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Sample records for recurrent vesical calculi

  1. Cystoman® and calculi: a good alternative to standard therapies in preventing stone recurrence.

    PubMed

    Proietti, S; Giannantoni, A; Luciani, L G; Sortino, G; Graziotti, P; Giusti, G

    2014-08-01

    To assess the efficacy and tolerability of D-mannose-containing product (Cystoman(®)) in preventing recurrence in patients who underwent surgical treatment for infection related urinary stones. From January 2011 to February 2013 we have enrolled all consecutive patients affected by staghorn calculi and recurrent urinary tract infections (UTIs). All patients recommended for surgery were scheduled for percutaneous nephrolithotomy. The study agent was administered daily for 5 months after surgical procedure. At baseline and 5-month follow-up all patients underwent abdominal Computed Tomography (CT) scan and they also completed Medical Outcomes Study short-form, 36-item questionnaire (SF-36). They performed urine and urine culture monthly. The primary endpoints were the assessment of the efficacy with regard to infection-related urinary stone recurrence and the tolerability of Cystoman(®). The secondary endpoint was the evaluation of quality-of-life symptoms. During the study period, a total of 27 patients were included in the study. The data from 25 patients were analyzable. Seventeen patients (68%) did not report UTIs during follow-up. Eight patients (32%) remained infected and the average number of UTIs was 2.6 ± 1.6 in 5 months. At 5-month follow-up 17 (68%) patients were free from stones recurrence; in 8 (32%) cases CT scan revealed stone recurrence with an average stone diameter of 1.1 ± 0.4 cm. In nonrecurring patients, 2 (11.7%) reported an average of 1.5 ± 0.7 UTIs episodes; in recurring patients, 6 (75%) showed 3 ± 1.67 of UTIs episodes. Statistically significant differences were seen in the occurrence of UTIs episodes were detected between nonrecurring stone patients and recurring patients (p < 0.05). Moreover, statistically significant changes were detected in SF-36 scores from baseline to month 5 in the categories of physical functioning and energy/fatigue (p < 0.05). Cystoman(®) is effective in preventing infection-related urinary stones.

  2. [Infection-induced urinary calculi in children; current therapeutic schedule and prevention of recurrence].

    PubMed

    Bach, D; Brühl, P; Hesse, A

    1988-01-01

    Infection stones have an outstanding position in childhood urolithiasis. In non-infection stones one can mostly find a certain--for example metabolic--causes of stone formation. In infection stones, the urease-producing and thus urea-cleaving properties of some gram-negative bacteria are responsible for alkalization of the urine and lead especially in combination with disturbances of urine transport to the staghorn calculi. Therefore in such children early diagnosis, adequate therapy and consequent maintenance is the crucial point for good life quality in future. Preliminary condition for therapeutic success is a close coworking between pediatric nephrologist, pediatric urologist, family doctor and parents.

  3. Long-term incidence and risk factors for recurrent stones following percutaneous nephrostolithotomy or percutaneous nephrostolithotomy/extracorporeal shock wave lithotripsy for infection related calculi.

    PubMed

    Streem, S B

    1995-03-01

    A study was done to determine the long-term incidence and cause of recurrent stones following percutaneous nephrostolithotomy alone (13 patients) or combined with extracorporeal shock wave lithotripsy (31) for management of documented infection related struvite renal calculi. The patients were followed for 12 to 111 months (mean 41.7) to censorship or time of new stone formation. Of these patients 12 (27%) had recurrent stones at 12 to 61 months (mean 32.3) after treatment. As determined by a Kaplan-Meier estimate, the risk of new stone formation 5 years after treatment was 36.8%. Potential risk factors for recurrence, including history of stones, associated anatomical abnormalities, procedure used, radiographic status at completion of treatment and recurrent infection during followup, were analyzed with Cox's proportional hazards model. Of these potential risk factors, only an associated anatomical abnormality was found to influence significantly the rate of recurrent stone formation (p = 0.005). We conclude that continued surveillance for recurrent stones is mandatory even for patients initially rendered stone-free and those who maintain sterile urine. In addition, because the presence of a significant anatomical or functional urinary tract abnormality places a patient at much higher risk for recurrence, we suggest that subsequent studies be stratified as to the presence or absence of these abnormalities.

  4. Mustards and Vesicants

    SciTech Connect

    Young, Robert A; Bast, Cheryl B

    2009-01-01

    Vesicants (sulfur mustards, lewisite, and nitrogen mustards) are chemicals that cause blistering of the skin. Developed as chemical warfare agents, their biological activity is complex and not fully understood. These vesicants in liquid or vapor form are capable of causing injury to most any tissue. Contact with the skin results in erythema and blistering. Exposure to vapors produces ocular and respiratory effects which occur at exposures below those causing dermal effects. Systemic and long-lasting effects may occur, especially following acute exposures that result in severe injury. Multi-organ involvement and fluid loss shock resulting in death may follow severe exposures. As alkylating agents, all of the mustards are known or potential carcinogens. The carcinogenic potential of lewisite in humans is equivocal. Toxicity data in animals are available for the vesicants although data on sulfur mustard and lewisite are more extensive than for the nitrogen mustards. Data from tests with human volunteers and occupational exposure information are also available. These data collectively have provided a basis for the development of exposure standards, guidelines, and criteria for use in emergency planning and emergency response, and remediation efforts. The mode of action of the vesicants is complex, not fully understood, and represents an ongoing area of investigation especially with respect to treatment of vesicant-induced injury. Prevention of exposure and decontamination are critical initial steps in eliminating or minimizing injury. With the exception of arsenic chelating antidotes (e.g., British anti-lewisite; BAL) for lewisite, no antidotes exist for the vesicant agents. Medical management currently focuses on palliative treatment of signs and symptoms.

  5. PA03.12. Role of stonvil capsule with varunadi kwath in renal & ureteric calculi

    PubMed Central

    Khandare, Dnyaneshwar

    2013-01-01

    Purpose: Now a day's Renal & Ureteric calculi is very common problem in our society. In this patient experiences so much Renal pain, Ureteric colic, Haematuria, Recurrent UTI & they disturbed his daily routine work. Modern Medicines have limitations to treat it & advised Surgery to many patients. A poor & middle class patient was not tolerating surgical expenses. And there were chances of recurrences also. So I thought to use combinations to dissolve renal & Ureteric calculi and cure patients. Method: I had chosen Stonvil Capsule (Phyto Pharma) & Varunadi Kwath. Stonvil Capsule contains multiple ayurvedic drugs. I gave one Stonvil capsule with 10ml Varunadi Kwath three times a day. Before & after treatment I advised USG, Xray. Result: This Clinical study is done on 20 patients in K.G. Mittal Hospital. After starting treatment patient had relieves renal pain, Ureteric colic, Haematuria, Recurrent UTI within 1 to 4 days. Also relieves Burning Micturation & them able to do their daily routine work. This treatment was also effective in gall bladder calculi. After every 3 months advised to do USG. In some patients calculi disappeared (dissolved) after 3 months. But In some patients calculi took 6 months or more periods to dissolve. After dissolved the calculi, 1 month treatment also given for the nonrecurrence. Calculi didn’t recur after treatment. Multiple calculi in two patients also dissolved by this treatment. Conclusion: Over all study the patients cured from renal & Ureteric calculi. Patient had relieved Renal pain, Ureteric colic, Haematuria, Recurrent UTI within 1 to 4 days. Also relieved Burning Micturation. Calculi dissolved & flushed out through urethra & didn’t recur. Calculi disappeared in after treatment USG. Patients having multiple calculi didn’t need surgery.

  6. Anatrophic nephrolithotomy for removal of staghorn or branched renal calculi.

    PubMed

    James, R; Novick, A C; Straffon, R A; Stewart, B H

    1980-02-01

    Forty anatrophic nephrolithotomies were performed in 38 patients between November, 1965, and December, 1977, to remove staghorn or branched renal calculi. Thirty-six (95 per cent) of the patients' preoperative urine cultures were infected, and postoperatively 35 of the cultures (88 per cent) were sterile. Magnesium ammonium phosphate calculi were present in the majority of patients (67 per cent). In 6 patients (15 per cent) transient nephrocutaneous fistulas developed. Thirty-six of the 40 renal units (90 per cent) had improved or stable intravenous pyelograms postoperatively. The patients had been followed for an average of twenty months (four to one hundred and twelve months). In 6 patients (15 per cent) recurrent renal calculi developed, and 3 patients (8 per cent) had residual calculi during this period.

  7. Cystine calculi: challenging group of stones.

    PubMed

    Ahmed, Kamran; Dasgupta, Prokar; Khan, Mohammad Shamim

    2006-12-01

    Cystinuria is an autosomal recessive disorder in renal tubular and intestinal transport of dibasic amino acids, which results in increased urinary excretion of cystine, ornithine, lysine and arginine. It affects 1 in 20 000 people and is caused by a defect in the rBAT gene on chromosome 2. Development of urinary tract cystine calculi is the only clinical manifestation of this disease. Owing to recurrent episodes of stone formation, these patients require a multi-modal approach to management. The role of medical management and minimally invasive surgery was reviewed for the treatment of cystinuria.

  8. Cystine calculi: challenging group of stones

    PubMed Central

    Ahmed, Kamran; Dasgupta, Prokar; Khan, Mohammad Shamim

    2006-01-01

    Cystinuria is an autosomal recessive disorder in renal tubular and intestinal transport of dibasic amino acids, which results in increased urinary excretion of cystine, ornithine, lysine and arginine. It affects 1 in 20 000 people and is caused by a defect in the rBAT gene on chromosome 2. Development of urinary tract cystine calculi is the only clinical manifestation of this disease. Owing to recurrent episodes of stone formation, these patients require a multi‐modal approach to management. The role of medical management and minimally invasive surgery was reviewed for the treatment of cystinuria. PMID:17148700

  9. Drug-induced urinary calculi.

    PubMed

    Matlaga, Brian R; Shah, Ojas D; Assimos, Dean G

    2003-01-01

    Urinary calculi may be induced by a number of medications used to treat a variety of conditions. These medications may lead to metabolic abnormalities that facilitate the formation of stones. Drugs that induce metabolic calculi include loop diuretics; carbonic anhydrase inhibitors; and laxatives, when abused. Correcting the metabolic abnormality may eliminate or dramatically attenuate stone activity. Urinary calculi can also be induced by medications when the drugs crystallize and become the primary component of the stones. In this case, urinary supersaturation of the agent may promote formation of the calculi. Drugs that induce calculi via this process include magnesium trisilicate; ciprofloxacin; sulfa medications; triamterene; indinavir; and ephedrine, alone or in combination with guaifenesin. When this situation occurs, discontinuation of the medication is usually necessary.

  10. Aeromedical certification of aircrew and controllers with renal calculi.

    PubMed

    Drane, A Michael C; Navathe, Pooshan; Clem, Peter

    2013-10-01

    Acute renal colic is an incapacitating condition. Advances in understanding the pathogenesis of calculi and their detection and treatment require a new approach to aeromedical risk assessment. Can this new information support the stratification of aeromedical risk into "High" and "Low" categories, and fulfill the paramount responsibility of the Civil Aviation Safety Authority, Australia's aviation regulator, which isthe maintenance of aviation safety? This article reviews the epidemiology of calculi and finds 2-10% annual risk of a symptomatic event following incidental detection of a calculus. While calculi 4 mm or less in size may not require surgical intervention, this does not equate to a pain-free passage. Similarly, calculus recurrence rates may vary in different anatomical locations, but no location can be considered "safe." The recognition of parenchymal calcification and Randall's plaques as precursors to the development of calculi places such individuals at elevated risk of developing calculi. More recently evidence has supported a link between metabolic syndrome and calculus formation. In an occupational group where there is potential for elevated radiation exposure, appropriate imaging is of particular importance. CT, X-ray, and ultrasound modalities are reviewed with recommendations presented for aeromedical assessment and surveillance based on identification of those at high risk of colic and minimization of investigational radiation exposure.

  11. Transoral removal of hiloparenchymal submandibular calculi: a long-term clinical experience.

    PubMed

    Capaccio, Pasquale; Clemente, Ignazio Alessandro; McGurk, Mark; Bossi, Anna; Pignataro, Lorenzo

    2011-07-01

    Traditional management of hiloparenchymal submandibular calculi is based on sialadenectomy. Recently, different minimally invasive and conservative techniques have been developed for the treatment of the submandibular calculi. We aimed to investigate the effectiveness of transoral surgical removal of large hiloparenchymal calculi by monitoring the trend for recurrence with clinical and ultrasonographic follow-up. A consecutive series of 84 patients with large (>7 mm) hilar or hiloparenchymal submandibular calculi underwent the transoral surgical removal under general anaesthesia. A video-assisted endoscopic procedure was performed in eight patients. All the patients underwent diagnostic ultrasonography and colour Doppler ultrasonography and clinical evaluation to define the exact location (hilar vs. parenchymal) and the diameter of the stone. The surgical procedure was successful in all but one of the patients. Stone recurrence was observed in 16 patients but obstructive symptoms were observed in only 12 patients during a median follow-up time of 52 months. The risk for recurrence was higher in patients who previously underwent extracorporeal shockwave lithotripsy. Conservative transoral removal of large hiloparenchymal submandibular calculi is a safe and effective surgical procedure. Future studies with longer follow-up will confirm the risk for recurrence of calculi.

  12. Vesicant chemotherapy extravasation antidotes and treatments.

    PubMed

    Schulmeister, Lisa

    2009-08-01

    Oncology nurses and pharmacists often are given the responsibility of developing or updating institutional policies to manage vesicant chemotherapy extravasations. Antidote and treatment recommendations of vesicant chemotherapy manufacturers, antidotes and treatments approved by the U.S. Food and Drug Administration (FDA), and guidelines and recommendations made by professional oncology organizations are useful resources in this process. This article describes manufacturers' recommendations, lists antidotes and treatments approved by the FDA, and reviews published guidelines and recommendations. Available antidote and treatment formulations and their preparation and administration also are discussed.

  13. Proceedings of the Vesicant Workshop, February 1987

    DTIC Science & Technology

    1987-12-01

    Rapid detection and decontamination, therefore, become essential in order to permit reduction of MOPP levels. The medical intensity inherent in vesicant...I ~ i Y I " Paipirueister Sum$ary of Presentation I Induction of Glutathione S-Transferase Enhances Detoxification of Aflatoxin I B Control <®, RzW...profiles are shown for aflatoxin B (AFB ) adducts of rat liver DNA. Rats fed 3 control or ethoxyquin-sup~lemented diets were gavaged with I H]AFB 1

  14. Extracorporeal shockwave lithotripsy for salivary calculi in pediatric patients.

    PubMed

    Ottaviani, F; Marchisio, P; Arisi, E; Capaccio, P

    2001-10-01

    Salivary gland lithiasis is uncommon in pediatric patients. Color Doppler ultrasonography (US) enables an accurate diagnosis of lithiasis to be made without exposure to the radiation of traditional imaging techniques. The development of minimally invasive techniques in the ENT field has made salivary lithotripsy a feasible alternative to traditional invasive surgery. The safety and efficacy of shock wave lithotripsy for salivary calculi were evaluated in pediatric patients. Seven children (5 males; age 4-15 years) with single calculi (mean diameter 4.4 mm) of the submandibular (n = 4) and parotid glands (n = 3) underwent extracorporeal electromagnetic shock wave lithotripsy (EESWL). In four cases the stone was intraductal (two submandibular and two parotideal) and in the remaining three cases it was intraparenchymal (two submandibular and one parotideal). In one case sedative anesthesia was performed. The mean number of therapeutic sessions was five. Patients were followed up clinically and with US for 6-72 months (mean 32 months). Complete disintegration of the calculi was achieved in five cases while in two cases a residual fragment < 2 mm in diameter was observed. None of the patients had recurrence of calculi in the treated gland. Mild self-limited adverse effects (pain, swelling of the gland, self-limiting bleeding from the duct, cutaneous petechiae) were observed in four cases. Our data suggest that EESWL is effective, safe and well tolerated; the minimal invasiveness of the technique suggests that EESWL should be used as the primary approach to salivary calculi in pediatric patients. The continuous US monitoring enables the efficacy of EESWL to be evaluated during both treatment and follow-up, with only slight discomfort for the pediatric patient.

  15. 21 CFR 862.1780 - Urinary calculi (stones) test system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Urinary calculi (stones) test system. 862.1780... Systems § 862.1780 Urinary calculi (stones) test system. (a) Identification. A urinary calculi (stones) test system is a device intended for the analysis of urinary calculi. Analysis of urinary calculi...

  16. 21 CFR 862.1780 - Urinary calculi (stones) test system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Urinary calculi (stones) test system. 862.1780... Systems § 862.1780 Urinary calculi (stones) test system. (a) Identification. A urinary calculi (stones) test system is a device intended for the analysis of urinary calculi. Analysis of urinary calculi...

  17. 21 CFR 862.1780 - Urinary calculi (stones) test system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Urinary calculi (stones) test system. 862.1780... Systems § 862.1780 Urinary calculi (stones) test system. (a) Identification. A urinary calculi (stones) test system is a device intended for the analysis of urinary calculi. Analysis of urinary calculi...

  18. 21 CFR 862.1780 - Urinary calculi (stones) test system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Urinary calculi (stones) test system. 862.1780... Systems § 862.1780 Urinary calculi (stones) test system. (a) Identification. A urinary calculi (stones) test system is a device intended for the analysis of urinary calculi. Analysis of urinary calculi...

  19. 21 CFR 862.1780 - Urinary calculi (stones) test system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Urinary calculi (stones) test system. 862.1780... Systems § 862.1780 Urinary calculi (stones) test system. (a) Identification. A urinary calculi (stones) test system is a device intended for the analysis of urinary calculi. Analysis of urinary calculi...

  20. Jackstone: A rare entity of vesical calculus

    PubMed Central

    Singh, Kamal Jeet; Tiwari, Anuj; Goyal, Adarsh

    2011-01-01

    Jackstone calculi are urinary tract stones that have a specific appearance resembling toy jacks. They are almost always composed of calcium oxalate dihydrate consist of a dense central core and radiating spicules. They are usually light brown with dark patches and are usually described to occur in the urinary bladder and rarely in the upper urinary tract. Their appearance on plain radiographs and computed tomography in human patients has been described. PMID:22279326

  1. Novel Methods of Determining Urinary Calculi Composition: Petrographic Thin Sectioning of Calculi and Nanoscale Flow Cytometry Urinalysis

    PubMed Central

    Gavin, Carson T; Ali, Sohrab N; Tailly, Thomas; Olvera-Posada, Daniel; Alenezi, Husain; Power, Nicholas E; Hou, Jinqiang; St. Amant, Andre H; Luyt, Leonard G; Wood, Stephen; Wu, Charles; Razvi, Hassan; Leong, Hon S

    2016-01-01

    Accurate determination of urinary stone composition has significant bearing on understanding pathophysiology, choosing treatment modalities and preventing recurrence. A need exists for improved methods to determine stone composition. Urine of 31 patients with known renal calculi was examined with nanoscale flow cytometry and the calculi collected during surgery subsequently underwent petrographic thin sectioning with polarized and fluorescent microscopy. Fluorescently labeled bisphosphonate probes (Alendronate-fluorescein/Alendronate-Cy5) were developed for nanoscale flow cytometry to enumerate nanocrystals that bound the fluorescent probes. Petrographic sections of stones were also imaged by fluorescent and polarized light microscopy with composition analysis correlated to alendronate +ve nanocrystal counts in corresponding urine samples. Urine samples from patients with Ca2+ and Mg2+ based calculi exhibited the highest alendronate +ve nanocrystal counts, ranging from 100–1000 nm in diameter. This novel urine based assay was in agreement with composition determined by petrographic thin sections with Alendronate probes. In some cases, high alendronate +ve nanocrystal counts indicated a Ca2+ or Mg2+ composition, as confirmed by petrographic analysis, overturning initial spectrophotometric diagnosis of stone composition. The combination of nanoscale flow cytometry and petrographic thin sections offer an alternative means for determining stone composition. Nanoscale flow cytometry of alendronate +ve nanocrystals alone may provide a high-throughput means of evaluating stone burden. PMID:26771074

  2. [Urinary calculi and infection].

    PubMed

    Trinchieri, Alberto

    2014-01-01

    Infection urinary stones resulting from urease-producing bacteria are composed by struvite and/or carbonate apatite. Bacterial urease splits urea and promotes the formation of ammonia and carbon dioxide leading to urine alkalinization and formation of phosphate salts. Proteus species are urease-producers, whereas a limited number of strains of other Gram negative and positive species may produce urease. Ureaplasma urealyticum and Corynebacterium urealyticum are urease-producers that are not isolated by conventional urine cultures, but require specific tests for identification. Primary treatment requires surgical removal of stones as complete as possible. Extracorporeal and endoscopic treatments are usually preferred, while open surgery is actually limited to few selected cases. Residual stones or fragments should be treated by chemolysis via ureteral catheter or nephrostomy or administration of citrate salts in order to achieve a stone-free renal unit. Postoperatively, recurrent urinary tract infection should be treated with appropriate antibiotic treatment although long-term antibiotic prophylaxis can cause resistance. Urinary acidification has been proposed for the prophylaxis of infection stones, but long-term acidification is difficult to achieve in urine infected by urease-producing bacteria. Urease inhibitors lead to prevention and/or dissolution of stones and encrustations in patients with infection by urea-splitting bacteria, but their use is limited by their toxicity. The administration of citrate salts involves an increase of the value of nucleation pH (pHn), that is the pH value at which calcium and magnesium phosphate crystallization occurs, in a greater way than the corresponding increase in the urinary pH due to its alkalinizing effect and resulting in a reduction of the risk of struvite crystallization. In conclusion prevention of the recurrence of infection stones can be achieved by an integrated approach tailored on the single patient. Complete

  3. [Functional evaluation in patients with kidney calculi].

    PubMed

    Stojimirović, B

    1998-01-01

    Nephrolithiasis is a common disorder and a significant problem because of incidence, recurrence and severe consequences. Stone disease is a surgical as well as a medical problem. Major progress has been made recently in understanding the pathophysiological disturbances responsible for stone formation as well as in the techniques of stone removal. The introduction of extracorporeal shock wave lithotripsy has considerably reduced the need for surgery. Improvements in methods of kidney stone removal have not diminished the need for the application of an effective prophylactic program. The internist should take a complete history of stone events (number, composition, location and outcome of stone event), family history of stones, dietary habits (focusing on the consumption of animal protein, salt and dairy products), medications and physical examination. Radiopaque stones should be documented by plane X-ray films. Ultrasonography should be used to image calculi that are nonopaque, and to easily distinguish them from masses such as tumour or blood clot. Computed tomography is also an excellent method for imaging nonopaque renal calculi but higher cost and radiation exposure are disadvantages [2]. Crystallographic analysis is the essential diagnostic procedure. If available, previous stones should also be examined. "In stone disease, everything is measurement. What the laboratory cannot tell you, you will not know; what it tells you in error, you will not correct by using your instincts, your medical experience, or your art [3]". Reliable diagnostic protocols are available for the identification of different causes of stones. The complexity of protocols depend on the severity of nephrolithiasis. Patients with a single stone episode undergo simple protocol, and extensive detailed protocol is used for patients with recurrent stone disease, or patients at increased risk. Simple protocol, besides the already mentioned history of stone events, radiographic investigation and

  4. Cartan calculi on the quantum superplane

    SciTech Connect

    Celik, Salih

    2006-08-15

    Cartan calculi on the extended quantum superplane are given. To this end, the noncommutative differential calculus on the extended quantum superplane is extended by introducing inner derivations and Lie derivatives.

  5. Giant salivary calculi of the submandibular gland

    PubMed Central

    Fowell, C; MacBean, A

    2012-01-01

    Sialolithasis is the most common salivary gland disease. A case of an unusually large sialolith arising in the submandibular gland is presented, along with a review of the management of giant salivary gland calculi. PMID:24960792

  6. Vesical nephrogenic adenoma: an unusual presentation of a bladder tumour

    PubMed Central

    Martínez-Sanchíz, Carlos; Martínez-Ruiz, Jesús; Anguita-Fernandez, Pedro J.; Giménez-Bachs, José M.; Atiénzar-Tobarra, Manuel; Rodríguez, Julio Antonio Virseda; Salinas-Sánchez, Antonio S.

    2011-01-01

    Vesical nephrogenic adenoma is a rare, benign entity that appears most commonly in middle-aged males. Its etiology is unknown, but it has been linked to chronic irritating factors, such as infection, trauma, urological surgery, kidney stones, foreign bodies and chemical agents, such as Bacille Calmette-Guerin. We report 2 new cases with a history of transurethral resection of the bladder and the prostate and a history of prolonged voiding symptoms. In both cases, the findings of encysted tubular structures lined with flattened cuboidal cells without atypia were consistent with the diagnosis of vesical nephrogenic adenoma. PMID:21989174

  7. [Experiences with instrumental methods for urinary calculi analysis].

    PubMed

    Asper, R; Schmucki, O

    1979-08-01

    To reduce the urinary calculi incidence by calculi formers, it is important to know the composition of these stones. Unfortunately the chemical analysis does not give very reliable results. Looking for a better method to analyse urinary calculi, three instrumental methods were tested: infared spectroscopy, thermal analysis and X-ray diffraction. The experimental results and economical considerations show that the X-ray diffraction analysis of urinary calculi would meet the goal of improved care of patients with stones.

  8. Oxalate urinary calculi in beef steers.

    PubMed

    Huntington, G B; Emerick, R J

    1984-01-01

    Hereford X Angus steers (10/treatment) were fed 90% concentrate diets containing 0.3%, 0.6%, 0.9%, or 1.2% of calcium for 92 days (trial 1) or 114 days (trial 2). Ground limestone was the supplemental calcium source. At slaughter, 12 of 20 steers fed 0.3% calcium had calculi in the urinary bladder or kidneys, compared with 5 of 20 fed 0.6% calcium, 5 of 20 fed 0.9% calcium, and 4 of 20 fed 1.2% calcium. Analyses of calculi indicated they were oxalate calculi. During the first 49 days of trial 2, plasma hydroxyproline concentrations were higher (P less than 0.10) for steers fed 0.3% calcium than for steers fed higher calcium concentrations. Increased bone resorption in steers fed concentrations of 0.3% calcium, resulting in increased plasma hydroxyproline, an oxalate precursor, was indicated as a source of oxalate in calculi and as an explanation of lower occurrence of calculi in steers fed higher concentrations of calcium.

  9. Management of Pancreatic Calculi: An Update

    PubMed Central

    Tandan, Manu; Talukdar, Rupjyoti; Reddy, Duvvur Nageshwar

    2016-01-01

    Pancreatolithiasis, or pancreatic calculi (PC), is a sequel of chronic pancreatitis (CP) and may occur in the main ducts, side branches or parenchyma. Calculi are the end result, irrespective of the etiology of CP. PC contains an inner nidus surrounded by successive layers of calcium carbonate. These calculi obstruct the pancreatic ducts and produce ductal hypertension, which leads to pain, the cardinal feature of CP. Both endoscopic therapy and surgery aim to clear these calculi and decrease ductal hypertension. In small PC, endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincterotomy and extraction is the treatment of choice. Large calculi require fragmentation by extracorporeal shock wave lithotripsy (ESWL) prior to their extraction or spontaneous expulsion. In properly selected cases, ESWL followed by ERCP is the standard of care for the management of large PC. Long-term outcomes following ESWL have demonstrated good pain relief in approximately 60% of patients. However, ESWL has limitations. Per oral pancreatoscopy and intraductal lithotripsy represent techniques in evolution, and in current practice their use is limited to centers with considerable expertise. Surgery should be offered to all patients with extensive PC, associated multiple ductal strictures or following failed endotherapy. PMID:27784844

  10. Massive Pulmonary Calculi Embolism: A Novel Complication of Pneumatic Lithotripsy

    PubMed Central

    Zhang, Lin; Zhou, Yiwu

    2015-01-01

    Abstract Pneumatic lithotripsy is a minimally invasive technique mainly for the treatment of urinary staghorn stones. Previous literatures have reported some therapeutic complications during or after this procedure, but calculi embolism has not been mentioned before. We report here a fatal case of calculi-induced pulmonary embolism in an adult woman who underwent pneumatic lithotripsy. An autopsy did not reveal any evidence of pulmonary embolism. However, light microscopy revealed noticeable presence of calculi in pulmonary arterioles and capillaries, as evidenced by environmental scanning electron microscope and energy dispersive X-ray analysis. The primary determinants of calculi embolism include intrarenal pressure, and volume and viscosity of the calculi fragments formation. Vascular intravasation of smashed calculi might increase pulmonary vascular resistance and hypoxemia and decrease cardiac output. This case report intends to provide information for clinicians to consider the probability of intraoperative calculi embolism during lithotripsies when patients develop typical symptoms of acute pulmonary embolism. PMID:26222867

  11. Mustard vesicant-induced lung injury: Advances in therapy.

    PubMed

    Weinberger, Barry; Malaviya, Rama; Sunil, Vasanthi R; Venosa, Alessandro; Heck, Diane E; Laskin, Jeffrey D; Laskin, Debra L

    2016-08-15

    Most mortality and morbidity following exposure to vesicants such as sulfur mustard is due to pulmonary toxicity. Acute injury is characterized by epithelial detachment and necrosis in the pharynx, trachea and bronchioles, while long-term consequences include fibrosis and, in some instances, cancer. Current therapies to treat mustard poisoning are primarily palliative and do not target underlying pathophysiologic mechanisms. New knowledge about vesicant-induced pulmonary disease pathogenesis has led to the identification of potentially efficacious strategies to reduce injury by targeting inflammatory cells and mediators including reactive oxygen and nitrogen species, proteases and proinflammatory/cytotoxic cytokines. Therapeutics under investigation include corticosteroids, N-acetyl cysteine, which has both mucolytic and antioxidant properties, inducible nitric oxide synthase inhibitors, liposomes containing superoxide dismutase, catalase, and/or tocopherols, protease inhibitors, and cytokine antagonists such as anti-tumor necrosis factor (TNF)-α antibody and pentoxifylline. Antifibrotic and fibrinolytic treatments may also prove beneficial in ameliorating airway obstruction and lung remodeling. More speculative approaches include inhibitors of transient receptor potential channels, which regulate pulmonary epithelial cell membrane permeability, non-coding RNAs and mesenchymal stem cells. As mustards represent high priority chemical threat agents, identification of effective therapeutics for mitigating toxicity is highly significant.

  12. Renal calculi in wild Eurasian otters (Lutra lutra) in England.

    PubMed

    Simpson, V R; Tomlinson, A J; Molenaar, F M; Lawson, B; Rogers, K D

    2011-07-09

    Macroscopic renal calculi were seen in 50 of 492 (10.2 per cent) wild Eurasian otters found dead in England from 1988 to 2007. Forty-eight adults and two subadults were affected. Calculi were present in 15.7 per cent (31 of 197) of adult males and 12.7 per cent (17 of 134) of adult females. There was an increase in prevalence in the study population over time; no calculi were found in 73 otters examined between 1988 and 1996, but in most subsequent years they were observed with increased frequency. Calculi occurred in both kidneys but were more common in the right kidney. They varied greatly in shape and size; larger calculi were mostly seen in the calyces while the smallest ones were commonly found in the renal medulla. Calculi from 45 cases were examined by x-ray diffraction analysis; in 43 (96 per cent), they were composed solely of ammonium acid urate. Affected otters had heavier adrenal glands relative to their body size than unaffected otters (P<0.001). There was no significant association between body condition index and the presence of calculi (P>0.05). Many otters had fresh bite wounds consistent with intraspecific aggression. The proportion bitten increased over time and this coincided with the increased prevalence of renal calculi.

  13. Recurrent pyogenic cholangitis in Asian immigrants: use of ultrasonography, computed tomography, and cholangiography

    SciTech Connect

    Federle, M.P.; Cello J.P.; Laing, F.C.; Jeffery, R.B. Jr.

    1982-04-01

    Five cases of recurrent pyogenic cholangitis (RPC) were studied by ultrasonography, computed tomography (CT), and cholangiography. All patients were recent immigrants from the Orient or Indonesia and had had recurrent attacks of cholangitis for many years. The bile was infected by E. coli and the biliary ducts were dilated; in addition, extrahepatic bile-pigment calculi we represent in all 5 and intrahepatic calculi in 4. Abdominal ultrasound usually failed to demonstrate duct calculi and extrahepatic dilatation due to the soft, mud-like consistency of the stones. CT was successful in showing the calculi and the full extent of dilatation. The authors conclude that preoperative diagnosis of RPC is best achieved by awareness of the characteristic clinical presentation and the findings on abdominal CT. Preoperative cholangiography provides excellent detail, but poses the danger of biliary sepsis requiring antibiotics.

  14. Spontaneous bladder rupture caused by a giant vesical calculus.

    PubMed

    Kaur, Navneet; Attam, Amit; Gupta, Ashish; Amratash

    2006-01-01

    Spontaneous rupture of the urinary bladder is an uncommon occurrence. A 36-year-old man had complaints of pain and progressive distension of abdomen and anuria for 2 days. His abdomen was tense, tender and distended with free fluid. Blood urea was 340 mg% and ascitic fluid urea was 337 mg%. An USG showed massive ascitis, a large vesical calculus and a left renal calculus. The urinary bladder could not be catheterized. Patient underwent hemodialysis and placement of abdominal drains. About 2 l of yellow turbid fluid was drained. Cystolithotomy showed a 6 cm size impacted calculus with a rent in the dome of the bladder, which was repaired. Subsequently patient underwent percutaneous nephrolithotrypsy for left staghorn renal calculus and nephrectomy for right non-functioning kidney.

  15. Molecular Mechanisms of Sulfur Mustard Vesicant-Induced Cell Death: Early and Late Cell Responses

    DTIC Science & Technology

    2005-10-01

    Mechanisms of Sulfur Mustard Vesicant-Induced Cell Death : Early and late cell responses 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6...It possess mutagenic, carcinogenic, cytotoxic, vesicating effects, and results in cell death . However, the biomedical mechanism of cell death induced... cell death via apoptosis: • In early stage, It induces JNK activity and then triggers apoptosis pathway. • In late stage, sulphur mustard attacks the

  16. SEM and X-ray microanalysis of human prostatic calculi

    SciTech Connect

    Vilches, J.; Lopez, A.; De Palacio, L.; Munoz, C.; Gomez, J.

    1982-02-01

    Calculi removed from human prostates affected with nodular hyperplasia were analyzed with scanning electron microscopy and EDAX system. The general spectrum was made up of Na, Al, Mg, S, P, Ca and Zn. Two types of stone were identified morphostructurally and microanalytically: calculi type I of nodular surface with high peaks of S, and calculi type II polyfaceted with high peaks of P and Ca. Their formation from corpora amylacea and/or exogenous constituents is discussed. The superficial deposit of Zn suggests its incorporation from the prostatic liquid and does not seem to play an important role in the genesis.

  17. The incidence and location of prostatic calculi on noncontrast computed tomography images in patients with renal calculi.

    PubMed

    Balasar, Mehmet; Poyraz, Necdet; Göğer, Yunus Emre; Unal, Yunus; Pişkin, Mehmet Mesut

    2015-08-01

    In this study, the incidence and location of prostatic calculi on noncontrast abdominal computed tomography (NCACT) images of patients with and without renal stones were investigated. Between 2006 and 2013, NCACT images were taken of 133 patients treated for renal stones (Group I) and of 100 age-matched control patients with putative urinary stone disease (Group II) in our clinic. The incidence and location of prostatic calculi on these images were determined. The location of prostatic calculus was classified as type A if they were located in the main prostatic ducts, and type B if they were located outside the ducts. Prostatic calculi were present in 44.4% of patients in Group I and 21.0% of patients in Group II. The incidence of prostatic calculi was significantly higher in patients with urinary stones compared with those without (P<0.001). The location of prostatic calculi in Group I included 74.6% type A and 25.4% type B while in Group II the locations were 76.2% type A and 23.8% type B. The incidence of prostatic calculi is more prevalent in patients with renal stones. On NCACT images, prostatic calculi were mostly detected in the main prostatic ducts, which were defined as type A.

  18. Inhibition of urinary calculi -- a spectroscopic study

    NASA Astrophysics Data System (ADS)

    Manciu, Felicia; Govani, Jayesh; Durrer, William; Reza, Layra; Pinales, Luis

    2008-10-01

    Although a considerable number of investigations have already been undertaken and many causes such as life habits, metabolic disorders, and genetic factors have been noted as sources that accelerate calculi depositions and aggregations, there are still plenty of unanswered questions regarding efficient inhibition and treatment mechanisms. Thus, in an attempt to acquire more insights, we propose here a detailed scientific study of kidney stone formation and growth inhibition based on a traditional medicine approach with Rotula Aquatica Lour (RAL) herbal extracts. A simplified single diffusion gel growth technique was used for synthesizing the samples for the present study. The unexpected Zn presence in the sample with RAL inhibitor, as revealed by XPS measurements, explains the inhibition process and the dramatic reflectance of the incident light observed in the infrared transmission studies. Raman data demonstrate potential binding of the inhibitor with the oxygen of the kidney stone. Photoluminescence results corroborate to provide additional evidence of Zn-related inhibition.

  19. Histotripsy Erosion of Model Urinary Calculi

    PubMed Central

    Hall, Timothy L.; Maxwell, Adam D.; Xu, Zhen; Cain, Charles A.; Roberts, William W.

    2011-01-01

    Abstract Background and Purpose Histotripsy is a pulsed focused ultrasound technology in which initiation and control of acoustic cavitation allow for precise mechanical fractionation of tissues. The present study examines the feasibility of using histotripsy for erosion of urinary calculi. Materials and Methods Histotripsy treatment was delivered from a 750-kHz transducer in the form of 5-cycle acoustic pulses at a 1-kHz pulse repetition frequency. Model stones were sonicated for 5 minutes at peak negative pressures (p-) of 10, 15, 19, 22, and 24-MPa. Resulting fragment sizes and comminution rates were assessed and compared with those achieved with a piezoelectric lithotripter (Wolf Piezolith 3000) operated at 2-Hz pulse repetition frequency and power level 17 (p- = 14-MPa). Results Histotripsy eroded the surface of stones producing fine (<100 μm) particulate debris in contrast to the progressive and incomplete subdivision of stones achieved with piezoelectric lithotripsy. The histotripsy erosion rate increased with increasing peak negative pressure from 10 to 19 MPa and then saturated, yielding an average rate of 87.9 ± 12.8 mg/min at maximum treatment intensity. Piezoelectric lithotripsy achieved an average treatment rate of 110.7 ± 27.4 mg/min. Conclusions Histotripsy comminution of urinary calculi is a surface erosion phenomenon that is mechanistically distinct from conventional shockwave lithotripsy (SWL), producing only fine debris as opposed to coarse fragments. These characteristics suggest that histotripsy offers a potential adjunct to traditional SWL procedures, and synergistic interplay of the two modalities may lead to possible increases in both rate and degree of stone fragmentation. PMID:21091223

  20. Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi

    PubMed Central

    Healy, Kelly; Chamsuddin, Abbas; Spivey, James; Martin, Louis; Nieh, Peter

    2009-01-01

    Background and Objectives: Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi. Methods: We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and postoperatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging. Results: Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted. Conclusions: Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach. PMID:19660213

  1. Laparoscopic Transcystic Treatment Biliary Calculi by Laser Lithotripsy

    PubMed Central

    Jin, Lan; Zhang, Zhongtao

    2016-01-01

    Background and Objectives: Laparoscopic transcystic common bile duct exploration (LTCBDE) is a complex procedure requiring expertise in laparoscopic and choledochoscopic skills. The purpose of this study was to investigate the safety and feasibility of treating biliary calculi through laparoscopic transcystic exploration of the CBD via an ultrathin choledochoscope combined with dual-frequency laser lithotripsy. Methods: From August 2011 through September 2014, 89 patients at our hospital were treated for cholecystolithiasis with biliary calculi. Patients underwent laparoscopic cholecystectomy and exploration of the CBD via the cystic duct and the choledochoscope instrument channel. A dual-band, dual-pulse laser lithotripsy system was used to destroy the calculi. Two intermittent laser emissions (intensity, 0.12 J; pulse width 1.2 μs; and pulse frequency, 10 Hz) were applied during each contact with the calculi. The stones were washed out by water injection or removed by a stone-retrieval basket. Results: Biliary calculi were removed in 1 treatment in all 89 patients. No biliary tract injury or bile leakage was observed. Follow-up examination with type-B ultrasonography or magnetic resonance cholangiopancreatography 3 months after surgery revealed no instances of retained-calculi–related biliary tract stenosis. Conclusion: The combined use of laparoscopic transcystic CBD exploration by ultrathin choledochoscopy and dual-frequency laser lithotripsy offers an accurate, convenient, safe, effective method of treating biliary calculi. PMID:27904308

  2. Study of cystine urinary calculi in dogs.

    PubMed Central

    Escolar, E; Bellanato, J; Rodriquez, M

    1991-01-01

    The composition and structure of 48 canine cystine urinary stones were determined by infrared spectroscopy, scanning electron microscopy and electron dispersive X-ray analysis. The infrared analysis showed that about 45% of the specimens were composed of pure cystine. The remainder also contained calcium oxalate (mono and/or dihydrate), magnesium ammonium phosphate hexadydrate (struvite), calcium hydrogen phosphate dihydrate (brushite) and complex urates (ammonium, ammonium potassium and/or potassium enriched ammonium urate). The infrared study of several samples heated at 620 degrees C and 750 degrees C revealed the presence of apatitic calcium phosphate. This compound was difficult to detect in the spectrum of the original samples due to the small proportion of phosphate contained in the calculi and to band overlapping. The examination of a series of selected samples by means of scanning electron microscopy and energy dispersive X-ray analysis complemented the infrared results. Images Fig. 3. Fig. 4. Fig. 5a. Fig. 5b. Fig. 6a. Fig. 6b. Fig. 7. Fig. 8. Fig. 9. PMID:1884286

  3. Proteus mirabilis viability after lithotripsy of struvite calculi

    NASA Astrophysics Data System (ADS)

    Prabakharan, Sabitha; Teichman, Joel M. H.; Spore, Scott S.; Sabanegh, Edmund; Glickman, Randolph D.; McLean, Robert J. C.

    2000-05-01

    Urinary calculi composed of struvite harbor urease-producing bacteria within the stone. The photothermal mechanism of holmium:YAG lithotripsy is uniquely different than other lithotripsy devices. We postulated that bacterial viability of struvite calculi would be less for calculi fragmented with holmium:YAG irradiation compared to other lithotripsy devices. Human calculi of known struvite composition (greater than 90% magnesium ammonium phosphate hexahydrate) were incubated with Proteus mirabilis. Calculi were fragmented with no lithotripsy (controls), or shock wave, intracorporeal ultrasonic, electrohydraulic, pneumatic, holmium:YAG or pulsed dye laser lithotripsy. After lithotripsy, stone fragments were sonicated and specimens were serially plated for 48 hours at 38 C. Bacterial counts and the rate of bacterial sterilization were compared. Median bacterial counts (colony forming units per ml) were 8 X 106 in controls and 3 X 106 in shock wave, 3 X 107 in ultrasonic, 4 X 105 in electrohydraulic, 8 X 106 in pneumatic, 5 X 104 in holmium:YAG and 1 X 106 in pulsed dye laser lithotripsy, p less than 0.001. The rate of bacterial sterilization was 50% for holmium:YAG lithotripsy treated stones versus 0% for each of the other cohorts, p less than 0.01. P. mirabilis viability is less after holmium:YAG irradiation compared to other lithotripsy devices.

  4. Prostate calculi in cancer and BPH in a cohort of Korean men: Presence of calculi did not correlate with cancer risk.

    PubMed

    Hwang, Eu-Chang; Choi, Hyang-Sik; Im, Chang-Min; Jung, Seung-Il; Kim, Sun-Ouck; Kang, Taek-Won; Kwon, Dong-Deuk; Park, Kwang-Sung; Ryu, Soo-Bang

    2010-03-01

    Prostatic calculi are common and are associated with inflammation of the prostate. Recently, it has been suggested that this inflammation may be associated with prostate carcinogenesis. The aim of this study was to investigate the relationship between prostatic calculi and prostate cancer (PCa) in prostate biopsy specimens. We retrospectively analyzed 417 consecutive patients who underwent transrectal ultrasonography (TRUS) and prostate biopsies between January 2005 and January 2008. Based on the biopsy findings, patients were divided into benign prostatic hyperplasia and PCa groups. TRUS was used to detect prostatic calculi and to measure prostate volume. The correlations between PCa risk and age, serum total PSA levels, prostate volume, and prostatic calculi were analyzed. Patient age and PSA, as well as the frequency of prostatic calculi in the biopsy specimens, differed significantly between both the groups (P < 0.05). In the PCa group, the Gleason scores (GSs) were higher in patients with prostatic calculi than in patients without prostatic calculi (P = 0.023). Using multivariate logistic regression analysis, we found that patient age, serum total PSA and prostate volume were risk factors for PCa (P = 0.001), but that the presence of prostatic calculi was not associated with an increased risk of PCa (P = 0.13). In conclusion, although the presence of prostatic calculi was not shown to be a risk factor for PCa, prostatic calculi were more common in patients with PCa and were associated with a higher GS among these men.

  5. Percutaneous Removal of Retained Calculi from the Abdomen

    SciTech Connect

    O'Shea, S.J.; Martin, D.F.

    2003-02-15

    With rising pressure placed on health service resources minimally invasive techniques requiring only short hospital admissions are increasing in importance. We describe the techniques used to remove calculi from the peritoneal cavity which had been retained after surgery and continued to cause clinical problems. In both cases described the calculi lay within abscess cavities associated with fistulous tracks to the skin. The fistulae were dilated to allow passage of therapeutic radiologic and endoscopic equipment enabling manipulation and subsequent extraction of the stones. In both cases removal of the calculi allowed complete resolution of the fistulae and the patients made a full clinical recovery. Removal of gallstones which have escaped into the peritoneum at laparoscopic cholecystectomy leading to sepsis has been described; we describe the novel management of a patient in whom extraction had already been attempted, at another hospital, without success. Removal of an appendicolith, described herein another patient, does not appear to have been reported previously.

  6. Massive Pulmonary Calculi Embolism: A Novel Complication of Pneumatic Lithotripsy: A Case Report.

    PubMed

    Zhang, Lin; Zhou, Yiwu

    2015-07-01

    Pneumatic lithotripsy is a minimally invasive technique mainly for the treatment of urinary staghorn stones. Previous literatures have reported some therapeutic complications during or after this procedure, but calculi embolism has not been mentioned before.We report here a fatal case of calculi-induced pulmonary embolism in an adult woman who underwent pneumatic lithotripsy. An autopsy did not reveal any evidence of pulmonary embolism. However, light microscopy revealed noticeable presence of calculi in pulmonary arterioles and capillaries, as evidenced by environmental scanning electron microscope and energy dispersive X-ray analysis. The primary determinants of calculi embolism include intrarenal pressure, and volume and viscosity of the calculi fragments formation. Vascular intravasation of smashed calculi might increase pulmonary vascular resistance and hypoxemia and decrease cardiac output.This case report intends to provide information for clinicians to consider the probability of intraoperative calculi embolism during lithotripsies when patients develop typical symptoms of acute pulmonary embolism.

  7. Internet based expert system for the management of gallstones, renal, ureteric and bladder calculi.

    PubMed

    Sridhar, S; Kumaravel, N

    2003-01-01

    An Internet based expert system for the management of gallstones, Renal, Ureteric and bladder calculi based on ultrasound images is presented in this paper. Calculi are due to abnormal collection of certain chemicals like oxalate, phosphate and Uric acid. These calculi can be present in kidney, Ureter or in Urinary bladder and also in gall bladder. The expert system is designed to assist the physician to detect, extract, classify and diagnose calculi with greater accuracy. It also helps physicians in the management of calculi based on the etiological analysis of calculi. The Expert system takes an ultrasound image as input along with the symptoms of the patients. The expert system extracts the renal calculi and analyzes it using different image processing techniques to extract the image features like size, location and texture. These image features along with the clinical data of the patient enable the expert system to provide the decisions to decide the future course of treatment with more accuracy.

  8. Doxycycline loaded poly(ethylene glycol) hydrogels for healing vesicant-induced ocular wounds

    PubMed Central

    Anumolu, SivaNaga S; DeSantis, Andrea S; Menjoge, Anupa R; Hahn, Rita A; Beloni, John A; Gordon, Marion K; Sinko, Patrick J

    2015-01-01

    Half mustard (CEES) and nitrogen mustard (NM) are commonly used surrogates and vesicant analogs of the chemical warfare agent sulfur mustard. In the current study, in situ forming poly(ethylene glycol) (PEG)-based doxycycline hydrogels are developed and evaluated for their wound healing efficacy in CEES and NM exposed rabbit corneas in organ culture. The hydrogels, characterized by UV-Vis spectrophotometry, rheometry, and swelling kinetics, showed that the hydrogels are optically transparent, have good mechanical strength and a relatively low degree of swelling (<7%). In vitro doxycycline release from the hydrogel disks (0.25% w/v) was found to be biphasic with release half times of ~12 and 72 h, respectively, with 80–100% released over a 7-day period. Permeation of doxycycline through vesicant wounded corneas was found to be 2.5 to 3.4 fold higher than non-wounded corneas. Histology and immunofluorescence studies showed a significant reduction of matrix metalloproteinase-9 (MMP-9) and improved healing of vesicant exposed corneas by doxycycline hydrogels compared to a similar dose of doxycycline delivered in phosphate buffered saline (PBS, pH 7.4). In conclusion, the current studies demonstrate that the doxycycline-PEG hydrogels accelerate corneal wound healing after vesicant injury offering a therapeutic option for ocular mustard injuries. PMID:19853296

  9. Doxycycline loaded poly(ethylene glycol) hydrogels for healing vesicant-induced ocular wounds.

    PubMed

    Anumolu, SivaNaga S; DeSantis, Andrea S; Menjoge, Anupa R; Hahn, Rita A; Beloni, John A; Gordon, Marion K; Sinko, Patrick J

    2010-02-01

    Half mustard (CEES) and nitrogen mustard (NM) are commonly used surrogates and vesicant analogs of the chemical warfare agent sulfur mustard. In the current study, in situ forming poly(ethylene glycol) (PEG)-based doxycycline hydrogels are developed and evaluated for their wound healing efficacy in CEES and NM-exposed rabbit corneas in organ culture. The hydrogels, characterized by UV-Vis spectrophotometry, rheometry, and swelling kinetics, showed that the hydrogels are optically transparent, have good mechanical strength and a relatively low degree of swelling (<7%). In vitro doxycycline release from the hydrogel disks (0.25% w/v) was found to be biphasic with release half times of approximately 12 and 72h, respectively, with 80-100% released over a 7-day period. Permeation of doxycycline through vesicant wounded corneas was found to be 2.5 to 3.4 fold higher than non-wounded corneas. Histology and immunofluorescence studies showed a significant reduction of matrix metalloproteinase-9 (MMP-9) and improved healing of vesicant-exposed corneas by doxycycline hydrogels compared to a similar dose of doxycycline delivered in phosphate buffered saline (PBS, pH 7.4). In conclusion, the current studies demonstrate that the doxycycline-PEG hydrogels accelerate corneal wound healing after vesicant injury offering a therapeutic option for ocular mustard injuries.

  10. Mustard vesicating agent-induced toxicity in the skin tissue and silibinin as a potential countermeasure.

    PubMed

    Tewari-Singh, Neera; Agarwal, Rajesh

    2016-06-01

    Exposure to the vesicating agents sulfur mustard (SM) and nitrogen mustard (NM) causes severe skin injury with delayed blistering. Depending upon the dose and time of their exposure, edema and erythema develop into blisters, ulceration, necrosis, desquamation, and pigmentation changes, which persist weeks and even years after exposure. Research advances have generated data that have started to explain the probable mechanism of action of vesicant-induced skin toxicity; however, despite these advances, effective and targeted therapies are still deficient. This review highlights studies on two SM analogs, 2-chloroethyl ethyl sulfide (CEES) and NM, and CEES- and NM-induced skin injury mouse models that have substantially added to the knowledge on the complex pathways involved in mustard vesicating agent-induced skin injury. Furthermore, employing these mouse models, studies under the National Institutes of Health Countermeasures Against Chemical Threats program have identified the flavanone silibinin as a novel therapeutic intervention with the potential to be developed as an effective countermeasure against skin injury following exposure to mustard vesicating agents.

  11. Brown tumor and staghorn calculi in primary hyperparathyroidism.

    PubMed

    Philip George, Arun Jacob; Banerji, John S

    2013-08-01

    A case of primary hyperparathyroidism with bilateral renal staghorn calculi and brown tumor right thumb is reported in these images, along with the appropriate sequential management. Percutaneous nephrolithotomy (PCNL)was done after management of hypercalcemia and after parathyroidectomy. This case highlights the need for urologists and general practitioners to have a holistic approach in patient management.

  12. Treatment of Renal Calculi with Extracorporeal Shock Wave Lithotripsy

    PubMed Central

    Eberwein, P. M.; Denstedt, J. D.

    1992-01-01

    In 12 years, extracorporeal shock wave lithotripsy has replaced other treatment techniques for most surgical calculi in the upper urinary tract. Worldwide clinical series have documented its efficacy. Technological advances and modifications have significantly expanded the clinical applications of this technique. Imagesp1673-aFigure 3 PMID:21221368

  13. Interventional sialendoscopy for parotid ductal calculi: our preliminary experience.

    PubMed

    Singh, P P; Gupta, Neelima; Goyal, Arun; Tomar, Sanjeev

    2012-09-01

    With this article we present our initial experience with interventional sialendoscopy of the parotid duct for the parotid calculi. We carried out a prospective study of patients of parotid calculi in a tertiary referral centre. Diagnostic and interventional sialendoscopy was performed in five cases of parotid calculi. The outcome was classified on the basis of clearance of the lumen of the duct and resolution of symptoms. Diagnostic sialendoscopy was able to diagnose the calculus in all cases. Interventional sialendoscopy was done under general anesthesia in all cases and calculus was successfully removed. The average size of sialolith was 8.2 mm. No complications occurred in any of the cases. Check sialendoscopy was done in all cases after a minimum follow up of 6 months, which showed the duct lumen to be free of stone with no stricture of the duct. Sialendoscopy is an optimal technique for removal of intraductal parotid calculi and avoids removal of the gland. In our series there was no associated morbidity and complication.

  14. Recurrent recurrent gallstone ileus.

    PubMed

    Hussain, Z; Ahmed, M S; Alexander, D J; Miller, G V; Chintapatla, S

    2010-07-01

    We describe the second reported case of three consecutive episodes of gallstone ileus and ask the question whether recurrent gallstone ileus justifies definitive surgery to the fistula itself or can be safely managed by repeated enterotomies.

  15. Sulfur mustard induces an endoplasmic reticulum stress response in the mouse ear vesicant model

    SciTech Connect

    Chang, Yoke-Chen; Wang, James D.; Svoboda, Kathy K.; Casillas, Robert P.; Laskin, Jeffrey D.; Gordon, Marion K.; Gerecke, Donald R.

    2013-04-15

    The endoplasmic reticulum (ER) stress response is a cell survival pathway upregulated when cells are under severe stress. Severely damaged mouse ear skin exposed to the vesicant, sulfur mustard (bis-2-chloroethyl sulfide, SM), resulted in increased expression of ER chaperone proteins that accompany misfolded and incorrectly made proteins targeted for degradation. Time course studies with SM using the mouse ear vesicant model (MEVM) showed progressive histopathologic changes including edema, separation of the epidermis from the dermis, persistent inflammation, upregulation of laminin γ2 (one of the chains of laminin-332, a heterotrimeric skin glycoprotein required for wound repair), and delayed wound healing from 24 h to 168 h post exposure. This was associated with time related increased expression of the cell survival ER stress marker, GRP78/BiP, and the ER stress apoptosis marker, GADD153/CHOP, suggesting simultaneous activation of both cell survival and non-mitochondrial apoptosis pathways. Dual immunofluorescence labeling of a keratinocyte migration promoting protein, laminin γ2 and GRP78/BIP, showed colocalization of the two molecules 72 h post exposure indicating that the laminin γ2 was misfolded after SM exposure and trapped within the ER. Taken together, these data show that ER stress is induced in mouse skin within 24 h of vesicant exposure in a defensive response to promote cell survival; however, it appears that this response is rapidly overwhelmed by the apoptotic pathway as a consequence of severe SM-induced injury. - Highlights: ► We demonstrated ER stress response in the mouse ear vesicant model. ► We described the asymmetrical nature of wound repair in the MEVM. ► We identified the distribution of various ER stress markers in the MEVM.

  16. The treatment of lower pole renal calculi in 2003.

    PubMed

    Matlaga, Brian R; Assimos, Dean G

    2002-01-01

    The optimal treatment of patients with lower pole renal calculi is still being defined. Shock wave lithotripsy, percutaneous nephrolithotomy, and ureteroscopy are all currently utilized to treat patients with this condition. These methods have yielded varying degrees of success. The influence of collecting system anatomy on shock wave lithotripsy results remains controversial. Ongoing randomized, prospective trials evaluating the efficacy of all of these respective therapeutic options will, it is hoped, determine the best approaches for this patient cohort.

  17. Sulfur mustard induces an endoplasmic reticulum stress response in the mouse ear vesicant model

    PubMed Central

    Chang, Yoke-Chen; Wang, James D.; Svoboda, Kathy K.; Casillas, Robert P.; Laskin, Jeffrey D.; Gordon, Marion K.; Gerecke, Donald R.

    2013-01-01

    The endoplasmic reticulum (ER) stress response is a cell survival pathway upregulated when cells are under severe stress. Severely damaged mouse ear skin exposed to the vesicant, sulfur mustard (bis-2-chloroethyl sulfide, SM), resulted in increased expression of ER chaperone proteins that accompany misfolded and incorrectly made proteins targeted for degradation. Time course studies with SM using the mouse ear vesicant model (MEVM) showed progressive histopathologic changes including edema, separation of the epidermis from the dermis, persistent inflammation, upregulation of laminin γ2 (one of the chains of laminin-332, a heterotrimeric skin glycoprotein required for wound repair), and delayed wound healing from 24 h to 168 h post exposure. This was associated with time related increased expression of the cell survival ER stress marker, GRP78/BiP, and the ER stress apoptosis marker, GADD153/CHOP, suggesting simultaneous activation of both cell survival and non-mitochondrial apoptosis pathways. Dual immunofluorescence labeling of a keratinocyte migration promoting protein, laminin γ2 and GRP78/BIP, showed colocalization of the two molecules 72 h post exposure indicating that the laminin γ2 was misfolded after SM exposure and trapped within the ER. Taken together, these data show that ER stress is induced in mouse skin within 24 h of vesicant exposure in a defensive response to promote cell survival; however, it appears that this response is rapidly overwhelmed by the apoptotic pathway as a consequence of severe SM-induced injury. PMID:23357548

  18. Recurrent Pure Calcite Urolithiasis Confirmed by Endoscopic Removal and Infrared Spectroscopy in a Malnourished Anorectic Female

    PubMed Central

    Andreassen, Kim Hovgaard; Sloth Osther, Palle Jörn

    2016-01-01

    Abstract Often when calcite is found as a component of urinary calculi, they are considered false calculi or artifacts. We present a case of true calcite urolithiasis. The stone material was removed percutaneously from a severely malnourished anorectic woman and analyzed by infrared spectroscopy (IRS). In addition, calcite urolithiasis was confirmed in several recurrent stone events by IRS. Laxative abuse with magnesium oxide was believed to be the underlying cause of stone formation, and ammonium chloride given as one weekly dose turned out to be effective for stone prevention. PMID:27579419

  19. Some critical aspects of FT-IR, TGA, powder XRD, EDAX and SEM studies of calcium oxalate urinary calculi.

    PubMed

    Joshi, Vimal S; Vasant, Sonal R; Bhatt, J G; Joshi, Mihir J

    2014-06-01

    Urinary calculi constitute one of the oldest afflictions of humans as well as animals, which are occurring globally. The calculi vary in shape, size and composition, which influence their clinical course. They are usually of the mixed-type with varying percentages of the ingredients. In medical management of urinary calculi, either the nature of calculi is to be known or the exact composition of calculi is required. In the present study, two selected calculi were recovered after surgery from two different patients for detailed examination and investigated by using Fourier-Transform infrared spectroscopy (FT-IR), thermo-gravimetric analysis (TGA), powder X-ray diffraction (XRD), scanning electron microscopy and energy dispersive analysis of X-rays (EDAX) techniques. The study demonstrated that the nature of urinary calculi and presence of major phase in mixed calculi could be identified by FT-IR, TGA and powder XRD, however, the exact content of various elements could be found by EDAX only.

  20. Citrate and renal calculi: an update

    NASA Technical Reports Server (NTRS)

    Pak, C. Y.

    1994-01-01

    Citrate is an inhibitor of the crystallization of stone-forming calcium salts. Hypocitraturia, frequently encountered in patients with nephrolithiasis, is therefore an important risk factor for stone formation. Potassium citrate provides physiological and physicochemical correction and inhibits new stone formation, not only in hypocitraturic calcium nephrolithiasis but also in uric acid nephrolithiasis. Inhibition of stone recurrence has now been validated by a randomized trial. Ongoing research has disclosed additional causes of hypocitraturia (sodium excess, low intestinal alkali absorption, but not primary citrate malabsorption). Moreover, new insights on potassium citrate action have been shown, notably that some of absorbed citrate escapes oxidation and contributes to the citraturic response, that ingestion with a meal does not sacrifice physiological or physicochemical action, that orange juice mimics but does not completely duplicate its actions, that potassium citrate may have a beneficial bone-sparing effect, that it may reduce stone fragments following ESWL, and that danger of aluminum toxicity is not great in subjects with functioning kidneys. Finally, the research on potassium citrate has led to two promising products, calcium citrate as an optimum calcium supplement and potassium-magnesium citrate which may be superior to potassium citrate in the management of stone disease.

  1. Possible etiology of calculi formation in salivary glands: biophysical analysis of calculus.

    PubMed

    Mimura, Masafumi; Tanaka, Nobuyuki; Ichinose, Shizuko; Kimijima, Yutaka; Amagasa, Teruo

    2005-09-01

    Sialolithiasis is one of the common diseases of the salivary glands. It was speculated that, in the process of calculi formation, degenerative substances are emitted by saliva and calcification then occurs around these substances, and finally calculi are formed. However, the exact mechanism of the formation of calculi is still unclear. In this study, we identify some possible etiologies of calculi formation in salivary glands through biophysical analysis. Calculi from 13 patients with submandibular sialolithiasis were investigated by transmission electron microscopy, scanning electron microscopy, X-ray microanalyzer, and electron diffraction. Transmission electron microscopic observation of calculi was performed in the submandibular gland (n = 13). In 3 of the 13 cases, a number of mitochondria-like structures and lysosomes were found near calcified materials. Scanning electron microscopic examination of these materials revealed that there were lamellar and concentric structures and that the degree of calcification was different among the calculi. X-ray microanalysis disclosed the component elements in the calculi to be Ca, P, S, Na, etc., and the main constituents were Ca and P. The calcium-to-phosphorus ratio was 1.60-1.89. Analysis of the area including mitochondria-like structures, lysosomes, and the fibrous structures by electron diffraction revealed the presence of hydroxyapatite and calcified materials. It is speculated that mitochondria and lysosomal bodies from the ductal system of the submandibular gland are an etiological source for calcification in the salivary gland.

  2. Minimally invasive percutaneous nephrolithotomy guided by ultrasonography to treat upper urinary tract calculi complicated with severe spinal deformity

    PubMed Central

    He, Zhaohui; Zhang, Caixia; Zeng, Guohua

    2016-01-01

    ABSTRACT Objective: To report our experience of minimally invasive percutaneous nephrolithotomy(MPCNL) in managing upper urinary tract calculi complicated with severe spinal deformity. Materials and Methods: Between August 2001 to December 2012, 16 upper urinary calculi in 13 patients with severe spinal deformity were treated by MPCNL. Preoperative investigation of the respiratory function, evaluation of anatomy by intravenous urography (IVU) and CT scan, and preoperative kidney ultrasonagraphy with simulation of the percutaneous puncture were performed in all patients. The percutaneous puncture was guided by ultrasonography. Results: A total of 19 MPCNL procedures were performed in 16 kidneys, with an average 1.2 procedures in each kidney. Three kidneys needed two sessions of MPCNL, and 2 kidneys needed combined treatment with retrograde flexible ureterscopic lithotripsy. All procedures were successfully completed with no major complications during or after surgery. The mean (range) operative duration was 67 (20-150) min and the mean postoperative haemoglobin drop was 1.0 (0.2-3.1) g/dL. Complete stone-free status was achieved in 14 kidneys. At a mean follow-up of 48(3-86) months, recurrence of small lower calyx stone was detected in one patient. Recurrent UTI was documented by urine culture in two patients and managed with sensitive antibiotics. Conclusion: PCNL for patients with severe spinal deformities is challenging. Ultrasonography-assisted puncture can allow safe and successfully establishment of PCN tract through a narrow safety margin of puncture and avoid the injury to the adjacent organs. However, the operation should be performed in tertiary centers with significant expertise in managing complex urolithiasis. PMID:27509373

  3. Types of Renal Calculi and Management Regimen for Chinese Minimally Invasive Percutaneous Nephrolithotomy.

    PubMed

    Gu, Si-Ping; Zeng, Guo-Hua; You, Zhi-Yuan; Lu, Yi-Jin; Huang, Yun-Teng; Wang, Qing-Mao; He, Zhao-Hui

    2015-12-01

    Strict selection of patients for minimally invasive percutaneous nephrolithotomy could effectively improve the success rate of surgery. This study aimed to understand the required skills and the efficacy of mini-PCNL in the treatment of five types of upper ureteral calculi. Data collected after X-ray analysis and B mode ultrasound from 633 patients with upper ureteral and renal pelvis calculi who underwent B ultrasound-guided lithotomy was reviewed, including the following: type I, upper ureteral or renal pelvis calculi with moderate hydronephrosis (154 cases); type II, upper ureteral or renal pelvis calculi with severe hydronephrosis (157 cases); type III, upper ureteral or renal pelvis calculi without hydronephrosis (61 cases); type IV, renal pelvis calculi, one or two renal calyx calculi (206 cases); and type V, renal staghorn calculi (55 cases). Operations on 611 cases were successful. The treatment method for five patients was converted to open surgery. Twelve cases were treated by indwelling double-J tube retro-catheterization and extracorporeal shock wave lithotripsy. Five patients gave up the treatment. The rate of calculus clearance was 82.3 %, and the rate of residual calculus was 17.6 %. Selective renal artery embolization was performed in nine cases. Hydropneumothorax occurred in nine cases. No intestinal fistula occurred, and no patient had to undergo nephrectomy. The difficulty and the curative effect of the operation were different because the types of calculi varied. Selection of the procedure based on the different types of calculi could effectively improve the success rate of the procedure, reduce complications, and shorten the learning curve.

