Sample records for arteriosus mimicking traumatic

  1. Percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder

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    Er-Ping Xi


    Full Text Available OBJECTIVE: Ventricular septal defects resulting from post-traumatic cardiac injury are very rare. Percutaneous closure has emerged as a method for treating this disorder. We wish to report our experience in three patients who underwent percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder. METHODS: We treated three patients with post-traumatic ventricular septal defects caused by stab wounds with knives. After the heart wound was repaired, patient examinations revealed ventricular septal defects with pulmonary/systemic flow ratios (Qp/Qs of over 1.7. The post-traumatic ventricular septal defects were closed percutaneously with a patent ductus arteriosus occluder (Lifetech Scientific (Shenzhen Co., LTD, Guangdong, China utilizing standard techniques. RESULTS: Post-operative transthoracic echocardiography revealed no residual left-to-right shunt and indicated normal ventricular function. In addition, 320-slice computerized tomography showed that the occluder was well placed and exhibited normal morphology. CONCLUSION: Our experiences indicate that closure of a post-traumatic ventricular septal defect using a patent ductus arteriosus occluder is feasible, safe, and effective.

  2. Delayed traumatic diaphragmatic hernia mimicking hydropneumothorax

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    Rachna Wadhwa


    Full Text Available Traumatic diaphragmatic hernia (TDH is generally a consequence of thoraco-abdominal trauma. Anaesthetic problems arise due to herniation of abdominal contents into the thoracic cavity causing diaphragmatic dysfunction, lung collapse, mediastinal shift and haemodynamic instability. Diagnosis depends on history, clinical signs and radiological investigations. Sometimes, it may be misdiagnosed as hydropneumothorax due to the presence of air and fluid in the viscera lying in the pleural cavity. We report a case of TDH mimicking hydropneumothorax on radiological investigations and subsequent surgical management, which led to serious complications.

  3. Traumatic Neuroma around the Celiac Trunk after Gastrectomy Mimicking a Nodal Metastasis: A Case Report

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    Kwon, Jung Hyeok; Ryu, Seung Wan; Kang, Yu Na [Keimyung University School of Medicine, Daegu (Korea, Republic of)


    Traumatic neuroma is a well-known disorder that occurs after trauma or surgery involving the peripheral nerve and develops from a nonneoplastic proliferation of the proximal end of a severed, partially transected, or injured nerve. However, in the abdomen, traumatic neuromas have been sporadically reported to occur in the bile duct. We present here a case of traumatic neuroma around the celiac trunk after gastrectomy that mimicks a nodal metastasis. In conclusion, the imaging finding of traumatic neuroma around the celiac trunk was a homogeneous hypovascular mass without narrowing or irregularity of encased arteries and without increased uptake on PET-CT. Although from a clinical standpoint, establishing an accurate preoperative diagnosis is difficult to perform, the presence of a traumatic neuroma should be included in the differential diagnosis of a mass around the celiac trunk in a patient that has undergone celiac nodal dissection.

  4. Patent ductus arteriosus (United States)

    ... this page: // Patent ductus arteriosus To use the sharing features on this page, please enable JavaScript. Patent ductus arteriosus (PDA) is a condition in which the ductus ...

  5. What Is Patent Ductus Arteriosus? (United States)

    ... page from the NHLBI on Twitter. What Is Patent Ductus Arteriosus? Patent ductus arteriosus (PDA) is a heart problem ... the lung arteries. Normal Heart and Heart With Patent Ductus Arteriosus Figure A shows the interior of a normal ...

  6. An experimental protocol for mimicking pathomechanisms of traumatic brain injury in mice

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    Albert-Weißenberger Christiane


    Full Text Available Abstract Traumatic brain injury (TBI is a result of an outside force causing immediate mechanical disruption of brain tissue and delayed pathogenic events. In order to examine injury processes associated with TBI, a number of rodent models to induce brain trauma have been described. However, none of these models covers the entire spectrum of events that might occur in TBI. Here we provide a thorough methodological description of a straightforward closed head weight drop mouse model to assess brain injuries close to the clinical conditions of human TBI.


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    Full Text Available INTRODUCTION: TRUNCUS ARTERIOSUS was first recognized in 1798 and account for 0.7-1.2% of all congenital Cardiac malformation. It occurs with equal frequency in males and Females. Truncus has been reported with Trisomy 18, Trisomy 21 and C hromosome 22q11 deletion. It is also been reported with Di George syndrome which include Hype rtelorism, low set ears , Micrognathia, small fish like mouth, short down slanting palpebral fiss ure, absent pinna, cleft lip and high arch palate . In TRUNCUS ARTERIOSUS, a single artery with a singl e semilunar valve leaves the base of heart and gives rise to pulmonary, Systemic and Cor onary circulation. The single arterial trunk receives blood from both the ventricle so a ventric ular septal defect is obligatory. Anomalies associated with TA are Right aortic arch, Truncal valve abnormality coronary artery anomaly atresia of Right or left pulmonary a rtery, Atresia of ductus arteriosus, single ventric le, TAPVC, subclavian artery and SVC abnormality. At ti mes Right aortic arch accompanies Truncus Arteriosus.

  8. Lupus mimickers. (United States)

    Calixto, Omar-Javier; Franco, Juan-Sebastian; Anaya, Juan-Manuel


    Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multisystem organ involvement, heterogeneity of clinical features, and variety in degree of severity. The differential diagnosis is a crucial aspect in SLE as many other autoimmune diseases portray clinical similarities and autoantibody positivity. Lupus mimickers refer to a group of conditions that exhibit both clinical features and laboratory characteristics, including autoantibody profiles that resemble those present in patients with SLE, and prompt a diagnostic challenge in everyday clinical practice. Thus, lupus mimickers may present as a lupus-like condition (i.e., 2 or 3 criteria) or as one meeting the classification criteria for SLE. Herein we review and classify the current literature on lupus mimickers based on diverse etiologies which include infections, malign and benign neoplasms, medications, and vaccine-related reactions.

  9. Surgical correction of truncus arteriosus in infancy. (United States)

    Sullivan, H; Sulayman, R; Replogle, R; Arcilla, R A


    An 8 week old infant with severe heart failure from type 1 truncus arteriosus underwent successful corrective surgery employing the Rastelli procedure with use of deep hypothermia and total circulatory arrest. Postoperative hemodynamic studies showed complete closure of the septal defect, disappearance of truncal stenosis, but presence of mild porcine valve stenosis. This procedure is possible even in very small subjects and is preferable to palliative pulmonary arterial banding.

  10. Patent ductus arteriosus with Eisenmenger syndrome. (United States)

    Moustafa, Sherif; Patton, David J; Balon, Yvonne; Connelly, Michael S; Alvarez, Nanette


    Herein we report a 21 year-old woman with a previously documented patent ductus arteriosus and Eisenmenger physiology. She presented with increasing cyanosis and exercise intolerance which could be explained by a new finding of right to left shunting through an interatrial communication. She was started on Bosentan therapy aiming to reduce the pulmonary pressure with consideration for heart-lung transplantation should any further deterioration occur.

  11. A rare association with patent ductus arteriosus

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    Dhanya Warrier


    Full Text Available Persistent fifth aortic arch (PFAA, also known as congenital double-lumen aortic arch, is a rare developmental anomaly of the aortic arch. A 5-month-old baby who presented with congestive cardiac failure was diagnosed to have a large patent ductus arteriosus with PFAA. Although this arch anomaly had no hemodynamic relevance in this case, preoperative diagnosis prevented surprises "on table."

  12. Protective strategies to prevent patent ductus arteriosus

    Institute of Scientific and Technical Information of China (English)

    Kris C. Sekar


    Ductus arteriosus is the communication between the proximal aorta and the pulmonary artery which diverts well oxygenated blood from the placenta to the systemic circulation bypassing the fluid filled lung in the fetal circulation. Therefore it is very essential for fetal survival. After birth, in term infants the ductus usually closes within the first day of life, starting with functional closure followed by anatomical closure by vascular remodeling.1

  13. Identification of differentially regulated genes in human patent ductus arteriosus. (United States)

    Parikh, Pratik; Bai, Haiqing; Swartz, Michael F; Alfieris, George M; Dean, David A


    In order to identify differentially expressed genes that are specific to the ductus arteriosus, 18 candidate genes were evaluated in matched ductus arteriosus and aortic samples from infants with coarctation of the aorta. The cell specificity of the gene's promoters was assessed by performing transient transfection studies in primary cells derived from several patients. Segments of ductus arteriosus and aorta were isolated from infants requiring repair for coarctation of the aorta and used for mRNA quantitation and culturing of cells. Differences in expression were determined by quantitative PCR using the ΔΔCt method. Promoter regions of six of these genes were cloned into luciferase reporter plasmids for transient transfection studies in matched human ductus arteriosus and aorta cells. Transcription factor AP-2b and phospholipase A2 were significantly up-regulated in ductus arteriosus compared to aorta in whole tissues and cultured cells, respectively. In transient transfection experiments, Angiotensin II type 1 receptor and Prostaglandin E receptor 4 promoters consistently gave higher expression in matched ductus arteriosus versus aorta cells from multiple patients. Taken together, these results demonstrate that several genes are differentially expressed in ductus arteriosus and that their promoters may be used to drive ductus arteriosus-enriched transgene expression.

  14. Etiology of patent ductus arteriosus in dogs. (United States)

    Buchanan, James W; Patterson, Donald F


    Patent ductus arteriosus (PDA) is the most common congenital heart disease in dogs and usually causes heart failure and death unless corrected at a young age. Previous histologic studies in a line of dogs derived from Miniature Poodles with hereditary PDA identified varying degrees of hypoplasia and asymmetry of ductus-specific smooth muscle and the presence of aortalike elastic tissue in the ductus wall sufficient to cause patency. To determine if similar structural abnormalities cause PDA in other dogs, serial-section, 3-dimensional histology of ductal architecture was studied in 8 non-Poodle purebred dogs with PDA with no immediate family history of PDA. Morphologic abnormalities were observed in 7 of 8 dogs with PDA and essentially were the same as those in dogs known to have a hereditary form of PDA. These findings suggest that apparently sporadic PDA in these breeds is caused by a genetic defect in the structure of the ductus arteriosus that is similar or identical to that in the Poodle. The relatives of dogs with PDA, particularly parents, offspring, and siblings, should be screened for evidence of PDA. Dogs with PDA should not be used for breeding, regardless of breed.

  15. Pharmacologic management of patent ductus arteriosus. (United States)

    Bhatt, V; Nahata, M C


    The incidence, pathophysiology, and clinical findings of symptomatic patent ductus arteriosus (PDA) are reviewed, and the pharmacologic management of symptomatic PDA is discussed. Spontaneous closure of the ductus arteriosus (DA) usually occurs within four days after birth in most premature and full-term infants. The incidence of PDA is related to birth weight in premature infants and has been shown to decrease with an increase in birth weight. Clinical findings are reviewed. Prophylactic treatment in the first few hours after birth may not be needed in most premature infants. Treatment should be considered only if the ductus becomes symptomatic. Medical management consists of respiratory support, fluid restriction, diuretics, digoxin, and indomethacin. Respiratory support, fluid restriction, and diuretics are used as first-line treatment of symptomatic PDA. Digoxin cannot be recommended as part of first-line therapy, since its risks seem to outweigh the benefits in preterm infants. Indomethacin should be used only if other standard measures including fluid restriction and diuretic treatment fail. The mechanism of action, pharmacokinetics, adverse effects, and drug interactions of indomethacin are discussed. Symptomatic PDA can increase morbidity and mortality, especially in very low birth weight infants. Treatment of symptomatic PDA may decrease the morbidity associated with this condition.

  16. Frontal Cardiac area in patent ductus arteriosus patients

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    Kim, Kun Sang; Choo, Dong Woon [Seoul Natinal University College of Medicine, Seoul (Korea, Republic of)


    Cardiac mensuration by radiographic frontal cardiac area method was carried out on 21 patent ductus arteriosus patients, 15 females and 6 males. Formula used in this study is as follows. Frontal cardiac area = {pi}/4 X long diameter X broad diameter. Increase of frontal cardiac area in patent ductus arteriosus patients seems to be evident but the degree of the cardiomegaly is variable. Comparing to normal data by Choo and Kim, frontal cardiac area in patent ductus arteriosus patients in this series is increased in 15.9% to 98.1%. After surgical ligation of the ductus arteriosus, significant decrease of the frontal cardiac area is observed and the average is 12.5%.

  17. Ibuprofen and paracetamol for patent ductus arteriosus

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    Carlo Dani


    Full Text Available We aimed to assess the state of the art of pharmacological treatment of patency of ductus arteriosus (PDA with ibuprofen and paracetamol in preterm infants. We pointed out that ibuprofen is the first choice drug for PDA treatment and indomethacin should be abandoned for its frequent adverse effects. However, also the pharmacological prevention of PDA should be abandoned because many preterm infants have spontaneous closure of PDA and ibuprofen may have dangerous adverse effects. Oral paracetamol has been found in two randomized controlled studies to have the same effectiveness of ibuprofen in closing PDA but without toxicity. If these data will be confirmed the management of PDA in preterm infants should be re-evaluated. Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  18. Impact of patent ductus arteriosus and subsequent therapy with indomethacin on cerebral oxygenation in preterm infants

    NARCIS (Netherlands)

    Lemmers, Petra M. A.; Toet, Mona C.; van Bel, Frank


    OBJECTIVES. A hemodynamically important patent ductus arteriosus is a common problem in the first week of life in the preterm infant. Although patent ductus arteriosus induces alterations in organ perfusion, scarce information is available of the impact of patent ductus arteriosus and its subsequent

  19. Radiologic findings of truncus arteriosus; incidence and associated anomalies

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    Lee, Hyeon Kyeong; Yeon, Kyung Mo; Kim, In One; Choe, Du Whan; Lee, Kyung Hwan [Seoul National University College of Medicine, Seoul (Korea, Republic of); Choe, Young Hi; Choe, Yun Hyun [Sejong General Hospital, Bucheon (Korea, Republic of); Choi, Yo Won [Armed Forces Chungpyung Hospital, Chungpyung (Korea, Republic of); Ahn, In Ok [Kumkang Hospital, Seoul (Korea, Republic of)


    Truncus arteriosus is characterized by a single arterial vessel arising from the base of the heart and giving origin to the systemic, pulmonary and coronary circulation. To evaluate the incidence, types, and associated anomalies, 18 cases of truncus arteriosus diagnosed by angiocardiography, were reviewed and were compared with other reports. Ten of them were confirmed by operation. The overall incidence of truncus arteriosus was 0.127%. According to Collett and Edwards classification, type I was encountered in 11 cases (61%), type II in 4 cases (22%), and type III in 3 cases (17%). All the patients had subtruncal ventricular septal defects. Eight patients showed truncal valve regurgitation and valve stenosis was noted in one case. A right aortic arch was present in 9 cases. Associated anomalies were atrial septal defect (8 cases), patent ductus arteriosus (3 cases), coarctation of the aorta (2 cases), isolation of the left subclavian artery (2 cases) and right aortic arch with an aberrant left subclavian artery (1 case). Truncus arteriosus is an uncommon congenital cardio vascular malformation. In the group of cases which we encountered, type I was the most common anomaly. Frequently associated anomalies were right aortic arch, incompetent truncal valve and atrial septal defect.


    Institute of Scientific and Technical Information of China (English)

    高伟; 周爱卿; 余志庆; 李奋; 王荣发; 黄美蓉


    Objective To explore the efficacy of transcatheter closure of patent ductus arteriosus (PDA) with detachable coil and Amplatzer duct occluder (ADO). Methods Transcatheter colsure of PDA was performed in 160 cases, aged 4.56±2.67 years, of whom 3 had residual shunt after surgical ligation, 2 had pulmomary stenosis (PS), 1 had coarctation of aorta (COA), 1 had right aortic arch, and 2 had atrial septal defect (ASD). Results Detachable coils (Duct Occlude pfm or Cook Inc) were successfully used in 51 patients with a smallest PDA diameter of 1.86±0.78mm. Amplatzer duct occluders were also successfully performed in other 109 with a moderate to large PDA diameter of 3.89±1.32mm, of whom 3 with PS or COA were performed balloon dilation firstly, and 2 with ASD were performed PDA occlusion firstly; 1 month to 4.8years follow-up coil or Amplatzer device closure of PDA showed that neither residual shunt nor any complication. Conclusion It is suggested that the detachable coil and Amplatzer duct occluder are simple and safe for the catheter closure from small to large sized PDA.

  1. Unusual presentation for a patent ductus arteriosus

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    C. D. Vizza


    Full Text Available A 63-yr-old black female, with a 1-yr history of hepatitis C and ascites was referred to an expert centre with suspicion of portopulmonary hypertension (PPHTN. Her poor condition made a rapid diagnosis imperative and precluded a normal diagnostic work-up. Echocardiography confirmed severe pulmonary hypertension (PH. A hepatic scintigraphy and an abdominal echo-Doppler study excluded liver cirrhosis and portal hypertension. Cardiac magnetic resonance imaging showed marked dilation of the right ventricle with significant hypertrophy of the free wall, a finding that is uncommon in idiopathic pulmonary arterial hypertension or PPHTN. Right heart catheterisation demonstrated severe pre-capillary PH without response to acute vasodilator testing. Finally the patient underwent computed tomography angiography, which showed marked dilation of the pulmonary artery without thromboembolic disease and, unexpectedly, a partially calcified large patent ductus arteriosus. The correct diagnosis of the underlying cause of pulmonary arterial hypertension is essential. Patients with underlying heart defects may have an atypical presentation and be referred to expert centres with an incorrect diagnosis. A full investigation is necessary; careful examination of right ventricular anatomy can provide clues about the aetiology of PH, and it is important to exclude intra- and extracardiac shunts during haemodynamic studies.

  2. The patent ductus arteriosus in term infants, children, and adults. (United States)

    Schneider, Douglas J


    During fetal life, the ductus arteriosus is a normal and essential structure that connects the pulmonary artery to the distal aortic arch, permitting right ventricular ejection into the aorta. After birth, with commencement of pulmonary blood flow and a 2-ventricle circulation, a variety of physiological and biochemical signals normally result in complete closure of the ductus. Persistent patency of the ductus arteriosus may impair systemic cardiac output and result in deleterious effects on the cardiovascular system and lungs. Although surgery is still the treatment of choice for most premature infants with patent ductus arteriosus (PDA), transcatheter techniques have largely supplanted surgery for closure of PDA in children and adults. This article is a review of the PDA in term infants, children, and adults, with focus on the clinical manifestations and management.

  3. Adult patent ductus arteriosus complicated by endocarditis and hemolytic anemia. (United States)

    Sabzi, Feridoun; Faraji, Reza


    An adult with a large patent ductus arteriosus may present with fatigue, dyspnea or palpitations or in rare presentation with endocarditis. The case illustrated unique role of vegetation of endocarditis in hemolytic anemia in adult with patent ductus arteriosus (PDA). Despite treatment of endocarditis with complete course of appropriate antibiotic therapy and normality of C- reactive protein, erythrocyte sedimentation rate and leukocytosis and wellness of general condition, transthoracic echocardiography revealed large vegetation in PDA lumen, surgical closure of PDA completely relieved hemolysis, and fragmented red cell disappeared from peripheral blood smear. The 3-month follow-up revealed complete occlusion of PDA and abolishment of hemolytic anemia confirmed by clinical and laboratory examination.

  4. Pros and cons of patent ductus arteriosus ligation: hemodynamic changes and other morbidities after patent ductus arteriosus ligation. (United States)

    Noori, Shahab


    Although surgical ligation of a persistent patent ductus arteriosus resolves the adverse hemodynamic consequences of the systemic-to-pulmonary shunt and may confer some long-term benefits, it is also associated with both immediate and long-term negative effects. The population that benefits from or is harmed by the procedure is not clearly defined. Although indiscriminate ligation of the patent ductus arteriosus in all patients is not supported by the available information, the recent suggestion declaring the ductus harmless is not supported either. As we await the results of appropriately designed randomized control studies to define the indications for ligation, we must use clinical and echocardiographic indicators of a hemodynamically significant ductus arteriosus and thoughtful assessment of each individual patient to help guide us in addressing this complex problem.

  5. Surgical ligation of patent ductus arteriosus in premature infants

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    Sørensen, Cristel M; Steensberg, Jesper N; Greisen, Gorm


    The objective was to evaluate the mortality and the morbidity in neonates operated for persistent ductus arteriosus at Copenhagen University Hospital in the 10-year period from 1 January 1998 to 31 December 2007, and to compare the results with results reported in extant literature....

  6. Guinea pig ductus arteriosus. II - Irreversible closure after birth. (United States)

    Fay, F. S.; Cooke, P. H.


    To investigate the mechanism underlying irreversibility of ductal closure after birth, studies were undertaken to determine the exact time course for the onset of irreversible closure of the guinea pig ductus arteriosus. Parallel studies of the reactivity of ductal smooth muscle to oxygen and studies of the postpartum cellular changes within the vessel were also carried out.

  7. Adrenal function in preterm infants undergoing patent ductus arteriosus ligation.

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    El-Khuffash, Afif


    Targeted milrinone treatment for low left ventricular output (LVO) reduces the incidence of acute cardiorespiratory instability following ligation of patent ductus arteriosus (PDA) in preterm infants. Despite this, some infants continue to experience postoperative deterioration. Adrenal insufficiency related to prematurity has been postulated as a possible mechanism.

  8. Patent Ductus Arteriosus Treatment in Very Preterm Infants

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    Edstedt Bonamy, Anna-Karin; Gudmundsdottir, Anna; Maier, Rolf F


    BACKGROUND: Spontaneous closure of patent ductus arteriosus (PDA) occurs frequently in very preterm infants and despite the lack of evidence for treatment benefits, treatment for PDA is common in neonatal medicine. OBJECTIVES: The aim of this work was to study regional variations in PDA treatment...

  9. Ibuprofen pharmacokinetics in preterm infants with patent ductus arteriosus

    NARCIS (Netherlands)

    Van Overmeire, B; Touw, D; Schepens, P J; Kearns, G L; van den Anker, J N


    OBJECTIVE: Our objective was to study the pharmacokinetics of ibuprofen in premature infants with patent ductus arteriosus on day 3 and day 5 after birth. METHODS: Ibuprofen was administered on days 3, 4, and 5 by a 15-minute intravenous infusion of 10, 5, and 5 mg/kg, respectively, with the aim of

  10. Evaluation of cerebral electrical activity and cardiac output after patent ductus arteriosus ligation in preterm infants.

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    Leslie, A T F S


    To characterize and investigate the relationship between systemic blood flow and pre- and postoperative cerebral electrical activity in preterm neonates undergoing patent ductus arteriosus (PDA) ligation.

  11. History of the ductus arteriosus: 1. Anatomy and spontaneous closure. (United States)

    Obladen, Michael


    Ductus arteriosus and foramen ovale were described by Galen without understanding their functions. His beliefs in soul localization and spiritization within the left ventricle established religious pneumatology which became a theological need in the Middle Ages. Pulmonary transit was recognized by Servetus and Colombo after the Reformation around 1550. This prompted Harvey's full understanding of the fetal circulation. Botallo did not describe the ductus arteriosus, but in 1564 redescribed the foramen ovale, making his way into the nomina anatomica by mistake. Most authors of the 19th and 20th century believed ductal patency to be passive, and postnatal closure to be an active process, explained by mechanical theories. After the discovery of prostaglandins by Bergstrom and Vane, Coceani proved that ductal patency is maintained by the relaxant action of prostaglandins.

  12. Magnetic resonance imaging of the ductus arteriosus - case report

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    Yousry, T.; Bacherler, B.; Tiling, R.; Fink, U.; Werdan, K.


    In a female patient suffering from renal insufficiency in whom angiography could not be performed, it was possible to confirm the diagnosis of a ductus arteriosus (ductus of Botalli) by magnetic resonance imaging. The present case report shows that it is possible to visualise this congenital heart disease by MRI. This can be of importance especially if angiography cannot be performed (as in this case) because of renal insufficiency or because of contrast medium allergy.

  13. Efficacy of paracetamol on patent ductus arteriosus closure may be dose dependent: evidence from human and murine studies.

    LENUS (Irish Health Repository)

    El-Khuffash, Afif


    We evaluated the clinical effectiveness of variable courses of paracetamol on patent ductus arteriosus (PDA) closure and examined its effect on the in vitro term and preterm murine ductus arteriosus (DA).

  14. Gentamicin pharmacokinetics in preterm infants with a patent and a closed ductus arteriosus

    NARCIS (Netherlands)

    Touw, D J; Proost, J H; Stevens, R; Lafeber, H N; van Weissenbruch, M M


    BACKGROUND AND AIM: A patent ductus arteriosus (PDA) may influence renal and hepatic blood flow and hence pharmacokinetics of drugs in neonates compared to neonates with a closed ductus arteriosus (CDA). A 10-percent difference of gentamicin pharmacokinetic parameters between PDA and CDA has been re

  15. Anomalous Origin of the Left Pulmonary Artery: Hemi-Truncus Arteriosus (United States)

    Shakir, Mariam; Ariff, Shabina; Ali, Rehan; Hassan, Babar


    Hemi-truncus arteriosus is a rare congenital cardiovascular malformation. It usually presents in infancy and leads to development of progressive pulmonary vascular disease, heart failure, and death. We report a case of hemi truncus arteriosus in a 12-day-old neonate who was successfully managed at our institute.

  16. Thrombosed aneurysmal nonpatent ductus arteriosus: a case report

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    Sattar, P. [Radiology Department, Regionalspital Biel, Vogelsang 84, CH-2502 Biel-Bienne (Switzerland); Ehrensperger, J. [Pediatric Surgery Department, Kinderspital Wildermeth, Kloosweg 22, CH-2502 Biel-Bienne (Switzerland); Ducommun, J.C. [Radiology Department, Regionalspital Biel, Vogelsang 84, CH-2502 Biel-Bienne (Switzerland)


    We report our observations made clinically and by conventional radiography, ultrasound, computed tomography and MRI on a newborn full-term infant with a thrombosed patent aneurysmal ductus arteriosus of Botallo. The baby had no heart murmurs, but from the beginning of the 2nd day of life developed sinus tachycardia, especially when in a left-sided position, and dyspnoea mainly when drinking. From his 1st day of life we observed generalized muscular hypotonia and a tendency for hyperextension at neurological examination. (orig.). With 5 figs.

  17. Persistent truncus arteriosus with intact ventricular septum diagnosed by echocardiography

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yu-qi; SHEN Rong; SUN Kun; ZHONG Shu-wen; WU Yu-rong


    Persistent truncus arteriosus (PTA) is a rare congenital cardiac anomaly, and has an incidence of about 0.5 to 0.9 per 10 000 live births. Almost all cases described in the literatures had a large ventricular septal defect, only few rare cases were reported with intact ventricular septum. From June 1998 to December 2008, cardiac angiography were performed in 10 880 patients with congenital heart disease in our hospital, 47 patients with PTA were diagnosed, one case with tricuspid atresia,hypoplastic right ventricle, and intact ventricular septum was encountered.

  18. Management of patent ductus arteriosus in premature infants. (United States)

    Bhat, Rama; Das, Utpala G


    Patency of the ductus arteriosus is required for fetal survival in utero. In infants born prematurely, ductus fails to close and shunt reverses from left to right. Incidence of patent ductus arteriosus (PDA) is inversely proportional to the gestational age. A large PDA (>1.5 mm diameter) with left to right shunt in very low birth weight infants can cause pulmonary edema, congestive heart failure, pulmonary hemorrhage and increase the risk for bronchopulmonary dysplasia. Attempts to prevent or close the duct by pharmacological or surgical methods have not changed the morbidity or the long term outcome. Pharmacological treatment with indomethacin or ibuprofen is successful in 75 to 80 % of infants but its use also exposes these infants to undesirable side effects like gastrointestinal bleeding, perforation and necrotizing enterocolitis. Prophylactic therapy with indomethacin or ibuprofen to prevent PDA has not altered the morbidity or long term outcome. Currently, there is a dilemma as to how to treat, when to treat and whom to treat. Recent literature suggests a trial of conservative management during the first week followed by selective use of anti-inflammatory drugs. Surgical ligation is reserved for infants who fail medical therapy and still remain symptomatic. Spontaneous closure of the PDA has been reported in up to 40-67 % of very low birth weight (VLBW) infants by 7 d. In this review authors discuss these controversies and propose a more rational approach.

  19. Necrobiosis lipoidica mimicking cellulitis

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    Joshi A


    Full Text Available A 57-year-old obese patient presented with a 5 month history of tender, indurated, erythematous plaques with superficial ulceration on the right shin. The lesions closely mimicked cellulitis but were unresponsive to antibiotics. Though the patient was not a known diabetic, on investigations she was found to be a diabetic. Histology confirmed the diagnosis of necrobiosis lipoidica. This acutely inflammed presentation of necrobiosis lipoidica is extremely rare.

  20. Observation of right descending pulmonary arterial size and frontal cardiac area in patent ductus arteriosus patients

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    Ahn, Kyung Soo; Seol, Hae Yung; Suh, Won Huk; Lee, Min Jae [Korea University College of Medicine, Seoul (Korea, Republic of)


    Frontal cardiac area, right descending pulmonary arterial size and size of the ductus arteriosus were measured on 29 patients with patent ductus arteriosus,21 females and 8 males. The results are as follows: 1. Frontal cardiac area in PDA patient in this series is increased in 0.63% to 100.11 % and the average is 38.91-23.54%. 2. Central branch of the right descending pulmonary artery is dilated in 28 cases (96.55%) on pre-operative stage, and combination with dilation of central branch and constriction of peripheral branch is in 18 cases (62.1%). 3. Degree of dilation of central branch is correlated with increase of age, but it is not related with size of ductus arteriosus. 4. Increase rate of frontal cardiac area is not related with size of ductus arteriosus.

  1. A Case of Pulmonary Artery Aneurysm Associated with Patent Ductus Arteriosus : Detection by Radionuclide Cardiac Angiography

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    Sohn, I.; Lee, M. C.; Cho, B. Y.; Koh, C. S.; Yoon, Y. S.; Hong, C. Y.; Rho, J. R.; Youn, K. M.; Han, M. C. [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    A Case of main pulmonary artery aneurysm in a 9-year-old boy with patent ductus arteriosus is presented. In this case presented with a huge mass density on the chest X-ray, radionuclide cardiac angiography showed a vascular lesion, which was confirmed as an aneurysm of the main pulmonary artery at roentgenologic angiogram. The aneurysm appeared following an episode of bacterial endocarditis and pulmonary hypertension. A successful aneurysmectomy with multiple ligation of ductus arteriosus was performed.

  2. Risk factors for patent ductus arteriosus in preterm neonates

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    Novia Bernati


    Full Text Available Background The reported prevalences of patent ductus arteriosus (PDA in preterm neonates vary, and are currently unknown in Palembang. Birth weight, gestational age, asphyxia, history of antenatal steroid use, hyaline membrane disease (HMD, race and ethnicity, are potential risk factors for PDA. Objective To determine the prevalence of PDA and its risk factors in preterm neonates at Mmohammad Hoesin Hospital, Palembang. Methods This cross-sectional study was conducted from October 2011 to April 2012. Echocardiographic examinations were performed on 242 preterm neonates aged 15 hours to 7 days. Data was taken from medical records and interviews, and analyzed by Chi square and logistic regression analyses. Results Patent ductus arteriosus was found in 142 (58.7% preterm neonates with a prevalence ratio of 1.43. Neonates with birthweight ≤2,000 grams tended to have 1.9 (95% CI 1.17 to 3.32 times higher risk for PDA (P=0.01. Neonates ≤30 weeks gestation were also at 1.9 times higher risk for PDA (P=0.16. Probabilities for PDA occurrence in neonates with asphyxia, without antenatal corticosteroids and HMD were 1.6 (95% CI 1.13 to 3.36 times, 1.3 (95%CI 0.73 to 2.50 times and 2.2 (95%CI 1.29 to 3.72 times higher risk for PDA, respectively (P=0.22, 0.41, and 0.005, respectively. Conclusion Birth weight and HMD are statistically significant risk factors of PDA, but the more significant one is HMD.

  3. Notch signal reception is required in vascular smooth muscle cells for ductus arteriosus closure. (United States)

    Krebs, Luke T; Norton, Christine R; Gridley, Thomas


    The ductus arteriosus is an arterial vessel that shunts blood flow away from the lungs during fetal life, but normally occludes after birth to establish the adult circulation pattern. Failure of the ductus arteriosus to close after birth is termed patent ductus arteriosus, and is one of the most common congenital heart defects. Our previous work demonstrated that vascular smooth muscle cell expression of the Jag1 gene, which encodes a ligand for Notch family receptors, is essential for postnatal closure of the ductus arteriosus in mice. However, it was not known what cell population was responsible for receiving the Jag1-mediated signal. Here we show, using smooth muscle cell-specific deletion of the Rbpj gene, which encodes a transcription factor that mediates all canonical Notch signaling, that Notch signal reception in the vascular smooth muscle cell compartment is required for ductus arteriosus closure. These data indicate that homotypic vascular smooth muscle cell interactions are required for proper contractile smooth muscle cell differentiation and postnatal closure of the ductus arteriosus in mice.

  4. Traumatic pseudophacocele.

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    Mandal Anil


    Full Text Available Post-traumatic subconjunctival dislocation of an intraocular lens (pseudophacocele is a rare but serious complication following cataract surgery. All the previously reported cases were managed by removal of the IOL rendering the eye aphakic. We report a case of traumatic pseudophacocele which was successfully managed by an IOL exchange.

  5. Prostaglandin E2 and patent ductus arteriosus in premature infants

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    Full Text Available Background Patent ductus arteriosus (PDA is a congenital heart disease most commonly occurring in premature infants. Spontaneous ductus arteriosus (DA closure in premature infants has been suggested to be associated with duct lumen maturity and the DA sensitivity to prostaglandin E2 (PGE2. Objective To assess for a possible correlation between serum PGE2 levels and PDA size in premature infants. Methods This observational study using repeated measurements on premature infants with PDA detected at days 2-3 of life was undertaken in Cipto Mangunkusumo Hospital and Fatmawati Hospital, Jakarta, from April to May 2014. The PDA was diagnosed using 2-D echocardiography and PGE2 levels were measured by immunoassay. Pearson’s correlation test was used to evaluate a possible correlation between PGE2 level and DA diameter. Results Thirty-three premature infants of median gestational age 31 (range 28-32 weeks and median birth weight 1,360 (range 1,000-1,500 grams were enrolled. Almost two-thirds of the subjects were male. Almost all (30/33 subjects had spontaneous DA closure before the age of 10 days. Subjects’ mean DA diameter was 2.9 (SD 0.5 mm with maximum flow velocity of 0.2 (SD 0.06 cm/sec, and left atrial-to-aortic root ratio (LA/Ao of 1.5 (SD 0.2. Their mean PGE2 levels at the ages of 2-3, 5-7, and after 10 days were 5,238.6 (SD 1,225.2, 4,178.2 (SD 1,534.5, and 915.2 (SD 151.6 pg/mL, respectively. The PGE2 level at days 2-3 was significantly correlated with DA diameter (r = 0.667; P < 0.001, but not at days 5-7 (r = 0.292; P = 0.105 or at day 10 (r = 0.041; P = 0.941. Conclusion There is a strong, positive correlation between the PGE2 level and DA diameter in preterm infants at 2-3 days of age. However, there is no significant correlation between PGE2 level and persistence of PDA.

  6. Amputation - traumatic (United States)

    ... critical care management. A well-fitting and functional prosthesis can speed rehabilitation. Causes Traumatic amputations usually result ... More Bleeding Cuts and puncture wounds Leg or foot amputation Shock Patient Instructions Foot amputation - discharge Leg ...

  7. C-reactive protein, platelets, and patent ductus arteriosus. (United States)

    Meinarde, Leonardo; Hillman, Macarena; Rizzotti, Alina; Basquiera, Ana Lisa; Tabares, Aldo; Cuestas, Eduardo


    The association between inflammation, platelets, and patent ductus arteriosus (PDA) has not been studied so far. The purpose of this study was to evaluate whether C-reactive protein (CRP) is related to low platelet count and PDA. This was a retrospective study of 88 infants with a birth weight ≤1500 g and a gestational age ≤30 weeks. Platelet count, CRP, and an echocardiogram were assessed in all infants. The subjects were matched by sex, gestational age, and birth weight. Differences were compared using the χ(2), t-test, or Mann-Whitney U-test, as appropriate. Significant variables were entered into a logistic regression model. The association between CRP and platelets was evaluated by correlation and regression analysis. Platelet count (167 000 vs. 213 000 µl(-1), p = 0.015) was lower and the CRP (0.45 vs. 0.20 mg/dl, p = 0.002) was higher, and the platelet count correlated inversely with CRP (r = -0.145, p = 0.049) in the infants with vs. without PDA. Only CRP was independently associated with PDA in a logistic regression model (OR 64.1, 95% confidence interval 1.4-2941, p = 0.033).

  8. Preterm patent ductus arteriosus: A continuing conundrum for the neonatologist? (United States)

    Evans, Nick


    How to manage the preterm patent ductus arteriosus (PDA) remains a conundrum. On the one hand, physiology and statistical association with adverse outcomes suggest that it is pathological. On the other hand, clinical trials of treatment strategies have failed to show any long-term benefit. Ultrasound studies of PDA have suggested that the haemodynamic impact may be much earlier after birth than previously thought (in the first hours); however, we still do not know when to treat PDA. Studies that have tested symptomatic or pre-symptomatic treatment are mainly historical and have not tested the effect of no treatment. Prophylactic treatment is the best-studied regimen but improvements in some short-term outcomes do not translate to any difference in longer-term outcomes. Neonatologists have been reluctant to engage in trials that test treatment against almost never treating. Observations of very early postnatal haemodynamic significance suggest that targeting treatment on the basis of the early postnatal constrictive response of the duct may optimize benefits. A pilot trial of this strategy showed reduction in the incidence of pulmonary haemorrhage but more trials of this strategy are needed.

  9. Transcatheter closure of patent ductus arteriosus: past, present and future. (United States)

    Baruteau, Alban-Elouen; Hascoët, Sébastien; Baruteau, Julien; Boudjemline, Younes; Lambert, Virginie; Angel, Claude-Yves; Belli, Emre; Petit, Jérôme; Pass, Robert


    This review aims to describe the past history, present techniques and future directions in transcatheter treatment of patent ductus arteriosus (PDA). Transcatheter PDA closure is the standard of care in most cases and PDA closure is indicated in any patient with signs of left ventricular volume overload due to a ductus. In cases of left-to-right PDA with severe pulmonary arterial hypertension, closure may be performed under specific conditions. The management of clinically silent or very tiny PDAs remains highly controversial. Techniques have evolved and the transcatheter approach to PDA closure is now feasible and safe with current devices. Coils and the Amplatzer Duct Occluder are used most frequently for PDA closure worldwide, with a high occlusion rate and few complications. Transcatheter PDA closure in preterm or low-bodyweight infants remains a highly challenging procedure and further device and catheter design development is indicated before transcatheter closure is the treatment of choice in this delicate patient population. The evolution of transcatheter PDA closure from just 40 years ago with 18F sheaths to device delivery via a 3F sheath is remarkable and it is anticipated that further improvements will result in better safety and efficacy of transcatheter PDA closure techniques.

  10. Transcatheter Closure of Patent Ductus Arteriosus: The Penang Hospital's Experience. (United States)

    Amir Hamzah, A R; Tiow, C A; Koh, G T; Sharifah, A M


    Transcatheter closure of small and moderate sizes of Patent Ductus Arteriosus (PDA) is a standard and well accepted form of treatment. The aim of this study is to describe the experience of transcatheter closure of PDA in Penang Hospital. All patients who underwent transcatheter closure of PDA at our institution between 20th January 2006 and 27th June 2008 were retrospectively identified and studied. There were a total of 66 patients who had undergone transcatheter closure of PDA during this period which comprised of 24 male and 42 female. The PDA was closed by Amplatzer Duct Occluder (ADO) in 31 patients, Gianturco coil in 29 patients and other types of devices in 6 patients. There were 4 patients (6%) who had developed acute complication during the procedure (3 of them developed coil embolization and 1 had bleeding from puncture site). The PDA was successfully close in 95.5% of the study population without any residual PDA shunting. All the patients were alive but 5 of them (4.5%) have some abnormalities (2 has mild left pulmonary stenosis, 3 has small residual). Comparison between ADO and Gianturco coil revealed no significant difference in the outcome. Transcatheter closure of PDA has proven to be safe and effective with good midterm outcome. There was no significant difference between Amplatzer Ductal Occluder and Gianturco coil in term of the outcome.

  11. Cardiac involvement of primary hyperoxaluria accompanied by non-compaction cardiomyopathy and patent ductus arteriosus. (United States)

    Arat, Nurcan; Akyıldız, Murat; Tellioğlu, Gürkan; Tokat, Yaman


    Primary hyperoxaluria is a rare hereditary metabolic disorder resulting in accumulation of calcium oxalate in visceral organs, including the heart. We report a 19-year-old male with non- compaction cardiomyopathy combined with patent ductus arteriosus awaiting combined liver-kidney transplantation for primary hyperoxaluria. After surgical closure of the patent ductus arteriosus, the patient underwent a successful renal and subsequent liver transplantation. The presence of hypertrophic cardiomyopathy in hyperoxaluria patients has been reported before, but this is the first report of non-compaction myocardium with patent ductus arteriosus in a patient with primary hyperoxaluria. At the third month after combined liver and renal transplantation, improvement in cardiac functions were observed. Primary hyperoxaluria is a clinical entity to be taken into consideration in differential diagnosis of hypertrophied myocardium with high myocardial echocardiographic intensity. In cases of hyperoxaluria, additional congenital abnormalities may complicate the clinical picture.

  12. Does ibuprofen treatment in patent ductus arteriosus alter oxygen free radicals in premature infants? (United States)

    Akar, Melek; Yildirim, Tulin G; Sandal, Gonca; Bozdag, Senol; Erdeve, Omer; Altug, Nahide; Uras, Nurdan; Oguz, Serife S; Dilmen, Ugur


    Introduction Ibuprofen is used widely to close patent ductus arteriosus in preterm infants. The anti-inflammatory activity of ibuprofen may also be partly due to its ability to scavenge reactive oxygen species and reactive nitrogen species. We evaluated the interaction between oxidative status and the medical treatment of patent ductus arteriosus with two forms of ibuprofen. Materials and methods This study enrolled newborns of gestational age ⩽32 weeks, birth weight ⩽1500 g, and postnatal age 48-96 hours, who received either intravenous or oral ibuprofen to treat patent ductus arteriosus. Venous blood was sampled before ibuprofen treatment from each patient to determine antioxidant and oxidant concentrations. Secondary samples were collected 24 hours after the end of the treatment. Total oxidant status and total antioxidant capacity were measured using Erel's method.

  13. [Antenatal closure of ductus arteriosus following maternal intoxication by niflumic acid]. (United States)

    Bouissou, A; Glorieux, I; Dulac, Y; Marcoux, M O; Casper, C


    Antenatal closure of the ductus arteriosus is an uncommon event that has been considered as a risk factor for development of congestive heart failure and persistent pulmonary hypertension of the newborn. We report here on a case of antenatal ductus arteriosus closure due to niflumic acid maternal intoxication at 32 weeks of gestation. Fetal extraction was performed few days later because of echographic signs of congestive heart failure. The child survived after 3 days of severe persistent pulmonary hypertension. This case emphasizes the potential risk of niflumic acid during pregnancy and the need of antenatal echographic monitoring for optimal management.

  14. Modern treatment of patent ductus arteriosus – single center experience

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    Senka Mesihović Dinarević


    Full Text Available  Introduction: Transcatheter closure is a treatment choice for the most children with patent ductus arteriosus (PDA. The closure of the ductus is indicated in any child or adolescent with developed symptoms of significant L-R shunt. The aim of this article is to present our results in 5 years treatment of patients with PDA and their outcome. Methods: From 2009 to 2014, 30 patients underwent a transcatheter closure of PDA at Centre for Heart and Pediatric clinic of Clinical University Centre of Sarajevo. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for selection of appropriate occluder device type and size. All procedures were performed by local team of cardiologists from the Department of Cardiology, Pediatric clinic, with invasive cardiologists team from Sweden and Austria. Echocardiography was repeated at intervals of 24 hours, then 1month, 3 months, and 1 year after the procedure to assess the outcome. Results: Thirty patients underwent transcatheter closure of PDA during the study period. PDA of ≤ 2.0 mm was present in 8 patients and they underwent PDA closure with coils, while 22 patients had PDA diameter  ≥ 2 mm, and they were treated by Amplatzer duct occluder (ADO. Only in 2 (6.2% patients complications have been observed. The length of hospital stay after the treatment was two to three days. Conclusion: Transcatheter closure of PDA is a modern, safe and efficient method that ensures a faster recovery of the patients, shortens the length of hospitalization.

  15. Transcatheter closure of small ductus arteriosus with amplatzer vascular plug

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    Eunhyun Cho


    Full Text Available Purpose: The purpose of this study was to share our experience of transcatheter closure of small patent ductus arteriosus (PDA by using an Amplatzer vascular plug (AVP.&lt;br&gt; Methods: We reviewed the medical records of 20 patients who underwent transcatheter closure at Samsung Medical Center and Sejong General Hospital from January 2008 to August 2012. The size and shape of the PDAs were evaluated by performing angiograms, and the PDA size and the AVP devices size were compared.&lt;br&gt;Results: The mean age of the patients was 54.9±45.7 months old. The PDAs were of type C (n=5, type D (n=12 and type E (n=3. The mean pulmonary end diameter of the PDA was 1.7±0.6 mm, and the aortic end diameter was 3.6±1.4 mm. The mean length was 7.3±1.8 mm. We used 3 types of AVP devices: AVP I (n=5, AVP II (n=7, and AVP IV (n=8. The ratio of AVP size to the pulmonary end diameter was 3.37±1.64, and AVP size/aortic end ratio was 1.72±0.97. The aortic end diameter was significantly larger in those cases repaired with AVP II than in the others (P =0.002. The AVP size did not significantly correlate with the PDA size, but did correlate with smaller ratio of AVP size to aortic end diameter (1.10±0.31, P =0.032. &lt;br&gt;Conclusion: Transcatheter closure of small PDA with AVP devices yielded satisfactory outcome. AVP II was equally effective with smaller size of device, compared to others.

  16. [The transcatheter closure of patent ductus arteriosus. The initial experience]. (United States)

    Vázquez-Antona, C A; Rijlaarsdam, M; Gaspar, J; Gil Moreno, M; Buendía Hernández, A; Martínez Ríos, M A; Attie, F


    Percutaneous closure of the patent ductus arteriosus (PDA) has been recently reported to be an effective alternative in the treatment of patients with ductal shunting. We report the initial experience and results during follow-up of percutaneous ductal occlusion with the Rashkind occluder (USCI) in six patients with isolated PDA. Ages ranged from 3 to 23 years. Diagnosis was corroborated with two dimensional and Doppler echocardiography in all patients. During cardiac catheterization systolic pulmonary artery pressure oscillated between 22 and 64 mmHg and Qp/Qs ratio between 1.3 and 4.1. In two patients prosthesis of 12 mm were used and in the remaining prosthesis of 17 mm. Only one patient demonstrated total occlusion during immediate control aortography, the other patients presented central residual shunting over the occluder. In the three patients occlusion with balloon-catheter was added to the procedure, resulting in total occlusion in two and significant reduction of the shunt magnitude in one. Two technical problems were resolved satisfactorily. None of the cases presented device embolization. Mean follow-up was 23.8 months with control echocardiograms at 24 hours, 1, 4, 12 and 24 months. In all patients immediate reduction of the left atrial dimension was demonstrated. Three patients presented residual shunts in the first 24 hours. In two of them total occlusion had occurred after one month and the other patient persisted with a small residual shunt until one year after the procedure. In conclusion, in this small study group good results were obtained with percutaneous ductal closure.

  17. Closure of a short patent ductus arteriosus using an atrial septal occluder

    Institute of Scientific and Technical Information of China (English)

    Keyhan Sayadpour Zanjani


    @@ Patent ductus arteriosus (PDA) device closure was first attempted by Porstmann et al1 in 1967. Due to the rapid development in this field, it is the therapy of choice in current era. As most of PDAs have conical shape, Amplatzer PDA occluders were designed to fit into these ducts.

  18. Aneurysm after surgical ligation of patent ductus arteriosus: a case report

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    Kim, Sung Gyu; Yang, Sang Kyu; Chi, Jung Ik; Lee, Chang Jun [National Medical Center, Seoul (Korea, Republic of)


    Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases. A rare complication occurring after its surgical treatment is the development of an aneurysm, and we report the radiologic findings in a case in which this occurred after surgical ligation.

  19. Epidemiology, presentation and population genetics of patent ductus arteriosus (PDA) in the Dutch Stabyhoun dog

    NARCIS (Netherlands)

    Toom, den Marjolein L.; Meiling, Agnes E.; Thomas, Rachel E.; Leegwater, Peter A.J.; Heuven, Henri C.M.


    Background: Patent ductus arteriosus (PDA) is one of the most common congenital heart defects in dogs and is considered to be a complex, polygenic threshold trait for which a female sex predisposition has been described. Histological studies in dogs suggest that smooth muscle hypoplasia and asymm

  20. The ductus arteriosus in the preterm infant: Histologic and clinical observations

    NARCIS (Netherlands)

    Gittenberger-de Groot, A.C.; Ertbruggen, I. van; Moulaert, A.J.M.G.; Harinck, E.


    In order to elucidate some of the unexplained phenomena in prolonged patency of the ductus arteriosus in preterm infants, the histology of the ductus was studied in 27 cases. Some of the infants had been treated with indomethacin. Four morphologic maturation stages are distinguinguished. There was n

  1. A novel approach to ductal spasm during percutaneous device occlusion of patent ductus arteriosus. (United States)

    De Decker, Rik; Comitis, George; Thomas, Jenny; van der Merwe, Elmarie; Lawrenson, John


    Ductal spasm is a rare yet important complication of device occlusions of patent ductus arteriosus. Spasm may result in failure of the procedure, under-sizing of the device, or embolisation of the implanted device as the spasm resolves after the procedure. We describe a novel protocol that rapidly and completely reversed the spasm in eight prematurely born infants who experienced ductal spasm during cardiac catheterisations for patent ductus arteriosus occlusion. In total, eight infants born between 25 and 34 weeks of gestation presented for transcatheter patent ductus arteriosus occlusion between 13 and 87 months of age. All eight patients experienced ductal spasm either immediately before, during, or soon after induction of anaesthesia or only after entering the ductus arteriosus with a catheter. After detection of the spasm, the anaesthetist, in each case, changed the mode of anaesthesia from inhaled sevoflurane to total intravenous anaesthesia with propofol, reduced the inhaled oxygen fraction to 21%, and initiated a continuous intravenous infusion of prostaglandin E1. The first two steps (total intravenous anaesthesia and FiO2 0.21) resulted in only partial relaxation of the spasm. Complete relaxation was attained after intravenous prostaglandin E1 infusions of only 10-15 minutes' duration. While maintaining this protocol, six ducti were successfully occluded and two were considered to be unsuitable for device occlusion and were referred for surgery. Ductal spasm during transcatheter occlusion may be reliably resolved and the procedure safely completed by a simple anaesthetic protocol, including the continuous infusion of intravenous prostaglandin E1.

  2. Is thoracoscopic patent ductus arteriosus closure superior to conventional surgery? (United States)

    Stankowski, Tomasz; Aboul-Hassan, Sleiman Sebastian; Marczak, Jakub; Cichon, Romuald


    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether thoracoscopic patent ductus arteriosus (PDA) closure is superior to conventional surgery. Altogether 821 papers were found using the reported search, 11 of which represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Eleven studies included in the analysis consisted of two prospective and three retrospective, non-randomized studies and six case series. Four included studies focused only on preterm infants, three studies enrolled neonates and the other four analysed all age groups from neonates to older children or young adults. There were no differences in mortality between video-assisted thoracoscopic surgery (VATS) and conventional surgery. Two studies suggested that VATS offers shorter operative times. Two papers observed shorter hospital stay, although the other two noted no significant difference. A large prospective trial found VATS to be associated with a lower number of postoperative complications in neonates and infants, whereas other studies suggested no significant differences in short-term postoperative complications. There is little evidence to suggest better musculoskeletal status and cosmesis in neonates following VATS. Conversion from thoracoscopy to thoracotomy described in six papers was seldom and it did not lead to any additional complications. All observational studies confirmed that both techniques are free from major adverse cardiovascular complications and these two techniques can be safely used in all patients qualified for surgical PDA closure. Two studies compared cost-effectiveness between the two techniques; one of them described VATS as significantly more cost-efficient, whereas the other study observed no difference. However, it should be noted that data

  3. Pan-nitinol occluder and special delivery device for closure of patent ductus arteriosus: a canine-model feasibility study. (United States)

    Jiang, Hai-bin; Bai, Yuan; Zong, Gang-jun; Han, Lin; Li, Wei-ping; Lu, Yang; Qin, Yong-wen; Zhao, Xian-xian


    The aim of this study was to evaluate a new type of occluder for patent ductus arteriosus. Patent ductus arteriosus was established in a canine model by anastomosing a length of autologous jugular vein to the descending aorta and the left pulmonary artery in an end-to-side fashion. Transcatheter closure of each patent ductus arteriosus was performed on 10 dogs, which were then monitored for as long as 6 months with aortography, echocardiography, and histologic evaluation. Transcatheter closure with use of the novel pan-nitinol device was successful in all canine models. Postoperative echocardiography showed that the location and shape of the occluders were normal, without any residual shunting. Further histologic evaluation confirmed that the occluder surface was completely endothelialized 3 months after implantation. Transcatheter patent ductus arteriosus closure with the pan-nitinol occluder can be performed safely and successfully in a canine model and shows good biological compatibility and low mortality rates.

  4. Ductus arteriosus aneurysm with community-acquired methicillin-resistant Staphylococcus aureus infection and spontaneous rupture: a potentially fatal quandary. (United States)

    Stewart, Audra; Dyamenahalli, Umesh; Greenberg, S Bruce; Drummond-Webb, Jonathan


    We present the case of a 6-month-old previously healthy girl who presented with high fever, labored breathing, and an enlarged cardiac silhouette on her chest radiograph. Comprehensive evaluation discovered a ductus arteriosus aneurysm and pericardial effusion with methicillin-resistant Staphylococcus aureus bacteremia. Despite pericardiocentesis and appropriate intravenous antibiotics, there was rapid enlargement of the aneurysm and accumulation of echogenic material within the ductus arteriosus aneurysm. Infected aneurysm rupture was identified during emergency surgery. This infant also had vocal cord paresis, a likely complication of the surgery. The clinical course, diagnosis, and treatment of this patient are discussed. Infection of a ductus arteriosus or an infected ductal arteriosus aneurysm is a rare and potentially fatal clinical entity. In the era of increasing community-acquired methicillin-resistant S aureus infections, this is a diagnosis that requires a high index of suspicion.

  5. Congenital Heart Disease Requiring Maintenance of Ductus Arteriosus in Critically Ill Newborns Admitted at A Tertiary Neonatal Intensive Care Unit

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    Cucerea Manuela


    Full Text Available Introduction: Congenital heart diseases (CHD have been reported to be responsible for 30 to 50% of infant mortality caused by congenital disabilities. In critical cases, survival of newborns with CHD depends on the patency of the ductus arteriosus (PDA, for maintaining the systemic or pulmonary circulation. The aim of the study was to assess the efficacy and side effects of PGE (prostaglandin E administration in newborns with critical congenital heart disease requiring maintenance of the ductus arteriosus.

  6. Reversal of severe mitral regurgitation by device closure of a large patent ductus arteriosus in a premature infant. (United States)

    Kheiwa, Ahmed; Ross, Robert D; Kobayashi, Daisuke


    We report a critically ill premature infant with severe mitral valve regurgitation associated with pulmonary hypertension and a severely dilated left atrium from a large patent ductus arteriosus. The mitral valve regurgitation improved significantly with normalisation of left atrial size 4 weeks after percutaneous closure of the patent ductus arteriosus. This case highlights the potential reversibility of severe mitral valve regurgitation with treatment of an underlying cardiac shunt.

  7. Xanthogranulomatous cholecystitis mimicking gallbladder cancer. (United States)

    Ewelukwa, Ofor; Ali, Omair; Akram, Salma


    Xanthogranulomatous cholecystitis (XGC) is a benign, uncommon variant of chronic cholecystitis characterised by focal or diffuse destructive inflammatory process of the gallbladder (GB). Macroscopically, it appears like yellowish tumour-like masses in the wall of the GB. This article reports on a 74-year-old woman with XGC mimicking GB cancer.

