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Sample records for acute necrotizing encephalopathy

  1. Pharm GKB: Acute Necrotizing Encephalopathy [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Overview Alternate Names: PharmGKB Accession Id: PA164924608 Publications related to Acute...uman genetics. 2009. Neilson Derek E, et al. Common Searches Search Medline Plus Search CTD Pharm GKB: Acute Necrotizing Encephalopathy ...

  2. Acute Necrotizing Encephalopathy of Childhood; A Case Report

    Directory of Open Access Journals (Sweden)

    Mohammad Reza SALEHIOMRAN

    2013-06-01

    Full Text Available How to Cite this Article: Salehi Omran MR, Nooreddini H, Baghdadi F. Acute Necrotizing Encephalopathy of Childhood; A Case Report. Iran J Child Neurol. 2013 Spring;7(2:51-54. AbstractAcute Necrotizing Encephalopathy of Childhood (ANEC is an atypical disease followed by respiratory or gastrointestinal infection, high fever, which is accompanied with rapid alteration of consciousness and seizures. This disease is seen nearly exclusively in East Asian infants and children who had previously a good health. Serial MRI examinations demonstrated symmetric lesions involving the thalami, brainstem, cerebellum, and white matter. This disease has a poor prognosis, often culminating in profound morbidity and mortality. A 22-month infant with ANEC hospitalized in Amirkola Children Hospital has been evaluated. References1. Mizuguchi M. Acute necrotizing encephalopathy of childhood: a novel form of acute encephalopathy prevalent in Japan and Taiwan. Brain Dev. 1997 Mar;19(2:81-92. Review.2. Wang HS, Huang SC. Acute necrotizing encephalopathy of childhood. Chang Gung Med J 2001 Jan;24(1:1-10.3. Campistol J, Gassió R, Pineda M, Fernandez-Alvarez E. Acute necrotizing encephalopathy of childhood (infantile bilateral  thalamic necrosis: two non-Japanese cases. Dev Med Child Neurol 1998 Nov;40(11:771-4.4. Ito Y, Ichiyama T, Kimura H, Shibata M, Ishiwada N, Kuroki H, Furukawa S, Morishima T. Detection of influenza virus RNA by reverse transcription-PCR and proinflammatory cytokines in influenza-virus-associated encephalopathy. J Med Virol 1999 Aug;58(4:420-5.5. Sugaya N. Influenza-associated encephalopathy in Japan. Semin Pediatr Infect Dis 2002 Apr;13(2:79-84. Review.6. Skelton BW, Hollingshead MC, Sledd AT, Phillips CD, Castillo M. Acute necrotizing encephalopathy of childhood: typical findings in an atypical disease. Pediatr Radiol 2008 Jul; 38(7:810-3.7. Wong AM, Simon EM, Zimmerman RA, Wang HS, Toh CH, Ng SH. Acute necrotizing encephalopathy of childhood

  3. Acute necrotizing encephalopathy of childhood: a Turkish case

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    Olcay Unver

    2014-06-01

    Full Text Available Acute necrotizing encephalopathy of childhood (ANEC is a rare form of acute encephalopathy of unknown etiology characterized by typical symmetrical lesions in the thalami, with variable involvement of the white matter, brainstem and cerebellum. Clinically there is a rapid neurologic deterioration after a short period of a nonspecific viral-like illness associated with gastrointestinal or respiratory signs. Asian children are especially affected. Here we present a 3-year-old boy admitted to our hospital with fever and deterioration of consciousness. The diagnosis of ANEC was made by radiologic findings [Cukurova Med J 2014; 39(3.000: 641-645

  4. MRI gadolinium enhancement precedes neuroradiological findings in acute necrotizing encephalopathy.

    Science.gov (United States)

    Yoshida, Takeshi; Tamura, Takuya; Nagai, Yuhki; Ueda, Hiroyuki; Awaya, Tomonari; Shibata, Minoru; Kato, Takeo; Heike, Toshio

    2013-11-01

    We report a 2-year-old Japanese boy with acute necrotizing encephalopathy (ANE) triggered by human herpes virus-6, who presented insightful magnetic resonance imaging (MRI) findings. He was admitted due to impaired consciousness and a convulsion, 2 days after the onset of an upper respiratory infection. At admission, cranial MRI showed marked gadolinium enhancement at the bilateral thalami, brainstem and periventricular white matter without abnormal findings in noncontrast MRI sequences. On the following day, noncontrast computed tomography demonstrated homogeneous low-density lesions in the bilateral thalami and severe diffuse brain edema. The patient progressively deteriorated and died on the 18th day of admission. The pathogenesis of ANE remains mostly unknown, but it has been suggested that hypercytokinemia may play a major role. Overproduced cytokines cause vascular endothelial damage and alter the permeability of the vessel wall in the multiple organs, including the brain. The MRI findings in our case demonstrate that blood-brain barrier permeability was altered prior to the appearance of typical neuroradiological findings. This suggests that alteration of blood-brain barrier permeability is the first step in the development of the brain lesions in ANE, and supports the proposed mechanism whereby hypercytokinemia causes necrotic brain lesions. This is the first report demonstrating MRI gadolinium enhancement antecedent to typical neuroradiological findings in ANE.

  5. Moyamoya disease in a child with previous acute necrotizing encephalopathy

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    Kim, Taik-Kun; Cha, Sang Hoon; Chung, Kyoo Byung; Kim, Jung Hyuck; Kim, Baek Hyun; Chung, Hwan Hoon [Department of Diagnostic Radiology, Korea University College of Medicine, Ansan Hospital, 516 Kojan-Dong, Ansan City, Kyungki-Do 425-020 (Korea); Eun, Baik-Lin [Department of Pediatrics, Korea University College of Medicine, Seoul (Korea)

    2003-09-01

    A previously healthy 24-day-old boy presented with a 2-day history of fever and had a convulsion on the day of admission. MRI showed abnormal signal in the thalami, caudate nuclei and central white matter. Acute necrotising encephalopathy was diagnosed, other causes having been excluded after biochemical and haematological analysis of blood, urine and CSF. He recovered, but with spastic quadriparesis. At the age of 28 months, he suffered sudden deterioration of consciousness and motor weakness of his right limbs. MRI was consistent with an acute cerebrovascular accident. Angiography showed bilateral middle cerebral artery stenosis or frank occlusion with numerous lenticulostriate collateral vessels consistent with moyamoya disease. (orig.)

  6. Acute necrotizing encephalopathy in Korean infants and children: imaging findings and diverse clinical outcome

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    Kim, Ji Hye [Sansung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, In One [Seoul National University College of Medicine, Seoul (Korea, Republic of); Lim, Myung Kwan [Incheon Medical Center, College of Medicine, Inha University, Incheon (Korea, Republic of)] (and others)

    2004-09-15

    The purpose of our study was to describe acute necrotizing encephalopathy in Korean infants and children, and we sought to evaluate the prognostic factors. Acute necrotizing encephalopathy was diagnosed in 14 Korean infants and children. We retrospectively analyzed the neuroimaging findings including the follow-up changes. The clinical course of the disease was graded, and we evaluated prognostic factors including age, serum level of the aminotransferase, hemorrhage, and localized atrophy of the brain. This encephalopathy predominantly affected the bilateral thalami (n = 14), pons (n = 12), and midbrain (n = 10) in a symmetrical pattern. Hemorrhage was observed in eight patients (57%). On the follow-up images (n = 12), the brain lesions were reduced in extent for all patients, and generalized atrophy was seen in six patients. Localized tissue loss was observed in five patients and a complete resolution occurred for one patient. All the patients survived and two recovered completely; mild (n = 6) to severe (n = 6) neurological deficits persisted in the remaining 12 patient. The significant prognostic factors identified in this study were the presence of hemorrhage ({rho} 0.009) and localized atrophy ({rho} = 0.015). Acute necrotizing encephalopathy in Korean patients showed the characteristic patterns of the post-infectious encephalopathy as described in the literature. The high survival rate and the relatively favorable clinical course observed for the present study suggest a more diverse spectrum of disease severity than was previously described. The presence of hemorrhage and localized tissue loss on MR images may suggest a poor prognosis.

  7. Acute necrotizing encephalopathy in a child with H1N1 influenza infection

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    Lyon, Jane B. [Driscoll Children' s Hospital, Department of Radiology, Corpus Christi, TX (United States); Remigio, Cheryl [Pediatric Residency Program, Department of Medical Education, Corpus Christi, TX (United States); Milligan, Thomas [Driscoll Children' s Hospital, Department of Pathology, Corpus Christi, TX (United States); Deline, Carol [Driscoll Children' s Hospital, Division of Neurology, Corpus Christi, TX (United States)

    2010-02-15

    Since the World Health Organization declared a global pandemic of novel influenza A H1N1 in June 2009, there has been a sustained rise in the number of cases of this strain of influenza. Although most cases are mild with complete and uneventful recovery, multiple cases of severe infection with complications including death have been reported. To the best of our knowledge, the majority of fatal outcomes in the United States have been related to pulmonary complications. We report a 12-year-old girl infected with influenza A H1N1 whose clinical course was complicated by rapid progressive neurologic deterioration and striking CT and MRI findings consistent with acute necrotizing encephalopathy (ANE). To our knowledge this has not been reported in the pediatric radiology literature. We hope this case will alert radiologists to this complication and familiarize radiologists with imaging findings that herald ANE. (orig.)

  8. Infection-triggered familial or recurrent cases of acute necrotizing encephalopathy caused by mutations in a component of the nuclear pore, RANBP2

    DEFF Research Database (Denmark)

    Neilson, Derek E; Adams, Mark D; Orr, Caitlin M D;

    2009-01-01

    Acute necrotizing encephalopathy (ANE) is a rapidly progressive encephalopathy that can occur in otherwise healthy children after common viral infections such as influenza and parainfluenza. Most ANE is sporadic and nonrecurrent (isolated ANE). However, we identified a 7 Mb interval containing a ...

  9. Encefalopatia necrotizante aguda: paciente com evolução recidivante e letal Acute necrotizing encephalopathy: patient with a relapsing and lethal evolution

    Directory of Open Access Journals (Sweden)

    Erasmo B. Casella

    2007-06-01

    Full Text Available A encefalopatia necrotizante aguda foi descrita inicialmente em crianças japonesas e se caracteriza por rápida evolução e lesões simétricas no tronco encefálico, cerebelo e especialmente nos tálamos. Avaliamos uma menina de 7 meses de idade, que apresentou dois episódios de depressão da consciência de rápida instalação e paresias, sem alterações metabólicas. Houve uma rápida melhora na primeira crise, porém o segundo episódio foi fulminante, tendo evoluído para estado de morte encefálica em dois dias. Os estudos de ressonância magnética mostraram lesões simétricas nos tálamos e acometimento também do tronco encefálico e cerebelo.Acute necrotizing encephalopathy was initially reported in Japanese children. The rapid evolution and symmetrical brain lesions seen in the brainstem, cerebellum and specially in the thalamus characterize the disease. We studied a 7-month-old-girl, who presented with two episodes of rapid loss of consciousness and paresis without metabolic disturbances. At the first time she had a rapid improvement, but at the second episode the course was fulminant and in two days she lapsed into a clinical state of brain death. The magnetic resonance studies showed symmetrical lesions in the thalamus and additional lesions involving the brainstem and the cerebellum.

  10. Acute necrotizing encephalopathy secondary to diphtheria, tetanus toxoid and whole-cell pertussis vaccination: diffusion-weighted imaging and proton MR spectroscopy findings

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    Aydin, Hale; Ozgul, Esra; Agildere, Ahmet Muhtesem [Baskent University Hospital, Department of Radiology, Ankara (Turkey)

    2010-07-15

    We present a previously healthy 6-month-old boy who was admitted to our hospital with lethargy, hypotonia and focal clonic seizures 6 days following diptheria, tetanus toxoid and whole-cell pertussis vaccination. A diagnosis of acute necrotising encephalopathy was made with the aid of MRI, including diffusion-weighted imaging and proton MR spectroscopy. (orig.)

  11. Pharm GKB: Acute necrotizing pancreatitis [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available A165108252 External Vocabularies MeSH: Pancreatitis, Acute Necrotizing (D019283) SnoMedCT: Acute necrotizing... pancreatitis (7881005) UMLS: C0267941 (C0267941) MedDRA: Necrotising pancreatitis (10056219) NDFRT: Pancreatitis, Acute... Necrotizing [Disease/Finding] (N0000003910) Common Searches Search Medline Plus Search CTD Pharm GKB: Acute necrotizing pancreatitis ...

  12. Acute hepatic encephalopathy with diffuse cortical lesions

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    Arnold, S.M.; Spreer, J.; Schumacher, M. [Section of Neuroradiology, Univ. of Freiburg (Germany); Els, T. [Dept. of Neurology, University of Freiburg (Germany)

    2001-07-01

    Acute hepatic encephalopathy is a poorly defined syndrome of heterogeneous aetiology. We report a 49-year-old woman with alcoholic cirrhosis and hereditary haemorrhagic telangiectasia who developed acute hepatic coma induced by severe gastrointestinal bleeding. Laboratory analysis revealed excessively elevated blood ammonia. MRI showed lesions compatible with chronic hepatic encephalopathy and widespread cortical signal change sparing the perirolandic and occipital cortex. The cortical lesions resembled those of hypoxic brain damage and were interpreted as acute toxic cortical laminar necrosis. (orig.)

  13. Tumor necrosis factor α antibody prevents brain damage of rats with acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Yan-Ling Yang; Ji-Peng Li; Kai-Zong Li; Ke-Feng Dou

    2004-01-01

    AIM: To study the protective effects of tumor necrosis factor á (TNFα) antibody on pancreatic encephalopathy in rats.METHODS:One hundred and twenty SD rats were randomly divided into normal control group,acute necrotizing pancreatitis group and TNFα antibody treated group.Acute hemorrhage necrotizing pancreatitis model in rats was induced by retrograde injection of 50 g/L sodium taurocholate into the pancreatobiliary duct.Serum TNFα was detected and animals were killed 12 h after drug administration.Changes in content of brain water,MDA and SOD as well as leucocyte adhesion of brain microvessels were measured.RESULTS:In TNFα antibody treated group,serum TNFálevel was decreased.Content of brain water,MDA and SOD as well as leucocyte adhesion were decreased significantly in comparison with those of acute necrotizing pancreatitis group (P<0.05).CONCLUSION:TNFα antibody can alleviate the brain damage of rats with acute hemorrhage necrotizing pancreatitis.

  14. Acute Necrotizing Esophagitis Followed by Duodenal Necrosis.

    Science.gov (United States)

    Del Hierro, Piedad Magdalena

    2011-12-01

    Acute Necrotizing Esophagitis is an uncommon pathology, characterized by endoscopic finding of diffuse black coloration in esophageal mucosa and histological presence of necrosis in patients with upper gastrointestinal bleeding. The first case of acute necrotizing esophagitis followed by duodenal necrosis, in 81 years old woman with a positive history of Type 2 Diabetes Mellitus, Hypertension, and usual intake of Nonsteroidal Anti-inflammatory drugs, is reported. Although its etiology remains unknown, the duodenal necrosis suggests that ischemia could be the main cause given that the branches off the celiac axis provide common blood supply to the distal esophageal and duodenal tissue. The massive gastroesophagic reflux and NSAID intake could be involved.

  15. Hashimoto's Encephalopathy Presenting with Acute Cognitive Dysfunction and Convulsion.

    Science.gov (United States)

    Kang, Woo-Hyuk; Na, Ju-Young; Kim, Meyung-Kug; Yoo, Bong-Goo

    2013-12-01

    Hashimoto's encephalopathy is an immune-mediated disorder characterized by acute or subacute encephalopathy related to increased anti-thyroid antibodies. Clinical manifestations of Hashimoto's encephalopathy may include stroke-like episodes, altered consciousness, psychosis, myoclonus, abnormal movements, seizures, and cognitive dysfunction. Acute cognitive dysfunction with convulsion as initial clinical manifestations of Hashimoto's encephalopathy is very rare. We report a 65-year-old man who developed acute onset of cognitive decline and convulsion due to Hashimoto's encephalopathy.

  16. Pharm GKB: Acute necrotizing ulcerative gingivostomatitis [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Overview Alternate Names: Synonym Acute necrotising ulcerative gingivostomatitis; V...lcerative (D005892) SnoMedCT: Acute necrotizing ulcerative gingivostomatitis (173599005) UMLS: C0017575 (C00...lcerative [Disease/Finding] (N0000001343) Common Searches Search Medline Plus Search CTD Pharm GKB: Acute necrotizing ulcerative gingivostomatitis ...

  17. Ischemic Acute Necrotizing Pancreatitis in a Marathon Runner

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    Jay J Mast

    2009-01-01

    Full Text Available Context Acute pancreatitis due to pancreatic ischemia is a rare condition. Case report In this case report we describe a 57-year-old male who developed an acute necrotizing pancreatitis after running a marathon and visiting a sauna the same evening, with an inadequate fluid and food consumption during both events. Conclusions Pancreatic ischemia imposed by mechanical and physical stress and dehydration can induce the development of acute pancreatitis. Separately, these factors are rare causes of ischemic acute pancreatitis. But when combined, as in this particular case, the risk of an acute necrotizing pancreatitis cannot be neglected

  18. Acute necrotizing pancreatitis: a multicenter study.

    Science.gov (United States)

    Fernández-Cruz, L; Navarro, S; Valderrama, R; Sáenz, A; Guarner, L; Aparisi, L; Espi, A; Jaurietta, E; Marruecos, L; Gener, J

    1994-04-01

    A multicenter study of acute necrotizing pancreatitis (ANP) classified in accordance with the Balthazar criteria (grades D and E), has been performed in 12 teaching hospitals. A total of 233 patients were reviewed, and the mortality rate was 26.6%. The most common etiology was biliary pancreatitis (45.5%). Among the complications, shock, renal insufficiency, pulmonary insufficiency and hemorrhagic gastritis were associated with a mortality rate of 51-66%. Diffuse fluid collections were associated with a higher mortality rate (26.8%) than localized fluid collections (14.5%). In 106 patients with gallstone pancreatitis, early surgery was performed in 17, and 5 patients (29.4%) died. No mortality was observed in 32 patients with delayed surgery. Sphincterotomy was performed in 13 patients, and 4 (30.7%) died. Early surgery (necrosectomy and closed peritoneal lavage) was undertaken in 75 patients, with a mortality rate of 39%. In conclusion, the morbidity and mortality rates of ANP can be improved with proper monitoring, adequate supportive care and the judicious use of surgery based on clinical and morphological findings.

  19. Risk Factors For Development Of Acute Necrotizing Pancreatitis

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    Stojanovic Bojan

    2015-06-01

    Full Text Available Acute necrotizing pancreatitis (ANP is a severe form of acute pancreatitis that is associated with high morbidity and mortality. Thus, an adequate initial treatment of patients who present with acute pancreatitis (AP based on correct interpretation of early detected laboratory and clinical abnormalities may have a significant positive impact on the disease course.

  20. Necrotizing Faciitis-Acute Abdomen And Anaesthesia

    OpenAIRE

    Güleç, Handan; Akın Kepek, Yurdal; Yaşar, Hansa; Kurtay, Aysun; Tutal, Zehra; Babayiğit, Münire; Horasanlı, Eyüp

    2014-01-01

    Necrotizing fasciitis ( NF) is a rare  soft-tissue infection characterized by progressive necrosis of the skin, subcutaneous tissue, and fascia with a high morbidity and mortality.  This infection, which is usually induced by  toxin producing bacteria, can occur in any region of the body but it is predominantly located in the abdominal wall, perineum and extremities . NF treatments consist of  radical surgical debridement of all involved necrotic tissue, use of broad spectrum antibiotics, and...

  1. Acute encephalopathy with biphasic seizures and late reduced diffusion

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    Saroj S Yadav

    2013-01-01

    Full Text Available Acute encephalopathy with biphasic seizures and reduced diffusion (AESD is a syndrome of encephalopathy characterized by biphasic seizures and altered consciousness in the acute stage followed in the subacute stage by restricted diffusion in the subcortical white matter on magnetic resonance imaging. The etiology of AESD has been attributed to viral infection like influenza A and human herpes virus 6. The exact pathogenesis of AESD is uncertain. Here we report a case of AESD, diagnosed based on clinicoradiological correlation.

  2. Acute necrotizing pancreatitis as fi rst manifestation of primary hyperparathyroidism

    Institute of Scientific and Technical Information of China (English)

    Jeroen; I; Lenz; Jimmy; M; Jacobs; Bart; Op; de; Beeck; Ivan; A; Huyghe; Paul; A; Pelckmans; Tom; G; Moreels

    2010-01-01

    We report the case of a female patient with severe acute necrotizing pancreatitis associated with hypercalcemia as first manifestation of primary hyperparathyroidism caused by a benign parathyroid adenoma.Initially the acute pancreatitis was treated conservatively.The patient subsequently underwent surgical resection of the parathyroid adenoma and surgical clearance of a large infected pancreatic pseudocyst.Although the association of parathyroid adenoma-induced hypercalcemia and acute pancreatitis is a kno...

  3. A case of acute periorbital necrotizing fasciitis

    Institute of Scientific and Technical Information of China (English)

    Nurhayati Abdul Kadir; Syed Shoeb Ahmad; Shuaibah Abdul Ghani; Madusudhan Paramananda

    2016-01-01

    Periorbital necrotizing fasciitis is a rare but potentially fatal infection. It is most commonly caused by Gram-positive group A b-haemolytic Streptococci and rarely by fungal infections. In this report, we present a rare case of periorbital necrotizing fasciitis caused by Aspergillus species in an immunocompromised patient. He presented to us with a history of a slowly progressive eyelid necrosis leading to a loss of vision in one eye. The patient was started on an antibiotic and subsequently, surgical debridement and enucle-ation were performed. A few days post-operatively, yellow white mould colonies were noted to grow on the wound surface. Microbiology cultures identified them as Aspergillus species and intravenous amphotericin B 10 mg was added daily. However, despite the extensive medical and surgical treatments, he failed to respond and succumbed from septicaemia and multi-organ failure.

  4. Hepatic encephalopathy in acute-on-chronic liver failure.

    Science.gov (United States)

    Lee, Guan-Huei

    2015-10-01

    The presence of hepatic encephalopathy (HE) within 4 weeks is part of the criteria for defining acute-on-chronic liver failure (ACLF). The pathophysiology of HE is complex, and hyperammonemia and cerebral hemodynamic dysfunction appear to be central in the pathogenesis of encephalopathy. Recent data also suggest that inflammatory mediators may have a significant role in modulating the cerebral effect of ammonia. Multiple prospective and retrospective studies have shown that hepatic encephalopathy in ACLF patients is associated with higher mortality, especially in those with grade III-IV encephalopathy, similar to that of acute liver failure (ALF). Although significant cerebral edema detected by CT in ACLF patients appeared to be less common, specialized MRI imaging was able to detect cerebral edema even in low grade HE. Ammonia-focused therapy constitutes the basis of current therapy, as in the treatment of ALF. Emerging treatment strategies focusing on modulating the gut-liver-circulation-brain axis are discussed.

  5. Wernicke Encephalopathy Presenting in a Patient with Severe Acute Pancreatitis

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    Ana Cecilia Arana-Guajardo

    2012-01-01

    Full Text Available Context Acute pancreatitis can lead to prolonged fasting and malnutrition. Many metabolic changes, including thiamine deficiency, may lead to the well know pancreatic encephalopathy. In this condition however the thiamine deficiency is rarely suspected. Case report We report the case of a 17-year-old woman with severe acute pancreatitis who developed mental status changes and ophthalmoplegia. A magnetic resonance image showed hyperintensive signals in periventricular areas, medial thalamus, and mammillary bodies, findings consistent with the diagnosis of Wernicke encephalopathy. Thiamine treatment reversed neurological complications. Conclusion Wernicke encephalopathy secondary to thiamine deficiency should be considered as a possible cause of acute mental status changes in patients with acute pancreatitis and malnutrition. Prophylactic doses of thiamine could be considered in susceptible patients.

  6. Genetics Home Reference: acute necrotizing encephalopathy type 1

    Science.gov (United States)

    ... cell's nucleus. The RANBP2 protein helps regulate the transport of proteins and other molecules through the nuclear pore and ... that are known to trigger this condition include human herpesvirus 6, coxsackie virus, and enteroviruses. In rare ...

  7. Acute hyperammonemic encephalopathy with features on diffusion-weighted images: Report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ja Young; Yu, In Kyu [Dept. of Radiology, Eulji University Hospital, Daejeon (Korea, Republic of)

    2015-02-15

    Acute hyperammonemic encephalopathy is a rare toxic encephalopathy caused by accumulated plasma ammonia. A few literatures are reported about MRI findings of acute hyperammonemic encephalopathy. It is different from the well-known chronic hepatic encephalopathy. The clinical symptom and MRI findings of acute hyperammonemic encephalopathy can be reversible with proper treatment. Acute hepatic encephalopathy involves the cingulate cortex, diffuse cerebral cortices, insula, bilateral thalami on diffusion-weighted imaging (DWI), and fluid-attenuated inversion-recovery. Acute hepatic encephalopathy might mimic hypoxic-ischemic encephalopathy because of their similar predominant involving sites. We experienced 2 cases of acute hyperammonemic encephalopathy consecutively. They showed restricted diffusion at the cingulate cortex, cerebral cortices, insula, and bilateral dorsomedial thalami on DWI. One patient underwent acute fulminant hepatitis A, the other patient with underlying chronic liver disease had acute liver failure due to hepatotoxicity of tuberculosis medication. In this report, we presented the characteristic features of DWI in acute hyperammonemic encephalopathy. In addition, we reviewed articles on MRI findings of acute hyperammonemic encephalopathy.

  8. Hemorrhagic Encephalopathy From Acute Baking Soda Ingestion

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    Adrienne Hughes

    2016-09-01

    Full Text Available Baking soda is a readily available household product composed of sodium bicarbonate. It can be used as a home remedy to treat dyspepsia. If used in excessive amounts, baking soda has the potential to cause a variety of serious metabolic abnormalities. We believe this is the first reported case of hemorrhagic encephalopathy induced by baking soda ingestion. Healthcare providers should be aware of the dangers of baking soda misuse and the associated adverse effects.

  9. Hemorrhagic Encephalopathy From Acute Baking Soda Ingestion.

    Science.gov (United States)

    Hughes, Adrienne; Brown, Alisha; Valento, Matthew

    2016-09-01

    Baking soda is a readily available household product composed of sodium bicarbonate. It can be used as a home remedy to treat dyspepsia. If used in excessive amounts, baking soda has the potential to cause a variety of serious metabolic abnormalities. We believe this is the first reported case of hemorrhagic encephalopathy induced by baking soda ingestion. Healthcare providers should be aware of the dangers of baking soda misuse and the associated adverse effects.

  10. About pathognomonic images: an infrequent case of acute encephalopathy

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    Alessandro Grasso

    2013-05-01

    Full Text Available BACKGROUND The occurrence of acute encephalopathy is a dramatic clinical dilemma when usual diagnostic techniques (blood tests, cerebral CT and cerebrospinal fluid analysis show no abnormalities. CLINICAL CASE We describe a case of a 73 years old man admitted in our Internal Medicine Unit for acute diarrhoea with vomiting and fever who developed a prolonged gastrointestinal dysmotility syndrome with poor nutritional intake. Although a parenteral support was provided, he developed acute encephalopathy followed by hypotension and lactic acidosis without evidence of renal and hepatic disease or glycemic alterations. Likewise, no cerebral CT and cerebrospinal fluid alterations were found. Conversely, cerebral MRI showed marked and diffuse DP-2 and FLAIR hyperintensity of the mesencephalic tectal plate, of the periaqueductal area, and of the periventricular region of the third ventricle including the median thalamic area. These MRI descriptions were considered pathognomonic of Wernicke encephalopathy. Thus, the immediate use of ev thiamine was followed by a prompt and complete recovery of neurological, hemodinamic and metabolic conditions. CONCLUSIONS Non-alcoholic Wernicke encephalopathy is a rare and dramatic clinical event with high mortality. In this context, brain MRI is the best diagnostic tool providing a typical picture.

  11. Pancreatic encephalopathy and Wernicke encephalopathy in association with acute pancreatitis: A clinical study

    Institute of Scientific and Technical Information of China (English)

    Guo-Hui Sun; Yun-Sheng Yang; Qing-Sen Liu; Liu-Fang Cheng; Xu-Sheng Huang

    2006-01-01

    AIM: To investigate clinical characteristics and therapy of pancreatic encephalopathy (PE) and Wernicke encephalopathy (WE).METHODS: In a retrospective study of 596 patients with acute pancreatitis (AP), patients with PE were compared to those with WE in regards to history, clinical manifestation, diagnosis, treatment and outcome.RESULTS: There were 93 patients with severe acute pancreatitis (SAP). Encephalopathies were discovered in 10 patients (1.7%). Six patients with PE all developed in SAP (6.5%), and three of them died (3% of SAP, 50% of PE). Four patients with WE developed in AP (0.7%),and two of them died (0.3% of AP, 50% of WE). Two patients with WE were treated with parenteral thiamine and survived. Global confusions were seen in all patients with encephalopathy. Ocular abnormalities were found.Conjugate gaze palsies were seen in 1 of 6 (16.7%)patients with PE. Of 4 patients with WE, one (25%)had conjugate gaze palsies, two (50%) had horizontal nystagmus, three (75%) had diplopia, and one (25%)had myosis. Ataxia was not seen in all patients. None of patients with WE presented with the classic clinical triad.CSF examinations for 2 patients with WE showed lightlyincreased proteins and glucose. CT and MRI of the brain had no evidence of characteristic abnormalities.CONCLUSION: PE occurs in early or reiteration stage of SAP, and WE in restoration stage of SAP/AR Ocular abnormalities are the hallmarks of WE, and horizontal nystagmus is common. It is difficult to diagnose earlier an encephalopathy as PE or WE, as well as differentiate one from the other. Long fasting, hyperemesis and total parenteral nutrition (TPN) without thiamine are main causes of thiamine deficiency in the course of pancreatitis.

  12. Hashimoto’s Encephalopathy Presenting with Acute Cognitive Dysfunction and Convulsion

    OpenAIRE

    Kang, Woo-Hyuk; Na, Ju-Young; Kim, Meyung-Kug; Yoo, Bong-Goo

    2013-01-01

    Hashimoto’s encephalopathy is an immune-mediated disorder characterized by acute or subacute encephalopathy related to increased anti-thyroid antibodies. Clinical manifestations of Hashimoto’s encephalopathy may include stroke-like episodes, altered consciousness, psychosis, myoclonus, abnormal movements, seizures, and cognitive dysfunction. Acute cognitive dysfunction with convulsion as initial clinical manifestations of Hashimoto’s encephalopathy is very rare. We report a 65-year-old man wh...

  13. Diagnosis of acute necrotizing pancreatitis and acute hemorrhagic pancreatitis in 5 severe acute pancreatitis by plain computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Keishoku; Kim, Jong-hyo; Nakasaku, Osamu

    1987-12-01

    The diagnosis of acute pancreatitis is still mainly based on the clinical signs and symptoms of patients. In a prospective study of 64 patients with acute pancreatitis, computed tomography (CT) findings were correlated with the clinical types of acute pancreatitis. We were able to correctly diagnose 3 acute necrotizing pancreatitis with autopsy and 2 acute hemorrhagic pancreatitis by plain CT about 48 hours after onset. At present, CT about 48 hours after onset seems to be the most accurate method for the early detection of necrotizing, hemorrhagic and edematous forms of acute pancreatitis.

  14. Autopsy report of acute necrotizing opticomyelopathy associated with thyroid cancer.

    Science.gov (United States)

    Kuroda, Y; Miyahara, M; Sakemi, T; Matsui, M; Ryu, T; Yamaguchi, M; Sasadomi, E; Sugihara, H

    1993-12-01

    We report an autopsied case of paraneoplastic necrotizing myelopathy. The patient had bilateral blindness, quadriplegia, and dyspnea of acute onset and died without remission 7 weeks later. The severe tissue necrosis and demyelination were found in the optic chiasm and from the medulla oblongata throughout the whole length of spinal cord. A papillary carcinoma was found in the thyroid gland at autopsy. In the present case IgG, myelin basic protein and activated helper T cells were increased in the CSF at onset, suggesting a mechanism of autoimmune demyelination for the condition.

  15. Acute encephalopathy and tubulointerstitial nephritis associated with Yersinia pseudotuberculosis.

    Science.gov (United States)

    Kaito, Hiroshi; Kamei, Koichi; Ogura, Masao; Kikuchi, Eriko; Hoshino, Hideki; Nakagawa, Satoshi; Matsuoka, Kentaro; Abe, Jun; Ito, Shuichi

    2012-12-01

    We report the case of a 28-month-old boy with encephalopathy and acute tubulointerstitial nephritis possibly associated with Yersinia pseudotuberculosis (Yp) infection. He was transferred to our center because of impairment of renal function and altered consciousness. He had fever for 5 days after recurrent vomiting and diarrhea. Computed tomography scan was normal, but electroencephalogram (EEG) analyses showed generalized slow wave patterns. Continuous hemodialysis was undergone and then his renal function was improved, but altered consciousness persisted. Single photon emission computed tomography (SPECT) revealed abnormally low signals at entire field, which suggested that he was suffered from encephalopathy. Phenobarbital administration and post-encephalopathy rehabilitation were started, and he recovered in fully premorbid state with normal EEG and SPECT findings on the 33rd hospital day. Various bacterial cultures were negative, but both Yp antibody and Yp-derived mitogen (YPM) antibody, the antibody of a specific Yp exotoxin, had an extremely high titer. This is the first report of encephalopathy potentially caused by Yp, indicated by the presence of a high Yp and YPM antibody titer.

  16. Acute febrile encephalopathy in adults from Northwest India

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    Bhalla Ashish

    2010-01-01

    Full Text Available Background : Acute onset fever with altered mentation is a common problem encountered by the physician practicing in tropical countries. Central nervous system (CNS infections are the most common cause resulting in fever with altered mentation in children. Aim : In this study, we have tried to analyze the cause of encephalopathy following short febrile illness in adults presenting to a tertiary care center in Northwestern part of India. Setting and Design : A prospective observational study carried out in a tertiary care center in the Northwestern India over a period of 1 year. Material and Methods : A total of 127 patients with fever of less than 2 weeks duration along with alteration in mentation were studied prospectively over a period of 12 months. The demographic variables were recorded in detail. In addition to routine investigations, cerebrospinal fluid analysis, noncontrast- and contrast-enhanced computed tomography, along with magnetic resonance imaging were performed in all the subjects. Statistical Analysis : The results were analyzed using SPSS statistical software. The values were expressed as mean with standard deviation for contiguous variable as percentage for the others. Results and Conclusion : Out of these, 70% had primary CNS infection as the etiology. A total of 33% patients had meningitis, 29.9% had evidence of meningoencephalitis, and 12.7% were diagnosed as sepsis-associated encephalopathy. These were followed by cerebral malaria, leptospirosis, and brain abscess as the cause of febrile encephalopathy in adults. Among the noninfectious causes, acute disseminated encephalomyelitis, cortical venous thrombosis, and neuroleptic malignant syndrome were documented in 2.36% each. In 11% of the patients, the final diagnosis could not be made in spite of the extensive investigations. Our study demonstrates that acute febrile encephalopathy in adults is a heterogeneous syndrome with primary CNS infections being the commonest

  17. Acute Liver Failure and Hepatic Encephalopathy After Cleft Palate Repair.

    Science.gov (United States)

    Kocaaslan, Nihal Durmuş; Tuncer, Fatma Betul; Tutar, Engin; Celebiler, Ozhan

    2015-09-01

    Paracetamol is the most commonly used analgesic after cleft palate repair. It has rarely caused acute hepatic failure at therapeutic or supratherapeutic doses. Only one case of therapeutic paracetamol toxicity after cleft palate repair had been reported previously. Here, we present a similar patient who developed acute liver failure and hepatic encephalopathy after an uncomplicated cleft palate surgery. Lack of large prospective trials in young children due to ethical concerns increases the value of the case reports of acetaminophen toxicity at therapeutic doses. The dosing recommendations of paracetamol may need to be reconsidered after cleft palate surgery.

  18. ANALYSIS OF DEATH FACTORS FOR ACUTE HEMORRHAGIC NECROTIZING PANCREATITIS

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Objective:To analyse the factors affecting the mortality of acute hemorrhagic necrotizing pancreatitis (AHNP). Methods:One hundred and twelve patients with AHNP were retrospectively divided into two groups--the dead and survivors. Some parameters were analysed statistically.Results:The average age,sex ratio and onset of illness were similar between two groups. The difference of early shock, early ARDS, high body temperature, leukocytosis and high blood glucose between two groups were not significant. The important factors affecting the mortality were: severe pancreatic necrosis; incorrect therapeutic surgery;improper surgical methods.Conclusion: The patients with mild or moderate AHNP should mainly receive conservative treatment for 48~72 hours. The early shock and ARDS should be corrected before surgical intervention, the swelling pancreas should be dissected fully and duodenostomy should be performed in operation.

  19. Wernicke's Encephalopathy Mimicking Acute Onset Stroke Diagnosed by CT Perfusion

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    Alok Bhan

    2014-01-01

    Full Text Available Background. Metabolic syndromes such as Wernicke’s encephalopathy may present with a sudden neurological deficit, thus mimicking acute onset stroke. Due to current emphasis on rapid admission and treatment of acute stroke patients, there is a significant risk that these stroke mimics may end up being treated with thrombolysis. Rigorous clinical and radiological skills are necessary to correctly identify such metabolic stroke mimics, in order to avoid doing any harm to these patients due to the unnecessary use of thrombolysis. Patient. A 51-year-old Caucasian male was admitted to our hospital with suspicion of an acute stroke due to sudden onset dysarthria and unilateral facial nerve paresis. Clinical examination revealed confusion and dysconjugate gaze. Computed tomography (CT including a CT perfusion (CTP scan revealed bilateral thalamic hyperperfusion. The use of both clinical and radiological findings led to correctly diagnosing Wernicke’s encephalopathy. Conclusion. The application of CTP as a standard diagnostic tool in acute stroke patients can improve the detection of stroke mimics caused by metabolic syndromes as shown in our case report.

  20. RANBP2基因突变导致的家族性急性坏死性脑病一家系报道%Clinical and genetic analysis of a family with familiar acute necrotizing encephalopathy due to mutation in the RANBP2 gene

    Institute of Scientific and Technical Information of China (English)

    朱金兰; 黄铁栓; 段婧; 崔冬; 文家伦; 廖建湘

    2015-01-01

    目的:总结家族性急性坏死性脑病一家系的临床特点及治疗,提高对本病的认识。方法收集并分析深圳市儿童医院确诊的1例 RANBP2基因突变导致的家族性急性坏死性脑病患儿的临床资料,对其家族成员进行基因检查。结果患儿,女,分别在出生8个月、18个月、25个月发病3次。每次均因发热性感染疾病3~4 d 出现精神差,肢体震颤住院。第3次发病出现浅昏迷和抽搐,四肢肌张力增高,膝腱反射亢进。头颅 MRI 检查可见双侧丘脑、脑干、小脑、屏状核、海马长 T2信号,脑干、胼胝体以及颞叶顶叶扣带回等处异常信号。患儿第1次发病后基本恢复正常;第2次发病恢复到能说话,走路不稳;第3次发病后至今患儿意识清楚,不能说话和走路。患儿既往体健,有一姐姐出生18个月患脑干脑炎死亡。叔叔出生17个月发热抽搐后出现智力障碍。基因检测显示患儿及其父亲、叔叔、姑姑和祖母均为 RANBP2基因 c.1754C ﹥ T(p. Thr585Met)杂合错义突变。结论家族性急性坏死性脑病有典型临床症状和特征性 MRI 等表现,有家族史或反复发作病史者应尽早进行 RANBP2基因检测以明确诊断。%Objective To analyze the clinical manifestations of familial acute necrotizing encephalopathy (ANE)and to improve the recognition of this disease. Methods The clinical data of a 25 - month - old girl with fa-milial and recurrent ANE with evidence of mutation in the RANBP2 gene were collected and analyzed,and the gene examination of their family members was performed. Results A previously healthy girl experienced recurrent ANE epi-sodes at the ages of 8 months,18 months and 25 months,respectively. At each beginning of each episodes the patient presented with lethargy and tremor of limbs following febrile illness of 3 - 4 days,even developed coma and convulsions in the last time. Brain magnetic resonance imaging

  1. Acute headache as a presenting symptom of tacrolimus encephalopathy.

    Science.gov (United States)

    Kiemeneij, I M; de Leeuw, F-E; Ramos, L M P; van Gijn, J

    2003-08-01

    A 24 year old woman presented with a sudden excruciating headache mimicking an acute vascular event. She had undergone a lung transplantation because of cystic fibrosis and was receiving maintenance treatment with tacrolimus and prednisone. Ancillary investigation excluded vascular causes. Magnetic resonance imaging demonstrated hyperintense lesions in the infratentorial and parieto-occipital regions consistent with posterior leucencephalopathy syndrome. Both her clinical condition improved and the lesions disappeared completely after withdrawal of tacrolimus, suggesting that her condition could be explained by a tacrolimus encephalopathy.

  2. Effects of octreotide on acute necrotizing pancreatitis in rabbits

    Institute of Scientific and Technical Information of China (English)

    László Czakó; Péter Hegyi; Tamás Takács; Csaba Góg; András Farkas; Yvette Mándy; Ilona Sz. Varga; László Tiszlavicz; János Lonovics

    2004-01-01

    AIM: To assess the role of oxygen-derived free radicals and cytokines in the pathogenesis of taurocholic acid-induced acute pancreatitiS, and to evaluate the preventive effects of octreotide towards the development of acute pancreatitis.METHODS: Acute pancreatitis was induced in male New Zealand 50 g/L sodium taurocholate (NaTC) in the pancreatic duct. Shamwas administered subcutaneously before the induction of pancreatitis. Blood was taken from the jugular vein before and at 1, 3, 6, 12 and 24 h after pancreatitis induction.Serum activities of amylase, IL-6 and TNF-α and levels of malonyl dialdehyde (MDA), glutathione (GSH), glutathione peroxidase (GPx), catalase and superoxide dismutase (Mn-,Cu-, and Zn-SOD) in pancreatic tissue were measured.RESULTS: Serum TNF-α and IL-6 levels increased significantly 3 h after the onset of pancreatitis, and then returned to control level. The tissue concentration of MDA was significantly elevated at 24 h, while the GSH level and GP-x, catalase, Mn-SOD, Cu-, Zn-SOD activities were all significantly decreased in animals with pancreatitis as compared to the control. Octreotide pretreatment significantly reversed the changes in cytokines and reactive oxygen metabolites. Octreotide treatment did not alter the serum amylase activity and did not have any beneficial effects on the development of histopathological changes.CONCLUSION: Oxygen-derived free radicals and proinflammatory cytokines are generated at an early stage of NaTc-induced acute pancreatitis in rabbits. Prophylactic octreotide treatment can prevent release of cytokines and generation of reactive oxygen metabolites, but does not have any beneficial effects on the development of necrotizing pancreatitis.

  3. Pathogenesis of pancreatic encephalopathy in severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Xi-Ping Zhang; Hua Tian

    2007-01-01

    BACKGROUND:Pancreatic encephalopathy (PE) is a serious complication of severe acute pancreatitis (SAP). In recent years, more and more PE cases have been reported worldwide, and the onset PE in the early stage was regarded as a poor prognosis sign of SAP, but the pathogenesis of PE in SAP still has not been clariifed in the past decade. The purpose of this review is to elucidate the possible pathogenesis of PE in SAP. DATA SOURCES:The English-language literature concern-ing PE in this review came from the Database of MEDLINE (period of 1991-2005), and the keywords of severe acute pancreatitis and pancreatic encephalopathy were used in the searching. RESULTS:Many factors were involved in the pathogenesis of PE in SAP. Pancreatin activation, excessive release of cytokines and oxygen free radicals, microcirculation abnormalities of hemodynamic disturbance, ET-1/NO ratio, hypoxemia, bacterial infection, water and electrolyte imbalance, and vitamin B1 deifciency participated in the development of PE in SAP. CONCLUSIONS:The pathogenesis of PE in SAP has not yet been fully understood. The development of PE in SAP may be a multi-factor process. To ifnd out the possible inducing factor is essential to the clinical management of PE in SAP.

  4. Analysis of Treatment-Related Factors Affecting Mortality in Patients with Severe Necrotizing Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Praznik Ivan

    2016-09-01

    Full Text Available The aim of the paper was to determine the factors related to the initial therapy that may contribute to death from severe necrotizing acute pancreatitis and to analyze their clinical importance as well as possible additive effects.

  5. ACUTE BILATERAL VIRAL NECROTIZING RETINITIS : AN UNCOMMON CASE REPORT

    Directory of Open Access Journals (Sweden)

    Rajendra Ku.

    2015-08-01

    Full Text Available A 22 year old male with a history of high grade fever 2 days, diarrhea 3 times and vomiting 2 times presented with diminution of vision in right eye of 1 days duration. His best corrected visual acuity (BCVA was counting finger 1 meter with no pin hole im provement and 20/20 ( S nellen ’ s in the right and left eye respectively. Fundus examination RE revealed white lesion in geographic fashion with clear edge involving macula and in left eye small peanut size white lesion present at paramacular area. Clinicall y a diagnosis of acute necrotizing was made. We started treatment by intra venous antiviral and systemic steroid. ELISA (serum and PCR (aqueous were positive for herpes simplex virus ( I ndex above 1.1 i.e. 1.54 . 1,2 The lesions showed a good response to t he above treatment. At 2 months follow - up, lesion had resolved well with BCVA of 20/40 and 20/20 in right and left eye respectively

  6. Multiple Ascending Aortic Mural Thrombi and Acute Necrotizing Mediastinitis Secondary to Acute Pancreatitis

    Science.gov (United States)

    Chong, Byung Kwon; Yun, Jae Kwang; Kim, Joon Bum; Park, Do Hyun

    2016-01-01

    The formation of aortic thrombi is an extremely rare complication of acute pancreatitis. Here we report a case of acute pancreatitis complicated by a paraesophageal pseudocyst, necrotizing mediastinitis, and the formation of multiple thrombi in the ascending aorta. The patient was successfully treated by surgical therapy, which included extensive debridement of the mediastinum and removal of the aortic thrombi under cardiopulmonary bypass. Although esophageal resection was not carried out concomitantly, the lesions were resolved and the patient remained free of complications over 2 years of follow-up care. PMID:27734004

  7. Quantitative EEG evaluation in patients with acute encephalopathy

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    Aline Souza Marques da Silva Braga

    2013-12-01

    Full Text Available Objective To investigate the use of quantitative EEG (qEEG in patients with acute encephalopathies (AEs and EEG background abnormalities. Method Patients were divided into favorable outcome (group A, 43 patients and an unfavorable outcome (group B, 5 patients. EEGLAB software was used for the qEEG analysis. A graphic of the spectral power from all channels was generated for each participant. Statistical comparisons between the groups were performed. Results In group A, spectral analysis revealed spectral peaks (theta and alpha frequency bands in 84% (38/45 of the patients. In group B, a spectral peak in the delta frequency range was detected in one patient. The remainder of the patients in both groups did not present spectral peaks. Statistical analysis showed lower frequencies recorded from the posterior electrodes in group B patients. Conclusion qEEG may be useful in the evaluations of patients with AEs by assisting with the prognostic determination.

  8. Acute cortical blindness due to posterior reversible encephalopathy.

    Science.gov (United States)

    Nguyen-Lam, Jenny; Kiernan, Matthew C

    2008-10-01

    An acutely hypertensive 55 year-old male experienced seizures and cortical blindness post-operatively. CT scans demonstrated hypointensities in the occipital lobes bilaterally. MRI revealed symmetrical bilateral hyperintense signals in the same region, involving both grey and white matter. Thromboembolic screening investigations including vertebral artery doppler studies were normal and echocardiography demonstrated borderline left ventricular hypertrophy. A diagnosis of posterior reversible encephalopathy syndrome (PRES) was reached and there was complete resolution of blindness with antihypertensive therapy. This case supports the vasogenic theory of PRES which suggests that sustained high grade fluctuations in blood pressure lead to a reduction in cerebral vascular autoregulatory function. The resultant failure of compensatory vasoconstriction to prevent hyperperfusion causes fluid to extravasate into the occipital lobes, which in the present case resulted in cortical blindness.

  9. Bacterial diversity in oral samples of children in niger with acute noma, acute necrotizing gingivitis, and healthy controls.

    Directory of Open Access Journals (Sweden)

    Ignacio Bolivar

    Full Text Available BACKGROUND: Noma is a gangrenous disease that leads to severe disfigurement of the face with high morbidity and mortality, but its etiology remains unknown. Young children in developing countries are almost exclusively affected. The purpose of the study was to record and compare bacterial diversity in oral samples from children with or without acute noma or acute necrotizing gingivitis from a defined geographical region in Niger by culture-independent molecular methods. METHODS AND PRINCIPAL FINDINGS: Gingival samples from 23 healthy children, nine children with acute necrotizing gingivitis, and 23 children with acute noma (both healthy and diseased oral sites were amplified using "universal" PCR primers for the 16 S rRNA gene and pooled according to category (noma, healthy, or acute necrotizing gingivitis, gender, and site status (diseased or control site. Seven libraries were generated. A total of 1237 partial 16 S rRNA sequences representing 339 bacterial species or phylotypes at a 98-99% identity level were obtained. Analysis of bacterial composition and frequency showed that diseased (noma or acute necrotizing gingivitis and healthy site bacterial communities are composed of similar bacteria, but differ in the prevalence of a limited group of phylotypes. Large increases in counts of Prevotella intermedia and members of the Peptostreptococcus genus are associated with disease. In contrast, no clear-cut differences were found between noma and non-noma libraries. CONCLUSIONS: Similarities between acute necrotizing gingivitis and noma samples support the hypothesis that the disease could evolve from acute necrotizing gingivitis in certain children for reasons still to be elucidated. This study revealed oral microbiological patterns associated with noma and acute necrotizing gingivitis, but no evidence was found for a specific infection-triggering agent.

  10. Septic Encephalopathy Characterized by Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion and Early Nonconvulsive Status Epilepticus

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    Hiroshi Yamaguchi

    2016-01-01

    Full Text Available Infection, whether viral or bacterial, can result in various forms of brain dysfunction (encephalopathy. Septic encephalopathy (SE is caused by an excessive immune reaction to infection, with clinical features including disturbed consciousness and seizures. Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD is usually accompanied by viral infection in children and is characterized by biphasic seizures and impaired consciousness. The initial neurologic symptom of AESD is typically a febrile seizure that frequently lasts longer than 30 minutes. However, the possible forms this seizure takes are unclear. For example, it is unknown if nonconvulsive status epilepticus (NCSE could be an early seizure symptomatic of AESD. In addition, thus far no cases of combined SE and AESD have been reported. Here, we describe the first reported case of SE with AESD that notably demonstrated NCSE as an early seizure.

  11. Prognostic Value of Cytochrome C and Cytokines in Acute Viral Encephalopathy

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2006-06-01

    Full Text Available Serum cytochrome c and cytokines were evaluated as prognostic predictors in 29 children (ages 9 mos to 9 yrs 11 mos with viral acute encephalopathies and multiple organ failure at Fukushima Medical University School of Medicine, Japan.

  12. Early Cytokine Profile Changes In Interstitial And Necrotic Forms Of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Kostic Irena

    2015-03-01

    Full Text Available Acute pancreatitis (AP is a common, potentially lethal, acute inflammatory process with a highly variable clinical course. The aim of this study was to analyse early changes in the serum concentrations of pro- and anti-inflammatory cytokines in the peripheral blood of patients with the interstitial form of acute pancreatitis (IAP and necrotic acute pancreatitis (NAP, especially in those patients who had lethal outcomes.

  13. Acute necrotizing retinal vasculitis as onset of systemic lupus erythematosus

    Science.gov (United States)

    Monov, Simeon; Hristova, Ruska; Dacheva, Rositza; Toncheva, Reni; Shumnalieva, Russka; Shoumnalieva-Ivanova, Viara; Monova, Daniela

    2017-01-01

    Abstract Rationale: Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by autoantibody production, complement activation, and deposition of immune complexes in tissues and organs. SLE can involve any region of the visual system. Although ocular manifestations are not part of the classification criteria for SLE, they can be observed in up to one-third of the patients with SLE. They are rarely reported at the time of disease onset. Retinal vasculitis is usually associated with active generalized disease. Due to its low frequency, we report a case of acute necrotizing retinal vasculitis as onset of SLE. Patient concerns and diagnosis: A 25-year-old white female was referred to the rheumatology clinic with gradually and rapid deterioration of the vision due to abnormal vessel permeability in the right fundus with edema along the vessels, occlusion of arterial branches in the middle periphery with leakage of the dye in these areas and indentical but less prominent changes with cotton wool spots in the papillomacular area and extensive hemorrhages in the left eye. The onset of malar rash, arthralgias and positive antinuclear, anti-double stranded DNA, anti-ribosomal P and anti-β2 glycoprotein I antibodies with decreased C4 complement levels, as well as the positive lupus-band test confirmed the diagnosis of SLE. Interventions: Aggressive immunomodulating therapy with high-dose methylprednisolone, intravenous immunoglobulin, and cyclophosphamide was used for suppression of the disease activity followed by azathioprine as maintaince therapy. Outcomes: Substantial improvement and partial resorption of the vasculitic changes, including central retinal artery and vein, was achieved prominently in the left eye. The study was conducted in accordance with the Declaration of Helsinki and written informed consent was obtained from the patient. Because of this, there is no need to conduct special ethic review and the ethical approval is not necessary

  14. Continuous veno venous hemofiltration in treatment of acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    谢红浪; 季大玺; 龚德华; 刘芸; 徐斌; 周红; 刘志红; 黎磊石; 李维勤; 全竹富; 黎介寿

    2003-01-01

    Objective To investigate the effectiveness of using continuous veno venous hemofiltration (CVVH) in the treatment of acute necrotizing pancreatitis (ANP). Methods Thirteen ANP patients were involved in this study, including 4 females and 9 males, averaging 50.6±10.8 years old. CT scans upon admission revealed 33% necrosis involving the body of the pancreas in 2 patients, 67% necrosis in 3 patients and 100% necrosis in the other 8; the CT severity score was 8.9±2.1. CVVH was maintained for at least 72 hours and the AN69 hemofilter (1.2 m2) was changed every 24 hours. The ultrafiltration rate during CVVH was 2993.9±983.0 ml/h, the blood flow rate was 250-300 ml/min, and the substitute fluid was infused in a pre-diluted manner. Low molecular weight heparin was used as anticoagulant. Results CVVH was well tolerated in all the patients. Bloody abdominal cavity drainage fluid was observed in 2 patients, but no other side-effects related with CVVH were observed. Two patients died of systemic fungal infections and another died of intracranial fungi infection, resulting in an ICU mortality of 23.1%. Ten of the patients survived in the ICU, but one of them died for other reasons unrelated to the SAP before discharge. The APACHE Ⅱ score before CVVH was 15.2±6.5, but decreased significantly to 8.1±5.3, 7.5±4.9 and 8.0±5.2 at the 24th, 48th and 72nd hour after CVVH, respectively (P<0.01). Serum concentration of IL-1β and TNFα decreased to the trough at the 6th hour after a new hemofilter was used and increased slowly to pre-CVVH levels 12 hours later. After CVVH had ceased, the serum levels of two cytokines increased to their peaks at the 120th hour and decreased eventually at the 144th hour. The sieving coefficient (SC) of IL-1β and TNFα was 0.33±0.11 and 0.16±0.08. Conclusion CVVH offered therapeutic options for ANP and was well tolerated resulting in clearance of IL-1β and TNFα; CVVH at early stages of SAP may contribute to the improvement of outcome.

  15. Paeoniflorin ameliorates acute necrotizing pancreatitis and pancreatitis‑induced acute renal injury.

    Science.gov (United States)

    Wang, Peng; Wang, Weixing; Shi, Qiao; Zhao, Liang; Mei, Fangchao; Li, Chen; Zuo, Teng; He, Xiaobo

    2016-08-01

    Acute renal injury caused by acute necrotizing pancreatitis (ANP) is a common complication that is associated with a high rate of mortality. Paeoniflorin is the active ingredient of paeonia radix and exhibits a number of pharmacological effects, such as anti‑inflammatory, anticancer, analgesic and immunomodulatory effects. The present study detected the potential treatment effects of paeoniflorin on acute renal injury induced by ANP in a rat model. The optimal dose of paeoniflorin for preventing acute renal injury induced by ANP was determined. Then, the possible protective mechanism of paeoniflorin was investigated. The serum levels of tumor necrosis factor (TNF)‑α, interleukin (IL)‑1β and IL‑6 were measured with enzyme‑linked immunosorbent assay kits. Renal inflammation and apoptosis were measured by immunohistochemistry and terminal deoxynucleotidyl transferase‑mediated dUTP nick end labeling assay. The expression of nitric oxide in kidney tissues was also evaluated. The p38 mitogen‑activated protein kinases (MAPKs) were measured by western blotting. The results shown that paeoniflorin may ameliorate acute renal injury following ANP in rats by inhibiting inflammatory responses and renal cell apoptosis. These effects may be associated with the p38MAPK and nuclear factor‑κB signal pathway.

  16. Acute anterior necrotizing scleritis:A case report

    Institute of Scientific and Technical Information of China (English)

    Yuen Keat Gan; Syed Shoeb Ahmad; Sheena Mary Alexander; Amir Samsudin

    2016-01-01

    Necrotizing scleritis is an uncommon but potential disastrous infection to the eye. It is commonly caused by vaso-occlusive autoimmune diseases such as rheumatoid arthritis or surgically-induced, and rarely due to infections. In this article, we presented a rare case of necrotizing scleritis caused by herpes infection in an immunocompromised patient. A 49 years old, retroviral positive gentleman presented to our clinic with a painful, red right eye associated with watering, photophobia and blurring of vision. His right eye rapidly deteriorated leading to an impending perforation of the sclera despite intensive antimicrobial therapy. The patient was started on acyclovir ointment and subsequently improved remarkably salvaging the eye from the need of an evis-ceration. Although the visual prognosis was poor, structural integrity of the eye was achieved.

  17. Biomarkers of acute kidney injury in neonatal encephalopathy.

    LENUS (Irish Health Repository)

    Sweetman, D U

    2013-03-01

    Acute kidney injury (AKI) is a common complication of neonatal encephalopathy (NE). The accurate diagnosis of neonatal AKI, irrespective of the cause, relies on suboptimal methods such as identification of rising serum creatinine, decreased urinary output and glomerular filtration rate. Studies of AKI biomarkers in adults and children have shown that biomarkers can improve the early diagnosis of AKI. Hypoxia-ischaemia is the proposed aetiological basis of AKI in both NE and cardiopulmonary bypass (CPB). However, there is a paucity of studies examining the role of AKI biomarkers specifically in NE. Urinary cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18, kidney injury molecule-1, liver-type fatty acid-binding protein, serum CysC and serum NGAL all show good ability to predict early AKI in a heterogeneous critically ill neonatal population including infants post-CPB. Moreover, serum and urinary NGAL and urinary CysC are early predictors of AKI secondary to NE. These findings are promising and open up the possibility of biomarkers playing a significant role in the early diagnosis and treatment of NE-related AKI. There is an urgent need to explore the role of AKI biomarkers in infants with NE as establishing the diagnosis of AKI earlier may allow more timely intervention with potential for improving long-term outcome.

  18. Ordered transcriptional factor recruitment and epigenetic regulation of tnf-alpha in necrotizing acute pancreatitis.

    NARCIS (Netherlands)

    Sandoval, J.; Pereda, J.; Rodriguez, J.L.; Escobar, J.; Hidalgo, J.; Joosten, L.A.B.; Franco, L.; Sastre, J.; Lopez-Rodas, G.

    2010-01-01

    Tauhe expression of the critical initiator cytokine TNF-alpha was strongly upregulated in vivo in acute necrotic pancreatitis (AP) in rodents and in vitro in TNF-alpha activated acinar AR42J cells. Upregulation of tnf-alpha, inos, icam-1 and il-6 occurred both in TNF-alpha receptor 1 and 2 knock-out

  19. Cyclosporin A acute encephalopathy and seizure syndrome in childhood: clinical features and risk of seizure recurrence.

    Science.gov (United States)

    Gleeson, J G; duPlessis, A J; Barnes, P D; Riviello, J J

    1998-07-01

    Cyclosporin A is associated with an acute encephalopathy including seizures and alterations in mental status, herein referred to as cyclosporin A acute encephalopathy and seizure syndrome. The clinical history, electroencephalogram (EEG), and neuroimaging findings in 19 children with cyclosporin A acute encephalopathy and seizure syndrome over a 10-year period were reviewed in order to delineate clinical characteristics, imaging features, and to determine the risk of seizure recurrence in this population. All 19 had motor seizures associated with other features of cortical and subcortical dysfunction. The acute mean cyclosporin A level was 342 microg/L, but was within the "therapeutic" range in five cases. Brain imaging by computed tomography (CT) or magnetic resonance imaging (MRI) in the acute or subacute phase revealed lesions characteristic of cyclosporin A toxicity in 14 cases. Acute EEG abnormalities were present in all and included epileptiform discharges or focal slowing. Patients were followed for a median of 49 months (1-9 years). Follow-up imaging (n = 10) showed lesion resolution or improvement in the majority while EEG (n = 10) had normalized in only three. Seizures recurred in six patients and only in those with persistent EEG or imaging abnormalities. No patient had a second episode of cyclosporin A associated neurotoxicity or seizure. It appears that a significant risk of seizure recurrence exists following cyclosporin A acute encephalopathy and seizure syndrome and primarily in those children with persistent EEG or imaging abnormalities.

  20. Multimodality evoked potentials in patients with delayed encephalopathy after acute carbon monoxide poisoning

    Institute of Scientific and Technical Information of China (English)

    Xiahong Wang; Bo Xiao; Renjun Gu; Lan Xiao; Yi Yang; Yinhui Hao; Nini Wang; Junlin Mu; Jinggang Yin

    2006-01-01

    Objective: To evaluate the diagnostic and prognostic values in patients with delayed encephalopathy after acute carbon monoxide poisoning. Methods: The tibial nerve somatosensory evoked potentials (SEPs), vision evoked potentials (VEPs), and brain stem audition evoked potentials(BAEPs) were performed in 32 healthy adults and 43 patients with delayed encephalopathy after acute carbon monoxide poisoning. Results: This paper indicated abnormalities of tibial nerve SEPs in 31 patients (31/43, 72.1%), VEPs in 17 patients (17/28, 60.7%), and BAEPs in 14 patients (14/43, 32.6%). These results showed that the greatest diagnostic value was SEPs, followed by VEPs and, BAEPs with the lowest sensitivity. Conclusion: Multimodality evoked potentials (EPs) can be used for evaluating the diagnostic and prognostic values in cases of delayed encephalopathy after acute carbon monoxide poisoning.

  1. Acute fulminant drug induced necrotizing pancreatitis in a patient with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Pablo Miramontes

    2015-03-01

    Full Text Available Drug-induced acute necrotizing pancreatitis is a rare adverse event, although it has been reported in association with different drugs, including non-steroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, and analgesic agents commonly used in rheumatology. In different reviews of the pancreotoxicity of drugs, infliximab and etanercept are mentioned among all medications implicated in drug-induced pancreatitis, but clinical cases of acute pancreatitis complicating treatment with these anti-TNF-α agents have been exceptionally reported. We describe a patient with ankylosing spondylitis treated with etanercept, who developed an acute fulminant necrotizing pancreatitis that resulted in death. Doctors should pay close attention to patients taking biologic drugs in which a complaint of abdominal pain lasting for several days with no apparent cause may require a prompt referral for medical consultation.

  2. Neutrophil extracellular traps form a barrier between necrotic and viable areas in acute abdominal inflammation

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    Rostyslav Bilyy

    2016-10-01

    Full Text Available Neutrophils form neutrophil extracellular traps (NETs of decondensed DNA and histones that trap and immobilize particulate matter and microbial pathogens like bacteria. NET aggregates reportedly surround and isolate large objects like monosodium urate (MSU crystals, which cannot be sufficiently cleared from tissues. In the setting of acute necrotizing pancreatitis massive tissue necrosis occurs, which is organized as pancreatic pseudocysts. In contrast to regular cysts, these pseudocysts are not surrounded by epithelial layers. We hypothesize that, instead, the necrotic areas observed in necrotizing pancreatitis are isolated from the surrounding healthy tissues by aggregated NETs. These may form an alternative, putatively transient barrier separating necrotic areas from viable tissue. To test this hypothesis, we investigated histological samples from the necropsy material of internal organs of two patients with necrotizing pancreatitis and peritonitis accompanied by multiple organ failure. Tissues including the inflammatory zone were stained with H&E and evaluated for signs of inflammation. Infiltrating neutrophils and NETs were detected by immunohistochemistry for DNA, neutrophil elastase, and citrullinated histone H3. Interestingly, in severely affected areas of pancreatic necrosis or peritonitis, chromatin stained positive for neutrophil elastase and citrullinated histone H3, and may, therefore, be considered NET-derived. These NET structures formed a layer which separated the necrotic core from the areas of viable tissue remains. A condensed layer of aggregated NETs thus spatially shields and isolates the site of necrosis, thereby limiting the spread of necrosis-associated proinflammatory mediators. We propose that necrotic debris may initiate and/or facilitate the formation of the NET-based surrogate barrier.

  3. Bacterial diversity in oral samples of children in niger with acute noma, acute necrotizing gingivitis, and healthy controls

    OpenAIRE

    Ignacio Bolivar; Katrine Whiteson; Benoît Stadelmann; Denise Baratti-Mayer; Yann Gizard; Andrea Mombelli; Didier Pittet; Jacques Schrenzel

    2012-01-01

    BACKGROUND: Noma is a gangrenous disease that leads to severe disfigurement of the face with high morbidity and mortality, but its etiology remains unknown. Young children in developing countries are almost exclusively affected. The purpose of the study was to record and compare bacterial diversity in oral samples from children with or without acute noma or acute necrotizing gingivitis from a defined geographical region in Niger by culture-independent molecular methods. METHODS AND PRINCIPAL ...

  4. RETROPERITONEAL NECROTIZING FASCIITIS WITH ADNEXITIS PRESENTING AS ACUTE ABDOMEN IN A 40 YEAR UNMARRIED FEMALE PATIENT: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Sribatsa Kumar

    2014-12-01

    Full Text Available Retroperitoneal Necrotizing Fasciitis is a rare variant of Necrotizing fasciitis (NF which is fulminant and potentially lethal. Although NF is a common occurrence in Indian Subcontinent due to low standard of living and poor hygiene Necrotizing fasciitis of retroperitoneum is extremely rare and only few cases have been reported till now. Herein we report a case of a 40yr unmarried female patient presenting to emergency department for acute abdomen and on exploratory laparotomy it was found out to be a case of extensive retroperitoneal necrotizing fasciitis with pregangrenous right ovary and adjacent fallopian tube.

  5. Ligustrazine alleviates acute lung injury in a rat model of acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jian-Xin Zhang; Sheng-Chun Dang

    2006-01-01

    BACKGROUND:Acute necrotizing pancreatitis leads to a systemic inlfammatory response characterized by widespread leukocyte activation and, as a consequence, distant lung injury. The aim of this study was to evaluate the effect of ligustrazine, extracted from Ligusticum wallichii a traditional Chinese medicine, on lung injury in a rat model of acute necrotizing pancreatitis (ANP). METHODS:A total of 192 rats were randomly divided into three groups: control (C group); ANP without treatment (P group); and ANP treated with ligustrazine (T group). Each group was further divided into 0.5, 2, 6 and 12 hours subgroups. All rats were anesthetized with an intraperitoneal injection of sodium pentobarbital. Sodium taurocholate was infused through the pancreatic membrane to induce ANP. For the T group, sodium taurocholate was infused as above, then 0.6%ligustrazine was administered via the femoral vein. The effects of ligustrazine on the severity of lung injury were assessed by lung wet/dry weight ratio, myeloperoxidase (MPO) activity and histopathological changes. Pulmonary blood lfow was determined by the radioactive microsphere technique (RMT). RESULTS:The blood lfow in the P group was signiifcantly lower than that of the C group, while the blood lfow in the T group was signiifcantly higher than that of the P group but showed no signiifcant difference from the C group. Compared with C group, the lung wet/dry ratios in both the P and T groups were signiifcantly increased, but there was no signiifcant difference between them. The MPO activity in the P group was greatly increased over that of the C group. In the T group, although the MPO activity was also higher than in the C group, it much less increased than in the P group. Moreover, the difference between P and T groups was signiifcant after 0.5 to 12 hours. After induction of the ANP model, the pancreas showed mild edema and congestion;the longer the time, the more severe this became. The pulmonary pathological changes were

  6. Benzodiazepine receptor antagonists for acute and chronic hepatic encephalopathy

    DEFF Research Database (Denmark)

    Als-Nielsen, B; Kjaergard, L L; Gluud, C

    2001-01-01

    The pathogenesis of hepatic encephalopathy is unknown. It has been suggested that liver failure leads to the accumulation of substances that bind to a receptor-complex in the brain resulting in neural inhibition which may progress to coma. Several trials have assessed benzodiazepine receptor...

  7. Cervical necrotizing fasciitis and acute mediastinitis of odontogenic origin: A case series

    Science.gov (United States)

    Monsalve-Iglesias, Fernando; Cabello-Serrano, Almudena; Valencia-Laseca, Alfredo; Garcia-Medina, Blas

    2017-01-01

    Necrotising fasciitis (NF) is an uncommon infection. Early signs and symptoms include fever, severe pain and swelling, and redness at the wound site. Moreover, fulminant evolution and high mortality rate are typical of this pathology. In the present report we describes three cases of cervical necrotizing fasciitis complicated by acute mediastinitis. All patients were apparently immunocompetent adults. The main aim of the present report is to show the serious consequences that a dental infection might trigger. Furthermore, we highlight the importance of a multidisciplinary approach in these cases. The constant interaction between different medical specialties is essential for ensuring a proper management of each case. Key words:Cervical necrotizing fasciitis, acute mediastinitis, odontogenic origin , multidisciplinary approach. PMID:28149480

  8. Antiproteases in the Treatment of Acute Necrotizing Pancreatitis: Continuous Regional Arterial Infusion

    Directory of Open Access Journals (Sweden)

    Kazunori Takeda

    2007-07-01

    Full Text Available Acute necrotizing pancreatitis is still a fatal disease. Pancreatic necrosis might be, in part, a result of infarction due to ischemia with vasospasm and an increase in intravascular coagulability. Synthetic antiproteases have a broad inhibitory action on pancreatic enzymes, the coagulation system, the complement system and the production of proinflammatory cytokines. Therefore, antiproteases have been expected to prevent necrotic changes in the pancreas and to reduce the mortality rate. However, the clinical efficacy of antiproteases is still a matter of controversy. Unfortunately, an antiprotease cannot easily reach the pancreas when administered intravenously because of its pharmacokinetic characteristics and impaired microcirculation. Administration through a catheter placed in one of the arteries which supplies the inflamed area of the pancreas, dramatically increases the concentration of the antiprotease in the pancreas. Clinical studies of continuous regional arterial infusion of a protease inhibitor have been conducted in Japan and have demonstrated the possible therapeutic efficacy of the new treatment in severe acute pancreatitis.

