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Sample records for symptomatic chronic cholecystitis

  1. A sign of symptomatic chronic cholecystitis on biliary scintigraphy

    SciTech Connect

    Al-Sheikh, W.; Hourani, M.; Barkin, J.S.; Clarke, L.P.; Ashkar, F.S.; Serafini, A.N.

    1983-02-01

    Five hundred patients with acute right-upper-quadrant pain underwent biliary scintigraphy with /sup 99m/Tc paraisopropyliminodiacetic acid. One hundred and thirty-four studies were reported normal (both gallbladder and activity in bowel are noted in 1 hr). Of the 134 studies reported as normal, 32 showed intestinal activity before gallbladder visualization during the first hour of the study. Sonography and/or oral cholecystography revealed that 24 patients had gallstones, and eight patients had no demonstrable pathology in the biliary system. Of the 134 studies, 102 showed visualization of the gallbladder before intestinal activity during the first hour of the study. Sonography and/or oral cholecystography showed that 73 patients had normal biliary system. The remaining 29 patients had gallstones. The overall sensitivity of this finding is 45%, the specificity is 90%, and the accuracy is 73%. In this group of symptomatic patients, the appearance of intestinal activity before gallbladder activity on biliary scintigraphy warrants further evaluation of these patients by sonography and/or oral cholecystography.

  2. Cholecystitis.

    PubMed

    Elwood, David R

    2008-12-01

    Cholecystitis is the most prevalent surgical condition affecting populations in industrialized countries. Rather than a single clinical entity, cholecystitis is a class of related disease states with different causes, degrees of severity, clinical courses, and management strategies. Appropriate care of the patient who has a diseased gallbladder requires a broad understanding of the acute, chronic, and acalculous cholecystitis syndromes, and awareness of their particular clinical nuances and potential complications. PMID:18992593

  3. CHOLECYSTITIS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Cholecystitis is an acute or chronic inflammatory disease of the gallbladder that may be classified as calculous or acalculous, based on the presence or absence of gallstones. In developed countries, gallstones occur in 50% to 70% of children who have cholecystitis, but in developing countries, a ca...

  4. Mechanisms of impaired gallbladder contractile response in chronic acalculous cholecystitis.

    PubMed

    Merg, Anders R; Kalinowski, Scott E; Hinkhouse, Marilyn M; Mitros, Frank A; Ephgrave, Kimberly S; Cullen, Joseph J

    2002-01-01

    The mechanisms involved in the impaired gallbladder contractile response in chronic acalculous cholecystitis are unknown. To determine the mechanisms that may lead to impaired gallbladder emptying in chronic acalculous cholecystitis, gallbladder specimens removed during hepatic resection (controls) and after cholecystectomy for chronic acalculous cholecystitis were attached to force transducers and placed in tissue baths with oxygenated Krebs solution. Electrical field stimulation (EFS) (1 to 10 Hz, 0.1 msec, 70 V) or the contractile agonists, CCK-8 (10(-9) to 10(-5)) or K(+) (80 mmol/L), were placed separately in the tissue baths and changes in tension were determined. Patients with chronic acalculous cholecystitis had a mean gallbladder ejection fraction of 12% +/- 4%. Pathologic examination of all gallbladders removed for chronic acalculous cholecystitis revealed chronic cholecystitis. Spontaneous contractile activity was present in gallbladder strips in 83% of control specimens but only 29% of gallbladder strips from patients with chronic acalculous cholecystitis (P < 0.05 vs. controls). CCK-8 contractions were decreased by 54% and EFS-stimulated contractions were decreased by 50% in the presence of chronic acalculous cholecystitis (P < 0.05 vs. controls). K(+)-induced contractions were similar between control and chronic acalculous cholecystitis gallbladder strips. The impaired gallbladder emptying in chronic acalculous cholecystitis appears to be due to diminished spontaneous contractile activity and decreased contractile responsiveness to both CCK and EFS.

  5. Pancreatitis and cholecystitis in primary acute symptomatic Epstein-Barr virus infection - Systematic review of the literature.

    PubMed

    Kottanattu, Lisa; Lava, Sebastiano A G; Helbling, Rossana; Simonetti, Giacomo D; Bianchetti, Mario G; Milani, Gregorio P

    2016-09-01

    Acute pancreatitis and acalculous cholecystitis have been occasionally reported in primary acute symptomatic Epstein-Barr virus infection. We completed a review of the literature and retained 48 scientific reports published between 1966 and 2016 for the final analysis. Acute pancreatitis was recognized in 14 and acalculous cholecystitis in 37 patients with primary acute symptomatic Epstein-Barr virus infection. In all patients, the features of acute pancreatitis or acalculous cholecystitis concurrently developed with those of primary acute symptomatic Epstein-Barr virus infection. Acute pancreatitis and acalculous cholecystitis resolved following a hospital stay of 25days or less. Acalculous cholecystitis was associated with Gilbert-Meulengracht syndrome in two cases. In conclusion, this thorough analysis indicates that acute pancreatitis and acalculous cholecystitis are unusual but plausible complications of primary acute symptomatic Epstein-Barr virus infection. Pancreatitis and cholecystitis deserve consideration in cases with severe abdominal pain. These complications are usually rather mild and resolve spontaneously without sequelae. PMID:27434148

  6. Acute and chronic acalculous cholecystitis associated with aortic dissection.

    PubMed

    Inagaki, Fuyuki F; Hara, Yoshiaki; Kamei, Masako; Tanaka, Michio; Yasuno, Masamichi

    2015-01-01

    Acalculous cholecystitis is a rare but life-threatening disease, but its pathogenesis is not fully revealed yet. We experienced two acalculous cholecystitis cases associated with aortic dissection. In Case 1, acalculous cholecystitis occurred just after the exacerbation of the aortic dissection. Laparotomy showed necrotized cholecystitis with fresh thrombi formation. Case 2 developed acalculous cholecystitis on the 65th hospital day of aortic dissection. Laparotomy revealed the perforation of the gallbladder. Histological study revealed fibrosis and hemosiderosis in the subserosal layer. The histological findings of these two patients are quite different: Case 1 is acute ischemic and Case 2 is chronic ischemic. While a few cases of acute ischemic cholecystitis have been reported previously, chronic acalculous cholecystitis (CAC) has not been documented. History of aortic dissection could be a risk factor of acute and CAC due to relatively decreased splanchnic blood flow. PMID:26232599

  7. Cholecystokinin cholecystography, sonography, and scintigraphy: detection of chronic acalculous cholecystitis

    SciTech Connect

    Davis, G.B.; Berk, R.N.; Sheible, F.W.; Witztum, K.F.; Gilmore, I.T.; Strong, R.M.; Hofmann, A.F.

    1982-12-01

    Because the efficacy of cholecystokinin cholecystography in the detection of chronic acalculous cholecystitis remains in doubt, the procedure is rarely used in clinical practice. However, the ability to observe gallbladder contraction with sonography and /sup 99m/Tc-para-isopropylacetanilido-iminodiacetic acid cholescintigraphy (PIPIDA) offers a possibility to improve the sensitivity of the test. To determine if the degree of gallbladder contraction after cholecystokinin is the same as measured by the three techniques and if it differs in symptomatic patients compared to the normal population, cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA were performed in 10 symptomatic patients and 10 normal volunteers. The mean maximum contraction of the gallbladder during the three studies was 63%, 61%, and 68%, respectively, for the volunteers, and 72%, 63%, and 73%, respectively, for the patients. The mean maximum gallbladder contraction during all three procedues was 64% +/- 26% SD in the volunteers and 74% +/- 17% SD in the patients. The differences were not statistically significant. Although there was good correlation in the degree of maximum gallbladder contraction among cholecystokinin PIPIDA, marked variation in both the volunteers and the patients makes it unlikely that the degree of contraction as observed by any of these techniques can be used to indicate the presence of chronic acalculous cholecystitis.

  8. Cholecystokinin cholecystography, sonography, and scintigraphy: detection of chronic acalculous cholecystitis

    SciTech Connect

    Davis, G.B.; Berk, R.N.; Scheible, F.W.; Witztum, K.F.; Gilmore, I.T.; Strong, R.M.; Hofmann, A.F.

    1982-12-01

    Because the efficacy of cholecystokinin cholecystography in the detection of chronic acalculous cholecystitis remains in doubt, the procedure is rarely used in clinical practice. However, the ability to observe gallbladder contraction with sonography and /sup 99m/Tc-para-isopropylacetanilido-iminodiacetic acid cholescintigraphy (PIPIDA) offers a possibility to improve the sensitivity of the test. To determine if the degree of gallbladder contraction after cholecystokinin is the same as measured by the three techniques and if it differs in symptomatic patients compared to the normal population, cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA were performed in 10 symptomatic patients and 10 normal volunteers. The mean maximum contraction of the gallbladder during the three studies was 63%, 61%, and 68%, respectively, for the volunteers, and 72%, 63%, and 73%, respectively, for the patients. The mean maximum gallbladder contraction during all three procedures was 64% +/- 26% SD in the volunteers and 74% +/- 17% SD in the patients. The differences were not statistically significant. Although there was good correlation in the degree of maximum gallbladder contraction among cholecystokinin cholecystography, cholecystokinin sonography, and cholecystokinin PIPIDA, marked variation in both the volunteers and the patients makes it unlikely that the degree of contraction as observed by any of these techniques can be used to indicate the presence of chronic acalculous cholecystitis.

  9. [The effectiveness of spasmolytic therapy in chronic acalculous cholecystitis].

    PubMed

    Shaĭkhutdinova, O V; Galiakberova, A R; Gur'ev, D A; Ionova, S I; Volevach, L V

    2009-01-01

    The therapeutic efficacy of duspatalin was evaluated in 69 patients with chronic cholecystitis and dyskinesia of the biliary tract (BT). Supplementation of duspatalin to the combined therapy in the patients with chronic cholecystitis shown to exert a pronounced therapeutic effect. This caused positive changes in clinical symptoms and BT function and quality of life, diminished the lithogenic properties of bile. PMID:19552029

  10. Fatty meal ultrasonography in chronic acalculous cholecystitis.

    PubMed

    Donen, Anna; Kantor, Robin

    2014-01-01

    Chronic acalculous cholecystits typically presents with biliary symptoms, normal blood tests and unremarkable ultrasound, computerized tomography and magnetic resonance cholangiopancreatography. However, cholescintigraphy may show reduced gallbladder ejection fraction (GBEF). There are no reports on using ultrasound to measure GBEF in adults. Twenty-eight patients with the above presentation underwent ultrasound before and after ingestion of a standardized fatty meal. Consequently, GBEF was calculated. Seven patients had reduced GBEFs (<38%). Two of these patients underwent cholecystectomy and both were found to have chronic gallbladder inflammation. Three patients with normal GBEFs underwent cholecystectomy and were also found to have chronic gallbladder inflammation. There may be a role for fatty meal ultrasonography in the diagnosis of chronic acalculous cholecystitis, but it should be used more widely in this patient cohort for its role to be established. It ideally needs to performed alongside cholescintigraphy for the comparison of accuracy. PMID:25409675

  11. [Chronic cholecystitis and its clinical masks: diagnosis and differential diagnosis].

    PubMed

    Tsimmerman, Ia S

    2006-01-01

    The author adduces modern data on the ethiology and pathogenesis of chronic cholecystitis and the stages of the development of biliary pathology (motorotonic disturbances of the gall bladder and the sphincter apparatus of the extrahepatic biliary tract - chronic acalculous cholecystitis - chronic calculous cholecystitis). He considers in detail the methods of diagnostics of chronic cholecystitis paying special attention to clinical (non-instrumental) methods. The author offers an original classification of physical symptoms of chronic cholecystitis, distinguishing three groups of symptoms according to their pathogenesis and clinical significance: segmentary reflectory symptoms ("exacerbation symptoms"); reflectory symptoms, localized in the right half of the body outside the segments of hepatobiliary system innervation ("severity symptoms"); irritative symptoms, observed during all the periods of chronic cholecystitis. The article contains a description of various clinical "masks" of chronic cholecystitis, which make the diagnosis more difficult: cardial, duodenal (gastrointestinal), rheumatic, solaralgic, allergic, pre-menstrual tension, and other masks, as well as a description of their differential diagnostic methods. PMID:16827271

  12. Cholecystitis.

    PubMed

    Knab, Lawrence M; Boller, Anne-Marie; Mahvi, David M

    2014-04-01

    Acute cholecystitis is defined as inflammation of the gallbladder and is usually caused by obstruction of the cystic duct. Cholescintigraphy is the most sensitive imaging modality for cholecystitis. The gold standard treatment of acute cholecystitis is laparoscopic cholecystectomy. Operating early in the disease course decreases overall hospital stay and avoids increased complications, conversion to open procedures, and mortality. Cholecystitis during pregnancy is a challenging problem for surgeons. Operative intervention is generally safe for both mother and fetus, given the improved morbidity of the laparoscopic approach compared with open, although increased caution should be exercised in women with gallstone pancreatitis. PMID:24679431

  13. [Laser therapy in complex treatment of chronic acalculous cholecystitis].

    PubMed

    Burduli, N M; Raniuk, L G

    2006-01-01

    The effectiveness of various laser techniques in patients with exacerbation of chronic acalculous cholecystitis was studied. The subjects were 62 patients, in whom the diagnosis was made using clinical and instrumental tests. The patients were divided into three groups. Group I received conventional pharmacotherapy; group II received a course of intravenous laser therapy in addition to it; group III received a course of laseropuncture and low-intensive laser irradiation of the hepatic area in addition to pharmacotherapy. The best results according to clinical and instrumental data were achieved in group III. Thus, the study demonstrates advantages provided by laser therapy in complex treatment of exacerbation of chronic acalculous cholecystitis PMID:16924800

  14. Chronic cholecystitis with Cystoisospora belli in an immunocompetent patient.

    PubMed

    Takahashi, Hideo; Falk, Gavin A; Cruise, Michael; Morris-Stiff, Gareth

    2015-01-01

    A 47-year-old woman presented with a history of vague abdominal pain for several years, which worsened over the past 2 months, with pain more prominent in the right upper quadrant. She also had a history of peptic ulcer disease. The ultrasound scan of right upper quadrant revealed normal gallbladder and oesophagogastroduodenoscopy was unremarkable. A (99m)technetium labelled hepato iminodiacetic acid (HIDA) scan with cholecystokinin provocation demonstrated a decreased gallbladder ejection fraction (EF) of 32%. On this basis, the patient was diagnosed with biliary dyskinesia and underwent an elective laparoscopic cholecystectomy. Histopathological analysis revealed chronic cholecystitis with Cystoisospora belli identified in the gallbladder wall. Cystoisospora has been identified to cause an opportunistic acalculous cholecystitis among immunocompromised hosts, especially those with AIDS. This is the first case report of chronic cholecystitis due to C. belli in an immunocompetent patient. PMID:26065551

  15. [Asymptomatic celiac disease in patient with chronic acalculous cholecystitis].

    PubMed

    Parfenov, A I; Dolgasheva, G M; Krums, L M; Bystrovskaia, E V; Sabel'nikova, E A; Gudkova, R B; Vorob'eva, N N; Lishchinskaia, A A

    2011-01-01

    We described a patient 40 years old, admitted to the clinic with periodic attacks of pain in the right upper quadrant. With ultrasound it was confirmed chronic acalculous cholecystitis, and at endoscopy and multiple biopsies revealed atrophy of the mucosa of the duodenum (DM), corresponding to celiac disease (stage III in the Marsh classification). Titer of antibodies to gliadin (AGA) and tissue transglutaminase (AtTG) were higher: 60 and 110 units/ml, respectively, at a rate of 10 units/ml. The patient was assigned a lifetime adherence to a gluten-free diet, serologic test and a control endoscopy with biopsy at 6 months. The important role of the doctor-endoscopist in the diagnosis of latent forms of celiac disease. The significance of DM atrophy in the pathogenesis of patients with chronic cholecystitis. PMID:21695960

  16. Chronically symptomatic patients with undetectable gall bladder on ultrasonography could benefit from early cholecystectomy.

    PubMed

    Adams, Stephen D; Blackburn, Simon C; Adewole, Victoria A; Mahomed, Anies A

    2013-01-01

    90 percent of symptomatic patients undergoing cholecystectomy have cholelithiasis with 10% categorized as asymptomatic cholecystitis. In both instances, the gallbladder is evident on ultrasonography. In children with symptomatic biliary dyspepsia, the decision to proceed to cholecystectomy is made difficult if choleliths are not seen on ultrasonography. This decision is made even more difficult if the gallbladder itself is not seen on repeated imaging. In a cohort of 54 cholecystectomies, 3 cases, with recurrent right upper quadrant pain and undetectable gallbladders on repeat ultrasonography, were identified. After prolonged observation all underwent successful cholecystectomy. Histology demonstrated a markedly fibrotic and thickened gallbladder in all. Given this experience, we suggest that nonvisibility of the gallbladder, in fact, maybe be a feature of a chronic acalculous cholecystitis. We advise consideration of cholecystectomy for chronic biliary dyspepsia where repeat ultrasonography fails to demonstrate a gallbladder. PMID:23401761

  17. DETECTION OF HELICOBACTER ANTIGEN IN STOOL SAMPLES AND ITS RELATION TO H. PYLORI POSITIVE CHOLECYSTITIS IN EGYPTIAN PATIENTS WITH CHRONIC CALCULAR CHOLECYSTITIS.

    PubMed

    Hassan, Ehsan H; Gerges, Shawkat S; Ahmed, Rehab; Mostafa, Zeinab M; Al-Hamid, Hager Abd; Abd El-Galil, Heba; Thabet, Suzan

    2015-12-01

    Evidences supporting the association between H. pylori infection and chronic cholecystitis could be found by using direct culture or staining of H. pylori in gallbladder tissues as well as indirect techniques. Stool antigen test has been widely used due to its noninvasive nature. Various stool antigen tests were developed to detect H. pylori using an enzyme immunoassay (EIA) based on monoclonal or polyclonal antibodies This study evaluated the frequency of H. pylori antigen in stool samples of patients with chronic calcular cholecystitis as regard gall bladder histopathological changes. Fifty patients were included presented with symptomatic qholecystolithiasis recruited from the outpatient clinic of National Hepatology and Tropical Medicine Research Institute during 2014-2015. Full history and clinical examination and abdominal ultrasonography were performed. Stool samples were collected, prepared and examined for detection of H. pylori antigen. Cholecystectomy was done for all patients; 45 patients (90%) by laparoscopic Cholecystectomy and 5 patients (10%) by open surgery and removed gallbladders were submitted to pathology department for detection of H. pylori in tissue under microscope using Giemsa stain. The results showed that (82%) were females with mean age (42.6 +/- 1 years). The mean BMI was (29 + 7.2) H. pylori-specific antigen in stool samples was detected in 40% of patients and 38% were detected in patients; tissue, with significant correlation between H. pylori-specific antigen in stool and in tissue. Histopathological pictures infection in tissue were 68.4% mucosal erosions, 63.2% mucosal atrophy, 57.9% mucosal hyperplasia, 26.3% metaplasia, 42.1% musculosa hypertrophy, 26.3% fibrosis, but lymphoid aggregates were in 42.1% of cases. PMID:26939235

  18. [The role of stomach epithelial cells being immunopositive for NO synthase in the formation of chronic cholecystitis].

    PubMed

    Osadchuk, M A; Kon'kov, A V; Lipatov, T E

    2004-01-01

    The article provides information on 145 patients with chronic acalculous cholecystitis and 62 patients with chronic calculous cholecystitis subjected to a study of the quantitative characteristic of gastric antral epithelial cells immunopositive for NO synthase. The increased number of NO synthase immunopositive gastric epithelial cells at chronic cholecystitis was discovered. Most of them were discovered at the calculous process. The study discovered the relation between the gallbladder inflammatory activity, bile lithogenicity and the number of NO synthase immunopositive gastric epithelial cells. The clinical, biochemical and morphologic analyses showed that the application of Hepabene for treating patients with chronic acalculous cholecystitis produces a clinical and biochemical remission in a shorter term. Bile lithogenicity decreases; the quantitative characteristic of NO synthase immunopositive gastric epithelial cells normalizes. The study results make it possible to recommend Hepabene as a highly efficient drug for treating patients with chronic acalculous cholecystitis. PMID:15770857

  19. [The use of natural hitamine-based natural substance at chronic cholecystitis].

    PubMed

    Antoniuk, M V; Saĭno, O V; Knyshova, V V

    2005-01-01

    The results of application of hitamine, enterosorbent of marine origin, by the patients with chronic noncalculous cholecystitis in the remission phase are cited. It has been established that dietotheraphy in complex with hitamine renders the antiinflammatory and lipidcorrected action, favours the increase of remission terms. PMID:16044844

  20. [Pathogenesis of chronic acalculous cholecystitis in inhabitants of the Republic of Chuvashia].

    PubMed

    Tarasova, L V; Khokhlova, E A; Arkhipova, A V

    2009-01-01

    The study of Serum content of Selenium, Zinc, Manganese in inhabitants of the Republic of Chuvashia and also in chronic acalculous cholecystitis patients. Possibility of correction motor dysfunction of gallbladder with the use of natural mineral water "Syvlah-Zdorovie". PMID:19938285

  1. [A case of chronic acalculous cholecystitis diagnosed by delayed contrast emptying in gallbladder].

    PubMed

    Kim, Chang Won; Lee, Jong Min; Coh, Jane; Jung, In Sung; Kang, Ki Man; Jung, Shin Hong; Lee, Gye Sung; Kim, Anna; Kwak, Seung Soo; Lee, Mi Sun

    2004-05-01

    Chronic acalculous cholecystitis is a diagnosis of exclusion in patients complaining acalculous biliary pain. The possible causes of acalculous biliary pain are chronic gallbladder (GB) inflammation, GB dysfunction, cholesterolosis, cystic duct stenosis or microlithiasis. Recently, laparoscopic cholecystectomy is the choice of treatment for acalculous biliary pain. We experienced a 32-year-old woman whose initial symptoms were right upper quadrant pain and nausea only. The abdominal computed tomography, DISIDA scan, and upper and lower endoscopic examinations were nonspecific. Up to 48 hours after endoscopic retrograde cholangiopancreatography, contrast emptying of GB was delayed, implying dysfunctional GB. As the patient's right upper quadrant pain and tenderness became aggravated, the laparoscopic cholecystectomy was done and the final diagnosis of chronic acalculous cholecystitis was confirmed. PMID:15156120

  2. [The chronobiological peculiarities of the hepatobiliary system function in chronic cholecystitis with dysfunction of the gallbladder].

    PubMed

    Poddubnaia, O A; Levitskiĭ, E F; Zamoshchina, T A

    2014-01-01

    Study of biological cycles in chronic cholecystitis with dysfunction of gallbladder has a great practical importance. The results of chronoanalysis testify a dominance of 24-hours cycle in structure of cycles of functional activity of organs of hepatobiliary system. The comparative analysis of trust intervals reveals the intensification of internal connections, expressed intensification of synchronization of cycles of functional activity of system and a breach of synchronism of central regulation and self-regulation, testifying overstrain of proper adaptive possibilities and unconcordance in system of regulation. This manifestations of desynchronization provokes development and progress of dysfunction of gallbladder and dysbalance of vegetative nervous system, that make worse the present disturbances. PMID:25911916

  3. Percutaneous Cholecystostomy as a First-Line Therapy in Chronic Hemodialysis Patients with Acute Cholecystitis with Midterm Follow-up

    SciTech Connect

    Gumus, Burcak

    2011-04-15

    Purpose: The purpose of this article was to share midterm results of percutaneous cholecystostomy (PC) as a first-line therapy in chronic hemodialysis patients with acute cholecystitis. Methods: Fourteen chronic hemodialysis patients with acute cholecystitis underwent PC between March 2007 and May 2009 at our institute. On preoperative assessment, the patients were classified into the ASA score by the anesthesiology team. All patients were class IV because of severe underlying comorbidities. The patients were referred to interventional radiology unit for PC by consensus of the multidisciplinary team. Results: The PC was technically successful in all the patients without minor or major complications related to the procedure. Clinical symptoms in three patients who presented with sepsis and multiorgan failure did not resolve after PC, and these patients died following urgent surgery, including open cholecystectomy and common bile duct exploration. A new cholecystitis attack was detected in one patient in the acalculous group at the sixth month of the follow-up period. The mean catheterization time was 31.7 (range, 28-41) days. The mean follow-up time was 13.3 (range 4-21) months. Conclusions: The PC may come into consideration as a first-line treatment modality in the management of acute cholecystitis in poor surgical candidate chronic hemodialysis patients. This is the first report focusing on the midterm results of PC as a first-line therapy in hemodialysis patients with acute cholecystitis who could be operated on.

  4. [Use of tykveol in the treatment of impaired biliary tract function in patients with chronic non-calculous cholecystitis].

    PubMed

    Vakhrushev, Ia M; Petrova, L I

    2004-01-01

    The therapeutic efficacy of tykveol was evaluated in 22 patients with chronic non-calculous cholecystitis and/or dyskinesia of the biliary tract (BT) concurrent with gallbladder deformity (GD). Supplementation of tykveol to the combined therapy in the patients with chronic non-calculous cholecystitis concurrent with GD was shown to exert a pronounced therapeutic effect. This caused positive changes in clinical symptoms and BT function, diminished the lithogenic propertes of bile. With the use of tykveol, recovery of neurohumoral regulation is an important factor that improves biliary tract function, as evidenced by decreased gastrin secretion. PMID:15584601

  5. Aberrant activation of Sonic hedgehog signaling in chronic cholecystitis and gallbladder carcinoma.

    PubMed

    Xie, Fang; Xu, Xiaoping; Xu, Angao; Liu, Cuiping; Liang, Fenfen; Xue, Minmin; Bai, Lan

    2014-03-01

    Sonic hedgehog (Shh) signaling has been extensively studied and is implicated in various inflammatory diseases and malignant tumors. We summarized the clinicopathological features and performed immunohistochemistry assays to examine expression of Shh signaling proteins in 10 normal mucosa, 32 gallbladder carcinoma (GBC), and 95 chronic cholecystitis (CC) specimens. The CC specimens were classified into three groups according to degree of inflammation. Compared with normal mucosa, CC, and GBC specimens exhibited increased expression of Shh. The immunoreactive score of Shh in the GBC group was higher than that in the mild to moderate CC groups but lower than that in the severe CC group (P < .05). Expression of Patched (Ptch) and Gli1 gradually increased from non-malignant cholecystitis to malignant tumors. Compared with CC specimens, GBC specimens showed higher cytoplasmic and membranous expression for Ptch (P < .05). Gli1 staining showed cytoplasmic expression of Gli1 in both CC (60% for mild, 77% for moderate, and 84% for severe) and GBC specimens (97%). Nuclear expression of Gli1 was detected in 16% of severe CC specimens with moderate to poor atypical hyperplasia, and in 62.5% of GBC specimens. Shh expression strongly correlated with expression of Ptch and Gli1. Furthermore, patients with strongly positive Gli1 staining had significantly lower survival rates than those with weakly positive staining. Our data indicate that the Shh signaling pathway is aberrantly activated in CC and GBC, and altered Shh signaling may be involved in the course of development from CC to gallbladder carcinogenesis.

  6. Acute gangrenous cholecystitis: radionuclide diagnosis

    SciTech Connect

    Brachman, M.B.; Tanasescu, D.E.; Ramanna, L.; Waxman, A.D.

    1984-04-01

    Radionuclide hepatobiliary imaging with Tc-99m IDA is a useful procedure for the diagnosis of acute cholecystitis. Visualization of the gallbladder essentially rules out acute cholecystitis. Nonvisualization suggest acute cholecystitis but may also be associated with chronic gallbladder disease or other conditions. The authors recently observed five patients in whom a rim of increased parenchymal liver activity was seen adjacent to the gallbladder fossa. All five patients had acute gangrenous cholecystitis. The rim of increased activity appears to be a useful secondary sign of acute cholecystitis.

  7. Outcome of pulmonary endarterectomy in symptomatic chronic thromboembolic disease.

    PubMed

    Taboada, Dolores; Pepke-Zaba, Joanna; Jenkins, David P; Berman, Marius; Treacy, Carmen M; Cannon, John E; Toshner, Mark; Dunning, John J; Ng, Choo; Tsui, Steven S; Sheares, Karen K

    2014-12-01

    Chronic thromboembolic disease is characterised by persistent pulmonary thromboembolic occlusions without pulmonary hypertension. Early surgical treatment with pulmonary endarterectomy may improve symptoms and prevent disease progression. We sought to assess the outcome of pulmonary endarterectomy in symptomatic patients with chronic thromboembolic disease. Patients with symptomatic chronic thromboembolic disease and a mean pulmonary artery pressure <25 mmHg at baseline with right heart catheterisation and treated with pulmonary endarterectomy between January 2000 and July 2013 were identified. Patients were reassessed at 6 months and at 1 year following surgery. A total of 42 patients underwent surgery and the median length of stay in hospital was 11 days. There was no in-hospital mortality but complications occurred in 40% of patients. At 1 year, following surgery, 95% of the patients remained alive. There was a significant symptomatic improvement with 95% of patients in the New York Heart Association functional classes I or II at 6 months. There was a significant improvement in quality of life assessed by the Cambridge pulmonary hypertension outcome review questionnaire. In this carefully selected cohort of chronic thromboembolic disease patients, pulmonary endarterectomy resulted in significant improvement in symptoms and quality of life. Appropriate patient selection is paramount given the known surgical morbidity and mortality, and surgery should only be performed in expert centres.

  8. [New approaches to diagnosing and treating hyperkinetic biliary dyskinesia associated with chronic acalculous cholecystitis].

    PubMed

    Bartosh, L F; Balakina, I V; Gridneva, L M

    2004-01-01

    Ninety patients aged 21 to 56 years who had chronic non-calculous cholecystitis (CNCC) concurrent with hyperkinetic dyskinesia (HKD) detectable by a stepwise duodenal probing and sonography, by using a choleretic breakfast and by determining the relaxation coefficient (RC) that was equal to the ratio of the volume of the gallbladder (GB) after the use of a spasmolytic to the baseline GB volume. The patients were divided into 3 groups. The authors used as a spasmolytic agent pinaverium bromide (dicetel) in a dose of 50 mg (1 tablet) in Group 1), octylonium bromide (spasmomen) in a dose of 40 mg (1 dragee) in Group 2, and drotaverine (no-spa) in a dose of 40 mg (1 tablet). There was a more significant sonographic increase in the size of GB in Groups 1 and 2 as compared with Group 3. In the acute drug test and during long-term treatment as well, the highest spasmolytic effect was noted in patients receiving dicetel (Group 1) and spasmomen (Group 2) as compared with that in Group 3 patients taking drotaverine. With this, RC was 1.25 +/- 0.2, 1.6 +/- 0.15, and 1.08 +/- 0.1, respectively. No adverse reactions occurred in the patients having selective calcium blockers (SCBs) whereas the patients receiving no-spa were found to have the following side effects: dry mouth (n = 3), transient constipation (n = 1), and numb tongue (n = 1). Thus, the study has provided evidence for the fact that SCBs have some advantage over myotropic spasmolytic agents in the treatment of CNCC with the signs of HKD. PMID:15540426

  9. [Clinical use of flavonoid enriched biologically active food supplements in patients with chronic atrophic gastritis in combination with chronic cholecystitis or bile ducts dyskinesia].

    PubMed

    Tutel'ian, V A; Vasil'ev, A V; Kochetkov, A M; Pogozheva, A V; Lysikova, S L; Akol'zina, S E; Vorob'eva, L Sh

    2003-01-01

    60 patients with chronic atrophic gastritis and secretory insufficiency allied with chelicobacterial infection in combination with chronic unlithic cholecystitis or diskinesia of choledoch ways were explored with a view to study the efficiency of dietary cure including biologically active food supplements--flavonoids source. Fortification of the patients food intake with flavonoids-containing biologically active food supplements benefits mucous membrane of gastroduodenal zone that is evidenced in decrease of activity of pyloric chelicobacteriosis and resolvent and reparative effect, it also contributes to normalization of hepatobiliaric system condition and antioxidant status.

  10. Clinical effectiveness and cost-effectiveness of cholecystectomy compared with observation/conservative management for preventing recurrent symptoms and complications in adults presenting with uncomplicated symptomatic gallstones or cholecystitis: a systematic review and economic evaluation.

    PubMed Central

    Brazzelli, Miriam; Cruickshank, Moira; Kilonzo, Mary; Ahmed, Irfan; Stewart, Fiona; McNamee, Paul; Elders, Andrew; Fraser, Cynthia; Avenell, Alison; Ramsay, Craig

    2014-01-01

    BACKGROUND Approximately 10-15% of the adult population suffer from gallstone disease, cholelithiasis, with more women than men being affected. Cholecystectomy is the treatment of choice for people who present with biliary pain or acute cholecystitis and evidence of gallstones. However, some people do not experience a recurrence after an initial episode of biliary pain or cholecystitis. As most of the current research focuses on the surgical management of the disease, less attention has been dedicated to the consequences of conservative management. OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of cholecystectomy compared with observation/conservative management in people presenting with uncomplicated symptomatic gallstones (biliary pain) or cholecystitis. DATA SOURCES We searched all major electronic databases (e.g. MEDLINE, EMBASE, Science Citation Index, Bioscience Information Service, Cochrane Central Register of Controlled Trials) from 1980 to September 2012 and we contacted experts in the field. REVIEW METHODS Evidence was considered from randomised controlled trials (RCTs) and non-randomised comparative studies that enrolled people with symptomatic gallstone disease (pain attacks only and/or acute cholecystitis). Two reviewers independently extracted data and assessed the risk of bias of included studies. Standard meta-analysis techniques were used to combine results from included studies. A de novo Markov model was developed to assess the cost-effectiveness of the interventions. RESULTS Two Norwegian RCTs involving 201 participants were included. Eighty-eight per cent of people randomised to surgery and 45% of people randomised to observation underwent cholecystectomy during the 14-year follow-up period. Participants randomised to observation were significantly more likely to experience gallstone-related complications [risk ratio = 6.69; 95% confidence interval (CI) 1.57 to 28.51; p = 0.01], in particular acute

  11. [Electrophoresis with the mulberry leave extract and officinal peat for the rehabilitative treatment of chronic non-calculous cholecystitis].

    PubMed

    Grigorian, E G; Malerian, D S; Seropian, N S; Sarkisian, R A; Iskandarian, V A; Khachatrian, K K; Avetisian, K G

    2008-01-01

    Electrophoresis using a 5% aqueous extract of mulberry leaves and a 5% aqueous extract of Tavish peat at the right hypochondrium of patients included in the study had beneficial effect on the clinical picture of chronic non-calculous cholecystitis. Specifically, the state of the hepatobiliary system improved judging by the results of staged chromatic duodenal probing, ultrasonographic examination of biliary ducts, and bioresonance diagnostics. Also, positive changes were recorded in energy metabolism. It is recommended that electrophoresis using an aqueous mulberry leaf extract be prescribed to patients with a short duration of the disease and hyperkinetic biliary ducts and intestines. In case of an inflammatory process in these organs or hypomotor dyskinesia of biliary ducts, good results can be obtained using electrophoresis with Tavish peat extracts having a wide spectrum of action. They are indicated for the rehabilitative treatment of digestive organ pathology. PMID:19069798

  12. [The effectiveness of sulfate magnesium-calcium mineral water for the treatment of the patients presenting with chronic acalculous cholecystitis].

    PubMed

    Tudakova, V G; Vladimirskiĭ, E V; Kunstman, T G

    2013-01-01

    This paper was designed to report the results of investigations into the therapeutic effectiveness of "Kluchi" sulfate magnesiumcalcium mineral water used to treat 194 patients presenting with chronic acalculous cholecystitis and different types of biliary tract dysfunction. The control group was comprised of 92 patients who took a diet. It was shown, that mineral water "Kluchi" exerted well apparent beneficial action on the motor function of the gallbladder and the sphincter apparatus. Moreover, drinking the mineral water improved colloidal stability of bile. It is concluded that the therapeutic application of "Kluchi" sulfate magnesium-calcium mineral water results in the reduction of bile lihogenicity, produces anti-inflammatory and choleretic effects, and promotes normalization of the motor and tonic condition of the biliary tract. PMID:23819416

  13. [The pneumoperitoneum course forecasting and surgery tactic in the group of patients with acute and chronic cholecystitis and concomitant pathology of cardiovascular system].

    PubMed

    Korotkyĭ, V M; Soliaryk, S O; Tsyganok, A M; Sysak, O M

    2012-01-01

    The share of elderly and senile patients with acute cholecystitis concomitant cardiovascular pathology whom the laparoscopic cholecystectomy has been provided is increased. The heightened intraabdominal pressure has negative influence at the cardiovascular system, so the alternative ways for treatment of this group of patients are used in clinic. We propose the pneumoperitoneum model using the pneumatic belt which is fixed at the abdomen in preoperative period in patients with an acute and chronic cholecystitis. This model is useful to forecast cardiovascular disorders during future laparoscopic cholecystectomy. The arterial pressure level, pulse score and ECG are monitored during the test (90 min). Myocardial ischemia appearance seems that the risk of laparoscopic cholecystectomy with pneumoperitoneum is high. The alternative method of surgery in such group of patients (no pneumoperitoneum is applied) is laparoscopic assisted cholecystectomya from miniaccess. This method allows to reducing frequency of intra- and postoperative complications connected with pneumoperitoneum negative influence at the patients with concomitant pathology of cardiovascular system.

  14. [Daily variation of some cardiovascular parameters in healthy children and in those with chronic cholecystitis, changes on mud cure].

    PubMed

    Kochergin, Iu V

    2007-01-01

    Studies covered chronologic algorithm of physiologic parameters in healthy children and those with hepato-biliary diseases. 71.3% of children suffering from hepato-biliary diseases appeared to have significant desynchronization. The authors conducted time-wise optimization of mud care in children with cholecystitis. Findings are that mud care has considerable sanogenous effect and could be recommended as a treatment for children with ecologically mediated cholecystitis.

  15. [The contingency of the therapeutic effectiveness with the peculiarities of the non-pharmacological treatment of the patients presenting with chronic cholecystitis].

    PubMed

    Poddubnaya, O A

    2016-01-01

    The elaboration of new technologies for the medical rehabilitation of the patients presenting with chronic cholecystitis in combination with chronic opisthorchiasis is a topical problem facing modern clinical gastroenterology. The application of up-to-date non-pharmacological therapeutic modalities, such as ultrahigh-frequency (UHF) therapy concomitantly with group chronophysiotherapy makes it possible to significantly improve the final outcome of the treatment. The results of clinical studies give evidence of the favourable influence of the combined chronorehabilitative treatment including UHF therapy on the characteristics of the functional state of the biliary-hepatic system and of the organism as a whole. The positive dynamics of these characteristics is suggestive of the high (up to 87,5%) therapeutic effectiveness of the proposed treatment. The investigations into the relationship between this effect and the peculiarities of the combined therapeutic modalities have demonstrated their correlation (χ2=104,13; p=0,0001; V-Kramer´s coefficient =0,35) and showed that the use of combined chronorehabilitation including UHF therapy based on the application of phone resonance radiation guarantees (and is a predictor of) high therapeutic effect (percent concordance =95,6%; standard coefficient=2,13; p=0,001) of the treatment of the patients with chronic cholecystitis in combination with chronic opisthorchiasis. The statistical analysis of the results of application of the modern non-pharmacological therapeutic modalities and the chronobiological approach for the purpose of the combined treatment of patients presenting with chronic cholecystitis in combination with opisthorchiasis with the use of contingency table and logit regression, allowed not only to estimate the interdependence and interrelation between the characteristics of interest but also to reveal predictors of therapeutic effectiveness. These findings are of great practical importance since they can be

  16. Granulomatous Lithiasic Cholecystitis in Sarcoidosis

    PubMed Central

    Handra-Luca, Adriana

    2016-01-01

    Gallbladder granulomas are exceedingly rare, reported in association with tuberculosis or sarcoidosis. Here we report a case of gallbladder granulomatous cholecystitis occurring in the context of sarcoidosis. A 70-years old man presented with abdominal pain, nausea and vomiting. The medical history revealed sarcoidosis diagnosed more than 20-years previously. 2-years previously the patient showed renal lithiasis, hypercalcemia and, increased angiotensin converting enzyme. The imaging features suggested thoraco-abdominal sarcoidosis. Prednisone was given at 1.2 mg/kg/day initially, than decreased, being at 2.5 mg/day at present. The ultrasound examination showed gallbladder lithiasis. A cholecystectomy was performed. Microscopy showed subacute and chronic cholecystitis with several epithelioid and giant cell granulomas some of them perineural. In conclusion, we report a case of granulomatous cholecystitis occurring in the course of treated sarcoidosis. The perineural location of granulomas may give further insights into the pathogenesis of gallbladder dysmotility. PMID:27162601

  17. Juxtarenal Mycotic Aneurysm as a Complication of Acute Exacerbation of Chronic Cholecystitis Treated by Resection and Replacement by a Fresh Allograft.

    PubMed

    Grus, Tomáš; Lambert, Lukáš; Rohn, Vilém; Klika, Tomáš; Grusová, Gabriela; Michálek, Pavel

    2016-01-01

    We present a case of a female patient with infectious (mycotic) juxtarenal abdominal aneurysm with atypical symptoms beginning as acute exacerbation of chronic cholecystitis. Apart from common antibiotic treatment, the patient successfully underwent resection of the diseased segment and replacement by a fresh allograft in order to reduce the risk of infection of the graft, but with the need of subsequent life-long immunosuppressive therapy. Perioperative monitoring of the spinal cord by near infrared spectroscopy was used to identify possible spinal ischemia. The choice of the fresh allograft was based on our experience supported by review of the literature. PMID:26995203

  18. [CHRONIC PERIODONTITIS WITH SYMPTOMATIC HYPERTROPHIC GINGIVITIS: CASE REPORT AND REVIEW OF THE LITERATURE].

    PubMed

    Shinkevich, V; Udaltsova, K; Pisarenko, E; Kolomiets, S; Khmil, T

    2015-12-01

    Gingivitis in traditional national dentistry referred to independent diseases or symptomatic condition in periodontitis and classified morphologically. The diagnostic features of the diseases are characteristic, but the clinical presentation of symptomatic gingivitis and patterns of bone destructions may vary between patients. Successful treatment of the disease depends from proper diagnosis and advanced disease stages, but for symptomatic gingivitis that accompanying chronic periodontitis, protocols include surgical excision. Despite of the high prevalence of chronic generalized periodontitis, its active treatment often start in severe destruction and bone loss (2-3 stage severity). Today etiotropic antimicrobial therapy is real way to control microbial biofilm and has solid evidence base. Applying of etiotropic antimicrobial therapy as systemic azithromycin with timely treatment of mild to moderate periodontal and bone destruction may reduce severe periodontitis incidence of and treatment-related complications in the future. This paper attempts to describe the clinical diagnostic features and the current treatment options along with a suggested protocol for comprehensive management of chronic generalized periodontitis and hypertrophic gingivitis patient with case reports and a brief review. PMID:26719550

  19. [Endoscopic gallbladder stenting for acute cholecystitis].

    PubMed

    Maekawa, Satoshi; Nomura, Ryosuke; Murase, Takayuki; Ann, Yasuyoshi; Oeholm, Masayuki; Harada, Masaru

    2014-12-01

    Acute cholecystitis is an inflammatory disease of the gallbladder. Inflammation often remains in the gallbladder, but some patients may take a fatal course with exacerbation of inflammation. Although laparoscopic cholecystectomy is recommended for moderate and severe acute cystitis, sometimes cholecystectomy is impossible in elder patients. Because many elder patients have bad general conditions, cholecystectomy should not be performed. Such patients are generally treated by percutaneous transhepatic gallbladder drainage (PTGBD), but PTGBD has the risk of intra-abdominal bleeding. In previous reports, endoscopic gallbladder stenting (EGBS) has been shown to be an effective strategy in cirrhosis patients with symptomatic cholelithiasis as a bridge to transplantation. Recent studies on EGBS have demonstrated an effective long-term management of acute cholecystitis in elderly patients who are poor surgical candidates. Here, we reviewed EGBS for the management of acute cholecystitis.

  20. Modeling methodology for the accurate and prompt prediction of symptomatic events in chronic diseases.

    PubMed

    Pagán, Josué; Risco-Martín, José L; Moya, José M; Ayala, José L

    2016-08-01

    Prediction of symptomatic crises in chronic diseases allows to take decisions before the symptoms occur, such as the intake of drugs to avoid the symptoms or the activation of medical alarms. The prediction horizon is in this case an important parameter in order to fulfill the pharmacokinetics of medications, or the time response of medical services. This paper presents a study about the prediction limits of a chronic disease with symptomatic crises: the migraine. For that purpose, this work develops a methodology to build predictive migraine models and to improve these predictions beyond the limits of the initial models. The maximum prediction horizon is analyzed, and its dependency on the selected features is studied. A strategy for model selection is proposed to tackle the trade off between conservative but robust predictive models, with respect to less accurate predictions with higher horizons. The obtained results show a prediction horizon close to 40min, which is in the time range of the drug pharmacokinetics. Experiments have been performed in a realistic scenario where input data have been acquired in an ambulatory clinical study by the deployment of a non-intrusive Wireless Body Sensor Network. Our results provide an effective methodology for the selection of the future horizon in the development of prediction algorithms for diseases experiencing symptomatic crises. PMID:27260782

  1. Hepatobiliary scanning with 99mTc-PIPIDA in acute cholecystitis

    SciTech Connect

    Mauro, M.A.; McCartney, W.H.; Melmed, J.R.

    1982-01-01

    Ninety-five patients with clinically suspected acute cholecystitis underwent hepatobiliary scanning with 99mTc-PIPIDA. A positive scan (nonvisualization of the gallbladder with visualization of the common bile duct and gut) was found in 29 patients; 25 of them (86%) had surgically proven acute cholecystitis and 4 (14%) had chronic cholecystitis. Five of the 25 with acute cholecystitis had acalculous disease. A negative examination (gallbladder visualization) occurred in 63 patients; 18 (29%) had chronic cholecystitis and 45 (71%) were subsequently found to have nonbiliary disease. Three indeterminate studies (nonvisualization of both the gallbladder and gut) were obtained in patients with choledocholithiasis and chronic cholecystitis. In the evaluation of acute cholecystitis, the 99mTc-PIPIDA hepatobiliary scan was 100% sensitive and 94% specific.

  2. Hepatobiliary scanning with /sup 99//sup m/Tc-PIPIDA in acute cholecystitis

    SciTech Connect

    Mauro, M.A.; McCartney, W.H.; Melmed, J.R.

    1982-01-01

    Ninety-five patients with clinically suspected acute cholecystitis underwent hepatobiliary scanning with /sup 99//sup m/Tc-PIPIDA. A positive scan (nonvisualization of the gallbladder with visualization of the common bile duct and gut) was found in 29 patients; 25 of them (86%) had surgically proven acute cholecystitis and 4(14%) had chronic cholecystitis. Five of the 25 with acute cholecystitis had acalculous disease. A negative examination (gallbladder visualization) occurred in 63 patients; 18 (29%) had chronic cholecystitis and 45 (71%) were subsequently found to have nonbiliary disease. Three indeterminate studies (nonvisualization of both the gallbladder and gut) were obtained in patients with choledocholithiasis and chronic cholecystitis. In the evaluation of acute cholecystitis, the /sup 99//sup m/Tc-PIPIDA hepatobiliary scan was 100% sensitive and 94% specific.

  3. Use of morphine in cholescintigraphy for obstructive cholecystitis

    SciTech Connect

    Kim, E.E.; Nguyen, M.; Pjura, G.; Pollack, M.; Gobuty, A.

    1985-05-01

    Non-visualization of the gallbladder (GB) during the first hour of cholescintigraphy is observed in cystic duct obstruction (e.g. in acute cholecystitis) but may also occur in chronic cholecystitis, hepatocellular disease, alcoholism and prolonged total parenteral nutrition. Low dose morphine is shown to improve the specificity of the diagnosis of acute cholecystitis (from 85% to 100%) with no loss in sensitivity (98%) at a small cost in terms of additional study time. The authors reviewed 27 selected cholescintigraphic examinations augmented by intravenous (IV) morphine (0.04 mg/Kg). Of the 16 cases with persistent nonvisualization of the GB, ultrasound revealed gallstones in 5 cases, sludge in 4, acalculous cholecystitis in 3, one distended GB, one contracted GB and 2 normal GB's. Of the 4 patients taken to surgery, one with gallstones and one with acalculous cholecystitis were confirmed to have acute cholecystitis while another with gallstones had chronic cholecystitis and the final patient, who was sonographically normal, presented a single common duct stone. The authors conclude that the use of IV morphine is an effective adjunct to cholescintigraphy in the evaluation of gallbladder disease, especially when visualization post morphine rules out acute cholecystitis.

  4. Passive tobacco exposure may impair symptomatic improvement in patients with chronic angina undergoing enhanced external counterpulsation

    PubMed Central

    Efstratiadis, Stilianos; Kennard, Elizabeth D; Kelsey, Sheryl F; Michaels, Andrew D

    2008-01-01

    Background The adverse effects of tobacco abuse on cardiovascular outcomes are well-known. However, the impact of passive smoke exposure on angina status and therapeutic response is less well-established. We examined the impact of second-hand smoke (SHS) exposure on symptomatic improvement in patients with chronic ischemic coronary disease undergoing enhanced external counterpulsation (EECP). Methods This observational study included 1,026 non-smokers (108 exposed and 918 not-exposed to SHS) from the Second International EECP Patient Registry. We also assessed angina response in 363 current smokers. Patient demographics, symptomatic improvement and quality of life assessment were determined by self-report prior and after EECP treatment. Results Non-smoking SHS subjects had a lower prevalence of prior revascularization (85% vs 90%), and had an increased prevalence of stroke (13% vs 7%) and prior smoking (72% vs 61%; all p < 0.05) compared to non-smokers without SHS exposure. Despite comparable degrees of coronary disease, baseline angina class, medical regimens and side effects during EECP, fewer SHS non-smokers completed a full 35-hour treatment course (77% vs 85%, p = 0.020) compared to non-smokers without SHS. Compared to non-smokers without SHS, non-smoking SHS subjects had less angina relief after EECP (angina class decreased ≥ 1 class: 68% vs 79%; p = 0.0082), both higher than that achieved in current smokers (66%). By multivariable logistic regression, SHS exposure was an independent predictor of failure to symptomatic improvement after EECP among non-smokers (OR 1.81, 95% confidence intervals 1.16–2.83). Conclusion Non-smokers with SHS exposure had an attenuated improvement in anginal symptoms compared to those without SHS following EECP. PMID:18798998

  5. Hemorrhagic acalculous cholecystitis: an unusual location of uremic bleeding.

    PubMed

    Lai, Yi-Chun; Tarng, Der-Cherng

    2009-09-01

    Hemorrhagic acalculous cholecystitis is a rare but potentially fatal disease. An increased bleeding tendency is present in both acute and chronic renal failure with impaired platelet function. We herein present a case of hemorrhagic acalculous cholecystitis in a hemodialysis patient who suffered from acute abdomen and upper gastrointestinal bleeding. The pathogenesis may have been associated with ischemia and reperfusion injury, eventually leading to necrosis of the gallbladder wall. Abdominal ultrasound can aid in diagnosis. Biliary colic, jaundice, and melena are the typical symptoms of hemorrhagic cholecystitis, particularly in a patient with unexplained gastrointestinal bleeding. PMID:19762317

  6. Xanthogranulomatous cholecystitis in laparoscopic surgery.

    PubMed

    Guzmán-Valdivia, Gilberto

    2005-04-01

    Xanthogranulomatous cholecystitis (XGC) is one presentation of cholecystitis and can be a cause of difficulty in cholecystectomy. We reviewed the clinical files of 12,426 patients who had undergone cholecystectomy. In this group, there were 182 cases of XGC, and 41 of these patients had undergone laparoscopic surgery. Patients with XGC represented 1.46% of the cholecystectomies that were performed. Of the 41 patients who underwent laparoscopic surgery, 27 were men (66%) and 14 were women (34%) (average age, 52 years). A total of 36 patients (88%) presented with a chronic condition. XGC was found to be associated with lithiasis in 85%, with jaundice in 22%, and with cancer in 2.4% (one patient). A total of 33 patients (80%) required conversion to open surgery, because of technical difficulties; of these patients, 64% underwent partial cholecystectomy. We conclude that XGC creates difficulty at laparoscopy and therefore any preoperative suspicion of XGC should cause the clinician to consider open cholecystectomy. PMID:15797229

  7. Cholecystitis occurring without stones

    SciTech Connect

    Seal, M.L.

    1986-03-01

    A case of acalculous cholecystitis in a 65-year-old man with underlying diabetes mellitus, hypertension, and peripheral arteriosclerosis is presented here. His case remained diagnostically puzzling for some time until symptoms and signs became more severe and very suggestive of acute cholecystitis. The clinical impression was then supported by an abnormal radioisotope biliary scan. The scan has fairly good sensitivity in detecting this condition but may not be totally dependable. Acalculous cholecystitis is an unusual but serious variant of a common disorder in which treatable gallbladder disease may masquerade as a less treatable liver malady. A common denominator among this disorder's many etiologies may be impairment of the gallbladder microcirculation in the presence of one or more conditions that lower the gallbladder's resistance to bacterial invasion. Prompt detection and treatment are desirable to reduce morbidity and mortality. However, early diagnosis is not always possible, because the clinical picture often is unclear, clear, gallstones are absent, and laboratory test results may be normal or equivocal. As in the case reported here, the vague clinical picture may dictate following a patient until the illness reaches an intensity acute enough to permit identification. The greatest aid to earlier diagnosis for the physician faced with circumstances similar to those described here is to think of cholecystitis and then to give strong weight to that clinical suspicion. At times, a recommendation for cholecystectomy may have to be made mainly on clinical judgment.

  8. Cholescintigraphy in cholecystic cancer

    SciTech Connect

    Nagle, C.E.; Freitas, J.; Dworkin, H.J.

    1983-05-01

    Two case reports of nonvisualization of the gallbladder by hepatobiliary scintigraphy in patients with carcinoma of the gallbladder are described. A hypothesis regarding the pathogenesis of gallbladder nonvisualization in cholecystic cancer is offered. The possible clinical utility of hepatobiliary scintigraphy in these patients is discussed.

  9. Randomized phase 2 study of obinutuzumab monotherapy in symptomatic, previously untreated chronic lymphocytic leukemia

    PubMed Central

    Flynn, Joseph M.; Kipps, Thomas J.; Boxer, Michael; Kolibaba, Kathryn S.; Carlile, David J.; Fingerle-Rowson, Guenter; Tyson, Nicola; Hirata, Jamie; Sharman, Jeff P.

    2016-01-01

    Obinutuzumab is a glycoengineered, type 2 anti-CD20 humanized antibody with single-agent activity in relapsed chronic lymphocytic leukemia (CLL). With other CD20 antibodies, a dose-response relationship has been shown. We therefore performed a randomized phase 2 study in symptomatic, untreated CLL patients to evaluate if an obinutuzumab dose response exists. Obinutuzumab was given at a dose of 1000 mg (100 mg IV day 1, 900 mg day 2, 1000 mg day 8 and day 15 of cycle 1; 1000 mg day 1 of cycles 2-8) or 2000 mg (100 mg IV day 1, 900 mg day 2, 1000 mg day 3, 2000 mg day 8 and day 15 of cycle 1; 2000 mg day 1 of cycles 2-8). The primary end point was overall response rate (ORR). Eighty patients were enrolled with similar demographics: median age 67 years, 41% high-risk Rai disease, and 10% del(17p)(13.1). ORR (67% vs 49%, P = .08) and complete response (CR) or CR with incomplete cytopenia response (20% vs 5%) favored 2000 mg obinutuzumab. Overall, therapy was well tolerated, and infusion events were manageable. This study demonstrates significant efficacy of obinutuzumab monotherapy, for 1000 mg as well as for 2000 mg, in untreated CLL patients with acceptable toxicity. Although exploratory, a dose-response relationship may exist, but its relevance to improving progression-free survival is uncertain and will require further follow-up. This trial was registered at www.clinicaltrials.gov as #NCT01414205. PMID:26472752

  10. Parasitic Infection of the Gallbladder: Cystoisospora belli Infection as a Cause of Chronic Abdominal Pain and Acalculous Cholecystitis.

    PubMed

    Martelli, Matthew G; Lee, Johnathan Y

    2016-06-01

    Herein we describe two cases of Cystoisospora belli infection of the gallbladder in patients with chronic abdominal pain and review the published literature to date. C. belli is an intracellular protozoan parasite that typically infects the small bowel of immunocompromised hosts. Little is known of the significance of C. belli infection of the gallbladder at this point as only four cases have been reported as yet, only one of which occurred in an immunocompetent patient. It is often treatable with antibiotics, and the patient's immune status, including HIV testing, should be investigated. Neither of the patients at our institution was found to be immunocompromised, and HIV-1/2 antibody testing was non-reactive in both. PMID:27526491

  11. Atherosclerotic inferior mesenteric artery stenosis resulting in large intestinal hypoperfusion: a paradigm shift in the diagnosis and management of symptomatic chronic mesenteric ischemia.

    PubMed

    Lotun, Kapildeo; Shetty, Ranjith; Topaz, On

    2012-11-01

    Symptomatic chronic mesenteric ischemia results from intestinal hypoperfusion and is classically thought to result from involvement of two or more mesenteric arteries. The celiac artery and superior mesenteric artery are most frequently implicated in this disease process, and their involvement usually results in symptoms of small intestinal ischemia. Symptomatic chronic mesenteric ischemia resulting predominantly from inferior mesenteric artery involvement has largely been overlooked but does gives rise to its own, unique clinical presentation with symptoms resulting from large intestinal ischemia. We present four patients with atherosclerotic inferior mesenteric artery stenosis with symptomatic chronic mesenteric ischemia that have unique clinical presentations consistent with large intestinal ischemia that resolved following percutaneous endovascular treatment of the inferior mesenteric artery stenosis. These cases represent a novel approach to the diagnosis and management of this disease process and may warrant a further subclassification of chronic mesenteric ischemia into chronic small intestinal ischemia and chronic large intestinal ischemia.

  12. Laparoscopic Cholecystectomy for Acute Cholecystitis in Elderly Patients

    PubMed Central

    Filho, Euler de Medeiros Ázaro; Galvão, Thales Delmondes; Ettinger, João Eduardo Marques de Menezes; Silva Reis, Jadson Murilo; Lima, Marcos; Fahel, Edvaldo

    2006-01-01

    Background: Acute cholecystitis is the major complication of biliary lithiasis, for which laparoscopic treatment has been established as the standard therapy. With longer life expectancy, acute cholecystitis has often been seen in elderly patients (>65 years old) and is often accompanied by comorbity and severe complications. We sought to compare the outcome of laparoscopic treatment for acute cholecystitis with special focus on comparison between elderly and nonelderly patients. Method: This study was a prospective analysis of 190 patients who underwent laparoscopic cholecystectomy due to acute cholecystitis or chronic acute cholecystitis, comparing elderly and nonelderly patients. Results: Of 190 patients, 39 (21%) were elderly (>65 years old) and 151 (79%) were not elderly (≤65 years), with conversion rates of 10.3% and 6.6% (P=0.49), respectively. The incidence of postoperative complications in elderly and nonelderly patients were the following, respectively: atelectasis 5.1% and 2.0% (P=0.27); respiratory infection 5.1% and 2.7% (P=0.6); bile leakage 5.1% and 2.0% (P=0.27), and intraabdominal abscess 1 case (0.7%) and no incidence (P=1). Conclusion: According to our data, laparoscopic cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in patients older than 65 years of age. PMID:17575761

  13. [Enzymatic cholecystitis and cholecystopancreatitis].

    PubMed

    Sobeshchanskaia, E A; Myrkin, S D; Babalich, A K

    1977-02-01

    Taking into consideration the role of pancreatic enzymes in the etiology of cholecystitis and cholecystopancreatits, the authors examined amylase in 92 patients, bile lipase--in 39 patients during cholecystectomy and also amylase in the choledochus bile during external drainage of the duct in 15 patients in the early postoperative period. The investigations inducated different levels of pancreatic enzymes in bile. Their level is found to depend on the occurrence of hypertension in the bile tract both pre- and postoperatively.

  14. Acute acalculous cholecystitis.

    PubMed

    Barie, Philip S; Eachempati, Soumitra R

    2010-06-01

    Acute acalculous cholecystitis (ACC) can develop with or without gallstones after surgery and in critically ill or injured patients. Diabetes mellitus, malignant disease, abdominal vasculitis, congestive heart failure, cholesterol embolization, shock, and cardiac arrest also have been associated with AAC. The pathogenesis of AAC is complex and multifactorial. Ultrasound of the gallbladder is most accurate for the diagnosis of AAC in the critically ill patient. CT is probably of comparable accuracy, but carries both advantages and disadvantages. Rapid improvement may be expected when AAC is diagnosed correctly and cholecystostomy is performed timely. PMID:20478490

  15. Effect of pancreatic biliary reflux as a cofactor in cholecystitis.

    PubMed

    Amr, Abdel Raouf; Hamdy, Hussam Mohamed; Nasr, Magid Mahmoud; Hedaya, Mohammed Saied; Hassan, Ahmed Mohamed Abdelaziz

    2012-04-01

    This study assessed the effect of pancreatico-biliary reflux (PBR) as co-factor in the process of chronic cholecystitis by measurement of the levels of active pancreatic enzyme amylase in gallbladder bile and serum of patients undergoing cholecystectomy. Pancreatic Amylase levels in bile from the gallbladder and serum were measured during surgery in 68 patients with chronic calcular cholecystitis subjected to elective open or laparoscopic cholecystectomy in the National Hepatology and Tropical Medicine Research Institution and Theodore Bilharz Research Institute. Bile amylase was detected in 64 patients (94.1%) indicating pancreatico-biliary reflux. Biliary amylase level ranged from 20-50 IU/L in 42 patients (61.76%), below 20 IU/l in 14 patients (20.59%), over 50 IU/L in 8 patients (11.76%) and undetectable in two patients. According to gallbladder bile amylase, the incidence of Occult PBR in patients operated upon for chronic calcular cholecystitis was 94.1%. The reason should be clarified by further research and wider scale study. Routinely investigating biliary amylase in every patient having cholecystitis can be a method for early detection of precancerous lesions.

  16. Normal gallbladder scintigraphy in acute cholecystitis

    SciTech Connect

    Ohrt, H.J.; Posalaky, I.P.; Shafer, R.B.

    1983-03-01

    Normal gallbladder scintigraphy occurs in 2 to 5% of reported patients with acute cholecystitis. Gallbladder visualization is found in patients with acalculous cholecystitis and in those with recent relief of cystic duct obstruction but persistence of inflammation. A patient is reported who had clinical and pathologic findings of acute cholecystitis but normal gallbladder visualization. This reemphasizes that the diagnosis of acute cholecystitis cannot be excluded by normal gallbladder scintigraphy.

  17. First detection of acalculous cholecystitis associated with Sarcocystis infection in a patient with AIDS.

    PubMed

    Agholi, Mahmoud; Heidarian, Hamid Reza; Moghadami, Mohsen; Hatam, Gholam Reza

    2014-06-01

    Acalculous cholecystitis and cholangitis are increasingly being recognized as complications of AIDS. The opportunistic parasites that have been most commonly associated with these disorders are Cryptosporidium species, Isospora belli, Cyclospora cayetanensis and Enterocytozoon bieneusi. The authors performed a parasitological survey on the gallbladder tissue sections of patients underwent cholecystectomy due to chronic acalculous cholecystitis at the Shiraz University of Medical Sciences, Iran. Light microscopic investigation in more than three hundred archived histopathological slides revealed the presence of sexual stages (i.e., mature sporocysts) of a coccidial protozoan in a patient with AIDS who developed acalculous cholecystitis as confirmed by histological, parasitological and molecular tests in which Sarcocystis species was the only identifiable pathogen in gallbladder sections. In the best of our knowledge it's the first documented case of chronic non-calculous cholecystitis due to Sarcocystis parasite in an Iranian AIDS patient from worldwide. PMID:24827104

  18. A literature review to evaluate the economic value of ranolazine for the symptomatic treatment of chronic angina pectoris.

    PubMed

    Vellopoulou, Katerina; Kourlaba, Georgia; Maniadakis, Nikos; Vardas, Panagiotis

    2016-05-15

    To conduct a systematic review of the evidence regarding the economic value of ranolazine relative to standard-of-care (SOC) for the treatment of symptomatic chronic stable angina (CSA). Electronic databases were searched using relevant keywords. The identified studies were independently reviewed by two investigators against pre-determined inclusion and exclusion criteria. Their data were extracted using a relevant form and consequently were synthesized. Studies were also evaluated using the Quality of Health Economic Studies scale. The main outcomes considered were the cost and effectiveness for each comparator and the incremental cost per quality-adjusted-life year (QALY) gained. Six studies were included in the review. Five of these assessed the cost-utility of ranolazine added to SOC, compared to SOC alone, using decision trees or Markov models whereas one was a retrospective cost evaluation study. The analysis was conducted from a payer perspective in five studies and from a societal perspective in one study with the time horizon varying between six months and a year. The incremental cost-effectiveness ratio (ICER), ranged from €4000 to €15,000 per QALY gained. Ranolazine appears to be dominant or cost-effective, mainly due to its ability to decrease angina-related hospitalizations and also due to a marginal improvement in quality of life. The acquisition cost of ranolazine was the variable with the greatest impact upon the ICER. The existing evidence, although limited, indicates that ranolazine may be a dominant or cost-effective therapy option, for the treatment of patients with symptomatic CSA. Further research is required to evaluate the cost-effectiveness of ranolazine. PMID:26994453

  19. Effectiveness of topical peppermint oil on symptomatic treatment of chronic pruritus

    PubMed Central

    Elsaie, Lotfy T; El Mohsen, Abdelraouf M; Ibrahim, Ibrahim M; Mohey-Eddin, Mahmoud H; Elsaie, Mohamed L

    2016-01-01

    Background Pruritus is one of the commonest skin complaints. Peppermint oil can be effective in reducing the severity of such a condition. Aim The aim of this study was to assess the efficacy of topically applied peppermint oil in the treatment of chronic pruritus. Subjects and methods Fifty selected subjects diagnosed with chronic pruritus due to hepatic, renal, or diabetic cause were studied and divided into two groups of 25 patients each. Group I patients were instructed to hydrate the skin and then apply topical peppermint oil, while Group II patients applied petrolatum topically by hand; this application was done on the areas of pruritus, twice daily for 2 weeks. The severity of the itch was assessed and compared before and after the study by the 5-D itch scale (5D-IS). The results were analyzed by SPSS software. Statistical methods such as descriptive analysis, independent samples t-test, paired samples t-test, and chi-square test were employed. Results There was a significant improvement regarding all studied individual parameters (5-D IS) for the peppermint oil users with no significance among petrolatum users. A comparison of total score of 5-D IS between patients of Group I and patients of Group II favored the improvement following the use of peppermint oil than using placebo (P-value <0.05). Conclusion The topical treatment of chronic pruritus with peppermint oil is effective, easy to use, safe, cheap, and more acceptable for those whose topical and systemic treatments tend to be irritating, contraindicated, or less well tolerated. PMID:27785084

  20. The Health Impact of Symptomatic Adult Spinal Deformity: Comparison of Deformity Types to United States Population Norms and Chronic Diseases

    PubMed Central

    Bess, Shay; Line, Breton; Fu, Kai-Ming; McCarthy, Ian; Lafage, Virgine; Schwab, Frank; Shaffrey, Christopher; Ames, Christopher; Akbarnia, Behrooz; Jo, Han; Kelly, Michael; Burton, Douglas; Hart, Robert; Klineberg, Eric; Kebaish, Khaled; Hostin, Richard; Mundis, Gregory; Mummaneni, Praveen; Smith, Justin S.

    2016-01-01

    Study Design. A retrospective analysis of a prospective, multicenter database. Objective. The aim of this study was to evaluate the health impact of symptomatic adult spinal deformity (SASD) by comparing Standard Form Version 2 (SF-36) scores for SASD with United States normative and chronic disease values. Summary of Background Data. Recent data have identified radiographic parameters correlating with poor health-related quality of life for SASD. Disability comparisons between SASD patients and patients with chronic diseases may provide further insight to the disease burden caused by SASD. Methods. Consecutive SASD patients, with no history of spine surgery, were enrolled into a multicenter database and evaluated for type and severity of spinal deformity. Baseline SF-36 physical component summary (PCS) and mental component summary (MCS) values for SASD patients were compared with reported U.S. normative and chronic disease SF-36 scores. SF-36 scores were reported as normative-based scores (NBS) and evaluated for minimally clinical important difference (MCID). Results. Between 2008 and 2011, 497 SASD patients were prospectively enrolled and evaluated. Mean PCS for all SASD was lower than U.S. total population (ASD = 40.9; US = 50; P < 0.05). Generational decline in PCS for SASD patients with no other reported comorbidities was more rapid than U.S. norms (P < 0.05). PCS worsened with lumbar scoliosis and increasing sagittal vertical axis (SVA). PCS scores for patients with isolated thoracic scoliosis were similar to values reported by individuals with chronic back pain (45.5 vs 45.7, respectively; P > 0.05), whereas patients with lumbar scoliosis combined with severe sagittal malalignment (SVA >10 cm) demonstrated worse PCS scores than values reported by patients with limited use of arms and legs (24.7 vs 29.1, respectively; P < 0.05). Conclusions. SASD is a heterogeneous condition that, depending upon the type and severity of the deformity

  1. Rim sign: association with acute cholecystitis

    SciTech Connect

    Bushnell, D.L.; Perlman, S.B.; Wilson, M.A.; Polcyn, R.E.

    1986-03-01

    In a retrospective analysis of 218 hepatobiliary studies in patients clinically suspected of acute cholecystitis, a rim of increased hepatic activity adjacent to the gallbladder fossa (the rim sign) has been evaluated as a scintigraphic predictor of confirmed acute cholecystitis. Of 28 cases with pathologic confirmation of acute cholecystitis in this series, 17 (60%) demonstrated this sign. When associated with nonvisualization of the gallbladder at 1 hr, the positive predictive value of this photon-intense rim for acute cholecystitis was 94%. When the rim sign was absent, the positive predictive value of nonvisualization of the gallbladder at 1 hr for acute cholecystitis was only 36%. As this sign was always seen during the first hour postinjection, it can, when associated with nonvisualization, reduce the time required for completion of an hepatobiliary examination in suspected acute cholecystitis.

  2. Dengue fever with acute acalculous cholecystitis.

    PubMed

    Wu, Keng-Liang; Changchien, Chi-Sin; Kuo, Chung-Mou; Chuah, Seng-Kee; Lu, Sheng-Nan; Eng, Hock-Liew; Kuo, Chung-Huang

    2003-06-01

    Dengue fever (DF) with acute acalculous cholecystitis is rarely reported. To investigate the incidence, treatment, and prognosis of acute acalculous cholecystitis in DF patients, we retrospectively studied 10 patients with DF and acute acalculous cholecystitis. From October 2001 to July 2002, 131 patients were diagnosed with DF. Ten of 131 DF patients (7.63%) had complications of acute acalculous cholecystitis. Two patients underwent cholecystectomy and one underwent percutaneous transhepatic gallbladder drainage due to poor resolution of acute acalculous cholecystitis. We found acute acalculous cholecystitis in a small proportion of patients with DF. In our experience, closely monitoring vital signs to avoid shock and correct thrombocytopenia to avoid bleeding could be adequate for most patients. In some cases, surgical treatment may be needed for DF fever patients with complications of diffuse peritonitis.

  3. Cholelithiasis and Cholecystitis in Childhood

    PubMed Central

    Wingert, Willis A.; Mikity, Victor G.

    1967-01-01

    Six cases of cholecystitis and cholelithiasis confirmed by x-ray examination and surgical operation were observed in a ten-year period. Due to the wide variability in signs and symptoms in children, cholecystitis and cholelithiasis can be diagnosed only with a high degree of clinical suspicion and roentgenological examination. Gallbladder disease is uncommon in childhood but should be considered in children with vague abdominal pains or bouts of unexplained jaundice. If a normal appendix is found at laparotomy in the “acute abdomen,” the surgeon would be wise to palpate other specific organs within the abdomen, including the liver and gallbladder. The treatment of choice is cholecystectomy. The prognosis for recovery is excellent if there is no complicating systemic disease. ImagesFigure 1.Figure 2.Figure 3. PMID:6045485

  4. How to image the gallbladder in suspected cholecystitis

    SciTech Connect

    Marton, K.I.; Doubilet, P.

    1988-11-01

    As a result of important advances in medical imaging, the oral cholecystogram is no longer the primary test of gallbladder function and anatomy. Real-time ultrasonography and cholescintigraphy, both highly sensitive and specific tests, are the two major methods for assessing gallbladder pathology. Oral cholecystography, endoscopic retrograde pancreatography, and percutaneous gallbladder puncture serve as supplementary tests. Decisions about which test to use depend on the kind of gallbladder disease that is suspected as well as the estimated likelihood of the disease before the information is obtained from the procedure. Thus, ultrasonography is the test of choice for chronic cholecystitis, with oral cholecystography reserved for situations in which the diagnosis is uncertain after ultrasonography. When acute cholecystitis is suspected, ultrasonography is also the test of choice in most patients, and cholescintigraphy is used to resolve uncertainty. 103 references.

  5. Tissue expression of S100 proteins in gallbladder mucosa of the patients with calculous cholecystitis.

    PubMed

    Szmyt, Mirosław; Kasprzak, Aldona; Malkowski, Wojciech; Surdyk-Zasada, Joanna; Przybyszewska, Wiesława; Siodła, Elżbieta; Seraszek-Jaros, Agnieszka; Jagielska, Joanna

    2013-01-01

    Proteins of S100 group, produced by phagocytes represent endogenous activators of innate immune responses. Role of these proteins in the etiopathogenesis of cholelithiasis remains unknown. The studies aimed at the morphometric evaluation of S100A8 and S100A9 protein expression in gallbladder mucosa in patients with acute and chronic calculous cholecystitis (n = 71). The presence of proteins was detected by immunohistochemistry while quantitative analysis employed the spatial visualization technique. We found the immunopositive expression of the two studied S100 proteins in neutrophils and monocytes/macrophages of the gallbladder's wall and a higher expression in acute cholecystitis. Quantitative study revealed higher immunoexpression of S100A9 over S100A8 in both studied groups of patients. Moreover, a reciprocal linear relationship between the expression of the studied proteins and a positive correlation between expression of either S100A8 or S100A9 and inflammatory activity (grading) in the gallbladder wall were found. The expression of S100A8 protein in the chronic cholecystitis group and in older patients correlated with leukocytosis, which suggests the role of S100A8 particularly at the chronic stage of cholecystitis. The obtained results indicated close relationship between S100A8 and S100A9 proteins in their proinflammatory functions. The increased expression of only one of them can be recognized as a useful index of local inflammatory activity in calculous cholecystitis. PMID:23907944

  6. Acalculous cholecystitis: an unusual presentation of acute Q fever masquerading as infectious endocarditis.

    PubMed

    Ergas, David; Abdul-Hai, Ali; Sthoeger, Zev Moshe

    2008-10-01

    We report here a patient with acute Q fever-related acalculous cholecystitis, who presented with prolonged fever, valvular abnormalities, and positive serology for Q fever phase 1 antigens, features suggesting chronic Q fever endocarditis. The pathogenesis of this rare presentation of Q fever is discussed. PMID:18854682

  7. [Toxocarosis and acalculous acute cholecystitis: Consequence or coincidence?].

    PubMed

    Strickler, Alexis; Vásquez, Natalia; Maggi, Leonardo; Hernández, Juvenal; Hidalgo, Ximena

    2016-06-01

    Human toxocarosis is a chronic larval parasitosis listed as one of the five most important neglected diseases by the CDC. The larvae can spread systemically and migrate to different tissues including liver and gallbladder. Acalculous acute cholecystitis (AAC) is a rare disease in children. The diagnosis is based on clinical parameters and imaging criteria. It has been reported in relation to sepsis, shock, trauma, burns, severe systemic diseases, congenital anomalies, infections and also in healthy children. We report a pediatric case of toxocarosis, with clinical symptoms and imaging criteria compatible with AAC treated medically, and discuss the relationship between toxocarosis and AAC based on published evidence.

  8. [Toxocarosis and acalculous acute cholecystitis: Consequence or coincidence?].

    PubMed

    Strickler, Alexis; Vásquez, Natalia; Maggi, Leonardo; Hernández, Juvenal; Hidalgo, Ximena

    2016-06-01

    Human toxocarosis is a chronic larval parasitosis listed as one of the five most important neglected diseases by the CDC. The larvae can spread systemically and migrate to different tissues including liver and gallbladder. Acalculous acute cholecystitis (AAC) is a rare disease in children. The diagnosis is based on clinical parameters and imaging criteria. It has been reported in relation to sepsis, shock, trauma, burns, severe systemic diseases, congenital anomalies, infections and also in healthy children. We report a pediatric case of toxocarosis, with clinical symptoms and imaging criteria compatible with AAC treated medically, and discuss the relationship between toxocarosis and AAC based on published evidence. PMID:27598288

  9. Acute acalculous cholecystitis simulating Mirizzi syndrome: a very rare condition.

    PubMed

    Ahlawat, Sushil K

    2009-02-01

    Mirizzi syndrome, a rare complication of chronic cholelithiasis, is caused by an impacted stone in the cystic duct or the neck of the gallbladder. Patients present with abdominal pain, fever, and obstructive jaundice. The cholangiographic finding is a smooth stricture caused by lateral compression of the common hepatic duct. A similar appearance on cholangiogram can result from carcinoma of the gallbladder, carcinoma of the cystic duct, or hilar adenopathy. Acute acalculous cholecystitis simulating Mirizzi syndrome is extremely rare. This is the report of such a case in which marked inflammatory changes around the neck of the gallbladder likely caused significant mechanical obstruction of the common hepatic duct. PMID:19139716

  10. PRE-SYMPTOMATIC DETECTION OF CHRONIC MOTOR DEFICITS AND GENOTYPE PREDICTION IN CONGENIC B6.SOD1G93A ALS MOUSE MODEL

    PubMed Central

    Hayworth, C. R.; Gonzalez-Lima, F.