  8. A review of stent’s failure on patent ductus arteriosus (United States)

    Lazim, Zulfaqih; Ismail, Al Emran; Taib, Ishkrizat; Atan, Bainun Akmal Mohd


    This paper presents a review of stent’s failure on patent ductus arteriosus (PDA). Ductus arteriosus (DA) is an opening for newborn babies and some patient that experienced cynotic congenital heart disease (CCHD) should maintain the duct opening for survival. To date, there are no specific research on mechanical stent failure study at DA. The challenging of the stent implantation on PDA is the PDA morphology. The failure of stent in term of stent fracture have been reported and reviewed in this paper. Furthermore, the failure prediction of stent is important for further stent design development. The morphology of PDA, stent type and material used in PDA and method for accessing the failure of stent is reviewed.

  9. Persistent Truncus Arteriosus With Intact Ventricular Septum: Clinical, Hemodynamic and Short-term Surgical Outcome

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    Gholamhossein Ajami


    Full Text Available Introduction: Truncus arteriosus with intact ventricular septum is a rare and unique variant of persistent truncus arteriosus (PTA which usually presents with central cyanosis and congestive heart failure in neonate and early infancy. Associated cardiac and non-cardiac anomalies may affect morbidity and mortality of these patients. Case Presentation: We describe clinical presentation, echocardiography and angiographic features of a 7-month old boy with PTA and intact ventricular septum who underwent surgical repair of the anomaly at our institution. Operative findings, surgical procedure and short-term outcome are reported. Conclusions: While our patient had systemic pulmonary arterial pressure at the time of complete surgical repair, it was improved after surgery.

  10. Spontaneous closure of patent ductus arteriosus after an episode of Kawasaki disease: a case report

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    Lin Ming-Chih


    Full Text Available Abstract Introduction Kawasaki disease is regarded as systemic vasculitis. Many experts believe that not only coronary arteries but also other small arteries are involved during the period of systemic inflammation. However, the evidence to support this point view is limited. Case presentation We report the case of a one-year-four-month-old Taiwanese girl whose patent ductus arteriosus was incidentally found during an episode of Kawasaki disease. The ductus closed spontaneously after the acute phase of Kawasaki disease. Conclusions In this patient, the patent ductus arteriosus may have closed spontaneously after Kawasaki disease due to its involvement in the generalized vasculitis that this disease incurs. This would support the theory that the vasculitis of Kawasaki disease is limited not only to coronary arteries but also to all medium- sized arteries.

  11. Patent ductus arteriosus in an adult amur leopard (Panthera pardus orientalis). (United States)

    Douay, Guillaume; Drut, Amandine; Ribas, Thibault; Gomis, David; Graille, Mélanie; Lemberger, Karin; Bublot, Isabelle


    A clinically healthy 16-yr-old female leopard (Panthera pardus orientalis) was diagnosed with a patent ductus arteriosus on echocardiography and later confirmed on necropsy A murmur was heard on auscultation during a routine examination, and the congenital defect was an incidental finding. The animal had been asymptomatic its entire life. This deformity is rarely observed in nondomestic felids and may be asymptomatic, as has been described in domestic cats.

  12. Left-Sided Patent Ductus Arteriosus in a Right-Sided Aortic Arch

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    Ming-Yen Ng


    Full Text Available We present a 31-year-old female with repaired tetralogy of Fallot (TOF and right-sided aortic arch (RAA with left-sided patent ductus arteriosus (PDA originating from the left brachiocephalic artery. This is a rare finding but most common site for a PDA in TOF and a RAA. To the best of our knowledge, this is the first demonstration of this rare finding on MRI in the literature.

  13. Transcatheter occlusion of a large coronary artery fistula using a patent ductus arteriosus occluder. (United States)

    Białkowski, Jacek; Szkutnik, Małgorzata; Fiszer, Roland; Zembala, Marian


    A large fistula from the left coronary artery to the right ventricle was successfully closed percutaneously in a 40 year-old patient using a patent ductus arteriosus occluder. The device was positioned and deployed via the venous system using a guidewire that had been advanced via the aorta, coronary artery and fistula to the venous circulation (arterio-venous loop creation). No complications were reported at follow-up.

  14. Angiographic evidence of absent ductus arteriosus in severe right ventricular outflow obstruction. (United States)

    Lacina, S J; Hamilton, W T; Thilenius, O G; Bharati, S; Lev, M; Arcilla, R A


    The angiocardiograms of 5 newborn infants with autopsy and/or surgically-proven congenital absence of the ductus arteriosus (ADA) and right ventricular outflow obstruction (Group A), and of 14 neonates with pulmonary atresia complex and patent ductus arteriosus (Group B) were reviewed. Aortic size was similar in both groups; however, the diameters of the right and left pulmonary arteries were much smaller in Group A than in Group B (right pulmonary artery: 2.6 vs 4.5 mm, P less than 0.005; left pulmonary artery: 2.5 vs 4.3 mm, P less than 0.005). Extensive bronchial collaterals were observed in Group A but not in Group B. Tricuspid aortic valve stenosis was present in 2 patients in Group A but in none in Group B. The diagnosis of ADA may be made in newborn infants with severe right ventricular outflow obstruction if the angiocardiograms reveal hypoplasia of the pulmonary arteries, extensive bronchial collaterals, and nonvisualization of the ductus arteriosus. Other suggestive features include aortic valve stenosis and/or right aortic arch with aberrant left subclavian artery.

  15. Deleterious effects of maternal ingestion of cocoa upon fetal ductus arteriosus in late pregnancy

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    Paulo eZielinsky


    Full Text Available Cocoa powder has twice more antioxidants than red wine and three times more than green tea. Ten prcent of its weight is made up of flavonoids. Cocoa has antioxidant and antiinflamatory effects by downregulating cyclooxigenase-2 receptors expression in the endothelium and enhancing nitric oxide bioavailability. There are evidences that while polyphenols ingestion have cardioprotective effects in the adult, it may have deleterious effect on the fetus if ingested by the mother on the third trimester of pregnancy, causing intrauterine fetal ductus arteriosus constriction.Polyphenols present in many foods and their anti-inflammatory and antinociceptive activities have been shown to be as or more powerful than those of indomethacin. These effects are dependent on the inhibition of modulation of the arachidonic acid and the synthesis of prostaglandins, especially E-2, which is responsible for fetal ductus arteriosus patency. So, we hypothesized that this same mechanism is responsible for the harmful effect of polyphenol-rich foods, such as cocoa, upon the fetal ductus arteriosus after maternal intake of such substances in the third trimester of pregnancy, thereby rising the perspective of a note of caution for pregnant women diet.

  16. Noncavernous arteriovenous shunts mimicking carotid cavernous fistulae (United States)

    Kobkitsuksakul, Chai; Jiarakongmun, Pakorn; Chanthanaphak, Ekachat; Singhara Na Ayudya, Sirintara (Pongpech)


    PURPOSE The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinus with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outside the cavernous sinus, but mimic symptoms and radiography of the cavernous shunt. We would like to present the other locations of the arteriovenous shunt, which mimic the clinical presentation of carotid cavernous fistulae, and analyze venous drainages. METHODS We retrospectively examined the records of 350 patients who were given provisional diagnoses of carotid cavernous sinus fistulae or cavernous sinus dural AVF in the division of Interventional Neuroradiology, Ramathibodi Hospital, Bangkok between 2008 and 2014. Any patient with cavernous arteriovenous shunt was excluded. RESULTS Of those 350 patients, 10 patients (2.85%) were identified as having noncavernous sinus AVF. The angiographic diagnoses consisted of three anterior condylar (hypoglossal) dural AVF, two traumatic middle meningeal AVF, one lesser sphenoid wing dural AVF, one vertebro-vertebral fistula (VVF), one intraorbital AVF, one direct dural artery to cortical vein dural AVF, and one transverse-sigmoid dural AVF. Six cases (60%) were found to have venous efferent obstruction. CONCLUSION Arteriovenous shunts mimicking the cavernous AVF are rare, with a prevalence of only 2.85% in this series. The clinical presentation mainly depends on venous outflow. The venous outlet of the arteriovenous shunts is influenced by venous afferent-efferent patterns according to the venous anatomy of the central nervous system and the skull base, as well as by architectural disturbance, specifically, obstruction of the venous outflow. PMID:27767958

  17. Multicystic Hepatocarcinoma Mimicking Liver Abscess

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    Evangelos Falidas


    Full Text Available The diagnosis of hepatocellular carcinoma (HCC became easier in relation to the improved radiological examinations; however, the neoplasm may occur under atypical presentations mimicking other benign or malignant processes. Multicystic HCC mimicking a liver abscess associated with septic-type fever and leukocytosis is rare, has a poor prognosis, and poses diagnostic and therapeutic dilemmas. We present the case of an 80-year-old patient, who presented with fever, leukocytosis, and large cystic masses involving right and left lobes of the liver initially considered abscesses and finally diagnosed as HCC after open drainage and liver biopsy. Although the patient died on the tenth postoperative day due to pulmonary oedema, the authors emphasize the high index of suspicion needed in the diagnosis of this unusual presentation of HCC.

  18. Ibubrofen in the treatment of patent ductus arteriosus in preterm infants: what we know, what we still do not know. (United States)

    Mercanti, Isabelle; Ligi, Isabelle; Boubred, Farid; Grandvuillemin, Isabelle; Buffat, Christophe; Fayol, Laurance; Millet, Veronique; Simeoni, Umberto


    The patency of the ductus arteriosus has ever been considered as a pathological situation in preterm infants and one likely cause of mortality and morbidity, including broncho-pulmonary dysplasia, necrotizing enterocolitis, intraventricular haemorrhage, retinopathy of prematurity. The incidence of patent ductus arteriosus is inversely proportional to gestational age and infants with the lowest gestational ages are the most exposed to the complications of prematurity. So, associations between patent ductus arteriosus and the other morbidities may not be causative and patent ductus arteriosus could be more a sign of immaturity and severity of disease than the cause of these problems. Non-steroidal anti-inflammatory agents, such as indomethacin or ibuprofen, have been shown to be effective in closing or preventing patent ductus arteriosus, with differences in side effects. However nearly all randomized controlled trials have been designed with the closure of the ductus arteriosus, not mortality or morbidity, as the main endpoint. Thus, evidence is still lacking on the eventual benefits for the patient of pharmacological or surgical intervention on PDA. Moreover, both ibuprofen and indomethacin efficacy seems markedly reduced in extremely low gestational age infants, who are the most likely to benefit from such intervention. The explanation of the reduced pharmacodymanic effect in such population is unclear; so far, studies using increased dosing of ibuprofen have failed to show a clear benefit. Prophylaxis with indomethacin or ibuprofen has failed to show sustained benefits on neurodevelopment at 2 years of age in low gestational age infants. New curative trials may aim at investigating the effects of early curative administration of ibuprofen, which has reduced side effects compared to indomethacin, on immature kidney function, on mortality and morbidity in very low gestational age infants, ideally with a combined endpoint such as survival in the absence of severe

  19. Clinical pharmacology of indomethacin in preterm infants: implications in patent ductus arteriosus closure. (United States)

    Pacifici, Gian Maria


    Indomethacin is a non-steroidal anti-inflammatory drug that is a potent inhibitor of prostaglandin E(2) synthesis. After birth, the ductus arteriosus closes spontaneously within 2-4 days in term infants. The major factor closing the ductus arteriosus is the tension of oxygen, which increases significantly after birth. Prostaglandin E(2) has the opposite effect to that of oxygen; it relaxes smooth muscle and tends to inhibit the closure of the ductus arteriosus. In preterm infants with respiratory distress syndrome, the ductus arteriosus fails to close (patent ductus arteriosus [PDA]) because the concentration of prostaglandin E2 is relatively high. PDA occurs in more than 70 % of neonates weighing less than 1,500 g at birth. The aim of this article was to review the published data on the clinical pharmacology of indomethacin in preterm infants in order to provide a critical analysis of the literature and a useful tool for physicians. The bibliographic search was performed electronically using the PubMed and EMBASE databases as search engines and February 2012 was the cutoff point. A remarkable interindividual variability was observed for the half-life (t(½)), clearance (CL), and volume of distribution (V(d)) of indomethacin. Prophylactic indomethacin consists of a continuous infusion of low levels of indomethacin and may be useful in preterm infants. Extremely preterm infants are less likely to respond to indomethacin. Infants with a postnatal age of 2 months do not respond to treatment with indomethacin. Indomethacin has several adverse effects, the most common of which is renal failure. An increase in serum creatinine of ≥0.5 % mg/dL after indomethacin was observed in about 10-15 % of the patients and creatinine returns to a normal level about 1 week after cessation of therapy. Indomethacin should be administered intravenously by syringe pump for at least 30 min to minimize adverse effects on cerebral, gastrointestinal, and renal blood flow velocities. A

  20. Decidualized Ovarian Mass Mimicking Malignancy

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    Lufee Wong


    Full Text Available Deciduosis classically occurs in the context of known endometriosis in the pelvis, most commonly in the ovaries, but also in the peritoneum. However, ovarian deciduosis outside the context of endometriosis is rare and makes diagnosis difficult, especially as the sonographic appearance suggests a malignant process. We report a case of decidualized ovarian mass in a patient without prior history of endometriosis that mimicked an ovarian malignancy. MRI may be a useful imaging modality to monitor these lesions and guide management. Consultation with a multidisciplinary team accustomed to such conditions will help to tailor the management to each individual.

  1. Painful Traumatic Trigeminal Neuropathy. (United States)

    Rafael, Benoliel; Sorin, Teich; Eli, Eliav


    This article discusses neuropathic pain of traumatic origin affecting the trigeminal nerve. This syndrome has been termed painful traumatic trigeminal neuropathy by the International Headache Society and replaces atypical odontalgia, deafferentation pain, traumatic neuropathy, and phantom toothache. The discussion emphasizes the diagnosis and the early and late management of injuries to the trigeminal nerve and subsequent painful conditions.

  2. A case of coarctation of the aorta associated with the patent ductus arteriosus and the persistent left superior vena cava

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    Lee, Yoo Keun [Hanyang University College of Medicine, Seoul (Korea, Republic of)


    This is a case report of multiple congenital vascular anomalies in which coarctation of the aorta combined with the patent ductus arteriosus and the persistent left superior vena cava. The patient was a 15 year old girl and congenital heart disease was suspected during infancy. However, she heard the disease incurable, so she had been well with herb medicine until admission in our hospital. By physical examination and roentgenological studies including aortography, the diagnosis of the patent ductus arteriosus was detected and the coarctation of the aorta was suspected. The persistent left superior vena cava was found during surgery and it was proved roentgenologically by venography.

  3. Simultaneous transcatheter closure of intralobar pulmonary sequestration and patent ductus arteriosus in a patient with infantile Scimitar syndrome. (United States)

    Aslan, Eyüp; Tanıdır, İbrahim Cansaran; Saygı, Murat; Onan, Sertaç Hanedan; Güzeltaş, Alper


    Scimitar syndrome is a rare disease associated with a right lung sequestration vascularised by arteries arising from the abdominal aorta and abnormal venous drainage into the inferior vena cava. The infantile form is generally presented with severe heart failure, pulmonary hypertension and respiratory distress. It may be associated with various intracardiac defects, including atrial septal defects, ventricular septal defects, patent ductus arteriosus or more complicated structural congenital heart defects. Here, we present a 2-month-old girl with Scimitar syndrome whose pulmonary arterial pressure decreased after transcatheter patent ductus arteriosus closure and embolization of the anomalous systemic arterial supply.

  4. Dynamic Changes of Pulmonary Arterial Pressure and Ductus Arteriosus in Human Newborns From Birth to 72 Hours of Age



    Abstract Normal pulmonary artery pressure and pulmonary hypertension assessment of newborns is rarely reported. The aim of the study is to explore dynamic changes of pulmonary arterial pressure and ductus arteriosus in human newborns from birth to 72 h of age with echocardiography. A total of 76 cases of normal newborns were prospectively detected by echocardiography after birth of 2 h, 6 h, 12 h, 24 h, 48 h, and 72 h, respectively. Ductus arteriosus diameter, blood shunt direction, blood flo...

  5. Transcatheter interruption of large residual flow after device closure of "Type A" patent ductus arteriosus

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    Anuradha Sridhar


    Full Text Available We report a case of 3-year-old girl who had persistence of large residual flow following transcatheter closure of a 6 mm ′Type A′ patent ductus arteriosus using a 12 × 10 mm duct occluder. Angiography revealed a large left-to-right shunt coursing through and exiting around the implanted device. Near total abolition of the residual shunt was achieved by initial implantation of an embolization coil within the duct occluder and subsequently an Amplatzer duct occluder (ADO II adjacent to the duct occluder. This challenging case describes an additional technique of abolishing a large residual flow in and around a Nitinol duct occluder device.

  6. Thoracic endovascular aortic repair for patent ductus arteriosus in an elderly patient with congestive heart failure. (United States)

    Kato, Gentaro; Nakai, Mikizo; Tokunaga, Noriyuki; Shimizu, Shuji; Okada, Masahiro


    In elderly patients, open surgery for patent ductus arteriosus (PDA) is more difficult than that in children and often requires a cardiopulmonary bypass. We report the case of a 67-year-old patient with a PDA that was successfully treated with thoracic endovascular aortic repair (TEVAR). The patient was diagnosed with congestive heart failure (ejection fraction, 36 %) and PDA (9.7 mm in diameter). TEVAR was successfully performed to exclude the PDA. After TEVAR, the patient's heart failure was well controlled by diuretics. TEVAR may be a good alternative to open surgery.

  7. Should we definitively abandon prophylaxis for patent ductus arteriosus in preterm new-borns?

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    Vassilios Fanos


    Full Text Available Although the prophylactic administration of indomethacin in extremely low-birth weight infants reduces the frequency of patent ductus arteriosus and severe intraventricular hemorrhage, it does not appear to provide any long-term benefit in terms of survival without neurosensory and cognitive outcomes. Considering the increased drug-induced reduction in renal, intestinal, and cerebral blood flow, the use of prophylaxis cannot be routinely recommended in preterm neonates. However, a better understanding of the genetic background of each infant may allow for individualized prophylaxis using NSAIDs and metabolomics.

  8. Endovascular occlusion of primary major pelvic arteriovenous fistula using patent ductus arteriosus occluder. (United States)

    Xu, L; Wu, Z; Qu, L; Burchell, S


    The aim of the present study was to investigate the effects and safety of a patent ductus arteriosus occluder (PDAO) in the management of major abdominal arteriovenous fistula. A 56-year-old man was admitted into our hospital, presenting with impeded defecation and claudication. Computed tomographic angiography (CTA) was conducted upon admission, which revealed an aneurysm-like lesion, with the left internal iliac artery as its feeding artery. Super-selective embolization treatment was accomplished using a single PDAO. The results of the CTA at follow-up showed no recanalization of the lesion and that a PDAO was at the site. The patient had no pelvic ischemia complications.

  9. Eisenmenger syndrome in an adult patient with a large patent ductus arteriosus

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    Konstantinos Dimopoulos


    Full Text Available This is the case of a young female who was seen at our adult congenital heart disease and pulmonary hypertension service (Royal Brompton Hospital, London, UK at the age of 17 years. She initially presented at the age of 4 years with increasing shortness of breath. At that time, there was differential cyanosis with clubbing and lower oxygen saturations in the toes (82% compared with her fingers (95%. On echocardiography there was evidence of severe pulmonary hypertension and a large patent ductus arteriosus (PDA with low velocity bidirectional shunting. She underwent cardiac catheterisation at the time which showed a pulmonary arterial pressure equal to that of the aorta.

  10. Reflections of the changes in patent ductus arteriosus management during the last 10 years. (United States)

    El-Khuffash, Afif; Weisz, Dany E; McNamara, Patrick J


    Despite a large body of scientific evidence on the management of premature infants with a patent ductus arteriosus controversy remains and neonatologists remain challenged for knowing which patient to treat, what is the most optimal timing of treatment and which treatments have a positive impact on both short-term and long-term outcomes. In this review article we discuss the increased body of evidence over the past 10 years, much of which questions the role of treatment and suggests the need to reconsider how haemodynamic significance is adjudicated. In addition, we discuss novel approaches to assessment and diagnosis, and highlight areas for future investigation.

  11. Use of a Stent Graft for Patent Ductus Arteriosus in an Octogenarian Eliminates Ductus Flow. (United States)

    Tatsuishi, Wataru; Kataoka, Go; Asano, Ryota; Sato, Atsuhiko; Nakano, Kiyoharu


    Closure of a patent ductus arteriosus (PDA) in the elderly is a high-risk procedure because of tissue fragility and many possible complications. The patient in our case was an 81-year-old woman with a window-type PDA caused by cardiac failure. Based on the anatomy of the PDA and aorta and to minimize invasion, we used a stent graft to close the PDA. This approach was successful; hemodynamics improved and ductus flow was eliminated during the follow-up period without intervention from the pulmonary artery side.

  12. [Management of persistent ductus arteriosus in the newborn with respiratory insufficiency]. (United States)

    Hurtado del Rio, D; Holden Barker, A M; Pezzotti, M A; Gutiérrez Bosque, R; Archundia, A; Pérez Mejia, J; Carrillo, H


    Sixteen newborn babies with severe respiratory distress and patent ductus arteriosus with congestive heart failure are presented. Fifteen of them were premature and one at full term. Management consisted of the accepted medical and ventilatory aids such as digitalis, diuretics, ventilators, etc. Thirteen cases were given indomethacin with clinical closure in five of them (38%). Ten cases underwent surgical closure with 30% mortality. It is recommended that these patients be given indomethacin inicially; if there is no response in 36 hours surgical closure of the duct should be performed prior to progressive deterioration and eventual death.

  13. Role of perioperative transesophageal echocardiography in the management of adolescent truncus arteriosus: Rare case report

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    P S Nagaraja


    Full Text Available Truncus arteriosus (TA is a rare congenital heart disease defined as a single arterial vessel arising from the heart that gives origin to the systemic, pulmonary and coronary circulations. The truncal valve in majority of the cases is tricuspid though quadricuspid and bicuspid valves have been reported. Patients with TA typically have a large nonrestrictive sub truncal ventricular septal defect. Survival of these infants beyond 1-year is uncommon. Here, we report a unique case of 12-year-old female patient with persistent TA who underwent surgical repair by using transesophageal echocardiography as a monitoring device during the perioperative management.

  14. An aborted human fetus with truncus arteriosus communis--possible teratogenic effect of Tedral. (United States)

    Matsuoka, R; Gilbert, E F; Bruyers, H; Optiz, J M


    We recently performed a detailed anatomicopathologic examination on an aborted human embryo whose mother had taken four tablets of Tedral (one tablet of Tedral contains 130 mg theophylline, 25 mg ephedrine, 8 mg phenobarbital) for an upper respiratory tract infection when the embryo was at approximately 30 days of development. On the same day, the mother developed acute chest pain and a fast, irregular heart beat. The abortion occurred at approximately 80 days of gestation. The heart of the fetus showed truncus arteriosus (Van Praagh type A1). Although no direct cause and effect relationship was proven in this case, the possibility of a teratogenic effect of Tedral during early pregnancy is considered.

  15. Gout: radiographic findings mimicking infection

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    Rousseau, I.; Raymond-Tremblay, D. [Dept. of Diagnostic Radiology, Centre Hospitalier de l' Univ. de Montreal, Que. (Canada); Cardinal, E. [Dept. of Radiology, Centre Hospitalier de l' Univ. de Montreal, Que. (Canada); Beauregard, C.G. [Dept. of Diagnostic Radiology, Hopital du Sacre-Coeur de Montreal,Que. (Canada); Braunstein, E.M. [Dept. of Radiology, Indiana University Hospital (United States); Saint-Pierre, A. [Rheumatology Unit, Centre Hospitalier de l' Univ. de Montreal, Que. (Canada)


    Objective: To describe radiographic features of gout that may mimic infection. Design and patients: We report five patients with acute bacterial gout who presented with clinical as well as radiological findings mimicking acute bacterial septic arthritis or osteomyelitis. Three patients had delay in the appropriate treatment with the final diagnosis being established after needle aspiration and identification of urate crystals under polarized light microscopy. Two patients underwent digit amputation for not responding to antibiotic treatment and had histological findings confirming the diagnosis of gout. Conclusion: It is important for the radiologist to be aware of the radiological manifestations of acute gout that can resemble infection in order to avoid inappropriate diagnosis and delay in adequate treatment. The definitive diagnosis should rely on needle aspiration and a specific search for urate crystals. (orig.)

  16. Transcatheter closure of tubular type patent ductus arteriosus using Amplatzer� ductal occluder II: a case report

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    Mulyadi M Djer


    Full Text Available Patent ductus arteriosus (PDA is a common congenital heart disease, accounting for 5-10% of all congenital heart diseases. The incidence of PDA is even higher in preterm neonates, ranging from 20-60%.1-4 Closure of PDA is indicated in all cases, except for duct-dependent congenital heart diseases or PDA with Eisenmenger syndrome.1,5,6 In small asymptomatic PDAs, closure is indicated to prevent the risk of complications, such as endarteritis, endocarditis, aneurysm of ductus arteriosus, or congestive heart failure.1,2,7 In recent years, interventional cardiology has become a gold standard therapy for the majority of PDA cases beyond neonatal age. Since its introduction in 1967, many devices and methods have been developed to allow transcatheter closure of virtually all PDAs, regardless of size or configuration. Nevertheless, the tubular shape (type C PDA, which has the highest residual shunt rate, still poses a great challenge for the interventionist.8-10 The second generation of Amplatzer® device occluders (ADO II, released in 2007, has been suggested to be effective in closing tubular PDAs.10 The purpose of this study was to report the initial clinical experience using ADO II to close a tubular type PDA in Indonesia

  17. Percutaneous closure of patent ductus arteriosus: Experience of a tertiary referral center

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    Hasan Kaya


    Full Text Available Objective: We sought to evaluate our clinical experienceand short-term results of percutaneous closure of patentductus arteriosus (PDA.Methods: We studied 20 patients (17 female, mean age24±8 years undergoing percutaneous closure of PDA betweenMarch 2010-March 2013 in our clinic. Amplatzerduct occluder (ADO I was used in 13 patients and ADOII was used in 7 patients for PDA closure. Clinical characteristicsof patients, properties of percutaneous closureintervention, complications and short-term results areevaluated.Results: The mean ductus waist diameter measured byangiographic examination was 5±2 mm (2-9 mm. Procedurewas successfully performed in all patients. Occluderdevice embolization was occurred in one patientin whom device was retrieved by snare catheter and PDAwas successfully closed with same device. The early totalocclusion rate was 85%. Occlusion rate as determinedby echocardiographic control performed the day afterwas 95% whereas 100% at first month. In the follow-up of19±9 months, no complications were observed.Conclusion: Percutaneous closure of PDA using ADO Iand II devices are safe and effective.Key words: patent ductus arteriosus, percutaneous closure,Amplatzer duct occluder

  18. Serum ibuprofen levels of extremely preterm infants treated prophylactically with oral ibuprofen to prevent patent ductus arteriosus

    NARCIS (Netherlands)

    Kanmaz, Gozde; Erdeve, Omer; Canpolat, Fuat Emre; Oguz, Serife Suna; Uras, Nurdan; Altug, Nahide; Greijdanus, Ben; Dilmen, Ugur


    The aim of this study was to explore the effects of early oral ibuprofen administration on the incidence of hemodynamically significant patent ductus arteriosus (hsPDA) and define the association between serum ibuprofen levels and ductal closure. Preterm infants with a gestational age of <28 weeks a

  19. Isolated left brachiocephalic artery with the right aortic arch: A rare differential of large patent ductus arteriosus (United States)

    Dubey, Gajendra; Gupta, Saurabh Kumar; Kothari, Shyam Sundar


    We report a case of isolation of the left brachiocephalic artery with the right aortic arch in a 9-year-old male child masquerading as large patent ductus arteriosus with left-to-right shunt. We have emphasized the subtle clinical findings which served as clues to the diagnosis. PMID:28163435

  20. Right pulmonary artery agenesis with patent ductus arteriosus and Eisenmenger syndrome: a rare case diagnosed during the postpartum period. (United States)

    Beker-Acay, Mehtap; Ozkececi, Gulay; Unlu, Ebru; Hocaoglu, Elif; Kacar, Emre; Onrat, Ersel


    Unilateral absence of a pulmonary artery a very rare congenital disorder. We here present a case of a 22-year-old female patient with agenesis of the right pulmonary artery accompanying patent ductus arteriosus and Eisenmenger syndrome, diagnosed by chest X-ray and multidetector computed tomography 5 days after giving birth.

  1. Coarctation of the Aorta as a Complication of Surgical Ligation of Patent Ductus Arteriosus in a Premature Infant (United States)

    Qasim, Amna; Jain, Sunil K.; Jiwani, Amyn K.


    Surgical ligation of a patent ductus arteriosus (PDA) is a commonly performed procedure. Complications are infrequent and most commonly include recurrent laryngeal nerve injury and rarely ligation of left pulmonary artery. We report a case of accidental ligation of the descending thoracic aorta leading to a clinically significant coarctation. PMID:28386503

  2. Reduction in Cerebral Oxygenation due to Patent Ductus Arteriosus Is Pronounced in Small-for-Gestational-Age Neonates

    NARCIS (Netherlands)

    Cohen, Emily; Dix, Laura; Baerts, Willem; Alderliesten, Thomas; Lemmers, Petra; van Bel, Frank


    BACKGROUND: A haemodynamically significant patent ductus arteriosus (hsPDA) reduces cerebral oxygenation in appropriate-for-gestational-age (AGA) preterm neonates. Reduced cerebral oxygenation has been associated with brain injury. Preterm small-for-gestational-age (SGA) neonates show higher cerebra

  3. Pentoxifylline as adjunct therapy to long-term clinical management of a right-to-left patent ductus arteriosus. (United States)

    Turner, Elizabeth


    Management of a right-to-left ("reversed") patent ductus arteriosus (PDA) focuses on control of clinical signs associated with hyperviscosity due to erythrocytosis. Pentoxifylline therapy is presented as an adjunct to routine phlebotomies for the long-term clinical management of reversed PDA in a 10-year-old Chihuahua.

  4. Thoracic Stent Graft Implantation for Aortic Coarctation with Patent Ductus Arteriosus via Retroperitoneal Iliac Approach in the Presence of Small Sized Femoral Artery

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    Ozge Korkmaz


    Full Text Available Endovascular stent graft implantation is a favorable method for complex aortic coarctation accompanied by patent ductus arteriosus. Herein, an 18-year-old woman with complex aortic coarctation and patent ductus arteriosus was successfully treated by endovascular thoracic stent graft via retroperitoneal approach. The reason for retroperitoneal iliac approach was small sized common femoral arteries which were not suitable for stent graft passage. This case is the first aortic coarctation plus patent ductus arteriosus case described in the literature which is treated by endovascular thoracic stent graft via retroperitoneal approach.

  5. Humanlike Robots - Synthetically Mimicking Humans (United States)

    Bar-Cohen, Yoseph


    Nature inspired many inventions and the field of technology that is based on the mimicking or inspiration of nature is widely known as Biomimetics and it is increasingly leading to many new capabilities. There are numerous examples of biomimetic successes including the copying of fins for swimming, and the inspiration of the insects and birds flight. More and more commercial implementations of biomimetics are appearing and behaving lifelike and applications are emerging that are important to our daily life. Making humanlike robots is the ultimate challenge to biomimetics and, for many years, it was considered science fiction, but such robots are becoming an engineering reality. Advances in producing such robot are allowing them to perform impressive functions and tasks. The development of such robots involves addressing many challenges and is raising concerns that are related to fear of their application implications and potential ethical issues. In this paper, the state-of-the-art of humanlike robots, potential applications and challenges will be reviewed.

  6. Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience (United States)

    Chen, Qiuming; Gao, Huawei; Hua, Zhongdong; Yang, Keming; Yan, Jun; Zhang, Hao; Ma, Kai; Zhang, Sen; Qi, Lei; Li, Shoujun


    Objective This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus. Methods From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years). Results Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years). Thirty patients (60%) were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9) units.m2 and 64.3±17.9 (range, 38 to 101) mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28%) patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335–43.092; p = 0.022). Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II. Conclusions Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up. PMID:26752522

  7. Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience.

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    Qiuming Chen

    Full Text Available This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus.From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years.Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years. Thirty patients (60% were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9 units.m2 and 64.3±17.9 (range, 38 to 101 mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28% patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335-43.092; p = 0.022. Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II.Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up.

  8. Isobaric Tags for Relative and Absolute Quantitation-Based Proteomic Analysis of Patent and Constricted Ductus Arteriosus Tissues Confirms the Systemic Regulation of Ductus Arteriosus Closure. (United States)

    Hong, Haifa; Ye, Lincai; Chen, Huiwen; Xia, Yu; Liu, Yue; Liu, Jinfen; Lu, Yanan; Zhang, Haibo


    We aimed to evaluate global changes in protein expression associated with patency by undertaking proteomic analysis of human constricted and patent ductus arteriosus (DA). Ten constricted and 10 patent human DAs were excised from infants with ductal-dependent heart disease during surgery. Using isobaric tags for relative and absolute quantitation-based quantitative proteomics, 132 differentially expressed proteins were identified. Of 132 proteins, voltage-gated sodium channel 1.3 (SCN3A), myosin 1d (Myo1d), Rho GTPase activating protein 26 (ARHGAP26), and retinitis pigmentosa 1 (RP1) were selected for validation by Western blot and quantitative real-time polymerase chain reaction analyses. Significant upregulation of SCN3A, Myo1d, and RP1 messenger RNA, and protein levels was observed in the patent DA group (all P ≤ 0.048). ARHGAP26 messenger RNA and protein levels were decreased in patent DA tissue (both P ≤ 0.018). Immunohistochemistry analysis revealed that Myo1d, ARHGAP26, and RP1 were specifically expressed in the subendothelial region of constricted DAs; however, diffuse expression of these proteins was noted in the patent group. Proteomic analysis revealed global changes in the expression of proteins that regulate oxygen sensing, ion channels, smooth muscle cell migration, nervous system, immune system, and metabolism, suggesting a basis for the systemic regulation of DA patency by diverse signaling pathways, which will be confirmed in further studies.

  9. 介入治疗动脉导管未闭的护理体会%Nursing experience for treating patent ductus arteriosus by interventional therapy

    Institute of Scientific and Technical Information of China (English)



    介入治疗在医治动脉导管未闭方面具有创伤小、风险小、术后恢复快等优点。对74例动脉导管未闭患者采取了介入治疗、护理之后,有72例痊愈,疗效显著,值得在临床上推广。%In treating patent ductus arteriosus, the interventional therapy hold the advantages of little trauma, low risk, faster postoperative recovery etc. 74 patients with patent ductus arteriosus received the interventional therapy and nursing. 72 cases of patent ductus arteriosus were cured. The interventional therapy was effective on patent ductus arteriosus, and worthy of promotion in clinic.

  10. Truncus arteriosus operado aos 28 anos: importância do diagnóstico diferencial

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    Lilian Maria Lopes


    Full Text Available Descrevemos um caso de adulto de 28 anos com suspeita de cardiopatia congênita desde o nascimento, não tratada na infância por opção da família. Aos 27 anos, foi feito diagnóstico de atresia pulmonar com comunicação interventricular e colaterais sistêmico-pulmonares, sendo contraindicada a cirurgia. Uma nova reavaliação em nosso serviço demonstrou tratar-se de um truncus arteriosus atípico. O fato de um tronco arterial comum com shunt esquerda-direita ter sido visualizado ao ecocardiograma foi um dado crucial para a indicação de novo cateterismo, abrindo perspectiva de correção cirúrgica. No momento, o paciente encontra-se bem, com 7 anos de evolução pós-operatória.

  11. Three-dimensional modeling of a patent ductus arteriosus in a cat. (United States)

    Saunders, A B; Birch, S A


    A left-to-right shunting patent ductus arteriosus was diagnosed in a 13-week-old, 2.5 kg, male, domestic Shorthair cat with a continuous murmur. Echocardiographic abnormalities were identified, including: cardiomegaly, wide and presumably short ductal ampulla, and a large right branch pulmonary artery. When these findings were combined with the small patient size, additional imaging was considered prior to surgical ligation, and computed tomography angiography was preferred over standard angiography to provide multi-dimensional appreciation of the anatomy prior to surgery. The dataset from a computed tomography angiographic study performed prior to surgical ligation was used to create a three-dimensional model of the heart and great vessels. The rendered images accurately depicted the cardiac anatomy in situ, which can be utilized for surgical procedural planning and to enhance visuospatial understanding of the anatomy at all levels of training.

  12. History of the ductus arteriosus: 2. Persisting patency in the preterm infant. (United States)

    Obladen, Michael


    By 1769, it was known to Morgagni that the ductus arteriosus may persist until adulthood. In 1835, Jörg linked delayed postnatal closure with disturbed respiration, a discovery that was afterwards forgotten for a century. When blood gas analysis became available, the association between persisting patency and diminished oxygenation resurfaced. When it became known that prostaglandins played a role in maintaining ductal patency, the development of pharmacologic intervention with cyclooxygenase inhibitors immediately followed. This rapid progress was due to the interaction between basic science, pediatric cardiology, and neonatology disciplines at the Cardiovascular Research Institute in San Francisco, coordinated by Julius Comroe, as well as President Kennedy's foundation of the National Institute of Child Health and Development. This series of events exemplifies how clinical research became an integrated managed multidisciplinary endeavor in the 20th century.


    Directory of Open Access Journals (Sweden)

    Iuliu Scurtu


    Full Text Available Introduction: PDA represents one of the most frequently diagnosed type of congenital heart disease. Ductus arteriosus is a normal structure in foetal life, which permits shunting of oxygenated blood from the pulmonary artery into the aorta. Failure of sealing after birth is an abnormal condition and is called patent ductus arteriosus. In normal PDA, due to fact that systemic pressure is fivefold higher than pulmonary circulation, blood is shunted from the aorta into the pulmonary artery. In reverse PDA, pulmonary artery pressure does not drop after birth, and blood will be shunted form right to left. Aims: We want to evaluate clinical, haematological, ECG and echocardiographic changes in case of reverse PDA. Materials and Methods: Two-year old female Bichon Frise was referred to our clinic with signs of effort intolerance and dyspnoea for more than a year. ECG was performed in the right lateral recumbency using a digital device and echocardiography was done with Esaote MyLab40 Vet with a phased array transducer matched with the size of the dog (7.5 MHz. Results: We identified a dog with a good body score, quite alert and without any sign of illness. Haematological investigation underlined polycythaemia and very high PCV. The ECG revealed a normal sinus rhythm with a deep S wave, changes consistent with right ventricle enlargement.  Right atrial dilation and right ventricle hypertrophy were found on cardiac ultrasonography. The right ventricle free wall was hypertrophied and interventricular septum was flattened, changes consistent with increased pressure on the right side of the heart. The left heart was small. Positive diagnosis was done, performing “bubble study” and identification of contrast bubble within the abdominal aorta.   Conclusion: Reverse PDA is a rarely diagnosed congenital heart disease. Polycythaemia in young dogs could raise the suspicion of reverse PDA.  For positive diagnosis, echocardiography and bubble study are

  14. Intrauterine ductus arteriosus constriction: analysis of a historic cohort of 20 cases

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    Luchese Stelamaris


    Full Text Available OBJECTIVE: To describe the relative incidence, presentation, and evolvement of fetuses with early ductus constriction. METHODS: Twenty fetal echocardiograms indicating ductus constriction were reviewed in a population of 7000 pregnants. RESULTS: The cases were divided into group A (related to maternal use of cyclooxygenase inhibitors [n=7] and group B (idiopathics [n=13]. Mean gestational age was 32.5±3.1 (27-38 weeks and maternal age was 28.2±8.5 (17-42 years. Mean systolic velocity in the ductus was 2.22±0.34 (1.66-2.81 m/s, diastolic velocity 0.79±0.28 (0.45-1.5 m/s, and pulsatility index 1.33±0.36 (0.52-1.83. Two cases of ductal occlusion were noted. In 65% of the cases, an increase occurred in the right cavities; in 90% of the cases, tricuspid or pulmonary regurgitation, or both, occurred, with functional pulmonary atresia in 1 case. Diastolic velocity was greater in group A (1.13±0.33 than in group B (0.68±0.15 (P=0.008. The other data were similar in the 2 groups. The evolvement was not favorable in 4 patients from group B, including 1 death and 2 cases of persistent pulmonary hypertension. CONCLUSION: The high incidence of idiopathic constriction of the ductus arteriosus suggests that its diagnosis is underestimated and that many cases of persistence of fetal circulation in newborns may be related to constriction of the ductus arteriosus not diagnosed during intrauterine life. Group B had a lower severity but a risk of an unfavorable evolvement, suggesting a distinct alteration.

  15. The peptide hormone cholecystokinin modulates the tonus and compliance of the bulbus arteriosus and pre-branchial vessels of the rainbow trout (Oncorhynchus mykiss). (United States)

    Seth, Henrik; Axelsson, Michael; Gräns, Albin


    The bulbus arteriosus is a compliant structure between the ventricle and ventral aorta of teleost fish. It serves as a "wind-kessel" that dampens pressure variations during the cardiac cycle allowing a continuous flow of blood into the gills. The bulbus arteriosus receives sympathetic innervation and is affected by several circulating substances, indicating neurohumoral control. We have previously shown that the peptide hormone, cholecystokinin (CCK), affects the hemodynamics of the cardiovascular system in rainbow trout (Oncorhynchus mykiss) by increasing flow pulse amplitude without affecting cardiac output. We hypothesized that this could be explained by an altered tonus or compliance/distensibility of the bulbus arteriosus. Our results show that there is a substantial effect of CCK on the bulbus arteriosus. Concentrations of CCK that altered the cardiac function of in situ perfused hearts also contracted the bulbus arteriosus in vitro. Pressure-volume curves revealed a change in both the tonus and the compliance/distensibility of this structure. Furthermore, the stimulatory (constricting) effect of CCK was also evident in the ventricle and vasculature leading to the gills, but absent in the atrium, efferent branchial arteries and dorsal aorta. In conclusion, CCK alters the mechanical properties of the ventricle, bulbus arteriosus, ventral aorta and afferent gill vasculature, thus maintaining adequate branchial and systemic blood flow and pressure when cardiorespiratory demands change, such as after feeding.

  16. Evaluation of Risk Factors Related with Neonatal Patent Ductus Arteriosus in Hospitalized Neonates of Neonatal Intensive Care Unit

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    Reza Saeidi


    Full Text Available Background: Patent ductus arteriosus or patent arterial duct (PDA is a condition in which a structure called the ductus arteriosus, normal in fetal life, remains into infancy and onwards, when it should have disappeared. Thus, in this study we want to discuss about frequency of its symptoms and risk factors. Materials and Methods: It is a descriptive study which has been done among 100 newborns registered in Ghaem Hospital of Mashhad. Sampling was gathered easily.Results: The most prevalent symptom among newborn babies was systolic heart murmur (89%. According to the obtained risk factors, hypoxia (71% and acidosis (70% are followed by prematurity (41%. Out of all registered newborn babies 68% were suffering from associated disorders.Conclusion: For achieving an on-time diagnosis of PDA, clinical examination of heart and respiratory symptoms must be examined very precisely. Newborn babies must be examined in terms of two risk factors: prematurity and light weight.

  17. Comparison of two dose regimens of ibuprofen for the closure of patent ductus arteriosus in preterm newborns,

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    Laura Vargas Dornelles


    Full Text Available Abstract Objective: To compare the efficacy of intravenous ibuprofen at high (20-10-10 mg/kg/dose and low doses (10-5-5 mg/kg/dose the closure of patent ductus arteriosus in preterm newborns. Methods: A cohort study with historical control of newborns that received high- and low-dose intravenous ibuprofen, from 2010 to 2013 in a neonatal intensive care unit, for closure of the patent ductus arteriosus, documented by echocardiography. Secondary outcomes included the number of ibuprofen cycles, incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, changes in renal function, and death. Results: Seventy-seven patients received three doses of ibuprofen for the treatment of patent ductus arteriosus, with 33 receiving high-dose and 44 low-dose therapy. The ductus closed after the first cycle in 25 (56.8% low-dose patients and in 17 (51.5% high-dose patients (p > 0.99. Sixteen patients received a second cycle of ibuprofen, and the ductus closed in 50% after low-dose and in 60% after high-dose therapy (p > 0.99. Seven patients required surgery for ductus closure, 13.6% in the low-dose group and 3% in the high-dose group (p = 0.22. Thirty-nine patients developed bronchopulmonary dysplasia, 50% in the low-dose group and 51.5% in the high-dose group (p > 0.99. Twenty-two (50% low-dose patients died vs. 15 (45.5% high-dose patients (p = 0.86. Conclusions: There was no difference in closure of the ductus arteriosus or occurrence of adverse effects between the two dose regimens.

  18. Transcatheter closure of a patent ductus arteriosus in an elderly patient with the Gianturco-Grifka vascular occlusion device. (United States)

    Befeler, B; Justiniano, A; Zahn, E


    This paper reports the unusual case of a 76-year-old woman who was discovered to have a hemodynamically significant patent ductus arteriosus following uneventful mitral valve replacement, utilizing cardiopulmonary bypass. The shunt was successfully eliminated using a new transcatheter device, thereby obviating the need for further surgery. The patient did not have calcification within the ductus, making diagnosis prior to surgery more difficult.

  19. Neurogenic chronic idiopathic intestinal pseudo-obstruction, patent ductus arteriosus, and thrombocytopenia segregating as an X linked recessive disorder. (United States)

    FitzPatrick, D R; Strain, L; Thomas, A E; Barr, D G; Todd, A; Smith, N M; Scobie, W G


    We present a family with three affected males in two generations with congenital neurogenic chronic idiopathic intestinal pseudo-obstruction (CIIP), patent ductus arteriosus, and large platelet thrombocytopenia apparently segregating as an X linked recessive disorder. The pattern of segregation of DNA markers within the family is consistent with linkage to the previously described neurogenic CIIP (CIIPX) locus at Xq28. This combination may represent a new contiguous gene disorder and appears to have a good prognosis with supportive therapy.

  20. Recurrent epiploic appendagitis mimicking appendicitis and cholecystitis (United States)

    Hearne, Christopher B.; Taboada, Jorge


    Epiploic appendagitis (EA) is a rare cause of acute abdominal pain caused by inflammation of an epiploic appendage. It has a nonspecific clinical presentation that may mimic other acute abdominal pathologies on physical exam, such as appendicitis, diverticulitis, or cholecystitis. However, EA is usually benign and self-limiting and can be treated conservatively. We present the case of a patient with two episodes of EA, the first mimicking acute appendicitis and the second mimicking acute cholecystitis. Although recurrence of EA is rare, it should be part of the differential diagnosis of acute, localized abdominal pain. A correct diagnosis of EA will prevent unnecessary hospitalization, antibiotic use, and surgical procedures. PMID:28127129

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  4. A Major Cause of Mortality and Morbidity of Very Low Birth Weight Infants: Patent Ductus Arteriosus

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    Fatih Aygün


    Full Text Available In­tro­duc­ti­on: Patent Ductus Arteriosus (PDA, a cardiac pathology commonly seen in preterm infants, has negative effects on mortality and morbidity. Persistent patency of PDA is positively correlated with respiratory distress syndrome (RDS, prolonged respiratory support, pulmonary hemorrhage, broncopulmonary dysplasia (BPD, necrotizing enterocolitis (NEC, intraventricular hemorrhage, renal failure, neurodevelopmental impairment (cerebral palsy, retinopathy of prematurity and death. The standard treatment regimen is to close symptomatic PDA and cyclooxygenase inhibitors such as indomethacin, ibuprofen are the first choises. Our aim in this study is to report PDA rate, treatment and complications in premature infants. Materials and Methods: This study retrospectively enrolled 103 infants born <33 gestational weeks, without any major congenital anomaly or congenital heart defects between January 2010-November 2011. Echocardiograms was performed in the first week. PDA related pulmonary hemorrhage, NEC, BPD, ROP and death were demonstrated.Results: Among of 103 infants, 45 were male and 58 were female. Seventy infants were born with cesarian section and 33 were born with normal labor. The mean gestational week was 29.7±2.2, the mean gestational week of infants with PDA was 28.8±2.3. The mean birth weight of infants was 1323±375 grams. The mean Apgar score was 7.25±1.83, the scores of infants with patent ductus arteriosus were significantly low (6.7±1.9. Echocardiography was performed on the mean of 4.8±4.4 days, PDA was determined in 48 of 103 infants (%46. The mean of birth weight of infants with persistant PDA was 1162±351 grams, it was 1465±340 g in the closed group. The rate of pulmonary hemorrhage, NEC, BPD, ROP and death was significantly higher in infants with PDA compared with infants having ductal closure (p<0.05.Conclusion: The early closure of PDA in very low birth weight infants will reduce both mortality and early or late

  5. Ovarian Heterotopic Pregnancy Clinically Mimicking Endometrioma

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    Full Text Available Heterotopic pregnancy is a very uncommon entity with a difficult preoperative diagnosis. In the present study, we presented an ovarian heterotopic pregnancy case, clinically mimicking endometrioma developed in a 33-year-old female following an in vitro fertilization procedure. The importance of clinical, histopathological, and immunohistochemical examinations in the diagnosis of heterotopic pregnancy are emphasized.

  6. An adult intussusception mimicking early appendicitis

    Institute of Scientific and Technical Information of China (English)

    Wei-Chun Tseng; Cheng-Ting Hsiao; Yu-Cheng Hung


    Adult intussusception is rare with variable clinical presentation. We reported a case of adult intussusception presenting with symptoms mimicking acute appendicitis. The patient presented as an abdominal pain from epigastric area with shifting gradually to RLQ. The atypical presentation of adult intussusception remains a diagnostic challenge to the emergency physician.

  7. Acute dystonia mimicking angioedema of the tongue

    DEFF Research Database (Denmark)

    Rasmussen, Eva Rye; Pallesen, Kristine A U; Bygum, Anette


    We report a case of acute dystonia of the face, jaw and tongue caused by metoclopramide and mimicking angioedema. The patient had attacks for several years before the correct diagnosis was made and we present the first ever published video footage of an attack. This adverse drug reaction is known...

  8. Toward restrictions on boson stars as black hole mimickers

    Energy Technology Data Exchange (ETDEWEB)

    Guzman, F S, E-mail: [Instituto de Fisica y Matematicas, Universidad Michoacana de San Nicolas de Hidalgo, Edificio C3, Cd. Universitaria, 58040 Morelia, Michoacan (Mexico)


    The status of boson stars as black hole mimickers is presented among other mimickers. We focus on the analysis of the emission spectrum of a simple accretion disk model. We describe the free parameters that allow a boson star to become a black hole mimicker and present an example of a particular astrophysical case.

  9. Patent Ductus Arteriosus in Preterm Infants: Do We Have the Right Answers?

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    Hesham Abdel-Hady


    Full Text Available Patent ductus arteriosus (PDA is a common clinical condition in preterm infants. Preterm newborns with PDA are at greater risk for several morbidities, including higher rates of bronchopulmonary dysplasia (BPD, decreased perfusion of vital organs, and mortality. Therefore, cyclooxygenase (COX inhibitors and surgical interventions for ligation of PDA are widely used. However, these interventions were reported to be associated with side effects. In the absence of clear restricted rules for application of these interventions, different strategies are adopted by neonatologists. Three different approaches have been investigated including prophylactic treatment shortly after birth irrespective of the state of PDA, presymptomatic treatment using echocardiography at variable postnatal ages to select infants for treatment prior to the duct becoming clinically significant, and symptomatic treatment once PDA becomes clinically apparent or hemodynamically significant. Future appropriately designed randomized controlled trials (RCTs to refine selection of patients for medical and surgical treatments should be conducted. Waiting for new evidence, it seems wise to employ available clinical and echocardiographic parameters of a hemodynamically significant (HS PDA to select patients who are candidates for medical treatment. Surgical ligation of PDA could be used as a back-up tool for those patients who failed medical treatment and continued to have hemodynamic compromise.

  10. Transcatheter Closure of Patent Ductus Arteriosus and Atrial Septal Defects Using the Amplatzer Occluder

    Institute of Scientific and Technical Information of China (English)


    Objective:To evalte the efficiency,safety and complications of transcatheter closure of patent ductus arteriosus (PDA) or secundum atrial septal defects (ASD)using the Amplatzer occluder device.Methods:30 patients underwent transcatheter closure of PDA or ASD with the Amplatzer occluder.The lateral descending aortographies were performed to evaluate immediate results in the 20 patients of PDA.Hemodynamics was studied before and after the procedure.X-ray and echocardiography were performed in order to detect residual shunt and recanalization.Results:The device was successfully implanted in 28 patients.There was on clinical evidence of hemolysis andon incidence of device emboliszation.The median operation time waw 56min and median fluoroscopy time was 11min .The devices'positions were optmal and on residual shunt was found 24h and 1month after the procedure No complicatios were observed during the 3-month follow-up in 25 patients.Conclusions:The Amplatzer occluder device is a highly efficient prosthesis that can be safely applied in most patients with PDA or ASD.

  11. Luaran Penutupan Duktus Arteriosus Persisten Transkateter di Rumah Sakit Dr. Hasan Sadikin Bandung

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    Rahmat Budi Kuswiyanto


    Full Text Available Transcatheter closure of patent ductus arteriosus (PDA is a treatment of choice with good efficacy, shorter hospitalization, less risks, and chest scar free. The objective of this study was to evaluate the immediate and mid-term outcomes of transcatheter closure of PDA. An analytic descriptive study was peformed on patients underwent transcatheter PDA occlusion in Dr. Hasan Sadikin General Hospital Bandung between May 2011 and June 2014. Evaluation was conducted through clinical examination and echocardiography 24 hours, 1, 3, 6 and 12 months after the procedure. The procedure was successful in 132 PDA patients (42 males and 90 females. The median age, body weight, systolic pulmonary artery pressure, PDA size, flow ratio, fluoroscopy time, and procedure time were 3.9 years, 11.25 kg, 56 mmHg, 3.4 mm, 2.8, 16 minutes, and 67 minutes, respectively. Immediately after the procedure, 54% patients had complete closure, 41% experienced smoky residual shunt and only 5% experienced small residual shunt. The mortality and complication rate was 3.8%. Most of the patients were discharged the next day after the procedure. All patients showed complete closure during followed-up. Transcatheter closure of PDA is safe and effective with shorter hospitalization and minimum complications. [MKB. 2016;48(4:234–40

  12. Management of patent ductus arteriosus in preterm infants--where do we stand? (United States)

    Mitra, Souvik; Rønnestad, Arild; Holmstrøm, Henrik


    Patent ductus arteriosus (PDA) in preterm infants is a controversial topic in the management of preterm neonates. There are no generally accepted guidelines for diagnosis, treatment, and follow-up of PDA, and few publications have covered the whole topic or have been conclusively summarized to give a proper direction for the treating physician. Major issues remain to be clarified, both with respect to diagnosis and treatment. The definition of hemodynamic significance varies because of different use of echocardiographic criteria and uncertainty about the role of biomarkers. The detailed risks and benefits of available treatment alternatives are still under investigation. There has been a general shift in the management of PDA in preterm neonates from the "aggressive approach" to a more "conservative approach," but the effects of this strategy on morbidity in a longer time perspective are not fully known. An individualized therapeutic strategy with special emphasis on identification of hemodynamically significance seems to be the way forward. In this review we put forward the scientific background in favor of a seemingly growing body of evidence against active treatment, but we raise caution against shying away from all forms of treatment or instituting them too late. Finally, we try to integrate the current knowledge into suggestions for the management of PDA in premature infants.

  13. Mechanical and in vitro evaluation of an experimental canine patent ductus arteriosus occlusion device. (United States)

    Wierzbicki, Mark A; Bryant, Jesse; Miller, Matthew W; Keller, Brandis; Maitland, Duncan J


    Patent ductus arteriosus (PDA) is a congenital cardiovascular malformation in which a fetal connection between the aorta and pulmonary artery remains patent after birth. This defect commonly results in clinical complications, even death, necessitating closure. Surgical ligation is the most common treatment but requires a thoracotomy and is therefore invasive. A minimally invasive option is preferable. A prototype device for PDA occlusion which utilizes shape memory polymer foams has been developed and evaluated using mechanical and in vitro experiments. Removal force and radial pressure measurements show that the prototype device exhibited a lower removal force and radial pressure than a commercially available device. The in vitro experiments conducted within simplified and physiological PDA models showed that the prototype does not migrate out of position into the pulmonary artery at either physiological or elevated pressures in multiple model configurations. While the radial pressure and removal force were lower than commercial devices, the device performed acceptably in the in vitro benchtop experiments warranting further prototype development.

