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Sample records for case series evaluating

  1. Case Series: Evaluation of Behavioral Sleep Intervention for Medicated Children With ADHD.

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    Vetrayan, Jayachandran; Othman, Suhana; Victor Paulraj, Smily Jesu Priya

    2013-03-25

    Objective: To assess the effectiveness and feasibility of behavioral sleep intervention for medicated children with ADHD. Method: Six medicated children (five boys, one girl; aged 6-12 years) with ADHD participated in a 4-week sleep intervention program. The main behavioral strategies used were Faded Bedtime With Response Cost (FBRC) and positive reinforcement. Within a case-series design, objective measure (Sleep Disturbance Scale for Children [SDSC]) and subjective measure (sleep diaries) were used to record changes in children's sleep. Results: For all six children, significant decrease was found in the severity of children's sleep problems (based on SDSC data). Bedtime resistance and mean sleep onset latency were reduced following the 4-week intervention program according to sleep diaries data. Gains were generally maintained at the follow-up. Parents perceived the intervention as being helpful. Conclusion: Based on the initial data, this intervention shows promise as an effective and feasible treatment. (J. of Att. Dis. 2013; XX(X) 1-XX).

  2. An Intercultural Approach to Textbook Evaluation: A Case of Top Notch and Summit Series

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    Maryam Homayounzadeh

    2015-01-01

    Full Text Available This study investigated the representation of sociocultural identities in six textbooks selected from Top Notch and Summit series, to assess their potential to promote intercultural communicative competence in the learners. Ting-Toomey’s identity negotiation theory and Scollon and Scollon’s (2001 discourse system structure were used to assess the identity representations and the structure of discourses in the books. Identity representations were analyzed in terms of the four primary elements of cultural, ethnic, gender and personal identities, to determine the extent to which the books could foster communication between members of various identity groups. In the analysis of discourse structures, the study investigated primarily the politeness and face strategies used in the conversations and further the particular ideology they perpetuated, as a clue to their potential to promote the learners’ pragmatic competence for intercultural communication. Concerning identity representations in the books, different results were found for the two series. Top Notch, addressing beginner to intermediate level students, proved considerate of diversity in the sociocultural identities it presented and providing information about the values of different cultures and the customs and traditions of various nations it tried to set the bases of interculturality within its audience. Summit, on the other hand, addressing higher intermediate and advanced learners, had a unilateral approach in its identity presentations, depicting principally European and American nationalities and the cultural values of individualism typically associated with them. Nevertheless, where the discourse structures in the books were concerned, both the two series were identical in their exclusive focus upon the utilitarian ideology of discourse and its related politeness and face strategies. This was found as a pitfall in the books, limiting the students’ range of discursive resources

  3. Functional evaluation of repairs to circumferential labral lesions of the glenoid - Case series

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    Alexandre Tadeu do Nascimento

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the clinical results among patients undergoing arthroscopic repair of circumferential labral lesions. METHODS: This was a retrospective study on 10 patients who underwent arthroscopic repair to circumferential labral lesions of the shoulder, between September 2012 and September 2015. The patients were evaluated by means of the Carter-Rowe score, DASH score, UCLA score, visual analog scale (VAS for pain and Short-Form 36 (SF36. The average age at surgery was 29.6 years. The mean follow-up was 27.44 months (range: 12-41.3. RESULTS: The mean score was 16 points for DASH; 32 points for UCLA, among which six patients (60% had excellent results, three (30% good and one (10% poor; 1.8 points for VAS, among which nine patients (90% had minor pain and one (10% moderate pain; 79.47 for SF-36; and 92.5 for Carter-Rowe, among which nine patients (90% had excellent results and one (10% good. Joint degeneration was present in one case (10%, of grade 1. We did not observe any significant complications, except for grade 1 glenohumeral arthrosis, which one patient developed after the operation. CONCLUSION: Arthroscopic repair of circumferential labral lesions of the shoulder through use of absorbable anchors is effective, with improvements in all scores applied, and it presents low complication rates. Cases associated with glenohumeral dislocation have lower long-term residual pain.

  4. A Textbook Evaluation of Speech Acts: The Case of English Result Series

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    Minoo Alemi

    2012-11-01

    Full Text Available The present work aimed to investigate the frequency of occurrences and proportions of speech acts of complaints and compliments in the four volumes of the course book English Result (Elementary, Pre-intermediate, Intermediate, and Upper-intermediate, by Mark Hancock and Annie McDonald (2009, published by Oxford University Press. Investigation of the two speech act strategies was based on complaints strategies (Olshtain and Weinbach, 1987 and compliment strategies (Wolfson and Manes, 1981. It was found that the books were rich in terms of the number of the two speech acts, but in presenting them, there were one or two dominant strategies in both cases. Chi-square analysis demonstrated that there was a significant difference in the proportion of complaint and compliment strategies through the four course books. In general, the books were reported to provide learners with adequate amount of complaints and compliments, but with low variations in strategy types, which may result in learners not having sufficient conceptual and practical knowledge of speech acts to use them appropriately in different contexts. Based on the findings of this study, it seems necessary to incorporate more authentic and helpful instruction of speech acts along with the course books, to improve the learners’ performance in real life communication.Keywords: Course book evaluation, Speech acts, speech acts strategies, Complaints, Compliments

  5. Tinea incognito: Case series

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    Mikail Yılmaz

    2015-09-01

    Full Text Available Tinea incognito is a dermatophytic infection which has lost its typical clinical appearance because of inappropriate use of topical or systemic corticosteroids. The clinical manifestations of tinea incognito can mimic many dermatoses such as eczema, psoriasis, allergic contact dermatitis, rosacea, seborrheic dermatitis and atopic dermatitis. The diagnosis of tinea incognito is confirmed by direct KOH (potassium hydroxide examination ( native preparation, making the fungal cultures from the lesion and histopathological examination in some cases. Systemic antifungal therapy is recommended in the treatment of tinea incognito. Herein, 10 cases of tinea incognito which mimicking various dermatoses were diagnosed and treated in our clinic in 2014 is presented.

  6. Evaluation of series of 177 cases of acute gynaecological emergencies in tertiary care hospital

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    Vrunda Choudhary

    2016-06-01

    Conclusions: Accurate clinical and laboratory evaluation are essential in gynecological emergencies. There should be a high index of suspicion for early detection and early intervention to reduce morbidity and mortality. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1700-1704

  7. Treatment of severe frontobasilar fractures in growing patients: a case series evaluation

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    Alan S Herford; Rahul Tandon; Luca Pivetti; Marco Cicciù

    2013-01-01

    Objective:The treatment offrontobasilar fractures is a demanding aspect of craniofacial fracture management.A sequel of inadequate or improper fracture management presents cosmetic and functional problems which are very difficult to correct.The aim of this manuscript was to examine a group of growing patients treated for frontobasilar fractures and provide clinicians a possible therapeutic option for the treatment of these challenging fractures.Methods:In this investigation,12 patients under the age of 16 years treated for severe injuries to the frontobasilar region were included.Their records were reviewed to evaluate the clinical diagnosis,preoperative findings,hospital course,postoperative results,and long-term follow-up.Preoperative and postoperative CT scans were performed in all children treated.Postoperative complications were reviewed in detail.Surgical procedures were evaluated for type and location of fixation.All complications and treatments were recorded.Results:Three of the patients presented with a cerebrospinal fluid (CSF) leak and required pericranial flaps.Only 3 patients underwent removal of plates and screws due to palpability in 1 patient,loose hardware in 1 patient,and limited disturbance on growth in the rest patient.Seven patients underwent open reduction and internal fixation with resorbable plates,4 patients with titanium plates,and 1 parent with a combination.Follow-up ranged from 6 months to 5 years.No patients with a preoperative CSF leak developed any recurrence of the leak.Conclusion:According to basic craniofacial principles,reducing and stabilizing the fractures should reconstruct the anterior cranial base.However,the treatment of paediatric maxillofacial trauma requires the evaluation of several factors.The facial skeleton of a child is constantly evolving and its growth depends on the balance of basal bone and soft tissues.

  8. Evaluation of Teriparatide for Treatment of Osteoporosis in Four Patients with Cystic Fibrosis: A Case Series

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    Oranan Siwamogsatham

    2014-01-01

    Full Text Available Introduction. Bone disease is a common complication of cystic fibrosis (CF. To date, there have been no reports on the effectiveness of teriparatide, recombinant human parathyroid hormone, to treat CF-related bone disease. Case Presentation. We report on four patients with CF-related bone disease who were treated with teriparatide. Three patients completed two years of therapy with teriparatide, and all had significant improvements in their bone mineral density (BMD. One patient was unable to tolerate teriparatide and discontinued treatment 1 week into therapy. Conclusion. Teriparatide may be a potential treatment option for CF-related bone disease. This report highlights the need for further investigation into the use of teripartide in the CF population.

  9. A prospective case series evaluating the safety and efficacy of the Klox BioPhotonic System in venous leg ulcers

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    Nikolis A

    2016-09-01

    Full Text Available Andreas Nikolis,1 Doria Grimard,2 Yves Pesant,3 Giovanni Scapagnini,4 Denis Vézina5 1Division of Plastic Surgery, Victoria Park Research Centre, Montreal, 2Q&T Research Chicoutimi, Chicoutimi, 3St-Jerome Medical Research Inc., St-Jerome, Quebec, Canada; 4Department of Medicine and Health Sciences, School of Medicine, University of Molise, Campobasso, Italy; 5Klox Technologies, Laval, Quebec, Canada Purpose: To investigate the safety and efficacy of the BioPhotonic System developed by Klox Technologies in a case series of ten patients with venous leg ulcers.Patients and methods: Ten patients with chronic venous leg ulcers, having failed on at least one previous therapy, were enrolled into this case series.Results: Nine patients were evaluable for efficacy. A response (defined as decrease in wound surface area was observed in seven patients (77.8%. Of these, four patients (44.4% achieved wound closure on average 4 months (127.5 days following the beginning of the treatment. Two patients did not respond to the investigational treatment. Quality of life improved over time throughout the study. Compliance was excellent, with 93.2% of visits completed as per protocol. Safety was unremarkable, with only four treatment-emergent-related adverse events, for which no specific intervention was required.Conclusion: The BioPhotonic System was shown to be safe and extremely well tolerated. It also demonstrated potential in terms of wound closure, wound surface area decrease, and wound bed preparation. Keywords: biophotonics, light, photobiomodulation, venous leg ulcers

  10. An Evaluation of the Mulligan Stew 4-H Television Series for Extension Service, USDA. Volume III: Case Studies.

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    Abt Associates, Inc., Cambridge, MA.

    Conducted on over 3,000 fourth, fifth, and sixth grade children in six states, this study documents changes in nutrition-related knowledge and behaviors which can be related to participating in the Mulligan Stew television series. The case studies which comprise this volume function as a brief organizational analysis of the Mulligan Stew effort at…

  11. Osseous genioplasty: A case series

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    Sanjeev N Deshpande

    2011-01-01

    Full Text Available Introduction: The chin (mentum is vital to the human facial morphology as it contributes to the facial aesthetics and harmony both on frontal and lateral views. Osseous genioplasty, the alteration of the chin through skeletal modification, can lead to significant enhancement of the overall facial profile. Aim and Study Design: A case series was designed to study the long-term results of osseous genioplasty in Indian patients with regard to patient satisfaction, complications, and long-term stability. Materials and Methods: All subjects who underwent osseous genioplasty either alone or as a component of orthognathic surgery between January 1992 and December 2010, with a minimum follow-up of 2 years, were included. The genioplasty was performed using standard protocols of assessment and execution. Post-operative evaluation included patient satisfaction, complications and radiological evidence of long-term stability. A comprehensive score was formulated for the purpose of the study. Results: Thirty-seven subjects underwent osseous genioplasty with at least 2 years of follow-up in the study period. This included 17 male and 20 female subjects, with a mean age of 22.8 years (15-52 years and a mean follow-up of 3 years 4 months (2 years to 4 years and 11 months. Nineteen subjects underwent isolated genioplasty while 18 underwent genioplasty as a part of orthognathic surgery. The procedures included advancement (22, pushback (9, side-to-side (4 and vertical reduction (2 genioplasty.Thirty-six subjects (97.3% were extremely pleased with the results with only one subject expressing reservations, without, however, demanding any further procedure. There were no significant complications. The osteotomised segment was well maintained in its new position with good bony union and minimal resorption. Overall, 35 (94.6% cases had excellent results and 2 (4.4% cases had good results, according to the comprehensive score. Conclusions: Osseous genioplasty is a safe

  12. Familial Chiari malformation: case series.

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    Schanker, Benjamin D; Walcott, Brian P; Nahed, Brian V; Kahle, Kristopher T; Li, Yan Michael; Coumans, Jean-Valery C E

    2011-09-01

    Chiari malformations (Types I-IV) are abnormalities of the posterior fossa that affect the cerebellum, brainstem, and the spinal cord with prevalence rates of 0.1%-0.5%. Case reports of familial aggregation of Chiari malformation, twin studies, cosegregation of Chiari malformation with known genetic conditions, and recent gene and genome-wide association studies provide strong evidence of the genetic underpinnings of familial Chiari malformation. The authors report on a series of 3 family pairs with Chiari malformation Type I: 2 mother-daughter pairs and 1 father-daughter pair. The specific genetic causes of familial Chiari malformation have yet to be fully elucidated. The authors review the literature and discuss several candidate genes. Recent advances in the understanding of the genetic influences and pathogenesis of familial Chiari malformation are expected to improve management of affected patients and monitoring of at-risk family members.

  13. Delusional Parasitosis : Series Of 25 Cases

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    Bhatia M S

    1996-01-01

    Full Text Available A series 25 cases of delusional parasitosis is being reported. There were three cases below 45 years, 12 cases between 46-45 years and 11 cases above 55 years of age, 64% cases were females. A majority of cases (92% had insidious onset. The duration of symptoms in all the cases (except one was 6 months or more. 13 cases presented with infestation with insects over body and 10 cases with insects crawling over scalp. There were three cases each with diabetes mellitus and leprosy. Three cased had dementia, 2 cases had depression and one case presented with trichotillomania. Pimozide was used in22 cases, amitriptyline in 2 cases and fluoxetine in one. 14 cases (52% showed complete remission while receiving drug, 8 cases showed partial improvement and 3 cases did not respond.

  14. Acute genital ulcers in nonsexually active young girls: case series, review of the literature, and evaluation and management recommendations.

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    Rosman, Ilana S; Berk, David R; Bayliss, Susan J; White, Andrew J; Merritt, Diane F

    2012-01-01

    Acute genital ulcers rarely occur in nonsexually active young girls. When present, they can cause significant physical and emotional distress for the patient and her parents, and prompt an evaluation for sexual abuse and sexually transmitted diseases. With this review, we aim to further characterize acute genital ulcers in nonsexually active young girls by reviewing the medical records of patients with this disorder and to offer an approach to the diagnosis, evaluation, and treatment of acute genital ulcers based on our understanding and knowledge of this condition. We retrospectively review our understanding and knowledge of acute genital ulcers in nonsexually active girls at a pediatric hospital. A review of the recent literature on acute genital ulcers and a multidisciplinary approach to the diagnosis, evaluation, and treatment of acute genital ulcers are also presented. Twelve patients presented with acute genital ulcers, 11 of which were hospitalized for evaluation and pain management. Extensive work-up failed to reveal a specific infectious or autoimmune etiology in all but one patient, who was diagnosed with acute mycoplasma pneumonia. Acute genital ulcers in nonsexually active young girls likely represent a form of idiopathic vulvar aphthosis. Evaluation of a first episode of acute genital ulcers with mild prodromal symptoms should be limited. Treatment consists primarily of supportive care and symptom relief.

  15. MUCORMYCOSIS – A CASE SERIES.

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    Shankaranarayanan Gopalakrishnan

    2012-04-01

    Full Text Available Mucormycosis is a rare opportunistic fungal infection with a rapidly progressive and fulminantcourse with often fatal outcome. A less fulminant variety of this is the Rhino maxillary subtypewhich usually presents with palatal ulceration, facial swelling, turbinate necrosis and purulentsinusitis. We are reporting our experience of 4 such cases seen during the last 10 yrs. A strongsuspicion, prompt diagnosis with pathological confirmation and aggressive surgical treatmentgives a better outcome.

  16. Evaluating the levels of salivary alkaline and acid phosphatase activities as biochemical markers for periodontal disease: A case series

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    Sarita Dabra

    2012-01-01

    Full Text Available Background: The purpose of this study was to determine the salivary levels of alkaline phosphatase (ALP and acid phosphatase (ACP activities in patients with periodontal disease and to evaluate the use of these enzymes as biochemical markers for periodontal tissue damage. Materials and Methods: In this prospective analytical study, we examined the activities of salivary ALP and ACP in patients with periodontal disease, before and after periodontal treatment. The experimental groups consisted of 20 gingivitis patients and 20 periodontitis patients and the control group had healthy subjects (20 samples. The stimulated saliva of the patient was collected in a sterile test tube and analyzed using Hitachi′s Diagnostic Automatic Analyser. Periodontal disease was determined based on clinical parameters such as gingival index, probing depth and clinical attachment loss. Patients with periodontal disease were under conventional periodontal treatment. The statistical analysis applied was Student′s t-test. Probabilities less than 0.05 (P < 0.05 were considered significant. Results: The obtained results showed statistically significant increased activities of ALP and ACP in saliva from patients with periodontal disease in relation to control group. A significant reduction in the enzyme levels was seen after conventional periodontal therapy. Conclusions: Based on these results, salivary ALP and ACP can be considered to be the biomarkers for evaluating periodontal tissue damage.

  17. A Case-Series Evaluation of a Brief, Psycho-Social Approach Intended for the Prevention of Relapse in Psychosis

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    Petrina Brett

    2014-11-01

    Full Text Available There is a wealth of research into relapse prevention in psychosis; however, specific research into the effectiveness of short-term, self-management strategies aimed to prevent relapse is lacking. This pilot study aimed to evaluate the effects of Sorensen’s ‘Relapse Prevention in Schizophrenia and Other Psychoses’ manual-based therapy (Sorensen, 2006b with 11 participants in one UK National Health Service Trust. The intervention was delivered over four sessions and interviews were conducted pre and post intervention. The effect of the intervention on measures of hopelessness, perceived control over internal states, and satisfaction were recorded using validated questionnaires at one week, one month and two months follow-up, supported by measures taken from visual analogue scales. Data analysis revealed significant improvements on hopelessness, perceived control over internal states, and satisfaction at one week follow-up, although these results were not maintained at one and two months follow-up. Additionally, the attrition rate meant that results lacked statistical power at one and two months follow-up. The study also considered the clinical significance of the research findings with the Jacobson-Truax (Jacobson & Truax, 1991 method for measuring reliable change. A substantial number of clients attained clinically significant changes with regards to hopelessness and perceived control over internal states. Future research is required in order to evaluate the use of self-management strategies to prevent relapse. It would be valuable to repeat the current study with the additional use of booster sessions in order to assess whether the positive impacts on hopelessness and perceived control over illness can be maintained at the longer term follow up.

  18. Peripartum cardiomyopathy – case series

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    Prasad, Gowri Sayi; Bhupali, Ashok; Prasad, Sayi; Patil, Ajit N.; Deka, Yashodhan

    2014-01-01

    Objectives To study the pattern of presentation, course of disease and outcome of pregnancy in Peripartum Cardiomyopathy. Methods A prospective study of sixteen cases of PPCM was conducted at Apple Saraswati Multispecialty Hospital and Dr. D.Y. Patil Medical College and Hospital, Kolhapur, Maharashtra, India from January 2006 to December 2012. Data included age distribution, parity, gestational age, symptoms and risk factors. Medical management and pregnancy outcome were documented. Serial echocardiography data was compiled for a period of one year. Results In our study 9/16 (56%) were primigravidae, 4/16 (25%) had pre-eclamsia and 6/16 (35%) had co-existing hypertension. The difference in Echocardiography parameters observed between recovered and non-recovered patients was significant: Left Ventricular End diastolic dimension (5.6 cm vs 6.06 cm), Left Ventricular Ejection Fraction (28.7% vs 22.4%) and Left Ventricular fractional shortening (17.5% vs 13.4%). Thirteen out of sixteen patients were followed up for a period of one year out of which 61% (8/13) patients recovered completely. There was one mortality. Conclusion PPCM is a diagnosis of exclusion. Majority were young primigravidae presenting postnatally. Pre-eclampsia and hypertension were risk factors. ECHO parameters were reliable predictors of recovery. Future pregnancies are better avoided. PMID:24814122

  19. The methodology of self-controlled case series studies.

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    Whitaker, Heather J; Hocine, Mounia N; Farrington, C Paddy

    2009-02-01

    The self-controlled case series method is increasingly being used in pharmacoepidemiology, particularly in vaccine safety studies. This method is typically used to evaluate the association between a transient exposure and an acute event, using only cases. We present both parametric and semiparametric models using a motivating example on MMR vaccine and bleeding disorders. We briefly describe approaches for interferent events and a sequential version of the method for prospective surveillance of drug safety. The efficiency of the self-controlled case series method is compared to the that of cohort and case control studies. Some further extensions, to long or indefinite exposures and to bivariate counts, are described.

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

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

    2011-10-01

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

  1. Evaluation of the "Feeling Good" Television Series.

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    Mielke, Keith W.; Swinehart, James W.

    This report provides an overview of the development and evaluation of an experimental television series for adult viewers on health care. The series was produced by the Children's Television Workshop and aired in prime time during 1974-1975 by the Public Broadcasting Service. The report synthesizes results of complementary impact studies conducted…

  2. Unusual Cases of Epidermoid cyst: Case Series

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    Lalita Yadav

    2013-09-01

    Full Text Available In the oro-facial region cystic lesions of different etiologies are encountered owing to the presence of the teeth in the jaw bones. A bewildering variety of developmental, odontogenic and non-odontogenic cysts are seen. Epidermoid cyst is a rare developmental cyst of the oro-facial region which results from entrapped epidermal elements without adnexal appendages. Dermoid and epidermoid cysts occur in oro-facial region with an incidence of 6.9-7% and represents less than 0.01% of all oral cavity cysts. Here we report two cases of epidermoid cysts occurring at unusual locations involving upper left maxillary region lateral to the nose and pinna of the ear.

  3. Transvestism as a symptom: A case series

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    M Anupama

    2016-01-01

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

  4. Dance-related concussion: a case series.

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

    2014-01-01

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

  5. Evaluación de 30 coronas individuales realizadas en un servicio odontológico universitario. Serie de casos / Evaluation of 30 Individual Crowns made at a University Dental Service. Case Series

    OpenAIRE

    2015-01-01

    Antecedentes: existen factores de riesgo y condiciones clínicas que hacen que fracasen prótesis dentales, como las coronas individuales. Ello hace imperativo monitorear y controlar permanentemente las fases de tratamiento y seguimiento en clínicas de formación de odontólogos. Objetivo: evaluar parámetros biológicos y funcionales de coronas individuales cementadas en un servicio de formación en pregrado de odontología. Métodos: este estudio descriptivo, serie de casos, evaluó 30 coronas metalc...

  6. Pulmonary Artery Agenesis: A Case Series

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    Meltem Ağca

    2015-04-01

    Full Text Available Pulmonary artery agenesis is a rare congenital abnormality in which atresia was encountered in the short segment of the right or left pulmonary arteries. It can be isolated or associated with cardiac abnormalities such as tetralogy of Fallot, septal defects or pulmonary stenosis.The majority of cases are diagnosed in childhood whereas some cases yield no symptoms until adulthood. We evaluated retrospectively 5 pulmonary artery agenesis cases diagnosed in our clinics between 1998-2010 with respect to the literature.

  7. The Power of Color: A Case Series

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    Christina Esposito, OD

    2014-12-01

    Full Text Available Background: The use of colored light, filters, and therapeutic tinting dates back to the early years of optometry. It has been used by optometrists and other professionals throughout history for a variety of different reasons, including photophobia, near point stress, migraines, and dyslexia. Case Series: A series of cases are presented where color is used to help patients resolve their visual disturbances. The patients who were identified are those suffering from photophobia, reading difficulties, and visual changes related to a vestibular condition. The colors are chosen using the Intuitive Colorimeter. This instrument is used to investigate the possible preferences for a specific color to reduce the patient’s symptomatology. This is done logically and sequentially to explore color space in order to find the optimal precision tint for the relief of perceptual distortions. Discussion: Tinting contact lenses and/or glasses for therapeutic reasons can be time consuming but can be a rewarding experience for both the clinician and the patient.

  8. Pneumothorax, music and balloons: A case series

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    Shiferaw Dejene

    2013-01-01

    Full Text Available We describe two cases of spontaneous pneumothorax in young healthy adults with no underlying structural lung disease. The onset of pneumothorax was following physical activity including playing musical instruments and blowing of balloons. There is sparse data evaluating the pathophysiology of primary spontaneous pneumothorax in relation to increased mouth pressures. These cases highlight the possible physical effect of valsalva manoeuvre on transpulmonary pressures, and the potential risk of developing pneumothorax in otherwise healthy individuals. This aspect of pneumothorax development is worthy of further exploration, to better elucidate the mechanism and enhance our understanding of this common respiratory presentation.

  9. Rehabilitation of the Upper Extremity after Stroke: A Case Series Evaluating REO Therapy and an Auditory Sensor Feedback for Trunk Control

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    G. Thielman

    2012-01-01

    Full Text Available Background and Purpose. Training in the virtual environment in post stroke rehab is being established as a new approach for neurorehabilitation, specifically, ReoTherapy (REO a robot-assisted virtual training device. Trunk stabilization strapping has been part of the concept with this device, and literature is lacking to support this for long-term functional changes with individuals after stroke. The purpose of this case series was to measure the feasibility of auditory trunk sensor feedback during REO therapy, in moderate to severely impaired individuals after stroke. Case Description. Using an open label crossover comparison design, 3 chronic stroke subjects were trained for 12 sessions over six weeks on either the REO or the control condition of task related training (TRT; after a washout period of 4 weeks; the alternative therapy was given. Outcomes. With both interventions, clinically relevant improvements were found for measures of body function and structure, as well as for activity, for two participants. Providing auditory feedback during REO training for trunk control was found to be feasible. Discussion. The degree of changes evident varied per protocol and may be due to the appropriateness of the technique chosen, as well as based on patients impaired arm motor control.

  10. Surgical Management of Acetabular Fractures: A Case Series

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    Hassan Rahimi

    2013-01-01

    Full Text Available Introduction: For decades, acetabular fractures were treated conservatively. Judet et al. in 1960s established the operative treatment of these fractures by continuous improvement of pre-operative evaluation and classification of fractures. Several studies demonstrated that accurate fracture reduction decreases the incidence of post-traumatic arthritis and improves functional outcome.Case Series: We report 67 consecutive patients who underwent surgical treatment for acetabular fracture; 44 patients were available for follow-up. In 35 (79.5% cases, congruent reductions were achieved. The final mean Harris hip score was 81.8 (53-95. Functional outcomes according to Harris score were excellent and good in 31 patients (70.5%.Conclusions: The results of internal fixation of displaced acetabular fractures in our series were satisfactory.

  11. Acute eclipse retinopathy: a small case series.

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

    2014-01-01

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

  12. Kartagener′s syndrome: A case series

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    Mayank Mishra

    2012-01-01

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

  13. Treatment of gingival pigmentation: a case series.

    Science.gov (United States)

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

    2005-01-01

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

  14. Facial Firework Injury: A Case Series

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    Kashyap Tadisina

    2014-07-01

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

  15. Treatment of gingival pigmentation : A case series

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    Prasad Deepak

    2005-01-01

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

  16. Intramuscular Olanzapine – a UK case series of early cases

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    Taylor Mark

    2007-04-01

    Full Text Available Abstract Background Clinical trials assessing efficacy and safety of Intramuscular (IM Olanzapine in acute schizophrenia and acute mania have previously been undertaken in studies required for drug registration in patients who were required to give informed consent. These patients may have less severe forms of psychosis than patients treated in routine practice. Data derived from naturalistic practice following the launch of IM olanzapine may be helpful for clinicians in assessing efficacy and safety of IM olanzapine. The PANSS-EC scale used in the clinical studies may represent a tool that could be used in routine clinical practice. Case presentation We report on an early unselected case series of 7 patients who received IM olanzapine in routine clinical practice settings in the UK. In this case series, olanzapine IM was generally effective, and no adverse events were reported. Adjunctive benzodiazepines were given concomitantly in 1 of the 7 subjects. This is relevant as concomitant benzodiazepines are not recommended for a minimum of 1 hour post IM olanzapine administration. PANSS-EC data was collected in 2 of the 7 subjects. Conclusion Although patients had greater severity of psychosis than clinical trial patients there were no unexpected findings. In addition the PANSS-EC scale is a scale that may be useful in assessing the efficacy of IM antipsychotics in routine clinical practice.

  17. Case Teaching and Evaluation

    Science.gov (United States)

    Patton, Michael Quinn; Patrizi, Patricia

    2005-01-01

    Experience and reflection on experience are the best teachers, yet rich cases that capture experience for reflection have largely eluded professional training in evaluation. The absence of high-quality, readily available teaching cases has been an important gap in the field. This article reviews the benefits of case teaching, examines evaluation…

  18. Doxycyclin induced esophageal injury: A Case series

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    İsmail Demiryılmaz

    2013-01-01

    Full Text Available Some drugs have been known to damage to esophagusfor a long time. Half of the cases reported are of tetracyclineand its derivatives. The damage caused by thesedrugs is depends on the drug itself and the patient.In this paper we present 5 patients having diagnosedesophageal damage endoscopically after due to doxycyclinuse. The mean age of the patients was 26 years.Three of them for acne and 2 for heir complaints gynecologicalinfection were taking these drugs. Lesions werelocated at the middle in 4 cases and lover part in 1 patient.The common complaint was retrosternal pain and heartburnafter taking the drug with insufficient water or withoutwater. All the patients were relieved by symtomatic teratment.Esophageal damage is to be remembered in patientscomplaning sudden pain and difficult swallowing on doxycyclintreatment and endoscopic procedure should beemployed for definition of diagnosis and evaluation of theseverity of the damage. After treatment, endoscopic controlis not necessary. Physicians must not forget to advicethe patients to take these drugs with splendid amount ofwater.Key words: Doxycycline, esophagus damage, endoscopy

  19. Evaluation of Causes,Frequency and Prognosis of Hydrops Fetalis: A Case- Series Study at a Referral Hospital in Tehran, Iran

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    Elahe Amini

    2015-01-01

    Full Text Available Introduction Hydrops Fetalis is a serious condition in fetal period, characterized by the presence of serous fluid accumulation in at least two potential spaces in fetus including pleural effusion, pericardial effusion, and ascites. The incidence of hydrops fetalis is one per 2500-3000 pregnancies. This condition is followed by different diseases. Fetal hemolytic anemia and its hypoxemia due to hydrops fetalis are potentially life or function threatening. Mortality rate is 50-90%; this poor prognosis is improving with advances in prenatal and medical treatment.                   Methods and Materials This study performed on patients’ records with hydrops fetalis diagnosis in one of the neonatal referral and academic center, Vali-e-Asr Hospital Tehran, the capital of Iran from 2003 to 2010. Etiology, prognosis, and frequency of Hydrops fetalis in newborns were evaluated. Results Out of 10878 cases, 0.35% was born with hydrops fetalis:18.42% immune [Rh incompatibility  (%85.71, Kell antigen system(%14.29 ] and 81.58% non-immune. Conclusion The rate of hydrops due to Rh incompatibility is significant in our center (85.71%, however, it is unusual in most of medical centers all over the world.

  20. Clinical Approach in Orbital Cellulitis Cases: Case Series

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    Altan Atakan Özcan

    2012-07-01

    Full Text Available Pur po se: To evaluate the etiological factors, diagnosis, follow-up and treatment procedures in cases of orbital cellulitis. Ma te ri al and Met hod: A retrospective review was performed on medical records of patients with orbital cellulitis treated between 2009 and 2011 in our clinic. The patients were studied for age, ophthalmologic examination features, laboratory and radiology results, treatment modalities and the response to these treatments. Re sults: Eleven patients (7 male, 4 female having an average age of 9.7 years (6 months-25 years participated in the study. All patients had eyelid oedema, hyperemia and ocular pain; with chemosis in 3, gaze restriction in 6, relative afferent pupillary defect and proptosis in 4 cases. Orbital cellulitis was observed to occur secondary to paranasal sinusitis in 10 patients (90.9% and 1 patient had only history of superior respiratory tract infection. Sinus infection was localized in ethmoid and maxillary sinuses in all except one case. Laboratory tests showed leukocytosis in 8 patients. Surgical drainage was performed in 7 of 8 patients with abscess formation observed with radiological imaging. The remainder of the patients were followed with sole medical treatment. All patients recovered without any vision loss or life-threatening complication. Dis cus si on: Orbital cellulitis cases must be followed with radiologic imaging for any complication that may occur and patients with abscess should be evaluated for surgical drainage besides antimicrobial treatment.(Turk J Ophthalmol 2012; 42: 284-7

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

    Science.gov (United States)

    Rapp, Brenda

    2011-10-01

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

  2. Surgical management of palatine Torus - case series

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    Thaís Sumie Nozu Imada

    Full Text Available INTRODUCTION: Torus palatinus is a specific name to identify exostoses developed in the hard palate along the median palatine suture. Despite of not being a pathological condition, its presence requires attention and knowledge regarding its management. Surgical removal of exostoses is indicated when the patient frequently traumatizes the area of palatine torus during mastication and speech or when it is necessary for the rehabilitation of the upper arcade with complete dentures. OBJECTIVE: The aim of this article is to present three cases of Torus palatinus and to discuss the management of them. CASE REPORT: In the first case, a 57-year-old Caucasian man sought oral rehabilitation of his edentulous maxilla but presented a hard nodules in the hard palate; in the second case, a 40-year-old Caucasian woman was referred for frequent trauma of palatal mucosa during mastication, aesthetic complaint, and discomfort caused by the trauma of her tongue in this area; and in the third case, a 45-year-old Caucasian woman presented with a lesion on the palate that caused difficulty swallowing. When the Torus palatinus was impairing the basic physiological functions of the patients, all cases were surgically treated, improving the patients' quality of life. FINAL CONSIDERATION: The dentist should be properly prepared to choose the best from among the existing surgical approaches for each individual lesion in order to improve the results and avoid possible complications.

  3. Rhinocerebral mucormycosis: A series of 3 cases

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    Vinay Vaidyanathan

    2012-01-01

    Full Text Available Three cases of rhinocerebral mucormycosis (RCM with different courses of illness following a common standardized treatment protocol are discussed. Seen predominantly in diabetics. Clinical picture is often blurred by overlapping features of chronic rhinosinusitis. CT picture is helpful in assessing extent. Histopathological evidence is diagnostic. We describe three cases of RCM with different presentations but followed same treatment protocol. RCM is not just a disease of chronic uncontrolled diabetics. Its indolent clinical course doesn′t correlate with its aggressive pathology for which strict treatment protocol to be followed. In suspected cases of RCM, improvement of predisposing diseases, radical surgical debridement and effective systemic antifungal therapy must be instituted immediately. Absence of intracranial or orbital extension are indicators of good prognosis. Ketoacidosis is the single most important detrimental factor.

  4. Adenoid Hypertrophy in Adults: A case Series.

    Science.gov (United States)

    Rout, Manas Ranjan; Mohanty, Diganta; Vijaylaxmi, Y; Bobba, Kamlesh; Metta, Chakradhar

    2013-07-01

    Adenoid hypertrophy is common in children. Size of the adenoid increases up to the age of 6 years, then slowly atrophies and completely disappears at the age of 16 years. Adenoid hypertrophy in adults is rare. Present study shows that adenoid hypertrophy is now increasing in adults because of various causes. Study has been conducted in the Department of ENT and Head & Neck Surgery, Alluri Sitarama Raju Academy of Medical science, Eluru, Andhra Pradesh, India. Study shows that incidence of adenoid hypertrophy is increasing as the cause of nasal obstruction in adults. This study identified the different causes of adenoid hypertrophy in adult patients. The common causes of adenoid hypertrophy in adults are chronic infection and allergy. Pollution and smoking are also important predisposing factors. Sometimes it is also associated with sinonasal malignancy, lymphoma and HIV infection. Study shows that 21 % of adult nasal obstruction is due to adenoid hypertrophy. But in case of the patient with chronic tonsillitis only 9 % were associated with adenoid hypertrophy. Males are more commonly involved (70 %) then female, may be because of out door activities and more commonly exposed to pollutants. And most commonly involved age group is 16-25 years (60 %). Majority of the cases with adenoid hypertrophy are associated with infection and allergy i.e. descending infection in 33.3 % cases, ascending infection in 20 % cases and allergic rhinitis in 30 % cases. Association of malignant sinonasal tumors, non Hodgkin's lymphoma and HIV infections are rare i.e. 3.3 % each. So any cases of adult adenoid hypertrophy should be treated seriously to exclude the dangerous causes.

  5. Dieulafoy's lesion: A case series study

    Institute of Scientific and Technical Information of China (English)

    RS Walmsley; Yuk-Tong Lee; Joseph JY Sung

    2005-01-01

    AIM: Dieulafoy's lesion (DL) accounts for 1-5.8% of cases of acute upper gastrointestinal bleeding (GIB). Its mortality is high, approaching 20%, despite recent advances in endoscopic therapy. We aimed to report our experience in the treatment of DL.METHODS: A retrospective case study of all patients with DL between January 1993 and January 2003 was done. Characteristics, treatment methods, success rates and 30-d mortality of the patients were analyzed. RESULTS: Thirty-six patients were noted to have DL in the study period. Thirty-three records were available for assessment in which 35 DL were identified. The median age of the patients was 67 years with male to female ratio of 5.6:1. Significant comorbidities existed in 69% of the patients. Eighty-nine percent of the DL was found at first endoscopy, three DL at laparotomy. Significant coexistent endoscopic findings existed in 23%. Hemostasis was achieved in 88% by using adrenaline injection, or in combination with heater probe application at first endoscopy. Four cases had re-bleeding, all were successfully treated endoscopically. The 30-d mortality rate was 23%.CONCLUSION: Successful endoscopic hemostasis could be achieved in 100% of cases of DL. The overall mortality may still remain high, mainly due to the comorbidities and age of these patients.

  6. Acute metheamoglobinemia due to nitrobenzene poisoning: Case series

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    Harish Kumar S, Ujjawal Kumar, Raghavendra Prasad B N, Kiran BJ, Anil Kumar M

    2014-04-01

    Full Text Available Nitrobenzene is a nitrite compound; its toxic effects are due to its ability to convert hemoglobin to methaemoglobin by oxidizing iron. The clinical features of nitrobenzene poisoning vary based on the concentration of methaemoglobin in blood. Immediate identification based on clinical features, odour of the compound with supporting evidence of increased methaemoglobin levels will help in a timely intervention thus preventing fatal outcome. Early haemodynamic and ventilator support along with administration of methylene blue as an antidote has been proved crucial in saving some lives. An acute nitrobenzene poisoning presenting with methaemoglobinemia is becoming quite common in this part of the country. Here authorsreport a series of cases of nitrobenzene poisoning where immediate clinical evaluation, with repeated intravenous methylene blue saved three patients, but two patients presenting late and with heavy exposure could not be saved

  7. Evaluation of the TV Series "Statistics" (SABC-ERTV1).

    Science.gov (United States)

    Stupart, J. D. C.; Duby, Aliza

    A summative evaluation of the effectiveness of the educational television series, "Statistics," that aired on South African television is presented. The two episodes chosen from the six-episode series covered pie charts, pictograms, and pictographs (episode 1); and point-of-view interpretations of statistics (episode 4). The evaluation was…

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

    Science.gov (United States)

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

    2015-04-16

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

  9. Case series on tropical diabetic hand syndrome.

    Science.gov (United States)

    Ezeani, I U; Edo, A E

    2014-01-01

    Tropical diabetic hand syndrome is a term used to describe diabetes complication of the hand affecting people in the tropics. It consists of localized cellulitis with variable swelling and ulceration of the hands, progressive, fulminant hand sepsis and gangrene in extreme cases. This syndrome is not well-recognized and is therefore less frequently reported. The authors describe three different female patients who were known diabetics of varying duration presenting with this syndrome at our tertiary health center and who were successfully managed by both the surgical and medical units. The need for early diagnosis and aggressive management is emphasized.

  10. Clinical evaluation of the marginal gingiva as a donor tissue to augment the width of keratinized gingiva: Series of 2 cases with 3-year follow-up

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    Palka Kaur Khanuja

    2015-01-01

    Full Text Available The indications to increase the width of keratinized gingiva have not been proven beyond doubt; however it becomes indispensable in certain clinical situations. Inspite of frequently encountered complications, palate is considered most preferred area to harvest the free gingival graft (FGG. This procedure aimed at investigating the potential of buccal marginal gingiva as a donor to augment keratinized gingiva. To the best of our knowledge, no such cases have been documented in the literature. FGG harvested from maxillary buccal marginal gingiva was used to augment gingiva in the mandibular anterior region for two patients. This not only improved plaque control but also resulted in acceptable esthetic results over 3 years. Furthermore, gingiva at donor sites gained its normal form and was in harmony with the neighboring teeth. It may be concluded that buccal marginal gingiva may provide a predictable substitute to other donor tissues to augment gingiva.

  11. A clinical evaluation of guided tissue regeneration with a bioabsorbable matrix membrane combined with an allograft bone graft. A series of case reports.

    Science.gov (United States)

    Harris, R J

    1997-06-01

    THE PURPOSE OF THIS STUDY was to evaluate the clinical effectiveness of a surgical technique in treating periodontal defects. The technique combined tetracycline treatment of a root planed root, grafting of the osseous defect with a demineralized freeze-dried bone allograft combined with tetracycline and the placement of a bioabsorbable matrix membrane, made of polylactic acid softened with citric acid ester. Thirty defects were treated in 27 patients. Statistically significant changes, as a result of the surgical procedure, were observed in marginal recession (mean: 0.5 mm), probing depth reductions (mean: 5.7 mm), and attachment level gain (mean: 5.2 mm). No statistically significant difference existed between the results in the furcation and non-furcation groups. The defects with probing depths > or = 10 mm had a greater mean probing depth reduction (7.4 mm) and mean attachment level improvement (7.2 mm) than the defects with effective method to treat periodontal defects.

  12. Various hysterosalpingography findings of female genital tuberculosis: A case series

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    Nargess Afzali

    2013-01-01

    Full Text Available Background: Genital tuberculosis is a chorionic disease and mostly occurs by haematogenous spread from extra genital source like lungs, peritoneum, lymph nodes and bones. Transmission through a sexual intercourse is also possible. Since the majority of patients are in reproductive ages, involvement of fallopian tubes and endometrium cause infertility in patients. Cases: Reviewing 4 cases of female genital tuberculosis, which referred to an infertility treatment center with various symptoms, we encountered various appearances on hysterosalpingography (HSG. Conclusion: The genitourinary tract is the most common site of extra pulmonary TB. The primary focus of genital tuberculosis is fallopian tubes, which are almost always affected bilaterally but not symmetrically. Because of common involvement of fallopian tubes and endometrial cavity, disease causes infertility. Diagnosis is not easy because genital tuberculosis has a wide range of clinical and radiological manifestations with slow growing symptoms. Detailed hysterosalpingography finding may be helpful in better diagnosis of the disease. This case series aims to depict the various hystrosalpingographic appearances and pathology produced by tuberculosis and related literatures are reviewed in order to establish a better diagnostic evaluation of genital tuberculosis

  13. Pregnancy in dialysis patients: a case series

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    Al-Saran Khalid A

    2008-01-01

    Full Text Available Abstract Fertility is markedly reduced in patients with chronic renal failure. For women with pre-existing renal disease, pregnancy is associated with an increased rate of fetal complications and a considerable risk of renal disease progression. Due to substantial improvements in antenatal and neonatal care, fetal outcome has improved considerably in the last two decade. A Saudi survey which examined the frequency of pregnancy among women in end stage renal disease (ESRD and undergoing regular hemodialysis (HD, showed an incidence of 7% over a five year period (1.4 per year. This may reflect the cultural endorsement of having offspring. We hereby report 2 cases of successful pregnancy managed at the Prince Salman Center for Kidney Diseases (PSCKD.

  14. Vascular parkinsonism: a case series of 17 patients

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    Thiago Cardoso Vale

    2013-10-01

    Full Text Available Objective To report the clinical and neuroimaging findings in a case series of vascular parkinsonism (VP. Methods Seventeen patients with VP were evaluated with motor, cognitive, and neuroimaging standardized tests and scales. Results All patients had arterial hypertension. Ten patients were male and the mean age of the whole sample was 75.8±10.1 years. The mean age of parkinsonism onset was 72.2±10.0 years. Common clinical features were urinary incontinence (88.2%, lower limb parkinsonism with freezing of gait and falls (82.3%, and pyramidal signs (76.4%. The mean Unified Parkinson’s Disease Rating Scale (UPDRS and Hoehn-Yahr scores were 72.5±21.6 points and 3.3±0.9 points, respectively. Sixteen (94.1% patients had freezing of gait and executive dysfunction. Twelve (70.5% patients had probable vascular dementia. The mean dose of levodopa was 530.9 mg/day. Unresponsiveness to the drug was confirmed by a 6.9 mean point reduction in the UPDRS score after the “practically defined off” test. Conclusion This series provides a profile of VP with predominant lower-limb involvement, freezing of gait and falls, pyramidal signs, executive dysfunction, concomitant vascular dementia, and poor levodopa response.

  15. Salon sink radiculopathy: a case series.

    Science.gov (United States)

    Stitik, T P; Nadler, S F; Foye, P M

    1999-01-01

    Cervical radiculopathy can be diagnosed on physical examination with the Spurling test, which narrows neural foramina via neck extension along with coupled rotation and side-bending. In the presence of cervical radiculopathy, this test can reproduce radicular symptoms by transmitting compressive forces to affected nerve roots as they traverse the neural foramina. Treatment of cervical radiculopathy includes patient education to avoid obvious postures that exacerbate radicular symptoms and to assume positions that centralize discomfort. A potentially harmful position to which many patients are unwittingly subjected at least several times per year occurs when their hair is being shampooed in a salon sink before a haircut. This posture causes neck extension and is combined with rotation and side-bending as the patient's head is being manipulated during the shampooing. When the stylist then also applies a mild compressive force while shampooing the patient's hair, hyperextension of the neck is produced. We present two patients with cervical radiculopathy that was significantly exacerbated after the patient's hair had been shampooed in a salon sink; subsequently, these patients required oral administration of steroids. These cases illustrate that patients with suspected or known cervical radiculopathy should be forewarned to avoid this otherwise seemingly innocuous activity.

  16. Granulomatous lobular mastitis ,A case series.

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    Ali Pourzand

    2014-05-01

    Full Text Available BACKGROUND: Granulomatous lobular mastitis (GLM is an inflammatory disease of the breast, which can mimic breast cancer in clinical and radiological findings. We conducted the present study in order to determine the diagnostic and other important aspects of this disease. METHODS: In this study, we reviewed the records of 38 patients with granulomatous lobular mastitis in order to describe the clinical, imaging, laboratory, pathologic, and treatment aspects of this disease. RESULTS: All of the patients’ ages were in the range of 22-62 years (mean age: 42 years. All of them had children, history of oral contraceptive pill (OCP usage, antibiotic therapy and mammoplasty. In physical examination, dimpling, edema, inflammation, ulcer, abscess, and firm mass were detected. Size of masses was in the range of 2 × 2 to 8 × 6 cm and their location, in most cases, was in the superior lateral quadrant or central region. In Ultrasonography, a hypoechoic fibroglandular mass and collection, and in pathologic findings, granulomatous reaction was reported. These patients were treated by antibiotics, corticosteroids, and surgery. CONCLUSIONS: GLM is a chronic inflammatory lesion of the breast which can mimic breast cancer. A history of child bearing, lactation, and OCP drug usage have suspicious roles in the formation of GLM. The most common clinical sign in these patients is a painful mass in the breast. We uncovered that clinical and radiological findings are not specific and sufficient for diagnosis of GLM. Therefore, for better diagnosis of this disease, usage of core, incisional, or excisional biopsy are recommended.

  17. Pica in iron deficiency: a case series

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    Tisman Glenn

    2010-03-01

    Full Text Available Abstract Introduction Pica is an unusual condition where patients develop cravings for non-nutritive substances that can cause significant health risks. We report three patients with pica, two of them showing evolutionary changes associated with pica and the third demonstrating a peculiar nature of pica, which has yet to be reported. Case presentation We describe three patients who presented with symptoms of pica. The first patient is a 36-year-old Caucasian woman who had dysfunctional uterine bleeding associated with daily ingestion of two super-sized cups of ice as iced tea. The second patient is a 62-year-old Caucasian man who presented with bleeding from colonic polyps associated with drinking partially frozen bottled water. Lastly, the third patient, a 37-year-old Hispanic woman, presented with dysfunctional uterine bleeding and habitually chewed rubber bands. All three patients presented with hematological parameters diagnostic for iron deficiency anemia. Conclusion Pica has been practiced for centuries without a clear etiology. We have noticed that the younger community of academic and community physicians are not aware of the importance of complaints related to pica. None of our patients we describe here, as well as their primary care physicians, were aware of the importance of their pica related symptoms. Pica symptoms abated in one of our patients upon iron supplementation, while the other two are currently under treatment as of this writing. We believe pica is an important sign of iron deficiency that should never be ignored, and the craving for any unusual substance should compel clinicians to search for occult blood loss with secondary iron deficiency.

  18. Program evaluation and case study

    OpenAIRE

    Kushner, S

    2009-01-01

    This entry looks at the convergence of case study methodology and program evaluation. An early insight of some educational evaluation theorists was of the convergence of case study and program evaluation – the fusion of method with purpose. Program evaluation and case study came to be mutually-bracketed. In the educational evaluation field 'Responsive', 'Democratic', 'Illuminative' methodologies were developed in parallel with case study methods - the same authors contributing freely to both ...

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

    Science.gov (United States)

    Eckshtain, Dikla; Gaynor, Scott T.

    2009-01-01

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

  20. Myofascial trigger points in cluster headache patients: a case series

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    Rico-Villademoros Fernando

    2008-12-01

    Full Text Available Abstract Active myofascial trigger points (MTrPs have been found to contribute to chronic tension-type headache and migraine. The purpose of this case series was to examine if active trigger points (TrPs provoking cluster-type referred pain could be found in cluster headache patients and, if so, to evaluate the effectiveness of active TrPs anaesthetic injections both in the acute and preventive headache's treatment. Twelve patients, 4 experiencing episodic and 8 chronic cluster headache, were studied. TrPs were found in all of them. Abortive infiltrations could be done in 2 episodic and 4 chronic patients, and preemptive infiltrations could be done in 2 episodic and 5 chronic patients, both kind of interventions being successful in 5 (83.3% and in 6 (85.7% of the cases respectively. When combined with prophylactic drug therapy, injections were associated with significant improvement in 7 of the 8 chronic cluster patients. Our data suggest that peripheral sensitization may play a role in cluster headache pathophysiology and that first neuron afferent blockade can be useful in cluster headache management.

  1. Firecracker eye injuries during Deepavali festival: A case series

    OpenAIRE

    Kumar Ravi; Puttanna Manohar; Sriprakash K; Sujatha Rathod B; Prabhakaran Venkatesh

    2010-01-01

    We report a large series of ocular injuries caused by fire-crackers. This study was a hospital-based, singlecenter, retrospective case series in which the records of 51 patients with ocular injuries were analyzed. Injuries were classified according to Birmingham eye trauma terminology system (BETTS). Visual outcomes before and after the intervention were recorded. Ten patients were admitted for further management. As ocular firecracker injuries result in significant morbidity, public educatio...

  2. Clozapine responsive catatonia: A series of five cases

    Directory of Open Access Journals (Sweden)

    Somsubhra Chattopadhyay

    2012-01-01

    Full Text Available The main objective of presenting the case series is that despite dramatic symptomatic response by intra venous lorazepam or electro convulsive therapy irrespective of primary diagnosis in catatonia cases some cases remain difficult to treat by conventional treatment. Here, we present five catatonia cases who did not respond to conventional treatment even when treated for primary psychiatric diagnosis along with treatment for catatonia. They ultimately responded partially or completely to clozapine only, which explains the multi-factorial causation of catatonia syndrome as postulated by different scientific research.

  3. Fahr′s disease and psychiatric syndromes: A case series

    Directory of Open Access Journals (Sweden)

    Deepak Ghormode

    2011-01-01

    Full Text Available Fahr′s disease is characterized by basal ganglia calcification with clinical manifestations in the form of neuropsychiatric disorders, neurological symptoms, and cognitive symptoms. In this case series, we describe two cases of basal ganglia calcification, one of whom presented with psychotic symptoms and the other with mood symptoms, and discuss the literature with regard to psychiatric manifestations of basal ganglia calcification.

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

    Science.gov (United States)

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

    2015-08-01

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

  5. Cacogeusia following pine nut ingestion: a six patient case series.

    Science.gov (United States)

    Hampton, Rachael L; Scully, Crispian; Gandhi, Shan; Raber-Durlacher, Judith

    2013-01-01

    This is a retrospective case series of 6 patients complaining of a bad taste (cacogeusia) specifically metallogeusia, following the ingestion of pine nuts.(1) The taste arose always within 48h of ingestion, and in all but one patient spontaneously resolved within 14 days. Pine nuts also have a potential for triggering anaphylaxis.(2).

  6. Firecracker eye injuries during Deepavali festival: a case series.

    Science.gov (United States)

    Kumar, Ravi; Puttanna, Manohar; Sriprakash, K S; Sujatha Rathod, B L; Prabhakaran, Venkatesh C

    2010-01-01

    We report a large series of ocular injuries caused by fire-crackers. This study was a hospital-based, singlecenter, retrospective case series in which the records of 51 patients with ocular injuries were analyzed. Injuries were classified according to Birmingham eye trauma terminology system (BETTS). Visual outcomes before and after the intervention were recorded. Ten patients were admitted for further management. As ocular firecracker injuries result in significant morbidity, public education regarding proper use of firecrackers may help in reducing the incidence of ocular injuries.

  7. Firecracker eye injuries during Deepavali festival: A case series

    Directory of Open Access Journals (Sweden)

    Kumar Ravi

    2010-01-01

    Full Text Available We report a large series of ocular injuries caused by fire-crackers. This study was a hospital-based, singlecenter, retrospective case series in which the records of 51 patients with ocular injuries were analyzed. Injuries were classified according to Birmingham eye trauma terminology system (BETTS. Visual outcomes before and after the intervention were recorded. Ten patients were admitted for further management. As ocular firecracker injuries result in significant morbidity, public education regarding proper use of firecrackers may help in reducing the incidence of ocular injuries.

  8. Evaluation of scaling invariance embedded in short time series.

    Directory of Open Access Journals (Sweden)

    Xue Pan

    Full Text Available Scaling invariance of time series has been making great contributions in diverse research fields. But how to evaluate scaling exponent from a real-world series is still an open problem. Finite length of time series may induce unacceptable fluctuation and bias to statistical quantities and consequent invalidation of currently used standard methods. In this paper a new concept called correlation-dependent balanced estimation of diffusion entropy is developed to evaluate scale-invariance in very short time series with length ~10(2. Calculations with specified Hurst exponent values of 0.2,0.3,...,0.9 show that by using the standard central moving average de-trending procedure this method can evaluate the scaling exponents for short time series with ignorable bias (≤0.03 and sharp confidential interval (standard deviation ≤0.05. Considering the stride series from ten volunteers along an approximate oval path of a specified length, we observe that though the averages and deviations of scaling exponents are close, their evolutionary behaviors display rich patterns. It has potential use in analyzing physiological signals, detecting early warning signals, and so on. As an emphasis, the our core contribution is that by means of the proposed method one can estimate precisely shannon entropy from limited records.

  9. A case series of Osteoid Osteoma: 7 cases

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    Farzan M

    1997-08-01

    Full Text Available Osteoid osteoma is a unique benign primary bone tumor that may present in the metaphyseal diaphyseal areas of the short tubular bones and has also been reported in the carpal bones. It occurs in the first two decades of life. The classic history is bone pain, often relieved by aspirin. The clinical appearance is local swelling and tenderness. The typical radiographic appearance is very characteristic: an eccentric area of cortical sclerosis, frequently with a radiolucent nidus. The lesion does not exceed 1 cm in diameter. The use of a bone scan may be helpful diagnostically, as are the CAT scan and tomography. Doyle et al described seven cases of osteoid osteoma with a prolonged delay in diagnosis, but reported an excellent cure rate following excision. The carpus is not unusual as a site for this tumor, especially the scaphoid. Treatment is windowing with curettage of the tumor nidus. The use of a dental drill to window the phalanx and expose the nidus is very helpful. Removal of the entire nidus is permanently curative, but if a portion of the tumor is missed, prompt recurrence of the symptoms is the rule.

  10. Hereditary vitamin D rickets: a case series in a family.

    Science.gov (United States)

    Surender, Kumar; Kochar, I P S; Ahmad, Ayesha; Kapoor, Meenal

    2014-11-01

    Hereditary vitamin D-resistant rickets (HVDRR) is an autosomal recessive disorder characterized by end-organ resistance to 1α,25-dihydroxyvitamin D3 (1,25D3). Clinically, the syndrome is recognized by severe early onset rickets with bowing of the lower extremities, short stature, and often alopecia. Here, we report a case series on three siblings who had HVDRR with varied clinical findings.

  11. Renal transplantation in HIV patients: A series of four cases

    OpenAIRE

    2012-01-01

    Human immunodeficiency virus (HIV) infection in a patient with end-stage renal disease was considered a contraindication for renal transplantation till now despite the advent of highly active antiretroviral therapy with the apprehension that immunosuppression would further jeopardize the already compromised immune status of the patients. Renal transplantation in HIV patients is rare in developing countries including ours. Here we report a series of four cases of renal transplantation in HIV p...