  4. Evaluation of the vesicating properties of neutralized chemical agent identification sets. Final report, November 1995-August 1997

    SciTech Connect

    Olajos, E.J.; Salem, H.; Gieseking, J.K.

    1997-08-01

    Vesication and skin irritation studies were conducted in hairless guinea-pigs to determine the vesicant and skin irritation potential of Chemical Agent Identification Sets (CAIS). Guinea-pigs were topically dosed with `test article` NEAT HD, 10% agent/chloroform solutions, or product solutions (wastestreams) and evaluated for skin-damaging effects (gross and light microscopic). Product solutions from the chemical neutralization of neat sulfur mustard resulted in microvesicle formation (vesication). All agent-dosed (agent/chloroform solutions or HD) sites exhibited microblisters, as well as other histopathologic lesions of the skin. Wastestreams from the neutalization of agent (agent/chloroform; agent on charcoal) were devoid of microvesicant activity. Dermal irritant effects (erythema and edema) were consistent with the skin-injurious activity associated with the neutralizing reagent 1,3-dichloro-5,5-dimethylhydantoin (DCDMH).

  5. A rare entity in adults: Bilateral Hutch diverticulum with calculi

    PubMed Central

    Telli, Onur; Guclu, Adil Gucal; Haciyev, Perviz; Burgu, Berk; Gogus, Cagatay

    2015-01-01

    Congenital bladder diverticulum (CBD) is a very uncommon entity in adults. CBD could be unilateral or bilateral and is caused by a congenital weakness in the bladder musculature. CBD is differentiated from the paraureteral or Hutch type of diverticula. A 42-year-old male presented with bilateral Hutch diverticulum and multiple diverticulum calculus on intravenous pyelography. Cystoscopy revealed bladder diverticulum just medial to the left ureteral orifice with multiple calculi; the patient successfully underwent endoscopic laser cystolithotripsy with resolution of his urinary tract infection. To the best of our knowledge, this is the first case report presenting stone formation of CBD in an adult. PMID:26029313

  6. Spectral triples and differential calculi related to the Kronecker foliation

    NASA Astrophysics Data System (ADS)

    Matthes, R.; Richter, O.; Rudolph, G.

    2003-04-01

    Following the ideas of Connes and Moscovici, we describe two spectral triples related to the Kronecker foliation, whose generalized Dirac operators are related to first and second order signature operators. We also consider the corresponding differential calculi Ω D, which are drastically different in the two cases. For the second order signature operator we calculate the Chern character of the spectral triple and the Dixmier trace of certain powers of its Dirac operator. As a side-remark, we give a description of a known calculus on the two-dimensional noncommutative torus in terms of generators and relations.

  7. Silibinin, Dexamethasone, and Doxycycline as Potential Therapeutic Agents for Treating Vesicant-Inflicted Ocular Injuries

    PubMed Central

    Tewari-Singh, Neera; Jain, Anil K; Inturi, Swetha; Ammar, David A; Agarwal, Chapla; Tyagi, Puneet; Kompella, Uday B; Enzenauer, Robert W; Petrash, J Mark; Agarwal, Rajesh

    2014-01-01

    There are no effective and approved therapies against devastating ocular injuries caused by vesicating chemical agents sulfur mustard (SM) and nitrogen mustard (NM). Herein, studies were carried out in rabbit corneal cultures to establish relevant ocular injury biomarkers with NM for screening potential efficacious agents in laboratory settings. NM (100 nmol) exposure of the corneas for 2 h (cultured for 24 h), showed increases in epithelial thickness, ulceration, apoptotic cell death, epithelial detachment microbullae formation, and the levels of VEGF, cyclooxygenase-2 (COX-2) and matrix metalloproteinase-9 (MMP-9). Employing these biomarkers, efficacy studies were performed with agent treatments 2 h and every 4 h thereafter, for 24 h following NM exposure. Three agents were evaluated, including prescription drugs dexamethasone (0.1%; anti-inflammatory steroid) and doxycycline (100 nmol; antibiotic and MMP inhibitor) that have been studied earlier for treating vesicant-induced eye injuries. We also examined silibinin (100 µg), a non-toxic natural flavanone found to be effective in treating SM analog-induced skin injuries in our earlier studies. Treatments of doxycycline + dexamethasone, and silibinin were more effective than doxycycline or dexamethasone alone in reversing NM-induced epithelial thickening, microbullae formation, apoptotic cell death, and MMP-9 elevation. However, dexamethasone and silibinin alone were more effective in reversing NM-induced VEGF levels. Doxycycline, dexamethasone and silibinin were all effective in reversing NM-induced COX-2 levels. Apart from therapeutic efficacy of doxycycline and dexamethasone, these results show strong multifunctional efficacy of silibinin in reversing NM-induced ocular injuries, which could help develop effective and safe therapeutics against ocular injuries by vesicants. PMID:22841772

  8. Silibinin, dexamethasone, and doxycycline as potential therapeutic agents for treating vesicant-inflicted ocular injuries

    SciTech Connect

    Tewari-Singh, Neera; Jain, Anil K.; Inturi, Swetha; Ammar, David A.; Agarwal, Chapla; Tyagi, Puneet; Kompella, Uday B.; Enzenauer, Robert W.; Petrash, J. Mark; Agarwal, Rajesh

    2012-10-01

    There are no effective and approved therapies against devastating ocular injuries caused by vesicating chemical agents sulfur mustard (SM) and nitrogen mustard (NM). Herein, studies were carried out in rabbit corneal cultures to establish relevant ocular injury biomarkers with NM for screening potential efficacious agents in laboratory settings. NM (100 nmol) exposure of the corneas for 2 h (cultured for 24 h), showed increases in epithelial thickness, ulceration, apoptotic cell death, epithelial detachment microbullae formation, and the levels of VEGF, cyclooxygenase-2 (COX-2) and matrix metalloproteinase-9 (MMP-9). Employing these biomarkers, efficacy studies were performed with agent treatments 2 h and every 4 h thereafter, for 24 h following NM exposure. Three agents were evaluated, including prescription drugs dexamethasone (0.1%; anti-inflammatory steroid) and doxycycline (100 nmol; antibiotic and MMP inhibitor) that have been studied earlier for treating vesicant-induced eye injuries. We also examined silibinin (100 μg), a non-toxic natural flavanone found to be effective in treating SM analog-induced skin injuries in our earlier studies. Treatments of doxycycline + dexamethasone, and silibinin were more effective than doxycycline or dexamethasone alone in reversing NM-induced epithelial thickening, microbullae formation, apoptotic cell death, and MMP-9 elevation. However, dexamethasone and silibinin alone were more effective in reversing NM-induced VEGF levels. Doxycycline, dexamethasone and silibinin were all effective in reversing NM-induced COX-2 levels. Apart from therapeutic efficacy of doxycycline and dexamethasone, these results show strong multifunctional efficacy of silibinin in reversing NM-induced ocular injuries, which could help develop effective and safe therapeutics against ocular injuries by vesicants. -- Highlights: ► Established injury biomarkers in rabbit corneal culture with nitrogen mustard (NM) ► This NM model is a cost effective

  9. General guidelines for medically screening mixed population groups potentially exposed to nerve or vesicant agents

    SciTech Connect

    Watson, A.P.; Munro, N.B. ); Sidell, F.R. ); Leffingwell, S.S. . Center for Environmental Health and Injury Control)

    1992-01-01

    A number of state and local planners have requested guidance on screening protocols and have expressed interest in sampling body fluids from exposed or potentially exposed individuals as a means of estimating agent dose. These guidelines have been developed to provide a clear statement that could be used by state and local emergency response personnel in the event of a nerve or vesicant agent incident resulting in off-post contamination; maximum protection from harm is the goal. The assumption is that any population group so exposed would be heterogeneous for age, gender, reproductive status, and state of health.

  10. Percutaneous nephroscopic with holmium laser and ultrasound lithotripsy for complicated renal calculi.

    PubMed

    Gu, Zhengqin; Qi, Jun; Shen, Haibo; Liu, Jianhe; Chen, Jianhua

    2010-07-01

    The aim of this work is to validate the clinical efficacy of the high-power holmium:YAG laser with percutaneous nephrolithotripsy (PCNL) in combination with ultrasound lithotripsy for complicated renal calculi. From November 2006 to December 2007, 60 patients with complicated renal calculi were treated with PCNL, where an F24 standard renal access tract was established by percutaneous renal puncture under the guidance of B-mode ultrasound, and stones were fragmented and cleared by high-power holmium laser in combination with ultrasound under an F20.8 nephroscope. Of the 60 patients with complicated renal calculi, 20 were complete staghorn calculi and 30 were partial staghorn calculi, of which six patients were accompanied with renal insufficiency; two were solitary calculi, and eight were caliceal diverticular calculi. Calculi were removed by one attempt in 49 patients and by two attempts in 11 patients; through one tract in 50 patients and through two and three tracts in ten patients. The stone-free rate was 81.7%. No injury to the pleura and abdominal organs occurred during the intraoperative puncture. No postoperative blood transfusion was needed in any patient, nor did fever and secondary hemorrhage occur. The mean operation duration was 98 min (range, 60-150 min), and the mean lithotripsy time was 45 min (range, 30-85 min). Additional postoperative extracorporeal shock wave lithotripsy (ESWL) was performed on six patients. High-power holmium laser PCNL in combination with ultrasound lithotripsy is safe, effective, and minimally invasive, with a high stone-free rate, especially for complicated renal calculi.

  11. Mechanisms Mediating the Vesicant Actions of Sulfur Mustard after Cutaneous Exposure

    PubMed Central

    Shakarjian, Michael P.; Heck, Diane E.; Gray, Joshua P.; Sinko, Patrick J.; Gordon, Marion K.; Casillas, Robert P.; Heindel, Ned D.; Gerecke, Donald R.; Laskin, Debra L.; Laskin, Jeffrey D.

    2010-01-01

    Sulfur mustard (SM), a chemical weapon first employed during World War I, targets the skin, eyes, and lung. It remains a significant military and civilian threat. The characteristic response of human skin to SM involves erythema of delayed onset, followed by edema with inflammatory cell infiltration, the appearance of large blisters in the affected area, and a prolonged healing period. Several in vivo and in vitro models have been established to understand the pathology and investigate the mechanism of action of this vesicating agent in the skin. SM is a bifunctional alkylating agent which reacts with many targets including lipids, proteins, and DNA, forming both intra- and intermolecular cross-links. Despite the relatively nonselective chemical reactivity of this agent, basal keratinocytes are more sensitive, and blistering involves detachment of these cells from their basement membrane adherence zones. The sequence and manner in which these cells die and detach is still unresolved. Much has been discovered over the past two decades with respect to the mechanisms of SM-induced cytotoxicity and the intracellular and extracellular targets of this vesicant. In this review, the effects of SM exposure on the skin are described, as well as potential mechanisms mediating its actions. Successful therapy for SM poisoning will depend on following new mechanistic leads to develop drugs that target one or more of its sites of action. PMID:19833738

  12. Toxicity of vesicant agents scheduled for destruction by the Chemical Stockpile Disposal Program.

    PubMed Central

    Watson, A P; Griffin, G D

    1992-01-01

    The vesicant agents of the unitary chemical munitions stockpile include various formulations of sulfur mustard [bis-(2-chloroethyl) sulfide; agents H, HD, and HT] and small quantities of the organic arsenical Lewisite [dichloro(2-chlorovinyl) arsine; agent L]. These agents can be dispersed in liquid, aerosol, or vapor form and are capable of producing severe chemical burns upon direct contact with tissue. Moist tissues such as the eyes, respiratory tract, and axillary areas are particularly affected. Available data summarizing acute dose response in humans and laboratory animals are summarized. Vesicant agents are also capable of generating delayed effects such as chronic bronchitis, carcinogenesis, or keratitis/keratopathy of the eye under appropriate conditions of exposure and dose. These effects may not become manifest until years following exposure. Risk analysis derived from carcinogenesis data indicates that sulfur mustard possesses a carcinogenic potency similar to that of benzo[a]pyrene. Because mustard agents are alkylating compounds, they destroy individual cells by reaction with cellular proteins, enzymes, RNA, and DNA. Once begun, tissue reaction is irreversible. Mustard agents are mutagenic; data for cellular and laboratory animal assays are presented. Reproductive effects have not been demonstrated in the offspring of laboratory rats. Acute Lewisite exposure has been implicated in cases of Bowen's disease, an intraepidermal squamous cell carcinoma. Lewisite is not known to generate reproductive or teratogenic effects. PMID:1486858

  13. Toxicity of vesicant agents scheduled for destruction by the chemical stockpile disposal program

    SciTech Connect

    Watson, A.P.; Griffin, G.D. )

    1992-11-01

    The vesicant agents of the unitary chemical munitions stockpile include various formulations of sulfur mustard [bis-(2-chloroethyl) sulfide; agents H, HD, and HT] and small quantities of the organic arsenical Lewisite [dichloro(2-chlorovinyl)arsine; agent L]. These agents can be dispersed in liquid, aerosol, or vapor form and are capable of producing severe chemical burns upon direct contact with tissue. Moist tissues such as the eyes, respiratory tract, and axillary areas are particularly affected. Available data summarizing acute dose response in humans and laboratory animals are summarized. Vesicant agents are also capable of generating delayed effects such as chronic bronchitis, carcinogenesis, or keratitis/keratopathy of the eye under appropriate conditions of exposure and dose. These effects may not become manifest until years following exposure. Risk analysis derived from carcinogenesis data indicates that sulfur mustard possesses a carcinogenic potency similar to that of benzo[a]pyrene. Because mustard agents are alkylating compounds, they destroy individual cells by reaction with cellular proteins, enzymes, RNA, and DNA. Once begun, tissue reaction is irreversible. Mustard agents are mutagenic; data for cellular and laboratory animal assays are presented. Reproductive effects have not been demonstrated in the offspring of laboratory rats. Acute Lewisite exposure has been implicated in cases of Bowen's disease, an intraepidermal squamous cell carcinoma. Lewisite is not known to generate reproductive or teratogenic effects. 112 refs., 1 fig., 6 tabs.

  14. Evaluation of protective ointments used against dermal effects of nitrogen mustard, a vesicant warfare agent.

    PubMed

    Kenar, Levent; Karayilanoğlu, Turan; Yuksel, Altan; Gunhan, Omer; Kose, Songul; Kurt, Bulent

    2005-01-01

    Mustard, a vesicant warfare agent, has cytotoxic, mutagenic, and cytostatic effects via alkylation of DNA and inhibition of DNA replication. Since symptoms appear following a latent period, it can cause some subacute and chronic effects to occur and delay in the treatment. Therefore, the main approach should be the use of protective preparation to reduce the skin toxicity. Thus, this study was conducted in guinea pigs (350-400 g) shaved in areas of 10 x 10 cm. Mechlorethamine HCl (100 mg), a nitrogen mustard derivative, in ethanol was applied by spraying on hairless regions where previously prepared pharmaceutical topical formulations were medicated before. The experimental regions of the animals were kept preserved from environmental factors. Forty-eight hours after the application of the protective ointments and mechlorethamine consecutively, skin-damaging effects were macroscopically evaluated in terms of erythema formation, ulceration, necrosis, and inflammation occurrences. Then, punch biopsy was performed from these damaged sites for histopathological evaluation. Although numerous topical formulations were prepared and tested for protection, according to microscopic examination of the pathologic sections, tissue specimen treated with the ointment containing the mixture of zinc oxide, zinc chloride, dimethylpolysiloxane in a base of petroleum jelly was determined as being the most effective protective against skin injury caused by the vesicant agent.

  15. Formation of bobierrite (magnesium phosphate) crystal aggregates by bacteria from human urine and renal calculi.

    PubMed

    del Moral, A; Rivadeneyra, M A; Roldán, E; Perez-García, I; Ramos-Cormenzana, A; García-Cervigón, A

    1989-01-01

    The formation of extracellular crystal aggregates of bobierrite [Mg3(PO4)2.8H2O] by bacteria isolated from renal calculi and urine of urolithiasic patients is found with the use of B-17 and B-43 media. The crystal aggregates were observed in the colonies as deposits of brown-yellow coloration, and were identified by X-ray powder diffraction, chemical analysis and scanning electron microscopy. The production of bobierrite by bacteria from human urine and renal calculi implies further versatility of crystal formation by microorganisms, and it may be interesting to investigate the possible relationships between calculi precipitation and urinary infection.

  16. [Rigid ureteroscopy and the pulsed laser. Apropos of 325 treated calculi].

    PubMed

    Gautier, J R; Leandri, P; Rossignol, G; Quintens, H; Caissel, J

    1990-01-01

    A pulsed dye laser (Candela) was used in our lithiasis treatment center during the period 02/88-09/89 to remove 325 calculi in 278 patients, requiring 285 endoscopic instrumentations. The pulsed laser allowed to obtain fragmentation of 318 calculi, 238 of which were reduced to thin sand and 80 to coarser fragments. The latter were either cleared using a Dormia probe or further disintegrated by electrohydrolytic shock wave treatment or extracorporeal shock wave lithotripsy (ESWL). No complication imputable to laser stone fragmentation was noted. Failure of stone clearance was chiefly due to the nature and shape of the stone (black, smooth monohydrated calcium oxalate calculi). The thinness of the laser fiber has made it possible to use small caliber ureteroscopes, thereby increasing the reliability of ureteroscopy. Coupled with ESWL (EDAP LT01), this technique has caused the rate of open surgical removal of ureter confined calculi to fall from 11% to 1%.

  17. Surgical treatment of incarcerated calculi via laparoscopic bile duct exploration using laparotomy biliary lithotomy forceps

    PubMed Central

    Jiang, H.; Wang, S. Y.; Jin, X. L.; Jin, J. C.; Gu, H. B.; Zhang, F. M.

    2016-01-01

    The present study aimed to investigate the practicability and clinical value of applying laparotomy biliary lithotomy forceps to laparoscopic bile duct exploration (LCBDE) for the surgical treatment of incarcerated calculi. A total of 63 patients were diagnosed with cholecystolithiasis and choledocholithiasis. The present study performed a retrospective analysis of clinical samples from 16 of these patients who had incarcerated calculi at the terminus of the common bile duct, and who had been treated with laparoscopic cholecystectomy and LCBDE. During the procedure, laparotomy biliary lithotomy forceps were used to gently remove the calculi from the common bile duct. Of the surgical procedures that used laparotomy biliary lithotomy forceps, one case was unsuccessful and 15 cases were successful. The results of the present study suggested that it may be clinically advisable to use laparotomy biliary lithotomy forceps to remove incarcerated calculi from the common bile duct during a laparoscopy, since it is easy, economical and effective. PMID:27698730

  18. The role of laparoscopic surgery for renal calculi management

    PubMed Central

    Kijvikai, Kittinut

    2011-01-01

    To date, most cases of renal calculi have been managed with extracorporeal shockwave lithotripsy and endoscopic procedures. However, for complex renal stone conditions, these minimally invasive procedures may require multiple operative sessions. Open surgery is usually reserved as a salvage procedure, although it is invasive in nature. Laparoscopic treatment is well accepted in renal surgery. For stone disease, it can duplicate open surgical techniques such as pyelolithotomy, pyeloplasty, anatrophic nephrolithotomy, caliceal diverticulectomy and nephrectomy. Although the laparoscopic techniques for stone treatment are quite challenging, it is both feasible and safe. Laparoscopic treatment is a viable option for large renal stone treatment with an excellent stone-free rate, especially when patients require their stones to be treated within a single session. However, it is more invasive in nature than endourology procedures and so should be reserved as the last resort option for renal stone management in the modern endourology era. PMID:21789095

  19. Medullary Sponge Kidney and Urinary Calculi Aeromedical Concerns

    NASA Technical Reports Server (NTRS)

    Jones, Jeffrey A.; Cherian, Sebastian F.; Barr, Yael R.; Stocco, Amber

    2008-01-01

    Medullary Sponge Kidney (MSK) is a benign disorder associated with renal stones in 60% of patients. Patients frequently have episodic painless hematuria but are otherwise asymptomatic unless renal calculi or infections complicate the disease. Nephrolithiasis is a relative, but frequently enforced, contraindication to space or other high performance flight. Two case reports of asymptomatic NASA flight crew with MSK and three cases of military aviators diagnosed with MSK are reviewed, all cases resulted in waiver and return to flight status after treatment and a vigorous follow up and prophylaxis protocol. MSK in aviation and space flight necessitates a highly case-by-case dependent evaluation and treatment process to rule out other potential confounding factors that might also contribute to stone formation and in order to re-qualify the aviator for flight duties.

  20. Spectroscopic analysis of urinary calculi and inhibition of their growth

    NASA Astrophysics Data System (ADS)

    Manciu, Felicia; Durrer, William; Govani, Jayesh; Reza, Layra; Pinales, Luis

    2009-10-01

    We present here a study of kidney stone formation and growth inhibition based on a traditional medicine approach with Aquatica Lour (RAL) herbal extracts. Kidney stone material systems were synthesized in vitro using a simplified single diffusion gel growth technique. With the objective of revealing the mechanism of inhibition of calculi formation by RAL extracts, samples prepared without the presence of extract, and with the presence of extract, were analyzed using Raman, photoluminescence, and XPS. The unexpected presence of Zn revealed by XPS in a sample prepared with RAL provides an explanation for the inhibition process, and also explains the dramatic reflectance of incident light observed in attempts to obtain infrared transmission data. Raman data are consistent with the binding of the inhibitor to the oxygen of the kidney stone. Photoluminescence data corroborate with the other results to provide additional evidence of Zn-related inhibition.

  1. [Experiences with transparenchymal coral calculi removal under local hypothermia].

    PubMed

    Albert, L; Zacher, W; Meyer, S

    1984-06-01

    Under certain conditions genuine coral calculi are an absolute offication for nephrotomy. In order to achieve complete hygienization of the cavity ischaemia times of more than 25-30 min are often necessary. Controlled surface cooling proved to be very good for improving ischaemia tolerance and reducing post-ischaemic loss of function in 21 necessary nephrotomies out of a total of 651 operations for concrements in the calyx system of the renal pelvis (= 3.2%; = 32.8% of all nephrotomies). A kidney thermometer with a temperature feeler developed by us allows fine control of the hypothermia induced by means of plastic bags filled with ice crystals. The technique of operation together with its advantages and disadvantages are described.

  2. Ultrasonic parameters of renal calculi and gall bladder stones as a function of density.

    PubMed

    Agarwal, R

    1998-01-01

    In this investigation, ultrasonic parameters of complex renal calculi and gall bladder stones, in vitro are measured using a double-probe contact by pulse-echo technique. Due to the variation in the chemical composition of the stones, a large variation in the value of ultrasonic parameters is found. A correlation between ultrasonic parameters and various renal calculi and gall bladder stone pathologies are also discussed. The ultrasonic parameters are found to vary as a function of density of the specimen used.

  3. Treatment of ureteral calculi with an 8.3-Fr. disposable shaft rigid ureteroscope.

    PubMed

    D'Amico, F C; Belis, J A

    1996-01-01

    One hundred forty-two adult patients underwent ureteroscopy for treatment of ureteral calculi using a disposable shaft semirigid mini-ureteroscope. The ureteroscope has an 8.3-French (Fr.) outer diameter with a fiberoptic core that allows some flexibility of the shaft. It has a 4.0-Fr. working channel that allows simultaneous use of 3-Fr. instruments and irrigation. Twenty-nine patients had upper ureteral calculi and 113 patients had lower ureteral calculi. Forty-eight patients did not require ureteral dilation, and the remainder had minimal dilation to 10-12 Fr. One hundred fifteen patients underwent laser lithotripsy, 15 patients underwent basket extraction, and 12 patients underwent both. Ten patients required use of a flexible ureteroscope. Ninety-three percent of the patients went home the day of the procedure, 4% stayed one night in the hospital, and the remaining three percent had longer hospital stays. No major complications or infections were noted. Only 11% of the patients required intravenous or intramuscular narcotics for pain management postoperatively. The stone-free results at one month were 98% for lower ureteral calculi and 93% for upper ureteral calculi. We have found this ureteroscope to be similar to other rigid mini-ureteroscopes with some additional advantages. A larger working channel, increased flexibility, and improved optics make it useful for treating ureteral calculi in the lower ureter in men and the entire ureter in selected women.

  4. Symptomatic treatment of ascites with a peritoneo-vesical automated fluid shunt system in a dog.

    PubMed

    Venzin, C; Kook, P; Jenni, S; Wilhelm, S; Degen, T; Braun, A; Rütten, M; Glaus, T M

    2012-02-01

    A six-year-old Rottweiler with chronic ascites and moderate panhypoproteinaemia that had been treated with large volume paracentesis over several months duration was diagnosed with a large bi-atrial mass and hepatic fibrosis. For palliative treatment, a peritoneo-vesical automated fluid shunt system with an integrated chargeable battery and an integrated computer to control pump function and to transmit data transcutaneously was implanted by coeliotomy. The pump was left in place for 10 weeks, eliminating the need for further paracentesis during this time. At the end of this period, no ascites was discernible and serum protein concentrations had returned to their respective reference intervals. As a complication, decubitus with skin perforation had developed above the pump. Besides palliative treatment of chronic refractory ascites, this pump may have application in other conditions characterised by chronic cavity effusion or in peritoneal dialysis.

  5. Outcome and complications of percutaneous nephrolithotomy as primary versus secondary procedure for renal calculi

    PubMed Central

    Krishna Reddy, S. V.; Shaik, Ahammad Basha

    2016-01-01

    ABSTRACT Purpose To compare the efficacy of percutaneous nephrolithotomy (PCNL) as a primary procedure of patients following previous open surgery or post percutaneous nephrolithotomy (PCNL) for renal calculi. Materials and Methods The medical records of 367 patients who underwent PCNL by a single surgeon from January 2008 to December 2013 were reviewed retrospectively. All patients were divided into 3 Groups. Group-1 (n=232) included patients with no history of ipsilateral open stone surgery. Group 2 (n=86) patients had undergone one or more open stone surgeries before PCNL, patients with failed or recurrence following PCNL were placed in Group-3 (n=49). The demographic data, operation duration, stone free rate (SFR), number of attempts to access the collecting system and intra operative and postoperative complications between the three Groups were compared. Results There was no difference in sex, Body Mass Index (BMI), stone burden and laterality among the three Groups. Operation time was significantly less in first Group, while there was a statistically significant difference in operation duration between second and third Groups (p<0.05). The number of attempts to enter the collecting system was lower in the first Group in comparison to other two Groups (p<0.5). There was no significant differences among three groups in stone free rate. Intra operative and postoperative complications were slightly more frequent in Groups 2 and 3. Mortality occurred in 1 patient with colon perforation in Group-2. Conclusion Our study demonstrated that PCNL can be performed in patients even as secondary procedure without further complications. PMID:27256180

  6. The role of climate on prevalence or eradication of vesical schistosomiasis in Khuzestan Province of Iran.

    PubMed

    Hamidinia, Dariush; Maraghi, Sharif; Azimi, Farideh; Ai, Armin; Shirian, Sadegh

    2016-06-01

    Climate is defined as the combination of climate and air elements of a given region which is usually measured for a period of decades. De-marton climate classification has been established based on many factors, including elements such as temperature and rainfall. Vesicle schistosomiasis is a parasitic disease caused by Schistosoma haematobium. This parasite lives in the blood vessels of the bladder. The parasite can cause hematuria in human and if not treated properly can lead to vesicale carcinoma. The parasite is distributed only in certain parts of the province and it is highly dispersed along the rivers of Dez, Karkheh and Karun with high emissions. In 1970, the prevalence of infection in infected foci was 23.8 %. Campaign against the parasite began in 1958 but it did not encompass all centers of infection. Preventive measures include diagnosis and treatment of patients, public health promotion, health education, drying swamps and ponds, improving the environment, cementing the irrigation canals, and the use of moluscocide eventually leads to changing the ecological and conditions of parasite and snail inhabits. Application of preventive measures resulted in the reduction of infection level to 0.7 % in 1979. By continuing struggle and intensifying preventive measures and changing ecological and climatic environment, in 2008, the examination of 3400 urine samples of students in Andimeshk district revealed no cases of the vesical schistosomiasis. It is concluded that S. haematobium and vesical schistosomiasis is eliminated from Khuzestan province southwest Iran, but the disease is still prevalent in neighboring Iran's western border country (Iraq) and due to the special conditions of its facilities and the traffic between the two countries, it is necessary to control and eradicate the disease in Iraq by using the experiences of Iran in eliminating the disease.

  7. Recurrent vulvovaginitis.

    PubMed

    Powell, Anna M; Nyirjesy, Paul

    2014-10-01

    Vulvovaginitis (VV) is one of the most commonly encountered problems by a gynecologist. Many women frequently self-treat with over-the-counter medications, and may present to their health-care provider after a treatment failure. Vulvovaginal candidiasis, bacterial vaginosis, and trichomoniasis may occur as discreet or recurrent episodes, and have been associated with significant treatment cost and morbidity. We present an update on diagnostic capabilities and treatment modalities that address recurrent and refractory episodes of VV.

  8. Meningioma recurrence

    PubMed Central

    Bencze, János; Varkoly, Gréta; Kouhsari, Mahan C; Klekner, Álmos

    2016-01-01

    Abstract Meningioma accounts for more than 30% of all intracranial tumours. It affects mainly the elderly above the age of 60, at a female:male ratio of 3:2. The prognosis is variable: it is usually favourable with no progression in tumour grade and no recurrence in WHO grade 1 tumours. However, a minority of tumours represent atypical (grade 2) or anaplastic (grade 3) meningiomas; this heterogeneity is also reflected in histopathological appearances. Irrespective of the grade, the size of the tumour and the localisation may have severe, sometimes lethal consequences. Following neurosurgical interventions to remove the tumour, recurrence and progression in WHO grade may occur. Our knowledge on predisposing histomorphological and molecular factors of recurrence is rather limited. These can be classified as I) demographic II) environmental, III) genetic and epigenetic IV) imaging, V) neuropathological, and VI) neurosurgical. In view of the complex background of tumour recurrence, the recognition of often subtle signs of increased risk of recurrence requires close collaboration of experts from several medical specialties. This multidisciplinary approach results in better therapy and fewer complications related to tumour recurrence. PMID:28352788

  9. Recurrence of primary hyperoxaluria after kidney transplantation.

    PubMed

    Malakoutian, Tahereh; Asgari, Mojgan; Houshmand, Massoud; Mohammadi, Ronak; Aryani, Omid; Mohammadi Pargoo, Esmaeel; Ghods, Ahad J

    2011-11-01

    Primary hyperoxaluria is a genetic disorder in glyoxylate metabolism that leads to systemic overproduction of oxalate. Functional deficiency of alanine-glyoxylate aminotransferase in this disease leads to recurrent nephrolithiasis, nephrocalcinosis, systemic oxalosis, and kidney failure. We present a young woman with end-stage renal disease who received a kidney allograft and experienced early graft failure presumed to be an acute rejection. There was no improvement in kidney function, and she was required hemodialysis. Ultimately, biopsy revealed birefringent calcium oxalate crystals, which raised suspicion of primary hyperoxaluria. Further evaluations including genetic study and metabolic assay confirmed the diagnosis of primary hyperoxaluria type 1. This suggests a screening method for ruling out primary hyperoxaluria in suspected cases, especially before planning for kidney transplantation in patients with end-stage renal disease who have nephrocalcinosis, calcium oxalate calculi, or a family history of primary hyperoxaluria.

  10. In-vitro Comminution of Model Renal Calculi using Histotripsy

    PubMed Central

    Duryea, Alexander P.; Maxwell, Adam D.; Roberts, William W.; Xu, Zhen; Hall, Timothy L.; Cain, Charles A.

    2013-01-01

    Shock wave lithotripsy (SWL) suffers from the fact that it can produce residual stone fragments of significant size (>2 mm). Mechanistically, cavitation has been shown to play an important role in the reduction of such fragments to smaller debris. In this study we assessed the feasibility of using cavitationally-based pulsed ultrasound therapy (histotripsy) to erode kidney stones. Previous work has shown that histotripsy is capable of mechanically fractionating soft tissue into fine, acellular debris. Here, we investigated the potential for translating this technology to renal calculi through the use of a commonly accepted stone model, Ultracal-30 cement. Stones were sonicated using a 1-MHz focused transducer, with 5-cycle pulses delivered at a rate of 1 kHz. Pulses having peak negative pressures ranging from 3–21 MPa were tested. Results indicate that histotripsy is capable of effectively eroding the Ultracal-30 model, achieving an average stone erosion rate of 26 mg/min at maximum treatment pressure; substantial stone erosion was only observed in the presence of a dense cavitational bubble cloud. Sequential sieving of residual stone fragments indicated that debris produced by histotripsy was smaller than 100 μm in size, and treatment monitoring showed that both the cavitational bubble cloud and model stone appear as hyperechoic regions on B-mode imaging. These preliminary results indicate that histotripsy shows promise in its use for stone comminution, and an optimized erosion process may provide a potential adjunct to conventional SWL procedures. PMID:21622053

  11. Salivary gland calculi – contemporary methods of imaging

    PubMed Central

    Rzymska-Grala, Iwona; Stopa, Zygmunt; Grala, Bartłomiej; Gołębiowski, Marek; Wanyura, Hubert; Zuchowska, Anna; Sawicka, Monika; Zmorzyński, Michał

    2010-01-01

    Summary Sialolithiasis is the most common disorder of major salivary glands. The main site of salivary stones’ formation is submandibular gland, followed by parotid and sublingual gland. The aim of this article was to present current diagnostic imaging modalities carried out in patients suspected with salivary stones on the basis of own material and review of literature. Current diagnostic imaging tools used in the imaging of salivary stones were described and illustrated in this paper. These are: conventional radiography, sialography, ultrasonography, computed tomography, magnetic resonance sialography and sialoendoscopy. Digital subtraction sialography and ultrasonography are the methods of choice in the imaging of salivary gland calculi. Although sialography is a very old diagnostic method, still it is the best diagnostic tool in the imaging of subtle anatomy of salivary gland duct system. Digital subtraction sialography can show the exact location of salivary stone and enables imaging of salivary ducts’ pathology (e.g. stenoses), which is especially important when sialoendoscopy is planned. Sialography is also used as the treatment method, i.e. interventional sialography. Nonenhanced computed tomography is recommended when multiple and tiny salivary stones are suspected. Magnetic resonance imaging is the evolving alternative diagnostic method. In this diagnostic modality there is no need for salivary ducts’ cannulation and administration of contrast material. Thus magnetic resonance sialography can also be carried out in the acute sialoadenitis. In the future, sialoendoscopy may become one of the main diagnostic and treatment procedures for salivary duct disorders, especially in salivary stone cases. PMID:22802788

  12. Inflamed urachal cyst containing calculi in an adult.

    PubMed

    Milotic, Franko; Fuckar, Zeljko; Gazdik, Miljen; Cicvaric, Tedi; Milotic, Irena; Zauhar, Gordana

    2002-05-01

    The urachus is an embryonic structure that persists after birth in some individuals and can cause various problems. We report a case of an inflamed urachal cyst filled with a thick yellow fluid and several calculi in a woman with a 1-month history of dysuria. Physical examination revealed a fist-sized tumor located infraumbically in the midline. The patient's erythrocyte sedimentation rate was elevated; the results of all other routine laboratory studies were normal. Sonography showed a regularly shaped, ovoid, hypoechoic cystic area in the abdominal wall measuring 8 x 4 x 3 cm and containing several hyperechoic masses associated with acoustic shadowing. The wall of the cyst was inhomogeneous, and a thin hypoechoic linear tract linked the superior aspect of the mass to the umbilicus. The results of excretory urography, voiding cystography, and cystoscopy excluded an abnormality of the urinary system. A urachal cyst was diagnosed, and the mass was surgically removed. The surgical specimen was sent for histopathologic analysis, which confirmed the diagnosis.

  13. The feasibility of using microwave-induced thermoacoustic tomography for detection and evaluation of renal calculi.

    PubMed

    Cao, Caijun; Nie, Liming; Lou, Cunguang; Xing, Da

    2010-09-07

    Imaging of renal calculi is important for patients who suffered a urinary calculus prior to treatment. The available imaging techniques include plain x-ray, ultrasound scan, intravenous urogram, computed tomography, etc. However, the visualization of a uric acid calculus (radiolucent calculi) is difficult and often impossible by the above imaging methods. In this paper, a new detection method based on microwave-induced thermoacoustic tomography was developed to detect the renal calculi. Thermoacoustic images of calcium oxalate and uric acid calculus were compared with their x-ray images. The microwave absorption differences among the calcium oxalate calculus, uric acid calculus and normal kidney tissue could be evaluated by the amplitude of the thermoacoustic signals. The calculi hidden in the swine kidney were clearly imaged with excellent contrast and resolution in the three orthogonal thermoacoustic images. The results indicate that thermoacoustic imaging may be developed as a complementary method for detecting renal calculi, and its low cost and effective feature shows high potential for clinical applications.

  14. Outcomes of urethral calculi patients in an endemic region and an undiagnosed primary fossa navicularis calculus.

    PubMed

    Verit, Ayhan; Savas, Murat; Ciftci, Halil; Unal, Dogan; Yeni, Ercan; Kaya, Mete

    2006-02-01

    Urethral calculus is a rare form of urolithiasis with an incidence lower than 0.3%. We determined the outcomes of 15 patients with urethral stone, of which 8 were pediatric, including an undiagnosed primary fossa navicularis calculus. Fifteen consecutive male patients, of whom eight were children, with urethral calculi were assessed between 2000 and 2005 with a mean of 19 months' follow-up. All stones were fusiform in shape and solitary. Acute urinary retention, interrupted or weak stream, pain (penile, urethral, perineal) and gross hematuria were the main presenting symptoms in 7 (46.7%), 4 (26.7%), 3 (20%) and 1 (6.6%) patient, respectively. Six of them had accompanying urethral pathologies such as stenosis (primary or with hypospadias) and diverticulum. Two patients were associated with upper urinary tract calculi but none of them secondary to bladder calculi. A 50-year-old patient with a primary urethral stone disease had urethral meatal stenosis accompanied by lifelong lower urinary tract symptoms. Unlike the past reports, urethral stones secondary to bladder calculi were decreasing, especially in the pediatric population. However, the pediatric patients in their first decade are still under risk secondary to the upper urinary tract calculi or the primary ones.

  15. Recurrent novae

    NASA Technical Reports Server (NTRS)

    Hack, Margherita; Selvelli, Pierluigi

    1993-01-01

    Recurrent novae seem to be a rather inhomogeneous group: T CrB is a binary with a M III companion; U Sco probably has a late dwarf as companion. Three are fast novae; two are slow novae. Some of them appear to have normal chemical composition; others may present He and CNO excess. Some present a mass-loss that is lower by two orders of magnitude than classical novae. However, our sample is too small for saying whether there are several classes of recurrent novae, which may be related to the various classes of classical novae, or whether the low mass-loss is a general property of the class or just a peculiarity of one member of the larger class of classical novae and recurrent novae.

  16. Computer-aided detection of renal calculi from noncontrast CT images using TV-flow and MSER features

    SciTech Connect

    Liu, Jianfei; Wang, Shijun; Turkbey, Evrim B.; Yao, Jianhua; Summers, Ronald M.; Linguraru, Marius George

    2015-01-15

    Purpose: Renal calculi are common extracolonic incidental findings on computed tomographic colonography (CTC). This work aims to develop a fully automated computer-aided diagnosis system to accurately detect renal calculi on CTC images. Methods: The authors developed a total variation (TV) flow method to reduce image noise within the kidneys while maintaining the characteristic appearance of renal calculi. Maximally stable extremal region (MSER) features were then calculated to robustly identify calculi candidates. Finally, the authors computed texture and shape features that were imported to support vector machines for calculus classification. The method was validated on a dataset of 192 patients and compared to a baseline approach that detects calculi by thresholding. The authors also compared their method with the detection approaches using anisotropic diffusion and nonsmoothing. Results: At a false positive rate of 8 per patient, the sensitivities of the new method and the baseline thresholding approach were 69% and 35% (p < 1e − 3) on all calculi from 1 to 433 mm{sup 3} in the testing dataset. The sensitivities of the detection methods using anisotropic diffusion and nonsmoothing were 36% and 0%, respectively. The sensitivity of the new method increased to 90% if only larger and more clinically relevant calculi were considered. Conclusions: Experimental results demonstrated that TV-flow and MSER features are efficient means to robustly and accurately detect renal calculi on low-dose, high noise CTC images. Thus, the proposed method can potentially improve diagnosis.

  17. Adenoid cystic carcinoma of the parotid gland associated with salivary calculi: An unusual presentation.

    PubMed

    Shenoy, Vijendra S; Kamath, M Panduranga; Sreedharan, Suja; Suhas, S S

    2015-01-01

    Adenoid cystic carcinomas (ACC) of the head and neck are relatively rare tumors, consisting of approximately 10-15% of all salivary gland neoplasms. ACC, a slow-growing aggressive malignant tumor of salivary gland commonly seen in the submandibular, sublingual, minor salivary glands is seldom found in the parotid. Calculus, the common cause of salivary gland dysfunction is usually identified in submandibular salivary gland because of its duct anatomy and physiochemical characteristic serous secretion. We report an unusual case of co-existent presentation of ACC with salivary calculi in the parotid gland which is never been reported in the literature. Co-existence of ductal calculi and ACC is rare. Presence of parotid calculus could be due to long standing ductal obstruction by the slow-growing ACC of the parotid or other possibility is that the malignancy could have developed because of chronic irritation by parotid calculi. Confirmatory studies are required to understand its mutual pathological association.

  18. Current role of microperc in the management of small renal calculi

    PubMed Central

    Sabnis, Ravindra B; Ganesamoni, Raguram; Ganpule, Arvind P; Mishra, Shashikant; Vyas, Jigish; Jagtap, Jitendra; Desai, Mahesh

    2013-01-01

    ‘Microperc’ is a recently described technique in which percutaneous renal access and lithotripsy are performed in a single step using a 16 G micropuncture needle. ‘Mini-microperc’ is a further technical modification in which an 8 Fr sheath is used to allow insertion of ultrasonic or pneumatic lithoclast probe with suction. The available evidence indicates that microperc is safe and efficient in the management of small renal calculi in adult and pediatric population. It can also be used for renal calculi in ectopic kidneys and bladder calculi. The high stone clearance rate and lower complication rate associated with microperc make it a viable alternative to retrograde intrarenal surgery. PMID:24082443

  19. Optimization of supervised self-organizing maps with genetic algorithms for classification of urinary calculi

    NASA Astrophysics Data System (ADS)

    Kuzmanovski, Igor; Trpkovska, Mira; Šoptrajanov, Bojan

    2005-06-01

    Supervised self-organizing maps were used for classification of 160 infrared spectra of urinary calculi composed of calcium oxalates (whewellite and weddellite), pure or in binary or ternary mixtures with carbonate apatite, struvite or uric acid. The study was focused to such calculi since more than 80% of the samples analyzed contained some or all of the above-mentioned constituents. The classification was done on the basis of the infrared spectra in the 1450-450 cm -1 region. Two procedures were used in order to find the most suitable size and for optimizing the self-organizing map of which that using the genetic algorithms gave better results. Using this procedure several sets of solutions with zero misclassifications were obtained. Thus, the self-organizing maps may be considered as a promising tool for qualitative analysis of urinary calculi.

  20. Melamine-induced infant urinary calculi: a report on 24 cases and a 1-year follow-up.

    PubMed

    Zhang, Xiangbo; Bai, Jinliang; Ma, Pengcheng; Ma, Jianhua; Wan, Jianghou; Jiang, Bin

    2010-10-01

    Melamine has been the main factor leading to infant urinary calculi occurring on a rather wide scale in China in 2008, which were the results of a rapid aggradation of metabolites such as cyanuric acid diamide, cyanuric acid, etc., causing uric acid stone to accumulate. Here, we present a report on 24 infants who were admitted to our department, their ages ranging from 3 to 10 months. All of these infants had a confirmed history of having been fed with the "Sanlu" brand milk powder, which contained excessive levels of melamine, with the highest being 2,563 mg/kg. The diagnosis, medical treatment and follow-up by ultrasonography at 1, 3, 6, 12 months were reported. 22 cases of these infants were rehabilitated after medical treatment and 1 infant underwent pyelolithotomy for relieving an obvious ureter obstruction. No recurrence was found in these babies thereafter. Another infant died from rapidly worsening renal failure. Therefore, this series of cases have demonstrated that melamine contained in the "Sanlu" milk powder was the main cause of these urinary stones. Urine alkalinization and stone liberalization were the most effective treatments. Fast diagnosis and treatment of acute obstructive urolithiasis may prevent the development of acute renal failure, which is associated with high morbidity and mortality rates.

  1. Transurethral holmium-YAG laser lithotripsy for large symptomatic prostatic calculi: initial experience.

    PubMed

    Goyal, Neeraj Kumar; Goel, Apul; Sankhwar, Satyanarayan

    2013-08-01

    Symptomatic prostatic calculi are a rare clinical entity with wide range of management options, however, there is no agreement about the preferred method for treating these symptomatic calculi. In this study we describe our experience of transurethral management of symptomatic prostatic calculi using holmium-YAG laser lithotripsy. Patients with large, symptomatic prostatic stones managed by transurethral lithotripsy using holmium-YAG laser over 3-year duration were included in this retrospective study. Patients were evaluated for any underlying pathological condition and calculus load was determined by preoperative X-ray KUB film/CT scan. Urethrocystoscopy was performed using 30° cystoscope in lithotomy position under spinal anesthesia, followed by transurethral lithotripsy of prostatic calculi using a 550 μm laser fiber. Stone fragments were disintegrated using 100 W laser generators (VersaPulse PowerSuite 100 W, LUMENIS Surgical, CA). Larger stone fragments were retreived using Ellik's evacuator while smaller fragments got flushed under continuous irrigation. Five patients (median age 42 years) with large symptomatic prostatic calculi were operated using the described technique. Three patients had idiopathic stones while rest two had bulbar urethral stricture and neurogenic bladder, respectively. Median operative time was 62 min. All the patients were stone free at the end of procedure. Median duration of catheterization was 2 days. Significant improvement was observed in symptoms score and peak urinary flow and none of the patient had any complication. Transurethral management using holmium-YAG laser lithotripsy is a safe and highly effective, minimally invasive technique for managing symptomatic prostatic calculi of all sizes with no associated morbidity.

  2. Mucoadhesion on pig vesical mucosa: influence of polycarbophil/calcium interactions.

    PubMed

    Kerec, M; Bogataj, M; Mugerle, B; Gasperlin, M; Mrhar, A

    2002-07-08

    The influence of polycarbophil/calcium interactions on the mucoadhesive properties of polycarbophil has been examined. Polycarbophil dispersions and films with different concentrations of calcium or sodium ions were prepared and the following parameters were measured: detachment force on pig vesical mucosa, zeta potential, pH and viscosity. Polycarbophil detachment force decreased significantly in the presence of calcium but not sodium. Both ions decrease the pH of polycarbophil dispersions. On the other hand, altering the pH of hydrated polycarbophil films in the absence of added ions had an insignificant effect on detachment force. Both ions reduce the absolute values of polycarbophil zeta potential, calcium more efficiently than sodium. We could conclude that decreased mucoadhesion strength of polycarbophil in the presence of calcium is due to the chelation of polycarbophil carboxylic groups by calcium and crosslinking of polymer. The crosslinked polymer chains would be expected to be less flexible, and therefore, interpenetrate to a lesser extent with the glycosaminoglycans of mucus. Additionally, the interactions between functional groups of polycarbophil and mucus glycosaminoglycans are lowered due to the calcium, blocking the carboxylic groups. The mechanism of calcium influence on viscosity of polycarbophil dispersions appears to be different: repulsion between ionised carboxylic groups of polycarbophil prevails over the crosslinking of polycarbophil by calcium.

  3. The correlation between zeta potential and mucoadhesion strength on pig vesical mucosa.

    PubMed

    Bogataj, Marija; Vovk, Tomaz; Kerec, Mojca; Dimnik, Ales; Grabnar, Iztok; Mrhar, Ales

    2003-05-01

    The detachment forces of various polymers are frequently measured to determine their mucoadhesion strength. As the process of mucoadhesion is a consequence of interactions between the mucus layer on mucosa and mucoadhesive polymers, it is greatly dependent on mucus and polymer structure including their charge. It is also known that the glycosaminoglycan layer, which covers the urinary bladder mucosa surface, is highly negatively charged. Therefore, by measuring the zeta potential of polymer dispersions and mucosal homogenates an insight into electrostatic interactions during mucoadhesion can be obtained. In our experiments we chose three polymers, two anionic (polycarbophil, PC; sodium carboxymethyl cellulose, CMCNa) and one cationic (chitosan hydrochloride, CH), for which we expected different zeta potential values and different mucoadhesion strengths. The correlation between the zeta potential and the detachment force was determined. In addition to that, the zeta potential of the scraped surface layer of pig urinary bladders was measured to confirm its negative value. The mucoadhesion strength decreased in the following order: CH>CMCNa=PC. The zeta potentials for all three polymers and for porcine vesical mucosal homogenates were measured in Tyrode solution and two NaCl solutions with different ionic strengths. The lower values of the detachment force correlated well with the more negative zeta potential of the polymer, which might be a consequence of the greater repulsion between negative charges of polymers and glycosaminoglycans.

  4. Hematological profile of the euthymic hairless guinea pig following sulfur mustard vesicant exposure.

    PubMed

    Gold, M B; Scharf, B A

    1995-01-01

    Sulfur mustard (HD) is a potent vesicating agent of military importance, with known radiomimetic properties. The euthymic hairless guinea pig (EHGP) (Cavia porcellus) is emerging as the animal model of choice for cutaneous HD study. With elucidation of the systemic effects, we may better utilize this animal for all HD toxicity work. To this end, studies were conducted to determine the definitive median lethal dose (MLD) of subcutaneously applied sulfur mustard (HD) in the EHGP, and to correlate the induced hematological changes. Eight groups of two animals each were dosed at 0.3 log intervals from an extrapolated expected dose, deriving a tentative mean around which five groups of six animals each were dosed at 0.1 log intervals, resulting in a definitive MLD of 48.17 mg kg(-1). Sulfur mustard was then administered to seven groups of six animals each at a dose of 30 mg kg(-1) and hematology performed. Significant leukocyte count suppression was found to occur on days 4, 5 and 6, following a leukocyte elevation on day 1 after exposure. Serum potassium levels were found to be elevated all 7 days after HD exposure. Establishing the MLD for subcutaneously applied HD and the pattern of induced leukocyte suppression allows for more definitive evaluation of successful toxicity counter-measures.

  5. Nd:YAG laser incision of the vesical neck in obstructive BPH

    NASA Astrophysics Data System (ADS)

    Gilbert, Peter T. O.

    2003-06-01

    From February, 1995 through June, 2002, 68 patients underwent laser incision of the prostate at our clinic. By means of a 23 F cytoscope and a 600 micrometer lateral firing quartz fiber the vesical neck was incised at the 5 and 7 o'clock position at 60 W power. Total energy averaged 13648 J. Operative time did not exceed 15 minutes. General anesthesia was employed in all but one patient. 38 patients remained catheter-free whereas 30 patients were catheterized for two hours. Except for three cases, all patients were discharged on the same day, usually after the first micturition. Anti-inflammatory treatment was administered for two weeks, Cotrimoxazole for 5 days. No serious complications were encountered. Minor side effects included urinary retention (1 pat.), urinary infection (3 pat.) and retrograde ejaculation (1 pat.). Considering a mean follow-up of 21 months, the average Qmax improved enormously (25.4 ml/s versus 10.9 ml/s), as did residual urine volume (35 ml versus 95 ml) and IPSS (7.1 versus 20.5). Three patients required TUR-P 2-3 years after laser surgery and one patient underwent radical retropubic prostatectomy for prostate cancer 2 years later. In conclusion, Nd:YAG laser incision of the prostate is a simple, safe, reliable and cost-effective outpatient procedure.

  6. Pathogenesis of renal calculi in distal renal tubular acidosis. Possible role of parathyroid hormone.

    PubMed

    Lee, D B; Drinkard, J P; Gonick, H C; Coulson, W F; Cracchiolo, A

    1976-01-01

    Elevated circulating levels of immunoreactive parathyroid hormone (PTH), hypercalciuria and renal calculi were found in 3 patients with distal renal tubular acidosis (RTA). Treatment with alkali resulted in a fall of PTH toward normal and a reduction in urinary calcium, but the frequency of urolithiasis was unchanged. In one patient in whom prolonged follow-up was possible, a subtotal parathyroidectomy was performed. This was followed by virtual cessation of stone formation despite persistence of the acidification defect. This study suggests that RTA may be associated with secondary hyperparathyroidism and that the consequent elevation in PTH may play a contributory role in the pathogenesis of renal calculi.

  7. Use of internal polyethylene ureteral stents in extracorporeal shock-wave lithotripsy of staghorn calculi.

    PubMed

    Pode, D; Shapiro, A; Verstandig, A; Pfau, A

    1987-01-01

    Ureteral stenting during extracorporeal shock-wave lithotripsy (ESWL) of complete staghorn calculi, using an internal polyethylene pigtail catheter, was found to be an efficient prophylactic measure against the high rate of complications in these cases. In the presence of a ureteral stent the stone fragments passed more easily into the bladder, accumulation of obstructing stone streets was prevented, and internal drainage of the urine was guaranteed. The need for auxiliary measures such as percutaneous nephrostomy, ureteroscopy or ureteral meatotomy was prevented in most cases. This prophylactic measure may turn ESWL to become the primary treatment of large staghorn calculi.

  8. Calcium oxalate calculi-induced clusterin expression in kidney.

    PubMed

    Li, Jin-Yi; Liu, Junjiang; Jiang, Junyi; Pumill, Chris; Elaiho, Cordelia; Zhang, Yunxia; Li, Shoubin; Zhou, Tie

    2015-10-01

    The aim of the study was to investigate clusterin expression in the kidney and evaluate the urine clusterin level in the kidney stone formers. (1) In vitro, we treated the Madin-Darby canine kidney (MDCK) cell line with different concentrations of calcium oxalate (CaOx), and then the clusterin protein expression in the cells was evaluated by Western blotting. (2) Kidney stone patients who received percutaneous nephrolithotomy were enrolled in our study. Urine samples were collected before surgery, the kidney punctured to obtain kidney tissue guided by ultrasound intraoperatively. Clusterin expression in the human kidney tissue was evaluated by immunochemistry. The urine clusterin level was determined by enzyme-linked immunosorbent assay. Non-kidney disease subjects were chosen as controls. In vitro, the clusterin expression was up-regulated in the MDCK cells induced by CaOx. The study included 49 patients and 41 non-kidney disease subjects. All calculi were composed of calcium oxalate monohydrate or calcium oxalate dihydrate and a few also contained protein or uric acid. Mean ± SD urine clusterin level was 17.47 ± 18.61 μg/ml in patients, and 3.31 ± 5.42 μg/ml in non-kidney disease subjects, respectively (p < 0.001). Immunohistochemistry revealed the clusterin was located in the cytoplasm of the renal distal and collecting tubular epithelial cells. Also the tissue clusterin expression increased significantly in the kidney stone formers compared to the control groups (p = 0.001). CaOx could induce clusterin expression in renal tubular cells, and increase clusterin levels in the kidney and urine from the kidney stone formers.

  9. Covariant differential calculi on quantum symplectic superspace S Pq 1 | 2

    NASA Astrophysics Data System (ADS)

    Celik, Salih

    2017-02-01

    A unitary orthosymplectic quantum supergroup is introduced. Two covariant differential calculi on the quantum superspace S Pq 1 | 2 are presented. The h-deformed symplectic superspaces via a contraction of the q-deformed symplectic superspaces are obtained. A new h-deformation of the Heisenberg superalgebra is given.

  10. Feline porphyria associated with anemia, severe hepatic disease, and renal calculi

    PubMed Central

    Schnier, Jonathan J.; Hanna, Paul

    2010-01-01

    A 13-year-old, neutered male domestic cat presented with signs of weight loss, anemia, and hepatomegaly. Pathognomonic signs of porphyria were identified. Charcoal-like renal calculi and severe liver changes were observed, neither of which has been previously reported in association with feline porphyria. PMID:21197209

  11. Disintegration of urinary calculi by laser beam: drilling experiment in extracted urinary stones.

    PubMed

    Tanahashi, Y; Orikasa, S; Chiba, R; Tahira, K; Fukatsu, T; Miyakawa, T

    1979-06-01

    Disintegration of urinary calculi was attempted by the use of laser beam. As a first step, drilling of extracted urinary stones was attempted using a continuous wave CO2 laser and a pulse ruby laser. Stones were drilled easily by either laser beam. The power around 10 W of continuous CO2 laser beam was sufficient to drill through the stone.

  12. Feline porphyria associated with anemia, severe hepatic disease, and renal calculi.

    PubMed

    Schnier, Jonathan J; Hanna, Paul

    2010-10-01

    A 13-year-old, neutered male domestic cat presented with signs of weight loss, anemia, and hepatomegaly. Pathognomonic signs of porphyria were identified. Charcoal-like renal calculi and severe liver changes were observed, neither of which has been previously reported in association with feline porphyria.

  13. Ureteropyeloscopy and homium: YAG laser lithotripsy for treatment of ureteral calculi (report of 356 cases)

    NASA Astrophysics Data System (ADS)

    Wu, Zhong; Din, Qiang; Jiang, Hao-wen; Zen, Jing-cun; Yu, Jiang; Zhang, Yuanfang

    2005-07-01

    Objective: To evaluate the efficacy and safety of holmium YAG laser lithotripsy for the treatment of ureteral calculi. Methods: A total of 356 patients underwent ureteropyeloscopic lithotripsy using holmium YAG laser with a semirigid uretesopyeloscope, 93 upper, 135 middle, and 128 lower ureteral stones were treated. Results: The overall successful fragmentation rate for all ureteral stones in a single session achieved 98% (349/356). The successful fragmentation rate stratified by stone location was 95% 88/93 in the upper ureter, 99% (134/135) in the mid ureter , and 99%(127/128) in the distal ureter. 12 cases with bilateral ureteral stones which caused acute renal failure and anuria were treated rapidly and effectively by the holmium YAG laser lithotripsy. No complications such as perforation and severe trauma were encountered during the operations. 2 weeks 17months (with an average of 6.8 month ) follow up postoperatively revealed that the overall stone-free rate was 98%(343/349) and no ureteral stenosis was found. Conclusions Holmium YAG laser lithotripsy is a highly effective, minimally invasive and safe therapy for ureteral calculi. It is indicated as a first choice of treatment for patients with ureteral calculi, especially for the ones with mid- lower levels of ureteral calculi.

  14. Medical management of urinary calculi in a stallion with breeding dysfunction.

    PubMed

    Sertich, P L; Pozor, M A; Meyers, S A; Brown, J S

    1998-09-15

    A 9-year-old Thoroughbred stallion was examined because of breeding dysfunction and possible urethritis. The stallion had good libido and readily obtained an erection, mounted, and intromitted but did not thrust and ejaculate. After mounting the mare, the stallion would squeal and dismount. Endoscopic examination of the urethra and bladder revealed irregular, spiculate yellow crystals (< 1 cm in size) and sabulous deposits; numerous calculi were embedded in the mucosa of the bladder. Because the horse was at the start of a breeding season, the owner would not give permission for general anesthesia. Medical management was attempted, because postoperative convalescence after surgical removal of calculi might have curtailed breeding activities, and the calculi were small. Every 1 to 3 days, the bladder was lavaged with saline solution containing acetic acid, and anti-inflammatory and antimicrobial drugs were administered. The stallion was able to return to breeding mares, and sperm numbers and semen quality were good. However, urine contamination of the ejaculate was detected, suggesting that the stallion may have had a primary neurologic deficit affecting bladder control and function that was causing calculi to form secondarily because of delay in movement of urine through the urinary tract.

  15. Robust detection of renal calculi from non-contract CT images using TV-flow and MSER features

    NASA Astrophysics Data System (ADS)

    Liu, Jianfei; Wang, Shijun; Linguraru, Marius George; Summers, Ronald M.

    2013-03-01

    Renal calculi are one of the most painful urologic disorders causing 3 million treatments per year in the United States. The objective of this paper is the automated detection of renal calculi from CT colonography (CTC) images on which they are one of the major extracolonic findings. However, the primary purpose of the CTC protocols is not for the detection of renal calculi, but for screening of colon cancer. The kidneys are imaged with significant amounts of noise in the non-contrast CTC images, which makes the detection of renal calculi extremely challenging. We propose a computer-aided diagnosis method to detect renal calculi in CTC images. It is built on three novel techniques: 1) total variation (TV) flow to reduce image noise while keeping calculi, 2) maximally stable extremal region (MSER) features to find calculus candidates, 3) salient feature descriptors based on intensity properties to train a support vector machine classifier and filter false positives. We selected 23 CTC cases with 36 renal calculi to analyze the detection algorithm. The calculus size ranged from 1.0mm to 6.8mm. Fifteen cases were selected as the training dataset, and the remaining eight cases were used for the testing dataset. The area under the receiver operating characteristic curve (AUC) values were 0.92 in the training datasets and 0.93 in the testing datasets. The testing dataset confidence interval for AUC reported by ROCKIT was [0.8799, 0.9591] and the training dataset was [0.8974, 0.9642]. These encouraging results demonstrated that our detection algorithm can robustly and accurately identify renal calculi from CTC images.

  16. Ibn-Sina's life and contributions to medicinal therapies of kidney calculi.

    PubMed

    Faridi, Pouya; Roozbeh, Jamshid; Mohagheghzadeh, Abdoali

    2012-09-01

    Ibn-Sina (commonly known as Avicenna) is one of the most famous and influential scientists in the history of medicine. The Canon of Medicine, which is his most celebrated book in medicine, presents a summary of all the medical knowledge of his time. Ibn-Sina wrote a complete section about kidney calculi in his book. Totally, 65 herbal, 8 animal, and 4 mineral medicines are mentioned in the Canon of Medicine as beneficial drugs for dissolving, expelling, and preventing kidney calculi. Ibn-Sina introduced very advanced drug designing based on drug delivery, targeting the organ, deposition in the site of action, pain control, wound healing, clearance after action, and supporting the organ. Using Ibn-Sina's ideas help scientists to choose better drugs with a historical background to reduce the cost of therapies and research projects.

  17. Renal calculi in pregnancy? The role of ultralow-dose CT

    PubMed Central

    Nash, Zachary; Mascarenhas, Lawrence

    2013-01-01

    Presented is a case of an acute, right flank, loin to groin pain in the third trimester of an otherwise uncomplicated pregnancy. Renal calculi was suspected clinically and supported by radiological evidence. Temporising treatment was undertaken successfully by retrograde ureteric stenting, which became blocked, secondarily resulting in a percutaneous nephrostomy. Good symptomatic control was achieved before the delivery at 38 weeks and 1 day gestation. Postpartum intravenous urogram and ureteroscopy did not reveal evidence of calculi. The patient does not recall passing a stone. With existing diagnostic modalities having poor sensitivity and specificity, the clinical role of ultralow-dose CT is explored, in light of recent new evidence. PMID:23729704

  18. Treatment of calculi in kidneys with congenital anomalies: an assessment of the efficacy of lithotripsy.

    PubMed

    Al-Tawheed, Adel R; Al-Awadi, Khaleel A; Kehinde, Elijah O; Abdul-Halim, Hamdy; Hanafi, Akram M; Ali, Yusuf

    2006-10-01

    We studied the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of stones in kidneys with congenital anomalies to determine factors that may affect the results. Patients found to have renal calculi in kidneys with different types of congenital anomalies were treated using ESWL. All patients were investigated by intravenous urography (IVU) to confirm the diagnosis. J stents were inserted prior to therapy in renal units with calculi exceeding 1.5 cm in diameter. Complications encountered and factors affecting success using this treatment modality were analysed. Twenty-five patients (18 males, 7 females) were studied between August 1988 and July 2005. There were nine patients with horseshoe kidneys, eight with ectopic kidneys, three with malrotated kidneys, two with duplex renal system, and one patient each with polycystic kidneys and hypoplastic kidney. The IVU showed 31 isolated calyceal or renal pelvic stones with mean stone burden of 1.44cc. All 25 patients were treated by lithotripsy. Twenty-four (77.4%) renal units (in 19 patients) were completely cleared of stones, 2 (6.5%) renal units (2 patients) were partially cleared of calculi and the procedures failed in 5 (16.1%) renal units (4 patients). Out of five renal units in which the procedures failed, open surgery was performed in three renal units and percutaneous nephrolithotomy (PCNL) was performed in two. None of the 25 patients developed any major complications. No significant adverse changes in renal function tests were observed at 3-month follow-up. The stone-free rate was influenced and reduced by stone size and location in the pelvi-calyceal system. Calculi in kidneys with congenital anomalies may be treated successfully by ESWL as a first-line therapy in the majority of patients. With position modifications, localization of stones may be facilitated and disintegrated. The outcome in patients so treated does not differ significantly from that in those with normal kidneys.