  14. Pharmacoeconomics of Surgical Interventions vs. Cyclooxygenase Inhibitors for the Treatment of Patent Ductus Arteriosus (United States)

    Turck, Charles J; Marsh, Wallace; Stevenson, James G.; York, John M.; Miller, Henry; Patel, Snehal


    Management of neonatal patent ductus arteriosus (PDA) often is resource-intensive and costly. Therefore, it is in hospitals' best interests to ensure the most cost-efficient use of associated resources. Clinical status, comorbidities, and response to prior therapy are considered in selecting the most appropriate intervention for PDA management. Currently, supportive measures (e.g., fluid restriction), surgical ligation, and pharmacologically based medical therapy are the primary treatment modalities for correcting PDA. Medical therapy, which comprises a small percentage (2.0%–5.0%)1 of overall PDA treatment expenses in the United States, consists of either of the 2 intravenous (IV) cyclooxygenase (COX) inhibitors: IV indomethacin and the newly available IV ibuprofen lysine. Although IV COX inhibitors represent a small portion of medical expenses, their benefits appear to be considerable. Pharmacoeconomic studies have evaluated indomethacin's beneficial impact on cost-effectiveness per quality-adjusted life year in PDA prophylaxis; however, no analysis to date prospectively assesses the effect of COX inhibitors on resource use or expenses in treating PDA. Such analysis is desirable and should consider efficacy and safety outcomes, impact on health care resource use and length of stay (LOS), and any differential effects of the agents' safety profiles; notably, IV indomethacin adversely affects renal and mesenteric blood flow and increases serum creatinine and oliguria significantly more than IV ibuprofen. These observations lay the foundation to conduct studies assessing the influence of these differences on resource use, LOS and expenses associated with PDA management. PMID:23055853

  15. Pharmacokinetics and clinical efficacy of indomethacin in premature infants with patent ductus arteriosus. (United States)

    Regazzi, M B; Rondanelli, R; Vidale, E; Chirico, G; Rondini, G; Chiara, A; Piccolo, A


    Despite a considerable amount of investigation, controversy continues concerning the use of indomethacin in inducing the closure of patent ductus arteriosus. This controversy may be attributable to differences in dosage, route of administration, postnatal age at treatment and the variable pharmacokinetics of the drug in premature infants. The pharmacokinetics and clinical efficacy of i.v. administered indomethacin in five premature infants with PDA were evaluated. There was considerable intersubject variability in the half life of elimination (63.1 +/- 38 h). This variability was mainly due to clearance (0.0086 +/- 0.0069 l/h/kg) rather than to distribution volume variability (0.54 +/- 0.27 l/kg). A reduction of half life was observed after the second dose, probably due to a maturation process. A permanent closure of the ductus was obtained in two patients after the first dose and in two patients after the second dose. The side-effects observed in our infants were transient and no long-term complication was attributable to this drug.

  16. [Percutaneous closure of patent ductus arteriosus: results and costs compared to surgical closure]. (United States)

    Vieu, T; Beaurain, S; Angel, C; Leriche, H; Petit, J; Conso, J F; Planché, C; Losay, J


    The comparison of the clinical results and costs of the two methods of closure of patient ductus arteriosus was undertaken in two comparable groups of 40 patients treated in the same period in the same hospital. After transcatheter closure there was a 9% residual shunt rate at 3 years, the 2 patients with a residual continuous murmur being operated secondarily. The only complication was severe haemolysis which regressed after transcatheter ablation of the prosthesis. After surgical closure, there were no residual shunt. Some postoperative complications were observed in 20% of cases, usually benign (ventilatory problems, dysphonia or urinary infection), but occasionally more serious (peroperative lesion of the pulmonary artery). Morbidity, inherent to the technique of closure, was very different and much less in catheter closure. The average cost (daily cost x average length of hospital stay) was much less with transcatheter closure 38,558 francs versus 11,240 francs. On the other hand, the direct cost of transcatheter closure was greater than that of surgery: 32,798 francs versus 20,903 francs, the difference being related to the actual price of the prosthesis. The authors conclude that the 3 year results of transcatheter closure of patent ductus arterious make this technique a reasonable therapeutic alternative to surgery. From the safety point of view, the two techniques are comparable bu patient confort is greater with transcatheter closure for an increase in cost of the initial procedure which should decrease in relation to the types and prices of the prosthesis used.

  17. Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation.

    LENUS (Irish Health Repository)

    Noori, S


    Objective:We performed a multicenter study of preterm infants, who were about to undergo patent ductus arteriosus ligation, to determine whether echocardiographic indices of impaired myocardial performance were associated with subsequent development of catecholamine-resistant hypotension following ligation.Study Design:A standardized treatment approach for hypotension was followed at each center. Infants were considered to have catecholamine-resistant hypotension if their dopamine infusion was >15 μg kg(-1)min(-1). Echocardiograms and cortisol measurements were obtained between 6 and 14 h after the ligation (prior to the presence of catecholamine-resistant hypotension).Result:Forty-five infants were enrolled, 10 received catecholamines (6 were catecholamine-responsive and 4 developed catecholamine-resistant hypotension). Catecholamine-resistant hypotension was not associated with decreased preload, shortening fraction or ventricular output. Infants with catecholamine-resistant hypotension had significantly lower levels of systemic vascular resistance and postoperative cortisol concentration.Conclusion:We speculate that low cortisol levels and impaired vascular tone may have a more important role than impaired cardiac performance in post-ligation catecholamine-resistant hypotension.Journal of Perinatology advance online publication, 14 August 2014; doi:10.1038\\/jp.2014.151.

  18. The expression of VEGF and its receptors in the human ductus arteriosus. (United States)

    Weber, Sven C; Rheinlaender, Cornelia; Sarioglu, Nanette; Peiser, Christian; Rüdiger, Mario; Obladen, Michael; Koehne, Petra S


    Programmed proliferative degeneration of the human fetal ductus arteriosus (DA) preceding definite postnatal closure has a large developmental variability and is controlled by several signaling pathways. Among these vascular endothelial growth factor (VEGF) and its receptors (VEGF-Rs) play an important role. Until now, gestational age dependent expression of VEGF and its receptors has not been investigated in a large number of human DA tissue specimens. We examined protein expression of VEGF and the three VEGF-Rs immunohistochemically in 63 human fetal autopsy DA specimens of 11-38 wk gestation. Specimens were classified into different maturity stages according to their histologic appearance. VEGF and VEGF-Rs-staining was detected in all maturity stages. VEGF-staining was localized perinuclearly in all vascular layers and did not change during development. VEGF-R1 and VEGF-R3 expression was marked in the endothelium in early maturity stages and decreased during development. In contrast, -R2 predominated in the media in later developmental stages. Our results emphasize the importance of VEGF as a mediator during programmed proliferative degeneration of fetal DA and support the hypothesis that VEGF-R1 and VEGF-R3 are required for normal blood vessel development during embryogenesis. In contrast, VEGF-R2 is the predominant receptor in later angiogenic signaling.

  19. Facilitating post traumatic growth

    Directory of Open Access Journals (Sweden)

    Cox Helen


    Full Text Available Abstract Background Whilst negative responses to traumatic injury have been well documented in the literature, there is a small but growing body of work that identifies posttraumatic growth as a salient feature of this experience. We contribute to this discourse by reporting on the experiences of 13 individuals who were traumatically injured, had undergone extensive rehabilitation and were discharged from formal care. All participants were injured through involvement in a motor vehicle accident, with the exception of one, who was injured through falling off the roof of a house. Methods In this qualitative study, we used an audio-taped in-depth interview with each participant as the means of data collection. Interviews were transcribed verbatim and analysed thematically to determine the participants' unique perspectives on the experience of recovery from traumatic injury. In reporting the findings, all participants' were given a pseudonym to assure their anonymity. Results Most participants indicated that their involvement in a traumatic occurrence was a springboard for growth that enabled them to develop new perspectives on life and living. Conclusion There are a number of contributions that health providers may make to the recovery of individuals who have been traumatically injured to assist them to develop new views of vulnerability and strength, make changes in relationships, and facilitate philosophical, physical and spiritual growth.

  20. Facilitating post traumatic growth (United States)

    Turner, de Sales; Cox, Helen


    Background Whilst negative responses to traumatic injury have been well documented in the literature, there is a small but growing body of work that identifies posttraumatic growth as a salient feature of this experience. We contribute to this discourse by reporting on the experiences of 13 individuals who were traumatically injured, had undergone extensive rehabilitation and were discharged from formal care. All participants were injured through involvement in a motor vehicle accident, with the exception of one, who was injured through falling off the roof of a house. Methods In this qualitative study, we used an audio-taped in-depth interview with each participant as the means of data collection. Interviews were transcribed verbatim and analysed thematically to determine the participants' unique perspectives on the experience of recovery from traumatic injury. In reporting the findings, all participants' were given a pseudonym to assure their anonymity. Results Most participants indicated that their involvement in a traumatic occurrence was a springboard for growth that enabled them to develop new perspectives on life and living. Conclusion There are a number of contributions that health providers may make to the recovery of individuals who have been traumatically injured to assist them to develop new views of vulnerability and strength, make changes in relationships, and facilitate philosophical, physical and spiritual growth. PMID:15248894

  1. Spherical Boson Stars as Black Hole mimickers

    CERN Document Server

    Guzman, F S; 10.1103/PhysRevD.80.084023


    We present spherically symmetric boson stars as black hole mimickers based on the power spectrum of a simple accretion disk model. The free parameters of the boson star are the mass of the boson and the fourth order self-interaction coefficient in the scalar field potential. We show that even if the mass of the boson is the only free parameter it is possible to find a configuration that mimics the power spectrum of the disk due to a black hole of the same mass. We also show that for each value of the self-interaction a single boson star configuration can mimic a black hole at very different astrophysical scales in terms of the mass of the object and the accretion rate. In order to show that it is possible to distinguish one of our mimickers from a black hole we also study the deflection of light.

  2. Cardiac sarcoidosis mimicking right ventricular dysplasia. (United States)

    Shiraishi, Jun; Tatsumi, Tetsuya; Shimoo, Kazutoshi; Katsume, Asako; Mani, Hiroki; Kobara, Miyuki; Shirayama, Takeshi; Azuma, Akihiro; Nakagawa, Masao


    A 59-year-old woman with skin sarcoidosis was admitted to hospital for assessment of complete atrioventricular block. Cross-sectional echocardiography showed that the apical free wall of the right ventricle was thin and dyskinetic with dilation of the right ventricle. Thallium-201 myocardial imaging revealed a normal distribution. Both gallium-67 and technetium-99m pyrophosphate scintigraphy revealed no abnormal uptake in the myocardium. Right ventriculography showed chamber dilation and dyskinesis of the apical free wall, whereas left ventriculography showed normokinesis, mimicking right ventricular dysplasia. Cardiac sarcoidosis was diagnosed on examination of an endomyocardial biopsy specimen from the right ventricle. A permanent pacemaker was implanted to manage the complete atrioventricular block. After steroid treatment, electrocardiography showed first-degree atrioventricular block and echocardiography revealed an improvement in the right ventricular chamber dilation. Reports of cardiac sarcoidosis mimicking right ventricular dysplasia are extremely rare and as this case shows, right ventricular involvement may be one of its manifestations.

  3. [Morgagni hernia mimicking intrathoracic lipomatous tumor]. (United States)

    Pinto, Carlos Silva; Bernardo, João; Eugénio, Luís; Antunes, Manuel J


    Morgagni hernia is the rarest type of diaphragmatic hernia, accounting for 2% of all cases. It consists in the thoracic protrusion of fat and/or abdominal viscera through a congenital defect in a retro or parasternal position. The clinical importance of this pathological entity is associated with the fact that it can be asymptomatic, mimicking other diseases, such as a large intrathoracic lipoma, as it happened in the case presented here. Incorrect diagnosis can cause catastrophic complications during surgery.

  4. Intra-abdominal gout mimicking pelvic abscess

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Chia-Hui; Chen, Clement Kuen-Huang [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (Taiwan); National Yang-Ming University, School of Medicine, Taipei (Taiwan); Yeh, Lee-Ren; Pan, Huay-Ban; Yang, Chien-Fang [Kaohsiung Veterans General Hospital, Department of Radiology, Kaohsiung (Taiwan)


    Gout is the most common crystal-induced arthritis. Gouty tophi typically deposit in the extremities, especially toes and fingers. We present an unusual case of intrapelvic tophaceous gout in a patient suffering from chronic gouty arthritis. CT and MRI of the abdomen and pelvic cavity disclosed calcified gouty tophi around both hips, and a cystic lesion with peripheral enhancement in the pelvic cavity along the course of the iliopsoas muscle. The intra-abdominal tophus mimicked pelvic abscess. (orig.)

  5. Benzalkonium Chloride Intoxication Mimicking Herpes Zoster Encephalitis


    Güler, Ekrem; Olgar, Şeref; Davutoğlu, Mehmet; Garipardıç, Mesut; Karabiber, Hamza


    Benzalkonium chloride (BAC) is a frequently used disinfectant and its most well-known side effect is contact dermatitis. In this report, two children who had vesicular dermatitis, headache, lethargy, fever and encephalopathy mimicking Herpes zoster encephalitis were presented. Their consciousness level improved on the second day. From the medical history it was understood that the mother had applied 20% BAC solution to the scalps of two children. The aim of the presentation of this report is ...

  6. Benzalkonium Chloride Intoxication Mimicking Herpes Zoster Encephalitis


    Ekrem Güler; Şeref Olgar; Mehmet Davutoğlu; Mesut Garipardıç; Hamza Karabiber


    Benzalkonium chloride (BAC) is a frequently used disinfectant and its most well-known side effect is contact dermatitis. In this report, two children who had vesicular dermatitis, headache, lethargy, fever and encephalopathy mimicking Herpes zoster encephalitis were presented. Their consciousness level improved on the second day. From the medical history it was understood that the mother had applied 20% BAC solution to the scalps of two children. The aim of the presentation of this report is...

  7. Intradural extramedullary tuberculoma mimicking en plaque meningioma

    Directory of Open Access Journals (Sweden)

    Ozek Erdinc


    Full Text Available In this paper we report an 18 year old woman with an intradural extramedullary tuberculoma mimicking en plaque meningioma located in the thoracic region. The patient was operated via thoracic laminoplasty and tumor was totally resected. On the follow-up examination the magnetic resonance imaging demonstrated the total excision of the tumor. Here we describe a case of intradural extramedullary tuberculoma of the spinal cord as a complication of tuberculosis meningitis in a previously healthy young female.

  8. [Traumatic and occupational deafness]. (United States)

    Poncet, J L; Kossowski, M; Verdaille, P


    The frequency of accidental, traumatic hearing loss is increasing due to a sometimes violently noisy environment and to the development of sports as leisure activities. The diagnosis is based on knowledge of the circumstances of the trauma and on otoscopic examination. Total audiometry localises the damage. Occupational hearing loss forms a special subset of traumatic deafness. This trauma is usually due to intense noise occurring at the work-place. It is of insidious onset, irreversibly progressive and without treatment once under way; Prevention is based on knowledge of the deleterious effects of noise and on the individual factors of the subject at risk.

  9. Anomalous left coronary artery from the pulmonary artery with a large patent ductus arteriosus: aversion of a catastrophe. (United States)

    Aggarwal, Sanjeev; Delius, Ralph E; Pettersen, Michael D


    We present an infant who had an anomalous left coronary artery arising from the pulmonary artery (ALCAPA) and a large patent ductus arteriosus (PDA), who was diagnosed before a potentially catastrophic closure of PDA. In the presence of normal left ventricular function and the absence of coronary artery collaterals, it is difficult to diagnose ALCAPA. A disproportionate degree of left ventricular dilation and severity of mitral valve regurgitation relative to the degree of PDA shunt, and echogenic papillary muscles on an echocardiogram should raise a suspicion of coronary artery anomalies. The infant underwent surgical ligation of PDA with translocation of coronary arteries and had an uneventful recovery.

  10. Clinical Exploration of Transcatheter Closure of Patent Ductus Arteriosus With Duct Occluder in Infants

    Institute of Scientific and Technical Information of China (English)

    Mingyang Qian; Yufen Li; Zhiwei Zhang; jijun Shi; Shushui Wang; Junjie Li


    To explore the feasibility,necessity,and security of transcatheter closure of patent ductus arteriosus (PDA) in infants.Methods There were 230 infants with PDA.The ages were (7.3 ± 3.2) months and the weight (6.6 ± 2.8) Kg in average.They were separated into two groups.Group A was formed by the infants weighing less than 6 Kg,Group B over 6 Kg.Right heart catheterizaton was performed first to calculate the ratio of Qp/Qs.Then descending aortography demonstrated the diameter and shape of PDA.Proper occluder was selected to finish the intervention.Echocardiography was performed after intervention 24 hours and 1,3,6,12 and 24 months.Results In Group A the technical achievement ratio was 94.6% with the average diameter of PDA (6.2 ± 3.2) mm.In Group B the technical achievement ratio was 100% with the average diameter of PDA (4.8 ±2.5) mm.We used the Amplatzer Duct Occluder with the type from 6-8 mm to 12-14 mm,the delivery sheath from 6 French to 8 French.24 hours after intervention,echocardiography demonstrated that there were 6 residual shunts in Group A while 22 in Group B.After 1 year,residual shunt existed in neither group.There were 4 patients whose femoral arteries pulsed weakly after intervention in Group A,while in Group B there were 3.They all recovered 24 hours after the application of urokinase.In Group A blood flow velocity in descending aorta increased in 5 infants,while in Group B there were 3.They all resumed in 6-12 months.Conclusions Transcatheter closure of PDA in infants is safe and technically feasible.However,indication should be strictly selected and the intervention should be performed by experienced physician.

  11. Transcatheter closure of patent ductus arteriosus: Evaluating the effect of the learning curve on the outcome

    Directory of Open Access Journals (Sweden)

    Azhar Ahmad


    Full Text Available Background and Objectives : Initial experience with transcatheter closure of patent ductus arteriosus (PDA using detachable coils and Amplatzer duct occluder devices is reported. We evaluated the outcome, complications, and influence of the learning curve, and also assessed the need of surgical backup for such interventional procedures. Methods: From January 2000 to December 2004, 121 patients underwent transcatheter closure of PDA. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for appropriately choosing the occluder device type and size. A second aortic angiogram was performed 10 minutes after device deployment. Echocardiography was repeated at intervals of 24 hours, then at 1, 3, and 6 months after the procedure to assess complications. Stepwise multiple regression analysis was used to assess the role of experience in improving the outcome of the procedure. Results: Of 121 cases, four patients had pulmonary artery embolization of the occluder device which was successfully retrieved in the catheterization laboratory, while two others had embolization that required surgical intervention. Four patients had temporary residual leak, nine had protrusion of the device into the aorta without significant Doppler pressure gradient or hemolysis on follow-up, and five had partial hemodynamically insignificant obstruction to the left pulmonary artery. Statistical analysis showed that the effect of the learning curve and experience was responsible for 93% improvement in the procedural outcome over the five-year study period. Conclusion: Transcatheter occlusion of PDA is safe and effective alternative to surgery. Complications occurred in those with unfavorable duct anatomy and with the use of multiple coils. Surgical backup was important for such interventional procedures. Experience played a major role in the proper choice of device type and size which greatly influenced the outcome of the procedure.

  12. Different doses of ibuprofen in the treatment of patent ductus arteriosus: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    E Amini


    Full Text Available Background: Patent ductus arteriosus (PDA is a common finding among premature or low-birth-weight infants and it often does not close. Nowadays, drugs used for its treatment include indomethacin and more commonly ibuprofen. Oral ibuprofen was recently shown to be as effective and have several important advantages in preterm infants. Studies performed to find the best dose of ibuprofen for PDA treatment are limited; hence, we compared the effects of two different doses of ibuprofen in this interventional study.Methods: In this randomized controlled clinical trial, we randomly divided 60 patients with echocardiographically confirmed PDA into two groups of 30. This study was done in NICU of Valiasr hospital in 1387-89 years. In the first group, we administered a loading dose of 10 mg/kg ibuprofen on the first day, followed by two doses of 5 mg/kg in the next two days. In the second group, we administered a loading dose of 15 mg/kg ibuprofen on the first day followed by two doses of 7.5 mg/kg in next two days. Eventually, we compared PDA closure rates and complications of therapy between the two groups. Results: Thirty (100% patients in 15-mg/kg group and 23 (76.7% patients in 10 mg/kg group had successful PDA closure with no need for surgery. The two groups had a statistically significant difference (P=0.011 and the highest response to treatment was seen within the first 24 hours of treatment.Conclusion: We may conclude that higher doses of ibuprofen (15 and 2×7.5 mg/kg would offer better outcomes for PDA closure without gastrointestinal or renal complications and less need for surgery.

  13. Radionuclide determination of left-to-right shunt in patients with patent ductus arteriosus

    Energy Technology Data Exchange (ETDEWEB)

    Klepzig, H. Jr.; Sievert, H.; Mildenberger, D.; Bussmann, W.D.; Kaltenbach, M.; Standke, R.; Hoer, G.


    In 9 patients with patent ductus arteriosus, quantification of left-to-right shunt was performed with dye dilution curves after peripheral injection and with radionuclide ventriculography. The study was repeated within 7 days after successful transluminal occlusion of the ductus with an Ivalon-plug. Reproducibility of the method could be studied in one patient in whom reopening of the ductus occurred. Dye dilution curves were analyzed using the method of Carter et al. Radionuclide ventriculography was performed as a combined first-pass and equilibrium study: effective stroke volume was derived from the first pass of the tracer through the heart; during the equilibrium phase left ventricular ejection fraction (EF) and left ventricular enddiastolic volume (EDV) were evaluated. The difference between total left ventricular stroke volume (product of EF and EDV) and effective stroke volume was taken as shunt volume. This volume as a fraction of total left ventricular stroke volume resulted in percent left-to-right shunt. The sensitivity of the dye technique was 78%; a quantification of the shunt lesion was possible in 55% of all cases (shunt greater than 35%). The sensitivity of the radionuclide technique was 90%. The severity of the lesion could not be determined in one patient with a minimal shunt. After successful occlusion of the ductus, dye dilution curves normalized in all cases. Radionuclide ventriculography showed normalization in all but one patient. This patient with concomitant mitral regurgitation still showed moderate left ventricular volume overload. After occlusion, left ventricular enddiastolic volume significantly decreased (from 224 to 181 ml, p < 0.05), effective cardiac output increased (from 6186 to 7476 ml, p < 0.01) and ejection fraction remained unchanged (55 vs. 51%). (orig./TRV).

  14. Treatment of severe pulmonary hypertension in the setting of the large patent ductus arteriosus. (United States)

    Niu, Mary C; Mallory, George B; Justino, Henri; Ruiz, Fadel E; Petit, Christopher J


    Treatment of the large patent ductus arteriosus (PDA) in the setting of pulmonary hypertension (PH) is challenging. Left patent, the large PDA can result in irreversible pulmonary vascular disease. Occlusion, however, may lead to right ventricular failure for certain patients with severe PH. Our center has adopted a staged management strategy using medical management, noninvasive imaging, and invasive cardiac catheterization to treat PH in the presence of a large PDA. This approach determines the safety of ductal closure but also leverages medical therapy to create an opportunity for safe PDA occlusion. We reviewed our experience with this approach. Patients with both severe PH and PDAs were studied. PH treatment history and hemodynamic data obtained during catheterizations were reviewed. Repeat catheterizations, echocardiograms, and clinical status at latest follow-up were also reviewed. Seven patients had both PH and large, unrestrictive PDAs. At baseline, all patients had near-systemic right ventricular pressures. Nine catheterizations were performed. Two patients underwent 2 catheterizations each due to poor initial response to balloon test occlusion. Six of 7 patients exhibited subsystemic pulmonary pressures during test occlusion and underwent successful PDA occlusion. One patient did not undergo PDA occlusion. In follow-up, 2 additional catheterizations were performed after successful PDA occlusion for subsequent hemodynamic assessment. At the latest follow-up, the 6 patients who underwent PDA occlusion are well, with continued improvement in PH. Five patients remain on PH treatment. A staged approach to PDA closure for patients with severe PH is an effective treatment paradigm. Aggressive treatment of PH creates a window of opportunity for PDA occlusion, echocardiography assists in identifying the timing for closure, and balloon test occlusion during cardiac catheterization is critical in determining safety of closure. By safely eliminating the large PDA

  15. Differential temporal and spatial progerin expression during closure of the ductus arteriosus in neonates.

    Directory of Open Access Journals (Sweden)

    Regina Bökenkamp

    Full Text Available Closure of the ductus arteriosus (DA at birth is essential for the transition from fetal to postnatal life. Before birth the DA bypasses the uninflated lungs by shunting blood from the pulmonary trunk into the systemic circulation. The molecular mechanism underlying DA closure and degeneration has not been fully elucidated, but is associated with apoptosis and cytolytic necrosis in the inner media and intima. We detected features of histology during DA degeneration that are comparable to Hutchinson Gilford Progeria syndrome and ageing. Immunohistochemistry on human fetal and neonatal DA, and aorta showed that lamin A/C was expressed in all layers of the vessel wall. As a novel finding we report that progerin, a splicing variant of lamin A/C was expressed almost selectively in the normal closing neonatal DA, from which we hypothesized that progerin is involved in DA closure. Progerin was detected in 16.2%±7.2 cells of the DA. Progerin-expressing cells were predominantly located in intima and inner media where cytolytic necrosis accompanied by apoptosis will develop. Concomitantly we found loss of α-smooth muscle actin as well as reduced lamin A/C expression compared to the fetal and non-closing DA. In cells of the adjacent aorta, that remains patent, progerin expression was only sporadically detected in 2.5%±1.5 of the cells. Data were substantiated by the detection of mRNA of progerin in the neonatal DA but not in the aorta, by PCR and sequencing analysis. The fetal DA and the non-closing persistent DA did not present with progerin expressing cells. Our analysis revealed that the spatiotemporal expression of lamin A/C and progerin in the neonatal DA was mutually exclusive. We suggest that activation of LMNA alternative splicing is involved in vascular remodeling in the circulatory system during normal neonatal DA closure.

  16. Calcium-dependent and calcium-sensitizing pathways in the mature and immature ductus arteriosus. (United States)

    Clyman, Ronald I; Waleh, Nahid; Kajino, Hiroki; Roman, Christine; Mauray, Francoise


    Studies performed in sheep and baboons have shown that after birth, the normoxic muscle media of ductus arteriosus (DA) becomes profoundly hypoxic as it constricts and undergoes anatomic remodeling. We used isolated fetal lamb DA (pretreated with inhibitors of prostaglandin and nitric oxide production) to determine why the immature DA fails to remain tightly constricted during the hypoxic phase of remodeling. Under normoxic conditions, mature DA constricts to 70% of its maximal active tension (MAT). Half of its normoxic tension is due to Ca(2+) entry through calcium L-channels and store-operated calcium (SOC) channels. The other half is independent of extracellular Ca(2+) and is unaffected by inhibitors of sarcoplasmic reticulum (SR) Ca(2+) release (ryanodine) or reuptake [cyclopiazonic acid (CPA)]. The mature DA relaxes slightly during hypoxia (to 60% MAT) due to decreases in calcium L-channel-mediated Ca(2+) entry. Inhibitors of Rho kinase and tyrosine kinase inhibit both Ca(2+)-dependent and Ca(2+)-independent DA tension. Although Rho kinase activity may increase during gestation, immature DA develop lower tensions than mature DA, primarily because of differences in the way they process Ca(2+). Calcium L-channel expression increases with advancing gestation. Under normoxic conditions, differences in calcium L-channel-mediated Ca(2+) entry account for differences in tension between immature (60% MAT) and mature (70% MAT) DA. Under hypoxic conditions, differences in both calcium L-channel-dependent and calcium L-channel-independent Ca(2+) entry, account for differences in tension between immature (33% MAT) and mature (60% MAT) DA. Stimulation of Ca(2+) entry through reverse-mode Na(+)/Ca(2+) exchange or CPA-induced SOC channel activity constrict the DA and eliminate differences between immature and mature DA during both hypoxia and normoxia.

  17. Comparison of the Mortality and In-Hospital Outcomes of Preterm Infants Treated with Ibuprofen for Patent Ductus Arteriosus with or without Clinical Symptoms Attributable to the Patent Ductus Arteriosus at the Time of Ibuprofen Treatment. (United States)

    Yoo, Hani; Lee, Jin A; Oh, Sohee; Jung, Young Hwa; Sohn, Jin A; Shin, Seung Han; Choi, Chang Won; Kim, Ee Kyung; Kim, Han Suk; Kim, Beyong Il


    The aim of this study was to assess the differences in the mortality and in-hospital outcomes of preterm infants with patent ductus arteriosus (hsPDA) at the time of first ibuprofen treatment. In total, 91 infants born from April 2010 to March 2015 were included. Fourteen infants (15.4%) received ibuprofen treatment when there were clinical symptoms due to hsPDA (clinical symptoms group). In clinical symptoms group, infants were younger (25 [23-27] vs. 26 [23-27] weeks; P = 0.012) and lighter (655 [500-930] vs. 880 [370-1,780] grams; P patent ductus arteriosus (PDA) ligation and the incidence of bronchopulmonary dysplasia (BPD) was higher in the clinical symptoms group in the univariate analysis, after multivariate logistic regression analysis adjusting for the CRIB-II score, birthweight, birth year, and the invasive ventilator care ≤ 2 postnatal days, there were no significant differences in mortality, frequency of secondary ligation and in-hospital outcomes including necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), BPD or death. Our data suggest that we can hold off on PDA treatment until the clinical symptoms become prominent.

  18. Traumatic transection of aorta. (United States)

    Ho, C K; Yip, K T; Eng, J B; Rajan, L; Tan, B H


    A 16 year-old man presented with fracture of both his femurs after a road traffic accident. Chest radiograph revealed mediastinal widening. Subsequent CT scan and arch aortogram confirmed the findings of traumatic aortic arch transection at the isthmus. He underwent successful surgical repair. High index of suspicion and prompt actions are important in managing this potentially fatal but treatable condition.

  19. Traumatic plexus lesion.

    NARCIS (Netherlands)

    Dongen, R.T.M. van; Cohen, S.P.; Kleef, M. van; Mekhail, N.; Huygen, F.


    Pain, motor, and sensory deficits characterize patients with a traumatic lesion of the brachial plexus. Frequently, more severe injuries co-exist that require immediate surgical attention. Early rehabilitation and physical therapy are the cornerstones of treatment. Pharmacological management can be

  20. Effect of Indomethacin Infused over 30 Minutes on Cerebral Fractional Tissue Oxygen Extraction in Preterm Newborns with a Patent Ductus Arteriosus

    NARCIS (Netherlands)

    Keating, Paul; Verhagen, Elise; van Hoften, Jacorina; ter Horst, Henk; Bos, Arend F.


    Background: A significant patent ductus arteriosus (PDA) is a common finding in the first days of life and, if persistent, is associated with an increased morbidity and mortality in the preterm newborn. Objectives: Our aim was to investigate, using near-infrared spectroscopy, the effect of indometha

  1. Limited effects of intravenous paracetamol on patent ductus arteriosus in very low birth weight infants with contraindications for ibuprofen or after ibuprofen failure

    NARCIS (Netherlands)

    D.W.E. Roofthooft (Daniella); I.M. van Beynum (I.); J.C.A. de Klerk (Johan C. A.); M. van Dijk (Monique); J.N. van den Anker (John); I.K.M. Reiss (Irwin); D. Tibboel (Dick); S.H. Simons (Sinno)


    textabstractFinding the optimal pharmacological treatment of a patent ductus arteriosus (PDA) in preterm neonates remains challenging. There is a growing interest in paracetamol as a new drug for PDA closure. In this prospective observational cohort study, we evaluated the effectiveness of intraveno

  2. Troponin T, N-terminal pro natriuretic peptide and a patent ductus arteriosus scoring system predict death before discharge or neurodevelopmental outcome at 2 years in preterm infants.

    LENUS (Irish Health Repository)

    El-Khuffash, Afif F


    There is little consensus regarding the use of echocardiography in patent ductus arteriosus (PDA) treatment in preterm infants. The use of troponin T (cTnT) and N-terminal Pro-BNP (NTpBNP) in combination with echocardiography assessment may facilitate the development of a superior predictive model.

  3. Benzalkonium Chloride Intoxication Mimicking Herpes Zoster Encephalitis

    Directory of Open Access Journals (Sweden)

    Ekrem Güler


    Full Text Available Benzalkonium chloride (BAC is a frequently used disinfectant and its most well-known side effect is contact dermatitis. In this report, two children who had vesicular dermatitis, headache, lethargy, fever and encephalopathy mimicking Herpes zoster encephalitis were presented. Their consciousness level improved on the second day. From the medical history it was understood that the mother had applied 20% BAC solution to the scalps of two children. The aim of the presentation of this report is to draw attention to the fact that BAC application to the scalp for treating pediculosis capitis may resemble the herpes encephalitis clinical picture.

  4. Immunoglobulin G4-Related Disease Mimicking Asthma

    Directory of Open Access Journals (Sweden)

    Hiroshi Sekiguchi


    Full Text Available Immunoglobulin (Ig G4-related disease (also known as ‘IgG4-related sclerosing disease’, ‘IgG4-related systemic disease’ or ‘hyper-IgG4-disease’ is a recently recognized systemic fibroinflammatory disease associated with IgG4-positive plasma cells in tissue lesions. IgG4-related disease was initially described as autoimmune pancreatitis, but it is now known to affect virtually any organ. The authors describe a patient presenting with multi-organ manifestations, including airway inflammation mimicking asthma, pulmonary parenchymal infiltrates, intrathoracic lymphadenopathy, submandibular gland swelling and a kidney mass.

  5. Post-pancreatitis Fat Necrosis Mimicking Carcinomatosis. (United States)

    Smith, Joshua P; Arnoletti, J Pablo; Varadarajulu, Shyam; Morgan, Desiree E


    Acute pancreatitis can result in retroperitoneal fat necrosis, typically occurring in the peripancreatic region, with extension into the transverse mesocolon, omentum and mesenteric root. When evaluated with contrast enhanced computed tomography (CECT), acute peripancreatic post necrotic collections typically become lower in attenuation over time, and often appear as homogeneous fluid collections. Saponification as a complication of fat necrosis in patients with acute pancreatitis is a well recognized clinical entity. While retroperitonal fat necrosis is commonly seen on CECT, saponification is not a prominent imaging feature. We present a case of acute pancreatitis complicated by extensive saponification of fat throughout the retroperitoneum and peritoneal lining, mimicking carcinomatosis.

  6. Brucellosis in spondyloarthritis mimicking an exacerbation. (United States)

    Garip, Y; Eser, F; Erten, S; Yilmaz, O; Yildirim, P


    Spondyloarthritis are a group of chronic inflammatory diseases that affect the axial skeleton, entheses and peripheral joints and may have extraarticular manifestations such as uveitis, psoriasis and inflammatory bowel disease. Brucellosis is a systemic infectious disease, endemic in Middle East, Latin America, and Mediterranean countries, which may present manifestations that resemble other diseases posing serious problems of differential diagnosis. Some hallmarks of Brucellosis may mimic a spondyloarthritis flare. In this paper, authors present a clinical case of brucellosis occurring in a patient with spondyloarthritis. Clinical symptoms initially mimicked exacerbation of spondyloarthritis.

  7. Acute Myopericarditis Mimicking Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Seval İzdeş


    Full Text Available Acute coronary syndromes among young adults are relatively low when compared with older population in the intensive care unit. Electrocardiographic abnormalities mimicking acute coronary syndromes may be caused by non-coronary syndromes and the differential diagnosis requires a detailed evaluation. We are reporting a case of myopericarditis presenting with acute ST elevation and elevated cardiac enzymes simulating acute coronary syndrome. In this case report, the literature is reviewed to discuss the approach to distinguish an acute coronary syndrome from myopericarditis. (Journal of the Turkish Society Intensive Care 2011; 9:68-70

  8. Hypertrophic Nonunion Humerus Mimicking an Enchondroma

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    N. K. Magu


    Full Text Available Introduction. Although fractures of humeral shaft show excellent results with conservative management, nonunion does occur. Case Report. We bring forth the case of a young male with a 1.5-year-old hypertrophic nonunion of the humerus mimicking an enchondroma. The initial X-ray images of the patient appeared to be an enchondroma, which only on further evaluation and histopathological analysis was diagnosed conclusively to be a hypertrophic nonunion. Discussion. Enchondromas are often incidentally diagnosed benign tumours. It is however not common to misdiagnose a hypertrophic nonunion to be an enchondroma. We present this case to highlight the unique diagnostic dilemma the treating team had to face.

  9. Permissive tolerance of the patent ductus arteriosus may increase the risk of Chronic Lung Disease

    Directory of Open Access Journals (Sweden)

    Kaempf JW


    Full Text Available Joseph W Kaempf,1 Robert Huston,2 YingXing Wu,1 Andrew J Kaempf,1 Lian Wang,1 Gary Grunkemeier,1 Rebecca Mischel,2 Howard Cohen,3 Bret Freitag41Providence St Vincent Medical Center, Portland, OR, 2Randall Children’s Hospital at Legacy Emanuel, Portland, OR, 3Salem Hospital, Salem, OR, 4Legacy Salmon Creek Hospital, Vancouver, WA, USAPurpose: Because early closure therapies of the patent ductus arteriosus (PDA have not been shown to confer benefit to premature infants, the authors’ four neonatal intensive care units adopted a less aggressive PDA management protocol.Study design: A before–after investigation in infants with PDAs born 501–1500 g. Era 1 (January 2005 to December 2007 featured traditional management with indomethacin and/or surgical ligation used early to close PDAs; Era 2 (January 2008 to June 2009 featured fluid restriction and watchful waiting for PDA closure, limiting indomethacin or surgical ligation to only those infants with large PDAs needing significant respiratory support.Results: Era 2 infants (n = 129, mean ± standard deviation 27 ± 2 weeks received less and later indomethacin and less Day 1–28 total fluids as compared to Era 1 infants (n = 240, mean ± standard deviation 27 ± 2 weeks. The Chronic Lung Disease (CLD rate was higher in Era 2 (48% versus 34%, P < 0.01 as was the combined outcome of Death after Day 7 or CLD (57% versus 42%, P < 0.01. Multiple regression analysis showed Era 2 birth was a predictor of CLD. However, Poisson regression analysis determined the predictors of all seven major Vermont Oxford Network morbidities were earlier gestational age, lower birth weight, and male gender, not the era of birth. Significantly more infants were discharged home with PDAs in Era 2.Conclusion: Permissive tolerance of PDAs may increase the risk of CLD and Death after Day 7 or CLD but is not associated with significant changes in other Vermont Oxford Network morbidities.Keywords: premature infant

  10. A Retrospective Study of 1526 Cases of Transcatheter Occlusion of Patent Ductus Arteriosus

    Institute of Scientific and Technical Information of China (English)

    Mei Jin; Yong-Mei Liang; Xiao-Fang Wang; Bao-Jing Guo; Ke Zheng; Yan Gu; Zhen-Yu Lyu


    Background:Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases and began to get treated by transcatheter occlusion since 1997 in China.Since then,several devices have been invented for occluding PDA.This study aimed to evaluate the technical feasibility,safety,and efficacy of transcatheter occlusion of PDA with different devices.Methods:One thousand five hundred and twenty-six patients (537 boys,989 girls) with PDA from January 1997 to September 2014 underwent descending aortogram and transcatheter occlusion procedure.We retrospectively analyzed data of these patients,including gender,age,weight,size and morphology of PDA,and devices used in transcatheter occlusion,outcomes,and postoperational complications.Results:Median age and median weight were 4.0 years (range:0.3-52.0 years old) and 15.3 kg (range:4.5-91.0 kg),respectively.Mean ductal diameter,aortic ductal diameter,ductal length,and pulmonary artery pressure were 3.50 ± 2.15 mm,l 0.08 ± 2.46 mm,7.49 ± 3.02 mm,and 30.21 ± 17.28 mmHg,respectively.Morphology of PDA assessed by descending aortogram was of type A in 1428 patients,type B in 6 patients,type C in 79 patients,type D in 4 patients,and type E in 9 patients according to the classification of Krichenko.Of all the 1526 patients,1497 patients underwent transcatheter PDA closure,among which 1492 were successful.Devices used were Amplatzer duct occluder Ⅰ (ADO Ⅰ,1280,85.8%),Cook detachable coils (116,7.8%),ADO Ⅱ (ADO Ⅱ,68,4.6%),muscular VSD occluder (12,0.8%),and Amplatzer vascular plug (16,1.0%).Conclusions:Excellent occlusion rates with low complication rates were achieved with all devices regardless of PDA types.With transcatheter occlusion technique and devices developing,more patients with PDA can be treated with transcatheter closure both safely and efficiently.

  11. Transcription profiles of endothelial cells in the rat ductus arteriosus during a perinatal period.

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    Norika Mengchia Liu

    Full Text Available Endothelial cells (ECs lining the blood vessels serve a variety of functions and play a central role in the homeostasis of the circulatory system. Since the ductus arteriosus (DA has different arterial characteristics from its connecting vessels, we hypothesized that ECs of the DA exhibited a unique gene profile involved in the regulation of DA-specific morphology and function. Using a fluorescence-activated cell sorter, we isolated ECs from pooled tissues from the DA or the descending aorta of Wistar rat fetuses at full-term of gestation (F group or neonates 30 minutes after birth (N group. Using anti-CD31 and anti-CD45 antibodies as cell surface markers for ECs and hematopoietic derived cells, respectively, cDNAs from the CD31-positive and CD45-negative cells were hybridized to the Affymetrix GeneChip® Rat Gene 1.0 ST Array. Among 26,469 gene-level probe sets, 82 genes in the F group and 81 genes in the N group were expressed at higher levels in DA ECs than in aortic ECs (p2.0. In addition to well-known endothelium-enriched genes such as Tgfb2 and Vegfa, novel DA endothelium-dominant genes including Slc38a1, Capn6, and Lrat were discovered. Enrichment analysis using GeneGo MetaCore software showed that DA endothelium-related biological processes were involved in morphogenesis and development. We identified many overlapping genes in each process including neural crest-related genes (Hoxa1, Hoxa4, and Hand2, etc and the second heart field-related genes (Tbx1, Isl1, and Fgf10, etc. Moreover, we found that regulation of epithelial-to-mesenchymal transition, cell adhesion, and retinol metabolism are the active pathways involved in the network via potential interactions with many of the identified genes to form DA-specific endothelia. In conclusion, the present study uncovered several significant differences of the transcriptional profile between the DA and aortic ECs. Newly identified DA endothelium-dominant genes may play an important role in DA

  12. Secondary scoliosis after thoracotomy in patients with aortic coarctation and patent ductus arteriosus. (United States)

    Roclawski, Marek; Pankowski, Rafal; Smoczynski, Andrzej; Ceynowa, Marcin; Kloc, Wojciech; Wasilewski, Wojciech; Jende, Piotr; Liczbik, Wieslaw; Beldzinski, Piotr; Libionka, Witold; Pierzak, Olaf; Adamski, Stanislaw; Niedbala, Miroslaw


    The aim of this study was to determine the influence of lateral thoracotomy on the development of scoliosis in subjects undergoing repair of coarctation of the aorta (CoAo) and patent ductus arteriosus (PDA). A group of 133 patients with CoAo and PDA was evaluated. Forty-five patients with CoAo and 38 with PDA were operated on using lateral thoracotomy (operative group) while 12 patients with CoAo and 31 with PDA were treated using balloon dilatation and stent or coil implantation (non-operative group). Clinical examination and the evaluation of spinal roentgenograms were performed. Among the operated patients 46.6% of those with CoAo and 39.5% of those with PDA had clinical scoliosis. In the non-operated patients scoliosis was present in only 16.6% of those with CoAo and 12.9% of those with PDA. Scoliosis ranged between 10° and 42° and it was mild in the majority of cases. In 90.4% of the operated scoliotic patients with CoAo and 73.3% of those with PDA the curve was thoracic and in 47.6% of the CoAo group and 53,3% of the PDA group the curve was left sided. All curves were right sided in non-operated subjects. Scoliosis in the operated group was higher in males than in females (63.3% versus 60% in CoAo and 68.2% versus 37.5% in PDA). The prevalence of scoliosis after thoracotomy was significantly higher than after non-surgical methods of treatment of both CoAo and PDA as well as in the general population. The rate of single thoracic and the rate of left thoracic curves in patients after thoracotomy is higher than in patients treated non-surgically or in idiopathic scoliosis. The rate of scoliosis after thoracotomy is higher in males than females especially following thoracotomy for PDA.

  13. Vasoactivity of the gasotransmitters hydrogen sulfide and carbon monoxide in the chicken ductus arteriosus. (United States)

    van der Sterren, Saskia; Kleikers, Pamela; Zimmermann, Luc J I; Villamor, Eduardo


    Besides nitric oxide (NO) and carbon monoxide (CO), hydrogen sulfide (H(2)S) is a third gaseous messenger that may play a role in controlling vascular tone and has been proposed to serve as an O(2) sensor. However, whether H(2)S is vasoactive in the ductus arteriosus (DA) has not yet been studied. We investigated, using wire myography, the mechanical responses induced by Na(2)S (1 μM-1 mM), which forms H(2)S and HS(-) in solution, and by authentic CO (0.1 μM-0.1 mM) in DA rings from 19-day chicken embryos. Na(2)S elicited a 100% relaxation (pD(2) 4.02) of 21% O(2)-contracted and a 50.3% relaxation of 62.5 mM KCl-contracted DA rings. Na(2)S-induced relaxation was not affected by presence of the NO synthase inhibitor l-NAME, the soluble guanylate cyclase (sGC) inhibitor ODQ, or the K(+) channel inhibitors tetraethylammonium (TEA; nonselective), 4-aminopyridine (4-AP, K(V)), glibenclamide (K(ATP)), iberiotoxin (BK(Ca)), TRAM-34 (IK(Ca)), and apamin (SK(Ca)). CO also relaxed O(2)-contracted (60.8% relaxation) and KCl-contracted (18.6% relaxation) DA rings. CO-induced relaxation was impaired by ODQ, TEA, and 4-AP (but not by L-NAME, glibenclamide, iberiotoxin, TRAM-34 or apamin), suggesting the involvement of sGC and K(V) channel stimulation. The presence of inhibitors of H(2)S or CO synthesis as well as the H(2)S precursor L-cysteine or the CO precursor hemin did not significantly affect the response of the DA to changes in O(2) tension. Endothelium-dependent and -independent relaxations were also unaffected. In conclusion, our results indicate that the gasotransmitters H(2)S and CO are vasoactive in the chicken DA but they do not suggest an important role for endogenous H(2)S or CO in the control of chicken ductal reactivity.

  14. Mimicked Web Page Detection over Internet

    Directory of Open Access Journals (Sweden)

    Y. Narasimha Rao


    Full Text Available Phishing is process of steeling valuable information such as ATM pins, Credit card details over internet. Where the attacker creates mimicked web pages from the legitimate web pages to fool users. In this paper, we propose an effective anti-phishing solution, by combining image based visual similarity based approach to detect plagiarized web pages. We used effective algorithms for our detection mechanism, speeded up Robust Features (SURF algorithm in order to generate signature based on extracting stable key points from the screen shot of the web page. When a legitimate web page is registered with our system, this algorithm applied on that web page in order to generate signatures, and these signatures are stored in the database for our trained system. When there is a suspected web page, this algorithm is applied to generate both the signatures of the suspected page and is verified against our database of corresponding legitimate web pages. Our results verified that our proposed system is very effective to detect the mimicked web pages with minimal false positives

  15. Mimicking Seawater For Culturing Marine Bacteria

    DEFF Research Database (Denmark)

    Rygaard, Anita Mac; Sonnenschein, Eva; Gram, Lone


    Only about 1% of marine bacteria have been brought into culture using traditional techniques. The purpose of this study was to investigate if mimicking the natural bacterial environment can increase culturability.We used marine substrates containing defined algal polymers or gellan gum as solidif......Only about 1% of marine bacteria have been brought into culture using traditional techniques. The purpose of this study was to investigate if mimicking the natural bacterial environment can increase culturability.We used marine substrates containing defined algal polymers or gellan gum...... as solidifying agents, and enumerated bacteria from seawater and algal exudates. We tested if culturability could be influenced by addition of quorum sensing signals (AHLs). All plates were incubated at 15°C. Bacterial counts (CFU/g) from algal exudates from brown algae were highest on media containing algal...... polymers. In general, bacteria isolated from algal exudates preferred more rich media than bacteria isolated from seawater. Overall, culturability ranged from 0.01 to 0.8% as compared to total cell count. Substitution of agar with gellan gum increased the culturability of seawater bacteria approximately...

  16. Traumatic transconjunctival orbital emphysema.


    Stroh, E M; Finger, P T


    Orbital emphysema can be produced by trans-conjunctival migration of air from a high pressure airgun. In an industrial accident an 8 mm conjunctival laceration was produced in the superior fornix which acted as a portal of entry for air into the subconjunctival, subcutaneous, and retrobulbar spaces. Computed tomography revealed no evidence of orbital fracture and showed that traumatic orbital emphysema occurred without a broken orbital bone.

  17. Traumatic-event headaches

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    Haas David C


    Full Text Available Abstract Background Chronic headaches from head trauma and whiplash injury are well-known and common, but chronic headaches from other sorts of physical traumas are not recognized. Methods Specific information was obtained from the medical records of 15 consecutive patients with chronic headaches related to physically injurious traumatic events that did not include either head trauma or whiplash injury. The events and the physical injuries produced by them were noted. The headaches' development, characteristics, duration, frequency, and accompaniments were recorded, as were the patients' use of pain-alleviative drugs. From this latter information, the headaches were classified by the diagnostic criteria of the International Headache Society as though they were naturally-occurring headaches. The presence of other post-traumatic symptoms and litigation were also recorded. Results The intervals between the events and the onset of the headaches resembled those between head traumas or whiplash injuries and their subsequent headaches. The headaches themselves were, as a group, similar to those after head trauma and whiplash injury. Thirteen of the patients had chronic tension-type headache, two had migraine. The sustained bodily injuries were trivial or unidentifiable in nine patients. Fabrication of symptoms for financial remuneration was not evident in these patients of whom seven were not even seeking payments of any kind. Conclusions This study suggests that these hitherto unrecognized post-traumatic headaches constitute a class of headaches characterized by a relation to traumatic events affecting the body but not including head or whiplash traumas. The bodily injuries per se can be discounted as the cause of the headaches. So can fabrication of symptoms for financial remuneration. Altered mental states, not systematically evaluated here, were a possible cause of the headaches. The overall resemblance of these headaches to the headaches after

  18. Traumatic Brain Injury (United States)


    symptoms which delays treatment and may lead to worse outcomes of care. The military culture values and esteems physical and mental toughness. In this...culture service members suffering mental health problems fear being ostracized , humiliated, and belittled. They also fear negative career... self regulate and inhibit behavioral responses. The individual’s ability to emotionally cope with a traumatic event in the immediate aftermath of a

  19. Delayed traumatic diaphragmatic hernia (United States)

    Lu, Jing; Wang, Bo; Che, Xiangming; Li, Xuqi; Qiu, Guanglin; He, Shicai; Fan, Lin


    Abstract Background: Traumatic diaphragmatic hernias (TDHs) are sometimes difficult to identify at an early stage and can consequently result in diagnostic delays with life-threatening outcomes. It is the aim of this case study to highlight the difficulties encountered with the earlier detection of traumatic diaphragmatic hernias. Methods: Clinical data of patients who received treatment for delayed traumatic diaphragmatic hernias in registers of the First Affiliated Hospital of Xi’an Jiaotong University from 1998 to 2014 were analyzed retrospectively. Results: Six patients were included in this study. Left hemidiaphragm was affected in all of them. Most of the patients had a history of traffic accident and 1 a stab-penetrating injury. The interval from injury to developing symptoms ranged from 2 to 11 years (median 5 years). The hernial contents included the stomach, omentum, small intestine, and colon. Diaphragmatic injury was missed in all of them during the initial managements. All patients received operations once the diagnosis of delayed TDH was confirmed, and no postoperative mortality was detected. Conclusions: Delayed TDHs are not common, but can lead to serious consequences once occurred. Early detection of diaphragmatic injuries is crucial. Surgeons should maintain a high suspicion for injuries of the diaphragm in cases with abdominal or lower chest traumas, especially in the initial surgical explorations. We emphasize the need for radiographical follow-up to detect diaphragmatic injuries at an earlier stage. PMID:27512848

  20. Chronic Traumatic Encephalopathy: The Neuropathological Legacy of Traumatic Brain Injury. (United States)

    Hay, Jennifer; Johnson, Victoria E; Smith, Douglas H; Stewart, William


    Almost a century ago, the first clinical account of the punch-drunk syndrome emerged, describing chronic neurological and neuropsychiatric sequelae occurring in former boxers. Thereafter, throughout the twentieth century, further reports added to our understanding of the neuropathological consequences of a career in boxing, leading to descriptions of a distinct neurodegenerative pathology, termed dementia pugilistica. During the past decade, growing recognition of this pathology in autopsy studies of nonboxers who were exposed to repetitive, mild traumatic brain injury, or to a single, moderate or severe traumatic brain injury, has led to an awareness that it is exposure to traumatic brain injury that carries with it a risk of this neurodegenerative disease, not the sport or the circumstance in which the injury is sustained. Furthermore, the neuropathology of the neurodegeneration that occurs after traumatic brain injury, now termed chronic traumatic encephalopathy, is acknowledged as being a complex, mixed, but distinctive pathology, the detail of which is reviewed in this article.

  1. A Critical Review on the Surgical Treatment of 153 Cases of Adult Patent Ductus Arteriosus within 1964-2000

    Institute of Scientific and Technical Information of China (English)



    Objective This paper evaluates the experiences of treatment of adult patent ductus arteriosus (PDA) in Nanjing Medical University in recent 36 years. Methods From October 1964 to December 2000, 153 adult PDA patients in our hospital were operated by means of ligation of PDA(105), ductal division (24), intra-aortic suture with left heart bypass(11), cardiopulmonary bypass (CPB) without heart beating(7), and the duct occlusion with cardiac catheterization(6). Results The mortalities of the afore mentioned 5 techniques were 0.0%,4.2%,0.0%,14.3%,0.0% respectively. Conclusion Ligation of PDA is still a safe, simple and efficient method, while CPB is suitable for patients with certain special types of PDA or/and other deformities of the heart. Perhaps the advent of interventional therapy would offer a safer and simpler method of choice in the treatment of PDA.

  2. Pulmonary arterial dissection in a post-partum patient with patent ductus arteriosus: Case report and review of the literature. (United States)

    Yaman, Mehmet; Arslan, Uğur; Ateş, Ahmet Hakan; Aksakal, Aytekin


    Pulmonary arterial dissection is an uncommon but usually a deadly complication of chronic pulmonary hypertension. A 26-year-old female patient was admitted to our clinics with sudden dyspnea and chest discomfort one hour after giving birth to twins by vaginal delivery. An echocardiography was performed with a pre-diagnosis of pulmonary embolism. However, echocardiographic examination revealed a dilated main pulmonary artery and a dissection flap extending from main pulmonary artery to left pulmonary artery. In summary, in this report, we described a very rare case of pulmonary artery dissection in a pregnant patient with a previously un-diagnosed patent ductus arteriosus without an obvious rise in pulmonary artery pressure and reviewed the relevant literature.

  3. Range-gated pulsed Doppler ultrasonographic evaluation of carotid arterial blood flow in small preterm infants with patent ductus arteriosus. (United States)

    Wilcox, W D; Carrigan, T A; Dooley, K J; Giddens, D P; Dykes, F D; Lazzara, A; Ray, J L; Ahmann, P A


    Range-gated pulsed Doppler (RGPD) ultrasonography was utilized to study the effect of a patent ductus arteriosus (PDA) on carotid arterial blood flow in small preterm infants. Carotid arterial flow velocity studies were performed on 23 preterm infants, sampling right and left carotid arteries. Studies on seven infants after PDA ligation and on seven who developed no evidence of PDA were used as controls. A strong relationship was demonstrated between diastolic reversal in the carotid arteries and PDA. The results of this study indicate that the RGPD flow velocity curve from the carotid artery is more sensitive than M-mode echocardiography or clinical examination in detecting PDA, and that PDA in small preterm infants is associated with a distinct abnormality in the carotid arterial flow pattern.

  4. Entropy score, patent ductus arteriosus (PDA), and cardiopulmonary bypass (CPB): ligation of PDA on CPB can compromise cerebral blood flow. (United States)

    Neema, Praveen Kumar; Dharan, Baiju S; Singha, Subrata Kumar; Sethuraman, Manikandan; Rathod, Ramesh Chandra


    A patent ductus arteriosus (PDA) is often present in patients undergoing correction of congenital heart disease. It is well appreciated that during cardiopulmonary bypass (CPB), a PDA steals arterial inflow into pulmonary circulation, and may lead to systemic hypoperfusion, excessive pulmonary blood flow (PBF) and distention of the left heart. Therefore, PDA is preferably ligated before initiation of CPB. We describe acute decreases of arterial blood pressure and entropy score with the initiation of CPB and immediate increase in entropy score following the PDA ligation in a child undergoing intracardiac repair of ventricular septal defect and right ventricular infundibular stenosis. The observation strongly indicates that a PDA steals arterial inflow into pulmonary circulation and if the PDA is dissected and ligated on CPB or its ligation on CPB is delayed the cerebral perfusion is potentially compromised.