  12. Aneurysmal subarachnoid haemorrhage in pregnancy: a case series.

    Science.gov (United States)

    Guida, Maurizio; Maurizio, Guida; Altieri, Roberto; Roberto, Altieri; Palatucci, Valeria; Valeria, Palatucci; Visconti, Federica; Federica, Visconti; Pascale, Renato; Renato, Pascale; Marra, Marialuisa; Marialuisa, Marra; Locatelli, Giampiero; Giampiero, Locatelli; Saponiero, Renato; Renato, Saponiero; Tufano, Rosalba; Rosalba, Tufano; Bifulco, Francesca; Francesca, Bifulco; Piazza, Ornella

    2012-01-01

    Pregnancy is a recognized risk factor for aneurysmal subarachnoid hemorrhage (SAH). Headache is very frequent in normal pregnancy and it is a common sign shared between several intracranial diseases. We present a case series of 10 women in the third trimester of pregnancy admitted to our intensive care unit (ICU) with neurological signs and symptoms. 4 of these patients were diagnosed with SAH. Data in this study suggest that a timely diagnosis and an appropriate treatment is crucial for mother and baby.

  13. Aneurysmal subarachnoid haemorrhage in pregnancy: a case series

    OpenAIRE

    Guida, Maurizio; Altieri, Roberto; Palatucci, Valeria; Visconti, Federica; Pascale, Renato; Marra, Marialuisa; Locatelli, Giampiero; Saponiero, Renato; Tufano, Rosalba; Bifulco, Francesca; Piazza, Ornella

    2012-01-01

    Pregnancy is a recognized risk factor for aneurysmal subarachnoid hemorrhage (SAH). Headache is very frequent in normal pregnancy and it is a common sign shared between several intracranial diseases. We present a case series of 10 women in the third trimester of pregnancy admitted to our intensive care unit (ICU) with neurological signs and symptoms. 4 of these patients were diagnosed with SAH. Data in this study suggest that a timely diagnosis and an appropriate treatment is crucial for moth...

  14. Hereditary Nonsyndromic Gingival Fibromatosis: Report of Family Case Series

    Directory of Open Access Journals (Sweden)

    Syed Wali Peeran

    2013-01-01

    Full Text Available Hereditary gingival fibromatosis (HGF is a rare, benign disorder with slowly progressive enlargement of maxillary and mandibular gingiva. Herewith, we report the first case series of HGF presenting among mother and all of her 3 children. Their complaints included unaesthetic appearance due to gingival growth, malocclusion, and difficulty in mastication. Conventional gingivectomy with oral hygiene measures and regular followup is the treatment of choice for such presentation.

  15. KARTAGENER’S SYNDROME : A CASE SERIES STUDY

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    Prakash

    2015-08-01

    Full Text Available Kartagener’s Syndrome is a rare Autosomal recessive disorder presents as a triad of Sinusitis, Bronchiectasis and Situs inversus. Chronic Rhino sinusitis is a common condition seen is ENT OPD routinely. Of the several causes of Sinusitis, Kartagener’s is rare entity and can remain undetected. This case series is to emphasize the diagnosis of the disease and alert the patient about it.

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

    Science.gov (United States)

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

    2016-01-01

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

  17. Seldinger technique for nasal intubation: a case series.

    Science.gov (United States)

    Abrons, Ron O; Vansickle, Ryan A; Ouanes, Jean-Pierre P

    2016-11-01

    Nasotracheal intubation can be both challenging and traumatic, especially in cases of atypical anatomy. We present a series of 3 such cases in which an endotracheal tube introducer (bougie) was used to facilitate successful, atraumatic, nasotracheal intubation via Seldinger technique. The technique described can guide a nasotracheal tube through narrow nasal passages, small pharyngeal spaces, and past acute laryngeal approach angles, all without transoral manipulation of the tube. The technique is easy to perform, uses a routine skill set, and can be advantageous in numerous clinical scenarios.

  18. Isolated gingival overgrowths: A review of case series

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    Shruti Raizada

    2016-01-01

    Full Text Available Clinicians are often intrigued by the varied manifestations of the gingival tissue. Gingival overgrowth is a common clinical finding and most of them represent a reactive hyperplasia as a direct result of plaque-related inflammatory gingival disease. These types of growth generally respond to good plaque control, removal of the causative irritants, and conservative tissue management. This case series highlights three different cases of localized gingival overgrowth and its management with emphasis on the importance of patient awareness and motivation.

  19. Delusional parasitosis with folie à deux: A case series

    Science.gov (United States)

    Sawant, Neena Sanjiv; Vispute, Chetan Dilip

    2015-01-01

    Delusional parasitosis (DP) is characterized by single hypochondriacal delusion in which patient feels he/she is infested with insects. The authors present a case series of three cases of DP with shared psychotic disorder (folie à deux) in which one individual developed a delusional belief in the context of a close relationship with another person or people who already had an established delusional idea. All patients of DP were assessed in the outpatient department of Psychiatry of a tertiary care hospital. Diagnosis of DP was made on detail clinical history and supporting clinical findings. All our primary cases had DP and the accompanying relatives of our patients had folie à deux as they shared the belief of parasite infestation which was firm and persisted despite evidence to the contrary. The primary cases of delusional parasitosis responded well to oral risperidone. The intensity of the belief in the secondary person also reduced with improvement in the symptoms of the patients. PMID:26257494

  20. Evaluation of a Function at Infinity from Its Power Series

    Science.gov (United States)

    Caflisch, Russel E.; Nunan, Kevin C.

    1981-05-01

    A new procedure for evaluating a function at infinity from its power series is analyzed. The limit in the procedure is shown to converge to the smallest singularity of the inverse function, which may or may not be the desired value.

  1. Mulligan Stew; An Evaluation of the Television Series.

    Science.gov (United States)

    Nolan, Jeanne; Gross, John

    To evaluate the effects of the public-television series on nutrition, Mulligan Stew, a survey was conducted of 4,332 4th, 5th and 6th-grade students in four areas of Missouri. Children were asked if they had voluntarily watched the program and pre- and post-tested for nutrition knowledge. Comparisons were also made between teacher-reinforced…

  2. Waardenburg Syndrome: A Report of Two Familial Case Series

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    Safal Khanal, BOptom

    2013-12-01

    Full Text Available Background: Waardenburg syndrome is a rare autosomally-inherited developmental disorder characterized by sensorineural deafness in association with pigmentary anomalies comprising various ocular features including dystopia canthorum, iris heterochromia, eyebrow flare, and fundus alterations. It is a congenital non-progressive genetic disorder that has been found to result in hearing loss, reduced vision, reduced self esteem, problems related to appearance, and decreased intellectual functioning.Case Reports: We report two familial case series that presented with the characteristic ocular findings and the systemic features of Waardenburg syndrome. The first series comprised a 32-year-old father with his two sons aged nine and six years. Two female siblings, aged 10 and eight years, both with cochlear implants, were included in the second series.Conclusion: Waardenburg syndrome manifests differently with dissimilar genetic penetration even within the same family. Some individuals will require no treatment, while others may need treatment or surgery for other abnormalities. Appropriate measures can be undertaken to negotiate the disabilities resulting from the ocular conditions associated with this syndrome.

  3. Cutaneous manifestations in renal failure patients: A case series

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    Banerjee S

    2007-01-01

    Full Text Available Cutaneous involvement in renal disease is due to a host of factors ranging from metabolic disturbances to immunosuppressive drugs. Herein we report a series of six cases of renal failure with varied cutaneous manifestations ranging from infections to neoplasms due to prolonged immunosuppression. Our first case had cutaneous cryptococcosis where skin lesions gave a clue to the diagnosis of altered sensorium and underlying meningitis. The second case initially presented with florid warts and was treated successfully but later presented with an explosive recurrence of skin lesions due to malignant transformation. Our third case had basal cell carcinoma over the presternal region that was successfully treated with liquid nitrogen cryotherapy. Our fourth case had diabetic nephropathy that presented with septicemia and purpura fulminans. The last case had cutaneous manifestations of drug therapy because of heparin infusion. To conclude, cutaneous manifestations in patients with renal failure are varied and a high degree of suspicion is needed for early diagnosis and aggressive treatment to effectively combat mortality and morbidity.

  4. Perinatal asphyxia and medical professional liability: A case series

    Directory of Open Access Journals (Sweden)

    Andrea Verzeletti

    2016-12-01

    Full Text Available In the context of medical professional liability, obstetrics is one of the most involved medical specialties because the unfavorable outcome of a pregnancy is difficult to accept for parents, who tend to reduce it to inappropriate care that occurred during pregnancy or birth. 32 cases of perinatal asphyxia were evaluated by the Institute of Forensic Medicine in Brescia during the period between 1999 and 2014 (13 in Civil Court and 19 in Penal Court. 9 out of the 32 pregnancies were twins, so the considerations were carried out on a total of 41 fetuses/newborns. Profiles of inadequacy were identified in 66% of cases (85% of the cases evaluated in Civil Court; 53% of the cases evaluated in Penal Court. The existence of a causal relationship between the medical conduct and the onset of asphyxia was recognized in 79% of civil cases and in 38% of penal cases. There is a “greater rigor” in the verification of causal relationship and malpractice profiles in penal cases compared to civil ones: this is in harmony with the most recent Italian Court decisions, characterized by compelling suspect’s protection in the presence of a reasonable doubt in criminal matters and by victim’s protection in civil ones.

  5. Anterior Segment Findings in Vitamin A Deficiency: A Case Series

    Science.gov (United States)

    Rubino, Pierangela; Mora, Paolo; Ungaro, Nicola; Gandolfi, Stefano A.; Orsoni, Jelka G.

    2015-01-01

    Vitamin A deficiency is a rare but vision threatening disorder in the developed world, which can lead to blindness for severe keratomalacia with cornea scarring and perforation or night blindness due to impaired dark adaptation. Conversely, the disease is quite common in developing countries, as a consequence of chronic malnutrition. The correct diagnosis and therapy with prompt vitamin A supplementation avoid blindness. We report a series of 3 local cases with different age and causes for vitamin A deficiency. The diagnostic workup, therapy, and prognosis are discussed. PMID:26509090

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

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    Kenneth D. Katz

    2016-05-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  8. DISK BATTERIES IN THE ESOPHAGUS OF NIGERIAN CHILDREN: CASE SERIES

    Directory of Open Access Journals (Sweden)

    LUCKY OBUKOWHO ONOTAI

    2015-07-01

    Full Text Available Foreign body (FB ingestion is common in clinical practice especially in children. Its impaction in the esophagus constitutes an important cause of morbidity and mortality in our environment. Due to technological advancement and increase use of disk batteries to power children toys and remote control gadgets, ingestion of disk batteries is now commonplace. In our environment there is paucity of information on disk batteries hence we decided to present case series of disk batteries in the esophagus of children highlighting the peculiarities of disk batteries, the dangers posed by them, the mode of retrieval, complications encountered, and possible recommendations to curtail the increasing occurrence.

  9. Brucella endocarditis – A series of five case reports

    Science.gov (United States)

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

    2013-01-01

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

  10. Meningitis admitted to a military hospital: a retrospective case series.

    Science.gov (United States)

    Harrell, Travis; Hammes, John S

    2012-10-01

    Meningitis is a common admission diagnosis. No case series or descriptive studies on meningitis have recently been published. Additionally, no recent data exist on meningitis in the U.S. Military Health System. We reviewed charts of adult patients admitted to Naval Medical Center San Diego between January 2004 and December 2008 with an admission diagnosis of meningitis. Charts were excluded if they did not meet our case definition of meningitis, if missing data, or if meningitis was nosocomial or iatrogenic. We reviewed results of cerebrospinal fluid cultures during this period. We compared rates and characteristics, and outcomes of bacterial and aseptic meningitis. Two hundred twenty-one cases met our criteria. Of these, 208 were aseptic. Cerebrospinal fluid polymerase chain reaction testing was positive for enteroviruses and herpes simplex viruses in 42 (20.2%) and 17 (8.2%) cases, respectively. Of culture/polymerase chain reaction/serologically positive cases, the pathogens were Neisseria meningitidis (3), Streptococcus pneumoniae (3), viridans streptococci (2), Cryptococcus neoformans (2), Coccidioides immitis (2), and Mycobacterium tuberculosis (1). Three patients had poor outcomes: one died from S. pneumoniae and two had long-term neurologic deficits. Meningitis is a common admission diagnosis, but serious virulent pathogens are uncommon and adverse outcomes are rare.

  11. Leiomyoma cutis: A clinicopathological series of 37 cases

    Directory of Open Access Journals (Sweden)

    Malhotra Purnima

    2010-01-01

    Full Text Available Background: Cutaneous leiomyomas are benign smooth muscle tumors that comprise three distinct types such as piloleimyoma, angioleiomyoma, and genital leiomyoma. Aim: The objective of this study was to report a series of cases seen in last 8 years in a tertiary care hospital in north India and to discuss their clinicopathologic findings. Material and Methods: Paraffin-embedded blocks of cases reported as cutaneous leiomyoma from 1999 to 2007 were retrieved from the Institute of Pathology, New Delhi, and their clinical parameters were noted. Their histopathological features were reviewed on hematoxylin-eosin stained slides. Immunohistochemistry was performed where necessary. Results: Twenty-seven cases of piloleiomyoma, three cases of angioleiomyoma, five breast leiomyomas, and two scrotal leiomyomas were seen in patients ranging from 21 to 65 years of age, with an average of 38.2 years at presentation. There was a male predominance with 26 males and 11 females (M:F = 2.2:1. Solitary lesions (n = 21 were more common than multiple ( n = 16. The trunk and upper limbs were involved most commonly, comprising 23 of 37 (62.2% cases. This was followed by lower limb, face, breast, and scrotum. Conclusion: Cutaneous leiomyomas are rare lesions and form an important clinical differential diagnosis of painful papulonodules. These must be biopsied in order to differentiate them from other spindle cell lesions.

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

    Science.gov (United States)

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

    2016-12-01

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

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

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    Rahul Saha

    2016-01-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

  15. Ruptured primary ovarian ectopic pregnancy: a case series

    Directory of Open Access Journals (Sweden)

    Neha Singh

    2016-10-01

    Full Text Available Ovarian ectopic pregnancy (OEP is one of the rarest forms of nontubal ectopic pregnancies. Less than 1% of ectopic pregnancies are primary OEP. Exact etio-pathogenesis and predisposing factors for OEP are not yet well understood. Review of literature suggests its possible association with conditions like tubal sterilization, intrauterine contraceptive device (IUCD, IVF-ET in patients with bilateral salpingectomy etc. Clinical and radiological presentation often mimics like tubal ectopic pregnancy, making preoperative diagnosis difficult for clinicians. Thus, correct diagnosis can be made only intraoperatively using Speigelberg's criteria followed by histopathological confirmation. Treatment includes wedge resection of affected ovarian tissue or salpingo-oophorectomy in selected cases. We present a case series of primary ruptured ovarian ectopic pregnancy with no identifiable risk factors with inconclusive radiological diagnosis. [Int J Reprod Contracept Obstet Gynecol 2016; 5(10.000: 3641-3644

  16. Can masturbatory guilt lead to severe psychopathology: A case series

    Directory of Open Access Journals (Sweden)

    Jitender Aneja

    2015-01-01

    Full Text Available Masturbation is common in all societies. Despite being common, it is admonished culturally and almost all religions prohibit masturbation and consider it an act of immorality. The prohibition for masturbation leads to a lot of cultural beliefs, including certain myths, which influence sexual behavior of the person. The impact of these common cultural myths associated with masturbation, are clinically understood as Dhat syndrome and masturbatory guilt. Although there is a reasonable literature on Dhat syndrome, there is limited literature with regard to masturbatory guilt especially linking the same with axis-I psychopathology. In this case series, three cases of masturbatory guilt are presented in whom masturbatory guilt was associated with manifestation of severe psychopathology. This report suggests that masturbatory guilt must be enquired for in patients presenting with severe mental disorder.

  17. Laser-assisted flapless crown lengthening: a case series.

    Science.gov (United States)

    McGuire, Michael K; Scheyer, E Todd

    2011-01-01

    As part of the paradigm shift toward more minimally invasive surgical procedures, increasing numbers of references to laser-mediated flapless crown lengthening are noted in the published literature. The vast majority of these references are noncontrolled case reports or technique-focused articles. Therefore, prospective, randomized controlled studies that objectively examine the safety and efficacy of flapless crown lengthening are lacking. The current case series represents an initial attempt to examine some of the clinical issues posed by this minimally invasive flapless approach. Ultimately, only well-designed controlled clinical trials can yield the type of evidence-based data necessary to categorize this approach to crown lengthening as standard-of-care treatment.

  18. Lie-series for orbital elements -- II. The spatial case

    CERN Document Server

    Pál, András

    2016-01-01

    If one has to attain high accuracy over long timescales during the numerical computation of the N-body problem, the method called Lie-integration is one of the most effective algorithms. In this paper we present a set of recurrence relations with which the coefficients needed by the Lie-integration of the orbital elements related to the spatial N-body problem can be derived up to arbitrary order. Similarly to the planar case, these formulae yields identically zero series in the case of no perturbations. In addition, the derivation of the formulae has two stages, analogously to the planar problem. Namely, the formulae are obtained to the first order, and then, higher order relations are expanded by involving directly the multilinear and fractional properties of the Lie-operator.

  19. CASE SERIES ON PHYLLODES TUMOUR OF THE BREAST

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    Sri

    2015-11-01

    Full Text Available : BACKGROUND: Phyllodes tumor of breast is one of the rare neoplasms comprising less than 1% of all breast tumours.aim of the study is to evaluate the clinical charecteristics, treatment regimens and complications of phyllodes tumor in our institution. PATIENTS AND METHODS: We have retrospectively reviewed the medical records of 2 years from 2013 to 2015 of patients who presented to our department, government general hospital, Kakinada. RESULTS: 342 patients presented with breast tumors of which 126 are malignant and 216 are benign. Phyllodes tumor constituted 8 cases of the total breastlump cases presented in our institution from 2013 to 2015. 3 out of 8 cases are recurrent. CONCLUSION: In benign cases wide local excision with clear margins is sufficient to prevent recurrence. In recurrent and malignant cases simple mastectomy has to be done.

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

    Science.gov (United States)

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

    2016-08-26

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

  1. Evaluation of recent GRACE monthly solution series with an ice sheet perspective

    Science.gov (United States)

    Horwath, Martin; Groh, Andreas

    2016-04-01

    GRACE monthly global gravity field solutions have undergone a remarkable evolution, leading to the latest (Release 5) series by CSR, GFZ, and JPL, to new series by other processing centers, such as ITSG and AIUB, as well as to efforts to derive combined solutions, particularly by the EGSIEM (European Gravity Service for Improved Emergency Management) project. For applications, such as GRACE inferences on ice sheet mass balance, the obvious question is on what GRACE solution series to base the assessment. Here we evaluate different GRACE solution series (including the ones listed above) in a unified framework. We concentrate on solutions expanded up to degree 90 or higher, since this is most appropriate for polar applications. We empirically assess the error levels in the spectral as well as in the spatial domain based on the month-to-month scatter in the high spherical harmonic degrees. We include empirical assessment of error correlations. We then apply all series to infer Antarctic and Greenland mass change time series and compare the results in terms of apparent signal content and noise level. We find that the ITSG solutions show lowest noise level in the high degrees (above 60). A preliminary combined solution from the EGSIEM project shows lowest noise in the degrees below 60. This virtue maps into the derived ice mass time series, where the EGSIEM-based results show the lowest noise in most cases. Meanwhile, there is no indication that any of the considered series systematically dampens actual geophysical signals.

  2. Rapidly destructive osteoarthritis of the hip joint: a case series

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    McMurtrie A

    2008-01-01

    Full Text Available Abstract Background Rapidly destructive arthrosis of the hip is a rare and incompletely understood disorder with scarce literature about variations in natural history within a population. Methods A series of cases from North Wales with rapid progressive joint destruction and extensive subchondral bone loss in the femoral head and acetabulum are presented. Radiographic findings mimicked those of other disorders such as septic arthritis, rheumatoid and seronegative arthritis, primary osteonecrosis with secondary osteoarthritis, or neuropathic osteoarthropathy, but none of the patients had clinical, pathologic, or laboratory evidence of these entities. Results Rapid progression of hip pain and disability was a consistent clinical feature. The average duration of symptoms was 1.4 years. Radiographs obtained at various intervals before surgery (average 14 months in 18 patients documented rapid hip destruction, involvement being unilateral in 13 cases. All patients underwent total hip arthroplasty, and osteoarthritis was confirmed at pathologic examination. Conclusion The authors postulate that these cases represent an uncommon subset of osteoarthritis and regular review, both clinically and radiologically, are required to assess speed of progression and prevent rapid loss of bone stock without the surgeon being aware. These cases are unsuitable for being placed on long waiting list due to technical difficulties in delayed surgery and compromised outcome following surgery.

  3. Qigong program on insomnia and stress in cancer patients: A case series report

    OpenAIRE

    Seungmo Kim; Sangnam Lee; Osung Kwon; Seonghoon Park; Jungchul Seo; Kyungsoon Kim

    2015-01-01

    Background: In recent years, the interest in Qigong as an alternative therapy has grown following reports of its ability to regulate psychological factors in cancer patients. This is a case series to evaluate the outcome measures of Qigong when used as an adjunct to standard medical care to treat insomnia and stress in cancer patients. Patients and methods: The Qigong program was applied to four cancer patients with insomnia, stress, and anxiety. The program consisted of 30-min sessions invol...

  4. Pneumothoraces in a Neonatal Tertiary Care Unit: Case Series

    Directory of Open Access Journals (Sweden)

    Rehan Ali

    2013-01-01

    Full Text Available Objective: Neonatal pneumothoraces are associated with high mortality. Prompt recognition to minimize its complications is paramount for ultimate outcome of these babies.Methods: A retrospective case series study was carried out at Aga khan University Hospital, from January 2010 to December 2010 to determine the etiology and outcome of neonates with pneumothorax in a neonatal tertiary care unit.Results: Ten neonates diagnosed radiologically with pneumothoraces were included. M: F ratio was 1:2.3. Birth weight ranged from 1750-3600 grams with a mean of 2100 grams. The occurrence of pneumothoraces was 50% on the left side, 20% on right, and 30% were bilateral. Primary etiology included pneumonia and sepsis (30%, hyaline membrane disease (20%, meconium aspiration syndrome (20% and congenital diaphragmatic hernia (10%. Spontaneous pneumothoraces were present in 20% of cases. In our study, the incidence of neonatal pneumothoraces was 2.5/1000 births compared to 10-15/1000 in Denmark, 10-20/1000 in Turkey and 6.3/1000 from Vermont Oxford Group. Despite the small number of cases, one incidental finding was the occurrence of pneumothorax, which declined in elective cesarean section after 37 weeks gestation i.e., 1.3 of 1000 births. Mortality was 60% determined mainly by the primary etiology and other co-morbid conditions.Conclusion: The study showed a higher number of mortality cases (60%. Although, it was difficult to draw a conclusion from the limited number of cases, there may be a benefit on neonatal respiratory outcome to be obtained by better selection of mothers and by waiting until 37 weeks before performing elective cesarean section. Adequate clinician training in soft ventilation strategies will reduce the occurrence of pneumothoraces.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Arthiie Thangavelu

    2012-01-01

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

  7. Snus (nass and oral cancer: A case series report

    Directory of Open Access Journals (Sweden)

    Maryam Alsadat Hashemipour

    2013-01-01

    Full Text Available Snus (nass is a form of snuff used in a similar manner to American dipping tobacco, but it does not typically result in a need for spitting. Possible hazards associated with this material include malignant and premalignant lesions in the oral cavity and gastrointestinal tract. The use of smokeless tobacco has increased in the Middle East in recent decades, particularly among teenagers and young adults. Therefore, practitioners must be able to recognize malignant and premalignant lesions. Although, an estimated 10-25% of the world′s population uses smokeless tobacco, this practice is virtually unknown in Iran. The aim of this study is to report a series of cases of squamous cell carcinoma and verrucous carcinoma occurring in the users of snus, who referred to the Department of Oral Medicine in Kerman Dental School.

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

    Science.gov (United States)

    Sangani, Indiya; Watt, Eileen; Cross, David

    2013-03-01

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

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

    Science.gov (United States)

    Chang, Christopher Y; Thrasher, Richard

    2012-06-01

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

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

    Science.gov (United States)

    Thangavelu, Arthiie; Elavarasu, Sugumari; Jayapalan, Piranitha

    2012-08-01

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

  11. Adverse events associated with yoga: a systematic review of published case reports and case series.

    Science.gov (United States)

    Cramer, Holger; Krucoff, Carol; Dobos, Gustav

    2013-01-01

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

  12. Acute sterile endophthalmitis following intravitreal bevacizumab: case series

    Directory of Open Access Journals (Sweden)

    Orozco-Hernández A

    2014-09-01

    Full Text Available Axel Orozco-Hernández,1 Ximena Ortega-Larrocea,1 Gustavo Sánchez-Bermúdez,1 Gerardo García-Aguirre,1 Virgilio Morales Cantón,1 Raul Velez-Montoya2 1Retina Department, Asociación para Evitar la Ceguera en México IAP, Mexico City, Mexico; 2Department of Ophthalmology, University of Colorado School of Medicine, Rocky Mountain Lions Eye Institute, Aurora, CO, USA Background: Since the ophthalmological community adopted the use of intravitreal bevacizumab as an accepted off-label treatment for neovascular diseases, the amount of knowledge regarding its effects and properties has been increasing continually. In the last few years, there have been an increasing number of reports about sterile intraocular inflammation and intraocular pressure elevations after intravitreal bevacizumab. In the following case series, we describe the clinical presentation and outcomes of ten consecutive cases of patients developing mild-to-severe sterile intraocular inflammation after intravitreal bevacizumab and their management. Methods: This report presents a retrospective case series. We reviewed the medical records of ten consecutive patients from a group of 46, in whom repackaged bevacizumab in individual aliquots from two vials from the same batch were used. All surgical procedures were performed using standard sterile techniques in the operating room. At each follow-up visit, patients underwent a complete ophthalmological examination including visual acuity assessment, intraocular pressure, biomicroscopy, and posterior fundus examination. Results: Ten patients presented sterile endophthalmitis with an onset time of 3.5±1.95 days. The clinical characteristics were mild pain, slight visual loss, conjunctival hyperemia, and various degrees of intraocular inflammation with microhypopyon. All cultures were negative. All patients were managed with topical steroids and antibiotics, except two, in whom, due to severe vitreous cells, intravitreal antibiotics were

  13. Ertapenem for treatment of osteomyelitis: a case series

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    Johnson Melissa D

    2011-11-01

    Full Text Available Abstract Background Ertapenem is a once-daily broad spectrum carbapenem that is increasingly used to treat polymicrobial osteomyelitis due to diabetic foot and traumatic wound infections. However, limited data exists on ertapenem use for osteomyelitis. This study aimed to characterize outcomes and adverse effects with empiric use of ertapenem for osteomyelitis. Findings A total of 112 patients presenting to Duke, Durham Regional or Durham VA Medical Centers with a suspected diagnosis of osteomyelitis and ertapenem use from 11/2001 to 8/2009 were screened, and 12 subjects met inclusion criteria for the study. Mean age was 60 ± 16 years, 68% were female, 75% were Caucasian, and the most common comorbidities included diabetes (58%, peripheral vascular disease (42%, and history of tobacco use (75%. Over half of the patients presented to a primary care clinic or emergency room greater than six months after the onset of clinical symptoms. Bone culture was obtained for diagnostic guidance in only two cases; and surgical intervention was pursued in three cases. Patients received a mean duration of 34.6 ± 7.8 days of therapy, and in three cases, subsequent suppressive oral antibiotics were given. Six (50% patients met criteria for clinical success, defined as resolution of clinical signs and symptoms of infection such that discontinuation of antibiotics was deemed appropriate at end of ertapenem therapy, without recurrence at one year follow-up. No adverse drug effects were noted. Conclusions In this case series of mostly community-acquired, lower extremity osteomyelitis, bone biopsy was infrequent, and an average six-week course of empiric ertapenem was well-tolerated with curative rates of 50% at one year.

  14. LIPOMA OF HAND AND FINGER : A 6 PATIENT CASE SERIES

    Directory of Open Access Journals (Sweden)

    Prakash Kumar

    2014-01-01

    Full Text Available INTRODUCTION: Lipoma , the ubiquitous benign tumor , is not very common in the hand and that to involving the palmar space or finger is very rare. This series of case presentation lays emphasis on consideration of lipoma in the differential diagnosis of swellings/ soft tissue tumors of the hand and the use o f imaging studies in their diagnosis. We report a ser ies of six cases of lipoma in different parts and planes of hand , involving palm and fingers . An uncommon site , size , shape , plane and age of occurrence of this common tumor warrants it’s reporting and an effort had been made to highlight the management. CONCLUSION : Hand lipoma is rare entity for a surgeon in the differential diagnosis of soft tissue tumors with radiology being an invaluable tool. Though rare but frequently seen in this pa rt of country , Precise surgical techniques with a sound anatomic knowledge helps in complete excision without damaging the vital structures and abates recurrences Lipoma , subcutaneous , mid - palmar space.

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

    Science.gov (United States)

    Tree, Jeremy J; Wilkie, Jaimie

    2010-10-01

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

  16. The Histopathological Spectrum of Pyogenic Granuloma: A Case Series

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    Vinay Marla

    2016-01-01

    Full Text Available Background. Pyogenic granuloma is a reactive tumor-like lesion commonly affecting the oral cavity. These lesions usually appear as localized solitary nodule with a sessile or pedunculated base and colour varying from red, purplish, or pink, depending on the vascularity of the lesion. Pyogenic granuloma shows predilection for gingiva and is usually slow growing, but at times it shows rapid growth. The natural course of this lesion can be categorized into three distinct phases, namely, (i cellular phase, (ii capillary phase/vascular phase, and (iii involutionary phase. Histopathologically, pyogenic granuloma is classified into lobular capillary hemangioma (LCH and non-lobular capillary hemangioma (non-LCH. Case Presentation. In this series, four cases (varied age groups and both genders of pyogenic granuloma showing varying histopathological presentation in relation to its clinical course have been described. The lesion in its early phase reveals diffuse endothelial cells, with few budding into capillaries. Among the capillary phase, the LCH type shows numerous blood vessels organized into lobular aggregates whereas the non-LCH type does not show any such organization and resembles granulation tissue. The involutionary phase shows healing of the lesion and is characterized by extensive fibrosis in the connective tissue. Conclusion. In conclusion, knowledge of the various histopathological presentation of this lesion is necessary for proper identification.

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

    Science.gov (United States)

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

    2007-01-01

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

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

    Science.gov (United States)

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

    2015-09-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  20. Evaluation of Harmonic Analysis of Time Series (HANTS): impact of gaps on time series reconstruction

    NARCIS (Netherlands)

    Zhou, J.Y.; Jia, L.; Hu, G.; Menenti, M.

    2012-01-01

    In recent decades, researchers have developed methods and models to reconstruct time series of irregularly spaced observations from satellite remote sensing, among which the widely used Harmonic Analysis of Time Series (HANTS) method. Many studies based on time series reconstructed with HANTS docume

  1. Odontoma serie de casos: Revisión de literatura Odontoma case series: Review of literature

    Directory of Open Access Journals (Sweden)

    J. Harris Ricardo

    2011-02-01

    Full Text Available El odontoma es el tumor odontogénico más frecuente en cavidad oral, compuesto por una mezcla de células odontogénicas formando dentina y esmalte, presenta células y tejidos normales pero de estructura defectuosa, estos tejidos se encuentran en el área del cuerpo donde se presenta su crecimiento, al examen radiográfico se puede presentar imágenes radiopacas como un gran número de dientes rudimentarios llamados dentículos, en este caso se conoce como odontoma compuesto o presentarse imagen radiopaca como conglomeraciones amorfas, recibiendo el nombre de odontoma complejo. Su etiología se le relaciona con restos paradentales de Malassez, procesos inflamatorios, traumatismos, se le asocia en algunos casos con el quiste odontogénico calcificante, son asintomáticos, producen retención dentaria. El tratamiento es quirúrgico y su recurrencia es baja. Se reporta serie de casos que acudieron al servicio de estomatología y cirugía oral de la Universidad de Cartagena con impresión diagnostica de odontoma, se realizaron los procedimientos quirúrgicos confirmando los diagnósticos con los reportes histopatológicos.Odontoma is the most frequent odontogenic tumor in oral cavity, comprising a mixture of odontogenic cells forming dentin and enamel. It shows cells and normal tissues but in abnormal structure. These tissues are located in the area of the body where it presents its growth. Under radiographic examination may be radiopaque images as a large number of rudimentary teeth called denticles, in this case is known as compound odontoma or presented as conglomerates amorphous radiopaque image, receiving the name of complex odontoma. Its etiology is related to remnants of Malassez paradontals, inflammatory processes. Trauma is sometimes associated with calcifying odontogenic cyst. Generally are asymptomatic, produce tooth retention. Treatment is surgical and recurrence is low. Is reported in the present paper a number of cases that went to

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

    Directory of Open Access Journals (Sweden)

    Raza Shahzad

    2009-01-01

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

  3. Transforaminal versus posterior lumbar interbody fusion as operative treatment of lumbar spondylolisthesis, a retrospective case series

    Directory of Open Access Journals (Sweden)

    S.L. de Kunder, MD

    2016-09-01

    Conclusion: In this case series, TLIF was associated with shorter surgical time. Other assumed advantages of TLIF could not be verified in this retrospective patient series. Further prospective research is needed to confirm these results.

  4. The International Documentation and Evaluation System IDES: a single center observational case series for development of an ankle prosthesis documentation questionnaire and study of its feasibility and face validity

    Directory of Open Access Journals (Sweden)

    Dudda Marcel

    2010-03-01

    Full Text Available Abstract Background The number of implanted total ankle replacements is increasing and most articles present short- and mid-term results. Comparison of outcomes is difficult because of inconsistent terminology and different use of parameters. Materials and methods We created a module for total ankle prostheses in the framework of the International Documentation and Evaluation System (IDES. Content development was conducted with an iterative process based on a single surgeon series of 74 HINTEGRA© total ankle replacements and expert opinions. Results The IDES ankle module comprises three forms A, B and C for recording of primary (A, revision (B and followup (C procedures. 74 primary interventions, 28 revisions and 92 followups could be documented in detail with the final version of the questionnaires. Conclusion The IDES-forms facilitate a structured and standardized data collection for total ankle arthroplasties. Implemented on the academic MEMdoc portal http://www.memdoc.org of the University of Bern, all registered users can make use of IDES in its online or paper based versions.

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

    Science.gov (United States)

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

    2016-01-01

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

  6. Minimally Invasive Surgical Treatment of Acute Epidural Hematoma: Case Series

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    Weijun Wang

    2016-01-01

    Full Text Available Background and Objective. Although minimally invasive surgical treatment of acute epidural hematoma attracts increasing attention, no generalized indications for the surgery have been adopted. This study aimed to evaluate the effects of minimally invasive surgery in acute epidural hematoma with various hematoma volumes. Methods. Minimally invasive puncture and aspiration surgery were performed in 59 cases of acute epidural hematoma with various hematoma volumes (13–145 mL; postoperative follow-up was 3 months. Clinical data, including surgical trauma, surgery time, complications, and outcome of hematoma drainage, recovery, and Barthel index scores, were assessed, as well as treatment outcome. Results. Surgical trauma was minimal and surgery time was short (10–20 minutes; no anesthesia accidents or surgical complications occurred. Two patients died. Drainage was completed within 7 days in the remaining 57 cases. Barthel index scores of ADL were ≤40 (n=1, 41–60 (n=1, and >60 (n=55; scores of 100 were obtained in 48 cases, with no dysfunctions. Conclusion. Satisfactory results can be achieved with minimally invasive surgery in treating acute epidural hematoma with hematoma volumes ranging from 13 to 145 mL. For patients with hematoma volume >50 mL and even cerebral herniation, flexible application of minimally invasive surgery would help improve treatment efficacy.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  9. Clinical outcomes following manual physical therapy and exercise for hip osteoarthritis: a case series.

    NARCIS (Netherlands)

    MacDonald, C.W.; Whitman, J.M.; Cleland, J.A.; Smith, M.; Hoeksma, H.L.

    2006-01-01

    Study Design: Case series describing the outcomes of individual patients with hip osteoarthritis treated with manual physical therapy and exercise. Case Description: Seven patients referred to physical therapy with hip osteoarthritis and/or hip pain were included in this case series. All patients we

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

    Science.gov (United States)

    Malande, Oliver Ombeva

    2014-01-01

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

  11. Metformin-induced lactic acidosis: a case series

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    Silvestre Joana

    2007-10-01

    Full Text Available Abstract Introduction Unlike other agents used in the treatment of type 2 diabetes mellitus, metformin has been shown to reduce mortality in obese patients. It is therefore being increasingly used in higher doses. The major concern of many physicians is a possible risk of lactic acidosis. The reported frequency of metformin related lactic acidosis is 0.05 per 1000 patient-years; some authors advocate that this rate is equal in those patients not taking metformin. Case presentation We present two case reports of metformin-associated lactic acidosis. The first case is a 77 year old female with a past medical history of hypertension and type 2 diabetes mellitus who had recently been prescribed metformin (3 g/day, perindopril and acetylsalicylic acid. She was admitted to the emergency department two weeks later with abdominal pain and psychomotor agitation. Physical examination revealed only signs of poor perfusion. Laboratory evaluation revealed hyperkalemia, elevated creatinine and blood urea nitrogen and mild leukocytosis. Arterial blood gases showed severe lactic acidemia. She was admitted to the intensive care unit. Vasopressor and ventilatory support was initiated and continuous venovenous hemodiafiltration was instituted. Twenty-four hours later, full clinical recovery was observed, with return to a normal serum lactate level. The patient was discharged from the intensive care unit on the sixth day. The second patient is a 69 year old male with a past medical history of hypertension, type 2 diabetes mellitus and ischemic heart disease who was on metformin (4 g/day, glycazide, acetylsalicylic acid and isosorbide dinitrate. He was admitted to the emergency department in shock with extreme bradycardia. Initial evaluation revealed severe lactic acidosis and elevated creatinine and urea. The patient was admitted to the Intensive Care Unit and commenced on continuous venovenous hemodiafiltration in addition to other supportive measures. A

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

    Science.gov (United States)

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

    2016-01-01

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

  13. Fahr’s disease: a case series

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    Osama Shukir Muhammed Amin

    2013-08-01

    Full Text Available Fahr’s disease is a rare idiopathic bilateral and symmetrical calcification of the basal ganglia, thalami, subcortical hemispheric white matter, and deep cerebellar nuclei that usually presents between the 4nd and 6th decade of life with a variable combination of involuntary movements, Parkinsonism, presenile subcortical dementia, seizures, and ataxia. This longitudinal observational case series was conducted at the neurology outpatients’ department of Sulaimaniya general teaching hospital, Iraq. Three patients were diagnosed with Fahr’s disease. Their chief presenting complaint and other coexistent clinical features were noted and followed-up for at least one year. The ages of those consecutive patients were 25, 34, and 21 years, respectively. Two were females and the other patient was a male. The chief presenting complaint among the 3 patients was heterogeneous; cognitive impairment, seizures, and chorea, respectively. At the time of diagnosis, Parkinsonism and cognitive decline were present in all patients. The 3 patients never developed dystonia, dyskinesia, or athetosis and one patient only had mild cerebellar ataxia. Seizures were the presenting feature in one patient and they never developed in the other 2 patients. All patients had a variable degree of intracerebral calcification. Fahr’s disease has heterogeneous phenotypes and the brain radiological findings do not predict the clinical presentation and course. Although Parkinsonism was not the presenting feature, it was found in all patients at the time of diagnosis. Involuntary movements and cerebellar dysfunction were uncommon and the cognitive impairment was of the frontal lobe subcortical dysfunction. [Cukurova Med J 2013; 38(4.000: 823-831

  14. Benign paroxysmal positional vertigo after radiologic scanning: a case series

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    Aydin Erdinc

    2008-03-01

    Full Text Available Abstract Introduction Benign paroxysmal positional vertigo (BPPV is the most common type of vertigo. It is frequently seen in elderly patients, and the course of the attack may easily mimic cerebrovascular disease. A BPPV attack after a radiologic examination has not been reported previously. We report the cases of two patients who had BPPV attacks after radiologic imaging. Case presentation The first patient with headache and tremor was admitted to the radiology department for cranial computed tomography (CT imaging. During scanning, she was asked to lie in the supine position with no other head movements for approximately 10 minutes. After the cranial CT imaging, she stood up rapidly, and suddenly experienced a vertigo attack and nausea. The second patient was admitted to the radiology department for evaluation of his renal arteries. During the renal magnetic resonance angiography, he was in the supine position for 20 minutes and asked not to move. After the examination, he stood up rapidly with the help of the technician and suddenly experienced a vertigo attack with nausea and vomiting. The results of standard laboratory analyses and their neurologic examinations were within normal limits and Dix-Hallpike tests showed rotatory nystagmus in both cases. An Epley maneuver was performed to the patients. The results of a control Dix-Hallpike tests after 1 Epley maneuver were negative in both patients. Conclusion Radiologists and clinicians must keep in mind that after radiologic imaging in which the patient is still for some time in the supine position and then helped to stand up rapidly, a BPPV attack may occur.

  15. BISPHOSPHONATES IN LANGERHANS CELL HISTIOCYTOSIS: AN INTERNATIONAL RETROSPECTIVE CASE SERIES

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    Deepak Chellapandian

    2016-07-01

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

  16. Solid pseudopapillary neoplasm of the pancreas in pediatric patients: A case report and institutional case series

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    Justin B. Mahida

    2015-04-01

    Full Text Available Solid pseudopapillary neoplasm (SPN of the pancreas is a rare tumor presenting in adolescent and young adult females. A previously healthy 13 year-old female presented to our institution with abdominal pain and emesis. Imaging revealed a pancreatic cystic mass. Endoscopic ultrasound (EUS with fine needle biopsy suggested SPN. Pathologic evaluation following resection revealed immunohistochemical (IHC staining positive for β-catenin and α-1-antitrypsin despite extensive necrosis. We discuss this patient as well as our institutional series of SPN of the pancreas, describing the evaluation, management, and histopathology of this rare tumor.

  17. Task-Driven Evaluation of Aggregation in Time Series Visualization.

    Science.gov (United States)

    Albers, Danielle; Correll, Michael; Gleicher, Michael

    2014-01-01

    Many visualization tasks require the viewer to make judgments about aggregate properties of data. Recent work has shown that viewers can perform such tasks effectively, for example to efficiently compare the maximums or means over ranges of data. However, this work also shows that such effectiveness depends on the designs of the displays. In this paper, we explore this relationship between aggregation task and visualization design to provide guidance on matching tasks with designs. We combine prior results from perceptual science and graphical perception to suggest a set of design variables that influence performance on various aggregate comparison tasks. We describe how choices in these variables can lead to designs that are matched to particular tasks. We use these variables to assess a set of eight different designs, predicting how they will support a set of six aggregate time series comparison tasks. A crowd-sourced evaluation confirms these predictions. These results not only provide evidence for how the specific visualizations support various tasks, but also suggest using the identified design variables as a tool for designing visualizations well suited for various types of tasks.

  18. Cognitive behavior therapy for Stuttering: A case series

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    Reddy R

    2010-01-01

    Full Text Available The present investigation was aimed at studying the efficacy of cognitive behavior therapy (CBT in reducing the symptoms of stuttering and dysfunctional cognitions and in enhancing assertiveness and quality of life in clients with stuttering. Five clients with stuttering who met the inclusion criteria (male clients with diagnosis of stuttering and exclusion criteria (clients with brian damage, substance abuse or mental retardation were enrolled for the study. A single-case design was adopted. The pre-, mid- and post-assessment were carried out using Stuttering Severity Scale (SSI, Perception of Stuttering Inventory (PSI, Beck′s Anxiety Inventory (BAI, Dysfunctional Attitude (DAS, Fear of Negative Evaluation (FNE, Assertiveness Scale (AS, Rosenberg′s Self-Esteem Scale (RSES, and World Health Organization - Quality of Life Scale (WHO-QOL. Five clients received cognitive behavioral intervention comprising of psycho-education, relaxation, deep breathing, humming, prolongation, cognitive restructuring, problem-solving strategies and assertiveness. At post-treatment assessment, there was improvement. The findings of the study are discussed in the light of available research work, implications, limitations of the study and suggestions for future research.

  19. Prospective small bowel mucosal assessment immediately after chemoradiotherapy of unresectable locally advanced pancreatic cancer using capsule endoscopy: a case series.

    Science.gov (United States)

    Yamashina, Takeshi; Takada, Ryoji; Uedo, Noriya; Akasaka, Tomofumi; Hanaoka, Noboru; Takeuchi, Yoji; Higashino, Koji; Ioka, Tatsuya; Ishihara, Ryu; Teshima, Teruki; Nishiyama, Kinji; Iishi, Hiroyasu

    2016-01-01

    In this case series, three consecutive patients with unresectable locally advanced pancreatic cancer (ULAPC) underwent capsule endoscopy (CE) before and after chemoradiotherapy (CRT) to evaluate duodenal and jejunal mucosa, and to examine the relationship between CE findings and dose distribution. CE after CRT showed duodenitis and proximal jejunitis in all three patients. The most inflamed region was the third part of the duodenum, and in dose distribution, this was the closest region to the center of irradiation. This case series shows that CE can safely diagnose acute duodenitis and proximal jejunitis caused by CRT for ULAPC, and that dose distribution is possible to predict the degree of duodenal and jejunal mucosal injuries.

  20. Evaluation of the "Feeling Good" Television Series. Summary.

    Science.gov (United States)

    Mielke, Keith W.; Swinehart, James W.

    "Feeling Good" is the first television series for adults produced by the Children's Television Workshop, aired in prime time during 1974-1975 by the Public Broadcasting Service. The series attempted to reach the general public and motivate them to practice health maintenance behaviors. Various presentation formats were used. It was…

  1. Facial contouring with parascapular free flap: A case series of 22 cases

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    Guru Dayal Singh Kalra

    2013-01-01

    Full Text Available Background: The facial asymmetry correction in complex craniofacial malformations presents a challenging problem for reconstructive surgeons. Progressive hemifacial atrophy (HFA and hemifacial microsomia (HFM can manifest in different grades of severity. Most patients require only soft-tissue augmentation. Free flaps are the best option for correction of severe facial soft-tissue deficiency. Materials and Methods: Twenty-two patients of HFM and HFA were included in this study from January 2006 to March 2009 in the Department of Plastic and Reconstructive Surgery, SMS Medical College and Hospital. In all cases, atrophy correction was done using de-epithelialised parascapular free flap with the de-epithelialised surface was placed under the skin. A small skin paddle was taken for monitoring. Results: All cases were reconstructed with de-epithelialised parascapular free flap. There was no flap loss in this series. Hematoma was noted in five cases. Debulking and removal of skin paddle were done in all cases after 6 months. Atrophy recurrence was not observed in any of the cases on follow-up. Conclusion: Contouring of face in cases of HMF and HFA is satisfactorily done with the parascapular free flap. It gives better cosmetic results with minimal donor site morbidity. Facial vessels are better recipient vessels for anastomosis. Keeping de-epithelialised surface of flap under the skin helped in preventing sagging.

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

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    Priya Sreedaran

    2015-01-01

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

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

    Science.gov (United States)

    Sreedaran, Priya; Ashok, M V

    2015-01-01

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

  4. Metacognitive therapy in recurrent depression: a case replication series in Denmark.

    Science.gov (United States)

    Callesen, Pia; Jensen, Anne Backhausen; Wells, Adrian

    2014-02-01

    Metacognitive therapy (MCT) for depression is derived from the Wells and Matthews (1994) self-regulatory model, in which a Cognitive-Attentional Syndrome (CAS) is the cause of psychological disorders. MCT for depression focuses on identifying patients' CAS and helps them to stop it. The CAS consists of worry, rumination and dysfunctional coping strategies. The focus in MCT is on removing the CAS by challenging positive and negative metacognitive beliefs and eliminating dysfunctional behaviors. In this case series, MCT was delivered to four depressed Danes and treatment was evaluated in 5-11 sessions of up to one hour each. An A-B design with follow-up at 3 and 6 months was conducted and the primary outcome was Beck's Depression Inventory II (BDI-II). We measured CAS processes with the Major depressive Disorder Scale (MDD-S). The results of the case series showed clinically significant improvements in depressive symptoms, rumination and metacognitive beliefs and the effects were still present at follow-up for all patients. The small number of patients and decreasing baselines observed in some cases limits the conclusions. However, the results suggest that this treatment is feasible and was associated with large improvements in symptoms when delivered away from its point of origin and in a Danish help-seeking sample.

  5. Epidermoid carcinoma of the anal canal. A series of 276 cases

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    Papillon, J.; Montbarbon, J.F.

    1987-05-01

    During the past ten years, substantial progress has been made in the knowledge of the natural history of epidermoid carcinoma of the anal canal and of the response of the disease to radiotherapy alone or combined with chemotherapy. At the present time, the main problem in the management of this tumor concerns identification of the best modalities to achieve local control and preservation of anal function. From a series of 276 cases, followed for more than three years, the necessity for a careful pretreatment evaluation was stressed. This included a systematic search for pelvic metastatic lymph nodes by palpation and CT scan. All patients were treated initially by irradiation except those who underwent groin dissection for inguinal node metastasis or colostomy for complete anal obstruction. Three groups of patients have been identified: unresectable or disseminated tumors (33 cases), resectable tumors but not suitable for sphincter conservation (21 cases) treated by radiochemotherapy and delayed surgery, and resectable tumors suitable for sphincter conservation (222 cases) which were treated by a split-course regimen combining a short course of carefully planned external beam irradiation (19 days) followed by an iridium 192 implant after a two-month rest. In this group, which represents 80 percent of the whole series, 80 percent of patients have had their cancer controlled and 90 percent of controlled patients have retained normal anal function. The use of chemotherapy during the first days of irradiation is advisable in all cases to reinforce the efficacy of treatment and increase the chance of anal preservation. Results of the split-course regimen, combining external beam and interstitial irradiation, demonstrate a clear superiority over external beam irradiation alone, especially for large infiltrating tumors, which represent the majority of cases.

  6. Carbamazepine-induced Stevens Johnson syndrome: a case series of three case reports

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    Arvind Kumar

    2015-08-01

    Full Text Available Carbamazepine is an iminostilbene derivative that was initially used as an antiepileptic but has been used with increased frequency for different indications including chronic pain, trigeminal neuralgia, and herpetic neuralgias. This has resulted in increased incidence of carbamazepine related adverse effects such as nausea, vomiting, and serious hematological toxicities such as aplastic anemia, agranulocytosis, eosinophilia, lymphadenopathy, and splenomegaly. Life-threatening hypersensitivity reactions such as Steven Johnson syndrome (SJS and toxic epidermal necrolysis can also occur. We hereby present a series of three cases that were prescribed carbamazepine for different indications and presented with SJS. [Int J Basic Clin Pharmacol 2015; 4(4.000: 797-801

  7. Eosinophilic Gastroenteritis Presenting as Intestinal Obstruction - A Case Series

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    Amita Krishnappa

    2011-07-01

    Full Text Available Eosinophilic Gastroenteritis is a rare disease characterized by infiltration of the gastrointestinal tract by an increased number of eosinophils as compared to the normal. The anatomic location and intensity of the infiltrate decides the varied clinical symptomatology with which these patients present. The present report deals with four cases, all presenting with clinical signs of intestinal obstruction A laparotomy performed revealed a stricture in the first case, superficial ulcers and adhesions in the second case, an ileocaecal mass in the third case and volvulus formation in the fourth case. Eosinophilic gastroenteritis was confirmed on histopathology in all the four cases. All the four patients experienced relief of symptoms after resection. It is essential to diagnose the disease to differentiate it from other conditions presenting as intestinal obstruction. The cases are presented because of the rarity of occurrence and presentation. Relevant literature has been reviewed.

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

    Science.gov (United States)

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

    2010-10-01

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

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

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    Abhay P Kolte

    2010-01-01

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

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

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    Philip McClure; David Booy; Julia Katarincic; Craig Eberson

    2016-01-01

    Background. Mobius Syndrome is a rare disease defined by bilateral congenital 7th nerve palsy. We focus on reporting the prevalence of orthopedic disease in this population. Methods. Twenty-three individuals with Mobius Syndrome underwent orthopedic physical examination, and additional 96 patients filled out a survey for self-reported orthopedic diagnoses. Results. Clubfoot was present in 60% of individuals in the physical exam series and 42% of those in the survey. Scoliosis was present in 2...

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

    OpenAIRE

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

    2010-01-01

    Intraoral fibrous overgrowths of the soft tissues are relatively common and may be benign reactive or neoplastic lesions. A series of 10 lesions is presented which included pyogenic granuloma, fibroma and peripheral ossifying fibroma. Almost all the lesions occurred in the second and third decades and were present in the anterior segment of the jaws, with a distinct female predilection. Majority of these lesions were asymptomatic and the patients reported for treatment only due to the discomf...

  12. Cerebral venous sinus thrombosis complicated by subdural hematomas: Case series and literature review

    OpenAIRE

    Akins, Paul T.; Axelrod, Yekaterina K; Ji, Cheng; Ciporen, Jeremy N.; Arshad, Syed T.; Hawk, Mark W.; Guppy, Kern H.

    2013-01-01

    Background: Cerebral venous sinus thrombosis (CVST) can cause elevated intracranial pressure, hemorrhagic venous infarct, and cortical subarachnoid hemorrhage. We present a case series and literature review to illustrate that CVST can also present with subdural hematoma (SDH). Case Description: Chart review was completed on a retrospective case series of CVST with spontaneous SDH. We also conducted a literature search. Over a 6 year interval, three patients with CVST and SDH were admitted to ...

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

    Science.gov (United States)

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

    2005-01-01

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

  14. Newer antidepressants in pregnancy: prospective outcome of a case series.

    Science.gov (United States)

    Yaris, Fusun; Kadioglu, Mine; Kesim, Murat; Ulku, Cunay; Yaris, Ersin; Kalyoncu, Nuri Ihsan; Unsal, Mesut

    2004-12-01

    Antidepressant drug choice in pregnancy is a complex problem especially for new drugs. Among 590 cases exposed to drugs during pregnancy who were followed by our center, 21 cases used newer antidepressants, i.e., venlafaxine, mirtazapine, nefazodone. We present the gestational findings and fetal outcomes of these cases. Ten cases had used venlafaxine, one case had used both venlafaxine and mirtazapine, eight had used mirtazapine alone or with some other drugs and two had used nefazodone, in the first trimester. Of the 21 cases, 17 (80.9%) had healthy babies, 3 (14.3%) decided to terminate the pregnancy, and 1 (4.8%) spontaneous abortion was observed in a case exposed to mirtazapine, alprazolam, diazepam and trifluoperazine. All obstetrical findings were normal during the pregnancy of each case. No congenital abnormality and developmental problem was observed in the babies followed up for 12 months. The aim of the present study is to contribute the data to the limited knowledge available in the literature regarding human pregnancy.

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

    Science.gov (United States)

    Setia, Maninder Singh

    2016-01-01

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

  16. Filicide-Suicide: Case Series and Review of the Literature.

    Science.gov (United States)

    Shields, Lisa B E; Rolf, Cristin M; Goolsby, Mary E; Hunsaker, John C

    2015-09-01

    Homicide-suicides or "dyadic deaths" refer to a homicide followed by the suicide of the perpetrator within 1 week of the homicide. A unique subset is filicide-suicide: a parent kills his/her child before committing suicide. Shooting is the preferred method for both the homicide and suicide. The perpetrator has depression in most cases.We present 3 cases of filicide-suicide. In case 1, a divorced mother with schizophrenia and bipolar disorder shot her son and herself. In case 2, a father shot his son and himself while involved in a child-custody dispute. In case 3, a father, experiencing a divorce and financial difficulties, and his daughter with Angelman syndrome succumbed to carbon monoxide poisoning.The forensic pathologist should be aware of the psychosocial dynamics that interplay in filicide-suicide. Diligent attention to a parent's life stressors may aid in determining risk factors for filicide-suicide.

  17. Open refrigerating display case 'MAX series' for supermarkets; Supermarket muke denki reizo open showcase (MAX series)

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, E.; Sudo, H.; Aoyama, Y. [Fuji Electric Co. Ltd., Tokyo (Japan)

    2000-03-10

    Fuji Electric has developed the open refrigerating display case 'MAX Series' for supermarkets which has further pursued 'articles easy to see, select, and take out' on the concept of 'friendliness' as well as friendliness to customers and installation workers. Its main advantages are (1) The dimensions were determined based on human engineering and improved the display effect of articles. This enables the exhibits to strongly appeal to customers. (2) The air curtain optimized through simulation realizes uniform temperature in the case, reduction in energy consumption, and high freshness control. (author)

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

    Science.gov (United States)

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

    2016-01-01

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

  19. Transmetatarsal Amputation: A Case Series and Review of the Literature

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    Ryan McCallum

    2012-01-01

    Full Text Available Foot ulceration is a major cause of morbidity amongst patients with diabetes. In severe cases of ulceration, osteomyelitis and amputation can ensue. A distinct lack of agreement exists on the most appropriate level of amputation in cases of severe foot ulceration/infection to provide predictable healing rates. This paper provides an overview of the transmetatarsal amputation (TMA as a limb salvage procedure and is written with the perspective and experiences of the Department of Podiatric Surgery at West Middlesex University Hospital (WMUH. We have reflected on the cases of 11 patients (12 feet and have found the TMA to be an effective procedure in the management of cases of severe forefoot ulceration and infection.