  9. Flumazenil does not improve hepatic encephalopathy associated with acute ischemic liver failure in the rabbit

    NARCIS (Netherlands)

    C.C.D. van der Rijt (Carin); R.J. de Knegt (Robert); S.W. Schalm (Solko); O.T. Terpstra (Onno); K. Mechelse (Karel)

    1990-01-01

    textabstractThe effect of flumazenil, a benzodiazepine antagonist, on hepatic encephalopathy was studied in rabbits with acute hepatic failure induced by a two-stage liver devascularization procedure. The rabbits were randomized for treatment with 5 mg/kg of flumazenil or the placebo. The drug was a

  10. [Necrotizing tonsillitis and renal vein thrombosis due to acute myeloid leukaemia].

    Science.gov (United States)

    Akram, Javed; Josefsson, Pernilla; Rømeling, Frans

    2012-09-01

    A 37-year-old woman was admitted to hospital with severe tonsillitis with unilateral necrotizing tonsillitis. She suddenly got fever, malaise, difficulties swallowing, pain in the throat and deterioration despite four days of penicillin treatment. During hospitalisation, she experienced abdominal pain, and blood tests showed pancytopenia. She was transferred to a haematological department, where a bone marrow biopsy showed acute myeloid leukaemia. Subsequently, an abdominal computed tomography with intravenous contrast revealed bilateral renal vein thrombosis, probably because of coagulopathy due to leukaemia.

  11. Effect of emodin and sandostatin on metabolism of eicosanoids in acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jian Xin Wu; Jia Yu Xu; Yao Zong Yuan

    2000-01-01

    @@INTRODUCTION In order to study the therapeutic mechanisms of emodin, an extract of Rhubarb (Rhizoma et Radix Rhei, a traditional Chinese herbal medicine), and sandostatin in the treatment of acute necrotizing pancreatitis (ANP), we used the two drugs in rat models of the disease and observed the changes of plasma thromboxane-2 (TXB2),6-ketoprostaglandin F1α (6-keto-PGF1α) and prostaglandin E2 (PEG2).

  12. Effects of ORP150 on appearance and function of pancreatic beta cells following acute necrotizing pancreatitis.

    Science.gov (United States)

    Deng, Wen-Hong; Chen, Chen; Wang, Wei-Xing; Yu, Jia; Li, Jin-You; Liu, Lei

    2011-06-15

    Pancreatic beta cells produce and release insulin, which decreases the blood glucose level. Endoplasmic reticulum stress caused pancreatic beta cell dysfunction and death in acute necrotizing pancreatitis (ANP). The 150kD oxygen-regulated protein (ORP150) took part in the process of endoplasmic reticulum stress. This study investigated the effect of ORP150 on appearance and function of pancreatic beta cells in ANP. Acute necrotizing pancreatitis relied on retrograde infusion of 5% sodium taurocholate into the bile-pancreatic duct. The severity of ANP was estimated by serum amylase, secretory phospholipase A(2,) and pancreatic histopathology. The changes in appearance and function of pancreatic beta cells were detected by light and electron microscopy and the levels of serum glucose, insulin, and C-peptide. ORP150 expression was studied using western blot and immunohistochemisty assay. The expression of ORP150 mainly appeared on pancreatic beta cells and decreased gradually during the pathogenesis of ANP. The results of light and electron microscopy indicated pancreatic beta cell dysfunction and death, concomitant with elevation of serum glucose, insulin, and C-peptide in ANP. These results imply a probable role of ORP150 in the changes in appearance and function of pancreatic beta cells following acute necrotizing pancreatitis, through the pathway of endoplasmic reticulum stress.

  13. Diffusion MRI features of acute encephalopathy due to stopping steroid medication abruptly in congenital adrenal hyperplasia

    Directory of Open Access Journals (Sweden)

    Asli Serter

    2015-01-01

    Full Text Available Congenital adrenal hyperplasia (CAH is characterized by adrenal steroid biosynthesis defect. Steroid replacement therapy should be performed regularly in these patients. Adrenal crisis may be present in acute stress due to increased cortisol requirements or in steroid deficiency due to stopping steroid medication abruptly. In patients with acute adrenal insufficiency, severe hypotension or hypovolemic shock occurs typically. Acute encephalopathy can be seen due to hypoxia, hypervolemia, or hypoglycemia. Diffusion restriction can be seen in cortical-subcortical regions of frontal and parieto-occipital lobes and in splenium of corpus callosum. In CAH patients with neurologic symptoms, Diffusion weighted images (DWI is very important in the diagnosis and follow-up of acute encephalopathy.

  14. Posterior reversible encephalopathy syndrome and acute post-streptococcal glomerulonephritis mimicking breakthrough seizures

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    Kamille Abdool

    2015-05-01

    Full Text Available We report the case of a 14-year-old boy with a past history of primary generalized seizures, who had been seizure-free for 2 years on sodium valproate and presented with generalized tonic clonic seizures suggestive of breakthrough seizures. Examination revealed hypertension, impetiginous lesions of the lower limbs, microscopic hematuria, elevated antistreptolysin O titre and low complement levels consistent with acute post-streptococcal glomerulonephritis. Cranial magnetic resonance imaging (MRI demonstrated changes consistent with posterior reversible encephalopathy syndrome. Hypertension was controlled with intravenous nitroglycerin followed by oral captopril and amlodipine. Brain MRI changes returned normal within 2 weeks. The nephritis went in to remission within 2 months and after 8 months the patient has been seizure free again. Posterior reversible encephalopathy syndrome appeared to have neither short nor intermediate effect on seizure control in this patient. The relationship between posterior reversible encephalopathy syndrome and seizures is reviewed.

  15. Ischemic Acute Necrotizing Pancreatitis in a Marathon Runner. Comment

    Directory of Open Access Journals (Sweden)

    Johannes Matthias Löhr

    2009-03-01

    Full Text Available Dear Sir we read the contribution by Mast et al. with great interest [1]. They report on this unfortunate gentleman who developed acute pancreatitis after running marathon and taking a sauna. Although this combination of physical activities is not so uncommon in the Nordic countries, particularly during winter time, no such experience or reports exist on pancreatitis. Morbidity and mortality of sauna bathing is rather low [2], despite the fact that there is a readiness to combine sauna with alcohol intake. The more this case report appears worth publishing, even though we should have appreciated some more data on the level of hemoconcentration in this runner and sauna bather Furthermore, as it is routine in our pancreas clinic these days, we would have searched also for one of the known genetic factors contributing to the development of pancreatitis such as mutations in PRSS1, SPINK1, CFTR and CTRC genes [3]. Even more though in a patient who does not have one of the known or obvious causes such as alcohol, gallstones or hyperlipidemia. Further, despite his obvious physical condition, the presence of atherosclerotic microangiopathy would be worth knowing in a 57-year-old man, since most of the ischemic etiologies are thought to be associated with atherosclerotic disease [4].

  16. Ligustrazine alleviates acute renal injury in a rat model of acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jian-Xin Zhang; Sheng-Chun Dang; Jian-Guo Qu; Xue-Qing Wang

    2006-01-01

    AIM: To evaluate the effect of ligustrazine, a traditional Chinese medicine, on renal injury in a rat model of acute necrotizing pancreatitis (ANP).METHODS: A total of 192 rats were randomly divided into three groups: control (C group), ANP without treatment (P group), and ANP treated with ligustrazine (T group). Each group was further divided into 0.5,2, 6, 12 h subgroups. All rats were anesthetized with an intraperitoneal injection of sodium pentobarbital.Sodium taurocholate was infused through the pancreatic membrane to induce ANP. T group was infused sodium taurocholate as above, and 0.6% ligustrazine was then administered via the femoral vein. Serum urea nitrogen (BUN) and creatinine (Cr) concentrations were measured for the evaluation of renal function. The effects of ligustrazine on the severity of renal injury were assessed by renal function, TXA2/PGI2 and histopathological changes. Renal blood flow was determined by the radioactive microsphere technique (RMT).RESULTS: Compared with control group, the renal blood flow in P group was decreased significantly. Serious renal and pancreatic damages were found in P group, the BUN and Cr levels were elevated significantly, and the ratio of TXA2 to PGI2 was increased at 2, 6 and 12 h. Compared with P group, the blood flow of kidney was elevated significantly at 6 and 12 h after induction of ANP, the renal and pancreatic damages were attenuated, and the BUN and Cr levels were decreased significantly, and the ratio of TXA2 to PGI2 was decreased at 6 and 12 h in T group.CONCLUSION: Microcirculatory disorder (MCD) is an important factor for renal injury in ANP. Ligustrazine can ameliorate the condition of MCD and the damage of pancreas and kidney.

  17. Protective effects of erythropoietin against acute lung injury in a rat model of acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To investigate the effect of exogenous erythropoietin (EPO) administration on acute lung injury (ALI) in an experimental model of sodium taurodeoxycholateinduced acute necrotizing pancreatitis (ANP).METHODS: Forty-seven male Wistar albino rats were randomly divided into 7 groups: sham group (n = 5),3 ANP groups (n = 7 each) and 3 EPO groups (n = 7each). ANP was induced by retrograde infusion of 5% sodium taurodeoxycholate into the common bile duct.Rats in EPO groups received 1000 U/kg intramuscular EPO immediately after induction of ANP. Rats in ANP groups were given 1 mL normal saline instead. All animals were sacrificed at postoperative 24 h, 48 h and 72 h. Serum amilase, IL-2, IL-6 and lung tissue malondialdehyde (MDA) were measured. Pleural effusion volume and lung/body weight (LW/BW) ratios were calculated. Tissue levels of TNF-α, IL-2 and IL-6 were screened immunohistochemically. Additionally, ox-LDL accumulation was assessed with immune-fluorescent staining. Histopathological alterations in the lungs were also scored.RESULTS: The mean pleural effusion volume, calculated LW/BW ratio, serum IL-6 and lung tissue MDA levels were significantly lower in EPO groups than in ANP groups. No statistically significant difference was observed in either serum or tissue values of IL-2 among the groups. The level of tumor necrosis factor-α (TNF-α)and IL-6 and accumulation of ox-LDL were evident in the lung tissues of ANP groups when compared to EPO groups, particularly at 72 h. Histopathological evaluation confirmed the improvement in lung injury parameters after exogenous EPO administration, particularly at 48 h and 72 h.CONCLUSION: EPO administration leads to a significant decrease in ALI parameters by inhibiting polymorphonuclear leukocyte (PMNL) accumulation,decreasing the levels of proinflammatory cytokines in circulation, preserving microvascular endothelial cell integrity and reducing oxidative stress-associated lipid peroxidation and therefore, can be

  18. Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure.

    Science.gov (United States)

    Romero-Gómez, Manuel; Montagnese, Sara; Jalan, Rajiv

    2015-02-01

    Hepatic encephalopathy in a hospitalized cirrhotic patient is associated with a high mortality rate and its presence adds further to the mortality of patients with acute-on-chronic liver failure (ACLF). The exact pathophysiological mechanisms of HE in this group of patients are unclear but hyperammonemia, systemic inflammation (including sepsis, bacterial translocation, and insulin resistance) and oxidative stress, modulated by glutaminase gene alteration, remain as key factors. Moreover, alcohol misuse, hyponatremia, renal insufficiency, and microbiota are actively explored. HE diagnosis requires exclusion of other causes of neurological, metabolic and psychiatric dysfunction. Hospitalization in the ICU should be considered in every patient with overt HE, but particularly if this is associated with ACLF. Precipitating factors should be identified and treated as required. Evidence-based specific management options are limited to bowel cleansing and non-absorbable antibiotics. Ammonia lowering drugs, such as glycerol phenylbutyrate and ornithine phenylacetate show promise but are still in clinical trials. Albumin dialysis may be useful in refractory cases. Antibiotics, prebiotics, and treatment of diabetes reduce systemic inflammation. Where possible and not contraindicated, large portal-systemic shunts may be embolized but liver transplantation is the most definitive step in the management of HE in this setting. HE in patients with ACLF appears to be clinically and pathophysiologically distinct from that of acute decompensation and requires further studies and characterization.

  19. Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report.

    Science.gov (United States)

    Gollapalli, Rajesh Babu; Naiman, Ana Nusa; Merry, David

    2015-07-01

    Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.

  20. Contrast-enhanced magnetic resonance imaging for the detection of acute haemorrhagic necrotizing pancreatitis

    Energy Technology Data Exchange (ETDEWEB)

    Piironen, A. [Department of Radiology, Helsinki University Central Hospital, Helsinki (Finland); Kivisaari, R. [Department of Radiology, Helsinki University Central Hospital, Helsinki (Finland); Pitkaeranta, P. [Department of Radiology, Helsinki University Central Hospital, Helsinki (Finland); Poutanen, V.P. [Department of Radiology, Helsinki University Central Hospital, Helsinki (Finland); Laippala, P. [School of Public Health/Biometry Unit, Tampere University, Tampere (Finland); Laurila, P. [Department of Pathology, Helsinki Univ. (Finland); Kivisaari, L. [Department of Radiology, Helsinki University Central Hospital, Helsinki (Finland)

    1997-02-01

    Eleven piglets with haemorrhagic necrotizing pancreatitis and nine piglets with oedematous pancreatitis were imaged using a multi-breath-hold TurboFLASH (TR 6.5 ms, TE 3 ms, TI 300 ms, flip angle 8 , three slices) pre-excited T1-weighted sequence with an IV bolus injection of gadopentetate dimeglumine (Gd-DTPA, 0.3 mmol/kg) as a contrast agent to show dynamic contrast enhancement of the pancreas by MRI. All piglets were imaged according to the same protocol before inducing the disease. Following the IV Gd-DTPA bolus, time-enhancement curve of the pancreas during haemorrhagic necrotizing pancreatitis was significantly lower than during oedematous pancreatitis. The enhancement curves for the healthy piglets and piglets with oedematous pancreatitis did not differ significantly. Each piglet served as its own control. Because the results of this initial study are similar to those obtained with contrast-enhanced CT, we conclude that our results may encourage further clinical trials, and contrast-enhanced dynamic MRI may be an alternative to the established method of CT for diagnosing acute haemorrhagic necrotizing pancreatitis. (orig.). With 3 figs.

  1. Cyclophosphamide-Induced Severe Acute Hyponatremic Encephalopathy in Patients with Breast Cancer: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Michelle Baker

    2014-07-01

    Full Text Available Background: Cyclophosphamide is an alkylating agent widely used in antineoplastic and immunosuppressive therapies. Symptomatic hyponatremia can be a rare but life-threatening complication in patients treated with cyclophosphamide. Case Presentations: We report 2 patients who presented with severe acute hyponatremic encephalopathy after receiving their first cycles of a low-dose cyclophosphamide-containing regimen for breast cancer. In case 1, a 58-year-old female received the combination of docetaxel and cyclophosphamide, and in case 2, a 56-year-old female received the combination of doxorubicin and cyclophosphamide. Both patients recovered after correction of their serum sodium concentration without neurological deficits. Future cycles of chemotherapy were well tolerated without recurrence of hyponatremia after cyclophosphamide was discontinued from the respective regimens. Conclusion: Clinicians must always keep in mind that acute hyponatremic encephalopathy can be induced by low-dose cyclophosphamide.

  2. Diffusion MRI features of acute encephalopathy due to stopping steroid medication abruptly in congenital adrenal hyperplasia

    OpenAIRE

    Asli Serter; Alpay Alkan; Demet Demirkol

    2015-01-01

    Diffusion MRI features of acute encephalopathy due to stopping steroid medication abruptly in congenital adrenal hyperplasia Asli Serter, Alpay Alkan and Demet Demirkol Annals of Indian Academy of Neurology. 18.3 (July-September 2015): p342. Copyright: COPYRIGHT 2015 Medknow Publications and Media Pvt. Ltd. http://www.annalsofian.org/ Full Text: Byline: Asli. Serter, Alpay. Alkan, Demet. Demirkol Congenital adrenal hyperplasia (CAH) is characterized by adrenal steroid biosynthesis defect. Ste...

  3. Spider Bite: A Rare Case of Acute Necrotic Arachnidism with Rapid and Fatal Evolution

    Science.gov (United States)

    Giglio, Anna Maria; Scozzafava, Annamaria; Filippelli, Orazio; Serafino, Giuseppe; Verre, Mario

    2016-01-01

    The spider bites are quite frequent and often resolve quickly without leaving outcomes; only some species are capable of causing necrotic and systematic lesions in humans. Among them, we should mention the genus Loxosceles. The venom released from the spider bite of Loxosceles species is composed of proteins, enzymes, and nonenzymatic polypeptides. The phospholipase D family was identified as the active component of the venom. This family of enzymes is responsible for the local and systemic effects observed in loxoscelism. Phospholipases D interact with cell membranes triggering alterations which involve the complement system and activation of neutrophils and they cause the dermonecrotic skin lesions and systemic effects. We describe a fatal case of acute intoxication caused by a spider bite probably belonging to the species Loxosceles. The initial lesion was localized to a finger of a hand. Clinical course was worsening with deep necrotic lesions on limb, shock, hemolysis, acute kidney failure, and disseminated intravascular coagulation. All therapies were ineffective. This is the first fatal case described in Europe. PMID:27651958

  4. Spider Bite: A Rare Case of Acute Necrotic Arachnidism with Rapid and Fatal Evolution

    Directory of Open Access Journals (Sweden)

    Mario Pezzi

    2016-01-01

    Full Text Available The spider bites are quite frequent and often resolve quickly without leaving outcomes; only some species are capable of causing necrotic and systematic lesions in humans. Among them, we should mention the genus Loxosceles. The venom released from the spider bite of Loxosceles species is composed of proteins, enzymes, and nonenzymatic polypeptides. The phospholipase D family was identified as the active component of the venom. This family of enzymes is responsible for the local and systemic effects observed in loxoscelism. Phospholipases D interact with cell membranes triggering alterations which involve the complement system and activation of neutrophils and they cause the dermonecrotic skin lesions and systemic effects. We describe a fatal case of acute intoxication caused by a spider bite probably belonging to the species Loxosceles. The initial lesion was localized to a finger of a hand. Clinical course was worsening with deep necrotic lesions on limb, shock, hemolysis, acute kidney failure, and disseminated intravascular coagulation. All therapies were ineffective. This is the first fatal case described in Europe.

  5. Cerebral blood flow and liver function in patients with encephalopathy due to acute and chronic liver diseases

    DEFF Research Database (Denmark)

    Almdal, T; Schroeder, T; Ranek, L

    1989-01-01

    The purpose of the present investigation was to study changes in cerebral blood flow (CBF) in hepatic encephalopathy, to ascertain whether this was related to the changes in liver function and whether these changes gave any prognostic information. CBF, determined by the intravenous xenon-133 method......, and liver functions, assessed by the prothrombin index, bilirubin concentration, and the galactose elimination capacity, were studied in patients with acute fulminant liver failure and in patients with encephalopathy due to chronic liver diseases--that is, cirrhosis of various etiologies. The CBF range...... any differences between patients with acute or chronic liver diseases or the different degrees of hepatic encephalopathy. In conclusion, a marked reduction of the CBF was seen in hepatic encephalopathy, irrespective of the etiology of the disease....

  6. Acute headache as a presenting symptom of tacrolimus encephalopathy.

    NARCIS (Netherlands)

    Kiemeneij, I.M.; Leeuw, H.F. de; Ramos, L.; Gijn, J. van

    2003-01-01

    A 24 year old woman presented with a sudden excruciating headache mimicking an acute vascular event. She had undergone a lung transplantation because of cystic fibrosis and was receiving maintenance treatment with tacrolimus and prednisone. Ancillary investigation excluded vascular causes. Magnetic

  7. Long-Term Outcomes after Acute Necrotizing Pancreatitis: What Happens to the Pancreas and to the Patient?

    Directory of Open Access Journals (Sweden)

    Rafaela Cristina Goebel Winter Gasparoto

    2015-03-01

    Full Text Available Context Late consequences of acute pancreatitis have received little attention. It is controversial whether the pancreas fully recovers after an episode of acute pancreatitis, especially in the presence of necrosis. Therefore, the presence of late pancreatic dysfunction following acute necrotizing pancreatitis is uncertain and there are controversies about how it may affect long-term quality of life. Objectives To evaluate pancreatic function and morphology, besides quality of life, in patients with prior acute necrotizing pancreatitis. Patients Patients who were admitted to our hospital with acute necrotizing pancreatitis in a ten-year interval were identified and thirty-eight survivors were contacted to enroll in the study out of which sixteen patients were included. Methods Exocrine function was studied by qualitative fecal fat excretion. Endocrine function was evaluated by oral glucose tolerance test, HOMA-beta and C-peptide. Pancreatic morphology was examined by computed tomography. Quality of life was measured by 36-item short-form health survey. Tests were performed at leasttwelve months after the index episode of acute necrotizing pancreatitis. Results The prevalence of pancreatic exocrine insufficiency was 6.2%. Endocrine dysfunction was observed in half the cases, and no association with the extension of necrosis was found. Morphological changes were frequent (62.5% and more prevalent in those who faced extensive necrosis. Quality of life was considered good, and its impairment was found exclusively in mental health domain, markedly in patients who had alcoholic pancreatitis. There was no correlation between quality of life and prognostic indicators. Conclusions Exocrine function and quality of life were preserved in this group of patients. However, endocrine dysfunction and morphological abnormalities were frequent after acute necrotizing pancreatitis. These findings justify a long-term follow-up in order to initiate specific

  8. [Acute encephalopathy due to late-onset maple syrup urine disease in a school boy].

    Science.gov (United States)

    Qu, Su-Qing; Yang, Li-Cai; Luan, Zuo; Du, Kan; Yang, Hui

    2012-03-01

    Maple syrup urine disease is a common amino acids metabolic disease. In most patients, onset occurs in the neonatal period and infancy. In this study, the case of a school boy with acute encephalopathy due to late-onset maple syrup urine disease is summarized. The boy (8.5 years) was admitted because of acute encephalopathy after suffering from infection for two days at the age of eight and a half years. Metabolic acidosis, hyperuricemia and decreased protein level in cerebrospinal fluid were found by general laboratory tests. Magnetic resonance imaging of the brain revealed signal intensity abnormalities in the bilateral cerebellum dentate nucleus, brainstem, thalamus, putamen, caudate nucleus and cortex of the cerebral hemispheres. On T1WI and T2WI scanning, hyperintensive signal was found. Blood leucine and valine were significantly elevated. Urinary 2-hydroxy isovaleric acid, 3-hydroxybutyric acid, 2-keto isovaleric acid, and 2-keto acid also increased. Both the blood amino acid and urine organic acid profiles led to the diagnosis of maple syrup urine disease. In the acute period, the patient was treated with a large dose of vitamin B1, glucose, L-carnitine and a protein-restrict diet. The patient's condition improved significantly after five days of treatment, and he recovered completely two days later. Afterwards, treatment with vitamin B1, L-carnitine and a protein-restrict diet (1 g/kg/day) was continued. One and a half months later, blood amino acids and urine organic acids returned to normal. Magnetic resonance imaging of the brain also indicated a great improvement. It was concluded that inborn metabolic disease should be considered in the patients with an onset similar to acute encephalopathy. Early diagnosis and proper treatment can prevent brain damage and improve prognosis.

  9. THE CHANGES OF PANCREATIC ACINAR CELL FUNCTION IN ACUTE NECROTIZING PANCREATITIS OF RATS

    Institute of Scientific and Technical Information of China (English)

    余枭; 韩天权; 汤耀卿; 雷若庆; 夏宗勤

    2000-01-01

    Objective To evaluate the changes of pancreatic acinar cell functions in the rats with acute necrotizing pancreatitis (ANP). Methods Seventy SD rats were randomized into two groups: experimental group (n=35) and control group (n=35). To prepare the experimental model, the retrograde injection of 5% sodium taurocholate into the pancreatic duct was used for inducing ANP. Radioactive tracing by L- 3H-phenylalanine and autoradiography were performed for scoring the differences of changes of amino acid uptake, enzyme-protein synthesis and output from acinar cells in rats between both groups. Results No changes were observed in amino acid uptake and enzyme-protein synthesis in rats with dotted and haemorrhagic necrotizing foci as compared with control group. However, accumulated zymogen granules in the interstitial of acinar cells were seen in the experimental group. Conclusion It indicates that in experimental ANP rats, the functions of acinar cells in both amino acid uptake and protein synthesis were essentially normal, but the pathway of enzyme output was affected into ectopic secretion through the bottom or lateral cellular membrane of pancreatic acinar cell.

  10. [Acute edematous encephalopathy presenting with refractory generalized status epilepticus: an autopsy case].

    Science.gov (United States)

    Yamashita, M; Yamamoto, T; Yasuda, T

    2001-11-01

    A previously healthy, 29-year-old man developed generalized convulsion with disturbed consciousness 3 days after the flu-like symptoms. On the next day, his convulsion evolved into generalized status epilepticus (GSE) that was unresponsive to administration of various anticonvulsants. Then, intravenous anesthetic agents, including midazolam, propofol and vecuronium sodium, were continuously infused. During the following 9 days, despite of high-dose infusion of these anesthetic agents, his GSE could not be suppressed, and complex partial seizure with secondary generalization frequently occurred. The patient was comatose and mechanically ventilated, whereas the brainstem reflexes were preserved. Electroencephalogram revealed a diffuse slowing of the background activity and occasional focal spike and wave complexes with secondary generalization. Cerebrospinal fluid analysis showed pleocytosis and elevated protein concentration. Cranial CT scans obtained on day 8 demonstrated brain edema. On day 10, his GSE ceased with abolition of the brainstem reflexes, and he lapsed into brain death resulting from the progressive brain edema. Over the following six days, his systemic circulation gradually worsened, and he died on day 16. On postmortem examination, the brain was markedly edematous and showed the findings consistent with acute anoxic encephalopathy with extensive circulatory stasis. Mild gliosis was observed in the insular cortex, yet no evidence of inflammatory disease was found throughout the brain. This patient was characterized by acutely progressive severe brain edema without inflammatory changes, suggesting that his primary disease was acute toxic encephalopathy presumably induced by viral infection. His GSE was refractory and unresponsive to the intensive treatment with the intravenous anesthetic agents. This case epitomizes the difficulties in controlling refractory seizures in some patients with encephalopathy or encephalitis.

  11. Tranilast reduces serum IL-6 and IL-13 and protects against thioacetamide-induced acute liver injury and hepatic encephalopathy.

    Science.gov (United States)

    Abdelaziz, Rania R; Elkashef, Wagdi F; Said, Eman

    2015-07-01

    Hepatic encephalopathy is a serious neuropsychiatric disorder usually affecting either acute or chronic hepatic failure patients. Hepatic encephalopathy was replicated in a validated rat model to assess the potential protective efficacy of tranilast against experimentally induced hepatic encephalopathy. Thioacetamide injection significantly impaired hepatic synthetic, metabolic and excretory functions with significant increase in serum NO, IL-6 and IL-13 levels and negative shift in the oxidant/antioxidant balance. Most importantly, there was a significant increase in serum ammonia levels with significant astrocytes' swelling and vacuolization; hallmarks of hepatic encephalopathy. Tranilast administration (300 mg/kg, orally) for 15 days significantly improved hepatic functions, restored oxidant/antioxidant balance, reduced serum NO, IL-6 and IL-13 levels. Meanwhile, serum ammonia significantly declined with significant reduction in astrocytes' swelling and vacuolization. Several mechanisms can be implicated in the observed hepato- and neuroprotective potentials of tranilast, such as its anti-inflammatory potential, its antioxidant potential as well as its immunomodulatory properties.

  12. Drug-Related Hyponatremic Encephalopathy: Rapid Clinical Response Averts Life-Threatening Acute Cerebral Edema

    Science.gov (United States)

    Siegel, Arthur J.; Forte, Sophie S.; Bhatti, Nasir A.; Gelda, Steven E.

    2016-01-01

    Patient: Female, 63 Final Diagnosis: Drug-induced hyponatremic encephalopathy Symptoms: Seizures • coma Medication: Hypertonic 3% saline infusion Clinical Procedure: — Specialty: Internal Medicine Objective: Unusual clinical course Background: Drug-induced hyponatremia characteristically presents with subtle psychomotor symptoms due to its slow onset, which permits compensatory volume adjustment to hypo-osmolality in the central nervous system. Due mainly to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), this condition readily resolves following discontinuation of the responsible pharmacological agent. Here, we present an unusual case of life-threatening encephalopathy due to adverse drug-related effects, in which a rapid clinical response facilitated emergent treatment to avert life-threatening acute cerebral edema. Case Report: A 63-year-old woman with refractory depression was admitted for inpatient psychiatric care with a normal physical examination and laboratory values, including a serum sodium [Na+] of 144 mEq/L. She had a grand mal seizure and became unresponsive on the fourth day of treatment with the dual serotonin and norepinephrine reuptake inhibitor [SNRI] duloxetine while being continued on a thiazide-containing diuretic for a hypertensive disorder. Emergent infusion of intravenous hypertonic (3%) saline was initiated after determination of a serum sodium [Na+] of 103 mEq/L with a urine osmolality of 314 mOsm/kg H20 and urine [Na+] of 12 mEq/L. Correction of hyposmolality in accordance with current guidelines resulted in progressive improvement over several days, and she returned to her baseline mental status. Conclusions: Seizures with life-threatening hyponatremic encephalopathy in this case likely resulted from co-occurring SIADH and sodium depletion due to duloxetine and hydrochlorothiazide, respectively. A rapid clinical response expedited diagnosis and emergent treatment to reverse life-threatening acute cerebral edema

  13. Non-alcoholic acute Wernicke's encephalopathy: Role of MRI in non typical cases

    Energy Technology Data Exchange (ETDEWEB)

    Elefante, Andrea, E-mail: aelefant@unina.it [Department of Neuroradiology, University of Naples “Federico II”, Naples (Italy); Puoti, Gianfranco [I Division of Neurology, General Medicine Department, Second University of Naples, Naples (Italy); Senese, Rossana [Department of Neuroradiology, University of Naples “Federico II”, Naples (Italy); Coppola, Cinzia [I Division of Neurology, General Medicine Department, Second University of Naples, Naples (Italy); Russo, Carmela [Department of Neuroradiology, University of Naples “Federico II”, Naples (Italy); Tortora, Fabio [Department of Neuroradiology, Second University of Naples, Naples (Italy); Divitiis, Oreste de [Department of Neurosurgery, University of Naples “Federico II”, Naples (Italy); Brunetti, Arturo [Department of Neuroradiology, University of Naples “Federico II”, Naples (Italy)

    2012-12-15

    Aim: Acute Wernicke's encephalopathy (WE) is a severe neurological disorder caused by thiamine deficiency, most commonly found in chronic alcoholics. It is not so easy to suspect acute WE when the clinical picture does not include all the typical symptoms and alcohol abuse is not reported. Three rare cases of Wernicke's encephalopathy (WE) in non-alcoholic patients are reported. Cases presentation: Two patients developed the disease following prolonged intravenous feeding, the third was carrying a gastric lymphoma. None of them presented with the classic clinical triad of WE (ophtalmoplegia/nystagmus, ataxia and consciousness disturbance), showing just one or two of the typical symptoms. Brain Magnetic Resonance Imaging (MRI) represented the key tool to suspect and define WE diagnosis, showing a picture characterized by bilaterally altered signal of the thalamic pulvinar, mesencephalic cup, mammillary bodies, periaqueductal grey matter and floor of fourth ventricle. All patients dramatically improved within 48 h after administration of thiamine. Conclusion: We emphasize that WE should be suspected in all patients showing typical MRI features presenting with at least one of the clinical triad of WE.

  14. Disrupted glutamate-glutamine cycle in acute encephalopathy with biphasic seizures and late reduced diffusion

    Energy Technology Data Exchange (ETDEWEB)

    Takanashi, Jun-ichi; Terai, Masaru [Tokyo Women' s Medical University Yachiyo Medical Center, Department of Pediatrics, Yachiyo-shi (Japan); Mizuguchi, Masashi [The University of Tokyo, Department of Developmental Medical Sciences, Graduate School of Medicine, Tokyo (Japan); Barkovich, A.J. [University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States)

    2015-11-15

    Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is the most common subtype of infectious pediatric encephalopathy in Japan. It is sometimes difficult to make an early diagnosis of AESD; excitotoxicity is postulated to be the pathogenesis based on elevated glutamine (Gln) and glutamate (Glu) complex (Glx = Glu + Gln) observed on MR spectroscopy. It is uncertain whether Gln or Glu contributes to the elevated Glx, or whether MR spectroscopy is useful for an early diagnosis. Five Japanese patients with AESD (three boys and two girls, 1 year of age) were enrolled in this study. MR spectroscopy was acquired from the frontal white matter (repetition time (TR) of 5000 ms, echo time (TE) of 30 ms) with a 1.5- or 3.0-T scanner. MR spectroscopy was performed four times for two patients, three times for one patient, and two times for two patients. Quantification of Glu and Gln was performed using LCModel. Glu was elevated in three of four studies on days 1-4 and became normal or low afterward. Gln was normal in three studies on days 1-2, elevated in all seven studies on days 4-12, and became normal or low afterward. These findings suggest that MR spectroscopy may be useful for an early diagnosis. Acute Glu elevation changes to subacute Gln elevation, suggesting that a disrupted Glu-Gln cycle may play an important role. (orig.)

  15. Mielitis aguda necrotizante en un paciente con Sida Acute necrotizing myelitis in an AIDS patient

    Directory of Open Access Journals (Sweden)

    M. Corti

    2003-04-01

    Full Text Available Como consecuencia de la infección por el virus de la inmunodeficiencia humana tipo-1 (HIV-1, otros patógenos como citomegalovirus (CMV y herpes simple tipo 1-2 (HSV 1-2 pueden comprometer tanto el sistema nervioso central como el periférico. Estos agentes pueden involucrar también a la médula espinal y causar una mielitis aguda necrotizante. Esta complicación ocurre por lo general en pacientes con enfermedad HIV/sida avanzada y marcada inmunodeficiencia, con recuentos de linfocitos T CD4+ de menos de 50 cél/µL. El cuadro clínico, los cambios en el LCR y las neuroimágenes generan una importante sospecha diagnóstica. Es fundamental el inicio precoz de la terapia antiviral específica. Se presenta un paciente con enfermedad avanzada debida al HIV-1 y mielitis aguda necrotizante por CMV y HSV bajo la forma clínica de síndrome de la cola de caballo.In the setting of HIV infection, cytomegalovirus (CMV and herpes simplex virus type 1-2 (HSV 1-2 can affect both the central and peripheral nervous systems. These agents can involve the spinal cord and produce a necrotizing transverse myelitis. This usually occurs in AIDS patients with severe immunodeficiency: CD4 + lymphocyte counts typically are less than 50 cell/µL. The clinical presentation, CSF and imaging studies can provide a high level of suspicion diagnosis. Prompt initiation of antiviral specific drugs is essential. We report a patient with an acute necrotizing myelitis (cauda equina syndrome secondary to CMV and HSV infections.

  16. Acute cerebellar ataxia in a young woman: Wernicke’s encephalopathy?

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    S. G. Dolgova

    2015-01-01

    Full Text Available Wernicke’s encephalopathy (WE is a rare but severe neurological syndrome caused by thiamine deficiency. According to the data of autopsy studies, the prevalence of WE in the general population varies from 0.4 to 2.8 per 100,000 population; the disease occurs many times more frequently in alcohol abusers than in people who lead a healthy lifestyle. These studies also showed that most cases of WE were diagnosed postmortem; less than 20% of patients with the disease were diagnosed in life. A healthy adult requires 1–2 mg of thiamine daily, depending on the carbohydrate intake. Body’s reserves of thiamine are only 30–50 mg so any malnutrition condition lasting more than 3–4 weeks can cause complete depletion of the vitamin’s stores. Classically, WE is characterized by the sudden onset of a typical triad of symptoms: an altered mental state, ophthalmoplegia, and ataxia. However, this clinical picture can be seen in only one-third of patients. The onset of the disease may sometimes look completely different: heart failure with hypotension and tachycardia; gastrointestinal symptoms (abdominal pain and nausea; hypothermia due to the involvement of the posterior hypothalamus; deafness affecting the thalamus; epileptic seizures in case of enhanced activity of the glutamatergic system.The paper describes a clinical case of acute cerebellar ataxia that is apparently caused by Wernicke’s encephalopathy in a young woman.

  17. Traditional Chinese medicine "Qing Yi Tang" alleviates oxygen free radical injury in acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    1998-01-01

    AIM To observe the changes in oxygen free radical (OFR) and the curative effect of traditional Chinese medicine "Qing Yi Tang" in acute necrotizing pancreatitis (ANP).METHODS After induction of ANP by injection of sodium taurocholate into pancreatic duct, 16 dogs were randomly divided into control group and Chinese medicine group. Serum amylase, SOD and MDA were determined on postoperative day 1, 2, 4 and 7. The animals were sacrificed on day 7. SOD and MDA in organs were determined, and pathological changes in pancreas were observed.RESULTS As compared with control group, the serum level of amylase (734U/L vs 2783U/L) and MDA (7.8nmol/ml vs 14.8nmol/ml) in Chinese medicine group were decreased on day 7 (P<0.05), while SOD increased significantly (281nU/ml vs 55nU/ml, P<0.01), and similar changes occurred in MDA and SOD in organs, especially in the pancreas; the pathological changes in the pancreas were alleviated as well.CONCLUSION "Qing Yi Tang" is effective in clearing OFRs and alleviating pathological changes in ANP.

  18. Effects of chondroitin sulfate on alteration of actin cytoskeleton in rats with acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Zhong-Ye He; Ren-Xuan Guo

    2007-01-01

    BACKGROUND: In experimental acute pancreatitis, a large amount of reactive oxygen species are produced, and in turn cytoskeletal changes may be induced in pancreatic tissue. These changes contribute to an imbalance of digestive enzyme segregation, transport, exocytosis and activation, resulting in cell injury. In this study, we assessed the effects of chondroitin sulfate (CS) on attenuation of oxidative damage and protection of F-actin in rats with acute necrotizing pancreatitis (ANP). METHODS:Ninety male Wistar rats were divided randomly into three groups. Group A was infused with 5% sodium taurocholate; group B was treated with CS;and group C served as control. Rats from the three groups were killed at 1, 3 or 8 hours. The levels were measured of malonyl dialdehyde (MDA), total superoxide dismutase (SOD), glutathione synthetase (GSH), serum amylase (SAM) and adenosine triphosphate (ATP). F-actin immunostained with rhodamine-phalloidin was analyzed using a confocal laser scanning system and the content of F-actin protein was determined. RESULTS: The levels of SAM increased in groups A and B, whereas the levels of GSH, SOD and ATP in group A decreased markedly during pancreatitis, and MDA increased signiifcantly. The levels of GSH, SOD and ATP in group B were higher than those in group A, but the level of MDA was lower than in group A. At the same time, ANP resulted in early disruption of the cytoskeleton with dramatic changes and a loss of F-actin. Administration of CS moderated the damage to the actin cytoskeleton. CONCLUSIONS:Retrograde infusion of sodium taurocholate via the pancreatic duct may produce pancreatic necrosis and a marked increase in serum amylase activity, induce a severe depletion of ATP level, prime lipid peroxidation, and damage F-actin. Treatment with CS can ameliorate pancreatic cell conditions, limit cell membrane peroxidation, protect F-actin, and attenuate pancreatitis.

  19. Role of Kupffer cells in acute hemorrhagic necrotizing pancreatitis-associated lung injury of rats

    Institute of Scientific and Technical Information of China (English)

    Hong-Bin Liu; Nai-Qiang Cui; Dong-Hua Li; Chang Chen

    2006-01-01

    AIM: To investigate the role of Kupffer cells (KCs) in acute hemorrhagic necrotizing pancreatitis-associated lung injury (AHNP-LI).METHODS: Forty-two rats were allocated to four groups [sham operation, AHNP model, gadolinium chloride (GdCl3) pretreatment, GdCl3 control]. In GdCl3pretreatment group, GdCl3 was administered by caudal vein injection 24 h before the AHNP model induction.Blood from the iliac artery, alveolar macrophages and tissues from the pancreas and lung, were collected in six animals per group 3 and 6 h after acute pancreatitis induction. TNF-α, IL-1 of serum, myeloperoxidase (MPO)of lung tissue, NF-κB activation of alveolar macrophages were detected. Serum AST and ALT in sham operation group and GdCl3 control group were tested. In addition,histopathological changes of the pancreas and lung were observed under light microscope.RESULTS: MPO of lung tissue and TNF-α, IL-1 levels of serum were all reduced significantly in GdCl3pretreatment group compared to those in AHNP group(P<0.01). NF-κB activation of alveolar macrophages was also attenuated significantly in GdCl3 pretreatment group compared to that in AHNP group (P<0.01). The pathological injury of the lung was ameliorated obviously in GdCl3 pretreatment group compared to that in AHNP group. Nevertheless, the serum amylase level did not reduce and injury of the pancreas was not prevented in GdCl3 pretreatment group.CONCLUSION: Pulmonary injury induced by AHNP is mediated by KC activation and AHNP-LI can be significantly ameliorated by pretreatment with GdCl3 and KCs play a vital role in AHNP-LI.

  20. Posterior reversible encephalopathy syndrome in an AIDS patient with acute renal failure and hypertension

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    Olivia Bargiacchi

    2013-03-01

    Full Text Available Introduction: The posterior reversible encephalopathy syndrome (PRES is a neurological entity characterized by magnetic resonance imaging (MRI evidence of bilateral subcortical edema in the occipital regions of the brain. Case report: We report the case of a female patient with AIDS, pulmonary aspergillosis, CMV infection, and acute renal failure due to Clostridium difficile diarrhea. Her clinical course was complicated by seizures and hypertension. MRI findings were consistent with PRES. The patient was treated with anticonvulsants and antihypertensive agents with clinical improvement. Discussion and conclusions: Few cases of PRES in HIV-infected patients have been described, and it is not clear whether HIV infection is a predisposing factor for this syndrome. The article reviews the literature on PRES in HIV and discusses the role of HIV-associated endothelial damage in the pathogenesis of this syndrome.

  1. Transient widespread cortical and splenial lesions in acute encephalitis/encephalopathy associated with primary Epstein–Barr virus infection

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    Shuo Zhang

    2016-01-01

    Full Text Available Infection with Epstein–Barr virus (EBV is very common and usually occurs in childhood or early adulthood. Encephalitis/encephalopathy is an uncommon but serious neurological complication of EBV. A case of EBV-associated encephalitis/encephalopathy with involvement of reversible widespread cortical and splenial lesions is presented herein. An 8-year-old Chinese girl who presented with fever and headache, followed by seizures and drowsiness, was admitted to the hospital. Magnetic resonance imaging revealed high signal intensities on diffusion-weighted imaging in widespread cortical and splenial lesions. The clinical and laboratory examination results together with the unusual radiology findings suggested acute encephalitis/encephalopathy due to primary EBV infection. After methylprednisolone pulse therapy together with ganciclovir, the patient made a full recovery without any brain lesions. The hallmark clinical–radiological features of this patient included severe encephalitis/encephalopathy at onset, the prompt and complete recovery, and rapidly reversible widespread involvement of the cortex and splenium. Patients with EBV encephalitis/encephalopathy who have multiple lesions, even with the widespread involvement of cortex and splenium of the corpus callosum, may have a favorable outcome with complete disappearance of all brain lesions.

  2. Point-of-Care Ultrasound in Necrotizing Acute Pancreatitis Complicated by Perforated Ileum Due to Nonocclusive Mesenteric Ischemia

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    Sonia López-Cuenca

    2016-09-01

    Full Text Available Necrotizing acute pancreatitis is the most severe form of pancreatitis, and it is a potentially life-threatening condition. Its diagnosis and severity are based on radiological signs. Although computed tomography is the most used imaging tool, ultrasound can be a quick and useful technique in emergency and intensive care scenarios. The use of abdominal ultrasound is generally limited to ruling out cholecystitis. Bowel gas can limit the accuracy of pancreatic imaging. When the pancreas is visualized, ultrasound can reveal pancreatic enlargement, echotextural changes, and peripancreatic fluid. We present a patient with necrotizing pancreatitis who developed peritonitis due to ileal perforation, where the use of ultrasound as a bedside imaging technique was very useful.

  3. Kontribusi Higiene Mulut terhadap Timbulnya Acute Necrotizing Ulcerative Gingivitis (ANUG (Survei Epidemiologi di Kecamatan Pacet Kabupaten Cianjur Jawa Barat

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    Diana Mirna

    2015-10-01

    Full Text Available This analytical epidemiological survey was aimed to investigate the correlation between oral hygiene and the onset of an infectious, necrotic, ulcerative disease called acute necrotizing ulcerative gingivitis (ANUG. The study involved 319 elementary school children consisting of 163 (52% male and 156 (48% female pupils from Kecamatan Pacet, Cianjur, WestJawa. Samples were chosen by stratified simple random sampling. The obtained data were analyzed with Bivariant Test (Chi2Ttest, and the results showed a quite high prevalence of ANUG, aboout 15.3% in total and consisting 9% male and 6.3% female subjects. The correlation between oral hygiene and the onset of ANUG was found to be significant (p<0.05. It was concluded that oral hygiene has an important contribution to the onset of ANUG.

  4. Ligustrazine alleviates gastric mucosal injur y in a rat model of acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Sheng-Chun Dang; Jian-Xin Zhang; Jian-Guo Qu; Xue-Qing Wang; Xin Fan

    2007-01-01

    BACKGROUND: Acute necrotizing pancreatitis (ANP) leads to a systemic inlfammatory response characterized by widespread leukocyte activation and, as a consequence, distant organ injury. The aim of this study was to explore the relationship between gastric microcirculatory impairment and inlfammatory mediators released in rats and to evaluate the therapeutic effect of ligustrazine extracted from Rhizoma ligusticum wallichii on gastric mucosa injury in a rat model of ANP. METHODS: Ninety-six Sprague-Dawley rats were randomly divided into three groups: normal control (group C);ANP without treatment (group P); and ANP treated with ligustrazine (group T). The ANP model was induced by injection of 50 g/L sodium taurocholate under the pancreatic membrane (4 ml/kg). Group C was given isovolumetric injection of 9 g/L physiological saline by the same route. Group T was injected with ligustrazine (10 ml/kg) via the portal vein. The radioactive biomicrosphere technique was used to measure the blood lfow 2 and 12 hours after the induction of ANP. Samples of the pancreas and stomach were taken to assess pathological changes by a validated histology score;meanwhile, the levels of serum interleukin-1β(IL-1β) were determined. Gastric tissues were also used to measure the level of myeloperoxidase (MPO), which is expressed intracellularly in the azurophilic granules of neutrophils. RESULTS: Blood lfow in group P was signiifcantly lower than that in group C (P CONCLUSIONS: Decreased gastric blood lfow and increased inlfammatory mediators can be seen early in ANP, and both are important factors for gastric and mucosal injury. Ligustrazine can ameliorate microcirculatory disorder and alleviate the damage to the pancreas and stomach.

  5. Effects of Chai-Qin-Cheng-Qi Decoction on cefotaxime in rats with acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Li-Hui Deng; Da-Kai Xiang; Ping Xue; Hai-Yan Zhang; Lei Huang; Qing Xia

    2009-01-01

    AIM: To investigate the effect of Chai-Qin-Cheng-Qi Decoction (CQCQD) on cefotaxime (CTX) concentration in pancreas of rats with acute necrotizing pancreatitis (ANP).METHODS: Sixty healthy male Sprague-Dawley rats were divided randomly into an ANP group (ANP model + CTX, n = 20), treatment group (ANP model + CTX + CQCQD, n = 20) and control group (normal rats + CTX, n = 20). ANP models were induced by retrograde intraductal injection of 3.5% sodium taurocholate (1 mL/kg), and the control group was injected intraductally with normal saline. All rats were injected introperitoneally with 0.42 g/kg CTX (at 12-h intervals for a continuous 72 h) at 6 h after intraductal injection. Meanwhile, the treatment group received CQCQD (20 mL/kg) intragastrically at 8-h intervals, and the ANP and control group were treated intragastrically with normal saline. At 15 min after the last CTX injection, blood and pancreas samples were collected for the determination of CTX concentration using validated high-performance liquid chromatography. Pathological changes and wet-to-dry-weight (W/D) ratio of pancreatic tissue were examined.RESULTS: Serum CTX concentrations in three groups were not significantly different. Pancreatic CTXconcentration and penetration ratio were lower in ANP group vs control group (4.4 ±0.6 mg/mL vs 18.6±1.7 mg/mL, P = 0.000; 5% vs 19%, P = 0.000), but significantly higher in treatment group vs ANP group (6.4 ±1.7 mg/mL vs 4.4 ±0.6 mg/mL, P = 0.020; 7% vs 5%, P = 0.048). The histological scores and W/D ratio were significantly decreased in treatment group vs ANP and control group.CONCLUSION: CQCQD might have a promotive effect on CTX concentration in pancreatic tissues of rats with ANP.

  6. Laboratory risk indicators for acute necrotizing fasciitis in the emergency setting

    Institute of Scientific and Technical Information of China (English)

    Syed Shayan Ali; Fatimah Lateef

    2016-01-01

    Necrotizing fasciitis is a rare bacterial skin condition which forms a major diagnostic challenge and is associated with poor prognosis unless promptly treated. Initial clinical presentation is often misleading with characteristic features developing only late in the course of the disease. In this review, we discuss the applicability and usefulness of laboratory risk indicator for necrotizing fasciitis score in facilitating rapid diagnosis of necrotizing fasciitis in emergency department by differentiating it from other skin in-fections like cellulitis and abscesses. A high index of suspicion resulting from the lab-oratory risk indicator for necrotizing fasciitis score can facilitate early diagnosis enabling prompt antibiotic administration and timely referral to surgery for wound debridement, ultimately reducing both the morbidity and mortality.

  7. Laboratory risk indicators for acute necrotizing fasciitis in the emergency setting

    Directory of Open Access Journals (Sweden)

    Syed Shayan Ali

    2016-03-01

    Full Text Available Necrotizing fasciitis is a rare bacterial skin condition which forms a major diagnostic challenge and is associated with poor prognosis unless promptly treated. Initial clinical presentation is often misleading with characteristic features developing only late in the course of the disease. In this review, we discuss the applicability and usefulness of laboratory risk indicator for necrotizing fasciitis score in facilitating rapid diagnosis of necrotizing fasciitis in emergency department by differentiating it from other skin infections like cellulitis and abscesses. A high index of suspicion resulting from the laboratory risk indicator for necrotizing fasciitis score can facilitate early diagnosis enabling prompt antibiotic administration and timely referral to surgery for wound debridement, ultimately reducing both the morbidity and mortality.

  8. Pathogenesis of Hepatic Encephalopathy

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    Irena Ciećko-Michalska

    2012-01-01

    Full Text Available Hepatic encephalopathy can be a serious complication of acute liver failure and chronic liver diseases, predominantly liver cirrhosis. Hyperammonemia plays the most important role in the pathogenesis of hepatic encephalopathy. The brain-blood barrier disturbances, changes in neurotransmission, neuroinflammation, oxidative stress, GABA-ergic or benzodiazepine pathway abnormalities, manganese neurotoxicity, brain energetic disturbances, and brain blood flow abnormalities are considered to be involved in the development of hepatic encephalopathy. The influence of small intestine bacterial overgrowth (SIBO on the induction of minimal hepatic encephalopathy is recently emphasized. The aim of this paper is to present the current views on the pathogenesis of hepatic encephalopathy.

  9. Acute encephalopathy of the temporal lobes leading to m.3243A>G. When MELAS is not always MELAS.

    Science.gov (United States)

    Caldarazzo Ienco, Elena; Orsucci, Daniele; Simoncini, Costanza; Montano, Vincenzo; LoGerfo, Annalisa; Siciliano, Gabriele; Bonuccelli, Ubaldo; Mancuso, Michelangelo

    2016-09-01

    MELAS syndrome (mitochondrial encephalopathy with lactic acidosis and stroke-like episodes) is a rare genetic condition whose differential diagnosis is often posed with juvenile stroke, but more rarely even with inflammatory/infectious encephalitis, causing diagnostic challenges. Here we report the case of a young man harbouring the m.3243A>G MELAS mutation presenting an acute onset mimicking the clinical and neuroimaging features of infective encephalitis.

  10. Acute necrotizing eosinophilic myocarditis in a patient taking Garcinia cambogia extract successfully treated with high-dose corticosteroids.

    Science.gov (United States)

    Allen, Scott F; Godley, Robert W; Evron, Joshua M; Heider, Amer; Nicklas, John M; Thomas, Michael P

    2014-12-01

    A previously healthy 48-year-old woman was evaluated for lightheadedness and chest heaviness 2 weeks after starting the herbal supplement Garcinia cambogia. She was found to be hypotensive and had an elevated serum troponin level. The patient had a progressive clinical decline, ultimately experiencing fulminant heart failure and sustained ventricular arrhythmias, which required extracorporeal membrane oxygenation support. Endomyocardial biopsy results were consistent with acute necrotizing eosinophilic myocarditis (ANEM). High-dose corticosteroids were initiated promptly and her condition rapidly improved, with almost complete cardiac recovery 1 week later. In conclusion, we have described a case of ANEM associated with the use of Garcinia cambogia extract.

  11. Nuclear factor-kappaB activation on the reactive oxygen species in acute necrotizing pancreatitic rats

    Institute of Scientific and Technical Information of China (English)

    Jin Long; Na Song; Xi-Ping Liu; Ke-Jian Guo; Ren-Xuan Guo

    2005-01-01

    AIM: To investigate the potential role of nuclear factor kappa-B (NF-κB) activation on the reactive oxygen species in rat acute necrotizing pancreatitis (ANP) and to assess the effect of pyrrolidine dithiocarbamate (PDTC, an inhibitor of NF-κB).METHODS: Rat ANP model was established by retrograde injection of 5% sodium taurocholate into biliopancreatic duct. Rats were randomly assigned to three groups (10rats each): Control group, ANP group and PDTC group. At the 6th h of the model, the changes of the serum amylase,nitric oxide (NO), malondialdehyde (MDA), superoxide dismutase (SOD) and pancreatic morphological damage were observed. The expressions of inducible nitric oxide (iNOS) were observed by SP immunohistochemistry. And the expressions of NF-κB p65 subunit mRNA were observed by hybridization in situ.RESULTS: Serum amylase and NO level decreased significantly in ANP group as compared with PDTC administrated group [(7 170.40±1 308.63) U/L vs(4 074.10±1 719.78) U/L,P<0.05], [(76.95±9.04) μmol/L vs (65.18±9.02) μmol/L,P<0.05] respectively. MDA in both ANP and PDTC group rose significantly over that in control group [(9.88±1.52)nmol/L, (8.60±1.41) nmol/L, vs (6.04±1.78) nmol/L,P<0.05], while there was no significant difference between them. SOD levels in both ANP and PDTC group underwent a significant decrease as compared with that in control [(3 214.59±297.74) NU/mL, (3 260.62±229.44) NU/mL,vs (3 977.80±309.09) NU/mL, P<0.05], but there was no significant difference between them. Though they were still higher than those in Control group, pancreas destruction was slighter in PDTC group, iNOS expression and NF-κB p65 subunit mRNA expression were lower in PDTC group as compared with ANP group.CONCLUSION: We conclude that correlation among NF-κB activation, serum amylase, reactive oxygen species level and tissue damage suggests a key role of NF-κB in the pathogenesis of ANP. Inhibition of NF-κB activation may reverse the pancreatic damage

  12. Preventive effect of tetramethylpyrazine on intestinal mucosal injury in rats with acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jian-Xin Zhang; Sheng-Chun Dang; Jian-Guo Qu; Xue-Qing wang

    2006-01-01

    AIM: To evaluate the role of microcirculatory disorder(MCD) and the therapeutic effectivenessof tetramethylpyrazine (TMP) on intestinal mucosa injury in rats with acute necrotizing pancreatitis (ANP).METHODS: A total of 192 Sprague-Dawley rats were randomly divided into three groups: normal control group (C group), ANP group not treated with TMP (Pgroup), ANP group treated with TMP (T group). An ANP model was induced by injection of 50 g/L sodium taurocholate under the pancreatic membrane (4 mL/kg).C group received isovolumetric injection of 9 g/L physiological saline solution using the same method. T group received injection of TMP (10 mL/kg) via portal vein. Radioactive biomicrosphere technique was used to measure the blood flow at 0.5, 2, 6 and 12 h after the induction of ANP. Samples of pancreas, distal ileum were collected to observe pathological changes using a validated histology score. Intestinal tissues were also used for examination of myeloperoxidase (MPO) expressed intracellularly in azurophilic granules of neutrophils.RESULTS: The blood flow was significantly lower in P group than in C group (P < 0.01). The pathological changes were aggravated significantly in P group. The longer the time, the severer the pathological changes.The intestinal MPO activities were significantly higher in P group than in C group (P < 0.01). The blood flow of intestine was significantly higher in T group than in P group after 2 h (P < 0.01). The pathological changes were alleviated significantly in T group. MPO activities were significantly lower in T group than in P group (P <0.01 or P < 0.05). There was a negative correlation between intestinal blood flow and MPO activity (r = -0.981,P < 0.01) as well as between intestinal blood flow and pathologic scores (r = -0.922, P < 0.05).CONCLUSION: MCD is an important factor for intestinal injury in ANP. TMP can ameliorate the condition of MCD and the damage to pancreas and intestine.

  13. [A case of paroxysmal sympathetic storm after acute disseminated encephalomyelitis and hypoxic encephalopathy responding to clonidine hydrochloride].

    Science.gov (United States)

    Shimmura, Mitsunori; Kawamura, Nobutoshi; Tateishi, Takahisa; Shigeto, Hiroshi; Murai, Hiroyuki; Kira, Jun-Ichi

    2016-01-01

    We report the case of a 17-year-old woman with paroxysmal sympathetic storm (PSS), which was successfully treated with clonidine hydrochloride. The patient was hospitalized for acute disseminated encephalomyelitis in June 2006. Dysphagia led to severe aspiration pneumonia in September 2006, and she suffered cardiopulmonary arrest. She survived but had severe brain damage, with her brain MRI showing diffuse hypoxic encephalopathy. From October 2006, she had several episodes of profound tachypnea (> 60/min), tachycardia (160 to 170 beats/min), hypertension (> 140 mmHg), hyperthermia (39°C), and decerebrate posturing. During the attacks, the levels of catecholamines in the patient's blood and urine were markedly elevated. Accordingly, a diagnosis of PSS associated with hypoxic encephalopathy was made. Her PSS clearly improved after the administration of clonidine hydrochloride (900 μg/day). This case suggests that clonidine hydrochloride, an α2 blocker, may be one therapeutic option for PSS.

  14. Acute necrotising encephalopathy in a child with H1N1 influenza infection: a clinicoradiological diagnosis and follow-up.

    Science.gov (United States)

    Yoganathan, Sangeetha; Sudhakar, Sniya Valsa; James, Ebor Jacob; Thomas, Maya Mary

    2016-01-11

    Acute necrotising encephalopathy of childhood (ANEC) is a fulminant disorder with rapid progressive encephalopathy, seizures and poor outcome. It has been reported in association with various viral infections. We describe the clinicoradiological findings and short-term follow-up in a child with H1N1 influenza-associated ANEC. Laminar, target or tricolour pattern of involvement of the thalami was seen on apparent diffusion coefficient images. Our patient had significant morbidity at discharge despite early diagnosis and management with oseltamivir and immunoglobulin. Repeat imaging after 3 months had shown significant resolution of thalamic swelling, but there was persistence of cytotoxic oedema involving bilateral thalami. She was pulsed with intravenous steroids and maintained on a tapering schedule of oral steroids. This report emphasises the need for a high index of suspicion to establish early diagnosis, promotion of widespread immunisation strategies to prevent influenza outbreak, and more research to establish standard treatment protocols for this under-recognised entity.

  15. Acute urinary retention in a 23-year-old woman with mild encephalopathy with a reversible splenial lesion: a case report

    Directory of Open Access Journals (Sweden)

    Isobe Hideyuki

    2011-04-01

    Full Text Available Abstract Introduction Patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion present with relatively mild central nervous system disturbances. Although the exact etiology of the condition remains poorly understood, it is thought to be associated with infective agents. We present a case of a patient with mild encephalitis/encephalopathy with a reversible splenial lesion, who had the unusual feature of acute urinary retention. Case presentation A 23-year-old Japanese woman developed mild confusion, gait ataxia, and urinary retention seven days after onset of fever and headache. Magnetic resonance imaging demonstrated T2 prolongation in the splenium of the corpus callosum and bilateral cerebral white matter. These magnetic resonance imaging abnormalities disappeared two weeks later, and all of the symptoms resolved completely within four weeks. Except for the presence of acute urinary retention (due to underactive detrusor without hyper-reflexia, the clinical and radiologic features of our patient were consistent with those of previously reported patients with mild encephalitis/encephalopathy with a reversible splenial lesion. To the best of our knowledge, this is the first report of acute urinary retention recognized in a patient with mild encephalitis/encephalopathy with a reversible splenial lesion. Conclusion Our findings suggest that mild encephalitis/encephalopathy with a reversible splenial lesion can be associated with impaired bladder function and indicate that acute urinary retention in this benign disorder should be treated immediately to avoid bladder injury.

  16. Acute hypertensive encephalopathy with widespread small-vessel disease at MRI in a diabetic patient: pathogenetic hypotheses

    Energy Technology Data Exchange (ETDEWEB)

    Cotton, F. [Centre Hospitalier Lyon Sud, Department of Radiology, Pierre Benite (France); Universite Claude-Bernard Lyon-I, CREATIS, UMR CNRS (France); Universite Claude-Bernard Lyon-I, Laboratoire d' Anatomie, Laennec (France); Kamoun, S.; Rety-Jacob, F.; Tran-Minh, V.A. [Centre Hospitalier Lyon Sud, Department of Radiology, Pierre Benite (France); Nighoghossian, N. [Hopital Neurologique et Neurochirurgical, Department of Neurology, Bron (France); Universite Claude-Bernard Lyon-I, CREATIS, UMR CNRS (France); Hermier, M. [Hopital Neurologique et Neurochirurgical, Department of Neuroradiology and MRI, Bron (France); Universite Claude-Bernard Lyon-I, CREATIS, UMR CNRS (France)

    2005-08-01

    We report unusual magnetic resonance imaging (MRI) findings in a diabetic patient with neglected hypertension and hyperglycemia, presenting with seizures and coma. Outcome was fatal despite intensive care. The MRI findings included bilateral insular and temporo-occipital grey and white matter involvement, and numerous, scattered, lacunar-like lesions involving the peripheral and deep white matter, basal ganglia grey matter, and brainstem. Lesions had a low apparent diffusion coefficient, and some enhanced following contrast injection. Hypertensive encephalopathy with widespread and severe acute small-vessel disease was considered. Pathophysiology is discussed. (orig.)

  17. Effects of human interleukin 10 gene transfer on the expression of Bcl-2 Bax and apoptosis of hepatocyte in rats with acute hemorrhagic necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    GU Jun-chao; WANG Yu; ZHANG Zhong-tao; XUE Jian-guo; LI Jian-she; ZHOU Yan-zhong

    2005-01-01

    @@ Acute necrotising pancreatitis is characterized by inflammatory and necrotic events, which follow the initial intra-acinar injury involving enzyme activation, and disruption of the acinar cytoskeleton.1 At present, apoptosis has become a hot topic in many kinds of disease.

  18. Necrotizing enterocolitis

    Science.gov (United States)

    ... please enable JavaScript. Necrotizing enterocolitis (NEC) is the death of tissue in the intestine. It occurs most often in premature or sick babies. Causes Necrotizing enterocolitis occurs when the lining of the ...

  19. Current pathogenetic aspects of hepatic encephalopathy and noncirrhotic hyperammonemic encephalopathy.

    Science.gov (United States)

    Cichoż-Lach, Halina; Michalak, Agata

    2013-01-07

    Hepatic encephalopathy is a medical phenomenon that is described as a neuropsychiatric manifestation of chronic or acute liver disease that is characterized by psychomotor, intellectual and cognitive abnormalities with emotional/affective and behavioral disturbances. This article focuses on the underlying mechanisms of the condition and the differences between hepatic encephalopathy and noncirrhotic hyperammonemic encephalopathy. Hepatic encephalopathy is a serious condition that can cause neurological death with brain edema and intracranial hypertension. It is assumed that approximately 60%-80% of patients with liver cirrhosis develop hepatic encephalopathy. This review explores the complex mechanisms that lead to hepatic encephalopathy. However, noncirrhotic hyperammonemic encephalopathy is not associated with hepatic diseases and has a completely different etiology. Noncirrhotic hyperammonemic encephalopathy is a severe occurrence that is connected with multiple pathogeneses.

  20. Nitric oxide mediates effects of acute, not chronic, naltrexone on LPS-induced hepatic encephalopathy in cirrhotic rats.

    Science.gov (United States)

    Ghiassy, Bentolhoda; Rahimi, Nastaran; Javadi-Paydar, Mehrak; Gharedaghi, Mohammad Hadi; Norouzi-Javidan, Abbas; Dehpour, Ahmad R

    2017-01-01

    Recent studies suggest endogenous opioids and nitric oxide (NO) are involved in the pathophysiology of hepatic encephalopathy (HE). In this study, the interaction between the opioid receptor antagonist and NO was investigated on lipopolysaccharide (LPS)-induced HE in cirrhotic rats. Male rats were divided in the sham- and bile duct ligation (BDL)-operated groups. Animals were treated with saline; naltrexone (10 mg/kg, i.p.); or L-NAME (3 mg/kg, i.p.), alone or in combination with naltrexone. To induce HE, LPS (1 mg/kg, i.p.) was injected 1 h after the final drug treatment. HE scoring, hepatic histology, and plasma NO metabolites levels and mortality rate were recorded. Deteriorated level of consciousness and mortality after LPS administration significantly ameliorated following both acute and chronic treatment with naltrexone in cirrhotic rats. However, acute and chronic administration of L-NAME did not change HE scores in cirrhotic rats. The effects of acute but not chronic treatment of naltrexone on HE parameters were reversed by L-NAME. Plasma NOx concentrations elevated in BDL rats, which were decreased after acute and chronic treatment by naltrexone or L-NAME, significantly. We suggest both acute and chronic treatment with naltrexone improved LPS-induced HE. But, only acute treatment with naltrexone may affect through NO pathway.

  1. Posterior reversible encephalopathy syndrome (PRES, an acute neurological syndrome due to reversible multifactorial brain edema: a case report

    Directory of Open Access Journals (Sweden)

    Camilla Cicognani

    2013-04-01

    Full Text Available Background: The essential features of Posterior Reversible Encephalopathy Syndrome (PRES are headache, mental changes, seizures, visual symptoms and often arterial hypertension. Brain RMN typically shows cortico-sottocortical parieto-occipital edema, with a bilateral and symmetric distribution. PRES develops in clinical conditions as hypertensive encephalopathy, preeclampsia/ eclampsia, autoimmune diseases, after transplantation, infections and as an adverse effect of immunosuppressive drugs or chemotherapy. It usually completely reverses with treatment, although permanent sequelae are possible in case of delayed or missed diagnosis. Case report: We describe the case of a transsexual (M!F and tetraplegic patient, admitted for neck and low back pain. She suddenly developed headache, confusion, seizures and severe hypertension with normal blood tests. RMN showed multiple cortico-sottocortical areas of vasogenic and citotoxic edema in temporo-occipital, parietal, frontal, and cerebellar regions. Soon after the beginning of the antihypertensive therapy, clinical recovery was observed, as well as the disappearance of edema at RMN. Discussion and conclusions: Although PRES is usually associated with definite pathological conditions, it is not always the case, as was for the patient here described, who had no predisposing factors in her past clinical history, and presented hypertension only in the acute phase of the syndrome. Since, moreover, PRES usually presents with acute non specific features and it can be misdiagnosed with other serious diseases, the clinician will be helped by the knowledge of this syndrome to promptly start diagnostic workup and treatments, and avoid permanent neurological deficits.

  2. Acute cervicofacial necrotizing fasciitis: three clinical cases and a review of the current literature.

    Science.gov (United States)

    Bilodeau, Elizabeth; Parashar, Vijay P; Yeung, Allison; Potluri, Anitha

    2012-01-01

    Cervicofacial necrotizing fasciitis (NF) is a rare condition that can quickly become life-threatening if appropriate treatment is delayed. This condition is observed as a rapidly progressive infection that causes extensive necrosis of the superficial fascia. This report presents a case of cervicofacial NF with microbiological isolation of methicillin-resistant Staphylococcus aureus in a patient with a history of uncontrolled diabetes mellitus following a minor scalp trauma. The article also presents two cases of NF secondary to odontogenic infection. The radiographic finding of the presence of gas locules in the facial planes on the CT scan helped to confirm the diagnosis. Patients were treated with broad-spectrum antibiotic therapy, extensive surgical drainage, debridement, and supportive care. Awareness in the dental community of the signs of NF will facilitate optimal patient management.

  3. Rapid detection of sepsis complicating acute necrotizing pancreatitis using polymerase chain reaction

    Institute of Scientific and Technical Information of China (English)

    Wei Zhong Zhang; Tian Quan Han; Yao Qing Tang; Sheng Dao Zhang

    2001-01-01

    @@INTRODUCTION Acute narcotizing pancreatitis usually takes a severe clinical course and is associated with multiple organ dysfunction .With the further understanding of pathophysiological events of acute pancreatisis and the therapeutic measuses taken by the clinicians ,the patients can pass through the critical carry stages ,and then the septic complication caused by rtanslocated bacteria, mostly gram-negative microbes from the intestines ensues[1].

  4. Research progress on delayed encephalopathy after acute carbon monoxide poisoning%急性一氧化碳中毒迟发性脑病研究进展

    Institute of Scientific and Technical Information of China (English)

    葛桂荣

    2010-01-01

    @@ 急性一氧化碳(CO)中毒迟发性脑病(Delayed encephalopathy after acute canbon monoxide poisoning,DEACMP)系指急性CO中毒(Acute carbon monoxide poisoning,ACOP)患者经抢救,中毒症状缓解或消失2~30 d后,再度出现的神经精神症状.

