    ERIC Educational Resources Information Center

    Chin, James

    Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this first of ten manuals in the International Health Planning Methods Series deals with planning and evaluation of communicable disease control programs. The first…

  2. International Students' Networks: A Case Study in a UK University

    ERIC Educational Resources Information Center

    Taha, Nashrawan; Cox, Andrew

    2016-01-01

    The great influx of international students into UK universities has led to internationalisation becoming an important issue. Previous studies have focused on the integration of home and international students, illustrating a lack of intercultural interaction. Yet there has been a lack of research investigating international students' networks and…

  3. Chiropractic spinal manipulation for low back pain of pregnancy: a retrospective case series.

    PubMed

    Lisi, Anthony J

    2006-01-01

    Low back pain is a common complaint in pregnancy, with a reported prevalence of 57% to 69% and incidence of 61%. Although such pain can result in significant disability, it has been shown that as few as 32% of women report symptoms to their prenatal provider, and only 25% of providers recommend treatment. Chiropractors sometimes manage low back pain in pregnant women; however, scarce data exist regarding such treatment. This retrospective case series was undertaken to describe the results of a group of pregnant women with low back pain who underwent chiropractic treatment including spinal manipulation. Seventeen cases met all inclusion criteria. The overall group average Numerical Rating Scale pain score decreased from 5.9 (range 2-10) at initial presentation to 1.5 (range 0-5) at termination of care. Sixteen of 17 (94.1%) cases demonstrated clinically important improvement. The average time to initial clinically important pain relief was 4.5 (range 0-13) days after initial presentation, and the average number of visits undergone up to that point was 1.8 (range 1-5). No adverse effects were reported in any of the 17 cases. The results suggest that chiropractic treatment was safe in these cases and support the hypothesis that it may be effective for reducing pain intensity.

  4. Gallbladder tuberculosis camouflaging as gallbladder cancer – case series and review focussing on treatment

    PubMed Central

    Krishnamurthy, Gautham; Singh, Harjeet; Rajendran, Jayapal; Sharma, Vishal; Yadav, Thakur Deen; Gaspar, Balan Louis; Vasishta, Rakesh Kumar; Singh, Rajinder

    2016-01-01

    Introduction: Gallbladder tuberculosis, in an endemic region, is a common infectious etiology affecting a rare organ. The high prevalence of carcinoma gallbladder in the endemic regions of tuberculosis, like India, poses diagnostic dilemma. Case series: We are reporting three cases of gallbladder tuberculosis mimicking carcinoma gallbladder of which the first two cases were operated with a presumptive diagnosis of malignancy. The third case presented to us after laparoscopic cholecystectomy elsewhere and on evaluation was found to have disseminated tuberculosis. Discussion: The lack of pathognomonic clinical and radiological characters results in histological surprise of gallbladder tuberculosis following surgery performed for other indications like malignancy. In preoperatively diagnosed patients medical management plays pivotal role in management. Surgery is required in symptomatic patients. On the other hand, histologically proven cases following surgical resection require antitubercular therapy. Conclusion: Previous history of tuberculosis or concomitant tuberculosis at other sites may provide clue to the diagnosis of biliary tuberculosis. Antitubercular treatment after surgery plays an important role in preventing further dissemination. PMID:28386408

  5. Treatment of Langerhans cell histiocytosis bone lesions with zoledronic acid: a case series.

    PubMed

    Sivendran, Shanthi; Harvey, Harold; Lipton, Allan; Drabick, Joseph

    2011-06-01

    Langerhans cell histiocytosis (LCH) is a rare disease caused by a clonal proliferation of specialized dendritic (Langerhans) cells. Although uncommon, it is potentially fatal and carries significant morbidity. Bone involvement is particularly destructive and to date, no standard of care exists for management of both the disease and the significant bone pain as many of these patients experience. In the literature, 12 patients who had previously been heavily pretreated for their disease had their bone pain treated with a bisphosphonate as extrapolated from the cancer literature. Interestingly, these patients had a complete or near complete resolution of their pain, return of functional status and in 75% of cases radiographic evidence of reduction or regression of disease. Only 6 of these patients were treated with a newer generation bisphosphonate, zoledronic acid. In this paper, we report a case series of 2 patients with LCH bone involvement who received 4 mg of intravenous zoledronic acid monthly for 1 year with complete resolution in their bone pain. In addition, both patients demonstrated reduction in tumor burden after bisphosphonate treatment. Uniquely, our first case is the only reported case in the literature using a bisphosphonate as first line therapy in the treatment of LCH. This case demonstrates the potential role of zoledronic acid therapy in the first line setting for disease stabilization and symptomatic control in patients unable to receive conventional therapy.

  6. Nd:YAG laser photocoagulation of benign oral vascular lesions: a case series.

    PubMed

    Medeiros, Rui; Silva, Igor Henrique; Carvalho, Alessandra Tavares; Leão, Jair Carneiro; Gueiros, Luiz Alcino

    2015-11-01

    Vascular anomalies of the head and neck are common lesions usually associated with functional and/or aesthetic limitations. The aim of the present paper was to report a case series of oral vascular malformations treated with Nd:YAG laser photocoagulation, highlighting the clinical evolution and post-surgical complications. Fifteen patients diagnosed with oral vascular malformations were treated with Nd:YAG laser followed by three sessions of biostimulation. None of the patients presented post-surgical pain, but 6 of 15 patients (40%) experienced minimal post-surgical complications. All cases presented complete resolution of the lesions after laser treatment. More importantly, 12 out of 15 (80%) resolved after a single session. Low morbidity, minimal patient discomfort, and satisfactory aesthetic results point Nd:YAG laser photocoagulation as a promising option for the management of benign oral vascular lesions.

  7. Tinea genitalis: a new entity of sexually transmitted infection? Case series and review of the literature

    PubMed Central

    Luchsinger, Isabelle; Bosshard, Philipp Peter; Kasper, Romano Silvio; Reinhardt, Dominic; Lautenschlager, Stephan

    2015-01-01

    Objective Investigation on recent cases of tinea genitalis after travelling to South East Asia. Methods Patients with tinea in the genital region, which emerged after sex in South East Asia, underwent further assessment including microscopy, cultures and DNA analyses. Results The case series includes seven patients. In six patients, Trichophyton interdigitale (former Trichophyton mentagrophytes) was detected. Three patients suffered from a severe inflammatory reaction of the soft tissue and two of them needed hospitalisation due to severe pain. In four patients, cicatrising healing was noticed. Five patients were declared incapacitated for work. Conclusions Sexual activity should be considered as a potentially important and previously underappreciated means of transmission of T. interdigitale. To avoid irreversible scarring alopecia, prompt initiation of antifungal treatment is essential and adequate isolation and identification of the pathogen is mandatory. PMID:26071391

  8. Multidisciplinary management of Paget-Schroetter syndrome. A case series of eight patients.

    PubMed

    Rosa Salazar, Vladimir; Otálora Valderrama, Sonia Del Pilar; Hernández Contreras, María Encarnación; García Pérez, Bartolomé; Arroyo Tristán, Andrés Del Amor; García Méndez, María Del Mar

    2015-08-01

    Paget-Schroetter syndrome (PSS) in the context of upper extremity deep venous thrombosis (DVT) is an uncommon but potentially very serious condition affecting young, healthy adults, in which secondary post-thrombotic syndrome (PTS) can be a complication with major implications. The best treatment option remains controversial, with current guidelines recommending anticoagulation for at least 3 months. However, an incidence of PTS of approximately 50% after 6 months, 30% after 1 year and 25% after 2 years has been found using this therapeutic approach. Consequently, specialized units recommend local thrombolysis and early decompressive surgery. We describe a series of eight cases treated in this way. None of the patients showed signs of complications, and an early return to regular activities with no PTS was observed in 90% of cases.

  9. Iniencephaly: Radiological and pathological features of a series of three cases.

    PubMed

    Chikkannaiah, Panduranga; Srinivasamurthy, V; Satish Prasad, B S; Lalyanayak, Pradeepkumar; Shivaram, Divya N

    2014-10-01

    Iniencephaly is a rare form of neural tube defect with an incidence of 0.1-10 in 10,000 pregnancies. It is characterized by the presence of occipital bone defects at foramen magnum, fixed retroflexion of head, spinal dysmorphism, and lordosis of cervicothoracic vertebrae. It is usually associated with central nervous system, gastrointestinal, and cardiovascular anomalies. We present radiological and autopsy findings in a series of 3 cases of iniencephaly (gestational ages 29.3, 23, and 24 weeks) first fetus in addition showed omphalocele, pulmonary hypoplasia, two lobes in right lung, accessory spleen, atrial septal defect, bilateral clubfoot, ambiguous genitalia, and single umbilical artery. Second fetus was a classical case of iniencephaly apertus with spina bifida. Third fetus had colpocephaly and bifid spine.

  10. Iniencephaly: Radiological and pathological features of a series of three cases

    PubMed Central

    Chikkannaiah, Panduranga; Srinivasamurthy, V.; Satish Prasad, B. S.; Lalyanayak, Pradeepkumar; Shivaram, Divya N.

    2014-01-01

    Iniencephaly is a rare form of neural tube defect with an incidence of 0.1-10 in 10,000 pregnancies. It is characterized by the presence of occipital bone defects at foramen magnum, fixed retroflexion of head, spinal dysmorphism, and lordosis of cervicothoracic vertebrae. It is usually associated with central nervous system, gastrointestinal, and cardiovascular anomalies. We present radiological and autopsy findings in a series of 3 cases of iniencephaly (gestational ages 29.3, 23, and 24 weeks) first fetus in addition showed omphalocele, pulmonary hypoplasia, two lobes in right lung, accessory spleen, atrial septal defect, bilateral clubfoot, ambiguous genitalia, and single umbilical artery. Second fetus was a classical case of iniencephaly apertus with spina bifida. Third fetus had colpocephaly and bifid spine. PMID:25288843

  11. Subcutaneous intralesional Ksharodaka injection: A novel treatment for the management of Warts: A case series

    PubMed Central

    Gundeti, Manohar S.; Reddy, R. Govind; Muralidhar, Jangle Vidya

    2014-01-01

    Warts are generally managed using cryosurgery, keratolytic ointments, curettage and electrodessication. Warts, vis-a-vis Charmakila, in Ayurvedic classical texts are classified into different types depending on the dominance of dosha. Ayurveda prescribes oral medications, topical use of Kshara (alkaline ash of herbs), Agni (thermal cautery) and Shastrakarma (surgery) for removal of Charmakila. Use of topical Kshara in the form of powder, aqueous solution i.e. Ksharodaka and Ksharasutra (thread smeared with Kshara) for warts has been reported. However, these methods necessitate multiple sittings and takea longer duration for removal of the warts. Herewith, we report a case series of different types of warts treated with intralesional infiltration of Apamarga Ksharodaka (AK), i.e. aqueous solution of Apamarga (Achyranthes aspera) Kshara. We observed that all these warts took a minimum of 2-6 days to shed off, leaving minor scars. There were no adverse reactions reported in any of these cases. PMID:25624698

  12. Diagnostic value of MR imaging in the Lewis-Sumner syndrome: a case series.

    PubMed

    Rajabally, Yusuf A; Knopp, Michael J; Martin-Lamb, Darren; Morlese, John

    2014-07-15

    Lewis-Sumner syndrome (LSS) is considered a variant of chronic inflammatory demyelinating polyneuropathy (CIDP), which is more frequently described with exclusive upper limb involvement. The diagnosis of LSS is clinical and electrophysiological. However, these are not always obvious and in view of its rarity, the diagnosis may be missed and patients denied effective immunomodulatory therapy. We herein describe the magnetic resonance imaging (MRI) findings in a series of five consecutive patients with a clinical diagnosis of LSS, using T2 STIR (Short Tau Inversion recovery) images without contrast. We demonstrated hyperintensity with or without hypertrophy of cervical roots and/or brachial plexus on the affected side and/or controlaterally which aided diagnostic confirmation. This helped therapeutic decision making regarding immunotherapy in all cases. MR imaging of the cervical spine/brachial plexus with T2 STIR may be helpful in suspected cases of LSS as it represents a very useful additional diagnostic tool.

  13. The Emergence of Zoonotic Onchocerca lupi Infection in the United States--A Case-Series.

    PubMed

    Cantey, Paul T; Weeks, Jessica; Edwards, Morven; Rao, Suchitra; Ostovar, G Amin; Dehority, Walter; Alzona, Maria; Swoboda, Sara; Christiaens, Brooke; Ballan, Wassim; Hartley, John; Terranella, Andrew; Weatherhead, Jill; Dunn, James J; Marx, Douglas P; Hicks, M John; Rauch, Ronald A; Smith, Christiana; Dishop, Megan K; Handler, Michael H; Dudley, Roy W R; Chundu, Kote; Hobohm, Dan; Feiz-Erfan, Iman; Hakes, Joseph; Berry, Ryan S; Stepensaski, Shelly; Greenfield, Benjamin; Shroeder, Laura; Bishop, Henry; de Almeida, Marcos; Mathison, Blaine; Eberhard, Mark

    2016-03-15

    This case-series describes the 6 human infections with Onchocerca lupi, a parasite known to infect cats and dogs, that have been identified in the United States since 2013. Unlike cases reported outside the country, the American patients have not had subconjunctival nodules but have manifested more invasive disease (eg, spinal, orbital, and subdermal nodules). Diagnosis remains challenging in the absence of a serologic test. Treatment should be guided by what is done for Onchocerca volvulus as there are no data for O. lupi. Available evidence suggests that there may be transmission in southwestern United States, but the risk of transmission to humans is not known. Research is needed to better define the burden of disease in the United States and develop appropriately-targeted prevention strategies.

  14. Treatment of Myositis Ossificans with acetic acid phonophoresis: a case series

    PubMed Central

    Bagnulo, Angela; Gringmuth, Robert

    2014-01-01

    Objective To create awareness of myositis ossificans (MO) as a potential complication of muscle contusion by presenting its clinical presentation and diagnostic features. An effective method of treatment is offered for those patients who develop traumatic MO. Management: Patients in this case series developed traumatic MO, confirmed on diagnostic ultrasound. Patients participated in a treatment regimen consisting of phonophoresis of acetic acid with ultrasound. Outcome: In all cases, a trial of phonophoresis therapy significantly decreased patient signs, symptoms and the size of the calcification on diagnostic ultrasound in most at a 4-week post diagnosis mark. Discussion: Due to the potential damage to the muscle and its function, that surgical excision carries; safe effective methods of conservative treatment for MO are crucial. MO deserves more attention in the literature due to its common presentation in athletes. PMID:25550659

  15. The spectrum of psychosis in multiple sclerosis: a clinical case series

    PubMed Central

    Gilberthorpe, Thomas G; O’Connell, Kara E; Carolan, Alison; Silber, Eli; Brex, Peter A; Sibtain, Naomi A; David, Anthony S

    2017-01-01

    Psychosis in the context of multiple sclerosis (MS) has previously been reported as a rare occurrence. However, recent epidemiological studies have found prevalence rates of psychosis in MS that are two to three times higher than those in the general population. Untreated psychosis in patients with MS can adversely impact on adherence to MS medication, levels of disability, and quality of life. This retrospective case series describes the spectrum of psychotic disorders occurring in association with MS using demographic, clinical, and neuroimaging data. In the discussion, we highlight the particular diagnostic and treatment challenges that such disorders can pose for clinicians and through our case vignettes provide examples of potential interventions for this complex patient population. PMID:28203081

  16. Aesthetic Rehabilitation of Discoloured Nonvital Anterior tooth with Carbamide Peroxide Bleaching: Case Series.

    PubMed

    Badole, Gautam P; Warhadpande, Manjusha M; Bahadure, Rakesh N; Badole, Shital G

    2013-12-01

    Discolouration of teeth, especially the anteriores, can result in considerably cosmetic impairment in person. Combine effects of intrinsic and extrinsic colour determines the appearance of teeth. Whitening of teeth with bleaching is a more conservative therapeutic method than full crowns, veneers or composite restorations which is more invasive and expensive. Among bleaching techniques, in office bleaching with carbamide peroxide provide superior aesthetic result in short period of time with no adverse effects. This paper presents case series of tooth discolouration in non-vital tooth which was successfully bleached using 35 % carbamide peroxide. After 1 year follow up the prognosis was good with no reversal of tooth discolouration. This case report allows the better understanding of the concept of nonvital tooth bleaching with carbamide peroxide which gives a non-invasive alternative for aesthetic purpose in preserving the natural tooth structure.

  17. The use of levomepromazine in Hyperemesis Gravidarum resistant to drug therapy--a case series.

    PubMed

    Heazell, Alexander E P; Langford, Nigel; Judge, Jatinder K; Heazell, Martin A; Downey, Gabrielle P

    2005-01-01

    Hyperemesis Gravidarum (HG) is a potentially serious complication of early pregnancy, which may rarely be severe enough to warrant termination of pregnancy. HG requires prompt treatment with intravenous fluids, thiamine supplementation and appropriate anti-emetic therapy. Anti-histamines such as promethazine are favoured as first-line agents, with prochlorperazine being used as a second-line drug. However, there is no clear data as to the most appropriate drug if these are ineffective. A case series of six women who presented with HG resistant to drug treatment is described. In these cases, levomepromazine 6.25mg tds was used to control HG. Five pregnancies progressed leading to live born infants with no evidence of congenital anomaly. One pregnancy resulted in an intra-uterine death with no external or ultrasound evidence of congenital anomaly. The role of phenothiazines in the pharmacological management of HG is discussed.

  18. The Rehabilitation of Children with Anti-NMDA-Receptor Encephalitis: A Case Series

    PubMed Central

    Houtrow, Amy J.; Bhandal, Manjit; Pratini, Napala R.; Davidson, Loren; Neufeld, Jacob A.

    2012-01-01

    Anti-N-methyl-D-aspartate (NMDA)-receptor encephalitis is a serious, complex, and potentially fatal disease in children. Children with this condition frequently present with altered mental status, rapid functional deterioration, and seizures. Despite aggressive treatment with immune therapy such as corticosteroids, intravenous immunoglobin (IVIG), and plasmapheresis, children often need extensive rehabilitative services and can be left with lasting deficits. In this case series we report on six known consecutive pediatric cases of NMDA-receptor antibody encephalitis in Northern California requiring comprehensive inpatient rehabilitation. The children presented with a variety of symptoms and had waxing and waning clinical courses. All children progressed well through their rehabilitation programs, but were discharged home with persistent functional deficits. At follow-up, all but one child had lasting deficits. Because of the complicated management and extensive rehabilitation needs of children with anti-NMDA-receptor encephalitis, physiatrists and other rehabilitation providers should be knowledgeable about this complex condition. PMID:22415341

  19. Graded exposure therapy for addressing claustrophobic reactions to continuous positive airway pressure: a case series report.

    PubMed

    Means, Melanie K; Edinger, Jack D

    2007-01-01

    Continuous positive airway pressure (CPAP) is a safe, effective treatment for obstructive sleep apnea, and yet many patients develop claustrophobic reactions to the CPAP nasal mask and cannot tolerate this treatment. We examined the efficacy of a graded in-vivo exposure therapy for enhancing CPAP adherence using a retrospective, case series design. Objective CPAP adherence data were obtained on clinical patients who attended 1 or more sessions of exposure therapy with a behavioral sleep psychologist. Compared to pre-treatment, patients used CPAP significantly longer after exposure therapy. No predictors of treatment response were identified. CPAP exposure therapy may be beneficial in some cases; however, further research is needed to determine types of patients most likely to benefit from this therapy.

  20. Alive with the sound of music: a case series on patients presenting with musical hallucinations in a general hospital.

    PubMed

    Kinson, Rochelle Melina; Lim, Wen Phei; Rahman, Habeebul

    2015-01-01

    Musical hallucinations are a rare phenomenon that renders appropriate identification and treatment a challenge. This case series describes three women who presented with hearing complex, familiar melodies in the absence of external stimuli on a background of hearing impairment.

  1. Possible association of cutaneous Rosai-Dorfman disease and chronic Crohn disease: a case series report.

    PubMed

    Salva, Katrin A; Stenstrom, Melissa; Breadon, Jonith Y; Odland, Paul Blair; Bennett, Daniel; Longley, Jack; Wood, Gary S

    2014-02-01

    IMPORTANCE Cutaneous Rosai-Dorfman disease (CRDD), a variant of Rosai-Dorfman disease limited to the skin, has a wide range of clinical presentations. Rosai-Dorfman disease is believed to result from an aberrant response to antigens, caused by immunosuppressive macrophages. Macrophage-mediated immunosuppression is also implicated in the pathogenesis of Crohn disease, linking these otherwise unrelated entities. To our knowledge, the coexistence of these disorders has been described in only 2 cases, 1 of them confined to the skin and soft tissue. OBSERVATIONS We present a series of 3 patients who developed purely CRDD in the context of long-standing Crohn disease. Statistical estimates suggested that the association of these 2 disorders is not due to chance (P<.001). CONCLUSIONS AND RELEVANCE Our case series provides the clinical correlate to the pathogenetic parallels between CRDD and Crohn disease. Crohn disease is frequently complicated by various skin manifestations, which may be mimicked by CRDD. Therefore, it may be prudent for clinicians to include CRDD in the list of differential diagnoses when examining skin lesions in patients with Crohn disease.