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

    Science.gov (United States)

    Brown, George R

    2015-03-01

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

  1. Ophthalmologic manifestations of focal dermal hypoplasia (Goltz syndrome): A case series of 18 patients.

    Science.gov (United States)

    Gisseman, Jordan D; Herce, Honey H

    2016-03-01

    Focal Dermal Hypoplasia (FDH) or Goltz syndrome is a rare multi-system disorder with cutaneous, ocular, dental, and skeletal anomalies due to dysplasia of mesoectodermal derived tissues. It is an X-linked inheritance syndrome caused by mutations in the PORCN gene. This study is aimed to investigate the ocular findings in patients with Goltz syndrome. To date, there have been a limited number of case reports on the ocular manifestations of FDH. This is a prospective, non-consecutive, observational case series. Prospective ophthalmologic evaluation was performed on 18 patients with confirmed genetic testing for FDH, Goltz Syndrome, as a component of a larger multi-subspecialty study to better characterize the findings of this condition. Special attention was placed on evaluating the incidence of anophthalmia, microphthalmia, colobomas (iris, optic nerve, and/or retinal), cataracts, nystagmus, and strabismus. A complete ophthalmologic exam was done on all the patients. The mean patient age was 12.8 years (1-55 years). Eighty-nine percent were female and 77% (14/18) of patients had some form of an ophthalmologic manifestation of the condition. Ophthalmological findings included chorioretinal colobomas (61%), iris colobomas (50%), microphthalmia (44%), anophthalmia (11%), cataracts (11%), and conjunctival and eyelid papillomas (5%). Nystagmus was present in 33% and strabismus in 22% of the patients. Visual acuity ranged from 20/20 to no light perception. This study demonstrates a higher incidence of ophthalmologic manifestations as previously reported (77% vs. 40%). To our knowledge, this is the largest case series reported in the literature with 18 patients.

  2. Cysticercosis of the eye in south India - A case series

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    Kaliaperumal S

    2005-01-01

    Full Text Available Purpose: To study the clinical presentation and treatment outcome of patients with ocular cysticercosis in southern India. Methods: This study included 10 patients who were diagnosed to have ocular or adnexal cysticercosis over a period of one year in Pondicherry, India. The clinical presentation, results of investigation and treatment outcome of the cases were analysed retrospectively. Results: Age of these patients ranged from 12 to 55 years. Four presented with loss of vision, two with a swelling in the eyelid, one with proptosis, one with diplopia and two with conjunctival involvement. ELISA for cysticercus antibodies in serum was positive in all cases. Albendazole and prednisolone were given for the treatment of these cases. Two patients responded well to treatment and were completely cured of the disease. There was partial improvement in 6 cases. Surgery in the form of excision was performed in two cases following a course of medical therapy. There was no significant change in visual acuity in eyes with intraocular cysticercosis following treatment. Conclusion: Ultrasonography B scan and ELISA for anticysticercal antibodies help to establish the diagnosis of ocular cysticercosis. A combination of oral albendazole and corticosteroids is found to be effective in confirmed cases. Intraocular cysticercosis is associated with a poor prognosis for vision.

  3. NASAL GLIAL HETEROTOPIA-A SERIES OF FOUR CASES

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    Ramani

    2013-05-01

    Full Text Available ABSTRACT: Glial heterotopias are rare, benign, congenital, mi dline, non- teratomatous extra cranial glial tissues. They may masquerade as encep halocoele or dermoid cyst and mostly present in and around the nose. Clinically, these masses are firm and incompressibl e. Histologically, they are made up of astrocytes and neuroglial cells, emb edded in fibrous and vascular connective tissue. Here in, we present 4 cases of nasal glial heteroto pias. The first case was an 8 month old boy who presented with broadening of nose since birth. The second case was of 6 months old girl who presented with a soft tissue swelling over the root of the nose. The third case was of a 2 months old boy who presented with a soft tissue swelling over the nasolabial fold. The fourth case was a 5 month old boy with mass in left nostril. The radiol ogical and histological features along with differential diagnosis are discussed. These cases a re presented because of their rarity.

  4. Evaluation of Viral Meningoencephalitis Cases

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    Handan Ilhan

    2012-08-01

    Full Text Available AIM: To evaluate retrospectively adult cases of viral encephalitis. METHOD: Fifteen patients described viral encephalitis hospitalized between the years 2006-2011 follow-up and treatment at the infectious diseases clinic were analyzed retrospectively. RESULTS: Most of the patients (%60 had applied in the spring. Fever (87%, confusion (73%, neck stiffness (73%, headache (73%, nausea-vomiting (33%, loss of consciousness (33%, amnesia (33%, agitation (20%, convulsion (%20, focal neurological signs (13%, Brudzinski-sign (13% were most frequently encountered findings. Electroencephalography test was applied to 13 of 14 patients, and pathological findings compatible with encephalitis have been found. Radiological imaging methods such as CT and MRI were performed in 9 of the 14 patients, and findings consistent with encephalitis were reported. All of initial cerebrospinal fluid (CSF samples were abnormal. The domination of the first examples was lymphocytes in 14 patients; only one patient had an increase in neutrophilic cells have been found. CSF protein level was high in nine patients, and low glucose level was detected in two patients. Herpes simplex virus polymerized chain reaction (PCR analyze was performed to fourteen patients CSF. Only two of them (14% were found positive. One of the patients sample selectively examined was found to be Parvovirus B19 (+, the other patient urine sample Jacobs-creutzfeld virus PCR was found to be positively. Empiric acyclovir therapy was given to all patients. Neuropsychiatric squeal developed at the one patient. CONCLUSION: The cases in the forefront of change in mental status viral meningoencephalitis should be considered and empirical treatment with acyclovir should be started. [TAF Prev Med Bull 2012; 11(4.000: 447-452

  5. Candida parapsilosis candidaemia in a neonatal unit over 7 years: a case series study

    Science.gov (United States)

    Miranda, Lourdes das Neves; Rodrigues, Eliete C A; Costa, Silvia F; van der Heijden, Inneke Marie; Dantas, Kátia C; Lobo, Renata D; Basso, Mariusa; Varkulja, Gláucia F; Krebs, Vera Lúcia Jornada; Gibelli, Maria Augusta Bento Cicaroni; Criado, Paulo R; Levin, Anna Sara

    2012-01-01

    Objective To evaluate Candida parapsilosis candidaemia in a neonatal unit over 7 years. Design Case series study. Setting A 2000-bed tertiary-care university hospital at São Paulo, Brazil. Participants Neonates hospitalised in a 63-bed neonatal unit. Primary and secondary outcome measures We evaluated the incidence of C parapsilosis fungemia in a neonatal unit from 2002 through 2008 and the main microbiological, clinical and epidemiological aspects of this disease in neonates. During the study period an outbreak occurred, an infection control programme was implemented, and isolates from blood and hand healthcare workers (HCWs) were submitted to molecular typing. Results During 7 years, there were 36 cases of C parapsilosis fungaemia and annual incidence varied from 0 to 19.7 per 1000 admissions. Evaluating 31 neonates with fungemia, the mean age at diagnosis was 19 days. All children except for one were premature; all had received total parenteral nutrition and all but one had used central venous catheter. Three neonates had received antifungal treatment previously to the diagnosis. Thirty-day mortality was 45%. Only lower birthweight was associated with mortality. C parapsilosis species complex was isolated from hand cultures in eight (11%) of the HCWs (one isolate was identified as C orthopsilosis). By molecular typing no HCW isolate was similar to any of the blood isolates. Conclusions The incidence of C parapsilosis fungemia in a neonatal unit varied widely over 7 years. We observed in our series a higher death rate than that reported in European countries and the USA. PMID:22869093

  6. IMPACT OF SEQUENTIAL NEOADJUVANT CHEMOTHERAPY IN LOCALLY ADVANCED BREAST CANCER: A SERIES OF 10 CASES

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    Gopa

    2014-04-01

    Full Text Available Breast cancer currently is a major health problem among women worldwide accounting for around 13.7% cancer deaths, nearly 1/3rd of it being due to Locally advanced breast cancer (LABC. Despite progress achieved in diagnosis & therapy of Breast cancer, LABC remains a major clinical challenge and in efforts to increase pCR, CCR & DFS in LABC, Neoadjuvant or primary chemotherapy followed by locoregional therapy and adjuvant systemic CT is well accepted treatment strategy since last 3 decades. Further to address the issue of drug resistance in NACT sequential anthracycline-taxane NACT has been evaluated by many researchers and has resulted in better outcome in terms of overall survival and pCR. In this study we have evaluated 4 cycles of sequential anthracycline-taxane, 2 cycles of Cyclophosphamide, Epirubicin, Fluracil +2 cycles of Docetaxel, Epirubicin (CEF- DE NACT in a series of 10 cases of ER/PR +ve, Her -2 neu negative patients of LABC. 9/10 cases were rendered operable after primary chemotherapy and were subjected to further 4 cycles of adjuvant chemotherapy (1 cycle CEF, 1 cycle DE, 2cycles single agent Docetaxel, followed by locoregional RT. This tailored sequential NACT protocol in our subgroup of patient was well tolerated, well accepted and resulted in substantial increase in operability with CCR & DFS in 6/10 cases on 3 years follow up and pCR in one patient. Sequential NACT needs further validation by more RCT with extensive follow up

  7. Evaluation of Textbook Series "Life" in Terms of Cultural Components

    Science.gov (United States)

    Böcü, Ayça Berna; Razi, Salim

    2016-01-01

    This study aimed to identify elements related to "intercultural communicative competence" in the textbook series "Life" at A1 and A2 level published by "National Geographic Learning" which incorporates plentiful photographic content. Activities in the textbooks, based on the four skills and visuals, were analyzed…

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

    Science.gov (United States)

    Patra, Suravi

    2016-01-01

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

  9. Nevus of Ota: A series of 15 cases

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    Sekar Shanmuga

    2008-01-01

    Full Text Available Background: The nevus of Ota is a dermal nevus characterized by bluish pigmentation in the distribution of the first and the second division of the trigeminal nerve. Aim: Our aim was to study the cutaneous and extracutaneous manifestations of the nevus of Ota. Methods: A total of 15 cases were included in our study. A detailed history, clinical examination along with direct ophthalmoscopy and otoscopy were done for all the cases. Results: Most of the patients (60% had lesions at birth and the majority (86.7 % were females. Five (33.3% patients belonged to Tanino class II. Combined dermal and ocular involvement was observed in 60% of the cases. Conclusion: Tanino class II was the most common type observed in our studies. A few rarer associations such as nevus of Ito and hemangioma were also noted in our patients.

  10. Neuroinfection as a Mask of Lung Cancer: A Case Series

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    Beata Kuklińska

    2016-01-01

    Full Text Available Introduction. The diagnosis of lung cancer may still be difficult due to the fact that the first symptoms very often mimic symptoms of other diseases. Case Presentation. In this paper we present two cases, in which initial diagnosis of neuroinfection delayed proper diagnosis. Conclusion. Based on our experience we concluded that neurological symptoms in the area endemic for tick-borne diseases suggesting neuroinfection require careful differential diagnosis. Moreover, neurological symptoms in heavy smokers may be associated with metastases of lung cancer.

  11. Neuroinfection as a Mask of Lung Cancer: A Case Series

    Science.gov (United States)

    Kuklińska, Beata; Moniuszko-Malinowska, Anna; Mróz, Robert; Pancewicz, Sławomir; Zajkowska, Joanna

    2016-01-01

    Introduction. The diagnosis of lung cancer may still be difficult due to the fact that the first symptoms very often mimic symptoms of other diseases. Case Presentation. In this paper we present two cases, in which initial diagnosis of neuroinfection delayed proper diagnosis. Conclusion. Based on our experience we concluded that neurological symptoms in the area endemic for tick-borne diseases suggesting neuroinfection require careful differential diagnosis. Moreover, neurological symptoms in heavy smokers may be associated with metastases of lung cancer. PMID:27239354

  12. Pancreatitis secondary to Ascaris Lumbricoides: A case series analysis

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    Ab hameed Raina, Ghulam Nabi Yattoo, Feroz Ahmad Wani, Reyaz Ahmad Para, Khaild Hamid Changal, Arshed Hussain Parry

    2013-07-01

    Full Text Available Ascaris lumbricoides infestations are endemic in tropical countries. Ascaris lumbricoides is the second most common intestinal parasite world-wide and, although the infection can be asymptomatic, in some cases it can present with complications, such as acute pancreatitis. Pancreatitis secondary to ascaris is more common in females. We describe three cases who presented with Ascaris lumbricoides-induced acute pancreatitis and all of them were females and were diagnosed on ultrasonography. In two patients the sphicterotomy was done while in third patient the worm came out after two days of conservative management.

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

    Science.gov (United States)

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

    2007-01-01

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

  14. Traumatic abdominal wall hernia in two adults: a case series

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    Agarwal Nitin

    2009-06-01

    Full Text Available Abstract Introduction Traumatic hernia of the abdominal wall is a rare entity. A large proportion of reported cases are in children with a particular type of injury, i.e. from a handlebar injury. In adults, the presentation can vary substantially and the diagnosis is difficult. We present two cases in adults, with widely varying presentations and management. Case presentations A 40-year-old woman from rural north India presented with a low-velocity blunt injury to the lower abdomen. She was attacked by a bull. She had a clinically evident abdominal fascial disruption with intact skin, and was hemodynamically stable. An emergency mesh repair of the defect was performed, and she recovered well. A 38-year-old man from rural north India presented with blunt trauma to the abdomen following a motor vehicle accident. He was stable, with a central abdominal parietal wall swelling and bruising. A computed tomography scan revealed herniation of bowel loops in the area with minor intra-abdominal injuries. A laparotomy, resection-anastomosis of the ischemic bowel, and primary repair of the defect was performed and he recovered well. Conclusion Following blunt abdominal trauma, particularly high-velocity injuries, a high index of suspicion must be reserved for parietal wall swellings, as missed hernias in this setting have a high risk of strangulation. Computed tomography is the best aid to diagnosis. Management of each case needs to be individualized.

  15. Balloon atrial septostomy under echocardiographic guide: case series

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    SM Meraji

    2012-12-01

    Full Text Available Background: Balloon atrial septostomy is an emergent procedure in pediatric cardiology. Nowadays, most patients in need of the procedure have acceptable outcomes after surgical repair. Thus, it is important to perform this procedure as safe as possible. By performing early arterial switch operation and prostaglandin infusion, the rate of balloon atrial septostomy has markedly decreased. However, not all centers performing early arterial switch repairs have abandoned atrial septostomy, even in patients who respond favorably to prostaglandin infusion.Case presentation: In total, eight 1- to 15-day old term neonates admitted in Shahid Rajaee Heart Center in Tehran, Iran from October 2009 to February 2011, with congenital heart diseases were scheduled for balloon atrial septostomy. In six cases the procedure was done exclusively under echocardiographic guidance and in two cases with the help of fluoroscopy. Success was defined as the creation of an atrial septal defect with a diameter equal to or more than 5 mm and ample mobility of its margins.Results: Male sex was predominant (87% and the mean age of the neonates was six days. The diagnosis in all cases was simple transposition of great arteries. The procedure was successful in all patients with any cardiovascular complication.Conclusion: Balloon atrial septostomy is an emergent procedure that can be done safely and effectively under echocardiographic guidance. According to the feasibility of this technique it could be performed fast, safe and effective at bedside, avoiding patient transportation to hemodynamic laboratory or referral center.

  16. Parkinsonism caused by adverse drug reactions: a case series

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    Agaba Emmanuel I

    2011-03-01

    Full Text Available Abstract Introduction Parkinsonism puts a high direct cost burden on both patient and caregiver. Several reports of drug-induced parkinsonism have been published, but to the best of our knowledge, there has not been any report of quinine or halothane inducing parkinsonism. Case presentation We describe two cases of parkinsonism possibly caused by adverse drug reaction to quinine in a 29-year-old black Nigerian woman and to halothane in a 36-year-old black Hausa (Nigerian man who received it as general anaesthesia for appendicectomy in our teaching hospital. Conclusion These are two unusual cases of parkinsonism caused by adverse drug reactions to high-dose quinine and to halothane as general anaesthesia. We consider that these two cases are important in bringing this potential side-effect to the attention of both pharmacologists and primary care physicians as these are two of the most commonly used medications in our clinics. We conclude that parkinsonism should be included among the adverse drug reactions to high-dose quinine and halothane general anaesthetic.

  17. Transverse facial cleft: A series of 17 cases

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    L K Makhija

    2011-01-01

    Full Text Available Introduction: Transverse facial cleft (Tessier type 7 or congenital macrostomia is a rare congenital anomaly seldom occurring alone and is frequently associated with deformities of the structures developing from the first and second branchial arches. The reported incidence of No. 7 cleft varies from 1 in 60,000 to 1 in 300,000 live births. Material and Methods: Seventeen patients of transeverse facial cleft who presented to us in last 5 years were included in the study. Their history regarding familial and environmental predispositions was recorded. The cases were analysed on basis of sex, laterality, severity, associated anomalies and were graded according to severity. They were operated by z plasty technique and were followed up for 2 years to look for effectiveness of the technique and its complications. Result: Out of the seventeen patients of transverse cleft, none had familial predilection or any environmental etiology like antenatal radiological exposure or intake of drugs of teratogenic potential. Most of the patients (9/17 were associated with hemifacial microsomia and 1 patient was associated with Treacher Colin′s Syndrome. Out of the 6 cases of Grade I clefts, 4 were isolated transverse clefts and of the 10 patients of Grade II clefts, 7 were associated with hemifacial microsomia. We encountered only one case of Grade III Transverse Cleft which was not only associated with hemifacial microsomia but also had cardiac anomaly. Out of the17 cases, 15 were operated and in most of them the outcome was satisfactory.

  18. Demyelinating disease masquerading as a surgical problem: a case series

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    Awang Saufi M

    2009-08-01

    Full Text Available Abstract Introduction We report three cases of demyelinating disease with tumor-like presentation. This information is particularly important to both neurosurgeons and neurologists who should be aware that inflammatory demyelinating diseases can present as a mass lesion, which is indistinguishable from a tumor, both clinically and radiologically, especially when there is no evidence of temporal dissemination of this disease. Case presentation The first patient was a 42-year-old Malay woman who developed subacute onset of progressive quadriparesis with urinary incontinence. Magnetic resonance imaging of her spine showed an intramedullary lesion at the C5-C7 level. She was operated on and biopsy was suggestive of a demyelinating disease. Retrospective history discovered two episodes of acute onset of neurological deficits with partial recovery and magnetic resonance imaging of her brain revealed demyelinating plaques in the centrum semiovale. The second patient was a 16-year-old Malay boy who presented with symptoms of raised intracranial pressure. A computed tomography brain scan revealed obstructive hydrocephalus with a lesion adjacent to the fourth ventricle. An external ventricular drainage was inserted. Subsequently, a stereotactic biopsy was taken and histopathology was reported as demyelination. Retrospective history revealed similar episodes with full recovery in between episodes. The third case was a 28-year-old Malay man who presented with acute bilateral visual loss and confusion. Magnetic resonance imaging of his brain showed a large mass lesion in the right temporoparietal region. Biopsy was consistent with demyelinating disease. Reexamination of the patient revealed bilateral papillitis and not papilledema. Visual evoked potential was prolonged bilaterally. In all three cases, lumbar puncture for cerebrospinal fluid study was not carried out due to lack of patient consent. Conclusions These cases illustrate the importance of

  19. Metaplastic changes in the epithelium of radicular cysts: A series of 711 cases

    Science.gov (United States)

    Rosen, Eyal; Dubinsky, Liz; Buchner, Amos; Vered, Marilena

    2016-01-01

    Background This study was aimed to evaluate the prevalence of metaplastic changes in the epithelium of radicular cysts and to investigate how they relate to the clinical and radiographic characteristics of the cysts, based on a large series of radicular cysts. Material and Methods Biopsies of cysts of endodontic origin that were examined at the Department of Oral Pathology between 2004 and 2011 have been re-evaluated for this study. Only cases that were re-confirmed with clinical and histological diagnoses of a radicular or residual radicular cyst were included. The included cases were evaluated for the prevalence of metaplastic changes in the form of mucous secreting cells (MSC) or ciliated cells (CC). The relations between the metaplastic changes and the cyst type (radicular or residual radicular), as well as demographic, clinical and radiographic parameters, were statistically evaluated using Fischer and chi-square tests. Significance was set at p<0.05. Results A total of 711 cysts were included: 677 were radicular cysts (95%) and 34 (5%) were residual radicular cysts. 23 cases had histopathological diagnoses other than radicular or residual radicular cysts and were excluded from the study. MSC were present in 47 (6.6%) cysts. MSC were significantly more common in residual radicular cysts than in radicular cysts [8 (23.5%) and 39 (5.8%), respectively; p<0.001]. MSC-containing cysts were commonly found in asymptomatic patients (10.5%, p<0.001), and usually presented with well-defined radiographic borders (7.2%, p<0.05). CC were present in 34 (4.8%) cysts, with a markedly high prevalence in the maxillary molar sextant (15%, p<0.001). Conclusions In the epithelium of radicular and residual radicular cysts the presence of specific metaplastic changes may be related to cyst type, symptomatology, radiographic findings and tooth location. Key words:Radicular cyst, metaplasia, mucous secreting cells, ciliated cells. PMID:27957265

  20. Bilateral simultaneous acute angle closure caused by sulphonamide derivatives: A case series

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    Senthil Sirisha

    2010-01-01

    Full Text Available The sulphonamide group of drugs is implicated in bilateral acute angle closure (AAC due to an idiosyncratic response. We report a series of three cases with bilateral AAC caused by different sulphonamide derivatives, their presentation and management.

  1. Bilateral simultaneous acute angle closure caused by sulphonamide derivatives: A case series

    OpenAIRE

    Senthil Sirisha; Garudadri Chandrasekhar; Rao Harsha; Maheshwari Rajat

    2010-01-01

    The sulphonamide group of drugs is implicated in bilateral acute angle closure (AAC) due to an idiosyncratic response. We report a series of three cases with bilateral AAC caused by different sulphonamide derivatives, their presentation and management.

  2. Bilateral simultaneous acute angle closure caused by sulphonamide derivatives: a case series.

    Science.gov (United States)

    Senthil, Sirisha; Garudadri, Chandrasekhar; Rao, Harsha B L; Maheshwari, Rajat

    2010-01-01

    The sulphonamide group of drugs is implicated in bilateral acute angle closure (AAC) due to an idiosyncratic response. We report a series of three cases with bilateral AAC caused by different sulphonamide derivatives, their presentation and management.

  3. Terra firma-forme dermatosis: Case Series and dermoscopic features.

    Science.gov (United States)

    Abdel-Razek, Moheb M; Fathy, Hanan

    2015-10-01

    Terra firma-forme dermatosis (TFFD) is characterized by dirt-like skin lesions that disappear after rubbing with alcohol. We describe the dermoscopic features of TFFD before and after alcohol swabbing in six patients. All patients showed similar dermoscopic appearance with large polygonal plate-like brown scales arranged together giving a mosaic pattern. These features disappear completely after isopropyl alcohol swabbing of the lesions. In conclusion dermoscopy can assist in the evaluation of terra firma-forme dermatosis and the dermoscopic evaluation of other dirty dermatoses is recommended in the future to compare findings with TFFD.

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

    Science.gov (United States)

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

    2016-10-01

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

  5. Transphyseal spread of benign tumors and infections in pediatric patients: A series of six cases

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    Bagaria Vaibhav

    2005-06-01

    Full Text Available Epiphyseal extension of benign pathology is regarded as an infrequent occurrence. This observation has been attributed to anatomical and biochemical phenomenon unique to physeal cartilage. We report a retrospective series of six patients over a period of 4 years, diagnosed with benign pathologies that showed crossing of an open physeal plate by the disease. Four of these cases were infections and two were benign tumors. The patients were aged between 5 and 11 years, all of them were treated at a tertiary referral centre and followed up for a minimum period of 6 months to evaluate the progress of disease. The findings are more than just a pathological curiosity as they alter the management and surgical procedure that needs to be performed for these conditions. The recognition of the fact that benign tumors may occasionally present with transphyseal spread will prevent unjustified radical procedures that are best reserved for aggressive malignant conditions.

  6. Connecting Hospitalized Patients with Their Families: Case Series and Commentary

    OpenAIRE

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

    2011-01-01

    The overall aim of this project was to ascertain the utilization of a custom-designed telemedicine service for patients to maintain close contact (via videoconference) with family and friends during hospitalization. We conducted a retrospective chart review of hospitalized patients (primarily children) with extended hospital length of stays. Telecommunication equipment was used to provide videoconference links from the patient's bedside to friends and family in the community. Thirty-six case...

  7. Filiform polyposis in the sigmoid colon: A case series

    Institute of Scientific and Technical Information of China (English)

    Chang; Geun; Lee; Yun; Jeong; Lim; Jong; Sun; Choi; Jin; Ho; Lee

    2010-01-01

    Filiform polyposis is a rare condition of uncertain patho-genesis that is usually found in association with Crohn’s disease, ulcerative colitis, intestinal tuberculosis or histiocytosis X. We report seven interesting cases of polyposis with various pathologic components, mainly located in the left side of the colon with no associated inflammatory bowel disease, intestinal tuberculosis or histiocytosis X. Multiple finger-like polypoid lesions with the appearance of stalactites were noted on the left side of ...

  8. Flatfoot in Müller-Weiss syndrome: a case series

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    Wang Xu

    2012-08-01

    Full Text Available Abstract Introduction Spontaneous osteonecrosis of the navicular bone in adults is a rare entity, known as Müller-Weiss syndrome. We report here on our experience with six patients with Müller-Weiss syndrome accompanied by flatfoot deformity, but on a literature search found no reports on this phenomenon. Because the natural history and treatment are controversial, an understanding of how to manage this deformity may be helpful for surgeons when choosing the most appropriate operative procedure. Case presentation Six patients (five women, one man; average age, 54 years with flatfoot caused by osteonecrosis of the navicular bone were followed up between January 2005 and December 2008 (mean follow-up period, 23.2 months. Conservative treatment, such as physical therapy, and non-steroidal anti-inflammatory drugs were used, but failed. Physical examinations revealed flattening of the medial arch of the involved foot and mild tenderness at the mid-tarsal joint. Weight-bearing X-rays (anterior-posterior and lateral views, computed tomography, and MRI scans were performed for each case. Talonavicular joint arthrodesis was performed in cases of single talonavicular joint arthritis. Triple arthrodesis was performed in cases of triple joint arthritis to reconstruct the medial arch. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale; the scores were 63.0 pre-operatively and 89.8 post-operatively. All patients developed bony fusion. Conclusions The reason for the development of flatfoot in patients with Müller-Weiss syndrome is unknown. Surgical treatment may achieve favorable outcomes in terms of deformity correction, pain relief, and functional restoration. The choice of operative procedure may differ in patients with both flatfoot and posterior tibial tendon dysfunction.

  9. Total Hip Arthroplasty in Failed Hip Fractures: A Case Series

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    Syed Shahid Noor

    2015-01-01

    Full Text Available Osteoporosis is epidemic in Asian countries. It is a major cause of fractures that orthopaedic surgeons deal in Pakistan, though proper epidemiological data is not available. Habiba U et al found that 75.3% of post menopausal women of Pakistan were predisposed to Osteoporosis; whereas Baig L has described an average T - score of -1.833±0.65 on bone mineral density calculation of post menopausal females of Pakistan. Osteoporotic hip fractures constitute a major cause of elderly mortality worldwide and recent figures supporting the idea that these patients have survival rates comparable to breast and thyroid cancer patients. Pakistan is a developing country with large burden of hip fractures. Patients living in remote areas are the ones which suffer more because of inadequate awareness, fear of surgical treatment and lack of availability of standard treatment. These patients are dealt by surgeons of various expertise and levels of experience. Lack of facilities in hospitals is well known and usage of sub-standard implant is a major cause of failure. Therefore these patients either because of their bone fragility or mal-treatment suffer frequently from failure of hip fracture surgeries. Being in a tertiary care centre we come across these types of cases very frequently. Six to eight such cases present to outpatient department of Liaquat National Hospital every month being referred from every part of the country. These patients may have been operated once, twice or even multiple times. Special attention is required to acquire an informative history from these cases and perform a comprehensive examination. Moreover previous records and radiographs provide invaluable information regarding cause of failure and deciding course of further treatment. We herein discuss few of the cases of failure of hip fractures which were treated by hip arthroplasty.

  10. Puerperal Group A Streptococcal Infections: A Case Series and Discussion

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    Mary T. Busowski

    2013-01-01

    Full Text Available Puerperal group A streptococcal infections, a major postpartum killer during the late 19th and early 20th centuries, have become (fortunately rare. We describe a cluster of 4 serious peripartum group A streptococcal infections occurring within the past five years at a single medical center. These cases were not epidemiologically linked and serve to illustrate the continuing risk of these potentially fulminant infections.

  11. Acetabular fractures following rugby tackles: a case series

    LENUS (Irish Health Repository)

    Good, Daniel W

    2011-10-05

    Abstract Introduction Rugby is the third most popular team contact sport in the world and is increasing in popularity. In 1995, rugby in Europe turned professional, and with this has come an increased rate of injury. Case presentation In a six-month period from July to December, two open reduction and internal fixations of acetabular fractures were performed in young Caucasian men (16 and 24 years old) who sustained their injuries after rugby tackles. Both of these cases are described as well as the biomechanical factors contributing to the fracture and the recovery. Acetabular fractures of the hip during sport are rare occurrences. Conclusion Our recent experience of two cases over a six-month period creates concern that these high-energy injuries may become more frequent as rugby continues to adopt advanced training regimens. Protective equipment is unlikely to reduce the forces imparted across the hip joint; however, limiting \\'the tackle\\' to only two players may well reduce the likelihood of this life-altering injury.

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

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    Philip McClure

    2016-01-01

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

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

    Science.gov (United States)

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

    2014-05-01

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

  14. Intraoperative ultrasonography for presumed brain metastases: a case series study

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    Helder Picarelli

    2012-10-01

    Full Text Available Brain metastases (BM are one of the most common intracranial tumors and surgical treatment can improve both the functional outcomes and patient survival, particularly when systemic disease is controlled. Image-guided BM resection using intraoperative exams, such as intraoperative ultrasound (IOUS, can lead to better surgical results. METHODS: To evaluate the use of IOUS for BM resection, 20 consecutives patients were operated using IOUS to locate tumors, identify their anatomical relationships and surgical cavity after resection. Technical difficulties, complications, recurrence and survival rates were noted. RESULTS: IOUS proved effective for locating, determining borders and defining the anatomical relationships of BM, as well as to identify incomplete tumor resection. No complications related to IOUS were seen. CONCLUSION: IOUS is a practical supporting method for the resection of BM, but further studies comparing this method with other intraoperative exams are needed to evaluate its actual contribution and reliability.

  15. Aquatic exercise therapy in fibromyalgia treatment: serie of cases.

    OpenAIRE

    Santos, Samara Tanaka dos; Centro Universitário de Maringá – CESUMAR; Facci, Ligia Maria; Centro Universitário de Maringá – CESUMAR

    2009-01-01

    This study had as its purpose verify the effects of water physiotherapy program in pain intensity, the number of painful points of the human body and quality of life in fibromyalgia patients. The study was done at Cesumar physiotherapy clinic. After selecting all the included patients were evaluated through a pre-elaborated card with Pain Visual Analog Scale, the Fibromyalgia Impact Questionnaire, besides investigations about linked complaints. The treatment was composed by 20 water physiothe...

  16. Neonates presenting with severe complications of frenotomy: a case series

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    Opara Peace I

    2012-03-01

    Full Text Available Abstract Introduction Tongue-tie or ankyloglossia is an anatomic variation in which the lingual frenulum is thick, short or tight. It may be asymptomatic, or present with complications like breast feeding difficulties or speech, dental and cosmetic problems. The treatment of this condition, where indicated, is frenotomy. This procedure usually has few or no complications. However, when it is done by untrained personnel, it may lead to life-threatening complications. This paper highlights complications that could arise from improper treatment of ankyloglossia. Case presentation Case 1 was a one-day-old male neonate, a Nigerian of Igbo ethnicity, who was admitted with bleeding from the mouth and passage of dark stools after clipping of the frenulum by a traditional birth attendant. He was severely pale and in hypovolemic shock, with a severed frenulum which was bleeding actively. His packed cell volume was 15%. He was resuscitated with intravenous fluids and a blood transfusion. The bleeding was controlled using an adrenaline pack. He also received antibiotics. He was discharged five days later. Case 2 was a three-day-old male neonate, a Nigerian of Ikwerre ethnicity, who was admitted with profuse bleeding from a soft tissue injury under the tongue, after clipping of the frenulum by a community health worker. He was severely pale and lethargic. He was resuscitated with intravenous fluids and a blood transfusion. The bleeding vessel was ligated with repair of the soft tissue. He also received antibiotics and was discharged home one week later. Conclusion Treatment of tongue-tie, a benign condition, when done by untrained personnel may result in life-threatening complications. Clinicians should pay more attention to parents' worries about this condition and give adequate counseling or refer them to trained personnel for surgical intervention where clinically indicated.

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

    Science.gov (United States)

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

    2012-04-01

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

  18. Metoprolol-induced visual hallucinations: a case series

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    Goldner Jonathan A

    2012-02-01

    Full Text Available Abstract Introduction Metoprolol is a widely used beta-adrenergic blocker that is commonly prescribed for a variety of cardiovascular syndromes and conditions. While central nervous system adverse effects have been well-described with most beta-blockers (especially lipophilic agents such as propranolol, visual hallucinations have been only rarely described with metoprolol. Case presentations Case 1 was an 84-year-old Caucasian woman with a history of hypertension and osteoarthritis, who suffered from visual hallucinations which she described as people in her bedroom at night. They would be standing in front of the bed or sitting on chairs watching her when she slept. Numerous medications were stopped before her physician realized the metoprolol was the causative agent. The hallucinations resolved only after discontinuation of this medication. Case 2 was a 62-year-old Caucasian man with an inferior wall myocardial infarction complicated by cardiac arrest, who was successfully resuscitated and discharged from the hospital on metoprolol. About 18 months after discharge, he related to his physician that he had been seeing dead people at night. He related his belief that since he 'had died and was brought back to life', he was now seeing people from the after-life. Upon discontinuation of the metoprolol the visual disturbances resolved within several days. Case 3 was a 68 year-old Caucasian woman with a history of severe hypertension and depression, who reported visual hallucinations at night for years while taking metoprolol. These included awakening during the night with people in her bedroom and seeing objects in her room turn into animals. After a new physician switched her from metoprolol to atenolol, the visual hallucinations ceased within four days. Conclusion We suspect that metoprolol-induced visual hallucinations may be under-recognized and under-reported. Patients may frequently fail to acknowledge this adverse effect believing that they

  19. [Crestal core elevation technique--case series and literature review].

    Science.gov (United States)

    Kolerman, R; Barnea, E

    2008-04-01

    Sinus floor augmentation is the most common surgical procedure for gaining bone volume in the posterior maxilla. The purpose of this procedure is to enable implant placement un edentulous ridges. The most common techniques for sinus augmentation are: 1. Bone added osteotome sinus floor elevation (BAOSFE). 2. Crestal core elevation (CCE). 3. Lateral window technique (LWT). Since the early 80's many articles describing the successful use of different augmentation materials for sinus elevation have been published. Although many articles have been published on the lateral window technique and the osteotome technique as described by Summers, few articles have been published on the crestsal core sinus elevation technique. This technique, first described by Summers, includes the use of wide diameter osteotomes and trephine bur with a diameter of 6 m"m. This technique is implemented in situations when the available bone for implant placement is less than 6 m"m , which impairs the possibility of achieving primary stability of the implant. In those cases crestal core elevation is performed and implant placement is postponed 3-8 months later. Modification of the technique described by Summers was published by Fugazzoto, this technique is implemented concomitant with the extraction of the upper molars. The crestal core elevation technique (CCE), which is based on the BAOSFE (Bone Added Osteotome Sinus Floor Elevation), is based on the principle of hydraulic force acting on fluids and particles which transfer the vector of force to all direction, in this case the sinus membrane. The detached core of interradicular bone prior to osteotome placement and malleting significantly reduces surgical trauma to the patient especially in cases where a significant portion of the pre-disease interradicular bone remains. The concomitant placement of particulate material and a membrane at the time of tooth extraction offers the advantage of minimizing if not eliminating significant 3

  20. A CASE SERIES OF CYSTIC LESIONS OF CONJUNCTIVA

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    Srinivas Rao

    2015-05-01

    Full Text Available INTRODUCTION: Cysticercosis is the most common parasitic disease of the nervous system. The disease occurs when humans become the intermediate host in the life cycle of Taenia solium by ingesting its eggs from contaminated food. The most common sites of involvement of cysticerci are soft tissue , eye and central nervous system. Unusual location of the cysts may result in uncommon manifestations. Ocular cysticercosis can involve both the intraocular and extra ocular muscle. Extra ocular muscle cysticercosis is rare. PRESENTATION OF CAS ES : In the department of ophthalmology , G.S.L medical college , Rajahmundry we are reporting 6 cases of cystic lesions of eye

  1. Rupture of the triceps tendon — A case series

    Institute of Scientific and Technical Information of China (English)

    Atin Jaiswal; Naiman Deep Kacchap; Yashwant Singh Tanwar; Devendra Kumar; Birendra Kumar

    2016-01-01

    Triceps rupture is the least common among all tendon injuries.The usual mechanism of injury is a fall on an outstretched hand,although direct contact injuries have also been reported to cause this injury.The diagnosis of acute triceps tendon rupture may be missed,which can result in prolonged disability and delayed operative management.We presented three cases of acute triceps tendon rupture each at different site showing the spectrum of injury to the muscle and mechanism of injury and management were also discussed.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nasim Jafari-Pozve

    2014-01-01

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

  4. Imaging of Various Aspects of Neurofibromatosis Involvement: Case Series

    Directory of Open Access Journals (Sweden)

    Nazila Tayari

    2010-05-01

    Full Text Available Neurofibromatosis (NF is often noticed at birth or soon after. NF is divided into two types: NF type 1 is a complex of cutaneous and deep neural tumors. It is an autosomal dominant familial disorder. CNS is affected in about 15% of the cases. Optic nerve gliomas have a high degree of association with NF 1."nNF type 2 is much less commonly seen. It is also inherited as an autosomal dominant trait. Bilateral acoustic neuromas are pathognomonic of NF 2 and may be associated with meningiomas or ependymo-mas."nTypical clinical manifestations of neurofibromatosis are cafe-au-lait spots and multiple cutaneous tumors. There are also bone involvement as scoliosis, pseudoarthrosis of long bones, scalloping of vertebral bodies, abnormal rib tubulation, and defective ossification of the posterior superior wall of the orbit."nExtraskeletal manifestations of neurofibromatosis include gliomas of the optic nerves, pheochromocytoma, aneurysms of cerebral and renal arteries, acoustic neurilemmoma and superficial skin nodular neurofibromas."nHere, we intend to present images of several cases of neurofibromatosis with different aspects of involvement of the body. "nKeywords: Neurofibromatosis, Glioma, Schwannoma, Neurinoma

  5. Pleuroperitoneal Leak Complicating Peritoneal Dialysis: A Case Series

    Directory of Open Access Journals (Sweden)

    C. Kennedy

    2011-01-01

    Full Text Available Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.

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

    Science.gov (United States)

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

    2017-05-01

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

  7. Hypertensive crisis-induced electrocardiographic changes: a case series

    Directory of Open Access Journals (Sweden)

    Farha Khalid Abou

    2009-08-01

    Full Text Available Abstract Introduction Myocardial injury is one of the most notorious complications of a hypertensive crisis. Key electrocardiograph signs used to detect cardiac injury such as ST segment changes and cardiac arrhythmias usually indicate acute ongoing end-organ damage. Lack of early signs to predict end-organ damage might lead to a delay in the initiation of therapy and selection of the incorrect therapeutic strategy. Case presentation We describe five cases of tall, hyper acute symmetrical T-waves alone or accompanied by other electrocardiograph abnormalities in five healthy participants: three women aged 52, 60 and 62-years and two men aged 49 and 66-years, during a tyramine-monoamine oxidase-inhibitor interaction, phase I clinical trial. T-wave changes appeared early during the course of the hypertensive crisis and were attributed to subendocardial ischemia. The changes were transient and reverted to baseline in parallel with a fall in blood pressure. Conclusion Recognition of tall symmetrical T-waves in early phases of hypertensive crisis heralds commencement of myocardial damage. This calls for prompt medical intervention to avoid an impending irreversible myocardial injury. It is our belief that these findings will add new insight into the management of hypertensive crisis and will open avenues of further investigation.

  8. Complications during pharmacological stress echocardiography: a video-case series

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    Bigi Riccardo

    2005-09-01

    Full Text Available Abstract Background Stress echocardiography is a cost-effective tool for the modern noninvasive diagnosis of coronary artery disease. Several physical and pharmacological stresses are used in combination with echocardiographic imaging, usually exercise, dobutamine and dipyridamole. The safety of a stress is (or should be a major determinant in the choice of testing. Although large scale single center experiences and multicenter trial information are available for both dobutamine and dipyridamole stress echo testing, complications or side effects still can occur even in the most experienced laboratories with the most skilled operators. Case presentation We decided to present a case collection of severe complications during pharmacological stress echo testing, including a ventricular tachycardia, cardiogenic shock, transient ischemic attack, torsade de pointe, fatal ventricular fibrillation, and free wall rupture. Conclusion We believe that, in this field, every past complication described is a future complication avoided; what happens in your lab is more true of what you read in journals; and Good Clinical Practice is not "not having complications", but to describe the complications you had.

  9. Congenital portosystemic shunts with and without gastrointestinal bleeding - case series

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    Gong, Ying; Chen, Jun; Chen, Qi; Ji, Min; Pa, Mier; Qiao, Zhongwei [Children' s Hospital of Fudan University, Department of Radiology, Shanghai (China); Zhu, Hui [Fudan University Shanghai Cancer Center, Department of Radiology, Shanghai (China); Zheng, Shan [Children' s Hospital of Fudan University, Department of Surgery, Shanghai (China)

    2015-12-15

    The clinical presentation of congenital portosystemic shunt is variable and gastrointestinal bleeding is an uncommon presentation. To describe the imaging features of congenital portosystemic shunt as it presented in 11 children with (n = 6) and without gastrointestinal bleeding (n = 5). We performed a retrospective study on a clinical and imaging dataset of 11 children diagnosed with congenital portosystemic shunt. A total of 11 children with congenital portosystemic shunt were included in this study, 7 with extrahepatic portosystemic shunts and 4 with intrahepatic portosystemic shunts. Six patients with gastrointestinal bleeding had an extrahepatic portosystemic shunt, and the imaging results showed that the shunts originated from the splenomesenteric junction (n = 5) or splenic vein (n = 1) and connected to the internal iliac vein. Among the five cases of congenital portosystemic shunt without gastrointestinal bleeding, one case was an extrahepatic portosystemic shunt and the other four were intrahepatic portosystemic shunts. Most congenital portosystemic shunt patients with gastrointestinal bleeding had a shunt that drained portal blood into the iliac vein via an inferior mesenteric vein. This type of shunt was uncommon, but the concomitant rate of gastrointestinal bleeding with this type of shunt was high. (orig.)

  10. Bipolar Disorder and Multiple Sclerosis: A Case Series

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    Youssef Sidhom

    2014-01-01

    Full Text Available Background. The prevalence of psychiatric disturbance for patients with multiple sclerosis (MS is higher than that observed in other chronic health conditions. We report three cases of MS and bipolar disorder and we discuss the possible etiological hypothesis and treatment options. Observations. All patients fulfilled the McDonald criteria for MS. Two patients were followed up in psychiatry for manic or depressive symptoms before developing MS. A third patient was diagnosed with MS and developed deferred psychotic symptoms. Some clinical and radiological features are highlighted in our patients: one manic episode induced by high dose corticosteroids and one case of a new orbitofrontal MRI lesion concomitant with the emergence of psychiatric symptoms. All patients needed antipsychotic treatment with almost good tolerance for high dose corticosteroids and interferon beta treatment. Conclusions. MRI lesions suggest the possible implication of local MS-related brain damage in development of pure “psychiatric fits” in MS. Genetic susceptibility is another hypothesis for this association. We have noticed that interferon beta treatments were well tolerated while high dose corticosteroids may induce manic fits.

  11. Pleuroperitoneal leak complicating peritoneal dialysis: a case series.

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    Kennedy, C

    2012-02-01

    Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.

  12. Malignant orbital tumors in children: A series of 4 cases.

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    Fadoua Alami

    2014-12-01

    Full Text Available Introduction: Malignant tumors in children are rare but serious conditions as they can impair function and survival. Tumors in pediatric patients can originate from the orbit. Rarely, the tumor spreads to the adjacent areas and occasionally it may metastasize.Objectives: The objective of this study is to present the common symptoms and the clinical and radiological characteristics of most common malignant orbital tumors in children.Materials and methods: Through the discussion of 4 clinical cases of children presenting with exophthalmos due to a tumor, the authors highlight that clinical symptoms are usually less specific, and that imaging has an important role in diagnosis, determining location, and local and regional expansion of the tumor in order to find the adequate therapy.Results: Our patients' ages ranged from 2 to 5 years. The revealing sign in each case was a unilateral exophthalmos due to a tumor, which could only be reduced minimally or not at all. Its evolution has been rapidly progressive. Orbital imaging and histologic study, if biopsy was possible, allowed guiding the positive diagnosis of the malignant nature and its local and regional spreading, as well as the adequate treatment.Conclusion: Orbital tumors are rare in the pediatric population. However, due to recent remarkable progress obtained through both complimentary diagnostic tools and treatments, these malignancies deserve the attention of both the ophthalmologists and the pediatricians.

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

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

    2017-01-01

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

  14. Hemophagocytic lymphohistiocytosis: a case series of a Brazilian institution

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    Daniela Guimarães Rocha Ferreira

    2014-12-01

    Full Text Available Objective:To describe the clinical and laboratory presentation of hemophagocytic lymphohistiocytosis in children treated at a referral institution.Methods:A retrospective descriptive study was carried out of seven children diagnosed with hemophagocytic lymphohistiocytosis between 2010 and 2012. The criteria for diagnosis were those proposed by the Histiocyte Society. When indicated, immunochemotherapy was prescribed according to the HLH94 and HLH2004 protocols of the Histiocyte Society.Results:The patients' ages at diagnosis ranged from one month to nine years. All patients had splenomegaly, fever, anemia, thrombocytopenia, hyperferritinemia and hypertriglyceridemia. Bone marrow hemophagocytosis was detected in six patients. In six cases, infectious diseases triggered the syndrome. In two cases, associated with visceral leishmaniasis, remission was achieved after treatment of the underlying infection. Three patients, who had Epstein–Barr-related hemophagocytic lymphohistiocytosis, required treatment with immunochemotherapy. They are alive and in remission; one patient had symptoms of juvenile rheumatoid arthritis and another, who was suspected of having primary hemophagocytic lymphohistiocytosis, entered into remission after bone marrow transplantation. Two deaths (28.6% occurred in patients with suspected primary hemophagocytic lymphohistiocytosis; one whose clinical picture was triggered by cytomegalovirus infection did not respond to immunochemotherapy and the other died before any specific treatment was provided.Conclusion:As reported before, hemophagocytic lymphohistiocytosis has a multifaceted presentation with nonspecific signs and symptoms. In secondary forms, remission may be achieved by treating the underlying disease. In the primary forms, remission may be achieved with immunochemotherapy, but bone marrow transplantation is required for cure.

  15. Awake tracheal intubation using Pentax airway scope in 30 patients: A Case series

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    Payal Kajekar

    2014-01-01

    Full Text Available Background and Aims: Pentax airway scope (AWS has been successfully used for managing difficult intubations. In this case series, we aimed to evaluate the success rate and time taken to complete intubation, when AWS was used for awake tracheal intubation. Methods: We prospectively evaluated the use of AWS for awake tracheal intubation in 30 patients. Indication for awake intubation, intubation time, total time to complete tracheal intubation, laryngoscopic view (Cormack and Lehane grade, total dose of local anaesthetic used, anaesthetists rating and patient′s tolerance of the procedure were recorded. Results: The procedure was successful in 25 out of the 30 patients (83%. The mean (standard deviation intubation time and total time to complete the tracheal intubation was 5.4 (2.4 and 13.9 (3.7 min, respectively in successful cases. The laryngeal view was grade 1 in 24 and grade 2 in one of 25 successful intubations. In three out of the five patients where the AWS failed, awake tracheal intubation was successfully completed with the assistance of flexible fibre optic scope (FOS. Conclusion: Awake tracheal intubation using AWS was successful in 83% of patients. Success rate can be further improved using a combination of AWS and FOS. Anaesthesiologists who do not routinely use FOS may find AWS easier to use for awake tracheal intubation using an oral route.

  16. Index for Evaluating Heart Rate Variability based on the Extreme Point of Time Series

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    Yoshida, Yutaka; Yokoyama, Kiyoko; Ishii, Naohiro

    In this study, it aimed at the proposal of real time and continuous estimating method of physiological states using biological signals. The proposal method will be one of the basic technology to develop physiological state monitor. The proposal index is defined in the ratio of the number of extreme points of the heart rate time series and the number of heart rate. This index is called NEP. The characteristic of the NEP was shown by simulation analysis. The NEP was compared with classical indices of heart rate variability by the analysis of measured heart rate time series. NEP decreased significantly (p<0.05) when posture changed from supine to standing. In this case, the autonomic nervous activity balance changes from the parasympathetic to the sympathetic nerve. Moreover, the NEP was correlated with the respiratory frequency in supine position (p<0.01). It is not necessary to consider individual variation of NEP in the physiological state evaluation. Standardization process or relative value is not necessary to compare individual persons. This parameter is applicable to evaluate physiological state at real time and continuously.

  17. 68Ga-DOTATATE uptake in pineal gland, a rare physiological variant: case series.

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    Riaz, Saima; Syed, Rizwan; Skoura, Evangelia; Alshammari, Alshaima; Gaze, Mark; Sajjan, Rakesh; Halsey, Richard; Bomanji, Jamshed

    2015-11-01

    (68)Ga-DOTATATE PET-CT is widely used for the evaluation of neuroendocrine tumours. Knowledge of the physiological distribution of the radiotracer is of critical importance in characterizing focal areas of uptake. In this case series, we report three paediatric cases (average age 4.7 years ± 0.6 SD) with diagnosed advanced stage IV Neuroblastoma. Two had (68)Ga-DOTATATE PET-CT scans and one underwent (68)Ga-DOTATATE PET-MRI scan to assess for suitability of molecular therapy. Focal increased tracer uptake in the pineal gland was noted in all cases with no morphological abnormality on the corresponding CT and MRI scans. The uptake within the gland was thought to be a physiological variant rather than metastases owing to the heterogeneity of somatostatin receptors expression. The pineal gland has been reported to express somatostatin receptors. The physiological distribution of (68)Ga-DOTATATE uptake in the pineal gland is not routinely seen. Furthermore, the possibility of pineal meningioma is very unlikely as pineal meningiomas are very rare and there was no convincing morphological evidence of meningiomas on CT/MRI scan.

  18. Unani Treatment Decreased Fibrosis and Improved Liver Functions in Decompensated Cirrhosis of Liver: A Case Series

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    Akhtar Siddiqui

    2016-03-01

    Full Text Available At present, liver transplantation remains the only curative option for the patients with cirrhosis and end-stage liver diseases. The survival rate and recurrent diseases remain the major issues in the patient post-transplantation. Unani medicine is one of the oldest traditional systems of medicine which has been treating chronic liver diseases and cirrhosis (Talayyaful-Kabid for centuries. The current study aimed to assess the impact of Unani treatment on decompensated cirrhosis and collect data to warrant further clinical trials. Authors conducted a case series on five patients with decompensated cirrhosis and portal hypertension. The disease was confirmed through FibroScan and ultrasound and treated with Unani treatment orally for seven months. Results were evaluated based on FibroScan, liver function test (LFT, EuroQol-5D (EQ5D, Child-Pugh and TTO-TIME (trade-off question. Significant improvements in LFT, fibrosis and quality of life were achieved in the studied patients. The literature related to the herbal constituents of chief medicines used to treat in this case was reviewed. The herbs proved their potential anti-oxidative, anti-inflammatory, hepato-protective, immuno-modulator and antiviral activities, suggesting plausible mechanisms of action in the cases. The preliminary findings indicated the potential therapeutic role of Unani treatment in decompensated cirrhosis. Clinical trials should be conducted to explore further therapeutic potential of Unani treatment in decompensated cirrhosis.

  19. Diagnosis of pericardial cysts using diffusion weighted magnetic resonance imaging: A case series

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    Mousavi Negareh

    2011-09-01

    Full Text Available Abstract Introduction Congenital pericardial cysts are benign lesions that arise from the pericardium during embryonic development. The diagnosis is based on typical imaging features, but atypical locations and signal magnetic resonance imaging sequences make it difficult to exclude other lesions. Diffusion-weighted magnetic resonance imaging is a novel method that can be used to differentiate tissues based on their restriction to proton diffusion. Its use in differentiating pericardial cysts from other pericardial lesions has not yet been described. Case presentation We present three cases (a 51-year-old Caucasian woman, a 66-year-old Caucasian woman and a 77-year-old Caucasian woman with pericardial cysts evaluated with diffusion-weighted imaging using cardiac magnetic resonance imaging. Each lesion demonstrated a high apparent diffusion coefficient similar to that of free water. Conclusion This case series is the first attempt to investigate the utility of diffusion-weighted magnetic resonance imaging in the assessment of pericardial cysts. Diffusion-weighted imaging may be a useful noninvasive diagnostic tool for pericardial cysts when conventional imaging findings are inconclusive.

  20. Modified semilunar coronally advanced flap: A case series.

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    Pai, B S Jagadish; Rajan, Smitha Anitha; Padma, R; Suragimath, Girish; Annaji, Shridhar; Kamath, K Vinesh

    2013-01-01

    Dentists traditionally think of periodontal treatment as a means of saving the teeth while leaving the patient with an esthetic problem. The goal of gingival esthetics is to maintain normal healthy gingival appearance around teeth that must be restored. Gingival recession represents a significant concern for patients and a therapeutic problem for the clinician. Root coverage is the goal of periodontal plastic surgery when treating gingival recessions in the esthetic zone. Correction of mucogingival recession deformities with a variety of periodontal plastic surgical procedures have been described each demonstrating a variable degree of success. This case report presents to you the treatment outcomes and predictability of modified semilunar coronally advanced flap (Kamran Haghighat) techniques described for the treatment of recession defects on single and multiple adjacent teeth, respectively.

  1. Marantic Endocarditis Associated with Pancreatic Cancer: A Case Series

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    Gayle S. Jameson

    2009-04-01

    Full Text Available Marantic endocarditis, otherwise known as nonbacterial thrombotic endocarditis (NBTE, is a well-documented phenomenon due to hypercoagulability from an underlying cause. It has been associated with a variety of inflammatory states including malignancy. Surprisingly, although hypercoagulability is often seen in patients with pancreatic cancer, marantic endocarditis has rarely been reported antemortem in this population. We report three cases of marantic endocarditis in patients with advanced pancreatic cancer. In two instances, the patients’ neurological symptoms preceded the diagnosis of advanced pancreatic cancer. Health care professionals should be alert to the possibility of marantic endocarditis in any patient with cancer, especially pancreatic cancer, who presents with symptoms of neurological dysfunction or an arterial thrombotic event. Prompt diagnosis and treatment with heparin, unfractionated or low molecular weight, may prevent catastrophic CNS events and decrease morbidity in patients with pancreatic cancer and other malignancies.

  2. Facial Blanching After Cosmetic Botulinum Toxin Injection: Case Series.

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    Warren, Donald; Woody, Meghan; Vickers, Jennifer

    2016-01-01

    Case 1 A 32-year-old woman was treated for the first time with onabotulinumtoxinA (BoNT), receiving 10 units in her forehead and 20 units in her glabella. She reported no history of skin disease and had a very active lifestyle. She first noticed blanching while doing a group workout and a friend inquired if she had "hives" on her forehead (Figure 1). She continued to note the blanching during workouts 5 months after injection. Each episode lasted 30 minutes to 2 hours. There were no associated symptoms with the blanching other than minor embarrassment. Given her active lifestyle and frequent blanching, she has elected not to receive further injections.

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

    Science.gov (United States)

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

    2011-01-01

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

  4. Connecting Hospitalized Patients with Their Families: Case Series and Commentary

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    Kourosh Parsapour

    2011-01-01

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

  5. Marfan Syndrome in an Iranian Family: A Case Series

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    Mohammad Hossein Davari

    2015-07-01

    Full Text Available Marfan syndrome (MFS is a genetic disorder which is inherited by autosomal dominant traits. In MFS, lens displacement and cardiovascular involvement are important causes of morbidity and mortality in the clinical course of the disease. In this case study, the ocular involvement in a family with severe penetration of MFS is reported. Twelve members of a family (father, two daughters, three sons, and six grandchildren had MFS. Lens ectopia was the most common ophthalmic involvement among the family (100%. Other ocular involvements were as follows; Hypoplastic iris or ciliary’s muscle hypoplasia (50%, on gated eyeball (42%, flat cornea (30%, glaucoma and cataract (25%, retinal detachment (16%. Three members of the family underwent eye surgery including lens extraction, glaucoma surgery and retinal surgery.