  5. Impetigo presenting as an acute necrotizing swelling of the lower lip in an adult patient.

    Science.gov (United States)

    Ghafoor, Mohammed; Halsnad, Moorthy; Fowell, Christopher; Millar, Brian G

    2012-06-01

    The authors present an unusual case of an acute swelling of the lower lip and septicemia in a 35-year-old, recent immigrant male arriving from India. The patient presented in our emergency department with a 48-hour history of a worsening, painful swelling of the lower lip. On presentation, he was pyrexial and the lip was found to be acutely inflamed with honey-colored crusting, pustular lesions, and induration . A diagnosis of impetigo leading to necrosis of the lip was established, a rare phenomenon potentially resulting in significant tissue destruction. Appropriate medical management achieved a good outcome and prevented disabling tissue loss of the orofacial region.

  6. Diphtheria, pertussis (whooping cough, and tetanus vaccine induced recurrent seizures and acute encephalopathy in a pediatric patient: Possibly due to pertussis fraction

    Directory of Open Access Journals (Sweden)

    Mahendra K Patel

    2012-01-01

    Full Text Available A 5-month-old male patient developed recurrent seizures and acute encephalopathy possibly due to first dose of diphtheria, pertussis (whooping cough, and tetanus (DPT vaccine used for routine immunization. Postreaction computed tomography (CT scan of brain, magnetic resonance imaging (MRI of brain, and electroencephalogram were normal. Pertussis fraction of DPT vaccine is responsible for this reaction. It is suggested that acellular pertussis vaccine should be used instead of whole cell vaccine because it is associated with lower frequency of neurological complications, such as seizures, encephalopathy, and hypotensive episodes. However, acellular pertussis-containing vaccines are currently not affordable in most developing countries.

  7. Gastrodin protects neonatal rat brain against hypoxic-ischemic encephalopathy Acute therapeutic drug effects

    Institute of Scientific and Technical Information of China (English)

    Yanjun Niu; Zhengyong Jin

    2008-01-01

    BACKGROUND:Pharmacological experiments have demonstrated that gastrodin has a protective effect on neonatal rat brain subjected to hypoxia-ischemia; however,the underlying mechanism has not been fully elucidated. OBJECTIVE:The aim of this study was to investigate the acute therapeutic effects of gastrodin by observing prostaglandin B2 and 6-keto-prostaglandin F 1 a in brain issue of neonatal rats that received gastrodin injections immediately after hypoxia-ischemia.DESIGN:Single-factor design.SETTING:Department of Pediatrics,Affiliated Hospital of Yanbian University. MATERIALS:This study was performed in the Laboratory of the Department of Pediatrics,Affiliated Hospital of Yanbian University(key laboratory of provincial Health Department)from April to December 2003.Fifty-five Wistar rats of either gender,aged 7 days,were provided by the Laboratory Animal Center of Affiliated Hospital of Yanbian University.The rats were randomly divided into normal control(n=10), model(n=15),gastrodin-treated(n=15),and Danshen-treated(n=15)groups.The protocol was performed in accordance with guidelines from the Institute of Health Sciences for the use and care of animals.The following reagents were.used:Gastrodin(Sancai Medicine Group Co.,Ltd.,Zhongshan,Guangdong Province,China;component:gastrodin),Danshen(Conba Stock Company,Jinhua,Zhengjiang Province,China; component:salvia miltiorrhiza),and reagent kits for 125I-prostaglandin B2 and 125I-6-prostaglandin F 1 a (Research and Development Center for Science and Technology,General Hospital of Chinese PLA). METHODS:Rats in the normal control group received no treatment.Rats in the remaining 3 groups were anesthetized,followed by ligation of the left common carotid artery.One hour later,the rats were placed in a closed hypoxic box and allowed to inhale 8% oxygen-air(2.0-3.0 L/min)for 2 hours to develop hypoxic-ischemic encephalopathy.Immediately after lesion,rats in the gastrodin and Danshen-treated groups were intraperitoneally

  8. Hashimoto’s encephalopathy presenting with acute confusional state in a patient with hypothyroidism

    OpenAIRE

    Naglaa Fathy Barseem; Mohamed Ahmed Helwa

    2015-01-01

    Hashimoto’s encephalopathy is a neurological disorder of unknown etiology associated with thyroid autoimmunity. The disease may present as two types, a sudden vasculitic type or a progressive subacute type associated with cognitive dysfunction, confusion and memory loss. We report a case of a 6 year old previously healthy Egyptian female , who developed a subacute onset of declining upper brain function. Serologic studies demonstrated high levels of antithyroid antibodies. Electroencephalo...

  9. Describing computed tomography findings in acute necrotizing pancreatitis with the Atlanta classification - an interobserver agreement study

    NARCIS (Netherlands)

    Besselink, Marc G. H.; van Santvoort, Hjalmar C.; Bollen, Thomas L.; van Leeuwen, Maarten S.; Lameris, Johan S.; van der Jagt, Eric J.; Strijk, Simon P.; Buskens, Erik; Freeny, Patrick C.; Gooszen, Hein G.

    2006-01-01

    Objectives: The 1992 Atlanta classification is a clinically based classification system that defines the severity and complications of acute pancreatitis. A study was under taken to assess the interobserver agreement of categorizing peripancreatic collections on computed tomography (CT) using the At

  10. Modification in CSF specific gravity in acutely decompensated cirrhosis and acute on chronic liver failure independent of encephalopathy, evidences for an early blood-CSF barrier dysfunction in cirrhosis.

    Science.gov (United States)

    Weiss, Nicolas; Rosselli, Matteo; Mouri, Sarah; Galanaud, Damien; Puybasset, Louis; Agarwal, Banwari; Thabut, Dominique; Jalan, Rajiv

    2017-04-01

    Although hepatic encephalopathy (HE) on the background of acute on chronic liver failure (ACLF) is associated with high mortality rates, it is unknown whether this is due to increased blood-brain barrier permeability. Specific gravity of cerebrospinal fluid measured by CT is able to estimate blood-cerebrospinal fluid-barrier permeability. This study aimed to assess cerebrospinal fluid specific gravity in acutely decompensated cirrhosis and to compare it in patients with or without ACLF and with or without hepatic encephalopathy. We identified all the patients admitted for acute decompensation of cirrhosis who underwent a brain CT-scan. Those patients could present acute decompensation with or without ACLF. The presence of hepatic encephalopathy was noted. They were compared to a group of stable cirrhotic patients and healthy controls. Quantitative brain CT analysis used the Brainview software that gives the weight, the volume and the specific gravity of each determined brain regions. Results are given as median and interquartile ranges and as relative variation compared to the control/baseline group. 36 patients presented an acute decompensation of cirrhosis. Among them, 25 presented with ACLF and 11 without ACLF; 20 presented with hepatic encephalopathy grade ≥ 2. They were compared to 31 stable cirrhosis patients and 61 healthy controls. Cirrhotic patients had increased cerebrospinal fluid specific gravity (CSF-SG) compared to healthy controls (+0.4 %, p gravity did not differ between different brain regions according to the presence or absence of either ACLF or HE. In patients with acute decompensation of cirrhosis, and those with ACLF, CSF specific gravity is modified compared to both stable cirrhotic patients and healthy controls. This pattern is observed even in the absence of hepatic encephalopathy suggesting that blood-CSF barrier impairment is manifest even in absence of overt hepatic encephalopathy.

  11. Low Cerebral Oxygen Consumption and Blood Flow in Patients With Cirrhosis and an Acute Episode of Hepatic Encephalopathy

    DEFF Research Database (Denmark)

    Iversen, Peter; Bak, Lasse Kristoffer; Waagepetersen, Helle Sønderby

    2009-01-01

    BACKGROUND & AIMS: It is unclear whether patients with hepatic encephalopathy (HE) have disturbed brain oxygen metabolism and blood flow. METHODS: We measured cerebral oxygen metabolism rate (CMRO(2)) by using (15)O-oxygen positron emission tomography (PET), and cerebral blood flow (CBF) by using....../min in patients with HE, 0.47 +/- 0.02 in patients without HE, and 0.49 +/- 0.03 in healthy subjects. CMRO(2) and CBF were correlated, and both variables correlated negatively with arterial ammonia concentration. Analysis of regional values, using individual magnetic resonance co-registrations, showed...... that the reductions in CMRO(2) and CBF in patients with HE were essentially generalized throughout the brain. CONCLUSIONS: The observations imply that reduced cerebral oxygen consumption and blood flow in cirrhotic patients with an acute episode of overt HE are associated with HE and not cirrhosis as such...

  12. Necrotizing meningoencephalitis of Pug dogs associates with dog leukocyte antigen class II and resembles acute variant forms of multiple sclerosis.

    Science.gov (United States)

    Greer, K A; Wong, A K; Liu, H; Famula, T R; Pedersen, N C; Ruhe, A; Wallace, M; Neff, M W

    2010-08-01

    Necrotizing meningoencephalitis (NME) is a disorder of Pug Dogs that appears to have an immune etiology and high heritability based on population studies. The present study was undertaken to identify a genetic basis for the disease. A genome-wide association scan with single tandem repeat (STR) markers showed a single strong association near the dog leukocyte antigen (DLA) complex on CFA12. Fine resolution mapping with 27 STR markers on CFA12 further narrowed association to the region containing DLA-DRB1, -DQA1 and, -DQB1 genes. Sequencing confirmed that affected dogs were more likely to be homozygous for specific alleles at each locus and that these alleles were linked, forming a single high risk haplotype. The strong DLA class II association of NME in Pug Dogs resembles that of human multiple sclerosis (MS). Like MS, NME appears to have an autoimmune basis, involves genetic and nongenetic factors, has a relatively low incidence, is more frequent in females than males, and is associated with a vascularly orientated nonsuppurative inflammation. However, NME of Pug Dogs is more aggressive in disease course than classical human MS, appears to be relatively earlier in onset, and involves necrosis rather than demyelination as the central pathobiologic feature. Thus, Pug Dog encephalitis (PDE) shares clinical features with the less common acute variant forms of MS. Accordingly, NME of Pug Dogs may represent a naturally occurring canine model of certain idiopathic inflammatory disorders of the human central nervous system.

  13. 小儿急性坏死性胰腺炎的外科处理%Surgical Treatment of Acute Necrotizing Pancreatitis in Children

    Institute of Scientific and Technical Information of China (English)

    宋连城; 夏毓华; 龚代贤; 郭伟文; 张圣道

    1986-01-01

    @@ 小儿急性坏死性胰腺炎是一种少见疾病(1),我院小儿外科近几年收治了2例重型患儿,经过积极手术治疗,均获痊愈.%Two children with acute necrotizing pancreatitis were treated by aggressive surgical intervention,and survived.The sequelae of this condition are also outlined.It is concluded that acute necrotizing pancreatitis should be considered when a child complains of upper abdominal pain,bloody ascites,acute onset and signs of peritoneal irritability.The serum and urine amylase determination should be imminent,wh1ch is helpful in confirming the diagnosis and lend to earlier surgical intervend tion.Once exploratory laporotomy has ruled out the biliary diseaseas as the original cause,wide debridement of the necrotic gland tissue and removal of the adjacent abscess and external drainage are indicated.Gastrotomy and cholecystomy for decompression and jejunostomy for early tube feeding are necessary.After one week,re-debridement through the patient's wound is recommended.

  14. A rare case of acute poster ior reversible encephalopathy syndrome involving brainstem in a child

    Directory of Open Access Journals (Sweden)

    Olfa Chakroun-Walha

    2016-11-01

    Full Text Available Posterior reversible encephalopathy syndrome (PRES is a rare entity involving brainstem in very rare reported cases. We describe here the case of a boy who presented to the emergency department for headaches and strabismus. Diagnosis of PRES was retained by magnetic resonance imaging. The causes were blood pressure urgency and renal failure. Location of lesions was very rarely reported in literature and neurological troubles were persistent. Emergency physicians should evocate PRES each time there is a clinical context associated with neurological troubles by a normal brain CT scan. Early diagnosis is very important to treat its causes and improve prognosis.

  15. A rare case of acute posterior reversible encephalopathy syndrome involving brainstem in a child

    Institute of Scientific and Technical Information of China (English)

    Olfa Chakroun-Walha; Ichrak Bacha; Mehdi Frikha; Kheireddine Ben Mahfoudh; Noureddine Rekik

    2016-01-01

    Posterior reversible encephalopathy syndrome (PRES) is a rare entity involving brainstem in very rare reported cases. We describe here the case of a boy who presented to the emergency department for headaches and strabismus. Diagnosis of PRES was retained by magnetic resonance imaging. The causes were blood pressure urgency and renal failure. Location of lesions was very rarely reported in literature and neurological troubles were persistent. Emergency physicians should evocate PRES each time there is a clinical context associated with neurological troubles by a normal brain CT scan. Early diagnosis is very important to treat its causes and improve prognosis.

  16. Insulin is necessary for the hypertrophic effect of cholecystokinin-octapeptide following acute necrotizing experimental pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Péter Hegyi; Zoltán Rakonczay Jr; Réka Sári; László Czakó; Norbert Farkas; Csaba Góg; József Németh; János Lonovics; Tamás Takács

    2004-01-01

    AIM: In previous experiments we have demonstrated that by administering low doses of cholecystokinin-octapeptide (CCK-8), the process of regeneration following L-arginine (Arg)-induced pancreatitis is accelerated. In rats that were also diabetic (induced by streptozotocin, STZ), pancreatic regeneration was not observed. The aim of this study was to deduce whether the administration of exogenous insulin could in fact restore the hypertrophic effect of CCK-8 in diabetic-pancreatitic rats.METHODS: Male Wistar rats were used for the experiments.Diabetes mellitus was induced by administering 60 mg/kg body mass of STZ intraperitoneally (i.p.), then, on d 8,pancreatitis was induced by 200 mg/100 g body mass Arg i.p. twice at an interval of 1 h. The animals were injected subcutaneously twice daily (at 7 a.m. and 7 p.m.) with 1 μg/kg of CCK-8 and/or 2 IU mixed insulin (300 g/L shortaction and 700 g/L intermediate-action insulin) for 14 d after pancreatitis induction. Following this the animals were killed and the serum amylase, glucose and insulin levels as well as the plasma glucagon levels, the pancreatic mass/body mass ratio (pm/bm), the pancreatic contents of DNA, protein, amylase, lipase and trypsinogen were measured. Pancreatic tissue samples were examined by light microscopy on paraffin-embedded sections.RESULTS: In the diabetic-pancreatitic rats treatment with insulin and CCK-8 significantly elevated pw/bm and the pancreatic contents of protein, amylase and lipase vs the rats receiving only CCK-8 treatment. CCK-8 administered in combination with insulin also elevated the number of acinar cells with mitotic activities, whereas CCK-8 alone had no effect on laboratory parameters or the mitotic activities in diabetic-pancreatitic rats.CONCLUSION: Despite the hypertrophic effect of CCK-8 being absent following acute pancreatitis in diabetic-rats,the simultaneous administration of exogenous insulin restored this effect. Our results clearly demonstrate that insulin is

  17. Acute necrotizing colitis with pneumatosis intestinalis in an Amazonian manatee calf.

    Science.gov (United States)

    Guerra Neto, Guilherme; Galvão Bueno, Marina; Silveira Silva, Rodrigo Otavio; Faria Lobato, Francisco Carlos; Plácido Guimarães, Juliana; Bossart, Gregory D; Marmontel, Miriam

    2016-08-09

    On 25 January 2014, a 1 mo old female Amazonian manatee Trichechus inunguis calf weighing 12 kg was rescued by air transport in Guajará, Brazil, and transferred to Mamirauá Institute's Community-based Amazonian Manatee Rehabilitation Center. The calf presented piercing/cutting lesions on the back, neck, and head, in addition to dehydration and intermittent involuntary buoyancy. X-ray analysis revealed a large amount of gases in the gastrointestinal tract. Daily procedures included wound cleaning and dressing, clinical and laboratory monitoring, treatment for intestinal tympanism, and artificial feeding. Adaptation to the nursing formula included 2 kinds of whole milk. Up to 20 d post-rescue the calf presented appetite, was active, and gained weight progressively. Past this period the calf started losing weight and presented constant involuntary buoyancy and died after 41 d in rehabilitation. The major findings at necropsy were pneumatosis intestinalis in cecum and colon, pulmonary edema, and hepatomegaly. The microscopic examination revealed pyogranulomatous and necrohemohrragic colitis with multinucleated giant cells, acute multifocal lymphadenitis with lymphoid depletion in cortical and paramedullary regions of mesenteric lymph nodes, and diffuse severe acinar atrophy of the pancreas. Anaerobic cultures of fragments of cecum and colon revealed colonies genotyped as Clostridium perfringens type A. We speculate that compromised immunity, thermoregulatory failure, and intolerance to artificial diet may have been contributing factors to the infection, leading to enterotoxemia and death.

  18. Necrotizing Fasciitis

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    Jagdish Sadasivan

    2013-01-01

    Full Text Available Necrotizing fasciitis (NF is among the most challenging surgical infections faced by a surgeon. The difficulty in managing this entity is due to a combination of difficulty in diagnosis, and also of early as well as late management. For the patient, such a diagnosis means prolonged hospital stay, painful dressings, an extended recovery, and in some unfortunate cases even loss of limb or life. Necrotizing fasciitis is a fairly common condition in surgical practice in the Indian context resulting in a fairly large body of clinical experience. This article reviews literature on MEDLINE with the key words ′′necrotizing,′′ ′′fasciitis,′′ and ′′necrotizing infections′′ from 1970, as well as from articles cross referenced therein. The authors attempt to draw comparisons to their own experience in managing this condition to give an Indian perspective to the condition.

  19. [A young patient of acute encephalitis complicated with acyclovir encephalopathy without renal dysfunction].

    Science.gov (United States)

    Tomori, Koji; Isozumi, Kazuo; Motohashi, Sachiko; Komatsumoto, Satoru; Fukuuchi, Yasuo

    2003-08-01

    A previously healthy 30-year-old woman was admitted to our hospital because of impaired consciousness after convulsion. A temporary diagnosis of herpes simplex encephalitis was made, and intravenous acyclovir (ACV) therapy (250 mg four times daily in normal saline over 2 hours) was started. Three days later, she became confused, and was having hallucinations, dysarthria and generalized painful seizures occurred without focal neurologic deficit. Whether the neuropsychiatric symptoms were related to herpes simplex encephalitis or acyclovir neurotoxity was initially unclear. The brain MRI and lumbar puncture findings were initially normal, but abnormal FLAIR lesions appeared later. ACV-associated encephalopathy was considered. ACV was discontinued, and she recovered from the neurological disorder within 24 hours. Although blood levels of acyclovir were not determined, it is unlikely that they were in a toxic range, in view of her normal renal function.

  20. Isolated acute non-cystic white matter injury in term infants presenting with neonatal encephalopathy.

    LENUS (Irish Health Repository)

    Barrett, Michael Joseph

    2013-03-01

    We discuss possible aetiological factors, MRI evolution of injury and neuro-developmental outcomes of neonatal encephalopathy (NE). Thirty-six consecutive infants diagnosed with NE were included. In this cohort, four infants (11%) were identified with injury predominantly in the deep white matter on MRI who were significantly of younger gestation, lower birthweight with higher Apgars at one and five minutes compared to controls. Placental high grade villitis of unknown aetiology (VUA) was identified in all four of these infants. Our hypothesis states VUA may induce white matter injury by causing a local inflammatory response and\\/or oxidative stress during the perinatal period. We underline the importance of continued close and systematic evaluation of all cases of NE, including examination of the placenta, in order to come to a better understanding of the clinical presentation, the patterns of brain injury and the underlying pathophysiological processes.

  1. Cervicofacial necrotizing fasciitis.

    Science.gov (United States)

    Hohlweg-Majert, Bettina; Weyer, Nils; Metzger, Marc C; Schön, Ralf

    2006-05-01

    Cervical necrotizing fasciitis is a fast spreading acute soft tissue inflammation. Death can occur within 12-24 h. Early identification and treatment is needed. We report the case of a 75 year old woman with diabetes and high cholesterol, adipositas who developed cervical necrotizing fasciitis of odotongenic origin with massive subcutaneous air collection and first sign of septicaemia. Surgical treatment with debridement and drainage in combination with intravenous broadbased antibiotics as well as daily irrigation of the wound with iodine solution (Betaisodona) and metronidazol (local antibiotic treatment) was performed. The patient recovered completely. Surgical debridement combined with broad-spectrum of antibiotics showed satisfying result for the management of cervical necrotizing fasciitis of dentogenous origin.

  2. Total Pancreatectomy and Islet Auto-Transplantation as Treatment for Ampullary Adenocarcinoma in the Setting of Pancreatic Ductal Disruption Secondary to Acute Necrotizing Pancreatitis. A Case Report

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    Uroghupatei P Iyegha

    2012-03-01

    Full Text Available Context Ampullary adenocarcinoma is the third most common periampullary malignancy. Obstruction of the main pancreatic duct is linked with an increased incidence of acute pancreatitis. Acute necrotizing pancreatitis leading to pancreatic duct disruption carries significant morbidity. When these conditions occur in combination, the treatment can be drastically limited as pancreaticoduodenectomy is not a viable option in the setting of friable ductal tissue, which precludes pancreatic ductal anastomosis and can lead to the complications of leak or stricture. Case report Our patient is a 72-year-old woman who developed pancreatic ductal disruption and splenic vein thrombosis as a result of acute necrotizing pancreatitis. Concurrently, she was found to have an ampullary adenoma with high-grade dysplasia. Her treatment options were limited, as she was neither a candidate for pancreaticoduodenectomy given the ductal disruption nor total pancreatectomy, which would render her a brittle diabetic. She was successfully treated with total pancreatectomy and islet auto-transplantation thereby resecting her ampullary lesion while both avoiding a pancreatic anastomosis and preserving pancreatic endocrine beta-cell function. Conclusion We report a case where total pancreatectomy and islet auto-transplantation can be considered as a viable option for treatment of ampullary lesions in a setting where standard surgical options are suboptimal.

  3. DNA pooling base genome-wide association study identifies variants at NRXN3 associated with delayed encephalopathy after acute carbon monoxide poisoning.

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    Wenqiang Li

    Full Text Available Delayed encephalopathy after acute carbon monoxide poisoning (DEACMP is more characteristic of anoxic encephalopathy than of other types of anoxia. Those who have the same poisoning degree and are of similar age and gender have a greater risk of getting DEACMP. This has made it clear that there are obvious personal differences. Genetic factors may play a very important role. The authors performed a genome-wide association study involving pooling of DNA obtained from 175 patients and 244 matched acute carbon monoxide poisoning without delayed encephalopathy controls. The Illumina HumanHap 660 Chip array was used for DNA pools. Allele frequencies of all SNPs were compared between delayed encephalopathy after acute carbon monoxide poisoning and control groups and ranked. A total of 123 SNPs gave an OR >1.4. Of these, 46 mapped in or close to known genes. Forty-eight SNPs located in 19 genes were associated with DEACMP after correction for 5% FDR in the genome-wide association of pooled DNA. Two SNPs (rs11845632 and rs2196447 locate in the Neurexin 3 gene were selected for individual genotyping in all samples and another cohort consisted of 234 and 271 controls. There were significant differences in the genotype and allele frequencies of rs11845632 and rs2196447 between the DEACMP group and controls group (all P-values <0.05. This study describes a positive association between Neurexin 3 and controls in the Han Chinese population, and provides genetic evidence to support the susceptibility of DEACMP, which may be the resulting interaction of environmental and genetic factors.

  4. MR Imaging Findings in Alcoholic and Nonalcoholic Acute Wernicke’s Encephalopathy: A Review

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    Gaetana Manzo

    2014-01-01

    Full Text Available Wernicke’s encephalopathy (WE is a severe neurological syndrome caused by thiamine (vitamin B1 deficiency and clinically characterized by the sudden onset of mental status changes, ocular abnormalities, and ataxia. Apart from chronic alcoholism, the most common cause of WE, a lot of other conditions causing malnutrition and decreasing thiamine absorption such as gastrointestinal surgical procedures and hyperemesis gravidarum must be considered as predisposing factors. Due to its low prevalence and clinical heterogeneity, WE is often misdiagnosed, leading to persistent dysfunctions and, in some cases, to death. Nowadays, MR imaging of the brain, showing T2 and FLAIR hyperintensities in typical (thalami, mammillary bodies, tectal plate, and periaqueductal area and atypical areas (cerebellum, cranial nerve nuclei, and cerebral cortex, is surely the most important and effective tool in the diagnostic assessment of WE. The aim of this paper is to propose a state of the art of the role of MR imaging in the early diagnosis of this complex disease.

  5. Development of case definitions for acute encephalopathy, encephalitis, and multiple sclerosis reports to the vaccine: Adverse Event Reporting System.

    Science.gov (United States)

    Ball, Robert; Halsey, Neal; Braun, M Miles; Moulton, Lawrence H; Gale, Arnold D; Rammohan, Kottil; Wiznitzer, Max; Johnson, Richard; Salive, Marcel E

    2002-08-01

    The Vaccine Adverse Event Reporting System (VAERS), administered by the FDA and CDC, is the U.S. system for surveillance of vaccine adverse events (AE). Acute encephalopathy age or =18 months (EO > or = 18), encephalitis (EI), and multiple sclerosis (MS) after vaccination have been reported to VAERS, but reports often contain insufficient information to validate diagnoses. Standardized case definitions would enhance the utility of VAERS reports for AE surveillance. We developed practical case definitions for classification of VAERS reports, and three neurologists independently applied the definitions to reports submitted in 1993. Inter-observer agreement was assessed, and non-concordant classifications were reviewed in a follow-up conference call. Reports of EO or = 18 (n = 20), EI (n = 15), and MS (n = 16) were classified as "definite" in 7% to 30% of the cases, while 26% to 51% of reports were thought to have insufficient information to make a classification. Agreement among reviewers was good to excellent, (kappa: 0.65 to 0.85) except for EO Elsevier Science Inc.

  6. Management of Hepatic Encephalopathy

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    G. Wright

    2011-01-01

    Full Text Available Hepatic encephalopathy (HE, the neuropsychiatric presentation of liver disease, is associated with high morbidity and mortality. Reduction of plasma ammonia remains the central therapeutic strategy, but there is a need for newer novel therapies. We discuss current evidence supporting the use of interventions for both the general management of chronic HE and that necessary for more acute and advanced disease.

  7. Diffusion-weighted MR imaging in acute Wernicke's encephalopathy associated with pseudomembranous colitis: a case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Hye On; Lee, Yong Chul; Park, Tai Hwan; Yoo, Seung Min; Lee, Hwa Yeon; Song, In Sup; Lee, Jong Beum; Kim, Kun Sang [Chung-Ang University Medical Center, Seoul (Korea, Republic of)

    2006-06-15

    Wernicke's encephalopathy is a common complication of thiamine deficiency among chronic alcoholics. However, there have been few reports about MR imaging findings, including the diffusion-weighted changes of this neurologic disorder, in nonalcoholic patients. We present here a rare case of acute Wernicke's encephalopathy that developed in a patient who received prolonged total parenteral nutrition for his pseudomembranous colitis. The MR imaging, including the diffusion-weighted imaging, was performed at the onset of disease and during follow-up. The diagnosis was made by the characteristic MR imaging findings and it was supported by the clinical features. The initial and follow-up MR imaging findings with diffusion-weighted imaging changes are described and correlated with the clinical status.

  8. NECROTIZING SIALOMETAPLASIA. CASE REPORT

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    A.I. Navazo Eguía

    2010-01-01

    Full Text Available Introduction: Necrotizing sialometaplasia (NSM is a benign lesion affecting the salivary glands mainly in the hard palate. It presents as an ulcer with irregular borders, slightly elevated and necrotic The differential diagnosis should include malignant neoplasms. Case Report: A 26-year-old woman sought medical advice for a painful 2 cm ulceration of the hard palate. She is carrying pierced tongue. The patient had a history of cigarette smoking, chronic anxiety disorder and bulimia,. Analytical normal (including HIV and syphilis serology. Histopathology: accessory gland with squamous metaplasia, pseudoepitheliomatous hyperplasia and conservation lobulararchitecture. She had an important improvement with total resolution of the lesion in 4 months Discussion: The NSM is a necrotizing inflammatory process. It presents as an ulcer located in the posterior hard palate or the junction between the hard and soft palate. This situation has been associated with local ischemia as surgical trauma, thromboangiitis obliterans, dentures, alcohol, snuff, cocaine, and certain malignancies such as lymphomas, rhabdomyosarcoma or Warthin tumor. Currently associated withbulimia, it being necessary suspected in young women. It is important to rule out neoplasms and infectious processes (tuberculosis or syphilis. Also consider subacute necrotizing sialadenitis, nonspecific acute inflammatory process of unknown cause, with focal necrosis without hyperplasia or ductal metaplasia pseudoepitheliomatous. Treatment is symptomatic and usually resolves in 2-3 months. Conclusion: The NSM is a benign lesion which may mimic neoplasia. The trend is toward resolution. It must be recognized to avoid unnecessary surgery.

  9. A case of acute post-streptococcal glomerulonephritis that developed posterior reversible encephalopathy syndrome

    OpenAIRE

    Belde KASAP; Çarman, Kürşat Bora; Yiş, Uluç

    2014-01-01

    A 10-year male patient presented with swelling in the face, legs and scrotal area which developed 8 days after tonsillitis treatment. Acute post-sterotococcal glomerulonephritis (APSGN) was considered in the patient whose urinalysis revealed hematuria and proteinuria at nephrotic level, whose urea, creatinine, lipid profile and anti-streptolysine O antibody levels were increased, albumin and C3 value were decreased and whose 24-hour urine test revealed proteinuria. Renal biopsy was found to b...

  10. Eosinophilic Fasciitis and Acute Encephalopathy Toxicity from Pembrolizumab Treatment of a Patient with Metastatic Melanoma.

    Science.gov (United States)

    Khoja, Leila; Maurice, Catherine; Chappell, MaryAnne; MacMillan, Leslie; Al-Habeeb, Ayman S; Al-Faraidy, Nada; Butler, Marcus O; Rogalla, Patrik; Mason, Warren; Joshua, Anthony M; Hogg, David

    2016-03-01

    Anti-PD-1 inhibitors have significant activity in metastatic melanoma. Responses often occur early and may be sustained. The optimal duration of treatment with these agents is unknown. Here, we report the case of a 51-year-old woman treated with pembrolizumab, as part of the Keynote-001 trial, as first-line treatment for metastatic disease. She experienced a complete response after 13.8 months of treatment with no adverse events. One month after the last drug infusion and 18 months from starting treatment, the patient presented with eosinophilic fasciitis. She then developed acute confusion and weakness, thought to be due to intracranial vasculitis. High-dose steroids were initiated with resolution of the fasciitis. Aspirin was commenced for presumed vasculitis with resolution of the neurologic symptoms. To our knowledge, there are no previous reports of eosinophilic fasciitis or cerebral vasculitis due to anti-PD-1 agents. This case demonstrates that toxicity may occur in association with pembrolizumab treatment after a prolonged period of treatment without toxicity. Future trials should explore the optimal duration of treatment with pembrolizumab.

  11. Metabolic encephalopathies.

    Science.gov (United States)

    Angel, Michael J; Young, G Bryan

    2011-11-01

    Kinnier Wilson coined the term metabolic encephalopathy to describe a clinical state of global cerebral dysfunction induced by systemic stress that can vary in clinical presentation from mild executive dysfunction to deep coma with decerebrate posturing; the causes are numerous. Some mechanisms by which cerebral dysfunction occurs in metabolic encephalopathies include focal or global cerebral edema, alterations in transmitter function, the accumulation of uncleared toxic metabolites, postcapillary venule vasogenic edema, and energy failure. This article focuses on common causes of metabolic encephalopathy, and reviews common causes, clinical presentations and, where relevant, management.

  12. Increased toll-like receptor 4 in cerebral endothelial cells contributes to the astrocyte swelling and brain edema in acute hepatic encephalopathy.

    Science.gov (United States)

    Jayakumar, Arumugam R; Tong, Xiao Y; Curtis, Kevin M; Ruiz-Cordero, Roberto; Abreu, Maria T; Norenberg, Michael D

    2014-03-01

    Astrocyte swelling and the subsequent increase in intracranial pressure and brain herniation are major clinical consequences in patients with acute hepatic encephalopathy. We recently reported that conditioned media from brain endothelial cells (ECs) exposed to ammonia, a mixture of cytokines (CKs) or lipopolysaccharide (LPS), when added to astrocytes caused cell swelling. In this study, we investigated the possibility that ammonia and inflammatory agents activate the toll-like receptor 4 (TLR4) in ECs, resulting in the release of factors that ultimately cause astrocyte swelling. We found a significant increase in TLR4 protein expression when ECs were exposed to ammonia, CKs or LPS alone, while exposure of ECs to a combination of these agents potentiate such effects. In addition, astrocytes exposed to conditioned media from TLR4-silenced ECs that were treated with ammonia, CKs or LPS, resulted in a significant reduction in astrocyte swelling. TLR4 protein up-regulation was also detected in rat brain ECs after treatment with the liver toxin thioacetamide, and that thioacetamide-treated TLR4 knock-out mice exhibited a reduction in brain edema. These studies strongly suggest that ECs significantly contribute to the astrocyte swelling/brain edema in acute hepatic encephalopathy, likely as a consequence of increased TLR4 protein expression by blood-borne noxious agents.

  13. Identification of a novel biomarker candidate, a 4.8-kDa peptide fragment from a neurosecretory protein VGF precursor, by proteomic analysis of cerebrospinal fluid from children with acute encephalopathy using SELDI-TOF-MS

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    Fujino Osamu

    2011-08-01

    Full Text Available Abstract Background Acute encephalopathy includes rapid deterioration and has a poor prognosis. Early intervention is essential to prevent progression of the disease and subsequent neurologic complications. However, in the acute period, true encephalopathy cannot easily be differentiated from febrile seizures, especially febrile seizures of the complex type. Thus, an early diagnostic marker has been sought in order to enable early intervention. The purpose of this study was to identify a novel marker candidate protein differentially expressed in the cerebrospinal fluid (CSF of children with encephalopathy using proteomic analysis. Methods For detection of biomarkers, CSF samples were obtained from 13 children with acute encephalopathy and 42 children with febrile seizure. Mass spectral data were generated by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS technology, which is currently applied in many fields of biological and medical sciences. Diagnosis was made by at least two pediatric neurologists based on the clinical findings and routine examinations. All specimens were collected for diagnostic tests and the remaining portion of the specimens were used for the SELDI-TOF MS investigations. Results In experiment 1, CSF from patients with febrile seizures (n = 28, patients with encephalopathy (n = 8 (including influenza encephalopathy (n = 3, encephalopathy due to rotavirus (n = 1, human herpes virus 6 (n = 1 were used for the SELDI analysis. In experiment 2, SELDI analysis was performed on CSF from a second set of febrile seizure patients (n = 14 and encephalopathy patients (n = 5. We found that the peak with an m/z of 4810 contributed the most to the separation of the two groups. After purification and identification of the 4.8-kDa protein, a 4.8-kDa proteolytic peptide fragment from the neurosecretory protein VGF precursor (VGF4.8 was identified as a novel biomarker for encephalopathy. Conclusions

  14. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... Get Worse? How is HE Diagnosed? Prior to Treatment Who treats HE? Preparing for your Medical Appointment Hepatic Encephalopathy Treatment Options Treatment Basics Treatment Medications Importance of Adhering ...

  15. [Hashimoto's encephalopathy and autoantibodies].

    Science.gov (United States)

    Yoneda, Makoto

    2013-04-01

    Encephalopathy occasionally occurs in association with thyroid disorders, but most of these are treatable. These encephalopathies include a neuropsychiatric disorder associated with hypothyroidism, called myxedema encephalopathy. Moreover, Hashimoto's encephalopathy (HE) has been recognized as a new clinical disease based on an autoimmune mechanism associated with Hashimoto's thyroiditis. Steroid treatment was successfully administered to these patients. Recently, we discovered that the serum autoantibodies against the NH2-terminal of α-enolase (NAE) are highly specific diagnostic biomarkers for HE. Further, we analyzed serum anti-NAE autoantibodies and the clinical features in many cases of HE from institutions throughout Japan and other countries. Approximately half of assessed HE patients carry anti-NAE antibodies. The age was widely distributed with 2 peaks (20-30 years and 50-70 years). Most HE patients were in euthyroid states, and all patients had anti-thyroid (TG) antibodies and anti-thyroid peroxidase (TPO) antibodies. Anti-TSH receptor (TSH-R) antibodies were observed in some cases. The common neuropsychiatry features are consciousness disturbance and psychosis, followed by cognitive dysfunction, involuntary movements, seizures, and ataxia. Abnormalities on electroencephalography (EEG) and decreased cerebral blood flow on brain SPECT were common findings, whereas abnormal findings on brain magnetic resonance imaging (MRI) were rare. HE patients have various clinical phenotypes such as the acute encephalopathy form, the chronic psychiatric form, and other particular clinical forms, including limbic encephalitis, progressive cerebellar ataxia, and Creutzfeldt-Jakob disease (CJD)-like form. The cerebellar ataxic form of HE clinically mimics spinocerebellar degeneration (SCD) and is characterized by the absence of nystagmus, absent or mild cerebellar atrophy, and lazy background activities on EEG. Taken together, these data suggest that the possibility of

  16. Necrotizing soft tissue infection

    Science.gov (United States)

    Necrotizing fasciitis; Fasciitis - necrotizing; Flesh-eating bacteria; Soft tissue gangrene; Gangrene - soft tissue ... 2014:chap 137. Pasternack MS, Swartz MN. Cellulitis, necrotizing fasciitis, and subcutaneous tissue infections. In: Bennett JE, Dolin ...

  17. Hypertensive Encephalopathy

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    Mostafa SHARIFIAN

    2012-09-01

    Full Text Available How to cite this article: Sharifian M. Hypertensive Encephalopathy. Iran J Child Neurol 2012; 6(3:1-7.Hypertension is called the silent killer and vital organs such as the brain, eyes,kidneys and the heart are the targets. Seizure, central nervous system (CNShemorrhage, and cerebrovascular accident (CVA, blindness and heart attacksare the end points.The prevalence of hypertension in children is much less than adults, but evidencereveals that the source of hypertension in adulthood goes back to childhood. In70-80% of cases hypertension is due to renal diseases. In children, hypertensiveencephalopathy (HE may be the first manifestation of renal diseases. Seizure isone of the most common manifestations of HE.In this article, definitions, etiology, pathophysiology and finally the acute andchronic managements of HE will be discussed.ReferencesSawicka K, Szczyrek M, Jastrzębska I, Prasal M, ZwolakA, Jadwiga D. Hypertension – The silent killer. J Pre-Clin Clin Res 2011;5(2:43-6.Croix B, Feig DI. Childhood hypertension is not a silent disease. Pediatr Nephrol 2006 Apr;21(4:527-32.Wong TY, Mitchell P. Hypertensive retinopathy. N Engl J Med 2004 Nov;351(22:2310-7.Krzesinski JM, Cohen EP.Hypertension and the kidney.Acta Clin Belg 2007 Jan-Feb;62(1:5-14.Report of the Second Task Force on Blood Pressure Control in Children – 1987. Task Force on Blood Pressure Control in Children. National Heart, Lung, and Blood Institute, Bethesda, Maryland. Pediatrics 1987Jan;79(1:1-25.Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. National High Blood Pressure Education Program Working Group on Hypertension Control in Children and Adolescents. Pediatrics 1996 Oct;98(4 Pt1:649-58.Ataei N, Aghamohammadi A, Yousefi E, Hosseini M, Nourijelyani K, Tayebi M, et al. Blood pressure nomograms for school children in Iran. Pediatr Nephrol 2004 Feb;19

  18. Pancreatitis aguda necrotizante en una intoxicación fatal por metadona Acute necrotizing pancreatitis in a fatal poisoning with methadone

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    A. Sibón

    2004-01-01

    Full Text Available La pancreatitis necrotizante es una causa infrecuente de muerte súbita. La metadona, un fármaco empleado en el tratamiento sustitutivo de adictos a opiáceos, ha sido responsable de muertes tras su ingestión accidental por niños cuando estaba a su alcance, en intentos autolíticos o después de un período de abstinencia en pacientes con tolerancia. La muerte se debe a depresión del sistema nervioso central y depresión respiratoria. Reportamos un caso de muerte súbita con pancreatitis aguda necrotizante y hemorrágica, hemorragia suprarrenal y edema pulmonar en el contexto de una sobredosis por metadona en un paciente en programa de mantenimiento. Se descartaron otras causas frecuentes de pancreatitis como el alcoholismo crónico o la patología de tracto biliar. Discutimos la constelación de hallazgos para sugerir un posible mecanismo fisiopatológico.Necrotic pancreatitis is a rare cause of sudden death. Methadone, a drug used as a substitution treatment in heroin addicts, has been responsible for deaths after accidental ingestion by children of carelessly stored methadone, in suicide attempts or after a period of abstinence in tolerant patients. Death results from central nervous system and respiratory depression. We report a case of a sudden death with acute hemorrhagic and necrotizing pancreatitis, suprarenal haemorrhagia and pulmonary edema in the context of an overdose of methadone in a patient in an opioid maintenance program. Other frequent causes of pancreatitis such as chronic alcoholism and biliary tract disease were ruled out. We discuss the constellation of findings with regard to possible pathophysiological mechanisms.

  19. Acute necrotizing myopathy and podophyllin toxicity: report of a fatal case Miopatia necrotizante aguda e toxicidade por podofilina: relato de caso fatal

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    Acary Souza Bulle Oliveira

    1996-06-01

    Full Text Available A 21 year old male ingested podophyllin in a suicide attempt. The disorder was marked by seizures, coma, peripheral neuropathy, renal failure and acute necrotizing myopathy, an unusual finding. The coma and systemic disturbances resolved within three weeks. The myopathy resolved in 7 weeks, demonstrating a high capacity of muscle recuperation. The sensorimotor peripheral neuropathy persisted until the patient's death 9 weeks after the ingestion, due to septicemia. This report confirms the transient central neurotoxicity of podophyllin and persistent peripheral neurotoxicity of podophyllin, and describes a reversible necrotizing myopathy associated to mitochondrial abnormalities, a still unreported feature of podophyllin toxicity.Paciente de 21 anos, sexo masculino, ingeriu 20 mL de podofilina a 25% como tentativa de suicídio. O quadro clínico caracterizou-se por crises convulsivas, coma, neuropatia periférica, insuficiência renal e miopatia necrotizante aguda. O estado de coma e os distúrbios sistêmicos resolveram-se em 3 semanas. A miopatia resolveu-se em 7 semanas, demonstrando uma alta capacidade de recuperação muscular. A neuropatia periférica sensitivo-motora persistiu até o óbito do paciente, por septicemia, 9 semanas após a ingestão da podofilina. Esta descrição confirma os achados de literatura com alterações transitórias do sistema nervoso central e persistentes do nervo periférico relacionadas à podofilina, e descreve uma miopatia necrotizante associada com anormalidades mitocondriais, mas de caráter reversível, característica até então não reportada de toxicidade pela podofilina.

  20. Cat scratch encephalopathy.

    Science.gov (United States)

    Silver, B E; Bean, C S

    1991-06-01

    Cat scratch disease is usually benign, self-limited and without sequelae. Margileth has established four clinical criteria, three of which must be satisfied to make the diagnosis: 1) a history of animal exposure, usually kitten, with primary skin or ocular lesions; 2) regional chronic adenopathy without other apparent cause; 3) a positive cat scratch disease antigen skin test; and 4) lymph node biopsy demonstrating noncaseating granulomas and germinal center hyperplasia. Central nervous system involvement in cat scratch disease has been previously reported, although it is extremely uncommon. In a several-month period, we encountered two cases of cat scratch disease complicated by encephalopathy. The intents of this paper are twofold: 1) to briefly review the current literature on cat scratch disease, 2) to demonstrate that cat scratch disease complicated by encephalopathy presents acutely with seizures, posturing and coma and resolves rapidly with supportive care.

  1. Hashimoto's encephalopathy.

    Science.gov (United States)

    Ramalho, Joana; Castillo, Mauricio

    2011-01-01

    We report a case of Hashimoto's encephalopathy with atypical and partially reversible MRI findings. T2-weighted MRI images revealed bilaterally symmetric areas of increased signal in the mesial temporal lobes and basal ganglia. Despite clinical and imaging improvement after steroid therapy, some memory deficits and MRI abnormalities persisted.

  2. Effectiveness and safety of noninvasive positive-pressure ventilation for severe hypercapnic encephalopathy due to acute exacerbation of chronic obstructive pulmonary disease:a prospective case-control study

    Institute of Scientific and Technical Information of China (English)

    ZHU Guang-fa; ZHANG Wei; ZONG Hua; XU Qiu-fen; LIANG Ying

    2007-01-01

    Background Although severe encephalopathy has been proposed as a possible contraindication to the use of noninvasive positive-pressure ventilation(NPPV),increasing clinical reports showed it was effective in patients with impaired consciousness and even coma secondary to acute respiratory failure,especially hypercapnic acute respiratory failure(HARF).To further evaluate the effectiveness and safety of NPPV for severe hypercapnic encephalopathy,a prospective case-control study was conducted at a university respiratory intensive care unit(RICU)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)during the past 3 years.Methods Forty-three of 68 consecutive AECOPD patients requiring ventilatory support for HARF were divided into 2 groups,which were carefully matched for age,sex,COPD course,tobacco use and previous hospitalization history,according to the severity of encephalopathy,22 patients with Glasgow coma scale(GCS)0.05),but group A needed an average of 7 cmH2O higher of maximal pressure support during NPPV,and 4,4 and 7 days longer of NPPV time,RICU stay and hospital stay respectively than group B(P<0.05 or P<0.01).NPPV therapy failed in 12 patients(6 in each group)because of excessive airway secretions(7 patients),hemodynamic instability(2),worsening of dyspnea and deterioration of gas exchange(2),and gastric content aspiration(1).Conclusions Selected patients with severe hypercapnic encephalopathy secondary to HARF can be treated as effectively and safely with NPPV as awake patients with HARF due to AECOPD;a trial of NPPV should be instituted to reduce the need of endotracheal intubation in patients with severe hypercapnic encephalopathy who are otherwise good candidates for NPPV due to AECOPD.

  3. Management of necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    John Slavin1; Paula Ghaneh; Robert Sutton1; Mark Hartley; Peter Rowlands; Conall Garvey; Mark Hughes; John Neoptolemos

    2001-01-01

    Infection complicating pancreatic necrosis leads to persisting sepsis, multiple organ dysfunction syndrome and accounts for about half the deaths that occur following acute pancreatitis. Severe cases due to gallstones require urgent endoscopic sphincterotomy. Patients with pancreatic necrosis should be followed with serial contrast enhanced computed tomography (CE-CT) and if infection is suspected fine needle aspiration of the necrotic area for bacteriology (FNAB) should be undertaken. Treatment of sterile necrosis should initially be non-operative. In the presence of infection necrosectomy is indicated. Although traditionally this has been by open surgery, minimally invasive procedures are a promising new alternative. There are many unresolved issues in the management of pancreatic necrosis. These include, the use of antibiotic prophylaxis, the precise indications for and frequency of repeat CE-CT and FNAB,and the role of enteral feeding.

  4. Hashimoto's encephalopathy

    DEFF Research Database (Denmark)

    Montagna, Giacomo; Imperiali, Mauro; Agazzi, Pamela

    2016-01-01

    Hashimoto's encephalopathy (HE) is a rare not well understood, progressive and relapsing multiform disease, characterized by seizures, movement disorders, subacute cognitive dysfunction, psychiatric symptoms and responsiveness to steroid therapy. The disorder is generally associated with thyroid...... diseases and the most common feature is the presence of anti-thyroperoxidase antibodies (TPOAb). Patients are usually euthyroid or mildly hypothyroid at presentation. All age groups can be affected. The pathophysiology is still unclear, especially the link between elevated serum TPOAb...

  5. Value of Plasmodium falciparum Histidine-Rich Protein 2 Level and Malaria Retinopathy in Distinguishing Cerebral Malaria From Other Acute Encephalopathies in Kenyan Children

    Science.gov (United States)

    Kariuki, Symon M.; Gitau, Evelyn; Gwer, Samson; Karanja, Henry K.; Chengo, Eddie; Kazungu, Michael; Urban, Britta C.; Newton, Charles R. J. C.

    2014-01-01

    Background. The diagnosis of cerebral malaria is problematic in malaria-endemic areas because encephalopathy in patients with parasitemia may have another cause. Abnormal retinal findings are thought to increase the specificity of the diagnosis, and the level of histidine-rich protein 2 (HRP2) may reflect the parasite biomass. Methods. We examined the retina and measured plasma HRP2 levels in children with acute nontraumatic encephalopathy in Kenya. Logistic regression, with HRP2 level as an independent variable and World Health Organization–defined cerebral malaria and/or retinopathy as the outcome, was used to calculate malaria-attributable fractions (MAFs) and retinopathy-attributable fractions (RAFs). Results. Of 270 children, 140 (52%) had peripheral parasitemia, 80 (30%) had malaria retinopathy, and 164 (61%) had an HRP2 level of >0 U/mL. During 2006–2011, the incidence of HRP2 positivity among admitted children declined by 49 cases per 100 000 per year (a 78% reduction). An HRP2 level of >0 U/mL had a MAF of 93% for cerebral malaria, with a MAF of 97% observed for HRP2 levels of ≥10 U/mL (the level of the best combined sensitivity and specificity). HRP2 levels of >0 U/mL had a RAF of 77% for features of retinopathy combined, with the highest RAFs for macular whitening (99%), peripheral whitening (98%), and hemorrhages (90%). Conclusion. HRP2 has a high attributable fraction for features of malarial retinopathy, supporting its use in the diagnosis of cerebral malaria. HRP2 thresholds improve the specificity of the definition. PMID:24041795

  6. NECROTIZING FASCIITIS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    F. S. Kharlamova

    2013-01-01

    Full Text Available The authors presented a review of literature of necrotizing fasciitis in children. A rare case of necrotizing fasciitis in 3-year-old child is described. The difficulties of differential diagnostics of the given disease are presented.

  7. Surveillance of intra-abdominal pressure and intestinal barrier function in a rat model of acute necrotizing pancreatitis and its potential early therapeutic window.

    Directory of Open Access Journals (Sweden)

    Wei-Dong Li

    Full Text Available OBJECTIVES: To monitor intra-abdominal pressure (IAP and intestinal barrier function in a rat model of acute necrotizing pancreatitis (ANP to elucidate a potential relevant therapeutic window. METHODS: Sprague-Dawley rats were randomly divided into experimental or control groups. The ANP group (n = 40 was injected with 4.5% sodium taurocholate into the pancreatic duct to induce ANP. The controls received only abdominal opening surgery (sham-operated, SO; n = 40 or no treatment or surgery (baseline; 0 h, n = 20. The SO and ANP groups were then randomly subdivided into 3, 6, 12 and 24 h groups (n = 10 each. IAP was measured at each time point and the rats were sacrificed to measure the weight of accumulated ascites fluid and the amylase, endogenous creatinine (Cr, total bilirubin (TB, tumor necrosis factor- alpha (TNF-alpha, diamine oxidase (DAO, and D-lactate. Mortality and the development of pathological changes in the pancreas and intestines were also monitored. RESULTS: IAP showed a continuous upward trend in the ANP group, with values 2 to 3 times higher than those in the SO group at the corresponding time points and the rising rate was peaking at 6 h. The levels of plasma amylase, TNF-alpha, Cr, TB, DAO, and D-lactate also gradually increased in the ANP group over time and were significantly higher than in the SO group at 3, 6, 12 and 24 h (all P<0.05. Moreover, the rising rate of TNF-alpha, DAO, and D-lactate also peaked at 6 h. CONCLUSIONS: The ANP-induced changes in IAP, inflammatory factors and intestinal barrier that we observed in the rat model were especially obvious at 6 h post-induction, suggesting an early therapeutic window for the treatment of ANP in humans.

  8. Changes of gastric and intestinal blood flow, serum phospholipase A2 and interleukin-1β in rats with acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Jian-Xin Zhang; Sheng-Chun Dang; Jian-Guo Qu; Xue-Qing Wang; Guo-Zuo Chen

    2005-01-01

    AIM: To explore the relationship between gastric and intestinal microcirculatory impairment and inflammatory mediators released in rats with acute necrotizing pancreatitis (ANP).METHODS: A total of 64 rats were randomized into control group and ANP group. ANP model was induced by injection of 5% sodium taurocholate under the pancreatic membrane.Radioactive biomicrosphere technique was used to measure the gastric and intestinal tissue blood flow at 2 and 12 h after the induction of ANP, meanwhile serum phospholipase A2 (PLA2) activities and interleukin-1β levels were determined. Pathologic changes in pancreas, gastric and intestinal mucosae were studied. RESULTS: The gastric blood flow in ANP group (0.62±0.06 (P<0.01) at 2 and 12 h after induction of ANP. The intestinal blood flow in ANP group (0.80±0.07 and (P<0.01). Serum PLA2 activities (94.29±9.96 and 103.71± 14.40) U/L and IL-1β levels (0.78±0.13 and 0.83±0.20) μg/L in ANP group were higher than those in control group (65.27±10.52 and 66.63±9.81) U/L, (0.32±0.06 and 0.33±0.07) μg/L (P<0.01). At 2 and 12 h after introduction of the model, typical pathologic changes were found in ANP. Compared with control group, the gastric and intestinal mucosal pathologic changes were aggravated significantly (P<0.01) at 12 h after induction of ANP. Gastric and intestinal mucosal necrosis, multiple ulcer and hemorrhage occurred.CONCLUSION: Decrease of gastric and intestinal blood flow and increase of inflammatory mediators occur simultaneously early in ANP, both of them are important pathogenic factors for gastric and intestinal mucosal injury in ANP.

  9. 重症急性胰腺炎并发胰腺脑病的发病机制研究进展%Advanced on the pathogenesis of severe acute pancreatitis complicated with pancreatic encephalopathy

    Institute of Scientific and Technical Information of China (English)

    刘补报; 李得溪

    2015-01-01

    胰腺脑病是重症急性胰腺炎的严重并发症,病死率高,预后差。目前关于胰腺脑病的发病机制主要有胰酶学说、细胞因子学说、营养缺乏学说、细菌和真菌感染学说、低氧血症与微循环障碍和组织代谢紊乱学说等,但尚未有哪一种学说能独立阐明其发病机制。笔者主要综述近几年来发展的各种学说。%Pancreatic encephalopathy (PE) is a severe complication of severe acute pancreatitis, and has the characteristics of the high mortality and poor prognosis. Although about the pathogenesis of pancreatic encephalopathy mainly include theory of pancreatic enzyme, the theory of cytokines, the theory of alimentary deficiency, the theory of bacterial and fungal infection, the theory of hypoxemia and microcirculation dysfunction, the theory of tissue metabolism disorder and so on, the pathogenesis of pancreatic encephalopathy still unclear at present. The author mainly reviews the development of the pathogenesis of pancreatic encephalopathy in recent years.

  10. 急性坏死性胰腺炎继发细菌感染的早期诊断%Early Diagnosis of Bacterial Infection Secondary to Acute Necrotizing P ancreatitis

    Institute of Scientific and Technical Information of China (English)

    张卫中; 韩天权; 汤耀卿; 张圣道

    2001-01-01

    Objective: To assess the diagnosis of bacter ial infection secondary to acute necrotic pancreatitis by polymerase chain re action (PCR).Methods: The PCR assay was used to detect bacteria in p eripancreatic fluid and necrotizing tissue from patients with acute necrotic pan creatitis and the method was compared with conventional culture.Results: Of 43 samples of peripancreatic fluid,40 were positive and 3 negative by PC R,whil e 39 were identified positive and 4 negative by conventional culture;for 5 sampl es of necrotic tissue,4 were proved positive and 1 negative by both PCR and cult ure,respectively.The PCR procedure was completed within 4 hours.Conclusion : The PCR assay is a quick and sensitively method,and can be used to diagn ose bacterial infection secondary to acute necrotic pancreatitis.%目的:探讨针对细菌16s rRNA基因的通用引物聚合酶链反应(PCR)技术诊断急性坏死性胰腺炎继发感染的价值。方法:采用 PCR检测急性坏死性胰腺炎患者的胰周渗液和坏死组织,并与常规培养结果作比较。结果:43份胰周渗液PCR检测阳性40份,阴性3份,而培养阳性39份,阴性4份;5 份坏死组织PCR阳性4份,阴性1份,而培养阳性4份,阴性1份。PCR检测需时间仅4 h。结论:该PCR方法可快速、敏感地诊断急性坏死性胰腺炎继发细菌感染。

  11. Necrotizing gastritis due to Bacillus cereus in an immunocompromised patient.

    Science.gov (United States)

    Le Scanff, J; Mohammedi, I; Thiebaut, A; Martin, O; Argaud, L; Robert, D

    2006-04-01

    Bacillus cereus is increasingly being acknowledged as a serious bacterial pathogen in immunocompromised patients. We present a case of acute necrotizing gastritis caused by B. cereus in a 37-year-old woman with acute myeloblastic leukemia, who recovered following total parenteral nutrition and treatment with imipenem and vancomycin. B. cereus was isolated from gastric mucosa and blood cultures. Up to now, no case of acute necrotizing gastritis due to this organism has been reported.

  12. Necrotizing pneumonia and acute purulent pericarditis caused by Streptococcus pneumoniae serotype 19A in a healthy 4-year-old girl after one catch-up dose of 13-valent pneumococcal conjugate vaccine.

    Science.gov (United States)

    Lu, Shay; Tsai, Jeng-Dau; Tsao, Ten-Fu; Liao, Pei-Fen; Sheu, Ji-Nan

    2016-08-01

    Streptococcus pneumoniae is a common cause of infectious diseases in children that may lead to life-threatening complications. Acute purulent pericarditis is an uncommon complication of S. pneumoniae in the antibiotic era. A healthy 4-year-old girl was admitted with pneumonia and pleural effusion. She had received one catch-up dose of 13-valent pneumococcal conjugate vaccine at 2 years of age. She rapidly developed necrotizing pneumonia, complicated by bronchopleural fistula presenting as subcutaneous emphysema and pneumothorax and acute purulent pericarditis. S. pneumoniae serotype 19A was subsequently identified from blood, empyema and pericardial fluid cultures. After appropriate antibiotic therapy and a right lower lobectomy, her condition stabilized and she promptly recovered. This case highlights two rare potential clinical complications of pneumococcal disease in a child: necrotizing pneumonia and acute purulent pericarditis. This is the first report of a child who received just one catch-up dose of 13-valent pneumococcal conjugate vaccine at 2 years of age, as per the United States' Advisory Committee on Immunization Practice's recommendations, but who still developed severe invasive pneumococcal disease with life-threatening complications caused by S. pneumoniae serotype 19A.

  13. Combined application of dexamethasone and hyperbaric oxygen therapy yields better efficacy for patients with delayed encephalopathy after acute carbon monoxide poisoning

    Science.gov (United States)

    Xiang, Wenping; Xue, Hui; Wang, Baojun; Li, Yuechun; Zhang, Jun; Jiang, Changchun; Liang, Furu; Pang, Jiangxia; Yu, Lehua

    2017-01-01

    Background Delayed encephalopathy after acute carbon monoxide (CO) poisoning (DEACMP) commonly occurs after recovering from acute CO poisoning. This study was performed to assess the efficacy of the combined application of dexamethasone and hyperbaric oxygen (HBO) therapy in patients with DEACMP. Patients and methods A total of 120 patients with DEACMP were recruited and randomly assigned into the experimental group (receiving dexamethasone 5 mg/day or 10 mg/day plus HBO therapy) and control group (HBO therapy as monotherapy). Meanwhile, the conventional treatments were provided for all the patients. We used the Mini-Mental State Examination (MMSE) scale to assess the cognitive function, the National Institutes of Health Stroke Scale (NIHSS) to assess the neurological function and the remission rate (RR) to assess the clinical efficacy. Myelin basic protein (MBP) in the cerebrospinal fluid (CSF) was also measured. Results After 4 weeks of treatment, compared to the control group, the experimental group had a significantly higher remission rate (P=0.032), a significantly higher average MMSE score (P=0.037) and a significantly lower average NIHSS score (P=0.002). Meanwhile, there was a trend toward better improvement with dexamethasone 10 mg/day, and the level of MBP in the CSF of patients was significantly lower in the experimental group than in the control group (P<0.0001). The addition of dexamethasone did not significantly increase the incidence of adverse events. Conclusion These results indicate that the combined application of dexamethasone and HBO therapy could yield better efficacy for patients with DEACMP and should be viewed as a potential new therapy. PMID:28260864

  14. Challenges in diagnosing hepatic encephalopathy.

    Science.gov (United States)

    Weissenborn, K

    2015-02-01

    The term "hepatic encephalopathy" (HE) covers the neuropsychiatric syndrome associated with acute, chronic and acute-on-chronic liver disease (CLD). This paper deals with clinical features and diagnosis of HE in patients with liver cirrhosis and portal hypertension or porto-systemic shunts. The possible impact of concomitant disorders and the cirrhosis underlying liver disease upon brain function is described emphasizing the need of a detailed diagnostic work up of every individual case before diagnosing HE. Currently used methods for diagnosing minimal or covert hepatic encephalopathy are compared with regard to their sensitivity and specificity for diagnosing HE against the background of a multitude of concomitant disorders and diseases that could contribute to brain dysfunction.

  15. Hypertension and hypertensive encephalopathy.

    Science.gov (United States)

    Price, Raymond S; Kasner, Scott E

    2014-01-01

    The definition of hypertension has continuously evolved over the last 50 years. Hypertension is currently defined as a blood pressure greater than 140/90mmHg. One in every four people in the US has been diagnosed with hypertension. The prevalence of hypertension increases further with age, affecting 75% of people over the age of 70. Hypertension is by far the most common risk factor identified in stroke patients. Hypertension causes pathologic changes in the walls of small (diameter<300 microns) arteries and arterioles usually at short branches of major arteries, which may result in either ischemic stroke or intracerebral hemorrhage. Reduction of blood pressure with diuretics, β-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors have all been shown to markedly reduce the incidence of stroke. Hypertensive emergency is defined as a blood pressure greater than 180/120mmHg with end organ dysfunction, such as chest pain, shortness of breath, encephalopathy, or focal neurologic deficits. Hypertensive encephalopathy is believed to be caused by acute failure of cerebrovascular autoregulation. Hypertensive emergency is treated with intravenous antihypertensive agents to reduce blood pressure by 25% within the first hour. Selective inhibition of cerebrovascular blood vessel permeability for the treatment of hypertensive emergency is beginning early clinical trials.

  16. Necrotizing Fasciitis of the lower limbs

    Directory of Open Access Journals (Sweden)

    Paola Muggeo

    2012-02-01

    Full Text Available We report an uncommon ssevere soft-tissue infection of the thighs in a male child with acute lymphoblastic leukemia. Early and aggressive medical treatment and the conservative surgical approach were successful. Necrotizing fasciitis should be suspected in any soft-tissue infection until it can be definitely ruled out, since prompt deliver of medical and surgical intervention is essential.

  17. 慢加急性肝衰竭合并肝性脑病159例生存分析%Survival analysis of 159 patients with hepatic encephalopathy in acute-on-chronic liver failure

    Institute of Scientific and Technical Information of China (English)

    崔燕平; 崔霞; 管珊; 李庆方; 王思奎

    2015-01-01

    Objective To analyze the prognostic factors for patients with hepatic encephalopathy (HE) in acute-on-chronic liver failure(ACLF).Methods A retrospective analysis was performed on 159 ACLF patients with HE.The hepatic encephalopathy was determined to baseline,the patients were divided into survivors(n =13) and nonsurvivors(n =146),The 32 factors affecting the prognosis were analyzed by Cox proportional hazard model with SPSS.Results One-month,three-month,and six-month survival rates were 20.13%,10.06% and 8.18%,respectively.Cox regression analysis of prognostic factors showed that it could the stage of hepatic encephalopathy and HRS significantly improve the survival rate of the patients with HE in acute-on-chronic liver failure.The stage of hepatic encephalopathy and HRS could significantly decrease the survival rate of the patients(x2 =18.344,11.368,all P < 0.05),elevated the levels of hepatic encephalopathy (relative risk (RR) =1.591) and HRS (RR =1.809) indicate worse prognosis with hepatic encephalopathy in acute-on-chronic failure.Conclusion The stage of hepatic encephalopathy and HRS were independent risk factor sof prognosis in acute-on-chronic liver failure.%目的 对影响慢加急性肝衰竭(ACLF)伴肝性脑病(HE)患者预后的因素进行分析,探讨影响预后的危险因素.方法 回顾性分析159例ACLF伴HE患者的临床资料,以确定HE为起点,将患者分为生存组(13例)和死亡组(146例),选择32个相关临床指标,用SPSS软件对相关数据进行单因素和多因素非比例风险的Cox模型分析.结果 ACLF伴HE患者1、3、6个月的生存率分别为20.13%、10.06%、8.18%,经Cox回归分析,筛选出HE分期、肝肾综合征(HRS)为独立的预后因素(x2=18.344、11.368,均P<0.05),HE分期越高、出现HRS增加患者死亡风险,相对危险度(RR)分别为1.591、1.809.结论 HE分期、HRS是判断ACLF伴HE患者预后的重要指标.

  18. Interventions for Necrotizing Pancreatitis Summary of a Multidisciplinary Consensus Conference

    NARCIS (Netherlands)

    Freeman, Martin L.; Werner, Jens; van Santvoort, Hjalmar C.; Baron, Todd H.; Besselink, Marc G.; Windsor, John A.; Horvath, Karen D.; vanSonnenberg, Eric; Bollen, Thomas L.; Vege, Santhi Swaroop

    2012-01-01

    Pancreatic and peripancreatic necrosis may result in significant morbidity and mortality in patients with acute pancreatitis. Many recommendations have been made for management of necrotizing pancreatitis, but no published guidelines have incorporated the many recent developments in minimally invasi

  19. Early use of noninvasive techniques for clearing respiratory secretions during noninvasive positive-pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease and hypercapnic encephalopathy

    Science.gov (United States)

    Wang, Jinrong; Cui, Zhaobo; Liu, Shuhong; Gao, Xiuling; Gao, Pan; Shi, Yi; Guo, Shufen; Li, Peipei

    2017-01-01

    Abstract Noninvasive positive-pressure ventilation (NPPV) might be superior to conventional mechanical ventilation (CMV) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPDs). Inefficient clearance of respiratory secretions provokes NPPV failure in patients with hypercapnic encephalopathy (HE). This study compared CMV and NPPV combined with a noninvasive strategy for clearing secretions in HE and AECOPD patients. The present study is a prospective cohort study of AECOPD and HE patients enrolled between October 2013 and August 2015 in a critical care unit of a major university teaching hospital in China. A total of 74 patients received NPPV and 90 patients received CMV. Inclusion criteria included the following: physician-diagnosed AECOPD, spontaneous airway clearance of excessive secretions, arterial blood gas analysis requiring intensive care, moderate-to-severe dyspnea, and a Kelly–Matthay scale score of 3 to 5. Exclusion criteria included the following: preexisting psychiatric/neurological disorders unrelated to HE, upper gastrointestinal bleeding, upper airway obstruction, acute coronary syndromes, preadmission tracheostomy or endotracheal intubation, and urgent endotracheal intubation for cardiovascular, psychomotor agitation, or severe hemodynamic conditions. Intensive care unit participants were managed by NPPV. Participants received standard treatment consisting of controlled oxygen therapy during NPPV-free periods; antibiotics, intravenous doxofylline, corticosteroids (e.g., salbutamol and ambroxol), and subcutaneous low-molecular-weight heparin; and therapy for comorbidities if necessary. Nasogastric tubes were inserted only in participants who developed gastric distension. No pharmacological sedation was administered. The primary and secondary outcome measures included comparative complication rates, durations of ventilation and hospitalization, number of invasive devices/patient, and in-hospital and 1-year mortality

  20. Cervicofacial necrotizing fasciitis following periodontal abscess.

    Science.gov (United States)

    Medeiros, Rui; Catunda, Ivson de Sousa; Queiroz, Isaac Vieira; de Morais, Hecio Henrique Araujo; Leao, Jair Carneiro; Gueiros, Luiz Alcino Monteiro

    2012-01-01

    Soft tissue infections are characterized by acute inflammation, diffuse edema, and suppuration, and are often associated with symptoms such as malaise, fever, tachycardia, and chills. Necrotizing fasciitis is a destructive bacterial infection affecting subcutaneous tissue and superficial fascia and is associated with high rates of mortality. It usually involves the abdomen and extremities, but it also can occur in the head and neck. Early diagnosis is critical and the most commonly accepted treatment includes radical surgical intervention and administration of broad-spectrum antibiotics. This article reports and discusses the case of a patient with odontogenic cervicofacial necrotizing fasciitis, and emphasizes the importance of early and effective treatment.

  1. Clinical characteristics and MR imaging features of nonalcoholic acute Wernicke encephalopathy%非酒精性急性Wernicke 脑病的临床及MRI特点

    Institute of Scientific and Technical Information of China (English)

    董季平; 陈慧玲; 刘红生; 宁文德; 李安泰

    2012-01-01

    目的 探讨非酒精性急性Wernicke 脑病的临床及MRI表现.方法 回顾分析6例非酒精性急性Wernicke 脑病的临床与MRI所见.均为女性,年龄21~75岁,平均45岁.无嗜酒史.使用GE 1.5T MR扫描仪,行常规T1WI、T2WI、T2FLAIR、DWI扫描,2例行增强扫描.结果 6例均有2周以上呕吐及不能进食史.起病急,首发症状均为精神异常及意识障碍,其中2例发病后即进入昏迷状态.其他症状有眼部症状4例,共济失调1例.MRI表现:6例均有双侧对称性第三脑室旁、丘脑内侧、大脑导水管周围、中脑被盖长T1长T2异常信号.其他部位信号异常的有第四脑室底部4例,桥脑延髓3例,乳头体3例.DWI病灶区呈扩散受限的高信号.增强扫描病灶边缘有强化.经大剂量维生素B1治疗,临床好转5例,死亡1例.结论 非酒精性急性Wernicke 脑病有特征性的MRI表现,是诊断本病的重要影像学方法.%Objective To investigate the clinical and MR] features of nonalcoholic acute Wernicke encephalopathy( WE). Methods The clinical and MR imaging findings of six cases with nonalcoholic acute WE were analyzed retrospectively. All of them were female with an average age of 45 ycars( range, 20-75ycars). All patients denied a history of alcoholic abuse. 6 cases underwent conventional MR imaging and 2 cases were imaged with contrast enhanced MR imaging. Results All patients had vomiting and less intake of food for more than 2 weeks,symptoms were acute onset. Initial central nervous system (CNS) symptoms included psychotic disorder and disturbance of consciousness, including 2 patients with coma. Some patients had other symptoms:A with ocular abnormalities, 1 with ataxia. MR imaging findings: All six patients showed symmetrically abnormal long T, and long T2 signals in the arc-as surrounding the third ventricle and aqueduct, medial thalami and tegmentum of brain, another areas of abnormal signal intensity were observed in the floor of forth vcntriclc (4

  2. Cervical Necrotizing Fasciitis Caused by Dental Extraction

    Science.gov (United States)

    Figueiredo, Eugênia; Álvares, Pâmella; Silva, Luciano; Silva, Leorik; Caubi, Antônio; Silveira, Marcia; Sobral, Ana Paula

    2016-01-01

    Cervical necrotizing fasciitis is an unusual infection characterized by necrosis of the subcutaneous tissue and fascial layers. Risk factors for the development of necrotizing fasciitis include diabetes mellitus, chronic renal disease, peripheral vascular disease, malnutrition, advanced age, obesity, alcohol abuse, intravenous drug use, surgery, and ischemic ulcers. This report presents a case of necrotizing fasciitis in the cervical area caused by dental extraction in a 73-year-old woman. Cervical necrotizing fasciitis in geriatric patient is rare, and even when establishing the diagnosis and having it timely treated, the patient can suffer irreversible damage or even death. Clinical manifestations in the head and neck usually have an acute onset characterized by severe pain, swelling, redness, erythema, presence of necrotic tissue, and in severe cases obstruction of the upper airways. Therefore, the presentation of this clinical case can serve as guidance to dentists as a precaution to maintain an aseptic chain and be aware of the clinical condition of older patients and the systemic conditions that may increase the risk of infections. PMID:27375905

  3. Cervical Necrotizing Fasciitis Caused by Dental Extraction

    Directory of Open Access Journals (Sweden)

    José Alcides Arruda

    2016-01-01

    Full Text Available Cervical necrotizing fasciitis is an unusual infection characterized by necrosis of the subcutaneous tissue and fascial layers. Risk factors for the development of necrotizing fasciitis include diabetes mellitus, chronic renal disease, peripheral vascular disease, malnutrition, advanced age, obesity, alcohol abuse, intravenous drug use, surgery, and ischemic ulcers. This report presents a case of necrotizing fasciitis in the cervical area caused by dental extraction in a 73-year-old woman. Cervical necrotizing fasciitis in geriatric patient is rare, and even when establishing the diagnosis and having it timely treated, the patient can suffer irreversible damage or even death. Clinical manifestations in the head and neck usually have an acute onset characterized by severe pain, swelling, redness, erythema, presence of necrotic tissue, and in severe cases obstruction of the upper airways. Therefore, the presentation of this clinical case can serve as guidance to dentists as a precaution to maintain an aseptic chain and be aware of the clinical condition of older patients and the systemic conditions that may increase the risk of infections.