  5. Pulmonary arterial dissection in a post-partum patient with patent ductus arteriosus: Case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Mehmet; Yaman; Ugur; Arslan; Ahmet; Hakan; Ates; Aytekin; Aksakal


    Pulmonary arterial dissection is an uncommon but usually a deadly complication of chronic pulmonary hypertension. A 26-year-old female patient was admitted to our clinics with sudden dyspnea and chest discomfort one hour after giving birth to twins by vaginal delivery. An echocardiography was performed with a pre-diagnosis of pulmonary embolism. However, echocardiographic examination revealed a dilated main pulmonary artery and a dissection flap extending from main pulmonary artery to left pulmonary artery. In summary, in this report, we described a very rare case of pulmonary artery dissection in a pregnant patient with a previously un-diagnosed patent ductus arteriosus without an obvious rise in pulmonary artery pressure and reviewed the relevant literature.

  6. A subtle mimicker in emergency department (United States)

    Angelis, Maria Vittoria De; Giacomo, Roberta Di; Muzio, Antonio Di; Onofrj, Marco; Bonanni, Laura


    Abstract Background: Movement disorder emergencies include any movement disorder which develops over hours to days, in which failure to appropriately diagnose and manage can result in patient morbidity or mortality. Movement disorder emergencies include acute dystonia: sustained or intermittent muscle contractions causing abnormal, often repetitive, movements. Acute dystonia is a serious challenge for emergency room doctors and neurologists, because of the high probability of misdiagnosis, due to the presence of several mimickers including partial seizures, meningitis, localized tetanus, serum electrolyte level abnormalities, strychnine poisoning, angioedema, malingering, catatonia, and conversion. Methods: We describe 2 examples, accompanied by videos, of acute drug-induced oro-mandibular dystonia, both subsequent to occasional haloperidol intake. Results: Management and treatment of this movement disorder are often difficult: neuroleptics withdrawal, treatment with benzodiazepines, and anticholinergics are recommended. Conclusion: Alternative treatment options are also discussed. PMID:27741141

  7. Orbital Lymphoma Mimicking Lacrimal Gland Pleomorphic Adenoma

    Directory of Open Access Journals (Sweden)

    Diego Strianese


    Full Text Available Purpose: To describe the case of a patient affected by orbital lymphoma mimicking pleomorphic adenoma of the lacrimal gland. Methods: This was a retrospective case report. Results: We present the case of a patient with 15-year history of slowly progressive left proptosis and inferomedial bulbar dislocation who had the presumptive diagnosis of lacrimal gland pleomorphic adenoma based on clinical and radiological features. The patient underwent lateral orbitotomy and lacrimal gland excision. Postoperative histological features were consistent with low-grade B-cell non-Hodgkin lymphoma. Conclusion: The accepted clinico-radiological criteria used for the diagnosis of lacrimal gland fossa lesions might have a certain false-positive rate, even in recent years. The initial surgical approach with the appropriate choice between fine-needle aspiration biopsies, intraoperative biopsies and lacrimal gland excisions might be a challenge.


    Directory of Open Access Journals (Sweden)



    Full Text Available Eventration of diaphragm is a condition in which there is abnormal elevation of the diaphragm as a result of thinning of muscular layer. It can be congenital as well as acquired. It is more common left sided. Herniation of the abdominal contents can be there. Clinical manifestations range from asymptomatic to life threatening respiratory distress requiring mechanical ventilator support. Ultrasound provides valuable information regarding the integrity of the diaphragm. Other imaging modalities include fluoroscopy, CT and MRI that provide valuable information when diagnosis is in doubt. We are presenting a case report of 25-year-old male with eventration of left hemidiaphragm mimicking as cavity. After taking detail history, examination and proper investigations we finally reached to this diagnosis.

  9. Case report. Pityriasis versicolor mimicking Pityriasis rotunda. (United States)

    Aste, Nicola; Pau, Monica; Aste, Natalia; Biggio, P


    Pityriasis versicolor is a common dermatomycosis, occurring throughout the world, characterized by irregular, slightly scaly patches, varying in color from red/light brown to white. Pityriasis rotunda, on the other hand, is an uncommon disease, reported in specific ethnic groups, and characterized by perfectly round or oval patches of varying color, with a scaly surface. The histologic pattern is that of ichthyosis vulgaris. We report here the case of a male patient, aged 31, from Sardinia (Italy), affected by Pityriasis versicolor mimicking Pityriasis rotunda. Mycological examination allowed us to formulate the correct diagnosis, and ensuing treatment with antifungal drugs was entirely successful. The authors, while pointing out the rarity of this case, stress the possibility that Pityriasis versicolor mimics Pityriasis rotunda and vice-versa, especially in those countries in which the two diseases are endemic. More widespread recourse to microscopic examination can help avoid the risk of mistaken diagnosis and consequent incorrect treatment.

  10. Contiguous spinal metastasis mimicking infectious spondylodiscitis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chul Min; Lee, Seung Hun [Dept. of Radiology, Hanyang University Hospital, Seoul (Korea, Republic of); Bae, Ji Yoon [Dept. of Pathology, National Police Hospital, Seoul (Korea, Republic of)


    Differential diagnosis between spinal metastasis and infectious spondylodiscitis is one of the occasional challenges in daily clinical practice. We encountered an unusual case of spinal metastasis in a 75-year-old female breast cancer patient that mimicked infectious spondylodiscitis. Magnetic resonance imaging (MRI) showed diffuse bone marrow infiltrations with paraspinal soft tissue infiltrative changes in 5 contiguous cervical vertebrae without significant compression fracture or cortical destruction. These MRI findings made it difficult to differentiate between spinal metastasis and infectious spondylodiscitis. Infectious spondylodiscitis such as tuberculous spondylodiscitis was regarded as the more appropriate diagnosis due to the continuous involvement of > 5 cervical vertebrae. The patient's clinical presentation also supported the presumptive diagnosis of infectious spondylodiscitis rather than spinal metastasis. Intravenous antibiotics were administered, but clinical symptoms worsened despite treatment. After pathologic confirmation by computed tomography-guided biopsy, we were able to confirm a final diagnosis of spinal metastasis.

  11. Prolonged acute hepatitis A mimicking autoimmune hepatitis

    Institute of Scientific and Technical Information of China (English)

    Rintaro Mikata; Osamu Yokosuka; Fumio Imazeki; Kenichi Fukai; Tatsuo Kanda; Hiromitsu Saisho


    AIM: We report a case with a prolonged course of hepatitisA, with alanine aminotransferase (ALT) higher than 500 IU/Lfor more than 2 mo.METHODS: A middle-aged woman had an elevated IgG level of more than 2 000 mg/dL, positive arti-nudear antibodies (ANA) and anti-smooth muscle antibodies (ASMA), but no evidence of persistent hepatitis A virus (HAV) infection. Liver biopsy findings were compatible with prolonged acute hepatitis, although acute onset of autoimmune hepatitis could not be ruled out.RESULTS: It was assumed that she developed a course of hepatitis similar to autoimmune hepatitis triggered by HAV infection. Ursodeoxycholic acid (UDCA) treatment was initiated and a favorable outcome was obtained. CONCLUSION: We describe a case of a middle-aged woman who showed a prolonged course of acute hepatitis A mimicking autoimmune hepatitis. Treatment with UDCAproved to be effective.

  12. Tentorium schwannoma mimicking meningioma: an unusual location. (United States)

    Calişaneller, Tarkan; Ozen, Ozlem; Altinörs, Nur; Caner, Hakan


    A 60-year-old female was admitted to our clinic complaining of a long-lasting headache. Cranial magnetic resonance imagining examination of the patient revealed a 22x24 mm extra-axial, well-demarcated, mass lesion based on the left tentorium. The patient underwent a craniotomy and the tumor was totally excised with the adjacent tentorium. The histopathological examination of the tumor complied with the diagnosis of schwannoma. The rest of the clinical course was uneventful and the patient was released from the hospital without any neurological deficit. Intracranial schwannomas can rarely originate from atypical dural locations and radiological techniques are not always helpful in distinguishing tentorial schwannoma from tentorial meningioma. We presented a patient with a tentorium schwannoma mimicking meningioma and discussed the current literature.

  13. Lumbar Epidural Varix Mimicking Perineural Cyst (United States)

    Pusat, Serhat; Kural, Cahit; Aslanoglu, Atilla; Kurt, Bulent


    Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery via right L5 and S1 hemilaminectomy, and the lesion was coagulated and removed. The histopathological diagnosis was epidural varix. The patient was clinically improved and the follow-up magnetic resonance imaging showed the absence of the lesion. Lumbar epidural varix should be kept in mind in the differential diagnosis of the cystic lesions which compress the spinal roots. PMID:23741553

  14. Post-Traumatic Stress Disorder (United States)

    Post-traumatic stress disorder (PTSD) is a real illness. You can get PTSD after living through or seeing a traumatic event, such as war, a ... sexual assault, physical abuse, or a bad accident. PTSD makes you feel stressed and afraid after the ...

  15. [Post-traumatic lung herniation

    NARCIS (Netherlands)

    WIjs, M.J. de; Verhagen, A.F.T.M.; Tan, E.C.T.H.


    BACKGROUND: Post-traumatic lung herniation due to a pathological defect in the chest wall is rare. CASE DESCRIPTION: We present a 73-year-old polytrauma patient who had extensive chest wall trauma after an accident, resulting in traumatic herniation of the lung. The patient was initially treated acc

  16. Transesophageal echocardiography guided patent ductus arteriosus occlusion in adults with severe pulmonary hypertension through a parasternal approach. (United States)

    Dai, Xiao-Fu; Chen, Liang-Wan; Chen, Dong-Zhong; Chen, Qiang; Zhen, Guo-Zhong; Zhang, Gui-Can


    Between April 2010 and April 2014, 39 consective adult patients (> 18 years) with PDA associated severe pulmonary hypertension underwent transesophageal echocardiography guided patent ductus arteriosus occlusion through a parasternal minimally invasive approach. Among 39 patients, the procedure was successful in 32 cases (82.1%) and failed in 7 cases (17.9%). In the failed cases, 3 cases had a large residual shunt and 4 cases had persistent pulmonary hypertension. The mean minimum miameter of the successfully closed PDAs was 15.2 ± 2.1 mm (range 9 to 24), and the mean diameter of the mushroom-shaped occluder was 17.5 ± 2.5 mm (range 11 to 26). The pulmonary artery pressure decreased significantly after occlusion (P 0.05). Echocardiography performed on the first postoperative day showed decreased volume within the left atrium, left ventricle, and pulmonary artery in 23 cases, decreased volume within the left atrium and left ventricle in 4 cases, and no change in the volume of the atrium and ventricle in 3 cases. A minor residual shunt was observed in 6 cases. The posteroanterior chest X-ray showed improved pulmonary congestion in all cases and significantly reduced cardiothoracic ratio in 25 cases. Patients were followed-up at least for 1 year. No symptoms including palpitation, dyspnoea, or chest tightness were observed. The heart function ranged from NYHA class I to II. A minor residual shunt was observed only in one case. There were varying degrees of decrease in volume within the atrium and ventricle. In conclusion, transesophageal echocardiography guided patent ductus arteriosus occlusion through a parasternal minimally invasive approach is a feasible and effective method for the treatment of PDA in adults with severe pulmonary hypertension.

  17. [Traumatic neurogenic shock]. (United States)

    Maurin, O; de Régloix, S; Caballé, D; Arvis, A-M; Perrochon, J-C; Tourtier, J-P


    Traumatic neurogenic shock is a rare but serious complication of spinal cord injury. It associates bradycardia and hypotension caused by a medullary trauma. It is life-threatening for the patient and it aggravates the neurological deficit. Strict immobilization and a quick assessment of the gravity of cord injury are necessary as soon as prehospital care has begun. Initial treatment requires vasopressors associated with fluid resuscitation. Steroids are not recommended. Early decompression is recommended for incomplete deficit seen in the first 6 hours. We relate the case of secondary spinal shock to a luxation C6/C7 treated in prehospital care.

  18. [Post-traumatic tics]. (United States)

    Alegre, S; Chacón, J; Redondo, L; Navarro-Busto, C; Solana, B


    Secondary tics are those in which an aetiology justifying them can be found, as compared to idiopathic tics, which make up the majority, and the Gilles de la Tourette syndrome (SGT), which is, at the moment, of unknown origin. Of the possible aetiologies described as causing tics, craneo-encephalic trauma has been mentioned on very few occasions. We present a case of post-traumatic tics (verbal and neck) in a young man of 24, and review the published cases which can be considered to be of post-traumatic tics. We have found six cases of tics secondary to traumas, all craneo-encephalic, like ours (the one under study). The time interval between the blow and the appearance of the tic or tics varied between 2 weeks and 3 months. The absence of significant lesions seen in the complementary investigations make it impossible for us to discover the site of the lesion caused by the trauma. However, the presence in some cases of other tics before the trauma, and of family histories of tics, supports the idea of a genetic basis or predisposition to suffer this disorder.

  19. Progress of treatment in children with patent ductus arteriosus%儿童动脉导管未闭治疗进展

    Institute of Scientific and Technical Information of China (English)



    Patent ductus arteriosus is a common congenital heart disease in children.Effective and promptly treatment can prevent complications,such as pneumonia,congestive heart failure,infective endocarditic and pulmonary artery hypertension.The treatments include medication,transcatheter intervention and surgery.The vast majority of the patent ductus arteriosus can be cured by transcatheter interventional therapy now.%动脉导管未闭是儿童常见先天性心脏病,及时有效治疗可防止肺炎、心力衰竭、感染性心内膜炎、肺动脉高压等并发症的发生.治疗方法包括药物治疗、经导管介入治疗和手术治疗.目前绝大部分动脉导管未闭通过介入封堵可获治愈.

  20. Large patent ductus arteriosus in a 44-year-old woman leading to calcium deposition in the left atrium and mitral and aortic valves. (United States)

    Roberts, Carey Camille; Roberts, William Clifford


    This report describes unusual autopsy findings in a 44-year-old woman who had a large, calcified patent ductus arteriosus that produced substantial left-to-right shunting. The patient died in 1962, 7 days after patch closure of the aortic orifice of the ductus. Numerous calcific deposits were present in the mural left atrial endocardium, the mitral valve leaflets and annulus, and the aortic valve cusps. The cause of the left-sided calcific deposits was perhaps related to the patient's several-decades-old giant aortopulmonary shunt, causing a major increase in the volume of blood passing through the left-sided cardiac chambers in comparison with the volume in the right side. To our knowledge, such findings in a patient with patent ductus arteriosus have not been reported previously.

  1. Rare case of truncus arteriosus with anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) and unilateral left pulmonary artery agenesis. (United States)

    Mittal, Kartik; Dey, Amit K; Gadewar, Rohit; Sharma, Rajaram; Pandit, Nilesh; Rajput, Priya; Hira, Priya


    The incidence of congenital heart disease (CHD) is 2.4-3.8/1000 live births. Up to 70.7 % of all cases of CHD are reported to be benign; complex heart anomalies are extremely rare. Our case is extremely rare, as we report three very rare findings-truncus arteriosus, anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA), and unilateral left pulmonary artery agenesis-in a single patient. Congenital complex cardiac abnormalities are very rare, and two-dimensional echocardiography screening should be supported by cardiac computed tomography (CT). We report a case of truncus arteriosus associated with ARCAPA and left pulmonary artery agenesis diagnosed by cardiac computed tomography; we believe that such an unusual case with all three of these entities has never been reported before.

  2. Treatment of patent ductus arteriosus by Amplatzer occluder device%Amplatzer伞堵闭术治疗动脉导管未闭

    Institute of Scientific and Technical Information of China (English)

    江隆福; 陈国方; 陈玉锋


    @@ 经皮动脉导管未闭封堵术是治疗动脉导管未闭(patent ductus arteriosus,PDA)的非手术方法,具有创伤小、术后恢复快等优点,即刻及近期疗效较好.我们对7例PDA进行封堵治疗,在此进行探讨.

  3. [Occlusion of patent ductus arteriosus with a Gianturco-Grifka device. First case at the Instituo Mexicano del Seguro Social (IMSS)]. (United States)

    Munayer Calderón, J; Aldana Pérez, T; San Luis Miranda, R; Maza Juárez, G; Lázaro Castillo, J L; Ramírez Reyes, H; Quintero, L R; Arias Monroy, L; Campos Gómez, A


    We present the initial experience of closing of patent ductus arteriosus (PDA) with a new device; Gianturco-Grifka, at the General Hospital of The Medical Center "La Raza". The patient was a 4 year's old girl, in whom we detected continuous murmur in the second intercostal space, echocardiography showed a long conical patent ductus arteriosus 4.9 mm of diameter, systolic pressure of the pulmonary artery was 35 mm Hg with QP/QS 1.6:1. Hemodynamic study revealed a long conical ductus arteriosus 5 mm of diameter, type A1 from Krichenko classification. We proceeded to occlude the PDA with a Gianturco-Grifka device of 7 mm. Immediately after the PDA occlusion the shunt disappeared, there were no complications during the procedure. More cases are needed to determine long term benefits and limitations, of this procedure. However we conclude that technically it is easy to use. There is greater decrease of residual shunt that the one reported with other devices.

  4. 胎儿动脉导管异常的超声心动图表现%Diagnosis of fetal ductus arteriosus anomalies by echocardiography

    Institute of Scientific and Technical Information of China (English)

    许燕; 接连利; 刘清华; 赵霞; 董发进


    目的 总结胎儿动脉导管异常的声像图特征.方法 对8例经引产后尸体解剖及产后超声随访证实为动脉导管异常的胎儿产前超声心动图检查资料进行回顾性分析.结果 8例动脉导管异常胎儿中3例产前超声多切面扫查均不能显示动脉导管的管腔结构和血流,2例伴发法洛四联症,1例伴发永存动脉干,提示动脉导管缺如;2例胎儿动脉导管和主动脉弓血流方向相反,主动脉血流经动脉导管逆行灌注于肺动脉主干或左、右肺动脉,其中1例伴发于室间隔缺损型肺动脉闭锁,另1例伴发于室间隔完整型肺动脉闭锁,合并右心室发育不良,提示动脉导管逆行灌注;5例伴有复杂先天性心脏病的胎儿引产后经尸体解剖证实.2例胎儿动脉导管管腔细窄,血流速度增快,提示动脉导管狭窄;1例胎儿动脉导管管腔内充填实性低回声,内无血流信号,提示动脉导管早闭;2例动脉导管狭窄和1例动脉导管早闭的胎儿均表现右心房、右心室增大,伴有三尖瓣重度反流,并经产后超声心动图随访证实.结论 胎儿超声心动图能显示胎儿动脉导管缺如、逆行灌注、狭窄及早闭的异常声像图特征,在胎儿动脉导管异常的诊断中具有重要的临床价值.%Objective To summarize the features of fetal ductus arteriosus anomalies by ultrasound. Methods Eight cases of fetal ductus arteriosus anomalies confirmed by autopsy after abortion or postnatal follow-up were retrospectively analyzed by echocardiography. Results Among 8 cases of fetal ductus arteriosus anomalies, 3cases were diagnosed with ductus arteriosus absent including two cases associated with tetralogy of Fallot and one case associated with persistent truncus arteriosus, neither the structure nor the blood flow of ductus arteriosus was observed on multiple views.Two cases were shown with reverse flow in fetal ductus arteriosus, retrograde aortic blood flow infused into the

  5. Mimicking Bone - Chemical and Physical Challenges

    Directory of Open Access Journals (Sweden)

    Sophie C Cox


    Full Text Available It is known that chemical and physical features of bone contribute to its functionality, reactivity and mechanical performance. This fundamental rationale underpins the author’s research strategy. This paper presents a summary of efforts to fabricate a synthetic structure, referred to as a scaffold, that both chemically and physical emulates the intricate structure of bone. An understanding of key features of bone tissue that contribute to its remarkable properties is presented as a background to this work. Novel work aimed at improving the understanding of the synthesis of a ceramic biomaterial, namely hydroxyapatite, that is chemically similar to bone mineral is discussed. A case study involving the manufacture of porous scaffolds by 3D printing is also presented. In summary, this article highlights a number of on-going challenges that multidisciplinary tissue engineers aim to solve to get one step closer to mimicking bone, which clinically could improve the quality of life for millions of people worldwide.  Photo credit: By Doc. RNDr. Josef Reischig, CSc. (Author's archive [CC-BY-SA-3.0 (], via Wikimedia Commons

  6. Microfabricated adhesive mimicking gecko foot-hair (United States)

    Geim, A. K.; Dubonos, S. V.; Grigorieva, I. V.; Novoselov, K. S.; Zhukov, A. A.; Shapoval, S. Yu.


    The amazing climbing ability of geckos has attracted the interest of philosophers and scientists alike for centuries. However, only in the past few years has progress been made in understanding the mechanism behind this ability, which relies on submicrometre keratin hairs covering the soles of geckos. Each hair produces a miniscule force ~10-7 N (due to van der Waals and/or capillary interactions) but millions of hairs acting together create a formidable adhesion of ~10 N cm-2: sufficient to keep geckos firmly on their feet, even when upside down on a glass ceiling. It is very tempting to create a new type of adhesive by mimicking the gecko mechanism. Here we report on a prototype of such 'gecko tape' made by microfabrication of dense arrays of flexible plastic pillars, the geometry of which is optimized to ensure their collective adhesion. Our approach shows a way to manufacture self-cleaning, re-attachable dry adhesives, although problems related to their durability and mass production are yet to be resolved.

  7. Controlled Deposition of HAp Mimicking Tooth Enamel

    Institute of Scientific and Technical Information of China (English)


    Chemical compositions and microsturcture of mature human tooth enamel were investigated by XRD , FTIR and SEM to further understand the characteristics of tooth enamel. In order to obtain apatite crystals chemically and structurally similar to those in tooth enamel, biomimetic way was employed. Selfassembled monolyers terminated with-SO3 H groups were used as deposition substrates and 1.5 SBF ( the concentrations of Ca2+ and PO43- ions 1.5 times than those in simulated body fluid ) with and without 5 ppm F- were used as soaking medium. The XRD and FTIR results showed that both the deposited fluoride-substituted hydroxyapatite( F-HAp ) crystals in 1.5 SBF with F- and hydroxyapatite ( HAp ) crystals in 1.5 SBF were carbonate-containing, mimicking human tooth enamel in chemical compositions. The SEM photos showed that needle-like F-HAp crystals bad large aspect ratios and grew in bundles, which were similar to the crystals in human tooth enamel.The results provide available information on dental restoration.

  8. Lymphocitic infundibuloneurohypophysitis mimicking a pituitary adenoma

    Directory of Open Access Journals (Sweden)

    Hubertus Maximilian Mehdorn


    Full Text Available A rare case of infundibulo-neurohypophysitis mimicking a pituitary adenoma is presented. A 69-years-old female patient developed polyuria and polydipsia. Laboratory analysis revealed central diabetes insipidus. No hormonal abnormalities. Cranial-magnetic resonance imaging (MRI showed a left sided mass in the adenohypophysis presuming a pituitary adenoma. The mass had contact to both internal carotids. Admission to our department for neurosurgical treatment followed. Ophthalmo - logic examination and neurological examination yielded normal findings. A second MRI focussing on the sellar-region showed a leftsided (T2-MRI.hyperintense, distended adenohypophysis, without contrast enhancement in T1. The stalk appeared thickened. T1- weighted sequences of the neurohypophysis showed loss of signal intensity. We diagnosed an infundibulo-neurohypophysitis and abstai - ned from surgical removal. The patient was discharged under treatment with corticosteroids and desmopressin. Hypophysitis is rare and shows special clinical characteristics. Despite defined radiological features to differentiate between hypophysitis and adenoma the possibility of misdiagnosis, and unnecessary surgical procedures, should always kept in mind.

  9. Post-traumatic syringomyelia

    Directory of Open Access Journals (Sweden)

    Agrawal Amit


    Full Text Available Progressive post-traumatic cystic syringomyelia is an uncommon and increasingly recognized cause of morbidity following spinal cord injury. We hereby report a 35-year-old gentleman who sustained wedge compression fracture of L-1 vertebral body 15 years back and had complete paraplegia with bowel/bladder involvement. The neurological deficit recovered with minimal residual motor deficits and erectile dysfunction. He presented now with increasing neurological deficits associated with pain and paresthesia. The MRI spine showed a syrinx extending from the site of injury up to the medulla. He underwent a syringo-peritoneal shunt and at follow-up his pain and motor functions had improved but erectile dysfunction was persisting.

  10. Blunt traumatic diaphragmatic rupture

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira


    Full Text Available Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5%among patients who were victims of blunt trauma and underwent laparotomy.Clinical suspicion associated with radiological assessment contributes to earlydiagnosis. Isolated diaphragmatic injury has a good prognosis. Generallyworse outcomes are associated with other trauma injuries. Bilateral andright diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT scan of the chest and abdomen provides better diagnosticaccuracy using the possibility of image multiplanar reconstruction. Surgicalrepair via laparotomy and/ or thoracotomy in the acute phase of the injury hasa better outcome and avoids chronic complications of diaphragmatic hernia.The authors present the case of a young male patient, victim of blunt abdominaltrauma due to motor vehicle accident with rupture of the diaphragm, spleenand kidney injuries. The diagnosis was made by computed tomography of thethorax and abdomen and was confirmed during laparotomy.

  11. Non-harmful insertion of data mimicking computer network attacks

    Energy Technology Data Exchange (ETDEWEB)

    Neil, Joshua Charles; Kent, Alexander; Hash, Jr, Curtis Lee


    Non-harmful data mimicking computer network attacks may be inserted in a computer network. Anomalous real network connections may be generated between a plurality of computing systems in the network. Data mimicking an attack may also be generated. The generated data may be transmitted between the plurality of computing systems using the real network connections and measured to determine whether an attack is detected.

  12. Infrasellar craniopharyngioma mimicking a clival chordoma : a case report.

    Directory of Open Access Journals (Sweden)

    Kachhara R


    Full Text Available An unusual case of entirely infrasellar craniopharyngioma mimicking a clival chordoma is described. Only 22 cases of craniopharyngioma with nasopharyngeal extension have been reported in the literature. Of the reported cases, most were primarily intracranial with secondary downward extension; only two were thought to originate from an infrasellar location. The present case is another example of an entirely infrasellar craniopharyngioma, with extensive clival destruction, mimicking a clival chordoma. Relevant literature on the subject is reviewed.

  13. Concussion and Traumatic Brain Injury (United States)

    ... turn JavaScript on. Feature: Concussion Concussion and Traumatic Brain Injury Past Issues / Summer 2015 Table of Contents Children ... body, may have a concussion or more serious brain injury. Concussion Signs Observed Can't recall events prior ...

  14. Coping with a Traumatic Event (United States)

    ... Traumatic events are marked by a sense of horror, helplessness, serious injury, or the threat of serious ... the number of times an event happened, a history of past trauma, and psychological problems before the ...

  15. Traumatic Brain Injury Registry (TBI) (United States)

    Department of Veterans Affairs — As the number of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Traumatic Brain Injury (TBI) patients has grown, so has the need to track and monitor...

  16. Traumatic hand amputation while wakeboarding (United States)

    Woodacre, Timothy; Marshall, Morwena


    Wakeboarding is a sport increasing in popularity in the UK and the rest of the world. It is known to be associated with a high incidence of relatively minor injuries to the participating sportsperson. The authors present the case of a traumatic hand amputation to an associated third party and highlight the potential for serious injuries to all those directly involved with the sport. The authors demonstrate the successful application of military principles to a traumatic amputation in a civilian setting. PMID:22693318


    Directory of Open Access Journals (Sweden)



    Full Text Available BACKGROUND: Posterior embryotoxon is a congenital anomaly, considered to be a relatively mild disorder and can occur in 15% of normal eyes. Bilateral posterior embryotoxon associated with maxillary hypoplasia, Ventricular Septal Defect (VSD, Pulmonary Atresia (PA with Patent Ductus Arteriosus (PDA is of rare occurrence and hasn’t been reported in literature till date. CASE: We report a case of 12 year old female who came to us in eye Out Patient Department for routine eye checkup and on detailed ocular examination we found anteriorly displaced Schwalbe’s line. On detailed physical examination and investigations she was found to have pan-systolic murmur and continuous machinery murmur. On Echocardiography, the patient was found to have large peri-membranous VSD with PA and PDA. On Oro-dental examination she was found to have maxillary hypoplasia. CONCLUSION: The present case is reported due to the rarity and sporadic character of the condition and its rare association with cardiac defect and maxillary hypoplasia.

  18. Effects of Intravenous Indomethacin on Reduction of Symptomatic Patent Ductus Arteriosus Cases and Decreasing the Need for Prolonged Mechanical Ventilation

    Directory of Open Access Journals (Sweden)

    Jannatdoust Abdollah


    Full Text Available Introduction: We decided to investigate the effects of injecting Indomethacin on reducing complications of Patent Ductus Arteriosus (PDA and the need for prolonged mechanical ventilation. Methods: During this randomized clinical trial, 70 premature infants with matched gestational age and birth weight were divided into case and control groups. In the study group, intravenous indomethacin started from the first 2-12 hours of birth. All patients were followed by echocardiography at the fourth day and skull ultrasound in the second week. Results: Symptomatic PDA rate was significantly higher in the control group (25.7% vs. 0%; P≤0.001. Incidence of grade 1-3 intraventricular hemorrhage was higher in the control group and the ratio of needed time for respiratory support in the control group to the case group was approximately 2.1. Conclusion: Intravenous Indomethacin reduced the number of PDA cases and incidence of grade 2 and 3 intraventricular hemorrhage, without any short term side effects.

  19. Amplatzer PDA occluder used in adult patent ductus arteriosus with serious pulmonary hypertension after testing balloon occlusio

    Institute of Scientific and Technical Information of China (English)

    卢才义; 魏璇; 黄丛春; 罗惠兰; 谈维洁; 毛树森


    @@ A 36-years-old female had heart palpitation and chest press for five years and the symptoms had been worsening for half a year. She was diagnosed with patent ductus arteriosus with moderate pulmonary hypertension in a local hospital 5 years before but was not operated. Physical examination showed: T 37℃, P 87?bpm, R 18?bpm and BP 130/70?mm?Hg. There was no distension of the jugular vein, and the lungs were clear. There was continuous mechanic murmur at the second intercostal space, and grade 2 systolic blowing murmur at the apex. P2 was strengthened. The liver and spleen were not enlarged and there was no edema in either leg. ECG showed a pulmonary P wave and right ventricular hypertrophy. Chest X-ray film showed pulmonary segment projection 3?cm, and the dimension of the right inferior pulmonary artery bed increased to 3?cm in diameter. On echocardiography, both atria, the pulmonary artery and the right ventricle were enlarged.

  20. Patent ductus arteriosus in the preterm infant: a survey of clinical practices in French neonatal intensive care units. (United States)

    Brissaud, Olivier; Guichoux, Julie


    Patent ductus arteriosus (PDA) is one of the most common problems in the care of premature infants, especially the extremely premature. There is no real consensus regarding the diagnostic criteria or treatment of a hemodynamically significant PDA. Its diagnosis, assessment, and treatment still remain challenges. Therefore, we investigated clinical practices in French tertiary neonatology centers regarding the management of PDA to compare their similarities and differences. We sent a questionnaire by email to the PDA specialist in every French tertiary neonatal intensive care unit. It contained 27 items regarding the unit's structure, method of diagnosing PDA, and treatment choices. The completed questionnaire were returned via email and analyzed blindly. The questionnaire response rate was 87.5%, which allowed us to draw some conclusions regarding French clinical practices in the care of neonates with PDA. Although the diagnostic criteria are quite similar, the therapeutic practices are rather different across neonatal care units. We highlight the great variability in French clinical practices when it comes to treating PDA and underscore the necessity for harmonization of these practices, which could be achieved using multicenter, randomized studies to identify the advantages of one approach compared with another.

  1. A rare presentation of patent ductus arteriosus in an adult patient with normal pulmonary hypertension and limb edema (United States)

    Pishgoo, Bahram; Saburi, Amin; Khosravi, Arezoo


    BACKGROUND Patent ductus arteriosus (PDA) at childhood is one of the five major and frequent congenital abnormalities, but it can be rarely seen in adults. Pulmonary hypertension (PHTN) and other presentations such as heart failure and edema are the identified complications of longstanding PDA, but adult case with no permanent heart symptoms and PHTN was rare. We reported a rare case of with an obvious PDA and normal pulmonary pressure. CASE REPORT A 61-year-old woman presented with dyspnea (New York Heart Association class 2), chest pain, and lower limb edema. Echocardiogram showed; normal left ventricular chamber size and function, normal size of both atria. Furthermore, an obvious PDA (diameter = 6-7 mm) connecting the aortic arch to the pulmonary artery was reported in echocardiography. No lung congestion and evidence for PHTN was reported by computed tomographic angiography [Pulmonary capillary wedge pressure (PCWP) = 30 mmHg]. The patient was treated with antihypertensive drugs and after 1 and 3 months follow-up, edema and other symptoms were resolved. CONCLUSION Finally, we conclude that PDA in adulthood can present with nonspecific cardiovascular symptoms, and it seems that PHTN is not a fixed echocardiographic finding in these patients. PMID:25477985

  2. Evaluation of the Efficacy and Safety of Oral İbuprofen in the Treatment of Patent Ductus Arteriosus

    Directory of Open Access Journals (Sweden)

    Mehmet Kervancıoğlu


    Full Text Available Since indomethacin has many side effects, ibuprofen has been started to be used with beneficial results and less side effects for the closure of patent ductus arteriosus (PDA in recent years. The frequency of PDA, and the effects and side effects of oral ibuprofen were investigated by echocardiographic evaluation, in 164 preterm neonates in Neonatology Unit of Dicle University,between April and December 2004. Oral ibufrofen was given at 10 mg/kg/day dose to infants who had significant left-right shunt on the third day of birth but those who had contraindication for ibuprofen were excluded. By daily echocardiographic evaluations in those without closure after the first dose, a second and third dose of 5 mg/kg/day were given if necessary. Ductus closure has ocured in 24 of 27 (88.8% patients, at a mean period of 1.7±0.9 (1-4 days. Complications like hyponatremia, hypercreatininemia, thrombocytopenia, and necrotizing enterocolitis were not seen. Only in one patient intracranial hemorrhage was occured two days after the treatment. In conclusion, treatment with oral ibuprofen is an effective and safe treatment method for the closure of the PDA in preterm infants.

  3. Hybrid management of a large atrial septal defect and a patent ductus arteriosus in an infant with chronic lung disease

    Directory of Open Access Journals (Sweden)

    Pedra Simone


    Full Text Available We report a case wherein a dysmorphic four-month-old infant (weighing 4.5 kgs with an 8 mm atrial septal defect (ASD, a 1.5 mm patent ductus arteriosus (PDA, a 2 mm mid-muscular ventricular septal defect (VSD associated with chronic lung disease, and severe pulmonary hypertension, was successfully managed using a hybrid approach, without the use of cardiopulmonary bypass (CPB. Through a median sternotomy, the PDA was ligated and the ASD was closed with a 9 mm Amplatzer septal occluder implanted through peratrial access. The VSD was left untouched. Serial echocardiograms showed complete closure of the ASD and PDA, with progressive normalization of the pulmonary artery (PA pressures within three months. The child rapidly gained weight and was weaned from sildenafil and oxygen administration. After 12 months, the VSD closed spontaneously and the child remained well, with normal PA pressures. A hybrid approach without the use of CPB should be considered in the management of infants with congenital heart disease, associated with chronic lung disease and pulmonary hypertension.


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    Full Text Available ABSTRACT : A traumatic abdominal wall hernia is a rare type of hernia, which follows blunt trauma to the abdomen, where disruption of the musculature and fascia occu rs, with the overlying skin remaining intact. Associated abdominal injuries are infrequent. An elderly male patient was seen in emergency within 6 hrs of alleged history of bull gore injury, while working in the fields; he presented with complaints of pain abdomen and swelling in the right side of lower abdomen. On Examination, soft, tender swelling is noted in RIF with overlying contusion, which increased in size over the next two days, with expansile cough impulse. Swelling was completely reducible and vi sible peristalsis seen.USG Abdomen showed defect in right iliac fossa abdominal wall with bowel loops in subcutaneous plane. A local exploration was performed incorporating the site of injury. A defect in all layers of abdominal wall muscles in right iliac fossa with intact skin and subcutaneous tissue was found. Primary tension free repair of the defect in layers done with inlay placement of prolene mesh due to poor abdominal muscle tone. A high index of clinical suspicion is essential, as an accompanying hematoma often confounds the diagnosis. Mesh repair is desirable in the elderly with weak anterior abdominal wall so as to prevent the long - term complications of recurrences

  5. Traumatic Brain Injury: FDA Research and Actions (United States)

    ... Control—Traumatic Brain Injury Public Workshop: Advancing the Development of Biomarkers in Traumatic Brain Injury, March 3, 2016 ... Health Cosmetics Dietary Supplements Drugs Food Medical Devices Nutrition Radiation-Emitting Products Tobacco Products Vaccines, Blood & Biologics ...

  6. Traumatic Brain Injury (TBI) Data and Statistics (United States)

    ... The CDC Cancel Submit Search The CDC Traumatic Brain Injury & Concussion Note: Javascript is disabled or is not ... please visit this page: About . Traumatic Brain Injury & Concussion Basic Information Get the Facts Signs and ...

  7. Traumatic brain injury : from impact to rehabilitation

    NARCIS (Netherlands)

    Halliday, J.; Absalom, A. R.


    Traumatic brain injury is a significant cause of mortality and morbidity in our society, particularly among the young. This review discusses the pathophysiology of traumatic brain injury, and current management from the acute phase through to rehabilitation of the traumatic brain injury patient.

  8. Traumatic Childhood Events and Autism Spectrum Disorder (United States)

    Kerns, Connor Morrow; Newschaffer, Craig J.; Berkowitz, Steven J.


    Traumatic childhood events are associated with a wide range of negative physical, psychological and adaptive outcomes over the life course and are one of the few identifiable causes of psychiatric illness. Children with autism spectrum disorder (ASD) may be at increased risk for both encountering traumatic events and developing traumatic sequelae;…

  9. Knowledge of Traumatic Brain Injury among Educators (United States)

    Ernst, William J.; Gallo, Adrienne B.; Sellers, Amanda L.; Mulrine, Jessica; MacNamara, Luciana; Abrahamson, Allison; Kneavel, Meredith


    The purpose of this study is to determine knowledge of traumatic brain injury among educators. Few studies have examined knowledge of traumatic brain injury in this population and fewer still have included a substantial proportion of general education teachers. Examining knowledge of traumatic brain injury in educators is important as the vast…

  10. Establishment of the patent ductus arteriosus model in preterm rats%早产大鼠动脉导管开放模型的建立

    Institute of Scientific and Technical Information of China (English)

    朱梦茹; 刘海岩; 刘盼盼; 武辉


    ObjectiveTo establish the patent ductus arteriosus model in preterm rats using the improved natural development method.MethodsIn the light of the lfaws of the natural development method in establishing the patent ductus arteriosus model, the experimental technology was modified to avoid the influence of fixation, dehydration, and section method on blood vessel diameter. Cesarean section was performed for a Wistar rat pregnant for 19 days, and 8 neonatal rats were obtained. After they were sacriifced by dislocation, they were embedded as a whole to avoid dehydration, and the microsection and horizontal section were made. After hematoxylin and eosin staining, a microscope was used to measure the inner diameters of the ductus arteriosus, the main pulmonary artery, and the descending aorta.ResultsAfter the cesarean section for the rat pregnant for 19 days, patent ductus arteriosus occurred in all the 8 neonatal rats. The measurements of the inner diameters of blood vessels were as follows: the long diameter and short diameter of the descending aorta were 354±106 and 182±140 μm, respectively; the short diameter of the ductus arteriosus was 155±122 μm, and its area was 36 847±42 582 μm2; the long axis and short axis of the main pulmonary artery were 589±150 and 174±170 μm, respectively.ConclusionsThe improved natural development method can help to successfully establish the patent ductus arteriosus model in preterm rats.%目的:利用改良的自然发育法构建早产大鼠动脉导管开放模型。方法基于自然发育法在构建早产大鼠动脉导管开放模型上的缺陷,本研究对实验技术进行了改进,避免固定方式、脱水处理及切片方式对血管管径的影响。将1只孕19 d的Wistar大鼠行剖宫产,取出8只新生大鼠,脱臼处死后整体包埋、避免脱水、微距切片、水平切片,苏木精-伊红染色后镜下测量动脉导管、主肺动脉、降主动脉内径。结果孕19 d

  11. Mesalamine treatment mimicking relapse in a child with ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    Iva Hojsak; Ana M Pavić; Sanja Kolaček


    Background: There are reports on mesalamine-induced bloody diarrhea mimicking ulcerative colitis (UC) relapse, mostly in adults. Methods: Herein we present a case of a child with UC who developed relapse of hemorrhagic colitis related to mesalamine. Results: A 10-year-old girl developed severe symptoms mimicking UC relapse 3 weeks after introduction of mesalamine therapy. After mesalamine was withdrawn, her symptoms improved, but deteriorated again during the challenge of mesalamine despite concomitant use of corticosteroids. Conclusion: This is the fi rst case report on such a young child during the concomitant use of corticosteroids.

  12. A heart-hand syndrome gene: Tfap2b plays a critical role in the development and remodeling of mouse ductus arteriosus and limb patterning.

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    Feng Zhao

    Full Text Available BACKGROUND: Patent ductus arteriosus (PDA is one of the most common forms of congenital heart disease. Mutations in transcription factor TFAP2B cause Char syndrome, a human disorder characterized by PDA, facial dysmorphysm and hand anomalies. Animal research data are needed to understand the mechanisms. The aim of our study was to elucidate the pathogenesis of Char syndrome at the molecular level. METHODOLOGY/PRINCIPAL FINDINGS: Gene expression of Tfap2b during mouse development was studied, and newborns of Tfap2b-deficient mice were examined to identify phenotypes. Gel shift assays had been carried out to search for Tfap2 downstream genes. Promoters of candidate genes were cloned into a reporter construct and used to demonstrate their regulation by Tfap2b in cell transfection. In situ hybridizations showed that the murine transcription factor Tfap2b was expressed during the entire development of mouse ductus arteriosus. Histological examination of ductus arteriosus from Tfap2b knockout mice 6 hours after birth revealed that they were not closed. Consequently, the lungs of Tfap2b(-/- mice demonstrated progressive congestion of the pulmonary capillaries, which was postulated to result secondarily from PDA. In addition, Tfap2b was expressed in the limb buds, particularly in the posterior limb field during development. Lack of Tfap2b resulted in bilateral postaxial accessory digits. Further study indicated that expressions of bone morphogenetic protein (Bmp genes, which are reported to be involved in the limb patterning and ductal development, were altered in limb buds of Tfap2b-deficient embryos, due to direct control of Bmp2 and Bmp4 promoter activity by Tfap2b. CONCLUSIONS/SIGNIFICANCE: Tfap2b plays important roles in the development of mouse ductus arteriosus and limb patterning. Loss of Tfap2b results in altered Bmp expression that may cause the heart-limb defects observed in Tfap2b mouse mutants and Char syndrome patients. The Tfap2b knockout

  13. Long-Term Follow-up of Patent Ductus Arteriosus Closure with the Amplatzer Duct Occluder in Children

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    Mostafa Behjati-Ardakani


    Full Text Available Background: Transcatheter closure of patent ductus arteriosus (PDA has become an alternative treatment to surgery. We evaluated the long-term results of the transcatheter closure of PDA with the Amplatzer Duct Occluder (ADO in children.Methods: Between May 2004 and October 2012, 138 children with PDA (43 males and 95 females underwent transcatheter PDA closure. Clinical, electrocardiographic, echocardiographic, and hemodynamic data were assessed pre and postprocedurally and at follow-up.Results: The mean age of the patients at procedure was 3.53 ± 2.43 years (range = 1.1 to 9.5 years, mean weight was11.9±4.6 kg (range = 6 to 29 kg, median pulmonary end diameter of the PDA was 5 mm (range = 4 to 15 mm, and median diameter of the ADO was 8 mm (range = 6 to 16 mm. The mean follow-up time was 43.4 ± 23.5 months (range = 13.5 to98 months.The devices were successfully deployed in 136 (98.5% patients. Device embolization occurred in 2 patients, immediately in one patient and during the first postprocedural night in the other patient. The first patient had percutaneous device retrieval, followed by implantation of a larger device. The second patient had surgical device removal and PDA ligation. Immediately after device implantation, trivial to mild residual shunts were detected in 112 (80% patients; all the shunts, however, disappeared 24 hours after the procedure. One patient had left pulmonary artery stenosis with a gradient of 25 mm Hg at 24 hours', 40 mmHg at one month's, and 64 mmHg at 6 months' follow-up. There were no cases of late embolization, aortic obstruction, late hemolysis, infective endocarditis, or death.Conclusion: Transcatheter PDA closure with the ADO was safe and effective, with a high success rate at long-term follow-up.

  14. Current Status of Therapeutic Strategies for Patent Ductus Arteriosus in Very-Low-Birth-Weight Infants in Korea. (United States)

    Lee, Jin A; Kim, Myo-Jing; Oh, Sohee; Choi, Byung Min


    This study aimed to investigate current therapeutic strategies for patent ductus arteriosus (PDA) in very-low-birth-weight (VLBW) infants in Korea. A total of 2,254 VLBW infants among 2,386 from Korean Neonatal Network cohort born from January 2013 to June 2014 were included. No PDA was seen for 1,206 infants (53.5%) and the infants diagnosed or treated for PDA were 1,048 infants (46.5%). The proportion of infants with PDA was decreased according to the increase in gestational age (GA) and birthweight. Infants with PDA were divided into groups according to the therapeutic strategies of PDA: prophylactic treatment (PT, n = 69, 3.1%), pre-symptomatic treatment (PST, n = 212, 9.4%), symptomatic treatment (ST, n = 596, 26.4%), and conservative treatment (CT, n = 171, 7.6%). ST was the most preferred treatment modality for preterm PDA and the proportion of the patients was decreased in the order of PST, CT, and PT. Although ST was still the most favored treatment in GA < 24 weeks group, CT was more preferred than PST or ST when compared with GA ≥ 32 weeks group [CT vs. PST, OR 5.3, 95% CI 1.56-18.18; CT vs. ST, OR 2.9, 95% CI 1.03-8.13]. A total of 877 infants (38.9%) received pharmacological or surgical treatment about PDA, and 35.5% (801 infants) received pharmacological treatment, mostly with ibuprofen. Seventy-six infants (3.4%) received primary ligation and 8.9% (201 infants) received secondary ligation. Diverse treatment strategies are currently used for preterm PDA in Korea. Further analyses of neonatal outcomes according to the treatment strategies are necessary to obtain a standardized treatment guideline for preterm PDA.

  15. Understanding Traumatic Stress in Children (United States)

    ... events can leave people feeling overwhelmed and unsafe. Children may be especially vulnerable and require adults and caregivers to help them re-establish a sense of safety. Though recovering may take time, it is possible, ... Traumatic Stress in Children , to help. This guide describes the most common ...

  16. Evaluation after Traumatic Brain Injury (United States)

    Trudel, Tina M.; Halper, James; Pines, Hayley; Cancro, Lorraine


    It is important to determine if a traumatic brain injury (TBI) has occurred when an individual is assessed in a hospital emergency room after a car accident, fall, or other injury that affects the head. This determination influences decisions about treatment. It is essential to screen for the injury, because the sooner they begin appropriate…

  17. Traumatic Brain Injury Inpatient Rehabilitation (United States)

    Im, Brian; Schrer, Marcia J.; Gaeta, Raphael; Elias, Eileen


    Traumatic brain injuries (TBI) can cause multiple medical and functional problems. As the brain is involved in regulating nearly every bodily function, a TBI can affect any part of the body and aspect of cognitive, behavioral, and physical functioning. However, TBI affects each individual differently. Optimal management requires understanding the…

  18. Imaging of Traumatic Brain Injury

    NARCIS (Netherlands)

    Zagorchev, L.; McAllister, T.


    Traumatic brain injury (TBI) represents an enormous public health challenge and is often associated with life long neurobehavioral sequelae in survivors. Several factors including higher percentages of individuals surviving TBI, as well as increasing concern about potential long term sequelae of ev

  19. Trichophyton Schoenleinii-induced widespread tinea corporis mimicking parapsoriasis. (United States)

    Mansouri, P; Farshi, S; Khosravi, A R; Naraghi, Z S; Chalangari, R


    We report a case of extensive tinea corporis in an 80-year-old woman on her forearms, thighs, legs, buttocks and trunk, mimicking parapsoriasis due to Trichophyton schoenleinii, without scalp involvement. Diagnosis of Trichophyton schoenleinii was confirmed by microscopy and mycological culture specimens.

  20. Diffuse Large B Cell Lymphoma Mimicking Granulomatosis with Polyangiitis

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    Mohammad E. Naffaa


    Full Text Available In a patient with systemic multiorgan disease with overlapping features, the differential diagnosis included infectious diseases, malignancies, and systemic autoimmune or inflammatory diseases. We present an unusual case of a young male with B cell lymphoma who presented with symptoms mimicking systemic vasculitis and review the existing literature.

  1. Diffuse Large B Cell Lymphoma Mimicking Granulomatosis with Polyangiitis (United States)

    Horowitz, Netanel; Ben-Itzhak, Ofer; Braun-Moscovici, Yolanda


    In a patient with systemic multiorgan disease with overlapping features, the differential diagnosis included infectious diseases, malignancies, and systemic autoimmune or inflammatory diseases. We present an unusual case of a young male with B cell lymphoma who presented with symptoms mimicking systemic vasculitis and review the existing literature. PMID:27293945

  2. Cutaneous lymphoid hyperplasia mimicking cutaneous lymphoma in a hyperthyroid cat. (United States)

    Snead, Elisabeth; Kerr, Moira; Macdonald, Valerie


    A 12-year-old neutered male domestic shorthair cat presented for chronic, localized, swelling and crusting of the left upper lip, weight loss, sporadic vomiting, and focal alopecia between the scapulae was diagnosed with hyperthyroidism and regional eosinophilic lymphadenitis. Treatment with methimazole exacerbated an underlying hypersensitivity disorder leading to marked generalized lymphadenopathy that histologically mimicked lymphoma.

  3. Spinal MRI of vincristine neuropathy mimicking Guillain-Barre syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Yun Woo; Yoon, Hye-Kyung; Cho, Jae Min [Department of Radiology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul 135-710 (Korea); Sung, Ki Woong [Department of Paediatrics, Samsung Medical Centre, Seoul 135-710 (Korea)


    A 4.3-year-old girl with acute leukaemia, who was being treated with chemotherapy (including vincristine), developed paraplegia. Spinal MRI showed diffusely enhancing nerve roots on contrast-enhanced images. Spinal fluid analysis showed a normal protein level. Vincristine neuropathy mimicking Guillain-Barre syndrome is thought to be the cause of the MRI abnormalities. (orig.)

  4. Primary Papillary Mucinous Adenocarcinoma of the Ureter Mimicking Genitourinary Tuberculosis

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    Hanni Gulwani


    Full Text Available Primary adenocarcinomas of the renal pelvis and ureter are rare and account for less than 1% of all malignancies at this site. We report a case of primary papillary mucinous adenocarcinoma of the ureter that clinically mimicked genitourinary tuberculosis. Early diagnosis is important for the better outcome.

  5. Calcified Klatskin tumor mimicking intrahepatic stone: case report. (United States)

    Park, H S; Han, J K; Lee, H S; Lee, K H; Kim, S H; Kim, K W; Kim, Y J; Kim, H-C; Choi, B I


    Calcification is a relatively uncommon manifestation of malignant liver neoplasm. Calcifications in peripheral cholangiocarcinomas but not in Klatskin tumor have been reported. We present a rare case of Klatskin tumor that had dystrophic calcification mimicking a intrahepatic stone in a 65-year-old man.

  6. Osteoid osteoma of the radial styloid mimicking de quervain tenosynovitis. (United States)

    Chloros, George D; Themistocleous, George S; Papagelopoulos, Panayiotis J; Khaldi, Lubna; Efstathopoulos, Dimitrios G; Soucacos, Panayotis N


    A very unusual location of osteoid osteoma arising in the radial styloid is presented, which strongly mimicked de Quervain tenosynovitis, thereby resulting in the patient undergoing an additional unnecessary operation and a substantial delay of more than 2 years in diagnosis.

  7. Achromobacter xylosoxidans infection presenting as a pulmonary nodule mimicking cancer. (United States)

    Claassen, Stephanie L; Reese, Jason M; Mysliwiec, Vincent; Mahlen, Steven D


    Achromobacter xylosoxidans is typically isolated from pulmonary sources, presenting as pneumonia in immunosuppressed individuals. We describe a novel clinical presentation of A. xylosoxidans infection presenting as multiple spiculated, pulmonary nodules mimicking cancer for which the patient underwent a wedge resection of the lung for diagnosis and staging of presumptive cancer.

  8. Headache attributed to unruptured saccular aneurysm, mimicking hemicrania continua. (United States)

    Vikelis, Michail; Xifaras, Michail; Magoufis, Georgios; Gekas, Georgios; Mitsikostas, Dimos Dimitrios


    Unruptured cerebral arterial aneurysms most often remain asymptomatic, but they may cause headache or other symptoms or signs. We describe herewith a case of headache attributed to an unruptured internal carotid artery aneurysm, clearly mimicking the phenotype of hemicrania continua. Potential pathophysiological explanations and recommendations for recognition of similar cases are discussed.

  9. Post-traumatic stress disorder and traumatic brain injury. (United States)

    Motzkin, Julian C; Koenigs, Michael R


    Disentangling the effects of "organic" neurologic damage and psychological distress after a traumatic brain injury poses a significant challenge to researchers and clinicians. Establishing a link between traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) has been particularly contentious, reflecting difficulties in establishing a unique diagnosis for conditions with overlapping and sometimes contradictory symptom profiles. However, each disorder is linked to a variety of adverse health outcomes, underscoring the need to better understand how neurologic and psychiatric risk factors interact following trauma. Here, we present data showing that individuals with a TBI are more likely to develop PTSD, and that individuals with PTSD are more likely to develop persistent cognitive sequelae related to TBI. Further, we describe neurobiological models of PTSD, highlighting how patterns of neurologic damage typical in TBI may promote or protect against the development of PTSD in brain-injured populations. These data highlight the unique course of PTSD following a TBI and have important diagnostic, prognostic, and treatment implications for individuals with a dual diagnosis.

  10. Severe cerebral vasospasm after traumatic brain injury. (United States)

    Fehnel, Corey R; Wendell, Linda C; Potter, N Stevenson; Klinge, Petra; Thompson, Bradford B


    Severe traumatic brain injury is associated with both acute and delayed neuro- logical injury. Cerebral vasospasm is commonly associated with delayed neurological decline in aneurysmal subarachnoid hemorrhage patients. However, the role played by vasospasm in traumatic brain injury is less clear. Vasospasm occurs earlier, for a shorter duration, and often without significant neurological consequence among traumatic brain injury patients. Detection and management strategies for vasospasm in aneurysmal subarachnoid hemorrhage are not easily transferrable to traumatic brain injury patients. We present a patient with a severe traumatic brain injury who had dramatic improvement following emergent decompressive hemicraniectomy. Two weeks after initial presentation he suffered a precipitous decline despite intensive surveillance. This case illustrates the distinct challenges of diagnosing cerebral vasospasm in the setting of severe traumatic brain injury.

  11. Traumatic brain injury among Indiana state prisoners. (United States)

    Ray, Bradley; Sapp, Dona; Kincaid, Ashley


    Research on traumatic brain injury among inmates has focused on comparing the rate of traumatic brain injury among offenders to the general population, but also how best to screen for traumatic brain injury among this population. This study administered the short version of the Ohio State University Traumatic Brain Injury Identification Method to all male inmates admitted into Indiana state prisons were screened for a month (N = 831). Results indicate that 35.7% of the inmates reported experiencing a traumatic brain injury during their lifetime and that these inmates were more likely to have a psychiatric disorder and a prior period of incarceration than those without. Logistic regression analysis finds that a traumatic brain injury predicts the likelihood of prior incarceration net of age, race, education, and psychiatric disorder. This study suggests that brief instruments can be successfully implemented into prison screenings to help divert inmates into needed treatment.

  12. Middle Range Theory of Traumatic Childbirth

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    Cheryl Tatano Beck


    Full Text Available A middle range theory of traumatic childbirth was developed using Morse’s method of theoretical coalescence. The scope of this qualitative theory was increased by formalizing the connections between 14 individual studies all conducted by the same researcher on the same topic, with different groups, using different research designs and different types of analyses. Axioms were derived from this research program along with attributes of traumatic childbirth, posttraumatic stress, and secondary traumatic stress. This middle range theory addresses the long-term chronic consequences of a traumatic birth for mothers including its impact on breastfeeding, subsequent childbirth, and the anniversary of birth trauma. The impact on fathers and clinicians present at the traumatic birth is highlighted as secondary traumatic stress comes into play. Troubling glimpses of difficulties in mother–infant bonding are revealed.