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

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

    1984-02-16

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

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

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    Peter O. Okokhere

    2016-01-01

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

  8. Safety of escitalopram in pregnancy: a case series

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    Bellantuono C

    2013-09-01

    Full Text Available Cesario Bellantuono, Francesca Bozzi, Laura Orsolini Psychiatric Unit and DEGRA Center, United Hospital and Academic Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy Background: The aim of this paper is to report maternal and neonatal outcomes in pregnant women treated with escitalopram during pregnancy and breastfeeding. Methods: Women enrolled in the DEGRA Database at the Clinic of Affective Disorders in Pregnancy and Postpartum in Italy, treated during pregnancy with escitalopram and followed up throughout pregnancy, were included in this study. All patients provided written informed consent and the study was approved by the local ethics committee. Psychiatric diagnoses were assessed using the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition Axis I Disorders and symptoms were assessed using the Hamilton Rating Scale for Depression (17 items and Hamilton Rating Scale for Anxiety (14 items. Clinical and sociodemographic characteristics as well as maternal and neonatal outcomes were recorded. Results: The case histories of seven pregnant women treated for depression and/or anxiety disorders with escitalopram were reported. Four women were also treated with benzodiazepines. All pregnancies were full-term and all newborns had normal Apgar scores. There were no major malformations or miscarriages following exposure to escitalopram. Mild withdrawal syndrome was reported only in a newborn who was also exposed to a benzodiazepine. Two infants exposed to escitalopram during breastfeeding did not show any health problems. Conclusion: Our experience with use of escitalopram in pregnant women did not reveal any maternal or neonatal concerns. However, considering the few cases analyzed and the paucity of published literature, no conclusions can be drawn on its safety profile in pregnancy and breastfeeding. Keywords: escitalopram, pregnancy

  9. Fungal otitis externa as a cause of tympanic membrane perforation: a case series.

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    Song, James Eingun; Haberkamp, Thomas J; Patel, Riddhi; Redleaf, Miriam I

    2014-08-01

    We describe a series of 11 patients--8 men and 3 women, aged 18 to 70 years (mean: 46.0)--who had fungal otitis externa that had been complicated by a tympanic membrane perforation. These patients had been referred to us for evaluation of chronic, mostly treatment-refractory otitis externa, which had manifested as otorrhea, otalgia, and/or pruritus. Seven of the 11 patients had no history of ear problems prior to their current condition. Five patients had been referred to us by a primary care physician and 4 by an otolaryngologist; the other 2 patients were self-referred. All patients were treated with a thorough debridement of the ear and one of two antifungal medication regimens. Eight of the 11 patients experienced a complete resolution of signs and symptoms, including closure of the tympanic membrane perforation. The other 3 patients underwent either a tympanoplasty (n = 2) or a fat-graft myringotomy (n = 1) because the perforation did not close within a reasonable amount of time. This series demonstrates that the nonspecific signs and symptoms of fungal otitis externa can make diagnosis difficult for both primary care physicians and general otolaryngologists. This study also demonstrates that most cases of tympanic membrane perforation secondary to fungal otitis externa will resolve with cleaning of the ear and proper medical treatment. Therefore, most patients with this condition will not require surgery.

  10. Longitudinal Deformation of Pulmonary Artery: A Case Series Study

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    Ali Hosseinsabet

    2013-12-01

    Full Text Available Objectives:: In this study, pulmonary artery longitudinal deformation was evaluated and attempted to clarify pulmonary artery deformation. Methods:: Eight healthy men and seven healthy women with structurally normal hearts were enrolled. In the parasternal short axis view at the aortic valve level, longitudinal axis of pulmonary artery was obtained and color coded Doppler myocardial imaging applied. Results:: The systolic strain was positive in most the pulmonary segments, velocity and strain rate waves had three defined peaks, one positive in systole and two negative in diastole. Conclusions:: This study revealed for first time, deformation pattern of pulmonary artery by color coded Doppler myocardial imaging and can be basis for future researches in cardiopulmonary diseases.

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

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

    2016-01-01

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

  12. Fatal Cerebral Air Embolism: A Case Series and Literature Review

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    Reddy, Pavithra; Khaja, Misbahuddin

    2016-01-01

    Cerebral air embolism (CAE) is an infrequently reported complication of routine medical procedures. We present two cases of CAE. The first patient was a 55-year-old male presenting with vomiting and loss of consciousness one day after his hemodialysis session. Physical exam was significant for hypotension and hypoxia with no focal neurologic deficits. Computed tomography (CT) scan of head showed gas in cerebral venous circulation. The patient did not undergo any procedures prior to presentation, and his last hemodialysis session was uneventful. Retrograde rise of venous air to the cerebral circulation was the likely mechanism for venous CAE. The second patient was a 46-year-old female presenting with fever, shortness of breath, and hematemesis. She was febrile, tachypneic, and tachycardic and required intubation and mechanical ventilation. An orogastric tube inserted drained 2500 mL of bright red blood. Flexible laryngoscopy and esophagogastroduodenoscopy were performed. She also underwent central venous catheter placement. CT scan of head performed the next day due to absent brain stem reflexes revealed intravascular air within cerebral arteries. A transthoracic echocardiogram with bubble study ruled out patent foramen ovale. The patient had a paradoxical CAE in the absence of a patent foramen ovale. PMID:27635266

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

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    Murray B. Gordon

    2016-01-01

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

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

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    Nakhle, Samer; Ludlam, William H.

    2016-01-01

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

  15. Glycogenic hepatopathy in young adults: a case series

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    Marco Silva

    Full Text Available Glycogenic hepatopathy is a rare and underecognized complication in long-standing poorly controlled type 1 diabetes mellitus patients. This is a distinct entity from other causes of hepatomegaly and elevated liver enzymes in diabetics, such as nonalcoholic fatty liver disease. Glycogenic hepatopathy is characterized by the combination of poorly controlled diabetes, acute liver injury with marked elevation in serum aminotransferases, and the characteristic histological features on liver biopsy. It is important to distinguish this entity as it has the potential for resolution following improved glycemic control. In this report, we describe four cases of adult patients presenting elevated serum transaminases and hepatomegaly with a history of poorly controlled type I diabetes mellitus. One of the patients had also elevated amylase and lipase in the serum, without clinical or imagiologic evidence of acute pancreatitis. Liver biopsy was performed in all patients and revealed glycogenic hepatopathy. Clinician's awareness of glycogenic hepatopathy should prevent diagnostic delay or misdiagnosis and will provide better insight and management for this condition.

  16. A Change of Heart: Case Series of Peripartum Cardiomyopathy

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    Sean Martin

    2013-01-01

    Full Text Available Peripartum cardiomyopathy (PPCM is an uncommon disease of pregnancy, occurring in about 1 in 2000 live births, and is characterized by the development of heart failure, due to left ventricular systolic dysfunction. It is associated with high rates of maternal and neonatal mortality. Cardiac disease is the leading cause of maternal death in the UK: PPCM accounts for about 17% of these. Clinical findings of decompensated heart failure (HF are often masked by the normal physiological changes seen in pregnancy making the diagnosis challenging. A high index of suspicion is essential—prompting referral for echocardiogram, which is crucial for diagnosis. Favourable prognosis is dependent on the early initiation of HF medications. Although full recovery occurs in around half of cases, left ventricular systolic dysfunction persists in a significant proportion of patients with PPCM and the risk of recurrence in subsequent pregnancies is high. The pathophysiology of PPCM is under intense research. We present four patients with PPCM and a review of the literature. Owing to the diagnostic challenge of PPCM and decompensated HF in pregnant mothers and its high mortality rate without treatment, prompt investigation and referral are key to improving maternal survival.

  17. Kluyvera ascorbata infections in children: a case series.

    Science.gov (United States)

    Karadağ Öncel, Eda; Özsürekci, Yasemin; Akyön, Yakut; Gür, Deniz; Cengiz, Ali Bülent; Kara, Ateş

    2015-06-01

    Kluyvera is a relatively newly described member of the Enterobacteriaceae family that rarely causes infections in humans. In the pediatric population, it is described in association with clinically significant infections ranging from urinary tract infections to sepsis with multiorgan failure. Our aim is to determine the clinical significance of K. ascorbata infections in the pediatric population at our institution. We retrospectively analyzed clinical microbiology data as from 2006 and identified four clinically significant isolates in this period. The isolates were from four cases who presented with sepsis, bacteremia associated with central venous catheter, pyelonephritis and intraabdominal collection. The ages of these patients ranged between seven months to 17 years. All patients received prompt antimicrobial treatment on the basis of susceptibility testing and good clinical response was obtained in all patients. Successful treatment options include third-generation cephalosporins, aminoglycosides, betalactams with beta-lactamase inhibitors and carbapenems. Clinicians should be aware of the spectrum of disease and increasing clinical importance associated with this pathogen.

  18. Gastroparesis secondary to a demyelinating disease: a case series

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    Bonino John

    2007-01-01

    Full Text Available Abstract Background Gastroparesis has a number of etiologies. The main ones are secondary to a complication from diabetes mellitus, related to post vagotomy or post gastric surgical resections, or idiopathic when the etiology is unclear. Gastroparesis secondary to a demyelinating disease of the brain is unusual. Case presentation A 22-year-old woman was referred for acute onset of intractable nausea and vomiting. She also had cerebellar deficits, dysphagia and paresthesias. Magnetic resonance imaging (MRI of the brain revealed an isolated area of demyelination in the medullary region. Another 24-year-old woman had a similar presentation with right hemiplegia and MRI of the brain revealed a distal medullary region. Both these patients had an abnormal gastric emptying test. Gastroparesis and neurological deficits improved with intravenous corticosteroids. While the former patient has had no further recurrences, the latter patient developed multiple sclerosis within three months of presentation. Conclusion A demyelinating disease is a rare cause gastropareis, but should be suspected when symptoms of gastroparesis are associated with neurological deficits. MRI might help in the diagnosis and intravenous coriticosteroids can address the underlying disease process and improve gastric emptying, especially when used early during the course of the disease.

  19. Gastroparesis secondary to a demyelinating disease: a case series

    Science.gov (United States)

    Reddymasu, Savio C; Bonino, John; McCallum, Richard W

    2007-01-01

    Background Gastroparesis has a number of etiologies. The main ones are secondary to a complication from diabetes mellitus, related to post vagotomy or post gastric surgical resections, or idiopathic when the etiology is unclear. Gastroparesis secondary to a demyelinating disease of the brain is unusual. Case presentation A 22-year-old woman was referred for acute onset of intractable nausea and vomiting. She also had cerebellar deficits, dysphagia and paresthesias. Magnetic resonance imaging (MRI) of the brain revealed an isolated area of demyelination in the medullary region. Another 24-year-old woman had a similar presentation with right hemiplegia and MRI of the brain revealed a distal medullary region. Both these patients had an abnormal gastric emptying test. Gastroparesis and neurological deficits improved with intravenous corticosteroids. While the former patient has had no further recurrences, the latter patient developed multiple sclerosis within three months of presentation. Conclusion A demyelinating disease is a rare cause gastropareis, but should be suspected when symptoms of gastroparesis are associated with neurological deficits. MRI might help in the diagnosis and intravenous coriticosteroids can address the underlying disease process and improve gastric emptying, especially when used early during the course of the disease. PMID:17266755

  20. Solitary rectal ulcer syndrome: A single-center case series

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    Abdulaziz I AlGhulayqah

    2016-01-01

    Full Text Available Background/Aim: Solitary rectal ulcer syndrome (SRUS is a benign, chronic defecation disorder with varied presentations. The aim of this study is to summarize the clinical features, endoscopic findings, histological appearance, and treatment strategies associated with SRUS. Patients and Methods: This is a retrospective study of all patients diagnosed with SRUS at the King Faisal Specialist Hospital and Research Centre in Riyadh from January 2003 to December 2013. Cases were identified using the Department of Pathology database. Data were obtained from medical records that included clinical manifestation, endoscopic findings, and histopathological features. Results: Twenty patients were identified. The mean age was 42.5 years (±18.5 and 55% were females. Most of the patients presented with bleeding per rectum (85%, constipation (75%, and straining (50%, with a mean symptom duration of 26.7 months. The most common associated factors identified were constipation (75%, history of rectal surgery (25%, digital rectal manipulation (20%, and rectal prolapse (20%. Endoscopic findings included a single ulcer (50% and multiple ulcers (30%; 55% had a polypoidal appearance. On histopathology, there was surface ulceration (95%, fibrosis of the lamina propria (60%, distorted architecture (55%, and muscle hypertrophy with increased mucin production (50%. Patients were treated conservatively and none required surgery. Conclusion: SRUS is a rare disorder with variable clinical presentations. Stool softeners, a high fiber diet in addition to topical mesalamine, and biofeedback proved to be effective in this patient population.

  1. Khat chewing and cirrhosis in Somaliland: Case series

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    Hawa D. Mahamoud

    2016-03-01

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

  2. Brucella bacteremia in patients with acute leukemia: a case series

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    Al-Anazi Khalid

    2007-11-01

    Full Text Available Abstract Background Brucellosis may cause serious infections in healthy individuals living in countries that are endemic for the infection. However, reports of brucella infections in immunocompromised hosts are relatively rare. Case Presentations Reported here are two patients with acute leukemia who developed Brucella melitensis bacteremia during their follow up at the Armed Forces Hospital in Riyadh. The first patient developed B. melitensis bacteremia during the transformation of his myelodysplasia into acute myeloid leukemia. The second patient developed B. melitensis bacteremia while his acute lymphoblastic leukemia was under control. Interestingly, he presented with acute cholecystitis during the brucella sepsis. Both brucella infections were associated with a marked reduction in the hematological parameters in addition to other complications. The bacteremic episodes were successfully treated with netilmicin, doxycycline and ciprofloxacin. Conclusion Brucellosis can cause systemic infections, complicated bacteremia and serious morbidity in patients with acute leukemia living in endemic areas. These infections may occur at the presentation of the leukemia or even when the leukemia is in remission. Nevertheless, the early diagnosis of brucellosis and the administration of appropriate antimicrobial therapy for sufficient duration usually improves the outcome in these immunocompromised patients.

  3. Case series of ruptured Jamaican berry aneurysms four decades ago

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    MON Ibe

    2011-01-01

    Full Text Available Objective From our personal experiences, it is our wish to examine the incidence of ruptured intracranial aneurysms about four decades ago in Jamaica, the West Indies, with regards to postoperative deterioration of neurological/psychological functions. Materials and Method The author, while working in Jamaica, the West Indies, from 1975 to 1977 (3 years, operated on 6 cases of ruptured intracranial aneurysms of 5 females and 1 male. The source of these data is from the author′s surgery records. Result There were 4 aneurysms from the posterior communicating artery, and 1 each from the anterior communicating artery, and the middle cerebral artery. Their ages ranged from 31 to 64 years. They presented with diverse neurological disturbances. Their aneurysms, which were diagnosed through contrast carotid angiography, were all clipped through fronto-lateral craniotomy under general anaesthesia. The procedures were well tolerated by the patients. There were no complications and no gross additional neurological deficits postoperatively. The wounds had healed by primary intention. The patients were discharged home 12 days postoperatively, the stitches having been removed 2 days earlier. Follow-up checks started about 7 days after discharge. The neurological deficits had cleared about 3 months later. Conclusion Having bled, the aneurysms exposed themselves by causing sudden severe headaches, and various neurological problems, depending on their locations. We found more females than males. The posterior communicating artery aneurysm was predominant. There were no cerebro-vascular spasms postoperatively. Greek ANEURYSMA (Ana= up or across, eurys - wide or broad

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

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

    2013-04-19

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

  5. Fatal Cerebral Air Embolism: A Case Series and Literature Review

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    Rashmi Mishra

    2016-01-01

    Full Text Available Cerebral air embolism (CAE is an infrequently reported complication of routine medical procedures. We present two cases of CAE. The first patient was a 55-year-old male presenting with vomiting and loss of consciousness one day after his hemodialysis session. Physical exam was significant for hypotension and hypoxia with no focal neurologic deficits. Computed tomography (CT scan of head showed gas in cerebral venous circulation. The patient did not undergo any procedures prior to presentation, and his last hemodialysis session was uneventful. Retrograde rise of venous air to the cerebral circulation was the likely mechanism for venous CAE. The second patient was a 46-year-old female presenting with fever, shortness of breath, and hematemesis. She was febrile, tachypneic, and tachycardic and required intubation and mechanical ventilation. An orogastric tube inserted drained 2500 mL of bright red blood. Flexible laryngoscopy and esophagogastroduodenoscopy were performed. She also underwent central venous catheter placement. CT scan of head performed the next day due to absent brain stem reflexes revealed intravascular air within cerebral arteries. A transthoracic echocardiogram with bubble study ruled out patent foramen ovale. The patient had a paradoxical CAE in the absence of a patent foramen ovale.

  6. Anaesthesia for parturients with severe cystic fibrosis: a case series.

    LENUS (Irish Health Repository)

    Deighan, M

    2014-02-01

    Cystic fibrosis affects 1 in 1600-2500 live births and is inherited in an autosomal recessive manner. It primarily involves the respiratory, gastrointestinal and reproductive tracts, with impaired clearance of, and obstruction by, increasingly viscous secretions. Severe respiratory disease, diabetes and gastro-oesophageal reflux may result. Improvements in medical management and survival of cystic fibrosis patients means more are committing to pregnancies. Although guidance for anaesthesia in this patient group is available, management and outcome data associated with more severe cases are sparse. Patients with severe cystic fibrosis require multidisciplinary input and should be managed in a tertiary referral centre. Close monitoring of respiratory function and preoperative optimisation during pregnancy are mandatory. The risk of preterm labour and delivery is increased. Pregnancy and delivery can be managed successfully, even in patients with FEV1 <40% predicted. Neuraxial anaesthesia and analgesia should be the technique of choice for delivery. Postoperative care should be carried out in a critical care setting with the provision of postoperative ventilation if necessary.

  7. Healthcare-Associated Infective Endocarditis: a Case Series in a Referral Hospital from 2006 to 2011

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    Oslan Francischetto

    2014-10-01

    Full Text Available Background: Healthcare-associated infective endocarditis (HCA-IE, a severe complication of medical care, shows a growing incidence in literature. Objective: To evaluate epidemiology, etiology, risk factors for acquisition, complications, surgical treatment, and outcome of HCA-IE. Methods: Observational prospective case series study (2006-2011 in a public hospital in Rio de Janeiro. Results: Fifty-three patients with HCA-IE from a total of 151 cases of infective endocarditis (IE were included. There were 26 (49% males (mean age of 47 ± 18.7 years, 27 (51% females (mean age of 42 ± 20.1 years. IE was acute in 37 (70% cases and subacute in 16 (30% cases. The mitral valve was affected in 19 (36% patients and the aortic valve in 12 (36%; prosthetic valves were affected in 23 (43% patients and native valves in 30 (57%. Deep intravenous access was used in 43 (81% cases. Negative blood cultures were observed in 11 (21% patients, Enterococcus faecalis in 10 (19%, Staphylococcus aureus in 9 (17%, and Candida sp. in 7 (13%. Fever was present in 49 (92% patients, splenomegaly in 12 (23%, new regurgitation murmur in 31 (58%, and elevated C-reactive protein in 44/53 (83%. Echocardiograms showed major criteria in 46 (87% patients, and 34 (64% patients were submitted to cardiac surgery. Overall mortality was 17/53 (32%. Conclusion: In Brazil HCA-IE affected young subjects. Patients with prosthetic and native valves were affected in a similar proportion, and non-cardiac surgery was an infrequent predisposing factor, whereas intravenous access was a common one. S. aureus was significantly frequent in native valve HCA-IE, and overall mortality was high.

  8. Contribution of arthroscopy in case of septic appearance arthritis of the wrist: a nine cases series.

    Science.gov (United States)

    Hariri, A; Lebailly, F; Zemirline, A; Hendriks, S; Facca, S; Liverneaux, P

    2013-09-01

    Septic arthritis of the wrist is a diagnostic and therapeutic emergency. Synovectomy and lavage by arthrotomy is often followed by stiffness. The purpose of this study was to evaluate the diagnostic and therapeutic contribution of emergency arthroscopic synovectomy with intraarticular lavage. Nine patients were operated on for wrist pathology with septic appearance. All had signs of local inflammation, three showed locoregional inflammation, three were febrile. In one patient several joints were involved. Seven patients presented with inflammatory or degenerative arthritis. All patients underwent emergency surgery using radiocarpal joint puncture, arthroscopic exploration, intraarticular lavage and synovectomy at both the radiocarpal and midcarpal joints. The results were evaluated by pain, Quick DASH, grip strength, and wrist range of motion. In three cases, joint fluid appeared clear, in three it was turbid, and in three purulent. Gram stain and culture revealed bacteria in four cases. Synovitis was radiocarpal four times, radiocarpal and midcarpal once. In one case, there was radiocarpal and midcarpal chondritis. Average pain was 5.3/10 preoperatively and 2/10 at the last clinical follow-up visit. Mean grip strength was 23.3 kg on the involved side vs. 33.5 kg on the opposite one. Mean flexion was 55° for the involved wrist vs. 68°; mean extension was 52° for the affected wrist vs. 59°. No patient was reoperated on. In all cases, there was no sign of local inflammation, regional lymphadenopathy or systemic infection at the last follow-up. One patient died of colon metastatic cancer. Another patient developed a severe Complex Regional Pain Syndrome type I (CRPS1). Our results suggest three principles of management of wrist arthritis with septic appearance: extended surgical indication, emergency operation and arthroscopic procedure.

  9. Minimally invasive repair of Morgagni hernia - A multicenter case series.

    Science.gov (United States)

    Lamas-Pinheiro, R; Pereira, J; Carvalho, F; Horta, P; Ochoa, A; Knoblich, M; Henriques, J; Henriques-Coelho, T; Correia-Pinto, J; Casella, P; Estevão-Costa, J

    2016-01-01

    Children may benefit from minimally invasive surgery (MIS) in the correction of Morgagni hernia (MH). The present study aims to evaluate the outcome of MIS through a multicenter study. National institutions that use MIS in the treatment of MH were included. Demographic, clinical and operative data were analyzed. Thirteen patients with MH (6 males) were operated using similar MIS technique (percutaneous stitches) at a mean age of 22.2±18.3 months. Six patients had chromosomopathies (46%), five with Down syndrome (39%). Respiratory complaints were the most common presentation (54%). Surgery lasted 95±23min. In none of the patients was the hernia sac removed; prosthesis was never used. In the immediate post-operative period, 4 patients (36%) were admitted to intensive care unit (all with Down syndrome); all patients started enteral feeds within the first 24h. With a mean follow-up of 56±16.6 months, there were two recurrences (18%) at the same institution, one of which was repaired with an absorbable suture; both with Down syndrome. The application of MIS in the MH repair is effective even in the presence of comorbidities such as Down syndrome; the latter influences the immediate postoperative recovery and possibly the recurrence rate. Removal of hernia sac does not seem necessary. Non-absorbable sutures may be more appropriate.

  10. Methamphetamine Related Radiculopathy: Case Series and Review of Literature

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    Mohsen Foroughipour

    2013-06-01

    Full Text Available Background: Peripheral nervous injury and neuromuscular complications from methamphetamine abuse has not been reported. The mechanism is not yet identified. Methods: Eight patients with lower extremity weakness following methamphetamine abuse were reported during December 2009 to May 2010. Results: Patients presented with lower extremity weakness. All patients were co-abusers of methamphetamine and opioids. Other clinical manifestations comprised of distal paresthesia of the lower extremities with progression to proximal portions, with minimal sensory involvement in the distal of the lower extremities. Electrodiagnostic findings were consistent with lumbosacral Radiculopathy. Vital signs were unremarkable and all laboratory tests were within normal limits. Follow-up examination after three months showed improvement of weakness in 3 patients. Conclusion: For patients with a history of illicit drug abuse and acute neuromuscular weakness, methamphetamine or heroin toxicity should be taken into account. Hence, urine morphine and amphetamine/ methamphetamine tests should be performed and serum lead and thallium levels should be evaluated. In addition, rhabdomyolysis and myoglobinuria should be worked up.

  11. Improvement in hearing after chiropractic care: a case series

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    Di Duro Joseph O

    2006-01-01

    Full Text Available Abstract Background The first chiropractic adjustment given in 1895 was reported to have cured deafness. This study examined the effects of a single, initial chiropractic visit on the central nervous system by documenting clinical changes of audiometry in patients after chiropractic care. Case presentation Fifteen patients are presented (9 male, 6 female with a mean age of 54.3 (range 34–71. A Welch Allyn AudioScope 3 was used to screen frequencies of 1000, 2000, 4000 and 500 Hz respectively at three standard decibel levels 20 decibels (dB, 25 dB and 40 dB, respectively, before and immediately after the first chiropractic intervention. Several criteria were used to determine hearing impairment. Ventry & Weinstein criteria of missing one or more tones in either ear at 40 dB and Speech-frequency criteria of missing one or more tones in either ear at 25 dB. All patients were classified as hearing impaired though greater on the right. At 40 dB using the Ventry & Weinstein criteria, 6 had hearing restored, 7 improved and 2 had no change. At 25 dB using the Speech-frequency criteria, none were restored, 11 improved, 4 had no change and 3 missed a tone. Conclusion A percentage of patients presenting to the chiropractor have a mild to moderate hearing loss, most notably in the right ear. The clinical progress documented in this report suggests that manipulation delivered to the neuromusculoskeletal system may create central plastic changes in the auditory system.

  12. Cerebral Venous-Sinus Thrombosis: A Case Series Analysis

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    Nahid Ashjazadeh

    2011-09-01

    Full Text Available Background: Cerebral venous-sinus thrombosis is an uncommon form but important cause of stroke, especially in young-aged women. Methods: We performed a retrospective descriptive-analytical study in which 124 patients with cerebral venous-sinus thrombosis, who referred to Nemazee Hospital, Shiraz University of Medical Sciences from January 2000 to March 2008, were included, and their demographic, etiologic, radiological and prognostic characteristics were evaluated. Results: The patients' mean age was 34.01±10.25. Eighty seven (70.16% were women and 37 (29.83% were men. The most frequent clinical manifestations were headache, papilledema and seizures. Fifty seven (65.51% women took oral contraceptive pills. Twenty of 57 women (35.08% took the pill longer than one month to be able to fast in Ramadan or perform the Hajj ceremonies. In the mean time they developed cerebral venous-sinus thrombosis. Superior sagital sinus, with or without lateral sinuses, was the most involved area (70.96%. High mortality and morbidity rates (14.51% and 35.48%, respectively were found in patients. Poor prognostic factors at the time of admission were stupor and coma (P=0.001 and evidence of hemorrhage in primary CT scan (P=0.005. Conclusion: Taking oral contraceptive pills was a main factor associated with cerebral venous-sinus thrombosis. Clinical manifestations, prognostic factors, common involved sinuses and image findings of this study were similar to those of other studies. Health care policy makers should design a plan to warn susceptible women of the risk of cerebral venous-sinus thrombosis, and to educate them the ways to prevent it

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

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    Harvey William T

    2009-07-01

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

  14. Evaluating Interagency Collaborations. State Series Paper (Number 2).

    Science.gov (United States)

    McLaughlin, John A.; Covert, Robert C.

    A procedure is outlined for understanding and evaluating interagency collaboration. Five steps are addressed: (1) understanding the context of an interagency collaboration (stages of development, communication channels used); (2) verifying the need for interagency collaboration (needs for increased client access to services and reduced duplication…

  15. Values, Inquiry, and Education. CSE Monograph Series in Evaluation, 9.

    Science.gov (United States)

    Gideonse, Hendrik, Ed.; And Others

    This edited volume contains 16 social science-related educational research articles based on papers presented at the 1979 annual meeting of the American Educational Research Association (AERA). The articles and associated commentary are organized according to six symposia held at the meeting--anthropology, evaluation, history, political science,…

  16. Pitfalls in fractal time series analysis: fMRI BOLD as an exemplary case

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    Andras eEke

    2012-11-01

    Full Text Available This article will be positioned on our previous work demonstrating the importance of adhering to a carefully selected set of criteria when choosing the suitable method from those available ensuring its adequate performance when applied to real temporal signals, such as fMRI BOLD, to evaluate one important facet of their behavior, fractality.Earlier, we have reviewed on a range of monofractal tools and evaluated their performance. Given the advance in the fractal field, in this article we will discuss the most widely used implementations of multifractal analyses, too.Our recommended flowchart for the fractal characterization of spontaneous, low frequency fluctuations in fMRI BOLD will be used as the framework for this article to make certain that it will provide a hands-on experience for the reader in handling the perplexed issues of fractal analysis. The reason why this particular signal modality and its fractal analysis has been chosen was due to its high impact on today's neuroscience given it had powerfully emerged as a new way of interpreting the complex functioning of the brain (see intrinsic activity.The reader will first be presented with the basic concepts of mono and multifractal time series analyses, followed by some of the most relevant implementations, characterization by numerical approaches. The notion of the dichotomy of fractional Gaussian noise (fGn and fractional Brownian motion (fBm signal classes and their impact on fractal time series analyses will be thoroughly discussed as the central theme of our application strategy. Sources of pitfalls and way how to avoid them will be identified followed by a demonstration on fractal studies of fMRI BOLD taken from the literature and that of our own in an attempt to consolidate the best practice in fractal analysis of empirical fMRI-BOLD signals mapped throughout the brain as an exemplary case of potentially wide interest.

  17. Severe somatoform and dysautonomic syndromes after HPV vaccination: case series and review of literature.

    Science.gov (United States)

    Palmieri, Beniamino; Poddighe, Dimitri; Vadalà, Maria; Laurino, Carmen; Carnovale, Carla; Clementi, Emilio

    2016-08-09

    Human papilloma virus (HPV) is recognized as a major cause for cervical cancer among women worldwide. Two HPV vaccines are currently available: Gardasil(®) and Cervarix(®). Both vaccines enclose viral antigenic proteins, but differ as to the biological systems of culture and the adjuvant components. Recently, a collection of symptoms, indicating nervous system dysfunction, has been described after HPV vaccination. We retrospectively described a case series including 18 girls (aged 12-24 years) referred to our "Second Opinion Medical Network" for the evaluation of "neuropathy with autonomic dysfunction" after HPV vaccination. All girls complained of long-lasting and invalidating somatoform symptoms (including asthenia, headache, cognitive dysfunctions, myalgia, sinus tachycardia and skin rashes) that have developed 1-5 days (n = 11), 5-15 days (n = 5) and 15-20 days (n = 2) after the vaccination. These cases can be included in the recently described immune dysfunction named autoimmune/inflammatory syndrome induced by adjuvants (ASIA). HPV vaccine, through its adjuvant component, is speculated to induce an abnormal activation of the immune system, involving glia cells in the nervous system too. Further researches should aim at defining the pathological and clinical aspects of these post-vaccination diseases and identifying a genetic background predisposing to these adverse reactions.

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

    Science.gov (United States)

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

    2011-01-01

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

  19. Neuroendocrine tumors of the lung: major radiologic findings in a series of 22 histopathologically confirmed cases

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Marcel Koenigkam, E-mail: marcelk46@yahoo.com.br [Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (HCFMRP-USP), SP (Brazil); Department of Diagnostic and Interventional Radiology, Heidelberg University (Germany); Barreto, Andre Rodrigues Facanha [Clinica Radius, Clinica Sao Carlos Imagem and Santa Casa de Misericordia de Fortaleza, Fortaleza, CE (Brazil); Chagas Neto, Francisco Abaete [Program of Health Sciences Applied to the Locomotor System - Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (FMRP-USP), Ribeirao Preto, SP (Brazil); Muglia, Valdair Francisco; Elias Junior, Jorge [Division of Radiology, Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo (FMRPUSP), Ribeirao Preto, SP (Brazil)

    2012-07-15

    Objective: To describe key imaging findings in a series of cases of primary neuroendocrine tumors of the lung (NTLs), with emphasis on computed tomography changes. Materials And Methods: Imaging studies of 22 patients (12 men, mean age 60 years) with histopathologically confirmed diagnosis, evaluated in the author's institution during the last five years were retrospectively reviewed by two radiologists, with findings being consensually described focusing on changes observed at computed tomography. Results: The authors have described five typical carcinoids, three atypical carcinoids, three large-cell neuroendocrine carcinomas (LCNCs), and 11 small-cell lung cancers (SCLCs). Only one typical carcinoid presented the characteristic appearance of central endobronchial nodule with distal pulmonary atelectasis, while the others were pulmonary nodules or masses. The atypical carcinoids corresponded to peripheral heterogeneous masses. One out of the three LCNCs was a peripheral homogeneous mass, while the others were ill-defined and heterogeneous. The 11 SCLCs corresponded to central, infiltrating and heterogeneous masses with secondary pleuropulmonary changes. Calcifications were absent both in LGNCs and SCLCs. Metastases were found initially and also at follow-up of all the cases of LCNCs and SCLCs. Conclusion: Although some imaging features may be similar, radiologic findings considered together with clinical information may play a relevant role in the differentiation of histological types of NTLs. (author)

  20. Anomalous Left Main Coronary Artery: Case Series of Different Courses and Literature Review

    Directory of Open Access Journals (Sweden)

    Adam T. Marler

    2013-01-01

    Full Text Available Background. Congenital anomalies of the coronary arteries are a cause of sudden cardiac death. Of the known anatomic variants, anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS remains the main focus of debate. Case Series. We present three cases, all presenting to our facility within one week’s time, of patients with newly discovered anomalous origination of the left coronary artery from the right sinus of Valsalva (L-ACAOS. All patients underwent cardiac computed tomography for evaluation of coronary anatomy along with other forms of functional testing. Despite the high risk nature of two of the anomalies, the patients are being treated medically without recurrence of symptoms. Summary. After review of the literature, we have found that the risk of sudden cardiac death in patients with congenital coronary anomalies, even among variants considered the highest risk, may be overestimated. In addition, the exact prevalence of coronary anomalies in the general population is currently underestimated. A national coronary artery anomaly registry based on cardiac computed tomography and invasive coronary angiography data would be helpful in advancing our understanding of these cardiac peculiarities. The true prevalence of congenital coronary anomalies and overall risk of sudden cardiac death in this population are not well known. Surgical intervention remains the mainstay of therapy in certain patients though recent investigations into the pathophysiology of these abnormalities have shown that the risk of surgery may outweigh the minimal reduction in risk of sudden cardiac death.

  1. Unerupted teeth associated with dentigerous cysts and treated with coronectomy: mini case series.

    Science.gov (United States)

    Patel, Vinod; Sproat, Chris; Samani, Meera; Kwok, Jerry; McGurk, Mark

    2013-10-01

    There is a resurgence of interest in coronectomy, but its appropriate application in the management of third molar teeth has yet to be defined. Dentigerous cysts associated with unerupted teeth are most commonly associated with mandibular third molars. In this case series we evaluate outcome after coronectomy of teeth with associated dentigerous cysts in cases where the inferior dental nerve was thought to be at risk, or there was an increased risk of mandibular fracture. We retrospectively studied 21 consecutive patients treated by coronectomy for dentigerous cysts at the Oral Surgery Department at Guy's Hospital. The most commonly affected teeth were mandibular third molars (20/21). One patient had permanent injury to the inferior dental nerve, but no mandibular fracture or recurrence of cyst was reported. One patient required secondary retrieval of the retained root because of eruption. Coronectomy of unerupted teeth associated with dentigerous cysts is an effective treatment when there is high risk of injury to the inferior dental nerve injury or potential for mandibular fracture. Further work with larger numbers and longer follow-up is required to discover the long-term outcome of the electively retained root.

  2. Pediatric and staff dose evaluation in fluoroscopy upper gastrointestinal series

    Energy Technology Data Exchange (ETDEWEB)

    Filipov, Danielle; Nascimento, Eduarda X. do; Lacerda, Camila M., E-mail: diilipov@utfpr.edu.br [Universidade Tecnologica Federal do Parana (UFTPR), Curitiba, PR (Brazil); Schelin, Hugo R.; Ledesma, Jorge A.; Denyak, Valeriy; Legnani, Adriano, E-mail: ledesmajorgealberto@gmail.com [Instituto de Pesquisa Pele Pequeno Principe, Curitiba, PR (Brazil)

    2014-07-01

    Fluoroscopy upper GI series are widely used for the diagnosis of gastroesophageal reflux disease in children. Pediatric radiological procedures bring concern due to the high life expectancy and radiosensitivity on children, as well as the risks to the exposed staff Important studies present the mean KAP values on patients and the European Commission (EC) recommends specific techniques for these procedures. For the occupational expositions, staffs doses must be within the annual limit, according to the CNEN 3.01. Based on those data, the aims of the current study are: analyzing the upper GI procedure; determining the KAP on the patient and estimating the annual equivalent dose on the staff's crystalline. LiF :Mg,Ti TLDs were positioned on the patient upper chest center, so that the entrance surface air kerma could be determined. The field size on the patient s surface and the kerma were multiplied so that the KAP was obtained. LiF:Mg,Cu,P dosimeters were used to estimate the equivalent dose on the staff s crystalline. The results showed discrepancy in the kVp range and in the exposure time when compared to the EC data. The mean KAP values for the 0-1,1-3 and 3-10 years old patients were, respectively: 102 ± 19 cGy.cm2, 142 ± 25 cGy.cm2 and 323 ± 39 cGy.cm2; which are higher than the KAPs presented in the studies used for comparison. The estimated annual equivalent dose in the staff s crystalline would be approximately 85% higher than the limit set by the CNEN. Analyzing the data, it becomes clear that an optimization implementation is necessary in order to reduce the radiation levels. (author)

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

    Science.gov (United States)

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

    2016-01-26

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

  4. Mechanical-property evaluation of a series of commercial tungsten alloys. Memorandum report

    Energy Technology Data Exchange (ETDEWEB)

    Bruchey, W.J.; Montiel, D.M.

    1987-06-01

    A series of commercially available tungsten alloys ranging in tungsten content from 75% to 95% were evaluated. Typical tensile and compressive engineering properties are reported. These tests were conducted in support of penetrator ballistic-test programs.

  5. Surgery or radiotherapy for the treatment of bone hydatid disease: a retrospective case series

    Directory of Open Access Journals (Sweden)

    Zengru Xie

    2015-04-01

    Conclusion: This retrospective case series describes, for the first time, the clinical outcomes in a series of patients treated with radiotherapy for bone hydatid disease. Although no direct comparison between the treatment groups could be made due to methodological limitations of the study design, this study indicates that well-designed prospective randomized controlled clinical trials assessing radiotherapy may be warranted in patients with inoperable hydatid disease of the bones.

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

    Science.gov (United States)

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

    2014-03-01

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

  7. Epley's Maneuver in Benign Paroxysmal Positional Vertigo: Series of Cases Reports

    Directory of Open Access Journals (Sweden)

    Marchiori, Luciana Lozza de Moraes

    2011-04-01

    Full Text Available Introduction: Benign paroxysmal positional vertigo (BPPV is probably the most common cause of vertigo in women. Objective: To report the result of Epley's maneuver when treating BPPV patients. Method: Study of a series of 9-month-long cases of five female individuals aged between 46 and 64 with BPPV, who were submitted to Epley's maneuver at a scholar clinics, having the positive Dix-Hallpike maneuver at the first consultation as an inclusion criterion, and evaluations were repeated in a six and nine-month term. Results: Only one Epley's maneuver, as the only therapeutic procedure, was enough to eliminate nystagmus and positional vertigo in 4 patients, who did not show a positive Dix-Hallpike maneuver in the two reevaluations performed. Only one patient showed BPPV in the first reevaluation of the study term, and nystagmus reoccurred in the second evaluation only. Conclusion: Epley's repositioning maneuver proved to be a simple and effective BPPV treatment method for this study's patients at length.

  8. 18F-FDG PET/CT and primary hepatic MALT: a case series.

    Science.gov (United States)

    Albano, Domenico; Giubbini, Raffaele; Bertagna, Francesco

    2016-10-01

    Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is an extremely rare disease and its glucidic metabolic behavior is not clear. We retrospectively analyzed five patients with histological diagnosis of primary hepatic MALT lymphoma who underwent twelve 18F-FDG PET/CT. All staging 18F-FDG PET/CT were positive showing 18F-FDG uptake (average SUVmax was 5.62 ± 1.6) at the corresponding liver lesion. 18F-FDG PET/CT also was useful in evaluating the complete metabolic response after chemotherapy in three patients and radiotherapy in two. Besides, in one patient 18F-FDG PET/CT detected disease relapse during follow-up. Despite the low number of patients, our case series shows the 18F-FDG avidity of hepatic MALT and the possible role of 18F-FDG PET/CT in the management of these patients, both for staging, treatment response evaluation and restaging. Further studies are needed to confirm our results.

  9. Canine small clear cell/T-zone lymphoma: clinical presentation and outcome in a retrospective case series.

    Science.gov (United States)

    Martini, V; Marconato, L; Poggi, A; Riondato, F; Aresu, L; Cozzi, M; Comazzi, S

    2016-08-01

    Published studies, taken together, suggest the existence of a single canine lymphoma entity, with a small clear cell appearance by cytological evaluation, a histopathological T-zone pattern and an aberrant CD45-negative T-cell phenotype, mostly characterized by long-term survival. We describe clinical presentation and outcome in a retrospective case series of canine small clear cell/T-zone lymphoma. Despite the reported predisposition of Golden retriever, this breed was not represented in our case series. Most dogs presented with stage V disease, whereas only few had clinical signs or peripheral cytopenias. Blood was almost always more infiltrated than bone marrow. Median survival confirmed the favourable prognosis described in literature, but a few dogs died within a short time. Also, a subgroup of dogs developed second malignancies, eventually leading to death. We did not investigate possible prognostic factors because of the wide variety in treatments, and further studies are needed to identify high-risk animals.

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

    OpenAIRE

    Payam Khomand; Kambiz Hassanzadeh

    2016-01-01

    Background: We report a case series of cerebral vein thrombosis (CVT) in women who used oral contraceptive pill (OCP) in the Muslims Ramadan and fasting month.Methods: This study was a retrospective case series of 9 patients with diagnosis of CVT, who admitted in the neurology ward of Tohid Hospital of Sanandaj, Iran, in July-August 2014-2015.Results: Patients had no history of thrombosis before. They were treated with oral contraceptive more than 1 month to be able to fast during Ramadan. Th...

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

    Science.gov (United States)

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

    2016-10-01

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

  12. Shared written case formulations and weight change in outpatient therapy for anorexia nervosa: a naturalistic single case series.

    Science.gov (United States)

    Gladwin, Alice M; Evangeli, Michael

    2013-01-01

    The therapeutic effects of written shared case formulations are underexplored and have not been examined in anorexia nervosa. This study explored the relationship between (a) the delivery (b) the quality of a shared written case formulation and weight in outpatient psychological therapy for anorexia nervosa. A naturalistic single case series approach was used to examine the case notes of women who had attended a specialist eating disorders service over a 2-year period. The case notes of 15 adult women who had undergone outpatient psychological therapy for anorexia nervosa with a shared written case formulation component were reviewed. The impact of the quality of the case formulation on weekly weight was examined for 14 of the clients where the case formulation was available. The nature of the relationship between the delivery of the written shared case formulation and weight was examined for all 15 clients. There was some evidence to support an association between delivery of the shared written case formulation and weight changes (both weight gain [five out of 15 clients] and weight loss [three out of 15 clients]) in individual cases. Higher case formulation quality was related to cases where weight change did not occur. The delivery of case formulations can be associated with important therapeutic change (both beneficial and potentially harmful) in anorexia nervosa. Future research into the causal mechanisms associated with sharing formulations will face the challenge of adopting strategies that allow for an in-depth exploration of complex therapy variables whilst overcoming methodological challenges.

  13. Cogan's Syndrome in Patients With Inflammatory Bowel Disease--A Case Series

    DEFF Research Database (Denmark)

    Vavricka, Stephan R; Greuter, Thomas; Scharl, Michael

    2015-01-01

    treatment at the time of CSy diagnosis, of whom 6 (37.5%) were on anti-tumour necrosis factor (TNF). Seven out of 10 patients, who were treated for CSy with immunomodulators (mostly with corticosteroids), demonstrated at least partial response. CONCLUSION: This is the largest CSy-IBD case series so far......BACKGROUND: Cogan's syndrome (CSy) is a very rare autoimmune disorder, mainly affecting the inner ear and the eye, and is associated with inflammatory bowel disease (IBD). METHODS: This was a European Crohn's and Colitis Organisation (ECCO) retrospective observational study, performed as part...... of the CONFER project. A call to all ECCO members was made to report concomitant CSy and inflammatory bowel disease (IBD) cases. Clinical data were recorded in a standardized questionnaire. RESULTS: This international case series reports on 22 concomitant CSy-IBD cases from 14 large medical centres. Mean...

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

    Science.gov (United States)

    Shah, I; Barot, S; Madvariya, M

    2015-01-01

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

  15. Investigation of Severe Craniomaxillofacial Battle Injuries Sustained by U.S. Service Members: A Case Series

    Science.gov (United States)

    2012-11-05

    treatment options, surgical procedures, and outcomes were collected and detailed. Case Reports Patient 1 Patient 1 is a 22-year-old male soldier injured...were also placed in the temporal bone to support ear prosthesis . Patient 4 currently suffers from microstomia, recurrent ectropion, decreased...injuries ► reconstruction ► surgical complications ► surgical outcomes Abstract This case series describes craniomaxillofacial battle injuries

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Science.gov (United States)

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

    2008-01-01

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

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

    Science.gov (United States)

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

    2006-01-01

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

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

    Science.gov (United States)

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

    2005-01-01

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

  20. Clinical Advantages and Limitations of Monolithic Zirconia Restorations Full Arch Implant Supported Reconstruction: Case Series

    Directory of Open Access Journals (Sweden)

    Joao Carames

    2015-01-01

    Full Text Available Purpose. The purpose of this retrospective case series is to evaluate the clinical advantages and limitations of monolithic zirconia restorations for full arch implant supported restorations and report the rate of complications up to 2 years after insertion. Materials and Methods. Fourteen patients received implant placement for monolithic zirconia full arch reconstructions. Four implants were placed in seven arches, eleven arches received six implants, two arches received seven implants, two arches received eight implants, and one arch received nine implants. Results. No implant failures or complications were reported for an implant survival rate of 100% with follow-up ranging from 3 to 24 months. Conclusions. Monolithic zirconia CAD-/CAM-milled framework restorations are a treatment option for full arch restorations over implants, showing a 96% success rate in the present study. Some of the benefits are accuracy, reduced veneering porcelain, and minimal occlusal adjustments. The outcome of the present study showed high success in function, aesthetics, phonetics, and high patient satisfaction.

  1. Measurement of tibial slope angle after medial opening wedge high tibial osteotomy: case series

    Directory of Open Access Journals (Sweden)

    Ricardo Hideki Yanasse

    Full Text Available CONTEXT AND OBJECTIVE: In the past, changes in tibial slope were not considered when planning or evaluating osteotomies, and success in high tibial osteotomy was related to the alignment and amount of femorotibial angular correction. The aim here was to measure changes in tibial slope after medial opening wedge tibial osteotomy and investigate the effect of tibial slope angle on the clinical results. DESIGN AND SETTING: Retrospective review study on a series of cases, at the Department of Orthopedics and Traumatology, Faculdade de Medicina de Marília (Famema, Marília, Brazil. METHODS: Twenty-eight patients were studied, and a total of thirty-one knees. Lateral roentgenograms of the tibia were used pre and postoperatively to measure the tibial slope based on the proximal tibial anatomical axis. The clinical results were measured using the Lysholm knee score. RESULTS: There was an average increase in tibial slope angle after surgery of 2.38° (95% confidence interval: ± 0.73°. There was no correlation (r = -0.28 between the postoperative Lysholm knee score and the difference in tibial slope angle from before to after surgery (P = 0.13. CONCLUSION: Medial opening wedge tibial osteotomy led to a small increase in tibial slope. No significant correlation was found between increased tibial slope and short-term clinical results after high tibial osteotomy. Other clinical studies are needed in order to establish whether extension or flexion osteotomy could benefit patients with medial compartment gonarthrosis.

  2. Qigong program on insomnia and stress in cancer patients: A case series report

    Directory of Open Access Journals (Sweden)

    Seungmo Kim

    2015-01-01

    Full Text Available Background: In recent years, the interest in Qigong as an alternative therapy has grown following reports of its ability to regulate psychological factors in cancer patients. This is a case series to evaluate the outcome measures of Qigong when used as an adjunct to standard medical care to treat insomnia and stress in cancer patients. Patients and methods: The Qigong program was applied to four cancer patients with insomnia, stress, and anxiety. The program consisted of 30-min sessions involving exercise, patting of the 12 meridians, and spontaneous breathing exercises three times a week for a period of 4 weeks. The Pittsburgh Sleep Quality Index was measured as the primary outcome, while the Stress Scale, the State–Trait Anxiety Inventory, and the Functional Assessment Cancer Therapy–General determined the secondary outcomes. Insomnia, stress, and anxiety levels were examined weekly, while quality of life was examined on the first visit and the last visit. Results: The Pittsburgh Sleep Quality Index and Stress Scale scores were reduced after conduct of the Qigong program. Conclusion: This study could provide a better understanding of Qigong’s influence on insomnia and stress in cancer patients. However, a larger controlled trial should be conducted to confirm these findings.

  3. In-office bleaching effects on the pulp flow and tooth sensitivity - case series.

    Science.gov (United States)

    Cartagena, Andrés Felipe; Parreiras, Sibelli Olivieri; Loguercio, Alessandro Dourado; Reis, Alessandra; Campanha, Nara Hellen

    2015-01-01

    Laser Doppler flowmetry (LDF) is a noninvasive method capable of evaluating variations in pulp blood flow (PBF) and pulp vitality. This method has thus far not been used to assess changes in blood flow after in-office bleaching. The aim of this case series report was to measure changes in PBF by LDF in the upper central incisor of three patients submitted to in-office bleaching. The buccal surfaces of the upper arch were bleached with a single session of 35% hydrogen peroxide gel with three 15-min applications. The color was recorded using a value-oriented Vita shade guide before in-office bleaching and one week after the procedure. The tooth sensitivity (TS) in a verbal scale was reported, and PBF was assessed by LDF before, immediately, and one week after the bleaching session. The lower arch was submitted to dental bleaching but not used for data assessment. A whitening degree of 3 to 4 shade guide units was detected. All participants experienced moderate to considerable TS after the procedure. The PBF readings reduced 20% to 40% immediately after bleaching. One week post-bleaching, TS and PBF were shown to be equal to baseline values. A reversible decrease of PBF was detected immediately after bleaching, which recovered to the baseline values or showed a slight increase sooner than one week post-bleaching. The LDF method allows detection of pulp blood changes in teeth submitted to in-office bleaching, but further studies are still required.

  4. Recovery of brachial plexus lesions resulting from heavy backpack use: A follow-up case series

    Directory of Open Access Journals (Sweden)

    Pihlajamäki Harri K

    2011-03-01

    Full Text Available Abstract Background Brachial plexus lesions as a consequence of carrying a heavy backpack have been reported, but the typical clinical course and long-term consequences are not clear. Here we evaluated the clinical course and pattern of recovery of backpack palsy (BPP in a large series of patients. Methods Thirty-eight consecutive patients with idiopathic BPP were identified from our population of 193,450 Finnish conscripts by means of computerised register. A physiotherapist provided instructions for proper hand use and rehabilitative exercises at disease onset. The patients were followed up for 2 to 8 years from the diagnosis. We also searched for genetic markers of hereditary neuropathy with pressure palsies. Mann-Whitney U-test was used to analyze continuous data. The Fischer's exact test was used to assess two-way tables. Results Eighty percent of the patients recovered totally within 9 months after the onset of weakness. Prolonged symptoms occurred in 15% of the patients, but daily activities were not affected. The weight of the carried load at the symptom onset significantly affected the severity of the muscle strength loss in the physiotherapeutic testing at the follow-up. The initial electromyography did not predict recovery. Genetic testing did not reveal de novo hereditary neuropathy with pressure palsies. Conclusions The prognosis of BPP is favorable in the vast majority of cases. Electromyography is useful for diagnosis. To prevent brachial plexus lesions, backpack loads greater than 40 kg should be avoided.

  5. In-office bleaching effects on the pulp flow and tooth sensitivity – case series

    Directory of Open Access Journals (Sweden)

    Andrés Felipe CARTAGENA

    2015-01-01

    Full Text Available Laser Doppler flowmetry (LDF is a noninvasive method capable of evaluating variations in pulp blood flow (PBF and pulp vitality. This method has thus far not been used to assess changes in blood flow after in-office bleaching. The aim of this case series report was to measure changes in PBF by LDF in the upper central incisor of three patients submitted to in-office bleaching. The buccal surfaces of the upper arch were bleached with a single session of 35% hydrogen peroxide gel with three 15-min applications. The color was recorded using a value-oriented Vita shade guide before in-office bleaching and one week after the procedure. The tooth sensitivity (TS in a verbal scale was reported, and PBF was assessed by LDF before, immediately, and one week after the bleaching session. The lower arch was submitted to dental bleaching but not used for data assessment. A whitening degree of 3 to 4 shade guide units was detected. All participants experienced moderate to considerable TS after the procedure. The PBF readings reduced 20% to 40% immediately after bleaching. One week post-bleaching, TS and PBF were shown to be equal to baseline values. A reversible decrease of PBF was detected immediately after bleaching, which recovered to the baseline values or showed a slight increase sooner than one week post-bleaching. The LDF method allows detection of pulp blood changes in teeth submitted to in-office bleaching, but further studies are still required.

  6. A Case Series on the Effects of Kripalu Yoga for Generalized Anxiety Disorder.

    Science.gov (United States)

    Morgan, Jessica R; Sullivan, Marlysa; Masuda, Akihiko; Tully, Erin; Cohen, Lindsey L; Anderson, Page L

    2016-07-14

    Generalized anxiety disorder (GAD) is a prevalent psychiatric disorder associated with substantial impairment and poor treatment response. Yoga influences processes that are linked to the maintenance of GAD including mindfulness, anxiety, and heart rate variability, but has yet to be evaluated among people with the disorder. The present study is a first step toward documenting the efficacy of yoga for reducing worry among people with GAD using a single-subject AB design case series and daily ratings of worry. Standardized self-report measures of worry, trait anxiety, experiential avoidance, mindfulness, and heart rate variability were assessed pre- and post-intervention. Three participants with primary GAD received eight twice-weekly Kripalu yoga sessions following a baseline data collection period. All participants showed systematic improvement in daily worry ratings on at least one index and all scores on self-reported measures of worry, anxiety, experiential avoidance, and mindfulness changed in the expected direction following yoga (with one or two exceptions). Participants also showed improved heart rate variability during a worry period from pre- to post-intervention. Yoga has the potential to improve the processes linked to GAD and should stimulate further research in this area.

  7. Impact of an Innovative Classroom-Based Lecture Series on Residents' Evaluations of an Anesthesiology Rotation.

    Science.gov (United States)

    Tanaka, Pedro; Yanez, David; Lemmens, Hendrikus; Djurdjulov, Adam; Scotto, Lena; Borg, Lindsay; Walker, Kim; Bereknyei Merrell, Sylvia; Macario, Alex

    2016-01-01

    Introduction. Millennial resident learners may benefit from innovative instructional methods. The goal of this study is to assess the impact of a new daily, 15 minutes on one anesthesia keyword, lecture series given by faculty member each weekday on resident postrotation evaluation scores. Methods. A quasi-experimental study design was implemented with the residents' rotation evaluations for the 24-month period ending by 7/30/2013 before the new lecture series was implemented which was compared to the 14-month period after the lecture series began on 8/1/2013. The primary endpoint was "overall teaching quality of this rotation." We also collected survey data from residents at clinical rotations at two other different institutions during the same two evaluation periods that did not have the education intervention. Results. One hundred and thirty-one residents were eligible to participate in the study. Completed surveys ranged from 77 to 87% for the eight-question evaluation instrument. On a 5-point Likert-type scale the mean score on "overall teaching quality of this rotation" increased significantly from 3.9 (SD 0.8) to 4.2 (SD 0.7) after addition of the lecture series, whereas the scores decreased slightly at the comparison sites. Conclusion. Rotation evaluation scores for overall teaching quality improved with implementation of a new structured slide daily lectures series.

  8. Impact of an Innovative Classroom-Based Lecture Series on Residents’ Evaluations of an Anesthesiology Rotation

    Directory of Open Access Journals (Sweden)

    Pedro Tanaka

    2016-01-01

    Full Text Available Introduction. Millennial resident learners may benefit from innovative instructional methods. The goal of this study is to assess the impact of a new daily, 15 minutes on one anesthesia keyword, lecture series given by faculty member each weekday on resident postrotation evaluation scores. Methods. A quasi-experimental study design was implemented with the residents’ rotation evaluations for the 24-month period ending by 7/30/2013 before the new lecture series was implemented which was compared to the 14-month period after the lecture series began on 8/1/2013. The primary endpoint was “overall teaching quality of this rotation.” We also collected survey data from residents at clinical rotations at two other different institutions during the same two evaluation periods that did not have the education intervention. Results. One hundred and thirty-one residents were eligible to participate in the study. Completed surveys ranged from 77 to 87% for the eight-question evaluation instrument. On a 5-point Likert-type scale the mean score on “overall teaching quality of this rotation” increased significantly from 3.9 (SD 0.8 to 4.2 (SD 0.7 after addition of the lecture series, whereas the scores decreased slightly at the comparison sites. Conclusion. Rotation evaluation scores for overall teaching quality improved with implementation of a new structured slide daily lectures series.

  9. The versatile reverse flow sural artery neurocutaneous flap: A case series and review of literature

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    Fok Margaret

    2008-04-01

    Full Text Available Abstract Background Reverse flow sural neurocutaneous flap has been utilized more frequently during the past decade to cover vital structures around the foot and ankle area. The potential advantages are the relatively constant blood supply, ease of elevation and preservation of major vascular trunks in the leg. The potential disadvantages remain venous congestion, donor site morbidity and lack of sensation. Methods This descriptive case series was conducted at Queen Mary Hospital, Hong Kong, from 1997 to 2003. Ten patients having undergone reverse flow sural neurocutaneous flap were identified through medical records. There were six females (60% and four males (40%, with an average age of 59.8 years. The defects occurred as a result of trauma in five patients (50%, diabetic ulcers in four (40% and decubitus ulcer in one (10% paraplegic patient. The defect site included non weight bearing heel in four (40%, tendo Achilles in two (20%, distal tibia in two (20%, lateral malleolus in one (10% and medial aspect of the midfoot in one patient (10%. The maximum flap size harvested was 14 × 6 cm. Preoperative doppler evaluation was performed in all patients to identify perforators and modified plaster of paris boot was used in the post operative period. A detailed questionnaire was developed addressing variables of interest. Results There was no flap failure. Venous congestion was encountered in one case. The donor site was relatively unsightly but acceptable to all patients. The loss of sensation in the sural nerve distribution was transient in all patients. Conclusion Reverse sural artery flap remains to be the workhorse flap to resurface the soft tissue defects of the foot and ankle. Anastomosis of the sural nerve to the digital plantar nerve can potentially solve the issue of lack of sensation in the flap especially when used for weight bearing heel.