  4. Wernicke's encephalopathy induced by total parenteral nutrition in patient with acute leukaemia: unusual involvement of caudate nuclei and cerebral cortex on MRI

    Energy Technology Data Exchange (ETDEWEB)

    D' Aprile, P.; Tarantino, A.; Carella, A. [Division of Neuroradiology, Policlinico, Univ. of Bari (Italy); Santoro, N. [Inst. of Paediatric Clinic I, Policlinico, University of Bari, Bari (Italy)

    2000-10-01

    We report a 13-year-old girl with leukaemia and Wernicke's encephalopathy induced by total parenteral nutrition. MRI showed unusual bilateral lesions of the caudate nuclei and cerebral cortex, as well as typical lesions surrounding the third ventricle and aqueduct. After intravenous thiamine, the patient improved, and the abnormalities on MRI disappeared. (orig.)

  5. [Necrotizing fasciitis after varicella].

    Science.gov (United States)

    Gonçalves, E; Furtado, F; Estrada, J; Vale, M C; Pinto, M; Santos, M; Moura, G; Vasconcelos, C

    2001-01-01

    Necrotizing fasciitis is a rare and severe infection characterised by extremely rapid progressive involvement of the superficial fascias and deep dermal layers of the skin, with resultant vasculitis and necrosis. The authors present three clinical cases of necrotizing fasciitis; all three patients previously had varicella rash, rapid progressive spreading erythema with severe pain and toxic shock syndrome. Two patients had positive cultures of b-haemolytic streptococcus. Early stage differential diagnosis with celulitis, aggressive antibiotic treatment and pediatric intensive care support are essential. However, the main therapy is early extensive surgical approach involving all indurate areas, down to and including the muscle fascia.

  6. A Case of Necrotizing Epiglottitis Due to Nontoxigenic Corynebacterium diphtheriae.

    Science.gov (United States)

    Lake, Jessica A; Ehrhardt, Matthew J; Suchi, Mariko; Chun, Robert H; Willoughby, Rodney E

    2015-07-01

    Diphtheria is a rare cause of infection in highly vaccinated populations and may not be recognized by modern clinicians. Infections by nontoxigenic Corynebacterium diphtheriae are emerging. We report the first case of necrotizing epiglottitis secondary to nontoxigenic C diphtheriae. A fully vaccinated child developed fever, poor oral intake, and sore throat and was found to have necrotizing epiglottitis. Necrotizing epiglottitis predominantly occurs in the immunocompromised host. Laboratory evaluation revealed pancytopenia, and bone marrow biopsy was diagnostic for acute lymphoblastic leukemia. Clinicians should be aware of aggressive infections that identify immunocompromised patients. This case highlights the features of a reemerging pathogen, C diphtheriae.

  7. An atypical case of necrotizing fasciitis of the breast.

    Science.gov (United States)

    Mufty, H; Smeets, A; Christiaens, M R

    2014-01-01

    Necrotizing fasciitis is a rare and aggressive soft tissue infection involving the fascia and subcutaneous tissues. It carries a high mortality and morbidity rate. In literature, the few case reports on necrotizing fasciitis of the breast, describe the need for a mastectomy in 90% of the cases. We report on a case of a 72-year old Caucasian women with an atypical presentation of necrotizing fasciitis of the breast in combination with an acute abdomen, successfully treated with breast-conserving debridement and secondary wound closure.

  8. Necrotizing fasciitis: an alternative approach

    OpenAIRE

    Percival, R.; Hargreaves, A. W.

    1982-01-01

    Three cases of necrotizing fasciitis are presented. The initial management of necrotizing fasciitis remains undisputed. However, following a limited success with a conventional treatment policy, a more radical approach with immediate skin grafting following debridement is suggested.

  9. 代谢性脑病%Metabolic Encephalopathies

    Institute of Scientific and Technical Information of China (English)

    石青

    2013-01-01

    Metabolic encephalopathy is a clinical syndrome which describes a state of global cerebral dysfunction induced by many different metabolic disturbances.Organic acids disorders,hepatic encephalopathy,uremic encephalopathy and its dialysis disequilibrium posterior,reversible leukoencephalopathy syndrome,Hashimoto encephalopathy,acute adrenal failure and encephalopathy due to electrolyte disturbances were reviewed.%代谢性脑病是由不同代谢障碍引起全脑功能紊乱的一种临床综合征.本文就有机酸代谢障碍、肝性脑病、尿毒症性脑病及其血透后脑病、可逆性大脑后部白质脑病、Hashimoto脑病和电介质失衡脑病的临床表现和神经影像学进行讨论.

  10. Progressive multicystic encephalopathy: is there more than hypoxia-ischemia?

    Science.gov (United States)

    Garten, Lars; Hueseman, Dieter; Stoltenburg-Didinger, Gisela; Felderhoff-Mueser, Ursula; Weizsaecker, Katharina; Scheer, Ianina; Boltshauser, Eugen; Obladen, Michael

    2007-05-01

    Progressive multicystic encephalopathy following prenatal or perinatal hypoxia-ischemia is a well-described phenomenon in the literature. The authors report on a term infant with a devastating encephalopathy and severe neuronal dysfunction immediately after delivery without a known antecedent of prenatal or perinatal hypoxia or distress. Clinical and paraclinical findings in the patient are compared with those described in the literature. The authors focus on the specific results guiding to the final diagnosis of progressive multicystic encephalopathy and the timing of morphologic changes. As in this case, if the criteria of an acute hypoxic event sufficient to cause neonatal encephalopathy are not met, then factors other than hypoxia-ischemia may be leading to progressive multicystic encephalopathy.

  11. No oxygen delivery limitation in hepatic encephalopathy

    DEFF Research Database (Denmark)

    Gjedde, Albert; Keiding, Susanne; Vilstrup, Hendrik

    2010-01-01

    declined in all gray matter regions of the brain in patients with HE but not significantly in patients with CL. Analysis of flow-metabolism coupling indicated that blood flow declined in HE as a consequence of reduced brain energy metabolism implied by the calculation of increased mitochondrial oxygen......Hepatic encephalopathy is a condition of reduced brain functioning in which both blood flow and brain energy metabolism declined. It is not known whether blood flow or metabolism is the primary limiting factor of brain function in this condition. We used calculations of mitochondrial oxygen tension...... to choose between cause and effect in three groups of volunteers, including healthy control subjects (HC), patients with cirrhosis of the liver without hepatic encephalopathy (CL), and patients with cirrhosis with acute hepatic encephalopathy. Compared to HC subjects, blood flow and energy metabolism had...

  12. Dengue viral infections as a cause of encephalopathy

    Directory of Open Access Journals (Sweden)

    Malavige G

    2007-01-01

    Full Text Available The aim of this study was to determine the clinical characteristics and poor prognostic factors associated with high mortality in dengue encephalopathy. Fifteen patients with confirmed dengue infections, who developed encephalopathy, were recruited from two tertiary care hospitals in Colombo, Sri Lanka. Among the factors that contributed to encephalopathy were: Acute liver failure (73%, electrolyte imbalances (80% and shock (40%. Five (33.3% patients developed seizures. Disseminated intravascular coagulation was seen in five (33.3%. Secondary bacterial infections were observed in 8 (53.3% of our patients. The overall mortality rate was 47%.

  13. Current concepts in the assessment and treatment of hepatic encephalopathy.

    LENUS (Irish Health Repository)

    Cash, W J

    2012-02-01

    Hepatic encephalopathy (HE) is defined as a metabolically induced, potentially reversible, functional disturbance of the brain that may occur in acute or chronic liver disease. Standardized nomenclature has been proposed but a standardized approach to the treatment, particularly of persistent, episodic and recurrent encephalopathy associated with liver cirrhosis has not been proposed. This review focuses on the pathogenesis and treatment of HE in patients with cirrhosis. The pathogenesis and treatment of hepatic encephalopathy in fulminant hepatic failure is quite different and is reviewed elsewhere.

  14. Disseminated necrotizing myeloencephalitis: a herpes-associated neurological disease of horses.

    Science.gov (United States)

    Little, P B; Thorsen, J

    1976-01-01

    Equine viral rhinopneumonitis type I virus was isolated from spinal cord and brain of a paraparetic horse with disseminated necrotizing myeloencephalitis. Necrotic arteriolitis,nonsuppurative necrotizing myeloencephalitis and Gasserian ganglioneuritis were present. On record were 12 more cases of horses with similar lesions. The horses had been ataxic or paretic for up to several weeks. A field survey indicated that 14 of 24 horses with acute myelitic signs developed them after recent exposure to respiratory disease.

  15. Case Report of Necrotizing Fasciitis Associated with Streptococcus pneumoniae

    Directory of Open Access Journals (Sweden)

    Lei Jiao

    2016-01-01

    Full Text Available Necrotizing fasciitis, caused by Streptococcus pneumoniae, is an extremely rare and life-threatening bacterial soft tissue infection. We report a case of early necrotizing fasciitis associated with Streptococcus pneumoniae infection in a 26-year-old man who was immunocompromised with mixed connective tissue disease. The patient presented with acute, painful, erythematous, and edematous skin lesions of his right lower back, which rapidly progressed to the right knee. The patient underwent surgical exploration, and a diagnosis of necrotizing fasciitis was confirmed by pathological evidence of necrosis of the fascia and neutrophil infiltration in tissue biopsies. Cultures of fascial tissue biopsies and blood samples were positive for Streptococcus pneumoniae. To our knowledge, this is the first report of necrotizing fasciitis resulting from Streptococcus pneumoniae diagnosed at early phase; the patient recovered well without surgical debridement.

  16. Value of plasmapheresis in hepatic encephalopathy.

    Science.gov (United States)

    Riviello, J J; Halligan, G E; Dunn, S P; Widzer, S J; Foley, C M; Breningstall, G N; Grover, W D

    1990-01-01

    Plasmapheresis is used for treating the complications of liver failure. We performed plasmapheresis on 6 children with hepatic encephalopathy resulting from acute hepatic failure and prospectively assessed its effects on neurologic and electrophysiologic (electroencephalography and evoked potentials) function. Clinical improvement was observed in 3 of 6 patients; changes in the serum ammonia value or the results of initial electrophysiologic tests did not predict the patient response. Two patients underwent transplantation after neurologic improvement was produced by plasmapheresis; however, despite plasmapheresis, 4 patients progressed to brain death. Our data demonstrate that plasmapheresis may transiently improve the encephalopathy of acute hepatic failure but is not curative alone. Therefore, plasmapheresis may be a useful adjunct in the treatment of liver failure, potentially improving the pretransplantation status of the patient.

  17. [Hashimoto's encephalopathy - rare encephalopathy with good prognosis].

    Science.gov (United States)

    Kaczmarczyk, Aleksandra; Patalong-Ogiewa, M; Krzystanek, E

    2016-01-01

    Hashimoto's encephalopathy (HE) is a rare neuropsychiatric syndrome associated with increased level of antithyroid antibodies. Two types of clinical manifestation can be described: a vasculitic type with stroke like episodes and diffuse progressive type with deterioration of mental function. Neurologic symptoms are present in euthyreosis as well as in thyroid dysfunction. Because of good response to immunosuppressive therapy, the prompt diagnosis and management of HE are crucial. In this study we present the review of current literature and discuss two representative cases.

  18. Complicated necrotizing otitis externa.

    Science.gov (United States)

    Nawas, Mariam T; Daruwalla, Vistasp J; Spirer, David; Micco, Alan G; Nemeth, Alexander J

    2013-01-01

    Necrotizing (malignant) otitis externa (NOE) is a rare and invasive infection originating in the external acoustic meatus seen most commonly in diabetes and other immunocompromised states. After a protracted course, disease can smolder and extend into the mastoid, skull base, dural sinuses, and intracranially. We present a case of NOE complicated by mastoiditis, dural sinus thrombosis, and Bezold's abscess in an uncontrolled diabetic presenting with a prolonged course of facial nerve palsy. We stress the importance of maintaining a high index of clinical suspicion for NOE in diabetic patients and offering timely, aggressive treatment to mitigate its complications.

  19. 急性出血坏死性胰腺炎大鼠肠道免疫功能的改变%Intestinal mucosal immune barrier injury of rats with acute hemorrhagic necrotic pancreatiti

    Institute of Scientific and Technical Information of China (English)

    金英朝; 王海宽; 张弘超; 李小东; 刘大伟

    2015-01-01

    ObjectiveTo observe intestinal mucosal immune barrier relative factors TNF-α in serum, sIgA levels of intestinal juice, and CD3+ and CD4+ cell change of intestinal tissue in rats with acute hemorrhagic necrotic pancreatitis. To investigate the change of intestinal mucosal immune barrier injury in this model.Methods36 wistar rats were randomly divided into three groups: SAP model group(A group), the sham operation control group (B group) (N = 18). Abdominal aortic and Portal vein blood were collected, and stored in refrigerator for next assays. Intestinal juice were collected and stored in refrigerator for next assays. The intestinal tissue were ifxed in 4% neutral formaldehyde buffer. TNF-α concentration of blood and sIgA levels of intestinal juice were evaluated by ELISA method. Immunohistochemistry was adopted to detect intestinal tissue CD3+ and CD4+ expression. Endotoxin levels of portal vein blood was detected following the kit instruction.ResultsTesting the indicators after model building of each group,we have the following ifndings: In group A, Blood TNF-a and sIgA levels of intestinal juice are signiifcantly lower than that in the group B, while endotoxin levels of portal vein blood signiifcantly higher. The expression of CD3+ and CD4+ T immune cell are signiifcantly lower in group A.ConclusionThis study conifrmed the participation of the intestinal mucosal immune barrier function injury are important inlfammatory disorders in acute pancreatitis in rats with acute hemorrhagic necrotic pancreatitis.%目的:探讨分析急性出血坏死性胰腺炎(AHNP)大鼠肠道黏膜免疫功能的变化情况。方法选取成年的Wistar雄性大鼠,随机分成AHNP组、假手术组。分别于造模后24 h取标本检测(主要包括内毒素的含量、CD3、CD4及CD8的阳性T淋巴细胞的比例、盲肠内容物sIgA的浓度,血清肿瘤坏死因子-α(TNF-α)的水平等。结果 AHNP组各时间段的门静脉血内毒素含量均有显著

  20. Thiamine in the treatment of Wernicke encephalopathy in patients with alcohol use disorders.

    Science.gov (United States)

    Latt, N; Dore, G

    2014-09-01

    Wernicke encephalopathy is an acute, reversible neuropsychiatric emergency due to thiamine deficiency. Urgent and adequate thiamine replacement is necessary to avoid death or progression to Korsakoff syndrome with largely irreversible brain damage. Wernicke Korsakoff syndrome refers to a condition where features of Wernicke encephalopathy are mixed with those of Korsakoff syndrome. Although thiamine is the cornerstone of treatment of Wernicke encephalopathy, there are no universally accepted guidelines with regard to its optimal dose, mode of administration, frequency of administration or duration of treatment. Currently, different dose recommendations are being made. We present recommendations for the assessment and treatment of Wernicke encephalopathy based on literature review and our clinical experience.

  1. Necrotizing faciitis: report of case.

    Science.gov (United States)

    Mruthyunjaya, B

    1981-01-01

    A case of necrotizing fasciitis following infection of a mandibular third molar is reported. Necrotizing fasciitis is a relatively rare but fulminating clinical entity characterized by necrosis of fascia with widespread undermining of the superficial tissue and extreme systemic toxicity. Prompt recognition and proper management can reduce the morbidity and mortality in this severe soft tissue infection.

  2. The encephalopathy of sepsis.

    Science.gov (United States)

    Jackson, A C; Gilbert, J J; Young, G B; Bolton, C F

    1985-11-01

    Twelve fatal cases of encephalopathy associated with sepsis were examined in a ten-year retrospective study. The sources of infection and organisms isolated were variable. Six of the patients had focal neurologic signs; five had seizures. The level of consciousness varied from drowsiness to deep coma, and electroencephalograms revealed diffuse or multifocal abnormalities. Computed tomographic head scans and cerebrospinal fluid examinations were usually unremarkable. Eight patients had disseminated microabscesses in the brain at autopsy. Four patients had proliferation of astrocytes and microglia in the cerebral cortex, a feature associated with metabolic encephalopathies. Additional findings included cerebral infarcts, brain purpura, multiple small white matter hemorrhages, and central pontine myelinolysis. Although sepsis may cause encephalopathy by producing disturbances in cerebral synaptic transmission and cerebral energy production through a toxic mechanism, bacterial invasion of the brain with the formation of disseminated microabscesses is also an important cause.

  3. Minimal hepatic encephalopathy.

    Science.gov (United States)

    Zamora Nava, Luis Eduardo; Torre Delgadillo, Aldo

    2011-06-01

    The term minimal hepatic encephalopathy (MHE) refers to the subtle changes in cognitive function, electrophysiological parameters, cerebral neurochemical/neurotransmitter homeostasis, cerebral blood flow, metabolism, and fluid homeostasis that can be observed in patients with cirrhosis who have no clinical evidence of hepatic encephalopathy; the prevalence is as high as 84% in patients with hepatic cirrhosis. Physician does generally not perceive cirrhosis complications, and neuropsychological tests and another especial measurement like evoked potentials and image studies like positron emission tomography can only make diagnosis. Diagnosis of minimal hepatic encephalopathy may have prognostic and therapeutic implications in cirrhotic patients. The present review pretends to explore the clinic, therapeutic, diagnosis and prognostic aspects of this complication.

  4. Wernicke’s encephalopathy following hyperemesis gravidarum

    Directory of Open Access Journals (Sweden)

    Leila Pourali

    2016-06-01

    Full Text Available Background: ″Wernicke’s Korsakoff″ syndrome is the most important complication of severe thiamine deficiency. The term refers to two different syndromes, each representing a different stage of the disease. Wernicke’s encephalopathy (WE is an acute syndrome requiring emergent treatment to prevent death and neurologic morbidity. Korsakoff syndrome (KS refers to a chronic neurologic condition that usually occurs as a consequence of WE. It is a rare complication of hyperemesis gravidarum that confusion, ocular signs, and gait ataxia are the most prevalent symptoms, respectively. Typical brain lesions of wernicke’s encephalopathy (WE are observed at autopsy in 0.4 to 2.8 percent of the general population in the western world and the majority of affected patients are alcoholic. The prevalence of wernicke’s encephalopathy lesions seen on autopsy was 12.5% of alcohol abusers in one report. Among those who with alcohol-related death, it has been reported to be even higher, 29 to 59%. The aim of this study was to report a case of wernicke’s encephalopathy following hyperemesis gravidarum. Case Presentation: A 28-year-old-pregnant woman in 19th weeks of gestation referred to the hospital with hyperemesis, gait ataxia, and dysarthria before that she had hyperemesis gravidarum with weight loss and unresponsive to outpatient and inpatient medical therapy. MRI showed hyperdense lesion around thalamus which was characteristic of wernicke’s encephalopathy. Rapid improvement in patient’s condition occurred after high dose thiamine infusion. Conclusion: In hyperemesis gravidarum, presence of either symptoms of ocular or mental disorder or ataxia must be considered to rule out and appropriate treatment of Wernicke’s syndrome which can cause maternal and fetal death.

  5. Psychopathology and Hepatic Encephalopathy

    Directory of Open Access Journals (Sweden)

    João Gama Marques

    2013-12-01

    Full Text Available Since Hippocrates that neuropsychiatric illness secondary to liver disease fascinates physicians, but only in the XIX century Marcel Nencki and Ivan Pavlov suggested the relation between high concentrations of ammonia and Hepatic Encephalopathy (HE. The reaction of ammonia and glutamate (origins glutamine, “the Trojan Horse of neurotoxicity of ammonia continues to be the main responsible for the neurologic lesions, recently confirmed by neurochemistry and neuroimagiology studies. Glutamine starts the inflammatory reaction at the central nervous sys- tem but other important actors seem to be manganese and the neurotransmitters systems of GABA and endocanabinoids. Nowadays there are three different etiologic big groups for HE: type A associated with acute liver failure; type B associated with portosystemic bypass; and type C associated with cirrhosis of the liver. The staging of HE is still based on classic West Haven system, but a latent Grade 0 was introduced (the so called minimal HE; remaining the aggra- vating HE from Grade 1 (subtle changes at clinical examination to Grade 4 (coma. In this work a bibliographic review was made on 30 of the most pertinent and recent papers, focusing in psychopathology, physiopathology, etiology and staging of this clinical entity transversal to Psychiatry and Gastroenterology. Alterations are described in vigility and conscience like temporal, spatial and personal disorientation. Attention, concentration and memory are impaired very early, on latent phase and can be accessed through neuropsychological tests. Mood oscillates between euphoric and depressive. Personality changes begin obviously and abruptly or in a subtle and insidious way. There can be changes in perception like visual hallucinations or even of acoustic-verbal. The thought disorders can be of delusional type, paranoid, systematized or not, but also monothematic ala Capgras Syndrome. Speech can be accelerated, slowed down or completely in

  6. Clinical diagnosis and treatment of necrotizing ulcerative gingivitis in the orthodontic patient. A case report.

    Directory of Open Access Journals (Sweden)

    Jesús Rodríguez-Pulido

    2016-04-01

    Full Text Available Introduction: About 0.1% of the population suffers from necrotizing ulcerative gingivitis, a disease of rapid progression and acute manifestation, which may progress to necrotizing ulcerative periodontitis and eventually to bone sequestration and loss of gingival tissue. Case report: A 21-year-old female patient undergoing orthodontic treatment for six months, diagnosed with necrotizing ulcerative gingivitis due to acute pain in the gingival tissue, spontaneous bleeding, halitosis and abundant plaque. The treatment was conservative and effective, obtaining total remission of the lesion after seven days and three months of postoperative follow-up. Conclusion: Today there are no epidemiological or clinical reports that support the relationship of necrotizing ulcerative gingivitis and orthodontic treatment. Prevention is critical to the success of the treatment, which is why the dentist should recognize the clinical features of necrotizing ulcerative gingivitis to raise awareness of its risks in the orthodontic patient.

  7. Cervical necrotizing fasciitis.

    Science.gov (United States)

    Maisel, R H; Karlen, R

    1994-07-01

    Nine cases of cervical necrotizing faciitis are presented. Five were odontogenic, three were pharyngeal in origin, and one developed from a soft-tissue spider bite. The bacteriology represented a polyculture of gram-positive, gram-negative, as well as anaerobic bacteria, and initial medical treatment by third-generation cephalosporin and metronidazole or clindamycin was successful and is recommended. Airway control is necessary early, as is a wide exploration of the fascial spaces of the neck, with frequent reexploration in either the operating room or at the bedside to evaluate the effects of treatment and to prevent further progression of the disease. Intensive medical support is crucial, and hyperbaric oxygen is advised for patients who are deteriorating under standard therapy.

  8. Treatment of necrotizing pancreatitis

    NARCIS (Netherlands)

    Brunschot, S. van; Bakker, O.J.; Besselink, M.G.; Bollen, T.L.; Fockens, P.; Gooszen, H.G.; Santvoort, H.C. van; Dutch Pancreatitis Study, G.

    2012-01-01

    Acute pancreatitis is a common and potentially lethal disease. It is associated with significant morbidity and consumes enormous health care resources. Over the last 2 decades, the treatment of acute pancreatitis has undergone fundamental changes based on new conceptual insights and evidence from cl

  9. Management of covert hepatic encephalopathy.

    Science.gov (United States)

    Waghray, Abhijeet; Waghray, Nisheet; Mullen, Kevin

    2015-03-01

    Hepatic encephalopathy is a reversible progressive neuropsychiatric disorder that encompasses a wide clinical spectrum. Covert hepatic encephalopathy is defined as patients with minimal hepatic encephalopathy and Grade I encephalopathy by West-Haven Criteria. Terminology such as "sub-clinical", "latent", and "minimal" appear to trivialize the disease and have been replaced by the term covert. The lack of clinical signs means that covert hepatic encephalopathy is rarely recognized or treated outside of clinical trials with options for therapy based on patients with episodic hepatic encephalopathy. This review discusses the current available options for therapy in covert hepatic encephalopathy and focuses on non-absorbable disacharides (lactulose or lactitol), antibiotics (rifaximin), probiotics/synbiotics and l-ornithine-l-aspartate.

  10. Is it necrotizing fasciitis or necrotizing cellulitis after varicella zoster infection? Two case reports.

    Science.gov (United States)

    Gundeslioglu, Ayse Ozlem; Selimoglu, Muhammed Nebil; Toy, Hatice

    2014-08-01

    Necrotizing fasciitis and necrotizing cellulitis are serious cutaneous complications in varicella patients. Differentiation of necrotizing cellulitis from necrotizing fasciitis can initially be challenging because of indistinct clinical course at the onset of infection and the lack of definitive diagnostic criteria. This paper reports 2 children with necrotizing cellulitis that developed after varicella infection to draw the attention of health care providers to necrotizing cellulitis that showed slower clinical course than necrotizing fasciitis and recovered with conservative treatment approaches without aggressive surgical intervention.

  11. Cerebral lesions in acute arterial hypertension: the characteristic MRI in hypertensive encephalopathy; Zerebrale Veraenderungen bei krisenhafter arterieller Hypertonie: MRT-Befunde der hypertensiven Enzephalopathie sind wegweisend fuer Diagnose und Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, J.P.; Krohmer, S. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Abt. Neuroradiologie, Universitaetsklinikum Leipzig AoeR (Germany); Guenther, A. [Klinik und Poliklinik fuer Neurologie, Universitaetsklinikum Leipzig AoeR (Germany); Zimmer, C. [Abt. fuer Neuroradiologie, Klinikum rechts der Isar der TU Muenchen (Germany)

    2006-06-15

    Purpose: in the nine years since the posterior reversible (leuc) encephalopathy syndrome (PRES) was first described, a number of causes have been under discussion. These not only include arterial hypertension, i. e. hypertensive crises, but also various toxic substances, i. e. immunosuppressive or chemotherapeutic agents, that are responsible for the formation of the symptoms and characteristic MR tomographic brain findings. Materials and methods: initial and follow-up MRI examinations of 8 patients were analyzed. All patients had acute neurological symptoms (headaches, seizures, visual disorders and vigilance disturbances) together with a detectable hypertensive crisis. Results: MRI disclosed increased signal intensity in subcortical and some cortical lesions in all patient FLAIR sequences. These changes were particularly extensive in the posterior circulation (occipital, cerebellum and brain stem) although they were also detected in brain areas supplied by the carotid artery. However, a cytotoxic genesis of the changes was ruled out in each patient by means of a normal DWI. Furthermore, when the blood pressure was normalized, reversibility of the lesions as proof of the diagnosis was detectable. (orig.)

  12. Bovine Spongiform Encephalopathy

    Science.gov (United States)

    Bovine spongiform encephalopathy (BSE) is caused by a novel contagion, known to as a prion. Prions are proteins capable of converting a normal cellular protein into a prion, thereby propagating an infection. BSE is the first known prion zoonotic. As such it has attracted broad scientific and, to a r...

  13. An experimental model of acute encephalopathy after total body irradiation in the rat: effect of Ginkgo biloba extract (EGb 761); Effet de l'extrait de Ginkgo biloba (EGb 761) chez le rat sur un modele experimental d'encephalopathie aigue apres irradiation corporelle totale

    Energy Technology Data Exchange (ETDEWEB)

    Lamproglou, I.; Bok, B. [Hopital Bichat, 75 - Paris (France); Boisserie, G.; Mazeron, J.J.; Baillet, F. [Hopital Pitie-Salpetriere, 75 - Paris (France); Drieu, K. [IHB-IPSEN, 75 - Paris (France)

    2000-06-01

    To define the therapeutic effect of Ginkgo biloba extract (EGb 761) in an experimental model of acute encephalopathy following total body irradiation in rats. Ninety four-month-old rats received 4.5 Gy total body irradiation (TBI) at day 1 while 15 rats received sham irradiation. A behavioural study based on a conditioning test of negative reinforcement, the one-way avoidance test, was performed test, was performed after irradiation. Orally treatment was started one day (study A) or twenty two days (study B) after irradiation and repeated daily for twelve days. In the irradiated group, three subgroups were defined according to the treatment received: EGb 761 (50 mg/kg), EGb 761 (100 mg/kg), water. This work comprised two consecutive studies. In study A (45 rats) the one-way avoidance test was administered daily from day 7 to day 14. In study B (45 rats) the behavioural test was performed from day 28 to day 35. Study A (three groups of 15 rats): following TBI, irradiated rats treated with water demonstrated a significant delay in a learning the one-way avoidance test in comparison with sham-irradiated rats (P < 0.0002) or irradiated rats treated with EGb 761 (50 mg/kg; P < 0.007) or EGb 761 (100 mg/kg; P < 0.0002). The irradiated rats, treated with EGb 761 (50 or 100 mg/kg) did not differ from the sham-irradiated controls. Study B (three groups of 15 rats): the irradiated rats, treated with water of EGb 761 (50 or 100 mg/kg) did not differ from the sham-irradiated controls. (authors)

  14. Pauci-immune necrotizing glomerulonephritis

    NARCIS (Netherlands)

    Rutgers, Abraham; Sanders, Jan S F; Stegeman, Coen A; Kallenberg, Cees G M

    2010-01-01

    Pauci-immune necrotizing glomerulonephritis is the most frequent cause of rapidly progressive glomerulonephritis and, in most cases, is associated with antineutrophil cytoplasmic antibodies (ANCA). It is either the renal manifestation of Wegener's granulomatosis, microscopic polyangiitis of Churg-St

  15. A case of chronic Wernicke's encephalopathy: A neuropsychological study

    NARCIS (Netherlands)

    Oudman, Erik; Van der Stigchel, Stefan; Postma, Albert; Wijnia, Jan W.; Nijboer, Tanja C W

    2014-01-01

    A 54-year-old woman was referred to our Korsakoff Center because of extensive cognitive problems following acute Wernicke's encephalopathy (WE). She had a relatively short history of alcohol abuse and was found lying on the floor in her home by her son. After 5 days without treatment, she was diagno

  16. Antithyroperoxidase Antibodies in Encephalopathy : Diagnostic Marker or Incidental Finding?

    NARCIS (Netherlands)

    Dontje, B.; Van Santen, H. M.; Niermeijer, J. M.; Schonenberg-Meinema, D.; Van Trotsenburg, A. S P

    2016-01-01

    Patients with acute encephalopathy who are thoroughly examined for an underlying diagnosis and in whom infectious, metabolic, and malignant causes are excluded can form a true diagnostic dilemma. If antithyroperoxidase antibodies (anti-TPO abs) are present, the diagnosis steroid responsive encephalo

  17. Pediatric Cervicofacial Necrotizing Fasciitis

    Science.gov (United States)

    King, Ericka; Chun, Robert; Sulman, Cecille

    2015-01-01

    Objective To present a case of a pediatric cervicofacial necrotizing fasciitis (NF), a rapidly progressive infection, and a review of a 10-year pediatric inpatient database. Design Case report and review. Setting Pediatric intensive care unit. Patients A healthy 5-year-old male who developed NF of the lower lip 36 hours following minor trauma. International Classification of Diseases, Ninth Revision, code 728.86 (NF), was the inclusion criteria for the Kids’ Inpatient Database (KID) in 1997 and 2006. Results A pediatric case is presented with a thorough photographic record demonstrating the need for rapid diagnosis and treatment. In a review of the KID from 1997 and 2006, the relative risk of being discharged with NF in 2006 vs 1997 was 1.4 (95% CI, 9.95-2.28). Age at diagnosis of NF was older in 2006 compared with 1997 (11.5 years vs 8.05 years; Ppediatric discharges with a diagnosis of NF compared with discharges without a diagnosis of NF (Pnecrotizing fasciitis with aggressive medical and surgical treatment are still the foundation in disease survival. PMID:22508620

  18. Probiotics and necrotizing enterocolitis.

    Science.gov (United States)

    Fleming, Paul; Hall, Nigel J; Eaton, Simon

    2015-12-01

    Probiotics for the prevention of necrotizing enterocolitis have attracted a huge interest. Combined data from heterogeneous randomised controlled trials suggest that probiotics may decrease the incidence of NEC. However, the individual studies use a variety of probiotic products, and the group at greatest risk of NEC, i.e., those with a birth weight of less than 1000 g, is relatively under-represented in these trials so we do not have adequate evidence of either efficacy or safety to recommend universal prophylactic administration of probiotics to premature infants. These problems have polarized neonatologists, with some taking the view that it is unethical not to universally administer probiotics to premature infants, whereas others regard the meta-analyses as flawed and that there is insufficient evidence to recommend routine probiotic administration. Another problem is that the mechanism by which probiotics might act is not clear, although some experimental evidence is starting to accumulate. This may allow development of surrogate endpoints of effectiveness, refinement of probiotic regimes, or even development of pharmacological agents that may act through the same mechanism. Hence, although routine probiotic administration is controversial, studies of probiotic effects may ultimately lead us to effective means to prevent this devastating disease.

  19. Trombosis de la vena yugular interna y mediastinitis aguda necrosante descendente debido a una faringoamigdalitis aguda Thrombosis of the internal jugular vein and descending necrotizing mediastinitis due to acute pharyngotonsilitis

    Directory of Open Access Journals (Sweden)

    Celia Sánchez Acedo

    2010-09-01

    Full Text Available El síndrome de Lemierre es una patología muy infrecuente en la época actual, pero muy grave, y siempre debe considerarse ante un cuadro de fiebre con antecedente de infección orofaríngea, tumefacción laterocervical a lo largo del músculo esternocleidomastoideo y signos de sepsis. El diagnóstico de este síndrome es fundamentalmente clínico, y las pruebas complementarias tan sólo ayudan a confirmar el cuadro. Presentamos el caso de un varón de 31 años que acudió a urgencias con clínica de faringoamigdalitis junto con tumefacción en la región submandibular izquierda e importante dolor cervical ipsilateral, que mostró un deterioro rápido y progresivo del estado general pese al tratamiento antibiótico intravenoso. Finalmente tuvo que ser intervenido debido al desarrollo de mediastinitis aguda necrosante descendente desde la región pretiroidea hasta el diafragma, con trombosis de la vena yugular interna izquierda. Se le realizó toracotomía urgente y cervicotomía izquierda con drenaje de abundante material purulento y ligadura de la vena yugular interna.Lemierre syndrome is a potentially fatal condition after an oropharyngeal infection. It is characterized by thrombophlebitis of head and neck veins with systemic dissemination of septic emboli. The diagnosis of this syndrome is mainly clinical and complementary test only serve as aid to confirm it. We report an unusual case of Lemierre syndrome in a 31-year-old man caused by Gemella spp. and Streptococcus pyogenes. It developed following a pharyngotonsillitis infection, which deteriorated rapidly and progressively despite intravenous antibiotic treatment. He finally had to be intervened due to developing acute descending necrotizing mediastinitis from the pre-thyroid region to the diaphragm, with thrombosis of the internal jugular vein. An urgent thoracotomy and left cervicotomy was performed, with drainage of abundant purulent material and ligature of the internal jugular vein

  20. Encefalopatia hipóxico-isquêmica em recém-nascidos a termo: aspectos da fase aguda e evolução Perinatal hypoxic-ischemic encephalopathy: acute period and outcome

    Directory of Open Access Journals (Sweden)

    Carolina A. R. Funayama

    1997-01-01

    Full Text Available Noventa e quatro recém-nascidos com encefalopatia hipóxico-isquêmica (EHI, atendidos no Hospital das Clínicas de Ribeirão Preto desde 1982, foram avaliados evolutivamente na fase aguda e por período médio de 47 meses. De 43 casos com EHI 1,40 se recuperaram em 96 horas e 3 faleceram. Dos 40 com EHI II, 37,5% se recuperaram até o sétimo dia e demais permaneceram com alterações. Os 11 casos com grau III faleceram até o segundo mês de vida. As crianças com EHI grau I não apresentaram seqüelas motoras. Do grupo com EHI grau II 34,5% apresentaram paralisia cerebral e 17,7% atraso neuromotor. 80% dos casos com sequela apresentaram exame neurológico anormal além do sétimo dia, na fase aguda da EHI. Epilepsia ocorreu em 17,5% dos casos com EHI grau II e somente no grupo com seqüelas motoras. Teste de QI não evidenciou diferença significativa entre os grupos com grau I, II sem seqüelas motoras e o grupo controle. Com esses dados os autores reafirmaram a importância prognostica da evolução da EHI na fase aguda.Ninety four neonates with hypoxic ischemic encephalopathy HIE attended at the University of Ribeirão Preto since 1982 were studied in terms of the neurological alterations during the acute phase and outcome over a mean period of 47 months. From 43 newborns with HIE I, 40 recovered within 96 hours and 3 died. Among 40 infants with HIE II, 37.5% recovered within the first week, and the others continued abnormal beyond the 7th day. All 11 infants with HIE III died before the second month of life. The HIE I group had no motor sequelae. Among the HIE II group, 34.5% showed cerebral palsy and 17.7% neuromotor retardation. 80.0% of those with sequelae persisted abnormal beyond 7th day of life, during the acute phase of the HIE. Epilepsy occurred in 17.5% of cases with HIE grade II, only among those with neuromotor sequelae. The 1Q test did not show statistically significant difference between the HIE I, II without motor sequelae

  1. 急性脑病起病的晚发枫糖尿症%Acute encephalopathy due to late-onset maple syrup urine disease in a school boy

    Institute of Scientific and Technical Information of China (English)

    屈素清; 杨丽彩; 栾佐; 杜侃; 杨辉

    2012-01-01

    枫糖尿症(maple syrup urine disease,MSUD)是一种较常见的氨基酸代谢障碍性疾病.患者通常在新生儿期至婴幼儿期发病,学龄期以急性脑病起病的病例未见报道.本文报道1例MSUD患儿,8岁6个月首次发病,以感染后急性脑病症状为主要临床表现,于发病第2天时来院,一般化验发现代谢性酸中毒、血尿酸增高、脑脊液蛋白质降低,头颅磁共振扫描显示双侧小脑齿状核、脑干、双侧丘脑、壳核、尾状核及双侧大脑半球皮层呈现长T1,长T2信号,头颅弥散频谱(DWI)示以上部位呈明显高信号.血代谢检查示:血亮氨酸/异亮氨酸、缬氨酸显著高于正常范围;尿液代谢结果示:2-羟基异戊酸、2-羟基丁酸、2-酮异戊酸和2-酮异己酸亦显著增高,提示MSUD.同时游离肉碱明显降低,提示继发性肉碱缺乏、酮症.经控制氨基酸摄入,予大剂量维生素B1、葡萄糖、左旋肉碱静脉点滴,入院后第5天病情明显好转,第7天病情完全恢复,未遗留任何中枢神经系统后遗症.根据患儿治疗效果考虑为硫胺有效型.继续给予维生素B1口服,控制蛋白质饮食(每日1 g/kg)治疗1个半月后复查,血、尿代谢结果完全正常,复查头颅MRI结果明显改善.对以急性脑病起病的病例,要警惕遗传代谢性疾病的可能.如能及时诊断、正确治疗,可以有效地预防中枢神经系统后遗症的发生,改善预后.%Maple syrup urine disease is a common amino acids metabolic disease. In most patients, onset occurs in the neonatal period and infancy. In this study, the case of a school boy with acute encephalopathy due to late-onset maple syrup urine disease is summarized. The boy (8.5 years) was admitted because of acute encephalopathy after suffering from infection for two days at the age of eight and a half years. Metabolic acidosis, hyperuricemia and decreased protein level in cerebrospinal fluid were found by general laboratory tests. Magnetic

  2. Necrotizing vasculitis in acute postinfectious glomerulonephritis

    OpenAIRE

    Riyuso,Márcia C; CARVALHO Maria Fernanda C.; Trindade,Amélia A. T; Luciana B. Mendonça; Saggioro, Fabiano P.; Viero, Rosa Marlene

    2004-01-01

    Os autores relatam dois casos de glomerulonefrite difusa aguda pós-infecciosa com evolução clinicomorfológica incomum. As biópsias renais mostraram alterações características de glomerulonefrite difusa aguda associada à extensa necrose fibrinóide e infiltrado inflamatório leucocitário na parede de arteríolas e artérias interlobulares. Foram também observadas crescentes. Ambos os pacientes cursaram com insuficiência renal aguda severa, sendo que um dos pacientes recuperou a função renal e outr...

  3. Approach to Clinical Syndrome of Jaundice and Encephalopathy in Tropics

    OpenAIRE

    Anand, Anil C.; Garg, Hitendra K.

    2014-01-01

    A large number of patients present with jaundice and encephalopathy in tropical country like India and acute liver failure is the usual cause. Clinical presentation like ALF is also a complication of many tropical infections, and these conditions may mimic ALF but may have subtle differences from ALF. Moreover, what hepatologists see as acute liver failure in tropics is different from what is commonly described in Western Textbooks. Paracetamol overdose, which is possibly the commonest cause ...

  4. Fatal rhinocerebral mucormycosis under the shade of hepatic encephalopathy.

    Science.gov (United States)

    Ataseven, Hilmi; Yüksel, Ilhami; Gültuna, Selcan; Köklü, Seyfettin; Uysal, Serkan; Basar, Omer; Sasmaz, Nurgül

    2010-01-01

    Mucormycosis is an acutely fatal infection that occurs in immuncompromised patients. Cirrhosis is an acquired immune deficiency state and those patients are more prone to develop opportunistic infections. A 42-years-old cirrhotic man was admitted to our gastroenterology clinic with hepatic encephalopathy. Although he recovered from encephalopathy with supportive measurements, he developed paresthesia on the face. He was diagnosed with rhinocerebral mucormycosis and antifungal therapy was administered. Surgical treatment couldn.t be performed because of his bleeding diathesis and poor general condition. He succumbed on the 12th day of his admission.

  5. Hepatic Encephalopathy: Early Diagnosis in Pediatric Patients With Cirrhosis

    OpenAIRE

    2013-01-01

    How to Cite This Article: Dara N, Sayyari AA, Imanzadeh F. Hepatic Encephalopathy: Early Diagnosis in Pediatric Patients With Cirrhosis. Iran J Child Neurol. 2014 Winter; 8(1):1-11.ObjectiveAs acute liver failure (ALF) and chronic liver disease (cirrhosis) continue to increase in prevalence, we will see more cases of hepatic encephalopathy.Primary care physician are often the first to suspect it, since they are familiar with the patient’s usual physical and mental status. This serious complic...

  6. Hyperammonemic Encephalopathy due to Valproic Acid and Topiramate Interaction

    Directory of Open Access Journals (Sweden)

    Jennifer D. Twilla

    2014-01-01

    Full Text Available Valproic acid-induced hyperammonemic encephalopathy is a rare yet serious adverse drug reaction. Medication interactions such a valproic acid and topiramate can precipitate an event. We present the case of a 52-year-old female that presented with acute mental status change and hypersomnolence due to hyperammonemia caused by a valproic acid derivative. The patient improved after withdrawal of the offending medications and treatment with lactulose. Clinicians should remain hypervigilant in monitoring for valproic acid-induced hyperammonemic encephalopathy and risk factors such as polypharmacy.

  7. Recovery of cognitive dysfunction in a case of delayed encephalopathy of carbon monoxide poisoning after treatment with donepezil hydrochloride

    Directory of Open Access Journals (Sweden)

    Wang Pin

    2009-01-01

    Full Text Available Delayed encephalopathy following carbon monoxide poisoning is a serious complication. Here, we report a patient with delayed encephalopathy who suffered from cognitive disorders and urinary incontinence after a temporal normal period of 15 days after acute intoxication, and his cognitive function recovered gradually following donepezil hydrochloride treatment. Now, he can undertake slight farming work.

  8. [Necrotizing fasciitis of the neck].

    Science.gov (United States)

    Kovacić, Marijan; Kovacić, Ivan; Delalija, Boris

    2013-03-01

    Necrotizing fasciitis is a rare and rapidly progressive infection characterized by necrosis of the superficial fascia and spread on the surrounding skin or muscles, which can be fatal. It usually occurs in the limbs, abdominal wall and perineum. In this retrospective review, the authors present 15 patients with cervical necrotizing fasciitis. The patient mean age was 54.7 years and they had one or more comorbid health problems. Five of them had descending necrotizing mediastinitis and three had progressive sepsis with toxic shock syndrome. Broad-spectrum intravenous antibiotic therapy was administered to all patients immediately, and in three of them we used five-day intravenous immunoglobulin therapy for the signs of toxic shock syndrome. After positive computed tomography imaging for necrotizing fasciitis, we used surgical exploration and debridement of necrotic tissue. In five patients, the initial surgery also included mediastinal transcervical drainage. Preoperative tracheotomy was performed in six patients and delayed tracheotomy in one patient. Histopathologically, all cases showed extensive necrosis of debrided fascia and vascular thrombosis of the neck soft tissue. The mortality rate was 6.7% (1/15). The authors point to the importance of early diagnosis and timely surgical management, broad-spectrum antibiotics and intravenous immunoglobulin therapy when patients are too unstable to undergo surgery.

  9. Unusual tomographic findings of complicated necrotizing pancreatitis

    Directory of Open Access Journals (Sweden)

    Rosa Maria Silveira Sigrist

    2013-12-01

    Full Text Available Acute pancreatitis (AP is a potential life-threatening disease, which originates from inflammatory involvement of the pancreas and surrounding tissues. Serious complications eventuate and treatment is difficult. AP is classified in both interstitial edematous pancreatitis, which occurs in 70-80% of patients, and necrotizing pancreatitis, which occurs in 20-30% of patients. Diagnosis is based on the presence of two of the following criteria: abdominal pain, increased serum determination of amylase and/or lipase more than three times the reference value, and characteristic tomographic findings. Among the latter, there is the pancreatic and surrounding tissue damage as well as that related to distant organ involvement. This case report shows the fatal case of a male patient with a history of heavy alcoholic abuse admitted with the diagnosis of necrotizing pancreatitis. The authors call attention to the unusual tomographic findings; namely, a huge duodenal hematoma and a large hemoperitoneum, ischemic involvement of the spleen and kidneys, as well as pancreatic and peripancreatic necrosis.

  10. Necrotizing enterocolitis Enterocolitis necrosante.

    Directory of Open Access Journals (Sweden)

    Norma Carmenate González

    Full Text Available Necrosantizing enterocolitis constitutes the most frequent and devastator gastrointestinal emergency in newborn patients, affecting especially premature patients and those with low weight (< 1500 g during the two first weeks of life, that by some motive have suffered episodes of anoxy during the labor or shortly after and in which habitually the oral diet has been initiated. It can be seen in small infants, especially in the less than 3 months and associated to diarrhea. It is reported between 15 and 75 cases by each 1000 admissions in a unit of neonatal intensive cares. The mortality varies from 10 to 40%, greater in groups of high risk and is greater than the surgical mortality of all the congenital anomalies of the digestive tract combined. We presented the Good Clinical Practices Guideline for Necrotizing enterocolitis, approved by consensus in the 2nd National Good Clinical Practices Workshop in Pediatric Surgery (Manzanillo, Cuba, September 31 - October 3, 2002.

    La enterocolitis necrosante constituye la emergencia gastrointestinal más frecuente y devastadora del recién nacido, afecta especialmente a los pretérminos y a los de bajo peso al nacer (< 1500 g durante las dos primeras semanas de vida, que por algún motivo han sufrido episodios de anoxia durante el parto o poco después y en los que habitualmente se ha iniciado la alimentación oral. Puede verse en lactantes pequeños, en especial en los menores de tres meses y asociado a cuadros de diarrea. Se reportan entre 15 y 75 casos por cada 1000 admisiones en una unidad de cuidados intensivos neonatales. La mortalidad varía de 10 a 40 %, mayor en grupos de alto riesgo y supera la mortalidad quirúrgica de todas las anomalías congénitas del tracto digestivo combinadas. Se presenta la Guía de Buenas Prácticas Clínicas para Enterocolitis Necrosante, aprobada por consenso en el 2º Taller Nacional de Buenas Prácticas Clínicas en Cirugía Pedi

  11. [Wernicke encephalopathy and Korsakoff's psychosis: clinical-pathophysiological correlation, diagnostics and treatment].

    Science.gov (United States)

    Sivolap, Iu P; Damulin, I V

    2013-01-01

    Wernicke's encephalopathy and Korsakoff's psychosis are severe unfavorable forms of alcoholic brain damage with poor prognosis. Thiamine deficiency represents a common cause of both diseases. In many cases, Korsakoff's psychosis develops in the outcome of Wernicke's encephalopathy, which, along with the general etiology, lets talk about a single disease - Wernicke-Korsakoff syndrome, acute (usually reversible) stage of which is Wernicke's encephalopathy and a chronic one (often irreversible) is Korsakoff psychosis. The dramatic paradox of Wernicke's encephalopathy is that in most cases it is difficult to detect, but early diagnosed cases are quite easy to cure. Unrecognized and therefore go untreated Wernicke's encephalopathy is a serious threat to the health and lives of patients, worsens the processes of brain aging and increases the risk of Alzheimer's disease in later life. The basic approach to the treatment of Wernicke-Korsakoff syndrome is long-term parenteral administration of thiamine, often in high doses. As an adjuvant means of therapy memantine is considered.

  12. Toxic encephalopathy induced by capecitabine.

    Science.gov (United States)

    Niemann, B; Rochlitz, C; Herrmann, R; Pless, M

    2004-01-01

    Toxic encephalopathy is a rarely described side effect of 5-fluorouracil which usually presents with cerebellar, neuropsychiatric, and focal neurological symptoms. Magnetic resonance imaging findings are described as patchy white matter alterations. We report the 1st case of capecitabine-induced toxic encephalopathy with epilepsy-like symptoms and diffuse white matter alterations on magnetic resonance imaging.

  13. Screening of subclinical hepatic encephalopathy

    NARCIS (Netherlands)

    Groeneweg, M; Moerland, W; Quero, J C; Hop, W C; Krabbe, P F; Schalm, S W

    2000-01-01

    BACKGROUND/AIMS: Subclinical hepatic encephalopathy adversely affects daily functioning. The aim of this study was to determine which elements of daily life have predictive value for subclinical hepatic encephalopathy. METHODS: The study was performed in 179 outpatients with liver cirrhosis. Subclin

  14. Genistein Alleviates Neuroinflammation and Restores Cognitive Function in Rat Model of Hepatic Encephalopathy: Underlying Mechanisms.

    Science.gov (United States)

    Ganai, Ajaz Ahmad; Husain, Mohammad

    2017-02-21

    Hepatic encephalopathy (HE) is a neuropsychiatric syndrome resulting from acute liver failure. Previously, we demonstrated hepatoprotective effects of genistein in D-galactosamine (D-GalN)-induced fulminant hepatic failure (FHF). In this study, we evaluated behavioural and neuroprotective effects of genistein in rat model of HE. HE was induced by intraperitonial administration of D-GalN (250 mg/kg BW) twice a week for 30 days Genistein was given as co-treatment through oral gavage daily at dose of 5 mg/kg BW. D-GalN administration significantly resulted in acute liver failure which was further associated with hyperammonemia, neurological dysfunction, as evident from behavioural and functional impairment and reduced learning ability in Morris water maze. Genistein significantly alleviated behavioural and functional impairment and restored learning ability in Morris water maze. Considerable histopathological changes, including portal inflammation, sinusoidal dilation, necrotic lesions and swelled astrocytes with pale nuclei, were seen in the liver and brain sections of D-GalN-challenged rats while genistein co-treated rats revealed normal cellular and morphological architecture as no pathological features were seen. Furthermore, pro-inflammatory markers (interleukin (IL)-10, IL-4, IL-1β and TNF-α) and membrane expression of subunits α1 of GABAA receptor and GluR2 of AMPA marked significant increase, while subunits GluR1 of AMPA receptors showed reduced expression in D-GalN-challenged rats leading to neuroinflammation and dysregulated neurotransmission. Genistein significantly normalized altered expression of pro-inflammatory cytokines and membrane receptor of GABA and GluR. Our study suggests strong therapeutic potential of genistein in animal model of HE. Genistein can be used a strong anti-oxidant to attenuate neurotoxic effects of xenobiotics.

  15. Pure White Cell Aplasia and Necrotizing Myositis

    Directory of Open Access Journals (Sweden)

    Peter Geon Kim

    2016-01-01

    Full Text Available Pure white cell aplasia (PWCA is a rare hematologic disorder characterized by the absence of neutrophil lineages in the bone marrow with intact megakaryopoiesis and erythropoiesis. PWCA has been associated with autoimmune, drug-induced, and viral exposures. Here, we report a case of a 74-year-old female who presented with severe proximal weakness without pain and was found to have PWCA with nonspecific inflammatory necrotizing myositis and acute liver injury on biopsies. These findings were associated with a recent course of azithromycin and her daily use of a statin. Myositis improved on prednisone but PWCA persisted. With intravenous immunoglobulin and granulocyte-colony stimulating factor therapies, her symptoms and neutrophil counts improved and were sustained for months.

  16. Seeing more clearly through the fog of encephalopathy.

    Science.gov (United States)

    Kaplan, Peter W; Sutter, Raoul

    2013-10-01

    Patients with acute confusional states (often referred to as encephalopathy or delirium) pose diagnostic and management challenges for treating physicians. Encephalopathy is associated with a high morbidity and mortality rate, and the diagnosis rests on clinical grounds but may also be supported by the finding of electroencephalographic (EEG) evidence for diffuse cerebral dysfunction. The myriad cerebral transmitter and metabolic disruptions are generated by systemic organ system failures, principal among which are those of the liver, kidneys, lungs, heart, and endocrine system, along with the effects of exogenous toxins and medications. In most cases, several of these organ failures together contribute to the confusional state, frequently in the context of a diffuse cerebral atrophy that affects the aging brain. This special issue of the Journal of Clinical Neurophysiology is dedicated to exploring the electrophysiology of these conditions. It reviews the pathophysiology, psychiatric manifestations, clinical and imaging correlations of the many causes and types of encephalopathy. A literature review of the EEG abnormalities in the various types of encephalopathy provides an overview that ranges from paraneoplastic causes, through organ system failures, postcardiorespiratory arrest, to postoperative delirium. The issue is supplemented by tables of relevant clinical correlations, graphs, Venn diagrams, and the use of mathematical modeling used to explain how defects in the neuronal interplay might generate the EEG patterns seen in encephalopathy. We hope that this assembly will act as a springboard for further discussion and investigation into the EEG underpinnings, clinical correlations, diagnosis. and prognostication of these common and morbid disturbances of brain function.

  17. Posterior reversible encephalopathy syndrome in a patient with lupus nephritis

    Directory of Open Access Journals (Sweden)

    Huseyin Kadikoy

    2012-01-01

    Full Text Available Posterior reversible encephalopathy syndrome (PRES is characterized by acute onset of headache, nausea, focal neurological deficits or seizures along with radiological findings of white matter defects in the parietal and occipital lobes. Causes of PRES include uremia, hypertensive encephalopathy, eclampsia and immunosuppressive medications. Usually, the treat-ment of choice involves correcting the underlying abnormality. We describe an unusual case of recurrent PRES caused by uremia during a lupus flare in a patient with biopsy-proven Class IV Lupus Nephritis (LN with vasculitis. PRES in systemic lupus erythematosis (SLE is a rare clin-ical phenomenon and, when reported, it is associated with hypertensive encephalopathy. Our patient did not have hypertensive crisis, but had uremic encephalopathy. The patient′s PRES-related symptoms resolved after initiation of hemodialysis. The temporal correlation of the correc-tion of the uremia and the resolution of the symptoms of PRES show the etiology to be uremic encephalopathy, making this the first reported case of uremia-induced PRES in Class IV LN with vasculitis.

  18. SCN2A encephalopathy

    Science.gov (United States)

    Howell, Katherine B.; McMahon, Jacinta M.; Carvill, Gemma L.; Tambunan, Dimira; Mackay, Mark T.; Rodriguez-Casero, Victoria; Webster, Richard; Clark, Damian; Freeman, Jeremy L.; Calvert, Sophie; Olson, Heather E.; Mandelstam, Simone; Poduri, Annapurna; Mefford, Heather C.; Harvey, A. Simon

    2015-01-01

    Objective: De novo SCN2A mutations have recently been associated with severe infantile-onset epilepsies. Herein, we define the phenotypic spectrum of SCN2A encephalopathy. Methods: Twelve patients with an SCN2A epileptic encephalopathy underwent electroclinical phenotyping. Results: Patients were aged 0.7 to 22 years; 3 were deceased. Seizures commenced on day 1–4 in 8, week 2–6 in 2, and after 1 year in 2. Characteristic features included clusters of brief focal seizures with multiple hourly (9 patients), multiple daily (2), or multiple weekly (1) seizures, peaking at maximal frequency within 3 months of onset. Multifocal interictal epileptiform discharges were seen in all. Three of 12 patients had infantile spasms. The epileptic syndrome at presentation was epilepsy of infancy with migrating focal seizures (EIMFS) in 7 and Ohtahara syndrome in 2. Nine patients had improved seizure control with sodium channel blockers including supratherapeutic or high therapeutic phenytoin levels in 5. Eight had severe to profound developmental impairment. Other features included movement disorders (10), axial hypotonia (11) with intermittent or persistent appendicular spasticity, early handedness, and severe gastrointestinal symptoms. Mutations arose de novo in 11 patients; paternal DNA was unavailable in one. Conclusions: Review of our 12 and 34 other reported cases of SCN2A encephalopathy suggests 3 phenotypes: neonatal-infantile–onset groups with severe and intermediate outcomes, and a childhood-onset group. Here, we show that SCN2A is the second most common cause of EIMFS and, importantly, does not always have a poor developmental outcome. Sodium channel blockers, particularly phenytoin, may improve seizure control. PMID:26291284

  19. Necrotizing meningoencephalitis in five Chihuahua dogs.

    Science.gov (United States)

    Higgins, R J; Dickinson, P J; Kube, S A; Moore, P F; Couto, S S; Vernau, K M; Sturges, B K; Lecouteur, R A

    2008-05-01

    An acute to chronic idiopathic necrotizing meningoencephalitis was diagnosed in 5 Chihuahua dogs aged between 1.5 and 10 years. Presenting neurologic signs included seizures, blindness, mentation changes, and postural deficits occurring from 5 days to 5.5 months prior to presentation. Cerebrospinal fluid analyses from 2 of 3 dogs sampled were consistent with an inflammatory disease. Magnetic resonance imaging of the brain of 2 dogs demonstrated multifocal loss or collapse of cortical gray/white matter demarcation hypointense on T1-weighted images, with T2-weighted hyperintensity and slight postcontrast enhancement. Multifocal asymmetrical areas of necrosis or collapse in both gray and white matter of the cerebral hemispheres was seen grossly in 4 brains. Microscopically in all dogs, there was a severe, asymmetrical, intensely cellular, nonsuppurative meningoencephalitis usually with cystic necrosis in subcortical white matter. There were no lesions in the mesencephalon or metencephalon except in 1 dog. Immunophenotyping defined populations of CD3, CD11d, CD18, CD20, CD45, CD45 RA, and CD79a immunoreactive inflammatory cells varying in density and location but common to acute and chronic lesions. In fresh frozen lesions, both CD1b,c and CD11c immunoreactive dendritic antigen-presenting cells were also identified. Immunoreactivity for canine distemper viral (CDV) antigen was negative in all dogs. The clinical signs, distribution pattern, and histologic type of lesions bear close similarities to necrotizing meningoencephalitis as described in series of both Pug and Maltese breed dogs and less commonly in other breeds.

  20. Necrotizing myelitis in an immunocompetent child : a case report with review of literature.

    Directory of Open Access Journals (Sweden)

    Parmar R

    2003-12-01

    Full Text Available A few cases of necrotizing myelitis have been reported in adults since its first description in 1973. No case has been described in the pediatric age group. A 12-year-old boy, who presented with acute flaccid paraplegia, loss of sphincter control and sensory loss showed features suggestive of necrotizing myelitis on magnetic resonance imaging. Investigations carried out could not reveal a specific etiological or pre-disposing factor. No clinical improvement occurred despite the therapy.

  1. Cervical necrotizing fasciitis: management challenges in poor resource environment.

    Science.gov (United States)

    Adekanye, Abiola Grace; Umana, A N; Offiong, M E; Mgbe, R B; Owughalu, B C; Inyama, M; Omang, H M

    2016-09-01

    Necrotizing fasciitis of the head and neck is a rare and potentially fatal disease. It is a bacterial infection characterized by spreading along fascia planes and subcutaneous tissue resulting in tissue necrosis and likely death. It is commonly of dental or pharyngeal origin. Factors affecting the success of the treatment are early diagnosis, appropriate antibiotics and surgical debridement. Our study showed eight patients, five males and three females with mean age of 49.25 years (range 20-71 years). Clinical presentations were a rapidly progressing painful neck swelling, fever, dysphagia and trismus. The aetiology varied from idiopathic, pharyngeal/tonsillar infection, trauma and nasal malignancy. There were associated variable comorbidities (diabetes mellitus, HIV infection, hypertension and congestive cardiac failure). All the patients received early and aggressive medical treatment. The earliest time of surgery was 12 h after admission because of the poor financial status of patients. Three cases came in with complications of the disease and were not fit for extensive debridement under general anaesthesia. For them limited and reasonable bed side debridement was done. Mortality was 50 % from multiple organ failure, HIV encephalopathy, aspiration pneumonitis and septicemia. The duration of hospital stay for the patients that died ranged from 1 to 16 days and 4 to 34 days for the survivor. Our study heightens awareness and outlines the management challenges of necrotizing fasciitis of the head and neck in a poor resource setting.

  2. 大鼠急性坏死性胰腺炎和慢性胰腺炎代谢特征分析%Metabolic features of acute necrotizing pancreatitis and chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    潘春树; 马超; 田冰; 汪剑; 杨根金; 陆建平

    2012-01-01

    Objective To study the metabolite features of acute necrotizing pancreatitis (ANP) and chronic pancreatitis (CP) in rats.Methods A total of 22 Wistar rats were divided into ANP group (n =7 ),CP group (n =6) and the control group (n =9).ANP model was induced peritoneous injection of 20% Larginine,and the rats were sacrificed 12 hours later.CP model was induced by intravenously injection of DBTC (8 mg/kg body weight),and the rats were sacrificed after 2 months.The rats in the control group received same amount of saline.Serum amylase was determined and pancreatic tissues were pathologically examined.Metabolic changes of pancreatic tissues in vitro were studied by high resolution magic angle spinning nuclear magnetic resonance (MAS NMR ),and analyzed by using principal components analysis (PCA).Characteristic metabolites of ANP and CP were compared. Results Compared with the control group,increased leucine,iso-leucine and valine levels were observed in ANP group,however,the opposite trends were observed in CP group.Phosphocholine,glycerophosphocholine,choline levels were increased and fatty acids,lactate,betaine,glycine levels were decreased in both ANP and CP groups.The lipid content in CP group were significantly higher than that in ANP group and the increased taurine was only observed in CP group. Conclusions There were obvious metabolic features in pancreatic tissue in rats with pancreatitis disorders,and the increased taurine could be used as biomarker to discriminate ANP and CP.%目的 用代谢组学方法研究大鼠胰腺组织代谢特征,以期发现胰腺炎症的标记性代谢物.方法 Wistar大鼠22只,按数字表法随机分成急性坏死性胰腺炎组(ANP,7只)、慢性胰腺炎组(CP,6只)和对照组(9只).ANP组经腹腔注射20%L-精氨酸溶液制模;CP组经尾静脉注射二丁基二氯基锡(DBTC)溶液制模;对照组注射等量生理盐水.检测血清淀粉酶含量,胰腺组织行病理学检查.利用高分辨魔角旋转核

  3. Impact of ESKAPE bloodstream infection on prognosis of acute necrotizing pancreatitis%ESKAPE血流感染对急性坏死型胰腺炎预后的影响

    Institute of Scientific and Technical Information of China (English)

    杨双汇; 杨慧明; 黄耿文; 李宜雄

    2015-01-01

    目的:探讨ESKAPE血流感染对急性坏死性胰腺炎(ANP)患者预后及并发症的影响。  方法:回顾性分析2003年1月—2014年7月收治的有血培养结果的87例ANP患者,其中血培养阴性49例,阳性38例,分析血流感染,尤其是ESKAPE血流感染对ANP患者治疗结果的影响。  结果:在38例血培养阳性ANP患者的69份的病原学结果中,40.6%为ESKAPE,其中鲍曼不动杆菌占比50.0%,其余依次为屎肠球菌(14.3%)、肺炎克雷伯菌(10.7%),肠杆菌属(10.7%),金黄色葡萄球菌(7.1%)和铜绿假单胞菌(7.1%)。血流感染患者休克、呼吸衰竭、肾功能衰竭与消化道出血等并发症的发生率、病死率、住院费用及ICU住院天数均较非血流感染患者明显增高(均P  结论:血流感染明显增加ANP患者的并发症和病死率。ESKAPE是导致ANP患者血流感染的主要病原体,其与患者休克的发生密切相关。%Objective:To investigate the impact of ESAKPE bloodstream infection on the prognosis and complications in patients with acute necrotizing pancreatitis (ANP). Methods:Eighty-seven ANP patients admitted from January 2003 to July 2014 with blood culture results were retrospectively studied. Of the patients, 49 cases had negative and 38 cases had positive blood culture. hTe impact of bloodstream infection, especially ESKAPE bloodstream infection on therapeutic outcomes of these ANP patients was analyzed. Results:In the 69 pathogen test results from the 38 ANP patients with positive blood culture, 40.6%were ESAKPE pathogens that included Acinetobacter baumanni (50.0%), Enterococcus faecium (14.3%), Klebsiella pneumonia (10.7%), Enterobacter species (10.7%), Staphylococcus aureus (7.1%) and Pseudomonas aeruginosa (7.1%). Patients with bloodstream infection had significantly increased incidence of shock, respiratory failure, renal failure and digestive tract bleeding and mortality, as well as

  4. Pioglitazone pretreatment for acute necrotizing pancreatitis in rats%吡格列酮预处理对急性坏死性胰腺炎大鼠模型的影响

    Institute of Scientific and Technical Information of China (English)

    李清华; 徐萍; 陈令全; 刘丕; 吕农华

    2008-01-01

    Objective To investigate the effect of pretreatment of pioglitazone on acute necrotizing pancreatitis (ANP) rats. Methods ANP was induced by retrograde injection of 5% sedinm deoxycholate into bilio-pancreatic ducts. The animals were randomly divided into ANP (n=18), sham operation (n=18) and pioglitazone pretreatment group (n=18). Pioglitazone was given 20 mg/kg in pioglitazone group before ANP was induced. The rats were sacrificed 3 h, 6 h, 12 h after ANP induction, respectively. Bblood samples were taken for serum amylase measurement. Tissue samples of pancreas were harvested for morphological observation under conventional light microscopy. Pathological change of pancreas was evaluated by Hughes and Kusske score system. Results The concentration of serum amylase and the pancreatic histological score in pioglitazone and ANP groups were significantly higher than those in sham operation group (P<0.001 ). The concentration of serum amylase, Hughes and Kusske score in pioglitazone group at 12 h after ANP induction were (2980± 1080) U/L,4.50±2.07 and 7.50±1.05, respectively, and were lower than (7598±1072) U/L, 7.17±1.47 and 11.33±1.75 of ANP group at 12 h (P<0.01). Conclusions Pioglitazone pretreatment could decrease the serum level of amylase and the pancreatic histological score. Pioglitazone may ameliorate the severity of ANP.%目的 探讨吡格列酮预处理对ANP大鼠的影响.方法 54只大鼠采用经胆胰管逆行注射5%牛磺胆酸钠制备ANP模型.大鼠按随机数字法分为ANP组、吡格列酮组和假手术组,各18只.吡格列酮组在制模前2 h腹腔注射0.2%吡格列酮20 mg/kg体重.分别在术后3 h、6 h、12 h处死动物,取血检测血淀粉酶,取胰腺组织观察胰腺大体及组织学变化,分别按Hushes和Kusske标准评分.结果 术后3 h、6 h、12 h,ANP组及吡格列酮组血淀粉酶、胰腺大体病理的Hughes评分和胰腺组织学Kusske评分比假手术组明显升高;吡格列酮组大鼠术后12

  5. Escherichia coli necrotizing fasciitis in Hirschsprung's disease

    Directory of Open Access Journals (Sweden)

    Manal A. Alsaif

    2015-04-01

    Full Text Available Necrotizing fasciitis is a rare post-operative complication of Hirschsprung's disease. Very recently the only previous case of necrotizing fasciitis following a Soave procedure was reported with the etiologic agent being Pseudomonas aeruginosa. Here we are reporting the second case of necrotizing fasciitis following a Soave procedure caused by an extended spectrum beta lactamase harboring strain of Escherichia coli which is a rare pathogen in type II necrotizing fasciitis.