    2009-01-01

    Amyotrophic lateral sclerosis (ALS) is an incurable progressive paralytic motor neuron disease with limited therapeutic options. Since their creation by Gurney et al. (1994), transgenic SOD1G93A mice have become the benchmark pre-clinical model for screening ALS therapies. Surprisingly, despite physiological, anatomical, ultrastructural and biochemical evidence of early motor system dysfunction it has proven difficult to detect motor performance deficits in pre-symptomatic SOD1G93A mice. As an alternative to conventional forced motor tests, we investigated the progression of motor performance deficits in freely behaving pre-symptomatic congenic B6.SOD1G93A mice. We found that motor performance deficits began several weeks prior to the onset of overt clinical symptoms (postnatal day 45). More importantly, once motor performance deficits manifested, they persisted in parallel with disease progression. In addition, two physical measures of muscle girth revealed progressive hindlimb muscle atrophy that predicted genotype in individual pre-symptomatic mice with 80% accuracy. Together, these data suggest that muscle girth is a reliable and indirect measure of hindlimb muscle denervation and an early, objective marker for disease onset in congenic B6.SOD1G93A ALS mice. Moreover, we present regression equations based on hindlimb muscle girth for predicting genotype in future studies using B6.SOD1G93A mice. These findings support new objective criteria for clinical disease onset and provide objective measures that require little expertise. These studies demonstrate a cost-effective approach for more thorough evaluation of neuroprotective strategies that seek to disrupt disease mechanisms early in the disease process. To our knowledge, these findings are the first to report early chronic motor performance and physical deficits that are coincident with the earliest known motor dysfunction in any ALS mouse model. PMID:19699279

  11. Who experiences endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy for symptomatic gallstone disease?

    PubMed Central

    Joo, Sun-Hyung; Cho, Sungsin; Han, Min-Soo

    2016-01-01

    Purpose Laparoscopic cholecystectomy (LC) has become a standard treatment of symptomatic gallstone disease. But, some patients suffer from retained common bile duct stones after LC. The aim of this study is to analyze the predicting factors associated with subsequent postoperative endoscopic retrograde cholangiopancreatography (ERCP) after LC. Methods We retrospectively reviewed a database of every LC performed between July 2006 and September 2012. We classify 28 patients who underwent ERCP within 6 months after LC for symptomatic gallstone disease as the ERCP group and 56 patients who underwent LC for symptomatic gallstone disease during same period paired by sex, age, underlying disease, operation history, and body mass index as the control group. To identify risk factor performing postoperative ERCP after LC, we compared admission route, preoperative biochemical liver function test, number of gall stones, gallstone size, adhesion around GB, wall thickening of GB, and existence of acute cholecystitis between the 2 groups. Results Admission route, preoperative AST, ALT, and ALP, stone size, longer operation time, and acute cholecystitis were identified as risk factors of postoperative ERCP in univariate analyses. But, longer operation time (P = 0.004) and acute cholecystitis (P = 0.048) were identified as independent risk factors of postoperative ERCP in multivariate analyses. Conclusion The patient who underwent ERCP after LC for symptomatic gallstone disease are more likely experienced longer operation time and acute cholecystitis than the patient who did not undergo ERCP after LC. PMID:27274506

  12. Indium-111-leukocyte imaging in acute cholecystitis

    SciTech Connect

    Fink-Bennett, D.; Clarke, K.; Tsai, D.; Nuechterlein, P.; Gora, G. )

    1991-05-01

    Eleven patients with suspected acute cholecystitis underwent sequential {sup 99}mTc-iminodiacetic derivative (IDA) and {sup 111}In-white blood cell (WBC) imaging to determine if {sup 111}In-WBCs accumulate within an acutely inflamed hemorrhagic gallbladder wall and, thus, could be employed as a reasonable alternative to {sup 99}mTc-IDA scintigraphy in detecting acute cholecystitis. Seven patients had surgically confirmed acute cholecystitis. Of these cases, five had a true-positive {sup 99}mTc-IDA and {sup 111}In-WBC, one an indeterminate {sup 111}In-WBC and true-positive {sup 99}mTc-IDA, and one a true-positive {sup 111}In-WBC and false-negative {sup 99}mTc-IDA scan. The remaining four patients did not have acute cholecystitis. All visualized their gallbladder within 1 hr after {sup 99}mTc-IDA administration and none had {sup 111}In-WBC gallbladder wall uptake. Both {sup 111}In-WBC and {sup 99}mTc-IDA scintigraphy accurately detected acute cholecystitis: hepatobiliary scintigraphy demonstrated a cystic duct obstruction and {sup 111}In-WBC imaging detected the inflammatory infiltrate within the gallbladder wall. The sensitivity and specificity of each was 86% and 100%, respectively.

  13. [Acute cholecystitis in the elderly].

    PubMed

    Kunin, N; Letoquart, J P; La Gamma, A; Chaperon, J; Mambrini, A

    1994-05-01

    We retrospectively studied 150 patients aged over 65 years who had been operated for acute cholecystitis in order to define the surgical results and evaluate this treatment as a function of age. The patients were divided into two groups. Group I included patients between the age of 65 and 79 years, n = 99 (53 males and 46 females). Group II included patients aged 80 years and over, n = 51 (14 males and 37 females). The data were compared with the chi 2 test and the Kruskall and Wallis test. Associated affections were observed in 69 patients in group I and in 36 patients in group II (NS). The clinical picture was similar in the 2 groups with manifestations of pain in the right hypochondral region (group I, n = 97; group II, n = 50), fever (group I, n = 73; group 2, n = 38) and abdominal defence (group I, n = 62; group II, n = 35). Echography revealed the diagnosis in almost all cases in both groups. There was no statistical difference between the two groups in terms of mean operative delay and length of hospital stay. Age increased significantly the risk of exploration of the main bile duct (group I, n = 14; group II, n = 15, p < 0.05). Nevertheless, this exploration did not affect post-operative follow-up. Mortality was 6.7% with 4 deaths in group I and 6% in group II (NS). Post-operative complications were observed in 36 patients in group I and 28 in group II (p < 0.05) (43% overall including deaths).(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Emphysematous cholecystitis in a Siberian husky.

    PubMed

    Armstrong, J A; Taylor, S M; Tryon, K A; Porter, C D

    2000-01-01

    A 6-year-old, intact male Siberian husky was evaluated for a 24-hour history of vomiting and lethargy. Diagnosis of emphysematous cholecystitis was achieved based on survey abdominal radiographs, a barium contrast gastrointestinal series, and abdominal ultrasound. Diagnosis and medical and surgical management of the condition are discussed.

  15. [Evaluation of the impact of symptomatic gastroesophageal reflux disease on the result of surgical treatment with the use of endoscopic techniques and postoperative pharmacological treatment in patients with chronic sinusitis].

    PubMed

    Nieckarz, Rafał; Szaleniec, Joanna; Hartwich, Patryk; Wróbel, Agnieszka; Hydzik-Sobocińska, Karolina; Muszyński, Piotr; Markiewicz, Beata; Turczynowski, Łukasz; Składzień, Jacek; Strek, Paweł

    2013-01-01

    It is estimated that in Europe 10% of adults suffer from chronic sinusitis. Chronic sinusitis can be caused by many different diseases that share chronic inflammation of the sinuses as a common symptom. Rhinitis can be caused by stomach acid coming up from the stomach into the esophagus, which successively can result in chronic sinusitis. The current gold standard for diagnosing GERD is--bothersome for the patient--24 h esophageal pH monitoring. This method can be unpleasant for the patients, which makes it less acceptable. Because of that the criteria for symptomatic GERD were made an alternative diagnostic way. We acknowledge that the presence of heartburn and stomach acid coming up from the stomach into the esophagus at least once a week can be diagnosed as symptomatic GERD. The aim of the study is the assessment of the frequency of symptomatic GERD in patients operated because of chronic sinusitis and impact of symptomatic GERD on the follow-up treatment up to 12 months after endoscopic nasal surgery. The authors analysed 144 patients operated at the JUCM Otolaryngological Clinic in Kraków between 2011 and 2013 because of sinusitis. The inclusion criteria were: diagnosed chronic sinusitis, indications for endoscopic sinus surgery, and a written consent for the research. Each patient was examined laryngologically and surveyed. Patients were divided into two groups: with and without symptomatic GERD. We analysed the symptoms in patients treated for sinusitis with or without GERD before, between 3 and 6 as well as in the 12th month after endonasal surgery. Moreover, we analysed the intensity of the global symptoms (expressed in the VAS scale) and separately for each of the 13 symptoms of chronic sinusitis (expressed on a scale 0 - 3). We established that 33 out of the 144 patients (22.9%) qualified for the first survey reported the symptoms of GERD. In the second survey, which was conducted between 3 and 6 month after ESS, 24 out of 119 (20%) people reported the

  16. Immunological profiling in chronic rhinosinusitis with nasal polyps reveals distinct VEGF and GMCSF signatures during symptomatic exacerbations

    PubMed Central

    Divekar, Rohit D.; Samant, Shefali; Rank, Matthew A.; Hagan, John; Lal, Devyani; O’Brien, Erin K.; Kita, Hirohito

    2015-01-01

    Background The mechanisms and immune pathways associated with chronic rhinosinusitis (CRS) are not fully understood. Immunological changes during acute exacerbation of CRS may provide valuable clues to the pathogenesis and perpetuation of the disease. Objective To characterize local and systemic immune responses associated with acute worsening of sinonasal symptoms during exacerbation in CRS with nasal polyps (CRSwNP) compared to controls. Methods This was a noninterventional prospective study of individuals with CRSwNP and normal controls. Subjects underwent a baseline visit with collection of nasal secretions, nasal washes, and serum specimens. Within 3 days of acute worsening of sinonasal symptoms, subjects underwent a study visit, followed by a post-visit 2 weeks later. The Sinonasal Outcome Test-22 (SNOT-22) scores and immunological parameters in the specimens were analyzed using a novel, unsupervised learning method and by conventional univariate analysis. Results Both CRSwNP patients and control subjects showed a significant increase in SNOT-22 scores during acute exacerbation. Increased nasal levels of IL-6, IL-5, and eosinophil major basic protein were observed in CRSwNP patients. A network analysis of serum specimens revealed changes in a set of immunological parameters, which are distinctly associated with CRSwNP but not with controls. In particular, systemic increases in VEGF and GM-CSF levels were notable and were validated by a conventional analysis. Conclusions CRSwNP patients demonstrate distinct immunological changes locally and systemically during acute exacerbation. Growth factors VEGF and GM-CSF may be involved in the immunopathogenesis of subjects with CRS and nasal polyps experiencing exacerbation. PMID:25429844

  17. Computed tomography in acute cholecystitis: new observations

    SciTech Connect

    Kane, R.A.; Costello, P.; Duszlak, E.

    1983-10-01

    The computed tomographic CT findings in five patients with acute cholecystitis were analyzed. Common findings included thickening and nodularity of the gallbladder wall, cholelithiasis, and dilatation of the gallbladder lumen. Other more specific findings included poor definition of the gallbladder wall, pericholecystic fluid collections, and gas collections within the gallbladder wall. Most of the CT findings are suggestive but not pathognomonic, and correlation with the clinical, scintigraphic, and sonographic findings is necessary.

  18. Endoscopic Gallbladder Drainage for Acute Cholecystitis

    PubMed Central

    Widmer, Jessica; Alvarez, Paloma; Sharaiha, Reem Z.; Gossain, Sonia; Kedia, Prashant; Sarkaria, Savreet; Sethi, Amrita; Turner, Brian G.; Millman, Jennifer; Lieberman, Michael; Nandakumar, Govind; Umrania, Hiren; Gaidhane, Monica

    2015-01-01

    Background/Aims Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. Methods Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. Results During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). Conclusions Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities. PMID:26473125

  19. Percutaneous gallbladder aspiration for acute cholecystitis

    PubMed Central

    Rassameehiran, Supannee; Nugent, Kenneth

    2016-01-01

    Early cholecystectomy for patients with acute cholecystitis may not be possible in some clinical settings. Percutaneous gallbladder aspiration (PGBA) offers an alternative approach, but the benefits and risks of this procedure are unclear. We synthesized data on the outcomes of PGBA in acute cholecystitis patients using data sources from online databases, including MEDLINE and EMBASE, and bibliographies of included studies from January 2000 through December 2015. Two reviewers independently reviewed and critiqued the quality of each study. Seven eligible studies met our criteria. The success rates in single PGBA and repetitive PGBA (2–4 times) were 50% to 93% and 76% to 96%, respectively. Complication rates were 0% to 8% and were unrelated to the size of needle gauge used for aspiration and the number of aspirations. Salvage percutaneous cholecystostomy (PC) and urgent surgery were required in 0% to 43% of patients and 0% to 4% of patients, respectively. Two studies with antibiotic instillation had clinical success rates of 95% and 96%. In conclusion, repetitive PGBA combined with antibiotic instillation and salvage PC are useful alternatives to early cholecystectomy in patients with acute cholecystitis. PMID:27695167

  20. Percutaneous gallbladder aspiration for acute cholecystitis

    PubMed Central

    Rassameehiran, Supannee; Nugent, Kenneth

    2016-01-01

    Early cholecystectomy for patients with acute cholecystitis may not be possible in some clinical settings. Percutaneous gallbladder aspiration (PGBA) offers an alternative approach, but the benefits and risks of this procedure are unclear. We synthesized data on the outcomes of PGBA in acute cholecystitis patients using data sources from online databases, including MEDLINE and EMBASE, and bibliographies of included studies from January 2000 through December 2015. Two reviewers independently reviewed and critiqued the quality of each study. Seven eligible studies met our criteria. The success rates in single PGBA and repetitive PGBA (2–4 times) were 50% to 93% and 76% to 96%, respectively. Complication rates were 0% to 8% and were unrelated to the size of needle gauge used for aspiration and the number of aspirations. Salvage percutaneous cholecystostomy (PC) and urgent surgery were required in 0% to 43% of patients and 0% to 4% of patients, respectively. Two studies with antibiotic instillation had clinical success rates of 95% and 96%. In conclusion, repetitive PGBA combined with antibiotic instillation and salvage PC are useful alternatives to early cholecystectomy in patients with acute cholecystitis.

  1. Diagnostic utility of cholescintigraphy and ultrasonography in acute cholecystitis

    SciTech Connect

    Zeman, R.K.; Burrell, M.I.; Cahow, C.E.; Caride, V.

    1981-04-01

    When faced with a patient with possible acute cholecystitis, technetium-99m-HIDA scintigraphy should be the primary diagnostic procedure performed. If scintigraphy reveals a normal gallbladder, acute cholecystitis is excluded. If the scintigram fails to visualize the gallbladder, ultrasonography is deemed advisable to exclude potential false-positive scintigrams and confirm the presence of cholelithiasis.

  2. Unusual presentation of carcinoid tumor as acute cholecystitis

    SciTech Connect

    Saxton, C.R.

    1983-07-01

    The patient described had signs, symptoms, and laboratory data consistent with acute cholecystitis. A sonogram also suggested cholecystitis, and the gallbladder was not displayed by nuclear imaging. Cholecystectomy revealed the absence of stones but showed carcinoid tumor metastatic to the gallbladder.

  3. Monitoring, characterization and control of chronic, symptomatic malaria infections in rural Zambia through monthly household visits by paid community health workers

    PubMed Central

    2014-01-01

    Background Active, population-wide mass screening and treatment (MSAT) for chronic Plasmodium falciparum carriage to eliminate infectious reservoirs of malaria transmission have proven difficult to apply on large national scales through trained clinicians from central health authorities. Methodology Fourteen population clusters of approximately 1,000 residents centred around health facilities (HF) in two rural Zambian districts were each provided with three modestly remunerated community health workers (CHWs) conducting active monthly household visits to screen and treat all consenting residents for malaria infection with rapid diagnostic tests (RDT). Both CHWs and HFs also conducted passive case detection among residents who self-reported for screening and treatment. Results Diagnostic positivity was higher among symptomatic patients self-reporting to CHWs (42.5%) and HFs (24%) than actively screened residents (20.3%), but spatial and temporal variations of diagnostic positivity were highly consistent across all three systems. However, most malaria infections (55.6%) were identified through active home visits by CHWs rather than self-reporting to CHWs or HFs. Most (62%) malaria infections detected actively by CHWs reported one or more symptoms of illness. Most reports of fever and vomiting, plus more than a quarter of history of fever, headache and diarrhoea, were attributable to malaria infection. The minority of residents who participated >12 times had lower rates of malaria infection and associated symptoms in later contacts but most residents were tested <4 times and high malaria diagnostic positivity (32%) in active surveys, as well as incidence (1.7 detected infections per person per year) persisted in the population. Per capita cost for active service delivery by CHWs was US$5.14 but this would rise to US$10.68 with full community compliance with monthly testing at current levels of transmission, and US$6.25 if pre-elimination transmission levels and

  4. Acute calculous cholecystitis with patent cystic duct

    SciTech Connect

    Massie, J.D.; Moinuddin, M.; Phillips, J.C.

    1983-07-01

    In the diagnosis of acute cholecystitis, the interpretation of cholescintigraphy is usually not difficult. It is conceivable, however, that wth unusual location of obstructing calculi atypical images could result. Three cases were studied with cholescintigraphy and one with cholecystography in which more distal locations of obstructing calculi resulted in partial visualization of the gallbladder and erroneous interpretations were possible. Nuclear medicine radiologists should, therefore, be aware that atypical gallbladder images may be the result of unexpected location of obstructing calculi. Clues for assisting in interpretation are offered.

  5. Differentiation of complicated cholecystitis from gallbladder carcinoma by computed tomography

    SciTech Connect

    Smathers, R.L.; Lee, J.K.T.; Heiken, J.P.

    1984-08-01

    Differentiation between complicated cholecystitis and advanced gallbladder carcinoma can be difficult when clinical findings are confusing. Computed tomographic (CT) scans were reviewed from 22 patients with a surgical diagnosis of complicated cholecystitis (11 cases) or advanced gallbladder carcinoma (11 cases). The presence of a curvilinear low-attenuation halo around the gallbladder wall was specific for complicated cholecystitis. Findings indicative of gallbladder carcinoma included a focal soft-invasion or metastases. Knowledge of these differential CT findings may result in a more accurate preoperative diagnosis.

  6. Evidence for a pyloro-cholecystic reflex for gallbladder contraction.

    PubMed Central

    Debas, H T; Yamagishi, T

    1979-01-01

    We studied the effect of graded antral distension on gallbladder contraction both when gastrin release was promoted (alkaline distension) and when gastrin release was blocked (acid distension) in five dogs provided with innervated antral pouch, chronic bile fistula and gastric fistula. Graded distension of the antrum caused graded gallbladder contraction as evidenced by bilirubin output even when gastrin release was completely suppressed. This nongastrin mechanism of gallbladder contraction is abolished by parenteral atropine and by transthoracic truncal vagotomy. These observations provide evidence for a cholinergic, pyloro-cholecystic reflex for gallbladder contraction that is dependent on intact long vagal pathways. Similar reflex mechanisms have been shown to be initiated by antral distension and to cause pancreatic enzyme secretion (pyloro-pancreatic reflex) or acid secretion from the oxyntic gland area of the stomach (pyloro-oxyntic reflex). It would appear, therefore, that the antrum plays a central role in the integration of upper gastrointestinal function not only through the hormone gastrin but also through neural reflex mechanisms. PMID:464689

  7. Endovascular stent placement for chronic post-thrombotic symptomatic ilio-femoral venous obstructive lesions: a single-center study of safety, efficacy and quality-of-life improvement

    PubMed Central

    Falcoz, Marie-Tiphaine; Falvo, Nicolas; Aho-Glélé, Serge; Demaistre, Emmanuel; Galland, Christophe; Favelier, Sylvain; Pottecher, Pierre; Chevallier, Olivier; Bonnotte, Bernard; Audia, Sylvain; Samson, Maxime; Terriat, Béatrice; Midulla, Marco

    2016-01-01

    Background Post-thrombotic syndrome (PTS) is a frequent complication of deep vein thrombosis (DVT) despite adequate treatment. Venous angioplasty and stent placement has been progressively used to restore and maintain venous patency in PTS patients. This study reports our single-center experience with the use of endovascular treatment for chronic post-thrombotic symptomatic ilio-femoral venous obstructive lesions. Methods A prospective mono-centric observational cohort study of PTS patients with chronic symptomatic ilio-femoral venous obstructive lesions referred for endovascular treatment was conducted from March 2012 to April 2016. Procedure consisted in recanalization, pre-dilation and self-expandable stenting of stenotic or occluded iliac and/or femoral veins. Severity of PTS, quality-of-life and treatment outcomes were assessed using Villalta scale and Chronic Venous Insufficiency Questionnaire (CIVIQ-20) at baseline and 3 months after the procedure. Imaging follow-up was based on duplex ultrasound (US) and computed tomography (CT). Results Twenty-one patients (11 females, 10 males; median age, 41 years; range, 32–60) were included. Recanalization and stenting was successfully accomplished in all prime procedures, 4 patients benefitted from an additional procedure. Immediate technical success rate was 96% considering 25 procedures, performed without any complications. Median follow-up was 18 months (range, 6–30 months) with a 90.5% stent patency rate. Villalta score significantly decreased from baseline compared with 3 months after the procedure [14 (range, 11–22) and 5 (range, 1–10), respectively, P<0.0001], showing a significant decrease in the severity of PTS. CIVIQ-20 score significantly decreased from baseline compared with 3 months after stenting [48.5 (range, 39–73) and 26.5 (range, 21–45), respectively, P<0.0001] thus showing a significant improvement of quality-of-life. Post-procedural CIVIQ-20 score was significantly associated with

  8. 2016 WSES guidelines on acute calculous cholecystitis.

    PubMed

    Ansaloni, L; Pisano, M; Coccolini, F; Peitzmann, A B; Fingerhut, A; Catena, F; Agresta, F; Allegri, A; Bailey, I; Balogh, Z J; Bendinelli, C; Biffl, W; Bonavina, L; Borzellino, G; Brunetti, F; Burlew, C C; Camapanelli, G; Campanile, F C; Ceresoli, M; Chiara, O; Civil, I; Coimbra, R; De Moya, M; Di Saverio, S; Fraga, G P; Gupta, S; Kashuk, J; Kelly, M D; Koka, V; Jeekel, H; Latifi, R; Leppaniemi, A; Maier, R V; Marzi, I; Moore, F; Piazzalunga, D; Sakakushev, B; Sartelli, M; Scalea, T; Stahel, P F; Taviloglu, K; Tugnoli, G; Uraneus, S; Velmahos, G C; Wani, I; Weber, D G; Viale, P; Sugrue, M; Ivatury, R; Kluger, Y; Gurusamy, K S; Moore, E E

    2016-01-01

    Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of "high risk" patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient. PMID:27307785

  9. Risk Factors for Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis

    PubMed Central

    Ohtaka, Kazuto; Shoji, Yasuhito; Ichimura, Tatsunosuke; Fujita, Miri; Senmaru, Naoto; Hirano, Satoshi

    2016-01-01

    Background and Objectives: Factors that contribute to difficult laparoscopic cholecystectomy (LC) in acute cholecystitis (AC) that would affect the performance of early surgery remain unclear. The purpose of this study was to identify such risk factors. Methods: One hundred fifty-four patients who underwent LC for AC were retrospectively analyzed. The patients were categorized into early surgery and delayed surgery. Factors predicting difficult LC were analyzed for each group. The operation time, bleeding, and cases of difficult laparoscopic surgery (CDLS)/conversion rate were analyzed as an index of difficulty. Analyses of patients in the early group were especially focused on 3 consecutive histopathological phases: edematous cholecystitis (E), necrotizing cholecystitis (N), suppurative/subacute cholecystitis (S). Results: In the early group, the CDLS/conversion rate was highest in necrotizing cholecystitis. Its rate was significantly higher than that of the other 2 histopathological types (N 27.9% vs E and S 7.4%; P = .037). In the delayed-surgery group, a higher white blood cell (WBC) count and older age showed significant correlations with the CDLS/conversion rate (P = .034 and P = .004). Conclusion: In early surgery, histopathologic necrotizing cholecystitis is a risk factor for difficult LC in AC. A higher WBC count and older age are risk factors for delayed surgery.

  10. Celiac territory ischemic syndrome in a patient on chronic hemodialysis.

    PubMed

    Ori, Y; Korzets, A; Neyman, H; Herman, M; Baytner, S; Gafter, U; Atar, E

    2007-10-01

    Mesenteric ischemia among chronic dialysis patients is usually of the nonocclusive type. Chronic occlusive mesenteric ischemia has been reported rarely in the dialysis population. The subset of"celiac-territory ischemic syndrome" has not been described in dialysis. The current report involves a 66-year-old female on chronic dialysis for 11 years. She experienced abdominal pain following sessions of hemodialysis, that later became more pronounced after eating. Abdominal angiography showed heavily calcified aorta, celiac trunk and superior mesenteric artery (SMA), with a 50% narrowing of the celiac and superior mesenteric arteries. During the following 9 months the symptoms worsened and weight loss set in. She was admitted with an episode of upper abdominal pain. Acalculous cholecystitis was found, along with multiple gastric and duodenal erosions including the second part, with an antral ulcer and multiple duodenal bulb ulcers. Repeated abdominal angiography showed progression of the stenotic lesions with significant narrowing of both the celiac trunk and the SMA. A stent was placed in the SMA. Following the procedure, the patient noted marked symptomatic improvement. On follow-up gastroduodenoscopy, all ischemic ulcers had healed completely. Serum albumin rose from a nadir of 31 to 40 g/l, and an extremely elevated c-reactive protein of 205,000 microg/l returned to normal (8,000 microg/l). The diagnosis of chronic occlusive mesenteric ischemia should be suspected among dialysis patients with post-prandial pain and weight loss in the face of calcified vessels. Predominant celiac territory ischemic syndrome presents as gastric and duodenal erosions and ulcers with or without acalculous cholecystitis. PMID:17969495

  11. [Leptospirosis with necro-haemorrhagic cholecystitis in a Boxer puppy].

    PubMed

    Steil, D; Quandt, A; Mayer-Scholl, A; Sie, J M; Löhr, C V; Teifke, J P

    2014-01-01

    A Boxer puppy from the island of Rügen, which was properly vaccinated according to its age, was presented with acute gastrointestinal symptoms. The presumptive diagnosis of leptospirosis with acute renal failure, hepatic damage, and jaundice was confirmed by seroconversion (increased titre to 1 : 800 in a non-vaccine serogroup 4 weeks after disease onset). Cholecystitis was diagnosed based on clinical symptoms and sonographic results. After an initial improvement, the puppy's condition deteriorated and cholecystectomy was performed. Histopathological diagnosis indicated a haemorrhagic necrotizing cholecystitis.

  12. [Leptospirosis with necro-haemorrhagic cholecystitis in a Boxer puppy].

    PubMed

    Steil, D; Quandt, A; Mayer-Scholl, A; Sie, J M; Löhr, C V; Teifke, J P

    2014-01-01

    A Boxer puppy from the island of Rügen, which was properly vaccinated according to its age, was presented with acute gastrointestinal symptoms. The presumptive diagnosis of leptospirosis with acute renal failure, hepatic damage, and jaundice was confirmed by seroconversion (increased titre to 1 : 800 in a non-vaccine serogroup 4 weeks after disease onset). Cholecystitis was diagnosed based on clinical symptoms and sonographic results. After an initial improvement, the puppy's condition deteriorated and cholecystectomy was performed. Histopathological diagnosis indicated a haemorrhagic necrotizing cholecystitis. PMID:25423604

  13. Cholescintigraphy in acute cholecystitis: use of intravenous morphine

    SciTech Connect

    Choy, D.; Shi, E.C.; McLean, R.G.; Hoschl, R.; Murray, I.P.C.; Ham, J.M.

    1984-04-01

    Conventional cholescintigraphy (60 patients) and a modified protocol (59 patients) were compared in 74 females and 45 males with acute cholecystitis. In the modified protocol, intravenous morphine was administered whenever the gallbladder was not seen 40 minutes after injection of Tc-99m-pyroxylidene-glutamate. Accuracy was 98% with morphine, compared with 88% for the conventional protocol; specificity improved from 83% to 100% with no loss of sensitivity. Low doses of morphine are well tolerated and can result in a highly accurate diagnosis of acute cholecystitis without the need for delayed imaging.

  14. A phase II study of two dose levels of ofatumumab induction followed by maintenance therapy in symptomatic, previously untreated chronic lymphocytic leukemia.

    PubMed

    Flinn, Ian W; Ruppert, Amy S; Harwin, William; Waterhouse, David; Papish, Steven; Jones, Jeffrey A; Hainsworth, John; Byrd, John C

    2016-10-01

    Despite the recent advances in treatment of CLL with targeted agents such as ibrutinib, availability of nonchemotherapy based therapies is desired. Given the 58% response rate (1996 NCI-WG criteria) of single agent ofatumumab in CLL refractory to fludarabine and alemtuzumab, we initiated a phase II trial examining response, safety, and progression-free survival (PFS) of ofatumumab as front-line monotherapy. Patients enrolled included untreated, symptomatic CLL patients over the age of 65 or those who were inappropriate/did not desire chemotherapy. Two cohorts were enrolled sequentially examining either 1 g (33 patients) or 2 g (44 patients) weekly for 8 weeks followed by maintenance dosing every 2 months for a total of 24 months. Patients receiving 1 g were older than those receiving 2 g, but there were no significant differences in other clinical characteristics. The best overall response rates in the 1 and 2 g patient cohorts were 72 and 89% (1996 NCI-WG criteria), respectively (54 and 68%, respectively, using 2008 IWCLL criteria). All but two responses were partial. The 24-month estimated PFS rates were 46 and 78%, respectively. Response and PFS was lower in del(17p) and del(11q) CLL patients. Differences in PFS between dose cohorts were statistically significant and remained so when adjusting for age or high-risk cytogenetics. Toxicity of this treatment was mild with only six patients not completing therapy due to toxicity. Ofatumumab induction followed by maintenance therapy in untreated CLL represents a well-tolerated and active regimen, particularly with the 2 g of ofatumumab. Am. J. Hematol. 91:1020-1025, 2016. © 2016 Wiley Periodicals, Inc. PMID:27387131

  15. Acute cholecystitis or metastatic renal cell carcinoma? a diagnostic dilemma.

    PubMed

    Finkelstein, L H; Coffman, L M

    1996-05-01

    Renal cell carcinoma is known to metastasize to many different organ systems. Lung and bone are clearly the most common sites of metastasis, but the symptoms at presentation may simulate those of other diseases of the organ system involved. The patient with metastatic renal cell carcinoma described here had symptoms of acute cholecystitis.

  16. Symptomatic cervicogenic headache.

    PubMed

    Delfini, R; Salvati, M; Passacantilli, E; Pacciani, E

    2000-01-01

    Cervicogenic headache is a little-known clinical condition whose true importance has only recently been recognized. A number of causes may lie at the basis of the onset of headache (symptomatic cervicogenic headache). However, despite exhaustive attempts, sometimes it is not possible to identify a clear cause responsible for the onset of the syndrome (primitive cervicogenic headache). The genesis of symptomatic cervicogenic headaches sometimes may be easy to identify as a result of a close, pre-existing, cause-effect relationship (i.e. trauma). On other occasions it may be much more laborious to pinpoint the pathology responsible for headache (some cranio-cervical anomalies, etc.). Clinically, it is necessary to perform a thorough preliminary clinical and anamnestic evaluation which can orient subsequent investigations to achieve a diagnosis in the least time possible with the minimum discomfort to the patient and his relatives, not to mention lower costs for society. PMID:10824284

  17. Scaling and root planning, and locally delivered minocycline reduces the load of Prevotella intermedia in an interdependent pattern, correlating with symptomatic improvements of chronic periodontitis: a short-term randomized clinical trial

    PubMed Central

    Deng, Shuli; Wang, Ying; Sun, Wei; Chen, Hui; Wu, Gang

    2015-01-01

    Background To evaluate the respective or combinatory efficacy of locally delivered 2% minocycline (MO), and scaling and root planning (SRP) by assessing both clinical parameters and the loads of four main periodontal pathogens in treating chronic periodontitis (CP). Methods Seventy adults with CP were randomly assigned to the three treatment groups: 1) SRP alone; 2) MO alone; and 3) combinatory use of SRP and MO (SRP + MO). Before and 7 days after the treatments, we evaluated both clinical parameters (pocket depth [PD] and sulcus bleeding index [SBI]) and the gene load of four main periodontal pathogens (Aggregatibacter actinomycetemcomitans [Aa], Fusobacterium nucleatum [Fn], Porphyromonas gingivalis [Pg], and Prevotella intermedia [Pi]). Results The bacterial prevalence per patient was: Aa, 31.25%; Fn, 100%; Pg, 95.31%; and Pi, 98.44%. Seven days after treatment, the three treatments significantly reduced both PD and SBI, but not detection frequencies of the four pathogens. For PD, the reduction efficacy of SRP + MO was significantly higher than that of either MO or SRP. Only Pg responded significantly to SRP. Pg and Fn were significantly reduced in the presence of MO. Only SRP + MO showed a significant reduction effect on the gene load of Pi. The reduction of PD significantly correlated with the gene load of Pi (r=0.26; P=0.042) but not of the other bacteria. Conclusion SRP and MO reduced the load of Pi in an interdependent pattern, which correlated with symptomatic improvements of CP. PMID:26676022

  18. Surgical treatment of the symptomatic os trigonum in children.

    PubMed

    de Landevoisin, E Soucanye; Jacopin, S; Glard, Y; Launay, F; Jouve, J-L; Bollini, G

    2009-04-01

    Symptomatic os trigonum is a rare condition, well described in adults, that causes chronic ankle pain. To date there are no reported cases of successfully managed symptomatic os trigonum in the children population. We retrospectively reviewed four paediatric patients (11-17 years of age) successfully operated for a symptomatic os trigonum using an open excision through a posteromedial approach. One case was bilateral. Postoperative pain relief was obtained in all cases. All of the patients were able to return to unrestricted physical activities after three months. The average follow-up was 12 months. Symptomatic os trigonum may be held responsible for chronic ankle pain in children and adolescents as well as in adults. The surgical treatment is effective in children.

  19. A rare case of listeriosis, acute cholecystitis and multiple myeloma

    PubMed Central

    Polanco, Thais O.; Alothman, Sara; Depaz, Hector; Ramcharan, Alexius

    2016-01-01

    Listeria monocytogenes (LM) is an aerobic, motile, intracellular gram-positive bacterium. Most invasive systemic infections caused by LM are commonly seen in patients at both extremes of age, during pregnancy or in immunocompromised hosts. Common clinical manifestations of LM infection in immunocompromised adults are bacteremia, infections of central nervous system, such as meningitis, and self-limiting febrile gastroenteritis. Focal infections of listeria are rare, especially cholecystitis, with only few cases reported in the last 33 years. A 62-year-old man presented with multiple myeloma, cholecystitis and LM bacteremia. Due to prompt surgical treatment and antibiotics (amoxicillin plus clavulanic acid and gentamycin), this high-risk patient recovered without any complications. PMID:27170703

  20. Leptospirosis mimicking acute cholecystitis among athletes participating in a triathlon.

    PubMed

    Guarner, J; Shieh, W J; Morgan, J; Bragg, S L; Bajani, M D; Tappero, J W; Zaki, S R

    2001-07-01

    Leptospirosis, a disease acquired by exposure to contaminated water, is characterized by fever accompanied by various symptoms, including abdominal pain. An acute febrile illness occurred in athletes who participated in an Illinois triathlon in which the swimming event took place in a freshwater lake. Of 876 athletes, 120 sought medical care and 22 were hospitalized. Two of the athletes had their gallbladders removed because of abdominal pain and clinical suspicion of acute cholecystitis. We applied an immunohistochemical test for leptospirosis to these gallbladders and demonstrated bacterial antigens staining (granular and filamentous patterns) around blood vessels of the serosa and muscle layer. Rare intact bacteria were seen in 1 case. These results show that leptospirosis can mimic the clinical symptoms of acute cholecystitis. If a cholecystectomy is performed in febrile patients with suspicious environmental or animal exposure, pathologic studies for leptospirosis on formalin-fixed, paraffin-embedded tissues may be of great value.

  1. Laparoscopic Cholecystectomy for Acute Calcular Cholecystitis in a Patient with Ventriculoperitoneal Shunt: A Case Report and Literature Review

    PubMed Central

    Albarrak, Abdullah A.; Khairy, Sami; Ahmed, Alzahrani Mohammed

    2015-01-01

    Management of patients who have ventriculoperitoneal shunt presenting with acute calcular cholecystitis has remained a clinical challenge. In this paper, the hospital course and the follow-up of a patient presenting with acute calcular cholecystitis and ventriculoperitoneal shunt managed with laparoscopic cholecystectomy are presented followed by literature review on the management of acute calcular cholecystitis in patients who have ventriculoperitoneal shunts. PMID:26798543

  2. Radiofrequency Ablation Treatment in Proximity to the Gallbladder Without Subsequent Acute Cholecystitis

    SciTech Connect

    Patti, Jay W.; Neeman, Ziv Wood, Bradford J.

    2003-08-15

    Initial reports have suggested that proximity of liver tumors to the gallbladder may increase the risk for cholecystitis after radiofrequency ablation. A colon adenocarcinoma metastasis to the liver in contact with the gallbladder was successfully treated with radiofrequency ablation without subsequent cholecystitis.

  3. Acute acalculous cholecystitis in systemic lupus erythematosus: a rare initial manifestation.

    PubMed

    Manuel, Valdano; Pedro, Gertrudes Maria; Cordeiro, Lemuel Bornelli; de Miranda, Sandra Maria da Rocha Neto

    2016-01-01

    Acute acalculous cholecystitis is a very rare gastrointestinal manifestation in systemic lupus erythematosus and becomes rarer as an initial manifestation. There are only two cases reported. The authors report a 20-year-old black woman that presented acute acalculous cholecystitis revealed by abdominal computed tomography. During hospitalization, she was diagnosed systemic lupus erythematosus. Conservative treatment with antibiotics was performed with complete remission of the symptoms. Corticosteroid was started in ambulatory. Cholecystectomy has been the treatment of choice in acute acalculous cholecystitis as a complication of systemic lupus erythematosus. The patient responded well to conservative treatment, and surgery was not required. This case is unique in the way that corticosteroid was started in ambulatory care. We should not forget that the acute acalculous cholecystitis can be the initial presentation of systemic lupus erythematosus although its occurrence is very rare. Conservative treatment should be considered. Abdominal computed tomography was a determinant exam for better assessment of acute acalculous cholecystitis. PMID:27267533

  4. Acute acalculous cholecystitis in systemic lupus erythematosus: a rare initial manifestation.

    PubMed

    Manuel, Valdano; Pedro, Gertrudes Maria; Cordeiro, Lemuel Bornelli; de Miranda, Sandra Maria da Rocha Neto

    2016-01-01

    Acute acalculous cholecystitis is a very rare gastrointestinal manifestation in systemic lupus erythematosus and becomes rarer as an initial manifestation. There are only two cases reported. The authors report a 20-year-old black woman that presented acute acalculous cholecystitis revealed by abdominal computed tomography. During hospitalization, she was diagnosed systemic lupus erythematosus. Conservative treatment with antibiotics was performed with complete remission of the symptoms. Corticosteroid was started in ambulatory. Cholecystectomy has been the treatment of choice in acute acalculous cholecystitis as a complication of systemic lupus erythematosus. The patient responded well to conservative treatment, and surgery was not required. This case is unique in the way that corticosteroid was started in ambulatory care. We should not forget that the acute acalculous cholecystitis can be the initial presentation of systemic lupus erythematosus although its occurrence is very rare. Conservative treatment should be considered. Abdominal computed tomography was a determinant exam for better assessment of acute acalculous cholecystitis.

  5. Primary gallbladder lymphoma presenting with perforated cholecystitis and hyperamylasaemia.

    PubMed

    Shah, K S V; Shelat, V G; Jogai, S; Trompetas, V

    2016-02-01

    Primary gallbladder lymphoma is rare. Perforated cholecystitis due to primary gallbladder lymphoma and not related to chemotherapy has been unreported. We report the case of an 80-year-old woman presenting with an acute abdomen and clinical peritonitis. Her serum amylase was raised to 878 iu/l. Urgent computed tomography revealed generalised free fluid with a normal pancreas and was non-diagnostic as to the underlying pathology. An emergency laparotomy revealed bilious peritonitis with a necrotic patch on a distended gallbladder. A cholecystectomy was carried out and histology of the gallbladder revealed a marginal zone lymphoma.

  6. Symptomatic intratendinous ganglion cyst of the patellar tendon.

    PubMed

    Jose, Jean; O'Donnell, Kevin; Lesniak, Bryson

    2011-01-01

    Ganglion cysts have been previously described throughout the body, most commonly about the wrist, hand, knee, ankle, and feet. When symptomatic, they may interfere with joint mechanics, resulting in snapping, catching, and locking. Intratendinous ganglion cysts lack a synovial epithelial lining and are thought to develop from the mucoid degeneration of connective tissue caused by chronic irritation, chronic repetitive injury, and chronic ischemia. On magnetic resonance imaging, ganglion cysts originating from tendons, ligaments, tendon sheaths, menisci, or joint capsules appear as well-defined lobulated masses that follow simple or complex fluid signal intensity on all pulse sequences, with enhancing walls and internal septations on post-contrast images. There may be appreciable degeneration and partial tearing of the structure of origin, particularly if associated with tendons. On ultrasonography, they present as hypoechoic masses, with internal septations and lobulations of varying sizes, without significant vascularity on power or color Doppler sampling. A thin fluid neck extending from the structure of origin (tail sign), when present, is a reliable sign of a ganglion cyst. This article describes a sonographically guided technique to treat symptomatic ganglion cysts within the patellar tendon. Complete evacuation of the ganglion cyst, with disappearance of the tail sign, is considered the determining factor for a successful procedure. A similar technique can be used for the treatment of other symptomatic intratendinous ganglion cysts elsewhere in the body. To our knowledge, symptomatic intratendinous ganglion cysts within the patellar tendon and their treatment have not been previously reported.

  7. A Case of Symptomatic Tracheal Diverticulum and Surgical Resection as a Treatment Modality

    PubMed Central

    Lee, Shin-Young; Joo, Seok; Lee, Geun Dong; Ham, Seok Jin; Park, Chul Hwan; Lee, Sungsoo

    2016-01-01

    Tracheal diverticulum is often diagnosed incidentally and, due to its rarity, there is no standard treatment. It is a benign entity, but has the potential to cause specific symptoms, such as chronic upper respiratory infection and chronic cough. Symptomatic tracheal diverticulum can be medically treated, but likelihood of recurrence is high. We report a case of surgical resection of symptomatic tracheal diverticulum to prevent recurrence. PMID:27734005

  8. A Case Report of Acute Acalculous Cholecystitis and Acute Hemorrhagic Cystitis due to Salmonella Typhi

    PubMed Central

    Beyazal Polat, Hatice; Beyazal Çeliker, Fatma

    2014-01-01

    Acute acalculous cholecystitis and acute hemorrhagic cystitis due to Salmonella Typhi are a rare condition. A 24-year-old female patient was admitted to our clinic with abdominal pain, nausea, fever, headache, urinary burning, and bloody urine. Based on clinical, laboratory, and radiological evaluations, the patient was diagnosed with acute acalculous cholecystitis and acute hemorrhagic cystitis due to Salmonella Typhi. The patient was treated with intravenous ceftriaxone for two weeks. After the treatment, the patient's clinical and laboratory findings improved. Acute acalculous cholecystitis due to Salmonella Typhi concomitant with acute hemorrhagic cystitis is very rare and might be difficult to diagnose. Infectious agents such as Salmonella Typhi should be considered when acute acalculous cholecystitis and acute hemorrhagic cystitis are detected in adult patients with no underlying diseases. PMID:25161668

  9. Acute Cholecystitis Caused by Malignant Cystic Duct Obstruction: Treatment with Metallic Stent Placement

    SciTech Connect

    Miyayama, Shiro Yamashiro, Masashi; Takeda, Taro; Aburano, Hiroyuki; Komatsu, Tetsuya; Sanada, Taku; Kosaka, Shotaro; Toya, Daisyu; Matsui, Osamu

    2008-07-15

    We report the successful management of acute cholecystitis using cystic duct stent placement in 3 patients with inoperable malignant cystic duct obstruction (2 cholangiocarcinoma and 1 pancreatic carcinoma). All patients underwent stent placement in the bile duct, using an uncovered stent in 2 and a covered stent in 1, to relieve jaundice occurring 8-184 days (mean 120 days) before the development of acute cholecystitis. The occluded cystic duct was traversed by a microcatheter and a stent was implanted 4-17 days (mean 12 days) after cholecystostomy. Acute cholecystitis was improved after the procedure in all patients. Two patients died 3 and 10 months later, while 1 has survived without cholecystitis for 22 months after the procedure to date.

  10. PIPIDA scintigraphy for cholecystitis: false positives in alcoholism and total parenteral nutrition

    SciTech Connect

    Shuman, W.P.; Gibbs, P.; Rudd, T.G.; Mack, L.A.

    1982-01-01

    A review of gallbladder scintigraphy in patients with potentially compromised hepatobiliary function revealed two groups in whom cholecystitis might be mistakenly diagnosed. In 200 consecutive hospitalized patients studied with technetium-99m-PIPIDA for acute cholecystitis or cholestasis, there were 41 alcoholics and 17 patients on total parenteral nutrition. In 60% of the alcoholics and 92% of those on parenteral nutrition, absent or delayed visualization of the gallbladder occurred without physical or clinical evidence of cholecystitis. A cholecystagogue, sincalide, did not prevent the false-positive features which presumably are due to altered bile flow kinetics related to alcoholism and parenteral nutrition. Four patients on parenteral nutrition undergoing cholecystectomy for suspected cholecystitis had normal gallbladders filled with jellylike viscous thick bile. A positive (nonvisualized or delayed visualized) gallbladder PIPIDA scintigram in these two populations should not be interpreted as indicating a need for cholecystectomy.

  11. Cholecystitis Associated with Heterotopic Pancreas, Pseudopyloric Metaplasia, and Adenomyomatous Hyperplasia: A Rare Combination.

    PubMed

    Kaur, Navjot; Chander, Bal; Kaur, Harjit; Kaul, Rashmi

    2016-01-01

    Heterotopic pancreatic tissue in the gall bladder is an uncommon incidental finding in most cases. We hereby describe the case of a 45-year-old woman who presented with symptoms of acalculous cholecystitis. Pathological examination detected heterotopic pancreatic tissue, pseudopyloric metaplasia, and adenomyomatous hyperplasia in the gall bladder. This is a rare combination of three entities which is being reported for the first time. This case emphasizes that heterotopic pancreas might be the causative factor for cholecystitis. PMID:27365925

  12. Gallbladder torsion with acute cholecystitis and gross necrosis.

    PubMed

    Alkhalili, Eyas; Bencsath, Kalman

    2014-01-01

    A 92-year-old woman presented to the emergency department with a 2-week history of worsening right-sided abdominal pain. On examination she had right mid-abdominal tenderness. Laboratory studies demonstrated leukocytosis with normal liver function tests. A CT of the abdomen was remarkable for a large fluid collection in the right abdomen and no discernible gallbladder in the gallbladder fossa. An ultrasound confirmed the suspicion of a distended, floating gallbladder. The patient was taken to the operating room for laparoscopic cholecystectomy. The gallbladder was found to have volvulised in a counter -clockwise manner around its pedicle, with gross necrosis of the gallbladder. She underwent laparoscopic cholecystectomy. Pathological examination revealed acute necrotising calculus cholecystitis.

  13. A Rare Case of Cholecystitis Caused by Raoultella planticola.

    PubMed

    Teo, Isabel; Wild, Jonathan; Ray, Saikat; Chadwick, David

    2012-01-01

    A 62-year-old female presented with right upper quadrant pain. Clinical examination and ultrasound scan were consistent with gallstones and acute cholecystitis. She received 3 days of intravenous Co-amoxiclav and was discharged with 5-days of oral antibiotics with arrangements to return for an elective cholecystectomy. This was performed 5 months later which revealed an inflamed gallbladder and a localised abscess secondary to gallbladder perforation. Fluid from the gallbladder was taken which cultured Raoultella planticola, a gram-negative, nonmotile environmental bacteria (Bagley et al. (1981)). This is the first report of biliary sepsis with a primary infection by R. planticola. This patient was treated with a 5-day course of oral Co-amoxiclav and made a full recovery.

  14. Acute acalculous cholecystitis in a patient with juvenile dermatomyositis

    PubMed Central

    Sanches, Bruno Fernandes; Martins, Teresa; Santos, Maria José; Azeredo, Paula

    2014-01-01

    Juvenile dermatomyositis (JDM) is a rare autoimmune disease, characterised by a systemic capillary vasculopathy that typically affects skin and muscle. Gastrointestinal involvement is relatively rare. We report the case of an 11-year-old girl admitted for investigation of skin rash, progressive symmetric proximal muscle weakness, dysphagia and weight loss. The diagnosis of JDM was confirmed and during hospitalisation the patient developed abrupt and intense right hypocondrium pain associated with nausea and vomiting. Abdominal ultrasound revealed a thick gallbladder wall (8 mm) with pericholecystic fluid and no evidence of gallstones. An acute acalculous cholecystitis was assumed and the patient was started on intravenous fluids, prednisolone and analgaesic therapy. Clinical resolution was verified after 48 h. We hypothesised that the vasculitic process of JDM could have been the basis for this complication as described in other autoimmune diseases. PMID:25239990

  15. Ascaris cholecystitis and cholangitis: an experience in Myanmar.

    PubMed

    Lwin, M; Tint, K S

    1994-08-01

    Twenty-seven cases of ascaris cholecystitis and cholangitis were managed in a surgical unit of a general hospital in Yangon, Myanmar, from January 1989 to March 1990. Nineteen women and eight men with a mean age of 42 years were studied. Main clinical manifestations were right hypochondrial pain, fever, chills, rigors, nausea, vomiting and jaundice. Diagnosis was established by abdominal ultrasonograms in all cases. Laparotomy was performed in all cases because of failure to respond to initial conservative treatment. Live and dead ascarids were found in the gall bladder and biliary ductal system. Cholecystectomy, bile duct exploration, worm extraction and T-tube drainage were done in all cases. There were no deaths. Two patients developed minor wound sepsis. During the follow-up period ranging from 3 to 12 months, there was no recurrence of symptoms in all patients. All patients were given antihelminthics before discharge and three weeks later.

  16. Suspected acute cholecystitis. Comparison of hepatobiliary scintigraphy versus ultrasonography

    SciTech Connect

    Freitas, J.E.; Mirkes, S.H.; Fink-Bennett, D.M.; Bree, R.L.

    1982-08-01

    One hundred ninety-five patients with suspected acute cholecystitis (AC) underwent both hepatobiliary scintigraphy (HBS) and static gray-scale ultrasonography (US) to assess the relative value of each imaging modality in this clinical setting. HBS was performed after the intravenous injection of 5 mCi /sup 99m/Tc iprofenin. Abnormal HBS indicative of AC visualized the common bile duct, but not the gallbladder, within 1 to 4 hours after tracer administration. Abnormal US indicative of AC demonstrated cholelithiasis and/or gallbladder wall edema. In this series, HBS surpassed US in sensitivity (98.3% versus 81.4%), specificity (90.2% versus 60.2%), predictive value of an abnormal test (91.4% versus 51.6%), and predictive value of a normal test (100% versus 92%), HBS should be the procedure of choice for the rapid detection of AC.

  17. Percutaneous Cholecystostomy for Patients with Acute Cholecystitis and an Increased Surgical Risk

    SciTech Connect

    Overhagen, Hans van; Meyers, Hjalmar; Tilanus, Hugo W.; Jeekel, Johannes; Lameris, Johan S.

    1996-03-15

    Purpose: To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk. Methods: Thirty-three patients with acute cholecystitis (calculous, n= 22; acalculous, n= 11) underwent percutaneous cholecystostomy by means of a transhepatic (n= 21) or transperitoneal (n= 12) access route. Clinical and laboratory parameters were retrospectively studied to determine the benefit from cholecystostomy. Results: All procedures were technically successful. Twenty-two (67%) patients improved clinically within 48 hr; showing a significant decrease in body temperature (n= 13), normalization of the white blood cell count (n= 3), or both (n= 6). There were 6 (18%) minor/moderate complications (transhepatic access, n= 3; transperitoneal access, n= 3). Further treatment for patients with calculous cholecystitis was cholecystectomy (n= 9) and percutaneous and endoscopic stone removal (n= 8). Further treatment for patients with acalculous cholecystitis was cholecystectomy (n= 2) and gallbladder ablation (n= 2). There were 4 deaths (12%) either in hospital or within 30 days of drainage; none of the deaths was procedure-related. Conclusions: Percutaneous cholecystostomy is a safe and effective procedure for patients with acute cholecystitis. For most patients with acalculous cholecystitis percutaneous cholecystostomy may be considered a definitive therapy. In calculous disease this treatment is often only temporizing and a definitive surgical, endoscopic, or radiologic treatment becomes necessary.

  18. Symptomatic fatigue in multiple sclerosis.

    PubMed

    Freal, J E; Kraft, G H; Coryell, J K

    1984-03-01

    Symptomatic fatigue has not been investigated previously in a multiple sclerosis population. Potential subjects were the 78% of 656 individuals with multiple sclerosis who indicated in a previous study that they experienced symptomatic fatigue. Three hundred nine subjects (60%) returned a follow-up questionnaire on symptomatic fatigue. Ninety percent described fatigue as "tiredness or the need to rest," but 43% of them indicated that "sleepiness" was part of the symptomatology. In 48% fatigue made other MS symptoms worse. Fatigue tended to occur in the late afternoon and evening. It occurred almost daily for more than 66% of the subjects. In 47% of the subjects fatigue usually subsided within a few hours; in other subjects occurrences were of variable length (40%) or lasted between 6 and 24 hours (8%). Ninety percent said that fatigue was worse at warmer environmental temperatures. Fatigue was worse for 83% after "vigorous exercise" and for 64% after "moderate exercise" although 15% reported that moderate exercise helped to reduce fatigue. Meditation, some drugs, and cooling with water reduced fatigue in a majority of the small proportion of the population trying these techniques. A planned daily schedule of activity and rest seemed to be a partially effective response to symptomatic fatigue for the majority of subjects studied.

  19. Endoscopic fenestration of a symptomatic cyst of the septum pellucidum.

    PubMed

    Vaquero, J; Manrique, M; De Prado, F

    2000-12-01

    We present the case of a 25-year-old woman suffering from chronic severe headaches and syncope associated with an expanding cyst of the septum pellucidum. After a simple endoscopic fenestration of the cyst the symptoms resolved, resulting in an excellent clinical outcome. This case shows that simple endoscopic fenestration may produce a rapid and maintained symptomatic improvement in patients with an expanding cyst of the septum pellucidum. PMID:11272036

  20. Symptomatic carpal coalition: scaphotrapezial joint.

    PubMed

    Campaigniac, Erin; Eskander, Mark; Jones, Marci

    2013-12-01

    Carpal coalition is an uncommon congenital abnormality that arises from incomplete cavitation of the common cartilaginous precursor that forms the carpal bones. When carpal coalition is discovered, it is typically an asymptomatic incidental radiographic finding, and is often bilateral. We present a case of symptomatic unilateral carpal coalition of the scaphotrapezial joint, which was treated by excising the fibrous coalition and placing an interposition fat graft. This treatment was effective in alleviating the patient's symptoms.

  1. Management of Symptomatic Intracranial Stenosis.

    PubMed

    Hoak, David A; Lutsep, Helmi L

    2016-09-01

    Intracranial atherosclerotic disease is a common cause of stroke worldwide, causing approximately 10 % of strokes in the USA and up to 50 % in Asian populations. Recurrent stroke risks are particularly high in those with a stenosis of 70 % or more and a recent transient ischemic attack or stroke. Warfarin has been associated with higher major hemorrhage rates and no reduction of recurrent stroke compared to aspirin in patients with symptomatic intracranial stenosis. After early trials showed the feasibility of stenting, two randomized trials compared stenting plus medical management to medical management alone in symptomatic intracranial stenosis. Stenting was linked with increased risk and showed no benefit in any subpopulation of patients. Aggressive medical management in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial was associated with half the risk of stroke compared to that in similar patients in a previous symptomatic intracranial stenosis trial after adjustment of confounding characteristics. Aggressive medical management comprises risk factor control, including a target systolic blood pressure <140 mmHg, a low density lipoprotein <70 mg/dL, hemoglobin A1C <7.0 %, and lifestyle management that incorporates exercise, smoking cessation and weight management, and the use of antithrombotics. PMID:27443379

  2. Deficiencies of Circulating Mucosal-associated Invariant T Cells and Natural Killer T Cells in Patients with Acute Cholecystitis.

    PubMed

    Kim, Jung-Chul; Jin, Hye-Mi; Cho, Young-Nan; Kwon, Yong-Soo; Kee, Seung-Jung; Park, Yong-Wook

    2015-05-01

    Mucosal-associated invariant T (MAIT) cells and natural killer T (NKT) cells are known to play crucial roles in a variety of diseases, including autoimmunity, infectious diseases, and cancers. However, little is known about the roles of these invariant T cells in acute cholecystitis. The purposes of this study were to examine the levels of MAIT cells and NKT cells in patients with acute cholecystitis and to investigate potential relationships between clinical parameters and these cell levels. Thirty patients with pathologically proven acute cholecystitis and 47 age- and sex-matched healthy controls were enrolled. Disease grades were classified according to the revised Tokyo guidelines (TG13) for the severity assessment for acute cholecystitis. Levels of MAIT and NKT cells in peripheral blood were measured by flow cytometry. Circulating MAIT and NKT cell numbers were significantly lower in acute cholecystitis patients than in healthy controls, and these deficiencies in MAIT cells and NKT cell numbers were associated with aging in acute cholecystitis patients. Notably, a reduction in NKT cell numbers was found to be associated with severe TG13 grade, death, and high blood urea nitrogen levels. The study shows numerical deficiencies of circulating MAIT and NKT cells and age-related decline of these invariant T cells. In addition, NKT cell deficiency was associated with acute cholecystitis severity and outcome. These findings provide an information regarding the monitoring of these changes in circulating MAIT and NKT cell numbers during the course of acute cholecystitis and predicting prognosis.

  3. Update on bedside ultrasound (US) diagnosis of acute cholecystitis (AC).

    PubMed

    Zenobii, Maria Francesca; Accogli, Esterita; Domanico, Andrea; Arienti, Vincenzo

    2016-03-01

    Acute cholecystitis (AC) represents a principal cause of morbidity worldwide and is one of the most frequent reasons for hospitalization due to gastroenteric tract diseases. AC should be suspected in presence of clinical signs and of gallstones on an imaging study. Upper abdominal US represents the first diagnostic imaging step in the case of suspected AC. Computed tomography (CT) with intravenous contrast (IV) or magnetic resonance imaging (MRI) with gadolinium contrast and technetium hepatobiliary iminodiacetic acid (Tc-HIDA) can be employed to exclude complications. US examination should be performed with right subcostal oblique, with longitudinal and intercostal scans. Normal gallbladder US findings and AC major and minor US signs are described. Polyps, sludge and gallbladder wall thickening represent the more frequent pitfalls and they must be differentiated from stones, duodenal artifacts and many other non-inflammatory conditions that cause wall thickening, respectively. By means of bedside ultrasound, the finding of gallstones in combination with acute pain, when the clinician presses the gallbladder with the US probe (the sonographic Murphy's sign), has a 92.2 % positive predictive value for AC. In our preliminary experience, bedside US-performed by echoscopy (ES) and/or point-of-care US (POCUS) demonstrated good reliability in detecting signs of AC, and was always integrated with physical examination and performed by a skilled operator.

  4. Acute acalculous cholecystitis and cardiovascular disease: a land of confusion.

    PubMed

    Tana, Marco; Tana, Claudio; Cocco, Giulio; Iannetti, Giovanni; Romano, Marcello; Schiavone, Cosima

    2015-12-01

    Acute acalculous cholecystitis (AAC) can be defined as acute inflammatory disease of the gallbladder without evidence of gallstones. The first case was reported in 1844 by Duncan et al.; however, some cases may have been missed previously in view of the complexity of the diagnosis. Several risk factors have been identified, and cardiovascular disease (CVD), in view of its multiple mechanisms of action, seems to play a key role. Atypical clinical onset, paucity of symptoms, overlap with comorbidities, and lack of robust, controlled trials result often in under or misdiagnosed cases. Moreover, laboratory results may be negative or not specific in the late stage of the disease, when a surgical treatment cannot be longer helpful if complications arise. A rapid diagnosis is therefore essential to achieve a prompt treatment and to avoid further clinical deterioration. In this short review, we would present the current evidence regarding epidemiology, pathophysiology, and clinical presentation of the complex relation between AAC and CVD. Then, we fully emphasize the role of ultrasound to achieve an early diagnosis and an appropriate treatment in suspected cases, reducing mortality and complications rates.

  5. Morphine-augmented cholescintigraphy in the diagnosis of acute cholecystitis

    SciTech Connect

    Kim, E.E.; Pjura, G.; Lowry, P.; Nguyen, M.; Pollack, M.

    1986-12-01

    Cholescintigraphy is a sensitive procedure for diagnosing or excluding acute cholecystitis. However, when rapid diagnosis is critical, the requirement for delayed images (4 hr or more after injection) to minimize the false-positive rate diminishes its utility. We prospectively evaluated 40 cholescintigraphic examinations that did not visualize the gallbladder 1 hr after injection of 99mTc diisopropyliminodiacetic acid. These examinations were then augmented by administration of IV morphine, followed by an additional 30 min of imaging. After the morphine, 18 of these examinations demonstrated visualization of the gallbladder; none subsequently required surgical exploration. Of the remaining 22, who demonstrated persistent nonvisualization of the gallbladder post-morphine, 11 were explored surgically and found to be abnormal. The 11 others were treated medically. Low-dose morphine administered when the gallbladder fails to visualize after 1 hr is a useful adjunct to conventional cholescintigraphy because it reduces the time required to obtain a diagnostic result and decreases the number of false-positive results.

  6. Chronic granulomatous disease in an adolescent with recurrent impetigo and cholecystectomy.

    PubMed

    Scholnicoff, Ellen T; MacGinnitie, Andrew J; Lin, Philana Ling; Darville, Toni

    2009-03-01

    Chronic granulomatous disease is a rare primary immunodeficiency disorder resulting from a defect in the microbicidal activity of phagocytes. Patients are susceptible to certain bacterial and fungal infections, as well as other inflammatory complications. We report the case of a 12-year-old girl with recurrent impetigo whose history of cholecystitis triggered an evaluation that revealed chronic granulomatous disease.

  7. Laparoscopic Management of a Very Rare Case: Cystic Artery Pseudoaneurysm Secondary to Acute Cholecystitis

    PubMed Central

    Ferahman, Sina; Demiryas, Süleyman; Samanci, Cesur

    2016-01-01

    Pseudoaneurysm of a cystic artery is a rare entity that commonly occurs secondary to biliary procedures. Most of the cases in literature are consisted of ruptured aneurysms and to our knowledge, except our case, there were only 3 cases with unruptured aneurysms, which incidentally were detected by radiological methods. When cystic artery pseudoaneurysm is present with acute cholecystitis, most of the reports in literature suggested open cholecystectomy with the ligation of the cystic artery as a main treatment option. In this paper we present a case of acute cholecystitis with unruptured cystic artery pseudoaneurysm that incidentally was detected by computed tomography (CT). Cystic artery pseudoaneurysm was handled laparoscopically with simultaneous cholecystectomy. Due to high risk of rupture, surgeons have evaded laparoscopic approach to acute cholecystitis, which accompanied cystic artery pseudoaneurysm. However herein, we proved that laparoscopic management of cystic artery pseudoaneurysm with simultaneous cholecystectomy is feasible and reliable method. PMID:27635274

  8. Surgical management of acute cholecystitis. Results of a nation-wide survey among Spanish surgeons.

    PubMed

    Badia, Josep M; Nve, Esther; Jimeno, Jaime; Guirao, Xavier; Figueras, Joan; Arias-Díaz, Javier

    2014-10-01

    There is a wide variability in the management of acute cholecystitis. A survey among the members of the Spanish Association of Surgeons (AEC) analyzed the preferences of Spanish surgeons for its surgical management. The majority of the 771 responders didn't declare any subspecialty (41.6%), 21% were HPB surgeons, followed by colorectal and upper-GI specialities. Early cholecystectomy during the first admission is the preferred method of management of 92.3% of surgeons, but only 42.7% succeed in adopting this practice. The most frequent reasons for changing their preferred practice were: Patients not fit for surgery (43.6%) and lack of availability of emergency operating room (35.2%). A total of 88.9% perform surgery laparoscopically. The majority of AEC surgeons advise index admission cholecystectomy for acute cholecystitis, although only half of them succeed in its actual implementation. There is room for improvement in the management of acute cholecystitis in Spanish hospitals.

  9. State of the art in the diagnosis and management of acute cholecystitis.

    PubMed

    Reiss, R; Deutsch, A A

    1993-01-01

    The analysis of 664 cases operated upon for acute cholecystitis as well as a review of the literature indicate the dramatic increase in the age of patients presenting with this complication. Other obvious changes: increasing rate of diabetes mellitus and acalculous cholecystitis. The development of preoperative and operative sonography has contributed greatly to the safety of surgery for acute cholecystitis. The majority of patients classified as having low risks should, at the present state of our knowledge, undergo early and definitive surgery. This approach has shown to be the most beneficial from both the medical and economic standpoint. High risk patients as well as patients refusing surgery are optimally treated by sonar-guided percutaneous transhepatic cholecystostomy. Among the recent changes observed over the last 5 years, a marked decrease in septic complications as well as in the length of hospital stay was noted. Both changes improve the cost-benefit ratio of early surgery in this condition.

  10. Laparoscopic Management of a Very Rare Case: Cystic Artery Pseudoaneurysm Secondary to Acute Cholecystitis.

    PubMed

    Alis, Deniz; Ferahman, Sina; Demiryas, Süleyman; Samanci, Cesur; Ustabasioglu, Fethi Emre

    2016-01-01

    Pseudoaneurysm of a cystic artery is a rare entity that commonly occurs secondary to biliary procedures. Most of the cases in literature are consisted of ruptured aneurysms and to our knowledge, except our case, there were only 3 cases with unruptured aneurysms, which incidentally were detected by radiological methods. When cystic artery pseudoaneurysm is present with acute cholecystitis, most of the reports in literature suggested open cholecystectomy with the ligation of the cystic artery as a main treatment option. In this paper we present a case of acute cholecystitis with unruptured cystic artery pseudoaneurysm that incidentally was detected by computed tomography (CT). Cystic artery pseudoaneurysm was handled laparoscopically with simultaneous cholecystectomy. Due to high risk of rupture, surgeons have evaded laparoscopic approach to acute cholecystitis, which accompanied cystic artery pseudoaneurysm. However herein, we proved that laparoscopic management of cystic artery pseudoaneurysm with simultaneous cholecystectomy is feasible and reliable method. PMID:27635274

  11. Laparoscopic Management of a Very Rare Case: Cystic Artery Pseudoaneurysm Secondary to Acute Cholecystitis

    PubMed Central

    Ferahman, Sina; Demiryas, Süleyman; Samanci, Cesur

    2016-01-01

    Pseudoaneurysm of a cystic artery is a rare entity that commonly occurs secondary to biliary procedures. Most of the cases in literature are consisted of ruptured aneurysms and to our knowledge, except our case, there were only 3 cases with unruptured aneurysms, which incidentally were detected by radiological methods. When cystic artery pseudoaneurysm is present with acute cholecystitis, most of the reports in literature suggested open cholecystectomy with the ligation of the cystic artery as a main treatment option. In this paper we present a case of acute cholecystitis with unruptured cystic artery pseudoaneurysm that incidentally was detected by computed tomography (CT). Cystic artery pseudoaneurysm was handled laparoscopically with simultaneous cholecystectomy. Due to high risk of rupture, surgeons have evaded laparoscopic approach to acute cholecystitis, which accompanied cystic artery pseudoaneurysm. However herein, we proved that laparoscopic management of cystic artery pseudoaneurysm with simultaneous cholecystectomy is feasible and reliable method.

  12. Symptomatic management in multiple sclerosis

    PubMed Central

    Shah, Pushkar

    2015-01-01

    Multiple sclerosis (MS) is the commonest cause of disability in young adults. While there is increasing choice and better treatments available for delaying disease progression, there are still, very few, effective symptomatic treatments. For many patients such as those with primary progressive MS (PPMS) and those that inevitably become secondary progressive, symptom management is the only treatment available. MS related symptoms are complex, interrelated, and can be interdependent. It requires good understanding of the condition, a holistic multidisciplinary approach, and above all, patient education and empowerment. PMID:26538847

  13. Arthroscopic treatment of symptomatic type D medial plica.

    PubMed

    Uysal, Mustafa; Asik, Mehmet; Akpinar, Sercan; Ciftci, Feyyaz; Cesur, Necip; Tandogan, Reha N

    2008-12-01

    We aimed to review the results of subtotal arthroscopic resection of symptomatic type D medial plica. We retrospectively evaluated 23 knees with symptomatic type D medial plica in 22 patients without other intra-articular pathology. All patients complained of chronic knee pain that had not been alleviated by medical treatment or physical therapy. In only three (13%) of the patients studied was the plica diagnosed pre-operatively with magnetic resonance imaging. The type D medial plicae in our series were classified as fenestrated (14 knees), torn (5 knees), or reduplicated (4 knees). Fibrotic changes in the plicae and degenerative changes on the medial femoral condyle were found in 16 knees Patellofemoral chondromalacia was present in three knees Arthroscopic partial resection was performed in all patients. Comparative Lysholm Knee Scale scores before and after surgery revealed a significant clinical improvement (pre-operative status, 67.19 +/- 8.05 vs. post-operative status, 90.57 +/- 9.80; P < 0.001). Type D medial plica should be considered as a possible cause of chronic knee pain. Arthroscopic partial resection of the plicae in symptomatic patients gives satisfactory results.

  14. Progressive accumulation of the abnormal conformer of the prion protein and spongiform encephalopathy in the obex of nonsymptomatic and symptomatic Rocky Mountain elk (Cervus elaphus nelsoni) with chronic wasting disease

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Chronic wasting disease (CWD), a transmissible spongiform encephalopathy, has been reported in captive and free-ranging cervids. An abnormal isoform of a prion protein (PrP-CWD) has been associated with CWD in Rocky Mountain elk (Cervus elaphus nelsoni) and this prion protein can be detected with i...

  15. Laparoscopic ablation of symptomatic renal cysts.

    PubMed

    Rubenstein, S C; Hulbert, J C; Pharand, D; Schuessler, W W; Vancaillie, T G; Kavoussi, L R

    1993-10-01

    We report a laparoscopic approach to the drainage and ablation of symptomatic simple renal cysts. Ten patients with chronic pain, 6 of whom failed primary aspiration, underwent laparoscopic cyst ablation: 6 had solitary renal cysts, 3 had multiple cysts and 1 had a peripelvic cyst. The approach was transabdominal in 9 patients and extraperitoneal in 1. Intraoperatively, cyst fluid was obtained for cytological examination, and cyst walls were excised and sent for pathological examination. When possible, the remaining inner cyst walls were fulgurated to prevent recurrence. Mean total operating room time was 2 hours 27 minutes and blood loss was minimal. The sole complication was a postoperative retroperitoneal hematoma, which was managed conservatively. Malignancy was diagnosed in 2 patients, each of whom had a negative preoperative aspiration. These patients subsequently underwent radical nephrectomy. All remaining patients were asymptomatic at a mean followup of 10 months. Laparoscopic ablation of renal cysts is a safe and effective alternative to open surgery in patients who have failed conservative measures. Preoperative and intraoperative evaluation for malignancy should be performed.

  16. First report of acute cholecystitis with sepsis caused by Cellulomonas denverensis.

    PubMed

    Ohtaki, Hirofumi; Ohkusu, Kiyofumi; Sawamura, Haruki; Ohta, Hirotoshi; Inoue, Rina; Iwasa, Junpei; Ito, Hiroyasu; Murakami, Nobuo; Ezaki, Takayuki; Moriwaki, Hisataka; Seishima, Mitsuru

    2009-10-01

    Cellulomonas denverensis is a small and thin gram-positive rod-shaped bacterium that was proposed as a new species in 2005. Here we report a female case of acute cholecystitis and sepsis in which C. denverensis was determined to be causative.

  17. Determination of optimal operation time for the management of acute cholecystitis: a clinical trial

    PubMed Central

    Ucar, Ahmet Deniz; Yakan, Savas; Carti, Erdem Baris; Coskun, Ali; Erkan, Nazif; Yildirim, Mehmet

    2014-01-01

    Introduction Although all studies have reported that laparoscopic cholecystectomy (LC) is a safe and effective treatment for acute cholecystitis, the optimal timing for the procedure is still the subject of some debate. Aim This retrospective analysis of a prospective database was aimed at comparing early with delayed LC for acute cholecystitis. Material and methods The LC was performed in 165 patients, of whom 83 were operated within 72 h of admission (group 1) and 82 patients after 72 h (group 2) with acute cholecystitis between January 2012 and August 2013. All data were collected prospectively and both groups compared in terms of age, sex, fever, white blood count count, ultrasound findings, operation time, conversion to open surgery, complications and mean hospital stay. Results The study included 165 patients, 53 men and 112 women, who had median age 54 (20–85) years. The overall conversion rate was 27.9%. There was no significant difference in conversion rates (21% vs. 34%) between groups (p = 0.08). The operation time (116 min vs. 102 min, p = 0.02) was significantly increased in group 1. The complication rates (9% vs. 18%, p = 0.03) and total hospital stay (3.8 days vs. 7.9 days, p = 0.001) were significantly reduced in group 1. Conclusions Early LC within 72 h of admission reduces complications and hospital stay and is the preferred approach for acute cholecystitis. PMID:25097711

  18. Evaluation of affecting factors for conversion to open cholecystectomy in acute cholecystitis

    PubMed Central

    Ucar, Ahmet Deniz; Aydogan, Serdar; Sari, Erdem; Erkan, Nazif; Yildirim, Mehmet

    2014-01-01

    Introduction Laparoscopic cholecystectomy has become the gold standard for the surgical treatment of gallbladder disease. Severe inflammation makes laparoscopic dissection technically more demanding in acute cholecystitis. Conversion to open cholecystectomy due to adverse conditions is still required in some patients. Aim To evaluate predictive risk factors associated with conversion to open cholecystectomy in acute cholecystitis. Material and methods A retrospective analysis was performed on 165 patients who underwent a laparoscopic cholecystectomy for acute cholecystitis in our clinic. Patients who completed laparoscopic cholecystectomy and required conversion to open cholecystectomy were compared in terms of age, sex, fever, laboratory and USG findings, operation timing, complications, and duration of hospital stay. Results There were 53 (32%) male and 112 (68%) female patients; the mean age was 52.4 ±12.5 years. Forty-six (27.9%) of the 165 patients were converted to open cholecystectomy. Male sex of the patients who underwent conversion (47.1%) was found to be statistically significant (p < 0.001). Preoperative white blood count, blood glucose and amylase values, morbidity rate, and hospital stay were raised in patients who underwent conversion, and all were found to be statistically significant (p < 0.05). Conclusions Male sex, blood leucocyte, glucose, and raised amylase emerged as the effective factors for conversion cholecystectomy in our study. These factors should help the clinical decision-making process when planning laparoscopic cholecystectomy in acute cholecystitis. By predicting these risk factors for conversion, preoperative patient counselling can be improved. PMID:25653728

  19. Signal Intensity of Superb Microvascular Imaging Correlates with the Severity of Acute Cholecystitis

    PubMed Central

    Tomizawa, Minoru; Shinozaki, Fuminobu; Motoyoshi, Yasufumi; Sugiyama, Takao; Yamamoto, Shigenori; Ishige, Naoki

    2016-01-01

    Evaluation of the severity of acute cholecystitis is critical for the management of this condition. Superb microvascular imaging (SMI) enables the assessment of slow blood flow of small vessels without any contrast medium. An 84-year-old man visited our hospital with right upper abdominal pain. Computed tomography and abdominal ultrasonography showed a slight thickening of the gallbladder. White blood cell count and C-reactive protein levels were elevated. He was diagnosed with acute cholecystitis and treated conservatively with antibiotics. Two days later, his condition worsened and percutaneous transhepatic gallbladder drainage (PTGBD) was performed. The patient recovered and was discharged, and his drainage was withdrawn 7 days later. On admission, color-coded SMI (cSMI) showed pulsatory signals on the slightly thickened gallbladder wall. On the day of PTGBD, the intensity of the signal on cSMI had increased. Once the patient was cured, no further signal was observed on the gallbladder wall with either cSMI or mSMI. In conclusion, the strong pulsatory signal correlated with the severity of acute cholecystitis observed with cSMI and mSMI. Illustrating the signal intensity is useful for the evaluation of the severity of acute cholecystitis. PMID:27721732

  20. First Report of Acute Cholecystitis with Sepsis Caused by Cellulomonas denverensis▿

    PubMed Central

    Ohtaki, Hirofumi; Ohkusu, Kiyofumi; Sawamura, Haruki; Ohta, Hirotoshi; Inoue, Rina; Iwasa, Junpei; Ito, Hiroyasu; Murakami, Nobuo; Ezaki, Takayuki; Moriwaki, Hisataka; Seishima, Mitsuru

    2009-01-01

    Cellulomonas denverensis is a small and thin gram-positive rod-shaped bacterium that was proposed as a new species in 2005. Here we report a female case of acute cholecystitis and sepsis in which C. denverensis was determined to be causative. PMID:19656981

  1. Endoscopic ultrasound-guided gallbladder drainage for the management of acute cholecystitis (with video).

    PubMed

    Peñas-Herrero, Irene; de la Serna-Higuera, Carlos; Perez-Miranda, Manuel

    2015-01-01

    Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has been introduced as an alternative to percutaneous transhepatic gallbladder drainage for the treatment of acute cholecystitis in non-surgical candidates. A systematic review of the English language literature through PubMed search until June 2014 was conducted. One hundred and fifty-five patients with acute cholecystitis treated with EUS-GBD in eight studies and 12 case reports, and two patients with EUS-GBD for other causes were identified. Overall, technical success was obtained in 153 patients (97.45%) and clinical success in 150 (99.34%) patients with acute cholecystitis. Adverse events developed in less than 8% of patients, all of them managed conservatively. EUS-GBD has been performed with plastic stents, nasobiliary drainage tubes, standard or modified tubular self-expandable metal stents (SEMS) and lumen-apposing metal stents (LAMS) by different authors with apparently similar outcomes. No comparison studies between stent types for EUS-GBD have been reported. EUS-GBD is a promising novel alternative intervention for the treatment of acute cholecystitis in high surgical risk patients. Feasibility, safety and efficacy in published studies from expert centers are very high compared to currently available alternatives. Further studies are needed to establish the safety and long-term outcomes of this procedure in other practice settings before EUS-GBD can be widely disseminated.