  19. Efficacy of retrograde ureteropyeloscopic holmium laser lithotripsy for intrarenal calculi >2 cm.

    PubMed

    Bader, M J; Gratzke, C; Walther, S; Weidlich, P; Staehler, M; Seitz, M; Sroka, R; Reich, O; Stief, C G; Schlenker, B

    2010-10-01

    The objectives of this study are to assess the efficacy and safety of retrograde ureteroscopic holmium laser lithotripsy for intrarenal calculi greater than 2 cm in diameter. A total of 24 patients with a stone burden >2 cm were treated with retrograde ureteroscopic laser lithotripsy. Primary study endpoints were number of treatments until the patient was stone free and perioperative complications with a follow-up of at least 3 months after intervention. In 24 patients (11 women and 13 men, 20-78 years of age), a total of 40 intrarenal calculi were treated with retrograde endoscopic procedures. At the time of the initial procedure, calculi had an average total linear diameter of 29.75 ± 1.57 mm and an average stone volume of 739.52 ± 82.12 mm(3). The mean number of procedures per patient was 1.7 ± 0.8 (range 1-3 procedures). The overall stone-free rate was 92%. After 1, 2 and 3 procedures 54, 79 and 92% of patients were stone free, respectively. There were no major complications. Minor postoperative complications included pyelonephritis in three cases (7.5%), of whom all responded immediately to parenteral antibiotics. In one patient the development of steinstrasse in the distal ureter required ureteroscopic fragment disruption and basketing. Ureteroscopy with holmium laser lithotripsy represents an efficient treatment option and allows the treatment of large intrarenal calculi of all compositions and throughout the whole collecting system even for patients with a stone burden of more than 2 cm size.

  20. Spectroscopic study of the inhibition of calcium oxalate calculi by Larrea tridentata

    NASA Astrophysics Data System (ADS)

    Pinales, Luis Alonso

    The causes of urolithiasis include such influences as diet, metabolic disorders, and genetic factors which have been documented as sources that aggravate urinary calculi depositions and aggregations, and, implicitly, as causes of urolithiasis. This study endeavors to detail the scientific mechanisms involved in calcium oxalate calculi formation, and, more importantly, their inhibition under growth conditions imposed by the traditional medicinal approach using the herbal extract, Larrea tridentata. The calculi were synthesized without and with Larrea tridentata infusion by employing the single diffusion gel technique. A visible decrease in calcium oxalate crystal growth with increasing amounts of Larrea tridentata herbal infusion was observed in photomicrographs, as well as a color change from white-transparent for pure crystals to light orange-brown for crystals with inhibitor. Analysis of the samples, which includes Raman, infrared absorption, scanning electron microscopy (SEM), and X-ray powder diffraction (XRD) techniques, demonstrate an overall transition in morphology of the crystals from monohydrate without herbal extract to dihydrate with inhibitor. Furthermore, the resulting data from Raman and infrared absorption support the possibilities of the influences, in this complex process, of NDGA and its derivative compounds from Larrea tridentata, and of the bonding of the magnesium of the inhibitor with the oxalate ion on the surface of the calculi crystals. This assumption corroborates well with the micrographs obtained under higher magnification, which show that the separated small crystallites consist of darker brownish cores, which we attribute to the dominance of growth inhibition by NDGA, surrounded by light transparent thin shells, which possibly correspond to passivation of the crystals by magnesium oxalate. The SEM results reveal the transformation from the dominant monoclinic structure of the calcium oxalate crystals grown alone to the tetragonal

  1. Minimally invasive percutaneous nephrolithotomy with multiple mini tracts in a single session in treating staghorn calculi.

    PubMed

    Zhong, Wen; Zeng, Guohua; Wu, Wenqi; Chen, Wenzhong; Wu, Kaijun

    2011-04-01

    There has been continuing controversy regarding multiple tracts in a percutaneous nephrolithotomy (PCNL) session that may bring more complications, especially severe bleeding need for transfusion, even nephrectomy. Little tracts may bring less trauma to renal parenchyma than standard PCNL tracts. We carried minimally invasive PCNL (MPCNL) in treating staghorn calculi with multiple 16Fr percutaneous tracts in a single session, in an attempt to get high stone free with little trauma, and compared the morbidity of standard PCNL procedures in a prospective trial. A total of 54 consecutive patients with staghorn calculi were prospectively randomized for MPCNL (29) and PCNL (25). The size and location of stone, operative parameters, number of tracts, stone-free rate, operating time, hospital stay and complications were analyzed. In MPCNL group, a total of 67 percutaneous tracts were established in 29 renal units, while 28 tracts in 25 renal units in PCNL group. Compared to PCNL, MPCNL was associated with higher clearance rate (89.7 vs. 68%, p = 0.049), less chance need for adjunctive procedure of SWL or second-look PCNL (24.1 vs. 60%, p = 0.007), while a similar complication rate (37.9 vs. 52%, p = 0.300). In conclusion, with the development of instruments and increased experience, judiciously made multiple percutaneous tracts in a single session of MPCNL for treating staghorn calculi were safe, feasible and efficient with an acceptable morbidity.

  2. Shock wave lithotripsy is effective and safe for distal ureteral calculi in children.

    PubMed

    Ozbey, Isa; Aksoy, Yilmaz; Ziypak, Tevfik; Yapanoglu, Turgut; Polat, Ozkan; Aksoy, Mehmet

    2007-10-01

    We evaluated the effectiveness of the Siemens Lithostar Modularis lithotriptor for the management of distal ureteric calculi in children. Between 2004 and 2006, 29 children with distal ureteric calculi were treated in our stone center with the Siemens Lithostar Modularis (Siemens Medical Solutions, Inc.) Effectiveness of lithotripsy, retreatment and efficacy quotient rates, and complications were assessed. The series consisted of 18 (62%) boys and 11 (38%) girls with an age range of 1-13 years (average age 7.0 +/- 3.5). Under fluoroscopic guidance, children were treated with a maximum 3,000 shocks at an average of 2.2 +/- 0.3 kV. Mean stone size was 8.2 +/- 3.2 mm (range 4-18). Success was defined as the lack of any visible stone fragments on posttreatment radiological evaluation. The mean number of sessions required was 1.5 +/- 0.8/patient (range 1-4). Complete clearance rate at 3 months was 86.2%. Re-treatment and efficacy quotient rates for distal ureteral stones were 41.4 and 55.6%, respectively. Complications such as urinary tract infection or steinstrasse occurred in 2 (6.9%) patients. Minor complications included petechial skin hemorrhage at the site of entry of shock waves in all patients. Our results show that shock wave lithotripsy for distal ureteral calculi with the Siemens Lithostar Modularis lithotriptor has a high success rate (86.2%) and efficacy quotient (55.6%) with negligible complications in children.

  3. Prediction of outcome of extracorporeal shock wave lithotripsy in the management of ureteric calculi.

    PubMed

    Wang, Mingqing; Shi, Qiduo; Wang, Xuguang; Yang, Kun; Yang, Rui

    2011-02-01

    The present study was designed to evaluate the clinical outcome of using extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteric calculi and to establish a predictive model for the stone-free rate in patients receiving the treatment. A total of 831 patients with ureteric calculi were accepted in this study. Several parameters, including stone site, stone number, stone size, history of urolithiasis, renal colic, hydronephrosis, and double-J ureteric stent, were analyzed using univariate and multivariate analyses. A prediction model was established based on the logistic regression analysis of the significant factors, and the goodness-of-fit of the model was evaluated by employing the Hosmer-Lemeshow test. At a 3-month follow-up after ESWL treatment, the overall stone-free rate was 96.8% (804/831) with no serious complications being found, while the treatment failed in 3.2% (27/831) of the patients. Five factors, including stone number, stone size, history of urolithiasis, renal colic, and double-J ureteric stent contributed significantly to the clinical outcome of the ESWL treatment. The prediction model had a sensitivity and overall accuracy of 99.8 and 96.9%, respectively. The results show that ESWL remains an effective method for treating ureteric calculi. The prediction model established in this study could be used as a method for estimating prognosis in patients following ESWL treatment.

  4. Laser ablation methods for analysis of urinary calculi: Comparison study based on calibration pellets

    NASA Astrophysics Data System (ADS)

    Štěpánková, K.; Novotný, K.; Vašinová Galiová, M.; Kanický, V.; Kaiser, J.; Hahn, D. W.

    2013-03-01

    Methods based on laser ablation, such as Laser-Induced Breakdown Spectroscopy (LIBS) and Laser-Ablation Inductively Coupled Plasma Mass/Optical Emission Spectrometry (LA-ICP-MS/OES) are particularly suitable for urinary calculi bulk and micro analysis. Investigation of spatial distribution of matrix and trace elements can help to explain their emergence and growth. However, quantification is still very problematic and these methods are often used only for qualitative elemental mapping. There are no commercially available standards, which would correspond to the urinary calculi matrix. Internal standardization is also difficult, mainly due to different crystalline phases in one kidney stone. The aim of this study is to demonstrate the calibration capabilities and examine the limitations of laser ablation based techniques. Calibration pellets were prepared from powdered human urinary calculi with phosphate, oxalate and urate matrix. For this comparative study, the most frequently used laser-ablation based analytical techniques were chosen, such as LIBS and LA-ICP-MS. Moreover, some alternative techniques such as simultaneous LIBS-LA-ICP-OES and laser ablation LA-LIBS were also utilized.

  5. [Search for a new rinsing solution for the local lysis of calcium-containing urinary calculi].

    PubMed

    Leskovar, P; Hropot, M; Wellnhofer, E

    1982-04-01

    Due to improved rinsing techniques local chemolitholysis is again becoming more important. Good result good results in the local chemolysis of phosphate calculi (calculi caused by remains of Struvit) with Renacidin and other rinsing solutions (Fam, Rossier, Gittes, Jacobs, Smith, Royle, Nemoy, Stamey) have led to a revival chemolitholysis (Alken) in the last 4--5 years, however only in the case of phosphate calculi, which account for 60--80%, cannot be dissolved by Renacidin, as is explicitly pointed out by the manufacturer. The experiments carried out by the group headed by Kallistratos and Timmermann in the 60's using rinsing solutions based on EDTA were discontinued, probably because of physiological reservations concerning the chemicals used and the long duration of treatment at physiologically tolerable concentrations and pH values. In order to extend the range of rinsing solutions to be tested, we tested new substances, including some which complex not only the anion (oxalate) but also the cation (Ca). Alternating treatment with oxalate binding and Ca binding rinsing solutions has been found to give particularly good results.

  6. Retroperitoneoscopic pyelolithotomy: a good alternative treatment for renal pelvic calculi in children

    PubMed Central

    Cezarino, Bruno Nicolino; Park, Rubens; Moscardi, Paulo Renato Marcelo; Lopes, Roberto Iglesias; Denes, Francisco T.; Srougi, Miguel

    2016-01-01

    ABSTRACT Introduction: Nephrolitiasis, once considered an adult disease, has become increasingly prevalent in children, with an increase from 6% to 10 % annually in past 25 years. Kidney stones in pediatric population can result from metabolic diseases in up to 50% of children affected. Other factors associated with litiasis are infection, dietary factors, and anatomic malformations of urinary tract. Standard treatment procedures for pediatric population are similar to adult population. Extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), percutaneous nepfrolithotomy (PCNL), as well as laparoscopic and retroperitoneoscopic approaches can be indicated in selected cases. The advantages of laparoscopic or retroperitoneoscopic approaches are shorter mean operation time, no trauma of renal parenchyma, lower bleeding risk, and higher stone-free rates, especially in pelvic calculi with extrarenal pelvis, where the stone is removed intact. Patient and Methods: A 10 year-old girl presented with right abdominal flank pain, macroscopic hematuria, with previous history of urinary infections‥ Further investigation showed an 1,5 centimeter calculi in right kidney pelvis. A previous ureterorenoscopy was tried with no success, and a double J catheter was placed. After discussing options, a retroperitoneoscopic pielolithotomy was performed. Results: The procedure occurred with no complications, and the calculi was completely removed. The foley catheter was removed in first postoperative day and she was discharged 2 days after surgery. Double J stent was removed after 2 weeks. Conclusions: Retroperitoneoscopic pielolithotomy is a feasible and safe procedure in children, with same outcomes of the procedure for adult population. PMID:27813386

  7. Effectiveness and Safety of Ureteroscopic Holmium Laser Lithotripsy for Upper Urinary Tract Calculi in Elderly Patients.

    PubMed

    Yoshioka, Takashi; Otsuki, Hideo; Uehara, Shinya; Shimizu, Toshihiro; Murao, Wataru; Fujio, Koji; Fujio, Kei; Wada, Koichiro; Araki, Motoo; Nasu, Yasutomo

    2016-06-01

    Upper urinary tract calculi are common; however, there is no recommended treatment selection for elderly patients. Ureteroscopic holmium laser lithotripsy (URS lithotripsy) is minimally invasive, and it provides a high stone-free rate (SFR) treatment for upper urinary tract calculi. Here, we retrospectively evaluated the surgical outcomes of URS lithotripsy after dividing the 189 cases into 3 groups by patient age: the '<65 group' (<65 years old, n=108), the '65-74 group' (65-74 years old, n=42), and the ' 75 group' ( 75 years old, n=39). The patients' characteristics, stone status, and perioperative outcomes were assessed. The 65-74 group and the 75 group had a significantly higher prevalence of hypertension compared to the<65 group. Compared to the<65 group, the 65-74 group had a significantly higher prevalence of hyperlipidemia, and the 75 group had significantly higher the American Society of Anesthesiologists (ASA) scores. Despite these preoperative risk factors, SFR and postoperative pyelonephritis in the 65-74 group and the 75 group were similar to those of the<65 group. In conclusion, URS lithotripsy is the preferred treatment for upper urinary tract calculi, even for elderly patients who have multiple preoperative risk factors.

  8. Prostatic calculi influence the antimicrobial efficacy in men with chronic bacterial prostatitis

    PubMed Central

    Zhao, Wei-Ping; Li, Yong-Tao; Chen, Jun; Zhang, Zhi-Gen; Jiang, Hai; Xia, Dan; Wang, Shuo; Wang, Ping

    2012-01-01

    We studied the efficacy of culture-specific antibiotic therapy for chronic bacterial prostatitis (CBP) patients with or without prostatic calculi. This study included 101 patients (21–62 years old) who met the consensus criteria for CBP (National Institutes of Health category II). According to the results of transrectal ultrasonography (TRUS), all patients were divided into two groups: Group 1, CBP with prostatic calculi, n=39; Group 2, CBP without prostatic calculi, n=62. All patients received optimal antimicrobial therapy for 4 weeks and followed up for a minimum of 3 months (range: 3–8 months). In addition to expressed prostatic secretions (EPS) and urine culture, all patients were asked to complete the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the subjective global assessment (SGA). The microbiological eradication rate at the end of treatment were 32/39 (82.1%) and 54/62 (87.1%), while the rates for continued eradication at the end of study were 17/39 (43.6%) and 45/62 (72.6%) in Group 1 and Group 2 (P<0.01), respectively. We observed a decrease in the total NIH-CPSI score median values from 24 to 19 in Group 1 and from 24 to 11 in Group 2. The pain subscore (P<0.01), urinary sunscore (P<0.05) and quality of life (QoL; P<0.05) as well as the total NIH-CPSI score (P<0.01) were significantly improved after antimicrobial treatment in Group 2 compared to Group 1. Response, defined as a decrease of the NIH-CPSI total score by at least 50%, was seen in Group 1 versus Group 2 in 38.5% and 58.1% (P<0.01), respectively. Our results showed that prostatic calculi influence the antimicrobial efficacy in men with CBP. There was a noticeable decrease in the cure rate of CBP patients with prostatic calculi due to relapse after antimicrobial therapy. PMID:22796735

  9. Retrospective Analysis of Ultrasound-guided Flexible Ureteroscopy in the Management of Calyceal Diverticular Calculi

    PubMed Central

    Zhang, Ji-Qing; Wang, Yong; Zhang, Jun-Hui; Zhang, Xiao-Dong; Xing, Nian-Zeng

    2016-01-01

    Background: Percutaneous nephrolithotomy (PCNL) is the most widely recommended treatment for calyceal diverticular calculi, providing excellent stone-free results. However, its invasiveness is not negligible considering its major complication rates. Flexible ureteroscopy (FURS) is currently used to treat calyceal diverticula. However, the greatest drawback of FURS is locating the diverticulum since its neck is narrow and concealed. In such a case, the FURS procedure must be converted to PCNL. The aim of this study was to evaluate ultrasound-guided flexible ureteroscopy (UFURS) identifying diverticulum and the management of calyceal diverticular calculi. Methods: A retrospective analysis was conducted on 24 patients who had calyceal diverticular calculi. In all 12 patients in the UFURS group, direct FURS failed to find evidence of calyceal diverticula but were confirmed with imaging. The other 12 patients in the PCNL group received PCNL plus fulguration of the diverticular walls. Results: Puncture of calyceal diverticulum was successful in all 12 UFURS patients. Two patients in this group had postoperative residual calculi and two patients developed fever. In the PCNL group, percutaneous renal access and lithotomy were successful in all 12 patients. One patient in this group had residual calculi, one had perirenal hematoma, and two patients developed fever. No significant difference was found in the operating time (UFURS vs. PCNL, 91.8 ± 24.2 vs. 86.3 ± 18.7 min), stone-free rate (UFURS vs. PCNL, 9/12 vs. 10/12), and rate of successful lithotripsy (UFURS vs. PCNL, 10/12 vs. 11/12) between the two groups (all P > 0.05). Postoperative pain scores in the FURS group were significantly lower than that in the PCNL group (2.7 ± 1.2 vs. 6.2 ± 1.5, P < 0.05). Hospital stay in the UFURS group was significantly shorter than that in the PCNL group (3.4 ± 0.8 vs. 5.4 ± 1.0 days, P < 0.05). All patients were symptom-free following surgery (UFURS vs. PCNL, 10/10 vs. 12

  10. Bilirubin calculi crushing by laser irradiation at a molecular oscillating region wavelength based on infrared absorption spectrum analysis using a free-electron laser: an experimental study.

    PubMed

    Watanabe, M; Kajiwara, H; Awazu, K; Aizawa, K

    2001-01-01

    We investigated a new laser technique of crushing bilirubin calculi, our aim being to crush calculi in isolation using a minimally invasive procedure. Infrared absorption spectrum analysis of the bilirubin calculi was conducted, revealing maximum absorption spectrum at a wavelength of the C=O stretching vibration of ester binding that exists within the molecular structure of bilirubin calcium. As an experiment to crush calculi using the free-electron laser, we set the laser at the effective irradiation wavelength of ester binding, and conducted noncontact irradiation of the bilirubin calculi. The calculi began to slowly ablate until the irradiated site had been completely obliterated after 20s of irradiation. Moreover, absorption spectrum analysis of the irradiated site, from a comparison of absorption peak ratios, revealed that absorption peak intensities decreased over time at the absorption wavelength of ester binding. These findings suggest that irradiation of molecular oscillating region wavelengths peculiar to calculi based on infrared absorption spectrum analysis results in the gradual crushing of calculi in isolation by breaking down their molecular structure.

  11. Medical management of urinary calculi: up to date 2016.

    PubMed

    Marangella, Martino

    2016-09-26

    Nephrolithiasis (NL) is one of the most prevalent nontransmissible diseases in western countries. It is being associated with other frequent diseases, including osteoporosis, cardiovascular disease, hypertension, diabetes mellitus, through a putative common link with metabolic syndrome and insulin resistance or altered mineral metabolism. This review will focus on classification, physicochemical basis, risk factors, laboratory and imaging investigations, medical management.Classification as to stone composition includes calcium, uric acid (UA), cystine (Cys), infected, 2-8 dihydroxyadenine and rare NL. According to pathophysiology, NL is classified as primary, secondary to systemic diseases or drugs, caused by renal or metabolic hereditary disorders.A stone can only form in supersaturated environment, and this is sufficient in UA, Cys and infected NL, but not in Ca-NL, which results from the imbalance between supersaturation and inhibition. All types are characterized by derangements of peculiar risk factors. Laboratory investigations aim at identifying type of NL, underlying risk factors and state of saturation, and pathophysiology. This justifies a rationale therapy able to dissolve some types of stones and/or produce reduction in recurrence rate in others.Medical management includes alkali and allopurinol for UA nephrolithiasis (UA-NL), thiols and alkali in Cys-NL, dietary and pharmacological intervention for Ca-NL. Thiazides and alkaline citrate salts are the most widely used drugs in Ca-NL, where they proved efficient to prevent new stones. Other drugs have only been used in particular subsets.Proper medical management and modern urological approaches have already notably improved clinical outcomes. Future studies will further clarify mechanisms of NL with expected new and targeted therapeutic options.

  12. [Somatic parameters in patients with urinary calculi and their relationship to age, sex and kind of calculus].

    PubMed

    Schneider, H J; Janitzky, H; Schüler, G

    1979-05-01

    In the present investigation in 515 carriers of nephroliths (311 males and 204 females) age, sex, type of constitution, body weight, physical load and blood pressure are set in relation to the various kinds of calculi. Here it was revealed that males more frequently fall ill with nephrolithiasis than females, that there exist certain age peaks, the pycnic typ of constitution preferredly appears in female carriers of calculi and the athletic type in male ones, the majority of all examined patients had in comparison to the normal an increased body weight, and a very large proportion of persons with only insignificant physical load is found among the carriers of calculi. The result of the relations of blood pressure was that only half of all patients with urolithiasis examined had a normotonic blood pressure.

  13. Dual-energy CT for the characterization of urinary calculi: In vitro and in vivo evaluation of a low-dose scanning protocol.

    PubMed

    Thomas, C; Patschan, O; Ketelsen, D; Tsiflikas, I; Reimann, A; Brodoefel, H; Buchgeister, M; Nagele, U; Stenzl, A; Claussen, C; Kopp, A; Heuschmid, M; Schlemmer, H-P

    2009-06-01

    The efficiency and radiation dose of a low-dose dual-energy (DE) CT protocol for the evaluation of urinary calculus disease were evaluated. A low-dose dual-source DE-CT renal calculi protocol (140 kV, 46 mAs; 80 kV, 210 mAs) was derived from the single-energy (SE) CT protocol used in our institution for the detection of renal calculi (120 kV, 75 mAs). An Alderson-Rando phantom was equipped with thermoluminescence dosimeters and examined by CT with both protocols. The effective doses were calculated. Fifty-one patients with suspected or known urinary calculus disease underwent DE-CT. DE analysis was performed if calculi were detected using a dedicated software tool. Results were compared to chemical analysis after invasive calculus extraction. An effective dose of 3.43 mSv (male) and 5.30 mSv (female) was measured in the phantom for the DE protocol (vs. 3.17/4.57 mSv for the SE protocol). Urinary calculi were found in 34 patients; in 28 patients, calculi were removed and analyzed (23 patients with calcified calculi, three with uric acid calculi, one with 2,8-dihyxdroxyadenine-calculi, one patient with a mixed struvite calculus). DE analysis was able to distinguish between calcified and non-calcified calculi in all cases. In conclusion, dual-energy urinary calculus analysis is effective also with a low-dose protocol. The protocol tested in this study reliably identified calcified urinary calculi in vivo.

  14. Multiple tracts percutaneous nephrolithotomy assisted by LithoClast master in one session for staghorn calculi: report of 117 cases.

    PubMed

    Chen, Jinbo; Zhou, Xu; Chen, Zhi; Liu, Longfei; Jiang, Li; Chen, Cheng; Qi, Lin; Zu, Xiongbing; Chen, Hequn

    2014-04-01

    The objective of the study is to evaluate the safety, efficacy and outcome of multiple tracts percutaneous nephrolithotomy (PCNL) assisted by LithoClast master (the third-generation Electro Medical System) in one session for the treatment of staghorn calculi. From October 2011 to March 2013, 117 patients with staghorn calculi underwent multiple tracts PCNL in our hospital. The combined pneumatic and ultrasonic powered lithotripter (EMS LithoClast master) was used to fragment and remove the calculi. The data were retrospectively analyzed with regard to stone burden, number of tracts, operation time, total operative blood loss, postoperative hospital stay, complications rate, and stone clearance rate. A total of 142 renal units in 117 patients (63 men and 54 women) were treated. Of the 142 renal units, 77 (54.2 %) had complete staghorn calculi, and 65 (45.8 %) had partial staghorn calculi. A total of 416 tracts were established in the 142 renal units. The mean number of tracts used in a single renal unit was 2.8 (range 2-4), most required three tracts. The mean (range) operating time is 72 (55-130) min. The mean (range) duration of postoperative hospital stay is 5.5 (3-9) days. Mean estimated operative blood loss is 150 (60-350) mL. The complications included blood transfusion in 9 (7.7 %) patients, high fever in 12 (10.3 %), sepsis in 5 (4.3 %), hydrothorax in 4 (3.4 %), and pseudoaneurysm in 3 (2.6 %). A complete stone clearance rate of 87.2 % (102/117) was achieved after one session of PCNL. This rate increased to 94.0 % after a secondlook procedure. In conclusion, multiple tracts PCNL assisted by EMS LithoClast master in one session is safe and effective in achieving a great stone clearance rate with acceptable morbidity for the treatment of staghorn calculi.

  15. Efficacy and safety of Ho:YAG Laser Lithotripsy for ureteroscopic removal of proximal and distal ureteral calculi

    PubMed Central

    2014-01-01

    Background Laser lithotripsy is an established endourological modality. Ho:YAG laser have broadened the indications for ureteroscopic stone managements to include larger stone sizes throughout the whole upper urinary tract. Aim of current work is to assess efficacy and safety of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral calculi in different locations. Methods 88 patients were treated with ureteroscopic Ho:YAG laser lithotripsy in our institute. Study endpoint was the number of treatments until the patient was stone-free. Patients were classified according to the location of their stones as Group I (distal ureteric stones, 51 patients) and group II (proximal ureteral stones, 37). Group I patients have larger stones as Group II (10.70 mm vs. 8.24 mm, respectively, P = 0.020). Results Overall stone free rate for both groups was 95.8%. The mean number of procedures for proximal calculi was 1.1 ± 0.1 (1–3) and for distal calculi was 1.0 ± 0.0. The initial treatment was more successful in patients with distal ureteral calculi (100% vs. 82.40%, respectively, P = 0.008). No significant difference in the stone free rate was noticed after the second laser procedure for stones smaller versus larger than 10 mm (100% versus 94.1%, P = 0.13). Overall complication rate was 7.9% (Clavien II und IIIb). Overall and grade-adjusted complication rates were not dependant on the stone location. No laser induced complications were noticed. Conclusions The use of the Ho:YAG laser appears to be an adequate tool to disintegrate ureteral calculi independent of primary location. Combination of the semirigid and flexible ureteroscopes as well as the appropriate endourologic tools could likely improve the stone clearance rates for proximal calculi regardless of stone-size. PMID:25107528

  16. Recurrent groin hernia

    PubMed Central

    Cox, P. J.; Leach, R. D.; Ellis, Harold

    1981-01-01

    One hundred consecutive recurrences following repair of inguinal hernias have been studied; 62 were direct, 30 indirect, 7 pantaloon and one a femoral hernia. Half the indirect recurrences occurred within a year of repair and probably represented failure to detect a small indirect sac. Later indirect recurrences probably represented failure to repair the internal ring. Nine of the direct hernias were medial funicular recurrences and represented failure to anchor the darn medially. The rest of the direct recurrences were attributable to tissue insufficiency and could probably have been averted by larger tissue bites. Recurrences following inguinal herniorrhaphy remain an all too common problem but can be reduced by meticulous surgical technique. PMID:7339602

  17. Common site of urinary calculi in kidney, ureter and bladder region.

    PubMed

    Chand, R B; Shah, A K; Pant, D K; Paudel, S

    2013-03-01

    Urolithiasis is an ancient disease with global distribution. It refers to stones originating anywhere in the urinary system. Urinary calculi or stones are the most common cause of acute urinary system obstruction. The study was aimed with finding out the common site of urinary calculus in kidney ureter bladder (KUB) region. This was a prospective cross-sectional study conducted from June 2012 to September 2012 at Tribhuvan University, Teaching Hospital, Maharajgunj. A total 240 urolitiasis patients were enrolled for plain KUB examination. Site of urinary calculus was identified by observing KUB film of the subjects under the supervision of radiologist. The data were analyzed prospectively with outcome measures of gender & stone location. Out of 240 patients, 138 were male and 102 were female with male to female ratio of 1.35:1. The age ranged from 9 to 83 years. Out of total 240 patients, 71.9% (187) patients belonged to productive age group (20-60 years). Total number of urinary calculi was 345 in which 208 were found in male patients and 137 were found in female patients. Of total 345 calculi, 237 were renal stones, 47 were ureteric stones, 22 of the stones were found in pelviureteric junction (PUJ), 33 of stones were found in vesicoureteric junction (VUJ), and 6 were in bladder. In conclusion, urinary stone disease is a major public health problem in a developing country like Nepal with male and productive age group predominance. Kidney stones are most common. Distal ureter is the most common site of ureteric stone.

  18. Biomineralogy of human urinary calculi (kidney stones) from some geographic regions of Sri Lanka.

    PubMed

    Chandrajith, Rohana; Wijewardana, Geethika; Dissanayake, C B; Abeygunasekara, Anurudha

    2006-08-01

    Kidney stones (urinary calculi) have become a global scourge since it has been recognized as one of the most painful medical problems. Primary causative factors for the formation of these stones are not clearly understood, though they are suspected to have a direct relationship to the composition of urine, which is mainly governed by diet and drinking water. Sixty nine urinary calculi samples which were collected from stone removal surgeries were analyzed chemically for their Na, K, Ca, Mg, Cu, Zn, Pb, Fe and phosphate contents. Structural and mineralogical properties of stones were studied by XRD and FT-IR methods. The mean contents of trace elements were 1348 mg kg(-1) (Na); 294 mg kg(-1) (K); 32% (Ca); 1426 mg kg(-1) (Mg); 8.39 mg kg(-1) (Mn); 258 mg kg(-1) (Fe); 67 mg kg(-1) (Cu); 675 mg kg(-1) (Zn); 69 mg kg(-1) (Pb); and 1.93% (PO (4) (3-) ). The major crystalline constituent in the calculi of Sri Lanka is calcium oxalate monohydrate. Principal component analysis was used to identify the multi element relationships in kidney stones. Three components were extracted and the first component represents positively correlated Na-K-Mg-PO (4) (3-) whereas the second components represent the larger positively weighted Fe-Cu-Pb. Ca-Zn correlated positively in the third component in which Mn-Cu correlated negatively. This study indicates that during the crystallization of human urinary stones, Ca shows more affinity towards oxalates whereas other alkali and alkaline earths precipitate with phosphates.

  19. Expression of proliferative and inflammatory markers in a full-thickness human skin equivalent following exposure to the model sulfur mustard vesicant, 2-chloroethyl ethyl sulfide

    SciTech Connect

    Black, Adrienne T.; Hayden, Patrick J.; Casillas, Robert P.; Heck, Diane E.; Gerecke, Donald R.; Sinko, Patrick J.; Laskin, Debra L.; Laskin, Jeffrey D.

    2010-12-01

    Sulfur mustard is a potent vesicant that induces inflammation, edema and blistering following dermal exposure. To assess molecular mechanisms mediating these responses, we analyzed the effects of the model sulfur mustard vesicant, 2-chloroethyl ethyl sulfide, on EpiDerm-FT{sup TM}, a commercially available full-thickness human skin equivalent. CEES (100-1000 {mu}M) caused a concentration-dependent increase in pyknotic nuclei and vacuolization in basal keratinocytes; at high concentrations (300-1000 {mu}M), CEES also disrupted keratin filament architecture in the stratum corneum. This was associated with time-dependent increases in expression of proliferating cell nuclear antigen, a marker of cell proliferation, and poly(ADP-ribose) polymerase (PARP) and phosphorylated histone H2AX, markers of DNA damage. Concentration- and time-dependent increases in mRNA and protein expression of eicosanoid biosynthetic enzymes including COX-2, 5-lipoxygenase, microsomal PGE{sub 2} synthases, leukotriene (LT) A{sub 4} hydrolase and LTC{sub 4} synthase were observed in CEES-treated skin equivalents, as well as in antioxidant enzymes, glutathione S-transferases A1-2 (GSTA1-2), GSTA3 and GSTA4. These data demonstrate that CEES induces rapid cellular damage, cytotoxicity and inflammation in full-thickness skin equivalents. These effects are similar to human responses to vesicants in vivo and suggest that the full thickness skin equivalent is a useful in vitro model to characterize the biological effects of mustards and to develop potential therapeutics.

  20. Inhibition of NADPH cytochrome P450 reductase by the model sulfur mustard vesicant 2-chloroethyl ethyl sulfide is associated with increased production of reactive oxygen species

    SciTech Connect

    Gray, Joshua P.; Mishin, Vladimir; Heck, Diane E.; Laskin, Debra L.; Laskin, Jeffrey D.

    2010-09-01

    Inhalation of vesicants including sulfur mustard can cause significant damage to the upper airways. This is the result of vesicant-induced modifications of proteins important in maintaining the integrity of the lung. Cytochrome P450s are the major enzymes in the lung mediating detoxification of sulfur mustard and its metabolites. NADPH cytochrome P450 reductase is a flavin-containing electron donor for cytochrome P450. The present studies demonstrate that the sulfur mustard analog, 2-chloroethyl ethyl sulfide (CEES), is a potent inhibitor of human recombinant cytochrome P450 reductase, as well as native cytochrome P450 reductase from liver microsomes of saline and {beta}-naphthoflavone-treated rats, and cytochrome P450 reductase from type II lung epithelial cells. Using rat liver microsomes from {beta}-naphthoflavone-treated rats, CEES was found to inhibit CYP 1A1 activity. This inhibition was overcome by microsomal cytochrome P450 reductase from saline-treated rats, which lack CYP 1A1 activity, demonstrating that the CEES inhibitory activity was selective for cytochrome P450 reductase. Cytochrome P450 reductase also generates reactive oxygen species (ROS) via oxidation of NADPH. In contrast to its inhibitory effects on the reduction of cytochrome c and CYP1A1 activity, CEES was found to stimulate ROS formation. Taken together, these data demonstrate that sulfur mustard vesicants target cytochrome P450 reductase and that this effect may be an important mechanism mediating oxidative stress and lung injury.

  1. Treatment of small lower pole calculi--SWL vs. URS vs. PNL?

    PubMed

    Knoll, Thomas; Tasca, Andrea; Buchholz, Noor P

    2011-03-01

    According to current guideline recommendations extracorporeal shock wave lithotripsy (SWL) remains the first choice treatment for small and mid-sized renal calculi. However, the results of SWL treatment for lower pole stones can be disappointing whilst more invasive endoscopic modalities, such as flexible ureterorenoscopy (fURS) and percutaneous nephrolithotomy (PNL) are often considered more effective. This article summarizes a point-counterpoint discussion at the 9th eULIS symposium in Como, Italy, and discusses the potential advantages and disadvantages of the different therapeutic approaches.

  2. BET 2: Tadalafil medical expulsive therapy in ureteral calculi: a new kid on the block?

    PubMed

    Christie, Brian; Oostema, Adam

    2016-08-01

    A short cut review was carried out to see if tadalafil, a phosphodiesterase type-5 (PDE5) inhibitor, was superior to standard α-adrenergic antagonists at promoting spontaneous ureteric calculi excretion. Two relevant papers were found, published by the same research group. The author, date and country of publication, patient group studied, study type, relevant outcomes, results study weaknesses of these papers are tabulated. Tadalafil was not shown to have significant superiority in terms of efficacy or adverse effects compared with standard treatment.

  3. [Identification of the mineral constituents of various salivary calculi by study of their thermal behavior].

    PubMed

    Vignoles, M; Faure, J; Legros, R; Bonel, G; Guichard, M

    1980-06-01

    Studies of the physicochemical nature of five salivary calculi have shown that they are practically similar. They are composed of a nucleus and a shell which contain an organic phase and two crystalline mineral phases. These two phases are respectively a whitlockite and an apatite: the composition of the last agrees with the general formula: Ca10-(x+y) (PO4) T-(x+y) (CO3) x (HPO4) y (20H,CO3) (Formula: see text). The shell is different from the nucleus by the fact that it is less mineralized than the nucleus. The apatite of the shell contains more carbonate ions than the apatite of the nucleus.

  4. Recurrent aphthous stomatitis.

    PubMed

    Chattopadhyay, Amit; Shetty, Kishore V

    2011-02-01

    Recurrent aphthous stomatitis is a common oral ulcerative disease, affecting 10% to 15% of the general US population. This article reviews the epidemiology and clinical presentations of recurrent aphthous stomatitis, including diagnosis and management.

  5. [Chronic recurrent multifocal osteomyelitis].

    PubMed

    Marrero Calvo, M; Merino Arribas, J; Rodrigo Palacios, J; Bartolomé Albistegui, M; Camino Fernández, A; Grande Sáez, C

    2001-02-01

    Chronic recurrent multifocal osteomyelitis is a rare disorder of unknown etiology, characterized by multiple bone lesions and a variable clinical course. We present a 10 year old boy with chronic recurrent multifocal osteomyelitis who improved after treatment with naproxen.

  6. Recurrent sialoliths after excision of the bilateral submandibular glands for sialolithiasis treatment: A case report

    PubMed Central

    YING, XIAOXIA; KANG, JIANAN; ZHANG, FUYIN; DONG, HUI

    2016-01-01

    Sialolithiasis is a common disease that is characterized by the obstruction of the salivary gland. Sialolithiasis mainly affects the submandibular glands and the Wharton's duct. However, bilateral sialolithiasis is a rare condition. In addition, recurrence of sialoliths subsequent to surgical excision of the submandibular gland for the treatment of sialolithiasis has been rarely reported. The present study reported a case presenting with recurrent sialoliths with sialadenitis in the residual Wharton's duct following the excision of bilateral submandibular glands. An 81-year-old man presented with a solid and painful mass in the left submandibular area. The patient had a history of bilateral submandibular sialolithiasis, and had undergone excision of bilateral submandibular glands with the right Wharton's duct 4 years earlier. Computed tomography scans demonstrated two calculi in the residual Wharton's duct, which were surgically removed without any complications. The present study discussed the mechanisms underlying sialolith formation subsequent to the excision of submandibular glands. PMID:26889264

  7. Evaluation of anti-urolithiatic activity of Pashanabhedadi Ghrita against experimentally induced renal calculi in rats

    PubMed Central

    Gupta, Sanjay Kumar; Baghel, Madhav Singh; Bhuyan, Chaturbhuja; Ravishankar, B.; Ashok, B. K.; Patil, Panchakshari D.

    2012-01-01

    Population in an industrialized world is afflicted by urinary stone disease. Kidney stones are common in all kinds of urolithiasis. One distinguished formulation mentioned by Sushruta for management of Ashmari (urolithiasis) is Pashanabhedadi Ghrita (PBG), which is in clinical practice since centuries. Validation of drug is the requirement of time through the experimental study. In this study, trial of PBG has been made against ammonium oxalate rich diet and gentamicin injection induced renal calculi in albino rats. The calculi were induced by gentamicin injection and ammonium oxalate rich diet. Test drug was administered concomitantly in the dose of 900 mg/kg for 15 consecutive days. Rats were sacrificed on the 16th day. Parameters like kidney weight, serum biochemical, kidney tissue and histopathology of kidney were studied. Concomitant treatment of PBG attenuates blood biochemical parameters non-significantly, where as it significantly attenuated lipid peroxidation and enhanced glutathione and glutathione peroxidase activities. It also decreased crystal deposition markedly into the renal tubules in number as well as size and prevented damage to the renal tubules. The findings showed that PBG is having significant anti-urolithiatic activities against ammonium oxalate rich diet plus gentamicine injection induced urolithiasis in rats. PMID:23723654

  8. Use of a laparoscopic specimen retrieval pouch to facilitate removal of intact or fragmented cystic calculi from standing sedated horses: 8 cases (2012-2015).

    PubMed

    Katzman, Scott A; Vaughan, Betsy; Nieto, Jorge E; Galuppo, Larry D

    2016-08-01

    OBJECTIVE To evaluate the use of a laparoscopic specimen retrieval pouch for removal of intact or fragmented cystic calculi from standing horses. DESIGN Retrospective case series. ANIMALS 8 horses (5 geldings and 3 mares) with cystic calculi. PROCEDURES Physical examination and cystoscopic, ultrasonographic, and hematologic evaluations of urinary tract function were performed for each horse. A diagnosis of cystic calculus was made on the basis of results of cystoscopy and ultrasonography. Concurrent urolithiasis or other urinary tract abnormalities identified during preoperative evaluation were recorded. Horses were sedated and placed in standing stocks, and the perineum was aseptically prepared. Direct access to the urinary bladder was gained in geldings via perineal urethrotomy or in mares by a transurethral approach. Calculi were visualized endoscopically, manipulated into the retrieval pouch, and removed intact or fragmented (for larger calculi). RESULTS For 4 geldings and 1 mare, fragmentation was necessary to facilitate calculus removal. Mean duration of surgery was 125 minutes, and trauma to the urinary bladder and urethra was limited to areas of hyperemia and submucosal petechiation. No postoperative complications were encountered for any horse. When lithotripsy was required, the retrieval pouch provided an effective means of stabilizing calculi and containing the fragments for removal. CONCLUSIONS AND CLINICAL RELEVANCE Use of the laparoscopic specimen retrieval pouch was an effective, minimally traumatic method for retrieving cystic calculi from standing horses. The pouch protected the urinary bladder and urethra from trauma during calculus removal and allowed for stabilization, containment, and fragmentation of calculi when necessary.

  9. Experimental supratrigonal cystectomy: II--Evaluation of urinary calculi, infection, and bladder dysfunction in the pathogenesis of renal failure.

    PubMed

    Barros, Milton; Martinelli, Reinaldo; Rocha, Heonir

    2008-01-01

    The objective of this study was to evaluate the role of urolithiasis, infection, and bladder dysfunction in the pathogenesis of renal failure in rats subjected to supratrigonal cystectomy. One group of Sprague-Dawley rats was submitted to supratrigonal cystectomy, a second to cystectomy during which a suspension of Proteus mirabilis was injected into the bladder stump, and a third to sham surgery (controls). The animals were sacrificed two months after surgery. Blood pressure and serum urea and creatinine were measured before surgery and at sacrifice when a careful inspection of the urinary tract was performed to determine the presence of hydronephrosis and calculi. Microbiological analyses were performed on urine aspirated from the bladder and on the kidneys. Significant differences were found between values of systolic blood pressure and serum urea and creatinine recorded prior to the surgical procedure and those recorded at sacrifice in each group except the control group. Renal failure was present in all animals subjected to cystectomy. Urinary calculi were documented in 5/10 animals subjected to cystectomy only and in all rats inoculated with P. mirabilis. Hypertension was documented in 43.75% of animals subjected to cystectomy. Pyelonephritis was diagnosed only in animals with urinary calculi, in each of which urine culture was also positive. No cases of renal failure, hypertension, calculi, and/or pyelonephritis were detected in the sham group. The findings of this study indicate that kidney failure in rats subjected to supratrigonal cystectomy is related to the severe bladder dysfunction induced by the surgical procedure.

  10. The Laparoscopic Re-Exploration in the Management of the Gallbladder Remnant and the Cystic Duct Stump Calculi

    PubMed Central

    Kumar, Satendra; Afaque, Yusuf; Bhartia, Abhishek; Bhartia, Vishnu Kumar

    2016-01-01

    Introduction The gallbladder remnant and the cystic duct stump calculi are uncommon causes of post-cholecystectomy syndrome. Re-exploration is usually needed in the cases where symptom persists. Very few case series and reports are available regarding laparoscopic re-exploration. Aim To assess the safety and feasibility of Laparoscopic re-exploration in the cases of gallbladder remnant and cystic duct stump calculi leading to post cholecystectomy syndromes. Materials and Methods In this study, laparoscopic re-explorations was done in 22 patients in which 17 patients had gallbladder remnant calculi and 5 had cystic duct stump calculi. The study considered parameters like the operative time, conversion rate, post-operative complications, post-operative hospital stay and mortality in these patients. The duration of study was 15 years and the data was retrospectively reviewed. Results The median operating time was 83 minutes (range 51 to 134 minutes). Only one patient had conversion to open surgery. In postoperative period two patients had bile leak. They were managed conservatively and leak subsided in 8 and 11 days respectively. One patient had postoperative bleeding not requiring blood transfusion. There was no major complication requiring further intervention and no mortality. Patients were discharged on median day 4 (range 2-11) after the surgery. Patients were followed up every 3 months for one year. However, out of these three patients did not turn up for follow-up. Conclusion In expert hands laparoscopic re-exploration of the gallbladder remnant/cystic duct stump calculi can be performed within a reasonable operating time. The conversion to conventional re–exploration rate was very low with minimal post-operative complications and shorter hospital stay. PMID:27656498

  11. Molecular analysis of the fragile histidine triad (FHIT) tumor suppressor gene in vesical tumors of cattle with chronic enzootic hematuria (CEH).

    PubMed

    Guidi, E; Uboldi, C; Ferretti, L

    2008-01-01

    The FHIT (fragile histidine triad) gene is a tumor suppressor gene known to be inactivated in many tumors including bladder tumors and is spanning FRA3B, a very active common fragile site in the human genome. We have recently isolated the bovine gene, and the aim of this study was to test whether FHIT presents altered expression patterns in vesical tumors of cattle with CEH (chronic enzootic hematuria). CEH is a common syndrome affecting Mediterranean cattle: clastogenic, mutagenic and cancerogenic substances released by the bracken fern (Pteridium spp) grazed by animals induce the formation of neoplastic lesions, among which bladder tumors have a high incidence. We analysed FHIT in 23 bladder tumors of CEH cattle looking at: 1) the methylation status of the CpG island comprising the promoter and part of exon 1; 2) the presence of altered FHIT transcripts; 3) the mRNA expression levels measured with a quantitative real time PCR (QRT-PCR) approach. Our results suggest that unlike in human tumors, FHIT in vesical tumors of CEH cattle is largely unmethylated. Furthermore, the same mRNA isoforms of FHIT were detected in tumors and in healthy tissues, including a novel isoform that was found in this study. Finally, QRT-PCR data did not reveal significantly altered expression profiles of FHIT transcripts. Further studies and larger sets of cases will be useful to confirm this finding, but the data seem to suggest that epigenetic modifications of FHIT and altered expression profiles are not a hallmark of bovine vesical tumors like they are in human tumors.

  12. Pre- and postoperative evaluation of renal function in patients with staghorn calculi utilizing quantitative renal scanning.

    PubMed

    Stage, K H; Lewis, S

    1981-01-01

    Differential quantitative renal scans using 99-technetium diethylene triaminepentaacetic acid (DTPA) or 131I Hippuran were obtained properatively on 12 patients with unilateral or bilateral staghorn calculi. Of the 14 renal units studied, 12 kidneys underwent anatrophic nephrolithotomy, pyelolithotomy, or a combination of both techniques; 2 patients underwent nephrectomy based on poor function of the affected side preoperatively. Postoperative follow-up scans were obtained on the 12 kidneys undergoing stone cleanout. Seven of 12 kidneys (58 per cent) studied pre- and postoperatively showed moderate to significant improvement in per cent contribution to total renal function. Seven of 10 kidneys (70 per cent) studied pre- and postoperatively showed improvement in glomerular filtration rate or effective renal plasma flow. The scans revelaed no dramatic difference in postoperative functional loss between pyelolithotomy and anatrophic nephrolithotomy. The computerizewd quantitative renal scan helps in selection of surgical technique and objective postoperative assessment of surgical results.

  13. New potential solutions for the chemolysis of urinary phosphate calculi determined by an in vitro study.

    PubMed

    Zhang, Jinqing; Wang, Shuo; Hong, Jingfan; Liu, Chunxiao; Jiang, Yanbin

    2015-04-01

    To find a more efficient solution for chemolysis of urinary calculi, several organic acids were chosen to form solutions by consulting the composition of a classic solution, Suby G. The solutions together with Renacidin, another classic solution, were designed to react with the 4 phosphate components of urinary stone. The processes were real-time measured and analysed by a focused beam reflectance measurement, and the efficiency factors were investigated and discussed in detail. The results show that several organic acids, e.g. hydroxyacetic acid, lactic acid and α-ketoglutaric acid, are more efficient than citric acid in dissolving urinary phosphate calculus. The new solutions containing the organic acids are promising for improving chemolysis treatment.

  14. An unusual cause of mechanical dysphagia: an agglomerate of calculi in a tonsillar residue.

    PubMed

    Cantarella, Giovanna; Pagani, Davide; Biondetti, Pietro

    2006-04-01

    We report the case of a 68-year-old man affected by severe oropharyngeal dysphagia for solid food, who had undergone tonsillectomy when he was 22 years old. Videolaryngoscopy revealed a smooth-surfaced, elongated overgrowth on the left lateral pharyngeal wall that protruded toward the left pyriform fossa and impeded the transit of solid boli. A computed tomography scan showed that the solid content of the lesion was markedly inhomogeneous and denser than the surrounding soft tissues. The mass was removed by means of direct pharyngoscopy under general anesthesia. It was found that it arose from the inferior pole of the left tonsillar fossa and had a central cavity filled with caseum and multiple calculi. Histopathologic examination showed that its soft tissue component consisted of lymphoid tonsillar tissue. The operation totally resolved the swallowing disturbance. This case report highlights that tonsilloliths in a tonsillar residue should be considered in the differential diagnosis of mechanical oropharyngeal dysphagia, even in tonsillectomized patients.

  15. Frequency-doubled dual-pulse freddy lithrotripsy laser in the treatment of urinary tract calculi

    NASA Astrophysics Data System (ADS)

    Huang, Xuyuan; Bo, Juanjie; Chen, Bin; Wang, Yi-Xin

    2005-07-01

    Background and Purpose: The Frequency-Doubled Dual-Pulse Nd:YAG FREDDY laser is a short-pulsed, solid-state laser with wavelengths of 532 and 1064 nm that was developed for intracorporeal lithothripsy. This clinical study is designed to test its fragmentation efficiency in the treatment of urinary tract calculi. Patients and Methods: 500 urinary tract calculi treated in 194 female and 306 male patients with a mean age of 46 years. All patients were assessed one week post-op with a plain film of the kidneys, ureters and bladder. Stone-free rate and final outcome have been evaluated. Final outcome is defined as stone-free or residual fragments. Analysis has been made according to stone size, location and number of stones. The analgesia requirements during each treatment and complications have also been analyzed. Results: The overall stone-free rate for patients was 92.4%. The success rate for upper ureteral was 85.1% (126/148), while the rate for mid/lower was 95.3% (307/322). Bladder stone success rate 96.6% (29/30). Of all 38 incomplete fragmentations, 20 cases (4%) were treated with ESWL and 18 cases (3.6%) had open surgery. Neither fever nor pyonephrosis was reported. The average laser treatment time was 3.3 minutes and the average post-op hospitalization was 2.5 days. Conclusions: The FREDDY laser is an extremely efficient and safe minimally invasive lithotripsy treatment for urinary stones. It should be considered as an alternative treatment for urolithiasis.

  16. Role of reactive nitrogen species generated via inducible nitric oxide synthase in vesicant-induced lung injury, inflammation and altered lung functioning

    SciTech Connect

    Sunil, Vasanthi R.; Shen, Jianliang; Patel-Vayas, Kinal; Gow, Andrew J.; Laskin, Jeffrey D.; Laskin, Debra L.

    2012-05-15

    Pulmonary toxicity induced by sulfur mustard and related vesicants is associated with oxidative stress. In the present studies we analyzed the role of reactive nitrogen species (RNS) generated via inducible nitric oxide synthase (iNOS) in lung injury and inflammation induced by vesicants using 2-chloroethyl ethyl sulfide (CEES) as a model. C57Bl/6 (WT) and iNOS −/− mice were sacrificed 3 days or 14 days following intratracheal administration of CEES (6 mg/kg) or control. CEES intoxication resulted in transient (3 days) increases in bronchoalveolar lavage (BAL) cell and protein content in WT, but not iNOS −/− mice. This correlated with expression of Ym1, a marker of oxidative stress in alveolar macrophages and epithelial cells. In contrast, in iNOS −/− mice, Ym1 was only observed 14 days post-exposure in enlarged alveolar macrophages, suggesting that they are alternatively activated. This is supported by findings that lung tumor necrosis factor and lipocalin Lcn2 expression, mediators involved in tissue repair were also upregulated at this time in iNOS −/− mice. Conversely, CEES-induced increases in the proinflammatory genes, monocyte chemotactic protein-1 and cyclooxygenase-2, were abrogated in iNOS −/− mice. In WT mice, CEES treatment also resulted in increases in total lung resistance and decreases in compliance in response to methacholine, effects blunted by loss of iNOS. These data demonstrate that RNS, generated via iNOS play a role in the pathogenic responses to CEES, augmenting oxidative stress and inflammation and suppressing tissue repair. Elucidating inflammatory mechanisms mediating vesicant-induced lung injury is key to the development of therapeutics to treat mustard poisoning. -- Highlights: ► Lung injury, inflammation and oxidative stress are induced by the model vesicant CEES ► RNS generated via iNOS are important in the CEES-induced pulmonary toxicity ► iNOS −/− mice are protected from CEES-induced lung toxicity and

  17. Recurrent inguinal hernia.

    PubMed Central

    Postlethwait, R W

    1985-01-01

    An analysis of 584 operations for recurrent inguinal hernia was made in an attempt to determine the cause of the recurrence based on the anatomic findings. The recurrence was indirect in 300, direct in 241, and various other in 43 operations. The causes of the indirect recurrences appeared to be an unrecognized hernia, incomplete dissection or improper ligation of the sac, failure to narrow the cord, or inadequate reconstruction of the internal ring. No cause for the diffuse direct recurrences was apparent. Of the 241 hernias in Hesselbach's triangle, 144 were small localized defects, usually (112) just lateral to the symphysis. These were considered to be caused by the cutting action of a suture placed under tension. On the basis of these findings, suggestions are made for primary inguinal hernia operations. PMID:4073990

  18. [Assessment of the renal consequences as related to operative technique in surgery for 190 staghorn or calyceal calculi. Comparative value of renal scintigraphy and intravenous urography (author's transl)].

    PubMed

    Beurton, D; Gonties, D; Malloum, M; Ngeh, D; Daskalov, I; Pascal, B; Cukier, J

    1981-01-01

    The authors have studied 86 patients with staghorn calculi who underwent preoperative quantitative renal scintigraphy. 50 of them (63 kidneys) had one or two follow-up scans between 1 and 9 years after the operation. These scintigraphic data were compared with those of I.V.U. These 50 patients had undergone surgery on 60 kidneys (12 pyelotomies only, 26 pyelotomies associated with limited nephrotomies, 18 extended nephrotomies and finally 4 bi-value nephrotomies). In 46 of these patients, the urine became definitively sterile and there was no recurrence of lithiasis in any of them. These quite exceptional conditions were such that it is possible to bear in mind only the operative technique in assessing the possible harmful consequences of each type of operation. The authors clearly show that the threat to function of the kidney which has been operated upon is more threatened when there has been a nephrotomy and when such a nephrotomy has been more extensive. A limited nephrotomy is associated with a mean loss of (% of renal function. Extended nephrotomies or more than 3 cm result in a loss of function of approximately 22%. Large bi-value nephrotomies result in a 36% loss of function. Simultaneous study of scintigraphic scans and I.V.U. revealed that a loss of 1 cm in height of the renal parenchyma corresponds to a functional loss of 10% as determined by scintigraphy. Of basic importance is the fact that the impairment caused by nephrotomies remains stable and does not worsen with the passage of time.

  19. [Contribution to the problem of preventing recurrences of oxalate and phosphate urinary caluli: active modification of citrate excretion and Ca++-binding capacity in the urine of Wistar rats].

    PubMed

    Leskovar, P; Hropot, M; Wellnhofer, E; Scherm, D; Schade, K L

    1982-03-01

    Citric acid may well be, quantitatively and in terms of complex chemistry, the most important of the organic acids capable of binding Ca++ in urine. Since the quantitative determination of citrates in urine became a routine method in many research-orientated urological laboratories thanks to the introduction of standardized enzymatic tests, reports of a reduced excretion of citrates in patients with (recurrent) (oxalate) calculi have become frequent. During our long-term study of patients with recurrent formation of calculi we also observed a clear deficit of citrates in their morning, midday and evening urine. The conspicuous incidence of calculi when there is a concurrence of hypocitraturia and alkaline urine (RTA, in animal experiments: acetazolamide) clearly suggests the lithoprotective significance of citric acid. By quantitatively testing a large number of organic compounds which are interesting both structurally and in terms of complex chemistry, it has been possible to find some substances which restrict crystallization, raise the level of citrates and bind Ca++. A few have also found to restrict the excretion of oxalate in Wistar rats.

  20. Coping with Fear of Recurrence

    MedlinePlus

    ... With Fear of Recurrence Request Permissions Coping With Fear of Recurrence Approved by the Cancer.Net Editorial ... affects your life. Tips for coping with the fear of recurrence Living with uncertainty is never easy. ...

  1. Percutaneous nephrolithotomy of bilateral staghorn renal calculi in pediatric patients: 12 years experience in a tertiary care centre.

    PubMed

    Purkait, Bimalesh; Kumar, Manoj; Sokhal, Ashok Kumar; Bansal, Ankur; Sankhwar, Satya Narayan; Gupta, Ashok Kumar

    2016-09-15

    To assess the outcomes of percutaneous nephrolithotomy (PCNL) in bilateral staghorn calculi in pediatric patients, we have performed a retrospective analysis. Staghorn calculus is defined as stone that fills a greater part of the pelvic-caliceal system. Still, in developing countries, patients may present with staghorn calculus. PCNL is the preferred treatment modality for staghorn calculus both in adult and children. Our study included fifty-one pediatric patients (<15 years) of bilateral staghorn calculi from 2004 to 2015. Staged PCNL was done after 2-3 days if needed and opposite side PCNL was performed after 10-14 days. Fifty-one patients with bilateral staghorn renal calculi underwent PCNL. The mean age of the study group was 10.25 ± 2.13 (range 3-15). Mean stone burden was 778.3 + 613.4 (range 231-3850 mm(2)). Forty-five patients underwent single puncture, twenty-two patients underwent double punctures whereas six patients underwent triple punctures during first session PCNL procedure. Most common puncture location was through the superior calyx (58.82 %). The mean operating time was 77.25 + 30.21 (range 58-145). After the first session PCNL, the success rate was 76.47 %. Thirteen patients (17 renal units) underwent relook PCNL and seven patients underwent ESWL. Overall complication noted in twenty-four (47.05 %) cases. Most of the complications were minor grade. Percutaneous nephrolithotomy for staghorn calculus in children needs expertise. PCNL in B/L staghorn renal calculus in children is safe and effective. B/L staghorn renal calculi with compromised renal function have higher chance of complications including bleeding.

  2. Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

    PubMed Central

    Atmoko, Widi; Birowo, Ponco; Rasyid, Nur

    2016-01-01

    Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery ( p = 0.01), stone burden ( p = < 0.001), and type of anesthesia ( p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free. PMID:27703669

  3. Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years.

    PubMed

    Atmoko, Widi; Birowo, Ponco; Rasyid, Nur

    2016-01-01

    Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery ( p = 0.01), stone burden ( p = < 0.001), and type of anesthesia ( p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

  4. Predictors of Recurrent AKI.

    PubMed

    Siew, Edward D; Parr, Sharidan K; Abdel-Kader, Khaled; Eden, Svetlana K; Peterson, Josh F; Bansal, Nisha; Hung, Adriana M; Fly, James; Speroff, Ted; Ikizler, T Alp; Matheny, Michael E

    2016-04-01

    Recurrent AKI is common among patients after hospitalized AKI and is associated with progressive CKD. In this study, we identified clinical risk factors for recurrent AKI present during index AKI hospitalizations that occurred between 2003 and 2010 using a regional Veterans Administration database in the United States. AKI was defined as a 0.3 mg/dl or 50% increase from a baseline creatinine measure. The primary outcome was hospitalization with recurrent AKI within 12 months of discharge from the index hospitalization. Time to recurrent AKI was examined using Cox regression analysis, and sensitivity analyses were performed using a competing risk approach. Among 11,683 qualifying AKI hospitalizations, 2954 patients (25%) were hospitalized with recurrent AKI within 12 months of discharge. Median time to recurrent AKI within 12 months was 64 (interquartile range 19-167) days. In addition to known demographic and comorbid risk factors for AKI, patients with longer AKI duration and those whose discharge diagnosis at index AKI hospitalization included congestive heart failure (primary diagnosis), decompensated advanced liver disease, cancer with or without chemotherapy, acute coronary syndrome, or volume depletion, were at highest risk for being hospitalized with recurrent AKI. Risk factors identified were similar when a competing risk model for death was applied. In conclusion, several inpatient conditions associated with AKI may increase the risk for recurrent AKI. These findings should facilitate risk stratification, guide appropriate patient referral after AKI, and help generate potential risk reduction strategies. Efforts to identify modifiable factors to prevent recurrent AKI in these patients are warranted.

  5. Clinical comparison of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy in treating renal calculi.

    PubMed Central

    Mays, N.; Challah, S.; Patel, S.; Palfrey, E.; Creeser, R.; Vadera, P.; Burney, P.

    1988-01-01

    STUDY OBJECTIVE: To compare extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for efficacy in treating renal calculi. DESIGN: Non-randomised multicentre cohort study with 3 month follow up and 13 month data collection period. SETTING: Lithotripter centre in London, tertiary referral hospital, and urological clinics in several secondary and tertiary care centres. PATIENTS: 933 of 1001 patients treated by lithotripsy at the lithotripter centre were compared with 195 treated by nephrolithotomy. Missing patients were due to incomplete collection of data. Age and sex distributions and characteristics of the stones were similar in the two treatment groups. Two patients died in the lithotripsy group. Three month follow up was achieved in about 84% of both groups (783/933 for lithotripsy; 163/195 for nephrolithotomy). INTERVENTIONS: The nephrolithotomy group had surgical nephrolithotomy alone. In the lithotripsy group 83% (774/933) had lithotripsy alone, 11% (103/933) had combined lithotripsy and nephrolithotomy, and 6% (56/933) had lithotripsy plus ureteroscopy. Single and combined lithotripter treatments were analysed as one group and compared with nephrolithotomy. END POINT: Presence of stones three months after treatment. MEASUREMENTS AND MAIN RESULTS: Presence of residual stones was assessed by plain radiography, ultrasonography, or intravenous urography. After adjustment for age and size and position of stone for patients with single stones the likelihood of being free of stones three months after treatment was significantly greater in the nephrolithotomy group than the lithotripsy group (odds ratio 6.6; 95% confidence interval 3.0 to 14.6) and the response was particularly pronounced with staghorn calculi (62% (8/13) v 15% (141/96) patients free of stones after nephrolithotomy and lithotripsy, respectively). OTHER FINDINGS: 19%(146/775) of patients who had had lithotripsy had to be readmitted within three months after treatment compared with 14

  6. Cystolithiasis in a Syrian hamster: a different outcome

    PubMed Central

    Petrini, D.; Di Giuseppe, M.; Deli, G.; De Caro Carella, C.

    2016-01-01

    A 14-month-old intact male Syrian hamster was admitted for lethargy and hematuria. A total body radiographic image and abdominal ultrasonography showed the presence of a vesical calculus. During cystotomy, a sterile urine sample was obtained and sent to the diagnostic laboratory along with the urolith for analysis. Urine culture was found negative for bacterial growth, and the urolith was identified as a calcium-oxalate stone. Diet supplementation with palmitoylethanolamide, glucosamine and hesperidin was adopted the day after discharge. One year follow up revealed no presence of vesical calculi. Although this is the report of a single clinical case, this outcome differs from the results reported in the literature characterized by recurrences after few months. Considering the positive outcome and the beneficial properties of palmitoylethanolamide, glucosamine, and hesperidin, these nutritional elements in Syrian hamsters, are recommended to reduce recurrence after surgical treatment of urolithiasis. PMID:27540515

  7. Identification of mineral compositions in some renal calculi by FT Raman and IR spectral analysis

    NASA Astrophysics Data System (ADS)

    Tonannavar, J.; Deshpande, Gouri; Yenagi, Jayashree; Patil, Siddanagouda B.; Patil, Nikhil A.; Mulimani, B. G.

    2016-02-01

    We present in this paper accurate and reliable Raman and IR spectral identification of mineral constituents in nine samples of renal calculi (kidney stones) removed from patients suffering from nephrolithiasis. The identified mineral components include Calcium Oxalate Monohydrate (COM, whewellite), Calcium Oxalate Dihydrate (COD, weddellite), Magnesium Ammonium Phosphate Hexahydrate (MAPH, struvite), Calcium Hydrogen Phosphate Dihydrate (CHPD, brushite), Pentacalcium Hydroxy Triphosphate (PCHT, hydroxyapatite) and Uric Acid (UA). The identification is based on a satisfactory assignment of all the observed IR and Raman bands (3500-400 cm- 1) to chemical functional groups of mineral components in the samples, aided by spectral analysis of pure materials of COM, MAPH, CHPD and UA. It is found that the eight samples are composed of COM as the common component, the other mineral species as common components are: MAPH in five samples, PCHT in three samples, COD in three samples, UA in three samples and CHPD in two samples. One sample is wholly composed of UA as a single component; this inference is supported by the good agreement between ab initio density functional theoretical spectra and experimental spectral measurements of both sample and pure material. A combined application of Raman and IR techniques has shown that, where the IR is ambiguous, the Raman analysis can differentiate COD from COM and PCHT from MAPH.