  6. Fatal Necrotizing Fasciitis following Episiotomy

    Directory of Open Access Journals (Sweden)

    Faris Almarzouqi

    2015-01-01

    Full Text Available Introduction. Necrotizing fasciitis is an uncommon condition in general practice but one that provokes serious morbidity. It is characterized by widespread fascial necrosis with relative sparing of skin and underlying muscle. Herein, we report a fatal case of necrotizing fasciitis in a young healthy woman after episiotomy. Case Report. A 17-year-old primigravida underwent a vaginal delivery with mediolateral episiotomy. Necrotizing fasciitis was diagnosed on the 5th postpartum day, when the patient was referred to our tertiary care medical center. Surgical debridement was initiated together with antibiotics and followed by hyperbaric oxygen therapy. The patient died due to septic shock after 16 hours from the referral. Conclusion. Delay of diagnosis and consequently the surgical debridement were most likely the reasons for maternal death. In puerperal period, a physician must consider necrotizing fasciitis as a possible diagnosis in any local sings of infection especially when accompanied by fever and/or tenderness. Early diagnosis is the key for low mortality and morbidity.

  7. Brain MRI findings in Wernicke encephalopathy.

    Science.gov (United States)

    Wicklund, Meredith R; Knopman, David S

    2013-08-01

    A 71-year-old woman with myelofibrosis on chemotherapy experienced an acute illness with nausea, vomiting, and diarrhea. Two weeks later, she developed an acute confusional state characterized by disorientation and fluctuating alertness with normal speech and language. Her neurologic examination demonstrated an upper motor neuron pattern of right hemiparesis. She reported double vision though ophthalmoparesis was not appreciated. Her gait was normal. While hospitalized, she developed generalized tonic-clonic seizures. Brain MRI revealed a small area of restricted diffusion of the left precentral gyrus (figure). She was diagnosed with a stroke with secondary seizures; however, as the confusional state resolved, she developed profound retrograde and anterograde amnesia. Review of the brain MRI showed high T2 signal in the medial thalamus and contrast enhancement of the mamillary bodies; a diagnosis of Wernicke-Korsakoff syndrome was entertained and she was started on thiamine replacement. The encephalopathy and hemiparesis resolved though she remains severely amnestic.

  8. A Case of Valproate Induced Hyperammonemic Encephalopathy

    Directory of Open Access Journals (Sweden)

    Surjit Tarafdar

    2011-01-01

    Full Text Available A 36-years-old man on phenytoin, levetiracetam, and sodium valproate presented with acute confusion. Routine investigations including serum valproate and phenytoin concentration were normal. His serum ammonia concentration was raised. His valproate was held and 2 days later he recovered with concordant normalisation of serum ammonia concentration. Urea acid cycle disorder was ruled out, and a diagnosis of valproate induced hyperammonemic encephalopathy (VHE was made. Asymptomatic hyperammonemia occurs in 15–50% of valproate-treated patients, and while the true incidence of VHE is not known, it is a recognized complication of sodium valproate treatment. VHE typically presents acutely with impaired consciousness, lethargy, and vomiting. Valproate concentrations may be in the therapeutic range, and liver function tests are typically “normal.” Treatment for VHE consists of ceasing valproate and providing supportive care. Some have advocated carnitine replacement.

  9. Brain-derived neurotrophic factor and interleukin-6 levels in the serum and cerebrospinal fluid of children with viral infection-induced encephalopathy.

    Science.gov (United States)

    Morichi, Shinichiro; Yamanaka, Gaku; Ishida, Yu; Oana, Shingo; Kashiwagi, Yasuyo; Kawashima, Hisashi

    2014-11-01

    We investigated changes in the brain-derived neurotrophic factor (BDNF) and interleukin (IL)-6 levels in pediatric patients with central nervous system (CNS) infections, particularly viral infection-induced encephalopathy. Over a 5-year study period, 24 children hospitalized with encephalopathy were grouped based on their acute encephalopathy type (the excitotoxicity, cytokine storm, and metabolic error types). Children without CNS infections served as controls. In serum and cerebrospinal fluid (CSF) samples, BDNF and IL-6 levels were increased in all encephalopathy groups, and significant increases were noted in the influenza-associated and cytokine storm encephalopathy groups. Children with sequelae showed higher BDNF and IL-6 levels than those without sequelae. In pediatric patients, changes in serum and CSF BDNF and IL-6 levels may serve as a prognostic index of CNS infections, particularly for the diagnosis of encephalopathy and differentiation of encephalopathy types.

  10. Hepatic Encephalopathy: Early Diagnosis in Pediatric Patients With Cirrhosis

    Directory of Open Access Journals (Sweden)

    Naghi DARA*

    2014-01-01

    Full Text Available How to Cite This Article: Dara N, Sayyari AA, Imanzadeh F. Hepatic Encephalopathy: Early Diagnosis in Pediatric Patients With Cirrhosis. Iran J Child Neurol. 2014 Winter; 8(1:1-11.ObjectiveAs acute liver failure (ALF and chronic liver disease (cirrhosis continue to increase in prevalence, we will see more cases of hepatic encephalopathy.Primary care physician are often the first to suspect it, since they are familiar with the patient’s usual physical and mental status. This serious complication typically occurs in patients with severe comorbidities and needs multidisciplinary evaluation and care. Hepatic encephalopathy should be considered in any patient with acute liver failure and cirrhosis who presents with neuropsychiatric manifestations, decrease level of consciousness (coma, change of personality, intellectualand behavioral deterioration, speech and motor dysfunction.Every cirrhotic patient may be at risk; potential precipitating factors should be addressed in regular clinic visits. The encephalopathy of liver disease may be prominent, or can be present in subtle forms, such as decline of school performance, emotional outbursts, or depression.“Subtle form” of hepatic encephalopathy may not be obvious on clinical examination, but can be detected by neurophysiologic and neuropsychiatric testing.References:Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998.Hepatology 2002;35:716-21.BleiAT,Cordoba J. Hepatic encephalopathy. AmJ Gastroenterol 2001;96:1968–76.Vaquero J,Chung C, Cahill ME, BleiAT. Pathogenesis of hepatic encephalopathy in acute liver failure. Semin Liver Dis 2003;23:259-69.Bajaj JS, Wade JB, Sanyal AJ. Spectrum of neurocognitive impairment in cirrhosis: Implications for the assessment of hepatic encephalopathy

  11. Neonatal scrotal wall necrotizing fasciitis (Fournier gangrene): a case report

    LENUS (Irish Health Repository)

    Zgraj, Oskar

    2011-12-12

    Abstract Introduction Necrotizing fasciitis in neonates is rare and is associated with almost 50% mortality. Although more than 80 cases of neonates (under one month of age) with necrotizing fasciitis have been reported in the literature, only six of them are identified as originating in the scrotum. Case presentation We report the case of a four-week-old, full-term, otherwise-healthy Caucasian baby boy who presented with an ulcerating lesion of his scrotal wall. His scrotum was explored because of a provisional diagnosis of missed torsion of the testis. He was found to have necrotizing fasciitis of the scrotum. We were able to preserve the testis and excise the necrotic tissue, and with intravenous antibiotics there was a successful outcome. Conclusions Fournier gangrene is rarely considered as part of the differential diagnosis in the clinical management of the acute scrotum. However, all doctors who care for small babies must be aware of this serious condition and, if it is suspected, should not hesitate in referring the babies to a specialist pediatric surgical center immediately.

  12. Neonatal scrotal wall necrotizing fasciitis (Fournier gangrene: a case report

    Directory of Open Access Journals (Sweden)

    Zgraj Oskar

    2011-12-01

    Full Text Available Abstract Introduction Necrotizing fasciitis in neonates is rare and is associated with almost 50% mortality. Although more than 80 cases of neonates (under one month of age with necrotizing fasciitis have been reported in the literature, only six of them are identified as originating in the scrotum. Case presentation We report the case of a four-week-old, full-term, otherwise-healthy Caucasian baby boy who presented with an ulcerating lesion of his scrotal wall. His scrotum was explored because of a provisional diagnosis of missed torsion of the testis. He was found to have necrotizing fasciitis of the scrotum. We were able to preserve the testis and excise the necrotic tissue, and with intravenous antibiotics there was a successful outcome. Conclusions Fournier gangrene is rarely considered as part of the differential diagnosis in the clinical management of the acute scrotum. However, all doctors who care for small babies must be aware of this serious condition and, if it is suspected, should not hesitate in referring the babies to a specialist pediatric surgical center immediately.

  13. Posterior reversible encephalopathy syndrome is not associated with mutations in aquaporin-4.

    Science.gov (United States)

    Matiello, Marcelo; Muralidharan, Rajanandini; Sun, David; Rabinstein, Alejandro A; Weinshenker, Brian G

    2015-08-01

    Posterior reversible encephalopathy syndrome (PRES) is characterized by acute reversible subcortical vasogenic edema that is typically bilateral and self-limiting. It preferentially affects posterior regions of the brain. Clinical manifestations include encephalopathy, seizures, headache, and cortical blindness. PRES may be precipitated by hypertensive crises such as eclampsia and by immunosuppressive agents. The pathophysiology of PRES is incompletely understood. Disordered cerebral autoregulation leading to protein and fluid extravasation is thought to be important.(1) Other theories implicate endothelial dysfunction or vasospasm.(2).

  14. The analysis of evoked potentials about the patients who suffered from delayed encephalopathy by acute carbon monoxide poisoning%急性一氧化碳中毒后迟发性脑病患者诱发电位的分析

    Institute of Scientific and Technical Information of China (English)

    任何茂; 王芳; 王丽

    2014-01-01

    目的:分析急性一氧化碳中毒迟发性脑病(DEACMP)患者脑干听觉诱发电位(BAEP)、视觉诱发电位(VEP)的变化。方法对38例DEACMP患者进行BAEP、VEP检查。结果本组BAEP、VEP的异常率分别为71.1%,63.2%。结论 BAEP、VEP检查对DEACMP患者听神经、视神经功能的评估有一定意义。%Objective Analyze the change of brainstem auditory evoked potential and visual evoked potential of the patients who Suffered from delayed encephalopathy by acute carbon monoxide poisoning.Methods Inspect 38 patients who Suffered from delayed encephalopathy by acute carbon monoxide poisoning.Results The abnormal rates of BAEP, VEP of this group were 71.1% and 63.2%.Conclusion The check of BAEP,VEP have some significance for the evaluation the patients' functions of auditory nerve and optic nerve.

  15. Transjugular intrahepatic portosystemic shunt: results and prognostic factors in patients with post-necrotic liver cirrhosis

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Chung, Jin Wook; Han, Joon Koo; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Yong Joo [Kyungbook National University College of Medicine, Taegu (Korea, Republic of)

    1997-01-01

    To evaluate the effectiveness of transjugular intrahepatic portosystemic shunt(TIPS) in the management of gastroesophageal variceal bleeding and predictive factors for long-term survival in patients with post-necrotic liver cirrhosis. A total of 49 patients with post-necrotic liver cirrhosis underwent TIPS over a recent three-year period. Forty-five had a history of hepatitis B viral infection, and four, of hepatitis C viral infection. In all patients, the indication for the procedure was variceal bleeding. Child-Pugh class was A in seven patients, B in 16 and C in 26 patients at the time of the last bleeding. The effectiveness of portal decompression and bleeding control was evaluated. Long-term survival was calculated by the Kaplan-Meier method and predictive factors were analyzed using the Wilcoxon test. The procedure was technically successful in all cases. The portosystemic pressure gradient decreased significantly from 21.4 {+-} 6.4 mmHg to 12.0 {+-} 5.1 mmHg(N=45). Active variceal bleeding was controlled in 34 of the 37 emergency patients. The total length of follow-up was from one day to three and a half years(mean : 383 {+-} 357 days). Rebleeding developed in 17 patients (35%). Hepatic encephalopathy, either newly developed or aggravated, occurred in 16 (32.7%). The thirty-day mortality rate was 20.4%, and the one-year survival rate was 63.8%. The significant predictive factors for poor prognosis were Child-Pugh class C and post-TIPS hepatic encephalopathy. TIPS is effective in portal decompression in the patients with variceal bleeding due to post-necrotic liver cirrhosis. The Child-Pugh classification and hepatic encephalopathy after TIPS are considered to be significant predictive factors for long-term survival.

  16. Pancreas and liver damage of acute necrotizing pancreatitis rats under hypoxia plateau%高原低氧环境下急性坏死性胰腺炎大鼠胰腺及肝脏损害的研究

    Institute of Scientific and Technical Information of China (English)

    朱海宏; 袁冬林; 吴新民; 郭亚民; 叶谢智华; 叶成杰

    2015-01-01

    目的 观察高原低氧环境下急性坏死性胰腺炎(ANP)大鼠胰腺及肝功能损害程度,为临床更好地诊治高原地区重症急性胰腺炎(SAP)患者提供参考.方法 96只SPF级雄性Wistar大鼠分别在海拔1 500、3 300、4300 m高度进行实验.采用胰腺被膜下注射牛磺胆酸钠的方法制备ANP模型,以仅翻动胰腺数次后关腹的大鼠作为假手术组.假手术组在术后6h处死,ANP组在造模后6、12、24 h分批处死.取血检测血清淀粉酶活性,取胰腺及肝脏常规行组织病理学检查,并进行病理评分.结果 假手术组大鼠的血清淀粉酶活性无明显变化,胰腺及肝脏无明显组织病理改变.同一海拔高度,ANP组各时间点大鼠的血清淀粉酶活性、胰腺及肝脏病理评分均显著高于假手术组,ANP 12、24 h组大鼠的血清淀粉酶活性、胰腺及肝脏病理评分均显著高于ANP 6 h组,差异均有统计学意义(P值均<0.05).海拔3 300、4300 m高度的ANP各时间点组大鼠的胰腺及肝脏病理评分均显著高于海拔1500m高度的同时间点组大鼠,差异均有统计学意义(P值均<0.05),但血清淀粉酶活性的差异无统计学意义.结论 随着海拔高度的增加,ANP大鼠的胰腺及肝脏的病理损害呈持续性加重.%Objective To investigate the extent of pancreatic and liver function damage of acute necrotizing pancreatitis (ANP) rats under altitude hypoxia environment,and to provide a reference for better diagnosis and treatment of severe acute pancreatitis (SAP) in the plateau region.Methods Ninety-six specific pathogen free (SPF) Wistar male rats were involved in 1 500 meters,3 300 meters and 4 300 meters altitude.The model of ANP was established by using pancreatic capsule injection of sodium taurocholate (NaTc).In the sham operation group,the rats' belly was opened and closed after only flipping its pancreas several times.Rats in sham group were sacrificed at 6 h,and ANP group were sacrificed at 6,12,24 h

  17. Hashimoto Encephalopathy in Case of Progressive Cognitive Impairment; a Case Report

    Directory of Open Access Journals (Sweden)

    Abbas Tafakhori

    2014-08-01

    Full Text Available Hashimoto's encephalopathy (HE is a rare condition characterized by atypical psychiatric and heterogeneous neurological manifestations such as acute cerebral ischemia, seizure, tremors, myoclonus, psychosis, depression, cognitive disorders, and fluctuating loss of consciousness. Here, a case of 28 year-old man was reported who referred to the emergency department (ED with different acute neurologic disorders and final diagnose of HE.

  18. Dopamine agents for hepatic encephalopathy

    DEFF Research Database (Denmark)

    Junker, Anders Ellekær; Als-Nielsen, Bodil; Gluud, Christian

    2014-01-01

    BACKGROUND: Patients with hepatic encephalopathy may present with extrapyramidal symptoms and changes in basal ganglia. These changes are similar to those seen in patients with Parkinson's disease. Dopamine agents (such as bromocriptine and levodopa, used for patients with Parkinson's disease) have...... therefore been assessed as a potential treatment for patients with hepatic encephalopathy. OBJECTIVES: To evaluate the beneficial and harmful effects of dopamine agents versus placebo or no intervention for patients with hepatic encephalopathy. SEARCH METHODS: Trials were identified through the Cochrane...... of the trials followed participants after the end of treatment. Only one trial reported adequate bias control; the remaining four trials were considered to have high risk of bias. Random-effects model meta-analyses showed that dopamine agents had no beneficial or detrimental effect on hepatic encephalopathy...

  19. Diabetic encephalopathy: a cerebrovascular disorder?

    NARCIS (Netherlands)

    Manschot, S.M.

    2006-01-01

    Animal study: The aim was to investigate the role of vascular disturbances in the development of experimental diabetic encephalopathy. We describe the effects of treatment with the Angiotensin Converting Enzyme(ACE)-inhibitor enalapril (treatment aimed at the vasculature)

  20. Infant with MRSA necrotizing fasciitis

    Directory of Open Access Journals (Sweden)

    Panglao Rajan M

    2014-05-01

    Full Text Available Maria Panglao Rajan,1 Pinkal Patel,1 Lori Cash,1 Anjali Parish,2 Scott Darby,1 Jack Yu,3 Jatinder Bhatia11Department of Pediatrics, Children's Hospital of Georgia, Augusta, GA, USA; 2Medical Center of Central Georgia, Augusta, GA, USA; 3Department of Plastic Surgery, Children's Hospital of Georgia, Augusta, GA, USAAbstract: This is an unusual case of necrotizing fasciitis caused by methicillin resistant Staphylococcus aureus in this premature infant, which highlights severity, rapid progression of this disease and shows outcome if intervention is initiated at an early stage. This case also highlights one of the possible serious complications of percutaneous inserted central catheter (PICC line, which can be life threatening.Keywords: necrotizing fasciitis, methicillin resistant Staphylococcus aureus, PICC, premature infant

  1. EXTENSIVE NECROTIZING FASCIITIS OF TRUNK FOLLOWING APPENDICECTOMY

    Directory of Open Access Journals (Sweden)

    Siddharth

    2015-03-01

    Full Text Available Acute appendicitis is usually diagnosed and managed easily with a low mortality and morbidity. However, in 20.74% patients, acute appendicitis may occasionally become extraordinarily complicated and life threatening with significant morbidity and mortality . [1] We report a case of 44 year old male, a known case of Diabetes Mellitus since 4 years (on irregular treatment who was brought to our hospital with severe pain in right lower quadrant of abdomen since 4 days. On examination, patient had tachycardia, tender ness and guarding in the right iliac fossa. Laboratory results revealed leucocytosis and raised blood glucose levels. Measures for glycemic control were initiated. At exploratory laparotomy, an inflamed and retrocaecal appendix ruptured at the base with sm all local abscess was found. Abscess was drained and appendectomy done. Initially patient did well but at the end of second post - operative week, the patient started having pain and swelling over posterior chest wall, flank, sacral and occipital regions sug gestive of inflammation. CT abdomen and pelvis showed extensive necrotizing fasciitis of trunk, occiput and sacrum. Repeated multiple fasciotomies were performed over the back. The patient finally recovered fully at the end of 8 th post - operative week

  2. Necrotizing fasciitis caused by perforated appendicitis: a case report.

    Science.gov (United States)

    Hua, Jie; Yao, Le; He, Zhi-Gang; Xu, Bin; Song, Zhen-Shun

    2015-01-01

    Acute appendicitis is one of the most common causes of acute abdominal pain. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in diagnosis or treatment may result in increased risks of complications, such as perforation, which is associated with increased morbidity and mortality rates. Necrotizing fasciitis caused by perforated appendicitis is extremely rare. We herein report a case of 50-year-old man presenting with an appendiceal abscess in local hospital. After ten days of conservative treatment with intravenous antibiotics, the patient complained about pain and swelling of the right lower limb and computed tomography (CT) demonstrated a perforated appendix and gas and fluid collection extending from his retroperitoneal cavity to the subcutaneous layer of his right loin and right lower limb. He was transferred to our hospital and was diagnosed with necrotizing fasciitis caused by perforated appendicitis. Emergency surgery including surgical debridement and appendectomy was performed. However, the patient died of severe sepsis and multiple organ failure two days after the operation. This case represents an unusual complication of a common disease and we should bear in mind that retroperitoneal inflammation and/or abscesses may cause necrotizing fasciitis through lumbar triangles.

  3. Necrotizing fasciitis: an urgent diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Paz Maya, Silvia; Dualde Beltran, Delfina [Hospital Clinico Universitario de Valencia, Valencia (Spain); Lemercier, Pierre; Leiva-Salinas, Carlos [Hospital Politecnico y Universitario La Fe, Valencia (Spain)

    2014-05-15

    Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection and a medical and surgical emergency, with increasing incidence in the last few years. It is characterized by a rapidly spreading, progressive necrosis of the deep fascia and subcutaneous tissue. Necrotizing fasciitis is often underestimated because of the lack of specific clinical findings in the initial stages of the disease. Many adjuncts such as laboratory findings, bedside tests - e.g., the ''finger test'' or biopsy - and imaging tests have been described as being helpful in the early recognition of the disease. Imaging is very useful to confirm the diagnosis, but also to assess the extent of the disorder, the potential surgical planning, and the detection of underlying etiologies. The presence of gas within the necrotized fasciae is characteristic, but may be lacking. The main finding is thickening of the deep fasciae due to fluid accumulation and reactive hyperemia, best seen on magnetic resonance imaging. (orig.)

  4. [Necrotizing Fasciitis: A comprehensive review].

    Science.gov (United States)

    Carbonetti, F; Carusi, V; Guidi, M; David, V

    Even though necrotizing fasciitis is considered a rare disease, the spreading of the predisposing factors such as diabetes and chronic diseases, contribute to increase the incidence of this infection. Thus, how to diagnose and treat this clinical pathology, which represents an emerging need. This infection could be fatal for patients if not early diagnosed and treated and it represents a challenge both for the clinicians both for the surgeons. From this consideration was born the idea to write this review article in order to furnish to the readers a helpful tool in the management of this disease starting from its clinical and epidemiological features leading to the diagnosis, both clinical and radiological, and concluding with the treatment both medical both surgical .This article reviews literature on PubMed/MEDLINE with key words "necrotizing", "fasciitis" and "necrotizing fasciitis" from 1967 to 2014, considering all the aspects of the disease. The authors attempt to draw comparisons to their own experience managing this condition to give an Italian perspective to the condition.

  5. Brainstem variant of posterior reversible encephalopathy syndrome: A case report.

    Science.gov (United States)

    Tortora, Fabio; Caranci, Ferdinando; Belfiore, Maria Paola; Manzi, Francesca; Pagliano, Pasquale; Cirillo, Sossio

    2015-12-01

    Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological condition, generally observed in conjunction with severe and acute hypertension, that involves mainly the posterior head areas (occipital and temporal lobes) and anterior "watershed" areas. In this syndrome it is rare to observe a predominant involvement of the brainstem. We describe the clinical and radiological findings in a patient with brainstem involvement, discussing its pathophysiological features and possible differential diagnosis.

  6. Guillain-Barre syndrome with posterior reversible encephalopathy syndrome

    OpenAIRE

    2014-01-01

    Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity commonly associated with eclampsia, septicemia, chemotherapeutic drugs etc. Concurrent occurrence of Guillain-Barre syndrome (GBS) with PRES is a rare entity. Dysautonomia is a proposed mechanism for such occurrence. Here we present a non-diabetic, non-hypertensive 63-year-old male patient, who came with acute onset flaccid quadriparesis, developing generalized seizures, altered sensorium and raised blood pressu...

  7. The why and wherefore of hepatic encephalopathy

    Directory of Open Access Journals (Sweden)

    Grover VPB

    2015-12-01

    Full Text Available Vijay PB Grover, Joshua M Tognarelli, Nicolas Massie, Mary ME Crossey, Nicola A Cook, Simon D Taylor-Robinson Liver Unit, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, UK Abstract: Hepatic encephalopathy is a common neuropsychiatric abnormality, which complicates the course of patients with liver disease. It was probably first described by Hippocrates over 2000 years ago, who said that "those whose madness arises from phlegm are quiet and neither shout nor make a disturbance, while those whose madness arises from bile shout, play tricks and will not keep still, but are always up to some mischief". He was presumably describing the differences between patients with pneumonia and acute liver failure. Despite the fact that the syndrome was probably first recognized thousands of years ago, the exact pathogenesis still remains unclear. Furthermore, a precise definition of the syndrome is lacking, as are definitive methods of diagnosing this condition. It is important as both patients with cirrhosis and the general population with whom they interact may be affected as a consequence. At a minimum, the individual may be affected by impaired quality of life, impaired ability to work, and slowed reaction times, which are relevant to the population at large if affected individuals operate heavy machinery or drive a car. Pathogenic mechanisms, diagnostic tools, and treatment options are discussed. Keywords: hepatic encephalopathy, cirrhosis, ammonia, pathology, treatment, rifaximin, lactulose

  8. Risk factors for sepsis-associated encephalopathy

    Institute of Scientific and Technical Information of China (English)

    Jian Li; Ang Li; Yibing Weng; Shuwen Zhang; Meili Duan

    2011-01-01

    Sepsis-associated encephalopathy (SAE) is a diffuse and acute cerebral dysfunction caused by sepsis. Many sepsis patients exhibit acute deterioration in mental status during the early stage of disease, and central nervous system dysfunction has been shown to increase patient mortality. The present study selected 284 sepsis patients who were admitted to the Intensive Care Unit of Beijing Friendship Hospital, Capital Medical University, from January to December 2009. The patients were assigned to SAE and non-SAE patient groups according to SAE occurrence. SAE incidence was 37.68%, and mortality was significantly greater in SAE patients compared with non-SAE patients (41.12% vs. 17.51%, P < 0.01). Univariate analysis and multivariate logistic regression analysis indicated lower arterial partial pressure of oxygen and greater alanine aminotransferase and Acute Physiology and Chronic Health Evaluation II scores in the SAE group compared with the non-SAE group. Arterial partial pressure of oxygen, alanine aminotransferase, and Acute Physiology and Chronic Health Evaluation II scores were determined to be potential risk factors for SAE.

  9. Need for early diagnosis of mental and mobility changes in Wernicke encephalopathy.

    Science.gov (United States)

    Wijnia, Jan W; Oudman, Erik; Bresser, Esmay L; Gerridzen, Ineke J; van de Wiel, Albert; Beuman, Carla; Mulder, Cornelis L

    2014-12-01

    Korsakoff syndrome is a chronic form of amnesia resulting from thiamine deficiency. The syndrome can develop from unrecognized or undertreated Wernicke encephalopathy. The intra-individual course of Wernicke-Korsakoff syndrome has not been studied extensively, nor has the temporal progression of gait disturbances and other symptoms of Wernicke encephalopathy. Here we present the detailed history of a patient whose acute symptoms of Wernicke encephalopathy were far from stable. We follow his mobility changes and the shifts in his mental status from global confusion and impaired consciousness to more selective cognitive deficits. His Wernicke encephalopathy was missed and left untreated, being labeled as "probable" Korsakoff syndrome. Patients with a history of self-neglect and alcohol abuse, at risk of or suffering with Wernicke encephalopathy, should receive immediate and adequate vitamin replacement. Self-neglecting alcoholics who are bedridden may have severe illness and probably active Wernicke encephalopathy. In these patients, mobility changes, delirium, or impaired consciousness can be an expression of Wernicke encephalopathy, and should be treated to prevent further damage from the neurologic complications of thiamine deficiency.

  10. Clinical analysis of 22 cases with Hashimoto's encephalopathy

    Directory of Open Access Journals (Sweden)

    Xiao-yan GE

    2014-07-01

    Full Text Available Objective To investigate the clinical presentations of Hashimoto's encephalopathy (HE, so as to improve the diagnosis and treatment of this disease. Methods A retrospective analysis was performed on clinical features, laboratory findings, imaging profiles, treatment and outcomes of 22 patients with HE who were admitted to our hospital between June 2010 and September 2013.  Results Clinical symptoms were mainly acute or subacute cognitive impairment (9 cases, psychiatric symptoms (6 cases, seizures (5 cases, ataxia (5 cases, stroke-like episodes (6 cases, tremor (1 case, myoclonus (2 cases and disturbance of consciousness (3 cases. Marked increase was found in serum anti-thyroid peroxidase (anti-TPO antibody level (19 cases and anti-thyroglobulin (anti-TG antibody level (20 cases. Twenty-one cases were treated with glucocorticoids, and one patient was treated only with general neurotrophic therapy, such as ganglioside. Except for 4 cases showed bad response to steroids, the rest patients had an obvious improvement. Conclusions Hashimoto's encephalopathy is an encephalopathy with the presence of elevated antithyroid antibodies, and most patients showed good response to steroids. So early diagnosis and treatment is particularly important for improving prognosis. This disease should be considered as an important differential diagnosis for encephalopathy of unknown etiology, and screening for serum antithyroid antibodies should be performed as initial screening test. doi: 10.3969/j.issn.1672-6731.2014.07.008

  11. MRI finding of ethylmalonic encephalopathy: case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Yong; Lee, Shi Kyung; Han, Chun Hwan; Rho, Eun Jin [Kangnam General Hospital Public Corporation, Seoul (Korea, Republic of)

    2002-12-01

    Ethylmalonic encephalopathy is a rare syndrom characterized by developmental delay, acrocyanosis, petechiae, chronic diarrhea, and ethylmalonic, lactic, and methylsuccinic aciduria. We report the MRI finding of ethylmalonic encephalopathy including previously unreported intracranial hematoma.

  12. The transmissible spongiform encephalopathies of livestock

    Science.gov (United States)

    Prion diseases or transmissible spongiform encephalopathies (TSEs) are fatal protein misfolding neurodegenerative diseases. TSEs have been described in several species including bovine spongiform encephalopathy (BSE) in cattle, scrapie in sheep and goats, chronic wasting disease (CWD) in cervids, tr...

  13. Nonodontogenic Cervical Necrotizing Fasciitis Caused by Sialadenitis

    OpenAIRE

    Alper Yenigun; Bayram Veyseller; Omer Vural; Orhan Ozturan

    2016-01-01

    Necrotizing fasciitis is a rapidly progressive infectious disease of the soft tissue with high mortality and morbidity rates. Necrotizing fasciitis is occasionally located in the head and neck region and develops after odontogenic infections. Factors affecting treatment success rates are early diagnosis, appropriate antibiotic treatment, and surgical debridement. We present a necrotizing fasciitis case located in the neck region that developed after sialoadenitis. It is important to emphasize...

  14. Necrotizing otitis externa: a painless reminder.

    Science.gov (United States)

    Thio, Daniel; Reece, Phillip; Herdman, Rory

    2008-08-01

    Necrotizing otitis externa is a necrotizing osteomyelitis of the skull base that predominantly affects diabetic and immunocompromised patients. Pseudomonas aeruginosa is the most frequently implicated organism. Patients present with severe otalgia, otorrhoea with or without facial palsy, or rarely, facial pain as a symptomatic feature. We report a case of necrotizing otitis externa presenting with totally painless otorrhoea and highlight the need for a high index of suspicion when treating patients with otitis externa.

  15. [Wernicke's encephalopathy induced by the use of diet pills and unbalanced diet].

    Science.gov (United States)

    Tóth, Adrián; Aradi, Gabriella; Várallyay, György; Arányi, Zsuzsanna; Bereczki, Dániel; Vastagh, Ildikó

    2014-03-23

    Wernicke's encephalopathy is an acute, potentially life-threatening, neurological syndrome resulting from thiamine deficiency. The disorder is still greatly underdiagnosed and, without prompt treatment, the condition can lead to the chronic form of the disease, Korsakoff's syndrome or even death. In developed countries Wernicke's encephalopathy has been associated with alcoholism, but in recent years there has been an increasing number of non-alcoholic cases. Authors report the case of a 23-year-old woman who developed oculomotor dysfunction, encephalopathy and ataxia as a result of an extreme diet and use of diet pills. The diagnosis of Wernicke's encephalopathy was supported by the resolution of neurological signs after parenteral thiamine replacement. This case is presented because of the rare etiology and diagnostic difficulty, and the latest diagnostic and therapic guidelines are also highlighted.

  16. An unusual cause of anemia and encephalopathy

    OpenAIRE

    Sanjeev Kumar Sharma; Dharma Choudhary; Anil Handoo; Gaurav Dhamija; Gaurav Kharya; Vipin Khandelwal; Mayank Dhamija; Sweta Kothari

    2015-01-01

    The authors present here an interesting case of recent onset anemia that was associated with an encephalopathy of the unusual cause.Although severe anemia can theoretically result in anemic hypoxia and can then lead to hypoxic encephalopathy, it is not a primary cause of encephalopathy. More frequently anemia can contribute together with other multiple causes of encephalopathy, such as infections, metabolic abnormalities, trauma, hepatic dysfunction, hypertension, toxins.

  17. Benzodiazepine receptor antagonists for hepatic encephalopathy

    DEFF Research Database (Denmark)

    Als-Nielsen, B; Gluud, L L; Gluud, C

    2004-01-01

    Hepatic encephalopathy may be associated with accumulation of substances that bind to a receptor-complex in the brain resulting in neural inhibition. Benzodiazepine receptor antagonists may have a beneficial effect on patients with hepatic encephalopathy.......Hepatic encephalopathy may be associated with accumulation of substances that bind to a receptor-complex in the brain resulting in neural inhibition. Benzodiazepine receptor antagonists may have a beneficial effect on patients with hepatic encephalopathy....

  18. MRI in necrotizing fasciitis of the extremities.

    Science.gov (United States)

    Ali, S Z; Srinivasan, S; Peh, W C G

    2014-01-01

    Necrotizing fasciitis is a life-threatening soft-tissue infection of bacterial origin, which involves mainly the deep fascia. Early recognition of this condition may be hampered by the uncommon nature of the disease and non-specificity of initial clinical signs and symptoms in less fulminant cases, making the role of imaging important. MRI is the most useful imaging modality in the diagnosis of necrotizing fasciitis. The presence of thick (>3 mm) hyperintense signal in the deep fascia (particularly intermuscular fascia) on fat-suppressed T2 weighted or short tau inversion-recovery images is an important marker for necrotizing fasciitis. Contrast enhancement of the thickened necrotic fascia can be variable, with a mixed-pattern of enhancement being more commonly encountered. Involvement of multiple musculofascial compartments increases the likelihood of necrotizing fasciitis. It is important to remember that T2-hyperintense signal in the deep fascia is not specific to necrotizing fasciitis and can also be seen in cases such as non-infective inflammatory fasciitis or muscle tear. In this pictorial essay, we aim to review the MRI findings in necrotizing fasciitis, discuss its limitations and pitfalls and identify differentiating features from non-necrotizing soft-tissue infections, such as cellulitis and infective myositis/pyomyositis, conditions which may clinically mimic necrotizing fasciitis.

  19. Sepsis associated encephalopathy (SAE): a review.

    Science.gov (United States)

    Green, Rebecca; Scott, L Keith; Minagar, Alireza; Conrad, Steven

    2004-05-01

    Sepsis associated encephalopathy (SAE) is a poorly understood condition that is associated with severe sepsis and appears to have a negative influence on survival. The incidence of encephalopathy secondary to sepsis is unknown. Amino acid derangements, blood-brain barrier disruption, abnormal neurotransmitters, and direct CNS effect are possible causes of septic encephalopathy. Research has not defined the pathogenesis of SAE.

  20. Cortical blindness in a child with acute glomerulonephritis.

    Science.gov (United States)

    Kaarthigeyan, K; Vijayalakshmi, A M

    2012-01-01

    The association between hypertensive encephalopathy and cortical blindness in children with acute glomerulonephritis is extremely rare. We report the case of a 9-year old girl who presented with headache, seizures, altered sensorium, hematuria, and transient cortical blindness as a complication of hypertensive encephalopathy which showed complete reversal following normalization of blood pressure and an underlying post-infectious acute glomerulonephritis was revealed.

  1. [NUG--necrotizing ulcerative gingivitis: a review].

    Science.gov (United States)

    Mizrahi, Y

    2014-07-01

    Necrotizing Ulcerative Gingivitis (NUG) is an acute and rare (0.5-11% of the population) infectious disease of the gum tissue, which is characterized by ulceration and inflammation of the inter-dental gum tissue. NUG was documented by historians since the fourth century BC, most of the reports from the ancient world were in the context of illness among fighting troops, present studies of NUG in the modern world are still common among soldiers. NUG is associated with poor oral hygiene and weakening of the host, especially in immunocompromised patients, malnutrition and poor living conditions, as well as in the context of mental stress. NUG is more common in young adults, but reports of morbidity in young children with malnutrition in the background are not uncommon. NUG diagnosis is based on three essential symptoms: sore gums, bleeding gums and the most diagnostic characteristic, ulceration and necrosis of the interdental papillae. The disease is considered to have a clear initial infectious etiology, when the main bacteria, associated with the disease, include: Bacteroides intermedius and Fusobacterium sp. The infection involves anaerobic \\ aerobic bacteria with a majority of Gram-negative bacteria. The treatment of NUG is based on combining mechanical removal of tartar with local and systemic delivery of antimicrobial agents. Adequate treatment usually prevent the progression of the disease and ulcer healing is expected in a few days. Nevertheless, lack of treatment can lead to deterioration in the form NUP to Noma.

  2. Necrotizing Fasciitis and The Diabetic Foot.

    Science.gov (United States)

    Iacopi, Elisabetta; Coppelli, Alberto; Goretti, Chiara; Piaggesi, Alberto

    2015-12-01

    Necrotizing fasciitis (NF) represents a rapidly progressive, life-threatening infection involving skin, soft tissue, and deep fascia. An early diagnosis is crucial to treat NF effectively. The disease is generally due to an external trauma that occurs in predisposed patients: the most important risk factor is represented by diabetes mellitus. NF is classified into 3 different subtypes according to bacterial strains responsible: type 1 associated to polymicrobial infection, type 2 NF, generally associated to Streptococcus species, often associated to Staphylococcus aureus and, eventually, Type 3, due to Gram-negative strains, such as Clostridium difficile or Vibrio. NF is usually characterized by the presence of the classic triad of symptoms: local pain, swelling, and erythema. In daily clinical practice immune-compromised or neuropathic diabetic patients present with atypical symptomatology. This explains the high percentage of misdiagnosed cases in the emergency department and, consequently, the worse outcome presented by these patients. Prompt aggressive surgical debridement and antibiotic systemic therapy are the cornerstone of its treatment. These must be associated with an accurate systemic management, consisting in nutritional support, glycemic compensation, and hemodynamic stabilization. Innovative methods, such as negative pressure therapy, once the acute conditions have resolved, can help fasten the surgical wound closure. Prompt management can improve prognosis of patients affected from NF reducing limb loss and saving lives.

  3. Current trends in the treatment of hepatic encephalopathy

    Directory of Open Access Journals (Sweden)

    Mohamad Rasm Al Sibae

    2009-07-01

    Full Text Available Mohamad Rasm Al Sibae, Brendan M McGuireDepartment of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USAAbstract: Hepatic encephalopathy (HE is a common reversible neuropsychiatric syndrome associated with chronic and acute liver dysfunction and significant morbidity and mortality. Although a clear pathogenesis is yet to be determined, elevated ammonia in the serum and central nervous system are the mainstay for pathogenesis and treatment. Management includes early diagnosis and prompt treatment of precipitating factors (infection, gastrointestinal bleeding, electrolyte disturbances, hepatocellular carcinoma, dehydration, hypotension, and use of benzodiazepines, psychoactive drugs, and/or alcohol. Clinical trials have established the efficacy of lactulose and lactitol enemas in the treatment of acute hepatic encephalopathy. Extensive clinical experience has demonstrated the efficacy of oral lactulose and lactitol with the goal of two to three soft bowel movements a day for the treatment of chronic HE. However, lactulose and lactitol have significant gastrointestinal side effects. For patients unable to tolerate lactulose or lactitol or who still have persistent chronic HE with lactulose or lactitol, neomycin, metronidazole and rifaximin are second-line agents. More recent data supports the benefits of rifaximin used solely and as an additional agent with fewer side effects than neomycin or metronidazole. Newer therapies being investigated in humans with clinical promise include nitazoxanide, the molecular adsorbent recirculating system (MARS, L-ornithine phenylacetate, sodium benzoate, and/or sodium phenylacetate and Kremezin® (AST-120.Keywords: hepatic encephalopathy, liver dysfunction, lactulose, lactitol

  4. Olanzapine-Induced Hypertriglyceridemia Resulting in Necrotizing Pancreatitis

    Science.gov (United States)

    Roy-Chaudhury, Prabir; Yadlapalli, Ganesh

    2016-01-01

    Olanzapine is an atypical antipsychotic agent that was approved by the Food and Drug Administration in 1996 for treatment of psychotic disorders, bipolar disorder, and schizophrenia. Since that time, numerous case reports have been published that describe the association of olanzapine and the development of pancreatitis. Furthermore, 3 reports suggest the mechanism of olanzapine-induced hypertriglyceridemia as the etiology of this progression. We report a case of a 36-year-old man who developed necrotizing pancreatitis secondary to olanzapine-induced hypertriglyceridemia. This case, to our knowledge, is the most severe case of this progression and the first case requiring plasmapheresis for acute management.

  5. Necrotizing fasciitis in a pediatric orthopedic population.

    Science.gov (United States)

    Tancevski, Aleksandar; Bono, Kenneth; Willis, Leisel; Klingele, Kevin

    2013-06-01

    Few studies have analyzed necrotizing fasciitis in children, and all have relied on cases of necrotizing fasciitis in the abdomen, head, and neck region. The authors sought to correlate the preoperative values of several laboratory tests previously validated in the adult literature, such as the Laboratory Risk Indicator for Necrotizing Fasciitis, with surgically confirmed necrotizing fasciitis in children to provide clinical guidance for the preoperative laboratory workup of necrotizing fasciitis. A retrospective chart review was performed on consecutive patients younger than 18 years with a diagnosis of necrotizing fasciitis. A total of 13 patients with an average age of 7.9 years (range, 9 months-16 years) were included. Ten (76.9%) infections were found in the lower extremity and 3 (23.1%) in the upper extremity. Seven (53.8%) patients had ecchymosis on examination. All patients presented with an elevated white blood cell count. No amputations were performed, and no mortality occurred. All patients underwent surgery within 24 hours of presentation. Elevated temperature, white blood count, erythrocyte sedimentation rate, and C-reactive protein values are typically seen in pediatric patients with necrotizing fasciitis; however, no correlation existed between other the preoperative laboratory values with the previously described scoring systems, such as the Laboratory Risk Indicator for Necrotizing Fasciitis. Aggressive monitoring of signs and symptoms is suggested, even if a patient does not meet all conventional diagnostic criteria. The authors recommend prompt surgical debridement and early administration of antibiotics, which should include clindamycin.

  6. Candida albicans-associated necrotizing vasculitis producing life-threatening gastrointestinal hemorrhage.

    LENUS (Irish Health Repository)

    Sargent, Jeremy

    2012-02-01

    Patients undergoing treatment of acute lymphoblastic leukemia are at risk for fungal infections including disseminated candidiasis. We describe a case of systemic Candida albicans infection associated with life-threatening gastrointestinal hemorrhage due to unusual necrotizing vasculitis involving the gastrointestinal tract. We explore the association between Candida and such vasculopathy.

  7. Necrotizing Fasciitis Associated with Staphylococcus lugdunensis

    Directory of Open Access Journals (Sweden)

    Tony Hung

    2012-01-01

    Full Text Available Necrotizing fasciitis is a life-threatening soft tissue infection that results in rapid local tissue destruction. Type 1 necrotizing fasciitis is characterized by polymicrobial, synergistic infections that are caused by non-Group A streptococci, aerobic and anaerobic organisms. Type 2 necrotizing fasciitis involves Group A Streptococcus (GAS with or without a coexisting staphylococcal infection. Here we provide the first report of necrotizing fasciitis jointly associated with the microbes Group B Streptococcus and Staphylococcus lugdunensis. S. lugdunensis is a commensal human skin bacterium known to cause often painful and prolonged skin and soft tissue infections. To our knowledge, however, this is the first case of Staph. lugdunensis-associated necrotizing fasciitis to be reported in the literature.

  8. Necrotizing Fasciitis: A Study of 48 Cases.

    Science.gov (United States)

    Singh, Gurjit; Bharpoda, Pragnesh; Reddy, Raghuveer

    2015-12-01

    Necrotizing fasciitis represents a group of highly lethal infections characterized by rapidly progressing inflammation and necrosis. The aim of the study was to analyze the clinical profile, microbial flora, and predisposing risk factors in patients with necrotizing fasciitis. Lastly, we aimed to formulate a protocol for management of necrotizing fasciitis. Forty-eight cases of necrotizing fasciitis patients who reported to our hospital between April 2007 and September 2009 were included in the study. The commonest predisposing factors were age greater than 50 years (58 % cases) and diabetes mellitus (52 % cases). The commonest site involved was extremity (70.8 %). Majority of infections were polymicrobial (87.5 %). Repeated aggressive debridement was the commonest surgical procedure performed. Early and aggressive surgical debridement, often in multiple sittings, supplemented by appropriate antibiotics and supportive therapy, forms the key to a successful outcome in necrotizing fasciitis.

  9. Anti-NMDAR encephalitis misdiagnosed as Hashimoto's encephalopathy.

    Science.gov (United States)

    Mirabelli-Badenier, M; Biancheri, R; Morana, G; Fornarino, S; Siri, L; Celle, M E; Veneselli, E; Vincent, A; Gaggero, R; Mancardi, M M

    2014-01-01

    Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a well-defined autoimmune disorder. Hashimoto's encephalopathy (HE) is a still controversial entity, lacking definite diagnostic criteria. We described a 14-year-old-girl presenting with a clinical picture consistent with the diagnosis of anti-NMDAR encephalitis, confirmed by NMDAR antibody testing. Four years earlier, she had presented a similar episode of acute encephalopathy diagnosed as HE. Anti-NMDAR encephalitis and HE share similar clinical features so that the differential diagnosis can be difficult if specific antibodies are not tested. The correct diagnosis of anti-NMDAR encephalitis is crucial to plan the appropriate management and follow-up, namely in term of oncological screening, since it can be paraneoplastic in origin. We suggest to re-evaluate the clinical history of all subjects with previous HE diagnosis in order to evaluate the possible diagnosis of anti-NMDAR encephalitis and plan the appropriate management of these patients.

  10. Contributions of microdialysis to new alternative therapeutics for hepatic encephalopathy.

    Science.gov (United States)

    Rivera-Espinosa, Liliana; Floriano-Sánchez, Esaú; Pedraza-Chaverrí, José; Coballase-Urrutia, Elvia; Sampieri, Aristides Iii; Ortega-Cuellar, Daniel; Cárdenas-Rodríguez, Noemí; Carmona-Aparicio, Liliana

    2013-08-05

    Hepatic encephalopathy (HE) is a common complication of cirrhosis, of largely reversible impairment of brain function occurring in patients with acute or chronic liver failure or when the liver is bypassed by portosystemic shunts. The mechanisms causing this brain dysfunction are still largely unclear. The need to avoid complications caused by late diagnosis has attracted interest to understand the mechanisms underlying neuronal damage in order to find markers that will allow timely diagnosis and to propose new therapeutic alternatives to improve the care of patients. One of the experimental approaches to study HE is microdialysis; this technique allows evaluation of different chemical substances in several organs through the recollection of samples in specific places by semi-permeable membranes. In this review we will discuss the contributions of microdialysis in the understanding of the physiological alterations in human hepatic encephalopathy and experimental models and the studies to find novel alternative therapies for this disease.

  11. Contributions of Microdialysis to New Alternative Therapeutics for Hepatic Encephalopathy

    Directory of Open Access Journals (Sweden)

    Liliana Carmona-Aparicio

    2013-08-01

    Full Text Available Hepatic encephalopathy (HE is a common complication of cirrhosis, of largely reversible impairment of brain function occurring in patients with acute or chronic liver failure or when the liver is bypassed by portosystemic shunts. The mechanisms causing this brain dysfunction are still largely unclear. The need to avoid complications caused by late diagnosis has attracted interest to understand the mechanisms underlying neuronal damage in order to find markers that will allow timely diagnosis and to propose new therapeutic alternatives to improve the care of patients. One of the experimental approaches to study HE is microdialysis; this technique allows evaluation of different chemical substances in several organs through the recollection of samples in specific places by semi-permeable membranes. In this review we will discuss the contributions of microdialysis in the understanding of the physiological alterations in human hepatic encephalopathy and experimental models and the studies to find novel alternative therapies for this disease.

  12. Contributions of Microdialysis to New Alternative Therapeutics for Hepatic Encephalopathy

    Science.gov (United States)

    Rivera-Espinosa, Liliana; Floriano-Sánchez, Esaú; Pedraza-Chaverrí, José; Coballase-Urrutia, Elvia; Sampieri, Aristides; Ortega-Cuellar, Daniel; Cárdenas-Rodríguez, Noemí; Carmona-Aparicio, Liliana

    2013-01-01

    Hepatic encephalopathy (HE) is a common complication of cirrhosis, of largely reversible impairment of brain function occurring in patients with acute or chronic liver failure or when the liver is bypassed by portosystemic shunts. The mechanisms causing this brain dysfunction are still largely unclear. The need to avoid complications caused by late diagnosis has attracted interest to understand the mechanisms underlying neuronal damage in order to find markers that will allow timely diagnosis and to propose new therapeutic alternatives to improve the care of patients. One of the experimental approaches to study HE is microdialysis; this technique allows evaluation of different chemical substances in several organs through the recollection of samples in specific places by semi-permeable membranes. In this review we will discuss the contributions of microdialysis in the understanding of the physiological alterations in human hepatic encephalopathy and experimental models and the studies to find novel alternative therapies for this disease. PMID:23921686

  13. 急性一氧化碳中毒后迟发性脑病发病的危险因素分析%Risk factor analysis of the delayed encephalopathy after acute carbon monoxide poisoning

    Institute of Scientific and Technical Information of China (English)

    张晓莉; 潘登; 韩亚州; 赵国有; 顾仁骏; 曾皎; 顾家鹏; 李瑞杰; 张萍; 吴强; 田松朝; 赵建华; 靳玫

    2016-01-01

    Objective To investigate the associated risk factors of the delayed encephalopathy after acute carbon mon-oxide poisoning (DEACMP) .Methods Seven hundred and fifty-two cases of acute carbon monoxide poisoning (ACMP) in-patients admitted to 10 hospitals in northern Henan during 2001 -2014 who met the inclusive and exclusive criteria were re-cruited .The clinical information of each ACMP patient was collected ,and following-up for each patient was more than 90 days .Based on the occurrence of DEACMP ,the patients were divided into ACMP group and DEACMP group .The statistical induction of 26 indicators in each patient ,such as age ,coma duration ,severity of coma ,smoking & drinking ,etc .was con-ducted to analyze the possible risk factors of DEACMP in ACMP patients .Results One hundred and twenty-seven out of 752 patients demonstrated DEACMP ,the univariate analysis showed that male ACMP patients were more susceptible to DEACMP than female patients ,and the difference was statistically significant (P12 h ,the inci-dence of DEACMP significantly increased ,and up to 58 .3% once the coma last for >48 h .The patients who had moderate-a-bove coma ,positive pathology ,being widowed ,history of smoking and drinking ,major mental stimulation was more suscepti-ble to DEACMP than those without above issues ,and the differences were all statistically significant (All P12 h .Additional care has to be taken for their clinical monitoring to take premorbid preventive treatment as early in-tervention to the disease .%目的:探讨急性一氧化碳中毒后迟发性脑病(DEACM P)发病的相关危险因素。方法以2001—2014年在豫北地区10家医院符合入组标准和排除标准的急性一氧化碳中毒(ACM P)752例住院患者为研究对象,收集临床资料,并随访90 d以上,根据以后是否发生DEACM P分为ACM P组和DEACM P组,对所有患者的年龄、昏迷时间、昏迷程度、吸烟饮酒史等26个指标

  14. Bovine spongiform encephalopathy in sheep?

    NARCIS (Netherlands)

    Schreuder, B.E.C.; Somerville, R.A.

    2003-01-01

    Bovine spongiform encephalopathy (BSE) in sheep has not been identified under natural conditions at the time of writing and remains a hypothetical issue. However, rumours about the possible finding of a BSE-like isolate in sheep have led to great unrest within the sheep industry, among the general p

  15. Pharm GKB: Acute ulcerative gingivitis [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Overview Alternate Names: Synonym ANUG - Acute necrotising ulcerative gingivitis; ANUG - Acute... necrotizing ulcerative gingivitis; AUG - Acute ulcerative gingivitis; Vincent's disease; Vincent...g] (N0000001343) Common Searches Search Medline Plus Search CTD Pharm GKB: Acute ulcerative gingivitis ... ...ive (D005892) SnoMedCT: Acute ulcerative gingivitis (172697005) UMLS: C0017575 (C...'s gingivitis PharmGKB Accession Id: PA165109110 External Vocabularies MeSH: Gingivitis, Necrotizing Ulcerat

  16. Necrotizing sialometaplasia: A diagnostic dilemma!

    Directory of Open Access Journals (Sweden)

    Samir A Joshi

    2014-01-01

    Full Text Available Necrotizing sialometaplasia (NS is a benign, self-limiting inflammatory reaction of salivary gland tissue which may mimic squamous cell carcinoma or mucoepidermoid carcinoma, both clinically and histologically, that creates diagnostic dilemma leading to unwarranted aggressive surgery. Most commonly affected site is the minor salivary glands of the palate. The pathogenesis is unknown but is believed to be due to ischemia of vasculature supplying the salivary gland lobules. A simple incisional biopsy is required to confirm the histological diagnosis and to rule out more serious disease processes. It is a self-limiting disease process and requires no treatment. It will be prudent to do repeat biopsy in case if the lesion does not heal within 3 months.

  17. What next in necrotizing enterocolitis?

    Science.gov (United States)

    Yurdakök, Murat

    2008-01-01

    Necrotizing enterocolitis (NEC) is a devastating disease of premature infants, with a mortality rate of 10-50%. It is uncommon in term infants and in premature infants who have not yet been fed. Most commonly NEC develops suddenly in a preterm infant who was otherwise well, with initial symptoms of abdominal distention, bilious or bloody emesis or gastric aspirates, hematochezia, and pneumatosis intestinalis, and sometimes progresses quickly to include bowel perforation, acidosis, shock, and death. Trigger factors (i.e. perinatal hypoxia, mild infection or formula feeding) cause focal mild intestinal mucosal injury. In the presence of proliferation of commensal bacteria, local breakdown of mucosal barrier may cause entry of bacterial products (e.g. lipopolysaccharides, platelet-activating factor). Endothelial platelet-activating factor and/or tumor necrotizing factor and/or direct stimulating effects of polymorphonuclear leukocytes cause proinflammatory cascade and focal necrosis, which increase the entry of large amounts of bacterial toxins, and then severe NEC, sepsis, and shock develop. Therapies for the prevention of NEC that appear to have some benefit are breastfeeding and antenatal steroids, and probably probiotics. Enteral immunoglobulin, polyunsaturated fatty acids, and arginine or glutamine supplementation are therapies for the prevention of NEC that do not appear to be of benefit. Enteral erythropoietin and enteral granulocyte colony-stimulating factor are promising novel therapies. Treatment options are limited to gut rest, parenteral nutrition, broad-spectrum antibiotics, and surgical interventions for enteral perforation. Two commonly used methods for NEC with intestinal perforation are laparotomy or primary peritoneal drainage ("patch, drain and wait"); however, the preferred method is controversial.

  18. Infection increases mortality in necrotizing pancreatitis

    DEFF Research Database (Denmark)

    Werge, Mikkel; Novovic, Srdan; Schmidt, Palle N

    2016-01-01

    OBJECTIVES: To assess the influence of infection on mortality in necrotizing pancreatitis. METHODS: Eligible prospective and retrospective studies were identified through manual and electronic searches (August 2015). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Meta...... sterile necrosis and organ failure was associated with a mortality of 19.8%. If the patients had infected necrosis without organ failure the mortality was 1.4%. CONCLUSIONS: Patients with necrotizing pancreatitis are more than twice as likely to die if the necrosis becomes infected. Both organ failure...... and infected necrosis increase mortality in necrotizing pancreatitis....

  19. Mortality associated with cervicofacial necrotizing fasciitis.

    Science.gov (United States)

    Roberson, J B; Harper, J L; Jauch, E C

    1996-09-01

    Cervicofacial necrotizing fasciitis is a rare infection but still occurs and carries a mortality rate up to 60%. It is a polymicrobial infection that is characterized by diffuse necrosis of fascial planes and subcutaneous tissues. Diagnosing early stages of cervicofacial necrotizing fasciitis in relationship to other soft tissue infections of odontogenic origin is difficult and leads to less aggressive treatment with resulting increased morbidity and mortality. To prevent this significant mortality and morbidity associated with cervicofacial necrotizing fasciitis early presentation, recognition and treatment by health care provider is essential.

  20. Anxiety in mice with acute hepatic encephalopathy induced by thioacetamide%硫代乙酰胺诱导的A型肝性脑病小鼠焦虑样反应观察

    Institute of Scientific and Technical Information of China (English)

    陈启明; 袁宏; 戴丽蓉; 蒋妮; 任文婷; 陈青锋

    2014-01-01

    Objective To evaluate the mental disorders in mice with thioacetamide (TAA)-induced acute hepatic encephalopathy (AHE). Methods Thirty male Kunming mice were equally and randomly divided into two groups (treatment group and control group).Mice in the treatment group received an intraperitoneal injection of TAA (200 mg·kg -1 ·d -1 for 3 days,up to 600 mg·kg -1 ),as compared with the same volume of physiological saline in the control group.Neurological function score,light/dark box,open field,and elevated plus -maze test were used to determine behavioral parameters at 24 h after the model was established.Serum ammonia,aspartate amino transferase (AST),al-anine aminotransferase (ALT),and total bilirubin (TBil)were measured at 24 h post determination of behavioral parameters.Comparison be-tween two groups was made by independent -samples t test.Results In the light/dark box test,the treatment group had significantly reduced residence time in the light box and number of shuttles between two boxes (t =-4.006,P 0.05).Moreover,compared with the control group,the treatment group had significant-ly higher levels of serum ammonia (t =-3.168,P <0.05),ALT (t =4.316,P <0.05),AST (t =-2.581,P <0.05),and TBil (t =-9.127,P <0.01).Conclusion Mice with AHE induced by an intraperitoneal injection of low -dose TAA have anxiety -related behav-iors;the anxiety -related behaviors are not associated with reduced locomotor activities.%目的:探讨硫代乙酰胺(TAA)诱导的 A 型肝性脑病小鼠的精神障碍。方法30只雄性昆明种小鼠随机分为实验组15只,对照组15只。实验组采用 TAA 200 mg·kg -1·d -1,连续腹腔注射3 d 至累积计量到600 mg/kg,正常对照组腹腔注射生理盐水,造模24 h 后进行脑功能评分、明暗箱、旷场及高架十字实验。行为学检测结束后24 h 行血氨及肝脏生化指标检测。两组间比较采用独立样本 t 检验。结果实验组小鼠在明暗箱实验

  1. Expression of glutamine transporter isoforms in cerebral cortex of rats with chronic hepatic encephalopathy

    DEFF Research Database (Denmark)

    Leke, Renata; Escobar, Thayssa D.C.; Rama Rao, Kakulavarapu V.

    2015-01-01

    Hepatic encephalopathy (HE) is a neuropsychiatric disorder that occurs due to acute and chronic liver diseases, the hallmark of which is the increased levels of ammonia and subsequent alterations in glutamine synthesis, i.e. conditions associated with the pathophysiology of HE. Under physiological...

  2. Necrotizing fasciitis: a case report of a premature infant with necrotizing enterocolitis.

    Science.gov (United States)

    Casey, Denise M; Stebbins, Karen; Howland, Victoria

    2013-01-01

    Necrotizing fasciitis (NF) is a severe infection involving the superficial fascia, subcutaneous tissue, and, occasionally, deeper tissue layers. Usual treatment is with surgical debridement in combination with antibiotics. In review of the literature there is one neonatal report of NF associated with necrotizing enterocolitis. We present a case report of a 25 week gestation infant with necrotizing fasciitis and the complexity of wound and pain management presented for the nursing staff in the neonatal intensive care unit.

  3. Necrotizing sialometaplasia: Report of 2 cases

    Energy Technology Data Exchange (ETDEWEB)

    Nah, Kyung Soo; Cho, Bong Hae; Jung, Yun Hoa [Pusan National Univ. College of Dentistry, Busan (Korea, Republic of)

    2006-12-15

    Necrotizing sialometaplasia (NS) was defined by Abrams et al. in 1973 as a reactive necrotizing inflammatory process involving minor salivary glands of the hard palate. Before that recognition, many patients with this condition had been improperly treated because of its clinical and histologic resemblance to malignancy such as mucoepidermoid carcinoma and squamous cell carcinoma. We report two cases of necrotizing sialometaplasia. One case involved a 58-year-old male who had an ulcerative palatal lesion exposing underlying bone which has the typical features of the above mentioned condition. Another case involved a 59-year-old male who developed a necrotizing sialometaplasia in association with a dome-shaped palatal swelling which was proves as an adenoid cystic carcinoma after operation biopsy.

  4. Surgical intervention in patients with necrotizing pancreatitis

    NARCIS (Netherlands)

    Besselink, MG; de Bruijn, MT; Rutten, JP; Boermeester, MA; Hofker, HS; Gooszen, HG

    2006-01-01

    Background: This study evaluated the various surgical strategies for treatment of (suspected) infected necrotizing pancreatitis (INP) and patient referrals for this condition in the Netherlands. Methods: This retrospective study included all 106 consecutive patients who had surgical treatment for IN

  5. Guillain-Barre syndrome with posterior reversible encephalopathy syndrome

    Directory of Open Access Journals (Sweden)

    Basavaraj F Banakar

    2014-01-01

    Full Text Available Posterior reversible encephalopathy syndrome (PRES is a clinicoradiologic entity commonly associated with eclampsia, septicemia, chemotherapeutic drugs etc. Concurrent occurrence of Guillain-Barre syndrome (GBS with PRES is a rare entity. Dysautonomia is a proposed mechanism for such occurrence. Here we present a non-diabetic, non-hypertensive 63-year-old male patient, who came with acute onset flaccid quadriparesis, developing generalized seizures, altered sensorium and raised blood pressure on fifth day of illness. Magnetic resonance imaging (MRI of brain showed altered signal intensities involving the parieto-occipital areas suggestive of posterior reversible encephalopathy. Cerebrospinal fluid analysis showed albuminocytological dissociation, nerve conduction studies revealed demyelinating type of polyneuropathy. The patient was treated with antihypertensives and antiepileptics. After resolution of the encephalopathy, intravenous immunoglobulin (IVIg was given. The patient recovered gradually over few months. Our case concludes GBS as independent risk factor, for PRES may be secondary to dysautonomia and physicians should be aware of such rare coexistence so that early treatment can be done to reduce the mortality and morbidity.

  6. [Wernicke encephalopathy accompanying linitis plastica].

    Science.gov (United States)

    Soós, Zsuzsanna; Salamon, Mónika; Oláh, Roland; Czégeni, Anna; Salamon, Ferenc; Folyovich, András; Winkler, Gábor

    2014-01-05

    Wernicke encephalopathy (or Wernicke-Korsakoff encephalopathy) is a rarely diagnosed neurological disorder, which is caused by vitamin B1 deficiency. In the classical form it is characterized by a typical triad (confusion, oculomotor disturbance and ataxia), however, in the majority of the cases only confusion is present. It can be frequently observed in subjects with chronic alcohol consumption, but it may accompany different pathological states of which end stage malignant diseases are the most importants, where confusion may have different backgrounds. The authors present the case of an old male patient with advanced gastric cancer recognised and treated vitamin B1 deficiency, and they draw attention to difficulties of the diagnosis of Wernicke's disease.

  7. Fatal necrotizing fasciitis due to Vibrio damsela.

    Science.gov (United States)

    Yuen, K Y; Ma, L; Wong, S S; Ng, W F

    1993-01-01

    A patient who succumbed to fulminant necrotizing fasciitis due to Vibrio damsela after injury by a rabbitfish is described. Despite the absence of any known underlying illness, he did not respond to appropriate antibiotic therapy and radical surgical intervention. This represents the first documented case of necrotizing fasciitis due to this organism, and is also the first reported case in Southeast Asia inflicted by rabbitfish.

  8. Ketogenic Diet in Epileptic Encephalopathies

    OpenAIRE

    Suvasini Sharma; Manjari Tripathi

    2013-01-01

    The ketogenic diet is a medically supervised high-fat, low-carbohydrate diet that has been found useful in patients with refractory epilepsy. It has been shown to be effective in treating multiple seizure types and epilepsy syndromes. In this paper, we review the use of the ketogenic diet in epileptic encephalopathies such as Ohtahara syndrome, West syndrome, Dravet syndrome, epilepsy with myoclonic atonic seizures, and Lennox-Gastaut syndrome.

  9. Ketogenic Diet in Epileptic Encephalopathies

    Directory of Open Access Journals (Sweden)

    Suvasini Sharma

    2013-01-01

    Full Text Available The ketogenic diet is a medically supervised high-fat, low-carbohydrate diet that has been found useful in patients with refractory epilepsy. It has been shown to be effective in treating multiple seizure types and epilepsy syndromes. In this paper, we review the use of the ketogenic diet in epileptic encephalopathies such as Ohtahara syndrome, West syndrome, Dravet syndrome, epilepsy with myoclonic atonic seizures, and Lennox-Gastaut syndrome.

  10. Metabolic Causes of Epileptic Encephalopathy

    Directory of Open Access Journals (Sweden)

    Joe Yuezhou Yu

    2013-01-01

    Full Text Available Epileptic encephalopathy can be induced by inborn metabolic defects that may be rare individually but in aggregate represent a substantial clinical portion of child neurology. These may present with various epilepsy phenotypes including refractory neonatal seizures, early myoclonic encephalopathy, early infantile epileptic encephalopathy, infantile spasms, and generalized epilepsies which in particular include myoclonic seizures. There are varying degrees of treatability, but the outcome if untreated can often be catastrophic. The importance of early recognition cannot be overemphasized. This paper provides an overview of inborn metabolic errors associated with persistent brain disturbances due to highly active clinical or electrographic ictal activity. Selected diseases are organized by the defective molecule or mechanism and categorized as small molecule disorders (involving amino and organic acids, fatty acids, neurotransmitters, urea cycle, vitamers and cofactors, and mitochondria and large molecule disorders (including lysosomal storage disorders, peroxisomal disorders, glycosylation disorders, and leukodystrophies. Details including key clinical features, salient electrophysiological and neuroradiological findings, biochemical findings, and treatment options are summarized for prominent disorders in each category.

  11. Necrotizing fasciitis following varicella in a child

    Institute of Scientific and Technical Information of China (English)

    LI Feng; XIA Jie

    2012-01-01

    Varicella is a self-limited disease,but sometimes it may be associated with some serious life-threatening complications.Necrotizing fasciitis is a rare complication of varicella.This is a case of a 7-year-old girl with septic shock caused'by necrotizing fasciitis as a complication of varicella.Swelling and pain in the left inguinal region and left axillary region were found five days after varicella.Then a high fever occurred followed by hypotension.Fluid infusion,vasopressor and antibiotics were administered.Group A beta-hemolytic Streptococcus was isolated from exudates from the wounds.The clinical symptoms markedly improved after surgical drainage and removal of the necrotic tissue.Both wounds were covered with skin grafts after healthy granulation tissue formed.Although there have been few reports of life-threatening necrotizing fasciitis following varicella in western countries,it is rare in China.Usually patients with varicella were admitted to pediatric or infectious disease department but not surgical departments; so that the clinicians should be aware that varicella may be complicated by life-threatening surgical infections.Necrotizing fasciitis should be suspected in patients of varicella who showed an increasing pain and swelling in any body areas associated with increasing fever and local erythema.Early identification,surgical drainage and debridement are essential for successful treatment of necrotizing fasciitis.

  12. Necrotizing fasciitis following varicella in a child.

    Science.gov (United States)

    Li, Feng; Xia, Jie

    2012-03-01

    Varicella is a self-limited disease, but sometimes it may be associated with some serious life-threatening complications.Necrotizing fasciitis is a rare complication of varicella. This is a case of a 7-year-old girl with septic shock caused by necrotizing fasciitis as a complication of varicella. Swelling and pain in the left inguinal region and left axillary region were found five days after varicella. Then a high fever occurred followed by hypotension. Fluid infusion, vasopressor and antibiotics were administered. Group A beta-hemolytic Streptococcus was isolated from exudates from the wounds. The clinical symptoms markedly improved after surgical drainage and removal of the necrotic tissue. Both wounds were covered with skin grafts after healthy granulation tissue formed. Although there have been few reports of life-threatening necrotizing fasciitis following varicella in western countries, it is rare in China. Usually patients with varicella were admitted to pediatric or infectious disease department but not surgical departments; so that the clinicians should be aware that varicella may be complicated by life-threatening surgical infections. Necrotizing fasciitis should be suspected in patients of varicella who showed an increasing pain and swelling in any body areas associated with increasing fever and local erythema. Early identification, surgical drainage and debridement are essential for successful treatment of necrotizing fasciitis.

  13. Neuropathology of a fatal case of posterior reversible encephalopathy syndrome.

    Science.gov (United States)

    Kheir, John N; Lawlor, Michael W; Ahn, Edward S; Lehmann, Leslie; Riviello, James J; Silvera, V Michelle; McManus, Michael; Folkerth, Rebecca D

    2010-01-01

    The pathology of posterior reversible encephalopathy syndrome (PRES) is undefined, since it is rarely fatal and is biopsied in only exceptional circumstances. We describe rapidly progressive PRES following stem cell transplant for acute lymphoblastic leukemia. After development of altered mental status, this 8-year-old girl had T2 prolongation of the white matter in a posterior-dominant distribution, eventually developing cerebellar edema, hemorrhage, hydrocephalus, and herniation. Despite surgical and medical management, she died 36 hours later. At autopsy, the occipital and cerebellar white matter and focal occipital cortical gray matter showed a spectrum of microvascular changes, including dilated perivascular spaces containing proteinaceous exudates and macrophages, as well as fibrinoid necrosis and acute hemorrhage, in a distribution corresponding to the neuroimaging abnormalities and reminiscent of those seen in patients with acute hypertensive encephalopathy. Of note, similar microvascular changes were not seen in the kidney or other systemic sites. Thus, the findings indicate a brain-specific microvascular compromise as the substrate of PRES, at least in the rare instance of cases progressing to fatal outcome.

  14. Contemporary Understanding and Management of Overt and Covert Hepatic Encephalopathy.

    Science.gov (United States)

    NeSmith, Meghan; Ahn, Joseph; Flamm, Steven L

    2016-02-01

    Hepatic encephalopathy (HE) is a major complication of liver disease that leads to significant morbidity and mortality. Caring for hospitalized patients with HE is becoming more complex, and the economic burden of HE continues to rise. Defining and diagnosing HE, particularly covert HE (CHE), remain challenging. In this article, we review new tools and those currently under development for the diagnosis of CHE and the latest advances in the acute and long-term management of overt HE (OHE) and CHE. In particular, we review the latest data on the use of lactulose and rifaximin for treatment of OHE and summarize the data on adjunctive agents such as sodium benzoate and probiotics.