  2. Eminectomy for Habitual Luxation of the Temporomandibular Joint with Sedation and Local Anesthesia: A Case Series

    PubMed Central

    Nakamura, Yoshiaki; Kusukawa, Jingo; Tubbs, R. Shane

    2016-01-01

    Eminectomy which is one of the popular and most effective treatments for habitual temporomandibular joint luxation was first described by Myrhaug in 1951. There are few reports which described eminectomy being performed under local anesthesia and conscious sedation. We present a case series of habitual luxation of the TMJ treated by eminectomy performed under local anesthesia and conscious sedation and general anesthesia. Five patients were examined and found to have recurrent luxation of the TMJ. The age of patients ranged from 18 to 93 years. Bilateral eminectomy of the TMJ was performed for two patients, and unilateral eminectomy was performed for three patients. Two were examined under intravenous propofol sedation and local anesthesia, while three patients were examined under general anesthesia. One patient died from ileus one month after surgery. The follow-up period except for the case that died from ileus ranged from 12 to 33 months. No recurrent dislocation of the TMJ has been identified. Based on our experience and two other series in the literature, eminectomy with sedation and local anesthesia can be considered and might be a good option in elderly patients. PMID:27818803

  3. Cognitive-behavioral therapy for subthreshold bulimia nervosa: A case series.

    PubMed

    Peterson, C B; Miller, K B; Willer, M G; Ziesmer, J; Durkin, N; Arikian, A; Crow, S J

    2011-09-01

    The extent to which cognitive-behavioral therapy (CBT) is helpful in treating individuals with bulimic symptoms who do not meet full criteria for bulimia nervosa is unclear. The purpose of this investigation was to examine the potential efficacy of CBT for eating disorder individuals with bulimic symptoms who do not meet full criteria for bulimia nervosa. Twelve participants with subthreshold bulimia nervosa were treated in a case series with 20 sessions of CBT. Ten of the 12 participants (83.3%) completed treatment. Intent-to-treat abstinent percentages were 75.0% for objectively large episodes of binge eating (OBEs), 33.3% for subjectively large episodes of binge eating (SBEs), and 50% for purging at end of treatment. At one year follow-up, 66.7% were abstinent for OBEs, 41.7% for SBEs, and 50.0% for purging. The majority also reported improvements in associated symptoms. This case series provides support for the use of CBT with individuals with subthreshold bulimia nervosa.

  4. Repository corticotropin injection in patients with refractory psoriatic arthritis: a case series

    PubMed Central

    Brown, Alan N

    2016-01-01

    Purpose Although numerous treatment options are available for patients with psoriatic arthritis (PsA), a need for effective and tolerable treatments remains for patients with refractory disease who have failed previous therapies and continue to experience tender and/or swollen joints, pain, and disease activity. Repository corticotropin injection (RCI) is believed to produce steroidogenic, steroid-independent, anti-inflammatory, and immunomodulatory effects in patients with rheumatic disorders, such as PsA. Limited literature exists on the use of RCI in patients with refractory PsA. The objective of this case series is to provide information on the clinical features of patients with refractory PsA and their response to RCI. Patients Nine patients treated with RCI for refractory PsA were retrospectively identified and included in the case series. Results All the nine patients experienced at least transient improvements in their active skin and joint disease. In some patients, it was necessary to titrate the RCI to an appropriate dose. RCI was used in some patients to bridge with another PsA therapy, such as apremilast or certolizumab. RCI was well tolerated, but discontinued in three patients due to preexisting conditions (hypertension and hyperglycemia). Conclusion RCI may be a safe and effective option for patients with refractory PsA who failed therapy with multiple previous treatments. PMID:27956846

  5. Augmentation of Psychotherapy through Alternative Preconscious Priming: A Case Series Exploring Effects on Residual Symptoms

    PubMed Central

    Zidani, Melha; Audet, Jean-Sébastien; Borgeat, François; Aardema, Frederick; O’Connor, Kieron Philip; Khazaal, Yasser

    2017-01-01

    The current paper describes a case series using a new strategy for facilitating change based on Augmentation of Psychotherapy through Alternative Preconscious Priming (APAP) (1) in the treatment of eight treatment-resistant patients suffering from social phobia or generalized anxiety disorder. The patients had previously only shown a partial response to cognitive behavioral therapy (CBT) despite good treatment adherence. The patients completed APAP using a computerized program, which consisted of three steps during which alternative, more functional thoughts and beliefs relevant to the idiosyncratic difficulties experienced by the patients were formulated. Subsequently, these formulations were recorded and mixed with masking relaxing music, which the patient listened to in a passive state twice daily for 20 min for a period of 8 weeks. This case series aimed to assess the effect and acceptability of APAP using quantitative and qualitative measures administered before, after, and 16 weeks’ posttreatment. Results showed a reduction in dysfunctional idiosyncratic thoughts reported by most patients, as well as mild improvements in anxiety and important improvements in quality of life. APAP could be a valuable addition to CBT by facilitating or enhancing cognitive and symptom change. Further studies are needed to confirm these promising results. PMID:28197107

  6. Successful treatment of rare-earth magnet ingestion via minimally invasive techniques: a case series.

    PubMed

    Kosut, Jessica S; Johnson, Sidney M; King, Jeremy L; Garnett, Gwendolyn; Woo, Russell K

    2013-04-01

    Cases of rare-earth magnet ingestions have been increasingly reported in the literature. However, these descriptions have focused on the severity of the injuries, rather than the clinical presentation and/or therapeutic approach. We report a series of eight children, ranging in age from 2 to 10 years, who ingested powerful rare-earth magnets. The rare-earth magnets were marketed in 2009 under the trade name Buckyballs(®) (Maxfield & Oberton, New York, NY). They are about 5 mm in size, spherical, and brightly colored, making them appealing for young children to play with and place in their mouths. Three children presented within hours of ingestion, and the magnets were successfully removed via endoscopy in two, whereas the third child required laparoscopy. No fistulas were found in these children. A fourth child presented 2 days after ingestion with evidence of bowel wall erosion, but without fistula formation; the magnets were removed via laparoscopy. A fifth child ingested nine magnets in a ring formation, which were removed via colonoscopy without evidence of injury or fistula formation. The three remaining children presented late (5-8 days after ingestion) and were found to have associated fistulas. They were treated successfully with a combination of endoscopy and laparoscopy with fluoroscopy. None of the children in our series required an open surgical procedure. All children were discharged home without complications. This case series highlights the potential dangers of rare-earth magnet ingestion in children. Our experience suggests that prompt intervention using minimally invasive approaches can lead to successful outcomes.

  7. Key challenges in simulated patient programs: An international comparative case study

    PubMed Central

    2011-01-01

    Background The literature on simulated or standardized patient (SP) methodology is expanding. However, at the level of the program, there are several gaps in the literature. We seek to fill this gap through documenting experiences from four programs in Australia, Canada, Switzerland and the United Kingdom. We focused on challenges in SP methodology, faculty, organisational structure and quality assurance. Methods We used a multiple case study method with cross-case synthesis. Over eighteen months during a series of informal and formal interactions (focused meetings and conference presentations) we documented key characteristics of programs and drew on secondary document sources. Results Although programs shared challenges in SP methodology they also experienced differences. Key challenges common to programs included systematic quality assurance and the opportunity for research. There were differences in the terminology used to describe SPs, in their recruitment and training. Other differences reflected local conditions and demands in organisational structure, funding relationships with the host institution and national trends, especially in assessments. Conclusion This international case study reveals similarities and differences in SP methodology. Programs were highly contextualised and have emerged in response to local, institutional, profession/discipline and national conditions. Broader trends in healthcare education have also influenced development. Each of the programs experienced challenges in the same themes but the nature of the challenges often varied widely. PMID:21943295

  8. Verrucous Oesophageal Carcinoma: Single Case Report and Case Series Including 15 Patients – Issues for Consideration of Therapeutic Strategies

    PubMed Central

    Behrens, Angelika; Stolte, Manfred; Pech, Oliver; May, Andrea; Ell, Christian

    2014-01-01

    Background Verrucous carcinomas (VC) of the oesophagus are a rarity. Due to their histological resemblance to squamous cell carcinoma, the diagnostic and treatment standards applicable to the latter have so far also been applied to VC as a disease entity. Quite limited data are available including two case series of 5 or 11 patients. The present study reports on a single case treated by local endoscopic therapy and a series of 15 patients, 9 of whom received local endoscopic therapy. Methods The data for patients diagnosed with VC of the oesophagus who had been treated from January 1999 to May 2011 were analysed retrospectively. Results 15 patients with the diagnosis of oesophageal VC were included. The male-female ratio was 3:1. 9 of 11 pT1-VC patients presented with the cardinal symptom dysphagia or odynophagia. For the majority of the patients, the growth pattern is one of extensive superficial expansion showing a median length of 9 cm (range: 2-22 cm). Surprisingly, none of the VC patients showed lymph node or distant metastasis. 9 of 15 VC patients received local endoscopic therapy; 4 were treated with curative intent and 5 were treated palliatively. 3 patients underwent oesophageal resection, and definitive chemoradiotherapy was administered in a further 3 patients. One severe complication, consisting of a postoperative anastomotic insufficiency with a fatal outcome, occurred in this group of patients. Conclusion This is the largest published study describing patients diagnosed with VC of the oesophagus so far. The option of local endoscopic therapy and its results in 9 patients are reported for the first time. The superficial growth pattern of the tumour and the frequent absence of lymph node or distant metastasis suggest that endoscopic resection can be carried out as a diagnostic and/or therapeutic approach. Due to the rarity of this entity, the case numbers are unfortunately so limited that evidence-based recommendations are unlikely to become available

  9. Determining Financial Capability of SSI/SSDI Beneficiaries with Psychiatric Disabilities: A Case Series

    PubMed Central

    Lazar, Christina M.; Black, Anne C.; McMahon, Thomas J; O’Shea, Kevin; Rosen, Marc I.

    2015-01-01

    Objective Social Security beneficiaries’ liberty is constrained if they are judged incapable of managing their disability payments and are assigned a fiduciary to manage benefit payments on their behalf. Conversely, beneficiaries’ well-being may be compromised if they misspend money that they need to survive. Several studies have shown that determinations of financial capability are made inconsistently and capability guidelines appear to be applied inconsistently in practice. This case series describes the ambiguities remaining for a small number of individuals even after published criteria for capability— failing to meet basic needs and/or harmful spending on drugs— are applied. Methods Trained, experienced assessors rated the financial capability of 119 individuals in intensive outpatient or inpatient psychiatric facilities who received SSI or SSDI payments. Ten individuals’ cases were determined difficult to judge. Results Six sources of ambiguity were identified by case review: distinguishing incapability from the challenges of navigating poverty, the amount of nonessential spending needed to be considered incapable, the amount of spending on harmful things needed to be considered incapable, how intermittent periods of capability and incapability should be considered, the relative weighting of past behavior and future plans to change, and discrepancies between different sources of information. Conclusion The cases raise fundamental questions about what financial incapability is, but also illustrate how detailed consideration of beneficiaries’ living situations and decision making can inform the difficult dichotomous decision about capability. PMID:25727116

  10. Sonography of Occult Rib and Costal Cartilage Fractures: A Case Series

    PubMed Central

    Mattox, Ross; Reckelhoff, Kenneth E.; Welk, Aaron B.; Kettner, Norman W.

    2014-01-01

    Objective The purpose of this case series is to describe the use of diagnostic ultrasound (US) in the detection of occult rib and costal cartilage fractures presenting as chest wall pain to a chiropractic clinic. Clinical features Three patients presented with chest wall pain and tenderness. Two of the patients presented with acute chest wall injury and 1 carried a previous diagnosis of rib fracture after trivial trauma 2 months earlier. Intervention and outcomes Diagnostic US was selected as a non-ionizing imaging tool for these patients after negative digital radiography studies. All fractures were considered isolated as there was no associated injury, such as pneumothorax. Both of the acute cases were followed up to complete healing (evidence of osseous union) using US. All patients eventually achieved pain-free status. Conclusion In these cases, US was more sensitive than radiography for diagnosing these cases of acute rib and costal cartilage fractures. Early recognition of rib injury could avoid potential complications from local manipulative therapy. PMID:25685124

  11. Case Series of an Intraoral Balancing Appliance Therapy on Subjective Symptom Severity and Cervical Spine Alignment

    PubMed Central

    Lee, Young Jun; Lee, Joo Kang; Jung, Soo Chang; Lee, Hwang-woo; Yin, Chang Shik; Lee, Young Jin

    2013-01-01

    Objective. The objective of this study was to investigate the effect of a holistic intraoral appliance (OA) on cervical spine alignment and subjective symptom severity. Design. An observational study on case series with holistic OA therapy. Setting. An outpatient clinic for holistic temporomandibular joint (TMJ) therapy under the supervision of the Pain Center, CHA Biomedical center, CHA University. Subjects. Ambulatory patients presenting with diverse chief complaints in the holistic TMJ clinic. Main Measures. Any immediate change in the curvature of cervical spine and the degree of atlantoaxial rotation was investigated in the images of simple X-ray and computed tomography of cervical spine with or without OA. Changes of subjective symptom severity were also analyzed for the holistic OA therapy cases. Results. A total of 59 cases were reviewed. Alignment of upper cervical spine rotation showed an immediate improvement (P < 0.001). Changes of subjective symptom severity also showed significant improvement (P < 0.05). Conclusion. These cases revealed rudimentary clinical evidence that holistic OA therapy may be related to an alleviated symptom severity and an improved cervical spinal alignment. These results show that further researches may warrant for the holistic TMJ therapy. PMID:23935655

  12. Symptomatic retention of the patency capsule: a multicenter real life case series

    PubMed Central

    Kopylov, Uri; Nemeth, Artur; Cebrian, Alba; Wurm Johansson, Gabriele; Thorlacius, Henrik; Fernandez-Urien Sainz, Ignacio; Koulaouzidis, Anastasios; Eliakim, Rami; Toth, Ervin

    2016-01-01

    Background and aims: The patency capsule is designed to evaluate the patency of the small bowel before administration of small-bowel capsule endoscopy (SBCE) in patients at high risk of retention. The utilization of a patency capsule may be associated with a risk of symptomatic retention, but very few cases have been reported to date. The aim of our study was to describe our experience with this rare complication of a patency capsule. Methods: This was a multicenter retrospective case series. The medical records of patients who underwent a patency capsule test were scanned and all cases of symptomatic retention were collected. Results: In total, 20 symptomatic cases of retention out of 1615 (1.2 %) patency capsule tests were identified; in one patient, the patency capsule was retained in the esophagus, in the rest, the capsule was detected in the small bowel resulting in abdominal pain or small-bowel obstruction. One patient (5 %) required surgery; all other patients resolved spontaneously or after corticosteroid therapy. Conclusions: Symptomatic patency capsule retention is a very rare complication with a favorable prognosis. It should be recognized but its use in patients with suspected small-bowel stenosis should not be discouraged. PMID:27652302

  13. Clinical outcomes of antimicrobial lock solutions used in a treatment modality: a retrospective case series analysis

    PubMed Central

    Bookstaver, P Brandon; Gerrald, Katherine R; Moran, Robert R

    2010-01-01

    Background Antimicrobial lock therapy (ALT) may be considered as adjunctive therapy in the treatment of catheter-related bloodstream infections (CRBSI) when catheter removal is not a favorable option. Objective To evaluate the outcomes associated with ALT as adjunctive treatment of CRBSI. Methods This was a 24-month retrospective case series analysis evaluating patients treated for more than 24 hours with ALT. The primary outcome was blood culture sterilization for 30 days posttherapy. The impact of ALT duration and time to initiation on central venous catheter (CVC) salvage were evaluated. Logistic regression modeled the association between ALT and sterilization rates, with a prespecified level of significance (α) of 0.1. Results Twenty-six cases were included in data analysis. Patients included ranged from 5 months to 82 years of age; 77% of patients were receiving total parenteral nutrition or chemotherapy. The majority of patients received vancomycin, daptomycin, or gentamicin combined with heparin in a lock solution. Blood culture sterilization was achieved in 69.2% of cases, and sterilization plus CVC retention was achieved in 11 cases (42.3%). Longer durations of ALT (≥9 days) were significantly correlated with blood culture sterilization (odds ratio = 1.367, P = 0.077). Conclusion ALT used as an adjunct to systemic therapy for adequate duration in CRBSI can achieve CVC sterilization and retainment without subsequent infectious complications. PMID:22291495

  14. Internal [sup 238]U-series systematics of pumice from the November 13, 1985, eruption of Nevado de Ruiz, Colombia

    SciTech Connect

    Schaefer, S.J.; Williams, S.N. ); Sturchio, N.C. ); Murrell, M.T. )

    1993-03-01

    High-precision mass spectrometer and alpha scintillation measurements of [sup 238]U-series nuclides were obtained for whole-rock pumice and constituent mineral and glass separates to help interpret the timing and nature of magmatic processes that led up to the 1985 eruption of Nevado de Ruiz volcano. Internal isochron diagrams for [sup 226]Ra/Ba vs. [sup 230]Th/Ba and [sup 230]Th/[sup 232]Th vs. [sup 238]U/[sup 232]Th show that data define linear arrays, indicating an average crystallization age of 6.1 [+-] 0.5 ka (Ra-Th isochron) and 7 [+-] 6 ka (Th-U isochron). Stratigraphic, petrographic geochemical, repose time, and eruption volume data for the Holocene eruptive sequence of Nevado del Ruiz indicate that significant changes occurred in the subvolcanic magma chamber between eruptions R9 ([approx]8.6 ka) and R8 ([approx]3.0 ka). This coincides with the average crystallization age derived from the U-series data and may represent the injection of a new batch (or batches) of mantle-derived magma into the subvolcanic magma chamber. 26 refs., 4 figs., 2 tabs.

  15. Adult-onset Alexander disease: a series of eleven unrelated cases with review of the literature.

    PubMed

    Pareyson, Davide; Fancellu, Roberto; Mariotti, Caterina; Romano, Silvia; Salmaggi, Andrea; Carella, Francesco; Girotti, Floriano; Gattellaro, Grazietta; Carriero, Maria Rita; Farina, Laura; Ceccherini, Isabella; Savoiardo, Mario

    2008-09-01

    Alexander disease (AD) in its typical form is an infantile lethal leucodystrophy, characterized pathologically by Rosenthal fibre accumulation. Following the identification of glial fibrillary acidic protein (GFAP) gene as the causative gene, cases of adult-onset AD (AOAD) are being described with increasing frequency. AOAD has a different clinical and neuroradiological presentation with respect to early-onset AD, as abnormalities are mainly concentrated in the brainstem-spinal cord junction. We report detailed clinical and genetic data of 11 cases of AOAD, observed over a 4-year period, and a review of the previously reported 25 cases of genetically confirmed AOAD. In our series, onset occurred as late as age 62, and up to 71 in an affected deceased relative. Most cases appeared sporadic, but family history may be misleading. The most frequent symptoms were related to bulbar dysfunction-with dysarthria, dysphagia, dysphonia (seven patients)-, pyramidal involvement (seven patients) and cerebellar ataxia (seven patients). Four patients had palatal myoclonus. Sleep disorders were also observed (four cases). Bulbar symptoms, however, were infrequent at onset and two symptomatic patients had an almost pure pyramidal involvement. Two subjects were asymptomatic. Misdiagnosis at presentation was frequent and MRI was instrumental in suggesting the correct diagnosis by showing, in all cases, mild to severe atrophy of the medulla oblongata extending caudally to the cervical spinal cord. In ten patients, molecular studies revealed six novel missense mutations and three previously reported changes in GFAP. The last typical patient carried no definitely pathogenic mutation, but a missense variant (p.D157N), supposedly a rare polymorphism. Revision of the literature and the present series indicate that the clinical picture is not specific, but AOAD must be considered in patients of any age with lower brainstem signs. When present, palatal myoclonus is strongly suggestive

  16. Manual Therapy and Exercise to Improve Outcomes in Patients With Muscle Tension Dysphonia: A Case Series

    PubMed Central

    Archer, Kristin R.

    2015-01-01

    Background and Purpose Muscle tension dysphonia (MTD), a common voice disorder that is not commonly referred for physical therapy intervention, is characterized by excessive muscle recruitment, resulting in incorrect vibratory patterns of vocal folds and an alteration in voice production. This case series was conducted to determine whether physical therapy including manual therapy, exercise, and stress management education would be beneficial to this population by reducing excess muscle tension. Case Description Nine patients with MTD completed a minimum of 9 sessions of the intervention. Patient-reported outcomes of pain, function, and quality of life were assessed at baseline and the conclusion of treatment. The outcome measures were the numeric rating scale (NRS), Patient-Specific Functional Scale (PSFS), and Voice Handicap Index (VHI). Cervical and jaw range of motion also were assessed at baseline and postintervention using standard goniometric measurements. Outcomes Eight of the patients had no pain after treatment. All 9 of the patients demonstrated an improvement in PSFS score, with 7 patients exceeding a clinically meaningful improvement at the conclusion of the intervention. Three of the patients also had a clinically meaningful change in VHI scores. All 9 of the patients demonstrated improvement in cervical flexion and lateral flexion and jaw opening, whereas 8 patients improved in cervical extension and rotation postintervention. Discussion The findings suggest that physical therapists can feasibly implement an intervention to improve outcomes in patients with MTD. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the intervention. A clinical implication is the expansion of physical therapy to include referrals from voice centers for the treatment of MTD. PMID:25256740

  17. EFFECTS OF FOREFOOT RUNNING ON CHRONIC EXERTIONAL COMPARTMENT SYNDROME: A CASE SERIES

    PubMed Central

    Gregory, Robert; Alitz, Curtis; Gerber, J. Parry

    2011-01-01

    Introduction: Chronic exertional compartment syndrome (CECS) is a condition that occurs almost exclusively with running whereby exercise increases intramuscular pressure compromising circulation, prohibiting muscular function, and causing pain in the lower leg. Currently, a lack of evidence exists for the effective conservative management of CECS. Altering running mechanics by adopting forefoot running as opposed to heel striking may assist in the treatment of CECS, specifically with anterior compartment symptoms. Case Description: The purpose of this case series is to describe the outcomes for subjects with CECS through a systematic conservative treatment model focused on forefoot running. Subject one was a 21 y/o female with a 4 year history of CECS and subject two was a 21 y/o male, 7 months status-post two-compartment right leg fasciotomy with a return of symptoms and a new onset of symptoms on the contralateral side. Outcome: Both subjects modified their running technique over a period of six weeks. Kinematic and kinetic analysis revealed increased step rate while step length, impulse, and peak vertical ground reaction forces decreased. In addition, leg intracompartmental pressures decreased from pre-training to post-training. Within 6 weeks of intervention subjects increased their running distance and speed absent of symptoms of CECS. Follow-up questionnaires were completed by the subjects at 7 months following intervention; subject one reported running distances up to 12.87 km pain-free and subject two reported running 6.44 km pain-free consistently 3 times a week. Discussion: This case series describes a potentially beneficial conservative management approach to CECS in the form of forefoot running instruction. Further research in this area is warranted to further explore the benefits of adopting a forefoot running technique for CECS as well as other musculoskeletal overuse complaints. PMID:22163093

  18. Ophthalmologic manifestations of focal dermal hypoplasia (Goltz syndrome): A case series of 18 patients.

    PubMed

    Gisseman, Jordan D; Herce, Honey H

    2016-03-01

    Focal Dermal Hypoplasia (FDH) or Goltz syndrome is a rare multi-system disorder with cutaneous, ocular, dental, and skeletal anomalies due to dysplasia of mesoectodermal derived tissues. It is an X-linked inheritance syndrome caused by mutations in the PORCN gene. This study is aimed to investigate the ocular findings in patients with Goltz syndrome. To date, there have been a limited number of case reports on the ocular manifestations of FDH. This is a prospective, non-consecutive, observational case series. Prospective ophthalmologic evaluation was performed on 18 patients with confirmed genetic testing for FDH, Goltz Syndrome, as a component of a larger multi-subspecialty study to better characterize the findings of this condition. Special attention was placed on evaluating the incidence of anophthalmia, microphthalmia, colobomas (iris, optic nerve, and/or retinal), cataracts, nystagmus, and strabismus. A complete ophthalmologic exam was done on all the patients. The mean patient age was 12.8 years (1-55 years). Eighty-nine percent were female and 77% (14/18) of patients had some form of an ophthalmologic manifestation of the condition. Ophthalmological findings included chorioretinal colobomas (61%), iris colobomas (50%), microphthalmia (44%), anophthalmia (11%), cataracts (11%), and conjunctival and eyelid papillomas (5%). Nystagmus was present in 33% and strabismus in 22% of the patients. Visual acuity ranged from 20/20 to no light perception. This study demonstrates a higher incidence of ophthalmologic manifestations as previously reported (77% vs. 40%). To our knowledge, this is the largest case series reported in the literature with 18 patients.