  13. Effects of therapeutic approach on the neonatal evolution of very low birth weight infants with patent ductus arteriosus

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    Lilian S.R. Sadeck


    Full Text Available OBJECTIVE: To analyze the effects of treatment approach on the outcomes of newborns (birth weight [BW] < 1,000 g with patent ductus arteriosus (PDA, from the Brazilian Neonatal Research Network (BNRN on: death, bronchopulmonary dysplasia (BPD, severe intraventricular hemorrhage (IVH III/IV, retinopathy of prematurity requiring surgical (ROPsur, necrotizing enterocolitis requiring surgery (NECsur, and death/BPD. METHODS: This was a multicentric cohort study, retrospective data collection, including newborns (BW < 1000 g with gestational age (GA < 33 weeks and echocardiographic diagnosis of PDA, from 16 neonatal units of the BNRN from January 1, 2010 to Dec 31, 2011. Newborns who died or were transferred until the third day of life, and those with presence of congenital malformation or infection were excluded. Groups: G1 - conservative approach (without treatment, G2 - pharmacologic (indomethacin or ibuprofen, G3 - surgical ligation (independent of previous treatment. Factors analyzed: antenatal corticosteroid, cesarean section, BW, GA, 5 min. Apgar score < 4, male gender, Score for Neonatal Acute Physiology Perinatal Extension (SNAPPE II, respiratory distress syndrome (RDS, late sepsis (LS, mechanical ventilation (MV, surfactant (< 2 h of life, and time of MV. Outcomes: death, O2 dependence at 36 weeks (BPD36wks, IVH III/IV, ROPsur, NECsur, and death/BPD36wks. Statistics: Student's t-test, chi-squared test, or Fisher's exact test; Odds ratio (95% CI; logistic binary regression and backward stepwise multiple regression. Software: MedCalc (Medical Calculator software, version p-values < 0.05 were considered statistically significant. RESULTS: 1,097 newborns were selected and 494 newborns were included: G1 - 187 (37.8%, G2 - 205 (41.5%, and G3 - 102 (20.6%. The highest mortality was observed in G1 (51.3% and the lowest in G3 (14.7%. The highest frequencies of BPD36wks (70.6% and ROPsur were observed in G3 (23.5%. The lowest occurrence of

  14. Traumatic andropause after combat injury. (United States)

    Jones, Gareth Huw; Kirkman-Brown, Jackson; Sharma, Davendra Murray; Bowley, Douglas


    In association with lower extremity amputation, complex genitourinary injuries have emerged as a specific challenge in modern military trauma surgery. Testicular injury or loss has profound implications for the recovering serviceman, in terms of hormone production and future fertility. The initial focus of treatment for patients with traumatic testicular loss is haemostasis, resuscitation and management of concurrent life-threatening injuries. Multiple reoperations are commonly required to control infection in combat wounds; in a review of 300 major lower extremity amputations, 53% of limbs required revisional surgery, with infection the commonest indication. Atypical infections, such as invasive fungal organisms, can also complicate military wounding. We report the case of a severely wounded serviceman with complete traumatic andropause, whose symptomatic temperature swings were initially mistaken for signs of occult sepsis.

  15. An audit of traumatic nerve injury.

    LENUS (Irish Health Repository)

    O'Connor, G


    The impact of trauma in the Irish healthcare setting is considerable. We present the results of a retrospective assessment of referrals to a Neurophysiology department for suspected traumatic nerve injury. A broad range of traumatic neuropathies was demonstrated on testing, from numerous causes. We demonstrate an increased liklihood of traumatic nerve injury after fracture \\/ dislocation (p = 0.007). Our series demonstrates the need for clinicians to be aware of the possibility of nerve injury post trauma, especially after bony injury.

  16. Cell Delivery System for Traumatic Brain Injury (United States)


    REPORT Cell Delivery System for Traumatic Brain Injury 14. ABSTRACT 16. SECURITY CLASSIFICATION OF: We have met all of the milestones outlined in this...COVERED (From - To) 18-Sep-2006 Standard Form 298 (Rev 8/98) Prescribed by ANSI Std. Z39.18 - 17-Mar-2008 Cell Delivery System for Traumatic Brain Injury Report...Manassero*, Justin Kim*, Maureen St Georges*, Nicole Esclamado* and Elizabeth Orwin. “Development of a Cell Delivery System for Traumatic Brain Injury Using

  17. Traumatic Brain Injury: Same or Different (United States)


    TRAUMATIC BRAIN INJURY : SAME OR DIFFERENT Kimberly Meyer, ACNP-BC, CNRN Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting...TITLE AND SUBTITLE Traumatic Brain Injury : Same or Different 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...official policy of the Department of the Army, Department of Defense, or U.S. Government. DISCLOSURES Nothing to disclose TRAUMATIC BRAIN INJURY Mild

  18. Traumatic hemipelvectomy (amputae: Report of one case

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    Errol U. Hutagalung


    Full Text Available Traumatic hemipelvectomy (amputae is a catastrophic injury resulting front violent shearing forces which avulsed the lower limb at the level sacroiliac joint and symphisis pubis. Patients surviving traumatic hemipelvectomy are rare. One case of a 25 months old girl surviving traumatic hemipelvectomy, is presented. This is the first case reported from Indonesia. (Med J Indones 2001; 10: 169-73Keywords: Colostomy, skin graft, traffic accident

  19. Chronic issues related to traumatic brain injury : traumatic brain injury is not an incident

    NARCIS (Netherlands)

    Grauwmeijer, Erik; van der Naalt, Joukje; ribbers, gerard


    Despite an increased awareness of the long-term consequences of traumatic brain injury, health care professionals often consider traumatic brain injury as an incident. However, patients with traumatic brain injury may experience long-term neurological, cognitive and behavioural problems. Due to the

  20. Traumatic reticulopericarditis: a case report


    Rodríguez Fernández, Gabriel; Murillo Herrera, Jaime; Hueckman Voss, Frank; Romero Zúñiga, Juan José


    Traumatic reticuloperitonitis is a disease that can severely affect cattle by producing important chronic effects leading to decreased productive performance and early culling. The ingestion of sharp objects, which can cause reticuloperitonitis as a primary cause, is the primary factor. Conditions such as ruminal contractions and the pressure of the gravid uterus may favor the disease. This paper describes clinical aspects and post-mortem findings of a case of reticuloperitonitis in an eight-...

  1. Neuroimaging in Traumatic Brain Imaging


    Lee, Bruce; Newberg, Andrew


    Summary: Traumatic brain injury (TBI) is a common and potentially devastating clinical problem. Because prompt proper management of TBI sequelae can significantly alter the clinical course especially within 48 h of the injury, neuroimaging techniques have become an important part of the diagnostic work up of such patients. In the acute setting, these imaging studies can determine the presence and extent of injury and guide surgical planning and minimally invasive interventions. Neuroimaging a...

  2. Traumatic injuries in revue dancers. (United States)

    Wanke, Eileen M; Arendt, Michael; Mill, Helmgard; Koch, Franziska; Wanke, Alice; Groneberg, David A


    Revue productions are a combination of dancing and singing, musical and spoken sequences, and acrobatics, performed with or without a story line, and characterized by a versatility of dance styles and a high number of performances (over 250 in a 10-month season). The aim of this quantitative single cohort study is to evaluate work-related traumatic injuries in this dance genre. Data were obtained from work accident reports of the German Social Accident Insurance Institution for the public sector in Berlin (UKB) involving 440 revue dancers (183 males and 257 females). Analysis was conducted with Excel 2007 and PASW Statistics 18. One out of three female dancers and one out of two male dancers sustained an acute injury in the course of a theatrical season (0.22 injuries per 1,000 hours). The incidence rate was 0.44 for males and 0.31 for females, with the lower extremity as the most commonly injured body region, followed by the spine. Of all occupational accidents, 75.1% happened on stage, with 69% during performances. The dance partner and dance floor were the most common exogenous factors resulting in a traumatic injury. Of all traumatic injuries, 81.7% occurred in the first 3 hours after starting work. Gender specific differences could be observed. Due to the limited availability of comparable studies of other forms of professional dance, in this study revue dance is largely considered as an independent genre.

  3. Granuloma inguinale mimicking as squamous cell carcinoma of penis

    Directory of Open Access Journals (Sweden)

    Abhishek Pilani


    Full Text Available Granuloma inguinale (GI is an acquired chronic, slowly progressive, mildly contagious disease of venereal origin, characterized by granulomatous ulceration of the genitalia and neighboring sites, with little or no tendency to spontaneous healing caused by Klebsiella (Calymmatobacterium granulomatis. A 55-year-old male presented with fissured, foul smelling, fungating growth over prepuce with phimosis mimicking squamous cell carcinoma (SCC without lymphadenopathy. It started with painless papulonodular showed pseudoepitheliomatous hyperplasia, infiltration in dermis, acanthosis and vacuolated macrophages suggestive of GI and not showing any histopathological features of SCC. Patient was successfully treated by giving cotrimoxazole twice a day for 21 days. Here, we presented a case of GI mimicking SCC of penis, which was diagnosed on basis of histopathology and treated with excision followed by medical therapy with cotrimoxazole.

  4. Mimicking biological functionality with polymers for biomedical applications (United States)

    Green, Jordan J.; Elisseeff, Jennifer H.


    The vast opportunities for biomaterials design and functionality enabled by mimicking nature continue to stretch the limits of imagination. As both biological understanding and engineering capabilities develop, more sophisticated biomedical materials can be synthesized that have multifaceted chemical, biological and physical characteristics designed to achieve specific therapeutic goals. Mimicry is being used in the design of polymers for biomedical applications that are required locally in tissues, systemically throughout the body, and at the interface with tissues.

  5. Localized IgG4-related Cholecystitis Mimicking Gallbladder Cancer. (United States)

    Inoue, Tadahisa; Okumura, Fumihiro; Mizushima, Takashi; Nishie, Hirotada; Iwasaki, Hiroyasu; Anbe, Kaiki; Ozeki, Takanori; Kachi, Kenta; Fukusada, Shigeki; Suzuki, Yuta; Watanabe, Kazuko; Sano, Hitoshi


    We encountered a case of localized IgG4-cholecystitis mimicking gallbladder cancer with focal/segmental type1 autoimmune pancreatitis (AIP). In this case, we were unable to exclude a diagnosis of gallbladder cancer and thus performed radical cholecystectomy. Type1 AIP is often associated with gallbladder lesions, accompanied by generally diffuse, circumferential thickening of the gallbladder wall. Although localized IgG4-related cholecystitis is extremely rare, differentiating this condition from gallbladder cancer is often very difficult.

  6. Embryonal rhabdomyosarcoma of the biliary tree mimicking a choledochal cyst

    Directory of Open Access Journals (Sweden)

    Nemade Bhushan


    Full Text Available Embryonal rhabdomyosarcoma (ERMS of biliary tree is a rare type of mesenchymal neoplasm diagnosed at surgery or by preoperative liver biopsy. We present a one year eight months old child who mimicked a choledochal cyst and was eventually treated with surgery, chemotherapy with IRS IV protocol and adjuvant postoperative radiotherapy to surgical bed with 6 MV photons to a dose of 5040cGy in 28 fractions.

  7. Osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis

    Directory of Open Access Journals (Sweden)

    Nirmal Raj Gopinathan


    Full Text Available Osteofibrous dysplasia or ossifying fibroma is an uncommon benign fibro-osseous lesion of childhood, commonly described in the maxilla and the mandible. Among long bones, it usually presents in the tibia as a painless swelling or anterior bowing. Ossifying fibroma of clavicle has never been reported in English literature, to the best of our knowledge. Here, we would like to present an unusual case of osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis.

  8. Acutely calcified hematoma mimicking a displaced medial epicondyle fracture

    Directory of Open Access Journals (Sweden)

    Majed Addie


    Full Text Available We present an interesting and unusual case of an acutely calcified pin-site infection hematoma mimicking a displaced cartilaginous medial epicondyle, in a child with a Gartland type III fracture. The treatment of such pathology could be confusing and may interfere with the correct clinical decision-making process. To our knowledge, this is the first presentation of such a case.

  9. Osteolytic nasal polyp of the maxillary sinus mimicking malignancy

    Directory of Open Access Journals (Sweden)

    Arvind Karikal


    Full Text Available We present an osteolytic nasal polyp of the maxillary sinus with clinical features and radiographic features mimicking that of a malignancy. Maxillary sinusitis being a common inflammatory condition progressed to cause destruction of the maxillary bone and spread into the facial soft tissue, which is quite a rare occurrence. We have discussed in detail the clinical, radiological, histopathology and management of this uncommon presentation of a common case.

  10. Spitz Nevus on the Earlobe Mimicking Cutaneous Leishmaniasis

    Directory of Open Access Journals (Sweden)

    İbrahim Özmen


    Full Text Available Spitz nevus is a benign, usually acquired melanocytic tumor which is seen especially in children and adolescents. It usually appears as a pink or light-brown, smooth-surfaced, well-circumscribed and asymptomatic papulonodular lesion. A large group of dermatologic disorders should be considered in the differential diagnosis. Herein we present a case of Spitz nevus with a two month history of a nodular lesion on the earlobe which mimicks cutaneous leishmaniasis clinically.

  11. Sciatic Hernia Mimicking Perianal Abscess in a Cirrhotic Patient

    Directory of Open Access Journals (Sweden)

    Wellington Andraus


    Full Text Available Abdominal hernias are very frequent in cirrhotic patients with ascites. The hernias usually present as umbilical, inguinal, incisional, or femoral. However, these patients can also develop uncommon hernias such as pelvic hernias because of pelvic floor weakness and high abdominal pressure due to ascites. We present the first case of a cirrhotic patient with ascites that developed a giant sciatic hernia mimicking a perianal abscess.

  12. Tuberculosis of the skull mimicking a bony tumor



    We present a rare case of calvarial tuberculosis mimicking a solitary bone tumor, which was surgically removed. A 52-year-old female presented with a right forehead swelling, which gradually enlarged over the course of 2 years, with no symptoms or raised intracranial pressure or neurological deficits. Plain and contrast-enhanced brain computed tomography scans were done, revealing a punched-out lesion of the right frontal bone, with a nonenhancing lytic mass. With an initial diagnosis of an i...

  13. A case of gallbladder mass: Malakoplakia (The tumor mimicker

    Directory of Open Access Journals (Sweden)

    Kanwaljeet Singh


    Full Text Available Diagnosis of malakoplakia presenting as gall bladder mass is a diagnostic dilemma faced by pathologists, radiologists, and surgeons. Malakoplakia is a rare inflammatory disorder and tumor mimicker usually occurring in the urinary tract, may occasionally be found in gall bladder. Here, we present a rare case, presenting as gall bladder mass in a known case of gallstone disease, clinically suspected as carcinoma and later turned out to be malakoplakia in gall bladder.

  14. Heparin-Mimicking Polymers: Synthesis and Biological Applications (United States)


    Heparin is a naturally occurring, highly sulfated polysaccharide that plays a critical role in a range of different biological processes. Therapeutically, it is mostly commonly used as an injectable solution as an anticoagulant for a variety of indications, although it has also been employed in other forms such as coatings on various biomedical devices. Due to the diverse functions of this polysaccharide in the body, including anticoagulation, tissue regeneration, anti-inflammation, and protein stabilization, and drawbacks of its use, analogous heparin-mimicking materials are also widely studied for therapeutic applications. This review focuses on one type of these materials, namely, synthetic heparin-mimicking polymers. Utilization of these polymers provides significant benefits compared to heparin, including enhancing therapeutic efficacy and reducing side effects as a result of fine-tuning heparin-binding motifs and other molecular characteristics. The major types of the various polymers are summarized, as well as their applications. Because development of a broader range of heparin-mimicking materials would further expand the impact of these polymers in the treatment of various diseases, future directions are also discussed. PMID:27739666

  15. Traumatic Bonding: Clinical Implications in Incest. (United States)

    deYoung, Mary; Lowry, Judith A.


    "Traumatic bonding" is defined as "the evolution of emotional dependency between...a child and an adult [in] a relationship characterized by periodic sexual abuse." Maintains that the concept holds promise for explaining confusing dynamics of incest. Demonstrates ways in which traumatic bonding can be applied to cases of incest and discusses…

  16. Secondary Traumatic Stress in Substance Abuse Treatment (United States)

    Bride, Brian E.; Walls, Erin


    The terms secondary traumatic stress (STS), vicarious traumatization (VT), and compassion fatigue (CF) have all been used, sometimes interchangeably, to refer to the observation that those who provide clinical services to trauma survivors may themselves experience considerable emotional disruption, becoming indirect victims of the trauma.…

  17. Epidemiology of traumatic brain injury in Europe

    NARCIS (Netherlands)

    W. Peeters (Wouter); R. van den Brande (Ruben); S. Polinder (Suzanne); A. Brazinova (Alexandra); E.W. Steyerberg (Ewout); H.F. Lingsma (Hester); A.I.R. Maas (Andrew)


    textabstractBackground: Traumatic brain injury (TBI) is a critical public health and socio-economic problem throughout the world, making epidemiological monitoring of incidence, prevalence and outcome of TBI necessary. We aimed to describe the epidemiology of traumatic brain injury in Europe and to

  18. Patent ductus arteriosus in an adult cat with pulmonary hypertension and right-sided congestive heart failure: hemodynamic evaluation and clinical outcome following ductal closure. (United States)

    Novo-Matos, José; Hurter, Karin; Bektas, Rima; Grest, Paula; Glaus, Tony


    Right-sided congestive heart failure (CHF) developed secondary to severe pulmonary hypertension (PH) in an 8-year-old cat with a left-to-right shunting patent ductus arteriosus (PDA). Vascular reactivity was tested prior to shunt ligation by treatment with oxygen and sildenafil. This treatment was associated with a significant decrease in pulmonary artery pressure as assessed by echocardiography. Subsequently surgical shunt ligation was planned. During thoracotomy, digital occlusion of the PDA was performed for 10 min with simultaneous catheter measurement of right ventricular pressure, which did not increase. Permanent shunt ligation resulted in a complete and sustained clinical recovery. A lung biopsy sample obtained during thoracotomy demonstrated histopathological arterial changes typical of PH. Cats can develop clinically severe PH and right-sided CHF secondary to a left-to-right PDA even at an advanced age. Assuming there is evidence of pulmonary reactivity, PDA occlusion might be tolerated and can potentially produce long-term clinical benefits.

  19. Post-traumatic Stress Disorder. (United States)

    Javidi, H; Yadollahie, M


    Unexpected extreme sudden traumatic stressor may cause post-traumatic stress disorder (PTSD). Important traumatic events include war, violent personal assault (e.g., sexual assault, and physical attack), being taken hostage or kidnapped, confinement as a prisoner of war, torture, terrorist attack, severe car accidents, and natural disasters. In childhood age sexual abuse or witnessing serious injuries or unexpected death of a beloved one are among important traumatic events.PTSD can be categorized into two types of acute and chronic PTSD: if symptoms persist for less than three months, it is termed "acute PTSD," otherwise, it is called "chronic PTSD." 60.7% of men and 51.2% of women would experience at least one potentially traumatic event in their lifetime. The lifetime prevalence of PTSD is significantly higher in women than men. Lifetime prevalence of PTSD varies from 0.3% in China to 6.1% in New Zealand. The prevalence of PTSD in crime victims are between 19% and 75%; rates as high as 80% have been reported following rape. The prevalence of PTSD among direct victims of disasters was reported to be 30%-40%; the rate in rescue workers was 10%-20%. The prevalence of PTSD among police, fire, and emergency service workers ranged from 6%-32%. An overall prevalence rate of 4% for the general population, the rate in rescue/recovery occupations ranged from 5% to 32%, with the highest rate reported in search and rescue personnel (25%), firefighters (21%), and workers with no prior training for facing disaster. War is one of the most intense stressors known to man. Armed forces have a higher prevalence of depression, anxiety disorders, alcohol abuse and PTSD. High-risk children who have been abused or experienced natural disasters may have an even higher prevalence of PTSD than adults.Female gender, previous psychiatric problem, intensity and nature of exposure to the traumatic event, and lack of social support are known risk factors for work-related PTSD. Working with

  20. Post-traumatic Stress Disorder

    Directory of Open Access Journals (Sweden)

    M Yadollahie


    Full Text Available Unexpected extreme sudden traumatic stressor may cause post-traumatic stress disorder (PTSD. Important traumatic events include war, violent personal assault (e.g., sexual assault, and physical attack, being taken hostage or kidnapped, confinement as a prisoner of war, torture, terrorist attack, severe car accidents, and natural disasters. In childhood age sexual abuse or witnessing serious injuries or unexpected death of a beloved one are among important traumatic events.PTSD can be categorized into two types of acute and chronic PTSD: if symptoms persist for less than three months, it is termed “acute PTSD,” otherwise, it is called “chronic PTSD.” 60.7% of men and 51.2% of women would experience at least one potentially traumatic event in their lifetime. The lifetime prevalence of PTSD is significantly higher in women than men. Lifetime prevalence of PTSD varies from 0.3% in China to 6.1% in New Zealand. The prevalence of PTSD in crime victims are between 19% and 75%; rates as high as 80% have been reported following rape. The prevalence of PTSD among direct victims of disasters was reported to be 30%–40%; the rate in rescue workers was 10%–20%. The prevalence of PTSD among police, fire, and emergency service workers ranged from 6%–32%. An overall prevalence rate of 4% for the general population, the rate in rescue/recovery occupations ranged from 5% to 32%, with the highest rate reported in search and rescue personnel (25%, firefighters (21%, and workers with no prior training for facing disaster. War is one of the most intense stressors known to man. Armed forces have a higher prevalence of depression, anxiety disorders, alcohol abuse and PTSD. High-risk children who have been abused or experienced natural disasters may have an even higher prevalence of PTSD than adults.Female gender, previous psychiatric problem, intensity and nature of exposure to the traumatic event, and lack of social support are known risk factors for work

  1. Traumatic injuries of the hip.

    LENUS (Irish Health Repository)

    Marshall, Nina


    Traumatic lesions of the hip in athletes may be clinically challenging because of the overlap in clinical presentation due to differing pathologies and the presence of multiple injuries. Imaging of the hip in the athlete has undergone a recent resurgence of interest and understanding related to the increasing accessibility and use of hip arthroscopy, which expands the treatment options available for intra-articular pathology. MR imaging and MR arthrography have a unique role in diagnosis of these pathologies, guiding the surgeon, arthroscopist, and referring clinician in their management of bony and soft tissue injury.

  2. Surgical, non-traumatic splenopathies

    Directory of Open Access Journals (Sweden)

    Ivonne López Masó


    Full Text Available As our modern-day understanding about the role of the spleen in the immune system has developed, indications for splenectomies have also changed. Illnesses like idiopatic thrombocytopenic purple, hereditary spherocytosis, sickle cell anemia, beta thalassemia, portal hypertension and other non-traumatic disseases that carry out with congestive splenomegaly and hypersplenism, find an effective alternative with the total or partially splenectomy. We presented the Good Clinical Practices Guideline for Portal hypertension, approved by consensus in the 4th National Good Clinical Practices Workshop in Pediatric Surgery (Las Tunas, Cuba, March, 2005.

  3. Hypopituitarism after traumatic brain injury. (United States)

    Fernandez-Rodriguez, Eva; Bernabeu, Ignacio; Castro, Ana I; Casanueva, Felipe F


    The prevalence of hypopituitarism after traumatic brain (TBI) injury is widely variable in the literature; a meta-analysis determined a pooled prevalence of anterior hypopituitarism of 27.5%. Growth hormone deficiency is the most prevalent hormone insufficiency after TBI; however, the prevalence of each type of pituitary deficiency is influenced by the assays used for diagnosis, severity of head trauma, and time of evaluation. Recent studies have demonstrated improvement in cognitive function and cognitive quality of life with substitution therapy in GH-deficient patients after TBI.

  4. Early traumatic events in psychopaths. (United States)

    Borja, Karina; Ostrosky, Feggy


    The relationship between diverse early traumatic events and psychopathy was studied in 194 male inmates. Criminal history transcripts were revised, and clinical interviews were conducted to determine the level of psychopathy using the Psychopathy Checklist-Revised (PCL-R) Form, and the Early Trauma Inventory was applied to assess the incidence of abuse before 18 years of age. Psychopathic inmates presented a higher victimization level and were more exposed to certain types of intended abuse than sociopathic inmates, while the sum of events and emotional abuse were associated with the PCL-R score. Our studies support the influence of early adverse events in the development of psychopathic offenders.

  5. Analysis of CT angiography of persistent truncus arteriosus Ⅳ%永存动脉干Ⅳ型的CT血管造影分析

    Institute of Scientific and Technical Information of China (English)

    袁亮; 邹利光; 付刘霞


    目的 探讨永存动脉干Ⅳ型的CT血管造影特征.方法 回顾性分析CT血管造影证实的永存动脉干Ⅳ型共14例,男5例,女9例;评估心脏形态、室间隔缺损、动脉干骑跨、支气管动脉异常及侧支循环、其他心血管畸形特征.结果 CT血管造影显示:①双心室增大明显,伴右心房增大;②高位室间隔缺损,缺损平均直径(20.1±5.2) mm,其中男性为(23.7±5.2) mm,女性为(18.2±5.6) mm,差异无统计学意义(t=1.813,P=0.095,P>0.05);③动脉干骑跨率为(50±5.2)%,男性为(51±2.3)%,女性为(49±6.3)%,差异无统计学意义(t=0.522,P=0.611,P>0.05);动脉干平均内径(34.2±6.4) mm,男性为(39.1±4.3) mm,女性为(31.4±5.8) mm,差异有统计学意义( t=2.589,P=0.024,P<0.05);④无肺动脉主干,心腰明显凹陷,肺血由支气管动脉及侧支循环供应,部分支气管动脉呈"残根"征;⑤男女各2例伴右位主动脉弓,其中1例男性有左侧肺静脉异常粗大,女性1例伴永存左上腔静脉.结论 永存动脉干Ⅳ型特征复杂多变,CT血管造影有利于提高诊断准确率,对手术有重要参考价值.%Objective To evaluate the findings of computed tomography angiography of persistent truncus arteriosus Ⅳ. Methods 14 patients (5 men and 9 women) of persistent truncus arteriosus Ⅳ confirmed by CT angiography were involved in this study. The cardiac morphology,ventricular septal defect,arteriosus truncus straddle,anomalism bronchial arteries and complicating vascular malformations were analysed retrospectively. Results CT angiography showed:①Biventricular enlargement obviously and accompanying with right atrium enlargement;②The average diameter of ventricular septal defect was (20. 1±5. 2) mm, (23. 7 ± 5. 2) mm in men and (18. 2 + 5. 6) mm in women,there was no statistically signfificant difference between them(t= 1. 813,P = 0. 095 , P>0. 05) ; ③The average rate of the arteriosus truncus straddle was (50 ± 5. 2) % , (51 ± 2. 3)% in men

  6. The Spectrum of Disease in Chronic Traumatic Encephalopathy (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.


    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…

  7. BPSD following traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Renato Anghinah

    Full Text Available ABSTRACT Annually, 700,000 people are hospitalized with brain injury acquired after traumatic brain injury (TBI in Brazil. Objective: We aim to review the basic concepts related to TBI, and the most common Behavioral and Psychological Symptoms of Dementia (BPSD findings in moderate and severe TBI survivors. We also discussed our strategies used to manage such patients in the post-acute period. Methods: Fifteen TBI outpatients followed at the Center for Cognitive Rehabilitation Post-TBI of the Clinicas Hospital of the University of São Paulo were submitted to a neurological, neuropsychological, speech and occupational therapy evaluation, including the Mini-Mental State Examination. Rehabilitation strategies will then be developed, together with the interdisciplinary team, for each patient individually. Where necessary, the pharmacological approach will be adopted. Results: Our study will discuss options of pharmacologic treatment choices for cognitive, behavioral, or affective disorders following TBI, providing relevant information related to a structured cognitive rehabilitation service and certainly will offer an alternative for patients and families afflicted by TBI. Conclusion: Traumatic brain injury can cause a variety of potentially disabling psychiatric symptoms and syndromes. Combined behavioral and pharmacological strategies, in the treatment of a set of highly challenging behavioral problems, appears to be essential for good patient recovery.

  8. Symptomatic ecchordosis physaliphora mimicking as an intracranial arachnoid cyst. (United States)

    Filis, Andreas; Kalakoti, Piyush; Nanda, Anil


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

  9. Klebsiella pneumoniae pharyngitis mimicking malignancy: a diagnostic dilemma. (United States)

    Yeh, C-F; Li, W-Y; Hsu, Y-B


    Acute pharyngitis is a common disease. However, acute pharyngitis caused by Klebsiella pneumoniae with a gross appearance mimicking hypopharyngeal malignancy has never previously been reported. We report the case of a 57-year-old man with a right hypopharyngeal tumor which was disclosed by fiberoptic laryngoscopy and computed tomography scan. However, both the frozen and final pathologies showed no evidence of malignant cells, and a bacterial culture revealed the growth of K. pneumoniae. The hypopharyngeal lesion completely regressed after 2 weeks of antibiotic treatment. Clinicians should perform biopsy along with tissue culture for tumor-like lesions because infectious agents can lead to lesions with malignancy-like appearance.

  10. Aneurysm of the common iliac vein mimicking a pelvic mass

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Eun Joo; Kim, Dong Hun [Dept. of Radiology, Chosun University College of Medicine, Gwangju (Korea, Republic of); Suk, Eun Ha [Dept. of Anesthesiology and Pain Medicine, Seonam University College of Medicine, Namwon (Korea, Republic of)


    Venous aneurysm, especially of primary origin, is rare. The authors report a case of a 63-year-old female who was admitted for back pain and an aneurysm of the common iliac which was detected incidentally. CT, magnetic resonance (MR), Doppler ultrasonography, and conventional venography showed an aneurysm of the left common iliac vein measuring 4.5 , 00D7, 3, 00D7, 4 cm. Because there were no complications of the aneurysm, no further treatment was administered. Herein, we describe findings of a venous aneurysm of the common iliac vein mimicking a pelvic mass on CT and MR scans and with a review of the literature.

  11. Pancreatitis with Electrocardiographic Changes Mimicking Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Paul Khairy


    Full Text Available A 64-year-old woman with mild acute pancreatitis presented with epigastric pain, nausea and vomiting while undergoing hemodialysis for chronic renal insufficiency. Serial electrocardiograms revealed new onset ST segment elevations in leads V2 to V4 mimicking an anterior myocardial infarction, followed by diffusely inverted deep T waves. No cardiac pathology was demonstrated by echocardiography or coronary angiography. A review of the literature and possible pathophysiological mechanisms of electrocardiographic changes in acute pancreatitis, such as metabolic abnormalities, hemodynamic instability, vasopressors, pericarditis, myocarditis, a cardiobiliary reflex, exacerbation of underlying cardiac pathology, coagulopathy and coronary vasospasm, are discussed.

  12. Intracortical bone metastasis mimicking intracortical osteoid osteoma: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Yu Ri; Kim, Jee Young [St. Vincent' s Hospital, The Catholic University of Korea, Suwon (Korea, Republic of)


    Cortical metastasis usually occurs in the diaphysis of the long bones with the appearance of a cookie-bite pattern; this is associated with cortical destruction extending into the soft tissue as well as into the medullary cavity, or there can be a periosteal reaction. We report here on a 66-year-old woman who was diagnosed with intracortical metastasis in the proximal metaphysis of the right femur as an initial metastatic focus from primary lung cancer. CT detected an intracortical osteolytic lesion without cortical destruction or thickening. The MR images showed extensive peritumoral edema in the surrounding soft tissue and adjacent bone marrow edema, and this all mimicked osteoid osteoma.

  13. Enterobiasis in Ectopic Locations Mimicking Tumor-Like Lesions


    Silvio Pampiglione; Francesco Rivasi


    Both the clinical and the histopathological diagnostic difficulties of oxyuriasis in unusual sites and their importance from a clinical point of view are pointed out. The authors report two ectoptic cases of enterobiasis observed in Northern Italy, one located in a fallopian tube of a 57-year-old woman and the other in a perianal subcutaneous tissue of a 59-year-old man, mimicking tumor-like lesions. The authors take advantage of the occasion to focus the attention of the medical world on thi...

  14. A huge renal capsular leiomyoma mimicking retroperitoneal sarcoma

    Directory of Open Access Journals (Sweden)

    Lal Anupam


    Full Text Available A huge left renal capsular leiomyoma mimicking retroperitoneal sarcoma presented in a patient as an abdominal mass. Computed tomography displayed a large heterogeneous retro-peritoneal mass in the left side of the abdomen with inferior and medial displacement as well as loss of fat plane with the left kidney. Surgical exploration revealed a capsulated mass that was tightly adherent to the left kidney; therefore, total tumor resection with radical left nephrectomy was performed. Histopathology ultimately confirmed the benign nature of the mass. This is the largest leiomyoma reported in literature to the best of our knowledge.

  15. Iliacus pyomyositis mimicking septic arthritis of the hip joint. (United States)

    Chen W-S; Wan Y-L


    The iliacus muscle is closely associated with the psoas muscle, femoral nerve, hip joint, pelvic and intraabdominal structures; thus, its disorders may present as lower abdominal pain, hip pain, or femoral neuropathy. Iliacus pyomyositis, a primary bacterial infection of the skeletal muscle not secondary to a contiguous skin, bone, or soft-tissue infection, presenting as hip pain, femoral neuropathy, and sympathetic effusion of the hip joint in an 8-year-old boy mimicked septic arthritis of the hip joint. Computed tomography was helpful in delineating the accurate location of the lesion. Surgical drainage and appropriate antibiotic therapy led to complete resolution and full functional recovery.

  16. Subcutaneous phaeohyphomycosis due to Pyrenochaeta romeroi mimicking a synovial cyst

    Directory of Open Access Journals (Sweden)

    Aurelien Dinh


    Full Text Available Opportunistic subcutaneous fungal infections are increasing nowadays due to the growing number of medical conditions causing immunosuppression, especially organ transplant. The incidence rate of subcutaneous phaeohyphomycosis is very low. Most studies found are case reports. They showed a wide variation of clinical presentations. Pyrenochaeta romeroi, a fungus from the Dematiaceae group is a saprophyte found in soil and plants and a possible causative agent of phaeohyphomycosis. We present a rare case of subcutaneous phaeohyphomycosis caused by P. romeroi mimicking a synovial cyst in a diabetic patient.

  17. Lepra reaction with lucio phenomenon mimicking cutaneous vasculitis. (United States)

    Misra, Durga Prasanna; Parida, Jyoti Ranjan; Chowdhury, Abhra Chandra; Pani, Krushna Chandra; Kumari, Niraj; Krishnani, Narendra; Agarwal, Vikas


    Leprosy is a disease typically found in the tropics. Patients with leprosy can have varying presentation with constitutional symptoms, joint pains, skin nodules, and rarely a vasculitis-like picture with skin ulcers and neuropathy. We present a young lady who presented with the rare manifestation of skin infarcts mimicking cutaneous vasculitis, diagnosed on histopathology to have Lucio phenomenon on a background of lepromatous leprosy. With increasing migration and widespread use of biologic response modifiers, clinicians all over the world need to be aware of various presentations of leprosy as well as needing to keep an open mind while considering the differential diagnoses of vasculitis.

  18. Dual anaplastic large cell lymphoma mimicking meningioma: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Keun Ho; Kim, Ki Hwan; Lee, Ghi Jai; Lee, Hye Kyung; Shim, Jae Chan; Lee, Kyoung Eun; Suh, Jung Ho [Seoul Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of); Lee, Chae Heuck [Dept. of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang (Korea, Republic of)


    Anaplastic large cell lymphoma (ALCL) is a rare T cell lymphoma composed of CD30-positive lymphoid cells. Most ALCLs present as nodal disease, with skin, bone, soft tissue, lung, and liver as common extranodal sites. ALCL rarely occurs in the central nervous system and is even more infrequent in the dura of the brain. We report a case of dural-based ALCL secondary to systemic disease in a 17-year-old male that mimicked meningioma on magnetic resonance imaging and angiography.

  19. Endometriosis mimicking the perianal fistula tract: Case report

    Directory of Open Access Journals (Sweden)

    Gül Türkcü


    Full Text Available Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. Nowadays, in many cases, although routine use of episiotomy perineal endo metriosis is extremely rare. A 36 year old female patient was referred to our hospital with complaints of pain in the perianal region for five months. On physical examination, stiffness was palpated and then magnetic resonance im aging (MRI was performed. MRI is compatible with fistula tract. The lesion was excised and the histopathological appearance correspond to endometriosis. Perianal endo metriosis is rare in the perianal region and in the clinic mimicking perianal fistulas and malignancy should be kept in mind in the differential diagnosis

  20. Simple bone cyst of mandible mimicking periapical cyst

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    Charan Babu HS


    Full Text Available Simple bone cysts (SBC are pseudocysts occurring less commonly in the maxillofacial region. The uncertain and unclear etiopathogenesis led to numerous synonyms to refer this particular cyst. These cysts are devoid of an epithelial lining and are usually empty or contain blood or straw-colored fluid. In jaws initially it mimics a periapical cyst and later can lead to cortical bone expansion warranting for radical approach, which is seldom required. SBC is predominantly diagnosed in first two decades of life. Here we report a case of solitary bone cyst mimicking a periapical cyst of a mandibular molar in a 37-year-old patient.

  1. Simple bone cyst of mandible mimicking periapical cyst. (United States)

    Hs, Charan Babu; Rai, Bhagawan Das; Nair, Manju A; Astekar, Madhusudan S


    Simple bone cysts (SBC) are pseudocysts occurring less commonly in the maxillofacial region. The uncertain and unclear etiopathogenesis led to numerous synonyms to refer this particular cyst. These cysts are devoid of an epithelial lining and are usually empty or contain blood or straw-colored fluid. In jaws initially it mimics a periapical cyst and later can lead to cortical bone expansion warranting for radical approach, which is seldom required. SBC is predominantly diagnosed in first two decades of life. Here we report a case of solitary bone cyst mimicking a periapical cyst of a mandibular molar in a 37-year-old patient.

  2. Brucellosis mimicking Henoch-Schönlein purpura. (United States)

    Massasso, David; Gibson, Kathryn


    A young male immigrant from Syria with a vasculitic-appearing leg rash, asymmetrical polyarthritis, microscopic haematuria, and raised inflammatory markers was provisionally diagnosed with Henoch-Schönlein purpura. Skin biopsy showed leukocytoclastic vasculitis. Low-grade fevers persisted despite non-steroidal anti-inflammatory therapy, and Brucella sp. was subsequently grown from both blood and synovial fluid aspirates. Further tests gave positive results for B. abortus, and triple antibiotic therapy produced a rapid clinical response. Cutaneous vasculitis has rarely been described in brucellosis, and this is the first report in the English medical literature of brucellosis mimicking Henoch-Schönlein purpura.


    Directory of Open Access Journals (Sweden)

    Funda Tamer


    Full Text Available A cutaneous horn is a general name for cornified material protruding from skin. On the other hand, polydactyly is a common congenital anomaly of the hand and foot which is characterized by extra finger or toe. A cutaneous horn might mimick polydactyly by resembling an extra toe. Hereby, we present a 72-year-old white Caucasian male with an extra toe-like projection on his fourth toe. Initially, polydactyly was suspected, however a cutaneous horn was also considered. The lesion was surgically removed. The histopathological examination of the specimen revealed hyperkeratosis, and thus confirmed the  lesion to be a cutaneous horn. 

  4. Hızma Induced Papul of Nose Mimicking Pyogenic Granuloma

    Directory of Open Access Journals (Sweden)

    Mualla Polat


    Full Text Available The application of body piercing is popular among young people, who consider it as a sign of marginality, beauty, or group identity. Piercing procedure is observed to cause a large number of complications such as infections, pain, inflammatory reactions, bleeding, dental fractures or fissures, and gingival damage, etc., mostly in young individuals. Hizma is a traditional body ornament worn by Anatolian women via a piercing procedure. Herein, we describe a papule of nose mimicking pyogenic granuloma as an uncommon complication of Hızma.

  5. Tissue-Mimicking Materials Using Segmented Polyurethane Gel and Their Acoustic Properties (United States)

    Yoshida, Tomoji; Tanaka, Kouhei; Kondo, Toshio; Yasukawa, Kazuhiro; Miyamoto, Nobuaki; Taniguchi, Masahiko; Shikinami, Yasuo


    Accurate testing of an instrument by phantoms requires a tissue-mimicking material that has the acoustic velocity and density defined in the International Electrotechnical Commission (IEC) standard, and furthermore the tissue-mimicking material must be stable over time. To achieve the tissue-mimicking materials with the desired acoustic velocity and density defined in the IEC standard, new materials have been developed. The form of tissue-mimicking materials reported comprised polystyrene and poly(methyl methacrylate) (PMMA) particles dispersed in segmented polyurethane gel. They were stable over a period of 40 days and the changes in weight and acoustic velocity did not exceed 0.5%.

  6. Research progress in traumatic brain penumbra

    Institute of Scientific and Technical Information of China (English)

    Wang Kai; Liu Baiyun; Ma Jun


    Objective Following traumatic brain injury (TBI),brain tissue that surrounding the regional primary lesion is known as traumatic penumbra; this region may undergo secondary injury and is considered to have the potential to recover.This review aimed to reveal the existence and significance of traumatic penumbra by analyzing all relevant studies concerning basic pathologic changes and brain imaging after TBI.Data sources We collected all relevant studies about TBI and traumatic penumbra in Medline (1995 to June 2013) and ISI (1997 to March 2013),evaluated their quality and relevance,then extracted and synthesized the information.Study selection We included all relevant studies concerning TBI and traumatic penumbra (there was no limitation of research design and article language) and excluded the duplicated articles.Results The crucial pathological changes after TBI include cerebral blood flow change,cerebral edema,blood-brain barrier damage,cell apoptosis and necrosis.Besides,traditional imaging method cannot characterize the consequences of CBF reduction at an early stage and provides limited insights into the underlying pathophysiology.While advanced imaging technique,such as diffusion tensor imaging (DTI) and positron emission tomography (PET),may provide better characterization of such pathophysiology.Conclusions The future of traumatic brain lesions depends to a large extent on the evolution of the penumbra.Therefore,understanding the formation and pathophysiologic process of the traumatic penumbra and its imaging research progress is of great significant for early clinical determination and timely brain rescue.

  7. Differential shunting in the diagnosis of patent ductus arteriosus with Eisenmenger physiology by radionuclide angiography. [/sup 99m/Te-pertechnetate; (sup 99m/Te-MAA; aorta-pulmanary artery shunts

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, J.L.; Scherer, J.; Kahl, F.R.; Watson, N.; Cowan, R.


    Radionuclide angiography and static whole-body imaging performed with technetium-99m-labeled particulates can clearly demonstrate differential shunting in patients with patent ductus arteriosus (PDA) with Eisenmenger physiology. The anatomic arterial relationships in this condition which direct deoxygenated blood into the lower body (differential cyanosis) produce specific radionuclide images characterized by differential shunting of the technetium-99m-labeled particulates into the abdomen and lower extremity.

  8. A Patient With Plaque Type Morphea Mimicking Systemic Lupus Erythematosus

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    Wardhana Wardhana


    Full Text Available Morphea is an uncommon connective tissue disease with the most prominent feature being thickening or fibrosis of the dermal without internal organ involvement. It is also known as a part of localized scleroderma. Based on clinical presentation and depth of tissue involvement, morphea is classified into several forms, and about two thirds of adults with morphea have plaque type. Overproduction of collagen production by fibroblast is the cause of abnormality in morphea, and the hyperactivity mechanism of fibroblast is still unknown, although there are several mechanisms already proposed. Plaque type morphea is actually a benign and self limited. Plaque type morphea that mimicking systemic lupus erythematosus in clinical appearance, such as alopecia and oral mucosal ulcers, is uncommon. A case of plaque type morphea mimicking systemic lupus erythematosus in a 20 year old woman was discussed. The patient was treated with local and systemic immunosuppressant and antioxydant. The patient’s condition is improved without any significant side effects. Key words: morphea, plaque type.

  9. Characterization of various tissue mimicking materials for medical ultrasound imaging (United States)

    Thouvenot, Audrey; Poepping, Tamie; Peters, Terry M.; Chen, Elvis C. S.


    Tissue mimicking materials are physical constructs exhibiting certain desired properties, which are used in machine calibration, medical imaging research, surgical planning, training, and simulation. For medical ultrasound, those specific properties include acoustic propagation speed and attenuation coefficient over the diagnostic frequency range. We investigated the acoustic characteristics of polyvinyl chloride (PVC) plastisol, polydimethylsiloxane (PDMS), and isopropanol using a time-of-light technique, where a pulse was passed through a sample of known thickness contained in a water bath. The propagation speed in PVC is approximately 1400ms-1 depending on the exact chemical composition, with the attenuation coefficient ranging from 0:35 dB cm-1 at 1MHz to 10:57 dB cm-1 at 9 MHz. The propagation speed in PDMS is in the range of 1100ms-1, with an attenuation coefficient of 1:28 dB cm-1 at 1MHz to 21:22 dB cm-1 at 9 MHz. At room temperature (22 °C), a mixture of water-isopropanol (7:25% isopropanol by volume) exhibits a propagation speed of 1540ms-1, making it an excellent and inexpensive tissue-mimicking liquid for medical ultrasound imaging.

  10. Progress in pathogenesis of patent ductus arteriosus in preterm infants%早产儿动脉导管未闭发病机制的研究进展

    Institute of Scientific and Technical Information of China (English)

    杨文庆; 杨长仪; 陈涵强


    Patent ductus arteriosus(PDA) is a common condition in the premature infants. It is associated with an increase in mortality and sequelae in these infants. The various factors contributing to an patency of the ductus arteriosus in the preterm infants are involved in: insufficient histological development of ductus arteriosus, failure of remodeling theductus, abnormal sensitivity of the ductus to oxygen and vasoactive substances,and genes.%动脉导管未闭(PDA)是早产儿常见并发症,也是影响早产儿存活率和后遗症发生率的主要原因之一.近年研究发现,早产儿PDA的发生除与自身动脉导管的组织发育不成熟、不易发生重塑有关外,还与动脉导管对氧、血管活性物质的反应异常相关;遗传因素也参与早产儿PDA的发病.

  11. Traumatic Brain Injury in Kenya

    Directory of Open Access Journals (Sweden)

    Benson Kinyanjui


    Full Text Available Kenya has a disproportionately high rate of road traffic accidents each year, many of them resulting in traumatic brain injuries (TBIs. A review of articles written on issues pertaining to the medical treatment of people with TBI in the past 15 years in Kenya indicates a significantly high incidence of TBIs and a high mortality rate. This article reviews the available literature as a first step in exploring the status of rehabilitation of Kenyans with cognitive impairments and other disabilities resulting from TBIs. From this preliminary review, it is apparent that despite TBI being a pervasive public health problem in Kenya, it has not received due attention in the public and private sectors as evidenced by a serious lack of post-acute rehabilitation services for people with TBIs. Implications for this lack of services are discussed and recommendations are made for potential approaches to this problem.

  12. Hypopituitarism in Traumatic Brain Injury

    DEFF Research Database (Denmark)

    Klose, Marianne; Feldt-Rasmussen, Ulla


    While hypopituitarism after traumatic brain injury (TBI) was previously considered rare, it is now thought to be a major cause of treatable morbidity among TBI survivors. Consequently, recommendations for assessment of pituitary function and replacement in TBI were recently introduced. Given...... the high incidence of TBI with more than 100 pr. 100,000 inhabitants, TBI would be by far the most common cause of hypopituitarism if the recently reported prevalence rates hold true. The disproportion between this proposed incidence and the occasional cases of post-TBI hypopituitarism in clinical practice...... justifies reflection as to whether hypopituitarism has been unrecognized in TBI patients or whether diagnostic testing designed for high risk populations such as patients with obvious pituitary pathology has overestimated the true risk and thereby the disease burden of hypopituitarism in TBI. The findings...

  13. Nonsurgical interventions after mild traumatic brain injury

    DEFF Research Database (Denmark)

    Nygren-de Boussard, Catharina; Holm, Lena W; Cancelliere, Carol;


    OBJECTIVE: To synthesize the best available evidence regarding the impact of nonsurgical interventions on persistent symptoms after mild traumatic brain injury (MTBI). DATA SOURCES: MEDLINE and other databases were searched (2001-2012) with terms including "rehabilitation." Inclusion criteria wer...

  14. Traumatic Brain Injury (TBI) in Kids (United States)

    ... Research Information Clinical Trials Resources and Publications Traumatic Brain Injury (TBI): Condition Information Skip sharing on social ... external force that affects the functioning of the brain. It can be caused by a bump or ...


    Directory of Open Access Journals (Sweden)

    Denismar Borges de Miranda


    Full Text Available Objective: to know the scientific literature on head injury in children. Method: this study is an integrative review of published articles in the database SciELO the period 2000-2010. Results: 10 articles were analyzed, from which emerged four categories: causes of traumatic brain child infant prognosis of traumatic brain child, treating children victims of child head injury and complications of therapy used for child victims of traumatic brain injury in children. Conclusions: there is consensus among the authors investigated the factors associated with better prognosis of traumatic brain child, remain vague and uncertain. They add that the success of this customer service related to the control of complications arising from cerebral trauma and mostly are treatable and / or preventable.

  16. Acute chylous ascites mimicking acute appendicitis in a patient with pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Emily K Smith; Edmund Ek; Daniel Croagh; Lavinia A Spain; Stephen Farrell


    We report a case of acute chylous peritonitis mimicking acute appendicitis in a man with acute on chronic pancreatitis. Pancreatitis, both acute and chronic, causing the development of acute chylous ascites and peritonitis has rarely been reported in the English literature. This is the fourth published case of acute chylous ascites mimicking acute appendicitis in the literature.

  17. Tax mimicking and yardstick competition among local governments in the Netherlands

    NARCIS (Netherlands)

    Allers, MA; Elhorst, JP


    This paper provides a spatial-econometric analysis of the setting of property tax rates by Dutch municipalities. We find evidence of tax mimicking: a ten percent higher property tax rate in neighboring municipalities leads to a 3.5 percent higher tax rate. Mimicking is less pronounced in municipalit

  18. Gene Therapy for Post-Traumatic Osteoarthritis (United States)


    AD______________ AWARD NUMBER: W81XWH-14-1-0498 TITLE: Gene Therapy for Post-Traumatic Osteoarthritis PRINCIPAL INVESTIGATOR: Steven C...COVERED 30Sept 2014 - 29 Sept 2015 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Gene Therapy for Posttraumatic Osteoarthritis 5b. GRANT NUMBER...Osteoarthritis (OA) Gene Therapy Equine Adeno-Associated Virus (AAV) Interleukin-1 Receptor Antagonist (IL-1Ra) Post-traumatic OA (PTOA) Self

  19. Post Traumatic Glioma – An association questioned

    Directory of Open Access Journals (Sweden)

    Chaurasia I.D.


    Full Text Available Post traumatic glioma has been a matter of debate. Few reports favor its occurrence in previous head injury scar, subsequently developing into glioma. Here we report a case of young patient presented with headache, seizures and gradual loss of vision. On investigation found to have brain tumor. Patient had head injury occurred 3 yrs back. It fulfills all the criteria required to establish traumatic origin, further supporting the association.

  20. Cerebral Vasospasm in Traumatic Brain Injury


    Kramer, Daniel R.; Winer, Jesse L.; B. A. Matthew Pease; Arun P. Amar; Mack, William J.


    Vasospasm following traumatic brain injury (TBI) may dramatically affect the neurological and functional recovery of a vulnerable patient population. While the reported incidence of traumatic vasospasm ranges from 19%–68%, the true incidence remains unknown due to variability in protocols for its detection. Only 3.9%–16.6% of patients exhibit clinical deficits. Compared to vasospasm resulting from aneurysmal SAH (aSAH), the onset occurs earlier and the duration is shorter. Overall, the clinic...

  1. Pulmonary hematocele mimicking posterior mediastinal mass : two cases report

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Dae Sik; Kim, Nam Hyeun; Jung, Seung Mun; Choi, Soo Jung; Wo, Don Hee; Kim, Jong Ook; Park, Chong Bin; Park, Man Soo [Asan foundation. Kangneung Hospital, Seoul (Korea, Republic of)


    Closed chest trauma occasionally results in the development of traumatic lung cyst or pulmonary hematocele.Radiologically, this latter rarely mimics posterior mediastinal mass, which can cause unnecessary surgical resection, We encountered two cases of pulmonary hematocele simulating posterior mediastinal mass. Multiplicity of the lesion, fracture of surrounding bony structure, decrease of mass size at follow-up examination, an acute angle between the mass and chest wall, peripheral rim enhancement of the mass, as seen on CT scans, or characteristic signal intensity suggesting hematoma, as seen on MR images, helped differentiate pulmonary hematocele from posterior mediastinal mass.

  2. Successful Endoscopic Therapy of Traumatic Bile Leaks

    Directory of Open Access Journals (Sweden)

    Matthew P. Spinn


    Full Text Available Traumatic bile leaks often result in high morbidity and prolonged hospital stay that requires multimodality management. Data on endoscopic management of traumatic bile leaks are scarce. Our study objective was to evaluate the efficacy of the endoscopic management of a traumatic bile leak. We performed a retrospective case review of patients who were referred for endoscopic retrograde cholangiopancreatography (ERCP after traumatic bile duct injury secondary to blunt (motor vehicle accident or penetrating (gunshot trauma for management of bile leaks at our tertiary academic referral center. Fourteen patients underwent ERCP for the management of a traumatic bile leak over a 5-year period. The etiology included blunt trauma from motor vehicle accident in 8 patients, motorcycle accident in 3 patients and penetrating injury from a gunshot wound in 3 patients. Liver injuries were grade III in 1 patient, grade IV in 10 patients, and grade V in 3 patients. All patients were treated by biliary stent placement, and the outcome was successful in 14 of 14 cases (100%. The mean duration of follow-up was 85.6 days (range 54-175 days. There were no ERCP-related complications. In our case review, endoscopic management with endobiliary stent placement was found to be successful and resulted in resolution of the bile leak in all 14 patients. Based on our study results, ERCP should be considered as first-line therapy in the management of traumatic bile leaks.


    Directory of Open Access Journals (Sweden)

    Erlina Listiyanti Widuri


    Full Text Available One of the deadly diseases for women is breast cancer. The wisdomdefined in this study was post traumatic growth. Post traumatic growth is apositive changes experience arising from the struggle of the great crises oflife. The purpose of this study was to determine the growth dynamics ofpost traumatic or post-traumatic growth toward positive life changes andwant to understand further the factors that influence the formation of posttraumatic growth in patients with breast cancer. The method used is basedon qualitative research using phenomenology method. The analysis showedthere were two factors that affecting the aspects of post traumatic growthin patients with breast cancer. External factors are the children andgrandchildren as life expectation and as encouragement or motivationsupport of both parents to perform the treatment, so it eventually leads tothe strengthening of internal factors. Internal factors include the factor offaith (spirituality, a strong desire to recover factors (optimism, resiliencefactors, and reframing factors. There are 4 (four post traumatic growtharising from the struggle with breast cancer in the face of illness: an increasein spirituality, positive improvement in life, and the higher prosocial andbetter social relations.

  4. Transcatheter occlusion of patent ductus arteriosus in small weight infants%低体重婴儿动脉导管未闭介入治疗研究

    Institute of Scientific and Technical Information of China (English)

    肖云彬; 黄希勇; 陈智; 王祥; 王勋


    目的 评价国产封堵器治疗动脉导管未闭(patent ductus arteriosus,PDA)低体重婴儿的有效性和安全性.方法 2010年10月至2011年10月应用国产封堵器治疗30例体重低于8 kg 的PDA婴儿.术后24 h查血常规、尿常规,并于术后24 h、1、3和6个月行心脏彩色多普勒超声、胸部正位片、心电图检查.结果 1例患儿术后24 h彩色多普勒超声示残余分流,1个月随访时残余分流消失,其余29例术后及随访期间均未出现残余分流;未出现介入治疗的主要并发症,无一例死亡.结论 应用国产PDA封堵器介入治疗体重低于8 kg的PDA婴儿的近、中期疗效确切,安全.%Objective To evaluate the efficacy and safety of transcatheter occlusion of patent ductus arteriosus (PDA) by using domestic occluder in small weight infants. Methods During the period from Oct. 2010 to Oct. 2011 transcatheter occlusion of PDA by using domestic occluder was carried out in 30 PDA infants with body weight ≤ 8 kg. Two-dimensional and color Doppler echocardiography, chest radiograph, electrocardiogram, routine blood test and routine urine test were performed after the treatment in all infants. The results were analyzed. Results Colour Doppler echocardiography performed at 24 hours after the procedure showed that residual shunt was seen in one infant, which disappeared one month later. In the remaining 29 infants no residual shunt was detected during the follow-up period. Neither intervention-related complications nor death occurred. Conclusion For the treatment of PDA infants with body weight ≤ 8 kg, transcatheter occlusion of PDA by using domestic occluder is quite safe with reliable short-term and mid-term efficacy.