  10. Ultrasound-guided rectus sheath block in children with umbilical hernia: Case series

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    Abdul Hamid Alsaeed

    2013-01-01

    Full Text Available Background: Umbilical hernia repair, a common day-case surgery procedure in children, is associated with a significant postoperative pain. The most popular peripheral nerve blocks used in umbilical hernia repair are rectus sheath infiltration and caudal block. The rectus sheath block may offer improved pain relief following umbilical hernia repair with no undesired effects such as lower limb motor weakness or urinary retention seen with caudal block which might delay discharge from the hospital. Ultrasound guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks.The aim of this case series is to assess the post rectus sheath block pain relief in pediatric patients coming for umbilical surgery. Methods: Twenty two (22 children (age range: 1.5-8 years scheduled for umbilical hernia repair were included in the study. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 5-16 MHz 50 mm linear probe. An ultrasound-guided posterior rectus sheath block of both rectus abdominis muscles (RMs was performed (total of 44 punctures. An in-plain technique using Stimuplex A insulated facet tip needle 22G 50mm. Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia by means of the modified CHEOPS scale were evaluated. Results: ultrasonograghic visualization of the posterior sheath was possible in all patients. The ultrasound guided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia except for one patient who postoperatively required morphine 0.1 mg/kg intravenously. There were no complications. Conclusions: Ultrasound guidance enables performances of an effective rectus sheath block for umbilical hernia. Use of the Stimuplex A insulated facet tip needle 22G 50mm provides easy, less traumatic skin and rectus muscle penetration and satisfactory needle

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

    Science.gov (United States)

    Calice, Ivana; Moens, Yves

    2016-01-01

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

  12. PECTUS EXCAVATUM: REPARACIóN CON LA TéCNICA DE NUSS. SERIE DE 10 CASOS Pectus excavatum: repair with Nuss technique. A series of 10 cases

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    Fernando Fierro-ávila

    2009-01-01

    observation upon the open procedure changed radically the treatment and has been rapidly adopted by surgeons all around the world. Objetive. This study evaluates the results of the MIRPE in the Clínica Infantil Colsubsidio. Materials and methods. We carried out a case series of patients treated with the Nuss procedure betweeen December 2004 and July 2008. Information was gathered from medical records , considering personal and familiar past medical history, laboratory and radiologic tests. Results of the procedure were evaluated, including duration of the procedure, early and late onset complications and analgesic use. Results. 10 patients between 13 and 17 years were included, 90 percent were men. The cosmetic result was satisfactory in all cases. The most frequent complications were pneumothorax and dislodgement of the bar; We did not find any case of infection, allergy, pleural effusion, pericarditis or hemothorax. Conclusions. This descriptive study allows us to compare our early experience with the worldwide reports, finding that it is a safe and reproducible technique, with good results in most patients; It also has a more prompt functional recovery and satisfactory esthetic result. Complications in our series were similar to the reported in the literature.

  13. Minimally Invasive Pyeloplasty in Horseshoe Kidneys with Ureteropelvic Junction obstruction: A case series

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    Stephen Faddegon

    2013-04-01

    Full Text Available Background and Purpose Horseshoe kidney is an uncommon renal anomaly often associated with ureteropelvic junction (UPJ obstruction. Advanced minimally invasive surgical (MIS reconstructive techniques including laparoscopic and robotic surgery are now being utilized in this population. However, fewer than 30 cases of MIS UPJ reconstruction in horseshoe kidneys have been reported. We herein report our experience with these techniques in the largest series to date. Materials and Methods We performed a retrospective chart review of nine patients with UPJ obstruction in horseshoe kidneys who underwent MIS repair at our institution between March 2000 and January 2012. Four underwent laparoscopic, two robotic, and one laparoendoscopic single-site (LESS dismembered pyeloplasty. An additional two pediatric patients underwent robotic Hellstrom repair. Perioperative outcomes and treatment success were evaluated. Results Median patient age was 18 years (range 2.5-62 years. Median operative time was 136 minutes (range 109-230 min. and there were no perioperative complications. After a median follow-up of 11 months, clinical (symptomatic success was 100%, while radiographic success based on MAG-3 renogram was 78%. The two failures were defined by prolonged t1/2 drainage, but neither patient has required salvage therapy as they remain asymptomatic with stable differential renal function. Conclusions MIS repair of UPJ obstruction in horseshoe kidneys is feasible and safe. Although excellent short-term clinical success is achieved, radiographic success may be lower than MIS pyeloplasty in heterotopic kidneys, possibly due to inherent differences in anatomy. Larger studies are needed to evaluate MIS pyeloplasty in this population.

  14. Management of the proximal tibia fractures by mini external fixation: A case series of 30 cases

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    Samar K Biswas

    2014-01-01

    Full Text Available Background: Management of high velocity trauma is a challenging problem because of morbidity of trauma and sometime residual problems of failure of proper healing of fractures with the restriction of movements of knee, shortening, and added risk of compartment syndrome in the proximal tibia fracture. There is always risk of post-operative infection and infected non-union in extensive open surgical procedure and internal fixation. Hence, there is always look out for the middle path procedure for a solution to the above said problems with the added advantage of less hospital stay and early return to work by minimal invasive procedure and stabilization of fracture reduction by multiple K-wire fixation with a frame applied externally. Stabilization of fracture with reduced pain allows early movements of neighbouring joint knee and ankle; hence, reduces the chances of fracture diseases. With this we have been stimulated to take-up the study of managing the proximal tibia fracture by mini external fixator. Aim: The aim of this study was to manage proximal tibia fractures by mini external fixator and evaluate the results and efficacy of this method. Material and Method: A total of 30 patients having proximal tibial fractures admitted at our center between 2008 and 2010 were taken and the procedure carried out was closed manipulative reduction and stabilization with mini external fixator. All acute proximal tibia fractures including tibial plateau fractures above 17 years of age of either sex were included in the study. Fracture more than 3 weeks old were excluded from the study. Result: Out of 30 cases 13 were excellent, 14 cases good, and 3 showed fair. It was found that type 5 and 6 of Schatzker′s classification have lesser outcome type of fractures Conclusion: We have found that management of the proximal tibia fractures by mini external fixation method has a better outcome. Early mobilization of knee in the proximal tibia fractures after

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

    Science.gov (United States)

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

    2015-01-01

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

  16. Functional surgery of the temporomandibular joint with conscious sedation for "closed lock" using eminectomy as a treatment: a case series.

    LENUS (Irish Health Repository)

    Stassen, Leo F

    2011-06-01

    The purpose of this case series study was to evaluate the advantages and disadvantages of using local anesthesia and conscious sedation (CS) rather than general anesthesia (GA) for performing functional surgery on patients suffering from temporomandibular joint (TMJ) closed lock, using the eminectomy procedure. Performing this procedure using CS allows functional assessment of the TMJ meniscus at the time of surgery. The objectives of this study were to determine if this surgery is possible under CS, to determine the benefits of being able to see the meniscus in action, and to investigate the patients\\' acceptability for this form of anesthesia.

  17. An uncommon clinical feature of IAN injury after third molar removal: a delayed paresthesia case series and literature review.

    Science.gov (United States)

    Borgonovo, Andrea; Bianchi, Albino; Marchetti, Andrea; Censi, Rachele; Maiorana, Carlo

    2012-05-01

    After an inferior alveolar nerve (IAN) injury, the onset of altered sensation usually begins immediately after surgery. However, it sometimes begins after several days, which is referred to as delayed paresthesia. The authors considered three different etiologies that likely produce inflammation along the nerve trunk and cause delayed paresthesia: compression of the clot, fibrous reorganization of the clot, and nerve trauma caused by bone fragments during clot organization. The aim of this article was to evaluate the etiology of IAN delayed paresthesia, analyze the literature, present a case series related to three different causes of this pathology, and compare delayed paresthesia with the classic immediate symptomatic paresthesia.

  18. Central neuraxial anaesthesia presenting with spinal myoclonus in the perioperative period: a case series

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    Bamgbade Olumuyiwa A

    2009-06-01

    Full Text Available Abstract Introduction Perioperative spinal myoclonus is extremely rare. Many anaesthetists and perioperative practitioners may not diagnose or manage this complication appropriately when it occurs. This case report of unusual acute spinal myoclonus following regional anaesthesia highlights certain aspects of this rare complication that have not previously been published. Case presentations A series of four consecutive patients who developed acute lower-limb myoclonus following spinal or epidural anaesthesia are described. The case series occurred at three different hospitals and involved four anaesthetists over a 3-year period. Two Caucasian men, aged 90-years-old and 67-years-old, manifested unilateral myoclonus. Two Caucasian women, aged 64-years-old and 53-years-old, developed bilateral myoclonus. Myoclonus was self-limiting in one patient, treated with further regional anaesthesia in one patient and treated with intravenous midazolam in two patients. The overall outcome was good in all patients, with no recurrence or sequelae in any of the patients. Conclusion This case series emphasizes that spinal myoclonus following regional anaesthesia is rare, has diverse pathophysiology and can have diverse presentations. The treatment of perioperative spinal myoclonus should be directed at the aetiology. Anaesthetists and perioperative practitioners who are unfamiliar with this rare complication should be reassured that it may be treated successfully with midazolam.

  19. Secondary ovarian tumors: Evaluation of 44 cases

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    Sevgiye KAÇAR ÖZKARA

    2007-09-01

    Full Text Available Secondary ovarian tumors compose 3-8% of all, and 10-30% of malignant ovarian tumors. Histopathological features of SOT diagnosed in our department in 10-year period are discussed. Macroscopical, microscopical, immunohistochemical and cytopathological features of secondary ovarian tumors diagnosed between 1997- 2006 were re-evaluated. Additional histochemical and immunohistochemical studies were applied to find the primaries. Data was statistically evaluated. Totally, 44 secondary ovarian tumors had been diagnosed within this period. The mean age of the patients was 52.9 years; the mean tumor diameter was 103.7 mm.The primary was gastrointestinal system in 50% of the cases. Ten of them (22.7% were metastases of signet ring cell carcinoma of stomach (Kruckenberg tumor while 9 cases (20.5% were from colorectal and three (6.8% were from appendiceal adenocarcinomas. 27.3% of our cases were originated from genital tract. Synchronous endometrioid adenocarcinomas of corpus uteri and ovary were seen in six cases (13.6%. Ovarian involvement of serous carcinomas of corpus uteri was seen in five (11.4% cases. Ovarian metastases of breast carcinoma in four cases (9.1% were seen while the ovarian involvement of adrenal cortical and tubal carcinomas was observed in one case, each. The primary was peritoneal surface in five (11.4% of the cases. Tumors were bilateral in 65.9% of the cases, and there was statistically significant correlation between the bilaterality rate of the tumors and the primary (p=0.015.The more precise diagnosis of secondary ovarian tumors could be reached by evaluation of clinical, surgical, macroscopical, microscopical, cytopathological and immunohistochemical findings together.

  20. Tubercular Uveitis with Ocular Manifestation as the First Presentation of Tuberculosis: A Case Series.

    Science.gov (United States)

    Shah, Jayashree S; Shetty, Niharika; Shah, Sharath Kumar D; Shah, Neelesh Kumar S

    2016-03-01

    Tuberculosis is very common disease in India. It is one of the most common causes of Granulomatous Uveitis in our Country even today. So the strongest suspicion in our mind when we are treating a case of Uveitis, should be TB. We reviewed all the cases of clinically suspected ocular tuberculosis attending the Ophthalmology OPD of Sri Siddhartha Medical College between December 2012 and December 2014 who were refractory to routine uveitis management and later on responded to anti-Tubercular treatment. History of TB contact, Ocular manifestation, Demographic Profile of the patients, Diagnostic test, Treatment regime were looked into. Here by we present a case series of 15 cases of refractory uveitis that later were detected to be of tuberculous origin. We studied the characteristic features, complications and correlation of mantoux test, ESR and Koch's contact with these cases.

  1. A Case Series: Outcome of Endoscopic Electrocautery in the Management of Branchial Fistula

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    Goh Bee See

    2015-09-01

    Full Text Available Objective: This is a series of five cases of branchial anomalies which were diagnosed and treated in a span of six years in the Department of Otorhinolaryngology, Head & Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre (UKMMC. The main objective of this article is to highlight the use of endoscopic electrocautery in the management of branchial fistula. Case report: five cases were reported of the age group between 11 months old to 16 years who presented with an intermittent mucoid discharge from an external opening in the neck since birth and three cases were on the left side and the other two cases were bilateral fistula. Direct laryngoscopy under general anaesthesia was done as part of diagnostic and therapeutic management for the patients. Conclusion: Endoscopic electrocautery is a safe method and appears to be an effective alternative to open excision for branchial fistula.

  2. [Retrospective evaluation of 15 cases with psoas abscesses].

    Science.gov (United States)

    Turunç, Tahsin; Turunç, Tuba; Demiroğlu, Y Ziya; Colakoğlu, Sule

    2009-01-01

    Psoas abscesses are suppurative collections within the fascia surrounding the psoas and iliacus muscles. In this retrospective study it was aimed to evaluate the demographic characteristics, clinical and laboratory findings and treatment outcomes of 15 psoas abscess cases admitted to Baskent University Hospital, Ankara, Turkey during June 2003-January 2008 period. The mean age of the patients was 55.8 years (range 18 to 70 years) with a female to male ratio of 5/10. Thirteen of the cases (86.5%) were admitted with the complaints of fever and back pain. Thirteen of the cases were diagnosed by abdominal computerized tomography while the other two by abdominal ultrasonography. One of the 15 patients was considered as primary psoas abscess, while the remaining 14 as secondary psoas abscess. The most common accompanying disease was diabetes mellitus (66.6%). Fourteen patients with secondary psoas abscess had vertebral osteomyelitis which was due to tuberculosis in five cases, to urinary tract infection in five cases, to pneumoniae in two cases, to surgical infection in one case and to brucellosis in one case. The cultivation of the abscess material from the 14 secondary psoas abscess cases revealed growth of bacteria in 11 of them (5 Mycobacterium tuberculosis, 1 Escherichia coli, 1 methicillin-sensitive Staphylococcus aureus, 1 methicilin-resistant S. aureus, 1 Acinetobacter baumannii, 1 Brucella melitensis, 1 Serratia marcescens). The biochemical parameters of the cases (mean leukocyte counts: 14.500 cell/mm3; mean erythrocyte sedimentation rates: 78 mm/hour; mean C-reactive protein levels: 108 mg/dl) were also high. Thirteen patients underwent percutaneous drainage and received appropriate antibiotic treatment and the other two patients were treated with open surgical debridement. The duration of antimicrobial treatment was one year for M. tuberculosis cases and about 4-6 weeks in the others. One of the cases died due to complicating meningitis and sepsis. It is

  3. Disulfiram-induced reversible hypertension: A prospective case series and review of the literature

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    Ranganath R Kulkarni

    2014-01-01

    Full Text Available Disulfiram (DSF is one of the recommended aids in the management of selected patients with alcohol dependence. Hypertension (HTN as an adverse effect of DSF therapy is less understood. In our prospective case series of 7 subjects with co-morbid alcohol and nicotine dependence, a temporal, dose-dependent, and reversible grade 1-3 HTN within 1-6 weeks of initiation of DSF therapy (125-500 mg/day with no other detectable causes of HTN was noted. Challenges and strategies surrounding diagnosis and treatment along with mean change and percentage rise in blood pressure are described. Literature review and clinical description of case series may suggest neurobiological role in its causation. HTN may be a clinically significant, dose-dependent, and reversible adverse effect of DSF therapy, especially in co-morbid alcohol and nicotine-dependent patients. Awareness amongst clinicians may render better health care delivery to subjects with alcohol dependence.

  4. Disulfiram-induced reversible hypertension: a prospective case series and review of the literature.

    Science.gov (United States)

    Kulkarni, Ranganath R; Ramdurg, Santosh I; Bairy, Bhavya K

    2014-10-01

    Disulfiram (DSF) is one of the recommended aids in the management of selected patients with alcohol dependence. Hypertension (HTN) as an adverse effect of DSF therapy is less understood. In our prospective case series of 7 subjects with co-morbid alcohol and nicotine dependence, a temporal, dose-dependent, and reversible grade 1-3 HTN within 1-6 weeks of initiation of DSF therapy (125-500 mg/day) with no other detectable causes of HTN was noted. Challenges and strategies surrounding diagnosis and treatment along with mean change and percentage rise in blood pressure are described. Literature review and clinical description of case series may suggest neurobiological role in its causation. HTN may be a clinically significant, dose-dependent, and reversible adverse effect of DSF therapy, especially in co-morbid alcohol and nicotine-dependent patients. Awareness amongst clinicians may render better health care delivery to subjects with alcohol dependence.

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

    Science.gov (United States)

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

    2011-01-01

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

  6. Parenthood in patients with acute promyelocytic leukemia after treatment with arsenic trioxide: a case series.

    Science.gov (United States)

    Gupta, Shilpa; Bagel, Bhausaheb; Gujral, Sumeet; Subramanian, P G; Khattry, Navin; Menon, Hari; Nair, Reena

    2012-11-01

    Arsenic trioxide, believed to be a carcinogen and a teratogen, has found its niche in the treatment of acute promyelocytic leukemia (APL). APL is a disease affecting young patients. Post-treatment fertility and outcome of pregnancy are always a concern in a disease with high cure rates. We report a case series of six patients who were treated successfully for APL with arsenic trioxide and who parented at least one healthy offspring after completing their treatment.

  7. Concurrent upper and lower urinary tract robotic surgery: A case series

    OpenAIRE

    Pisipati, Sailaja; Bach, Christian; Daneshwar, Datesh; Rowe, Edward W.; Koupparis, Anthony J.

    2014-01-01

    The da Vinci Surgical System (Intuitive Surgical Inc.) continues to develop as a platform in urological surgery. Synchronous upper and lower urinary tract tumours requiring extirpative surgery are not uncommon. We report the first case robotic series of combined complex upper and lower urinary tract surgery. Six high-risk anaesthetic patients with a median age of 71 years and apparent synchronous upper and lower urinary tract pathologies underwent concurrent robotic surgery. Five underwent ro...

  8. Prehospital Use of the Intubating Laryngeal Mask Airway in Patients with Severe Polytrauma: A Case Series

    Directory of Open Access Journals (Sweden)

    Andrew M. Mason

    2009-01-01

    Full Text Available A case series of five patients is described demonstrating the utility of the intubating laryngeal mask airway in the prehospital setting, both as a primary airway rescue device and as a bridge to tracheal intubation. All patients were hypoxaemic, had sustained severe polytrauma and were trapped in their vehicles following road traffic collisions. A probability of survival study showed better-than-predicted outcomes for the group as a whole.

  9. Simple facet joint repair with dynamic pedicular system: Technical note and case series

    OpenAIRE

    Ali Fahir Ozer; Tuncer Suzer; Mehdi Sasani; Tunc Oktenoglu; Phillip Cezayirli; Hosein Jafari Marandi; Deniz Ufuk Erbulut

    2015-01-01

    Simple facet joint repair with dynamic pedicular system: Technical note and case series Ali Ozer, Tuncer Suzer, Mehdi Sasani, Tunc Oktenoglu, Phillip Cezayirli and Hosein Marandi Journal of Craniovertebral Junction and Spine. 6.2 (April-June 2015): p65. Copyright: COPYRIGHT 2015 Medknow Publications and Media Pvt. Ltd. http://www.jcvjs.com/ Full Text: Byline: Ali. Ozer, Tuncer. Suzer, Mehdi. Sasani, Tunc. Oktenoglu, Phillip. Cezayirli, Hosein. Marandi, Deniz. Erbulut Purpose: Facet joints are...

  10. Case Series of an Intraoral Balancing Appliance Therapy on Subjective Symptom Severity and Cervical Spine Alignment

    OpenAIRE

    2013-01-01

    Objective. The objective of this study was to investigate the effect of a holistic intraoral appliance (OA) on cervical spine alignment and subjective symptom severity. Design. An observational study on case series with holistic OA therapy. Setting. An outpatient clinic for holistic temporomandibular joint (TMJ) therapy under the supervision of the Pain Center, CHA Biomedical center, CHA University. Subjects. Ambulatory patients presenting with diverse chief complaints in the holistic TMJ cli...

  11. Combined spinal epidural anesthesia for laparoscopic appendectomy in adults: A case series

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    Rajesh S Mane

    2012-01-01

    Full Text Available Background: Laparoscopy is one of the most common surgical procedures and is the procedure of choice for most of the elective abdominal surgeries performed preferably under endotracheal general anesthesia. Technical advances in the field of laparoscopy have helped to reduce surgical trauma and discomfort, reduce anesthetic requirement resulting in shortened hospital stay. Recently, regional anaesthetic techniques have been found beneficial, especially in patients at a high risk to receive general anesthesia. Herewith we present a case series of laparoscopic appendectomy in eight American Society of Anaesthesiologists (ASA I and II patients performed under spinal-epidural anaesthesia. Methods: Eight ASA Grade I and II adult patients undergoing elective Laparoscopic appendectomy received Combined Spinal Epidural Anaesthesia. Spinal Anaesthesia was performed at L 2 -L 3 interspace using 2 ml of 0.5% (10 mg hyperbaric Bupivacaine mixed with 0.5ml (25 micrograms of Fentanyl. Epidural catheter was inserted at T 10 -T 11 interspace for inadequate spinal anaesthesia and postoperative pain relief. Perioperative events and operative difficulty were studied. Systemic drugs were administered if patients complained of shoulder pain, abdominal discomfort, nausea or hypotension. Results: Spinal anaesthesia was adequate for surgery with no operative difficulty in all the patients. Intraoperatively, two patients experienced right shoulder pain and received Fentanyl, one patient was given Midazolam for anxiety and two were given Ephedrine for hypotension. The postoperative period was uneventful. Conclusion: Spinal anaesthesia with Hyperbaric Bupivacaine and Fentanyl is adequate and safe for elective laparoscopic appendectomy in healthy patients but careful evaluation of the method is needed particularly in compromised cardio respiratory conditions.

  12. Volitional cycling augmented by functional electrical stimulation in hemiparetic adolescents: A case series study

    Directory of Open Access Journals (Sweden)

    Peri Elisabetta

    2013-01-01

    Full Text Available The aim of this work was to assess the feasibility of a treatment based on volitional cycling augmented by Functional Electrical Stimulation (FES on hemiparetic adolescents. Six chronic hemiparetic adolescents were included in a case series study. Patients underwent FES-cycling training combined with voluntary pedaling. The intervention consisted of 21 sessions lasting 30 minutes each. Patients were evaluated before, after training, and at a 3-month follow-up visit through clinical scales (Winter scale, observational gait scale, gross motor function measurement, Boyd test and Ashworth scale, a standard gait analysis and a voluntary pedaling test. Results were compared with an age-matched healthy control group (N=6. Two subjects withdrew the study before the completion of the intervention. Concerning the four remaining subjects, the clinical scales showed a slight level of disability already at baseline and no changes were observed after the intervention. In terms of walking ability, some significant improvements (Kruskal-Wallis test, p-value<0.05 were obtained after training in two out of four subjects: an increase of about 16% and 41% of the ankle range of motion and of about 18% and 33% of the ankle propelling power were achieved for two subjects, respectively. During pedaling, the work produced by the paretic leg while pulling the pedal significantly increased in 3 out of 4 subjects. In one subject a more symmetrical cycling movement was observed, whilst for another subject a significant improvement in terms of co-contraction between rectus femoris and biceps femoris was achieved. In conclusion, this study assessed the feasibility of FES-cycling training on hemiparetic adolescents, but did not provide evidences about the effectiveness of this intervention in improving motor recovery and walking ability. However, since only a small group of patients with a low level of disability was involved in the study, further investigations are needed to

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

    Science.gov (United States)

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

    2014-01-01

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

  14. Forecasting Malaria Cases Using Climatic Factors in Delhi, India: A Time Series Analysis

    Directory of Open Access Journals (Sweden)

    Varun Kumar

    2014-01-01

    Full Text Available Background. Malaria still remains a public health problem in developing countries and changing environmental and climatic factors pose the biggest challenge in fighting against the scourge of malaria. Therefore, the study was designed to forecast malaria cases using climatic factors as predictors in Delhi, India. Methods. The total number of monthly cases of malaria slide positives occurring from January 2006 to December 2013 was taken from the register maintained at the malaria clinic at Rural Health Training Centre (RHTC, Najafgarh, Delhi. Climatic data of monthly mean rainfall, relative humidity, and mean maximum temperature were taken from Regional Meteorological Centre, Delhi. Expert modeler of SPSS ver. 21 was used for analyzing the time series data. Results. Autoregressive integrated moving average, ARIMA (0,1,1 (0,1,012, was the best fit model and it could explain 72.5% variability in the time series data. Rainfall (P value = 0.004 and relative humidity (P value = 0.001 were found to be significant predictors for malaria transmission in the study area. Seasonal adjusted factor (SAF for malaria cases shows peak during the months of August and September. Conclusion. ARIMA models of time series analysis is a simple and reliable tool for producing reliable forecasts for malaria in Delhi, India.

  15. Evaluation of Two CD-ROMs from a Series on Cell Biology

    Science.gov (United States)

    Sander, Uwe; Kerlen, Gertraude; Steinke, Mattias; Huk, Thomas; Floto, Christian

    2003-01-01

    Two CD-ROMs from a series dealing with various major aspects of cell biology are evaluated in this paper using quantitative and qualitative approaches. The findings delimit similarities and differences of the two CD-ROMs and shed light on how the programs could be used in the learning process and how they should not be. The overall impression, as…

  16. The Evaluation and Selection of Instructional Software for Use with the Learning Disabled. CREATE Monograph Series.

    Science.gov (United States)

    Weisgerber, Robert A.; Blake, Patricia L.

    Fourth in a series of six monographs on the use of new technologies in the instruction of learning disabled (LD) students, this paper explores issues related to the evaluation and selection of instructional software for LD students. Topics discussed include the following: (1) criteria for instructionally useful software (e.g., flexibility and…

  17. The Representation of Multiple Intelligences Types in the Top-Notch Series: A Textbook Evaluation

    Science.gov (United States)

    Razmjoo, Seyyed Ayatollah; Jozaghi, Zahra

    2010-01-01

    This study aims at evaluating Top-Notch series through a checklist devised by the researchers based on the elements of the Multiple Intelligences (MI) theory proposed by Gardner (1998). With the shift from teacher-centered classrooms to learner-centered one, more and more research is needed to be done in the realm of students' need analysis. One…

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

    Science.gov (United States)

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

    2010-03-01

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

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

    Science.gov (United States)

    Lai, J B; Poon, C Y

    2009-10-01

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

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

    Science.gov (United States)

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

    2013-12-01

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

  1. Inferior dislocation of the hip: a case series and literature review

    Institute of Scientific and Technical Information of China (English)

    Sameer Aggarwal; Vishal Kumar; Kishan Ramachandra Bhagwat; Vokkaleri Shankaranarayana Shashikanth; Holalu Shankaralingegowda Ravikumar

    2012-01-01

    Inferior hip dislocation is the rarest type among all hip dislocations.Very few cases have been reported in the English literature.Most of the earlier reported cases involves the pediatric age group.No single case series could be found in the English literature.We came across 4 cases of inferior hip dislocation with a varied age profile (range 10 to 56 years,mean 33.8 years).Patients with this disease usually complained of pain and kept the thigh flexed and abducted.The diagnosis can be confirmed by radiographs which reveal that the long axis of the femur varies in alignment with respect to the spine from parallel to an angle almost 90° away from the axis.In our series,closed reduction was successful in all patients,either under sedation or general anaesthesia.Skin traction for a period of 6 weeks was applied in all of them and follow-up revealed pain-free,stable and mobile hips.In this study we present the details of these cases along with a review of literature discussing the various modes and mechanisms that produce inferior hip dislocation.

  2. Inferior dislocation of the hip: a case series and literature review

    Directory of Open Access Journals (Sweden)

    Aggarwal Sameer

    2012-11-01

    Full Text Available 【Abstract】 Inferior hip dislocation is the rarest type among all hip dislocations. Very few cases have been re-ported in the English literature. Most of the earlier reported cases involves the pediatric age group. No single case series could be found in the English literature. We came across 4 cases of inferior hip dislocation with a varied age profile (range 10 to 56 years, mean 33.8 years. Patients with this disease usually complained of pain and kept the thigh flexed and abducted. The diagnosis can be confirmed by radiographs which reveal that the long axis of the femur varies in alignment with respect to the spine from parallel to an angle almost 90° away from the axis. In our series, closed reduction was successful in all patients, either under seda-tion or general anaesthesia. Skin traction for a period of 6 weeks was applied in all of them and follow-up revealed pain-free, stable and mobile hips. In this study we present the details of these cases along with a review of literature discussing the various modes and mechanisms that pro-duce inferior hip dislocation. Key words: Hip dislocation; Therapeutics; Traction; Weight-bearing

  3. Second-Trimester Diagnosis of Triploidy: A Series of Four Cases

    Directory of Open Access Journals (Sweden)

    J. B. Wick

    2013-05-01

    Full Text Available Triploidy occurs in 2 to 3% of conceptuses and accounts for approximately 20% of chromosomally abnormal first-trimester miscarriages. As such, triploidy is estimated to occur in 1 of 3,500 pregnancies at 12 weeks', 1 in 30,000 at 16 weeks', and 1 in 250,000 at 20 weeks' gestation. We present a series of four cases of second-trimester triploidy diagnosed at our center within a 1-year timeframe. This is remarkable, as the delivery volume at our institution is roughly 2,500/y. All patients were at least 19 weeks' gestation, with multiple abnormalities identified on prenatal ultrasound at 18 to 20 weeks' gestation; all fetuses had lethal anomalies, but anomalies were not consistent between cases. All patients elected for induction of labor before 24 weeks' gestational age. Two of the four cases had amniocentesis and chromosome analysis prior to delivery, and two cases had chromosome analysis performed on fetal tissue after delivery. All fetuses were examined following delivery. This case series demonstrates that the diagnosis of triploidy may not be obvious based on ultrasound and physical examination findings and highlights the importance of routine chromosome analysis on all prenatal diagnoses of multiple congenital anomalies prior to consideration of more complex genetic testing.

  4. Trunnion Corrosion and Early Failure in Monolithic Metal-on-Polyethylene TMZF Femoral Components: A Case Series

    Directory of Open Access Journals (Sweden)

    Peter Walker

    2016-09-01

    Full Text Available We describe four patients who were treated with primary total hip arthroplasty (THA at two tertiary academic Australian teaching hospitals that experienced premature failure of head-neck trunnions through dissociation of the head-neck taper junction. This retrospective case series have similar clinical presentations and macroscopic pathology with severe head-neck taper junction loss of material, corrosion and early catastrophic failure. It is proposed that the accelerated wear is related to use of varus offset neck in a proprietary beta titanium alloy (Ti-12Mo-6Zr-2Fe  or TMZFÒ Stryker Osteonics, Mahwah NJ, USA TMZF femoral stem, longer head-neck combination in a relatively active, older, male patient population. In this limited case series presentation was on average 80 months (range 53-92 following index procedure. In three of the four patients, a prodromal period of groin or buttock pain was reported for between 1 week and 2 months prior to acute presentation. Significant metallosis and local tissue damage including gluteal muscle insufficiency was evident. Each stem revised was well fixed. An extended trochanteric osteotomy was required in two of the four cases for stem extraction. We recommend caution and further evaluation on the relationship between TMZF metal alloy and its longevity in higher demand patients with high neck offset, varus stem geometry and large CoCr bearing heads.

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

    Science.gov (United States)

    Gauffin, Helena; Landtblom, Anne-Marie

    2014-01-01

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

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

    Science.gov (United States)

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

    2011-06-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  8. Treatment of Klebsiella Pneumoniae Carbapenemase (KPC infections: a review of published case series and case reports

    Directory of Open Access Journals (Sweden)

    Lee Grace C

    2012-12-01

    Full Text Available Abstract The emergence of Klebsiella pneumoniae carbapenemases (KPCs producing bacteria has become a significant global public health challenge while the optimal treatment remains undefined. We performed a systematic review of published studies and reports of treatment outcomes of KPC infections using MEDLINE (2001–2011. Articles or cases were excluded if one of the following was fulfilled: no individual patient data provided, no treatment regimen specified, no treatment outcome specified, report of colonization, or greater than three antibiotics were used to treat the KPC infection. Data extracted included patient demographics, site of infection, organism, KPC subtype, antimicrobial therapy directed at KPC-infection, and treatment outcome. Statistical analysis was performed in an exploratory manner. A total of 38 articles comprising 105 cases were included in the analysis. The majority of infections were due to K. pneumoniae (89%. The most common site of infection was blood (52%, followed by respiratory (30%, and urine (10%. Forty-nine (47% cases received monotherapy and 56 (53% cases received combination therapy directed at the KPC-infection. Significantly more treatment failures were seen in cases that received monotherapy compared to cases who received combination therapy (49% vs 25%; p= 0.01. Respiratory infections were associated with higher rates of treatment failure with monotherapy compared to combination therapy (67% vs 29% p= 0.03. Polymyxin monotherapy was associated with higher treatment failure rates compared to polymyxin-based combination therapy (73% vs 29%; p= 0.02; similarly, higher treatment failure rates were seen with carbapenem monotherapy compared to carbapenem-based combination therapy (60% vs 26%; p= 0.03. Overall treatment failure rates were not significantly different in the three most common antibiotic-class combinations: polymyxin plus carbapenem, polymyxin plus tigecycline, polymyxin plus aminoglycoside (30%, 29

  9. Rare case of congenital anomaly in two different gestational ages: a case series

    Directory of Open Access Journals (Sweden)

    Lopamudra B. John

    2013-04-01

    Full Text Available Acrania is a rare congenital anomaly involving faulty development of membranous flat bones of neurocalvarium. Commonest differential diagnosis is anencephaly. The first case was diagnosed in a second gravida at 13 weeks and terminated by vaginal misoprostol instillation. The second case was diagnosed only by scan at 32 weeks in an unbooked second gravida with previous LSCS. She underwent emergency LSCS for failed induction and a fresh stillborn baby of 1.9 kg was born. [Int J Reprod Contracept Obstet Gynecol 2013; 2(2.000: 240-241

  10. Iranian Junior High school English Book Series (Right Path to English Weighted against Material Evaluation Checklists

    Directory of Open Access Journals (Sweden)

    Farhad Golpour

    2012-11-01

    Full Text Available Choosing a course textbook is an overwhelming task for both teachers and administrators. The aim of this study was to evaluate Iranian junior high school textbook series base on validated criteria. For this purpose a careful analyzing textbook evaluation checklists suggested by Sheldon (1984 skierso (1991 and Tucker (1992 was picked out. Among proposed criteria, eighteen critical features were selected to analyze Iranian junior high school series written by Birjandi in (1991. The Criteria were applied to the series analytically by researcher to examine the materials. The criteria in a form of questionnaire given to 15 experienced teachers who were teaching mentioned series for more than ten years. The gathered data revealed that it lacks appropriate layout and physical characteristics, materials have not be recycled, not all skills have been considered equally, emphasis is on grammatical points which practiced through speaking and listening. Moreover; recordings are artificial, no attention is paid to students needs and topics are out of date and boring .Also audio-visual materials, teachers’ guide and communicative tasks seems to be forgotten by writer. Therefore; all eighteen features except vocabulary lists, availability of glossary and lots of grammatical points have not been considered a lot. That is, students' interests have been ignored totally and little communicative issues have been regarded in these series. In fact, at end of this determined time students would be proficient at structural points with no efficiency at communication. These findings can be helpful for curriculum designers, textbook writers to design some valuable textbooks that are useful for teachers to teach language communicatively. Keywords: Junior High school, Evaluation, book series, criteria

  11. Evaluation of 28 cases of mucormycosis.

    Science.gov (United States)

    Kursun, Ebru; Turunc, Tuba; Demiroglu, Yusuf Ziya; Alışkan, Hikmet Eda; Arslan, Ayşe Hande

    2015-02-01

    Mucormycosis is a rare but invasive fungal disease with high mortality. The present study aimed to retrospectively investigate the demographic characteristics, as well as the clinical, radiological and laboratory features and the results of treatment, in the patients followed in our hospital because of mucormycosis. The present study retrospectively evaluated 28 cases, which were followed in our hospital because of mucormycosis between January 2002 and July 2013. The clinical form was rhinocerebral in 27 cases (rhinoorbital in 12, nasal in 8 and rhinoorbitocerebral in 7) and disseminated in one case. With regard to predisposing factors, diabetes mellitus (n = 20), haematological malignancy (n = 6) and chronic renal insufficiency (n = 5) were the leading concomitant diseases. Seventeen (61%) of 28 cases showed atypical clinical picture. With regard to the therapeutic outcomes; it was found that 14 (50%) cases died and six cases recovered with sequel. Today, when particularly the prevalence of immunosuppressive diseases and conditions are gradually increasing, the incidence of mucormycosis is also increased. Considering that the majority of our cases had atypical clinical involvement and complications, being familiar with the characteristics of this disease could be life-saving together with early diagnosis and treatment.

  12. Mantle cell lymphoma of the oral cavity. Case Series and Comprehensive Review of the Literature

    Science.gov (United States)

    Guggisberg, Kelly; Jordan, Richard C.K.

    2009-01-01

    Objective Mantle cell lymphoma (MCL) is a rare B cell neoplasm that has only recently been defined as a distinct entity. Because of its rarity and histological similarities with other small cell lymphomas, the microscopic diagnosis of MCL may be challenging. This is particularly true within the oral cavity where other lymphomas are more frequent. To date, few cases of MCL presenting within the oral cavity have been reported. Study Design We present 2 new cases of MCL presenting within the oral cavity and systematically reviewed 7 other cases of MCL reported in the English language literature. Historical cases were reviewed and available data regarding morphology, special stains, demographics, clinical presentation, radiographic findings, management and outcome were extracted. Data from our current series was then compared with the earlier published literature. Results To the best of our knowledge, this is the largest reviewed series of MCL within the oral cavity totaling 9 cases. The features of our cases, including histology, clinical presentation and outcome, are consistent with the 7 previously reported cases. The majority of oral MCLs occur in an older male population and a high proportion occur on the palate. Conclusion We conclude that MCL of the oral cavity is an uncommon diagnosis. Most oral MCLs occur in an elderly male population and have a possible predilection for the palate. The microscopic diagnosis can be challenging given its similar appearance to other small cell lymphomas requiring a comprehensive immunohistochemical panel for the accurate diagnosis. Like MCL occurring in other sites in the body, the prognosis and outcome of oral MCL appears to be poor. PMID:19880332

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

    Science.gov (United States)

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

    2017-02-01

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

  14. Upper airway alterations/abnormalities in a case series of obstructive sleep apnea patients identified with cone-beam CT

    Energy Technology Data Exchange (ETDEWEB)

    Shigeta, Y.; Shintaku, W.H.; Clark, G.T. [Orofacial Pain/Oral Medicine Center, Div. of Diagnostic Sciences, School of Dentistry, Univ. of Southern California, Los Angeles, CA (United States); Enciso, R. [Div. of Craniofacial Sciences and Therapeutics, School of Dentistry, Univ. of Southern California, Los Angeles, CA (United States); Ogawa, T. [Dept. of Fixed Prosthodontic Dentistry, Tsurumi Univ., School of Dental Medicine, Tsurumi (Japan)

    2007-06-15

    There are many factors that influence the configuration of the upper airway and may contribute to the development of obstructive sleep apnea (OSA). This paper presents a series of 12 consecutive OSA cases where various upper airway alteration/abnormalities were identified using 3D anatomic reconstructions generated from cone-beam CT (CBCT) images. Some cases exhibited more than one type of abnormality and below we describe each of the six types identified with CBCT in this case series. (orig.)

  15. [Surgical treatment of temporal lobe epilepsy: a series of forty-three cases analysis].

    Science.gov (United States)

    Meneses, Murilo S; Rocha, Samanta B; Kowacs, Pedro A; Andrade, Nelson O; Santos, Heraldo L; Narata, Ana Paula; Bacchi, Ana Paula; Silva, Erasmo B; Simão, Cristiane; Hunhevicz, Sonival C

    2005-09-01

    Forty-three patients with epilepsy resistant to drug therapy were submitted to temporal lobe epilepsy surgery at the Instituto de Neurologia de Curitiba, from 1998 to 2003. Thirty-nine patients (90.6%) had mesial temporal sclerosis, and four had brain tumors. According to Engel's rating, 83.7% from 37 patients with complete postoperative evaluation were classified as Class I (free of disabling seizure). Postoperative complications (18.6%) were evaluated, with one case of surgical wound infection, one case of hydrocephalus, one case of cerebrospinal fluid fistula, two cases of transient palsy of the trochlear nerve and one case of transient hemiparesis. No death related to epilepsy surgery was found in our study.

  16. Hepatitis E in Singapore: A Case-Series and Viral Phylodynamics Study.

    Science.gov (United States)

    Teo, Esmeralda Chi-Yuan; Tan, Boon-Huan; Purdy, Michael A; Wong, Pui-San; Ting, Pei-Jun; Chang, Pik-Eu Jason; Oon, Lynette Lin-Ean; Sue, Amanda; Teo, Chong-Gee; Tan, Chee-Kiat

    2017-01-16

    The incidence of hepatitis E in Singapore appears to be increasing. A retrospective case-series study of patients diagnosed with hepatitis E in a tertiary hospital from 2009 to 2013 was conducted. Of 16 cases, eight (50%) were solid-organ transplant recipients (SOTRs), and 14 (88%) were found infected by genotype 3 hepatitis E virus (HEV-3). Bayesian inferences based on HEV subgenomic sequences from seven cases suggest that HEV-3 strains were introduced to Singapore as two principal lineages. Within limitations of the study, it can be inferred that one lineage, in the 3efg clade, emerged about 83 years ago, probably originating from Japan, whereas the other, in the 3abchij clade, emerged about 40 years ago, from the United States. Establishment and subsequent transmissions of strains from these two lineages likely contribute to the current endemicity of hepatitis E in Singapore.

  17. Treatment of Catatonia With Ultrabrief Right Unilateral Electroconvulsive Therapy: A Case Series.

    Science.gov (United States)

    Kugler, Joseph L; Hauptman, Aaron J; Collier, Samuel J; Walton, Amy E; Murthy, Smitha; Funderburg, Linda G; Garcia, Keith S

    2015-09-01

    Catatonia is a syndrome heterogeneous with regard to presentation and etiology. Electroconvulsive therapy (ECT) remains the first-line treatment for catatonia. Literature review reveals only a few published case reports on the use of right unilateral (RUL) ECT in catatonia, 1 case report on ultrabrief RUL ECT, and an absence of evidence on the relative effectiveness and tolerability of RUL versus bilateral ECT in treating catatonia. In contrast, there are multiple reports in the literature of robustly dosed bilateral ECT, often administered on consecutive days. Reasons for choosing this intervention over the better-tolerated RUL treatment include assumptions about its relative speed and/or breadth of efficacy. Here we present a case series of 13 catatonic patients treated in an academic center over the course of the last 3 years. Our experience suggests that ultrabrief RUL ECT can rapidly and effectively treat catatonia from diverse etiologies.

  18. Case series of an intraoral balancing appliance therapy on subjective symptom severity and cervical spine alignment.

    Science.gov (United States)

    Lee, Young Jun; Lee, Joo Kang; Jung, Soo Chang; Lee, Hwang-Woo; Yin, Chang Shik; Lee, Young Jin

    2013-01-01

    Objective. The objective of this study was to investigate the effect of a holistic intraoral appliance (OA) on cervical spine alignment and subjective symptom severity. Design. An observational study on case series with holistic OA therapy. Setting. An outpatient clinic for holistic temporomandibular joint (TMJ) therapy under the supervision of the Pain Center, CHA Biomedical center, CHA University. Subjects. Ambulatory patients presenting with diverse chief complaints in the holistic TMJ clinic. Main Measures. Any immediate change in the curvature of cervical spine and the degree of atlantoaxial rotation was investigated in the images of simple X-ray and computed tomography of cervical spine with or without OA. Changes of subjective symptom severity were also analyzed for the holistic OA therapy cases. Results. A total of 59 cases were reviewed. Alignment of upper cervical spine rotation showed an immediate improvement (P alignment. These results show that further researches may warrant for the holistic TMJ therapy.

  19. Direct Cranial Nerve Involvement by Gliomas: Case series and review of the literature

    Science.gov (United States)

    Mabray, Marc C.; Glastonbury, Christine M.; Mamlouk, Mark D.; Punch, Gregory E.; Solomon, David A.; Cha, Soonmee

    2017-01-01

    Malignant gliomas are characterized by infiltrative growth of tumor cells, including along white matter tracts. This may result in clinical cranial neuropathy due to direct involvement of a cranial nerve rather than by leptomeningeal spread along cranial nerves. Gliomas directly involving cranial nerves III-XII are rare with only eleven cases reported in the literature prior to 2014, including eight with imaging. We present eight additional cases demonstrating direct infiltration of a cranial nerve by glioma. Asymmetric cisternal nerve expansion as compared to the contralateral nerve was noted with a mean length of involvement of 9.4 mm. Based on our case series, the key imaging feature to recognize direct cranial nerve involvement by a glioma is the detection of an intra-axial mass in the pons or midbrain that is directly associated with expansion, signal abnormality, and/or enhancement of the adjacent cranial nerve(s). PMID:25857757

  20. Schema therapy for patients with borderline personality disorder: a single case series.

    Science.gov (United States)

    Nordahl, Hans M; Nysaeter, Tor E

    2005-09-01

    The effectiveness of schema therapy for patients with borderline personality disorder (BPD) developed by Young was investigated using a single case series trial of six patients who all had primarily a DSM-IV BPD diagnosis. The treatment approach comprised the core elements of schema therapy with an emphasis on schema mode work and limited re-parenting. An A-B direct replication series with follow-up assessments at 12 months was implemented. From baseline to follow-up improvement was large, as indicated by large effect sizes, and improvement was clinically meaningful for five of the six patients included. Three of the six patients did not any longer fulfill the criteria for BPD by the end of the treatment.

  1. The scheme and research of TV series multidimensional comprehensive evaluation on cross-platform

    Science.gov (United States)

    Chai, Jianping; Bai, Xuesong; Zhou, Hongjun; Yin, Fulian

    2016-10-01

    As for shortcomings of the comprehensive evaluation system on traditional TV programs such as single data source, ignorance of new media as well as the high time cost and difficulty of making surveys, a new evaluation of TV series is proposed in this paper, which has a perspective in cross-platform multidimensional evaluation after broadcasting. This scheme considers the data directly collected from cable television and the Internet as research objects. It's based on TOPSIS principle, after preprocessing and calculation of the data, they become primary indicators that reflect different profiles of the viewing of TV series. Then after the process of reasonable empowerment and summation by the six methods(PCA, AHP, etc.), the primary indicators form the composite indices on different channels or websites. The scheme avoids the inefficiency and difficulty of survey and marking; At the same time, it not only reflects different dimensions of viewing, but also combines TV media and new media, completing the multidimensional comprehensive evaluation of TV series on cross-platform.

  2. POSTMENOPAUSAL BLEEDING: HISTOPATHOLOGICAL SPECTRUM AND ASSOCIATION WITH AGE AND CLEAR SPAN: CASE SERIES OF 328 CASES

    Directory of Open Access Journals (Sweden)

    Ruchita

    2014-06-01

    Full Text Available : Introduction: Postmenopausal bleeding is defined as vaginal bleeding occurring after twelve months of amenorrhea in a woman of the age where the menopause can be expected. With increase in life expectancy, a larger proportion of female population will be in postmenopausal age group; hence, the incidence of postmenopausal bleeding is expected to increase. AIM: We studied the prevalence of malignancy as well as the histopathological spectrum of genital tract lesions in cases of postmenopausal bleeding. The association between age, period between cessation of menses and onset of bleeding per vaginum (clear span was also studied. RESULTS: Malignant causes were more common (58.5% than benign causes and included cervical carcinoma, malignant uterine tumors (13.1%, carcinoma vagina (4.3%, malignant ovarian tumors (5.5%, carcinoma vulva (0.9% and carcinoma fallopian tube (0.3%. Squamous cell carcinoma was the commonest among cervical malignancies. The benign causes included polyps (16.5%, endometrial hyperplasia (4.9%, adenomyosis (2.7%, atrophic endometrium (2.4%, cervicitis (2.1%, leiomyoma (1.8%, proliferative endometrium (1.5%, endometritis (1.5%, secretory endometrium (1.2%, retained IUCD (0.9% and uterovaginal prolapse (0.6%. The likelihood of malignancy increased significantly with advancing age (p-value 0.042. The clear span of cases with malignant tumors was significantly longer than the clear span of cases with benign lesions. Hence, the likelihood of malignancy increased with length of clear span (p-value 0.00809. CONCLUSION: Any postmenopausal patient with vaginal bleeding needs to be investigated thoroughly to determine the cause of the bleeding and should be considered to have abnormal histopathology until proved otherwise

  3. SHORT TERM RESULTS OF MUSCLE PEDICLE BONE GRAFT (MPBG IN FRACTURE NECK FEMUR: A CASE SERIES OF 7 CASES

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    Sarabjeet

    2016-03-01

    Full Text Available INTRODUCTION Neglected, untreated and delayed neck femur fractures are commonly encountered fractures and the treatment dilemma arises specially when the patient is physiologically young and osteosynthesis is the preferred option. Past literature creates confusion as the various head salvage surgeries like valgus subtrochanteric osteotomy, non-vascularised fibular bone grafting, muscle pedicle bone grafting (Tensor fascia lata (TFL and Quadratus femoris graft and vascularised bone grafting do not have clear lines of indications. We present a series of fracture neck femur cases, each with delayed presentation beyond the vascular emergency period, which were treated with osteosynthesis with MPBG using tensor fascia lata muscle pedicle graft.

  4. 28 CASES OF TRAUMATIC POSTERIOR FOSSA EXTRA DURAL HEMATOMA OUR EXPERIENCE : CASE SERIES

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    Hayagriva

    2015-04-01

    Full Text Available A retrospective study of 28 1 cases of traumatic posterior fossa Extra dural hematoma 2,3 in K ing George Hospital, V isakhapatnam from A ugust 2012 to February 2015 . This study was aimed to present the experience in treating patients with traumatic posterior fossa extra dural hematoma 2 and to discuss the clinical features, risk factors 4 and outcome . 5 Posterior fossa e xtradural hematoma 2,3 uncommon but potentially fatal condition. The incidence of posterior fossa extra dural hematoma 2,3 among intracranial extra dural hematomas has been reported 4% to 7%. Occipital skull bone fracture with venous sinus bleeding that resulted in a posterior fossa extradural haematoma . 2 low Gcs [or] hematoma more than 10ml were subjected to evacuation . Since the volume of the posterior fossa 6 is small, patients deteriorate early because of compression of vital structures in the brain stem, development of obstructive hydrocephalus, which is visible in the CT scan in only thirty percent of cases

  5. Positron emission tomography in the diagnostic pathway for intracystic infection in adpkd and "cystic" kidneys. a case series

    Directory of Open Access Journals (Sweden)

    Douroukas Anastasios

    2011-09-01

    Full Text Available Abstract Background Intracystic infection, in Autosomal Dominant Polycystic Kidney Disease (ADPKD and in kidneys with multiple cysts, is a diagnostic and therapeutic challenge, as conventional imaging techniques may not discriminate among "complicated" cysts (infection, bleeding, neoplasia, and as the clinical picture may be attenuated, in particular in early phases. Positron Emission Tomography with fluorodeoxyglucose (FDG-PET was recently suggested as a tool to detect infection in ADPKD, in single cases and small series. The aim of the study was to report on the role of FDG-PET in the work-up of 10 cases of suspected cystic infections, affected by ADPKD or with multiple kidney cysts. Methods Observational study. Review of clinical charts and of the imaging data since the use of FDG-PET for detecting cystic infections (2008-2010. Results In 2008-2010, 6 patients with ADPKD and 4 with multiple kidney cysts were referred for suspected intracystic infections (3 males, 7 females, aged 55-83 years, in all CKD stages; in one case the imaging was done in the work-up of a complicated "uremic" cyst. The clinical picture, the usual inflammatory markers and/or the conventional imaging techniques did not allow conclusive diagnosis at referral or during follow-up (ultrasounds in all, CT in 8/10. Nine patients displayed inflammatory signs (increase in C-reactive protein and other biochemical markers and constitutional symptoms (fever in 9/10. FDG-PET was positive in 6 cases (5 kidney and 1 liver cyst, was repeated during follow-up in 4 patients and was negative in 4 cases. In the positive cases, FDG-PET guided the therapeutic choices; in particular, the duration of therapy was supported by imaging data in the 4 cases with multiple scans. No relapse was recorded after discontinuation of antibiotic therapy in the treated patients. The negative cases did not develop clinical signs of cystic infection over follow-up. Conclusion In this case series, the largest

  6. Split mouth de-epithelization techniques for gingival depigmentation: A case series and review of literature.

    Science.gov (United States)

    Kathariya, Rahul; Pradeep, A R

    2011-04-01

    Gingival melanin pigmentation occurs in all races of mankind. Although clinical melanin pigmentation does neither present itself as a medical problem nor a disease entity, it is a major esthetic concern for many people, especially Asians. Esthetic gingival depigmentation procedures can be performed in such patients with excellent results. This case series presents a split mouth de-epithelization procedure using popular surgical techniques such as scalpel, bur abrasion or electrosurgery. These techniques were successfully used to treat gingival hyperpigmentation. Although we found that electrosurgery increased the efficacy of our work, giving a cleaner and neater work field, it required a lot of precision. In contrast, scalpel de-epithelization was easy and technique-friendly, giving excellent results and patient satisfaction. However, the cases are being followed-up to study the factors affecting the rate and length of time required for repigmentation and to study the repigmentation patterns. This case series also reviews the advantages and disadvantages of various techniques available for depigmentation, and reiterates that the scalpel technique still serves as a gold standard for depigmentation.

  7. Treatment strategy for guided tissue regeneration in various class II furcation defect: Case series.

    Science.gov (United States)

    Verma, Pushpendra Kumar; Srivastava, Ruchi; Gupta, K K; Chaturvedi, T P

    2013-09-01

    Periodontal regeneration is a main aspect in the treatment of teeth affected by periodontitis. Periodontal regeneration in furcation areas is quite challenging, especially when it is in interproximal region. There are several techniques used alone or in combination considered to achieve periodontal regeneration, including the bone grafts or substitutes, guided tissue regeneration (GTR), root surface modification, and biological mediators. Many factors may account for variability in response to regenerative therapy in class II furcation. This case series describes the management of class II furcation defect in a mesial interproximal region of a maxillary tooth and other with a buccal class II furcation of mandibular tooth, with the help of surgical intervention including the GTR membrane and bone graft materials. This combined treatment resulted in healthy periodontium with a radiographic evidence of alveolar bone gain in both cases. This case series demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the combined treatment modalities will restore health and function of the tooth with the severe attachment loss.

  8. Identical fracture patterns in combat vehicle blast injuries due to improvised explosive devices; a case series

    Directory of Open Access Journals (Sweden)

    Commandeur Joris

    2012-10-01

    Full Text Available Abstract Background In November 2008, a surgical team from the Red Cross Hospital Beverwijk, the Netherlands, was deployed in Afghanistan for three months to attend in the army hospital of Kandahar. During their stay, four incidents of armored personnel carriers encountering an improvised explosive device were assessed. In each incident, two soldiers were involved, whose injuries were strikingly similar. Case presentation The described cases comprise paired thoracic vertebral fractures, radial neck fractures, calcaneal fractures and talar fractures. Moreover, the different types of blast injury are mentioned and related to the injuries described in our series. Acknowledging the different blast mechanisms is important for understanding possible injury patterns. Conclusion From this case series, as well as the existing literature on injury patterns caused by blast injuries, it seems appropriate to pay extra attention to bodily areas that were injured in other occupants of the same vehicle. Obviously, the additional surveillance for specific injuries should be complementary to the regular trauma work-up (e.g., ATLS.

  9. Psychotic symptoms in refugees diagnosed with PTSD: a series of case reports

    DEFF Research Database (Denmark)

    Nørredam, Marie Louise; Ekstrøm, Morten; Jensen, Mette

    2011-01-01

    BACKGROUND: In our clinical work, we treat refugees who have been exposed to trauma and who subsequently develop psychotic symptoms. However, the literature does not address the relationship between refugees with depression, post-traumatic stress disorder (PTSD) and psychotic symptoms. Therefore ...... into the prevalence of psychotic symptoms among refugees with depression and PTSD, including the qualitative dimensions of the symptoms in order to optimize diagnosis and treatment among this group of psychiatric patients.......BACKGROUND: In our clinical work, we treat refugees who have been exposed to trauma and who subsequently develop psychotic symptoms. However, the literature does not address the relationship between refugees with depression, post-traumatic stress disorder (PTSD) and psychotic symptoms. Therefore...... the aim of this study is firstly to present a series of cases showing how psychotic symptoms may present in refugees diagnosed with PTSD, and secondly to discuss the underlying explanations of the involved psychopathology. METHODS: The study is based on a presentation of a series of cases. All six cases...