  19. Diagnostic criteria and follow-up in neuroendocrine cell hyperplasia of infancy: a case series*

    PubMed Central

    Gomes, Vivianne Calheiros Chaves; Silva, Mara Cristina Coelho; Maia, José Holanda; Daltro, Pedro; Ramos, Simone Gusmão; Brody, Alan S.; Marchiori, Edson

    2013-01-01

    OBJECTIVE: Neuroendocrine cell hyperplasia of infancy (NEHI) is a form of childhood interstitial lung disease characterized by tachypnea, retractions, crackles, and hypoxia. The aim of this study was to report and discuss the clinical, imaging, and histopathological findings in a series of NEHI cases at a tertiary pediatric hospital, with an emphasis on diagnostic criteria and clinical outcomes. METHODS: Between 2003 and 2011, 12 full-term infants were diagnosed with NEHI, based on clinical and tomographic findings. Those infants were followed for 1-91 months. Four infants were biopsied, and the histopathological specimens were stained with bombesin antibody. RESULTS: In this case series, symptoms appeared at birth in 6 infants and by 3 months of age in the remaining 6. In all of the cases, NEHI was associated with acute respiratory infection. The most common initial chest HRCT findings were ground-glass opacities that were in the middle lobe/lingula in 12 patients and in other medullary areas in 10. Air trapping was the second most common finding, being observed in 7 patients. Follow-up HRCT scans (performed in 10 patients) revealed normal results in 1 patient and improvement in 9. The biopsy findings were nonspecific, and the staining was positive for bombesin in all samples. Confirmation of NEHI was primarily based on clinical and tomographic findings. Symptoms improved during the follow-up period (mean, 41 months). A clinical cure was achieved in 4 patients. CONCLUSIONS: In this sample of patients, the diagnosis of NEHI was made on the basis of the clinical and tomographic findings, independent of the lung biopsy results. Most of the patients showed clinical improvement and persistent tomographic changes during the follow-up period, regardless of the initial severity of the disease or type of treatment. PMID:24310630

  20. Delayed puberty: analysis of a large case series from an academic center.

    PubMed

    Sedlmeyer, Ines L; Palmert, Mark R

    2002-04-01

    Despite the clinical importance of delayed puberty, the understanding of this condition is hampered by the lack of studies evaluating etiologies and predisposing factors among large case series. We performed a retrospective study of clinical and laboratory data from adolescents (< or =18 yr of age) with delayed puberty who had been seen in our clinic between 1/96 and 7/99 (n = 232 subjects; 158 males and 74 females). Family histories of pubertal timing among primary relatives were classified as negative, having at least a tendency to pubertal delay (development > or =1 SD beyond the mean), or diagnostic of delay (development > or =2 SD beyond the mean). The most common cause of delayed puberty was constitutional delay of growth and maturation (CD), which affected 53% of the subjects (63% of males and 30% of females). The remaining subjects could be divided into four categories: those with an underlying condition associated with delayed, but spontaneous, pubertal development [functional hypogonadotropic hypogonadism (FHH)], 19% of subjects; those with permanent hypogonadotropic hypogonadism, 12% of subjects; those with permanent hypergonadotropic hypogonadism, 13% of subjects; and those without clearly classified disorders, 3% of subjects. Like CD, FHH was male predominant, whereas the other categories either affected both genders equally or were predominantly female. In total, 50 different etiologies led to pubertal delay within our case series. Data permitted classification of family histories of pubertal timing among primary relatives in 95 of 122 of the CD and in 25 of 45 of the FHH cases. Analysis revealed at least a tendency to pubertal delay in 77% of the CD and in 64% of the FHH families and a diagnosis of delay in 38% of the CD and 44% of the FHH families. Both parents contributed to the positive family histories. The rates of positive family histories among the CD and FHH groups were approximately twice those seen among the other subjects in our case

  1. Maltreatment of Strongyloides infection: Case series and worldwide physicians-in-training survey

    PubMed Central

    Boulware, David R.; Stauffer, William M.; Hendel-Paterson, Brett R.; Rocha, Jaime Luís Lopes; Seet, Raymond Chee-Seong; Summer, Andrea P.; Nield, Linda S.; Supparatpinyo, Khuanchai; Chaiwarith, Romanee; Walker, Patricia F.

    2007-01-01

    Background Strongyloidiasis infects hundreds of millions of people worldwide and is an important cause of mortality from intestinal helminth infection in developed countries. The persistence of infection, increasing international travel, lack of familiarity by healthcare providers, and potential for iatrogenic hyperinfection, all make strongyloidiasis an important emerging infection. Design & Methods Two studies were performed. A retrospective chart review of Strongyloides stercoralis cases identified through microbiology laboratory records from 1993–2002 was conducted. Subsequently, 363 resident physicians in 15 training programs worldwide were queried with a case scenario of strongyloidiasis presenting an immigrant with wheezing and eosinophilia. The evaluation focused on resident recognition and diagnostic recommendations. Results In 151 strongyloidiasis cases, stool ova and parasite sensitivity is poor (51%), and eosinophilia (>5% or >400 cells/μL) commonly present (84%). Diagnosis averaged 56 months (Intra-quartile range: 4 to 72 months) after immigration. Presenting complaints were non-specific, although 10% presented with wheezing. Hyperinfection occurred in five patients prescribed corticosteroids with two deaths. Treatment errors occurred more often among providers unfamiliar with immigrant health (Relative Risk of Error: 8.4; 95% CI: 3.4 to 21.0; P<0.001). When presented a hypothetical case scenario, U.S. physicians-in-training had poor recognition (9%) of the need for parasite screening and frequently advocated empiric corticosteroids (23%). International trainees had superior recognition at 56% (P<0.001). Among U.S. trainees, 41% were unable to choose any parasite causing pulmonary symptoms. Conclusions Strongyloidiasis is present in U.S. patients. Diagnostic consideration should occur with appropriate exposure, non-specific symptoms including wheezing, or eosinophilia (>5% relative or >400 eosinophils/μL). U.S. residents’ helminth knowledge is

  2. Teachers' Stances towards Chinese International Students: An Australian Case Study

    ERIC Educational Resources Information Center

    Love, Kristina; Arkoudis, Sophie

    2006-01-01

    The international marketing of school education has gathered momentum in the Asia Pacific region, where an English medium education is prized by many parents. This paper investigates the responses of a group of teachers in Australia to the needs of international students in their school. The analysis of a 1 h professional discussion between four…

  3. Using English for International Business: A European Case Study

    ERIC Educational Resources Information Center

    Rogerson-Revell, Pamela

    2007-01-01

    With the continuing globalisation of markets and internationalisation of trade, professionals from a wide range of organisations, from large multinational corporations to small to medium size enterprises, are increasingly coming together to do business in the international workplace, particularly in meetings. Such international events usually…

  4. Menkes disease and response to copper histidine: An Indian case series

    PubMed Central

    Yoganathan, Sangeetha; Sudhakar, Sniya Valsa; Arunachal, Gautham; Thomas, Maya; Subramanian, Annadurai; George, Renu; Danda, Sumita

    2017-01-01

    Background: Menkes disease (MD) is an X-linked recessive neurodegenerative disorder caused by mutations in ATP7A gene. Depending on the residual ATP7A activity, manifestation may be classical MD, occipital horn syndrome, or distal motor neuropathy. Neurological sparing is expected in female carriers. However, on rare occasions, females may manifest with classical clinical phenotype due to skewed X-chromosome inactivation, X-autosome translocation, and XO genotype. Here, we describe a small series of probands with MD and their response to copper histidine therapy. This series also includes a female with X-13 translocation manifesting neurological symptoms. Methods: The clinical profile, laboratory and radiological data, and follow-up of four children with MD were collected from the hospital database and are being presented. Results: All the four children in our series had developmental delay, recurrent respiratory tract infections, hair and skeletal changes, axial hypotonia, tortuous vessels on imaging, low serum copper, ceruloplasmin, and elevated lactate. Fetal hypokinesia and fetal growth retardation were present in two cases. Failure to thrive was present in three children and only one child had epilepsy. Subcutaneous copper histidine was administered to all children. The average time lapse in the initiation of treatment was 20.3 months, and average duration of follow-up was 14.3 months. Conclusion: We conclude that copper histidine therapy is beneficial in reversing the skin and hair changes, improving appendicular tone, socio-cognitive milestones, and improving weight gain, and immunity. Early diagnosis and management of MD are essential to have a better clinical outcome. More research is needed to explore and devise new strategies in the management of patients with MD. PMID:28298846

  5. A Case Review Series of Christiana Care Health System’s Experience with Negative Pressure Wound Therapy Instillation

    PubMed Central

    Gallagher, Kathy E; Tinkoff, Glen H; Cipolle, Mark

    2016-01-01

    Acute and chronic wounds afflict a multitude of patients to varying degrees. Wound care treatment modalities span the spectrum of technological advancement and with that differ greatly in cost. Negative pressure wound therapy (NPWT) can now be combined with instillation and dwell time (NPWTi-d). This case review series of 11 patients in a community hospital setting provides support for the utilization of NPWTi-d. Additionally, current literature on the use of NPWTi-d in comparison to NPWT will be reviewed.  We highlight three specific cases. The first case is a 16-year-old male who was shot in the left leg. He suffered a pseudoaneurysm and resultant compartment syndrome. This required a fasciotomy and delayed primary closure. To facilitate this, NPWTi-d was employed and resulted in a total of four operative procedures before closure 13 days after admission. Next, a 61-year-old uncontrolled diabetic female presented with necrotizing fasciitis of the lower abdomen and pelvis. She underwent extensive debridement and placement of NPWTi-d with Dakin’s solution. A total of four operative procedures were performed including delayed primary closure six days after admission. Finally, a 48-year-old female suffered a crush injury with internal degloving. NPWTi-d with saline was utilized until discharge home on postoperative day 12. NPWTi-d, when compared to NPWT, has been reported to lead to a decrease in time to operative closure, hospital length of stay, as well as operative procedures required. The cost-benefit analysis in one retrospective review noted a $1,400 savings when these factors were taken into account. This mode of wound care therapy has significant benefits that warrant the development of a prospective randomized controlled trial to further define the improvement in quality-of-life provided to the patient and the reduction of potential overall healthcare costs. PMID:27980886

  6. Drug-induced Fanconi syndrome associated with fumaric acid esters treatment for psoriasis: a case series

    PubMed Central

    Balak, Deepak M.W.; Bouwes Bavinck, Jan Nico; de Vries, Aiko P.J.; Hartman, Jenny; Neumann, Hendrik A. Martino; Zietse, Robert; Thio, Hok Bing

    2016-01-01

    Background Fumaric acid esters (FAEs), an oral immunomodulating treatment for psoriasis and multiple sclerosis, have been anecdotally associated with proximal renal tubular dysfunction due to a drug-induced Fanconi syndrome. Few data are available on clinical outcomes of FAE-induced Fanconi syndrome. Methods Descriptive case series with two cases of Fanconi syndrome associated with FAE treatment diagnosed at two Dutch university nephrology departments, three cases reported at the Dutch and German national pharmacovigilance databases and six previously reported cases. Results All 11 cases involved female patients with psoriasis. The median age at the time of onset was 38 years [interquartile range (IQR) 37–46]. Patients received long-term FAEs treatment with a median treatment duration of 60 months (IQR 28–111). Laboratory tests were typically significant for low serum levels of phosphate and uric acid, while urinalysis showed glycosuria and proteinuria. Eight (73%) patients had developed a hypophosphataemic osteomalacia and three (27%) had pathological bone fractures. All patients discontinued FAEs, while four (36%) patients were treated with supplementation of phosphate and/or vitamin D. Five (45%) patients had persisting symptoms despite FAEs discontinuation. Conclusions FAEs treatment can cause drug-induced Fanconi syndrome, but the association has been reported infrequently. Female patients with psoriasis treated long term with FAEs seem to be particularly at risk. Physicians treating patients with FAEs should be vigilant and monitor for the potential occurrence of Fanconi syndrome. Measurement of the urinary albumin:total protein ratio is a suggested screening tool for tubular proteinuria in Fanconi syndrome. PMID:26798466

  7. Retrospective testing and case series study of porcine delta coronavirus in U.S. swine herds.

    PubMed

    McCluskey, Brian J; Haley, Charles; Rovira, Albert; Main, Rodger; Zhang, Yan; Barder, Sunny

    2016-01-01

    Porcine deltacoronavirus (PDCoV) was first reported in the United States (US) in February 2014. This was the second novel swine enteric coronavirus detected in the US since May 2013. In this study, we conducted retrospective testing of samples submitted to three veterinary diagnostic laboratories where qualifying biological samples were derived from previously submitted diagnostic case submissions from US commercial swine farms with a clinical history of enteric disease or from cases that had been previously tested for transmissible gastroenteritis virus, PEDV, or rotavirus. Overall, 2286 banked samples were tested from 27 States. Samples were collected in 3 separate years and in 17 different months. Test results revealed 4 positive samples, 3 collected in August 2013 and 1 collected in October 2013. In addition, a case series including 42 operations in 10 States was conducted through administration of a survey. Survey data collected included information on characteristics of swine operations that had experienced PDCoV clinical signs. Special emphasis was placed on obtaining descriptive estimates of biosecurity practices and disease status over time of each operation. Clinical signs of PDCoV were reported to be similar to those of PEDV. The average number of animals on each operation exhibiting clinical signs (morbidity) and the average number of case fatalities was greatest for suckling and weaned pigs. Average operation-level weaned pig morbidity was greatest in the first week of the outbreak while average operation-level suckling pig case fatality was greatest in the second week of the outbreak. The survey included questions regarding biosecurity practices for visitors and operation employees; trucks, equipment and drivers; and feed sources. These questions attempted to identify a likely pathway of introduction of PDCoV onto the operations surveyed.

  8. Sporadic nocturnal frontal lobe epilepsy: A consecutive series of 8 cases

    PubMed Central

    Yeh, Shih-Bin; Schenck, Carlos H.

    2014-01-01

    Objective To present findings on a series of cases of sporadic nocturnal frontal lobe epilepsy (NFLE), a form of NFLE that is infrequently reported, in contrast to familial (autosomal dominant) NFLE. Both forms of NFLE need to be distinguished from parasomnias, nocturnal temporal lobe epilepsy, and other nocturnal disorders. Methods Eight consecutive cases of sporadic NFLE were evaluated at a sleep clinic in Taiwan. All patients had clinical evaluations, daytime waking and sleeping EEGs, brain MRIs, and overnight video-polysomnography (vPSG) with seizure montage. Results Gender was equal (four males, four females); mean age was 18.4 yrs (range, 7–41 yrs). Age of NFLE onset was by puberty. Premorbid history was negative for any neurologic, medical or psychiatric disorder. NFLE subtypes: nocturnal paroxysmal dystonia, n=6; paroxysmal arousals, n=2. MRI brain scan abnormalities with clinical correlates were found in one patient. Daytime awake EEGs were negative for ictal/interictal activity in all patients, but two patients had daytime sleep EEGs with interictal epileptiform EEG activity. During vPSG studies, three of eight patients with NFLE seizure events had concurrent epileptiform EEG activity, and two patients had interictal epileptiform EEG activity during their vPSG studies. No case had a spontaneous remission. Anticonvulsant therapy was highly effective in all eight cases (>75% reduction in seizure frequency). Discussion These cases confirm that sporadic NFLE closely resembles familial NFLE, and comprises a set of distinct clinical manifestations, with variable intensity, and variable scalp EEG epileptiform abnormalities across sleep and wakefulness, which have previously been identified in Caucasian patients from Europe and North America. PMID:26483923

  9. Evaluation of the North American Guidelines for Children's Agricultural Tasks using a case series of injuries

    PubMed Central

    Marlenga, B; Brison, R; Berg, R; Zentner, J; Linneman, J; Pickett, W

    2004-01-01

    Objective: To evaluate the potential for the North American Guidelines for Children's Agricultural Tasks (NAGCAT) to prevent the occurrence of pediatric farm injuries. This evaluation focuses upon farm injuries experienced when children were engaged in farm work. Design: Novel outcome evaluation involving primary review of three retrospective case series. Setting: Fatal, hospitalized, and restricted activity injuries from the United States and Canada. Subjects: Nine hundred and thirty four pediatric farm injury cases. Methods: The applicability of NAGCAT to each case was rated. For injuries where NAGCAT were applicable, recurrent injury patterns were described and the potential for NAGCAT to prevent their occurrence was assessed. Results: A total of 283 (30.3%) cases involved children engaged in farm work. There was an applicable NAGCAT guideline in 64.9% of the work related cases. Leading individual guidelines applicable to the injury events were: (1) working with large animals; (2) driving a farm tractor; and (3) farm work with an all-terrain vehicle. In the judgment of the research team, 59.6% of these injuries were totally preventable if the principles espoused by NAGCAT had been applied. Conclusions: NAGCAT are a set of consensus guidelines aimed at the prevention of pediatric farm injuries. The findings suggest that NAGCAT, if applied, would be efficacious in preventing many of the most serious injuries experienced by children engaged in farm work. However, work related injuries represent only a modest portion of pediatric farm injuries. This new information assists in the refinement of NAGCAT as an injury control resource and puts its potential efficacy into context. PMID:15583256

  10. Diagnosis of pericardial cysts using diffusion weighted magnetic resonance imaging: A case series

    PubMed Central

    2011-01-01

    Introduction Congenital pericardial cysts are benign lesions that arise from the pericardium during embryonic development. The diagnosis is based on typical imaging features, but atypical locations and signal magnetic resonance imaging sequences make it difficult to exclude other lesions. Diffusion-weighted magnetic resonance imaging is a novel method that can be used to differentiate tissues based on their restriction to proton diffusion. Its use in differentiating pericardial cysts from other pericardial lesions has not yet been described. Case presentation We present three cases (a 51-year-old Caucasian woman, a 66-year-old Caucasian woman and a 77-year-old Caucasian woman) with pericardial cysts evaluated with diffusion-weighted imaging using cardiac magnetic resonance imaging. Each lesion demonstrated a high apparent diffusion coefficient similar to that of free water. Conclusion This case series is the first attempt to investigate the utility of diffusion-weighted magnetic resonance imaging in the assessment of pericardial cysts. Diffusion-weighted imaging may be a useful noninvasive diagnostic tool for pericardial cysts when conventional imaging findings are inconclusive. PMID:21943086

  11. 68Ga-DOTATATE uptake in pineal gland, a rare physiological variant: case series.

    PubMed

    Riaz, Saima; Syed, Rizwan; Skoura, Evangelia; Alshammari, Alshaima; Gaze, Mark; Sajjan, Rakesh; Halsey, Richard; Bomanji, Jamshed

    2015-11-01

    (68)Ga-DOTATATE PET-CT is widely used for the evaluation of neuroendocrine tumours. Knowledge of the physiological distribution of the radiotracer is of critical importance in characterizing focal areas of uptake. In this case series, we report three paediatric cases (average age 4.7 years ± 0.6 SD) with diagnosed advanced stage IV Neuroblastoma. Two had (68)Ga-DOTATATE PET-CT scans and one underwent (68)Ga-DOTATATE PET-MRI scan to assess for suitability of molecular therapy. Focal increased tracer uptake in the pineal gland was noted in all cases with no morphological abnormality on the corresponding CT and MRI scans. The uptake within the gland was thought to be a physiological variant rather than metastases owing to the heterogeneity of somatostatin receptors expression. The pineal gland has been reported to express somatostatin receptors. The physiological distribution of (68)Ga-DOTATATE uptake in the pineal gland is not routinely seen. Furthermore, the possibility of pineal meningioma is very unlikely as pineal meningiomas are very rare and there was no convincing morphological evidence of meningiomas on CT/MRI scan.

  12. Should Prophylactic Anticoagulation Be Considered with Large Uterine Leiomyoma? A Case Series and Literature Review

    PubMed Central

    Paredes Saenz, Carmen; Raju, Rubin; Cuthpert, Sierra; Kanzy, Abed; Abhari, Sina; Hebert III, John; Rocha, Frederico G.