  8. Scintigraphy and Doppler ultrasonography for the evaluation of obstructive urinary calculi.

    PubMed

    Gandolpho, L; Sevillano, M; Barbieri, A; Ajzen, S; Schor, N; Ortiz, V; Heilberg, I P

    2001-06-01

    Forty-seven patients with unilateral obstructive calculi (12 males and 35 females) were submitted to 99mTc-diethylene triamine pentaacetic acid (DTPA) or 99mTc-dimercaptosuccinic acid (DMSA) scans for assessment of renal function. The scans revealed unilateral functional deficit in 68 and 66% of the patients, respectively. A calculus size of 1.1 to 2.0 cm was significantly associated with deficit detected by DTPA, but duration of obstruction and calculus localization were not. After relief of the obstruction, the mean percent renal function of the affected kidney was found to be significantly increased from 25 +/- 12% to 29 +/- 12% in DTPA and from 21 +/- 15% to 24 +/- 12% in DMSA. Initial Doppler ultrasonography performed in 35 patients detected an increased resistive index in 10 (29%). In the remaining patients with a normal resistive index, ureteral urinary jet was observed, indicating partial obstruction. The high frequency of renal function impairment detected by DTPA and of tubulointerstitial damage detected by DMSA as well as the slight amelioration of unilateral renal function after relief of obstruction suggest that scintigraphy assessment may help evaluate the unilateral percentage of renal function and monitor renal function recovery when it occurs. The presence of a urinary jet detected by Doppler ultrasonography further indicates the severity of obstruction and the recovery prognosis.

  9. Identification of mineral compositions in some renal calculi by FT Raman and IR spectral analysis.

    PubMed

    Tonannavar, J; Deshpande, Gouri; Yenagi, Jayashree; Patil, Siddanagouda B; Patil, Nikhil A; Mulimani, B G

    2016-02-05

    We present in this paper accurate and reliable Raman and IR spectral identification of mineral constituents in nine samples of renal calculi (kidney stones) removed from patients suffering from nephrolithiasis. The identified mineral components include Calcium Oxalate Monohydrate (COM, whewellite), Calcium Oxalate Dihydrate (COD, weddellite), Magnesium Ammonium Phosphate Hexahydrate (MAPH, struvite), Calcium Hydrogen Phosphate Dihydrate (CHPD, brushite), Pentacalcium Hydroxy Triphosphate (PCHT, hydroxyapatite) and Uric Acid (UA). The identification is based on a satisfactory assignment of all the observed IR and Raman bands (3500-400c m(-1)) to chemical functional groups of mineral components in the samples, aided by spectral analysis of pure materials of COM, MAPH, CHPD and UA. It is found that the eight samples are composed of COM as the common component, the other mineral species as common components are: MAPH in five samples, PCHT in three samples, COD in three samples, UA in three samples and CHPD in two samples. One sample is wholly composed of UA as a single component; this inference is supported by the good agreement between ab initio density functional theoretical spectra and experimental spectral measurements of both sample and pure material. A combined application of Raman and IR techniques has shown that, where the IR is ambiguous, the Raman analysis can differentiate COD from COM and PCHT from MAPH.

  10. Minimally Invasive Radiologically Guided Intervention for the Treatment of Salivary Calculi

    SciTech Connect

    Brown, Jackie E.; Drage, Nicholas A.; Escudier, Michael P.; Wilson, Ron F.; McGurk, Mark

    2002-10-15

    Purpose: To describe the technique and examine the value of salivary stone extraction using a minimally invasive, radiologically guided approach as an alternative to salivary gland surgery for the treatment of benign salivary gland obstruction. Methods: Eighty-six cases of sialolithiasis (83 patients) were treated by stone removal using a Dormia basket under local anesthesia and fluoroscopic guidance. Postoperative assessment was made clinically at review, by sialogram and by questionnaire. Results: Of 86 cases of sialolithiasis treated, in 55 (64%)it was possible to remove all stones. In 12 cases (14%) part of a stone or some of a number of calculi were removed and in 19 cases (22%) the procedure failed. The commonest reason for failure was fixation of the stone within the duct. Symptoms at review (range 1-49 months, mean 17 months) were relieved in 55 of 67 (82%) of cases where a stone or portion of stone was removed. Conclusions:Stone removal from the salivary duct system by radiologically guided,minimally invasive approach is a simple procedure with low morbidity and high patient acceptance when appropriate selection criteria are applied. These criteria are considered and recommendations made.

  11. Combined micro-and standard percutaneous nephrolithotomy for complex renal calculi

    PubMed Central

    Buldu, İbrahim; Tepeler, Abdulkadir; Karatağ, Tuna; İnan, Ramazan; Armağan, Abdullah; İstanbulluoğlu, Okan

    2016-01-01

    Objective We aimed to present the technique of combination of standard percutaneous nephrolithotomy (PNL) with microperc for achieving higher success rates without increasing complication rates in the management of complex renal calculi. Material and methods The patients who underwent microperc procedure as a complementary procedure to standard PNL for complex kidney stones in two reference hospitals between 2013 and 2015, were evaluated retrospectively. Results All patients underwent a total of two accesses one for standard PNL and one for microperc. The mean stone size was measured as 54.3 mm. The procedures were completed after an average operative time of 88.2 minutes and fluoroscopy time of 5.3 minutes. Stone free status was achieved in 18 cases (78.2%) and small residual fragments (≤4 mm) were detected in 3 cases (13.1%). Complications were seen in three patients (13%) as hemorrhage in one and postoperative fever in two patients. Conclusion Despite the limitations of this study, the combination of standard PNL and microperc might reduce the complication rates and increase the success rates when treating complex kidney stones. Future prospective and comparative studies are needed. PMID:27635289

  12. Recurrent Fever in Children

    PubMed Central

    Torreggiani, Sofia; Filocamo, Giovanni; Esposito, Susanna

    2016-01-01

    Children presenting with recurrent fever may represent a diagnostic challenge. After excluding the most common etiologies, which include the consecutive occurrence of independent uncomplicated infections, a wide range of possible causes are considered. This article summarizes infectious and noninfectious causes of recurrent fever in pediatric patients. We highlight that, when investigating recurrent fever, it is important to consider age at onset, family history, duration of febrile episodes, length of interval between episodes, associated symptoms and response to treatment. Additionally, information regarding travel history and exposure to animals is helpful, especially with regard to infections. With the exclusion of repeated independent uncomplicated infections, many infective causes of recurrent fever are relatively rare in Western countries; therefore, clinicians should be attuned to suggestive case history data. It is important to rule out the possibility of an infectious process or a malignancy, in particular, if steroid therapy is being considered. After excluding an infectious or neoplastic etiology, immune-mediated and autoinflammatory diseases should be taken into consideration. Together with case history data, a careful physical exam during and between febrile episodes may give useful clues and guide laboratory investigations. However, despite a thorough evaluation, a recurrent fever may remain unexplained. A watchful follow-up is thus mandatory because new signs and symptoms may appear over time. PMID:27023528

  13. Recurrent Fever in Children.

    PubMed

    Torreggiani, Sofia; Filocamo, Giovanni; Esposito, Susanna

    2016-03-25

    Children presenting with recurrent fever may represent a diagnostic challenge. After excluding the most common etiologies, which include the consecutive occurrence of independent uncomplicated infections, a wide range of possible causes are considered. This article summarizes infectious and noninfectious causes of recurrent fever in pediatric patients. We highlight that, when investigating recurrent fever, it is important to consider age at onset, family history, duration of febrile episodes, length of interval between episodes, associated symptoms and response to treatment. Additionally, information regarding travel history and exposure to animals is helpful, especially with regard to infections. With the exclusion of repeated independent uncomplicated infections, many infective causes of recurrent fever are relatively rare in Western countries; therefore, clinicians should be attuned to suggestive case history data. It is important to rule out the possibility of an infectious process or a malignancy, in particular, if steroid therapy is being considered. After excluding an infectious or neoplastic etiology, immune-mediated and autoinflammatory diseases should be taken into consideration. Together with case history data, a careful physical exam during and between febrile episodes may give useful clues and guide laboratory investigations. However, despite a thorough evaluation, a recurrent fever may remain unexplained. A watchful follow-up is thus mandatory because new signs and symptoms may appear over time.

  14. Mechanism of Cutaneous Vesication

    DTIC Science & Technology

    1994-02-17

    neurofilibroma. J. Invest. Dermatol. 85:54- 59. Foidart, J.M., Bere, E.W., Yaar, M ., Rennard, S.I., Gullino , M ., Martin, G.R., and Katz, S.I. (1980). Distribution...of animal models for predicting skin penetration in man. Fundam. Appl. Toxicol. 4:S224-S230. Requena, L ., Requena, C., Sanchez, M ., Jaqueti, G...H., Gullino , M ., and Katz, S.I. (1976). Herpes gestationis. Ultrastructure and ultrastructural localization of in vivo-bound complement: Modified

  15. Recurrent wheezing in children

    PubMed Central

    Piazza, Michele; Piacentini, Giorgio

    2016-01-01

    Recurrent wheezing have a significant morbidity and it’s estimated that about one third of school-age children manifest the symptom during the first 5 years of life. Proper identification of children at risk of developing asthma at school age may predict long-term outcomes and improve treatment and preventive approach, but the possibility to identify these children at preschool age remains limited. For many years authors focused their studies to identify early children with recurrent wheezing at risk to develop asthma at school age. Different phenotypes have been proposed for a more precise characterization and a personalized plan of treatment. The main criticism concerns the inability to define stable phenotypes with the risk of overestimating or underestimating the characteristics of symptoms in these children. The aim of this review is to report the recent developments on the diagnosis and treatment of recurrent paediatric wheezing. PMID:26835404

  16. Recurrence of angular cheilitis.

    PubMed

    Ohman, S C; Jontell, M; Dahlen, G

    1988-08-01

    The incidence of recurrence of angular cheilitis following a successful antimicrobial treatment was studied in 48 patients. Clinical assessments including a microbial examination were carried out 8 months and 5 yr after termination of treatment. Eighty percent of the patients reported recurrence of their angular cheilitis on one or more occasions during the observation period. Patients with cutaneous disorders associated with dry skin or intraoral leukoplakia had an increased incidence of recrudescence. Neither the presence of denture stomatitis nor the type of microorganisms isolated from the original lesions of angular cheilitis, i.e. Candida albicans and/or Staphylococcus aureus, were associated with the number of recurrences. The present observations indicate that treatment of the majority of patients with angular cheilitis should be considered in a longer perspective than previously supposed, due to the short lasting therapeutic effects of the antimicrobial therapy.

  17. Recurrent aphthous stomatitis.

    PubMed

    Akintoye, Sunday O; Greenberg, Martin S

    2014-04-01

    Recurrent aphthous stomatitis (RAS) is the most common ulcerative disease affecting the oral mucosa. RAS occurs mostly in healthy individuals and has an atypical clinical presentation in immunocompromised individuals. The etiology of RAS is still unknown, but several local, systemic, immunologic, genetic, allergic, nutritional, and microbial factors, as well as immunosuppressive drugs, have been proposed as causative agents. Clinical management of RAS using topical and systemic therapies is based on severity of symptoms and the frequency, size, and number of lesions. The goals of therapy are to decrease pain and ulcer size, promote healing, and decrease the frequency of recurrence.

  18. [Recurrent purulent bacterial meningoencephalitis].

    PubMed

    Janeczko, J; Pogorzelska, E; Lipowski, D; Przyjałkowski, W; Rzadkiewicz, E

    2001-01-01

    During the period of 25 years there were 55 patients treated in our Institute because of recurrent purulent bacterial meningoencephalitis(rpbme). This group consisted of 42 males (76%) and 13 (24%) females, the prevalent number (53%) of patients being under 21 years of age. The diagnosis of rpbme was based on the commonly accepted criteria and confirmed by the laboratory results of CSF examination. The cause of the recurrences was established considering the skull X-ray examination, CT and MRI. The evaluation of the clinical status was based on the Glasgow Coma Score (GCS). During the first hospitalisation, severe or critic clinical status was noted in 42 patients (76%) and moderate in 13 (24%). The subsequent recurrences were mostly moderate, rarely severe or mild. The number of recurrences varied from 1 to 9. During the first hospitalisation, the etiologic factor was detected in 39 patients (71%), i.e. Streptococcus pneumoniae in 28 (51%), Neisseria meningitidis in 8 (14%), Pseudomonas aeruginosa and Staphylococcus aureus in 2 and 1 patients respectively. In 37 patients (67%) rpbme developed following cranial trauma, in 18 cases (33%) with single or comminuted fractures of the anterior cranial fossa (in 4 cases accompanied by CSF nasal exsudate). In 4 it followed neurosurgical intervention, in 3 it accompanied recurrent purulent highmorities, in 1 case--after removal of the nasal polyps and subsequent CSF nasal exsudate, and in 1 patient with recurrent mastoiditis. In 6 cases (11%) the cause of the recurrences remained unelucidated. The clinical signs and symptoms, diagnostic difficulties and the causative treatment of rpbme are discussed. In the authors' opinion, surgical treatment of the communication between the CSF and the external environment prevents the recurrences and is the only successful way of treatment. Special attention is drawn to the great diagnostic value of CT and MRI. The use of other modern techniques, e.g. positron emission tomography (PET

  19. Serially recurrent osteoid osteoma.

    PubMed

    Sampath, Srihari C; Sampath, Srinath C; Rosenthal, Daniel I

    2015-06-01

    Osteoid osteoma is a relatively common, benign, painful tumor of bone. It is widely believed to run a course culminating in spontaneous regression. The tumor can usually be eliminated by excision or ablation, although it may recur locally. Although management has classically been surgical, thermocoagulation via percutaneously delivered radiofrequency energy has demonstrated excellent results, typically resulting in durable response following a single treatment. Here, we present an unusual case of serially recurrent pathologically proven pediatric osteoid osteoma, treated by radiofrequency ablation five times over the course of 11 years. Limitations of RF ablation of osteoid osteoma and possible factors predisposing to incomplete treatment or recurrence are discussed.

  20. Recurrent Aphthous Stomatitis

    PubMed Central

    Akintoye, Sunday O.; Greenberg, Martin S.

    2014-01-01

    Recurrent Aphthous Stomatitis (RAS) is the most common ulcerative disease affecting the oral mucosa. It occurs mostly in healthy individuals and has atypical clinical presentation in immunocompromised individuals. The etiology of RAS is still unknown, but several local, systemic, immunologic, genetic, allergic, nutritional, and microbial factors, as well as immunosuppressive drugs, have been proposed as causative agents. Clinical management of RAS is based on severity of symptoms, frequency, size and number of lesions using topical and systemic therapies. The goals of therapy are to decrease pain and ulcer size, promote healing and decrease frequency of recurrence. PMID:24655523

  1. Efficacy of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi: A systematic review and meta-analysis

    PubMed Central

    García-Perdomo, Herney Andrés

    2017-01-01

    Purpose To determine the efficacy of phosphodiesterase type 5 inhibitors (PDE5i) as medical expulsive therapy (MET) for the treatment of distal ureteral calculi. Materials and Methods A search strategy was conducted in the MEDLINE, CENTRAL, and Embase databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of random effects due to statistical heterogeneity was conducted. The primary outcome was the expulsion rate of the distal ureteral calculus in 28 days. The secondary outcomes were the time to expulsion, side effects of treatment, and amount (mg) of nonopioid analgesia. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were PDE5i vs. placebo, tadalafil vs. placebo, and tadalafil vs. tamsulosin. Results Four articles were included in the qualitative and quantitative analysis. Records of 580 patients were found among the four studies. A low risk of bias was shown for the majority of the study items. The calculi expulsion rate had an RD of 0.26 (95% CI, 0.15–0.37) and a less prolonged expulsion as a secondary outcome with a mean difference of -4.39 days (95% CI, -6.69 to -2.09) in favor of PDE5i compared with the placebo. No significant difference was found for these outcomes when comparing tadalafil with tamsulosin. Conclusions Compared with a placebo, PDE5i could be effective as MET for the treatment of distal ureter calculi. PMID:28261676

  2. On Solving Linear Recurrences

    ERIC Educational Resources Information Center

    Dobbs, David E.

    2013-01-01

    A direct method is given for solving first-order linear recurrences with constant coefficients. The limiting value of that solution is studied as "n to infinity." This classroom note could serve as enrichment material for the typical introductory course on discrete mathematics that follows a calculus course.

  3. Recurrent gallstone ileus.

    PubMed

    Hayes, Nicolas; Saha, Sanjoy

    2012-11-01

    Mechanical small bowel obstructions caused by gallstones account for 1% to 3% of cases. In these patients, 80% to 90% of residual gallstones in these patients will pass through a remaining fistula without consequence. Recurrent gallstone ileus has been reported in 5% of patients. We report the case of a woman, aged 72 years, who presented with mechanical small bowel obstruction caused by gallstone ileus. After successful surgical therapy for gallstone ileus, the patient's symptoms recurred, and she was diagnosed with recurrent gallstone ileus requiring a repeat operation. While management of gallstone ileus can be achieved through a single-stage operation including enterolithotomy and cholecystectomy with repair of biliary-enteric fistula or by enterolithotomy alone, the literature supports enterolithotomy alone as the treatment of choice for gallstone ileus due to decreased mortality and morbidity. However, the latter approach does not obviate potential recurrence. We present this case of recurrent gallstone ileus to elucidate and review the pathogenesis, presentation, diagnosis, and consensus recommendations regarding management of this disorder.

  4. Lung Cancer Indicators Recurrence

    Cancer.gov

    This study describes prognostic factors for lung cancer spread and recurrence, as well as subsequent risk of death from the disease. The investigators observed that regardless of cancer stage, grade, or type of lung cancer, patients in the study were more

  5. Emergency ureteroscopic lithotripsy in acute renal colic caused by ureteral calculi: a retrospective study.

    PubMed

    Al-Ghazo, Mohammed A; Ghalayini, Ibrahim Fathi; Al-Azab, Rami S; Bani Hani, Osamah; Bani-Hani, Ibrahim; Abuharfil, Mohammad; Haddad, Yazan

    2011-12-01

    This work was conducted to evaluate the safety and efficacy of emergency ureteroscopic lithotripsy in patients with ureteral stones. From May 2003 to December 2010, 244 patients (184 men and 60 women, mean age 45.6 ± 12.7 years (range 22-73 years) were treated with emergency ureteroscopic lithotripsy for ureteral calculi. All patients were divided into three groups according to the stone location in the ureter. Intracorporeal lithotripsy when necessary was performed with the Swiss lithoclast. The overall stone-free status was defined as the complete absence of stone fragments at 4 weeks, postoperatively. A double J stent was inserted in selected patients if there was significant ureteral wall trauma, edema at the stone impaction site, suspected or proved ureteral perforation, and if the stone migrated to the kidney. The overall success rate was 90.6%. The success rates were different according to the stone site. The success rate of groups A, B and C was 69.4, 94.8 and 96.6%, respectively. The overall rate of ureteral stent insertion at the end of the procedure was 177/244 (72.5%). The rate of stent insertion was 41/49 (83.7%), 32/46 (69.6%) and 104/149 (69.8%) in groups A, B and C, respectively. The overall complication, failure, and stricture rate was 32/244 (13.1%), 23/244 (9.4%) and 0.8%, respectively. With the recent advances in ureteroscopic technology, intracorporeal probes and stone extraction devices, emergency ureteroscopy is found to be a safe and effective procedure with immediate relief from ureteral colic and ureteral stone fragmentation.

  6. Protective effect of Urtica dioica methanol extract against experimentally induced urinary calculi in rats.

    PubMed

    Zhang, Haiying; Li, Ning; Li, Kun; Li, Peng

    2014-12-01

    Renal calculi formation is one of the most common urological disorders. Urinary stone disease is a common disease, which affects 10‑12% of the population in industrialized countries. In males, the highest prevalence of the disease occurs between the age of 20 and 40 years, while in females, the highest incidence of the disease occurs later. Previous studies have shown that long‑term exposure to oxalate is toxic to renal epithelial cells and results in oxidative stress. In the present study, a methanolic extract of aerial parts of Urtica dioica was screened for antiurolithiatic activity against ethylene glycol and ammonium chloride‑induced calcium oxalate renal stones in male rats. In the control rats, ethylene glycol and ammonium chloride administration was observed to cause an increase in urinary calcium, oxalate and creatinine levels, as well as an increase in renal calcium and oxalate deposition. Histopathological observations revealed calcium oxalate microcrystal deposits in the kidney sections of the rats treated with ethylene glycol and ammonium chloride, indicating the induction of lithiasis. In the test rats, treatment with the methanolic extract of Urtica dioica was found to decrease the elevated levels of urinary calcium, oxalate and creatinine, and significantly decrease the renal deposition of calcium and oxalate. Furthermore, renal histological observations revealed a significant reduction in calcium oxalate crystal deposition in the test rats. Phytochemical analysis of the Urtica dioica extract was also performed using liquid chromatography‑electrospray ionization tandem mass spectrometry and high-performance liquid chromatography with photodiode array detection, to determine the chemical composition of the extract. The eight chemical constituents identified in the extract were protocatechuic acid, salicylic acid, luteolin, gossypetin, rutin, kaempferol‑3‑O‑rutinoside, kaempferol‑3‑O‑glucoside and chlorogenic acid. In conclusion

  7. Ureteroscopy and holmium:YAG laser lithotripsy: an emerging definitive management strategy for symptomatic ureteral calculi in pregnancy

    NASA Astrophysics Data System (ADS)

    Watterson, James D.; Girvan, Andrew R.; Beiko, Darren T.; Nott, Linda; Wollin, Timothy A.; Razvi, Hassan A.; Denstedt, John D.

    2003-06-01

    Objectives: Symptomatic urolithiasis in pregnancy that does not respond to conservative measures has traditionally been managed with ureteral stent insertion or percutaneous nephrostomy (PCN). Holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy using state-of-the-art ureteroscopes represents an emerging strategy for definitive stone management in pregnancy. The purpose of this study was to review the results of holmium laser lithotripsy in a cohort of patients who presented with symptomatic urolithiasis in pregnancy. Methods: A retrospective analysis was conducted at 2 tertiary stone centers from January 1996 to August 2001 to identify pregnant patients who were treated with ureteroscopic holmium laser lithotripsy for symptomatic urolithiasis or encrusted stents. Eight patients with a total of 10 symptomatic ureteral calculi and 2 encrusted ureteral stents were treated. Mean gestational age at presentation was 22 weeks. Mean stone size was 8.1 mm. Stones were located in the proximal ureter/ureteropelvic junction (UPJ) (3), mid ureter (1), and distal ureter (6). Results: Complete stone fragmentation and/or removal of encrusted ureteral stents were achieved in all patients using the holmium:YAG laser. The overall procedural success rate was 91%. The overall stone-free rate was 89%. No obstetrical or urological complications were encountered. Conclusions: Ureteroscopy and holmium laser lithotripsy can be performed safely in all stages of pregnancy providing definitive management of symptomatic ureteral calculi. The procedure can be done with minimal or no fluoroscopy and avoids the undesirable features of stents or nephrostomy tubes.

  8. Chronic recurrent multifocal osteomyelitis.

    PubMed

    Jurik, Anne Grethe

    2004-09-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is a clinical entity distinct from bacterial osteomyelitis. It occurs mainly in children and adolescents and is characterized by a prolonged, fluctuating course with recurrent episodes of pain occurring over several years. CRMO is often multifocal and most often seen in tubular bones, the clavicle, and less frequently the spine and pelvic bones; other locations are rare. The radiographic appearance suggests subacute or chronic osteomyelitis. Histopathological and laboratory findings are nonspecific and bacterial culture is usually negative. CRMO is often diagnosed by exclusion of the two main differential diagnoses--bacterial infections and tumor--by assessing for a characteristic course and the findings by conventional radiography, if necessary supplemented by scintigraphy and/or magnetic resonance imaging (MRI). The MRI appearance of CRMO lesions in tubular bones and the spine is often rather characteristic and support the diagnosis. It is important to diagnose CRMO to avoid unnecessary diagnostic procedures and initiate an appropriate therapy.

  9. Chronic recurrent multifocal osteomyelitis.

    PubMed

    Costa-Reis, Patrícia; Sullivan, Kathleen E

    2013-08-01

    Chronic recurrent multifocal osteomyelitis is a rare auto-inflammatory condition that primarily affects children and adolescents. It presents with recurrent episodes of pain related to the presence of foci of sterile bone inflammation. The long bones of the lower extremities are more frequently affected and the spine can also be involved. Imaging studies, including whole-body magnetic resonance, are important for diagnosis and detection of asymptomatic lesions. Bone biopsies may be necessary to exclude other diseases, including malignancy and infections. Non-steroidal anti-inflammatory drugs cause relief of symptoms in the majority of cases. Bisphosphonates and TNF-α blockers are alternatives for patients who do not respond or who have spinal involvement.

  10. Treatment of recurrent concussion.

    PubMed

    McCrory, Paul

    2002-02-01

    The management of an athlete with recurrent concussions, whether persistently symptomatic or not, remains anecdotal. Currently, there are no evidence-based guidelines upon which a team physician can advise the athlete. All doctors involved in athlete care need to be aware of the potential for medicolegal problems if athletes are inappropriately returned to sport prematurely or, in the case of professional athletes, held out of sport or retired on the basis of nonscientific recommendations. This paper discusses such issues.

  11. Chronic recurrent multifocal osteomyelitis.

    PubMed

    Wedman, Jan; van Weissenbruch, Ranny

    2005-01-01

    We report what is, to our best knowledge, the first case of chronic recurrent multifocal osteomyelitis (CRMO) in which the frontal and sphenoid bones were involved. Characterized by a prolonged and fluctuating course of osteomyelitis at different sites, CRMO is self-limited, although sequelae can occur. The diagnosis is one of exclusion. It is important to publish cases like this, because the recognition of CRMO can prevent aggressive surgical and medical treatment.

  12. [Chronic recurrent multifocal osteomyelitis].

    PubMed

    Király, Balázs; Feith, Sándor; Barta, Miklós; Oroszlán, György

    2003-12-21

    The chronic recurrent multifocal osteomyelitis has been reported very rarely in the literature. However, its significance must be emphasized, because it is a spontaneously healing, benign disease, as compared to the classical forms of osteomyelitis. It leaves behind almost no residual symptoms, and many operations, long antimicrobial therapy may be avoided by diagnosing it. In this case report the authors provide the review of the disease through the history of a 9-year-old boy.

  13. A rare case of asymptomatic bilateral submandibular gland sialolithiasis: a giant, fistulized calculus on the right and multiple calculi on the left.

    PubMed

    Emir, Hatice; Kaptan, Zeynep Kizilkaya; Uzunkulaoglu, Hakki; Dogan, Sedat

    2010-10-01

    Sialolithiasis is the most common disease of the submandibular gland; sialoliths account for at least 80% of all salivary duct calculi. We present a rare case of asymptomatic bilateral submandibular gland sialoliths. On the right, the patient had a giant (35 × 35 mm) sialolith that had fistulized into the oral cavity. In the left submandibular gland, he had 30 differently sized sialoliths.

  14. Laparoscopic repair of recurrent hernias.

    PubMed

    Felix, E L; Michas, C A; McKnight, R L

    1995-02-01

    The purpose of this study was to evaluate the results of a laparoscopic approach to recurrent inguinal hernia repair which dissected the entire inguinal floor and repaired all potential areas of recurrence without producing tension. Both a transabdominal preperitoneal and a totally extraperitoneal laparoscopic approach were utilized. Ninety recurrent hernias were repaired in 81 patients. The patients had 26 indirect, 36 direct, and 26 pantaloon recurrent hernias of which eight had a femoral component. In all but one patient the primary operations were open anterior repairs. The median follow-up was 14 months, ranging from 1 to 28 months. Patients returned to normal activities in an average of 1 week. The only recurrence observed was in the one patient whose primary repair was laparoscopic. When the entire inguinal floor of the recurrent hernia was redissected and buttressed with mesh, early recurrence was eliminated and recovery was shortened.

  15. Multiscale recurrence quantification analysis of order recurrence plots

    NASA Astrophysics Data System (ADS)

    Xu, Mengjia; Shang, Pengjian; Lin, Aijing

    2017-03-01

    In this paper, we propose a new method of multiscale recurrence quantification analysis (MSRQA) to analyze the structure of order recurrence plots. The MSRQA is based on order patterns over a range of time scales. Compared with conventional recurrence quantification analysis (RQA), the MSRQA can show richer and more recognizable information on the local characteristics of diverse systems which successfully describes their recurrence properties. Both synthetic series and stock market indexes exhibit their properties of recurrence at large time scales that quite differ from those at a single time scale. Some systems present more accurate recurrence patterns under large time scales. It demonstrates that the new approach is effective for distinguishing three similar stock market systems and showing some inherent differences.

  16. Recurrent brachial plexus neuropathy.

    PubMed

    Bradley, W G; Madrid, R; Thrush, D C; Campbell, M J

    1975-09-01

    The clinical, electrophysiological and pathological changes in 3 patients with recurrent attacks of non-traumatic brachial plexus neuropathy have been described. Two had recurrent attacks and a dominant family history of similar attacks, together with evidence of lesser degrees of nerve involvement outside the brachial plexus. In one patient the attacks were moderately painful, while in the other there was little or no pain. Only one showed undue slowing of motor nerve conduction during ischaemia, but in both cases the sural nerves had the changes of tomaculous neuropathy, with many sausage-shaped swellings of the myelin sheaths, and extensive segmental demyelination and remyelination. The third patient had two attacks of acute brachial plexus neuropathy which were both extremely painful. The clinical features were compatible with a diagnosis of neuralgic amuotrophy. In the second attack, there was vagus nerve involvement and the sural nerve showed evidence of healed extensive segmental demyelination. The various syndromes presenting with acute non-traumatic brachial plexus neuropathy are reviewed, and a tentative nonsological classification advanced. Most patients fall into the category of acute, painful paralysis with amyotrophy, with no family history and no evidence of lesions outside the brachial plexus. It is suggested that the term "neuralgic amyotrophy" be restricted to this group. Patients with features outside this clinical picture probably suffer from other disease entities presenting with brachial plexus neuropathy. The familial cases constitute one or more aetioliogical subgroups, differing from neuralgic amyotrophy in the frequency of recurrences, the relative freedom from pain in the attacks, the frequency of nerve lesions outside the brachial plexus, and of hypotelorism. Individual attacks of acute brachial plexus neuropathy, however, may be identical in patients with the different diseases, and further pathological and biochemical studies are

  17. Recurrent tarsal tunnel syndrome.

    PubMed

    Gould, John S

    2014-09-01

    Recurrence of tarsal tunnel syndrome after surgery may be due to inadequate release, lack of understanding or appreciation of the actual anatomy involved, variations in the anatomy of the nerve(s), failure to execute the release properly, bleeding with subsequent scarring, damage to the nerve and branches, persistent hypersensitivity of the nerves, and preexisting intrinsic damage to the nerve. Approaches include more thorough release, use of barrier materials to decrease adherence of the nerve to surrounding tissues to avoid traction neuritis, excisions of neuromas using conduits, and consideration of nerve stimulators and systemic medications to deal with persistent neural pain.

  18. Recurrent respiratory papillomatosis.

    PubMed

    Venkatesan, Naren N; Pine, Harold S; Underbrink, Michael P

    2012-06-01

    Recurrent respiratory papillomatosis (RRP) is a rare, benign disease with no known cure. RRP is caused by infection of the upper aerodigestive tract with the human papillomavirus (HPV). Passage through the birth canal is thought to be the initial transmission event, but infection may occur in utero. HPV vaccines have helped to provide protection from cervical cancer; however, their role in the prevention of RRP is undetermined. Clinical presentation of initial symptoms of RRP may be subtle. RRP course varies, and current management focuses on surgical debulking of papillomatous lesions with or without concurrent adjuvant therapy.

  19. Recurrent acute pancreatitis.

    PubMed

    Khurana, Vishal; Ganguly, Ishita

    2014-09-28

    Recurrent acute pancreatitis (RAP) is commonly encountered, but less commonly understood clinical entity, especially idiopathic RAP, with propensity to lead to repeated attacks and may be chronic pancreatitis if attacks continue to recur. A great number of studies have been published on acute pancreatitis, but few have focused on RAP. Analysing the results of clinical studies focusing specifically on RAP is problematic in view due to lack of standard definitions, randomised clinical trials, standard evaluation protocol used and less post intervention follow-up duration. With the availability of newer investigation modalities less number of etiologies will remains undiagnosed. This review particularly is focused on the present knowledge in understanding of RAP.

  20. [Chronic recurrent parotitis].

    PubMed

    Zenk, J; Koch, M; Klintworth, N; Iro, H

    2010-03-01

    Chronic recurrent parotitis is a non-obstructive disease with episodes of mostly painful swelling of the gland. It is categorized into a juvenile and an adult form, even without clear information on its actual origin. As to the etiology of the juvenile form, genetic factors and duct malformations as well as bacterial infections are discussed. Very rarely a complete lymphatic transformation of the gland might take place. Juvenile chronic recurrent parotitis is self-limiting in about 90% of all cases, as patients grow up. The diagnosis is based on patient history and clinical findings. Sonography is the imaging method of choice. Sialendoscopy shows a typical whitish pattern of the ducts in juvenile disease. Strictures or stenoses are typical for the adult form. The therapy of choice is gland massage and sialagogues, in addition to the administration of antibiotics. In more severe cases sialendoscopy together with rinsing of the ducts and instillation of cortisone are indicated. Total parotidectomy remains the last choice and is rarely necessary.

  1. Clinically-Relevant Cutaneous Lesions by Nitrogen Mustard: Useful Biomarkers of Vesicants Skin Injury in SKH-1 Hairless and C57BL/6 Mice

    PubMed Central

    Tewari-Singh, Neera; Jain, Anil K.; Inturi, Swetha; White, Carl W.; Agarwal, Rajesh

    2013-01-01

    A paucity of clinically applicable biomarkers to screen therapies in laboratory is a limitation in the development of countermeasures against cutaneous injuries by chemical weapon, sulfur mustard (SM), and its analog nitrogen mustard (NM). Consequently, we assessed NM-caused progression of clinical cutaneous lesions; notably, skin injury with NM is comparable to SM. Exposure of SKH-1 hairless and C57BL/6 (haired) mice to NM (3.2 mg) for 12–120 h caused clinical sequelae of toxicity, including microblister formation, edema, erythema, altered pigmentation, wounding, xerosis and scaly dry skin. These toxic effects of NM were similar in both mouse strains, except that wounding and altered pigmentation at 12–24 h and appearance of dry skin at 24 and 72 h post-NM exposure were more pronounced in C57BL/6 compared to SKH-1 mice. Conversely, edema, erythema and microblister formation were more prominent in SKH-1 than C57BL/6 mice at 24–72 h after NM exposure. In addition, 40–60% mortality was observed following 120 h of NM exposure in the both mouse strains. Overall, these toxic effects of NM are comparable to those reported in humans and other animal species with SM, and thus represent clinically-relevant cutaneous injury endpoints in screening and optimization of therapies for skin injuries by vesicating agents. PMID:23826320

  2. Recurrence theorems: A unified account

    SciTech Connect

    Wallace, David

    2015-02-15

    I discuss classical and quantum recurrence theorems in a unified manner, treating both as generalisations of the fact that a system with a finite state space only has so many places to go. Along the way, I prove versions of the recurrence theorem applicable to dynamics on linear and metric spaces and make some comments about applications of the classical recurrence theorem in the foundations of statistical mechanics.

  3. [Urinary calculi in small and other animals--a retrospective study of the years 1980-1989].

    PubMed

    Wenkel, R; Berg, W; Prange, H

    1998-05-01

    More than 500 uroliths from dogs, cats, minks, rabbits and 9 further animal species originating from various regions of former East Germany were analysed. The observations were made between 1980 and 1989 using X-ray diffraction and infrared spectroscopy. The urinary stones consisted of struvite, whewellite, weddellite, cystine, ammonium urate, brushite, whitlockite, hydroxyapatite or carbonate-apatite, calcium carbonate, silicon dioxide and organic matrix stones. In dogs, the most frequent types were struvite and apatite concrements, followed by calcium oxalate and cystine uroliths. Among the diseased animals poodles, dachshunds and terriers ranked first. In the analysed material from cats apatite and struvite predominated. With few exceptions, minks formed struvite uroliths only. The analysed calculi from rabbits consisted principally of calcium phosphate or calcium carbonate concrements. The present analysis has been compared with results of former studies, differences are discussed.

  4. Preoperative and postoperative cortical function of the kidney with staghorn calculi assessed by 99mtechnetium-dimercaptosuccinic acid renal scintigraphy.

    PubMed

    Kawamura, J; Itoh, H; Okada, Y; Higashi, Y; Yoshida, O; Fujita, T; Torizuka, K

    1983-09-01

    99mTechnetium dimercaptosuccinic acid renal scintigraphy, consisting of the cortical image and dimercaptosuccinic acid renal uptake rate, was used to assess preoperative and postoperative renal function in 55 patients with staghorn calculi. In 14 of 20 patients who had undergone extended pyelolithotomy and in 4 of 22 who had undergone nephrolithotomy there was an increase or no change in the postoperative dimercaptosuccinic acid renal uptake in the surgically treated kidney. However, there was no increase in the postoperative dimercaptosuccinic acid renal uptake in the patients who had undergone pyelolithotomy combined with nephrotomy or partial nephrectomy. Eight per cent of the preoperative dimercaptosuccinic acid renal uptake rate in the diseased kidney seems to be the absolute level for predicting the postoperative recovery of renal function. Dimercaptosuccinic acid renal images provide evidence of morphological changes in the cortex of the kidney with stones and the dimercaptosuccinic acid uptake rate is a useful adjunct for quantitative assessments of preoperative and postoperative residual cortical function.

  5. The preventive effect of N-butanol fraction of Nigella sativa on ethylene glycol-induced kidney calculi in rats

    PubMed Central

    Hadjzadeh, Mousa-Al-Reza; Rad, Abolfazl Khajavi; Rajaei, Ziba; Tehranipour, Maryam; Monavar, Nahid

    2011-01-01

    Background: The current study was carried out to determine whether the aqueous-ethanolic extract or the butanolic fraction of Nigella sativa (NS) seeds could prevent or reduce calculi aggregation in experimental calcium oxalate nephrolithiasis in Wistar rats. Materials and Methods: Male Wistar rats were randomly divided into 5 groups: group A received tap drinking water for 28 days. Groups B, C, D and E received 1% ethylene glycol for induction of calcium oxalate (CaOx) calculus formation for 28 days. Rats in groups C, D and E also received aqueous-ethanolic extract of NS, N-butanol fraction and N-butanol phase remnant of NS, respectively, in drinking water at a dose of 250 mg/kg for 28 days. Urine concentration of oxalate, citrate, and calcium on days 0, 14, and 28, and also serum concentration of magnesium and calcium on days 0 and 28, were measured. On day 29, kidneys were removed for histopathologic study and examined for counting the calcium oxalate deposits in 10 microscopic fields. Result: Treatment of rats with N-butanol fraction and N-butanol phase remnant of NS significantly reduced the number and size of kidney calcium oxalate deposits compared with ethylene glycol group. Urinary concentration of oxalate in all experimental groups increased compared with control group on days 14 and 28, whereas the urine citrate concentration was lower in all experimental groups compared with control group on days 14 and 28. Conclusion: N-butanol fraction and N-butanol phase remnant of NS showed a beneficial effect on calcium oxalate deposition in the rat kidney. Therefore, the butanolic fraction of NS may be suggested for prevention of calcium oxalate calculi in humans. PMID:22262938

  6. Abemaciclib in Children With DIPG or Recurrent/Refractory Solid Tumors

    ClinicalTrials.gov

    2017-02-10

    Diffuse Intrinsic Pontine Glioma; Brain Tumor, Recurrent; Solid Tumor, Recurrent; Neuroblastoma, Recurrent, Refractory; Ewing Sarcoma, Recurrent, Refractory; Rhabdomyosarcoma, Recurrent, Refractory; Osteosarcoma, Recurrent, Refractory; Rhabdoid Tumor, Recurrent, Refractory

  7. Recurrence plots revisited

    NASA Astrophysics Data System (ADS)

    Casdagli, M. C.

    1997-09-01

    We show that recurrence plots (RPs) give detailed characterizations of time series generated by dynamical systems driven by slowly varying external forces. For deterministic systems we show that RPs of the time series can be used to reconstruct the RP of the driving force if it varies sufficiently slowly. If the driving force is one-dimensional, its functional form can then be inferred up to an invertible coordinate transformation. The same results hold for stochastic systems if the RP of the time series is suitably averaged and transformed. These results are used to investigate the nonlinear prediction of time series generated by dynamical systems driven by slowly varying external forces. We also consider the problem of detecting a small change in the driving force, and propose a surrogate data technique for assessing statistical significance. Numerically simulated time series and a time series of respiration rates recorded from a subject with sleep apnea are used as illustrative examples.

  8. Recurrent vulvovaginal candidiasis.

    PubMed

    Sobel, Jack D

    2016-01-01

    Recurrent vulvovaginal candidiasis (RVVC) is a common cause of significant morbidity in women in all strata of society affecting millions of women worldwide. Previously, RVVC occurrence was limited by onset of menopause but the widespread use of hormone replacement therapy has extended the at-risk period. Candida albicans remains the dominant species responsible for RVVC, however optimal management of RVVC requires species determination and effective treatment measures are best if species-specific. Considerable progress has been made in understanding risk factors that determine susceptibility to RVVC, particularly genetic factors, as well as new insights into normal vaginal defense immune mechanisms and their aberrations in RVVC. While effective control of RVVC is achievable with the use of fluconazole maintenance suppressive therapy, cure of RVVC remains elusive especially in this era of fluconazole drug resistance. Vaccine development remains a critical challenge and need.

  9. [Mucinous adenocarcinoma of the renal pelvis associated with renal calculi of the inflammatory type].

    PubMed

    Kalafatis, P; Zarifis, I; Sotrillis, T; Stefis, A

    1999-03-01

    A rare case of mucinous adenocarcinoma of the renal pelvis associated with renal staghorn calculosis in a 60-years-old male patient with pyuria and mucin content of the urine is presented. History was significant for recurrent calculosis of the left kidney. A non functioning hydronephrotic left kidney with staghorn calculosis was diagnosed. Laboratory tests were remarkable only for Carcinoembrionic Antigen (CEA). Pathology of the surgical specimen followed by its immunoreactivity revealed an intestinal type metaplasia and papillary, tubular and mucinous adenocarcinoma of the renal pelvis. Pathogenesis of the intestinal metaplasia and the role of chronic irritation of the urothelium are mentioned.

  10. Treatment of juvenile recurrent parotitis.

    PubMed

    Katz, Philippe; Hartl, Dana M; Guerre, Agnès

    2009-12-01

    Juvenile recurrent parotitis (JRP) can be a debilitating illness in children. Knowing how to recognize and diagnose it for early treatment avoids recurrences that could lead to significant destruction of the glandular parenchyma. This article discusses the various therapeutic modalities proposed in the literature (medical treatment or sialendoscopy) and describes the authors' treatment of choice of combining antibiotics and iodinated oil sialography.

  11. Recurrent Bell's palsy in pregnancy.

    PubMed

    Deshpande, A D

    1990-09-01

    A case of recurrent Bell's palsy occurring in two successive pregnancies in a 37-year-old woman is presented. The causes of facial nerve paralysis of the lower motor neurone type are discussed. The rate of recurrence of Bell's palsy during pregnancy is unknown. Treatment with corticosteroids of Bell's palsy during pregnancy poses the threat of possible side effects on the fetus.

  12. Recurrent Aphthous Stomatitis: A Review

    PubMed Central

    Saleh, Dahlia; Miller, Richard A.

    2017-01-01

    Aphthous stomatitis is a painful and often recurrent inflammatory process of the oral mucosa that can appear secondary to various well-defined disease processes. Idiopathic recurrent aphthous stomatitis is referred to as recurrent aphthous stomatitis. The differential diagnosis for recurrent aphthous ulcerations is extensive and ranges from idiopathic benign causes to inherited fever syndromes, to connective tissue disease, or even inflammatory bowel diseases. A thorough history and review of systems can assist the clinician in determining whether it is related to a systemic inflammatory process or truly idiopathic. Management of aphthous stomatitis is challenging. For recurrent aphthous stomatitis or recalcitrant aphthous stomatitis from underlying disease, first-line treatment consists of topical medications with use of systemic medications as necessary. Herein, the authors discuss the differential diagnosis and treatment ladder of aphthous stomatitis as described in the literature. PMID:28360966

  13. Recurrent Aphthous Stomatitis: A Review.

    PubMed

    Edgar, Natalie Rose; Saleh, Dahlia; Miller, Richard A

    2017-03-01

    Aphthous stomatitis is a painful and often recurrent inflammatory process of the oral mucosa that can appear secondary to various well-defined disease processes. Idiopathic recurrent aphthous stomatitis is referred to as recurrent aphthous stomatitis. The differential diagnosis for recurrent aphthous ulcerations is extensive and ranges from idiopathic benign causes to inherited fever syndromes, to connective tissue disease, or even inflammatory bowel diseases. A thorough history and review of systems can assist the clinician in determining whether it is related to a systemic inflammatory process or truly idiopathic. Management of aphthous stomatitis is challenging. For recurrent aphthous stomatitis or recalcitrant aphthous stomatitis from underlying disease, first-line treatment consists of topical medications with use of systemic medications as necessary. Herein, the authors discuss the differential diagnosis and treatment ladder of aphthous stomatitis as described in the literature.

  14. Case report of primary renal pelvis squamous cell carcinoma coexisting with long-standing calculi in left kidney on 18F-FDG PET/CT

    PubMed Central

    Deng, Shengming; Zhang, Bin; Huang, Ying; Li, Jihui; Sang, Shibiao; Zhang, Wei

    2017-01-01

    Abstract Rationale: Primary renal pelvis squamous cell carcinoma (SCC) is an extremely rare neoplasm. In many patients, the SCC was associated with renal calculi. Patient concerns: A 61-year-old male presented with intermittent pain at the left lumbar region for 3 days. The PET/CT images demonstrated increased 18F-FDG uptake in the upper pole of the left kidney and left renal hilar lymph nodes. Diagnoses: Pathologic examination revealed well-moderately differentiated renal pelvis SCC with lymphatic metastasis. Interventions: The patient underwent a left nephrectomy a few days after the initial staging PET/CT study. Outcomes: No growing lesion or metastasis was observed during a 6-month follow-up. Lessons: Our case demonstrates that 18F-FDG PET/CT is a useful diagnostic tool to evaluate primary renal pelvic SCC and detect metastatic lymph nodes in patients with long-standing calculi. PMID:28296764

  15. Recurrence plots and recurrence quantification analysis of human motion data

    NASA Astrophysics Data System (ADS)

    Josiński, Henryk; Michalczuk, Agnieszka; Świtoński, Adam; Szczesna, Agnieszka; Wojciechowski, Konrad

    2016-06-01

    The authors present exemplary application of recurrence plots, cross recurrence plots and recurrence quantification analysis for the purpose of exploration of experimental time series describing selected aspects of human motion. Time series were extracted from treadmill gait sequences which were recorded in the Human Motion Laboratory (HML) of the Polish-Japanese Academy of Information Technology in Bytom, Poland by means of the Vicon system. Analysis was focused on the time series representing movements of hip, knee, ankle and wrist joints in the sagittal plane.

  16. Regulation of Hsp27 and Hsp70 expression in human and mouse skin construct models by caveolae following exposure to the model sulfur mustard vesicant, 2-chloroethyl ethyl sulfide.

    PubMed

    Black, Adrienne T; Hayden, Patrick J; Casillas, Robert P; Heck, Diane E; Gerecke, Donald R; Sinko, Patrick J; Laskin, Debra L; Laskin, Jeffrey D

    2011-06-01

    Dermal exposure to the vesicant sulfur mustard causes marked inflammation and tissue damage. Basal keratinocytes appear to be a major target of sulfur mustard. In the present studies, mechanisms mediating skin toxicity were examined using a mouse skin construct model and a full-thickness human skin equivalent (EpiDerm-FT™). In both systems, administration of the model sulfur mustard vesicant, 2-chloroethyl ethyl sulfide (CEES, 100-1000μM) at the air surface induced mRNA and protein expression of heat shock proteins 27 and 70 (Hsp27 and Hsp70). CEES treatment also resulted in increased expression of caveolin-1, the major structural component of caveolae. Immunohistochemistry revealed that Hsp27, Hsp70 and caveolin-1 were localized in basal and suprabasal layers of the epidermis. Caveolin-1 was also detected in fibroblasts in the dermal component of the full thickness human skin equivalent. Western blot analysis of caveolar membrane fractions isolated by sucrose density centrifugation demonstrated that Hsp27 and Hsp70 were localized in caveolae. Treatment of mouse keratinocytes with filipin III or methyl-β-cyclodextrin, which disrupt caveolar structure, markedly suppressed CEES-induced Hsp27 and Hsp70 mRNA and protein expression. CEES treatment is known to activate JNK and p38 MAP kinases; in mouse keratinocytes, inhibition of these enzymes suppressed CEES-induced expression of Hsp27 and Hsp70. These data suggest that MAP kinases regulate Hsp 27 and Hsp70; moreover, caveolae-mediated regulation of heat shock protein expression may be important in the pathophysiology of vesicant-induced skin toxicity.

  17. Regulation of Hsp27 and Hsp70 expression in human and mouse skin construct models by caveolae following exposure to the model sulfur mustard vesicant, 2-chloroethyl ethyl sulfide

    SciTech Connect

    Black, Adrienne T.; Hayden, Patrick J.; Casillas, Robert P.; Heck, Diane E.; Gerecke, Donald R.; Sinko, Patrick J.; Laskin, Debra L.; Laskin, Jeffrey D.

    2011-06-01

    Dermal exposure to the vesicant sulfur mustard causes marked inflammation and tissue damage. Basal keratinocytes appear to be a major target of sulfur mustard. In the present studies, mechanisms mediating skin toxicity were examined using a mouse skin construct model and a full-thickness human skin equivalent (EpiDerm-FT{sup TM}). In both systems, administration of the model sulfur mustard vesicant, 2-chloroethyl ethyl sulfide (CEES, 100-1000 {mu}M) at the air surface induced mRNA and protein expression of heat shock proteins 27 and 70 (Hsp27 and Hsp70). CEES treatment also resulted in increased expression of caveolin-1, the major structural component of caveolae. Immunohistochemistry revealed that Hsp27, Hsp70 and caveolin-1 were localized in basal and suprabasal layers of the epidermis. Caveolin-1 was also detected in fibroblasts in the dermal component of the full thickness human skin equivalent. Western blot analysis of caveolar membrane fractions isolated by sucrose density centrifugation demonstrated that Hsp27 and Hsp70 were localized in caveolae. Treatment of mouse keratinocytes with filipin III or methyl-{beta}-cyclodextrin, which disrupt caveolar structure, markedly suppressed CEES-induced Hsp27 and Hsp70 mRNA and protein expression. CEES treatment is known to activate JNK and p38 MAP kinases; in mouse keratinocytes, inhibition of these enzymes suppressed CEES-induced expression of Hsp27 and Hsp70. These data suggest that MAP kinases regulate Hsp 27 and Hsp70; moreover, caveolae-mediated regulation of heat shock protein expression may be important in the pathophysiology of vesicant-induced skin toxicity.

  18. Regulation of Hsp27 and Hsp70 expression in human and mouse skin construct models by caveolae following exposure to the model sulfur mustard vesicant, 2-chloroethyl ethyl sulfide

    PubMed Central

    Black, Adrienne T.; Hayden, Patrick J.; Casillas, Robert P.; Heck, Diane E.; Gerecke, Donald R.; Sinko, Patrick J.; Laskin, Debra L.; Laskin, Jeffrey D.

    2012-01-01

    Dermal exposure to the vesicant sulfur mustard causes marked inflammation and tissue damage. Basal keratinocytes appear to be a major target of sulfur mustard. In the present studies, mechanisms mediating skin toxicity were examined using a mouse skin construct model and a full-thickness human skin equivalent (EpiDerm-FTTM). In both systems, administration of the model sulfur mustard vesicant, 2-chloroethyl ethyl sulfide (CEES, 100–1000 µM) at the air surface induced mRNA and protein expression of heat shock proteins 27 and 70 (Hsp27 and Hsp70). CEES treatment also resulted in increased expression of caveolin-1, the major structural component of caveolae. Immunohistochemistry revealed that Hsp27, Hsp70 and caveolin-1 were localized in basal and suprabasal layers of the epidermis. Caveolin-1 was also detected in fibroblasts in the dermal component of the full thickness human skin equivalent. Western blot analysis of caveolar membrane fractions isolated by sucrose density centrifugation demonstrated that Hsp27 and Hsp70 were localized in caveolae. Treatment of mouse keratinocytes with filipin III or methyl-β-cyclodextrin, which disrupt caveolar structure, markedly suppressed CEES-induced Hsp27 and Hsp70 mRNA and protein expression. CEES treatment is known to activate JNK and p38 MAP kinases; in mouse keratinocytes, inhibition of these enzymes suppressed CEES-induced expression of Hsp27 and Hsp70. These data suggest that MAP kinases regulate Hsp 27 and Hsp70; moreover, caveolae-mediated regulation of heat shock protein expression may be important in the pathophysiology of vesicant-induced skin toxicity. PMID:21457723

  19. Free radical production from the interaction of 2-chloroethyl vesicants (mustard gas) with pyridine nucleotide-driven flavoprotein electron transport systems

    SciTech Connect

    Brimfield, A.A. Mancebo, A.M.; Mason, R.P.; Jiang, J.J.; Siraki, A.G.; Novak, M.J.

    2009-01-01

    The biochemical sequelae to chloroethyl mustard exposure correspond very well to toxic processes initiated by free radicals. Additionally, mustard solutions contain spontaneously formed cyclic onium ions which produce carbon free radicals when reduced electrochemically. Therefore, we hypothesized that the onium ions of sulfur or nitrogen mustards might produce carbon free radicals upon being reduced enzymatically, and that these radicals might constitute a metabolic activation. We set out to document radical production using an in vitro metabolic system and electron paramagnetic resonance (EPR). Our system consisted of NADPH, one of several pyridine nucleotide-driven flavoprotein reductases, cytochrome c as a terminal electron acceptor, various sulfur or nitrogen mustards and the spin trap {alpha}-[4-pyridyl-1-oxide]-N-tert-butylnitrone in buffer. Reactions were started by adding the reductase to the other materials, vortexing and immediately transferring the mixture to a 10 mm EPR flat cell. Repeated scans on a Bruker ESP 300E EPR spectrometer produced a triplet of doublets with hyperfine splitting constants of a{sub N} = 15.483 G and a{sub H} = 2.512 G. The outcome supported our hypothesis that carbon-centered free radicals are produced when mustard-related onium ions are enzymatically reduced. The EPR results varied little with the chloroethyl compound used or with porcine or human cytochrome P450 reductase, the reductase domain of rat brain neuronal nitric oxide synthase or rat liver thioredoxin reductase. Our results offer new insight into the basis for mustard-induced vesication and the outcome of exposure to different mustards. The free radical model provides an explanation for similarities in the lesions arising from mustard exposure and energy-based lesions such as those from heat, ultraviolet and nuclear radiation as well as damage across tissue types such as skin, eyes or airway epithelium.

  20. Recurrent uric acid stones.

    PubMed

    Kamel, K S; Cheema-Dhadli, S; Shafiee, M A; Davids, M R; Halperin, M L

    2005-01-01

    A 46-year-old female had a history of recurrent uric acid stone formation, but the reason why uric acid precipitated in her urine was not obvious, because the rate of urate excretion was not high, urine volume was not low, and the pH in her 24-h urine was not low enough. In his discussion of the case, Professor McCance provided new insights into the pathophysiology of uric acid stone formation. He illustrated that measuring the pH in a 24-h urine might obscure the fact that the urine pH was low enough to cause uric acid to precipitate during most of the day. Because he found a low rate of excretion of NH(4)(+) relative to that of sulphate anions, as well as a high rate of citrate excretion, he speculated that the low urine pH would be due to a more alkaline pH in proximal convoluted tubule cells. He went on to suspect that there was a problem in our understanding of the function of renal medullary NH(3) shunt pathway, and he suggested that its major function might be to ensure a urine pH close to 6.0 throughout the day, to minimize the likelihood of forming uric acid kidney stones.

  1. [Chronic recurrent multifocal osteomyelitis].

    PubMed

    Seidl, T; Maier, M; Refior, H J; Veihelmann, A

    2003-06-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, inflammatory, skeletal disease of unknown origin, which mainly affects children and adolescents in terms of cleido-spondylo-metaphysal skeletal inflammation. Only 10% of the patients are older than 20 years. To date, only about 200 cases have been reported in the literature. In the course of the disease, the initial radiological signs are osteolysis followed by sclerosis and hyperostosis in the end stage. The histological investigations reveal chronic inflammatory infiltrates with lymphocytes and hyperostosis. Although the prognosis of CRMO, to our current understanding, is self limiting, serious complications have been reported such as pathological fractures and compression fractures of the spine. A recently recommended therapy scheme is based on the administration of azithromycin combined with calcitonin. We present the case of a 25 year old female patient who has suffered from CRMO for 1.5 years with the cervical spine and the manubrium sterni being affected. The current state of diagnosis, therapy, and prognostic outlook of this rare disease are discussed.

  2. Chronic recurrent multifocal osteomyelitis.

    PubMed

    Roderick, Marion R; Ramanan, Athimalaipet V

    2013-01-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease occurring primarily in children and adolescents. Episodes of systemic inflammation occur due to immune dysregulation without autoantibodies, pathogens or antigen-specific T cells. CRMO is characterised by the insidious onset of pain with swelling and tenderness over the affected bones. Clavicular involvement was the classical description; however, the metaphyses and epiphyses of long bones are frequently affected. Lesions may occur in any bone, including vertebrae. Characteristic imaging includes bone oedema, lytic areas, periosteal reaction and soft tissue reaction. Biopsies from affected areas display polymorphonuclear leucocytes with osteoclasts and necrosis in the early stages. Subsequently, lymphocytes and plasma cells predominate followed by fibrosis and signs of reactive new bone forming around the inflammation. Diagnosis is facilitated by the use of STIR MRI scanning, potentially obviating the need for biopsy and unnecessary long-term antibiotics due to incorrect diagnosis. Treatment options include non-steroidal anti-inflammatory drugs and bisphosphonates. Biologics have been tried in resistant cases with promising initial results. Gene identification has not proved easy although research in this area continues. Early descriptions of the disease suggested a benign course; however, longer-term follow up shows that it can cause significant morbidity and longer-term disability. Although it has always been thought of as very rare, the prevalence is likely to be vastly underestimated due to poor recognition of the disease.

  3. [Chronic recurrent multifocal osteomyelitis].

    PubMed

    Schilling, F; Eckardt, A; Kessler, S

    2000-01-01

    The aim of this paper is to give a detailed description of the so-called "chronic recurrent multifocal osteomyelitis" (CRMO). The clinical, radiological and histopathological results of an analysis of 29 cases (15 children/adolescents and 14 adults) are presented and correlated to current data from the literature. We could delinate the following points: 1. CRMO is a systemic aseptic inflammation of the bone marrow (Osteitis), it can occur polytopically and association with pustulous dermatologic symptoms is possible. 2. It is not a rare disease 3. Osteomyelitis is probably "reactive" and a plasma-cell sclerotic process with ist own characteristic histologic three-phase course. 4. We could observe 5 specific types of localization which can be documented by X-ray or bone scan. 5. Accompanying arthritis os often present, especially "sympathetic coxitis". 6. The use of drugs in treatment of CRMO (i.e. azithromycin, calcitonin, and bisphosphonates) is discussed. In conclusion we want to point out, that 1. 99mTC bone scan should always be performed when there is suspicion for CRMO to reveal the pattern of affection, 2. the rheumatologist and dermatologist should be contacted, 3. operation is normally not necessary for treatment of the mostly self-limitin disease, and 4. the term "SAPHO syndrome" should be avoided, further differentiation of the diagnosis is necessary.

  4. [Recurrent urinary tract infections].

    PubMed

    Pigrau-Serrallach, Carlos

    2005-12-01

    Recurrent urinary tract infections (RUTI) are a frequent clinical problem in sexually active young women, pregnant or postmenopausal women and in patients with underlying urological abnormalities. The present chapter reviews RUTI based on their classification: relapses, which usually occur early (< 1 month), are caused by the same microorganism and are associated with underlying urological abnormalities, and reinfections, which usually occur later and are caused by a new distinct microorganism (or by the same microorganism usually located in the rectum or uroepithelial cells). The pathogenesis of RUTI is reviewed and the risk factors associated with RUTI in premenopausal women (usually related to sexual activity), postmenopausal women (in whom estrogen deficiency has a significant effect on the vaginal Lactobacillus flora), and in pregnant women are discussed. Likewise, an extensive review of the distinct therapeutic strategies to prevent RUTI is provided: self-treatment of cystitis, continuous antibiotic prophylaxis, postcoital antibiotic prophylaxis, topical vaginal estrogens, Lactobacillus, cranberry juice, intravesical administration of non-virulent E. coli strains and vaccines, among others. Several diagnostic-therapeutic algorithms are included. These algorithms are based on the type of urinary infection (relapse-reinfection), on the type of patient (young, postmenopausal, or pregnant women) and on the number of episodes of RUTI.

  5. Vulvovaginitis candidiasis recurrence during pregnancy.

    PubMed

    Fardiazar, Z; Ronaci, F; Torab, R; Goldust, M

    2012-04-15

    Vulvovaginitis is the most common gynecologic condition seen by practitioners rendering primary care to women. Vulvovaginitis Candidiasis (VVC) is the most common type of vaginitis and this study aimed at specifying VVC recurrence during pregnancy. In this prospective study, 150 pregnant women suffering from vaginal excretion, morsus and itching were studied. Initially, the patients were treated using clotrimazole local cream (5 g) for 7 successive days. After initial treatment, the patients were freely visited once a month until delivery considering vaginitis symptoms and VVC recurrence was examined during pregnancy. Mean age of the understudy mothers was 27.26 +/- 3.76. Mean of recurrence number was 0.17 +/- 0.48 during the first trimester. Mean of recurrence number was 0.92 +/- 0.76 during the second trimester. Mean of recurrence number was 2.16 +/- 0.63 during the third trimester. Statistically significant difference was between recurrences during three trimesters of pregnancy (p < 0.001). There is statistically significant difference between mean number of recurrences during three trimesters of pregnancy.

  6. Endourologic and Open Ureterolithotomy and Common Sheath Reimplant for Large Bladder and Distal Ureteral Calculi

    PubMed Central

    Brito, Joseph; Renzulli, Joseph; Pareek, Gyan

    2016-01-01

    Abstract A twenty-eight-year-old female with a history of suprapubic pain and recurrent urinary tract infections presents for urology referral with a kidney, ureter, and bladder radiograph showing a 4.4 cm bladder calculus and 6.5 cm distal left ureteral stone. She underwent effective cystolitholapaxy of the bladder stone. Endourologic attempt (left ureteroscopy) was unsuccessful because of ureteral stone burden. Findings at ureteroscopy revealed a duplicated system on the left with the lower pole moiety joining just proximal to the ureteral orifice. The stone was found to be in the upper pole moiety ureter. An open ureterolithotomy was performed with intraoperative ureteroscopic laser lithotripsy and common sheath ureteral reimplant. Furthermore, a previously placed stent was found to be encrusted at the time of the ureterolithotomy. Effective ureteroscopy and lasering were performed through the ureterotomy up to the renal pelvis of the upper pole ureter. PMID:27868099

  7. Contralateral recurrence of tumefactive demyelination

    PubMed Central

    Guranda, Mihail; Essig, Marco

    2015-01-01

    Tumefactive demyelination refers to large focal demyelinating lesions in the brain, which can be mistaken for malignancy. In some patients, these lesions are monophasic with a self-limited course; however, other patients demonstrate recurrent disease with new tumefactive or non-tumefactive lesions, and a subsequent diagnosis of relapsing-remitting multiple sclerosis is not uncommon. Owing to the limited data available in the literature, many questions about the patterns and prognostic significance of recurrent tumefactive lesions remain unanswered. The current case report involves a patient who recovered from tumefactive demyelination and presented two years later with a new recurrent tumefactive lesion in the contralateral brain. PMID:26427896

  8. [Recurrent aphthous stomatitis in Rheumatology].

    PubMed

    Riera Matute, Gabriel; Riera Alonso, Elena

    2011-01-01

    Recurrent aphthous stomatitis consists on recurring oral ulcers of unknown etiology. Oral ulcers may be different in number and size depending on the clinical presentation, which also determines the time needed for healing. Moreover, there are factors associated to outbreaks but not implicated in its etiopathogenesis. When oral aphthosis has a known etiology, it is not considered as recurrent aphthous stomatitis. The severity and the clinical presentation helps in the differential diagnosis. Treatment is symptomatic in recurrent aphthous stomatitis while, if there is an underlying systemic disease, the treatment of such disease is need in addition to topical treatment.

  9. Intracorporeal or extracorporeal lithotripsy for distal ureteral calculi? Effect of stone size and multiplicity on success rates.