  10. Treatment strategy for guided tissue regeneration in various class II furcation defect: Case series

    Directory of Open Access Journals (Sweden)

    Pushpendra Kumar Verma

    2013-01-01

    Full Text Available Periodontal regeneration is a main aspect in the treatment of teeth affected by periodontitis. Periodontal regeneration in furcation areas is quite challenging, especially when it is in interproximal region. There are several techniques used alone or in combination considered to achieve periodontal regeneration, including the bone grafts or substitutes, guided tissue regeneration (GTR, root surface modification, and biological mediators. Many factors may account for variability in response to regenerative therapy in class II furcation. This case series describes the management of class II furcation defect in a mesial interproximal region of a maxillary tooth and other with a buccal class II furcation of mandibular tooth, with the help of surgical intervention including the GTR membrane and bone graft materials. This combined treatment resulted in healthy periodontium with a radiographic evidence of alveolar bone gain in both cases. This case series demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the combined treatment modalities will restore health and function of the tooth with the severe attachment loss.

  11. The use of pyloric exclusion for treating duodenal trauma: case series

    Directory of Open Access Journals (Sweden)

    Gustavo Pereira Fraga

    Full Text Available CONTEXT AND OBJECTIVES: Significant controversy exists regarding the best surgical treatment for complex duodenal injuries. The aims of this study were to report on a series of eight cases of duodenal repairs using pyloric exclusion and to describe reported complications or improvements in clinical outcomes among patients with complex duodenal trauma. DESIGN AND SETTING: Cross-sectional study followed by a case series in a university hospital. METHODS: Data on eight patients with duodenal trauma who underwent pyloric exclusion over a 17.5 year period were collected and analyzed. RESULTS: The causes of the injuries included penetrating gunshot wounds (GSW in five patients and motor vehicle accidents (blunt trauma in three patients. The time elapsed until surgery was longer in the blunt trauma group, while in one patient, the gunshot injury was initially missed and thus the procedure was carried out 36 hours after the original injury. The injuries were grade III (50% or IV (50% and the morbidity rate was 87.5%. Four patients (50% died during the postoperative period from complications, including hypovolemic shock (one patient, sepsis (peritonitis following the missed injury and pancreatitis with an anastomotic fistula (two patients. CONCLUSIONS: Pyloric exclusion was associated with multiple complications and a high mortality rate. This surgical technique is indicated for rare cases of complex injury to the duodenum and the surgeon should be aware that treatment with a minimalistic approach, with only primary repair, may be ideal.

  12. Generating Hourly Rainfall Model using Bayesian Time Series Model (A Case Study at Sentral Station, Bondowoso

    Directory of Open Access Journals (Sweden)

    Entin Hidayah

    2011-02-01

    Full Text Available Disaggregation of hourly rainfall data is very important to fulfil the input of continual rainfall-runoff model, when the availability of automatic rainfall records are limited. Continual rainfall-runoff modeling requires rainfall data in form of series of hourly. Such specification can be obtained by temporal disaggregation in single site. The paper attempts to generate single-site rainfall model based upon time series (AR1 model by adjusting and establishing dummy procedure. Estimated with Bayesian Markov Chain Monte Carlo (MCMC the objective variable is hourly rainfall depth. Performance of model has been evaluated by comparison of history data and model prediction. The result shows that the model has a good performance for dry interval periods. The performance of the model good represented by smaller number of MAE by 0.21 respectively.

  13. Transcatheter Closure of Patent Ductus Arteriosus in Adolescents and Adults: A Case Series

    Directory of Open Access Journals (Sweden)

    Sukman Tulus Putra

    2017-02-01

    Full Text Available During 11 years period from January 2005 to December 2015 there were 18 adolescent and adult patients  who underwent transcatheter closure of PDA using PDA Amplatzer Duct Occluder (ADO. There were 9 cases with age of 14 to 18 years and 9 cases with age of more than 18 years where the oldest case was 46 years old. Two cases were male and 16 cases were female. Prior to procedures, clinical assessment, ECG, chest x-ray and transthoracic echocardiography (TTE were performed to confirm the diagnosis of PDA. The procedures of device implantation was performed under conscious sedation in adults and using general anesthesia in adolescents.The size of PDA ranged from 1.6 mm to 11.1 mm. Based on Kritchenko classification, the type of PDA were 15 type A1 and 3type A2. Flow ratio between pulmonary to systemic circulation was between 1.1 and 5.9. The procedure time ranged from 60-189 minutes and the fluoroscopic time 7.1-77.3 minutes. The PA pressure ranged from 22 to 63 mmHg. Immediate results after procedures as seen in angiography showed complete closure in 14 cases and smoky residual shunt or minimal residual shunts in 4 cases, which probably due to the temporary leaking through the devices. In 24 hours, complete closure was achieved in all cases (100% and continued until 1months. At 6 month follow up, there was no residual shunts detected and also there was no significant complications, such as device embolization or recanalization. This case series suggest that transcatheter closure of PDA in adolescents and adults using Amplatzer duct occluder (ADO is effective and has excellent resultswithout significant complication. However, long-term follow up is required to assess long term efficacy and safety.

  14. Diagnostic role of magnetic resonance angiography in Swyer James syndrome: Case series of two cases

    Directory of Open Access Journals (Sweden)

    Parashari Umesh

    2010-01-01

    Full Text Available Swyer James syndrome is a rare syndrome which occurs due to viral illness in early childhood. The post infective obliterative bronchiolitis results in arrest of lung growth and alveolarization with reduced vascularity resulting in classical radiological features. We describe two cases of patients fulfilling all the criteria of the syndrome - 1 Unilateral hyperlucent small lung in chest radiograph with air trapping on expiration, small ipsilateral hila and pulmonary artery. 2 Diffuse decrease in attenuation of lung parenchyma with bronchiectasis and reduction in vascularity. 3 Unilateral pruned tree appearance on angiography (MRA. The clinical presentation was recurrent chest infection in a child and infrequent bouts of hemoptysis in a middle aged female. The study demonstrates the role of magnetic resonance angiography in diagnosing the condition.

  15. Congenital familial subglottic stenosis: a case series and review of literature.

    Science.gov (United States)

    Manickavasagam, J; Yapa, S; Bateman, N D; Thevasagayam, M S

    2014-02-01

    Subglottic stenosis is a narrowing of the endolarynx and maybe classified as congenital (primary) or acquired (secondary). Congenital stenosis maybe caused by a small cricoid cartilage, thick submucosa or other laryngeal abnormalities and remains a well-known cause of stridor in infancy. It occurs sporadically and familial occurrence is rare. Our case series identifies three children with congenital subglottic stenosis born to consanguineous parents. Congenital subglottic stenosis in siblings of unrelated parents has been previously reported, but not in consanguineous parents indicating a strong genetic link. We recommend further genetic research to assess the mode of possible heritage in this disease.

  16. Infrequent Reservoir‐Related Complications of Urologic Prosthetics: A Case Series and Literature Review

    Directory of Open Access Journals (Sweden)

    Tao Cui, MD

    2015-12-01

    Conclusion: Complications involving urologic prosthesis reservoirs, although rare, can have serious implications for patients. A high index of suspicion and familiarity with treatment options is required in order to allow timely diagnosis and appropriate treatment. Patients with prior major abdominal surgeries seem to be more prone to intestinal complications of reservoirs and warrant special concern. Cui T, Terlecki R, and Mirzazadeh M. Infrequent reservoir‐related complications of urologic prosthetics: A case series and literature review. Sex Med 2015;3:334–338.

  17. Ultrasound-Accelerated Thrombolysis in Patients With Intracardiac Thrombi: A Case Series.

    Science.gov (United States)

    Yadlapati, Ajay; Sweis, Ranya; Schimmel, Daniel

    2016-03-01

    We describe a case series of 3 patients presenting with intracardiac thrombi treated with standard anticoagulation therapy and intervention with ultrasound-accelerated thrombolysis therapy. Right-sided intracardiac thrombi portend significant mortality due to their susceptibility for embolization and pulmonary embolus despite the continuation of current standard of therapy of parenteral anticoagulation and surgical embolectomy if warranted. We demonstrate the safety and clinical efficacy of ultrasound-accelerated thrombolysis therapy with the EkoSonic Endovascular System infusion catheter system (EKOS Corporation) and highlight its use in resolving intracardiac thrombi and impeding the propagation of pulmonary emboli.

  18. Suspect novel adverse drug reactions to trimethoprim-sulphonamide combinations in horses: a case series.

    Science.gov (United States)

    Stack, A; Schott, H C

    2011-01-01

    Adverse drug reactions to trimethoprim-sulphonamide combinations are common in many species, manifesting as gastrointestinal tract disorders, dermatopathies and blood dyscrasias. In this case series, neurological abnormalities in 4 horses being treated with trimethoprim-sulphonamide combinations at normal dosages and in one foal that received an overdose are described. The horses developed hypermetric gait, agitation and erratic behaviour. All signs resolved once medication was withdrawn, and no horse had residual deficits. No other cause for observed neurological deficits could be determined. These clinical signs appear to represent a novel adverse drug reaction to some commonly used antimicrobial combinations.

  19. Anesthetic management of peripartum cardiomyopathy using "epidural volume extension" technique: A case series

    Directory of Open Access Journals (Sweden)

    Akhilesh Kumar Tiwari

    2012-01-01

    Full Text Available Peripartum cardiomyopathy is a rare cause of dilated cardiomyopathy in parturients, occurring in approximately one in 1000 deliveries, manifesting during the last few months or the first 5 months of the postpartum period. It can result in severe ventricular dysfunction during late puerperium. The major concern while managing these patients is to optimize fluid administration and avoid myocardial depression, while maintaining stable intraoperative hemodynamics. We present a case series of five parturients that were posted for elective cesarean section and managed successfully by the epidural volume extension technique.

  20. Vallecular Cyst: Diverse Clinical Presentation and Airway Management Techniques – A Case Series

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    Jui Lagoo

    2013-08-01

    Full Text Available Vallecular Cysts (VC are laryngeal cysts found most frequently at true vocal cords followed by epiglottis and vallecula, which develops due to obstruction of the submucosal gland. In children, they present with stridor, respiratory distress, feeding difficulty, failure to thrive or as an incidental finding on laryngoscopy. The anaesthesiologist can face the risk of obstructed breathing during mask holding, obscured laryngeal view, loss of airway, rupture of cyst and potential aspiration of cyst contents. Various techniques of airway management have been described in literature. We report a series of three cases with VC where we managed the airway successfully. We also discuss the relevant literature review.

  1. Myasthenia gravis mimicking stroke: a case series with sudden onset dysarthria.

    Science.gov (United States)

    Tremolizzo, Lucio; Giopato, Federico; Piatti, Maria Luisa; Rigamonti, Andrea; Ferrarese, Carlo; Appollonio, Ildebrando

    2015-06-01

    Myasthenia gravis (MG) is an immune-mediated disorder characterized by fluctuating fatigue of skeletal muscles, often involving extrinsic ocular or bulbar districts. Myasthenia gravis in the elderly is an under-recognized condition, sometimes confused with cerebrovascular disease. Here we present a case series of myasthenia patients which onset was characterized by sudden dysarthria, clearly raising this diagnostic dilemma. In the workout of sudden onset isolated dysarthria, MG should be always considered. In fact, even if myasthenia is a rare condition, lacunar stroke only with this clinical presentation is also unusual, and significant risks may arise (e.g., unexpected myasthenic crisis).

  2. Treatment outcome with guiding flange prosthesis in hemimandibulectomy patients: Case series of three patients

    Science.gov (United States)

    Kar, Sushil; Tripathi, Arvind; Madhok, Riti

    2015-01-01

    There are various indications that may necessitate partial or complete resection of the mandible, from trauma to congenital deformities. However, the most prevalent indication that requires surgical resection of the mandible along with the involved adjacent oral structures is the presence of a locally aggressive neoplastic growth. The resultant continuity defect leads to an alteration in the range and direction of mandibular movement, impedes clear articulation of syllables and cosmetic disfigurement. The role of a prosthodontist is paramount in bringing about the restoration of the esthetic and functional dysfunction. This article discusses a series of hemimandibulectomy cases wherein mandibular deviation was successfully corrected using guide-flange prosthesis. PMID:26981486

  3. Mucormycosis in Patients with Inflammatory Bowel Disease: Case Series and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Maheen Z. Abidi

    2014-01-01

    Full Text Available Mucormycosis is a rare and often fatal invasive fungal infection mostly seen in immune-compromised individuals. A high index of clinical suspicion is necessary, so that effective preemptive therapy can be started, as timely intervention is crucial. In this series we present three cases of invasive mucormycosis in patients with underlying inflammatory bowel disease that had received therapy with immunomodulators prior to the infection. All three had varied clinical manifestations. We also review the literature of invasive mucormycosis in patients with inflammatory bowel disease.

  4. The versatility of intraosseous vascular access in perioperative medicine: a case series.

    Science.gov (United States)

    Anson, Jonathan A; Sinz, Elizabeth H; Swick, John T

    2015-02-01

    Intraosseous vascular access is a time-tested procedure that is reemerging in popularity. This is primarily a result of the emphasis on intraosseous access in the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Advanced Cardiac Life Support. Modern intraosseous insertion devices are easy to learn and use, suggesting the possibility of use beyond the resuscitation setting. We present a case series of recent intraosseous insertions for a variety of indications by anesthesiologists at our institution to demonstrate the potential utility of this alternative access technique.

  5. Bullous disorders as a manifestation of immune reconstitution inflammatory syndrome: A series of three cases

    Directory of Open Access Journals (Sweden)

    Rama Das

    2013-01-01

    Full Text Available Bullous disorders such as pemphigus vulgaris, bullous pemphigoid after the initiation of highly active antiretroviral therapy in certain human immunodeficiency virus reactive individuals have been described in this case series as a manifestation of an immune reconstitution inflammatory syndrome. This phenomenon should be suspected in individuals who present with bullous lesions within 3-8 weeks after initiation of therapy despite of improved immunological response. Strong clinical suspicion, through clinical examination, appropriate laboratory investigation such as CD4 T-cell count, histopathological examinations with H and E stain, direct immunofluorescence test are required for diagnosis.

  6. Anatomical features and management of bioresorbable vascular scaffolds failure: A case series from the GHOST registry.

    Science.gov (United States)

    Longo, Giovanni; Granata, Francesco; Capodanno, Davide; Ohno, Yohei; Tamburino, Claudia Ina; Capranzano, Piera; La Manna, Alessio; Francaviglia, Bruno; Gargiulo, Giuseppe; Tamburino, Corrado

    2015-06-01

    The Absorb bioresorbable vascular scaffold (Absorb BVS, Abbott Vascular, Santa Clara, California) promises to address some of the residual shortcomings of existing metallic stents, such as late events induced by permanent caging of the coronary vessel. Scaffold restenosis (ScR) of BVS has been poorly described so far and treatment strategies for this event remain to be codified. We report on a case series of 14 lesions in 12 patients presenting with ScR and discuss their anatomical features and management strategies. © 2015 Wiley Periodicals, Inc.

  7. Rapid Evaluation of Power Degradation in Series Connection of Single Feeding Microsized Microbial Fuel Cells

    KAUST Repository

    Rojas, Jhonathan Prieto

    2014-07-08

    We have developed a sustainable, single feeding, microsized, air-cathode and membrane-free microbial fuel cells with a volume of 40 mu L each, which we have used for rapid evaluation of power generation and viability of a series array of three cells seeking higher voltage levels. Contrary to expectations, the achieved power density was modest (45 mWm(-3)), limited due to non-uniformities in assembly and the single-channel feeding system.

  8. Interdisciplinary evaluations of alleged sexual abuse cases.

    Science.gov (United States)

    Jaudes, P K; Martone, M

    1992-06-01

    Children who are alleged to have been sexually abused often go through gruelling interrogations to relate their experiences to adults and, even then, most are not viewed as reliable sources of information. The Victim Sensitive Interviewing Program (VSIP) was initiated to decrease the number of interviews endured by a child who allegedly had been sexually abused. The program brought together the disciplines involved in the evaluation of these cases: hospital-based social worker and pediatrician, state child protective agency worker, police, and assistant state's attorney. This team established a protocol for an investigative interview to be conducted by a team member. Pre-VSIP sexual abuse evaluations from 1985 and 1986 (38) were compared with VSIP evaluations (226) from 1987 and 1988. There was no significant difference between the two groups in relation to gender or age of victim, physical symptoms, physical findings, sexually transmitted diseases present, age of perpetrator, or length of stay in hospital. However, there were significant differences between the two groups in (1) number of interviews, 11% pre-VSIP vs 79% VSIP receiving only one interview (P less than .001); (2) number of interviewers, 24% pre-VSIP vs 88% VSIP were interviewed by only one interviewer (P less than .001); (3) indicated cases of sexual abuse, 68% pre-VSIP vs 88% VSIP (P less than .006); (4) identification of the perpetrator, 71% pre-VSIP vs 85% VSIP (P less than .035); and (5) charges pressed if perpetrator identified, 33% pre-VSIP vs 60% VSIP (P less than .010). It is concluded that interdisciplinary evaluations of alleged sexual abuse in children not only decreased the number of interviews a child must undergo but also increased the likelihood of indicated cases, identification of the perpetrator, and charges being pressed. Therefore, it is strongly recommended that interdisciplinary teams be formed to assess alleged sexual abuse in children.

  9. Outcomes of surgical management of tracheobronchial injuries a case series from a developing country

    Institute of Scientific and Technical Information of China (English)

    Saulat H.Fatimi; Hashim M. Hanif; Ameera Ahmed; Ghina Shamsi; Marium Muzaffar

    2011-01-01

    Objective: Tracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with most of the tracheobronchial injuries found to be sustained after penetrating trauma.Methods: A retrospective review was performed at the Aga Khan University, Karachi, Pakistan. From January 2004to December 2009, 168 patients with thoracic trauma were treated, of whom 15 were recognized to have major tracheobronchial and pulmonary injuries.Results: The average age was 31 years with most of the patients being male (14:1). Among them,11 patients had penetrating trauma as the main cause of injury, 3 patients had blunt trauma from road traffic accidents, only 1 patient had combined trauma (blunt and penetrating trauma). Eight patients were diagnosed based on radiological findings. All the patients were treated surgically. Lobectomy was the most common intervention performed in 7 patients. The mortality rate was 7% (1 patient). Most patients survived with no sequelae (10 patients) while 5 survived with disability. We found that penetrating trauma was the leading cause of injury in our series. The severity of injury depends upon the weapon causing the trauma. Patients in our series had multiple injuries and required surgical management.Conclusions: Tracheobronchial injuries are rare but potentially life threatening. They require quick diagnosis and management. Diagnosis tends to be difficult since there are no specialised diagnostic modalities available at present.

  10. Aromatase inhibitors with or without gonadotropin-releasing hormone analogue in metastatic male breast cancer: a case series

    Science.gov (United States)

    Zagouri, F; Sergentanis, T N; Koutoulidis, V; Sparber, C; Steger, G G; Dubsky, P; Zografos, G C; Psaltopoulou, T; Gnant, M; Dimopoulos, M-A; Bartsch, R

    2013-01-01

    Background: Data regarding the safety and effectiveness of aromatase inhibitors (AIs) as monotherapy or combined with gonadotropin-releasing hormone (GnRH) analogue in male breast cancer are scarce. Methods: In this retrospective chart review, cases of male breast cancer patients treated with AIs with or without a GnRH analogue were evaluated. Results: Twenty-three men were included into this case series. Aromatase inhibitors in combination with or without a GnRH analogue were given as first-line therapy in 60.9% and as second-line therapy in 39.1% of patients, respectively. All patients had visceral metastases, whereas in five of them bone lesions coexisted. In all cases AIs were tolerated well, and no case of grade 3 and 4 adverse events was reported. A partial response was observed in 26.1% of patients and stable disease in 56.5%. Median overall survival (OS) was 39 months and median progression-free survival (PFS) was 13 months. Regarding OS and PFS, no significant effects of GnRH analogue co-administration or type of AI were noted. Conclusion: Our study shows that AIs with or without GnRH analogues may represent an effective and safe treatment option for hormone-receptor positive, pretreated, metastatic, male breast cancer patients. PMID:23722469

  11. Distraction osteogenesis therapy in patients affected by Goldenhar syndrome: a case series

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    Francesco Grecchi

    2011-06-01

    Full Text Available Background: Hemifacial microsomia (HM is a syndrome characterized by the presence of structural alterations of the skeletal, nervous, vascular, and muscular structures derived from the first and second branchial arch. Goldenhar syndrome (Gs consistisof the triad of craniofacial microsomia, ocular dermoid cysts, and spinal anomalies. When the patient has hypoplasia of the mandible, orthognatic surgery or distraction osteogenesis (DO can be used to correct the asymmetry. Mandibular DO has been applied for many years, but long-term reports showed controversial results. The aim of this paper is to describe three cases of patients affected by Gs in which DO was performed to correct the mandibular asymmetry. Case series: The cases reported show an increasing degree of dismorphism which required a increasing complexity of the surgical approach: a single mandibular DO in the first patient, and a mandibular DO associated with a Le Fort I osteotomy in the second one, a double mandibular DO associated with Le Fort I and surgical disjunction of the middle palatal suture in the third case. Discussion: The effects of DO involve not only the skeletal segment but also all the surrounding soft tissues. DO leads to rapid and remarkable improvement in facial symmetry due to emimandible hypoplasia. When correct spatial repositioning of the maxilla cann ot be expected, mandibular DO can be carried out by associating a Le Fort I osteotomy. In this way DO minimize the need for major osteotomies and allows an earlier treatment in selected cases.

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

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    Gauffin H

    2014-11-01

    Full Text Available Helena Gauffin1,2 Anne-Marie Landtblom1–4 1Department of Neurology, Linköping University, Linköping, Sweden; 2Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; 3Neurology Unit, Department of Medical Specialist, General Hospital, Department of Medicine and Health Sciences, IMM, County Council, Linköping University, Motala, Sweden; 4Department of Neuroscience, Uppsala University, Uppsala, Sweden Abstract: Historically, epilepsy has been associated with violence, but more recent studies have emphasized genetic and psychosocial factors as more important. The case series presented here aim to highlight the difficult situation the affected children are in. We report on three cases when children have been traumatized and, in one case, even been killed by their parent who was diagnosed with epilepsy. In the first case, we describe a woman with juvenile myoclonic epilepsy who was sentenced to forensic psychiatry care for killing her child. She lived under difficult psychosocial circumstances and a suicide attempt contributed to what happened. The second case describes a man with post-traumatic seizures who was sentenced for child abuse. Ictal or postictal violence was considered in these two cases but a causal link between the violence and epilepsy has not been established. In the third case, we describe a woman with focal epilepsy and psychogenic non-epileptic seizures (PNESs. Her child was hurt and frightened in relation to violent seizures, which were regarded as PNESs. This case series demonstrates that children of parents with epilepsy can be in a vulnerable situation. No causality has been established between the seizures and these events, so consequently other factors such as psychosocial stress, low cognitive function, and a suicide attempt must also be considered as important. When a child is hurt by a parent with epilepsy the patient must be closely examined to determine the role of the seizures

  13. Successful salvage therapy of Fusarium endophthalmitis secondary to keratitis: an interventional case series

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    Comer GM

    2012-05-01

    Full Text Available Grant M Comer, Maxwell S Stem, Stephen J SaxeUniversity of Michigan, Department of Ophthalmology and Visual Sciences, Ann Arbor, MI, USAPurpose: To describe a combination of treatment modalities used for the successful eradication of Fusarium endophthalmitis.Design: Interventional case series.Participants: Three consecutive patients with keratitis-associated Fusarium endophthalmitis.Methods: After failure of traditional management options, a combination of intravitreal and long-term, high-dose systemic voriconazole, topical antifungal medications, and surgical intervention, with penetrating keratoplasty, lensectomy, and endoscopic-guided pars plana vitrectomy, was administered to each patient.Results: All three cases achieved full resolution of the infection, with a final Snellen visual acuity score of 20/50 to 20/70.Conclusions: An aggressive combination of therapeutic modalities, including the removal of subiris abscesses, might be needed for the successful resolution of Fusarium endophthalmitis.Keywords: endophthalmitis, fungal, Fusarium, keratitis, keratoplasty, voriconazole 

  14. Subcutaneous intralesional Ksharodaka injection: A novel treatment for the management of Warts: A case series.

    Science.gov (United States)

    Gundeti, Manohar S; Reddy, R Govind; Muralidhar, Jangle Vidya

    2014-01-01

    Warts are generally managed using cryosurgery, keratolytic ointments, curettage and electrodessication. Warts, vis-a-vis Charmakila, in Ayurvedic classical texts are classified into different types depending on the dominance of dosha. Ayurveda prescribes oral medications, topical use of Kshara (alkaline ash of herbs), Agni (thermal cautery) and Shastrakarma (surgery) for removal of Charmakila. Use of topical Kshara in the form of powder, aqueous solution i.e. Ksharodaka and Ksharasutra (thread smeared with Kshara) for warts has been reported. However, these methods necessitate multiple sittings and takea longer duration for removal of the warts. Herewith, we report a case series of different types of warts treated with intralesional infiltration of Apamarga Ksharodaka (AK), i.e. aqueous solution of Apamarga (Achyranthes aspera) Kshara. We observed that all these warts took a minimum of 2-6 days to shed off, leaving minor scars. There were no adverse reactions reported in any of these cases.

  15. Management of amlodipine-induced gingival enlargement: Series of three cases

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    Srivastava Amit

    2010-01-01

    Full Text Available Gingival enlargement is one of the side effects associated with certain drugs. Amlodipine, a calcium channel blocker, used as antihypertensive drug has been found associated with gingival hyperplasia. This case series presents diagnosis and management of amlodipine-induced gingival hyperplasia. Amlodipine-induced gingival enlargement was diagnosed and managed by thorough scaling and root planning. Drug substitution and surgical intervention was performed in first two cases. The pathogenesis of gingival enlargement is uncertain and the treatment is still largely limited to the maintenance of an improved level of oral hygiene and surgical removal of the overgrown tissue. Several factors may influence the relationship between the drugs and gingival tissues as discussed by Seymour et al. Meticulous oral hygiene maintenance, switchover to alternative drug, professional scaling and root planning and surgical excision of enlarged gingival tissue may help overcome the effect of these drugs.

  16. Subcutaneous intralesional Ksharodaka injection: A novel treatment for the management of Warts: A case series

    Science.gov (United States)

    Gundeti, Manohar S.; Reddy, R. Govind; Muralidhar, Jangle Vidya

    2014-01-01

    Warts are generally managed using cryosurgery, keratolytic ointments, curettage and electrodessication. Warts, vis-a-vis Charmakila, in Ayurvedic classical texts are classified into different types depending on the dominance of dosha. Ayurveda prescribes oral medications, topical use of Kshara (alkaline ash of herbs), Agni (thermal cautery) and Shastrakarma (surgery) for removal of Charmakila. Use of topical Kshara in the form of powder, aqueous solution i.e. Ksharodaka and Ksharasutra (thread smeared with Kshara) for warts has been reported. However, these methods necessitate multiple sittings and takea longer duration for removal of the warts. Herewith, we report a case series of different types of warts treated with intralesional infiltration of Apamarga Ksharodaka (AK), i.e. aqueous solution of Apamarga (Achyranthes aspera) Kshara. We observed that all these warts took a minimum of 2-6 days to shed off, leaving minor scars. There were no adverse reactions reported in any of these cases. PMID:25624698

  17. Clomipramine in the treatment of compulsive behavior in frontotemporal dementia: a case series.

    Science.gov (United States)

    Furlan, Julio C; Henri-Bhargava, Alexandre; Freedman, Morris

    2014-01-01

    Compulsive behaviors in patients with behavioral variant frontotemporal dementia (bvFTD) occur frequently and are challenging to manage. We report three cases of probable bvFTD associated with compulsive behaviors that responded well to treatment with clomipramine at daily dosages varying from 20 to 175 mg. The titration approach involved an initial 10-mg dose that was subsequently increased in 10 mg increments on a weekly basis until symptom relief without intolerable side effects. Our case series supports the consideration for a therapeutic trial with clomipramine in bvFTD when compulsive behavior occurs in these patients. It also highlights the need for further research on pharmacological treatments in bvFTD.

  18. Ultrasound of the sural nerve: Normal anatomy on cadaveric dissection and case series

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    Belsack, Dries, E-mail: dries.belsack@uzbrussel.be [Department of Radiology, UZ Brussel, Laarbeeklaan 101, 1090 Jette, Brussels (Belgium); Jager, Tjeerd, E-mail: tjeerd.jager@asz.be [Department of Radiology, Aalsters Stedelijk Ziekenhuis, Merestraat 80, 9300 Aalst (Belgium); Scafoglieri, Aldo, E-mail: aldo.scafoglieri@vub.ac.be [Department of Experimental Anatomy, Free University Brussels, Laarbeeklaan 103, 1090 Jette (Belgium); Vanderdood, Kurt, E-mail: kvanderd@yahoo.com [Department of Radiology, Maaslandziekenhuis, Dr H van der Hoffplein 1, 6162 Sittard-Geleen, Sittard (Netherlands); Van Hedent, Eddy, E-mail: eddy.vanhedent@asz.be [Department of Radiology, Aalsters Stedelijk Ziekenhuis, Merestraat 80, 9300 Aalst (Belgium); Vanhoenacker, Filip, E-mail: filip.vanhoenacker@telenet.be [Department of Radiology, AZ Sint-Maarten, Duffel-Mechelen, Rooienberg 25, 2570 Duffel (Belgium); Marcelis, Stefaan, E-mail: stefaan.marcelis@sintandriesstielt.be [Department of Radiology, Sint Andriesziekenhuis, Krommewalstraat 11, 8700 Tielt (Belgium); De Maeseneer, Michel, E-mail: michel.demaeseneer@uzbrussel.be [Department of Radiology, UZ Brussel, Laarbeeklaan 101, 1090 Jette, Brussels (Belgium)

    2013-11-01

    The sural nerve is a small sensory nerve innervating the lateral aspect of the ankle and foot. Clinical symptoms of pathology may present as atypical sensory changes in this region. We present the normal anatomy and ultrasound technique for examination of the sural nerve based on an anatomical dissection, as well as imaging in a normal volunteer. We also present a case series (n = 10) of different conditions of the sural nerve that we encountered based on a review of interesting cases from 4 institutions. The pathological conditions included neuropathy related to stripping or venous laser surgery, compression by abscess, Lyme disease, nerve tumors, traumatic transsection, and encasement by fibrous plaque and edema. Ultrasound with its exquisite resolution is the preferred imaging method for examining the sural nerve in patients with unexplained sensory changes at the lateral aspect of the ankle and foot.

  19. Imaging in the Diagnosis of Cemento-Ossifying Fibroma: A Case Series

    Directory of Open Access Journals (Sweden)

    R Mithra

    2012-01-01

    Full Text Available Cemento-ossifying fibroma is a benign fibro-osseous lesion belonging to the same category as fibrous dysplasia and cementifying dysplasia. These are slow-growing lesions that are seen in the third and fourth decades of life. Both the ossifying fibroma and cemento-ossifying fibroma represent two extremes of the same disease process since histologically both contain bone and cementum. However, the term cemento-ossifying fibroma is justified on the basis of clinical and radiological correlation. Radiographs have become an essential tool in the diagnosis of lesions in the jaw, where the anatomy is complex. Nowadays, CT provides information for diagnosis as well as treatment planning. In this case series, we report three cases of cemento-ossifying fibroma that were histologically confirmed and discuss the imaging findings.

  20. Subcutaneous intralesional Ksharodaka injection: A novel treatment for the management of Warts: A case series

    Directory of Open Access Journals (Sweden)

    Manohar S Gundeti

    2014-01-01

    Full Text Available Warts are generally managed using cryosurgery, keratolytic ointments, curettage and electrodessication. Warts, vis-a-vis Charmakila, in Ayurvedic classical texts are classified into different types depending on the dominance of dosha. Ayurveda prescribes oral medications, topical use of Kshara (alkaline ash of herbs, Agni (thermal cautery and Shastrakarma (surgery for removal of Charmakila. Use of topical Kshara in the form of powder, aqueous solution i.e. Ksharodaka and Ksharasutra (thread smeared with Kshara for warts has been reported. However, these methods necessitate multiple sittings and takea longer duration for removal of the warts. Herewith, we report a case series of different types of warts treated with intralesional infiltration of Apamarga Ksharodaka (AK, i.e. aqueous solution of Apamarga (Achyranthes aspera Kshara. We observed that all these warts took a minimum of 2-6 days to shed off, leaving minor scars. There were no adverse reactions reported in any of these cases.

  1. Diagnostic value of MR imaging in the Lewis-Sumner syndrome: a case series.

    Science.gov (United States)

    Rajabally, Yusuf A; Knopp, Michael J; Martin-Lamb, Darren; Morlese, John

    2014-07-15

    Lewis-Sumner syndrome (LSS) is considered a variant of chronic inflammatory demyelinating polyneuropathy (CIDP), which is more frequently described with exclusive upper limb involvement. The diagnosis of LSS is clinical and electrophysiological. However, these are not always obvious and in view of its rarity, the diagnosis may be missed and patients denied effective immunomodulatory therapy. We herein describe the magnetic resonance imaging (MRI) findings in a series of five consecutive patients with a clinical diagnosis of LSS, using T2 STIR (Short Tau Inversion recovery) images without contrast. We demonstrated hyperintensity with or without hypertrophy of cervical roots and/or brachial plexus on the affected side and/or controlaterally which aided diagnostic confirmation. This helped therapeutic decision making regarding immunotherapy in all cases. MR imaging of the cervical spine/brachial plexus with T2 STIR may be helpful in suspected cases of LSS as it represents a very useful additional diagnostic tool.

  2. Iniencephaly: Radiological and pathological features of a series of three cases

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    Panduranga Chikkannaiah

    2014-01-01

    Full Text Available Iniencephaly is a rare form of neural tube defect with an incidence of 0.1-10 in 10,000 pregnancies. It is characterized by the presence of occipital bone defects at foramen magnum, fixed retroflexion of head, spinal dysmorphism, and lordosis of cervicothoracic vertebrae. It is usually associated with central nervous system, gastrointestinal, and cardiovascular anomalies. We present radiological and autopsy findings in a series of 3 cases of iniencephaly (gestational ages 29.3, 23, and 24 weeks first fetus in addition showed omphalocele, pulmonary hypoplasia, two lobes in right lung, accessory spleen, atrial septal defect, bilateral clubfoot, ambiguous genitalia, and single umbilical artery. Second fetus was a classical case of iniencephaly apertus with spina bifida. Third fetus had colpocephaly and bifid spine.

  3. The use of levomepromazine in Hyperemesis Gravidarum resistant to drug therapy--a case series.

    Science.gov (United States)

    Heazell, Alexander E P; Langford, Nigel; Judge, Jatinder K; Heazell, Martin A; Downey, Gabrielle P

    2005-01-01

    Hyperemesis Gravidarum (HG) is a potentially serious complication of early pregnancy, which may rarely be severe enough to warrant termination of pregnancy. HG requires prompt treatment with intravenous fluids, thiamine supplementation and appropriate anti-emetic therapy. Anti-histamines such as promethazine are favoured as first-line agents, with prochlorperazine being used as a second-line drug. However, there is no clear data as to the most appropriate drug if these are ineffective. A case series of six women who presented with HG resistant to drug treatment is described. In these cases, levomepromazine 6.25mg tds was used to control HG. Five pregnancies progressed leading to live born infants with no evidence of congenital anomaly. One pregnancy resulted in an intra-uterine death with no external or ultrasound evidence of congenital anomaly. The role of phenothiazines in the pharmacological management of HG is discussed.

  4. Isoniazid overdose : a case series, literature review and survey of antidote availability.

    Science.gov (United States)

    Maw, Graeme; Aitken, Peter

    2003-01-01

    Tuberculosis has re-emerged as a significant public health threat over the last decade both globally and within Australia. This is thought to be largely due to the HIV epidemic, a growing itinerant population, and immigration. The antibiotic isoniazid remains an integral part of drug therapy. With the numbers of patients receiving isoniazid remaining high, the number of cases of acute poisoning is expected to be significant. This paper presents a series of two cases of isoniazid poisoning presenting to a tertiary referral centre in North Queensland. Isoniazid toxicity produces a triad of coma, metabolic acidosis and seizures. The seizures are often refractory to traditional antiepileptics. A specific antidote is available (pyridoxine [vitamin B6]) and both patients were administered this as part of their treatment. We also surveyed all hospitals in Australia with an accredited adult Emergency Department to assess the availability of pyridoxine.

  5. Omalizumab for Chronic Urticaria: A Case Series and Overview of the Literature

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    Ilya Ivyanskiy

    2012-01-01

    Full Text Available Omalizumab is a recombinant humanized monoclonal antibody that blocks the high-affinity Fc receptor of IgE. Omalizumab has been approved for the treatment of moderate to severe asthma; however, there is currently more and more data showing promising results in the management also of chronic urticaria. We present a case series of 19 patients with chronic urticaria treated in a university department with omalizumab and give an overview of the existing literature comprising an additional 59 cases as well as a total of 139 patients enrolled in two randomized controlled trials comparing omalizumab with placebo. The collective evidence points to omalizumab as a safe and effective treatment option for patients with chronic urticaria who do not sufficiently respond to standard therapy as recommended by existing guidelines.

  6. Complications associated with tissue anchor migration after vaginal surgery using the tissue fixation system - a case series.

    Science.gov (United States)

    Atherton, Michelle J; Daborn, John P; Tsokos, Nicolas; Jeffery, James T; Yin, Michelle J

    2012-02-01

    This case series describes eleven women with serious complications related to migration of tissue anchors after vaginal surgery for uterovaginal prolapse and/or urinary incontinence using the tissue fixation system.

  7. Alive with the sound of music: a case series on patients presenting with musical hallucinations in a general hospital.

    Science.gov (United States)

    Kinson, Rochelle Melina; Lim, Wen Phei; Rahman, Habeebul

    2015-01-01

    Musical hallucinations are a rare phenomenon that renders appropriate identification and treatment a challenge. This case series describes three women who presented with hearing complex, familiar melodies in the absence of external stimuli on a background of hearing impairment.

  8. Child Maltreatment; Types and effects: Series of six cases from a university hospital in Oman

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    Muna Al-Saadoon

    2012-02-01

    Full Text Available Child maltreatment (CM is common worldwide, and can take many forms. It may even endanger the child’s life, especially when younger children are the victims. CM affects the child’s quality of life and consequently leads to long term issues to be dealt with by the child, family and community. This case series discusses six children who have been subjected to CM, and diagnosed by the child protection team of the departments of Child Health and Behavioural Medicine at Sultan Qaboos University Hospital (SQUH, Oman. The aim of this case series is to increase the level of awareness of CM among Oman’s medical professionals and to highlight the difficulties encountered in diagnosing and providing optimal care for these children. Although treatment is provided in Oman’s health care system, it is clear that there are gaps in the existing system which affect the quality of child protection services provided to the children and their families.

  9. Sedative Dosing Of Propofol For Treatment Of Migraine Headache In The Emergency Department: A Case Series

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    Mosier, Jarrod

    2013-11-01

    Full Text Available Introduction: Migraine headaches requiring an emergency department visit due to failed outpatient rescue therapy present a significant challenge in terms of length of stay (LOS and financial costs. Propofol therapy may be effective at pain reduction and reduce that length of stay given its pharmacokinetic properties as a short acting intravenous sedative anesthetic and pharmacodynamics on GABA mediated chloride flux.Methods: Case series of 4 patients presenting to an urban academic medical center with migraine headache failing outpatient therapy. Each patient was given a sedation dose (1 mg/kg of propofol under standard procedural sedation precautions.Results: Each of the 4 patients experienced dramatic reductions or complete resolution of headache severity. LOS for 3 of the 4 patients was 50% less than the average LOS for patients with similar chief complaints to our emergency department. 1 patient required further treatment with standard therapy but had a significant reduction in pain and a shorter LOS. There were no episodes of hypotension, hypoxia, or apnea during the sedations.Conclusion: In this small case series, sedation dose propofol appears to be effective and safe for the treatment of refractory migraines, and may result in a reduced LOS. [West J Emerg Med. 2013;14(6:646-649.

  10. Cognitive-behavioral therapy for subthreshold bulimia nervosa: A case series.

    Science.gov (United States)

    Peterson, C B; Miller, K B; Willer, M G; Ziesmer, J; Durkin, N; Arikian, A; Crow, S J

    2011-09-01

    The extent to which cognitive-behavioral therapy (CBT) is helpful in treating individuals with bulimic symptoms who do not meet full criteria for bulimia nervosa is unclear. The purpose of this investigation was to examine the potential efficacy of CBT for eating disorder individuals with bulimic symptoms who do not meet full criteria for bulimia nervosa. Twelve participants with subthreshold bulimia nervosa were treated in a case series with 20 sessions of CBT. Ten of the 12 participants (83.3%) completed treatment. Intent-to-treat abstinent percentages were 75.0% for objectively large episodes of binge eating (OBEs), 33.3% for subjectively large episodes of binge eating (SBEs), and 50% for purging at end of treatment. At one year follow-up, 66.7% were abstinent for OBEs, 41.7% for SBEs, and 50.0% for purging. The majority also reported improvements in associated symptoms. This case series provides support for the use of CBT with individuals with subthreshold bulimia nervosa.

  11. Eminectomy for Habitual Luxation of the Temporomandibular Joint with Sedation and Local Anesthesia: A Case Series

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    Joe Iwanaga

    2016-01-01

    Full Text Available Eminectomy which is one of the popular and most effective treatments for habitual temporomandibular joint luxation was first described by Myrhaug in 1951. There are few reports which described eminectomy being performed under local anesthesia and conscious sedation. We present a case series of habitual luxation of the TMJ treated by eminectomy performed under local anesthesia and conscious sedation and general anesthesia. Five patients were examined and found to have recurrent luxation of the TMJ. The age of patients ranged from 18 to 93 years. Bilateral eminectomy of the TMJ was performed for two patients, and unilateral eminectomy was performed for three patients. Two were examined under intravenous propofol sedation and local anesthesia, while three patients were examined under general anesthesia. One patient died from ileus one month after surgery. The follow-up period except for the case that died from ileus ranged from 12 to 33 months. No recurrent dislocation of the TMJ has been identified. Based on our experience and two other series in the literature, eminectomy with sedation and local anesthesia can be considered and might be a good option in elderly patients.

  12. Augmentation of Psychotherapy through Alternative Preconscious Priming: A Case Series Exploring Effects on Residual Symptoms

    Science.gov (United States)

    Zidani, Melha; Audet, Jean-Sébastien; Borgeat, François; Aardema, Frederick; O’Connor, Kieron Philip; Khazaal, Yasser

    2017-01-01

    The current paper describes a case series using a new strategy for facilitating change based on Augmentation of Psychotherapy through Alternative Preconscious Priming (APAP) (1) in the treatment of eight treatment-resistant patients suffering from social phobia or generalized anxiety disorder. The patients had previously only shown a partial response to cognitive behavioral therapy (CBT) despite good treatment adherence. The patients completed APAP using a computerized program, which consisted of three steps during which alternative, more functional thoughts and beliefs relevant to the idiosyncratic difficulties experienced by the patients were formulated. Subsequently, these formulations were recorded and mixed with masking relaxing music, which the patient listened to in a passive state twice daily for 20 min for a period of 8 weeks. This case series aimed to assess the effect and acceptability of APAP using quantitative and qualitative measures administered before, after, and 16 weeks’ posttreatment. Results showed a reduction in dysfunctional idiosyncratic thoughts reported by most patients, as well as mild improvements in anxiety and important improvements in quality of life. APAP could be a valuable addition to CBT by facilitating or enhancing cognitive and symptom change. Further studies are needed to confirm these promising results. PMID:28197107

  13. Alemtuzumab use in neuromyelitis optica spectrum disorders: a brief case series.

    Science.gov (United States)

    Azzopardi, Laura; Cox, Amanda L; McCarthy, Claire L; Jones, Joanne L; Coles, Alasdair J

    2016-01-01

    Alemtuzumab is an anti-CD52 monoclonal antibody recently licensed for use in relapsing-remitting multiple sclerosis. Here, we report our experience of its use in neuromyelitis optica (NMO) spectrum disorders. A retrospective case review of patients treated with alemtuzumab in Cambridge, UK, was conducted to identify those who fulfil the criteria for NMO spectrum disorder. Three cases were identified. Case 1, 9-year-old female, presented with transverse myelitis and bilateral optic neuritis,with one lower medullary and several longitudinally extensive cord lesions. Despite immunosuppression including two courses of alemtuzumab, she continued to relapse, was wheelchair bound and registered blind by age 12, and died at age 18. Case 2, 41-year-old female, presented with bilateral optic neuritis and transverse myelitis with longitudinally extensive cervical cord lesions. Despite three courses of alemtuzumab, she had five relapses with visual impairment and new cord lesions. She later developed tumefactive white matter lesions and died aged 51.Case 3, 31-year-old female, presented with transverse myelitis with longitudinally extensive cervical cord lesions and positive aquaporin-4 antibody. After one course of alemtuzumab, she relapsed with 4 episodes of myelitis with new enhancing lesions and accumulating disability. She became relapse free after rituximab and mycophenolate mofetil. From this case series, we conclude that alemtuzumab failed to prevent disabling relapses and poor outcome in NMO. We hypothesise that rituximab is more effective, as in case 3, because it causes much more prolonged B lymphocyte depletion than alemtuzumab. We therefore caution against the use of alemtuzumab in NMO.

  14. Case Fatality among Patients Hospitalized for Community-acquired Pneumonia according to Initial Antibiotic Treatment. A Comparison of Two Case Series

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    Luis Alberto Corona Martínez

    2016-04-01

    Full Text Available Background: community-acquired pneumonia is one of the major health problems worldwide and in the hospital of Cienfuegos.Objective: to determine the changes in the relationship between the type of antimicrobial agent used empirically at admission and case fatality for community-acquired pneumonia in two case series designed at different times.Methods: an observational, descriptive study was conducted to compare two case series of patients hospitalized due to the condition under study. The relationship between the antimicrobial agents selected (amoxicillin/sulbactam, cefuroxime, ceftriaxone and cefotaxime and case fatality was analyzed taking into account potentially confounding variables. In the statistical analysis, the Chi-square test was used to compare the proportions, and Fisher's exact test was applied, with a 95% confidence level (p <.05. Results: in the two case series, the same pattern was observed in terms of the antimicrobial agents associated with the lowest and highest case fatality: cefuroxime and cefotaxime, respectively. In contrast to the A series, the B series showed a more uniform behavior of case fatality with the use of the antimicrobials selected, which meant a considerable reduction in case fatality among patients treated initially with third-generation cephalosporins in the B series. In this sense, the most significant impact on case fatality was observed in patients receiving ceftriaxone.Conclusions: cefuroxime remains the initial empirical antimicrobial agent associated with the lowest case fatality among patients with community-acquired pneumonia. In the second case series, a clear reduction in case fatality was found in patients treated with ceftriaxone and cefotaxime.

  15. Management of self-inflicted dental injuries with various nonsurgical techniques: Case series

    Directory of Open Access Journals (Sweden)

    Ganesh Ranganath Jadhav

    2016-01-01

    Full Text Available Children have a common habit of exploring carious or traumatically exposed teeth using various foreign objects such as metal screws, staple pins, darning needles, pencil leads, beads, paper clip, and toothpicks, which may sometimes break inside the pulp chamber or root canal. Majority of such cases are asymptomatic and hence diagnosed accidentally on routine radiographic examination. However, embedded foreign objects may sometimes act as a potential source of infection and are convoyed with pain or recurrent swelling. Dentists must be aware of the self-inflicted dental injury, its consequences, and selection of the all-inclusive treatment strategies giving due consideration to cost-benefit ratio of the different treatment options. This case series highlights the possible dental consequences of placing foreign objects in the mouth and various management strategies. Four cases of self-inflicted dental injuries involving patients aged 10–20 years are presented and investigated from the endodontic, pedodontic, and psychiatric viewpoints. In all cases, the cause has been easily identified by clinical appearance corroborated with a good history. This paper discusses a nonsurgical technique to retrieve these objects from the root canal with minimal damage to internal tooth structure.

  16. Case Series of an Intraoral Balancing Appliance Therapy on Subjective Symptom Severity and Cervical Spine Alignment

    Directory of Open Access Journals (Sweden)

    Young Jun Lee

    2013-01-01

    Full Text Available Objective. The objective of this study was to investigate the effect of a holistic intraoral appliance (OA on cervical spine alignment and subjective symptom severity. Design. An observational study on case series with holistic OA therapy. Setting. An outpatient clinic for holistic temporomandibular joint (TMJ therapy under the supervision of the Pain Center, CHA Biomedical center, CHA University. Subjects. Ambulatory patients presenting with diverse chief complaints in the holistic TMJ clinic. Main Measures. Any immediate change in the curvature of cervical spine and the degree of atlantoaxial rotation was investigated in the images of simple X-ray and computed tomography of cervical spine with or without OA. Changes of subjective symptom severity were also analyzed for the holistic OA therapy cases. Results. A total of 59 cases were reviewed. Alignment of upper cervical spine rotation showed an immediate improvement (. Changes of subjective symptom severity also showed significant improvement (. Conclusion. These cases revealed rudimentary clinical evidence that holistic OA therapy may be related to an alleviated symptom severity and an improved cervical spinal alignment. These results show that further researches may warrant for the holistic TMJ therapy.

  17. Effect of Intensive Atropine Doses (Rapid Incremental Loading and Titration for Management of Organophosphorus Pesticide Poisoning: a Case Series

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    Abu Saleh Ahmed

    2014-03-01

    Full Text Available Background:Acute poisoning with organophosphorus (OP pesticides is a common method of suicide and entails considerable mortality in Bangladesh. The objective of this study was to evaluate the effects and outcomes of a protocol for treatment of OP poisoning that included titrated incremental atropine as loading dose and slow infusion for maintenance.  Methods:In this prospective descriptive case series, definitive OP poisoned patients were enrolled in an adult medicine unit of Dhaka Medical College Hospital from April 2006 to April 2007. Clinical examinations were done as soon as the patient entered the ward. Patient’s demographics, comorbid conditions and the occurrence of specific clinical outcomes including death, need for assisted ventilation and clinical complications were recorded. The patients were treated according to the protocol. Results: A total of 56 patients were enrolled over the study period. The median age of the study population was 22.5 years. Most patients were men (67.8%. The most common clinical presentation was miosis (58.9%. In total, 11 patients died (19.6%. Intermediate syndrome developed in 12 patients (21.4% and 6 of them died. Assisted ventilation was required in 16 cases (28.5. Patients with diastolic blood pressure ≤ 70 mmHg and/or GCS ≤ 10 were significantly less likely to survive (P = 0.02, 0.006, respectively. Moreover, early respiratory failure (P < 0.001 and the need for assisted ventilation (P < 0.001 were significantly higher among deceased cases. The mortality rate in this study was similar to previous studies. The frequency of atropine toxicity in the present study (1.8% was considerably lower than conventional regimen used in previous studies. Conclusion:Using the new protocol, lower rate of atropine toxicity developed in victims. Hence, the new protocol appears to be safer and its effectiveness should be further evaluated in case control studies in Bangladesh.    How to cite this article: Ahmed AS

  18. An Empirical Evaluation of Jolly Phonics Series Being Taught in Iran's Baby College Institutes

    Directory of Open Access Journals (Sweden)

    Ali Derakhshan

    2016-03-01

    Full Text Available With growth of EFL in Iran, based on context requirements, textbook evaluation has received substantial attention. Teachers' experiences and perceptions play vital roles in the process of book evaluation. The study is based on the Jolly Phonics series (Lloyd & Wernham, 1995 used by number of institutes and colleges in teaching in Iran. The main objective of the study was to find out whether this teaching material follows the essential objectives for teaching English as a foreign language to children or not. Considering the point that teachers have an indispensable role in analyzing and making an applicable and practical decision on evaluating and choosing the best possible material to be taught, the study focused on the teachers’ perceptions. The series were evaluated against Nokelainen's (2006 checklist. To this end, 72 female experienced teachers of Baby College institutes in Tehran and Gorgan branches, Iran, were randomly selected and given the Pedagogically Meaningful Learning Questionnaire (PMLQ of 40 questions to fill in. The findings showed that teachers mostly believe Jolly Phonics series and the teaching method can stand as a capable and trustable material for young EFL learners. However, in order to make it more profitable it may involve using decisions in adapting textual materials to the needs and interests of pupils as the learners' requirements are changing regarding the adventures of their environment. It is suggested that being a teacher’s guide to educate the teachers how to adapt and teach the materials on the base of learners' needs would be much better than just knowing or learning how to teach it. The textbook will continue to play an important role in helping teachers in teaching process, but it should not be a dictator (Williams, 1983, and the investigated material is respectful to this idea as it can well cover the flexibility, motivation, applicability, learner control and learner activity objectives since most of

  19. Performance Evaluation and Quality Assurance Management during the Series Power Tests of LHC Main Lattice Magnets

    CERN Document Server

    Siemko, A

    2008-01-01

    Within the LHC magnet program a series production of superconducting dipoles and quadrupoles has recently been completed in industry and all magnets were cold tested at CERN. The main features of these magnets are: two-in-one structure, 56 mm aperture, two layer coils wound from 15.1 mm wide Nb-Ti cables, and all-polyimide insulation. This paper reviews the process of the power test quality assurance and performance evaluation, which was applied during the LHC magnet series tests. The main test results of magnets tested in both supercritical and superfluid helium, including the quench training, the conductor performance, the magnet protection efficiency and the electrical integrity are presented and discussed in terms of the design parameters and the requirements of the LHC project.

  20. Clinical experiences of delayed contrast enhancement with cardiac computed tomography: case series

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    Sidhu Manavjot S

    2013-01-01

    Full Text Available Abstract Background Myocardial delayed enhancement (MDE by gadolinium-enhanced cardiac MRI is well established for myocardial scar assessment in ischemic and non-ischemic heart disease. The role of MDE by cardiac CT (CT-MDE is not yet defined. Findings We reviewed all clinical cases of CT-MDE at a tertiary referral center to present the cases as a case series. All clinical cardiac CT exams which utilized CT-MDE imaging between January 1, 2005 and October 1, 2010 were collected as a series and their findings were also compared with available myocardial imaging to assess for myocardial abnormalities, including echocardiography (wall motion, morphology, cardiac MRI (delayed enhancement, morphology, SPECT MPI (perfusion defects. 5,860 clinical cardiac CT exams were performed during the study period. CT-MDE was obtained in 18 patients and was reported to be present in 9 patients. The indications for CT-MDE included ischemic and non-ischemic heart diseases. In segments positive for CT-MDE, there was excellent agreement of CT with other modalities: echocardiography (n=8 demonstrated abnormal morphology and wall motion (k=1.0 and k=0.82 respectively; prior MRI (n=2 demonstrated abnormal delayed enhancement (MR-MDE (k=1.0; SPECT MPI (n=1 demonstrated fixed perfusion defects (k=1.0. In the subset of patients without CT-MDE, no abnormal segments were identified by echocardiography (n=8, MRI (n=1 and nuclear MPI (n=0. Conclusions CT-MDE was performed in rare clinical situations. The indications included both ischemic and non-ischemic heart disease and there was an excellent agreement between CT-MDE and abnormal myocardium by echocardiography, cardiac MRI, and nuclear MPI.

  1. Complications and subsequent removal of retained shunt hardware after endoscopic third ventriculostomy: case series.

    Science.gov (United States)

    Pindrik, Jonathan; Jallo, George I; Ahn, Edward S

    2013-06-01

    This case series highlights multiple complications and subsequent removal of retained shunt hardware in pediatric patients after successful endoscopic third ventriculostomy (ETV). Removal or retention of existing shunt hardware following ETV represents an important dilemma. Prior studies have reported infections and organ perforation related to nonfunctioning shunts but none in the context of successful ETV. Data obtained in 3 children with hydrocephalus treated at the authors' institution were retrospectively reviewed after the patients experienced complications due to retained shunt hardware following ETV. Etiologies of hydrocephalus included tectal glioma and intraventricular hemorrhage. All 3 patients had a history of multiple shunt revisions and underwent urgent ETV in the setting of a shunt malfunction. In each case, the entire shunt system was left in situ, but it became the source of subsequent complications. Two of the 3 patients presented with the shunt infected by gram-negative bacilli 10 days and 4.5 months postoperatively, respectively. The remaining patient experienced wound dehiscence over the shunt valve 4.5 months after ETV. In all patients, the complications were managed successfully by removing the shunt hardware. None of the patients required repeat shunt insertion from the time of removal throughout the follow-up period (mean 24 months, range 9-36 months). During the study period, a total of 6 patients with indwelling shunt hardware underwent ETV with the expectation of being shunt independent. Among these 6 patients, 3 experienced no complications from the retained hardware whereas 3 patients (50%) ultimately experienced adverse consequences related to retained hardware. This case series illustrates complications involving retained shunt hardware after successful ETV. These examples support consideration of shunt removal at the time of ETV in the appropriate context.

  2. Diagnostic criteria and follow-up in neuroendocrine cell hyperplasia of infancy: a case series

    Directory of Open Access Journals (Sweden)

    Vivianne Calheiros Chaves Gomes

    2013-09-01

    Full Text Available OBJECTIVE: Neuroendocrine cell hyperplasia of infancy (NEHI is a form of childhood interstitial lung disease characterized by tachypnea, retractions, crackles, and hypoxia. The aim of this study was to report and discuss the clinical, imaging, and histopathological findings in a series of NEHI cases at a tertiary pediatric hospital, with an emphasis on diagnostic criteria and clinical outcomes. METHODS: Between 2003 and 2011, 12 full-term infants were diagnosed with NEHI, based on clinical and tomographic findings. Those infants were followed for 1-91 months. Four infants were biopsied, and the histopathological specimens were stained with bombesin antibody. RESULTS: In this case series, symptoms appeared at birth in 6 infants and by 3 months of age in the remaining 6. In all of the cases, NEHI was associated with acute respiratory infection. The most common initial chest HRCT findings were ground-glass opacities that were in the middle lobe/lingula in 12 patients and in other medullary areas in 10. Air trapping was the second most common finding, being observed in 7 patients. Follow-up HRCT scans (performed in 10 patients revealed normal results in 1 patient and improvement in 9. The biopsy findings were nonspecific, and the staining was positive for bombesin in all samples. Confirmation of NEHI was primarily based on clinical and tomographic findings. Symptoms improved during the follow-up period (mean, 41 months. A clinical cure was achieved in 4 patients. CONCLUSIONS: In this sample of patients, the diagnosis of NEHI was made on the basis of the clinical and tomographic findings, independent of the lung biopsy results. Most of the patients showed clinical improvement and persistent tomographic changes during the follow-up period, regardless of the initial severity of the disease or type of treatment.