    2016-01-01

    Introduction. Uterine leiomyomas, also called uterine fibroids or myomas, are the most common pelvic tumors in women. They are very rarely the cause of acute complications. However, when complications occur they cause significant morbidity and mortality. Thromboembolic disease has been described as a rare complication of uterine leiomyomas. DVT is a serious illness, sometimes causing death due to acute PE. Cases. We report a case series of 3 patients with thromboembolic disease associated with uterine leiomyoma at Hurley Medical Center, Flint, Michigan, during 2015 and conduct a literature review on the topic. A literature search was conducted using Medline, PubMed, and PMC databases from 1966 to 2015. Conclusion. The uterine leiomyoma is a very rare cause of PE and only few cases have been reported. DVT secondary to uterine leiomyoma should be considered in a female presenting with abdominal mass and pelvic pressure, if there is no clear common cause for her symptoms. Thromboembolic disease secondary to large uterine leiomyoma should be treated with acute stabilization and then hysterectomy. Prophylactic anticoagulation would be beneficial for lowering the risk of VTE in patients with large uterine leiomyoma. PMID:27885348

  13. Hemophagocytic Lymphohistiocytosis mimics many common conditions: case series and review of literature.

    PubMed

    Akenroye, A T; Madan, N; Mohammadi, F; Leider, J

    2017-01-01

    Introduction. Hemophagocytic lymphohistiocytosis (HLH), a rare but potentially fatal disease, is characterized by excessive immune activation and cytokine release which stimulates bone marrow macrophages to engulf hematopoietic cells. HLH could be secondary to infections: viral, fungal, and bacterial; malignancies and autoimmune diseases. The diagnosis of HLH is usually delayed due to the presence of non-specific symptoms at presentation. This delay contributes to increased mortality. Cases and review. We present the case of 4 patients who presented with subjective fevers and extreme fatigue. Patients all had systemic inflammatory response syndrome (SIRS). All patients were initially managed as in sepsis from an underlying infection. All unfortunately progressed to multiple organs dysfunction and died. The underlying causes for HLH in the patients were considered to be: HIV/AIDS, T cell lymphoma, histoplasmosis and juvenile rheumatoid arthritis. We have also included a brief review of the literature on HLH highlighting the treatment and outcomes of patients in case series; and the many conditions which can trigger HLH. Conclusion. Patients with HLH usually share various non-specific symptoms, such as fever and malaise, with patients across a wide spectrum of conditions: from bacterial sepsis to malignancies. Since early suspicion and diagnosis is critical to prompt therapy and improved mortality, including HLH as a possible cause of fever particularly in patients with prolonged fever of unknown origin and cytopenias will be crucial.

  14. Fatal caffeine intoxication: a series of eight cases from 1999 to 2009.

    PubMed

    Banerjee, Priya; Ali, Zabiullah; Levine, Barry; Fowler, David R

    2014-05-01

    Caffeine, 1,3,7-trimethylxanthine, is the most widely consumed legal stimulant. The most potent form is over the counter oral tablets. The estimated average daily adult caffeine consumption is 300 mg. Rarely, serious toxicities such as seizure and cardiac arrhythmias have caused death. Caffeine concentrations of 80 mg/L are considered lethal. Cases investigated over 10 years by the Office of the Chief Medical Examiner for the State of Maryland (OCME) whose cause of death was solely or in combination due to caffeine intoxication were reviewed. A total of eight adult cases were identified consisting of two suicides and six undetermined manners. The average postmortem caffeine concentration was 140.4 mg/L. This is the largest case series reported to date of lethal caffeine intoxication. Large doses of prescription medications and/or over the counter medications were abused. No overdoses were from consumption of caffeine-containing foods. Comprehensive postmortem toxicological testing should test for caffeine to capture these rare deaths.

  15. Case series of Bartonella quintana blood culture-negative endocarditis in Washington, DC

    PubMed Central

    Ghidey, Fisseha Y.; Mills, Kristin; Lai, Leon; Woods, Christian; Ruiz, Maria E.; Fishbein, Dawn; Sampath, Rahul; Lowery, Robert; Wortmann, Glenn

    2016-01-01

    Introduction: Prior studies (predominantly from Europe) have demonstrated blood culture-negative endocarditis due to Bartonella. Our objective was to describe three cases of Bartonella quintana endocarditis identified within one year at a large hospital in Washington, DC, USA. Case presentation: We constructed a descriptive case series from a retrospective review of medical records from April to December 2013 at an 800-bed urban hospital. All three patients (ages: 52, 55 and 57 years) were undomiciled/homeless men with a history of alcoholism. Although they had negative blood cultures, echocardiography demonstrated aortic/mitral valve perforation and regurgitation in one patient, aortic/mitral valve vegetation with mitral regurgitation in the second patient, and aortic valve vegetation with regurgitation in the third patient. The patients had positive Bartonella quintana serum immunoglobulin G (IgG) with negative immunoglobulin M (IgM). PCR on DNA extracted from cardiac valves was positive for Bartonella, and DNA sequencing of PCR amplicons identified Bartonella quintana. Patients received treatment with doxycycline/rifampin or doxycycline/gentamicin. Conclusion: Clinicians should consider Bartonella endocarditis as a differential diagnosis in patients who fit elements of the Duke Criteria, as well as having a history of homelessness and alcoholism. PMID:28348772

  16. Is Valproate Depressogenic in Patients Remitting from Acute Mania? Case Series

    PubMed Central

    Sharma, Priya

    2015-01-01

    Valproate is an effective antimanic agent and is recommended as a first-line medication in the treatment of acute mania. Current evidence based guidelines recommend that valproate should be given as a loading dose as it produces a rapid antimanic and antipsychotic response with minimal side-effects. However, no clear guidelines are available on the appropriate dosing or serum levels of valproate in the continuation or maintenance phase of bipolar disorder. We present 4 clinical cases to hypothesize that the higher doses of valproate, such as those used in the treatment of acute mania, may cause a depressive switch. So consideration should be given to reducing the dose of valproate if a patient develops depressive symptoms following recovery from the manic episode, as a therapeutic strategy. The cases also indicate that relatively lower doses and serum levels of valproate are effective in the maintenance phase compared to those needed in the acute manic phase of bipolar disorder. This is the first set of case series that questions the depressogenic potential of valproate in patients remitting from an acute manic episode. It highlights that different doses and serum levels of valproate may be therapeutic in different phases of bipolar disorder. PMID:26664794

  17. An Alternative Approach to Atopic Dermatitis: Part I—Case-Series Presentation

    PubMed Central

    2004-01-01

    Atopic dermatitis (AD) is a complex disease of obscure pathogenesis. A substantial portion of AD patients treated with conventional therapy become intractable after several cycles of recurrence. Over the last 20 years we have developed an alternative approach to treat many of these patients by diet and Kampo herbal medicine. However, as our approach is highly individualized and the Kampo formulae sometimes complicated, it is not easy to provide evidence to establish usefulness of this approach. In this Review, to demonstrate the effectiveness of the method of individualized Kampo therapy, results are presented for a series of patients who had failed with conventional therapy but were treated afterwards in our institution. Based on these data, we contend that there exist a definite subgroup of AD patients in whom conventional therapy fails, but the ‘Diet and Kampo’ approach succeeds, to heal. Therefore, this approach should be considered seriously as a second-line treatment for AD patients. In the Discussion, we review the evidential status of the current conventional strategies for AD treatment in general, and then specifically discuss the possibility of integrating Kampo regimens into it, taking our case-series presented here as evidential basis. We emphasize that Kampo therapy for AD is more ‘art’ than technology, for which expertise is an essential pre-requisite. PMID:15257326

  18. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

    PubMed Central

    Aktuerk, Dincer; Mishra, Pankaj Kumar; Luckraz, Heyman; Garnham, Andrew; Khazi, Fayaz Mohammed

    2016-01-01

    Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS). The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery) in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8). In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends) was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO2, etc.,) were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our “work in progress,” and we aim to conduct a larger study. PMID:26750675

  19. Fungal otitis externa as a cause of tympanic membrane perforation: a case series.

    PubMed

    Song, James Eingun; Haberkamp, Thomas J; Patel, Riddhi; Redleaf, Miriam I

    2014-08-01

    We describe a series of 11 patients--8 men and 3 women, aged 18 to 70 years (mean: 46.0)--who had fungal otitis externa that had been complicated by a tympanic membrane perforation. These patients had been referred to us for evaluation of chronic, mostly treatment-refractory otitis externa, which had manifested as otorrhea, otalgia, and/or pruritus. Seven of the 11 patients had no history of ear problems prior to their current condition. Five patients had been referred to us by a primary care physician and 4 by an otolaryngologist; the other 2 patients were self-referred. All patients were treated with a thorough debridement of the ear and one of two antifungal medication regimens. Eight of the 11 patients experienced a complete resolution of signs and symptoms, including closure of the tympanic membrane perforation. The other 3 patients underwent either a tympanoplasty (n = 2) or a fat-graft myringotomy (n = 1) because the perforation did not close within a reasonable amount of time. This series demonstrates that the nonspecific signs and symptoms of fungal otitis externa can make diagnosis difficult for both primary care physicians and general otolaryngologists. This study also demonstrates that most cases of tympanic membrane perforation secondary to fungal otitis externa will resolve with cleaning of the ear and proper medical treatment. Therefore, most patients with this condition will not require surgery.

  20. Ulnar Impaction Syndrome: A case series investigating the appropriate diagnosis, management, and post-operative considerations

    PubMed Central

    Woitzik, Erin; deGraauw, Chris; Easter, Brock

    2014-01-01

    Ulnar sided wrist pain is a common site for upper extremity disability. Ulnar impaction syndrome results in a spectrum of triangular fibrocartilage complex (TFCC) injuries and associated lunate, triquetrum, and ligamentous damage. Patients commonly present with insidious ulnar sided wrist pain and clicking, and a history of trauma or repetitive axial loading and rotation. In this case series, three patients presented to a sports chiropractor for evaluation and were subsequently diagnosed with ulnar impaction syndrome. Treatment strategies consist of conservative management, arthroscopic debridement or repair, arthroscopic wafer procedure, or ulnar shortening osteotomy. For the athlete, intervention should be individualized and sport-specific, considering athletic priorities, healing potential, return to play, and long-term health concerns. PMID:25550665

  1. Chondroblastoma of the Temporal Bone: A Case Series, Review, and Suggested Management Strategy

    PubMed Central

    Reid, Luke B.; Wong, David S.; Lyons, Bernard

    2011-01-01

    Chondroblastoma of the temporal bone is a rare condition. Chondroblastomas account for less than 1% of primary bone tumors, and those involving the temporal bone represent a tiny fraction of these tumors with most arising from the knee, rib, and pelvis. We present a case series of two patients who presented with chondroblastomas of the temporal bone over a period of 8 years to the St. Vincent's Hospital in Melbourne, Victoria, Australia. In particular, we outline the presenting complaint, diagnostic imaging undertaken, and the importance of preoperative histopathology in coming to the diagnosis and subsequent resection undertaken. A review of the current literature is presented with a suggested management strategy for these tumors. PMID:23984206

  2. Demodex treatment in external ocular disease: the outcomes of a Tasmanian case series.

    PubMed

    Nicholls, Stephen G; Oakley, Carmen L; Tan, Andrea; Vote, Brendan J

    2016-10-01

    Demodex species (spp.) have previously been implicated in the pathogenesis of blepharitis. This study aims to correlate improvement in symptoms of external ocular disease with treatment of underlying Demodex spp. This is a prospective, observational case series of patients with chronic external ocular disease. Demodicosis was confirmed by microscopic examination of epilated eyelashes. The main outcome measure was response to the treatment (5 % tee tree oil) in regard to change in subjective symptoms utilising a symptom-based patient questionnaire assessment. Overall patients had a good response to the treatment in terms of improvement or resolution of symptoms, with 91 % of patients reporting at least some improvement in symptoms. The treatment of underlying Demodex spp. appears to result in improvement of symptoms in patients with long standing external ocular disease and underlying Demodex spp. infestation.

  3. Bilateral Vocal Cord Palsy with Arnold Chiari Malformation: A Rare Case Series.

    PubMed

    Arora, Nikhil; Juneja, Ruchika; Meher, Ravi; Bhargava, Eishaan K

    2016-09-01

    Stridor in paediatric age group is not an uncommon presentation to the ENT emergency. The range of differential diagnosis is vast. The presentation may vary from noisy breathing to severe respiratory distress and apnea. Early and meticulous diagnosis is crucial for the management as the condition may be life threatening. We report a rare case series of 3 infants with Arnold Chiari Malformation who presented to the hospital with stridor and were diagnosed with bilateral vocal cord palsy. These 3 infants had similar underlying neurological condition with hydrocephalus and raised intracranial pressure. Chiari malformation is the one of the most common congenital central nervous system anomaly associated with bilateral vocal cord paralysis. However, the presentation is rare. This article, thus, emphasizes the significance of early diagnosis and immediate management of this condition.

  4. Bilateral Vocal Cord Palsy with Arnold Chiari Malformation: A Rare Case Series

    PubMed Central

    Arora, Nikhil; Meher, Ravi; Bhargava, Eishaan K.

    2016-01-01

    Stridor in paediatric age group is not an uncommon presentation to the ENT emergency. The range of differential diagnosis is vast. The presentation may vary from noisy breathing to severe respiratory distress and apnea. Early and meticulous diagnosis is crucial for the management as the condition may be life threatening. We report a rare case series of 3 infants with Arnold Chiari Malformation who presented to the hospital with stridor and were diagnosed with bilateral vocal cord palsy. These 3 infants had similar underlying neurological condition with hydrocephalus and raised intracranial pressure. Chiari malformation is the one of the most common congenital central nervous system anomaly associated with bilateral vocal cord paralysis. However, the presentation is rare. This article, thus, emphasizes the significance of early diagnosis and immediate management of this condition. PMID:27790480

  5. Case series of rash associated with influenza B in school children

    PubMed Central

    Skowronski, Danuta M; Chambers, Catharine; Osei, William; Walker, Jill; Petric, Martin; Naus, Monika; Li, Yan; Krajden, Mel

    2015-01-01

    This case series describes morbilliform and other rash presentations among schoolchildren during a March 2014 outbreak of influenza-like illness (ILI) in British Columbia, Canada. Multiplex nucleic acid testing of nasopharyngeal specimens and paired serologic investigations identified that influenza B, characterized as B/Massachusetts/02/2012-like (Yamagata-lineage), was the only viral aetiology and most likely cause of ILI and rash. An association between influenza B and rash has been described infrequently elsewhere, and not previously in North America. Influenza B should be considered in the differential diagnosis of febrile exanthem. Evaluation of the nature, incidence and contributing agent–host–environment interactions, and immunologic mechanisms to possibly explain influenza-associated rash is warranted. PMID:25382064

  6. Intervention for infants at risk of developing autism: a case series.

    PubMed

    Green, Jonathan; Wan, Ming Wai; Guiraud, Jeanne; Holsgrove, Samina; McNally, Janet; Slonims, Vicky; Elsabbagh, Mayada; Charman, Tony; Pickles, Andrew; Johnson, Mark

    2013-11-01

    Theory and evidence suggest the potential value of prodromal intervention for infants at risk of developing autism. We report an initial case series (n = 8) of a parent-mediated, video-aided and interaction-focused intervention with infant siblings of autistic probands, beginning at 8-10 months of age. We outline the theory and evidence base behind this model and present data on feasibility, acceptability and measures ranging from parent-infant social interaction, to infant atypical behaviors, attention and cognition. The intervention proves to be both feasible and acceptable to families. Measurement across domains was successful and on larger samples promise to be an effective test of whether such an intervention in infancy will modify emergent atypical developmental trajectories in infants at risk for autism.

  7. Lupus pneumonitis as the initial presentation of systemic lupus erythematosus: case series from a single institution.

    PubMed

    Wan, S A; Teh, C L; Jobli, A T

    2016-11-01

    Objective The aim of this study was to examine the clinical features, treatment and outcome of systemic lupus erythematosus (SLE) patients in our centre who presented with lupus pneumonitis as the initial manifestation. Methods We performed a retrospective review of all patients who presented with lupus pneumonitis during the initial SLE manifestation from March 2006 to March 2015. Results There were a total of five patients in our study who presented with fever and cough as the main clinical features. All patients had pulmonary infiltrates on chest radiographs. High-resolution computed tomography, which was performed in two patients, showed ground glass opacities with patchy consolidations bilaterally. All patients received high-dose steroids, 80% received intravenous cyclophosphamide and 60% received intravenous immunoglobulin. Two patients died from severe lupus pneumonitis within 2 weeks of admission despite treatment with ventilation, steroids, cyclophosphamide and intravenous immunoglobulin. Conclusions Acute lupus pneumonitis is an uncommon presentation of SLE. Mortality in this case series is 40%.

  8. Viruses in case series of tumors: Consistent presence in different cancers in the same subject

    PubMed Central

    Arroyo Mühr, Laila Sara; Hortlund, Maria; Bzhalava, Zurab; Nordqvist Kleppe, Sara; Bzhalava, Davit; Dillner, Joakim

    2017-01-01

    Studies investigating presence of viruses in cancer often analyze case series of cancers, resulting in detection of many viruses that are not etiologically linked to the tumors where they are found. The incidence of virus-associated cancers is greatly increased in immunocompromised individuals. Non-melanoma skin cancer (NMSC) is also greatly increased and a variety of viruses have been detected in NMSC. As immunosuppressed patients often develop multiple independent NMSCs, we reasoned that viruses consistently present in independent tumors might be more likely to be involved in tumorigenesis. We sequenced 8 different NMSCs from 1 patient in comparison to 8 different NMSCs from 8 different patients. Among the latter, 12 different virus sequences were detected, but none in more than 1 tumor each. In contrast, the patient with multiple NMSCs had human papillomavirus type 15 and type 38 present in 6 out of 8 NMSCs. PMID:28257474

  9. Development of Emotion Acceptance Behavior Therapy for Anorexia Nervosa: A Case Series

    PubMed Central

    Wildes, Jennifer E.; Marcus, Marsha D.

    2015-01-01

    This case series describes the development of a novel psychotherapeutic intervention for older adolescents and adults with anorexia nervosa (AN). Emotion acceptance behavior therapy (EABT) is based on a model that emphasizes the role of anorexic symptoms in facilitating avoidance of emotions. EABT combines standard behavioral interventions that are central to the clinical management of AN with psychotherapeutic techniques designed to increase emotion awareness, decrease emotion avoidance, and encourage resumption of valued activities and relationships outside the eating disorder. Five AN patients ages 17-43 years were offered a 24-session manualized version of EABT. Four patients completed at least 90% of the therapy sessions, and three showed modest weight gains without return to intensive treatment. Improvements in depressive and anxiety symptoms, emotion avoidance, and quality of life also were observed. These results offer preliminary support for the potential utility of EABT in the treatment of older adolescents and adults with AN. PMID:20721894

  10. Improvements in chronic diseases with a comprehensive natural medicine approach: a review and case series.

    PubMed

    Nader, T; Rothenberg, S; Averbach, R; Charles, B; Fields, J Z; Schneider, R H

    2000-01-01

    Approximately 40% of the US population report using complementary and alternative medicine, including Maharishi Vedic Medicine (MVM), a traditional, comprehensive system of natural medicine, for relief from chronic and other disorders. Although many reports suggest health benefits from individual MVM techniques, reports on integrated holistic approaches are rare. This case series, designed to investigate the effectiveness of an integrated, multimodality MVM program in an ideal clinical setting, describes the outcomes in four patients: one with sarcoidosis; one with Parkinson's disease; a third with renal hypertension; and a fourth with diabetes/essential hypertension/anxiety disorder. Standard symptom reports and objective markers of disease were evaluated before, during, and after the treatment period. Results suggested substantial improvements as indicated by reductions in major signs, symptoms, and use of conventional medications in the four patients during the 3-week in-residence treatment phase and continuing through the home follow-up program.

  11. Accelerated wound healing with combined NPWT and IPC: a case series.

    PubMed

    Arvesen, Kristian; Nielsen, Camilla Bak; Fogh, Karsten

    2017-03-01

    Negative pressure wound therapy (NPWT) and intermittent pneumatic compression (IPC) have traditionally been used in patients with chronic complicated non-healing wounds. The aim of this study (retrospective case series) was to describe the use of NPWT in combination with IPC in patients with a relatively short history (2-6 months) of ulcers. All wounds showed improved healing during the treatment period with marked or moderate reduction in ulcer size, and granulation tissue formation was markedly stimulated. Oedema was markedly reduced due to IPC. Treatment was generally well tolerated. The results of this study indicate that combined NPWT and IPC can accelerate wound healing and reduce oedema, thus shortening the treatment period. Therefore, patients may have a shorter healing period and may avoid entering a chronic wound phase. However, controlled studies of longer duration are needed in order to show the long-term effect of a more accelerated treatment course.

  12. Development of emotion acceptance behavior therapy for anorexia nervosa: a case series.

    PubMed

    Wildes, Jennifer E; Marcus, Marsha D

    2011-07-01

    This case series describes the development of a novel psychotherapeutic intervention for older adolescents and adults with anorexia nervosa (AN). Emotion acceptance behavior therapy (EABT) is based on a model that emphasizes the role of anorexic symptoms in facilitating avoidance of emotions. EABT combines standard behavioral interventions that are central to the clinical management of AN with psychotherapeutic techniques designed to increase emotion awareness, decrease emotion avoidance, and encourage resumption of valued activities and relationships outside the eating disorder. Five patients with AN aged 17-43 years were offered a 24-session manualized version of EABT. Four patients completed at least 90% of the therapy sessions, and three showed modest weight gains without return to intensive treatment. Improvements in depressive and anxiety symptoms, emotion avoidance, and quality of life also were observed. These results offer preliminary support for the potential utility of EABT in the treatment of older adolescents and adults with AN.