    PubMed

    Eden, C G; Mark, I R; Gupta, R R; Eastman, J; Shrotri, N C; Tiptaft, R C

    1998-08-01

    Over a period of 57 months, 404 patients with distal ureteral calculi were treated by in situ SWL on a Storz Modulith SL 20 lithotripter and 163 by ureteroscopy (URS) and Swiss Lithoclast stone fragmentation. The case notes on these patients were reviewed for comparison of the initial stone number and individual length and for the calculation of the stone-free, treatment, retreatment, secondary procedure, and complication rates. Complete data were available on 447 patients. The median stone length was 7.0 (range 4-25) mm in the SWL group and 8.0 (range 5-13) mm in the URS group. The single-treatment stone-free rates for the SWL and URS groups were 74.8% and 89.7%, respectively, for single stones and 50.0% and 88.9%, respectively, for multiple (>1) stones. The mean treatment rates for the SWL and URS groups were 1.97 and 1.03, respectively, for single stones and 2.83 and 1.00, respectively, for multiple stones. The mean treatment rate for single stones subjected to SWL increased with increasing stone length (1.57 for stones <8 mm and 2.38 for stones >8 mm), whereas this was not the case for patients submitted to URS (1.20 and 1.27, respectively). The re-treatment rate for each group showed a reciprocal trend. Of the SWL group, 25.9% of the patients eventually required URS to render them stone-free. Nearly all (96%) of the patients undergoing SWL were treated as outpatients. The mean hospitalization in the URS group was 1.1 days. Three patients who underwent URS sustained a ureteral perforation, which was managed successfully by double-J stent insertion. The ideal primary treatment for small (<8 mm) distal ureteral calculi is in situ SWL, with URS plus Lithoclast fragmentation being reserved for failed SWL, single stones >8 mm in length, and multiple stones.

  10. Recurrence Quantification of Fractal Structures

    PubMed Central

    Webber, Charles L.

    2012-01-01

    By definition, fractal structures possess recurrent patterns. At different levels repeating patterns can be visualized at higher magnifications. The purpose of this chapter is threefold. First, general characteristics of dynamical systems are addressed from a theoretical mathematical perspective. Second, qualitative and quantitative recurrence analyses are reviewed in brief, but the reader is directed to other sources for explicit details. Third, example mathematical systems that generate strange attractors are explicitly defined, giving the reader the ability to reproduce the rich dynamics of continuous chaotic flows or discrete chaotic iterations. The challenge is then posited for the reader to study for themselves the recurrent structuring of these different dynamics. With a firm appreciation of the power of recurrence analysis, the reader will be prepared to turn their sights on real-world systems (physiological, psychological, mechanical, etc.). PMID:23060808

  11. Recurrent ameloblastoma of the mandible.

    PubMed

    Joshi, C P; Vyas, K C; Deedwania, S; Jain, S; Mangal, M M

    1999-10-01

    Ameloblastoma is an agressive locally recurring neoplasm of odentogenic epithelium. Here we describe a case of mandibular ameloblastoma with 12 yrs. history of local recurrences followed with history of excision twice (10 yrs. and 7 years back).

  12. Pathways to Breast Cancer Recurrence

    PubMed Central

    2013-01-01

    Breast cancer remains a deadly disease, even with all the recent technological advancements. Early intervention has made an impact, but an overwhelmingly large number of breast cancer patients still live under the fear of “recurrent” disease. Breast cancer recurrence is clinically a huge problem and one that is largely not well understood. Over the years, a number of factors have been studied with an overarching aim of being able to prognose recurrent disease. This paper attempts to provide an overview of our current knowledge of breast cancer recurrence and its associated challenges. Through a survey of the literature on cancer stem cells (CSCs), epithelial-mesenchymal transition (EMT), various signaling pathways such as Notch/Wnt/hedgehog, and microRNAs (miRNAs), we also examine the hypotheses that are currently under investigation for the prevention of breast cancer recurrence. PMID:23533807

  13. Inflammatory and fibrotic proteins proteomically identified as key protein constituents in urine and stone matrix of patients with kidney calculi.

    PubMed

    Boonla, Chanchai; Tosukhowong, Piyaratana; Spittau, Björn; Schlosser, Andreas; Pimratana, Chaowat; Krieglstein, Kerstin

    2014-02-15

    To uncover whether urinary proteins are incorporated into stones, the proteomic profiles of kidney stones and urine collected from the same patients have to be explored. We employed 1D-PAGE and nanoHPLC-ESI-MS/MS to analyze the proteomes of kidney stone matrix (n=16), nephrolithiatic urine (n=14) and healthy urine (n=3). We identified 62, 66 and 22 proteins in stone matrix, nephrolithiatic urine and healthy urine, respectively. Inflammation- and fibrosis-associated proteins were frequently detected in the stone matrix and nephrolithiatic urine. Eighteen proteins were exclusively found in the stone matrix and nephrolithiatic urine, considered as candidate biomarkers for kidney stone formation. S100A8 and fibronectin, representatives of inflammation and fibrosis, respectively, were up-regulated in nephrolithiasis renal tissues. S100A8 was strongly expressed in infiltrated leukocytes. Fibronectin was over-expressed in renal tubular cells. S100A8 and fibronectin were immunologically confirmed to exist in nephrolithiatic urine and stone matrix, but in healthy urine they were undetectable. Conclusion, both kidney stones and urine obtained from the same patients greatly contained inflammatory and fibrotic proteins. S100A8 and fibronectin were up-regulated in stone-baring kidneys and nephrolithiatic urine. Therefore, inflammation and fibrosis are suggested to be involved in the formation of kidney calculi.

  14. Scanning electron microscopy and energy-dispersive X-ray microanalysis studies of several human calculi containing calcium phosphate crystals.

    PubMed

    Kodaka, T; Debari, K; Sano, T; Yamada, M

    1994-01-01

    Human calcium phosphate calculi: two sialoliths, a urolith, a rhinolith, and a tonsillolith were investigated by scanning electron microscopy (SEM) and energy-dispersive X-ray analysis (EDX). The sialoliths and urolith had appositional shells with thick cortices, respectively, around several nuclei composed of calcospherulites and a rubber-film fragment. The rhinolith had a thin cortex with appositional laminations around a glomerulus-like mass of calcified cotton-like strings. The tonsillolith had a rough cortex with appositional laminations. Its porous interior was composed of numerous calcified conglomerates with microorganisms and calcified masses with fine appositional laminations around the conglomerates. The major crystals were identified as biological apatites (AP) with a sand-grain rather than a needle-like shape, and plate-shaped octacalcium phosphate (OCP). The AP deposits of the rhinolith probably were associated with magnesium (Mg) phosphates or contained Mg. No OCP was found in the rhinolith. The AP deposits were mainly formed by extracellular calcification. Hexahedral crystals, identified as Mg-containing whitlockite (WH), were precipitated in the internal spaces of the AP and OCP deposits. The rhinolith nucleus consisted of WH crystal deposits only.

  15. TNF-alpha expression patterns as potential molecular biomarker for human skin cells exposed to vesicant chemical warfare agents: sulfur mustard (HD) and Lewisite (L).

    PubMed

    Arroyo, C M; Burman, D L; Kahler, D W; Nelson, M R; Corun, C M; Guzman, J J; Smith, M A; Purcell, E D; Hackley, B E; Soni, S-D; Broomfield, C A

    2004-11-01

    Studies were conducted to examine the effect of two vesicant chemical warfare agents (VCWA), one of them an arsenical, on cytokine gene expression in normal human epidermal keratinocyte (NHEK) cells. We tested 2,2'-dichlorethylsulfide (sulfur mustard, military designation HD) and 2,chlorovinyldichloroarsine (Lewisite, military designation L), which have significant differences in their chemical, physical, and toxicological properties. Human tumor necrosis factor-alpha (hTNF-alpha) cytokine was detected by using the enzyme-linked immunosorbent assay, a protein multiplex immunoassay, Luminex100, and reverse transcription-polymerase chain reaction (RT-PCR). The messenger RNA expression of hTNF-alpha was determined to provide a semi-quantitative analysis. HD-stimulated NHEK induced secretion of hTNF-alpha in a dose-dependent manner. Dose response effect of Lewisite decreased hTNF-alpha levels. Time-response data indicated that the maximum response for HD occurred at 24 h with an associated cytotoxic concentration of 10(-4) mol/L. NHEK cells stimulated with 10(-4) mol/L HD for 24 h at 37 degrees C increased detectable levels of hTNF-alpha from 5 to 28 ng/ml at an index of cell viability between 85 to 93% as detected by Luminex100. Our results indicated that the increased levels of hTNF-alpha by HD are dependent on the primary cultures, cell densities, and chemical properties of the stimulation. Lewisite under the same conditions as HD caused a reduction of hTNF-alpha from control levels of 1.5 ng/ml to 0.3 ng/ml after stimulation (10(-4) mol/L), with an index of cell viability of reverse similar 34%. We analyzed the transcriptional of hTNF-alpha gene and found that HD (10(-6) to 10(-4) mol/L) activates hTNF-alpha gene in cultured NHEK and that L at 10(-6) to 10(-4) mol/L markedly reduces hTNF-alpha gene. We conclude that the pro-inflammatory mediator, hTNF-alpha, could be a potential biomarker for differentiating between exposure of HD or L.

  16. Treatment of recurrent vulvovaginal candidiasis.

    PubMed

    Ringdahl, E N

    2000-06-01

    Vulvovaginal candidiasis is considered recurrent when at least four specific episodes occur in one year or at least three episodes unrelated to antibiotic therapy occur within one year. Although greater than 50 percent of women more than 25 years of age develop vulvovaginal candidiasis at some time, fewer than 5 percent of these women experience recurrences. Clinical evaluation of recurrent episodes is essential. Patients who self-diagnose may miss other causes or concurrent infections. Known etiologies of recurrent vulvovaginal candidiasis include treatment-resistant Candida species other than Candida albicans, frequent antibiotic therapy, contraceptive use, compromise of the immune system, sexual activity and hyperglycemia. If microscopic examination of vaginal secretions in a potassium hydroxide preparation is negative but clinical suspicion is high, fungal cultures should be obtained. After the acute episode has been treated, subsequent prophylaxis (maintenance therapy) is important. Because many patients experience recurrences once prophylaxis is discontinued, long-term therapy may be warranted. Patients are more likely to comply when antifungal therapy is administered orally, but oral treatment carries a greater potential for systemic toxicity and drug interactions.

  17. RECURRENT NOVAE IN M31

    SciTech Connect

    Shafter, A. W.; Henze, M.; Rector, T. A.; Schweizer, F.; Hornoch, K.; Orio, M.; Pietsch, W.; Darnley, M. J.; Williams, S. C.; Bode, M. F.; Bryan, J.

    2015-02-01

    The reported positions of 964 suspected nova eruptions in M31 recorded through the end of calendar year 2013 have been compared in order to identify recurrent nova (RN) candidates. To pass the initial screen and qualify as a RN candidate, two or more eruptions were required to be coincident within 0.′1, although this criterion was relaxed to 0.′15 for novae discovered on early photographic patrols. A total of 118 eruptions from 51 potential RN systems satisfied the screening criterion. To determine what fraction of these novae are indeed recurrent, the original plates and published images of the relevant eruptions have been carefully compared. This procedure has resulted in the elimination of 27 of the 51 progenitor candidates (61 eruptions) from further consideration as RNe, with another 8 systems (17 eruptions) deemed unlikely to be recurrent. Of the remaining 16 systems, 12 candidates (32 eruptions) were judged to be RNe, with an additional 4 systems (8 eruptions) being possibly recurrent. It is estimated that ∼4% of the nova eruptions seen in M31 over the past century are associated with RNe. A Monte Carlo analysis shows that the discovery efficiency for RNe may be as low as 10% that for novae in general, suggesting that as many as one in three nova eruptions observed in M31 arise from progenitor systems having recurrence times ≲100 yr. For plausible system parameters, it appears unlikely that RNe can provide a significant channel for the production of Type Ia supernovae.

  18. Recurrent Novae in M31

    NASA Astrophysics Data System (ADS)

    Shafter, A. W.; Henze, M.; Rector, T. A.; Schweizer, F.; Hornoch, K.; Orio, M.; Pietsch, W.; Darnley, M. J.; Williams, S. C.; Bode, M. F.; Bryan, J.

    2015-02-01

    The reported positions of 964 suspected nova eruptions in M31 recorded through the end of calendar year 2013 have been compared in order to identify recurrent nova (RN) candidates. To pass the initial screen and qualify as a RN candidate, two or more eruptions were required to be coincident within 0.‧1, although this criterion was relaxed to 0.‧15 for novae discovered on early photographic patrols. A total of 118 eruptions from 51 potential RN systems satisfied the screening criterion. To determine what fraction of these novae are indeed recurrent, the original plates and published images of the relevant eruptions have been carefully compared. This procedure has resulted in the elimination of 27 of the 51 progenitor candidates (61 eruptions) from further consideration as RNe, with another 8 systems (17 eruptions) deemed unlikely to be recurrent. Of the remaining 16 systems, 12 candidates (32 eruptions) were judged to be RNe, with an additional 4 systems (8 eruptions) being possibly recurrent. It is estimated that ∼4% of the nova eruptions seen in M31 over the past century are associated with RNe. A Monte Carlo analysis shows that the discovery efficiency for RNe may be as low as 10% that for novae in general, suggesting that as many as one in three nova eruptions observed in M31 arise from progenitor systems having recurrence times ≲ 100 yr. For plausible system parameters, it appears unlikely that RNe can provide a significant channel for the production of Type Ia supernovae.

  19. Shortest recurrence periods of novae

    SciTech Connect

    Kato, Mariko; Saio, Hideyuki; Hachisu, Izumi; Nomoto, Ken'ichi

    2014-10-01

    Stimulated by the recent discovery of the 1 yr recurrence period nova M31N 2008-12a, we examined the shortest recurrence periods of hydrogen shell flashes on mass-accreting white dwarfs (WDs). We discuss the mechanism that yields a finite minimum recurrence period for a given WD mass. Calculating the unstable flashes for various WD masses and mass accretion rates, we identified a shortest recurrence period of about two months for a non-rotating 1.38 M {sub ☉} WD with a mass accretion rate of 3.6 × 10{sup –7} M {sub ☉} yr{sup –1}. A 1 yr recurrence period is realized for very massive (≳ 1.3 M {sub ☉}) WDs with very high accretion rates (≳ 1.5 × 10{sup –7} M {sub ☉} yr{sup –1}). We revised our stability limit of hydrogen shell burning, which will be useful for binary evolution calculations toward Type Ia supernovae.

  20. Oncolytic HSV-1716 in Treating Younger Patients With Refractory or Recurrent High Grade Glioma That Can Be Removed By Surgery

    ClinicalTrials.gov

    2016-05-26

    Recurrent Childhood Anaplastic Astrocytoma; Recurrent Childhood Anaplastic Oligoastrocytoma; Recurrent Childhood Anaplastic Oligodendroglioma; Recurrent Childhood Giant Cell Glioblastoma; Recurrent Childhood Glioblastoma; Recurrent Childhood Gliomatosis Cerebri; Recurrent Childhood Gliosarcoma

  1. Galactosemia presenting as recurrent sepsis.

    PubMed

    Rathi, Narendra; Rathi, Akanksha

    2011-12-01

    Galactosemia is a treatable metabolic disorder caused by the deficiency of enzyme galactose-1-phosphate uridyl transferase (GALT) and inherited as an autosomal recessive trait. A case of neonate manifesting with recurrent Escherichia coli sepsis is presented here which turned out to be a classic galactosemia. No other common presenting features were observed in this infant except cataract on slit lamp examination. To the best of our knowledge, there is no case of galactosemia reported in literature which presented with recurrent neonatal sepsis without hepatomegaly, hyperbilirubinemia, bleeding disorder, vomiting, diarrhea, failure to thrive, hypoglycemia, coagulopathy, hemolysis or renal tubular acidosis.

  2. Endometrial transcriptome in recurrent miscarriage and recurrent implantation failure.

    PubMed

    Huang, Jin; Qin, Hao; Yang, Yihua; Chen, Xiaoyan; Zhang, Jiamiao; Laird, Susan; Wang, Chi Chiu; Chan, Ting Fung; Li, Tin Chiu

    2017-03-10

    The endometrium becomes receptive to the embryo only in the mid-luteal phase, but not other stages of the menstrual cycle. Endometrial factors play an important role in implantation. Women with recurrent miscarriage and recurrent implantation failure have both been reported to have altered expression of receptivity markers during the window of implantation. We aimed to compare the gene expression profiles of the endometrium in the window of implantation among women with unexplained recurrent implantation failures (RIF) and unexplained recurrent miscarriages (RM) by RNA sequencing (RNA-Seq). In total 20 patients (9 RIF and 11 RM) were recruited. In addition 4 fertile subjects were included as reference. Endometrium samples were precisely timed on the 7th day after luteal hormone surge (LH+7). All the 24 samples were extracted for total RNA. The transcriptome was determined by RNA-Seq in first 14 RNA samples (5 RIF, 6 RM, and 3 fertile). Differentially expressed genes between RM and RIF were validated by quantitative real time PCR (qPCR) in all 24 RNA samples (9 RIF, 11 RM and 4 fertile). Complementary and coagulation cascades pathway was the significantly up-regulated in RIF while down-regulated in RM. Differentially expressed genes C3, C4, C4BP, DAF, DF and SERPING1 in complement and coagulation cascade pathway between RM and RIF were further validated by qPCR. This study identified differential molecular pathways in endometrium between RIF and RM, which potentially affect the implantation process.

  3. Lapatinib in Treating Young Patients With Recurrent or Refractory Central Nervous System Tumors

    ClinicalTrials.gov

    2014-05-07

    Recurrent Childhood Anaplastic Astrocytoma; Recurrent Childhood Brain Stem Glioma; Recurrent Childhood Ependymoma; Recurrent Childhood Giant Cell Glioblastoma; Recurrent Childhood Glioblastoma; Recurrent Childhood Gliosarcoma; Recurrent Childhood Medulloblastoma; Recurrent Childhood Oligodendroglioma

  4. Investigation of the microstructure and mineralogical composition of urinary calculi fragments by synchrotron radiation X-ray microtomography: a feasibility study.

    PubMed

    Kaiser, Jozef; Holá, Markéta; Galiová, Michaela; Novotný, Karel; Kanický, Viktor; Martinec, Petr; Sčučka, Jiří; Brun, Francesco; Sodini, Nicola; Tromba, Giuliana; Mancini, Lucia; Kořistková, Tamara

    2011-08-01

    The outcomes from the feasibility study on utilization of synchrotron radiation X-ray microtomography (SR-μCT) to investigate the texture and the quantitative mineralogical composition of selected calcium oxalate-based urinary calculi fragments are presented. The comparison of the results obtained by SR-μCT analysis with those derived from current standard analytical approaches is provided. SR-μCT is proved as a potential effective technique for determination of texture, 3D microstructure, and composition of kidney stones.

  5. Content and Face Validation of a Curriculum for Ultrasonic Propulsion of Calculi in a Human Renal Model

    PubMed Central

    Dunmire, Barbrina; Cunitz, Bryan W.; He, Xuemei; Sorensen, Mathew D.; Harper, Jonathan D.; Bailey, Michael R.; Lendvay, Thomas S.

    2014-01-01

    Abstract Purpose: Ultrasonic propulsion to reposition urinary tract calculi requires knowledge about ultrasound image capture, device manipulation, and interpretation. The purpose of this study was to validate a cognitive and technical skills curriculum to teach urologists ultrasonic propulsion to reposition kidney stones in tissue phantoms. Materials and Methods: Ten board-certified urologists recruited from a single institution underwent a didactic session on renal ultrasound imaging. Subjects completed technical skills modules in tissue phantoms, including kidney imaging, pushing a stone through a translucent maze, and repositioning a lower pole calyceal stone. Objective cognitive and technical performance metrics were recorded. Subjects completed a questionnaire to ascertain face and content validity on a five-point Likert scale. Results: Eight urologists (80%) had never attended a previous ultrasound course, and nine (90%) performed renal ultrasounds less frequently than every 6 months. Mean cognitive skills scores improved from 55% to 91% (p<0.0001) on pre- and post-didactic tests. In the kidney phantom, 10 subjects (100%) repositioned the lower pole calyceal stone to at least the lower pole infundibulum, while 9 (90%) successfully repositioned the stone to the renal pelvis. A mean±SD (15.7±13.3) pushes were required to complete the task over an average of 4.6±2.2 minutes. Urologists rated the curriculum's effectiveness and realism as a training tool at a mean score of 4.6/5.0 and 4.1/5.0, respectively. Conclusions: The curriculum for ultrasonic propulsion is effective and useful for training urologists with limited ultrasound proficiency in stone repositioning technique. Further studies in animate and human models will be required to assess predictive validity. PMID:24228719

  6. Role of combined use of potassium citrate and tamsulosin in the management of uric acid distal ureteral calculi.

    PubMed

    El-Gamal, Osama; El-Bendary, Mohamed; Ragab, Maged; Rasheed, Mohamed

    2012-06-01

    In this article, we investigated the effect of the combined use of tamsulosin and potassium citrate (Uralyt-U(®)) for the treatment of uric acid stones in the distal ureter. The study was designed as a prospective, double blind randomized controlled trial. A total of 191 adult patients with radiolucent distal ureteral calculi were recruited. We included patients with solitary stones ≥5 mm with mild or moderate hydronephrosis and a normal contralateral tract. The patients were randomized into four equal groups (the placebo, tamsulosin, Uralyt-U(®), and the combined treatment groups). The patients were treated for a maximum duration of 4 weeks or until stone expulsion. The stone size in all groups ranged from 5 to 11 mm (7.69 ± 1.7 mm). The total expulsion rate of the stones was significantly lower in the control group (26.1%) compared with that of any of the other three groups (68.8, 58.7, and 84.8% respectively) (P < 0.05). Meanwhile, the difference between the Uralyt-U(®) group and the combined treatment group was also statistically significant (P < 0.05). When we studied the patients with stones >8 mm as a separate subgroup to find the effect of the used drugs on the relatively large stones, we detected that the expulsion rate of these stones was significantly higher in the patients who received the combined treatment in comparison with any of the other three groups (P < 0.05). In conclusion, the use of urinary alkalization with tamsulosin can increase the frequency of spontaneous passage of distal ureteral uric acid stones especially those of 8-11 mm.

  7. Geoenvironmental factors related to high incidence of human urinary calculi (kidney stones) in Central Highlands of Sri Lanka.

    PubMed

    Abeywickarama, Buddhika; Ralapanawa, Udaya; Chandrajith, Rohana

    2016-10-01

    An area with extremely high incidence of urinary calculi was investigated in the view of identifying the relationship between the disease prevalence and the drinking water geochemistry. The prevalence of the kidney stone disease in the selected Padiyapelella-Hanguranketa area in Central Highlands of Sri Lanka is significantly higher compared with neighboring regions. Drinking water samples were collected from water sources that used by clinically identified kidney stone patients and healthy people. A total of 83 samples were collected and analyzed for major anions and cations. The anions in the area varied in the order HCO3 (-) > Cl(-) > SO4 (2-) > NO3 (-) and cations varied in the order Ca(2+) > Mg(2+) > Na(+) > K(+) > Fe(2+). The dissolved silica that occurs as silicic acid (H4SiO4) in natural waters varied from 8.8 to 84 mg/L in prevalence samples, while it was between 9.7 and 65 mg/L for samples from non-prevalence locations. Hydrogeochemical data obtained from the two groups were compared using the Wilcoxon rank-sum test. It showed that pH, total hardness, Na(+), Ca(2+) and Fe(2+) had significant difference (p < 0.005) between water sources used by patients and non-patients. Elemental ratio plots, Gibbs' plot and factor analysis indicated that the chemical composition of water sources in this area is strongly influenced by rock-water interactions, particularly the weathering of carbonate and silicate minerals. This study reveals a kind of association between stone formation and drinking water geochemistry as evident by the high hardness/calcium contents in spring water used by patients.

  8. [Radiodiagnosis of recurrences of lymphogranulomatosis].

    PubMed

    Mendeleev, I M; Miasnikov, A A; Balashov, A T; Polezhaev, Iu N

    1988-01-01

    The authors discuss the role and place of chest x-ray tomography, scintigraphy with 67Ga-citrate, ultrasonic investigation, angiography, angioscintigraphy, computed tomography, scintigraphy of the liver and bones in the diagnosis of recurrences of Hodgkin's disease and in control of a progress of disease. Indications for a successive use of one or the other method have been defined.

  9. Recurrent aphthous stomatitis: a review.

    PubMed

    Chavan, Mahesh; Jain, Hansa; Diwan, Nikhil; Khedkar, Shivaji; Shete, Anagha; Durkar, Sachin

    2012-09-01

    Recurrent aphthous stomatitis (RAS) is a common clinical condition producing painful ulcerations in oral cavity. The diagnosis of RAS is based on well-defined clinical characteristics but the precise etiology and pathogenesis of RAS remain unclear. The present article provides a detailed review of the current concepts and knowledge of the etiology, pathogenesis, and management of RAS.

  10. Recurrent Processing during Object Recognition

    PubMed Central

    O’Reilly, Randall C.; Wyatte, Dean; Herd, Seth; Mingus, Brian; Jilk, David J.

    2013-01-01

    How does the brain learn to recognize objects visually, and perform this difficult feat robustly in the face of many sources of ambiguity and variability? We present a computational model based on the biology of the relevant visual pathways that learns to reliably recognize 100 different object categories in the face of naturally occurring variability in location, rotation, size, and lighting. The model exhibits robustness to highly ambiguous, partially occluded inputs. Both the unified, biologically plausible learning mechanism and the robustness to occlusion derive from the role that recurrent connectivity and recurrent processing mechanisms play in the model. Furthermore, this interaction of recurrent connectivity and learning predicts that high-level visual representations should be shaped by error signals from nearby, associated brain areas over the course of visual learning. Consistent with this prediction, we show how semantic knowledge about object categories changes the nature of their learned visual representations, as well as how this representational shift supports the mapping between perceptual and conceptual knowledge. Altogether, these findings support the potential importance of ongoing recurrent processing throughout the brain’s visual system and suggest ways in which object recognition can be understood in terms of interactions within and between processes over time. PMID:23554596

  11. Recurrent Education. A Resource Guide.

    ERIC Educational Resources Information Center

    Rochte, Newton C.

    To assist both practitioner and reader to find answers to questions on the theory and practice of recurrent education, this resource guide compiles 715 abstracts of relevant articles, books, and monographs, from many countries. Descriptors and identifiers, used in computer searches to identify the materials, are arranged alphabetically in the…

  12. Onychomycosis: Strategies to Minimize Recurrence.

    PubMed

    Gupta, Aditya K; Elewski, Boni E; Rosen, Ted; Caldwell, Bryan; Pariser, David M; Kircik, Leon H; Bhatia, Neal; Tosti, Antonella

    2016-03-01

    Recurrence (relapse or re-infection) in onychomycosis is common, occurring in 10% to 53% of patients. However, data on prevalence is limited as few clinical studies follow patients beyond 12 months. It has been suggested that recurrence after continuous terbinafine treatment may be less common than with intermittent or continuous itraconazole therapy, probably due to the fungicidal activity of terbinafine, although these differences tended not to be significant. Relapse rates also increase with time, peaking at month 36. Although a number of factors have been suggested to play a role in recurrence, only the co-existence of diabetes has been shown to have a significant impact. Data with topical therapy is sparse; a small study showed amorolfine prophylaxis may delay recurrence. High concentrations of efinaconazole have been reported in the nail two weeks' post-treatment suggesting twice monthly prophylaxis with topical treatments may be a realistic option, and may be an important consideration in diabetic patients with onychomycosis. Data suggest that prophylaxis may need to be continued for up to three years for optimal effect. Treating tinea pedis and any immediate family members is also critical. Other preventative strategies include avoiding communal areas where infection can spread (such as swimming pools), and decontaminating footwear.

  13. [Thoracoscopic treatment of recurrent pneumothorax].

    PubMed

    Suter, M; Berner, M; Vandoni, R; Cuttat, J F

    1994-04-01

    Spontaneous pneumothorax (PNO) is usually due to rupture of a small subpleural bleb into the pleural cavity and affects mainly young men. After simple drainage, recurrence occurs in about 50% of cases. The risk of recurrence increases after each new PNO. Secondary PNO complicates an underlying pulmonary disease, especially chronic obstructive pulmonary disease with emphysema. A new form of secondary PNO has emerged in the recent years in AIDS patients with pneumocystis carinii pneumonia. We have shifted to a thoracoscopic therapy of PNO since May 1991. 25 PNO in 24 patients (1 bilateral) have been treated since that time up to April 1993. 19 PNO were primary, whereas 6 were secondary, included 3 iatrogenic PNO. Resection of the leaking parenchymal area was performed in 20 patients, and parietal partial pleurectomy was done in 20 cases. In the remaining cases, fibrin glue was applied on the lesion and in 3 cases, chemical pleurodesis was attempted using silver nitrate or talc. 1 AIDS patient died of ARDS. 3 patients had recurrent PNO and had thoracotomy without complication. 21 patients did well. Partial PNO recurred in one of them 4 months later, and was treated by simple needle aspiration. Thoracoscopy is a useful method to treat recurrent or persistent spontaneous PNO. After only 25 cases, our success rate in primary PNO is 90%. There should be a learning curve. On the basis of our experience, we believe that recognition of the lesion and its resection as well as apical parietal pleurectomy are necessary to obtain good results and a low recurrence rate.

  14. Recurrent facial urticaria following herpes simplex labialis.

    PubMed

    Zawar, Vijay; Godse, Kiran

    2012-03-01

    We describe recurrent acute right-sided facial urticaria associated with herpes labialis infection in a middle-aged female patient. Antiviral medications and antihistamines not only successfully cleared the herpes infection and urticaria but also prevented further recurrences.

  15. Recurrent MRSA skin infections in atopic dermatitis.

    PubMed

    Ong, Peck Y

    2014-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of recurrent skin and soft tissue infections. For patients with atopic dermatitis, recurrent skin infections with MRSA often lead to eczema exacerbation. There currently is no standard practice in the prevention of recurrent MRSA soft tissue infections in the general and the atopic dermatitis populations. The current article reviews recent data on S aureus decolonization treatments for the prevention of recurrent MRSA soft tissue infections in the community setting.

  16. 14 CFR 121.427 - Recurrent training.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Recurrent training. 121.427 Section 121.427..., FLAG, AND SUPPLEMENTAL OPERATIONS Training Program § 121.427 Recurrent training. (a) Recurrent training must ensure that each crew member or dispatcher is adequately trained and currently proficient...

  17. 14 CFR 91.1107 - Recurrent training.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Recurrent training. 91.1107 Section 91.1107... Management § 91.1107 Recurrent training. (a) Each program manager must ensure that each crewmember receives recurrent training and is adequately trained and currently proficient for the type aircraft and...

  18. 14 CFR 135.351 - Recurrent training.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Recurrent training. 135.351 Section 135.351... AND ON DEMAND OPERATIONS AND RULES GOVERNING PERSONS ON BOARD SUCH AIRCRAFT Training § 135.351 Recurrent training. (a) Each certificate holder must ensure that each crewmember receives recurrent...

  19. A perspective on recurrent vertigo.

    PubMed

    Gacek, Richard R

    2013-01-01

    The recurrent nature of the 3 most common vestibulopathies suggests a recurrent cause. Histopathology in temporal bones from patients with these syndromes - vestibular neuronitis (VN, n = 7), Ménière's disease (MD, n = 8) and benign paroxysmal positional vertigo (BPPV, n = 5) - shows focal degeneration of vestibular nerve axons and degenerated nearby facial nerve meatal ganglion cells. Transmission electron microscopic confirmation of intracytoplasmic viral particles in surgically excised vestibular nerves from patients with VN and MD support a viral etiology in these vestibulopathies. Antiviral treatment of these syndromes in a series of 211 patients with a 3- to 8-year follow-up resulted in complete control of vertigo in VN (88%), MD (90%) and BPPV (60%).

  20. Chronic recurrent multifocal osteomyelitis (CRMO).

    PubMed

    Schuster, T; Bielek, J; Dietz, H G; Belohradsky, B H

    1996-02-01

    Pathogenesis of CRMO still remains unknown. Characteristic, but not pathognomonic for this syndrome are clinical course (age, sex, chronic recurrent, intermittent course), radiological findings (metaphyseal lesions), histology (chronic osteomyelitis without colliquation) and microbiological results (lack of pathogen, infectious agents). Favorable, self-limited long-term prognosis of CRMO has been assumed. Antibiotics provide no improvement. Course, severity and recurrency can be influenced positively by antiphlogistic substances, although this has not yet been proved. Whether surgical intervention beyond biopsies might cause improvement on the follow-up is unknown. Our experience (4 cases), and the literature demonstrate great clinical importance that unusual types of osteomyelitis (OM) can be within the differential diagnosis of multifocal osteolytic changes.

  1. Recurrent airway obstruction: a review.

    PubMed

    Pirie, R S

    2014-05-01

    Recurrent airway obstruction is a widely recognised airway disorder, characterised by hypersensitivity-mediated neutrophilic airway inflammation and lower airway obstruction in a subpopulation of horses when exposed to suboptimal environments high in airborne organic dust. Over the past decade, numerous studies have further advanced our understanding of different aspects of the disease. These include clarification of the important inhaled airborne agents responsible for disease induction, improving our understanding of the underlying genetic basis of disease susceptibility and unveiling the fundamental immunological mechanisms leading to establishment of the classic disease phenotype. This review, as well as giving a clinical overview of recurrent airway obstruction, summarises much of the work in these areas that have culminated in a more thorough understanding of this debilitating disease.

  2. Spatiotemporal recurrences of sandpile avalanches

    NASA Astrophysics Data System (ADS)

    Tarun, Anjali B.; Paguirigan, Antonino A.; Batac, Rene C.

    2015-10-01

    We study the space and time properties of avalanches in a continuous sandpile model by constructing a temporally directed network linking together the recurrent avalanche events based on their spatial separation. We use two different criteria for network construction: a later event is connected to a previous one if it is either nearest or farthest from it among all the later events. With this, we observe scale-free regimes emerge as characterized by the following power-law exponents: (a) α = 1.7 for the avalanche size distributions; (b) βF = 2.1 in the in-degree distribution of farthest recurrences; (c) δ = 1 for the separation distances; and (d) γ = 1 for the temporal separations of recurrences. Our results agree with earlier observations that describe the sandpile avalanches as repulsive events, i.e. the next avalanche is more likely to be physically separated from an earlier one. These observations, which are not captured by usual interoccurrence statistics and by random connection mechanisms, suggest an underlying spatiotemporal organization in the sandpile that makes it useful for modeling real-world systems.

  3. Large subcapsular hematoma following ureteroscopic laser lithotripsy of renal calculi in a spina bifida patient: lessons we learn

    PubMed Central

    Vaidyanathan, Subramanian; Samsudin, Azi; Singh, Gurpreet; Hughes, Peter L; Soni, Bakul M; Selmi, Fahed

    2016-01-01

    Introduction Paraplegic patients are at greater risk of developing complications following ureteroscopic lithotripsy because of urine infection associated with neuropathic bladder, difficulties in access due to altered anatomy of urinary bladder and urethra, spinal curvature, spasticity, and contractures. We report the occurrence of large subcapsular hematoma following ureteroscopy and discuss lessons we learn from this case. Case report A 48-year-old male patient with spina bifida underwent ureteroscopy with laser lithotripsy and ureteric stenting for left ureteric stone and staghorn calculus with hydronephrosis; laser lithotripsy was repeated after 3 months; both procedures were performed by a senior urologist and did not result in any complications. Ureteroscopic laser lithotripsy was performed 5 months later by a urological trainee; it was difficult to negotiate the scope as vision became poor because of bleeding (as a result of the procedure). Postoperatively, hematuria persisted; temperature was 39°C. Cefuroxime was given intravenously followed by gentamicin for 5 days; hematuria subsided gradually; he was discharged home. Ten days later, this patient developed temperature, the urine culture grew Pseudomonas aeruginosa, and ciprofloxacin was given orally. Computed tomography (CT) of the urinary tract, performed 4 weeks after ureteroscopy, revealed a 9×7 cm subcapsular collection on the left kidney compressing underlying parenchyma. Percutaneous drainage was not feasible because of severe curvature of spine. Isotope renogram revealed deterioration in left renal function from 30% to 17%. Follow-up CT revealed reduction in the size of subcapsular hematoma, no hydronephrosis, and several residual calculi. Conclusion Risk of subcapsular hematoma following ureteroscopic lithotripsy can be reduced by avoiding prolonged endoscopy and performing ureteroscopy under low pressure. When a paraplegic patient develops features of infection after ureteroscopy, renal

  4. Stress Reduction in Improving Quality of Life in Patients With Recurrent Gynecologic or Breast Cancer

    ClinicalTrials.gov

    2015-10-08

    Anxiety Disorder; Depression; Fatigue; Leydig Cell Tumor; Ovarian Sarcoma; Ovarian Stromal Cancer; Pain; Peritoneal Carcinomatosis; Pseudomyxoma Peritonei; Recurrent Breast Cancer; Recurrent Cervical Cancer; Recurrent Endometrial Carcinoma; Recurrent Fallopian Tube Cancer; Recurrent Gestational Trophoblastic Tumor; Recurrent Ovarian Epithelial Cancer; Recurrent Ovarian Germ Cell Tumor; Recurrent Primary Peritoneal Cavity Cancer; Recurrent Uterine Sarcoma; Recurrent Vaginal Cancer; Recurrent Vulvar Cancer

  5. Erlotinib and Temozolomide in Treating Young Patients With Recurrent or Refractory Solid Tumors

    ClinicalTrials.gov

    2013-06-04

    Previously Treated Childhood Rhabdomyosarcoma; Recurrent Childhood Brain Tumor; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Ependymoma; Recurrent Childhood Malignant Germ Cell Tumor; Recurrent Childhood Medulloblastoma; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor; Recurrent Neuroblastoma; Recurrent Osteosarcoma

  6. Recurrent nephrolithiasis associated with atazanavir use.

    PubMed

    Wang, Lily C; Osterberg, E Charles; David, Scott G; Rosoff, James S

    2014-01-08

    A 64-year-old man with HIV on antiretroviral therapy (including atazanavir, a protease inhibitor) presented with left flank pain, nausea and vomiting. A kidney stone was suspected, and a CT scan demonstrated left hydronephrosis but failed to demonstrate nephrolithiasis or extrinsic compression. The patient had a ureteral stent placed which relieved his symptoms. A few months later, he underwent left ureteroscopy and a large ureteral calculus was found. The stone was removed and analysis showed 43% atazanavir and 57% calcium oxalate. Several months later, the patient developed flank pain on the opposite side. A renal ultrasound suggested right-sided nephrolithiasis and he subsequently underwent ureteroscopy with laser lithotripsy of two stones. Stone analysis showed that they were composed of 100% atazanavir. This case highlights the fact that patients treated with protease inhibitors remain at risk for developing nephrolithiasis. Ultrasonography can be a useful diagnostic tool in the setting of these radiolucent calculi.

  7. Can a brief period of double J stenting improve the outcome of extracorporeal shock wave lithotripsy for renal calculi sized 1 to 2 cm?

    PubMed Central

    Sharma, Rakesh; Das, Ranjit Kumar; Basu, Supriya; Dey, Ranjan Kumar; Gupta, Rupesh; Deb, Partha Pratim

    2017-01-01

    Purpose Extracorporeal shock wave lithotripsy (ESWL) is an established modality for renal calculi. Its role for large stones is being questioned. A novel model of temporary double J (DJ) stenting followed by ESWL was devised and outcomes were assessed. Materials and Methods The study included 95 patients with renal calculi sized 1 to 2 cm. Patients were randomized into 3 groups. Group 1 received ESWL only, whereas group 2 underwent stenting followed by ESWL. In group 3, a distinct model was applied in which the stent was kept for 1 week and then removed, followed by ESWL. Procedural details, analgesic requirements, and outcome were analyzed. Results Eighty-eight patients (male, 47; female, 41) were available for analysis. The patients' mean age was 37.9±10.9 years. Stone profile was similar among groups. Group 3 received fewer shocks (mean, 3,155) than did group 1 (mean, 3,859; p=0.05) or group 2 (mean, 3,872; p=0.04). The fragmentation rate was similar in group 3 (96.7%) and groups 1 (81.5%, p=0.12) and 2 (87.1%, p=0.16). Overall clearance in group 3 was significantly improved (83.3%) compared with that in groups 1 (63.0%, p=0.02) and 2 (64.5%, p=0.02) and was maintained even in lower pole stones. The percentage successful outcome in groups 1, 2, and 3 was 66.7%, 64.5%, and 83.3%, respectively (p=0.21). The analgesic requirement in group 2 was higher than in the other groups (p=0.00). Group 2 patients also had more grade IIIa (2/3) and IIIB (1/2) complications. Conclusions Stenting adversely affects stone clearance and also makes the later course uncomfortable. Our model of brief stenting followed by ESWL provided better clearance, comfort, and a modest improvement in outcome with fewer sittings and steinstrasse in selected patients with large renal calculi. PMID:28261679

  8. Detection of Recurrent Fluorescence Photons

    NASA Astrophysics Data System (ADS)

    Ebara, Yuta; Furukawa, Takeshi; Matsumoto, Jun; Tanuma, Hajime; Azuma, Toshiyuki; Shiromaru, Haruo; Hansen, Klavs

    2016-09-01

    We have detected visible photons emitted from the thermally populated electronic excited state, namely recurrent fluorescence (RF), of C6- stored in an electrostatic ion storage ring. Clear evidence is provided to distinguish RF from normal fluorescence, based on the temporal profile of detected photons synchronized with the revolution of C6- in the ring, for which the time scale is far longer than the lifetime of the intact photoexcited state. The relaxation (cooling) process via RF is likely to be commonplace for isolated molecular systems and crucial to the stabilization of molecules in interstellar environments.

  9. Recurrent hypoglycemia in a toddler.

    PubMed

    Cohen, Marissa; Zwiebel, Sean; Jeanmonod, Rebecca

    2015-12-01

    Idiopathic ketotic hypoglycemia is the most common cause of hypoglycemia in toddlers. This diagnosis should be considered in any hypoglycemic toddler with no prior history of abnormal growth who is developmentally normal when toxic ingestions and sepsis are inconsistent with the clinical picture. Diagnosis is important in preventing serious long-term sequelae and is made in the setting of hypoglycemia, ketonuria, and ketonemia. Therefore, checking urine and blood ketones is an essential part of the evaluation in any hypoglycemic toddler. We report the case of a 3-year-old girl with recurrent hypoglycemia secondary to idiopathic ketotic hypoglycemia.

  10. Long-term complications following bladder augmentations in patients with spina bifida: bladder calculi, perforation of the augmented bladder and upper tract deterioration

    PubMed Central

    2016-01-01

    Background We desire to review our experience with bladder augmentation in spina bifida patients followed in a transitional and adult urologic practice. This paper will specifically focus on three major complications: bladder calculi, the most frequent complication found following bladder augmentation, perforation of the augmentation, its most lethal complication and finally we will address loss of renal function as a direct result of our surgical reconstructive procedures. Methods We reviewed a prospective data base maintained on patients with spina bifida followed in our transitional and adult urology clinic from 1986 to date. Specific attention was given to patients who had developed bladder calculi, sustained a spontaneous perforation of the augmented bladder or had developed new onset of renal scarring or renal insufficiency (≥ stage 3 renal failure) during prolonged follow-up. Results The development of renal stones (P<0.05) and symptomatic urinary tract infections (P<0.0001) were found to be significantly reduced by the use of high volume (≥240 mL) daily bladder wash outs. Individuals who still developed bladder calculi recalcitrant to high volume wash outs were not benefited by the correction of underlying metabolic abnormalities or mucolytic agents. Spontaneous bladder perforations in the adult patient population with spina bifida were found to be directly correlated to substance abuse and noncompliance with intermittent catheterization, P<0.005. Deterioration of the upper tracts as defined by the new onset of renal scars occurred in 40% (32/80) of the patients managed by a ileocystoplasty and simultaneous bladder neck outlet procedure during a median follow-up interval 14 years (range, 8–45 years). Development of ≥ stage 3 chronic renal failure occurred within 38% (12/32) of the patients with scarring i.e., 15% (12/80) of the total patient population. Prior to the development of the renal scarring, 69% (22/32) of the patients had been noncompliant

  11. [Traumatic recurrence of idiopathic spinal cord herniation].

    PubMed

    Lorente-Muñoz, Asís; Cortés-Franco, Severiano; Moles-Herbera, Jesús; Casado-Pellejero, Juan; Rivero-Celada, David; Alberdi-Viñas, Juan

    2013-01-01

    Idiopathic spinal cord herniation is a rare cause of thoracic myelopathy and its recurrence is even more infrequent. Cord herniation is through an anterior dural defect in thoracic spine with unknown causes. Symptomatic cases must be surgically treated to reduce the hernia and seal the defect to prevent recurrences. We report a patient presenting a Brown-Séquard syndrome secondary to a D5 spinal cord herniation treated successfully and its posterior traumatic recurrence.

  12. Recurrence of spinal schwannoma: Is it preventable?

    PubMed Central

    Senapati, Satya B.; Mishra, Sudhansu S.; Dhir, Manmath K.; Patnaik, Ashis; Panigrahi, Souvagya

    2016-01-01

    Spinal schwannomas account for about 25% of primary intradural spinal cord tumors in adult. The prognosis for spinal schwannomas is excellent in most cases. Complete resection is curative. However following subtotal removal, recurrence develops after several years. We describe a case of recurrent spinal schwannoma who had been operated twice before for same disease. The possible cause of recurrence and difficulties in reoperation are discussed. PMID:27695564

  13. Effect of Dietary Countermeasures and Impact of Gravity on Renal Calculi Size Distributions Predicted by PBE-System and PBE-CFD Models

    NASA Technical Reports Server (NTRS)

    Kassemi, M.; Thompson, D.; Goodenow, D.; Gokoglu, S.; Myers, J.

    2016-01-01

    Renal stone disease is not only a concern on earth but can conceivably pose a serious risk to the astronauts health and safety in Space. In this work, two different deterministic models based on a Population Balance Equation (PBE) analysis of renal stone formation are developed to assess the risks of critical renal stone incidence for astronauts during space travel. In the first model, the nephron is treated as a continuous mixed suspension mixed product removal crystallizer and the PBE for the nucleating, growing and agglomerating renal calculi is coupled to speciation calculations performed by JESS. Predictions of stone size distributions in the kidney using this model indicate that the astronaut in microgravity is at noticeably greater but still subcritical risk and recommend administration of citrate and augmented hydration as effective means of minimizing and containing this risk. In the second model, the PBE analysis is coupled to a Computational Fluid Dynamics (CFD) model for flow of urine and transport of Calcium and Oxalate in the nephron to predict the impact of gravity on the stone size distributions. Results presented for realistic 3D tubule and collecting duct geometries, clearly indicate that agglomeration is the primary mode of size enhancement in both 1g and microgravity. 3D numerical simulations seem to further indicate that there will be an increased number of smaller stones developed in microgravity that will likely pass through the nephron in the absence of wall adhesion. However, upon reentry to a 1g (Earth) or 38g (Mars) partial gravitational fields, the renal calculi can lag behind the urinary flow in tubules that are adversely oriented with respect to the gravitational field and grow agglomerate to large sizes that are sedimented near the wall with increased propensity for wall adhesion, plaque formation, and risk to the astronauts.

  14. Procalcitonin determined at emergency department as an early indicator of progression to septic shock in patient with sepsis associated with ureteral calculi

    PubMed Central

    Ko, Young Hwii; Ji, Yoon Seob; Park, Sin-Youl; Kim, Su Jin; Song, Phil Hyun

    2016-01-01

    ABSTRACT Introduction: To investigate the role of initial procalcitonin (PCT) level as an early predictor of septic shock for the patient with sepsis induced by acute pyelonephritis (APN) secondary to ureteral calculi. Materials and Methods: The data from 49 consecutive patients who met criteria of sepsis due to APN following ureteral stone were collected and divided into two groups: with (n=15) or without (n=34) septic shock. The clinical variables including PCT level for this outcome were retrospectively compared by univariate analysis, followed by multivariable logistic regression model. Results: All subjects had hydronephrosis, and were hospitalized with the mean of 11.8 days (3–42 days). The mean size of the ureteral stones was 7.5mm (3–30mm), and 57% were located in upper ureter. At univariate analysis, patients with septic shock were significantly older, a higher proportion had hypertension, lower platelet count and serum albumin level, higher CRP and PCT level, and higher positive blood culture rate. Multivariate models indicated that lower platelet count and higher PCT level are independent risk factors (p=0.043 and 0.046, respectively). In ROC curve, the AUC was significantly wider in PCT (0.929), compared with the platelet count (0.822, p=0.004). At the cut-off of 0.52ng/mL, the sensitivity and specificity were 86.7% and 85.3%. Conclusion: Our study demonstrated elevated initial PCT levels as an early independent predictor to progress into septic shock in patients with sepsis associated with ureteral calculi. PMID:27256181

  15. Diagnosing Juvenile Recurrent Parotitis. Case Reports.

    PubMed

    Schorr, Brittany; Mandel, Louis

    2016-01-01

    Diagnosis of juvenile recurrent parotitis is based upon clinical symptomatology, because no positive serologic signs have been identified. Objective confirmation is best obtained from sialographic or ultrasound studies.

  16. Palbociclib Isethionate in Treating Younger Patients With Recurrent, Progressive, or Refractory Central Nervous System Tumors

    ClinicalTrials.gov

    2016-10-19

    Childhood Choroid Plexus Tumor; Childhood Ependymoblastoma; Childhood Grade III Meningioma; Childhood High-grade Cerebellar Astrocytoma; Childhood High-grade Cerebral Astrocytoma; Childhood Medulloepithelioma; Recurrent Childhood Anaplastic Astrocytoma; Recurrent Childhood Anaplastic Oligoastrocytoma; Recurrent Childhood Anaplastic Oligodendroglioma; Recurrent Childhood Brain Stem Glioma; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Giant Cell Glioblastoma; Recurrent Childhood Glioblastoma; Recurrent Childhood Gliomatosis Cerebri; Recurrent Childhood Gliosarcoma; Recurrent Childhood Medulloblastoma; Recurrent Childhood Pineoblastoma; Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor

  17. Recurrent pregnancy loss and obesity.

    PubMed

    Sugiura-Ogasawara, Mayumi

    2015-05-01

    Recurrent pregnancy loss (RPL) was defined as two or more miscarriages. Antiphospholipid syndrome, uterine anomalies, and parental chromosomal abnormalities, particularly translocation and abnormal embryonic karyotype, are identifiable causes of RPL. Obesity may increase the risk of sporadic miscarriage in pregnancies conceived spontaneously. Obesity with body mass index (BMI)>30 kg/m2 is an independent risk factor for further miscarriage with odds ratio 1.7-3.5 in patients with early RPL. Obesity is associated with euploid miscarriage. Unexplained RPL with euploid embryo might be a common disease caused by both polymorphisms of multiple susceptibility genes and lifestyle factors such as women's age, obesity, and smoking. Patients with a history of RPL were found to have a higher risk of cardiovascular disease, celiac disease, gastric ulcer, gastritis, and atopic dermatitis. No study has examined the effect of weight loss on the prevention of further miscarriage in patients with RPL.

  18. Recurrent Excitation in Neocortical Circuits

    NASA Astrophysics Data System (ADS)

    Douglas, Rodney J.; Koch, Christof; Mahowald, Misha; Martin, Kevan A. C.; Suarez, Humbert H.

    1995-08-01

    The majority of synapses in the mammalian cortex originate from cortical neurons. Indeed, the largest input to cortical cells comes from neighboring excitatory cells. However, most models of cortical development and processing do not reflect the anatomy and physiology of feedback excitation and are restricted to serial feedforward excitation. This report describes how populations of neurons in cat visual cortex can use excitatory feedback, characterized as an effective "network conductance," to amplify their feedforward input signals and demonstrates how neuronal discharge can be kept proportional to stimulus strength despite strong, recurrent connections that threaten to cause runaway excitation. These principles are incorporated into models of cortical direction and orientation selectivity that emphasize the basic design principles of cortical architectures.

  19. Nonsurgical treatment of recurrent glioblastoma

    PubMed Central

    Gallego, O.

    2015-01-01

    Standard treatment for glioblastoma multiforme is surgery followed by radiotherapy and chemotherapy, generally with temozolomide. However, disease recurs in almost all patients. Diagnosis of progression is complex given the possibility of pseudoprogression. The Response Assessment in Neuro-Oncology criteria increase the sensitivity for detecting progression. Most patients will not be candidates for new surgery or re-irradiation, and anticancer drugs are the most common approach for second-line treatment, if the patient’s condition allows. Antiangiogenics, inhibitors of the epidermal growth factor receptor, nitrosoureas, and re-treatment with temozolomide have been studied in the second line, but a standard therapy has not yet been established. This review considers currently available medical treatment options for patients with glioblastoma recurrence. PMID:26300678

  20. Preventing Relapse/Recurrence in Recurrent Depression With Cognitive Therapy: A Randomized Controlled Trial

    ERIC Educational Resources Information Center

    Bockting, Claudi L. H.; Schene, Aart H.; Spinhoven, Philip; Koeter, Maarten W. J.; Wouters, Luuk F.; Huyser, Jochanan; Kamphuis, Jan H.

    2005-01-01

    This article reports on the outcome of a randomized controlled trial of cognitive group therapy (CT) to prevent relapse/recurrence in a group of high-risk patients diagnosed with recurrent depression. Recurrently depressed patients (N = 187) currently in remission following various types of treatment were randomized to treatment as usual,…

  1. Oxaliplatin in Treating Young Patients With Recurrent Solid Tumors That Have Not Responded to Previous Treatment

    ClinicalTrials.gov

    2013-06-04

    Childhood Central Nervous System Germ Cell Tumor; Childhood Extragonadal Germ Cell Tumor; Childhood Hepatoblastoma; Childhood Hepatocellular Carcinoma; Childhood High-grade Cerebral Astrocytoma; Childhood Low-grade Cerebral Astrocytoma; Childhood Malignant Ovarian Germ Cell Tumor; Childhood Malignant Testicular Germ Cell Tumor; Childhood Teratoma; Recurrent Adrenocortical Carcinoma; Recurrent Childhood Brain Stem Glioma; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Ependymoma; Recurrent Childhood Liver Cancer; Recurrent Childhood Malignant Germ Cell Tumor; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Recurrent Childhood Visual Pathway and Hypothalamic Glioma; Recurrent Colon Cancer; Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Recurrent Nasopharyngeal Cancer; Recurrent Neuroblastoma; Recurrent Osteosarcoma; Recurrent Rectal Cancer; Recurrent Renal Cell Cancer

  2. Trials show delayed recurrence in ovarian cancer.

    PubMed

    Bender, Eric

    2013-06-01

    Phase I trials of 2 treatments for recurrent ovarian cancer-a 2-step immunotherapy treatment and an antibody-drug conjugate-demonstrated promising early results in delaying recurrence, in work presented at the American Association for Cancer Research Annual Meeting 2013.

  3. Recurrent takotsubo cardiomyopathy in a child.

    PubMed

    Srivastava, Nayan T; Parent, John J; Hurwitz, Roger A

    2016-02-01

    Takotsubo cardiomyopathy or transient apical ballooning syndrome very rarely presents in children. In all patients with takotsubo, it is estimated that only 3.5% will have recurrence. In this study, we describe a case of recurrent takotsubo cardiomyopathy in a child, likely triggered by status epilepticus.

  4. Recurrence Effects in the Parametric Spring Pendulum.

    ERIC Educational Resources Information Center

    Falk, Lars

    1978-01-01

    Gives a perturbation analysis to recurrence effects of the spring pendulum. The recurrence depends on two conservation laws which determine the motion in an intermediate region; oscillations outside this region are unstable and must return. Gives the relation to Fermi-Pasta-Ulam problem together with the explicit solution. (Author/GA)

  5. Ectopic recurrent craniopharyngioma of the frontal bone.

    PubMed

    Jakobs, Martin; Orakcioglu, Berk

    2012-09-01

    Ectopic recurrence of craniopharyngioma is a rare phenomenon after transcranial resection of the primary tumor. The authors present a case of ectopic recurrent adamantinomatous craniopharyngioma of the frontal bone resected 16 years after initial transcranial resection of the primary tumor. The lesion was first radiographically described 12 years after surgery and was adjacent to the osteosynthesis plate that had been implanted at the craniotomy site. The recurrent craniopharyngioma was totally resected via a lateral eyebrow approach. No infiltration of the meninges or the brain was detected. Only 50 cases of ectopic recurrent craniopharyngioma have been described to date, with the present case being the first one with recurrence located at the skull bone. So far 2 mechanisms have been described: contamination with tumor cells alongside the surgical tract and spreading via CSF and the subarachnoid space. The authors reviewed the literature, provided the largest collection of cases so far, and performed basic statistical analysis regarding ectopic recurrence. Pediatric and adult patients as well as male and female ones are affected equally by this phenomenon. The mean time of ectopic recurrence after initial surgery was 7.1 years. Ectopic recurrence, although rare, should always be considered in a patient with a newly diagnosed intracranial lesion who has undergone transcranial craniopharyngioma resection before.

  6. 28 CFR 51.14 - Recurrent practices.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Recurrent practices. 51.14 Section 51.14 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PROCEDURES FOR THE ADMINISTRATION OF SECTION 5 OF THE VOTING RIGHTS ACT OF 1965, AS AMENDED General Provisions § 51.14 Recurrent practices. Where...

  7. Recurrence in Major Depression: A Conceptual Analysis

    ERIC Educational Resources Information Center

    Monroe, Scott M.; Harkness, Kate L.

    2011-01-01

    Theory and research on major depression have increasingly assumed a recurrent and chronic disease model. Yet not all people who become depressed suffer recurrences, suggesting that depression is also an acute, time-limited condition. However, few if any risk indicators are available to forecast which of the initially depressed will or will not…

  8. Local Recurrence After Uveal Melanoma Proton Beam Therapy: Recurrence Types and Prognostic Consequences

    SciTech Connect

    Caujolle, Jean-Pierre; Paoli, Vincent; Chamorey, Emmanuel; Maschi, Celia; Baillif, Stéphanie; Herault, Joël; Gastaud, Pierre; Hannoun-Levi, Jean Michel

    2013-04-01

    Purpose: To study the prognosis of the different types of uveal melanoma recurrences treated by proton beam therapy (PBT). Methods and Materials: This retrospective study analyzed 61 cases of uveal melanoma local recurrences on a total of 1102 patients treated by PBT between June 1991 and December 2010. Survival rates have been determined by using Kaplan-Meier curves. Prognostic factors have been evaluated by using log-rank test or Cox model. Results: Our local recurrence rate was 6.1% at 5 years. These recurrences were divided into 25 patients with marginal recurrences, 18 global recurrences, 12 distant recurrences, and 6 extrascleral extensions. Five factors have been identified as statistically significant risk factors of local recurrence in the univariate analysis: large tumoral diameter, small tumoral volume, low ratio of tumoral volume over eyeball volume, iris root involvement, and safety margin inferior to 1 mm. In the local recurrence-free population, the overall survival rate was 68.7% at 10 years and the specific survival rate was 83.6% at 10 years. In the local recurrence population, the overall survival rate was 43.1% at 10 years and the specific survival rate was 55% at 10 years. The multivariate analysis of death risk factors has shown a better prognosis for marginal recurrences. Conclusion: Survival rate of marginal recurrences is superior to that of the other recurrences. The type of recurrence is a clinical prognostic value to take into account. The influence of local recurrence retreatment by proton beam therapy should be evaluated by novel studies.

  9. Evidence-based management of recurrent miscarriages

    PubMed Central

    Jeve, Yadava B.; Davies, William

    2014-01-01

    Recurrent miscarriages are postimplantation failures in natural conception; they are also termed as habitual abortions or recurrent pregnancy losses. Recurrent pregnancy loss is disheartening to the couple and to the treating clinician. There has been a wide range of research from aetiology to management of recurrent pregnancy loss. It is one of the most debated topic among clinicians and academics. The ideal management is unanswered. This review is aimed to produce an evidence-based guidance on clinical management of recurrent miscarriage. The review is structured to be clinically relevant. We have searched electronic databases (PubMed and Embase) using different key words. We have combined the searches and arranged them with the hierarchy of evidences. We have critically appraised the evidence to produce a concise answer for clinical practice. We have graded the evidence from level I to V on which these recommendations are based. PMID:25395740

  10. Recurrent well-differentiated thyroid carcinoma.

    PubMed

    Magarey, Matthew J R; Freeman, Jeremy L

    2013-07-01

    The incidence of Well-differentiated Thyroid Carcinoma (WDTC) has been increasing over the past several decades. Consequently, so has the incidence of recurrence, which ranges from 15% to 30%. Factors leading to increased risk of recurrence are well described. However, the impact of local and regional recurrence is not well understood, but distant recurrence dramatically reduces 10-year survival to 50%. Recurrent WDTC has several established options for treatment; Observation, Radioactive Iodine (RAI), Surgery and External Beam Radiotherapy (EBRT). Novel treatments such as radiofrequency ablation (RFA) and percutaneous ultrasound-guided ethanol injection (PUEI) are beginning to gain popularity and have promising early results. A review of the current literature, outcome measurements and a strategy for revision surgery within the central neck compartment are discussed within this manuscript.

  11. [Current status of prevention and therapy of urinary calculi and peroral chemo-litholysis with special attention to the relationship of increased excretion of uric acid in oxalate lithiasis].

    PubMed

    Leskovar, P

    1980-03-01

    A survey shall be given of the present state of prevention and therapy of urolithiasis as well as of the up to now much restricted possibilities of the chemolitholysis. Particular attention is paid to calcium on account of its participation in the development of oxalate and phosphate calculi which together might be 70--80% of all calculi as well as to the rather limited possibilities of the reduction of the oxalate secretion in the urine. The encouragement of the oxalate lithiasis by increased uric acid in the urine as well as the reduction of the frequency of relapses not only of the concrements of the uric acid but also of the oxalate concrements by the uricostatic Allopurinol (e.g. zyloric) is dealt with.

  12. Dasatinib in Treating Patients With Recurrent or Persistent Ovarian, Fallopian Tube, Endometrial or Peritoneal Cancer

    ClinicalTrials.gov

    2017-04-05

    Endometrial Clear Cell Adenocarcinoma; Estrogen Receptor Negative; Ovarian Clear Cell Cystadenocarcinoma; Recurrent Fallopian Tube Carcinoma; Recurrent Ovarian Carcinoma; Recurrent Primary Peritoneal Carcinoma; Recurrent Uterine Corpus Carcinoma

  13. Alisertib in Treating Young Patients With Recurrent or Refractory Solid Tumors or Leukemia

    ClinicalTrials.gov

    2016-07-20

    Hepatoblastoma; Previously Treated Childhood Rhabdomyosarcoma; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Recurrent Childhood Kidney Neoplasm; Recurrent Childhood Malignant Germ Cell Tumor; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Recurrent Neuroblastoma; Recurrent Osteosarcoma

  14. Cabozantinib S-Malate in Treating Younger Patients With Recurrent or Refractory Solid Tumors

    ClinicalTrials.gov

    2017-03-20

    Childhood Solid Neoplasm; Childhood Thyroid Gland Medullary Carcinoma; Recurrent Childhood Central Nervous System Neoplasm; Recurrent Malignant Solid Neoplasm; Recurrent Melanoma; Recurrent Thyroid Gland Carcinoma

  15. MDX-010 in Treating Patients With Recurrent or Refractory Lymphoma

    ClinicalTrials.gov

    2014-05-22

    Adult Grade III Lymphomatoid Granulomatosis; B-cell Chronic Lymphocytic Leukemia; Cutaneous B-cell Non-Hodgkin Lymphoma; Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue; Intraocular Lymphoma; Nodal Marginal Zone B-cell Lymphoma; Recurrent Adult Burkitt Lymphoma; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent Adult Diffuse Mixed Cell Lymphoma; Recurrent Adult Diffuse Small Cleaved Cell Lymphoma; Recurrent Adult Grade III Lymphomatoid Granulomatosis; Recurrent Adult Hodgkin Lymphoma; Recurrent Adult Immunoblastic Large Cell Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Refractory Hairy Cell Leukemia; Small Intestine Lymphoma; Splenic Marginal Zone Lymphoma; Testicular Lymphoma; Waldenström Macroglobulinemia

  16. [Annexins and recurrent pregnancy loss].

    PubMed

    Udry, Sebastián; Aranda, Federico; Latino, Omar; Larrañaga, Gabriela de

    2013-01-01

    Recurrent Pregnancy Loss (RPL) affects public health and directly compromises the quality of life of hundreds of women, with a detrimental effect on their physical and mental health. Approximately 50% of RPL are not associated to any of the currently known etiology and will be considered idiopathic. Recently, it has been demonstrated that the expression of annexin 5 (ANXA5), a protein found on the trophoblastic surface, plays a fundamental role in the development of pregnancy due to its immunomodulator and anticoagulant function at the placentary level. Some genetic haplotypes of ANXA5 are associated to alterations in the expression of this gene, such as haplotype M2 which is associated to a decrease in the expression of ANXA5. The presence of this haplotype is related to the following conditions occurring during pregnancy: RPL, foetal intrauterine growth restriction, low child weight at birth, preeclampsia and maternal pulmonary thromboembolism. This review describes the structure, function and genetic expression of ANXA5, as well as its possible implication in RPL.

  17. Urban legends: recurrent aphthous stomatitis.

    PubMed

    Baccaglini, L; Lalla, R V; Bruce, A J; Sartori-Valinotti, J C; Latortue, M C; Carrozzo, M; Rogers, R S

    2011-11-01

    Recurrent aphthous stomatitis (RAS) is the most common idiopathic intraoral ulcerative disease in the USA. Aphthae typically occur in apparently healthy individuals, although an association with certain systemic diseases has been reported. Despite the unclear etiopathogenesis, new drug trials are continuously conducted in an attempt to reduce pain and dysfunction. We investigated four controversial topics: (1) Is complex aphthosis a mild form of Behçet's disease (BD)? (2) Is periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome a distinct medical entity? (3) Is RAS associated with other systemic diseases [e.g., celiac disease (CD) and B12 deficiency]? (4) Are there any new RAS treatments? Results from extensive literature searches, including a systematic review of RAS trials, suggested the following: (1) Complex aphthosis is not a mild form of BD in North America or Western Europe; (2) Diagnostic criteria for PFAPA have low specificity and the characteristics of the oral ulcers warrant further studies; (3) Oral ulcers may be associated with CD; however, these ulcers may not be RAS; RAS is rarely associated with B12 deficiency; nevertheless, B12 treatment may be beneficial, via mechanisms that warrant further study; (4) Thirty-three controlled trials published in the past 6 years reported some effectiveness, although potential for bias was high.