  5. 新生儿动脉导管未闭的高危因素分析%Risk factors for patent ductus arteriosus in neonates

    Institute of Scientific and Technical Information of China (English)

    屈晓羽; 周先锋; 屈艺; 唐彬秩; 母得志


    Objective To identify the risk factors for patent ductus arteriosus (PDA) in neonates. Methods Fifty infants with PDA and 100 infants without PDA were enrolled. Chi-square test, Student's t test and the linear correlation analysis were used to study the clinical data. Logistic regression analysis was used to investigate the independent risk factors for PDA. Results The prevalence of PDA was negatively correlated with the gestation age ( r = -0.03, P <0.05)and birth weight (r = - 0.04, P < 0.05). Oxygen inhalation was a protective factor for the development of PDA. Fetal distress, meconium-stained amniotic fluid, oligohydramnios, cord entanglement, 1 minute Apgar score < 8, maternal infection and hypoxic-ischemic encephalopathy were the independent risk factors for the development of PDA. Conclusions The incidence of PDA can be reduced by preventing maternal infection, premature birth, low birth weight and hypoxia.%目的 探讨新生儿动脉导管未闭(patent ductus arteriosus,PDA)的高危因素,为PDA的预防提供临床依据.方法 以50例PDA新生儿为病例组,100例非PDA新生儿为对照组,采用x2检验、t检验或直线相关分析对两组患儿的临床资料进行分析,采用logistic回归分析研究PDA的独立危险因素.结果 PDA的发生与胎龄(r=-0.03,P<0.05)、出生体重(r=-0.04,P<0.05)呈负相关.出生时吸氧治疗为保护因素.宫内窘迫、羊水粪染、羊水过少、脐带绕颈、1 min Apgar评分<8分、母孕期感染、合并缺氧缺血性脑病是新生儿PDA的独立高危因素.结论 避免母孕期感染、早产、低出生体重、缺氧的发生,有利于减少PDA的发生.

  6. Fechamento de canal arterial por minitoracotomia: técnica e resultados Patent ductus arteriosus (PDA closure with minithoracotomy: technique and results

    Directory of Open Access Journals (Sweden)

    Pedro R. SALERNO


    Full Text Available CASUÍSTICA E MÉTODOS: No período de novembro de 1996 a dezembro de 1997, 15 crianças portadoras de canal arterial (CA, sendo 12 do sexo feminino, com idade média de 2,7 anos, peso médio de 13,9 kg foram submetidas a fechamento do CA por minitoracotomia. O ecodopplercardiograma confirmou o diagnóstico em todos o casos e mostrou o diâmetro do CA entre 2 mm e 10 mm, com média de 4,06 mm. A indicação cirúrgica foi eletiva em todos os casos. A operação consistiu de minitoracotomia esquerda no 4º espaço intercostal de 2,5 cm a 3,0 cm, seguida de dissecção do CA e clipagem do mesmo com 2 clips metálicos. Não foi utilizada drenagem pleural em nenhum dos casos. RESULTADOS: Todos os pacientes receberam alta em média no 4º dia de pós-operatório, sem nenhum escape pelo CA ao ecodopplercardiograma. CONCLUSÃO: O fechamento de CA por minitoracotomia é uma alternativa de tratamento que reduz o período de internação, bom efeito cosmético e baixo índice de complicações.OBJECTIVE:The purpose of this study was to describe a new technique for closure of patent ductus arteriosus (PDA by minithoracotomy (2.5 a 3.0 cm and clipping the PDA with titanium clips. MATERIAL AND METHODS: From November 1996 to December 1997, 15 children with PDA underwent surgical closure. The mean age at the time of operation was 2.7 years, mean weight was 13.9 kg. The procedure was through a left minithoracotomy at the 4º intercostal space. The ductus was identified, dissected and isolated. Interruption of ductal flow was performed by direct clipping with two clips. The chest was closed without a chest drain. Unless the patient was ventilator dependent before the closure, the child usually was extubated in the operating room. RESULTS: Color doppler echocardiography demonstrated total occlusion of the ductus in all patients. All 15 patients were discharged from the hospital on the 4º postoperative day (mean. CONCLUSION: We conclude that surgical closure of

  7. Classroom Strategies for Teaching Veterans with Post-Traumatic Stress Disorder and Traumatic Brain Injury (United States)

    Sinski, Jennifer Blevins


    Postsecondary institutions currently face the largest influx of veteran students since World War II. As the number of veteran students who may experience learning problems caused by Post-Traumatic Stress Disorder and/or Traumatic Brain Injury continues to rise, the need for instructional strategies that address their needs increases. Educators may…

  8. Tunable Transmission-Line Metamaterials Mimicking Electromagnetically Induced Transparency (United States)

    Feng, T. H.; Han, H. P.


    Tunable transmission-line (TL) metamaterials mimicking electromagnetically induced transparency (EIT) have been studied. Firstly, two types of tunable TL EIT-like metamaterial, based on the double split-ring resonator (DSRR) and single split-ring resonator (SSRR), were fabricated and their transmission properties carefully compared. The results showed that the transmittance maximum was almost invariable with shift of the transparency window for the tunable DSRR-based TL EIT-like metamaterial, but for the tunable SSRR-based TL EIT-like metamaterial, the transmittance maximum gradually diminished with shift of the transparency window toward the center of the absorption band. Moreover, the reason for these different transmission properties was explored, revealing that the reduction of the transmittance maximum of the transparency window for the tunable SSRR-based TL EIT-like metamaterial is mainly due to energy loss caused by the resistance of the loaded varactor diodes.

  9. Oral manifestion of Langerhans cell histiocytosis mimicking inflammation

    Directory of Open Access Journals (Sweden)

    K S Divya


    Full Text Available Langerhans cell histiocytosis (LCH is a rare idiopathic disease characterized by the clonal proliferation of Langerhans cells. LCH affects five children per million population. The peak incidence is from 1 to 4 years of age. LCH involves the head and neck region quite commonly. Oral soft tissue lesions are also common. The differential diagnosis of oral LCH includes leukemia, neutropenia, prepubertal periodontitis, hypophosphatasia, fibrous dysplasia, and Papillon-Lefevre syndrome. The prognosis of LCH depends on early detection and appropriate management. Surgical management alone is used in 50% of cases with an additional 23% of the lesions being treated with both surgery and radiation therapy. A case of LCH in a 6-year-old girl involving the mid root level of developing first permanent molar with a floating developing tooth bud of permanent second molar mimicking an inflammation is reported.

  10. Granulomatous prostatitis after intravesical immunotherapy mimicking prostate cancer. (United States)

    Białek, Waldemar; Rudzki, Sławomir; Iberszer, Paweł; Wronecki, Lech


    Intravesical immunotherapy with attenuated strains of Mycobacterium bovis is a widely used therapeutic option in patients with non-muscle-invasive transitional cell carcinoma of the bladder. A rare complication of intravesical therapy with the Bacillus Calmette-Guérin vaccine is granulomatous prostatitis, which due to increasing levels of prostate-specific antigen and abnormalities found in transrectal examination of the prostate may suggest concomitant prostate cancer. A case of extensive granulomatous prostatitis in a 61-year-old patient which occurred after the first course of a well-tolerated Bacillus Calmette-Guérin therapy is presented. Due to abnormalities found in rectal examination and an abnormal transrectal ultrasound image of the prostate with extensive infiltration mimicking neoplastic hyperplasia a core biopsy of the prostate was performed. Histopathological examination revealed inflammatory infiltration sites of tuberculosis origin.

  11. An Adolescent Patient with Scabies Mimicking Gottron Papules

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    Eiji Yoshinaga


    Full Text Available Atypical features of scabies occur in infants and children and patients with prolonged use of corticosteroids or immunosuppression. We report a non-immunosuppressed 15-year-old female case of scabies showing scaly reddish papules over the proximal interphalangeal joints mimicking Gottron papules in classic dermatomyositis. Periungal erythema was also seen. Four months’ topical corticosteroids from previous clinics had been used. Dermoscopic findings were consistent with typical pictures of scabies. Scraping of hand crusts demonstrated scabies mites and ova. Skin lesions of the patient were cured with oral ivermectin and topical 10% crotamiton. This case suggests that a lesion resembling Gottron papules may be added to the panel of unusual presentations of scabies.

  12. Malignant fibrous histiocytoma presenting as hemoperitoneum mimicking hepatocellular carcinoma rupture

    Institute of Scientific and Technical Information of China (English)


    Malignant fibrous histiocytoma (MFH) is a pleomorphic mesenchynal sarcoma. It is uncommonly arises primarily from the intra-peritoneal cavity. Primary peritoneal MFH with tumor bleeding and rupture is rare. We describe the imaging features of a 70-year-old patient presenting with ruptured hemorrhagic peritoneal MFH at subhepatic area, accompanied by massive hemoperitoneum,mimicking a ruptured pedunculated hepatocellular carcinoma. Computed tomography (CT) revealed a large heterogeneous enhanced subhepatic mass with adjacent liver, gallbladder and colon invasion. Tumor hemorrhage and rupture complicated with peritoneal seeding and massive bloody ascites were also detected.Angiography showed a hypervascular tumor fed by enlarged right hepatic arteries, cystic artery and omental branches of gastroepiploic artery. The patient underwent laparotomy for tumor resection, but the tumor recurred one month after operation. To our knowledge, the CT appearance of ruptured intraperitoneal MFH complicated by hemoperitoneum has not been previously described.

  13. Huge uterine-cervical diverticulum mimicking as a cyst

    Directory of Open Access Journals (Sweden)

    S Chufal


    Full Text Available Here we report an incidental huge uterine-cervical diverticulum from a total abdominal hysterectomy specimen in a perimenopausal woman who presented with acute abdominal pain. The diverticulum was mimicking with various cysts present in the lateral side of the female genital tract. Histopathological examination confirmed this to be a cervical diverticulum with communication to uterine cavity through two different openings. They can attain huge size if left ignored for long duration and present a diagnostic challenge to clinicians, radiologists, as well as pathologists because of its extreme rarity. Therefore, diverticula should also be included as a differential diagnosis. Its histopathological confirmation also highlights that diverticula can present as an acute abdomen, requiring early diagnosis with appropriate timely intervention. Immunohistochemistry CD 10 has also been used to differentiate it from a mesonephric cyst.

  14. Huge uterine-cervical diverticulum mimicking as a cyst. (United States)

    Chufal, S; Thapliyal, Naveen; Gupta, Manoj; Pangtey, Nirmal


    Here we report an incidental huge uterine-cervical diverticulum from a total abdominal hysterectomy specimen in a perimenopausal woman who presented with acute abdominal pain. The diverticulum was mimicking with various cysts present in the lateral side of the female genital tract. Histopathological examination confirmed this to be a cervical diverticulum with communication to uterine cavity through two different openings. They can attain huge size if left ignored for long duration and present a diagnostic challenge to clinicians, radiologists, as well as pathologists because of its extreme rarity. Therefore, diverticula should also be included as a differential diagnosis. Its histopathological confirmation also highlights that diverticula can present as an acute abdomen, requiring early diagnosis with appropriate timely intervention. Immunohistochemistry CD 10 has also been used to differentiate it from a mesonephric cyst.

  15. Enterobiasis in Ectopic Locations Mimicking Tumor-Like Lesions

    Directory of Open Access Journals (Sweden)

    Silvio Pampiglione


    Full Text Available Both the clinical and the histopathological diagnostic difficulties of oxyuriasis in unusual sites and their importance from a clinical point of view are pointed out. The authors report two ectoptic cases of enterobiasis observed in Northern Italy, one located in a fallopian tube of a 57-year-old woman and the other in a perianal subcutaneous tissue of a 59-year-old man, mimicking tumor-like lesions. The authors take advantage of the occasion to focus the attention of the medical world on this subject, lamenting the scarce importance given to this parasitosis in university courses of medical schools and in medical textbooks as it is incorrectly considered “out-of-fashion.”

  16. Enterobiasis in ectopic locations mimicking tumor-like lesions. (United States)

    Pampiglione, Silvio; Rivasi, Francesco


    Both the clinical and the histopathological diagnostic difficulties of oxyuriasis in unusual sites and their importance from a clinical point of view are pointed out. The authors report two ectoptic cases of enterobiasis observed in Northern Italy, one located in a fallopian tube of a 57-year-old woman and the other in a perianal subcutaneous tissue of a 59-year-old man, mimicking tumor-like lesions. The authors take advantage of the occasion to focus the attention of the medical world on this subject, lamenting the scarce importance given to this parasitosis in university courses of medical schools and in medical textbooks as it is incorrectly considered "out-of-fashion."

  17. Verrucous tumor mimicking squamous cell carcinoma in immunocompetent patient. (United States)

    Ruiz-Villaverde, Ricardo; Sanchez-Cano, Daniel; Martinez-Peinado, Carmen M; Galan-Gutierrez, Manuel


    Mycobacteria cause a range of diseases in both immunocompetent and immunosuppressed individuals. An increase in non-tuberculous mycobacterial (NTM) infections targeting skin has been described. Many hypotheses have been developed in order to explain it: the increasing burden of immunocompromised individuals, immigration from endemic countries, improved laboratory identification techniques, and changes inhuman behavior that expose individuals to this NTM. Mycobacterium mucogenicum group comprises M. mucogenicum, Mycobacterium aubagnense, and Mycobacterium phocaicum. This group of organisms was first named Mycobacterium chelonae-like organism in 1982. Most clinically significant cases of those organisms involved catheter-related infections. Nevertheless, we report an interesting patient with a cutaneous infection produced by M. mucogenicum mimicking a squamous cell carcinoma; an excellent response to combined therapy with rifampicin and clarythromicin was observed.

  18. Mimicking unfolding motion of a beetle hind wing

    Institute of Scientific and Technical Information of China (English)

    MUHAMMAD Azhar; PARK Hoon C; HWANG Do Y; BYUN Doyoung; GOO Nam S


    This paper presents an experimental research aiming to realize an artificial hind wing that can mimic the wing unfolding motion of Allomyrina dichotoma, an insect in coleopteran order. Based on the understanding of working principles of beetle wing folding/unfolding mechanisms, the hind wing unfolding motion is mimicked by a combination of creative ideas and state-of-art artificial muscle actuator. In this work, we devise two types of artificial wings and the successfully demonstrate that they can be unfolded by actuation of shape memory alloy wires to provide actuation force at the wing base and along the leading edge vein. The folding/unfolding mechanisms may provide an insight for portable nano/micro air vehicles with morphing wings.

  19. Adenoid Cystic Carcinoma Mimicking an Oroantral Fistula: A Case Report (United States)

    Monteiro, Bárbara Vanessa de Brito; Grempel, Rafael Grotta; Gomes, Daliana Queiroga de Castro; Godoy, Gustavo Pina; Miguel, Márcia Cristina da Costa


    Introduction Adenoid cystic carcinoma (ACC) is one of the most frequent malignant salivary gland tumors, which commonly affects the minor salivary glands of the mouth and is rare in the nose and paranasal sinuses. In the maxillary sinus, ACC can mimic inflammatory diseases and has a poor prognosis. Objective To report a case of a 50-year-old man with ACC of the maxillary sinus whose clinical findings in the alveolar ridge mimicked an oroantral fistula. Case Report An excisional biopsy was performed and histopathologic analysis revealed ACC. Lung metastases and residual tumor in the maxillary sinus were detected by imaging methods. In view of the poor general health of the patient, no new surgical intervention was performed and he was only treated by radiotherapy and follow-up. Conclusion Although rare in the maxillary sinus, ACC should be included in the differential diagnosis of lesions affecting this site. PMID:25992095

  20. Impedance of tissue-mimicking phantom material under compression

    Directory of Open Access Journals (Sweden)

    Barry Belmont


    Full Text Available The bioimpedance of tissues under compression is a field in need of study. While biological tissues can become compressed in a myriad of ways, very few experiments have been conducted to describe the relationship between the passive electrical properties of a material (impedance/admittance during mechanical deformation. Of the investigations that have been conducted, the exodus of fluid from samples under compression has been thought to be the cause of changes in impedance, though until now was not measured directly. Using a soft tissue-mimicking phantom material (tofu whose passive electrical properties are a function of the conducting fluid held within its porous structure, we have shown that the mechanical behavior of a sample under compression can be measured through bioimpedance techniques.

  1. Ewing sarcoma mimicking a peripheral nerve sheath tumor. (United States)

    Mitchell, B D; Fox, B D; Viswanathan, A; Mitchell, A H; Powell, S Z; Cech, D A


    We describe the first patient with an extradural, extramedullary Ewing's sarcoma tumor mimicking a nerve sheath tumor with no overt evidence of metastasis. A 28-year-old woman with no past medical history presented with a progressive 3-year history of low back pain and right-sided lower extremity radiculopathy after having failed conservative therapies. MRI of the lumbar spine revealed a right-sided enhancing, dumbbell-shaped lesion at the right neural foramen appearing to originate from the L4 nerve root, suspicious for a peripheral nerve sheath tumor or schwannoma. The patient and findings are discussed in the context of the literature, including an update on the relatively recent diagnostic redesignation of the Ewing's sarcoma family tumors.

  2. Dentinogenic Ghost Cell Tumor of the Peripheral Variant Mimicking Epulis

    Directory of Open Access Journals (Sweden)

    Uddipan Kumar


    Full Text Available Dentinogenic ghost cell tumor (DGCT is an uncommon locally invasive odontogenic tumor regarded by many as a variant of calcifying odontogenic cyst. The peripheral variant of this clinical rarity appears as a well-circumscribed mass mimicking a nonspecific gingival enlargement. Microscopic appearance of odontogenic epithelium admixed with focal areas of dentinoid formation and sheets of ghost cells giving the definitive diagnosis of dentinogenic ghost cell tumor imply that microscopic examination is compulsory for any gingival mass. Van Gieson histochemical stain further confirmed the nature of dentinoid-like material. A complete workup of a case of peripheral dentinogenic ghost cell tumor is presented in this paper and the current concept as well as the appraisal of literature is presented.

  3. Adenoid Cystic Carcinoma Mimicking an Oroantral Fistula: A Case Report

    Directory of Open Access Journals (Sweden)

    Monteiro, Bárbara Vanessa de Brito


    Full Text Available Introduction Adenoid cystic carcinoma (ACC is one of the most frequent malignant salivary gland tumors, which commonly affects the minor salivary glands of the mouth and is rare in the nose and paranasal sinuses. In the maxillary sinus, ACC can mimic inflammatory diseases and has a poor prognosis. Objective To report a case of a 50-year-old man with ACC of the maxillary sinus whose clinical findings in the alveolar ridge mimicked an oroantral fistula. Case Report An excisional biopsy was performed and histopathologic analysis revealed ACC. Lung metastases and residual tumor in the maxillary sinus were detected by imaging methods. In view of the poor general health of the patient, no new surgical intervention was performed and he was only treated by radiotherapy and follow-up. Conclusion Although rare in the maxillary sinus, ACC should be included in the differential diagnosis of lesions affecting this site.

  4. Myelodysplastic changes mimicking MDS following treatment for osteosarcoma

    DEFF Research Database (Denmark)

    Løhmann, Ditte

    Myelodysplastic changes mimicking MDS following treatment for osteosarcoma Ditte Juel Adolfsen Løhmann, Department of Pediatrics, Aarhus University Hospital, Skejby, Denmark Authors: Ditte Juel Adolfsen Løhmann and Henrik Hasle. Therapy-related myelodysplastic syndrome/acute myeloid leukaemia (t-MDS....../AML) is a feared long-term complication of paediatric cancer including osteosarcoma. Few develop t-MDS/AML, but it is not known how many have significant haematological changes after finishing treatment for osteosarcoma. In this study we reviewed biochemistry from a consecutive series of children for up to two...... MDS (refractory anaemia with excess blasts) with monosomy 7 was found and a hematopoietic stem cell transplant was performed. In the other case MDS without excess of blasts was found and a spontaneous normalization of the biochemistry occurred. In conclusion in our study most patients treated...

  5. An ideal blood mimicking fluid for doppler ultrasound phantoms. (United States)

    Samavat, H; Evans, J A


    In order to investigate the problems of detecting tumours by ultrasound it is very important to have a portable Doppler flow test object to use as a standardising tool. The flow Doppler test objects are intended to mimic the flow in human arteries. To make the test meaningful, the acoustic properties of the main test object components (tissue and blood mimic) should match closely the properties of the corresponding human tissues, while the tube should ideally have little influence. The blood mimic should also represent the haemodynamic properties of blood. An acceptable flow test object has been designed to closely mimic blood flow in arteries. We have evaluated the properties of three blood mimicking fluid: two have been described recently in the literature, the third is a local design. One of these has emerged as being particularly well matched to the necessary characteristics for in-vitro work.

  6. Blood-Mimicking Fluid for Testing Ultrasonic Diagnostic Instrument (United States)

    Tanaka, Kouhei; Yoshida, Tomoji; Sato, Kazuishi; Kondo, Toshio; Yasukawa, Kazuhiro; Miyamoto, Nobuaki; Taniguchi, Masahiko


    We present a blood-mimicking fluid (BMF) for the Doppler test object of medical diagnostic instruments. Accurate measurement in a flow Doppler test requires a BMF that has the acoustic velocity and density defined in the International Electrotechnical Commission (IEC) standard, and furthermore, they must be stable over time. To formulate a fluid with the desired density and acoustic velocity, we have developed a new fluid made of glycerine and water-soluble silicone oil. The new BMF includes dispersed polystyrene particles as scatterers. The density of the liquid can be adjusted to maintain it at the same value as that of the polystyrene particles, thus ensuring neutral buoyancy of the particles. The MBF was stable over a period of 2 weeks, during which the density and acoustic velocity did not change.

  7. Isolated angiitis in the hypothalamus mimicking brain tumor. (United States)

    Tsutsumi, Satoshi; Ito, Masanori; Yasumoto, Yukimasa; Kaneda, Kazuhiko


    A 64-year-old female presented with exaggerating somnolence without contributory medical and lifestyle histories. She was not aware of any preceding infection or headache. Cerebral magnetic resonance imaging demonstrated an isolated enhanced mass in the hypothalamus without meningeal enhancement. Blood and cerebrospinal fluid examinations showed no significant findings except for hypernatremia and hyperprolactinemia. She underwent an open biopsy via the interhemispheric route. Histological examination revealed marked perivascular lymphocytic aggregation with polyclonal immunostaining both for B and T lymphocytes. No findings suggestive of underlying malignancy were recognized. Extensive work-up aiming at systemic vasculitis and lymphoma revealed no signs of extracranial lesion, so the most probable diagnosis was isolated angiitis in the hypothalamus. Angiitis may originate from the hypothalamus and should be considered in the differential diagnosis of hypothalamic lesion mimicking brain tumor on neuroimaging.

  8. An ideal blood mimicking fluid for doppler ultrasound phantoms

    Directory of Open Access Journals (Sweden)

    Samavat H


    Full Text Available In order to investigate the problems of detecting tumours by ultrasound it is very important to have a portable Doppler flow test object to use as a standardising tool. The flow Doppler test objects are intended to mimic the flow in human arteries. To make the test meaningful, the acoustic properties of the main test object components (tissue and blood mimic should match closely the properties of the corresponding human tissues, while the tube should ideally have little influence. The blood mimic should also represent the haemodynamic properties of blood. An acceptable flow test object has been designed to closely mimic blood flow in arteries. We have evaluated the properties of three blood mimicking fluid: two have been described recently in the literature, the third is a local design. One of these has emerged as being particularly well matched to the necessary characteristics for in-vitro work.

  9. Sarcoidosis mimicking a venous ulcer: a case report. (United States)

    Joshi, Smita S; Romanelli, Paolo; Kirsner, Robert S


    Sarcoidosis--a chronic, multisystem disease of unknown etiology characterized by noncaseating granulomas--may cause ulcerative lesions, particularly in African American women. A case of ulcerative sarcoidosis mimicking a venous ulcer is presented. The patient is a 44-year-old African American hypertensive, obese woman with a nonhealing medially based lower leg ulcer of 3 years' duration clinically consistent with a venous ulcer. The ulcer did not heal with compression therapy and pentoxifylline. Subsequent biopsies showed granulomatous inflammation consistent with sarcoidosis. When intralesional triamcinolone was added to compression therapy, the ulcer resolved after 3 months. Given its propensity toward formation on the lower extremities and ulcerative and atrophic appearance, ulcerative sarcoidosis should be considered in the differential diagnosis of a venous ulcer refractory to standard therapy, especially in African American women.

  10. Eosinophilic Cystitis Mimicking Bladder Tumour – A Rare Case Report (United States)

    D, Manimaran; T M, Karthikeyan; M, Sreenivasulu; V R, Mrinalini; V, Gopinath


    A 16–year–old male presented with urinary urgency, a frequency of 4 months duration and intermittent gross haematuria which were there since one month. Eosinophilia was noted in complete blood count and CT KUB with contrast showed a filling defect in the right lateral wall, over the vesicoureteric junction. Cystoscopy revealed a sessile mass lesion over right vesico–ureteric junction, with bullous oedema . Rest of the mucosa was normal. Transurethral resection of lesion was performed and histological examination showed features of eosinophilic cystitis. Patient was treated with corticosteroids, antimicrobial agents and antihistaminics and he is recovering well. We are presenting this case for its rare presentation and its possibility of mimicking a bladder tumour. Biopsy of the lesion was diagnostic and an early treatment showed good results. PMID:24298501

  11. Leishmaniasis recidiva cutis of the lips mimicking granulomatous cheilitis

    Directory of Open Access Journals (Sweden)

    Özlem Ekiz


    Full Text Available Leishmaniasis recidiva cutis (LRC is an unusual form of acute cutaneous leishmaniasis. Herein, we present a case of LRC of the lips mimicking granulomatous cheilitis. An 8-year-old, Syrian child admitted with a swelling and disfigurement of his lips for 4 years. Abundant intra and extracellular Leishmania amastigotes were determined in the smear prepared from the lesion with Giemsa stain. Histopathology showed foamy histiocytes and leishmania parasites within the cytoplasm of macrophages in the epidermis and a dense dermal mixed type inflammatory cell infiltrate composed of lymphocytes, foamy histiocytes with multinucleated giant cells. On the basis of anamnestic data, the skin smears results, clinical and histopathologic findings, LRC was diagnosed. The patient was treated with meglumine antimoniate intramuscularly and fluconazole orally. Cryotherapy was applied to the residual papular lesions. The lesion improved markedly at the first month of the treatment.

  12. Malignant Mesothelioma Mimicking Invasive Mammary Carcinoma in a Male Breast

    Directory of Open Access Journals (Sweden)

    Mohamed Mokhtar Desouki


    Full Text Available Malignant mesothelioma is an uncommon tumor with strong association with asbestos exposure. Few cases of malignant pleural mesothelioma metastatic to the female breast have been reported. Herein, we presented, for the first time, a case of locally infiltrating malignant pleural mesothelioma forming a mass in the breast of a male as the first pathologically confirmed manifestation of the disease. Breast ultrasound revealed an irregular mass in the right breast which involves the pectoralis muscle. Breast core biopsy revealed a proliferation of neoplastic epithelioid cells mimicking an infiltrating pleomorphic lobular carcinoma. IHC studies showed the cells to be positive for calretinin, CK5/6, WT1, and CK7. The cells were negative for MOC-31, BerEp4, ER, and PR. A final diagnosis of malignant mesothelioma, epithelioid type, was rendered. This case demonstrates the importance of considering a broad differential diagnosis in the setting of atypical presentation with application of a panel of IHC markers.

  13. Intraosseous lipoma of the calcaneus mimicking plantar fascitis. (United States)

    Karthik, K; Aarthi, S


    Benign lytic lesions of the calcaneus are rare and are usually asymptomatic. We report this case of a 55-year-old man with bilateral non-traumatic plantar heel pain, which was treated conservatively as plantar fasciitis. At three months follow-up, the patient had complete relief of symptoms in the left heel with partial relief of symptoms on the right side. However under the insistence of the patient an X-ray was taken, which revealed an expansile lytic lesion of the right calcaneus and a normal left heel. CT-scan revealed an expansile lytic lesion on the right calcaneus and an early lytic lesion in the left calcaneus. Following surgical intervention, the diagnosis was confirmed as intra-osseous lipoma and the patient was completely symptom free at two-year follow-up. Patients presenting with non-traumatic heel pain should be explained about the possible causes of heel pain, and should be offered X-ray at the first visit. In patients with X-ray showing unilateral lipoma of the calcaneus, CT scan should be offered to rule out involvement of the opposite side.

  14. Increased cardiac workload by closure of the ductus arteriosus leads to hypertrophy and apoptosis rather than to hyperplasia in the late fetal period. (United States)

    van den Hoff, Maurice J B; Deprez, Ronald H Lekanne; Ruijter, Jan M; de Boer, Piet A J; Tesink-Taekema, Sabina; Buffing, Anita A; Lamers, Wouter H; Moorman, Antoon F M


    It is generally thought that adult mammalian cardiomyocytes compensate for an increased workload by hypertrophy, whereas fetal myocardium grows by cellular proliferation. We analyzed the response of late-fetal rat hearts upon an increased workload imposed by premature constriction of the ductus arteriosus with indomethacin. Initially the fetal heart responds by proliferative growth, as both wet weight and labeling index (bromodeoxyuridine incorporation) of the ventricles increased, whereas neither a change in the fibroblast fraction, ploidy and nucleation in the ventricles is observed. However, this hyperplastic growth is abrogated by a subsequent burst in apoptosis and followed by a hypertrophic response as based on a decrease in DNA and increase in both RNA and protein concentration. This hypertrophic growth was accompanied by a 1.4-fold increase in the volume of the cardiomyocytes. Changes in the molecular phenotype characteristic of pressure-overload hypertrophic growth accompany the process. Thus, the levels of expression of beta-myosin heavy chain and atrial natriuretic factor mRNA increased, of sarcoplasmic/endoplasmic reticulum ATPase (SERCA2) mRNA decreased, and of alpha-myosin heavy chain, phospholamban, and calsequestrin mRNA did not change. In situ hybridization showed that the pattern of mRNA expression changed first in the right ventricular wall and subsequently in the left ventricular free wall as well. It is concluded that pressure-overload imposed on the late-fetal heart induces limited proliferative growth complemented by extensive hypertrophic growth.

  15. The timing of surgical ligation for patent ductus arteriosus is associated with neonatal morbidity in extremely preterm infants born at 23-25 weeks of gestation. (United States)

    Sung, Se In; Choi, Soo Young; Park, Jae Hyun; Lee, Myung Sook; Yoo, Hye Soo; Ahn, So Yoon; Chang, Yun Sil; Park, Won Soon


    The purpose of this study was to evaluate prognostic factors associated with surgical ligation for patent ductus arteriosus (PDA) in extremely preterm infants born at the limits of viability. Ninety infants who were born at 23-25 weeks of gestation and who received surgical ligation were included and their cases were retrospectively reviewed. Infants were classified into two different groups: survivors with no major morbidity (N), and non-survivors or survivors with any major morbidity (M). Clinical characteristics were compared between the groups. Possible prognostic factors were derived from this comparison and further tested by logistic regression analysis. The mean gestational age and the mean birth weight of M were significantly lower than those of N. Notably, the mean postnatal age at time of ligation in N was significantly later than that of the other group (17 ± 12 vs 11 ± 8 days in N and M, respectively). An adjusted analysis showed that delayed ligation (>2 weeks) was uniquely associated with a significantly decreased risk for mortality or composite morbidity after surgical ligation (OR, 0.105; 95% CI, 0.012-0.928). In conclusion, delayed surgical ligation for PDA (>2 weeks) is associated with decreased mortality or morbidities in extremely preterm infants born at 23-25 weeks of gestation.

  16. Elevated NCX1 and NCKX4 expression in the patent postnatal ductus arteriosus of ductal-dependent congenital heart disease patients. (United States)

    Hong, Haifa; Xia, Yu; Sun, Yanjun; Ye, Lincai; Liu, Jinfen; Bai, Jie; Zhang, Haibo


    Patency of the ductus arteriosus (DA) after birth is essential in ductal-dependent congenital heart disease. The Na(+)/Ca(2+) exchanger (NCX) has been demonstrated to play a key role in regulating vascular tone. The potassium-dependent Na(+)/Ca(2+) exchanger (NCKX) is a related family of NCX depending on the K(+) gradients which triggers DA constriction. The present study investigated the comparative expression of NCX and NCKX between a constricted DA and patent DA in human ductal-dependant congenital heart disease. Human DAs, which were patent (n = 10, age = 20.2 ± 4.3 days) or constricted (n = 10, age = 18.3 ± 3.9 days), were excised during surgery from neonates with ductal-dependent congenital heart disease. Western blotting analysis, real-time quantitative polymerase chain reaction analysis and immunofluorescence studies were performed to detect the protein and mRNA levels of NCX1, NCKX3, and NCKX4. The expressions of NCX1 and NCKX4 were significantly higher in the patent DA group at both the protein and mRNA levels, and expression was localized to the smooth muscle layer. These findings indicate that NCX1 and NCKX4 are up-regulated in human postnatal patent DAs and may represent potential therapeutic targets for maintaining DA patency in ductal-dependent congenital heart disease.

  17. 动脉导管未闭的治疗方法研究进展%Research progress of therapeutic methods for patent ductus arteriosus

    Institute of Scientific and Technical Information of China (English)

    白敏; 许丹焰


    Patent ductus arteriosus (PDA) is a frequent congenital heart disease .Incidence rate of PDA accounts for 10% ~21% of total incidence rate of congenital heart disease .In recent years ,along with the continuous deepening understanding of anatomical structure and pathology of PDA ,there were a variety of treatment methods ,including drug therapy ,interventional therapy and operation .The present article made a review about indications ,contraindi‐cations ,advantages and disadvantages of above three treatments .%动脉导管未闭(PDA )是一种常见的先天性心脏病,其发病率占先天性心脏病总发病率的10%~21%。近年来随着人们对PDA的解剖结构及病理生理的认识不断加深,临床上出现了多种治疗方式(药物治疗、介入治疗及手术治疗)。本文就这三种治疗方式的适应证、禁忌证及优缺点作一综述。

  18. A High Ductal Flow Velocity Is Associated with Successful Pharmacological Closure of Patent Ductus Arteriosus in Infants 22–27 Weeks Gestational Age

    Directory of Open Access Journals (Sweden)

    Karl Wilhelm Olsson


    Full Text Available Objective. To identify factors affecting closure of patent ductus arteriosus (PDA in newborn infants born at 22–27 weeks gestational age (GA during pharmacological treatment with cyclooxygenase inhibitors. Method. Infants born at 22–27 weeks of GA between January 2006 and December 2009 who had been treated pharmacologically for PDA were identified retrospectively. Medical records were assessed for clinical, ventilatory, and outcome parameters. Echocardiographic examinations during treatment were reviewed. Results. Fifty-six infants were included in the study. Overall success rate of ductal closure with pharmacological treatment was 52%. Infants whose PDA was successfully closed had a higher GA (25+4 weeks versus 24+3 weeks; P=0.047, and a higher pretreatment left to right maximal ductal flow velocity (1.6 m/s versus 1.1 m/s; P=0.023. Correcting for GA, preeclampsia, antenatal steroids, and age at start of treatment, a higher maximal ductal flow velocity was still associated with successful ductal closure (OR 3.04; P=0.049. Conclusion. Maximal ductal flow velocity was independently associated with success of PDA treatment.

  19. Traumatic brain injury and reserve. (United States)

    Bigler, Erin D; Stern, Yaakov


    The potential role of brain and cognitive reserve in traumatic brain injury (TBI) is reviewed. Brain reserve capacity (BRC) refers to preinjury quantitative measures such as brain size that relate to outcome. Higher BRC implies threshold differences when clinical deficits will become apparent after injury, where those individuals with higher BRC require more pathology to reach that threshold. Cognitive reserve (CR) refers to how flexibly and efficiently the individual makes use of available brain resources. The CR model suggests the brain actively attempts to cope with brain damage by using pre-existing cognitive processing approaches or by enlisting compensatory approaches. Standard proxies for CR include education and IQ although this has expanded to include literacy, occupational attainment, engagement in leisure activities, and the integrity of social networks. Most research on BRC and CR has taken place in aging and degenerative disease but these concepts likely apply to the effects of TBI, especially with regards to recovery. Since high rates of TBI occur in those under age 35, both CR and BRC factors likely relate to how the individual copes with TBI over the lifespan. These factors may be particularly relevant to the relationship of developing dementia in the individual who has sustained a TBI earlier in life.

  20. Chronic Traumatic Encephalopathy: A Review

    Directory of Open Access Journals (Sweden)

    Michael Saulle


    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.

  1. Less invasive surgical treatment of traumatic thoracolumbar fractures

    NARCIS (Netherlands)

    Verlaan, J.J.


    Less invasive surgical treatment of traumatic thoracolumbar fractures. In this thesis various strategies were employed to evaluate the posibilities of reducing the invasiveness of the surgical treatment of traumatic thoracolumbar fractures. A systematic review of the literature suggested that adequ

  2. Prevalence and predictive factors of post-traumatic hypopituitarism

    DEFF Research Database (Denmark)

    Klose, M; Juul, A; Poulsgaard, L


    To estimate the prevalence and predictive factors of hypopituitarism following traumatic brain injury (TBI).......To estimate the prevalence and predictive factors of hypopituitarism following traumatic brain injury (TBI)....

  3. Traumatic brain injury-induced sleep disorders

    Directory of Open Access Journals (Sweden)

    Viola-Saltzman M


    Full Text Available Mari Viola-Saltzman, Camelia Musleh Department of Neurology, NorthShore University HealthSystem, Evanston, IL, USA Abstract: Sleep disturbances are frequently identified following traumatic brain injury, affecting 30%–70% of persons, and often occur after mild head injury. Insomnia, fatigue, and sleepiness are the most frequent sleep complaints after traumatic brain injury. Sleep apnea, narcolepsy, periodic limb movement disorder, and parasomnias may also occur after a head injury. In addition, depression, anxiety, and pain are common brain injury comorbidities with significant influence on sleep quality. Two types of traumatic brain injury that may negatively impact sleep are acceleration/deceleration injuries causing generalized brain damage and contact injuries causing focal brain damage. Polysomnography, multiple sleep latency testing, and/or actigraphy may be utilized to diagnose sleep disorders after a head injury. Depending on the disorder, treatment may include the use of medications, positive airway pressure, and/or behavioral modifications. Unfortunately, the treatment of sleep disorders associated with traumatic brain injury may not improve neuropsychological function or sleepiness. Keywords: traumatic brain injury, insomnia, hypersomnia, sleep apnea, periodic limb movement disorder, fatigue

  4. Occurrence of delayed-onset post-traumatic stress disorder

    DEFF Research Database (Denmark)

    Utzon-Frank, Nicolai; Breinegaard, Nina; Bertelsen, Mette


    Post-traumatic stress disorder (PTSD) develops according to consensus criteria within the first 1-6 months after a horrifying traumatic event, but it is alleged that PTSD may develop later. The objective was to review the evidence addressing occurrence of PTSD with onset >6 months after a traumatic...

  5. 45 CFR 1308.16 - Eligibility criteria: Traumatic brain injury. (United States)


    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Eligibility criteria: Traumatic brain injury. 1308... DISABILITIES Health Services Performance Standards § 1308.16 Eligibility criteria: Traumatic brain injury. A child is classified as having traumatic brain injury whose brain injuries are caused by an...

  6. Resolving Child and Adolescent Traumatic Grief: Creative Techniques and Interventions (United States)

    Edgar-Bailey, Meredith; Kress, Victoria E.


    This article presents a review of creative interventions that can be helpful in facilitating the resolution of traumatic grief in children and adolescents. Traumatic grief is conceptualized as a condition in which a person loses a close loved one (e.g., a parent or a sibling) in a traumatic manner, and ensuing trauma-related symptoms disrupt the…

  7. Brief Information on Childhood Traumatic Grief for School Personnel (United States)

    National Child Traumatic Stress Network, 2008


    This information sheet summarizes material found in the "In-Depth General Information Guide to Childhood Traumatic Grief" and "In-Depth Information on Childhood Traumatic Grief for School Personnel." Childhood traumatic grief is a condition that some children develop after the death of a close friend or family member. Children who develop…

  8. Traumatic Brain Injury (TBI) Studies at Grady Memorial Hospital (United States)


    management of adult, blunt-mechanism traumatic brain injury ( TBI ) patients and assess the overall mortality of this cohort at Grady...this study is to determine the current compliance with widely accepted guidelines for the management of severe traumatic brain injury ( TBI ) patients...AD_________________ Award Number: W81XWH-09-2-0145 Study Title: Traumatic Brain Injury ( TBI

  9. Secondary traumatization and attachment among wives of former POWs

    DEFF Research Database (Denmark)

    Lahav, Yael; Kanat-Maymon, Yaniv; Solomon, Zahava


    The aim of the present study was to examine the directionality of the association between post-traumatic stress symptoms (PTSS) and attachment insecurities across time among indirect trauma survivors. Wives of former prisoners of war (ex-POWs), with and without post-traumatic stress disorder (PTSD...... that attachment anxiety might act as a risk factor for secondary traumatic reactions....

  10. Fatigue in adults with traumatic brain injury

    DEFF Research Database (Denmark)

    Mollayeva, Tatyana; Kendzerska, Tetyana; Mollayeva, Shirin;


    . CONCLUSIONS: The review will summarize the current knowledge in the field with the aim of increasing understanding and guiding future research on the associations between fatigue and clinically important factors, as well as the consequences of fatigue in traumatic brain injury. PROSPERO registry number: CRD......BACKGROUND: Despite strong indications that fatigue is the most common and debilitating symptom after traumatic brain injury, little is known about its frequency, natural history, or relation to other factors. The current protocol outlines a strategy for a systematic review that will identify......, assess, and critically appraise studies that assessed predictors for fatigue and the consequences of fatigue on at least two separate time points following traumatic brain injury. METHODS/DESIGN: MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, CINAHL, and PsycINFO will be systematically...

  11. Discriminating military and civilian traumatic brain injuries. (United States)

    Reid, Matthew W; Velez, Carmen S


    Traumatic brain injury (TBI) occurs at higher rates among service members than civilians. Explosions from improvised explosive devices and mines are the leading cause of TBI in the military. As such, TBI is frequently accompanied by other injuries, which makes its diagnosis and treatment difficult. In addition to postconcussion symptoms, those who sustain a TBI commonly report chronic pain and posttraumatic stress symptoms. This combination of symptoms is so typical they have been referred to as the "polytrauma clinical triad" among injured service members. We explore whether these symptoms discriminate civilian occurrences of TBI from those of service members, as well as the possibility that repeated blast exposure contributes to the development of chronic traumatic encephalopathy (CTE). This article is part of a Special Issue entitled 'Traumatic Brain Injury'.

  12. Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG) : toward integrated treatment of symptoms related to traumatic loss

    NARCIS (Netherlands)

    Smid, Geert E; Kleber, Rolf J; de la Rie, Simone M; Bos, Jannetta B A; Gersons, Berthold P R; Boelen, Paul A


    BACKGROUND: Traumatic events such as disasters, accidents, war, or criminal violence are often accompanied by the loss of loved ones, and may then give rise to traumatic grief. Traumatic grief refers to a clinical diagnosis of persistent complex bereavement disorder (PCBD) with comorbid (symptoms of

  13. Treating traumatic injuries of the diaphragm

    Directory of Open Access Journals (Sweden)

    Dwivedi Sankalp


    Full Text Available Traumatic diaphragmatic injury (DI is a unique clinical entity that is usually occult and can easily be missed. Their delayed presentation can be due to the delayed rupture of the diaphragm or delayed detection of diaphragmatic rupture, making the accurate diagnosis of DI challenging to the trauma surgeons. An emergency laparotomy and thorough exploration followed by the repair of the defect is the gold standard for the management of these cases. We report a case of blunt DI in an elderly gentleman and present a comprehensive overview for the management of traumatic injuries of the diaphragm.

  14. Traumatic Diaphragmatic Hernia. A Case Report

    Directory of Open Access Journals (Sweden)

    Daniel Olivera Fajardo


    Full Text Available Diaphragmatic trauma is secondary to penetrating injuries and blunt abdominal and thoracic trauma. Traumatic diaphragmatic hernia is an uncommon entity. Its diagnosis poses a real challenge to internists, surgeons and radiologists since it requires a high level of suspicion and appropriate use of diagnostic imaging. Surgical treatment is always needed. For these reasons, we present the case of a patient operated on due to a stab wound to the chest who was subsequently diagnosed with a traumatic diaphragmatic hernia on the left side of the chest. He underwent surgery again and had a successful postoperative recovery.

  15. Preparation of artificial plasma membrane mimicking vesicles with lipid asymmetry. (United States)

    Lin, Qingqing; London, Erwin


    Lipid asymmetry, the difference in lipid distribution across the lipid bilayer, is one of the most important features of eukaryotic cellular membranes. However, commonly used model membrane vesicles cannot provide control of lipid distribution between inner and outer leaflets. We recently developed methods to prepare asymmetric model membrane vesicles, but facile incorporation of a highly controlled level of cholesterol was not possible. In this study, using hydroxypropyl-α-cyclodextrin based lipid exchange, a simple method was devised to prepare large unilamellar model membrane vesicles that closely resemble mammalian plasma membranes in terms of their lipid composition and asymmetry (sphingomyelin (SM) and/or phosphatidylcholine (PC) outside/phosphatidylethanolamine (PE) and phosphatidylserine (PS) inside), and in which cholesterol content can be readily varied between 0 and 50 mol%. We call these model membranes "artificial plasma membrane mimicking" ("PMm") vesicles. Asymmetry was confirmed by both chemical labeling and measurement of the amount of externally-exposed anionic lipid. These vesicles should be superior and more realistic model membranes for studies of lipid-lipid and lipid-protein interaction in a lipid environment that resembles that of mammalian plasma membranes.

  16. Mimicking static anisotropic fluid spheres in general relativity (United States)

    Boonserm, Petarpa; Ngampitipan, Tritos; Visser, Matt


    We argue that an arbitrary general relativistic static anisotropic fluid sphere, (static and spherically symmetric but with transverse pressure not equal to radial pressure), can nevertheless be successfully mimicked by suitable linear combinations of theoretically attractive and quite simple classical matter: a classical (charged) isotropic perfect fluid, a classical electromagnetic field and a classical (minimally coupled) scalar field. While the most general decomposition is not unique, a preferred minimal decomposition can be constructed that is unique. We show how the classical energy conditions for the anisotropic fluid sphere can be related to energy conditions for the isotropic perfect fluid, electromagnetic field, and scalar field components of the model. Furthermore, we show how this decomposition relates to the distribution of both electric charge density and scalar charge density throughout the model. The generalized TOV equation implies that the perfect fluid component in this model is automatically in internal equilibrium, with pressure forces, electric forces, and scalar forces balancing the gravitational pseudo-force. Consequently, we can build theoretically attractive matter models that can be used to mimic almost any static spherically symmetric spacetime.

  17. Riboswitch Structure: an Internal Residue Mimicking the Purine Ligand

    Energy Technology Data Exchange (ETDEWEB)

    Delfosse, V.; Bouchard, P; Bonneau, E; Dagenais, P; Lemay, J; Lafontaine, D; Legault, P


    The adenine and guanine riboswitches regulate gene expression in response to their purine ligand. X-ray structures of the aptamer moiety of these riboswitches are characterized by a compact fold in which the ligand forms a Watson-Crick base pair with residue 65. Phylogenetic analyses revealed a strict restriction at position 39 of the aptamer that prevents the G39-C65 and A39-U65 combinations, and mutational studies indicate that aptamers with these sequence combinations are impaired for ligand binding. In order to investigate the rationale for sequence conservation at residue 39, structural characterization of the U65C mutant from Bacillus subtilis pbuE adenine riboswitch aptamer was undertaken. NMR spectroscopy and X-ray crystallography studies demonstrate that the U65C mutant adopts a compact ligand-free structure, in which G39 occupies the ligand-binding site of purine riboswitch aptamers. These studies present a remarkable example of a mutant RNA aptamer that adopts a native-like fold by means of ligand mimicking and explain why this mutant is impaired for ligand binding. Furthermore, this work provides a specific insight into how the natural sequence has evolved through selection of nucleotide identities that contribute to formation of the ligand-bound state, but ensures that the ligand-free state remains in an active conformation.

  18. Idiopathic hypertrophic pachymeningitis mimicking prolactinoma with recurrent vision loss. (United States)

    Lok, Julie Y C; Yip, Nelson K F; Chong, Kelvin K L; Li, C L; Young, Alvin L


    Idiopathic hypertrophic pachymeningitis is a rare inflammatory condition with diffuse thickening of the dura mater, which may cause a compressive effect or vascular compromise. We report on a 28-year-old Chinese woman with a history of granulomatous mastitis 7 years previously and oligomenorrhoea, headache, blurred vision, and raised prolactin level 2 years previously, that was diagnosed as prolactinoma and treated conservatively with bromocriptine. However, she had recurrent bilateral vision loss when the bromocriptine was stopped. Her symptoms were resolved by high-dose steroid injection but remained steroid-dependent. Serial magnetic resonance imaging scan showed progressive diffuse thickening of the pachymeningitis with disappearance of pituitary apoplexy. Lumbar puncture showed lymphocytosis with no organisms. Open biopsy of the meninges was performed and histology showed features of inflammatory infiltrates and vasculitis. This is an unusual presentation of a rare condition in this age-group, with co-existing granulomatous mastitis and chronic otitis media, and is a diagnostic challenge mimicking pituitary macroadenoma and meningioma in initial magnetic resonance imaging scans.

  19. Preparation of artificial plasma membrane mimicking vesicles with lipid asymmetry.

    Directory of Open Access Journals (Sweden)

    Qingqing Lin

    Full Text Available Lipid asymmetry, the difference in lipid distribution across the lipid bilayer, is one of the most important features of eukaryotic cellular membranes. However, commonly used model membrane vesicles cannot provide control of lipid distribution between inner and outer leaflets. We recently developed methods to prepare asymmetric model membrane vesicles, but facile incorporation of a highly controlled level of cholesterol was not possible. In this study, using hydroxypropyl-α-cyclodextrin based lipid exchange, a simple method was devised to prepare large unilamellar model membrane vesicles that closely resemble mammalian plasma membranes in terms of their lipid composition and asymmetry (sphingomyelin (SM and/or phosphatidylcholine (PC outside/phosphatidylethanolamine (PE and phosphatidylserine (PS inside, and in which cholesterol content can be readily varied between 0 and 50 mol%. We call these model membranes "artificial plasma membrane mimicking" ("PMm" vesicles. Asymmetry was confirmed by both chemical labeling and measurement of the amount of externally-exposed anionic lipid. These vesicles should be superior and more realistic model membranes for studies of lipid-lipid and lipid-protein interaction in a lipid environment that resembles that of mammalian plasma membranes.

  20. [Two cases of pulmonary sarcomatoid carcinoma mimicking malignant mesothelioma]. (United States)

    Inomata, Minehiko; Kawagishi, Yukio; Yamada, Toru; Miwa, Toshiro; Hayashi, Ryuji; Kashii, Tatsuhiko; Matsui, Shoko; Fukuoka, Junya; Tobe, Kazuyuki


    We report 2 cases of pulmonary sarcomatoid carcinoma mimicking malignant mesothelioma. Case 1: A 69 year-old man presented, complaining of right chest pain. The chest X ray film and CT showed tumors in the right chest wall and pleura. Histological findings of specimens obtained from a percutaneous biopsy revealed spindle tumor cells, and the immunohistochemistry showed that the tumor cells were positive for CK-7, AE1/AE3, and vimentin and negative for calretinin, D2-40, and WT-1. We diagnosed pulmonary sarcomatoid carcinoma and started chemotherapy with carboplatin and paclitaxel, but it was ineffective. Case 2: A 68 year-old man was admitted complaining of general malaise. The chest X ray film and CT revealed tumors in the right chest wall. Histological findings showed necrosis and spindle tumor cells which were positive for AE1/AE3 and vimentin, and negative for calretinin, D2-40, and WT-1. We diagnosed pulmonary sarcomatoid carcinoma and started chemotherapy with carboplatin and paclitaxel. However the disease continued to progress and he died 2 months after admission. The pulmonary sarcomatoid carcinoma was reported to have spred to the pleural and chest wall. The present two cases showed prominent chest wall and pleural tumors with obscure primary lung tumors. Therefore, we needed to differentiate sarcomatoid carcinoma from malignant pleural mesothelioma.

  1. A case of relapsing polychondritis mimicking Ludwig’s angina

    Directory of Open Access Journals (Sweden)

    Adnan Agha


    Full Text Available Relapsing polychondritis (RP is a severe progressive inflammatory condition involving cartilaginous structures and caused by an autoimmune process, for which there is no confirmatory serological biomarker and which still is diagnosed on a mainly clinical basis. RP has been associated with many diseases like Sweet’s syndrome, Behcet’s disease, rheumatoid arthritis, and other autoimmune disorders. We attempt to describe here a unique case of a 38-year-old female with a high-grade fever, sore throat, difficulty in swallowing, hoarseness of the voice, and found to have signs of tongue swelling and inflammation of the oral cavity that mimicked Ludwig’s angina, necessitating antibiotic use. On careful re-evaluation the patient was diagnosed to have relapsing polychondritis based on auricular and respiratory tract chondritis and response to steroids. The purpose of this report is to emphasize the fact that careful clinical assessment is needed to diagnose RP, which may be misdiagnosed as Ludwig’s angina.

  2. A Case of Congenital Adrenal Hyperplasia Mimicking Cushing's Syndrome (United States)

    Kim, Hye Jeong; Kang, Mira; Kim, Jae Hyeon; Kim, Sun Wook; Chung, Jae Hoon; Min, Yong-Ki; Lee, Moon-Kyu; Kim, Kwang-Won


    Congenital adrenal hyperplasia (CAH) is characterized by decreased adrenal hormone production due to enzymatic defects and subsequent rise of adrenocorticotrophic hormone that stimulates the adrenal cortex to become hyperplastic, and sometimes tumorous. As the pathophysiology is basically a defect in the biosynthesis of cortisol, one may not consider CAH in patients with hypercortisolism. We report a case of a 41-yr-old man with a 4 cm-sized left adrenal tumorous lesion mimicking Cushing's syndrome who was diagnosed with CAH. He had central obesity and acanthosis nigricans involving the axillae together with elevated 24-hr urine cortisol level, supporting the diagnosis of Cushing's syndrome. However, the 24-hr urine cortisol was suppressed by 95% with the low dose dexamethasone suppression test. CAH was suspected based on the history of precocious puberty, short stature and a profound suppression of cortisol production by dexamethasone. CAH was confirmed by a remarkably increased level of serum 17-hydroxyprogesterone level. Gene mutation analysis revealed a compound heterozygote mutation of CYP21A2 (I173N and R357W). PMID:23166432

  3. Bartonella henselae Infection: An Uncommon Mimicker of Autoimmune Disease

    Directory of Open Access Journals (Sweden)

    Despoina N. Maritsi


    Full Text Available We present a case of a seven-year-old immunocompetent female patient who developed systemic symptoms mimicking an autoimmune rather than an infectious disease. The patient presented with rash, biquotidian fever, night sweats, and arthralgias. There was no antecedent history of cat contact. Investigations showed increased inflammatory markers, leukocytosis, thrombocytosis, hypercalcemia, and raised angiotensin-converting enzyme. Interferon-gamma releasing assay for tuberculosis infection was negative. Abdominal imaging demonstrated multifocal lesions of the liver and spleen (later proved to be granulomata, chest X-ray showed enlarged hilar lymph nodes, and ophthalmology review revealed uveitis. Clinical, laboratory, and imaging features pointed towards sarcoidosis. Subsequently, raised titers (IgM 1 : 32, IgG 1 : 256 against Bartonella confirmed the diagnosis of B. henselae infection. She was treated with gentamycin followed by ciprofloxacin; repeat investigations showed complete resolution of findings. The presence of hepatic and splenic lesions in children with bartonellosis is well documented. Our case, however, exhibited certain unusual findings such as the coexistence of acute ocular and systemic involvement in an immunocompetent host. Serological testing is an inexpensive and effective way to diagnose bartonellosis in immunocompetent patients; we suggest that bartonella serology is included in the baseline tests performed on children with prolonged fever even in the absence of contact with cats in countries where bartonellosis is prevalent.

  4. Osteopoikilosis: A Sign Mimicking Skeletal Metastases in a Cancer Patient

    Directory of Open Access Journals (Sweden)

    Hamid Nasrolahi


    Full Text Available Osteopoikilosis is a rare benign osteosclerotic bone disorder that may be misdiagnosed as skeletal metastases. Here we describe a case of coincidental breast cancer and osteopoikilosis mimicking skeletal metastases. A 41-year-old woman underwent right modified radical mastectomy in April 2007. Twenty-eight months after initial treatment,the patient complained of bilateral knee and foot pain. Plain X-rays of the feet and knees showed multiple well-defined osteosclerotic lesions. According to the radiographic appearance, the most likely differential diagnoses included skeletal metastases from breast cancer and osteopoikilosis. A whole-body bone scintigraphy showed no increase in uptake by the sclerotic lesions, and serum lactic dehydrogenase, carcinoembryonic antigen, alkaline phosphatase and cancer antigen 15-3 were not elevated. We therefore diagnosed the patient’s skeletal lesions as osteopoikilosis. This case and ourliterature review suggest that the radiographic appearance of osteopoikilosis may mimic or mask skeletal metastases, potentially leading to misdiagnosis in patients with cancer.