  13. Surgical techniques for the treatment of ankyloglossia in children: a case series.

    PubMed

    Junqueira, Marina Azevedo; Cunha, Nayara Nery Oliveira; Costa e Silva, Lidiane Lucas; Araújo, Leandro Borges; Moretti, Ana Beatriz Silveira; Couto Filho, Carlos Eduardo Gomes; Sakai, Vivien Thiemy

    2014-06-01

    This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.

  14. Clinical and histologic evaluation of calcium carbonate in sinus augmentation: a case series.

    PubMed

    Mangano, Carlo; Iaculli, Flavia; Piattelli, Adriano; Mangano, Francesco; Shibli, Jamil Awad; Perrotti, Vittoria; Iezzi, Giovanna

    2014-01-01

    The aim of this case series was a clinical, histologic, and histomorphometric evaluation of calcium carbonate in sinus elevation procedures. Sinus augmentation was performed in the atrophic maxillae of 24 subjects using calcium carbonate. Six months after the regeneration procedures, 68 implants were placed and clinically followed for 1 to 5 years, depending on the placement timing. At the last implant placement procedure, 8 bone cores were harvested and processed for histology. After a 6-month healing period, sinuses grafted with calcium carbonate showed a mean vertical bone gain of 6.93 ± 0.23 mm. The histomorphometric analysis revealed 15% ± 3% residual grafted biomaterial, 28% ± 2% newly formed bone, and 57% ± 2% marrow spaces. The implant survival rate was 98.5%. It can be concluded that calcium carbonate was shown to be clinically suitable for sinus elevation procedures after 1 to 5 years of follow-up and histologically biocompatible and osteoconductive.

  15. Improvements in Chronic Diseases With a Comprehensive Natural Medicine Approach: A Review and Case Series

    PubMed Central

    Nader, Tony; Rothenberg, Stuart; Averbach, Richard; Charles, Barry; Fields, Jeremy Z.; Schneider, Robert H.

    2008-01-01

    Approximately 40% of the US population report using complementary and alternative medicine, including Maharishi Vedic Medicine (MVM), a traditional, comprehensive system of natural medicine, for relief from chronic and other disorders. Although many reports suggest health benefits from individual MVM techniques, reports on integrated holistic approaches are rare. This case series, designed to investigate the effectiveness of an integrated, multi-modality MVM program in an ideal clinical setting, describes the outcomes in four patients: one with sarcoidosis; one with Parkinson’s disease; a third with renal hypertension; and a fourth with diabetes/essential hypertension/anxiety disorder. Standard symptom reports and objective markers of disease were evaluated before, during, and after the treatment period. Results suggested substantial improvements as indicated by reductions in major signs, symptoms, and use of conventional medications in the four patients during the 3-week in-residence treatment phase and continuing through the home follow-up program. PMID:10971882

  16. Compassionate mind training with people who hear malevolent voices: a case series report.

    PubMed

    Mayhew, Sophie L; Gilbert, Paul

    2008-01-01

    This paper presents a series of case studies to explore the understanding, acceptance and value of compassionate mind training (CMT) with psychotic voice hearers. We were interested in the degree to which such people are able to access and feel the positive emotions of 'warmth' and 'contentment' to become more self-compassionate. We also explored how CMT affected participants' hostile voices, their levels of anxiety, depression, paranoia and self-criticism. Participants were invited to offer suggestions for tailoring this approach for voice hearers. Results showed decreases for all participants in depression, psychoticism, anxiety, paranoia, Obsessive-Compulsive Disorder and interpersonal sensitivity. All participants' auditory hallucinations became less malevolent, less persecuting and more reassuring.

  17. Minimally invasive maxillary sinus elevation using balloon system: A case series

    PubMed Central

    Dhandapani, Radha Bharathi; Baskaran, Shivakumar; Arun, Kurumathur Vasudevan; Kumar, Thirunelveli Saravanan Subbu

    2016-01-01

    The posterior maxillary segment frequently exhibits insufficient bone mass to support dental implants. Sinus floor augmentation enables implant placement in the posterior maxilla. This case series included ten sites, in which sinus floor elevation was done using sinus lift balloon system followed by augmentation utilizing irradiated cancellous bone allograft. Postoperative radiographic assessment of vertical bone gain was done at 3 and 6 months follow-up period. The mean initial and final bone height were 6.16 and 10.50 mm, respectively, with a mean increase of 4.34 mm at 6 months being observed with nil complication. The presented technique might represent a viable alternative for sinus elevation in posterior atrophied maxilla. Irradiated cancellous bone allograft can be advocated as an ideal bone graft material for sinus augmentation procedures. PMID:28298833

  18. Tranexamic Acid in cardiac surgery and postoperative seizures: a case report series.

    PubMed

    Bell, David; Marasco, Silvana; Almeida, Aubrey; Rowland, Michael

    2010-08-01

    With the recent withdrawal of the antifibrinolytic aprotinin from the market, tranexamic acid (TxA) has become more widely used. This change has led to increasing concern about the side-effect profile of TxA, particularly the incidence of postoperative seizures. In this case series, we describe 7 patients over an 18-month period who had open-chamber cardiac surgery and developed seizures in the postoperative period. This incidence is increased compared with that of a cohort of patients in the previous 36 months who did not receive TxA (0.66% versus 0%; P < .05). The exact mechanism of TxA-induced seizures is thought to be via inhibition of gamma-aminobutyric acid receptors in neurons. Data from the neurosurgical literature show a well-established link between this antifibrinolytic and seizures. There is now increasing awareness of this association in cardiac surgery, particularly when high TxA doses are used.

  19. Surgical techniques for the treatment of ankyloglossia in children: a case series

    PubMed Central

    JUNQUEIRA, Marina Azevedo; CUNHA, Nayara Nery Oliveira; SILVA, Lidiane Lucas Costa e; ARAÚJO, Leandro Borges; MORETTI, Ana Beatriz Silveira; COUTO FILHO, Carlos Eduardo Gomes; SAKAI, Vivien Thiemy

    2014-01-01

    This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort. PMID:25025566

  20. Desensitization of triggers and urge reprocessing for pathological gambling: a case series.

    PubMed

    Bae, Hwallip; Han, Changwoo; Kim, Daeho

    2015-03-01

    This case series introduces the desensitization of triggers and urge reprocessing (DeTUR), as a promising adjunctive therapy in addition to comprehensive treatment package for pathological gambling. This addiction protocol of eye movement desensitization and reprocessing was delivered to four male inpatients admitted to a 10-week inpatient program for pathological gambling. The therapist gave three 60-min weekly sessions of the DeTUR using bilateral stimulation (horizontal eye movements or alternative tactile stimuli) focusing on the hierarchy of triggering situations and the urge to initiate gambling behaviors. After treatment, self-reported gambling symptoms, depression, anxiety, and impulsiveness were all improved, and all the participants reported satisfaction with the therapy. They were followed up for 6 months and all maintained their abstinence from gambling and their symptomatic improvements. Given the efficiency (i.e., brevity and efficacy) of the treatment, a controlled study to confirm the effects of the DeTUR on pathological gambling would be justified.

  1. Impact of different troposphere modelling methods on ZTD time series: case study of mountainous GPS stations

    NASA Astrophysics Data System (ADS)

    Stepniak, Katarzyna; Klos, Anna; Bock, Olivier; Bogusz, Janusz

    2016-04-01

    GNSS Zenith Total Delay (ZTD) data is useful for numerical weather forecasting and climate analysis. Considering the fact that tropospheric delays over the mountainous areas are the most difficult to be modelled, we explored the influence of different troposphere models in Precise Point Positioning (PPP) mode. We used GPS data from 2008 to 2014 at 28 permanent EUPOS (European Position Determination System) stations, including 9 EPN (EUREF Permanent Network) ones, located in the Sudeten and Carpathians. The GPS data was processed in PPP mode using Bernese 5.2 GNSS software with the final IGS (International GNSS Service) orbits and clocks. Different processing variants were tested implying the newest mapping functions (Global Mapping Function - GMF, and Vienna Mapping Function - VMF1) as well as different time resolutions and constraints on estimated parameters (ZTD and gradients). Median trends and amplitudes of annual/semi-annual oscillations for ZTD series were determined with Weighted Least Squares Estimation (WLSE) obtaining 0.1±0.5 mm/year and 44.7 / 7.2 ± 5 mm, respectively. Power Spectral Densities (PSDs) were estimated using Lomb-Scargle method for each of individual variants. PSDs showed, except oscillations of year and half a year, many other significant peaks in ZTD time series at higher frequencies, about 60, 30, 24, 20, 15, 12, 10, 8, 7, 6, 5, 4 and 3 cpy. The proper subtraction of the periodicities is crucial, because they will make stochastic part appear to be artificially autocorrelated. In order to recognized the periodicities in the ZTD signal, we analyzed the ZTD differences between GPS-derived delays and ERA-Interim reanalysis. The results of analysis showed the significant change from station to station and between variants. According to these results the authors will indicate an optimal processing strategy concerning troposphere modelling.

  2. Internet-Delivered, Family-Based Treatment for Early-Onset OCD: A Preliminary Case Series

    PubMed Central

    Comer, Jonathan S.; Furr, Jami M.; Cooper-Vince, Christine E.; Kerns, Caroline E.; Chan, Priscilla T.; Edson, Aubrey L.; Khanna, Muniya; Franklin, Martin E.; Garcia, Abbe M.; Freeman, Jennifer B.

    2014-01-01

    Given the burdens of early-onset obsessive-compulsive disorder (OCD), limitations in the broad availability and accessibility of evidence-based care for affected youth present serious public health concerns. The growing potential for technological innovations to transform care for the most traditionally remote and underserved families holds enormous promise. This article presents the rationale, key considerations, and a preliminary case series for a promising behavioral telehealth innovation in the evidence-based treatment of early-onset OCD. We developed an Internet-based format for the delivery of family-based treatment for early-onset OCD directly to families in their homes, regardless of their geographic proximity to a mental health facility. Videoteleconferencing (VTC) methods were used to deliver real-time cognitive-behavioral therapy centering on exposure and response prevention to affected families. Participants in the preliminary case series included 5 children between the ages of 4 and 8 (MAge = 6.5) who received the Internet-delivered treatment format. All youth completed a full treatment course, all showed OCD symptom improvements and global severity improvements from pre- to posttreatment, all showed at least partial diagnostic response, and 60% no longer met diagnostic criteria for OCD at posttreatment. No participants got worse, and all mothers characterized the quality of services received as “excellent.” The present work adds to a growing literature supporting the potential of VTC and related computer technology for meaningfully expanding the reach of supported treatments for OCD and lays the foundation for subsequent controlled evaluations to evaluate matters of efficacy and engagement relative to standard in-office evidence-based care. PMID:24295036

  3. Mycobacterium bovis in California dairies: a case series of 2002-2013 outbreaks.

    PubMed

    McCluskey, B; Lombard, J; Strunk, S; Nelson, D; Robbe-Austerman, S; Naugle, A; Edmondson, A

    2014-08-01

    From 2002 to 2013, bovine tuberculosis (bTB) caused by Mycobacterium bovis (M. bovis) has been detected on numerous dairies in California. In total, twelve herds had bTB detected and are included in the case series which describes these recent outbreaks and discusses potential pathways of introduction. Epidemiological investigations to determine the initial source of bTB in each herd included obtaining data on likely pathways of pathogen introduction. Pathways included purchasing cattle, use of heifer-raising operations, commingling of cattle at greater risk of exposure to infected cattle with cattle destined for California dairies, contact with infected wildlife, exposure to humans with bTB infections, community and neighboring herds and others. Epidemiologic and molecular typing data confirmed the source of infection in 3 herds and probable sources of infection in 2 herds. In the 7 remaining herds described in this case series an epidemiologic link to a source could not be determined and molecular typing results did not associate M. bovis isolates acquired from these herds with another specific U.S. herd or U.S.-born animal. Preventing new introductions of M. bovis onto California dairies will require rigorous epidemiologic investigation of all the potential pathways of introduction discussed here. The root cause(s) of bTB on California dairies is certainly multifactorial with complex interactions of herd management practices, importation of cattle at greater risk of exposure to infected cattle, and the potential of human M. bovis exposure. The extensive use of molecular typing has improved epidemiologists' ability to narrow the scope of potential sources.

  4. The modified use of Surfasoft® in skin grafts: case series

    PubMed Central

    Salibi, A.; Chasapi, M.; Farroha, A.

    2016-01-01

    Summary Surfasoft® is a monofilament woven polyamide thread. Its use over skin grafts has always been combined with other occlusive dressings. Its rapid application and transparent property makes it an ideal primary dressing in the absence of any occlusive layers after the first two days following skin graft application. We describe this modified use in our case series. We modified the use of Surfasoft® in four different burns patients and one skin cancer case. Surfasoft® was predominantly used on difficult sites and secured with either staples or sutures. A secondary occlusive dressing was only applied in the first 48 hours, then removed, leaving Surfasoft® as a single dressing until it spontaneously separated from the graft approximately 7-10 days post op. Complete healing of grafts was defined when dressing was no longer required. The majority of burns were full thickness with an average TBSA of 6.5%. Distribution was mainly to the neck and upper torso areas. The skin cancer was located on the right shoulder region. Graft healing was completed in 3-4 weeks following surgery. No complications were reported. Advantages of the modified Surfasoft® in addition to factors associated with graft survival in our series are discussed. The modified Surfasoft® was shown to be a simple and reliable dressing for meshed STSGs in both burns and elective procedures. We believe that it can be effectively used in sites associated with poor tolerance to conventional dressing and when nursing resources are limited. PMID:28149250

  5. MODIFYING MARCHING TECHNIQUE IN MILITARY SERVICE MEMBERS WITH CHRONIC EXERTIONAL COMPARTMENT SYNDROME: A CASE SERIES

    PubMed Central

    Diebal-Lee, MAJ Angela; Poelsma, Laurens R.; Harts, Chris C.; Zimmermann, LTC Wes O.

    2016-01-01

    Background and Purpose The long-term effectiveness of both operative and non-operative management approaches for Chronic Exertional Compartment Syndrome of the lower legs (CECS) is moderate at best. Positive outcomes have recently been reported on modifying running technique in individuals with CECS. The purpose of this case series was to evaluate a training program aimed at changing marching technique in individuals with CECS, based on principles that aim to eliminate heel strike and decrease impact during foot strike. Study Design Case series. Methods Six service members with CECS underwent a five-week training program aimed at modifying marching technique. The program was comprised of foot/lower leg strengthening exercises, perception drills, and treadmill/outdoor marching bouts. Self-assessed leg condition, march endurance performance, and kinematic/kinetic measurements were assessed at baseline (T0), post-treatment (T5), and nine months post-intervention (T40). Results Moderate to fair pre- to post improvements on the self-assessed leg condition outcomes were demonstrated for most participants (4% to 73% improvements). These scores continued to improve until the 9 months follow-up. Marching performance improved during the intervention period in all but one subject, ranging from 6% to 38% improvement in marching time. Kinematic and kinetic data showed pre- to post-intervention changes that were reflective of the marching technique modification in most subjects. Post-intervention pain profiles of participants during marching showed that, in most subjects, the onset of leg pain was delayed compared to baseline. Conclusions A five-week intervention aimed at altering marching technique has demonstrated moderately promising results in a group of service members with CECS of the lower legs who had previously undergone other conservative management interventions without success. Due to the relatively small sample size and the variability in subject outcomes, further

  6. The modified use of Surfasoft® in skin grafts: case series.

    PubMed

    Salibi, A; Chasapi, M; Farroha, A

    2016-09-30

    Surfasoft® is a monofilament woven polyamide thread. Its use over skin grafts has always been combined with other occlusive dressings. Its rapid application and transparent property makes it an ideal primary dressing in the absence of any occlusive layers after the first two days following skin graft application. We describe this modified use in our case series. We modified the use of Surfasoft® in four different burns patients and one skin cancer case. Surfasoft® was predominantly used on difficult sites and secured with either staples or sutures. A secondary occlusive dressing was only applied in the first 48 hours, then removed, leaving Surfasoft® as a single dressing until it spontaneously separated from the graft approximately 7-10 days post op. Complete healing of grafts was defined when dressing was no longer required. The majority of burns were full thickness with an average TBSA of 6.5%. Distribution was mainly to the neck and upper torso areas. The skin cancer was located on the right shoulder region. Graft healing was completed in 3-4 weeks following surgery. No complications were reported. Advantages of the modified Surfasoft® in addition to factors associated with graft survival in our series are discussed. The modified Surfasoft® was shown to be a simple and reliable dressing for meshed STSGs in both burns and elective procedures. We believe that it can be effectively used in sites associated with poor tolerance to conventional dressing and when nursing resources are limited.

  7. Teaching the Japanese American Internment: A Case Study of Social Studies Curriculum Conflict and Change

    ERIC Educational Resources Information Center

    Camicia, Steven P.

    2009-01-01

    This article examines a case of curriculum conflict in order to understand how the social studies curriculum is changed by such conflicts. In the case, a small group of activists challenged a local sixth grade history curriculum, which claimed that the WWII internment of Japanese Americans was a mistake. Activists claimed that the internment was…

  8. Use of the levonorgestrel 52-mg intrauterine system in adolescent and young adult solid organ transplant recipients: a case series.

    PubMed

    Huguelet, P S; Sheehan, C; Spitzer, R F; Scott, S

    2017-04-01

    This case series reports on the safety and efficacy of the levonorgestrel 52-mg intrauterine system in adolescent and young adult solid organ transplant recipients. All patients used the device for contraception, with no documented cases of disseminated pelvic infection or unplanned pregnancy.

  9. Surgery and perioperative management for post-intubation tracheoesophageal fistula: case series analysis

    PubMed Central

    Puma, Francesco; Santoprete, Stefano; Urbani, Moira; Cagini, Lucio; Andolfi, Marco; Potenza, Rossella; Daddi, Niccolò

    2017-01-01

    Background Post-intubation tracheoesophageal fistula (PITEF) is an often mistreated, severe condition. This case series reviewed for both the choice and timing of surgical technique and outcome PITEF patients. Methods This case series reviewed ten consecutive patients who had undergone esophageal defect repair and airway resection/reconstruction between 2000 and 2014. All cases were examined for patients: general condition, medical history, preparation to surgery, diagnostic work-up, timing of surgery and procedure, fistula size and site, ventilation type, nutrition, post-operative course and complications. Results All patients were treated according to Grillo’s technique. Overall, 6/10 patients had undergone a preliminary period of medical preparation. Additionally, 3 patients had already had a tracheostomy, one had had a gastrostomy and 4 had both. One patient had a Dumon stent with enlargement of the fistula. Concomitant tracheal stenosis had been found in 7 patients. The mean length of the fistulas was 20.5 mm (median 17.5 mm; range, 8–45 mm), at a median distance from the glottis of 43 mm (range, 20–68 mm). Tracheal resection was performed in all ten cases. The fistula was included in the resection in 6 patients, while it was excluded in the remaining 4 due to their distance. Post-repair tracheotomy was performed in 3 patients. The procedure was performed in 2 ventilated patients. Morbidity related to fistula and anastomosis was recorded in 3 patients (30%), with one postoperative death (10%); T-Tube placement was necessary in 3 patients, with 2/3 decannulations after long-stenting. Definitive PITEF closure was obtained for all patients. At 5-year follow-up, the 9 surviving patients had no fistula-related morbidity. Conclusions Primary esophageal closure with tracheal resection/reconstruction seemed to be effective treatment both short and long-term. Systemic conditions, mechanical ventilation, detailed preoperative assessment and appropriate preparation

  10. University Response to Crisis Events Involving International Populations: The Case of Seven Directors of International Offices

    ERIC Educational Resources Information Center

    Andrews, James P.

    2012-01-01

    This qualitative research study focuses on crisis events affecting university international populations. It explores how seven directors of university international offices at seven different geographical locations in Texas respond to those events. The study findings shed light on the current state of crisis preparedness in higher education from…

  11. Attention Bias Modification Treatment for Children with Anxiety Disorders who do not Respond to Cognitive Behavioral Therapy: A Case Series

    PubMed Central

    Bechor, Michele; Pettit, Jeremy W.; Silverman, Wendy K.; Bar-Haim, Yair; Abend, Rany; Pine, Daniel S.; Vasey, Michael W.