  18. Recurrent gene mutations in CLL.

    PubMed

    Martínez-Trillos, Alejandra; Quesada, Víctor; Villamor, Neus; Puente, Xose S; López-Otín, Carlos; Campo, Elías

    2013-01-01

    Next-generation sequencing of whole genomes and exomes in chronic lymphocytic leukemia (CLL) has provided the first comprehensive view of somatic mutations in this disease. Subsequent studies have characterized the oncogenic pathways and clinical implications of a number of these mutations. The global number of somatic mutations per case is lower than those described in solid tumors but is in agreement with previous estimates of less than one mutation per megabase in hematological neoplasms. The number and pattern of somatic mutations differ in tumors with unmutated and mutated IGHV, extending at the genomic level the clinical differences observed in these two CLL subtypes. One of the striking conclusions of these studies has been the marked genetic heterogeneity of the disease, with a relatively large number of genes recurrently mutated at low frequency and only a few genes mutated in up to 10-15 % of the patients. The mutated genes tend to cluster in different pathways that include NOTCH1 signaling, RNA splicing and processing machinery, innate inflammatory response, Wnt signaling, and DNA damage and cell cycle control, among others. These results highlight the molecular heterogeneity of CLL and may provide new biomarkers and potential therapeutic targets for the diagnosis and management of the disease.

  19. [In vitro and first in vivo experiments for the dissolution of calcium-containing urinary calculi (author's transl)].

    PubMed

    Leskovar, P; Hartung, R; Hropot, M; Wellnhofer, E; Steffek, D; Hoffmann, E

    1981-01-01

    There are numerous reports dealing with the significantly reduced citrate secretion in (recurrent) tone formers. The critical values of the Ca/citrate ratio in the nocturnal urine of (oxalate) stone formers has also been reported, emphasizing the need of medicaments being capable to increase the citrate secretion and to raise the basal citrate level of the nocturnal urine in these patients. In our in vitro experiments, we tested quantitatively the inhibitory activity of some new substances on crystal growth. In Wistar rats we measured the Ca2+-binding capacity as well as the citrate and oxalate excretion before and after oral application of a great number of new compounds. Some of them were highly efficacious in the reduction of the Ca-oxalate activity product, as can be derived from the increased Ca2+-binding capacity and/or the decreased oxalate secretion in urine.

  20. Inguinal hernia recurrence: Classification and approach

    PubMed Central

    Campanelli, Giampiero; Pettinari, Diego; Cavalli, Marta; Avesani, Ettore Contessini

    2006-01-01

    The authors reviewed the records of 2,468 operations of groin hernia in 2,350 patients, including 277 recurrent hernias updated to January 2005. The data obtained - evaluating technique, results and complications - were used to propose a simple anatomo-clinical classification into three types which could be used to plan the surgical strategy: Type R1: first recurrence ‘high,’ oblique external, reducible hernia with small (<2 cm) defect in non-obese patients, after pure tissue or mesh repairType R2: first recurrence ‘low,’ direct, reducible hernia with small (<2 cm) defect in non-obese patients, after pure tissue or mesh repairType R3: all the other recurrences - including femoral recurrences; recurrent groin hernia with big defect (inguinal eventration); multirecurrent hernias; nonreducible, linked with a controlateral primitive or recurrent hernia; and situations compromised from aggravating factors (for example obesity) or anyway not easily included in R1 or R2, after pure tissue or mesh repair. PMID:21187986

  1. Recurrent neural processing and somatosensory awareness.

    PubMed

    Auksztulewicz, Ryszard; Spitzer, Bernhard; Blankenburg, Felix

    2012-01-18

    The neural mechanisms of stimulus detection, despite extensive research, remain elusive. The recurrent processing hypothesis, a prominent theoretical account of perceptual awareness, states that, although stimuli might in principle evoke feedforward activity propagating through the visual cortex, stimuli that become consciously detected are further processed in feedforward-feedback loops established between cortical areas. To test this theory in the tactile modality, we applied dynamic causal modeling to electroencephalography (EEG) data acquired from humans in a somatosensory detection task. In the analysis of stimulation-induced event-related potentials (ERPs), we focused on model-based evidence for feedforward, feedback, and recurrent processing between primary and secondary somatosensory cortices. Bayesian model comparison revealed that, although early EEG components were well explained by both the feedforward and the recurrent models, the recurrent model outperformed the other models when later EEG segments were analyzed. Within the recurrent model, stimulus detection was characterized by a relatively early strength increase of the feedforward connection from primary to secondary somatosensory cortex (>80 ms). At longer latencies (>140 ms), also the feedback connection showed a detection-related strength increase. The modeling results on relative evidence between recurrent and feedforward model comparison support the hypothesis that the ERP responses from sensory areas arising after aware stimulus detection can be explained by increased recurrent processing within the somatosensory network in the later stages of stimulus processing.

  2. Tea and Recurrent Clostridium difficile Infection

    PubMed Central

    Starley, Brad; Galagan, Jack Carl; Yabes, Joseph Michael; Evans, Sara

    2016-01-01

    Background and Aims. Studies have shown effects of diet on gut microbiota. We aimed to identify foods associated with recurrent Clostridium difficile infection (CDI). Methods. In this cross-sectional survey, consecutive patients diagnosed with CDI were identified by electronic medical records. Colitis symptoms and positive Clostridium difficile assay were confirmed. Health-care onset-health-care facility associated CDI was excluded. Food surveys were mailed to 411 patients. Survey responses served as the primary outcome measure. Spearman's rank correlation identified risk factors for CDI recurrence. Results. Surveys were returned by 68 patients. Nineteen patients experienced CDI recurrence. Compared to patients without CDI recurrence, patients with CDI recurrence had more antibiotics prescribed preceding their infection (p = 0.003). Greater numbers of the latter also listed tea (p = 0.002), coffee (p = 0.013), and eggs (p = 0.013), on their 24-hour food recall. Logistic regression identified tea as the only food risk factor for CDI recurrence (adjusted OR: 5.71; 95% CI: 1.26–25.89). Conclusion. The present results indicate a possible association between tea and CDI recurrence. Additional studies are needed to characterize and confirm this association. PMID:27651790

  3. Evaluating the importance of mean stone density and skin-to-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi.

    PubMed

    Wiesenthal, Joshua D; Ghiculete, Daniela; D'A Honey, R John; Pace, Kenneth T

    2010-08-01

    Shock wave lithotripsy (SWL) is considered the first line treatment for the majority of patients with renal and ureteric calculi, with success rates from contemporary series varying from 60 to 90%. Success is dependent on many patient and stone-related factors. We conducted a retrospective analysis of mean stone CT density (MSD) and skin-to-stone distance (SSD) to determine their influence on the success of SWL of renal and ureteric calculi. Data from all patients treated at the St. Michael's Hospital Lithotripsy Unit from May 2004 to June 2009 were reviewed. Analysis was restricted to those patients with a pre-treatment non-contrast CT scan conducted at our center demonstrating a solitary renal or ureteric calculus < or =20 mm in maximal diameter. Successful treatment of renal stones was defined as those patients who were stone free or had asymptomatic, clinically insignificant residual fragments < or =4 mm in diameter, as measured by KUB X-ray, 3 months after a single SWL treatment. Successful treatment of ureteric stones was defined as being stone free on KUB X-ray, 2-weeks post-SWL. Demographic, stone, patient, treatment and follow-up data were collected from a prospective database and review of CT and KUB imaging by two independent urologists and one radiologist. Data were analyzed with logistic regression, Chi square analysis and ANOVA where appropriate. 422 patients (69.7% male) with a mean age of 51.4 years (SD 12.9) and mean BMI 27.0 kg/m(2) (SD 4.9) were analyzed. Mean stone size was 78.9 mm(2) (SD 77.3) for ureteral stones and 66.1 mm(2) (SD 63.2) for renal stones, with 95 (43.6%) of the renal stones located in the lower pole. The single-treatment success rates for ureteral and renal stones were 62.3% and 68.8%, respectively. On univariate analysis, predictors of SWL success, regardless of stone location, were age (p = 0.01), BMI (p = 0.01), stone size (p < 0.01), MSD (p < 0.01) and SSD (p < 0.01). On multivariate analysis, MSD >900 HU (OR = 0.49, CI: 0

  4. Remote orbital recurrence of olfactory neuroblastoma (esthesioneuroblastoma).

    PubMed

    Breazzano, Mark P; Lewis, James S; Chambless, Lola B; Rohde, Sarah L; Sobel, Rachel K

    2017-03-31

    Olfactory neuroblastoma is a rare and often locally aggressive malignancy that invades the orbit via local destruction. It is known to recur in a delayed fashion, particularly to the neck lymph nodes. This is a case of a 65-year-old gentleman who presents with recurrence in the orbit and a neck lymph node 19 years after treatment for his initial disease. This report describes the longest known interval in orbital recurrence and should alert the monitoring physician that extreme delays in recurrence can occur.

  5. Complex partial status epilepticus: a recurrent problem.

    PubMed Central

    Cockerell, O C; Walker, M C; Sander, J W; Shorvon, S D

    1994-01-01

    Twenty patients with complex partial status epilepticus were identified retrospectively from a specialist neurology hospital. Seventeen patients experienced recurrent episodes of complex partial status epilepticus, often occurring at regular intervals, usually over many years, and while being treated with effective anti-epileptic drugs. No unifying cause for the recurrences, and no common epilepsy aetiologies, were identified. In spite of the frequency of recurrence and length of history, none of the patients showed any marked evidence of cognitive or neurological deterioration. Complex partial status epilepticus is more common than is generally recognised, should be differentiated from other forms of non-convulsive status, and is often difficult to treat. PMID:8021671

  6. Modular flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal and proximal ureteral calculi: A single-surgeon experience of 382 cases.

    PubMed

    Yan, Zejun; Xie, Guohai; Yuan, Hesheng; Cheng, Yue

    2015-10-01

    To determine the safety and efficacy of modular flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal and proximal ureteral calculi, a retrospective chart review of a single surgeon's 3-year modular flexible ureteroscopy experience was performed. All of the patients were treated with modular flexible ureteroscopy and holmium laser lithotripsy by a single surgeon. Stone-free status was defined as no fragments or a single fragment ≤4 mm in diameter at the 3-month follow-up. The procedure number, operative time, stone-free rates, repeat usage of the multilumen catheter, and perioperative complications were documented. The present study included 215 male patients and 167 female patients, with an average age of 48.5±13.7 years (range, 17-84 years). The mean stone size was 11.5±4.1 mm (range, 4-28 mm), and the mean total stone burden was 17.5±5.7 mm (range 15-46 mm). A total of 305 patients (79.8%) had a stone burden ≤20 mm, and 77 patients (20.2%) had a stone burden >20 mm. The mean number of primary procedures was 1.3±0.2 (range, 1-3). The stone-free rate following the first and the second procedure was 73.4 and 86.9%, respectively. The mean postoperative hospital stay was 3.1±1.2 days (range, 2-6 days). The highest clearance rates were observed for proximal ureteral stones (100%) and renal pelvic stones (88.7%), whereas the lowest clearance rates were observed for lower calyx stones (76.7%) and multiple calyx stones (77.8%). The higher the initial stone burden, the lower the postoperative stone-free rate (≤20 vs. >20 mm; 89.8 vs. 75.3%). The overall complication rate was 8.1%. The results of the present study suggest that modular flexible ureteroscopy with holmium laser lithotripsy may be considered the primary method for the treatment of renal and proximal ureteral calculi in select patients, due to its acceptable efficacy, low morbidity, and relatively low maintenance costs.

  7. Genetic Considerations in Recurrent Pregnancy Loss

    PubMed Central

    Hyde, Kassie J.; Schust, Danny J.

    2015-01-01

    Human reproduction is remarkably inefficient; nearly 70% of human conceptions do not survive to live birth. Spontaneous fetal aneuploidy is the most common cause for spontaneous loss, particularly in the first trimester of pregnancy. Although losses owing to de novo fetal aneuploidy occur at similar frequencies among women with sporadic and recurrent losses, some couples with recurrent pregnancy loss have additional associated genetic factors and some have nongenetic etiologies. Genetic testing of the products of conception from couples experiencing two or more losses may aid in defining the underlying etiology and in counseling patients about prognosis in a subsequent pregnancy. Parental karyotyping of couples who have experienced recurrent pregnancy loss (RPL) will detect some couples with an increased likelihood of recurrent fetal aneuploidy; this may direct interventions. The utility of preimplantation genetic analysis in couples with RPL is unproven, but new approaches to this testing show great promise. PMID:25659378

  8. Genetics Home Reference: benign recurrent intrahepatic cholestasis

    MedlinePlus

    ... All Close All Description Benign recurrent intrahepatic cholestasis (BRIC) is characterized by episodes of liver dysfunction called ... a lack of appetite. A common feature of BRIC is the reduced absorption of fat in the ...

  9. [Recurrent intestinal ischemia due to factor VIII].

    PubMed

    Castellanos Monedero, Jesús Javier; Legaz Huidobro, María Luisa; Galindo Andugar, María Angeles; Rodríguez Pérez, Alvaro; Mantrana del Valle, José María

    2008-01-01

    Intestinal ischemia is difficult to diagnose and can be caused by several etiologic processes. We report the case of a female patient with recurrent bowel ischemia due to small vessel thrombosis, which is caused by factor VIII, a procoagulant factor.

  10. Benign recurrent VI nerve palsy in childhood.

    PubMed

    Bixenman, W W; von Noorden, G K

    1981-01-01

    The case of a child with six documented episodes of benign recurrent unilateral VI nerve palsy between the ages of 2 1/2 months and 3 years is presented. Despite the recognized self-limiting course of this disorder, its possible evolution into a comitant esotropia makes close follow-up mandatory. The practical aspects of management including maintenance occlusion therapy are stressed as well as the need for prompt surgical intervention once the acquired stabismus has become stabilized. The etiology of benign VI nerve palsy of childhood may have the same immunological basis as other cases of para-infectious neuropathy. This isolated postinfective cranial mononeuropathy easily blends into the continuum of neurological involvement seen with the Landry-Guillian-Barre syndrome. With recovery from the initial episode, the abducens nerve may have become predisposed to recurrent inflammatory episodes and recurrent loss of function. Most often these recurrences are triggered by febrile illnesses of childhood.

  11. Childhood recurrent pneumonia caused by endobronchial sutures

    PubMed Central

    Zan, Yiheng; Liu, Hanmin; Zhong, Lin; Qiu, Li; Tao, Qingfen; Chen, Lina

    2017-01-01

    Abstract Background: Recurrent pneumonia is defined as more than two episodes of pneumonia in one year or three or more episodes anytime in life. Common clinical scenarios leading to recurrent pneumonia include anatomical abnormalities of respiratory tract, immunodeficiency, congenital heart diseases, primary ciliary dyskinesia, etc. Case report: A school-aged girl suffered from 1-2 episodes of pneumonia each year after trachea connection and lung repair operation resulted from an accident of car crash. Bronchoscopy revealed the sutures twisted with granulation in the left main bronchus and the patient's symptoms relieved after removal of the sutures. Here we report for the first time that surgical suture was the cause of recurrent pneumonia. Conclusions: This case indicates that children with late and recurrent onset of pneumonia should undergo detailed evaluation including bronchoscopy. PMID:28121955

  12. Management of Urethral Recurrences: Urothelial and Nonurothelial.

    PubMed

    Zargar-Shoshtari, Kamran; Sexton, Wade J; Poch, Michael A

    2016-11-01

    This article discusses the diagnostic and therapeutic options in the management of urethral cancer recurrence in patients treated with urethral sparing cystectomy as well as those who had urethral preservation following primary urethral carcinoma.

  13. Multifocal recurrent periostitis. Report of two cases.

    PubMed

    Kozlowski, K; Anderson, R; Tink, A

    1981-11-01

    Two case reports of recurrent multifocal periostitis in two girls aged 15 and 6 are added to the eight cases already reported in the literature. The disease is characterized clinically by recurrent mesomelic swelling of the extremities and radiologically by periosteal thickening and sclerosis of underlying bone. Hyperglobulinaemia is the most constant biochemical finding. The bone biopsy shows no typical features. The possibility of a viral etiology is discussed.

  14. Risk of Recurrence in Laryngeal Cancer

    PubMed Central

    Sørum Falk, Ragnhild; Folkvard Evensen, Jan; Boysen, Morten; Brøndbo, Kjell

    2016-01-01

    A cohort study was undertaken to analyze the risk of recurrence among 1616 patients with primary squamous cell carcinoma of the larynx from 1983 to 2010 at a single, tertiary academic center in Oslo, Norway. The cohort was followed from the date of diagnosis to September 2011. Competing risk regression analysis assessed the association between various risk factors and the risk of recurrence, where death was considered a competing event. Recurrence was observed in 368 patients (23%) during the study period. The majority (71%) of recurrences involved the location of the primary tumor. The overall risk of recurrence during the first three years after initiating treatment was 20.5%. Increased risk of recurrence was observed in patients with supraglottic cancer, younger patients, those with T2–T3 tumors and in patients treated in the earlier part of the study period. Significant factors for recurrence in glottic carcinomas were age, treatment in the earlier part of the study and T-status, whereas age was a significant factor in supraglottic cancer. N-status appeared less significant. In conclusion, follow-up of laryngeal squamous cell carcinoma should place particular emphasis on the site of the primary tumor, younger patients, cases of supraglottic cancer and T2-T4 primary tumors, especially during the first three years after treatment. More studies are needed to assess the impact of surgical versus non-surgical treatment, and eventually the significance of recurrence, for disease-specific and overall survival in cases of advanced laryngeal squamous cell carcinoma. PMID:27716797

  15. Laboratory constraints on models of earthquake recurrence

    NASA Astrophysics Data System (ADS)

    Beeler, N. M.; Tullis, Terry; Junger, Jenni; Kilgore, Brian; Goldsby, David

    2014-12-01

    In this study, rock friction "stick-slip" experiments are used to develop constraints on models of earthquake recurrence. Constant rate loading of bare rock surfaces in high-quality experiments produces stick-slip recurrence that is periodic at least to second order. When the loading rate is varied, recurrence is approximately inversely proportional to loading rate. These laboratory events initiate due to a slip-rate-dependent process that also determines the size of the stress drop and, as a consequence, stress drop varies weakly but systematically with loading rate. This is especially evident in experiments where the loading rate is changed by orders of magnitude, as is thought to be the loading condition of naturally occurring, small repeating earthquakes driven by afterslip, or low-frequency earthquakes loaded by episodic slip. The experimentally observed stress drops are well described by a logarithmic dependence on recurrence interval that can be cast as a nonlinear slip predictable model. The fault's rate dependence of strength is the key physical parameter. Additionally, even at constant loading rate the most reproducible laboratory recurrence is not exactly periodic, unlike existing friction recurrence models. We present example laboratory catalogs that document the variance and show that in large catalogs, even at constant loading rate, stress drop and recurrence covary systematically. The origin of this covariance is largely consistent with variability of the dependence of fault strength on slip rate. Laboratory catalogs show aspects of both slip and time predictability, and successive stress drops are strongly correlated indicating a "memory" of prior slip history that extends over at least one recurrence cycle.

  16. Heterogeneous recurrence monitoring and control of nonlinear stochastic processes

    SciTech Connect

    Yang, Hui Chen, Yun

    2014-03-15

    Recurrence is one of the most common phenomena in natural and engineering systems. Process monitoring of dynamic transitions in nonlinear and nonstationary systems is more concerned with aperiodic recurrences and recurrence variations. However, little has been done to investigate the heterogeneous recurrence variations and link with the objectives of process monitoring and anomaly detection. Notably, nonlinear recurrence methodologies are based on homogeneous recurrences, which treat all recurrence states in the same way as black dots, and non-recurrence is white in recurrence plots. Heterogeneous recurrences are more concerned about the variations of recurrence states in terms of state properties (e.g., values and relative locations) and the evolving dynamics (e.g., sequential state transitions). This paper presents a novel approach of heterogeneous recurrence analysis that utilizes a new fractal representation to delineate heterogeneous recurrence states in multiple scales, including the recurrences of both single states and multi-state sequences. Further, we developed a new set of heterogeneous recurrence quantifiers that are extracted from fractal representation in the transformed space. To that end, we integrated multivariate statistical control charts with heterogeneous recurrence analysis to simultaneously monitor two or more related quantifiers. Experimental results on nonlinear stochastic processes show that the proposed approach not only captures heterogeneous recurrence patterns in the fractal representation but also effectively monitors the changes in the dynamics of a complex system.

  17. Spinal Recurrence From Intracranial Germinoma: Risk Factors and Treatment Outcome for Spinal Recurrence

    SciTech Connect

    Ogawa, Kazuhiko Yoshii, Yoshihiko; Shikama, Naoto; Nakamura, Katsumasa; Uno, Takashi; Onishi, Hiroshi; Itami, Jun; Shioyama, Yoshiyuki; Iraha, Shiro; Hyodo, Akio; Toita, Takafumi; Kakinohana, Yasumasa; Tamaki, Wakana; Ito, Hisao; Murayama, Sadayuki

    2008-12-01

    Purpose: To analyze retrospectively the risk factors of spinal recurrence in patients with intracranial germinoma and clinical outcomes of patients who developed spinal recurrence. Methods and Materials: Between 1980 and 2007, 165 patients with no evidence of spinal metastases at diagnosis were treated with cranial radiotherapy without spinal irradiation. The median follow-up in all 165 patients was 61.2 months (range, 1.2-260.1 months). Results: After the initial treatment, 15 patients (9.1%) developed spinal recurrences. Multivariate analysis revealed that large intracranial disease ({>=}4 cm) and multifocal intracranial disease were independent risk factors for spinal recurrence. Radiation field, total radiation dose, and the use of chemotherapy did not affect the occurrence of spinal recurrences. Of the 15 patients who experienced spinal recurrence, the 3-year actuarial overall survival and disease-free survival (DFS) rates from the beginning of salvage treatments were 65% and 57%, respectively. In the analysis, presence of intracranial recurrence and salvage treatment modality (radiotherapy with chemotherapy vs. radiotherapy alone) had a statistically significant impact on DFS. The 3-year DFS rate in patients with no intracranial recurrence and treated with both spinal radiotherapy and chemotherapy was 100%, whereas only 17% in patients with intracranial recurrence or treated with radiotherapy alone (p = 0.001). Conclusion: Large intracranial disease and multifocal intracranial disease were risk factors for spinal recurrence in patients with intracranial germinoma with no evidence of spinal metastases at diagnosis. For patients who developed spinal recurrence alone, salvage treatment combined with spinal radiotherapy and chemotherapy was effective in controlling the recurrent disease.

  18. Dupuytren contracture recurrence project: reaching consensus on a definition of recurrence.

    PubMed

    Felici, N; Marcoccio, I; Giunta, R; Haerle, M; Leclercq, C; Pajardi, G; Wilbrand, S; Georgescu, A V; Pess, G

    2014-12-01

    The aim of this study was to determine a definition of recurrence of Dupuytren disease that could be utilized for the comparison of the results independently from the treatment used. 24 hand surgeons from 17 countries met in an international consensus conference. The participants used the Delphi method to evaluate a series of statements: (1) the need for defining recurrence, (2) the concept of recurrence applied to the Tubiana staging system, (3) the concept of recurrence applied to each single treated joint, and (4) the concept of recurrence applied to the finger ray. For each item, the possible answer was given on a scale of 1-5: 1=maximum disagreement; 2=disagreement; 3=agreement; 4=strong agreement; 5=absolute agreement. There was consensus on disagreement if 1 and 2 comprised at least 66% of the recorded answers and consensus on agreement if 3, 4 and 5 comprised at least 66% of the recorded answers. If a threshold of 66% was not reached, the related statement was considered "not defined". A need for a definition of recurrence was established. The presence of nodules or cords without finger contracture was not considered an indication of recurrence. The Tubiana staging system was considered inappropriate for reporting recurrence. Recurrence was best determined by the measurement of a specific joint, rather than a total ray. Time 0 occurred between 6 weeks and 3 months. Recurrence was defined as a PED of more than 20° for at least one of treated joint, in the presence of a palpable cord, compared to the result obtained at time 0. This study determined the need for a standard definition of recurrence and reached consensus on that definition, which we should become the standard for the reporting of recurrence. If utilized in subsequent publications, this will allow surgeons to compare different techniques and make is easier to help patients make an informed choice.

  19. Recurrence relations for spin foam vertices

    NASA Astrophysics Data System (ADS)

    Bonzom, Valentin; Livine, Etera R.; Speziale, Simone

    2010-06-01

    We study recurrence relations for various Wigner 3nj-symbols and the non-topological 10j-symbol. For the 6j- and the 15j-symbols which correspond to basic amplitudes of 3d and 4d topological spin foam models, recurrence relations are obtained from the invariance under Pachner moves and can be interpreted as quantizations of the constraints of the underlying classical field theories. We also derive recurrences from the action of holonomy operators on spin network functionals, making a more precise link between the topological Pachner moves and the classical constraints. Interestingly, our recurrence relations apply to any SU(2) invariant symbol, depending on the cycles of the corresponding spin network graph. Another method is used for non-topological objects such as the 10j-symbol and pseudo-isosceles 6j-symbols. The recurrence relations are also interpreted in terms of elementary geometric properties. Finally, we discuss the extension of the recurrences to take into account boundary states which leads to equations similar to Ward identities for correlation functions in the Barrett-Crane model.

  20. Aspirin-induced recurrent urticaria and recurrent angioedema in non-atopic children.

    PubMed

    Botey, J; Ibero, M; Malet, A; Marin, A; Eseverri, J L

    1984-09-01

    Recurrent urticaria and recurrent angioedema are frequent adverse reactions in non-atopic patients who do not tolerate aspirin. Of 1,632 infants and children who visited our allergy department for the first time, nine children (0.55%), five males and four females, presented recurrent urticaria or recurrent angioedema after taking aspirin. No evidence of atopy was disclosed either by clinical history (personal and family), skin testing, eosinophil levels or total IgE. Aspirin intolerance was established by oral challenge. Only three of the nine patients reported aspirin intolerance in their histories.

  1. Rapid recurrent sialolithiasis: Altered stone composition and potential factors for recurrence.

    PubMed

    Trujillo, Oscar; Drusin, Madeleine A; Rahmati, Rahmatullah

    2016-10-18

    The objective of this report was to identify potential factors associated with recurrent sialolithiasis after surgical intervention. This is a report of a woman with recurrent submandibular sialolithiasis after surgical intervention. Several characteristics of this patient indicate that she may have been predisposed to recurrent stone formation. Patient and disease factors leading to recurrent salivary stone formation are not well known. Notwithstanding, there may be stone factors and intraoperative findings that aid in determining whether a patient is likely to be successfully treated with a gland-sparing approach. Laryngoscope, 2016.

  2. Preoperative and postoperative cortical function of the kidney with staghorn calculi assessed by /sup 99m/technetium-dimercaptosuccinic acid renal scintigraphy

    SciTech Connect

    Kawamura, J.; Itoh, H.; Okada, Y.; Higashi, Y.; Yoshida, O.; Fujita, T.; Torizuka, K.

    1983-09-01

    /sup 99m/Technetium dimercaptosuccinic acid renal scintigraphy, consisting of the cortical image and dimercaptosuccinic acid renal uptake rate, was used to assess preoperative and postoperative renal function in 55 patients with staghorn calculi. In 14 of 20 patients who had undergone extended pyelolithotomy and in 4 of 22 who had undergone nephrolithotomy there was an increase or no change in the postoperative dimercaptosuccinic acid renal uptake in the surgically treated kidney. However, there was no increase in the postoperative dimercaptosuccinic acid renal uptake in the patients who had undergone pyelolithotomy combined with nephrotomy or partial nephrectomy. Eight per cent of the preoperative dimercaptosuccinic acid renal uptake rate in the diseased kidney seems to be the absolute level for predicting the postoperative recovery of renal function. Dimercaptosuccinic acid renal images provide evidence of morphological changes in the cortex of the kidney with stones and the dimercaptosuccinic acid uptake rate is a useful adjunct for quantitative assessments of preoperative and postoperative residual cortical function.

  3. Age-related delay in urinary stone clearance in elderly patients with solitary proximal ureteral calculi treated by extracorporeal shock wave lithotripsy.

    PubMed

    Ichiyanagi, Osamu; Nagaoka, Akira; Izumi, Takuji; Kawamura, Yuko; Kato, Tomoyuki

    2015-10-01

    We investigated the effects of aging on the stone-free rate (SFR) after shock wave lithotripsy (SWL) for the treatment of proximal ureteral calculi. A total of 247 consecutive patients were retrospectively selected, classified into seven groups set at 10 year increments (from 20 to 90 years), and examined for SFR after SWL. According to our final analysis, 185 male and 62 female patients with an average age of 54.1 years had stones with a diameter of 11.5 mm and a density of 893.1 Hounsfield units. On average, SFR was 74.9 % at 3 months after 1.7 SWL sessions. SFR gradually reached ≥ 90 % for each age-group after 1.5-2 years. Median durations to achieve 50 % SFR were estimated to be 21 and 86 days for those in their 20 and 80 s, respectively. However, the difference between the two estimates was not significant (p = 0.064). The durations to achieve 50 % SFR for the other groups lay between these two estimates. Aging does not affect long-term SFR, but patients aged ≥ 80 years might experience delayed stone clearance within the first 12 months after SWL.

  4. Percutaneous Nephrolithotomy under Ultrasound Guidance in Patients with Renal Calculi and Autosomal Dominant Polycystic Kidney Disease: A Report of 11 Cases

    PubMed Central

    Wang, Xiao; Yang, Xuecheng; Zhong, Xiulong; Wang, Zhenlin; Xue, Senyao; Yu, Weifeng

    2017-01-01

    Nephrolithiasis accelerates the renal failure in the patients with ADPKD. In order to evaluate the role of percutaneous nephrolithotomy in management of calculus in these patients, 11 patients with autosomal dominant polycystic kidney disease and renal stones were included in the study. Two patients had bilateral renal stones. All patients were treated by percutaneous nephrolithotomy under ultrasound guidance. 13 percutaneous nephrolithotomy procedures were performed in 1 stage by the urology team under ultrasound guidance. 5 people received second operation with flexible nephroscopy in lateral position. The success rate and morbidity and mortality of the technique and hospital stay were recorded. Results. The puncture procedure was fully successful in all cases. The renal function improved in these patients. 5 patients had moderate fever after the surgery. 5 patients received flexible nephroscopy to take out the residual calculi. 2 persons had ESWL therapy after the surgery. Conclusion. PCNL is an ideal, safe, and effective method to remove the stones from those patients with no definite increase in the risk of complication. The outcome and stone-free rate are satisfactory comparable to the PCNL in the patients without ADPKD. PMID:28321250

  5. Validation of a protocol to compare the effectiveness of experimental decontaminants with both components of the M258A1 kit against percutaneous application of undiluted vesicant chemical surety material to the laboratory albino rabbit. Final report, 1 March 1985-24 July 1987

    SciTech Connect

    Joiner, R.L.

    1987-07-24

    A rabbit model was developed and validated for screening noninvasive candidate decontamination systems for their efficacies against topical exposure to the vesicant chemical surety material sulfur mustard (HD). Rabbits were dosed with HD on their shaved dorsa and then decontaminated at varying times with either both components of the M258A1 field kit or twice with distilled water. Lesion lengths were estimated and compared contralaterally. Results revealed statistically shorter lesions for M258A1 decontamination relative to the respective lesions decontaminated with distilled water.

  6. Local Recurrence After Hepatic Radiofrequency Coagulation

    PubMed Central

    Mulier, Stefaan; Ni, Yicheng; Jamart, Jacques; Ruers, Theo; Marchal, Guy; Michel, Luc

    2005-01-01

    Objective: The purpose of this study was to analyze the factors that influence local recurrence after radiofrequency coagulation of liver tumors. Summary Background Data: Local recurrence rate varies widely between 2% and 60%. Apart from tumor size as an important risk factor for local recurrence, little is known about the impact of other factors. Methods: An exhaustive literature search was carried out for the period from January 1, 1990 to January 1, 2004. Only series with a minimal follow-up of 6 months and/or mean follow-up of 12 months were included. Univariate and multivariate meta-analyses were carried out. Results: Ninety-five independent series were included, allowing the analysis of the local recurrence rate of 5224 treated liver tumors. In a univariate analysis, tumor-dependent factors with significantly less local recurrences were: smaller size, neuroendocrine metastases, nonsubcapsular location, and location away from large vessels. Physician-dependent favorable factors were: surgical (open or laparoscopic) approach, vascular occlusion, general anesthesia, a 1-cm intentional margin, and a greater physician experience. In a multivariate analysis, significantly less local recurrences were observed for small size (P < 0.001) and a surgical (versus percutaneous) approach (P < 0.001). Conclusions: Radiofrequency coagulation by laparoscopy or laparotomy results in superior local control, independent of tumor size. The percutaneous route should mainly be reserved for patients who cannot tolerate a laparoscopy or laparotomy. The short-term benefits of less invasiveness for the percutaneous route do not outweigh the longer-term higher risk of local recurrence. PMID:16041205

  7. Recurrent Education, Policy and Development in OECD Countries: Recurrent Education in the Federal Republic of Germany.

    ERIC Educational Resources Information Center

    Rudolph, Hedwig; And Others

    This report, part of a series on the state of recurrent education in the Organization for Economic Cooperation and Development (OECD) member countries, focuses on recurrent education in West Germany. The West German thrust for continuing adult education has come from business, industry, and the 1969 Labor Promotion Act which publicly funds…

  8. Laparoscopic repair of recurrent groin hernias.

    PubMed

    Felix, E L; Michas, C; McKnight, R L

    1994-06-01

    Between November 1991 and May 1993, 54 recurrent groin hernias were laparoscopically repaired in 50 patients. Forty-eight were men and two were women. Forty-six recurrent hernias were unilateral and four bilateral. Twenty-five were direct, 19 indirect, 10 pantaloon, and two had a femoral component. In only 10 patients was the contralateral side normal. In 27 patients, the other side had been previously repaired, and in 13 they had a new contralateral hernia. A transabdominal preperitoneal technique was used to dissect and repair the entire floor in all patients. A single sheet of polypropylene mesh was used in the repair of the women patients, and a double-buttress technique with the first sheet slitted for the cord was used for the men. Patients were examined every 3 months for the first year and at 6-month intervals thereafter. Follow-up ranged from 1 to 18 months with a mean of 8 months. No patient was lost to follow-up, and no recurrence was observed. Patients returned to normal activity in an average of 1 week. Seroma, which resolved spontaneously, was the most common complication. The overall short-term results suggested that a laparoscopic mesh buttressed repair of recurrent groin hernias is technically feasible and can eliminate early rerecurrence of the hernia so commonly seen after repair of recurrent hernias.

  9. H pylori recurrence after successful eradication

    PubMed Central

    Niv, Yaron

    2008-01-01

    Recurrence of H pylori after eradication is rare in developed countries and more frequent in developing countries. Recrudescence (recolonization of the same strain within 12 mo after eradication) rather than reinfection (colonization with a new strain, more than 12 mo after eradication) is considered to be responsible for most of the cases. This observation was confirmed only in developed countries, while in developing countries a recent meta-analysis demonstrated a high rate of reinfection. The proportion of H pylori annual recurrence was 2.67% and 13.00% in developed and developing countries, respectively. Nested meta-analysis (only cases with a longer follow-up and a negative 13CUBT a year after eradication) revealed annual recurrence rate of 1.45% [relative risk (RR), 0.54] and 12.00% (RR, 0.92) in developed and developing countries, respectively. These findings support the notion that in developed countries many cases of recurrence are due to recrudescence within the first year after eradication, with a 46% drop in the recurrence rate after the first year post eradication, while in developing countries reinfection is more pronounced, and continue at the same rate since eradication. A different approach for follow-up after H pylori eradication is probably needed in patients of developing countries, since reinfection is highly prevalent. PMID:18330934

  10. Photodynamic therapy of recurrent cerebral glioma

    NASA Astrophysics Data System (ADS)

    Zhu, Shu-Gan; Wu, Si-En; Chen, Zong-Qian; Sun, Wei

    1993-03-01

    Photodynamic therapy (PDT) was performed on 11 cases of recurrent cerebral glioma, including 3 cases of recurrent glioblastoma, 7 of recurrent anaplastic astrocytoma, and 1 recurrent ependymoma. Hematoporphyrin derivative (HPD) was administered intravenously at a dose of 4 - 7 mg/kg 5 - 24 hours before the operation. All patients underwent a craniotomy with a nearly radical excision of the tumor following which the tumor bed was irradiated with 630 nm laser light emitting either an argon pumped dye laser or frequency double YAG pumped dye laser for 30 to 80 minutes with a total dose of 50 J/cm2 (n equals 1), 100 J/cm2 (n equals 2), 200 J/cm2 (n equals 7), and 300 J/cm2 (n equals 1). The temperature was kept below 37 degree(s)C by irrigation. Two patients underwent postoperative radiotherapy. There was no evidence of increased cerebral edema, and no other toxicity by the therapy. All patients were discharged from the hospital within 15 days after surgery. We conclude that PDT using 4 - 7 mg/kg of HPD and 630 nm light with a dose of up to 300 J/cm2 can be used as an adjuvant therapy with no additional complications. Adjuvant PDT in the treatment of recurrent glioma is better than simple surgery.

  11. Atorvastatin May Attenuate Recurrence of Chronic Subdural Hematoma

    PubMed Central

    Liu, Hua; Luo, Zhengxiang; Liu, Zhongkun; Yang, Jian; Kan, Shifeng

    2016-01-01

    Objective: Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a substantial recurrence rate. Atorvastatin may reduce CSDH via its anti-inflammatory and pro-angiogenesis effects, but its effectiveness for preventing recurrent CSDH has never been explored. We hypothesized that atorvastatin is effective in reducing recurrence of CSDH after surgery and identified determining factors predictive of hematoma recurrence. Methods: A prospective study was conducted in 168 surgical cases of CSDH.All patients were randomly assigned to the group treated with atorvastatin or control group. Clinically relevant data were compared between two groups, and subsequently between the recurrence and non-recurrence patients. Multiple logistic regression analysis of the relationship between atorvastatin treatment and the recurrence using brain atrophy, septated and bilateral hematoma was performed. Results: Atorvastatin group conferred an advantage by significantly decreasing the recurrence rate (P = 0.023), and patients managed with atorvastatin also had a longer time-to-recurrence (P = 0.038). Admission brain atrophy and bilateral hematoma differed significantly between the recurrence and non-recurrence patients (P = 0.047 and P = 0.045). The results of logistic regression analysis showed that atorvastatin significantly reduced the probability of recurrence; severe brain atrophy and bilateral hematoma were independent risk factors for recurrent CSDH. Conclusions: Atorvastatin administration may decrease the risks of recurrence.Patients with severe brain atrophy and bilateral CSDH are prone to the recurrence. PMID:27445673

  12. [Unexplained recurrent early miscarriages: Role of immunomodulation?

    PubMed

    Mekinian, A; Cohen, J; Kayem, G; Carbillon, L; Nicaise-Roland, P; Gaugler, B; Darai, E; Bornes, M; Fain, O

    2017-04-01

    About 1-3% of women experience early recurrent miscarriages, defined by ≥3 fetal loss before 14 weeks of gestation. About half of these recurrent early miscarriages could be related to a genetic cause. Pre-implantation genetic diagnosis is used in several European countries, but it is still prohibited in France except for couples at risk for transmission of severe genetic diseases. The immune dysregulation, and in particular allo-immune excessive response, could be responsible for fetal loss in remaining cases, although currently we lack biomarker to confirm the immune-mediated fetal loss. Several immunosuppressive and immunomodulatory treatments have been the subject of small studies in patients with early recurrent miscarriages. The available data do not allow to define the treatment recommendations in this topic, and further studies are necessary.

  13. Prevention of Recurrent Staphylococcal Skin Infections

    PubMed Central

    Creech, C. Buddy; Al-Zubeidi, Duha N.; Fritz, Stephanie A.

    2015-01-01

    Synopsis Staphylococcus aureus infections pose a significant health burden. The emergence of community-associated methicillin-resistant S. aureus has resulted in an epidemic of skin and soft tissue infections (SSTI), and many patients experience recurrent SSTI. As S. aureus colonization is associated with subsequent infection, decolonization is recommended for patients with recurrent SSTI or in settings of ongoing transmission. S. aureus infections often cluster within households and asymptomatic carriers serve as reservoirs for transmission; therefore, a household approach to decolonization is more effective than measures performed by individuals alone. Other factors, such as environmental surface contamination, may also be considered. Novel strategies for the prevention of recurrent SSTI are needed. PMID:26311356

  14. Acute recurrent pancreatitis: An autoimmune disease?

    PubMed Central

    Pezzilli, Raffaele

    2008-01-01

    In this review article, we will briefly describe the main characteristics of autoimmune pancreatitis and then we will concentrate on our aim, namely, evaluating the clinical characteristics of patients having recurrence of pain from the disease. In fact, the open question is to evaluate the possible presence of autoimmune pancreatitis in patients with an undefined etiology of acute pancreatitis and for this reason we carried out a search in the literature in order to explore this issue. In cases of recurrent attacks of pain in patients with “diopathic”pancreatitis, we need to keep in mind the possibility that our patients may have autoimmune pancreatitis. Even though the frequency of this disease seems to be quite low, we believe that in the future, by increasing our knowledge on the subject, we will be able to diagnose an ever-increasing number of patients having acute recurrence of pain from autoimmune pancreatitis. PMID:18286678

  15. Management of Recurrent Aphthous Stomatitis in Children.

    PubMed

    Montgomery-Cranny, Jodie A; Wallace, Ann; Rogers, Helen J; Hughes, Sophie C; Hegarty, Anne M; Zaitoun, Halla

    2015-01-01

    Recurrent oral ulceration is common and may present in childhood. Causes of recurrent oral ulceration are numerous and there may be an association with underlying systemic disease. Recurrent aphthous stomatitis (RAS) is the most common underlying diagnosis in children. The discomfort of oral ulcers can impact negatively on quality of life of a child, interfering with eating, speaking and may result in missed school days. The role of the general dental practitioner is to identify patients who can be treated with simple measures in primary dental care and those who require assessment and treatment in secondary care. Management may include topical agents for symptomatic relief, topical corticosteroids and, in severe recalcitrant cases, systemic agents may be necessary.

  16. Group G Streptococcus bacteremia in recurrent cellulitis.

    PubMed

    di Meo, Nicola; Stinco, Giuseppe; Gubertini, Nicoletta; Patriarca, Maria Martina; Trevisan, Giusto

    2014-01-01

    In recent years, group G Streptococcus has been reported with increasing frequency as the cause of a variety of human infections. Underlying host factors such as immunosuppression, malignancy, diabetes mellitus, and rheumatoid arthritis may be predisposing conditions leading to infection. Toxic involvement and post-streptococcal sequalae, once believed to be exclusive to infections caused by group A Streptococcus, are now known to occur following acute group G Streptococcus and group C Streptococcus infections. We report on a case of group G Streptococcus bacteremia and recurrent cellulitis with toxic involvement. Patient blood cultures were always negative for β-hemolytic Streptococci in all the recurrences, except during the last one. Antibiotic therapy based on antibiogram quickly resolved the infection. A regimen of intramuscular injection of 1.2 million units of benzathine penicillin every 15 days for one year prevented recurrences of cellulitis.

  17. Recurrence quantification analysis of global stock markets

    NASA Astrophysics Data System (ADS)

    Bastos, João A.; Caiado, Jorge

    2011-04-01

    This study investigates the presence of deterministic dependencies in international stock markets using recurrence plots and recurrence quantification analysis (RQA). The results are based on a large set of free float-adjusted market capitalization stock indices, covering a period of 15 years. The statistical tests suggest that the dynamics of stock prices in emerging markets is characterized by higher values of RQA measures when compared to their developed counterparts. The behavior of stock markets during critical financial events, such as the burst of the technology bubble, the Asian currency crisis, and the recent subprime mortgage crisis, is analyzed by performing RQA in sliding windows. It is shown that during these events stock markets exhibit a distinctive behavior that is characterized by temporary decreases in the fraction of recurrence points contained in diagonal and vertical structures.

  18. [Recurrent vulvovaginitis: diagnostic assessment and therapeutic management].

    PubMed

    Ramírez-Santos, A; Pereiro, M; Toribio, J

    2008-04-01

    Recurrent vulvovaginitis is a common problem in clinical practice. Management is often complicated by a long history of inappropriate treatments based on tentative diagnoses after an incomplete diagnostic workup. We review the most common causes of recurrent vulvovaginitis; the appropriate steps with which to establish a diagnosis, from the medical history through to the additional tests needed; and, finally, the best therapeutic options. We will focus on infectious, irritant, allergic, and hormonal causes as the ones of most interest to the dermatologist. Given that infection is the most frequent cause of these processes and also a common reason for inopportune treatment, we will pay particular attention to infectious etiologies and their differential diagnosis.

  19. Animal models of recurrent or bipolar depression.

    PubMed

    Kato, T; Kasahara, T; Kubota-Sakashita, M; Kato, T M; Nakajima, K

    2016-05-03

    Animal models of mental disorders should ideally have construct, face, and predictive validity, but current animal models do not always satisfy these validity criteria. Additionally, animal models of depression rely mainly on stress-induced behavioral changes. These stress-induced models have limited validity, because stress is not a risk factor specific to depression, and the models do not recapitulate the recurrent and spontaneous nature of depressive episodes. Although animal models exhibiting recurrent depressive episodes or bipolar depression have not yet been established, several researchers are trying to generate such animals by modeling clinical risk factors as well as by manipulating a specific neural circuit using emerging techniques.

  20. Recurrent pregnancy loss: evaluation and treatment.

    PubMed

    Shahine, Lora; Lathi, Ruth

    2015-03-01

    Recurrent pregnancy loss (RPL) is a multifactorial condition. Approximately half of patients with RPL will have no explanation for their miscarriages. De novo chromosome abnormalities are common in sporadic and recurrent pregnancy loss. Testing for embryonic abnormalities can provide an explanation for the miscarriage in many cases and prognostic information. Regardless of the cause of RPL, patients should be reassured that the prognosis for live birth with an evidence-based approach is excellent for most patients. The authors review current evidence for the evaluation and treatment of RPL and explore the proposed use of newer technology for patients with RPL.

  1. Evaluation of the patient with recurrent vertigo.

    PubMed

    Kaylie, David; Garrison, Douglas; Tucci, Debara L

    2012-06-01

    The evaluation of the patient with recurrent vertigo requires knowledge of vestibular anatomy and physiology. The patient's medical history and physical examination provide the majority of the information necessary for diagnosis. Many diagnostic tests are available to the clinician to aid in the diagnosis. Videonystagmography is useful for the evaluation of peripheral vestibular function and provides some information about central processes as well. Rotary chair testing provides excellent information about central processes and can aid in diagnosing peripheral vestibular impairment. Vestibular-evoked myogenic potential testing is sensitive for testing inferior vestibular nerve and saccule function. Many different medical and surgical options are available for the patient with recurrent vertigo.

  2. Inferior Vena Cava Filters for Recurrent Thrombosis

    PubMed Central

    Patel, Salil H.; Patel, Rima

    2007-01-01

    Inferior vena cava filters are often used as alternatives to anticoagulant therapy for the prevention of pulmonary embolism. Many of the clinical data that support the use of these devices stem from relatively limited retrospective studies. The dual purpose of this review is to examine the incidence of thrombotic complications associated with inferior vena cava filters and to discuss the role of anticoagulant therapy concurrent with filter placement. Device-associated morbidity and overall efficacy can be considered only in the context of rates of vena cava thrombosis, insertion-site thrombosis, recurrent deep venous thrombosis, and recurrent pulmonary embolism. PMID:17622366

  3. Cancer immunology and colorectal cancer recurrence.

    PubMed

    Vannucci, Luca

    2011-06-01

    The recurrence of a cancer - local or distant (metastasis) - is manifested by the persistence of cancer cells in the organism after the ablation of the primary lesion, an ineffective anticancer immune response, and by the activity of biological/immunological factors that can stimulate and sustain its development. This review focuses on colorectal carcinoma and discusses some aspects of cancer immunology regarding cancer development and its recurrence. It is addressed also to the clinician to provide new insights helpful for designing better therapeutic strategies and patient's follow up. Therapeutic approaches used during and after surgical treatments, found capable of modulating immunity (differently affecting disease outcome), will also be described.

  4. Intrapulmonary arteriovenous malformation causing recurrent strokes

    PubMed Central

    Abed, Kareem; Premachandra, Lalith; Vankawala, Viren; Sun, Qi

    2015-01-01

    This case reveals a left pulmonary arteriovenous malformation (PAVM) as a cause of recurrent cerebral and cerebellar emboli. Extensive workup excluded other etiologies of emboli formation, and the patient was transferred to a tertiary care center for percutaneous embolotherapy. In the absence of a clear etiology, PAVM should be considered as a potential cause of recurrent cerebral emboli, especially in the absence of carotid disease, intracardiac thrombus, atrial septal defect, and patent foramen ovale. Diagnostic work-up for the PAVM can be cost effective and expedited by utilization of agitated saline contrast echocardiography, as noted in our case. PMID:26486114

  5. Recurrent thyrotoxicosis after I-131 induced hypothyroidism

    SciTech Connect

    Liu, L.; Borowski, G.D.; Shtasel, P.; Rose, L.I.

    1984-01-01

    The first clinically and biochemically documented case of recurrent thyrotoxicosis after I-131 induced hypothyroidism in a patient with Graves' disease is reported. Two months after the administration of 9.2 mCi of I-131, the subject developed hypothyroidism. One month later, the patient became euthyroid. Then, nine months following ablation, the patient again developed thyrotoxicosis. A second dose of I-131 of 12.5 mCi was required to finally produce permanent hypothyroidism. This case illustrates the recurrence of hypothyroidism after what had seemed to have been adequate I-131 radiation.

  6. Recurrent endobronchial actinomycosis following an interventional procedure

    PubMed Central

    Padmanabhan, Arjun; Thomas, Abin Varghese

    2017-01-01

    Actinomycosis is an indolent, slowly progressive infection caused by anaerobic or microaerophilic bacteria, primarily from the genus Actinomyces. Thoracic involvement is observed in approximately 15% of cases of infection with actinomycosis. Here, we present a case of a 61-year-old male who presented with recurrent endobronchial actinomycosis. The case is being presented because of its rarity on three counts – endobronchial involvement, which is uncommon, recurrence in different sites in the bronchial tree, which is even rarer and development of the disease following an endobronchial procedure. PMID:28360473

  7. Oblimersen Sodium and Rituximab in Treating Patients With Recurrent B-cell Non-Hodgkin Lymphoma

    ClinicalTrials.gov

    2014-05-13

    Cutaneous B-cell Non-Hodgkin Lymphoma; Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue; Intraocular Lymphoma; Nodal Marginal Zone B-cell Lymphoma; Recurrent Adult Burkitt Lymphoma; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent Adult Diffuse Mixed Cell Lymphoma; Recurrent Adult Diffuse Small Cleaved Cell Lymphoma; Recurrent Adult Grade III Lymphomatoid Granulomatosis; Recurrent Adult Immunoblastic Large Cell Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Grade 3 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Recurrent Small Lymphocytic Lymphoma; Small Intestine Lymphoma; Splenic Marginal Zone Lymphoma; Testicular Lymphoma; Waldenström Macroglobulinemia

  8. Cediranib Maleate and Olaparib in Treating Patients With Recurrent Ovarian, Fallopian Tube, or Peritoneal Cancer or Recurrent Triple-Negative Breast Cancer

    ClinicalTrials.gov

    2017-04-04

    Estrogen Receptor Negative; HER2/Neu Negative; Ovarian Endometrioid Adenocarcinoma; Ovarian Serous Cystadenocarcinoma; Ovarian Serous Surface Papillary Adenocarcinoma; Progesterone Receptor Negative; Recurrent Breast Carcinoma; Recurrent Fallopian Tube Carcinoma; Recurrent Ovarian Carcinoma; Recurrent Primary Peritoneal Carcinoma; Triple-Negative Breast Carcinoma

  9. National Practice Pattern and Time Trends in Treatment of Upper Urinary Tract Calculi in Korea: a Nationwide Population-Based Study

    PubMed Central

    2016-01-01

    Despite high prevalence of upper urinary tract calculi (UUTC), there are few studies regarding patterns of care in Asian populations. We investigated treatment patterns and time trends in patients with newly diagnosed UUTC in Korea using the National Health Insurance database that includes de-identified claims from a random 2% sample of the entire population (> 1 million people). A total of 14,282 patients who received active treatments, including shock wave lithotripsy (SWL), ureteroscopic surgery (URS), percutaneous nephrolithotomy (PNL), and uretero/pyelolithotomy (UPL), for newly diagnosed UUTC between 2003 and 2013 were included. The number of primary and all treated cases of UUTC significantly (43% and 103.3%, respectively) increased over the 10-year period. While patients undergoing SWL, URS, PNL, and UPL as primary treatment increased by 43.7%, 31.9%, 87.5%, and 0%, respectively, the relative proportion undergoing each treatment remained constant over the 10 years (SWL > 90%, URS 4.5% to 7.8%, PNL 0.4% to 1.0%, and UPL < 0.4%, respectively). Multinomial logistic regression analysis showed that age > 40 years (compared to age < 30 years) was significantly associated with URS, PNL, and UPL, rather than SWL, while patients living in urban or suburban/rural areas (compared to metropolitan) were significantly less likely to undergo URS and PNL. In summary, the majority of Korean patients underwent SWL as primary treatment for UUTC, and the predominant use of SWL remained steady over a 10-year period in Korea. Our results will be valuable in examining treatment patterns and time trends in Korean UUTC patients. PMID:27822940

  10. National Practice Pattern and Time Trends in Treatment of Upper Urinary Tract Calculi in Korea: a Nationwide Population-Based Study.

    PubMed

    Park, Jinsung; Suh, Beomseok; Lee, Myung Shin; Woo, Seung Hyo; Shin, Dong Wook

    2016-12-01

    Despite high prevalence of upper urinary tract calculi (UUTC), there are few studies regarding patterns of care in Asian populations. We investigated treatment patterns and time trends in patients with newly diagnosed UUTC in Korea using the National Health Insurance database that includes de-identified claims from a random 2% sample of the entire population (> 1 million people). A total of 14,282 patients who received active treatments, including shock wave lithotripsy (SWL), ureteroscopic surgery (URS), percutaneous nephrolithotomy (PNL), and uretero/pyelolithotomy (UPL), for newly diagnosed UUTC between 2003 and 2013 were included. The number of primary and all treated cases of UUTC significantly (43% and 103.3%, respectively) increased over the 10-year period. While patients undergoing SWL, URS, PNL, and UPL as primary treatment increased by 43.7%, 31.9%, 87.5%, and 0%, respectively, the relative proportion undergoing each treatment remained constant over the 10 years (SWL > 90%, URS 4.5% to 7.8%, PNL 0.4% to 1.0%, and UPL < 0.4%, respectively). Multinomial logistic regression analysis showed that age > 40 years (compared to age < 30 years) was significantly associated with URS, PNL, and UPL, rather than SWL, while patients living in urban or suburban/rural areas (compared to metropolitan) were significantly less likely to undergo URS and PNL. In summary, the majority of Korean patients underwent SWL as primary treatment for UUTC, and the predominant use of SWL remained steady over a 10-year period in Korea. Our results will be valuable in examining treatment patterns and time trends in Korean UUTC patients.

  11. Factors predicting success of emergency extracorporeal shockwave lithotripsy (eESWL) in ureteric calculi--a single centre experience from the United Kingdom (UK).

    PubMed

    Panah, A; Patel, S; Bourdoumis, A; Kachrilas, S; Buchholz, N; Masood, J

    2013-10-01

    Few studies show that "emergency extracorporeal shockwave lithotripsy (eESWL)" reduces the incidence of ureteroscopy in patients with ureteric calculi. We assess success of eESWL and look to study and identify factors which predict successful outcome. We retrospectively studied patients presenting with their first episode of ureteric colic undergoing eESWL (within 72 h of presentation) over a 5-year period. Patient's age, gender, stone size and location, time between presentation and ESWL, number of shock waves and ESWL sessions, and Hounsfield units (HU) were recorded. 97 patients (mean age 40 years; 76 males, 21 females) were included. 71 patients were stone free after eESWL (73.2 %) (group 1) and 26 patients failed treatment and proceeded to ureteroscopy (group 2). The two groups were well matched for age and gender. Mean stone size in group 1 and 2 was 6.4 mm and 7.7 mm, respectively, (p = 0.00141). Stone location was 34, 21, and 16 in upper, middle and lower ureter in group 1 compared to 11, 5, and 10 in group 2, respectively. Mean HU in group 1 was 480 and 612 in group 2 (p value 0.0036). In group 2, significantly, more patients received treatment after 24 h compared with group 1 (38 vs 22.5 %). The number of shock waves, maximal intensity, and ESWL sessions were not significantly different in the two groups. No complications were noted. eESWL is safe and effective in patients with ureteric colic. Stone size and Hounsfield units are important factors in predicting success. Early treatment (≤24 h) minimizes stone impaction and increases the success rate of ESWL.

  12. Use of recurrence plot and recurrence quantification analysis in Taiwan unemployment rate time series

    NASA Astrophysics Data System (ADS)

    Chen, Wei-Shing

    2011-04-01

    The aim of the article is to answer the question if the Taiwan unemployment rate dynamics is generated by a non-linear deterministic dynamic process. This paper applies a recurrence plot and recurrence quantification approach based on the analysis of non-stationary hidden transition patterns of the unemployment rate of Taiwan. The case study uses the time series data of the Taiwan’s unemployment rate during the period from 1978/01 to 2010/06. The results show that recurrence techniques are able to identify various phases in the evolution of unemployment transition in Taiwan.

  13. 14 CFR 135.351 - Recurrent training.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Recurrent training. 135.351 Section 135.351... AND OPERATORS FOR COMPENSATION OR HIRE: CERTIFICATION AND OPERATIONS OPERATING REQUIREMENTS: COMMUTER AND ON DEMAND OPERATIONS AND RULES GOVERNING PERSONS ON BOARD SUCH AIRCRAFT Training §...

  14. 14 CFR 135.351 - Recurrent training.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Recurrent training. 135.351 Section 135.351... AND OPERATORS FOR COMPENSATION OR HIRE: CERTIFICATION AND OPERATIONS OPERATING REQUIREMENTS: COMMUTER AND ON DEMAND OPERATIONS AND RULES GOVERNING PERSONS ON BOARD SUCH AIRCRAFT Training §...

  15. 14 CFR 135.351 - Recurrent training.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Recurrent training. 135.351 Section 135.351... AND OPERATORS FOR COMPENSATION OR HIRE: CERTIFICATION AND OPERATIONS OPERATING REQUIREMENTS: COMMUTER AND ON DEMAND OPERATIONS AND RULES GOVERNING PERSONS ON BOARD SUCH AIRCRAFT Training §...

  16. 14 CFR 135.351 - Recurrent training.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Recurrent training. 135.351 Section 135.351... AND OPERATORS FOR COMPENSATION OR HIRE: CERTIFICATION AND OPERATIONS OPERATING REQUIREMENTS: COMMUTER AND ON DEMAND OPERATIONS AND RULES GOVERNING PERSONS ON BOARD SUCH AIRCRAFT Training §...

  17. Families of Linear Recurrences for Catalan Numbers

    ERIC Educational Resources Information Center

    Gauthier, N.

    2011-01-01

    Four different families of linear recurrences are derived for Catalan numbers. The derivations rest on John Riordan's 1973 generalization of Catalan numbers to a set of polynomials. Elementary differential and integral calculus techniques are used and the results should be of interest to teachers and students of introductory courses in calculus…

  18. Motion detection based on recurrent network dynamics

    PubMed Central

    Joukes, Jeroen; Hartmann, Till S.; Krekelberg, Bart

    2014-01-01

    The detection of visual motion requires temporal delays to compare current with earlier visual input. Models of motion detection assume that these delays reside in separate classes of slow and fast thalamic cells, or slow and fast synaptic transmission. We used a data-driven modeling approach to generate a model that instead uses recurrent network dynamics with a single, fixed temporal integration window to implement the velocity computation. This model successfully reproduced the temporal response dynamics of a population of motion sensitive neurons in macaque middle temporal area (MT) and its constituent parts matched many of the properties found in the motion processing pathway (e.g., Gabor-like receptive fields (RFs), simple and complex cells, spatially asymmetric excitation and inhibition). Reverse correlation analysis revealed that a simplified network based on first and second order space-time correlations of the recurrent model behaved much like a feedforward motion energy (ME) model. The feedforward model, however, failed to capture the full speed tuning and direction selectivity properties based on higher than second order space-time correlations typically found in MT. These findings support the idea that recurrent network connectivity can create temporal delays to compute velocity. Moreover, the model explains why the motion detection system often behaves like a feedforward ME network, even though the anatomical evidence strongly suggests that this network should be dominated by recurrent feedback. PMID:25565992

  19. Recurrent spinal adhesive arachnoiditis. A case report.

    PubMed

    de Mattos, J P; André, C; Couto, B A

    1988-03-01

    Spinal adhesive arachnoiditis is not an uncommon disease, usually having a monophasic course. We studied an atypical patient with recurrent spinal adhesive arachnoiditis nine years after intrathecal anesthesia and the first attack of the disease. Also noteworthy was the favorable evolution after surgery.

  20. Recurrent pendunculated osteochondroma of the tibia.

    PubMed

    Lawrance, Scott E

    2015-01-01

    Osteochondromas have been widely reported in the literature. Surgical management can be a successful primary treatment option, but tumors can occur again in the presence of open epiphyseal growth plates. This case reports a recurrent pedunculated osteochondroma in a 15-year-old female.

  1. [Therapeutic education for recurrent depressive disorder].

    PubMed

    Carde, Soufiane; Hatif, Séverine; Samama, Diane; Charbonnel, Patricia; Jouvent, Roland

    2016-01-01

    Depression is a serious and recurrent condition which can become chronic. As a complement to other therapeutic approaches, therapeutic patient education (TPE) or psychoeducation is effective. TPE groups led by a multidisciplinary hospitalisation team in a psychiatric department are thereby integrated into the global care in order to reduce relapses and improve patients' quality of life.

  2. Hepatic angiosarcoma manifested as recurrent hemoperitoneum.

    PubMed

    Lee, Seung-Woo; Song, Chun-Young; Gi, Young-Hwa; Kang, Sang-Beom; Kim, Yon-Soo; Nam, Soon-Woo; Lee, Dong-Soo; Kim, Jong-Ok

    2008-05-14

    Angiosarcoma is a rare tumor that account for less than 1% of all sarcomas. Although hepatic angiosarcoma usually presents with unspecific symptoms, it rapidly progresses and has a high mortality. We report a rare case of primary hepatic angiosarcoma manifested as recurrent hemoperitoneum.

  3. Lymphoedema - distichiasis syndrome with recurrent abortions.

    PubMed

    Sardesai, Vidyadhar R; Mhatre, Madhulika A; Patil, Rohan M

    2012-01-01

    Lymphoedema-distichiasis syndrome, a type of familial lymphoedema praecox, is a rare, primary lymphoedema of pubertal onset associated with distichiasis and other associations including congenital heart disease, ptosis, varicose veins, cleft palate, and spinal extradural cysts. We report a case of familial lymphoedema with associated distichiasis, atrial septal defect, varicose veins, and recurrent abortions in a 29-year-old female.

  4. 14 CFR 121.427 - Recurrent training.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR CARRIERS... hours unless reduced under § 121.405: (1) For pilots and flight engineers— (i) Group I, reciprocating... recurrent flight training as permitted in § 121.433(c). (2) For flight engineers, flight training...

  5. 14 CFR 121.427 - Recurrent training.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR CARRIERS... hours unless reduced under § 121.405: (1) For pilots and flight engineers— (i) Group I, reciprocating... recurrent flight training as permitted in § 121.433(c). (2) For flight engineers, flight training...

  6. 14 CFR 121.427 - Recurrent training.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR CARRIERS... hours unless reduced under § 121.405: (1) For pilots and flight engineers— (i) Group I, reciprocating... recurrent flight training as permitted in § 121.433(c). (2) For flight engineers, flight training...

  7. The Recurrent Case for the Renshaw Cell

    PubMed Central

    Bhumbra, Gardave S.; Bannatyne, B. Anne; Watanabe, Masahiko; Todd, Andrew J.

    2014-01-01

    Although Renshaw cells (RCs) were discovered over half a century ago, their precise role in recurrent inhibition and ability to modulate motoneuron excitability have yet to be established. Indirect measurements of recurrent inhibition have suggested only a weak modulatory effect but are limited by the lack of observed motoneuron responses to inputs from single RCs. Here we present dual recordings between connected RC–motoneuron pairs, performed on mouse spinal cord. Motoneuron responses demonstrated that Renshaw synapses elicit large inhibitory conductances and show short-term potentiation. Anatomical reconstruction, combined with a novel method of quantal analysis, showed that the strong inhibitory input from RCs results from the large number of synaptic contacts that they make onto individual motoneurons. We used the NEURON simulation environment to construct realistic electrotonic models, which showed that inhibitory conductances from Renshaw inputs exert considerable shunting effects in motoneurons and reduce the frequency of spikes generated by excitatory inputs. This was confirmed experimentally by showing that excitation of a single RC or selective activation of the recurrent inhibitory pathway to generate equivalent inhibitory conductances both suppress motoneuron firing. We conclude that recurrent inhibition is remarkably effective, in that a single action potential from one RC is sufficient to silence a motoneuron. Although our results may differ from previous indirect observations, they underline a need for a reevaluation of the role that RCs perform in one of the first neuronal circuits to be discovered. PMID:25232126

  8. Steroid-induced recurrent myocardial ischemia.

    PubMed

    Yildirim, Ufuk; Gulel, Okan; Soylu, Korhan; Yuksel, Serkan; Sahin, Mahmut

    2014-01-01

    We report the case of a female patient under oral prednisolone therapy due to a diagnosis of idiopathic intracranial hypertension with papilledema. Unfortunately, short-term treatment with prednisolone caused an unusual complication in the patient, i.e., recurrent myocardial ischemia. Possible mechanisms leading to this complication were evaluated in the light of current knowledge.