  5. Extramedullary Plasmacytoma Mimicking Pancreatic Cancer: An Unusual Presentation

    Directory of Open Access Journals (Sweden)

    Daniela Sciancalepore


    Full Text Available Multiple myeloma is a plasma cell tumor that homes to and expands in the bone marrow and that, despite the new available drugs, remains incurable. Extramedullary plasmacytoma is a not frequent manifestation during the natural history of multiple myeloma and is frequently associated with plasma cell bone marrow infiltration. The most common locations for an EMP include the gastrointestinal tract, pleura, testis, skin, peritoneum, liver, endocrine glands, and lymph nodes. Primary involvement of the gallbladder fossa is exceedingly rare. In this report, we describe a patient with multiple myeloma who achieved a clinical and serological remission after autologous transplant but progressed rapidly at extramedullary site mimicking a second cancer (i.e., pancreatic or biliary cancer. In this case, the extramedullary localization was refractory to standard therapy, differently from bone marrow localization, but responded to lymphoma-like therapy. In this patient (i the particular site of developing plasmacytoma is the gallbladder fossa, (ii the timing of onset of this neoplasm is immediately after autologous transplant, and (iii its disjunction from primary myeloma is that it appears in clinical and serological remission phase which may be confounding during the diagnostic approach simulating a different tumor (solid tumor.

  6. Moderately nonlinear ultrasound propagation in blood-mimicking fluid. (United States)

    Kharin, Nikolay A; Vince, D Geoffrey


    In medical diagnostic ultrasound (US), higher than-in-water nonlinearity of body fluids and tissue usually does not produce strong nonlinearly distorted waves because of the high absorption. The relative influence of absorption and nonlinearity can be characterized by the Gol'dberg number Gamma. There are two limiting cases in nonlinear acoustics: weak waves (Gamma 1). However, at diagnostic frequencies in tissue and body fluids, the nonlinear effects and effects of absorption more likely are comparable (Gol'dberg number Gamma approximately 1). The aim of this work was to study the nonlinear propagation of a moderately nonlinear US second harmonic signal in a blood-mimicking fluid. Quasilinear solutions to the KZK equation are presented, assuming radiation from a flat and geometrically focused circular Gaussian source. The solutions are expressed in a new simplified closed form and are in very good agreement with those of previous studies measuring and modeling Gaussian beams. The solutions also show good agreement with the measurements of the beams produced by commercially available transducers, even without special Gaussian shading.

  7. Acoustic resolution photoacoustic Doppler velocimetry in blood-mimicking fluids (United States)

    Brunker, Joanna; Beard, Paul


    Photoacoustic Doppler velocimetry provides a major opportunity to overcome limitations of existing blood flow measuring methods. By enabling measurements with high spatial resolution several millimetres deep in tissue, it could probe microvascular blood flow abnormalities characteristic of many different diseases. Although previous work has demonstrated feasibility in solid phantoms, measurements in blood have proved significantly more challenging. This difficulty is commonly attributed to the requirement that the absorber spatial distribution is heterogeneous relative to the minimum detectable acoustic wavelength. By undertaking a rigorous study using blood-mimicking fluid suspensions of 3 μm absorbing microspheres, it was discovered that the perceived heterogeneity is not only limited by the intrinsic detector bandwidth; in addition, bandlimiting due to spatial averaging within the detector field-of-view also reduces perceived heterogeneity and compromises velocity measurement accuracy. These detrimental effects were found to be mitigated by high-pass filtering to select photoacoustic signal components associated with high heterogeneity. Measurement under-reading due to limited light penetration into the flow vessel was also observed. Accurate average velocity measurements were recovered using “range-gating”, which furthermore maps the cross-sectional velocity profile. These insights may help pave the way to deep-tissue non-invasive mapping of microvascular blood flow using photoacoustic methods.

  8. Tuberculosis of the skull mimicking a bony tumor. (United States)

    Rosli, Fadzlishah Johanabas; Haron, Rahmat


    We present a rare case of calvarial tuberculosis mimicking a solitary bone tumor, which was surgically removed. A 52-year-old female presented with a right forehead swelling, which gradually enlarged over the course of 2 years, with no symptoms or raised intracranial pressure or neurological deficits. Plain and contrast-enhanced brain computed tomography scans were done, revealing a punched-out lesion of the right frontal bone, with a nonenhancing lytic mass. With an initial diagnosis of an intraosseous meningioma, and later on intraoperatively thought to be a metastatic tumor, the mass was excised along with a rim of bone. Histopathological examination results came back as caseous necrosis, highly suggestive of tuberculosis. The patient was then treated with a 1 year regimen of anti-tuberculous medications. Tuberculosis of the cranium is a rare entity, and can mimic tumors or multiple myeloma. A high index of suspicion and knowledge is required for an early diagnosis. A combined surgical and medical therapy is curative.

  9. Chondroid chordoma of the sella turcica mimicking a pituitary adenoma. (United States)

    Wu, Arthur W; Bhuta, Sunita; Salamon, Noriko; Martin, Neil; Wang, Marilene B


    We report an unusual case of a chondroid chordoma of the sella turcica that mimicked the clinical and radiologic presentation of the more common pituitary adenoma. A 50-year-old man presented with bitemporal visual field deficits. Magnetic resonance imaging (MRI) detected a sellar mass that was suggestive of a pituitary adenoma. However, the intraoperative appearance of the mass was not consistent with an adenoma, and frozen-section pathology was obtained. Pathology identified the mass as a malignant lesion. Based on this finding, the mass was treated more aggressively. Chondroid chordomas are rare and slowly growing but locally aggressive tumors. The prognosis depends on the ability to totally resect the mass, so differentiating this tumor from a benign lesion is critical. An intrasellar chordoma can be confused clinically and radiologically with a pituitary adenoma. These two lesions are nearly identical on MRI, although T2-weighted imaging sometimes demonstrates higher intensity with a chondroid chordoma. Computed tomography may be helpful in demonstrating bony destruction by these lesions, as can the presence of intralesional calcifications. Intraoperative findings of bony invasion or a purple-red color may also lead the surgeon to suspect a diagnosis other than pituitary adenoma.

  10. Duodenal White Spots Mimicking Intestinal Candidiasis: Report of Case

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    Ozgur Turk


    Full Text Available Duodenal white spots are mentioned in these nonspecific lesions until recently. Although there is not enough studies about duedonal white spots yet; these lesions described in a separate syndrome. Here now we reported a case that we diagnosed multiple Duodenal white spots mimicking intestinal candidiasis. Clinical manifestation and endoscopic appearance of lesions gave rise to thought intestinal candidiasis histopathological examination revealed us several duodenitis. There was no evidence of fungal infection in PAS staining. Early after endoscopy patient took treatment of Lansoprozole at the 30 mg dose and bismuth salicylate. Patients compliant declined and control endoscopy exposed white duodenal spots cleared away three months later. Duodenal white spots are becoming to be designated as a separate disease even a syndrome. Etiology of duodenal white spots must be determined carefully during endoscopy. Sometimes it is difficult to make the correct diagnosis by appearance of lesion; in such cases histopathological examination can be useful both differential diagnosis of disease and determination of etiological factor. [J Contemp Med 2015; 5(4.000: 249-252

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

    Directory of Open Access Journals (Sweden)

    Alok Bhan


    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.

  12. Estudo anatomotopográfico do canal arterial em fetos natimortos dirigido para sua abordagem por videotoracoscopia Anatomotopographic study of ductus arteriosus in newborn cadavers directed for its videotoracoscopic approach

    Directory of Open Access Journals (Sweden)

    Josué Viana de Castro Neto


    Full Text Available Este trabalho objetiva realizar um estudo anatomotopográfico do Canal Arterial em fetos natimortos enfatizando o seu comprimento e seu diâmetro de acordo com o tamanho de cada feto. Além de que, descrevemos as distâncias entre este e pontos de reparo importantes para sua abordagem por videotoracoscopia. Estudamos dezesseis fetos natimortos, sendo que oito eram do sexo masculino. O tamanho do feto e os perímetros torácico e cefálico variaram de 42-57, 26-35 e 29-35,5 cm, respectivamente. A média de comprimento e diâmetro foram 11,06 e 5,56 cm. Distâncias entre o Canal e as seguintes estruturas: clavícula-22,13mm, segunda costela-20,75mm, esterno-33,88mm e a.subclávia esquerda-5,30mm. Acreditamos que as medidas apresentadas podem facilitar a abordagem do canal por videotoracoscopia.The purpose of this work is to realize an anatomic and topographic study of the ductus arteriosus in newborn cadavers emphasizing its lenght and diameter according to each size of the newborn cadaver. We also describe distances between the ductus and important structures for thoracoscopic approach. We study sixteen newborn cadavers. Eight were male. Size of the cadavers, thoracic and cephalic perimeters ranged from 42-47,26-35 and 29-35,5 cm, respectively. Median lenght and diameter were 11,06 and 5,56 mm. Distances between ductus arteriosus and follow structures were: collarbone-22,13mm, second rib-20,75mm, sternum-33,88mm and left subclavian artery-5,30mm. We belived that these distances described can facilitate thoracoscopic surgical approach to the ductus arteriosus.

  13. Traumatic pseudocyst due to blunt trauma: Case report. (United States)

    Becel, Sinan; Oztok, Beliz; Kurtoglu Celik, Gulhan; Icme, Ferhat; Sener, Alp; Pamukcu Gunaydin, Gul


    Damage to lung parenchyma due to blunt thoracic trauma often appears as contusion or hematoma. Cavitary lung lesions or pseudocyst formation due to trauma is a rare phenomenon. In the literature traumatic pseudocysts are also known as pseudocystic hematomas, traumatic lung cavity and traumatic pneumotocel. Traumatic pseudocysts usually have good clinical prognosis, recover spontaneously with supportive treatment and do not require surgery. In this article, we present the case of 52 year old male who was brought to the emergency department after a fall from height and was diagnosed with lung contusions and traumatic cyst.

  14. Correção cirúrgica da persistência do canal arterial em crianças de baixo peso e neonatos Surgical treatment of patent ductus arteriosus in low-weight child and neonates

    Directory of Open Access Journals (Sweden)

    Ciro Denevitz de Castro Herdy


    Full Text Available A persistência do canal arterial ocorre com freqüência em neonatos prematuros, provocando um grave quadro de disfunção cardiopulmonar. O tratamento envolve duas abordagens, sendo uma clínica e outra cirúrgica. A operação para a ligadura do canal arterial é praticada desde 1938. O enfoque clínico preconiza o uso da indometacina, com o intuito de promover a oclusão do canal arterial. O presente trabalho tem por objetivo avaliar os resultados obtidos com o tratamento cirúrgico da persistência do canal arterial, através de toracotomia e ligadura em 14 pacientes, incluindo crianças de baixo peso e neonatos prematuros com quadro clínico instável. A principal indicação cirúrgica, nestes casos, foi a presença de insuficiência respiratória aguda e insuficiência cardíaca. A técnica empregada foi a tripla ligadura do canal arterial. Nos 14 casos não obtivemos nenhum tipo de complicação e sem mortalidade. A presença de uma Unidade de Tratamento Intensivo Neonatal (U.T.I no Hospital foi de extremo valor no preparo dos pacientes e na evolução no período de pós-operatório. Este trabalho comprova a eficácia do método cirúrgico empregado, com baixas taxas de morbidade e mortalidade e a importância da U.T.I neonatal no acompanhamento dos pacientes.The patent ductus arterious frequently occurs in premature neonates causing serious cardiopulmonary disfunction. The treatment includes two options; one clinic and the other surgical procedure. The surgery for patent ductus arteriosus has been done since 1938. Clinical treatment with indometacin induces closure of the arteriosus ductus. The aim of the article is to analize the surgical results with thoractomy by triple-ligature of the ductus for the treatment of persistent ductus arteriosus in fourteen patients including low weight children and premature neonates with cardiopulmonary disfunction. The indications for surgery in these cases were respiratory distress and congestive

  15. Traumatic endophthalmitis caused by Nocardia kruczakiae in a patient with traumatic eye injury


    Compte, Rafael Barraquer; Martínez-Osorio, Hernán; Carrasco, Gema; Lorente, Betty; Elizalde, Javier; Valdezate, Sylvia; Lorente, Ramón; Iglesias, Emilio; Saez-Nieto, Juan Antonio


    Background We describe a case of traumatic ocular endophthalmitis caused by Nocardia kruczakiae after vegetable trauma in an immunocompetent child. Findings A 5-year-old boy suffered from a trauma with a palm tree leaflet. Two months later, he was diagnosed with traumatic infectious uveitis and intumescent cataract with anterior capsule rupture. Intensive treatment with systemic and topical vancomycin, ceftazidime and methylprednisolone began. After 1 month, he underwent phacoemulsification w...

  16. 高龄动脉导管未闭的外科治疗%Surgical treatment of patent ductus arteriosus in advanced age

    Institute of Scientific and Technical Information of China (English)

    陶宝华; 刘捷夫


    Objective Ten patients with patent ductus arteriosus (PDA) in advanced age were retrospectivelyevaluated. Methods The PDA included aneurysmal dilatation of ductus arteriosus(4),giant ductus(3),and severepulmonary hypertension(2),PDA accompanied with rheumatic mitral valvular disease(1), Results Seven were lig-ated under hypothermia,2 ligated with Dacron pledget of PDA under temporary cardiopulmonary bypass;division of 1PDA under hypothermia; there were two early deaths(20%), The mean follow-up period was 50 months,all werefree from symptoms and cardiac murmur.Conclusion Optimum results achieved must be in accordance with propertechniques used in situations of PDAs in advanced age. Correction with Dacron patch is a safe, simple and reliablemethod for preventing rupture of PDA or aorta.(Shanghai Med J, 2000,23:458-460)%目的 探讨高龄动脉导管未闭患者的特点和手术方法的选择对手术结果的影响。方法 10例患者术前均经超声心动图证实诊断,导管直径0.9~2.5 cm(平均1.7 cm)。萁中2例肺动脉高压,导管水平有双向分流。4例肺动脉呈瘤样扩张。1例同时伴有风湿性二尖瓣美闭不全并发慢性右心衰竭。7例在全麻低温下施以带特制垫片结扎术。在低温部分阻断循环和左心辅助循环下行导管切断缝合各1例。正中切口,体外循环下行导管缝闭合并人工二尖瓣置换术1例。结果 住院死亡2例。其余8例痊愈出院。随访14~50个月,(平均32个月)无复发再通。结论 高静动脉导管未闭患者常并发各种病变,手术治疗效果主要取决于手术方法的选择。带特制垫片的结扎术对防止导管和主动脉破裂似乎是一种简单、安全、可靠的方法之一。

  17. Patent ductus arteriosus stenting in complex congenital heart disease: early and midterm results for a single-center experience at children hospital, Mansoura, Egypt. (United States)

    Matter, Mohamed; Almarsafawey, Hala; Hafez, Mona; Attia, Gehan; Abuelkheir, Mohamed-Magdy


    This study aimed to assess the efficacy and outcome of transcatheter ductus arteriosus stenting in newborns and infants with ductal-dependent or decreased pulmonary circulation. Between September 2009 and December 2011, 33 newborns and infants were subjected to patent ductus arteriosus (PDA) stenting as an alternative to a surgical shunt. Of the 33 patients, 20 had pulmonary atresia (PA) with a ventricular septal defect, 4 had PA with an intact ventricular septum, 5 had PA with a double-outlet right ventricle, and 4 had critical pulmonary stenosis. The McGoon ratio ranged from 0.8 to 1.9 (median 1.27). The ages of the patients ranged from 3 to 56 days, and their weight ranged from 2.7 to 4.1 kg. The oxygen saturation ranged from 45 to 61 %, and the pH ranged from 7.13 to 7.27. Premounted coronary stents with diameters of 3, 3.5, and 4 mm were used to cover the whole length of the ductus. The PDA was tortuous in 23 patients and straight in 10 patients. The mean ductal length was 12.2 ± 3.7 mm (range 7.8-23 mm). The mean stent length was 14.3 ± 3.4 mm (range, 8-23 mm), and the mean narrowest ductal diameter was 1.9 ± 0.6 mm (range, 0.8-2.9 mm). Immediately after the procedure, the oxygen saturation was increased from a mean of 75.1 ± 13.2-91.5 ± 6.3 % (p < 0.0001), and the PDA diameter was increased from a mean of 1.9 ± 0.6-4.3 ± 0.8 mm (p < 0.0001). Stent redilation was necessary in two patients 8 days after the procedure, and their oxygen saturation increased 79-88 %. The mean fluoroscopy time was 39.4 ± 15.5 min. Stent dislocation to the left main pulmonary artery was seen in one patient, with another stent placed in the arterial duct. No procedure-related mortality occurred. Two neonates died a few days after the procedure due to sepsis related to the procedure. The surviving patients were discharged home 8-30 days (median, 9.5 days) after the procedure. Stent patency was achieved for 8-550 days. The McGoon ratio increased and ranged from 1.6 to 2

  18. Tratamento do canal arterial persistente em neonatos prematuros: análise de 18 casos Treatment of patent ductus arteriosus in neonate premature: analysis of 18 cases

    Directory of Open Access Journals (Sweden)

    Wagner Ciongoli


    Full Text Available A presente investigação tem o propósito de analisar, retrospectivamente, os resultados obtidos em 18 pacientes neonatos prematuros, submetidos a operação para oclusão da PCA, no período entre julho de 1990 e dezembro de 1993 (42 meses, sendo 12 (66,6% pacientes do sexo feminino, com idade que variou entre 10 e 44 (20,8±8,3 dias, idade gestacional entre 26 e 28 (27,2±0,9 semanas. No dia da operação o peso dos pacientes esteve compreendido entre 700 e 1380 (985,8±181,6 gramas. A insuficiência respiratória aguda ocorreu em todos os pacientes sendo a principal indicação cirúrgica, estando em 6 (33,3% pacientes associada à insuficiência cardíaca congestiva. A indometacina endovenosa foi utilizada no período pré-operatório em 9 (50% pacientes na tentativa de se obter o fechamento farmacológico, sem sucesso, do canal arterial e apesar de não influenciar nos resultados pós-operatórios, apresentou como principal efeito secundário a redução significativa da diurese (p 40% 60% (p=0,033. O período de internação hospitalar variou de 43 a 157 (96,0±24,8 dias. Não houve mortalidade operatória, observando-se ainda baixa morbidade com este método. As causas de óbito, no período pós-operatório, não estiveram relacionadas com o tratamento cirúrgico. Pode-se concluir que a ligadura cirúrgica da PCA, nos pacientes neonatos e prematuros, é método eficaz e seguro podendo ser praticado com baixa morbidade e mortalidade.The purpose of our study was to analyse the results obtained in 18 neonate premature patients who underwent surgical closure of the patent ductus arteriosus, between July 1990 and December 1993 (42 months. Twelve (66.6% patients were female, with age between 10 and 44 (20.8±8.3 days, gestacional age ranged from 26 to 28 (27.2±0.9 weeks. In the surgery day the birth weight was between 700 and 1380 (985.8 ±181.6 grams. Acute respiratory insufficiency was present in all patients, as the principal surgical

  19. Thoracotomy for Traumatic Diaphragmatic Hernia. (United States)

    Fangbiao, Zhang; Chunhui, Zheng; Chun, Zhao; Hongcan, Shi; Xiangyan, Zhang; Shaosong, Tu


    The aim of this retrospective study is to review our experience in the diagnosis and role of thoracotomy for traumatic diaphragmatic hernia (TDH). Between January 2008 and June 2014, 23 patients from Yangzhou Medical College (Yangzhou China) and Lishui Center Hospital (Lishui China), who underwent thoracotomy for TDH, were analyzed. The clinical features, imaging findings, operative findings, and outcome of treatment in these patients are presented. There were 23 patients (18 males and 5 females) who underwent surgical procedures due to TDH. The median age of the patients was 43.2 years (range, 15-68 years). The cause of rupture was penetrating trauma in 1 (4.3 %) patient and blunt trauma in 22 (95.7 %) patients. The TDH was left sided in 21 patients and right sided in two patients. The diagnosis was made by chest X-ray (n = 2) and chest or abdominal CT (n = 13) and at thoracotomy based on a high index of suspicion (n = 8). Associated injuries were seen in 21 patients (91.3 %). Twenty-two patients underwent thoracotomy, and one underwent thoracotomy with laparotomy. The mean operating time was 112 min (range, 60-185 min) and the mean blood loss was 116 mL (range, 20-400 mL). The most common herniated organs were the omentum (n = 15), stomach (n = 14), spleen (n = 11), colon (n = 10), small bowel (n = 2), and liver (n = 1). All diaphragmatic defects were repaired using interrupted prolene sutures. The overall mortality rate was 4.3 % (n = 1). The diagnosis of TDH is easily missed or delayed. Chest X-ray and computer tomography (CT), especially chest and abdominal CT, are useful in the diagnosis of diaphragmatic ruptures, and thoracotomy is an effective and successful treatment for TDH.

  20. The Changes of Left Ventricular Form and Function After Closure of Moderate-to Large-sized Patent Ductus Arteriosus Using Domestic-made Occluder

    Institute of Scientific and Technical Information of China (English)

    Mo Jianmei; Wu Weifeng; Liu Tangwei; Huang Kai; Guo Shenglan; Zhang Bingdong; Wu Ji


    Objectives To evaluate the changes of the left ventricular form and function after closure of moderate- to large-sized patent ductus arteriosus (PDA) using domestic-made occluder.Methods 22 patients with PDA underwent procedure successfuly using the domestic-made occluder. The mean PDA minimal (pulmonary end) diameter by aortography was 8.01±2.47 mm (range 4 to 15.Smm).All patients underwent transthoracic echocardiography (TTE) study before the procedure and the following 48hours, 3 months after procedure. Results All patients had been implanted the domestic-made occluders successfully with no haematolysis, infective endocarditis, recanalization and other complications.At 3 months, mean LVED was decreased to 50.05±6.55mm, compared to the pre-procedure (55.67±8.48mm), P < 0.01. After 48 hours of the procedure, mean LVEDD and LVESD decreased significantly (156.22±51.40 mLvs. 121.28±35.73ml, 57.16±32.07 mL vs.45.88±15.97 mL), P<0.05. At3 months, LVEDDdecreased to 110.93±15.08ml, LVSV reached 73.50±9.19 mL, compared to the pre-procedure, P < 0.01.LVESD decreased to 37.43±10.44 mL at 3 months, P <0.05. Conclusions Closuring of moderate- to largesized PDA using domestic-made occluder is effective and safe. After procedure, left ventricular form and function improved.

  1. Experience with percutaneous closure of ductus arteriosus using the Amplatzer duct occluder in 243 consecutive patients and long-term results-A single centre study

    Directory of Open Access Journals (Sweden)

    Mostafa Behjati-Ardakani


    Full Text Available Background: Percutaneous closure of patent ductus arteriosus (PDA with Amplatzer duct occluder (ADO has become increasingly popular in many cardiovascular centres. This study analysed the long-term results of percutaneous closure of PDA with ADO in a single centre. Materials and Methods: Between May 2004 and January 2013, 243 patients with median age of 2.5 years (range = 30 months to 38 years and median weight of 10 Kg (range 4.5-80.5 Kg underwent percutaneous closure of PDA using the ADO. The devices were implanted under fluoroscopic guidance. Patients were followed-up for any complications. Results: The mean diameter of narrow part of PDA was 6.4 ± 2.2 mm. The mean diameter of devices was 7.8 ± 2.3 mm. The devices were successfully implanted in 239 (98.3% cases. At immediate, 1 day, 1, 6, 12 months and late follow-up, the complete occlusion rate was 33% (79 case, 97.1% (236 case, 97.5% (237 case, 98.3% (238 case, 98.3% (238 case and 98.3% (238 case, respectively. Residual shunt remained in one case at late follow-up. The device embolisation occurred in five patients. The devices were successful retrieved in three patient and second larger devices were inserted. Two other devices were surgically retrieved and PDAs were ligated. Moderate left pulmonary artery stenosis (LPA in one child and mild LPA stenosis in one infant were detected. Mild aortic obstruction occurred in one infant. Conclusions: Long-term follow-up of patients indicate that percutaneous closure of PDA using ADO is a safe and effective procedure. However, some complications, including device embolisation, left pulmonary stenosis and aortic obstruction may be observed in some cases.

  2. [Patent ductus arteriosus in the dog: a retrospective study of clinical presentation, diagnostics and comparison of interventional techniques in 102 dogs (2003-2011)]. (United States)

    Meijer, M; Beijerink, N J


    A left-to-right shunting patent ductus arteriosus (PDA) is a common congenital heart defect in dogs. If it is left uncorrected, life expectancy in most cases is decreased due to the development of left-sided congestive heart failure. The aim of this study was to describe the dogs diagnosed with PDA in the Utrecht University Companion Animal Clinic from 2003 to 2011. The medical records of 102 patients were retrieved, and the clinical presentation and outcome of PDA closure by surgical ligation or transarterial catheter occlusion (TCO) were reviewed. In the TCO group, the result of coiling was compared with the placement of an Amplatz Canine Duct Occluder (ACDO). A predisposition to PDA was found in the German Brak, Stabyhoun, and Schapendoes. Dogs treated with surgical ligation were significantly older and heavier than those treated with TCO; within the TCO group, dogs treated with ACDO were significantly older and heavier The initial success rate (complete disappearance of the audible murmur in a patient that survived the procedure) was not significantly different between the different treatment modalities. Major complications were more common with surgical ligation, but the incidence of minor complications was not significantly different. There was no diference in survival between dogs treated with surgical ligation and dogs treated with TCO. This study shows a previously unreported predisposition to PDA in certain breeds. Both surgical ligation and TCO are suitable techniques for PDA closure, although major complications were more common with surgical ligation. ACDO appears to be the method with the least complications and thus can be considered the safest method.

  3. School Reentry Following Traumatic Brain Injury (United States)

    Deidrick, Kathleen K. M.; Farmer, Janet E.


    Successful school reentry following traumatic brain injury (TBI) is critical to recovery. Physical, cognitive, behavioral, academic, and social problems can affect a child's school performance after a TBI. However, early intervention has the potential to improve child academic outcomes and promote effective coping with any persistent changes in…

  4. Helping Classrooms Cope with Traumatic Events. (United States)

    Brock, Stephen E.


    An updated model for Classroom Crisis Intervention (CCI) including post-CCI activities is presented. CCI may be applied following various types of traumatic incident involvement and for the management of grief reactions. By promoting the idea that trauma responses are normal, CCI helps survivors regain optimism. (EMK)

  5. Working with Students with Traumatic Brain Injury (United States)

    Lucas, Matthew D.


    The participation of a student with Traumatic Brain Injury (TBI) in general physical education can often be challenging and rewarding for the student and physical education teacher. This article addresses common characteristics of students with TBI and presents basic solutions to improve the education of students with TBI in the general physical…

  6. Understanding Traumatic Brain Injury: An Introduction (United States)

    Trudel, Tina M.; Scherer, Marcia J.; Elias, Eileen


    This article is the first of a multi-part series on traumatic brain injury (TBI). Historically, TBI has received very limited national public policy attention and support. However since it has become the signature injury of the military conflicts in Iraq and Afghanistan, TBI has gained the attention of elected officials, military leaders,…

  7. Assessment of Students with Traumatic Brain Injury (United States)

    Chesire, David J.; Buckley, Valerie A.; Canto, Angela I.


    The incidence of brain injuries, as well as their impact on individuals who sustain them, has received growing attention from American media in recent years. This attention is likely the result of high profile individuals suffering brain injuries. Greater public awareness of traumatic brain injuries (TBIs) has also been promoted by sources such as…

  8. Adolescent Post-Traumatic Stress Disorder (United States)

    Yule, William


    Based on over a decade of work in the area of PTSD, including a longitudinal study of PTSD among adolescents, Dr. Yule provides an introduction to post-traumatic stress disorder as it occurs in youth. This includes a look at the manifestations of stress reactions, the incidence and prevalence of PTSD, and the relationship between levels of…

  9. International Society for Traumatic Stress Studies (United States)

    ... Traumatic Stress? Public Education ePamphlets Adult Survivors of Childhood Trauma Survivors Talk About Trauma Press Releases and Media ... Stress Public Education ePamphlets iCAN Adult Survivors of Childhood Trauma Getting Help What is Childhood Trauma? Effects of ...

  10. Mild Traumatic Brain Injury – Case Report

    Directory of Open Access Journals (Sweden)


    Full Text Available A mild traumatic brain injury or a concussion represents the majority of all traumatic brain injuries. The consequences show on physical, cognitive, and emotional functioning and even though the injury classifies as mild, it can have a significant effect on a patient, patient’s family and their quality of life. Defects are often overlooked as objective clinical methods are lacking. Neuropsychological evaluation can aid in appraisal of the defect magnitude and determine factors that influence the outcome of the injured. The following case report addresses the importance of neuropsychological evaluation in treating cognitive defects along with the Cognitive Behavioral therapy approach toward emotional and behavioral disorders treatment in mild traumatic brain injury. It has been shown how important it is to find possible causes for slow recovery. The annuity tendencies have been noted as an important factor for prolongation of the post-concussion syndrome. We can detect the symptom simulation with appropriate psychological instruments. Described is a case of 38-year-old man who suffered a mild traumatic brain injury.

  11. Executive Functioning after Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap


    Full Text Available The Behavior Rating Inventory of Executive Function (BRIEF, a caregiver-report questionnaire, was used to measure changes in executive function in the first year after traumatic brain injury (TBI in a study of children, aged 5 to 15 years, at University of Minnesota, Minneapolis, and Johns Hopkins University School of Medicine, Baltimore, MD.

  12. Clinimetric measurement in traumatic brain injuries. (United States)

    Opara, J A; Małecka, E; Szczygiel, J


    Traumatic brain injury is a leading cause of death and disability worldwide. Every year, about 1.5 million affected people die and several millions receive emergency treatment. Most of the burden (90%) is in low and middle-income countries. The costs of care depend on the level of disability. The burden of care after traumatic brain injury is caused by disability as well as by psychosocial and emotional sequelae of injury. The final consequence of brain injury is the reduction of quality of life. It is very difficult to predict the outcome after traumatic brain injury. The basic clinical model included four predictors: age, score in Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. These are the neuroradiological markers of recovery after TBI (CT, MRI and PET) and biomarkers: genetic markers of ApoE Gene, ectoenzyme CD 38 (cluster of differentiation 38), serum S100B, myelin basic protein (MBP), neuron specific endolase (NSE), and glial fibrillary acidic protein (GPAP). These are many clinimetric scales which are helpful in prognosing after head injury. In this review paper, the most commonly used scales evaluating the level of consciousness after traumatic brain injury have been presented.

  13. Bleaching of the discolored traumatized tooth

    DEFF Research Database (Denmark)

    Dahl, Jon E.; Kopperud, Siemen E.; Pallesen, Ulla


    This chapter focuses on the treatment of discolored traumatized teeth, most of them being non-vital and subsequently, endodontically treated. Tooth bleaching based upon hydrogen peroxide as the active agent, applied directly or produced in a chemical reaction from sodium perborate or carbamide pe...... retreatment....

  14. The electrocardiogram in traumatic right atrial rupture

    NARCIS (Netherlands)

    van Veldhuisen, DJ; van den Berg, MP


    We:report the case of a previously healthy 20-year-old man who had a traumatic rupture of the right atrium. On admission an electrocardiogram (ECG) was recorded which is highly remarkable and, retrospectively, suggestive for the diagnosis. The patient died soon after the EGG, and the diagnosis was m

  15. Traumatic and alternating delayed intracranial hematomas

    Energy Technology Data Exchange (ETDEWEB)

    Lesoin, F.; Redford, H.; Jomin, M.; Viaud, C.; Pruvo, J.


    Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma.

  16. Predictors of tonic immobility during traumatic events

    Directory of Open Access Journals (Sweden)

    Arturo Bados


    Full Text Available Tonic immobility (TI is a possible reaction to danger that is facilitated by intense fear, physical restraint and perceived inability to escape. Other variables that could affect TI, such as the type and characteristics of traumatic events and personal characteristics have been little or no studied. The present study evaluated the power of these variables to predict TI in a sample of 273 college students who had experienced at least one traumatic event. Of the sample, 7.7% and 13.2% responded with TI according to the two stricter definitions adopted. Most of the variables were significantly associated with TI in univariate analyses. However, in a multiple regression analysis, only certain features of the events (occurrence of physical/sexual abuse, number of different types of events experienced and certain reactions to them (perception of how traumatic were the events, severe fear response were significant predictors of TI. Since these predictors explained only 25% of the variance, the influence of other variables -such as neuroticism, negative affectivity and perceived lack of personal control or resources to cope with traumatic events- should be investigated.

  17. Spontaneous closure of traumatic tympanic membrane perforations

    DEFF Research Database (Denmark)

    Jellinge, Marlene Ersgaard; Kristensen, S.; Larsen, K


    BACKGROUND: The treatment of traumatic tympanic membrane perforations varies in different investigations, ranging from observation to early surgical repair. The present study aimed to focus on the closure rate and the closure time in a group of patients treated with a watchful waiting policy. MET...

  18. Post-traumatic unilateral plantar hyperhidrosis. (United States)

    Eren, Y; Yavasoglu, N G; Comoglu, S S


    Localized unilateral hyperhidrosis is rare and poorly understood, sometimes stemming from trauma. Feet, quite vulnerable to trauma are affected by disease-mediated plantar hyperhidrosis, usually bilaterally. This report describes partial hyperhidrosis developing post-traumatically on the left plantar region of a 52-year-old male.

  19. Traumatic Brain Injury: Nuclear Medicine Neuroimaging

    NARCIS (Netherlands)

    Sánchez-Catasús, Carlos A; Vállez Garcia, David; Le Riverend Morales, Eloísa; Galvizu Sánchez, Reinaldo; Dierckx, Rudi; Dierckx, Rudi AJO; Otte, Andreas; de Vries, Erik FJ; van Waarde, Aren; Leenders, Klaus L


    This chapter provides an up-to-date review of nuclear medicine neuroimaging in traumatic brain injury (TBI). 18F-FDG PET will remain a valuable tool in researching complex mechanisms associated with early metabolic dysfunction in TBI. Although evidence-based imaging studies are needed, 18F-FDG PET i

  20. Aquaporin-4 and traumatic brain edema

    Institute of Scientific and Technical Information of China (English)

    XU Miao; SU Wei; XU Qiu-ping


    Brain edema leading to an expansion of brain volume has a crucial impact on morbidity and mortal-ity following traumatic brain injury as it increases intracra-nial pressure, impairs cerebral perfusion and oxygenation,and contributes to additional ischemic injuries.Classically,two major types of traumatic brain edema exist: "vasogenic"and "cytotoxic/cellular".However, the cellular and molecu-lar mechanisms contributing to the development/resolution of traumatic brain edema are poorly understood and no ef-fective drugs can be used now.Aquaporin-4 (AQP4) is a water-channel protein expressed strongly in the brain, pre-dominantly in astrocyte foot processes at the borders be-tween the brain parenchyma and major fluid compartments, including cerebrospinal fluid and blood.This distribution suggests that AQP4 controls water fluxes into and out of the brain parenchyma.In cytotoxic edema, AQP4 deletion slows the rate of water entry into brain, whereas in vasogenic edema, AQP4 deletion reduces the rate of water outflow from brain parenchyma.AQP4 has been proposed as a novel drug target in brain edema.These findings sug-gest that modulation of AQP4 expression or function may be beneficial in traumatic brain edema.

  1. Narrative Language in Traumatic Brain Injury (United States)

    Marini, Andrea; Galetto, Valentina; Zampieri, Elisa; Vorano, Lorenza; Zettin, Marina; Carlomagno, Sergio


    Persons with traumatic brain injury (TBI) often show impaired linguistic and/or narrative abilities. The present study aimed to document the features of narrative discourse impairment in a group of adults with TBI. 14 severe TBI non-aphasic speakers (GCS less than 8) in the phase of neurological stability and 14 neurologically intact participants…

  2. Perioperative Management of Adult Traumatic Brain Injury


    Sharma, Deepak; Vavilala, Monica S.


    This article presents an overview of the management of traumatic brain injury (TBI) as relevant to the practicing anesthesiologist. Key concepts surrounding the pathophysiology, anesthetic principles are used to describe potential ways to reduce secondary insults and improve outcomes after TBI.

  3. Traumatic brain injury and olfactory deficits

    DEFF Research Database (Denmark)

    Fortin, Audrey; Lefebvre, Mathilde Beaulieu; Ptito, Maurice


    PRIMARY OBJECTIVE: Olfactory functions are not systematically evaluated following traumatic brain injury (TBI). This study aimed at comparing two smell tests that are used in a clinical setting. RESEARCH DESIGN: The University of Pennsylvania Smell Identification Test (UPSIT) and the Alberta Smell...

  4. Whiplash and post-traumatic stress disorder

    NARCIS (Netherlands)

    Jaspers, JPC


    Purpose : This study examined the comorbidity of whiplash and post-traumatic stress disorder (PTSD) following motor vehicle accidents. A treatment strategy in cases with both disorders is proposed. Method: A review of the literature on psychological consequences of motor vehicle accidents and on ris

  5. [Psychotherapeutic treatment of traumatized refugees in Germany]. (United States)

    Böttche, M; Stammel, N; Knaevelsrud, C


    Traumatic experiences resulting from war and violence can lead to a broad spectrum of psychological and somatic stress responses. The psychological strain of traumatized refugees is frequently aggravated by specific post-migration stressors. The current healthcare provision in Germany is characterized by many restrictions. The different residence permits are associated with a limited access to medical and psychotherapeutic services. In addition, there are several barriers limiting access of this group of patients to the healthcare system (e. g. low level of training of mental healthcare staff, language barriers and lack of financing for interpreters). Empirical studies have shown that traumatized refugees profit from existing trauma-focused and evidence-based interventions. Treatment is associated with particular challenges and issues (e. g. use of interpreters, migration and culture-specific as well as legal aspects). Specialized treatment centers for traumatized refugees use a multidisciplinary treatment approach, which includes psychotherapeutic, medical and social work interventions as well as assistance with the residential status and integration programs.

  6. Mimicking Photosynthesis with Electrode-Supported Lipid Nanoassemblies. (United States)

    Wang, Mingming; Zhan, Wei


    as well as their sequential formation on electrodes. Supported on electrodes, these bilayers uniformly afford reliable photocurrent generation and modular system design. (2) Gold-supported hybrid bilayers as a powerful model platform for probing biomembrane-associated photoelectrochemical processes. These hybrid nanostructures consist of one alkanethiol (or substituted alkanethiol) and one lipid monolayer, whose chemical identity and makeup can be separately controlled and modified. Such precise molecular organization and flexible formation, in turn, enable a series of physicochemical parameters key to photosynthetic processes to be explicitly examined and cross-compared. A few such examples, based on donor/acceptor distance and loading, interfacial dipole, and redox level, are included here to illustrate the usefulness and versatility of this system. (3) Mimicking photosynthesis with supercomplexed lipid nanoassemblies. This research effort was motivated to address the low light absorption suffered by single-bilayer based photosynthetic mimics and has yielded a new lipid-based approach to mimicking Nature's way of organizing multiple photosynthetic subunits. Rhodamine and fullerene assembled within these lipid supercomplexes display robust electronic communication. The remarkable possibility of using lipid matrix to further improve photoconversion efficiency is revealed by cholesterol, whose addition triggers exciton formation that promotes faster energy and electron transfer in these lipid nanoassemblies.

  7. Mimicking Nonequilibrium Steady States with Time-Periodic Driving (United States)

    Raz, O.; Subaşı, Y.; Jarzynski, C.


    Under static conditions, a system satisfying detailed balance generically relaxes to an equilibrium state in which there are no currents. To generate persistent currents, either detailed balance must be broken or the system must be driven in a time-dependent manner. A stationary system that violates detailed balance evolves to a nonequilibrium steady state (NESS) characterized by fixed currents. Conversely, a system that satisfies instantaneous detailed balance but is driven by the time-periodic variation of external parameters—also known as a stochastic pump (SP)—reaches a periodic state with nonvanishing currents. In both cases, these currents are maintained at the cost of entropy production. Are these two paradigmatic scenarios effectively equivalent? For discrete-state systems, we establish a mapping between nonequilibrium stationary states and stochastic pumps. Given a NESS characterized by a particular set of stationary probabilities, currents, and entropy production rates, we show how to construct a SP with exactly the same (time-averaged) values. The mapping works in the opposite direction as well. These results establish a proof of principle: They show that stochastic pumps are able to mimic the behavior of nonequilibrium steady states, and vice versa, within the theoretical framework of discrete-state stochastic thermodynamics. Nonequilibrium steady states and stochastic pumps are often used to model, respectively, biomolecular motors driven by chemical reactions and artificial molecular machines steered by the variation of external, macroscopic parameters. Our results loosely suggest that anything a biomolecular machine can do, an artificial molecular machine can do equally well. We illustrate this principle by showing that kinetic proofreading, a NESS mechanism that explains the low error rates in biochemical reactions, can be effectively mimicked by a constrained periodic driving.

  8. Chronic multifocal non-bacterial osteomyelitis in hypophosphatasia mimicking malignancy

    Directory of Open Access Journals (Sweden)

    Warmuth-Metz Monika


    Full Text Available Abstract Background Hypophosphatasia (HP is characterized by a genetic defect in the tissue-nonspecific alkaline phosphatase (TNSALP gene and predominantly an autosomal recessive trait. HP patients suffer from reduced bone mineralization. Biochemically, elevated concentrations of substrates of TNSALP, including pyridoxal-5'-phosphate and inorganic pyrophosphate occur in serum, tissues and urine. The latter has been associated with chronic inflammation and hyperprostaglandinism. Case presentation We report on 2 affected children presenting with multifocal inflammatory bone lesions mimicking malignancy: A 6 years old girl with short stature had been treated with human growth hormone since 6 months. Then she started to complain about a painful swelling of her left cheek. MRI suggested a malignant bone lesion. Bone biopsy, however, revealed chronic inflammation. A bone scan showed a second rib lesion. Since biopsy was sterile, the descriptive diagnosis of chronic non-bacterial osteomyelitis (CNO was established. The diagnostic tests related to growth failure were repeated and subsequent analyses demonstrated a molecular defect in the TNSALP gene. The second girl (10 years old complained about back pain after she had fallen from her bike. X rays of her spine revealed compressions of 2 thoracic vertebrae. At first these were considered trauma related, however a bone scan did show an additional lesion in the right 4th rib. A biopsy of this rib revealed a sterile lympho- plasmocytoid osteomyelitis suggesting multifocal CNO. Further analyses did show a decreased TNSALP in leukocytes and elevated pyridoxal phosphate in plasma, suggesting a heterozygous carrier status of HP. Conclusion Chronic bone oedema in adult HP and chronic hyper-prostaglandinism in childhood HP do suggest that in some HP patients bone inflammation is present in conjunction with the metabolic defect. Sterile multifocal osteomyelitis could be demonstrated. Non-steroidal anti

  9. Atypical lymphocytes in malaria mimicking dengue infection in Thailand

    Directory of Open Access Journals (Sweden)

    Polrat Wilairatana


    Full Text Available Polrat Wilairatana1, Noppadon Tangpukdee1, Sant Muangnoicharoen1, Srivicha Krudsood2, Shigeyuki Kano31Department of Clinical Tropical Medicine, 2Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; 3Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, Tokyo, JapanAbstract: Patients with uncomplicated falciparum or vivax malaria usually present with acute febrile illness and thrombocytopenia similar to dengue infection. We retrospectively studied atypical lymphocytes (AL and atypical lymphocytosis (ALO, defined as AL > 5% of total white blood cells in 1310 uncomplicated malaria patients. In 718 falciparum malaria patients, AL and ALO on day 0 were found in 53.2% and 5.7% of the patients, respectively, with median AL on admission of 1% (range 0%–10%, whereas in 592 vivax malaria patients, AL and ALO on day 0 were found in 55.4% and 9.5% of the patients, respectively, with median AL on admission of 1% (range 0%–14%. After antimalarial treatment, AL and ALO declined in both falciparum and vivax malaria. However, AL and ALO remained in falciparum malaria on days 7, 14, and 21, whereas AL and ALO remained in vivax malaria on days 7, 14, 21, and 28. In both falciparum and vivax malaria patients, there was a positive correlation between AL and total lymphocytes, but a negative correlation between AL and highest fever on admission, white blood cells, and neutrophils, eosinophils, and platelets (P < 0.05. In conclusion, AL or ALO may be found in uncomplicated falciparum and vivax malaria mimicking dengue infection. In tropical countries where both dengue and malaria are endemic, presence of AL or ALO in any acute febrile patients with thrombocytopenia (similar to the findings in dengue malaria could not be excluded. Particularly if the patients have risk of malaria infection, confirmative microscopic examination for malaria should be carried out

  10. Fate of pathogenic bacteria in microcosms mimicking human body sites. (United States)

    Castellani, Francesco; Ghidini, Valentina; Tafi, Maria Carla; Boaretti, Marzia; Lleo, Maria M


    During the infectious process, pathogens may reach anatomical sites where they are exposed to substances interfering with their growth. These substances can include molecules produced by the host, and his resident microbial population, as well as exogenous antibacterial drugs. Suboptimal concentrations of inhibitory molecules and stress conditions found in vivo (high or low temperatures, lack of oxygen, extreme pH) might induce in bacteria the activation of survival mechanisms blocking their division capability but allowing them to stay alive. These "dormant" bacteria can be reactivated in particular circumstances and would be able to express their virulence traits. In this study, it was evaluated the effect of some environmental conditions, such as optimal and suboptimal temperatures, direct light and antibiotic sub-inhibitory concentrations doses of antibiotic, on the human pathogens Escherichia coli and Enterococcus faecalis when incubated in fluids accumulated in the body of patients with different pathologies. It is shown that inoculation in a number of accumulated body fluids and the presence of gentamicin, reliable conditions encountered during pathological states, induce stress-responding strategies enabling bacteria to persist in microcosms mimicking the human body. Significant differences were detected in Gram-negative and Gram-positive species with E. faecalis surviving, as starved or viable but non-culturable forms, in any microcosm and condition tested and E. coli activating a viable but non-culturable state only in some clinical samples. The persistence of bacteria under these conditions, being non-culturable, might explain some recurrent infections without isolation of the causative agent after application of the standard microbiological methods.

  11. Kawasaki disease mimicking a parapharyngeal abscess: a case report. (United States)

    Cai, Qianyun; Luo, Rong; Gan, Jing; Zhang, Li; Qu, Yi; Mu, Dezhi


    Parapharyngeal abscess (PPA)-like lesion is a very rare manifestation of Kawasaki disease (KD). Here we report a Chinese case of KD initially mimicking PPA, which is the first one reported in Asia.A 3-year-old male patient presented with fever, drooling, and bilateral painful cervical lymphadenopathy for 3 days. Chest X-ray and echocardiogram were normal. With substantial elevation of white blood count and C-reactive protein, purulent cervical lymphadenitis was considered. Symptoms did not improve after treatment with vancomycin, and the patient further developed trismus and restricted neck movement. Neck CT revealed a 2 × 1.5 cm hypodense lesion in the right parapharyngeal space with peripheral enhancement. PPA was suspected and on the 3rd day following admission, the patient received surgical incision and drainage. One milliliter of serous fluid was drained without bacterial growth on cultures. Fever persisted after surgery. As the clinical course proceeded, additional major signs of KD gradually evolved, and on the 6th day following admission the patient completely fulfilled the diagnostic criteria for KD. Rapid clinical improvement was observed following treatment with high-dose immunoglobulin and aspirin. Due to the parapharyngeal operation, the patient was fed milk through a nasogastric tube for 15 days. His neck incision became infected but healed gradually following dressing change and antibiotic treatment. Currently he remains asymptomatic during regular follow-up and repeated echocardiograms are normal.Both pediatricians and otolaryngologists can learn from this case that KD may initially manifest as PPA. Careful observation for major signs of KD during the clinical course can help to achieve a prompt and correct diagnosis. Thus, unnecessary surgery and cardiac complications of KD may be avoided.

  12. Isolated neurosarcoidosis mimicking multifocal meningiomas: a diagnosis pitfall (United States)

    Wang, Kun; He, Xiaoying; Wang, Wei; Niu, Huanjiang; Wang, Yirong; Cai, Xiujun; Yang, Shuxu


    Abstract Introduction: Neurosarcoidosis accounts for approximately 5% of the sarcoidosis, which develops exclusively in the nervous system and is always difficult to diagnose. We describe a rare case of isolated neurosarcoidosis mimicking as multifocal meningiomas. A 27-year-old male was admitted to our hospital with a history of unconsciousness and convulsion 1 month ago, which was suspected as a seizure. The results showed no abnormalities in complete blood count; serum electrolytes; erythrocyte sedimentation rate and ultrasonography of the liver, pancreas, spleen, kidney and parotid gland, and so on. Chest radiograph and electroencephalogram were also normal. Serum-angiotensin-converting enzyme slightly increased. Normal opening pressure was shown in cerebrospinal fluid sampling, which includes 8/μL white blood cells, 0.93 g/L protein, and 3.03 mmol/L glucose. Enhanced magnetic resonance imaging revealed multifocal enhancement lesions, including left sphenoid wing region, left temporal and bilateral occipitoparietal region, which were suspected as multiple “meningioma”. A left frontotemporal craniotomy was further performed. Both necrotizing and non-necrotizing granulomas were revealed in the pathological specimen, most of which were associated with multinucleated giant cells and macrophages. We could also see the fibrosis and inflammatory reaction in the sample composed of lymphocytes, histiocytes, and plasma cells. Histopathological examination showed that the cells were positive for human CD68 (KP1), CD68 (PGM1), and CD163; however, they were negative for the AF, epithelial membrane antigen, and glial fibrillary acidic protein. Tuberculosis-deoxyribonucleic acid test and special stains for acid-fast bacilli and fungi were negative. The diagnosis was finally made as isolated neurosarcoidosis. Then the patient was treated with additional corticosteroid therapy. Serial imaging examination 4 months later revealed that the lesions extremely decreased

  13. A Case of Spontaneous Spinal Epidural Hematoma Mimicking Stroke

    Directory of Open Access Journals (Sweden)

    Emine Rabia Koç


    Full Text Available Spontaneous spinal epidural hematoma is an uncommon cause of acute non-traumatic myelopathy and may present with various clinical phenotypes. Focal neurological symptoms can result in overlooking this differential diagnosis in patients presenting with neurological deficits and assuming the diagnosis of a stroke. Therefore, a thorough documentation of patient history is of great importance, since this can reveal symptoms suggestive of a different etiology. Here, we present a case of an 80-year-old female who was admitted with a hemiparesis without cortical or cranial neurological abnormalities. She mentioned of preceding shoulder and neck pain. Diagnosis of epidural hematoma was made by cervical magnetic resonance imaging. Symptoms resolved partially after surgical intervention. Our case illustrates the variation in the clinical presentation of spontaneous spinal epidural hematoma which can be misdiagnosed as stroke. Therefore, in patients with preceding neck, shoulder or interscapular pain and focal neurological deficits, this diagnosis should be included in the differential, particularly when cortical and cranial signs are lacking.

  14. Hemosiderotic clear-cell acanthoma: A pigmented mimicker

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    Leonardo Bugatti


    Full Text Available The authors report on a case of a 65-year-old man with pigmented clear-cell acanthoma located on the right thigh. Dermoscopy disclosed a peculiar picture consisting of diffuse black pigmentation with a superficial greyish veil in the central portion, dotted-to-globular dark red-black structures mainly located at the periphery with a homogenous regular reticular arrangement; peripheral translucid desquamation. Dermoscopic features are correlated with the histology, where hemosiderin deposits present in a sheet-like arrangement in the perivascular papillary dermis and in a band-like disposition in the reticular dermis at the base of the lesion can account for the pigmented picture. The lesion arose on a trauma-prone skin site; thus the authors believe that traumatic irritation may be responsible for the clinical and dermoscopic pictures, giving rise to a reaction similar in a way to the Auspitz′s sign provocated by trauma for psoriasis. Red blood cells extravasation from extremely superficialized capillaries may have led to hemosiderin deposition in the papillary and the reticular dermis.

  15. Traumatic Wound Dehiscence following Corneal Transplantation

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    Mohammad-Reza Jafarinasab


    Full Text Available Purpose: To investigate the incidence, mechanisms, characteristics, and visual outcomes of traumatic wound dehiscence following keratoplasty. Methods: Medical records of 32 consecutive patients with traumatic globe rupture following keratoplasty who had been treated at our center from 2001 to 2009 were retrospectively reviewed. Results: The study population consisted of 32 eyes of 32 patients including 25 men and 7 women with history of corneal transplantation who had sustained eye trauma leading to globe rupture. Mean patient age was 38.1 (range, 8 to 87 years and median interval between keratoplasty and the traumatic event was 9 months (range, 30 days to 20 years. Associated anterior segment findings included iris prolapse in 71.9%, lens extrusion in 34.4%, and hyphema in 40.6% of eyes. Posterior segment complications included vitreous prolapse (56%, vitreous hemorrhage (28% and retinal detachment (18%. Eyes which had undergone deep anterior lamellar keratoplasty (DALK; 5 cases, 15.6% tended to have less severe presentation and better final visual acuity. There was no correlation between the time interval from keratoplasty to the traumatic event, and final visual outcomes. Conclusion: The host-graft interface demonstrates decreased stability long after surgery and the visual prognosis of traumatic wound dehiscence is poor in many cases. An intact Descemet′s membrane in DALK may mitigate the severity of ocular injuries, but even in these cases, the visual outcome of globe rupture is not good and prevention of ocular trauma should be emphasized to all patients undergoing any kind of keratoplasty.

  16. Evolução ecocardiográfica de recém-nascidos com persistência do canal arterial Echocardiographic post-neonatal progress of preterm neonates with patent ductus arteriosus

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    Jorge Yussef Afiune


    ínico associado.OBJECTIVE: To identify clinical and echocardiography predictors of the spontaneous closure of patent ductus arteriosus in preterm neonates. METHODS: Sixty-one consecutive preterm neonates (gestational age 30±2 weeks, birth weight 1.2±0.2 kg were evaluated by echocardiogram on their third day of life and those with patent ductus arteriosus were selected for a prospective cohort. Echocardiography was repeated weekly until they reached term. Based on their progress, the sample population was divided into two groups, depending on whether spontaneous closure of patent ductus arteriosus took place (Group A or not (Group B. The prevalence of clinical signs of patent ductus arteriosus and echocardiography findings at baseline were compared between the groups. RESULTS: Patent ductus arteriosus was found in 21 neonates (34%. Spontaneuous closure was observed during follow-up of seven patients (Group A, 33% of those with patent ductus arteriosus, in contrast with the remaining 14 patients (Group B, 67%. Clinical signs of patent ductus arteriosus were present in 14% of the patients in Group A, compared with 71% in group B (p = 0.01. At baseline, Group B had a larger ductus diameter in relation to Group A (2.6±0.6 mm vs. 1.4±0.6 mm; p = 0.003. The area under the ROC curve in relation to ductus diameter was 0.93 (p = 0.003 and 100% sensitivity for identifying cases without spontaneous closure was obtained at the cutoff point of 1.7 mm, while 100% specificity was observed taking 2.2 mm as the cutoff. CONCLUSIONS: In preterm neonates, a patent ductus arteriosus greater than 2.2 mm on the third day of life predicts no spontaneous closure and suggests a need for early treatment, especially when associated with clinical signs.

  17. Transcatheter closure of special types of patent ductus arteriosus%特殊类型动脉导管未闭的介入治疗(附30例报告)

    Institute of Scientific and Technical Information of China (English)

    邓军; 孔祥清; 杨荣; 盛燕辉; 钱玲梅; 周蕾; 杨振文; 孙伟; 曹克将


    目的:探讨特殊类型动脉导管未闭(patent ductus arteriosus,PDA)介入治疗的方法.方法:应用蘑菇伞封堵器(patent ductus arteriosus occluder,PDAO)介入封堵特殊类型的PDA 30例.结果:30例中巨大PDA 5例[最窄径平均12.4±1.7 mm (10.1~16.3 mm)],细小PDA 15例(最窄径平均2.10±0.42 mm),外科手术后再通的PDA 6例(最窄径平均3.20±0.34 mm),伴重度肺动脉压增高的PDA 3例[(平均肺动脉压88±7 mmHg(75~97 mmHg)],合并严重脊柱侧弯畸形1例.对5种不同类型的PDA根据其不同特点,采取不同的方法均成功封堵.结论:对于特殊类型动脉导管未闭选择恰当的方法可成功封堵.