    2013-01-01

    Evidence is emerging to support the promise of Attention Bias Modification Treatment (ABMT), a computer-based attention training program, in reducing anxiety in children. ABMT has not been tested as an adjuvant for children with anxiety disorders who do not respond to Cognitive-Behavioral Therapy (CBT). This case series presents findings from an open trial of ABMT among six children (four girls; M age =11.2 years) who completed a CBT protocol and continued to meet diagnostic criteria for an anxiety disorder. All children completed the ABMT protocol with no cancelled or missed sessions. Child self-ratings on anxiety symptoms and depressive symptoms significantly decreased from pretreatment to posttreatment, as did parent ratings on child anxiety-related impairment. Parent ratings on child anxiety and internalizing symptoms displayed non-significant decreases from pretreatment to posttreatment. These findings support the potential promise of ABMT as a feasible adjuvant treatment that reduces anxiety and impairment among child anxiety CBT nonresponders. PMID:24211147

  12. Petroleum Dependency: The Case to Replace the Internal Combustion Engine

    DTIC Science & Technology

    2015-02-17

    link between the internal combustion engine and oil leads to an inevitable energy security problem. This concern has led President Obama to call for a...promotion of alternative energy fuels. 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT Same as Report (SAR) 18...internal combustion engine and oil leads to an inevitable energy security problem. This concern has led President Obama to call for a promotion of

  13. Shrinking lung syndrome in systemic lupus erythematosus: A case series and review of the literature.

    PubMed

    Borrell, Helena; Narváez, Javier; Alegre, Juan José; Castellví, Ivan; Mitjavila, Francesca; Aparicio, María; Armengol, Eulàlia; Molina-Molina, María; Nolla, Joan M

    2016-08-01

    Shrinking lung syndrome (SLS) is a rare and less known complication mainly associated with systemic lupus erythematosus (SLE). In this study, we analyze the clinical features, investigation findings, approaches to management, and outcome in a case series of 9 adult patients with SLE and SLS diagnosed during a 35-year period in 3 referral tertiary care hospitals in Spain. Additionally, we reviewed 80 additional cases previously reported (PubMed 1965-2015). These 80 cases, together with our 9 patients, form the basis of the present analysis.The overall SLS prevalence in our SLE population was 1.1% (9/829). SLS may complicate SLE at any time over its course, and it usually occurs in patients without previous or concomitant major organ involvement. More than half of the patients had inactive lupus according to SELENA-systemic lupus erythematosus disease activity index (SLEDAI) scores. Typically, it presents with progressive exertional dyspnea of variable severity, accompanied by pleuritic chest pain in 76% of the cases.An important diagnostic delay is common. The diagnostic tools that showed better yield for SLS detection are the imaging techniques (chest x-ray and high-resolution computed tomography) along with pulmonary and diaphragmatic function tests. Evaluation of diaphragm dome motion by M-mode ultrasonography and phrenic nerve conduction studies are less useful.There are no standardized guidelines for the treatment of SLS in SLE. The majority of patients were treated with medium or high doses of glucocorticoids. Several immunosuppressive agents have been used in conjunction with steroids either if the patient fails to improve or since the beginning of the treatment. Theophylline and beta-agonists, alone or in combination with glucocorticoids, have been suggested with the intent to increase diaphragmatic strength.The overall long-term prognosis was good. The great majority of patients had significant clinical improvement and stabilization, or mild to moderate

  14. Microvascular decompression for glossopharyngeal neuralgia through a microasterional approach: A case series

    PubMed Central

    Revuelta-Gutiérrez, Rogelio; Morales-Martínez, Andres Humberto; Mejías-Soto, Carolina; Martínez-Anda, Jaime Jesús; Ortega-Porcayo, Luis Alberto

    2016-01-01

    Background: Glossopharyngeal neuralgia (GPN) is an uncommon craniofacial pain syndrome. It is characterized by a sudden onset lancinating pain usually localized in the sensory distribution of the IX cranial nerve associated with excessive vagal outflow, which leads to bradycardia, hypotension, syncope, or cardiac arrest. This study aims to review our surgical experience performing microvascular decompression (MVD) in patients with GPN. Methods: Over the last 20 years, 14 consecutive cases were diagnosed with GPN. MVD using a microasterional approach was performed in all patients. Demographic data, clinical presentation, surgical findings, clinical outcome, complications, and long-term follow-up were reviewed. Results: The median age of onset was 58.7 years. The mean time from onset of symptoms to treatment was 8.8 years. Glossopharyngeal and vagus nerve compression was from the posterior inferior cerebellar artery in eleven cases (78.5%), vertebral artery in two cases (14.2%), and choroid plexus in one case (7.1%). Postoperative mean follow-up was 26 months (3–180 months). Pain analysis demonstrated long-term pain improvement of 114 ± 27.1 months and pain remission in 13 patients (92.9%) (P = 0.0001) two complications were documented, one patient had a cerebrospinal fluid leak, and another had bacterial meningitis. There was no surgical mortality. Conclusions: GPN is a rare entity, and secondary causes should be discarded. MVD through a retractorless microasterional approach is a safe and effective technique. Our series demonstrated an excellent clinical outcome with pain remission in 92.9%. PMID:27213105

  15. Ability of Ultrasonography in Detection of Different Extremity Bone Fractures; a Case Series Study

    PubMed Central

    Bozorgi, Farzad; Shayesteh Azar, Massoud; Montazer, Seyed Hossein; Chabra, Aroona; Heidari, Seyed Farshad; Khalilian, Alireza

    2017-01-01

    Introduction: Despite radiography being the gold standard in evaluation of orthopedic injuries, using bedside ultrasonography has several potential supremacies such as avoiding exposure to ionizing radiation, availability in pre-hospital settings, being extensively accessible, and ability to be used on the bedside. The aim of the present study is to evaluate the diagnostic accuracy of ultrasonography in detection of extremity bone fractures. Methods: This study is a case series study, which was prospectively conducted on multiple blunt trauma patients, who were 18 years old or older, had stable hemodynamic, Glasgow coma scale 15, and signs or symptoms of a possible extremity bone fracture. After initial assessment, ultrasonography of suspected bones was performed by a trained emergency medicine resident and prevalence of true positive and false negative findings were calculated compared to plain radiology. Results: 108 patients with the mean age of 44.6 ± 20.4 years were studied (67.6% male). Analysis was done on 158 sites of fracture, which were confirmed with plain radiography. 91 (57.6%) cases were suspected to have upper extremity fracture(s) and 67 (42.4%) to have lower ones. The most frequent site of injuries were forearm (36.7%) in upper limbs and leg (27.8%) in lower limbs. Prevalence of true positive and false negative cases for fractures detected by ultrasonography were 59 (64.8%) and 32 (35.52%) for upper and 49 (73.1%) and 18 (26.9%) for lower extremities, respectively. In addition, prevalence of true positive and false negative detected cases for intra-articular fractures were 24 (48%) and 26 (52%), respectively. Conclusion The present study shows the moderate sensitivity (68.3%) of ultrasonography in detection of different extremity bone fractures. Ultrasonography showed the best sensitivity in detection of femur (100%) and humerus (76.2%) fractures, respectively. It had low sensitivity in detection of in intra-articular fractures. PMID:28286822

  16. The clinical psychologist and the management of inpatient pain: a small case series

    PubMed Central

    Childs, Susan R; Casely, Emma M; Kuehler, Bianca M; Ward, Stephen; Halmshaw, Charlotte L; Thomas, Sarah E; Goodall, Ian D; Bantel, Carsten

    2014-01-01

    Recent research has confirmed that between 25% and 33% of all hospitalized patients experience unacceptable levels of pain. Studies further indicate that this reduces patient satisfaction levels, lengthens hospital stays, and increases cost. Hospitals are aiming to discharge patients earlier, and this can interfere with adequate pain management. Therefore, the pain service at Chelsea and Westminster Hospital has adapted to this changing model of care. An increasing body of evidence demonstrates that psychological factors are key components of patients’ pain experiences in both acute and chronic pain. Therefore, it is reasonable to suggest a clinical psychologist should be involved in inpatient pain management. This small study discusses three cases that highlight how patient care could be improved by including a clinical psychologist as part of the inpatient pain team. Two cases particularly highlight the active role of the psychologist in the diagnosis and management of common conditions such as fear and anxiety, along with other psychiatric comorbidities. The management therefore employed an eclectic approach adapted from chronic pain and comprising of behavioral, cognitive behavioral, and dialectical behavioral therapeutic techniques blended with brief counseling. The third case exemplifies the importance of nurse-patient interactions and the quality of nurse-patient relationships on patient outcomes. Here, the psychologist helped to optimize communication and to resolve a difficult and potentially risk-laden situation. This small case series discusses the benefits derived from the involvement of a clinical psychologist in the management of inpatient pain, and therefore illustrates the need for novel initiatives for inpatient pain services. However, future research is warranted to validate this approach. PMID:25506221

  17. Internal combustion engine control for series hybrid electric vehicles by parallel and distributed genetic programming/multiobjective genetic algorithms

    NASA Astrophysics Data System (ADS)

    Gladwin, D.; Stewart, P.; Stewart, J.

    2011-02-01

    This article addresses the problem of maintaining a stable rectified DC output from the three-phase AC generator in a series-hybrid vehicle powertrain. The series-hybrid prime power source generally comprises an internal combustion (IC) engine driving a three-phase permanent magnet generator whose output is rectified to DC. A recent development has been to control the engine/generator combination by an electronically actuated throttle. This system can be represented as a nonlinear system with significant time delay. Previously, voltage control of the generator output has been achieved by model predictive methods such as the Smith Predictor. These methods rely on the incorporation of an accurate system model and time delay into the control algorithm, with a consequent increase in computational complexity in the real-time controller, and as a necessity relies to some extent on the accuracy of the models. Two complementary performance objectives exist for the control system. Firstly, to maintain the IC engine at its optimal operating point, and secondly, to supply a stable DC supply to the traction drive inverters. Achievement of these goals minimises the transient energy storage requirements at the DC link, with a consequent reduction in both weight and cost. These objectives imply constant velocity operation of the IC engine under external load disturbances and changes in both operating conditions and vehicle speed set-points. In order to achieve these objectives, and reduce the complexity of implementation, in this article a controller is designed by the use of Genetic Programming methods in the Simulink modelling environment, with the aim of obtaining a relatively simple controller for the time-delay system which does not rely on the implementation of real time system models or time delay approximations in the controller. A methodology is presented to utilise the miriad of existing control blocks in the Simulink libraries to automatically evolve optimal control

  18. InSAR time-series investigation of long-term ground displacement at Beijing Capital International Airport, China

    NASA Astrophysics Data System (ADS)

    Gao, Mingliang; Gong, Huili; Chen, Beibei; Zhou, Chaofan; Chen, Wenfeng; Liang, Yue; Shi, Min; Si, Yuan

    2016-11-01

    Interferometric synthetic aperture radar (InSAR) time-series analysis provides high spatial resolution and continuous temporal coverage for investigations of long-term ground displacement. Beijing, the capital city of China, has suffered from land subsidence since the 1950s, and extreme groundwater extraction has led to subsidence rates of > 100 mm/year. In this study, InSAR time-series analysis is performed on different data subsets to investigate the ground displacement at Capital International Airport, Beijing, between June 2003 and November 2013. The results show that the ground surface in the airport has deformed at different rates ranging from - 66.2 mm/year (sinking) to 8.2 mm/year (uplift) relative to the reference point. The projected vertical displacement rates agreed with measurements estimated from ground-leveling surveys, and the correlation coefficient of the fitting result is 0.96, with a standard deviation of 0.9 mm/year and a mean different of 2.0 mm/year. The runways and terminals have been affected by land subsidence to various degrees. Previous studies has indicated that long-term intense groundwater extraction is the main reason leading to land subsidence in this area. Other triggering factors, such as active faults, the quaternary compressible layers and urbanization, also have different degrees of contribution or impact on land subsidence in Beijing Plain. Furthermore, some interesting behaviors from groundwater (such as inter- and semi-annual variations) and subsidence, the relationship between them are also found in this study.

  19. Electroencephalography when meditation advances: a case-based time-series analysis.

    PubMed

    Tsai, Jui-Feng; Jou, Shaw-Hwa; Cho, WenChun; Lin, Chieh-Min

    2013-11-01

    Increased alpha and theta activities in electroencephalography (EEG) have been found during various forms of meditation. However, advanced stage of meditation drew less attention to date. We aimed at exploring EEG characteristics during advanced meditation. Bilateral absolute alpha and theta EEG powers were recorded when a single meditator at rest, exercising breath meditation, and reaching the advanced meditative stage in 10 sessions of meditation. Averaged time-series data were analyzed using simulation modeling analysis to compare the powers during different meditative phases. During breath meditation, significantly higher activities compared with baseline were found only in bilateral theta (P = 0.0406, 0.0158 for left and right sides, respectively), but not in alpha (P = 0.1412, 0.0978 for left and right sides, respectively) bands. When meditation advanced, significantly increased activities were found both in bilateral alpha (P = 0.0218, 0.0258 for left and right sides, respectively) and theta (P = 0.0308, 0.0260 for left and right sides, respectively) bands compared against breath meditation. When advanced meditation compared against baseline, bilateral alpha (P = 0.0001, 0.0001 for left and right sides, respectively) and theta (P = 0.0001, 0.0001 for left and right sides, respectively) bands revealed significantly increased activities. Our findings support that internalized attention manifested as theta activity continuingly enhances significantly in sequential phases of meditation, while relaxation manifested as alpha activity is significant only after the advanced meditative phase is reached.

  20. The Reasons of Renal Transplant Recipients’ Admission to the Emergency Department; a Case Series Study

    PubMed Central

    Uysal, Erdal; Dokur, Mehmet; Bakir, Hasan; Ikidag, Mehmet Ali; Kirdak, Turkay; Kazimoglu, Hatem

    2016-01-01

    Introduction: Renal transplantation are admitted to emergency department (ED) more than normal population. The present brief report aimed to determine the reasons of renal transplant patients’ ED visits. Methods: This retrospective case series study analyzed the reasons of renal transplant recipients’ admission to one ED between 2011 and 2014. The patient data were collected via a checklist and presented using descriptive statistics tools. Results: 41 patients with the mean age of 40.63 ± 10.95 years were studied (60.9% male). The most common ED presenting complaints were fever (36.6%) and abdominal pain (26.8%). Infections were the most common final diagnosis (68.3%). Among non-infectious causes, the most common was acute renal failure (9.7 %). 73.2% of the patients were hospitalized and no cases of graft loss and mortality were seen. Conclusion: The most common reason for ED admission was fever, and infections were the most common diagnosis. Acute gastroenteritis being the most frequent infection and among non-infectious problems, acute renal failure was the most frequent one. PMID:27800542

  1. A multi-modal treatment approach for the shoulder: A 4 patient case series

    PubMed Central

    Pribicevic, Mario; Pollard, Henry

    2005-01-01

    Background This paper describes the clinical management of four cases of shoulder impingement syndrome using a conservative multimodal treatment approach. Clinical Features Four patients presented to a chiropractic clinic with chronic shoulder pain, tenderness in the shoulder region and a limited range of motion with pain and catching. After physical and orthopaedic examination a clinical diagnosis of shoulder impingement syndrome was reached. The four patients were admitted to a multi-modal treatment protocol including soft tissue therapy (ischaemic pressure and cross-friction massage), 7 minutes of phonophoresis (driving of medication into tissue with ultrasound) with 1% cortisone cream, diversified spinal and peripheral joint manipulation and rotator cuff and shoulder girdle muscle exercises. The outcome measures for the study were subjective/objective visual analogue pain scales (VAS), range of motion (goniometer) and return to normal daily, work and sporting activities. All four subjects at the end of the treatment protocol were symptom free with all outcome measures being normal. At 1 month follow up all patients continued to be symptom free with full range of motion and complete return to normal daily activities. Conclusion This case series demonstrates the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with a suspected clinical diagnosis of shoulder impingement syndrome. PMID:16168053

  2. Subcutaneous Fungal Cyst Masquerading as Benign Lesions – A Series of Eight Cases

    PubMed Central

    Varghese, Renu G’Boy; Phansalkar, Manjiri; Ramdas, Anita; K, Authy; G, Thangiah

    2015-01-01

    Background Subcutaneous fungal infections are caused by penetration of the causative fungi into the subcutaneous layer and are usually localised. We present a series of eight cases with subcutaneous fungal cystic lesions masquerading as benign lesions. Materials and Methods A retrospective study was conducted on subcutaneous fungal infections seen between January 2007 to July 2014 in the Department of Pathology. Eight patients with biopsy proven subcutaneous fungal infection were included. We collected and analysed their demographic, clinical and histopathological details. Results Among eight patients, six were male and two were female. The mean age was 47 years (Range: 21-70). All the eight patients presented with non-tender cystic swelling. The size of the swellings varied from a minimum of 3x3 cm to maximum of 10x4 cm. Out of eight, hand was involved in three, forearm in one, elbow in two, leg in one and foot in one. On H&E staining, all the cases showed fibro collagenous cyst wall, lined by histiocytes, granulomatous reaction, foreign body type of giant cells with acute and chronic inflammatory infiltrate containing fungal elements. Six were identified as hyalohyphomycosis and two were identified as phaeohyphomycotic cysts based on pigmentation of hyphae. Conclusion Fungal infection should be suspected in all subcutaneous cystic lesions. Excised tissue should always be sent for culture and histopathology. PMID:26557537

  3. Case series of 226 γ-hydroxybutyrate-associated deaths: lethal toxicity and trauma.

    PubMed

    Zvosec, Deborah L; Smith, Stephen W; Porrata, Trinka; Strobl, A Quinn; Dyer, Jo Ellen

    2011-03-01

    γ-Hydroxybutyrate (GHB) and its prodrugs are drugs of abuse that were also sold as "dietary supplements." Users present to emergency departments with overdose, impaired driving, withdrawal, and associated trauma. We compiled a series of GHB-associated deaths to elucidate lethal risks, GHB concentrations, cointoxicants, products, uses, and medical interventions. Death records were reviewed for toxicology, autopsy findings, and history. Inclusion cutoffs were as follows: 5/10 mg/L of GHB (antemortem blood/urine) and 50/20/7 mg/L of GHB (postmortem blood/urine/vitreous). Of 226 deaths included, 213 had cardiorespiratory arrest and 13 had fatal accidents. Seventy-eight deaths (35%) had no cointoxicants. Sixteen deaths involved "supplements" and 1 involved pharmaceutical GHB (Xyrem, Jazz Pharmaceuticals, Palo Alto, CA). Postmortem blood GHB was 18 to 4400 mg/L (median, 347 mg/L) in deaths negative for cointoxicants. Cardiorespiratory arrest occurred prehospital in 100% of 184 cases with available history. Of 72 cases with antemortem adverse effects reported, medical assistance was delayed or absent in 66; of these, acute GHB ingestion was known in 51, including 40 left to "sleep off" adverse effects. Thirty others were left "sleeping" and found dead. γ-Hydroxybutyrate is lethal even without cointoxicants, directly and through fatal accidents. Medical interventions were frequently delayed or absent despite known GHB ingestion, and witnessed adverse events and cardiorespiratory arrest occurred prehospital. Education is needed about the lethality of GHB and the necessity for prompt medical intervention.

  4. Anomalous left main coronary artery: case series of different courses and literature review.

    PubMed

    Marler, Adam T; Malik, Jamil A; Slim, Ahmad M

    2013-01-01

    Background. Congenital anomalies of the coronary arteries are a cause of sudden cardiac death. Of the known anatomic variants, anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) remains the main focus of debate. Case Series. We present three cases, all presenting to our facility within one week's time, of patients with newly discovered anomalous origination of the left coronary artery from the right sinus of Valsalva (L-ACAOS). All patients underwent cardiac computed tomography for evaluation of coronary anatomy along with other forms of functional testing. Despite the high risk nature of two of the anomalies, the patients are being treated medically without recurrence of symptoms. Summary. After review of the literature, we have found that the risk of sudden cardiac death in patients with congenital coronary anomalies, even among variants considered the highest risk, may be overestimated. In addition, the exact prevalence of coronary anomalies in the general population is currently underestimated. A national coronary artery anomaly registry based on cardiac computed tomography and invasive coronary angiography data would be helpful in advancing our understanding of these cardiac peculiarities. The true prevalence of congenital coronary anomalies and overall risk of sudden cardiac death in this population are not well known. Surgical intervention remains the mainstay of therapy in certain patients though recent investigations into the pathophysiology of these abnormalities have shown that the risk of surgery may outweigh the minimal reduction in risk of sudden cardiac death.

  5. Adolescent Premature Ovarian Insufficiency Following Human Papillomavirus Vaccination: A Case Series Seen in General Practice.

    PubMed

    Little, Deirdre Therese; Ward, Harvey Rodrick Grenville

    2014-01-01

    Three young women who developed premature ovarian insufficiency following quadrivalent human papillomavirus (HPV) vaccination presented to a general practitioner in rural New South Wales, Australia. The unrelated girls were aged 16, 16, and 18 years at diagnosis. Each had received HPV vaccinations prior to the onset of ovarian decline. Vaccinations had been administered in different regions of the state of New South Wales and the 3 girls lived in different towns in that state. Each had been prescribed the oral contraceptive pill to treat menstrual cycle abnormalities prior to investigation and diagnosis. Vaccine research does not present an ovary histology report of tested rats but does present a testicular histology report. Enduring ovarian capacity and duration of function following vaccination is unresearched in preclinical studies, clinical and postlicensure studies. Postmarketing surveillance does not accurately represent diagnoses in adverse event notifications and can neither represent unnotified cases nor compare incident statistics with vaccine course administration rates. The potential significance of a case series of adolescents with idiopathic premature ovarian insufficiency following HPV vaccination presenting to a general practice warrants further research. Preservation of reproductive health is a primary concern in the recipient target group. Since this group includes all prepubertal and pubertal young women, demonstration of ongoing, uncompromised safety for the ovary is urgently required. This matter needs to be resolved for the purposes of population health and public vaccine confidence.

  6. Severe somatoform and dysautonomic syndromes after HPV vaccination: case series and review of literature.

    PubMed

    Palmieri, Beniamino; Poddighe, Dimitri; Vadalà, Maria; Laurino, Carmen; Carnovale, Carla; Clementi, Emilio

    2016-08-09

    Human papilloma virus (HPV) is recognized as a major cause for cervical cancer among women worldwide. Two HPV vaccines are currently available: Gardasil(®) and Cervarix(®). Both vaccines enclose viral antigenic proteins, but differ as to the biological systems of culture and the adjuvant components. Recently, a collection of symptoms, indicating nervous system dysfunction, has been described after HPV vaccination. We retrospectively described a case series including 18 girls (aged 12-24 years) referred to our "Second Opinion Medical Network" for the evaluation of "neuropathy with autonomic dysfunction" after HPV vaccination. All girls complained of long-lasting and invalidating somatoform symptoms (including asthenia, headache, cognitive dysfunctions, myalgia, sinus tachycardia and skin rashes) that have developed 1-5 days (n = 11), 5-15 days (n = 5) and 15-20 days (n = 2) after the vaccination. These cases can be included in the recently described immune dysfunction named autoimmune/inflammatory syndrome induced by adjuvants (ASIA). HPV vaccine, through its adjuvant component, is speculated to induce an abnormal activation of the immune system, involving glia cells in the nervous system too. Further researches should aim at defining the pathological and clinical aspects of these post-vaccination diseases and identifying a genetic background predisposing to these adverse reactions.