  9. Multiple nodal locoregional recurrence of pheochromocytoma

    PubMed Central

    Ramírez-Plaza, César Pablo; Cárdenas, Elena Margarita Sanchiz; Humanes, Rocío Soler

    2015-01-01

    Introduction Malignancy is present in 10% of pheochromocytomas (PCC) and is defined as local/vascular infiltration of surrounding tissues or the presence of chromaffin cells deposits in distant organs. The presence of isolated nodal recurrence is very rare and only 7 cases have been reported in the medical literature. Presentation of the case The case of a 32-y male with a symptomatic recurrence of a previously operated (2-years ago) PCC is presented. Radiological and functional imaging studies confirmed the presence of multiple nodules in the surgical site. A radical left nephrectomy with extensive lymphatic clearance in order to get an R0 resection was performed. The pathologist confirmed the diagnosis of massive locoregional nodal invasion. Discussion A detailed histological report and a thorough genetic study must be considered in every operated PCC in order to identify mutations and profiles of risk for malignancy. When recurrence or metastastic disease is suspected, imaging and functional exams are done in order to obtain a proper staging. Radical surgery for the metastatic disease is the only treatment that may provide prolonged survival. If an R0 resection is not possible, then a debulking surgery is a good option when the benefit/risk ratio is acceptable. Conclusion Isolated lymph nodal recurrence is very rare in malignant PCC, with only 7 cases previously published. The role of surgery is essential to get long-term survival because provides clinical and functional control of the disease. PMID:26117450

  10. Complement related kidney diseases: Recurrence after transplantation.

    PubMed

    Salvadori, Maurizio; Bertoni, Elisabetta

    2016-12-24

    The recurrence of renal disease after renal transplantation is becoming one of the main causes of graft loss after kidney transplantation. This principally concerns some of the original diseases as the atypical hemolytic uremic syndrome (HUS), the membranoproliferative glomerulonephritis (MPGN), in particular the MPGN now called C3 glomerulopathy. Both this groups of renal diseases are characterized by congenital (genetic) or acquired (auto-antibodies) modifications of the alternative pathway of complement. These abnormalities often remain after transplantation because they are constitutional and poorly influenced by the immunosuppression. This fact justifies the high recurrence rate of these diseases. Early diagnosis of recurrence is essential for an optimal therapeutically approach, whenever possible. Patients affected by end stage renal disease due to C3 glomerulopathies or to atypical HUS, may be transplanted with extreme caution. Living donor donation from relatives is not recommended because members of the same family may be affected by the same gene mutation. Different therapeutically approaches have been attempted either for recurrence prevention and treatment. The most promising approach is represented by complement inhibitors. Eculizumab, a monoclonal antibody against C5 convertase is the most promising drug, even if to date is not known how long the therapy should be continued and which are the best dosing. These facts face the high costs of the treatment. Eculizumab resistant patients have been described. They could benefit by a C3 convertase inhibitor, but this class of drugs is by now the object of randomized controlled trials.

  11. Treatment effect of TUSPLV on recurrent varicocele

    PubMed Central

    Yan, Tian-Zhong; Wu, Xiao-Qiang; Wang, Zhi-Wei

    2017-01-01

    The aim of the study was to analyze the treatment effect of transumbilical single-port laparoscopic varicocelectomy (TUSPLV) on recurrent varicocele (VC). In order to compare the surgical effects of TUSPLV to traditional retroperitoneal ligation of the internal spermatic vein, 64 patients with recurrent VC were enrolled and divided into the control group (n=30) and the observation group (n=34). Patients in the control group underwent surgery using traditional retroperitoneal ligation of the internal spermatic vein, while those in the observation group underwent surgery using TUSPLV. The results showed that the time of operation and bleeding volume in the observation group were significantly lower. The occurrence and recurrence rates of periprocedural complications were considerably lower in the observation group. Differences were statistically significant (P<0.05). In terms of the pregnancy rate, the difference between the 2 groups had no statistical significance (P>0.05). We concluded that employing TUSPLV to treat recurrent VC was safe and effective. PMID:28123466

  12. Recurrent Cellulitis: How Can I Prevent It?

    MedlinePlus

    ... M.D. To help prevent recurrent episodes of cellulitis — a bacterial infection in the deepest layer of skin — keep skin ... www.merckmanuals.com/professional/dermatologic_disorders/bacterial_skin_infections/cellulitis.html?qt=cellulitis&alt=sh. Accessed Dec. 20, ...

  13. The recurrence sequence via the Fibonacci groups

    NASA Astrophysics Data System (ADS)

    Aküzüm, Yeşim; Deveci, Ömür

    2016-04-01

    This work develops properties of the recurrence sequence defined by the aid of the relation matrix of the Fibonacci groups. The study of this sequence modulo m yields cyclic groups and semigroups from generating matrix. Finally, we extend the sequence defined to groups and then, we obtain its period in the Fibonacci groups.

  14. Recurrent pancreatitis in ornithine transcarbamylase deficiency.

    PubMed

    Prada, Carlos E; Kaul, Ajay; Hopkin, Robert J; Page, Kimberley I; Nathan, Jaimie D; Bartholomew, Dennis W; Cohen, Mitchell B; Heubi, James E; Leslie, Nancy D; Burrow, T Andrew

    2012-08-01

    Ornithine transcarbamylase (OTC) deficiency is a urea cycle defect with varying frequency and severity of episodes of hyperammonemia. We report three patients with OTC deficiency with recurrent pancreatitis. The pathogenesis of acute pancreatitis in this patient population requires further elucidation. Pancreatitis significantly affected dietary/metabolic management and increased frequency of hospitalizations.

  15. Complement related kidney diseases: Recurrence after transplantation

    PubMed Central

    Salvadori, Maurizio; Bertoni, Elisabetta

    2016-01-01

    The recurrence of renal disease after renal transplantation is becoming one of the main causes of graft loss after kidney transplantation. This principally concerns some of the original diseases as the atypical hemolytic uremic syndrome (HUS), the membranoproliferative glomerulonephritis (MPGN), in particular the MPGN now called C3 glomerulopathy. Both this groups of renal diseases are characterized by congenital (genetic) or acquired (auto-antibodies) modifications of the alternative pathway of complement. These abnormalities often remain after transplantation because they are constitutional and poorly influenced by the immunosuppression. This fact justifies the high recurrence rate of these diseases. Early diagnosis of recurrence is essential for an optimal therapeutically approach, whenever possible. Patients affected by end stage renal disease due to C3 glomerulopathies or to atypical HUS, may be transplanted with extreme caution. Living donor donation from relatives is not recommended because members of the same family may be affected by the same gene mutation. Different therapeutically approaches have been attempted either for recurrence prevention and treatment. The most promising approach is represented by complement inhibitors. Eculizumab, a monoclonal antibody against C5 convertase is the most promising drug, even if to date is not known how long the therapy should be continued and which are the best dosing. These facts face the high costs of the treatment. Eculizumab resistant patients have been described. They could benefit by a C3 convertase inhibitor, but this class of drugs is by now the object of randomized controlled trials. PMID:28058212

  16. Exploring the Nature of Cortical Recurrent Interactions

    NASA Astrophysics Data System (ADS)

    Morita, Kenji; Kalra, Rita; Aihara, Kazuyuki; Robinson, Hugh P. C.

    2011-09-01

    Fast rhythmic activity of neural population has been frequently observed in cortical circuits, and suggested to be associated with various cognitive functions including working memory and selective attention. However, precisely how recurrent synaptic interactions, that are prominent in these circuits, shape and/or modulate such population rhythm has not been fully elucidated. We have addressed this issue by combining electrophysiological and computational approaches.

  17. Recurrent Pediatric Headaches: Behavioral Concepts and Interventions

    ERIC Educational Resources Information Center

    Allen, Keith D.

    2006-01-01

    Recurrent pediatric headaches are increasingly understood to be a function of both respondent and operant processes. In particular, the environment is thought to elicit internal autonomic instability and to evoke external maladaptive pain behavior. While medical interventions often provide an appropriate first line treatment, behavioral…

  18. Psychosocial Treatment for Recurrent Genital Herpes.

    ERIC Educational Resources Information Center

    Longo, David J.; And Others

    1988-01-01

    Assigned 21 individuals with recurrent genital herpes to psychosocial intervention, social support, or waiting-list control conditions. Those receiving psychosocial intervention (herpes simplex virus information, relaxation training, stress management instructions, and an imagery technique) reported significantly greater reductions in herpes…

  19. Tanespimycin in Treating Young Patients With Recurrent or Refractory Leukemia or Solid Tumors

    ClinicalTrials.gov

    2013-06-03

    Childhood Chronic Myelogenous Leukemia; Childhood Desmoplastic Small Round Cell Tumor; Disseminated Neuroblastoma; Metastatic Childhood Soft Tissue Sarcoma; Metastatic Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Metastatic Osteosarcoma; Previously Treated Childhood Rhabdomyosarcoma; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Recurrent Neuroblastoma; Recurrent Osteosarcoma

  20. Risk factors for early recurrence after inguinal hernia repair

    PubMed Central

    2009-01-01

    Background Family history, male gender and age are significant risk factors for inguinal hernia disease. Family history provides evidence for a genetic trait and could explain early recurrence after inguinal hernia repair despite technical advance at least in a subgroup of patients. This study evaluates if age and family history can be identified as risk factors for early recurrence after primary hernia repair. Methods We performed an observational cohort study for 75 patients having at least two recurrent hernias. The impact of age, gender and family history on the onset of primary hernias, age at first recurrence and recurrence rates was investigated. Results 44% (33/75) of recurrent hernia patients had a family history and primary as well as recurrent hernias occurred significantly earlier in this group (p = 0.04). The older the patients were at onset the earlier they got a recurrent hernia. Smoking could be identified as on additional risk factor for early onset of hernia disease but not for hernia recurrence. Conclusion Our data reveal an increased incidence of family history for recurrent hernia patients when compared with primary hernia patients. Patients with a family history have their primary hernias as well as their recurrence at younger age then patients without a family history. Though recurrent hernia has to be regarded as a disease caused by multiple factors, a family history may be considered as a criterion to identify the risk for recurrence before the primary operation. PMID:20003183

  1. Erlotinib in Treating Patients With Recurrent Malignant Glioma or Recurrent or Progressive Meningioma

    ClinicalTrials.gov

    2014-07-09

    Adult Anaplastic Astrocytoma; Adult Anaplastic Oligodendroglioma; Adult Giant Cell Glioblastoma; Adult Glioblastoma; Adult Gliosarcoma; Adult Grade I Meningioma; Adult Grade II Meningioma; Adult Grade III Meningioma; Adult Mixed Glioma; Recurrent Adult Brain Tumor

  2. Nonparametric inference for the joint distribution of recurrent marked variables and recurrent survival time.

    PubMed

    Yee, Laura M; Chan, Kwun Chuen Gary

    2017-04-01

    Time between recurrent medical events may be correlated with the cost incurred at each event. As a result, it may be of interest to describe the relationship between recurrent events and recurrent medical costs by estimating a joint distribution. In this paper, we propose a nonparametric estimator for the joint distribution of recurrent events and recurrent medical costs in right-censored data. We also derive the asymptotic variance of our estimator, a test for equality of recurrent marker distributions, and present simulation studies to demonstrate the performance of our point and variance estimators. Our estimator is shown to perform well for a wide range of levels of correlation, demonstrating that our estimators can be employed in a variety of situations when the correlation structure may be unknown in advance. We apply our methods to hospitalization events and their corresponding costs in the second Multicenter Automatic Defibrillator Implantation Trial (MADIT-II), which was a randomized clinical trial studying the effect of implantable cardioverter-defibrillators in preventing ventricular arrhythmia.

  3. Daily Aspirin May Help Prevent Some Recurrent Miscarriages

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_163515.html Daily Aspirin May Help Prevent Some Recurrent Miscarriages Approach seemed ... as simple as taking a daily low-dose aspirin could help prevent a recurrence. The intervention appears ...

  4. Etiology and management of recurrent parotid pleomorphic adenoma.

    PubMed

    Witt, Robert L; Eisele, David W; Morton, Randall P; Nicolai, Piero; Poorten, Vincent Vander; Zbären, Peter

    2015-04-01

    The objective of this review study was to encompass the relevant literature and current best practice options for this challenging, sometimes incurable problem. The source of the data was Ovid MEDLINE from 1946 to 2014. Review methods consisted of articles with clinical correlates. The most important cause of recurrence is enucleation with rupture and incomplete tumor excision at operation. Incomplete pseudocapsule, extracapsular extension, pseudopods of pleomorphic adenoma tissue, and satellite pleomorphic beyond the pseudocapsule are also likely linked to recurrent pleomorphic adenoma. Most recurrent pleomorphic adenoma are multinodular. Magnetic resonance imaging is the imaging study of choice for recurrent pleomorphic adenoma. Nerve integrity monitoring may reduce morbidity for recurrent pleomorphic adenoma. Treatment of recurrent pleomorphic adenoma must be individualized. Total parotidectomy, given the multicentricity of recurrent pleomorphic adenoma, is appropriate in many patients, but may be inadequate to control recurrent pleomorphic. There is accumulating evidence from retrospective series that postoperative radiation therapy results in significantly better local control.

  5. Metformin Hydrochloride, Carboplatin, and Paclitaxel in Treating Patients With Recurrent Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

    ClinicalTrials.gov

    2017-01-24

    Ovarian Papillary Serous Carcinoma; Ovarian Serous Cystadenocarcinoma; Recurrent Fallopian Tube Cancer; Recurrent Ovarian Epithelial Cancer; Recurrent Ovarian Germ Cell Tumor; Recurrent Primary Peritoneal Cavity Cancer

  6. Palliative Care in Improving Quality of Life in Patients With High Risk Primary or Recurrent Gynecologic Malignancies

    ClinicalTrials.gov

    2015-10-15

    Cervical Carcinoma; Ovarian Carcinoma; Primary Peritoneal Carcinoma; Recurrent Cervical Carcinoma; Recurrent Ovarian Carcinoma; Recurrent Uterine Corpus Carcinoma; Recurrent Vulvar Carcinoma; Uterine Corpus Cancer; Vulvar Carcinoma; Peritoneal Neoplasms

  7. Thalidomide in Treating Patients With Recurrent or Persistent Endometrial Cancer

    ClinicalTrials.gov

    2013-01-23

    Endometrial Adenoacanthoma; Endometrial Adenocarcinoma; Endometrial Adenosquamous Cell Carcinoma; Endometrial Clear Cell Carcinoma; Endometrial Papillary Serous Carcinoma; Recurrent Endometrial Carcinoma

  8. Copanlisib in Treating Patients With Persistent or Recurrent Endometrial Cancer

    ClinicalTrials.gov

    2017-01-20

    Endometrial Endometrioid Adenocarcinoma; Endometrial Mixed Adenocarcinoma; Endometrial Serous Adenocarcinoma; Endometrial Undifferentiated Carcinoma; Metastatic Endometrioid Adenocarcinoma; Recurrent Uterine Corpus Carcinoma

  9. Laparoscopic management of recurrent pheochromocytoma: A case report

    PubMed Central

    Garg, Harshit; Uppal, Manpreet; Sreedharan, Sreesanth Kelu; Aggarwal, Sandeep

    2016-01-01

    Recurrence of pheochromocytoma after a total adrenalectomy is uncommon. Such recurrent tumours are mostly managed by the open technique, with very few studies reporting laparoscopic management. We hereby report a case of successful laparoscopic management of a recurrent pheochromocytoma after total adrenalectomy for left adrenal pheochromocytoma. PMID:27279402

  10. Recurrent breast cancer in the subpectoral space after implant reconstruction.

    PubMed

    Pitcher, Austin A; Chao, Jerry W; Varma, Sonal; Swistel, Alexander J; Otterburn, David M

    2014-04-01

    Breast reconstruction after mastectomy is most commonly performed with a prosthetic implant placed beneath the pectoralis major. Recurrence may rarely be identified in the subpectoral space where the implant was placed. We report a case of recurrent breast cancer after implant-based reconstruction with isolated subpectoral recurrence discovered 5 years later during secondary revision of her reconstructed breast.

  11. Recurrent plunging ranula of the neck.

    PubMed

    Al Ruhaimi, Khalid A

    2013-03-01

    The reported case describes a mismanaged extensive recurrent plunging ranula that occupied a large portion of the neck. The ranula is usually clinically diagnosed. However, absence of visible intra-oral signs may mislead the diagnosis and leads to improper surgical management. Presence of amylase in the aspirated fluids is an important aid in the differential diagnosis. Thereby confirming the salivary origin of the fluids and thus avoiding extensive investigations. The recurrence rate varies according to the procedure performed. Diverse methods of treating ranula have been reported in the literature with variable results. These include marsuplization, excision of the ranula, incision of the ranula and drainage of the contents, excision of the sublingual gland and drainage. The successful procedure to treat plunging ranula depends on complete excision of the affected sublingual gland and drainage of its contents. In this paper, the useful diagnostic investigations and the recommended surgical intervention procedure were described.

  12. Juvenile-onset recurrent respiratory papillomatosis.

    PubMed

    Maturo, Stephen C; Hartnick, Christopher J

    2012-01-01

    Juvenile-onset recurrent respiratory papillomatosis, caused by the human papilloma virus, is the most common benign neoplasm of the larynx in children. Recurrent respiratory papillomatosis is relatively rare, but it can have a significant impact on afflicted children and their family's quality of life as dysphonia and multiple surgical procedures are hallmarks of this disease. The current standard of care is surgical therapy with a goal of complete papilloma removal and preservation of normal structures. The technique in this atlas combines both the microdebrider and the pulse KTP laser. The microdebrider allows for rapid removal of bulky lesions without the risk of thermal injury, yet it cannot provide precise removal in areas such as the anterior commissure and ventricle. The pulse KTP laser allows for removal of sessile lesions and in sensitive areas such as the vocal folds. The authors describe this technique as well as discuss adjuvant therapies and pearls for success.

  13. [Recurrent inflammatory optic neuritis and neuromyelitis optica].

    PubMed

    de Sèze, J; Arndt, C

    2010-12-01

    Inflammatory optic neuritis (ON) represents a frequent clinical situation in neurology and ophthalmology. When MRI and CSF analysis are normal, ON is considered idiopathic with a suspected viral etiology. However, in several cases either a recurrence or a myelitis may occur. In the first case, it is relapsing inflammatory optic neuritis (RION) and in the second case it is neuromyelitis optica (NMO). Nevertheless, predictive criteria of a recurrence or an extension of the disease to spinal cord remains unknown, excepted for anti-NMO IgG antibodies which are probably highly specific for a future evolution to NMO. In the present paper, the authors successively present the two clinical situations (RION and NMO) and attempt to summarize diagnostic and prognostic criteria.

  14. [How to cope with recurrent aphthous stomatitis].

    PubMed

    Madrid, C; Jaques, B; Bouferrrache, K; Broome, M

    2010-10-06

    Recurrent aphthous stomatitis (RAS) is the most common oral mucosa ailment. This condition is frequently considered as idiopathic due to the doubts about its etiology, probably related to a minor immunological dysregulation in a context of genetic predisposition. However, ulcers that resemble recurrent aphthous stomatitis in some respects can be found in systemic disorders that must be ruled out for the differential diagnosis of SAR, particularly when they appear after adolescence and/or when associated lesions exist out of the oral cavity. SAR management lies on the elimination of predisposing factors (drugs, oral trauma, food allergies...) and if needed, topical corticosteroids are the first choice regimen. More severe cases may require systemic regimens.

  15. Preventing recurrence of severe morning sickness

    PubMed Central

    Koren, Gideon; Maltepe, Caroline

    2006-01-01

    QUESTION A recent Motherisk article showed that initiating antinauseants even before symptoms start could prevent recurrence of severe morning sickness. In the study described, however, different physicians used different drugs. How can one be sure which drugs work? ANSWER The study of 26 women who had had severe morning sickness during previous pregnancies showed that using antiemetics before symptoms of morning sickness started appeared to prevent recurrence of severe morning sickness in subsequent pregnancies. Physicians in the United States used various antinauseant drugs. Physicians in Canada administered only one drug, the combination of doxylamine-pyridoxine (Diclectin®), to 12 women. Subanalysis of these 12 women revealed that pre-emptive use of doxylamine-pyridoxine significantly decreased the likelihood that severe morning sickness would recur. PMID:17279232

  16. Recurrent Oligodendroglioma Treated with Acupuncture and Pharmacopuncture.

    PubMed

    Kim, Jae Soo; Lee, Hyun Jong; Lee, Sang Hoon; Lee, Bong Hyo

    2015-06-01

    Acupuncture and pharmacopuncture have been shown to be effective in tumor treatment. However, their effectiveness for treating oligodendroglioma has not been reported yet. The purpose of this study was to provide an initial report on the effectiveness of acupuncture and pharmacopuncture for the treatment of an oligodendroglioma by presenting a case that was treated successfully. A 54-year-old man, who had experienced intracranial hemorrhage, was diagnosed with recurrent oligodendroglioma. His expected survival period was 3-6 months. The patient received daily acupuncture and weekly pharmacopuncture of mountain ginseng and bee venom. After treatment for 18 months, the tumor size was decreased markedly on brain magnetic resonance imaging, and severe seizures had disappeared. In this case, a combination of acupuncture and pharmacopuncture was shown to be effective for the treatment of recurrent oligodendroglioma.

  17. Human papillomavirus types and recurrent cervical warts

    SciTech Connect

    Nuovo, G.J. ); Pedemonte, B.M. )

    1990-03-02

    The authors analyzed cervical intraepithelial neoplasias (CINs) detected after cryotherapy to determine if recurrence is associated with the same human papillomavirus (HPV) type found in the original lesion. Eight women had detectable HPV DNA in CINs that occurred after ablation of another CIN, and for each patient the HPV type in the pretreatment lesion was different from that in the CIN that appeared after cryotherapy. This compares with 12 women who had HPV detected in two or more CINs present at the same time, 11 of whom had the same HPv type noted. they concluded that although multiple, simultaneous CINs in a woman often contain the same HPV type, recurrent CINs that occur after cryotherapy contain an HPV type different from that present in the pretreatment lesion.

  18. Equine recurrent uveitis: Human and equine perspectives.

    PubMed

    Malalana, Fernando; Stylianides, Amira; McGowan, Catherine

    2015-10-01

    Equine recurrent uveitis (ERU) is a spontaneous disease characterised by repeated episodes of intraocular inflammation. The epidemiology of ERU has not been fully elucidated, but the condition appears to be much more common in horses than is recurrent uveitis in humans, especially in certain breeds and geographical regions. Both humans and horses show a similarly altered immune response and a marked autoimmune response as the primary disease pathophysiology. However, an inciting cause is not always clear. Potential inciting factors in horses include microbial agents such as Leptospira spp. Microbial factors and genetic predisposition to the disease may provide clues as to why the horse appears so susceptible to this disease. The aim of this review is to discuss the immunology and genetics of ERU, compare the disease in horses with autoimmune anterior uveitis in humans, and discuss potential reasons for the increased prevalence in the horse.

  19. Microchimerism in women with recurrent miscarriage

    PubMed Central

    Gammill, Hilary S; Stephenson, Mary D; Aydelotte, Tessa M; Nelson, J Lee

    2014-01-01

    Miscarriage is the most common pregnancy complication, and recurrent miscarriage (3 or more consecutive pregnancy losses) affects 1–5% of couples. Maternal-fetal exchange and the persistence of exchanged material as microchimerism appears to be disrupted in complicated pregnancies. We recently conducted a longitudinal cohort study of microchimerism in women with recurrent miscarriage. Our initial data raise multiple questions that require further investigation. Here, we review our data from this recent study and provide additional information regarding microchimerism in the granulocyte cell layer. This area of investigation offers a unique window into early reproductive events, and future related studies have the potential to identify novel therapeutic approaches and insights into human evolution. PMID:25779348

  20. Once bitten, twice incised: recurrent gallstone ileus.

    PubMed

    Webb, Leland H; Ott, Mickey M; Gunter, Oliver L

    2010-12-01

    Uncommon causes of small bowel obstruction can provide interesting surgical decision-making challenges. This report describes a patient with recurrent gallstone ileus. According to most current reviews, erring on the side of enterolithotomy alone as the treatment of choice for gallstone ileus appears to be the most appropriate decision. Although a rare scenario, the situation of recurrent gallstone ileus presents an interesting learning opportunity. It is important to keep in mind the need for complete examination of the abdomen. Furthermore, evacuation of any remaining stones from the gallbladder is imperative if possible. Erring on the side of enterolithotomy alone as the treatment of choice for gallstone ileus has been shown to be a safe and effective treatment decision over a single-stage removal of the stone with closure of the cholecystoduodenostomy.

  1. Memory replay in balanced recurrent networks.

    PubMed

    Chenkov, Nikolay; Sprekeler, Henning; Kempter, Richard

    2017-01-01

    Complex patterns of neural activity appear during up-states in the neocortex and sharp waves in the hippocampus, including sequences that resemble those during prior behavioral experience. The mechanisms underlying this replay are not well understood. How can small synaptic footprints engraved by experience control large-scale network activity during memory retrieval and consolidation? We hypothesize that sparse and weak synaptic connectivity between Hebbian assemblies are boosted by pre-existing recurrent connectivity within them. To investigate this idea, we connect sequences of assemblies in randomly connected spiking neuronal networks with a balance of excitation and inhibition. Simulations and analytical calculations show that recurrent connections within assemblies allow for a fast amplification of signals that indeed reduces the required number of inter-assembly connections. Replay can be evoked by small sensory-like cues or emerge spontaneously by activity fluctuations. Global-potentially neuromodulatory-alterations of neuronal excitability can switch between network states that favor retrieval and consolidation.

  2. SBRT for recurrent head and neck cancer

    NASA Astrophysics Data System (ADS)

    Garg, M.; Kabarriti, R.; Baliga, S.; Guha, C.; Tome, W.; Kalnicki, S.

    2017-01-01

    The management of patients with recurrent head and neck cancers is complex. Concerns over toxicity with re-irradiation have limited its use in the clinical setting. Stereotactic Body Radiation Therapy (SBRT) has emerged as a highly conformal and precise type of radiotherapy and has the advantage of sparing normal tissue. Although SBRT is an attractive treatment modality, its use in the clinic is limited, given the technically challenging nature of the procedure. In this review, we attempt to provide a comprehensive overview of the role of re-irradiation in patients with recurrent head and neck cancers, with particular attention to the advent of SBRT and its use with systemic therapies such as cetuximab.

  3. Recurrence Analysis of Eddy Covariance Fluxes

    NASA Astrophysics Data System (ADS)

    Lange, Holger; Flach, Milan; Foken, Thomas; Hauhs, Michael

    2015-04-01

    The eddy covariance (EC) method is one key method to quantify fluxes in biogeochemical cycles in general, and carbon and energy transport across the vegetation-atmosphere boundary layer in particular. EC data from the worldwide net of flux towers (Fluxnet) have also been used to validate biogeochemical models. The high resolution data are usually obtained at 20 Hz sampling rate but are affected by missing values and other restrictions. In this contribution, we investigate the nonlinear dynamics of EC fluxes using Recurrence Analysis (RA). High resolution data from the site DE-Bay (Waldstein-Weidenbrunnen) and fluxes calculated at half-hourly resolution from eight locations (part of the La Thuile dataset) provide a set of very long time series to analyze. After careful quality assessment and Fluxnet standard gapfilling pretreatment, we calculate properties and indicators of the recurrent structure based both on Recurrence Plots as well as Recurrence Networks. Time series of RA measures obtained from windows moving along the time axis are presented. Their interpretation is guided by three different questions: (1) Is RA able to discern periods where the (atmospheric) conditions are particularly suitable to obtain reliable EC fluxes? (2) Is RA capable to detect dynamical transitions (different behavior) beyond those obvious from visual inspection? (3) Does RA contribute to an understanding of the nonlinear synchronization between EC fluxes and atmospheric parameters, which is crucial for both improving carbon flux models as well for reliable interpolation of gaps? (4) Is RA able to recommend an optimal time resolution for measuring EC data and for analyzing EC fluxes? (5) Is it possible to detect non-trivial periodicities with a global RA? We will demonstrate that the answers to all five questions is affirmative, and that RA provides insights into EC dynamics not easily obtained otherwise.

  4. Recurrence of Mooren's ulcer after lamellar keratoplasty.

    PubMed

    McDonnell, P J

    1989-09-01

    A 45-year-old man with unilateral Mooren's ulcer in a quiescent state underwent annular lamellar keratoplasty after corneal rupture due to minor trauma. Postoperatively, he did well until 8 months later when a recurrence of the Mooren's ulceration occurred, involving the central island of the patient's original corneal stroma. The stroma of the lamellar graft was uninvolved. This unusual occurrence lends support to the concept that there is a specific immunologic reaction to the cornea in patients with Mooren's ulcer.

  5. Multifocal recurrent periostitis responsive to colchicine.

    PubMed

    Festen, J J; Kuipers, F C; Schaars, A H

    1985-01-01

    A brother and sister with multifocal recurrent periostitis are presented. Their disease started at an early age and manifested itself as an episodic migrating arthropathy. At roentgenography, reversible solid periosteal reactions were visible along large tubular bones. Scintigraphic and histological investigations revealed a sterile osteitis and thickened periosteum, but there was no indication of a viral infection. The girl experienced spontaneous amelioration after puberty; the boy improved markedly on colchicine.

  6. Hormonal causes of recurrent pregnancy loss (RPL).

    PubMed

    Pluchino, Nicola; Drakopoulos, Panagiotis; Wenger, Jean Marie; Petignat, Patrick; Streuli, Isabelle; Genazzani, Andrea Riccardo

    2014-01-01

    Endocrine disorders play a major role in approximately 8% to 12% of recurrent pregnancy loss (RPL). Indeed, the local hormonal milieu is crucial in both embryo attachment and early pregnancy. Endocrine abnormalities, including thyroid disorders, luteal phase defects, polycystic ovary syndrome, hyperprolactinaemia and diabetes have to be evaluated in any case of RPL. Moreover, elevated androgen levels and some endocrinological aspects of endometriosis are also factors contributing to RPL. In the present article, we review the significance of endocrine disease on RPL.

  7. Preventing venous ulcer recurrence: a review.

    PubMed

    Vowden, Kathryn R; Vowden, Peter

    2006-03-01

    This review article examines the available evidence on both the primary and secondary prevention of venous ulceration, exploring both the individual, social and financial implications of system failures that allow patients to remain at increased risk of recurrent ulceration. The role of both venous disease assessment and corrective superficial venous surgery are discussed in the light of recently published randomised controlled studies on the role of superficial venous surgery as both an adjunct to ulcer healing and ulcer prevention.

  8. Approach to acute, recurrent, and chronic pancreatitis.

    PubMed

    Kinney, Timothy P; Freeman, Martin L

    2008-06-01

    Pancreatitis can manifest as a one-time episode, recurring attacks, or chronic pain. It is caused by numerous factors ranging from alcohol consumption to gallstones to subtle obstructive causes and occult autoimmune disorders. As a result, determining the etiology and effectively treating the causes and consequences of pancreatitis can be challenging. This article reviews the diagnosis and management of acute, acute recurrent, and chronic pancreatitis, focusing on more challenging scenarios.

  9. Recurrent oral ulcers--an overview.

    PubMed

    Gaffar, A

    2001-01-01

    Recurrent oral ulcers (ROUs) are the most common oral mucosal disease. The etiology of ROUs is complex. The factors include mechanical trauma, genetics, stress, smoking, and viral and bacterial infections. Treatment modalities depend on the differential diagnosis of ROUs and could consist of antimicrobial agents, anti-inflammatory agents, immunomodulators, or over-the-counter medications. New therapy available in the form of a coating polymer, Colgate ORABASE Soothe.N.Seal, is clinically proven to provide rapid relief and healing of ROUs.

  10. Extended quantification of the generalized recurrence plot

    NASA Astrophysics Data System (ADS)

    Riedl, Maik; Marwan, Norbert; Kurths, Jürgen

    2016-04-01

    The generalized recurrence plot is a modern tool for quantification of complex spatial patterns. Its application spans the analysis of trabecular bone structures, Turing structures, turbulent spatial plankton patterns, and fractals. But, it is also successfully applied to the description of spatio-temporal dynamics and the detection of regime shifts, such as in the complex Ginzburg-Landau- equation. The recurrence plot based determinism is a central measure in this framework quantifying the level of regularities in temporal and spatial structures. We extend this measure for the generalized recurrence plot considering additional operations of symmetry than the simple translation. It is tested not only on two-dimensional regular patterns and noise but also on complex spatial patterns reconstructing the parameter space of the complex Ginzburg-Landau-equation. The extended version of the determinism resulted in values which are consistent to the original recurrence plot approach. Furthermore, the proposed method allows a split of the determinism into parts which based on laminar and non-laminar regions of the two-dimensional pattern of the complex Ginzburg-Landau-equation. A comparison of these parts with a standard method of image classification, the co-occurrence matrix approach, shows differences especially in the description of patterns associated with turbulence. In that case, it seems that the extended version of the determinism allows a distinction of phase turbulence and defect turbulence by means of their spatial patterns. This ability of the proposed method promise new insights in other systems with turbulent dynamics coming from climatology, biology, ecology, and social sciences, for example.

  11. Recurrent aphthous stomatitis and Helicobacter pylori

    PubMed Central

    Gomes, Carolina-Cavaliéri; Gomez, Ricardo-Santiago; Zina, Lívia-Guimarães

    2016-01-01

    Background Recurrent aphthous stomatitis (RAS) is a recurrent painful ulcerative disorder that commonly affects the oral mucosa. Local and systemic factors such as trauma, food sensitivity, nutritional deficiencies, systemic conditions, immunological disorders and genetic polymorphisms are associated with the development of the disease. Helicobacter pylori (H. pylori) is a gram-negative, microaerophile bacteria, that colonizes the gastric mucosa and it was previously suggested to be involved in RAS development. In the present paper we reviewed all previous studies that investigated the association between RAS and H. pylori. Material and Methods A search in Pubmed (MEDLINE) databases was made of articles published up until July 2015 using the following keywords: Helicobacter Pylori or H. pylori and RAS or Recurrent aphthous stomatitis. Results Fifteen experimental studies that addressed the relationship between infection with H. pylori and the presence of RAS and three reviews, including a systematic review and a meta-analysis were included in this review. The studies reviewed used different methods to assess this relationship, including PCR, nested PCR, culture, ELISA and urea breath test. A large variation in the number of patients included in each study, as well as inclusion criteria and laboratorial methods was observed. H. pylori can be detected in the oral mucosa or ulcerated lesion of some patients with RAS. The quality of the all studies included in this review was assessed using levels of evidence based on the University of Oxford’s Center for Evidence Based Medicine Criteria. Conclusions Although the eradication of the infection may affect the clinical course of the oral lesions by undetermined mechanisms, RAS ulcers are not associated with the presence of the bacteria in the oral cavity and there is no evidence that H. pylori infection drives RAS development. Key words:Campylobacter, elisa, h. pylori, Helicobacter Pylori, RAS, recurrent aphthous

  12. Recurrent ischaemic stroke unveils polycythaemia vera

    PubMed Central

    Abdel-Rahman, Islam; Murphy, Christie

    2015-01-01

    Polycythaemia vera is a recognised cause of ischaemic stroke. If not treated, this condition may result in recurrent strokes. This is a case of a 61-year-old Caucasian man presenting with the inability to ambulate for 3 days. Brain imaging revealed acute and chronic infarctions in the brain stem and the cerebrum. Polycythaemia vera was diagnosed and treated during the admission. The unique mechanisms and management issues of ischaemic stroke associated with polycythaemia vera are discussed. PMID:25754163

  13. Equine recurrent uveitis: new methods of management.

    PubMed

    Gilger, Brian C; Michau, Tammy Miller

    2004-08-01

    Equine recurrent uveitis (ERU) is one of the most common causes of blindness in horses. Until recently, treatment of this condition consisted only of symptomatic therapy, typically with steroidal and nonsteroidal medications. A better understanding of the disease process(es) has permitted new medical and surgical therapies that have recently been described. This article highlights clinical features of ERU, the causes of ERU, and new management and treatment options for horses with ERU.

  14. Myeloablative chemotherapy for recurrent aggressive oligodendroglioma.

    PubMed Central

    Cairncross, G.; Swinnen, L.; Bayer, R.; Rosenfeld, S.; Salzman, D.; Paleologos, N.; Kaminer, L.; Forsyth, P.; Stewart, D.; Peterson, K.; Hu, W.; Macdonald, D.; Ramsay, D.; Smith, A.

    2000-01-01

    The objective of this study was to ascertain the duration of tumor control and the toxicities of dose-intense myeloablative chemotherapy for patients with recurrent oligodendrogliomas. Patients with previously irradiated oligodendrogliomas, either pure or mixed, that were contrast enhancing, measurable, and behaving aggressively at recurrence were eligible for this study. Only complete responders or major partial responders (75 % reduction in tumor size) to induction chemotherapy--either intensive-dose procarbazine, lomustine, and vincristine or cisplatin plus etoposide-could receive high-dose thiotepa (300 mg/m2/day for 3 days) followed by hematopoietic reconstitution using either bone marrow or peripheral blood stem cells. Thirty-eight patients began induction chemotherapy and 20 (10 men, 10 women; median age 46 years; median Karnofsky score 80) received high-dose thiotepa. For the high-dose group, the median event-free, progression-free, and overall survival times from recurrence were 17, 20, and 49 months, respectively. Tumor control in excess of 2 years was observed in 6 patients (30%). Four patients (20%) are alive and tumor free 27 to 77 months (median, 42 months) from the start of induction therapy; however, fatal treatment-related toxicities also occurred in 4 patients (20%). Three patients died as a result of a progressive encephalopathy which, in 2 instances, was accompanied by a wasting syndrome; 1 patient died as a consequence of an intracerebral (intratumoral) hemorrhage. Fatal toxicities occurred in patients with pretreatment Karnofsky scores of 60 or 70. High-dose thiotepa to consolidate response was a disappointing treatment strategy for patients with recurrent aggressive oligodendroglial neoplasms, although several patients had durable responses. Moreover, as prescribed, high-dose thiotepa had significant toxic effects in previously irradiated patients, especially those with poorer performance status. PMID:11303620

  15. Nonfunctioning giant pituitary adenomas: Invasiveness and recurrence

    PubMed Central

    Landeiro, José Alberto; Fonseca, Elissa Oliveira; Monnerat, Andrea Lima Cruz; Taboada, Giselle Fernandes; Cabral, Gustavo Augusto Porto Sereno; Antunes, Felippe

    2015-01-01

    Background: We report our surgical series of 35 patients with giant nonfunctioning pituitary adenomas (GNFPA). We analyzed the rule of Ki-67 antigen expression in predicting recurrence. Methods: Thirty-five patients were operated between 2000 and 2010. Suprassellar extension of the tumors were classified according to Hardy and Mohr based on magnetic resonance (MR) studies. Pituitary endocrine function and MR scans were assessed preoperatively and at 1, 6, and 12 months postoperatively. Immunohistochemical studies were based in regard to the expression of the proliferative Ki-67 index and the hormonal receptor for luteinizing hormone, follicle stimulating hormone, growth hormone, thyroid stimulating hormone, adrenocorticotropic hormone, and prolactin. Tumors specimens were obtained from 35 patients with GNFPA. Endoscopic transsphenoidal surgery was the approach of choice. Results: Thirty-five patients were submitted to 49 surgeries, 44 (89.8%) were transsphenoidal and 5 (10.2%) were transcranial. The most frequent preoperative complaints were visual acuity impairment and visual field defect in 25 (71.2%) and 23 (65.7%) cases, respectively. Improvement of visual acuitiy and visual field deficit after surgery was seen in 20 (80%) and 17 (73.9%) patients, respectively. Endocrinological deficits were encountered in 20 patients (57.1%). After surgery, 18 patients (51.4%) required hormonal replacement. Three patients had visual symptoms related to pituitary apoplexy and recovered after surgery. The Ki-67 labeling index (LI) ranged from <1% to 4.8%. The rate of recurrence in tumors with Ki-67 <3% was 7.7% (2 patients), Ki-67 >3% was present in 5 patients and the recurrence committed 3 patients. Conclusion: In our series, regardless the improvement of visual function and compressing symptoms, 5 patients with expression of Ki-67 LI more than 3% experienced a recurrence. PMID:26674325

  16. Divergent clonal selection dominates medulloblastoma at recurrence

    PubMed Central

    Morrissy, A. Sorana; Garzia, Livia; Shih, David J. H.; Zuyderduyn, Scott; Huang, Xi; Skowron, Patryk; Remke, Marc; Cavalli, Florence M. G.; Ramaswamy, Vijay; Lindsay, Patricia E.; Jelveh, Salomeh; Donovan, Laura K.; Wang, Xin; Luu, Betty; Zayne, Kory; Li, Yisu; Mayoh, Chelsea; Thiessen, Nina; Mercier, Eloi; Mungall, Karen L.; Ma, Yusanne; Tse, Kane; Zeng, Thomas; Shumansky, Karey; Roth, Andrew J. L.; Shah, Sohrab; Farooq, Hamza; Kijima, Noriyuki; Holgado, Borja L.; Lee, John J. Y.; Matan-Lithwick, Stuart; Liu, Jessica; Mack, Stephen C.; Manno, Alex; Michealraj, K. A.; Nor, Carolina; Peacock, John; Qin, Lei; Reimand, Juri; Rolider, Adi; Thompson, Yuan Y.; Wu, Xiaochong; Pugh, Trevor; Ally, Adrian; Bilenky, Mikhail; Butterfield, Yaron S. N.; Carlsen, Rebecca; Cheng, Young; Chuah, Eric; Corbett, Richard D.; Dhalla, Noreen; He, An; Lee, Darlene; Li, Haiyan I.; Long, William; Mayo, Michael; Plettner, Patrick; Qian, Jenny Q.; Schein, Jacqueline E.; Tam, Angela; Wong, Tina; Birol, Inanc; Zhao, Yongjun; Faria, Claudia C.; Pimentel, José; Nunes, Sofia; Shalaby, Tarek; Grotzer, Michael; Pollack, Ian F.; Hamilton, Ronald L.; Li, Xiao-Nan; Bendel, Anne E.; Fults, Daniel W.; Walter, Andrew W.; Kumabe, Toshihiro; Tominaga, Teiji; Collins, V. Peter; Cho, Yoon-Jae; Hoffman, Caitlin; Lyden, David; Wisoff, Jeffrey H.; Garvin, James H.; Stearns, Duncan S.; Massimi, Luca; Schüller, Ulrich; Sterba, Jaroslav; Zitterbart, Karel; Puget, Stephanie; Ayrault, Olivier; Dunn, Sandra E.; Tirapelli, Daniela P. C.; Carlotti, Carlos G.; Wheeler, Helen; Hallahan, Andrew R.; Ingram, Wendy; MacDonald, Tobey J.; Olson, Jeffrey J.; Van Meir, Erwin G.; Lee, Ji-Yeoun; Wang, Kyu-Chang; Kim, Seung-Ki; Cho, Byung-Kyu; Pietsch, Torsten; Fleischhack, Gudrun; Tippelt, Stephan; Ra, Young Shin; Bailey, Simon; Lindsey, Janet C.; Clifford, Steven C.; Eberhart, Charles G.; Cooper, Michael K.; Packer, Roger J.; Massimino, Maura; Garre, Maria Luisa; Bartels, Ute; Tabori, Uri; Hawkins, Cynthia E.; Dirks, Peter; Bouffet, Eric; Rutka, James T.; Wechsler-Reya, Robert J.; Weiss, William A.; Collier, Lara S.; Dupuy, Adam J.; Korshunov, Andrey; Jones, David T. W.; Kool, Marcel; Northcott, Paul A.; Pfister, Stefan M.; Largaespada, David A.; Mungall, Andrew J.; Moore, Richard A.; Jabado, Nada; Bader, Gary D.; Jones, Steven J. M.; Malkin, David; Marra, Marco A.; Taylor, Michael D.

    2016-01-01

    The development of targeted anti-cancer therapies through the study of cancer genomes is intended to increase survival rates and decrease treatment-related toxicity. We treated a transposon–driven, functional genomic mouse model of medulloblastoma with ‘humanized’ in vivo therapy (microneurosurgical tumour resection followed by multi-fractionated, image-guided radiotherapy). Genetic events in recurrent murine medulloblastoma exhibit a very poor overlap with those in matched murine diagnostic samples (<5%). Whole-genome sequencing of 33 pairs of human diagnostic and post-therapy medulloblastomas demonstrated substantial genetic divergence of the dominant clone after therapy (<12% diagnostic events were retained at recurrence). In both mice and humans, the dominant clone at recurrence arose through clonal selection of a pre-existing minor clone present at diagnosis. Targeted therapy is unlikely to be effective in the absence of the target, therefore our results offer a simple, proximal, and remediable explanation for the failure of prior clinical trials of targeted therapy. PMID:26760213

  17. New Madrid seismic zone recurrence intervals

    SciTech Connect

    Schweig, E.S. Center for Earthquake Research and Information, Memphis, TN ); Ellis, M.A. )

    1993-03-01

    Frequency-magnitude relations in the New Madrid seismic zone suggest that great earthquakes should occur every 700--1,200 yrs, implying relatively high strain rates. These estimates are supported by some geological and GPS results. Recurrence intervals of this order should have produced about 50 km of strike-slip offset since Miocene time. No subsurface evidence for such large displacements is known within the seismic zone. Moreover, the irregular fault pattern forming a compressive step that one sees today is not compatible with large displacements. There are at least three possible interpretations of the observations of short recurrence intervals and high strain rates, but apparently youthful fault geometry and lack of major post-Miocene deformation. One is that the seismological and geodetic evidence are misleading. A second possibility is that activity in the region is cyclic. That is, the geological and geodetic observations that suggest relatively short recurrence intervals reflect a time of high, but geologically temporary, pore-fluid pressure. Zoback and Zoback have suggested such a model for intraplate seismicity in general. Alternatively, the New Madrid seismic zone is geologically young feature that has been active for only the last few tens of thousands of years. In support of this, observe an irregular fault geometry associated with a unstable compressive step, a series of en echelon and discontinuous lineaments that may define the position of a youthful linking fault, and the general absence of significant post-Eocene faulting or topography.

  18. Radiotherapy and brachytherapy for recurrent colorectal cancer

    SciTech Connect

    Nag, S. )

    1991-05-01

    Radical surgical excision of locoregional recurrence of colorectal carcinoma usually produces the best survival and should be attempted whenever possible. However, recurrences are often unresectable; hence palliative local therapy may be indicated. There are several options for the radiation therapy of local, unresectable, recurrent, or metastatic colorectal cancer. Whole pelvis irradiation of 4,000-5,000 cGy followed by a coned-down boost of 1,000-1,500 cGy generally provides good symptomatic palliation in 80-90% of patients, but long-term control or cure is rarely achieved. External beam irradiation of 2,000-3,000 cGy to the whole liver with or without concurrent chemotherapy may be used for palliation of metastatic disease to the liver. A combination of intraoperative radiation therapy applied directly to the tumor bed and external beam irradiation may improve local control and survival rates. Multiple options are available for the intraoperative use of brachytherapy which can deliver high radiation doses to the residual tumor, or tumor bed, sparing normal tissue.

  19. Segmented-memory recurrent neural networks.

    PubMed

    Chen, Jinmiao; Chaudhari, Narendra S

    2009-08-01

    Conventional recurrent neural networks (RNNs) have difficulties in learning long-term dependencies. To tackle this problem, we propose an architecture called segmented-memory recurrent neural network (SMRNN). A symbolic sequence is broken into segments and then presented as inputs to the SMRNN one symbol per cycle. The SMRNN uses separate internal states to store symbol-level context, as well as segment-level context. The symbol-level context is updated for each symbol presented for input. The segment-level context is updated after each segment. The SMRNN is trained using an extended real-time recurrent learning algorithm. We test the performance of SMRNN on the information latching problem, the "two-sequence problem" and the problem of protein secondary structure (PSS) prediction. Our implementation results indicate that SMRNN performs better on long-term dependency problems than conventional RNNs. Besides, we also theoretically analyze how the segmented memory of SMRNN helps learning long-term temporal dependencies and study the impact of the segment length.

  20. Recurrent hepatitis C after liver transplant

    PubMed Central

    deLemos, Andrew S; Schmeltzer, Paul A; Russo, Mark W

    2014-01-01

    End stage liver disease from hepatitis C is the most common indication for liver transplantation in many parts of the world accounting for up to 40% of liver transplants. Antiviral therapy either before or after liver transplantation is challenging due to side effects and lower efficacy in patients with cirrhosis and liver transplant recipients, as well as from drug interactions with immunosuppressants. Factors that may affect recurrent hepatitis C include donor age, immunosuppression, IL28B genotype, cytomegalovirus infection, and metabolic syndrome. Older donor age has persistently been shown to have the greatest impact on recurrent hepatitis C. After liver transplantation, distinguishing recurrent hepatitis C from acute cellular rejection may be difficult, although the development of molecular markers may help in making the correct diagnosis. The advent of interferon free regimens with direct acting antiviral agents that include NS3/4A protease inhibitors, NS5B polymerase inhibitors and NS5A inhibitors holds great promise in improving outcomes for liver transplant candidates and recipients. PMID:25152571

  1. Detecting Recurrence Domains of Dynamical Systems by Symbolic Dynamics

    NASA Astrophysics Data System (ADS)

    Graben, Peter beim; Hutt, Axel

    2013-04-01

    We propose an algorithm for the detection of recurrence domains of complex dynamical systems from time series. Our approach exploits the characteristic checkerboard texture of recurrence domains exhibited in recurrence plots. In phase space, recurrence plots yield intersecting balls around sampling points that could be merged into cells of a phase space partition. We construct this partition by a rewriting grammar applied to the symbolic dynamics of time indices. A maximum entropy principle defines the optimal size of intersecting balls. The final application to high-dimensional brain signals yields an optimal symbolic recurrence plot revealing functional components of the signal.

  2. Sunitinib Malate in Treating Younger Patients With Recurrent, Refractory, or Progressive Malignant Glioma or Ependymoma

    ClinicalTrials.gov

    2015-08-18

    Childhood Cerebellar Anaplastic Astrocytoma; Childhood Cerebral Anaplastic Astrocytoma; Childhood Cerebral Astrocytoma; Childhood Infratentorial Ependymoma; Childhood Mixed Glioma; Childhood Oligodendroglioma; Childhood Supratentorial Ependymoma; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Ependymoma; Recurrent Childhood Subependymal Giant Cell Astrocytoma

  3. Talazoparib and Temozolomide in Treating Younger Patients With Refractory or Recurrent Malignancies

    ClinicalTrials.gov

    2017-03-26

    Adult Solid Neoplasm; Childhood Solid Neoplasm; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Central Nervous System Neoplasm; Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Refractory Central Nervous System Neoplasm

  4. Cancer Metastases: Early Dissemination and Late Recurrences

    PubMed Central

    Friberg, Sten; Nyström, Andreas

    2015-01-01

    BACKGROUND Metastatic cells from a primary tumor can occur before the primary cancer is detected. Metastatic cells can also remain in the patient for many years after removal of the primary tumor without proliferating. These dormant malignant cells can awaken and cause recurrent disease decades after the primary treatment. The purpose of this article is to review the clinical evidence for early dissemination and late recurrences in human malignant tumors. We used the following definitions: dormancy of cells may be defined as a nonproliferating state or an arrest in the cell cycle that results in a prolonged G0 phase. If one accepts the term “late metastases” to indicate a period exceeding 10 years from the removal of the primary tumor, then the two malignancies in which this occurs most frequently are cutaneous malignant melanoma (CMM) and renal cell carcinoma (RCC). METHODS PubMed, Web of Science, and Scopus were searched with the keywords “metastases,” “early dissemination,” “late recurrences,” “inadvertently transmitted cancer,” “tumor growth rate,” “dormancy,” “circulating tumor cells,” and “transplantation of cancer.” RESULTS Several case reports of early dissemination and late recurrences of various types of malignancies were found. Analyses of the growth rates of several malignant tumors in the original host indicated that the majority of cancers had metastasized years before they were detected. CMM, RCC, and malignant glioblastoma were the three most common malignancies resulting from an organ transplantation. CMM and RCC were also the two most common malignancies that showed dormancy. In several cases of transplanted CMM and RCC, the donor did not have any known malignancy or had had the malignancy removed so long ago that the donor was regarded as cured. CONCLUSION (1) Metastases can frequently exist prior to the detection of the primary tumor. (2) Metastatic cells may reside in organs in the original host that are not

  5. Optimal estimation of recurrence structures from time series

    NASA Astrophysics Data System (ADS)

    beim Graben, Peter; Sellers, Kristin K.; Fröhlich, Flavio; Hutt, Axel

    2016-05-01

    Recurrent temporal dynamics is a phenomenon observed frequently in high-dimensional complex systems and its detection is a challenging task. Recurrence quantification analysis utilizing recurrence plots may extract such dynamics, however it still encounters an unsolved pertinent problem: the optimal selection of distance thresholds for estimating the recurrence structure of dynamical systems. The present work proposes a stochastic Markov model for the recurrent dynamics that allows for the analytical derivation of a criterion for the optimal distance threshold. The goodness of fit is assessed by a utility function which assumes a local maximum for that threshold reflecting the optimal estimate of the system's recurrence structure. We validate our approach by means of the nonlinear Lorenz system and its linearized stochastic surrogates. The final application to neurophysiological time series obtained from anesthetized animals illustrates the method and reveals novel dynamic features of the underlying system. We propose the number of optimal recurrence domains as a statistic for classifying an animals' state of consciousness.

  6. Vesicant Therapeutics Collaborative Core Research Program

    DTIC Science & Technology

    2012-12-01

    could stabilize siRNA nanoparticles in a solution with physiological ionic strength. Nanoparticle Stability in the Presence of 50% Bovine Serum To test ... tested the efficiency of chitosan-siRNA nanoparticles and found that the transfection and gene knockdown efficiency is much lower than linear PEI/siRNA...leading to particle aggregation and uptake by macrophages. Enhanced stability of nanoparticles at physiological ionic strength. The complex

  7. Chromatin changes predict recurrence after radical prostatectomy

    PubMed Central

    Hveem, Tarjei S; Kleppe, Andreas; Vlatkovic, Ljiljana; Ersvær, Elin; Wæhre, Håkon; Nielsen, Birgitte; Kjær, Marte Avranden; Pradhan, Manohar; Syvertsen, Rolf Anders; Nesheim, John Arne; Liestøl, Knut; Albregtsen, Fritz; Danielsen, Håvard E

    2016-01-01

    Background: Pathological evaluations give the best prognostic markers for prostate cancer patients after radical prostatectomy, but the observer variance is substantial. These risk assessments should be supported and supplemented by objective methods for identifying patients at increased risk of recurrence. Markers of epigenetic aberrations have shown promising results in several cancer types and can be assessed by automatic analysis of chromatin organisation in tumour cell nuclei. Methods: A consecutive series of 317 prostate cancer patients treated with radical prostatectomy at a national hospital between 1987 and 2005 were followed for a median of 10 years (interquartile range, 7–14). On average three tumour block samples from each patient were included to account for tumour heterogeneity. We developed a novel marker, termed Nucleotyping, based on automatic assessment of disordered chromatin organisation, and validated its ability to predict recurrence after radical prostatectomy. Results: Nucleotyping predicted recurrence with a hazard ratio (HR) of 3.3 (95% confidence interval (CI), 2.1–5.1). With adjustment for clinical and pathological characteristics, the HR was 2.5 (95% CI, 1.5–4.1). An updated stratification into three risk groups significantly improved the concordance with patient outcome compared with a state-of-the-art risk-stratification tool (P<0.001). The prognostic impact was most evident for the patients who were high-risk by clinical and pathological characteristics and for patients with Gleason score 7. Conclusion: A novel assessment of epigenetic aberrations was capable of improving risk stratification after radical prostatectomy. PMID:27124335

  8. Inherited Thrombophilia and Recurrent Pregnancy Loss

    PubMed Central

    Parand, Alireza; Zolghadri, Jale; Nezam, Mozhgan; Afrasiabi, Abdolreza; Haghpanah, Sezaneh; Karimi, Mehran

    2013-01-01

    Background: Recurrent pregnancy loss (RPL) is a common health problem. The polymorphisms G20210A of prothrombin gene (FII G 20210A), and G 1691A of factor V gene (Factor V Leiden, FVL) are the most extensively studied thrombophilic mutations in association to recurrent miscarriage. Objectives: To determine the frequency of FII G20210A and FVL polymorphisms as well as protein C and protein S deficiency in a series of patients with RPL compared with control group. Patients and Methods: The study group included 90 randomly selected patients with three or more consecutive miscarriages with the same partner in <20 weeks gestation in 2012. The control population consisted of 44 age-matched women with at least one live born children and no history of pregnancy loss. Functional activity of protein C and S, activated protein C resistance, FVL assay by polymerase chain reaction and prothrombin gene mutation were assessed. The polymorphism frequencies were recorded for each group and comparisons were made. Results: The mean functional activity of protein C and protein S were not significantly different between case and control groups (P >0.05). Frequency of protein C deficiency was also not significantly different between the case and control groups (P=0.906), but frequency of protein S deficiency was significantly higher in patients than controls (P=0.03). Genotype pattern of the patients and healthy individuals were not significantly different with regard to either FVL or Prothrombin G20210A (P > 0.05). Conclusions: We determined a significant higher frequency of protein S deficiency in patients with RPL compared with controls. But the frequency of protein C deficiency and the frequency of two common thrombophilic mutations (Factor V Leiden and Prothrombin G20210A), were not significantly different between patients with recurrent miscarriage and healthy women. PMID:24693393

  9. Intraoperative radiation therapy in recurrent ovarian cancer

    SciTech Connect

    Yap, O.W. Stephanie . E-mail: stbeast@stanford.edu; Kapp, Daniel S.; Teng, Nelson N.H.; Husain, Amreen

    2005-11-15

    Purpose: To evaluate disease outcomes and complications in patients with recurrent ovarian cancer treated with cytoreductive surgery and intraoperative radiation therapy (IORT). Methods and Materials: A retrospective study of 24 consecutive patients with ovarian carcinoma who underwent secondary cytoreduction and intraoperative radiation therapy at our institution between 1994 and 2002 was conducted. After optimal cytoreductive surgery, IORT was delivered with orthovoltage X-rays (200 kVp) using individually sized and beveled cone applications. Outcomes measures were local control of disease, progression-free interval, overall survival, and treatment-related complications. Results: Of these 24 patients, 22 were available for follow-up analysis. Additional treatment at the time of and after IORT included whole abdominopelvic radiation, 9; pelvic or locoregional radiation, 5; chemotherapy, 6; and no adjuvant treatment, 2. IORT doses ranged from 9-14 Gy (median, 12 Gy). The anatomic sites treated were pelvis (sidewalls, vaginal cuff, presacral area, anterior pubis), para-aortic and paracaval lymph node beds, inguinal region, or porta hepatitis. At a median follow-up of 24 months, 5 patients remain free of disease, whereas 17 patients have recurred, of whom 4 are alive with disease and 13 died from disease. Five patients recurred within the radiation fields for a locoregional relapse rate of 32% and 12 patients recurred at distant sites with a median time to recurrence of 13.7 months. Five-year overall survival was 22% with a median survival of 26 months from time of IORT. Nine patients (41%) experienced Grade 3 toxicities from their treatments. Conclusion: In carefully selected patients with locally recurrent ovarian cancer, combined IORT and tumor reductive surgery is reasonably tolerated and may contribute to achieving local control and disease palliation.

  10. Recurrent Neural Networks With Auxiliary Memory Units.

    PubMed

    Wang, Jianyong; Zhang, Lei; Guo, Quan; Yi, Zhang

    2017-03-21

    Memory is one of the most important mechanisms in recurrent neural networks (RNNs) learning. It plays a crucial role in practical applications, such as sequence learning. With a good memory mechanism, long term history can be fused with current information, and can thus improve RNNs learning. Developing a suitable memory mechanism is always desirable in the field of RNNs. This paper proposes a novel memory mechanism for RNNs. The main contributions of this paper are: 1) an auxiliary memory unit (AMU) is proposed, which results in a new special RNN model (AMU-RNN), separating the memory and output explicitly and 2) an efficient learning algorithm is developed by employing the technique of error flow truncation. The proposed AMU-RNN model, together with the developed learning algorithm, can learn and maintain stable memory over a long time range. This method overcomes both the learning conflict problem and gradient vanishing problem. Unlike the traditional method, which mixes the memory and output with a single neuron in a recurrent unit, the AMU provides an auxiliary memory neuron to maintain memory in particular. By separating the memory and output in a recurrent unit, the problem of learning conflicts can be eliminated easily. Moreover, by using the technique of error flow truncation, each auxiliary memory neuron ensures constant error flow during the learning process. The experiments demonstrate good performance of the proposed AMU-RNNs and the developed learning algorithm. The method exhibits quite efficient learning performance with stable convergence in the AMU-RNN learning and outperforms the state-of-the-art RNN models in sequence generation and sequence classification tasks.

  11. Recurrent cubital tunnel syndrome. Etiology and treatment.

    PubMed

    Filippi, R; Charalampaki, P; Reisch, R; Koch, D; Grunert, P

    2001-12-01

    Controversy surrounds the treatment of recurrent cubital tunnel syndrome after previous surgery. Irrespective of the surgical technique, namely pure decompression in the ulnar groove and the cubital tunnel distal of the medial epicondyle, and the different methods of volar transposition (subcutaneous, intramuscular, and submuscular), the results of surgical therapy of cubital tunnel syndrome are often not favorable, especially in cases of long-standing symptoms and severe deficits. Twenty-two patients who had previously undergone surgical treatment for ulnar nerve entrapment at the elbow were evaluated because of persistent or recurrent pain, paresthesia, numbness, and motor weakness. Ten patients had undergone a nerve transposition, 5 patients underwent a simple decompression of the ulnar nerve, and 7 patients experienced two previous operations with different surgical techniques. Two patients underwent surgery at our hospital, whereas 20 patients underwent their primary surgery at other institutions. Various surgical techniques were used during the subsequent surgery, such as external neurolysis, subcutaneous anterior transposition, and subsequent transfer of the nerve back into the sulcus. The causes of continued or recurrent symptoms after initial surgery included dense perineural fibrosis of the nerve after subcutaneous transposition, adhesions of the nerve to the medial epicondyle and retention of the medial intermuscular septum. The average follow-up after the last procedure was 7 months (2 - 20 months). All 7 patients with subsequent transfer of the ulnar nerve back into the sulcus became pain-free, whereas only 11 of 15 patients who had external neurolysis or subcutaneous transposition became free of pain or experienced reduced pain. The recovery of motor function and return of sensibility were variable and unpredictable. In summary, reoperation after primary surgery of cubital tunnel syndrome gave satisfactory results in 18 of 22 cases. Subsequent

  12. Nivolumab With or Without Ipilimumab in Treating Younger Patients With Recurrent or Refractory Solid Tumors or Sarcomas

    ClinicalTrials.gov

    2017-04-04

    Childhood Solid Neoplasm; Metastatic Melanoma; Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Recurrent Hodgkin Lymphoma; Recurrent Malignant Solid Neoplasm; Recurrent Melanoma; Recurrent Neuroblastoma; Recurrent Non-Hodgkin Lymphoma; Recurrent Osteosarcoma; Recurrent Rhabdomyosarcoma; Refractory Hodgkin Lymphoma; Refractory Non-Hodgkin Lymphoma; Stage III Skin Melanoma; Stage IIIA Skin Melanoma; Stage IIIB Skin Melanoma; Stage IIIC Skin Melanoma; Stage IV Skin Melanoma

  13. Cilengitide in Treating Younger Patients With Recurrent or Progressive High-Grade Glioma That Has Not Responded to Standard Therapy

    ClinicalTrials.gov

    2014-05-05

    Childhood High-grade Cerebellar Astrocytoma; Childhood High-grade Cerebral Astrocytoma; Recurrent Childhood Anaplastic Astrocytoma; Recurrent Childhood Anaplastic Oligoastrocytoma; Recurrent Childhood Anaplastic Oligodendroglioma; Recurrent Childhood Brain Tumor; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Glioblastoma; Recurrent Childhood Visual Pathway and Hypothalamic Glioma

  14. Recurrent intraneural ganglion cysts: Pathoanatomic patterns and treatment implications.

    PubMed

    Desy, Nicholas M; Lipinski, Lindsay J; Tanaka, Shota; Amrami, Kimberly K; Rock, Michael G; Spinner, Robert J

    2015-11-01

    The etiology of intraneural ganglion cysts has been poorly understood. This has resulted in the development of multiple surgical treatment strategies and a high recurrence rate. We sought to analyze these recurrences in order to provide a pathoanatomic explanation and staging classification for intraneural cyst recurrence. An expanded literature search was performed to identify frequencies and patterns in cases of intraneural ganglion cyst recurrences following primary surgery. Two univariate analyses were completed to identify associations between the type of revision surgery and repeat cyst recurrences. The expanded literature search found an 11% recurrence rate following primary surgery, including 64 recurrences following isolated cyst decompression (Group 1); six after articular branch resection (Group 2); and none following surgical procedures that addressed the joint (Group 3). Eight cases did not specify the type of primary surgery. In group 1, forty-eight of the recurrences (75%) were in the parent nerve, three involved only the articular branch, and one travelled along the articular branch in a different distal direction without involving the main parent nerve. In group 2, only one case (17%) recurred/persisted within the parent nerve, one recurred within a persistent articular branch, and one formed within a persistent articular branch and travelled in a different distal direction. Intraneural recurrences most commonly occur following surgical procedures that only target the main parent nerve. We provide proven or theoretical explanations for all identified cases of intraneural recurrences for an occult or persistent articular branch pathway.