  2. Progressive accumulation of the abnormal conformer of the prion protein and spongiform encephalopathy in the obex of nonsymptomatic and symptomatic Rocky Mountain elk (Cervus elaphus nelsoni) with chronic wasting disease.

    PubMed

    Spraker, Terry R; Gidlewski, Thomas; Powers, Jenny G; Nichols, Tracy; Balachandran, Aru; Cummings, Bruce; Wild, Margaret A; VerCauteren, Kurt; O'Rourke, Katherine I

    2015-07-01

    The purpose of our study was to describe the progressive accumulation of the abnormal conformer of the prion protein (PrP(CWD)) and spongiform degeneration in a single section of brain stem in Rocky Mountain elk (Cervus elaphus nelsoni) with chronic wasting disease (CWD). A section of obex from 85 CWD-positive elk was scored using the presence and abundance of PrP(CWD) immunoreactivity and spongiform degeneration in 10 nuclear regions and the presence and abundance of PrP(CWD) in 10 axonal tracts, the subependymal area of the fourth ventricle, and the thin subpial astrocytic layer (glial limitans). Data was placed in a formula to generate an overall obex score. Data suggests that PrP(CWD) immunoreactivity and spongiform degeneration has a unique and relatively consistent pattern of progression throughout a section of obex. This scoring technique utilizing a single section of obex may prove useful in future work for estimating the presence and abundance of PrP(CWD) in peripheral tissues and the nervous system in elk with CWD. PMID:26185123

  3. Progressive accumulation of the abnormal conformer of the prion protein and spongiform encephalopathy in the obex of nonsymptomatic and symptomatic Rocky Mountain elk (Cervus elaphus nelsoni) with chronic wasting disease.

    PubMed

    Spraker, Terry R; Gidlewski, Thomas; Powers, Jenny G; Nichols, Tracy; Balachandran, Aru; Cummings, Bruce; Wild, Margaret A; VerCauteren, Kurt; O'Rourke, Katherine I

    2015-07-01

    The purpose of our study was to describe the progressive accumulation of the abnormal conformer of the prion protein (PrP(CWD)) and spongiform degeneration in a single section of brain stem in Rocky Mountain elk (Cervus elaphus nelsoni) with chronic wasting disease (CWD). A section of obex from 85 CWD-positive elk was scored using the presence and abundance of PrP(CWD) immunoreactivity and spongiform degeneration in 10 nuclear regions and the presence and abundance of PrP(CWD) in 10 axonal tracts, the subependymal area of the fourth ventricle, and the thin subpial astrocytic layer (glial limitans). Data was placed in a formula to generate an overall obex score. Data suggests that PrP(CWD) immunoreactivity and spongiform degeneration has a unique and relatively consistent pattern of progression throughout a section of obex. This scoring technique utilizing a single section of obex may prove useful in future work for estimating the presence and abundance of PrP(CWD) in peripheral tissues and the nervous system in elk with CWD.

  4. Endotherapy in symptomatic pancreas divisum: a systematic review.

    PubMed

    Kanth, Rajan; Samji, N Swetha; Inaganti, Anupama; Komanapalli, Sarah D; Rivera, Ramon; Antillon, Mainor R; Roy, Praveen K

    2014-01-01

    Pancreas divisum (PD) is the most common congenital variant of the pancreas and has been implicated as a cause of pancreatitis; however, endoscopic treatment is controversial. Our objective was to examine patient response to endotherapy for treatment of symptomatic PD in adult patients in a systematic review of the literature. A systematic review of all case series and case-control studies with ten or more patients undergoing endotherapy for treatment of symptomatic PD indicated by acute recurrent pancreatitis (ARP), chronic pancreatitis (CP), or chronic abdominal pain (CAP) was performed. PubMed, Embase, and Web of Science databases were searched from inception through February 2013 using [pancreas divisum] AND [endoscopic retrograde cholangiopancreatography (ERCP)] OR [endotherapy] OR [endoscopy] as search terms. Importantly, the majority of studies were retrospective in nature, significantly limiting analysis capacity. Main outcomes measures included endotherapy response rate in patients with PD and ARP, CP, or CAP. Twenty-two studies were included in the review, with a total of 838 patients. Response to endoscopy was seen in 528 patients, but response rate varied by clinical presentation. Patients with ARP had a response rate ranging from 43% to 100% (median 76%). Reported response rates were lower in the other two groups, ranging from 21% to 80% (median 42%) for patients with CP and 11%-55% (median 33%) for patients with CAP. Complications reported included perforation, post-endoscopic retrograde cholangiopancreatography pancreatitis, bleeding, and clogged stents. Endotherapy appears to offer an effective treatment option for patients with symptomatic PD, with the best results in patients presenting with ARP.

  5. Predicting symptomatic distress in emergency services personnel.

    PubMed

    Weiss, D S; Marmar, C R; Metzler, T J; Ronfeldt, H M

    1995-06-01

    This study identified predictors of symptomatic distress in emergency services (EMS) personnel exposed to traumatic critical incidents. A replication was performed in 2 groups: 154 EMS workers involved in the 1989 Interstate 880 freeway collapse during the San Francisco Bay area earthquake, and 213 counterparts from the Bay area and from San Diego. Evaluated predictors included exposure, social support, and psychological traits. Replicated analyses showed that levels of symptomatic distress were positively related to the degree of exposure to the critical incident. Level of adjustment was also related to symptomatic distress. After exposure, adjustment, social support, years of experience on the job, and locus of control were controlled, 2 dissociative variables remained strongly predictive of symptomatic response. The study strengthens the literature linking dissociative tendencies and experiences to distress from exposure to traumatic stressors.

  6. Symptomatic retroperitoneal cyst: a diagnostic challenge.

    PubMed

    Renzulli, Pietro; Candinas, Daniel

    2009-03-01

    Retroperitoneal cystic masses pose an important diagnostic and therapeutic challenge. Simple drainage, internal or external, is usually not sufficient. We report a case of a large symptomatic retroperitoneal cyst and its management.

  7. [Treatment of acute cholecystitis in a third-trimester pregnant women].

    PubMed

    Eller, Asger; Shim, Susy; Sigvardt, Louise; Rask, Peter; Nielsen, Michael Festersen

    2016-04-18

    This case report describes a 35-year-old female with acute cholecystitis 36 weeks into her pregnancy. Laparoscopic cholecystectomy was assessed not to be possible. An ultrasonic guided percutaneous transhepatic gall bladder drainage was performed resulting in immediate pain relief. The patient was discharged two days later, and the drain sat in place until a caesarian section was per--formed. A post-surgery cholangiography demonstrated stones in the gall bladder but no stones in the common bile duct. An uneventful laparoscopic cholecystectomy was carried out three months after surgery. The case report demonstrates that percutaneous transhepatic gall bladder drainage is a safe procedure to be considered in women with cholecystitis in which cholecystectomy is not possible or assumed to be associated with an unacceptable high risk. PMID:27094635

  8. Acute Cholecystitis Following Total Knee Replacement: A Case Report and Literature Review

    PubMed Central

    Ghalimah, Bayan; Hamdi, Amre

    2016-01-01

    Introduction: Infection poses a substantial challenge after joint replacement. Case Presentation: We report a 53-year-old female with multiple co-morbidities, who underwent unilateral total knee arthroplasty. Her postoperative course was complicated by acute cholecystitis necessitating cholecystectomy. Conclusion: In patients who require joint replacement surgery, careful and detailed preoperative assessment is important to identify those at risk for this complication in order to provide timely treatment. PMID:27703950

  9. Acute Cholecystitis with Significantly Elevated Levels of Serum Carbohydrate Antigen 19-9

    PubMed Central

    Akimoto, Shuji; Banshodani, Masataka; Nishihara, Masahiro; Nambu, Junko; Kawaguchi, Yasuo; Shimamoto, Fumio; Dohi, Kiyohiko; Sugino, Keizo; Ohdan, Hideki

    2016-01-01

    Serum carbohydrate antigen 19-9 (CA 19-9), a marker of malignant tumors, is generally slightly elevated in benign conditions. We report a case of acute cholecystitis with a significantly elevated level of serum CA 19-9 based on positron emission tomography (PET)-computed tomography (CT) findings. A 65-year-old woman presented with abdominal pain and fever. A CT image revealed an enlarged gallbladder without tumor shadows. The C-reactive protein (CRP) level was elevated to 7.66 mg/dl. Moreover, the serum CA 19-9 level was significantly elevated to 19,392 U/ml. We started antibiotic treatment, because we suspected acute cholecystitis, but still, we could not ignore the possible presence of malignant tumors. After 11 days of antibiotic treatment, serum CRP and CA 19-9 levels decreased to 0.11 mg/dl and 1,049 U/ml, respectively. There was an accumulation of fluorine 18-labeled fluorodeoxyglucose (maximum standardized uptake value, 9.3) without tumor shadows in the liver, near the gallbladder, on the PET-CT examination. We considered the possibility that the inflammation had spread from the gallbladder to the liver, made a diagnosis of acute cholecystitis, and performed a cholecystectomy 33 days after treatment initiation. The serum CA 19-9 level decreased to 45 U/ml after the surgery. One year after the surgery, the patient was alive, and the serum CA 19-9 level was 34 U/ml. Acute cholecystitis with a significantly high elevation of the serum CA 19-9 level is rare. In such cases, it is important to confirm the change in the serum CA 19-9 level over time after antibiotic treatment and perform imaging studies to distinguish between inflammation and malignancy. PMID:27721726

  10. Gallbladder torsion-induced emphysematous cholecystitis in a 16-year-old boy.

    PubMed

    Tanaka, Shogo; Kubota, Daisuke; Oba, Kazuki; Lee, Sang Hun; Yamamoto, Takatsugu; Uenishi, Takahiro; Tanaka, Hiromu; Kubo, Shoji; Matsuyama, Mitsuharu

    2007-01-01

    The patient was a 16-year-old boy who had turned to the right rapidly as he fielded a baseball that had come to him quickly. Two days after this event, which occurred in July 2004, he was admitted to hospital with repeated vomiting and increasing right hypochondralgia. Laboratory examination on admission showed elevation of the white blood count and of serum C-reactive protein and total bilirubin. Computed tomography on admission demonstrated an enlarged gallbladder and a thickened wall without gallstones, and magnetic resonance imaging performed 1 day later showed air within the gallbladder wall. His symptoms worsened, with a positive Murphy's sign, and emergency laparotomy was performed, with a diagnosis of emphysematous cholecystitis. Intraoperatively, the gallbladder was dark red, necrotic, distended, and enlarged. The cystic duct was attached only to the mesentery, and the gallbladder was floating freely, with the neck of the gallbladder having rotated 180 degrees counterclockwise, leading to a definitive diagnosis of gallbladder torsion with emphysematous cholecystitis. Cholecystectomy was performed, and analysis of bile showed Escherichia coli to be the causative organism. Histopathologic examination revealed necrotized cholecystitis. The patient is doing well 25 months after surgery, with an uneventful postoperative course.

  11. Endoscopic resection of a symptomatic os trigonum.

    PubMed

    Jerosch, Joerg; Fadel, Mohie

    2006-11-01

    The purpose of this study was to describe our technique and results of arthroscopic resection of a symptomatic os trigonum via two posterior portals in 10 cases. Between 1999 and 2005 we treated 10 patients with endoscopic resection of a symptomatic os trigonum. The age ranged between 19 and 32 years (average 25.9). The average follow-up was 25 months (6-61 months). Time interval between the onset of pain and endoscopic resection of the os trigonum was 20 months. Of the 10 patients, 9 were symptom free for activities of daily living (ADL) within 4 weeks after surgery. They resumed their professional sport activities in a period of 8 weeks. The average AOFAS ankle/hindfoot scale increased from 43 preoperative to 87 postoperatively. We observed no complication in these 10 patients. Endoscopic resection of the symptomatic os trigonum yields good results with minimal surgical morbidity and short recovery time.

  12. Non-Functional Adrenal Gland Ganglioneuroma Masquerading as Chronic Calculus Cholecystitis.

    PubMed

    Patel, Rashmi D; Vanikar, Aruna V; Trivedi, H L

    2015-09-01

    Adrenal ganglioneuromas in young adults are rare and ill-understood. We report an incidentally detected adrenal gland tumor diagnosed as ganglioneuroma (mature type) in 33 years old man who presented with vomiting and epigastric pain for 2 months. Histopathology examination revealed a well-encapsulated benign tumor of mature ganglion cells and Schwann-like cells arranged in fascicles, staining strongly with NSE and s-100 proteins, with adjacent unremarkable adrenal cortex and medulla. PMID:27608876

  13. [From symptomatic stability to functional recovery in the pharmacological treatment of schizophrenia and unipolar depression].

    PubMed

    Wikinski, Silvia

    2009-01-01

    This work summarizes the efficacy of pharmacotherapy in the chronic course of schizophrenia and unipolar depresion. It is aimed to answer three questions: does it cure these diseases? Does it exert any significant effect on the symptomatic presentation of the disorders? Which is its action on the social dysfunction provoked by schizophrenia or depression? A conceptual analysis of available bibliography was performed. It could be concluded that antypsychotics improve the symptomatic course of schizophrenia, although their efficacy is limited, and that these drugs does not act on the social dysfunction provoked by the disease. With respect to depression, it could be concluded that a significant proportion of patients remain symptomatic despite receiveng adequate treatments. No data about efficacy of pharmacotherapy on the dysfunction resultant from unipolar depression is available.

  14. [From symptomatic stability to functional recovery in the pharmacological treatment of schizophrenia and unipolar depression].

    PubMed

    Wikinski, Silvia

    2009-01-01

    This work summarizes the efficacy of pharmacotherapy in the chronic course of schizophrenia and unipolar depresion. It is aimed to answer three questions: does it cure these diseases? Does it exert any significant effect on the symptomatic presentation of the disorders? Which is its action on the social dysfunction provoked by schizophrenia or depression? A conceptual analysis of available bibliography was performed. It could be concluded that antypsychotics improve the symptomatic course of schizophrenia, although their efficacy is limited, and that these drugs does not act on the social dysfunction provoked by the disease. With respect to depression, it could be concluded that a significant proportion of patients remain symptomatic despite receiveng adequate treatments. No data about efficacy of pharmacotherapy on the dysfunction resultant from unipolar depression is available. PMID:20038986

  15. Henoch-Schönlein purpura complicated by acalculous cholecystitis and intussusception, and following recurrence with appendicitis.

    PubMed

    Özkaya, Ahmet Kağan; Güler, Ekrem; Çetinkaya, Ahmet; Karakaya, Ali Erdal; Göksügür, Yalçın; Katı, Ömer; Güler, Ahmet Gökhan; Davutoğlu, Mehmet

    2016-05-01

    Henoch-Schönlein purpura (HSP) is the most common childhood systemic vasculitis. Gastro-intestinal involvement occurs in two-thirds of patients. The characteristic skin lesions generally precede abdominal symptoms or present concurrently. A 7-year-old boy presented with intussusception and acalculous cholecystitis and had a cholecystectomy. Two weeks later he was re-admitted with features typical of HSP which responded to corticosteroids. Eleven months later he presented with abdominal pain and recurrence of HSP and, at laparotomy, there was acute appendicitis. This is the first case of a child presenting with HSP complicated by acalculous cholecystitis. PMID:27077617

  16. Two cases of cystic artery pseudoaneurysm rupture due to acute cholecystitis with gallstone impaction in the neck.

    PubMed

    Kaida, Shogo; Arahata, Kyouko; Itou, Asako; Takarabe, Sakiko; Kimura, Kayoko; Kishikawa, Hiroshi; Nishida, Jiro; Fujiyama, Yoshiki; Takigawa, Yutaka; Matsui, Junichi

    2016-09-01

    A cystic artery aneurysm is a rare cause of hemobilia. Herein, we report two cases of acute cholecystitis with a ruptured cystic artery pseudoaneurysm. Two patients (a 69-year-old man and an 83-year-old man) were admitted to our hospital because of acute cholecystitis with gallstone impaction in the neck. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed for both patients. After a few days of PTGBD, gallbladder hemorrhage was observed. Abdominal angiography showed cystic artery aneurysm. A transcatheter arterial embolization was therefore performed, followed by an open cholecystectomy. PMID:27593367

  17. HOSPITALIZATIONS FOR CHOLECYSTITIS AND CHOLELITHIASIS IN THE STATE OF RIO GRANDE DO SUL, BRAZIL

    PubMed Central

    NUNES, Emeline Caldana; ROSA, Roger dos Santos; BORDIN, Ronaldo

    2016-01-01

    ABSTRACT Background: The cholelithiasis is disease of surgical resolution with about 60,000 hospitalizations per year in the Sistema Único de Saúde (SUS - Brazilian National Health System) of the Rio Grande do Sul state. Aim: To describe the profile of hospitalizations for cholecystitis and cholelithiasis performed by the SUS of Rio Grande do Sul state, 2011-2013. Methods: Hospital Information System data from the National Health System through morbidity list for cholelithiasis and cholecystitis (ICD-10 K80-K81). Variables studied were sex, age, number of hospitalizations and approved Hospitalization Authorizations (AIH), total amount and value of hospital services generated, days and average length of stay, mortality, mortality and case fatality ratio, from health regions of the Rio Grande do Sul. Results: During 2011-2013 there were 60,517 hospitalizations for cholecystitis and cholelithiasis, representing 18.86 hospitalizations per 10,000 inhabitants/year, most often in the age group from 60 to 69 years (41.34 admissions per 10,000 inhabitants/year) and female (27.72 hospitalizations per 10,000 inhabitants/year). The fatality rate presented an inverse characteristic: 13.52 deaths per 1,000 admissions/year for males, compared with 7.12 deaths per 1,000 admissions/year in females. The state had an average total amount spent and value of hospital services of R$ 16,244,050.60 and R$ 10,890,461.31, respectively. The health region "Capital/Gravataí Valley" exhibit the highest total expenditure and hospital services, and the largest number of deaths, and average length of stay. Conclusion: The hospitalization and lethality coefficients, the deaths, the length of stay and spending related to admissions increased from 50 years old. Females had a higher frequency and higher values ​​spent on hospitalization, while the male higher coefficient of mortality and mean hospital stay. PMID:27438030

  18. Constipation, diarrhea, and symptomatic hemorrhoids during pregnancy.

    PubMed

    Wald, Arnold

    2003-03-01

    Constipation, diarrhea, and symptomatic hemorrhoids are disorders common in the general population, particularly in women. These conditions, if mild, often are self-treated with various home remedies or nonprescription preparations. Few of these patients, moreover, are referred to gastroenterologists, as primary care providers generally are confident managing these conditions, unless they are severe, refractory to conventional management, or require additional diagnostic studies.

  19. Symptomatic treatment of multiple sclerosis using cannabinoids: recent advances.

    PubMed

    Smith, Paul F

    2007-09-01

    Recent years have seen a dramatic increase in the number of clinical trials investigating the potential efficacy of medicinal cannabinoids for the symptomatic treatment of chronic pain and spasticity in multiple sclerosis (MS). A number of different cannabinoids have been used, including: delta9-tetrahydrocannabinol (THC) itself; the synthetic delta9-THC, dronabinol; a 1:1 ratio of delta9-THC:cannabidiol (Sativex); and the synthetic delta9-THC metabolites CT-3 and nabilone. Other Cannabis extracts have also been tested. While 2-3 years ago there was little consensus in the literature, now the majority of studies are beginning to suggest that cannabinoids are useful in the treatment of MS in at least a subset of individuals. Their adverse side-effect profile has generally been mild compared with other drugs used for pain and spasticity; nonetheless, there is still concern about potential long-term side effects, particularly psychiatric side effects and effects on fetal development. PMID:17868014

  20. [Gas in the abdominal cavity--due to cholecystitis caused by gas-producing bacteria].

    PubMed

    Miettinen, Simo; Hakkarainen, Timo; Reinikainen, Matti; Hakala, Tapio

    2010-01-01

    In most cases, gas in the abdominal cavity indicates perforation of the gastrointestinal wall. We describe a patient, in whom the cause of abdominal gas detected in computed tomography turned out to be emphysematous cholecystitis caused by gas-producing bacteria. It is a rare disease characterized by accumulation of gas into the gall bladder or its wall. The gas can be easily observed in computed tomography. The disease easily becomes complicated and is associated with high mortality. Prompt cholecystectomy and antibiotic therapy are the cornerstones of the treatment.

  1. Strong Association Between Endometriosis and Symptomatic Leiomyomas

    PubMed Central

    Nezhat, Camran; Li, Anjie; Abed, Sozdar; Balassiano, Erika; Soliemannjad, Rose; Nezhat, Ceana H.; Nezhat, Farr

    2016-01-01

    Background and Objectives: The relationship between leiomyoma and endometriosis is poorly understood. Both contribute to considerable pain and may cause subfertility or infertility in women. We conducted this retrospective study to assess the rate of coexistence of endometriosis in women with symptomatic leiomyoma. The primary outcome measured was the coexistence of histology-proven endometriosis in women with symptomatic leiomyoma. Methods: This is a retrospective review of a data-based collection of medical records of 244 patients treated at a tertiary medical center, who were evaluated for symptomatic leiomyoma from March 2011 through December 2015. Of those, 208 patients underwent laparoscopic or laparoscopic-assisted myomectomy or hysterectomy. All patients provided consent for possible concomitant diagnosis and treatment of endometriosis. The remaining 36 patients underwent medical therapy and were excluded from the study. All patients who had myomectomy or supracervical hysterectomy underwent minilaparotomy for extracorporeal morcellation and specimen removal beginning in April 2012. Results: Of the 208 patients with the presenting chief concern of symptomatic leiomyoma and who underwent surgical therapy, 181 had concomitant diagnoses of leiomyoma and endometriosis, whereas 27 had leiomyoma. Of the 27 patients, 9 also had adenomyosis. Patients with only fibroid tumors were, on average, 4.0 years older than those with endometriosis and fibroids (mean age, 44 vs 40 ± SD). Patients with both pathologies were also more likely to present with pelvic pain and nulliparity than those with fibroid tumors alone. Conclusions: In our patient population, 87.1% of patients with a chief concern of symptomatic fibroids also had a diagnosis of histology-proven endometriosis, which affirms the need for concomitant diagnosis and intraoperative treatment of both conditions. Overlooking the coexistence of endometriosis in women with symptomatic leiomyoma may lead to suboptimal

  2. Strong Association Between Endometriosis and Symptomatic Leiomyomas

    PubMed Central

    Nezhat, Camran; Li, Anjie; Abed, Sozdar; Balassiano, Erika; Soliemannjad, Rose; Nezhat, Ceana H.; Nezhat, Farr

    2016-01-01

    Background and Objectives: The relationship between leiomyoma and endometriosis is poorly understood. Both contribute to considerable pain and may cause subfertility or infertility in women. We conducted this retrospective study to assess the rate of coexistence of endometriosis in women with symptomatic leiomyoma. The primary outcome measured was the coexistence of histology-proven endometriosis in women with symptomatic leiomyoma. Methods: This is a retrospective review of a data-based collection of medical records of 244 patients treated at a tertiary medical center, who were evaluated for symptomatic leiomyoma from March 2011 through December 2015. Of those, 208 patients underwent laparoscopic or laparoscopic-assisted myomectomy or hysterectomy. All patients provided consent for possible concomitant diagnosis and treatment of endometriosis. The remaining 36 patients underwent medical therapy and were excluded from the study. All patients who had myomectomy or supracervical hysterectomy underwent minilaparotomy for extracorporeal morcellation and specimen removal beginning in April 2012. Results: Of the 208 patients with the presenting chief concern of symptomatic leiomyoma and who underwent surgical therapy, 181 had concomitant diagnoses of leiomyoma and endometriosis, whereas 27 had leiomyoma. Of the 27 patients, 9 also had adenomyosis. Patients with only fibroid tumors were, on average, 4.0 years older than those with endometriosis and fibroids (mean age, 44 vs 40 ± SD). Patients with both pathologies were also more likely to present with pelvic pain and nulliparity than those with fibroid tumors alone. Conclusions: In our patient population, 87.1% of patients with a chief concern of symptomatic fibroids also had a diagnosis of histology-proven endometriosis, which affirms the need for concomitant diagnosis and intraoperative treatment of both conditions. Overlooking the coexistence of endometriosis in women with symptomatic leiomyoma may lead to suboptimal

  3. Laparoscopic management of a cystic artery pseudoaneurysm in a patient with calculus cholecystitis

    PubMed Central

    Loizides, Sofronis; Ali, Asad; Newton, Richard; Singh, Krishna Kumar

    2015-01-01

    INTRODUCTION Pseudoaneurysm of the cystic artery is very rare. In the majority of cases it has been reported as a post-operative complication of laparoscopic cholecystectomy, however it has also been associated with the presence of acute cholecystitis or pancreatitis. When these pseudoaneurysms rupture they can lead to intraperitoneal bleeding, haemobilia and upper gastrointestinal haemorrhage. Radiological as well as open surgical approaches have been described for control of this rare pathology. PRESENTATION OF CASE We report the laparoscopic surgical management of an incidental, unruptured cystic artery pseudoaneurysm in a patient presenting with acute cholecystitis. DISCUSSION Cystic artery pseudoaneurysm is a rare entity and as such there is no consensus on the clinical management of this condition. A variety of treatment strategies have been reported in the literature including radiological selective embolisation and coiling, open cholecystectomy with ligation of the aneurysm, or a two-step approach involving radiological management of the pseudoaneurysm followed by an elective cholecystectomy. CONCLUSION In this report we have demonstrated that laparoscopic management of a cystic artery pseudoaneurysm with simultaneous laparoscopic cholecystectomy is feasible and safe. This avoids multiple invasive procedures and decreases morbidity associated with open surgery. PMID:26291047

  4. Intra-cholecystic approach for laparoscopic management of Mirizzi's syndrome: A case series

    PubMed Central

    Nag, Hirdaya H.; Gangadhara, Vageesh Bettageri; Dangi, Amit

    2016-01-01

    INTRODUCTION: Laparoscopic management of patients with Mirizzi's syndrome (MS) is not routinely recommended due to the high risk of iatrogenic complications. PATIENTS AND METHODS: Intra-cholecystic (IC) or inside-gall bladder (GB) approach was used for laparoscopic management of 16 patients with MS at a tertiary care referral centre in North India from May 2010 to August 2014; a retrospective analysis of prospectively collected data was performed. RESULTS: Mean age was 40.1 ± 14.7 years, the male-to-female ratio was 1:3, and 9 (56.25%) patients had type 1 MS (MS1) and 7 (43.75%) had type 2 MS (MS2) (McSherry's classification). The laparoscopic intra-cholecystic approach (LICA) was successful in 11 (68.75%) patients, whereas 5 patients (31.25%) required conversion to open method. Median blood loss was 100 mL (range: 50-400 mL), and median duration of surgery was 3.25 h (range: 2-7.5 h). No major complications were encountered except 1 patient (6.5%) who required re-operation for retained bile duct stones. The final histopathology report was benign in all the patients. No remote complications were noted during a mean follow-up of 20.18 months. CONCLUSION: LICA is a feasible and safe approach for selected patients with Mirizzi's syndrome; however, a low threshold for conversion is necessary to avoid iatrogenic complications. PMID:27251843

  5. Evaluation of Early Cholecystectomy versus Delayed Cholecystectomy in the Treatment of Acute Cholecystitis

    PubMed Central

    Rodríguez-Sanjuán, Juan C.; Martín-Acebes, Fernando; Llorca-Díaz, Francisco J.; Gómez-Fleitas, Manuel; Zambrano Muñoz, Rocío; Sánchez-Manuel, F. Javier

    2016-01-01

    Objective. To evaluate if early cholecystectomy (EC) is the most appropriate treatment for acute cholecystitis compared to delayed cholecystectomy (DC). Patients and Methods. A retrospective cohort study of 1043 patients was carried out, with a group of 531 EC cases and a group of 512 DC patients. The following parameters were recorded: (1) postoperative hospital morbidity, (2) hospital mortality, (3) days of hospital stay, (4) readmissions, (5) admission to the Intensive Care Unit (ICU), (6) type of surgery, (7) operating time, and (8) reoperations. In addition, we estimated the direct cost savings of implementing an EC program. Results. The overall morbidity of the EC group (29.9%) was significantly lower than the DC group (38.7%). EC demonstrated significantly better results than DC in days of hospital stay (8.9 versus 15.8 days), readmission percentage (6.8% versus 21.9%), and percentage of ICU admission (2.3% versus 7.8%), which can result in reducing the direct costs. The patients who benefited most from an EC were those with a Charlson index > 3. Conclusions. EC is safe in patients with acute cholecystitis and could lead to a reduction in the direct costs of treatment. PMID:27803512

  6. Bubaline Cholecyst Derived Extracellular Matrix for Reconstruction of Full Thickness Skin Wounds in Rats

    PubMed Central

    Shakya, Poonam; Sharma, A. K.; Kumar, Naveen; Vellachi, Remya; Mathew, Dayamon D.; Dubey, Prasoon; Singh, Kiranjeet; Shrivastava, Sonal; Shrivastava, Sameer; Maiti, S. K.; Hasan, Anwarul; Singh, K. P.

    2016-01-01

    An acellular cholecyst derived extracellular matrix (b-CEM) of bubaline origin was prepared using anionic biological detergent. Healing potential of b-CEM was compared with commercially available collagen sheet (b-CS) and open wound (C) in full thickness skin wounds in rats. Thirty-six clinically healthy adult Sprague Dawley rats of either sex were randomly divided into three equal groups. Under general anesthesia, a full thickness skin wound (20 × 20 mm2) was created on the dorsum of each rat. The defect in group I was kept as open wound and was taken as control. In group II, the defect was repaired with commercially available collagen sheet (b-CS). In group III, the defect was repaired with cholecyst derived extracellular matrix of bovine origin (b-CEM). Planimetry, wound contracture, and immunological and histological observations were carried out to evaluate healing process. Significantly (P < 0.05) increased wound contraction was observed in b-CEM (III) as compared to control (I) and b-CS (II) on day 21. Histologically, improved epithelization, neovascularization, fibroplasia, and best arranged collagen fibers were observed in b-CEM (III) as early as on postimplantation day 21. These findings indicate that b-CEM have potential for biomedical applications for full thickness skin wound repair in rats. PMID:27127678

  7. Gallbladder Metastasis of Non-small Cell Lung Cancer Presenting as Acute Cholecystitis.

    PubMed

    Jeong, Yu-Sook; Han, Hye-Suk; Lim, Sung-Nam; Kim, Mi-Jin; Han, Joung-Ho; Kang, Min-Ho; Ryu, Dong-Hee; Lee, Ok-Jun; Lee, Ki-Hyeong; Kim, Seung-Taik

    2012-09-01

    Although non-small cell lung cancer (NSCLC) can metastasize to almost any organ, metastasis to the gallbladder with significant clinical manifestation is relatively rare. Here, we report a case of gallbladder metastasis of NSCLC presenting as acute cholecystitis. A 79-year-old man presented with pain in the right upper quadrant and fever. A computed tomography (CT) scan of the chest and abdomen showed a cavitary mass in the right lower lobe of the lung and irregular wall thickening of the gallbladder. Open cholecystectomy and needle biopsy of the lung mass were performed. Histological examination of the gallbladder revealed a moderately-differentiated squamous cell carcinoma displaying the same morphology as the lung mass assessed by needle biopsy. Subsequent immunohistochemical examination of the gallbladder and lung tissue showed that the tumor cells were positive for P63 but negative for cytokeratin 7, cytokeratin 20 and thyroid transcription factor-1. A second primary tumor of the gallbladder was excluded by immunohistochemical methods, and the final pathological diagnosis was gallbladder metastasis of NSCLC. Although the incidence is extremely rare, acute cholecystitis can occur in association with lung cancer metastasis to the gallbladder. PMID:23358590

  8. Choledochal cyst complicated by acute cholecystitis and bypass obstruction: diagnostic role of Tc-99m-HIDA cholescintigraphy

    SciTech Connect

    Weissmann, H.S.; Gold, M.; Goldstein, R.D.; Sugarman, L.A.; Freeman, L.M.

    1981-09-01

    An unusual case of malignant degeneration of a choledochal cyst is presented. The presence of acute cholecystitis with the cystic duct originating from the cyst as well as the subsequent obstruction of the cyst-jejunal surgical anastomosis was readily detected with Tc-99m-dimethyl-iminodiacetic (Tc-99m-HIDA) cholescintigraphy.

  9. [A Case of Acute Acalculous Cholecystitis During Infectious Mononucleosis Caused by the Epstein-Barr Virus in a Young Woman].

    PubMed

    Ono, Shiro; Kobayashi, Tadanao; Nishio, Kenji

    2016-05-01

    Infection with the Epstein-Barr virus (EBV) is a common disease and is mainly asymptomatic during childhood, whereas infectious mononucleosis with clinical signs such as fever, pharyngitis, lymphadenopathy and hepatosplenomegaly often occurs in adolescents and adults with primary infection. Acalculous cholecystitis has been reported as a rare complication. We report herein a case of acalculous cholecystitis accompanied by infectious mononucleosis by EBV, which was treated successfully by medical treatment. A 33-year-old woman who had been admitted by fever, pharyngitis and lymphadenopathy developed a right upper quadrant pain, that was diagnosed as acalculous cholecystitis based on an imaging study. Antibiotic treatment did not resolve the symptoms, and surgical intervention was considered. We diagnosed her as having infectious mononucleosis based on a typical physical presentation and seropositivity for the EBV viral capsid antigen, suggesting that the acalculous cholecystatis might have been a complication of the EBV infection. After the administration of glucocorticoid and acyclovir, the patient became afebrile and the abdominal pain disappeared. Though acalculous cholecystitis rarely accompanies infectious mononucleosis caused by EBV, clinicians should be aware of this complication to avoid unnecessary cholecystectomy. PMID:27529970

  10. Rural-urban differences in the prevalence of chronic disease in northeast China.

    PubMed

    Wang, Shibin; Kou, Changgui; Liu, Yawen; Li, Bo; Tao, Yuchun; D'Arcy, Carl; Shi, Jieping; Wu, Yanhua; Liu, Jianwei; Zhu, Yingli; Yu, Yaqin

    2015-05-01

    Rural-urban differences in the prevalence of chronic diseases in the adult population of northeast China are examined. The Jilin Provincial Chronic Disease Survey used personal interviews and physical measures to research the presence of a range of chronic diseases among a large sample of rural and urban provincial residents aged 18 to 79 years (N = 21 435). Logistic regression analyses were used. After adjusting for age and gender, rural residents had higher prevalence of hypertension, chronic ischemic heart disease, cerebrovascular disease, chronic low back pain, arthritis, chronic gastroenteritis/peptic ulcer, chronic cholecystitis/gallstones, and chronic lower respiratory disease. Low education, low income, and smoking increased the risk of chronic diseases in rural areas. Reducing rural-urban differences in chronic disease presents a formidable public health challenge for China. The solution requires focusing attention on issues endemic to rural areas such as poverty, lack of chronic disease knowledge, and the inequality in access to primary care.

  11. Percutaneous Ultrasound-Guided Hydrodissection of a Symptomatic Sural Neuroma.

    PubMed

    Fader, Ryan R; Mitchell, Justin J; Chadayammuri, Vivek P; Hill, John; Wolcott, Michelle L

    2015-11-01

    Symptomatic neuromas of the sural nerve are a rare but significant cause of pain and debilitation in athletes. Presentation is usually in the form of chronic pain and dysesthesias or paresthesias of the lateral foot and ankle. Treatment traditionally ranges from conservative measures, such as removing all external compressive forces, to administration of nonsteroidal anti-inflammatory drugs, vitamin B6, tricyclic antidepressants, antiepileptics, or topical anesthetics. This article reports a case of sural nerve entrapment in a 34-year-old male triathlete with a history of recurrent training-induced right-sided gastrocnemius strains. The patient presented with numbness in the right lateral foot and ankle that had persisted for 3 months, after he was treated unsuccessfully with extensive nonoperative measures, including anti-inflammatory drugs, activity modification, and a dedicated physical therapy program of stretching and strengthening. Orthopedic assessment showed worsening pain with forced passive dorsiflexion and manual pressure applied over the distal aspect of the gastrocnemius. Plain radiographs showed normal findings, but in-office ultrasound imaging showed evidence of sural nerve entrapment with edema and neuromatous scar formation in the absence of gastrocnemius or soleus pathology. Percutaneous ultrasound-guided hydrodissection of the sural nerve at the area of symptomatic neuroma and neural edema was performed the same day. The patient had complete relief of symptoms and full return to the preinjury level of participation in competitive sports. This case report shows that hydrodissection, when performed by an experienced physician, can be an effective, minimally invasive technique for neurolysis in the setting of sural nerve entrapment, resulting in improvement in clinical symptoms.

  12. Diagnosis and Treatment of Symptomatic Carpal Bossing

    PubMed Central

    Radmer, Sebastian; Fresow, Robert; Tabibzada, Arash Mehdi; Kamusella, Peter; Scheer, Fabian; Andresen, Reimer

    2015-01-01

    Context Carpal bossing is an osseous formation at the dorsal portion of the quadrangular joint, which rarely becomes symptomatic. However, in some patients it causes pain, restricted mobility and can lead to complications like tendon rupture, inflammatory and degenerative joint disease. Aim In this article, we present our experiences with this rare disorder in order to improve diagnostic and therapeutic proceedings. Settings Design This is a multicenter and interdisciplinary observation made by orthopaedic surgeons and radiologists in the years 2010 to 2015. Retrospective observational study. The follow up period was 2 years. Materials and Methods In the observed time period, eight patients were diagnosed with symptomatic carpal bossing. Symptoms were pain at palmar flexion and limited mobility of the wrist in combination with a palpable protuberance over the quadrangular joint. All patients underwent X-ray, CT and MRI examinations. A conservative treatment strategy was initiated for 6 weeks in all patients, followed by a wedge resection when symptoms were persisting and disabling. Results After the conservative treatment schedule, five patients were asymptomatic. Three patients had persisting pain and were thus recommended for surgery. In the postoperative course, two patients were asymptomatic. One patient developed a type 1 complex regional pain syndrome (CRPS) in the first postoperative year, which was successfully treated with pain-adapted physiotherapy, pharmacotherapy with analgesics and calcitonin, and a triple CT-guided thoracic sympathetic nerve blockade. Conclusion Carpal bossing is a mostly asymptomatic entity, which in our experience gets symptomatic due to direct trauma or repetitive stress, especially in competitive racket sports players. It can be diagnosed by thorough clinical examination and multimodal diagnostic imaging. Conservative treatment comprises an excellent prognosis, however surgery, either wedge resection or arthrodesis, must be

  13. Symptomatic Hardware Removal After First Tarsometatarsal Arthrodesis.

    PubMed

    Peterson, Kyle S; McAlister, Jeffrey E; Hyer, Christopher F; Thompson, John

    2016-01-01

    Severe hallux valgus deformity with proximal instability creates pain and deformity in the forefoot. First tarsometatarsal joint arthrodesis is performed to reduce the intermetatarsal angle and stabilize the joint. Dorsomedial locking plate fixation with adjunctive lag screw fixation is used because of its superior construct strength and healing rate. Despite this, questions remain regarding whether this hardware is more prominent and more likely to need removal. The purpose of the present study was to determine the incidence of symptomatic hardware at the first tarsometatarsal joint and to determine the incidence of hardware removal resulting from prominence and/or discomfort. A review of 165 medical records of consecutive patients who had undergone first tarsometatarsal joint arthrodesis with plate fixation was conducted. The outcome of interest was the incidence of symptomatic hardware removal in patients with clinical union. The mean age was 55 (range 18.4 to 78.8) years. The mean follow-up duration was 65.9 ± 34.0 (range 7.0 to 369.0) weeks. In our cohort, 25 patients (15.2%) had undergone hardware removed because of pain and irritation. Of these patients, 18 (72.0%) had a locking plate and lag screw removed, and 7 (28.0%) had crossing lag screws removed. The fixation of a first tarsometatarsal joint fusion poses a difficult situation owing to minimal soft tissue coverage and the inherent need for robust fixation to promote fusion. Hardware can become prominent postoperatively and can become painful and/or induce cutaneous compromise. The results of the present observational investigation imply that surgeons can reasonably inform patients that the incidence of symptomatic hardware removal after first tarsometatarsal arthrodesis is approximately 15% within a median duration of 9.0 months after surgery.

  14. Acute Acalculous Cholecystitis by Epstein-Barr Virus Infection: A Rare Association

    PubMed Central

    Vieira, Maria; Couto, Cristiana; Coelho, Maria D.; Laranjeira, Carla

    2015-01-01

    Acute acalculous cholecystitis (AAC) is a rare complication of Epstein Barr virus (EBV) infection, with only a few cases reported among pediatric population. This clinical condition is frequently associated with a favorable outcome and, usually, a surgical intervention is not required. We report a 16-year-old girl who presented with AAC following primary EBV infection. The diagnosis of AAC was documented by clinical and ultrasonographic examination, whereas EBV infection was confirmed serologically. A conservative treatment was performed, with a careful monitoring and serial ultrasonographic examinations, which led to the clinical improvement of the patient. Pediatricians should be aware of the possible association between EBV and AAC, in order to offer the patients an appropriate management strategy. PMID:26753086

  15. Acute acalculous cholecystitis immediately after gastric operation: Case report and literatures review

    PubMed Central

    Liu, Feng-Lin; Li, He; Wang, Xue-Fei; Shen, Kun-Tang; Shen, Zhen-Bin; Sun, Yi-Hong; Qin, Xin-Yu

    2014-01-01

    Acute acalculous cholecystitis (AAC) is a rare complication of gastric surgery. The most commonly accepted concepts regarding its pathogenesis are bile stasis, sepsis and ischemia, but it has not been well described how to identify and manage this disease in the early stage. We report three cases of AAC in elderly patients immediately after gastric surgery, which were treated with three different strategies. One patient died 42 d after emergency cholecystectomy, and the other two finally recovered through timely cholecystostomy and percutaneous transhepatic gallbladder drainage, respectively. These cases informed us of the value of early diagnosis and proper treatment for perioperative AAC after gastric surgery. We further reviewed reported cases of AAC immediately after gastric operation, which may expand our knowledge of this disease. PMID:25132787

  16. Emphysematous Cholecystitis in 24-Year-old Male Without Predisposing Factors.

    PubMed

    Sayit, Asli Tanrivermis; Gunbey, Hediye Pinar

    2015-07-01

    Emphysematous cholecystitis (EC) is a life threatening condition characterized by gangrene of the gallbladder due to an infection with gas-forming organisms. It is more common in elderly men and has been associated with systemic disease, especially diabetes and vascular disease. Computed tomography is the most important and accurate imaging modality for the diagnosis of EC. EC should be thought of when the radiographic presence of gas is detected within the gallbladder wall or lumen. Emergency surgical intervention and antibiotic treatment for the gas-forming organism should be initiated after the diagnosis of the EC. Here, we present the imaging and pathologic findings of a 24-year-old male with EC without any predisposing factors, successfully treated with laparoscopic cholecystectomy. PMID:26393182

  17. Laparoscopic cholecystectomy for acalculous cholecystitis in a neutropenic patient after chemotherapy for acute lymphoblastic leukemia

    PubMed Central

    Ejduk, Anna; Wróblewski, Tadeusz; Szczepanik, Andrzej B.

    2014-01-01

    Acute acalculous cholecystitis (ACC) is most frequently reported in critically ill patients following sepsis, extensive injury or surgery. It is rather uncommon as a chemotherapy-induced complication, which is usually life-threatening in neutropenic patients subjected to myelosuppressive therapy. A 23-year-old patient with acute lymphoblastic leukemia was subjected to myelosuppressive chemotherapy (cyclophosphamide, cytarabine, pegaspargase). After the first chemotherapy cycle the patient was neutropenic and feverish; she presented with vomiting and pain in the right epigastrium. Ultrasound demonstrated an acalculous gallbladder with wall thickening up to 14 mm. The ACC was diagnosed. Medical therapy included a broad spectrum antibiotic regimen and granulocyte-colony stimulating factors. On the second day after ACC diagnosis the patient's general condition worsened. Laparoscopic cholecystectomy was performed. The resected gallbladder showed no signs of bacterial or leukemic infiltrates. The postoperative course was uneventful. In the management of neutropenic patients with ACC surgical treatment is as important as pharmacological therapy. PMID:25337176

  18. Endoscopic ultrasonography-guided gallbladder drainage for acute cholecystitis: from evidence to practice.

    PubMed

    Choi, Jun-Ho; Lee, Sang Soo

    2015-01-01

    With the evolution of the linear echoendoscope and the improved ability to direct a needle within the field of interest, the therapeutic potential of endoscopic ultrasonography (EUS) has greatly expanded. Endoscopic ultrasonography-guided transmural gallbladder drainage (EUS-GBD) may be the next frontier for therapeutic EUS. Since EUS-GBD was first described in 2007, recent reports have suggested it as an alternative to external gallbladder drainage for acute cholecystitis. EUS-GBD includes EUS-guided transmural nasogallbladder drainage, EUS-guided gallbladder aspiration, and EUS-guided transmural gallbladder stenting. Indications for the EUS-GBD technique as currently practiced, including equipment, technical details, complications, and efficacy are herein reviewed.

  19. True left-sided gallbladder with variations of bile duct and cholecystic vein.

    PubMed

    Ishii, Hiromichi; Noguchi, Akinori; Onishi, Mie; Takao, Koji; Maruyama, Takahiro; Taiyoh, Hiroaki; Araki, Yasunobu; Shimizu, Takeshi; Izumi, Hiroyuki; Tani, Naoki; Yamaguchi, Masahide; Yamane, Tetsuro

    2015-06-01

    A left-sided gallbladder without a right-sided round ligament, which is called a true left-sided gallbladder, is extremely rare. A 71-year-old woman was referred to our hospital due to a gallbladder polyp. Computed tomography (CT) revealed not only a gallbladder polyp but also the gallbladder located to the left of the round ligament connected to the left umbilical portion. CT portography revealed that the main portal vein diverged into the right posterior portal vein and the common trunk of the left portal vein and right anterior portal vein. CT cholangiography revealed that the infraportal bile duct of segment 2 joined the common bile duct. Laparoscopic cholecystectomy was performed for a gallbladder polyp, and the intraoperative finding showed that the cholecystic veins joined the round ligament. A true left-sided gallbladder is closely associated with several anomalies; therefore, surgeons encountering a true left-sided gallbladder should be aware of the potential for these anomalies.

  20. Acute Symptomatic Seizures Caused by Electrolyte Disturbances

    PubMed Central

    Nardone, Raffaele; Brigo, Francesco

    2016-01-01

    In this narrative review we focus on acute symptomatic seizures occurring in subjects with electrolyte disturbances. Quite surprisingly, despite its clinical relevance, this issue has received very little attention in the scientific literature. Electrolyte abnormalities are commonly encountered in clinical daily practice, and their diagnosis relies on routine laboratory findings. Acute and severe electrolyte imbalances can manifest with seizures, which may be the sole presenting symptom. Seizures are more frequently observed in patients with sodium disorders (especially hyponatremia), hypocalcemia, and hypomagnesemia. They do not entail a diagnosis of epilepsy, but are classified as acute symptomatic seizures. EEG has little specificity in differentiating between various electrolyte disturbances. The prominent EEG feature is slowing of the normal background activity, although other EEG findings, including various epileptiform abnormalities may occur. An accurate and prompt diagnosis should be established for a successful management of seizures, as rapid identification and correction of the underlying electrolyte disturbance (rather than an antiepileptic treatment) are of crucial importance in the control of seizures and prevention of permanent brain damage. PMID:26754778

  1. Symptomatic Epilepsies due to Cerebrovascular Diseases

    PubMed Central

    Dakaj, Nazim; Shatri, Nexhat; Isaku, Enver; Zeqiraj, Kamber

    2014-01-01

    Introduction: Cerebro-vascular diseases (CVD) are the leading cause of symptomatic epilepsies. This study aims to investigate: a) Frequency of epilepsy in patients with CVD; b) Correlation of epilepsy with the type of CVD (ischemic and hemorrhage) and with age. Methodology: It is analyzed medical documentation of 816 hospitalized patients with CVD in the clinic of Neurology in University Clinical Center (UCC) during the period January - December 2010. The study included data on patients presenting with epileptic seizures after CVD, and those with previously diagnosed epilepsy, are not included in the study. The diagnosis of CVD, are established in clinical neurological examination and the brain imaging (computer tomography and magnetic resonance imaging). The diagnosis of epilepsy is established by the criteria of ILAE (International League against Epilepsy) 1983, and epileptic seizures are classified according to the ILAE classification, of 1981. Results: Out of 816 patients with CVD, 692 were with ischemic stroke and 124 with hemorrhage. From 816 patients, epileptic seizures had 81 (10%), of which 9 patients had been diagnosed with epilepsy earlier and they are not included in the study. From 72 (99%) patients with seizures after CVD 25 (33%) have been with ischemia, whereas 47 (67%) with hemorrhage. Conclusion: CVD present fairly frequent cause of symptomatic epilepsies among patients treated in the clinic of Neurology at UCC (about 10%). The biggest number of patients with epilepsy after CVD was with intracerebral hemorrhage. PMID:25685086

  2. Acute Symptomatic Seizures Caused by Electrolyte Disturbances.

    PubMed

    Nardone, Raffaele; Brigo, Francesco; Trinka, Eugen

    2016-01-01

    In this narrative review we focus on acute symptomatic seizures occurring in subjects with electrolyte disturbances. Quite surprisingly, despite its clinical relevance, this issue has received very little attention in the scientific literature. Electrolyte abnormalities are commonly encountered in clinical daily practice, and their diagnosis relies on routine laboratory findings. Acute and severe electrolyte imbalances can manifest with seizures, which may be the sole presenting symptom. Seizures are more frequently observed in patients with sodium disorders (especially hyponatremia), hypocalcemia, and hypomagnesemia. They do not entail a diagnosis of epilepsy, but are classified as acute symptomatic seizures. EEG has little specificity in differentiating between various electrolyte disturbances. The prominent EEG feature is slowing of the normal background activity, although other EEG findings, including various epileptiform abnormalities may occur. An accurate and prompt diagnosis should be established for a successful management of seizures, as rapid identification and correction of the underlying electrolyte disturbance (rather than an antiepileptic treatment) are of crucial importance in the control of seizures and prevention of permanent brain damage. PMID:26754778

  3. Symptomatic thrower's exostosis. Arthroscopic evaluation and treatment.

    PubMed

    Meister, K; Andrews, J R; Batts, J; Wilk, K; Baumgarten, T; Baumgartner, T

    1999-01-01

    A long-term follow-up was performed on 22 patients treated for a posterior glenoid osteophyte and symptomatic posterior shoulder pain during either the late cocking, acceleration, or follow-through phases of throwing. Arthroscopic evaluation of these patients revealed undersurface tearing of the rotator cuff in all but one. Fifteen patients also had tearing of the posterior labrum. Anterior labral fraying was noted in four patients. Treatment consisted of debridement of the rotator cuff and labral tears. The posterior glenoid osteophyte was removed arthroscopically in 11 patients. Eighteen of 22 throwers treated were available for long-term follow-up at a mean of 6.3 years (range, 1 to 12). Only 10 of 18 (55%) throwers evaluated had returned to their premorbid level of throwing. All 10 were asymptomatic and had maintained a high level of performance for a mean of 3.6 years (range, 1 to 8). At the time of latest follow-up, five players were still participating at the major league level and five had retired. One patient had recurrence of the exostosis 8 years after surgery. Among our patients a trend existed toward a poorer result and failure of return to activity with a posterior osteophyte greater than 100 mm2. A posterior glenoid exostosis, when identified in the symptomatic shoulder of the throwing athlete, can be considered a definite marker of internal impingement.

  4. Chemical sensitivity in symptomatic Cambodia veterans.

    PubMed

    Bischoff, Erik W M A; Soetekouw, Patricia M M B; De Vries, Maaike; Scheepers, Paul T I; Bleijenberg, Gijs; van der Meer, Jos W M

    2003-12-01

    Following their participation in a United Nations peacekeeping operation in Cambodia (1992-1993), Dutch veterans complained of symptoms similar to those reported by Gulf War veterans. The authors conducted a matched case-control study to evaluate 76 symptomatic and 32 matched asymptomatic Cambodia veterans on the basis of data collected by postal questionnaire. The number of symptomatic veterans who reported having used insect repellants that contained N,N,-diethyl-meta-toluamide (DEET) during the mission in Cambodia was significantly higher, compared with asymptomatic veterans. The percentage of veterans who reported feeling ill following brief exposures to chemicals such as paint or pesticides was equal in both groups, but the percentage was low compared with the results of other studies of Multiple Chemical Sensitivity Syndrome. The current study was limited by self-report and time delay (potential recall bias) between deployment to Cambodia and the time of survey. Nevertheless, the study results did not support the hypothesis that symptoms in the total group of Cambodia veterans could be related to Multiple Chemical Sensitivity Syndrome. PMID:15859508

  5. Symptomatic spinal cord metastasis from cerebral oligodendroglioma.

    PubMed

    Elefante, A; Peca, C; Del Basso De Caro, M L; Russo, C; Formicola, F; Mariniello, G; Brunetti, A; Maiuri, F

    2012-06-01

    Spinal subarachnoid spread is not uncommon in brain oligodendrogliomas; on the other hand, symptomatic involvement of the spinal cord and cauda is very rare, with only 16 reported cases. We report the case of a 41-year-old man who underwent resection of a low-grade frontal oligodendroglioma 4 years previously. He was again observed because of bilateral sciatic pain followed by left leg paresis. A spine MRI showed an intramedullary T12-L1 tumor with root enhancement. At operation, an intramedullary anaplastic oligodendroglioma with left exophytic component was found and partially resected. Two weeks later, a large left frontoparietal anaplastic oligodendroglioma was diagnosed and completely resected. The patient was neurologically stable for 8 months and died 1 year after the spinal surgery because of diffuse brain and spinal leptomeningeal spread. The review of the reported cases shows that spinal symptomatic metastases can occur in both low-grade and anaplastic oligodendrogliomas, even many years after surgery of the primary tumor; however, they exceptionally occur as first clinical manifestation or as anaplastic progression. The spinal seeding represents a negative event leading to a short survival.

  6. Acute cholecystitis

    MedlinePlus

    ... that forms in the wall of the gallbladder) Pancreatitis (inflamed pancreas) Persistent bile duct blockage Inflammation of ... draining the liver (may occur after gallbladder surgery) Pancreatitis Perforation Peritonitis (inflammation of the lining of the ...

  7. Acute Calculous Cholecystitis Missed on Computed Tomography and Ultrasound but Diagnosed with Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography

    PubMed Central

    Aparici, Carina Mari; Win, Aung Zaw

    2016-01-01

    We present a case of a 69-year-old patient who underwent ascending aortic aneurysm repair with aortic valve replacement. On postsurgical day 12, he developed leukocytosis and low-grade fevers. The chest computed tomography (CT) showed a periaortic hematoma which represents a postsurgical change from aortic aneurysm repair, and a small pericardial effusion. The abdominal ultrasound showed cholelithiasis without any sign of cholecystitis. Finally, a fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT examination was ordered to find the cause of fever of unknown origin, and it showed increased FDG uptake in the gallbladder wall, with no uptake in the lumen. FDG-PET/CT can diagnose acute cholecystitis in patients with nonspecific clinical symptoms and laboratory results. PMID:27625897

  8. Acute Calculous Cholecystitis Missed on Computed Tomography and Ultrasound but Diagnosed with Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography.

    PubMed

    Aparici, Carina Mari; Win, Aung Zaw

    2016-01-01

    We present a case of a 69-year-old patient who underwent ascending aortic aneurysm repair with aortic valve replacement. On postsurgical day 12, he developed leukocytosis and low-grade fevers. The chest computed tomography (CT) showed a periaortic hematoma which represents a postsurgical change from aortic aneurysm repair, and a small pericardial effusion. The abdominal ultrasound showed cholelithiasis without any sign of cholecystitis. Finally, a fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT examination was ordered to find the cause of fever of unknown origin, and it showed increased FDG uptake in the gallbladder wall, with no uptake in the lumen. FDG-PET/CT can diagnose acute cholecystitis in patients with nonspecific clinical symptoms and laboratory results. PMID:27625897

  9. Acute Calculous Cholecystitis Missed on Computed Tomography and Ultrasound but Diagnosed with Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography

    PubMed Central

    Aparici, Carina Mari; Win, Aung Zaw

    2016-01-01

    We present a case of a 69-year-old patient who underwent ascending aortic aneurysm repair with aortic valve replacement. On postsurgical day 12, he developed leukocytosis and low-grade fevers. The chest computed tomography (CT) showed a periaortic hematoma which represents a postsurgical change from aortic aneurysm repair, and a small pericardial effusion. The abdominal ultrasound showed cholelithiasis without any sign of cholecystitis. Finally, a fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT examination was ordered to find the cause of fever of unknown origin, and it showed increased FDG uptake in the gallbladder wall, with no uptake in the lumen. FDG-PET/CT can diagnose acute cholecystitis in patients with nonspecific clinical symptoms and laboratory results.

  10. Symptomatic flexible flatfoot in adults: subtalar arthroereisis

    PubMed Central

    Ozan, Fırat; Doğar, Fatih; Gençer, Kürşat; Koyuncu, Şemmi; Vatansever, Fatih; Duygulu, Fuat; Altay, Taşkın

    2015-01-01

    Flexible flatfoot is a common deformity in pediatric and adult populations. In this study, we aimed to evaluate the functional and radiographic results of subtalar arthroereisis in adult patients with symptomatic flexible flatfoot. We included 26 feet in 16 patients who underwent subtalar arthroereisis for symptomatic flexible flatfoot. Radiographic examination included calcaneal inclination angle, lateral talocalcaneal angle, Meary’s angle, anteroposterior talonavicular angle, and Kite’s angle. The clinical assessment was based on the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale and a visual analog scale (VAS). The mean follow-up was 15.1±4.7 months. The mean preoperative AOFAS score was 53±6.6, while the mean AOFAS score at the last follow-up visit was 75±11.2 (P<0.05). The mean visual analog scale score was 6.9±0.6 preoperatively and 4.1±1.4 at the last follow-up visit (P<0.05). The mean preoperative and postoperative values measured were 13.4°±3.3° and 14.6°±2.7° for calcaneal inclination angles (P<0.05); 35.7°±6.9° and 33.2°±5.3° for lateral talocalcaneal angles (P>0.05); 8°±5.3° and 3.3±3 for Meary’s angles (P<0.05); 5.6°±3.5° and 2.6°±1.5° for anteroposterior talonavicular angles (P<0.05); and 23.7°±6.1° and 17.7°±5° for Kite’s angles, respectively (P<0.05). Implants were removed in three feet (11.5%). Subtalar arthroereisis is a minimally invasive procedure that can be used in the surgical treatment of adults with symptomatic flexible flatfoot. This procedure provided radiological and functional recovery in our series of patients. PMID:26527876

  11. What is the effect of treatment modality on red blood cell distribution width in patients with acute cholecystitis?

    PubMed Central

    Yazıcı, Pınar; Demir, Uygar; Bozdağ, Emre; Bozkurt, Emre; Işıl, Gürhan; Bostancı, Özgür; Mihmanlı, Mehmet

    2015-01-01

    Objective: The red blood cell distribution width (RDW) has recently been used as a marker to predict outcome in various patient groups. In this study, we aimed to examine how RDW is influenced during the treatment and follow-up of cases of acute cholecystitis which is a common inflammatory disease. Material and Methods: Seventy-two patients who were treated for acute cholecystitis, were included into the study. The demographic data, leukocyte count, RDW, C-reactive protein (CRP) values and treatment protocols of these patients were prospectively recorded. The patients who received medical treatment for acute cholecystitis (Group A, n=33) and those who underwent surgery (Group B, n=39) were examined in separate groups. Results: There were 27 male and 45 female patients with a mean age of 50.1±18 years (min-max: 21-94). In Group B, 33 patients underwent laparoscopic cholecystectomy, whereas 6 patients underwent open cholecystectomy. The RDW values on admission were not significantly different between two groups. However the post-treatment/pre-discharge RDW values were significantly lower in the surgical group (14.4±1.9 to 13.6±1.1, respectively, p<0.05). Also, no significant RDW change was identified in the medical treatment group based on an intra-group assessment, whereas a significant decrease was observed in Group B (on admission and following surgical treatment: 14.3±1.3, 13.6±1.1, respectively, p=0.015). No significant differences were observed between groups in terms of CRP and leucocyte values. Conclusion: There was a significant decrease in RDW values in patients who were treated with surgery for acute cholecystitis, while this response could not be observed with medical treatment. PMID:25931948

  12. Symptomatic Therapy and Rehabilitation in Primary Progressive Multiple Sclerosis

    PubMed Central

    Khan, Fary; Amatya, Bhasker; Turner-Stokes, Lynne

    2011-01-01

    Multiple sclerosis (MS) is an autoimmune inflammatory demyelinating disease of the central nervous system and a major cause of chronic neurological disability in young adults. Primary progressive MS (PPMS) constitutes about 10% of cases, and is characterized by a steady decline in function with no acute attacks. The rate of deterioration from disease onset is more rapid than relapsing remitting and secondary progressive MS types. Multiple system involvement at onset and rapid early progression have a worse prognosis. PPMS can cause significant disability and impact on quality of life. Recent studies are biased in favour of relapsing remitting patients as treatment is now available for them and they are more likely to be seen at MS clinics. Since prognosis for PPMS is worse than other types of MS, the focus of rehabilitation is on managing disability and enhancing participation, and application of a “neuropalliative” approach as the disease progresses. This chapter presents the symptomatic treatment and rehabilitation for persons with MS, including PPMS. A multidisciplinary approach optimizes the intermediate and long-term medical, psychological and social outcomes in this population. Restoration and maintenance of functional independence and societal reintegration, and issues relating to quality of life are addressed in rehabilitation processes. PMID:22013521

  13. Microsurgical technique of symptomatic intracavernous aneurysm.

    PubMed

    Liao, Chih-Hsiang; Lin, Chun-Fu; Hsu, Sanford P C; Chen, Min-Hsiung; Shih, Yang-Hsin

    2015-07-01

    Symptomatic intracavernous aneurysm is rare. Cranial nerves in the cavernous sinus are subjected to the mass effect of an expanding aneurysm. Microsurgical clipping is the treatment of choice to relieve compressive cranial neuropathy. In this video, the authors present a case of intracavernous aneurysm causing diplopia, ptosis, and facial numbness. The patient was operated on via a pretemporal transclinoid-transcavernous approach. The aneurysm was completely obliterated through direct clipping. There were no new-onset neurologic deficits and complications after the operation. Complete recovery of the diplopia, ptosis, and facial numbness was observed at the 6-month postoperative follow up. The video can be found here: http://youtu.be/4w5QUoNIAQM. PMID:26132609

  14. [Cannabinoids for symptomatic therapy of multiple sclerosis].

    PubMed

    Husseini, L; Leussink, V I; Warnke, C; Hartung, H-P; Kieseier, B C

    2012-06-01

    Spasticity represents a common troublesome symptom in patients with multiple sclerosis (MS). Treatment of spasticity remains difficult, which has prompted some patients to self-medicate with and perceive benefits from cannabis. Advances in the understanding of cannabinoid biology support these anecdotal observations. Various clinical reports as well as randomized, double-blind, placebo-controlled studies have now demonstrated clinical efficacy of cannabinoids for the treatment of spasticity in MS patients. Sativex is a 1:1 mix of delta-9-tetrahydocannabinol and cannabidiol extracted from cloned Cannabis sativa chemovars, which recently received a label for treating MS-related spasticity in Germany. The present article reviews the current understanding of cannabinoid biology and the value of cannabinoids as a symptomatic treatment option in MS. PMID:22080198

  15. Therapeutic Challenges for Symptomatic Portal Cavernoma Cholangiopathy.

    PubMed

    Cavași, Adriana; Mercea, Voicu; Anton, Ofelia; Puia, Ion Cosmin

    2016-09-01

    Although transjugular intrahepatic portosystemic shunts are most frequently used for the management of portal hypertension, the surgical approach is preferred for symptomatic portal cavernoma cholangiopathy. We present the case of a 25-year old female patient with a portal cavernoma secondary to catheterization of the umbilical vein at birth. She had had two episodes of esophageal variceal bleeding, successfully treated by endoscopic banding. and an episode of acute cholangitis secondary to portal cavernoma cholangiopathy. Endoscopic sphincterotomy and biliary stenting were performed, and were followed by repeated episodes of biliary stent occlusion. The last biliary drainage procedure triggered a massive hemobilia. Since endoscopic therapy was ineffective, a surgical mesocaval shunt with graft interposition and splenectomy was performed with favorable outcome. In selected cases, the mesocaval shunting plays an essential role in the treatment of portal cavernoma cholangiopathy even in the era of interventional radiology. PMID:27689206

  16. Assessing clinical outcomes of patients with acute calculous cholecystitis in addition to the Tokyo grading: a retrospective study.

    PubMed

    Cheng, Wei-Chun; Chiu, Yen-Cheng; Chuang, Chiao-Hsiung; Chen, Chiung-Yu

    2014-09-01

    The management of acute cholecystitis is still based on clinical expertise. This study aims to investigate whether the outcome of acute cholecystitis can be related to the severity criteria of the Tokyo guidelines and additional clinical comorbidities. A total of 103 patients with acute cholecystitis were retrospectively enrolled and their medical records were reviewed. They were all classified according to therapeutic modality, including early cholecystectomy and antibiotic treatment with or without percutaneous cholecystostomy. The impact of the Tokyo guidelines and the presence of comorbidities on clinical outcome were assessed by univariate and multivariate regression analyses. According to Tokyo severity grading, 48 patients were Grade I, 31 patients were Grade II, and 24 patients were Grade III. The Grade III patients had a longer hospital stay than Grade II and Grade I patients (15.2 days, 9.2 days, and 7.3 days, respectively, p < 0.05). According to multivariate analysis, patients with Grade III Tokyo severity, higher Charlson's Comorbidity Score, and encountering complications had a longer hospital stay. Based on treatment modality, surgeons selected the patients with less severity and fewer comorbidities for cholecystectomy, and these patients had a shorter hospital stay. In addition to the grading of the Tokyo guidelines, comorbidities had an additional impact on clinical outcomes and should be an important consideration when making therapeutic decisions.

  17. Eradication of Blastocystis hominis prevents the development of symptomatic Hashimoto's thyroiditis: a case report.

    PubMed

    Rajič, Borko; Arapović, Jurica; Raguž, Kazimir; Bošković, Mladen; Babić, Senaida Marina; Maslać, Suzana

    2015-07-01

    In this case report we describe a 49 year-old man who presented with chronic urticaria, angioedema and soft stool consistency. During diagnostic examinations Hashimoto's thyroiditis was found even though the patient never had clear symptoms of this disease. Blastocystis hominis was isolated through a stool microbiologic examination, implicating that this parasite can cause the development of Hashimoto's thyroiditis and chronic urticaria. After two-weeks treatment with metronidazole the Blastocystis hominis was eradicated, then urticaria and angioedema disappeared. During the four years of follow-up, the patient presented without any symptoms, whereas thyroid hormones were normalized and anti-thyroid antibodies declined. For the first time in the literature we show that eradication of Blastocystis hominis can prevent the development of both symptomatic Hashimoto's thyroiditis and chronic urticaria. PMID:26230132

  18. Yellow nails, lymphedema and pleural effusion. Treatment of chronic pleural effusion with pleuroperitoneal shunting.

    PubMed

    Brofman, J D; Hall, J B; Scott, W; Little, A G

    1990-03-01

    Pleural effusion secondary to lymphedema may be chronic, symptomatic and refractory to treatment, occasionally requiring invasive and painful procedures such as chemical pleurodesis, open pleural abrasion or pleurectomy to achieve control of the effusion and gain symptomatic relief. We report a patient with yellow nail syndrome and chronic pleural effusion successfully treated with pleuroperitoneal shunting.

  19. Cavum Septi Pellucidi in Symptomatic Former Professional Football Players.

    PubMed

    Koerte, Inga K; Hufschmidt, Jakob; Muehlmann, Marc; Tripodis, Yorghos; Stamm, Julie M; Pasternak, Ofer; Giwerc, Michelle Y; Coleman, Michael J; Baugh, Christine M; Fritts, Nathan G; Heinen, Florian; Lin, Alexander; Stern, Robert A; Shenton, Martha E

    2016-02-15

    Post-mortem studies reveal a high rate of cavum septi pellucidi (CSP) in chronic traumatic encephalopathy (CTE). It remains, however, to be determined whether or not the presence of CSP may be a potential in vivo imaging marker in populations at high risk to develop CTE. The aim of this study was to evaluate CSP in former professional American football players presenting with cognitive and behavioral symptoms compared with noncontact sports athletes. Seventy-two symptomatic former professional football players (mean age 54.53 years, standard deviation [SD] 7.97) as well as 14 former professional noncontact sports athletes (mean age 57.14 years, SD 7.35) underwent high-resolution structural 3T magnetic resonance imaging. Two raters independently evaluated the CSP, and interrater reliability was calculated. Within National Football League players, an association of CSP measures with cognitive and behavioral functioning was evaluated using a multivariate mixed effects model. The measurements of the two raters were highly correlated (CSP length: rho = 0.98; Intraclass Correlation Coefficient [ICC] 0.99; p < 0.0001; septum length: rho = 0.93; ICC 0.96; p < 0.0001). For presence versus absence of CSP, there was high agreement (Cohen kappa = 0.83, p < 0.0001). A higher rate of CSP, a greater length of CSP, as well as a greater ratio of CSP length to septum length was found in symptomatic former professional football players compared with athlete controls. In addition, a greater length of CSP was associated with decreased performance on a list learning task (Neuropsychological Assessment Battery List A Immediate Recall, p = 0.04) and decreased test scores on a measure of estimate verbal intelligence (Wide Range Achievement Test Fourth Edition Reading Test, p = 0.02). Given the high prevalence of CSP in neuropathologically confirmed CTE in addition to the results of this study, CSP may serve as a potential early in vivo imaging marker to identify those at high risk for CTE

  20. Symptomatic glial cysts of the pineal gland.

    PubMed

    Fain, J S; Tomlinson, F H; Scheithauer, B W; Parisi, J E; Fletcher, G P; Kelly, P J; Miller, G M

    1994-03-01

    Small asymptomatic cysts of the pineal gland represent a common incidental finding in adults undergoing computerized tomography or magnetic resonance (MR) imaging or at postmortem examination. In contrast, large symptomatic pineal cysts are rare, being limited to individual case reports or small series. The authors have reviewed 24 cases of large pineal cysts. The mean patient age at presentation was 28.7 years (range 15 to 46 years); 18 were female and six male. Presenting features in 20 symptomatic cases included: headache in 19; nausea and/or vomiting in seven; papilledema in five; visual disturbances in five (diplopia in three, "blurred vision" in two, and unilateral partial oculomotor nerve palsy in one); Parinaud's syndrome in two; hemiparesis in one; hemisensory aberration in one; and seizures in one. Four lesions were discovered incidentally. Magnetic resonance imaging typically demonstrated a 0.8- to 3.0-cm diameter mass (mean 1.7 cm) with homogeneous decreased signal intensity on T1-weighted images, increased signal intensity on T2-weighted images, and a distinct margin. Hydrocephalus was present in eight cases. The cysts were surgically excised via an infratentorial/supracerebellar approach (23 cases) or stereotactically biopsied (one case). Histological examination revealed a cyst wall 0.5 to 2.0 mm thick comprised of three layers: an outer fibrous layer, a middle layer of pineal parenchymal cells with variable calcification, and an inner layer of hypocellular glial tissue often exhibiting Rosenthal fibers and/or granular bodies. Evidence of prior hemorrhage, mild astrocytic degenerative atypia, and disorganization of pineal parenchyma were often present. Postoperative follow-up review in all 24 cases (range 3 months to 10 years) revealed no complications in 21, mild ocular movement deficit in one, gradually resolving Parinaud's syndrome in one, and radiographic evidence of a postoperative venous infarct of the superior cerebellum with ataxia of 1 week

  1. Risk of Psychiatric Disorders Following Symptomatic Menopausal Transition

    PubMed Central

    Hu, Li-Yu; Shen, Cheng-Che; Hung, Jeng-Hsiu; Chen, Pan-Ming; Wen, Chun-Hsien; Chiang, Yung-Yen; Lu, Ti

    2016-01-01

    Abstract Menopausal transition is highly symptomatic in at least 20% of women. A higher prevalence of psychiatric symptoms, including depression, anxiety, and sleep disturbance, has been shown in women with symptomatic menopausal transition. However, a clear correlation between symptomatic menopausal transition and psychiatric disorders has not been established. We explored the association between symptomatic menopausal transition and subsequent newly diagnosed psychiatric disorders, including schizophrenia as well as bipolar, depressive, anxiety, and sleep disorders. We investigated women who were diagnosed with symptomatic menopausal transition by an obstetrician-gynecologist according to the data in the Taiwan National Health Insurance Research Database. A comparison cohort comprised age-matched women without symptomatic menopausal transition. The incidence rate and the hazard ratios of subsequent newly diagnosed psychiatric disorders were evaluated in both cohorts, based on the diagnoses of psychiatrists. The symptomatic menopausal transition and control cohorts each consisted of 19,028 women. The incidences of bipolar disorders (hazard ratio [HR] = 1.69, 95% confidence interval [CI] = 1.01–2.80), depressive disorders (HR = 2.17, 95% CI = 1.93–2.45), anxiety disorders (HR = 2.11, 95% CI = 1.84–2.41), and sleep disorders (HR = 2.01, 95% CI = 1.73–2.34) were higher among the symptomatic menopausal transition women than in the comparison cohort. After stratifying for follow-up duration, the incidence of newly diagnosed bipolar disorders, depressive disorders, anxiety disorders, and sleep disorders following a diagnosis of symptomatic menopausal transition remained significantly increased in the longer follow-up groups (1–5 and ≥ 5 years). Symptomatic menopausal transition might increase the risk of subsequent newly onset bipolar disorders, depressive disorders, anxiety disorders, and sleep disorders. A prospective study

  2. True left-sided gallbladder with variations of bile duct and cholecystic vein

    PubMed Central

    Ishii, Hiromichi; Noguchi, Akinori; Onishi, Mie; Takao, Koji; Maruyama, Takahiro; Taiyoh, Hiroaki; Araki, Yasunobu; Shimizu, Takeshi; Izumi, Hiroyuki; Tani, Naoki; Yamaguchi, Masahide; Yamane, Tetsuro

    2015-01-01

    A left-sided gallbladder without a right-sided round ligament, which is called a true left-sided gallbladder, is extremely rare. A 71-year-old woman was referred to our hospital due to a gallbladder polyp. Computed tomography (CT) revealed not only a gallbladder polyp but also the gallbladder located to the left of the round ligament connected to the left umbilical portion. CT portography revealed that the main portal vein diverged into the right posterior portal vein and the common trunk of the left portal vein and right anterior portal vein. CT cholangiography revealed that the infraportal bile duct of segment 2 joined the common bile duct. Laparoscopic cholecystectomy was performed for a gallbladder polyp, and the intraoperative finding showed that the cholecystic veins joined the round ligament. A true left-sided gallbladder is closely associated with several anomalies; therefore, surgeons encountering a true left-sided gallbladder should be aware of the potential for these anomalies. PMID:26074714

  3. Acute acalculous cholecystitis caused by Hepatitis C: A rare case report

    PubMed Central

    Omar, Ahmed; Osman, Medhet; Bonnet, Gerard; Ghamri, Nafiz

    2015-01-01

    Introduction Acute acalculous cholecystitis (AAC) is rarely encountered in clinical practice and has a high morbidity and mortality. AAC caused by viral hepatitis, with hepatitis A, B and EBV infections are rare, but well documented in the literature. Hepatitis C virus has not been reported as cause of AAC. This case report documents the first case of AAC associated with Acute Hepatitis C. Presenting concerns We present a 40 years old female with abdominal pain. She has a history of previous HCV infection. Her liver function tests were markedly deranged with elevated inflammatory markers. USS scan showed rather a very unusual appearance of an inflamed gallbladder with no gallstones and associated acute hepatitis, confirmed by an abdominal CT scan. HCV RNA PCR confirms flair up of the virus. The patient was managed conservatively in the hospital with follow up USS scan and Liver function tests showed complete recovery. Follow up HCV RNA PCR also returned to an undetectable level. The patient recovered completely with no adverse outcomes. Conclusion This case report is to the first to document the association between acute HCV and AAC. Despite being uncommon in western countries, viral hepatitis should be suspected as a causative agent of AAC, particularly when there is abnormal liver function test and no biliary obstruction. PMID:26722714

  4. [The cytokine profile in the patients with acute calculous cholecystitis and correction of its disorders].