  15. Palatal-Myoclonus as a Presentation of Hashimoto Encephalopathy: an Interesting case Report

    Directory of Open Access Journals (Sweden)

    Esmaeel Ghoreishi

    2013-09-01

    Full Text Available Objective: Hashimoto encephalopathy (HE is known as a steroid-responsive encephalopathy associated with autoimmune thyroiditis or nonvascular inflammation-related autoimmune meningoencephalitis. The average age of onset of HE is approximately 50 years; and it is more common in women. The onset of HE may be acute or subacute. The course of most HE cases is relapsing and remitting, which is similar to that of vasculitis and stroke.Methods: In this article, we present a previously healthy 32 years old; veterinarian male with palatal myoclonus, as a rare presentation of this disorder, and review the neurologic aspects of hashimoto encephalitis . Results:The clinical presentation of HE is characterized by progressive cognitive decline tremor, transient aphasia, seizures, abnormal gait, sleep disorder and stroke-like episodes .Myoclonus, either generalized or multifocal, and tremor, often of the bilateral upper extremities, is the most frequently observed involuntary movements in HE.Conclusion:The rapidly progressive cognitive dysfunction and encephalopathies observed.

  16. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management.

    Science.gov (United States)

    Sechi, Gianpietro; Serra, Alessandro

    2007-05-01

    Wernicke's encephalopathy is an acute neuropsychiatric syndrome resulting from thiamine deficiency, which is associated with significant morbidity and mortality. According to autopsy-based studies, the disorder is still greatly underdiagnosed in both adults and children. In this review, we provide an update on the factors and clinical settings that predispose to Wernicke's encephalopathy, and discuss the most recent insights into epidemiology, pathophysiology, genetics, diagnosis, and treatment. To facilitate the diagnosis, we classify the common and rare symptoms at presentation and the late-stage symptoms. We emphasise the optimum dose of parenteral thiamine required for prophylaxis and treatment of Wernicke's encephalopathy and prevention of Korsakoff's syndrome associated with alcohol misuse. A systematic approach helps to ensure that patients receive a prompt diagnosis and adequate treatment.

  17. Autoimmune encephalopathy associated with thyroid autoantibodies as the cause of reversible cognitive impairment

    Directory of Open Access Journals (Sweden)

    Robert Dobbin Chow

    2012-04-01

    Full Text Available We herewith describe a patient with acute confusion, expressive aphasia and generalized seizures. A through workup excluded most causes of encephalopathy. He was, however, found to have TSH = 18.6 MIU/ml, T3reverse = 0.44nmol/L, T4 = 0.8ng/dl and Anti-Thyroid-Peroxidase AB titer >1000 IU/ml. Based on the above findings the patient was diagnosed with Hashimoto's encephalopathy and his mental status showed dramatic improvement (MMS 30/30 with high dose prednisone. Hashimoto's encephalopathy is rare disorder of presumed autoimmune origin characterized by cognitive decline, seizures, neuro-psychiatric symptoms, high titers of Anti-Thyroid-Peroxidase AB, and a positive response to steroids.

  18. Susceptibility of European red deer (Cervus elaphus elaphus) to alimentary challenge with bovine spongiform encephalopathy.

    Science.gov (United States)

    Dagleish, Mark P; Martin, Stuart; Steele, Philip; Finlayson, Jeanie; Eaton, Samantha L; Sisó, Sílvia; Stewart, Paula; Fernández-Borges, Natalia; Hamilton, Scott; Pang, Yvonne; Chianini, Francesca; Reid, Hugh W; Goldmann, Wilfred; González, Lorenzo; Castilla, Joaquín; Jeffrey, Martin

    2015-01-01

    European red deer (Cervus elaphus elaphus) are susceptible to the agent of bovine spongiform encephalopathy, one of the transmissible spongiform encephalopathies, when challenged intracerebrally but their susceptibility to alimentary challenge, the presumed natural route of transmission, is unknown. To determine this, eighteen deer were challenged via stomach tube with a large dose of the bovine spongiform encephalopathy agent and clinical signs, gross and histological lesions, presence and distribution of abnormal prion protein and the attack rate recorded. Only a single animal developed clinical disease, and this was acute with both neurological and respiratory signs, at 1726 days post challenge although there was significant (27.6%) weight loss in the preceding 141 days. The clinically affected animal had histological lesions of vacuolation in the neuronal perikaryon and neuropil, typical of transmissible spongiform encephalopathies. Abnormal prion protein, the diagnostic marker of transmissible encephalopathies, was primarily restricted to the central and peripheral nervous systems although a very small amount was present in tingible body macrophages in the lymphoid patches of the caecum and colon. Serial protein misfolding cyclical amplification, an in vitro ultra-sensitive diagnostic technique, was positive for neurological tissue from the single clinically diseased deer. All other alimentary challenged deer failed to develop clinical disease and were negative for all other investigations. These findings show that transmission of bovine spongiform encephalopathy to European red deer via the alimentary route is possible but the transmission rate is low. Additionally, when deer carcases are subjected to the same regulations that ruminants in Europe with respect to the removal of specified offal from the human food chain, the zoonotic risk of bovine spongiform encephalopathy, the cause of variant Creutzfeldt-Jakob disease, from consumption of venison is probably

  19. Birth defects in children with newborn encephalopathy

    NARCIS (Netherlands)

    Felix, JF; Badawi, N; Kurinczuk, JJ; Bower, C; Keogh, JM; Pemberton, PJ

    2000-01-01

    This study was designed to investigate birth defects found in association with newborn encephalopathy. All possible birth defects were ascertained in a population-based study of 276 term infants with moderate or severe encephalopathy and 564 unmatched term control infants. A strong association betwe

  20. De novo mutations in epileptic encephalopathies

    NARCIS (Netherlands)

    Allen, Andrew S.; Berkovic, Samuel F.; Cossette, Patrick; Delanty, Norman; Dlugos, Dennis; Eichler, Evan E.; Epstein, Michael P.; Glauser, Tracy; Goldstein, David B.; Han, Yujun; Heinzen, Erin L.; Hitomi, Yuki; Howell, Katherine B.; Johnson, Michael R.; Kuzniecky, Ruben; Lowenstein, Daniel H.; Lu, Yi-Fan; Madou, Maura R. Z.; Marson, Anthony G.; Mefford, Heather C.; Nieh, Sahar Esmaeeli; O'Brien, Terence J.; Ottman, Ruth; Petrovski, Slave; Poduri, Annapurna; Ruzzo, Elizabeth K.; Scheffer, Ingrid E.; Sherr, Elliott H.; Yuskaitis, Christopher J.; Abou-Khalil, Bassel; Alldredge, Brian K.; Bautista, Jocelyn F.; Berkovic, Samuel F.; Boro, Alex; Cascino, Gregory D.; Consalvo, Damian; Crumrine, Patricia; Devinsky, Orrin; Dlugos, Dennis; Epstein, Michael P.; Fiol, Miguel; Fountain, Nathan B.; French, Jacqueline; Friedman, Daniel; Geller, Eric B.; Glauser, Tracy; Glynn, Simon; Haut, Sheryl R.; Hayward, Jean; Helmers, Sandra L.; Joshi, Sucheta; Kanner, Andres; Kirsch, Heidi E.; Knowlton, Robert C.; Kossoff, Erich; Kuperman, Rachel; Kuzniecky, Ruben; Lowenstein, Daniel H.; McGuire, Shannon M.; Motika, Paul V.; Novotny, Edward J.; Ottman, Ruth; Paolicchi, Juliann M.; Parent, Jack M.; Park, Kristen; Poduri, Annapurna; Scheffer, Ingrid E.; Shellhaas, Renee A.; Sherr, Elliott H.; Shih, Jerry J.; Singh, Rani; Sirven, Joseph; Smith, Michael C.; Sullivan, Joseph; Thio, Liu Lin; Venkat, Anu; Vining, Eileen P. G.; Von Allmen, Gretchen K.; Weisenberg, Judith L.; Widdess-Walsh, Peter; Winawer, Melodie R.

    2013-01-01

    Epileptic encephalopathies are a devastating group of severe childhood epilepsy disorders for which the cause is often unknown(1). Here we report a screen for de novo mutations in patients with two classical epileptic encephalopathies: infantile spasms (n = 149) and Lennox-Gastaut syndrome (n = 115)

  1. Neuroimaging of Wernicke's encephalopathy and Korsakoff's syndrome.

    Science.gov (United States)

    Jung, Young-Chul; Chanraud, Sandra; Sullivan, Edith V

    2012-06-01

    There is considerable evidence that neuroimaging findings can improve the early diagnosis of Wernicke's encephalopathy (WE) in clinical settings. The most distinctive neuroimaging finding of acute WE are cytotoxic edema and vasogenic edema, which are represented by bilateral symmetric hyperintensity alterations on T2-weighted MR images in the periphery of the third ventricle, periaqueductal area, mammillary bodies and midbrain tectal plate. An initial bout of WE can result in Korsakoff's syndrome (KS), but repeated bouts in conjunction with its typical comorbidity, chronic alcoholism, can result in signs of tissue degeneration in vulnerable brain regions. Chronic abnormalities identified with neuroimaging enable examination of brain damage in living patients with KS and have expanded the understanding of the neuropsychological deficits resulting from thiamine deficiency, alcohol neurotoxicity, and their comorbidity. Brain structure and functional studies indicate that the interactions involving the thalamus, mammillary bodies, hippocampus, frontal lobes, and cerebellum are crucial for memory formation and executive functions, and the interruption of these circuits by WE and chronic alcoholism can contribute substantially to the neuropsychological deficits in KS.

  2. Hashimoto's encephalopathy in children and adolescents.

    Science.gov (United States)

    Erol, Ilknur; Saygi, Semra; Alehan, Füsun

    2011-12-01

    Hashimoto's encephalopathy is an underdiagnosed, steroid-responsive, progressive or relapsing encephalopathy associated with high titers of serum antithyroid antibodies. Although Hashimoto's encephalopathy is well documented in adults, it is rarely observed or studied in children and adolescents. We describe the clinical and laboratory findings of four children (aged 9-15 years) with Hashimoto's encephalopathy. The clinical features of two patients at presentation included epileptic seizures and confusion. The other presenting signs included breath-holding spells, behavioral problems, psychosis, and ataxia (one patient each). During their presentation, three patients were euthyroid, and one was hyperthyroid. All patients manifested increased antithyroid antibodies, and all improved with steroid treatment. Hashimoto's encephalopathy is rarely suspected at presentation. Therefore, greater awareness of its signs by clinicians is necessary for proper diagnoses.

  3. Opsoclonus as a manifestation of Hashimoto's encephalopathy.

    Science.gov (United States)

    Salazar, R; Mehta, C; Zaher, N; Miller, D

    2012-10-01

    We present a 59-year-old male with early manifestation of opsoclonus associated with gait ataxia as a rare clinical presentation of Hashimoto's encephalopathy. Empiric use of intravenous immunoglobulin followed by intravenous high dose methylprednisolone was initiated with subsequent remittance of opsoclonus, encephalopathy, ataxia, and tremor. Extensive workup for infectious, autoimmune, and paraneoplastic etiologies were undertaken and all studies were negative. Thyroglobulin antibodies (312 U/mL) and thyroid peroxidase antibodies (457 U/mL) were elevated (normal antibodies were retested and found to have decreased considerably. Thus, with steroid therapy, the patient's opsoclonus and encephalopathy improved. We have presented a patient with a rare case of opsoclonus as the principal presenting feature of Hashimoto's encephalopathy that was incompletely responsive to intravenous immunoglobulin and resolved with corticosteroids. This report underscores the importance for clinical practitioners to maintain a high index of suspicion for Hashimoto's encephalopathy in cases of opsoclonus, especially when accompanied by an atypical presentation.

  4. Imaging of Acute Pancreatitis.

    Science.gov (United States)

    Thoeni, Ruedi F

    2015-11-01

    Acute pancreatitis is an acute inflammation of the pancreas. Several classification systems have been used in the past but were considered unsatisfactory. A revised Atlanta classification of acute pancreatitis was published that assessed the clinical course and severity of disease; divided acute pancreatitis into interstitial edematous pancreatitis and necrotizing pancreatitis; discerned an early phase (first week) from a late phase (after the first week); and focused on systemic inflammatory response syndrome and organ failure. This article focuses on the revised classification of acute pancreatitis, with emphasis on imaging features, particularly on newly-termed fluid collections and implications for the radiologist.

  5. NECROTIZING FASCIITIS OF LIMB: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Dhaarna

    2015-11-01

    Full Text Available Necrotizing fasciitis is a severe, rare, potentially lethal, soft tissue infection that tends to develop in scrotum, perineum, abdominal wall or the extremities. It is a medical emergency that threatens both patient’s limb and life. Necrotizing fasciitis has the potential to become quite severe - in such cases a radical debridement amounting to amputation of the limb may be required to save the patient’s life. Early diagnosis requires a high index of suspicion. We describe a case of a 49-year-old obese woman who developed necrotizing fasciitis in her left lower limb for which she underwent multiple radical surgical debridement, followed by skin grafting for reconstruction of the limb defects. Our main focus was to salvage the limb with the help of antibiotics and multiple debridements. This report emphasizes the need to have a relook at the use of Parenteral Crystalline Penicillin and diligent management of wounds resulting from repeated debridements.

  6. Anesthetic implications of cervicofacial necrotizing fasciitis.

    Science.gov (United States)

    Durrani, Mehmood A; Mansfield, John F

    2003-08-01

    Cervicofacial necrotizing fasciitis is a necrotizing soft tissue infection of face and neck spreading at the level of fascia. It has been described as a putrid ulcer, phagedaena, and hospital gangrene. It has a high mortality rate, and presents a challenge to anesthesiologists who must secure an airway to deliver anesthesia safely. We report a case of cervicofacial necrotizing fasciitis in which the patient underwent repeated radical surgical debridement of face and neck, including a mandibulectomy. These critically ill patients often present with sepsis and multiple system organ failure. Extensive preoperative evaluation, invasive monitoring, and possibly the use of vasopressors and inotropes are essential in treating these patients. The tracheas of these patients should remain intubated after initial debridement. Tracheostomy should be performed early. Antibiotic therapy, nutritional support, early debridement, and hyperbaric oxygen therapy all help to decrease mortality in these patients.

  7. Posterior reversible encephalopathy syndrome following a scorpion sting.

    Science.gov (United States)

    Porcello Marrone, Luiz Carlos; Marrone, Bianca Fontana; Neto, Felipe Kalil; Costa, Francisco Cosme; Thomé, Gustavo Gomes; Aramburu, Martin Brandolt; Schilling, Lucas Porcello; Pascoal, Tharick Ali; Gadonski, Giovani; Huf Marrone, Antônio Carlos; da Costa, Jaderson Costa

    2013-10-01

    Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity not yet understood, that is present with transient neurologic symptoms and particular radiological findings. The most common imaging pattern in PRES is the presence of edema in the white matter of the posterior portions of both cerebral hemispheres. The cause of PRES is unclear. We report a case of 13-year-old male who was stung by a scorpion and developed a severe headache, visual disturbance, and seizures and had the diagnosis of PRES with a good outcome. Numerous factors can trigger this syndrome, most commonly: acute elevation of blood pressure, abnormal renal function, and immunosuppressive therapy. There are many cases described showing the relationship between PRES and eclampsia, transplantation, neoplasia and chemotherapy treatment, systemic infections, renal disease acute, or chronic. However, this is the first case of PRES following a scorpion sting.

  8. Necrotizing fasciitis caused by group A streptococcus

    Directory of Open Access Journals (Sweden)

    Mikić Dragan

    2002-01-01

    Full Text Available The first case of the confirmed necrotizing fasciitis caused by Group A Streptococcus in Yugoslavia was presented. Male patient, aged 28, in good health, suddenly developed symptoms and signs of severe infective syndrome and intensive pain in the axillary region. Parenteral antibiotic, substitution and supportive therapy was conducted along with the radical surgical excision of the necrotizing tissue. The patient did not develop streptococcal toxic shock syndrome thanks to the early established diagnosis and timely applied aggressive treatment. He was released from the hospital as completely cured two months after the admission.

  9. Effect of early enteral nutrition on pancreatic exocrine secretion in dogs with acute necrotizing pancreatitis%早期肠内营养对急性坏死性胰腺炎犬胰腺外分泌功能的影响

    Institute of Scientific and Technical Information of China (English)

    陈洁; 王兴鹏; 吴恺; 刘丕; 于晓峰; 竺越; 郑松柏

    2008-01-01

    Objective To evaluate the effect of early enteral nutrition (EN) on the pancreatic exocrine secretion in dogs with acute necrotizing panereatitis (ANP). Methods ANP model was induced by injection of mixtured solution of 5% sodium tanrecholate and trypsin into the pancreatic duct. Thirty dogs were randomly divided into total parenteral nutrition (TPN) group (n=5), duodenal PEPTI-2000VARIENT (DP) group (n=5), duodenal Nutrison MuhiFibre (DN) group (n=5), jejunal PEPTI-2000VARIENT (JP) group (n=5), jejunal Nutrison MuhiFibre (JN) group (n=5). The dogs were treated by either TPN or EN 24 hours after ANP model induction and the nutrition support lasted for 5 days. Serum amylase, LDH, lipase, secretin (SEC), cholecystokinin (CCK) and gastrin were measured at 1, 2, 3, 4, 5 d. Pancreatic juice was collected for 3 hours after TPN or EN started, and the amount of pancreatic juice and levels of proteinase, amylase, lipase, HCO3-, K+, Cl-, Na+ were determined. Dogs in each group were sacrificed at day 7. Histological and ultra-structure changes of the pancreatic tissues were evaluated pathologically. Results The levels of serum amylase, LDH, lipase, CCK, amount of pancreatic secretion and K+, Cl+, Na+ were not significantly different among these groups. The levels of plasma SEC and gastrin, HCO3-, proteinase, amylase, lipase in the duodenal nutrition groups were significantly higher than those in TPN group (P0.05).各组胰腺病理改变相似.空肠营养组胰腺腺泡细胞胞质内酶原颗粒数量与密度未明显低于TPN组.结论 近端空肠内低脂要素营养对胰腺外分泌无增强效应,是安全可行的.

  10. Necrotizing gastritis associated with Clostridium septicum in a rabbit.

    Science.gov (United States)

    Garcia, Jorge P; Moore, Janet; Loukopoulos, Panayiotis; Diab, Santiago S; Uzal, Francisco A

    2014-09-01

    Clostridium septicum is the causative agent of histotoxic infections, including malignant edema and braxy (necrotizing abomasitis) in several animal species. The carcass of a 2-year-old, female New Zealand white rabbit with a history of acute depression and obtundation followed by death was received at the California Animal Health and Food Safety Laboratory System (San Bernardino, California) for necropsy and diagnostic workup. No gross lesions were detected at necropsy. Microscopically, there was moderate to severe, multifocal fibrinonecrotizing, transmural gastritis with numerous intralesional Gram-positive, sporulated rods, and disseminated thrombosis of the brain, lungs, heart, and liver, with occasional intravascular rods. The rods observed within the gastric wall and thrombi in the stomach and lung were positive for C. septicum by immunohistochemical staining. However, this microorganism was not isolated from stomach content. Clostridium septicum should be included in the list of possible etiologies of gastritis in rabbits.

  11. Minimal hepatic encephalopathy: A review.

    Science.gov (United States)

    Nardone, Raffaele; Taylor, Alexandra C; Höller, Yvonne; Brigo, Francesco; Lochner, Piergiorgio; Trinka, Eugen

    2016-10-01

    Minimal hepatic encephalopathy (MHE) is the earliest form of hepatic encephalopathy and can affect up to 80% of patients with liver cirrhosis. By definition, MHE is characterized by cognitive function impairment in the domains of attention, vigilance and integrative function, but obvious clinical manifestation are lacking. MHE has been shown to affect daily functioning, quality of life, driving and overall mortality. The diagnosis can be achieved through neuropsychological testing, recently developed computerized psychometric tests, such as the critical flicker frequency and the inhibitory control tests, as well as neurophysiological procedures. Event related potentials can reveal subtle changes in patients with normal neuropsychological performances. Spectral analysis of electroencephalography (EEG) and quantitative analysis of sleep EEG provide early markers of cerebral dysfunction in cirrhotic patients with MHE. Neuroimaging, in particular MRI, also increasingly reveals diffuse abnormalities in intrinsic brain activity and altered organization of functional connectivity networks. Medical treatment for MHE to date has been focused on reducing serum ammonia levels and includes non-absorbable disaccharides, probiotics or rifaximin. Liver transplantation may not reverse the cognitive deficits associated with MHE. We performed here an updated review on epidemiology, burden and quality of life, neuropsychological testing, neuroimaging, neurophysiology and therapy in subjects with MHE.

  12. Dual-source Dual-energy Computed Tomography Imaging of Acute Necrotizing Pancreatitis——Priliminary Study%双源CT双能量扫描对急性坏死性胰腺炎影像诊断价值的初步探讨

    Institute of Scientific and Technical Information of China (English)

    袁元; 黄子星; 李真林; 宋彬; 邓莉萍

    2011-01-01

    目的 初步探讨双源CT双能量技术扫描对急性坏死性胰腺炎影像诊断的价值.方法 回顾性分析32例确诊急性坏死性胰腺炎患者的双源CT双能量门静脉期增强图像,测量、计算并评估80 kV、140 kV和加权融合120kV图像中的胰腺实质-坏死灶CT差值、胰腺实质-坏死灶对比噪声比以及图像主观诊断评分.结果 80 kV、140 kV和加权融合120 kV图像中胰腺实质-坏死灶CT差值分别为(67.22±21.11)HU、(42.91±15.12)HU、(48.78±16.13)HU;胰腺实质-坏死灶对比噪声比分别为8.35±3.63、5.89±2.67、7.72±3.58;图像主观诊断评分分别为3.87±0.34、3.28±0.81、3.56±0.67.3组图像中的胰腺实质-坏死灶CT差值、胰腺实质-坏死灶对比噪声比以及图像主观诊断评分之间差异均有统计学意义(P<0.05).其中80 kV图像的胰腺实质-坏死灶CT差值、胰腺实质-坏死灶对比噪声比和图像主观诊断评分均高于140 kV和加权融合120 kV图像.结论 急性坏死性胰腺炎患者双源CT双能量门静脉期增强扫描,80 kV图像对坏死灶的显示优于140 kV和加权融合120 kV图像.%Objective To investigate the clinical value of dual-source computed tomography dual-energy technology in the imaging diagnosis of acute necrotizing pancreatitis. Methods Thirty-two cases with diagnosed acute necrotizing pancreatitis and underwent contrast-enhanced dual-source dual-energy CT in portal venous phase were retrospectively analyzed. Difference of CT value between pancreatic parenchyma and necrosis, contrast to noise ratio of pancreatic parenchyma-to-necrosis and score of subjective diagnosis were measured, calculated and assessed on CT images of 80 kV, 140 kV and weighted-average 120 kV. Results The difference of CT value between pancreatic parenchyma and necrosis in the images of 80 kV, 140 kV and weighted-average 120 kV was (67. 22± 21. 11) HU, (42. 91 ±15. 12) HU, (48. 78 ±16. 13) HU; contrast to noise ratio of

  13. 2009 H1N1 influenza virus infection and necrotizing pneumonia treated with extracorporeal membrane oxygenation

    Directory of Open Access Journals (Sweden)

    Suntae Ji

    2011-08-01

    Full Text Available A 3-year-old girl with acute respiratory distress syndrome due to a H1N1 2009 influenza virus infection was complicated by necrotizing pneumonia was successfully treated with extracorporeal membrane oxygenation (ECMO. This is the first reported case in which a pediatric patient was rescued with ECMO during the H1N1 influenza epidemic in Korea in 2009.

  14. Necrotizing Fasciitis: A Rare Disease, Especially for the Healthy

    Science.gov (United States)

    ... What's this? Submit Button Past Emails CDC Features Necrotizing Fasciitis: A Rare Disease, Especially for the Healthy Language: ... based hand rub if washing is not possible. Necrotizing Fasciitis Is Rarely Spread from Person to Person Most ...

  15. Cervical necrotizing fasciitis in infant: case report

    Directory of Open Access Journals (Sweden)

    Schiavetto, Renata Rennó

    2008-12-01

    Full Text Available Introduction: Necrotizing fasciitis is a bacterial infection characterized by extensive necrosis of tissues, and may include skin and muscles. It's more frequent in adults than in children and generally involves the trunk and extremities. Head and neck area is less commonly affected. The most frequently isolated pathogens are the Streptococcus pyogenes (group A and Staphylococcus aureus. The anatomopathological exam is the best diagnostic method, which early identifies the disease. The clinical support, surgical debridement, and the intravenous antibiotic therapy, are fundamental for the treatment. Objective: To report a case of an infant who suffered from Cervical Necrotizing Fasciitis. Case Report: Infant, male sex, white, 2 months old, previously healthy, with Necrotizing Fasciitis involving the frontal and right lateral cervical regions. After adequate treatment the patient obtained excellent recovery without presenting important aesthetic or functional alterations. Conclusion: The Cervical Necrotizing Fasciitis is uncommon in children. The early surgical debridement is necessary to control the infection, even if it may result in great and deep injuries. The wide spectrum antibiotic therapy and hemodynamic support are also basic for the therapeutic success.

  16. Necrotizing fasciitis : plain radiographic and CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chang Dae; Park, Jeong Hee; Jeon, Hae Jeong; Lim, Jong Nam; Heo, Tae Haeng; Park, Dong Rib [Konkuk Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-11-01

    To evaluate the plain radiographic and CT findings of the necrotizing fasciitis. We retrospectively reviewed the radiologic findings of 4 cases with necrotizing fasciitis. Three cases were proven pathologically. We evaluated pattern and extent of the gas shadows in plain films. CT findings were analysed, with emphasis on : (a) gas pattern, (b) extent, (c) location and involved site, (d) associated focal abscess, and (e) swelling of the adjacent muscles. On plain radiographs, four cases showed streaky or mottled gas densities in the pelvis, three cases in the perineum, one case in the abdomen, and two cases in the thigh. On CT images, gas pattern was mottled and streaky appearance with swelling of the adjacent muscles. Gas shadows located in the extraperitoneal space in four cases, fascial layer in four cases, and subcutaneous layer in four cases. There were gas shadows in pelvic wall, perineum, abdominal wall, buttock, thigh, and scrotum. Focal low density lesion suggestive of focal abscess was not visualized. Plain radiography is useful for early diagnosis of the necrotizing fasciitis and CT is very useful for detection of precise location and extent of the disease. CT is also useful for differentiation of necrotizing fasciitis from focal abscess and cellulitis.

  17. Intestinal proteome changes during infant necrotizing enterocolitis

    DEFF Research Database (Denmark)

    Jiang, Pingping; Smith, Birgitte; Qvist, Niels;

    2013-01-01

    Background: Changes in the intestinal and colonic proteome in patients with necrotizing enterocolitis (NEC) may help to characterize the disease pathology and identify new biomarkers and treatment targets for NEC. Methods: Using gel-based proteomics, proteins in NEC-affected intestinal and coloni...

  18. Necrotizing Pneumonia Caused by Penicillium chrysogenum

    OpenAIRE

    D’Antonio, Domenico; Violante, Beatrice; Farina, Claudio; Sacco, Rocco; Angelucci, Domenico; Masciulli, Maurizio; Iacone, Antonio; Romano, Ferdinando

    1998-01-01

    We report a case of necrotizing pneumonia due to Penicillium chrysogenum in a 57-year-old woman operated on for lung cancer. The residual right lower pulmonary lobe was infiltrated by Penicillium chrysogenum. The patient underwent a second pulmonary right lobectomy and was successfully treated with oral itraconazole. To our knowledge, this is the first case of pneumonia due to P. chrysogenum.

  19. 双源CT双能量碘图对急性坏死性胰腺炎影像的诊断价值%The Value of Dual-source Dual-energy CT with Iodine Overlay in the Diagnosis of Acute Necrotizing Pancreatitis

    Institute of Scientific and Technical Information of China (English)

    袁元; 黄子星; 李真林; 宋彬; 邓莉萍

    2012-01-01

    Objective To investigate the clinical value of dual-source computed tomography dual-energy Iodine overlay technique in the imaging diagnosis of acute necrotizing pancreatitis. Methods The imaging data were retrospectively analyzed in 67 cases of acute necrotizing pancreatitis underwent contrast-enhanced dual-source dual-energy CT in portal venous phase. The CT imaging parameters, including the difference of CT value between pancreatic parenchyma and necrotic lesion, contrast-to-noise ratio of pancreatic parenchyma-to-necrosis, area of pancreatic necrosis and score of subjective diagnosis, were measured and assessed on CT images of 80 kV, 140 kV, weighted-average 120 kV as well as Iodine overlay. Results The differences of CT value between pancreatic parenchyma and necrosis in the images of 80 kV, 140 kV, weighted-average 120 kV and Iodine overlay were (67. 40 ±20.82) HU,(42. 87±14. 99) HU, (48. 69±15. 82) HU, (33. 01 ± 10. 26) HU, respectively;contrast-to-noise ratios of pancreatic parenchyma-to-necrosis of each group were 8. 36 ± 3. 58, 5. 85±2. 65, 7. 68±3. 51, 10. 60± 4. 34;area of pancreatic necrosis of each group was (3. 78 ±2. 68) cm2, (3.28 ± 2.59) cm2, (3. 37±2. 46) cm2, (2. 42 ± 1. 98) cm2 ;the score of subjective diagnosis of each group was 3. 88 ±0. 33, 3. 31 ± 0. 80, 3. 58 ±0. 66, 2. 81 ± 0. 76, respectively. The four indexes in the images of Iodine overlay were significantly different from those of another three groups (P<0. 05). Contrast-to-noise ratio of pancreatic parenchyma-to-necrosis in the images of Iodine overlay was significantly higher than that of another three groups, while the difference of CT value, area of pancreatic necrosis and score of subjective diagnosis were lower. Conclusion Dual-source CT dual-energy Iodine overlay is not helpful to improve subjective judgment in the diagnosis of pancreatic necrosis, but contributes to the display of hypoperfusion area around the necrosis.%目的 初步探讨双源CT双能量碘

  20. Hashimoto's encephalopathy: report of three cases.

    Science.gov (United States)

    Chang, Jan-Shun; Chang, Tien-Chun

    2014-11-01

    Both severe thyrotoxicosis and hypothyroidism may affect brain function and cause a change in consciousness, as seen with a thyroid storm or myxedema coma. However, encephalopathy may also develop in patients with autoimmune thyroid diseases independent of actual thyroid function level, and this is known as Hashimoto's encephalopathy. Although most patients are found to have Hashimoto's thyroiditis, less frequently they have Graves' disease. Clinical manifestations include epilepsy, disturbance of consciousness, cognitive impairment, memory loss, myoclonus, hallucinations, stroke-like episodes, tremor, involuntary movements, language impairment, and gait impairment. Hashimoto's encephalopathy is a relatively rare disease. As a good response can be obtained with corticosteroid therapy, early diagnosis and treatment is very beneficial for patients. Here we report three patients with Hashimoto's encephalopathy with typical manifestations of hallucinations that were associated with hypothyroidism, hyperthyroidism, and euthyroid status, respectively. They all showed a dramatic response to methylprednisolone pulse therapy.

  1. Bovine Spongiform Encephalopathy: Atypical Pros and Cons

    Science.gov (United States)

    Transmissible spongiform encephalopathies (TSEs) are fatal neurologic diseases that affect several mammalian species including human beings. Four animal TSE agents have been reported: scrapie of sheep and goats; chronic wasting disease (CWD) of deer, elk, and moose; transmissible mink encephalopath...

  2. Metabolic encephalopathy in Egyptian children.

    Science.gov (United States)

    Hindawy, A; Gouda, A; El-Ayyadi, A; Megahed, H; Bazaraa, H

    2007-01-01

    Fatty Acid Oxidation disorders represent an expanding group of inborn errors of metabolism. Clinical manifestations include episodic encephalopathy, hypoketotic hypoglycemia, Reye like episodes, hepatic, muscular, cardiac affection and sudden death. Analysis of urinary organic acids and plasma fatty acids of 44 clinically suspected patients by Gas Chromatography Mass spectrometry revealed 4 cases of Medium chain acyl-CoA dehydrogenase deficiency (MCADD), 3 cases of Very long chain acyl-CoA dehydrogenase deficiency, 9 cases of multiple defects of acyl-CoA dehydrogenation in addition to 3 patients with other metabolic disorders. Timely detection of these disorders including screening for MCADD can have a favorable impact on the outcome of these patients (Tab. 11, Fig. 3, Ref. 24) Full Text (Free, PDF).

  3. Encephalopathy

    Science.gov (United States)

    ... provide specific instructions for proper care and treatment. Anticonvulsants may be prescribed to reduce or halt any ... provide specific instructions for proper care and treatment. Anticonvulsants may be prescribed to reduce or halt any ...

  4. 清胰活血汤、Infliximab单抗治疗急性坏死性胰腺炎大鼠的疗效观察%Effects of Qingyi Huoxue decoction and Infliximab on rats with acute necrotizing pancreatitis

    Institute of Scientific and Technical Information of China (English)

    李伟冬; 贾林; 马军; 方建志; 邱嘉华; 黄耀星; 潘锦瑶

    2011-01-01

    目的 比较清胰活血汤和Infliximab单抗治疗大鼠急性坏死性胰腺炎(ANP)并发多器官功能衰竭(MOOS)的疗效.方法 采用胰管内逆行注射4.5%牛磺胆酸钠1 ml/kg体重的方法诱导大鼠ANP模型.按数字表法随机分为ANP组、清胰活血汤组(Q组)和Infliximab单抗组(Ⅰ组).Ⅰ组于建模后6 h尾静脉注射Infliximab单抗(8 mg/kg体重),ANP组和Q组于建模前4 h和建模后3、9 h分别给予生理盐水和清胰活血汤灌胃(20 ml/kg体重).24 h后处死大鼠,检测血清淀粉酶、总胆红素(TBil)、肌酐(Cr)、TNF-α、二胺氧化酶(DAO)水平,测腹腔内压,计算小肠碳末推进率,行胰腺组织病理学检查.结果 ANP组、Q组、Ⅰ组的胰腺病理评分分别为13.8±0.8、6.1±0.4、3.9±0.6,各组间差异均有统计学意义(P值均<0.05),血清淀粉酶、TBil、Cr及TNF-α水平亦依次显著降低.ANP组、Q组、ΒⅠ组血DAO水平分别为(186.3±10.2)、(134.6±14.3)、(149.1±16.3)U/L;小肠碳末推进率为(53±0.1)%、(89±0.1)%、(61±0.1)%;腹内压为(11.8±1.5)、(4.1±0.8)、(5.8±1.2)mmHg(1 mmHg=0.133 kPa).Q组及Ⅰ组的DAO和腹内压均较ANP组显著降低,而小肠碳末推进率均高于ANP组(P值均<0.05),且Q组小肠碳末推进率高于Ⅰ组,腹内压和DAO浓度低于Ⅰ组,两组的差异具有统计学意义(P值均<0.05).结论 清胰活血汤与Infliximab单抗治疗ANP并MODS大鼠均具显效,其中清胰活血汤在促胃肠动力、降腹内压和改善肠屏障功能方面疗效更显著.%Objective To compare the treatment effects of Qingyi Huoxue decoction and infliximab on acute necrosis pancreatitis ( ANP) complicated with MODS in a rat model. Methods 4.5% sodium taurocholate was injected into the pancreatic duct to induce the ANP complicated with MODS model. The ANP rats were randomly divided into 3 groups, ANP group (ANP), Qingyi Huoxue decoction treatment group ( QG) , infliximab treatment group (IG). Rats in infliximab group received

  5. Acute Hydrocephaly Following Methadone Intoxication in a Child

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    Afshin FAYYAZI

    2012-03-01

    Full Text Available Infantile methadone intoxication has been on the rise since the usage of methadone in opioid detoxification programs. We report a 30-month-old child with encephalopathy and acute hydrocephaly following methadone intoxication.

  6. Acute esophageal necrosis and liver pathology, a rare combination

    Institute of Scientific and Technical Information of China (English)

    Amir Maqbul Khan; Rangit Hundal; Vijaya Ramaswamy; Mark Korsten; Sunil Dhuper

    2004-01-01

    Acute esophageal necrosis (AEN) or "black esophagus" is a clinical condition found at endoscopy. It is a rare entity the exact etiology of which remains unknown. We describe of liver cirrhosis and hepatic encephalopathy.

  7. Delayed Encephalopathy of Carbon Monoxide Intoxication and Treatment with Hyperbaric Oxygen: A Case Report

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    Fatma Polat

    2012-09-01

    Full Text Available Delayed encephalopathy (DE is a neuropsychiatric syndrome that can arise generally within 20 days of acute carbon monoxide (CO intoxication after apparent recovery and involves variable degrees of cognitive deficits, personality changes, movement disorders and focal neurologic deficits. We report a 35-year-old female patient with delayed encephalopathy due to CO intoxication, presenting with cognitive impairment and mild parkinsonism despite receiving hyberbaric oxigen therapy (HBO. Magnetic resonance imaging showed abnormal signal intensity and decreased diffusivity at both caudate nuclei and globus pallidus. She continued to receive additional HBO therapy and complete recovery was reached within six months. The positive effect of early HBO therapy of selected patients in reversing the acute effects of CO intoxication is appearant. We here also review the beneficial effect of HBO in preventing or limitating the late neurocognitive deficits associated with severe CO intoxication.

  8. Epidemiological features and risk factors of sepsis-associated encephalopathy in intensive care unit patients: 2008-2011

    Institute of Scientific and Technical Information of China (English)

    ZHANG Li-na; WANG Xiao-ting; AI Yu-hang; GUO Qu-lian; HUANG Li; LIU Zhi-yong; Yao Bo

    2012-01-01

    Background Encephalopathy is a common complication of sepsis,and its onset can occur at any stage of sepsis and implies worse prognosis.However,the incidence,epidemiology,and pathogenesis of sepsis-associated encephalopathy remain controversial.The purpose of this study was to investigate the epidemiological features and risk factors for sepsis-associated encephalopathy.Methods Our retrospective study included all patients with sepsis admitted to our intensive care unit from 2008 to 2011.After excluding 91 patients,232 patients were assigned to either a sepsis-associated encephalopathy group or sepsis without encephalopathy group.Between-group differences in baseline patient data including vital signs,disease severity,pathogens,sites of infection,biochemical indicators,and time on a mechanical ventilator,intensive care unit (ICU) stay,and 28-day mortality rate were analyzed.Results The incidence of sepsis-associated encephalopathy was 17.7%.The sepsis-associated encephalopathy group had significantly higher 28-day mortality (56.1% vs.35.1%; P=0.013),spent a significantly longer time on a ventilator ((8.2±2.2) days vs.(2.9±0.4) days; P=0.021),and had a significantly longer ICU stay ((12.4±2.4) days vs.(7.1±0.6) days;P=0.042).Acute physiology and chronic health evaluation Ⅱ score,Glasgow coma scale,heart rate,blood lactate,serum sodium,platelets,serum albumin,and pH values were related to the presence of encephalopathy.Patients with biliary tract infections and intestinal infections caused by Staphylococcus aureus,Enterococcus faecium,Acinetobacter spp,Pseudomonas aeruginosa,and Stenotrophomonas maltophilia,were more prone to develop sepsis-associated encephalopathy.Conclusions Encephalopathy increases mortality rate in septic patients.Clinical intervention to reduce risk factors and thereby morbidity and mortality depends on a correct understanding of the differences between patients with sepsis and patients with both sepsis and encephalopathy.

  9. Calciphylaxis following acute renal injury: a case and literature review

    OpenAIRE

    Oda, Tomoko; Sawada, Yu; YAMAGUCHI, TAKASHI; Ohmori, Shun; Omoto, Daisuke; Haruyama, Sanehito; Yoshioka, Manabu; Okada, Etsuko; Nakamura, Motonobu

    2016-01-01

    Background Calciphylaxis following acute renal failure is rare. Findings We report A 57-year-old male with an acute renal failure associated with necrotizing fasciitis. We also review the cases of calciphylaxis due to acute renal disorder further. Conclusions It should be kept in mind that calciphylaxis is observed in patient with not only chronic renal disease but also acute renal failure.

  10. Differentiation of ruminant transmissible spongiform encephalopathy isolate types, including bovine spongiform encephalopathy and CH1641 scrapie

    NARCIS (Netherlands)

    Jacobs, J.G.; Sauer, M.; Keulen, van L.J.M.; Tang, Y.; Bossers, A.; Langeveld, J.P.M.

    2011-01-01

    With increased awareness of the diversity of transmissible spongiform encephalopathy (TSE) strains in the ruminant population, comes an appreciation of the need for improved methods of differential diagnosis. Exposure to bovine spongiform encephalopathy (BSE) has been associated with the human TSE,

  11. A case of tacrolimus-induced encephalopathy after kidney transplantation

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    Myoung Uk Kim

    2011-01-01

    Full Text Available We present a case of tacrolimus-induced encephalopathy after successful kidney transplantation. An 11-year-old girl presented with sudden onset of neurologic symptoms, hypertension, and psychiatric symptoms, with normal kidney function, after kidney transplantation. The symptoms improved after cessation of tacrolimus. Magnetic resonance imaging (MRI showed acute infarction of the middle cerebral artery (MCA territory in the right frontal lobe. Three days later, she had normal mental function and maintained normal blood pressure with left hemiparesis. Follow-up MRI was performed on D19, showing new infarct lesions at both cerebral hemispheres. Ten days later, MRI showed further improvement, but brain single photon emission computed tomography (SPECT showed mild reduction of uptake in both the anterior cingulate gyrus and the left thalamus. One month after onset of symptoms, angiography showed complete resolution of stenosis. However, presenting as a mild fine motor disability of both hands and mild dysarthria, what had been atrophy at both centrum semiovale at 4 months now showed progression to encephalomalacia. There are two points of interest in this case. First, encephalopathy occurred after administration of tacrolimus and improved after discontinuation of the drug. Second, the development of right-side hemiplegia could not be explained by conventional MRI; but through diffusion tensor imaging (DTI and diffusion tensor tractography (DTT of white matter tract, visualization was possible.

  12. Recurrent contrast-induced encephalopathy following coronary angiography.

    Science.gov (United States)

    Spina, Roberto; Simon, Neil; Markus, Romesh; Muller, David W M; Kathir, Krishna

    2017-02-01

    Contrast-induced encephalopathy (CIE) is an acute and reversible neurological disturbance associated with the intra-arterial administration of iodinated contrast medium during cardiac catheterisation. It may manifest with encephalopathy, motor and sensory disturbances; vision disturbances, including cortical blindness, ophthalmoplegia, aphasia; and seizures. Disruption of the blood-brain barrier and direct neuronal toxicity are believed to be implicated in the pathophysiology of the syndrome. Symptoms appear soon after contrast administration and resolve completely within 24-48 h. Risk factors may include hypertension, diabetes mellitus, renal impairment, the administration of large volumes of iodinated contrast, percutaneous coronary intervention or selective angiography of internal mammary grafts and previous adverse reaction to iodinated contrast. On cerebral imaging, CIE may mimic subarachnoid haemorrhage or cerebral ischaemia, but imaging may be normal. Prognosis is excellent with supportive management alone. CIE may recur, but re-challenge with iodinated contrast without adverse effects has been documented. CIE is a diagnosis of exclusion and is an important clinical entity to consider in the differential diagnosis of stroke following cardiac catheterisation. Physicians should be aware of it and consider it prior to initiating thrombolysis.

  13. [Necrotizing enterocolitis. Pathogenesis and iatrogenic factors].

    Science.gov (United States)

    Obladen, M

    1986-08-01

    Following clinical observations, measurements of osmolarity of liquid drugs, and determination of blood loss due to sampling in very low birthweight infants, the following hypothesis on iatrogenic factors contributing to the pathogenesis of necrotizing enterocolitis is proposed: Due to diagnostic blood sampling during intensive care, premature infants may become severely anemic. Therefore their intestinal perfusion is reduced, causing hypoxia and hypoperfusion in the submucosa. Especially in infants with oral feeding and hyperosmolar medication, mechanical factors, hyperosmolarity and infection can affect the mucosa from the luminal side. Simultaneous hypoperfusion and hyperosmolar load may contribute to the pathogenesis of necrotizing enterocolitis. This hypothesis, which needs experimental verification, explains the different incidence of the disease in different hospitals.

  14. Actualities on molecular pathogenesis and repairing processes of cerebral damage in perinatal hypoxic-ischemic encephalopathy.

    Science.gov (United States)

    Distefano, Giuseppe; Praticò, Andrea D

    2010-09-16

    Hypoxic-ischemic encephalopathy (HIE) is the most important cause of cerebral damage and long-term neurological sequelae in the perinatal period both in term and preterm infant. Hypoxic-ischemic (H-I) injuries develop in two phases: the ischemic phase, dominated by necrotic processes, and the reperfusion phase, dominated by apoptotic processes extending beyond ischemic areas. Due to selective ischemic vulnerability, cerebral damage affects gray matter in term newborns and white matter in preterm newborns with the typical neuropathological aspects of laminar cortical necrosis in the former and periventricular leukomalacia in the latter. This article summarises the principal physiopathological and biochemical processes leading to necrosis and/or apoptosis of neuronal and glial cells and reports recent insights into some endogenous and exogenous cellular and molecular mechanisms aimed at repairing H-I cerebral damage.

  15. Actualities on molecular pathogenesis and repairing processes of cerebral damage in perinatal hypoxic-ischemic encephalopathy

    Directory of Open Access Journals (Sweden)

    Praticò Andrea D

    2010-09-01

    Full Text Available Abstract Hypoxic-ischemic encephalopathy (HIE is the most important cause of cerebral damage and long-term neurological sequelae in the perinatal period both in term and preterm infant. Hypoxic-ischemic (H-I injuries develop in two phases: the ischemic phase, dominated by necrotic processes, and the reperfusion phase, dominated by apoptotic processes extending beyond ischemic areas. Due to selective ischemic vulnerability, cerebral damage affects gray matter in term newborns and white matter in preterm newborns with the typical neuropathological aspects of laminar cortical necrosis in the former and periventricular leukomalacia in the latter. This article summarises the principal physiopathological and biochemical processes leading to necrosis and/or apoptosis of neuronal and glial cells and reports recent insights into some endogenous and exogenous cellular and molecular mechanisms aimed at repairing H-I cerebral damage.

  16. Infections of the neck leading to descending necrotizing mediastinitis: Role of multi-detector row computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Pinto, Antonio [Department of Diagnostic Imaging, A. Cardarelli Hospital, 80131 Naples (Italy)], E-mail: antopin1968@libero.it; Scaglione, Mariano; Scuderi, Maria Giuseppina; Tortora, Giovanni; Daniele, Stefania; Romano, Luigia [Department of Diagnostic Imaging, A. Cardarelli Hospital, 80131 Naples (Italy)

    2008-03-15

    Descending necrotizing mediastinitis is an acute, polymicrobial infection of the mediastinum, originating from odontogenic, oropharyngeal and cervical infections. Anatomical continuity of the fascial spaces between the neck and the mediastinum leads to an occasional mediastinal extension of deep neck infection as a serious sequela. An understanding of the anatomy of the deep spaces of the neck and familiarity with the imaging findings in descending necrotizing mediastinitis may allow rapid diagnosis and treatment of this rare and life-threatening complication of deep neck space infection. In this article, we discuss the current role of radiology in diagnosing descending necrotizing mediastinitis, in determining the level of infection and the pathways of spread of infections from the neck to the mediastinum and in planning a successful treatment.

  17. Traumatic abdominal hernia complicated by necrotizing fasciitis.

    Science.gov (United States)

    Martínez-Pérez, Aleix; Garrigós-Ortega, Gonzalo; Gómez-Abril, Segundo Ángel; Martí-Martínez, Eva; Torres-Sánchez, Teresa

    2014-11-01

    Necrotizing fasciitis is a critical illness involving skin and soft tissues, which may develop after blunt abdominal trauma causing abdominal wall hernia and representing a great challenge for physicians. A 52-year-old man was brought to the emergency department after a road accident, presenting blunt abdominal trauma with a large non-reducible mass in the lower-right abdomen. A first, CT showed abdominal hernia without signs of complication. Three hours after ICU admission, he developed hemodynamic instability. Therefore, a new CT scan was requested, showing signs of hernia complication. He was moved to the operating room where a complete transversal section of an ileal loop was identified. Five hours after surgery, he presented a new episode of hemodynamic instability with signs of skin and soft tissue infection. Due to the high clinical suspicion of necrotizing fasciitis development, wide debridement was performed. Following traumatic abdominal wall hernia (TAWH), patients can present unsuspected injuries in abdominal organs. Helical CT can be falsely negative in the early moments, leading to misdiagnosis. Necrotizing fasciitis is a potentially fatal infection and, consequently, resuscitation measures, wide-spectrum antibiotics, and early surgical debridement are required. This type of fasciitis can develop after blunt abdominal trauma following wall hernia without skin disruption.

  18. Necrotizing Fasciitis in Paroxysmal Nocturnal Hemoglobinuria

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    Pusem Patir

    2015-01-01

    Full Text Available Paroxysmal nocturnal hemoglobinuria (PNH is a rare, progressive, and life-threatening hematopoietic stem cell disorder characterized by complement-mediated intravascular hemolysis and a prothrombotic state. Patients with PNH might have slightly increased risk of infections due to complement-associated defects subsequent to CD59 deficiency. Here, we report a rare case of a 65-year-old male patient with necrotic ulcers on both legs, where the recognition of pancytopenia and microthrombi led to the diagnosis of PNH based on FLAER (FLuorescent AERolysin flow cytometric analysis. He was subsequently started on eculizumab therapy, with starting and maintenance doses set as per drug labelling. Progression of the patient’s leg ulcers during follow-up, with fulminant tissue destruction, purulent discharge, and necrotic patches, led to a later diagnosis of necrotizing fasciitis due to Pseudomonas aeruginosa and Klebsiella pneumonia infection. Courses of broad-spectrum antibiotics, surgical debridement, and superficial skin grafting were applied with successful effect during ongoing eculizumab therapy. This case highlights the point that it is important to maintain treatment of underlying disorders such as PNH in the presence of life-threatening infections like NF.

  19. Early detection of hepatic encephalopathy by recording visual evoked potential (VEP).

    Science.gov (United States)

    Zamir, Doron; Storch, Shimon; Kovach, Ivan; Storch, Rita; Zamir, Chen

    2002-01-01

    The visual evoked potential (VEP) record in response to a pattern stimulus is a non invasive and reliable method of detecting central and peripheral nerve system abnormalities. VEP recording have been used in animals with fulminant hepatic failure, and also in-patients with hepatic encephalopathy and acute severe hepatitis. Our aims were: a. to evaluate the potency of PVEP in assessing hepatic encephalopathy. b. to find the rate of pathologic PVEP in patients with advanced liver cirrhosis. VEP was recorded in 14 chronic liver cirrhotic patients (6 alcoholic, 6 HCV-related, 2 cryptogenic) and 14 controls. Patients with any neurologic abnormalities were excluded from the study. All patients were subjected to the Mental State Score (MSS) test, and venous blood ammonia was measured on the same day of VEP recording. In 10/14 (71%) patients some VEP recording abnormality was detected. In the cirrhotic patients, P100 latency was significantly longer (P VEP developed hepatic encephalpathy during a follow-up of one year, compared to one out of 4 patients with no pathology on VEP recording. VEP recording may be a valuable tool in assessing patients with early hepatic encephalopathy and in predicting encephalopathy.

  20. Acute Necrotizing Ulcerative Gingivitis: Microbial and Immunologic Studies.

    Science.gov (United States)

    1984-08-05

    3. (1983) 3. Periodontol. Set.:557. 58. Nisengard, R. 3., Myers, D., Fischman , S. and Socransky, S. (1976) J. Dent. Res. Spec. Issue B:pB206 #576...by this Contract Rose Lai received M. S. degree 12/20/82 David Shaefer Ph.D. candidate Susan Mandel M. S. candidate John Czeculin M. S. candidate

  1. Acute Necrotizing Ulcerative Gingivitis: Microbial and Immunologic Studies

    Science.gov (United States)

    1983-10-01

    34 Odd ii 4n....00p IdaOdifir 0’ block flumber) Periodontal Disease Spirochetes Microbiology Fusobacteria immunology Bacteroides 20. AN3T7RAC~r C4.tft...and serological etudies with ’We 7. nucleatum isolates from patients with ANUG, chronic periodontitis , Juvenile periodontitis , and adults and children...routine periodontal procedures (34-37). Early studies on the histopathology of ANUG lesions reported that the pathological process appears to begin or the

  2. Bruxism Associated with Anoxic Encephalopathy: Successful Treatment with Baclofen

    Science.gov (United States)

    Janati, A. Bruce; ALGhasab, Naif Saad; ALGhassab, Fahad Saad

    2013-01-01

    Introduction. Bruxism is a movement disorder characterized by grinding and clenching of the teeth. Etiology of bruxism can be divided into three groups: psychosocial factors, peripheral factors, and pathophysiological factors. Methods. The clinical investigation was conducted at King Khaled Hospital in Hail, Saudi Arabia, in 2012. Results. A 16-year-old Saudi female was brought to the hospital in a comatose state and with generalized convulsive seizures secondary to acute anoxic encephalopathy. In the third week of hospitalization, while still in a state of akinetic mutism, she developed incessant bruxism which responded favorably to a GABA receptor agonist (baclofen). Conclusion. Our data support the hypothesis that bruxism emanates from imbalance or dysregulation of the neurotransmitter system. Larger scale studies will be needed to confirm this hypothesis. PMID:24455317

  3. [Wernicke encephalopathy after subtotal gastrectomy for morbid obesity].

    Science.gov (United States)

    Gabaudan, C; La-Folie, T; Sagui, E; Soulier, B; Dion, A-M; Richez, P; Brosset, C

    2008-05-01

    Wernicke's encephalopathy (WE) is one of the potential complications of obesity surgery. It is an acute neuropsychiatric syndrome resulting from thiamine deficiency often associated with repeated vomiting. The classic triad is frequently reported in these patients (optic neuropathy, ataxia and confusion), associated with uncommon features. Cerebral impairment affects the dorsal medial nucleus of the thalamus and the periaqueductal grey area, appearing on MRI, as hyperintense signals on T2, Flair and Diffusion weighted imaging. Early diagnosis and parenteral thiamine are required to decrease morbidity and mortality. We report a case of WE and Korsakoff's syndrome in a young obese patient after subtotal gastrectomy, who still has substantial sequelae. The contribution of MRI with diffusion-weighted imaging is illustrated. The interest of nutritional supervision in the first weeks and preventive thiamine supplementation in case of repeated vomiting are of particular importance in these risky situations.

  4. Bruxism Associated with Anoxic Encephalopathy: Successful Treatment with Baclofen

    Directory of Open Access Journals (Sweden)

    A. Bruce Janati

    2013-01-01

    Full Text Available Introduction. Bruxism is a movement disorder characterized by grinding and clenching of the teeth. Etiology of bruxism can be divided into three groups: psychosocial factors, peripheral factors, and pathophysiological factors. Methods. The clinical investigation was conducted at King Khaled Hospital in Hail, Saudi Arabia, in 2012. Results. A 16-year-old Saudi female was brought to the hospital in a comatose state and with generalized convulsive seizures secondary to acute anoxic encephalopathy. In the third week of hospitalization, while still in a state of akinetic mutism, she developed incessant bruxism which responded favorably to a GABA receptor agonist (baclofen. Conclusion. Our data support the hypothesis that bruxism emanates from imbalance or dysregulation of the neurotransmitter system. Larger scale studies will be needed to confirm this hypothesis.

  5. Wernicke's encephalopathy following Hyperemesis gravidarum. A report of three cases.

    Science.gov (United States)

    Kotha, V K; De Souza, A

    2013-02-01

    Wernicke's encephalopathy (WE) due to causes other than chronic alcohol abuse is an uncommon and often misdiagnosed condition. In the setting of hyperemesis gravidarum, an acute deficiency of thiamine results from body stores being unable to meet increased metabolic demands. The condition produces typical clinical and radiological findings and when diagnosed early and treated promptly has a good prognosis. Magnetic resonance imaging (MRI) is sensitive and specific for diagnosis. We describe three patients with hyperemesis gravidarum who developed WE, and highlight a range of clinical and imaging features important for appropriate diagnosis. A high degree of clinical suspicion is essential. Treatment is often empirical pending results of investigation, and consists of parenteral repletion of thiamine stores. Reversal of MRI findings parallels clinical improvement. Neurologic outcomes are usually good, but half the pregnancies complicated by this condition do not produce healthy children.

  6. Hashimoto's encephalopathy : epidemiology, pathogenesis and management.

    Science.gov (United States)

    Mocellin, Ramon; Walterfang, Mark; Velakoulis, Dennis

    2007-01-01

    Hashimoto's encephalopathy is a term used to describe an encephalopathy of presumed autoimmune origin characterised by high titres of antithyroid peroxidase antibodies. In a similar fashion to autoimmune thyroid disease, Hashimoto's encephalopathy is more common in women than in men. It has been reported in paediatric, adult and elderly populations throughout the world. The clinical presentation may involve a relapsing and remitting course and include seizures, stroke-like episodes, cognitive decline, neuropsychiatric symptoms and myoclonus. Thyroid function is usually clinically and biochemically normal.Hashimoto's encephalopathy appears to be a rare disorder, but, as it is responsive to treatment with corticosteroids, it must be considered in cases of 'investigation negative encephalopathies'. Diagnosis is made in the first instance by excluding other toxic, metabolic and infectious causes of encephalopathy with neuroimaging and CSF examination. Neuroimaging findings are often not helpful in clarifying the diagnosis. Common differential diagnoses when these conditions are excluded are Creutzfeldt-Jakob disease, rapidly progressive dementias, and paraneoplastic and nonparaneoplastic limbic encephalitis. In the context of the typical clinical picture, high titres of antithyroid antibodies, in particular antithyroid peroxidase antibodies, are diagnostic. These antibodies, however, can be detected in elevated titres in the healthy general population. Treatment with corticosteroids is almost always successful, although relapse may occur if this treatment is ceased abruptly. Other forms of immunomodulation, such as intravenous immune-globulin and plasma exchange, may also be effective. Despite the link to autoimmune thyroid disease, the aetiology of Hashimoto's encephalopathy is unknown. It is likely that antithyroid antibodies are not pathogenic, but titres can be a marker of treatment response. Pathological findings can suggest an inflammatory process, but features

  7. Gut microbiota and hepatic encephalopathy.

    Science.gov (United States)

    Dhiman, Radha K

    2013-06-01

    There is a strong relationship between liver and gut; while the portal venous system receives blood from the gut, and its contents may affect liver functions, liver in turn, affects intestinal functions through bile secretion. There is robust evidence that the pathogenesis of hepatic encephalopathy (HE) is linked to alterations in gut microbiota and their by-products such as ammonia, indoles, oxindoles, endotoxins, etc. In the setting of intestinal barrier and immune dysfunction, these by-products are involved in the pathogenesis of complications of liver cirrhosis including HE and systemic inflammation plays an important role. Prebiotics, probiotics and synbiotics may exhibit efficacy in the treatment of HE by modulating the gut flora. They improve derangement in flora by decreasing the counts of pathogenic bacteria and thus improving the endotoxemia, HE and the liver disease. Current evidence suggest that the trials evaluating the role of probiotics in the treatment of HE are of not high quality and all trials had high risk of bias and high risk of random errors. Therefore, the use of probiotics for patients with HE cannot be currently recommended. Further RCTs are required. This review summarizes the main literature findings about the relationships between gut flora and HE, both in terms of the pathogenesis and the treatment of HE.

  8. IMMUNOLOGICAL STUDY OF SPONGIFORM ENCEPHALOPATHIES

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    J. Meenupriya

    2013-04-01

    Full Text Available Spongiform encephalopathies, categorized as a subclass of neuro-degenerative diseases and commonly known as prion diseases, are a group of progressive conditions that affect the brain and nervous system of many animals, including humans. Prion diseases are common among cannibalistic communities; further research has revealed that the infected or malformed prion protein (named PrPsc spreads its virulence to the normal, healthy prion protein (named PrPc when people consume infected tissues. Knowing that a small interaction between normal and infected prion protein creates virulence, this relationship can be studied as a simple antigen-antibody interaction to understand the series of events that transform a normal prion protein into a virulent misfolded protein. Thoroughly modeled and validated structures of both PrPsc and PrPc can be effectively used to map the epitopes and thereby screen the antigen-antibody interaction using docking studies for a particular organism of concern. This simple immunological approach is used to understand the vital interaction between the normal and malformed proteins that is involved in the disease-spreading mechanism. Clarification of this mechanism could be used in various immune- and bioinformatics algorithms to map the interaction epitopes, furthering an understanding of these pathologies.

  9. Encephalopathy caused by lanthanum carbonate.

    Science.gov (United States)

    Fraile, Pilar; Cacharro, Luis Maria; Garcia-Cosmes, Pedro; Rosado, Consolacion; Tabernero, Jose Matias

    2011-06-01

    Lanthanum carbonate is a nonaluminum, noncalcium phosphate-binding agent, which is widely used in patients with end-stage chronic kidney disease. Until now, no significant side-effects have been described for the clinical use of lanthanum carbonate, and there are no available clinical data regarding its tissue stores. Here we report the case of a 59-year-old patient who was admitted with confusional syndrome. The patient received 3750 mg of lanthanum carbonate daily. Examinations were carried out, and the etiology of the encephalopathy of the patient could not be singled out. The lanthanum carbonate levels in serum and cerebrospinal fluid were high, and the syndrome eased after the drug was removed. The results of our study confirm that, in our case, the lanthanum carbonate did cross the blood-brain barrier (BBB). Although lanthanum carbonate seems a safe drug with minimal absorption, this work reveals the problem derived from the increase of serum levels of lanthanum carbonate, and the possibility that it may cross the BBB. Further research is required on the possible pathologies that increase serum levels of lanthanum carbonate, as well as the risks and side-effects derived from its absorption.

  10. Therapeutic approach to epileptic encephalopathies.

    Science.gov (United States)

    Vigevano, Federico; Arzimanoglou, Alexis; Plouin, Perrine; Specchio, Nicola

    2013-11-01

    Epileptic encephalopathies (EEs) are electroclinical entities with a peculiar course of disease; seizures and electroencephalographic (EEG) epileptiform abnormalities, ictal and interictal, contribute to progressive disturbance of cerebral functions. Frequently EEs are drug resistant, and consequences may be catastrophic. The main goal of treatment is to stop the peculiar course of epilepsy, operating on three parameters: seizure control, reduction of EEG abnormalities, and developmental outcome. For a correct therapeutic approach it is mandatory to have an as accurate as possible syndromic and etiologic diagnosis. Given the poor efficacy of conventional antiepileptic drugs (AEDs), the use of specific drugs for EEs, such as adrenocorticotropic hormone (ACTH) and corticosteroids or stiripentol is suggested. In some cases the choice of treatment is strictly related to the etiology: vigabatrin in tuberous sclerosis, ketogenic diet in glucose transporter type 1 (GLUT-1) deficiency, and pyridoxine in pyridoxine deficiency. Some AEDs combinations, such as sodium valproate with lamotrigine, have also provided interesting results, for example, in Lennox-Gastaut syndrome, although controlled studies are lacking. Finally, early surgery can be an option in children with focal structural abnormalities responsible for EEs preferably before irreversible damage on developmental outcome. Multispecialist support is recommended in EE. Management should be global from the onset, integrating not only seizure control but also all issues related to comorbidities, particularly neuropsychological and psychiatric.

  11. Chronic Traumatic Encephalopathy: A Review

    Directory of Open Access Journals (Sweden)

    Michael Saulle

    2012-01-01

    Full Text Available Chronic traumatic encephalopathy (CTE is a progressive neurodegenerative disease that is a long-term consequence of single or repetitive closed head injuries for which there is no treatment and no definitive pre-mortem diagnosis. It has been closely tied to athletes who participate in contact sports like boxing, American football, soccer, professional wrestling and hockey. Risk factors include head trauma, presence of ApoE3 or ApoE4 allele, military service, and old age. It is histologically identified by the presence of tau-immunoreactive NFTs and NTs with some cases having a TDP-43 proteinopathy or beta-amyloid plaques. It has an insidious clinical presentation that begins with cognitive and emotional disturbances and can progress to Parkinsonian symptoms. The exact mechanism for CTE has not been precisely defined however, research suggest it is due to an ongoing metabolic and immunologic cascade called immunoexcitiotoxicity. Prevention and education are currently the most compelling way to combat CTE and will be an emphasis of both physicians and athletes. Further research is needed to aid in pre-mortem diagnosis, therapies, and support for individuals and their families living with CTE.

  12. 急性一氧化碳中毒后迟发性脑病患者血清胰岛素样生长因子-1水平及其临床意义研究%Serum IGF-1 Level in Patients with Delayed Encephalopathy after Acute Carbon Monoxide Poisoning and Its Clinical Significance

    Institute of Scientific and Technical Information of China (English)

    顾家鹏; 李艳丽; 王冀康; 张萍; 顾仁骏; 李静; 潘登; 衣学伟; 史玫; 高琦

    2013-01-01

    Objective To investigate the dynamic changes of level of serum insulin - like growth factor - 1 ( IGF - 1 ) and its clinical significance in patients with delayed encephalopathy after acute carbon monoxide poisoning ( DEACMP ). Methods 33 DEACMP patients were selected form November 2007 to Jun 2008, IGF - 1 level was assayed with enzyme - linked im-munno - sorbent assay ( ELISA ). Their condition changes were evaluated with Activity of Daily Living Scale ( ADL ), Information - Memory - Concentration Test ( IMCT ) and Hasegawa's Dementia Scale ( HDS ). The above indexes were compared with those of 32 acute carbon monoxide poisoning ( ACMP ) patients without occurrence of DEACMP ( ACMP group ) and of 32 healthy subjects ( control group ). Results ( 1 ) IGF - 1 at acute stage was significantly lower in DEACMP group [ ( 136. 10 ±51. 51 ) μg/L ] than in control group [ ( 192. 91 ± 145. 97 ) μg/L, P 0. 05 ). IGF - 1 was higher at recovery stage [ ( 187. 69 ±92. 46 ) μg/L ] than at acute stage in DEACMP group, the difference was significant (P <0. 05 ). (2) ADL, HDS, IMCT at acute stage was significantly different from those at recovery stage in DEACMP group ( P < 0. 05 ). ( 3 ) IGF - 1 was negatively correlated with ADL in DEACMP group ( r = - 0. 377 , P = 0. 03 ). Conclusion IGF - 1, protecting probably DEACMP patients from brain damage, may be used as one of indexes for clinical outcomes and therapeutic effectiveness assessment.%目的 研究急性一氧化碳中毒后迟发性脑病(DEACMP)患者血清胰岛素样生长因子-1(IGF-1)水平的动态变化及其临床意义.方法 选择2007年11月-2008年6月在我院住院的33例DEACMP患者,采用酶联免疫吸附法动态测定血清IGF-1水平,用日常生活能力量表(ADL)、长谷川痴呆量表(HDS)、常识-记忆-注意测验(IMCT)动态评估DEACMP患者的病情变化,并与32例急性一氧化碳中毒(ACMP)后未发生DEACMP的患者(ACMP组)和32例健康体检者(正常对照组)的

  13. Posterior encephalopathy with vasospasm: MRI and angiography

    Energy Technology Data Exchange (ETDEWEB)

    Weidauer, S.; Gaa, J.; Lanfermann, H.; Zanella, F.E. [Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2-16, 60528, Frankfurt (Germany); Sitzer, M.; Hefner, R. [Department of Neurology, University of Frankfurt, Schleusenweg 2-16, 60528, Frankfurt (Germany)

    2003-12-01

    Posterior encephalopathy is characterised by headache, impairment of consciousness, seizures and progressive visual loss. MRI shows bilateral, predominantly posterior, cortical and subcortical lesions with a distribution. Our aim was to analyse the MRI lesion pattern and angiographic findings because the pathophysiology of posterior encephalopathy is incompletely understood. We report three patients with clinical and imaging findings consistent with posterior encephalopathy who underwent serial MRI including diffusion-weighted imaging (DWI) and construction of apparent diffusion coefficient (ADC) maps, and four-vessel digital subtraction angiography (DSA). DWI revealed symmetrical subcortical and cortical parieto-occipital high signal. High and also low ADCs indicated probable vasogenic and cytotoxic oedema. On follow-up there was focal cortical laminar necrosis, while the white-matter lesions resolved almost completely, except in the arterial border zones. DSA revealed diffuse arterial narrowing, slightly more marked in the posterior circulation. These findings suggest that posterior encephalopathy may in some cases be due to diffuse, severe vasospasm affecting especially in the parieto-occipital grey matter, with its higher vulnerability to ischemia. Cerebral vasospasm due to digitoxin intoxication, resulting in posterior encephalopathy, has not yet been described previously. (orig.)

  14. Effects of Qingyi Ⅱ Granules on Intestinal Bacterial Translocation In Rats with Acute Necrotizing Pancre-atitis%清胰Ⅱ号颗粒剂对急性坏死性胰腺炎大鼠肠道细菌移位的影响

    Institute of Scientific and Technical Information of China (English)

    肖青川; 兑丹华; 兰天罡; 李开伦

    2009-01-01

    目的 观察清胰Ⅱ号颗粒剂对急性坏死性胰腺炎(acute necrotizing pancreatitis,ANP)大鼠肠道细菌移位的影响并探讨其机理.方法 将18只SD大鼠随机等分为假手术组、ANP组及治疗组,每组6只;ANP组及治疗组以30 g/L牛磺胆酸钠逆行注入胰胆管制作大鼠ANP模型,造模术后1 h,治疗组以250 g/L清胰Ⅱ号颗粒剂灌胃给药(10 mL/kg),6 h 1次,共3次,假手术组及ANP组用同等剂量生理盐水以相同方式灌胃.造模后24 h,取大鼠肝脏、胰腺、脾脏、肠系膜淋巴结组织及回肠内容物行细菌培养及菌种鉴定,用real-time PCR检测回肠组织中高迁徙率族蛋白-1(high mobility group box 1,Hmgbl)mRNA表达,ELISA测定回肠组织中一氧化氮(nitric oxide,NO)、内皮素-1(endothelin-1,ET-1)浓度,同时观察胰腺、回肠组织病理改变,测定回肠组织湿/干重比值.结果 ANP组胰腺、回肠组织损伤明显,回肠组织Hmgb1 mRNA的表达较假手术组上调(P<0.01),NO、ET-1浓度较假手术组升高(P<0.01),分别为(1.67±0.21)μmol/L、(102.18±9.19)ng/L,细菌移位至肝脏、胰腺、脾脏及肠系膜淋巴结;治疗组回肠组织中Hmgb1 mRNA的表达较ANP组下调(P<0.01),NO、ET-1浓度较ANP组降低(P<0.05),分别为(1.39±0.23)μmol/L、(83.15±5.39)ng/L,回肠病理损害程度减轻,细菌移位减少.结论 Hmgb1、NO及ET-1浓度在ANP模型大鼠肠道细菌移位中可能具有重要作用.清胰Ⅱ号颗粒剂可能通过下调回肠组织中Hmgb1 mRNA的表达,降低NO、ET-1浓度,减轻胰腺、回肠组织的病理改变,从而抑制肠道细菌移位.%Objective To observe the effects and mechanism of Qingyi Ⅱ Granules(QYG)on the bacterial translocation in rats with acute necrotizing pancreatitis(ANP).Methods Eighteen Sprague-Dawley rats were randomized equally into 3 groups,the sham-operated group(A),the ANP model group(B)and the treated group(C).Rats in Group B and C were established into ANP model by retrograde

  15. The Relationship between Plasma Endothelin and Hypoxic- Ischemic Encephalopathy in 70 Tibetan Neonates of Plateau Area

    Institute of Scientific and Technical Information of China (English)

    DEJI Meiduo; ZHAO Rong; ZHAO Min; WU Sulan

    2002-01-01

    Objective To discuss the dynamic changing characteristics of plasma endothelin in Tibetan neonates of plateau area with hypoxic - ischemic encephalopathy. Methods Plasma ET level has been determined for 10 days 72 hours after birth by radioimmunoassay in 70 tibetan neonates with HIE.The control group consisted of 20 healthy neonates. Results During acute stage, plasma ET levels of mild, moderate and severe groups were significantly higher that of control group (P < 0.001 ). During acute stage, plasma ET level was closely related with the severity of HIE. Severer HIE was, higher ET level. Conclusion ET was involved in the regulation of HIE.