  15. Recurrent nontuberculous mycobacterial endophthalmitis: a diagnostic conundrum

    PubMed Central

    Venkateswaran, Nandini; Yeaney, Gabrielle; Chung, Mina; Hindman, Holly B

    2014-01-01

    Objective To report a case of recurrent nontuberculous mycobacterial endophthalmitis in the context of neurotrophic keratopathy secondary to herpes zoster ophthalmicus that had an atypical presentation and complex course, and highlights the challenges of causative organism identification and therapeutic interventions in this condition. Methods A retrospective chart review was conducted to determine the visual outcomes of the patient. Results A 68-year-old pseudophakic male with long-standing neurotrophic keratopathy and perforated descemetocele managed with cyanoacrylate glue and a contact bandage lens in the left eye, began experiencing recurrent episodes of endophthalmitis after undergoing a penetrating keratoplasty. Several therapeutic procedures including an anterior chamber washout, two pars plana vitrectomies, explantation of the posterior chamber intraocular lens and capsular bag, and multiple intravitreal antimicrobial injections, were performed to which he has ultimately responded favorably, with no signs of infection to date and stable visual acuity. The causative organism of his recurrent infections was initially identified as Mycobacterium abscessus through biochemical testing and 16S ribosomal ribonucleic acid gene sequencing; however, repeat polymerase chain reaction (PCR) and sequencing of the 65 kDa heat shock protein (hsp65) gene for experimental purposes confirmed the accurate identification of the organism to be Mycobacterium chelonae. Given the greater reliability of PCR and sequencing of the hsp65 gene over traditional biochemical tests and culture techniques, M. chelonae was likely the infectious agent all along, and the organism was originally misidentified on the basis of less accurate tests. Conclusion Recurrent atypical mycobacterial endophthalmitis requires expedient identification and management to prevent poor visual outcomes. Standard biochemical testing can identify the causative organism but is limited by the inability to distinguish

  16. Unusual underlying cause of recurrent vulval abscess

    PubMed Central

    Dutta, Debarati; Agur, Wael; Macleod, Calum

    2010-01-01

    An ex-intravenous drug user was admitted four times during a 2 year period from December 2006, with the same complaint of vulval abscess which required repeat incision and drainage procedures. In January 2009, a pelvic x-ray showed widening of the symphysis pubis, marginal irregularities, and severe erosive changes which were consistent with pubic osteomyelitis. She was treated with intravenous ciprofloxacin and clindamycin for 2 weeks and was discharged on oral antibiotics for 6 weeks. She recovered well and her condition has significantly improved with no recurrent infection so far. She is now being followed up every 4–6 weeks at the orthopaedics outpatient clinic. PMID:22461858

  17. Recurrent Urinary Tract Infections Management in Women

    PubMed Central

    Al-Badr, Ahmed; Al-Shaikh, Ghadeer

    2013-01-01

    Urinary tract infections (UTIs) are one of the most frequent clinical bacterial infections in women, accounting for nearly 25% of all infections. Around 50–60% of women will develop UTIs in their lifetimes. Escherichia coli is the organism that causes UTIs in most patients. Recurrent UTIs (RUTI) are mainly caused by reinfection by the same pathogen. Having frequent sexual intercourse is one of the greatest risk factors for RUTIs. In a subgroup of individuals with coexisting morbid conditions, complicated RUTIs can lead to upper tract infections or urosepsis. Although the initial treatment is antimicrobial therapy, use of different prophylactic regimens and alternative strategies are available to reduce exposure to antibiotics. PMID:23984019

  18. Rhythmicity, Recurrence, and Recovery of Flagellar Beating

    NASA Astrophysics Data System (ADS)

    Wan, Kirsty Y.; Goldstein, Raymond E.

    2014-12-01

    The eukaryotic flagellum beats with apparently unfailing periodicity, yet responds rapidly to stimuli. Like the human heartbeat, flagellar oscillations are now known to be noisy. Using the alga C. reinhardtii, we explore three aspects of nonuniform flagellar beating. We report the existence of rhythmicity, waveform noise peaking at transitions between power and recovery strokes, and fluctuations of interbeat intervals that are correlated and even recurrent, with memory extending to hundreds of beats. These features are altered qualitatively by physiological perturbations. Further, we quantify the recovery of periodic breaststroke beating from transient hydrodynamic forcing. These results will help constrain microscopic theories on the origins and regulation of flagellar beating.

  19. Isolated humeral recurrence in endometrial carcinoma

    PubMed Central

    Devdas, Santosh Kumar; Digumarti, Leela; Digumarti, Raghunadharao; Patro, Kunha Charan; Nutakki, Ramakoteswararao

    2016-01-01

    Isolated skeletal metastasis in endometrial carcinoma at recurrence is very rare. We report a 52-year-old woman diagnosed to have FIGO Stage 1b, Grade 1 endometrioid adenocarcinoma, presenting with isolated distal humerus metastasis, 2 years after surgery and adjuvant radiotherapy for primary disease. Imaging, bone scintigraphy, and cytology confirmed the diagnosis of poorly differentiated metastatic adenocarcinoma. She was treated with local radiotherapy followed by six cycles of paclitaxel and carboplatin chemotherapy along with zoledronic acid, monthly. She is symptom-free after the treatment and at a first follow-up visit after 3 months. PMID:27688615

  20. Recurrent craniospinal epidermoid: A case report

    PubMed Central

    Shah, Abhidha; Patil, Manoj; Goel, Atul

    2016-01-01

    We present a rare case of a fourth ventricular epidermoid cyst, which recurred 15 years after the initial radical tumor resection surgery. The recurrence of the tumor extended into the cervical spine. The patient was reoperated and a near-total excision of both the cranial and spinal components of the epidermoid was performed. Our literature search did not reveal any case where there was a simultaneous presence of both the cranial and spinal epidermoid tumors. The possible cause of extension of the cranial epidermoid into the spinal compartment is analyzed. PMID:27041888

  1. [Radiological changes in chronic recurrent multifocal osteomyelitis].

    PubMed

    Jurik, A G

    1997-07-21

    Chronic recurrent multifocal osteomyelitis (CRMO) is a well-established rare clinical and radiographical disease entity, occurring mainly in children and adolescents with a female predominance. It is predominantly located to tubular bones followed by the clavicle and the spine, and other locations are rare. The diagnosis is usually based on a characteristic fluctuating benign course and conventional radiography, if necessary supplemented by microbiological and histopathological examinations to exclude infectious diseases, tumour or tumour-like lesions. It is important to make the diagnosis in order to avoid unnecessary additional diagnostic procedures and give an appropriate therapy. To do this it is necessary to know the radiographic features, which are reviewed here.

  2. Recurrent epiploic appendagitis mimicking appendicitis and cholecystitis

    PubMed Central

    Hearne, Christopher B.; Taboada, Jorge

    2017-01-01

    Epiploic appendagitis (EA) is a rare cause of acute abdominal pain caused by inflammation of an epiploic appendage. It has a nonspecific clinical presentation that may mimic other acute abdominal pathologies on physical exam, such as appendicitis, diverticulitis, or cholecystitis. However, EA is usually benign and self-limiting and can be treated conservatively. We present the case of a patient with two episodes of EA, the first mimicking acute appendicitis and the second mimicking acute cholecystitis. Although recurrence of EA is rare, it should be part of the differential diagnosis of acute, localized abdominal pain. A correct diagnosis of EA will prevent unnecessary hospitalization, antibiotic use, and surgical procedures. PMID:28127129

  3. Karyotypes of 1142 couples with recurrent abortion.

    PubMed

    Portnoï, M F; Joye, N; van den Akker, J; Morlier, G; Taillemite, J L

    1988-07-01

    Cytogenetic analysis was performed on 1142 couples with recurrent pregnancy loss. The frequency of major chromosomal abnormalities per couple was 4.8%. Among 771 couples who had only abortions, the rate of rearrangement did not correlate with the number of abortions. The highest incidence of cytogenetic abnormalities (6.6%) was found in 256 couples with abortion and a normal child. With regard to pregnancy outcome, no unbalanced fetal karyotype was found in prenatal diagnoses, and 40 normal children were born. The risk of unbalanced fetal karyotype is therefore low, but probably high enough for these couples to be offered the possibility of a prenatal diagnosis.

  4. Fungal Biofilms, Drug Resistance, and Recurrent Infection

    PubMed Central

    Desai, Jigar V.; Mitchell, Aaron P.; Andes, David R.

    2014-01-01

    A biofilm is a surface-associated microbial community. Diverse fungi are capable of biofilm growth. The significance of this growth form for infection biology is that biofilm formation on implanted devices is a major cause of recurrent infection. Biofilms also have limited drug susceptibility, making device-associated infection extremely difficult to treat. Biofilm-like growth can occur during many kinds of infection, even when an implanted device is not present. Here we summarize the current understanding of fungal biofilm formation, its genetic control, and the basis for biofilm drug resistance. PMID:25274758

  5. Management of recurrent vulvovaginal candidiasis: unresolved issues.

    PubMed

    Sobel, Jack D

    2006-11-01

    The introduction and widespread use of long-term maintenance suppressive fluconazole prophylaxis for recurrent vulvovaginal candidiasis (RVVC) has improved the quality of life for thousands of women worldwide. Moreover, the regimen is no longer expensive, and it is safe and well tolerated. However, the regimen frequently fails to cure the condition and serves only as an effective control measure in many cases. Moreover, some women are unable to tolerate the regimen, and new curative approaches are needed. This review presents the limitations of this suppressive regimen and a discussion of the possible reasons for these limitations and failure to cure. Also, the rationale for new drug development is reviewed here.

  6. MORAb-004 in Treating Young Patients With Recurrent or Refractory Solid Tumors or Lymphoma

    ClinicalTrials.gov

    2016-01-07

    Adult Nasal Type Extranodal NK/T-cell Lymphoma; Anaplastic Large Cell Lymphoma; Angioimmunoblastic T-cell Lymphoma; Childhood Burkitt Lymphoma; Childhood Diffuse Large Cell Lymphoma; Childhood Immunoblastic Large Cell Lymphoma; Childhood Nasal Type Extranodal NK/T-cell Lymphoma; Cutaneous B-cell Non-Hodgkin Lymphoma; Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue; Hepatosplenic T-cell Lymphoma; Intraocular Lymphoma; Nodal Marginal Zone B-cell Lymphoma; Noncutaneous Extranodal Lymphoma; Peripheral T-cell Lymphoma; Post-transplant Lymphoproliferative Disorder; Recurrent Adult Burkitt Lymphoma; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent Adult Diffuse Mixed Cell Lymphoma; Recurrent Adult Diffuse Small Cleaved Cell Lymphoma; Recurrent Adult Grade III Lymphomatoid Granulomatosis; Recurrent Adult Hodgkin Lymphoma; Recurrent Adult Immunoblastic Large Cell Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Adult T-cell Leukemia/Lymphoma; Recurrent Childhood Anaplastic Large Cell Lymphoma; Recurrent Childhood Grade III Lymphomatoid Granulomatosis; Recurrent Childhood Large Cell Lymphoma; Recurrent Childhood Lymphoblastic Lymphoma; Recurrent Childhood Small Noncleaved Cell Lymphoma; Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Grade 3 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Recurrent Mycosis Fungoides/Sezary Syndrome; Recurrent Small Lymphocytic Lymphoma; Recurrent/Refractory Childhood Hodgkin Lymphoma; Refractory Hairy Cell Leukemia; Small Intestine Lymphoma; Splenic Marginal Zone Lymphoma; T-cell Large Granular Lymphocyte Leukemia; Testicular Lymphoma; Unspecified Adult Solid Tumor, Protocol Specific; Unspecified Childhood Solid Tumor, Protocol Specific; Waldenström Macroglobulinemia

  7. AZD2171 in Treating Young Patients With Recurrent, Progressive, or Refractory Primary CNS Tumors

    ClinicalTrials.gov

    2016-03-04

    Childhood Atypical Teratoid/Rhabdoid Tumor; Childhood Central Nervous System Germ Cell Tumor; Childhood Cerebral Anaplastic Astrocytoma; Childhood Cerebral Astrocytoma; Childhood Grade I Meningioma; Childhood Grade II Meningioma; Childhood Grade III Meningioma; Childhood Infratentorial Ependymoma; Childhood Oligodendroglioma; Childhood Spinal Cord Neoplasm; Childhood Supratentorial Ependymoma; Recurrent Childhood Brain Neoplasm; Recurrent Childhood Brain Stem Glioma; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Ependymoma; Recurrent Childhood Medulloblastoma; Recurrent Childhood Pineoblastoma; Recurrent Childhood Subependymal Giant Cell Astrocytoma; Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor; Recurrent Childhood Visual Pathway Glioma

  8. Recurrent chromosome 6 abnormalities in malignant mesothelioma.

    PubMed

    Ribotta, M; Roseo, F; Salvio, M; Castagneto, B; Carbone, M; Procopio, A; Giordano, A; Mutti, L

    1998-04-01

    The long latency period between asbestos exposure and the onset of malignant mesothelioma (MM) suggests that a multistep tumorigenesis process occurs whilst the capability of asbestos fibres to interfere directly with chromosomes focuses on the critical role of the chromosomal abnormalities in this neoplasm. The aim of our study was to identify any recurrent chromosomal changes in ten primary MM cell cultures derived from pleural effusions of patients with MM from the same geographic area and environmental and/or occupational exposure to asbestos fibers. Cytogenetic analysis was performed in accordance with International System for Human Cytogenetic Nomenclature. Our results confirmed a great number of cytogenetic abnormalities in MM cells. Recurrent loss of the long arms of chromosome 6 (6q-) was the most frequent abnormality detected (four epithelial and two mixed subtypes) while, on the whole, abnormalities of chromosome 6 were found in nine out of ten cases whereas chromosome 6 was normal only in the case with fibromatous subtype. Monosomy 13 and 17 was found in five cases, monosomy 14 in four cases and 22 in three cases. Since deletion of 6q- was detected even in relatively undisturbed karyotype, we hypothesize a multistep carcinogenic process in which deletion of 6q- is an early event in the development and progression of malignant mesothelioma.

  9. Nitrergic Mechanisms for Management of Recurrent Priapism

    PubMed Central

    Anele, Uzoma A.; Burnett, Arthur L.

    2015-01-01

    Introduction Priapism is a condition involving prolonged penile erection unrelated to sexual interest or desire. The ischemic type, including its recurrent variant, is often associated with both physical and psychological complications. As such, management is of critical importance. Ideal therapies for recurrent priapism should address its underlying pathophysiology. Aim To review the available literature on priapism management approaches particularly related to nitrergic mechanisms. Methods A literature review of the pathophysiology and management of priapism was performed using PubMed. Main Outcome Measure Publications pertaining to mechanisms of the molecular pathophysiology of priapism. Results Nitrergic mechanisms are characterized as major players in the molecular pathophysiology of priapism. PDE5 inhibitors represent an available therapeutic option with demonstrated ability in attenuating these underlying nitrergic derangements. Several additional signaling pathways have been found to play a role in the molecular pathophysiology of priapism and have also been associated with these nitrergic mechanisms. Conclusion An increasing understanding of the molecular pathophysiology of priapism has led to the discovery of new potential targets. Several mechanism-based therapeutic approaches may become available in the future. PMID:26478814

  10. Concept of healing of recurrent shoulder dislocation.

    PubMed

    D'Angelo, Donato

    2014-01-01

    This paper presents the main surgical techniques applied in the treatment of anterior recurrent shoulder dislocation, aiming the achievement of the normality of articulate movements. This was obtained by combining distinct surgical procedures, which allowed the recovery of a complete functional capacity of the shoulder, without jeopardizing the normality of movement, something that has not been recorded in the case of the tense sutures of the surgical procedures of Putti-Platt, Bankart, Latarjet, Dickson-O'Dell and others. The careful review of the methods applied supports the conclusion that recurrent shoulder dislocation can be cured, since cure has been obtained in 97% of the treated cases. However, some degree of limitation in the shoulder movement has been observed in most of the treated cases. Our main goal was to achieve a complete shoulder functional recovery, by treating simultaneously all of the anatomical-pathological lesions, without considering the so-called essential lesions. The period of post-operatory immobilization only last for the healing of soft parts; this takes place in a position of neutral shoulder rotation, since the use of vascular bone graft eliminates the need for long time immobilization, due to the shoulder stabilization provided by rigid fixation of the coracoid at the glenoid edge, as in the Latarjet's technique. Our procedure, used since 1959, comprises the association of several techniques, which has permitted shoulder healing without movement limitation. That was because of the tension reduction in the sutures of the subescapularis, capsule, and coracobraquialis muscles.

  11. Timing and recurrence interval of Himalayan landslides

    NASA Astrophysics Data System (ADS)

    Pachauri, A. K.

    2009-04-01

    Himalayan landsldies have been occurring since the 55 million years ever since the Hinmlayan mountains came into being. The fact is that Himalayas are rising even today at the rate of a few cm per year as supported by the Indian Plate mtion measured by GPS. The recurrence of landsldies has not beeen documented even for well known landsldies and therefore the Border Road Organisation and Public Works departments of India are unable to realise the value of the data as the records are scanty and not formalised. There is a need to establish a data bank for landslides and debris flows as well as landslide related disasters in himalayas so that moelling for recurrence can be done. Some intersting examples of the landslides after the Chamoli earthquake are good examples of landsldies that occurred after several weeks of the earthquake at Chamoli as studied by the author. The present paper proposes the need for the analyses and a program that can be chalked out to prognasticate landslide occurrence.

  12. Genetics of Recurrent Vertigo and Vestibular Disorders

    PubMed Central

    Gazquez, Irene; Lopez-Escamez, Jose A

    2011-01-01

    We present recent advances in the genetics of recurrent vertigo, including familial episodic ataxias, migraneous vertigo, bilateral vestibular hypofunction and Meniere’s disease. Although several vestibular disorders are more common within families, the genetics of vestibulopathies is largely not known. Genetic loci and clinical features of familial episodic ataxias have been defined in linkage disequilibrium studies with mutations in neuronal genes KCNA1 and CACNA1A. Migrainous vertigo is a clinical disorder with a high comorbidity within families much more common in females with overlapping features with episodic ataxia and migraine. Bilateral vestibular hypofunction is a heterogeneous clinical group defined by episodes of vertigo leading to progressive loss of vestibular function which also can include migraine. Meniere’s disease is a clinical syndrome characterized by spontaneous episodes of recurrent vertigo, sensorineural hearing loss, tinnitus and aural fullness and familial Meniere’s disease in around 10-20% of cases. An international collaborative effort to define the clinical phenotype and recruiting patients with migrainous vertigo and Meniere’s disease is ongoing for genome-wide association studies. PMID:22379397

  13. The causes of recurrent geomagnetic storms

    NASA Technical Reports Server (NTRS)

    Burlaga, L. F.; Lepping, R. P.

    1976-01-01

    The causes of recurrent geomagnetic activity were studied by analyzing interplanetary magnetic field and plasma data from earth-orbiting spacecraft in the interval from November 1973 to February 1974. This interval included the start of two long sequences of geomagnetic activity and two corresponding corotating interplanetary streams. In general, the geomagnetic activity was related to an electric field which was due to two factors: (1) the ordered, mesoscale pattern of the stream itself, and (2) random, smaller-scale fluctuations in the southward component of the interplanetary magnetic field Bz. The geomagnetic activity in each recurrent sequence consisted of two successive stages. The first stage was usually the most intense, and it occurred during the passage of the interaction region at the front of a stream. These large amplitudes of Bz were primarily produced in the interplanetary medium by compression of ambient fluctuations as the stream steepened in transit to 1 A.U. The second stage of geomagnetic activity immediately following the first was associated with the highest speeds in the stream.

  14. [Intraductal papillary mucinous neoplasm and recurrent pancreatitis].

    PubMed

    Gálvez, Eduardo; Gálvez, Gustavo; Barboza, Aurelio; Barboza, Eduardo; Combe, Juan Manuel; Combe, Mario R; Combe, Juan; Arias Stella C, Javier; Arias Stella, Javier

    2013-01-01

    Ohashi described for the first time the IPMN on 1982 as a pancreatic neoplasia with mucine cells forming papillae and producing dilatation of the main pancreatic duct or its branches. The IPMN represent the 1% of the pancreatic tumors and 5% of the cystic neoplasias. It is potentially malignant in a period of five years being more frequent in males between 60-70 and clinically these patients' presents as acute, recurrent or chronic pancreatitis, with an incidence of malignancy from 25% to 70%. CT scan and cholangio MRI allows the diagnosis, the variety, localization and possibility of determine malignancy. The treatment is the Whipple resection. We are reporting the case of an obese middle age male, being observed along the last 10 years because of recurrent pancreatitis with a cystic lesion of the head of the pancreas. The CT scan, endoscopic-ultrasound and the analysis of the liquid content suggested a mucinous lesion, reason why the patient underwent a pancreatic-duodenal resection. The histology study confirms the diagnosis of IPMN.

  15. Hereditary Amyloidosis with Recurrent Lung Infiltrates

    PubMed Central

    Revelo, Alberto E.; Magaspi, Crischelle; Maguire, George; Aronow, Wilbert S.

    2016-01-01

    Patient: Male, 51 Final Diagnosis: Familial amyloidotic polyneuropathy with lung involvement Symptoms: Cough • dyspnea • lethargy Medication: Diflunisal Clinical Procedure: Fiberoptic bronchoscopy with trans-bronchial biopsy Specialty: Pulmonary Medicine Objective: Rare co-existance of disease or patholog Background: Amyloidosis is a protein conformational disorder characterized by extracellular deposition of amyloid fibrils in extracellular tissue. Lung involvement is most commonly caused by secondary AL amyloidosis. The familial autosomal-dominant senile transthyretin (ATTR) disease manifests mainly as polyneuropathy and restrictive cardiomyopathy denoting the name familial amyloidotic polyneuropathy (FAP). Rarely, this form manifests with clinical and radiologically relevant respiratory tract symptoms and lung involvement. Case Report: A 51-year-old male former smoker presented with progressive lower-extremity weakness of several months’ duration. He was ultimately diagnosed with chronic demyelinating polyneuropathy and treated with intravenous immunoglobulin therapy. Subsequently, he was admitted with heart failure symptoms and pulmonary infiltrates and his echocardiogram showed a ‘myocardial speckled pattern’, prompting an endomyocardial biopsy, which showed transthyretin amyloid deposition. He was started on diflunisal. Additionally, serial radiographic imaging of his chest over 3 different admissions for cough, dyspnea, hypoxemia, and lethargy demonstrated recurrent pulmonary infiltrates. A fiberoptic bronchoscopy with trans-bronchial biopsies revealed amyloid deposition in the lung tissue. Conclusions: The clinical presentation of recurrent or persistent pulmonary symptoms and fleeting infiltrates on imaging in a patient with familial amyloidotic polyneuropathy is not common; when present, it should raise the suspicion of respiratory tract involvement. PMID:27872470

  16. Recurrent elbow dislocation--an uncommon presentation.

    PubMed

    Sunderamoorthy, D; Smith, A; Woods, D A

    2005-09-01

    A 58 year old female attended our A&E department following a fall in the garden with swelling and bruising of the right arm and the elbow. Anteroposterior and lateral radiographs were interpreted as showing a normal elbow joint. A diagnosis of soft tissue injury to the elbow was made and the patient was discharged with advice. She returned 2 days later, did not have an x ray, and again given advice. Three weeks later she was referred back to A&E by the general practitioner with persistent swelling of the elbow. Further radiographs showed a posterolateral dislocation of the elbow. The elbow was reduced under sedation but was subsequently dislocated at follow up, and was treated by external fixator and transolecranon pin. The fixator was removed at 4 weeks and the elbow was then stable. This case highlights that recurrent elbow dislocations due to significant ligament injuries can present in joint and subsequently dislocate. A high index of suspicion is necessary and appropriate referral to the specialist must be made to avoid the morbidity associated with recurrent dislocation. It also emphasises the need to always assess the patient on his or her own merits despite previously normal investigations.

  17. Collective stochastic coherence in recurrent neuronal networks

    NASA Astrophysics Data System (ADS)

    Sancristóbal, Belén; Rebollo, Beatriz; Boada, Pol; Sanchez-Vives, Maria V.; Garcia-Ojalvo, Jordi

    2016-09-01

    Recurrent networks of dynamic elements frequently exhibit emergent collective oscillations, which can show substantial regularity even when the individual elements are considerably noisy. How noise-induced dynamics at the local level coexists with regular oscillations at the global level is still unclear. Here we show that a combination of stochastic recurrence-based initiation with deterministic refractoriness in an excitable network can reconcile these two features, leading to maximum collective coherence for an intermediate noise level. We report this behaviour in the slow oscillation regime exhibited by a cerebral cortex network under dynamical conditions resembling slow-wave sleep and anaesthesia. Computational analysis of a biologically realistic network model reveals that an intermediate level of background noise leads to quasi-regular dynamics. We verify this prediction experimentally in cortical slices subject to varying amounts of extracellular potassium, which modulates neuronal excitability and thus synaptic noise. The model also predicts that this effectively regular state should exhibit noise-induced memory of the spatial propagation profile of the collective oscillations, which is also verified experimentally. Taken together, these results allow us to construe the high regularity observed experimentally in the brain as an instance of collective stochastic coherence.

  18. Recurrent Monostotic Fibrous Dysplasia in the Mandible

    PubMed Central

    de Oliveira, Reinaldo José; Takehana, Denise; Deana, Naira Figueiredo

    2016-01-01

    Fibrous dysplasia (FD) is a condition in which normal bone marrow is replaced by an abnormal proliferation of new fibrous connective tissue. Female patient, white, 20 years old, attended the dental clinic reporting a slow increase in volume in the right mandible region over the last 5 years. She was examined by imaging: the panoramic X-ray revealed a lesion with the appearance of ground glass while the cone-beam computed tomography showed an extensive lesion in the region of the right hemimandible. The histopathological examination was compatible with fibrous dysplasia. Bone gammagraphy was indicated, plus an endocrinological study to eliminate polyostotic forms, which produced a negative result. Monostotic fibrous dysplasia in the right hemimandible was diagnosed. Conservative surgery was carried out and after 1 year recurrence of the tumour was observed. We may conclude that conservative surgery might not be the best choice for treatment for monostotic fibrous dysplasia in the mandible and that other options must be considered, such as radical surgery or the use of bisphosphonates. In our study, we may also conclude that it is very important to explain to the patient the possibility of recurrence of the lesion and the need for monitoring with periodic imaging studies. PMID:27340572

  19. [Chronic recurrent multifocal osteomyelitis with interstitial myositis].

    PubMed

    Nagashima, Saori; Nozawa, Tomo; Kizawa, Toshitaka; Kikuchi, Masako; Miyamae, Takako; Imagawa, Tomoyuki; Inaba, Hiroshi; Sato, Tatsuharu; Hashimoto, Kunio; Aida, Noriko; Yokota, Shumpei

    2013-01-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory, non-infectious disorder of skeletal system mainly seen in children. We report a case of CRMO presenting with fever and leg pain. The patient was an 11-year-old boy complaining of a fever, swelling and pain on his right foot, and pain on both legs. Although serum levels of CK and aldolase were not increased, MRI imaging suggested polymyositis. Muscle biopsy showed interstitial infiltration of inflammatory cells without any evidences of dermatomyositis or polymyositis. One month later, he complained of a swelling, pain and redness of his left clavicle as recurrently experienced during the recent 6 months, and MRI investigation indicated the diagnosis of osteomyelitis. Bone biopsy was performed and showed chronic inflammatory changes with negative bacterial culture. Multiple bone lesions and muscle uptake of FDG in his legs were revealed by whole body FDG-PET/CT, and he was diagnosed as having CRMO with interstitial myositis. The combinatorial administration of non-steroidal anti-inflammatory drugs and bisphosphonate successfully improved his clinical symptoms and laboratory abnormalities. To our knowledge, there is no report of a patient of CRMO associated with interstitial myositis.

  20. Memory replay in balanced recurrent networks

    PubMed Central

    Chenkov, Nikolay; Sprekeler, Henning; Kempter, Richard

    2017-01-01

    Complex patterns of neural activity appear during up-states in the neocortex and sharp waves in the hippocampus, including sequences that resemble those during prior behavioral experience. The mechanisms underlying this replay are not well understood. How can small synaptic footprints engraved by experience control large-scale network activity during memory retrieval and consolidation? We hypothesize that sparse and weak synaptic connectivity between Hebbian assemblies are boosted by pre-existing recurrent connectivity within them. To investigate this idea, we connect sequences of assemblies in randomly connected spiking neuronal networks with a balance of excitation and inhibition. Simulations and analytical calculations show that recurrent connections within assemblies allow for a fast amplification of signals that indeed reduces the required number of inter-assembly connections. Replay can be evoked by small sensory-like cues or emerge spontaneously by activity fluctuations. Global—potentially neuromodulatory—alterations of neuronal excitability can switch between network states that favor retrieval and consolidation. PMID:28135266

  1. New geological perspectives on earthquake recurrence models

    SciTech Connect

    Schwartz, D.P.

    1997-02-01

    In most areas of the world the record of historical seismicity is too short or uncertain to accurately characterize the future distribution of earthquakes of different sizes in time and space. Most faults have not ruptured once, let alone repeatedly. Ultimately, the ability to correctly forecast the magnitude, location, and probability of future earthquakes depends on how well one can quantify the past behavior of earthquake sources. Paleoseismological trenching of active faults, historical surface ruptures, liquefaction features, and shaking-induced ground deformation structures provides fundamental information on the past behavior of earthquake sources. These studies quantify (a) the timing of individual past earthquakes and fault slip rates, which lead to estimates of recurrence intervals and the development of recurrence models and (b) the amount of displacement during individual events, which allows estimates of the sizes of past earthquakes on a fault. When timing and slip per event are combined with information on fault zone geometry and structure, models that define individual rupture segments can be developed. Paleoseismicity data, in the form of timing and size of past events, provide a window into the driving mechanism of the earthquake engine--the cycle of stress build-up and release.

  2. Intrinsic adaptation in autonomous recurrent neural networks.

    PubMed

    Marković, Dimitrije; Gros, Claudius

    2012-02-01

    A massively recurrent neural network responds on one side to input stimuli and is autonomously active, on the other side, in the absence of sensory inputs. Stimuli and information processing depend crucially on the quality of the autonomous-state dynamics of the ongoing neural activity. This default neural activity may be dynamically structured in time and space, showing regular, synchronized, bursting, or chaotic activity patterns. We study the influence of nonsynaptic plasticity on the default dynamical state of recurrent neural networks. The nonsynaptic adaption considered acts on intrinsic neural parameters, such as the threshold and the gain, and is driven by the optimization of the information entropy. We observe, in the presence of the intrinsic adaptation processes, three distinct and globally attracting dynamical regimes: a regular synchronized, an overall chaotic, and an intermittent bursting regime. The intermittent bursting regime is characterized by intervals of regular flows, which are quite insensitive to external stimuli, interceded by chaotic bursts that respond sensitively to input signals. We discuss these findings in the context of self-organized information processing and critical brain dynamics.

  3. Risk Factors for Recurrent Lumbar Disc Herniations

    PubMed Central

    2014-01-01

    The most common complication after lumbar discectomy is reherniation. As the first step in reducing the rate of recurrence, many studies have been conducted to find out the factors that may increase the reherniation risk. Some reported factors are age, sex, the type of lumbar disc herniation, the amount of fragments removed, smoking, alcohol consumption and the length of restricted activities. In this review, the factors studied thus far are summarized, excepting factors which cannot be chosen or changed, such as age or sex. Apart from the factors shown here, many other risk factors such as diabetes, family history, history of external injury, duration of illness and body mass index are considered. Few are agreed upon by all. The reason for the diverse opinions may be that many clinical and biomechanical variables are involved in the prognosis following operation. For the investigation of risk factors in recurrent lumbar disc herniation, large-scale multicenter prospective studies will be required in the future. PMID:24761206

  4. Risk Factors for Recurrent Lumbar Disc Herniation

    PubMed Central

    Huang, Weimin; Han, Zhiwei; Liu, Jiang; Yu, Lili; Yu, Xiuchun

    2016-01-01

    Abstract Recurrent lumbar disc herniation (rLDH) is a common complication following primary discectomy. This systematic review aimed to investigate the current evidence on risk factors for rLDH. Cohort or case-control studies addressing risk factors for rLDH were identified by search in Pubmed (Medline), Embase, Web of Science, and Cochrane library from inception to June 2015. Relevant results were pooled to give overall estimates if possible. Heterogeneity among studies was examined and publication bias was also assessed. A total of 17 studies were included in this systematic review. Risk factors that had significant relation with rLDH were smoking (OR 1.99, 95% CI 1.53–2.58), disc protrusion (OR 1.79, 95% CI 1.15–2.79), and diabetes (OR 1.19, 95% CI 1.06–1.32). Gender, BMI, occupational work, level, and side of herniation did not correlate with rLDH significantly. Based on current evidence, smoking, disc protrusion, and diabetes were predictors for rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery. More evidence provided by high-quality observational studies is still needed to further investigate risk factors for rLDH. PMID:26765413

  5. [Medical treatment of ureteral calculi].

    PubMed

    Vaessen, C; Roumeguere, T; Simon, J; Schulman, C

    1997-10-01

    Antiinflammatory drugs are the first choice in the treatment of the acute nephretic colic. This is due to their fast and direct action on the ureteral wall. The use of antispasmodics are still controversial and opioïds are not indicated. During the acute crisis, an hydric restriction should be associated to the medical treatment. After the crisis an increase of diuresis could help to "wash out" the stone. A spontaneous elimination can be expected, especially if the stone is small and located in the third part of the ureter. The ureteral rupture is rare but serious and must be treated by antibiotics and some time to be drained. The rapidity of a more aggressive treatment is function of numerous factors.

  6. Recurrence of initial state of nonlinear ion waves

    SciTech Connect

    Abe, K.; Satofuka, N.

    1981-06-01

    By solving the Korteweg--deVries equation in a wide range of the ratio between the nonlinearity and the dispersion, the recurrence of the initial state of the ion wave is examined. The recurrence is assured of taking place only when the dispersion of the initial ion wave predominates over the nonlinearity. If the initial wave has strong nonlinearity compared with the dispersion, the recurrence is indistinct, and the initial monochromatic wave evolves to a turbulent state.

  7. A Practical Approach to Preventing Postoperative Recurrence in Crohn's Disease.

    PubMed

    Hashash, Jana G; Regueiro, Miguel

    2016-05-01

    Postoperative Crohn's disease recurrence remains common, and preventing additional surgery remains a challenge. A critical step to postoperative management of Crohn's disease is being able to identify patients who should receive immediate postoperative therapy from the patients who can wait for recurrence prior to starting medications. All patients, regardless of their risk for recurrence, are advised to undergo a colonoscopy at 6 to 12 months after surgery to evaluate for endoscopic evidence of Crohn's disease. Further management of patients depends on symptoms and the presence or absence of endoscopic recurrence.

  8. Trebananib in Treating Patients With Persistent or Recurrent Endometrial Cancer

    ClinicalTrials.gov

    2016-02-10

    Endometrial Adenocarcinoma; Endometrial Adenosquamous Carcinoma; Endometrial Clear Cell Adenocarcinoma; Endometrial Endometrioid Adenocarcinoma, Variant With Squamous Differentiation; Endometrial Serous Adenocarcinoma; Endometrioid Stromal Sarcoma; Recurrent Uterine Corpus Carcinoma

  9. Recurrent mandibular ameloblastoma with anterior skull base invasion: Case report.

    PubMed

    Santini, L; Varoquaux, A; Giovanni, A; Dessi, P; Michel, J

    2015-01-01

    Recurrent ameloblastoma with skull base invasion is a rare clinical entity with poor prognosis. We report a case of a mandibular ameloblastoma recurrence involving the anterior skull base. The diagnostic and therapeutic processes are presented with emphasis on the radiologic features of ameloblastoma. Another aim of this case report is to underline the importance of close and long-term follow-up after resection. Ameloblastoma recurrences are frequent and mainly occur after incomplete surgical resection. These recurrences may be diagnosed late because of lack of symptoms in the mandibular area.

  10. Ornithine transcarbamylase deficiency presenting as recurrent abdominal pain in childhood.

    PubMed

    Mhanni, Aizeddin A; Prasad, Chitra; Rockman-Greenberg, Cheryl

    2011-09-01

    Recurrent abdominal pain remains one of the most common symptoms in pediatrics. We present the case of a 3-year-old girl who had recurrent episodes of abdominal pain requiring more than 13 visits to the emergency department. A diagnosis of ornithine transcarbamylase deficiency was eventually made. Urea cycle disorders often present beyond the neonatal period with frequent vomiting episodes; however, recurrent abdominal pain as a presenting symptom is unusual. Unnecessary invasive investigations of recurrent abdominal pain in childhood can be avoided by considering inborn errors of metabolism earlier in the differential diagnosis.

  11. An application of recurrent nets to phone probability estimation.

    PubMed

    Robinson, A J

    1994-01-01

    This paper presents an application of recurrent networks for phone probability estimation in large vocabulary speech recognition. The need for efficient exploitation of context information is discussed; a role for which the recurrent net appears suitable. An overview of early developments of recurrent nets for phone recognition is given along with the more recent improvements that include their integration with Markov models. Recognition results are presented for the DARPA TIMIT and Resource Management tasks, and it is concluded that recurrent nets are competitive with traditional means for performing phone probability estimation.

  12. A Brownian model for recurrent earthquakes

    USGS Publications Warehouse

    Matthews, M.V.; Ellsworth, W.L.; Reasenberg, P.A.

    2002-01-01

    We construct a probability model for rupture times on a recurrent earthquake source. Adding Brownian perturbations to steady tectonic loading produces a stochastic load-state process. Rupture is assumed to occur when this process reaches a critical-failure threshold. An earthquake relaxes the load state to a characteristic ground level and begins a new failure cycle. The load-state process is a Brownian relaxation oscillator. Intervals between events have a Brownian passage-time distribution that may serve as a temporal model for time-dependent, long-term seismic forecasting. This distribution has the following noteworthy properties: (1) the probability of immediate rerupture is zero; (2) the hazard rate increases steadily from zero at t = 0 to a finite maximum near the mean recurrence time and then decreases asymptotically to a quasi-stationary level, in which the conditional probability of an event becomes time independent; and (3) the quasi-stationary failure rate is greater than, equal to, or less than the mean failure rate because the coefficient of variation is less than, equal to, or greater than 1/???2 ??? 0.707. In addition, the model provides expressions for the hazard rate and probability of rupture on faults for which only a bound can be placed on the time of the last rupture. The Brownian relaxation oscillator provides a connection between observable event times and a formal state variable that reflects the macromechanics of stress and strain accumulation. Analysis of this process reveals that the quasi-stationary distance to failure has a gamma distribution, and residual life has a related exponential distribution. It also enables calculation of "interaction" effects due to external perturbations to the state, such as stress-transfer effects from earthquakes outside the target source. The influence of interaction effects on recurrence times is transient and strongly dependent on when in the loading cycle step pertubations occur. Transient effects may

  13. Recurrent unilateral headache associated with SAPHO syndrome.

    PubMed

    Tsugawa, Jun; Ouma, Shinji; Fukae, Jiro; Tsuboi, Yoshio

    2014-01-01

    A 57-year-old woman was admitted with recurrent episodes of right frontal headache. Head magnetic resonance imaging (MRI) revealed extensive thickening and enhancement of the right frontal dura, muscle and fascia, as well as abnormal signal intensity and enhancement of bone marrow at the lesions. Synovitis-acne-pustulosis-hyperostosis osteomyelitis (SAPHO) syndrome was diagnosed based on the patient's 8-year history of treatment of palmoplantar pustulosis and abnormal accumulations in the right temporal, sternum, and left medial clavicula on bone scintigraphy. SAPHO syndrome may be associated with skull lesions, which can contribute to the onset of repeated headache or dural thickening, thus these symptoms should be recognized as manifestations of this syndrome.

  14. Rhythmicity, recurrence, and recovery of flagellar beating

    NASA Astrophysics Data System (ADS)

    Wan, Kirsty; Goldstein, Raymond

    2015-03-01

    The eukaryotic flagellum beats with apparently unfailing periodicity, yet responds rapidly to stimuli. Like the human heartbeat, flagellar oscillations are now known to be noisy. Using the unicellular alga Chlamydomonas reinhardtii, we explore three aspects of nonuniform flagellar beating. We report the existence of rhythmicity, waveform noise peaking at transitions between power and recovery strokes, and fluctuations of interbeat intervals that are correlated and even recurrent, with memory extending to hundreds of beats. These features are altered qualitatively by physiological perturbations. Further, we quantify the recovery of periodic breaststroke beating from transient hydrodynamic forcing. These results will help constrain microscopic theories on the origins and regulation of flagellar beating. Financial support is acknowledged from the EPSRC, ERC Advanced Investigator Grant No. 247333, and a Senior Investigator Award from the Wellcome Trust.

  15. Recurrent adverse pregnancy outcome and antiphospholipid antibodies.

    PubMed

    Reece, E A; Gabrielli, S; Cullen, M T; Zheng, X Z; Hobbins, J C; Harris, E N

    1990-07-01

    Antiphospholipid antibodies, which include lupus-like anticoagulant and anticardiolipin antibody, have been linked to a number of adverse pregnancy outcomes, although their exact pathogenic mechanisms remain poorly defined. The relative risk of complications such as intrauterine growth retardation, spontaneous abortions, and stillbirth in patients with antiphospholipid antibodies also remains undetermined. Heightened attention has been focused on the association, leading to investigations into the pathogenesis. Uncontrolled studies have also explored therapeutic regimens such as aspirin, steroids, and heparin, and clinical trials have used various treatment protocols. Although knowledge into the association of antiphospholipid antibodies and recurrent adverse pregnancy outcome is limited and continues to evolve, this association provides new insights into the disease and offers promise for pharmacologic prophylaxis. In this article, current concepts on pathogenesis, diagnosis, and therapy are reviewed and recommendations are made for clinical care of these patients.

  16. Equine recurrent uveitis: the European viewpoint.

    PubMed

    Spiess, B M

    2010-03-01

    Equine recurrent uveitis (ERU) has always been and still is an important disease with a significant impact on the horse industry in Europe, with a prevalence of 8-10%. The need to understand and manage the disease has spurred the development of veterinary ophthalmology in general, although the aetiology of the disease remains the subject of intense discussion. It is most probably an autoimmune disease triggered, at least in Europe, in the majority of cases by Leptospira spp. The therapy of ERU has evolved over the centuries from various methods of bloodletting to rational medical therapy using mydriatics and steroidal and nonsteroidal anti-inflammatory drugs, to surgical therapies, such as vitrectomy or implantation of cyclosporin-releasing devices. In Europe, pars plana vitrectomy in horses testing positive for Leptospira spp. appears to be the most successful form of therapy at the present time.

  17. Ocular immunology in equine recurrent uveitis.

    PubMed

    Deeg, Cornelia A

    2008-09-01

    Equine recurrent uveitis (ERU) is a disease with high prevalence and relevance for the equine population, since it results in blindness. Over the last decade, important advancements have been made in our understanding of the underlying immune responses in this disease. ERU is mediated by an autoaggressive Th1 response directed against several retinal proteins. Interphotoreceptor-retinoid binding protein (IRBP) and cellular retinaldehyde-binding protein (CRALBP) are capable to induce ERU-like disease in experimental horses, with the unique possibility to activate relapses in a well-defined manner. Further, proteomic evidence now suggests that retinal Mueller glial cells (RMG) may play a fatal role in uveitic disease progression by directly triggering inflammation processes through the expression and secretion of interferon-gamma. Ongoing relapses in blind eyes can be associated with stable expression of the major autoantigens in ERU retinas. This review briefly summarizes the most significant developments in uveitis immune response research.

  18. Patterns of Regional Recurrence After Definitive Radiotherapy for Cervical Cancer

    SciTech Connect

    Beadle, Beth M.; Jhingran, Anuja; Yom, Sue S.; Ramirez, Pedro T.; Eifel, Patricia J.

    2010-04-15

    Purpose: To determine the patterns of regional recurrence in patients treated with definitive radiotherapy (RT) for cervical cancer. Methods and Materials: The records of 198 patients treated with definitive RT for cervical cancer between 1980 and 2000 who experienced a regional recurrence without a central or distal vaginal recurrence were reviewed. All patients received a combination of external-beam RT and intracavitary brachytherapy. In the 180 patients with a documented location of regional recurrence, the relationship between the recurrence and the radiation fields was determined. Results: The median time to regional recurrence was 13 months (range, 2-85 months). Of the 180 patients who had an evaluable regional recurrence, 119 (66%) had a component of marginal failure; 71 patients recurred above-the-field, 2 patients occurred in the inguinal nodes, and 2 patients recurred above-the-field and in the inguinal nodes. In addition, 105 patients (58%) had a component of in-field failure; 59 patients recurred in-field only, 39 patients recurred in-field and above-the-field, 2 patients recurred in-field, above-the-field, and in the inguinal nodes, and 5 patients recurred in-field and in the inguinal nodes. The median survival after regional recurrence was 8 months (range, 0-194 months). Conclusions: Most regional recurrences after definitive RT for cervical cancer include a component of marginal failure, usually immediately superior to the radiation field. These recurrences suggest a deficiency in target volume. Recurrences also occur in-field, suggesting a deficiency in dose. Developments in pretreatment staging, field delineation, dose escalation, and posttreatment surveillance may help to improve outcome in these patients.

  19. Immunohistochemical studies in equine recurrent uveitis (ERU).

    PubMed

    Romeike, A; Brügmann, M; Drommer, W

    1998-11-01

    Despite extensive clinical research, the etiology of equine recurrent uveitis (ERU) is still unknown. After an immunologic pathogenesis was established in recurrent uveitis in humans, a similar pathogenic mechanism was assumed to exist in ERU. To investigate whether immunopathologic mechanisms are involved in ERU, 20 eyes of 15 horses with ERU were examined immunohistochemically with a T cell marker, B cell marker, and anti-major histocompatibility complex (MHC) class II antibodies. Twenty-six eyes of 20 horses were used for investigation of MHC class II antigen expression in normal equine eyes. In 18 eyes of 14 horses, the number of T cells in the inflammatory cell population within the uvea was assessed. In 16/18 eyes (89%), the T lymphocyte fraction was > 70%. This cell population was distributed mostly in a diffuse manner throughout the uvea and also within the mantle zone of follicular lymphocytic aggregates. Foci of B lymphocytes could be found within the center of follicular aggregates in three eyes. The expression of MHC class II antigen on resident ocular cells was evaluated in 10 eyes of six horses with ERU. An increase of MHC class II antigen expression in the trabecular meshwork and on the nonpigmented ciliary epithelium was noted as was a deviant expression on proliferating Müller cells and retinal pigment epithelial cells. The predominance of T cells in the inflammatory infiltrates supports the central role of a cell-mediated immune response. Furthermore, the observation of a deviant MHC class II expression on resident ocular cells suggests that aberrant immune regulation may play a role in the pathogenesis of ERU.

  20. Temozolomide and O6-Benzylguanine in Treating Children With Recurrent Brain Tumors

    ClinicalTrials.gov

    2013-09-27

    Childhood Central Nervous System Germ Cell Tumor; Childhood Choroid Plexus Tumor; Childhood Craniopharyngioma; Childhood Ependymoblastoma; Childhood Grade I Meningioma; Childhood Grade II Meningioma; Childhood Grade III Meningioma; Childhood High-grade Cerebellar Astrocytoma; Childhood High-grade Cerebral Astrocytoma; Childhood Infratentorial Ependymoma; Childhood Low-grade Cerebellar Astrocytoma; Childhood Low-grade Cerebral Astrocytoma; Childhood Medulloepithelioma; Childhood Mixed Glioma; Childhood Oligodendroglioma; Childhood Supratentorial Ependymoma; Recurrent Childhood Brain Stem Glioma; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Ependymoma; Recurrent Childhood Medulloblastoma; Recurrent Childhood Pineoblastoma; Recurrent Childhood Subependymal Giant Cell Astrocytoma; Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor; Recurrent Childhood Visual Pathway and Hypothalamic Glioma

  1. Lenalidomide in Treating Young Patients With Recurrent, Progressive, or Refractory CNS Tumors

    ClinicalTrials.gov

    2013-09-27

    Childhood Atypical Teratoid/Rhabdoid Tumor; Childhood Central Nervous System Germ Cell Tumor; Childhood Choroid Plexus Tumor; Childhood Craniopharyngioma; Childhood Ependymoblastoma; Childhood Grade I Meningioma; Childhood Grade II Meningioma; Childhood Grade III Meningioma; Childhood High-grade Cerebellar Astrocytoma; Childhood High-grade Cerebral Astrocytoma; Childhood Infratentorial Ependymoma; Childhood Low-grade Cerebellar Astrocytoma; Childhood Low-grade Cerebral Astrocytoma; Childhood Medulloepithelioma; Childhood Mixed Glioma; Childhood Oligodendroglioma; Childhood Supratentorial Ependymoma; Recurrent Childhood Brain Tumor; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Ependymoma; Recurrent Childhood Medulloblastoma; Recurrent Childhood Pineoblastoma; Recurrent Childhood Subependymal Giant Cell Astrocytoma; Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor; Recurrent Childhood Visual Pathway and Hypothalamic Glioma

  2. FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia

    ClinicalTrials.gov

    2013-01-15

    Blastic Phase Chronic Myelogenous Leukemia; Childhood Central Nervous System Germ Cell Tumor; Childhood Choroid Plexus Tumor; Childhood Chronic Myelogenous Leukemia; Childhood Craniopharyngioma; Childhood Grade I Meningioma; Childhood Grade II Meningioma; Childhood Grade III Meningioma; Childhood High-grade Cerebral Astrocytoma; Childhood Infratentorial Ependymoma; Childhood Low-grade Cerebral Astrocytoma; Childhood Spinal Cord Neoplasm; Childhood Supratentorial Ependymoma; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Recurrent Childhood Brain Stem Glioma; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Ependymoma; Recurrent Childhood Medulloblastoma; Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor; Recurrent Childhood Visual Pathway and Hypothalamic Glioma; Refractory Chronic Lymphocytic Leukemia; Relapsing Chronic Myelogenous Leukemia; Unspecified Childhood Solid Tumor, Protocol Specific

  3. Recurrent Otitis Media and Attachment Security: A Path Model.

    ERIC Educational Resources Information Center

    McCallum, Michelle S.; McKim, Margaret K.

    1999-01-01

    Used regular telephone interviews over six months to examine processes through which recurrent episodes of otitis media influence children's attachment security. Found that recurrent otitis media negatively affected attachment security by increasing mothers' perceptions of their children as behaving more negatively. Parenting stress was not…

  4. Recurrent Education: "Apple Pie" ...or..."Atomic Bomb"?

    ERIC Educational Resources Information Center

    Day, William L.

    The author conceptualizes recurrent education as organized, structured, institutionally sponsored learning activities with intentional outcomes, which are distributed over the life span of the individual in a recurring way. Some problems to which recurrent education proposes solutions include: alienation at the inter-generational level,…

  5. Recurrent Education: Policy and Development in OECD Member Countries. Japan.

    ERIC Educational Resources Information Center

    Moro-oka, Kazufusa

    The report on recurrent education in Japan is one of a series describing continuation education in OECD member countries. Intended as a means of liberating individuals from the education-work-leisure-retirement sequence, recurrent education provides freedom to mix and alternate these phases of life within the limits of the socially possible.…

  6. Prediction of Prostate Cancer Recurrence Using Quantitative Phase Imaging

    NASA Astrophysics Data System (ADS)

    Sridharan, Shamira; Macias, Virgilia; Tangella, Krishnarao; Kajdacsy-Balla, André; Popescu, Gabriel

    2015-05-01

    The risk of biochemical recurrence of prostate cancer among individuals who undergo radical prostatectomy for treatment is around 25%. Current clinical methods often fail at successfully predicting recurrence among patients at intermediate risk for recurrence. We used a label-free method, spatial light interference microscopy, to perform localized measurements of light scattering in prostatectomy tissue microarrays. We show, for the first time to our knowledge, that anisotropy of light scattering in the stroma immediately adjoining cancerous glands can be used to identify patients at higher risk for recurrence. The data show that lower value of anisotropy corresponds to a higher risk for recurrence, meaning that the stroma adjoining the glands of recurrent patients is more fractionated than in non-recurrent patients. Our method outperformed the widely accepted clinical tool CAPRA-S in the cases we interrogated irrespective of Gleason grade, prostate-specific antigen (PSA) levels and pathological tumor-node-metastasis (pTNM) stage. These results suggest that QPI shows promise in assisting pathologists to improve prediction of prostate cancer recurrence.

  7. Food Allergy: A Rare Cause of Recurrent Intussusception

    PubMed Central

    Beşer, Ömer Faruk

    2017-01-01

    Recurrent intussusception is a management dilemma and have many causes. We report a 22-month old boy who presented multiple times for recurrent intussusception. At diagnostic work-up he was found to be suffering from non-IgE food allergy. The child did not develop further episodes of intussusception after removal of allergenic diet. PMID:28163999

  8. Recurrent Education: Policy and Development in OECD Member Countries. Denmark.

    ERIC Educational Resources Information Center

    Hansen, Berrit

    The report on recurrent education in Denmark is one of a series describing continuation education in OECD member countries. Intended as a means of liberating individuals from the education-work-leisure-retirement sequence, recurrent education provides freedom to mix and alternate these phases of life within the limits of the socially possible.…

  9. Palifosfamide in Treating Patients With Recurrent Germ Cell Tumors

    ClinicalTrials.gov

    2015-06-11

    Adult Central Nervous System Germ Cell Tumor; Adult Teratoma; Malignant Extragonadal Germ Cell Tumor; Malignant Extragonadal Non-Seminomatous Germ Cell Tumor; Extragonadal Seminoma; Recurrent Malignant Testicular Germ Cell Tumor; Recurrent Ovarian Germ Cell Tumor; Stage IV Extragonadal Non-Seminomatous Germ Cell Tumor; Stage IV Extragonadal Seminoma; Stage IV Ovarian Germ Cell Tumor

  10. Tipifarnib in Treating Young Patients With Recurrent or Progressive High-Grade Glioma, Medulloblastoma, Primitive Neuroectodermal Tumor, or Brain Stem Glioma

    ClinicalTrials.gov

    2013-10-07

    Childhood High-grade Cerebral Astrocytoma; Childhood Oligodendroglioma; Recurrent Childhood Brain Stem Glioma; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Medulloblastoma; Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor; Recurrent Childhood Visual Pathway and Hypothalamic Glioma

  11. Agatolimod Sodium, Rituximab, and Yttrium Y 90 Ibritumomab Tiuxetan in Treating Patients With Recurrent or Refractory Non-Hodgkin Lymphoma

    ClinicalTrials.gov

    2016-01-04

    Adult Non-Hodgkin Lymphoma; Extranodal Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue; Nodal Marginal Zone Lymphoma; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Grade 3 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Recurrent Small Lymphocytic Lymphoma; Splenic Marginal Zone Lymphoma; Waldenstrom Macroglobulinemia

  12. The content of recurrent dreams in young adolescents

    PubMed Central

    Gauchat, Aline; Séguin, Jean R.; McSween-Cadieux, Esther; Zadra, Antonio

    2015-01-01

    Studies on children’s recurrent dreams have been largely anecdotal and based on adults’ recollections of dreams experienced during childhood. We collected 102 reports of recurrent dreams from a sample of young adolescents aged between 11 and 15 years and scored the narratives using a range of content measures, including in relation to the threat simulation theory (TST) of dreaming. The most frequently reported themes involved confrontations with monsters or animals, followed by physical aggressions, falling and being chased. Recurrent dreams were more likely to include negative content elements than positive elements. Only half of the recurrent dreams contained threatening elements and their analysis provided mixed support for the TST. Differences between the content of recurrent dreams reported by young adolescent versus adults are discussed as are possible sex effects and key issues that remain to be addressed by future research. PMID:26366465

  13. An unusual course of the left recurrent laryngeal nerve.

    PubMed

    Khaki, Amir A; Tubbs, R Shane; Shoja, Mohammadali M; Zarrintan, Sina

    2007-04-01

    Variation in the course of the left recurrent laryngeal nerve is seemingly very rare. During the routine dissection of an adult male cadaver, the entire left recurrent laryngeal nerve after branching from the left vagus nerve was noted to travel medial to the ligamentum arteriosum. We hypothesize that this rare variation may occur, if the left recurrent laryngeal nerve passes inferior to the fifth rather than the sixth aortic arch during embryological development. As our case report demonstrates, the relationship between the ligamentum arteriosum and the left recurrent laryngeal nerve is not absolute. Although seemingly rare, cardiothoracic surgeons must consider variations of the left recurrent laryngeal nerve during surgical procedures in the region of the ligamentum arteriosum in order to minimize potential postoperative complications.

  14. The content of recurrent dreams in young adolescents.

    PubMed

    Gauchat, Aline; Séguin, Jean R; McSween-Cadieux, Esther; Zadra, Antonio

    2015-12-01

    Studies on children's recurrent dreams have been largely anecdotal and based on adults' recollections of dreams experienced during childhood. We collected 102 reports of recurrent dreams from a sample of young adolescents aged between 11 and 15years and scored the narratives using a range of content measures, including in relation to the threat simulation theory (TST) of dreaming. The most frequently reported themes involved confrontations with monsters or animals, followed by physical aggressions, falling and being chased. Recurrent dreams were more likely to include negative content elements than positive elements. Only half of the recurrent dreams contained threatening elements and their analysis provided mixed support for the TST. Differences between the content of recurrent dreams reported by young adolescent versus adults are discussed as are possible sex effects and key issues that remain to be addressed by future research.

  15. Contemporary Management of Recurrent Nodal Disease in Differentiated Thyroid Carcinoma

    PubMed Central

    Na’ara, Shorook; Amit, Moran; Fridman, Eran; Gil, Ziv

    2016-01-01

    Differentiated thyroid carcinoma (DTC) comprises over 90% of thyroid tumors and includes papillary and follicular carcinomas. Patients with DTC have an excellent prognosis, with a 10-year survival rate of over 90%. However, the risk of recurrent tumor ranges between 5% and 30% within 10 years of the initial diagnosis. Cervical lymph node disease accounts for the majority of recurrences and in most cases is detected during follow-up by ultrasound or elevated levels of serum thyroglobulin. Recurrent disease is accompanied by increased morbidity. The mainstay of treatment of nodal recurrence is surgical management. We provide an overview of the literature addressing surgical management of recurrent or persistent lymph node disease in patients with DTC. PMID:26886954

  16. Re-irradiation alternatives for recurrent high-grade glioma

    PubMed Central

    Dong, Yuanli; Fu, Chengrui; Guan, Hui; Zhang, Tianyi; Zhang, Zicheng; Zhou, Tao; Li, Baosheng

    2016-01-01

    Despite advances in the fields of surgery, chemotherapy and radiotherapy, the prognosis for high-grade glioma (HGG) remains unsatisfactory. The majority of HGG patients experience disease recurrence. To date, no standard treatments have been established for recurrent HGG. Repeat surgery and chemotherapy demonstrate moderate efficacy. As recurrent lesions are usually located within the previously irradiated field, a second course of irradiation was once considered controversial, as it was considered to exhibit unsatisfactory efficacy and radiation-related toxicities. However, an increasing number of studies have indicated that re-irradiation may present an efficacious treatment for recurrent HGG. Re-irradiation may be delivered via conventionally fractionated stereotactic radiotherapy, hypofractionated stereotactic radiation therapy, stereotactic radiosurgery and brachytherapy techniques. In the present review, the current literature regarding re-irradiation treatment for recurrent HGG is summarized with regard to survival outcome and side effects. PMID:27703519

  17. Genetic and epigenetic stability of oligodendrogliomas at recurrence.

    PubMed

    Aihara, Koki; Mukasa, Akitake; Nagae, Genta; Nomura, Masashi; Yamamoto, Shogo; Ueda, Hiroki; Tatsuno, Kenji; Shibahara, Junji; Takahashi, Miwako; Momose, Toshimitsu; Tanaka, Shota; Takayanagi, Shunsaku; Yanagisawa, Shunsuke; Nejo, Takahide; Takahashi, Satoshi; Omata, Mayu; Otani, Ryohei; Saito, Kuniaki; Narita, Yoshitaka; Nagane, Motoo; Nishikawa, Ryo; Ueki, Keisuke; Aburatani, Hiroyuki; Saito, Nobuhito

    2017-03-07

    Among diffuse gliomas, oligodendrogliomas show relatively better prognosis, respond well to radiotherapy and chemotherapy, and seldom progress to very aggressive tumors. To elucidate the genetic and epigenetic background for such behavior and tumor evolution during tumor relapse, we comparatively analyzed 12 pairs of primary and recurrent oligodendrogliomas with 1p/19q-codeletion. Initial treatment for these patients was mostly chemotherapy alone. Temozolomide was used for 3, and procarbazine, nimustine and vincristine (PAV chemotherapy) were used for 7 patients. World Health Organization histological grade at recurrence was mostly stable; it was increased in 2, the same in 9, and decreased in 1 cases. Whole-exome sequencing demonstrated that the rate of shared mutation between the primary and recurrent tumors was relatively low, ranging from 3.2-57.9% (average, 33.3%), indicating a branched evolutionary pattern. The trunk alterations that existed throughout the course were restricted to IDH1 mutation, 1p/19q-codeletion, and TERT promoter mutation, and mutation of the known candidate tumor suppressor genes CIC and FUBP1 were not consistently observed between primary and recurrent tumors. Multiple sampling from different regions within a tumor showed marked intratumoral heterogeneity. Notably, in general, the number of mutations was not significantly different after recurrence, remaining under 100, and no hypermutator phenotype was observed. FUBP1 mutation, loss of chr. 9p21, and TCF12 mutation were among a few recurrent de novo alterations that were found at recurrence, indicating that these events were clonally selected at recurrence but were not enough to enhance malignancy. Genome-wide methylation status, measured by Illumina 450 K arrays, was stable between recurrence and the primary tumor. In summary, although oligodendroglioma displays marked mutational heterogeneity, histological malignant transformation accompanying events such as considerable increase in

  18. Paclitaxel Albumin-Stabilized Nanoparticle Formulation and Carboplatin Followed By Chemoradiation in Treating Patients With Recurrent Head and Neck Cancer

    ClinicalTrials.gov

    2017-01-09

    Recurrent Salivary Gland Cancer; Recurrent Squamous Cell Carcinoma of the Hypopharynx; Recurrent Squamous Cell Carcinoma of the Larynx; Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity; Recurrent Squamous Cell Carcinoma of the Nasopharynx; Recurrent Squamous Cell Carcinoma of the Oropharynx; Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Recurrent Verrucous Carcinoma of the Larynx; Recurrent Verrucous Carcinoma of the Oral Cavity; Salivary Gland Squamous Cell Carcinoma; Tongue Cancer

  19. Everolimus, Erlotinib Hydrochloride, and Radiation Therapy in Treating Patients With Recurrent Head and Neck Cancer Previously Treated With Radiation Therapy

    ClinicalTrials.gov

    2016-03-01

    Recurrent Metastatic Squamous Neck Cancer With Occult Primary; Recurrent Salivary Gland Cancer; Recurrent Squamous Cell Carcinoma of the Hypopharynx; Recurrent Squamous Cell Carcinoma of the Larynx; Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity; Recurrent Squamous Cell Carcinoma of the Oropharynx; Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Recurrent Verrucous Carcinoma of the Larynx; Recurrent Verrucous Carcinoma of the Oral Cavity; Salivary Gland Squamous Cell Carcinoma; Tongue Cancer

  20. Recurrent aphthous stomatitis caused by food allergy.

    PubMed

    Wardhana; Datau, E A

    2010-10-01

    Recurrent Aphthous Stomatitis (RAS) is one of the most common oral lesions which occur either in single or multiple forms in oral mucosa. The mouth is subjected to a wide spectrum of antigenic agents, including foodstuff, and allergic reactions to such antigens may manifest in a number of diverse ways. Food allergy, however, has not been widely investigated as the cause of RAS. The main complaint of RAS typically is pain, and the main therapy is still corticosteroids, besides avoiding allergenic foodstuff. In RAS, there is often a genetic basis. More than 42 percent of patients with RAS have first-degree relatives with RAS. The likelihood of RAS is 90 percent when both parents are affected, but only 20 percent when neither parent has RAS, and it is also likely to be more severe and to start at an earlier age in patients with a positive family history. The primary goals of therapy of RAS are relief of pain, reduction of ulcer duration, and restoration of normal oral function. The secondary goals include reduction in frequency and severity of recurrences and maintenance of remission. Diagnostic elimination diets are frequently utilized both in diagnosis and management of RAS caused by food allergy. Patients with RAS may have increased levels of CD8+ T-lymphocytes and/or decreased CD4+ T-lymphocytes. There may be a reduced percentage of "virgin" T-cells and an increased of "memory" T-lymphocytes. Patients with active RAS have an increased proportion of gd T-cells compared with healthy control subjects and RAS patients with inactive disease. The gd T-cells may play a role in ADCC and it is believed that gd T-cells play a role in immunological damages. Preventive treatment is a consideration for patients with RAS caused by food allergy who report regular exacerbations of their condition. It focuses on dietary modifications, the earliest stage, the prodromal stage, and attempts to intercept ulcer development again by the use of topical immunosuppressant and particularly