    PubMed

    Gadzhiev, D N; Tagiev, É G; Guseĭnaliev, A G; Gadzhiev, N D; Talyshinskaia, L R

    2013-04-01

    The results of application of systemic cytokinotherapy and splenopid in patients, operated on for an acute calculous cholecystitis, are presented. While in patients of a control group the conventional basic therapy was conducted, to the patients of the main group the systemic cytokinotherapy and splenopid were conducted preoperatively and postoperatively on background of basic therapy during 3-10 days at average. In both groups preoperatively the reduction of interleukin-2 (IL-2) and gamma-interferon (IFNgamma) content were observed, as well as raising of the blood level of the tumor necrosis factor-alpha (TNF-alpha), IL-6 and IL-10. In the patients of a control group a tendency towards the studied indices normalisation was noted postoperatively, and in the patients of the main group the elimination of the organism cytokine state dysbalance was achieved. While doing comparative analysis of ratio of TNF-alpha/IL-10 and IL-2/IL-10 in the blood serum in the main group there was established, that up to the observation period end the both indices were close to the norm. PMID:23888711

  5. The role of scintiangiography in suspected acute cholecystitis: The hyperemic gallbladder fossa

    SciTech Connect

    Colletti, P.; Ralls, P.W.; Siegel, M.E.; Halls, J.

    1984-01-01

    Gallbladder hyperemia in acute cholecystitis (AC) has been described pathologically and angiographically. The authors' purpose is to evaluate the use of scintiangiography for the detection of this hypernia as a supporting sign of AC. Ten mCi of Tc 99m disofenin were injected by bolus technique in 64 patients with suspected AC. Sequential 3 second images were obtained with a 500K blood pool image at one minute. Routine images to 60 minutes were performed followed by delayed views. The scintiangiogram was positive if there was focal increased activity in the gallbladder fossa greater than liver and separate from right kidney during the preportal arterial phase. The location of the gallbladder fossa was determined by superimposition with the early hepatocyte phase. AC was confirmed surgically and normals confirmed clinically. Increased flow to the gallbladder fossa was demonstrated in 23/32 cases of AC and in 2/33 normals (72% sensitivity, 94% specificity). Accuracy is 54/65 (83%). Positive predictive value is 23/25 (92%). All patients with both a positive scintiangiogram and cholescintigram had AC, while 3 with pericholecystic abscess and false negative cholescintigram had positive scintiangiograms. Increased perfusion to the gallbladder fossa during scintiangiography is a sign of AC. This along with gallbladder nonvisualization by cholescintigraphy was able to predict AC in 100% of cases where both findings occurred. Scintiangiography may help select our patients with a very high likelihood of AC and may potentially shorten chole-scintigraphy examinations.

  6. Sensitivity of hepatobiliary imaging and real-time ultrasonography in the detection of acute cholecystitis

    SciTech Connect

    Fink-Bennett, D.; Freitas, J.E.; Ripley, S.D.; Bree, R.L.

    1985-08-01

    To determine the sensitivity of hepatobiliary imaging (HBI) and strict- and liberal-criteria real-time ultrasonography (RTUS), the authors retrospectively analyzed 100 cases of pathologically proved acute cholecystitis (AC). A positive HBI was one in which there was nonvisualization of the gallbladder up to four hours after the administration of technetium 99m-disofenin. In the absence of hypoalbuminemia, cirrhosis, or ascites, pathognomonic RTUS findings (strict criteria) for AC were wall edema and/or pericholecystic fluid. Findings indicative of AC (liberal criteria) included the demonstration of stones, a thick gallbladder wall, nonshadowing echoes, or the ultrasonographic Murphy's sign. Of the 100 cases of AC, 91 were calculous, and nine were acalculous. Four of 100 patients had associated choledocholithiasis. The sensitivities in detecting calculous AC were as follows: HBI, 97%; liberal-criteria RTUS, 86%; and strict-criteria RTUS, 24%. The sensitivities in detecting acalculous AC were as follows: HBI, 100%; liberal-criteria RTUS, 89%; and strict-criteria RTUS, 44%.

  7. Acute symptomatic hyponatremia in a flight attendant.

    PubMed

    Madero, Magdalena; Monares, Enrique; Domínguez, Aurelio Méndez; Ayus, Juan Carlos

    2015-08-01

    Acute symptomatic hyponatremia after thiazide diuretic initiation is a medical emergency. Here we describe the case of a flight attendant who developed acute hyponatremia during a flight and the potential risk factors for developing this condition. A 57-year-old flight attendant with history of essential hypertension was recently started on a thiazide diuretic. As she did routinely when working, she increased her water intake during a flight from London to Mexico City. She complained of nausea and headache during the flight. Upon arrival, she developed severe disorientation and presented to the hospital emergency room (ER) with a Glasgow scale of 12, hypoxia, and a generalized tonic clonic seizure. Her laboratory results on arrival were consistent with severe hyponatremia (serum Na 116 mEql/L) and severe cerebral edema by CT scan. She was treated with hypertonic saline, with complete resolution of the neurologic symptoms. We describe high water intake and hypoxia related to decreased partial pressure of oxygen in the cabin as the two main risk factors for thiazide-induced acute hyponatremia in this case. PMID:25500297

  8. A Quick Screening Model for Symptomatic Bacterascites in Cirrhosis

    PubMed Central

    Zhu, Long-Chuan; Xu, Long; He, Wen-Hua; Wu, Wei; Zhu, Xuan

    2016-01-01

    Background: Diagnosis of spontaneous bacterial peritonitis in cirrhosis can be made when a patient has an ascites polymorphonuclear leukocyte count ≥250/mm3. However, symptomatic bacterascites, which is a variant of spontaneous bacterial peritonitis with signs of infection but an ascites polymorphonuclear leukocyte count <250/mm3, cannot be confirmed until the time-consuming ascites culture becomes positive. Currently, early indicators for symptomatic bacterascites remain undetermined. Aims: To develop a quick screening model for early detection of symptomatic bacterascites in cirrhosis. Materials and Methods: Data on patients with cirrhotic ascites from two hospitals (from 2010 to 2014) were collected retrospectively. Patients with symptomatic bacterascites were enrolled in the case group and compared with patients without any infection in the control group. Logistic regression analysis was used to build a model for screening symptomatic bacterascites, and a receiver operating characteristics curve was used to assess the model. Results: In total, 103 patients were enrolled in the case group and 204 patients were enrolled in the control group. A screening model was constructed based on body temperature, abdominal tenderness, blood neutrophil percentage, blood total bilirubin, prothrombin time, and ascites nucleated leukocyte count. The area under the receiver operating characteristic curve was 0.939; a screening score of 0.328 was the best cutoff value. Conclusion: Patients with suspected symptomatic bacterascites can be quickly screened according to the developed model, and a screening score ≥0.328 indicates symptomatic bacterascites. PMID:27488322

  9. Mechanisms of exertional dyspnoea in symptomatic smokers without COPD.

    PubMed

    Elbehairy, Amany F; Guenette, Jordan A; Faisal, Azmy; Ciavaglia, Casey E; Webb, Katherine A; Jensen, Dennis; Ramsook, Andrew H; Neder, J Alberto; O'Donnell, Denis E

    2016-09-01

    Dyspnoea and activity limitation can occur in smokers who do not meet spirometric criteria for chronic obstructive pulmonary disease (COPD) but the underlying mechanisms are unknown.Detailed pulmonary function tests and sensory-mechanical relationships during incremental exercise with respiratory pressure measurements and diaphragmatic electromyography (EMGdi) were compared in 20 smokers without spirometric COPD and 20 age-matched healthy controls.Smokers (mean±sd post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity 75±4%, mean±sd FEV1 104±14% predicted) had greater activity-related dyspnoea, poorer health status and lower physical activity than controls. Smokers had peripheral airway dysfunction: higher phase-III nitrogen slopes (3.8±1.8 versus 2.6±1.1%·L(-1)) and airway resistance (difference between airway resistance measured at 5 Hz and 20 Hz 19±11 versus 12±7% at 5 Hz) than controls (p<0.05). Smokers had significantly (p<0.05) lower peak oxygen uptake (78±40 versus 107±45% predicted) and ventilation (61±26 versus 97±29 L·min(-1)). Exercise ventilatory requirements, operating lung volumes and cardio-circulatory responses were similar. However, submaximal dyspnoea ratings, resistive and total work of breathing were increased in smokers compared with controls (p<0.05); diaphragmatic effort (transdiaphragmatic pressure/maximumal transdiaphragmatic pressure) and fractional inspiratory neural drive to the diaphragm (EMGdi/maximal EMGdi) were also increased (p<0.05) mainly reflecting the reduced denominator.Symptomatic smokers at risk for COPD had greater exertional dyspnoea and lower exercise tolerance compared with healthy controls in association with greater airways resistance, contractile diaphragmatic effort and fractional inspiratory neural drive to the diaphragm. PMID:27492828

  10. Symptomatic therapy and neurorehabilitation in multiple sclerosis.

    PubMed

    Kesselring, Jürg; Beer, Serafin

    2005-10-01

    Multiple sclerosis (MS) is associated with a variety of symptoms and functional deficits that result in a range of progressive impairments and handicap. Symptoms that contribute to loss of independence and restrictions in social activities lead to continuing decline in quality of life. Our aim is to give an updated overview on the management of symptoms and rehabilitation measures in MS. Appropriate use of these treatment options might help to reduce long-term consequences of MS in daily life. First, we review treatment of the main symptoms of MS: fatigue, bladder and bowel disturbances, sexual dysfunction, cognitive and affective disorders, and spasticity. Even though these symptomatic therapies have benefits, their use is limited by possible side-effects. Moreover, many common disabling symptoms, such as weakness, are not amenable to drug treatment. However, neurorehabilitation has been shown to ease the burden of these symptoms by improving self-performance and independence. Second, we discuss comprehensive multidisciplinary rehabilitation and specific treatment options. Even though rehabilitation has no direct influence on disease progression, studies to date have shown that this type of intervention improves personal activities and ability to participate in social activities, thereby improving quality of life. Treatment should be adapted depending on: the individual patient's needs, demands of their surrounding environment, type and degree of disability, and treatment goals. Improvement commonly persists for several months beyond the treatment period, mostly as a result of reconditioning and adaptation and appropriate use of medical and social support at home. These findings suggest that quality of life is determined by disability and handicap more than by functional deficits and disease progression. PMID:16168933

  11. Importance of nutritional status in recovery from acute cholecystitis: benefit from enteral nutrition supplementation including medium chain triglycerides.

    PubMed

    Nomura, Yukinobu; Inui, Kazuo; Yoshino, Junji; Wakabayashi, Takao; Okushima, Kazumu; Kobayashi, Takashi; Miyoshi, Hironao; Nakamura, Yuta

    2007-09-01

    This study was undertaken to clarify the importance of nutritional status in patients with acute cholecystitis, and also evaluate whether they benefited from enteral nutrition supplementation, including medium-chain triglycerides (MCT), during the convalescent stage. Patients with acute cholecystitis admitted to our hospital between April 1994 and March 2002 were classified into a poor nutrition group (n=40; total serum protein<5.0 g/dl) or a fair nutrition group (n=71; >5.0 g/dl). Patients with poor nutrition were significantly more elderly than those with fair nutrition, and had significantly higher serum C-reactive protein (CRP) concentrations. The two groups did not differ significantly with respect to other laboratory data, gender distribution, or medical treatment. We supplemented ordinary meals with enteral nutrition including MCT in 16 patients during the convalescent stage (MCT group). We compared their length of hospital stay and days required to recovery to pre-admission functional status for activities of daily living (ADL) with the same intervals in 16 patients without supplementation (non-MCT group) selected to match for age, gender, and fair or poor nutritional status from among 111 patients. Hospitalizations were significantly longer in the poor nutrition group (43.0+/-2.2 days) than in the fair nutrition group (27.0+/-8.2 days). Significantly more days were required to recover ADL status in the poor nutrition group (12.0+/-7.2 days) than in the fair group (9.4+/-5.2 days). Hospitalizations were significantly shorter in the MCT group (20.1+/-15 days) than in the non-MCT group (35.4+/-12.8 days). Significantly fewer days were required to recover ADL status in the MCT group (10.9+/-7 days) than in the non-MCT group (13.1+/-6.8 days). Administration of enteral nutrition including MCT during convalescence from acute cholecystitis thus appears to promote functional recovery shorten hospital stay.

  12. Fibroblast-loaded cholecyst-derived scaffold induces faster healing of full thickness burn wound in rabbit.

    PubMed

    Revi, Deepa; Geetha, C; Thekkuveettil, Anoopkumar; Anilkumar, Thapasimuthu V

    2016-02-01

    Graft-assisted healing is often proposed for clinical management of large-sized third-degree cutaneous burn wounds. Skin-graft substitutes prepared by loading appropriate cell types on suitable scaffolds have been found successful. We have previously shown that cholecyst-derived scaffold prepared by a non-detergent/enzymatic method can be used as skin-graft substitute for promoting healing of full thickness excision wounds in rabbit. This article examines the use of this scaffold for preparing bio-artificial grafts by loading homologous fibroblasts. The healing potential was evaluated in a rabbit model of full thickness skin-burn wound. The healing process was evaluated by gross morphology evaluation and histomorphology evaluation at 7, 14 and 28 days of healing. Ex vivo imaging of the wounded tissue was performed and it was found that the loaded fibroblasts remained viable at least for 14 days in the healing wound. By the first week, re-epithelialisation was evident in all animals treated with the cell-loaded graft. Histomorphological wound healing parameters such as the quickness of re-epithelialisation, the nature of collagen deposition and the extent of neo-vascularisation indicated that cell-loaded grafts promoted faster healing of the wounds. Results of immunohistochemistry indicated a parallel change in the number of proliferating cells and myofibroblast in the healing tissue. Although the pathophysiology of the healing reaction was not established, the observations suggested that homologus fibroblast-loaded cholecyst-derived scaffold promoted faster healing of third-degree wounds in rabbit model by modulating myofibroblast response. It was concluded that cholecyst-derived scaffold prepared by the non-detergent/enzymatic method is a potential scaffold for fabricating bioartificial skin grafts. PMID:26589297

  13. Laparoscopic evacuation of a subcapsular renal hematoma causing symptomatic hypertension.

    PubMed

    Graham, C W; Lynch, S C; Muskat, P C; Mokulis, J A

    1998-12-01

    We report the case of a subcapsular hematoma following extracorporeal shockwave lithotripsy which presented as symptomatic hypertension. When medical therapy proved ineffective, laparoscopic decompression of the hematoma corrected the hypertension.

  14. Symptomatic Pericardial Effusion After Chemoradiation Therapy in Esophageal Cancer Patients

    SciTech Connect

    Fukada, Junichi; Shigematsu, Naoyuki; Takeuchi, Hiroya; Ohashi, Toshio; Saikawa, Yoshiro; Takaishi, Hiromasa; Hanada, Takashi; Shiraishi, Yutaka; Kitagawa, Yuko; Fukuda, Keiichi

    2013-11-01

    Purpose: We investigated clinical and treatment-related factors as predictors of symptomatic pericardial effusion in esophageal cancer patients after concurrent chemoradiation therapy. Methods and Materials: We reviewed 214 consecutive primary esophageal cancer patients treated with concurrent chemoradiation therapy between 2001 and 2010 in our institute. Pericardial effusion was detected on follow-up computed tomography. Symptomatic effusion was defined as effusion ≥grade 3 according to Common Terminology Criteria for Adverse Events v4.0 criteria. Percent volume irradiated with 5 to 65 Gy (V5-V65) and mean dose to the pericardium were evaluated employing dose-volume histograms. To evaluate dosimetry for patients treated with two-dimensional planning in the earlier period (2001-2005), computed tomography data at diagnosis were transferred to a treatment planning system to reconstruct three-dimensional plans without modification. Optimal dosimetric thresholds for symptomatic pericardial effusion were calculated by receiver operating characteristic curves. Associating clinical and treatment-related risk factors for symptomatic pericardial effusion were detected by univariate and multivariate analyses. Results: The median follow-up was 29 (range, 6-121) months for eligible 167 patients. Symptomatic pericardial effusion was observed in 14 (8.4%) patients. Dosimetric analyses revealed average values of V30 to V45 for the pericardium and mean pericardial doses were significantly higher in patients with symptomatic pericardial effusion than in those with asymptomatic pericardial effusion (P<.05). Pericardial V5 to V55 and mean pericardial doses were significantly higher in patients with symptomatic pericardial effusion than in those without pericardial effusion (P<.001). Mean pericardial doses of 36.5 Gy and V45 of 58% were selected as optimal cutoff values for predicting symptomatic pericardial effusion. Multivariate analysis identified mean pericardial dose as the

  15. Prolonged and symptomatic bradycardia following a single dose of fingolimod.

    PubMed

    Faber, Hans; Fischer, Hans-Jörg; Weber, Frank

    2013-01-01

    Fingolimod-related bradycardia is usually asymptomatic, reaches its nadir within 6 hours post-dose and recovers spontaneously. Here we report the case of a 30-year-old MS patient with vagotonia who developed symptomatic bradycardia with 33 beats per minute at nadir 39 hours after a single dose of fingolimod. Bradycardia was responsive to atropine, but returned within 2 hours. Overall, it took a week until the patient recovered. Extended monitoring is advised in patients with symptomatic bradycardia.

  16. Symptomatic Infundibulopelvic Dysgenesis in an Adolescent

    PubMed Central

    Chalmers, David; Jumper, Brian

    2015-01-01

    Infundibulopelvic dysgenesis is a rare condition characterized by congenital malformation of the pelvicalyceal system. We present the case of an 18-year-old boy with chronic intermittent right flank pain and cystic dilation with parenchymal thinning on ultrasonography. The left kidney was normal. The patient denied dysuria, constipation, and history of UTIs or renal calculi. Cystoscopy with retrograde pyelogram showed marked stenosis of the right pelvicalyceal system and anatomy unfavorable to stenting. The patient's symptoms were unresponsive to conservative management. Reconstruction of the right collecting system was unsuccessful and a simple nephrectomy was performed, which led to complete resolution of his symptoms. PMID:25949844

  17. Epidemiology of Acute Symptomatic Seizures among Adult Medical Admissions

    PubMed Central

    Nwani, Paul Osemeke; Nwosu, Maduaburochukwu Cosmas; Nwosu, Monica Nonyelum

    2016-01-01

    Acute symptomatic seizures are seizures occurring in close temporal relationship with an acute central nervous system (CNS) insult. The objective of the study was to determine the frequency of presentation and etiological risk factors of acute symptomatic seizures among adult medical admissions. It was a two-year retrospective study of the medical files of adults patients admitted with acute symptomatic seizures as the first presenting event. There were 94 cases of acute symptomatic seizures accounting for 5.2% (95% CI: 4.17–6.23) of the 1,802 medical admissions during the period under review. There were 49 (52.1%) males and 45 (47.9%) females aged between 18 years and 84 years. The etiological risk factors of acute symptomatic seizures were infections in 36.2% (n = 34) of cases, stroke in 29.8% (n = 28), metabolic in 12.8% (n = 12), toxic in 10.6% (n = 10), and other causes in 10.6% (n = 10). Infective causes were more among those below fifty years while stroke was more in those aged fifty years and above. CNS infections and stroke were the prominent causes of acute symptomatic seizures. This is an evidence of the “double tragedy” facing developing countries, the unresolved threat of infectious diseases on one hand and the increasing impact of noncommunicable diseases on the other one. PMID:26904280

  18. Does highly symptomatic class membership in the acute phase predict highly symptomatic classification in victims 6 months after traumatic exposure?

    PubMed

    Hansen, Maj; Hyland, Philip; Armour, Cherie

    2016-05-01

    Recently studies have indicated the existence of both posttraumatic stress disorder (PTSD) and acute stress disorder (ASD) subtypes but no studies have investigated their mutual association. Although ASD may not be a precursor of PTSD per se, there are potential benefits associated with early identification of victims at risk of developing PTSD subtypes. The present study investigates ASD and PTSD subtypes using latent class analysis (LCA) following bank robbery (N=371). Moreover, we assessed if highly symptomatic ASD and selected risk factors increased the probability of highly symptomatic PTSD. The results of LCA revealed a three class solution for ASD and a two class solution for PTSD. Negative cognitions about self (OR=1.08), neuroticism (OR=1.09) and membership of the 'High symptomatic ASD' class (OR=20.41) significantly increased the probability of 'symptomatic PTSD' class membership. Future studies are needed to investigate the existence of ASD and PTSD subtypes and their mutual relationship.

  19. [Determination of trace elements in Mongolian medicine Susi-12 curing cholecystitis and gallstone disease by ICP-AES].

    PubMed

    E, Er-Deng-sang; Hang, Gai-ba-te-re; Ba, Tu; Duan, Yi-wen

    2009-04-01

    Trace elements in Mongolian medicine Susi-12 for cholecystitis and gallstones were analyzed in order to discuss the relation between Susi-12's drug action and the trace elements. The analysis was carried out using the pressure seal microwave digestion and inductive coupled plasma atomic emission spectrometry (ICP-AES). It was found that the medicine contained great amount of trace elements, especially human-body-needed trace elements, such as Ca, Al, Mg, Fe, Sr, Mn, Zn, Cu etc., whereas heavy metals are very little, e.g. the contents of Pb, Cb, As etc are below the country's limit. The recoveries of standard addition are in the range of 94.63%-106.40%. The relative standard deviation RSD< or =3.35%, and detection limit is < or =0.009 mg x L(-1). It is concluded that Mongolian medicine Susi-12 can effectively control and cure cholecystitis and gallstones, and the effective rate reaches 91.2% to 100%. So the trace elements in Susi-12 must have a close connection with the drug action. PMID:19626913

  20. [Determination of trace elements in Mongolian medicine Susi-12 curing cholecystitis and gallstone disease by ICP-AES].

    PubMed

    E, Er-Deng-sang; Hang, Gai-ba-te-re; Ba, Tu; Duan, Yi-wen

    2009-04-01

    Trace elements in Mongolian medicine Susi-12 for cholecystitis and gallstones were analyzed in order to discuss the relation between Susi-12's drug action and the trace elements. The analysis was carried out using the pressure seal microwave digestion and inductive coupled plasma atomic emission spectrometry (ICP-AES). It was found that the medicine contained great amount of trace elements, especially human-body-needed trace elements, such as Ca, Al, Mg, Fe, Sr, Mn, Zn, Cu etc., whereas heavy metals are very little, e.g. the contents of Pb, Cb, As etc are below the country's limit. The recoveries of standard addition are in the range of 94.63%-106.40%. The relative standard deviation RSD< or =3.35%, and detection limit is < or =0.009 mg x L(-1). It is concluded that Mongolian medicine Susi-12 can effectively control and cure cholecystitis and gallstones, and the effective rate reaches 91.2% to 100%. So the trace elements in Susi-12 must have a close connection with the drug action.

  1. Feline cholecystitis and acute neutrophilic cholangitis: clinical findings, bacterial isolates and response to treatment in six cases.

    PubMed

    Brain, Philip H; Barrs, Vanessa R; Martin, Patricia; Baral, Randolph; White, Joanna D; Beatty, Julia A

    2006-04-01

    Clinicopathological findings from six cats with confirmed cholecystitis or acute neutrophilic cholangitis are presented. Historical findings included lethargy and anorexia or inappetence of up to five days duration. On physical examination all cats were pyrexic and four out of six were jaundiced and had cranial abdominal pain. Bile samples were obtained by cholecystocentesis at exploratory coeliotomy (two cases) or by percutaneous, ultrasound-guided cholecystocentesis (four cases). Gall bladder rupture and bile peritonitis occurred subsequent to ultrasound-guided cholecystocentesis in one case. The most common bacterial isolate was Escherichia coli (four cases); E coli was isolated alone in two cases, in combination with a Streptococcus species (one case) and in combination with a Clostridium species (one case). Streptococcus species alone was isolated from one case, as was Salmonella enterica serovar Typhimurium. The latter is the first reported case of Salmonella-associated cholecystitis in a cat. Concurrent pancreatic or intestinal disease was detected histologically in three cases. All cases were treated with antimicrobials based on in vitro susceptibility results. Treatment was successful in five cases. One cat with concurrent diffuse epitheliotropic intestinal lymphoma was euthanased. Percutaneous ultrasound-guided cholecystocentesis is an effective, minimally-invasive technique enabling identification of bacterial isolates in cats with inflammatory hepatobiliary disease.

  2. Chronic infections of the spine.

    PubMed

    Bas, Teresa; Bas, Paloma; Blasco, Alejandro; Bas, José Luis

    2013-07-01

    Chronic infections following posterior fusion are relatively uncommon. They develop in a previous asymptomatic patient at a distant time from the surgery. Chronic infections arise from direct inoculation or hematogenous seeding. To eradicate a chronic infection, the pathogens, biofilm, non-viable tissues, adherence on surfaces, and instrumentation must be removed. The appropriate antibiotherapy is used in a short (4 weeks) or long protocol (9 weeks). Some patients may need repeated surgeries (leaving the instrumentation in situ) to avoid progressive deformity or symptomatic pseudoarthrosis in cases of implant removal.

  3. Etiological Misidentification by Routine Biochemical Tests of Bacteremia Caused by Gordonia terrae Infection in the Course of an Episode of Acute Cholecystitis

    PubMed Central

    Gil-Sande, E.; Brun-Otero, M.; Campo-Cerecedo, F.; Esteban, E.; Aguilar, L.; García-de-Lomas, J.

    2006-01-01

    Gordonia terrae has been reported to be a rare cause of bacteremia. We report the first case of bacteremia associated with acute cholecystitis. Commercial biochemical testing was not able to identify the strain at the genus level, classifying it instead as Rhodococcus sp. Definitive identification was obtained by sequencing of the 16S rRNA gene. PMID:16825404

  4. Polarization-phase diagnostics of latent course of cholelithiasis in patients with chronic cholecystitis combined with diabetes mellitus type 2

    NASA Astrophysics Data System (ADS)

    Fediv, O. I.; Ivashchuk, O. I.; Marchuk, Yu. F.; Andriychuk, D. R.

    2012-01-01

    The principles of optical model of human bile polycrystalline structure are described. The three optical levels - isotropic, liquid-crystal and solid-crystal have been proposed. It has been introduced and proposed the scenarios of phase distribution formation in the boundary field of laser radiation, transformed by bile layers. The experimental scheme of direct measurement of coordinate phase distributions has been presented. The results of investigating the interrelation between the values of correlation and fractal parameters are presented. They characterize the coordinate distributions of phase shifts between the orthogonal components of the amplitude in the points of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

  5. Polarization-correlation diagnostics and differentiation of cholelithiasis in patients with chronic cholecystitis combined with diabetes mellitus type 2

    NASA Astrophysics Data System (ADS)

    Marchuk, Yu F.; Fediv, O. I.; Ivashchuk, I. O.; Andriychuk, D. R.

    2012-01-01

    The principles of optical modeling of human bile polycrystalline structure are described. The main types of polycrystalline structures are detailed. It has been proposed and founded the scenarios of formation of bile microscopic images polarization structure in coherent radiation. The results of investigating the interrelation between statistical moments of the 1st-4th order are presented that characterize the coordinate distributions of intensity of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

  6. Polarization-phase diagnostics of latent course of cholelithiasis in patients with chronic cholecystitis combined with diabetes mellitus type 2

    NASA Astrophysics Data System (ADS)

    Fediv, O. I.; Ivashchuk, O. I.; Marchuk, Yu. F.; Andriychuk, D. R.

    2011-09-01

    The principles of optical model of human bile polycrystalline structure are described. The three optical levels - isotropic, liquid-crystal and solid-crystal have been proposed. It has been introduced and proposed the scenarios of phase distribution formation in the boundary field of laser radiation, transformed by bile layers. The experimental scheme of direct measurement of coordinate phase distributions has been presented. The results of investigating the interrelation between the values of correlation and fractal parameters are presented. They characterize the coordinate distributions of phase shifts between the orthogonal components of the amplitude in the points of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

  7. Polarization-correlation diagnostics and differentiation of cholelithiasis in patients with chronic cholecystitis combined with diabetes mellitus type 2

    NASA Astrophysics Data System (ADS)

    Marchuk, Yu F.; Fediv, O. I.; Ivashchuk, I. O.; Andriychuk, D. R.

    2011-09-01

    The principles of optical modeling of human bile polycrystalline structure are described. The main types of polycrystalline structures are detailed. It has been proposed and founded the scenarios of formation of bile microscopic images polarization structure in coherent radiation. The results of investigating the interrelation between statistical moments of the 1st-4th order are presented that characterize the coordinate distributions of intensity of laser images of bile smears of cholelithiasis patients in combination with other pathologies. The diagnostic criteria of the cholelithiasis nascency and its severity degree differentiation are determined.

  8. Diagnosis of symptomatic disc by magnetic resonance imaging: T2-weighted and gadolinium-DTPA-enhanced T1-weighted magnetic resonance imaging.

    PubMed

    Yoshida, Hiroyuki; Fujiwara, Atsushi; Tamai, Kazuya; Kobayashi, Naoki; Saiki, Kazuhiko; Saotome, Koichi

    2002-06-01

    Although radial tear of the annulus fibrosus can be detected on T2-weighted and Gd-DTPA-enhanced magnetic resonance (MR) images, the association between the annular tear on MR images and the symptomatic discs is unclear. The purpose of this study was to investigate the relationship between T2-weighted, gadolinium-DTPA-enhanced MR images and pain response through discography in patients with chronic low back pain. A total of 56 lumbar discs from 23 patients with chronic low back pain (13 to 47 years old) underwent MR imaging (T2-weighted, gadolinium-DTPA-enhanced MR images) followed by provocative discography. The sensitivity, specificity, positive predictive value, and negative predictive value of T2-weighted and gadolinium-DTPA-enhanced MR images in detecting the symptomatic discs were calculated. The sensitivity, specificity, positive predictive value, and negative predictive value of T2-weighted images in detecting the symptomatic disc were 94%, 71%, 59%, and 97%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of gadolinium-DTPA-enhanced images were 71%, 75%, 56%, and 86%, respectively. The high sensitivity and the high negative predictive value of T2-weighted MR imaging in detecting the symptomatic disc indicated that MR imaging can be a useful screening tool in avoiding unnecessary discography in patients with chronic low back pain.

  9. Laparoscopic cholecystectomy for acute cholecystitis: early or delayed?: Evidence from a systematic review of discordant meta-analyses.

    PubMed

    Song, Guo-Min; Bian, Wei; Zeng, Xian-Tao; Zhou, Jian-Guo; Luo, Yong-Qiang; Tian, Xu

    2016-06-01

    The laparoscopic cholecystectomy (LC) is an important approach of treating acute cholecystitis and the timing of performing this given treatment is associated with clinical outcomes. Although several meta-analyses have been done to investigate the optimal timing of implementing this treatment, the conflicting findings from these meta-analyses still confuse decision-making. And thus, we performed this systematic review to assess discordant meta-analyses and generate conclusive findings to facilitate informed decision-making in clinical context eventually. We electronically searched the PubMed, Cochrane Library, and EMBASE to include meta-analysis comparing early (within 7 days of the onset of symptoms) with delayed LC (at least 1 week after initial conservative treatment) for acute cholecystitis through August 2015. Two independent investigators completed all tasks including scanning and appraising eligibility, abstracting essential information using prespecified extraction form, assessing methodological quality using Oxford Levels of Evidence and Assessment of Multiple Systematic Reviews (AMSTAR) tool, and assessing the reporting quality using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), as well as implementing Jadad algorithm in each step for the whole process. A heterogeneity degree of ≤50% is accepted. Seven eligible meta-analyses were included eventually. Only one was Level I of evidence and remaining studies were Level II of evidence. The AMSTAR scores varied from 8 to 11 with a median of 9. The PRISMA scores varied from 19 to 26. The most heterogeneity level fell into the desired criteria. After implementing Jadad algorithm, 2 meta-analyses with more eligible RCTs were selected based on search strategies and implication of selection. The best available evidence indicated a nonsignificant difference in mortality, bile duct injury, bile leakage, overall complications, and conversion to open surgery, but a significant reduction

  10. Symptomatic ecchordosis physaliphora mimicking as an intracranial arachnoid cyst.

    PubMed

    Filis, Andreas; Kalakoti, Piyush; Nanda, Anil

    2016-06-01

    Ecchordosis physaliphora (EP) is a rare, benign tumor derived from the notochordal remnants. Usually slow growing with an indolent course, most cases are incidental findings on autopsy. Limited data exists on symptomatic patients with EP. Diagnosis mainly relies on correlating histopathologic findings confirming the notochordal elements with MRI. We herein present a middle aged woman with symptomatic EP in the pre-pontine cistern that mimicked an arachnoid cyst on preoperative scans. Additionally, we emphasize the pathological and radiological characteristics of EP that could aid in prompt diagnosis of the lesion with emphasis on considering EP as a differential for mass lesions localized in the pre-pontine cistern.

  11. Risperidone in idiopathic and symptomatic dystonia: preliminary experience.

    PubMed

    Grassi, E; Latorraca, S; Piacentini, S; Marini, P; Sorbi, S

    2000-04-01

    Risperidone is a heterocyclic neuroleptic with prominent antiserotoninergic (5HT2) as well as antidopaminergic (D2) activity. We studied the efficacy of risperidone in the treatment of idiopathic and symptomatic dystonias in seven patients using the Fahn and Marsden rating scale for torsion dystonia before and after four weeks of treatment (2-6 mg/day). The twisting and involuntary movements with abnormal postures decreased in all the patients treated, with a statistically significant mean improvement (41%; p = 0.009, CI 95%). Our results suggest that risperidone is useful in idiopathic and symptomatic dystonia. PMID:10938193

  12. Symptomatic hip plica: MR arthrographic and arthroscopic correlation.

    PubMed

    Katz, Lee D; Haims, Andrew; Medvecky, Michael; McCallum, John

    2010-12-01

    Two cases of unilateral hip pain are reported in which MR arthrography demonstrated a prominent band medial to the ligamentum teres, running in the AP direction, consistent with a hip plica. Both patients underwent hip arthroscopy with resection of the band. No labral tear or additional intra-articular pathological features was identified in either case. Both patients became asymptomatic following surgery and have remained such. The pathology report demonstrated the specimens to be a synovial band with fibroconnective tissue. This is the first MR arthrographic report of the identification and resection of a symptomatic hip plica. The symptomatic plica may represent an alternative diagnosis for mechanical hip pain.

  13. Chronic pancreatitis

    MedlinePlus

    Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... abuse over many years. Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. Genetics may be ...

  14. Chronic biliary colic associated with ketamine abuse

    PubMed Central

    Al-Nowfal, Ahmed; Al-Abed, Yahya A

    2016-01-01

    Introduction Biliary colic is a common clinical presentation, with the majority of cases being related to gallstone disease. However, rarely, patients may present with biliary symptoms without evidence of gallbladder stones – referred to as acalculous gallstone disease. This case report details a rare case of chronic biliary colic associated with ketamine abuse. Case presentation A 24-year-old Caucasian female presented to the emergency department with a history of intermittent right upper quadrant pain associated with nausea and malaise. She had experienced bouts of similar symptoms three times a year for the past 4 years. Various investigations had been conducted during her multiple admissions, which showed possible dilatation of the common bile duct, with no evidence of gallstones. Conclusion Patients can present with a dilated common bile duct and an acalculous cholecystitis. This requires considerable investigation, with an emphasis on drug history, especially with the current rise of recreational hallucinogenic drug abuse. PMID:27330331

  15. Low prevalence of Helicobacter pylori among symptomatic children from a hospital in Havana, Cuba.

    PubMed

    Llanes, Rafael; Millán, Leslie M; Escobar, María P; Gala, Angela; Capó, Virginia; Feliciano, Onelkis; Gutiérrez, Oderay; Llop, Alina; Ponce, Félix; Pérez-Pérez, Guillermo I

    2012-06-01

    The aims of this study were to assess the prevalence of Helicobacter pylori infection and to introduce a new algorithm to improve its diagnosis in Cuban symptomatic children. One hundred and thirty-three consecutive children with upper gastrointestinal symptoms were studied. Patients were endoscoped and antral biopsies were obtained for rapid urease test (RUT), culture and histology. Prevalence of H. pylori infection was 30.8%. No statistical differences were found concerning demographic, socio-economic factors or chief clinical complaints, between H. pylori-positive and negative children, except for haematemesis, which was significantly higher in infected children (p = 0.003). Histologically, there was statistical association between moderate chronic gastritis in infected children (p = 0.04). Culture and RUT had the highest specificity and sensitivity, respectively. The prevalence of H. pylori infection in Cuban symptomatic children is similar to the one observed in developed countries. Culture and RUT is a useful combination to diagnose H. pylori infection in paediatric patients.

  16. Draft Genome Sequence of Human-Pathogenic Lactococcus garvieae LG-ilsanpaik-gs201105 That Caused Acute Acalculous Cholecystitis.

    PubMed

    Kim, Ji Hyung; Kang, Do-Hyung; Park, Se Chang

    2015-06-04

    Lactococcus garvieae, which is generally known as a marine and freshwater fish pathogen, is now considered to be an emerging zoonotic pathogen in both human and veterinary medicine. In recent years, we have reported the infection of L. garvieae LG-ilsanpaik-gs201105 in the gallbladder of an old fisherman. In this study, we present the draft genome sequence of L. garvieae LG-ilsanpaik-gs201105, with a total genome size of 1,960,261 bp in 53 contigs and a 38.1% average G+C content. Interestingly, the capsule gene cluster, which was known as one of the crucial virulence factors in L. garvieae, was not detected in our isolate. This is the first genome sequence of human-pathogenic L. garvieae, which caused acute acalculous cholecystitis.

  17. LigaSure Hemorrhoidectomy for Symptomatic Hemorrhoids: First Pediatric Experience.

    PubMed

    Grossmann, Ole; Soccorso, Giampiero; Murthi, Govind

    2015-08-01

    Hemorrhoids are uncommon in children. Third and fourth degree symptomatic hemorrhoids may be surgically excised. We describe the first experience of using LigaSure (Covidien, Mansfield, Massachusetts, United States) to perform hemorrhoidectomies in children. LigaSure hemorrhoidectomy has been well described in adults and is found to be superior in patient tolerance as compared with conventional hemorrhoidectomy.

  18. MicroRNA-155 Mediates Augmented CD40 Expression in Bone Marrow Derived Plasmacytoid Dendritic Cells in Symptomatic Lupus-Prone NZB/W F1 Mice

    PubMed Central

    Yan, Sheng; Yim, Lok Yan; Tam, Rachel Chun Yee; Chan, Albert; Lu, Liwei; Lau, Chak Sing; Chan, Vera Sau-Fong

    2016-01-01

    Systemic lupus erythematosus (SLE) is a chronic multi-organ autoimmune disease characterized by hyperactivated immune responses to self-antigens and persistent systemic inflammation. Previously, we reported abnormalities in circulating and bone marrow (BM)-derived plasmacytoid dendritic cells (pDCs) from SLE patients. Here, we aim to seek for potential regulators that mediate functional aberrations of pDCs in SLE. BM-derived pDCs from NZB/W F1 mice before and after the disease onset were compared for toll-like receptor (TLR) induced responses and microRNA profile changes. While pDCs derived from symptomatic mice were phenotypically comparable to pre-symptomatic ones, functionally they exhibited hypersensitivity to TLR7 but not TLR9 stimulation, as represented by the elevated upregulation of CD40, CD86 and MHC class II molecules upon R837 stimulation. Upregulated induction of miR-155 in symptomatic pDCs following TLR7 stimulation was observed. Transfection of miR-155 mimics in pre-symptomatic pDCs induced an augmented expression of Cd40, which is consistent with the increased CD40 expression in symptomatic pDCs. Overall, our results provide evidence for miR-155-mediated regulation in pDC functional abnormalities in SLE. Findings from this study contribute to a better understanding of SLE pathogenesis and ignite future interests in evaluating the molecular regulation in autoimmunity. PMID:27509492

  19. Responses to novelty and vulnerability to cocaine addiction: contribution of a multi-symptomatic animal model.

    PubMed

    Belin, David; Deroche-Gamonet, Véronique

    2012-11-01

    Epidemiological studies have revealed striking associations between several distinct behavioral/personality traits and drug addiction, with a large emphasis on the sensation-seeking trait and the associated impulsive dimension of personality. However, in human studies, it is difficult to identify whether personality/behavioral traits actually contribute to increased vulnerability to drug addiction or reflect psychobiological adaptations to chronic drug exposure. Here we show how animal models, including the first multi-symptomatic model of addiction in the rat, have contributed to a better understanding of the relationships between different subdimensions of the sensation-seeking trait and different stages of the development of cocaine addiction, from vulnerability to initiation of cocaine self-administration to the transition to compulsive drug intake. We argue that sensation seeking predicts vulnerability to use cocaine, whereas novelty seeking, akin to high impulsivity, predicts instead vulnerability to shift from controlled to compulsive cocaine use, that is, addiction. PMID:23125204

  20. Physician Alerts to Prevent Symptomatic Venous Thromboembolism in Hospitalized Patients

    PubMed Central

    Piazza, Gregory; Rosenbaum, Erin J.; Pendergast, William; Jacobson, Joseph O.; Pendleton, Robert C.; McLaren, Gordon D.; Elliott, C. Gregory; Stevens, Scott M.; Patton, William F.; Dabbagh, Ousama; Paterno, Marilyn D.; Catapane, Elaine; Li, Zhongzhen; Goldhaber, Samuel Z.

    2010-01-01

    Background Venous thromboembolism (VTE) prophylaxis remains underutilized among hospitalized patients. We designed and carried out a large multicenter randomized controlled trial to test the hypothesis that an alert from a hospital staff member to the Attending Physician will reduce the rate of symptomatic VTE among high-risk patients not receiving prophylaxis. Methods and Results We enrolled patients using a validated point score system to detect hospitalized patients at high risk for symptomatic VTE who were not receiving prophylaxis. 2,493 patients (82% on Medical Services) from 25 study sites were randomized to the intervention group (n=1,238), in which the responsible physician was alerted by another hospital staff member, versus the control group (n=1,255), in which no alert was issued. The primary end point was symptomatic, objectively confirmed VTE within 90 days. Patients whose physicians were alerted were more than twice as likely to receive VTE prophylaxis as controls (46.0% versus 20.6%, p<0.0001). The symptomatic VTE rate was lower in the intervention group (2.7% versus 3.4%; hazard ratio, 0.79; 95% confidence interval, 0.50 to 1.25), but the difference did not achieve statistical significance. The rate of major bleeding at 30 days in the alert group was similar to the control group (2.1% versus 2.3%, p=0.68). Conclusions A strategy of direct staff member to physician notification increases prophylaxis utilization and leads toward reducing the rate of symptomatic VTE in hospitalized patients. However, VTE prophylaxis continues to be underutilized even after physician notification, especially among Medical Service patients. PMID:19364975

  1. The ROKS nomogram for predicting a second symptomatic stone episode.

    PubMed

    Rule, Andrew D; Lieske, John C; Li, Xujian; Melton, L Joseph; Krambeck, Amy E; Bergstralh, Eric J

    2014-12-01

    Most patients with first-time kidney stones undergo limited evaluations, and few receive preventive therapy. A prediction tool for the risk of a second kidney stone episode is needed to optimize treatment strategies. We identified adult first-time symptomatic stone formers residing in Olmsted County, Minnesota, from 1984 to 2003 and manually reviewed their linked comprehensive medical records through the Rochester Epidemiology Project. Clinical characteristics in the medical record before or up to 90 days after the first stone episode were evaluated as predictors for symptomatic recurrence. A nomogram was developed from a multivariable model based on these characteristics. There were 2239 first-time adult kidney stone formers with evidence of a passed, obstructing, or infected stone causing pain or gross hematuria. Symptomatic recurrence occurred in 707 of these stone formers through 2012 (recurrence rates at 2, 5, 10, and 15 years were 11%, 20%, 31%, and 39%, respectively). A parsimonious model had the following risk factors for recurrence: younger age, male sex, white race, family history of stones, prior asymptomatic stone on imaging, prior suspected stone episode, gross hematuria, nonobstructing (asymptomatic) stone on imaging, symptomatic renal pelvic or lower-pole stone on imaging, no ureterovesicular junction stone on imaging, and uric acid stone composition. Ten-year recurrence rates varied from 12% to 56% between the first and fifth quintiles of nomogram score. The Recurrence of Kidney Stone nomogram identifies kidney stone formers at greatest risk for a second symptomatic episode. Such individuals may benefit from medical intervention and be good candidates for prevention trials.

  2. Management of Chronic Spinal Cord Dysfunction

    PubMed Central

    Abrams, Gary M.; Ganguly, Karunesh

    2015-01-01

    Purpose of Review: Both acute and chronic spinal cord disorders present multisystem management problems to the clinician. This article highlights key issues associated with chronic spinal cord dysfunction. Recent Findings: Advances in symptomatic management for chronic spinal cord dysfunction include use of botulinum toxin to manage detrusor hyperreflexia, pregabalin for management of neuropathic pain, and intensive locomotor training for improved walking ability in incomplete spinal cord injuries. Summary: The care of spinal cord dysfunction has advanced significantly over the past 2 decades. Management and treatment of neurologic and non-neurologic complications of chronic myelopathies ensure that each patient will be able to maximize their functional independence and quality of life. PMID:25651225

  3. Bacterial flora and the epidemiology of staphylococcus aureus in the nose among patients with symptomatic nasal septal perforations.

    PubMed

    Hulterström, Anna Karin; Sellin, Mats; Monsen, Tor; Widerström, Micael; Gurram, Bharath Kumar; Berggren, Diana

    2016-06-01

    Conclusions Patients with symptomatic perforations of the nasal septum had a high prevalence of S. aureus in the nasal mucosa. Pulsed field gel electrophoresis (PFGE) analysis revealed a high genetic heterogeneity of S. aureus among both patients and controls. This indicates that presence of different strains of S. aureus can maintain a chronic inflammation in symptomatic nasal septal perforations. Objective The purpose of this study was to investigate the microbial flora around nasal septal perforations in patients having severe symptoms regarding bleeding, obstruction, and crustation associated with their perforation. Methods Twenty-five patients with untreated symptomatic nasal septal perforations were included. For culture, swabs around the perforations were collected. Bacteria were identified with standard laboratory techniques including a MALDI-TOF mass spectrometer. Epidemiological analysis was done using PFGE protocols. Bacteriological data were compared with data from a healthy control group. Results Staphylococcus aureus was present in the mucosa surrounding the nasal perforation significantly more often (p < 0.0001) in the patients (88%) compared to a control group (13%). Corynebacterium spp. and Propionibacterium spp. were significantly more frequently identified in the control group. The PFGE analysis of S. aureus strains revealed a high genetic heterogeneity and no specific S. aureus genotypes were associated with septal perforation. PMID:26852671

  4. Episode of Familial Mediterranean Fever-Related Peritonitis in the Second Trimester of Pregnancy Followed by Acute Cholecystitis: Dilemmas and Pitfalls

    PubMed Central

    Kosmidis, Christophoros; Anthimidis, Georgios; Varsamis, Nikolaos; Makedou, Fotini; Georgakoudi, Eleni; Efthimiadis, Christophoros

    2016-01-01

    Patient: Female, 33 Final Diagnosis: Acute cholecystitis after Familial Mediterranean Fever-related peritonitis Symptoms: Acute abdomen • fever Medication: Colchicine Clinical Procedure: Laparoscopic cholecystectomy and adhesiolysis in the second trimester of pregnancy Specialty: Surgery Objective: Rare co-existance of disease or pathology Background: Differential diagnosis of acute abdomen in pregnant patients is one of the greatest challenges for the clinician. Occurrence of Familial Mediterranean Fever (FMF) paroxysm of peritonitis and acute cholecystitis during pregnancy is a unique clinical entity that leads to serious diagnostic and therapeutic dilemmas. Case Report: We present the case of a 33-year-old Armenian patient at 16 weeks’ gestational age with a history of FMF, who was admitted twice within 1 month with acute abdomen. The first episode was attributed to FMF and successfully treated conservatively with colchicine. The second episode was diagnosed as acute cholecystitis and led to emergent laparoscopic cholecystectomy and lysis of peritoneal adhesions from previous FMF attacks. The patient presented an uneventful postoperative clinical course and had a normal delivery of a healthy infant at the 39th week of gestation. Conclusions: Pregnant patients with acute abdomen should be evaluated with open mind. To the best of our knowledge, this is the first published report of the coexistence of 2 different causes of acute abdomen during pregnancy. Meticulous history and thorough physical, laboratory, and radiologic examination are the keys to reach a correct diagnosis. Treatment of pregnant patients with acute abdomen should be individualized. Administration of colchicine should be continued during conception, pregnancy, and lactation in patients with FMF history. Laparoscopic intervention in pregnant patients with surgical abdomen such as acute cholecystitis is the optimal method of treatment. PMID:26907752

  5. [Comparative analysis of application of highly intensive laser irradiation and electrocoagulation during laparoscopic cholecystectomy performed for destructive forms of an acute calculous cholecystitis].

    PubMed

    Nichitayio, M Yu; Bazyak, A M; Klochan, V V; Grusha, P K; Goman, A V

    2015-02-01

    Comparative analysis of results of the laser diode (the wave length 940 nm) and elec- trocoagulation application while performing laparoscopic cholecystectomy was con- ducted. For an acute calculous cholecystitis 52 patients were operated, in whom instead of electrocoagulation the laser was applied, provide for reduction of thermal impact on tissues, the complications absence, reduction of the patients stationary treatment duration postoperatively from (5.2 ± 1.2) to (4.9 ± 0.6) days.

  6. Management of Chronic Urticaria

    PubMed Central

    Grahame, Ann

    1987-01-01

    Effective treatment of chronic urticaria depends on identification of the etiologic factor, if possible, and its subsequent elimination, although symptoms may be suppressed by appropriate medication. The investigation of the patient who presents with chronic urticaria is discussed, with emphasis on the need for a detailed history, meticulous physical examination (including a search for occult infection) and full routine hematologic, biochemical and radiologic monitoring. The author discusses the use of intradermal skin tests, scratch tests for inhalants and the need for skin biopsy and gastro-intestinal tract screening. Dietary treatments reviewed include the elimination diet and the elemental diet, which is used in combination with gradual re-introduction of foods. Symptomatic treatments, including antihistamines, the newer H1-histamine receptor antagonists, used with tricyclic antidepressants and with combination therapy, and systemic corticosteroid therapy are also discussed. PMID:21263827

  7. Symptomatic subserosal gastric lipoma successfully treated with enucleation.

    PubMed

    Krasniqi, Avdyl-Selmon; Hoxha, Faton-Tatil; Bicaj, Besnik-Xhafer; Hashani, Shemsedin-Isuf; Hasimja, Shpresa-Mehmet; Kelmendi, Sadik-Mal; Gashi-Luci, Lumturije-Hasan

    2008-10-14

    Gastric lipomas are rare tumors, accounting for 2%-3% of all benign gastric tumors. They are of submucosal or extremely rare subserosal origin. Although most gastric lipomas are usually detected incidentally, they can cause abdominal pain, dyspeptic disorders, obstruction, invagination, and hemorrhages. Subserosal gastric lipomas are rarely symptomatic. There is no report on treatment of subserosal gastric lipomas in the English literature. We present a case of a 50-year-old male with symptomatic subserosal gastric lipoma which was successfully managed with removal, enucleation of lipoma, explorative gastrotomy and edge resection for histology check of gastric wall. The incidence of gastric lipoma, advanced diagnostic possibilities and their role in treatment modalities are discussed.

  8. [Symptomatic treatments (pain management excluded) for adults in palliative care].

    PubMed

    Laval, Guillemette; Béziaud, Nicolas; Villard, Marie-Laure

    2009-06-20

    Patients with evolutive and terminal desease often present 4 to 5 annoying symptoms, linked to the desease and implying a rigorous assessment as well as a treatment of the cause whenever possible. When all etiologic treatments have been used, the symptomatic treatments often allow to relieve the patient. This demands allying care and medication as well as mastering the available therapeutics so as to adapt the prescriptions at best. The present work essentially approaches the etiologies and symptomatic treatments of nausea and vomiting, hiccup, constipation, bowel obstruction, dyspnoea, congestion and death rattle and neuropsychic disfunctionning, in particular anxiety, depression and delirium. For the situations where the oral, transdermic and intravenous routes become difficult or impossible, medication to be administrated through subcutaneous routes are listed, with prudence, for not regulated. PMID:19642434

  9. Symptomatic atherosclerosis is associated with an altered gut metagenome

    PubMed Central

    Karlsson, Fredrik H.; Fåk, Frida; Nookaew, Intawat; Tremaroli, Valentina; Fagerberg, Björn; Petranovic, Dina; Bäckhed, Fredrik; Nielsen, Jens

    2012-01-01

    Recent findings have implicated the gut microbiota as a contributor of metabolic diseases through the modulation of host metabolism and inflammation. Atherosclerosis is associated with lipid accumulation and inflammation in the arterial wall, and bacteria have been suggested as a causative agent of this disease. Here we use shotgun sequencing of the gut metagenome to demonstrate that the genus Collinsella was enriched in patients with symptomatic atherosclerosis, defined as stenotic atherosclerotic plaques in the carotid artery leading to cerebrovascular events, whereas Roseburia and Eubacterium were enriched in healthy controls. Further characterization of the functional capacity of the metagenomes revealed that patient gut metagenomes were enriched in genes encoding peptidoglycan synthesis and depleted in phytoene dehydrogenase; patients also had reduced serum levels of β-carotene. Our findings suggest that the gut metagenome is associated with the inflammatory status of the host and patients with symptomatic atherosclerosis harbor characteristic changes in the gut metagenome. PMID:23212374

  10. Symptomatic Mullerian Duct Cyst in a Male Infant.

    PubMed

    Chinya, Abhishek; Raj, Prince; Sinha, Shandip Kumar; Sarin, Yogesh Kumar

    2016-01-01

    Symptomatic Mullerian duct cyst is a rare entity in children. A 9-month-old male infant presented with bowel and urinary obstructive symptoms. Imaging investigations revealed a cystic mass in the rectovesical pouch compressing bladder neck and rectum. At laparotomy, a Mullerian duct cyst was found. Most of the cyst was excised and the remaining cyst mucosa was cauterized. The child improved thereafter. PMID:27672581

  11. Symptomatic Mullerian Duct Cyst in a Male Infant

    PubMed Central

    Chinya, Abhishek; Raj, Prince; Sinha, Shandip Kumar

    2016-01-01

    Symptomatic Mullerian duct cyst is a rare entity in children. A 9-month-old male infant presented with bowel and urinary obstructive symptoms. Imaging investigations revealed a cystic mass in the rectovesical pouch compressing bladder neck and rectum. At laparotomy, a Mullerian duct cyst was found. Most of the cyst was excised and the remaining cyst mucosa was cauterized. The child improved thereafter. PMID:27672581

  12. [Symptomatic heterotopic splenic tissue in the adrenal gland area].

    PubMed

    Heider, J; Winter, P; Kreft, B

    1998-05-01

    We report on a 33-year-old man with symptomatic heterotopic suprarenal splenic tissue. Heterotopic splenic tissue can often be found after posttraumatic splenectomy. It is a result of autotransplantation induced by trauma (splenosis). Additionally it can grow during embryogenic development. Such an accessory spleen is found in 10-44% of all autopsies. In this case report the patient was treated by resection due to increasing flank pain and suspected neoplasm.

  13. [Chronic migraine: treatment].

    PubMed

    Pascual, Julio

    2012-04-10

    We define chronic migraine as that clinical situation in which migraine attacks appear 15 or more days per month. Until recently, and in spite of its negative impact, patients with chronic migraine were excluded of the clinical trials. This manuscript revises the current treatment of chronic migraine. The first step should include the avoidance of potential precipitating/aggravating factors for chronic migraine, mainly analgesic overuse and the treatment of comorbid disorders, such as anxiety and depression. The symptomatic treatment should be based on the use of nonsteroidal anti-inflammatory agents and triptans (in this case < 10 days per month). It is necessary to avoid the use of combined analgesics, opioids and ergotamine-containing medications. Preventive treatment includes a 'transitional' treatment with nonsteroidal anti-inflammatory agents or steroids, while preventive treatment exerts its actions. Even though those medications efficacious in episodic migraine prevention are used, the only drugs with demonstrated efficacy in the preventive treatment of chronic migraine are topiramate and pericranial infiltrations of Onabotulinumtoxin A.

  14. Treatment of symptomatic thoracic disc herniations with lateral interbody fusion

    PubMed Central

    Parker, Rhiannon M.

    2015-01-01

    Background Symptomatic thoracic herniated discs have historically been treated using open exposures (i.e., thoracotomy), posing a clinical challenge given the approach related morbidity. Lateral interbody fusion (LIF) is one modern minimally disruptive alternative to thoracotomy. The direct lateral technique for lumbar pathologies has seen a sharp increase in procedural numbers; however application of this technique in thoracic pathologies has not been widely reported. Methods This study presents the results of three cases where LIF was used to treat symptomatic thoracic disc herniations. Indications for surgery included thoracic myelopathy, radiculopathy and discogenic pain. Patients were treated with LIF, without supplemental internal fixation, and followed for 24 months postoperatively. Results: Average length of hospital stay was 5 days. One patient experienced mild persistent neuropathic thoracic pain, which was managed medically. At 3 months postoperative all patients had returned to work and by 12 months all patients were fused. From preoperative to 24-month follow-up there were mean improvements of 83.3% in visual analogue scale (VAS), 75.3% in Oswestry Disability Index (ODI), and 79.2% and 17.4% in SF-36 physical (PCS) and mental component scores (MCS), respectively. Conclusions LIF is a viable minimally invasive alternative to conventional approaches in treating symptomatic thoracic pathology without an access surgeon, rib resection, or lung deflation.

  15. Symptomatic treatment of migraine: from scientific evidence to patient management.

    PubMed

    Manzoni, Gian Camillo; Torelli, P

    2014-05-01

    All migraine patients need symptomatic treatment to stop individual attacks or, at least, significantly relieve pain. When attacks are very frequent (more than 3 days of headache per month on average), they will also need preventive treatment. The first physician the patient must address to for preventive treatment is the general practitioner (GP). If the medication prescribed by the GP is not effective or there is overuse of symptomatic drugs, the patient will have to be referred to a neurologist or a headache clinic. The drugs to be used as symptomatic treatment are triptans and non-steroidal anti-inflammatory drugs. Combination therapy with antiemetics is also important. While specialists will base their therapeutic decisions on guidelines in the literature and on their personal experience, GPs do not yet have any easy-to-use tools to support them. To fill this gap, an algorithm is proposed here that can be easily used by GPs to make decisions during their patients' migraine attacks.

  16. Human giardiasis in Serbia: asymptomatic vs symptomatic infection*

    PubMed Central

    Nikolić, A.; Klun, I.; Bobić, B.; Ivović, V.; Vujanić, M.; Živković, T.; Djurković-Djaković, O.

    2011-01-01

    Despite the public health importance of giardiasis in all of Europe, reliable data on the incidence and prevalence in Western Balkan Countries (Serbia, Bosnia and Herzegovina, Croatia, Montenegro and FYR Macedonia) are scarce, and the relative contribution of waterborne and food-borne, or person-to-person and/or animalto- person, transmission of human giardiasis is not yet clear. To provide baseline data for the estimation of the public health risk caused by Giardia, we here review the information available on the epidemiological characteristics of asymptomatic and symptomatic human infection in Serbia. Although asymptomatic cases of Giardia represent a major proportion of the total cases of infection, high rates of Giardia infection were found in both asymptomatic and symptomatic populations. No waterborne outbreaks of giardiasis have been reported, and it thus seems that giardiasis mostly occurs sporadically in our milieu. Under such circumstances, control measures to reduce the high prevalence of giardiasis in Serbia have focused on person-to-person transmission, encouraging proper hygiene, but for more targeted intervention measures, studies to identify other risk factors for asymptomatic and symptomatic infections are needed. PMID:21678797

  17. Articulated dental cast analysis of asymptomatic and symptomatic populations.

    PubMed

    Cordray, Frank E

    2016-06-30

    Dental instrumentation has long provided insight into the mechanism of musculo-skeletal function of the gnathic system. While large population studies associate dental arch displacement (DAD), especially laterally, with symptoms, mandibular condyle displacement (CD) resulting from DAD has not been targeted as possibly etiologic in the production of common muscle contraction headache (CMCH) and temporo-mandibular dysfunction (TMD). The objective was to evaluate the three-dimensional nature of DAD and CD between the seated condylar position (SCP) and the intercuspal position (ICP) and to compare results derived from large deprogrammed asymptomatic and symptomatic populations. A total of 1 192 sets of dental casts collected from asymptomatic and symptomatic populations were articulated in the SCP. The initial occlusal contact, DAD, and condylar displacement were evaluated for frequency, direction, and magnitude of displacement between the SCP and ICP. The data revealed significant displacement between the SCP and ICP of the condyles (displaced most frequently inferior (down) and posterior (distal)) and substantially increased frequency and magnitude of displacement of the dental arches (with posterior premature occlusal contacts, increased overjet, decreased overbite, midline differences, and occlusal classification changes) in symptomatic subjects. These discrepancies were statistically significant and clinically significant. The data support the concept of increased DAD and CD with dysfunction. Transverse condylar displacement, commonly presenting with dental cross bite, may be associated with CMCH and TMD. Displacement of the mandibular condyle may be an etiologic factor in CMCH and dysfunction of the temporo-mandibular joint.

  18. Articulated dental cast analysis of asymptomatic and symptomatic populations

    PubMed Central

    Cordray, Frank E

    2016-01-01

    Dental instrumentation has long provided insight into the mechanism of musculo-skeletal function of the gnathic system. While large population studies associate dental arch displacement (DAD), especially laterally, with symptoms, mandibular condyle displacement (CD) resulting from DAD has not been targeted as possibly etiologic in the production of common muscle contraction headache (CMCH) and temporo-mandibular dysfunction (TMD). The objective was to evaluate the three-dimensional nature of DAD and CD between the seated condylar position (SCP) and the intercuspal position (ICP) and to compare results derived from large deprogrammed asymptomatic and symptomatic populations. A total of 1 192 sets of dental casts collected from asymptomatic and symptomatic populations were articulated in the SCP. The initial occlusal contact, DAD, and condylar displacement were evaluated for frequency, direction, and magnitude of displacement between the SCP and ICP. The data revealed significant displacement between the SCP and ICP of the condyles (displaced most frequently inferior (down) and posterior (distal)) and substantially increased frequency and magnitude of displacement of the dental arches (with posterior premature occlusal contacts, increased overjet, decreased overbite, midline differences, and occlusal classification changes) in symptomatic subjects. These discrepancies were statistically significant and clinically significant. The data support the concept of increased DAD and CD with dysfunction. Transverse condylar displacement, commonly presenting with dental cross bite, may be associated with CMCH and TMD. Displacement of the mandibular condyle may be an etiologic factor in CMCH and dysfunction of the temporo-mandibular joint. PMID:27357324

  19. Articulated dental cast analysis of asymptomatic and symptomatic populations.

    PubMed

    Cordray, Frank E

    2016-01-01

    Dental instrumentation has long provided insight into the mechanism of musculo-skeletal function of the gnathic system. While large population studies associate dental arch displacement (DAD), especially laterally, with symptoms, mandibular condyle displacement (CD) resulting from DAD has not been targeted as possibly etiologic in the production of common muscle contraction headache (CMCH) and temporo-mandibular dysfunction (TMD). The objective was to evaluate the three-dimensional nature of DAD and CD between the seated condylar position (SCP) and the intercuspal position (ICP) and to compare results derived from large deprogrammed asymptomatic and symptomatic populations. A total of 1 192 sets of dental casts collected from asymptomatic and symptomatic populations were articulated in the SCP. The initial occlusal contact, DAD, and condylar displacement were evaluated for frequency, direction, and magnitude of displacement between the SCP and ICP. The data revealed significant displacement between the SCP and ICP of the condyles (displaced most frequently inferior (down) and posterior (distal)) and substantially increased frequency and magnitude of displacement of the dental arches (with posterior premature occlusal contacts, increased overjet, decreased overbite, midline differences, and occlusal classification changes) in symptomatic subjects. These discrepancies were statistically significant and clinically significant. The data support the concept of increased DAD and CD with dysfunction. Transverse condylar displacement, commonly presenting with dental cross bite, may be associated with CMCH and TMD. Displacement of the mandibular condyle may be an etiologic factor in CMCH and dysfunction of the temporo-mandibular joint. PMID:27357324

  20. Symptomatic intravenous antipyretic therapy: efficacy of metamizol, diclofenac, and propacetamol.

    PubMed

    Oborilová, Andrea; Mayer, Jirí; Pospísil, Zdenek; Korístek, Zdenek

    2002-12-01

    Fever is a common symptom in cancer patients. The most frequent causes of fever are infections, malignancy itself, various medications, transfusions, and allergy. Although it is necessary to treat the cause of fever, if possible, symptomatic fever management is also important. Surprisingly, little attention is paid to this topic in the medical literature, despite the fact that it is a very frequent problem. In order to support symptomatic fever therapy, we wanted to study the patients' discomfort accompanying fever and the beneficial effects of the symptomatic fever management. To the best of our knowledge, there is an absence of studies in this area, despite the fever discomfort can be an important reason for the antipyretic treatment, mainly in cancer patients. In this non-randomized open label pilot study, three intravenous antipyretics were tested in five groups of patients: diclofenac (75 mg, brief intravenous [IV] infusion) vs. metamizol (2500 mg or 1000 mg, brief IV infusion) vs. propacetamol (2000 mg or 1000 mg, slow IV injection or brief IV infusion). The study included 254 febrile episodes mainly in hemato-oncological patients with axillary temperature at least 38 degrees C. The main study endpoints were: changes in axillary temperature, improvement in patient comfort, and number and nature of adverse events. To support justification for symptomatic fever management in febrile patients, we asked the first 45 study subjects to fill in a questionnaire concerning their opinions about fever, fever-associated discomfort, and relief upon antipyretic therapy. All study medications had a significant antipyretic effect. However, metamizol at the dose 2500 mg was considered as the most effective, while propacetamol at the dose 1000 mg showed the lowest antipyretic efficacy. Concerning tolerability and adverse events, there were significant differences among the treatment groups. Diclofenac and metamizol (both 2500 mg and 1000 mg) were tolerated at best. All tested

  1. Fat-reduced diet in the symptomatic treatment of small bowel disease

    PubMed Central

    Andersson, H.; Isaksson, B.; Sjögren, B.

    1974-01-01

    Thirteen patients suffering from Crohn's disease or subjected to small bowel resection were studied under metabolic ward conditions for an average of 32 days. Most of these patients had chronic, severe diarrhoea and varying degrees of steatorrhoea. All were studied at two levels of fat intake, 100 g and 40 g daily. After the introduction of the low-fat diet, there was a marked reduction in the faecal excretion of water and sodium in most patients and 10 of them passed solid faeces. Two other subjects improved only after the addition of cholestyramine. In one patient with an ileostomy, no improvement occurred. On the low-fat diet, there was a positive balance of nitrogen and potassium in many cases. Faecal fat excretion decreased, but there was no change in the fractional absorption of fat. The most gratifying improvement was seen in patients with a functioning gallbladder. Previous resection of the colon seemed to limit the reduction of faecal water and sodium excretion which followed the reduction in fat intake. A fat-reduced diet is recommended in the symptomatic therapy of chronic diarrhoea in patients suffering from diseases of the ileum. PMID:18668843

  2. Regulation of peripheral blood flow in Complex Regional Pain Syndrome: clinical implication for symptomatic relief and pain management

    PubMed Central

    Groeneweg, George; Huygen, Frank JPM; Coderre, Terence J; Zijlstra, Freek J

    2009-01-01

    Background During the chronic stage of Complex Regional Pain Syndrome (CRPS), impaired microcirculation is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Several mechanisms may be responsible for the ischemia and pain in chronic cold CPRS. Discussion The diminished blood flow may be caused by either sympathetic dysfunction, hypersensitivity to circulating catecholamines, or endothelial dysfunction. The pain may be of neuropathic, inflammatory, nociceptive, or functional nature, or of mixed origin. Summary The origin of the pain should be the basis of the symptomatic therapy. Since the difference in temperature between both hands fluctuates over time in cold CRPS, when in doubt, the clinician should prioritize the patient's report of a persistent cold extremity over clinical tests that show no difference. Future research should focus on developing easily applied methods for clinical use to differentiate between central and peripheral blood flow regulation disorders in individual patients. PMID:19775468

  3. Prevalence of Cryptosporidium species among HIV positive asymptomatic and symptomatic immigrant population in Kashmir, India

    PubMed Central

    Masarat, S; Ahmad, F; Chisti, M; Hamid, S; Sofi, B Ahmad

    2012-01-01

    Background and Objectives Cryptosporidiosis has not been reported as an endemic disease in Kashmir, but high prevalence of Cryptosporidium sp. has been found among asymptomatic (non-diarrheic) HIV positive immigrants in present study. Due to increasing number of HIV positive immigrants in Kashmir, Cryptosporidium may become a public health problem in Kashmir. Materials and Methods A total of 45 stool samples were obtained from symptomatic (diarrheic n = 9) and asymptomatic (non-diarrheic n = 36) patients infected with HIV. The stool samples were concentrated using formalin ethyl acetate concentration technique, stained with modified Kinyoun's cold stain and oocysts were identified by microscopy under 1000 x magnification. It was confirmed by detection of antigens in stool samples by ELISA. Results It was established that all the patients studied were carriers of Cryptosporidium. In present study though 80% of patients were asymptomatic (non-diarrheic) and HIV positive which involved non-Kashmiri army personals and travelers (immigrants) but were carriers of Cryptosporidium and 20% of HIV positive patients were emigrants (local Kashmiri traders) who travelled different states of India were having diarrhea (symptomatic) as well as carrier of Cryptosporidium. Conclusion Though Cryptosporidium infection causes chronic diarrhea but in present study all HIV positive patients screened whether diarrheic or non-diarrheic were positive for Cryptosporidium. To prevent the transmission of Cryptosporidium oocyst in environment and endemic spread of cryptosporidiosis as non-diarrheic HIV positive population may be potential source of infection, obligatory laboratory testing for Cryptosporidium in HIV positive immigrant population like traders and travelers is highly recommended in order to have a better understanding of the cause of spread Cryptosporidium infection in Kashmir. PMID:22783459

  4. Chemical cholecystitis associated with hepatic arterial chemotherapy delivered by a permanently implanted pump.

    PubMed

    Marymont, J V; Dakhil, S R; Travers, H; Housholder, D F

    1985-10-01

    The introduction of chemotherapeutic agents directly into the proper hepatic artery via an indwelling catheter results in perfusion of the gallbladder, because the cystic artery is usually a branch of the right hepatic artery. Five gallbladders, removed two to 16 months after insertion of permanently implanted Infusaid model 400 pumps, were examined. All of the gallbladders had significant arteritis, with narrowing or occlusion of lumina or necrosis of vessel walls. Fibrosis of the gallbladder wall was also a constant finding. Nuclear atypia of mucosal epithelium and connective tissue was common. Varying degrees of acute and chronic inflammation were present. These abnormalities may have a radiomimetic and direct irritant pathogenesis.

  5. Symptomatic hemangioma of oral cavity treated with CO2 laser

    NASA Astrophysics Data System (ADS)

    Nicola, Ester M. D.; Coutinho, Adriana A.; Nicola, Jorge H.; Gusmao, Reinaldo J.

    1995-05-01

    The CO2 laser has been used by our group as a secure and efficient tool for the treatment of symptomatic oral cavity hemangiomas which can be responsible for disturbance for swallowing, phonation and in hygienic, besides discomfort and bleeding to patients. During the last four years, twelve patients with symptomatic oral cavity hemangioma were treated at the Laser Unit of our University. The treatment consisted in the application of CO2 laser at medium to low intensity according to characteristics and location of the lesions. For hemangiomas located at sites of easy surgical access such as anterior 1/3 of the tongue, lips, bucal vestibule we use 10 to 37 J/mm2 over the surface of the lesion. When the hemangioma was located at difficult surgical access sites, such as, tonsils, posterior 1/3 of tongue, or at pharyngeal wall we used 3.0 to 4.0 J/mm2 encircling the whole hemangioma. This causes reduction in the size of the lesion throughout sclerosis of nutrition vessels. After this initial procedure we applied 0.8 to 1.0 J/mm2 over the whole extent of the lesion. For both procedures we observed no significant bleeding or inflammatory reaction. The patients referred minimal post-operative discomfort with good cicatricial evolution. The evident reduction in the vascularization and size could be confirmed by photographic documentation. The good results described above, with disappearance of symptoms lead to the conclusion that CO2 laser is an efficient and secure method of treatment for symptomatic hemangioma of the oral cavity.