  3. Evaluation of School Administrators. NAESP School Leadership Digest Series, Number Five. ERIC/CEM Research Analysis Series, Number Seven.

    Science.gov (United States)

    Barraclough, Terry

    Administrators have always been evaluated in one way or another. Decisions on hiring, training, promotion, and firing of administrators have always been necessary; such decisions are based on some sort of evaluation, whether formal or informal, of administrative performance. The concept of accountability has also affected administrator evaluation.…

  4. Menkes disease and response to copper histidine: An Indian case series

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    Sangeetha Yoganathan

    2017-01-01

    Full Text Available Background: Menkes disease (MD is an X-linked recessive neurodegenerative disorder caused by mutations in ATP7A gene. Depending on the residual ATP7A activity, manifestation may be classical MD, occipital horn syndrome, or distal motor neuropathy. Neurological sparing is expected in female carriers. However, on rare occasions, females may manifest with classical clinical phenotype due to skewed X-chromosome inactivation, X-autosome translocation, and XO genotype. Here, we describe a small series of probands with MD and their response to copper histidine therapy. This series also includes a female with X-13 translocation manifesting neurological symptoms. Methods: The clinical profile, laboratory and radiological data, and follow-up of four children with MD were collected from the hospital database and are being presented. Results: All the four children in our series had developmental delay, recurrent respiratory tract infections, hair and skeletal changes, axial hypotonia, tortuous vessels on imaging, low serum copper, ceruloplasmin, and elevated lactate. Fetal hypokinesia and fetal growth retardation were present in two cases. Failure to thrive was present in three children and only one child had epilepsy. Subcutaneous copper histidine was administered to all children. The average time lapse in the initiation of treatment was 20.3 months, and average duration of follow-up was 14.3 months. Conclusion: We conclude that copper histidine therapy is beneficial in reversing the skin and hair changes, improving appendicular tone, socio-cognitive milestones, and improving weight gain, and immunity. Early diagnosis and management of MD are essential to have a better clinical outcome. More research is needed to explore and devise new strategies in the management of patients with MD.

  5. Serie de feocromocitomas durante 15 años en Navarra Analysis of a series pheochromocytoma cases over 15 years

    Directory of Open Access Journals (Sweden)

    J. Rojo

    2012-08-01

    Full Text Available Fundamento. El feocromocitoma es un tumor productor de catecolaminas que procede de las células cromafines del sistema nervioso simpático. El 80-85% se localiza en la médula adrenal. El diagnóstico se confirma con la determinación de catecolaminas y metanefrinas en plasma y orina. El diagnóstico de localización debe realizarse una vez confirmado el diagnóstico bioquímico, preferentemente mediante tomografía computarizada y/o resonancia magnética. El tratamiento de elección es la cirugía vía laparoscópica. Material y métodos. Revisión de las historias clínicas de los pacientes con diagnóstico anatomo-patológico de feocromocitoma en los servicios de Anatomía Patológica del Complejo Hospitalario de Navarra entre los años 1996 y 2010. Se realiza el análisis descriptivo de los resultados mediante el programa estadístico SPSS. Resultados. Esta serie está formada por 43 pacientes con diagnóstico anatomo-patológico de feocromocitoma durante los últimos 15 años. La edad media de presentación es de 47 años. Entre los más jóvenes hay condensación de pacientes con determinados síndromes genéticos. El método de imagen más empleado ha sido la tomografía computarizada. Encontramos resultados contradictorios en cuanto al empleo de medicación preoperatoria. El comportamiento en todos los casos ha sido benigno. Conclusiones. Creemos conveniente realizar estudio genético en pacientes menores de 20 años de edad. Los parámetros con mayor sensibilidad para el diagnóstico han sido normetanefrina y metanefrina en orina. El único tratamiento curativo es la cirugía, que debería realizarse preferentemente vía laparoscópica.Background. The pheochromocytoma is a catecholamine secreting tumour derived from chromaffin cells of the sympathetic nervous system. Eighty to eighty-five percent of these tumours are localized in the adrenal medulla. When pheocromocytomas are found outside the adrenal gland they are referred to as

  6. Warthin-Like Papillary Carcinoma of the Thyroid: A Case Series and Review of the Literature

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    Ayça ERŞEN

    2013-01-01

    Full Text Available Warthin-like tumor of the thyroid is a recently described rare variant of thyroid papillary carcinoma. The distinguishing histological feature of this variant is papillary foldings lined by oncocytic neoplastic cells with clear nuclei and nuclear pseudoinclusions, accompanied by prominent lymphocytic infiltrate in the papillary stalks. Its prognosis has been reported to be almost similar to conventional papillary carcinoma. In this case series, we report four cases with Warthin-like papillary carcinoma of the thyroid, diagnosed at Dokuz Eylul University Faculty of Medicine Department of Pathology in 2008 and 2009. Three patients were female. The mean patient age was 39 years (range, 20-56 and the mean tumor size was 1.7 cm (range, 0.9-2.0 cm. All of the cases had lymphocytic thyroiditis in the background. None of the tumors showed lymphovascular invasion. The patients are free of any recurrence and/or distant metastasis with a mean follow-up of 25 months. This rare variant of thyroid papillary carcinoma with distinct histopathological features should be indicated in pathology reports. Further studies and long-term follow-up of patients are needed to highlight the biological behavior of this variant.

  7. Should Prophylactic Anticoagulation Be Considered with Large Uterine Leiomyoma? A Case Series and Literature Review

    Science.gov (United States)

    Paredes Saenz, Carmen; Raju, Rubin; Cuthpert, Sierra; Kanzy, Abed; Abhari, Sina; Hebert III, John; Rocha, Frederico G.

    2016-01-01

    Introduction. Uterine leiomyomas, also called uterine fibroids or myomas, are the most common pelvic tumors in women. They are very rarely the cause of acute complications. However, when complications occur they cause significant morbidity and mortality. Thromboembolic disease has been described as a rare complication of uterine leiomyomas. DVT is a serious illness, sometimes causing death due to acute PE. Cases. We report a case series of 3 patients with thromboembolic disease associated with uterine leiomyoma at Hurley Medical Center, Flint, Michigan, during 2015 and conduct a literature review on the topic. A literature search was conducted using Medline, PubMed, and PMC databases from 1966 to 2015. Conclusion. The uterine leiomyoma is a very rare cause of PE and only few cases have been reported. DVT secondary to uterine leiomyoma should be considered in a female presenting with abdominal mass and pelvic pressure, if there is no clear common cause for her symptoms. Thromboembolic disease secondary to large uterine leiomyoma should be treated with acute stabilization and then hysterectomy. Prophylactic anticoagulation would be beneficial for lowering the risk of VTE in patients with large uterine leiomyoma. PMID:27885348

  8. Is Valproate Depressogenic in Patients Remitting from Acute Mania? Case Series

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    Kamini Vasudev

    2015-01-01

    Full Text Available Valproate is an effective antimanic agent and is recommended as a first-line medication in the treatment of acute mania. Current evidence based guidelines recommend that valproate should be given as a loading dose as it produces a rapid antimanic and antipsychotic response with minimal side-effects. However, no clear guidelines are available on the appropriate dosing or serum levels of valproate in the continuation or maintenance phase of bipolar disorder. We present 4 clinical cases to hypothesize that the higher doses of valproate, such as those used in the treatment of acute mania, may cause a depressive switch. So consideration should be given to reducing the dose of valproate if a patient develops depressive symptoms following recovery from the manic episode, as a therapeutic strategy. The cases also indicate that relatively lower doses and serum levels of valproate are effective in the maintenance phase compared to those needed in the acute manic phase of bipolar disorder. This is the first set of case series that questions the depressogenic potential of valproate in patients remitting from an acute manic episode. It highlights that different doses and serum levels of valproate may be therapeutic in different phases of bipolar disorder.

  9. BRCA1 and BRCA2 mutation prevalence and clinical characteristics of a population-based series of ovarian cancer cases from Denmark

    DEFF Research Database (Denmark)

    Soegaard, M.; Kjaer, S.K.; Cox, M.;

    2008-01-01

    PURPOSE: To evaluate the prevalence of BRCA1 and BRCA2 mutations and associations with clinical correlates of disease in a population-based series of ovarian cancer cases from Denmark. METHODS: DNA sequencing and multiplex ligation-dependent probe amplification analysis were used to analyze...... the BRCA1 and BRCA2 genes for coding sequence mutations and large genomic rearrangements in 445 confirmed cases of ovarian cancer. We evaluated associations between mutation status and clinical characteristics, including cancer risks for first-degree relatives and clinicopathologic features of tumors....... RESULTS: Deleterious BRCA1 or BRCA2 mutations were identified in 26 cases; thus, mutations in these genes are responsible for at least 5.8% of ovarian cancer cases in this population. Five different mutations were identified in more than one individual, suggesting that they may be founder mutations...

  10. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

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    Dincer Aktuerk

    2016-01-01

    Full Text Available Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS. The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8. In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc., were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study.

  11. Synthesis and biological evaluation against Mycobacterium tuberculosis and Leishmania amazonensis of a series of diaminated terpenoids.

    Science.gov (United States)

    Dos Reis, Dijovani Batista; Souza, Thalita Cristina Alves; Lourenço, Maria Cristina S; de Almeida, Mauro Vieira; Barbosa, Adriano; Eger, Iriane; Saraiva, Mauricio Frota

    2016-12-01

    We report the synthesis of a series of diaminated terpenoids containing, as side-chain of the diamine core, the "head-to-tail" prenyl derivatives, with amino amino spacers of variable length. In vitro biological activity of these compounds was evaluated against Mycobacterium tuberculosis and Leishmania amazonensis, and the structure-activity relationships are discussed. Different biological results were observed depending on the terpenic side-chain length. The best results were obtained for trans,trans-farnesol derivatives. Moreover, these results demonstrated that the stereochemistry of the double bond could play an important role in determining antitubercular and antileishmanial activities of these compounds.

  12. Experimental Behavior Evaluation of Series and Parallel Connected Constant Phase Elements

    KAUST Repository

    Tsirimokou, Georgia

    2017-01-28

    Fractional-order capacitors are the core building blocks for implementing fractional-order circuits. Due to the absence of their commercial availability, they can be approximated through appropriately configured passive or active integer-order element topologies. Such a topology, constructed using Operational Transconductance Amplifiers (OTAs) and capacitors has been implemented in monolithic form through the AMS 0.35μm CMOS process, and the fabricated chips are employed here for the experimental evaluation of the behavior of networks constructed from fractional-order capacitors connected in series or in parallel.

  13. Treatment of gingival hyperpigmentation with rotary abrasive, scalpel, and laser techniques: A case series.

    Science.gov (United States)

    Murthy, M Bhanu; Kaur, Jasjit; Das, Rupali

    2012-10-01

    Melanin pigmentation often occurs in the gingiva as a result of an abnormal deposition of melanin, due to which the gums may appear black, but the principles, techniques, and management of the problems associated with gingival melanin pigmentation are still not fully established. Depigmentation procedures such as scalpel surgery, gingivectomy with free gingival autografting, electrosurgery, cryosurgery, chemical agents such as 90% phenol and 95% alcohol, abrasion with diamond bur, Nd: YAG laser, semiconductor diode laser, and CO2 laser have been employed for removal of melanin hyper pigmentation. The following case series describes three different surgical depigmentation techniques: scalpel surgery, abrasion with rotary abrasive, and a diode laser. Better results of depigmentation were achieved with diode laser than conventional scalpel and with rotary abrasion with respect to esthetics. The results point out that lasers are an effective and a safe means to removal of hyperpigmentation from the gingiva. Healing was uneventful and no repigmentation occurred.

  14. The experience of older patients with cancer in phase 1 clinical trials: a qualitative case series.

    Science.gov (United States)

    Kvale, Elizabeth A; Woodby, Lesa; Williams, Beverly Rosa

    2010-11-01

    This article explores the experiences of older patients with cancer in phase 1 clinical trials. Conducting a case series of face-to-face, in-depth, open-ended interviews and using qualitative methods of analysis, we find that the psychosocial process of social comparison is relevant for understanding older adults' phase 1 clinical trial participation. Social comparison influences decisions to enroll in a phase 1 clinical trial, shapes perceptions of supportive care needs, and encourages the utilization of hope. Additional research should develop strategies for addressing supportive care needs among this patient cohort whose use of social comparison can inhibit articulation of pain, suffering, and symptom burden as well as use of informal support systems.

  15. Abdominal wall necrotizing fasciitis from dislodged percutaneous endoscopic gastrostomy tubes: a case series.

    Science.gov (United States)

    MacLean, Alexandra A; Miller, George; Bamboat, Zubin M; Hiotis, Karen

    2004-09-01

    We report three cases of abdominal wall necrotizing fasciitis that occurred as a result of leakage from displaced percutaneous endoscopic gastrostomy tubes. This is the first report of such a series. Patients underwent extensive operative excisions of their abdominal walls down to their posterior fascia. All patients tolerated their initial surgery, however, two patients ultimately expired from respiratory complications. The surviving patient underwent multiple repeat debridements and reconstructive abdominal wall surgery. We review the epidemiology of patients at risk for this complication and discuss its presentation, as well as the appropriate workup and management. We also address the issues of closure of large abdominal wall defects and future alimentation in this patient group. Finally, abdominal wall necrotizing faciitis from gastrostomy tube leakage is a devastating complication, and the development of preventative strategies for patients at risk is of paramount importance.

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

    LENUS (Irish Health Repository)

    Fitzmaurice, Gerard J

    2014-04-01

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

  17. Lupus pneumonitis as the initial presentation of systemic lupus erythematosus: case series from a single institution.

    Science.gov (United States)

    Wan, S A; Teh, C L; Jobli, A T

    2016-11-01

    Objective The aim of this study was to examine the clinical features, treatment and outcome of systemic lupus erythematosus (SLE) patients in our centre who presented with lupus pneumonitis as the initial manifestation. Methods We performed a retrospective review of all patients who presented with lupus pneumonitis during the initial SLE manifestation from March 2006 to March 2015. Results There were a total of five patients in our study who presented with fever and cough as the main clinical features. All patients had pulmonary infiltrates on chest radiographs. High-resolution computed tomography, which was performed in two patients, showed ground glass opacities with patchy consolidations bilaterally. All patients received high-dose steroids, 80% received intravenous cyclophosphamide and 60% received intravenous immunoglobulin. Two patients died from severe lupus pneumonitis within 2 weeks of admission despite treatment with ventilation, steroids, cyclophosphamide and intravenous immunoglobulin. Conclusions Acute lupus pneumonitis is an uncommon presentation of SLE. Mortality in this case series is 40%.

  18. Surgical techniques for the treatment of ankyloglossia in children: a case series

    Directory of Open Access Journals (Sweden)

    Marina Azevedo JUNQUEIRA

    2014-06-01

    Full Text Available This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.

  19. Desensitization of triggers and urge reprocessing for pathological gambling: a case series.

    Science.gov (United States)

    Bae, Hwallip; Han, Changwoo; Kim, Daeho

    2015-03-01

    This case series introduces the desensitization of triggers and urge reprocessing (DeTUR), as a promising adjunctive therapy in addition to comprehensive treatment package for pathological gambling. This addiction protocol of eye movement desensitization and reprocessing was delivered to four male inpatients admitted to a 10-week inpatient program for pathological gambling. The therapist gave three 60-min weekly sessions of the DeTUR using bilateral stimulation (horizontal eye movements or alternative tactile stimuli) focusing on the hierarchy of triggering situations and the urge to initiate gambling behaviors. After treatment, self-reported gambling symptoms, depression, anxiety, and impulsiveness were all improved, and all the participants reported satisfaction with the therapy. They were followed up for 6 months and all maintained their abstinence from gambling and their symptomatic improvements. Given the efficiency (i.e., brevity and efficacy) of the treatment, a controlled study to confirm the effects of the DeTUR on pathological gambling would be justified.

  20. Accelerated wound healing with combined NPWT and IPC: a case series.

    Science.gov (United States)

    Arvesen, Kristian; Nielsen, Camilla Bak; Fogh, Karsten

    2017-03-01

    Negative pressure wound therapy (NPWT) and intermittent pneumatic compression (IPC) have traditionally been used in patients with chronic complicated non-healing wounds. The aim of this study (retrospective case series) was to describe the use of NPWT in combination with IPC in patients with a relatively short history (2-6 months) of ulcers. All wounds showed improved healing during the treatment period with marked or moderate reduction in ulcer size, and granulation tissue formation was markedly stimulated. Oedema was markedly reduced due to IPC. Treatment was generally well tolerated. The results of this study indicate that combined NPWT and IPC can accelerate wound healing and reduce oedema, thus shortening the treatment period. Therefore, patients may have a shorter healing period and may avoid entering a chronic wound phase. However, controlled studies of longer duration are needed in order to show the long-term effect of a more accelerated treatment course.

  1. Combined manual therapy techniques for the treatment of women with infertility: a case series.

    Science.gov (United States)

    Kramp, Mary Ellen

    2012-10-01

    Current management options for infertility, including hormone therapy, intrauterine insemination, and in vitro fertilization, tend to be expensive, are not necessarily covered by insurance, and carry different levels of short-term and long-term health risks. Many of the issues that contribute to infertility can be traced to scar tissue, fascial restriction, and lymphatic congestion in the pelvic region. Manual therapy techniques exist to release fascial restrictions, to mobilize tight ligaments, and to drain congested lymphatics, all of which can be applied to the reproductive system. In this case series, 10 infertile women were treated with 1 to 6 sessions of manual therapy applied to the pelvic region. Techniques included muscle energy, lymphatic drainage, and visceral manipulation. Six of the 10 women conceived within 3 months of the last treatment session, and all 6 of those women delivered at full term.

  2. Fine-needle aspiration cytology of subcutaneous cysticercosis: A series of five cases

    Directory of Open Access Journals (Sweden)

    Kusum D Jashnani

    2016-01-01

    Full Text Available Taenia solium, a potentially dangerous parasite, causes human cysticercosis that can cause a gamut of manifestations affecting the various systems of the body. Sometimes, parasitic infestations present as only superficial palpable subcutaneous or intramuscular nodules that are usually mistaken for lymph nodes or benign tumors like lipoma, neurofibroma, or epidermal inclusion cysts. Fine-needle aspiration cytology (FNAC has emerged as a useful tool in the diagnosis of these superficial parasitic lesions. It also helps in avoiding unnecessary open biopsy to obtain a diagnosis. We, herein, report a series of five cases of subcutaneous cysticercosis at different sites (axilla, chest wall, abdominal wall, lateral neck, and cheek misdiagnosed as lipomas and lymph nodes and finally diagnosed on FNAC.

  3. Envenoming following bites by the Balkan adder Vipera berus bosniensis - first documented case series from Bulgaria.

    Science.gov (United States)

    Westerström, Alexander; Petrov, Boyan; Tzankov, Nikolay

    2010-12-01

    We report the first detailed accounts of bites by the Balkan adder, Vipera berus bosniensis from Bulgaria. Documentation of bites by this subspecies is very rare in the literature and most available accounts are from the northern limit of its distribution. V. berus bosniensis is considered to possess neurotoxic venom but little evidence has hitherto been available to support this supposition. In this case series symptoms typical of adder bites developed including oedema, nausea, dizziness, lymphangitis, vomiting, and diarrhoea together with aberrant symptoms such as diplopia and ptosis that confirm the presence of neurotoxic venom in Balkan adders. In addition, unusual and atypical symptoms of adder bites such as painless bites and muscle cramps appeared. The inadequate treatment in hospital and the remote habitats in which this species is encountered are potential sources of complication.

  4. Creeping eruption on the move: A case series from Northern India

    Directory of Open Access Journals (Sweden)

    Sarabjit Kaur

    2015-01-01

    Full Text Available Cutaneous larva migrans (CLM is the most common tropically acquired dermatosis caused by infection with hookworm larvae. It is commonly seen in tropical areas, and in people who have a history of foreign travel and of walking barefoot on sandy soil or beaches. An increased incidence has been seen in non-endemic areas due to change in environmental and behavioral factors. The presence of this entity is questionable in Northern region as the environmental conditions and the type of soil is not favorable, both of which are required for the survival of nematode. We describe a case series of six patients presented during winter season in the outpatient department of Dermatology within a short period of 2 months. We also review the clinical features of various other creeping eruptions and factors that are responsible for boosting infection in North India.

  5. Vertical Ridge Augmentation and Soft Tissue Reconstruction of the Anterior Atrophic Maxillae: A Case Series.

    Science.gov (United States)

    Urban, Istvan A; Monje, Alberto; Wang, Hom-Lay

    2015-01-01

    Severe vertical ridge deficiency in the anterior maxilla represents one of the most challenging clinical scenarios in the bone regeneration arena. As such, a combination of vertical bone augmentation using various biomaterials and soft tissue manipulation is needed to obtain successful outcomes. The present case series describes a novel approach to overcome vertical deficiencies in the anterior atrophied maxillae by using a mixture of autologous and anorganic bovine bone. Soft tissue manipulation including, but not limited to, free soft tissue graft was used to overcome the drawbacks of vertical bone augmentation (eg, loss of vestibular depth and keratinized mucosa). By combining soft and hard tissue grafts, optimum esthetic and long-term implant prosthesis stability can be achieved and sustained.

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

    Directory of Open Access Journals (Sweden)

    Gerard J Fitzmaurice

    2014-01-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  8. Male lupus: a diagnosis often delayed--a case series and review of the literature.

    LENUS (Irish Health Repository)

    Ambrose, N L

    2012-02-01

    INTRODUCTION: Systemic lupus erythematosus (SLE) is an auto-immune disease that is characterised by autoantibody production. Male lupus is rare, apart from at either end of the age spectrum. AIM: In this series, we review the histories of six male lupus patients attending our service. RESULTS: Our patients presented in middle age and tended to develop haematological abnormalities, renal involvement and neurological manifestations which preceded the onset of their skin and joint complaints. Our patients accrued damage rapidly and overall did badly. They tended to respond sub-optimally to standard treatments. These cases highlight the need an increased awareness that male SLE patients present with a wide variety of symptoms, and that they accrue damage quickly. There is a need for timely diagnosis and appropriate initiation of treatment. This may help avoid preventable organ damage and increase the survival of men with SLE.

  9. Oral and periodontal manifestations associated with systemic sclerosis: A case series and review

    Directory of Open Access Journals (Sweden)

    Rekha Jagadish

    2012-01-01

    Full Text Available Systemic sclerosis is a rare connective tissue disorder with a wide range of oral manifestations. This case series reports significant oral and periodontal changes and also makes an attempt to correlate oral and systemic findings in these patients which enable the clinician for a better diagnosis and evolve a comprehensive treatment plan. Six patients with a known diagnosis of systemic sclerosis were included. After obtaining the patient′s informed consent, relevant medical history, oral manifestations including periodontal findings and oral hygiene index simplified index were recorded. In these patients, oral changes included restricted mouth opening and, resorption of the mandible. The periodontal changes observed were gingival recession, absence or minimal gingival bleeding on probing, and widened periodontal ligament space, radiographically. Patients with systemic sclerosis often show wide range of oral manifestations, which is of major concern for the dentist.

  10. Case series utilizing exposure, relaxation, and rescripting therapy: impact on nightmares, sleep quality, and psychological distress.

    Science.gov (United States)

    Davis, Joanne L; Wright, David C

    2005-01-01

    Experiencing a traumatic event may initiate or exacerbate the occurrence of nightmares. Nightmares may impact sleep quality and quantity, posttraumatic stress symptoms, and depression. Recently, imagery rehearsal has gained attention in the treatment of trauma-related nightmares and is reported to be promising in the reduction of nightmares. On the basis of the vast literature describing the therapeutic benefits of exposure techniques for anxiety-related problems, the treatment was modified to enhance the exposure component. This article presents a case series using this modified version of imagery rehearsal, Exposure, Relaxation, and Rescripting Therapy, with 1 male and 3 female participants. Overall, the participants treated reported a reduction in nightmare frequency and severity; 3 out of 4 participants also reported a reduction in posttraumatic stress and depression symptomotology and an increase in sleep quality and quantity. Clinical implications and future research directions are discussed.

  11. Efficacy of topical photodynamic therapy for keratoacanthomas: A case-series of four patients

    Directory of Open Access Journals (Sweden)

    Maria M Farias

    2012-01-01

    Full Text Available Topical photodynamic therapy (PDT is an excellent treatment option for various non-melanoma skin cancers and precancerous lesions, including actinic keratosis, Bowen′s disease, and basal cell carcinoma. The clinical use of PDT includes a broad range of neoplastic, inflammatory, and infectious skin diseases. There is also anecdotal evidence suggesting the efficacy of PDT for the treatment of keratoacanthomas (KA. We report a case-series of four patients with solitary KA confirmed by histology, treated with topical PDT with methylaminolevulinic acid (MAL cream. After three sessions of PDT, the lesions completely disappeared. There was no evidence of recurrence and excellent cosmetic outcome was achieved after three years of follow-up. Topical photodynamic therapy with MAL can be a therapeutic alternative for KA with good clinical and cosmetic outcomes.

  12. Demodex treatment in external ocular disease: the outcomes of a Tasmanian case series.

    Science.gov (United States)

    Nicholls, Stephen G; Oakley, Carmen L; Tan, Andrea; Vote, Brendan J

    2016-10-01

    Demodex species (spp.) have previously been implicated in the pathogenesis of blepharitis. This study aims to correlate improvement in symptoms of external ocular disease with treatment of underlying Demodex spp. This is a prospective, observational case series of patients with chronic external ocular disease. Demodicosis was confirmed by microscopic examination of epilated eyelashes. The main outcome measure was response to the treatment (5 % tee tree oil) in regard to change in subjective symptoms utilising a symptom-based patient questionnaire assessment. Overall patients had a good response to the treatment in terms of improvement or resolution of symptoms, with 91 % of patients reporting at least some improvement in symptoms. The treatment of underlying Demodex spp. appears to result in improvement of symptoms in patients with long standing external ocular disease and underlying Demodex spp. infestation.

  13. Surgical techniques for the treatment of ankyloglossia in children: a case series.

    Science.gov (United States)

    Junqueira, Marina Azevedo; Cunha, Nayara Nery Oliveira; Costa e Silva, Lidiane Lucas; Araújo, Leandro Borges; Moretti, Ana Beatriz Silveira; Couto Filho, Carlos Eduardo Gomes; Sakai, Vivien Thiemy

    2014-06-01

    This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.

  14. Bilateral Vocal Cord Palsy with Arnold Chiari Malformation: A Rare Case Series

    Science.gov (United States)

    Arora, Nikhil; Meher, Ravi; Bhargava, Eishaan K.

    2016-01-01

    Stridor in paediatric age group is not an uncommon presentation to the ENT emergency. The range of differential diagnosis is vast. The presentation may vary from noisy breathing to severe respiratory distress and apnea. Early and meticulous diagnosis is crucial for the management as the condition may be life threatening. We report a rare case series of 3 infants with Arnold Chiari Malformation who presented to the hospital with stridor and were diagnosed with bilateral vocal cord palsy. These 3 infants had similar underlying neurological condition with hydrocephalus and raised intracranial pressure. Chiari malformation is the one of the most common congenital central nervous system anomaly associated with bilateral vocal cord paralysis. However, the presentation is rare. This article, thus, emphasizes the significance of early diagnosis and immediate management of this condition. PMID:27790480

  15. The use of hemospray in portal hypertensive bleeding; a case series.

    Science.gov (United States)

    Smith, L A; Morris, A J; Stanley, A J

    2014-02-01

    Hemospray is a haemostatic agent licensed for endoscopic haemostasis of non-variceal upper gastrointestinal bleeding (NVUGIB) in Europe and Canada. Hemospray has been shown to be safe and effective in achieving haemostasis in bleeding peptic ulcers in a prospective clinical study and several further case series have described the use of hemospray in other non-variceal causes of gastrointestinal bleeding. Portal hypertensive gastropathy and colopathy are common in patients with portal hypertension. As hemospray is an easy to apply, non-contact method, which can cover large areas of mucosa, it may be of benefit in acute non-variceal portal hypertensive bleeding. We present data from the first four consecutive patients presenting to our institution with acute haemorrhage secondary to non-variceal diffuse portal hypertensive bleeding treated with hemospray.

  16. Endoscopic ultrasound guided thrombin injection of angiographically occult pancreatitis associated visceral artery pseudoaneurysms:Case series

    Institute of Scientific and Technical Information of China (English)

    Shivanand; Gamanagatti; Usha; Thingujam; Pramod; Garg; Surajkumar; Nongthombam; Nihar; Ranjan; Dash

    2015-01-01

    Pseudoaneurysm is a known complication of pancreatitis associated with significant mortality and morbidity. Imaging plays an important role in the diagnosis and management. Computed tomography(CT) helps localize the lesion and the severity of the background pancreatitis but digital subtraction angiography with coil embolization is recommended to avoid bleeding and inadvertent surgery. However, in cases where angiographic coil embolization is not feasible due to technical reasons, thrombin injection via CT or ultrasound guidance remains a viable option and often described in literature. In this series, effort has been made to highlight the role of endoscopic ultrasound guided thrombin instillation especially in patients with poorly visualized pseudoaneurysm on ultrasound thereby avoiding surgery and the associated mortality and morbidity.

  17. INDUSTRIAL PRODUCTION IN GERMANY AND AUSTRIA: A CASE STUDY IN STRUCTURAL TIME SERIES MODELLING

    Institute of Scientific and Technical Information of China (English)

    Gerhard THURY

    2003-01-01

    Industrial production series are volatile and often cyclical. Time series models can be used to establish certain stylized facts, such as trends and cycles, which may be present in these series. In certain situations, it is also possible that common factors, which may have an interesting interpretation, can be detected in production series. Series from two neighboring countries with close economic relationships, such as Germany and Austria, are especially likely to exhibit such joint stylized facts.

  18. Radiological findings in cerebral venous thrombosis presenting as subarachnoid hemorrhage: a series of 22 cases

    Energy Technology Data Exchange (ETDEWEB)

    Boukobza, Monique [APHP - Paris-Diderot University, Department of Neuroradiology and Therapeutic Angiography, Assistance publique - University Hospitals Lariboisiere-St-Louis-Fernand-Widal, Paris (France); Crassard, Isabelle; Bousser, Marie-Germaine [Assistance publique - University Hospitals Lariboisiere-St-Louis-Fernand-Widal, APHP - Paris-Diderot University Paris, France, Department of Neurology, Paris (France); Chabriat, Hugues [Assistance publique - University Hospitals Lariboisiere-St-Louis-Fernand-Widal, APHP - Paris-Diderot University Paris, France, Department of Neurology, Paris (France); INSERM UMR 1161 and DHU NeuroVasc, Paris (France)

    2016-01-15

    The main objectives of the present study are to assess the incidence of cerebral venous thrombosis (CVT) presenting as isolated subarachnoid hemorrhage (SAH) and to determine the occurrence of cortical venous thrombosis (CoVT). Among 332 patients with CVT, investigated with the same CT and MR standardized protocol, 33 (10 %) presented with SAH, associated in 11 cases with hemorrhagic infarct or intracerebral hemorrhage. This study is based on 22 cases of CVT presenting as SAH in the absence of hemorrhagic brain lesion. Diagnosis of sinus thrombosis was established on T2* and magnetic resonance venography and that of CoVT on T2* sequence. Diagnostic of SAH was based on fluid-attenuated inversion recovery (FLAIR) sequence. CVT involved lateral sinus in 18 patients, superior sagittal sinus in 16, and straight sinus in 1. Cortical veins were involved in all patients, in continuity with dural sinus thrombosis when present. SAH was circumscribed to few sulci in all cases and mainly localized at the convexity (21 cases). CoVT implied different areas on the same side in four patients and was bilateral in seven. There was no perimesencephalic or basal cisterns hemorrhage. Cortical swelling was present in 12 cases, associated with localized edema. All patients except one had a favorable outcome. This report shows that the incidence of CVT presenting as isolated SAH is evaluated to 6.4 % and that SAH is, in all cases, in the vicinity of CoVT and when dural thrombosis is present in continuity with it. (orig.)

  19. Exertional rhabdomyolysis after spinning: case series and review of the literature.

    Science.gov (United States)

    Ramme, Austin J; Vira, Shaleen; Alaia, Michael J; VAN DE Leuv, Jonathan; Rothberg, Robert C

    2016-06-01

    Spinning is a popular indoor stationary cycling program that uses group classes as a motivational tool. Exertional rhabdomyolysis (ER) is frequently reported in athletes and military recruits; however, infrequently it has been reported after spinning class. ER is diagnosed by clinical history, physical exam, and laboratory values. Hydration, electrolyte management, and pain control are key components to treatment of this condition. Severe cases can be complicated by acute renal failure, compartment syndrome, arrhythmia, and disseminated intravascular coagulation. We describe three cases of admission due to rhabdomyolysis after spinning. The diagnosis, admission criteria, and medical treatment of ER are presented in the context of a literature review. A retrospective review of three cases with review of the current literature. The medical and laboratory records of three patient cases were reviewed. A search of the PubMed database was used to perform a comprehensive review of exertional rhabdomyolysis. Our institution's IRB reviewed this study. We report three cases of exertional rhabdomyolysis after spinning and describe the diagnostic workup and medical management of these patients. The diagnosis of ER is made by clinical history, physical exam, and laboratory values. The disease spectrum ranges from mild to severe with the potential of serious complications in some patients. We demonstrate three cases of ER in deconditioned individuals who presented to the emergency department for evaluation. Careful medical management and patient monitoring resulted in improved patient symptomatology and eventual return to physical activity.

  20. Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients

    Energy Technology Data Exchange (ETDEWEB)

    Ingraham, Christopher R., E-mail: cringra@uw.edu; Padia, Siddharth A., E-mail: spadia@uw.edu; Johnson, Guy E., E-mail: gej@uw.edu [University of Washington, Department of Interventional Radiology (United States); Easterling, Thomas R., E-mail: easter@uw.edu [University of Washington, Department of Obstetrics and Gynecology (United States); Liou, Iris W., E-mail: irisl@medicine.washington.edu [University of Washington, Department of Medicine (United States); Kanal, Kalpana M., E-mail: kkanal@uw.edu [University of Washington, Physics Section, Department of Radiology (United States); Valji, Karim, E-mail: kvalji@uw.edu [University of Washington, Department of Interventional Radiology (United States)

    2015-10-15

    Background and AimsComplications of portal hypertension, such as variceal hemorrhage and ascites, are associated with significant increases in both mortality and complications during pregnancy. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure for treating portal hypertension, but the safety of TIPS during pregnancy is largely unknown. In this series, we review five patients who underwent TIPS placement while pregnant and describe their clinical outcomes.MethodsFive pregnant patients with cirrhosis and portal hypertension underwent elective TIPS for complications of portal hypertension (four for secondary prevention of variceal bleeding and one for refractory ascites). Outcomes measured were recurrent bleeding episodes or need for further paracenteses during pregnancy, estimated radiation dose to the fetus and gestational age at delivery. All patients were followed after delivery to evaluate technical and clinical success of the procedure.ResultsAll five patients survived pregnancy and went on to deliver successfully. When TIPS was performed for secondary prevention of variceal bleeding (n = 4), no patients demonstrated variceal bleeding after TIPS placement. When TIPS was performed for refractory ascites (n = 1), no further paracenteses were required. All patients delivered successfully, albeit prematurely. Average radiation dose estimated to the fetus was 16.3 mGy.ConclusionsThis series suggests that TIPS can be performed in selective pregnant patients with portal hypertension, with little added risk to the mother or fetus.

  1. Central nervous system infections masquerading as cerebrovascular accidents: Case series and review of literature

    Directory of Open Access Journals (Sweden)

    Lisa Hayes

    2014-01-01

    Conclusion: The cases described demonstrate that CNS infections need to be considered in the differential diagnosis of CVAs presenting with fevers. The signs and symptoms of non-CNS infections associated with CVAs may be clinically indistinguishable from those of CNS infections. The outcomes of untreated CNS infections are extremely poor. It is thus imperative to have a high index of suspicion for CNS infection when evaluating CVAs with fevers or other signs of infection.

  2. TVOntario's Substance Abuse Series: Dealing with Drugs and Chemical Solutions. A Summative Evaluation. Report No. 19-1991-1992.

    Science.gov (United States)

    Filson, Gerald W.

    A summative evaluation of the two TVOntario series, Dealing with Drugs and Chemical Solutions was carried out in the April-to-June 1991 period. Classes (N=23) were recruited for the intermediate and senior grade level study, which included more than 550 students. The intermediate series, Dealing with Drugs, designed for grade 7 and 8 students,…

  3. Treatment of hypergranulation tissue in burn wounds with topical steroid dressings: a case series

    Directory of Open Access Journals (Sweden)

    Jaeger M

    2016-08-01

    Full Text Available Marie Jaeger,1,* Moti Harats,1,* Rachel Kornhaber,2 Uri Aviv,1 Amir Zerach,1 Josef Haik1,3 1Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel; 2School of Health Sciences, Faculty of Health, University of Tasmania, Sydney, NSW, Australia; 3Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel *These authors contributed equally to this work. Abstract: Hypergranulation tissue (or also known as overgranulation may negatively influence burn wound healing time and contribute to recurrence of contractures in burn wounds and grafts. Subsequently, the treatment of hypergranulation tissue remains controversial and problematic. In this case series, we aimed to examine the feasibility and document the use of topical hydrocortisone in the treatment of hypergranulation tissue formation resulting from burn wounds. We report five cases where hypergranulation tissue developed following deep dermal/full-thickness burns. Initial burn wound treatment included necrotic tissue debridement, wound cleansing, and Flaminal®. All five cases underwent surgical debridement and split-skin ­grafting. Upon identification of hypergranulation tissue, hydrocortisone acetate 0.25% was applied ­topically as usual care for the treatment of hypergranulation tissue. All five patients had deep dermal/full-thickness burns with a total body surface area ranging from 22% to 61% and were aged from 3–41 years. All five cases developed hypergranulation tissue during their admission after debridement and split-thickness skin grafts. All patients showed an improvement in the treated areas with a complete regression of hypergranulation tissue and closure of the burn wounds. No clinically apparent local or systemic side effects of the treatment were observed. Topical hydrocortisone can be utilized as an effective, inexpensive, and noninvasive practical option in the treatment of hypergranulation tissue resulting from burn wounds

  4. Clinical and laboratory description of a series of cases of acute viral myositis

    Directory of Open Access Journals (Sweden)

    Silvana Paula Cardin

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVE: Describe the clinical and laboratory profile, follow-up, and outcome of a series of cases of acute viral myositis. METHOD: A retrospective analysis of suspected cases under observation in the emergency department was performed, including outpatient follow-up with the recording of respiratory infection and musculoskeletal symptoms, measurement of muscle enzymes, creatine phosphokinase (CPK, lactate dehydrogenase (LDH, transaminases (AST and ALT, blood count, C-reactive protein, and erythrocyte sedimentation rate in the acute phase and during follow-up until normalization. RESULTS: Between 2000 and 2009, 42 suspected cases were identified and 35 (27 boys were included. The median age was 7 years and the diagnosis was reported in 89% in the first emergency visit. The observed respiratory symptoms were cough (31%, rhinorrhea (23%, and fever (63%, with a mean duration of 4.3 days. Musculoskeletal symptoms were localized pain in the calves (80%, limited ambulation (57%, gait abnormality (40%, and muscle weakness in the lower limbs (71%, with a mean duration of 3.6 days. There was significant increase in CPK enzymes (5507 ± 9180 U/L, LDH (827 ± 598 U/L, and AST (199 ± 245 U/L, with a tendency to leukopenia (4590 ± 1420 leukocytes/mm3. The complete recovery of laboratory parameters was observed in 30 days (median, and laboratory and clinical recurrence was documented in one case after 10 months. CONCLUSION: Typical symptoms with increased muscle enzymes after diagnosis of influenza and self-limited course of the disease were the clues to the diagnosis. The increase in muscle enzymes indicate transient myotropic activity related to seasonal influenza, which should be considered, regardless of the viral identification, possibly associated with influenza virus or other respiratory viruses.

  5. The clinical psychologist and the management of inpatient pain: a small case series

    Science.gov (United States)

    Childs, Susan R; Casely, Emma M; Kuehler, Bianca M; Ward, Stephen; Halmshaw, Charlotte L; Thomas, Sarah E; Goodall, Ian D; Bantel, Carsten

    2014-01-01

    Recent research has confirmed that between 25% and 33% of all hospitalized patients experience unacceptable levels of pain. Studies further indicate that this reduces patient satisfaction levels, lengthens hospital stays, and increases cost. Hospitals are aiming to discharge patients earlier, and this can interfere with adequate pain management. Therefore, the pain service at Chelsea and Westminster Hospital has adapted to this changing model of care. An increasing body of evidence demonstrates that psychological factors are key components of patients’ pain experiences in both acute and chronic pain. Therefore, it is reasonable to suggest a clinical psychologist should be involved in inpatient pain management. This small study discusses three cases that highlight how patient care could be improved by including a clinical psychologist as part of the inpatient pain team. Two cases particularly highlight the active role of the psychologist in the diagnosis and management of common conditions such as fear and anxiety, along with other psychiatric comorbidities. The management therefore employed an eclectic approach adapted from chronic pain and comprising of behavioral, cognitive behavioral, and dialectical behavioral therapeutic techniques blended with brief counseling. The third case exemplifies the importance of nurse-patient interactions and the quality of nurse-patient relationships on patient outcomes. Here, the psychologist helped to optimize communication and to resolve a difficult and potentially risk-laden situation. This small case series discusses the benefits derived from the involvement of a clinical psychologist in the management of inpatient pain, and therefore illustrates the need for novel initiatives for inpatient pain services. However, future research is warranted to validate this approach. PMID:25506221

  6. Low-dose Amisulpride for Debilitating Clozapine-induced Sialorrhea: Case Series and Review of Literature.

    Science.gov (United States)

    Kulkarni, Ranganath R

    2015-01-01

    Clozapine-induced sialorrhea (CIS) affects about one-third of patients treated with clozapine, at times can be stigmatizing, socially embarrassing, disabling, affect quality-of-life, cause poor compliance and can be potentially life-threatening adverse effect. Prompt and effective treatment of CIS may assist treatment tolerability, adherence, and better outcomes in patients with treatment nonresponsive schizophrenia. The beneficial effect of amisulpride augmentation of clozapine therapy for such patients may be enhanced by its anti-salivatory effect on CIS. Current series of five subjects who developed CIS that responded poorly to anticholinergic drugs found drastic improvement in daytime and nocturnal CIS with very low-dose (50-100 mg/day) of amisulpride. Low-dose amisulpride augmentation may also provide strong ameliorating effect on CIS. Nevertheless, a long-term, large-scale study with a broader dose range is warranted to evaluate the stability of this effect across time.

  7. Low-dose amisulpride for debilitating clozapine-induced sialorrhea: Case series and review of literature

    Directory of Open Access Journals (Sweden)

    Ranganath R Kulkarni

    2015-01-01

    Full Text Available Clozapine-induced sialorrhea (CIS affects about one-third of patients treated with clozapine, at times can be stigmatizing, socially embarrassing, disabling, affect quality-of-life, cause poor compliance and can be potentially life-threatening adverse effect. Prompt and effective treatment of CIS may assist treatment tolerability, adherence, and better outcomes in patients with treatment nonresponsive schizophrenia. The beneficial effect of amisulpride augmentation of clozapine therapy for such patients may be enhanced by its anti-salivatory effect on CIS. Current series of five subjects who developed CIS that responded poorly to anticholinergic drugs found drastic improvement in daytime and nocturnal CIS with very low-dose (50-100 mg/day of amisulpride. Low-dose amisulpride augmentation may also provide strong ameliorating effect on CIS. Nevertheless, a long-term, large-scale study with a broader dose range is warranted to evaluate the stability of this effect across time.

  8. Cognition in a multiple system atrophy series of cases from Argentina

    Directory of Open Access Journals (Sweden)

    Emilia Gatto

    2014-10-01

    Full Text Available Cognitive dysfunction may occur in 17-40% of patients with multiple system atrophy (MSA. It has been suggested a milder cognitive impairment in cerebellar (MSA-C than in parkinsonian variant (MSA-P. However, differences in cognitive profiles remain under discussion. Objective To evaluate cognitive features in a series of patients with “probable MSA” from Argentina. Method After informed consent was obtained, an extensive cognitive tests battery was administered. Nine patients (6 MSA-P and 3 MSA-C composed the sample. Results Depression was detected in 43% of patients. Seven patients showed at least one cognitive domain impairment. Temporospatial orientation, visuospatial abilities, executive and attentional functions, episodic memory and language were compromised in MSA-P, while MSA-C dysfunction was restricted to attentional and executive domains. Conclusion Despite the small sample size, our findings could suggest a more widespread cognitive impairment in MSA-P than MSA-C.

  9. Static winging of the scapula caused by osteochondroma in adults: a case series

    Directory of Open Access Journals (Sweden)

    Orth Patrick

    2012-10-01

    Full Text Available Abstract Introduction Although palsy of the long thoracic nerve is the classical pathogenesis of winging scapula, it may also be caused by osteochondroma. This rare etiopathology has previously been described in pediatric patients, but it is seldom observed in adults. Case presentation We describe three cases of static scapular winging with pain on movement. Case 1 is a Caucasian woman aged 35 years with a wing-like prominence of the medial margin of her right scapula due to an osteochondroma originating from the ventral omoplate. Histopathological evaluation after surgical resection confirmed the diagnosis. The postoperative course was unremarkable without signs of recurrence on examination at 2 years. Case 2 is a Caucasian woman aged 39 years with painful scapula alata and neuralgic pain projected along the left ribcage caused by an osteochondroma of the left scapula with contact to the 2nd and 3rd rib. Following surgical resection, the neuropathic pain continued, demanding neurolysis of the 3rd and 4th intercostal nerve after 8 months. The patient was free of symptoms 2 years after neurolysis. Case 3 is a Caucasian woman aged 48 years with scapular winging due to a large exostosis of the left ventral scapular surface with a broad cartilaginous cap and a large pseudobursa. Following exclusion of malignancy by an incisional biopsy, exostosis and pseudobursa were resected. The patient had an unremarkable postoperative course without signs of recurrence 1 year postoperatively. Based on these cases, we developed an algorithm for the diagnostic evaluation and therapeutic management of scapula alata due to osteochondroma. Conclusions Orthopedic surgeons should be aware of this uncommon condition in the differential diagnosis of winged scapula not only in children, but also in adult patients.

  10. Paracetamol in therapeutic dosages and acute liver injury: causality assessment in a prospective case series

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    Castellote José

    2011-07-01

    Full Text Available Abstract Background Acute liver injury (ALI induced by paracetamol overdose is a well known cause of emergency hospital admission and death. However, there is debate regarding the risk of ALI after therapeutic dosages of the drug. The aim is to describe the characteristics of patients admitted to hospital with jaundice who had previous exposure to therapeutic doses of paracetamol. An assessment of the causality role of paracetamol was performed in each case. Methods Based on the evaluation of prospectively gathered cases of ALI with detailed clinical information, thirty-two cases of ALI in non-alcoholic patients exposed to therapeutic doses of paracetamol were identified. Two authors assessed all drug exposures by using the CIOMS/RUCAM scale. Each case was classified into one of five categories based on the causality score for paracetamol. Results In four cases the role of paracetamol was judged to be unrelated, in two unlikely, and these were excluded from evaluation. In seven of the remaining 26 cases, the RUCAM score associated with paracetamol was higher than that associated with other concomitant medications. The estimated incidence of ALI related to the use of paracetamol in therapeutic dosages was 0.4 per million inhabitants older than 15 years of age and per year (99%CI, 0.2-0.8 and of 10 per million paracetamol users-year (95% CI 4.3-19.4. Conclusions Our results indicate that paracetamol in therapeutic dosages may be considered in the causality assessment in non-alcoholic patients with liver injury, even if the estimated incidence of ALI related to paracetamol appears to be low.

  11. Renal involvement in MELAS syndrome - a series of 5 cases and review of the literature.

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    Seidowsky, Alexandre; Hoffmann, Maxime; Glowacki, François; Dhaenens, Claire-Marie; Devaux, Jean-Philippe; de Sainte Foy, Celia Lessore; Provot, François; Gheerbrant, Jean-Dominique; Hummel, Aurelie; Hazzan, Marc; Dracon, Michel; Dieux-Coeslier, Anne; Copin, Marie-Christine; Noël, Christian; Buob, David

    2013-12-01

    Renal dysfunction is increasingly recognized as a potential clinical feature of mitochondrial cytopathies such as mitochondrial encephalomyopathy, lacticacidosis and stroke-like episodes (MELAS) syndrome. Five cases of MELAS syndrome with renal involvement from 4 unrelated families are presented in this case series. Three of the 5 patients had a history of maternally-inherited diabetes and/or deafness. Focal and segmental glomerulosclerosis and arteriolar hyaline thickening were the most striking findings on renal biopsy. In addition to clinical presentation with the typical symptoms of MELAS syndrome, genetic testing in these patients identified the A3243G point mutation in the tRNALeu gene of the mitochondrial DNA (mtDNA). The diagnosis of MELAS syndrome was thus considered to be unequivocal. The incidence of kidney disease in MELAS syndrome may be underestimated although a study is required to investigate this hypothesis. As the A3243G mtDNA mutation leads to a progressive adult-onset form of focal segmental glomerulosclerosis (FSGS), screening for the MELAS A3243G mtDNA mutation should therefore be performed especially in patients with maternally-inherited diabetes or hearing loss presenting with FSGS.

  12. Cardiac myxoma in Iceland: a case series with an estimation of population incidence.

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    Sigurjonsson, Hannes; Andersen, Karl; Gardarsdottir, Marianna; Petursdottir, Vigdis; Klemenzson, Gudmundur; Gunnarsson, Gunnar; Danielsen, Ragnar; Gudbjartsson, Tomas

    2011-09-01

    Cardiac myxoma (CM) is the most common primary benign tumor of the heart, but the true age-standardized incidence rate (ASR) has remained unknown. We therefore used nationwide registries in Iceland to study CM and establish its incidence rate. This was a retrospective study involving all patients diagnosed with CM in Iceland between 1986 and 2010. Cases were identified through three different registries, and hospital charts and histology results reviewed. An ASR was estimated based on a world standard population (w). Nine cases of CM (six women) were identified with a mean age of 62.8 years (range: 37-85), giving an ASR of 0.11 (95% CI: 0.05-0.22) per 100,000. The mean tumor size was 4.4 cm (range: 1.5-8.0) with all the tumors located in the left atrium. Dyspnea (n = 6) and ischemic stroke (n = 2) were the most common symptoms. All patients underwent complete resection of the tumor and there were no postoperative deaths or CM-related deaths at follow-up (mean 85 months). The ASR of CM in Iceland was 0.11 per 100,000. To our knowledge, this is the first study to determine the incidence of CM in an entire population. In Iceland, the presenting symptoms and mode of detection of CM are similar to those in other series.

  13. Labour exploitation and health: a case series of men and women seeking post-trafficking services.

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    Turner-Moss, Eleanor; Zimmerman, Cathy; Howard, Louise M; Oram, Siân

    2014-06-01

    Research on the health of trafficked men and on the health problems associated with trafficking for labor exploitation are extremely limited. This study analysed data from a case series of anonymised case records of a consecutive sample of 35 men and women who had been trafficked for labor exploitation in the UK and who were receiving support from a non-governmental service between June 2009 and July 2010. Over three-quarters of our sample was male (77 %) and two-thirds aged between 18 and 35 years (mean 32.9 years, SD 10.2). Forty percent reported experiencing physical violence while they were trafficked. Eighty-one percent (25/31) reported one or more physical health symptoms. Fifty-seven percent (17/30) reported one or more post-traumatic stress symptoms. A substantial proportion of men and women who are trafficked for labor exploitation may experience violence and abuse, and have physical and mental health symptoms. People who have been trafficked for forced labor need access to medical assessment and treatment.

  14. Concha bullosa mucocele: A case series and review of the literature

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    Khalife, Sarah; Marchica, Cinzia; Zawawi, Faisal; Daniel, Sam J.; Manoukian, John J.

    2016-01-01

    Background: Concha bullosa mucocele is a rare diagnosis that presents as a nasal mass. It impinges on surrounding structures and can easily be mistaken for a neoplasm. Objective: The objective of this study was to shed light on this rare entity and report its diagnostic features and treatment outcomes. Methods: A case series conducted in a tertiary health care center. Demographic data, clinical presentation, imaging, cultures, and treatments were recorded. Operative video illustration and key images were obtained. A review of the literature was also performed. Results: A total of five cases were reviewed, four of which were concha bullosa mucoceles and one was a mucopyocele. Three of the patients had some form of previous nasal trauma. Headache and nasal obstruction were the most common symptoms with a nasal mass finding on physical examination. Computed tomography was used in all the patients, and magnetic resonance imaging was used in four of the five patients. Four patients had coexistent chronic rhinosinusitis, and three had positive bacterial cultures. All these patients were treated endoscopically either with middle turbinate marsupialization or subtotal resection. No recurrence has been noted thus far. Conclusion: Concha bullosa mucocele is a rare diagnosis. Imaging characteristics are helpful in considering the diagnosis, although surgical intervention is often necessary to confirm the diagnosis and treat concha bullosa mucocele.

  15. Pediatric seizure-related posttraumatic stress and anxiety symptoms treated with EMDR: a case series

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    Elmedina Dautovic

    2016-07-01

    Full Text Available Purpose: To examine the potential effects of eye movement desensitization and reprocessing (EMDR in children with epilepsy-related posttraumatic stress and/or anxiety symptoms, using a case series design. Methods: Five children (aged 8–18 with epilepsy identified for seizure-related posttraumatic stress and/or anxiety symptoms were treated with EMDR. To examine potential treatment effects, posttraumatic stress and anxiety symptoms were assessed (CRTI and SCARED pre- and post-EMDR and at 3-month follow-up. Normative deviation scores were calculated to examine the severity of seizure-related posttraumatic stress and anxiety symptoms over time. The reliable change index was calculated for pre- to posttreatment change of seizure-related posttraumatic stress and/or anxiety symptoms. Results: Before EMDR, overall or subscale scores indicated that all children had (subclinical seizure-related posttraumatic stress symptoms and/or anxiety symptoms. Directly after EMDR, most children showed significant and/or clinical individual improvement, and these beneficial effects were maintained or reached at follow-up. The mean number of sessions was 2 (range 1–3, 45 min per session. Conclusions: In case of seizure-related posttraumatic stress and/or anxiety, this study indicates that EMDR is a potentially successful quick and safe psychological treatment for children with epilepsy.

  16. Adolescent Premature Ovarian Insufficiency Following Human Papillomavirus Vaccination: A Case Series Seen in General Practice.

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    Little, Deirdre Therese; Ward, Harvey Rodrick Grenville

    2014-01-01

    Three young women who developed premature ovarian insufficiency following quadrivalent human papillomavirus (HPV) vaccination presented to a general practitioner in rural New South Wales, Australia. The unrelated girls were aged 16, 16, and 18 years at diagnosis. Each had received HPV vaccinations prior to the onset of ovarian decline. Vaccinations had been administered in different regions of the state of New South Wales and the 3 girls lived in different towns in that state. Each had been prescribed the oral contraceptive pill to treat menstrual cycle abnormalities prior to investigation and diagnosis. Vaccine research does not present an ovary histology report of tested rats but does present a testicular histology report. Enduring ovarian capacity and duration of function following vaccination is unresearched in preclinical studies, clinical and postlicensure studies. Postmarketing surveillance does not accurately represent diagnoses in adverse event notifications and can neither represent unnotified cases nor compare incident statistics with vaccine course administration rates. The potential significance of a case series of adolescents with idiopathic premature ovarian insufficiency following HPV vaccination presenting to a general practice warrants further research. Preservation of reproductive health is a primary concern in the recipient target group. Since this group includes all prepubertal and pubertal young women, demonstration of ongoing, uncompromised safety for the ovary is urgently required. This matter needs to be resolved for the purposes of population health and public vaccine confidence.

  17. Palliative and Supportive Care in Acrometastasis to the Hand: Case Series

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    Narendra Kumar

    2011-01-01

    Full Text Available Acrometastasis to the hand is an unusual presentation which might mimic an infectious, inflammatory, or a metabolic pathology. We herein describe a case series of three patients of acrometastasis to the hand. We encountered three cases of acrometastasis to the hand attending the departmental clinics from 2007 to 2010. The median age at presentation was noted to be 55 years. All were males. The primaries included squamous cell carcinoma of the skin, larynx, and esophagus. In two patients, acrometastasis was detected at presentation and in one it was detected 2 years postcompletion of radical therapy. Two patients were offered palliative radiation to acrometastasis, and best supportive care was given to one. Palliation achieved after radiation was noted to be modest to good. The brief report highlights the importance of the clinical awareness of metastatic dissemination to unusual sites in the face of increasing cancer survivorship. Acrometastasis portends a poor prognosis with limited survival, and optimal integration of the best supportive care is mandatory. A short course of hypofractionated palliative radiation therapy results in modest to good palliation.