  16. Necrotizing sialometaplasia of the palate. Ulcerative or necrotizing stage of leukokeratosis nicotina palati?

    Science.gov (United States)

    Philipsen, H P; Petersen, J K; Simonsen, B H

    1976-12-01

    A typical case of the recently described tumor-suspect lesion, necrotizing sialometaplasia (NS) of the palate, in a 54-year old Caucasian male is presented. Results of complete blood- and urinanalysis including serum electrophoresis and labial salivary gland biopsy strongly pointed at a local etiologic factor. Previous statements that the disease represents a new entity are questioned. The present authors favor the idea that NS is the necrotizing (ulcerative) or terminal stage of leukokeratosis nicotina palati (nicotinic stomatitis). It is of particular importance that this lesion is not diagnosed as a malignancy, as it heals spontaneously and uneventfully.

  17. Necrotizing fasciitis caused by a primary appendicocutaneous fistula.

    Science.gov (United States)

    Takeda, Makoto; Higashi, Yukihiro; Shoji, Tuyoshi; Hiraide, Takanori; Maruo, Hirotoshi

    2012-08-01

    We report a case of necrotizing fasciitis in the loin of a 76-year old man with several coexisting or past health issues, including diabetes mellitus, hypertension, alcohol-related liver cirrhosis, gastrectomy for gastric cancer, subarachnoid hemorrhage, normal pressure hydrocephalus, and cerebral infarction. Incision of the necrotizing fasciitis was successful, but it revealed an appendicocutaneous fistula; thus, we performed appendectomy and fistulectomy. We think that the necrotizing fasciitis was caused by appendicitis perforation involving the retroperitoneum, inducing the formation of an appendicocutaneous fistula. Necrotizing fasciitis and appendicocutaneous fistulae are rare complications of appendicitis. Moreover, to our knowledge, this is the first report of fluoroscopic examination demonstrating that a primary appendicocutaneous fistula had caused necrotizing fasciitis. Our search of the literature found 12 cases of necrotizing fasciitis caused by preoperative appendicitis. We discuss the characteristics and findings of these cases.

  18. Fatal necrotizing fasciitis due to Streptococcus pneumoniae: a case report.

    Science.gov (United States)

    Park, So-Youn; Park, So Young; Moon, Soo-Youn; Son, Jun Seong; Lee, Mi Suk

    2011-01-01

    Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.

  19. Necrotizing fasciitis: A decade of surgical intensive care experience

    OpenAIRE

    Shaikh Nissar

    2006-01-01

    Necrotizing fasciitis is a rare disease, potentially limb and life-threatening infection of fascia, subcutaneous tissue with occasionally muscular involvement. Necrotizing faciitis is surgical emergency with high morbidity and mortality. Aim: Aim of this study was to analyze presentation, microbiology, surgical, resuscitative management and outcome of this devastating soft tissue infection. Materials and Methods: The medical records of necrotizing fasciitis patients treated in surgical in...

  20. Necrotizing Fasciitis of vulva: A report of two cases

    Directory of Open Access Journals (Sweden)

    Jamal A

    2000-08-01

    Full Text Available Vulvar necrotizing fascitis is an uncommon infectious disorder. Since the first reported cases almost 100 years, ago, necrotizing fasciitis continues to present a diagnostic and therapeutic challenge. What usually begins as a subtle infection can become life-threatening. We report two cases of vulvar necrotizing fasciitis, one after posterior colporrhaphy in a woman with four risk factors and the other in a young woman without any risk factor.

  1. Serum IL-18 Levels and Its Clinical Significance in the Blood of Patients with Delated Encephalopathy after Acute Carbon Monoxide Poisoning%急性一氧化碳中毒后迟发性脑病患者血清白介素18水平及临床意义研究

    Institute of Scientific and Technical Information of China (English)

    张萍; 王传升; 韩永凯; 赵国有; 顾家鹏; 魏蕤荭; 顾仁骏

    2013-01-01

    目的 探讨白介素18(IL-18)的水平动态变化与急性一氧化碳中毒后迟发性脑病(DEACMP)发生机制的关系,寻找其发生时可能引起的细胞因子的变化,为进一步研究DEACMP免疫学机制提供线索.方法 选择2009年1月-2011年1月住我院神经内科的DEACMP患者40例为DEACMP组及同期我院门诊体检健康者36例为对照组,应用酶联免疫吸附法分别测定DEACMP患者急性期及恢复期的血清IL-18水平,并与对照者进行比较分析.结果 DEACMP患者急性期、恢复期血清IL-18水平[(29.7±8.4)ng/L、(28.3±7.9)ng/L]均高于对照组[(24.1±5.3)ng/L、(24.1±5.3)ng/L],差异均有统计学意义(t=3.433,P=0.001;t=2.693,P=0.009).DEACMP组急性期血清IL-18水平高于恢复期差异有统计学意义(t=2.421,P=0.020).结论 IL-18可能通过迟发性免疫途径参与DEACMP的发病过程,对疾病的发展可能有一定的影响.%Objective To investigate the relationship between dynamic changes of serum IL - 18 level and mechanism of delayed encephalopathy after acute carbon monoxide poisoning ( DEACMP ) to find potential cytokine variation during DEAC-MP occurrence and to provide evidence for further study on immunological mechanism of DEACMP. Methods 40 DEACMP patients admitted to the Neurology Department of our hospital from January 2009 to January 2011 were selected as DEACMP group and another 36 healthy people underwent physical examination in the same period were selected as control group. Enzyme - linked Immunoassay ( ELISA ) method was used to detect the levels of IL - 18 in acute stage and recovery stage, and the results were compared with the control group. Results The levels of IL - 18 in DEACMP patients [ ( 29. 7 ± 8. 4 ) ng/L, ( 28. 3 ± 7. 9 ) ng/L ] were significantly higher than the control group [ ( 24. 1 ±5.3) ng/L, ( 24. 1 ±5.3 ) ng/L ] both in acute stage and recovery stage ( t =3. 433 , P = 0. 001 ; t = 2. 693 , P =0. 009 ). In DEACMP group, the IL - 18 level in

  2. Qualifying and quantifying minimal hepatic encephalopathy

    DEFF Research Database (Denmark)

    Morgan, Marsha Y; Amodio, Piero; Cook, Nicola A

    2016-01-01

    , the Inhibitory Control Test, the Stroop test, the Scan package and the Continuous Reaction Time; each has its pros and cons; strengths and weaknesses; protagonists and detractors. Recent AASLD/EASL Practice Guidelines suggest that the diagnosis of minimal hepatic encephalopathy should be based on the PHES test...... hepatic encephalopathy since the 1950s but, once popular, the technology is not as accessible now as it once was. The performance characteristics of the EEG are critically dependent on the type of analysis undertaken; spectral analysis has better performance characteristics than visual analysis; evolving...

  3. Epileptic Encephalopathies in Adults and Childhood

    Directory of Open Access Journals (Sweden)

    Zekiye Kural

    2012-01-01

    Full Text Available Epileptic encephalopathies are motor-mental retardations or cognitive disorders secondary to epileptic seizures or epileptiform activities. Encephalopaties due to brain damage, medications, or systemic diseases are generally not in the scope of this definition, but they may rarely accompany the condition. Appropriate differential diagnosis of epileptic seizures as well as subclinical electroencephalographic discharges are crucial for management of seizures and epileptiform discharges and relative regression of cognitive deterioration in long-term followup. Proper antiepileptic drug, hormonal treatment, or i.v. immunoglobulin choice play major role in prognosis. In this paper, we evaluated the current treatment approaches by reviewing clinical electrophysiological characteristics of epileptic encephalopathies.

  4. Hyperammonemia Is Associated with Increasing Severity of Both Liver Cirrhosis and Hepatic Encephalopathy

    Directory of Open Access Journals (Sweden)

    Abidullah Khan

    2016-01-01

    Full Text Available Background. Hyperammonemia resulting from chronic liver disease (CLD can potentially challenge and damage any organ system of the body, particularly the brain. However, there is still some controversy regarding the diagnostic or prognostic values of serum ammonia in patients with over hepatic encephalopathy, especially in the setting of acute-on-chronic or chronic liver failure. Moreover, the association of serum ammonia with worsening Child-Pugh grade of liver cirrhosis has not been studied. Objective. This study was conducted to solve the controversy regarding the association between hyperammonemia and cirrhosis, especially hepatic encephalopathy in chronically failed liver. Material and Methods. In this study, 171 cirrhotic patients had their serum ammonia measured and analyzed by SPSS version 16. Chi-squared test and one-way ANOVA were applied. Results. The study had 110 male and 61 female participants. The mean age of all the participants in years was 42.33±7.60. The mean duration (years of CLD was 10.15±3.53 while the mean Child-Pugh (CP score was 8.84±3.30. Chronic viral hepatitis alone was responsible for 71.3% of the cases. Moreover, 86.5% of participants had hepatic encephalopathy (HE. The frequency of hyperammonemia was 67.3%, more frequent in males (N=81, z-score = 2.4, and P<0.05 than in females (N=34, z-score = 2.4, and P<0.05, and had a statistically significant relationship with increasing CP grade of cirrhosis (χ2(2 = 27.46, P<0.001, Phi = 0.40, and P<0.001. Furthermore, serum ammonia level was higher in patients with hepatic encephalopathy than in those without it; P<0.001. Conclusion. Hyperammonemia is associated with both increasing Child-Pugh grade of liver cirrhosis and hepatic encephalopathy.

  5. Necrotizing fasciitis: strategies for diagnosis and management

    Directory of Open Access Journals (Sweden)

    Yanar Hakan

    2007-08-01

    Full Text Available Abstract Necrotizing fasciitis (NF is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically. The literature addressed NF contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy. A delay in diagnosis is associated with a grave prognosis and increased mortality. The main goal of the clinician must be to establish the diagnosis and initially treat the patient within the standard of care. This review is planned as a guide for the clinician in making an early diagnosis of NF and initiating effective medical and surgical therapy.

  6. Fatal necrotizing fasciitis due to necrotic toxin-producing Escherichia coli strain

    Science.gov (United States)

    Gallois, C.; Hauw-Berlemont, C.; Richaud, C.; Bonacorsi, S.; Diehl, J.-L.; Mainardi, J.-L.

    2015-01-01

    We report a fatal case of necrotizing soft tissues infection caused by an Escherichia coli strain belonging to phylogenetic group C and harbouring numerous virulence factors reported to be part of a pathogenicity island (PAI) such as PAI IIJ96 and conserved virulence plasmidic region. PMID:26693024

  7. Fatal necrotizing fasciitis due to necrotic toxin-producing Escherichia coli strain

    Directory of Open Access Journals (Sweden)

    C. Gallois

    2015-11-01

    Full Text Available We report a fatal case of necrotizing soft tissues infection caused by an Escherichia coli strain belonging to phylogenetic group C and harbouring numerous virulence factors reported to be part of a pathogenicity island (PAI such as PAI IIJ96 and conserved virulence plasmidic region.

  8. Hashimoto′s encephalopathy and motor neuron disease: A common autoimmune pathogenesis?

    Directory of Open Access Journals (Sweden)

    Harzheim Michael

    2006-01-01

    Full Text Available Hashimoto′s encephalopathy is a rare complication of autoimmune thyroiditis not associated with thyroidal function decline. We report a 50-year-old man presenting with lower motor neuron symptoms evolving over 3 years and changes in behavior associated with attentive and cognitive impairment occurring in the last few months. Memory deficits, emotional instability, marked dysarthria, mild symmetric weakness of the lower extremities, and fasciculations were the most striking clinical features. EEG was diffusely slow, cranial MRI revealed multiple subcortical white matter lesions, CSF protein was slightly elevated, electromyographic recordings showed acute and chronic denervation, and extremely high TPO antibody titers were found in the serum. Hashimoto′s encephalopathy and lower motor neuron disease were diagnosed. As repeated high-dose intravenous methylprednisolone administration followed by oral tapering improved both central nervous system and lower motor neuron symptoms, the question was raised whether there was a common autoimmune pathogenesis of both clinically distinct diseases.

  9. Neonatal hypoglycaemic encephalopathy: diffusion-weighted imaging and proton MR spectroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, So Yeon; Goo, Hyun Woo [University of Ulsan College of Medicine, Department of Radiology, Asan Medical Center, Seoul (Korea); Lim, Keun Ho; Kim, Sang Tae [Asan Institute for Life Science, NMR Laboratory, Seoul (Korea); Kim, Ki Soo [University of Ulsan College of Medicine, Department of Neonatology, Asan Medical Center, Seoul (Korea)

    2006-02-01

    We report two infants with neonatal hypoglycaemic encephalopathy who were evaluated with diffusion-weighted imaging (DWI) and proton MR spectroscopy (MRS) as well as conventional MR. As in conventional MR, DWI and proton MRS revealed a predominance of abnormalities in the parieto-occipital lobes and underlying white matter including the splenium of the corpus callosum. In the acute phase of the disease, lesions on DWI showed restricted water diffusion and on DWI the characteristic lesions seemed to be more readily discernible than on conventional MRI. In the chronic phase, DWI demonstrated increased water diffusion in the affected areas showing atrophy on conventional MRI. Proton MRS revealed an increased lactate-lipid peak and a decreased NAA peak in the involved areas. DWI and proton MRS findings appear helpful in evaluating the extent and the presence of neuronal damage early in the course of neonatal hypoglycaemic encephalopathy. (orig.)

  10. A Fatal Case of Wernicke’s Encephalopathy after Sleeve Gastrectomy for Morbid Obesity

    Directory of Open Access Journals (Sweden)

    Dimitrios K. Manatakis

    2014-01-01

    Full Text Available Wernicke’s encephalopathy is an acute neuropsychiatric disorder, due to thiamine (vitamin B1 deficiency. It is traditionally described in chronic alcohol abusers; however obesity surgery is an emerging cause, as the number of bariatric procedures increases. A high index of clinical suspicion is required, since initial symptoms may be nonspecific and the classic triad of ophthalmoplegia, gait and stance disorders, and mental confusion is present only in one-third of patients. Laboratory tests can be within normal range and typical MRI brain lesions are found only in 50% of cases. Aggressive supplementation with intravenous thiamine should not be delayed until confirmation of diagnosis, as it may fully reverse symptoms, but almost half the patients will still display permanent neurological deficit. We present our experience with a fatal case of Wernicke’s encephalopathy, following laparoscopic sleeve gastrectomy for morbid obesity.

  11. A STUDY OF THE CLINICAL PROFILE OF CIRRHOSIS OF LIVER AND ANALYSIS OF PRECIPITATING FACTORS IN HEPATIC ENCEPHALOPATHY

    Directory of Open Access Journals (Sweden)

    Sai Lakshmikanth

    2015-08-01

    Full Text Available BACKGROUND AND OBJECTIVES : Liver cirrhosis and its complications are a major health problem in the developing countries where cost of health care is high. The syndrome of hepatic encephalopathy ( HE can occur either due to acute liver failure or due to one or more precipitating factors in a cirrhotic patient. Survival of patients having chronic portal systemic encephalopathy is better than those who develop HE acutely. However prognosis in the later group can be improved if the precipitating factors are recognized early and managed accordingly. The present study was done to analyze the precipitating factors of hepatic encephalopathy and the final outcome . METHODS: The study included a total of 200 patients ( 173 male s & 27 female s presenting as cirrhosis with hepatic encephalopathy at Sri Ramachandra Medical College from November 2011 to November 2012. All lab parameters, coagulation profile and abdominal ultrasound were done. Abdominal paracentesis was done and Child Pugh score calculated. RESULTS: Alcoholic cirrhosis was the most common etiology and gastrointestinal bleed was the most common presentation. 58 % patients were in Child Pugh C group. GI bleed was the most common precipitating factor followed by infection and hyponatremia. 80% patients recovered with treatment and 15 % died.

  12. Mycobacterium tuberculosis replicates within necrotic human macrophages

    Science.gov (United States)

    Lerner, Thomas R.; Repnik, Urska; Herbst, Susanne; Collinson, Lucy M.; Griffiths, Gareth

    2017-01-01

    Mycobacterium tuberculosis modulation of macrophage cell death is a well-documented phenomenon, but its role during bacterial replication is less characterized. In this study, we investigate the impact of plasma membrane (PM) integrity on bacterial replication in different functional populations of human primary macrophages. We discovered that IFN-γ enhanced bacterial replication in macrophage colony-stimulating factor–differentiated macrophages more than in granulocyte–macrophage colony-stimulating factor–differentiated macrophages. We show that permissiveness in the different populations of macrophages to bacterial growth is the result of a differential ability to preserve PM integrity. By combining live-cell imaging, correlative light electron microscopy, and single-cell analysis, we found that after infection, a population of macrophages became necrotic, providing a niche for M. tuberculosis replication before escaping into the extracellular milieu. Thus, in addition to bacterial dissemination, necrotic cells provide first a niche for bacterial replication. Our results are relevant to understanding the environment of M. tuberculosis replication in the host. PMID:28242744

  13. Intestinal microcirculatory dysfunction and neonatal necrotizing enterocolitis

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hong-yi; WANG Fang; FENG Jie-xiong

    2013-01-01

    Objective Based on the observation that coagulation necrosis occurs in the majority of neonatal necrotizing enterocolitis (NEC) patients,it is clear that intestinal ischemia is a contributing factor to the pathogenesis of NEC.However,the published studies regarding the role of intestinal ischemia in NEC are controversial.The aim of this paper is to review the current studies regarding intestinal microcirculatory dysfunction and NEC,and try to elucidate the exact role of intestinal microcirculatory dysfunction in NEC.Data sources The studies cited in this review were mainly obtained from articles listed in Medline and PubMed.The search terms used were "intestinal microcirculatory dysfunction" and "neonatal necrotizing enterocolitis".Study selection Mainly original milestone articles and critical reviews written by major pioneer investigators in the field were selected.Results Immature regulatory control of mesentery circulation makes the neonatal intestinal microvasculature vulnerable.When neonates are subjected to stress,endothelial cell dysfunction occurs and results in vasoconstriction of arterioles,inflammatory cell infiltration and activation in venules,and endothelial barrier disruption in capillaries.The compromised vasculature increases circulation resistance and therefore decreases intestinal perfusion,and may eventually progress to intestinal necrosis.Conclusion Intestinal ischemia plays an important role through the whole course of NEC.New therapeutic agents targeting intestinal ischemia,like HB-EGF,are promising therapeutic agents for the treatment of NEC.

  14. An experimental study on selective decontamination of digestive tract in prevention of infections secondary to acute necrotizing pancreatitis%选择性肠道脱污染预防急性坏死性胰腺炎继发感染的实验研究

    Institute of Scientific and Technical Information of China (English)

    邓群; 黎沾良; 陆连荣; 熊德鑫

    2001-01-01

    目的 通过急性坏死性胰腺炎(ANP)动物模型,探讨选择性消化道脱污染(SDD)预防胰腺继发感染的作用。方法 Wistar大鼠60只,向总胆胰管逆行输入人工胆汁复制ANP模型,随机设立正常对照组、假手术对照组、ANP组和SDD治疗组,观察胰肠组织学、胰淀粉酶、肠道菌群、脏器细菌移位率和死亡率的变化。结果 SDD使ANP动物胰腺和小肠粘膜病理改变减轻,胰淀粉酶水平下降(P<0.05),并使ANP时肠道菌群的紊乱状态得以恢复,肠粘膜和肠内容物双歧杆菌/大肠杆菌比值(B/E)分别由-0.37±0.72升至1.73±1.23(P<0.01)和由0.88±0.77升至无穷大。SDD组72 h脏器细菌移位率由59.5%降至33.3%(P<0.05),72 h死亡率由58.8%降至14.3%(P=0.005)。结论 SDD通过减轻肠道菌群紊乱状态,减少细菌移位,有利于预防ANP继发感染。%Objective To investigate the role of selective decontamination of the digestive tract (SDD) in prevention of bacterial infections secondary to acute necrotizing pancreatitis (ANP). Methods A total of 60 rats were employed to establish the model of ANP with retrograde infusion of artificial bile into the main pancreatic duct. Then animals were randomized into the normal control group (n =6), sham operated group (n = 14) and SDD-treated group (polymycinE, tobramycin and nystatin mixture were used). Visceral pathological changes, serum levels of amylase, intestinal flora, incidence of bacterial translocation to organs and mortality were determined 72 h after the operation in all the 3 groups. Results In SDD-treated group, damages in the pancreas were remarkably attenuated and serum level of amylase significantly decreased. At the 72nd h after treatment, the rate of bacterial translocation to other organs and mortality markedly decreased to 33.3% and 14.3% from the original 59.5% and 58.8%, respectively (P<0.05). Conclusions SDD can prevent infections secondary to ANP through

  15. Necrotic stercoral colitis: Importance of computed tomography findings

    Institute of Scientific and Technical Information of China (English)

    Cheng-Hsien Wu; Li-Jen Wang; Yon-Cheong Wong; Chen-Chih Huang; Chien-Cheng Chen; Chao-Jan Wang; Jen-Feng Fang; Chuen Hsueh

    2011-01-01

    AIM: To study the computed tomography (CT) signs in facilitating early diagnosis of necrotic stercoral colitis(NSC).METHODS: Ten patients with surgically and pathologically confirmed NSC were recruited from the Clinico-Pathologic-Radiologic conference at Chang Gung MemorialHospital, Taoyuan, Taiwan. Their CT images and medical records were reviewed retrospectively to correlate CT findings with clinical presentation.RESULTS: All these ten elderly patients with a mean age of 77.1 years presented with acute abdomen at our Emergency Room. Nine of them were with systemic medmedical disease and 8 with chronic constipation. Seven were with leukocytosis, two with low-grade fever, two with peritoneal sign, and three with hypotensive shock. Only one patient was with radiographic detected abnormal gas. Except the crux of fecal impaction, the frequency of the CT signs of NSC were, proximal colon dilatation (20%),colon wall thickening (60%), dense mucosa (62.5%),mucosal sloughing (10%), perfusion defect (70%),pericolonic stranding (80%), abnormal gas (50%) with pneumo-mesocolon (40%) in them, pericolonic abscess(20%). The most sensitive signs in decreasing order were pericolonic stranding, perfusion defect, dense mucosal,detecting about 80%, 70%, and 62.5% of the cases, respectively.CONCLUSION: Awareness of NSC and familiarity with the CT diagnostic signs enable the differential diagnosis between NSC and benign stool impaction.

  16. Going Out on a Limb: Do Not Delay Diagnosis of Necrotizing Fasciitis in Varicella Infection.

    Science.gov (United States)

    Sturgeon, Jonathan P; Segal, Laura; Verma, Anita

    2015-07-01

    Necrotizing fasciitis (NF) is a rare complication of varicella zoster (chicken pox) infection. Its diagnosis can be delayed or missed, which increases mortality and morbidity, because it initially presents similarly to cellulitis. We present the case of a 5-year-old boy who presented with a swollen leg, the difficulties in the diagnosis of NF, and a review of the literature. Necrotizing fasciitis complicating varicella zoster in children is associated with 3.4% mortality, although this rises to 13.6% in streptococcal toxic shock syndrome. Seventy-one percent of cases are confirmed as being caused by group A β-hemolytic Streptococcus. The association of NF with chicken pox is discussed along with the difficulties in diagnosis and treatment options. Necrotizing fasciitis is a surgical emergency and should be considered by all emergency department acute care practitioners in cases of varicella in which fever is enduring and swelling or pain is disproportionate. Because of the difficulty in diagnosis, senior opinion should be sought early.

  17. STXBP1 encephalopathy

    DEFF Research Database (Denmark)

    Stamberger, Hannah; Nikanorova, Marina; Willemsen, Marjolein H

    2016-01-01

    OBJECTIVE: To give a comprehensive overview of the phenotypic and genetic spectrum of STXBP1 encephalopathy (STXBP1-E) by systematically reviewing newly diagnosed and previously reported patients. METHODS: We recruited newly diagnosed patients with STXBP1 mutations through an international networ...

  18. Wernicke encephalopathy in children and adolescents

    Institute of Scientific and Technical Information of China (English)

    Matt Lallas; Jay Desai

    2014-01-01

    Background: Wernicke encephalopathy is caused by thiamine (vitamin B1) defi ciency. It is generally considered to be a disease of adult alcoholics. However, it is known to occur in the pediatric population and in non-alcoholic conditions. Data sources: We searched PubMed with the key words Wernicke, thiamine, pediatric, children and adolescents and selected publications that were deemed appropriate. Results: The global prevalence rates of hunger, poverty and resultant nutrient deprivation have decreased in the 21st century. However, several scenarios which may predispose to Wernicke encephalopathy may be increasingly prevalent in children and adolescents such as malignancies, intensive care unit stays and surgical procedures for the treatment of obesity. Other predisposing conditions include magnesium defi ciency and defects in the SLC19A3 gene causing thiamine transporter-2 deficiency. The classic triad consists of encephalopathy, oculomotor dysfunction and gait ataxia but is not seen in a majority of patients. Treatment should be instituted immediately when the diagnosis is suspected clinically without waiting for laboratory confi rmation. Common magnetic resonance findings include symmetric T2 hyperintensities in dorsal medial thalamus, mammillary bodies, periaqueductal gray matter, and tectal plate. Conclusions: Wernicke encephalopathy is a medical emergency. Delay in its recognition and treatment may lead to significant morbidity, irreversible neurological damage or even death. This article aims to raise the awareness of this condition among pediatricians.

  19. PRIONS AND THE TRANSMISSIBLE SPONGIFORM ENCEPHALOPATHIES

    Science.gov (United States)

    This book chapter is an invited, scholarly review of the mechanism(s) of TSEs for the 2nd edition of Metabolic Encephalopathies. Each chapter in the book assumes a professional knowledge of neuroscience and biochemistry, and the focus of the book is on the metabolic basis of dise...

  20. Hepatic encephalopathy: clinical and experimental studies

    NARCIS (Netherlands)

    C.C.D. van der Rijt (Carin)

    1991-01-01

    textabstractThe pathogenesis of hepatic encephalopathy is still unsolved. Therapy, therefore, is often insufficient. For the development of effective, new therapies insight into the disease-inducing substrates and the mechanisms of its toxic actions in the central nervous system ·are required. For b

  1. Pathogenesis of bovine spongiform encephalopathy in sheep

    NARCIS (Netherlands)

    Keulen, van L.J.M.; Vromans, M.E.W.; Dolstra, C.H.; Bossers, A.; Zijderveld, van F.G.

    2008-01-01

    The pathogenesis of bovine spongiform encephalopathy (BSE) in sheep was studied by immunohistochemical detection of scrapie-associated prion protein (PrPSc) in the gastrointestinal, lymphoid and neural tissues following oral inoculation with BSE brain homogenate. First accumulation of PrPSc was dete

  2. Review of 58 patients with necrotizing fasciitis in the Netherlands

    NARCIS (Netherlands)

    Stigt, S.F. van; Vries, J. de; Bijker, J.B.; Mollen, R.M.; Hekma, E.J.; Lemson, S.M.; Tan, E.C.T.H.

    2016-01-01

    BACKGROUND: Necrotizing fasciitis is a rare, life threatening soft tissue infection, primarily involving the fascia and subcutaneous tissue. In a large cohort of patients presenting with Necrotizing fasciitis in the Netherlands we analysed all available data to determine the causative pathogens and

  3. Necrotizing fasciitis: contribution and limitations of diagnostic imaging.

    Science.gov (United States)

    Malghem, Jacques; Lecouvet, Frédéric E; Omoumi, Patrick; Maldague, Baudouin E; Vande Berg, Bruno C

    2013-03-01

    Necrotizing fasciitis is a rare, rapidly spreading, deep-seated infection causing thrombosis of the blood vessels located in the fascia. Necrotizing fasciitis is a surgical emergency. The diagnosis typically relies on clinical findings of severe sepsis and intense pain, although subacute forms may be difficult to recognize. Imaging studies can help to differentiate necrotizing fasciitis from infections located more superficially (dermohypodermitis). The presence of gas within the necrotized fasciae is characteristic but may be lacking. The main finding is thickening of the deep fasciae due to fluid accumulation and reactive hyperemia, which can be visualized using computed tomography and, above all, magnetic resonance imaging (high signal on contrast-enhanced T1 images and T2 images, best seen with fat saturation). These findings lack specificity, as they can be seen in non-necrotizing fasciitis and even in non-inflammatory conditions. Signs that support a diagnosis of necrotizing fasciitis include extensive involvement of the deep intermuscular fascias (high sensitivity but low specificity), thickening to more than 3mm, and partial or complete absence on post-gadolinium images of signal enhancement of the thickened fasciae (fairly high sensitivity and specificity). Ultrasonography is not recommended in adults, as the infiltration of the hypodermis blocks ultrasound transmission. Thus, imaging studies in patients with necrotizing fasciitis may be challenging to interpret. Although imaging may help to confirm deep tissue involvement and to evaluate lesion spread, it should never delay emergency surgical treatment in patients with established necrotizing fasciitis.

  4. Biofilm in group A streptococcal necrotizing soft tissue infections

    DEFF Research Database (Denmark)

    Siemens, Nikolai; Chakrakodi, Bhavya; Shambat, Srikanth Mairpady

    2016-01-01

    Necrotizing fasciitis caused by group A streptococcus (GAS) is a life-threatening, rapidly progressing infection. At present, biofilm is not recognized as a potential problem in GAS necrotizing soft tissue infections (NSTI), as it is typically linked to chronic infections or associated with foreign...

  5. A case of fatal necrotizing fasciitis arising from chronic lymphedema.

    Science.gov (United States)

    Jun, Young Joon; Kang, In Sook; Lee, Jung Ho; Kim, Sue Min; Kim, Young Jin

    2013-12-01

    Chronic lymphedema and lymphangitis are common adverse effects following treatment for gynecological cancer. Because the early symptoms of necrotizing fasciitis are similar to those of lymphangitis, fatal outcome can occur if patients or physicians underestimate this condition. Here, we present a case of necrotizing fasciitis in a patient with chronic lymphedema.

  6. Necrotizing fasciitis in association with Ludwig's angina - A case report.

    Science.gov (United States)

    Kavarodi, A M

    2011-07-01

    A 28 year old male diabetic patient developed Ludwig's angina which subsequently evolved into cervicofacial necrotizing fasciitis. The differential characteristic of Ludwig's angina and cervicofacial necrotizing fasciitis, as it relates to this rare presentation is discussed. The clinical and radiological features, pathophysiology, diagnosis and the management that resulted in a successful outcome are presented.

  7. Carbohydrate maldigestion induces necrotizing enterocolitis in preterm pigs.

    Science.gov (United States)

    Thymann, Thomas; Møller, Hanne K; Stoll, Barbara; Støy, Ann Cathrine F; Buddington, Randal K; Bering, Stine B; Jensen, Bent B; Olutoye, Oluyinka O; Siggers, Richard H; Mølbak, Lars; Sangild, Per T; Burrin, Douglas G

    2009-12-01

    Necrotizing enterocolitis (NEC) remains the most severe gastrointestinal disorder in preterm infants. It is associated with the initiation of enteral nutrition and may be related to immature carbohydrate digestive capacity. We tested the hypothesis that a formula containing maltodextrin vs. a formula containing lactose as the principal source of carbohydrate would predispose preterm pigs to a higher NEC incidence. Cesarean-derived preterm pigs were given total parenteral nutrition for 48 h followed by total enteral nutrition with a lactose-based (n = 11) or maltodextrin-based (n = 11) formula for 36 h. A higher incidence (91% vs. 27%) and severity (score of 3.3 vs. 1.8) of NEC were observed in the maltodextrin than in the lactose group. This higher incidence of NEC in the maltodextrin group was associated with significantly lower activities of lactase, maltase, and aminopeptidase; reduced villus height; transiently reduced in vivo aldohexose uptake; and reduced ex vivo aldohexose uptake capacity in the middle region of the small intestine. Bacterial diversity was low for both diets, but alterations in bacterial composition and luminal concentrations of short-chain fatty acids were observed in the maltodextrin group. In a second study, we quantified net portal absorption of aldohexoses (glucose and galactose) during acute jejunal infusion of a maltodextrin- or a lactose-based formula (n = 8) into preterm pigs. We found lower net portal aldohexose absorption (4% vs. 42%) and greater intestinal recovery of undigested carbohydrate (68% vs. 27%) in pigs acutely perfused with the maltodextrin-based formula than those perfused with the lactose-based formula. The higher digestibility of the lactose than the maltodextrin in the formulas can be attributed to a 5- to 20-fold higher hydrolytic activity of tissue-specific lactase than maltases. We conclude that carbohydrate maldigestion is sufficient to increase the incidence and severity of NEC in preterm pigs.

  8. Acute liver failure due to concomitant arterial, portal and biliary injury during laparoscopic cholecystectomy: is transplantation a valid life-saving strategy? A case report

    Directory of Open Access Journals (Sweden)

    Goldaracena Nicolas

    2009-09-01

    Full Text Available Abstract Background Combined iatrogenic vascular and biliary injury during cholecystectomy resulting in ischemic hepatic necrosis is a very rare cause of acute liver failure. We describe a patient who developed fulminant liver failure as a result of severe cholestasis and liver gangrene secondary to iatrogenic combine injury or the hepatic pedicle (i.e. hepatic artery, portal vein and bile duct during laparoscopic cholecystectomy. Case presentation A 40-years-old woman underwent laparoscopic cholecystectomy for acute cholecystitis. During laparoscopy, a severe bleeding at the liver hilum motivated the conversion to open surgery. Many sutures were placed across the parenchyma for bleeding control. After 48 hours, she rapidly deteriorated with encephalopathy, coagulopathy, persistent hypotension and progressive organ dysfunction including acute renal failure requiring hemodialysis and mechanical ventilation. An angiography documented an occlusion of right hepatic artery and right portal vein. In the clinical of acute liver failure secondary to liver gangrene, severe coagulopathy and progressive secondary multi-organ failure, the patient was included in the waiting list for liver transplantation. Two days later, the patient was successfully transplanted with initial adequate liver graft function. However, she developed bilateral pneumonia and severe gastrointestinal bleeding and finally died 24 days after transplantation due to bilateral necrotizing pneumonia. Conclusion The occurrence of acute liver failure due to portal triad injury during laparoscopic cholecystectomy is a catastrophic complication. Probably, the indication of liver transplantation as a life-saving strategy in patients with late diagnosis, acute liver failure, severe coagulopathy and progressive secondary multi-organ failure could be considered but only minimizing immunosuppressive regimen to avoid postoperative infections.

  9. A case of Hashimoto`s encephalopathy presenting with seizures and psychosis

    Directory of Open Access Journals (Sweden)

    Min-Joo Lee

    2012-03-01

    Full Text Available Hashimoto’s encephalopathy (HE is a rare, poorly understood, autoimmune disease characterized by symptoms of acute or subacute encephalopathy associated with increased anti-thyroid antibody levels. Here, we report a case of a 14-year-old girl with HE and briefly review the literature. The patient presented with acute mental changes and seizures, but no evidence of infectious encephalitis. In the acute stage, the seizures did not respond to conventional antiepileptic drugs, including valproic acid, phenytoin, and topiramate. The clinical course was complicated by the development of acute psychosis, including bipolar mood, insomnia, agitation, and hallucinations. The diagnosis of HE was supported by positive results for antithyroperoxidase and antithyroglobulin antibodies. Treatment with methylprednisolone was effective; her psychosis improved and the number of seizures decreased. HE is a serious but curable, condition, which might be underdiagnosed if not suspected. Anti-thyroid antibodies must be measured for the diagnosis. HE should be considered in patients with diverse neuropsychiatric manifestations.

  10. Recurrent encephalopathy? No I'm a sleeping beauty!

    Science.gov (United States)

    Iqbal, Mehtab; Prasad, Manish; Ritey, Christopher

    2014-01-01

    To describe the clinical presentation of 'Kleine-Levin (sleeping beauty) syndrome' in a child, who presented with recurrent episodes consistent with encephalopathy, associated with excessive sleepiness, cognitive and behavioural disturbance and hyper sexuality. 14 years old boy presented acutely with excessive tiredness, sleeping excessively, abnormal behaviour and hypersexuality following a viral throat infection. On examination he was sleepy but easily arousable. His GCS (15/15) and rest of the neurological examination including fundoscopy and other systemic examination was completely unremarkable. All his initial investigations including electrolytes, LFTs, CSF, virology screen and MRI brain scan were normal. Detailed autoimmune screening was also negative. EEG showed non-specific diffuse slowing consistent with encephalopathy. His excessive sleepiness gradually improved together with his altered behaviour in about two weeks after presentation. Hyper sexuality became more overt during this phase. All these symptoms completely disappeared three weeks after his presentation and he attended school as before. He was readmitted six weeks later with exactly similar presentation and again only positive result being diffuse non-specific slowing of EEG. His recovery was also similar and he was completely back to his normal self in three weeks time. His recurrent symptoms were consistent with 'Kleine-Levin syndrome (KLS)' or 'sleeping beauty syndrome'. KLS is a rare disorder which mainly affects adolescent males. Common symptoms include hypersomnia (100%), cognitive changes (96%), eating disturbances (80%), hypersexuality, compulsions, and depressed mood. The syndrome usually lasts for 8 years, with on an average seven episode of 10 days each recurring every 3.5 months. It is most frequently precipitated by infections and somnolence decreases using stimulants in nearly 40% of cases.

  11. Hypertensive Encephalopathy: Isolated Pons Involvement Mimicking Central Pontine Myelinolysis

    Energy Technology Data Exchange (ETDEWEB)

    Gamanagatti, S.; Subramanian, S. [India Institute of Medical Sciences, New Delhi (India)

    2006-09-15

    MRI of the brain was performed, and it demonstrated an isolated high signal on the T2 weighted and fluid attenuated inversion recovery sequences that involved only the central pons with sparing the periphery. There was no restricted diffusion on diffusion weighted imaging. The differential diagnosis included posterior reversible syndrome and central pontine myelinolysis; however, the blood sodium on admission was normal. The pathogenesis of HE is that the auto-regulatory mechanisms that control the cerebral blood flow are exceeded, resulting in hyper-perfusion. The consequent over-distension of the cerebral vessels, the breakdown of the blood brain barrier and ultimately, the extravasation of fluid into the interstitium all cause vasogenic edema. In most cases, the changes of hypertensive encephalopathy represent reversible vasogenic edema, which can be seen on T2-weighted images, and restricted diffusion is not seen on the diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) maps. Hypertensive encephalopathy that manifests as a reversible increased signal isolated to the pons on T2-weighted images is extremely uncommon. The differential diagnosis for such pontine T2 hyperintensity includes pontine glioma, ischemic and radiation changes (generally irreversible conditions), as well as central pontine myelinolysis (CPM) and demyelinating disorders such as multiple sclerosis, acute disseminated encephalomyelitis and rhomb-encephalitis. In CPM electrolyte imbalances provide a clue for the diagnosis, where as for glioma, there will be an expansion and mass effect. In conclusion, clinical recognition of brainstem HE may be difficult. The features of a lack of correlation between the severity of the radiological abnormality and the clinical status, combined with the rapid resolution following antihypertensive treatment, should suggest the diagnosis. It is important for the radiologist to be familiar with the imaging abnormalities of this life

  12. Recurrent encephalopathy? No I′m a sleeping beauty!

    Directory of Open Access Journals (Sweden)

    Mehtab Iqbal

    2014-01-01

    Full Text Available To describe the clinical presentation of ′Kleine-Levin (sleeping beauty syndrome′ in a child, who presented with recurrent episodes consistent with encephalopathy, associated with excessive sleepiness, cognitive and behavioural disturbance and hyper sexuality. 14 years old boy presented acutely with excessive tiredness, sleeping excessively, abnormal behaviour and hypersexuality following a viral throat infection. On examination he was sleepy but easily arousable. His GCS (15/15 and rest of the neurological examination including fundoscopy and other systemic examination was completely unremarkable. All his initial investigations including electrolytes, LFTs, CSF, virology screen and MRI brain scan were normal. Detailed autoimmune screening was also negative. EEG showed non-specific diffuse slowing consistent with encephalopathy. His excessive sleepiness gradually improved together with his altered behaviour in about two weeks after presentation. Hyper sexuality became more overt during this phase. All these symptoms completely disappeared three weeks after his presentation and he attended school as before. He was readmitted six weeks later with exactly similar presentation and again only positive result being diffuse non-specific slowing of EEG. His recovery was also similar and he was completely back to his normal self in three weeks time. His recurrent symptoms were consistent with ′Kleine-Levin syndrome (KLS′ or ′sleeping beauty syndrome′. KLS is a rare disorder which mainly affects adolescent males. Common symptoms include hypersomnia (100%, cognitive changes (96%, eating disturbances (80%, hypersexuality, compulsions, and depressed mood. The syndrome usually lasts for 8 years, with on an average seven episode of 10 days each recurring every 3.5 months. It is most frequently precipitated by infections and somnolence decreases using stimulants in nearly 40% of cases.

  13. Recurrent encephalopathy? No I’m a sleeping beauty!

    Science.gov (United States)

    Iqbal, Mehtab; Prasad, Manish; Ritey, Christopher

    2014-01-01

    To describe the clinical presentation of ‘Kleine-Levin (sleeping beauty) syndrome’ in a child, who presented with recurrent episodes consistent with encephalopathy, associated with excessive sleepiness, cognitive and behavioural disturbance and hyper sexuality. 14 years old boy presented acutely with excessive tiredness, sleeping excessively, abnormal behaviour and hypersexuality following a viral throat infection. On examination he was sleepy but easily arousable. His GCS (15/15) and rest of the neurological examination including fundoscopy and other systemic examination was completely unremarkable. All his initial investigations including electrolytes, LFTs, CSF, virology screen and MRI brain scan were normal. Detailed autoimmune screening was also negative. EEG showed non-specific diffuse slowing consistent with encephalopathy. His excessive sleepiness gradually improved together with his altered behaviour in about two weeks after presentation. Hyper sexuality became more overt during this phase. All these symptoms completely disappeared three weeks after his presentation and he attended school as before. He was readmitted six weeks later with exactly similar presentation and again only positive result being diffuse non-specific slowing of EEG. His recovery was also similar and he was completely back to his normal self in three weeks time. His recurrent symptoms were consistent with ‘Kleine-Levin syndrome (KLS)’ or ‘sleeping beauty syndrome’. KLS is a rare disorder which mainly affects adolescent males. Common symptoms include hypersomnia (100%), cognitive changes (96%), eating disturbances (80%), hypersexuality, compulsions, and depressed mood. The syndrome usually lasts for 8 years, with on an average seven episode of 10 days each recurring every 3.5 months. It is most frequently precipitated by infections and somnolence decreases using stimulants in nearly 40% of cases. PMID:24891916

  14. Fatores associados à enterocolite necrosante Factors associated with necrotizing enterocolitis

    Directory of Open Access Journals (Sweden)

    Maria Teresa Campos Vieira

    2003-04-01

    Full Text Available OBJETIVO: avaliar as formas de apresentação clínica da enterocolite necrosante neonatal e os fatores associados à doença. MÉTODOS: estudo retrospectivo dos casos de enterocolite necrosante neonatal (ECN (n = 56 ocorridos na UTI Neonatal Lagoa, entre dezembro de 1986 e julho de 1992. O diagnóstico e estadiamento da doença seguiram o critério de Bell modificado. Foram avaliados o diagnóstico e a evolução de todos os casos. Posteriormente, foram selecionados os casos de enterocolite grau II e III (n =44 e comparados com um grupo controle (n = 44, selecionado pelo peso de nascimento (± 250g e época de internação (± 2 semanas. Para a análise estatística, foi considerado significante p OBJECTIVE: to evaluate the features of clinical presentation of neonatal necrotizing enterocolitis and its associated factors. METHODS: retrospective study of the cases of neonatal necrotizing enterocolitis (n = 56 diagnosed at Neonatal Intensive Care Unit Lagoa (NICU, between December 1986 and July 1992. Diagnosis and stages of the disease followed the modified Bell's criteria. Diagnosis and follow-up of all cases were evaluated. The cases of enterocolitis - degrees II and III (n = 44 - were subsequently selected and compared to a case-control group (n = 44, selected according to birthweight ( 250 g and hospitalization period ( 2 weeks. The statistically significant analysis was considered as p < 0.05. RESULTS: out of 2,447 newborns admitted to the NICU, 56 (2.3% presented enterocolitis. Mean weight was 1908.5 g; mean gestational age was 35 weeks and 1 day; mean period for diagnosis was 10.7 days; 51 (91.1% patients were fed before diagnosis; 18 (32.1% needed urgent surgery; nine (16.9% hemocultures were positive; 10 (17.8% patients died. Four clinical standards were observed: fulminant, acute with pneumatosis, insidious and suspect. Comparatively to the case-control group, three factors were significantly associated with enterocolitis: apnea (p = 0

  15. 新生儿胆红素脑病发病机制与临床评价%Pathogenesis and clinical evaluation of bilirubin encephalopathy in newborn infant

    Institute of Scientific and Technical Information of China (English)

    毛健

    2006-01-01

    @@ 新生儿时期严重的高胆红素血症,特别是生后1周内发生的严重高胆红素血症常易导致急性神经系统功能障碍,即急性胆红素脑病(Acute bilirubin encephalopathy,ABE).

  16. Hyperbaric oxygen therapy of encephalopathy tarda induced by CO intoxication%一氧化碳中毒迟发脑病的高压氧治疗

    Institute of Scientific and Technical Information of China (English)

    杨金华; 王金春

    2003-01-01

    @@ INTRODUCTION Encephalopathy tarda of CO intoxication is the result of incomplete therapy or in- timely treatment of acut intermedium or severe CO intoxication leading to a series of nerve system injury.Due to long period of course,serious condition and unlcrear mechanism,therapy is difficult and poor effect.

  17. Necrotizing granulomatous inflammation of the glans penis.

    Science.gov (United States)

    Christodoulidou, Michelle; Bunker, Christopher B; Trevisan, Giorgia; Muneer, Asif

    2016-08-24

    We describe the case of a 73-year-old man who presented with a 10-month history of an ulcerating lesion on the glans penis. Initially this was thought to be an invasive squamous cell carcinoma but a biopsy showed histological features consistent with necrotizing granulomatous inflammation. Extensive serological, immunological and microbiological tests only showed a positive antinuclear and perinuclear antineutrophil cytoplasmic antibodies indicating a possible autoimmune aetiology but an underlying systemic cause was not identified. Treatment with oral corticosteroids limited the inflammatory process but due to the gross destruction of the glans penis, he still required a glansectomy and split-skin graft reconstruction from which he recovered well. Although this patient ultimately required surgery for this rare presentation, this case highlights the differential diagnosis of penile ulceration (that transcends neoplasia) and the importance of performing and interpreting penile biopsies before undertaking potentially mutilating definitive surgery.

  18. Cutaneous necrotizing vasculitis. Relation to systemic disease.

    Science.gov (United States)

    Lotti, T M; Comacchi, C; Ghersetich, I

    1999-01-01

    Cutaneous necrotizing vasculitis (CNV) is a complex multisystem disease generally involving the skin and mucous membranes, often accompanied by renal, gastrointestinal, pericardial, neurological, and articular signs and symptoms. CNV may be idiopatical or occur in association with a drug, infection, or underlying disease. CNV has been shown in patients with chronic infections (viral, bacterial, protozoa, helminthic), serum sickness, a variety of collagen vascular diseases (systemic lupus erythematous, Sjögren's syndrome, rheumatoid arthritis, Behçet's disease) hyperglobulinemic states, cryoglobulinemia, bowel bypass syndrome, ulcerative colitis, cystic fibrosis, primary biliary cirrhosis and HIV infection. Association with malignancies is not frequent. Lymphoproliferative disorders (Hodgkin's disease, mycosis fungoides, lymphosarcoma, adult T-cell leukemia, multiple mieloma) and solid tumors (lung cancer, colon carcinoma, renal, prostate, head and neck cancer and breast cancer) may be associated with CNV. Whenever possible, treatment is directed at the elimination of the cause. In other cases after adequate laboratory screening local and systemic therapy are recommended.

  19. Necrotizing sialometaplasia of palate: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Krishna, Sowmya [V.S Dental College and Hospital, Karnataka (India); Ramnarayan BK [Dayanada Sagar College of Dental Sciences and Hospital, Karnataka (India)

    2011-03-15

    Necrotizing sialometaplasia (NS) which mimics malignancy both clinically and histopathologically is an uncommon benign, self-limiting inflammatory disease of the mucus-secreting minor salivary glands. The lesion is believed to be the result of vascular ischemia that may be initiated by trauma. Till date, the diagnosis of NS remains a challenge. This report demonstrates a case of NS in a 73-year-old male patient who presented with an ulcerative lesion in his palate. He had a history of local trauma and was long-term user of salbutamol inhaler. An incisional biopsy was carried out and the diagnosis was established through history, clinical examination, histopathology using Hematoxylin and Eosin stain. The patient was given symptomatic treatment and the lesion healed in about 7 weeks.

  20. Qualifying and quantifying minimal hepatic encephalopathy.

    Science.gov (United States)

    Morgan, Marsha Y; Amodio, Piero; Cook, Nicola A; Jackson, Clive D; Kircheis, Gerald; Lauridsen, Mette M; Montagnese, Sara; Schiff, Sami; Weissenborn, Karin

    2016-12-01

    Minimal hepatic encephalopathy is the term applied to the neuropsychiatric status of patients with cirrhosis who are unimpaired on clinical examination but show alterations in neuropsychological tests exploring psychomotor speed/executive function and/or in neurophysiological variables. There is no gold standard for the diagnosis of this syndrome. As these patients have, by definition, no recognizable clinical features of brain dysfunction, the primary prerequisite for the diagnosis is careful exclusion of clinical symptoms and signs. A large number of psychometric tests/test systems have been evaluated in this patient group. Of these the best known and validated is the Portal Systemic Hepatic Encephalopathy Score (PHES) derived from a test battery of five paper and pencil tests; normative reference data are available in several countries. The electroencephalogram (EEG) has been used to diagnose hepatic encephalopathy since the 1950s but, once popular, the technology is not as accessible now as it once was. The performance characteristics of the EEG are critically dependent on the type of analysis undertaken; spectral analysis has better performance characteristics than visual analysis; evolving analytical techniques may provide better diagnostic information while the advent of portable wireless headsets may facilitate more widespread use. A large number of other diagnostic tools have been validated for the diagnosis of minimal hepatic encephalopathy including Critical Flicker Frequency, the Inhibitory Control Test, the Stroop test, the Scan package and the Continuous Reaction Time; each has its pros and cons; strengths and weaknesses; protagonists and detractors. Recent AASLD/EASL Practice Guidelines suggest that the diagnosis of minimal hepatic encephalopathy should be based on the PHES test together with one of the validated alternative techniques or the EEG. Minimal hepatic encephalopathy has a detrimental effect on the well-being of patients and their care

  1. Does aetiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy influence the outcome of treatment?

    Science.gov (United States)

    Mcintyre, Sarah; Badawi, Nadia; Blair, Eve; Nelson, Karin B

    2015-04-01

    Neonatal encephalopathy, a clinical syndrome affecting term-born and late preterm newborn infants, increases the risk of perinatal death and long-term neurological morbidity, especially cerebral palsy. With the advent of therapeutic hypothermia, a treatment designed for hypoxic or ischaemic injury, associated mortality and morbidity rates have decreased. Unfortunately, only about one in eight neonates (95% confidence interval) who meet eligibility criteria for therapeutic cooling apparently benefit from the treatment. Studies of infants in representative populations indicate that neonatal encephalopathy is a potential result of a variety of antecedents and that asphyxial complications at birth account for only a small percentage of neonatal encephalopathy. In contrast, clinical case series suggest that a large proportion of neonatal encephalopathy is hypoxic or ischaemic, and trials of therapeutic hypothermia are specifically designed to include only infants exposed to hypoxia or ischaemia. This review addresses the differences, definitional and methodological, between infants studied and investigations undertaken, in population studies compared with cooling trials. It raises the question if there may be subgroups of infants with a clinical diagnosis of hypoxic-ischaemic encephalopathy (HIE) in whom the pathobiology of neonatal neurological depression is not fundamentally hypoxic or ischaemic and, therefore, for whom cooling may not be beneficial. In addition, it suggests approaches to future trials of cooling plus adjuvant therapy that may contribute to further improvement of care for these vulnerable neonates.

  2. Retroperitoneal Necrotizing Fasciitis Masquerading as Perianal Abscess - Rare and Perilous.

    Science.gov (United States)

    Amaranathan, Anandhi; Sahoo, Ashok Kumar; Barathi, Deepak; Shankar, Gomathi; Sistla, Sarath Chandra

    2017-01-17

    Necrotizing fasciitis is one of the uncommon presentations of a rapidly spreading subcutaneous tissue infection. Although the actual cause is unclear in many cases, most of them are due to the rapid proliferation of microorganisms. Retroperitoneal necrotizing fasciitis is extremely rare. It is a potentially lethal infection that requires immediate and aggressive surgical care. Early diagnosis is the key to a better prognosis. The possibility of retroperitoneal necrotizing fasciitis should be suspected in patients with symptoms of sepsis that are disproportionate to clinical findings. The rapid deterioration of the patient also gives a clue towards the diagnosis. We report a 35-year-old male with perianal abscess who had been progressed to retroperitoneal necrotizing fasciitis. The patient was managed successfully with aggressive debridement and drainage after laparotomy. Appropriate antibiotics were used to combat the sepsis. The patient recovered well at follow up, three months after discharge. Another patient, a 45-year-old male with a retroperitoneal abscess, progressed to retroperitoneal necrotizing fasciitis, and extra peritoneal drainage and debridement was done. Antibiotics depending upon the culture and sensitivity were used to control sepsis. But the patient succumbed to death 45 days after surgery due to uncontrolled sepsis. Necrotizing fasciitis of any anatomical site needs aggressive surgical care with early intervention. But retroperitoneal necrotizing fasciitis needs an extra effort for diagnosis. After diagnosis, it needs timely surgical intervention and appropriate antibiotic therapy for the recovery of the patients.

  3. [Cosmetic blepharoplasty complicated by necrotizing periorbital fasciitis: a case report].

    Science.gov (United States)

    Laouar, K; Ruban, J-M; Baggio, E; Dupeyron, G

    2012-06-01

    Necrotizing periorbital or palpebro-orbital fasciitis represents a unique anatomical site for necrotizing fasciitis, which is an extremely rare and very severe, potentially devastating bacterial infection, rapidly leading to facial necrosis with loss of vision and even death of the patient from toxic shock. In this paper, we report a case of necrotizing periorbital fasciitis as a complication of cosmetic lower eyelid blepharoplasty. Necrotizing fasciitis most often affects the upper and lower limbs, the trunk and the perineal area. It is rarely observed in the facial region due to the rich blood supply in this area. The most commonly implicated pathogen is group A, β-hemolytic "pyogenic"Streptococcus, either alone or in combination with other bacteria, such as staphylococcus or pseudomonas. Mortality varies according to the series and anatomical site. The mortality rate for necrotizing fasciitis is approximately 28 %. It is slightly lower in the periorbital area (15 %). Risk factors for death include alcoholism, diabetes mellitus, immunocompromise, hematologic or pulmonary diseases, and the identity of the causative agent (group A Streptococcus), although approximately 50 % of patients have no predisposing conditions. Management of periorbital necrotizing fasciitis is based on early detection of initial symptoms and on aggressive multidisciplinary treatment including surgical debridement of necrotic areas and antibiotic coverage. The timeliness of treatment and the multidisciplinary approach are considered to be the two essential factors in influencing the mortality and morbidity of this condition.

  4. Posterior Reversible Encephalopathy Syndrome in a Patient with Newly Diagnosed HIV Infection and End Stage Renal Disease

    OpenAIRE

    2013-01-01

    Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome in which patients present with an acute or subacute clinical presentation of seizures, visual disturbances, headache, and altered mental status. The pathophysiology of PRES may be explained by endothelial dysfunction that leads to transudation of fluids and protein, resulting in vasogenic cerebral edema. PRES is typically associated with many conditions such as hypertension, uremia, immunosuppressive drugs, ...

  5. Hepatic encephalopathy after treatment with temozolomide.

    Science.gov (United States)

    Goldbecker, Annemarie; Tryc, Anita Blanka; Raab, Peter; Worthmann, Hans; Herrmann, Julian; Weissenborn, Karin

    2011-05-01

    Temozolomide in combination with radiation has been in use for more than 5 years for the therapy of glioblastoma. Known adverse effects concerning the gastrointestinal system are elevation of liver enzymes. We present the case of a patient treated with temozolomide who developed severe cholestatic liver damage and consecutive hepatic encephalopathy. Neurological symptoms were mistaken as being caused by focal brain damage for more than 9 months. After the correct diagnosis had been made and the treatment had been started, the patient's condition ameliorated. In conclusion, neurological deficits in patients with known brain lesion should not be attributed automatically to the pre-existing damage even if it is progressive but should be examined carefully, also including toxic and metabolic encephalopathies into the differential diagnosis. Furthermore, new side effects of drugs have to be considered. At least this case might lead to a closer monitoring of liver enzymes during temozolomide therapy.

  6. Hashimoto's encephalopathy: A rare proteiform disorder.

    Science.gov (United States)

    Montagna, Giacomo; Imperiali, Mauro; Agazzi, Pamela; D'Aurizio, Federica; Tozzoli, Renato; Feldt-Rasmussen, Ulla; Giovanella, Luca

    2016-05-01

    Hashimoto's encephalopathy (HE) is a rare not well understood, progressive and relapsing multiform disease, characterized by seizures, movement disorders, subacute cognitive dysfunction, psychiatric symptoms and responsiveness to steroid therapy. The disorder is generally associated with thyroid diseases and the most common feature is the presence of anti-thyroperoxidase antibodies (TPOAb). Patients are usually euthyroid or mildly hypothyroid at presentation. All age groups can be affected. The pathophysiology is still unclear, especially the link between elevated serum TPOAb and the encephalopathy. Most reported cases occurred in women and girls. Unspecific symptoms, non-pathognomonic laboratory neurophysiology and neuroimaging features make its diagnosis a real challenge for clinicians. The case of a 16 year old boy, with a clinical picture of HE associated with hypothyroidism, demonstrating an excellent response to high dose steroids is presented together with a systematic review of the literature.

  7. Nonconvulsive Status Epilepticus in Hepatic Encephalopathy

    Directory of Open Access Journals (Sweden)

    Hyung Kim

    2011-05-01

    Full Text Available We discuss a case of a 64-year-old male with a history of liver failure presenting with altered mental status, initially diagnosed with hepatic encephalopathy but ultimately diagnosed with nonconvulsive status epilepticus (NCSE by electroencephalogram (EEG. NCSE is a difficult diagnosis to make, given no clear consensus on diagnostic criteria. Especially in the intensive care unit setting of persistent altered mental status with no clear etiology, NCSE must be considered in the differential diagnosis, as the consequences of delayed diagnosis and treatment can be substantial. EEG can be useful in the evaluation of patients with hepatic encephalopathy who have persistently altered levels of consciousness despite optimal medical management. [West J Emerg Med. 2011;12(4:372–374.

  8. Diagnosis of necrotizing faciitis with bedside ultrasound: the STAFF Exam.

    Science.gov (United States)

    Castleberg, Erik; Jenson, Natasa; Dinh, Vi Am

    2014-02-01

    The early diagnosis of necrotizing fasciitis is often ambiguous. Computed tomography and magnetic resonance imaging, while sensitive and specific modalities, are often time consuming or unavailable. We present a case of necrotizing fasciitis that was rapidly diagnosed using bedside ultrasound evaluating for subcutaneous thickening, air, and fascial fluid (STAFF). We propose the STAFF ultrasound exam may be beneficial in the rapid evaluation of unstable patients with consideration of necrotizing fasciitis, in a similar fashion to the current use of a focused assessment with sonography for trauma exam in the setting of trauma.

  9. Polymicrobial abdominal wall necrotizing fasciitis after cesarean section.

    Science.gov (United States)

    DeMuro, Jp; Hanna, Af; Chalas, E; Cunha, Ba

    2012-09-01

    We report a case of a previously healthy woman after an uneventful caesarean section who developed polymicrobial necrotizing fasciitis. She was given a non-steroidal anti-inflamatory drug (NSAID) after her delivery. Her post-delivery course was complicated by septic shock, and required multiple debridements before abdominal reconstruction. This case describes the increased risk of necrotizing fasciitis with NSAID use. Unusual were the organisms causing the polymicrobial necrotizing fasciitis: Staphylococcus aureus, Enterobacter agglomerans, Acinetobacter baumannii, and two strains of Enterobacter cloacae.

  10. Necrotizing sialometaplasia of the lip simulating squamous cell carcinoma.

    Science.gov (United States)

    Gad, A; Willén, H; Willén, R; Thorstensson, S; Ekman, L

    1980-01-01

    A case of necrotizing sialometaplasia of the lip in an 68-year-old pipe smoker is described. Necrotizing sialometaplasia is a self-healing non-neoplastic disease probably of ischaemic nature. Thirty-nine cases of sialometaplasia are described in the literature up to early 1979. These cases appeared in the palate, nasal cavity, gingiva, lip, hypopharynx and maxillary sinus. Six cases have also been reported from major salivary glands. Histologically there is necrosis of mucous cells with partial replacement by squamous epithelium. This entity has often been mistaken for squamous or mucoepidermoid carcinoma. One has to be familiar with the existence of necrotizing sialometaplasia in ordeg surgery.

  11. Streptococcus pneumoniae necrotizing fasciitis in systemic lupus erythematosus.

    Science.gov (United States)

    Sánchez, A; Robaina, R; Pérez, G; Cairoli, E

    2016-04-01

    Necrotizing fasciitis is a rapidly progressive destructive soft tissue infection with high mortality. Streptococcus pneumoniae as etiologic agent of necrotizing fasciitis is extremely unusual. The increased susceptibility to Streptococcus pneumoniae infection in patients with systemic lupus erythematosus is probably a multifactorial phenomenon. We report a case of a patient, a 36-year-old Caucasian female with 8-year history of systemic lupus erythematosus who presented a fatal Streptococcus pneumoniae necrotizing fasciitis. The role of computed tomography and the high performance of blood cultures for isolation of the causative microorganism are emphasized. Once diagnosis is suspected, empiric antibiotic treatment must be prescribed and prompt surgical exploration is mandatory.

  12. Necrotizing Fasciitis of the Nose Complicated with Cavernous Sinus Thrombosis

    Directory of Open Access Journals (Sweden)

    D. Swaminath

    2014-01-01

    Full Text Available Necrotizing fasciitis is a rapidly progressive life threatening bacterial infection of the skin, the subcutaneous tissue, and the fascia. We present a case of necrotizing fasciitis involving the nose complicated by cavernous sinus thrombosis. Few cases of septic cavernous sinus thrombosis have been reported to be caused by cellulitis of the face but necrotizing fasciitis of the nose is rare. It is very important to recognize the early signs of cavernous thrombosis. Treatment for septic cavernous sinus thrombosis is controversial but early use of empirical antibiotics is imperative.

  13. Ascariasis-associated worm encephalopathy in a young child.

    Science.gov (United States)

    Jat, Kana Ram; Marwaha, R K; Panigrahi, Inusha; Gupta, Kunal

    2009-04-01

    Infestation with Ascaris lumbricoides in children has a varied manifestation, but encephalopathy is a very rare presentation. This report describes a case of ascariasis-associated encephalopathy in a child. An 18-month-old boy was admitted with altered sensorium. He had a history of vomiting and was passing Ascaris worms in the vomitus. The cerebrospinal fluid analysis did not reveal any abnormality. The patient was treated with an antihelminthic drug and he recovered completely. Worm encephalopathy should be considered as a differential diagnosis for unexplained encephalopathy in tropical areas.

  14. Wernicke′s encephalopathy following hyperemesis gravidarum

    Directory of Open Access Journals (Sweden)

    Sandeep Kantor

    2014-01-01

    Full Text Available Wernicke′s encephalopathy (WE is a potentially reversible yet serious neurological manifestation caused by vitamin B 1 (thiamine deficiency. It is commonly associated with heavy alcohol consumption. Other clinical associations are with hyperemesis gravidarum (HG, starvation, and prolonged intravenous feeding. Most patients present with the triad of ocular signs, ataxia, and confusion. It can be associated with life-threatening complication like central pontine myelinolysis (CPM. We report two cases of WE following HG, with two different outcomes.

  15. Pyridoxal phosphate-dependent neonatal epileptic encephalopathy.

    Science.gov (United States)

    Bagci, S; Zschocke, J; Hoffmann, G F; Bast, T; Klepper, J; Müller, A; Heep, A; Bartmann, P; Franz, A R

    2008-03-01

    Pyridox(am)ine-5'-phosphate oxidase converts pyridoxine phosphate and pyridoxamine phosphate to pyridoxal phosphate, a cofactor in many metabolic reactions, including neurotransmitter synthesis. A family with a mutation in the pyridox(am)ine-5'-phosphate oxidase gene presenting with neonatal seizures unresponsive to pyridoxine and anticonvulsant treatment but responsive to pyridoxal phosphate is described. Pyridoxal phosphate should be considered in neonatal epileptic encephalopathy unresponsive to pyridoxine.

  16. Pyridoxal phosphate-dependent neonatal epileptic encephalopathy

    OpenAIRE

    2009-01-01

    Pyridox(am)ine-5′-phosphate oxidase converts pyridoxine phosphate and pyridoxamine phosphate to pyridoxal phosphate, a cofactor in many metabolic reactions, including neurotransmitter synthesis. A family with a mutation in the pyridox(am)ine-5′-phosphate oxidase gene presenting with neonatal seizures unresponsive to pyridoxine and anticonvulsant treatment but responsive to pyridoxal phosphate is described. Pyridoxal phosphate should be considered in neonatal epileptic encephalopathy unrespons...

  17. C-peptide and Diabetic Encephalopathy

    Institute of Scientific and Technical Information of China (English)

    Xiao-jun Cai; Hui-qin Xu; Yi Lu

    2011-01-01

    With the changes of life style, diabetes and its complications have become a major cause of morbidity and mortality. It is reasonable to anticipate a continued rise in the incidence of diabetes and its complications along with the aging of the population, increase in adult obesity rate, and other risk factors. Diabetic encephalopathy is one of the severe microvascular complications of diabetes, characterized by impaired cognitive functions, and electrophysiological, neurochemical, and structural abnormalities. It may involve direct neuronal damage caused by intracellular glucose. However, the pathogenesis of this disease is complex and its diagnosis is not very clear. Previous researches have suggested that chronic metabolic alterations, vascular changes, and neuronal apoptosis may play important roles in neuronal loss and damaged cognitive fimctions.Multiple factors are responsible for neuronal apoptosis, such as disturbed insulin growth factor (IGF) system,hyperglycemia, and the aging process. Recent data suggest that insulin/C-peptide defidency may exert a primary and key effect in diabetic encephalopathy. Administration of C-peptide partially improves the condition of the IGF system in the brain and prevents neuronal apoptosis in the hippocampus of diabetic patients.Those Findings provide a basis for application of C-peptide as a potentially effective therapy for diabetes and diabetic encephalopathy.

  18. Minimal hepatic encephalopathy matters in daily life

    Institute of Scientific and Technical Information of China (English)

    Jasmohan S Bajaj

    2008-01-01

    Minimal hepatic encephalopathy is a neuro-cognitive dysfunction which occurs in an epidemic proportion of cirrhotic patients, estimated as high as 80% of the population tested. It is characterized by a specific, complex cognitive dysfunction which is independent of sleep dysfunction or problems with overall intelligence. Although named "minimal", minimal hepatic encephalopathy (MHE) can have a far-reaching impact on quality of life, ability to function in daily life and progression to overt hepatic encephalopathy. Importantly, MHE has a profound negative impact on the ability to drive a car and may be a significant factor behind motor vehicle accidents. A crucial aspect of the clinical care of MHE patients is their driving history, which is often ignored in routine care and can add a vital dimension to the overall disease assessment. Driving history should be an integral part of care in patients with MHE. The lack of specific signs and symptoms, the preserved communication skills and lack of insight make MHE a difficult condition to diagnose. Diagnostic strategies for MHE abound, but are usually limited by financial, normative or time constraints. Recent studies into the inhibitory control and critical flicker frequency tests are encouraging since these tests can increase the rates of MHE diagnosis without requiring a psychologist. Although testing for MHE and subsequent therapy is not standard of care at this time, it is important to consider this in cirrhotics in order to improve their ability to live their life to the fullest.

  19. BLOOD BIOMARKERS FOR EVALUATION OF PERINATAL ENCEPHALOPATHY

    Directory of Open Access Journals (Sweden)

    Ernest Marshall Graham

    2016-07-01

    Full Text Available Recent research in identification of brain injury after trauma shows many possible blood biomarkers that may help identify the fetus and neonate with encephalopathy. Traumatic brain injury shares many common features with perinatal hypoxic-ischemic encephalopathy. Trauma has a hypoxic component, and one of the 1st physiologic consequences of moderate-severe traumatic brain injury is apnea. Trauma and hypoxia-ischemia initiate an excitotoxic cascade and free radical injury followed by the inflammatory cascade, producing injury in neurons, glial cells and white matter. Increased excitatory amino acids, lipid peroxidation products and alteration in microRNAs and inflammatory markers are common to both traumatic brain injury and perinatal encephalopathy. The blood-brain barrier is disrupted in both leading to egress of substances normally only found in the central nervous system. Brain exosomes may represent ideal biomarker containers, as RNA and protein transported within the vesicles are protected from enzymatic degradation. Evaluation of fetal or neonatal brain derived exosomes that cross the blood-brain barrier and circulate peripherally has been referred to as the liquid brain biopsy. A multiplex of serum biomarkers could improve upon the current imprecise methods of identifying fetal and neonatal brain injury such as fetal heart rate abnormalities, meconium, cord gases at delivery, and Apgar scores. Quantitative biomarker measurements of perinatal brain injury and recovery could lead to operative delivery only in the presence of significant fetal risk, triage to appropriate therapy after birth and measure the effectiveness of treatment.