  6. Treatment of symptomatic macromastia in a breast unit

    PubMed Central

    2010-01-01

    Background Patients suffering from symptomatic macromastia are usually underserved, as they have to put up with very long waiting lists and are usually selected under restrictive criteria. The Oncoplastic Breast Surgery subspeciality requires a cross-specialty training, which is difficult, in particular, for trainees who have a background in general surgery, and not easily available. The introduction of reduction mammaplasty into a Breast Cancer Unit as treatment for symptomatic macromastia could have a synergic effect, making the scarce therapeutic offer at present available to these patients, who are usually treated in Plastic Departments, somewhat larger, and accelerating the uptake of oncoplastic training as a whole and, specifically, the oncoplastic breast conserving procedures based on the reduction mammaplasty techniques such as displacement conservative techniques and onco-therapeutic mammaplasty. This is a retrospective study analyzing the outcome of reduction mammaplasty for symptomatic macromastia in our Breast Cancer Unit. Methods A cohort study of 56 patients who underwent bilateral reduction mammaplasty at our Breast Unit between 2005 and 2009 were evaluated; morbidity and patient satisfaction were considered as end points. Data were collected by reviewing medical records and interviewing patients. Results Eight patients (14.28%) presented complications in the early postoperative period, two of them being reoperated on. The physical symptoms disappeared or significantly improved in 88% of patients and the degree of satisfaction with the care process and with the overall outcome were really high. Conclusion Our experience of the introduction of reduction mammaplasty in our Breast Cancer Unit has given good results, enabling us to learn the use of different reduction mammaplasty techniques using several pedicles which made it posssible to perform oncoplastic breast conserving surgery. In our opinion, this management policy could bring clear advantages

  7. Treatment of symptomatic intraosseous pneumatocyst using intraoperative navigation.

    PubMed

    Formby, Peter M; Kang, Daniel G; Potter, Benjamin K; Forsberg, Jonathan A

    2015-03-01

    Intraosseous pneumatocysts are benign air-containing lesions that are most often found in the spine and pelvis and are nearly always treated nonoperatively. Although rarely clinically symptomatic, studies have shown pneumatocysts to be present in up to 10% of computed tomography (CT) scans of the pelvis and spine. Radiographic characteristics of these lesions include a localized collection of gas with a thin sclerotic rim, no bony destruction, no soft tissue masses, and no medullary abnormalities. Computed tomography is the diagnostic study of choice, with Hounsfield units ranging from -580 to -950, showing a gas-containing lesion. Few studies have described the management of symptomatic pneumatocysts, and all reported cases concern underwater divers, presumably because of greater pressure cycling and barotrauma encountered while underwater diving. The goal of this report is to describe the intraoperative CT-guided navigation and percutaneous injection of calcium sulfate-calcium phosphate composite bone graft substitute material for the treatment of a symptomatic pneumatocyst in the ilium of a Navy dive instructor. The patient reported a 1-year history of increasing buttock pain with increased depth of diving, consistently reproduced by diving past a depth of 20 to 30 feet. To the authors' knowledge, this is the first description in the English literature of the operative treatment of an intraosseous pneumatocyst of the ilium. The use of intraoperative CT guidance permitted accurate percutaneous localization, decompression, and filling of the lesion with synthetic bone graft substitute, with complete early relief of symptoms. At 6-month follow up, the patient had reached diving depths of 170 feet without pain. PMID:25760515

  8. Analysis of the Molecular Evolution of Hepatitis B Virus Genotypes in Symptomatic Acute Infections in Argentina

    PubMed Central

    Rodrigo, María Belén; Mojsiejczuk, Laura Noelia; Torres, Carolina; Sevic, Ina; González López Ledesma, María Mora; Perez, Paula Soledad; Bouzas, María Belén; Galdame, Omar; Marciano, Sebastián; Fainboim, Hugo; Flichman, Diego Martín; Campos, Rodolfo Héctor

    2016-01-01

    Hepatitis B virus (HBV) is a globally distributed human pathogen that leads to both self-limited and chronic infections. At least eight genotypes (A-H) with distinct geographical allocations and phylodynamic behaviors have been described. They differ substantially in many virological and probably some clinical parameters. The aim of this study was to analyze full-length HBV genome sequences from individuals with symptomatic acute HBV infections using phylogenetic and coalescent methods. The phylogenetic analysis resulted in the following subgenotype distribution: F1b (52.7%), A2 (18.2%), F4 (18.2%) and A1, B2, D3 and F2a 1.8% each. These results contrast with those previously reported from chronic infections, where subgenotypes F1b, F4, A2 and genotype D were evenly distributed. This differential distribution might be related to recent internal migrations and/or intrinsic biological features of each viral genotype that could impact on the probability of transmission. The coalescence analysis showed that after a diversification process started in the 80s, the current sequences of subgenotype F1b were grouped in at least four highly supported lineages, whereas subgenotype F4 revealed a more limited diversification pattern with most lineages without offspring in the present. In addition, the genetic characterization of the studied sequences showed that only two of them presented mutations of clinical relevance at S codifyng region and none at the polymerase catalytic domains. Finally, since the acute infections could be an expression of the genotypes currently being transmitted to new hosts, the predominance of subgenotype F1b might have epidemiological, as well as, clinical relevance due to its potential adverse disease outcome among the chronic cases. PMID:27433800

  9. Snapping knee caused by symptomatic fabella in a native knee.

    PubMed

    Hire, Justin M; Oliver, David L; Hubbard, Ryan C; Fontaine, Michelle L; Bojescul, John A

    2014-08-01

    We report a case of a 31-year-old man with a 5-year history of snapping knee syndrome secondary to a single, large symptomatic fabella of the knee. On physical examination, the patient was able to reproduce an audible and palpable snapping with active range of motion. His condition was refractory to physical therapy. He had undergone a prior iliotibial band release at an outside facility. After excision of the fabella, measuring 15 × 8 × 9 mm, the patient's snapping and pain with activity were resolved.

  10. Polyarteritis with symptomatic intracerebral aneurysms at initial presentation.

    PubMed

    Munn, E J; Alloway, J A; Diffin, D C; Arroyo, R A

    1998-10-01

    Polyarteritis rarely involves the cerebral vasculature, and has not been reported to have an initial presentation with intracerebral aneurysms. We describe the first case of polyarteritis presenting with symptomatic intracerebral aneurysms. A literature review from 1966 to 1997 identified 5 additional cases with evidence of intracerebral aneurysms and polyarteritis. The cases reviewed all had evidence of longstanding systemic symptoms suggestive of polyarteritis prior to diagnosis. Polyarteritis with intracerebral aneurysms is associated with significant morbidity and mortality, and therefore must be recognized and treated early.

  11. Symptomatic stenosis of left subclavian artery from Kommerell's diverticulum.

    PubMed

    Batheeb, Nabil A; Habbab, Louay M; Qattan, Nabil M

    2015-11-01

    Patients with a right aortic arch frequently develop an aneurysm at the origin of the left subclavian artery, called Kommerell's diverticulum; it is a remnant of the left fourth aortic arch. These variants may occur in combination with congenital heart defects or they may be isolated. We report an extremely rare case of symptomatic stenotic origin of an aberrant left subclavian artery arising from a Kommerell's diverticulum in a 39-year-old man with right-sided aortic arch who had left upper limb pain and numbness on exercise. He was successfully treated by percutaneous angioplasty and primary stent implantation.

  12. Primary symptomatic adrenal insufficiency induced by megestrol acetate.

    PubMed

    Delitala, A P; Fanciulli, G; Maioli, M; Piga, G; Delitala, G

    2013-01-01

    Megestrol acetate (MA) is a progestational agent for the treatment of metastatic breast cancer and endometrial cancer. MA has also been used to promote weight gain in malnourished elderly patients, in patients with immunodeficiency virus and in cancer-induced cachexia. In addition to thromboembolic disease, MA may induce hyperglycaemia, osteoporosis, suppression of the gonadal axis, and Cushing's syndrome. MA has also been shown to cause symptomatic suppression of the hypothalamic-pituitary-adrenal (HPA) axis owing to its intrinsic glucocorticoid-like effect. Three additional patients are presented who developed symptomatic adrenal insufficiency while they were receiving 160-320 mg MA daily. The patients were treated with cortisone acetate supplements, had clear evidence of HPA-axis suppression but recovered fully after MA was discontinued. Patients receiving MA might have an inadequate adrenal response during stressful conditions, possibly because 160-320 mg MA daily may not provide adequate protection to prevent the symptoms of adrenal insufficiency. The adverse MA effect on the HPA axis is probably not well recognised in clinical practice, and clinicians need an increased awareness of the endocrine complications secondary to MA treatment.

  13. Symptomatic hyponatremia following lateral medullary infarction: a case report

    PubMed Central

    2014-01-01

    Background Hyponatremia has been reported from patients with severe neurological disease, and the syndrome of inappropriate secretion of antidiuretic hormone and cerebral salt wasting syndrome are the two main etiologies of hyponatremia after brain injury. Here we describe a patient with a lateral medullary infarction who experienced symptomatic hyponatremia with finding suggestive of syndrome of inappropriate secretion of antidiuretic hormone followed by cerebral salt wasting syndrome. Case presentation A 70-year-old Korean man visited emergency room complaining of sudden onset vertigo and gait disturbance. Neurological exam showed left side ataxia, Horner syndrome, and right side hypesthesia. Brain magnetic resonance imaging disclosed acute infarction involving left lateral medulla. His neurological status was stabilized, but he began to complain of non-vertiginous dizziness and general weakness five days after admission. Serum sodium level dropped from 131 mEq/mL to 122 mEq/mL with reduced serum osmolarity of 265 mOsm/L. The diagnosis of syndrome of inappropriate secretion of antidiuretic hormone was made and we restricted fluid intake, but his symptoms worsened and his mental status became drowsy. Follow up serum sodium level was 108 mEq/L with volume loss, suggesting cerebral salt wasting syndrome. We treated him with hypertonic saline and his consciousness was recovered. Conclusion This case shows symptomatic hyponatremia after lateral medullary infarction, providing insight about distinct pathogenesis of syndrome of inappropriate secretion of antidiuretic hormone and cerebral salt wasting syndrome. PMID:24886592

  14. Association of MICA and MICB alleles with symptomatic dengue infection.

    PubMed

    García, Gissel; del Puerto, Florencia; Pérez, Ana B; Sierra, Beatriz; Aguirre, Eglys; Kikuchi, Mihoko; Sánchez, Lizet; Hirayama, Kenji; Guzmán, María G

    2011-10-01

    Dengue viruses (DV) are one of the most important arthropod-borne viral diseases in the developing world. DV can cause syndromes that are either self-limiting or severe. Allelic variants of human leukocyte antigen (HLA) genes have been demonstrated to be associated with disease susceptibility. Here we report the association of nonclassical HLA class I MICA-MICB genes with disease outcome during DV infection. A sequencing-based typing method and genotyping of MICA and MICB in a well-characterized group of Cuban individuals with dengue hemorrhagic fever (DHF), dengue fever (DF), or asymptomatic dengue infection (ADI) was performed. Statistical analysis revealed a tendency for MICA*008 and MICB*008 to associate with susceptibility to illness when symptomatic versus asymptomatic cases (odds ratio [OR] = 2.1, p(v) = 0.03, and OR = 10.4, p = 0.0096, respectively) were compared. Surprisingly, a stronger association of both allelic forms was observed for the DF patients compared with the ADI group (MICA*008, OR = 5.2, p = 0.0001; and MICB*008, OR = 13.2, p = 0.0025) rather than the severe cases. Major histocompatibility class I-related gene-related natural killer cells and/or γδ and αβ T-cell activation might regulate the development of symptomatic DF and DHF.

  15. A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK.

    PubMed Central

    Senapati, P. S. P.; Bhattarcharya, D.; Harinath, G.; Ammori, B. J.

    2003-01-01

    BACKGROUND: Recent management guidelines and randomised clinical trials have provided evidence-based guidance to the management of acute biliary pancreatitis and acute cholecystitis. METHODS: A questionnaire was sent to the 1086 members of the Association of Surgeons of Great Britain and Ireland. There were 583 responders (54%). RESULTS: A policy of cholecystectomy during the index admission or within 4 weeks in fit patients recovering from mild acute biliary pancreatitis was adopted by 58% of surgeons, and was significantly associated with an upper gastrointestinal and hepato-pancreato-biliary subspecialty interest and a volume of more than 50 cholecystectomies per annum (OR, 0.43; 95% CI, 0.26-0.72; P = 0.001: and OR, 0.46; 95% CI, 0.29-0.74; P = 0.001, respectively). A policy of urgent cholecystectomy for acute cholecystitis was adopted by 20% of surgeons, and was significantly associated with an upper gastrointestinal/hepato-pancreato-biliary subspecialty interest and the 'routine' adoption of laparoscopic approach to cholecystectomy (OR, 0.34; 95% CI, 0.19-0.60; P < 0.001: and OR, 0.51; 95% CI, 0.3-0.86; P = 0.01, respectively). CONCLUSIONS: The management of cholelithiasis in patients with acute biliary pancreatitis in the UK remains suboptimal. Moreover, only a minority of surgeons offer patients presenting with acute cholecystitis the benefits of early laparoscopic cholecystectomy. The management of acute biliary disease may be improved if these cases were concentrated in the hands of surgeons with upper gastrointestinal/hepato-pancreato-biliary interest and those who perform laparoscopic cholecystectomy regularly. PMID:14594533

  16. The Role of Bone Cement Augmentation in the Treatment of Chronic Symptomatic Osteoporotic Compression Fracture

    PubMed Central

    Kim, Hyeun Sung; Kim, Sung Hoon; Ju, Chang Il; Lee, Sung Myung; Shin, Ho

    2010-01-01

    Objective Bone cement augmentation procedures such as percutaneous vertebroplasty and balloon kyphoplasty have been shown to be effective treatment for acute or subacute osteoporotic vertebral compression fractures. The purpose of this study was to determine the efficacy of bone cement augmentation procedures for long standing osteoporotic vertebral compression fracture with late vertebral collapse and persistent back pain. Methods Among 278 single level osteoporotic vertebral compression fractures that were treated by vertebral augmentation procedures at our institute, 18 consecutive patients were included in this study. Study inclusion was limited to initially, minimal compression fractures, but showing a poor prognosis due to late vertebral collapse, intravertebral vacuum clefts and continuous back pain despite conservative treatment for more than one year. The subjects included three men and 15 women. The mean age was 70.7 with a range from 64 to 85 years of age. After postural reduction for two days, bone cement augmentation procedures following intraoperative pressure reduction were performed. Imaging and clinical findings, including the level of the vertebra involved, vertebral height restoration, injected cement volume, local kyphosis, clinical outcome and complications were analyzed. Results The mean follow-up period after bone cement augmentation procedures was 14.3 months (range 12-27 months). The mean injected cement volume was 4.1 mL (range 2.4-5.9 mL). The unipedicular approach was possible in 15 patients. The mean pain score (visual analogue scale) prior to surgery was 7.1, which decreased to 3.1 at 7 days after the procedure. The pain relief was maintained at the final follow up. The kyphotic angle improved significantly from 21.2 ± 4.9° before surgery to 10.4 ± 3.8° after surgery. The fraction of vertebral height increased from 30% to 60% after bone cement augmentation, and the restored vertebral height was maintained at the final follow up. There were no serious complications related to cement leakage. Conclusion In the management of even long-standing osteoporotic vertebral compression fracture for over one year, bone cement augmentation procedures following postural reduction were considered safe and effective treatment in cases of non-healing evidence. PMID:21430974

  17. The effect of ‘Candidatus Liberibacter asiaticus’ infection on the proteomic profiles and nutritional status of pre-symptomatic and symptomatic grapefruit (Citrus paradisi) plants

    PubMed Central

    2013-01-01

    Background Huanglongbing (HLB) is a highly destructive citrus disease which threatens citrus production worldwide and ‘Candidatus Liberibacter asiaticus’ (Las), a non-culturable phloem-limited bacterium, is an associated causal agent of the disease. To better understand the physiological and molecular processes involved in host responses to Las, 2-DE and mass spectrometry analyses, as well as ICP spectroscopy analysis were employed to elucidate the global protein expression profiles and nutrient concentrations in leaves of Las-infected grapefruit plants at pre-symptomatic or symptomatic stages for HLB. Results This study identified 123 protein spots out of 191 spots that showed significant changes in the leaves of grapefruit plants in response to Las infection and all identified spots matched to 69 unique proteins/peptides. A down-regulation of 56 proteins including those associated with photosynthesis, protein synthesis, and metabolism was correlated with significant reductions in the concentrations of Ca, Mg, Fe, Zn, Mn, and Cu in leaves of grapefruit plants in response to Las infection, particularly in symptomatic plants. Oxygen-evolving enhancer (OEE) proteins, a PSI 9 kDa protein, and a Btf3-like protein were among a small group of proteins that were down-regulated in both pre-symptomatic and symptomatic plants in response to Las infection. Furthermore, a Las-mediated up-regulation of 13 grapefruit proteins was detected, which included Cu/Zn superoxide dismutase, chitinases, lectin-related proteins, miraculin-like proteins, peroxiredoxins and a CAP 160 protein. Interestingly, a Las-mediated up-regulation of granule-bound starch synthase was correlated with an increase in the K concentrations of pre-symptomatic and symptomatic plants. Conclusions This study constitutes the first attempt to characterize the interrelationships between protein expression and nutritional status of Las-infected pre-symptomatic or symptomatic grapefruit plants and sheds light on

  18. Angioplasty and Stenting of Symptomatic Vertebral Artery Stenosis

    PubMed Central

    Mohammadian, R.; Sharifipour, E.; Mansourizadeh, R.; Sohrabi, B.; Nayebi, A.R; Haririan, S.; Farhoudi, M.; Charsouei, S.; Najmi, S.

    2013-01-01

    Summary Percutaneous transluminal angioplasty (PTA) has recently become a noteworthy treatment option for significant stenosis involving the vertebral artery (VA) in selected patients. We conducted a prospective study to evaluate the efficacy, safety and mid-term follow up results of 206 cases received PTA with or without stent implant to treat their symptomatic atherosclerotic VA stenosis in all segments (V1-V4). In a prospective mono-arm trial from October 2008 to July 2012 in a single center, 239 lesions affecting the intra or extracranial VA (171 in V1, 17 in V2, 14 in V3, 21 in V4 and 16 in combined segments) were treated by PTA with or without stent implant. Non-disabling stroke patients who had failed conservative medical treatment and had angiographic evidence of >50% stenosis in the dominant VA with clinical signs and symptoms of VB stenosis were included in this study. They were mean followed for 13.15±5.24 months after treatment. Overall, 206 patients underwent the procedure. A stent was implemented in 199 patients (96.6%). The periprocedural complication rate was 7.2%. The procedural (technical) success rate was 97.6%. Of the total 239 lesions, 223 were treated with stent implant. Clinical success was achieved in all 206 symptomatic patients after the procedure. Restenosis occurred in 15.9% after a mean 10.8 (6-24) months. Of those, 63.1% and 34.2% had mild and moderate stenosis that was treated medically, whereas one case (2.6%) with severe restenosis underwent balloon angioplasty. No deaths occurred during the follow-up period. The follow-up complication rate was 6.3%. TIA occurred in 4.4%, a minor stroke in 1.4% and a major stroke in one patient. The overall patient event-free survival was 92.4%. These results demonstrate the safety and feasibility of PTA with or without stent implant, with a high technical success rate, a low complication rate, a low restenosis rate and durable clinical success in patients with symptomatic VA stenosis. This

  19. Association between megestrol acetate treatment and symptomatic adrenal insufficiency with hypogonadism in male patients with cancer.

    PubMed

    Dev, Rony; Del Fabbro, Egidio; Bruera, Eduardo

    2007-09-15

    Patients with advanced cancer may develop cachexia, which is often treated with megestrol acetate (MA). In addition to thromboembolic disease, MA may cause symptomatic suppression of the hypothalamic pituitary adrenal axis. In male patients with cancer, treatment with MA may also suppress the gonadal axis, resulting in symptomatic androgen deficiency. Three cases are presented to highlight the symptomatic burden of adrenal insufficiency and hypogonadism. Clinicians need an increased awareness of the complication of adrenal insufficiency secondary to MA treatment and a low threshold to test for adrenal and gonadal dysfunction in symptomatic male patients with advanced cancer.

  20. Probiotics for the Treatment of Symptomatic Uncomplicated Diverticular Disease: Rationale and Current Evidence.

    PubMed

    Scarpignato, Carmelo; Bertelé, Anna; Tursi, Antonio

    2016-10-01

    Changes in the colonic microbiota are critical to the pathogenesis of diverticular complications such as diverticulitis and peridiverticular abscesses. However, more subtle changes in microbiota composition may well be important to the more chronic manifestations of diverticulosis. Some studies have shown the presence of bacterial overgrowth in subgroups of patients with diverticular disease and recent studies, using molecular biology techniques, found an increase of proteobacteria and actinobacteria in patients with symptomatic uncomplicated diverticular disease (SUDD), compared with healthy controls. The use of probiotics to modulate intestinal microecology in SUDD appears therefore rational. Although several investigations evaluating the clinical efficacy of probiotics have been performed, no definitive results have yet been achieved, mainly due to the heterogeneity of the available studies. Most of the studies used probiotics in combination with poorly absorbed antimicrobials or anti-inflammatory drugs. In only 4 studies, there was a harm using probiotics alone, but only 1 was a placebo-controlled, double-blind trial. The analysis of the available evidence reveals a poor quality of the published studies, whose design was heterogeneous, with only 2 out of 11 trials being double-blind and randomized. Therefore, available data can only suggest a benefit of probiotics in SUDD, but do not allow any evidence-based definite conclusion. As a consequence, current guidelines state that there is insufficient evidence to recommend probiotics for symptom relief in patients with diverticular disease. PMID:27622371

  1. Fatty acid amide hydrolase inhibition for the symptomatic relief of Parkinson's disease.

    PubMed

    Celorrio, Marta; Fernández-Suárez, Diana; Rojo-Bustamante, Estefanía; Echeverry-Alzate, Víctor; Ramírez, María J; Hillard, Cecilia J; López-Moreno, José A; Maldonado, Rafael; Oyarzábal, Julen; Franco, Rafael; Aymerich, María S

    2016-10-01

    Elements of the endocannabinoid system are strongly expressed in the basal ganglia where they suffer profound rearrangements after dopamine depletion. Modulation of the levels of the endocannabinoid 2-arachidonoyl-glycerol by inhibiting monoacylglycerol lipase alters glial phenotypes and provides neuroprotection in a mouse model of Parkinson's disease. In this study, we assessed whether inhibiting fatty acid amide hydrolase could also provide beneficial effects on the time course of this disease. The fatty acid amide hydrolase inhibitor, URB597, was administered chronically to mice treated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine and probenecid (MPTPp) over 5weeks. URB597 (1mg/kg) prevented MPTPp induced motor impairment but it did not preserve the dopamine levels in the nigrostriatal pathway or regulate glial cell activation. The symptomatic relief of URB597 was confirmed in haloperidol-induced catalepsy assays, where its anti-cataleptic effects were both blocked by antagonists of the two cannabinoid receptors (CB1 and CB2), and abolished in animals deficient in these receptors. Other fatty acid amide hydrolase inhibitors, JNJ1661010 and TCF2, also had anti-cataleptic properties. Together, these results demonstrate an effect of fatty acid amide hydrolase inhibition on the motor symptoms of Parkinson's disease in two distinct experimental models that is mediated by cannabinoid receptors. PMID:27318096

  2. Association Between Hematological Indices and Coronary Calcification in Symptomatic Patients without History of Coronary Artery Disease

    PubMed Central

    Chaikriangkrai, Kongkiat; Kassi, Mahwash; Alchalabi, Sama; Bala, Sayf Khaleel; Adigun, Rosalyn; Botero, Sharleen; Chang, Su Min

    2014-01-01

    Background: Atherosclerotic coronary artery disease (CAD) has long been shown to involve chronic low-grade subclinical inflammation. However, whether there is association between hematological indices assessed by complete blood count (CBC) and coronary atherosclerotic burden has not been well studied. Materials and Methods: Consecutive 868 patients without known CAD who presented with acute chest pain to emergency department and underwent coronary artery calcium (CAC) scoring evaluation by multi-detector cardiac computed tomography were included in our study. Clinical characteristics and CBC indices were compared among different CAC groups. Results: The cohort comprised 60% male with a mean age of 61 (SD = 14) years. Median Framingham risk of CAD was 4% (range 1-16%). Median CAC score was 0 (IQR 0-43). Higher CAC groups had significantly higher Framingham risk of CAD than lower CAC groups (P < 0.001). Among different CAC categories, there was no statistically significant difference in hemoglobin level (p 0.45), mean corpuscular volume (p 0.43), mean corpuscular hemoglobin (p 0.28), mean corpuscular hemoglobin volume (p 0.36), red cell distribution width (0.42), total white blood cell counts (p 0.291), neutrophil counts (p 0.352), lymphocyte counts (p 0.92), neutrophil to lymphocyte ratio (p 0.68), monocyte count (p 0.48), and platelet counts (p 0.25). Conclusion: Our study did not detect significant association between hematological indices assessed with CBC and coronary calcification in symptomatic patients without known CAD. PMID:25317386

  3. Unusual shunt for symptomatic portal vein thrombosis after liver transplantation - Clatworthy revisited.

    PubMed

    Mali, V P; Robless, P A; Aw, M; Loh, D L; Quak, S H; Prabhakaran, K

    2012-06-01

    PV thrombosis is not an uncommon occurrence following pediatric LT. Symptomatic PHT following PV thrombosis is treated medically, surgical portosystemic shunting (mesorex, splenorenal, and mesocaval) being reserved for refractory cases. A 10-yr-old boy suffered recurrent malena and hemorrhagic shock because of chronic PV thrombosis following LT nine yr ago (1999). Extensive work-up failed to localize the bleeding source. The liver function remained normal. Initial attempts at surgical shunts failed owing to thrombosis (mesocaval 2001, splenorenal, inferior mesenteric-left renal vein, splenic-left external iliac vein 2008). In this situation, we performed a Clatworthy shunt by anastomosing the divided lower end of the LCIV to the side of SMV. There was a single, large caliber anastomosis. Post-operatively, the malena stopped completely, and clinically, there was no lower limb edema or encephalopathy. Doppler USG revealed persistence of hepatopetal flow within the portal collaterals. Follow-up at two yr reveals stable hepatic function with a patent shunt. To the best of our knowledge, we are not aware of a Clatworthy shunt being performed in a transplant setting. We reviewed the literature pertaining to this shunt in non-transplant patients with PHT.

  4. Fatty acid amide hydrolase inhibition for the symptomatic relief of Parkinson's disease.

    PubMed

    Celorrio, Marta; Fernández-Suárez, Diana; Rojo-Bustamante, Estefanía; Echeverry-Alzate, Víctor; Ramírez, María J; Hillard, Cecilia J; López-Moreno, José A; Maldonado, Rafael; Oyarzábal, Julen; Franco, Rafael; Aymerich, María S

    2016-10-01

    Elements of the endocannabinoid system are strongly expressed in the basal ganglia where they suffer profound rearrangements after dopamine depletion. Modulation of the levels of the endocannabinoid 2-arachidonoyl-glycerol by inhibiting monoacylglycerol lipase alters glial phenotypes and provides neuroprotection in a mouse model of Parkinson's disease. In this study, we assessed whether inhibiting fatty acid amide hydrolase could also provide beneficial effects on the time course of this disease. The fatty acid amide hydrolase inhibitor, URB597, was administered chronically to mice treated with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine and probenecid (MPTPp) over 5weeks. URB597 (1mg/kg) prevented MPTPp induced motor impairment but it did not preserve the dopamine levels in the nigrostriatal pathway or regulate glial cell activation. The symptomatic relief of URB597 was confirmed in haloperidol-induced catalepsy assays, where its anti-cataleptic effects were both blocked by antagonists of the two cannabinoid receptors (CB1 and CB2), and abolished in animals deficient in these receptors. Other fatty acid amide hydrolase inhibitors, JNJ1661010 and TCF2, also had anti-cataleptic properties. Together, these results demonstrate an effect of fatty acid amide hydrolase inhibition on the motor symptoms of Parkinson's disease in two distinct experimental models that is mediated by cannabinoid receptors.

  5. Symptomatic sinus bradycardia: A rare adverse effect of intravenous ondansetron

    PubMed Central

    Moazzam, Md Shahnawaz; Nasreen, Farah; Bano, Shahjahan; Amir, Syed Hussain

    2011-01-01

    Ondansetron is a serotonin receptor antagonist which has been used frequently to reduce the incidence of post-operative nausea and vomiting in laparoscopic surgery. It has become very popular drug for the prevention of post-operative nausea and vomiting due to its superiority in-terms of efficacy as well as lack of side effects and drug interactions. Although cardiovascular adverse effects of this drug are rare, we found a case of symptomatic sinus bradycardia in a 43-year-old female patient, going for laparoscopic cholecystectomy, who developed the same after she was given intravenous ondansetron in operation theater during premedication. Hence, we report this case, as the rare possibility of encountering bradycardia effect after intravenous administration of ondansetron should be born in mind. PMID:21655029

  6. Chronic arsenic poisoning.

    PubMed

    Hall, Alan H

    2002-03-10

    Symptomatic arsenic poisoning is not often seen in occupational exposure settings. Attempted homicide and deliberate long-term poisoning have resulted in chronic toxicity. Skin pigmentation changes, palmar and plantar hyperkeratoses, gastrointestinal symptoms, anemia, and liver disease are common. Noncirrhotic portal hypertension with bleeding esophageal varices, splenomegaly, and hypersplenism may occur. A metallic taste, gastrointestinal disturbances, and Mee's lines may be seen. Bone marrow depression is common. 'Blackfoot disease' has been associated with arsenic-contaminated drinking water in Taiwan; Raynaud's phenomenon and acrocyanosis also may occur. Large numbers of persons in areas of India, Pakistan, and several other countries have been chronically poisoned from naturally occurring arsenic in ground water. Toxic delirium and encephalopathy can be present. CCA-treated wood (chromated copper arsenate) is not a health risk unless burned in fireplaces or woodstoves. Peripheral neuropathy may also occur. Workplace exposure or chronic ingestion of arsenic-contaminated water or arsenical medications is associated with development of skin, lung, and other cancers. Treatment may incklude the use of chelating agents such as dimercaprol (BAL), dimercaptosuccinic acid (DMSA), and dimercaptopanesulfonic acid (DMPS).

  7. Approach to chronic cough.

    PubMed

    Lahiri, Keya Rani; Landge, Amruta Avinash

    2014-10-01

    Chronic cough does affect quality of life in children. Most of the times it is treated with over-the-counter cough syrups and antibiotics. The etiology of chronic cough is so diverse, that treatment needs to be directed to the specific etiology, rather than treating symptomatically. Grossly, chronic cough is classified as specific and non-specific cough. Allergic conditions, followed by tuberculosis are more commonly encountered etiologies in India. Baseline investigations to be performed are chest radiograph and peak flow metry. If specific cause of cough is not obvious, then therapeutic trial with β2 agonist, followed by peak flowmetry to evaluate reversibility of airway hypersensitivity, is useful to label the child asthmatic or non-asthmatic. Rampant uses of antibiotics need to be avoided for conditions like asthma. If tuberculosis is diagnosed or suspected, it is better to treat the child, rather than giving therapeutic trial. Over-the-counter cough syrups are as good as placebo, and should be avoided. Trial of anti asthma, anti allergic rhinitis and anti reflux therapies are avoided, unless the diagnosis is one of these conditions. If the child is distressed or the case seems to be complicated, it is best to refer the child to a tertiary care centre and keep a close follow up. PMID:24752628

  8. Incidence of Symptomatic Vertebral Fractures in Patients After Percutaneous Vertebroplasty

    SciTech Connect

    Hierholzer, Johannes Fuchs, Heiko; Westphalen, Kerstin; Baumann, Clemens; Slotosch, Christine; Schulz, Rudolf

    2008-11-15

    The aim of this study was to evaluate the incidence of secondary symptomatic vertebral compression fractures (VCFs) in patients previously treated by percutaneous vertebroplasty (VTP). Three hundred sixteen patients with 486 treated VCFs were included in the study according to the inclusion criteria. Patients were kept in regular follow-up using a standardized questionairre before, 1 day, 7 days, 6 months, and 1 year after, and, further on, on a yearly basis after VTP. The incidence of secondary symptomatic VCF was calculated, and anatomical distribution with respect to previous fractures characterized. Mean follow-up was 8 months (6-56 months) after VTP. Fifty-two of 316 (16.4 %) patients (45 female, 7 male) returned for treatment of 69 secondary VCFs adjacent to (35/69; 51%) or distant from (34/69; 49%) previously treated levels. Adjacent secondary VCF occurred significantly more often compared to distant secondary VCF. Of the total 69 secondary VCFs, 35 of 69 occurred below and 27 of 69 above pretreated VCFs. Of the 65 sandwich levels generated, in 7 of 65 (11%) secondary VCFs were observed. Secondary VCF below pretreated VCF occurred significantly earlier in time compared to VCF above and compared to sandwich body fractures. No major complication occurred during initial or follow-up intervention. We conclude that secondary VCFs do occur in individuals after VTP but the rate found in our study remains below the level expected from epidemiologic studies. Adjacent fractures occur more often and follow the cluster distribution of VCF as expected from the natural history of the underlying osteoporosis. No increased rate of secondary VCF after VTP was observed in this retrospective analysis. In accordance with the pertinent literature, short-term and also midterm clinical results are encouraging and provide further support for the usefulness and the low complication rate of this procedure as an adjunct to the spectrum of pain management in patients with severe

  9. Symptomatic Exposures Among California Inmates 2011-2013.

    PubMed

    Butterfield, Michael; Al-Abri, Suad; Huntington, Serena; Carlson, Terry; Geller, Richard J; Olson, Kent R

    2015-09-01

    Prisoners have a high prevalence of substance misuse and abuse, but few studies have examined symptomatic exposures among incarcerated populations. We sought to further characterize the nature of these exposures among this population using the California Poison Control System data. Keyword searches identified inmate cases in 2011-2013 for patients 20+ years old exposed to a single substance and taken to hospital from jail, prison, or police custody. Comparisons were made with non-inmate cases during the same period, using similar limitations. Body stuffers and body packers were analyzed as a subgroup. Seven hundred four inmate cases were compared to 106,260 non-inmate cases. Inmates were more likely to be younger, male, and to have engaged in drug misuse or abuse. They most commonly ingested methamphetamine, heroin, acetaminophen, and anticonvulsants. Inmates were more likely to receive activated charcoal (OR 9.87, 8.20-11.88), whole bowel irrigation (OR 44.50, 33.83-58.54), undergo endotracheal intubation (OR 4.09, 2.91-5.73), and to experience a major clinical outcome or death (OR 1.41, 1.05-1.89). When body stuffers and packers were removed, clinical findings were similar, though the odds of a major outcome or death became statistically non-significant. Body stuffers and body packers primarily used methamphetamine and heroin, and compared with other inmates had significantly higher odds of both adverse clinical effects and poor outcome. This large series provides a profile of symptomatic exposures among inmates, a little-studied population. The potential for high morbidity among body stuffers and packers suggests that a high index of suspicion of such ingestions be maintained when evaluating patients prior to incarceration.

  10. The role of cumulative physical work load in symptomatic knee osteoarthritis – a case-control study in Germany

    PubMed Central

    Seidler, Andreas; Bolm-Audorff, Ulrich; Abolmaali, Nasreddin; Elsner, Gine

    2008-01-01

    Objectives To examine the dose-response relationship between cumulative exposure to kneeling and squatting as well as to lifting and carrying of loads and symptomatic knee osteoarthritis (OA) in a population-based case-control study. Methods In five orthopedic clinics and five practices we recruited 295 male patients aged 25 to 70 with radiographically confirmed knee osteoarthritis associated with chronic complaints. A total of 327 male control subjects were recruited. Data were gathered in a structured personal interview. To calculate cumulative exposure, the self-reported duration of kneeling and squatting as well as the duration of lifting and carrying of loads were summed up over the entire working life. Results The results of our study support a dose-response relationship between kneeling/squatting and symptomatic knee osteoarthritis. For a cumulative exposure to kneeling and squatting > 10.800 hours, the risk of having radiographically confirmed knee osteoarthritis as measured by the odds ratio (adjusted for age, region, weight, jogging/athletics, and lifting or carrying of loads) is 2.4 (95% CI 1.1–5.0) compared to unexposed subjects. Lifting and carrying of loads is significantly associated with knee osteoarthritis independent of kneeling or similar activities. Conclusion As the knee osteoarthritis risk is strongly elevated in occupations that involve both kneeling/squatting and heavy lifting/carrying, preventive efforts should particularly focus on these "high-risk occupations". PMID:18625053

  11. Significance of preoperative ultrasound measurement of gallbladder wall thickness.

    PubMed

    Majeski, James

    2007-09-01

    Evaluation of patients with signs and symptoms of biliary tract disease usually includes ultrasound assessment of the gallbladder. Does measurement of the thickness of the gallbladder wall yield any significant information to the clinical surgeon? The records of all my patients undergoing cholecystectomy since 1990 were reviewed. The entire series consists of 401 consecutive patients, in whom 388 procedures were completed laparoscopically, with 14 patients requiring conversion to an open cholecystectomy. Each patient's preoperative evaluation included a gallbladder ultrasound, which included measurement of the diameter of the gallbladder wall. The entire series of cholecystectomies was evaluated according to the ultrasound measured diameter of the gallbladder wall. A thin gallbladder wall was less than 3 mm in diameter. A thick gallbladder wall was 3 mm or greater in diameter. Of the 401 consecutive patients who underwent cholecystectomy for symptomatic gallbladder disease, 86 (21.5%) were removed laparoscopically for acalculous disease. Eleven per cent of patients with acalculous cholecystitis had acute cholecystitis and 89 per cent had chronic cholecystitis. Every patient with either a thin or thick gallbladder wall with acalculous cholecystitis had a successful laparoscopic cholecystectomy. Three-hundred fifteen patients had a laparoscopic cholecystectomy for calculous cholecystitis. In patients with calculous cholecystitis, 28.3 per cent had acute cholecystitis and 71.7 per cent had chronic cholecystitis. The gallbladder wall was found to be greater than 3 mm in 38 per cent of patients with acute calculous cholecystitis and greater than 3 mm in 41 per cent of patients with chronic calculous cholecystitis. One-hundred, forty-two patients, out of a series total of 401, had a gallbladder wall thickness greater than 3 mm by preoperative sonography and 14 of these patients (10%) required conversion to an open cholecystectomy. A preoperative gallbladder ultrasound

  12. Chronic coinfections in patients diagnosed with chronic Lyme disease: a systematic literature review

    PubMed Central

    Lantos, Paul M.; Wormser, Gary P.

    2014-01-01

    Purpose The controversial diagnosis of chronic Lyme disease is often given to patients with prolonged, medically unexplained physical symptoms. Many such patients are also treated for chronic co-infections with Babesia, Anaplasma, or Bartonella in the absence of typical presentations, objective clinical findings, or laboratory confirmation of active infection. We have undertaken a systematic review of the literature to evaluate several aspects of this practice. Methods Five systematic literature searches were performed using Boolean operators and the PubMed search engine. Results The literature searches did not demonstrate convincing evidence of 1) chronic anaplasmosis infection, 2) treatment responsive symptomatic chronic babesiosis in immunocompetent persons in the absence of fever, laboratory abnormalities and detectable parasitemia, 3) either geographically widespread or treatment responsive symptomatic chronic infection with Babesia duncani in the absence of fever, laboratory abnormalities and detectable parasitemia, 4) tick-borne transmission of Bartonella species, or 5) simultaneous Lyme disease and Bartonella infection. Conclusions The medical literature does not support the diagnosis of chronic, atypical tick-borne coinfections in patients with chronic, nonspecific illnesses. PMID:24929022

  13. Caspofungin irrigation through percutaneous calicostomy catheter combined with oral flucytosine to treat fluconazole-resistant symptomatic candiduria.

    PubMed

    Garcia, H; Guitard, J; Peltier, J; Tligui, M; Benbouzid, S; Elhaj, S Ait; Rondeau, E; Hennequin, C

    2015-03-01

    Candiduria may be a marker of serious fungal infections such as pyelonephritis. With the exception of fluconazole and flucytosine, antifungals drugs are not excreted into the urine as active drugs, making the management of infection due to fluconazole-resistant Candida difficult. We report a case of recurrent Candida parapsilosis candiduria in a kidney transplant recipient suffering from chronic ureteral obstruction requiring permanent ureteral catheterization (double-J stent). Attempts to remove the stent led to pyelonephritis episodes during which only Candida was isolated from the urine. Following several courses of azole-based therapy, the causative agent became resistant to fluconazole. Clinical and mycological cure were obtained combining irrigations of caspofungin through a percutaneous calicostomy catheter and oral flucytosine. This strategy may represent an interesting therapeutic alternative in case of fluconazole-resistant symptomatic candiduria. PMID:25649231

  14. Histopathological analysis of Salmonella chronic carriage in the mouse hepatopancreatobiliary system.

    PubMed

    Gonzalez-Escobedo, Geoffrey; La Perle, Krista M D; Gunn, John S

    2013-01-01

    Salmonella Typhi asymptomatic chronic carriage represents a challenge for the diagnosis and prevention of typhoid fever in endemic areas. Such carriers are thought to be reservoirs for further spread of the disease. Gallbladder carriage has been demonstrated to be mediated by biofilm formation on gallstones and by intracellular persistence in the gallbladder epithelium of mice. In addition, both gallstones and chronic carriage have been associated with chronic inflammation and the development of gallbladder carcinoma. However, the pathogenic relationship between typhoid carriage and the development of pre-malignant and/or malignant lesions in the hepatopancreatobiliary system as well as the host-pathogen interactions occurring during chronic carriage remains unclear. In this study, we monitored the histopathological features of chronic carriage up to 1 year post-infection. Chronic cholecystitis and hepatitis ranging from mild to severe were present in infected mice regardless of the presence of gallstones. Biliary epithelial hyperplasia was observed more commonly in the gallbladder of mice with gallstones (uninfected or infected). However, pre-malignant lesions, atypical hyperplasia and metaplasia of the gallbladder and exocrine pancreas, respectively, were only associated with chronic Salmonella carriage. This study has implications regarding the role of Salmonella chronic infection and inflammation in the development of pre-malignant lesions in the epithelium of the gallbladder and pancreas that could lead to oncogenesis. PMID:24349565

  15. Recurrence Risk after a First Remote Symptomatic Unprovoked Seizure in Childhood: A Prospective Study

    ERIC Educational Resources Information Center

    Ramos-Lizana, J.; Aguirre-Rodriguez, J.; Aguilera-Lopez, P.; Cassinello-Garcia, E.

    2009-01-01

    The aim of this study was to assess recurrence risk after a first remote symptomatic unprovoked seizure in childhood. All consecutive patients younger than 14 years with a first remote symptomatic unprovoked seizure who were seen at our hospital between 1994 and 2006 were included in the study and prospectively followed. Only two patients received…

  16. Vaginal epithelial cell anti-Candida albicans activity is associated with protection against symptomatic vaginal candidiasis.

    PubMed

    Barousse, Melissa M; Espinosa, Terri; Dunlap, Kathleen; Fidel, Paul L

    2005-11-01

    Vaginal epithelial cell (VEC) anti-Candida albicans activity, despite being measured in vitro, is considered an innate host defense mechanism. This was supported further by the fact that women protected from symptomatic infection following a live intravaginal Candida challenge had increased VEC anti-Candida activity compared to those who acquired a symptomatic infection.

  17. Irritable bowel syndrome: a mild disorder; purely symptomatic treatment.

    PubMed

    2009-04-01

    (1) Patients frequently complain of occasional bowel movement disorders, associated with abdominal pain or discomfort, but they are rarely due to an underlying organ involvement. Even when patients have recurrent symptoms, serious disorders are no more frequent in these patients than in the general population, unless other manifestations, anaemia, or an inflammatory syndrome is also present; (2) There is currently no way of radically modifying the natural course of recurrent irritable bowel syndrome; (3) The effects of antispasmodics on abdominal pain have been tested in about 20 randomised controlled trials. Pinaverium and peppermint essential oil have the best-documented efficacy and only moderate adverse effects. Antispasmodics with marked atropinic effects do not have a favourable risk-benefit balance; (4) Tricylic antidepressants seem to have only modest analgesic effects in this setting. In contrast, their adverse effects are frequent and they have somewhat negative risk-benefit balances. Nor has the efficacy of selective serotonin reuptake inhibitor antidepressants (SSRIs) been demonstrated; (5) Alosetron and tegaserod carry a risk of potentially life-threatening adverse effects and therefore have negative risk-benefit balances; (6) Seeds of plants such as psyllium and ispaghul, as well as raw apples and pears, have a limited impact on constipation and pain. Osmotic laxatives are effective on constipation. Symptomatic treatments for constipation can sometimes aggravate abdominal discomfort; (7) Loperamide has been poorly assessed in patients with recurrent irritable bowel syndrome with diarrhoea. It modestly slows bowel movement but does not relieve pain or abdominal discomfort; (8) Dietary measures have not been tested in comparative trials. Some patients are convinced that certain foods provoke a recurrence of irritable bowel syndrome, but restrictive diets carry a risk of nutritional deficiencies; (9) Various techniques intended to control emotional and

  18. Chronic Bronchitis

    MedlinePlus

    ... chronic. Chronic bronchitis is one type of COPD (chronic obstructive pulmonary disease). The inflamed bronchial tubes produce a lot of mucus. This leads to coughing and difficulty breathing. Cigarette smoking is the most ... diagnose chronic bronchitis, your doctor will look at your signs ...

  19. Risk stratification of patients with acute symptomatic pulmonary embolism.

    PubMed

    Jiménez, David; Lobo, Jose Luis; Barrios, Deisy; Prandoni, Paolo; Yusen, Roger D

    2016-02-01

    Patients with acute symptomatic pulmonary embolism (PE) who present with arterial hypotension or shock have a high risk of death (high-risk PE), and treatment guidelines recommend strong consideration of thrombolysis in this setting. For normotensive patients diagnosed with PE, risk stratification should aim to differentiate the group of patients deemed as having a low risk for early complications (all-cause mortality, recurrent venous thromboembolism, and major bleeding) (low-risk PE) from the group of patients at higher risk for PE-related complications (intermediate-high risk PE), so low-risk patients could undergo consideration of early outpatient treatment of PE and intermediate-high risk patients would undergo close observation and consideration of thrombolysis. Clinicians should also use risk stratification and eligibility criteria to identify a third group of patients that should not undergo escalated or home therapy (intermediate-low risk PE). Such patients should initiate standard therapy of PE while in the hospital. Clinical models [e.g., Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI)] may accurately identify those at low risk of dying shortly after the diagnosis of PE. For identification of intermediate-high risk patients with acute PE, studies have validated predictive models that use a combination of clinical, laboratory and imaging variables. PMID:26768476

  20. Unusual symptomatic inclusion cysts in a newborn: a case report

    PubMed Central

    2014-01-01

    Introduction Dental lamina cysts are cysts that occur as white or pink small nodules, often multiple, approximately 1 to 3mm in diameter. They are typically located on the midpalatine raphe and less frequently on the maxillary and mandibular alveolar mucosa; in the latter case these can be appear to be neonatal teeth. On microscopic examination, these lesions show a stratified squamous epithelium (two to three cell layers); it is possible to find protein, keratin and/or exfoliated epithelial cells in the lumen of the lesions. Neonatal cysts usually show no particular symptoms. They are associated with an excellent prognosis because they regress spontaneously within a few weeks and are not associated to any complications. However, if pain, bleeding or other symptoms occur, a surgical excision is required. Case presentation In this paper, we present an anomalous case of symptomatic dental lamina cyst which affected a 60-day-old male Caucasian newborn. The surgical treatment was elective in this case and 6-month follow-ups were mandatory. Conclusions We can underline the successful predictability of the surgical approach; however, we consider that the treatment choice should take place in the light of medical history and clinical considerations, and always be evaluated on a case-by-case basis. Further studies and reviews in this field should be performed in order to suggest guidelines for clinicians, although these cases are rare. PMID:25241967

  1. Outcome after endoscopically assisted surgical retrieval of symptomatic parotid stones.

    PubMed

    Overton, A; Combes, J; McGurk, M

    2012-02-01

    10% of symptomatic parotid stones cannot be removed by minimally invasive radiological or endoscopic techniques alone. In these cases endoscopically assisted surgical parotid sialolithectomy can be performed via an extraoral approach, reconstituting the duct and preserving functioning glandular tissue. Between 2003 and 2010, 55 consecutive patients underwent endoscopically assisted surgical removal of parotid stones from 57 glands, two having bilateral procedures. Outcome was assessed using a structured questionnaire. 39/55 patients (71%) patients were successfully contacted (40 procedures; one bilateral case). At median follow-up of 3.1 years 28 glands (70%) were symptomless, whilst 11 (28%) were much improved but causing mild or occasional residual symptoms. One patient required postoperative lithotripsy and basket retrieval of a retained stone, but was subsequently symptom free. A further patient was initially symptom free then relapsed, did not respond to lithotripsy and is awaiting further assessment. In 10% of cases a short-lived sialocoele developed postoperatively. No individual reported facial weakness and one had a scar of concern. 37/39 (95%) patients were pleased to have had the operation and would have the procedure contralaterally in similar circumstances. Endoscopically assisted surgical removal of parotid stones is a successful technique with low morbidity that is well received by patients. PMID:22018956

  2. Percutaneous vertebroplasty in symptomatic hemangioma versus osteoporotic compression fracture

    PubMed Central

    Omidi-Kashani, Farzad; Hasankhani, Ebrahim G; Akhlaghi, Saeed; Golhasani-Keshtan, Farideh; Toosi, Katayoun Z

    2013-01-01

    Background: Percutaneous vertebroplasty (PVP) is more commonly used for osteoporotic compression fractures (OCFs) and osteolytic vertebral body tumors. This study aimed to study the differences between OCFs and vertebral hemangiomas (VHs) treated with PVP. Materials and Methods: Between September 2007 and January 2010, we prospectively treated 28 consecutive patients of OCFs (43 recently symptomatic OCFs) and 24 cases of VHs (26 VHs). We used visual analogue scale (VAS) pain and Oswestry Disability Index (ODI) to evaluate the patients. The followup period in group 1 and 2 were 25.1 months (range 12 - 31 months) and 21.3 months (range 14 - 28 months), respectively. Comparison of means was carried out with the Chi Square Tests, t-test, and N Par-Test for multiple comparisons, whenever appropriate. The level of statistical significance was set at P < 0.05. Results: Following PVP the VAS score decreased to 4.57 and 4.17 in group 1 and 2, respectively. The ODI scores were 32.5% and 30%, respectively. This decrease in ODI scores lasted throughout the followup period. Conclusions: Although the preoperative scores were significantly different between group 1 and 2, there was no significant difference between two groups following the PVP. PMID:23798752

  3. [Symptomatic cyst of the pancreas and asymptomatic bilateral phaeochromocytoma

    PubMed

    Karvar, S; Breidert, M; Nagel, M; Kirsch, C; Pinkert, J; Ehninger, G

    2001-01-01

    Symptomatic cyst of the pancreas and asymptomatic bilateral phaeochromocytoma. HISTORY AND CLINICAL FINDINGS: A 39-year-old woman was admitted to our department of gastroenterology with recurrent epigastrical pain. Ten years previously the diagnosis of von Hippel-Lindau (VHL)-syndrome has been established. Two years before a germ line mutation in exon 3 of the VHL-tumour suppressor gene has been detected. The patient has a healthy son with a normal VHL-gene and four healthy siblings who had refused a genetic blood test. INVESTIGATIONS: At abdominal ultrasound at the head of the pancreas three 4 2 cm large cysts and in the region of the left adrenal gland a 2,9 2,7 cm large tumor were visible. MRI of the abdomen revealed in addition a 2,2 1,5 cm large tumour of the right adrenal gland. An asymptomatic biadrenal phaeochromocytoma was detected by elevated urine catecholamines and 123I-MIBG-scintigraphy. TREATMENT AND COURSE: The cysts of the pancreas were punctured under endosonographical control and analysis of the cyst fluid was not suspicious of a malignant cystic tumour. The patient had no further abdominal complaints. After oral treatment with the alpha-blocker phentolamine the biadrenal phaeochromocytoma was treated by retroperitoneal laparoscopic surgery in an organ-sparing fashion. Postoperatively ACTH-stimulating test revealed a normal cortisol response. CONCLUSION: Adrenocortical function can be preserved by la-paroscopic adrenal-sparing surgery in bilateral phaeochromocytoma.

  4. Symptomatic lumbar epidural varices. Report of two cases.

    PubMed

    Zimmerman, G A; Weingarten, K; Lavyne, M H

    1994-05-01

    Lumbar epidural varices have been infrequently described in the literature and rarely accepted as a primary pathophysiological entity. The authors' total experience with symptomatic lumbar epidural varices over the last 15 years includes four cases (incidence 0.067% of all lumbar spine operations), two of which are described in detail in this paper. The mechanism for their formation is proposed: central disc herniations obstruct the anterior epidural venous flow leading to anterolateral caudal venous distention. Subsequent venous endothelial injury predisposes to varying degrees of phlebothrombosis. Decompression of partially thrombosed varices may occur during operative discectomy or spontaneously during regression of the nonoperated disc prolapse. Regression of the central disc herniation may also explain the "disappearing disc" phenomenon, in which patients with clinical and radiographic evidence of apparently large caudal disc herniations exhibit clinical and radiographic resolution. Magnetic resonance (MR) imaging characteristics of the epidural varix depend upon the degree of thrombosis within this anomaly. A thrombosed varix is hyperintense on T1-weighted, proton-density, and T2-weighted images, whereas flowing blood is hypointense. The variable hypo- and hyperintensity on the T2-weighted MR imaging sequences correlate with a partially patent lumen within the varix. PMID:8169634

  5. Brachiocephalic vein bypass with sternal reconstruction for symptomatic occlusion.

    PubMed

    O'Donnell, Mark E; Jaroszewski, Dawn E; Coan, Kathryn; Kazmier, Francis J; Money, Samuel R

    2014-11-01

    Complications attributed to central venous stenosis and subsequent thrombosis are increasing in frequency and are most commonly associated with neointimal fibroplasia as well as neoplastic, fibrotic, and traumatic pathologies. We present the successful venous bypass and thoracic wall reconstruction of a 58-year-old female with chronic atypical symptoms secondary to brachiocephalic vein occlusion from congenital thoracic dystrophy.

  6. Pharmacologic Agents for Chronic Diarrhea.

    PubMed

    Lee, Kwang Jae

    2015-10-01

    Chronic diarrhea is usually associated with a number of non-infectious causes. When definitive treatment is unavailable, symptomatic drug therapy is indicated. Pharmacologic agents for chronic diarrhea include loperamide, 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, diosmectite, cholestyramine, probiotics, antispasmodics, rifaximin, and anti-inflammatory agents. Loperamide, a synthetic opiate agonist, decreases peristaltic activity and inhibits secretion, resulting in the reduction of fluid and electrolyte loss and an increase in stool consistency. Cholestyramine is a bile acid sequestrant that is generally considered as the first-line treatment for bile acid diarrhea. 5-HT3 receptor antagonists have significant benefits in patients with irritable bowel syndrome (IBS) with diarrhea. Ramosetron improves stool consistency as well as global IBS symptoms. Probiotics may have a role in the prevention of antibiotic-associated diarrhea. However, data on the role of probiotics in the treatment of chronic diarrhea are lacking. Diosmectite, an absorbent, can be used for the treatment of chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea. Antispasmodics including alverine citrate, mebeverine, otilonium bromide, and pinaverium bromide are used for relieving diarrheal symptoms and abdominal pain. Rifaximin can be effective for chronic diarrhea associated with IBS and small intestinal bacterial overgrowth. Budesonide is effective in both lymphocytic colitis and collagenous colitis. The efficacy of mesalazine in microscopic colitis is weak or remains uncertain. Considering their mechanisms of action, these agents should be prescribed properly. PMID:26576135

  7. Pharmacologic Agents for Chronic Diarrhea

    PubMed Central

    2015-01-01

    Chronic diarrhea is usually associated with a number of non-infectious causes. When definitive treatment is unavailable, symptomatic drug therapy is indicated. Pharmacologic agents for chronic diarrhea include loperamide, 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, diosmectite, cholestyramine, probiotics, antispasmodics, rifaximin, and anti-inflammatory agents. Loperamide, a synthetic opiate agonist, decreases peristaltic activity and inhibits secretion, resulting in the reduction of fluid and electrolyte loss and an increase in stool consistency. Cholestyramine is a bile acid sequestrant that is generally considered as the first-line treatment for bile acid diarrhea. 5-HT3 receptor antagonists have significant benefits in patients with irritable bowel syndrome (IBS) with diarrhea. Ramosetron improves stool consistency as well as global IBS symptoms. Probiotics may have a role in the prevention of antibiotic-associated diarrhea. However, data on the role of probiotics in the treatment of chronic diarrhea are lacking. Diosmectite, an absorbent, can be used for the treatment of chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea. Antispasmodics including alverine citrate, mebeverine, otilonium bromide, and pinaverium bromide are used for relieving diarrheal symptoms and abdominal pain. Rifaximin can be effective for chronic diarrhea associated with IBS and small intestinal bacterial overgrowth. Budesonide is effective in both lymphocytic colitis and collagenous colitis. The efficacy of mesalazine in microscopic colitis is weak or remains uncertain. Considering their mechanisms of action, these agents should be prescribed properly. PMID:26576135

  8. Pharmacologic Agents for Chronic Diarrhea.

    PubMed

    Lee, Kwang Jae

    2015-10-01

    Chronic diarrhea is usually associated with a number of non-infectious causes. When definitive treatment is unavailable, symptomatic drug therapy is indicated. Pharmacologic agents for chronic diarrhea include loperamide, 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, diosmectite, cholestyramine, probiotics, antispasmodics, rifaximin, and anti-inflammatory agents. Loperamide, a synthetic opiate agonist, decreases peristaltic activity and inhibits secretion, resulting in the reduction of fluid and electrolyte loss and an increase in stool consistency. Cholestyramine is a bile acid sequestrant that is generally considered as the first-line treatment for bile acid diarrhea. 5-HT3 receptor antagonists have significant benefits in patients with irritable bowel syndrome (IBS) with diarrhea. Ramosetron improves stool consistency as well as global IBS symptoms. Probiotics may have a role in the prevention of antibiotic-associated diarrhea. However, data on the role of probiotics in the treatment of chronic diarrhea are lacking. Diosmectite, an absorbent, can be used for the treatment of chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea. Antispasmodics including alverine citrate, mebeverine, otilonium bromide, and pinaverium bromide are used for relieving diarrheal symptoms and abdominal pain. Rifaximin can be effective for chronic diarrhea associated with IBS and small intestinal bacterial overgrowth. Budesonide is effective in both lymphocytic colitis and collagenous colitis. The efficacy of mesalazine in microscopic colitis is weak or remains uncertain. Considering their mechanisms of action, these agents should be prescribed properly.

  9. Chronic Chagas disease: from basics to laboratory medicine.

    PubMed

    Haberland, Annekathrin; Saravia, Silvia Gilka Munoz; Wallukat, Gerd; Ziebig, Reinhard; Schimke, Ingolf

    2013-02-01

    Chagas disease, caused by Trypanosoma cruzi infection, is ranked as the most serious parasitic disease in Latin America and has huge potential to become a worldwide problem, due to increasing migration, and international tourism, as well as infectant transfer by blood contact and transfusion, intrauterine transfer, and organ transplantation. Nearly 30% of chronically-infected patients become symptomatic, often with a latency of 10-30 years, developing life-threatening complications. Of those, nearly 90% develop Chagas heart disease, while the others manifest gastrointestinal disease and neuronal disorders. Besides interrupting the infection cycle and chemo therapeutic infectant elimination, starting therapy early in symptomatic patients is important for counteracting the disease. This would be essentially supported by optimized patient management, involving risk assessment, early diagnosis and monitoring of the disease and its treatment. From economic and logistic viewpoints, the tools of laboratory medicine should be especially able to guarantee this. After summarizing the basics of chronic Chagas disease, such as the epidemiological data, the pathogenetic mechanisms thought to drive symptomatic Chagas disease and also treatment options, we present tools of laboratory medicine that address patient diagnosis, risk assessment for becoming symptomatic and guidance, focusing on autoantibody estimation for risk assessment and heart marker measurement for patient guidance. In addition, increases in levels of inflammation and oxidative stress markers in chronic Chagas disease are discussed.

  10. Symptomatic Atherosclerotic Disease and Decreased Risk of Cancer-Specific Mortality

    PubMed Central

    Benito-León, Julián; de la Aleja, Jesús González; Martínez-Salio, Antonio; Louis, Elan D.; Lichtman, Judith H.; Bermejo-Pareja, Félix

    2015-01-01

    Abstract The few studies that have assessed the association between symptomatic atherosclerotic disease and risk of cancer have had conflicting results. In addition, these studies ascertained participants either from treatment settings (ie, service-based studies) or by using a records linkage system (ie, medical records of patients evaluated at clinics or hospitals) and, therefore, were prone to selection bias. Our purpose was to estimate the risk of cancer mortality in a large population-based sample of elderly people, comparing participants with symptomatic atherosclerotic disease (atherosclerotic stroke and coronary disease) to their counterparts without symptomatic atherosclerotic disease (ie, controls) in the same population. In this population-based, prospective study (Neurological Disorders of Central Spain, NEDICES), 5262 elderly community-dwelling participants with and without symptomatic atherosclerotic disease were identified and followed for a median of 12.1 years, after which the death certificates of those who died were reviewed. A total of 2701 (53.3%) of 5262 participants died, including 314 (68.6%) of 458 participants with symptomatic atherosclerotic disease and 2387 (49.7%) of 4804 controls. Cancer mortality was reported significantly less often in those with symptomatic atherosclerotic disease (15.6%) than in controls (25.6%) (P < 0.001). In an unadjusted Cox model, risk of cancer-specific mortality was decreased in participants with symptomatic atherosclerotic disease (HR = 0.74, 95% confidence interval [CI], 0.55−0.98, P = 0.04) vs. those without symptomatic atherosclerotic disease (reference group). In an adjusted Cox model, HR = 0.58; 95% CI, 0.38−0.89; P = 0.01. This population-based, prospective study suggests that there is an inverse association between symptomatic atherosclerotic disease and risk of cancer mortality. PMID:26266364

  11. Hemoglobin Targets and Blood Transfusions in Hemodialysis Patients without Symptomatic Cardiac Disease Receiving Erythropoietin Therapy

    PubMed Central

    Foley, Robert N.; Curtis, Bryan M.; Parfrey, Patrick S.

    2008-01-01

    Background and objectives: Optimal hemoglobin targets for chronic kidney disease patients receiving erythropoiesis-stimulating agents remain controversial. The effects of different hemoglobin targets on blood transfusion requirements have not been well characterized, despite their relevance to clinical decision-making. Design, setting, participants, & measurements: Five hundred ninety-six incident hemodialysis patients without symptomatic cardiac disease were randomly assigned to hemoglobin targets of 9.5 to 11.5 g/dl or 13.5 to 14.5 g/dl for 96 wk using epoetin alfa as primary therapy and changes in left ventricular structure as the primary outcome (previously reported). Patients were masked to treatment assignment. Blood transfusion data were prospectively collected at 4-wk intervals. Results: The mean age and prior duration of dialysis therapy of the study population were 50.8 and 0.8 yr, respectively. Previously reported mortality was similar in low and high-target subjects, at 4.7 (95% confidence interval 3.0, 7.3) and 3.1 (1.8, 5.4) per hundred patient years, respectively. Transfusion rates were 0.66 (0.59, 0.74) units of blood per year in low and 0.26 (0.22, 0.32) in high-target subjects (P < 0.0001). Hemoglobin level at transfusion (7.7 [7.5, 7.9]) versus 8.1 [7.6, 8.5] g/dl) were similar with both groups. High hemoglobin target was a significant predictor of time to first transfusion independent of baseline associations (hazard ratio = 0.42; 95% confidence interval = 0.26 − 0.67). Conclusions: In hemodialysis patients with comparatively low mortality risks, normal hemoglobin targets may reduce the need for transfusions. PMID:18922988

  12. Prevalence of Symptomatic Lumbar Spondylolysis in Pediatric Patients.

    PubMed

    Nitta, Akihiro; Sakai, Toshinori; Goda, Yuichiro; Takata, Yoichiro; Higashino, Kosaku; Sakamaki, Tadanori; Sairyo, Koichi

    2016-05-01

    Lumbar spondylolysis, a stress fracture of the pars interarticularis, is prevalent in adolescent athletes. Recent advances in diagnostic tools and techniques enable early diagnosis before these fractures progress to complete fractures through the pars. However, because patients often consult family physicians for primary care of low back pain and these physicians may not have access to diagnostic modalities such as magnetic resonance imaging (MRI) and computed tomography, stress fractures can be missed. This study surveyed the prevalence of symptomatic spondylolysis in pediatric patients who consulted an orthopedic clinic for primary care and investigated whether such acute stress fractures may be overlooked without MRI. The prospective study investigated 264 patients who were younger than 19 years and had low back pain. Of the 153 patients (58.0%) with low back pain persisting for longer than 2 weeks, 136 who agreed to undergo MRI were included in the study. This group included 11 elementary school students, 71 junior high school students, and 54 high school students. The overall prevalence of lumbar spondylolysis was 39.7% (54 of 136) and was 9.3% in elementary school students (5 of 11, 45.5%), 59.3% in junior high school students (32 of 71, 45.1%), and 31.5% in high school students (17 of 54, 31.5%). All 54 patients with spondylolysis had a history of athletic activity. Primary care physicians should recognize that approximately 40% of pediatric patients presenting with low back pain persisting for longer than 2 weeks may have spondylolysis and should consider MRI in those with a history of athletic activity. Because the spine is immature in this age group, almost half of affected elementary school and junior high school students may have lumbar spondylolysis. [Orthopedics. 2016; 39(3):e434-e437.]. PMID:27064777

  13. A Review of Symptomatic Lumbosacral Transitional Vertebrae: Bertolotti's Syndrome

    PubMed Central

    Jancuska, Jeffrey M.; Spivak, Jeffrey M.

    2015-01-01

    Background Lumbosacral transitional vertebrae (LSTV) are increasingly recognized as a common anatomical variant associated with altered patterns of degenerative spine changes. This review will focus on the clinical significance of LSTV, disruptions in normal spine biomechanics, imaging techniques, diagnosis, and treatment. Methods A Pubmed search using the specific key words “LSTV,” “lumbosacral transitional vertebrae,” and “Bertolotti's Syndrome” was performed. The resulting group of manuscripts from our search was evaluated. Results LSTV are associated with alterations in biomechanics and anatomy of spinal and paraspinal structures, which have important implications on surgical approaches and techniques. LSTV are often inaccurately detected and classified on standard AP radiographs and MRI. The use of whole-spine images as well as geometric relationships between the sacrum and lumbar vertebra increase accuracy. Uncertainty regarding the cause, clinical significance, and treatment of LSTV persists. Some authors suggest an association between LSTV types II and IV and low back pain. Pseudoarticulation between the transverse process and the sacrum creates a “false joint” susceptible to arthritic changes and osteophyte formation potentially leading to nerve root entrapment. The diagnosis of symptomatic LSTV is considered with appropriate patient history, imaging studies, and diagnostic injections. A positive radionuclide study along with a positive effect from a local injection helps distinguish the transitional vertebra as a significant pain source. Surgical resection is reserved for a subgroup of LSTV patients who fail conservative treatment and whose pain is definitively attributed to the anomalous pseudoarticulation. Conclusions Due to the common finding of low back pain and the wide prevalence of LSTV in the general population, it is essential to differentiate between symptoms originating from an anomalous psuedoarticulation from other potential

  14. Pre-symptomatic diagnosis and treatment of filovirus diseases

    PubMed Central

    Shurtleff, Amy C.; Whitehouse, Chris A.; Ward, Michael D.; Cazares, Lisa H.; Bavari, Sina

    2015-01-01

    Filoviruses are virulent human pathogens which cause severe illness with high case fatality rates and for which there are no available FDA-approved vaccines or therapeutics. Diagnostic tools including antibody- and molecular-based assays, mass spectrometry, and next-generation sequencing are continually under development. Assays using the polymerase chain reaction (PCR) have become the mainstay for the detection of filoviruses in outbreak settings. In many cases, real-time reverse transcriptase-PCR allows for the detection of filoviruses to be carried out with minimal manipulation and equipment and can provide results in less than 2 h. In cases of novel, highly diverse filoviruses, random-primed pyrosequencing approaches have proved useful. Ideally, diagnostic tests would allow for diagnosis of filovirus infection as early as possible after infection, either before symptoms begin, in the event of a known exposure or epidemiologic outbreak, or post-symptomatically. If tests could provide an early definitive diagnosis, then this information may be used to inform the choice of possible therapeutics. Several exciting new candidate therapeutics have been described recently; molecules that have therapeutic activity when administered to animal models of infection several days post-exposure, once signs of disease have begun. The latest data for candidate nucleoside analogs, small interfering RNA (siRNA) molecules, phosphorodiamidate (PMO) molecules, as well as antibody and blood-product therapeutics and therapeutic vaccines are discussed. For filovirus researchers and government agencies interested in making treatments available for a nation’s defense as well as its general public, having the right diagnostic tools to identify filovirus infections, as well as a panel of available therapeutics for treatment when needed, is a high priority. Additional research in both areas is required for ultimate success, but significant progress is being made to reach these goals. PMID

  15. [ROLE OF MICROFLORA OF THE ABDOMINAL CAVITY EXUDATE IN THE ENDOGENIC INTOXICATION OCCURRENCE IN PATIENTS, SUFFERING COMPLICATED ACUTE CHOLECYSTITIS WITH CONCURRENT CARDIAC INSUFFICIENCY OF ISCHEMIC GENESIS].

    PubMed

    Ivantsok, V M

    2015-05-01

    While complicated acute cholecystitis (ACH) course the focus of infection constitutes one of the main causes of the endogenic intoxication (EI) occurrence, what leads to ischemic and hypoxic myocardial damage. There were presented the treatment results analysis in 213 patients, ageing 60 years old and older, managed for an ACH, complicated by peritonitis, paravesical abscess, with concurrent cardiac insufficiency of ischemic genesis, to whom laparoscopic cholecytectomy (LCHE) was conducted. Microflora of the abdominal cavity exudates in the patients, suffering an ACH of various severity, was studied. More rapid regression of inflammatory process, the EI severity and the ischemic-hypoxic myocardial affection reduction, positive impact on hemodynamics, reduction of myocardial ischemia severity were noted while local affection, when bacteriophages for treatment were applied.

  16. Intravascular large B-cell lymphoma manifesting as cholecystitis: report of an Asian variant showing gain of chromosome 18 with concurrent deletion of chromosome 6q.

    PubMed

    Tajima, Shogo; Waki, Michihiko; Yamazaki, Hiroyuki; Nagata, Yasuyuki; Fukano, Hana; Hossen, Md Amir; Hoshi, Shoji; Takeuchi, Takahiro

    2014-01-01

    Intravascular large B-cell lymphoma (IVLBCL), which involves the lumen of small vessels, is a rare variant of extranodal diffuse large B-cell lymphomas. Herein, we present a case of IVLBCL manifesting as cholecystitis in a 77-year-old Japanese man. He presented with fever, fatigue, and weight loss. Physical examination revealed tenderness of the right upper quadrant. The white blood cell count and C-reactive protein levels were elevated. Computed tomography revealed gallbladder thickening and pericholecystic fluid collection; these observations were consistent with the diagnosis of cholecystitis. Serum soluble interleukin-2 receptor levels were highly elevated, and gallium scintigraphy revealed an abnormal accumulation in the spleen, implying lymphoma. Consequently, G-banding analysis of the patient's bone marrow aspirates revealed the presence of different abnormal clones, including those with gain of chromosome 18 and deletion of chromosome 6q. As cholecystectomy was necessary, a concurrent splenectomy was performed to diagnose the disease definitively. Histopathologically, atypical large lymphoid cells were observed to be localized in the vasculature in both the spleen and gallbladder; the atypical cells expressed high levels of CD20, CD5, and CD10, immunohistochemically. These findings were consistent with IVLBCL. The patient underwent post-operative treatment with rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone. However, a pancreatic fistula developed during chemotherapy, causing left pleural effusion and peritoneal effusion; the patient developed sepsis from multidrug-resistant microorganisms, and subsequently died of multi-organ failure 6 months after the diagnosis. No obvious recurrence of the tumor was found during autopsy. We discuss the characteristic karyotype and immunohistochemical status observed in this case. PMID:25550870

  17. Interventions for chronic blepharitis

    PubMed Central

    Lindsley, Kristina; Matsumura, Sueko; Hatef, Elham; Akpek, Esen K

    2012-01-01

    additional studies not identified by the electronic searches. There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 9 February 2012. Selection criteria We included randomized controlled trials (RCTs) and quasi-randomized controlled trials (CCTs) in which participants were adults aged 16 years or older and clinically diagnosed with chronic blepharitis. We also included trials where participants with chronic blepharitis were a subset of the participants included in the study and data were reported separately for these participants. Interventions within the scope of this review included medical treatment and lid hygiene measures. Data collection and analysis Two authors independently assessed search results, reviewed full-text copies for eligibility, examined risk of bias, and extracted data. Data were meta-analyzed for studies comparing similar interventions and reporting comparable outcomes with the same timing. Otherwise, results for included studies were summarized in the text. Main results There were 34 studies (2169 participants with blepharitis) included in this review: 20 studies (14 RCTs and 6 CCTs) included 1661 participants with anterior or mixed blepharitis and 14 studies (12 RCTs and 2 CCTs) included 508 participants with posterior blepharitis (MGD). Due to the heterogeneity of study characteristics among the included studies, with respect to follow-up periods and types of interventions, comparisons, and condition of participants, our ability to perform meta-analyses was limited. Topical antibiotics were shown to provide some symptomatic relief and were effective in eradicating bacteria from the eyelid margin for anterior blepharitis. Lid hygiene may provide symptomatic relief for anterior and posterior blepharitis. The effectiveness of other treatments for blepharitis, such as topical steroids and oral antibiotics, were inconclusive. Authors’ conclusions Despite identifying 34 trials

  18. An update on the management of chronic lumbar discogenic pain.

    PubMed

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2015-09-01

    Lumbar degenerative disc disease without disc herniation, also known as discogenic pain, is an elusive diagnosis of chronic low back pain. Lumbar provocation discography and fusion surgery have been frequently utilized for several decades as the gold standards for the diagnosis and treatment of symptomatic lumbar discogenic pain, though controversial, based on conjecture, rather than evidence. In addition to lumbar fusion, various other operative and nonoperative modalities of treatments are available in managing chronic lumbar discogenic pain. This review provides an updated assessment of the management of chronic lumbar discogenic pain with a critical look at the many modalities of treatments that are currently available. PMID:26255722

  19. Epicardial Automatic Implantable Cardiac Defibrillator In A Child With Symptomatic Bugada Syndrome

    PubMed Central

    Moltedo, Jose M; Abello, Mauricio; Gustavo, Sivori; Javier, Celada; Delucis, Pablo Garcia

    2011-01-01

    An 18 month old 14 kg male with symptomatic Brugada syndrome underwent placement of an epicardial automatic implantable cardiac defibrillator using a single coil transvenous lead sutured to the anterolateral aspect of the left ventricle. PMID:21760684

  20. Antibody isotypes in urethral swabs of symptomatic and asymptomatic men infected with Trichomonas vaginalis.

    PubMed

    Imam, Naglaa F A; Eassa, Ahmed H A; Shoeib, Eman Y S; Abo-Raia, Gamal Y S

    2007-12-01

    Trichomoniasis may be asymptomatic or symptomatic in both sexes. The outcome of infection depends on the virulence factors of T. vaginalis, but these factors remain unclear. Genetic variability of the isolates and the host's immune response are likely to be key factors in that respect. Symptomatic and asymptomatic males infected with T. vaginalis were compared regarding the differences in antibody subclasses response in the urethral samples. In symptomatic cases there was a significant elevation in IgM, IgG1 & IgG2b levels in urethral samples, and a little, non-significant rise in IgG2a levels. However, there were no statistically significant differences between levels of IgA, IgG3 & IgG4. The results showed that specific IgG1 & IgM and to a lesser extent IgG2 may be involved in established symptomatic trichomoniasis in men, compared to asymptomatic ones. PMID:18383797

  1. Cortical dopamine dysfunction in symptomatic and premanifest Huntington's disease gene carriers.

    PubMed

    Pavese, Nicola; Politis, Marios; Tai, Yen F; Barker, Roger A; Tabrizi, Sarah J; Mason, Sarah L; Brooks, David J; Piccini, Paola

    2010-02-01

    We used (11)C-raclopride PET, a marker of D(2) dopamine receptor binding, and statistical parametric mapping (SPM) to localise cortical D(2) receptor dysfunction in individual Huntington's disease (HD) gene carriers (16 symptomatic and 11 premanifest subjects) and assess its clinical significance. 62.5% of symptomatic HD patients and 54.5% of premanifest carriers showed cortical reductions in D(2) binding. The most frequent decreases in cortical binding in individual HD subjects were seen in temporal and frontal areas. Symptomatic HD subjects with decreased cortical D(2) binding had worse scores on neuropsychological tests assessing attention and executive functions than subjects without cortical dopamine dysfunction, notwithstanding comparable reduction in striatal D(2) binding and motor disability. Our results indicate that cortical dopaminergic dysfunction is common in both symptomatic and premanifest HD gene carriers. It is an early event in HD pathophysiology and could contribute to the impairment in neuropsychological performance in these patients.

  2. [Holistic therapy of chronic heart failure].

    PubMed

    Feldmann, C; Ertl, G; Angermann, C E

    2014-06-01

    The rising prevalence and increasing disease-related costs render chronic heart failure a rapidly growing socioeconomic challenge. The concerted action of guideline-adjusted therapy and holistic patient care is essential to achieve improvements in mortality, morbidity, functional status and quality of life of patients with symptomatic heart failure. Holistic care strategies comprise consideration of comorbidities and individual needs, lifestyle recommendations and multidisciplinary management programs for high-risk symptomatic patients in addition to basic medication and surgical therapies. For optimal patient care and coaching, seamless interaction is required between in-hospital treatment and outpatient facilities. Moreover, the palliative needs of heart failure patients need to be considered, a topic that is currently not receiving enough attention.

  3. C-Kit expression in the gallbladder of guinea pig with chronic calculous cholecystitis and the effect of Artemisia capillaris Thunb on interstitial cells of Cajal

    PubMed Central

    Feng, Hua; Wang, Fang; Wang, Changmiao

    2016-01-01

    Objective(s): To study the c-Kit expression in the gallbladder of cholesterol lithogenic guinea pig model and the effect of Artemisia capillaris Thunb on interstitial cells of Cajal (ICCs). Materials and Methods: A total of 45 guinea pigs were randomly assigned into three groups: the control group (guinea pigs fed a standard diet, normal group); the model group (guinea pigs fed a cholesterol gallstone-inducing diet); and the Chinese medicine group (guinea pigs fed the cholesterol gallstone-inducing diet and treated with A. capillaris through intragastric administration, therapy group). Each group had 15 guinea pigs. The gallbladders of the guinea pigs were harvested after 8 weeks. C-Kit expression was detected using an immunohistochemistry staining, real-time PCR, and Western blot analyses. The effect of A. capillaris on ICCs was evaluated by muscle strip contraction experiments. Results: C-Kit expression significantly decreased in the gallbladder of model group, but increased in the Chinese medicine group. The Contractility of guinea pig gallbladder muscle strip significantly improved in the Chinese medicine group. Conclusion: Our results indicated that A. capillaris improves gallbladder impairment by up-regulating c-Kit expression, and it also can improve the contractile response of in vitro guinea pig gallbladder muscle strips.