  18. Klatskin-mimicking lesions--a case series and literature review.

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    Dumitrascu, Traian; Ionescu, Mihnea; Ciurea, Silviu; Herlea, Vlad; Lupescu, Ioana; Popescu, Irinel

    2010-01-01

    Obstruction of the hepatic hilum in patients without prior surgery is generally due to hilar adenocarcinoma (Klatskin tumor). However, not all the hilar strictures are malignant. Although uncommon, benign strictures of the proximal bile duct should be taken into consideration in differential diagnosis of Klatskin tumors, since the incidence could reach up to 25% of patients with presumed Klatskin tumor diagnosis. This group of benign proximal bile duct strictures (Klatskin-mimicking lesions) is usually represented by segmental fibrosis and non-specific chronic inflammation. The clinical and imaging features can not differentiate between benign and malignant strictures. Herein, we present a case series of three patients with benign proximal bile duct strictures (representing 4.1% of 73 patients resected with presumptive preoperative diagnosis of Klatskin tumor) and literature review. There are presented the clinical and biochemical features, imaging preoperative workup, surgical treatment and histological analysis of the specimen, along with postoperative outcome. For benign strictures of the hilum limited resections are curative. However, despite new diagnosis tools developed in the last years, patients with hilar obstructions still require unnecessary extensive resections due to impossibility of excluding the malignancy. In all cases of proximal bile duct obstruction presumed malignant, they should be managed accordingly, even with the risk of over-treatment for some benign lesions.

  19. TRAUMATIC HIP DISLOCATION IN CHILDREN YOUNGER THAN 3 YEARS : A SERIES OF 3 CASES

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    Navin

    2015-03-01

    Full Text Available The musculoskeletal anatomy of children is qui te different from that of adults. The capsule, periosteum and other soft tissues surrounding the joints is very pliable and dislocations can occur even following trivial injuries . However dislocation occurring in a child population is a rare entity. There are a few case reports of hip dislocations in children < 3 years. We present here a series of 3 cases of paediatric hip dislocations which presented to us for management. The age of the children were between 24 - 27 months. Incidentally all 3 patients were b oys and all 3 were right sided dislocations. None of them had any associated fractures. Two of them had a fall from height and one child fell off a slide. All 3 patients presented within 5 hours following injury. Closed reduction under anaesthesia was perf ormed and post reduction the children were immobilized in a broom - stick plaster for 6 weeks. All children were followed up with serial x - rays and a MRI done immediately following reduction then at 6 and 18 months. There was no evidence of chondrolysis or a vascular necrosis in any of the children at the last follow - up. They all had full range of movements with no limitation of function. We conclude that with early recognition and early reduction of the hip within the golden period (6 hours the occurrence of complications can be prevented.

  20. Prevention of postoperative recurrence of Crohn's disease by Adalimumab: a case series.

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    Savarino, Edoardo; Dulbecco, Pietro; Bodini, Giorgia; Assandri, Lorenzo; Savarino, Vincenzo

    2012-04-01

    Adalimumab, an anti-TNF-α monoclonal antibody, was found to be effective for the treatment of luminal Crohn's disease (CD), but its efficacy for the prevention of postoperative recurrence of CD is still unknown. Here, we present a case series of six patients who underwent resection for an ileocecal stricture caused by CD. Surgery removed the involved ileocolon, and pathology confirmed the presence of a fibrotic stricture. Two weeks after the operation, they were given Adalimumab at the dose of 160/80/40 mg every 2 weeks and were followed up. Since then, they have been disease-free for ≈ 3 years after surgery on clinical, radiological, and endoscopic/histological grounds (Crohn's Disease Activity Index ≤ 110 in all occasions). Up to now, they have had no anemia, no increase in inflammatory indices, and no abnormal blood tests. These are the first cases, to our knowledge, in which Adalimumab has been successfully used to prevent the postsurgical recurrence of CD, an event so far considered to be mandatory. Further large placebo-controlled studies are necessary to show the therapeutic advantage and the economic implications of these observations.

  1. A multi-modal treatment approach for the shoulder: A 4 patient case series

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    Pollard Henry

    2005-09-01

    Full Text Available Abstract Background This paper describes the clinical management of four cases of shoulder impingement syndrome using a conservative multimodal treatment approach. Clinical Features Four patients presented to a chiropractic clinic with chronic shoulder pain, tenderness in the shoulder region and a limited range of motion with pain and catching. After physical and orthopaedic examination a clinical diagnosis of shoulder impingement syndrome was reached. The four patients were admitted to a multi-modal treatment protocol including soft tissue therapy (ischaemic pressure and cross-friction massage, 7 minutes of phonophoresis (driving of medication into tissue with ultrasound with 1% cortisone cream, diversified spinal and peripheral joint manipulation and rotator cuff and shoulder girdle muscle exercises. The outcome measures for the study were subjective/objective visual analogue pain scales (VAS, range of motion (goniometer and return to normal daily, work and sporting activities. All four subjects at the end of the treatment protocol were symptom free with all outcome measures being normal. At 1 month follow up all patients continued to be symptom free with full range of motion and complete return to normal daily activities. Conclusion This case series demonstrates the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with a suspected clinical diagnosis of shoulder impingement syndrome.

  2. TARDIVE DYSKINESIA AND OTHER EXTRAPYRAMIDAL SYMPTOMS ASSOCIATED WITH ARIPIPRAZOLE: A CASE SERIES

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    Nayana Sanjay

    2016-06-01

    Full Text Available BACKGROUND Aripiprazole is a third generation antipsychotic introduced in 2004 for treatment of Schizophrenia and bipolar disorders. It has partial agonist activity at dopamine D2 receptor and D2 antagonist activity under hyperdopaminergic condition. In addition, it is a partial agonist at serotonin 5HT1A receptor and antagonist at 5HT2A receptor. Because its pharmacological profile differs from other atypical antipsychotics, it was initially thought to produce lesser side effects and movement disorders. But over the years, there is a growing body of evidence in the form of case reports and case series of Aripiprazole induced movement disorders like Tardive dyskinesia, Parkinsonism, akathisia and dystonia. Of late it has been advocated for irritability associated with autism and as an augmenter for depressive disorder. It has lower potential for weight gain and sedation, as it has relatively low affinity for H1 [Histamine] receptor compared to clozapine, olanzapine and quetiapine. Based on this unique mechanism, it is claimed to have minimal or non-significant motor side effects like Tardive dyskinesia. We document a case series of 8 patients who developed Tardive dyskinesia, Parkinsonism and akathisia following treatment with Aripiprazole (ARP. METHODS This is both retrospective and observational study. Patients from outpatient and inpatient department of a tertiary psychiatric teaching hospital with an ICD-10 diagnosis of psychiatric disorder, who has experienced movement disorder while on treatment with Aripiprazole are included in this report. All these patients were under the care of authors as treating Psychiatrists. Rating scales like Abnormal Involuntary Movement Scale (AIMS, Naranjo’s Causality Scale, Barnes Akathisia Rating Scale (BARS and Simpson Angus extrapyramidal Scale (SAS were used. RESULTS Total of eight patients presented with various movement disorders associated with Aripiprazole, out of which three patients with tardive

  3. Rickets: case series and diagnostic review of hypovitaminosis D in swine.

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    Madson, Darin M; Ensley, Steve M; Gauger, Phil C; Schwartz, Kent J; Stevenson, Greg W; Cooper, Vickie L; Janke, Bruce H; Burrough, Eric R; Goff, Jesse P; Horst, Ronald L

    2012-11-01

    Rickets can be attributed to nutritional, genetic, hormonal, or toxic disturbances and is classified as a metabolic bone disease. Rickets is most often associated with inappropriate dietary levels of calcium, phosphorus, and/or vitamin D. During a 27-month period (January 2010 through March 2012), the Iowa State University Veterinary Diagnostic Laboratory investigated causes of sudden, unexpected death and lameness in growing pigs throughout the Midwestern United States. Clinical observations from 17 growing pig cases included weakness, lameness, reluctance to move, muscle fasciculations and/or tremors, tetany, and death. Ribs were weak, soft, and bent prior to breaking; rachitic lesions were apparent at costochondral junctions in multiple cases. Acute and/or chronic bone fractures were also noted in multiple bones. Failure of endochondral ossification, expanded physes, infractions, thin trabeculae, and increased osteoclasts were noted microscopically. Decreased bone ash and serum 25(OH)D(3), combined with clinical and microscopic evaluation, confirmed a diagnosis of vitamin D-dependent rickets in all cases. In 3 cases, disease was linked to a specific nutrient supplier that ultimately resulted in a voluntary feed recall; however, most cases in the current investigation were not associated with a particular feed company. The present report describes vitamin D-associated rickets and its importance as a potential cause of weakness, lameness, muscle fasciculations, recumbency or sudden unexpected death in swine, and describes appropriate samples and tests for disease diagnosis.

  4. Percutaneous nephrolithotomy in horseshoe Kidneys: is rigid nephroscopy sufficient tool for complete clearance? a case series study

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    Shaban Ahmed M

    2009-11-01

    Full Text Available Abstract Background this study represents a case series to evaluate how successful is the rigid percutaneous nephroscopy as a tool for clearance of all stones in various locations in horseshoe kidneys. Methods Between 2005 and 2009, we carried out PCNL (percutaneous nephrolithotomy for calculi in horseshoe kidneys in 21 renal units (17 patients in our department. The indications were large stone burden in 18 units and failed SWL(shock wave lithotripsy in 3 renal units. All procedures were done under general anesthesia; using fluoroscopic guidance for localization and standard alkan dilatation followed by rigid nephroscopy and stone extraction with or without stone disintegration. We analyzed our results regarding the site and number of the required access, the intra and postoperative complications, the presence of any residual stones, as well as their location. Results The procedure was completed, using a single access tract in 20 renal units, with the site of puncture being the upper calyx in nine units and the posterior middle calyx in eleven units. Only in one renal unit, two access tracts (an upper and a lower calyceal were required for completion and a supracostal puncture was required in another case. There was no significant intraoperative bleeding and no blood transfusion was required in any patient. A pelvic perforation occurred in one case, requiring longer PCN (percutaneous nephrostomy drainage. One patient with infection stones suffered urosepsis postoperatively which was successfully managed. Three cases had residual stones, all located in the renal isthmus, all residuals were un approachable with the rigid instrument; resulting in a overall stone-free rate of 85.7% at discharge. Conclusion Percutaneous nephrolithotomy is generally safe and successful in the management of stones in horseshoe kidneys. However, location of the stones in these patients is crucial to decide the proper tool for optimal stone clearance result.

  5. Evaluation of Pleistocene groundwater flow through fractured tuffs using a U-series disequilibrium approach, Pahute Mesa, Nevada, USA

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    Paces, James B.; Nichols, Paul J.; Neymark, Leonid A.; Rajaram, Harihar

    2013-01-01

    Groundwater flow through fractured felsic tuffs and lavas at the Nevada National Security Site represents the most likely mechanism for transport of radionuclides away from underground nuclear tests at Pahute Mesa. To help evaluate fracture flow and matrix–water exchange, we have determined U-series isotopic compositions on more than 40 drill core samples from 5 boreholes that represent discrete fracture surfaces, breccia zones, and interiors of unfractured core. The U-series approach relies on the disruption of radioactive secular equilibrium between isotopes in the uranium-series decay chain due to preferential mobilization of 234U relative to 238U, and U relative to Th. Samples from discrete fractures were obtained by milling fracture surfaces containing thin secondary mineral coatings of clays, silica, Fe–Mn oxyhydroxides, and zeolite. Intact core interiors and breccia fragments were sampled in bulk. In addition, profiles of rock matrix extending 15 to 44 mm away from several fractures that show evidence of recent flow were analyzed to investigate the extent of fracture/matrix water exchange. Samples of rock matrix have 234U/238U and 230Th/238U activity ratios (AR) closest to radioactive secular equilibrium indicating only small amounts of groundwater penetrated unfractured matrix. Greater U mobility was observed in welded-tuff matrix with elevated porosity and in zeolitized bedded tuff. Samples of brecciated core were also in secular equilibrium implying a lack of long-range hydraulic connectivity in these cases. Samples of discrete fracture surfaces typically, but not always, were in radioactive disequilibrium. Many fractures had isotopic compositions plotting near the 230Th-234U 1:1 line indicating a steady-state balance between U input and removal along with radioactive decay. Numerical simulations of U-series isotope evolution indicate that 0.5 to 1 million years are required to reach steady-state compositions. Once attained, disequilibrium 234U/238U

  6. International benchmarking of specialty hospitals. A series of case studies on comprehensive cancer centres

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    van Lent Wineke AM

    2010-08-01

    Full Text Available Abstract Background Benchmarking is one of the methods used in business that is applied to hospitals to improve the management of their operations. International comparison between hospitals can explain performance differences. As there is a trend towards specialization of hospitals, this study examines the benchmarking process and the success factors of benchmarking in international specialized cancer centres. Methods Three independent international benchmarking studies on operations management in cancer centres were conducted. The first study included three comprehensive cancer centres (CCC, three chemotherapy day units (CDU were involved in the second study and four radiotherapy departments were included in the final study. Per multiple case study a research protocol was used to structure the benchmarking process. After reviewing the multiple case studies, the resulting description was used to study the research objectives. Results We adapted and evaluated existing benchmarking processes through formalizing stakeholder involvement and verifying the comparability of the partners. We also devised a framework to structure the indicators to produce a coherent indicator set and better improvement suggestions. Evaluating the feasibility of benchmarking as a tool to improve hospital processes led to mixed results. Case study 1 resulted in general recommendations for the organizations involved. In case study 2, the combination of benchmarking and lean management led in one CDU to a 24% increase in bed utilization and a 12% increase in productivity. Three radiotherapy departments of case study 3, were considering implementing the recommendations. Additionally, success factors, such as a well-defined and small project scope, partner selection based on clear criteria, stakeholder involvement, simple and well-structured indicators, analysis of both the process and its results and, adapt the identified better working methods to the own setting, were found

  7. Chagasic megacolon and large bowel neoplasms: case series and literature review

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    Maxwel Capsy Boga Ribeiro

    2011-12-01

    Full Text Available There is a clear association between chagasic megaesophagus and the esophageal cancer. On the other hand, the association between chagasic megacolon and intestinal neoplasm is uncommon. There are only a few cases described in literature. We selected two cases of colorectal adenocarcinoma associated with adenoma from 2000 to 2011, which are added to the four patients already described by this group. The mean age of the patients, was 68.5 years. Both had been submitted to surgical resection of the neoplasm. Survival rates ranged and were directly related to tumor staging at the time of diagnosis. In this context, we report our case series and reviwed the corresponding literature, especially the clinical and epidemiological aspects of this rare association.Há uma clara associação entre megaesôfago por doença de Chagas e o câncer esofágico. Ao contrário, tal relação, entre megacólon chagásico e neoplasias do intestino grosso é, reconhecidamente, incomum. Existem poucos casos relatados na literatura. Destacamos, entre 2000 e 2011, dois casos, sendo ambos adenocarcinomas colorretais e associados a adenomas, que se somam aos outros quatro já descritos por este grupo. A média de idade dos pacientes, foi de 68,5 anos. Todos foram submetidos à ressecção cirúrgica da neoplasia. A sobrevida foi variável e diretamente relacionada ao estádio do tumor no momento do diagnóstico. Dentro desse contexto, relatamos essa série de casos e revisamos a literatura correlata, com relação aos aspectos clínicos e epidemiológicos dessa rara associação.

  8. Bartonella and intraocular inflammation: a series of cases and review of literature

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    Kalogeropoulos C

    2011-06-01

    Full Text Available Chris Kalogeropoulos1, Ioannis Koumpoulis1, Andreas Mentis2, Chrisavgi Pappa1, Paraskevas Zafeiropoulos1, Miltiadis Aspiotis11Department of Ophthalmology, Medical School, University of Ioannina, Greece; 2Laboratory of Medical Microbiology, Hellenic Pasteur Institute, Athens, GreecePurpose: To present various forms of uveitis and/or retinal vasculitis attributed to Bartonella infection and review the impact of this microorganism in patients with uveitis.Methods: Retrospective case series study. Review of clinical records of patients diagnosed with Bartonella henselae and Bartonella quintana intraocular inflammation from 2001 to 2010 in the Ocular Inflammation Department of the University Eye Clinic, Ioannina, Greece. Presentation of epidemiological and clinical data concerning Bartonella infection was provided by the international literature.Results: Eight patients with the diagnosis of Bartonella henselae and two patients with B. quintana intraocular inflammation were identified. Since four patients experienced bilateral involvement, the affected eyes totaled 14. The mean age was 36.6 years (range 12–62. Uveitic clinical entities that we found included intermediate uveitis in seven eyes (50%, vitritis in two eyes (14.2%, neuroretinitis in one eye (7.1%, focal retinochoroiditis in one eye (7.1%, branch retinal vein occlusion (BRVO due to vasculitis in one eye (7.1%, disc edema with peripapillary serous retinal detachment in one eye (7.1%, and iridocyclitis in one eye (7.1%. Most of the patients (70% did not experience systemic symptoms preceding the intraocular inflammation. Antimicrobial treatment was efficient in all cases with the exception of the case with neuroretinitis complicated by anterior ischemic optic neuropathy and tubulointerstitial nephritis.Conclusion: Intraocular involvement caused not only by B. henselae but also by B. quintana is being diagnosed with increasing frequency. A high index of suspicion is needed because the

  9. Huntington disease and Huntington disease-like in a case series from Brazil.

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    Castilhos, R M; Souza, A F D; Furtado, G V; Gheno, T C; Silva, A L; Vargas, F R; Lima, M-A F D; Barsottini, O; Pedroso, J L; Godeiro, C; Salarini, D; Pereira, E T; Lin, K; Toralles, M-B; Saute, J A M; Rieder, C R; Quintas, M; Sequeiros, J; Alonso, I; Saraiva-Pereira, M L; Jardim, L B

    2014-10-01

    The aim of this study was to identify the relative frequency of Huntington's disease (HD) and HD-like (HDL) disorders HDL1, HDL2, spinocerebellar ataxia type 2 (SCA2), SCA17, dentatorubral-pallidoluysian degeneration (DRPLA), benign hereditary chorea, neuroferritinopathy and chorea-acanthocytosis (CHAC), in a series of Brazilian families. Patients were recruited in seven centers if they or their relatives presented at least chorea, besides other findings. Molecular studies of HTT, ATXN2, TBP, ATN1, JPH3, FTL, NKX2-1/TITF1 and VPS13A genes were performed. A total of 104 families were ascertained from 2001 to 2012: 71 families from South, 25 from Southeast and 8 from Northeast Brazil. There were 93 HD, 4 HDL2 and 1 SCA2 families. Eleven of 104 index cases did not have a family history: 10 with HD. Clinical characteristics were similar between HD and non-HD cases. In HD, the median expanded (CAG)n (range) was 44 (40-81) units; R(2) between expanded HTT and age-at-onset (AO) was 0.55 (p=0.0001, Pearson). HDL2 was found in Rio de Janeiro (2 of 9 families) and Rio Grande do Sul states (2 of 68 families). We detected HD in 89.4%, HDL2 in 3.8% and SCA2 in 1% of 104 Brazilian families. There were no cases of HDL1, SCA17, DRPLA, neuroferritinopathy, benign hereditary chorea or CHAC. Only six families (5.8%) remained without diagnosis.

  10. Convergence in spectral forward modelling: Binominal series solutions vs. direct integral solutions at high degrees - spherical and ellipsoidal case

    Science.gov (United States)

    Rexer, Moritz; Claessens, Sten; Hirt, Christian

    2016-04-01

    The number of relevant terms of binominal series expansions used in spectral forward modelling of the gravitational potential is known to rise substantially as the resolution of the models increases. Here, we investigate and compare the binominal series expansions in forward modelling w.r.t. a sphere and w.r.t. an ellipsoid (Claessens and Hirt, 2013) in view of high degree forward modelling (d/o 10800). The series in each case depend on different parameters - such as elevation of the topographic function or ellipsoidal radius/co-latitude - and reveal different maximum orders of truncation for a 1% convergence level (=relative error). The results are verified in a real data scenario up to d/o 5400 by spot-checks using direct integral solutions that do not depend on binomial series expansions. As a conclusion, our study demonstrates that for d/o 10800 modelling up to 30 terms of the binominal series accounting for the radial integral are needed within the spherical and the ellipsoidal case, while up to 60 terms are needed for the binominal series accounting for the oblateness of Earth in the ellipsoidal case for a convergence at the 1% level. References: Claessens, S.J.; Hirt, C.: Ellipsoidal topographic potential - new solutions for spectral forward gravity modelling of topography with respect to a reference ellipsoid; Journal of Geophysical Research (JGR) - Solid Earth, Vol. 118, DOI: 10.1002/2013JB010457, 2013.

  11. Learning with Multimedia Cases: An Evaluation Study

    Science.gov (United States)

    Van Den Berg, Ellen; Jansen, Leanne; Blijleven, Peter

    2004-01-01

    This article is about the relation between case-based learning and transfer in teacher education. Through a design research approach a multimedia case has been developed. The topic of the case is "outdoor activities in science education." The core of the case is a 17 minute video that is supplemented by all kinds of background information. Results…

  12. The Volterra series as special case of artificial neural network model

    Science.gov (United States)

    Napiorkowski, J.; O Kane, J. P.

    2003-04-01

    The geophysical processes contributing to the hydrological cycle are described by theoretically sound non-linear partial differential equations of mass and energy transfer. The hydrodynamic equations describing hydrological processes were developed in non-linear form in the nineteenth century. In the case of surface runoff from a natural catchment or flow in an open channel, an accurate application of the hydraulic approach requires a detailed topographical survey and determination of roughness parameters. In order to avoid these difficulties, alternative approaches e.g. via conceptual models and black box models were developed in the second half of the last century. The conceptual model approach is to simulate the nature of the catchment response or the channel response by relatively simple non-linear model built up from simple non-linear elements, e.g. cascade of non-linear reservoirs. Each non-linear reservoir is responsible for part of the attenuation of the system response. This lumped dynamic model can be represented by a set of ordinary differential equations: begin{gathered} dot S_1 (t) = - f[S_1 (t)] + x(t) dot S_2 (t) = - f[S_2 (t)] + f[S_1 (t)] ... dot S_n (t) = - f[S_n (t)] + f[Sn - 1 (t)] y(t) = f[S_n (t)] % MathType!End!2!1! (1) where x is the input signal(rainfall or flow at the upstream end of the channel), Si is the storage in the i-th reservoir, f(.) represents the outflow-storage relation and y is the output signal (surface runoff or flow at the downstream end of the channel). Non-linear black box analysis is concerned with representing a system by a functional Volterra series in the form of a sum of convolution integrals: begin{gathered} y(t) = intlimits_0^t {h_1 (τ )x(t - τ )dτ + intlimits_0^t {intlimits_0^t {h_2 (τ _1 ,τ _2 )x(t - τ _1 )x(t - τ _2 )dτ _1 dτ _2 } } } quad quad + intlimits_0^t {intlimits_0^t {intlimits_0^t {h_3 (τ _1 ,τ _2 ,τ _3 )x(t - τ _1 )x(t - τ _2 )x(t - τ _3 )dτ _1 dτ _2 dτ _3 } + ...} } % MathType!End!2

  13. Mammary-type Myofibroblastoma: Clinicopathologic Characterization in a Series of 143 Cases.

    Science.gov (United States)

    Howitt, Brooke E; Fletcher, Christopher D M

    2016-03-01

    Mammary-type myofibroblastoma (MTMF) is a benign mesenchymal neoplasm initially described to occur in the breast. MTMF is typically CD34 and desmin positive and genetically has rearrangement or deletion of 13q14, resulting in loss of Rb expression by immunohistochemistry (IHC). Although the wider anatomic distribution of MTMF is increasingly recognized, no large series with clinicopathologic information has been reported to date. Archival cases were retrieved, and the diagnosis of MTMF was confirmed. Hematoxylin and eosin-stained slides and IHC slides were reviewed when available (CD34, Desmin, Rb, SMA, S100, EMA, MDM2, CDK4). The patient age, sex, tumor anatomic location and size, preceding symptoms, and margin status were recorded when possible. Clinical follow-up data were requested for tumor recurrence, metastasis, and patient status at last follow-up. A total of 143 cases of MTMF comprised this study, affecting 94 (66%) male and 49 (34%) female individuals. Mean tumor size was 6.6 cm (range, 1 to 22 cm). Anatomic locations included: inguinal/groin region (65; 45%), breast (15; 10%), chest wall/axilla (7; 5%), trunk (17; 12%), lower (18; 13%) and upper (2; 1%) extremities, or intra-abdominal/retroperitoneal (14; 10%). MTMFs were characterized by spindle cells with relatively short, stubby nuclei and a variable adipocytic component. Hyalinization and myxoid stroma were common. Less common morphologic features included nuclear atypia, epithelioid tumor cell morphology, and neurilemmoma-type nuclear palisading. CD34 and desmin were positive in 89% and 91%, respectively, and were both negative in 3%. Rb expression was lost in 92% (57/62). No cases with follow-up data available had tumor recurrence, although 1 case was reportedly a recurrence itself. In summary, MTMF appears more common at extramammary sites than in the breast and can cause diagnostic difficulty when atypia or epithelioid morphology is present or when located in an unusual anatomic location. MTMF is

  14. The clinical psychologist and the management of inpatient pain: a small case series

    Directory of Open Access Journals (Sweden)

    Childs SR

    2014-12-01

    communication and to resolve a difficult and potentially risk-laden situation. This small case series discusses the benefits derived from the involvement of a clinical psychologist in the management of inpatient pain, and therefore illustrates the need for novel initiatives for inpatient pain services. However, future research is warranted to validate this approach. Keywords: acute pain, aggression, anxiety, borderline personality disorder, psychology

  15. Pyoderma Gangrenosum: Retrospective Evaluation of 20 Cases

    Directory of Open Access Journals (Sweden)

    Zehra Aşiran Serdar

    2011-06-01

    Full Text Available Background and Design: The objective of this study is to examine the clinical properties, comorbid systemic diseases and the treatment protocols of the patients diagnosed with pyoderma gangrenosum (PG. Material and Method: Between 2003 and 2009 years, 20 patients diagnosed with pyoderma gangrenosum were evaluated in this study. The clinical properties, comorbid systemic diseases and the treatment protocols were examined retrospectively.Results: In a six-year period, 20 patients with PG (11 female and 9 male, ranging in age from 19 to 75 (mean age 45±16.39 years were evaluated. Lesions had started as papule in 3 (16% patients, as bullous in 1 (5% patient, as erythematous plaque in 1 (5% patient and as pustule in 15 (74% patients. Whereas 14 (70% patients had single lesion, the other patients had multiple lesions. The lesions were located at lower extremities in 14 (70% patients most frequently, The most frequent comorbid disease in patients with pyoderma gangrenosum was inflammatory bowel diseases (colitis ulcerosa n: 4 and Crohn disease n: 2 total n: 6, 30%. The other comorbid diseases included vitiligo (n: 1, 5%, Behcet’s disease (n: 1, 5%, hidradenitis suppurativa (n: 1, 5%, deep venous thrombosis and pulmonary embolism (n: 1, 5%, pangastritis (n: 1, 5%, acute renal failure (n: 1, 5%, systemic lupus erythematosus (n: 2, 10% and iatrogenic immunosuppression (n: 1, 5%. Systemic corticosteroid therapy was the most common treatment (n=16, 80%. The treatment response was 100% in all patients. Conclusion: In our study, inflammatory bowel diseases were the most frequent comorbid diseases with pyoderma gangrenosum. Most of cases were as single lesions located in the lower extremities and the best treatment response was achieved by the administration of systemic corticosteroids.

  16. Improved Fault Classification in Series Compensated Transmission Line: Comparative Evaluation of Chebyshev Neural Network Training Algorithms.

    Science.gov (United States)

    Vyas, Bhargav Y; Das, Biswarup; Maheshwari, Rudra Prakash

    2016-08-01

    This paper presents the Chebyshev neural network (ChNN) as an improved artificial intelligence technique for power system protection studies and examines the performances of two ChNN learning algorithms for fault classification of series compensated transmission line. The training algorithms are least-square Levenberg-Marquardt (LSLM) and recursive least-square algorithm with forgetting factor (RLSFF). The performances of these algorithms are assessed based on their generalization capability in relating the fault current parameters with an event of fault in the transmission line. The proposed algorithm is fast in response as it utilizes postfault samples of three phase currents measured at the relaying end corresponding to half-cycle duration only. After being trained with only a small part of the generated fault data, the algorithms have been tested over a large number of fault cases with wide variation of system and fault parameters. Based on the studies carried out in this paper, it has been found that although the RLSFF algorithm is faster for training the ChNN in the fault classification application for series compensated transmission lines, the LSLM algorithm has the best accuracy in testing. The results prove that the proposed ChNN-based method is accurate, fast, easy to design, and immune to the level of compensations. Thus, it is suitable for digital relaying applications.

  17. Transcranial direct current stimulation for the treatment of post-stroke depression in aphasic patients: a case series.

    Science.gov (United States)

    Valiengo, Leandro; Casati, Roberta; Bolognini, Nadia; Lotufo, Paulo A; Benseñor, Isabela M; Goulart, Alessandra C; Brunoni, André R

    2016-01-01

    Aphasia is a common consequence of stroke; it is estimated that about two-thirds of aphasic patients will develop depression in the first year after the stroke. Treatment of post-stroke depression (PSD) is challenging due to the adverse effects of pharmacotherapy and difficulties in evaluating clinical outcomes, including aphasia. Transcranial direct current stimulation (tDCS) is a novel treatment that may improve clinical outcomes in the traditionally pharmacotherapy-refractory PSD. Our aim was to evaluate the safety and efficacy of tDCS for patients with PSD and with aphasia. The Stroke Aphasic Depression Questionnaire (SADQ) and the Aphasic Depression Rating Scale (ADRS) were used to evaluate the severity of PSD. The diagnoses of PSD and aphasia were confirmed by a psychiatrist and a speech-language pathologist, respectively. In this open case series, patients (n = 4) received 10 sessions (once a day) of bilateral tDCS to the dorsolateral prefrontal cortex (DLPFC) and two additional sessions after two and four weeks, for a total of 12 sessions. All patients exhibited improvement in depression after tDCS, as indicated by a decrease in SADQ (47.5%) and in ADRS (65.7%). This improvement was maintained four weeks after the treatment. In this preliminary, open-label study conducted in four PSD patients with aphasia, bilateral tDCS over the DLPFC was shown to induce a substantial mood improvement; tDCS was safe and well tolerated by every patient. Stroke patients with aphasia can be safely treated for PSD with tDCS. Sham-controlled studies are necessary to evaluate this technique further.

  18. Evaluation of Interpolants in Their Ability to Fit Seismometric Time Series

    Directory of Open Access Journals (Sweden)

    Kanadpriya Basu

    2015-08-01

    Full Text Available This article is devoted to the study of the ASARCO demolition seismic data. Two different classes of modeling techniques are explored: First, mathematical interpolation methods and second statistical smoothing approaches for curve fitting. We estimate the characteristic parameters of the propagation medium for seismic waves with multiple mathematical and statistical techniques, and provide the relative advantages of each approach to address fitting of such data. We conclude that mathematical interpolation techniques and statistical curve fitting techniques complement each other and can add value to the study of one dimensional time series seismographic data: they can be use to add more data to the system in case the data set is not large enough to perform standard statistical tests.

  19. Multilocular Cystic Renal Cell Carcinoma: A Series of 8 Cases and Review of the Literature

    Institute of Scientific and Technical Information of China (English)

    Shuo Liu; Guang Sun; Zhanjun Guo; Xiaodong Li

    2007-01-01

    OBJECTIVE To study the clinical, pathologic and imaging features of multilocular cystic renal cell carcinoma (MCRCC) and to review the diagnosis and treatment of this subtype of renal cell carcinoma (RCC). METHODS The data from 8 cases (mean age, 49.4; 5 men and 3 women) who had been treated from 2004 to 2006, were reviewed retrospectively. Radiologic and pathologic documents were evaluated. For treatments, radical nephrectomy was conducted in 4 patients, partial nephrectomy in 2 and laparoscopic nephrectomy in 2.RESULTS Postoperative pathological findings confirmed the diagnosis of MCRCC. The stage of all 8 cases was pT1. For pathologic grade, 7 cases were G1 and 1 case was G2. Seven patients available for follow-up had survived tumor-free during the mean time of 8 months. CONCLUSION MCRCC is an uncommon subtype of RCC, it has a lower malignant potential and a better prognosis compared with other types of RCC. Nephron-sparing surgery may be an appropriate treatment options for MCRCC.

  20. Challenges in identifying Lennox–Gastaut syndrome in adults: A case series illustrating its changing nature

    Directory of Open Access Journals (Sweden)

    Jesus Eric Piña-Garza

    2016-01-01

    Full Text Available The variable presentation and progression of Lennox–Gastaut syndrome (LGS can make it difficult to recognize, particularly in adults. To improve diagnosis, a retrospective chart review was conducted on patients who were diagnosed as adults and/or were followed for several years after diagnosis. We present 5 cases that illustrate changes in LGS features over time. Cases 1 and 2 were diagnosed by age 8 with intractable seizures, developmental delay, and abnormal EEGs with 1.5–2 Hz SSW discharges. However, seizure type and frequency changed over time for both patients, and the incidence of SSW discharges decreased. Cases 3, 4, and 5 were diagnosed with LGS as adults based on current and past features and symptoms, including treatment-resistant seizures, cognitive and motor impairment, and abnormal EEG findings. While incomplete, their records indicate that an earlier LGS diagnosis may have been missed or lost to history. These cases demonstrate the need to thoroughly and continuously evaluate all aspects of a patient's encephalopathy, bearing in mind the potential for LGS features to change over time.

  1. Challenges in identifying Lennox-Gastaut syndrome in adults: A case series illustrating its changing nature.

    Science.gov (United States)

    Piña-Garza, Jesus Eric; Chung, Steve; Montouris, Georgia D; Radtke, Rodney A; Resnick, Trevor; Wechsler, Robert T

    2016-01-01

    The variable presentation and progression of Lennox-Gastaut syndrome (LGS) can make it difficult to recognize, particularly in adults. To improve diagnosis, a retrospective chart review was conducted on patients who were diagnosed as adults and/or were followed for several years after diagnosis. We present 5 cases that illustrate changes in LGS features over time. Cases 1 and 2 were diagnosed by age 8 with intractable seizures, developmental delay, and abnormal EEGs with 1.5-2 Hz SSW discharges. However, seizure type and frequency changed over time for both patients, and the incidence of SSW discharges decreased. Cases 3, 4, and 5 were diagnosed with LGS as adults based on current and past features and symptoms, including treatment-resistant seizures, cognitive and motor impairment, and abnormal EEG findings. While incomplete, their records indicate that an earlier LGS diagnosis may have been missed or lost to history. These cases demonstrate the need to thoroughly and continuously evaluate all aspects of a patient's encephalopathy, bearing in mind the potential for LGS features to change over time.

  2. CASE/A - COMPUTER AIDED SYSTEM ENGINEERING AND ANALYSIS, ECLSS/ATCS SERIES

    Science.gov (United States)

    Bacskay, A.

    1994-01-01

    , specific heat, density, and viscosity) is generated at user-selected output intervals and stored for reference. The Integrated Plot Utility (IPU) provides plotting capability for all data output. System utility commands are provided to enable the user to operate more efficiently in the CASE/A environment. The user is able to customize a simulation through optional operations FORTRAN logic. This user-developed code is compiled and linked with a CASE/A model and enables the user to control and timeline component operating parameters during various phases of the iterative solution process. CASE/A provides for transient tracking of the flow stream constituents and determination of their thermodynamic state throughout an ECLSS/ATCS simulation, performing heat transfer, chemical reaction, mass/energy balance, and system pressure drop analysis based on user-specified operating conditions. The program tracks each constituent through all combination and decomposition states while maintaining a mass and energy balance on the overall system. This allows rapid assessment of ECLSS designs, the impact of alternate technologies, and impacts due to changes in metabolic forcing functions, consumables usage, and system control considerations. CASE/A is written in FORTRAN 77 for the DEC VAX/VMS computer series, and requires 12Mb of disk storage and a minimum paging file quota of 20,000 pages. The program operates on the Tektronix 4014 graphics standard and VT100 text standard. The program requires a Tektronix 4014 or later graphics terminal, third party composite graphics/text terminal, or personal computer loaded with appropriate VT100/TEK 4014 emulator software. The use of composite terminals or personal computers with popular emulation software is recommended for enhanced CASE/A operations and general ease of use. The program is available on an unlabeled 9-track 6250 BPI DEC VAX BACKUP format magnetic tape. CASE/A development began in 1985 under contract to NASA/Marshall Space Flight

  3. A Process Evaluation of Project Developmental Continuity. Interim Report II, Part A: Program Case Studies. Volume I.

    Science.gov (United States)

    Spencer, Lynn, Ed.

    These 8 case studies are part of a series of documents on the evaluation of Project Developmental Continuity (PDC), a Head Start demonstration program aimed at providing educational and developmental continuity between children's Head Start and primary school experiences. Each case study reviews the planning year at a PDC demonstration site in one…

  4. A Process Evaluation of Project Developmental Continuity. Interim Report II, Part A: Program Case Studies. Volume 2.

    Science.gov (United States)

    Spencer, Lynn, Ed.

    These 7 case studies are part of a series of documents on the evaluation of Project Developmental Continuity (PDC), a Head Start demonstration program aimed at providing educational and developmental continuity between children's Head Start and primary school experiences. Each case study reviews the planning year at a PDC demonstration site in one…

  5. Robust evaluation of time series classification algorithms for structural health monitoring

    Science.gov (United States)

    Harvey, Dustin Y.; Worden, Keith; Todd, Michael D.

    2014-03-01

    Structural health monitoring (SHM) systems provide real-time damage and performance information for civil, aerospace, and mechanical infrastructure through analysis of structural response measurements. The supervised learning methodology for data-driven SHM involves computation of low-dimensional, damage-sensitive features from raw measurement data that are then used in conjunction with machine learning algorithms to detect, classify, and quantify damage states. However, these systems often suffer from performance degradation in real-world applications due to varying operational and environmental conditions. Probabilistic approaches to robust SHM system design suffer from incomplete knowledge of all conditions a system will experience over its lifetime. Info-gap decision theory enables nonprobabilistic evaluation of the robustness of competing models and systems in a variety of decision making applications. Previous work employed info-gap models to handle feature uncertainty when selecting various components of a supervised learning system, namely features from a pre-selected family and classifiers. In this work, the info-gap framework is extended to robust feature design and classifier selection for general time series classification through an efficient, interval arithmetic implementation of an info-gap data model. Experimental results are presented for a damage type classification problem on a ball bearing in a rotating machine. The info-gap framework in conjunction with an evolutionary feature design system allows for fully automated design of a time series classifier to meet performance requirements under maximum allowable uncertainty.

  6. Appendicitis Diagnosed by Emergency Physician Performed Point-of-care Transvaginal Ultrasound: Case Series

    Directory of Open Access Journals (Sweden)

    Robert Bramante

    2013-09-01

    Full Text Available Lower abdominal pain in females of reproductive age continues to be a diagnostic dilemma for the emergency physician (EP. Point-of-care ultrasound (US allows for rapid, accurate, and safe evaluation of abdominal and pelvic pain in both the pregnant and non-pregnant patient. We present 3 cases of females presenting with right lower quadrant and adnexal tenderness where transvaginal ultrasonography revealed acute appendicitis. The discussion focuses on the use of EP-performed transvaginal US in gynecologic and intra-abdominal pathology and discusses the use of a staged approach to evaluation using US and computed tomography, as indicated. [West J Emerg Med. 2013;14(5:415-418.

  7. Synthesis and Evaluation of a Series of Novel Asymmetrical Curcumin Analogs for the Treatment of Inflammation

    Directory of Open Access Journals (Sweden)

    Yali Zhang

    2014-06-01

    Full Text Available Curcumin has been reported to possess multiple bioactivities, such as antioxidant, anticancer, and anti-inflammatory properties, however the clinical application of curcumin has been significantly limited by its instability and poor metabolism. Modification of curcumin has led to discovery and development of lots of novel therapeutic candidates. In recent years acute and chronic inflammation has been the focus of numerous studies in various diseases. Here, we synthesized a series of asymmetrical curcumin analogs with high in vitro chemical stability, and their anti-inflammatory activity was evaluated in LPS-stimulated macrophages. According to the bio-screening results and QSAR analysis, these analogs exhibited potent activities against LPS-induced TNF-α and IL-6 release. Among the analogs of the potent anti-inflammatory activity, compounds 3b8 and 3b9 exhibited significant protection and possess enhanced anti-inflammatory activity thereby attenuated the LPS-induced septic death in mice.

  8. Fabrication and evaluation of series-triple quantum dots by thermal oxidation of silicon nanowire

    Energy Technology Data Exchange (ETDEWEB)

    Uchida, Takafumi, E-mail: takafumi-uchida@frontier.hokudai.ac.jp; Jo, Mingyu; Tsurumaki-Fukuchi, Atsushi; Arita, Masashi; Takahashi, Yasuo [Graduate School of Information Science and Technology, Hokkaido University, Sapporo, 060-0814 Japan (Japan); Fujiwara, Akira [NTT Basic Research Laboratories, NTT Corporation, 3-1 Morinosato Wakamiya, Atsugi, 243-0198 Japan (Japan)

    2015-11-15

    Series-connected triple quantum dots were fabricated by a simple two-step oxidation technique using the pattern-dependent oxidation of a silicon nanowire and an additional oxidation of the nanowire through the gap of the fine gates attached to the nanowire. The characteristics of multi-dot single-electron devices are obtained. The formation of each quantum dot beneath an attached gate is confirmed by analyzing the electrical characteristics and by evaluating the gate capacitances between all pairings of gates and quantum dots. Because the gate electrode is automatically attached to each dot, the device structure benefits from scalability. This technique promises integrability of multiple quantum dots with individual control gates.

  9. Roturas retinianas em retinocoroidite por toxoplasmose: série de casos Retinal tears in toxoplasmic retinochoroiditis: case series

    Directory of Open Access Journals (Sweden)

    Daniel da Rocha Lucena

    2009-12-01

    Full Text Available Trata-se de série retrospectiva de 10 pacientes com rotura retiniana e retinocoroidite por toxoplasmose atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, de janeiro de 2007 a abril de 2008, com objetivo de avaliar a relação entre lesões de retinocoroidite e a ocorrência de rotura retiniana. Foram utilizados teste de Fisher e qui-quadrado com nível de significância pThis study is a retrospective case series aiming to evaluate the relation between toxoplasmic retinochoroiditis scars and the occurrence of retinal tears. Ten patients with retinal tear and toxoplasmic retinochoroiditis examined at the School of Medicine of Ribeirão Preto Clinics Hospital, between January 2007 and April 2008, were included. Fisher test and qui-square test with significance level of p<0.05 were used. Eight cases (80% had retinal detachment. Twelve tears were found and localized mostly in the temporal superior periphery (6 cases, 50%. No statistically significant association between retinal tear and chorioretinal scar localization was observed considering five retinal quadrants (p=0.0828 or three zones (p=0.2507. The occurrence of retinal tears in patients with uveitis may be related to early posterior vitreous detachment caused by the intraocular inflammatory process. No correlation was observed between the localization of retinal tears and chorioretinal scars in this study, which suggests a causative factor not directly related to the presence of a scar.

  10. The modified Pirogoff's amputation in treating diabetic foot infections: surgical technique and case series

    Directory of Open Access Journals (Sweden)

    Aziz Nather

    2014-04-01

    Full Text Available Background: This paper describes the surgical technique of a modified Pirogoff's amputation performed by the senior author and reports the results of this operation in a single surgeon case series for patients with diabetic foot infections. Methods: Six patients with diabetic foot infections were operated on by the National University Hospital (NUH diabetic foot team in Singapore between November 2011 and January 2012. All patients underwent a modified Pirogoff's amputation for diabetic foot infections. Inclusion criteria included the presence of a palpable posterior tibial pulse, ankle brachial index (ABI of more than 0.7, and distal infections not extending proximally beyond the midfoot level. Clinical parameters such as presence of pulses and ABI were recorded. Preoperative blood tests performed included a glycated hemoglobin level, hemoglobin, total white blood cell count, C-reactive protein, erythrocyte sedimentation rate, albumin, and creatinine levels. All patients were subjected to 14 sessions of hyperbaric oxygen therapy postoperatively and were followed up for a minimum of 10 months. Results: All six patients had good wound healing. Tibio-calcaneal arthrodesis of the stump was achieved in all cases by 6 months postoperatively. All patients were able to walk with the prosthesis. Conclusions: The modified Pirogoff's amputation has been found to show good results in carefully selected patients with diabetic foot infections. The selection criteria included a palpable posterior tibial pulse, distal infections not extending proximally beyond the midfoot level, ABI of more than 0.7, hemoglobin level of more than 10 g/dL, and serum albumin level of more than 30 g/L.

  11. Pediatric seizure-related posttraumatic stress and anxiety symptoms treated with EMDR: a case series

    Science.gov (United States)

    Dautovic, Elmedina; de Roos, Carlijn; van Rood, Yanda; Dommerholt, Agnes; Rodenburg, Roos

    2016-01-01

    Purpose To examine the potential effects of eye movement desensitization and reprocessing (EMDR) in children with epilepsy-related posttraumatic stress and/or anxiety symptoms, using a case series design. Methods Five children (aged 8–18) with epilepsy identified for seizure-related posttraumatic stress and/or anxiety symptoms were treated with EMDR. To examine potential treatment effects, posttraumatic stress and anxiety symptoms were assessed (CRTI and SCARED) pre- and post-EMDR and at 3-month follow-up. Normative deviation scores were calculated to examine the severity of seizure-related posttraumatic stress and anxiety symptoms over time. The reliable change index was calculated for pre- to posttreatment change of seizure-related posttraumatic stress and/or anxiety symptoms. Results Before EMDR, overall or subscale scores indicated that all children had (sub)clinical seizure-related posttraumatic stress symptoms and/or anxiety symptoms. Directly after EMDR, most children showed significant and/or clinical individual improvement, and these beneficial effects were maintained or reached at follow-up. The mean number of sessions was 2 (range 1–3, 45 min per session). Conclusions In case of seizure-related posttraumatic stress and/or anxiety, this study indicates that EMDR is a potentially successful quick and safe psychological treatment for children with epilepsy. Highlights of the article The first study to examine the potential effects of EMDR to reduce clinical seizure-related posttraumatic stress symptoms and/or anxiety symptoms in children with epilepsy. After 1–3 EMDR (45 min) sessions, positive treatment effects were found on a range of seizure-related PTSD symptoms and/or anxiety symptoms. During treatment, no seizures, absences, or any other adverse events were observed; the seizure diaries showed that none of the children experienced more seizures (or an unusual pattern) after treatment. At the reevaluation of EMDR, all children and parents

  12. AWAKE CRANIOTOMY USING DEXMEDETOMIDINE INFUSION AND SCALP BLOCK: OUR EXPERIENCE IN SERIES OF CASES

    Directory of Open Access Journals (Sweden)

    Annapurna Sarma

    2015-06-01

    Full Text Available BACKGROUND: Awake craniotomy is an important technique used for brain tumour excision from eloquent cortex. Awake craniotomy allows maximum resection of the tumor with minimum functional impairment . The critical aspect is to maintain adequate analgesia and sedation, hemodynamic stability, airway safety, while keeping the patient awake and cooperative for neurological testing. AIM OF THE STUDY: We are reporting cases series of awake craniotomy under monito red anesthesia care using dexmedetomidine infusion as an adjuvant to scalp block, titrating the sedation level by BIS monitoring. MATERIALS AND METHODS: After careful patient selection and psychological preparation Monitored Anesthesia Care was provided by continuous infusion of dexmedetomidine at a rate of 0.2 - 0.5ug/kg/min titrating sedation score to BIS value of 70 - 90. Bilateral scalp block was administered using 0.5% bupivacaine. For dura mater incision, a pad with 2% lidocaine was applied for 3 minutes . The tumor removal was complete with no neurological deficiency. All the patients were discharged on 5 th postoperative day without complications and with full patient satisfaction. CONCLUSION: We conclude that monitored anesthesia care with dexmedetomidine infusion and scalp block for awake craniotomy is safe and efficacious. Absence of complications and high patient satisfaction score makes this technique close to an ideal technique for awake craniotomy. KEYWORDS: Awake craniotomy; Dexmedetomidine; Scalp b lock; BIS index

  13. Diuretics, Limited Ultrafiltration, and Residual Renal Function in Incident Hemodialysis Patients: A Case Series.

    Science.gov (United States)

    Sjolund, Jessica; Garcia Anton, Desiree; Bayes, Liz Y; Hoekstra, Tiny; Dekker, Friedo W; Munoz Mendoza, Jair

    2016-09-01

    The effect of diuretics on residual renal function expressed as residual GFR (rGFR) and urine volume (rUV) using 24-hour urine collections has not been well examined in hemodialysis (HD) patients. We present a small (seven patient) but provocative case series describing a strikingly low rate of decline in rUV and rGFR (average of creatinine and urea clearances, 24-hour urine collections) in patients treated with increasing doses of furosemide (up to 360 mg/day) during the first 2 years after initiation of HD. Between 6 and 12 months, the mean rUV fell by 1 ml/month, whereas rGFR declined by 0.03 ml/min/1.73 m(2) /month. The mean rate of decline from 12 to 24 months for rUV (33 ml/month) and rGFR (0.02 ml/min/1.73 m(2) /month) were also low. While data are clearly limited and the observation retrospective, they are consistent with the better documented benefit of diuretics observed in end-stage renal disease patients treated with peritoneal dialysis.

  14. Case series of mercury toxicity among children in a hot, closed environment.

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    Akyildiz, Basak Nur; Kondolot, Meda; Kurtoğlu, Selim; Konuşkan, Bahadir

    2012-03-01

    Mercury poisoning is much more prevalent in the general population than possibly many physicians realize. We present data on 26 pediatric cases with mercury intoxication from exposure to mercury by inhalation or skin contact as a result of a broken thermometer in a school laboratory. This is the largest pediatric series in Turkey. During a 3-month period, the study team observed the children for clinical symptoms, physical findings, and blood and mercury levels. Of all patients, 21 inhaled, 3 inhaled and touched the element, and 2 took the mercury home. Sixteen children were symptomatic at admission, although blood mercury levels in the symptomatic children were higher than those in asymptomatic children (P = 0.003). The urine mercury levels were not statistically different between the groups at the admission (P > 0.05). The exposure times were 3.5 and 2 hours for symptomatic and asymptomatic children, respectively (P = 0.003). The 2 children who took the mercury home had the highest blood mercury levels and the most prolonged exposure time. N-acetylcysteine and chelation treatments were started in 21 children who had symptoms of mercury intoxication and high mercury levels in their blood or urine. No adverse effects were observed during chelation therapy. Prompt removal of children from contaminated environments and proper decontamination or elimination of devices containing large amounts of mercury from schools are necessary to prevent serious complications caused by exposure to mercury.

  15. Ophthalmic findings in acute mercury poisoning in adults: A case series study.

    Science.gov (United States)

    Aslan, Lokman; Aslankurt, Murat; Bozkurt, Selim; Aksoy, Adnan; Ozdemir, Murat; Gizir, Harun; Yasar, Ibrahim

    2015-08-01

    The aim of this study is to report ophthalmic findings of acute mercury poisoning in 48 adults referred to emergency department. Full ophthalmologic examination including the best corrected visual acuity, external eye examination, reaction to light, a slit-lamp examination, funduscopy, intraocular pressure measurements, and visual field (VF) and color vision (CV) tests were performed at the presentation and repeated after 6 months. The parametric values of VF test, the mean deviation (MD), and pattern standard deviation (PSD) were recorded in order to compare patients and the 30 healthy controls. The mean parameter of color confusion index in patients was found to be statistically different than controls (p < 0.01). The MD and PSD in patients were different from controls statistically significant (p < 0.01 and p < 0.01, respectively). There was no correlation between the ocular findings and the urine and blood mercury levels. Methyl mercury, held in the school laboratory for experimental purpose, may be a source of poisoning. In this case series, we showed that acute exposure to mercury had hazardous effect on the visual system, especially CV and VF. We propose that emphasizing the public education on the potential hazards of mercury is crucial for preventive community health.

  16. Various Techniques to Increase Keratinized Tissue for Implant Supported Overdentures: Retrospective Case Series

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    Ahmed Elkhaweldi

    2015-01-01

    Full Text Available Purpose. The purpose of this retrospective case series is to describe and compare different surgical techniques that can be utilized to augment the keratinized soft tissue around implant-supported overdentures. Materials and Methods. The data set was extracted as deidentified information from the routine treatment of patients at the Ashman Department of Periodontology and Implant Dentistry at New York University College of Dentistry. Eight edentulous patients were selected to be included in this study. Patients were treated for lack of keratinized tissue prior to implant placement, during the second stage surgery, and after delivery of the final prosthesis. Results. All 8 patients in this study were wearing a complete maxillary and/or mandibular denture for at least a year before the time of the surgery. One of the following surgical techniques was utilized to increase the amount of keratinized tissue: apically positioned flap (APF, pedicle graft (PG, connective tissue graft (CTG, or free gingival graft (FGG. Conclusions. The amount of keratinized tissue should be taken into consideration when planning for implant-supported overdentures. The apical repositioning flap is an effective approach to increase the width of keratinized tissue prior to the implant placement.

  17. Disulfiram-induced de novo convulsions without alcohol challenge: Case series and review of literature

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    Ranganath Ramarao Kulkarni

    2015-01-01

    Full Text Available Seizure induction by disulfiram (DSF an adverse effect of therapeutic dosages of DSF is less understood. In our prospective case series of eight subjects with alcohol dependence a temporal, dose-dependent, and reversible epileptogenic potential due to DSF was noted. Mean duration of onset of first seizure was 2.13 ± 1.13 weeks after initiation of DSF therapy (125-500 mg/day with no other detectable causes of seizures. Presence of alcohol withdrawal seizures (50%, DSF-induced hypertension (HTN (37.5%, psychosis (12.5% were noted, that may suggest common neurobiological underpinnings like dopamine-beta-hydroxylase inhibition. Various types of DSF-induced generalized seizures (tonic-clonic, 62.5%; myoclonic and tonic-clonic, 25%; myoclonic, 12.5% were effectively managed by halving initial DSF dose (37.5% even after cessation of antiepileptics, or stopping DSF (37.5%. Presence of alcohol withdrawal seizures, DSF-induced HTN/psychosis during DSF therapy may be early risk factors for dose-dependent and reversible adverse effect of DSF therapy - seizure induction, emphasizing caution.

  18. Hypoglycemic encephalopathy: a case series and literature review on outcome determination.

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    Witsch, Jens; Neugebauer, Hermann; Flechsenhar, Julia; Jüttler, Eric

    2012-10-01

    Data on clinical long-term outcome after the acute phase of hypoglycemic encephalopathy (HE) using validated outcome scales is currently unavailable. Here we report the results of a systematic literature search for studies on HE and data on long-term outcome in patients with HE admitted to three Charité hospitals between January 2005 and July 2010. HE was defined as coma/stupor and blood glucose levels GOS), and Barthel index (BI). Fifteen patients were included, with a mean age of 60 years (range 29-79). Two were lost to follow-up. Of the remaining 13 patients, six had died (46 %). In the seven survivors, the median mRS score was 0 (range 0-5), median GOS score was 5 (range 2-5), and median BI was 100 (range 0-100). MRIs made in the acute phase were available for three patients and revealed no obvious relation between lesion size or pattern and clinical outcome. To our knowledge, this is the first case series using validated clinical scoring systems to determine clinical long-term outcome after HE. The results suggest that mortality is high, but long-term survival with little or no disability is possible and can be observed in the majority of survivors. Risk of death or poor outcome does not seem to be related to MRI features in the acute phase but rather to other presumably medical factors.

  19. Unplanned decannulation of tracheotomy tube in massive burn patients: a retrospective case series study

    Institute of Scientific and Technical Information of China (English)

    BEN Dao-feng; MA bing; XIA Zhao-fan; L(U) Kai-yang; CHEN Xu-lin; YU Xi-ya; XI Hui-Jun; CHANG Fei; ZHU Shi-hui; TANG Hong-tai; LU Wei

    2011-01-01

    Background Unplanned extubation is associated with adverse outcomes in intensive care unit.The massive burn patient differs from other critically ill patients in many ways.However,little is known about the unplanned decannulation (UD) in Burn Intensive Care Unit.This paper describes the special features of the circumstances and outcome of UD of tracheotomy tube in massive burn patients.Methods A case series study was performed between January 1999 and December 2008 and UD of tracheotomy tube was analyzed retrospectively.A total of 21 patients with 29 UD events were identified.Demographic data,diagnosis,intervention,UD events and outcome of UD patients were collected.Differences in proportions were compared using the chi-square (X2) or Fisher's exact test.Results Patients with UD were often burned with head and neck (67%) and combined with inhalation injury (62%).The majority of them (76%) were transferred patients,occurred early (55%) and were accidental UD (79%).UD events tended to happen in day shift (90%) and to be associated with the medical procedure that was performing by caregivers at besides (79%).Loose of the stabilizing rope,medical procedure and tracheotomy malposition were the main causes of UD.Early UD and reintubation failure were associated with patients' death.Conclusions UD happened to massive burn patients can lead to patient death.Careful management of respiratory tract was essential for massive burn patients.

  20. Permanent molar pulpotomy with a new endodontic cement: A case series

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    Asgary Saeed

    2009-01-01

    Full Text Available The aim of this case series was to determine the clinical and radiographic success rate of pulpotomy, with new endodontic cement (NEC, in human mature permanent molar teeth. Twelve molars with established irreversible pulpitis were selected from patients 14 - 62 years old. The selection criteria included carious pulp exposure with a positive history of lingering pain. After isolation, caries removal, and pulp exposure, pulpotomy with NEC was performed and a permanent restoration was immediately placed. At the first recall (+1 day no patients reported postoperative pain. One wisdom tooth had been extracted after two months because of failure in coronal restoration. Eleven patients were available for the second recall, with a mean time of 15.8 months. Clinical and radiographic examination revealed that all teeth were functional and free of signs and symptoms. Histological examination of the extracted teeth revealed complete dentin bridge formation and a normal pulp. Although the results favored the use of NEC, more studies with larger samples and a longer recall period were suggested, to justify the use of this novel material for treatment of irreversible pulpitis in human permanent molar teeth.