  7. Educational case series: β-lactam allergy and cross-reactivity.

    PubMed

    Atanasković-Marković, Marina

    2011-12-01

    Penicillins and cephalosporins are the most widely used antibiotics for the treatment of common infections, and they are the two main classes of β-lactams. On the basis of the time of appearance of the reaction after drug intake and for diagnostic purposes, hypersensitivity reactions to β-lactams have been classified as immediate or non-immediate. The diagnostic evaluation of allergic reactions to β-lactams has changed over the last decade, for several reasons. In many countries, major and minor determinants for skin testing are not available. In immediate allergic reactions, the sensitivity of skin testing is decreasing. For non-immediate reactions, skin testing appears to be less sensitive than previously reported. The drug provocation test is still necessary for diagnosis. In this education review series, we described three cases of β-lactam allergy: first, a child with an IgE-mediated allergy to benzyl-penicillin; second, a child with a non-allergic hypersensitivity to amoxicillin; and in the third patient, we will discuss about cross-reactivity between penicillins and cephalosporins. These cases are correlated with the practical management of evaluating β-lactam allergy.

  8. Hemophagocytic Lymphohistiocytosis: Single-Center Series of 12 Cases from Saudi Arabia

    PubMed Central

    Elyamany, Ghaleb; Alzahrani, Azzah; Elfaraidi, Huda; Alsuhaibani, Omar; Othman, Nada; Al Mussaed, Eman; Alabbas, Fahad

    2016-01-01

    BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal disease that commonly appears in infancy, although it has been reported in adults. Chemoimmunotherapy-based treatments have improved the survival of patients with HLH; however, overall survival is still poor. We retrospectively analyzed the data of 12 HLH patients who were admitted between 2005 and 2014. All patients were Saudi Arabia in origin with a female predominance (75%) and a median age of onset of 9.5 months. The consanguinity rates were significantly high (75%) with a positive family history in 41% of cases. Of the 12 patients, nine were defined as primary HLH patients and three were confirmed to be secondary HLH patients. All patients fulfilled the 2004 diagnostic criteria for HLH and received HLH-2004 treatment. Six of these patients showed a good response to chemotherapy, while the remainder of the patients showed partial or no response to chemotherapy. Five patients in this cohort received stem cell transplant, and these patients are currently in remission. The mortality rate of this cohort is currently 50%. Genetic mutational analysis showed a positive STX11 mutation in five patients and a PRF1 (perforin) mutation in two patients. To the best of our knowledge, this is the first case series of HLH from Saudi Arabia. PMID:27081327

  9. Xanthogranuloma of the sellar region of children: series of five cases and literature review.

    PubMed

    Kamoshima, Yuuta; Sawamura, Yutaka; Motegi, Hiroaki; Kubota, Kanako; Houkin, Kiyohiro

    2011-01-01

    Five Japanese children presented with rare xanthogranuloma located in the sellar region between 2000 and 2010 at the Department of Neurosurgery, Hokkaido University Hospital. Endocrinological examination disclosed central diabetes in four patients. Preoperative magnetic resonance (MR) imaging and computed tomography (CT) demonstrated clearly defined intra- or suprasellar masses appearing as isointense or hyperintense on T(1)-weighted MR imaging with no calcification on CT. The tumor was totally removed under preoperative diagnosis of craniopharyngioma in all cases. Histological examination found fibrous tissue with abundant cholesterol clefts and hemosiderin deposits, but no or only tiny amounts of epithelial cells in each case. Therefore, the histological diagnoses were xanthogranuloma of the sellar region, not adamantinomatous craniopharyngioma. Postoperatively, no patient recovered from endocrinological deficits, whereas visual disturbances were improved immediately after operation. Currently, whether xanthogranuloma is distinct from adamantinomatous craniopharyngioma remains unclear. Only a few clinical reports of xanthogranuloma of the sellar region have been reported in pediatric patients. Our series shows that xanthogranuloma should be included in the differential diagnosis of pediatric tumor of the sellar region.

  10. Cardiac myxoma in Iceland: a case series with an estimation of population incidence.

    PubMed

    Sigurjonsson, Hannes; Andersen, Karl; Gardarsdottir, Marianna; Petursdottir, Vigdis; Klemenzson, Gudmundur; Gunnarsson, Gunnar; Danielsen, Ragnar; Gudbjartsson, Tomas

    2011-09-01

    Cardiac myxoma (CM) is the most common primary benign tumor of the heart, but the true age-standardized incidence rate (ASR) has remained unknown. We therefore used nationwide registries in Iceland to study CM and establish its incidence rate. This was a retrospective study involving all patients diagnosed with CM in Iceland between 1986 and 2010. Cases were identified through three different registries, and hospital charts and histology results reviewed. An ASR was estimated based on a world standard population (w). Nine cases of CM (six women) were identified with a mean age of 62.8 years (range: 37-85), giving an ASR of 0.11 (95% CI: 0.05-0.22) per 100,000. The mean tumor size was 4.4 cm (range: 1.5-8.0) with all the tumors located in the left atrium. Dyspnea (n = 6) and ischemic stroke (n = 2) were the most common symptoms. All patients underwent complete resection of the tumor and there were no postoperative deaths or CM-related deaths at follow-up (mean 85 months). The ASR of CM in Iceland was 0.11 per 100,000. To our knowledge, this is the first study to determine the incidence of CM in an entire population. In Iceland, the presenting symptoms and mode of detection of CM are similar to those in other series.

  11. Labour exploitation and health: a case series of men and women seeking post-trafficking services.

    PubMed

    Turner-Moss, Eleanor; Zimmerman, Cathy; Howard, Louise M; Oram, Siân

    2014-06-01

    Research on the health of trafficked men and on the health problems associated with trafficking for labor exploitation are extremely limited. This study analysed data from a case series of anonymised case records of a consecutive sample of 35 men and women who had been trafficked for labor exploitation in the UK and who were receiving support from a non-governmental service between June 2009 and July 2010. Over three-quarters of our sample was male (77 %) and two-thirds aged between 18 and 35 years (mean 32.9 years, SD 10.2). Forty percent reported experiencing physical violence while they were trafficked. Eighty-one percent (25/31) reported one or more physical health symptoms. Fifty-seven percent (17/30) reported one or more post-traumatic stress symptoms. A substantial proportion of men and women who are trafficked for labor exploitation may experience violence and abuse, and have physical and mental health symptoms. People who have been trafficked for forced labor need access to medical assessment and treatment.

  12. Steroid-responsive Encephalopathy Subsequently Associated with Alzheimer Disease Pathology: A Case Series

    PubMed Central

    Mateen, Farrah J.; Josephs, Keith A.; Parisi, Joseph E.; Drubach, Daniel A.; Caselli, Richard J.; Kantarci, Kejal; Lennon, Vanda; Jack, Clifford; Boeve, Bradley F.

    2011-01-01

    Background Steroid-responsive encephalopathies can considered vasculitic or nonvasculitic. Clinicopathological studies of nonvasculitic steroid-responsive encephalopathy are unusual, but can explain the range of diagnoses consistent with a steroid responsive presentation in life. Objective To extend the range of clinical features and pathological findings consistent with steroid-responsive encephalopathy. Design, Methods, and Patients A clinicopathological case series of four patients (ages 54–71 years, 2 women) with steroid-responsive encephalopathy followed at this institution until the time of death. Results Clinical features were suggestive of Creutzfeld-Jakob disease, dementia with Lewy Bodies, and parkinsonism, but pathological examination revealed only Alzheimer’s Disease-related findings without evidence of Lewy bodies or prion disease in all cases. All patients demonstrated marked, sustained improvement following steroid treatment, based on clinical, magnetic resonance imaging, and/or electroencephalogram studiesAlzheimer’s Disease was not diagnosed in life due to a lack of hippocampal atrophy on brain imaging and a dramatic symptomatic response to steroids. Conclusions Steroid-responsive encephalopathy is the clinical presentation of some patients with Alzheimer’s Disease related pathology at autopsy, and can be consistent with the clinical diagnoses of parkisonism, dementia with Lewy Bodies, or Creutzfeld-Jakob Disease in life. PMID:21714739

  13. Animal Bite Injuries in Children: Review of Literature and Case Series

    PubMed Central

    Kumar, Pradeep; Singhal, Ruchi; Singh, Virendra; Bhagol, Amrish

    2017-01-01

    Introduction Maxillofacial region in children is particularly vulnerable to animal bite injuries. These injuries may range from insignificant scratches to life-threatening neck and facial injuries. Children are the common victims, particularly of dog bites. Materials and methods Three cases of animal bite injuries in children with their clinical presentation and their management are being presented along with review of literature. Surgical management included cleansing and primary closure of the wound. Rabies and tetanus prophylaxis were given. Discussion The most common site of injury was the face. For the facial injuries, the most frequently affected area was the middle third (55%), also called as the “central target area.” The small stature of children, the disproportionate size of the head relative to the body, their willingness to bring their faces close to the animal, and limited motor skills to provide defense are believed to account for this. The resulting soft-tissue injuries can vary in relation to their extent. Treatment involved initial surgical exploration, and secondary repair later depending on the severity of the injury. Conclusion Prompt assessment and treatment can prevent most bite wound complications. Early management of such injuries usually guarantees satisfactory outcome. Prevention strategies include close supervision of child-dog interactions, better reporting of bites, etc. How to cite this article Agrawal A, Kumar P, Singhal R, Singh V, Bhagol A. Animal Bite Injuries in Children: Review of Literature and Case Series. Int J Clin Pediatr Dent 2017;10(1):67-72. PMID:28377659

  14. Tetramethylenedisulfotetramine intoxication presenting with de novo Status Epilepticus: a case series.

    PubMed

    Li, Jin-Mei; Gan, Jing; Zeng, Tian-Fang; Sander, Josemir W; Zhou, Dong

    2012-03-01

    Tetramethylenedisulfotetramine (TETS), a neurotoxic rodenticide banned in China, has repeatedly been shown to kill healthy people. We report a series of nine people with TETS intoxication presenting with Convulsive Status Epilepticus (CSE) as the initial manifestation. Median duration of CSE after admission was 6h. All had normal neuro-imaging but inter-ictal EEG showed bilateral epileptic waves. Despite aggressive anti-convulsive treatment, attempts at reducing TETS levels and supportive therapy, outcomes were poor. Multiple organ dysfunction syndrome (MODS) occurred in six people, of whom three died. TETS exposure should be part of the differential diagnosis in people presenting with unexplained SE in rural China, particularly if this occurs in family clusters. Over 14,000 cases of TETS intoxication occurred in China between 1 January 1991 and 31 December 2010, and 932 of these died. Cases were widely distributed throughout the country, occurring primarily in rural areas. CSE seems to be a frequent symptom of severe intoxication. There is, however, still a lack of information about the hazards of TETS and it is imperative that both the public and physicians are made aware of its risks and complications.

  15. Concha bullosa mucocele: A case series and review of the literature

    PubMed Central

    Khalife, Sarah; Marchica, Cinzia; Zawawi, Faisal; Daniel, Sam J.; Manoukian, John J.

    2016-01-01

    Background: Concha bullosa mucocele is a rare diagnosis that presents as a nasal mass. It impinges on surrounding structures and can easily be mistaken for a neoplasm. Objective: The objective of this study was to shed light on this rare entity and report its diagnostic features and treatment outcomes. Methods: A case series conducted in a tertiary health care center. Demographic data, clinical presentation, imaging, cultures, and treatments were recorded. Operative video illustration and key images were obtained. A review of the literature was also performed. Results: A total of five cases were reviewed, four of which were concha bullosa mucoceles and one was a mucopyocele. Three of the patients had some form of previous nasal trauma. Headache and nasal obstruction were the most common symptoms with a nasal mass finding on physical examination. Computed tomography was used in all the patients, and magnetic resonance imaging was used in four of the five patients. Four patients had coexistent chronic rhinosinusitis, and three had positive bacterial cultures. All these patients were treated endoscopically either with middle turbinate marsupialization or subtotal resection. No recurrence has been noted thus far. Conclusion: Concha bullosa mucocele is a rare diagnosis. Imaging characteristics are helpful in considering the diagnosis, although surgical intervention is often necessary to confirm the diagnosis and treat concha bullosa mucocele.

  16. Potential utility of precision medicine for older adults with polypharmacy: a case series study

    PubMed Central

    Finkelstein, Joseph; Friedman, Carol; Hripcsak, George; Cabrera, Manuel

    2016-01-01

    Pharmacogenomic (PGx) testing has been increasingly used to optimize drug regimens; however, its potential in older adults with polypharmacy has not been systematically studied. In this hypothesis-generating study, we employed a case series design to explore potential utility of PGx testing in older adults with polypharmacy and to highlight barriers in implementing this methodology in routine clinical practice. Three patients with concurrent chronic heart and lung disease aged 74, 78, and 83 years and whose medication regimen comprised 26, 17, and 18 drugs, correspondingly, served as cases for this study. PGx testing identified major genetic polymorphisms in the first two cases. The first case was identified as “CYP3A4/CYP3A5 poor metabolizer”, which affected metabolism of eleven prescribed drugs. The second case had “CYP2D6 rapid metabolizer” status affecting three prescribed medications, two of which were key drugs for managing this patient’s chronic conditions. Both these patients also had VKORC1 allele *A, resulting in higher sensitivity to warfarin. All cases demonstrated a significant number of potential drug–drug interactions. Both patients with significant drug–gene interactions had a history of frequent hospitalizations (six and 23, respectively), whereas the person without impaired cytochrome P450 enzyme activity had only two acute episodes in the last 5 years, although he was older and had multiple comorbidities. Since all patients received guideline-concordant therapy from the same providers and were adherent to their drug regimen, we hypothesized that genetic polymorphism may represent an additional risk factor for higher hospitalization rates in older adults with polypharmacy. However, evidence to support or reject this hypothesis is yet to be established. Studies evaluating clinical impact of PGx testing in older adults with polypharmacy are warranted. For practical implementation of pharmacogenomics in routine clinical care, besides

  17. [Pregnancy in patients with a history of ischaemic heart disease - Case series and literature review].

    PubMed

    Matura-Bedouhene, M; Maatouk, A; Moulin, F; Welter, E; Morel, O; Perdriolle-Galet, E

    2016-04-01

    Heart diseases complicate 1 to 3% of pregnancies and are the leading cause of indirect maternal deaths. Prior ischaemic heart event in pregnant patients is increasing. Most knowledge is based on few reports and there are no French nor international recommendations about the specific management of these patients. The specificity of the management of these patients during pregnancy, delivery and post-partum depends on the severity of the prior cardiac event and its consequences. This will be illustrated by the report of four recent cases managed in our hospital. First patient had myocardial infarction with normal left ventricular ejection fraction (LVEF). Second patient had a Tako-Tsubo syndrome with LVEF 45%. Third patient had ischemic cardiopathy with LVEF 30%. Fourth patient had myocardial infarction with LVEF 20%. A multidisciplinary follow-up should be required, especially in patients with severe ventricular dysfunction. The risk of fetal growth restriction appears to be increased, suggesting that closer ultrasound monitoring is necessary.

  18. Use of negative pressure therapy on closed surgical incisions: a case series.

    PubMed

    Stannard, James P; Atkins, Broadus Zane; O'Malley, David; Singh, Hardayal; Bernstein, Brent; Fahey, Michael; Masden, Derek; Attinger, Christopher E

    2009-08-01

    Multiple patient comorbidities and environmental factors increase the risk of incisional wound complications. The literature suggests that negative pressure therapy (NPT) on clean closed surgical incisions may help reduce the risk of wound infections and other complications. In this case study, NPT was applied in the operating room to clean closed surgical wounds in four high-risk patients (two men, two women) following coronary artery bypass grafting using bilateral internal mammary arteries, transmetatarsal amputation, and abdominal hysterectomy. All wounds healed well. These results and currently available information suggest that prospective, randomized, controlled clinical studies to assess the safety, efficacy, and cost-effectiveness of NPT in the prevention of postoperative wound complications are warranted. In addition, if studies confirm the validity and reliability of the proposed patient grading system discussed, it may help guide use of NPT in postsurgical patients.

  19. Pituitary hyperplasia: case series and literature review of an under-recognised and heterogeneous condition

    PubMed Central

    Earls, Peter; McCormack, Ann I

    2015-01-01

    Summary Pituitary hyperplasia (PH) occurs in heterogeneous settings and remains under-recognised. Increased awareness of this condition and its natural history should circumvent unnecessary trans-sphenoidal surgery. We performed an observational case series of patients referred to a single endocrinologist over a 3-year period. Four young women were identified with PH manifesting as diffuse, symmetrical pituitary enlargement near or touching the optic apparatus on MRI. The first woman presented with primary hypothyroidism and likely had thyrotroph hyperplasia given prompt resolution with thyroxine. The second and third women were diagnosed with pathological gonadotroph hyperplasia due to primary gonadal insufficiency, with histopathological confirmation including gonadal-deficiency cells in the third case where surgery could have been avoided. The fourth woman likely had idiopathic PH, though she had concomitant polycystic ovary syndrome which is a debated cause of PH. Patients suspected of PH should undergo comprehensive hormonal, radiological and sometimes ophthalmological evaluation. This is best conducted by a specialised multidisciplinary team with preference for treatment of underlying conditions and close monitoring over surgical intervention. Learning points Normal pituitary dimensions are influenced by age and gender with the greatest pituitary heights seen in young adults and perimenopausal women.Pituitary enlargement may be seen in the settings of pregnancy, end-organ insufficiency with loss of negative feedback, and excess trophic hormone from the hypothalamus or neuroendocrine tumours.PH may be caused or exacerbated by medications including oestrogen, GNRH analogues and antipsychotics.Management involves identification of cases of idiopathic PH suitable for simple surveillance and reversal of pathological or iatrogenic causes where they exist.Surgery should be avoided in PH as it rarely progresses. PMID:26124954

  20. Huntington disease and Huntington disease-like in a case series from Brazil.

    PubMed

    Castilhos, R M; Souza, A F D; Furtado, G V; Gheno, T C; Silva, A L; Vargas, F R; Lima, M-A F D; Barsottini, O; Pedroso, J L; Godeiro, C; Salarini, D; Pereira, E T; Lin, K; Toralles, M-B; Saute, J A M; Rieder, C R; Quintas, M; Sequeiros, J; Alonso, I; Saraiva-Pereira, M L; Jardim, L B

    2014-10-01

    The aim of this study was to identify the relative frequency of Huntington's disease (HD) and HD-like (HDL) disorders HDL1, HDL2, spinocerebellar ataxia type 2 (SCA2), SCA17, dentatorubral-pallidoluysian degeneration (DRPLA), benign hereditary chorea, neuroferritinopathy and chorea-acanthocytosis (CHAC), in a series of Brazilian families. Patients were recruited in seven centers if they or their relatives presented at least chorea, besides other findings. Molecular studies of HTT, ATXN2, TBP, ATN1, JPH3, FTL, NKX2-1/TITF1 and VPS13A genes were performed. A total of 104 families were ascertained from 2001 to 2012: 71 families from South, 25 from Southeast and 8 from Northeast Brazil. There were 93 HD, 4 HDL2 and 1 SCA2 families. Eleven of 104 index cases did not have a family history: 10 with HD. Clinical characteristics were similar between HD and non-HD cases. In HD, the median expanded (CAG)n (range) was 44 (40-81) units; R(2) between expanded HTT and age-at-onset (AO) was 0.55 (p=0.0001, Pearson). HDL2 was found in Rio de Janeiro (2 of 9 families) and Rio Grande do Sul states (2 of 68 families). We detected HD in 89.4%, HDL2 in 3.8% and SCA2 in 1% of 104 Brazilian families. There were no cases of HDL1, SCA17, DRPLA, neuroferritinopathy, benign hereditary chorea or CHAC. Only six families (5.8%) remained without diagnosis.