  4. C-Kit expression in the gallbladder of guinea pig with chronic calculous cholecystitis and the effect of Artemisia capillaris Thunb on interstitial cells of Cajal

    PubMed Central

    Feng, Hua; Wang, Fang; Wang, Changmiao

    2016-01-01

    Objective(s): To study the c-Kit expression in the gallbladder of cholesterol lithogenic guinea pig model and the effect of Artemisia capillaris Thunb on interstitial cells of Cajal (ICCs). Materials and Methods: A total of 45 guinea pigs were randomly assigned into three groups: the control group (guinea pigs fed a standard diet, normal group); the model group (guinea pigs fed a cholesterol gallstone-inducing diet); and the Chinese medicine group (guinea pigs fed the cholesterol gallstone-inducing diet and treated with A. capillaris through intragastric administration, therapy group). Each group had 15 guinea pigs. The gallbladders of the guinea pigs were harvested after 8 weeks. C-Kit expression was detected using an immunohistochemistry staining, real-time PCR, and Western blot analyses. The effect of A. capillaris on ICCs was evaluated by muscle strip contraction experiments. Results: C-Kit expression significantly decreased in the gallbladder of model group, but increased in the Chinese medicine group. The Contractility of guinea pig gallbladder muscle strip significantly improved in the Chinese medicine group. Conclusion: Our results indicated that A. capillaris improves gallbladder impairment by up-regulating c-Kit expression, and it also can improve the contractile response of in vitro guinea pig gallbladder muscle strips. PMID:27635195

  5. The nature of iron deposits differs between symptomatic and asymptomatic carotid atherosclerotic plaques

    SciTech Connect

    Kopriva, David; Kisheev, Anastasye; Meena, Deiter; Pelle, Shaneen; Karnitsky, Max; Lavoie, Andrea; Buttigieg, Josef; Hagemeyer, Christoph E.

    2015-11-25

    Iron within atherosclerotic plaque has been implicated as a catalyst of oxidative stress that causes progression of plaque, and plaque rupture. Iron is believed to accumulate within plaque by incorporation of erythrocytes following plaque rupture and hemorrhage. There is only indirect evidence to support this hypothesis. Plaque specimens were obtained from ten symptomatic and fifteen asymptomatic patients undergoing carotid endarterectomy at a single institution. Plaques were sectioned for study using synchrotron radiation induced X-ray fluorescence the study the distribution of zinc, calcium and iron. Histologic staining was carried out with Prussian Blue, and immunohistochemical staining was done to localize macrophages with CD68. Data were compared against patient clinical variables. Ten symptomatic (15 ± 10 days between index symptoms and surgery) and fifteen asymptomatic carotid plaques were studied. Zinc and calcium co-localized in mineralized areas of symptomatic and asymptomatic plaque. Iron was identified away from zinc and calcium in both symptomatic and asymptomatic plaques. Within the symptomatic plaques, iron was found within the thrombus associated with plaque rupture and hemorrhage. It did not stain with Prussian Blue, but was found in association with CD68 positive macrophages. In symptomatic plaques, the abundance of iron showed an association with the source patient’s LDL cholesterol (R2 = 0.39, Significance F = 0.05). Iron in asymptomatic plaque was present as hemosiderin/ferritin that stained positive with Prussian Blue, and was observed in association with CD68 positive macrophages. Iron in acutely symptomatic plaques is found within thrombus, in the presence of macrophages. Moreover, the abundance of iron in symptomatic plaques is associated with the source patient’s LDL cholesterol. Within asymptomatic plaques, iron is found in association with macrophages, as hemosiderin/ferritin.

  6. The nature of iron deposits differs between symptomatic and asymptomatic carotid atherosclerotic plaques

    DOE PAGES

    Kopriva, David; Kisheev, Anastasye; Meena, Deiter; Pelle, Shaneen; Karnitsky, Max; Lavoie, Andrea; Buttigieg, Josef; Hagemeyer, Christoph E.

    2015-11-25

    Iron within atherosclerotic plaque has been implicated as a catalyst of oxidative stress that causes progression of plaque, and plaque rupture. Iron is believed to accumulate within plaque by incorporation of erythrocytes following plaque rupture and hemorrhage. There is only indirect evidence to support this hypothesis. Plaque specimens were obtained from ten symptomatic and fifteen asymptomatic patients undergoing carotid endarterectomy at a single institution. Plaques were sectioned for study using synchrotron radiation induced X-ray fluorescence the study the distribution of zinc, calcium and iron. Histologic staining was carried out with Prussian Blue, and immunohistochemical staining was done to localize macrophagesmore » with CD68. Data were compared against patient clinical variables. Ten symptomatic (15 ± 10 days between index symptoms and surgery) and fifteen asymptomatic carotid plaques were studied. Zinc and calcium co-localized in mineralized areas of symptomatic and asymptomatic plaque. Iron was identified away from zinc and calcium in both symptomatic and asymptomatic plaques. Within the symptomatic plaques, iron was found within the thrombus associated with plaque rupture and hemorrhage. It did not stain with Prussian Blue, but was found in association with CD68 positive macrophages. In symptomatic plaques, the abundance of iron showed an association with the source patient’s LDL cholesterol (R2 = 0.39, Significance F = 0.05). Iron in asymptomatic plaque was present as hemosiderin/ferritin that stained positive with Prussian Blue, and was observed in association with CD68 positive macrophages. Iron in acutely symptomatic plaques is found within thrombus, in the presence of macrophages. Moreover, the abundance of iron in symptomatic plaques is associated with the source patient’s LDL cholesterol. Within asymptomatic plaques, iron is found in association with macrophages, as hemosiderin/ferritin.« less

  7. Symptomatic Trichomonas vaginalis infection in the setting of severe nitroimidazole allergy: successful treatment with boric acid.

    PubMed

    Muzny, Christina; Barnes, Arti; Mena, Leandro

    2012-09-01

    This report describes a patient with symptomatic Trichomonas vaginalis infection who was unable to tolerate nitroimidazole drugs because of severe hypersensitivity, for which desensitisation was not possible. Use of intravaginal clotrimazole, intravaginal paromomycin, intravaginal furazolidone, povidone-iodine douches, and oral nitazoxanide were unsuccessful in eradicating the patient's T. vaginalis infection. A 2-month course of intravaginal topical boric acid subsequently achieved a complete symptomatic cure and the patient remained T. vaginalis wet prep- and culture-negative 60 days after treatment.

  8. Long-term incidence of symptomatic urolithiasis post-bariatric surgery

    PubMed Central

    Haddad, Nicholas; Scheffler, Patrick; Elkoushy, Mohamed A.; Court, Olivier; Christou, Nicolas V.; Andersen, Ross E.; Andonian, Sero

    2014-01-01

    Introduction: The risk of urolithiasis post-Roux-en-Y gastric bypass (RYGB) surgery is higher when compared to the general population. Calcium and vitamin D supplementation is routinely prescribed to these patients, yet compliance with these supplements is unknown. The aim of this study was to assess the incidence of symptomatic de novo urolithiasis post-RYGB and compliance with calcium and vitamin D supplementation. Methods: A standardized telephone questionnaire was administered to patients who underwent RYGB between 1996 and 2011. Personal and medical histories were obtained with emphasis on episodes of symptomatic urolithiasis and calcium and vitamin D supplementation. Results: The response rate was 48% with 478 patients completing the telephone questionnaire. After a mean follow-up of 7.0 years (range: 1–15), the incidence of post-RYGB symptomatic urolithiasis was 7.3%, while the rate of de novo symptomatic urolithiasis was 5%. The overall median time to present with symptomatic urolithiasis was 3.1 years, with 3.3 years for de novo stone-formers, and 2.0 years for recurrent stone-formers (p = 0.38). In de novo stone-formers, 33% presented with symptomatic urolithiasis 4 to 14 years postoperatively. Compliance with calcium and vitamin D supplementation was 56% and 51%, respectively. Conclusions: Despite recall bias and lack of confirmatory imaging studies, a high postoperative incidence of symptomatic urolithiasis was found in a large sample of post-RYGB patients. A third of patients with de novo stones, presented with symptomatic urolithiasis 4 to 14 years postoperatively. Compliance with postoperative calcium and vitamin D supplementation was poor and needs improvement. PMID:25408808

  9. The Nature of Iron Deposits Differs between Symptomatic and Asymptomatic Carotid Atherosclerotic Plaques

    PubMed Central

    Kopriva, David; Kisheev, Anastasye; Meena, Deiter; Pelle, Shaneen; Karnitsky, Max; Lavoie, Andrea; Buttigieg, Josef

    2015-01-01

    Iron within atherosclerotic plaque has been implicated as a catalyst of oxidative stress that causes progression of plaque, and plaque rupture. Iron is believed to accumulate within plaque by incorporation of erythrocytes following plaque rupture and hemorrhage. There is only indirect evidence to support this hypothesis. Plaque specimens were obtained from ten symptomatic and fifteen asymptomatic patients undergoing carotid endarterectomy at a single institution. Plaques were sectioned for study using synchrotron radiation induced X-ray fluorescence the study the distribution of zinc, calcium and iron. Histologic staining was carried out with Prussian Blue, and immunohistochemical staining was done to localize macrophages with CD68. Data were compared against patient clinical variables. Ten symptomatic (15 ± 10 days between index symptoms and surgery) and fifteen asymptomatic carotid plaques were studied. Zinc and calcium co-localized in mineralized areas of symptomatic and asymptomatic plaque. Iron was identified away from zinc and calcium in both symptomatic and asymptomatic plaques. Within the symptomatic plaques, iron was found within the thrombus associated with plaque rupture and hemorrhage. It did not stain with Prussian Blue, but was found in association with CD68 positive macrophages. In symptomatic plaques, the abundance of iron showed an association with the source patient’s LDL cholesterol (R2 = 0.39, Significance F = 0.05). Iron in asymptomatic plaque was present as hemosiderin/ferritin that stained positive with Prussian Blue, and was observed in association with CD68 positive macrophages. Iron in acutely symptomatic plaques is found within thrombus, in the presence of macrophages. The abundance of iron in symptomatic plaques is associated with the source patient’s LDL cholesterol. Within asymptomatic plaques, iron is found in association with macrophages, as hemosiderin/ferritin. PMID:26606178

  10. Successful treatment of a large symptomatic lymphocyst with percutaneus drainage and repeated iodopovidone sclerotherapy.

    PubMed

    Stukan, M; Dudziak, M

    2014-01-01

    The objective of the case report was to present an easy and safe method for treatment of a large, persistent lymphocyst, through a procedure performed in an ambulatory setting. The patient diagnosed with large (1,800 mi), symptomatic (pains, renal insufficiency) lymphocyst after lymphadenectomy for cervical cancer, was successfully treated with percutaneous drainage (using vascular drains) and five sessions of sclerotherapy with 10% iodopovidone, performed in ambulatory settings. The method was minimally invasive, safe, and effective in management of symptomatic lymphocyst.

  11. Invasive evaluation of plaque morphology of symptomatic superficial femoral artery stenoses using combined near-infrared spectroscopy and intravascular ultrasound.

    PubMed

    Zacharias, Sibin K; Safian, Robert D; Madder, Ryan D; Hanson, Ivan D; Pica, Mark C; Smith, James L; Goldstein, James A; Abbas, Amr E

    2016-08-01

    The purpose of this study is to characterize the plaque morphology of severe stenoses in the superficial femoral artery (SFA) employing combined near-infrared spectroscopy and intravascular ultrasound (NIRS-IVUS). Atherosclerosis is the most common cause of symptomatic peripheral arterial disease. Plaque composition of SFA stenoses has been characterized as primarily fibrous or fibrocalcific by non-invasive and autopsy studies. NIRS has been validated to detect lipid-core plaque (LCP) in the coronary circulation. We imaged severe SFA stenoses with NIRS-IVUS prior to revascularization in 31 patients (46 stenoses) with Rutherford claudication ⩾ class 3. Angiographic parameters included lesion location and stenosis severity. IVUS parameters included plaque burden and presence of calcium. NIRS images were analyzed for LCP and maximum lipid-core burden index in a 4-mm length of artery (maxLCBI4mm). By angiography, 38 (82.6%) lesions were calcified and 9 (19.6%) were chronic total occlusions. Baseline stenosis severity and lesion length were 86.0 ± 11.0% and 36.5 ± 46.5 mm, respectively. NIRS-IVUS identified calcium in 45 (97.8%) lesions and LCP in 17 (37.0%) lesions. MaxLCBI4mm was 433 ± 244. All lesions with LCP also contained calcium; there were no non-calcified lesions with LCP. In conclusion, this is the first study of combined NIRS-IVUS in patients with PAD. NIRS-IVUS demonstrates that nearly all patients with symptomatic severe SFA disease have fibrocalcific plaque, and one-third of such lesions contain LCP. These findings contrast with those in patients with acute coronary syndromes, and may have implications regarding the pathophysiology of atherosclerosis in different vascular beds.

  12. Peak CSF Velocities in Patients with Symptomatic and Asymptomatic Chiari I Malformation

    PubMed Central

    Krueger, K.D.; Haughton, V.M.; Hetzel, S.

    2011-01-01

    BACKGROUND AND PURPOSE PCMR is used to evaluate the Chiari I malformation. We compared quantitative PCMR in symptomatic and asymptomatic patients with Chiari I. MATERIALS AND METHODS PCMR image data in an axial section near the foramen magnum in a consecutive series of patients with Chiari I malformations were evaluated. Patients were classified as symptomatic for a Chiari I if they had apnea spells and/or exertional headaches and as asymptomatic if they had symptoms not considered specific for a Chiari I malformation. The PCMR CSF flow study was obtained with the same protocol for all patients and with the neck in neutral, flexed, and extended positions. Images were inspected for CSF flow jets and synchronous bidirectional flow. Peak CSF flow velocities were calculated with commercial software. Differences between the 2 groups were tested with mixed-effects ANOVA and Wilcoxon rank sum or Fisher exact probability tests with significance set at the .05 level. RESULTS Twenty-six patients with Chiari I were classified as symptomatic, and 24, as asymptomatic. Abnormal flow jets tended to occur more often in the symptomatic than in the asymptomatic patients (P = .054). Peak CSF velocities ranged from 2 to 20 cm/s in the symptomatic and the asymptomatic groups and did not differ significantly between the 2 groups or with neck position. CONCLUSIONS Peak CSF flow velocities near the foramen magnum did not differentiate symptomatic and asymptomatic patients with Chiari I. PMID:20884747

  13. The concept of symptomatic epilepsy and the complexities of assigning cause in epilepsy.

    PubMed

    Shorvon, Simon

    2014-03-01

    The concept of symptomatic epilepsy and the difficulties in assigning cause in epilepsy are described. A historical review is given, emphasizing aspects of the history which are relevant today. The historical review is divided into three approximately semicentenial periods (1860-1910, 1910-1960, 1960-present). A definition of symptomatic epilepsy and this is followed by listing of causes of symptomatic epilepsy. The fact that not all the causes of idiopathic epilepsy are genetic is discussed. A category of provoked epilepsy is proposed. The complexities in assigning cause include the following: the multifactorial nature of epilepsy, the distinction between remote and proximate causes, the role of nongenetic factors in idiopathic epilepsy, the role of investigation in determining the range of causes, the fact that not all symptomatic epilepsy is acquired, the nosological position of provoked epilepsy and the view of epilepsy as a process, and the differentiation of new-onset and established epilepsy. The newly proposed ILAE classification of epilepsy and its changes in terminologies and the difficulties in the concept of acute symptomatic epilepsy are discussed, including the inconsistencies and gray areas and the distinction between idiopathic, symptomatic, and provoked epilepsies. Points to be considered in future work are listed.

  14. Chronic prostatitis: management strategies.

    PubMed

    Murphy, Adam B; Macejko, Amanda; Taylor, Aisha; Nadler, Robert B

    2009-01-01

    The National Institutes of Health (NIH) has redefined prostatitis into four distinct entities. Category I is acute bacterial prostatitis. It is an acute prostatic infection with a uropathogen, often with systemic symptoms of fever, chills and hypotension. The treatment hinges on antimicrobials and drainage of the bladder because the inflamed prostate may block urinary flow. Category II prostatitis is called chronic bacterial prostatitis. It is characterized by recurrent episodes of documented urinary tract infections with the same uropathogen and causes pelvic pain, urinary symptoms and ejaculatory pain. It is diagnosed by means of localization cultures that are 90% accurate in localizing the source of recurrent infections within the lower urinary tract. Asymptomatic inflammatory prostatitis comprises NIH category IV. This entity is, by definition, asymptomatic and is often diagnosed incidentally during the evaluation of infertility or prostate cancer. The clinical significance of category IV prostatitis is unknown and it is often left untreated. Category III prostatitis is called chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). It is characterized by pelvic pain for more than 3 of the previous 6 months, urinary symptoms and painful ejaculation, without documented urinary tract infections from uropathogens. The syndrome can be devastating, affecting 10-15% of the male population, and results in nearly 2 million outpatient visits each year. The aetiology of CP/CPPS is poorly understood, but may be the result of an infectious or inflammatory initiator that results in neurological injury and eventually results in pelvic floor dysfunction in the form of increased pelvic muscle tone. The diagnosis relies on separating this entity from chronic bacterial prostatitis. If there is no history of documented urinary tract infections with a urinary tract pathogen, then cultures should be taken when patients are symptomatic. Prostatic localization cultures, called the

  15. Reconstituted high-density lipoproteins acutely reduce soluble brain Aβ levels in symptomatic APP/PS1 mice.

    PubMed

    Robert, Jérôme; Stukas, Sophie; Button, Emily; Cheng, Wai Hang; Lee, Michael; Fan, Jianjia; Wilkinson, Anna; Kulic, Iva; Wright, Samuel D; Wellington, Cheryl L

    2016-05-01

    Many lines of evidence suggest a protective role for high-density lipoprotein (HDL) and its major apolipoprotein (apo)A-I in Alzheimer's Disease (AD). HDL/apoA-I particles are produced by the liver and intestine and, in addition to removing excess cholesterol from the body, are increasingly recognized to have vasoprotective functions. Here we tested the ability of reconstituted HDL (rHDL) consisting of human apoA-I reconstituted with soy phosphatidylcholine for its ability to lower amyloid beta (Aβ) levels in symptomatic APP/PS1 mice, a well-characterized preclinical model of amyloidosis. Animals were treated intravenously either with four weekly doses (chronic study) or a single dose of 60mg/kg of rHDL (acute study). The major finding of our acute study is that soluble brain Aβ40 and Aβ42 levels were significantly reduced within 24h of a single dose of rHDL. By contrast, no changes were observed in our chronic study with respect to soluble or deposited Aβ levels in animals assessed 7days after the final weekly dose of rHDL, suggesting that beneficial effects diminish as rHDL is cleared from the body. Further, rHDL-treated animals showed no change in amyloid burden, cerebrospinal fluid (CSF) Aβ levels, neuroinflammation, or endothelial activation in the chronic study, suggesting that the pathology-modifying effects of rHDL may indeed be acute and may be specific to the soluble Aβ pool. That systemic administration of rHDL can acutely modify brain Aβ levels provides support for further investigation of the therapeutic potential of apoA-I-based agents for AD. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock.

  16. Symptomatic atypical femoral fractures are related to underlying hip geometry.

    PubMed

    Taormina, David P; Marcano, Alejandro I; Karia, Raj; Egol, Kenneth A; Tejwani, Nirmal C

    2014-06-01

    The benefits of bisphosphonates are well documented, but prolonged use has been associated with atypical femur fractures. Radiographic markers for fracture predisposition could potentially aid in safer medication use. In this case-control designed study, we compared hip radiographic parameters and the demographic characteristics of chronic bisphosphonate users who sustained an atypical femoral fracture with a group of chronic bisphosphonate users who did not sustain an atypical femur fracture and also a group who sustained an intertrochanteric hip fracture. Radiographic parameters included were neck-shaft angle (NSA), hip-axis length (HAL) and center-edge angle (CE). Multivariate regression was used to evaluate the relationship between radiographic measures and femur fracture. Receiver-operating characteristic analysis determined cut-off points for neck-shaft angle and risk of atypical femur fracture. Ultimately, pre-fracture radiographs of 53 bisphosphonate users who developed atypical fracture were compared with 43 asymptomatic chronic bisphosphonate users and 64 intertrochanteric fracture patients. Duration of bisphosphonate use did not statistically differ between users sustaining atypical fracture and those without fracture (7.9 [±3.5] vs. 7.7 [±3.3] years, p=0.7). Bisphosphonate users who fractured had acute/varus pre-fracture neck-shaft angles (p<0.001), shorter hip-axis length (p<0.01), and narrower center-edge angles (p<0.01). Regression analysis revealed associations between neck-shaft angle (OR=0.89 [95% CI=0.81-0.97; p=0.01), center edge angle (OR=0.89 [95% CI=0.80-0.99]; p=0.03), and BMI (OR=1.15 [95% CI=1.02-1.31; p=0.03) with fracture development. ROC curve analysis (AUC=0.67 [95% CI=0.56-0.79]) determined that a cut-off point for neck-shaft angle <128.3° yielded 69% sensitivity and 63% specificity for development of atypical femoral fracture. Ultimately, an acute/varus angle of the femoral neck, high BMI, and narrow center-edge angle were

  17. Symptomatic Peripheral Mycotic Aneurysms Due to Infective Endocarditis

    PubMed Central

    González, Isabel; Sarriá, Cristina; López, Javier; Vilacosta, Isidre; San Román, Alberto; Olmos, Carmen; Sáez, Carmen; Revilla, Ana; Hernández, Miguel; Caniego, Jose Luis; Fernández, Cristina

    2014-01-01

    Abstract Peripheral mycotic aneurysms (PMAs) are a relatively rare but serious complication of infective endocarditis (IE). We conducted the current study to describe and compare the current epidemiologic, microbiologic, clinical, diagnostic, therapeutic, and prognostic characteristics of patients with symptomatic PMAs (SPMAs). A descriptive, comparative, retrospective observational study was performed in 3 tertiary hospitals, which are reference centers for cardiac surgery. From 922 definite IE episodes collected from 1996 to 2011, 18 patients (1.9%) had SPMAs. Because all SPMAs developed in left-sided IE, we performed a comparative study between 719 episodes of left-sided IE without SPMAs and 18 episodes with SPMAs. We found a higher frequency of intravenous drug abuse, native valve IE, intracranial bleeding, septic emboli, multiple embolisms, and IE diagnostic delay >30 days in patients with SPMAs than in patients without SPMAs. The causal microorganisms were gram-positive cocci (n =10), gram-negative bacilli (n = 2), gram-positive bacilli (n = 3), Bartonella henselae (n = 1), Candida albicans (n = 1), and negative culture (n = 1). The median IE diagnosis delay was 15 days (interquartile range [IQR], 13–33 d) in the case of high-virulence microorganisms versus 45 days (IQR, 30–240 d) in the case of low- to medium-virulence microorganisms. Twelve SPMAs were intracranial and 6 were extracranial. In 10 cases (8 intracranial and 2 extracranial), SPMAs were the initial presentation of IE; the remaining cases developed symptoms during or after finishing parenteral antibiotic treatment. The initial diagnosis of intracranial SPMAs was made by computed tomography (CT) or magnetic resonance imaging in 6 unruptured aneurysms and by angiography in 6 ruptured aneurysms. The initial test in extracranial SPMAs was Doppler ultrasonography in limbs, CT in liver, and coronary angiography in heart. Four (3 intracranial, 1 extracranial) of 7 (6 intracranial, 1 extracranial

  18. The interaction between aggrecan gene VNTR polymorphism and obesity in predicting incident symptomatic lumbar disc herniation.

    PubMed

    Cong, Lin; Zhu, Yue; Pang, Hao; Guanjun, T U

    2014-01-01

    An association between aggrecan gene variable number of tandem repeats polymorphism (VNTR) and symptomatic lumbar disc herniation (LDH) has been reported in Chinese Han of Northern China, and obesity had previously been suspected of causing severe LDH. However, the interaction between aggrecan VNTR and obesity in symptomatic LDH has not been well studied. To examine the interaction between aggrecan VNTR and obesity in the susceptibility of symptomatic LDH, 259 participants participated in this study and donated a blood sample. The disease group comprised 61 patients already diagnosed with symptomatic LDH. The control group consisted of 198 healthy blood donors without symptoms of LDH who were not diagnosed with LDH. The aggrecan gene VNTR region was analyzed using polymerase chain reaction. The data indicated that between the two groups, participants carrying one or two alleles ≤25 repeats who were non-obese people showed a 1.057-fold increase in risk for symptomatic LDH (p = 0.895, changing the number of repeat alleles to <25 repeats alone did not demonstrably change the risk of LDH), and participants carrying two alleles >25 repeats who were obese people showed an 1.061-fold higher risk (p = 0.885, adding obesity to the mix alone did not demonstrably increase the risk of LDH), while participants carrying one or two alleles ≤25 repeats who were obese people showed a 4.667-fold increase in risk for symptomatic LDH (p = 0.0003, adding obesity plus changing the repeat allele number significantly increased the risk of LDH by 4.667). Overall, the findings suggest an underlying interaction between aggrecan VNTR and obesity in symptomatic LDH.

  19. Asymptomatic HIV-associated neurocognitive impairment increases risk for symptomatic decline

    PubMed Central

    Franklin, Donald R.; Deutsch, Reena; Woods, Steven P.; Vaida, Florin; Ellis, Ronald J.; Letendre, Scott L.; Marcotte, Thomas D.; Atkinson, J.H.; Collier, Ann C.; Marra, Christina M.; Clifford, David B.; Gelman, Benjamin B.; McArthur, Justin C.; Morgello, Susan; Simpson, David M.; McCutchan, John A.; Abramson, Ian; Gamst, Anthony; Fennema-Notestine, Christine; Smith, Davey M.; Heaton, Robert K.

    2014-01-01

    Objective: While HIV-associated neurocognitive disorders (HAND) remain prevalent despite combination antiretroviral therapy (CART), the clinical relevance of asymptomatic neurocognitive impairment (ANI), the most common HAND diagnosis, remains unclear. We investigated whether HIV-infected persons with ANI were more likely than those who were neurocognitively normal (NCN) to experience a decline in everyday functioning (symptomatic decline). Methods: A total of 347 human participants from the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) cohort were NCN (n = 226) or had ANI (n = 121) at baseline. Neurocognitive assessments occurred approximately every 6 months, with median (interquartile range) follow-up of 45.2 (28.7–63.7) months. Symptomatic decline was based on self-report (SR) or objective, performance-based (PB) problems in everyday functioning. Proportional hazards modeling was used to generate risk ratios for progression to symptomatic HAND after adjusting for baseline and time-dependent covariates, including CD4+ T-lymphocyte count (CD4), virologic suppression, CART, and mood. Results: The ANI group had a shorter time to symptomatic HAND than the NCN after adjusting for baseline predictors: adjusted risk ratios for symptomatic HAND were 2.0 (confidence interval [CI] 1.1–3.6; p = 0.02) for SR, 5.8 (CI 3.2–10.7; p < 0.0001) for PB, and 3.2 (CI 2.0–5.0; p < 0.0001) for either SR or PB. Current CD4 and depression were significant time-dependent covariates, but antiretroviral regimen, virologic suppression, and substance abuse or dependence were not. Conclusions: This longitudinal study demonstrates that ANI conveys a 2-fold to 6-fold increase in risk for earlier development of symptomatic HAND, supporting the prognostic value of the ANI diagnosis in clinical settings. Identifying those at highest risk for symptomatic decline may offer an opportunity to modify treatment to delay progression. PMID:24814848

  20. Chronic migraine.

    PubMed

    Schwedt, Todd J

    2014-03-24

    Chronic migraine is a disabling neurologic condition that affects 2% of the general population. Patients with chronic migraine have headaches on at least 15 days a month, with at least eight days a month on which their headaches and associated symptoms meet diagnostic criteria for migraine. Chronic migraine places an enormous burden on patients owing to frequent headaches; hypersensitivity to visual, auditory, and olfactory stimuli; nausea; and vomiting. It also affects society through direct and indirect medical costs. Chronic migraine typically develops after a slow increase in headache frequency over months to years. Several factors are associated with an increased risk of transforming to chronic migraine. The diagnosis requires a carefully performed patient interview and neurologic examination, sometimes combined with additional diagnostic tests, to differentiate chronic migraine from secondary headache disorders and other primary chronic headaches of long duration. Treatment takes a multifaceted approach that may include risk factor modification, avoidance of migraine triggers, drug and non-drug based prophylaxis, and abortive migraine treatment, the frequency of which is limited to avoid drug overuse. This article provides an overview of current knowledge regarding chronic migraine, including epidemiology, risk factors for its development, pathophysiology, diagnosis, management, and guidelines. The future of chronic migraine treatment and research is also discussed.

  1. Chronic kidney disease

    MedlinePlus

    Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; Chronic kidney failure; Chronic renal failure ... Chronic kidney disease (CKD) slowly gets worse over months or years. You may not notice any symptoms for some ...

  2. Respiratory Conditions Update: Chronic Obstructive Pulmonary Disease.

    PubMed

    Karel, Daphne J

    2016-09-01

    Chronic obstructive pulmonary disease (COPD) is defined as persistent airflow limitation due to irritant-induced chronic inflammation. A postbronchodilator forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio of 0.7 or less is diagnostic in a patient with dyspnea, chronic cough or sputum production, and a history of irritant exposure. Tobacco smoking is the most significant etiology, and smoking cessation is the only intervention shown to slow disease progression. Long-acting beta2-agonists and long-acting muscarinic antagonists are first-line treatments for patients with persistently symptomatic COPD with an FEV1 of 80% or less of predicted. When COPD is uncontrolled with a long-acting bronchodilator, combination therapy with a long-acting muscarinic antagonist-long-acting beta2-agonist or long-acting beta2-agonist-inhaled corticosteroid should be prescribed. Patients with COPD and reduced exercise tolerance should undergo pulmonary rehabilitation and be evaluated for supplemental oxygen therapy. Other treatment options for persistently symptomatic COPD include inhaler triple therapy (ie, long-acting muscarinic antagonist, long-acting beta2-agonist, inhaled corticosteroid), phosphodiesterase type 4 inhibitors, oxygen, and surgical interventions. PMID:27576232

  3. Nitric oxide radicals in leucocytes and vaginal washes of Trichomonas vaginalis -infected symptomatic and asymptomatic women.

    PubMed

    Yadav, M; Dubey, M L; Gupta, I; Malla, N

    2006-03-01

    The clinical spectrum of Trichomonas vaginalis infection varies from asymptomatic to mild, moderate or severe vaginitis. Nitric oxide and other reactive nitrogen radicals produced by immune effector cells are important cytotoxic and cytostatic mediators against several microorganisms including parasites. In the present study, inducible nitric oxide synthase (iNOS) and reactive nitrogen intermediates (RNI) were determined in leucocyte cultures (stimulated with T. vaginalis in vitro) and vaginal washes (VWs) of 22 symptomatic and 20 asymptomatic T. vaginalis-infected and 20 healthy women by immunoblotting and Griess method respectively. The iNOS protein was detected in leucocytes and VWs of all the symptomatic and asymptomatic women, but was not detected in any of the samples from healthy women. Mean iNOS protein band intensity was significantly higher in leucocytes as compared to VWs (P<0.001) of both symptomatic and asymptomatic women and was also higher in leucocytes of asymptomatic as compared to symptomatic women (P<0.05). Mean RNI concentration was also significantly higher in leucocytes (P<0.01) and VWs (P<0.05) of asymptomatic as compared to symptomatic women, and was also higher in samples of infected as compared to healthy women (P<0.001). These results suggest that reactive nitrogen radicals may have a role in limiting T. vaginalis infection in asymptomatic women. PMID:16529664

  4. Retrospective clinical comparison of idiopathic versus symptomatic epilepsy in 240 dogs with seizures.

    PubMed

    Pákozdy, Akos; Leschnik, Michael; Tichy, Alexander G; Thalhammer, Johann G

    2008-12-01

    In the present study, 240 cases of dogs with seizures were analysed retrospectively. The aim was to examine the underlying aetiology and to compare primary or idiopathic epilepsy (IE) with symptomatic epilepsy (SE) concerning signalment, history, ictal pattern, clinical and neurological findings. The diagnosis of symptomatic epilepsy was based on confirmed pathological changes in haematology, serum biochemistry, cerebrospinal fluid (CSF) analysis and morphological changes of the brain by CT/MRI or histopathological examination. Seizure aetiologies were classified as idiopathic epilepsy (IE, n = 115) and symptomatic epilepsy (SE, n = 125). Symptomatic epilepsy was mainly caused by intracranial neoplasia (39) and encephalitis (23). The following variables showed significant difference between the IE and SE group: age, body weight, presence of partial seizures, cluster seizures, status epilepticus, ictal vocalisation and neurological deficits. In 48% of the cases, seizures were found to be due to IE, while 16% were due to intracranial neoplasia and 10% to encephalitis. Status epilepticus, cluster seizures, partial seizures, vocalisation during seizure and impaired neurological status were more readily seen with symptomatic epilepsy. If the first seizure occurred between one and five years of age or the seizures occurred during resting condition, the diagnosis was more likely IE than SE.

  5. Deconstructing major depression: a validation study of the DSM-IV symptomatic criteria

    PubMed Central

    Lux, V.; Kendler, K. S.

    2010-01-01

    Background The DSM-IV symptomatic criteria for major depression (MD) derive primarily from clinical experience with modest empirical support. Method The sample studied included 1015 (518 males, 497 females) Caucasian twins from a population-based registry who met criteria for MD in the year prior to the interview. Logistic regression analyses were conducted to compare the associations of: (1) single symptomatic criterion, (2) two groups of criteria reflecting cognitive and neurovegetative symptoms, with a wide range of potential validators including demographic factors, risk for future episodes, risk of MD in the co-twin, characteristics of the depressive episode, the pattern of co-morbidity and personality traits. Results The individual symptomatic criteria showed widely varying associations with the pattern of co-morbidity, personality traits, features of the depressive episode and demographic characteristics. When examined separately, these two criteria groups showed robust differences in their patterns of association, with the validators with the cognitive criteria generally producing stronger associations than the neurovegetative. Conclusions Among depressed individuals, individual DSM-IV symptomatic criteria differ substantially in their predictive relationship with a range of clinical validators. These results challenge the equivalence assumption for the symptomatic criteria for MD and suggest a more than expected degree of ‘ covert ’ heterogeneity among these criteria. Part of this heterogeneity is captured by the distinction between cognitive versus neurovegetative symptoms, with cognitive symptoms being more strongly associated with most clinically relevant characteristics. Detailed psychometric evaluation of DSM-IV criteria is overdue. PMID:20059797

  6. Shunt malfunction presenting with symptomatic syringomyelia: Demonstrated on contrast ventriculogram

    PubMed Central

    Aniruddha, T. J; Pruthi, Nupur

    2014-01-01

    Ventriculoperitoneal (VP) shunt malfunction commonly presents as raised intracranial pressure. Rarely, when the central canal of the spinal cord communicates with the 4th ventricle, shunt malfunction can present as an expanding syrinx. The diagnosis is often delayed, resulting in severe morbidity. Some of these patients undergo repeated syrinx surgeries without much benefits. We report a case of chronic tuberculous meningitis with shunt malfunction presenting as an expanding spinal canal syrinx and quadriparesis. Fourth ventricular communication with syrinx was demonstrated with the help of a contrast ventriculogram. After shunt revision, syrinx resolved completely and the patient made significant improvement in his neurological deficits. The present case illustrates that a historical and rarely used investigation like contrast ventriculogram aids in the diagnosis and management even in the current neurosurgical practice. All patients with late onset syrinx and a previous VP shunt need to be investigated for shunt malfunction before considering syrinx surgery. A simple shunt revision resolves the syrinx in such conditions and avoids more complex procedures like Foramen magnum decompression. Relevant literature has been reviewed; pathophysiology and management options have been discussed. PMID:25250067

  7. [Chronicity, chronicization, systematization of delusions].

    PubMed

    Trapet, P; Fernandez, C; Galtier, M C; Gisselmann, A

    1984-05-01

    Chronicity in psychopathology is indicative of a term, a decay. Chronicization only leads the way to this term. Here, chronicization is taken literally as an inscription in the time course of delusions. The mechanism of systematization seems to be a central mark in the approach to chronic delusions. It is not an alienation or an irreversible closing but an attempted accommodation with reality in the life of psychotic subjects, irrespective of the delusional structure. The role of therapy and drug treatment as a follow-up may in that case assume another meaning.

  8. Chronic pancreatitis.

    PubMed

    Chari, S T; DiMagno, E P

    2001-09-01

    An increasing number of novel mutations are associated with chronic pancreatitis. Some cause a high-penetrance, autosomal dominant type of clinical picture (eg, mutations at codons 29 and 122 of the cationic trypsinogen gene), whereas others have a low penetrance or are frequent in the general population (eg, mutations in Kazal type 1 [SPINK1] and in codons 16, 22, and 23 of the cationic trypsinogen gene) and act as disease modifiers. The results of recent studies indicate that smoking adversely affects the course and complications of chronic pancreatitis (more frequent and faster rate of calcification and higher risk of development of pancreatic cancer). Thus, regardless of the cause of chronic pancreatis, patients with this condition should not smoke. Using current diagnostic criteria, the accuracy of endoscopic ultrasound for the diagnosis of chronic pancreatitis is not good. For example, 39% of dyspeptic persons without any other evidence of chronic pancreatitis fulfilled the endoscopic ultrasound criteria for chronic pancreatitis. Diabetes frequently occurs in chronic pancreatitis, but it is not prevented or increased by pancreatic surgery. Islet cell autotransplantation holds promise for the prevention of diabetes in patients requiring total pancreatectomy if the pancreas is not extensively fibrotic. Splenic vein occlusion is present in 7% of patients undergoing surgery for chronic pancreatitis, but fewer than one fifth of these patients have variceal bleeding before or after surgery.

  9. Chronic pancreatitis.

    PubMed

    Majumder, Shounak; Chari, Suresh T

    2016-05-01

    Chronic pancreatitis describes a wide spectrum of fibro-inflammatory disorders of the exocrine pancreas that includes calcifying, obstructive, and steroid-responsive forms. Use of the term chronic pancreatitis without qualification generally refers to calcifying chronic pancreatitis. Epidemiology is poorly defined, but incidence worldwide seems to be on the rise. Smoking, drinking alcohol, and genetic predisposition are the major risk factors for chronic calcifying pancreatitis. In this Seminar, we discuss the clinical features, diagnosis, and management of chronic calcifying pancreatitis, focusing on pain management, the role of endoscopic and surgical intervention, and the use of pancreatic enzyme-replacement therapy. Management of patients is often challenging and necessitates a multidisciplinary approach. PMID:26948434

  10. Cognitive dysfunction at baseline predicts symptomatic 1-year outcome in first-episode schizophrenics.

    PubMed

    Moritz, S; Krausz, M; Gottwalz, E; Lambert, M; Perro, C; Ganzer, S; Naber, D

    2000-01-01

    The present study addresses the consequences of cognitive disturbances on symptomatic outcome. Fifty-three first-episode schizophrenics were reassessed (n = 32) 1 year after admission. Simple regression analyses revealed that several self-perceived cognitive deficits at baseline as measured with the Frankfurt Complaint Questionnaire significantly predicted increased Brief Psychiatric Rating Scale global scores at follow-up (p = 0.05 to p = 0.005). A stepwise regression analysis proved memory dysfunction to be the strongest predictor of symptomatic worsening (p = 0.005). It is suggested that the exploration and treatment of neuropsychological deficits in schizophrenia is of great clinical importance with regard to its impact on both functional and symptomatic outcome in schizophrenia.

  11. PET evaluation of cerebral blood flow reactivity in symptomatic and asymptomatic carotid artery stenosis

    SciTech Connect

    Dey, H.M.; Brass, L.; Rich, D.

    1994-05-01

    The purpose of this study was to use acetazolamide (AZ) enhanced O-15 water PET to evaluate cerebral perfusion reserve in symptomatic and asymptomatic carotid artery stenosis. We hypothesized that impaired vasoreactivity would be associated with symptomatic disease and a higher likelihood of future ischemic events. Twenty-two patients with significant (>75%) carotid artery occlusion underwent cerebral blood flow imaging at baseline and following AZ infusion. Paired O-15 data sets were coregistered and globally normalized. Regions of interest were drawn on baseline blood flow images and superimposed upon (AZ - baseline) difference images to derive a % change in regional blood flow after AZ administration. The results showed a significant difference in cerebral perfusion reserve between symptomatic (n=19) and asymptomatic (n=3) carotid artery disease.

  12. Cognitive dysfunction at baseline predicts symptomatic 1-year outcome in first-episode schizophrenics.

    PubMed

    Moritz, S; Krausz, M; Gottwalz, E; Lambert, M; Perro, C; Ganzer, S; Naber, D

    2000-01-01

    The present study addresses the consequences of cognitive disturbances on symptomatic outcome. Fifty-three first-episode schizophrenics were reassessed (n = 32) 1 year after admission. Simple regression analyses revealed that several self-perceived cognitive deficits at baseline as measured with the Frankfurt Complaint Questionnaire significantly predicted increased Brief Psychiatric Rating Scale global scores at follow-up (p = 0.05 to p = 0.005). A stepwise regression analysis proved memory dysfunction to be the strongest predictor of symptomatic worsening (p = 0.005). It is suggested that the exploration and treatment of neuropsychological deficits in schizophrenia is of great clinical importance with regard to its impact on both functional and symptomatic outcome in schizophrenia. PMID:10601828

  13. NMR-Based Metabolomic Analysis of Huanglongbing-Asymptomatic and -Symptomatic Citrus Trees.

    PubMed

    Freitas, Deisy dos Santos; Carlos, Eduardo Fermino; Gil, Márcia Cristina Soares de Souza; Vieira, Luiz Gonzaga Esteves; Alcantara, Glaucia Braz

    2015-09-01

    Huanglongbing (HLB) is one of the most severe diseases that affects citrus trees worldwide and is associated with the yet uncultured bacteria Candidatus Liberibacter spp. To assess the metabolomic differences between HLB-asymptomatic and -symptomatic tissues, extracts from leaf and root samples taken from a uniform 6-year-old commercial orchard of Valencia trees were subjected to nuclear magnetic resonance (NMR) and chemometrics. The results show that the symptomatic trees had higher sucrose content in their leaves and no variation in their roots. In addition, proline betaine and malate were detected in smaller amounts in the HLB-affected symptomatic leaves. The changes in metabolic processes of the plant in response to HLB are corroborated by the relationship between the bacterial levels and the metabolic profiles.

  14. Symptomatic Bilateral Torn Discoid Medial Meniscus Treated with Saucerization and Suture

    PubMed Central

    2016-01-01

    Discoid meniscus is an anatomical congenital anomaly more often found in the lateral meniscus. A discoid medial meniscus is a very rare anomaly, and even more rare is to diagnose a bilateral discoid medial meniscus although the real prevalence of this situation is unknown because not all the discoid medial menisci are symptomatic and if the contralateral knee is not symptomatic then it is not usually studied. The standard treatment of this kind of pathology is partial meniscectomy. Currently the tendency is to be very conservative so suture and saucerization of a torn discoid meniscus when possible are gaining support. We present the case of a 13-year-old patient who was diagnosed with symptomatic torn bilateral discoid medial meniscus treated by suturing the tear and saucerization. To the best of our knowledge this is the first case reported of bilateral torn discoid medial meniscus treated in this manner in the same patient. PMID:27656305

  15. Symptomatic Bilateral Torn Discoid Medial Meniscus Treated with Saucerization and Suture

    PubMed Central

    2016-01-01

    Discoid meniscus is an anatomical congenital anomaly more often found in the lateral meniscus. A discoid medial meniscus is a very rare anomaly, and even more rare is to diagnose a bilateral discoid medial meniscus although the real prevalence of this situation is unknown because not all the discoid medial menisci are symptomatic and if the contralateral knee is not symptomatic then it is not usually studied. The standard treatment of this kind of pathology is partial meniscectomy. Currently the tendency is to be very conservative so suture and saucerization of a torn discoid meniscus when possible are gaining support. We present the case of a 13-year-old patient who was diagnosed with symptomatic torn bilateral discoid medial meniscus treated by suturing the tear and saucerization. To the best of our knowledge this is the first case reported of bilateral torn discoid medial meniscus treated in this manner in the same patient.

  16. Neutralizing antibody titers against dengue virus correlate with protection from symptomatic infection in a longitudinal cohort

    PubMed Central

    Katzelnick, Leah C.; Montoya, Magelda; Gresh, Lionel; Balmaseda, Angel; Harris, Eva

    2016-01-01

    The four dengue virus serotypes (DENV1–4) are mosquito-borne flaviviruses that infect ∼390 million people annually; up to 100 million infections are symptomatic, and 500,000 cases progress to severe disease. Exposure to a heterologous DENV serotype, the specific infecting DENV strains, and the interval of time between infections, as well as age, ethnicity, genetic polymorphisms, and comorbidities of the host, are all risk factors for severe dengue. In contrast, neutralizing antibodies (NAbs) are thought to provide long-lived protection against symptomatic infection and severe dengue. The objective of dengue vaccines is to provide balanced protection against all DENV serotypes simultaneously. However, the association between homotypic and heterotypic NAb titers and protection against symptomatic infection remains poorly understood. Here, we demonstrate that the titer of preinfection cross-reactive NAbs correlates with reduced likelihood of symptomatic secondary infection in a longitudinal pediatric dengue cohort in Nicaragua. The protective effect of NAb titers on infection outcome remained significant when controlled for age, number of years between infections, and epidemic force, as well as with relaxed or more stringent criteria for defining inapparent DENV infections. Further, individuals with higher NAb titers immediately after primary infection had delayed symptomatic infections compared with those with lower titers. However, overall NAb titers increased modestly in magnitude and remained serotype cross-reactive in the years between infections, possibly due to reexposure. These findings establish that anti-DENV NAb titers correlate with reduced probability of symptomatic DENV infection and provide insights into longitudinal characteristics of antibody-mediated immunity to DENV in an endemic setting. PMID:26729879

  17. Symptomatic Management of Multiple Sclerosis–Associated Tremor Among Participants in the NARCOMS Registry

    PubMed Central

    Salter, Amber R.; Rinker, John R.

    2016-01-01

    Background: Tremor affects 25% to 58% of patients with multiple sclerosis (MS) and is associated with poor prognosis and increased disability. MS-related tremor is difficult to treat, and data regarding patient-reported characterization and response to treatment are limited. We describe the symptomatic treatment of tremor in 508 enrollees in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry who self-reported tremor. Methods: From 777 surveys sent to NARCOMS participants who indicated mild or greater tremor using the Tremor and Coordination Scale, we compiled data regarding disability, tremor severity, symptomatic medication use, and reported response to medications. Results: Symptomatic medications reported to reduce tremor were used by 238 respondents (46.9%). Symptomatic medication use was associated with increased rates of unemployment and disability, and many other characteristics were similar between groups. Symptomatic drug use was more likely in participants reporting moderate (53.9%) or severe (51.3%) tremor than in those with mild (36.6%) or totally disabling (35.0%) tremor. This disparity held true across multiple tremor severity scores. The most commonly used drug classes were anticonvulsants (50.8%) and benzodiazepines (46.2%), with gabapentin and clonazepam used most often in their respective classes. Conclusions: Tremor in MS remains poorly treated; less than half of the participants reported benefit from symptomatic medications. Patients with moderate-to-severe tremor are more likely to report tremor benefit than are those with mild or disabling tremor. γ-Aminobutyric acid–active medications were most commonly reported as beneficial. PMID:27252602

  18. 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.

  19. Neutralizing antibody titers against dengue virus correlate with protection from symptomatic infection in a longitudinal cohort.

    PubMed

    Katzelnick, Leah C; Montoya, Magelda; Gresh, Lionel; Balmaseda, Angel; Harris, Eva

    2016-01-19

    The four dengue virus serotypes (DENV1-4) are mosquito-borne flaviviruses that infect ∼ 390 million people annually; up to 100 million infections are symptomatic, and 500,000 cases progress to severe disease. Exposure to a heterologous DENV serotype, the specific infecting DENV strains, and the interval of time between infections, as well as age, ethnicity, genetic polymorphisms, and comorbidities of the host, are all risk factors for severe dengue. In contrast, neutralizing antibodies (NAbs) are thought to provide long-lived protection against symptomatic infection and severe dengue. The objective of dengue vaccines is to provide balanced protection against all DENV serotypes simultaneously. However, the association between homotypic and heterotypic NAb titers and protection against symptomatic infection remains poorly understood. Here, we demonstrate that the titer of preinfection cross-reactive NAbs correlates with reduced likelihood of symptomatic secondary infection in a longitudinal pediatric dengue cohort in Nicaragua. The protective effect of NAb titers on infection outcome remained significant when controlled for age, number of years between infections, and epidemic force, as well as with relaxed or more stringent criteria for defining inapparent DENV infections. Further, individuals with higher NAb titers immediately after primary infection had delayed symptomatic infections compared with those with lower titers. However, overall NAb titers increased modestly in magnitude and remained serotype cross-reactive in the years between infections, possibly due to reexposure. These findings establish that anti-DENV NAb titers correlate with reduced probability of symptomatic DENV infection and provide insights into longitudinal characteristics of antibody-mediated immunity to DENV in an endemic setting.

  20. Neutralizing antibody titers against dengue virus correlate with protection from symptomatic infection in a longitudinal cohort.

    PubMed

    Katzelnick, Leah C; Montoya, Magelda; Gresh, Lionel; Balmaseda, Angel; Harris, Eva

    2016-01-19

    The four dengue virus serotypes (DENV1-4) are mosquito-borne flaviviruses that infect ∼ 390 million people annually; up to 100 million infections are symptomatic, and 500,000 cases progress to severe disease. Exposure to a heterologous DENV serotype, the specific infecting DENV strains, and the interval of time between infections, as well as age, ethnicity, genetic polymorphisms, and comorbidities of the host, are all risk factors for severe dengue. In contrast, neutralizing antibodies (NAbs) are thought to provide long-lived protection against symptomatic infection and severe dengue. The objective of dengue vaccines is to provide balanced protection against all DENV serotypes simultaneously. However, the association between homotypic and heterotypic NAb titers and protection against symptomatic infection remains poorly understood. Here, we demonstrate that the titer of preinfection cross-reactive NAbs correlates with reduced likelihood of symptomatic secondary infection in a longitudinal pediatric dengue cohort in Nicaragua. The protective effect of NAb titers on infection outcome remained significant when controlled for age, number of years between infections, and epidemic force, as well as with relaxed or more stringent criteria for defining inapparent DENV infections. Further, individuals with higher NAb titers immediately after primary infection had delayed symptomatic infections compared with those with lower titers. However, overall NAb titers increased modestly in magnitude and remained serotype cross-reactive in the years between infections, possibly due to reexposure. These findings establish that anti-DENV NAb titers correlate with reduced probability of symptomatic DENV infection and provide insights into longitudinal characteristics of antibody-mediated immunity to DENV in an endemic setting. PMID:26729879

  1. Sexual behaviour and condom use among individuals with a history of symptomatic genital herpes

    PubMed Central

    Rana, R K; Pimenta, J M; Rosenberg, D M; Warren, T; Sekhin, S; Cook, S F; Robinson, N J

    2006-01-01

    Objectives This study describes the differences in sexual behaviour in individuals with genital herpes (GH) during “symptomatic” and “asymptomatic” periods of the disease. Methods A cross sectional questionnaire was undertaken by 1193 individuals attending clinics between 1998 and 2001. All participants in this analysis were in heterosexual, monogamous partnerships, self identified with a history of symptomatic GH and with confirmed HSV‐2 infection. Results Sexual activity reported during asymptomatic v symptomatic periods of GH was 98% v 40% (p<0.001), 76% v 29% (p<0.001), and 25% v 11% (p<0.001) for vaginal, oral, and anal intercourse, respectively, while “always” condom use during asymptomatic and symptomatic periods was 20% v 35% (p<0.001), 2% v 7% (p<0.001), and 10% v 15% (p = 0.131), respectively. The proportion of individuals who either abstained from vaginal intercourse or “always” used condoms was 21% v 74% (p<0.001), for asymptomatic v symptomatic periods. Multivariable analyses indicated that factors associated with engaging in intercourse during symptomatic periods of GH included current intrauterine device use (adjusted odds ratio (aOR) = 2.96, 95% confidence interval (CI) = 1.46 to 6.02); living in Latin America (aOR = 2.16, CI = 1.19 to 3.91) or Europe (aOR = 1.67, CI = 1.21 to 2.28), compared with North America; previous sexually transmitted disease (aOR = 1.42, CI = 1.08 to 1.89); a higher number of sexual acts per month (aOR = 1.09, CI = 1.06 to 1.11); and a higher number of GH recurrences per year (aOR = 1.08, CI = 1.03 to 1.12). Conclusions These data indicate that the majority of people with GH either abstained from intercourse or “always” used condoms during symptomatic periods of GH. However, condom use was relatively low during asymptomatic periods in comparison with symptomatic periods. These results highlight that further education on GH prevention is warranted

  2. Differences in Acetabular Rim Thickness in Patients with Unilateral Symptomatic Pincer-Type Femoroacetabular Impingement

    PubMed Central

    Weber, Alexander E.; Kuhns, Benjamin; Cvetanovich, Gregory; Inoue, Nozomu; Nho, Shane Jay

    2016-01-01

    Objectives: The objective of this study was to identify the location and magnitude of difference in acetabular rim morphology between the symptomatic and asymptomatic acetabula in a cohort of patients with symptomatic unilateral pincer-type FAI. Methods: After IRB approval, computed tomography (CT) scans of 43 patients (22 males, 21 females) diagnosed with unilateral pincer-type FAI were obtained. CT images of both hips were imported in DICOM format and segmented into 3-dimensional (3D) hemi-pelvises using 3D reconstruction software (Mimics, Materialise, Leuven, Belgium). The point-cloud data of the asymptomatic hemi-pelvis was mirrored onto the symptomatic side. Protrusion of the symptomatic side was recorded as a positive value and appeared as red on the color map (Figure 1). Data was collected in 3° intervals and analyzed by quadrant using the clock face method; reflecting the 12-3, 3-6, 6-9, and 9-12 o’clock positions. Results: The symptomatic acetabular rim was on average 0.39 ± 0.36 mm thicker than the corresponding location on the asymptomatic rim. When the acetabular clock face was broken up into quadrants, reflecting the 12-3, 3-6, 6-9, and 9-12 o’clock positions, the 12-3 o’clock position demonstrated the greatest difference between symptomatic and asymptomatic sides (Table 1). The 12-3 o’clock quadrant demonstrated significantly greater difference between symptomatic and asymptomatic sides (0.53±0.22 mm) as compared to the 3-6 o’clock position (0.39±0.27 mm; p=0.006), the 6-9 o’clock position (0.34±0.05 mm; p<0.001), and the 9-12 o’clock position (0.33±0.03; p<0.001). There was no correlation between gender and magnitude of difference at any location. Conclusion: Small changes in acetabular rim morphology, on the order of 0.5 mm or less can be the difference between symptomatic pincer-type FAI and the asymptomatic state. Knowledge of the healthy, unaffected side in unilateral FAI may provide a better template for rim recession rather

  3. Symptomatic and asymptomatic benign prostatic hyperplasia: Molecular differentiation by using microarrays

    NASA Astrophysics Data System (ADS)

    Prakash, Kulkarni; Pirozzi, Gregorio; Elashoff, Michael; Munger, William; Waga, Iwao; Dhir, Rajiv; Kakehi, Yoshiyuki; Getzenberg, Robert H.

    2002-05-01

    Benign prostatic hyperplasia (BPH) is a disease of unknown etiology that significantly affects the quality of life in aging men. Histologic BPH may present itself either as symptomatic or asymptomatic in nature. To elucidate the molecular differences underlying BPH, gene expression profiles from the prostate transition zone tissue have been analyzed by using microarrays. A set of 511 differentially expressed genes distinguished symptomatic and asymptomatic BPH. This genetic signature separates BPH from normal tissue but does not seem to change with age. These data could provide novel approaches for alleviating symptoms and hyperplasia in BPH.

  4. [Dependence of the operation stress degree from the kind of operative intervention for an acute cholecystitis in the patients with high operative-anesthesiological risk].

    PubMed

    Bezruchko, M V; Malyk, S V; Kravchenko, S P; Osipov, O S; Sytnik, D A

    2013-03-01

    The results of comparison between the operation stress degree in various kinds of surgical interventions, performed for an acute cholecystitis, using determination of cortizol, prolactin and glucose content before the operation, intraoperatively and postoperatively in 50 patients, are adduced. There was established, that the largest (in 5.3 times) and the most durable (more than 24 hours) intr erative raising of the cortizol level in the blood serum was noted in patients, to whom open cholecystectomy (OCH) was done, and the minimal (in 2.2 times) and the least durable (up to 1 hour)--while performing transcutaneous transhepatic draining (TTD) of gallbladder under ultrasonographic control. While performance of laparoscopic cholecystectomy (LCH) there was noted the most pronounced intraoperative raising of prolactin level (in 3.6 times) and more rapid its lowering (during 24 hours) in comparison with such while the OCH performance (during 72 hours). In TTD there was observed the minimal intraoperative inhancing of the prolactin level (in 2.3 times) and its duration (during 1 hour) postoperatively. The above mentioned have witnessed, that while TTD of gallbladder performance stimulation of the anterior hypophysis is significantly lesser, than while LCH and OCH.

  5. Interventions for chronic blepharitis

    PubMed Central

    Lindsley, Kristina; Matsumura, Sueko; Hatef, Elham; Akpek, Esen K

    2012-01-01

    additional studies not identified by the electronic searches. There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 9 February 2012. Selection criteria We included randomized controlled trials (RCTs) and quasi-randomized controlled trials (CCTs) in which participants were adults aged 16 years or older and clinically diagnosed with chronic blepharitis. We also included trials where participants with chronic blepharitis were a subset of the participants included in the study and data were reported separately for these participants. Interventions within the scope of this review included medical treatment and lid hygiene measures. Data collection and analysis Two authors independently assessed search results, reviewed full-text copies for eligibility, examined risk of bias, and extracted data. Data were meta-analyzed for studies comparing similar interventions and reporting comparable outcomes with the same timing. Otherwise, results for included studies were summarized in the text. Main results There were 34 studies (2169 participants with blepharitis) included in this review: 20 studies (14 RCTs and 6 CCTs) included 1661 participants with anterior or mixed blepharitis and 14 studies (12 RCTs and 2 CCTs) included 508 participants with posterior blepharitis (MGD). Due to the heterogeneity of study characteristics among the included studies, with respect to follow-up periods and types of interventions, comparisons, and condition of participants, our ability to perform meta-analyses was limited. Topical antibiotics were shown to provide some symptomatic relief and were effective in eradicating bacteria from the eyelid margin for anterior blepharitis. Lid hygiene may provide symptomatic relief for anterior and posterior blepharitis. The effectiveness of other treatments for blepharitis, such as topical steroids and oral antibiotics, were inconclusive. Authors’ conclusions Despite identifying 34 trials

  6. Chronic pancreatitis.

    PubMed

    Chari, S T; DiMagno, E P

    2000-09-01

    In the past year, there has been at least one important clinical paper that sheds light on the character and natural history of painful chronic pancreatitis, which has important clinical implications. In addition, several novel mutations have been described in the cationic trypsinogen gene in patients with hereditary pancreatitis. The mechanism by which these mutations cause pancreatic disease remains speculative. The diagnosis of early chronic pancreatitis is controversial. A novel noninvasive pancreatic function test (measurement of postprandial APOB-48) was reported but is unlikely to be a sensitive test of pancreatic function. Pancreatic fibrosis is frequently seen in alcoholics without chronic pancreatitis, and this makes it difficult to interpret the findings on endoscopic ultrasonogram. Recent studies highlight the difficulty in abolishing pancreatic steatorrhea. Recently fibrosing colonopathy in adult patients has been reported. Extracorporeal shockwave lithotripsy combined with endoscopic therapy failed to benefit patients with calcific chronic pancreatitis.

  7. Chronic Pain

    MedlinePlus

    ... adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting ... Institute of Neurological Disorders and Stroke (NINDS). Low Back Pain Fact Sheet Back Pain information sheet compiled by ...

  8. An atypical presentation of intrahepatic perforated cholecystitis: a modern indication to open cholecystectomy. Report of a case

    PubMed Central

    2014-01-01

    Background Intrahepatic gallbladder perforation with chronic liver abscess formation was anecdotically reported in the literature. The aim of this work is to report a case of intrahepatic gallbladder perforation and its atypical clinical presentation. Case presentation A 62-year-old male patient came to our observation; his medical history showed intermittent fever up to 39-40°C of about 2 weeks and anorexia, with an overall weight loss of about 12 Kg. Physical examination of the abdomen was negative. An ultrasound of the liver and an abdominal CT angiogram detected a disomogeneous hypoechoic-hypodense area in the 5th segment of the liver. Differential diagnosis between hepatic abscess or gallbladder cancer remained open. A surgical exploration was planned. After laparoscopic exploration, a conversion to open procedure with an atypical resection of the 5th hepatic segment was performed. Histologic examination of the specimen showed an intrahepatic chronic perforation of the gallbladder with intrahepatic abscess. Conclusion To the best of our knowledge, 18 cases have been reported in the literature as a Niemeier type I perforation. Clinical presentation, even in its extreme rarity, is more often acute. Differential diagnosis between gallbladder cancer versus liver abscess remains controversial. Open approach is mandatory in such cases. PMID:24468118

  9. Ear infection - chronic

    MedlinePlus

    Middle ear infection - chronic; Otitis media - chronic; Chronic otitis media; Chronic ear infection ... Chole RA. Chronic otitis media, mastoiditis, and petrositis. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head & Neck Surgery . 6th ed. ...

  10. Functional Compensation of Motor Function in Pre-Symptomatic Huntington's Disease

    ERIC Educational Resources Information Center

    Kloppel, Stefan; Draganski, Bogdan; Siebner, Hartwig R.; Tabrizi, Sarah J.; Weiller, Cornelius; Frackowiak, Richard S. J.

    2009-01-01

    Involuntary choreiform movements are a clinical hallmark of Huntington's disease. Studies in clinically affected patients suggest a shift of motor activations to parietal cortices in response to progressive neurodegeneration. Here, we studied pre-symptomatic gene carriers to examine the compensatory mechanisms that underlie the phenomenon of…

  11. Endovascular treatment of symptomatic vestibular aqueduct dehiscence as a result of jugular bulb abnormalities.

    PubMed

    Thénint, Marie-Aude; Barbier, Charlotte; Hitier, Martin; Patron, Vincent; Saleme, Suzana; Courthéoux, Patrick

    2014-11-01

    A new endovascular treatment consisting of stent-assisted coil implantation is described for jugular bulb abnormalities causing symptomatic vestibular aqueduct dehiscence. Three patients presenting with vertigo associated with pulsatile tinnitus or hearing loss were treated. This technique cured the vertigo and pulsatile tinnitus in all patients and preserved normal cerebral venous drainage with no side effects.

  12. Coloured Filters Improve Exclusion of Perceptual Noise in Visually Symptomatic Dyslexics

    ERIC Educational Resources Information Center

    Northway, Nadia; Manahilov, Velitchko; Simpson, William

    2010-01-01

    Previous studies of visually symptomatic dyslexics have found that their contrast thresholds for pattern discrimination are the same as non-dyslexics. However, when noise is added to the stimuli, contrast thresholds rise markedly in dyslexics compared with non-dyslexics. This result could be due to impaired noise exclusion in dyslexics. Some…

  13. Radiotherapy for Symptomatic Vertebral Hemangiomas: Results of a Multicenter Study and Literature Review

    SciTech Connect

    Heyd, Reinhard; Seegenschmiedt, M. Heinrich; Rades, Dirk; Winkler, Cornelia; Eich, Hans T.; Bruns, Frank; Gosheger, Georg; Willich, Normann; Micke, Oliver

    2010-05-01

    Purpose: The current study analyzes the potential role of radiotherapy (RT) in symptomatic vertebral hemangioma (SVH). Methods and Materials: Seven cooperating German institutions collected clinical information, treatment plans, and outcome data for all patients with SVH referred for local RT. Results: From 1969 to 2008, a total of 84 patients with 96 symptomatic lesions were irradiated for SVH. The primary indication for radiotherapy was pain (97.6%), and 28.6% of patients had additional neurological symptoms. RT was performed at a median total dose of 34 Gy, with a median single dose of 2.0 Gy. After receiving a median follow-up of 68 months, the overall patient response rate was 90.5%. Complete symptom remission occurred in 61.9% of patients, 28.6% of patients had partial pain relief, and 9.5% of patients had no pain relief. In 26.2% of patients, radiological signs of reossification were observed in long-term follow-up but not significantly correlated with pain relief. Most importantly, total doses of >=34 Gy resulted in significantly greater symptomatic relief and control rate than total doses of <34 Gy. Conclusions: This study consists of the largest database of cases reported so far using RT for SVH. RT is easy, safe, and effective for pain relief treatment for SVH. Total doses of at least 34 Gy give the best symptomatic response.

  14. Symptomatic retention of the patency capsule: a multicenter real life case series

    PubMed Central

    Kopylov, Uri; Nemeth, Artur; Cebrian, Alba; Wurm Johansson, Gabriele; Thorlacius, Henrik; Fernandez-Urien Sainz, Ignacio; Koulaouzidis, Anastasios; Eliakim, Rami; Toth, Ervin

    2016-01-01

    Background and aims: The patency capsule is designed to evaluate the patency of the small bowel before administration of small-bowel capsule endoscopy (SBCE) in patients at high risk of retention. The utilization of a patency capsule may be associated with a risk of symptomatic retention, but very few cases have been reported to date. The aim of our study was to describe our experience with this rare complication of a patency capsule. Methods: This was a multicenter retrospective case series. The medical records of patients who underwent a patency capsule test were scanned and all cases of symptomatic retention were collected. Results: In total, 20 symptomatic cases of retention out of 1615 (1.2 %) patency capsule tests were identified; in one patient, the patency capsule was retained in the esophagus, in the rest, the capsule was detected in the small bowel resulting in abdominal pain or small-bowel obstruction. One patient (5 %) required surgery; all other patients resolved spontaneously or after corticosteroid therapy. Conclusions: Symptomatic patency capsule retention is a very rare complication with a favorable prognosis. It should be recognized but its use in patients with suspected small-bowel stenosis should not be discouraged.

  15. [The symptomatic psychosis of Friedrich Nietzsche, made evident by his last attempt at an autobiography].

    PubMed

    Peters, U H

    1990-01-01

    Nietzsche's autobiography gestates neither conflicts, nor life problems, nor matter suppressed from his subconscious, nor are the speech distortions of the schizophrenic patient to be found. In all, analysis allows with certainty the conclusion that is was written by a sick person suffering from a psycho-organic disorder of the kind Bonhoeffer referred to by the general term "symptomatic psychosis".

  16. Dysgeusia in symptomatic syndrome of inappropriate antidiuretic hormone secretion: think of lung cancer

    PubMed Central

    Singh, Nishith K; Hayes, Shelbi; Hahs, Seth; Varney, Andrew

    2009-01-01

    The case of a 60-year-old woman who presented with marked dysgeusia to all food and symptomatic syndrome of inappropriate antidiuretic hormone secretion (SIADH) is described. She eventually turned out to have metastatic small cell lung cancer. The case study explores the interesting constellation of dysgeusia, SIADH and lung cancer. PMID:21686989

  17. The prevalence of obstructive sleep apnea in symptomatic patients with syndromic craniosynostosis.

    PubMed

    Inverso, G; Brustowicz, K A; Katz, E; Padwa, B L

    2016-02-01

    The reported prevalence of obstructive sleep apnea (OSA) in patients with syndromic craniosynostosis (SCS) varies due to inconsistent definitions of OSA, lack of uniform diagnostic testing, and different mixes of syndromic diagnoses. The purpose of this study was to determine the prevalence of OSA in symptomatic patients with SCS, and to determine whether this differs by phenotypic diagnosis. A retrospective cohort study of children with SCS was conducted. The primary outcome was presence of OSA diagnosed by polysomnography. The prevalence of OSA was calculated and stratified by diagnosis to compare differences in prevalence and severity (mild, moderate, or severe). The prevalence of OSA in symptomatic patients was 74.2%. Patients with Apert syndrome had the highest prevalence (80.6%), followed by Pfeiffer, Crouzon with acanthosis nigricans, and Crouzon syndromes (72.7%, 66.7%, and 64.7%, respectively). Severe OSA was most common in patients with Pfeiffer syndrome (45.5%), while patients with Apert and Crouzon syndromes were more likely to have moderate OSA (29.0% and 23.5%, respectively). Given that 56.4% of patients with SCS are symptomatic and that 74.2% of these symptomatic patients have OSA, it is recommended that a screening level I polysomnography be part of the clinical care for all patients with SCS. PMID:26602951

  18. Exportations of Symptomatic Cases of MERS-CoV Infection to Countries outside the Middle East

    PubMed Central

    O’Hagan, Justin J.; Jewett, Amy; Gambhir, Manoj; Cohen, Nicole J.; Haber, Yoni; Pesik, Nicki; Swerdlow, David L.

    2016-01-01

    In 2012, an outbreak of infection with Middle East respiratory syndrome coronavirus (MERS-CoV), was detected in the Arabian Peninsula. Modeling can produce estimates of the expected annual number of symptomatic cases of MERS-CoV infection exported and the likelihood of exportation from source countries in the Middle East to countries outside the region. PMID:27358972

  19. Association of Vitamin D Receptor Polymorphism with Susceptibility to Symptomatic Pertussis.

    PubMed

    Han, Wanda G H; Hodemaekers, Hennie M; Nagarajah, Bhawani; Poelen, Martien M C; Helm, Kina; Janssen, Riny; van Els, Cécile A C M

    2016-01-01

    Pertussis, caused by infection with the gram negative B. pertussis bacterium, is a serious respiratory illness that can last for months. While B. pertussis infection rates are estimated between 1-10% in the general population, notifications of symptomatic pertussis only comprise 0.01-0.1% indicating that most individuals clear B. pertussis infections without developing (severe) clinical symptoms. In this study we investigated whether genetic risk factors are involved in the development of symptomatic pertussis upon B. pertussis infection. Single-nucleotide polymorphisms (SNPs) in candidate genes, MBL2, IL17A, TNFα, VDR, and IL10 were genotyped in a unique Dutch cohort of symptomatic clinically confirmed (ex-)pertussis patients and in a Dutch population cohort. Of the seven investigated SNPs in five genes, a polymorphism in the Vitamin D receptor (VDR) gene (rs10735810) was associated with pertussis. The VDR major allele and its homozygous genotype were more present in the symptomatic pertussis patient cohort compared to the control population cohort. Interestingly, the VDR major allele correlated also with the duration of reported pertussis symptoms. Vitamin D3 (VD3) and VDR are important regulators of immune activation. Altogether, these findings suggest that polymorphisms in the VDR gene may affect immune activation and the clinical outcome of B. pertussis infection. PMID:26894582

  20. Symptomatic retention of the patency capsule: a multicenter real life case series

    PubMed Central

    Kopylov, Uri; Nemeth, Artur; Cebrian, Alba; Wurm Johansson, Gabriele; Thorlacius, Henrik; Fernandez-Urien Sainz, Ignacio; Koulaouzidis, Anastasios; Eliakim, Rami; Toth, Ervin

    2016-01-01

    Background and aims: The patency capsule is designed to evaluate the patency of the small bowel before administration of small-bowel capsule endoscopy (SBCE) in patients at high risk of retention. The utilization of a patency capsule may be associated with a risk of symptomatic retention, but very few cases have been reported to date. The aim of our study was to describe our experience with this rare complication of a patency capsule. Methods: This was a multicenter retrospective case series. The medical records of patients who underwent a patency capsule test were scanned and all cases of symptomatic retention were collected. Results: In total, 20 symptomatic cases of retention out of 1615 (1.2 %) patency capsule tests were identified; in one patient, the patency capsule was retained in the esophagus, in the rest, the capsule was detected in the small bowel resulting in abdominal pain or small-bowel obstruction. One patient (5 %) required surgery; all other patients resolved spontaneously or after corticosteroid therapy. Conclusions: Symptomatic patency capsule retention is a very rare complication with a favorable prognosis. It should be recognized but its use in patients with suspected small-bowel stenosis should not be discouraged. PMID:27652302

  1. Use of the Crawford tube for symptomatic epiphora without nasolacrimal obstruction

    PubMed Central

    Tong, Nyu-Xia; Zhao, Ying-Ying; Jin, Xiu-Ming

    2016-01-01

    AIM To evaluate the effectiveness of the Crawford tube in treating symptomatic epiphora without nasolacrimal obstruction. METHODS A protocol was adopted for the management of symptomatic epiphora without nasolacrimal obstruction. Patients who suffered symptomatic epiphora without nasolacrimal obstruction in both eyes were included in the study. One eye was treated with Crawford tube intubation and the other eye was treated with medication therapy. Degree of watering, patient satisfaction, and symptomatic improvement were carefully evaluated by one of the authors at the end of the follow-up period, after Crawford tube removal, to ascertain functional results. RESULTS Thirty-seven adult patients (37 eyes) underwent Crawford tube intubation for functional epiphora. The mean follow-up time after removal of the tube was 14.8±4.8mo. The procedure was an overall success in 28 eyes (75.7%), with symptoms improving significantly. Two eyes (5.4%) were relieved of indoor epiphora, two (5.4%) had minimal epiphora outdoors, but only with wind or cold, and five (13.5%) continued to experience tearing both indoors and outdoors. Thirty of the patients (81%) expressed satisfaction with the procedure. CONCLUSION Crawford tube insertion is an effective, safe, simple, and relatively noninvasive treatment strategy for functional lacrimal system obstruction. PMID:26949652

  2. Association of Vitamin D Receptor Polymorphism with Susceptibility to Symptomatic Pertussis

    PubMed Central

    Han, Wanda G. H.; Hodemaekers, Hennie M.; Nagarajah, Bhawani; Poelen, Martien M. C.; Helm, Kina; Janssen, Riny; van Els, Cécile A. C. M.

    2016-01-01

    Pertussis, caused by infection with the gram negative B. pertussis bacterium, is a serious respiratory illness that can last for months. While B. pertussis infection rates are estimated between 1–10% in the general population, notifications of symptomatic pertussis only comprise 0.01–0.1% indicating that most individuals clear B. pertussis infections without developing (severe) clinical symptoms. In this study we investigated whether genetic risk factors are involved in the development of symptomatic pertussis upon B. pertussis infection. Single-nucleotide polymorphisms (SNPs) in candidate genes, MBL2, IL17A, TNFα, VDR, and IL10 were genotyped in a unique Dutch cohort of symptomatic clinically confirmed (ex-)pertussis patients and in a Dutch population cohort. Of the seven investigated SNPs in five genes, a polymorphism in the Vitamin D receptor (VDR) gene (rs10735810) was associated with pertussis. The VDR major allele and its homozygous genotype were more present in the symptomatic pertussis patient cohort compared to the control population cohort. Interestingly, the VDR major allele correlated also with the duration of reported pertussis symptoms. Vitamin D3 (VD3) and VDR are important regulators of immune activation. Altogether, these findings suggest that polymorphisms in the VDR gene may affect immune activation and the clinical outcome of B. pertussis infection. PMID:26894582

  3. Current status of endotherapy for chronic pancreatitis.

    PubMed

    Kwek, Andrew Boon Eu; Ang, Tiing Leong; Maydeo, Amit

    2014-12-01

    Chronic pancreatitis is associated with varied morphological complications, including intraductal stones, main pancreatic ductal strictures, distal biliary strictures and pseudocysts. Endoscopic therapy provides a less invasive alternative to surgery. In addition, extracorporeal shockwave lithotripsy improves the success rate of endoscopic clearance of intraductal stones. However, recent data from randomised trials have shown better long-term outcomes with surgical drainage for obstructive pancreatic ductal disease. In patients with distal biliary strictures, stent insertion leads to good immediate drainage, but after stent removal, recurrent narrowing is common. Endoscopic drainage of pancreatic pseudocysts has excellent outcome and should be accompanied by pancreatic ductal stenting when a ductal communication is evident. In those who remain symptomatic, endoscopic ultrasonography-guided coeliac plexus block may provide effective but short-term pain relief. In this review, we present the current evidence for the role of endotherapy in the management of patients with chronic pancreatitis.

  4. An undiagnosed cause of chronic cough

    PubMed Central

    Malvi, Ketan; Padmanabhan, Arjun; Hari, T. A.