  18. 早产儿动脉导管未闭现状和危险因素调查研究%Investigation on the present situation and risk factors of premature infants with patent ductus arteriosus

    Institute of Scientific and Technical Information of China (English)

    石小娟; 冯璇


    Objective To study the present situation of premature infants with patent ductus arteriosus and its risk factors.Methods A total of 824 premature infants in our hospital from October 2011 to October 2012 were selected as research object,then the patent ductus arteriosus rate of all the premature infants was investigated,and the rates of premature infants with different maternal factors and neonatal factors were compared.Results 190 cases of 824 premature infants were with patent ductus arteriosus,the rate was 23.05%,the patent ductus arteriosus rate of premature infants with meconium stained amniotic fluid,oligohydramnios,infection during pregnancy and gestational diabetes mellitus were higher than those of others,the rate of those with maternal hormone application was lower than that without hormone,the rates of those with lower gestational age and birth weight,intrauterine distress,Apgar score < 8 points were all higher than those of others (all P < 0.05),there were significant differences.Conclusions The risk factors of premature infants with patent ductus arteriosus is more,and it mainly includes the maternal gestational factors and neonatal factors.So they should be paid enough attention.%目的 调查分析早产儿动脉导管未闭的现状及其危险因素.方法 选取2011年10月至2012年10月的824例早产儿为研究对象,将其动脉导管未闭发生率进行调查,并将其中不同母体因素及新生儿因素的发生率进行比较.结果 824例早产儿中发生动脉导管未闭190例,发生率为23.05%;羊水粪染、羊水过少、孕期感染及妊娠期糖尿病患者的动脉导管未闭发生率高于其他患者,而母体应用激素者低于未用激素者(P均<0.05);胎龄及出生体重较小、宫内窘迫、Apgar评分<8分患儿动脉导管未闭发生率均高于其他患儿,差异有统计学意义(P<0.05).结论 早产儿动脉导管未闭的危险因素较多,主要包括母体妊娠期因素及新生儿因素,应给予充分重视.

  19. Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG: toward integrated treatment of symptoms related to traumatic loss

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    Geert E. Smid


    Full Text Available Background: Traumatic events such as disasters, accidents, war, or criminal violence are often accompanied by the loss of loved ones, and may then give rise to traumatic grief. Traumatic grief refers to a clinical diagnosis of persistent complex bereavement disorder (PCBD with comorbid (symptoms of posttraumatic stress disorder (PTSD and/or major depressive disorder (MDD following confrontation with a traumatic loss. Trauma survivors, who are frequently from different cultural backgrounds, have often experienced multiple losses and ambiguous loss (missing family members or friends. Current evidence-based treatments for PTSD do not focus on traumatic grief. Objective: To develop a treatment for traumatic grief combining treatment interventions for PTSD and PCBD that may accommodate cultural aspects of grief. Method: To provide a rationale for treatment, we propose a cognitive stress model of traumatic grief. Based on this model and on existing evidence-based treatments for PTSD and complicated grief, we developed Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG for the treatment of patients with traumatic grief. The treatment is presented along with a case vignette. Results: Processes contributing to traumatic grief include inadequately integrating the memory of the traumatic loss, negative appraisal of the traumatic loss, sensitivity to matching triggers and new stressors, and attempting to avoid distress. BEP-TG targets these processes. The BEP-TG protocol consists of five parts with proven effectiveness in the treatment of PCBD, PTSD, and MDD: information and motivation, grief-focused exposure, memorabilia and writing assignments, finding meaning and activation, and a farewell ritual. Conclusion: Tailored to fit the needs of trauma survivors, BEP-TG can be used to address traumatic grief symptoms related to multiple losses and ambiguous loss, as well as cultural aspects of bereavement through its different components.

  20. Neurotherapy of Traumatic Brain Injury/Post-Traumatic Stress Symptoms in Vietnam Veterans. (United States)

    Nelson, David V; Esty, Mary Lee


    Previous report suggested the beneficial effects of an adaptation of the Flexyx Neurotherapy System (FNS) for the amelioration of mixed traumatic brain injury/post-traumatic stress symptoms in veterans of the Afghanistan and Iraq wars. As a novel variant of electroencephalograph biofeedback, FNS falls within the bioenergy domain of complementary and alternative medicine. Rather than learning voluntary control over the production/inhibition of brain wave patterns, FNS involves offsetting stimulation of brain wave activity by means of an external energy source, specifically, the conduction of electromagnetic energy stimulation via the connecting electroencephalograph cables. Essentially, these procedures subliminally induce strategic distortion of ongoing brain wave activity to presumably facilitate resetting of more adaptive patterns of activity. Reported herein are two cases of Vietnam veterans with mixed traumatic brain injury/post-traumatic stress symptoms, each treated with FNS for 25 sessions. Comparisons of pre- and post-treatment questionnaire assessments revealed notable decreases for all symptoms, suggesting improvements across the broad domains of cognition, pain, sleep, fatigue, and mood/emotion, including post-traumatic stress symptoms, as well as for overall activity levels. Findings suggest FNS treatment may be of potential benefit for the partial amelioration of symptoms, even in some individuals for whom symptoms have been present for decades.

  1. Traumatic lumbar hernia: report of a case. (United States)

    Torer, Nurkan; Yildirim, Sedat; Tarim, Akin; Colakoglu, Tamer; Moray, Gokhan


    Traumatic lumbar hernias are very rare. Here, we present a case of secondary lumbar hernia. A 44-year-old man sustained a crushing injury. On admission, ecchymotic, fluctuating swelling was present on his left flank with normal vital signs. Subcutaneous intestinal segments were revealed at his left flank on abdominal CT. Emergency laparotomy revealed a 10-cm defect on the left postero-lateral abdominal wall. The splenic flexure was herniated through the defect. Herniated segments was reduced, the defect was repaired with a polypropylene mesh graft. There was also a serosal tear and an ischemic area 3mm wide on the splenic flexure and was repaired primarily. The patient had an uneventful recovery. Most traumatic lumbar hernias are caused by blunt trauma. Trauma that causes abdominal wall disruption also may cause intraabdominal organ injury. Abdominal CT is useful in the diagnosis and allows for diagnosis of coexisting organ injury. Emergency laparotomy should be performed to repair possible coexisting injuries.

  2. [Traumatic and iatrogenic lesions of abdominal vessels]. (United States)

    Farah, I; Tarabula, P; Voirin, L; Magne, J L; Delannoy, P; Gattaz, F; Guidicelli, H


    Gravity of abdominal vessels traumatisms is secondary to multiple factors. It depends on the type of injured vessels, aetiology and associated lesions. Between September 1984 and March 1995, 22 abdominal vessel traumatisms in 16 patients (mean age: 39 years) were treated. At surgical exploration, 4 aortic and 2 renal vein lesions, 7 iliac artery and 3 renal artery contusions, 2 superior mesenteric artery dissections; 3 infra-renal vena cava ruptures and 1 superior mesenteric vein dilaceration were found. All lesions were caused by penetrant wounds secondary to firearm or blade injury or secondary to injuries due to ski or traffic accidents. In 5 cases, lesions were iatrogenic. There was no mortality in the post-operative period, 14 patients out of the 16 patients operated on have been followed during a period from 1 to 120 months.

  3. Traumatic knee extension deficit (the locked knee)

    DEFF Research Database (Denmark)

    Helmark, I C; Neergaard, K; Krogsgaard, M R


    In the present study we investigated the validity of magnetic resonance imaging (MRI) and arthroscopy in knees with acute, traumatic extension deficit (the "locked knee"), and evaluated whether arthroscopy of knees with no mechanical pathology could be avoided by MRI evaluation. The study consisted...... of 50 patients who had an acute, traumatic extension deficit of the knee. All patients were submitted to MRI prior to arthroscopy. Following MRI and surgery, standardized forms were filled out, attempting to objectify the findings. The orthopaedic surgeon was not aware of the MRI result prior to surgery......, the following results were calculated for the overall appearance of a lesion able to cause locking: Positive predictive value = 0.85, negative predictive value = 0.77, sensitivity = 0.95, specificity = 0.53. Two knees were erroneously evaluated with no mechanical locking at MRI (one bucket-handle lesion and one...

  4. Mission Connect Mild TBI Translational Research Consortium, Post Traumatic Hypopituitarism (United States)


    10 Aug 2010 4. TITLE AND SUBTITLE The Mission Connect MTBI Translational Research Consortium 5a. CONTRACT NUMBER Post traumatic hypopituitarism 5b...distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT The purpose of this project is to identify the incidence of post traumatic hypopituitarism ...June 21, 2010; however, none have reached the six month milestone for blood testing 15. SUBJECT TERMS post traumatic hypopituitarism 16. SECURITY

  5. Glyburide - Novel Prophylaxis and Effective Treatment for Traumatic Brain Injury (United States)


    ABSTRACT The overall subject of this project is blast- traumatic brain injury (blast- TBI ) and the role of the SUR1-regulated NCCa-ATP channel in blast- TBI ...project is blast- traumatic brain injury (blast- TBI ) and the role of the SUR1-regulated NCCa-ATP channel in secondary injury following blast- TBI . The...effective treatment for traumatic brain injury PRINCIPAL INVESTIGATOR: J. Marc Simard, M.D., Ph.D

  6. A Blast Model of Traumatic Brain Injury in Swine (United States)


    public release; distribution unlimited Although blast-induced traumatic brain injury (BI- TBI ) is a significant cause of morbidity and behavioral...survival model of BI- TBI in swine. Traumatic Brain Injury , Swine, Blast, Model Development U U U 7 USAMRMC W81XWH-08-2-0082... Injury , TBI Scientific Advisor, Defense Center of Excellence for Psychological Health and Traumatic Brain Injury ) and Dr. Tamara Crowder at the DoD

  7. Traumatic avulsion of extraocular muscles: case reports

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    Nilza Minguini


    Full Text Available We described the clinical, surgical details and results (motor and sensory of the retrieving procedure of traumatically avulsed muscles in three patients with no previous history of strabismus or diplopia seen in the Department of Ophthalmology, State University of Campinas, Brazil. The slipped muscle portion was reinserted at the original insertion and under the remaining stump, which was sutured over the reinserted muscle. For all three cases there was recovery of single binocular vision and stereopsis.

  8. Managing traumatic brain injury secondary to explosions

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    Burgess Paula


    Full Text Available Explosions and bombings are the most common deliberate cause of disasters with large numbers of casualties. Despite this fact, disaster medical response training has traditionally focused on the management of injuries following natural disasters and terrorist attacks with biological, chemical, and nuclear agents. The following article is a clinical primer for physicians regarding traumatic brain injury (TBI caused by explosions and bombings. The history, physics, and treatment of TBI are outlined.

  9. Anesthesia for Patients with Traumatic Brain Injuries. (United States)

    Bhattacharya, Bishwajit; Maung, Adrian A


    Traumatic brain injury (TBI) represents a wide spectrum of disease and disease severity. Because the primary brain injury occurs before the patient enters the health care system, medical interventions seek principally to prevent secondary injury. Anesthesia teams that provide care for patients with TBI both in and out of the operating room should be aware of the specific therapies and needs of this unique and complex patient population.

  10. Perioperative management of traumatic brain injury


    Curry, Parichat; Viernes, Darwin; Sharma, Deepak


    Traumatic brain injury (TBI) is a major public health problem and the leading cause of death and disability worldwide. Despite the modern diagnosis and treatment, the prognosis for patients with TBI remains poor. While severity of primary injury is the major factor determining the outcomes, the secondary injury caused by physiological insults such as hypotension, hypoxemia, hypercarbia, hypocarbia, hyperglycemia and hypoglycemia, etc. that develop over time after the onset of the initial inju...

  11. Caregiver stress in traumatic brain injury


    Blake, Holly


    Aims\\ud Many patients experience physical, behavioural, cognitive and emotional problems following traumatic brain injury (TBI). They may require continuing care for many years, most of which is provided by informal caregivers, such as spouses, parents, or other family members. The caregiving role is associated with a range of adverse effects including anxiety, depression, poor physical health and lowered quality of life. This article explores issues around caregiver stress; highlighting inte...

  12. Functional Recovery After Severe Traumatic Brain Injury

    DEFF Research Database (Denmark)

    Hart, Tessa; Kozlowski, Allan; Whyte, John


    OBJECTIVE: To examine person, injury, and treatment characteristics associated with recovery trajectories of people with severe traumatic brain injury (TBI) during inpatient rehabilitation. DESIGN: Observational prospective longitudinal study. SETTING: Two specialized inpatient TBI rehabilitation...... functional levels received more treatment and more treatment was associated with slower recovery, presumably because treatment was allocated according to need. Thus, effects of treatment on outcome could not be disentangled from effects of case mix factors. CONCLUSIONS: FIM gain during inpatient recovery...

  13. Reducing Secondary Insults in Traumatic Brain Injury (United States)


    persons, and leaves 99,000 persons permanently disabled [1]. The total cost for treatment and rehabilitation of patients with brain injuries is...registry based or retrospective or include only secondary insults that occur in the intensive care unit ( ICU ) setting. Most prior investigations the surgical and neurosurgical ICU diagnosed with a traumatic brain injury requiring a diagnostic procedure were eligible for the study. The study

  14. Mesenchymal stromal cells for traumatic brain injury




    The multiple pathological cascades activated after traumatic brain injury (TBI) and their extended nature offer the possibility for therapeutic interventions possibly affecting multiple injury mechanisms simultaneously. Mesenchymal stromal cell (MSC) therapy matches this need, being a bioreactor of a variety of molecules able to interact and modify the injured brain microenvironment. Compared to autologous MSCs, bank stored GMP-graded allogenic MSCs appear to be a realistic choice for TBI ...

  15. Traumatic brain injuries: Forensic and expertise aspects

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    Vuleković Petar


    Full Text Available Introduction. Traumatic brain injuries have major socio-economic importance due to their frequency, high mortality and serious consequences. According to their nature the consequences of these injuries may be classified as neurological, psychiatric and esthetic. Various lesions of brain structures cause neurological consequences such as disturbance of motor functions, sensibility, coordination or involuntary movements, speech disturbances and other deviations, as well as epilepsy. Psychiatric consequences include cognitive deficit, emotional disturbances and behavior disturbances. Criminal-legal aspect of traumatic brain injuries and litigation. Criminal-legal aspect of traumatic brain injuries expertise understands the qualification of these injuries as mild, serious and qualified serious body injuries as well as the expertise about the mechanisms of their occurrence. Litigation expertise includes the estimation of pain, fear, diminished, i.e. lost vital activity and disability, esthetic marring, and psychological suffer based on the diminished general vital activity and esthetic marring. Competence and timing of expertise. Evaluation of consequences of traumatic brain injuries should be performed only when it can be positively confirmed that they are permanent, i.e. at least one year after the injury. Expertise of these injuries is interdisciplinary. Among clinical doctors the most competent medical expert is the one who is in charge for diagnostics and injury treatment, with the recommendation to avoid, if possible, the doctor who conducted treatment. For the estimation of general vital activity, the neurological consequences, pain and esthetic marring expertise, the most competent doctors are neurosurgeon and neurologist. Psychological psychiatric consequences and fear expertise have to be performed by the psychiatrist. Specialists of forensic medicine contribute with knowledge of criminal low and legal expertise.

  16. Traumatic globe luxation: A case report

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    Ekta Kumari


    Full Text Available Globe luxation is a rare clinical event. Most of the cases are usually traumatic, although spontaneous globe luxation has also been reported. The majority of the posttraumatic cases are usually associated with the injury or fracture of the bony orbit. We report here a case of globe luxation that occurred per se without any injury to the orbital or maxillo-facial bony structures.

  17. Traumatic fistula:the case for reparations

    Directory of Open Access Journals (Sweden)

    Arletty Pinel


    Full Text Available As a conflict strategy, women are often sexually assaulted using sticks, guns, branches of trees and bottles. Women’s genitals are deliberately destroyed, some permanently. Traumatic fistula often results. As with victims of torture and other grave human rights abuses, there exists an obligation to restore the women to health as far as possible and to provide reparation for their violations.

  18. Traumatic brain injuries: Forensic and expertise aspects


    Vuleković Petar; Simić Milan; Mišić-Pavkov Gordana; Cigić Tomislav; Kojadinović Željko; Đilvesi Đula


    Introduction. Traumatic brain injuries have major socio-economic importance due to their frequency, high mortality and serious consequences. According to their nature the consequences of these injuries may be classified as neurological, psychiatric and esthetic. Various lesions of brain structures cause neurological consequences such as disturbance of motor functions, sensibility, coordination or involuntary movements, speech disturbances and other deviations, as well as epilepsy. Psychiatric...

  19. Center for the Study of Traumatic Stress (United States)


    problems of those exposed to war, disaster and other traumatic events. Third, we are dedicated to research in translational studies, neuro- science ...and high- ly-productive team functions in a well-coordinated manner and in a unified direction . That combined effort and synergy results in the rapid...Center continued its clinical work in neuro- science and neurobiology by conducting clinical trials to improve the treatment of stress, PTSD and TBI

  20. Traumatic Brain Injury, Microglia, and Beta Amyloid


    Mannix, Rebekah C.; Whalen, Michael J


    Recently, there has been growing interest in the association between traumatic brain injury (TBI) and Alzheimer's Disease (AD). TBI and AD share many pathologic features including chronic inflammation and the accumulation of beta amyloid (A\\(\\beta\\)). Data from both AD and TBI studies suggest that microglia play a central role in A\\(\\beta\\) accumulation after TBI. This paper focuses on the current research on the role of microglia response to A\\(\\beta\\) after TBI.

  1. Traumatic Tympanic Membrane perforation: An aetiological profile

    Directory of Open Access Journals (Sweden)

    Alabi Biodun S


    Full Text Available Abstract Background Traumatic perforation of the tympanic membrane may be due to direct or indirect source. The aim of the study is to profile the various aetiologies of traumatic tympanic membrane perforation in Ilorin, north central Nigeria. A retrospective review of 64 patients seen at the University of Ilorin Teaching hospital, Ilorin, Nigeria over a ten year period (January 1998 to Dec 2007 with history of traumatic tympanic membrane perforation from various causes, these also included multiply injured patients with bleeding from middle ear as part of their presentations. The data retrieved included the biodata, the clinical presentations, source of injury, the clinical findings and the treatment outcome. The data were entered into an SPSS version 11 computer soft ware and analyzed descriptively. Findings Sixty four (64 ears were analysed, Age range 6 months to 50 yrs, mean age of 29.2 yrs 7.9% of them were ≤5 years, 29.7% between 21-34 years, and 37.7% were 35 years and above. The male to female ratio was 2.5:1.0. Commonest aetiology was from slaps, then road traffic injury (RTI in 35.9% and 23.5%, Majority of the slap injury were from fights (30.5%, security agents, senior students and cultists at schools (17.4% each. Sudden hearing loss was a typical presentation (95.3%, majority of the patient defaulted from follow up once the symptoms of bleeding and pain subsided. Only 7.8% had neomembrane formation on follow up Conclusion Traumatic perforation of the tympanic membrane is an uncommon injury that is under-reported, there is the need to educate on alternative punitive measure among students and security agents, unskilled removal of foreign body, early identification, evaluation and referral of patients reduces the attendant morbidity.

  2. Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in adults: immediate and two-year follow-up results

    Institute of Scientific and Technical Information of China (English)

    ZHANG Cao-jin; HUANG Yi-gao; HUANG Xin-sheng; HUANG Tao; HUANG Wen-hui; XIA Chun-li; MO Yu-jing


    Background Transcatheter closure of patent ductus arteriosus (PDA) is a well established procedure and an accepted treatment modality for small to moderate-sized PDA.This study aimed to evaluate the immediate and follow-up results of transcatheter closure of large PDAs with severe pulmonary arterial hypertension (PAH) in adults.Methods After a complete hemodynamic evaluation differentiating from the reversibility of severe PAH,transcatheter closure of PDA was performed.Patients were followed up clinically and echocardiographically at 24 hours,1 month,3months,6 months,12 months and 24 months after occlusion.Results Twenty-nine patients had successful occlusion,pulmonary artery pressure (PAP),left ventricular ejection fraction (LVEF) and fractional shortening (FS) significantly decreased immediately after occlusion ((106±25) mmHg vs.(50±14) mmHg,P <0.01; (63.7±7.2)% vs.(51.4±10.1)%,P <0.01 and (36.9±8.2)% vs.(28.9±8.6)%,P <0.05,respectively).At 1 month after PDA closure,the signs and symptoms improved markedly in all 29 patients,and PDAs were completely closed and remained closed during the follow-up.Eighteen patients having different degrees of dyspnea were treated with angiotensin converting enzyme inhibitor (ACEI) and/or digoxin after occlusion.Nine patients whose pulmonary vascular resistence (PVR) >6 Wood units accepted targeted PAH therapy.After 1 to 3 months of peroral drug therapy,their exercise tolerance improved from New York Heart Association (NYHA) class Ⅲ-Ⅳ to NYHA class Ⅰ.During follow-up,no latent arrhythmias were found,the left atrial diameter (LAD),left ventricular end-diastolic diameter (LVEDD),left ventricular end-systolic diameter (LVESD),left ventricular mass index (LVMI) and pulmonary artery systolic pressure (PASP) decreased significantly (P <0.05),and FS and LVEF recovered compared to the immediate postclosure state.However,FS and LVEF remained low compared to the preclosure state.Conclusions Transcatheter closure

  3. Experiência global no fechamento percutâneo do canal arterial Overall experience with percutaneous occlusion of the patent ductus arteriosus

    Directory of Open Access Journals (Sweden)

    Carlos Augusto Cardoso Pedra


    Full Text Available OBJETIVO: Avaliar a experiência global da nossa instituição com o fechamento percutâneo do canal arterial. MÉTODOS: Desde dezembro/92, 150 pacientes foram submetidos a 178 procedimentos (85 - técnica de Rashkind; 87 - coils de Gianturco; 6 - coils Duct Occlud. A mediana de idade foi de 6,5 anos (1 a 57. A média do diâmetro mínimo do canal foi de 3,05±1,24mm (1 a 8. Avaliações clínicas e ecocardiográficas foram realizadas seriadamente. RESULTADOS: Implantes adequados ocorreram em 143 (95,3% pacientes. A prevalência de shunt residual imediato foi de 52,1%, decrescendo para 15,9% no seguimento. Esta taxa caiu para 5,2% após a realização de procedimentos adicionais. Embolização de coils ocorreu em 12 procedimentos e de umbrella em 1. Um paciente apresentou hemólise e outro estenose discreta da artéria pulmonar esquerda. Não houve mortalidade. CONCLUSÃO: Esta modalidade terapêutica é segura e eficaz, proporcionando bons resultados a longo prazo.PURPOSE: To evaluate the overall experience of our institution with percutaneous occlusion of the patent ductus arteriosus. METHODS: Since December/92, 150 patients underwent 178 procedures (85 - Rashkind technique; 87 - Gianturco coils; 6 - Duct Occlud. Median age was 6.5 years (1 to 57. Mean minimum ductal diameter was 3.05±1.24mm (1 to 8. Clinical and echocardiographic evaluations were performed periodically. RESULTS: Adequate implantation was achieved in 143 (95.3% patients. Prevalence of immediate residual shunting was 52.1%, falling to 15.9% during follow-up. This figure decreased to 5.2% after new additional procedures. Umbrella and coil embolization occurred in 1 and 12 procedures, respectively. Hemolysis and mild stenosis of left pulmonary artery were observed in one patient each. There was no mortality. CONCLUSION: This therapeutic modality is safe and efficacious with good follow-up results.

  4. Surgical treatment of traumatic lower limb pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    Pan Zhongjie; Zhang Hua; Li Li; Jia Yutao; Tian Rong


    Objective:To summarize our experience in surgical treatment of traumatic lower limb pseudoaneurysm.Methods:Twenty patients with traumatic lower limb pseudoaneurysm were surgically treated in our department from January 2007 to January 2012.The treatment protocols included interventional covered-stent placement (10 cases),spring coil embolization (2 cases),and surgical operation (8 cases).Surgical operations included pseudoaneurysm repair (2 cases),autologousvein transplantation (1 case),and artificial-vessel bypass graft (5 cases).Results:All the patients were successfully treated without aggravating lower limb ischemia.Pseudoaneurysm disappeared after treatment.A surgical operation is suitable to most pseudoaneurysms,but its damage is relatively obvious and usually leads to more bleeding.It also requires a longer operating time.Compared to a surgical operation,interventional therapy is less traumatic and patients usually have a quicker recovery (P<0.05).All patients were followed up once per month for 12-36 months by color Doppler ultrasound examination.There were no cases of pseudoaneurysm recurrence.Conclusion:Both surgical operation and interventional therapy are safe and effective in the treatment of pseudoaneurysm.

  5. Catecholamines and cognition after traumatic brain injury. (United States)

    Jenkins, Peter O; Mehta, Mitul A; Sharp, David J


    Cognitive problems are one of the main causes of ongoing disability after traumatic brain injury. The heterogeneity of the injuries sustained and the variability of the resulting cognitive deficits makes treating these problems difficult. Identifying the underlying pathology allows a targeted treatment approach aimed at cognitive enhancement. For example, damage to neuromodulatory neurotransmitter systems is common after traumatic brain injury and is an important cause of cognitive impairment. Here, we discuss the evidence implicating disruption of the catecholamines (dopamine and noradrenaline) and review the efficacy of catecholaminergic drugs in treating post-traumatic brain injury cognitive impairments. The response to these therapies is often variable, a likely consequence of the heterogeneous patterns of injury as well as a non-linear relationship between catecholamine levels and cognitive functions. This individual variability means that measuring the structure and function of a person's catecholaminergic systems is likely to allow more refined therapy. Advanced structural and molecular imaging techniques offer the potential to identify disruption to the catecholaminergic systems and to provide a direct measure of catecholamine levels. In addition, measures of structural and functional connectivity can be used to identify common patterns of injury and to measure the functioning of brain 'networks' that are important for normal cognitive functioning. As the catecholamine systems modulate these cognitive networks, these measures could potentially be used to stratify treatment selection and monitor response to treatment in a more sophisticated manner.

  6. Teachers' experiences supporting children after traumatic exposure. (United States)

    Alisic, Eva; Bus, Marissa; Dulack, Wendel; Pennings, Lenneke; Splinter, Jessica


    Teachers can be instrumental in supporting children's recovery after trauma, but some work suggests that elementary school teachers are uncertain about their role and about what to do to assist children effectively after their students have been exposed to traumatic stressors. This study examined the extent to which teachers working with children from ages 8 to 12 years report similar concerns. A random sample of teachers in the Netherlands (N = 765) completed a questionnaire that included 9 items measuring difficulties on a 6-point Likert scale (potential range of total scores: 9-54). The mean total difficulty score was 29.8 (ranging from 10 to 50; SD = 7.37). On individual items, the fraction of teachers scoring 4 or more varied between 25 and 63%. A multiple regression analysis showed that teachers' total scores depended on amount of teaching experience, attendance at trauma-focused training, and the number of traumatized children they had worked with. The model explained 4% of the variance, a small effect. Because traumatic exposure in children is rather common, the findings point to a need to better understand what influences teachers' difficulties and develop trauma-informed practice in elementary schools.

  7. Endoscopic Surgery for Traumatic Acute Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Hiroyuki Kon


    Full Text Available Traumatic acute subdural hematoma (ASDH is generally addressed by craniotomy under general anesthesia. We report a patient whose traumatic ASDH was treated under local anesthesia by one-burr-hole endoscopic surgery. This 87-year-old woman had undergone coil embolization for a ruptured right middle-cerebral artery aneurysm and placement of a ventriculoperitoneal shunt for normal pressure hydrocephalus 5 years earlier. Upon admission, she manifested consciousness disturbance after suffering head trauma and right hemiplegia. Her Glasgow Coma Scale score was 8 (E2V2M4. Computed tomography (CT demonstrated a thick, left-frontotemporal ASDH. Due to her advanced age and poor condition, we performed endoscopic surgery rather than craniotomy to evacuate the ASDH. Under local anesthesia, we made a burr hole in her left forehead and increased its size to 15 mm in diameter. After introducing a transparent sheath into the hematoma cavity with a rigid endoscope, the clot was evacuated with a suction tube. The arterial bleeding point was electrically coagulated. A postoperative CT scan confirmed the reduction of the hematoma. There was neither brain compression nor brain swelling. Her consciousness disturbance and right hemiplegia improved immediately. Endoscopic surgery may represent a viable method to address traumatic intracranial hematomas in some patients.

  8. Combat Helmets and Blast Traumatic Brain Injury

    Directory of Open Access Journals (Sweden)

    Duncan Wallace


    Full Text Available Background: The conflicts in Iraq and Afghanistan and the prominence of traumatic brain injury (TBI, mostly from improvised explosive devices, have focused attention on the effectiveness of combat helmets. Purpose: This paper examines the importance of TBI, the role and history of the development of combat helmets, current helmet designs and effectiveness, helmet design methodology, helmet sensors, future research and recommendations. Method: A literature review was conducted using search terms – combat helmets, traumatic brain injury, concussion, Iraq, Afghanistan and helmet sensors, searching PubMed, MEDLINE, ProQuest and Google Scholar. Conclusions: At present, no existing helmet is able to fully protect against all threats faced on the battlefield. The prominence of traumatic brain injury from improvised explosive devices in the current conflicts in Iraq and Afghanistan has highlighted the limitations in knowledge about blast and how to provide protection from it. As a result, considerable research is currently occurring in how to protect the head from blast over-pressure. Helmet sensors may provide valuable data. Some new combat helmets may be able to protect against rifle rounds, but may result in injuries occurring behind body armour. Optimal combat helmet design requires a balance between the need for protection from trauma and the comfort and practicality of the helmet for the user to ensure the best outcomes.

  9. Pathophysiological links between traumatic brain injury and post-traumatic headaches [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Robert L. Ruff


    Full Text Available This article reviews possible ways that traumatic brain injury (TBI can induce migraine-type post-traumatic headaches (PTHs in children, adults, civilians, and military personnel. Several cerebral alterations resulting from TBI can foster the development of PTH, including neuroinflammation that can activate neural systems associated with migraine. TBI can also compromise the intrinsic pain modulation system and this would increase the level of perceived pain associated with PTH. Depression and anxiety disorders, especially post-traumatic stress disorder (PTSD, are associated with TBI and these psychological conditions can directly intensify PTH. Additionally, depression and PTSD alter sleep and this will increase headache severity and foster the genesis of PTH. This article also reviews the anatomic loci of injury associated with TBI and notes the overlap between areas of injury associated with TBI and PTSD.

  10. Chronic neck pain patients with traumatic or non-traumatic onset

    DEFF Research Database (Denmark)

    Ris Hansen, Inge; Juul-Kristensen, Birgit; Boyle, Eleanor


    tests of cervical range of motion, gaze stability, eye movement, cranio-cervical flexion, cervical extensors, and pressure pain threshold. The participants completed the following questionnaires: physical and mental component summary of the Short Form Health Survey, EuroQol-5D, Neck Disability Index....... The purpose of this study was to investigate the clinical presentation of chronic neck pain patients with and without traumatic onset by examining cervical mobility, sensorimotor function, cervical muscle performance and pressure pain threshold in addition to the following self-reported characteristics...... in the traumatic group showed worse results on all measures compared with those in the non-traumatic group, significantly on neck muscle function (cervical extension mobility p = 0.005, cranio-cervical flexion test p = 0.007, cervical extensor test p = 0.006) and cervical pressure pain threshold bilateral (p = 0...

  11. Client-centred therapy, post-traumatic stress disorder and post-traumatic growth: theoretical perspectives and practical implications. (United States)

    Joseph, Stephen


    In practice it is not unusual for client-centred therapists to work with people who have experienced traumatic events. However, client-centred therapy is not usually considered within texts on traumatic stress and questions have been raised over the appropriateness of client-centred therapy with trauma survivors. The present study shows how, although he was writing well before the introduction of the term 'post-traumatic stress disorder', Carl Rogers provided a theory of therapy and personality that contains an account of threat-related psychological processes largely consistent with contemporary trauma theory. Rogers' theory provides the conceptual underpinnings to the client-centred and experiential ways of working with traumatized people. Furthermore, Rogers' theory provides an understanding of post-traumatic growth processes, and encourages therapists to adopt a more positive psychological perspective to their understanding of how people adjust to traumatic events.

  12. Polymerization of a divalent/tetravalent metal-storing atom-mimicking dendrimer. (United States)

    Albrecht, Ken; Hirabayashi, Yuki; Otake, Masaya; Mendori, Shin; Tobari, Yuta; Azuma, Yasuo; Majima, Yutaka; Yamamoto, Kimihisa


    The phenylazomethine dendrimer (DPA) has a layer-by-layer electron density gradient that is an analog of the Bohr atom (atom mimicry). In combination with electron pair mimicry, the polymerization of this atom-mimicking dendrimer was achieved. The valency of the mimicked atom was controlled by changing the chemical structure of the dendrimer. By mimicking a divalent atom, a one-dimensional (1D) polymer was obtained, and by using a planar tetravalent atom mimic, a 2D polymer was obtained. These poly(dendrimer) polymers could store Lewis acids (SnCl2) in their unoccupied orbitals, thus indicating that these poly(dendrimer) polymers consist of a series of nanocontainers.

  13. Attenuated traumatic axonal injury and improved functional outcome after traumatic brain injury in mice lacking Sarm1. (United States)

    Henninger, Nils; Bouley, James; Sikoglu, Elif M; An, Jiyan; Moore, Constance M; King, Jean A; Bowser, Robert; Freeman, Marc R; Brown, Robert H


    Axonal degeneration is a critical, early event in many acute and chronic neurological disorders. It has been consistently observed after traumatic brain injury, but whether axon degeneration is a driver of traumatic brain injury remains unclear. Molecular pathways underlying the pathology of traumatic brain injury have not been defined, and there is no efficacious treatment for traumatic brain injury. Here we show that mice lacking the mouse Toll receptor adaptor Sarm1 (sterile α/Armadillo/Toll-Interleukin receptor homology domain protein) gene, a key mediator of Wallerian degeneration, demonstrate multiple improved traumatic brain injury-associated phenotypes after injury in a closed-head mild traumatic brain injury model. Sarm1(-/-) mice developed fewer β-amyloid precursor protein aggregates in axons of the corpus callosum after traumatic brain injury as compared to Sarm1(+/+) mice. Furthermore, mice lacking Sarm1 had reduced plasma concentrations of the phophorylated axonal neurofilament subunit H, indicating that axonal integrity is maintained after traumatic brain injury. Strikingly, whereas wild-type mice exibited a number of behavioural deficits after traumatic brain injury, we observed a strong, early preservation of neurological function in Sarm1(-/-) animals. Finally, using in vivo proton magnetic resonance spectroscopy we found tissue signatures consistent with substantially preserved neuronal energy metabolism in Sarm1(-/-) mice compared to controls immediately following traumatic brain injury. Our results indicate that the SARM1-mediated prodegenerative pathway promotes pathogenesis in traumatic brain injury and suggest that anti-SARM1 therapeutics are a viable approach for preserving neurological function after traumatic brain injury.

  14. Military-related traumatic brain injury and neurodegeneration. (United States)

    McKee, Ann C; Robinson, Meghan E


    Mild traumatic brain injury (mTBI) includes concussion, subconcussion, and most exposures to explosive blast from improvised explosive devices. mTBI is the most common traumatic brain injury affecting military personnel; however, it is the most difficult to diagnose and the least well understood. It is also recognized that some mTBIs have persistent, and sometimes progressive, long-term debilitating effects. Increasing evidence suggests that a single traumatic brain injury can produce long-term gray and white matter atrophy, precipitate or accelerate age-related neurodegeneration, and increase the risk of developing Alzheimer's disease, Parkinson's disease, and motor neuron disease. In addition, repetitive mTBIs can provoke the development of a tauopathy, chronic traumatic encephalopathy. We found early changes of chronic traumatic encephalopathy in four young veterans of the Iraq and Afghanistan conflict who were exposed to explosive blast and in another young veteran who was repetitively concussed. Four of the five veterans with early-stage chronic traumatic encephalopathy were also diagnosed with posttraumatic stress disorder. Advanced chronic traumatic encephalopathy has been found in veterans who experienced repetitive neurotrauma while in service and in others who were accomplished athletes. Clinically, chronic traumatic encephalopathy is associated with behavioral changes, executive dysfunction, memory loss, and cognitive impairments that begin insidiously and progress slowly over decades. Pathologically, chronic traumatic encephalopathy produces atrophy of the frontal and temporal lobes, thalamus, and hypothalamus; septal abnormalities; and abnormal deposits of hyperphosphorylated tau as neurofibrillary tangles and disordered neurites throughout the brain. The incidence and prevalence of chronic traumatic encephalopathy and the genetic risk factors critical to its development are currently unknown. Chronic traumatic encephalopathy has clinical and

  15. Application of patent ductus arteriosus occluder in transcatheter occlusion of coronary artery fistula%动脉导管未闭封堵器在冠状动脉瘘介入治疗的应用

    Institute of Scientific and Technical Information of China (English)

    肖云彬; 陈智; 黄希勇; 王祥; 杨舟


    Objective To assess the clinical short-term to mid-term efficacy of transcatheter closure of coronary artery fistula by using patent ductus arteriosus occluder in pediatric patients. Methods During the period from Jan. 2008 to May 2013 at authors’ hospital, transcatheter closure of coronary artery fistula using patent ductus arteriosus occluder was performed in 8 pediatric patients. The clinical data, including follow-up information, were retrospectively analyzed. Results A total of 8 pediatric patients with a mean age of (4.1 ± 3.8) years were enrolled in this study. The fistula originated from the right coronary artery in five cases and from the left coronary artery in three cases. The blood flow shunted to the right atrium (n=4) or to the right ventricle (n = 4). Obstruction of the fistula was successfully accomplished in all patients. All patients were followed up for (2.2 ± 1.2) years. No procedure-related complications or cardiac ischemia occurred. Conclusion For the treatment of coronary artery fistula in pediatric patients, the use of domestic patent ductus arteriosus occluder is safe and effective with satisfactory short-term to mid-term clinical efficacy.%目的:评价动脉导管未闭(PDA)封堵器在小儿冠状动脉瘘介入封堵治疗的近中期疗效。方法回顾性分析2008年1月-2013年5月在我院采用PDA封堵器进行冠状动脉瘘介入封堵治疗患儿的临床资料及术后随访资料。结果本组8例患儿,年龄(4.1±3.8)岁,右冠状动脉起源5例,左冠状动脉起源3例,分流入右心房、右心室各4例。所有患儿均成功进行封堵治疗,术后随访(2.2±1.2)年,无介入治疗相关并发症、心肌缺血表现。结论 PDA封堵器应用于冠状动脉瘘介入封堵治疗近中期疗效满意。

  16. The Clinical Application Analysis of Evidence-based Nursing in Congenital Patent Ductus Arteriosus Closure Occlusion%循证护理在先天性动脉导管未闭封堵术中的应用分析

    Institute of Scientific and Technical Information of China (English)



      Objective  Explore evidence-based care in congenital patent ductus arteriosus closure occlusion value. Method Select the hospital in January 2010 to November 2012 were congenital patent ductus arteriosus in patients with 110 cases of the study were randomly divided into control and experimental groups and control group for patients with postoperative conventional care. The experimental group patients using evidence-based care model for care, patients were observed incidence of postoperative complications, patient satisfaction and other indicators. Results The incidence of postoperative complications of the experimental group was significantly lower than the control group; experimental group were satisfied with degrees higher than that in the control group, the difference was statistically different(P<0.05). Conclusion Congenital patent ductus arteriosus closure in patients with evidence-based care model for post-operative care can effectively reduce the incidence of postoperative complications, improve patient satisfaction.%  目的探讨循证护理在先天性动脉导管未闭封堵术中的应用价值.方法选取本院从2010年1月至2012年11月收治的先天性动脉导管未闭患儿55例作为研究对象,将其随机分为对照组和实验组,对照组患儿实施术后传统常规护理,实验组患儿术后介入循证护理模式,观察两组患儿术后并发症发生情况、患者满意度等指标.结果实验组术后并发症发生率(14.3%)显著低于对照组(33.3%),差异有统计学差异(P <0.05);实验组患儿及其家属满意度(96.4%)高于对照组(63%),差异有统计学差异(P <0.05).结论对先天性动脉导管未闭封堵术患儿采用循证护理模式,可有效降低术后并发症发生率,提高患儿及其家属满意度.

  17. Nucleus-staining with biomolecule-mimicking nitrogen-doped carbon dots prepared by a fast neutralization heat strategy. (United States)

    Kang, Yan-Fei; Fang, Yang-Wu; Li, Yu-Hao; Li, Wen; Yin, Xue-Bo


    Biomolecule-mimicking nitrogen-doped carbon dots (N-Cdots) were synthesized from dopamine by a neutralization heat strategy. Fluorescence imaging of various cells validated their nucleus-staining efficiency. The dopamine-mimicking N-Cdots "trick" nuclear membranes to achieve nuclear localization and imaging.

  18. Reprodaetion of an animal model of multiple intestinal injuries mimicking "lethal triad" caused by severe penetrating abdominal trauma

    Directory of Open Access Journals (Sweden)

    Peng-fei WANG


    Full Text Available Objective To reproduce an animal model of multi-intestinal injuries with "lethal triad" characterized by low body temperature,acidosis and coagulopathy.Methods Six female domestic outbred pigs were anesthetized,and the carotid artery and jugular vein were cannulated for monitoring the blood pressure and heart rate and for infusion of fluid.The animals were shot with a gun to create a severe penetrating abdominal trauma.Immediately after the shooting,50% of total blood volume(35ml/kg hemorrhage was drawn from the carotid artery in 20min.After a 40min shock period,4h of pre-hospital phase was mimicked by normal saline(NS resuscitation to maintain systolic blood pressure(SBP > 80mmHg or mean arterial pressure(MAP > 60mmHg.When SBP > 80mmHg or MAP > 60mmHg,no fluid infusion or additional bleeding was given.Hemodynamic parameters were recorded,and pathology of myocardium,lung,small intestine and liver was observed.Results There were multiple intestinal perforations(8-10 site injuries/pig leading to intra-abdominal contamination,mesenteric injury(1-2 site injuries/pig resulted in partial intestinal ischemia and intra-abdominal hemorrhage,and no large colon and mesenteric vascular injury.One pig died before the completion of the model establishment(at the end of pre-hospital resuscitation.The typical symptoms of trauma-induced hemorrhagic shock were observed in survival animals.Low temperature(33.3±0.5℃,acidosis(pH=7.242±0.064,and coagulopathy(protrombin time and activated partial thromboplasting time prolonged were observed after pre-hospital resuscitation.Pathology showed that myocardium,lung,small intestine and liver were severely injured.Conclusions A new model,simulating three stages of "traumatic hemorrhagic shock,pre-hospital recovery and hospital treatment" and inducing the "lethal triad" accompanied with abdominal pollution,has been successfully established.This model has good stability and high reproducibility.The survival animals can be

  19. The relationship between neuroticism, pre-traumatic stress, and post-traumatic stress: A prospective study.

    NARCIS (Netherlands)

    Engelhard, I.M.; van den Hout, M.; Kindt, M.


    The personality trait of Neuroticism has been repeatedly associated with symptoms of post-traumatic stress disorder (PTSD). However, the nature of this relationship is unclear. There are at least two possible interpretations: neuroticism might be a risk factor for PTSD symptoms, or, alternatively, t

  20. Autobiographical Memory for Stressful Events, Traumatic Memory and Post Traumatic Stress Disorder: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Pânila Longhi Lorenzzon


    Full Text Available Stressors and traumatic events may contribute in the development of many psychopathologies, especially Post Traumatic Stress Disorder (PTSD. People with this disorder can present significant memory loss, particularly in Autobiographical Memory (AM. This paper aims to present a systematic review of the literature regarding the changes in the Autobiographical Memory in people exposed to potentially traumatic stressors. Therefore a research in the databases PsycINFO, PubMed, Web of Science and Pilots was performed during March 2012. A total of 29 articles were selected. Results demonstrate that people with PTSD present alterations in a larger number of AM components compared to the cases where PTSD did not develop the disorder. In the same way, subjects who were never exposed to trauma did not demonstrate significant AM alterations when compared to the other groups. The results indicate that the changes in AM are primarily associated with PTSD, yet it was not possible to clarify whether such changes are related to the timely development of the disorder or if they are also observed in traumatic memories even in the absence of the disorder.

  1. Secondary traumatization in pediatric healthcare providers: compassion fatigue, burnout, and secondary traumatic stress. (United States)

    Meadors, Patrick; Lamson, Angela; Swanson, Mel; White, Mark; Sira, Natalia

    The primary aim for this research was to explore the overlap and differences between the concepts related to secondary traumatization: posttraumatic stress disorder (PTSD), secondary traumatic stress (STS), compassion fatigue (CF), and burnout (BRN). A secondary aim for this research was to examine the impact of secondary traumatization and some of the personal and professional elements that affect how pediatric healthcare providers experience PTSD, STS, CF, and BRN. An online survey was sent via e-mail to numerous list serves for healthcare providers who had worked on PICU, NICU, or PEDS units within the last year. The analyses revealed that a significant overlap existed between the terms of STS, PTSD, BRN, CS, and CF for PICU, NICU, and PEDS providers. However, a hierarchical linear regression revealed a significant amount of unique contributions to the variance in CF based on each of the measured concepts. Despite previous literature that indicates that the terms STS and CF can be used interchangeably, the two most prominent measures utilized in the assessment of CF and STS are actually capturing at least some unique elements. Given these results, future researchers should examine and conceptualize the difference in etiology, prevalence, symptoms, and treatment efficacy for CF and STS as separate but related entities and then return their focus to understanding secondary traumatization in healthcare providers.

  2. Assessment of Cerebral Hemodynamics in Traumatic Brain Injury (United States)


    haemorrhage, and 6 with subarach- noid hemorrhage from ruptured aneurysm . There were 4 cases of cerebral contusions and a single case of traumatic...B. Goldstein, 2003: Significance of Intracranial Pressure Pulse Morphology in Pediatric Traumatic Brain Injury. IEEE, 2491-2494. Anile, C., H. D

  3. Traumatic Experience in Infancy: How Responses to Stress Affect Development (United States)

    Witten, Molly Romer


    Responses to traumatic stress during the earliest years of life can change quickly and can be difficult to identify because of the young child's rapid rate of development. The symptoms of traumatic stress will depend on the child's developmental level and individual coping styles, as well as the quality and nature of the child's most important…

  4. Emotional Reasoning in Acutely Traumatized Children and Adolescents

    NARCIS (Netherlands)

    Verduijn, Nina J.C.; Vincken, Manon J.B.; Meesters, Cor M.G.; Engelhard, I.M.


    After a traumatic event, many children and adolescents develop post-traumatic stress disorder. Studies in adults suggest that emotional reasoning (i.e., drawing conclusions about situations on the basis of one’s emotional responses) is involved in PTSD development or maintenance. This longitudinal s

  5. Supporting Children with Traumatic Grief: What Educators Need to Know (United States)

    Cohen, Judith A.; Mannarino, Anthony P.


    Following traumatic deaths children may develop Childhood Traumatic Grief (CTG), a condition in which trauma symptoms interfere with adaptive child grieving. Educators have an important role in supporting children who have CTG. Key contributions that educators can make are to (a) recognize CTG symptoms in school settings; (b) refer children for…

  6. Traumatic aneurysm of superficial temporal artery. CT demonstration

    Energy Technology Data Exchange (ETDEWEB)

    Sharma, A.; Tyagi, G.; Sahai, A.; Baijal, S.S. (G.B. Pant Hospital and M.A. Medical Coll., New Delhi (India). Dept. of Neurosurgery G.B. Pant Hospital and M.A. Medical Coll., New Delhi (India). Dept. of Radiology)


    A case of traumatic pseudo-aneurysm of the superficial temporal artery documented on Computed tomography (CT) and angiography is described in a 55-year-old female, who was treated by surgical excision. Computed tomographic appearance of this lesion is illustrated. This represents, to our knowledge, the first CT demonstration of traumatic aneurysm of superficial temporal artery within a large subgaleal haematoma. (orig.).

  7. Center for the Study of Traumatic Stress. Annual Report 2009 (United States)


    neurobiology of post traumatic stress disorder (PTSD). In addition to characterizing the function of serotonin (5-HT2A) receptors in stress response, the CSTS...Traumatic Stress■■ Corticosterone Administration to Promote Fear Memory Forgetting Process in an ■■ Animal Model of PTSD Neurobiological Evaluation of Novel

  8. Bisphosphonates in the Prevention of Post-Traumatic Osteoarthritis (United States)


    TITLE: Bisphosphonates in the Prevention of Post-Traumatic Osteoarthritis PRINCIPAL INVESTIGATOR: Christopher Price, Ph.D... osteoarthritis CONTRACT NUMBER Ostearthritis 5b. GRANT NUMBER W81XWH-13-1-0147 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Christopher Price...5   1   INTRODUCTION: This grant focuses on the investigation of a pharmacological treatment for “post-traumatic osteoarthritis

  9. Imagery Rescripting of Early Traumatic Memories in Social Phobia (United States)

    Wild, Jennifer; Clark, David M.


    Negative self-images appear to play a role in the maintenance of social phobia and research suggests they are often linked to earlier memories of socially traumatic events. Imagery rescripting is a clinical intervention that aims to update such unpleasant or traumatic memories, and is increasingly being incorporated in cognitive behavioral therapy…

  10. Dental management of traumatic injuries to the primary dentition. (United States)

    Dummett, C O


    There is considerable information on traumatic injury management of permanent teeth. However, there are no conclusive guidelines for treating traumatized primary teeth. This article will summarize a number of issues relative to primary dentition trauma and provide a system for treatment.

  11. Traumatic basilar pseudoaneurysm with a basilar-cavernous arteriovenous fistula

    Energy Technology Data Exchange (ETDEWEB)

    Connor, S.E.J.; Deasy, N.P.; Jeffree, M.A. [Dept. of Neuroradiology, King' s Coll. Hospital, London (United Kingdom); Martin, A.J.; Strong, A.J. [Dept. of Neurosurgery, King' s Coll. Hospital, London (United Kingdom)


    A traumatic pseudoaneurysm of the basilar artery with a basilar-cavernous sinus arteriovenous fistula was diagnosed in a 12-year-old girl using CT, MRI and angiography. It was successfully treated by coil embolisation. We speculate on the mode of formation of this rare traumatic lesion. (orig.)

  12. Resilience and vulnerability among refugee children of traumatized and non-traumatized parents

    Directory of Open Access Journals (Sweden)

    Daud Atia


    Full Text Available Abstract Background The aim of the study was to explore resilience among refugee children whose parents had been traumatized and were suffering from Post-Traumatic Stress Disorder (PTSD. Methods The study comprised 80 refugee children (40 boys and 40 girls, age range 6–17 yrs, divided into two groups. The test group consisted of 40 refugee children whose parents had been tortured in Iraq before coming to Sweden. In accordance with DSM-IV criteria, these children were further divided in two sub-groups, those who were assessed as having PTSD-related symptoms (n = 31 and those who did not have PTSD-related symptoms (n = 9. The comparison group consisted of 40 children from Egypt, Syria and Morocco whose parents had not been tortured. Wechsler Intelligence Scale for Children, 3rd edn. (WISC-III, Diagnostic Interview for Children and Adolescents- Revised (DICA-R, Post-Traumatic Stress Symptoms checklist (PTSS, "I Think I am" (ITIA and Strengths and Difficulties Questionnaire (SDQ were used to assess IQ; PTSD-related symptoms; self-esteem; possible resilience and vulnerability. Results Children without PTSD/PTSS in the traumatized parents group had more favorable values (ITIA and SDQ with respect to total scores, emotionality, relation to family, peer relations and prosocial behavior than the children in the same group with PTSD/PTSS and these values were similar to those the children in the comparison group (the non-traumatized parents group. The children in the non-traumatized parents group scored significantly higher on the IQ test than the children with traumatized parents, both the children with PTSD-related symptoms and those without PTSD-related symptoms. Conclusion Adequate emotional expression, supportive family relations, good peer relations, and prosociality constituted the main indicators of resilience. Further investigation is needed to explore the possible effects of these factors and the effects of IQ. The findings of this study are

  13. Posterior fossa vermian cystic schwannoma mimicking as pilocytic astrocytoma: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Alok Umredkar


    Full Text Available Intraparenchymal schwannomas are rare and most of the reported cases are in supratentorial region with frontal lobe being most common. Infratentorial location is very rare. We report a posterior fossa midline large cystic schwannoma with mural nodule mimicking as pilocytic astrocytoma. The pathogenesis and neuroradiological findings of intraparenchymal schwannomas are discussed with review of the related literature.

  14. Marked left ventricular hypertrophy mimicking hypertrophic cardiomyopathy associated with steroid therapy for congenital adrenal hyperplasia. (United States)

    Scirè, Giuseppe; D'Anella, Giorgio; Cristofori, Laura; Mazzuca, Valentina; Cianfarani, Stefano


    We describe a child treated with high-dose steroid therapy for congenital adrenal hyperplasia who showed marked left ventricular hypertrophy mimicking hypertrophic cardiomyopathy associated with steroid therapy for congenital adrenal hyperplasia. Cardiomyopathy reversed completely when an appropriate steroid therapeutic regimen was established.

  15. Collar Osteophytes Mimicking Osteonecrosis in Planar Bone Scintigraphy and Usefulness of SPECT/CT Images. (United States)

    Juang, Jr-Jian; Chen, Yi-Hsing; Tsai, Shih-Chuan; Lin, Wan-Yu


    The use of prednisolone is one major risk factor for osteonecrosis in patients with systemic lupus erythematosus. Bone scintigraphy can be a diagnostic tool for early diagnosis. We present a case who had collar osteophytes at the bilateral femoral heads, which mimicked osteonecrosis in the planar bone scintigram. An SPECT/CT scan avoided this pitfall and increased the diagnostic accuracy for osteonecrosis.

  16. Rapidly progressive sarcomatoid malignant mesothelioma of the pleura mimicking pulmonary empyema. (United States)

    Fujita, Kohei; Kim, Young Hak; Nakatani, Koichi; Mio, Tadashi


    Refractory empyema occasionally reflects hidden malignant disease. We presented a rare case of rapidly progressive malignant mesothelioma of the pleura (MPM) mimicking empyema. Physicians should be aware of MPM when patients with empyema are refractory to the standard treatment, and PET-CT may be helpful in establishing a precise diagnosis in such cases.

  17. Rapidly progressive sarcomatoid malignant mesothelioma of the pleura mimicking pulmonary empyema


    Fujita, Kohei; KIM, YOUNG HAK; Nakatani, Koichi; Mio, Tadashi


    Key Clinical Message Refractory empyema occasionally reflects hidden malignant disease. We presented a rare case of rapidly progressive malignant mesothelioma of the pleura (MPM) mimicking empyema. Physicians should be aware of MPM when patients with empyema are refractory to the standard treatment, and PET-CT may be helpful in establishing a precise diagnosis in such cases.

  18. Diaphragmatic metastases from colon carcinoma mimicking a hepatic neoplasm: report of a case

    Institute of Scientific and Technical Information of China (English)

    JIN Shu-guang; CHEN Zhe-yu; CHEN Wei-xia; HUANG Wei; YAN Lü-nan; ZENG Yong


    @@ The incidence of primary and metastatic diaphragm tumors is rare.Etiologically speaking, diaphragmatic metastases usually derive from either lymphatic or hematogenous spread.Furthermore, studies show that peritoneal stomata played an important role in this process.We herein cover a metastatic diaphragm tumor mimicking a liver lesion originating from ascending colon carcinoma, an entity that has rarely been reported previously.

  19. Redox enzyme-mimicking activities of CeO2 nanostructures: Intrinsic influence of exposed facets (United States)

    Yang, Yushi; Mao, Zhou; Huang, Wenjie; Liu, Lihua; Li, Junli; Li, Jialiang; Wu, Qingzhi


    CeO2 nanoparticles (NPs) have been well demonstrated as an antioxidant in protecting against oxidative stress-induced cellular damages and a potential therapeutic agent for various diseases thanks to their redox enzyme-mimicking activities. The Ce3+/Ce4+ ratio and oxygen vacancies on the surface have been considered as the major originations responsible for the redox enzyme-mimicking activities of CeO2 NPs. Herein, CeO2 nanostructures (nanocubes and nanorods) exposed different facets were synthesized via a facile hydrothermal method. The characterizations by X-ray photoelectron spectroscopy, Raman spectroscopy, and UV-Vis spectroscopy show that the Ce3+/Ce4+ ratio and oxygen vacancy content on the surfaces of as-synthesized CeO2 nanostructures are nearly at the same levels. Meanwhile, the enzymatic activity measurements indicate that the redox enzyme-mimicking activities of as-synthesized CeO2 nanostructures are greatly dependent on their exposed facets. CeO2 nanocubes with exposed {100} facets exhibit a higher peroxidase but lower superoxide dismutase activity than those of the CeO2 nanorods with exposed {110} facets. Our results provide new insights into the redox enzyme-mimicking activities of CeO2 nanostructures, as well as the design and synthesis of inorganic nanomaterials-based artificial enzymes.

  20. Using Role-Taking and Behavioral Mimicking in Games to Increase Awareness on the Bystander Effect

    DEFF Research Database (Denmark)

    Soegaard Andersen, Josephine; Schoenau-Fog, Henrik


    with behavioral mimicking. The game concept should include a relatable (preferably player modifiable) avatar, so the player can relate and adhere to the empathy and intent to help. Since the bystander effect takes place in groups where deindividuation also is common, this should require a behavioral change...