  1. Metaplastic changes in the epithelium of radicular cysts: A series of 711 cases

    PubMed Central

    Rosen, Eyal; Dubinsky, Liz; Buchner, Amos; Vered, Marilena

    2016-01-01

    Background This study was aimed to evaluate the prevalence of metaplastic changes in the epithelium of radicular cysts and to investigate how they relate to the clinical and radiographic characteristics of the cysts, based on a large series of radicular cysts. Material and Methods Biopsies of cysts of endodontic origin that were examined at the Department of Oral Pathology between 2004 and 2011 have been re-evaluated for this study. Only cases that were re-confirmed with clinical and histological diagnoses of a radicular or residual radicular cyst were included. The included cases were evaluated for the prevalence of metaplastic changes in the form of mucous secreting cells (MSC) or ciliated cells (CC). The relations between the metaplastic changes and the cyst type (radicular or residual radicular), as well as demographic, clinical and radiographic parameters, were statistically evaluated using Fischer and chi-square tests. Significance was set at p<0.05. Results A total of 711 cysts were included: 677 were radicular cysts (95%) and 34 (5%) were residual radicular cysts. 23 cases had histopathological diagnoses other than radicular or residual radicular cysts and were excluded from the study. MSC were present in 47 (6.6%) cysts. MSC were significantly more common in residual radicular cysts than in radicular cysts [8 (23.5%) and 39 (5.8%), respectively; p<0.001]. MSC-containing cysts were commonly found in asymptomatic patients (10.5%, p<0.001), and usually presented with well-defined radiographic borders (7.2%, p<0.05). CC were present in 34 (4.8%) cysts, with a markedly high prevalence in the maxillary molar sextant (15%, p<0.001). Conclusions In the epithelium of radicular and residual radicular cysts the presence of specific metaplastic changes may be related to cyst type, symptomatology, radiographic findings and tooth location. Key words:Radicular cyst, metaplasia, mucous secreting cells, ciliated cells. PMID:27957265

  2. Vitrectomy with complete posterior hyaloid removal for ischemic central retinal vein occlusion: Series of cases

    PubMed Central

    Leizaola-Fernández, Carlos; Suárez-Tatá, Luis; Quiroz-Mercado, Hugo; Colina-Luquez, Juner; Fromow-Guerra, J; Jiménez-Sierra, Juan M; Guerrero-Naranjo, Jose L; Morales-Cantón, Virgilio

    2005-01-01

    Background Central retinal vein occlusion (CRVO) is a common retinal vascular disorder with potentially complications: (1) persistent macular edema and (2) neovascular glaucoma. No safe treatment exists that promotes the return of lost vision. Eyes with CRVO may be predisposed to vitreous degeneration. It has been suggested that if the vitreous remains attached to the macula owing to a firm vitreomacular adhesion, the resultant vitreous traction can cause inflammation with retinal capillary dilation, leakage and subsequent edema6. The roll of vitrectomy in ischemic CRVO surgical procedures has not been evaluated. Case presentation This is a non comparative, prospective, longitudinal, experimental and descriptive series of cases. Ten eyes with ischemic CRVO. Vitrectomy with complete posterior hyaloid removal was performed. VA, rubeosis, intraocular pressure (IOP), and macular edema were evaluated clinically. Multifocal ERG (m-ERG), fluorescein angiography (FAG) and optic coherence tomography (OCT) were performed. Follow-up was at least 6 months. Moderate improvement of visual acuity was observed in 60% eyes and stabilized in 40%. IOP changed from 15.7 ± 3.05 mmHg to 14.9 ± 2.69 mmHg post-operative and macular edema from 976 ± 196 μm to 640 ± 191 μm to six month. The P1 wave amplitude changed from 25.46 ± 12.4 mV to 20.54 ± 11.2 mV. Conclusion A solo PPV with posterior hyaloid removal may help to improve anatomic and functional retina conditions in some cases. These results should be considered when analyzing other surgical maneuvers. PMID:15943889

  3. Neglected dislocation in sub-axial cervical spine: Case series and a suggested treatment protocol

    PubMed Central

    Srivastava, Sudhir Kumar; Aggarwal, Rishi Anil; Bhosale, Sunil Krishna; Nemade, Pradip Sharad

    2016-01-01

    Context: Approaches suggested for treatment of neglected dislocations in the subaxial cervical spine (SACS) include only anterior approach (a), only posterior approach (b), posterior-anterior approach, posterior-anterior-posterior approach, and anterior-posterior-anterior-posterior approach. No protocol is suggested in literature to guide surgeons treating neglected dislocations. Aim: To describe a protocol for the treatment of neglected dislocation in the SACS. Settings and Designs: Retrospective case series and review of literature. Materials and Methods: Six consecutive patients of neglected dislocation (presenting to us more than 3 weeks following trauma) of the SACS were operated as per the protocol suggested in this paper. A retrospective review of the occupational therapy reports, patient records, and radiographs was performed. Only cases with time lapse of more than 3 weeks between the time of injury and initial management have been included in the review. Results: Closed reduction (CR) was achieved in three patients following cervical traction and these were managed by anterior cervical discectomy and fusion (ACDF). Open reduction via posterior approach and soft tissue release was required to achieve reduction in two patients. Following reduction posterior instrumented fusion was done in them. One patient with preoperative neurological deficit needed a facetectomy to achieve reduction. Following short-segment fixation, ACDF was also performed in this patient. None of the patients deteriorated neurologically following surgery. Fusion was achieved in all patients. Conclusions: Preoperative and intraoperative traction have a role in the management of neglected dislocations in the cervical spine. If CR is achieved the patient may be managed by ACDF. If CR is not achieved, posterior soft tissue release may be done to achieve reduction and partial facetectomy must be reserved for cases in which reduction is not achieved after soft tissue release. A treatment

  4. Delayed posthypoxic leukoencephalopathy: a case series and review of the literature

    PubMed Central

    Zamora, Carlos A; Nauen, David; Hynecek, Robert; Ilica, Ahmet T; Izbudak, Izlem; Sair, Haris I; Gujar, Sachin K; Pillai, Jay J

    2015-01-01

    Background Delayed posthypoxic leukoencephalopathy (DPHL) is a rare and underrecognized entity where patients manifest a neurological relapse after initial recovery from an acute hypoxic episode. We sought to describe the magnetic resonance imaging (MRI) findings in a group of patients with DPHL and review the available literature. Methods Retrospective case series including patients who presented with neurological and/or psychiatric symptoms after recovery from an acute hypoxic episode. The history and clinical presentation were reviewed from the electronic medical records. MRI scans were evaluated from the picture archiving and communication system. We performed a comprehensive review of the English medical literature for prior published cases of DPHL and describe the key imaging findings that have been reported related to this condition. Results A total of five patients were identified, including four patients with respiratory failure due to drug overdoses from benzodiazepines, opioids, and/or barbiturates, and one patient who presented after cardiopulmonary arrest due to pulmonary embolism. All patients showed diffuse, extensive, and confluent white matter signal abnormalities including prominent restricted diffusion, extending to the subcortical white matter and respecting the U-fibers. There was no gyral edema or contrast enhancement. In one case histopathology was available, which highlighted patchy subcortical myelin loss with sparing of U-fibers and demonstrated prominent macrophage/microglial inflammation with extensive axonal damage. Of the other four patients, two were at their neurological baselines and two had persistent neurological deficits at the time of discharge. Conclusions The described constellation of MRI findings is highly suggestive of DPHL in the appropriate clinical setting. PMID:26357591

  5. Convergence in spectral forward modelling: Binominal series solutions vs. direct integral solutions at high degrees - spherical and ellipsoidal case

    NASA Astrophysics Data System (ADS)

    Rexer, Moritz; Claessens, Sten; Hirt, Christian

    2016-04-01

    The number of relevant terms of binominal series expansions used in spectral forward modelling of the gravitational potential is known to rise substantially as the resolution of the models increases. Here, we investigate and compare the binominal series expansions in forward modelling w.r.t. a sphere and w.r.t. an ellipsoid (Claessens and Hirt, 2013) in view of high degree forward modelling (d/o 10800). The series in each case depend on different parameters - such as elevation of the topographic function or ellipsoidal radius/co-latitude - and reveal different maximum orders of truncation for a 1% convergence level (=relative error). The results are verified in a real data scenario up to d/o 5400 by spot-checks using direct integral solutions that do not depend on binomial series expansions. As a conclusion, our study demonstrates that for d/o 10800 modelling up to 30 terms of the binominal series accounting for the radial integral are needed within the spherical and the ellipsoidal case, while up to 60 terms are needed for the binominal series accounting for the oblateness of Earth in the ellipsoidal case for a convergence at the 1% level. References: Claessens, S.J.; Hirt, C.: Ellipsoidal topographic potential - new solutions for spectral forward gravity modelling of topography with respect to a reference ellipsoid; Journal of Geophysical Research (JGR) - Solid Earth, Vol. 118, DOI: 10.1002/2013JB010457, 2013.

  6. Pitfalls in Fractal Time Series Analysis: fMRI BOLD as an Exemplary Case

    PubMed Central

    Eke, Andras; Herman, Peter; Sanganahalli, Basavaraju G.; Hyder, Fahmeed; Mukli, Peter; Nagy, Zoltan

    2012-01-01

    This article will be positioned on our previous work demonstrating the importance of adhering to a carefully selected set of criteria when choosing the suitable method from those available ensuring its adequate performance when applied to real temporal signals, such as fMRI BOLD, to evaluate one important facet of their behavior, fractality. Earlier, we have reviewed on a range of monofractal tools and evaluated their performance. Given the advance in the fractal field, in this article we will discuss the most widely used implementations of multifractal analyses, too. Our recommended flowchart for the fractal characterization of spontaneous, low frequency fluctuations in fMRI BOLD will be used as the framework for this article to make certain that it will provide a hands-on experience for the reader in handling the perplexed issues of fractal analysis. The reason why this particular signal modality and its fractal analysis has been chosen was due to its high impact on today’s neuroscience given it had powerfully emerged as a new way of interpreting the complex functioning of the brain (see “intrinsic activity”). The reader will first be presented with the basic concepts of mono and multifractal time series analyses, followed by some of the most relevant implementations, characterization by numerical approaches. The notion of the dichotomy of fractional Gaussian noise and fractional Brownian motion signal classes and their impact on fractal time series analyses will be thoroughly discussed as the central theme of our application strategy. Sources of pitfalls and way how to avoid them will be identified followed by a demonstration on fractal studies of fMRI BOLD taken from the literature and that of our own in an attempt to consolidate the best practice in fractal analysis of empirical fMRI BOLD signals mapped throughout the brain as an exemplary case of potentially wide interest. PMID:23227008

  7. The Volterra series as special case of artificial neural network model

    NASA Astrophysics Data System (ADS)

    Napiorkowski, J.; O Kane, J. P.

    2003-04-01

    The geophysical processes contributing to the hydrological cycle are described by theoretically sound non-linear partial differential equations of mass and energy transfer. The hydrodynamic equations describing hydrological processes were developed in non-linear form in the nineteenth century. In the case of surface runoff from a natural catchment or flow in an open channel, an accurate application of the hydraulic approach requires a detailed topographical survey and determination of roughness parameters. In order to avoid these difficulties, alternative approaches e.g. via conceptual models and black box models were developed in the second half of the last century. The conceptual model approach is to simulate the nature of the catchment response or the channel response by relatively simple non-linear model built up from simple non-linear elements, e.g. cascade of non-linear reservoirs. Each non-linear reservoir is responsible for part of the attenuation of the system response. This lumped dynamic model can be represented by a set of ordinary differential equations: begin{gathered} dot S_1 (t) = - f[S_1 (t)] + x(t) dot S_2 (t) = - f[S_2 (t)] + f[S_1 (t)] ... dot S_n (t) = - f[S_n (t)] + f[Sn - 1 (t)] y(t) = f[S_n (t)] % MathType!End!2!1! (1) where x is the input signal(rainfall or flow at the upstream end of the channel), Si is the storage in the i-th reservoir, f(.) represents the outflow-storage relation and y is the output signal (surface runoff or flow at the downstream end of the channel). Non-linear black box analysis is concerned with representing a system by a functional Volterra series in the form of a sum of convolution integrals: begin{gathered} y(t) = intlimits_0^t {h_1 (τ )x(t - τ )dτ + intlimits_0^t {intlimits_0^t {h_2 (τ _1 ,τ _2 )x(t - τ _1 )x(t - τ _2 )dτ _1 dτ _2 } } } quad quad + intlimits_0^t {intlimits_0^t {intlimits_0^t {h_3 (τ _1 ,τ _2 ,τ _3 )x(t - τ _1 )x(t - τ _2 )x(t - τ _3 )dτ _1 dτ _2 dτ _3 } + ...} } % MathType!End!2

  8. Ovulation induction with minimal dose of follitropin alfa: a case series study

    PubMed Central

    2011-01-01

    Background Gonadotropins are used in ovulation induction (OI) for patients with anovulatory infertility. Pharmacologic OI is associated with risks of ovarian hyperstimulation syndrome and multiple pregnancy. Treatment protocols that minimize these risks by promoting monofollicular development are required. A starting dose of 37.5 IU/day follitropin alfa has been used in OI, particularly among women at high risk of multifollicular development and multiple pregnancy. A retrospective case series study was performed to evaluate rates of monofollicular development and singleton pregnancy following standard treatment with 37.5 IU/day follitropin alfa. Methods Spanish centers that had performed at least five OI cycles during 2008 using 37.5 IU/day follitropin alfa as a starting dose were invited to participate. Data could be provided from any cycle performed in 2008 (up to a maximum of 12 consecutive cycles per site). Case report forms were collected during April-November 2009 and reviewed centrally. Descriptive statistics were obtained from all cases, and follicular development and clinical pregnancy rates assessed. Potential associations of age and body mass index with follicular development and clinical pregnancy were assessed using univariate correlation analyses. Results Thirty centers provided data on 316 cycles of OI using a starting dose of 37.5 IU/day follitropin alfa. Polycystic ovary syndrome was the cause of anovulatory infertility in 217 (68.7%) cases. Follitropin alfa at 37.5 IU/day was sufficient to achieve ovarian stimulation in 230 (72.8%) cycles. A single follicle ≥16 mm in diameter developed in 193 cycles (61.1%; 95% confidence interval [CI] 55.7-66.4%). Seventy-eight women (24.7%; 95% CI 19.9-29.5%) became pregnant: 94.9% singleton and 5.1% twin pregnancies. Fourteen started cycles (4.4%) were cancelled, mainly due to poor response. Univariate correlation analyses detected weak associations. Conclusions Monofollicular growth rate was comparable with

  9. Killing two birds with one stone: successful opioid monotherapy in intractable migraine-triggered epilepsy, a case series.

    PubMed

    Derakhshan, Iraj

    2017-01-01

    The novel concept explored in this case series is the primacy of headaches in generating seizures in those patients who suffer from migraine-triggered epilepsy. In this series, once the migraine headaches were fully suppressed, via daily scheduled opioid therapy, the seizures also stopped. Seizures returned, however, after the patients stopped the opiate regimen for any reason. The above pharmacological scenario is reminiscent of a similar but naturalistic course of events reported on the salutary effects of ketogenic diet, or changes in life style, in similar cases of migraine-triggered epilepsy. The primacy of migraine in treating what has been named 'seizure headaches' is seen in two other scenarios (i.e. the salutary effect of ketogenic diet and lifestyle changes resulting in restoration of one's sleeping pattern) thus stopping the migraine as well as the seizures associated with the same. This case series recounts the same phenomenon via utilizing around-the-clock maintenance opioid therapy.

  10. Language Testing and International Intelligibility: A Hong Kong Case Study

    ERIC Educational Resources Information Center

    Sewell, Andrew

    2013-01-01

    A central issue in language testing is the choice of norms, and the need to reconcile notions of "standard" English with local language norms and features. Data from studies of international intelligibility indicate that some features of "standard" language descriptions, based on native-speaker language use, are not essential…

  11. Joining Forces: The Case of Alliant International University

    ERIC Educational Resources Information Center

    Leslie, Heather

    2013-01-01

    Mergers and acquisitions are a prevalent force in higher education as more colleges and universities are joining forces to expand resources, enhance missions, or prevent closures. This study examines the merger of Alliant University (formerly California School of Professional Psychology) with United States International University to create what…

  12. Integrating Experiential Learning and Cases in International Business

    ERIC Educational Resources Information Center

    Ramburuth, Prem; Daniel, Shirley

    2011-01-01

    In no other discipline is experiential learning more important than in the complex field of International Business (IB), which aims to prepare students to work and manage across political, economic, national, and sociocultural boundaries. This paper discusses various types of experiential learning activities and approaches to IB teaching, and…

  13. Foreign Languages and International Studies: Case for Survival.

    ERIC Educational Resources Information Center

    Buzash, Michael D.

    An argument is made for continued and strengthened programs in foreign language instruction in business curricula. Among the points made are the following: economic and commercial development in post-World War II America established strong international ties; the Vietnam War emphasized U.S. inadequacies in cultural literacy; some higher education…

  14. Dominant-Language Replacement: The Case of International Adoptees

    ERIC Educational Resources Information Center

    Hyltenstam, Kenneth; Bylund, Emanuel; Abrahamsson, Niclas; Park, Hyeon-Sook

    2009-01-01

    This article challenges a recent proposal for the theoretical interpretation of L1 and L2 interaction that results from the abrupt change of language environment in internationally adopted children. According to this proposal (Pallier, Dehaene, Poline, LeBihan, Argenti, Depoux and Mehler, 2003; Ventureyra, Pallier and Yoo, 2004), such children…

  15. Education for International Understanding: The Case of Ethiopia.

    ERIC Educational Resources Information Center

    International Bureau of Education, Paris (France).

    This study reviews Ethiopia's efforts, experiences, and achievements with respect to developing education for international understanding over the past two decades in response to the United Nations recognition of the role education plays in promoting peace. It is an overture aimed at sharing ideas and experiences with all concerned for the…

  16. CASE/A - COMPUTER AIDED SYSTEM ENGINEERING AND ANALYSIS, ECLSS/ATCS SERIES

    NASA Technical Reports Server (NTRS)

    Bacskay, A.

    1994-01-01

    , specific heat, density, and viscosity) is generated at user-selected output intervals and stored for reference. The Integrated Plot Utility (IPU) provides plotting capability for all data output. System utility commands are provided to enable the user to operate more efficiently in the CASE/A environment. The user is able to customize a simulation through optional operations FORTRAN logic. This user-developed code is compiled and linked with a CASE/A model and enables the user to control and timeline component operating parameters during various phases of the iterative solution process. CASE/A provides for transient tracking of the flow stream constituents and determination of their thermodynamic state throughout an ECLSS/ATCS simulation, performing heat transfer, chemical reaction, mass/energy balance, and system pressure drop analysis based on user-specified operating conditions. The program tracks each constituent through all combination and decomposition states while maintaining a mass and energy balance on the overall system. This allows rapid assessment of ECLSS designs, the impact of alternate technologies, and impacts due to changes in metabolic forcing functions, consumables usage, and system control considerations. CASE/A is written in FORTRAN 77 for the DEC VAX/VMS computer series, and requires 12Mb of disk storage and a minimum paging file quota of 20,000 pages. The program operates on the Tektronix 4014 graphics standard and VT100 text standard. The program requires a Tektronix 4014 or later graphics terminal, third party composite graphics/text terminal, or personal computer loaded with appropriate VT100/TEK 4014 emulator software. The use of composite terminals or personal computers with popular emulation software is recommended for enhanced CASE/A operations and general ease of use. The program is available on an unlabeled 9-track 6250 BPI DEC VAX BACKUP format magnetic tape. CASE/A development began in 1985 under contract to NASA/Marshall Space Flight

  17. CASE/A - COMPUTER AIDED SYSTEM ENGINEERING AND ANALYSIS, ECLSS/ATCS SERIES

    NASA Technical Reports Server (NTRS)

    Bacskay, A.

    1994-01-01

    , specific heat, density, and viscosity) is generated at user-selected output intervals and stored for reference. The Integrated Plot Utility (IPU) provides plotting capability for all data output. System utility commands are provided to enable the user to operate more efficiently in the CASE/A environment. The user is able to customize a simulation through optional operations FORTRAN logic. This user-developed code is compiled and linked with a CASE/A model and enables the user to control and timeline component operating parameters during various phases of the iterative solution process. CASE/A provides for transient tracking of the flow stream constituents and determination of their thermodynamic state throughout an ECLSS/ATCS simulation, performing heat transfer, chemical reaction, mass/energy balance, and system pressure drop analysis based on user-specified operating conditions. The program tracks each constituent through all combination and decomposition states while maintaining a mass and energy balance on the overall system. This allows rapid assessment of ECLSS designs, the impact of alternate technologies, and impacts due to changes in metabolic forcing functions, consumables usage, and system control considerations. CASE/A is written in FORTRAN 77 for the DEC VAX/VMS computer series, and requires 12Mb of disk storage and a minimum paging file quota of 20,000 pages. The program operates on the Tektronix 4014 graphics standard and VT100 text standard. The program requires a Tektronix 4014 or later graphics terminal, third party composite graphics/text terminal, or personal computer loaded with appropriate VT100/TEK 4014 emulator software. The use of composite terminals or personal computers with popular emulation software is recommended for enhanced CASE/A operations and general ease of use. The program is available on an unlabeled 9-track 6250 BPI DEC VAX BACKUP format magnetic tape. CASE/A development began in 1985 under contract to NASA/Marshall Space Flight

  18. Prospective small bowel mucosal assessment immediately after chemoradiotherapy of unresectable locally advanced pancreatic cancer using capsule endoscopy: a case series.

    PubMed

    Yamashina, Takeshi; Takada, Ryoji; Uedo, Noriya; Akasaka, Tomofumi; Hanaoka, Noboru; Takeuchi, Yoji; Higashino, Koji; Ioka, Tatsuya; Ishihara, Ryu; Teshima, Teruki; Nishiyama, Kinji; Iishi, Hiroyasu

    2016-01-01

    In this case series, three consecutive patients with unresectable locally advanced pancreatic cancer (ULAPC) underwent capsule endoscopy (CE) before and after chemoradiotherapy (CRT) to evaluate duodenal and jejunal mucosa, and to examine the relationship between CE findings and dose distribution. CE after CRT showed duodenitis and proximal jejunitis in all three patients. The most inflamed region was the third part of the duodenum, and in dose distribution, this was the closest region to the center of irradiation. This case series shows that CE can safely diagnose acute duodenitis and proximal jejunitis caused by CRT for ULAPC, and that dose distribution is possible to predict the degree of duodenal and jejunal mucosal injuries.

  19. Guidelines for Analysis of Pharmaceutical Supply System Planning in Developing Countries. Volume 7: Pharmaceutical Supply System Planning. International Health Planning Methods Series.

    ERIC Educational Resources Information Center

    Schaumann, Leif; And Others

    Intended to assist Agency for International Development (AID) officers, advisors, and health officials in incorporating health planning into national plans for economic development, this seventh of ten manuals in the Interational Health Planning Methods Series deals with pharmaceutical supply systems planning in developing countries. Following an…

  20. Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series.

    PubMed

    Träger, Karl; Fritzler, Daniel; Fischer, Guenther; Schröder, Janpeter; Skrabal, Christian; Liebold, Andreas; Reinelt, Helmut

    2016-05-16

    The use of cardiopulmonary bypass (CPB) in cardiothoracic surgery results in a well-known activation of the immunologic response. In some cases, however, this triggered immunologic response may be excessive, leading to a severe systemic inflammatory response syndrome (SIRS) and induced organ dysfunction. For example, patients frequently develop hemodynamic instability with hypotension and low systemic vascular resistance. To date, different therapeutic approaches, such as steroids, have been tried to control this maladaptive postoperative SIRS response, yet definitive proof of clinical efficacy is missing. A new cytokine adsorber device (CytoSorb; CytoSorbents) may be a useful approach to control hyperinflammatory systemic reactions by reducing a broad range of proinflammatory cytokines and other inflammatory mediators. This may, in turn, help to reestablish a physiologic immune response and help to restore deranged clinical parameters in these patients. In this retrospective case series study, we describe 16 cardiac surgery patients following prolonged CPB with post-CPB SIRS and subsequent acute kidney injury, who were then treated with hemoadsorption using CytoSorb in combination with continuous renal replacement therapy (CRRT). Treatment of patients with CytoSorb who presented with severe post-CPB SIRS resulted in a reduction of elevated cytokine levels, which was associated with a clear stabilization of deranged hemodynamic, metabolic, and organ function parameters. Treatment was well tolerated and safe, with no device-related adverse events occurring. CytoSorb therapy combined with CRRT is a potentially promising new treatment approach to achieve hemodynamic stability, cytokine reduction, and improved organ function in cardiac surgery patients who develop post-CPB SIRS.