    2015-01-01

    Tracheomalacia (TM) refers to loss of tracheal rigidity and resulting susceptibility to collapse. It is usually an incidental finding during investigations of other illness. The main symptoms are dyspnoea, cough, sputum production and hemoptysis. Most cases are considered as respiratory infection and are treated symptomatically. Acquired TM results from damage to trachea due to various conditions such as inflammation, chronic pressure, or medical/surgical procedures. The diagnosis is done by end-expiratory dynamic tracheal imaging, which demonstrates typical crescentric narrowing of trachea and reduced antero-posterior diameter <50% of normal. Management include conservative measures like cough suppressants or surgical measures like tracheoplasty, stenting or surgical repair. We are reporting a case of chronic cough, which was subsequently diagnosed as TM. PMID:26985425

  5. An undiagnosed cause of chronic cough.

    PubMed

    Malvi, Ketan; Padmanabhan, Arjun; Hari, T A

    2015-01-01

    Tracheomalacia (TM) refers to loss of tracheal rigidity and resulting susceptibility to collapse. It is usually an incidental finding during investigations of other illness. The main symptoms are dyspnoea, cough, sputum production and hemoptysis. Most cases are considered as respiratory infection and are treated symptomatically. Acquired TM results from damage to trachea due to various conditions such as inflammation, chronic pressure, or medical/surgical procedures. The diagnosis is done by end-expiratory dynamic tracheal imaging, which demonstrates typical crescentric narrowing of trachea and reduced antero-posterior diameter <50% of normal. Management include conservative measures like cough suppressants or surgical measures like tracheoplasty, stenting or surgical repair. We are reporting a case of chronic cough, which was subsequently diagnosed as TM. PMID:26985425

  6. Uterine artery embolization for treatment of symptomatic fibroids; a single institution experience

    PubMed Central

    Laios, A; Baharuddin, N; Iliou, K; Gubara, E; O'Sullivan, G

    2014-01-01

    Background: Uterine fibroids are the most common reproductive tract tumours in females. Uterine artery embolization (UAE) is a fertility-sparing procedure for treatment of symptomatic fibroids. We evaluated the efficacy and safety of UAE in the treatment of 118 patients with symptomatic uterine fibroids in a single Academic Centre in the West of Ireland to determine whether fibroid and uterine size affect clinical outcomes and complications. Methods: This was a retrospective cohort of 118 patients who underwent UAE for treatment of symptomatic fibroids between November 2006 and August 2011. Diagnosis of fibroids in symptomatic patients was established by magnetic resonance imaging (MRI) and/or transabdominal ultrasonography (US). Three different embolic agents were used. All patients had at least one follow-up using MRI, at three and/or 12 months. A non-validated questionnaire was used to report patient satisfaction with regards to symptoms improvement on a yes-or-no basis. Results: Mean fibroid volume, uterine size and dominant fibroid size were significantly reduced at three months and one year follow-up (p = 0.00) and that was tallied with symptoms improvement (p < 0.05). Overall patient satisfaction at three months was 84% falling to 75.9% by 12 months (all p < 0.05). Few complications were reported (2.5%). No significant difference was observed in safety or efficacy for different embolic agents. Conclusion: The study confirms the safety and efficacy of UAE in the treatment of symptomatic fibroids. Hippokratia 2014; 18 (3): 258-261. PMID:25694762

  7. Chronic urticaria.

    PubMed Central

    Leznoff, A.

    1998-01-01

    OBJECTIVE: To review the pathophysiology of chronic urticaria in light of recent evidence for it being an autoimmune disease, and to recommend appropriate management. QUALITY OF EVIDENCE: An extensive literature review was supplemented with a MEDLINE search. Articles from easily available journals were preferred. These consisted of the most recent basic articles on autoimmunity in relation to chronic urticaria and a selection of previous articles on pathophysiology, which illustrate consistencies with recent evidence. The investigation and management protocol is supported by original and relevant literature. MAIN FINDINGS: The histopathology and immunohistology of chronic urticaria and certain clinical studies were a prelude to definitive evidence that most instances of chronic urticaria are autoimmune. Although allergic and other causes are uncommon, these must be sought because identification can lead to cure or specific treatment. Management of the much more common autoimmune urticaria is based on principles derived from the demonstrated pathogenesis and on results of published clinical trials. CONCLUSIONS: In most instances, chronic urticaria is an autoimmune disease, but uncommon allergic or other causes must be considered. PMID:9805172

  8. Chronic pain.

    PubMed

    Russo, C M; Brose, W G

    1998-01-01

    Chronic pain is an emotional experience and is defined as pain lasting greater than six months. It is important to understand the neurophysiology of pain in order to treat it. Nociceptors in the periphery travel to the substantia gelatinosa of the spinal cord while secondary and tertiary afferents transmit information from the dorsal horn to the brain. Modification of pain information may take place in these ascending pathways or in descending pathways. Treatment of chronic pain is most successful when it is approached in a multidisciplinary fashion with the focus not only on treatment of underlying etiology, but also on the secondary impacts of pain on the patient's life. The management of chronic pain requires special expertise. Most of the experts in chronic pain assessment and management organize themselves into pain treatment centers. These centers vary widely in their approach to the problem. The most sophisticated is a multidisciplinary center that is university-based and includes teaching and research. Treatment of chronic pain includes a variety of medications, psychological support, and rehabilitation. Multidisciplinary pain management is also an integral part of the palliative care and hospice concept used to treat cancer pain.

  9. Chronic Granulomatous Disease.

    PubMed

    Rawat, Amit; Bhattad, Sagar; Singh, Surjit

    2016-04-01

    Chronic granulomatous disease (CGD) is the most common symptomatic phagocytic defect. It is caused by mutations in genes encoding protein subunits of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex. CGD is characterized by a defective intracellular killing of phagocytosed organisms due to a defective oxidative burst in the neutrophils and macrophages. It is inherited in either X-linked recessive or autosomal recessive pattern. Staphylococcus aureus and Aspergillus species are the most common organisms reported. Infections with Burkholderia, Serratia, and Nocardia warrant a screen for CGD. Suppurative lymphadenitis, cutaneous abscesses, pneumonia and diarrhea constitute the most common problems in children with CGD. A small percentage of children develop autoimmune manifestations (e.g., rheumatoid arthritis, systemic lupus erythematosus, colitis, autoimmune hepatitis) and warrant immunosuppression. X-linked carriers of CGD are at an increased risk of developing autoimmune diseases. Nitroblue-tetrazolium dye reduction test and dihydro-rhodamine assay by flow cytometry are the screening tests for this disorder. While most children do well on long term antibiotic and antifungal prophylaxis, those with severe forms warrant hematopoietic stem cell transplant. The role of regular interferon-γ injections is debatable. Evidence for white cell transfusions is sparse, and gene therapy is under trial.This current review highlights various aspects and studies in CGD. X-linked form of CGD has been noted to carry a poorer prognosis compared to autosomal recessive variants. However, recent evidence suggests that outcome in CGD is determined by the amount of residual NADPH oxidase activity irrespective of mode of inheritance. PMID:26865172

  10. Chronic inflammatory systemic diseases

    PubMed Central

    Straub, Rainer H.; Schradin, Carsten

    2016-01-01

    It has been recognized that during chronic inflammatory systemic diseases (CIDs) maladaptations of the immune, nervous, endocrine and reproductive system occur. Maladaptation leads to disease sequelae in CIDs. The ultimate reason of disease sequelae in CIDs remained unclear because clinicians do not consider bodily energy trade-offs and evolutionary medicine. We review the evolution of physiological supersystems, fitness consequences of genes involved in CIDs during different life-history stages, environmental factors of CIDs, energy trade-offs during inflammatory episodes and the non-specificity of CIDs. Incorporating bodily energy regulation into evolutionary medicine builds a framework to better understand pathophysiology of CIDs by considering that genes and networks used are positively selected if they serve acute, highly energy-consuming inflammation. It is predicted that genes that protect energy stores are positively selected (as immune memory). This could explain why energy-demanding inflammatory episodes like infectious diseases must be terminated within 3–8 weeks to be adaptive, and otherwise become maladaptive. Considering energy regulation as an evolved adaptive trait explains why many known sequelae of different CIDs must be uniform. These are, e.g. sickness behavior/fatigue/depressive symptoms, sleep disturbance, anorexia, malnutrition, muscle wasting—cachexia, cachectic obesity, insulin resistance with hyperinsulinemia, dyslipidemia, alterations of steroid hormone axes, disturbances of the hypothalamic-pituitary-gonadal (HPG) axis, hypertension, bone loss and hypercoagulability. Considering evolved energy trade-offs helps us to understand how an energy imbalance can lead to the disease sequelae of CIDs. In the future, clinicians must translate this knowledge into early diagnosis and symptomatic treatment in CIDs. PMID:26817483

  11. [Chronic cough].

    PubMed

    Schafroth Török, Salome

    2013-09-18

    In non-smokers without intake of an ACE-inhibitor, the three most common causes of chronic cough are eosinophilic airways disease (asthma or eosinophilic bronchitis), Upper-airway-cough-syndrome (UACS) and Gastro-esophageal-reflux desease (GERD). In smokers, chronic bronchitis and COPD are common causes as well. In patients with a normal chest X-ray and lack of information on a less frequent cause in history and physical examination, it is recommended therefore to routinely look for these diseases and/or to treat them empirically. PMID:24025176

  12. Chronic Cough.

    PubMed

    Pacheco, Adalberto; de Diego, Alfredo; Domingo, Christian; Lamas, Adelaida; Gutierrez, Raimundo; Naberan, Karlos; Garrigues, Vicente; López Vime, Raquel

    2015-11-01

    Chronic cough (CC), or cough lasting more than 8 weeks, has attracted increased attention in recent years following advances that have changed opinions on the prevailing diagnostic and therapeutic triad in place since the 1970s. Suboptimal treatment results in two thirds of all cases, together with a new notion of CC as a peripheral and central hypersensitivity syndrome similar to chronic pain, have changed the approach to this common complaint in routine clinical practice. The peripheral receptors involved in CC are still a part of the diagnostic triad. However, both convergence of stimuli and central nervous system hypersensitivity are key factors in treatment success.

  13. Chronic Cough.

    PubMed

    Pacheco, Adalberto; de Diego, Alfredo; Domingo, Christian; Lamas, Adelaida; Gutierrez, Raimundo; Naberan, Karlos; Garrigues, Vicente; López Vime, Raquel

    2015-11-01

    Chronic cough (CC), or cough lasting more than 8 weeks, has attracted increased attention in recent years following advances that have changed opinions on the prevailing diagnostic and therapeutic triad in place since the 1970s. Suboptimal treatment results in two thirds of all cases, together with a new notion of CC as a peripheral and central hypersensitivity syndrome similar to chronic pain, have changed the approach to this common complaint in routine clinical practice. The peripheral receptors involved in CC are still a part of the diagnostic triad. However, both convergence of stimuli and central nervous system hypersensitivity are key factors in treatment success. PMID:26165783

  14. Chronic Bronchitis

    MedlinePlus

    ... risk for emphysema or chronic obstructive pulmonary disease (COPD)? What medicines will help relieve my symptoms? What lifestyle changes should I make at home to help relieve my symptoms? Is it safe for me to exercise? What kind of exercise should I do? What ...

  15. Chronic gastritis

    PubMed Central

    Sipponen, Pentti; Maaroos, Heidi-Ingrid

    2015-01-01

    Abstract Prevalence of chronic gastritis has markedly declined in developed populations during the past decades. However, chronic gastritis is still one of the most common serious pandemic infections with such severe killing sequelae as peptic ulcer or gastric cancer. Globally, on average, even more than half of people may have a chronic gastritis at present. Helicobacter pylori infection in childhood is the main cause of chronic gastritis, which microbial origin is the key for the understanding of the bizarre epidemiology and course of the disease. A life-long and aggressive inflammation in gastritis results in destruction (atrophic gastritis) of stomach mucosa with time (years and decades). The progressive worsening of atrophic gastritis results subsequently in dysfunctions of stomach mucosa. Atrophic gastritis will finally end up in a permanently acid-free stomach in the most extreme cases. Severe atrophic gastritis and acid-free stomach are the highest independent risk conditions for gastric cancer known so far. In addition to the risks of malignancy and peptic ulcer, acid-free stomach and severe forms of atrophic gastritis may associate with failures in absorption of essential vitamins, like vitamin B12, micronutrients (like iron, calcium, magnesium and zinc), diet and medicines. PMID:25901896

  16. Low risk of symptomatic venous thromboembolic events during growth factor administration for PBSC mobilization.

    PubMed

    Naina, H V; Pruthi, R K; Inwards, D J; Dingli, D; Litzow, M R; Ansell, S M; William, H J; Dispenzieri, A; Buadi, F K; Elliott, M A; Gastineau, D A; Gertz, M A; Hayman, S R; Johnston, P B; Lacy, M Q; Micallef, I N; Porrata, L F; Kumar, S

    2011-02-01

    The use of erythropoietic agents has been associated with an increased risk of venous thromboembolic events (VTEs), especially in patients with underlying malignancies. However, it is not known whether there is an increased risk of VTE associated with granulocyte growth factors. We reviewed 621 patients undergoing PBSC mobilization using granulocyte growth factors, alone or in combination with CY. Patients with a diagnosis of AL amyloidosis (AL: 114; 18%), multiple myeloma (MM: 278; 44%) Hodgkin lymphoma (HL: 20; 3%) or non-Hodgkin lymphoma (NHL: 209; 33%) were included. Symptomatic VTE occurred in six (0.97%) patients: two AL, two MM and two NHL. Of the six patients, two had pulmonary embolism, one developed deep vein thrombosis and three developed symptomatic catheter related thrombosis. Two patients with AL had heparin-induced thrombocytopenia and thrombosis. We found a low incidence of VTE among patients undergoing PBSC mobilization.

  17. Relationship between Cumulative BMI and Symptomatic, Psychosocial, and Medical Outcomes in Patients with Borderline Personality Disorder

    PubMed Central

    Frankenburg, Frances R.; Zanarini, Mary C.

    2011-01-01

    We examined the relationship between cumulative body mass index (BMI) and symptomatic, psychosocial, and medical outcomes in patients with borderline personality disorder (BPD). Two hundred female borderline patients were weighed and measured during their index admission. They were subsequently interviewed at six, eight, and 10 years intervals. Over 10 years of prospective follow-up, increases in cumulative BMI were significantly associated with self-mutilation and dissociation (but not suicide attempts). Increases in cumulative BMI were also significantly associated with having no life partner, a poor work or school history, being on disability, being rated with a GAF score in the fair or poor range, and having a low income. In addition, increases in BMI were related to having two or more obesity-related medical conditions and using costly forms of health care. Increases in cumulative BMI may be a marker for adverse symptomatic, functional, and medical outcomes in patients with BPD. PMID:21838559

  18. Discourses of the body in euthanasia: symptomatic, dependent, shameful and temporal.

    PubMed

    Street, A F; Kissane, D W

    2001-09-01

    This theoretical paper is derived from a discourse analysis of the textual material from a study of the seven deaths associated with legalised euthanasia in the Northern Territory, Australia. The textual analysis utilises evidence from interviews, letters written by people seeking euthanasia, medical reports, coroner's records and media reports concerning the social experiment of legalised euthanasia in Australia. The paper does not discuss the euthanasia debate. It argues that the body is a neglected concern in the debates and offers a construction of the discourses of the body as symptomatic, dependent, shameful and temporal. Medical discourses frame the body as symptomatic but these people were also concerned with the loss of autonomy associated with dependence, with shame connected with loss of bodily functions and the embodied experience of determining a 'time to die'.

  19. [Nootropics and antioxidants in the complex therapy of symptomatic posttraumatic epilepsy].

    PubMed

    Savenkov, A A; Badalian, O L; Avakian, G N

    2013-01-01

    To study the possibility of application of nootropics and antioxidants in the complex antiepileptic therapy, we examined 75 patients with symptomatic focal posttraumatic epilepsy. A statistically significant reduction in the number of epileptic seizures, improvement of cognitive function and quality of life of the patients as well as a decrease in the severity of depression and epileptic changes in the EEG were identified. The potentiation of antiepileptic activity of basic drugs, normalization of brain's electrical activity and reduction in EEG epileptiform activity, in particular coherent indicators of slow-wave activity, were noted after treatment with the antioxidant mexidol. A trend towards the improvement of neuropsychological performance and quality of life was observed. There was a lack of seizure aggravation typical of many nootropic drugs. Thus, phenotropil and mexidol can be recommended for complex treatment of symptomatic posttraumatic epilepsy.

  20. Occurrence of symptomatic knee osteoarthrosis in rural Finland: a prospective follow up study.

    PubMed Central

    Kannus, P; Järvinen, M; Kontiala, H; Bergius, L; Hyssy, E; Salminen, E; Tuomi, A; Unkila, T; Valtanen, I

    1987-01-01

    All visits to physicians in the Orivesi Region Federation of Municipalities for Public Health Work in Finland paid due to symptomatic osteoarthrosis of the knee joint were prospectively recorded over a period of one year. Two hundred and thirty four visits were made, accounting for 0.63% of all visits. The prevalence of knee osteoarthrosis was 1.11% (men 0.45%, women 1.72%), and the incidence was 0.60%. The disease occurred almost twice as often in the right knee than in the left. The study provides basic information about patients needing medical help because of symptomatic knee osteoarthrosis. The results can be used as an aid to the planning of examination and treatment resources and in assessment of the need for such services. PMID:3426287

  1. The Optimal Approach to Symptomatic Paraesophageal Hernia Repair: Important Technical Considerations.

    PubMed

    Zaman, Jessica A; Lidor, Anne O

    2016-10-01

    While the asymptomatic paraesophageal hernia (PEH) can be observed safely, surgery is indicated for symptomatic hernias. Laparoscopic repair is associated with decreased morbidity and mortality; however, it is associated with a higher rate of radiologic recurrence when compared with the open approach. Though a majority of patients experience good symptomatic relief from laparoscopic repair, strict adherence to good technique is critical to minimize recurrence. The fundamental steps of laparoscopic PEH repair include adequate mediastinal mobilization of the esophagus, tension-free approximation of the diaphragmatic crura, and gastric fundoplication. Collis gastroplasty, mesh reinforcement, use of relaxing incisions, and anterior gastropexy are just a few adjuncts to basic principles that can be utilized and have been widely studied in recent years. In this article, we present a comprehensive review of literature addressing key aspects and controversies regarding the optimal approach to repairing paraesophageal hernias laparoscopically. PMID:27595155

  2. Prevalence of filariasis in symptomatic patients in Moyen Chari district, south of Chad.

    PubMed

    Bregani, Enrico Rino; Balzarini, Laura; Mbaïdoum, Narassem; Rovellini, Angelo

    2007-07-01

    Filarial parasites infect an estimated 140 million people worldwide. Wuchereria bancrofti, Onchocerca volvulus, Loa loa and Mansonella perstans are responsible for most filarial infections in sub-Saharan Africa. We describe the prevalence and the clinical characteristics of filariasis in symptomatic patients in Goundi Sanitary district:167 patients were enrolled (99 men, 68 women). M. perstans microfilariae were isolated in peripheral blood in 164 cases, while Loa loa and Wuchereria bancrofti filariasis were diagnosed in only six and three cases, respectively. The most frequent filariasis observed in our study were due to M. perstans and L. loa, while the few cases of W. bancrofti filariasis seem to have been acquired abroad. No cases of O. volvulus were observed. Microfilarial burden was not related to symptoms, but a correlation between eosinophilia and pruritus was evident. No relationship was observed between eosinophils and symptoms. The prevalence observed in symptomatic patients could reflect the real prevalence of filariasis. PMID:17716512

  3. Preliminary report on the Jones, Ellison, Slocum (JES) repair for symptomatic anterior cruciate deficient knees.

    PubMed

    Ritter, M A; Leaming, E S; McCarroll, J R

    1983-01-01

    A modified Jones intraarticular anterior cruciate reconstruction was combined with a distal iliotibial band transfer (Ellison) and a pes anserinus transfer (Slocum) for patients with symptomatic anterior cruciate deficient knees. The procedure was performed on 15 young (average age, 22.5 years) athletes, in a single operation through a long, straight, anterior, midline incision. Preoperatively, all 15 patients (15 knees) had symptomatic instability and all but one had a positive pivot shift. At follow up (averaging 39 month range 24-60 months) 13 (93%) had the pivot shift eliminated and only one, with 36 months followup, had instability on return to sports. Postoperatively, patients were immobilized 3 weeks and then were started on a physical therapy program which ended in return to sports at 1 year.

  4. Cartilage degeneration at symptomatic persistent olecranon physis in adolescent baseball players.

    PubMed

    Enishi, Tetsuya; Matsuura, Tetsuya; Suzue, Naoto; Takahashi, Yoshinori; Sairyo, Koichi

    2014-01-01

    Background. Elbow overuse injuries are common in adolescent baseball players, but symptomatic persistent olecranon physis is rare, and its pathogenesis remains unclear. Purpose. To examine the histopathological and imaging findings of advanced persistent olecranon physis. Methods. The olecranon physes of 2 baseball pitchers, aged 14 and 15 years, were examined by preoperative magnetic resonance imaging (MRI), and surgical specimens were examined histologically. Results. T2-weighted MRI revealed alterations in the intrachondral signal intensity possibly related to collagen degeneration and increased free water content. Histological findings of specimens stained with hematoxylin-eosin showed complete disorganization of the cartilage structure, hypocellularity, chondrocyte cluster formation, and moderately reduced staining. All these findings are hallmarks of osteoarthritis and are suggestive of cartilage degeneration. Conclusion. Growth plate degeneration was evident in advanced cases of symptomatic persistent olecranon physis. These findings contribute to understanding the pathogenesis of this disease.

  5. A Critical Protection Level Derived from Dengue Infection Mathematical Model Considering Asymptomatic and Symptomatic Classes

    NASA Astrophysics Data System (ADS)

    Anggriani, N.; Supriatna, A. K.; Soewono, E.

    2013-04-01

    In this paper we formulate a model of dengue fever transmission by considering the presence of asymptomatic and symptomatic compartments. The model takes the form as a system of differential equations representing a host-vector SIR (Susceptible - Infective -Recovered) disease transmission. It is assumed that both host and vector populations are constant. It is also assumed that reinfection of recovered hosts by the disease is possible due to a wanning immunity in human body. We analyze the model to determine the qualitative behavior of the model solution and use the concept of effective basic reproduction number (fraktur Rp) as a control criteria of the disease transmission. The effect of mosquito biting protection (e.g. by using insect repellent) is also considered. We compute the long-term ratio of the asymptomatic and symptomatic classes and show a condition for which the iceberg phenomenon could appear.

  6. Symptomatic Lymphocele Formation After Sentinel Lymph Node Biopsy for Early Stage Cervical Cancer.

    PubMed

    Dogan, Nasuh Utku; Garagozova, Nigar; Pfiffer, Tatiana; Beier, Anna; Köhler, Christhardt; Favero, Giovanni

    2016-01-01

    In early stage cervical cancer, nodal status is the most important prognostic factor, and execution of retroperitoneal lymphadenectomy is currently an integral part of surgical therapy. Sentinel lymph node biopsy has been progressively incorporated with surgical therapy and could reduce morbidity. However, the current incidence of complications exclusively related to the procedure is unknown. We report on a 29-year-old woman affected by cervical cancer (Fédération Internationale de Gynécologie et d'Obstétrique Stage 1b1), who underwent sentinel lymph node biopsy in combination with radical vaginal trachelectomy, and who later developed a symptomatic pelvic lymphocele that required surgical therapy. Conservative procedures in the pelvic lymph nodes are not free of complications, especially with regard to the formation of symptomatic lymphoceles. This report brings to light an important discussion about the exact magnitude of the complications associated with the procedure.

  7. Diagnosis and perioperative management of ruptured AAA mimicking symptomatic groin hernia

    PubMed Central

    Klein, Holger Jan; Becker, Daniel; Rancic, Zoran

    2015-01-01

    Introduction Ruptured abdominal aortic aneurysm (RAAA) can infrequently present as symptomatic groin hernia. This misleading form of presentation often leads to erroneous preoperative management resulting in poor survival. Case presentation Two patients with RAAA mimicking symptomatic groin hernia underwent different preoperative managements pointing out the importance of the principles of hypotensive haemostasis in the scope of this emergency scenario. Conclusion Computed Tomography Angiography (CTA) remains the recommended diagnostic tool—for both safe diagnosis of the ruptured aneurysm and precise preoperative planning. Endovascular aortic repair of the RAAA—if feasible—is the treatment of choice. This rare form of RAAA manifestation should call physicians attention—especially in patients with known abdominal aortic aneurysms in their preceding medical history. PMID:26656148

  8. Cartilage Degeneration at Symptomatic Persistent Olecranon Physis in Adolescent Baseball Players

    PubMed Central

    Enishi, Tetsuya; Matsuura, Tetsuya; Suzue, Naoto; Takahashi, Yoshinori; Sairyo, Koichi

    2014-01-01

    Background. Elbow overuse injuries are common in adolescent baseball players, but symptomatic persistent olecranon physis is rare, and its pathogenesis remains unclear. Purpose. To examine the histopathological and imaging findings of advanced persistent olecranon physis. Methods. The olecranon physes of 2 baseball pitchers, aged 14 and 15 years, were examined by preoperative magnetic resonance imaging (MRI), and surgical specimens were examined histologically. Results. T2-weighted MRI revealed alterations in the intrachondral signal intensity possibly related to collagen degeneration and increased free water content. Histological findings of specimens stained with hematoxylin-eosin showed complete disorganization of the cartilage structure, hypocellularity, chondrocyte cluster formation, and moderately reduced staining. All these findings are hallmarks of osteoarthritis and are suggestive of cartilage degeneration. Conclusion. Growth plate degeneration was evident in advanced cases of symptomatic persistent olecranon physis. These findings contribute to understanding the pathogenesis of this disease. PMID:25580304

  9. Increased platelet count and leucocyte–platelet complex formation in acute symptomatic compared with asymptomatic severe carotid stenosis

    PubMed Central

    McCabe, D; Harrison, P; Mackie, I; Sidhu, P; Purdy, G; Lawrie, A; Watt, H; Machin, S; Brown, M

    2005-01-01

    Objective: The risk of stroke in patients with recently symptomatic carotid stenosis is considerably higher than in patients with asymptomatic stenosis. In the present study it was hypothesised that excessive platelet activation might partly contribute to this difference. Methods: A full blood count was done and whole blood flow cytometry used to measure platelet surface expression of CD62P, CD63, and PAC1 binding and the percentage of leucocyte–platelet complexes in patients with acute (0–21 days, n = 19) and convalescent (79–365 days) symptomatic (n = 16) and asymptomatic (n = 16) severe (⩾70%) carotid stenosis. Most patients were treated with aspirin (37.5–300 mg daily) although alternative antithrombotic regimens were more commonly used in the symptomatic group. Results: The mean platelet count was higher in patients with acute and convalescent symptomatic compared with asymptomatic carotid stenosis. There were no significant differences in the median percentage expression of CD62P and CD63, or PAC1 binding between the acute or convalescent symptomatic and asymptomatic patients. The median percentages of neutrophil–platelet (p = 0.004), monocyte–platelet (p = 0.046), and lymphocyte–platelet complexes (p = 0.02) were higher in acute symptomatic than in asymptomatic patients. In patients on aspirin monotherapy, the percentages of neutrophil–platelet and monocyte–platelet complexes (p = 0.03) were higher in acute symptomatic (n = 11) than asymptomatic patients (n = 14). In the convalescent phase, the median percentages of all leucocyte–platelet complexes in the symptomatic group dropped to levels similar to those found in the asymptomatic group. Conclusion: Increased platelet count and leucocyte–platelet complex formation may contribute to the early excess risk of stroke in patients with recently symptomatic carotid stenosis. PMID:16107361

  10. Symptomatic versus inapparent outcome in repeat dengue virus infections is influenced by the time interval between infections and study year.

    PubMed

    Montoya, Magelda; Gresh, Lionel; Mercado, Juan Carlos; Williams, Katherine L; Vargas, Maria José; Gutierrez, Gamaliel; Kuan, Guillermina; Gordon, Aubree; Balmaseda, Angel; Harris, Eva

    2013-01-01

    Four dengue virus serotypes (DENV1-4) circulate globally, causing more human illness than any other arthropod-borne virus. Dengue can present as a range of clinical manifestations from undifferentiated fever to Dengue Fever to severe, life-threatening syndromes. However, most DENV infections are inapparent. Yet, little is known about determinants of inapparent versus symptomatic DENV infection outcome. Here, we analyzed over 2,000 DENV infections from 2004 to 2011 in a prospective pediatric cohort study in Managua, Nicaragua. Symptomatic cases were captured at the study health center, and paired healthy annual samples were examined on a yearly basis using serological methods to identify inapparent DENV infections. Overall, inapparent and symptomatic DENV infections were equally distributed by sex. The mean age of infection was 1.2 years higher for symptomatic DENV infections as compared to inapparent infections. Although inapparent versus symptomatic outcome did not differ by infection number (first, second or third/post-second DENV infections), substantial variation in the proportion of symptomatic DENV infections among all DENV infections was observed across study years. In participants with repeat DENV infections, the time interval between a first inapparent DENV infection and a second inapparent infection was significantly shorter than the interval between a first inapparent and a second symptomatic infection. This difference was not observed in subsequent infections. This result was confirmed using two different serological techniques that measure total anti-DENV antibodies and serotype-specific neutralizing antibodies, respectively. Taken together, these findings show that, in this study, age, study year and time interval between consecutive DENV infections influence inapparent versus symptomatic infection outcome, while sex and infection number had no significant effect. Moreover, these results suggest that the window of cross-protection induced by a first

  11. Symptomatic knee osteonecrosis in patients with systemic lupus erythematosus: a case-control study.

    PubMed

    Zhao, Lidan; Wu, Xiuhua; Wu, Honghua; Su, Jinmei; Zhang, Wen; Zhao, Yan; Zhang, Xuan; Zheng, Wenjie

    2016-08-01

    To explore the associated risk factors of symptomatic knee osteonecrosis (KON) in patients with systemic lupus erythematosus (SLE), we conducted a retrospective case-control study to compare the clinical and laboratory features between SLE patients with and without symptomatic KON matched by age and gender. Univariate and multivariate regression analyses were used to evaluate possible associated risk factors. Twenty (one male, nineteen females) out of 3941 lupus patients were identified as symptomatic KON, which was confirmed by magnetic resonance imaging. The mean age at KON onset was 34.4 (range 12-67) years, and the median course of lupus at KON onset was 72.5 (range 8-123) months. Univariate and multivariate analyses identified that the prevalence of cutaneous vasculitis (OR 5.23; 95 % CI 1.11-24.70), hyperfibrinogenemia (OR 4.75; 95 % CI 1.08-20.85), and elevated IgG levels (OR 6.05; 95 % CI 1.58-23.16) were statistically higher in KON group, and hydroxychloroquine (HCQ) usage was statistically lower in KON group (OR 0.27; 95 % CI 0.07-0.97). Glucocorticoid usage, in terms of maximal dose, duration of treatment, and the percentage of receiving methylprednisolone pulse therapy, did not show statistical difference between the two groups (p > 0.05). Symptomatic KON is a relatively rare complication of SLE. Cutaneous vasculitis, hyperfibrinogenemia, and elevated IgG levels are possible risk factors, whereas HCQ may provide a protective effect. Our results suggest that lupus activity as well as hypercoagulation status may play a role in the pathogenesis of KON in lupus. PMID:27230994

  12. Dynamic Computational Model of Symptomatic Bacteremia to Inform Bacterial Separation Treatment Requirements

    PubMed Central

    Miller, Sinead E.; Bell, Charleson S.; Cover, Timothy L.; Giorgio, Todd D.

    2016-01-01

    The rise of multi-drug resistance has decreased the effectiveness of antibiotics, which has led to increased mortality rates associated with symptomatic bacteremia, or bacterial sepsis. To combat decreasing antibiotic effectiveness, extracorporeal bacterial separation approaches have been proposed to capture and separate bacteria from blood. However, bacteremia is dynamic and involves host-pathogen interactions across various anatomical sites. We developed a mathematical model that quantitatively describes the kinetics of pathogenesis and progression of symptomatic bacteremia under various conditions, including bacterial separation therapy, to better understand disease mechanisms and quantitatively assess the biological impact of bacterial separation therapy. Model validity was tested against experimental data from published studies. This is the first multi-compartment model of symptomatic bacteremia in mammals that includes extracorporeal bacterial separation and antibiotic treatment, separately and in combination. The addition of an extracorporeal bacterial separation circuit reduced the predicted time of total bacteria clearance from the blood of an immunocompromised rodent by 49%, compared to antibiotic treatment alone. Implementation of bacterial separation therapy resulted in predicted multi-drug resistant bacterial clearance from the blood of a human in 97% less time than antibiotic treatment alone. The model also proposes a quantitative correlation between time-dependent bacterial load among tissues and bacteremia severity, analogous to the well-known ‘area under the curve’ for characterization of drug efficacy. The engineering-based mathematical model developed may be useful for informing the design of extracorporeal bacterial separation devices. This work enables the quantitative identification of the characteristics required of an extracorporeal bacteria separation device to provide biological benefit. These devices will potentially decrease the

  13. Identification of Symptomatic Fetuses Infected with Cytomegalovirus Using Amniotic Fluid Peptide Biomarkers

    PubMed Central

    Leruez-Ville, Marianne; Ramirez-Torres, Adela; Lacroix, Chrystelle; Breuil, Benjamin; Froment, Carine; Bascands, Jean-Loup; Schanstra, Joost P.; Ville, Yves

    2016-01-01

    Cytomegalovirus (CMV) is the most common cause of congenital infection, and is a major cause of sensorineural hearing loss and neurological disabilities. Evaluating the risk for a CMV infected fetus to develop severe clinical symptoms after birth is crucial to provide appropriate guidance to pregnant women who might have to consider termination of pregnancy or experimental prenatal medical therapies. However, establishing the prognosis before birth remains a challenge. This evaluation is currently based upon fetal imaging and fetal biological parameters, but the positive and negative predictive values of these parameters are not optimal, leaving room for the development of new prognostic factors. Here, we compared the amniotic fluid peptidome between asymptomatic fetuses who were born as asymptomatic neonates and symptomatic fetuses who were either terminated in view of severe cerebral lesions or born as severely symptomatic neonates. This comparison allowed us to identify a 34-peptide classifier in a discovery cohort of 13 symptomatic and 13 asymptomatic neonates. This classifier further yielded 89% sensitivity, 75% specificity and an area under the curve of 0.90 to segregate 9 severely symptomatic from 12 asymptomatic neonates in a validation cohort, showing an overall better performance than that of classical fetal laboratory parameters. Pathway analysis of the 34 peptides underlined the role of viral entry in fetuses with severe brain disease as well as the potential importance of both beta-2-microglobulin and adiponectin to protect the injured fetal brain infected with CMV. The results also suggested the mechanistic implication of the T calcium channel alpha-1G (CACNA1G) protein in the development of seizures in severely CMV infected children. These results open a new field for potential therapeutic options. In conclusion, this study demonstrates that amniotic fluid peptidome analysis can effectively predict the severity of congenital CMV infection. This

  14. Utility of Microbiological Profile of Symptomatic Vaginal Discharge in Rural Women of Reproductive Age Group

    PubMed Central

    Patel, Jaya; Gupta, Sweta

    2015-01-01

    Introduction: Symptomatic vaginal discharge is the most frequent symptom in women of reproductive age group. Owing to social stigma majority of affected women hesitate to seek medical consultation. Therefore the actual incidence of vaginal discharge is much more than what is reported. The aim of the study is to determine the microbiological profile of symptomatic vaginal discharge in rural area and its utility in the management of genital tract infection. Materials and Methods: This was a descriptive type of observational study, conducted in sexually active women of reproductive age group (18-45 years) attending the OPD/IPD of Obstetrics and Gynaecology Department of National Institute of Medical Sciences, Shobhanagar, Jaipur (Rajasthan), over a period of 18 months from June 2012 to December 2013. Hundred sexually active non pregnant women of reproductive age group (18-45 years) were included in the study. After taking consent general physical examination along with pelvic examination was performed. Two high vaginal swabs and blood sample were collected for various tests. Hanging drop preparation was immediately made. This was followed by gram staining and culture. Chlamydia trachomatis IgM antibody was detected by ELISA method. Results: Out of 100 women with symptomatic vaginal discharge, specific diagnosis was obtained in 89% of cases whereas no specific aetiology was found in 11% cases. Mean age was 32.60 years. Fifty-three percent patient had Bacterial vaginosis, candidiasis was found in 14% cases, 16% had Chlamydia trachomatis infection while Trichomonas vaginalis infection was detected in 6% cases. Homogenous discharge was most prevalent (52%), followed by mucopurulant discharge in 23% of women. Conclusion: Patient with symptomatic vaginal discharge need to be actively managed with appropriate antimicrobial agents. Judicious management may be helpful in prevention of HIV, HPV, CIN and post infection sequelae. PMID:25954668

  15. Transurethral Unroofing of a Symptomatic Imperforate Cowper's Syringocele in an Adult Male

    PubMed Central

    Harris, Catherine R.; Gaither, Thomas W.; Osterberg, E. Charles

    2016-01-01

    Cystic dilatation of bulbourethral gland ducts (Cowper's gland syringocele) is a rare abnormality. The condition has been described among pediatric populations, but it is uncommon in adults. It can be asymptomatic or present with obstructive and irritative urinary symptoms. We report a case of a symptomatic imperforate Cowper's syringocele in a young patient that was successfully managed with transurethral unroofing of the cyst. PMID:27119039

  16. Complications of cerebral angiography in patients with symptomatic carotid territory ischaemia screened by carotid ultrasound.

    PubMed Central

    Davies, K N; Humphrey, P R

    1993-01-01

    After nearly 40 years, carotid endarterectomy has been shown to be of benefit to patients with symptomatic carotid territory ischaemia and greater than 70% stenosis of the relevant internal carotid artery. Cerebral angiography is performed before surgery and is not without risk. These risks must be added to those of surgery before recommending the procedure to patients. The study evaluated the local, systemic and neurological complications following digital subtraction angiography with selective catheterisation of the carotid arteries in 200 patients presenting to a cerebrovascular clinic for assessment of cerebral ischaemia. All patients had carotid ultrasound screening before angiography to screen out those with normal arteries or mild disease (less than 30% stenosis of symptomatic internal carotid artery). Complications occurred in 28 patients. There were six (3%) local, two (1%) systemic and 20 (10%) neurological complications. Seventeen neurological complications occurred within 24 hours and there were three late complications (24-72 hours). Neurological complications occurred more frequently when angiography was performed by a trainee rather than a consultant neuroradiologist (p < 0.01). The neurological complications were transient (resolved within 24 hours) in 10/200 (5%), reversible (resolved within seven days) in two (1%) and permanent in 8/200 (4%). Two patients died after a stroke and two other patients suffered a disabling stroke. At 24 hours post angiography the permanent (persisting beyond seven days) neurological complication rate was 2.5%. The incidence of total neurological complications and post angiographic strokes was higher in patients with greater than 90% stenosis of the symptomatic internal carotid artery (p < 0.001). The increased use of non-invasive Doppler duplex screening will reduced the absolute number of patients put at risk of angiography, yet the rate of post angiographic complications is likely to increase as patients with severe

  17. Progesterone for Symptomatic Perimenopause Treatment - Progesterone politics, physiology and potential for perimenopause.

    PubMed

    Prior, J C

    2011-01-01

    Perimenopause, women's normal midlife reproductive transition, is highly symptomatic for about 20% of women who are currently inaccurately counseled and inappropriately treated with oral contraceptives, menopausal hormone therapy or hysterectomy. About 80% of perimenopausal women experience vasomotor symptoms (VMS), 25% have menorrhagia, and about 10% experience mastalgia. The majority of women describe varying intensities of sleep, -coping or mood difficulties. Women are more symptomatic because common knowledge inaccurately says that estradiol (E2) levels are dropping/deficient. Evidence shows that with disturbed brain-ovary feedbacks, E2 levels average 26% higher and soar erratically - some women describe feeling pregnant! Also, ovulation and progesterone (P4) levels become insufficient or absent. The most symptomatic women have higher E2 and lower P4 levels. Because P4 and E2 complement/counterbalance each other's tissue effects, oral micronized P4 (OMP4 300 mg at -bedtime) is a physiological therapy for treatment-seeking, symptomatic perimenopausal women. Given cyclically (cycle d 14-27, or 14 on/off) in menstruating midlife women, OMP4 decreases cyclic VMS, improves sleep and premenstrual mastalgia. Menorrhagia is treated with ibuprofen 200mg/6h plus OMP4 cycle d 4-28. For insulin resistance, metformin plus cyclic or daily OMP4 decreases insulin resistance and weight gain. Non-responsive migraines need daily OMP4 plus usual therapies. VMS and insomnia in late perimenopause respond to daily OMP4. In summary, OMP4 is a physiology-based therapy that improves sleep, treats VMS, does not increase breast proliferation or cancer risk, increases bone formation and has beneficial cardiovascular effects. A controlled trial is testing OMP4 for perimenopausal VMS - more evidence-based data are needed. PMID:24753856

  18. Progesterone for Symptomatic Perimenopause Treatment – Progesterone politics, physiology and potential for perimenopause

    PubMed Central

    Prior, J.C.

    2011-01-01

    Perimenopause, women’s normal midlife reproductive transition, is highly symptomatic for about 20% of women who are currently inaccurately counseled and inappropriately treated with oral contraceptives, menopausal hormone therapy or hysterectomy. About 80% of perimenopausal women experience vasomotor symptoms (VMS), 25% have menorrhagia, and about 10% experience mastalgia. The majority of women describe varying intensities of sleep, coping or mood difficulties. Women are more symptomatic because common knowledge inaccurately says that estradiol (E2) levels are dropping/deficient. Evidence shows that with disturbed brain-ovary feedbacks, E2 levels average 26% higher and soar erratically – some women describe feeling pregnant! Also, ovulation and progesterone (P4) levels become insufficient or absent. The most symptomatic women have higher E2 and lower P4 levels. Because P4 and E2 complement/counterbalance each other’s tissue effects, oral micronized P4 (OMP4 300 mg at bedtime) is a physiological therapy for treatment-seeking, symptomatic perimenopausal women. Given cyclically (cycle d 14-27, or 14 on/off) in menstruating midlife women, OMP4 decreases cyclic VMS, improves sleep and premenstrual mastalgia. Menorrhagia is treated with ibuprofen 200mg/6h plus OMP4 cycle d 4-28. For insulin resistance, metformin plus cyclic or daily OMP4 decreases insulin resistance and weight gain. Non-responsive migraines need daily OMP4 plus usual therapies. VMS and insomnia in late perimenopause respond to daily OMP4. In summary, OMP4 is a physiology-based therapy that improves sleep, treats VMS, does not increase breast proliferation or cancer risk, increases bone formation and has beneficial cardiovascular effects. A controlled trial is testing OMP4 for perimenopausal VMS – more evidence-based data are needed. PMID:24753856

  19. Hip joint biomechanics during gait in people with and without symptomatic femoroacetabular impingement.

    PubMed

    Diamond, Laura E; Wrigley, Tim V; Bennell, Kim L; Hinman, Rana S; O'Donnell, John; Hodges, Paul W

    2016-01-01

    Femoroacetabular impingement (FAI) is a morphological hip condition that can cause hip/groin pain and impaired function in younger active adults, and may lead to stiffness, muscle weakness, structural damage, and hip osteoarthritis. Understanding the impairments associated with FAI is crucial to guide treatment and rehabilitation strategies. Evidence is limited and conflicting about whether hip biomechanics are impaired during walking in people with symptomatic FAI. The objective of this study was to determine whether kinematics and kinetics during gait differ between people with symptomatic FAI and control participants. Fifteen participants diagnosed with symptomatic cam-type or combined (cam plus pincer) FAI who were scheduled for arthroscopic surgery and 14 age-, and sex-matched disease-free controls underwent three-dimensional gait analysis. Tri-planar hip kinematics and kinetics were compared between the two groups. There were limited significant between-group differences with respect to spatiotemporal variables. Participants with FAI walked with less range of motion in the sagittal plane during a gait cycle, but did not exhibit any significant kinematic differences in the frontal or transverse planes. There were no systematic differences in kinetics between the groups in any plane. Findings suggest that individuals with symptomatic FAI have minimal impairments in gait biomechanics. Although these individuals demonstrate reduced hip joint motion in the sagittal plane, the size of the difference is small and its significance for symptoms and function is unclear. More pronounced deficits in hip kinetics and kinematics may be evident during functional tasks that challenge the hip towards the position of impingement.

  20. Endometrial pathology in postmenopausal tamoxifen treatment: comparison between gynaecologically symptomatic and asymptomatic breast cancer patients.

    PubMed Central

    Cohen, I; Perel, E; Flex, D; Tepper, R; Altaras, M M; Cordoba, M; Beyth, Y

    1999-01-01

    AIMS: To evaluate whether endometrial pathology is more likely to be diagnosed in gynaecologically symptomatic rather than in gynaecologically asymptomatic postmenopausal breast cancer patients with tamoxifen treatment; and to evaluate the possible influence of various clinical factors on the incidence of endometrial pathology. METHODS: Endometrial histological findings, transvaginal ultrasonographic endometrial thickness, demographic characteristics, health habits, and risk factors for endometrial cancer were compared between 14 gynaecologically symptomatic (group I) and 224 gynaecologically asymptomatic (group II) postmenopausal breast cancer patients with tamoxifen treatment. RESULTS: Overall, 28.6% of the study population had endometrial pathology. The incidence of overall positive endometrial histological findings was significantly higher in group I than in group II (92.9% v 24.6%, p < 0.0001). Atrophic endometrium was more common in group II than in group I (75.3% v 7.1%, p < 0.0001). Most other endometrial pathology was significantly more common in group I than in group II (endometrial hyperplasia, 35.7% v 5.6%, p < 0.0001; endometrial polyps, 35.7% v 13.4%, p < 0.0111; endometrial carcinoma, 21.5% v 0.9%, p < 0.0001). Endometrial pathology appeared considerably later in the gynaecologically asymptomatic patients than in gynaecologically symptomatic patients (p = 0.0002). Vaginal bleeding or spotting occurred exclusively in group I. The incidence of endometrial pathology in the entire study population was consistent with that reported elsewhere, and higher than that reported for healthy postmenopausal women. CONCLUSIONS: Endometrial pathology is more likely to be diagnosed in gynaecologically symptomatic postmenopausal breast cancer patients with tamoxifen treatment, and after a shorter duration of time, than in gynaecologically asymptomatic patients. PMID:10474520

  1. Efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome

    PubMed Central

    Chauhan, Vidyalaxmi; Shah, Maitri C.; Patel, Sangita V.; Marfatia, Yogesh S.; Zalavadiya, Dhara

    2016-01-01

    Background: In spite of a few shortcomings such as over diagnosis and over treatment, syndromic management is a recommended practice in India for sexually transmitted infections (STIs). This study tries to find out the efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. Objective: The objective of the study is to find out the effectiveness of syndromic management in terms of symptomatic improvement among females with vaginal discharge syndrome. Materials and Methods: A longitudinal study was conducted in Gynecology Department of Tertiary Care Hospital including 180 symptomatic females having vaginal discharge syndrome. Demographic profile, presenting complaints, menstrual history, obstetric history, partner history, and contraceptive history were noted. This was followed by clinical examination and specimen collection for laboratory tests and blood tests to find out type of STI including viral STI such as human immunodeficiency virus (HIV), herpes simplex virus (HSV), and hepatitis B surface antigen (HBsAg). Treatment was given according to syndromic management on the same day. All the participants were asked to come for follow-up after 15 days and their improvement in symptoms was noted as complete improvement, some improvement or no improvement on a five point scale. Results: 63.9% cases showed complete improvement, while 36.1% showed some improvement. None of the patients was without any improvement. Vaginal discharge syndrome was most common between 20 and 30 years (43.4%), and 67.8% of symptomatic females with vaginal discharge syndrome belonged to the lower socioeconomic group. HSV infection was the most common (15%) associated viral infection with vaginal discharge syndrome, while hepatitis B infection was the least common (0.5%). HIV was reactive in 2.8% cases only. Conclusion: Syndromic management was found to be effective in relieving symptoms in most of the cases of vaginal discharge syndrome

  2. Symptomatic Anterior Cervical Osteophyte Causing Dysphagia: Case Report, Imaging, and Review of the Literature

    PubMed Central

    Sung, Kwang; Tharin, Suzanne

    2016-01-01

    Anterior cervical osteophytes are found in 20-30% of elderly patients. Rarely, severe osteophytes can cause dysphagia, dysphonia, and dyspnea. Here, we illustrate a case of severe dysphagia caused by a large post-traumatic osteophyte with oropharyngeal swallow study showing a significant mass effect on the pharynx and resolution following osteophytectomy. We also review the literature regarding the etiology, diagnosis, and treatment of symptomatic anterior cervical osteophytes.  PMID:27004150

  3. Brief time-based activity pacing instruction as a singular behavioral intervention was not effective in participants with symptomatic osteoarthritis.

    PubMed

    Murphy, Susan L; Kratz, Anna L; Kidwell, Kelley; Lyden, Angela K; Geisser, Michael E; Williams, David A

    2016-07-01

    Osteoarthritis (OA) of the lower extremities is a prevalent cause of disability in which symptoms interfere with mobility and activity participation. Behavioral self-management for OA symptomatology is commonly recommended; but these interventions are underutilized, unstandardized in application, and at times, unavailable in the context of clinical care. For people with chronic pain, rehabilitation professionals may select to apply activity pacing instruction as one behavioral strategy to manage symptoms. Activity pacing is widely used in combination with other pharmacological and behavioral interventions but has not been studied as a singular behavioral intervention for people with OA. The purpose of this study was to evaluate the effectiveness of an occupational therapist-delivered, time-based activity pacing program for treatment of pain, fatigue, and physical function in people with symptomatic knee or hip OA. A 3-arm randomized controlled trial was conducted in which 193 people were randomized into tailored activity pacing, general activity pacing, or usual care arms. Assessments were done at 10 weeks and 6 months after baseline. Using linear mixed models, Western Ontario and McMaster Universities Osteoarthritis Index pain scores changed over time, decreasing the most in the general and usual care groups; only the usual care group had decreased pain over 6 months. The tailored and general activity pacing groups reported higher frequency of pacing behaviors than the usual care group at 10 weeks, but pacing was not sustained at 6 months. This trial does not support the use of time-based pacing as a singular behavioral strategy for people with knee or hip OA. PMID:26963847

  4. Increase number of mitochondrion-like organelle in symptomatic Blastocystis subtype 3 due to metronidazole treatment.

    PubMed

    Raman, Kalyani; Kumar, Suresh; Chye, Tan Tian

    2016-01-01

    Blastocystis sp., an intestinal organism is known to cause diarrhea with metronidazole regarded as the first line of treatment despite reports of its resistance. The conflicting reports of variation in drug treatment have been ascribed to subtype differences. The present study evaluated in vitro responses due to metronidazole on ST3 isolated from three symptomatic and asymptomatic patients, respectively. Symptomatic isolates were obtained from clinical patients who showed symptoms such as diarrhea and abdominal bloating. Asymptomatic isolates from a stool survey carried out in a rural area. These patients had no other pathogens other than Blastocystis. Ultrastructural studies using transmission electron microscopy (TEM) and scanning electron microscopy (SEM) revealed drug-treated ST3 from symptomatic patients were irregular and amoebic with surface showing high-convoluted folding when treated with metronidazole. These organisms had higher number of mitochondrion-like organelle (MLO) with prominent cristae. However, the drug-treated ST3 from asymptomatic persons remained spherical in shape. Asymptomatic ST3 showed increase in the size of its central body with the MLO located at the periphery.

  5. Increase number of mitochondrion-like organelle in symptomatic Blastocystis subtype 3 due to metronidazole treatment.

    PubMed

    Raman, Kalyani; Kumar, Suresh; Chye, Tan Tian

    2016-01-01

    Blastocystis sp., an intestinal organism is known to cause diarrhea with metronidazole regarded as the first line of treatment despite reports of its resistance. The conflicting reports of variation in drug treatment have been ascribed to subtype differences. The present study evaluated in vitro responses due to metronidazole on ST3 isolated from three symptomatic and asymptomatic patients, respectively. Symptomatic isolates were obtained from clinical patients who showed symptoms such as diarrhea and abdominal bloating. Asymptomatic isolates from a stool survey carried out in a rural area. These patients had no other pathogens other than Blastocystis. Ultrastructural studies using transmission electron microscopy (TEM) and scanning electron microscopy (SEM) revealed drug-treated ST3 from symptomatic patients were irregular and amoebic with surface showing high-convoluted folding when treated with metronidazole. These organisms had higher number of mitochondrion-like organelle (MLO) with prominent cristae. However, the drug-treated ST3 from asymptomatic persons remained spherical in shape. Asymptomatic ST3 showed increase in the size of its central body with the MLO located at the periphery. PMID:26481491

  6. Symptomatic Abdominal Simple Cysts: Is Percutaneous Sclerotherapy with Hypertonic Saline and Bleomycin a Treatment Option?

    PubMed Central

    Souftas, V. D.; Kosmidou, M.; Karanikas, M.; Souftas, D.; Menexes, G.; Prassopoulos, P.

    2015-01-01

    Aim. To evaluate the feasibility of percutaneous sclerotherapy of symptomatic simple abdominal cysts, using hypertonic saline and bleomycin, as an alternative to surgery. Materials and Methods. This study involved fourteen consecutive patients (ten women, four men, mean age: 59.2 y) with nineteen symptomatic simple cysts (liver n = 14, kidney n = 3, and adrenal n = 2) treated percutaneously using a modified method. Initially CT-guided drainage was performed; the next day the integrity of the cyst/exclusion of extravasation or communications was evaluated under fluoroscopy, followed by two injections/reabsorptions of the same quantity of hypertonic NaCl 15% solution and three-time repetition of the same procedure with the addition of bleomycin. The catheter was then removed; the patients were hospitalized for 12 hours and underwent follow-ups on 1st, 3rd, 6th, and 12th months. Cyst's volumes and the reduction rate (%) were calculated in each evaluation. Results. No pain or complications were noted. A significant cyst's volume reduction was documented over time (P < 0.001). On the 12th month 17 cysts disappeared and two displayed a 98.7% and 68.9% reduction, respectively. Conclusion. This percutaneous approach constitutes a very promising nonsurgical alternative for patients with symptomatic simple cyst, without complications under proper precautions, leading to eliminating the majority of cysts. PMID:25878660

  7. Respiratory sinus arrhythmia reactivity to a sad film predicts depression symptom improvement and symptomatic trajectory.

    PubMed

    Panaite, Vanessa; Hindash, Alexandra Cowden; Bylsma, Lauren M; Small, Brent J; Salomon, Kristen; Rottenberg, Jonathan

    2016-01-01

    Respiratory sinus arrhythmia (RSA) reactivity, an index of cardiac vagal tone, has been linked to self-regulation and the severity and course of depression (Rottenberg, 2007). Although initial data supports the proposition that RSA withdrawal during a sad film is a specific predictor of depression course (Fraguas, 2007; Rottenberg, 2005), the robustness and specificity of this finding are unclear. To provide a stronger test, RSA reactivity to three emotion films (happy, sad, fear) and to a more robust stressor, a speech task, were examined in currently depressed individuals (n=37), who were assessed for their degree of symptomatic improvement over 30weeks. Robust RSA reactivity to the sad film uniquely predicted overall symptom improvement over 30weeks. RSA reactivity to both sad and stressful stimuli predicted the speed and maintenance of symptomatic improvement. The current analyses provide the most robust support to date that RSA withdrawal to sad stimuli (but not stressful) has specificity in predicting the overall symptomatic improvement. In contrast, RSA reactivity to negative stimuli (both sad and stressful) predicted the trajectory of depression course. Patients' engagement with sad stimuli may be an important sign to attend to in therapeutic settings. PMID:26681648

  8. Symptomatic Infratentorial Thrombosed Developmental Venous Anomaly: Case Report and Review of the Literature

    PubMed Central

    Amuluru, Krishna; Al-Mufti, Fawaz; Hannaford, Stephen; Singh, Inder Paul; Prestigiacomo, Charles J.; Gandhi, Chirag D.

    2016-01-01

    Background Developmental venous anomalies (DVAs) are variations of normal transmedullary veins draining white and gray matter. In the vast majority of cases, DVAs are diagnosed incidentally and should be considered as benign entities. In extremely rare circumstances, DVAs may become symptomatic due to mechanical or flow-related etiologies. Thrombosis of the collector vein of a DVA is a rare type of a flow-related complication with only 29 cases reported in the literature, the majority of which are supratentorial. Infratentorial thrombosed DVAs are thus extremely rare and the few cases reported have typically caused symptoms due to venous ischemic infarctions. Summary We report a case of an infratentorial DVA with a thrombosed drainage vein in a patient with nonhemorrhagic, noninfarcted venous congestive edema, which was successfully treated with high-dose glucocorticoids and short-term anticoagulation. We review the pertinent venous anatomy of the posterior fossa as well as the literature of symptomatic infratentorial thrombosed DVAs. Key Message The presented case of an infratentorial thrombosed DVA with cerebellar and pontine venous congestive edema is extremely rare. A working knowledge of posterior fossa venous anatomy and possible pathomechanisms responsible for the rarely symptomatic lesion will aid in the timely and efficacious treatment of such lesions. PMID:27051409

  9. Microscopy outperformed in a comparison of five methods for detecting Trichomonas vaginalis in symptomatic women.

    PubMed

    Nathan, B; Appiah, J; Saunders, P; Heron, D; Nichols, T; Brum, R; Alexander, S; Baraitser, P; Ison, C

    2015-03-01

    In the UK, despite its low sensitivity, wet mount microscopy is often the only method of detecting Trichomonas vaginalis infection. A study was conducted in symptomatic women to compare the performance of five methods for detecting T. vaginalis: an in-house polymerase chain reaction (PCR); Aptima T. vaginalis kit; OSOM ®Trichomonas Rapid Test; culture and microscopy. Symptomatic women underwent routine testing; microscopy and further swabs were taken for molecular testing, OSOM and culture. A true positive was defined as a sample that was positive for T. vaginalis by two or more different methods. Two hundred and forty-six women were recruited: 24 patients were positive for T. vaginalis by two or more different methods. Of these 24 patients, 21 patients were detected by real-time PCR (sensitivity 88%); 22 patients were detected by the Aptima T. vaginalis kit (sensitivity 92%); 22 patients were detected by OSOM (sensitivity 92%); nine were detected by wet mount microscopy (sensitivity 38%); and 21 were detected by culture (sensitivity 88%). Two patients were positive by just one method and were not considered true positives. All the other detection methods had a sensitivity to detect T. vaginalis that was significantly greater than wet mount microscopy, highlighting the number of cases that are routinely missed even in symptomatic women if microscopy is the only diagnostic method available.

  10. Symptomatic female carriers of Duchenne muscular dystrophy (DMD): genetic and clinical characterization.

    PubMed

    Giliberto, Florencia; Radic, Claudia Pamela; Luce, Leonela; Ferreiro, Verónica; de Brasi, Carlos; Szijan, Irene

    2014-01-15

    Duchenne muscular dystrophy (DMD) is an X-linked recessive disease caused by mutations in the dystrophin gene and is characterized by muscle degeneration and death. DMD affects males; females being asymptomatic carriers of mutations. However, some of them manifest symptoms due to a translocation between X chromosome and an autosome or to a heterozygous mutation leading to inactivation of most of their normal X chromosome. Six symptomatic female carriers and two asymptomatic were analyzed by: I) Segregation of STRs-(CA)n and MLPA assays to detect a hemizygous alteration, and II) X chromosome inactivation pattern to uncover the reason for symptoms in these females. The symptomatic females shared mild but progressive muscular weakness and increased serum creatin kinase (CK) levels. Levels of dystrophin protein were below normal or absent in many fibers. Segregation of STRs-(CA)n revealed hemizygous patterns in three patients, which were confirmed by MLPA. In addition, this analysis showed a duplication in another patient. X chromosome inactivation assay revealed a skewed X inactivation pattern in the symptomatic females and a random inactivation pattern in the asymptomatic ones. Our results support the hypothesis that the DMD phenotype in female carriers of a dystrophin mutation has a direct correlation with a skewed X-chromosome inactivation pattern.

  11. Symptomatic Patients with Intraluminal Carotid Thrombus: Outcome with a Strategy of Initial Anticoagulation

    PubMed Central

    Vellimana, Ananth K.; Kadkhodayan, Yasha; Rich, Keith M.; Cross, Dewitte T.; Moran, Christopher J.; Zazulia, Allyson R.; Lee, Jin-Moo; Chicoine, Michael R.; Dacey, Ralph G.; Derdeyn, Colin P.; Zipfel, Gregory J.

    2013-01-01

    Background Optimal treatment for patients with symptomatic intraluminal carotid thrombus (ICT) remains poorly defined. Methods We performed a retrospective chart review of patients presenting to our institution between 2001 and 2011 with symptomatic ICT. Results Twenty-four patients (16 males, 8 females) with ICT presented with ischemic stroke (n=18) or TIA (n=6). All were treated initially with anticoagulation ± antiplatelet drugs. Eight of these patients had no or mild carotid stenosis on initial angiography and were treated with medical management alone. The remaining 16 patients had moderate or severe carotid stenosis on initial angiography. Of these, 10 underwent delayed revascularization (endarterectomy, n=8; angioplasty and stenting, n=2), 2 refused revascularization, and 4 were treated with medical therapy alone. One patient had multiple TIAs despite medical therapy and eventually underwent CEA; the remaining 23 patients had no TIAs. No patient suffered ischemic or hemorrhagic stroke while on anticoagulation, during the perioperative period or in long-term follow up; one patient died of an unrelated condition (mean follow-up = 16.4 months). Conclusion Our results suggest that initial anticoagulation of symptomatic ICT results in a low rate of recurrent ischemic events and that carotid revascularization, if indicated, can be safely performed in a delayed manner. PMID:23061393

  12. Clopidogrel plus Aspirin for Symptomatic Intracranial Atherosclerotic Stenosis: A Pilot Study

    PubMed Central

    Kass-Hout, Tareq; Winningham, Melanie; Kass-Hout, Omar; Henriquez, Laura; Tong, Frank; Dion, Jacques; Cawley, Michael; Belagaje, Samir; Frankel, Michael; Anderson, Aaron; Nahab, Fadi

    2016-01-01

    Background and Purpose There are limited data on the optimal duration of dual antiplatelet therapy for secondary stroke prevention in patients with symptomatic intracranial atherosclerotic disease. Methods Consecutive patients presenting with high-grade (70–99%) symptomatic intracranial stenosis from January 1, 2011, to December 31, 2013, and evaluated within 30 days of the index event were eligible for this analysis. All patients underwent treatment with aspirin plus clopidogrel for a target duration of 12 months along with aggressive medical management based on the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) protocol; all patients were given gastrointestinal prophylaxis for the duration of their aspirin and clopidogrel treatment. Clinical and safety outcomes of our cohort were compared with the medical arm of the SAMMPRIS trial cohort (n = 227). Results Our cohort included 25 patients that met the inclusion criteria. Achievement of blood pressure and LDL cholesterol targets were similar between our cohort and the SAMMPRIS cohort. At 1 year, the rates of stroke, myocardial infarction or vascular death were 0% in our cohort and 16% in the SAMMPRIS cohort (p = 0.03). At 1 year, major bleeding rates were similar between our cohort and the SAMMPRIS cohort (4 vs. 2.2%, p = 1.0). Conclusion A prolonged course of dual antiplatelet therapy for symptomatic intracranial atherosclerotic disease may be associated with less vascular events with no increase in hemorrhagic complications. PMID:27781044

  13. Tregs control the development of symptomatic West Nile virus infection in humans and mice.

    PubMed

    Lanteri, Marion C; O'Brien, Katie M; Purtha, Whitney E; Cameron, Mark J; Lund, Jennifer M; Owen, Rachel E; Heitman, John W; Custer, Brian; Hirschkorn, Dale F; Tobler, Leslie H; Kiely, Nancy; Prince, Harry E; Ndhlovu, Lishomwa C; Nixon, Douglas F; Kamel, Hany T; Kelvin, David J; Busch, Michael P; Rudensky, Alexander Y; Diamond, Michael S; Norris, Philip J

    2009-11-01

    West Nile virus (WNV) causes asymptomatic infection in most humans, but for undefined reasons, approximately 20% of immunocompetent individuals develop West Nile fever, a potentially debilitating febrile illness, and approximately 1% develop neuroinvasive disease syndromes. Notably, since its emergence in 1999, WNV has become the leading cause of epidemic viral encephalitis in North America. We hypothesized that CD4+ Tregs might be differentially regulated in subjects with symptomatic compared with those with asymptomatic WNV infection. Here, we show that in 32 blood donors with acute WNV infection, Tregs expanded significantly in the 3 months after index (RNA+) donations in all subjects. Symptomatic donors exhibited lower Treg frequencies from 2 weeks through 1 year after index donation yet did not show differences in systemic T cell or generalized inflammatory responses. In parallel prospective experimental studies, symptomatic WNV-infected mice also developed lower Treg frequencies compared with asymptomatic mice at 2 weeks after infection. Moreover, Treg-deficient mice developed lethal WNV infection at a higher rate than controls. Together, these results suggest that higher levels of peripheral Tregs after infection protect against severe WNV disease in immunocompetent animals and humans.

  14. Facial affect recognition in symptomatically remitted patients with schizophrenia and bipolar disorder.

    PubMed

    Yalcin-Siedentopf, Nursen; Hoertnagl, Christine M; Biedermann, Falko; Baumgartner, Susanne; Deisenhammer, Eberhard A; Hausmann, Armand; Kaufmann, Alexandra; Kemmler, Georg; Mühlbacher, Moritz; Rauch, Anna-Sophia; Fleischhacker, W Wolfgang; Hofer, Alex

    2014-02-01

    Both schizophrenia and bipolar disorder (BD) have consistently been associated with deficits in facial affect recognition (FAR). These impairments have been related to various aspects of social competence and functioning and are relatively stable over time. However, individuals in remission may outperform patients experiencing an acute phase of the disorders. The present study directly contrasted FAR in symptomatically remitted patients with schizophrenia or BD and healthy volunteers and investigated its relationship with patients' outcomes. Compared to healthy control subjects, schizophrenia patients were impaired in the recognition of angry, disgusted, sad and happy facial expressions, while BD patients showed deficits only in the recognition of disgusted and happy facial expressions. When directly comparing the two patient groups individuals suffering from BD outperformed those with schizophrenia in the recognition of expressions depicting anger. There was no significant association between affect recognition abilities and symptomatic or psychosocial outcomes in schizophrenia patients. Among BD patients, relatively higher depression scores were associated with impairments in both the identification of happy faces and psychosocial functioning. Overall, our findings indicate that during periods of symptomatic remission the recognition of facial affect may be less impaired in patients with BD than in those suffering from schizophrenia. However, in the psychosocial context BD patients seem to be more sensitive to residual symptomatology.

  15. Case Study: Symptomatic Exercise-Associated Hyponatremia in an Endurance Runner Despite Sodium Supplementation.

    PubMed

    Hoffman, Martin D; Myers, Thomas M

    2015-12-01

    Symptomatic exercise-associated hyponatremia (EAH) is known to be a potential complication from overhydration during exercise, but there remains a general belief that sodium supplementation will prevent EAH. We present a case in which a runner with a prior history of EAH consulted a sports nutritionist who advised him to consume considerable supplemental sodium, which did not prevent him from developing symptomatic EAH during a subsequent long run. Emergency medical services were requested for this runner shortly after he finished a 17-hr, 72-km run and hike in Grand Canyon National Park during which he reported having consumed 9.2-10.6 L of water and >6,500 mg of sodium. First responders determined his serum sodium concentration with point-of-care testing was 122 mEq/L. His hyponatremia was documented to have improved from field treatment with an oral hypertonic solution of 800 mg of sodium in 200 ml of water, and it improved further after significant aquaresis despite in-hospital treatment with isotonic fluids (lactated Ringer's). He was discharged about 5 hr after admission in good condition. This case demonstrates that while oral sodium supplementation does not necessarily prevent symptomatic EAH associated with overhydration, early recognition and field management with oral hypertonic saline in combination with fluid restriction can be effective treatment for mild EAH. There continues to be a lack of universal understanding of the underlying pathophysiology and appropriate hospital management of EAH. PMID:26061675

  16. Possible overlap between reversible cerebral vasoconstriction syndrome and symptomatic vasospasm after aneurysmal subarachnoid hemorrhage.

    PubMed

    Forget, Patrice; Goffette, Pierre; van de Wyngaert, Françoise; Raftopoulos, Christian; Hantson, Philippe

    2009-08-01

    A 34-year-old woman with a previous history of severe headache ("thunderclap") was admitted with a diagnosis of aneurysmal subarachnoid hemorrhage (SAH). The patient developed symptomatic vasospasm on day 5 that resolved rapidly after having increased arterial blood pressure. She experienced also short-lasting excruciating headache. On day 12, while velocities had normalised, as revealed by transcranial Doppler (TCD), for more than 48 h, she developed aphasia and right hemiplegia associated with diffuse segmental vasospasm on the left middle cerebral artery. Intra-arterial infusion of vasodilatory agents was required. Recurrence of symptomatic vasospasm was noted on day 25, with a great number of territories involved as shown in the cerebral angiogram. A second intra-arterial treatment was needed. The patient complained of multiple episodes of extremely severe headache ("thunderclap"), with also transient dysarthria and hemiparesia on day 30. She was discharged on day 38 after full recovery. The clinical and TCD/radiological findings were consistent with a reversible cerebral vasoconstriction syndrome overlapping SAH related symptomatic vasospasm. PMID:19381433

  17. Chronic motor tic disorder

    MedlinePlus

    Chronic vocal tic disorder; Tic - chronic motor tic disorder ... Chronic motor tic disorder is more common than Tourette syndrome . Chronic tics may be forms of Tourette syndrome. Tics usually start ...

  18. Chronic obstructive pulmonary disease

    MedlinePlus

    COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic ... can do to relieve symptoms and keep the disease from getting worse. If you smoke, now is ...

  19. Chronic pain - resources

    MedlinePlus

    Pain - resources; Resources - chronic pain ... The following organizations are good resources for information on chronic pain: American Chronic Pain Association -- www.theacpa.org National Fibromyalgia and Chronic Pain Association -- www.fmcpaware.org ...

  20. Symptomatic myoclonus.

    PubMed

    Borg, M

    2006-01-01

    A huge number of neurological disorders are associated with myoclonus. This paper describes these disorders whose diagnosis partly relies on the presence of myoclonus. The diagnostic approach is related to certain clinical features of myoclonus, which, after their integration in the clinical context, help orientate towards diagnosis. Myoclonus is frequent during dementia. Although its presence is well-known to take part in the diagnosis of Creutzfeldt-Jakob disease (CJD), myoclonus can also be present to a significant degree in Alzheimer's disease and Lewy body dementia (LBD), which raises a diagnostic issue. Both its clinical and electrophysiological features may help differential diagnosis, given that myoclonus with fast-evolving dementia and focal neurological signs should favor the diagnosis of CJD. Myoclonus in a context of progressive ataxia suggests one clinical form of the Ramsay-Hunt syndrome (progressive myoclonic ataxia, PMA), whose most frequent causes are: coeliac disease, mitochondriopathies, some spino-cerebellar degenerations, and some late metabolic disorders. In addition to ataxia and myoclonus, the presence of opsoclonus directs diagnosis toward the opsoclonus-myoclonus syndrome (OMS), whose origin, in adult, is idiopathic or paraneoplastic. Palatal tremor (myoclonus) with ataxia may represent either a sporadic pattern, which often reflects the evolution of degenerative or lesional disorders, or a familial pattern in some degenerative affections or metabolic diseases. Of more recent knowledge is the association of progressive ataxia, myoclonus, and renal failure, which corresponds to a recessive autosomic disease. In a context of encephalopathy, myoclonus is frequent in metabolic or hydro-electrolytic disorders, and in brain anoxia. One should distinguish these various forms of myoclonus which may occur in the acute post-anoxic phase, from those occurring as sequels at a later stage, i.e. the Lance and Adams syndrome whose clinical aspects are also multiple. Myoclonus is less frequent during toxic or drug exposures. Irrespective of its acute or insidious onset, Hashimoto's encephalopathy is accompanied by myoclonus and tremor. Myoclonus may also be present during encephalic and/or spinal infectious disorders. Myoclonus with focal neurological signs may be observed in thalamic lesions, responsible for unilateral asterixis or unilateral myoclonus superimposed on dystonic posture. Segmental spinal myoclonus or propriospinal myoclonus may be associated with several spinal-cord disorders. Myoclonus associated with peripheral nerve lesions is exceptional or even questionable for some of these.

  1. Treatment failure in patients with chronic Blastocystis infection.

    PubMed

    Roberts, Tamalee; Ellis, John; Harkness, John; Marriott, Deborah; Stark, Damien

    2014-02-01

    This article reports long-term infection and treatment failure in 18 symptomatic individuals infected with Blastocystis spp. Patients were initially treated with either metronidazole, iodoquinol or triple combination therapy consisting of nitazoxanide, furazolidone and secnidazole. Following treatment, resolution of clinical symptoms did not occur and follow-up testing revealed ongoing infection with the same subtype. Patients then underwent secondary treatment with a variety of antimicrobial agents but remained symptomatic with Blastocystis spp. still present in faeces. Sequencing of the SSU rDNA was completed on all isolates and four subtypes were identified in this group: ST1, ST3, ST4 and ST5. This study highlights the lack of efficacy of several commonly used antimicrobial regimens in the treatment of Blastocystis and the chronic nature of some infections. It also demonstrates the need for further research into treatment options for Blastocystis infection. PMID:24243286

  2. Chronic Myeloproliferative Neoplasms Treatment

    MedlinePlus

    ... Myeloproliferative Neoplasms Treatment Myelodysplastic/ Myeloproliferative Neoplasms Treatment Chronic Myeloproliferative Neoplasms Treatment (PDQ®)–Patient Version General Information About Chronic ...

  3. Chronic urticaria.

    PubMed Central

    Burrall, B. A.; Halpern, G. M.; Huntley, A. C.

    1990-01-01

    Urticaria affects 15% to 20% of the population once or more during a lifetime. Chronic urticaria is a frequent recurrent eruption over a period greater than 6 weeks; the cause remains a mystery in more than 75% of cases. Urticaria and angioedema may be produced by immunologic or nonimmunologic means. Urticarial vasculitis, contact urticaria, mastocytosis, physical urticarias, dermatographism, cholinergic urticaria, localized heat urticaria, cold urticaria, aquagenic urticaria, and vibratory angioedema all require specific evaluation and treatment. Chronic idiopathic urticaria is usually controlled by antihistamines; depending on the circadian rhythm of the eruption, sedative or nonsedative antihistamines are prescribed. Some patients will require a combination of H1 and H2 antagonists, or even parenteral corticosteroids. PMID:1970697

  4. Higher Caspase-like activity in symptomatic isolates of Blastocystis spp

    PubMed Central

    2014-01-01

    Background Biochemical evidence of a caspase-like execution pathway has been demonstrated in a variety of protozoan parasites, including Blastocystis spp. The distinct differences in the phenotypic characterization reported previously have prompted us to compare the rate of apoptosis in Blastocystis spp. isolated from individuals who were symptomatic and asymptomatic. In the current study, we analysed the caspase activation involved in PCD mediated by a cytotoxic drug, (metronidazole) in both symptomatic & asymptomatic isolates. Methods Apoptosis was induced in Blastocystis spp. by treating cultures of symptomatic and asymptomatic isolates of 3 sub-types namely 1, 3 and 5 with two different concentrations, 0.1 and 0.0001 mg/ml of metronidazole (with and without pre-treatment with a pan-caspase inhibitor, zVAD.fmk). The experiment was repeated to assess the number of apoptotic cells in all the isolates of both conditions. Results Symptomatic isolates of subtype 3 (without pre-treatment with a pan-caspase inhibitor, zVAD.fmk) showed high fluorescence intensity for active caspase-like proteases [0.0001 mg/ml, 88% (p < 0.001) at 0.1 mg/ml, 70% (p < 0.001)] at the 72nd hour in vitro culture in comparison with asymptomatic isolates [0.0001 mg/ml, 65%, at 0.1 mg/ml, 55%]. The number of apoptotic cells was higher [0.0001 mg/ml, 89% (p < 0.001) and at 0.1 mg/ml, 70% (p < 0.001)] at the 72nd hour of in vitro culture in comparison with asymptomatic isolates [0.0001 mg/ml, 66% (p < 0.001) and at 0.1 mg/ml, 45% (p < 0.01)]. Cells treated with metronidazole in the presence of zVAD.fmk showed less than 10% caspase activation. Conclusion The high number of symptomatic cells expressing active caspase-like proteases and becoming apoptotic compared to asymptomatic cells clearly demonstrates that the response to metronidazole treatment is isolate dependent. Hence this justifies the conflicting reports on the curative success rates when treated with

  5. Randomized trial of intensive bisphosphonate treatment versus symptomatic management in Paget's disease of bone.

    PubMed

    Langston, Anne L; Campbell, Marion K; Fraser, William D; MacLennan, Graeme S; Selby, Peter L; Ralston, Stuart H

    2010-01-01

    Bisphosphonates are widely regarded as the treatment of choice for Paget's disease of bone (PDB) because of their potent inhibitory effects on bone turnover, but the effects of bisphosphonate therapy on symptoms and complications of PDB have been little studied. Here we report the results of a randomized trial that compared the effects of symptomatic treatment with intensive bisphosphonate therapy in a cohort of 1324 patients with PDB who were followed up for a median of 3 years (range 2 to 5 years). The symptomatic treatment group was treated only if they had pagetic bone pain, for which they were first given analgesics or anti-inflammatory drugs, followed by bisphosphonates if they did not respond. The intensive group received repeat courses of bisphosphonates irrespective of symptoms with the aim of reducing and maintaining serum alkaline phosphatase (ALP) levels within the normal range. The endpoints were fracture, orthopedic surgery, quality of life, bone pain, and hearing thresholds. Serum ALP levels were significantly lower in the intensive treatment group than in with the symptomatic treatment group within 4 months of commencing treatment and remained lower throughout the study (p < .001). There was no difference between the groups in quality of life (as assessed by the SF36 questionnaire), in overall bodily pain, or in pagetic bone pain. Hearing thresholds, as assessed by audiometry did not change significantly and did not differ between the treatment groups. Clinical fractures occurred in 46 of 661 patients (7.0%) in the intensive treatment group compared with 49 of 663 patients (7.4%) in the symptomatic treatment group, and orthopedic surgery was required in 50 of 661 patients (7.3%) in the intensive treatment group and in 55 of 663 patients (8.3%) in the symptomatic treatment group. These differences were not significant. Subgroup analyses of patients with elevated ALP levels at baseline and those who did or did not receive bisphosphonates during the

  6. Treating symptomatic hyperprolactinemia in women with schizophrenia: presentation of the ongoing DAAMSEL clinical trial (Dopamine partial Agonist, Aripiprazole, for the Management of Symptomatic ELevated prolactin)

    PubMed Central

    2013-01-01

    Prolactin elevations occur in people treated with antipsychotic medications and are often much higher in women than in men. Hyperprolactinemia is known to cause amenorrhea, oligomenorrhea, galactorrhea and gynecomastia in females and is also associated with sexual dysfunction and bone loss. These side effects increase risk of antipsychotic nonadherence and suicide and pose significant problems in the long term management of women with schizophrenia. In this manuscript, we review the literature on prolactin; its physiology, plasma levels, side effects and strategies for treatment. We also present the rationale and protocol for an ongoing clinical trial to treat symptomatic hyperprolactinemia in premenopausal women with schizophrenia. More attention and focus are needed to address these significant side effects and help the field better personalize the treatment of women with schizophrenia. PMID:23968123

  7. Activity of Monoamine Oxidase in the Nigrostriatal System at Presymptomatic and Early Symptomatic Stages of Parkinsonism in Mice.