  20. Determining Prevalence of Acute Bilirubin Encephalopathy in Developing Countries

    Science.gov (United States)

    2015-11-11

    Demonstrate BIND II Score of >=5, is Valid for Detecting Moderate to Severe ABE in Neonates <14 Days Old.; Demonstrate Community-BIND Instrument, a Modified BIND II, is a Valid and Reliable Tool for Detecting ABE.; Demonstrate That Community-BIND Can be Used for Acquiring Population-based Prevalence of ABE in the Community.

  1. Acute hepatic encephalopathy presenting as cortical laminar necrosis: case report.

    Science.gov (United States)

    Choi, Jong Mun; Kim, Yoon Hee; Roh, Sook Young

    2013-01-01

    We report on a 55-year-old man with alcoholic liver cirrhosis who presented with status epilepticus. Laboratory analysis showed markedly elevated blood ammonia. Brain magnetic resonance imaging (MRI) showed widespread cortical signal changes with restricted diffusion, involving both temporo-fronto-parietal cortex, while the perirolandic regions and occipital cortex were uniquely spared. A follow-up brain MRI demonstrated diffuse cortical atrophy with increased signals on T1-weighted images in both the basal ganglia and temporal lobe cortex, representing cortical laminar necrosis. We suggest that the brain lesions, in our case, represent a consequence of toxic effect of ammonia.

  2. Acute hepatic encephalopathy presenting as cortical laminar necrosis: Case report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jong Mun; Kim, Yoon Hee; Roh, Sook Young [Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam (Korea, Republic of)

    2013-04-15

    We report on a 55-year-old man with alcoholic liver cirrhosis who presented with status epilepticus. Laboratory analysis showed markedly elevated blood ammonia. Brain magnetic resonance imaging (MRI) showed widespread cortical signal changes with restricted diffusion, involving both temporo-fronto-parietal cortex, while the perirolandic regions and occipital cortex were uniquely spared. A follow-up brain MRI demonstrated diffuse cortical atrophy with increased signals on T1-weighted images in both the basal ganglia and temporal lobe cortex, representing cortical laminar necrosis. We suggest that the brain lesions, in our case, represent a consequence of toxic effect of ammonia.

  3. A non-alcoholic Wernicke’s encephalopathy case with atypical MRI findings: Clinic versus radiology

    Science.gov (United States)

    Alpaydin, Sezin; Sirin, Hadiye; Calli, Cem; Celebisoy, Neşe

    2015-01-01

    Wernicke's Encephalopathy is an acute neuropsychiatric syndrome that can be seen in both alcohol abusers and non-alcoholic population as a result of thiamine deficiency. We herein report a non-alcoholic patient with typical clinical presentations but atypical MRI findings. Early clinical suspicion of WE is especially important in non-alcoholic patients with atypical MRI findings. The diagnosis of this group is more difficult to make and the prognosis of the syndrome mostly depends on early initiation of thiamine supplementation. PMID:26306933

  4. Hepatic encephalopathy is associated with decreased cerebral oxygen metabolism and blood flow, not increased ammonia uptake

    DEFF Research Database (Denmark)

    Dam, Gitte; Keiding, Susanne; Munk, Ole L

    2013-01-01

    Studies have shown decreased cerebral oxygen metabolism (CMRO(2)) and blood flow (CBF) in patients with cirrhosis with hepatic encephalopathy (HE). It remains unclear, however, whether these disturbances are associated with HE or with cirrhosis itself and how they may relate to arterial blood...... ammonia concentration and cerebral metabolic rate of blood ammonia (CMRA). We addressed these questions in a paired study design by investigating patients with cirrhosis during and after recovery from an acute episode of HE type C. CMRO(2), CBF, and CMRA were measured by dynamic positron emission...

  5. Changing face of hepatic encephalopathy:Role of inflammation and oxidative stress

    Institute of Scientific and Technical Information of China (English)

    Amit; S; Seyan; Robin; D; Hughes; Debbie; L; Shawcross

    2010-01-01

    The face of hepatic encephalopathy(HE) is changing.This review explores how this neurocognitive disorder,which is associated with both acute and chronic liver injury,has grown to become a dynamic syndrome that spans a spectrum of neuropsychological impairment,from normal performance to coma.The central role of ammonia in the pathogenesis of HE remains incontrovertible.However,over the past 10 years,the HE community has begun to characterise the key roles of inflammation,infection,and oxidative/nitrosative s...

  6. Mucosal necrosis of the small intestine in myopathy,encephalopathy, lactic acidosis, and stroke-like episodes syndrome

    Institute of Scientific and Technical Information of China (English)

    Keita Fukuyama; Yasuhide Ishikawa; Tetsuro Ogino; Hidenobu Inoue; Ryoya Yamaoka; Tetsuro Hirose; Tomohiko Nishihira

    2012-01-01

    This report presents a case of massive mucosal necrosis of the small intestine in a patient with mitochondrial myopathy,encephalopathy,lactic acidosis,and stroke-like episodes (MELAS),which particularly affects the brain,nervous system and muscles.A 45-year-old Japanese female,with an established diagnosis of MELAS,presented with vomiting.Computed tomography showed portomesenteric venous gas and pneumatosis intestinalis.She underwent a resection of the small intestine.A microscopic study showed necrosis of the mucosa and vacuolar degeneration of smooth muscle cells in the arterial wall.Immunohistochemistry showed anti-mitochondrial antibody to be highly expressed in the crypts adjacent the necrotic mucosa.The microscopic and immunohistochemical findings suggested the presence of a large number of abnormal mitochondria in MELAS to be closely linked to mucosal necrosis of the small intestine.

  7. Posterior reversible encephalopathy syndrome in alcoholic hepatitis: Hepatic encephalopathy a common theme

    Science.gov (United States)

    John, Elizabeth S; Sedhom, Ramy; Dalal, Ishita; Sharma, Ranita

    2017-01-01

    Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiologic diagnosis that has become more widely recognized and reported over the past few decades. As such, there are a number of known risk factors that contribute to the development of this syndrome, including volatile blood pressures, renal failure, cytotoxic drugs, autoimmune disorders, pre-eclampsia, and eclampsia. This report documents the first reported case of PRES in a patient with severe alcoholic hepatitis with hepatic encephalopathy and delves into a molecular pathophysiology of the syndrome. PMID:28127211

  8. Hospital epidemiology of emergent cervical necrotizing fasciitis

    Directory of Open Access Journals (Sweden)

    Shaikh Nissar

    2010-01-01

    Full Text Available Background : Necrotizing fasciitis (NF is a surgical emergency. It is a rapidly progressing infection of the fascia and subcutaneous tissue and could be fatal if not diagnosed early and treated properly. NF is common in the groin, abdomen, and extremities but rare in the neck and the head. Cervical necrotizing fasciitis (CNF is an aggressive infection of the neck and the head, with devastating complications such as airway obstruction, pneumonia, pulmonary abscess, jugular venous thrombophlebitis, mediastinitis, and septic shock associated with high mortality. Aim : To assess the presentation, comorbidities, type of infection, severity of disease, and intensive care outcome of CNF. Methods : Medical records of the patients treated for NF in the surgical intensive care unit (SICU from January 1995 to February 2005 were reviewed retrospectively. Results : Out of 94 patients with NF, 5 (5.3% had CNF. Four patients were male. The mean age of our patients was 41.2 ± 14.8 years. Sixty percent of patients had an operative procedure as the predisposing factor and 80% of patients received nonsteroidal anti-inflammatory drugs (NSAIDs. The only comorbidity associated was diabetes mellitus (DM in 3 patients (60%. Sixty percent of the cases had type1 NF. Mean sequential organ failure assessment (SOFA score on admission to the ICU was 8.8 ± 3.6. All patients had undergone debridement at least two times. During the initial 24 h our patients received 5.8 ± 3.0 l of fluid, 2.0 ± 1.4 units of packed red blood cells (PRBC, 4.8 ± 3.6 units of fresh frozen plasma (FFP, and 3.0 ± 4.5 units of platelet concentrate. The mean number of days patients were intubated was 5.2 ± 5.1 days and the mean ICU stay was 6.4 ± 5.2 days. Sixty percent of cases had multiorgan dysfunction (MODS and one patient died, resulting in a mortality rate of 20%. Conclusion : According to our study, CNF represents around 5% of NF patients. CNF was higher among male patients and in

  9. Atorvastatin-induced necrotizing autoimmune myositis

    Science.gov (United States)

    Troyanov, Yves; Landon-Cardinal, Océane; Fritzler, Marvin J.; Ferreira, José; Targoff, Ira N.; Rich, Eric; Goulet, Michelle; Goulet, Jean-Richard; Bourré-Tessier, Josiane; Robitaille, Yves; Drouin, Julie; Albert, Alexandra; Senécal, Jean-Luc

    2017-01-01

    Abstract The general aim of this study was to evaluate the disease spectrum in patients presenting with a pure polymyositis (pPM) phenotype. Specific objectives were to characterize clinical features, autoantibodies (aAbs), and membrane attack complex (MAC) in muscle biopsies of patients with treatment-responsive, statin-exposed necrotizing autoimmune myositis (NAM). Patients from the Centre hospitalier de l’Université de Montréal autoimmune myositis (AIM) Cohort with a pPM phenotype, response to immunosuppression, and follow-up ≥3 years were included. Of 17 consecutive patients with pPM, 14 patients had a NAM, of whom 12 were previously exposed to atorvastatin (mean 38.8 months). These 12 patients were therefore suspected of atorvastatin-induced AIM (atorAIM) and selected for study. All had aAbs to 3-hydroxy-3-methylglutaryl coenzyme A reductase, and none had overlap aAbs, aAbs to signal recognition particle, or cancer. Three stages of myopathy were recognized: stage 1 (isolated serum creatine kinase [CK] elevation), stage 2 (CK elevation, normal strength, and abnormal electromyogram [EMG]), and stage 3 (CK elevation, proximal weakness, and abnormal EMG). At diagnosis, 10/12 (83%) patients had stage 3 myopathy (mean CK elevation: 7247 U/L). The presenting mode was stage 1 in 6 patients (50%) (mean CK elevation: 1540 U/L), all of whom progressed to stage 3 (mean delay: 37 months) despite atorvastatin discontinuation. MAC deposition was observed in all muscle biopsies (isolated sarcolemmal deposition on non-necrotic fibers, isolated granular deposition on endomysial capillaries, or mixed pattern). Oral corticosteroids alone failed to normalize CKs and induce remission. Ten patients (83%) received intravenous immune globulin (IVIG) as part of an induction regimen. Of 10 patients with ≥1 year remission on stable maintenance therapy, IVIG was needed in 50%, either with methotrexate (MTX) monotherapy or combination immunosuppression. In the remaining

  10. Analysis on 30 Cases of Xuebijing Combined with Domestic Fourteen Peptides Treatment for Acute ;Hemorrhagic Necrotizing Pancreatitis%血必净联合国产十四肽治疗急性出血坏死性胰腺炎30例疗效分析

    Institute of Scientific and Technical Information of China (English)

    倪浩亮

    2015-01-01

    目的:研究血必净联合国产十四肽治疗急性出血坏死性胰腺炎( AHNP)的疗效。方法选取2013年11月至2014年5月南通市通州区人民医院收治的 AHNP患者60例,采用随机数字表法分为观察组和对照组,各30例。对照组在常规治疗基础上给予国产十四肽生长抑素100μg,缓慢静脉注射后再予以250μg/h的速度静脉泵入,连续治疗7 d。观察组在对照组治疗的基础上给予血必净注射液50 mL静脉滴注,每日2次。记录患者就诊当日及治疗3 d及5 d后体液淀粉酶(淀粉酶检测试剂盒检测法);记录患者腹胀腹痛时间、恶心呕吐时间、禁食时间、退热时间、住院时间及并发症发生率。结果两组治疗后血淀粉酶、尿淀粉酶随时间推移逐渐下降,且观察组下降幅度大于对照组,组间、不同时点间、组间·不同时点间交互作用差异有统计学意义( P<0.01)。观察组患者平均腹胀腹痛时间、恶心呕吐时间、禁食时间、退热时间、住院时间、并发症发生率显著低于对照组[(2.5±1.3) d 比(4.4±1.3) d,(3.6±1.0)d 比(5.1±1.1) d,(8.4±1.2) d 比(12.0±1.4) d,(4.9±1.4) d 比(7.1±1.7) d,(16.7±2.0) d 比(21.8±2.7) d,26.7%(8/30)比36.7%(11/30),均P<0.01]。结论血必净联合国产十四肽治疗AHNP疗效确切,值得推广。%Objective To study the effect of xuebijing combined domestic fourteen peptide therapy for acute hemorrhagic necrotizing pancreatitis(AHNP).Methods Total of 60 patients with AHNP admitted to Tongzhou District People′s Hospital from Nov.2013 to May 2014 were included in the study.The patients were divided into observation group and ontrol group ( 30 cases each ) according to random number table method.The control groupwas given domestically produced fourteen peptide somatostatin(100 μg slow bolus then 250 μg/h intravenous infusion) based on

  11. Avian necrotic enteritis: Experimental models, climate change, and vaccine development

    Science.gov (United States)

    This review summarizes recent developments in disease models, pathogenesis, host immunity, risk factors, and vaccine development for Clostridium perfringens infection of poultry and necrotic enteritis (NE). The increasing trends of legislative restrictions and voluntary removal of antibiotic growth...

  12. Klebsiella pneumoniae necrotizing fasciitis in a Latin American male.

    Science.gov (United States)

    Persichino, Jon; Tran, Richard; Sutjita, Made; Kim, Daniel

    2012-11-01

    Necrotizing fasciitis, caused by Klebsiella pneumoniae, is a rare and life-threatening bacterial infection. Most documented cases have been reported from Asia, particularly associated with diabetes mellitus. The prevalence of this infection in the USA is rare, especially among persons of non-Asian descent and those without travel to Asia. We report a case of disseminated necrotizing fasciitis, caused by K. pneumoniae, in a Latin American male with diabetes mellitus. Given our review of the literature, this is the only case report, to our knowledge, of a Latin American patient with Klebsiella necrotizing fasciitis in the USA. This case may reflect the geographical spread and emergence of K. pneumoniae infection in the USA. Clinicians need to be aware of the possible relationship between this organism and necrotizing fasciitis in persons of Latin American descent with diabetes mellitus.

  13. Metabolomic determinants of necrotizing enterocolitis in preterm piglets

    Science.gov (United States)

    Studies in premature infants and animals show that carbohydrate malabsorption and gut microbiota colonisation are key elements for triggering necrotizing enterocolitis (NEC). Our aim was to determine how dietary carbohydrate composition affects the metabolomic profile and whether unique metabolite s...

  14. Diagnosis of Necrotizing Fasciitis with Bedside Ultrasound: the STAFF Exam

    OpenAIRE

    Erik Castleberg; Natasa Jenson; Vi Am Dinh

    2014-01-01

    The early diagnosis of necrotizing fasciitis is often ambiguous. Computed tomography and magnetic resonance imaging, while sensitive and specific modalities, are often time consuming or unavailable. We present a case of necrotizing fasciitis that was rapidly diagnosed using bedside ultrasound evaluating for subcutaneous thickening, air, and fascial fluid (STAFF). We propose the STAFF ultrasound exam may be beneficial in the rapid evaluation of unstable patients with consideration of necrotizi...

  15. Necrotic enteritis in broilers: an updated review on the pathogenesis.

    Science.gov (United States)

    Timbermont, L; Haesebrouck, F; Ducatelle, R; Van Immerseel, F

    2011-08-01

    Clostridium perfringens-induced necrotic enteritis and related subclinical disease have become economically significant problems for the broiler industry. Fortunately, scientific interest in this topic has grown: new C. perfringens virulence factors have been discovered and new insight gained about the pathogenesis of necrotic enteritis. It has been shown that alpha toxin, for a long time thought to be the key virulence factor, is not essential for the development of the disease. Moreover, it is now clearly established that only certain C. perfringens strains are capable of inducing necrotic enteritis under specific conditions that predispose to the disease and they constitute only a minority in the intestinal tract of healthy chickens. A novel pore-forming toxin, NetB, has been identified in these virulent avian C. perfringens strains. Using a gene knockout mutant, it has been shown that NetB is a critical virulence factor in the pathogenesis of necrotic enteritis in broilers. In addition to toxin production, other factors have been described that contribute to the ability of certain C. perfringens strains to cause necrotic enteritis in broilers. It has been suggested that proteolytic enzymes play an important role in the initial stages of necrotic enteritis since the villi are first affected at the level of the basement membrane and the lateral domain of the enterocytes. In field outbreaks of necrotic enteritis, a single clone of C. perfringens is dominant in intestines of all affected birds, as opposed to the mixture of different C. perfringens strains that can be isolated from healthy bird intestines. It has been proposed that bacteriocin production is responsible for the dominance of a single strain in necrotic enteritis cases. Furthermore, it has been shown that virulent strains are more able to adhere to extracellular matrix molecules than non-virulent strains. The current knowledge on the pathogenesis of the disease has been summarized in this short review.

  16. Necrotizing Fasciitis of the Chest Wall: Report of Pediatric Cases.

    Science.gov (United States)

    Kumar, Monica; Meeks, Andrew; Kearl, Liza

    2015-09-01

    Necrotizing fasciitis is a soft tissue infection uncommonly described in children and is associated with significant morbidity and mortality if not treated early and aggressively. Reports of cases involving the upper torso are rare in general. In adults, necrotizing fasciitis is most commonly described in the abdomen, perineum, and extremities. For children, particularly neonates, necrotizing fasciitis most commonly involves the trunk presenting as omphalitis. In this report, we describe 2 pediatric cases of necrotizing fasciitis of the chest wall that presented within 6 months from each other at Los Angeles County Hospital/University of Southern California Pediatric Emergency Department. Both cases involved previously healthy children with above normal body mass indices of 36 and 25.6, respectively. These cases are noteworthy because of the rarity of necrotizing fasciitis among children especially in the chest wall, atypical presentation with nonspecific symptoms which made the diagnosis challenging, and suggestion that obesity may be a potential risk factor. Despite the rarity of this disease, the information presented in these cases may aid in raising the index of suspicion for diagnosis of necrotizing fasciitis.

  17. Branched-chain amino acids for people with hepatic encephalopathy

    DEFF Research Database (Denmark)

    Gluud, Lise Lotte; Dam, Gitte; Les, Iñigo;

    2015-01-01

    -chain amino acids (BCAA) versus control interventions has evaluated if BCAA may benefit people with hepatic encephalopathy. OBJECTIVES: To evaluate the beneficial and harmful effects of BCAA versus any control intervention for people with hepatic encephalopathy. SEARCH METHODS: We identified trials through...

  18. The Spectrum of Disease in Chronic Traumatic Encephalopathy

    Science.gov (United States)

    McKee, Ann C.; Stein, Thor D.; Nowinski, Christopher J.; Stern, Robert A.; Daneshvar, Daniel H.; Alvarez, Victor E.; Lee, Hyo-Soon; Hall, Garth; Wojtowicz, Sydney M.; Baugh, Christine M.; Riley, David O.; Kubilus, Caroline A.; Cormier, Kerry A.; Jacobs, Matthew A.; Martin, Brett R.; Abraham, Carmela R.; Ikezu, Tsuneya; Reichard, Robert Ross; Wolozin, Benjamin L.; Budson, Andrew E.; Goldstein, Lee E.; Kowall, Neil W.; Cantu, Robert C.

    2013-01-01

    Chronic traumatic encephalopathy is a progressive tauopathy that occurs as a consequence of repetitive mild traumatic brain injury. We analysed post-mortem brains obtained from a cohort of 85 subjects with histories of repetitive mild traumatic brain injury and found evidence of chronic traumatic encephalopathy in 68 subjects: all males, ranging…

  19. Typical and atypical cases of bovine spongiform encephalopathy

    Science.gov (United States)

    Bovine spongiform encephalopathy (BSE) is a transmissible spongiform encephalopathy of cattle, first detected in 1986 in the United Kingdom and subsequently in other countries. It is the most likely cause of variant Creutzfeldt-Jakob disease (vCJD) in humans, but the origin of BSE has not been eluci...

  20. Neuroimaging findings in pediatric Wernicke encephalopathy: a review

    Energy Technology Data Exchange (ETDEWEB)

    Zuccoli, Giulio [Children' s Hospital of Pittsburgh of UPMC, Children' s Hospital of Pittsburgh, Department of Radiology, Pittsburgh, PA (United States); University of Pittsburgh Medical Center, Department of Pediatric Radiology, Children' s Hospital of Pittsburgh, Pittsburgh, PA (United States); Siddiqui, Nasir; Bailey, Ariel; Bartoletti, Stefano C. [Children' s Hospital of Pittsburgh of UPMC, Children' s Hospital of Pittsburgh, Department of Radiology, Pittsburgh, PA (United States)

    2010-06-15

    Wernicke encephalopathy (WE) is an acute neurological disease resulting from dietary thiamine (vitamin B1) deficiency. WE is characterized by changes in consciousness, ocular dysfunction, and ataxia. Neuroradiologic findings usually show symmetric signal intensity alterations in the mammillary bodies, medial thalami, tectal plate, and periaqueductal area. Selective involvement of the cranial nerve nuclei, cerebellum, red nuclei, dentate nuclei, fornix, splenium, cerebral cortex, and basal ganglia characterize nonalcoholic WE patients. Furthermore, symmetric basal ganglia alterations with involvement of the putamen have only been observed in children. The incidence of WE is underestimated in both adult and pediatric patients. Interestingly, the frequency of WE in children appears to be similar to that observed in adults. The prognosis of the disease largely depends on the time from diagnosis to thiamine supplementation. The aim of this pediatric literature review is to provide an update on neuroradiologic findings in children affected by WE in an effort to determine pertinent clinical and imaging findings that can improve the detection and early identification of the disease. A thorough knowledge of the MRI findings of WE will assist in arriving at an early diagnosis, thereby reducing the morbidity and mortality associated with this disease in children. (orig.)

  1. Advances in cirrhosis: Optimizing the management ofhepatic encephalopathy

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Hepatic encephalopathy (HE) is a major complication ofcirrhosis resulting in significant socioeconomic burden,morbidity, and mortality. HE can be further subdividedinto covert HE (CHE) and overt HE (OHE). CHE is asubclinical, less severe manifestation of HE and requirespsychometric testing for diagnosis. Due to the timeconsuming screening process and lack of standardizeddiagnostic criteria, CHE is frequently underdiagnoseddespite its recognized role as a precursor to OHE. Screeningfor CHE with the availability of the Stroop test hasprovided a pragmatic method to promptly diagnoseCHE. Management of acute OHE involves institution oflactulose, the preferred first-line therapy. In addition,prompt recognition and treatment of precipitating factorsis critical as it may result in complete resolution of acuteepisodes of OHE. Treatment goals include improvementof daily functioning, evaluation for liver transplantation,and prevention of OHE recurrence. For secondary prophylaxis,intolerance to indefinite lactulose therapymay lead to non-adherence and has been identified asa precipitating factor for recurrent OHE. Rifaximin isan effective add-on therapy to lactulose for treatmentand prevention of recurrent OHE. Recent studies havedemonstrated comparable efficacy of probiotic therapy tolactulose use in both primary prophylaxis and secondaryprophylaxis.

  2. Treatment of hepatic encephalopathy by on-line hemodiafiltration: a case series study

    Directory of Open Access Journals (Sweden)

    Sugiyama Mitsugi

    2010-05-01

    Full Text Available Abstract Background It is thought that a good survival rate of patients with acute liver failure can be achieved by establishing an artificial liver support system that reliably compensates liver function until the liver regenerates or a patient undergoes transplantation. We introduced a new artificial liver support system, on-line hemodiafiltration, in patients with acute liver failure. Methods This case series study was conducted from May 2001 to October 2008 at the medical intensive care unit of a tertiary care academic medical center. Seventeen consecutive patients who admitted to our hospital presenting with acute liver failure were treated with artificial liver support including daily on-line hemodiafiltration and plasma exchange. Results After 4.9 ± 0.7 (mean ± SD on-line hemodiafiltration sessions, 16 of 17 (94.1% patients completely recovered from hepatic encephalopathy and maintained consciousness for 16.4 ± 3.4 (7-55 days until discontinuation of artificial liver support (a total of 14.4 ± 2.6 [6-47] on-line hemodiafiltration sessions. Significant correlation was observed between the degree of encephalopathy and number of sessions of on-line HDF required for recovery of consciousness. Of the 16 patients who recovered consciousness, 7 fully recovered and returned to society with no cognitive sequelae, 3 died of complications of acute liver failure except brain edema, and the remaining 6 were candidates for liver transplantation; 2 of them received living-related liver transplantation but 4 died without transplantation after discontinuation of therapy. Conclusions On-line hemodiafiltration was effective in patients with acute liver failure, and consciousness was maintained for the duration of artificial liver support, even in those in whom it was considered that hepatic function was completely abolished.

  3. Reversible cortical blindness in a case of hepatic encephalopathy

    Directory of Open Access Journals (Sweden)

    Amlan Kanti Biswas

    2016-01-01

    Full Text Available Hepatic encephalopathy is a frequent and often fatal manifestation of chronic liver disease. The pathogenesis of hepatic encephalopathy is believed to be multifactorial including impaired blood-brain barrier function, imbalance between the excitatory and inhibitory neurotransmitters in cortex, accumulation of various toxic and false neurotransmitters, and lack of nutrients like oxygen and glucose. Signs and symptoms of hepatic encephalopathy varies and commonly ranges from personality changes, disturbed consciousness, sleep pattern alternation, intellectual deterioration, speech disturbances, asterixis to frank coma and even death. Reversible or transient cortical blindness is rare manifestation of hepatic encephalopathy. It may even precede the phase of altered consciousness in such patients. Very few similar cases have been reported worldwide. Hence, we would like to report a case of transient cortical blindness in a patient of hepatic encephalopathy.

  4. Hepatic encephalopathy with status epileptics: A case report

    Institute of Scientific and Technical Information of China (English)

    Hiroto Tanaka; Hiroki Ueda; Yohei Kida; Hiroko Hamagami; Tomikimi Tsuji; Masakazu Ichinose

    2006-01-01

    A 62-year-old male with decompensated liver cirrhosis due to hepatitis C virus developed severe hepatic encephalopathy with status epileptic us. The blood ammonia level on admission was more than twice the normal level. Brain computed tomography and magnetic resonance imaging were normal. In addition, electroencephalogram showed diffuse sharp waves, consistent with hepatic encephalopathy. The status epilepticus was resolved after antiepileptic therapy (phenytoin sodium) and treatment for hepatic encephalopathy (Branched chain amino acids). The blood ammonia level normalized with the clinical improvement and the patient did not have a recurrence of status epilepticus after the end of the antiepileptic treatment. Additionally, the electroencephalogram showed normal findings. Thus, we diagnosed the patient as hepatic encephalopathy with status epilepticus. We consider the status epilepticus of this patient to a rare and interesting finding in hepatic encephalopathy.

  5. Necrotizing fasciitis: A decade of surgical intensive care experience

    Directory of Open Access Journals (Sweden)

    Shaikh Nissar

    2006-01-01

    Full Text Available Necrotizing fasciitis is a rare disease, potentially limb and life-threatening infection of fascia, subcutaneous tissue with occasionally muscular involvement. Necrotizing faciitis is surgical emergency with high morbidity and mortality. Aim: Aim of this study was to analyze presentation, microbiology, surgical, resuscitative management and outcome of this devastating soft tissue infection. Materials and Methods: The medical records of necrotizing fasciitis patients treated in surgical intensive care unit (SICU of our hospital from Jan 1995 to Feb 2005 were reviewed retrospectively. Results: Ninety-four patients with necrotizing fasciitis were treated in the surgical intensive care unit during the review period. Necrotizing fasciitis accounted for 1.15% of total admissions to our SICU. The mean age of our patients was 48.6 years, 75.5% of the cases were male. Diabetes mellitus was the most common comorbid disease (56.4%, 24.5% patients had hypertension, 14.9% patients had coronary artery disease, 9.6% had renal disease and 6.4% cases were obese. History of operation (11.7% was most common predisposing factor in our patients. All patients had leucocytosis at admission to the hospital. Mean duration of symptoms was 3.4 days. Mean number of surgical debridement was 2.1, mean sequential organ failure assessment (SOFA score at admission to SICU was 8.6, 56.38% cases were type 1 necrotizing fasciitis and 43.61% had type 2 infection. Streptococci were most common bacteria isolated (52.1%, commonest regions of the body affected by necrotizing fasciitis were the leg and the foot. Mean intubated days and intensive care unit (ICU stay were 4.8 and 7.6 days respectively. Mean fluid, blood, fresh frozen plasma and platelets concentrate received in first 24 hours were 4.8 liters, 2.0 units, 3.9 units and 1.6 units respectively. Most commonly used antibiotics were tazocin and clindamycin. Common complication was ventricular tachycardia (6.4. 46.8% patients had

  6. Some aspects of morphogenesis of diabetic encephalopathy

    Directory of Open Access Journals (Sweden)

    V. A. Tumanskiy

    2013-08-01

    Full Text Available On the basis of the literary data and conducted large-scale research it was ascertained that diabetes mellitus raises the risk of cerebral stroke in 2-6 times, the risk of transitional ischemic attacks in 3 times in comparison with the same risk in the general population [3]. Diabetic encephalopathy in its pure form can be found in 80.7% of patients with diabetes mellitus of the 1st type, its development is caused mainly by ineffective metabolic control of autoregulation of cerebral blood flow [4]. Mixed encephalopathy is prevailed among patients with diabetes mellitus of the 2nd type; lacunar heart attack is more often developed among this category of patients [5], multiple focus of ischemic affection of white substance – leukoaraiosis regarded as the areas of increased level of water, gliosis, and demyelination of white substance is often registered [6]. Pathogeny of diabetic encephalopathy hasn’t been studied properly. It is known that it is a multifactor effect in the development of which the main role is led by the vascular dysfunction with the reduction of blood supply and ischemia of brain tissue, as well as direct toxic influence of hyperglycemia and disorder of trophism of nerve tissue [7]. Microangiopathy and macroangiopathy acquire the special meaning in encephalopathy development among patients with diabetes mellitus. The evidence of microangiopathy and macroangiopathy is identified by the disease course and prognosis. On the ultrastructural level the changes of vessel microcircular movement are registered on the 1st month of the experimental alloxan diabetes. During electronic microscopy the thickening of basal membrane of capillaries as well as their dissection is observed. In micro vessels such phenomena as precipitation of lipoproteids, raising of the synthesis of collagen (the second type, dystrophic changes of endotheliocytes, and lowering of micropinocytosis can be found [11,12,13,14]. As the severity of diabetes mellitus

  7. Clinical and imaging correlates of EEG patterns in hospitalized patients with encephalopathy.

    Science.gov (United States)

    Sutter, Raoul; Stevens, Robert D; Kaplan, Peter W

    2013-04-01

    To identify the relationship between pathologic electroencephalographic (EEG) patterns, clinical and neuroradiological abnormalities, and outcome in hospitalized patients with acute encephalopathy. This 5-year cohort study was performed at an academic tertiary care center. EEGs in 154 patients with altered mental status were classified according to five predefined patterns: Isolated continuous slowing of background activity (theta, theta/delta, and delta activity) and patterns with slowing background activity with episodic transients [i.e., triphasic waves (TWs) or frontal intermittent delta activity (FIRDA)]. Clinical characteristics, blood tests and neuroimaging were compared among groups. Associations between EEG patterns and structural and non-structural abnormalities were calculated. Glasgow Outcome Score >3 at discharge was defined as favorable and 1-3 as unfavorable outcome. In multivariable analyses, theta was associated with brain atrophy (OR 2.6, p = 0.020), theta/delta with intracerebral hemorrhages (OR 6.8, p = 0.005), FIRDA with past cerebrovascular accidents (OR 2.7, p = 0.004), TWs with liver or multi-organ failure (OR 6, p = 0.004; OR 4, p = 0.039), and delta activity with alcohol/drug abuse with or without intoxication, and HIV infection (OR 3.8, p = 0.003; OR 9, p = 0.004). TWs were associated with death (OR 4.5, p = 0.005); theta/delta with unfavorable outcomes (OR 2.5, p = 0.033), while patients with FIRDA had favorable outcomes (OR 4.8, p = 0.004). In encephalopathic patients, well-defined EEG patterns are associated with specific pathological conditions and outcomes, suggesting that mechanistic hypotheses underlie these abnormal EEG patterns. To clarify the respective contributions of non-structural and structural abnormalities to encephalopathy reflected in specific EEG patterns, prospective studies using continuous EEG monitoring during the acute onset of encephalopathy are needed.

  8. Necrotizing fasciitis: a six-year experience.

    Science.gov (United States)

    Tunovic, Edin; Gawaziuk, Justin; Bzura, Tom; Embil, John; Esmail, Ali; Logsetty, Sarvesh

    2012-01-01

    Necrotizing fasciitis (NF) is a life-threatening infectious disease whose incidence has been on the rise. Commonly a consequence of group A beta-hemolytic Streptococcus infection, it results in high levels of morbidity and mortality. Diagnosis is difficult and treatment involves emergent surgical intervention and antibiotic therapy. The aim of this study is to examine the incidence of NF in Manitoba with the goal of observing whether there is a geographic variation in incidence and outcomes based on Regional Health Authorities (RHAs). This is a 6-year retrospective chart review of all NF patients who presented to the Health Sciences Center from 2004 to 2009. A total of 130 patients satisfied the inclusion criteria. The mean age was 47 ± 16 years. The most common comorbidities were diabetes (33.8%) and hypertension (33.1%). The overall mortality was 13.1% with advanced age being an independent risk factor (P < .05). Lower extremity was the most common location of infection (44.6%) and the most common causative organism was group A beta-hemolytic Streptococcus (63.9%). The type of infection (mono- vs. polymicrobial) was not found to affect length of stay, amputation rate, or mortality. There was no statistical difference in rate of amputations, length of stay, or mortality based on RHA. Incidence within the province, however, varied significantly based on RHA and ethnicity (P < .05). We determined that regardless of origin before admission, all our patients have equivalent prognosis. Burntwood RHA was found to have substantially higher incidence than the rest of the province, and higher incidence was established among the Aboriginal population.

  9. 大黄附子汤对急性坏死性胰腺炎大鼠小肠黏膜屏障功能的保护作用%Protective effects of Dahuangfuzi decoction on the intestine barrier functional of acute necrotizing pancreatitis in rats

    Institute of Scientific and Technical Information of China (English)

    路小光; 王小周; 战丽彬; 康新; 刘国辉; 董云; 范治伟; 白黎智; 刘莉; 纪春阳

    2011-01-01

    目的 探讨大黄附子汤对急性坏死性胰腺炎(ANP)大鼠小肠黏膜屏障功能的影响及意义.方法 将60只SD大鼠按数字表法随机分为假手术组(19只)、ANP组(21只)和大黄附子汤治疗组(20只).经胰胆管逆行注入4%牛磺且酸钠1 ml/kg体重建立ANP模型,同时行空肠造瘘.治疗组于制模后0.5 h经空肠造瘘管注入大黄附子汤2 ml,隔4、8 h再注入2 ml;其他两组注入等容积生理盐水.术后24 h经腹主动脉取血,测定血淀粉酶、内毒素、D-乳酸含量及二胺氧化酶(DAO)活性.取胰腺、小肠组织行病理学检查,测定肠上皮损伤指数,观察小肠黏膜超微结构改变.结果 假手术组大鼠血淀粉酶、内毒素、D-乳酸含量及DAO活性分别为(152±32)U/L、(6.95±2.10)pg/L、(3.96±1.08)μg/ml和(14.26±2.67)μg/ml,ANP组分别为(1549±93)U/L、(40.48±3.41)pg/L、(12.34±1.23)μg/ml和(80.28±3.54)μg/ml,治疗组分别为(655±49)U/L、(19.55±2.50)pg/L、(6.75±1.36)μg/ml和(20.69±7.53)μg/ml,ANP组较假手术组明显升高,而治疗组较ANP组显著降低,但仍高于假手术组(P<0.05或<0.01).ANP组小肠黏膜厚度、绒毛高度分别为(389.44±29.87)μm、(16.52±3.73)μm,显著低于治疗组的(501.95±45.38)μm、(27.82±5.17)μm,更显著低于假手术组的(658.72±57.49)μm和(35.49±6.43)μm;而肠上皮损伤指数为3.72±0.65,显著高于治疗组的2.12±0.37和假手术组的0.85±0.24.同时,大黄附子汤治疗后小肠黏膜组织学和超微结构改变亦均较ANP组明显减轻.结论 大黄附子汤可明显减轻ANP大鼠小肠黏膜屏障功能损害的程度.%Objective To observe the effects of Dahuangfuzi decoction on the intestine barrier functional of acute necrotizing pancreatitis in rats. Methods The 60 rats were randomly divided into sham operation group ( n = 19 ), ANP group ( n = 21 ), and Dahuangfuzi treatment group ( n = 20). The rats of ANP group were induced by injecting 1 ml/kg of 4% sodium

  10. Hepatic encephalopathy: etiology, pathogenesis, and clinical signs.

    Science.gov (United States)

    Salgado, Melissa; Cortes, Yonaira

    2013-06-01

    Hepatic encephalopathy (HE) is a manifestation of clinical signs that may result from a variety of liver diseases. In small animals, HE is most commonly a result of portosystemic shunting. The pathogenesis is not completely understood, although it is likely multifactorial. Theories of pathogenesis include altered ammonia metabolism and glutamine and glutamate transmission, an increase in gamma-aminobutyric acid agonists and benzodiazepine-like substances, alterations of the serotonergic system and amino acid metabolism, elevated taurine levels, contributions from inflammatory mediators, and toxic effects of manganese. An understanding of the underlying mechanisms that result in HE may lead to new treatments in the future.

  11. Bovine Spongiform Encephalopathy (BSE, Mad Cow Disease

    Directory of Open Access Journals (Sweden)

    G. K. Bruckner

    1997-07-01

    Full Text Available Mad Cow Disease or BSE (Bovine Spongiform Encephalopathy became a household name internationally and also in South Africa. International hysteria resulted following reports of a possible link between a disease diagnosed in cattle in Britain and a variant of the disease diagnosed in humans after the presumed ingestion or contact with meat from infected cattle. The European Union instituted a ban on the importation of beef from the United Kingdom during March 1996 that had a severe effect on the beef industry in the UK and also resulted in a world wide consumer resistance against beef consumption.

  12. Cardiovascular dysfunction in infants with neonatal encephalopathy.

    LENUS (Irish Health Repository)

    Armstrong, Katey

    2012-04-01

    Severe perinatal asphyxia with hypoxic ischaemic encephalopathy occurs in approximately 1-2\\/1000 live births and is an important cause of cerebral palsy and associated neurological disabilities in children. Multiorgan dysfunction commonly occurs as part of the asphyxial episode, with cardiovascular dysfunction occurring in up to a third of infants. This narrative paper attempts to review the literature on the importance of early recognition of cardiac dysfunction using echocardiography and biomarkers such as troponin and brain type natriuretic peptide. These tools may allow accurate assessment of cardiac dysfunction and guide therapy to improve outcome.

  13. Hashimoto's encephalopathy mimicking Creutzfeldt-Jakob disease.

    Science.gov (United States)

    Gauthier, Angela C; Baehring, Joachim M

    2017-01-01

    Hashimoto's encephalopathy is a rare, imprecisely defined autoimmune neurologic syndrome associated with Hashimoto's thyroiditis that normally responds to corticosteroids. Here, we describe the case of a 55-year-old woman who presented with subacute cognitive decline and ataxia. Neoplastic, paraneoplastic, infectious, and metabolic etiologies were ruled out. Anti-TPO antibody level was markedly elevated at 966U/mL. After one month of 60mg/day of oral prednisone, she felt back to baseline and her Montreal Cognitive Assessment dramatically improved. Physicians should strongly consider this uncommon diagnosis in patients with rapid cognitive decline and no other clear etiology.

  14. Reversible cortical blindness: posterior reversible encephalopathy syndrome.

    Science.gov (United States)

    Bandyopadhyay, Sabyasachi; Mondal, Kanchan Kumar; Das, Somnath; Gupta, Anindya; Biswas, Jaya; Bhattacharyya, Subir Kumar; Biswas, Gautam

    2010-11-01

    Cortical blindness is defined as visual failure with preserved pupillary reflexes in structurally intact eyes due to bilateral lesions affecting occipital cortex. Bilateral oedema and infarction of the posterior and middle cerebral arterial territory, trauma, glioma and meningioma of the occipital cortex are the main causes of cortical blindness. Posterior reversible encephalopathy syndrome (PRES) refers to the reversible subtype of cortical blindness and is usually associated with hypertension, diabetes, immunosuppression, puerperium with or without eclampsia. Here, 3 cases of PRES with complete or partial visual recovery following treatment in 6-month follow-up are reported.

  15. Black esophagus (acute esophageal necrosis) after spinal anesthesia.

    Science.gov (United States)

    Román Fernández, A; López Álvarez, A; Fossati Puertas, S; Areán González, I; Varela García, O; Viaño López, P M

    2014-01-01

    Acute esophagic necrosis or black esophagus is an uncommon clinical entity that owes its name to the endoscopic view of the necrotic esophageal mucosa. It is always related with a critical medical condition and usually has an ischemic etiology. We report the first case of acute esophageal necrosis after a spinal anesthetic for partial hip joint arthroplasty. We discuss the underlying pathophysiological mechanisms.

  16. A neurologist's approach to delirium: diagnosis and management of toxic metabolic encephalopathies.

    Science.gov (United States)

    Krishnan, Vaishnav; Leung, Lester Y; Caplan, Louis R

    2014-02-01

    Toxic metabolic encephalopathies (TMEs) present as an acute derangement in consciousness, cognition and behavior, and can be brought about by various triggers, including endocrine and metabolic disturbances, exogenous toxins, pain and infection. Also referred to as "delirium" or "acute confusional states," TMEs are characterized by (1) an altered level of consciousness and activity, (2) global changes in cognition with inattention, (3) a fluctuating course with disturbances in the sleep-wake cycle, and (4) asterixis and myoclonus. The pathophysiology of this syndrome is poorly understood. Imbalanced neurotransmitter signaling and pathologically heightened brain inflammatory cytokine signaling have been proposed as candidate mechanisms. Focal brain lesions can also occasionally mimic TMEs. A neurological examination is required to identify the presence of focal findings, which when present, identify a new focal lesion or the recrudescence of prior ischemic, inflammatory or neoplastic insults. Diagnostic testing must include a search for metabolic and infectious derangements. Offending medications should be withdrawn. Magnetic resonance imaging, cerebrospinal fluid analysis and electroencephalography should be considered in select clinical situations. In addition to being an unpleasant experience for the patient and family, this condition is associated with extended hospital stays, increased mortality and high costs. In individuals with diminished cognitive reserve, episodes of TME lead to an accelerated decline in cognitive functioning. Starting with an illustrative case, this paper provides a neurologist's approach to the diagnosis, differential diagnosis and management of toxic metabolic encephalopathies.

  17. A case of chronic Wernicke’s Encephalopathy: a neuropsychological study.

    Directory of Open Access Journals (Sweden)

    Erik eOudman

    2014-05-01

    Full Text Available A 54-year old woman was referred to our Korsakoff Center because of extensive cognitive problems following acute Wernicke's Encephalopathy (WE. She had a relatively short history of alcohol abuse and was found lying on the floor in her home by her son. After five days without treatment she was diagnosed with WE in a general hospital. During the course of the disease minimal change to the acute situation occurred, with chronic confusion, attention deficits and incoherent behavior symptoms most notable unlike classical Korsakoff's Syndrome (KS. Neuropsychological assessment after four and sixteen months after admission to the hospital revealed global cognitive decline, with striking impairments in attentional, executive and memory functions. The present case study suggests that the state of confusion and the neuropsychological symptoms in WE can become chronic in case of very late treatment. We therefore recommend that confused alcoholics should receive appropriate parenteral thiamine according to the current clinical standards.

  18. [Diagnostic significance of electrocortical responses to rhythmic and solitary photic stimuli in patients with hepato-portal encephalopathy].

    Science.gov (United States)

    Erokhina, L G; Ershov, Iu A; Puchinskaia, L M; Gubskiĭ, L V; Lisina, G I

    1976-01-01

    In order to clarify some diagnostical criteria of latent hepato-portal encephalopathy in 57 patients with intrahepatic forms of portal hypertension the authors studied the character of driving response in photorhythmical stimulation. In 9 patients the development of evoked potentials depending upon the significance of the stimula was studied as well. The studies confirmed the prognostical significance of a slowing down the mean frequency of rhythms in the EEG in relation to the development of acute encephalopathy and a certain tendency to the shift in the spectrum of driving responses to low frequency and a worsening of driving responses in slowing down the medium rhythm frequency of EEG. In patients with changed resting activity in the Background EEG there was a drop in the amplitude of late components of evoked potentials.

  19. Ohtahara syndrome: Early infantile epileptic encephalopathy

    Directory of Open Access Journals (Sweden)

    Knežević-Pogančev Marija

    2008-01-01

    Full Text Available DEFINITION Ohtahara syndrome (early infantile epileptic encephalopathy with suppression bursts, is the earliest developing form of epileptic encephalopathy. ETHIOLOGY It considered to be a result of static structural developing brain damage. CLINICAL PICTURE Variable seizures develop mostly within the first 10 days of life, but may occur during the first hour after delivery. The most frequently observed seizure type are epileptic spasms, which may be either generalized and symmetrical or lateralized. The tonic spasms may occur in clusters or singly, while awake and during sleep alike. The duration of spasms is up to 10 seconds, and the interval between spasms within cluster ranges from 9 to 15 seconds. In one third of cases, other seizure types include partial motor seizures or hemiconvulsions The disorder takes a progressively deteriorating course with increasing frequency of seizures and severe retardation of psychomotor development. DIAGNOSTIC WORKUP In the initial stage of Ohtahara syndrome, interictal EEG shows a pattern of suppression-burst with high-voltage paroxysmal discharges separated by prolonged periods of nearly flat tracing that last for up to 18 seconds. PROGNOSIS AND THREATMENT Half of the reported children having Ohtahara syndrome die in infancy. Anticonvulsant helps little in controlling the seizures and halting the deterioration of psychomotor development. Severe psychomotor retardation is the rule. With time, the disorder may evolve into West syndrome or partial epilepsy. Psychomotor development may be slightly better if the infants do not develop West and later Lennox-Gastaut syndrome.

  20. Endotoxemia, encephalopathy, and mortality in cirrhotic patients.

    Science.gov (United States)

    Bigatello, L M; Broitman, S A; Fattori, L; Di Paoli, M; Pontello, M; Bevilacqua, G; Nespoli, A

    1987-01-01

    Endotoxemia without sepsis was detected with a chromogenic Limulus assay in 36 of 39 (92.3%) cirrhotic patients and was absent in seven healthy volunteers. In 11 patients who underwent elective portasystemic shunt, portal vein endotoxemia was higher than inferior vena caval: p less than 0.05, systemic endotoxin levels did not change, compared to preoperative levels, on the 1st, 2nd, and 3rd postoperative days, attendant to an uneventful recovery. In 21 patients in hepatic encephalopathy after esophagogastric hemorrhage, systemic endotoxemia was higher than in well-compensated cirrhotics: p less than 0.001; it was higher in deep than in light coma: p less than 0.05; it was higher in those who died than in those who survived: p less than 0.001. Endotoxin levels showed a positive correlation with serum bilirubin: r = 0.59, p less than 0.001, and a negative correlation with prothrombin activity: r = -0.59, p less than 0.001. These data show endotoxemia without sepsis is a constant finding in cirrhosis and increasing levels of endotoxemia are associated with hepatic failure, encephalopathy, and death.

  1. Neonatal vitamin-responsive epileptic encephalopathies.

    Science.gov (United States)

    Gospe, Sidney M

    2010-01-01

    The treatment of neonatal seizures generally relies on the use of one or more anticonvulsant medications along with evaluation and management of any underlying etiology. In some circumstances, neonatal seizures are refractory to therapy and result in poor outcomes, including death. Certain rare vitamin- responsive inborn errors of metabolism may present as neonatal encephalopathy with anticonvulsant-resistant seizures. Therefore, it is vital for the clinicians of caring for seizing encephalopathic newborns to consider these particular disorders early in the hospital course. Pyridoxine-dependent seizures are due to deficiency of alpha-aminoadipic semialdehyde dehydrogenase (antiquitin) which is encoded by ALDH7A1. Seizures in infants who are pyridoxine-dependent must be treated using pharmacologic doses of pyridoxine (vitamin B(6)), and life-long therapy is required. Despite medical therapy, developmental handicaps, particularly in expressive language, are common. Folinic acidresponsive seizures are treated with supplements of folinic acid (5-formyltetrahydrofolate). Recently, patients with this condition were also demonstrated to be antiquitin deficient. Pyridoxal phosphate-dependent seizures result from a deficiency of pyridox(am)ine 5'-phosphate oxidase which is encoded by PNPO. Patients with this cause of seizures respond to pyridoxal phosphate but not to pyridoxine. This review discusses our current understanding of these three neonatal vitamin-responsive epileptic encephalopathies and a diagnostic and treatment protocol is proposed.

  2. Unusual Presentation of Necrotic Erythema Nodosum Leprosum on Scalp: A Case Report.

    Science.gov (United States)

    Barman, K D; Madan, A; Garg, V K; Goel, K; Khurana, N

    2015-01-01

    Lepra reactions are acute episodes occurring during the disease process of leprosy and are of 2 types: type 1 or reversal reaction and type 2 reaction or erythema odosumleprosum (ENL). In the episodes of lepra reaction several parts are affected including face and extremities like oral cavity. In the present case report we reported a rare case of lepromatous leprosy with necrotic ENL involving scalp apart from the usual sites. A 58 year old married male presented to us with complaints of spontaneous onset, recurrent eruption of multiple reddish raised painful lesions. Biopsy from the infiltrated skin over the back showed atrophic epidermis, free Grenz zone, diffuse and periadnexal macrophage granulomas with predominant mononuclear infiltrate, appandageal atrophy, fibrosis around the neural structures and leukocytoclastic vasculitis. Fites stain showed strong positivity for M. leprae. His routine blood investigations showed anemia (Hb = 7.8 gm%), neutrophil leukocytosis (TLC = 17,600, DLC = P66L28M4E2) and raised ESR (80 mm in the first hour). These bullous and necrotic lesions in leprosy may be a manifestation of severe type II reactions in patients with very high bacillary load.

  3. Streptococcal necrotizing fasciitis with toxic shock syndrome and rapid fatal outcome

    Directory of Open Access Journals (Sweden)

    Kojić Miroslav

    2015-01-01

    Full Text Available Introduction. Streptococcal necrotizing fasciitis (NF is a serious soft tissue infection with rapid progression of inflammatory process among superficial or deep fascia, systemic host response to infection leading to toxic shock syndrome (TSS, and multiple organ failure. Lethality is high. Case Outline. A 46-year-old male without co-morbidities was admitted to the Emergency Department with redness, swelling and pain on his right lower leg. He became sick two day s ea rlier with m alaise, chills and shivering. On admission he was hypotensive, anuric, with erythematous rash on his face, neck and chest, with acute ren al failure and elevated creatine phosphokinase level. During the next several hours, the changes on his right lower leg rapidly spread to the whole leg, followed by skin destruction and subcutaneo us bleeding, indicating NF. Aggressive antimicrobial, supportive and symptom atic therapy was initiated immediately and on the same evening surgical intervention was performed. Despite these measures, a rapid development of severe TSS, with lethal outcome, occurred in less than 40 hours after the admission. Stre ptococcus pyogenes (group A β-hemolytic Streptococcus was isolated from the throat, skin and tissue obtained duri ng the surgery. Conclusion. Necrotizing fasciitis is a very serious disease with unpre dictable course. For that reason doctors must devote a great deal of a ttention to early, i.e. timely diagnosis of this disease, whose treatment with a multid isciplinary approach is very important.

  4. [Clinical importance and diagnostic methods of minimal hepatic encephalopathy].

    Science.gov (United States)

    Stawicka, Agnieszka; Zbrzeźniak, Justyna; Świderska, Aleksandra; Kilisińska, Natalia; Świderska, Magdalena; Jaroszewicz, Jerzy; Flisiak, Robert

    2016-02-01

    Minimal hepatic encephalopathy (MHE) encompasses a number of neuropsychological and neurophysiological disorders in patients suffering from liver cirrhosis, who do not display abnormalities during a medical interview or physical examination. A negative influence of MHE on the quality of life of patients suffering from liver cirrhosis was confirmed, which include retardation of ability of operating motor vehicles and disruption of multiple health-related areas, as well as functioning in the society. The data on frequency of traffic offences and accidents amongst patients diagnosed with MHE in comparison to patients diagnosed with liver cirrhosis without MHE, as well as healthy persons is alarming. Those patients are unaware of their disorder and retardation of their ability to operate vehicles, therefore it is of utmost importance to define this group. The term minimal hepatic encephalopathy (formerly "subclinical" encephalopathy) erroneously suggested the unnecessity of diagnostic and therapeutic procedures in patients with liver cirrhosis. Diagnosing MHE is an important predictive factor for occurrence of overt encephalopathy - more than 50% of patients with this diagnosis develop overt encephalopathy during a period of 30 months after. Early diagnosing MHE gives a chance to implement proper treatment which can be a prevention of overt encephalopathy. Due to continuing lack of clinical research there exist no commonly agreed-upon standards for definition, diagnostics, classification and treatment of hepatic encephalopathy. This article introduces the newest findings regarding the importance of MHE, scientific recommendations and provides detailed descriptions of the most valuable diagnostic methods.

  5. Fetal heart rate patterns in neonatal hypoxic-ischemic encephalopathy: relationship with early cerebral activity and neurodevelopmental outcome.

    LENUS (Irish Health Repository)

    Murray, Deirdre M

    2012-01-31

    Despite widespread use of fetal heart rate monitoring, the timing of injury in hypoxic-ischemic encephalopathy (HIE) remains unclear. Our aim was to examine fetal heart rate patterns during labor in infants with clinical and electroencephalographic (EEG) evidence of HIE and to relate these findings to neurodevelopmental outcome. Timing of onset of pathological cardiotocographs (CTGs) was determined in each case by two blinded reviewers and related to EEG grade at birth and neurological outcome at 24 months. CTGs were available in 35 infants with HIE (17 mild, 12 moderate, 6 severe on EEG). Admission CTGs were normal in 24\\/35 (69%), suspicious in 8\\/35 (23%), and pathological in 3\\/35 (8%). All CTGs developed nonreassuring features prior to delivery. Three patterns of fetal heart rate abnormalities were seen: group 1, abnormal CTGs on admission in 11\\/35 (31%); group 2, normal CTGs on admission with gradual deterioration to pathological in 20\\/35 cases (57%); and group 3, normal CTGs on admission with acute sentinel events in 4\\/35 (11.5%). The median (interquartile range) duration between the development of pathological CTGs and delivery was 145 (81, 221) minutes in group 2 and 22 (12, 28) minutes in group 3. There was no correlation between duration of pathological CTG trace and grade of encephalopathy (R = 0.09, P = 0.63) or neurological outcome (P = 0.75). However, the grade of encephalopathy was significantly worse in group 3 (P = 0.001), with a trend to worse outcomes. The majority of infants with HIE have normal CTG traces on admission but develop pathological CTG patterns within hours of delivery. More severe encephalopathy was associated with normal admission CTG and acute sentinel events shortly before delivery.

  6. Fetal heart rate patterns in neonatal hypoxic-ischemic encephalopathy: relationship with early cerebral activity and neurodevelopmental outcome.

    LENUS (Irish Health Repository)

    Murray, Deirdre M

    2009-09-01

    Despite widespread use of fetal heart rate monitoring, the timing of injury in hypoxic-ischemic encephalopathy (HIE) remains unclear. Our aim was to examine fetal heart rate patterns during labor in infants with clinical and electroencephalographic (EEG) evidence of HIE and to relate these findings to neurodevelopmental outcome. Timing of onset of pathological cardiotocographs (CTGs) was determined in each case by two blinded reviewers and related to EEG grade at birth and neurological outcome at 24 months. CTGs were available in 35 infants with HIE (17 mild, 12 moderate, 6 severe on EEG). Admission CTGs were normal in 24\\/35 (69%), suspicious in 8\\/35 (23%), and pathological in 3\\/35 (8%). All CTGs developed nonreassuring features prior to delivery. Three patterns of fetal heart rate abnormalities were seen: group 1, abnormal CTGs on admission in 11\\/35 (31%); group 2, normal CTGs on admission with gradual deterioration to pathological in 20\\/35 cases (57%); and group 3, normal CTGs on admission with acute sentinel events in 4\\/35 (11.5%). The median (interquartile range) duration between the development of pathological CTGs and delivery was 145 (81, 221) minutes in group 2 and 22 (12, 28) minutes in group 3. There was no correlation between duration of pathological CTG trace and grade of encephalopathy (R = 0.09, P = 0.63) or neurological outcome (P = 0.75). However, the grade of encephalopathy was significantly worse in group 3 (P = 0.001), with a trend to worse outcomes. The majority of infants with HIE have normal CTG traces on admission but develop pathological CTG patterns within hours of delivery. More severe encephalopathy was associated with normal admission CTG and acute sentinel events shortly before delivery.

  7. Necrotizing black tattoo reaction: what's in a name?

    Science.gov (United States)

    Bhogal, Ricky Harminder; Thomas, Sunil Solomon

    2009-01-01

    We report the rare case of an 18-year-old man who developed a necrotizing cutaneous reaction 5 days after having a permanent black tattoo on his left forearm spelling his name. Three cases of reactions to permanent black tattoos have been reported within the literature. These cases described the development of cellulitis of the skin adjacent to the tattoo but none reported florid necrotizing cutaneous reactions. The initial management with oral antibacterials failed to resolve the symptoms and use of intravenous antibacterials and topical corticosteroids was needed. Six weeks after presentation the tattoo lettering showed the presence of hyperpigmented skin. Subsequent patch testing confirmed that the patient had no allergy to black tattoo pigments suggesting that the necrotizing cutaneous reaction was secondary to infection. We show that successful treatment of this rare infective complication of permanent black tattoos involves the early institution of intravenous antibacterial agents and topical corticosteroids.

  8. TNF α and reactive oxygen species in necrotic cell death

    Institute of Scientific and Technical Information of China (English)

    Michael J Morgan; You-Sun Kim; Zheng-gang Liu

    2008-01-01

    Death receptors, including the TNF receptor-1 (TNF-RI), have been shown to be able to initiate caspase-independent cell death. This form of "necrotic cell death" appears to be dependent on the generation of reactive oxygen species. Recent data have indicated that superoxide generation is dependent on the activation of NADPH oxidases, which form a complex with the adaptor molecules RIP1 and TRADD. The mechanism of superoxide generation further establishes RIP1 as the central molecule in ROS production and cell death initiated by TNFa and other death receptors. A role for the sustained JNK activation in necrotic cell death is also suggested. The sensitization of virus-infected cells to TNFa indicates that necrotic cell death may represent an alternative cell death pathway for clearance of infected cells.

  9. [Immunonegative necrotizing glomerulonephritis: an atypical case of lupus nephropathy].

    Science.gov (United States)

    Coll, E; Vallès, M; Torguet, P; Bronsoms, J; Maté, G; Bernadó, L; Mauri, J M

    2003-01-01

    We report here a case of systemic lupus erythematosus with severe, active pauci-immune necrotizing and crescentic glomerulonephritis. This patient had been diagnosed of a lupus nephritis type III previously and treated with steroids and azathioprine. After a renal symptomless period of nine years, she developed heavy proteinuria and hypertension. A second kidney biopsy was then performed. The pathological study disclosed a pauci-immune necrotizing crescentic and segmental glomerulonephritis. The absence of subendothelial and mesangial deposits was confirmed by both immunofluorescent microscopy and electron microscopy. The simultaneous immunological study showed normal ANCA levels while complement, anti-dsDNA and ANA were altered. The patient was treated with steroids and cyclophosphamide eith good response. This case points out the possibility previously recognized by others of an association between lupus and an pauci-immune necrotizing glomerulonephritis.

  10. Hepatic Encephalopathy-the Old and the New.

    Science.gov (United States)

    Kandiah, Prem A; Kumar, Gagan

    2016-07-01

    Hepatic encephalopathy occurs ubiquitously in all causes of advanced liver failure, however, its implications on mortality diverge and vary depending upon acuity and severity of liver failure. This associated mortality has decreased in subsets of liver failure over the last 20 years. Aside from liver transplantation, this improvement is not attributable to a single intervention but likely to a combination of practical advances in critical care management. Misconceptions surrounding many facets of hepatic encephalopathy exists due to heterogeneity in presentation, pathophysiology and outcome. This review is intended to highlight the important concepts, rationales and strategies for managing hepatic encephalopathy.

  11. Safety, efficacy, and patient acceptability of rifaximin for hepatic encephalopathy

    DEFF Research Database (Denmark)

    Kimer, Nina; Krag, Aleksander; Gluud, Lise L

    2014-01-01

    Hepatic encephalopathy is a complex disease entity ranging from mild cognitive dysfunction to deep coma. Traditionally, treatment has focused on a reduction of ammonia through a reduced production, absorption, or clearance. Rifaximin is a nonabsorbable antibiotic, which reduces the production of ...... and safety of long-term treatment with rifaximin and evaluate effects of combination therapy with lactulose and branched-chain amino acids for patients with liver cirrhosis and hepatic encephalopathy.......Hepatic encephalopathy is a complex disease entity ranging from mild cognitive dysfunction to deep coma. Traditionally, treatment has focused on a reduction of ammonia through a reduced production, absorption, or clearance. Rifaximin is a nonabsorbable antibiotic, which reduces the production...

  12. Legal Responsibilities of Physicians When They Diagnose Hepatic Encephalopathy.

    Science.gov (United States)

    Vierling, John M

    2015-08-01

    Both covert hepatic encephalopathy (CHE) and overt hepatic encephalopathy (OHE) impair the ability to operate machinery. The legal responsibilities of US physicians who diagnose and treat patients with hepatic encephalopathy vary among states. It is imperative that physicians know the laws regarding reporting in their state. OHE represents a neuropsychiatric impairment that meets general reporting criteria. The medical advisory boards of the states have not identified OHE as a reportable condition. In the absence of validated diagnostic guidelines, physicians are not obligated to perform tests for CHE. There is a need for explicit guidance from professional associations regarding this issue.

  13. Clinical and Neurologic Manifestation of Minimal Hepatic Encephalopathy and Overt Hepatic Encephalopathy.

    Science.gov (United States)

    Basu, P Patrick; Shah, Niraj James

    2015-08-01

    Hepatic encephalopathy (HE) shows a wide spectrum of neuropsychiatric manifestations. A combined effort with neuropsychological and psychometric evaluation has to be performed to recognize the syndrome, whereas minimal HE (MHE) is largely under-recognized. Subtle symptoms of MHE can only be diagnosed through specialized neuropsychiatric testing. Early diagnosis and treatment may drastically improve the quality of life for many cirrhotic patients. Further research to gain better insight into the pathophysiology and diagnostic accuracy of HE will help determine future management strategies.

  14. Concanavalin A/IFN-gamma triggers autophagy-related necrotic hepatocyte death through IRGM1-mediated lysosomal membrane disruption.

    Directory of Open Access Journals (Sweden)

    Chih-Peng Chang

    Full Text Available Interferon-gamma (IFN-γ, a potent Th1 cytokine with multiple biological functions, can induce autophagy to enhance the clearance of the invading microorganism or cause cell death. We have reported that Concanavalin A (Con A can cause autophagic cell death in hepatocytes and induce both T cell-dependent and -independent acute hepatitis in immunocompetent and immunodeficient mice, respectively. Although IFN-γ is known to enhance liver injury in Con A-induced hepatitis, its role in autophagy-related hepatocyte death is not clear. In this study we report that IFN-γ can enhance Con A-induced autophagic flux and cell death in hepatoma cell lines. A necrotic cell death with increased lysosomal membrane permeabilization (LMP is observed in Con A-treated hepatoma cells in the presence of IFN-γ. Cathepsin B and L were released from lysosomes to cause cell death. Furthermore, IFN-γ induces immunity related GTPase family M member 1(IRGM1 translocation to lysosomes and prolongs its activity in Con A-treated hepatoma cells. Knockdown of IRGM1 inhibits the IFN-γ/Con A-induced LMP change and cell death. Furthermore, IFN-γ(-/- mice are resistant to Con A-induced autophagy-associated necrotic hepatocyte death. We conclude that IFN-γ enhances Con A-induced autophagic flux and causes an IRGM1-dependent lysosome-mediated necrotic cell death in hepatocytes.

  15. Analysis of a mathematical model describing necrotic tumor growth

    CERN Document Server

    Escher, Joachim; Matioc, Bogdan-Vasile

    2010-01-01

    In this paper we study a model describing the growth of necrotic tumors in different regimes of vascularisation. The tumor consists of a necrotic core of death cells and a surrounding nonnecrotic shell. The corresponding mathematical formulation is a moving boundary problem where both boundaries delimiting the nonnecrotic shell are allowed to evolve in time.We determine all radially symmetric stationary solutions of the problem and reduce the moving boundary problem into a nonlinear evolution. Parabolic theory provides us the perfect context in order to show local well-posed of the problem for small initial data.

  16. Neonatal necrotizing fasciitis of the scrotum caused by Streptococcus agalactiae.

    Science.gov (United States)

    Kuroda, Junpei; Inoue, Nobuaki; Satoh, Hiroyuki; Fukuzawa, Ryuji; Terakawa, Toshiro; Hasegawa, Yukihiro

    2015-04-01

    We herein describe the case of a 27-day-old male infant who was brought to the emergency room for intermittent crying, and swelling of the left scrotum. Based on the clinical findings, necrotizing fasciitis was suspected, and surgical intervention was successfully completed within a few hours of admission. Streptococcus agalactiae type Ia was cultured from the drained abscess, and was considered the causative pathogen. To our knowledge, this is the first report of neonatal necrotizing fasciitis caused by S. agalactiae. Prompt diagnosis and immediate surgical debridement are crucial in the initial management of this disease.

  17. Cervicofacial necrotizing fasciitis: report of three cases and literature review.

    Science.gov (United States)

    Balcerak, R J; Sisto, J M; Bosack, R C

    1988-06-01

    Three cases of cervicofacial necrotizing fasciitis have been reported, two of dental etiology, and one the result of blunt and abrasive facial trauma. All cases responded well to aggressive surgical intervention in combination with broad spectrum antibiotic coverage and supportive medical therapy. The presence of increased vascularity in the head and neck region probably minimizes the amount of overlying soft tissue that must be excised during surgical management (in comparison to extremity and trunk necrotizing fasciitis cases). The key to successful management of such infections is early diagnosis of the disease process with prompt surgical and medical intervention.

  18. Necrotizing Soft Tissue Infection Occurring after Exposure to Mycobacterium marinum

    Directory of Open Access Journals (Sweden)

    Shivani S. Patel

    2014-01-01

    Full Text Available Cutaneous infections caused by Mycobacterium marinum have been attributed to aquarium or fish exposure after a break in the skin barrier. In most instances, the upper limbs and fingers account for a majority of the infection sites. While previous cases of necrotizing soft tissue infections related to M. marinum have been documented, the importance of our presenting case is to illustrate the aggressive nature of M. marinum resulting in a persistent necrotizing soft tissue infection of a finger that required multiple aggressive wound debridements, followed by an amputation of the affected extremity, in order to hasten recovery.

  19. Necrotizing Fasciitis: Diagnostic Challenges in a Mute Bedridden Patient with Atypical Laboratory Parameters

    Directory of Open Access Journals (Sweden)

    Ghan-Shyam Lohiya

    2012-01-01

    Full Text Available A 27-year-old mute bedridden patient required parenteral corticosteroids and antibiotics, and hospitalization for an acute respiratory illness. After 2 days, staff noted a ~0.3 cm blister on the patient’s right heel. Within 19 hours, blistering increased and the foot became partly gangrenous. The patient developed high fever (40.3°C, and leukocytosis (count: 13×109/L; was 6.5×109/L ten days earlier. Necrotizing fasciitis (NF was diagnosed and treated with emergency leg amputation. Histopathology revealed necrosis of fascia, muscle, subcutaneous tissue, and skin. In bedridden patients, corticosteroids may particularly facilitate serious infections, and initial NF blistering may be mistaken for pressure ulcers. Vigilant and frequent whole body monitoring is necessary for all patients incapable of verbalizing their symptoms.

  20. Management of hepatic encephalopathy in the hospital.

    Science.gov (United States)

    Leise, Michael D; Poterucha, John J; Kamath, Patrick S; Kim, W Ray

    2014-02-01

    Hepatic encephalopathy (HE) develops in up to 50% of patients with cirrhosis and is a feature of decompensated cirrhosis. With the goal of reviewing the evidence for treatment and prevention of overt hepatic encephalopathy, pubmed was searched using search terms hepatic encephalopathy AND treatment, limited to human studies from January 1, 2003, through December 1, 2013, and supplemented by key references. The inpatient incidence of HE is approximately 23,000 annually, and management of these patients is common for internists and subspecialists. Treatment of the hospitalized patient with HE has changed in recent years. Treatment entails 2 phases: induction and maintenance of remission. Most cases of significant HE are precipitated by infection, gastrointestinal bleeding, medications, or other culprits. All patients should be evaluated for secondary triggers of HE, and treatment should be initiated with a nonabsorbable disaccharide (ie, lactulose) in most patients. Rifaximin (off label) can be added in patients not responding to lactulose. Neomycin is a less preferred alternative to rifaximin owing to its adverse effect profile. Other therapies, including zinc, L-ornithine-L-aspartate, and branched-chain amino acids, can be considered for patients not responding to disaccharides and nonabsorbable antibiotics. Large portosystemic shunts may be embolized in patients with medically refractory recurrent or severe HE with otherwise well-compensated cirrhosis. Molecular Adsorbent Recirculating System is now available for patients with severe HE who do not respond to medical therapy. It is critically important that patients hospitalized with significant HE continue maintenance therapy at the time of dismissal to prevent further episodes. Patients with a first-time episode of HE can be administered lactulose, and careful instructions should be provided to patients and caregivers about dose titration to achieve 3 bowel movements daily. Patients with recurrent HE episodes