    PubMed

    Khakimova, G R; Kozina, E A; Buneeva, O A; Aksenova, L N; Medvedev, A E; Ugryumov, M V

    2015-08-01

    Activities of monoamine oxidases A and B were examined on the models of presymptomatic and early symptomatic stages of Parkinson's disease developed in mice treated with MPTP, a specific neurotoxin affecting dopaminergic neurons. Activity of monoamine oxidases A, the key enzyme of dopamine degradation, is increased in neuronal somas during the symptomatic stage, and it is augmented in the axons during both stages. Neuronal activity of monoamine oxidases A is higher during the symptomatic stage than that during the presymptomatic stage, which can explain depletion of intercellular dopamine and appearance of motor disturbances. Activity of monoamine oxidase B in the striatum is reduced during the presymptomatic stage, but returns to the control level during the symptomatic stage. Variation in monoamine oxidase activity seems to reflect the compensatory mechanisms triggered in degrading nigrostriatal dopaminergic system.

  8. CLINICAL AND GENETIC PREDICTORS AND PROGNOSTIC MODEL OF RAPIDLY PROGRESSIVE HEPATIC FIBROSIS IN CHRONIC HEPATITIS C.

    PubMed

    Dubinskaya, G; Sizova, L; Koval, T; Kovalyova, Е; Kaydashev, I

    2016-07-01

    The search for risk factors for rapid progression of hepatic fibrosis (HF) in chronic hepatitis C (CHC) is a topical scientific and practical task. The purpose of the study is to identify clinical and genetic predictors and create the prognostic model of rapidly progressive HF in CHC. A retrospective cohort study of 125 patients with CHC has been carried out. The logistic regression and ROC-analysis have been applied for statistical data processing. The resulting analysis of 46 potential predictors of rapidly progressive HF in CHC identified the following significant ctiteria: male gender - ОR=3.44 [95% СΙ 1.60-7.39], р=0.001; increased levels of alanine aminotransferase (ALT) - ОR=4.93 [95% СΙ 1.54-15.76], р=0.007, particularly, moderate cytolytic activity - ОR=2.36 [95% СΙ 1.08-5.16], р=0.031; aspartate aminotransferase (АSТ) - ОR=3.65 [95% СΙ 1.41-9.43] р=0.007; γ-glutamiltranspeptidase (GGTP) - ОR=3.63 [95% СΙ 1.73-7.61], р=0.001; total bilirubin - ОR=3.53 [95% СΙ 1.47-8.47], р=0.005; alkaline phosphatase - ОR=9.18 [95% 1.11-75.80], р=0.039; alcohol intake>40 g/day (ОR=3.53 [95% СΙ 1.36-9.17], р=0.009), Gln11Gln genotype of the TLR7 gene (ОR=4.56 [95% СΙ 1.57-13.22], р=0.005), presence of chronic cholecystitis and/or pancreatitis (ОR=5.30 [95% СΙ 1.84-15.25], р=0.002). The prognostic model, comprising 6 predictors (level of GGTP>upper limit of normal (ULN), male gender, Gln11Gln genotype of the TLR7 gene chronic cholecystitis and/or pancreatitis, levels of total bilirubin and АSТ>ULN) have been created, demonstrating the statistical significance (p=0.000) and high operational characteristics (sensitivity - 85.5%, specificity - 68.3%, total number of the appropriate assignments - 76.8%, positive and negative predictive value - 72,6% and 82.7%,, respectively, the AUC ROC-curve - 0.840). Use of the created model will help to predict the rapid progression of HF in CHC and form the risk-group, requiring individual

  9. CLINICAL AND GENETIC PREDICTORS AND PROGNOSTIC MODEL OF RAPIDLY PROGRESSIVE HEPATIC FIBROSIS IN CHRONIC HEPATITIS C.

    PubMed

    Dubinskaya, G; Sizova, L; Koval, T; Kovalyova, Е; Kaydashev, I

    2016-07-01

    The search for risk factors for rapid progression of hepatic fibrosis (HF) in chronic hepatitis C (CHC) is a topical scientific and practical task. The purpose of the study is to identify clinical and genetic predictors and create the prognostic model of rapidly progressive HF in CHC. A retrospective cohort study of 125 patients with CHC has been carried out. The logistic regression and ROC-analysis have been applied for statistical data processing. The resulting analysis of 46 potential predictors of rapidly progressive HF in CHC identified the following significant ctiteria: male gender - ОR=3.44 [95% СΙ 1.60-7.39], р=0.001; increased levels of alanine aminotransferase (ALT) - ОR=4.93 [95% СΙ 1.54-15.76], р=0.007, particularly, moderate cytolytic activity - ОR=2.36 [95% СΙ 1.08-5.16], р=0.031; aspartate aminotransferase (АSТ) - ОR=3.65 [95% СΙ 1.41-9.43] р=0.007; γ-glutamiltranspeptidase (GGTP) - ОR=3.63 [95% СΙ 1.73-7.61], р=0.001; total bilirubin - ОR=3.53 [95% СΙ 1.47-8.47], р=0.005; alkaline phosphatase - ОR=9.18 [95% 1.11-75.80], р=0.039; alcohol intake>40 g/day (ОR=3.53 [95% СΙ 1.36-9.17], р=0.009), Gln11Gln genotype of the TLR7 gene (ОR=4.56 [95% СΙ 1.57-13.22], р=0.005), presence of chronic cholecystitis and/or pancreatitis (ОR=5.30 [95% СΙ 1.84-15.25], р=0.002). The prognostic model, comprising 6 predictors (level of GGTP>upper limit of normal (ULN), male gender, Gln11Gln genotype of the TLR7 gene chronic cholecystitis and/or pancreatitis, levels of total bilirubin and АSТ>ULN) have been created, demonstrating the statistical significance (p=0.000) and high operational characteristics (sensitivity - 85.5%, specificity - 68.3%, total number of the appropriate assignments - 76.8%, positive and negative predictive value - 72,6% and 82.7%,, respectively, the AUC ROC-curve - 0.840). Use of the created model will help to predict the rapid progression of HF in CHC and form the risk-group, requiring individual

  10. [Chronic, non-infectious diarrhea: diagnostics and therapy].

    PubMed

    Ulbricht, Korinna; Layer, Peter; Andresen, Viola

    2016-09-01

    Chronic, non-infectious diarrhea can be caused by a variety of gastrointestinal diseases. In anamnesis, it is important to take accompanying warning symptoms and specific triggers into account. The fecal inflammatory marker calprotectin may help differentiating between organic and functional gastrointestinal disorders, but it is not specific. Among other options, gelling fibres, Loperamide and Cholestyramine as well as probiotics are available for the symptomatic treatment of chronic diarrhea. For long-term treatment of chronic diarrhea with the enkephalinase inhibitor racecadotril, which is approved for acute diarrhea, only limited data are available. Eluxadolin presents a new therapeutic option. It can alleviate abdominal pain and diarrhea by modulation of opioid receptors in the enteric nervous system. Additional approaches in intractable irritable bowel syndrome with diarrhea (IBS-D) include 5-HT3 receptor antagonists, the antibiotic Rifaximin as well as low-dose tricyclic antidepressants. Specific diets such as the low-FODMAP diet can also relieve symptoms in IBS. PMID:27642742

  11. Chronic kidney disease in kidney stone formers.

    PubMed

    Rule, Andrew D; Krambeck, Amy E; Lieske, John C

    2011-08-01

    Recent population studies have found symptomatic kidney stone formers to be at increased risk for chronic kidney disease (CKD). Although kidney stones are not commonly identified as the primary cause of ESRD, they still may be important contributing factors. Paradoxically, CKD can be protective against forming kidney stones because of the substantial reduction in urine calcium excretion. Among stone formers, those with rare hereditary diseases (cystinuria, primary hyperoxaluria, Dent disease, and 2,8 dihydroxyadenine stones), recurrent urinary tract infections, struvite stones, hypertension, and diabetes seem to be at highest risk for CKD. The primary mechanism for CKD from kidney stones is usually attributed to an obstructive uropathy or pyelonephritis, but crystal plugs at the ducts of Bellini and parenchymal injury from shockwave lithotripsy may also contribute. The historical shift to less invasive surgical management of kidney stones has likely had a beneficial impact on the risk for CKD. Among potential kidney donors, past symptomatic kidney stones but not radiographic stones found on computed tomography scans were associated with albuminuria. Kidney stones detected by ultrasound screening have also been associated with CKD in the general population. Further studies that better classify CKD, better characterize stone formers, more thoroughly address potential confounding by comorbidities, and have active instead of passive follow-up to avoid detection bias are needed.

  12. Predictors of Pain and Function in Patients With Symptomatic, Atraumatic Full-Thickness Rotator Cuff Tears

    PubMed Central

    Harris, Joshua D.; Pedroza, Angela; Jones, Grant L.

    2013-01-01

    Background Although the prevalence of full-thickness rotator cuff tears increases with age, many patients are asymptomatic and may not require surgical repair. The factors associated with pain and loss of function in patients with rotator cuff tears are not well defined. Purpose To determine which factors correlate with pain and loss of function in patients with symptomatic, atraumatic full-thickness rotator cuff tears who are enrolled in a structured physical therapy program. Study Design Cross-sectional study; Level of evidence, 3. Methods A multicenter group enrolled patients with symptomatic, atraumatic rotator cuff tears in a prospective, nonrandomized cohort study evaluating the effects of a structured physical therapy program. Time-zero patient data were reviewed to test which factors correlated with Western Ontario Rotator Cuff (WORC) index and American Shoulder and Elbow Surgeons (ASES) scores. Results A total of 389 patients were enrolled. Mean ASES score was 53.9; mean WORC score was 46.9. The following variables were associated with higher WORC and ASES scores: female sex (P = .001), education level (higher education, higher score; P <.001), active abduction (degrees; P = .021), and strength in forward elevation (P = .002) and abduction (P = .007). The following variables were associated with lower WORC and ASES scores: male sex (P = .001), atrophy of the supraspinatus (P = .04) and infraspinatus (P = .003), and presence of scapulothoracic dyskinesia (P < .001). Tear size was not a significant predictor (WORC) unless comparing isolated supraspinatus tears to supraspinatus, infraspinatus, and subscapularis tears (P = .004). Age, tear retraction, duration of symptoms, and humeral head migration were not statistically significant. Conclusion Nonsurgically modifiable factors, such as scapulothoracic dyskinesia, active abduction, and strength in forward elevation and abduction, were identified that could be addressed nonoperatively with therapy. Therefore

  13. Etiology and clinical characteristics of symptomatic unilateral maxillary sinusitis: A review of 174 cases.

    PubMed

    Troeltzsch, Matthias; Pache, Christoph; Troeltzsch, Markus; Kaeppler, Gabriele; Ehrenfeld, Michael; Otto, Sven; Probst, Florian

    2015-10-01

    The purpose of the study was to analyze the causative pathology associated with symptomatic unilateral maxillary sinusitis requiring surgical treatment. A retrospective review of all patients that have been treated surgically for unilateral symptomatic maxillary sinusitis between 2006 and 2013 at a single institution was performed. Demographic, anamnesis, clinical, radiological, microbiological and histological data were gathered and analyzed. The patients were allocated into groups depending on the underlying cause of the disease. Descriptive and inferential statistics were computed (level of significance: p ≤ 0.05). The study sample was composed of 174 patients (72 female; 102 male) with a mean age of 52.7 years (SD 16.9). Most cases (130; 75%) were triggered by odontogenic pathology following dentoalveolar surgical interventions (83/130 patients; 64%). Other etiological factors for odontogenic unilateral sinusitis were periapical (23/130 cases; 18%) and periodontal pathology (13/130 cases; 10%). Rhinogenic factors for sinusitis were detected in 13 patients (7.5%) and dental implant-associated unilateral maxillary sinusitis was diagnosed in nine patients (5.2%). Four patients (2.3%) had undergone previous sinus augmentation surgery. A leading cause for the sinus infection could not be identified in 18 patients (10%) who all had a history of midfacial surgery. Medication-related osteonecrosis of the jaw (8) and squamous cell carcinoma (2) were incidental findings. There were no differences in the clinical appearance of the disease with respect to its etiology. Odontogenic causes for maxillary sinusitis must be considered especially in unilateral cases. Maxillary dental implants may induce symptomatic unilateral maxillary sinusitis. PMID:26319958

  14. Endophytic bacterial diversity in the phyllosphere of Amazon Paullinia cupana associated with asymptomatic and symptomatic anthracnose.

    PubMed

    Bogas, Andréa Cristina; Ferreira, Almir José; Araújo, Welington Luiz; Astolfi-Filho, Spartaco; Kitajima, Elliot Watanabe; Lacava, Paulo Teixeira; Azevedo, João Lúcio

    2015-01-01

    Endophytes colonize an ecological niche similar to that of phytopathogens, which make them candidate for disease suppression. Anthracnose is a disease caused by Colletotrichum spp., a phytopathogen that can infect guarana (Paullinia cupana), an important commercial crop in the Brazilian Amazon. We investigated the diversity of endophytic bacteria inhabiting the phyllosphere of asymptomatic and symptomatic anthracnose guarana plants. The PCR-denaturation gradient gel electrophoresis (PCR-DGGE) fingerprints revealed differences in the structure of the evaluated communities. Detailed analysis of endophytic bacteria composition using culture-dependent and 16S rRNA clone libraries revealed the presence of Firmicutes, Proteobacteria, Actinobacteria, Bacteroidetes, and Acidobacteria phyla. Firmicutes comprised the majority of isolates in asymptomatic plants (2.40E(-4)). However, cloning and sequencing of 16S rRNA revealed differences at the genus level for Neisseria (1.4E(-4)), Haemophilus (2.1E(-3)) and Arsenophonus (3.6E(-5)) in asymptomatic plants, Aquicella (3.5E(-3)) in symptomatic anthracnose plants, and Pseudomonas (1.1E(-3)), which was mainly identified in asymptomatic plants. In cross-comparisons of the endophytic bacterial communities as a whole, symptomatic anthracnose plants contained higher diversity, as reflected in the Shannon-Weaver and Simpson indices estimation (P < 0.05). Similarly, comparisons using LIBSHUFF and heatmap analysis for the relative abundance of operational taxonomic units (OTUs) showed differences between endophytic bacterial communities. These data are in agreement with the NMSD and ANOSIM analysis of DGGE profiles. Our results suggest that anthracnose can restructure endophytic bacterial communities by selecting certain strains in the phyllosphere of P. cupana. The understanding of these interactions is important for the development of strategies of biocontrol for Colletotrichum. PMID:26090305

  15. Etiology and clinical characteristics of symptomatic unilateral maxillary sinusitis: A review of 174 cases.

    PubMed

    Troeltzsch, Matthias; Pache, Christoph; Troeltzsch, Markus; Kaeppler, Gabriele; Ehrenfeld, Michael; Otto, Sven; Probst, Florian

    2015-10-01

    The purpose of the study was to analyze the causative pathology associated with symptomatic unilateral maxillary sinusitis requiring surgical treatment. A retrospective review of all patients that have been treated surgically for unilateral symptomatic maxillary sinusitis between 2006 and 2013 at a single institution was performed. Demographic, anamnesis, clinical, radiological, microbiological and histological data were gathered and analyzed. The patients were allocated into groups depending on the underlying cause of the disease. Descriptive and inferential statistics were computed (level of significance: p ≤ 0.05). The study sample was composed of 174 patients (72 female; 102 male) with a mean age of 52.7 years (SD 16.9). Most cases (130; 75%) were triggered by odontogenic pathology following dentoalveolar surgical interventions (83/130 patients; 64%). Other etiological factors for odontogenic unilateral sinusitis were periapical (23/130 cases; 18%) and periodontal pathology (13/130 cases; 10%). Rhinogenic factors for sinusitis were detected in 13 patients (7.5%) and dental implant-associated unilateral maxillary sinusitis was diagnosed in nine patients (5.2%). Four patients (2.3%) had undergone previous sinus augmentation surgery. A leading cause for the sinus infection could not be identified in 18 patients (10%) who all had a history of midfacial surgery. Medication-related osteonecrosis of the jaw (8) and squamous cell carcinoma (2) were incidental findings. There were no differences in the clinical appearance of the disease with respect to its etiology. Odontogenic causes for maxillary sinusitis must be considered especially in unilateral cases. Maxillary dental implants may induce symptomatic unilateral maxillary sinusitis.

  16. Symptomatic Dengue Disease in Five Southeast Asian Countries: Epidemiological Evidence from a Dengue Vaccine Trial

    PubMed Central

    Taurel, Anne-Frieda; Capeding, Maria Rosario; Tran, Ngoc Huu; Hadinegoro, Sri Rezeki; Chotpitayasunondh, Tawee; Chong, Chee Kheong; Wartel, T. Anh; Beucher, Sophie; Frago, Carina; Moureau, Annick; Simmerman, Mark; Laot, Thelma; L’Azou, Maïna; Bouckenooghe, Alain

    2016-01-01

    Dengue incidence has increased globally, but empirical burden estimates are scarce. Prospective methods are best-able to capture all severities of disease. CYD14 was an observer-blinded dengue vaccine study conducted in children 2–14 years of age in Indonesia, Malaysia, Thailand, the Philippines, and Vietnam. The control group received no vaccine and resembled a prospective, observational study. We calculated the rates of dengue according to different laboratory or clinical criteria to make inferences about dengue burden, and compared with rates reported in the passive surveillance systems to calculate expansion factors which describe under-reporting. Over 6,933 person-years of observation in the control group there were 319 virologically confirmed dengue cases, a crude attack rate of 4.6%/year. Of these, 92 cases (28.8%) were clinically diagnosed as dengue fever or dengue hemorrhagic fever by investigators and 227 were not, indicating that most symptomatic disease fails to satisfy existing case definitions. When examining different case definitions, there was an inverse relationship between clinical severity and observed incidence rates. CYD14’s active surveillance system captured a greater proportion of symptomatic dengue than national passive surveillance systems, giving rise to expansion factors ranging from 0.5 to 31.7. This analysis showed substantial, unpredictable and variable under-reporting of symptomatic dengue, even within a controlled clinical trial environment, and emphasizes that burden estimates are highly sensitive to case definitions. These data will assist in generating disease burden estimates and have important policy implications when considering the introduction and health economics of dengue prevention and control interventions. PMID:27532617

  17. Differential evolution of peripheral cytokine levels in symptomatic and asymptomatic responses to experimental influenza virus challenge.

    PubMed

    McClain, M T; Henao, R; Williams, J; Nicholson, B; Veldman, T; Hudson, L; Tsalik, E L; Lambkin-Williams, R; Gilbert, A; Mann, A; Ginsburg, G S; Woods, C W

    2016-03-01

    Exposure to influenza virus triggers a complex cascade of events in the human host. In order to understand more clearly the evolution of this intricate response over time, human volunteers were inoculated with influenza A/Wisconsin/67/2005 (H3N2), and then had serial peripheral blood samples drawn and tested for the presence of 25 major human cytokines. Nine of 17 (53%) inoculated subjects developed symptomatic influenza infection. Individuals who will go on to become symptomatic demonstrate increased circulating levels of interleukin (IL)-6, IL-8, IL-15, monocyte chemotactic protein (MCP)-1 and interferon (IFN) gamma-induced protein (IP)-10 as early as 12-29 h post-inoculation (during the presymptomatic phase), whereas challenged patients who remain asymptomatic do not. Overall, the immunological pathways of leucocyte recruitment, Toll-like receptor (TLR)-signalling, innate anti-viral immunity and fever production are all over-represented in symptomatic individuals very early in disease, but are also dynamic and evolve continuously over time. Comparison with simultaneous peripheral blood genomics demonstrates that some inflammatory mediators (MCP-1, IP-10, IL-15) are being expressed actively in circulating cells, while others (IL-6, IL-8, IFN-α and IFN-γ) are probable effectors produced locally at the site of infection. Interestingly, asymptomatic exposed subjects are not quiescent either immunologically or genomically, but instead exhibit early and persistent down-regulation of important inflammatory mediators in the periphery. The host inflammatory response to influenza infection is variable but robust, and evolves over time. These results offer critical insight into pathways driving influenza-related symptomatology and offer the potential to contribute to early detection and differentiation of infected hosts.

  18. Symptomatic Dengue Disease in Five Southeast Asian Countries: Epidemiological Evidence from a Dengue Vaccine Trial.

    PubMed

    Nealon, Joshua; Taurel, Anne-Frieda; Capeding, Maria Rosario; Tran, Ngoc Huu; Hadinegoro, Sri Rezeki; Chotpitayasunondh, Tawee; Chong, Chee Kheong; Wartel, T Anh; Beucher, Sophie; Frago, Carina; Moureau, Annick; Simmerman, Mark; Laot, Thelma; L'Azou, Maïna; Bouckenooghe, Alain

    2016-08-01

    Dengue incidence has increased globally, but empirical burden estimates are scarce. Prospective methods are best-able to capture all severities of disease. CYD14 was an observer-blinded dengue vaccine study conducted in children 2-14 years of age in Indonesia, Malaysia, Thailand, the Philippines, and Vietnam. The control group received no vaccine and resembled a prospective, observational study. We calculated the rates of dengue according to different laboratory or clinical criteria to make inferences about dengue burden, and compared with rates reported in the passive surveillance systems to calculate expansion factors which describe under-reporting. Over 6,933 person-years of observation in the control group there were 319 virologically confirmed dengue cases, a crude attack rate of 4.6%/year. Of these, 92 cases (28.8%) were clinically diagnosed as dengue fever or dengue hemorrhagic fever by investigators and 227 were not, indicating that most symptomatic disease fails to satisfy existing case definitions. When examining different case definitions, there was an inverse relationship between clinical severity and observed incidence rates. CYD14's active surveillance system captured a greater proportion of symptomatic dengue than national passive surveillance systems, giving rise to expansion factors ranging from 0.5 to 31.7. This analysis showed substantial, unpredictable and variable under-reporting of symptomatic dengue, even within a controlled clinical trial environment, and emphasizes that burden estimates are highly sensitive to case definitions. These data will assist in generating disease burden estimates and have important policy implications when considering the introduction and health economics of dengue prevention and control interventions.

  19. A comparison of location of acute symptomatic vs. ‘silent’ small vessel lesions

    PubMed Central

    Valdés Hernández, Maria del C.; Maconick, Lucy C.; Muñoz Maniega, Susana; Wang, Xin; Wiseman, Stewart; Armitage, Paul A.; Doubal, Fergus N.; Makin, Stephen; Sudlow, Cathie L. M.; Dennis, Martin S.; Deary, Ian J.; Bastin, Mark

    2015-01-01

    Background Acute lacunar ischaemic stroke, white matter hyperintensities, and lacunes are all features of cerebral small vessel disease. It is unclear why some small vessel disease lesions present with acute stroke symptoms, whereas others typically do not. Aim To test if lesion location could be one reason why some small vessel disease lesions present with acute stroke, whereas others accumulate covertly. Methods We identified prospectively patients who presented with acute lacunar stroke symptoms with a recent small subcortical infarct confirmed on magnetic resonance diffusion imaging. We compared the distribution of the acute infarcts with that of white matter hyperintensity and lacunes using computational image mapping methods. Results In 188 patients, mean age 67 ± standard deviation 12 years, the lesions that presented with acute lacunar ischaemic stroke were located in or near the main motor and sensory tracts in (descending order): posterior limb of the internal capsule (probability density 0·2/mm3), centrum semiovale (probability density = 0·15/mm3), medial lentiform nucleus/lateral thalamus (probability density = 0·09/mm3), and pons (probability density = 0·02/mm3). Most lacunes were in the lentiform nucleus (probability density = 0·01–0·04/mm3) or external capsule (probability density = 0·05/mm3). Most white matter hyperintensities were in centrum semiovale (except for the area affected by the acute symptomatic infarcts), external capsules, basal ganglia, and brainstem, with little overlap with the acute symptomatic infarcts (analysis of variance, P < 0·01). Conclusions Lesions that present with acute lacunar ischaemic stroke symptoms may be more likely noticed by the patient through affecting the main motor and sensory tracts, whereas white matter hyperintensity and asymptomatic lacunes mainly affect other areas. Brain location could at least partly explain the symptomatic vs. covert development of small vessel

  20. Endophytic bacterial diversity in the phyllosphere of Amazon Paullinia cupana associated with asymptomatic and symptomatic anthracnose.

    PubMed

    Bogas, Andréa Cristina; Ferreira, Almir José; Araújo, Welington Luiz; Astolfi-Filho, Spartaco; Kitajima, Elliot Watanabe; Lacava, Paulo Teixeira; Azevedo, João Lúcio

    2015-01-01

    Endophytes colonize an ecological niche similar to that of phytopathogens, which make them candidate for disease suppression. Anthracnose is a disease caused by Colletotrichum spp., a phytopathogen that can infect guarana (Paullinia cupana), an important commercial crop in the Brazilian Amazon. We investigated the diversity of endophytic bacteria inhabiting the phyllosphere of asymptomatic and symptomatic anthracnose guarana plants. The PCR-denaturation gradient gel electrophoresis (PCR-DGGE) fingerprints revealed differences in the structure of the evaluated communities. Detailed analysis of endophytic bacteria composition using culture-dependent and 16S rRNA clone libraries revealed the presence of Firmicutes, Proteobacteria, Actinobacteria, Bacteroidetes, and Acidobacteria phyla. Firmicutes comprised the majority of isolates in asymptomatic plants (2.40E(-4)). However, cloning and sequencing of 16S rRNA revealed differences at the genus level for Neisseria (1.4E(-4)), Haemophilus (2.1E(-3)) and Arsenophonus (3.6E(-5)) in asymptomatic plants, Aquicella (3.5E(-3)) in symptomatic anthracnose plants, and Pseudomonas (1.1E(-3)), which was mainly identified in asymptomatic plants. In cross-comparisons of the endophytic bacterial communities as a whole, symptomatic anthracnose plants contained higher diversity, as reflected in the Shannon-Weaver and Simpson indices estimation (P < 0.05). Similarly, comparisons using LIBSHUFF and heatmap analysis for the relative abundance of operational taxonomic units (OTUs) showed differences between endophytic bacterial communities. These data are in agreement with the NMSD and ANOSIM analysis of DGGE profiles. Our results suggest that anthracnose can restructure endophytic bacterial communities by selecting certain strains in the phyllosphere of P. cupana. The understanding of these interactions is important for the development of strategies of biocontrol for Colletotrichum.

  1. Symptomatic Dengue Disease in Five Southeast Asian Countries: Epidemiological Evidence from a Dengue Vaccine Trial.

    PubMed

    Nealon, Joshua; Taurel, Anne-Frieda; Capeding, Maria Rosario; Tran, Ngoc Huu; Hadinegoro, Sri Rezeki; Chotpitayasunondh, Tawee; Chong, Chee Kheong; Wartel, T Anh; Beucher, Sophie; Frago, Carina; Moureau, Annick; Simmerman, Mark; Laot, Thelma; L'Azou, Maïna; Bouckenooghe, Alain

    2016-08-01

    Dengue incidence has increased globally, but empirical burden estimates are scarce. Prospective methods are best-able to capture all severities of disease. CYD14 was an observer-blinded dengue vaccine study conducted in children 2-14 years of age in Indonesia, Malaysia, Thailand, the Philippines, and Vietnam. The control group received no vaccine and resembled a prospective, observational study. We calculated the rates of dengue according to different laboratory or clinical criteria to make inferences about dengue burden, and compared with rates reported in the passive surveillance systems to calculate expansion factors which describe under-reporting. Over 6,933 person-years of observation in the control group there were 319 virologically confirmed dengue cases, a crude attack rate of 4.6%/year. Of these, 92 cases (28.8%) were clinically diagnosed as dengue fever or dengue hemorrhagic fever by investigators and 227 were not, indicating that most symptomatic disease fails to satisfy existing case definitions. When examining different case definitions, there was an inverse relationship between clinical severity and observed incidence rates. CYD14's active surveillance system captured a greater proportion of symptomatic dengue than national passive surveillance systems, giving rise to expansion factors ranging from 0.5 to 31.7. This analysis showed substantial, unpredictable and variable under-reporting of symptomatic dengue, even within a controlled clinical trial environment, and emphasizes that burden estimates are highly sensitive to case definitions. These data will assist in generating disease burden estimates and have important policy implications when considering the introduction and health economics of dengue prevention and control interventions. PMID:27532617

  2. Symptomatic and Asymptomatic Neurological Complications of Infective Endocarditis: Impact on Surgical Management and Prognosis

    PubMed Central

    Delahaye, François; Tattevin, Pierre; Federspiel, Claire; Le Moing, Vincent; Chirouze, Catherine; Nazeyrollas, Pierre; Vernet-Garnier, Véronique; Bernard, Yvette; Chocron, Sidney; Obadia, Jean-François; Alla, François; Hoen, Bruno; Duval, Xavier

    2016-01-01

    Objectives Symptomatic neurological complications (NC) are a major cause of mortality in infective endocarditis (IE) but the impact of asymptomatic complications is unknown. We aimed to assess the impact of asymptomatic NC (AsNC) on the management and prognosis of IE. Methods From the database of cases collected for a population-based study on IE, we selected 283 patients with definite left-sided IE who had undergone at least one neuroimaging procedure (cerebral CT scan and/or MRI) performed as part of initial evaluation. Results Among those 283 patients, 100 had symptomatic neurological complications (SNC) prior to the investigation, 35 had an asymptomatic neurological complications (AsNC), and 148 had a normal cerebral imaging (NoNC). The rate of valve surgery was 43% in the 100 patients with SNC, 77% in the 35 with AsNC, and 54% in the 148 with NoNC (p<0.001). In-hospital mortality was 42% in patients with SNC, 8.6% in patients with AsNC, and 16.9% in patients with NoNC (p<0.001). Among the 135 patients with NC, 95 had an indication for valve surgery (71%), which was performed in 70 of them (mortality 20%) and not performed in 25 (mortality 68%). In a multivariate adjusted analysis of the 135 patients with NC, age, renal failure, septic shock, and IE caused by S. aureus were independently associated with in-hospital and 1-year mortality. In addition SNC was an independent predictor of 1-year mortality. Conclusions The presence of NC was associated with a poorer prognosis when symptomatic. Patients with AsNC had the highest rate of valve surgery and the lowest mortality rate, which suggests a protective role of surgery guided by systematic neuroimaging results. PMID:27400273

  3. Uterine artery embolisation for symptomatic fibroids: the University of Malaya Medical Centre experience

    PubMed Central

    Subramaniam, RN; Vijayananthan, A; Omar, SZ; Nawawi, O; Abdullah, BJJ

    2010-01-01

    Background: Transcatheter uterine artery embolisation (UAE) for the treatment of symptomatic fibroids has been performed in several centres in the United States, Western Europe and Asia with promising results. This study reports the authors' experience with UAE at the University Malaya Medical Centre. Method: Fifty women with symptomatic uterine fibroids who declined surgery were treated by transcatheter UAE. The uterine arteries were selectively catheterised and embolised with polyvinyl alcohol particles. Post-procedure analgesia was administered via patient-controlled analgesic pump. The patients were followed up at an interval of 6/12 clinically and with MRI. Results: Transcatheter UAE was performed on all 50 patients with no major complications. 49 patients had both uterine arteries embolised while 1 patient had only the right uterine artery embolised on account of hypoplasia of the left uterine artery due to previous myomectomy. The mean hospital stay was 3.5 days (range, 2 to 7). At a mean follow-up of 24/52, all patients reported improvements in their presenting symptoms. Objective improvement in terms of reduction of uterine and fibroid sizes was determined on MRI. One patient, who initially responded with a decrease in uterine and dominant fibroid size, became symptomatic (menorrhagia) after 6 months and subsequent endometrial sampling revealed cystic glandular hyperplasia for which total abdominal hysterectomy was performed. Two other patients had no change in symptoms and after hysterectomy, the pathology revealed concurrent adenomyosis. Another 2 patients with cervical fibroids were treated with hysterectomy as there was no gross reduction in the size of fibroid following UAE. Overall, 90% of the patients had dramatic improvement of anaemia and symptoms at 1 year follow-up. Conclusion: Out of the 50 patients, 17 patients had total disappearance of their fibroids and 28 patients had more than 50% reduction in the size of fibroids after 1 year. 5 patients

  4. The Angelchik prosthesis for gastro-oesophageal reflux: symptomatic and objective assessment.

    PubMed Central

    Weaver, R. M.; Temple, J. G.

    1985-01-01

    Twenty-three patients with intractable gastro-oesophageal reflux were treated by insertion of the Angelchik antireflux prosthesis. Good symptomatic relief was achieved in over 80% of patients reviewed up to 28 months after operation and there was marked resolution of oesophagitis as seen on endoscopy. Oesophageal manometry and pH studies performed preoperatively and at 3 and 12 months after operation, showed a significant increase in lower oesophageal sphincter pressure with decreased acid reflux. Some technical problems were encountered, but the prosthesis is potentially a simple and effective means of controlling gastro-oesophageal reflux. Images Fig. 1 PMID:4051424

  5. Palliative Radiation Therapy for Symptomatic Control of Inoperable Renal Cell Carcinoma

    PubMed Central

    Nikolaev, Anatoly; Benda, Rashmi

    2015-01-01

    Renal cell carcinoma (RCC) is traditionally considered to be resistant to conventional low dose radiation therapy (RT). The emergence of image-guided stereotactic body radiation therapy (SBRT) made it possible to deliver much higher doses of radiation. Recent clinical trials of SBRT for RCC showed improvement in local control rates and acceptable toxicity. Here we report a case of inoperable symptomatic RCC that was managed with SBRT. Strikingly, the presenting symptoms of gross hematuria and severe anemia were completely resolved following a course of SBRT. Thus, our case report highlights the potential benefit of this technique for patients with inoperable RCC. PMID:26793580

  6. Palliative Radiation Therapy for Symptomatic Control of Inoperable Renal Cell Carcinoma.

    PubMed

    Nikolaev, Anatoly; Benda, Rashmi

    2016-01-01

    Renal cell carcinoma (RCC) is traditionally considered to be resistant to conventional low dose radiation therapy (RT). The emergence of image-guided stereotactic body radiation therapy (SBRT) made it possible to deliver much higher doses of radiation. Recent clinical trials of SBRT for RCC showed improvement in local control rates and acceptable toxicity. Here we report a case of inoperable symptomatic RCC that was managed with SBRT. Strikingly, the presenting symptoms of gross hematuria and severe anemia were completely resolved following a course of SBRT. Thus, our case report highlights the potential benefit of this technique for patients with inoperable RCC. PMID:26793580

  7. Symptomatic obstruction of the brachiocephalic and left subclavian arteries obscured by aortic stenosis.

    PubMed

    Hashim, Peter W; Assi, Roland; Grecu, Loreta; Dardik, Alan

    2014-04-01

    Stenosis or occlusion of the brachiocephalic artery represents an uncommon cause of cerebrovascular insufficiency. We report a patient with combined brachiocephalic and left subclavian obstruction with clinical manifestations of lightheadedness, syncope, and left-sided weakness who remained misdiagnosed essentially because of symmetrical pressures in the upper extremities. Aortic valve replacement for aortic stenosis failed to provide symptomatic relief. Eventual stenting of the brachiocephalic trunk resolved the patient's symptoms. Our report highlights the diagnostic challenges in this case of bilateral supraaortic vessel disease and shows that equal upper extremity pressures do not rule out brachiocephalic artery obstruction.

  8. Transcriptome analysis of symptomatic and recovered leaves of geminivirus-infected pepper (Capsicum annuum)

    PubMed Central

    2012-01-01

    Background Geminiviruses are a large and important family of plant viruses that infect a wide range of crops throughout the world. The Begomovirus genus contains species that are transmitted by whiteflies and are distributed worldwide causing disease on an array of horticultural crops. Symptom remission, in which newly developed leaves of systemically infected plants exhibit a reduction in symptom severity (recovery), has been observed on pepper (Capsicum annuum) plants infected with Pepper golden mosaic virus (PepGMV). Previous studies have shown that transcriptional and post-transcriptional gene silencing mechanisms are involved in the reduction of viral nucleic acid concentration in recovered tissue. In this study, we employed deep transcriptome sequencing methods to assess transcriptional variation in healthy (mock), symptomatic, and recovered pepper leaves following PepGMV infection. Results Differential expression analyses of the pepper leaf transcriptome from symptomatic and recovered stages revealed a total of 309 differentially expressed genes between healthy (mock) and symptomatic or recovered tissues. Computational prediction of differential expression was validated using quantitative reverse-transcription PCR confirming the robustness of our bioinformatic methods. Within the set of differentially expressed genes associated with the recovery process were genes involved in defense responses including pathogenesis-related proteins, reactive oxygen species, systemic acquired resistance, jasmonic acid biosynthesis, and ethylene signaling. No major differences were found when compared the differentially expressed genes in symptomatic and recovered tissues. On the other hand, a set of genes with novel roles in defense responses was identified including genes involved in histone modification. This latter result suggested that post-transcriptional and transcriptional gene silencing may be one of the major mechanisms involved in the recovery process. Genes

  9. Therapy decisions for the symptomatic patient with metastatic castration-resistant prostate cancer

    PubMed Central

    Markowski, Mark C; Pienta, Kenneth J

    2015-01-01

    Metastatic prostate cancer continues to kill approximately 30,000 men per year. Since 2010, five new therapeutic agents have been Food and Drug Administration (FDA) approved to treat metastatic castration-resistant prostate cancer (mCRPC). With the increasing number of therapies available to clinicians, the most effective sequence in which to implement these treatments remains unknown. The presence or absence of symptoms (i.e., bony pain, visceral crisis) is a key parameter that informs the decision-making process regarding therapy. Treatment algorithms based on: 1) asymptomatic/minimal symptoms, 2) moderate symptoms or chemotherapy ineligible or 3) symptomatic disease need to be developed. PMID:25865849

  10. A Rare Case of Symptomatic Double Optic Disc Pit without Maculopathy

    PubMed Central

    Abdul-Nabi, Mohammad

    2016-01-01

    Optic disc pits are an uncommon congenital abnormality. Patients remain asymptomatic unless they develop maculopathy. We present a rare case of a double optic disc pit of which only three others have been reported worldwide. A 51-year-old gentleman presented with blurred vision. Fundoscopy revealed a right double optic disc pit. Though he was symptomatic there was no evidence of maculopathy. OCT of macula and disc was otherwise unremarkable. Visual field demonstrated a paracentral defect. Although optic disc pits are rare they are still an important clinical entity. Prompt identification and treatment of complications are required to prevent a poor visual prognosis. PMID:27648324

  11. A Rare Case of Symptomatic Double Optic Disc Pit without Maculopathy.

    PubMed

    Ali, Zaria; Abdul-Nabi, Mohammad

    2016-01-01

    Optic disc pits are an uncommon congenital abnormality. Patients remain asymptomatic unless they develop maculopathy. We present a rare case of a double optic disc pit of which only three others have been reported worldwide. A 51-year-old gentleman presented with blurred vision. Fundoscopy revealed a right double optic disc pit. Though he was symptomatic there was no evidence of maculopathy. OCT of macula and disc was otherwise unremarkable. Visual field demonstrated a paracentral defect. Although optic disc pits are rare they are still an important clinical entity. Prompt identification and treatment of complications are required to prevent a poor visual prognosis. PMID:27648324

  12. Transmission of calicivirus by a foodhandler in the pre-symptomatic phase of illness.

    PubMed

    Gaulin, C; Frigon, M; Poirier, D; Fournier, C

    1999-12-01

    After a Christmas party in a restaurant, 48 (68%) of the 82 guests contracted calicivirus gastroenteritis. The epidemiological investigation showed that salad was strongly associated with the disease episode (RR = 2.43, P = 0.0005). Similar symptoms occurred among other customers who had had a meal at the same restaurant on the same evening. A foodhandler who had only prepared salad and appetizers became sick about 30 min after the end of his shift. He had been free of symptoms while preparing food. Few outbreak investigations have shown calicivirus transmission by foodhandlers some hours before becoming symptomatic.

  13. [Symptomatic adrenal myelolipoma: apropos of 2 cases. Review of the literature].

    PubMed

    Nova Sánchez, E; López López, C; Fernández Puentes, J C; Llorens Martínez, F J; García López, F

    1989-01-01

    We present two symptomatic cases of adrenal myelolipoma with good evolution 24 and 14 months after surgery. We discuss the clinical characteristics of these tumours and diagnostic methods, of which CAT seems to be the most effective. In therapy we single out the need for surgery in those that are of large size and without accompanying symptomatology owing to the risk of spontaneous hemorrhaging or subsequent to traumatism, as well as in those displaying clinical symptoms. In small asymptomatic ones, discovered incidentally, we will carry out periodic observation with controls by CAT and/or echography. PMID:2688368

  14. [Chronic prostatitis with chronic pelvic pain syndrome].

    PubMed

    Balvocius, Antanas

    2002-01-01

    Almost 10% of the adult male population suffer from prostatitis. The International Prostatitis Collaborative Network has devised and validated a clinically useful classification of prostatitis that urologists and primary care clinicians will find helpful. According to this schema, chronic bacterial prostatitis is clearly an infectious disease, and patients with chronic prostatitis associated with chronic pelvic pain syndrome can have either inflammatory or noninflammatory disease. Chronic bacterial prostatitis is uncommon, chronic nonbacterial prostatitis (CPPS) is extremely common. Antibiotic therapy is indicated in management of chronic bacterial prostatitis and inflammatory chronic pelvic pain syndrome. Fluoroquinolones are safe and effective in managing chronic bacterial prostatitis. Based on literature, noninflammatory chronic pelvic pain syndrome can be treated using adrenergic blockade, analgesic, tricyclic antidepressants, benzodiazepie, physical therapy. PMID:12556633

  15. Cinnarizine in the treatment of chronic asthma.

    PubMed Central

    Emanuel, M B; Chamberlain, J A; Whiting, S; Rigden, B G; Craven, A H

    1979-01-01

    1 Cinnarizine, an inhibitor of calcium ion transport across smooth muscle cell membrane, has been shown to exert an anti-asthmatic effect in patients with chronic asthma. 2 It is postulated that antagonism to calcium ion transport across the mast cell membrane may cause the compound to have a pharmacological effect similar to sodium cromoglycate. 3 Cinnarizine is orally active and its therapeutic effect is demonstrated in a double-blind, cross-over, placebo controlled study. 4 Patient benefit was shown by a significant improvement in peak flow rate. A non-significant trend towards a reduction in symptomatic bronchodilator usage and a decrease in asthma symptom score was also shown. 5 It is concluded that cinnarizine could well prove to be the first of a new family of anti-asthmatic drugs offering a protective effect when taken systemically. PMID:367414

  16. Pharmacological treatment of chronic obstructive pulmonary disease

    PubMed Central

    Montuschi, Paolo

    2006-01-01

    None of the drugs currently available for chronic obstructive pulmonary disease (COPD) are able to reduce the progressive decline in lung function which is the hallmark of this disease. Smoking cessation is the only intervention that has proved effective. The current pharmacological treatment of COPD is symptomatic and is mainly based on bronchodilators, such as selective β2-adrenergic agonists (short- and long-acting), anticholinergics, theophylline, or a combination of these drugs. Glucocorticoids are not generally recommended for patients with stable mild to moderate COPD due to their lack of efficacy, side effects, and high costs. However, glucocorticoids are recommended for severe COPD and frequent exacerbations of COPD. New pharmacological strategies for COPD need to be developed because the current treatment is inadequate. PMID:18044097

  17. Common lung conditions: chronic obstructive pulmonary disease.

    PubMed

    Delzell, John E

    2013-06-01

    The etiology of chronic obstructive pulmonary disease (COPD) is chronic lung inflammation. In the United States, this inflammation most commonly is caused by smoking. COPD is diagnosed when an at-risk patient presents with respiratory symptoms and has irreversible airway obstruction indicated by a forced expiratory volume in 1 second/forced vital capacity ratio of less than 0.7. Management goals for COPD include smoking cessation, symptom reduction, exacerbation reduction, hospitalization avoidance, and improvement of quality of life. Stable patients with COPD who remain symptomatic despite using short-acting bronchodilators should start inhaled maintenance drugs to reduce symptoms and exacerbations, avoid hospitalizations, and improve quality of life. A long-acting anticholinergic or a long-acting beta2-agonist (LABA) can be used for initial therapy; these drugs have fewer adverse effects than inhaled corticosteroids (ICS). If patients remain symptomatic despite monotherapy, dual therapy with a long-acting anticholinergic and a LABA, or a LABA and an ICS, may be beneficial. Triple therapy (ie, a long-acting anticholinergic, a LABA, and an ICS) also is used, but it is unclear if triple therapy is superior to dual therapy. Roflumilast, an oral selective inhibitor of phosphodiesterase 4, is used to manage moderate to severe COPD. Continuous oxygen therapy is indicated for patients with COPD who have severe hypoxemia (ie, PaO2 less than 55 mm Hg or an oxygen saturation less than 88% on room air). Nonpharmacologic strategies also are useful to improve patient outcomes. Pulmonary rehabilitation improves dyspnea and quality of life. Pulmonary rehabilitation after an acute exacerbation reduces hospitalizations and mortality, and improves quality of life and exercise capacity. Smoking cessation is the most effective management strategy for reducing morbidity and mortality in patients with COPD. Lung volume reduction surgery, bullectomy, and lung transplantation are

  18. Symptomatic lumbosacral perineural cysts: A report of three cases and review of literature.

    PubMed

    Sharma, Mayur; Velho, Vernon; Mally, Rahul; Khan, Shadma W

    2015-01-01

    Lumbosacral perineural cysts (Tarlov's cysts) are nerve root cysts, which are usually asymptomatic and are detected incidentally on imaging. These cysts are rare with an incidence of 4.6%. We report three cases of Lumbosacral Tarlov's cysts, which presented with cauda equina syndrome and radicular pain syndrome. Two of our patients had symptoms of cauda equina syndrome, and one had acute sciatica. Complete excision of the cyst was achieved in two patients and marsupialization of the cyst was done in another patient due to its large size and dense adherence to the sacral nerve roots. All the patients were relieved of the radicular pain with no new neurological deficit following surgery. Symptomatic lumbosacral Tarlov's cyst is a rare lesion, and the presentation can be low back pain, cauda equina syndrome or sciatica. Therefore, this entity should be kept in the differential diagnosis of patients presenting with these symptoms. Complete Surgical excision of these symptomatic cysts is the treatment of choice to achieve a cure. PMID:26396612

  19. Selection, management, and early outcome of 113 patients with symptomatic gall stones treated by percutaneous cholecystolithotomy.

    PubMed

    Cheslyn-Curtis, S; Gillams, A R; Russell, R C; Donald, J J; Lake, S P; Ainley, C A; Hatfield, A R; Lees, W R

    1992-09-01

    Between January 1988 and December 1990, 283 patients with symptomatic gall stones were referred for non-operative treatment. After ultrasound scanning including a functional assessment, 220 (78%) patients were found to be suitable for percutaneous cholecystolithotomy. Of these, 113 underwent the procedure including 10 in whom extracorporeal shock-wave lithotripsy or methyl tert-butyl ether therapy had failed. Forty four patients underwent extracorporeal shockwave lithotripsy, methyl tert-butyl ether therapy or rotary lithotripsy, 46 chose laparoscopic cholecystectomy or minicholecystectomy and 27 declined treatment. Percutaneous cholecystolithotomy was successfully performed in 100 patients. Thirty four patients were a high operative risk and 14 presented with an acute complication of gall stone disease. Complications developed in 15 patients, all of whom were managed conservatively and most occurred during development of the technique. Outcome has been assessed clinically and by ultrasound scanning in 92 patients with a median follow up period of 14 months (six to 37 months). Seventy nine per cent were completely cured of their symptoms. Ninety three per cent of gall bladders were shown to be functioning and nine (9.8%) contained stones, although five of these are believed to have developed from residual fragments. Percutaneous cholecystolithotomy is a safe, non-operative treatment for symptomatic gall stones and enabled the patient to fully recover within two to three weeks; it has a definite role in the management of the elderly and high risk patient but its use for the treatment of other groups is likely to remain controversial.

  20. Hysteroscopic treatment of symptomatic cesarean-induced isthmocele: a prospective study.

    PubMed

    Raimondo, Gennaro; Grifone, Gaetano; Raimondo, Diego; Seracchioli, Renato; Scambia, Giovanni; Masciullo, Valeria

    2015-02-01

    An isthmocele, also known as a cesarean scar defect, is an emerging condition that typically affects women with a history of previous cesarean section, and its presence is a novel under-recognized cause of postmenstrual abnormal uterine bleeding and/or pelvic pain. The incidence of symptoms and their resolution after hysteroscopic surgery were evaluated prospectively in 120 consecutive isthmocele patients. Patients included only symptomatic premenopausal women. Transvaginal ultrasound and office hysteroscopy were used to diagnose isthmocele. Operative hysteroscopy was performed to correct the cesarean scar defect, and histologic findings were evaluated. Correction of an isthmocele via operative hysteroscopy was successful in all cases evaluated. Isthmoplasty resulted in the resolution of postmenstrual abnormal uterine bleeding and suprapubic pelvic pain in 80% of patients. In the remaining cases, 7% of patients had an improvement of symptoms, whereas 13% did not obtain any relief. Considering the recent diagnostic recognition of isthmoceles, we conclude that surgical treatment of this pathology by operative hysteroscopy may represent the best choice in symptomatic women because of its minimal invasiveness and beneficial therapeutic results. PMID:25285773

  1. Microbial infection and its control in cases of symptomatic apical periodontitis: a review.

    PubMed

    Skucaite, Neringa; Peciuliene, Vytaute; Maciulskiene, Vita

    2009-01-01

    Apical periodontitis is an inflammation of dental periapical tissues developed as a response to colonization of microorganisms in root canal system. Etiology of periapical pathology is associated with different species of microorganisms that are not fully defined yet. The changes in the composition of root canal microbiota as well as other factors, such as host resistance to various infections and concomitant viral infection, etc., can influence development of the symptomatic apical periodontitis. Etiology of disease is reviewed in this article. The purpose of treatment of symptomatic apical periodontitis is to eliminate the infection in root canal system and to obtain relief of symptoms. It can be done by conventional root canal therapy, which can be combined with anti-inflammatory medication. Indications for antibiotic therapy in such cases are limited to particular occasions, which are considered in article. Nevertheless, findings show that usually dentists prescribe antibiotics improperly in clinical practice. It can render drugs ineffective against diseases of dental origin as well as against potentially fatal infectious diseases. Selection of antibiotics for the treatment of root canal infections is reviewed in this article. Importance of antimicrobial susceptibility testing is emphasized. There is a need for more research on microbial causes and interactions in different forms of apical periodontitis to improve diagnosis and treatment.

  2. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review

    PubMed Central

    Neal, R D; Tharmanathan, P; France, B; Din, N U; Cotton, S; Fallon-Ferguson, J; Hamilton, W; Hendry, A; Hendry, M; Lewis, R; Macleod, U; Mitchell, E D; Pickett, M; Rai, T; Shaw, K; Stuart, N; Tørring, M L; Wilkinson, C; Williams, B; Williams, N; Emery, J

    2015-01-01

    Background: It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. Methods: Systematic review of the literature and narrative synthesis. Results: We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. Conclusions: This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers. PMID:25734382

  3. Large symptomatic gastric diverticula: Two case reports and a brief review of literature

    PubMed Central

    Marano, Luigi; Reda, Gianmarco; Porfidia, Raffaele; Grassia, Michele; Petrillo, Marianna; Esposito, Giuseppe; Torelli, Francesco; Cosenza, Angelo; Izzo, Giuseppe; Di Martino, Natale

    2013-01-01

    Gastric diverticula are rare and uncommon conditions. Most gastric diverticula are asymptomatic. When symptoms arise, they are most commonly upper abdominal pain, nausea and emesis, while dyspepsia and vomiting are less common. Occasionally, patients with gastric diverticula can have dramatic presentations related to massive bleeding or perforation. The diagnosis may be difficult, as symptoms can be caused by more common gastrointestinal pathologies and only aggravated by diverticula. The appropriate management of diverticula depends mainly on the symptom pattern and as well as diverticulum size. There is no specific therapeutic strategy for an asymptomatic diverticulum. Although some authors support conservative therapy with antacids, this provides only temporary symptom relief since it is not able to resolve the underlying pathology. Surgical resection is the mainstay of treatment when the diverticulum is large, symptomatic or complicated by bleeding, perforation or malignancy, with over two-thirds of patients remaining symptom-free after surgery, while laparoscopic resection, combined with intraoperative endoscopy, is a safe and feasible approach with excellent outcomes. Here, we present two cases of uncommon large symptomatic gastric diverticula with a discussion of the cornerstones in management and report a minimally invasive solution, with a brief review of the literature. PMID:24106415

  4. A Randomized Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children

    PubMed Central

    2009-01-01

    Objective To compare home-based pencil push-ups (HBPP), home-based computer vergence/accommodative therapy and pencil push-ups (HBCVAT+), office-based vergence/accommodative therapy with home reinforcement (OBVAT), and office-based placebo therapy with home reinforcement (OBPT) as treatments for symptomatic convergence insufficiency (CI). Methods In a randomized clinical trial, 221 children 9 to 17 years with symptomatic CI were assigned to one of four treatments. Main Outcome Measures Convergence Insufficiency Symptom Survey (CISS) score after 12 weeks of treatment. Secondary outcomes were near point of convergence (NPC) and positive fusional vergence at near (PFV). Results After 12 weeks of treatment the OBVAT group’s CISS score (15.1) was statistically significantly lower than the HBCVAT+, HBPP, and OBPT groups’ scores of 21.3, 24.7, and 21.9, respectively (P < 0.001). The OBVAT group also demonstrated a significantly improved NPC and PFV compared with the other groups (P <= 0.005). A successful or improved outcome for the OBVAT, HBPP, HBCVAT+, and OBPT groups was found in 73%, 43%, 33%, and 35%, respectively. Conclusion Twelve weeks of OBVAT results in a significantly greater improvement in symptoms and clinical measures of NPC and PFV and a greater percentage of patients reaching pre-determined criteria of success when compared with HBPP, HBCVAT+, or OBPT. PMID:18852411

  5. Pulmonary fibrosis secondary to siderosis causing symptomatic respiratory disease: a case report

    PubMed Central

    McCormick, Liam M; Goddard, Martin; Mahadeva, Ravi

    2008-01-01

    Introduction Pulmonary siderosis secondary to the inhalation of iron compounds is a rare condition which, despite striking radiological and histopathological features, has not traditionally been associated with symptoms or functional impairment. Although not the first of its kind, we present an unusual case of pulmonary siderosis with symptomatic respiratory disease, most likely secondary to associated fibrosis. Case presentation A 66-year-old Caucasian man was referred to the outpatient clinic with a 2-year history of exertional breathlessness. He had worked as an engineer for 20 years where he did a significant amount of welding but always wore a face shield. Clinical, radiological and histological features were consistent with a diagnosis of pulmonary siderosis, with associated fibrosis, most likely related to his occupational welding history. Conclusion Our report illustrates that symptomatic respiratory disease due to mild peribronchiolar fibrosis can occur with pulmonary siderosis despite wearing a mask. Furthermore, it reinforces the need for all clinicians to compile a detailed occupational history in individuals presenting with breathlessness. PMID:18681950

  6. Symptomatic coalition between the first and second metatarsals in a child.

    PubMed

    Novak, Erik J; Elzik, Mark; Diab, Mohammad

    2008-12-01

    Coalitions of the foot are relatively uncommon abnormalities, occurring in approximately 1% of the population. Talocalcaneal and calcaneonavicular are the most common types of coalitions. Coalitions in the forefoot, however, are rare, with only a small number of case reports in the literature. We report on a unilateral, symptomatic coalition between the first and second metatarsals in a 12-year-old girl who presented with a several-month history of intermittent medial-sided, dorsal forefoot pain and difficulty with shoe wear. Her preoperative examination was notable for a firm, nontender dorsal medial forefoot mass centered between the first and second metatarsals. While the first metatarsal head was level with the second metatarsal head in the sagittal plane, the metatarsals were rigidly fixed to one another. First metatarsal-medial cuneiform motion was reduced compared to the unaffected foot. Preoperative magnetic resonance imaging demonstrated a bony and cartilaginous coalition between the first and second metatarsals. Following resection, an immediate improvement was noted in motion between the first and second metatarsals, as well as the first metatarsal and medial cuneiform. In our patient, rigidity between the first and second metatarsals contributed to a stiff first ray with higher plantar pressures beneath the first metatarsal head with walking. The abnormal kinematics likely contributed to her medial forefoot pain with prolonged ambulation and sports activities. Prompt identification and resection of these less common coalitions affecting the forefoot allows symptomatic relief and restoration of normal kinematics.

  7. Evaluation of symptomatic slow-acting drugs in osteoarthritis using the GRADE system

    PubMed Central

    Bruyère, Olivier; Burlet, Nansa; Delmas, Pierre D; Rizzoli, René; Cooper, Cyrus; Reginster, Jean-Yves

    2008-01-01

    Background Symptomatic slow-acting drugs (SYSADOA) have been largely studied over the last decade. The objective of this study is to prepare a document providing recommendations for the use of SYSADOA in osteoarthritis (OA). Methods The following interventions were taken into consideration: avocado/soybean unsaponifiables, chondroitin sulfate, diacereine, glucosamine sulfate, hyaluronic acid, oral calcitonin, risedronate, strontium ranelate. Recommendations were based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The GRADE system is based on a sequential assessment of the quality of evidence, followed by assessment of the balance between benefits versus downsides and subsequent judgment about the strength of recommendations. Results Chondroitin sulfate, diacereine, glucosamine sulfate, avocado/soybean unsaponifiables and hyaluronic acid have demonstrated pain reduction and physical function improvement with very low toxicity, with moderate to high quality evidence. Even if pre-clinical data and some preliminary in vivo studies have suggested that oral calcitonin and strontium ranelate could be of potential interest in OA, additional well-designed studies are needed. Conclusion In the benefit/risk ratio, the use of chondroitin sulfate, diacereine, glucosamine sulfate, avocado/soybean unsaponifiables and hyaluronic acid could be of potential interest for the symptomatic management of OA. PMID:19087296

  8. Prevalence and Genetic Diversity of Human Astroviruses in Mexican Children with Symptomatic and Asymptomatic Infections

    PubMed Central

    Méndez-Toss, Martha; Griffin, Dixie D.; Calva, Juan; Contreras, Juan F.; Puerto, Fernando I.; Mota, Felipe; Guiscafré, Héctor; Cedillo, Roberto; Muñoz, Onofre; Herrera, Ismael; López, Susana; Arias, Carlos F.

    2004-01-01

    The prevalence and type diversity of human astroviruses (HAstV) in children with symptomatic and asymptomatic infections were determined in five localities of Mexico. HAstV were detected in 4.6 (24 of 522) and 2.6% (11 of 428) of children with and without diarrhea, respectively. Genotyping of the detected strains showed that at least seven (types 1 to 4 and 6 to 8) of the eight known HAstV types circulated in Mexico between October 1994 and March 1995. HAstV types 1 and 3 were the most prevalent in children with diarrhea, although they were not found in all localities studied. HAstV type 8 was found in Mexico City, Monterrey, and Mérida; in the last it was as prevalent (40%) as type 1 viruses, indicating that this astrovirus type is more common than previously recognized. A correlation between the HAstV infecting type and the presence or absence of diarrheic symptoms was not observed. Enteric adenoviruses were also studied, and they were found to be present in 2.3 (12 of 522) and 1.4% (6 of 428) of symptomatic and asymptomatic children, respectively. PMID:14715746

  9. Symptomatic Very Delayed Parent Artery Occlusion After Flow Diversion Stent Embolization

    PubMed Central

    OISHI, Hidenori; TERANISHI, Kosuke; NONAKA, Senshu; YAMAMOTO, Munetaka; ARAI, Hajime

    2016-01-01

    Flow diversion stents (FDSs) are constructed from high-density braided mesh, which alters intra-aneurysmal hemodynamics and leads to aneurysm occlusion by inducing thrombus formation. Although there are potential complications associated with FDS embolization, one of the serious complications is the parent artery occlusion due to the in-stent thrombosis. A 72-year-old woman with a symptomatic giant fusiform aneurysm in the cavernous segment of ICA underwent single-layer pipeline embolization device (PED) embolization. Six-month and 1-year follow-up conventional angiographies showed the residual blood flow in the aneurysm. Two-year follow-up MRI showed the aneurysm sac shrinkage and the antiplatelet therapy was discontinued. The patient suffered from symptomatic parent artery occlusion due to the in-stent thrombosis, 4 months after antiplatelet therapy discontinuation. The patient with the incompletely occluded aneurysm after PED embolization should be given long-term antiplatelet therapy because of the risk of delayed parent artery occlusion. PMID:27169622

  10. Levonorgestrel-releasing intrauterine system use in premenopausal women with symptomatic uterine leiomyoma: a systematic review.

    PubMed

    Jiang, Wenxiao; Shen, Qi; Chen, Miaomiao; Wang, Ying; Zhou, Qingfeng; Zhu, Xuejie; Zhu, Xueqiong

    2014-08-01

    A systematic review is done to determine the efficacy and safety of levonorgestrel-releasing intrauterine systems as a treatment using in premenopausal women with symptomatic uterine leiomyoma. We searched the Medline, Central and ICTRP databases for all articles published from inception through July 2013 that examined the following outcomes: uterine volume, uterine leiomyoma volume, endometrial thickness, then menstrual blood loss, blood haemoglobin, ferritin and hematocrit levels, treatment failure rate, device expulsion rate, hysterectomy rate and side effects. From 645 studies, a total of 11 studies met our inclusion criteria with sample sizes ranging from 10 to 104. Evidence suggested that levonorgestrel-releasing intrauterine systems could decrease uterine volume and endometrial thickness, significantly reduce menstrual blood loss, and increase blood haemoglobin, ferritin and hematocrit levels. There was no evidence for decreasing uterine leiomyoma volume. There were no adverse effects on the ovarian function except for ovarian cysts. Device expulsion rates were low, which associated with leiomyoma size (larger than 3cm) but not with leiomyoma location. Irregular bleeding/spotting was observed at the beginning of the follow-up period and then decreased progressively. Results of this systematic review indicate that levonorgestrel-releasing intrauterine systems may be effective and safe treatment for symptomatic uterine leiomyoma in premenopausal women.

  11. A novel technique of arthroscopic excision of a symptomatic os trigonum.

    PubMed

    Horibe, Shuji; Kita, Keisuke; Natsu-ume, Takashi; Hamada, Masayuki; Mae, Tatsuo; Shino, Konsei

    2008-01-01

    We describe a new arthroscopic excision technique for a symptomatic os trigonum. With the patient lying in a prone position, a posterolateral portal just lateral to the Achilles tendon, at the 5-mm level proximal to the tip of the fibula, is used for the arthroscope and an accessory posterolateral portal just posterior to the peroneal tendon at the same level is used for instruments. The synovial tissues are then debrided with a power shaver through the accessory posterolateral portal for better visualization. An elevator is used to release the fibrous tissue between the os trigonum and the talus. The os trigonum is completely excised with a grasper to visualize the flexor hallucis longus tendon. Radiographic control is helpful to check the position of the arthroscope if it happens to be inserted into the ankle joint as a result of the reduced subtalar joint space. Postoperatively, no immobilization is necessary, and full weight-bearing is allowed as tolerated. Three of us have performed 11 procedures with excellent results and no cases of complications. This arthroscopic excision technique for the symptomatic os trigonum is a safe and effective procedure.

  12. Overdiagnosing of femoroacetabular impingement: correlation between clinical presentation and computed tomography in symptomatic patients☆

    PubMed Central

    Canella, Richard Prazeres; Adam, Guilherme Pradi; de Castillo, Roberto André Ulhôa; Codonho, Daniel; Ganev, Gerson Gandhi; de Vicenzi, Luiz Fernando

    2016-01-01

    Objective To correlate the angles between the acetabulum and the proximal femur in symptomatic patients with femoroacetabular impingement (FAI), using computed tomography (CT). Methods We retrospectively evaluated 103 hips from 103 patients, using multislice CT to measure the acetabular age, acetabular version (in its supraequatorial portion and in its middle third), femoral neck version, cervical-diaphyseal and alpha angles and the acetabular depth. For the statistical analysis, we used the Pearson correlation coefficient. Results There were inverse correlations between the following angles: (1) acetabular coverage versus alpha angle (p = 0.019); (2) acetabular version (supraequatorial) versus alpha angle (p = 0.049). For patients with femoral anteversion lower than 15 degrees: (1) acetabular version (supraequatorial) versus alpha angle (p = 0.026); (2) acetabular version (middle third) versus alpha angle (p = 0.02). For patients with acetabular version (supraequatorial) lower than 10 degrees: (1) acetabular version (supraequatorial) versus alpha angle (p = 0.004); (2) acetabular version (middle third) versus alpha angle (p = 0.009). Conclusion There was a statistically significant inverse correlation between the acetabular version and alpha angles (the smaller the acetabular anteversion angle was, the larger the alpha angle was) in symptomatic patients, thus supporting the hypothesis that FAI occurs when cam and pincer findings due to acetabular retroversion are seen simultaneously, and that the latter alone does not cause FAI, which leads to overdiagnosis in these cases. PMID:27069890

  13. Symptomatic pneumorachis associated with incidental durotomy during microscopic lumbar disc surgery. Case report.

    PubMed

    Rovlias, Aristedis; Pavlakis, Emmanuel; Kotsou, Serafim

    2006-08-01

    Unintended incidental durotomy is not a rare complication of lumbar microsurgery and is usually recognized and treated immediately. The reconstruction process can be complicated further by unpredictable factors. To their knowledge, the authors report the first case of a symptomatic pneumorachis associated with the accidental awakening of a patient during reconstruction of an incidental durotomy following lumbar microdiscectomy. Incomplete cauda equina syndrome developed in the patient on awakening from surgery after reconstruction of an unintended incidental dural tear that occurred during lumbar microdiscectomy. Symptomatic pneumorachis was revealed on an emergency computed tomography scan, and the patient underwent immediate repeated operation to remove air and decompress the spinal canal. The increasing number and complexity of surgical procedures in the lumbar spine contribute to the growing incidence of unintended durotomy. The surgeon should be aware of rare complications that may arise. Development of a vacuum phenomenon in conjunction with a ball-valve mechanism may lead to pneumorachis during durotomy repair. If this rare complication is promptly recognized and confronted, the outcome will not be associated with long-term sequelae.

  14. The potential role of CAMSAP1L1 in symptomatic epilepsy.

    PubMed

    Zhang, Shuai; Kwan, Patrick; Baum, Larry

    2013-11-27

    In a recent genome-wide association study (GWAS) of symptomatic epilepsy in the Chinese population, the most significant single nucleotide polymorphism (SNP) allele was rs2292096 [G] (P=1.0×10(-8), odds ratio [OR]=0.63), in the CAMSAP1L1 gene (also known as CAMSAP2). Here, we report that rs2292096 genotypes tended to associate with expression of CAMSAP1L1 RNA in the temporal lobe (p=0.054) and hippocampus (p=0.20) of epilepsy surgery patients, with expression tending to increase with the G allele. CAMSAP1L1 and β-tubulin double immunofluorescence exhibited partial overlap. CAMSAP1L1 siRNA transfection of human SH-SY5Y neuroblastoma cells treated with or without retinoic acid reduced the CAMSAP1L1 protein level nearly 60% and stimulated neurite outgrowth, as measured by total length, number of processes and number of branches. Therefore, the rs2292096 G allele of CAMSAP1L1, which was associated with reduced risk of symptomatic epilepsy, tended to associate with increased expression of CAMSAP1L1, which represses neurite outgrowth. Greater neurite growth in response to brain insults might increase formation of ectopic neural circuits and thus the risk of epileptogenesis. PMID:24148305

  15. Symptomatic phrenic nerve palsy after supraclavicular block in an obese man.

    PubMed

    Erickson, John M; Louis, Dean S; Naughton, Norah N

    2009-05-01

    Regional anesthesia has an expanding role in upper extremity surgery. Brachial plexus blocks offer several advantages including providing effective analgesia, reducing narcotic requirements, and facilitating ambulatory care surgery. Despite the popularity of nerve blocks, the surgeon must not forget the complications associated with regional anesthesia. This article describes a case of symptomatic phrenic nerve palsy after supraclavicular brachial plexus block in an obese man. A 46-year-old obese man underwent a left-sided supraclavicular block in preparation for decompression of Guyon's canal for ulnar mononeuropathy at the wrist. The patient experienced acute-onset dyspnea, chest discomfort, and anxiety, and physical examination demonstrated reduced breath sounds in the left hemithorax. Chest radiographs documented elevation of the left hemidiaphragm consistent with an iatrogenic phrenic nerve palsy. The patient was admitted for 23-hour observation and underwent an uncomplicated ulnar nerve decompression under Bier block anesthesia 1 week later. No long-term sequelae have been identified; however, there was a delay in surgical care, admission to the hospital, and transient pulmonary symptoms. We attribute this complication to significant abdominal obesity causing compromised pulmonary reserve and poor tolerance of transient hemidiaphragmatic paresis. In recent studies, waist circumference and abdominal height were inversely related to pulmonary function. We suspect that the incidence of symptomatic phrenic nerve palsy associated with brachial plexus blocks will increase as the prevalence of obesity increases in this country. PMID:19472948

  16. Level and Determinants of Knowledge of Symptomatic Knee Osteoarthritis among Railway Workers in Malaysia

    PubMed Central

    Menke, J. Michael; Challakere Ramaswamy, Vasudeva Murthy; Abdul Manaf, Rizal; Alabsi, Aied M.; Al-Dubai, Sami Abdo Radman

    2014-01-01

    Background. Symptomatic knee osteoarthritis, an ancient malady greatly impairing modern population quality of life, has stimulated global attention to find effective modes of prevention and intervention. Purpose. This study aimed to assess factors affecting knowledge of symptomatic knee osteoarthritis (knee OA) among Malaysian railway workers. Methods. A cross-sectional study was conducted among 513 railway workers involving eight major states within Peninsular Malaysia using population-based sampling. The assessment instrument was a face-validated, prepiloted, self-administered instrument with sociodemographics and knowledge items on knee OA. Results. Mean (±SD) age of the respondents was 41.4 (±10.7), with the majority aged 50 years or older (34.9%). Of the total respondents, 53.6% had low levels of knowledge of knee OA disease. Multivariate analysis found that four demographic predictors, age ≥50 years, family history of knee OA, self-awareness, and clinical diagnosis of the disease entity, were significantly associated with knowledge scores. Conclusion. The finding of a low level knee OA knowledge among Malaysian railway workers points to an urgent need for massive information to be disseminated among the workers at risk to foster primary prevention and self-care. PMID:24701573

  17. Fibromyalgia, chronic fatigue syndrome, and myofascial pain.

    PubMed

    Bennett, R

    1998-03-01

    Epidemiologic studies continue to provide evidence that fibromyalgia is part of a spectrum of chronic widespread pain. The prevalence of chronic widespread pain is several times higher than fibromyalgia as defined by the 1990 American College of Rheumatology guidelines. There is now compelling evidence of a familial clustering of fibromyalgia cases in female sufferers; whether this clustering results from nature or nature remains to be elucidated. A wide spectrum of fibromyalgia-associated symptomatology and syndromes continues to be described. During the past year the association with interstitial cystitis has been explored, and neurally mediated hypotension has been documented in both fibromyalgia and chronic fatigue syndrome. Abnormalities of the growth hormone-insulin-like growth factor-1 axis have been also documented in both fibromyalgia and chronic fatigue syndrome. The commonly reported but anecdotal association of fibromyalgia with whiplash-type neck trauma was validated in a report from Israel. However, unlike North America, 100% of Israeli patients with posttraumatic fibromyalgia returned to work. Basic research in fibromyalgia continues to pinpoint abnormal sensory processing as being integral to understanding fibromyalgia pain. Drugs such as ketamine, which block N-methyl-D-aspartate receptors (which are often upregulated in central pain states) were shown to benefit fibromyalgia pain in an experimental setting. The combination of fluoxetine and amitriptyline was reported to be more beneficial than either drug alone in patients with fibromyalgia. A high prevalence of autoantibodies to cytoskeletal and nuclear envelope proteins was found in chronic fatigue syndrome, and an increased prevalence of antipolymer antibodies was found in symptomatic silicone breast implant recipients who often have fibromyalgia.

  18. 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.

  19. Changes in the plasma proteome at asymptomatic and symptomatic stages of autosomal dominant Alzheimer’s disease

    PubMed Central

    Muenchhoff, Julia; Poljak, Anne; Thalamuthu, Anbupalam; Gupta, Veer B.; Chatterjee, Pratishtha; Raftery, Mark; Masters, Colin L.; Morris, John C.; Bateman, Randall J.; Fagan, Anne M.; Martins, Ralph N.; Sachdev, Perminder S.

    2016-01-01

    The autosomal dominant form of Alzheimer’s disease (ADAD) is far less prevalent than late onset Alzheimer’s disease (LOAD), but enables well-informed prospective studies, since symptom onset is near certain and age of onset is predictable. Our aim was to discover plasma proteins associated with early AD pathology by investigating plasma protein changes at the asymptomatic and symptomatic stages of ADAD. Eighty-one proteins were compared across asymptomatic mutation carriers (aMC, n = 15), symptomatic mutation carriers (sMC, n = 8) and related noncarriers (NC, n = 12). Proteins were also tested for associations with cognitive measures, brain amyloid deposition and glucose metabolism. Fewer changes were observed at the asymptomatic than symptomatic stage with seven and 16 proteins altered significantly in aMC and sMC, respectively. This included complement components C3, C5, C6, apolipoproteins A-I, A-IV, C-I and M, histidine-rich glycoprotein, heparin cofactor II and attractin, which are involved in inflammation, lipid metabolism and vascular health. Proteins involved in lipid metabolism differed only at the symptomatic stage, whereas changes in inflammation and vascular health were evident at asymptomatic and symptomatic stages. Due to increasing evidence supporting the usefulness of ADAD as a model for LOAD, these proteins warrant further investigation into their potential association with early stages of LOAD. PMID:27381087

  20. Evaluation of Fixation Disparity Curve Parameters With the Modified Near Mallett Unit in Symptomatic and Asymptomatic University Students

    PubMed Central

    Momeni Moghadam, Hamed; A Goss, David; Yekta, Abbas A; Ehsani, Marzieh

    2013-01-01

    Background Research suggests that fixation disparity data are extremely useful in the assessment of the binocular and accommodative systems. Objectives The purpose of this study was to evaluate fixation disparity curve (FDC) parameters with a modified near Mallett unit in symptomatic and asymptomatic students of Paramedical Sciences School of Mashhad University of Medical Sciences in 2007. Patients and Methods In this analytical-descriptive study, 100 students were selected randomly and divided into symptomatic and asymptomatic groups. Fixation disparity curve parameters were determined for each subject and compared in symptomatic and asymptomatic groups. Results There were more subjects with exo fixation disparity than eso fixation disparity in the study sample. The means for fixation disparity, fixation disparity curve x-intercept, and slope with the modified Mallett unit were each significantly different by Mann-Whitney U test in the symptomatic and asymptomatic groups. Also there was a significant difference in the distributions of fixation disparity curve types in the two symptom groups by Chi-square test. Conclusions The X-intercepts (point at which the FDC crosses the X-axis) were on average more in the base-in direction, Y-intercepts (point at which the FDC crosses the Y-axis) were shifted in the exo direction, and slopes were steeper in the symptomatic group. PMID:24719687